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E-Claims

In dentistry, almost all electronic claims are sent to a clearinghouse before being sent to the insurance company.

X-12 Format

This is the format that we use because it is the standard defined by HIPAA. No other dental software that we know of creates claims in X-12 format. They instead lock you in to one clearinghouse, and their clearinghouse converts the data to X-12 format. But since DentOffice can create X-12 format, we have a distinct advantage over other dental software, because the format is theoretically accepted by any clearinghouse and by any payer. Some of the large insurance companies accept e-claims directly instead of using a clearinghouse, and more are moving in that direction. So you will eventually be able to send claims directly to some payers, and you will be able to choose your clearinghouse for payers that do not accept direct transactions. This will improve the quality and drive down the cost for everyone which was the whole point of the HIPAA regulations in the first place.

Clearinghouses

We list clearinghouses below that work well with DentOffice, and we list some basic information. But we will never recommend which one you should use. That is your choice to make.

ClaimConnect (formerly WebClaim): more details

Renaissance: Does not use X-12 format. This means less validation will be done before sending, and less data will be sent. On the other hand, this format has been tested for many months compared to our X-12 format which probably has some kinks to work out over the next few months. Long term, this format will be much less powerfull than X-12. more details

WebMD: more details

RECS: more details

Inmediata: more details

Insurance Carriers

If you submit a large percentage of your claims to one of the following carriers, it may be worth your while to set up an account with them so that you can directly submit e-claims. You will still need a clearinghouse to submit e-claims to other carriers. We will add carriers to this list as fast as we can.

none yet

Carriers Not Functional Yet

This is a list of carriers that we have preliminarily contacted. They all accept X-12, but we have not finished the functionality to send them claims yet. They are in the approximate order that we will be able to get them working.

BCBS of Georgia

ACS - Handles claims for Medicaid of Georgia and a few other states. Testing phase seems to be long.

Medicaid of NJ - Could take a few months since they require certification

Medicaid of TX