Electronic Claims Submission (ECS), means our computer software prepares our client’s claim for their insurance benefit. These claims are stored during the day and then all are sent in a batch file usually at the end of the day. Those claims are then transmitted over the internet to our clearing house. The clearing house formats the claim in a form the insurance company can process (for a fee) and then sends the claim to the insurance company. The clearing house charges 35-50 cents each claim. If the insurance company doesn’t accept electronic claims, they will send a paper claim. The insurance company will check the accuracy of our claims and return any that have mistakes for us to correct and then resubmit.
Electronic claims submission has several advantages:
- Faster (saves at least 1 week)
- More accurate
- Fewer resubmissions (avoids lost forms by S. mail or insurance company)
- No paper forms to mess with
- Less expensive (Reduced need for paper, envelopes, etc)
- Less secretary time is needed
- Avoids mistakes by insurance company keying in the information.
- Improved communication with insurance companies
- x-rays submitted digitally can’t be lost
When treatment is set complete in the ledger, click on the “insurance today” icon. This produces an insurance claim and sends it to the batch processor. We can submit claims as often as we desire. When the batch processor is 2/3 full, go ahead and send the e-claims. The quicker you send them, the quicker they will be processed and payment will be on its way to us.
Here’s a review of the steps that an insurance company goes through when they receive our claim form in the US mail:
- Received at one of many receiving centers, if you send it to the wrong place it will be pitched.
- The claim arrives in the mail room – mail room employees are usually 18-22 years old and average 3 months of experience. They handle 10-12,000 pieces of mail daily and lose about 300 of them.
- Mail is sorted – general correspondence is separated from claim forms. If you send an explanatory letter with the claim and didn’t note “claim information” on the outside of the envelope, it will be lost.
- Mail that is clearly not identified is set aside for “special handling” which often means “pitch it.”
To keep up with the flow of payments to our office, the day’s charges must be processed and the insurance claims run and sent out daily. The quicker you submit the claims, the sooner we get our money.
This section on submitting insurance encompasses not only the traditional dental insurance but also includes any third party involved in the responsibility of payment for our services.
One of the most important steps in submitting any insurance is the set-up of the patient’s family file / edit patient screen. When the info is entered into the computer correctly from the beginning – before treatment is set complete – then submitting the insurance is fairly simple and painless.
Before transmitting E-Claims: Run Procedures Not Attached to Insurance Report in Dentrix
Before you send any claims, you will want to verify that all procedures that should be sent to insurance have been placed in the office manager.
- click on Office Manager
- click on Reports
- click on Ledger
- click on Procedures not attached to insurance
- change Select procedure date “from” date to last date e-claims transmitted
- click on okay
- print list from Office Manager
- review treatment for each patient on the list with their ledger (check that emergency exam were courtesy discounts, etc.)
- create an insurance claim for each person and submit, then pitch the report when done.
- when completed, return to Office Manager. You are now ready to send e-claims.
We use the Renaissance to submit our electronic claims.
RSS Tech Support
This is what is required in Dentrix before the claims can be submitted:
- Procedures w/ a zero amount will not be accepted. Do not send those procedures to insurance.
- Items we charge w/ a made up code will not be accepted. Do not send these to insurance.
Other Tips: In many cases when your claim does not go through you will need to delete the claim, correct the error in Dentrix, delete the existing claim (that was not correct) and send another claim to the batch processor. Here are some of those situations:
- Missing or incorrect social security number.
- Incorrect zip code for the insurance carrier.
- For MetLife the correct group number is necessary (6 digits)
- Missing street address for the subscriber.
Be sure that the claim format is set up to a DX2012F format – this makes sure that the standard fee will be submitted on the claims and the insurance fee will be entered into the ledger.
