In the Edit Claim window, at the upper right, is an Enter Payment area.

Click one of the three buttons.

• As Total: Enter a total payment amount. See below for details.
• By Procedure (recommended): Itemize the payment by procedure. See below for details.
• Supplemental: Add additional payments to procedures already received. See Supplemental Insurance Payments.

When payments have been entered, paid procedures and the claim will change to a status of Received.

When entering payments, it is recommended to include all EOB information, including remarks. This way all information is available in Open Dental and accessible from any computer. When a patient has questions, you can quickly determine what was/wasn't paid and why.

Also see:

• See our Webinar: Claim Payments
• Batch Insurance Payment
• Interest on Insurance Payments
• Incorrect Procedures on Claim
• Claims with No Payment (See below)
• Insurance Pays on Alternate Procedure Codes (See below)

As Total

Entering payments As Total is available for insurance plans with a type of Category Percentage, Medicaid or Flat Co-pay, and Capitation.

Entering an As Total payment differs depending on the Allocations Setup for Claim Pay by Total splits automatically.

When Claim Pay by Total splits automatically is checked:

1. Click As Total.
2. Enter the total amount paid, then click OK.
   
3. The Enter Payment window will open. Open Dental will automatically assign amounts to each procedure. Amounts can be changed if desired, or simply click OK to accept the amounts.
   
4. The paid amounts will show split to each procedure in the Edit Claim window.
   
5. Once complete, continue to Finalize Insurance Payment.

When Claim Pay by Total splits automatically is unchecked:

1. Click As Total.
2. The Edit Claim Procedure window will open. Enter the full Insurance Paid amount, then click OK.
   
3. The total payment will show as a new line item in the Edit Claim window.
   
4. Once complete, continue to Finalize Insurance Payment.

By Procedure

Entering payments By Procedure is available for all insurance plan types except Capitation. It is required for PPO plans to track write-offs.

1. To post payment to all procedures on the claim, click By Procedure. Alternatively, highlight specific procedures first.
2. The Enter Payment window will open.
   
   If needed, edit insurance payment information, then click OK.
   • Fee: Fee billed to patient.
   • Billed to Ins: Fee billed to insurance.
   • Deduct: Automatically calculated based on benefit information. Click in the cell to manually edit. To reassign a deductible to a different procedure, highlight the procedure, then click Deductible.
   • Allowed: Entered amounts will be saved to the out-of-network fee schedule for this insurance plan and used to calculate better estimates for patients with the same carrier.
     
     Note: Out-of-network fee schedules can be automatically generated by the Blue Book. If using Blue Book, the Allow Editing Fee Schedule While Receiving Claims and Fee Schedule Edit permissions are required.
   • Ins Pay: Automatically calculated based on benefit estimates. Click in the cell to edit.
   • Write-off: Automatically calculated. Click in the cell to edit or click Write Off in the lower left to create a write-off for all unpaid amounts by procedure (Fee Billed - Ins Pay).
   • Pat Resp: Displays patient responsibility for the procedure. Only displays when enabled in Account Module Preferences
   • Pay Tracking: Click in cell to select from a list of options (defined in Definitions: Claim Payment Tracking). Useful to track why payments are rejected. Only displays when enabled in Account Module Preferences.
   • Remarks: Click in the cell to enter remarks for any procedure that has a remark in the EOB.
   • Double-click on Date, Prov, Code, Th, Description, Fee Billed or Status to open the Claim Procedures ( claimprocs ) and edit information.
3. If not all procedures have been marked received, a popup will appear.
   
   
   • Click Yes to mark all procedures received, changing the Claim Status to received.
   • Click No to leave as unreceived procedures. This will leave the claim in a Sent - Verified status and remain on the Outstanding Insurance Claims Report.
4. Payments show associated with their procedures on the Edit Claim window.
   
5. Once complete, continue to Finalize Insurance Payment.

Claims with No Payment

If insurance does not pay on a claim, you must still receive it. Simply enter 0 as the insurance payment amount (As Total or By Procedure). This will mark it as Received so it is no longer considered an outstanding claim.

To scan the EOB associated with the zero payment, finalize the payment as normal (enter 0 as the amount) then scan. See Scan EOB.

In the patient account, claims received with no payment show as follows:

Any remaining balance will be due by the patient. Take patient payments as normal.

Insurance Pays on Alternate Procedure Codes

If insurance pays on different procedure codes than you sent (e.g. You filed a BW and Pano, but insurance paid on FMX), simply add the payment to the procedures you charted. No need to recreate the claims or procedures.

1. Enter the payment by Procedure.
2. Allocate the payment to the procedures you actually performed.
3. Add a note in the Remarks section.
4. Finalize the payment as normal.