Providing ERAs to Open Dental

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gBrown
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Joined: Tue Mar 28, 2023 9:07 am

Providing ERAs to Open Dental

Post by gBrown » Tue Jul 09, 2024 5:40 pm

Open Dental has a nice feature https://www.opendental.com/manual/era835workflow.html for automatically processing ERAs. We would like to become an additional ERA provider for our client offices and have those ERAs work nicely with this feature.

Based on the documentation https://www.opendental.com/manual/clearinghouses.html, it sounds like we could become an ERA provider by adding ourselves as a clearinghouse. Is that correct?

If yes:
  • What version of 835s is used with this feature? Is it X12 HIPAA 5010 or another version?
  • Would ERAs with the existing clearinghouse still be delivered? From the documentation, I'm assuming that this is not an issue, but just wanted to verify.
  • Where should we place the ERAs for Open Dental to receive them? Would that be in a folder on the local machine or would we provide an API endpoint that Open Dental would fetch from?
If not correct:
  • Is there another way we could become an ERA provider? Or is it not possible?
Thanks!

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jsalmon
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Re: Providing ERAs to Open Dental

Post by jsalmon » Wed Jul 10, 2024 4:26 pm

gBrown wrote:
Tue Jul 09, 2024 5:40 pm
Based on the documentation https://www.opendental.com/manual/clearinghouses.html, it sounds like we could become an ERA provider by adding ourselves as a clearinghouse. Is that correct?
The answer is yes but this could be quite the journey you are about to embark on depending on the next steps you want to take.
gBrown wrote:
Tue Jul 09, 2024 5:40 pm
  • What version of 835s is used with this feature? Is it X12 HIPAA 5010 or another version?
X12 is used (preferably 5010s). The message types that are currently supported are 999s, 997s, and 277s.
If an X12 message is not provided then we treat this as a "TextReport" and do not "process" it but instead just document the report in its raw state.
gBrown wrote:
Tue Jul 09, 2024 5:40 pm
  • Would ERAs with the existing clearinghouse still be delivered? From the documentation, I'm assuming that this is not an issue, but just wanted to verify.
Yes. Multiple clearinghouses can submit ERAs and Open Dental will process them (assuming the clearinghouses are set up to do so).
gBrown wrote:
Tue Jul 09, 2024 5:40 pm
  • Where should we place the ERAs for Open Dental to receive them? Would that be in a folder on the local machine or would we provide an API endpoint that Open Dental would fetch from?
The Report Path within the Edit Clearinghouse or Direct Carrier window is where Open Dental will monitor for new X12 ERAs. It can be local or a UNC path. The important part is that the Open Dental Service has access to it (or whatever workstation is processing the ERAs if automatic retrieval is not being used).

If you need Open Dental to utilize an API endpoint then you'll need to contact vendor.relations@opendental.com and we can start talking about how we can start integrating with each other. I highly recommend doing this step regardless. Especially if you would like to be part of the official list of clearinghouses built into Open Dental. It is really helpful from our perspective when special functionality (like API calls) are required during the process. Also, it will be a lot easier for your "client offices" to set up Open Dental to start receiving ERAs instead of having to manually create a clearinghouse.
The best thing about a boolean is even if you are wrong, you are only off by a bit.

Jason Salmon
Open Dental Software
http://www.opendental.com

gBrown
Posts: 13
Joined: Tue Mar 28, 2023 9:07 am

Re: Providing ERAs to Open Dental

Post by gBrown » Fri Jul 12, 2024 5:39 am

Thank you, jsalmon. This is very helpful information. We will evaluate this information and identify our next steps. Thanks again!

gBrown
Posts: 13
Joined: Tue Mar 28, 2023 9:07 am

Re: Providing ERAs to Open Dental

Post by gBrown » Fri Aug 09, 2024 10:14 am

Hi jsalmon,

We tested submitting ERAs with multiple clearinghouses using the following setup:

- Two clearinghouses configured with their respective report paths: a built-in clearinghouse and a clearinghouse that we manually added through the Clearinghouse UI
- ERA preference set to "Semi-Automatic"
- One patient assigned to each clearinghouse for testing

Steps taken:

1. Placed ERA files in the respective clearinghouse folders
2. Navigated to Manage → Send Claims

Issue observed:

- In our test, Open Dental only processed the ERAs for the clearinghouse set as the default. The ERAs for Clearinghouse 1 got processed when Clearinghouse 1 was the default. When Clearinghouse 2 was set as the default, Clearinghouse 2’s ERAs then got processed.

I assume that we misconfigured something and that is why only ERAs only got processed for the default clearinghouse. From these details, does this spark any theories as to what we might have misconfigured?

Thanks!

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jsalmon
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Re: Providing ERAs to Open Dental

Post by jsalmon » Mon Aug 12, 2024 10:55 am

The Open Dental Service needs to be installed and running. Then check the "Receive Reports by Service" box within the Clearinghouses window.

If the Send Claims window is more desirable then you might have to use the dropdown next to the "Send E-Claims" button within the Insurance Claims window? I'm not too sure on that one.
The best thing about a boolean is even if you are wrong, you are only off by a bit.

Jason Salmon
Open Dental Software
http://www.opendental.com

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