Jeffrey Wade
Open Dental is a software that allows users to manage medical insurance claims. It is equipped to handle medical insurance claims and has features that make it useful in oral surgery and hospital settings. The process of adding medical insurance to Open Dental involves enabling medical insurance in the Show Features section of the software. This allows patients to have unlimited insurance plans, with the option to designate a plan as medical by checking the Medical Insurance box in the Plan Info tab. Additionally, users can enter insurance plan information, select subscribers, and create or choose from existing insurance plans in the database. Understanding the different types of dental insurance plans, such as on-exchange, off-exchange, group, or individual plans, is essential when considering adding dental insurance to medical insurance.
How to add medical insurance to Open Dental
| Characteristics | Values |
|---|---|
| Enabling Medical Insurance | Go to Setup, Advanced Setup, Show Features. Check Medical Insurance and Public Health. |
| Cross-coding CPT codes to ADA codes | Click Add to create a new category for CPT codes, making them easily sortable from dental codes. |
| ICD-10 codes | Download ICD-10 codes. |
| Insurance plan setup | Enter the insurance plan, ensuring Medical Insurance is checked. Change the claim form to a medical claim form. |
| Charting medical procedures | Double-click the procedure and click the Medical tab. Only dental procedures need charting if cross-coded to medical codes. |
| Submitting medical claims | Claims can be printed and mailed or sent electronically if a medical clearinghouse is set up. |
| Clearinghouses | Set a default medical/institutional clearinghouse. Dental clearinghouses cannot accept medical or institutional claims. |
| Claim files | If generating claim files from Open Dental and uploading them manually to Medicaid, a default clearinghouse is required to specify the Claim Export Path. |
| Claim format | Medical and institutional claim format is 5010. Dental claim format can be 4010 or 5010. |
| Sending claims | Send batches of claims to one clearinghouse at once. |
| Claim format determination | Information is required from both the claim.MedType and the clearinghouse.Eformat. |
| Insurance plan information | Click Yes if the current patient is the plan subscriber. Enter insurance plan information for the subscriber before assigning the plan to non-subscriber family members. |
| New insurance plan | Click New Plan to open a blank insurance plan. Select an insurance plan from the list, then click OK to add it to the patient. |
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What You'll Learn
Enabling medical insurance
Firstly, navigate to the Setup section within Open Dental. From there, select Advanced Setup and then Show Features. This is where you will find the option to enable medical insurance. Tick the box next to "Medical Insurance" to ensure that this feature is activated. By doing so, you will be able to view and utilize the medical features offered by Open Dental, which are particularly useful in oral surgery and hospital settings.
In the same Setup section, you may also need to select Public Health if you require the ability to change the Place of Service, for example, for telehealth services or inpatient treatment. Additionally, if you utilize other Public Health features, ensure that "Public Health" is selected.
Next, move to the Definitions section within Setup, and select Proc Code Categories. Here, you will be able to create a new category for any CPT codes you will be adding. This step ensures that your CPT codes are easily distinguishable from your dental codes.
When entering a patient's insurance plan information, ensure that you check the "Medical Insurance" box in the "Plan Info" tab. This step is crucial in designating the insurance plan as medical. Additionally, in the Other Ins Info tab, select the appropriate claim form for the plan. Typically, the updated HCFA 1500 form, denoted as "1500_02_12", is used for medical claims.
It is important to note that if you intend to print and mail medical claims, you must use pre-printed forms due to the red background of the HCFA 1500 form. On the other hand, if you will be sending medical claims electronically, the claim form choice does not hold significance.
By following these steps, you will successfully enable medical insurance in Open Dental, allowing for a streamlined process when submitting medical insurance claims.
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Cross-coding CPT codes to ADA codes
Open Dental is equipped to handle medical insurance claims, but there are a few steps to be taken to ensure the process runs smoothly. One of these steps is cross-coding CPT codes to ADA codes. CPT stands for Current Procedural Terminology and is the standard code set for medical diagnoses and treatments. CPT codes are reviewed annually by the American Medical Association (AMA) and are used to report medical procedures to medical insurance plans.
To cross-code CPT codes to ADA codes in Open Dental, you must first create the medical codes that you will be using. Go to 'Lists, Procedure Codes', and then click 'New'. Then, click 'Add' for each new medical code. Now, cross-code the CPT code with the ADA code by finding the corresponding dental code in the 'Procedure Codes' list and double-clicking to open the 'Edit Procedure Code' window. Enter the CPT code in the 'Medical Code' box. This process must be repeated for each dental procedure with a corresponding medical code.
It is important to note that dental procedures that are cross-coded to medical codes do not need to be charted separately, as this may cause the patient to be double-billed. The medical code will automatically pull in the cross-coded information.
Additionally, medical claims require diagnoses, so it is necessary to download the latest ICD-10 codes. This can be done by going to 'Setup, Chart, EHR', and then clicking 'Code System Importer' and 'Check for Updates'. Highlight 'ICD10CM' and click 'Download Updates' to import the latest ICD-10 codes into your database.
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Downloading ICD-10 codes
Open Dental has features for medical insurance, which can be useful in oral surgery and hospital settings. To see medical features in Open Dental, enable Medical Insurance in Show Features. Patients can have unlimited insurance plans.
