How to Work a Dental Insurance Aging Report: Three Lists, Not One

Three lists, not one: never sent, sent and not paid, denied and parked

Each list has its own report, its own cause and its own owner’s question. In Open Dental the reports exist by these names; other systems carry equivalents under different names, and the PMS trainer or support line can point to them.

• Never sent. Open Dental’s Procedures Not Billed to Insurance report lists procedures with an outstanding insurance estimate that are not attached to a claim, and its manual says every procedure on it should either be billed or marked not to bill. The Claims Not Sent report lists claims created but without a status showing they were sent. The question for this list: why did it leave the office without a claim?
• Sent and not paid. Open Dental’s Outstanding Insurance Claims report tracks claims sent but not received, lets the office assign each claim to a user, and records a custom tracking status and error code per claim. This is the list the follow-up calls are for. The question: what is the status, and who has the next step?
• Denied and parked. No standard report collects these, which is why they hide. They live in the remittances: lines with a denial reason code that were posted, adjusted off or left waiting for an attachment. The question: was each one corrected, appealed or closed on purpose, and by whom?

One button deserves a line in the office’s written procedure. Open Dental’s Outstanding Insurance Claims report has a Zero Claims function, limited to users with the Security Admin permission, that marks the selected claims received with no payment and $0 write-offs; the manual warns that it does not prompt for secondary claims. Used to clear dead claims after research, it is housekeeping. Used to shorten a report, it moves money off the aging without collecting it.

Which date starts the clock on an insurance claim

An aging bucket is only as honest as the date it counts from. Open Dental’s Outstanding Insurance Claims report lets the Days Old filter run from Date Sent, the date the claim was last sent; Date Sent Orig, the date it was first sent; or Date of Service. The manual notes that DateSent changes when a claim is re-sent. A claim sent in March and re-sent in June ages from June on the first setting and from March on the second, so a re-send can make an old claim look new.

Use each date for its own question. Date of service answers the filing-limit question: each plan sets a time limit for filing in its documents or the network contract, and when it has passed the remittance carries CARC 29, “The time limit for filing has expired.” The original send date answers the follow-up question: how long the plan has had the claim. The last send date answers almost nothing on its own, and a report sorted by it will hide the claims that have been re-sent the most.

Dollar amounts need the same care. The Amount column on Open Dental’s outstanding-claims grid is the total fee billed to the carrier, and the manual cautions that it is not the insurance estimate and should not be used to determine outstanding insurance payment amounts. For what is really owed, use the insurance estimate columns of the Insurance Aging Report instead.

How to work the insurance aging report each week

Working the list is a routine with a fixed day, a named owner and a written trail. A version that a front office of two or three people can keep:

• Clear the never-sent list first. Every procedure on the not-billed report and every claim on the not-sent report is either sent the same day or marked with the reason it will not be.
• Sort the outstanding claims by carrier, then by date of service, oldest first, so one portal session or one call covers several claims.
• Check status before calling. HIPAA names a standard claim status transaction, a provider’s inquiry and a plan’s response, at 45 CFR 162.1401, and 45 CFR 162.1402 adopts the X12 276/277 for it. Where the clearinghouse or the plan’s portal offers a status check, it answers the simple cases without a phone queue.
• Record the answer on the claim: a tracking status, the date, the person, any reference number from the call, and the next date to look. In Dentrix, claim status notes entered on the claim can print on the Insurance Aging Report; in Open Dental, the custom tracking status and error code show on the outstanding-claims grid.
• Send what is missing in the form the plan asks for: an attachment, a corrected claim, the primary plan’s EOB for a secondary claim. Do not re-send an unchanged claim to “restart” it; that is how duplicate denials start.
• Post every remittance the day it arrives, and finalize it. Open Dental keeps an Unfinalized Insurance Payments report for payments entered but not finalized; a payment that is not finalized leaves the claim looking open.
• Move every denial onto the denial log the day it is posted, with its reason code and remark code, so it leaves the aging only after someone decides what to do about it.

