This article covers how to handle Canadian Dental Association (CDA) eClaims within MacPractice.
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An eClaims trainer will install and configure the eClaims template for the office before claims can be created and managed.
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Initial Setup
To configure CDA eClaims, first set the Localization panel in Preferences to "Use Canadian Claim Fields". Within the MacPractice menu, select Preferences > Localization and set any menu to the desired unit.
Note: Use Canadian Claim Fields should default all dropdown menu items to proper settings for the region. Additional changes can be made after checking this box.
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User Setup
Set up each provider with a User in MacPractice. In the References ability, select Users and create a new User if necessary.
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In the Provider Numbers tab, enter the Provider ID number in the SSN/Provider ID field, the Billing Provider number in the Federal/Billing Provider field, and the Billing Office number in the Sub ID/Billing Office # field. These numbers are provided by iTrans.
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Patient Setup
Each patient is set up within the Insurance box in the Primary or Secondary tab.
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The insurance company is also listed under the patient's Insurance tab. Scroll to the right to see a Dependent Code field and a Check Eligibility button where the company has made eligibility checking available. Check with the carrier for more information. Not all payers support eligibility checking. If the payer supports eligibility checking, click this button to retrieve eligibility reports for the selected patient. View the eligibility reports in the eClaims ability under Reports.
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Insurance Setup
To configure an insurance for use with eClaims, select the Insurance Company in References and create a new insurance reference if it does not already exist.
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A preference commonly related to providers accepting of assignment with a carrier is Preferences > Claims > Automatically Close New Claims If Provider Does Not Accept Assignment. This way if the patient gets paid by the insurance, there won't be a large amount of outstanding claims.
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Note: Scroll to the far right to see these columns. Columns can be rearranged with the CDA columns first, as the other fields are only used for US claims. |
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On the CDA tab, check the CDA version, Network, and Supported Transactions for each insurance company. This information is found on the Supported the Supported Transactions list.
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Managing CDA
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eClaims
With the provider, patient, and insurance records configured, claims can be created after the eClaims training and template installation is complete. For information on creating charges or claims, please see the ledger documentation.
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Depending on the level of supported transactions from the carrier, EOBs, Eligibility Acknowledgements, Claim Acknowledgements, and Predetermination Acknowledgements may be received. Review these reports carefully. Below is an image of a sample report, however each report may be formatted differently, depending on the information the carrier supplies.
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Important Notes
If a Claim Acknowledgement report displays "Payee has changed total payable to dentist," this indicates "Accepts Assignment" was not checked when sending the claim and the patient will receive payment.
Some claims have multiple reports attached to them, including some generic transaction files. Review all reports attached to a claim.
iTrans recommends that outstanding transactions are checked weekly if not daily. Create a separate Insurance reference with Payer ID 999999 and Carrier Identification # CDANET14. Click on the Provider IDs tab and click the "Outstanding" button to check for outstanding transactions from iTrans.
Reversal
Once a claim is sent, the office has until the 11:59pm the day the claim was sent to send the reversal. If the claim needs to be reversed after this time please contact the carrier for further instructions.
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