When a new patient joins your practice, they often bring a history of procedures already completed and paid for by their insurance plan earlier in the benefit year. If you fail to accurately record this open dental insurance history new patient data, your system will incorrectly calculate remaining benefits, leading to denied claims or over-billing the patient.
Before You Start
Before entering historical data, ensure the following prerequisites are met:
- The patient is already added to the Family Module.
- The insurance carrier and plan are correctly set up in the patient's insurance section within the Family Module.
- You have the patient's EOB (Explanation of Benefits) or a benefit breakdown from their previous provider showing the procedures, dates of service, and the amount paid by insurance.
Step-by-Step Instructions
Follow these steps to record historical insurance payments so your benefit tracking remains accurate in version 25.3.
- Navigate to the Account Module: Open the patient’s chart and click on the Account Module.
- Create a Historical Claim: Click the New Claim button. In the Edit Claim window, change the Date of Service to the actual date the procedure was performed at the previous office.
- Add Procedures: Click the Add Procedure button within the claim window. Since these procedures were done elsewhere, you may need to add them as "Existing Other" or "History" procedures if they are not already in the patient's chart.
- Set Claim Status: In the Edit Claim window, set the status to Received. This ensures the system recognizes the benefits have already been exhausted for these specific codes.
- Enter Payment Details: Click the Enter Payment button. In the payment window, enter the amount the previous insurance paid. Ensure you select the correct insurance plan from the dropdown.
- Finalize: Click OK to save the payment, then click OK again to close the Edit Claim window. The procedure will now show as "Received" and the insurance benefits will be correctly deducted from the patient's annual maximum.
Common Mistakes
- Entering the current date: If you enter the current date instead of the actual date of service for the historical procedure, the system will deduct the benefits from the wrong benefit year or period.
- Forgetting to mark as "Received": If you leave the claim status as "Waiting to Send," the system will continue to count those benefits as "pending" rather than "used," which will cause your benefit remaining calculations to be inaccurate.
- Not linking to the correct plan: If the patient has changed insurance carriers, ensure you are entering the history against the plan that actually paid the claim, otherwise, the annual maximum for the current plan will be incorrect.
Related Scenarios
- If you need to see a list of all claims that have not yet been processed, .
- If you are trying to identify procedures that were completed but never billed, .
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.