Tag Archives: dental insurance

DentalXChange Selected To Provide All Payer Portal For Humana

DentalXChange has announced a partnership with Humana Inc. (NYSE: HUM) to launch a co-branded online portal supporting electronic data interchange (EDI) for the dental community.

Better Solutions for your Practice!

DentalXChange has designed and will operate the insurance company’s All Payer Dental Portal, allowing Humana’s dental providers to securely file insurance claims and conduct insurance-related transactions.

Scott Wellwood

“Our goal in supporting Humana’s All Payer Portal is to improve utilization management and increase administratice efficiencies” Scott Wellwood 

“Our goal in supporting Humana’s All Payer Portal is to improve utilization management and increase administrative efficiencies for providers,” explained Scott Wellwood, President of DentalXChange. “By increasing the speed at which providers of dental care can gather and utilize insurance information, we will be helping to improve the overall healthcare experience for patients, while accelerating revenue cycles for each of Humana’s dental providers.”

Through the portal, providers will have the opportunity to interact more directly with Humana, completing all dental EDI transactions at reduced or no cost. Features include the submission of claims and predeterminations, checking patient eligibility and benefits, obtaining the status of claims and receiving remittance information to balance claim payments. Transactions can be conducted directly on ClaimConnect or through integration with popular dental software programs.

“Humana is one of the nation’s leading health and well-being companies,” Wellwood said. “We look forward to working with Humana to further streamline the company’s EDI processes and reduce costs for their providers.”

“DentalXChange’s EDI tools will help empower Humana’s dental providers with the ability to eliminate paper and manage their entire revenue cycle, from eligibility verification before a patient’s visit, through the receipt of the electronic remittance advice and payment,” he added.

Leave a comment

Filed under California Dental Association, ClaimConnect, Claims, Dental EDI, E-Credentialing, EDI Claims, Humana, Uncategorized

Why Are My Dental Insurance Claims Rejected?

The hours wasted into investigating why an insurance claim gets rejected can drive a person crazy and waste many quality hours that could be spent with patients.rejected dental claims

To help alleviate the aggravation, we talked to Lindsey Schurman, Manager of Client Services at DentalXChange, to find out how you can avoid being placed in a straightjacket and get those important claims paid quickly.

What are the top reasons claims are rejected? 

The three issues we see most often are:

  1. The provider’s information does not match what is on file with the payer
  2. The patient info does not match what is on file with the payer
  3. The patient is no longer covered under policy

How can these be avoided? 

The best way to avoid a rejected claim is to check the patient’s eligibility when they first make an appointment. This is easily done through ClaimConnect’s Real Time Eligibility. After eligibility is checked, make sure the patient’s ID card matches what is in their chart. This will help avoid discrepancies between information on file and what the payer has on record. After a client receives rejection, the advice we share is to verify that all the information matches what is on file with the payer.

When DentalXChange investigates a rejected claim we ask the following questions:

May I please confirm the patient info to make sure we have matching claims info?

Asked the payer to confirm:

  1. The Patient and Subscriber Name
  2. Dates of Birth
  3. Member IDs
  4. Addresses
  5. Genders
  6. Group/Plan numbers
  7. Plan Effective Date

May I also confirm that the correct Provider information listed on the claim is on file?

Ask them to confirm:

  1. Rendering and Billing
  2. Name
  3. NPI
  4. TIN
  5. Address
  6. License number
  7. Any applicable provider ID or Taxonomy code

One of these issues is usually the reason a claim gets rejected.

How does a product like ClaimConnect help?

When submitting a claim through ClaimConnect, the program focuses on minimizing rejections by checking claims for the preventable errors. We call these validation errors. Validation errors prevent claims from being sent when the information does not match what the payer requires. They can range from incorrect procedural codes to incomplete provider information. These errors are flagged and allow you to fix any discrepancies before the claim is submitted to the payer.

This saves a ton of time dealing with rejected claims. Of course, if anyone is having an issue with claims rejections, they can always give us a call. Our customer service representatives will be happy to help resolve any issues you might be having.

Thanks for taking the time to help us, Lindsey!

