Tuesday, November 10, 2015

How to Send Insurance Claims Electronically

Updated 7/18/2019

Sending claims electronically speeds up the process of getting the claim to the insurance company so that your office can get paid faster. When you use eClaims to send claims electronically, you can create the claims in Dentrix and send them electronically straight from Dentrix.

To send claims electronically:
  1. From the Batch Processor in the Office Manager, select the claims and attachments you want to send electronically. Click the Electronic Claims Submission button.

  2. Click the Selected Dental Claim Forms option and click OK to open the Validation Report dialog box.

  3. Dentrix eClaims performs checks on all the claims you are sending to help eliminate denials and rejections. After reviewing a claim, Dentrix eClaims assigns one of three statuses:
    • Validated: Dentrix eClaims has checked these claims and found no missing information. They are ready for submission. Note: Dentrix checks to make sure that all fields have been filled in, but cannot verify that the information is accurate. Inaccurate information can cause a validated claim to be rejected by the insurance carrier.
    • Warning: Dentrix eClaims has found a problem that could cause payment to be delayed. The report will list the specific problem that should be corrected (such as a missing Payor ID or missing attachments).
    • Rejected: Dentrix eClaims has found a problem with a claim that would cause the insurance company to reject the claim. The report will list the specific problems to be corrected (such as a missing subscriber number).
  4. If your claim is missing information that can be fixed without re-creating the claim, like subscriber address or subscriber ID number, the claim will have an Edit option available. Click the blue Edit link within the claim on the Validation Report to make changes to that claim.

  5. Click the tab for the information that needs to be fixed. (For example, if the subscriber ID is missing, you would click the Claim Subscriber tab and then enter the number in the appropriate field.) Click OK to exit the Edit Missing Claim Information dialog box. Your changes will be saved and the Validation Report will be regenerated.
  6. Once you have corrected errors and are ready to submit, click the Send Selected Claims button. After the claims have been submitted, Dentrix eClaims sends a copy of the Validation Report and a Transmission Report to the Batch Processor in the Office Manager.
  7. Review and fix any errors listed on the Transmission Report. Resubmit corrected claims.
    Note: You will need to wait 24 hours before resubmitted rejected claims.
  8. The delete the Sent claims and the Validation Report from the Batch Processor.

Some insurance carriers allow the submission of electronic claims in "real time." If a claim is submitted in real time, a response from the carrier will be returned immediately, updating the claim status in the Ledger to indicate that the claim has been accepted or rejected.

Not using eClaims? Get more information by reading Dentrix eClaims FAQ, or the 10 Reasons eClaims Mean Effective Insurance Management articles in the Dentrix Magazine online archive.

No comments: