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CDAnet Dental Office User Guide (PDF 2.4 MB)

1. 40 Appendix C Patient Information Form INSURED PATIENT INFORMATION Name of patient Name of policyholder Date of birth Insurance Company Policy No Subscriber ID number Place of employment Relationship of patient to policy holder Dependant Spouse Are you claiming from more than one insurance company No Yes If yes complete the following section SECONDARY INSURANCE INFORMATION Name of policyholder Date of birth Insurance Company Policy No Subscriber ID number Place of employment Relationship of patient to policyholder Dependant Spouse AUTHORIZED CONSENT TO RELEASE INFORMATION authorize release to my dental benefits plan administrator information contained in claims submitted electronically also authorize the communication of information related to the coverage of services described to the named dentist Signature of patient parent or guardian 41 Appendix D List of Error Codes Error Code Message 001 Missing Invalid Transaction Prefix 002 Missing Invalid Dental Claim or Office Sequence 003 Missing Invalid Version Number 004 Missing Invalid Transaction Code 005 Missing Invalid Carrier Identifi
2. ie 7 Real Time Processing orte terere 7 Batch Processing a u edere Pn e ear a iq aq aN FOE ew 7 IE NT Lm 7 Sample Explanation of Benefits Form nunana 9 Explanation of Benefits Form Headings 10 Claim Acknowledgement kau una e eee v der n e TE 11 Sample Claim Acknowledgement Form 12 Acknowledgement Form Headings 13 Employer Certified Claims Susa 12 14 Sample Employer Certified Form a 15 Employer Certified Form i H adlngs 2 a R l a nnne enhn nsns enne nnns 16 Reversing diit es ntes 17 TO reVers a 1 ee pr ES 17 Pended Claims Request for Outstanding Transactions a aaa 18 Pre treatment Plans Predetermination 19 To Submit a Pre treatment Plan eidem pde tes eruat asado x tia 19 Goordination OF Benefits etr eph datur Aet Au Lab 20 Coordination of Benefits for Version 2
3. TURO ME TU USE P 35 NexgenhX ING c ood NE NU 35 so bac dut anf iS At atlas da ici b sia 35 Pacific Blue CROSS 24 0 55 36 556 5 agas e coss HO ae dde bep 36 The COOP erator ee reet ede Ee da ea Wed tidie ea iis 36 Saskatchewan Blue Cross Identification Card 38 WaWwWanesed dotate te mete tpe b eT pi dee wet datus eee T a 38 Appendix B CDAnet Networks amp Insurance Carrier Information 39 Appendix C Patient Information duck e o tette PR ert pid s 41 Appendix D List of Error 4 42 Appendix E Patient Authorization 5 45 Introduction to CDAnet Welcome to CDAnet This User Guide has been provided to assist you in sending claims electronically through CDAnet formatted messages Please give this manual to your office manager and keep it beside the computer All staff processing claims are encouraged to read the manual carefully The User Guide contains a list of those insurance companies currently accepting dental claims electronically with CDAnet along with their corresponding ID numbers and processor contact phone numbers Your software vendor will
4. CANADIAN DENTAL ASSOCIATION CDAnet Dental Office User Guide Version 2 8 9 9 5 July 2013 Table of Contents 1414 81084810 to 1 WhatisCDANET l Ca Silat a hb uqa aaa daan 1 How will CDAnet affect my computer system 1 Will there be any change in office procedures 1 Rules and Reg lations E E e e ite gie ien mii 3 CDANeL Start Datei d eto tette et ehe te v tede etin 3 Patient Authorizatiofi tdem Cut Ein cts pu au as 3 Patient Informatio o eau ao ta te tme tau ud 3 Electronic Submission of Aged Claims 4 Explanation of Benefits and Claim Acknowledgement 4 Subscribing a dentist to 4 How and when to advise CDAnet of office information changes 4 Membership rte eee ttr et Eti IRE SI I tto steer nte tete 5 Prohibited ome e nel 5 CDAnet Claim Submission Basics Understanding Your Responsibilities 6 TALIS inl
5. v John Doe gi an paper apy yon w pen wasa Carrier Group No Certificate gt wan snup pen ap Drug 98 06828003 000117 an cao VOD fy sos NO usay amus Dental 510534 Benefit Coverage Benefit Coverage mo jp Voas und a Boe je a and epi psp oq cun Drug Family Health Family e prono ano 1004 pas Ox agam 6 ano y Dental Family Travel Assist Family Covered Family Members Patient Name Relationship Code John Primary 001 Carte des Soins Jane Spouse 002 Joe Child 003 coverage and eligibility detail please refer to plan documents available from your plan sponsor or log on to our web site al www nexgenex com obtenir plus de pr cisions au sujet des couvertures et des ions d admissibilit camultez les documents de votre Pharmacy 866 394 3648 nexfent R Quikcard Innovative Health Benefits easy affordable flexible Customer John Group 12345 Cert 123456789 35 Pacific Blue Cross gp BLOE cross DENTAL CARE PLAN Vancouver V6B 4E1 D066345 321 654 987 07 101 98 Dependent PIQUE DON Birthday Etfective Date MDM Number A 806 B 506 C 50 SCHEDULE 3 NONSTANDARD
6. n 25 Patient Information eet u 26 Office Information Chang es n na apa apay pasasha 26 Claims Processing Procedures and Transmission Issues 26 TRANS uqu ag aya 28 Appendix A Sample Insurance Cards 29 The TELUS Assure Card formerly the BCE Emergis or Emergis 29 AGA Benefit 30 Alberta BIYE KOSS epe R 30 Canadian Benefit Providers 30 dc tnit ou 31 Empire Lite 15 eorr citet e Hee Ric 31 ESORSE BenefitCard tn emite edo 31 Great West RII SERRE T a 32 Green Shield dede 32 Gro p Medical S e TORIS IPAE ksi 33 Groupe Premier 33 5 q s 33 Health d aa Ph RS 34 Manitoba Blue Cross 34 Medavie CrOSS 34
7. 846 14 Support and Income Assistance ESIA Quikcard 888 846 4484 000109 2 digits numeric 2 West 800 232 1997 Quikcard East 888 846 4484 000103 v4 14 5 alphanum 6 10 alphanum X X X X X X Sheet Metal Workers Local 30 Benefit Plan McAteer Group 800 263 3564 000119 V4 365 SMW30 SMW30 xX X x X Syndicat des Fonctionnaires Municipaux de Montreal Express Scripts 800 563 3274 610677 v4 365 The Building Union of Canada BATCH McAteer Group 800 263 3564 000120 365 BUC BUC X x U A Local 787 Health Trust Fund BATCH 866 946 2220 000110 365 787 787 X X x x U A Local 46 Health Plan BATCH 800 263 3564 000115 365 UA46 NA UA46 xX X x X U L Mutual UV mutuelle Express Scripts Canada 800 563 3274 610643 7 Xx x X X Manitoba Blue Cross 888 596 1032 Manitoba Blue Cross 800 873 2583 000094 365 1 5 digits 1 10 digits alphanum X X X X X X X X Pacific Blue Cross 800 487 3228 Pacific Blue Cross 888 275 4672 000064 v4 365 7 digits 10 digits alphanum X X X X X TELUS Health Solutions Group 866 272 2204 Equitable Life 800 722 6615 000029 v 2 365 5 digits na 9 10 digits numeric X X X X X X Great West Life Assurance Company The 800 957 9777 000011 v 2 8 1 6 digits na 1 9 digits alphanum X X X X X X X Industrial Alliance 514 499 3800 000060 v2 10 5 digits
8. Total Payable To Insured Provider The total amount payable to the insured or to the dentist if the claim is assigned Payee s Address The payee s address Notes Text related to the note number s beside procedure lines if applicable 10 Claim Acknowledgement When a claim cannot be adjudicated in Real time a Claim Acknowledgement is returned to you For an unassigned claim an EOB will be mailed to the insured For an assigned claim an EOB may be returned to your office electronically If an EOB is forwarded electronically you will be able to access and print the EOB from your mailbox Please refer to Request for Outstanding Transactions on page 18 for further instruction on this procedure It is mandatory that a copy of the Claim Acknowledgement be given to the patient before he or she leaves the office This form provides the patient with a record of the claim which you submitted to the claims processor on their behalf The printing of the claim acknowledgement for office use is at the discretion of the office If the claim is rejected you will receive an error message on your computer screen or printer explaining the reason for rejection Correct the error s and resubmit the claim Note A claim that is not adjudicated in Real time may later be rejected during Batch processing If this situation occurs the claims processor will contact either the insured or your office If no response is receiv
9. nnne nnne enne nnns 20 Coordination of Benefits for Version 4 eene eene nennen 20 Sample Plain Paper Claim Form 21 S rmmnary ReconelllatiOn u ka u ote eee eei ERE OH BIN CO ET 22 To Submit a Summary Reconciliation Request 22 To Submit a Payment Reconciliation Request 22 Email Transmissions as iti hasc vi Ape 22 Attachments a5 xo 23 IMAG Specifications iste atii e tete ite iss 23 Carrier Network Information au 23 Networks amp Insurance Carriers that support CDAnet 23 CDAnet NebWODKS uen telum uou cun 23 Problems with Modem or Connecting to the Network 24 Frequently Asked Questions about CDAnet 24 CDAnet ResoUrces 24 Suliscribe to 24 Dentist UIN What you need to know nnns isses enne annis 25 Office ID for Satellite Office Setup
10. SSQ Financial Group SSQ ssa Financial Group SSQ Rx POLICY 11111 CERTIFICATE 111111 WWW SSq ca The Co Operators w2 840 030d002 wa yt punoj ul 100 yas s0s0dand poyrja pue uogeoipnipt une1 20 euotaed ou 0 40 09 OUL fq PUB BEN uon2eoo 94 sjuesuo pae sug Kg 1080008 ud aq PAD VIOS y IUO 5 ISN ayy YOU SI par SNJ 702340800002 wA NO 404295 Utd BUYSA AQ IO 050005 0 aq ue uuo user NOK aqeun 5 00 NOK g Benefits Card For complete plan coverage and eligibility details please refer to your benefit plan documents available from your plan sponsor You can also us toll free at 1 800 667 8164 or visit us at www cooperators ca the co opet totS A Better Place For You 36 Of the co operators A Better Place For You Your new Co operators card is here the co opet tors Your plan sponsor has chosen to provide you with group benefits from the leading Canadian owned multi product insurer The Co operators With over 60 years experience The Co operators has provided Canadians
