Real-Time

In addition to the claims processing capabilities of ClaimConnect, DentalXChange also offers the ability to confirm patient eligibility, benefit details, and claim adjudication information from payers through the Real-Time package. Real-Time eligibility and benefits payers deliver up-to date information to DentalXChange regarding qualified patient information. This allows review of most patient eligibility and benefit information in real time.

Visit our Video Library for more helpful tutorials.

• Eligibility – a patient’s insurance plan status with the payer. Real-Time reports the status as either Active, Inactive, or Not Available.
• Benefits – a patient’s insurance plan coverage.
• Claim Status – the step that a claim has reached in the adjudication process.
• Note: Real-Time displays current information only as it is provided by the payer. Responses may vary dependent on the payer’s response level.

Confirming Payer Real-Time Participation

Providers can confirm which Real-Time Transactions are available for each payer by accessing the Payer List.

• After logging in and accessing Claim Connect, select thePayer List link in the left side menu.

• The Payer List displays.
• The Payer List details the transactions supported by each payer in a table format. Check marks indicate supported transactions.
• Note: Transactions that are not supported will result in less robust Real-Time responses.
• Enter a payer name in the Name field of the Search section to find a specific payer or,
• Enter a transaction type in the Transaction field of the Search section to find payers that support a specific transaction types.
• Review the Transaction Types section for the legend of available transaction types.

Eligibility & Benefits Search

	Eligibility, Coverage or Benefit Inquiry ASC X12 270, also: 270
	Eligibility, Coverage or Benefit Information ASC X12 271, also: 271

• Select the link below to view the video tutorial on this subject.
• How to Check Patients Eligibility
• From the Dashboard page, under Electronic Claim Services, select the Eligibility button.

• Or, from the Welcome to ClaimConnect page, under Real-Time section of the menu, select the Eligibility link.

Eligibility Page

• Select or enter provider, patient, and payer information.
• Only Payers with supported eligibility and/or benefits transactions are selectable.
• Note: Fields not marked with an asterisk (*) may be required. Errors display for affected fields.

• Select Continue to proceed.

• The Patient Details and Benefit Search page displays.
• The Patient Details and Benefit Search page is a first response that provides general eligibility information.
• The patient’s current enrollment status displays in the Status field.
• Select the search criteria in the Benefits Search section to review more detailed benefits information where available.
• Select General Benefits to view an overall explanation of the plan benefits.
• Select Single Category or Procedure Code to narrow the results to a specific range of procedure codes or a single procedure code respectively.
• Select the View Benefits button to proceed.
• Note: Payers that support both Eligibility and Benefits transactions may provide more robust search results.

• The Plan Benefits page displays with patient benefits information where available.
• Additional actions are available at the bottom of the page:
• Select the View Patient button to return to the Patient Details and Benefits Search page.
• Providers with a claim processing package, select Start Claim to submit a DDE Claim.
• Patient information from the Real-Time search is automatically populated in to the claim form.

• Providers with a claim processing package may also select Start Claim from the Patient Details and Benefits Search page to submit a DDE Claim.
• Select the New Search button to start a new Eligibility and Benefits search.

Claim Status

	Health Care Claim Status Inquiry ASC X12 276, also: 276
	Health Care Information Status Notification ASC X12 277, also: 277

Aside from providing access to patient eligibility information prior to providing service, Real-Time also grants the ability to review the status of a claim before it reaches its final outcome.

• From the Dashboard page, under Electronic Claims Services, select the Claim Status button, or
• From the ClaimConnect Welcome page select the Claim Status link in the Real-Time section of the menu.
• Select/Enter payer, provider, subscriber, patient, and claim information as necessary.
• Note: Fields not marked with an asterisk (*) may be required. Errors display for affected fields.
• Select Continue to proceed.

• The Claim Status Results page displays.
• Status, Claim Level Response, and Claim Item Response fields update as DentalXChange receives new information from the payer.
• Select the Update Status button to receive current information.

• Use the Advanced Search to review the status of several claims at once.
• Select the Refresh button to refresh the claim status.

Eligibility & Benefits with DMD

	Eligibility, Coverage or Benefit Inquiry ASC X12 270, also: 270
	Eligibility, Coverage or Benefit Information ASC X12 271, also: 271

Providers who have downloaded and installed the DentalXChange Management Desktop (DMD) are also able to review eligibility and benefits information through the DMD without accessing the DentalXChange website directly.

• Select the DMD Shortcut on the provider’s desktop to open DMD.

• Enter the DentalXChange account login information.
• Select the Login button to start the DMD.

• Select the Real-Time tab in DMD.
• Confirm that the Eligibility tab is active.
• Enter the search criteria.
• Required fields are marked with an asterisk (*).

• The Eligibility Response displays in a separate window.
• Select the Print button to print a copy of the response.
• Select the Close button to close the window.

Claim Status with DMD

	Health Care Claim Status Inquiry ASC X12 276, also: 276
	Health Care Information Status Notification ASC X12 277, also: 277

Claim Status information is also viewable through DMD without accessing the DentalXChange website directly.

• Select the Real-Time tab in DMD.
• Confirm that the Claim Status tab is active.
• Enter the search criteria.
• Required fields are marked with an asterisk (*).

• The Claim Status Response displays in a separate window.
• Select the Print button to print a copy of the response.
• Select the Close button to close the window.

Software Integration

Providers with participating Practice Management Systems (PMS) can also complete Real-Time transactions using their PMS. Providers can review their PMS user guide for more information on setup. Eligible software includes:

• Denticon/Planet DDS
• Dentimax
• Dentisoft & Dentisoft Online
• Open Dental
• Practice Web
• The Digital Office (TDO)

 

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