The owner of the list is one person, named, with protected time on the schedule for it. “Whoever has a minute” is how a list ends up worked only on slow days.

How do you work down a large 90+ day bucket on the insurance aging?

Work it down as a separate project with an end date, next to the weekly routine rather than inside it: pull every claim over 90 days by date of service, sort each one into a pile by what it needs next, and work the piles in order of deadline, then dollars. A large 90+ total can hold several different problems at once, and calling down the list oldest-first treats them all the same.

Keep the weekly routine running on newer claims while the backlog is worked, or a new 90+ bucket fills in behind it. For example, a practice that finds its largest pile is claims the plan has no record of has a sending problem, and the fix belongs on the never-sent list, not on the phone.

Add one line to the owner’s one-page weekly sheet for the backlog: claims and estimated dollars left in each pile. If a pile stops shrinking, give it a named owner and a date.

• Start from a clean list. Finish posting and finalizing the payments already received before anyone calls, so no one chases a claim that is already paid.
• Check status by carrier through the clearinghouse or the plan’s portal, and put each claim in one pile: no claim on file; missing information or an attachment (CARC 16 or 252 on the remittance); paid or denied but not posted; denied and still open to correct or appeal; past the filing limit (CARC 29).
• Hand each pile to the person who can close it: unposted remittances to whoever posts payments, missing records or attachments to the team that holds them, corrections and appeals to the insurance coordinator. The person who owns the list tracks the piles and the dates.
• Park claims that are waiting on the plan. In Open Dental, each Claim Custom Tracking status can carry a Days Suppressed number that keeps a claim off the Outstanding Insurance Claims report for that many days after the status is set, so the list shows only claims due for a next step.

A one-page weekly sheet for the owner

The doctor or practice owner does not need the report itself, only a page that shows whether the three lists are shrinking. One line per list, the same lines every week:

• Never sent: count and dollars, and the oldest date of service on the list.
• Sent and not paid: count and estimated dollars in each age bucket by date of service, with the oldest claim named by carrier.
• No status note in 14 days or more: count. These are claims nobody is working.
• Denied this week: count by reason code, and how many were corrected, appealed or closed.
• Written off or zeroed this week: count and dollars, with the reason for each.

Illustrative example: a practice’s sheet shows 12 claims on the never-sent list worth about $3,000, 60 claims outstanding with 8 past 90 days by date of service, 15 claims with no note in two weeks, and 4 claims zeroed with no reason recorded. The first and last lines are the findings; neither appears on the insurance aging report.

When the missing denial log is the finding

If the practice keeps no denial log, the aging can look clean for the wrong reason. Denials get adjusted off one at a time, each for a reasonable-looking cause, and the total never appears anywhere. The check takes an hour: pull the adjustments and write-offs for a quarter by type, set them beside the remittance lines that carried a denial reason code, and see which denials were closed by an adjustment instead of a correction or an appeal.

What turns up there is the next fix list. Missing attachments point at the chair and the attachment habit; frequency denials point at verification; filing-limit denials point at the never-sent list. The companion guide on dental claim denial codes reads each code from the X12 list and traces it to the step where it starts.

When to keep it in-house, and when not to buy anything

If the three lists are short, every claim on the outstanding report has a note from the last two weeks, and the owner sees the one-page sheet weekly, the office has done the work; outside help would only repeat it. If billing is outsourced, the same sheet is a fair monthly request of the billing company, and it costs nothing to ask.

An outside look earns its fee when nobody can say how much money sits on the never-sent list, when claims have no notes, or when write-offs have no reasons. The Revenue Review takes two weeks; its first pass reads aggregate exports — aging, adjustments by type, claim counts and dates — not patient names, and it ends with a written report that prices each finding and a 90-day plan. Implementation is scoped and priced separately. A free 20-minute call is enough to tell whether it fits.