When a PPO insurance payment arrives, failing to correctly account for the contractual write-off leaves the patient with an inflated balance and makes your aging reports inaccurate. If you manually adjust balances without linking them to the specific insurance payment, you lose the ability to track your actual production versus collections and contractual adjustments. Proper open dental PPO writeoffs setup is the foundation for keeping your accounts receivable clean and your patients happy.
Before You Start
Before you can process write-offs efficiently, ensure your insurance plans are configured correctly. Go to the Family Module, select the patient, and double-click the insurance plan to open the Edit Insurance Plan window. Ensure the "Fee Schedule" is set to the PPO fee schedule provided by the carrier. If this is not set, Open Dental cannot calculate the expected write-off amount automatically when you create a claim. Additionally, verify that your "Insurance Payment Type" is set up in Setup > Definitions > Insurance Payment Types so you can categorize these adjustments correctly for reporting.
Step-by-Step Instructions
Follow these steps in the Account Module to process an insurance payment and the associated PPO write-off:
- Locate the patient in the Account Module.
- Find the claim in the account grid that corresponds to the EOB or ERA you are processing.
- Double-click the claim to open the Edit Claim window.
- Click the Receive Payment button.
- In the Enter Payment window, click the By Procedure button. This is critical for accurate tracking.
- For each procedure listed, enter the amount paid by the insurance in the "Ins Paid" column.
- In the "Write-off" column, enter the contractual adjustment amount specified on the EOB.
- Ensure the "Status" of the claim is set to "Received."
- Click OK to save the payment.
- If the payment is part of a larger check, you may use the Batch button in the Manage Module to group these payments, but always ensure the write-off is attached to the specific procedure line item.
Common Mistakes
- Entering the write-off as a separate adjustment: If you go to the Account Module and click "Add Adjustment" to manually write off the balance, it is not linked to the insurance claim. This makes it impossible to reconcile the claim later and causes the Unfinalized Insurance Payments report to show incorrect data.
- Ignoring the "By Procedure" button: If you click Receive Payment without selecting the By Procedure button, the payment will be applied to the entire claim balance rather than individual procedures. This prevents Open Dental from accurately tracking which specific procedures were covered and which were written off, leading to messy reporting.
Related Scenarios
- If you need to handle a secondary insurance payment after the primary has already paid, use the Supplemental button within the Edit Claim window to add the remaining balance.
- If a claim is denied or requires more information, change the status to "Hold until Pri Received" in the Edit Claim window to keep it off your immediate follow-up list.
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.