Managing Open Dental Pre-Authorizations

When a patient’s insurance plan requires a pre-determination for major work, failing to track it correctly leads to denied claims and frustrated patients. If you don't link the pre-authorization to the treatment plan in Open Dental, you lose visibility on whether the insurance company has actually approved the procedure, often resulting in billing for services that aren't covered.

Before You Start

Before you begin an open dental pre authorization, ensure the following prerequisites are met in your version 25.2 or 25.3 system:

1. Insurance Plan: The patient must have an active insurance plan entered in the Family Module.
2. Procedure Codes: The procedures must be entered into the Treatment Plan Module with the correct ADA codes.
3. Clearinghouse: Ensure your clearinghouse is configured in Setup > Family/Insurance > Clearinghouses to allow for electronic submission of pre-determinations.
4. Provider/Clinic: Verify that the treating provider and clinic are correctly assigned to the procedures.

Step-by-Step Instructions

Follow these steps to create and track a pre-authorization:

1. Navigate to the Account Module: Select the patient from the Select Patient window.
2. Create the Pre-Auth: In the Account Module, click the dropdown arrow next to the "New Claim" button and select "New PreAuth."
3. Select Procedures: In the "Edit Claim" window that opens, ensure the correct procedures are checked in the list. If you only need to pre-authorize specific items, uncheck the others.
4. Verify Information: Check the "Other Ins Info" tab to ensure the "Pre-Auth Number" field is blank (you will fill this later) and the "Claim Type" is set to "PreAuth."
5. Submit the Claim: Click "OK" to save the claim. It will now appear in the Account Module with a status of "Waiting to Send."
6. Send the Claim: Go to the Manage Module > Send Claims. Select the pre-authorization and click "Send" to transmit it to your clearinghouse. The status will change to "Sent."
7. Receive Approval: Once you receive the EOB or ERA from the insurance company, go to the Account Module, double-click the pre-authorization claim to open the "Edit Claim" window.
8. Update Status: Change the status to "Received." Enter the approved amounts and the pre-authorization number provided by the insurance company in the "Pre-Auth Number" field. Click "OK."

Common Mistakes

• Confusing Claims with Pre-Auths: If you accidentally create a "New Claim" instead of a "New PreAuth," the system will attempt to bill the insurance for immediate payment. This creates confusion in your aging reports and may cause the insurance company to reject the submission.
• Ignoring the Status History: If you do not use the "Status History tab" to document when you sent the pre-authorization, you will have no record of when to follow up if the insurance company takes longer than expected to respond.
• Not Linking to Treatment Plan: If you do not attach the pre-authorization to the specific procedures in the Treatment Plan Module, the patient's account will not accurately reflect the expected insurance coverage, leading to incorrect patient estimates.

Related Scenarios

• If you need to see which procedures have been completed but not yet sent to insurance, use the .
• To manage your overall insurance follow-up workflow, regularly review 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.