Hi Open Dental Team,
We're integrating with the Open Dental API to automate insurance payment posting from EOBs, and we'd like some guidance on the intended workflow.
Our current workflow is:
Parse the EOB.
Match each claim to the corresponding claim in Open Dental.
Receive the claims by updating the appropriate ClaimProcs.
Create a Batch ClaimPayment for the check/EFT.
Attach the EOB PDF to the ClaimPayment.
This works well when all claims on the EOB can be received successfully.
Our question is about the following scenario:
An EOB contains multiple claims. For example:
Claim A – ready to receive
Claim B – ready to receive
Claim C – requires manual review before it can be received
Our customers would like Claims A and B to be posted immediately, while Claim C remains pending until they review it. That review may happen days or even weeks later.
Since there is only one physical check/EFT for the entire EOB, we're unsure what the recommended Open Dental workflow is.
Would you recommend:
Creating a single ClaimPayment for the full check/EFT amount, attaching only the ClaimProcs that are ready, and then attaching the remaining ClaimProcs later by updating their ClaimPaymentNum once they have been received?
If so, is this the intended use of partial ClaimPayments?
Specifically, we'd like to confirm:
Is it acceptable for the CheckAmt on the ClaimPayment to equal the full check/EFT amount even though the sum of the attached ClaimProcs is temporarily less until the remaining claims are received?
Can a partial ClaimPayment remain in this state for days or weeks while claims are under manual review, or is it expected that ClaimPayments are finalized immediately?
Will this workflow behave correctly with Open Dental's reporting, reconciliation, deposits, and accounting, or do you recommend a different approach?
Our goal is to follow the intended Open Dental workflow rather than just what is technically possible.
Thank you!