11. Call or write the claims processor quoting the claim reference number shown on the Explanation of Benefits or Claim Acknowledgement and inform the Claims Department of the error If the dental office staff does not know how to do a claim reversal they should contact their insurance carrier for information If the claim cannot be reversed on the same day due to errors the dental office must send a manual claim form with a letter referencing the initial claim to the insurance company Q tried to reverse a claim and received a message asking me to try again later What happened A The claims processor was unable to handle your request for a claim reversal at the time it was submitted Try to reverse the claim again later in the day If you are unable to reverse the claim on the same day follow the procedures outlined in the question for sending a claim reversal manually Q What if a patient deals with a claims processor that is not participating in CDAnet A The insured should continue to submit his or her claims on paper Where do receive updates A Your software vendor supplies updates to your practice management software Updates such as new carriers carrier networks and supported transactions types will appear on the CDAnet website on the News page and in the supported transactions list on the Networks and Insurance Carriers page What is the difference between Batch Mode and Real Time A Batch processing means th
12. a claim or predetermination is submitted and the dentist receives a response from the network This occurs when the network accepts the claim on behalf of the claims processor Dentists can recognize a response from a network by the message Transaction Received by Network Check Mailbox Tomorrow It is important for the dentist to check the mailbox after receiving this message as there might be an additional message from the claims processor The third party may also send a claim predetermination rejection to the mailbox The dentist needs to receive this message to know to resubmit the claim The claims processor might also send an Explanation of Benefits as a follow up response to the original Claim Acknowledgement This will only occur for assigned claims once the adjudication process has been completed by the carrier If the connection between the dental office and the network is lost during transmission a dentist should check their mailbox If after the claim was sent no response was received and if the claim was received by the network or claims processor a response will later be found in the mailbox Check your mailbox regularly This will ensure that all responses are received If you have any questions regarding how to complete this transaction please contact your software vendor for assistance 18 Pre treatment Plans Predetermination A pre treatment plan is used to submit information to the third party regarding planned
13. treatment so that the patient is aware of his or her portion of the overall cost CDAnet allows you to submit pre treatment plans electronically thereby reducing turnaround time and preventing lost and or misplaced forms Occasionally additional information related to the pre treatment plan such as x rays may need to be mailed to the claims processor To Submit a Pre treatment Plan Enter the information required for a pre treatment plan as defined by your computer system Ensure that all information for the patient insured is correct Follow the instructions provided by your dental software vendor If the pre treatment plan is sent successfully you will receive a message on your computer screen advising you of this If the claims processor is able to evaluate the pre treatment plan in Real time then a Pre treatment EOB will be printed If not then the third party response will indicate that either a Pre treatment EOB will be sent electronically at a later time or the review of the pre treatment plan will be mailed 19 Coordination of Benefits Coordination of Benefits for Version 2 The Canadian Life and Health Insurance Association provide these guidelines for Coordination of Benefits If the patient has dental coverage their insurance carrier is the primary carrier If the patient is a dependent the insurance carrier for the parent or covered person with the earlier birth date in the calendar year is used as the primary carrier
14. 6771 610172 v4 7 X X X Desjardins Financial Security Express Scripts Canada 800 563 3274 000051 7 6 digits 4 digits 9 digits GMS Group Medical Services Express Scripts Canada 800 563 3274 610217 7 1 12 digits 1 12 digits 1 12 digits X X GMS SK Group Medical Services Express Scripts Canada 800 563 3274 610218 7 1 12 digits 1 12 digits 1 12 digits X X Groupe Premier M dical Inc Express Scripts Canada 800 563 3274 610266 7 1 7 alphanumeric 1 12 digits groupSource LP 866 862 5246 1605064 7 6 digits n a 7 or 10 digits X X X X X Primary Code C17 required Humania Assurance Inc formerly La Survivance Express Scripts Canada 800 563 3274 000080 7 Local 1030 Pension and Health Benefit Plan BATCH McAteer Group 800 263 3564 000118 4 365 Local1030 Local1030 xX X Winnipeg 800 952 9932 s 7 Thi f 0 5 St John s 800 563 1930 610256 v4 3 3 or 5 digits n a or 9 digits NexGen RX 866 394 3648 610634 365 8 digits alphanum 3 alpha 10 numeric Non Insured Health Benefits NIHB Program Express Scripts Canada 888 511 4666 610124 7 10 digits Nova Scotia Medical Services Insurance MSI Quikcard 888 846 4484 000108 14 2 digits X X X Nova Scotia Department of Community Services Employment i
15. 7 digits of the Policy Number exactly as shown on the card e g 0093900 e In the Division Section Number field enter the remaining 3 digits of the Policy Number e g 001 e Inthe ID Number field enter the 11 digit Identification Number found on the right side of our Saskatchewan Blue Cross card Please note your vendor software may require splitting this entry into two separate fields entering the first 9 digits into one field and the last 2 digits into the other Wawanesea 38 Appendix B CDAnet Networks amp Insurance Carrier Information CDAnet Networks Carriers and Supported Transactions June 14 2013 Notify CDAnet of required changes to this document at Network Carrier Information Policy Information Supported CDAnet Transactions Additional Information Claims Predeterminations O S Tx Sum Recon Pmt Recon S Network 2 B 2 8 51 53 E 8859 2 518515 P 8 565 8 p vleles l8 s 2 825 ele 5 g 51812 5 5 E 28 5 2 55 32 2 5 S 5595 CDAnet Ag
16. Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I hereby assign my benefits payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date 46 I hereby assign my benefits payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I hereby assign my benefits payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I hereby assign my benefits payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I hereby assign my benefits payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I hereby assign my benef
17. Explanation of Benefits EOB will be sent to the patient by mail Or if the payment is assigned the EOB will be returned electronically or by mail to your office It is important that you check your mailbox frequently in order to receive responses from the insurance carriers Further information regarding Claim Acknowledgements may be found on page 11 For more details on accessing your mailbox please refer to the section Request for Outstanding Transactions on page 18 Pretreatment plans are always batch processed A message will be displayed on your computer screen advising you that the pretreatment plan was received successfully The claims processor s approval or denial of the pretreatment plan will be sent by mail to the insured Please refer to the section on Pretreatment Plans on page 19 for more information To Submit a Claim SEND ONLY VALID CLAIMS do not attempt to test the system by sending invalid claims All claims must be sent under the dentist s name that is providing the service Enter the information required for a claim as defined by your computer system Confirm that information regarding the insured patient is correct Follow the instructions supplied by your dental software vendor Note The number of performed procedures permitted in a claim is between 1 7 If more than 7 procedures are required a second claim can be sent for the balance of the procedures 7 The claims processor will not adjudicate late claims e
18. can notify CDAnet of changes by completing the CDAnet Update Dental Office Information form This form can be downloaded from the CDAnet website at www cdanet ca or retrieved through the CDAnet fax back system at 1 800 267 9701 CDAnet will inform all carriers claims processors of your office changes You do not need to contact the carriers Claims Processing Procedures and Transmission Issues Why did receive a message advising me that am not authorized to access CDAnet A If you recently subscribed to CDAnet and are unable to transmit claims to any of the CDAnet insurance carriers contact the CDAnet Help Desk at 1 800 267 9701 between 9 a m and 5 p m EST to verify that you and the claims processors are using the same identification numbers Q I cannot transmit claims to an insurance carrier and cannot correct an error message What should do A In the event that dental office staff cannot correct an error message the problem should be referred back to the networks as they are the ones sending the message back on behalf of the insurance carrier The networks can pull up the claim using the CDAnet office number and find out why the error was sent Before you call the network make sure that you have noted the CDAnet error message you received have the CDAnet office number and the dentist unique identification number UIN ready Download the CDAnet Supported Transaction 26 document from www cdanet ca for network help des
19. error codes A list of error codes can also be found in your CDAnet Dental Office User Guide see Appendix D List of Error Codes The icon or window depending on the software is not giving me the option to use CDAnet Why not A Either the dentist record in your software is not configured to allow electronic claims or the carrier record in your software does not indicate support for electronic claims Contact your software vendor in order to update the information found in your software to correct the above issue I m receiving the error code Datapac not responding What does that mean A This error does not apply to ITRANS users DATApac has been phased out by TELUS Health Solutions Offices can contact the TELUS Help Desk at 1 866 272 2204 send claims after normal business hours A Yes you will receive a Claim Acknowledgement shortly after submitting the claim CDAnet claims may be transmitted by telephone modem between 5 30 a m and 1 a m EST seven days a week excluding statutory holidays CDAnet claims may be transmitted to ITRANS 24 hours a day seven days a week including holidays If the carrier system is not available the ITRANS system will acknowledge receipt of the claim and forward the claim to the carrier system when it becomes available 27 Can reverse a claim that was submitted yesterday A No a claim reversal can only be performed on CDAnet on the same day the claim was submitted
