E-Claims 

In dentistry, almost all electronic claims are sent to a clearinghouse before being sent to the insurance company.

Tesia

Our preferred clearinghouse is Tesia.  The advantage of using Tesia is that the acknowledgement from Tesia will show automatically in the Claims Send window of Open Dental.

ClaimConnect

If you want to send Electronic Attachments, you should use Claim Connect. Another advantage of using Claim Connect is that they have a web-based claim management system.  So there are no reports to reconcile.  Instead, you manage the various batches and claims online.

Other Clearinghouses

Of course, we do not lock you into one clearinghouse.  If you prefer a different clearinghouse, such as one of those listed below, then you may also use them.  Our claims are created in X-12 format, which is accepted by any clearinghouse.  This is a very unique feature which no other dental software has. We list some clearinghouses below that are known to work well with Open Dental.

Renaissance (not X12 format)
Emdeon .
RECS
Inmediata
AOS
PostNTrack
Apex www.apexedi.com

Insurance Carriers

Open Dental can create X-12 files that can be used by any carrier that supports direct X12 claims. You can submit directly to many carries such as DentiCal, Medicaid, Delta, BCBS, etc. There is some work involved in contacting the carrier, getting their implementation guide, setting up a partnership agreement, testing, and finally uploading claims. We do not provide implementation details, leaving that up to the individual offices. But it can still be very useful. The hard part is always getting the X-12 file sent to the carrier because there is no standard.   Due to the complexity, it is really only immediately useful to large volume offices.

We try to post specific implementation details below as we run across them.

BCBS Nebraska: Instructions for Open Dental setup: Providers must have supplemental provider ID added for BlueShield and Electronic ID 00760. Use the provider ID that they assigned you. Setup a clearinghouse with a Clearinghouse ID of NEBLUECONNECT. No CommBridge. Add payor 00760 to this 'clearinghouse', and uncheck the default box. Create a folder to accept your claims as they get created by Open Dental. Upload your claims to BCBS using their website. See http://www.bcbsneprovider.com/NEBLUEconnect/contacts.asp for contact information.

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 timeline for this functionality and it might never even happen.

DentiCal (modified)

BCBS of Georgia

ACS - Handles claims for Medicaid of Georgia and a few other states. Testing phase seems to be long.

Medicaid of NJ - Could take a few months since they require certification

Medicaid of TX