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The Best Dental Clearinghouses for Submitting Electronic Claims

It’s 2020 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 ClaimSupport, 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 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. 

 

What else can clearinghouses do for you?

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 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!

  1. DentalXchange – (ClaimConnect/ EDI-Health Group, Inc)

    1. Charges $0.25/claim and $25 unlimited claim attachments through DentalXChange webportal (not NEA)
    2. Validation errors/attachment errors can be corrected to an extent on the web portal
      1. Attachments are not realtime – insurance will not be able to pull up attachment if not received
      2. Resending a claim with attachment/corrected information will cause duplication of claim charge
    3. Some claims will require call-in to push through
      1. If eClaim is rejected – it will be on the claim list for office to mail claim. Will not mail any claims on behalf of office
    4. $19.95/mo eligibility checks
    5. $19.95/mo ERA
  2. Dentrix – (eClaims)

    1. Charges $0.40/per claim submission
      1. Will be charged again if claim and/or attachment not received for resubmission
    2. Validation errors/rejected claims can not be corrected within the clearing house, claim will need to be resubmitted through software for resubmission
    3. Attachments included in software through screen grab or import. Sometimes attachments drop.
  3. Patterson – (Change Healthcare)

    1. Charges $0.45/per claim submission
    2. Integrates with NEA FastAttach for attachments in separate software outside of the clearinghouse
    3. Validation Errors/rejected claims can not be corrected within the clearinghouse and must be fixed within the dental practice software prior to resubmission.
  4. Vyne – Remote Lite

    1. Remote Lite
      1. Handles claim submission and attachments for a flat-rate fee
      2. Flat Fee of $- for unlimited claim submission/month
      3. 90 Day Free Trial
      4. Each Tax ID is billed separately 
      5. If eClaim is not accepted will mail most claims for office
    2. NEA FastAttach integration built into the clearinghouse 
      1. Ability to electronically save and send claim attachments such as radiographs, perio charting, EOBs, narratives, pre-treatment estimates, secondary insurance
    3. Validation Errors can be corrected within the clearinghouse after submission and resubmitted immediately
    4. EOBs can be viewed within the clearinghouse
    5. Add on feature Encrypted Email only

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. Check out this ultimate guide to getting claims paid to learn further about the life cycle of a claim and increase your collections.

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. 

Author: Josh Smith

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