20. inform you when additional carriers are to be added to your system For the most up to date list of carriers and the types of claims they accept please refer to the CDAnet section at www cdanet ca Please ensure that your staff is fully trained on CDAnet prior to using the system Please contact your software vendor to arrange for a training session This training is only offered by your software vendor We therefore encourage you to always maintain your support contact with your vendor so that you can receive all of the CDAnet updates regularly What is CDAnet CDAnet is the agreement between the dental profession and the insurance carriers on the format in which the information normally found on dental claims will be forwarded to the respective carrier electronically CDAnet formatted message Developed and managed by the dental profession CDAnet makes it possible for dentists to send a patient s insurance claim form directly to the carrier using either a telephone modem or the Internet via the ITRANS Claim Service Because dental claims are forwarded to the respective insurance carrier electronically patients are no longer required to send in their forms Processing the dental claims CDAnet formatted message electronically e Allows carriers to process them and reimburse patients for the covered portion of their treatment more quickly e Eliminates delays caused by late or lost mail e Reduces the time it takes for patients to be reimbu
21. my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian I authorize release to my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian I authorize release to my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian 48
22. to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date Sample label forms that may be photocopied for this purpose can be found in Appendix E Patient Information In order to submit claims through CDAnet your dental office requires insurance information that you may not have on file You may wish to ask your patients to complete a standard 3 information form so that you have all the necessary details on hand A Patient Information Form can be found in Appendix C It is important that your office maintains patient information records including address information To ensure that cheques are appropriately mailed by insurance carriers to patients your office should confirm patient information each time a patient visits your office If the patient information has changed you must update the information in your software Electronic Submission of Aged Claims While it is expected that all claims will be transmitted on the date of service problems may arise which do not allow for the transmission of the claims until a later date Please refer to Appendix B CDAnet Networks amp Insurance Carrier Information for details on CDAnet insurance carriers including age limits policies and supported transactions Note claims older than the insurance carrier age limit must be printed and cannot be transmitted electronically Explanation of Benefits and Claim Acknowledge
23. 1 9 digits Industrial Alliance Pacific Life Insurance Co 514 499 3800 000024 v2 10 5 digits n a 1 9 digits X X X X X X X Johnston Group BATCH 800 665 3365 627223 v 2 365 5 digits na 5 9 digits numeric X X X X X X X National Life of Canada 800 668 8270 000021 v 2 7 3 5 digits na 1 9 digits alphanum X X X X X X X Sunlife of Canada 800 361 2128 000016 v 2 365 1 5 digits na usually numeric XIXIX X X X X 39 CDAnet Networks Carriers and Supported Transactions June 14 2013 Notify CDAnet of required changes to this document at cdanet cda adc ca Network Carrier Information Policy Information Supported CDAnet Transactions Additional Information Claims Predeterminations O S Tx Sum Recon Pmt Recon E 8 Network 1 z 2 fs Ex gt _ 2 E s 8 z 8 561 E o a c o QD a 9 S 28815 6 2 g E Elele eyle el e E s d CDAnet CDAnet Age imit 5 2 Carrier Phone ID BIN Version indays Policy Number Division Number Certificate Number 8 8 158 5 8 0 Notes TELUS Health Solutions Group 866 272 2204 Accerta 416 922 6565 311140 365 12 alpha
24. ALLY TO THE ABC COMPANY OF CANADA PLEASE TAKE THIS FORM TO YOUR EMPLOYER FOR CERTIFICATION 15 Employer Certified Form Headings The headings on the Employer Certified Form are similar to those used on the Claim Acknowledgement with the exception of an additional area to be completed by the insured s employer The Policy holder Employer Certification section of the form is described below Employer The employer s name Date Coverage Commenced The initial date of coverage for the insured Date Dependent Covered The initial date of coverage for the insured Date Terminated The last day of insurance coverage Signature Of Authorized Official The signature of the person certifying that the insured s information is correct Authorization Date The date that the claim was certified 16 Reversing a Claim A claim submitted in error may be voided by performing a claim reversal A claim reversal voids all procedures that were part of the original claim A claim may only be reversed using CDAnet on the same day that it was submitted If you notice that a claim is invalid on a following day notify the claims processor either by phone or by mail quoting the carrier claim number and the dental office claim reference number as shown on the EOB or Claim Acknowledgement as soon as possible To reverse a claim Enter the information required for a claim reversal as defined by your computer system Be sure to indi
25. Birth date The insured s birth date Certificate No The insured s identification number Patient The patient s name Birth date The patient s birth date Relationship To Insured The patient s relationship to the insured Claim No The third party s claim reference number if applicable Date Submitted The date that the claim was submitted through CDAnet Procedure The dental procedure code submitted for the claim or the procedure code inserted by the third party Note In some cases a procedure code submitted might not be the one that is paid under the insurance policy The EOB will include the covered procedure code For insurance carrier inserted procedure codes a note may refer back to the original procedure line number This situation is likely to occur with package codes when not all procedures are covered or when submitted procedures make up a package code Th The tooth number if applicable Date The date of service Charge The total fee charged for the procedure Eligible The amount eligible for payment Deduct The deductible associated with the procedure If the claims processor cannot split the deductible amount on a procedural basis a total deductible amount will be printed on a separate line At The percentage insured Benefit The benefit amount payable Notes Note number s referring to the descriptions of procedures listed at bottom of page if applicable Expected Pymt Date The expected payment date
26. Financial West 800 265 6392 610059 v 2 4 6 digits 3 digits 9 digits numeric Medavie Blue Cross 800 667 4511 610047 v2 365 8 digits 11 digits numeric X X Interim Federal Health Program IFHP Medavie Blue Cross 888 614 1880 610047 v2 30 8 digits 8 digits numeric 800 838 1531 601052 v 2 7 11 digits numeric K X X x x NexGen RX 866 394 3648 610634 v4 365 8 digits alphanum 3 alpha 10 numeric Non Insured Health Benefits Program Express Scripts Canada 888 511 4666 610124 7 10 digits n a n a X X RWAM Insurance 519 669 1632 610616 365 1 5 digits 1 3 digits 1 9 digits numeric X X x X Saskatchewan Medavie Blue Cross BATCH 306 244 1192 000096 v2 365 7 digits 3 digits 11 digits SES Benefits 877 713 7379 610196 7 550 Societe d Assurance Vie Inc 800 563 3274 000079 v4 365 P 800 499 4415 English E digi m Standard Life Assurance Company The 800 499 4425 francais 000020 v4 7 3 5 digits 1 9 digits alphanum X X X X X X X x Syndicat des Fonctionnaires Municipaux de Montreal Express Scripts 800 563 3274 610677 v4 365 U L Mutual UV mutuelle Express Scripts Canada 800 563 3274 61 0643 7 xX X K X Wawanesa BATCH 204 985 3940 311109 v2 7 4 digits 3 digits 9 digits numeric
27. For example if Mrs Smith s birth date is February 14 and Mr Smith s birth date is August 11 then the insurance carrier for Mrs Smith is the primary carrier for the Smiths dependent children Both an EOB and a dental claim form will be printed if a claim involving COB is adjudicated in Real time The dental claim form may be a standard claim form or if your office has only one printer a Plain Paper Claim Form as shown on the next page The headings on this form are similar to those found on the standard claim form Coordination of Benefits for Version 4 Claims Claims should first be transmitted through CDAnet for the primary carrier An EOB will be printed for the primary carrier the handling of a COB will depend upon several factors e f the secondary coverage is adjudicated by the same party as the primary coverage such as when the primary and secondary carriers are the same then a second EOB for the secondary carrier may be printed e If the secondary carrier accepts COB Claim Transactions then a claim will be transmitted to the secondary carrier including a copy of the EOB from the primary carrier An EOB from the secondary carrier will be printed if the secondary claim is adjudicated in Real time e f the secondary carrier does not accept COB Claims then a dental claim form will be printed for the secondary coverage 20 Sample Plain Paper Claim Form DATE SEPT 15 1996 DENTIST ADDRESS DR A SMITH 10 JOHN S
28. INSON MARK ROBINSON 8123456 03 DENNIS ROBINSON 8123456 04 HEATHER ROBINSON BENEFITS EFFECTIVE YY MM DD DRUGS 80 DIRECT BILL LCA 01 04 01 DENTAL 01 04 01 VISION 01 04 01 SAM P L E HOSPITAL 01 04 01 E EXTENDED HEALTH BENEFITS 01 04 00 TRAVEL qusc 5901 04 01 Canadian Benefit Providers CBP COMPANY ABC1 Group 1009080001 Subscriber 00006161400 CASANOVA EMILIO INC 30 Claimsecure SMITH CERT Empire Life Insurance A L EMPIRE COMPAGNIE D ASSURANCE VIE THE EMPIRE LIFE INSURANCE COMPANY B Smith John C ABC Industries Limited 061234 E001 F000000078 G 09 Oct 1959 H Other K Dental Family 28Nov1997 ESORSE Benefit Card Upon enrollment ESORSE will issue a Benefit Card to its subscribers Such card will have to be presented to provider for any drugs and dental services in accordance to its plans A subscriber may have multiple dependants who are also allowed to avail of prescribed drugs and dental services For easy identification the card includes the following information John V Smith Member Carrier 01 Group 4234 Cert No 0000123456 For Customer Service Inquiries 647 288 0446 Use of this card constitutes acceptance to the terms and conditions governing the use of this card when issued as amended from time to time authorize ESORSE Corporation to release information necessary to process my clai
