Managing Open Dental Pre-Authorizations

When a patient’s insurance plan requires a pre-determination, failing to track it correctly in your software leads to inaccurate treatment plan estimates and frustrated patients at the time of service. Managing an open dental pre authorization correctly ensures that when the insurance company responds, the approved amounts are automatically linked to the patient's treatment plan, preventing billing surprises later.

Before You Start

Before you begin, ensure the following prerequisites are met in your version 25.3 environment:

1. The patient must have an active insurance plan entered in the Family Module.
2. The procedures requiring pre-determination must be entered in the Treatment Plan Module and set to a status of "Treatment Planned."
3. Your clearinghouse must be configured in Setup > Family/Insurance > Clearinghouses if you intend to send the pre-authorization electronically.

Step-by-Step Instructions

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

1. Create the Pre-Auth: Go to the Account Module. Select the patient, then click the dropdown arrow next to the New Claim button and select Pre-Auth.
2. Select Procedures: In the Edit Claim window, ensure the "Pre-Auth" radio button is selected at the top. Click the Procedures button to select the specific treatment-planned procedures you are submitting.
3. Verify Information: Review the Other Ins Info tab to ensure the "Pre-Auth" checkbox is marked. Click OK to save the claim.
4. Send the Claim: If sending electronically, click the Send button in the Edit Claim window. The status will change to "Waiting to Send" and then "Sent" once the batch is processed.
5. Receive the Response: Once you receive the EOB or ERA from the insurance company, go to the Account Module, locate the pre-authorization in the patient's account, and double-click it to open the Edit Claim window.
6. Update Status: Change the status to "Received." Enter the approved amounts for each procedure in the "Allowed" or "Ins Est" fields as specified by the insurance company.
7. Finalize: Click OK to save. The approved amounts will now reflect in the Treatment Plan Module for that patient.

Common Mistakes

• Confusing a Claim with a Pre-Auth: If you create a standard "New Claim" instead of selecting "Pre-Auth," the system will treat the request as a billable service. This can cause the insurance company to deny the claim for "service not performed" and may mess up your aging reports.
• Ignoring the Status History: If you do not update the Status History tab when you receive the response, your Outstanding Insurance Claims Report will continue to show the pre-authorization as "Sent" indefinitely, cluttering your workflow.

Related Scenarios

If you need to manage standard insurance claims that have already been processed, . For tracking claims that are taking longer than expected to pay, .

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.