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pksaari79
Premolar III

Insurance Claims

I check the status claims frequently, to make sure none have been paid and not deleted.  I also have our insurance coordinator check these and we both look at the e-claim status.  When we do, as we have one now, there are times the claim has been finalized due to max use of their benefits.  When a claim comes through, we delete that claim as it gets paid and keep them by scanning them under each date they get posted.  BUT I wonder, can we use the e-claim status as our EOB to get it off our books, so to say, and scan that....esp if it's marked they aren't paying.  We are not contracted but do we need to wait for THE EOB to tell us this....or is this a form of an EOB? softdentgirltshawdanelle.canales

lindamoseley

6 Replies
CS Dental Employee
CS Dental Employee

Re: Insurance Claims

jeremy.dempsey

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CS Dental Employee
CS Dental Employee

Re: Insurance Claims

Kay,

I would be hesitant to recommend marking a claim as finalized based only on the claim status check. The reason for this being that the claim status check returns what the status is at that moment and is not considered a replacement for the EOB. The EOB would be the final word after all reviews internally at the payer. Once you receive the formal EOB via paper or email, I would then attach that to the patient and finalize the claim. 

My recommendation has always been to follow up on unpaid claims within 30 days. Claim status can save you a phone call if a claim is slated for payment but the check just hasn't arrived yet(if claim is approved within a week or so of current date). If claim status shows a claim is denied, I would investigate why with what details are in the claim status and then potentially contact the payer for further information. I have seen many claims that are denied for easily correctable reasons. 

pksaari79
Premolar III

Re: Insurance Claims

Thanks for that information.  We will wait for the EOB to come.  We do exactly as you suggested....we generate a report that we run weekly and do check on insurance claims 30 days and older.  By doing this, we really don't have that many to check on, which is nice.  And if one is to be paid or has been sent, we might give it a couple of weeks and call again. We are good about calling and making sure money is sent as it should!!  I recently learned about the e-claim status and it has been a WONDERFUL help to monitor claims, instead of waiting on the phone to get the same information.  Happy Monday!!

bswh
Canine III

Re: Insurance Claims

Hello Kay, can you explain to me what you mean by e-claim status... is it something through Softdent or on the individual insurance websites?

Thanks Paula

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pksaari79
Premolar III

Re: Insurance Claims

It is through Softdent.  If you look under List, then find Claim (OR just do Ctrl Y), you will get a list of your outstanding claims with the oldest at the top. Not all have that capability, just like you can't always get eligibility.  But if you highlight a particular claim, look at the top for choices, and select the last one which is e-claim status.  If you double click it with the left button AND wait for the timer to stop, you will get information about the status.  I do not remember if this is a separate paid item but it has come in handy to track claims.  In fact, I just found one that said it was not found...so it means we need to do a little research on our end as to why.  We also get where they may be finalized and we know the check is coming, so if it is near the 30 day mark where do call and check on outstanding claims, we may not on this one because of the info we can see.  Otherwise we would call the insurance company and talk to who-knows-who and spend a lot of time.  This just helps with the process on claims.  Make sense??

CS Dental Employee
CS Dental Employee

Re: Insurance Claims

Hi Paula,

The Claim status check is a way to view the status of the claim electronically, it is not available for all carries, but is for most of the major insurance companies.

Try the following steps (for Quick eVerification also known as eClaim Status)  

From you main window in SoftDent 

Press CRTL-Y (this will list all unpaid claims)

highlight a claim 

look on the toolbar for eClaim Status (if it is not greyed out you can check it)

Click eClaim Status (the magic happens) 

the status will pop right up 

I think you have a 9 month window 

Wendy

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