29. M 05 85 Jill F 11 88 Ambulance Hospital Semi Private Extended Health Benefits Dental Service Plan Doe 1238567 1238 Medavie Blue Cross MEDAVIE BLUE CROSS Identification Number 0012345678 tw BLUE ADVANTAGE www blueadvantage ca Customer Service 1 800 667 4511 Identification Number 12345678901 John Smith 12345678900 12345678902 Lisa Smith 12345678903 Monica Smith Worldwide Travel Assistance Mary Smith 12345678904 Mark Smith Canada and U S A 12345678905 Simon Smith 110240400 Policy Number 12345678906 Nicole Smith Elsewhere in the world 12345678907 Jack Smith 1 506 854 2222 Call collect Claiming www medavie bluecross ca Privacy Pi 34 Guard Card Client LD 12345678901 EMPLOYEE NAME Company Name NexgenRx Inc TET Ae AP DIT wan eames DU Mc ID eMe IIealth Benefits pur vage Sur OD VOLIS s A pur sen Mam aja span cE poro Porn 44 dafs ap snemma ato EANAN 2 z sap 2n pad aur gt JUNIO un ABC Company JURO ucu 3590 pr VORTAN 1 HM age PERIOD ad pur ua 0r
30. N NO INSURED LINDA J SMITH BIRTHDATE CERTIFICATE NO 98794 PATIENT LINDA J SMITH BIRTHDATE RELATIONSHIP TO INSURED SELF INSURANCE COMPANY CLAIM NUMBER ABCO0000094561 Date Submitted PROCEDURE DATE CHARGE ELIGIBLE DEDUCT AT BENEFIT 01202 Recall exam AUG 10 96 21 77 21 77 10096 21 77 12101 Fluoride AUG 10 96 17 41 0 00 0 00 Expected Pymt Date AUG 17 1996 TOTAL PAYABLE TO INSURED Payee s Address 1736 COOKE ST UNIT 49 TORONTO ON LOC 110 Notes 01 This procedure is not covered under the terms of your contract This Claim Has Been Submitted Electronically On Your Behalf By Your Dentist Please Direct Any Inquiries To Your Insurer Expenses Not Payable May Be Considered For Income Tax Purposes Please Retain Copy 1702 MAY 26 1960 MAY 26 1960 AUG 10 1996 Explanation of Benefits Form Headings The headings on the EOB are described below HEADING DESCRIPTION Dentist Name of Dentist Providing Service Unique ID No 9 digit provider ID number assigned by the CDA to the dentist providing the service Dental Office Claim Reference No A sequential number identifying the claim submission which is generated automatically by your computer system Policy The patient s insurance policy number Division Section No The division or section number related to the policy number if applicable Insured The insured s name
31. T SUITE 115 TORONTO ON MAC 1A6 DENTAL OFFICE CLAIM REFERENCE NO 124489 PATIENT ANITA LYONS PATIENT S OFFICE ACCOUNT NO 57388 PATIENT S ADDRESS 16 FOREST DRIVE SCARBOROUGH ON L2R 7Y3 DATE PROCEDURE SEPT 15 96 01205 Emergency exam BENEFIT AMOUNT IS PAYABLE TO INSURED CARRIER CLAIM NO 0000093752 PREDETERMINATION NO UNIQUE ID NO 012345678 OFFICE NO 0001 TELEPHONE 416 889 6574 OFFICE VERIFICATION BIRTHDATE JAN 14 1940 CHARGE LAB 87 06 TOTAL SUBMITTED This is an accurate statement of services performed and the total fee payable E amp OE PATIENT AUTHORIZATION TO PAY BENEFIT TO DENTIST INSURANCE INFORMATION CARRIER ADDRESS PRIMARY THE ABC COMPANY 2277 MAPLE AVE TORONTO ON L3P 5H6 POLICY 4567 INSURED NAME ANITA LYONS BIRTHDATE JAN 14 1940 CERTIFICATE NO 123456789 EMPLOYER J WICKSON amp CO INSURED ADDRESS 16 FOREST DR WEST HILL ON L2R 7Y3 RELATIONSHIP TO PATIENT SELF PATIENT INFORMATION 1 If dependent indicate Student X Handicapped 2 Name of student s school 3 Is treatment resulting from an accident Yes No If yes give date of accident 4 15 this an initial placement for dentures crown or bridge Yes If no give date of initial placement 5 Is treatment for orthodontic purposes Yes INSTRUCTION FOR SUBMISSION DENTIST S COMMENTS POLICY HOLDER EMPLOYER CERTIFICATION Date Coverage Commenced Date Dependent Covered Date Terminated Posi
32. What CDAnet resources are available A The CDAnet Dental Office User Guide is provided to assist you in sending claims electronically through CDAnet formatted messages All staff processing claims are encouraged to read the Dental Office User Guide A The CDAnet Supported Transaction document provides a detailed list of the types of transactions supported by the networks and insurance carriers on CDAnet It also lists the Help Desk phone numbers carrier IDs and carrier policy information Download the CDAnet Supported Transaction document from www cdanet ca Subscribe to CDAnet Q Who can subscribe to CDAnet A You can subscribe to CDAnet when you are a licensed dentist and a member in good standing with the provincial territorial dental association Do not submit the CDAnet Subscription Agreement form until the license and membership information is confirmed Download the CDAnet Subscription Agreement from www cdanet ca Q How do I subscribe to CDAnet A Each dentist in an office who plans to transmit claims must complete a CDAnet Subscription Agreement form page 4 of the CDAnet Subscription Agreement to subscribe to CDAnet Q What are the steps to subscribe to CDAnet Step1 Complete all the mandatory fields on the CDAnet Subscription Agreement form Step2 Sign the completed form to confirm agreement to all the terms and conditions regarding the use of CDAnet Step 3 Fax the completed CDAnet Subscription Agreemen
33. acted Teeth Count 095 Missing Invalid Extracted Tooth Number 096 Missing Invalid Extraction Date 097 Invalid Reconciliation Date 098 Missing Invalid Lab Procedure Code 099 Invalid Encryption Code 100 Invalid Encryption 43 Error Code Message 101 Invalid Subscriber s Middle Initial 102 Invalid Patient s Middle Initial 103 Missing Invalid Primary Dependent Code 104 Missing Invalid Secondary Dependent Code 105 Missing Invalid Secondary Card Sequence Version Number 106 Missing Invalid Secondary Language 107 Missing Invalid Secondary Coverage Flag 108 Secondary Coverage Fields Missing 109 Missing Invalid Secondary Sequence Number 110 Missing Invalid Orthodontic Record Flag 111 Missing Invalid First Examination Fee 112 Missing Invalid Diagnostic Phase Fee 113 Missing Invalid Initial Payment 114 Missing Invalid Payment Mode 115 Missing Invalid Treatment Duration 116 Missing Invalid Number of Anticipated Payments 117 Missing Invalid Anticipated Payment Amount 118 Missing Invalid Lab Procedure Code 2 119 Missing Invalid Lab Procedure Fee 2 120 Missing Invalid Estimated Treatment Starting Date 121 Primary EOB Altered from the Original 122 Data no longer available 123 Missing Invalid Reconciliation Page Number 124 Transaction Type not supported by the carrier 125 Transaction Version not supported 997 Last Transaction U
34. and constitutes fraud L utilisation de changer des renseignements personnels avec Green Shield Canada pour l valuation des 5 autres services n cessaires pour moi m me ou mes personnes charge admissibles le carte constitue de la fraude 32 Group Medical Services Group Medical Services Sample Jon Carrier Group Client No 50 12345678 123456789 Dental Carrier 610217 GMS Individual Health 2 ES CANADA Prescription Drug amp Dental Pay Direct Card Groupe Premier M dicale 186 2 Place Laval oureau 390 aval Qu bec H7N 5NG oupepremiermecical ca niermedical ca Name GPM User ID John Smith ABC 1234 Carrier Group No Client ID 53 AB5678 5678001234 12 EXPRESS SCRIPTS groupSource 00 Employee Sample 02 Dependent 2 Child TUPE pm 01 Dependent 1 Spouse groupSource Sample Company Sample Employee i Calgary 403 228 1644 or 1 800 661 6195 Kelowna 250 861 8877 1 800 667 0252 CDAnet ID 1092722020 605064 33 Liberty Health LIBERTY HEALTH JOHN DOE amp Family IDENTIFICATION NUMBER 987654321 Elizabeth GROUP NUMBER Wendy 12345 Michael Insured Name Manitoba Blue Cross Birth Date 21 07 40 11 12 49 06 12 74 01 05 82 Jane Doe 123 Smith Street Winnipeg MB R2L 3B8 Name Sex Birth Ii BLUE CROSS subscriber Spouse John M 12 64 L V Jan 01 2003 Dependents James
35. and Regulations CDAnet Start Date The start date is an estimate of when the dentist will be able to transmit claims to most insurance carriers however some carriers are able to accept electronic claims within a day or two of CDAnet processing the subscription agreement Try to send claims electronically as soon as you are able Patient Authorization Offices are required to obtain patient signatures authorizing your office to submit their claims electronically Additional signatures must also be obtained for those patients for whom you accept assignment of benefits Original copies of the patient s authorization must be kept on file for three years Please note that a parent or guardian must sign on behalf of the children under the age of 18 For each patient participating in CDAnet the following wording should accompany the signature authorize release to my dental benefits plan administrator and the CDA information contained in claims submitted electronically 1 also authorize the communication of information related to the coverage of services described to the named dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or guardian Date For each patient for which you accept assignment of benefits the following wording should accompany the signature hereby assign my benefits payable from claims submitted electronically to Dr and authorize payment directly
36. and their families with group benefits through their employers and associations Take this card with you when you visit a provider of a covered service i e your pharmacist In many cases they w be able to submit your claim to The Co operators for immediate adjudication without the need for you to mail paper claim form Many health professionals have this capability and will inform you the extent of the claim payment immediately Certificate Number Covered Family Members Patient Name Relationship Code We have provided a duplicate card for you your spouse or dependant child if you don t need both keep one in a safe place After detaching the card fold along the perforation and keep in your wallet d the c ators How to Submit a Claim or alba Take your Co operators card with you when you obtain covered services and present it when it s time to pay If your pharmacist is not yet enrolled in the network they should call the toll free line at the bottom of the card If the provider does not or cannot submit your claim electronically you should arrange payment and keep the detailed receipt Obtain claim form from your plan administrator or online at www cooperators ca complete the required information attach the receipts retain copies for your records and send the completed form to the Co operators Life Insurance Company We are committed to making your claims experience a positive one but if Covered Family Members Patie
