The Claims Report is used to track the claims that have been generated in the practice. This report lets the user know the claims that require attention, the claims that have been sent out and are yet to hear back from the carrier, the claims that have been rejected, and so on.
The Claims Report can be used to view the expected insurance production from each carrier for the claims sent out, the claim status, the outstanding balance, and so on. This report shows real-time data and is available in two views: Summary and Detailed View.
Competitor Reports
- Insurance Aging Report (Dentrix)
- Outstanding Claims Report (Eaglesoft)
- Outstanding Insurance Claims Report (Open Dental)
Use Cases
- Evaluate top carriers, number of claims, and total dollar value outstanding.
- Monitor insurance claims' status from submission to resolution.
Let's get started!
Navigate to the System Menu > select Operational Reports under Insights.
Click the + icon on the left or the Generate Report button on the right for the chosen report.
Explore below to learn more about the desired views, filter criteria, and results.
The Summary view shows the total outstanding dollar amount and number of all claims that have remained unpaid in different aging buckets. The users have the flexibility to group the report by either Carrier or Claim status which allows them to see outstanding amounts by each carrier or in each claim status like Acknowledged (Payor), Finalized (Payor), On Hold, and so on. Moreover, the user can also choose the Aging based On the Submitted date or the DOS of the claim.
Let us explore the filters:
| No | Filters | Description |
|---|---|---|
| 1 | Group by* |
Select this option to group your report on either Carrier or Claim status. When you choose to group by carrier, the report is based on each carrier, and the total outstanding dollar amount for claims sent to each carrier is divided into aging buckets. Similarly, when you choose to group by claim status, the report is based on claim status, and the total outstanding dollar amount for claims in each status is divided into aging buckets. |
| 2 |
Carriers list* |
This filter is only available when you group by carrier. Choose to view your report on either the top 10 carriers or all of the carriers in your practice. *The default will be the top 10 carriers. |
| 3 |
Date As* |
Decide whether to date your report results by Aging Days or Creation Date of the claim. If you choose to date as Aging date, then all claims other than the ones in closed status and voided status will be considered, and their outstanding amount will be grouped into corresponding aging buckets. If you choose to date as Created date, then you will have to choose the date range. Only claims that are created within the date range selected will be considered for the report. |
| 4 | Aging based On* | Select this option to choose the aging bucket calculation based on the date of submission of the claim or the DOS of the claim. |
| 5 | Aging Days | Select this option to choose whether to generate data based on claims that have been aging within the last 30 days, 31-60 days, 61-90 days, 91-120 days, or over 120 days. |
| 6 | Location* |
Select this option to focus the report on the claim's location. You can select up to 5 locations only. *The default location will be the user's default location. |
| 7 | Claim Status | Select this option to focus your report on generated claims currently in the selected status(es). |
| 8 | Claim Flag | Select this option to focus your report on generated claims with the selected claim flags. |
| 9 | Plan Types | Select this option to focus your report data based on the claims with the selected type of insurance plan, whether it is PPO, Medicaid, Co-Pay, and so on. |
| 10 | Carrier | Select this option to focus your report on only the claims with the selected carrier(s). |
| 11 | Provider | Select this option to focus your report on only the selected Billing provider(s). |
| 12 | Outst. Amount >=* | Focus the report on unpaid claims billed out for an amount that is greater than or equal to the dollar amount you specify here. |
Once you have selected the desired filters, click on the Generate button to generate your on-screen report or Download Report As button to download your report.
Generation/Download Criteria
- Due to data volume, reports with more than 5 Treatment Locations or a date range exceeding 3 Months will not be generated on-screen.
- Reports meeting these criteria will be accessible in the Scheduled Downloads section.
Result - Summary View
Now, let's take a look at the results of the Claims Report (Summary View).
- Location: The location associated with the claim.
- Carrier: The insurance carrier associated with the claim.
- Status: The current status of the claim.
- 0 - 30 (Count): The outstanding amount of claims that have remained unpaid for 30 days or less (along with the total number of these claims).
- 31 - 60 (Count): The outstanding amount of claims that have remained unpaid for at least 31 to 60 days (along with the total number of these claims).
- 61 - 90 (Count): The outstanding amount of claims that have remained unpaid for at least 61 to 90 days (along with the total number of these claims).
- 91 - 120 (Count): The outstanding amount of claims that have remained unpaid for at least 91 to 120 days (along with the total number of these claims).
- Over 120 (Count): The outstanding amount of claims that have remained unpaid for more than 120 days (along with the total number of these claims).
- Report Total by Carrier (Count): The total outstanding amount of all claims that have remained unpaid (along with the total number of these claims).
- Report Total by Status (Count): The total outstanding amount of all claims of a particular status that have remained unpaid (along with the total number of these claims).
- Report Total by Location (Count): The total outstanding amount of all claims of a particular status that have remained unpaid (along with the total number of these claims).
Click on the blue-colored entries to view more information on the corresponding entries.
The detailed view shows the patient-level details along with the Code, Patient ID, Date Of Service, Patient and Insurance Amount, etc., that contributed to the production towards the provider and location.
