ClaimPayments

Finalize insurance payments for claims. Per OpenDental API.

What are ClaimPayments in OpenDental?

ClaimPayments record insurance checks received for claims. When you get a check from insurance, create a ClaimPayment with CheckAmt, CheckNum, etc. First ensure ClaimProcs have Status "Received" or "Supplemental" and InsPayAmt set, and the Claim has ClaimStatus "R". CheckAmt must match the total InsPayAmt of eligible ClaimProcs. Use single POST for one claim, or Batch for multiple claims on one check. ClaimPayments attach to ClaimProcs and update patient balances.

SecDateTEdit (from date)

Returns payments edited on or after this date. Leave empty for all.

ClaimPaymentNum	CheckDate	CheckAmt	CheckNum	CarrierName	payType	IsPartial	Actions

Click Load to fetch claim payments.

Create Claim Payment (Single Claim)

Prior: Update ClaimProcs Status to Received/Supplemental and InsPayAmt, then update Claim ClaimStatus to "R".

claimNum *

CheckAmt *

Must match total ClaimProcs InsPayAmt for claim

CheckDate

Default today

CheckNum

BankBranch

DateIssued

Date on the check

ClinicNum

CarrierName

PayType (Category 32)

PayGroup (Category 40)

Note

Result:

Create Batch Claim Payment

Finalize multiple claims with one check. claimNums: comma-separated (e.g. 2547,2568,2591).

claimNums *

Comma-separated ClaimNums

CheckAmt *

If different from total, marked partial

CheckDate

CheckNum

BankBranch

DateIssued

ClinicNum

CarrierName

PayType

PayGroup

Note

Result:

Search & Update ClaimPayment

ClaimPaymentNum

CheckAmt

CheckNum

BankBranch

CarrierName

PayType

PayGroup

Note

ClaimPayments - GET Response

GET /claimpayments?SecDateTEdit=yyyy-MM-dd HH:mm:ss. SecDateTEdit optional; returns payments edited on or after that datetime. Per OpenDental API.

{
  "ClaimPaymentNum": 5822,
  "CheckDate": "2023-08-16",
  "CheckAmt": "300",
  "CheckNum": "2468657",
  "BankBranch": "Southwest Federal Bank",
  "Note": "",
  "ClinicNum": 3,
  "DepositNum": 9867,
  "CarrierName": "ODS Oregon Dental Service",
  "DateIssued": "2023-08-16",
  "IsPartial": "false",
  "PayType": 356,
  "payType": "Check",
  "SecUserNumEntry": 12,
  "SecDateEntry": "2023-08-16",
  "SecDateTEdit": "2023-08-21 13:00:37",
  "PayGroup": 451,
  "payGroup": "Lockbox 1"
}

Fields:

ClaimPaymentNum: Unique claim payment ID
CheckDate: Date the check was entered (yyyy-MM-dd)
CheckAmt: Amount of the payment
CheckNum: Check number
BankBranch: Bank and branch info
Note: Note for this payment
ClinicNum: Clinic (0 if not using clinics)
DepositNum: Deposit this payment is on (0 if not deposited)
CarrierName: Descriptive carrier name for reporting
DateIssued: Date the carrier issued the check (yyyy-MM-dd)
IsPartial: "true" if CheckAmt differs from total ClaimProcs InsPayAmt
PayType: definition.DefNum where Category=32 (Insurance Payment Types)
payType: Human-readable payment type (e.g. "Check")
SecUserNumEntry: User who created (0 = system)
SecDateEntry: Date created (yyyy-MM-dd)
SecDateTEdit: Last edited datetime (yyyy-MM-dd HH:mm:ss)
PayGroup: definition.DefNum where Category=40 (Claim Payment Groups)
payGroup: Human-readable group (e.g. "Lockbox 1")

Create Claim Payment - POST

POST /claimpayments. Finalize a single claim. Per OpenDental API.

Request Body:

{
  "claimNum": 3567,
  "CheckAmt": "567.42",
  "CheckDate": "2022-10-25",
  "CheckNum": "1234",
  "BankBranch": "124-85425",
  "Note": "Check was lost in mail, but envelope is dated appropriately.",
  "ClinicNum": 3,
  "CarrierName": "Great Insurance",
  "DateIssued": "2022-10-20",
  "PayType": 386,
  "PayGroup": 394
}

Fields:

claimNum: Required. FK to Claim.ClaimNum that is receiving the payment.
CheckAmt: Required. Amount of the check. Must match total of ClaimProcs' InsPayAmt for the claim.
CheckDate: Optional. Date entered (yyyy-MM-dd). Default today.
CheckNum: Optional. Check number.
BankBranch: Optional. Bank and branch.
Note: Optional. Note for this check.
ClinicNum: Optional. Default is Claim's ClinicNum.
CarrierName: Optional. Default from InsPlan attached to Claim.
DateIssued: Optional. Date on the check (yyyy-MM-dd).
PayType: Optional. definition.DefNum Category=32. Default first in Category.
PayGroup: Optional. definition.DefNum Category=40. Default first in Category.

Create Batch Claim Payment - POST

POST /claimpayments/Batch. Creates a batch insurance payment for multiple claims. Per OpenDental API.

Request Body:

{
  "claimNums": [2547, 2568, 2591],
  "CheckAmt": "350.35",
  "CheckDate": "2024-05-25",
  "CheckNum": "5678",
  "BankBranch": "124-85425",
  "Note": "Check was lost in mail, but envelope is dated appropriately.",
  "ClinicNum": 2,
  "CarrierName": "Greater Insurance",
  "DateIssued": "2024-05-10",
  "PayType": 386,
  "PayGroup": 394
}

Fields:

claimNums: Required. Array of ClaimNums receiving the payment, e.g. [1,2,3].
CheckAmt: Required. Amount of the check. If different from total InsPayAmt, marked as partial.
CheckDate: Optional. Date entered (yyyy-MM-dd). Default today.
CheckNum: Optional. Check number.
BankBranch: Optional. Bank and branch.
Note: Optional. Note for this payment.
ClinicNum: Optional. Default 0.
CarrierName: Optional. Default from InsPlan of first Claim in claimNums.
DateIssued: Optional. Date carrier issued payment. Default "0001-01-01".
PayType: Optional. definition.DefNum Category=32.
PayGroup: Optional. definition.DefNum Category=40.

Update / Delete Claim Payment

PUT /claimpayments/{ClaimPaymentNum}. DELETE cannot be used if payment is on EOB or deposit. Per OpenDental API.

PUT Request Body (all optional):

{
  "CheckAmt": "450.99",
  "CheckNum": "758946",
  "BankBranch": "124-85425",
  "Note": "Check was lost in mail, but envelope is dated appropriately.",
  "CarrierName": "ODS Oregon Dental Service",
  "PayType": 356,
  "PayGroup": 412
}

Fields:

CheckAmt: Optional. Payment amount. If differs from ClaimProcs total, marked partial.
CheckNum: Optional. Check number.
BankBranch: Optional. Bank and branch.
Note: Optional. Replaces existing note.
CarrierName: Optional. Descriptive carrier name for reporting.
PayType: Optional. definition.DefNum Category=32.
PayGroup: Optional. definition.DefNum Category=40.