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.

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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!

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Filed under ClaimConnect, dentalxchange, EDI Claims