Managing an orthodontic case often involves recurring monthly payments or a large initial fee followed by periodic installments, which can quickly become a headache if not tracked correctly. If you fail to properly link these payments to the specific orthodontic claim, your aging report will show inaccurate balances and your patient statements will be confusing.
Before You Start
Before you begin processing an open dental ortho insurance payment, ensure your practice is prepared:
- Verify Insurance Plan: Ensure the patient’s insurance plan is correctly entered in the Family Module, including the ortho-specific coverage details and the "Ortho" benefit category.
- Claim Setup: The initial orthodontic claim must be created using the "New Claim" button in the Account Module. Ensure the claim is set to the correct status, such as "Waiting to Send" or "Sent."
- Clearinghouse: Verify that your clearinghouse is configured for electronic claims if you are not mailing paper claims.
- Fee Schedule: Ensure your orthodontic fee schedule is updated in the Setup > Definitions > Fee Schedules area so that the expected insurance portion calculates correctly.
Step-by-Step Instructions
Follow these steps to record an orthodontic insurance payment accurately:
- Locate the Claim: Go to the Account Module. Find the orthodontic claim in the patient's account grid. Double-click the claim to open the Edit Claim window.
- Verify Status: Ensure the claim status is set to "Sent." If you are receiving the first payment, you will eventually change this to "Received."
- Receive Payment: Click the "Receive Payment" button within the Edit Claim window. This opens the Enter Payment window.
- Select Payment Method: Choose the appropriate payment type (e.g., Check, EFT). Enter the payment amount and the check/reference number.
- Apply to Procedures: Click the By Procedure button. This ensures the payment is allocated to the specific orthodontic procedure codes rather than just sitting as a lump sum on the account.
- Finalize: Click "OK" to save the payment. The Edit Claim window will update the claim status to "Received."
- Handle Supplemental Payments: For subsequent monthly ortho payments, go to the Account Module, select the original claim, and click the Supplemental button in the Edit Claim window to add the next installment payment without creating a brand-new claim.
Common Mistakes
- Applying to the wrong claim: If you click "Receive Payment" without verifying you are in the correct claim window, the payment might be applied to a general dental claim instead of the orthodontic claim, causing your insurance aging to look incorrect.
- Ignoring the "By Procedure" button: If you do not use the By Procedure button, the payment will be applied to the entire claim balance. This makes it impossible to track which specific orthodontic installments have been paid and which are still outstanding.
- Creating new claims for every payment: Some offices create a "New Claim" for every monthly ortho payment. This is incorrect; you should use the Supplemental button on the original claim to keep the history clean and accurate.
Related Scenarios
- If you need to see which claims are overdue, .
- If you are struggling with secondary insurance, .
- If you need to verify that all procedures have been billed, .
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.