37. at the insurance carrier will adjudicate all claims at a predetermined time rather than on an as received basis When a claim is sent to a batch processing system you will receive a Claim Acknowledgement in response not an Explanation of Benefits The claim will usually be adjudicated later in the day or overnight A Real time processing means that when you submit a claim the claims processor will adjudicate it and send an Explanation of Benefits response back to you immediately approximately 20 40 seconds ITRANS Q How do contact ITRANS A ITRANS Help Desk Tel 1 866 788 1212 between 9 a m and 5 p m EST Monday to Friday Email Support goitrans com Website www goitrans com 28 Appendix A Sample Insurance Cards Some of the terms used on dental claim forms may be unfamiliar to you Policy number may also be referred to as group number plan number and control number Division number is also called section number suffix number and unit number Subscriber ID is also known as certificate number SIN employee ID and cardholder ID Below are sample insurance cards The TELUS Assure Card formerly the BCE Emergis or Emergis Card Some patients may carry a plastic or paper card identified as the TELUS Assure Card formerly the BCE Emergis or Emergis card These cards may have different artwork depending on the insurance carrier and or plan sponsor however all cards will contain the same information The TELUS A
38. ate CDAnet forms to change update office information can be downloaded from the CDAnet website at www cda adc ca cdanet and faxed to 613 523 7070 or the CDAnet forms can be faxed to your office by calling the CDAnet Help Desk at 1 800 267 9701 using the automated voice messaging system Membership Continued membership in the Canadian Dental Association and or your provincial association is a requirement of CDAnet Should a dentist not maintain their membership they will be advised to renew ASAP or be removed from the system Please ensure that the subscribing associate is an active member of the CDA or provincial association prior to submitting a CDAnet form Prohibited Practices e Use of non certified software to submit claims and predeterminations through CDAnet Contact the Canadian Dental Association if you are unsure of the status of your software A list of certified CDAnet software vendors is available from the CDA website at www cda adc ca cdanet e Attempts to access services other than those described in this User Guide e All dental procedures or treatments provided to a single patient are to be submitted as one claim on the day of treatment Splitting services from one appointment into two claims or any other manipulation to influence adjudication is forbidden e Any other fraudulent practices related to the use of CDAnet Sending claims under another dentist s Unique ID Number e Sending claims from another dentist s patien
39. cate the same carrier claim number and dental office claim reference number as shown on the Claim Acknowledgement or Explanation of Benefits Follow the instructions supplied by your dental software vendor If the reversal is successful you will receive a message on your computer screen advising you of this If the reversal is rejected you will receive an error message on your computer screen explaining the reason for rejection If possible correct the error s and resubmit the claim reversal If the reason for rejection cannot be corrected notify the third party either by phone or by mail that the original claim was invalid 17 Pended Claims Request for Outstanding Transactions The dental office should initiate the Request for Outstanding Transactions regularly This mailbox is referred to as the pended claims file in Version 2 It contains responses from the claims processors that are sent after the Real time transaction takes place Please note that this feature is available through TELUS Health Solutions Group A and Continovation Services Inc ITRANS only Assignment practices tend to have more EOBs sent to their mailbox and should therefore check their mailbox daily The types of responses that are placed in the mailbox for the dentist are outlined below a EOB Response b Claim Acknowledgement Outstanding Transaction Response d Predetermination EOB e Predetermination Acknowledgement f E mail Response Occasionally
40. cation Number 006 Missing Invalid Software System ID 007 Missing Invalid Dentist Unique ID Provider Number 008 Missing Invalid Dental Office Number 009 Missing Invalid Primary Policy Plan Number 010 Missing Invalid Division Section Number 011 Missing Invalid Subscriber Identification Number 012 Missing Invalid Relationship Code 013 Missing Invalid Patient s Sex 014 Missing Invalid Patient s Birthday 015 Missing Patient s Last Name 016 Missing Patient s First Name 017 Missing Invalid Eligibility Exception Code 018 Missing Name of School 019 Missing Subscriber s Last Name or Name did not match to the one on file 020 Missing Subscriber s First Name or Name did not match to the one on file 021 Missing Subscriber s Address 022 Missing Subscriber s City 023 Missing Invalid Subscriber s Postal Code 024 Invalid Language of Insured 025 Missing Invalid Subscriber s Birthday 026 Invalid Secondary Carrier ID Number 027 Missing Invalid Secondary Policy Plan Number 028 Missing Invalid Secondary Division Section Number 029 Missing Invalid Secondary Plan Subscriber Number 030 Missing Invalid Secondary Subscriber s Birthday 031 Claim should be submitted to secondary carrier first secondary is the primary carrier 032 Missing Invalid Payee 033 Invalid Accident Date 034 Missing Invalid Number of Procedures Performed 035 Missing Invalid Procedure Code 036 Missing Invalid Date of Service 037 Missing Invalid International Teeth or Sex
41. d for efficient claims adjudication and provide a means for the networks to inform you of any changes or problem areas 22 Attachments Attachments may now be sent with Version 4 1 only these attachments may consist of XRAYS or other oral images or documents describing treatment plans or other pertinent information The Attachment message is an optional message for application software A vendor does not need to support this message type if they choose not to Any supporting material for a claim needs to be physically mailed if the carrier or the application software does not support this message type The ITRANS Clinical Document Service may be used to send attachments to other dentists and health care providers and carriers who support this message type Image Specifications Black amp White XRAYS and other black and white images must be scanned in 8 or 16Bit Greyscale at a resolution between 150 DPI and 300 DPI inclusive Colour Intra oral and other images pictures must be scanned in 16 24 or 32bit Colour at a resolution between 300 DPI and 600 DPI inclusive Care must be taken to ensure that only originals are scanned to ensure optimum digital image quality and thereby usability of the image Document must be submitted in ASCII text or Microsoft Word formats Carrier and Network Information At times you may require assistance in solving problems related to CDAnet The following offer suggestions to address particular conce
42. dgement was printed Carrier Claim No The claims processor s claim reference number if applicable Disposition A message regarding the claim transaction if applicable Dentist Name of dentist providing service Address The dentist s address Unique ID No 9 digit provider ID number assigned by the CDA to the dentist providing the service Telephone The dentist s telephone number Dental Office Claim Reference No A sequential number identifying the claim submission automatically generated by your computer system Patient The patient s name Birth date The patient s birth date Insured Address The insured s address Policy The insured s policy number Division Section No The division or section number related to the policy number if applicable Insured The insured s name Certificate No The insured s identification number Procedure The dental procedure code submitted for the claim Th The tooth number if applicable Surface The tooth surface if applicable Date The date of service Charge The charge for the procedure Lab The lab fee charged for the procedure Benefit Amount is Payable To The benefit payee Total Submitted The total charges submitted for the claim Note The amount payable may differ 13 Employer Certified Claims Some claims must be signed and certified by the insured s employer before bein
43. e limit 51815 5 Carrier Phone ID BIN Version in days Policy Number Division Number Certificate Number 88 e 66 se iu Notes Alberta Blue Cross 800 661 7671 Alberta Blue Cross including m 1 3 digits v Alberta School Empoyee Benefit Plan 800 567 8104 800 661 7671 000090 v 2 v 4 1 5 digits alphanum alphanum 1 10 digits alphanum X X X X X X X X X X 6 digits 9 digits numeric SIN CDCS CDCS BATCH 705 675 2222 610129 365 8 digits n a 10 digits alphanum X X Continovation Services Inc ITRANS 866 788 1212 ADSC Alberta Dental Services Corporation Alberta Employment Immigration and Industry Program Quikcard 800 232 1997 000105 14 7 10 Benecaid Health Benefit Solutions Express Scripts Canada 800 563 3274 610708 7 X X X Boilermakers National Benefit Plan Canada BATCH McAteer Group 800 668 7547 000116 365 Boilers N A Boilers xX X Carpenters and Allied Workers Local 27 Shingling and Siding Division Health Benefit Plan McAteer Group 800 263 3564 000117 365 27585 27585 Co Operators 800 667 8164 606258 v 4 365 3 and 7 numeric and 5 digits numeric and 10 digits numerig X X X X X Cowan Insurance Group Express Scripts Canada 800 563 3274 610153 vd E Express Scripts Canada DeltaWare Systems Nunatsiavut Government 877 201
44. ed for the claim check your mailbox later for an EOB or Claim Acknowledgement If an EOB or Claim Acknowledgement cannot be retrieved resubmit the claim A sample Claim Acknowledgement is shown on the next page Note that the format of a Claim Acknowledgement may differ slightly because it might be combined with the patient s walkout bill produced by your computer system A Claim Acknowledgement reflects the submitted amount only the amount payable may differ 11 Sample Claim Acknowledgement Form THE ABC COMPANY OF CANADA DATE MAY 15 1996 CARRIER CLAIM NO 0000083742 DISPOSITION DENTIST DR WILSON UNIQUE ID NO ADDRESS 4710 MERRYVILLE RD SUITE 901 TELEPHONE TORONTO ON M9P 3A8 DENTAL OFFICE CLAIM REFERENCE NO 123456 PATIENT ANDREW G PATTERSON BIRTHDATE POLICY 6771 DIVISION SECTION NO INSURED ANDREW G PATTERSON INSURED ADDRESS 1556 LINDEN DRIVE WILLOWDALE ON M1X 979 CERTIFICATE NO DMWS8A PROCEDURE TH SURF DATE 01205 Emergency exam MAY 15 96 02141 Single bitewing x ray MAY 15 96 012345678 416 767 8463 JAN 21 1954 55 CHARGE LAB 87 06 15 29 BENEFIT AMOUNT IS PAYABLE TO INSURED TOTAL SUBMITTED 5 102 35 THIS CLAIM HAS BEEN SUBMITTED ELECTRONICALLY THIS IS A RECEIPT ONLY 12 Acknowledgement Form Headings The headings found on the sample Claim Acknowledgement are described as follows HEADING DESCRIPTION Date The date that the Claim Acknowle
