Upload Claims: Allows user to upload claims in a batch file manner. NOTE: This feature is not available to all users.

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1 Claims: Upload Claims: Allows user to upload claims in a batch file manner. NOTE: This feature is not available to all users. The user clicks on the Choose File button. This will then open a folder on the user s workstation. The user must locate and choose the file to send. Once the user has selected the file the Upload button must be clicked in order for the file to transmit to EDS for processing. Open Claims: Search Criteria: This allows the user to sort Open Claims by available options: Orange action buttons: Refresh: Refreshes the current view. Reject Claim: Allows the user to reject a claim. This prevents the claim from processing out to the insurance company. This option is only available in the Open Claims window and claims must be denied before 8:30PM CST on the day the claim was sent to EDS. To Reject an Open Claim: User must click into the box to the left of the claim that needs to be denied. This will highlight the row containing the claim. Once the checkmark appears, the user then must click Pop-Up box will appear confirming this request. Error Report: Shows the user an Error Report for Open Claims. Print: Allows the user to Print the current window. Edit: Allows the user to Edit a claim on the Portal before it is sent to the insurance company.. A

2 Editing a Claim in Open Claims: The user must click into the box to the left of the claim that needs to be edited. This will highlight the row containing the claim. Now the user must click the Edit button. This will load the claim in an easy to read format. The icon/link indicates an area that has a Pop-Up for additional information when clicked. When editing claims, this is used in Box 31a. to enter Primary Paid Amount and Date for secondary claims. The link indicates an area that has a Pop-Up where a list of active procedure codes is displayed when clicked. When editing claims, this is used to Add or Change a procedure code(s) in Box 29. The button is used to submit the edited claim to EDS. If sending a corrected or voided claim, please indicate in the bubble and add the original claim number in the box.

3 The check box allows the user to add additional information required by Minnesota offices submitting attachments via fax to select Minnesota Payers. Checking this will open a Pop-Up window for the user to add additional information: Once this Pop-Up is completed the user must click on Save & Print. This will pop up the pre-populated form for the user to print. Do not close the Fax & Appeals Submission Contact Information window until the PDF has printed. After printing, click on Close and Attachment Number will automatically be added to the Remarks section of the Claim. The user must now click on the the necessary Attachment number. button at the top or bottom of the claim form for the claim to be submitted with The MN AUC form that was printed must be faxed with the EOB to the Insurance Company/Fax number selected. The The button allows the user to submit the completed or edited claim form. button allows the user to clear the form completely.

4 Open Claims: View Open Claims. This is the same area as the dashboard option. Column Headings: Columns can be sorted by clicking on the Column Heading. Example: Clicking on Patient Last will sort claims alphabetically by last name. NEA Status: Shows the current status of a potential NEA attachment for each claim. Rec d Time: Indicates the time that EDS received the claim. EDS Claim ID: The ID number given to the claim once it reaches EDS. Type: How the claim will be forwarded to the insurance company. Either, Electronic or Paper. Patient Last: Patient Last Name Patient First: Patient First Name. Service Date: Date of Service as it was submitted on the claim. Amt: Amount of claim as it was submitted on the claim. Prim/Sec: Indicates if claim is a Primary or Secondary claim as it was submitted on the claim. Ins. Co.: Indicates what Insurance Company information as it was submitted on the claim. Payer ID: Indicates the Payer ID associated with the Insurance Company submitted on the claim. Insured ID: Indicates the Insured ID as it was submitted on the claim. Prov. Name: Indicates the Provider Name as it was submitted on the claim. Rec d Date: Indicates the date EDS received the claim. Location: Indicates the physical address of treatment as it was submitted on the claim. Status: Current status of the claim in EDS system. Denied or Pended, see example on following pages.

5 Denied Claims: Claims that are denied for missing or invalid information. Pended Claims: Claims that may need additional attention from the office, or require review from EDS. NEA: Allows user to view a list of NEA claims. (This feature is available for offices that are using NEA for their electronic attachments.) Open Claim Status: Allows user to see the rejections from Daily Detailed reports in one screen with sorting features of: Received Date, Patient Name, Batch type and Read Status. This feature is not available to all users. Notes can be added to the Denied claims in the Open Claim Status window. The user must click once in the Note section for the selected claim. The user will see the Edit Record Note window appear.

6 The user can type a message into this window and then click submit. The note will now appear in the Open Claim Status Window. Once a claim has been reviewed or read, the user then places a check mark in the far left column and clicks on the orange Mark Read button. This clears the claim from view, but can be viewed again in Claim History. Claim History: Allows user to search for claims by: Process Date, Processed Type, Payer ID, Patient Name, Subscriber ID and Status. Manual Claim Entry: Allows user to enter and submit claims manually. Clicking on the New Patient button allows the user to enter or edit patient and subscriber information to be stored for future use.

7 Clicking on will expand the insurance section to allow the user to enter Insurance information. Once all information has been added, click the Save or Save and Fill Form button. (Clicking on Save and Fill Form will auto-populate the information into the claim for the user.)

8 Clicking on the Existing Patient button allows the user to search for a previously saved Patient. The Patient s Last Name, First Name and DOB can be entered. Active or Inactive patient s may be searched. Once the patient list has been loaded into the window, it can be selected or edited. If the patient is selected from the list, the patient information will auto-populate into the claim form. Allows users to view a history of manual claim entry submissions:

9 Section Descriptions: 1. Select Type of Transaction 2. Add Predetermination/Preauthorization Number if necessary Select Primary or Secondary coverage If sending a corrected or voided claim, please indicate in the bubble and add the original claim number in the box. 3. Add Primary Payer Information. Select New to add Primary Payer information to database. Once completed, click Save and Fill Form. Click on the magnifying glass icon to Search for previously stored Insurance Payer/Carrier information. 4. Indicate Other Dental or Medical Coverage. 5. Secondary Coverage information, subscriber Last and First name 6. Date of Birth of Secondary Subscriber. 7. Gender of Secondary Subscriber.

