Denti-cal / Dentical EDI, sending claims directly

[doctordoom]

http://www.opendental.com/manual/dentical.html

Has anyone been able to get approved to send claims electronically directly to denti-cal (not through clearinghouse) as mentioned in the above help link? I got the process started, but seems like a very complicated process. Even denti-cal's support says its too complicated to do yourself unless you are a computer person. Any help or guidance appreciated.

[Arna]

I've helped a few users through the process. Every time I've attempted to do it, the process has changed slightly, however I keep the web manual as current as I understand the process to be. http://opendental.com/manual/dentical.html

[doctordoom]

Denti-cal is asking for

"At least one transaction with Service Facility information in Loop 2310C and service facility phone number in NTE segment of Loop 2300."

Any idea how to do this?



Also following step #6 from open dental instruction manual says
At least one transaction that includes a Share of Cost amount.
Select patient 1.
Create and complete one procedure: a D0270 with fee 100.
Create a claim for the D0270.
In the Edit Claim window, under the General tab, type the following Claim Note: "Share of Cost test"

This is what they replied with:

"Although the claim note segment of this transaction indicated it represented a Share of Cost transaction, a patient share of cost amount was not sent. A Patient Amount Paid (AMT) segment with a qualifier code of ‘F5’ is expected."

[jsalmon]

There is no way to send that information and no one would ever need to send it IMO. Regardless, we added a way to do it v15.4 which will be coming out soon because of this additional requirement they seem to have added.
http://www.opendental.com/manual/version15_4.html

[doctordoom]

How about for the share of cost issue?
"Although the claim note segment of this transaction indicated it represented a Share of Cost transaction, a patient share of cost amount was not sent. A Patient Amount Paid (AMT) segment with a qualifier code of ‘F5’ is expected."

Or is that what you were referring to for version 15.4?

[jsalmon]

How about for the share of cost issue?
"Although the claim note segment of this transaction indicated it represented a Share of Cost transaction, a patient share of cost amount was not sent. A Patient Amount Paid (AMT) segment with a qualifier code of ‘F5’ is expected."

Or is that what you were referring to for version 15.4?

Correct. We added a Share of Cost field in the Claim Edit window (Misc tab) in v15.4
http://www.opendental.com/manual/claimtabmisc.html

(I'm adding these links for future reference once our documentation has been updated which will be after v15.4 has been released, don't let them confuse you right now)

[doctordoom]

Ok so this what they want from me now:

The next step is for you to provide a test file or files that include a Share of Cost greater than zero and “MC” in the SBR09 element.

I tried following the directions in the online manual exactly but they want the above now. Any help appreciated. I am on 15.3.47. I dont yet see a opportunity to update to 15.4 yet when I click update button any idea when I can update to 15.4?

[jsalmon]

You can update to v15.4 if you are on active support with us otherwise v15.3 is where you will be held. If you have active support with us right now then v15.4 should be available to you right now (the beta version which shows up towards the bottom after clicking Check for Updates).

[doctordoom]

So finally got it approved and should be "going live" tomorrow.

When sending the test files and running all the tests, they had me log in to their webpage and manually upload the files to their website.

Is it possible to send the claims directly from open dental (like how the other clearinghouses work?).

Or will I have to create the claims and then upload the files manually to denti-cal via their website?

[jsalmon]

They should have provided you with SFTP credentials. You then enter those credentials into your Denti-Cal Clearinghouse Edit window and Open Dental will upload the claims automatically to the Denti-Cal SFTP site where they should be processed.

Step 3: Denti-Cal will issue a Remote ID, username, and password when a provider enters the full testing phase (step 4). Use this information to set up the Denti-Cal clearinghouse.

http://opendental.com/manual/dentical.html