Completing special enrollment forms for claims

Some insurance carriers, such as Blue Cross/Blue Shield and Medicaid, require a special enrollment form to be completed for processing electronic claims through DentalXChange, the clearinghouse that is used by Dentrix Ascend. These payers will not accept or pay for electronic claims until the applicable form has been completed and processed. Henry Schein One provides a search tool to help you determine if a payer requires a special enrollment form and provides a link to the applicable form.

To complete a special enrollment form

Open the Dentrix Ascend Payor Search Tool page (www.dentrixascend.com/products/eservices/eclaims/payer-search).
In the Payer ID or Payer Name box, enter all or part of a payer ID or name, and then click Search Payers.

The matching payers appear in the list.
If a payer requires a special enrollment form, a green check mark icon appears in the Special Enrollment column. Click that icon.

The DentalXChange website for Henry Schein One products (https://www.dentalxchange.com/channel-partner/lp/henry-schein-one) appears on a new browser tab.
Click Enroll in Claims.

The Claims Enrollment Form page opens.
For Which payers would you like to enroll for Claim Submission?, select the checkbox of each payer you submit claims to. Only the payers that require special enrollment are listed.
For Practice Information, specify the following practice information: name, address, Tax ID, billing NPI, and Medicaid ID (optional). Also, select Dentrix Enterprise as your Practice Management Software.
For How many providers do you want to enroll?, select the number of providers to be enrolled.
For each provider being enrolled, a Provider [#] Information section appears. For each provider, type the full name and NPI.
For What is your contact information?, type your name, job title, email address, and phone number.
For Complete the verification below, select the I'm not a robot checkbox.
Click Submit.