Outstanding claims represent money your practice has earned but hasn't yet collected. Until these claims are paid, they occupy your accounts receivable and tie up working capital. The longer outstanding claims remain unpaid, the greater the cash flow strain on your practice and the higher the risk they become uncollectable. Effective tracking of outstanding claims in OpenDental is essential for maintaining healthy cash flow and ensuring that no claim falls through the cracks.

OpenDental provides several tools for tracking outstanding claims, each serving a different purpose. Claims aging reports identify which claims have been pending longest. Status tracking shows exactly where each claim stands in the insurance processing pipeline. Payment history and posting details reveal what has been paid and what adjustments have been applied. By learning to use these tools effectively, you create accountability in your claims process and accelerate collections significantly.

Understanding OpenDental's Claims Aging Report

The Claims Aging Report is your primary tool for identifying outstanding claims. This report displays all submitted claims sorted by how long ago they were submitted, typically grouped into aging buckets: 0-30 days, 30-60 days, 60-90 days, and 90+ days. Claims in the 0-30 day bucket are normal and expected—most insurance carriers take 14-21 days to process and pay. Claims aging beyond 30 days warrant investigation and follow-up.

To access the Claims Aging Report in OpenDental, go to the Reports menu and select Claims Aging. You can customize the report to show only claims from specific date ranges, specific insurance carriers, or specific providers. You can also configure the report to show totals by aging bucket, allowing you to see at a glance how much money is outstanding in each aging category.

Pay special attention to claims in the 60+ day aging buckets. These claims should be exceptional—the vast majority should be paid within 45 days. If you regularly have claims aging beyond 60 days, that indicates systemic problems: either claims aren't being submitted properly (so carriers never receive them), claims are being denied repeatedly without successful appeals, or you're not following up adequately on slow-paying carriers.

Tracking Individual Claim Status in OpenDental

Beyond the summary aging report, OpenDental allows you to examine individual claim status. In the Claims module, select any claim to view detailed information: which procedures and charges are included, the responsible insurance carrier, claim submission date, status indicators, any denial information, and payment received to date.

The claim status indicator shows you where the claim stands: submitted to carrier, pending carrier processing, paid, denied with reason, or pending additional information. This status information comes from remittance data transmitted by insurance carriers through clearinghouses. When a carrier processes your claim, they send back an explanation of benefits (EOB) indicating whether it was paid, denied, or requires more information. OpenDental receives this transmission and updates the claim status automatically.

For claims stuck in "pending carrier processing" for longer than expected (typically beyond 21 days), OpenDental allows you to add internal notes documenting your follow-up attempts. You might note "Called carrier 4/8, claim received but not yet processed, will call back 4/15" or "Sent updated documentation 4/10 per carrier request." These notes create a tracking record of your follow-up efforts and help ensure nothing falls through the cracks when multiple staff members handle claim management.

Identifying Slow-Paying Insurance Carriers

Some insurance carriers are systematically slower than others at processing and paying claims. This isn't intentional inefficiency—some carriers have legitimate processing delays due to volume or more stringent verification requirements. However, by identifying which carriers are slowest, you can adjust your follow-up strategies accordingly and potentially address systemic issues.

Create a custom report showing claims organized by insurance carrier, with average days to payment calculated for each. You'll likely discover that most carriers pay within 14-21 days, while a few consistently take 30-40+ days. For slow-paying carriers, you might implement more aggressive follow-up (calling after 14 days rather than 21 days) or work with your billing staff to understand the carrier's specific requirements and avoid common causes of delays.

For carriers with particularly poor payment timelines, consider whether the effort required to work with them is worth the revenue. Some very small insurance carriers (local plans with limited networks) might process so slowly that it's hardly worth the effort to collect. In these cases, you might accept the delay as unavoidable and focus your follow-up efforts on carriers where you can meaningfully accelerate payment.

Setting Up Outstanding Claims Monitoring Processes

Effective outstanding claims tracking requires a defined process, not just occasional review. Establish a weekly or biweekly routine where someone on your team reviews the claims aging report and identifies claims requiring follow-up. For claims in the 30-45 day range, a status check call to the insurance carrier often reveals whether the claim is progressing normally or has encountered issues.

Create a tracking system (spreadsheet, task list, or OpenDental note) documenting follow-up activities. When you call a carrier, document the date, who you spoke with, what information they provided, and what the next action is. This documentation prevents repeated calls to the same carriers asking about the same claims—your staff can see that the claim was already checked and is proceeding normally.

For denied claims, establish a process to understand the reason for denial, determine whether to appeal or resubmit with corrections, and then execute that action promptly. Denied claims sitting unaddressed for weeks don't benefit anyone. Prompt action on denials—either correcting and resubmitting within days, or appealing if you believe the carrier's decision was incorrect—accelerates recovery and prevents claims from aging unnecessarily.

Analyzing Outstanding Claims by Procedure Type

Different types of procedures have different payment cycles. Simple fillings typically process and pay quickly (10-14 days). Crowns take longer (14-21 days) because carriers often conduct additional verification. Dentures and implants take even longer (21-35 days) because of specialized processing. By understanding your practice's payment patterns by procedure type, you can better assess whether a claim's timeline is normal or problematic.

