Insurance Processing
Generating Pre-Authorizations
- How are Preauths sent electronically when the 'E-claims' button is grayed out?
- My patient wants to know how much the insurance carrier will pay for treatment we propose. How do I generate a pre-authorization claim?
- I've tried to generate a pre-authorization claim, but I can't seem to get one to generate. What could cause this?
- When we try to generate a pre-authorization, the “Pre-Authorization Detail” screen is blank. What’s wrong with our patient’s treatment plan?
- When we try to generate a pre-authorization, we get an error message “one of the selected treatment has no billing order.” What’s wrong with our patient’s treatment plan?
- I need to pre-authorize a procedure for a supernumerary tooth. I cannot input a supernumerary tooth number. How can I generate a pre-authorization for a supernumerary tooth?
Updating Pre-Authorization Information
- How can we enter in a preauthorization number in Box 2 of the ADA claim form?
- How do I quickly identify the status of a Pre-Authorization?
- We have the insurance company’s pre-authorization determination. How are we able to locate a patient’s pre-authorization claim for updating?
- An insurance carrier has returned its estimated coverage for a pre-authorization (pre-auth) claim. How do we update the estimated coverage amount in Denticon? Are we able to update the pre-authorization (pre-auth)?
- I have a completed pre-authorization claim, and the patient wants to have the treatment performed. How do I link the pre-authorization claim and the appointment?
Preparing Claims
- We have the billing provider set up correctly in our provider setup. The correct treating provider is entered on the ledger. Why is the billing provider's information showing under the treating provider in box 53 of the claim form?
- We have claims that are rejecting through Dental Exchange due to the Taxonomy number not matching. Where in Denticon do I enter each providers Taxonomy number?
- We have a claim for a patient that's printing on separate pages for the same provider. Is there a way to combine the same codes onto one line item on the claim form?
- A patient called the office and provided us with new insurance information to rebill the outstanding claims to the new carrier. How can we quickly rebill the open claims to the new carrier?
- How do I prepare an insurance claim?
- What is the difference between the “Save” and the “E-Claim” button in the claim generation screen?
Correcting Information on Claim
- We created a claim in Denticon but when we sent the claim to DentalXChange the responsible party shows as the patient on the claim. Why?
- We entered procedures before insurance was attached to the patient. How do we change the billing order?
- How do we change the billing order on procedures that were entered on the ledger, prior to the insurance being entered?
- At the time of service the patient stated there was no insurance coverage. Now they've discovered they do have coverage. How do I submit the claim?
- We saw a patient and they stated they had no insurance coverage. Now they report they do have insurance and that I should submit a claim. We've already sent statements, and closed out. How do we submit a claim?
- Our office realized we missed posting a procedure for a patient’s visit. We entered the procedure today. The claim has today’s date for the Date of Service instead of when we really did it. How do we file a claim for the correct Date of Service?
Claim Information (Narratives, Attachments)
- Adding additional attachments to claim in Denticon
- How does the integrated "Claim Attachment' feature work?
- In Box #35 on the ADA claim form, are we able to go into the claim form & type comments in that area?
- How may our office utilize the 'Real Time' claim status feature?
- We need to supply a periodontal chart as an attachment to our e-claim. How do we attach a periodontal chart to our claim?
- How does Denticon and DentalXChange recommend to handle claims which need attachments?
Generating Electronic Claims
- Can't attach an xray to a claim. How can I fix this?
- Change Healthcare Contact information
- An insurance claim for our patient has an attachment that may be required by the insurance carrier – xray, periodontal charting, etc. What is the best protocol for submitting an attachment?
- How do I check on the status of my claims I sent electronically?
- How do I send a claim electronically?
- How does the Denticon and DentalXChange integration work?
Electronic Submissions
- Does DentalXChange provide e-claims training?
- Our office just signed up for eclaims processing, and have a DentalXChange account. How am I able to update Denticon with the DentalXChange username and password?
- Sometimes we need to contact DentalXChange for assistance. How can we contact DentalXChange?
