Receive Claim

In the Edit Claim window, at the upper right, is an Enter Payment area.

Click one of the three buttons:

The Ins Pay amounts will automatically populate based on insurance estimate calculations. The Status will be Recd (received). The Totals at the bottom for deductible and insurance paid should exactly match the EOB.

Receiving a claim means entering payment amounts. Once received, finalize payments by attaching the received claims. See Finalize Insurance Payment.

Follow the steps below to receive each claim on an EOB. If an insurance payment includes an additional amount for interest, see Interest on Insurance Payments.

If needed, edit insurance payment information.

Click OK to save the procedure payment amounts. The claim status will change to Received.

If entering a single claim, continue to Finalizing Insurance Payments.

If entering a batch payment click OK to close the claim, select the next patient on the EOB, and continue steps 1 - 4 to receive other claims on the EOB. Once all claims are received, continue to Finalizing Insurance Payments.

Note: If you enter all the EOB information, including remarks, you can file the EOB and never have to refer to it again. All the information will be in Open Dental and accessible from any computer. If a patient asks why insurance did not pay as expected, you can quickly determine exactly which procedures were not paid and why. If primary insurance is not paid as estimated, secondary insurance estimates do not update.

Claims with No Payment

If insurance does not pay on a claim, you must still receive it. Simply enter 0 as the insurance payment amount (As Total or By Procedure). This will mark it as Received so it is no longer considered an outstanding claim.

To scan the EOB associated with the zero payment, finalize the payment as normal (enter 0 as the amount) then scan. See Scan EOB.

In the patient account, claims received with no payment show as follows:

Any remaining balance will be due by the patient. Take patient payments as normal.

Insurance Pays on Alternate Procedure Codes

If insurance pays on different procedure codes than you sent (e.g. You filed a BW and Pano, but insurance paid on FMX), simply add the payment to the procedures you charted. No need to recreate the claims or procedures.

  1. Enter the payment by Procedure.
  2. Allocate the payment to the procedures you actually performed.
  3. Add a note in the Remarks section.
  4. Finalize the payment as normal.