When an insurance carrier denies a claim, simply deleting the claim or ignoring it leads to inaccurate aging reports and lost revenue. To perform an effective open dental claim denial fix, you must properly document the denial reason, adjust the claim status, and resubmit the corrected information without creating duplicate procedures or billing errors.
Before You Start
Before you begin the process of correcting a denied claim, ensure your practice is set up for success:
- Verify Insurance Plan: Ensure the patient's insurance plan is correctly entered in the Family Module, including the correct carrier address and electronic ID.
- Clearinghouse Connection: Confirm your clearinghouse is active and configured in Setup > Family/Insurance > Clearinghouses.
- EOB/ERA Access: Have the physical EOB or the digital ERA file ready, as you will need the specific denial code or reason provided by the carrier.
- Version Check: These instructions are based on Open Dental version 25.2. If you are on an older version, some button placements may vary slightly.
Step-by-Step Instructions
Follow these steps to process a denial and prepare the claim for resubmission.
- Locate the Claim: Go to the Account Module. Find the denied claim in the patient's account ledger. Double-click the claim to open the Edit Claim window.
- Update Status: In the Edit Claim window, change the status from "Received" to "Waiting to Send." This moves the claim back into your queue for resubmission.
- Document the Denial: Click on the Status History tab. Click "Add" to enter a note regarding the denial reason (e.g., "Missing narrative," "Coordination of benefits required"). This creates a permanent audit trail.
- Correct the Claim: If the denial was due to a coding error or missing information, make the necessary changes. If you need to attach a missing narrative or X-ray, use the "Attachments" button within the Edit Claim window.
- Split if Necessary: If only part of the claim was denied and you need to resubmit specific procedures, click the Split Claim button. This allows you to isolate the denied procedures from the ones that were already paid.
- Resubmit: Once the claim is corrected, click "OK" to save the changes. Go to the Manage Module and click the "Send Claims" button to transmit the corrected claim to your clearinghouse.
Common Mistakes
- Deleting the Claim: Never delete a denied claim. If you delete it, you lose the history of the original submission and the denial, making it impossible to track why the claim failed. Always change the status to "Waiting to Send" instead.
- Applying Payments Incorrectly: If you receive a partial payment on a claim that contains both paid and denied procedures, ensure you use the By Procedure button when receiving the payment. If you click "Receive Payment" without selecting procedures, the payment may be applied to the entire claim balance, which complicates the reconciliation of the denied portion.
- Ignoring Secondary Insurance: If a primary claim is denied, do not automatically move it to the secondary carrier. Ensure the primary denial is resolved or documented, or set the secondary claim status to "Hold until Pri Received" to prevent premature secondary billing.
Related Scenarios
If you are struggling with claims that have been sitting in your aging report for too long, will help you identify which claims need immediate attention. If you are seeing procedures that were completed but never sent to the carrier, is the best way to catch those missed opportunities.
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.