Denture code without treatment area for eCW

[notsosuperman1]

We are running 14.1.14.0 and have open dental passing the billing codes to eClinicalWorks. In order to have Open Dental paint the graphical tooth chart for a complete max or mand denture, you have to have the code have a treatment area of arch. However, when D5110 and D5120 are passed to eCW, the U or L for upper or lower is passed as well, and the insurance denies the claim because there is no treatment area used with those codes.

How do we get around this and keep Open Dental painting the chart that a denture has been planned or made but stop it from passing a treatment area to eCW?

Thanks!

[jsalmon]

What kind of carrier is mean enough to reject your claim for being overly specific??? You should email us your rejection letter / reply and reference this forum link so that we have it on file because I've personally never heard of this.
service@opendental.com

Open Dental isn't used by just "America" so we made the system very generic. In being generic, Open Dental cannot... well does not... know about specific codes under the hood. It doesn't know if you treatment planned a D5110 or an X2500. All it knows is that some code (any code) was planned and it needs to draw it based on the paint type and treat area. Thus it knows it need to paint a bridge and exactly where to paint it. That is why you have to specify a paint type and area within the procedure code window.

There currently isn't a way to stop Open Dental from sending that information over to eCW without a feature request (which I highly doubt you need one, we should be able to come up with something). I'm more curious to venture down the path of why exactly the carrier (or clearinghouse...) is being difficult when you are basically "over-specifying" what work was done.

[Pruce Dental]

Jason...

I use Dentalxchange Claim Connect and have this similar problem too... I chart surfaces on prefab post and core buildups D2954 and EVERY time I submit a claim to them I have to manually go to their website and find the claim in the validation errors..there is always a message to edit the claim details and it tells me to remove the tooth surfaces..then I can resubmit it...problem is that I forget to look at their website sometimes for a week or two and therefore I wait an additional week or two to get paid. It happens on several other ADA codes too with DentalXchange ..i cannot think of them though off the top of my head...Now why DentalXchange cannot just ignore the extra info when processing the claim puzzles me??..IDK is there some issue that they are not allowed to alter a claim that we submit?

[Pruce Dental]

Today alone..dentalxchange had an upper and lower denture on one claim and an occlusal guard on another claim sitting in the claims with validation errors because they had maxillary and mandibular arches transmitted on the claims....

[notsosuperman1]

Jason,

It's insane, especially being a programmer myself. Why they can't just drop that data is beyond me (other than it being in their best interest to minimize paying claims). It drives me crazy when sites do things like this (throwing errors if there is a trailing space in a text field). I work at a community health center, and so at first I thought it was just the Medicaid managed care plans, but aside from those (Dentaquest and Healthplex) I have also seen it with United Health Care. Literally every denture that I have billed since I've gotten here has been rejected because of this.

I don't have access to the original denial (I am a dentist employee that dabbles in trying to improve the efficiency of the whole site), but our billing is outsourced to another group and in the billing notes I can see the exact error that it comes back with. Would this be adequate to send to you? If so I can email that along with a link to this forum. If you need the original I can try to contact our liaison with the billing group.

We do have a dummy code that we use for the denture steps themselves, so I suppose I could give this code a treatment area and get rid of the treatment area for the denture, but this would be inconvenient since it would mean that if a user didn't select a max or mand tooth when clicking the Quick Button (not sure if that is the right term) to tx plan a denture it would prompt the user for the arch on all 4 of the dummy codes. Now it would just prompt for the actual D5110 or D5120 (it prepopulates all the no-fee codes that will be used on the interim visits). Let me know if you have any other ideas.

[notsosuperman1]

Jason,

Just checking, do you want me to do some digging and try to get a screenshot of the actual dental, our is it sufficient if I copy and paste the error they send back? Thanks.

[notsosuperman1]

Jason,

I emailed the error to support. It looks like it is the clearinghouse that is giving the error, not the insurance. As a newer dentist working for a community health center that outsources the billing, I don't know much about the insurance side of things, or what clearinghouse we use. But, what suggestions do you have to resolve this problem on the Open Dental end?

Thanks.

[jsalmon]

I don't fully understand the suggestion that some co-workers came up with (I don't deal with procedure buttons or alternate codes much) but you could probably call in and have someone walk you through this suggestion:

LoriC - If they weren't eCW, I'd suggest using an Alternate Code w/o a treatment area (something like D5110a) and set the insurance plan to use Alternate Codes. This would cause OD to send the alternate code w/o a treatment area on the claim but still allow the tooth chart to display the graphic.

Arna - That would still work, Lori. We could create a dummy code that won't match in eCW and a Procedure Button that has the actual Tx code and the dummy 'paint' code.

I personally can't think of anything programmatically that we can do that would help this situation shy of hardcoding in some checks and balances behind the scenes that I really don't want to do code by code for every code in the book...