How to Start Submitting Electronic Claims
Your Practice Management vendor or representative will provide you with all the necessary instructions and paperwork for submitting claims electronically via your office PC.
If you do not have a practice management software system, but do have a PC, you can contact Emdeon (formerly WebMD) at their toll-free number 1-888-416-0673 and speak to one of their technical support staff to see if your PC is capable of submitting claims electronically.
Delta Dental of Massachusetts does not require any special enrollment for electronic submission. All services, with the exception of orthodontic procedures, may be submitted electronically.
Requests for pre-treatment estimates may also be submitted electronically.
Who Is Involved in Electronic Claims Submission?
The Dentist:
The Dental Office submits claims electronically via their office PC to a clearinghouse.
The Practice Management Vendor:
The practice management vendor is responsible for your PC software. This vendor also provides daily technical support and troubleshooting assistance.
The Clearinghouse:
The clearinghouse is responsible for the transmission of the claims to Delta Dental of Massachusetts and other insurance carriers who accept claims electronically. At the clearinghouse, all claims are reviewed for completion to ensure they are ready to send to each carrier. They also provide several reports that include important information for tracking claims and requests for additional information from the insurance carrier. The reports vary depending on your practice management system and your vendor will provide a copy of the standard clearinghouse reports.
Delta Dental of Massachusetts:
We are available to discuss any questions you may have regarding your electronic claims submissions. Please call us at 1-800-451-1249 x1160 or e-mail us at EDI@deltamass.com.
Electronic Submission Tips
When selecting a clearinghouse vendor make sure that the submitted dental practice name, address, TIN number and names of practicing dentists are the same as what you have on file with Delta Dental of Massachusetts.
If you add or remove a dentist from your practice, you will need to notify both the clearinghouse and Delta Dental of Massachusetts.
Verify that the Payor ID number is accurate. Delta Dental of Massachusetts' Payor ID number is 04614.
Reports
Reports provide important information about your submitted claims. Reports will vary depending on the Practice Management Software you select; the most common reports are as follows:
Submitter Report (Validation Report) - usually generated from your practice management software system for your review prior to submitting the claims to the clearinghouse. This is not a confirmation report from the clearinghouse.
Transmission report - This is a confirmation report from the clearinghouse that is sent to you immediately after your claims are submitted.
Claim Status Report (Payer Report) - This report is a verification report from the insurance company on your submitted electronic claims. It is sent to you after your claims have been received at the insurance company and provides a status of your submitted claims. The report will tell you if a claim was rejected, denied, or requires additional information.
Banner Message - This comes from the clearinghouse to let you know of any software updates, changes, or submission tips, etc.
Back to Top
|
