Set Up Payments and Automatic Billing

For offices using FlexPayments powered by Stripe. 

Legacy Payments users may notice differences in functionality, layout, terminology, and workflow steps.

This guide will walk you through important settings needed to enable in-office payments in Flex, set up billing preferences —including automation, find templates, and more.

⚠️Important Notes:

• In this guide, settings are grouped by function so you can quickly find related feature settings. Within each section, the steps follow the order they appear in your Flex settings. This layout is designed to help you complete a full set up or quickly update a setting for a fast, targeted adjustment. 
• Beneath setting titles in Flex are detailed descriptions of what to expect. When enabling payments features, read each description carefully to decide which preferences work best for your practice. 
• To enable or disable, select toggles to the right of each setting. Save changes in the bottom right.
• The Flex user must have permissions in Flex to access settings. To update user preferences, check out this guide before proceeding: How Do I Change User's Permissions?↗️

Accessing Settings

Once logged in as an Administrative user:

• Find and click Settings in the top left.
• In Flex Settings, choose FlexPayments or Payments, depending on your subscription.

In-Office Payment Preferences

1. Enable In-Office Payments
   • Use this setting to process credit card payments in Flex using:
     1. Your integrated Stripe terminal
     2.  A legacy 3rd party integrated terminal
     3. A stored card on file
     4. Manual entry
2. In-Office Payments Prompt for Signature
   • When processing credit card payments on your terminal, this setting prompts the patient to sign their name when making payment, if supported by the terminal.
3. In-Office Payments Prompt to Confirm Amount
   • Similar to the option above, when making a payment in office, the terminal prompts patients to confirm the amount before finalizing payment, if supported by the terminal.
4. Your Default Payment Terminal
   • For practices with more than one payment device, setting a default terminal keeps payment processing quick and easy. Set default payment terminals for each user when your practice has more than one payment device.
5. Allow Payments From Treatment Plan
   • This setting creates an option on the treatment plan to collect payment when presenting treatment financials. Toggle on if your team prefers to collect payment before treatment codes are set complete in Open Dental and if you plan to include patient account balances in treatment plan payments.
     • The section below, Statement and Billing Preferences, outlines additional treatment plan balance and payment options.

Statement and Billing Preferences

1. Use The Fee Billed to Insurance If it is Greater Than Your UCR
   • Enable this setting if you bill insurance at a higher fee than your UCR and you want patient statements to reflect the billed claim amount. This helps align statements with EOBs. If your billed fees are equal to or lower than your UCR fees, this setting can remain off.
2. Prompt For Payment of Balance on Treatment Plans
   • This setting includes the patient’s individual account balance in the payment prompt shown after they sign and submit the treatment plan. To include and collect the balance, Allow Payments From Treatment Plan must also be enabled.
3. Balance Prompted Will Be Family Balance
   • Use this setting if you prefer the family balance amount in the treatment plan payment prompt instead of the individual patient balance. This also requires Allow Payments From Treatment Plan to be enabled.
4. Store Credit Card Details on Statements
   • Turn this on to let patients save their card when paying a statement balance, making future payments faster.
5. Buy Now Pay Later (BNPL) Provider — Upcoming Release                                                                                                         Arriving in an upcoming update for offices using FlexPayments powered by Stripe.
   • For practices offering third-party financing through Klarna or Affirm, set your creditor here. Options will be included during treatment planning and on patient statements.
6. Log Statements In Practice Management System
   • When this setting is on, Flex records when electronic statements are sent. A line item is added to the patient’s account in Open Dental for each text or email invoice.
7. Statement Email Subject Line
   • Customize the subject line patients see in their inbox when a balance is due.
8. Edit Email Templates:
   • Edit Statement Email: This is the email patients receive when you send a statement by email. Click the ‘Edit Statement Email’ button to adjust the message to match your office’s tone.
   • Edit Statement Re-Sent Email: This template is used when a statement email is resent to a patient. Use the ‘Edit Re-Sent Statement Email’ button to modify the message to fit your follow-up style.
9. Edit Text Templates: To edit text and email message templates, use our guide here: Access Statement Message Templates↗️

