Claim Types

In the Account Module toolbar, there are five options when creating a claim: New Claim, Primary, Secondary, Medical, Other. Open Dental assigns a claim type and other options based on the patient's insurance plan situation. The logic is as follows.

Some settings can be manually changed. Users are also not blocked from manually changing the secondary plan on a claim, though this could result in the e-claim sending secondary claim information that is inconsistent with the situations listed in the table.

Insurance Plan Situation (order listed in Family Module) New Claim Primary Secondary Medical
Dental Claim type: Primary

Med/Dent: Dental

Insurance Plan: Dental Plan

Other Coverage: Blank
Claim type: Primary

Med/Dent: Dental

Insurance Plan: Dental Plan

Other Coverage: Blank
Message displays informing the user that the patient does not have secondary insurance. Message displays informing the user that the patient does not have medical insurance.
Medical Claim type: Medical

Med/Dent: Medical or Institutional (default set in Account Module Preferences)

Insurance Plan: Medical Plan

Other Coverage: Blank
Message displays informing the user that the patient does not have any dental plans. Message displays informing the user that the patient does not have secondary insurance. Claim type: Medical

Med/Dent: Medical or Institutional (default set in Account Module Preferences)

Insurance Plan: Medical Plan

Other Coverage: Blank
Dental Dental Two claims are created (except in Canada only the primary is created).

Primary claim:

Claim Type: Primary

Med/Dent: Dental

Insurance Plan: Dental plan with lowest ordinal

Other Coverage: Dental plan with the second lowest ordinal

Secondary Claim:

Claim Type: Secondary

Med/Dent: Dental

Insurance Plan: Dental plan with the second lowest ordinal

Other Coverage: Dental plan with lowest ordinal
Claim Type: Primary

Med/Dent: Dental

Insurance plan: Dental plan with the lowest ordinal

Other Coverage: Dental plan with the second lowest ordinal
Claim Type: Secondary

Med/Dent: Dental

Insurance plan: Dental plan with the second lowest ordinal

Other Coverage: Dental plan with the lowest ordinal.
Message displays informing the user that the patient does not have medical insurance.
Dental Medical Same as Dental Same as Dental Message displays informing the user that the patient does not have secondary dental insurance. Same as Medical​
Medical Dental Same as Dental Same as Dental Message displays informing the user that the patient does not have secondary dental insurance. Same as Medical​
Medical Medical Same as Medical Message displays informing the user that the patient does not have any dental plans. Message displays informing the user that the patient does not have secondary insurance. Same as Medical​
Dental Dental Medical Same as Dental Dental Same as Dental Dental Same as Dental Dental Same as Medical​
Dental Medical Dental Same as Dental Dental Same as Dental Dental Same as Dental Dental Same as Medical​
Medical Dental Dental Same as Dental Dental Same as Dental Dental Same as Dental Dental Same as Medical​

Claim Type Other

When a patient has three or more dental insurance plans, create an Other type claim.

  1. In the Main Menu, click the New Claim dropdown, Other.

    All plans the patient is currently subscribed to will list. To list all insurance plans for the family, including inactive or dropped plans, check Show plans for family which are not in use by the current patient.

  2. Select the dental insurance plan.
  3. Select the patient's relationship to subscriber.
  4. Click OK.
  5. On the Edit Claim Window verify the claim information and change if necessary.
  6. Send or print the claim.