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Dental Claims: What Information is Required for Filing a Dental Claim?

Even though diagnosis and billing codes may vary from patient to patient, a few items are required consistently on each dental claim. We’ll now discuss which items you’ll need to ensure are visible on each claim before submission of payment to the payer.

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What’s Required

The following information is required for filing a dental claim. Each claim that your practice submits to payers needs to include the following:

  1. The Subscriber’s ID;
  2. The Patient’s Name, Date of Birth and relationship to the Subscriber;
  3. The Dentist’s name or Practice Name, Tax Identification Number or Social Security Number, National Provider Identifier (NPI) and phone number;
  4. The American Dental Association procedure code number (CDT), treatment date, tooth number, tooth surface(s), doctor’s fees, and a narrative or description of services as appropriate;
  5. The Member’s signature for release of information and/or assignment of benefits. Signature on file is acceptable;
  6. The Dentist’s signature.

Ensuring Correct Submission

In order to ensure that each claim is correctly filed and submitted to the payer, it is advisable that your dental practice maintain an up to date practice management software. These softwares will allow your staff to enter the necessary data that is required for proper dental claims.

Be sure that the software you use for your dental practice is optimized to include the required data for each patient. For example, you might be able to create forms within your practice management software that allow you to created mandatory or required fields to be filled out before the form can be officially saved to the patient’s chart. Check with your software provider to see if these options are available to you.

In addition to practice management software, it is important that your practice utilize a clearinghouse. A clearinghouse is a software that integrates with your existing practice management software to scrub your dental claims for errors or inaccuracies. The clearinghouse notifies your claims staff of errors within the claims, allowing the claims professional to address and correct the errors before final submission.

If you would like more information regarding dental claim clearinghouse submission, check out our Dental Provider page to learn more.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Dental Claims

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Chiropractic Claims: Tips to Submit Accurate Chiropractic Insurance Claims

As an increasing number of insurance companies are providing chiropractic benefits to their subscribers, chiropractors are submitting claims to insurance more regularly. Here are a few tips for submitting accurate chiropractic claims.


Date of Service

In many states it is required to include the initial date of service within a chiropractic claim. This initial date of service is intended to provide the very first visit of the patient to your practice, in which you, as the chiropractor, provided diagnosis and treatment for the patient requiring relief from subluxation through chiropractic care.

It is important to note that “date of onset” and “date of initial treatment” are not necessarily the same date. A patient may have acquired an injury several days or weeks before the actual chiropractic treatment had been initiated. Be sure to discuss the date of onset with your patient and make a record of it for claim submission.

Therapies Provided

Detailed documentation of the exact chiropractic therapy provided is essential to accurate chiropractic claims submission. For example, if a patient is requesting treatment for lower back pain, it is required that the exact vertebra that is in subluxation be recorded within the claim. Then articulate the adjustment completed to remedy the subluxation, and any additional therapies completed to ensure proper adjustment and setting of the vertebrae or extremity.

Keeping It Organized

In order to ensure that all of your claims are properly filed and submitted, it’s important to maintain an up to date practice management software and the records that correspond with that software. In addition to the practice management software, it’s important to incorporate a clearinghouse that integrates with chiropractic claims.

One such clearinghouse is Apex EDI. Apex integrates with dozens of practice management softwares to ensure proper scrubbing of chiropractic claims. For more information about how Apex EDI can help your chiropractic practice maintain accurate claims submission, be sure to check out our Chiropractic Claims page or contact us today.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Chiropractic Claims

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Claims Processing: Medical Claims vs. Vision Care Claims

When handling claims regarding eye health, there are a few things to be aware of. For example, there are specific differences between what can be billed to a vision plan and what should be billed through medical insurance. Let’s discuss the difference between the two claims, and why eye care professionals need to know the difference.

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The Difference

Vision plans cover routine wellness exams for eye health. This means examinations for near- or farsightedness, astigmatism, and corrective lenses. Medical eye care on the other hand is for the treatment of specific medical conditions related to the eye, such as pink eye, cataracts, double vision, etc.

Why It Matters

As we discussed above, vision plans cover annual exams for eye health. When an exam reveals a condition such as pink eye, cataracts, glaucoma, dry eye, or another condition, the diagnosis and treatment is billed through the medical eye care insurance. A medical eye condition typically requires a more intensive treatment plan than what is covered through a run of the mill vision plan, which is why medical insurance typically steps in.

