Entering an Insurance Payment 

An insurance payment frequently applies to multiple claims on the same EOB.  There are two strategies for entering an insurance payment:

Individual: Enter the payment for each individual claim from the Account module.  Then, from inside the last claim, create the "check" that ties them all together.  This is the original way of doing it in all previous versions of Open Dental.  It will not work well for large offices where multiple people are entering insurance payments at the same time.

Batch:  Enter the payment for each individual claim from the Account module. After all payments are entered, go to the Manage module, and create a new batch payment.  Attach the paid claims. 

There is also a third strategy which will not be used by very many people.  You could start by creating a blank batch payment object.  Then, enter payments directly from within the batch window by double clicking on each claim.  This attaches the claims to the batch as you go. It's fast, but it doesn't let you review each account.  A message will come up at the end, alerting you to secondary claims that need to be sent.

Enter Payment on Claim
Go into each patient on the list, double click on the appropriate Claim in the Account module, and enter the payment as described below. 

Payments can be entered by total amount or itemized by procedure. There are many advantages to itemizing by procedure and that is the method that is strongly recommended.  In fact, for PPO plans, you MUST itemize by procedure in order for your writeoffs to show properly in reports.  At the upper right of the Claim window are three buttons in the Enter Payment section: Total, By Procedure, and Supplemental. As explained in the Claim Procedures section, all payments are tracked as claim procedures, whether they are itemized as part of an existing dental procedure, or entered as a completely separate total payment.

If you click the Total button, it creates a separate Claim Procedure. This payment is attached to the claim, but not to any particular procedure. Enter the amount insurance paid and click OK. Note that you must still create the check as described in the section below.

If, instead, you click the By Procedure button, then this window will come up with a list of the procedures and a total at the bottom. If you want more control over which procedures to bring up, highlight some procedures first. The totals at the bottom for the deductible and for the insurance payment should exactly match the EOB.

Since the insurance paid amount is filled in for you when you follow the instructions above, there is usually very little editing that you will have to do and it should go fast. Many of the numbers can be directly edited in the cells of the grid without having to go to another window. Make sure to fill in the remarks field for any procedure that has a remark on the EOB. If you want to edit rarely used fields, you can double click on a row. See the Claim Procedure page if you need help with understanding the window that comes up.

The Allowed column causes the entered fees to flow into the Allowed Fee Schedule set up for this Ins Plan.  The allowed amounts will then be used for better estimates for other patients with the same carrier.  Allowed fee schedules can be automatically genereated by the program by setting that option in Module Setup, Family Module section.

There are two buttons at the lower left which can help speed things up. Instead of editing the deductible directly, you can reassign the procedure to which the deductible gets applied. Highlight that procedure and click the Deductible button. The writeoff button creates a writeoff amount for any amounts that insurance did not pay.

By entering all the information as described, including the remarks, you can file the EOBs and you will never have to refer back to them again. All the information you need will be present in Open Dental from any computer if a patient calls and complains that insurance did not pay as expected. You will be able to see why they didn't pay, and exactly which procedures were not paid on.

If insurance only paid on some of the procedures and you are still waiting on payment for the other procedures, then you can split the claim into two separate claims. One claim will be marked recieved, and the other will still be outstanding. The split claim button is on the Claim edit window just below the enter payment area at the upper right. You will need to first highlight the procedures that you want to split off.

Batch Insurance Payment
This section only applies to Batch payments. 

After entering in all the individual payments, go to the Manage module and click the Batch Ins button.

This is a list of insurance payments (EOBs) that have already been entered.  Click Add at the bottom.

Enter in at least the amount of the EOB, and probably the check information as well.

The information you just entered will be in the top section of this window.  The goal is to get the amount at the top to equal the Total Payment amount at the middle right.  The instructions for how to use this window are inside the window itself.  You can also right click on any claim in either grid to go to the Account module with that specific Claim highlighted.

To attach claims in the lower grid to the current batch payment, simply double click on them, and then click OK.

For procrastinators: This second step is generally done immediately.  It's ok to wait a few hours or a day or two, but this isn't something that you can put off for weeks and just get to it when you have  time.  All the reports and program logic make the assumption that you have finished the second step.

Creating the Check
This section only applies to Individual payments.

After entering the payment amount for each patient, it's time to create the insurance check that combines all those payments into one. This same process also applies if the check includes payment for only one claim. Open the Claim window for any of the claims that the check is paying on. In the lower middle of the claim window, click on the Create Check button.

Enter the check# and bank-branch, and click OK.

All insurance payments for all patients that have not been attached to an insurance check will be shown in the grid. Generally, the grid will only include the payments were just entered because all other payments will already be attached to other insurance checks. If you don't want to include certain claims on this payment, highlight them, then click the Detach button.  The total payments at the right must exactly match the amount at the upper left before continuing.

If you delete the check from this window, it does not affect any of the payment splits. They will simply remain unattached until you create a new check.

See the Insurance Overpaid Report for instructions on how to handle overpayment situations.

Scanning EOBs

There is currently no place to store scanned EOBs that have zero payment because there will be no Insurance Payment object to attach them to.