How to Split a Claim for Partial Payment

When an insurance carrier pays for some procedures on a claim but denies or delays payment on others, you need to perform an open dental split claim partial payment to keep your accounts receivable accurate. If you simply mark the entire claim as "Received" with a partial payment, the remaining procedures stay in limbo, making it impossible to track exactly what is still owed. This often leads to "lost" money that never gets followed up on because the system thinks the claim is closed.

Before You Start

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

1. The original claim must be in "Sent" status.
2. You must have the EOB or ERA in front of you to identify which specific procedures were paid and which were denied or are still pending.
3. Ensure your insurance plan information is correctly entered in the Family Module so that procedure codes and expected payments are accurate.
4. Verify that you are using Open Dental version 25.2 or 25.3 to ensure the interface matches these instructions.

Step-by-Step Instructions

Follow these steps to accurately separate procedures when you receive a partial payment.

1. Navigate to the Account Module for the patient.
2. Locate the claim in the account grid that has the partial payment. Double-click the claim to open the Edit Claim window.
3. Click the Split Claim button located in the bottom left area of the window.
4. A new window will appear listing all procedures currently on that claim. Check the boxes next to the procedures that you want to move to a new, separate claim (usually the procedures that were denied or are still pending).
5. Click OK. Open Dental will now create a new claim for the selected procedures and leave the original claim with only the paid procedures.
6. In the original claim (which now contains only the paid procedures), click the Receive Payment button.
7. In the Enter Payment window, ensure you select the By Procedure button. This allows you to apply the payment amount specifically to the procedures that were covered.
8. Enter the payment amount, check the appropriate procedures, and click OK to save the payment.
9. Change the status of the original claim to "Received" and click OK to close the Edit Claim window.
10. You can now manage the new, split claim independently by setting its status to "Waiting to Send" or "Hold until Pri Received" if you need to resubmit or appeal the denied procedures.

Common Mistakes

• Applying payment to the whole claim: If you click Receive Payment without using the By Procedure button, the payment will be applied to the entire claim balance. This makes it look like the insurance paid a portion of every procedure, which is rarely accurate and makes reconciling the EOB difficult.
• Forgetting to update the status: If you split the claim but leave the original claim status as "Sent," your Outstanding Insurance Claims Report will continue to show the full amount as pending, leading to inflated aging reports.
• Not documenting the split: Always use the Status History tab in the Edit Claim window to add a note about why the claim was split (e.g., "Split per EOB dated 04/01/26; procedures 1234 and 5678 denied").

Related Scenarios

If you need to handle additional payments after a claim has already been marked as received, use the Supplemental button to add the extra funds without creating a duplicate claim.

If you find procedures that were never billed, run the Procedures Not Billed to Insurance report to identify missing revenue before it becomes an aging issue.

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.