Insurance processing issues

[JillPB]

We are having difficulties with filing electronic claims. The clearinghouse (Tesia) we are using does not list many of the payor id's for our patients insurance companies. We are receiving rejected claims which are delaying payments to our patients. We are receiving calls from angry patients and we are losing patients as a result of delayed insurance claims. Is anyone else having issues with filing electronic claims? Are there any clearinghouses that are more responsive to inquiries and helping us work with our patients?

[KCalla]

We have had similar problems. We've given up for a while and are back to paper claims and filing directly online with the insurance company. The folks at Tesia were good to deal with, perhaps the problems we have are a combination of client density and geography. Like you, most of our patient's insurers were not part of the Tesia system. Tesia was generating paper claims for some and mailing them. I know that this might be a cost savings for us, but it added significant time (and frustration) to reimbursement for us and for patients (those for whom we are not contracting providers and therefore cannot take assignment of benefits). When the summer is over, we plan to try again. We hope to get a better feel for which insurance companies our patients have that we can efficiently use Tesia's services for. Perhaps on the coasts the majority Tesia has electronic access agreements with the majority of insurers. We put a fair amount of effort into trying to make Tesia work for us earlier this year. Perhaps we can build on what we have learned with that attempt. Years ago (before HIPAA) we did electronic claims with no problems. We were on a different practice management software at that time. We love Open Dental, and the Open Dental - Tesia interface seems to work well. We figure it is worth another try.

[cneelley]

We are using Renaissance service, and it has worked extremely well. I used Tesia for a short period of time earlier this year and had no problems. It is just that I am so used to using Renaissance that I don' want to change, even though they have recently gone up to $39.95 a month for unlimited claims. I like the feedback, it is so easy to understand. I have been using them for several years. They will mail claims to carriers when they do not have electronic connections, and I do not have a problem with this.

We accept assignments on all insurance plans, whether or not we are a PPO provider. I am a little confused about what you are saying about having to be a provider in order to get an assignment of benefits??

Dr. Neelley

[Rickliftig]

We have been using Emdeon with few problems. Most all errors have been caught before we have had to take action. There have been several instances of incorrect payor numbers, however. It's amazing how the company's don't even know theirown number! Also, sveral times, the payor may have a similar name, but be a different entity (ie. Delta vs. Delta USA)

[jordansparks]

Wow. Very sorry to hear that. If you want to try a different clearinghouse, ClaimConnect would be a good bet. I would stay away from Renaissance because our interface with them is not good enough.

[KCalla]

To clarify, there are a few insurance companies, like the local Blue Cross, that will not allow the patient to assign benefits to the provider if the dentist is not a participating provider. For our patients with that Blue Cross coverage, for example, Blue Cross will send the benefit check only directly to the patient because I am not a Blue Cross participating provider in their PPO. It is a way the insurer uses to encourage more dentists to become part of their network. As you say, the majority of insurers do allow out of network assignment of benefits, something that both the patients and we appreciate.

[Rickliftig]

We have the same issue with Delta. I believe what our front desk does on the Deltas is to mark them as received and bill the patient immediately. I believe that if you do NOT set the checkbox (in the insurance setup) as "benefits payable to the dentist" that this happens automatically.

I'm not sure (but can find out) if they are entering benefit payments and percentages after the fact.

[KCalla]

We are doing the same with Blue Cross as you do with Delta. It works well for us. Probably the only difference between what you do and what we do is that you are probably successfully sending the claim in electronically, and we are printing and sending the the Blue Cross claim by surface mail because, that way, Blue Cross gets it the next day. We'll try electronic to Blue Cross through Tesia or one of the other companies mentioned in this thread again this fall. Our Delta does not accept Tesia claims electronically (and, from what I can gather calling and asking, is unlikely to do so because Tesia is not a big player in this state), so Tesia has to print the claim and then send it by surface mail to the Delta office, which is only a few miles away from our office. We can submit the claim to Delta online directly to their website (unfortunately, this is double entry for us, but their portal is very user friendly). By doing so, the claim is adjudicated overnight and can be either direct deposited the next day or mailed to us.

[Rickliftig]

And when all else fails, we also send the form through the post office. These insurance companies gotta realize they're in the 21st century!

[bobo221]

Anyone tell me how to contact Renaissance clearing house?

Thanks

Bob Orenstein

[jordansparks]

http://www.rss-llc.com/