e-Claims, which clearinghouse to choose?

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ForrestGumpDDS
Posts: 177
Joined: Fri Oct 14, 2011 3:31 pm

e-Claims, which clearinghouse to choose?

Post by ForrestGumpDDS » Wed Apr 11, 2018 8:14 am

Stumbled upon this while making my research on clearinghouse selection:
cmcgehee wrote:Regarding Tesia, I would like to say that we have been informed that Renaissance will be phasing out Tesia. They will be transitioning Tesia's users to a custom Renaissance format that does not have data validation within Open Dental.
My OM approached me with the request to sign up with Renaissance due to the sudden hike in attachment issues with Tesia and after having a conversation with the Tesia rep, where she was advised of the Tesia not being supported in the future.
My understanding, Renaissance is using a proprietary format that lacks certain features like error checking? That seems to be a deal breaker for me, despite the fact that they offered a full featured package for 1 year for the same price I pay for Tesia now. I am not big fan of proprietary formats, so I would like to explore my options in terms of the clearinghouse and electronic attachments. There will not be any better moment out there to select the more appropriate vendor from the technical point of view.
I read E-Claims Complexities article and realized, that there is a huge number of the problems that can be inherited from choosing one format over another one.
Which vendors should I go with these days? What particular details I should pay attention to?
Would all vendors using X12 format be same and be preferred over the other formats?

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wjstarck
Posts: 935
Joined: Tue Jul 31, 2007 7:18 am
Location: Keller, TX
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Re: e-Claims, which clearinghouse to choose?

Post by wjstarck » Wed Apr 11, 2018 9:31 am

I used Emdeon and it always worked great. I assume they're still around
Cheers,

Bill Starck, DDS
Big Idea Software, LLC
Developer, EASy(Electronic Anesthesia System) for Open Dental
817-807-1709
TX, USA

ForrestGumpDDS
Posts: 177
Joined: Fri Oct 14, 2011 3:31 pm

Re: e-Claims, which clearinghouse to choose?

Post by ForrestGumpDDS » Wed Apr 11, 2018 10:34 am

Thank you. Looking into their info right now.
It's either .37c per claim, or $25/month, which translates into 11c per claim and gets 3c cheaper after first 225 claims in the tier where I see my practice.
Question to the OD team - is there any way to see the number of claims sent each month in the reports? I'd like to see an everage each month with deviation of the high side. Or just the average.
From what I imagine, I should be sending as many claims as I have appointments (we are PPO mainly), so the monthly fixed rate should provide me with better utilization after 67 claims sent.

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cmcgehee
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Location: Salem, Oregon

Re: e-Claims, which clearinghouse to choose?

Post by cmcgehee » Wed Apr 11, 2018 12:48 pm

Here's a modification of 491 that shows electronic claims sent in a date range. It doesn't look like we have any more detailed reports available.

Code: Select all

/*491 Find eclaims sent in date range */
SET @FromDate='2010-07-01' , @ToDate='2010-07-31';
SELECT c.PatNum, c.DateSent, c.DateService, e.Etype, e.DateTimeTrans, ca.CarrierName FROM etrans e
INNER JOIN claim c on c.ClaimNum=e.ClaimNum
INNER JOIN insplan i ON i.PlanNum=c.PlanNum
INNER JOIN carrier ca ON i.CarrierNum=ca.CarrierNum
INNER JOIN patient p ON c.PatNum=p.PatNum
WHERE c.DateSent BETWEEN @FromDate AND @ToDate
ORDER BY p.LName, p.FName, c.DateSent DESC;
Chris McGehee
Open Dental Software
http://www.opendental.com

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