Will whoever gave the insurance companies the power to do whatever they want please stand? Oh yeah … we did. We have given and continue to give them power when we don’t have proper documentation to justify our treatment plan or confirmation showing that our claims have been received. If we don’t manage our systems properly, we have to do what they tell us to do because we can’t prove anything.
The easiest way to have some leverage with your insurance companies when it comes to claims processing is to use Dentrix eClaims. The claims reports and support you get will give you a leg up when you have to follow up on an unpaid claim. When you use Dentrix eClaims, you receive a lot of reports. When I am training out in the field, I ask the team, “What do you do with these reports?” The most common answer is “Nothing” or “I don’t know”. These reports give you the information you need to be in charge of your claims and attachments, but you need to know what to look for.
The two most important eTrans reports for you to look for are the Payer/Clearinghouse Report and the Attachment Status Report.
Payer/Clearinghouse Report – You will receive this report about 24-48 hours after a claim is sent out and it contains some very important information. This report will give you the INSURANCE REFERENCE NUMBER also called a DC#. The DC# you are looking for is one that has the source as the insurance carrier. This is the only number the insurance company will be able to use to track your claim. My recommendation would be to copy this DC# into the claim status note so you have it readily available if you need it, then you can shred the rest of this report.
Attachment Status Report – This report will give you the NEA number assigned to your attachment within 6-24 hours after you send your claim. If the insurance company states they did not receive your X-ray or perio chart, you can use the NEA number to prove the attachment was received and they should be able to track it. As stated above with the DC#, my recommendation would be to copy this NEA number into the Claim Status Notes on the claim so if you need it, you don’t have to track down your reports.
Don’t give the insurance companies the power to manipulate the situation. If they say they do not have the claim and you have the DC#, do not resend another claim. Ask to speak to a supervisor or call the Dentrix eClaims support team and they will help facilitate the situation.
Another great resource for you to use is the Insurance Manager with eCentral and have the reports archived for you.