It’s the digital age everyone – you should not be mailing claims unless it’s absolutely necessary. If you are new to the electronic submission game or simply in search of a better fit for your office, you’re in the right place. You’re not alone if you’ve ever had issues with insurance companies receiving your dental claims.
Our company, Dental Claim Support, is an outsourced dental billing company working with hundreds of offices across the United States. Needless to say, we see and work in many different clearinghouses daily. Here’s the shocker…they are not all the same! We went ahead and took the liberty to give you our two cents on the subject.
This article will compare different dental clearinghouses in order for you to better determine which one may be the best fit for your office when submitting electronic claims. Before we dive into the comparisons, let’s discuss what a clearinghouse is and what it can do for you.
What is a dental clearinghouse?
“A private or public company that provides connectivity and often serves as a “middleman” between healthcare providers and payers.”
The simple explanation?
Clearinghouses make sure that claims sent from your dental software are distributed to the correct insurance company electronically.
Each insurance company has a Payer ID associated with it. A Payer ID is a five digit alpha/numeric number that is unique to every insurance company and signals where a claim needs to go.
Everyone loves a good sports analogy, right? Think of a clearinghouse as a football quarterback. Let’s say, Tom Brady. Don’t let this analogy make you hate clearinghouses though…
Tom has a bucket of footballs (claims). These footballs are in different colors (Payer IDs). Tom also throws these balls to receivers (insurances).
Since each of these colors signify a unique Payer ID and insurance provider, Tom knows which ball needs to be thrown to each receiver. It’s really that simple.
Are your claims reaching your income goals? We can help.
What are the functions of a dental clearinghouse?
What if a claim doesn’t make it to an insurance company correctly? This can happen but that is why clearinghouses provide some cool features to limit these instances. These features have a specific goal – to decrease reimbursement delays. Let’s take a look at 4 of these features.
1. Flags validation errors
Most clearinghouses comb through claims and flag anything found wrong with the claim for you. A validation error can be: a wrong group number, wrong TAX ID, incorrect code, etc. The error is flagged for you, so correct the claim in your clearinghouse and submit the claim to the payer immediately. However, some clearinghouses may not flag nor mark the claim as rejected. It is important to always verify the services offered with each clearinghouse service.
2. Flags rejected claims showing no coverage in effect
The clearinghouse typically will mark rejected claims. Rejected claims are those where the patient cannot be located or the patient’s coverage has been terminated. Your dental team can then quickly contact the patient to verify coverage and make any updates to current coverage in a timely manner, helping the claim be properly submitted to the payer.
3. Correct dental claim information within the clearinghouse software to get the claim submitted
This is a nifty tool. Making quick corrections to a claim in the clearinghouse allows for quicker more efficient claim submission. The claim does not need to be recreated, but only corrected in order for the claim to be sent through. Corrections could be something as simple as changing a procedure code or updating patient information.
Note: You will need to make the same corrections in your dental software for future claim submissions to avoid the same errors.
4. Prompts claim attachments for necessary procedure codes
Depending on the procedures performed, some claims need attachments. Attachments come in the form of x-rays, narratives, perio charting, intraoral photos, and more.
Attachments are supporting documentation establishing medical or dental necessity, that a procedure needed to be performed for a patient. If certain procedures are not sent with attachments, insurance will say “no attachment, equals no payment”. Utilization of a clearinghouse’s ability to prompt the practice for needed attachments decreases payment delays.
Which dental clearinghouse is best for you?
Below is a list of the most commonly used clearinghouses in the dental industry. Each clearinghouse provides similar types of service, but which one is the best fit for your office? Let’s review the features of each clearinghouse and you decide!
DentalXchange – (ClaimConnect/ EDI-Health Group, Inc)
- Charges $0.25/claim and $25 unlimited claim attachments through DentalXChange web portal (not NEA)
- Validation errors/attachment errors can be corrected to an extent on the web portal
- Attachments are not real-time – insurance will not be able to pull up attachments if not received
- Resending a claim with attachment/corrected information will cause duplication of the claim charge
- Some claims will require call-in to push through
- If a claim is rejected – it will be on the claim list for the office to mail the claim. Will not mail any claims on behalf of the office
- $19.95/mo eligibility checks
- $19.95/mo ERA
Dentrix (eClaims)
- Charges $0.40/per claim submission
- Will be charged again if claim and/or attachment not received for resubmission
- Validation errors/rejected claims can not be corrected within the clearing house, claim will need to be resubmitted through software for resubmission
- Attachments included in software through screen grab or import. Sometimes attachments drop.
Patterson – (Change Healthcare)
- Charges $0.45/per claim submission
- Integrates with NEA FastAttach for attachments in separate software outside of the clearinghouse
- Validation Errors/rejected claims can not be corrected within the clearinghouse and must be fixed within the dental practice software prior to resubmission.
Vyne Trellis – (Formerly known as Remote Lite)
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Vyne Trellis includes these services for an unlimited rate of $99 per practice location:
- Unlimited claims and attachments.
- ERAs (*provider must enroll to receive ERAs).
- Claim research and denial support.
- Real-time eligibility.
What happens after the clearinghouse? See how a great claims process works
We hope this article shed some light on clearinghouses. Once you have decided which clearinghouse is the right fit for you, an easy call or chat on their website is the next step for electronic claim submission.
Don’t stop there though. Claim submission is just the beginning. To learn more about how you can outsource your claims process to ensure reimbursement, check out our Ultimate Guide to Outsourcing your Dental Billing.
Disclaimer: The services and fees quoted for the clearinghouses included in this article are intended to be examples and may not reflect the current services offered or fees charged. Contact each clearinghouse service for current information.
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