- Go to Office Manager Screen
- Click on Reports
- Click on Ledger
- Click on Procedures not attached to Insurance
- Select procedure date (lower right corner) and change the “from” date to the day prior (or last date done if over a weekend)
- Click Okay
- Highlight Procedures not attached to Insurance claims on ledger
- Print Report
- On ledger Screen – look at each patient that was not sent to insurance and highlight the treatment and send it to insurance unless the treatment was courtesy adjusted or under warranty
- When completed, return to Office Manager Screen
- When in Office Manager you will see the code DX2012F. If you see DX2007F on any of the claims, you must complete the following :
- Go to family file
- Click on insurance section
- Click on insurance data
- Claim Format
- Arrow down to change to DX2007.
- Go to ledger
- Click on Claim
- Got to Office Manager and check to see if now the claim had DX2007F
Instructions for Renaissance claims processing software
First, send the claim from your software to RemoteLite
- In Dentrix office manager, click File, printer set up, choose the RES printer. (This will not print the claims, it will just send them over to RemoteLite.)
- Highlight the claims
- You will see a window open and it will scroll through data on a black background.
- Now, reset your printer back to the one you really use.
Second, send the claims using RemoteLite
- RemoteLite opens automatically. It lists your claims and if they are listed in black font that means the claim has the info needed to send successfully. If it is in red, then it is missing something. Double click on the claim to open it. You will see a red box to highlight the missing info. You can fill in this box but be sure to go back into your dental software and fill in this info or the next time you send a claim, it will kick back just like this.
- If there are several items missing, its best to delete this claim from RemoteLite (right click and choose delete) and then go back to your dental software to fix everything. Then, recreate the claim and send it over to Remote Lite again.
- To send a claim individually, right click and choose send selected claims.
- To send all the claims listed, click the Send/Receive button at the top.
Third, include an attachment
- Right click on your patient’s claim and choose Attach.
- To attach from scanner, choose the EOB type, click scan and save then file, click save and exit.
- To attach from a screenshot, minimize all your program windows.
- Next, open the image (xray or clinical notes or period chart) you want to attach.
- In the lower right taskbar, double click the R to open Remote Lite so that it is on top of your image.
- Find your patient’s claim, right click and attach from screenshot. Click capture. This will take you back to the other window where your image is waiting.
- Draw a square around the image, start top left and hold your mouse button down til you get to the bottom right, then let go of the mouse button.
- Click save.
- Click file and then click Save and exit.
To see that your claims were sent successfully
- Once claims are sent, history pops up automatically.
- If the claim was sent successfully, you will see a green checkmark beside the patient name and you may even see an estimated payment in the right column. (Not all carriers provide this info.)
- If the claim is marked printed, this is still a successful send. It just means that Renaissance has to print and mail the paper claim because the carrier is not accepting electronic claims submission.
- If the claim is marked duplicate, this means you have sent an identical claim within 24 hours and the duplicate did not go through.
- If the claim is marked rejected, then click into the claim to see what the problem is. Often, rejected claims are due to the fact that the patient no longer has dental insurance benefits. You may want to call the patient right now to let them know their benefits were denied and that if this was unexpected, they may want to call their human resources department. Otherwise, close the claim and send them a bill.
- In the Inbox you can see that the insurance company received the attachment. You can also confirm that they received the claim. So, in the future if this claim shows up on your insurance aging report and the insurance company tells you they didn’t receive either one, you can quickly check Remote Lite to see if there is a confirmation code there. If so, do not resend the claim, just tell the insurance company that you have confirmation that they did receive it.
To check eligibility using Remote Lite
- Click new
- Eligibility request
- New patient
- Now, fill in the insurance carrier information, the subscriber information and the patient information
- Or, choose Patient Lookup, this works for any patient we have processed claims through Remote Lite in the past
- Click Finish
- Now, go to Eligibility and click Send.
- To see when this information comes back, look in the inbox
PTE’s, check to see if it is a crown, bridge, implant, etc. See if an x-ray should be sent along with pte. This will save time in the future. Print these pte’s as well.