Dental Electronic Claims Clearinghouse: What Is It and How It Can Optimize Billing

A dental electronic claims clearinghouse can be considered the middleman between dental care Providers and insurance Payers. Think of a clearinghouse as an editor for your dental claims, looking for errors and ensuring the claims can get correctly processed by the Payer. After the claims are checked for inconsistencies, they are routed electronically to the necessary insurance carriers. 

It’s clear that a dental clearinghouse is an efficient part of dental insurance claims processing, but what is the problem it solves? Why do Payers and Providers utilize a dental claims processing vendor? 

Dental claims processing workflows are ripe with opportunity for error. Countless dental claims are filed on a daily basis using thousands of different practice management softwares to send claims, x-rays, and other collateral to a wide variety of insurance carriers across the country, all with Payer-specific edits and regulations.  If this wasn’t enough, the dental claims process used to be carried out via mail.  While the process is complex and often error-ridden, there is still room for improvement.

With the integration of electronic claims processing and HIPAA mandates, the dental claims processing workflow has become much more streamlined. By minimizing touchpoints and adding the ability to track claims throughout the entire process, dental electronic claims clearinghouses create a far more manageable workflow compared to the complex, manual process that once existed.

What to Look for in a High-Quality Dental Electronic Claims Clearinghouse

The goal of partnering with a dental claims clearinghouse is to implement a more streamlined exchange of claims data. Providers and Payers need claims and dental information properly edited and organized for the most streamlined processing possible. This is what a high-quality partner can achieve. 

Dental clearinghouses hire expert technologists who know how to bridge the gap between Providers and Payers. These organizations have a firm grasp on quality control and have payer-specific edits in place, to recognize errors prior to claims being sent out to the Payer. 

Trained electronic claims experts take the reins from internal processing teams. While internal teams often do quality work, they don’t have the time or resources e to understand all of the specific payer requirements to deliver a clean claim to the insurance carrier.

HIPAA Compliant Entity

When searching for a dental electronic claims clearinghouse, be aware that you are partnering with a HIPAA-compliant entity. Clearinghouses are one of several entities that require HIPAA compliance, which only guarantees that your data and personal information is well protected. Smart Data Solutions’ Stream Clearinghouse is also HITRUST-certified, ensuring the utmost safety and security of your data.

Streamline Claims Processing with Communication

Communication is key to effectively outsource dental claims processing. Partners such as Smart Data Solutions rapidly resolve problems with expert communication. The dental claims process becomes incredibly efficient by having a clearinghouse partner that communicates properly with all necessary parties, ultimately resulting in faster payments and fewer denials. 

One main benefit of having a clearinghouse partner is that they can be fully immersed in your claims workflow. They’re dedicated to processing, issuing, and disputing claims, without having to split their focus with other roles or duties. Not only do the workflows themselves get streamlined by funneling directly through a digital mailroom, but payments can be processed within days, and denials or disputes can happen much faster.

What Does the Dental Electronic Claims Process Look Like?

Dental electronic claims clearinghouses maintain a strong focus on quality control through their diligence in reviewing electronic claims. These electronic claims are created with a variety of claims software used by Providers, which then goes through data scrubbing. “Scrubbing” is a term used to describe analyzing information to make sure it’s secure and precise. This includes, but is not limited to, checking for errors and inconsistent data elements, with the end result of accurate information.

A dental electronic claims clearinghouse then receives the scrubbed claim, beginning the quality control process. During the quality control process, a claim is checked for code errors or discrepancies, while also ensuring that the patient information is correct. Quality control is essential, as it keeps claims from being discharged or denied, a critical necessity that keeps the workflow operating at top capacity.

For reference, at Smart Data Solutions, our quality control edits fall into three different categories:

• Data Integrity Edits: A sensitive edit used to weed out data entry errors. For example, if the billing “from date” is after the “to date”, the claim is highlighted for review. 
• Transformation Edits: This includes items such as name parsing and conversion from minutes to units for anesthesiology claims.
• EDI Compliance Edits: This edit is to ensure that a claim follows EDI rules. For example, on a UB an occurrence code must be accompanied by an occurrence date.

These benchmarks help us provide accurate information on every electronic claim. 

Smart Data Solutions provides businesses with a more streamlined and steadfast dental electronic claims process than ever before with our EDI/Clearinghouse services. Ready for an efficient workflow? Fill out this form to get started!