The Claims Dashboard: nothing gets stuck

Think of claims as a conveyor belt. Money moves from left to right, and your job is to make sure nothing gets stuck. Your billing coordinator works this dashboard daily; two buckets must hit zero by end of day, every day.

Every bucket on this dashboard is one stop on the same conveyor belt. Here's the whole life of a claim:

If your office walks out crowns as the crown ADA code on the day of prep and a custom code on the day of seat, Waiting to Send doubles as your unseated crowns manager: the crown claim waits for the seat before it goes out, so the bucket is a live list of every prepped, unseated crown.

If you do it the other way (custom code on prep, crown code on seat), you can't use it for that. Either way, anything waiting on attachments still sits in Waiting to Send.

The list of completed procedures with no claim. Every row is money the carrier hasn't been told about. Create the claim, get it out, same day as the work. The next three sections show exactly how to clear a row from this list in Open Dental.

Take a patient from the list and open their Account in Open Dental. Scan the ledger for the procedure: it will say (unsent) right next to the description. That's the row Smile Data flagged.

In this example, "Camera Images of Teeth (unsent)" is the flagged procedure. Notice the ledger below it: the primary claim already exists and is waiting to send, and the secondary claim sits on hold until the primary is received. That's what the finished state looks like once you've worked the row.

Double-click the procedure to open Procedure Info, then look at the bottom of the Financial tab. Two ways to clear it, and both count:

• It should be billed: create the claim (the New Claim button on the account toolbar). Done; it moves out of this bucket and into the claim pipeline.
• It should never be billed (a no-charge item, an in-house service, a courtesy): check Do Not Bill to Ins and save. The insurance row flips to an X in the NoBill column, and the procedure leaves the list for good.

First screenshot: the Procedure Info window with the Do Not Bill checkbox and the patient's insurance rows. Second: what it looks like after you check it, with the NoBill X set.

A patient with two insurances can show up on this list even though a claim exists. That happens when the claim was created for one insurance and not the other: the primary went out, the secondary never got its claim.

• If the secondary should be billed: create the second claim and place it on hold until the primary pays. You saw that state in step 1: "Sec Claim ... Hold until Pri received."
• If the secondary should not be billed: in Procedure Info, double-click the second insurance row in the Insurance Estimates grid. The Edit Claim Procedure window opens; check Do Not Bill to This Insurance in the top right and save. The primary claim is untouched; the secondary stops counting against you.

This is the fundamental step in claims follow-up, and we highly recommend it: it produces the highest ROI of any Smile Data report and it's the right way to follow up on your claims.

Go to Setup, then Definitions, then Claim Custom Tracking. Use our version (the statuses in the screenshot below) or build your own list of how you want claims tracked.

Days Suppressed is the whole point

The single most important column is Days Suppressed. That number is the snooze button: how many days a claim disappears from follow-up after you attach that status to it. A lot of offices set up the tracking statuses without Days Suppressed, which makes the whole thing useless. Make sure every status has it filled in. Our version: 7 day follow up = 7, 15 day = 15, 30 day = 30, Needs X-Rays = 30, Needs Narrative = 7, Waiting on EOB = 7, Rejected = 0, and so on.

When you actually follow up on a claim in Due for Follow-Up, here's the move that makes the system work:

• Open the claim, then open the Status History tab.
• Click Add.
• Choose a tracking status and enter your note (who you talked to, the reference number, what they said).
• Save.

You've just told the system: I followed up on this claim, it doesn't need to be touched for X days (the Days Suppressed on the status you picked). The claim moves out of Due for Follow-Up and back to In Process until the snooze expires. Your follow-up notes build a full history on the claim, so anyone can pick up where the last person left off.

Procedures Not Billed at 0. Claims Due for Follow-Up at 0. At the end of every single day.

That's the standard every dental office should run on. Nothing complicated: create or no-bill every procedure the day of the work, and touch-and-snooze every claim the day it comes due. We have seen the best results come from just following this simple rule.

The buckets as tabs, each with its worklist: patient, carrier, amount, dates, days outstanding. The daily routine for your billing coordinator:

• Start with Due for Follow-Up: the claims whose snooze woke up today. Call, add a status with your note, and it snoozes back to In Process.
• Then Procedures Not Billed: create the claim or mark Do Not Bill.
• Then clear Waiting to Send: attachments, narratives, X-rays out the door.
• Work by carrier: all your Delta calls together, then Cigna, then Aetna. You're already on hold with them anyway.

The service-to-payment picture: how many days each carrier takes from the date of service to the check, trended by year and broken down by carrier group. This report just shows you your trends; when you run the two-zeros standard above, this is where you'll see the results. When AR looks ugly, remember the order: start with claims; the patient balances behind bad claims are downstream noise.