10 8. Subscriber ID# for Secondary Subscriber. 9. Plan / Group number for Secondary Subscriber. 10. Relationship to Primary Subscriber. 11. Other Carrier Information. Click on New to add new Insurance Payer/Carrier information. Click on to Search for previously stored Insurance Payer/Carrier information. 12. Primary Subscriber Information: Last Name, First Name, Address, City, State and Zip. 13. Primary Subscriber Date of Birth 14. Primary Subscriber Gender. 15. Primary Subscriber ID#. 16. Primary Subscriber Plan/Group Number. 17. Primary Subscriber Employer Name. 18. Patient Information: Indicate Relationship to the Primary Subscriber. 19. Reserved for Future Use 20. Patient information: Last Name, First Name, Address, City, State and Zip. 21. Patient s Date of Birth. 22. Patient s Gender. 23. Patient ID/Account Number assigned by Dentist. 24. Procedure Date: Key in Procedure Date or click on to choose date. 25. Area of Oral Cavity: Click on to view list of Areas of Oral Cavity. Choose if needed. 26. Tooth System: Defaults to JP. 27. Tooth Number(s) or Letter(s): Click on to view a list of tooth numbers/letters to choose from. 28. Tooth Surface: Click on for each Surface needed per the procedure code used. 29. Procedure Code: Click on to view a list of procedure codes to choose from. Click on in the Procedure Code list to choose the procedure code. 29a. Diagnosis Pointer 29b. Quantity 30. Description: The Description will auto-populate when the procedure code is selected. 31. Fee: Enter the proper Fee associated with the code selected. *Rows may be added or deleted as needed by choosing or. 31a. Other Fee(s): Select the icon to enter Primary Paid Amount and Date. Select Save when information has been entered. 32. Total Fee: This will auto-populate and calculate the fee to be sent on the claim. 33. Missing teeth Information: Click on the tooth number(s) to indicate any missing teeth. 34. Diagnosis Code List Qualifier 34a. Diagnosis Code(s) A, B, C, D 35. Remarks: Located at the bottom of the form. Additional remarks or narrative may be added. 36. Authorizations: Click into the box to indicate that the patient agrees to the treatment plan and fees. Enter date or click on the icon to select date. 37. Click into the box to indicate payment is to pay to the provider. Enter date or click on the icon to select date. *No checkmark indicates that the payment will pay to the patient. 38. Place of Treatment: Select place of Treatment 39. Enclosures (Y or N) 40. Is Treatment for Orthodontics? Indicate if Treatment is for Orthodontics.

11 41. Date of Appliance Placed: If treatment is for Orthodontics, then there MUST be a placement date entered. 42. Months of Treatment Remaining: If treatment is for Orthodontics, then Months of Treatment Remaining must be entered. 43. Replacement of Prosthesis: Indicate if Prosthesis is New or Replacement. 44. Date Prior Placement: If the Prosthesis is a Replacement, then the Prior Placement Date must be keyed in or click on the icon to select date. 45. Treatment Resulting From: Indicate if an Occupational Illness/Injury, Auto Accident or Other Accident. 46. Date of Accident: If treatment was due to an Accident then the Date must be keyed in or click on to select date. 47. Auto Accident State: If the Auto Accident box was selected in box 45, the State of the Accident must be entered. 48. Billing Dentist or Dental Entity: Enter Name, Address, City and Zip Code of Billing Dentist or Dental Entity. Click on the icon to Search for previously stored Billing Dentist information. 49. Group NPI: Key in Group NPI. 50. License Number: Not Used 51. SSN or TIN: Enter SSN# or TID (Tax ID) 52. Phone Number: Enter Phone Number for the Office. 52A. Additional Provider ID: Enter required Insurance Company issued Group ID number. 53. Treating Dentist and Treatment Location Information: Enter Last Name, First Name and Date. Click on the icon to Search for previously stored Treating Dentist information. Enter date or click on the icon to select date. 54. NPI: Enter Treating Dentist s Individual NPI number. 55. License Number: Enter Treating Dentist s License Number. 56. Address, City, State, Zip Code: Enter Treating Dentists Physical Address, City, State and Zip Code. Click on the icon to search for previously stored Physical Location information. *This address CANNOT contain a P.O. Box in the address. 57. Phone Number: Enter Phone Number of the Office. 58. Additional Provider ID: Enter required Insurance Company issued Provider ID number. At the bottom of the form are 2 options: Checking this creates a Pop-Up for NEA information to be entered: Allows the user to add information required by Minnesota offices submitting requested information via fax to select Payers. This will Pop-Up a window for the user to add additional information:

12 Once this Pop-Up is completed the user must click on Save & Print. This will pop up the pre-populated form for the user to print. Do not close the Fax & Appeals Submission Contact Information window until the PDF has printed. After printing, click on Close and Attachment Number will automatically be added to the Remarks section of the Claim. The user must now click on the the necessary Attachment number. button at the top or bottom of the claim form for the claim to be submitted with The MN AUC form that was printed must be faxed with the EOB to the Insurance Company/Fax number selected. The The button allows the user to submit the completed or edited claim form. button allows the user to clear the form completely.