In the Main Menu, click Setup, Family/Insurance, Clearinghouses.
If sending e-claims to a clearinghouse, you must first set up the clearinghouse.
Clearinghouses are listed alphabetically. If clinics is turned on, you can override some information by clinic (e.g. login credentials, export path). See Clearinghouse Clinic Setup. To view a clinic's Export Path overrides for all clearinghouses listed on the E-Claims window, select the clinic in the upper right.
To enter clearinghouse or direct carrier settings, double click the clearinghouse.
Add: Add a clearinghouse that isn't listed
Dental default: Single click on a clearinghouse, then click Dental.
Medical default: Single click on a clearinghouse, then click Medical.
Eligibility requests: Single click on a clearinghouse, then click Eligibility.
The settings below affect the automatic download of clearinghouse reports (e.g. ERAs, acknowledgment reports, text reports).
Receive Reports by Service: Determines the method used to receive reports.
Computer to Receive Reports Automatically: Specify one computer which will download reports automatically from the clearinghouse server to the Report Path. Enter the IP address or computer/server name or click This Computer to use the computer you are currently on. If you enter a server name and leave Open Dental open on the server, the computer will automatically check the server for new reports according to the interval. If this field is blank, this feature is disabled.
Receive at an Interval: Set a time interval, in minutes, to automatically check the clearinghouse server and download new reports. Only values between 5 and 60 are allowed. 30 is the default.
Receive at a set time: Set a specific time to check the clearinghouse server and download new reports. Time will auto correct itself to valid format (e.g. 1:00 AM)
There are a number of Clearinghouses integrated with Open Dental to send Claims electronically. Users should first sign up with their selected clearinghouse, then set up the clearinghouse in Open Dental.
Clearinghouses differ greatly in size, infrastructure, and business model. Some are small and tend to serve a local geographic area or focus on customer service. Some are actively pursuing more direct connections with payors. Some clearinghouses are more accurately described as aggregators, having a direct connection to only a few payors and sending the bulk of their claims to another clearinghouse.
Additional clearinghouses and aggregators that are known to work well with Open Dental.
Other: These are clearinghouses or aggregators that we have had significant complaints about over many years and are not interested in supporting. Do not use them.
Renaissance E-Claims (Do not use!)
Most payors prefer to use clearinghouses so they do not have to maintain direct connections with thousands of dental offices. However, some do offer direct connections. To use Open Dental for direct submission, there is work involved including: contact the payor, get their implementation guide, set up a partnership agreement, test, and finally upload claims. We do not provide implementation details and leave it up to individual offices. But it can still be useful for very large volume offices. The X-12 files will typically need to be manually uploaded to the carrier because there is no standard for transport.
The carriers below are also known to accept X-12 claims, but we have not had time to do any testing with them yet. Remember that we have no time line for this functionality and it might never even happen.
For troubleshooting, see Clearinghouse Error Messages.
For more technical information about what is sent in e-claims, see E-Claim Complexities.