- We get an error message that says “Error Authenticating Eclaims [3]” on the Utilities/Batch Claims Processing screen. How can we correct our changed DentalXChange password in Denticon, on our own?
- I can't transmit an eclaim. I'm not sure what is missing when it says "record missing" when I try to send the claim from the batch electronic claims screen.
- When we send our claims to DentalXChange for processing, we see various status messages on claims. What are the status messages used on the DentalXChange website?
Submissions
- Is it necessary to batch claims in the “Batch Claims Processing” screen?
- How do I get my claims together for submission, either by printing or e-claiming?
- We want to ensure that our billing information will correctly print on claims. How can we create a test claim to see if the insurance billing provider and treating provider info is correct?
- Our office has several dentist providers. We need to make sure the correct dentist is listed as the Billing Provider on the insurance claims. How do we define the Insurance Billing Provider for our office?
- Where is the license number in Box 50 of the ADA claim form determined in our setup?
- How do I print a single claim rather than E-Claim?
Re-Submissions
- An insurance carrier is requesting more information for a procedure submitted within a claim (x-rays, perio-chart, narrative). How can we resubmit the claim to the carrier for a specific procedure and not all procedures?
- How do we re-create an electronic claim for re-sending to the carrier?
- How can I electronically resubmit a pre-authorization claim?
- My patient indicated at the appointment there was insurance with carrier A. Now my patient tells me there is insurance with carrier B. How do I re-submit the claim to carrier B?
- How can I resubmit or reprint a pre-authorization claim?
- I’ve sent a claim via electronic means, but now I need to print the claim and mail to the insurance carrier. How do I print a claim?
Medical Setup
- Our office bills medical carriers for certain procedures, e.g., oral surgery codes. What are the steps involved in setting up our account for submitting medical claims?
- We need to submit claims to medical carriers for certain procedures, e.g., evaluation codes. How do we cross-reference the dental and the medical codes?
- We need to submit claims to medical carriers for certain procedures, e.g., evaluation codes. How do we cross-reference the medical codes to the medical diagnosis codes?
- We need to submit claims to medical carriers for certain procedures, e.g., evaluation codes. How do we setup medical ICD (diagnostic) codes?
- We need to submit claims to medical carriers for certain procedures, e.g., evaluation codes. How do we setup medical ICD-10 (diagnostic) codes?
- We need to submit claims to medical carriers for certain procedures, e.g., evaluation codes. How do we setup medical modifier codes?
Medical Claims
- Our office desires to do e-claims for medical billing. What are the steps involved?
- Our office is interested in medical billing. What are the costs involved?
- How are we able to know if our office is setup to electronically submit medical claims?
- We need to submit claims to medical carriers for certain procedures, e.g., evaluation codes. How do we charge the patient and make a claim?
- Our office uses medical e-claims, and have a question about our account. How are we able to get help?
Carriers
- How do I add an insurance carrier?
- How do I change an insurance carrier’s information (address, phone)?
- We entered a new insurance carrier, and indicated the carrier for “paper claim” because the carrier did not have an electronic portal for claims. The carrier now does have an electronic Payer ID. How do we correct the carrier’s information for a payerID?
- How do I delete an insurance carrier?
Payer IDs
Plans
- How do I add an insurance plan?
- As our office sets up a new insurance plan, what are the critical items that must be considered?
- When I look at the dental carrier listing, the carrier is there. However, when I search for the plan, I can’t find it. What is wrong?
- When we add a “regular” insurance plan, we see there are two different types for selection: Indemnity, and PPO. How are they different?
- When we set up an insurance plan, we notice an option for “Notice of authorization (NOA) Only.” How is this used?
- How are insurance categories related to the ADA Codes?
Updating Plan Information
- Is there a way to edit a locked plan?
- The benefits for a plan have changed for all employees. Can I make changes to the insurance plan – changes in benefit anniversary date, in benefit coverage, in benefit maximum and deductible amounts?
- We have patients attached to an insurance plan and noticed the plan information is different than it should be (different carrier/group#/employer). What is the best way to make changes to this plan?
Attaching Plan to Patients
- Can I attach an insurance plan to a patient after I entered the patient’s information?
