How to Split a Claim for Partial Payment

You have a patient with a multi-procedure claim, but the insurance company only paid for some of the procedures while denying or delaying others. If you don't use the open dental split claim partial payment process, your claim status remains inaccurate, making it impossible to track what is truly outstanding versus what has been resolved.

Before You Start

Before attempting to split a claim, ensure the following prerequisites are met:

1. The insurance plan must be correctly attached to the patient in the Family Module.
2. The procedures must be completed and attached to a claim in the Account Module.
3. The claim status must currently be "Sent."
4. You must have the EOB or ERA in front of you to identify which specific procedures were paid and which were not.

Step-by-Step Instructions

Follow these steps to accurately manage an open dental split claim partial payment:

1. Go to the Account Module.
2. Locate the claim in the patient's account grid. Double-click the claim to open the Edit Claim window.
3. Click the Split Claim button located at the bottom of the Edit Claim window.
4. A window will appear asking you to select the procedures to move to a new claim. Check the boxes next to the procedures that were NOT paid or require a different status.
5. Click OK. Open Dental will create a new claim for the selected procedures and leave the original claim with only the paid procedures.
6. In the original claim (now containing only paid procedures), change the status to "Received."
7. Click the By Procedure button to enter the payment amounts exactly as they appear on your EOB/ERA.
8. Click OK to save the payment and close the claim.
9. For the new claim you created in step 5, ensure the status is set to "Waiting to Send" or "Sent" depending on whether you need to attach additional documentation or resubmit.

Common Mistakes

• Not splitting before receiving: If you click "Received" on the original claim before splitting, you will be forced to mark all procedures as paid or denied, which makes it difficult to track the remaining balance on the unpaid items.
• Ignoring the "Supplemental" button: If you receive a second payment for a claim that was already marked "Received," do not try to edit the original payment. Instead, use the Supplemental button to add the additional payment to the existing claim record.
• Misunderstanding "By Procedure": If you click "Receive Payment" without selecting the By Procedure button, the payment will be applied to the entire claim balance, which often leads to incorrect write-off calculations and skewed aging reports.

Related Scenarios

• If you need to see a list of all claims that have not been fully paid, use the .
• If you have procedures that were completed but never added 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.