45. ental software will either print the reconciliation information or store it to be used in clearing an EFT payment If the request is rejected you will receive an error message on your computer screen explaining the reason for the rejection Correct the error s and resubmit the request Payment Reconciliation This option is available through Version 4 0 only Payment reconciliation is retrieved from networks or carriers that support this feature to provide the claim settlement details for claims that have been settled with a bulk payment To Submit a Payment Reconciliation Request e Follow the instructions supplied by your dental software vendor regarding submitting request for payment reconciliation Ensure that you correctly enter the settlement date for which the reconciliation is requested If the request is sent successfully you will receive a message on your computer screen advising you of this Your dental software will either print the reconciliation information or store it to be used in clearing the bulk payment If the request is rejected you will receive an error message on your computer screen explaining the reason for the rejection Correct the error s and resubmit the request E mail Transmissions Version 4 0 of CDAnet will allow carriers and networks to send messages to your dental office regarding issues related to the electronic claims submission process This will greatly assist the transfer of information neede
46. g processed by the claims processor These claims cannot be adjudicated in Real time For this type of claim an Employer Certified Form will be returned to you shortly after claim submission This form will advise the insured that an authorized signature must first be obtained following which the Employer Certified Form can be mailed to the claims processor Some employers require forms with slightly different information In this situation simply staple the Employer Certified Form to the patient s form A sample Employer Certified Form is shown on the next page 14 Sample Employer Certified Form THE ABC COMPANY OF CANADA DATE MAY 15 1996 CARRIER CLAIM NO ABC00000083742 DISPOSITION DENTIST DR T G WILSON UNIQUE ID NO 012345678 ADDRESS 4710 MERRYVILLE RD SUITE 901 TELEPHONE 416 767 8463 TORONTO DENTAL OFFICE CLAIM REFERENCE NO 123456 PATIENT ANDREW G PATTERSON BIRTHDATE JAN 21 1954 POLICY 6771 DIVISION SECTION NO 55 INSURED ANDREW G PATTERSON INSURED ADDRESS 1556 LINDEN DRIVE WILLOWDALE ON M1X 979 CERTIFICATE NO DMWS8A PROCEDURE TH ft SURF DATE CHARGE LAB 01103 Initial exam May 15 96 87 06 BENEFIT AMOUNT IS PAYABLE TO INSURED TOTAL SUBMITTED POLICYHOLDER EMPLOYER CERTIFICATION EMPLOYER DATE COVERAGE COMMENCED DATE DEPENDENT COVERED DATE TERMINATED SIGNATURE OF AUTHORIZED OFFICIAL AUTHORIZATION DATE THIS CLAIM HAS BEEN SUBMITTED ELECTRONIC
47. its payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I authorize release to my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian I authorize release to my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian I authorize release to my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian I authorize release to my benefits plan administrator and CDA information contained in clai
48. k phone numbers Q What if the network has not received my claim A Contact your software vendor for support Q What should I do if a claim or predetermination is rejected A You will receive an error message on your screen explaining the reason for rejection Correct the error s and resubmit the claim or predetermination using a new claim reference number If your system does not accept the changes call the applicable carrier If you receive an error that you don t understand call the CDAnet Help Desk for technical support at 1 800 267 9701 select option 1 between 9 a m and 5 p m EST Monday to Friday or email cdanet cda adc ca Q I received a message stating Network error please resubmit claim Is there something wrong with my computer system A No this message indicates that there was a temporary transmission problem Try submitting the claim again Q I m getting an invalid carrier ID code What does that mean A It means that the ID number you have programmed for the insurance company is incorrect Verify the information on the CDAnet Supported Transaction document and make any necessary changes If you re unsure on how to change this information contact your software vendor for additional help Download the CDAnet Supported Transaction document from www cdanet ca Q received a message stating Error code What does this mean A Contact your software vendor to request that descriptions be added to these
49. lectronically Dental offices must not submit the same claim twice If the claim is sent successfully you will receive an Explanation of Benefits for claims processed in Real time or a Claim Acknowledgement if the claim is processed in Batch mode These forms should print automatically at your office If this is not the case contact your software vendor When a third party adjudicates a claim in Real time the resulting EOB is returned electronically to you shortly after claim submission One EOB is printed for an unassigned claim For an assigned claim your computer system might print two EOBs one for you and one for the patient or only one EOB for the patient You may also contact your software vendor to arrange for one or more printouts to be generated from your system The Explanation of Benefits or Claim Acknowledgement must be given to the patient before he or she leaves the dental office Patients must always receive this as a receipt of the procedures performed prior to leaving the dental office Inform your patient that any questions regarding the benefit calculation should be directed to the claims processor A cheque will be mailed to the insured or for assigned benefits directly to the dentist A sample EOB form is shown on the next page Sample Explanation of Benefits Form THE ABC COMPANY OF CANADA DENTIST DR L MACDONALD UNIQUE ID NO 012345678 DENTAL OFFICE CLAIM REFERENCE NO 123456 POLICY 70009 DIVISION SECTIO
50. ment It is a mandatory requirement that a copy of the EOB be printed and given to the patient in all cases where an EOB is received This is the patient s receipt for the claim sent The printing of an office copy of the EOB is at the discretion of the office Subscribing a dentist to CDAnet A CDAnet Subscription Agreement must be completed in order for the dentist to be added to the CDAnet system The CDAnet Subscription Agreement details the terms and conditions regarding the application for and the terms and conditions regarding the use of CDAnet Every dentist in a CDAnet office who plans to submit claims in his or her name must read and accept these terms and conditions before accessing CDAnet How and when to advise CDAnet of office information changes It is important to advise CDAnet immediately of any office information changes as claims processors and networks require this information to ensure successful claims transmission If the third party companies are unaware of such changes transmission errors might occur Types of office changes updates that require CDAnet notification Listed below are the types of changes that require CDAnet notification e Subscribing a dentist to CDAnet e Change of CDAnet office address information e Addition or deletion of dentist to a CDAnet office e Change in office practice management software e Addition or closing of a CDAnet office How to advise CDAnet of office information changes The appropri
51. ms Unauthorized use of this Card constitutes Fraud ESORSE Endovelicus Regular Hours 9am to 6pm EST Monday to Friday except holidays Position Label Description Example FRONT Carrier This 2 digit number refers to the employee benefit plan 01 Group The 4 digit code identifies the Employer Certificate Refers to the unique 10 digit Number assigned to the Employee The card can be shared by more than one dependants The system has the capability to determine from the Certificate Number on the card and Birthday of the patient if the patient or the cardholder are eligible on the plan 0000123456 Name Refers to the name of the cardholder John Doe Company Logo Logo of the Cardholder s company ESORSE Logo Company Logo of ESORSE Corporation For any concerns the client may call Customer Service Number printed on the card Business Hours to EST Monday to Friday except Holidays Contact Number 1 877 637 6773 Great West Life CANADIAN DENTAL ASSOCIATION John Doe PLAN 123456 ID 123 DIVISION 4 Great West Life company Green Shield 21 888 greenshield ca green shield canada 1234567 01 12345667 02 ANNE SMITH BABY SMITH John Smith 1234567 00 ABC Company Use of this card authorizes the provider to exchange personal information with Green Shield Canada for claims adjudication
52. ms submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian I authorize release to my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian 47 I authorize release to my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian I authorize release to my benefits plan administrator and CDA information contained in claims submitted electronically I also authorize the communication of information related to the coverage of services described to the named Dentist This authorization shall continue in effect until the undersigned revokes the same Signature of patient parent or Date Guardian I authorize release to
