Clearinghouses

Clearinghouses

If you'd like to send claims electronically and take advantage of a number of Electronic Data Interchange (EDI) benefits like electronic payments, and ERAs/EOBs, you'll likely work with a clearinghouse.

Most dental insurance companies don't directly accept electronic claims and clearinghouses offer additional benefits, such as managing claims all in one place and the ability to catch claims errors faster to speed up payments. Each one operates a bit differently. For example, some connect directly with lots of payors, while others aggregate claims and then send them to other clearinghouses that are connected to payors. Some are smaller or regional. Others are large. The services offered by each clearinghouse will vary too. 

Practice-Web integrates with a number of clearinghouses, so you can work with your preferred one. A few common clearinghouses include:
Once you sign up with a clearinghouse, you'll need to set up Practice-Web to reflect your choice.

Clearinghouse Setup

To access clearinghouse settings, click "Setup" in the main menu, choose "Family / Insurance" from the dropdown menu, and then select "Clearinghouses." The following dialog will open.


Setting a Default Clearinghouse

Clearinghouses appear in alphabetical order.  You can select a default clearinghouse depending on the activity by highlighting the clearinghouse in the list, then clicking the appropriate "Set Default" button in the lower left. Note that the "Is Default" column will reflect your selections.
  1. Dental: Sets the default clearinghouse for dental claims. Abbreviated "Dent" in the "Is Default" column.
  2. Medical: Sets the default clearinghouse for medical claims. Abbreviated "Med" in the "Is Default" column.
  3. Eligibility: Sets the default clearinghouse for insurance verifications and eligibility checks. Abbreviated "Elig" in the "Is Default" column.

Automatic Report Settings

Clearinghouse reports are accessible from any computer linked to your database once they're downloaded and processed. Settings for reports are addressed in the lower center portion of the Clearinghouses window.

The "Computer To Receive Reports Automatically" field determines which computer receives automatic downloads from the clearinghouse server to the Report Path. 
  1. If it's left blank, the feature will be disabled.
  2. Click the "This Computer" button to have reports pulled to the computer you're currently using or enter the IP address or computer/server name you wish to use in the field. 
The "Receive at" buttons determine when the computer will look for reports from the clearinghouse.
  1. Receive at an interval will default to 30 minutes, but you can enter numerals 5 to 60 to change the frequency.
  2. Receive at a set time allows you to choose a specific time of day for the computer to check for reports, such as 6:00:00 AM. The computer will need to be on at the time you select in order to receive. 

Add/ Edit a Clearinghouse

Click the "Add" button or double-click a clearinghouse line entry to open the "Edit Clearinghouse or Direct Carrier" window.


Each clearinghouse will have different settings. Run a search for your clearinghouse by name in the User's Guide to find the correct settings for yours. If you're unable to locate yours, connect directly with the clearinghouse for details or contact Practice-Web Support.

Clearinghouse Setup for Clinics

If your practice is using the Clinics feature, you can choose clearinghouses by clinic. A dropdown menu with your clinics listed will display in the upper right corner. Clinic-level overrides will be used instead of default settings when sending claims.



Clinic-Level Overrides

When adding or editing a clearinghouse with the clinics feature enabled, the Clinic dropdown will default to "Unassigned." Selecting a clinic will allow you to override specific settings at the clinic level. These items are highlighted below and include:
  1. Tax ID Number
  2. Name
  3. Telephone Number
  4. Login ID
  5. Password
  6. Claim Export Path
  7. Report Path
  8. Allow Sending Attachments
  9. Save Attachments to Images Module



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