Leave a comment

Filed under ClaimConnect, dentalxchange, EDI Claims

DentalXChange Announces New Partnership with NCDR, LLC

DentalXChange is proud to announce a new partnership with NCDR, LLC (NCDR), a dental services organization serving Kool Smiles and Resolution Dental nationally.Kool_smiles_logo

Through this partnership, DentalXChange is now supporting dental EDI services from claim submissions and real-time transactions, to the delivery of ERA’s electronically.

“By moving all of its EDI services to DentalXChange, NCDR has been able to improve its processes and reduce its operational costs, reaching an overall higher level of processing success,” explained Le Ann Eyres-Morris, Director of Channel Partners for DentalXChange.

We are very happy to have the opportunity to assist Kool Smiles and Resolution Dental in reaching their EDI and claim processing goals. Our relationships with our payer partners help drive the success of this unique implementation!”

After an analysis of their EDI and business processes, NCDR chose to migrate from a direct-connect model and move their claim and ERA transactions to DentalXChange, according to Eyres-Morris.

This change is indicative of a new direction in the industry, according to Scott Wellwood, President of DentalXChange.

“The industry is changing, and many companies are looking for strategic ways to reduce operational costs while continuing to provide exceptional service,” Wellwood noted.  “We are pleased that we have the opportunity to assist NCDR in improving its EDI delivery, and we anticipate that this partnership will continue for many years with great success.”

Damon Dunsmore, Manager of EDI and Integrations for NCDR, led the implementation, and noted “NCDR conducted an extensive selection process in order to identify the right partner, and DentalXChange emerged as the clear choice.  We implemented DentalXChange’s services in April and today, we couldn’t be happier with that decision,” Dunsmore explained.  “I have been working in EDI for over 10 years, and this has been the easiest implementation I’ve experienced.”

Dunsmore noted that the DentalXChange Account Management team was extremely efficient in driving the implementation which brought comfort in moving the remaining volume this July supporting a complete implementation in less than 120 days.

“The whole organization really seems to strive to ensure the customer is happy,” he said.  “I truly feel that we are business partners in the most literal sense of the word.”

According to Dunsmore, DentalXChange is a natural partner for NCDR, as the two companies’ visions are well-aligned.

“Both DentalXChange and NCDR are committed to using technology to provide high quality, affordable, health care reimbursement processes through secure, electronic transactions,” he said.

About NCDR, LLC

NCDR is a dental services organization offering business support services to some of the nation’s leading dental practices, including Kool Smiles and Resolution Dental. NCDR provides non-clinical support to affiliated practices freeing dentists to direct their energy and passions towards providing the best possible experience for their patients.
Affiliated practices benefit from support services including accounting, scheduling, human resources, insurance billing and collections, purchasing, industry leading information technology platforms, and the learning gained from affiliating with hundreds of other dentists nationally.  Our support system includes our award winning Boomerang Practice Management and Electronic Dental Records System, the backbone to our compliance and support systems.  Please visit us at www.ncdrllc.com.

Leave a comment

Filed under American Dental Association, California Dental Association, ClaimConnect, Claims, Customer Service, HIPAA

DENTALXCHANGE OFFERS GUARDIAN ENHANCED ELIGIBILITY TRANSACTION SYSTEM

Updated eligibility transaction system, now live with DentalXChange, will reduce costs by lowering the volume of eligibility request phone calls

ORANGE COUNTY, Calif. – January 31, 2012 – DentalXChange, an Irvine, CA, based technology company that specializes in providing online solutions to connect dentists, patients, and insurance companies, is proud to announce that The Guardian Life Insurance Company of America (Guardian), is the latest to offer enhanced online eligibility capabilities through DentalXChange.

Guardian worked with DentalXChange to offer dentists the ability to use their online service to obtain the “Top 50 Elements,” a list published by the Uniting the Industry Forum (UIF) of the most requested pieces of information needed when verifying patient eligibility.

These enhancements will allow dentists to receive comprehensive patient plan details, eliminating the need for time-consuming calls to the call center and making the process of checking eligibility faster and easier. Using the online functionality, dental office staff can properly present expected reimbursement and co-pay information so patients can make informed dental decisions at the time of service.

