Printed claim forms are set up from the Claim Forms window.

To open the Claim Forms window, in the Main Menu, click Setup, Family/Insurance, Claim Forms.

This page only contains information about claim forms that are printed.

• Set a default claim form for new insurance plans.
• Import/export a claim form.
• Reassign a different claim form to many insurance plans at once.
• Change the alignment when printing on a preprinted form.
• Select whether or not background images print.
• Hide a claim form so it no longer is a selection option.

Also see:

• ADA 2012 Claim Form: How fields in a printed ADA 2012 claim form are populated.
• HCFA 1500 Claim Form: How fields in a printed 1500 claim form are populated.

Internal Claim Forms: The original claim form templates that come with Open Dental. Can only be copied.

Custom Claim Forms: Claim forms that can be customized, duplicated, imported, exported, or deleted.

Set a Default Claim Form for New Insurance Plans

The default claim form determines the default claim form on the Insurance Plan when a new insurance plan is created.

Under Custom Claim Forms, highlight the claim form. Click Set Default. An X will appear in the Default column next to the ClaimForm name.

Reassign Claim Forms

If a new claim form is replacing an existing one, you can easily assign the new claim form to all insurance plans that use the old form.

1. Import the new claim form (see Import Claim Forms below).
2. In the Custom Claim Forms list, highlight the old form.
3. Click the Reassign dropdown and select the new form.
   
4. Click Reassign. A message will appear indicating how many insurance plans are affected by the reassignment.

Import Claim Forms

To import most claim forms, you need two files: an XML file and the background image file (GIF or JPG). Some claim forms only require an XML file.

1. Save the XML file and the image file in your A to Z Folder.
2. On the Claim Forms window, click Import.
3. Select the XML file, then click Open.

The new form will appear last in the Custom Claim Forms list. Once imported, the XML file is no longer needed by Open Dental, and you may delete it from your A to Z folder.

Export Claim Forms

Claims forms are exported in XML format.

1. Under Custom Claim Forms, highlight the claim form.
2. Click Export.
3. Select the location to save the XML file, then click Save.

Edit a Claim Form

Advanced users only.

Possible reasons to modify a claim form:

• Change the identifying name of the claim form.
• Remove the claim form as an option in various lists (hide).
• Set whether or not background claim form images print.
• Change the alignment when printing on a preprinted form.
• Modify fields on the claim form (not recommended).

To make changes to an existing claim form, double click the form in the Custom Claim Forms list. The left side of the window will show the items on the claim form. The right side of the window will have an edit panel.

Description: Name of the claim form

Width and Height: Dimensions of the claim form when printed. Edit width and height when claim form is not printed on standard 8.5x11 sized paper.

Is Hidden: Hide a claim form so it no longer shows as an option in various drop downs.

Print Images: Set whether or not background images print.

• Checked: Print background claim image.
• Unchecked: Do not print the image (e.g. when printing on a preprinted form such as Denti-Cal).

Offset X and Offset Y: Change the alignment of the form when printing on a preprinted form. Values can be positive or negative and will shift all elements on the page by the given number of pixels in hundredths of an inch.

Add a Claim Form

You can add your own claim form from scratch, but it is very involved and takes a lot of time.

Step 1: Prepare a background image.

1. Scan a paper form at a high resolution.
2. In an image editing program (e.g. Photoshop), increase the contrast to make the black lines look blacker and the white areas whiter. Also erase any black flecks that remain. Resample the image to about 250 dpi, 8 bit b/w palleted.
3. Save the image in the A to Z folder as a GIF or JPG.

Hint: On the edit window, GIF image size can be easily adjusted by changing the width and height, but JPG image size cannot be changed. If you save as a JPG, set the compression and smoothing for as small a file size as possible without losing detail, somewhere between 200 and 500 Kb. The larger it is, the longer it will take to print.

Step 2: Create a new blank claim form.

1. On the Claim Form window, click Add to open the edit window.

Step 3: Add the background image.

1. In the edit panel, click Add then enter the background Image File Name.
2. Do some trial printing to make sure it's sized right and is positioned on the page so that it won't get cut off on one side. If using a GIF, you can adjust size by entering Width and Height. You may also have to adjust the xPos or yPos (not the offsets).

Step 4: Add more items as needed.

1. Click Add, then select the field name to add, then click OK.
2. Move items by clicking and dragging or by using the arrow keys.
   • To make the movement larger press Shift while pressing an arrow key.
   • To select groups of items to move as a unit, press Ctrl while clicking. When you have groups selected, any change you make in the four text boxes at the bottom will apply to all items in the group.

Step 5: Click OK to save the form.

Hints:

• The dollar amount fields are right justified, so the x position will function differently (for now, click to the right of an amount field to highlight it).
• Be careful not to accidentally drag when highlighting items, especially groups.
• Set the width or height to zero to get rid of the surrounding rectangle and to not restrict the area of printing.
• The screen may flicker as you drag.

Delete a Claim Form

You can delete a custom claim form as long as it is not being used by any insurance plans. Highlight the claim form, then click Delete.

Questions & Answers

Does Open Dental have a New York State Medical Assistance Claim Form A (EMED 000201)?

No. You could create one, but it will require some effort. Another option would be to send these claims electronically using a clearinghouse or direct connection to payer.