53. nreadable 998 Reserved by CDAnet for future use 999 Host Processing Error Resubmit Claim Manually Note Not all error codes will apply to your version of CDAnet this list is intended for reference only 44 Appendix E Patient Authorization Labels The following two pages are sample sheets which you can use to create labels for insertion in your files The patient must provide your office with his or her authorization for claims to be sent electronically and for any assignment of benefits you undertake You may wish to obtain this authorization using a central logbook or with individual labels such as these 45 I hereby assign my benefits payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I hereby assign my benefits payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I hereby assign my benefits payable from claims submitted Electronically to Dr And authorize payment directly to him her This authorization shall continue in effect until the undersigned revokes the same Signature of subscriber Date I hereby assign my benefits payable from claims submitted Electronically to
54. nt you have any questions Name Relationship Code Contact us toll free at 1 800 667 8164 Certificate Number 37 Saskatchewan Blue Cross Identification Card Saskatchewan Blue Cross subscribers eligible for coverage are issued an identification card Front of Identification Card Please note that each participant has an eleven 11 digit identification number SASKATCHEWAN BLUE CROSS POLICYHOLDER NAME gt e o e Serving Identification No Name Birthdate Comments Canadians fom o 09999999900 NAMEOFSUBSCREER 01 Jan 60 SUBSCRIEER 99999999901 NAMEOFSPOLEE 01 Jan 60 Aaa abya 99999999902 NAMEOFDEFENDENT 01 01 Jan 60 T 01 Jan 60 STREET ADDPESS 99999999903 NAMEOFDEFENDENT 02 01 Jan 60 PO FR i CITY PROVINCE e This isa sample card only POSTCD Folicy No Effective Date E 0093900001 01 Jun 98 For information calltol free 1 888 873 9200 Ten Digit First 7 digits Eleven Digit Digit Group Policy Number Identification Number Dependent Number The following information can be found on the front of the Identification Card 1 Subscriber s name and address Policy Number including section number Effective date of coverage Name of policyholder Participant s unique identification number Participant s name Participant s date of birth Comments relating to participant e m m P e Inthe Primary Policy Plan Number field enter the first
55. nternet with ITRANS only the services provided by the treating dentist or a dental hygienist employed by the dentist can be transmitted under the dentist s UIN Q How do I request to Change to a Dentist UIN A The Unique Identification Number UIN changes when a dentist becomes a certified specialist The UIN is suspended when there is a change to license status Use Request to Change Suspend Dentist UIN form to request CDAnet to change a UIN due to a specialty registration or to suspend the UIN due to a change in license status CDAnet will inform all carriers claims processors of the changes You do not need to contact the carriers The change in UIN will apply to all the CDAnet offices you are registered in Download CDAnet forms from www cdanet ca Office ID for Satellite Office Setup Q We are opening a satellite office and will network the computers there to the main office do we still need a different office ID for the satellite office A Yes More and more practices are choosing to network the computers from satellite offices so all the claims are transmitted from the main office Although it may make administrative sense that those claims would have the office ID of the main office so that any cheques for assigned reimbursements would be delivered to the main office the purpose of the Provider Office Field in an electronic claim is to identify the location where the services were provided This is reinforced in the CDAnet Subscri
56. num n a 12 alphanum X x des polici res et policiers du Qu bec 450 922 5414 ext 7 628112 Assumption Life 888 869 9797 610191 7 x Autoben 877 944 7100 628151 365 10 digits 9 digits 12 digits X X Benecaid Health Benefit Solutions Express Scripts Canada 800 563 3274 610708 7 X X X X X X Benefits Trust The BATCH Formerly the Crowder Group 416 498 7723 610146 v 2 365 800 387 1670 400008 7 1 6 digits digits alphanum 9 digits xX X Canadian Benefit Providers 800 944 9166 ext 280 610202 7 10 digits 11 digits x Capitale 800 563 3274 600502 7 Claimsecure 888 513 4464 610099 v4 365 4 6 digits 10 digits alphanum X X X Commission de la construction du Quebec CCQ 514 736 6711 000036 v2 7 6 digits 4 digits 10 digits numeric X X X X X Coughlin amp Associates 877 768 3378 610105 v4 7 4 6 digits 2 digits 3 10 digits alphanum X X X X X X X X Co Operators The 800 667 8164 606258 365 3 7 and 5 digits and 10 digits numeri X X X X X X X X X X Cowan Insurance Group Express Scripts Canada 800 563 3274 610153 7 DeltaWare Systems Nunatsiavut Government 877 201 6771 610172 v4 7 X Desjardins Financial Security Express Scripts Canada 800 563 3274 000051 v4 7 6 digit
57. ption Agreement each CDAnet dentist signs where it states that the dentist certifies that the dental claim is an accurate statement of services 25 performed the provider who performed them the Office at which they were performed and of the total fee payable If a claim is being transmitted to a claims processor that supports version 4 of the CDAnet Messaging Standard then the field Billing Office Number can identify the main practice office This feature is not available for claims processors who can only receive version 2 claims Download the CDAnet Supported Transaction document from www cdanet ca Patient Information Q Do patients need to sign anything to transmit claims electronically and how do change patient address information A Yes a patient has to sign a statement authorizing the dental office to transmit his or her claims electronically The authorization information and a template for printing authorization labels can be found in the CDAnet Dental Office User Guide see Appendix E Patient Authorization Labels Q How do I change a patient s address A Update the information on your computer The new address will be reflected on subsequent claims Office Information Changes Q The dental office information has been changed the office is moving or closing ora dentist is no longer working from the CDAnet office What should I do A CDAnet must be notified if any of the office information has changed You
58. rns Networks amp Insurance Carriers that support CDAnet The format for entering numbers on your computer system differs by insurance carrier The details on the types of transactions supported by the Networks amp Insurance Carriers are attached in Appendix B This information is available on the CDA website at http www cda adc ca cdanet CDAnet Networks Networks such as TELUS Health Solutions and Continovation Services Inc ITRANS provide your office with the ability to submit claims electronically Pacific Blue Cross is a network operating in British Columbia Alberta Blue Cross and Manitoba Blue Cross are also networks facilitating receipt and adjudication of electronic claims If your claim is denied access to the network verify that all dentist and patient information has been entered correctly The error message appearing on your screen will indicate where the problem lies and you should contact the network directly Please refer to the List of 23 Transactions supported by the Networks amp Insurance Carriers in Appendix B for contact information Problems with Modem or Connecting to the Network If you have problems with your modem or connecting to the network this is likely a software or hardware problem and should be addressed to your software vendor A list of certified CDAnet vendors is available on the CDA website at http www cda adc ca cdanet Frequently Asked Questions about CDAnet CDAnet Resources Q
59. rror please re submit transaction 062 Missing Invalid Payee CDA Provider Number 063 Missing Invalid Payee Provider Office Number 064 Missing Invalid Referring Provider 065 Missing Invalid Referral Reason Code 066 Missing Invalid Plan Flag 067 Missing NIHB Plan fields 068 Missing Invalid Band Number 069 Missing Invalid Family Number 070 Missing Invalid Missing Teeth Map 071 Missing Invalid Secondary Relationship Code 072 Missing Invalid Procedure Type Codes 073 For Future Use 074 Date of Service is a future date 075 Date of Service is more than one year old 076 Group not acceptable through EDI 077 Procedure Type not supported by carrier 078 Please submit pre authorization manually 079 Duplicate claim 080 Missing Invalid Carrier Transaction Counter 081 Invalid Eligibility Date 082 Invalid Card Sequence Version Number 083 Missing Invalid Secondary Subscriber s Last Name 084 Missing Invalid Secondary Subscriber s First Name 085 Invalid Secondary Subscriber s Middle Initial 086 Missing Secondary Subscriber s Address Line 1 087 Missing Secondary Subscriber s City 088 Missing Secondary Subscriber s Province State Code 089 Invalid Secondary Subscriber s Postal Zip Code 090 Missing Invalid response to Question 15 this an Initial Placement Lower 091 Missing Invalid Date of Initial Placement Lower 092 Missing Invalid Maxillary Prosthesis Material 093 Missing Invalid Mandibular Prosthesis Material 094 Missing Invalid Extr
60. rsed for treatment by half How will CDAnet affect my computer system Your dental software vendor has made changes to your computer system to allow for the electronic transmission of claim information to claims processors In order to submit a claim through CDAnet you may be required to enter some additional information that was not previously required Because the additional details are specific to your computer system your dental software vendor will advise you of such changes Will there be any change in office procedures Since your computer system may require additional information about each patient it may be 1 necessary to request these details at every patient s first appointment after you begin using CDAnet A sample form currently being used by dental offices for the purpose of collecting this information is shown in Appendix C You may wish to use this form or create your own To prevent errors and possible rejection of claims due to invalid information please remind patients to inform your office of any changes in address employer policy number or related information upon arrival for an appointment You may wish to confirm the insurance information before submitting a claim Before the patient leaves the office you will receive a Claim Acknowledgement or Explanation of Benefits from the claims processor The form must be given to the patient prior to his her leaving the office as a receipt that their claim was sent Rules
