In Standard Reports, in the Monthly section, click Outstanding Insurance Claims.
This Report is useful for tracking claims that have been sent, but not received. From here you can also update tracking status for many claims at once or delegate staff to follow-up on claims.
Claims that meet the filter criteria will list. Click a column title to sort results in ascending or descending order. To view a claim, double click it.
Right click options: Right click on a claim row to select one of the following options:
- Go to Account: Jump to the patient's Account module without closing the report window.
- Assign to Me: Assign the claim to the logged on user.
- Assign to User: Assign the claim to any user.
Filters: If you change filter criteria, click Refresh to update list of results.
- Days Old (min/max): Filter by claim age. The age of the claim depends on the date type selected in the Date Range Applied to filter. Leave both fields blank to show all claims.
- Date Range (from/to): Filter by a date range. Use the Date Range Applies to filter to select which date type to use.
- Date Range Applies to: Select what date type to use when filtering the report.
- Date Sent: Date the claim was last sent.
- Date Sent Orig: Date the claim was originally sent.
- Date of Service: Date of service of procedures on claim.
- Preauth Options: Select option for displaying Preauthorization.
- Including Preauths: Include preauthorizations.
- Excluding Preauths: Do not include preauthorizations.
- Only Show Preauths: Only show preauthorizations.
- Ignore Custom Tracking: Do not consider or show claim tracking status in report results (Edit Claim - Status History Tab). If ignored, the days suppressed values as a result of the status will be ignored. If custom tracking status does show in the report (this box unchecked), the report will print in landscape mode.
- Treat Provs: Filter the report by treating provider. Click the dropdown, then highlight the providers to include. Press Ctrl while clicking to select multiple providers.
- Clinics: Filter by clinic. Click the dropdown, then highlight the clinics to include. Press Ctrl while clicking to select multiple clinics. Select All to include all clinics, including those that are hidden.
- For User: Only list outstanding claims assigned to a specific user for follow-up. Use the dropdown or click [...] to select from a pick list of users.
- Select All: Select all users, including those marked hidden.
- Select None: Select no users. Claims filtered in the list are unassigned.
- Mine: View outstanding claims assigned to the logged-on user
- Last Claim Custom Tracking Status: Filter by last recorded claim tracking status. Click the dropdown to select an option. Custom track statuses are attached to claims in the Edit Claim Window, Status Tab.
- Carrier: Filter by insurance carrier. Enter the carrier name.
- Last Error Definition: Filter by claim error code. Error codes are attached to claims in the Edit Claim window, Status Tab.
Claims: The columns below can show in the grid. Customize which columns show in Display Fields, Outstanding Ins Report.
- Carrier Name: The insurance carrier.
- Phone: The insurance carrier's phone number.
- Type: The type of insurance (primary, secondary, etc).
- User: The user assigned to follow-up on the claim.
- Patient Name: To show patient numbers with names, in Report Setup: Misc Settings, select the Show PatNum: Aging, OutstandingIns, ProcsNotBilled option.
- Clinic: The clinic on the claim.
- Date Sent / Orig Sent: If label is Date Sent, the date the claim was last sent shows. If Orig Sent, the date the claim was originally sent shows.
- Track Stat: The last claim tracking status entered. This column won't populate results if Ignore Custom Tracking is checked.
- Date Stat: The date the track status was entered. This column won't populate results if Ignore Custom Tracking is checked.
- Error: The Claim Error code, if one exists. This column won't populate results if Ignore Custom Tracking is checked.
- Amount: The total fee billed to each carrier. This is not the amount that will be paid, so do not use it to determine outstanding insurance payment amounts.
- GroupNum: Group number for the subscriber.
- GroupName: Group name for the subscriber.
- SubName: Subscriber name.
- SubDOB: Subscriber date of birth.
- SubID: Subscriber ID.
- PatDOB: The date of birth of the patient on the outstanding claim.
Assign Claims to Users
This tool is useful for delegating responsibility for outstanding claims to specific staff members.
- Highlight the claim(s) to assign.
- To assign to the logged on user: Right click, then select Assign to Me.
To assign to any user: Right click, select Assign to User, then select the user. Or, click Assign User, select the user from the Pick User window, then click OK.
To remove a claim assignment, right click and select another user or open the Assign User window and click Select None.
View Carrier/Plan and Patient/Subscriber Info
Click a row in the Claims grid to view information for the selected row.
Update Claim Tracking Status
Use this tool to change the Track Status and/or Error Code of all claims currently in the grid. The tool is only enabled for users who have the Update Custom Tracking security permission. See Definitions: Claim Custom Tracking for additional information.
- Change report filter criteria as needed.
- Click Update Custom Tracking.
- Click the dropdown to select a status.
- Add a note if desired.
- Click Update. The Track Status, Error Code and Date Status for all claims will update.
Print the Report
To print the report directly to the printer, click Print.
Export the Report
To export the report as a txt or xls file:
- Click Export.
- Select the location to save the file, and the file type. The default is the OpenDentalExports folder as set in Data Path Setup.
- Click Save.