Dental Transactions
UHIN supports the dental community and is focused on helping to reduce costs for dental practices. Through UHIN, dental claims, payments, reports, and x-rays can be transferred electronically. See below for more information.
- Why Exchange Electronically?
- Calculate Savings
- What Can Be Exchanged?
- Which Payers Are Available?
- How Do I Exchange?
- Billing Services/Clearinghouses
- Enrollment Tips
Resources
The following resources are to assist you with your dental claims:
Why Exchange Electronically?
Sending your claims electronically provides faster payments on your services and will reduce your Accounts Receivable. Many UHIN members have experienced a reduction in the time it takes to get a payment from two to three weeks to four days. You also benefit from the following:
- You reduce expenses for labor, paper, claim forms and postage
- You control the accuracy of your claim as the data your send is electronically transferred to the payer with no keying errors
- Proficiencies will allow your staff more time to work on other important tasks
- Increased security of your data; you direct where the claims need to go with no manual mailing
- Electronic transactions include the ability to check the patient's benefits and accumulators
Calculate Savings
Use this calculator provided by the National Dental EDI Council (NDEDIC) to estimate the amount of savings electronic claims can provide you. Microsoft Excel 2002 or later is required to use this document.
What Can Be Exchanged?
Electronic transactions are formatted in a national file format. This ensures that anyone that is receiving or sending transactions can expect that the data will be in the same place in the file. These formats are called ANSI or X12 formats. The following are common transactions that are exchanged for dental services:
- Claims-also called the 837
- Reports that tell you if the claims were received-also called the 277FE
- Payment Remittances, EOBs or vouchers-also called the 835
- Electronic Eligibility Requests and Responses-also called the 270/271
- Electronic Claims Status Requests and Responses-also called the 276/277
- Electronic prior authorization-also called the 278
- X-rays, perio charts, etc. can also be exchanged as an attachment
How Do I Exchange?
You need to create a file of claims, transmit your file and then receive and review the acceptance reports.
There are three common ways that you can exchange claims and other data electronically:
Option 1: Using your Practice Management System (PM) create an ANSI or X12 file. Some PM's have this functionality. You will want to contact them to verify. Then you can directly connect with the UHIN network to send the file or you can use the UHINt software (free of charge) to pull your file into the gateway.
Option 2: If you do not have a large volume of claims to send, you can type claims directly into the UHINt software. This software will create an ANSI or X12 file for you and send it to your payers.
Option 3: Use one of the approved billing services or clearinghouses to create a claims file and send it for you.
Billing Services/Clearinghouses
Billing Services
| Name | Contact | Telephone |
| A & A Billing Service | Margaret Adamson | 801-292-2146 |
| APEX EDI | Rob Armstrong | 801-642-0322 |
| Bentley Medical Billing | Christine Bentley | 801-685-8132 |
| William W. Neff, CPA PC | Bill Neff | 801-566-9800 |
Clearinghouses
| Name | Contact | Telephone |
| APEX EDI | Rob Armstrong | 801-642-0322 |
| Capario | UHIN Member Relations | 877-693-3071 |
| Emdeon | UHIN Member Relations | 877-693-3071 |
| Infinedi | Stephanie Wright | 800-688-8087 |
| National Information Services | Hayden | 801-763-9300 |
| Practice Works | Sales Department | 800-944-6365 |
Which Payers Are Available?
| Payer/Clearinghouse | Contact | Telephone/Email | 277FE | 835 | 270/271 | 276/277 | 278 | Attachments |
| Dental Select | EDI Department | EDI@dentalselect.com or (801)495-3000/(800)999-9789 | Yes | |||||
| DMBA | EDI Enrollment | edienrollment@dmba.com or (800) 777-3622, option 1,3 and then 4 | Yes | |||||
| EMI Health | Provider Assist | Lfoster@EMIhealth.com | Yes | Yes | ||||
| Medicaid (Utah) | Purita Buck | (801) 538-6509 or https://mmcs.health.utah.gov/hcfenroll/index.jsp | Yes | Yes | Batch | Batch | Yes | Yes |
| PEHP | EDI Help Desk | (801) 366-7544 | Yes | Yes | Batch/Fast Batch | Batch/Fast Batch | ||
| Regence | EDI Support Center | (801)333-2900/(888)344-5583 or edisupport@regence.com | Yes | Yes | Batch/Fast Batch | Batch/Fast Batch | ||
| Select Health | Front End EDI Team | (801) 442-5442 or edi@selecthealth.org | Yes | Batch/Fast Batch | Batch/Fast Batch |
In most situations, payers do not require an official enrollment process. Getting setup for EDI is a very simple process. Most payers want to know a provider's Tax ID (for payment), National Provider Identifier (for identification) and a trading partner number (for security and routing).
Have you submitted a paper claim to the payer in question recently? Most payers require current billing and rendering information in their processing system prior to EDI setup. Tax ID, National Provider ID (NPI) and billing/service location details are the common pieces of information required.
An electronic Trading Partner number is required by payers for EDI. Many of the clearinghouses already have a trading partner number and are connected to the payer you are interested in sending claims to. For direct connections, UHIN issues the trading partner number. You can contact UHIN at 877-693-3071. Payers may require electronic testing prior to going live. As you contact them, they will review the process with you.
With your Tax ID, NPI, and clearinghouse or trading partner information, use the payer contact list above in order to get setup for EDI. The payer will work with you on the next steps.
