Sending and Printing Insurance Claims 

In the Manage module, click the Send Claims button at the top.

You create a Claim from the Account module for a patient. From within the Claim Edit window, you can print or send a single E-claim.  Or, instead, you can create a claim with a status of 'Waiting to Send' and then send it from this window as part of a batch at the end of the day. The setting in the Insurance Plan determines whether it will show as an e-claim or a paper claim. To print all paper claims, click Print. If you have selected some claims first, only those claims will print. You can also select e-claims as well as paper claims before clicking the print button if you wish to manually print e-claims. The Blank button prints a blank claim form.

To send e-claims, use the Send E-claims button. See the E-Claims section for information on how to set up and use e-claims. If you are using e-claims (X-12 only), you may see missing info in the last column. You will have to go to other places in the program to fix the missing info, then return here to continue.

If you have multiple Clinics, you will be able to filter by clinic so that you can send claims from each clinic to a specific Clearinghouse.

After the claims are sent, they are moved down to the History grid.  If there was a problem with sending, you can highlight the claims and click the Undo button.  Double click on an item in History to see information about the transaction.

The message text in the screenshot was obscured for privacy reasons.  If there is ever any need to troubleshoot a sent claim, the full text of the batch is saved here.  Most of the text as well as the fields below are meaningful only to tech support.  The checkbox will indicate if attachments were sent.  You can add a note that you will be able to see in the main window.  If the transaction has been acknowledged by the clearinghouse, then that information, including the full text of the ack, will show at the right.

Reports

Reports usually come back from the clearinghouse as files placed in the report path specified in the clearinghouse edit window. They are then automatically imported by Open Dental and stored in the database.  The original text file is deleted.  Older versions of Open Dental did not store the report in the database, but instead moved the file to an archive folder.  Because of the new way that reports are handled, it is no longer important to always run e-claims from the same workstation.  However, if you use Tesia, then TesiaLink should only be running on one computer at a time.   Also, there is no need to manually archive reports.  Reports that have been imported will show as rows in the lower history grid.  Double click on the row to view or print.  Use the Note field to make comments about each report that you will find useful.

Some clearinghouses, like ClaimConnect, use a web-based followup system rather than sending back text reports.