How to Resubmit a Rejected Claim in Open Dental

When you receive a rejection notice from an insurance carrier, simply clicking "resend" often leads to a second denial for the same error. To successfully open dental resubmit rejected claim procedures, you must first correct the underlying data in the patient's record and then properly reset the claim status so the clearinghouse accepts the new transmission.

Before You Start

Before attempting to resubmit, ensure your office is prepared:

1. Verify Clearinghouse Connection: Ensure your clearinghouse is active and configured in Setup > Family/Insurance > Clearinghouses.
2. Review the Rejection: Have the EOB or electronic rejection report handy to identify the specific error (e.g., missing tooth chart, incorrect subscriber ID, or invalid procedure code).
3. Update Patient Data: If the rejection was due to demographic or insurance plan errors, update the information in the Family Module or the Edit Insurance Plan window before touching the claim.

Step-by-Step Instructions

Follow these steps to ensure the claim is corrected and sent with the proper status.

1. Locate the Claim: Go to the Account Module. Find the rejected claim in the patient's account grid. Double-click the claim to open the Edit Claim window.
2. Update Claim Information: If the rejection requires a change to the claim itself (like adding a missing attachment or correcting a procedure code), make those changes within the Edit Claim window. If you need to change the insurance plan details, you may need to click "Cancel" and edit the plan in the Family Module first.
3. Reset Claim Status: In the Edit Claim window, change the "Claim Status" dropdown from "Received" or "Sent" back to "Waiting to Send."
4. Save Changes: Click "OK" at the bottom of the Edit Claim window to save the status change.
5. Resend the Claim: Go to the Manage Module and click the "Send Claims" button. Your corrected claim will now appear in the list of claims "Waiting to Send." Select the claim and click "Send" to transmit it to your clearinghouse.
6. Verify Status: Once sent, the claim status will automatically update to "Sent" in the Account Module.

Common Mistakes

• Not Changing the Status: If you edit the claim but leave the status as "Sent," the claim will not appear in your "Send Claims" queue in the Manage Module. It will effectively sit in limbo.
• Creating a New Claim Instead of Editing: Some users click the "New Claim" button to create a duplicate claim when the first one is rejected. This creates duplicate entries in your ledger and makes it difficult to track which claim is actually active. Always edit the existing claim if possible.
• Ignoring the Status History: If you fail to check the Status History tab in the Edit Claim window, you lose the audit trail of why the claim was rejected and when it was resubmitted.

Related Scenarios

If you need to handle partial payments on claims that were partially approved, see . If you are struggling to identify which claims are overdue, see .

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.