Entering Insurance History for New Patients

When a new patient joins your practice, entering their existing insurance history correctly is vital to prevent duplicate billing and inaccurate benefit tracking. If you fail to record what has already been used toward their annual maximum, the software will incorrectly calculate remaining benefits, leading to denied claims or frustrated patients.

Before You Start

Before you begin entering an open dental insurance history new patient record, ensure the following prerequisites are met:

1. Insurance Plan: The patient’s insurance carrier and plan must already be created and attached to the patient in the Family Module.
2. Benefit Information: You must have a copy of the patient’s EOB (Explanation of Benefits) or a breakdown from their previous provider showing the amounts applied to their deductible and annual maximum for the current benefit year.
3. Permissions: Ensure your user role has permission to edit patient benefits.

Step-by-Step Instructions

Follow these steps to accurately record the patient's insurance history in Open Dental version 25.2 or 25.3:

1. Open the Family Module: Select the patient from the "Select Patient" search bar.
2. Access Insurance Plan: Locate the "Insurance" section in the Family Module. Double-click the insurance plan to open the "Edit Insurance Plan" window.
3. Open Benefits: Click the "Benefits" button located on the right side of the "Edit Insurance Plan" window.
4. Enter History: In the "Benefits" window, you will see a list of categories (e.g., Deductible, Annual Max).
   • Click the "Add" button to create a new benefit entry if one does not exist for the specific category.
   • Select the "Category" (e.g., General Services, Diagnostic, Preventive).
   • In the "Amount" field, enter the amount the patient has already used toward their annual maximum or deductible.
   • Ensure the "Time Period" is set correctly to "Calendar Year" or "Service Year" based on the plan.
5. Save Changes: Click "OK" in the "Benefits" window, then click "OK" again in the "Edit Insurance Plan" window to save your entries.
6. Verify in Account Module: Navigate to the Account Module. Click the "Ins Rem" (Insurance Remaining) button to verify that the software is now correctly calculating the remaining benefits based on the history you just entered.

Common Mistakes

• Entering "Remaining" instead of "Used": The most common error is entering the amount the patient has left instead of the amount they have used. If you enter the remaining amount as the "used" amount, Open Dental will subtract that from the total maximum, effectively zeroing out the patient's benefits.
• Ignoring the Time Period: If you enter history without verifying the "Time Period" (Calendar vs. Service Year), the software may apply the history to the wrong benefit cycle, causing the "Insurance Remaining" calculation to be off by thousands of dollars.
• Forgetting to Update Deductibles: Users often update the annual maximum but forget to enter the amount already met toward the deductible. This results in the software incorrectly suggesting that the patient still needs to meet their full deductible for the year.

Related Scenarios

• If you need to see a list of all claims that have not yet been paid, use the .
• If you are trying to identify procedures that were completed but never attached to a claim, check the .

Track all your outstanding claims at a glance with DentalCanvas — a visual dashboard that shows your insurance aging, pending claims, and collection trends in real time.

This article is provided by opendentalsupport.com, an independent community resource. We are not affiliated with Open Dental Software, Inc.