ClaimProcs

Procedure-to-claim links, insurance payments. Per OpenDental API.

What are ClaimProcs in OpenDental?

ClaimProcs link each procedure to a claim—one ClaimProc per procedure on a claim. They store FeeBilled, InsPayAmt (what insurance paid), Status (NotReceived → Received), and ClaimPaymentNum (which insurance check applied). When you finalize a ClaimPayment, eligible ClaimProcs get attached. Use InsAdjust to record insurance benefit adjustments (insUsed, deductibleUsed). Use Supplemental to add supplemental payments to an already-received procedure.

PatNum

ClaimNum

ProcNum

Status

At least one filter recommended. Leave all empty to load (may return many).

ClaimProcNum	ProcNum	ClaimNum	PatNum	Status	FeeBilled	InsPayAmt	Actions

ClaimProcs - GET Response

GET /claimprocs?PatNum=x&ClaimNum=x&ProcNum=x&Status=x&ClaimPaymentNum=x. All params optional. Per OpenDental API.

{
  "ClaimProcNum": 1984257,
  "ProcNum": 1734730,
  "ClaimNum": 98567,
  "PatNum": 1337,
  "ProvNum": 7,
  "FeeBilled": 88.0,
  "InsPayEst": 88.0,
  "DedApplied": 10.0,
  "Status": "Received",
  "InsPayAmt": 78.0,
  "Remarks": "",
  "ClaimPaymentNum": 6352,
  "PlanNum": 12,
  "DateCP": "2021-02-16",
  "WriteOff": 0.0,
  "CodeSent": "D0330",
  "AllowedOverride": -1.0,
  "Percentage": 100,
  "PercentOverride": -1,
  "CopayAmt": -1.0,
  "NoBillIns": "false",
  "PaidOtherIns": 0.0,
  "BaseEst": 88.0,
  "CopayOverride": -1.0,
  "ProcDate": "2021-02-16",
  "DateEntry": "0001-01-01",
  "DedEst": 0.0,
  "DedEstOverride": -1.0,
  "InsEstTotal": 88.0,
  "InsEstTotalOverride": -1.0,
  "PaidOtherInsOverride": -1.0,
  "EstimateNote": "",
  "WriteOffEst": -1.0,
  "WriteOffEstOverride": -1.0,
  "ClinicNum": 2,
  "InsSubNum": 3,
  "PaymentRow": 1,
  "PayPlanNum": 0,
  "ClaimPaymentTracking": 0,
  "claimPaymentTracking": "",
  "SecUserNumEntry": 1,
  "SecDateEntry": "2021-01-26",
  "SecDateTEdit": "2021-02-16 09:43:17",
  "DateSuppReceived": "2021-02-16",
  "DateInsFinalized": "2021-02-16",
  "IsTransfer": "false",
  "ClaimAdjReasonCodes": ""
}

Fields:

ClaimProcNum: Unique claim proc ID
ProcNum: FK to procedurelog.ProcNum
ClaimNum: FK to claim.ClaimNum
PatNum: FK to patient.PatNum
ProvNum: Provider
FeeBilled: Amount billed to insurance
InsPayEst: Estimated insurance payment
DedApplied: Deductible applied to this procedure
Status: NotReceived, Received, Preauth, Adjustment, Supplemental, Estimate, CapClaim, CapComplete, CapEstimate, InsHist
InsPayAmt: Amount insurance paid
Remarks: EOB remarks from insurance
ClaimPaymentNum: FK to claimpayment (0 if not attached)
PlanNum: Insurance plan
DateCP: Claim procedure date
WriteOff: Amount written off
CodeSent: Procedure code sent to insurance
AllowedOverride, PercentOverride, CopayOverride, etc.: Use -1 for no override
ClaimPaymentTracking: definition.DefNum Category=36. Tracks payment rejection reason
SecUserNumEntry, SecDateEntry, SecDateTEdit: Audit fields
DateSuppReceived, DateInsFinalized: Supplemental/finalized dates
IsTransfer: Income transfer flag

ClaimProcs

ClaimProcs

POST (Create)

PUT (Add/Change)

ClaimProcs

POST (Create)

PUT (Add/Change)

ClaimProcs - GET Response

Fields:

Update ClaimProc - PUT

Fields:

InsAdjust - POST & PUT

Request Body:

Fields:

Create Supplemental - POST

Request Body:

Fields: