How to Set Up a New Insurance Plan in Open Dental

When you need to open dental set up insurance plan entries, doing it incorrectly often leads to rejected claims, incorrect patient estimates, and hours of manual correction later. If the carrier information is not linked properly or the benefit details are missing, your practice will struggle to get paid accurately and on time.

Before You Start

Before you begin, ensure you have the patient's insurance card in front of you. You should already have your clearinghouse configured in Setup > Program Links > [Your Clearinghouse] to ensure electronic claims can be sent. Additionally, verify that the insurance carrier is not already in your system to avoid creating duplicate entries.

Step-by-Step Instructions

Follow these steps to correctly add a new insurance plan to a patient's file:

1. Open the Family Module: Locate the patient and click on the "Insurance" section in the top right area of the screen.
2. Add Insurance: Click the "Add Ins" button. This opens the "Edit Insurance Plan" window.
3. Select Carrier: Click the "Pick Plan" button. In the "Insurance Plans" window, click "Add" if the carrier is not listed. Enter the carrier name, address, and phone number, then click "OK."
4. Enter Plan Details: Back in the "Edit Insurance Plan" window, enter the Group Name, Group Number, and Plan Type (e.g., PPO, HMO).
5. Set Benefits: Click the "Benefits" tab within the "Edit Insurance Plan" window. Enter the annual maximum, deductible, and coverage percentages for diagnostic, preventive, and restorative procedures.
6. Save: Click "OK" to save the plan details.
7. Link to Patient: Once the plan is saved, ensure it is selected for the patient in the "Family Module" and click "OK" to finalize the link.

Common Mistakes

The most frequent error is failing to enter the "Group Number" or "Subscriber ID" correctly, which causes immediate electronic claim rejections. Another common mistake is neglecting to set the "Plan Type" (PPO vs. Indemnity); if this is wrong, Open Dental will calculate patient co-pays incorrectly, leading to under-collection at the time of service. Finally, if you do not verify the "Electronic ID" for the carrier, the claim will fail to transmit to the clearinghouse.

Related Scenarios

• If you need to manage existing plans, is a critical task for every practice.
• When a patient changes insurance, ensures you don't accidentally bill the wrong carrier.
• For tracking your revenue, helps you identify which claims are overdue.

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.