Submitting Electronic Claims (EDI)
The CSEA Employee Benefit Fund is now accepting dental claims electronically. This can reduce paperwork and costs related to printing and mailing of paper claims and it also improves claim processing time. Electronic claim submission can help to improve the efficiency and cash flow for your dental office. Because the claims are submitted electronically and have less human intervention there are usually fewer processing delays.
To submit claims electronically:
- Your office must have a practice management software program that has the ability to submit claims electronically. The software program, which submits claims through a telephone line or the Internet, connects to a clearinghouse. The clearinghouse directs the claims to the correct insurance company or benefit plan for processing.
- Your software vendor will assist you in the correct way to enter claims using your computer system.
- Clearinghouses charge a fee for each transaction. This fee is usually less than the cost of mailing claims.
- It is critical that the information submitted on electronic claims is correct or the claims may be stopped before being totally processed. The spelling of names, dates of birth, and gender are all extremely important information and if any are incorrect the claim cannot go through the system for processing.
- The appropriate American Dental Association Current Dental Terminology (CDT) codes must be utilized for claim submissions.
- At this time, CSEA EBF does not accept radiographs or periodontal charting electronically. If we require radiographs or periodontal charting for the submitted services, those claims can be submitted as paper claims or they can be submitted electronically and we will request the required information with a letter to your dental office. We have minimized the procedures that require radiographs to crowns and bridges and some surgical procedures. Periodontal charting is required for periodontal surgery. There may be times that our consultants need additional information for review and they may request radiographs for other procedures.
- Our clearinghouse is EMDEON/WEBMD (http://www.emdeon.com) and our payer identification number is CX054.