Let us explore the filters:
| No | Filters | Description |
|---|---|---|
| 1 | Date As* |
Decide whether to date your report results by the Aging Date or Created Date of the claim. If you choose the date as Aging date, then all claims other than the ones in closed status and voided status will be considered, and their outstanding amount will be grouped into corresponding aging buckets. If you choose the date as Created date, then you will have to choose the date range. Only claims that are created within the selected date range will be considered for the report. |
| 2 | Aging based On* | Select this option to choose the aging bucket calculation based on the date of submission of the claim or the DOS of the claim. |
| 3 | Aging Days | Select this option to choose whether to generate data based on claims that have been aging within the last 30 days, 31-60 days, 61-90 days, 91-120 days, or over 120 days. |
| 4 | Location* | Select this option to focus the report on the claim's location. You can select up to 5 locations only. *The default location will be the user's default location. |
| 5 | Claim Status | Select this option to focus your report on generated claims currently in the selected status(es). |
| 6 | Claim Flag | Select this option to focus your report on generated claims with the selected claim flags. |
| 7 | Plan Types | Select this option to focus your report data based on the claims with the selected type of insurance plan, whether it is PPO, Medicaid, Co-Pay, and so on. |
| 8 | Carrier | Select this option to focus your report on only the claims with the selected carrier(s). |
| 9 | Provider | Select this option to focus your report on only the selected Billing provider(s). |
| 10 | Outstanding Amount >=* | Focus the report on unpaid claims billed out for an amount that is greater than or equal to the dollar amount you specify here. |
| 11 | Columns* |
Choose the columns you wish to see in this report. *By default, all the columns will be selected. |
Once you have selected the desired filters, click on the Generate button to generate your on-screen report or Download Report As button to download your report.
Generation/Download Criteria
- Due to data volume, reports with more than 5 Treatment Locations or a date range exceeding 3 Months will not be generated on-screen.
- Reports meeting these criteria will be accessible in the Scheduled Downloads section.
Result - Detailed View
Now, let's take a look at the results of the Claims Report (Detailed View).
- Location: The location associated with the claim.
- First Submitted Date: The date the claim was first submitted to the insurance carrier.
- Last Submitted Date: The date the claim was last submitted (or resubmitted) to the insurance carrier.
- DOS: The date of service for the claim, indicating when the patient was seen by their treatment provider. If multiple procedure codes have different dates of service, the date of the first procedure code is used.
- Claim Aging Days: The number of days since the claim has been submitted and remains unpaid.
- Insurance Aging Days: The number of days since the completion of the code (date of service) linked to the claim. In case of multiple codes, the date of service of the earliest completed code is considered.
- Claim ID: The system-assigned number used to identify the unique claim that has been generated.
- Patient Name: The name of the patient.
- Patient ID: The system-assigned number used to identify this patient and their records. On clicking on the Patient ID, the user is taken to the claims tab within the patient's profile.
- D.O.B: The patient's date of birth as specified in their patient profile.
- Subscriber: The name of the subscriber listed on the patient's insurance plan.
- Subscriber ID/SSN: The subscriber's ID or social security number used to identify the subscriber and their coverage.
- Service Type: The type of dental services provided to the patient.
- Billed Amt.: The amount billed to insurance based on the total UCR fees of the procedure codes included on the claim.
- Ins. Amt.: The expected insurance receivable for the procedure codes included in the claim.
- Ins. Paid: The amount the insurance carrier has paid towards the claim so far.
- Paid Date: The transaction date of the latest payment transaction applied to the claim.
- Outst. Amt.: The amount that remains unpaid on this claim.
- Claim Status: The current status of the claim.
- Claim Flag: The latest flag tagged against the claim.
- Mode: The method by which the claim was submitted, whether electronically or by paper.
- Claim Order: The order of the claim, indicating whether it was the primary medical or primary dental claim, etc.
- Provider: The short name of the treatment provider associated with the procedures included in the insurance claim.
- Provider TIN/NPI: The treatment provider's unique identifier number used to distinguish eligible clinicians.
- Carrier: The insurance carrier associated with the claim
- Carrier ID: The carrier identifier number used to route an electronic claim to the correct insurance carrier.
- Phone Number: The phone number used to contact the insurance carrier, as entered in the insurance details in your practice settings.
- Group Number: The group number used to identify the patient’s insurance plan.
- Plan Name: The name of the plan under which the patient has insurance coverage.
- Plan Type: The type of insurance plan, such as PPO, Medicaid, Co-Pay, etc.
- Remarks: The most recent remarks included on the claim.
- Last Updated On: The date the claim was last updated.
- Last Updated By: The user who last updated the claim.
Click on the blue-colored entries to view more information on the corresponding entries.
If users in your practice cannot use this report, please ensure that the relevant permissions are enabled.
To enable Permissions for the Claims Report:
- Navigate to the System Menu > Practice Settings > Administration > Profiles.
- Click Manage Permissions for the intended profile.
- Select Insights.
- Select the Generate Claims Report option under Operational Reports to enable the permission.
- Click Save.
- On the Confirm Action modal that appears, click Yes to proceed.
- A toast notification appears on the top right stating, 'Profile updated successfully'.
Practices can use this comprehensive guide to efficiently generate reports, explore various use cases, and apply the necessary filter criteria to generate the desired report. Following this guide will help you create reports quickly, understand the different views available, and customize reports to meet specific needs.
Click here to explore the complete list of permissions and their descriptions.