Send Claims

In the Manage Module, click Send Claims.

Insurance claims can be sent, printed, and managed on the Insurance Claims window.

This window is non-modal so you can open other windows while sending or validating e-claim.

Toolbar

Claims Waiting to Send

The top half of the window lists claims that have a status of Waiting to Send. Click a column header to sort.

Filter options:

Columns:

Claim History

The lower History grid lists all claims sent or printed from this window and received reports (e.g. ERAs, acknowledgment reports). Double click an item to view more information. Right click an item to Go To Account. The list of claims and reports can be filtered by date or type.

Filter Options:

Columns:

Note: In order for a report to list, it must already exist in the clearinghouses default Report Path. You can set up automatic download, manually download (click Get Reports), or manually save the report file in the correct folder. Not all insurance carriers offer ERAs, reports, or the ability to automatically download.

Claim Details

To view details about a sent claim, double-click it.

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 technical support.

Attachments Sent: Indicates if attachments were sent.

Note: Add a note that will display on the Insurance Claims window.

Acknowledgment: If the transaction has been acknowledged by the clearinghouse, then that information, including the full Message Text and Date/Time, will show at the right.

Reports

In order for a report to list in the History grid, it must first be downloaded to the Clearinghouse Report Path.

Reports can only be retrieved once per minute. If a user attempts to retrieve reports more than once in a minute, they will get an error. As reports are retrieved a progress bar will appear. Errors will be recorded in the Error Log. Users can pause or cancel the progress at any time.

Acknowledgment Reports: There are 4 types of acknowledgment report formats; 997, 999, 277, and 835. They are listed in the order in which they are received from the clearinghouse. Clearinghouses are not obligated to provide these acknowledgment reports and may choose to return some or all reports for some batches and not others.

Text Reports: Reports usually come back from the clearinghouse as files placed in the report path specified in the Edit Clearinghouse 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 use a web-based follow-up system rather than sending back text reports.