Processing unresolved claims

From the practice dashboard, you can manage claims that are overdue. A claim is overdue if it was submitted 15 or more days ago and has one of the following statuses: Sent, Accepted, Pending, Printed, Unprocessable Claim, Additional Information Requested, NEA Error, or Paid (the payment was sent by the carrier but not received by your office). A claim will also be unresolved if it was previously unresolved, a follow-up was done, and then an additional follow-up reminder was applied to the claim. Unresolved claims also include any claim with a status of Rejected (by the payer or clearinghouse).

To process an unresolved claim

1. Do one of the following:

   • On the Home menu, under Location, click (or tap) Overview. On the location's Overview page (dashboard), the Unresolved Claims box displays the number of overdue insurance claims and a total of the charges for those claims. Click (or tap) the box.

     

   • On the Home menu, under Insurance, click (or tap) Unresolved Claims.

   The Unresolved Claims page opens.

2. On the list of unresolved claims, leave the first claim selected, or click (or tap) a different claim.

   

   Notes:

   • The unresolved claims are grouped by insurance plans, which appear as expandable and collapsible sections. You can click (or tap) a plan's button to view the corresponding claims.

   • To quickly navigate to the Denti-Cal Reports tab of your location's inbox, click (or tap) the Denti-Cal Reports link.

     

   The claim options become available.

   

3. Do any of the following as needed:

   • Click (or tap) Review/Edit to view the claim. In the Claim Detail dialog box, make any necessary changes, and then click (or tap) Save.

   • Contact the insurance carrier and/or patient.

   • To specify that the claim needs additional follow-up, type any Notes, and specify who to Follow up with (carrier or patient) and when you want to be reminded to follow up. Then, select the Dismiss Claim check box to remove the claim from the list until the specified number of days has elapsed.

   Note: For an electronic claim submission, Dentrix Ascend transmits separate service lines for identical procedures on the the same claim. For the known carriers, such as Medicaid and Blue Cross/Blue Shield, that require a single line with a quantity value for identical procedures on the the same claim, claims are processed accordingly through the clearinghouse. If you receive a notice from a payer, stating that a quantity value is required for identical procedures, contact Support with that information, so the needed functionality can be provided.

4. Click (or tap) Save.