Medical Insurance  

Open Dental has full support for medical insurance, making it useful in Oral Surgery and in hospital settings.

Insurance Plans
In the Family module, every patient can have unlimited insurance plans attached to them. There is a box in the Insurance Plan edit window on the left about half way down that says "Medical Insurance". Checking this box identifies the insurance plan as medical rather than dental. Just below that, also change the claim form to 1500.

Procedure Codes
Medical codes can be entered just like any other dental code in the Procedure Code setup. Cross coding works by entering the medical code in the corresponding dental code window as described in the procedure code setup page.

Diagnostic Codes
In the Procedure Edit window, there is a place at the top to enter the medical code and the ICD-9 code. If you have assigned a medical code in the procedure code setup, then it will have been filled in automatically for you, although you can still change it. The diagnosis code will need to be entered manually for each procedure. One procedure for each visit will need to have the box checked for Principal Diagnosis.

Creating Claims
If a patient has medical insurance, and there are any completed procedures with a medical code entered, then clicking the New Claim button at the top of the Account module, will automatically create a dental claim as well as a medical claim. The dental claim will show the dental code, and the medical claim will show the medical code.

Printing Claims
As described above, the medical insurance plan will have been assigned to use the 1500 claim form. If you do not have the new 1500 claim form as an option in Open Dental, then you will need to download it as described below.  Download these two files to your C drive or to some other easy to find location: 1500.gif and ClaimForm.xml .  Then, use the ClaimForm import feature to import the new 1500 claim form.

E-Claims
Any claim that is attached to a medical insurance plan will go out as a medical e-claim, which has a slightly different format than a dental claim. This feature must first be turned on in Setup | Miscellaneous. Additional validation is performed on medical claims, including requirements for National Provider ID, diagnostic codes, and a principal diagnostic code. You will have to make sure you find a clearinghouse that can accept both medical and dental e-claims. We have not done testing with any clearinghouses yet for medical claims.