The Insurance Pending Procedures report provides a list of completed procedure codes that are not being billed to insurance, completed procedures that have not been submitted on a claim yet, as well as completed services with mismatched insurances.
This report shows real-time data and is available in two views: Summary and Detail View.
Competitor Reports
- Procedures not attached to Insurance, Primary Insurance not created, Secondary Insurance not created, Insurance Claims to process (Dentrix).
- Claims Not Sent Report, Procedures Not Billed (Open Dental).
Use Cases
Monitor completed procedures pending insurance submission or mismatches.
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 count of the Completed Services Not Billed to Insurance, the count of Completed Services with Pending Primary Claim Creation, and the count of Completed Services with Insurance mismatch along with their total UCR Fee and the Gross Production.
Let's explore the filters:
| No | Filters | Description |
| 1 | Conditions |
Select whether to generate data based on completed services that match one or more of the following conditions:
The insurance is considered mismatched if the patient's insurance hierarchy has been changed while they still have an active claim out. For instance, if the primary claim was already sent out to the patient's primary insurance (for e.g., Cigna), but then the patient's primary insurance plan was changed to something else (for e.g., Aetna). |
| 2 | Date Range (Max 1 year)* |
Choose to focus the report on services completed (DOS of code) within the selected date range. *By default, the date range will be for Today. |
| 3 | Location* | Choose to focus the report on codes with treatment locations in the selected locations. By default, the location will be the user’s default location. |
| 4 | Provider | Choose whether to focus your report based on the selected treatment provider(s). |
| 5 | Carrier | Choose whether to focus your report only on the selected carrier(s). |
| 6 | Insurance Plan | Choose whether to generate data based on the selected insurance plan(s). |
| 7 | Code | Choose whether to focus your report based on the selected procedure code(s). |
| 8 | Patient Flag | Choose whether to focus your report based on patients with the selected patient flag(s). |
| 9 | Patient | Choose to focus the report based on the selected patients. |
| 10 | Exclude do not bill to Insurance Codes | Select this option if you would like to exclude procedure codes with the billing order 'N' (do not bill to insurance). |
| 11 | Exclude Ortho Codes Attached to Payment Plans | Select this option if you would like to exclude ortho codes that are attached to Payment Plans. |
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 1 Treatment Location 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 Insurance Pending Procedures Report (Summary View).
- Location: The short name of the location.
- Conditions: Indicates whether the data pertains to completed codes that were not billed to insurance, are pending claim creation, or have an insurance mismatch.
- UCR Fee: The total UCR calculated from these procedure codes based on the office's standard fees according to practice settings.
- Gross Production (DOS): The total amount of production generated according to the patient and insurance payables at the time of code completion.
- Gross Insurance Production (DOS): Total dollar value of insurance payable for completed procedures (including fee updates and deletions), based on date of service. Exclusion: Migrated balances. (MSB codes) Inclusions: contracted Checked out code, membership production, and fee for service.
- # Procedures: The total number of procedure codes with the listed condition completed within the selected time frame.
Click the blue-colored entries to view more information on the corresponding entries.
The Detail View shows the patient-level details along with the Code, Patient ID, DOS, Patient, Billing Order, Claim Status, and Gross Production.
Let's explore the filters:
| No | Filters | Description |
| 1 | Conditions |
Select whether to generate data based on completed services that match one or more of the following conditions:
The insurance is considered mismatched if the patient's insurance hierarchy has been changed while they still have an active claim out. For instance, if the primary claim was already sent out to the patient's primary insurance (for e.g., Cigna), but then the patient's primary insurance plan was changed to something else (for e.g., Aetna). |
| 2 | Date Range (Max 1 year)* |
Choose to focus the report on services completed (DOS of code) within the selected date range. *By default, the date range will be for the current day. |
| 3 | Location* | Choose to focus the report on codes with treatment locations in the selected locations. By default, the location will be the user’s default location. |
| 4 | Provider | Choose whether to focus your report based on the selected treatment provider(s). |
| 5 | Carrier | Choose whether to focus your report only on the selected carrier(s). |
| 6 | Insurance Plan | Choose whether to generate data based on the selected insurance plan(s). |
| 7 | Code | Choose whether to focus your report based on the selected procedure code(s). |
| 8 | Patient Flag | Choose whether to focus your report based on patients with the selected patient flag(s). |
| 9 | Patient | Choose to focus the report based on the selected patients. |
| 10 | Exclude do not bill to Insurance Codes | Select this option if you would like to exclude procedure codes with the billing order 'N' (do not bill to insurance). |
| 11 | Exclude Ortho Codes Attached to Payment Plans | Select this option if you would like to exclude ortho codes that are attached to Payment Plans. |
| 12 | Exclude Codes with No Insurance Balance Due |
Select this option if you would like to focus only on codes with a balance. |
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 1 Treatment Location 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 - Detail View
Now, let's take a look at the results of the Refer In Report (Detail View).
- Patient ID: The system-assigned number used to identify the patients and their records. On clicking on the Patient ID, the user is taken to the completed procedures section within a patient's profile.
- Patient: The name of the patient.
- Code: The procedure code that was completed for this patient.
- D.O.S.: The date on which the patient was seen by their treatment provider for the completion of these services.
- Provider: The short name of the treatment provider that completed these services for the patient.
- Ins. Type: The type of insurance coverage, indicating whether it is dental or medical. Dental insurance takes priority over medical if both are available.
- Ins. Status: The status of this patient's insurance plan, such as active, pending verification, or terminated.
- BO: The billing order of the procedure code.
- Claim Type: The type of insurance claim, indicating whether it is a dental or medical claim.
- Claim Status: The current status of the claim associated with these services, such as Accepted, Rejected, or Resubmitted.
- Carrier: The carrier pertaining to this patient's insurance plan.
- Plan: The name of the patient's insurance plan as entered in your practice settings.
- Claim Carrier: The insurance carrier to which the claim was submitted.
- UCR Fee: The total UCR calculated from these procedure codes based on the office's standard fees according to practice settings.
- Gross Production (DOS): The total amount of production generated according to the patient and insurance payables at the time of code completion.
- Gross Insurance Production (DOS): Total dollar value of insurance payable for completed procedures (including fee updates and deletions), based on date of service. Exclusion: Migrated balances. (MSB codes) Inclusions: Contracted Checked Out Code, Membership Production, and Fee for Service.
- Balance Due Insurance: The remaining insurance balance against the code, after adjustments.
- Insurance Adjustments: The amount that is being adjusted from the Insurance Balance.
If users in your practice cannot use this report, please ensure that the relevant permissions are enabled.
To enable Permissions for the Insurance Pending Procedures Report:
- Navigate to the System Menu > Practice Settings > Administration > Profiles.
- Click Manage Permissions for the intended profile.
- Select Insights.
- Select the Generate Insurance Pending Procedures 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.