- How do I attach an insurance plan to a patient while entering the patient’s information?
- How do I attach an insurance plan to additional family members?
- We have two family members with the same insurance plan but are self-subscribers to the plan. How can I assign the plan to each family member with different subscriber information?
- Our office utilizes family accounts, so multiple family members are assigned to one Responsible Party. Each member of the family has the same insurance plan, but each is supposed to be a self-subscriber. How do we assign the plan in this scenario?
- We have patients who have insurance plans with which we do not participate. Therefore, these patients pay for all services at the time of service. How does Denticon recommend we handle plan like this?
Changing Plans on Patient Record
- We converted and see an insurance plan that says we can’t delete it. How do we put the correct insurance plan on the patient’s record?
- How do I make a patients’ secondary insurance their primary?
- I accidently put in a patient's secondary insurance as the primary plan, and need to change it. I need to add the correct primary insurance to the patient’s record. How do I change a patient’s primary insurance to secondary?
- My patient has an insurance plan attached to the record. The patient’s insurance plan has changed to a different plan. What’s the best way to change the plan information?
- My patient has a new insurance plan; they switched carriers. The system says I can’t delete the old plan because there are outstanding claims. How do I attach a new plan to my patient?
- Our patient has changed insurance plans. We’ve attached the new insurance plan to the patient’s record. Is there a way to know all the insurance plans that have been attached to an account?
Understanding Managed Care/Capitation Plans
Fee Schedules for Managed Care Plans
Medicaid Patients
Default Insurance Coverage
- How can we add a new insurance category for a plan that does not follow the standard percentage coverage table in the insurance plan setup screen?
- When I enter an insurance plan, I notice there are various categories for plan percentages. Also, the percentages always show the dental insurance standard of 100/80/50. How can I change the entries and/or the default percentages?
- When I enter an insurance plan, I notice there are various categories for plan percentages. Also, the percentages always show the dental insurance standard of 100/80/50. Where is this information obtained?
Fees Charged on Claims
- The fees are not coming up correctly in my patient transactions. Why aren’t the fees calculating correctly?
- Tell me about the relationship between the fee schedule and the insurance plan. How does the fee schedule and insurance plan work together in Denticon?
- When I set up an insurance plan there’s a field indicated as “Fees to print on claims”. What’s the difference between the choices – Office UCR fees and Actual Charges?
- I’ve entered an insurance plan that has a PPO carrier. This carrier has a fee schedule. How do I enter the PPO fee schedule and how do I attach it to the carrier?
- One of my insurance carriers – example: Blue Cross Blue Shield FEP (Federal Employee Program) – has two fee schedules, one for ages to 13 and another for ages over 13. How can I make sure the patient gets the charged the correct amounts?
- How do we enter in a deductible?
Smart Fees on Plans
Entering Payments
Deleting Claims
Plan and Carrier Cleanup
- We notice that we have duplicate insurance plans with the same plan information including the coverage and benefits. How do we clean up the duplicate plans from showing up for selection?
- We noticed duplicate carriers when adding an insurance plan. How can we remove the duplicate carriers from showing up for selection?
Pre-Authorization Reports
Error Messages and Indicators
Update Patient Benefit Information
- Upon insurance verification of an individual patient’s benefits, how do I update the benefits remaining for my patient?
- We notice that the insurance plan assigned to the patient reflects the Anniversary Date when benefits reset. How can we update the Anniversary Date and ensure it updates all patients assigned to this plan?
- We have patients who have dental insurance. We notice a magnifying glass icon next to the word "Primary" and "Secondary.” How can we check the insurance eligibility of an individual patient?
- We have patients who have dental insurance. We sometimes notice a blue square ”C” icon next to the word "Primary" and "Secondary". When we mouseover the icon, the hovertip reveals that the eligibility is verified. How does this happen?
- We have patients who have dental insurance. We sometimes notice a yellow triangle icon next to the word "Primary" and "Secondary". When we mouseover the icon, the hovertip reveals that the eligibility was not verified. Why is this so?
- What does “SUPPORTYEAR” mean in the Subscriber screen?