Setup Automatic Statements and Billing

1. Automatically Resend Unpaid Statements
   • Turn this feature on to have Flex automatically send a follow-up invoice if a statement remains unpaid after a set number of days. The initial statement must be sent first. See below for related settings.
2. Statements Resend Limit
   • Use this field to set how many times Flex should automatically resend a statement.
3. Only Include Unopened Statements
   • When this is on, statements that have been opened but remain unpaid, will not be sent again. Most offices leave this off so unpaid balances continue to receive reminders.
4. Number of Days Before Resending Unpaid Statements
   • Set how many days Flex should wait before automatically resending a statement.
   • Notes:
     • Statement links remain active for 14 days. 
     • If the patient’s balance changes in Open Dental, Flex pauses the automatic reminders so the patient doesn't get an outdated bill. Simply send a new statement to reset the process.
5. Time of Day to Resend Unpaid Statements
   • Use the drop-down options to choose what time of day Flex should automatically resend unpaid statements on your behalf.
6. Send Automated Statements
   • Enable this setting to optimize your billing workflow using automatic statements.
   • Start by turning it on.                                                                                                                                                
   • Then click view settings and use the options to set billing preferences.
   • Available options are: 
     1. Include Family Credits: Use this toggle to skip statements for accounts with credits that offset the balance. If an overall family balance is $0.00 the patient will not receive a statement.
     2. Include patients with open claims: Turn this on to automatically invoice accounts even when insurance claims are still open.                                                                                                                             
     3. Billing Type: Choose which billing types to include in automatic billing. You create and manage these in Open Dental. For setup details, visit the Open Dental guide here: Definitions: Billing Types↗️
     4. Balance Age: Open the drop-down and choose which balance age range to include so you can target newer or older balances.                                                                                                                
     5. Last Statement: Use this drop-down to control how recently a Flex statement must have been sent before another invoice can go out.                                                                                                         
     6. Days: Select which days of the week automatic statements are sent.                                                        
     7. Patient Status: Limit automatic billing to specific patient statuses. These are managed in Open Dental, you can learn more in the Status, Gender, Position, and Relationships section within Open Dental's guide here: Edit Patient Information↗️.                                                                                                                  
     8. By: Choose how statements are delivered: text, email, or both.                                                                      
     9. Time: Set the time of day automatic statements are sent.                                                                                

Payment Posting Preferences

1. Online Payments
   • Choose which payment type Flex should use when payments processed outside of the terminal are posted to Open Dental. Payment types are set up and managed in Open Dental, see their guide here: Definitions: Payment Types↗️
2. In-office Payments
   • Select which payment type should be used in Open Dental for payments processed using your Stripe or 3rd party integrated terminal. To learn more about your payment types, view the Open Dental guide linked above, Definitions: Payment Types.
3. Provider to associate with payments
   • Automatic payments post to the provider tied to the procedure code. When taking an in-office terminal payment using the ‘charge card’ icon, you can choose not to allocate it to specific codes. This setting determines which provider receives those unallocated payments. To manage providers in Open Dental, check out their guide here: Provider setup in Open Dental↗️
4. Unallocated Overpayments Should Be Assigned to the Most Recent Procedure Code
   • By default, unallocated and overpayments are posted using the first in, first out posting method. Enable this setting to override that behavior, changing how those payments are applied.

With your settings enabled and preferences set, you are ready to start using FlexPayments powered by Stripe. Continue below for quick how-to guides and walkthroughs.

Upcoming Enhancements

Planned for users enrolled in FlexPayments Powered by Stripe.

• Surcharging: FlexPayments powered by Stripe users will be able to apply compliant credit card surcharges in accordance with applicable legal and card network guidelines. This enhancement helps practices offset processing costs while presenting surcharges clearly to patients and simplifying payment collection.

• By Now, Pay Later (BNPL) Financing with Klarna or Affirm: Patients will be able to view, apply for, and use financing directly from the Flex treatment plan. This enhancement helps reduce checkout friction, support patient affordability, and increase treatment acceptance.

• FlexSchedule Holds and Deposits: Currently available to legacy 3rd-party Payments users, this capability will soon be introduced for FlexPayments powered by Stripe users. Practices will be able to require an appointment deposit or capture a card on file during online booking, with settings applied by appointment type to help secure scheduled time and reduce last-minute cancellations or no-shows. In addition to FlexPayments powered by Stripe, FlexSchedule must be included in your Flex subscription to utilize this feature. Learn more about online booking here: Schedule a Demo↗️

Next Steps

Explore the resources below to get started on taking payments, processing manual statements, and more.

➡️Taking Payments through the Charge Card icon

➡️Know the Difference: Using ‘Present’ and ‘Consent’ with Confidence

➡️How to Send a Statement in Flex

➡️Patients with Balance List

➡️Sending Bulk Statements Manually

➡️How to Set Up Recurring Payments in Flex

➡️How to Manage Recurring Payments in Flex

You are all set!

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If you have questions, please contact Flex Support.

Thank you!