Managing Ortho Insurance Payments in Open Dental

Tracking an open dental ortho insurance payment is notoriously difficult because these claims are often paid in installments rather than as a single lump sum. If you do not set up the claim correctly from the start, your aging report will show inaccurate balances, and you will struggle to reconcile the monthly payments against the patient's remaining orthodontic benefit.

Before You Start

Before you begin posting payments, ensure your practice is prepared:

1. Insurance Plan Setup: Ensure the patient's insurance plan is set up with the correct orthodontic coverage, including the lifetime maximum and the specific ortho benefit percentage.
2. Claim Creation: You must have already generated the initial claim in the Account Module.
3. Fee Schedule: Verify that the orthodontic procedure codes (typically D8080 or D8090) are attached to the correct fee schedule to ensure the expected insurance portion is calculated accurately.

Step-by-Step Instructions

Follow these steps to post an installment payment for an orthodontic case:

1. Locate the Claim: Go to the Account Module. Find the orthodontic claim in the patient's account ledger. Double-click the claim to open the Edit Claim window.
2. Verify Status: Ensure the claim status is set to "Sent." If it is still "Waiting to Send," click the Send button to transmit it electronically or print it.
3. Receive the Payment: Once the EOB or ERA arrives, click the Receive Payment button within the Edit Claim window.
4. Apply by Procedure: In the payment window, click the By Procedure button. This allows you to allocate the payment specifically to the orthodontic procedure code.
5. Enter Payment Details: Enter the payment amount received from the insurance carrier. Ensure the "Date" matches the date on the EOB.
6. Finalize: Click OK to save the payment. If this is an installment payment and the claim is not yet paid in full, leave the claim status as "Received" (or "Supplemental" if your office policy requires a specific status for partial payments).
7. Future Installments: When the next installment arrives, go back to the Account Module, open the original claim, and click the Supplemental button to add the next payment amount without creating a new claim.

Common Mistakes

• Creating New Claims for Installments: Some users create a "New Claim" button click for every monthly payment. This creates a mess in your ledger and makes it impossible to track the total lifetime benefit used. Always use the Supplemental button on the original claim.
• Ignoring Procedure Allocation: If you click Receive Payment without using the By Procedure button, the payment is applied to the claim as a whole. This makes it difficult to audit which specific procedures have been covered if the patient terminates treatment early.
• Incorrect Status Updates: Failing to update the claim status to "Received" after the first payment keeps the claim on your Outstanding Insurance Claims Report, leading to unnecessary follow-up work.

Related Scenarios

• If you need to see a list of all claims that have not yet been paid, use the .
• If you are unsure if all completed ortho work has been billed, 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.