How to export claims data from Open Dental

What counts as claims data in Open Dental

Claims data is everything Open Dental holds about a claim once it exists. That means the claim and its status, its procedures, the payments posted to it, its tracking notes, attached EOBs, and the electronic transactions sent and received. In the API these are separate resources: Claims, ClaimProcs, ClaimPayments, ClaimTrackings, EobAttaches and Etranss, all readable under the "Read All" permission (Open Dental API permissions).

Most people who export claims data want one of three things:

1. A list of open claims to work, for a biller or an outside billing company.
2. A wider pull for reporting, such as every claim for one carrier over a date range.
3. A full open-claims list before a switch to or from Open Dental.

Sources: Outstanding Insurance Claims, User Query, Excel and ODBC, fees, Claims API, Queries API.

Open Dental claim report export: the Outstanding Insurance Claims report

This is the report to export for follow-up. Open Dental's Insurance Aging page says so directly: "Offices that want to ensure they are getting paid by insurance companies and want to follow up on older claims should use the Outstanding Insurance Claims Report instead" (Insurance Aging Report). It lists each claim and preauthorization, which is what a biller works from.

Steps, from the Outstanding Insurance Claims manual page and the Standard Reports page:

1. In the Main Menu, click Reports, then Standard.
2. In the Monthly section, click Outstanding Insurance Claims.
3. Set the filters: days old; date sent, original date sent or date of service; carrier; treating provider; clinic; assigned user; custom tracking status; error code.
4. Click Export. The manual says this exports "the list of claims and preauthorizations as a TXT or XLS file."

Open Dental insurance claims report options beyond outstanding claims

The Monthly group of Standard Reports holds the other claim and receivables reports, including Aging of A/R, Claims Not Sent, Insurance Aging, PPO Write-offs, Procedures Not Billed to Insurance, Receivables Breakdown and Unearned Income. The Lists group adds "ERAs Automatically Processed" (Standard Reports).

Two of these matter for claims work:

• Claims Not Sent lists claims that have been created but do not have a status showing they were sent (Claims Not Sent). The Outstanding Insurance Claims report tracks claims that have been sent but not received, so check this list too.
• Procedures Not Billed to Insurance lists procedures with an outstanding insurance estimate that are not attached to a claim (Procedures Not Billed to Insurance).

Use the Outstanding Insurance Claims export as the daily worklist, and these two as a weekly check that nothing is missing from it.

Open Dental data export with a User Query

When no standard report has the columns you need, a User Query reads the database directly with SQL and exports the result.

1. In the Main Menu, click Reports, then User Query. It can also be opened from Standard Reports.
2. Run a saved query, or write one if you have the permission.
3. Export the result. The manual lists two options: "Export.txt: Save the query as a tab-delimited text file. Export.csv: Save the query as a comma-delimited CSV file."

Source: User Query overview.

Permissions decide who can do this. The manual says "Users must have the User Query Admin permission to write, edit, run, save, and delete queries." Running a released query needs only the User Query permission. So one admin writes the query, and other staff run it once it is released.

Where the file goes: Open Dental's Excel page says a query export "will normally be saved as a text file in the OpenDentalExports folder on the local C: drive." The same page documents a direct ODBC link from Excel to the database. One limit to know: "Open Dental support technicians do not assist with Microsoft Excel spreadsheets" (Excel).

If nobody in the office writes SQL, Open Dental writes custom queries as a paid service. Its fee page says "Query requests are quoted before work is started based on a rate of $110/hour" (Open Dental fees).

Open Dental API claims: reading claims without exports

Exports are snapshots. Someone has to run them, and they go stale once saved. The Open Dental API removes that step for software that reads claims on a schedule.

The Claims endpoint. GET /claims returns a list of claims. The manual lists it as "Version Added: 22.2." Since version 23.3.11 it filters by ClaimStatus (U unsent, H hold until primary received, W waiting in queue, S sent, R received, I hold for in process) and by SecDateTEdit, the last time the claim was edited, and it also takes PatNum (Claims API). Filtering on SecDateTEdit lets a nightly job pull only the claims changed since the last run. Related resources (ClaimProcs, ClaimPayments, ClaimTrackings, EobAttaches, Etranss and the Aging report) are readable under the same "Read All" permission (API permissions).

The Queries endpoint. It runs a read-only SQL query and writes the result as a CSV file to an SFTP site. It was added in version 21.1. The manual says "Queries are screened to be read-only" (Queries API). This suits a team that already has a User Query it trusts and wants the same result delivered on a schedule.

What it takes to turn on, from API Setup and the API specification:

1. The office runs the eConnector. "In order to use the Remote API, the office must have an eConnector running."
2. The developer requests a Developer Portal key from Open Dental's vendor relations team. "Requests take one to three business days to process."
3. The office enables the API in API Setup.
4. The developer and the office put a BAA in place. "API developers should have a Business Associate Agreement (BAA) in place with their clients."

Open Dental does not list an API price on those pages or on its fee page, so ask the vendor that connects to it what the office will pay.

Exporting claims before a switch

If an office is moving onto Open Dental, export the open claims from the old system first. Open Dental's conversion page says "Most final conversions do not convert outstanding claims." Conversions from EZ Dental and Dentrix bring over outstanding primary claims, but not secondary claims. Its instruction is: "First, print an outstanding claim report from the old software (as of the final conversion date)," then recreate each claim in Open Dental (Open Dental conversions).

The same advice applies in reverse. Before leaving Open Dental, export the Outstanding Insurance Claims report as of the cutover date, and keep it until every claim on it is paid or closed. For the other common systems, see how to export claims data from Dentrix and how to export claims data from Eaglesoft.

Is an export the right tool for you?

An export fits when:

• One person works claims for one office, and a weekly list is enough.
• You need a one-time pull, such as a switch or an audit.
• The question is a report, not a daily worklist.

An export stops fitting when a billing team works claims for many offices, each on its own copy of Open Dental, or across several systems. The export becomes a daily job, and the results still have to be typed back into each office's software. At that point, reading claims through the API and writing answers back makes more sense. How a billing company works across several practice management systems covers that setup.

How Daybook writes back to Open Dental

Daybook Health runs agents for dental billing companies, the billing offices of dental groups and the software vendors that serve dental offices. Open Dental is one of the practice management systems Daybook writes back to. The others are Dentrix, Eaglesoft, Curve, Denticon, Sensei and tab32.

By morning the answers are on the claims, in the system each office already uses. Every unpaid claim gets a 276 overnight, and the 277 answer lands on the claim in plain words, with the denial reason and the next step. Remits are pulled, proven to the cent and matched to their claims line by line. Anything that does not balance is held for the posting lead to decide, and billers make every call on appeals, write-offs and posting. How claim data gets written back to a dental practice management system explains what lands where, and AI claim status for dental offices covers the service itself.

Daybook works through billers and software vendors, not with individual practices. Pricing is usage-based, with no subscriptions and no seats.