News

Update Regarding Change Healthcare and Recommended Options

Dear XLDent Client,

We have an update regarding our ongoing communications with the Change Healthcare team as we respond to the ramifications of this cyberattack.

Currently, Change Healthcare is in the process of finalizing an alternative network to use for submitting eClaims. However, this process is still evolving. We applaud Change Healthcare’s rapid response and dedication to keeping your data secure during this challenging time. They were unable to provide a specific timeline, but it has been stressed that Change Healthcare is sparing no effort in ensuring our shared data is secure with them.

In the meantime, we would like to detail the options available to our clients regarding claim submission as they currently stand.

Option 1:

Optum / Change Healthcare is offering a temporary financial relief program while they finalize an alternative network to use for submitting eClaims. This program would provide funding on a weekly basis that would need to be repaid after Change Healthcare is operational once more. We should have more information on this program by Monday.

Option 2:

If you wish to submit claims electronically during this time, you can upload Claims directly to individual payer portals. This would have the benefits of being able to immediately start submitting claims, and payments are likely to process quickly.

Items to consider with this solution would include:

• This method would require that you register for each individual payer portal.
• You would also need to manually enter claim details per patient for each payer, which would require more time from your staff.
• In XLDent you would need to be sure to manually mark claims as submitted and manually enter the payments into the software.
• Finally, any ERAs received during this period would not be tied to the appropriate charges automatically when Change Healthcare resumes normal service.
• If you are interested in this option, please see below for some basic guidance.

Option 3:

You can submit claims via paper or potentially fax to payers. This would ensure that claims can be sent to payers, and this would be a solution that you can employ immediately.

Items to consider with this solution would include:

• This method would include the potential for delayed processing and received payment.
• Claims can get lost in the mail, which might require re-submitting them in that situation.
• Some payers do not accept paper claims (although they may be willing to waive such restrictions during this critical situation)
• Medicare does not accept paper claims, so these claims would not be able to utilize this option.
• This is also dependent on having the supplies, such as claim paper, envelopes, and printing supplies.

Option 4:

You can use another non-integrated Clearinghouse to submit claims. This would allow you to submit claims to multiple payers with more ease.

Items to consider with this solution would include:

• This method would include that it may take up to 15 days to re-enroll with payers on the new clearinghouse for eClaims and ERAs.
• Furthermore, some payers are exclusively connected to Change Healthcare’s network and thus will not process in other clearinghouse environments.
• A non-integrated clearinghouse, as the name suggests, would not automatically interface with the XLDent software. This means that you would need to manually manage processed claims and payments issued within XLDent, and real time claim status would not be available.
• Finally, once this situation is resolved, you may need to enroll back with Change Healthcare for those payers. ERAs that were received during usage of a non-integrated clearinghouse would also not be tied as expected.

In closing, we would like to express our gratefulness for your patience and understanding during this critical period. We will continue to communicate information and temporary solutions as quickly as possible to help aid you, and we eagerly await the resolution of this situation.

Respectfully,

XLDent Support

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Submitting Claims to Individual Payer Sites

This information covers the general process for submitting claims to an individual payer site. Please note that every payer site is different, and will require a different registration process. This guidance assumes that you have followed the process of registering for that individual payer and are able to log into that portal.

1. Locating where to submit claims

After logging into the portal, you will need to locate where you can submit the claim.

Most times you will see a claims drop down and the drop down will allow you to select “Claims entry” or “Enter Claim/Predetermination.” Keep in mind that all insurance portals are different, and you may have to look around for the claims submission ability within the portal.

For example: Delta dental toolkit claims submission can be found by clicking “Member” on the left-hand side of the portal.

You will not be able to submit claims on all portals, some don’t give you the option.

Some portals may have you verify eligibility first but, that will be included in the claims submission process, you won’t have to go to the eligibility tab typically to look up this information.

2. Entering the Insured’s Information

Once you have selected claims submission, there will be a place to enter the insured’s information such as date of birth, name, and subscriber ID number. You will also need to select the date of service and select the place of service such as office, outpatient hospital, etc.

3. Entering Claim Data

Once you have entered the member’s information, you will be able to manually enter the procedure codes, procedure description (this may populate by itself), and if applicable, tooth number, surfaces, quadrant, modifiers, and fee charged.

You may also need to enter in NEA attachment numbers or upload documents that would ordinarily be included with a claim submission as well. A good rule of thumb is, if you were needing to add attachments to a charge when submitting a claim ordinarily, you would need to include that attachment somehow on the payer portal.

4. Submitting the Claim

Once you have entered all the procedures for the claim, there will be either a “Review” button or a “Submit” button to click. Once you have clicked that, you will have the opportunity to review your claim, and should have a confirm or submit button to finalize the claim.

The portal will typically provide you with a claim number that you can note for your records.