To add a new insurance plan in Open Dental, first, determine whether the current patient is the plan subscriber. If they are, click Yes, and enter the insurance plan information for the subscriber. If not, click No, and select the subscriber. If the subscriber is a non-family member, you can click More Patients to select anyone in the database. Once a subscriber is selected, a blank Insurance Plan window will open if no insurance plan has been previously entered for them. Click New Plan to open a new blank insurance plan, or use Pick from List to choose from existing insurance plans in the database. After selecting an insurance plan, click OK to add it to the patient.
Now, to download ICD-10 codes, go to the Procedure Info - Medical tab and check or uncheck Use ICD-10 Diagnosis Codes. The field labels for diagnosis codes will change to reflect the setting. For Problems, attach codes on the Problem Def Edit window. Click the pick list button to select. For Procedures, attach codes on the Procedures - Medical tab. You can enter the code manually or use the pick list button next to Diagnosis Code 1, 2, 3, or 4. If using the pick list, the list will initially be empty. Enter the first few characters of the description or code, then click Search. To see all diagnosis codes, leave the code and description blank, then click Search. Double-click the code to select it and close the window.
Some examples of ICD-10 codes include Z01.20 for routine checkups and cleanings with no abnormalities, Z13.84 for screening patients without specific symptoms, and K03.2 for the erosion of teeth.
It is important to note that not all dental insurance carriers require ICD-10 diagnosis codes on claims. However, a growing number of insurers, including Medicaid dental programs, are mandating them. Therefore, it is crucial to verify the specific requirements of each patient's insurance plan.
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Setting up insurance plans
Understanding Insurance Options:
Before setting up insurance plans, it is essential to explore the different options available. Research and compare various insurance plans, including dental and medical insurance, to find the one that best suits your needs. Consider factors such as coverage options, benefit structures, pricing, waiting periods, and eligibility for subsidies or tax credits.
Enabling Medical Insurance in Open Dental:
To set up medical insurance plans in Open Dental, follow these steps:
- Go to "Setup" and select "Advanced Setup."
- Click on "Show Features."
- Check the "Medical Insurance" box to enable this feature.
- If needed, also check "Public Health" if you require the ability to change the Place of Service (e.g., for telehealth or inpatient treatment).
Entering Patient Information:
When adding a new patient or updating existing patient information:
- Indicate whether the patient is the plan subscriber.
- If the patient is the subscriber, enter their insurance plan information.
- If the patient is not the subscriber, select the subscriber from the database or add them as a new subscriber if they are not already listed.
- Once the subscriber is selected, choose the appropriate insurance plan for the patient from the list or create a new plan if needed.
Selecting Insurance Plan Type:
When setting up an insurance plan, you will need to specify the type of insurance:
- Medical Insurance: Check the "Medical Insurance" box in the Plan Info tab to designate the plan as medical insurance.
- Dental Insurance: Ensure that the medical insurance box is unchecked if you are solely setting up dental insurance.
Claim Forms and Submission:
- In the "Other Ins Info" tab, select the appropriate claim form for the insurance plan.
- For medical insurance, the typical claim form is "1500_02_12" (the updated HCFA 1500 form).
- Printed medical claims must use pre-printed forms due to the red background requirement.
- Dental procedures should be charted separately from medical procedures to avoid potential double-billing issues.
- Once all information is entered, claims can be printed, mailed, or sent electronically if a medical clearinghouse has been set up.
By following these steps, you can effectively set up insurance plans, including medical insurance, in Open Dental, ensuring a streamlined process for managing patient treatment and insurance claims.
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Submitting medical claims
When creating a new medical claim, access the Account Module. If the patient has both dental and medical insurance, select the procedure(s) and click the New Claim dropdown in the toolbar, then select Medical. It is important to note that if the patient has one dental insurance plan listed first and one Medical Insurance plan listed second, the Ins Est column will always indicate 0, showing dental insurance estimates. To avoid this, ensure that the medical plan is listed first in the Family Module.
In the Edit Claim window, you can modify the Med/Dent and Claim Form settings. The default selection is based on the Claim Type and is used for e-claims to determine the format, either Dental, Medical, or Institutional. For e-claims, there are two formats: medical (837-P) or institutional (837-I). The default is medical, but you can change it to institutional when using medical insurance. This setting can also be adjusted for individual claims.
When submitting e-claims, there are a few complexities to consider. Each e-claim consists of loops, segments, and elements, and it is important to ensure that your practice address includes the full 9-digit zip code in your Open Dental database. Additionally, monitor your reports for dropped claims or other issues. Keep in mind that there are limits to the number of procedures that can be included in each claim, with dental and medical e-claims limited to 50 procedures, and institutional e-claims limited to 999 procedures.
If you need to resubmit a claim with updated information, set the Correction Type to Replacement and click Send after selecting the appropriate option. The Original Reference Number is required before sending a claim with a Correction Type of Replacement. Additionally, check the specific requirements of your state, as certain states, such as New York, have specific requirements for obtaining authorization for specific services.
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Frequently asked questions
Click on Setup, then Advanced Setup, then Show Features. Check "Medical Insurance" and Public Health. If the patient has never been a subscriber to an insurance plan, a blank insurance plan will open. Click New Plan and create a new plan or pick from the list of existing plans.
If the patient has been a subscriber before, the Select Insurance Plan window will open. Select the insurance plan from the list and click "OK" to add it to the patient.
In the Insurance Plan window, check the "Medical Insurance" box in the Plan Info tab. In the Other Ins Info tab, change the claim form to a medical claim form, typically "1500_02_12" (the updated HCFA 1500 form).
