• Quality • Loss Prevention • Quicker Payment • Less Work • Increased Efficiency

How electronic filing can help your practice boost efficiency and get paid faster.
By David Pettigrew, D.M.D.
(Payer Article)

Recently I was wrapping up a course I teach on CDT procedure coding when I asked how many dentists in the audience used practice management software (PMS).

Most of the audience members—about 30 professionals representing 25 mid to high-end dental practices—raised their hands.

"And how many of you submit your claims electronically?" I asked.

This time five hands went up.

I was dumfounded.

"Why not?"

The answers were typical: "There's nothing in it for the dental office," one dentist said. "The insurance companies are the only ones that benefit," another said.

Time for a Reality check!

Well, I'm here to say that nothing could be further from the truth.

According to the 2004 Dental Products Report Technology Survey and the American Dental Association, more than 90 percent of dental offices use computers in their offices and more than 75 percent use practice management software. Yet insurance companies that accept electronic claims—more than 300 of them—state that only 30 to 40 percent of their claims are electronically submitted.

Fact is, if your office participates in benefit plans, uses practice management software, and files claims manually, then you're missing out on major benefits in efficiency, productivity, cost control, and peace of mind. If you don't use computers in your practice, then consider electronic filing to be one more reason to move into the digital realm. Let's examine some good reasons to submit your claims electronically and find out what's in it for you.

1—Quality control

How many times have you submitted a claim or pre-determination only to have it returned six weeks later because of an omission or error, such as an incorrect group number or wrong procedure code? You need to correct the error, resubmit, and begin the whole process over again. Meanwhile, the patient is waiting for his/her prosthesis.

If you submit your claims or pre-determinations electronically, they arrive at the insurance company virtually error-free.

At various points in the filing process—from the software in your computer to the clearinghouse(s) and ultimately the insurance company where processing occurs—the claim is subjected to various checks, called "edits," that monitor accuracy and completeness.

If mistakes are found, a message is sent back to your computer at the office—usually within a day or two. You can make the correction and immediately re-file. 

These detailed reports are returned to you each time you transmit your claims. The reports may vary, depending on your software, but generally include:

• Submitter Report - generated prior to submitting your claims
• Transmission Summary – confirms that the claims were received electronically and summarizes all the information sent
• Claim Status Report - a verification report generated from an insurance company that explains if a claim was rejected, denied, or needs additional information submitted before it can be processed (e.g., invalid provider number, social security number verification, group number not found, etc.)

2—Loss prevention

How many times have you submitted a claim, waited for several weeks, and, after no reply, called the insurance company's customer service only to find that they never received the claim.

Electronic claims are assigned tracking numbers that allow you to locate them wherever they are in the process.

If a claim is overdue you can trace it using this number and determine where it stalled. What this means, in short, is no more lost claims.

3— Quicker payment

How would you like to receive your reimbursement in two to three weeks (maybe even quicker) instead of six to eight weeks or more?

A paper claim passes through many hands before you receive benefits. These include stuffing the envelope by hand and mailing it; time spent traveling in the mail; receipt and sorting by the insurance company; manual entry into the computer for processing; and printing of a paper check. And you still have to deposit that check when you receive it.

Now consider that when electronic claims leave your office they are received and usually processed without ever being touched by a human being. There is no mis-sorting, no mistakes made by a claims processor keying an incorrect procedure into the computer, and, most importantly, no paper to lose or misplace.

Many companies offer EFT (Electronic Funds Transfer), so rather than receiving a paper check, arrangements can be made to have benefits electronically deposited directly into your office’s checking account.

4—Less work

Electronic claim submission takes the hassle out of submitting x-rays or making duplicate films.

Many insurance companies accept electronic attachments. This means that your office can submit most forms of documentation (x-rays, periodontal charting, narratives, etc.) electronically.

You have two basic options concerning x-rays. One is to purchase a digital radiography system. The other is to convert your traditional films into a digital format using a special scanner.

Some payers accept digital attachments directly while others use a repository, such as the one managed by National Electronic Attachments Inc. (www.nea-fast.com).

5—Increased efficiency

How much time does your office staff waste on the phone with customer service representatives confirming patient eligibility?

A busy office often has a staff member spend as much as half a day, every day, checking on the next day's patients. But as electronic claims processing becomes more sophisticated, an increasing number of payers are allowing dental offices to check patient eligibility, dental plan specifics, and available benefits online.

What about claims you have already submitted?

Offices often waste even more time trying to find out where a previously submitted claim is in the payer’s system. Imagine no longer calling the payer for this information and, instead, looking it up yourself at any time of day when it’s convenient for you!

Emdeon Dental Services offers your practice an easy way to accomplish these time consuming, frustrating tasks via one web portal, accessing many different payers. In January 2006, Emdeon Dental introduced their portal, which will make telephoning the payer obsolete. At www.emdeondental.com, your office can receive eligibility and benefit information along with claim status directly from the payer. One portal – many payers – multiple transactions. And there are even more opportunities to immediately handle other pieces of the revenue cycle, including electronic remittance advices and electronic funds transfer.

What to do now?

If you don't have a computer or practice management software, consider making this intelligent investment.

Many articles have been written on implementing electronic claim submission. It's a big step, so do your research. (You can search the vast resources of Dental Practice Report and Dental Products Report and conduct a focused search of dental literature and manufacturer information on the Internet by using DentalExplorer Search at www.dentalproducts.net.)

Talk with your colleagues who have made the conversion, read everything you can on the topic, and visit the different software vendors at dental conventions.

Determine your needs and budget limitations. Let your staff assist you so they feel involved in the process. This often reduces resistance from office staff who might feel threatened by the conversion.

If you already have a computer with practice management software and are not submitting claims or pre-determinations electronically, dust off the training manuals and contact your vendor representative. It should be relatively easy to start electronic submissions.

Contact the various insurance companies you deal with. Most have staff dedicated to assisting dental offices submit electronic claims. These people are extremely helpful, can explain the requirements for their particular plans, and how to sign up.

The majority of payers have portions of their websites dedicated to providers, who can obtain information as to what documentation is required for what services, as well as how and where documentation should be submitted.

Providers can also contact Emdeon Dental Services at www.emdeondental.com or call 888-416-0673, Option 2, to speak to a representative who can help you get started. Emdeon Dental connects dental practices all over the country by partnering with over 130 practice management software systems, 300 dental payers, and processes more than 90 million dental claims annually nationwide.

David J Pettigrew, DMD received his B.A. from Lafayette College and his DMD from Fairleigh Dickinson School of Dentistry. He completed a General Practice Residency at Englewood Hospital and has been in private practice since 1977. He is a member of the American Dental Association, New Jersey Dental Association, and its local component. He has conducted lectures for students and graduates at the University of Medicine and Dentistry of New Jersey, and throughout New Jersey, New York, and Pennsylvania on Electronic Claim Submission (EDI), CDT (understanding and correct coding of dental procedures for insurance), and CHIP (Child Identification Program). Dr Pettigrew has been Dental Director of Horizon Blue Cross Blue Shield since 1994.