The CDA (Canadian Dental Association) iTrans enables dental offices to securely and electronically submit dental claim benefits on behalf of patients to insurance companies. EDI (Electronic Data Interchange) is a method for dental offices to submit dental claims electronically. The CDA created CDAnet to give Canadian dentists EDI capabilities. Below are some common tasks you would come across using our ClearDent EDI transaction manager.
View EDI responses from a patient ledger ClearDent has made it easy to access info regarding claims that have been submitted to the insurance company.
- Click on the Ledger tab
- Highlight the claim in question
- Right-click on the claim
- Select “View EDI response” from the menu list
- This will launch the EDI transaction manager and bring you directly to the explanation of benefit (EOB) that you received for that patient from their insurance
- Click on the “Details” button to access additional information about the claim
Check outstanding EDI responses To check any outstanding EDI responses, follow the steps below:
- From the main screen of Cleardent, click on the “Credit card manager”
- Then click on the “EDI transaction manager”
- Once it’s open, click on “Wizard”
- Select “Check mailbox for outstanding transactions and ClearDent emails”
- Then click “Next”
- Check the provider that you want to see the outstanding transactions from
- If you’re using iTrans, check “A CDA-ADQ paperwork” and select the iTrans selection
- If you’re not using iTrans and are using a modem, check “An insurance carrier” and select the insurance company you want to see outstanding claims from
- Click “Next”
- Once the transaction has gone through for the outstanding, you will see which has come back and get a reference number
- When you click “Finish”, you can print it out and see details as to which patients the outstanding transaction has been completed for
Skip the EDI wizard screen when non-ortho codes billed When creating an invoice to send to insurance, a window will pop up that allows you to change payee, add in the school name, and specify whether it’s an orthodontic claim before sending it out. Additionally, if it is a denture claim, the initial or prior placement claim would need to be entered. In most instances, you won’t need this screen if the majority of your claims will be for treatments like hygiene or basic restorations. Luckily, there’s a handy setting that allows you to skip this screen, saving you that extra click before submitting the claim electronically.
- Go to the Configurations menu from the main screen and click “Practice information”
- On the EDI tab, select “Skip Claim Detail for Non-Ortho EDI submission”.
- This will skip the additional window that pops up when you are submitting the claim if the orthodontic tag is unchecked
However, rest assured that this setting only skips the window if the orthodontic box is not checked. If there are ortho codes entered, the window will still appear as you would need to know if it’s an ortho billing.
Auto-adjust fees on invoice based on the EOB response ClearDent has an auto EOB reader function that allows you to charge the patient exactly what the EOB says you should be charging. This comes in handy in a number of scenarios: if the patient has insurance but you haven’t put in all the details of the coverage they have yet, if their plan is on an older fee guide coverage, or if they haven’t updated you on their new coverage yet. ClearDent will automatically calculate what falls under the patient side and the insurance side of the ledger based on the coverage that was inputted. But if the information is not accurate, the EOD from the insurance after sending the claim will most accurately reflect what the insurance is going to pay you.
If the patient is a non-assignment patient (the cheque comes to the patient), you won’t need to track it specifically. For reporting purposes, you can get a sense of what their coverage is without sending an EOB but when you turn on the feature, it’ll read the EOB and automatically update the invoice to which side the ledger the balance should fall on. To turn on this feature:
- Go to the Configuration menu
- Select “Practice information” and select the EDI tab
- Under “Auto adjustment after the EOD”, select whether to enable it just for the primary insurance or for duel insurance EOB. If you choose duel insurance, ClearDent will automatically update the invoice to match that secondary EOB once it comes back
- Some insurance companies will actually talk to each other through iTrans so you get an EOB from both primary and secondary together without having to wait for one and then the other
With this feature enabled, when you get to that final screen, the patient balance is going to match what the EOB says, regardless of what you have listed on the patient’s file. There are some instances when the EOB auto-adjust feature won’t work: if the claim is backdated or if the procedure code is split and does not match the EOB response. If there’s no EOB received, it will not automatically be adjusted. It will still be based on the details you have in the patient’s insurance breakdown. If the patient is not an assignment patient (the default payee is set to subscriber), and the cheque is going to the patient, then leave everything on the patient side of the ledger. You don’t want to have any of it showing on the insurance side of the ledger because the patient will pay the bill on when they come in for their appointment.
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