61. s 4 digits 9 digits Empire Life Insurance Group The 800 267 0215 000033 365 5 digits 3 digits alphanum 9 digits numeric X X X X ESORSE Corporation 877 637 6773 610650 7 4 digits 10 digits X X X X X X FAS Administrators 800 770 2998 610614 v4 7 6 digits 9 digits numeric X X X X X X X Green Shield Canada 800 265 5615 000102 v 4 365 num na 3 12 digits alphanum X X x GMS Group Medical Services Express Scripts Canada 800 563 3274 610217 T 1 12 digits 1 12 digits 1 12 digits 1 X X X GMS SK Group Medical Services Express Scripts Canada 800 563 3274 610218 7 1 12 digits 1 12 digits 1 12 digits 1 Groupe Financier Inc 866 272 2204 610226 7 X X Groupe Premier M dical Inc Express Scripts Canada 800 563 3274 610266 4 03 7 1 7 alphanumeric 1 12 digits X X X X Johnson Inc 800 638 4753 627265 7 1 5 digits 1 3 digits 1 9 digits numeric X X Humania Assurance Inc formerly La Survivance Express Scripts Canada 800 563 3274 000080 r X X X Lee Power BATCH 613 236 9007 627585 v 2 365 5 digits 1 9 digits numeric X X Liberty BATCH 800 268 3763 311113 v 2 365 4 6 digits 1 11digits alphanum X X X X Manion Wilkins 416 234 3511 610158 365 9 digits 3 digits 9 digits X X East 800 265 2260 um J i 365 4 Manulife
62. ssure logo will appear on all cards to allow easy recognition As the TELUS Assure Card is issued for both drug and dental plans some of the information on the card may not apply to dental claims A sample of the TELUS Assure Card is illustrated below 11 111111 1111111111 SAMPLE CARDS ABCDEFGHIJKL COMPANY LIMITED TELUS assure A 1 This is the identification number of the insurance carrier B Policy Number This is the insured s policy number C Certificate Number This is the insured s certificate number D Issue Number Not applicable to dental plans can be ignored 29 Benefit Card AGA Benefit Card 35 200123 LOIISMAUCI UL ABCD INC Emerg 55 Example This 2 digit number refers to the employee 35 benefit plan G Numt The 6 digit code identifies the insured policy Certificate Refers to the unique 10 digit number assigned OOTISMA001 Number to the Employee I t Not applicable to dental plans can be 2735 a For any concerns the client may call the Customer Service Number Mon Fri 8am to midnight ET Sat Sun Civic Holidays 9am to 8pm ET Statutory Holidays 12pm to 8pm ET at 866 272 2204 Alberta Blue Cross ALBERTA GROUP 35 SECTION E1 CLASS FAMILY BLUE CROSS S A M P L E IDENTIFICATION NO 8123456 01 MARK ROBINSON SUBSCRIBER 8123456 02 SARAH ROB
63. t form to 613 523 7070 Step4 CDAnet will contact the office to provide a CDAnet unique identification number UIN a CDAnet office number if not already assigned and start 24 date How do subscribe to CDAnet from multiple offices A To transmit claims from multiple offices you must submit one CDAnet Subscription Agreement form per office Dentist UIN What you need to know When is it appropriate to send a claim under the UIN of a different dentist for services 1 provided A Never Claims must always be sent under the Unique Identification Number UIN of the treating dentist For services provided by an associate dentist the claim must be sent under the UIN of the associate However if a claim is being transmitted to a claims processor that supports version 4 of the CDAnet Messaging Standard then the field Billing Provider Number can identify the dentist who is to receive assigned benefits This feature is not available for claims processors who can only receive version 2 claims Download the CDAnet Supported Transaction document from www cdanet ca Can I transmit claims for hygiene services provided by an independent dental hygienist A No An independent dental hygienist must submit benefit claims under her or his own Unique Identification Number UIN as an independent dental hygienist using their own system not CDAnet When transmitting dental claims with a modem or on the I
64. tant Quadrant Arch Designation 038 Missing Invalid Tooth Surface 039 Invalid Date of Initial Placement Upper 040 Missing Invalid Response re Treatment Required for Orthodontic Purposes 041 Missing Invalid Dentist s Fee Claimed 042 Missing Invalid Lab Fee 043 Missing Invalid Unit of Time 044 Message Length Field did not match length of message received 045 Missing Invalid E Mail Materials Forwarded Flag 046 Missing Invalid Claim Reference Number 047 Provider is not authorized to Access CDAnet 048 Please Submit Claim Manually 049 No outstanding responses from the network requested 42 Error Code Message 050 Missing Invalid Procedure Line Number 051 Predetermination number not found 052 At least one service must be entered for a claim predetermination 053 Missing Invalid Subscriber s province 054 Subscriber ID on reversal did not match that on file 055 Reversal not for today s transaction 056 Provider s specialty code does not match that on file 057 Missing Invalid response to Question Is this an initial placement Upper 058 Number of procedures found did not match with number indicated 059 Dental Office Software is not certified to submit transactions to CDAnet 060 Claim Reversal Transaction cannot be accepted now please try again later today 061 Network E
65. the associate or locum dentist not the host dentist It also means that a dental hygienist who is working independently cannot bring claims for the services provided as an independent back to the dental office and submit those claims under the UIN of a dentist at that office location Increasingly new satellite practices are set up with computers networked back to the main office and all the claims are sent from the main office computer However even though it is more convenient to receive assigned benefit cheques at the main office the claims must be sent with the office ID for the satellite office The purpose of the Provider Office Number field in an e claim is to record where the services were provided not facilitate administrative payment processes However if a claim 15 being transmitted to claims processor that supports version 4 of the CDAnet Messaging Standard then the field Billing OfficeNumber can identify the main practice office This feature is not available for claims processors who can 6 only receive version 2 claims claim has to clearly identify who provided the services where they were provided what services were provided and the total fees To see what version each claims processor supports see www cdanet ca Your software vendor can assist in getting the most out of your system to meet your business needs Although there are new ways dental practices can struct
66. tion Date 21 SECONDARY THE XYZ COMPANY 1399 OAK ST LONDON ON MAR 2B6 3321 MARK LYONS FEB 20 1941 987654321 LOW INC 16 FOREST DR WEST HILL ON L2R 7Y3 SPOUSE 6 understand that the fees listed in this claim may not be covered by or may exceed my plan benefits understand that am financially responsible to my dentist for the entire treatment amount authorize the release of any information or records requested in respect of this claim to the insurer plan administrator and certify that the information given is correct and complete to the best of my knowledge Insured s Signature Policy Contract Holder Authorized Signature Summary Reconciliation This option is available through Version 4 0 only A summary reconciliation is retrieved from networks that support this feature to confirm the claim settlement details which have been indicated on EOBs received on a specified business day When networks provide settlement for a day s claims via electronic funds transfer this reconciliation may serve as a detailed backup to the amount settled To Submit a Summary Reconciliation Request e Follow the instructions supplied by your dental software vendor regarding submitting a request for summary reconciliation Ensure that you correctly enter the date for which the reconciliation is requested If the request is sent successfully you will receive a message on your computer screen advising you of this Your d
67. ts under your Unique ID Number Failure to comply with the preceding provisions will result in termination of services provided by the networks CDAnet Claim Submission Basics Understanding Your Responsibilities When it comes to sending dental claims for your patients whether you send the claims with a modem or on the Internet with ITRANS you are using the CDAnet system The fundamental element of the CDAnet system for the dentist is the CDAnet Subscription Agreement that all dentists who transmit claims must agree to see the agreement at www cdanet ca subscription agreement is several pages in length but there is one sentence that captures a main part of the dentist s obligations The sentence reads that when a claim is sent the dentist named as the sender of the claim certifies that the dental claim is an accurate statement of services performed the provider who performed them the office at which they were performed and of the total fee payable This means that Only the treating dentist can send the claim e Adentist cannot send a claim for services provided by another dentist or another independent provider such as an independent dental hygienist e The Provider Office Number must be the office number of the location where the services were provided Claims for services provided by an associate or locum dentist must be sent under the unique identification number UIN
68. ured administratively and there are new ways to deliver dental services the basics of benefit claim submission remain the same a claim has to clearly identify who provided the services where they were provided what services were provided and the total fees The other basic that cannot be overlooked is obtaining proper written consent from the patient for the transmission of their benefit claims Claims Real Time Claim Processing Real time processing means that when you submit a claim the claims processor will adjudicate it and send a response back to you immediately approximately 20 40 seconds An Explanation of Benefits EOB is returned for a claim that is adjudicated in Real time However a Claim Acknowledgement CA may be sent back if the insurance company chooses to look into the claim further In some instances a claim adjudicated in Real time may be rejected due to errors If this occurs an error message will be displayed on your screen Correct the error s and resubmit the claim If still unsuccessful contact your software vendor for assistance Batch Processing Batch processing means that the insurance carrier will adjudicate all claims at a predetermined time rather than on an as received basis The claim will usually be adjudicated later in the day or overnight A Claim Acknowledgement is always returned for a claim that is received for batch processing Once the insurance carrier performs adjudication an

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