This article covers the general process for submitting claims to an individual payer site. Please note that every payer site is different, and will require a different registration process. This guidance assumes that you have followed the process of registering for that individual payer and are able to log into that portal.

Locating where to submit claims

After logging into the portal, you will need to locate where you can submit the claim.

Most times you will see a claims drop down and the drop down will allow you to select “Claims entry” or “Enter Claim/Predetermination.” Keep in mind that all insurance portals are different, and you may have to look around for the claims submission ability within the portal.

You will not be able to submit claims on all portals, some don’t give you the option.

Some portals may have you verify eligibility first but, that will be included in the claims submission process, you won’t have to go to the eligibility tab typically to look up this information.

Entering the Insured’s Information

Once you have selected claims submission, there will be a place to enter the insured’s information such as date of birth, name, and subscriber ID number. You will also need to select the date of service and select the place of service such as office, outpatient hospital, etc.

Entering Claim Data

Once you have entered the member’s information, you will be able to manually enter the procedure codes, procedure description (this may populate by itself), and if applicable, tooth number, surfaces, quadrant, modifiers, and fee charged.

You may also need to enter in NEA attachment numbers or upload documents that would ordinarily be included with a claim submission as well. A good rule of thumb is, if you were needing to add attachments to a charge when submitting a claim ordinarily, you would need to include that attachment somehow on the payer portal.

Submitting the Claim

Once you have entered all the procedures for the claim, there will be either a “Review” button or a “Submit” button to click. Once you have clicked that, you will have the opportunity to review your claim, and should have a confirm or submit button to finalize the claim.

The portal will typically provide you with a claim number that you can note for your records.