Processing unresolved claims

Dentrix Ascend provides an interactive tool to help you manage unresolved claims.

Note: A claim is considered to be unresolved if any of the following criteria are met:

• Overdue - The claim is considered to be overdue if both of the following apply to it:

  • The claim was submitted longer ago than the cut-off date (1-360 days) that has been specified for the corresponding carrier.

  • The claim has one of the following statuses: Sent, Paid (the payment was sent by the carrier but not received by your office), Accepted, Pending, Queued, Printed, Resubmitted, Settled, or Attachment Hold.

• Rejected - The claim is considered to have been rejected (by the payer or clearinghouse) if it has one of the following statuses: Zero Payment, Rejected by eServices, Rejected by Payer, Unprocessable Claim, Additional Information Requested, or Attachment Error.

• Requires additional follow-up - The claim is considered to be unresolved if it was previously unresolved, a follow-up reminder was applied to the claim, and the specified number of days for that reminder has elapsed.

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 unresolved insurance claims, the number of unresolved claims that have been rejected, and a total of the charges for those claims. Click (or tap) anywhere in the box, or click (or tap) the Rejected counter in the box to focus on rejected claims.

     

   • On the Home menu, under Location, click (or tap) Overview. On the location's Overview page (dashboard), the Insurance A/R Problematic Payers box displays a graph that represents by carrier the percentage of unresolved claims that were created over 30 days ago. Click (or tap) any of the bars on the graph.

     

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

   The Unresolved Claims page opens with the Unresolved Claims tab selected by default.

   

   Notes:

   • The claims are grouped by insurance plans, which appear as expandable and collapsible sections. Expand a plan to view the corresponding claims.

   • To list only rejected claims, set the Show only rejected claims switch to On. If you clicked (or tapped) the Rejected count on the Unresolved Claims box, this switch is automatically set to On.

     

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

     

2. Select a claim.

   

   The claim options become available.

   

3. Do any of the following as needed:

   • Click (or tap) the Visit carrier page link to view or update the insurance carrier's information.

   • 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.

   • Enter any relevant Notes.

   • Select one of the following options:

     • Set Follow up - To specify that the claim needs additional follow-up, select this option. Specify who to Follow up with (carrier or patient) and when you want to be reminded to follow up. The claim will not appear on the Unresolved Claims tab until the specified number of days in the In days box has elapsed.

       Tip: If you enter zero (0) in the In days box, the claim will reappear on the Unresolved Claims tab after one hour.

     • Dismiss claim - To move the claim from the Unresolved Claims tab to the Dismissed Claims tab, select this option. You can move the claim back when necessary.

       Note: Dentrix Ascend excludes dismissed claims from the total number of overdue insurance claims and the total amount of the charges for those claims.

   Note: For an electronic claim submission, Dentrix Ascend transmits separate service lines for identical procedures on 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 Dentrix Ascend Customer Support with that information so the needed functionality can be provided.

4. Click (or tap) Save.