How do I manage and reconcile insurance claims in Canada?
To open the claims management tool, go to the 'Claims Management' section (the shield icon) in the left-hand toolbar in Dentally.
Here you will see all your practice's claims:
When using the claim management tool:
You can choose for the claims to be sorted by invoice number, by treatment date or by date sent. Select your chosen order by clicking the relevant header at the top of the column.
Clicking the patient's name will open their patient record in a new window.
To complete bulk actions, select a claim by checking the tickbox to the left of it, then click one of the actions at the top. Choose from:
Add payments
Mark as reversed
Mark as manually submitted
Discard
Filters can be applied to the list using the filters at the top. After selecting filters, ensure you click 'Apply filters'. Choose from:
Date From/To
Insurance carrier
Claim status
Insurance status
Billing provider
How do I complete a reconciliation (or bulk reconciliation) in the claims manager?
If you receive payment from an insurance carrier which needs to be assigned to one or multiple patients:
In the claims management tool, filter the table by insurance carrier.
Check the tickbox against all of the payments you want to pay. If you tick the checkbox to the left of a payment, both primary and secondary will be selected. If there are options for primary and secondary, be sure to select/deselect the correct claim.
💡 Top tip: You can click on a claim (hover anywhere along the row and click) to open a side panel and see more details about the treatment.
Click 'Record payments'. If reconciling isn't appropriate for that particular claim(s), the 'Record payment' button will not be visible.
In the window that pops up, enter the amounts for each payment. If you adjust the amounts, the amount you set will be shown.
You can also select the pending payment, and add the payment method and transaction reference.
💡 Top tip: If there is an underpayment, the remaining amount will move to the patient balance, ready for you to collect. If there is an overpayment, then it will become a credit on the account.
When you are finished, click 'Record payment'.
This will then explain the payments to the corresponding invoice, and mark the claims as paid. If there is a remaining patient balance, this will show as due.
💡 Top tip: We recommend putting the cheque or deposit reference number as the transaction reference, so you can easily find it later.
How do I use the claims management tool to monitor claims that need attention?
Use the claims management tool to track insurance payments and make sure you are collecting payment.
On a monthly basis, we recommend reviewing older claims that you should have received payment on.
Use the treatment date filters to select the time period you would like to check eg the first to last day of a particular month.
Use the claim status filter to only show claims that are marked as 'Needs attention' or 'Pending'.
Review each claim and determine next steps. You can refine the search further - filter by insurance status and follow the recommended actions below:
Insurance status | Questions to ask | Action if yes |
Rejected | Was the invoice deleted and a new claim created? | Discard (we suggest leaving a comment about why you are discarding) |
| Was it not covered by insurance so the patient paid? (Invoice status is 'Paid'). | Discard (we suggest leaving a comment about why you are discarding) |
| Does it need to be resubmitted? (The invoice status will be 'Unpaid' and no other claims will be related to that invoice). | Determine why it was rejected or what the error was. Make the change and resubmit, or mark as manually submitted. |
Error | Was the invoice deleted and a new claim created? | Discard (we suggest leaving a comment about why you are discarding) |
| Was it not covered by insurance so the patient paid? (Invoice status is 'Paid'). | Discard (we suggest leaving a comment about why you are discarding) |
| Does it need to be resubmitted? (The invoice status will be 'Unpaid' and no other claims will be related to that invoice). | Determine why it was rejected or what the error was. Make the change and resubmit. |
Submit manually | Was the invoice deleted and a new claim created? | Mark as manually submitted, then mark as reversed. |
| Was it paid? | If there is a payment, then mark as paid. |
| Are you waiting on insurance to pay? | Follow up with insurance, leave a comment and mark as submitted manually. |
| Was it not sent? | Resend the claim manually, mark as submitted manually. |
| Was it rejected? | Discard (we suggest leaving a comment about why you are discarding) |
Submitted manually Acknowledged EOB received | Was it paid? | If there is a payment from insurance, then show as paid by using the 'Record payment' button and entering $0.00. Ensure the payment is properly explained. |
| Are you waiting on insurance to pay? | Follow up with insurance and leave a comment. |
| Was it rejected? | Discard (we suggest leaving a comment about why you are discarding) |