“Guardian is committed to making it easy for dentists in our network to work with us and manage their patient administration, while also helping our members better understand their benefits,” says Dr. Richard Goren, 2nd Vice President and National Dental Director for Guardian. “One of the ways to meet that commitment is by providing cutting edge, easy to use online services – DentalXChange helps us to do that.”

“DentalXChange is excited that Guardian saw the added value in these enhancements” said LeAnn Eyres, DentalXChange Director of Channel Partners and former Committee Chairman of the UIF. “We are looking forward to additional insurance companies following as they see the benefits of our enhanced system.”

About DentalXChange
Since 1989 DentalXChange (DXC) a subsidiary of EDI Health Group, Inc. (EHG), has earned industry-wide acclaim and recognition for pioneering the web-based dental EDI solutions industry. Today DXC has grown to support a current client base of over 12,000 healthcare offices. Headquartered in Irvine, CA, DXC accounts for more than $4 billion in healthcare claims. Through its own clearinghouse, ClaimConnect and PatientConnect portals, the company processes nearly 20 million EDI transactions, consisting of more than 15 million healthcare claims annually.

For more information or to schedule an interview with LeAnn Eyres please contact Asef Quader at 877.932.2567 x234 or email aquader@dentalxchange.com. For any other inquiries please visit: www.DentalXChange.com

About NDEDIC and the Uniting the Industry Forum
The National Dental EDI Council (NDEDIC) is the only organization to unite all stakeholders in promoting the value and increasing the utilization of electronic commerce within the dental industry. NDEDIC provides a community portal created to facilitate the exchange of information and unite stakeholders (payers, providers, vendors and clearinghouses), advancing the value and utilization of electronic connectivity in the dental community. The Council’s forum, “Uniting the Industry” is formed of stakeholders who support the development of useable standards for EDI transactions within today’s operations.

For more information please visit: www.NDEDIC.org

About Guardian
A mutual insurer founded in 1860, The Guardian Life Insurance Company of America and its subsidiaries are committed to protecting individuals, business owners and their employees with life insurance, disability income insurance, dental insurance products, and offer funding vehicles for 401(k) plans, annuities and other financial products. Guardian operates one of the largest dental networks in the United States, and protects more than six million employees and their families at 115,000 companies. The company has approximately 5,000 employees in the United States and a network of over 3,000 financial representatives in more than 80 agencies nationwide.

For more information about Guardian, please visit: www.GuardianLife.com

Leave a comment

Filed under Claims, Dental Office, dentalxchange

Top Five Reasons to Submit Electronic Claims

There are certainly many advantages to sending claims electronically, but many offices just aren’t convinced it’s the right step for them.  Here are five clear advantages to sending claims electronically versus paper.

1)      Save Money.  Believe it or not, even your office that sees “just” 10 dental patients a day can benefit from sending electronic dental claims.  Starting at just 25 cents per claim,* this can cost your office just $2.50 a day, whereas printing and mailing dental claims can cost over $5 a day including stamps and paper.  Multiply this by 20 working days, and you’re saving about $50 a month on just supplies.  Use our savings calculator here to find out exactly what you can save when you factor in labor.

2)      Save Time:  Click, capture and send.  That’s all it takes to send claims through DentalXChange (call us for a free demo!).  If you mail claims, you’re likely spending a few hours a day printing claims and checking errors.

3)      Reduce Errors:  Our state of the art Claim Validation system checks for errors on your claims.  For example, we match claim codes to tooth numbers, so if a code is wrong, we flag it for you.  Your DMD or Activity Snapshot lets you know within 2 minutes of uploading a claim, and you can easily fix the claim on our website.

4)      Real-Time Claim Status:  Do you constantly call insurance to check claim status?  Save time by checking claim status online for most dental insurance companies.  Get up-to-date information with the Real-Time Eligibility and Claim status package.

5)      Paid Faster:  On average, it can take up to 45 days to receive payment if mailing claims, but if you send your claims electronically, payment can be expected in as little as 48 hours for some insurance companies.

We have processed over 15 million dental claims a year and a total of $4 Billion in dental claims since 1989. If you’d like more information on why making the switch to DentalXChange is the right choice for your practice, give us a call at 800-576-6412 x 467.

1 Comment

Filed under Claims, dentalxchange