As the provider, you will want to ensure that you are billing the correct insurance in order to receive the fees you are due. Many eye care professionals bill the vision plan first, and then reach out to the medical plan if any fees have yet to be covered. It is also important to discuss the plan of action with the patient so that they are aware of how the services will be billed to their insurance and that they are aware of any fees that may accrue due to their specific plans.

The Solution

In order to ensure the best possible care for your patients and management of your optometry practice, implementation of a clearinghouse for claims billing is recommended. A clearinghouse verifies vision and medical claims before they can be sent to the payer for final submission.

Apex EDI is a user friendly and fully integratable clearinghouse that works to get you paid faster. For more information about how Apex EDI can be used to benefit your optometry practice, click here.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Claims Processing

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Dental Claims: Why You Should Use Dental Billing Software

Smiling woman at dentistAs a dental provider, you wear a lot of hats. Dental claims billing might be one of them. Let’s discuss why it will be beneficial for you and your dental practice to consider using a dental billing software, such as Apex EDI.

Specialized Software

Dental claims codes are completely different from standard medical claims codes. Dental billing software is designed specifically for dental claims billing. Without an efficient software to integrate with your practice management system, you’re risking increased opportunities for errors, missed claims, or denied payments.

Apex EDI dental software integrates with your existing dental practice management software to create properly completed dental claims to be billed to payers. Apex EDI will alert the dental claim preparer of any errors that may be present on the claim to be submitted. Such errors might include a typo, or an absence of other information such as x-rays.

Faster Processing

With the right dental billing software, your practice can get paid more quickly. Traditional dental claims filing through the postal service or through fax or email can take weeks to process. A dental billing software allows claims to be processed in significantly less time.

For example, Apex EDI provides real time information on the claims processing progress. Not only will you be able to view patient eligibility and benefits within minutes, you’ll also be able to process dental claims faster and more efficiently.

Faster processing means faster payment for your dental practice, so you can focus on providing exceptional service to your patients.

Cost Savings

Another benefit of using a dental billing software is the cost savings that is associated with the practice. Dental billing software traumatically cuts down on the physical paper trail of information, as well as postal service and shipping expenses to send claims to the payer.

Apex OneTouch (the desktop app) allows for the seamless integration of your existing dental practice management software with the EDI to provide exceptional cost savings and efficiency for your dental practice.

For more information on Apex EDI for Dental Practices, be sure to check out our Dental Claims page.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Dental Claims

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Medical Claims Processing: How Do Medical Claims Work?

medical expensesThe medical claims industry is only a small part of the trillion dollar healthcare field. However, it is arguably one of the most important aspects for providers, as the medical claims process allows physicians and practitioners to maintain their clinics and businesses by receiving payment for their services. Let’s take a look at how medical claims actually work.

Services Rendered

The first step is for a patient to request services from a healthcare provider. The healthcare provider then grants services to the patient, be it in the form of a physical exam, diagnostic procedure, or any other billable service.

Each service is recognized in the medical industry with a unique code specific to that service. When the physician completes the patient report, the report will be submitted to medical claims with the appropriate medical codes for the services rendered.

Processing The Claims

The next step is to process the claims. This can be completed via traditional methods, such as fax or postal service. However, many practices are now implementing electronic claims processing, as it is significantly more cost effective, efficient, and secure than traditional methods.

The claims preparer examines the physician’s report on the patient. The preparer verifies that the claims codes are correct for the services that were rendered. The preparer creates the claim that will be sent to the insurance provider for that specific patient. The preparer might use a software such as Apex EDI for secure and efficient transfer of documents to the insurance company.

The claim is then processed by the insurance company.

Payment, Denial, and Appeals

Once a claim is processed, it is either approved or denied. A claim can be denied for a variety of reasons. The reason for denial could be as simple as the insurance company requesting more information before approval, or it could be that the service rendered is not an eligible service under the patient’s insurance coverage.

When a claim is approved, the insurance provider issues payment to the clinic or physician that submitted the medical claim. When a claim is denied, it may be resubmitted by the preparer, or the patient can appeal the denied claim to their insurance company. Typically a denied claim will require out of pocket payment from the insured patient in order to cover the cost of services rendered. However, a few exceptions have been made through lengthy appeals processes.

While medical claims billing might seem like a fairly straightforward process on the surface, there is a bit more to it than this article can provide. If you would like to know more about the medical claims billing process and how this aspect of your business can be streamlined with an EDI software, be sure to reach out to us by filling out the contact us form here. The professionals at Apex EDI will be happy to assist you with any questions you may have about improving your medical claims process.

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 

Posted in: Medical Claims Processing

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