Patient State

This means a field in the patient’s address section is incomplete or missing, specifically the patient’s state. This pop-up will show up as soon as you save or mark the claim ‘waiting to send’ upon submission and should be addressed before clicking OK to send. If the claim is saved as Open Dental will reject the claim and will not allow electronic submission.

Secondary Subscriber Address, Secondary Subscriber City, Secondary Subscriber State, Secondary Subscriber Zip

This means that the subscriber of the insurance policy has missing fields in their address section. This specific example references the secondary insurance plan and this should be addressed before clicking OK when saving and sending the claim. If the claim is saved as, Open Dental will reject the claim and will not allow electronic submission.

Subscriber City, Subscriber State

This means that the subscriber of the insurance plan’s city or state is either missing or incorrect and because this pop-up comes up when the claim is marked ‘waiting to send’ it should be addressed before clicking OK. If the claim is saved as, Open Dental will reject the claim and will not allow electronic submission.

Patient Address,Patient City, Patient State, Patient Zip

This means that the patient’s address is incomplete and the city, state, and zip code are either missing or incorrect because this pop-up comes up when the claim is marked ‘waiting to send’ it should be addressed before clicking OK. If the claim is saved as, Open Dental will reject the claim and will not allow electronic submission.

Claim Relationship

This means that the patient’s insurance was entered incorrectly and there is an error with the subscriber relationship that was selected. Because this pop-up comes up when the claim is marked ‘waiting to send’ it should be addressed before clicking OK. If the claim is saved as, Open Dental will reject the claim and will not allow electronic submission.

Treating Prov FName

This means that the claim was not created and submitted under a billable provider and Open Dental recognizes that a doctors NPI/License number is missing because the provider selected is not a dentist, most likely resulting from a service in the claim that was billed under VDG in error. When a service is billed under VDG, it will change the treating provider in the claim field to VDG, which will cause a rejection. VDG is the correct billing provider, but the treating provider must be a dentist and the provider who treated the patient. This pop up will show up as soon as you save or mark the claim ‘waiting to send’ upon submission and should be addressed before clicking OK to send.

1. If the claim is saved as, Open Dental will reject the claim and will not allow electronic submission.
2. If the VDG service is not fixed, but the treating provider field in the claim is manually corrected, the claim will go through but the insurance and patient payments will be allocated incorrectly once payment is received.
   1. If the claim is pushed through, the A&B department will task the office to confirm the treating provider for any services billed incorrectly under VDG, and manual adjustments will be added to pay the correct provider. The goal is to have the provider issues resolved with steps 1 and 2, and also by checking the VDG provider report at the end of each day.

The whole claim needs reviewed to make sure that the VDG service is corrected and the billing and treating provider accurately reflects the provider who treated the patient.

Clearinghouse Sender Name, Clearinghouse Sender Phone, Clinic billing zip must contain nine digits., Clinic Pay To zip must contain nine digits, BillType, AdmissionType, AdmissionSource, PatientStatusCode, proc1-RevenueCode

This means that you tried batching services to a medical insurance policy on file and it’s rejected because Open Dental cannot electronically submit medical claims. This should be addressed before clicking OK when saving and sending the claim so you’ll want to review the commlog and see if the services you are trying to send are actually supposed to be billed to medical and if so, follow the medical submission protocol, OR check to see if the plan information in the family module is correct. Most times, the “medical insurance” box gets checked accidentally, and the plan is actually a dental plan. If the claim is saved as Open Dental will reject the claim and will not allow electronic submission.

Not allowed to send e-claims

This means that the insurance plan is set to “Don’t Send Claims Electronically” in the Open Dental insurance plan field. If this is correct, all claims will need printed and mailed but if it’s not correct, the insurance plan needs fixed and the electronic ID needs verified.

If the plan was accidentally changed to a medical plan in error and the medical insurance box was checked inside the plan info, you can fix the issue by unchecking that box. Once fixed, you’ll have to delete the claim that’s currently batched and create a brand new one once the plan has been updated. Unfortunately, updating or correcting that field will not automatically update the info in a claim that has already been generated.

This means that the patient has an optional ID in the Optional Patient ID field that needs removed. 

Open Dental and our clearinghouse don’t allow electronic submissions with information in this field. This must be removed when creating/submitting a claim.

This means that the attachment in the claim failed when uploading attachments and the picture below shows the “Attachments Sent” field is blank, indicating the attachment failed. The only way to fix this is to create and prep a brand new claim. 

 This means that a new plan was added to Open Dental and the ‘Release of Information’ box wasn’t checked.  

To fix this, check the appropriate box and resubmit the claim with a status note. 

This means that your DentalXChange password is invalid or needs reset. Please complete this process on the DentalXChange website and then task the A&B inbox. A&B will take care of updating the insurance password sheet as well as the clearinghouse links in Open Dental so claims and statements can be sent. 

This means that the attachment in the claim failed when uploading attachments and the picture below shows the “Attachments Sent” field is blank, indicating the attachment failed. The only way to fix this is to create and prep a brand new claim.