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Electronic Transactions for Dental Services Sending and receiving data electronically is not just for Medical Providers! Dental claims, payments, reports and even 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
cms/cmsfiles/NDEDIC%20ROI%20Calculator.xls What type of information 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 Who participates in electronic Dental Transactions? The table below lists the payers and the types of electronic transactions they process
*Capario and Emdeon are clearinghouses that can connect you with National payers not contained on this list. How Do I Exchange Electronically? You need to create a file of claims, transmit your file and then receive and review the acceptance reports. There are 3 common ways that you can exchange claims and other data electronically: Option 1: Using your practice management system create an ANSI or X12 file. Some practice management systems 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. Which billing services are connected through UHIN?
Which clearinghouses are connected through UHIN?
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 (801) 466-7705, option 1. 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.
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