Generate reports showing average days to payment broken down by procedure type. You'll quickly identify which procedures consistently slow-pay versus which are quick. This information helps your staff prioritize follow-up (spending more time on delayed complicated cases while assuming simple cases are progressing normally) and helps you understand realistic payment timelines for different treatment types.

If you notice that a particular procedure type is consistently slow (for example, implant crowns taking 50+ days), investigate why. Is it a carrier-specific issue? Do those claims need better documentation? Is there a verification step you could expedite? By understanding the root cause of delays, you can address them systematically rather than accepting slow payment as inevitable.

Managing Claims Requiring Additional Information

Some outstanding claims aren't in limbo—they're pending because the insurance carrier has requested additional documentation or information. In OpenDental, claims requesting additional information are marked with a status indicating what's needed. Your job is to quickly provide that information and resubmit the claim.

Common requests include: missing treatment notes justifying the procedure, radiographs documenting the condition, pre-operative/post-operative photos showing the work performed, or predetermination information showing what the patient was told regarding coverage. When a carrier requests this information, respond quickly—the faster you provide documentation, the faster they can complete processing.

Create a process where requests for additional information are routed immediately to the appropriate person (clinical staff for patient records, imaging, or photos; administrative staff for predetermination details). The longer these requests sit unaddressed, the longer payment is delayed. Some carriers consider claims inactive after a certain period (often 90 days) and consider them abandoned if you don't respond. Prompt response prevents this outcome.

Using OpenDental Reports for Collections Optimization

Beyond the Claims Aging Report, OpenDental provides several other reports useful for monitoring outstanding claims. The Accounts Receivable Aging Report shows all outstanding amounts (both insurance and patient responsibility) organized by aging bucket. The Insurance Payment Summary Report shows how much has been paid by each carrier over a specific period. The Denial Summary Report aggregates all denials and shows which denial codes appear most frequently.

Review these reports monthly to understand your collections trends. Are total accounts receivable increasing, stable, or decreasing? Are any insurance carriers consistently underpaying (paying less than expected)? Are denial rates stable or increasing? Are specific denial codes appearing repeatedly? By analyzing these trends, you identify patterns requiring attention and areas where process improvements would have the greatest impact.

Some practices create a "collections dashboard"—a single report or spreadsheet that consolidates key metrics: total outstanding claims, average days to payment, clean claim rate, denial rate, total claims awaiting additional information, and total by aging bucket. This dashboard provides at-a-glance visibility into collections health and highlights areas needing attention.

Integrating with External Collections Partners

For practices wanting to enhance their outstanding claims tracking and follow-up, integrating with external partners like DayDream provides additional capability. DayDream automatically tracks all outstanding claims, identifies claims that haven't progressed according to expected timelines, and escalates them for follow-up. This automated tracking ensures that no claim falls through the cracks, even when your internal team is busy with other responsibilities.

DayDream's 7-day follow-up protocol on outstanding claims means claims receive systematic attention immediately when they start aging. Rather than waiting for a staff member to review aging reports and make follow-up calls, DayDream's system proactively addresses slow-moving claims. This aggressive follow-up accelerates payment significantly.

When integrated with OpenDental, DayDream's tracking data feeds back into OpenDental so your team maintains visibility. You can see that a claim is aging AND see the follow-up actions DayDream has taken. This integrated approach combines OpenDental's native transaction management with specialized collections expertise.

Establishing Outstanding Claims Management Accountability

Make someone on your team responsible for outstanding claims management. This person should review aging reports weekly, identify claims requiring follow-up, make necessary calls to carriers, document all interactions, and escalate problematic claims for management attention. By concentrating responsibility, you ensure consistent attention rather than having claims management fall through the cracks when everyone assumes someone else is handling it.

Establish performance targets for your practice's collections. What's your goal for average days to payment? What percentage of claims should be paid within 30 days? What's your acceptable denial rate? When you have specific targets, your collections manager can track progress toward those targets and adjust processes to improve results.

Review outstanding claims metrics monthly with your management team. Celebrate when aging decreases or days to payment improve. Problem-solve when claims aging increases or denial rates spike. By treating collections as a priority and holding someone accountable for results, you drive significant improvements in cash flow and profitability.

Conclusion: Outstanding Claims Require Active Management

Tracking outstanding claims in OpenDental requires using the software's reporting tools effectively, establishing defined processes, and maintaining accountability for collections. By reviewing aging reports regularly, tracking individual claim status, identifying slow-paying carriers, and promptly addressing claims requiring additional information or appeals, you keep claims progressing toward payment and minimize accounts receivable aging.

For practices seeking maximum results, combining OpenDental's native tracking capabilities with external collections support like DayDream creates a comprehensive system. Your team handles transaction entry and initial tracking in OpenDental, while DayDream manages the specialized collections work—advanced verification, claim scrubbing, aggressive follow-up, and denial appeals. Together, they transform collections from a frustration into a controlled, efficient process.

Ready to accelerate your claims collections? Explore how DayDream's tracking and follow-up systems integrate with OpenDental to ensure no claim falls through the cracks. Learn more about comprehensive billing services that complement OpenDental's capabilities, or discover specialized claims processing designed to maximize your collections.