Dental Health Maintenance Organization

Online Dental Health Maintenance Organization Services are part of DentalXChange ClaimConnect. Claims submitted for subscribers who are part of a special network of dental professionals, known as a Dental Health Maintenance Organization (DHMO), use a different kind of claim. Dental Health Maintenance Organizations are insurance plans that restrict the subscriber to services rendered only from network dental professionals. For submitters, DHMOs provide a fixed payment on a regular basis, usually monthly, regardless of how many patients they see. A claim submitted to a DHMO insurance company is called an Encounter. The Practice must first sign up for the Online DHMO Services package.

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Aetna DHMO

To check a practice has signed up for the Package Online DHMO Services Package, select Account from the dashboard page.

From the Account page, under the Services section, select Add or Remove Services / Packages.

Ensure Online DHMO Services are appearing under Registered Solutions.
Add the Online DHMO Services if it is not appearing.

Select Account.
Select under settings DHMO Office Settings.

Enter the Aetna Office ID or enter the Group Health Cooperative of South Central Wisconsin ID.
If office doesn’t have the Aetna ID, the practice will need to call Aetna at (800)-451-7715 or check the ID in Aetna DocFind.
Select the Save button.

Account activation may take 24 to 48 hours for DentalXChange to verify the ID.
DentalXChange will send the confirmation email to practice once completed.
Allow 10-14 business days to start receiving Roster online.

Find A Provider ID on Aetna website

Navigate to Aetna's website.
Select tab labeled Search by NPI or PIN.
Select Provider ID (PIN) in Search by field.
Enter Provider ID.
Select Dental in Provider Type field.
Make sure the Aetna address matches DentalXChange’s provider address in DentalXChange account.

Payments

DHMO Payment report can be generated by DentalXChange including capitation payments, monthly active patient rosters and co-payment information and monthly terminated patient rosters. Follow below instructions to generate reports on the DentalXChange website.

Select ClaimConnect Home icon from Dashboard page under Electronic Claims Services.

Under the DHMO section, select the Payments link.

Select Payer from drop-down.
There are 2 different reports to choose from.
Capitation Payments
Monthly Active Patient Roster with Copayment Information
Select desired report type from drop down list.
Select View button to open report in a separate window.
Select Download button to download report to computer in excel spreadsheet.

Report: Current Active Roster.

Report: Payment Summary.
The report will display a breakdown of the monthly Aetna payments including any adjustments and terminations.

Patient Roster

Select Patient Roster under the DHMO section of the ClaimConnect home page.

Select Payer from drop down.
Select Plan from drop down.
Select View to open report in a separate window.
Select Download to download report to computer in excel spreadsheet.

Patient Roster Report.
Note: Patient Roster Reports show all previous and current DHMO patients for the provider.
Note: A date listed in the Term column reflects the termination date for inactive patients.

Plan Design

Plan Designs report is also available listing copay amounts associated with covered procedures.
Select Plan Design under the DHMO section of the ClaimConnect home page.

Select Payer from drop down.
Select Plan from drop down.
Select View to open report in a separate window.
Select Download to download report to computer in excel spreadsheet.

Plan Design Report.

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