Steps to create and submit Pre-Determinations and Claims electronically

Overview

How to send a Pre-determination or an E-Claim, step by step from Insurance, Creating, Submitting, and Uploading.

Detailed Instructions

• Make sure the patient’s insurance information is entered in the Insurance page.

Pre-Determination

• In the Fees page, add the fees without clicking ‘Post’ or ‘Post All’ buttons. 

  

• Click on the “New Claim”button. 

  

• On the “Create Claim” window, check the box for “Pre-Determination”. 

  

• Make sure the right doctor shows in the Doctor field, the Location is the right one (for multi-location offices), and the insurance name shows on the Insurance field.
• Highlight or select the fee available, then click the “Create Claim” button

Assigned vs Non- Assigned

• If the payment is elected to be received by the Office from the Insurance select Assigned.
• If the payment is elected to be received by the Patient from the Insurance select Non-Assigned
• The Pre-Determination form will be created in TDO
• Click on the “Submit E-Claim” button, Even though it is a predetermination it will send as a Pre-Determination

• If the E-Claim was elected to be Assigned and paid to the Office the claim will have Signature on file for both the Parent/Guardian and Subscriber (insured individual)

• If the E-Claim was elected to be Non-Assigned and paid to the Subscriber the claim will only have the Signature on File for the Parent and Guardian and not the subscriber

• Select YES to the question: Would you like to enter that this predetermination was filed as E-Claim today? 

  

• Click on Insurance Tools> Upload Claims, to send all made E-Claims to DentalxChange

In Version 11 click on the “upload” button on Main Page to submit the Pre-Determination online.

E-Claim

• After insurance is verified and filled out go to Fees tab
• Post the Fees that are planned to be billed to Insurance. Click Post or Post All if there are several fees to be posted for claim.
• Add the date by clicking in the box this will show when the fees were being posted and presented to the patient. Both boxes need to be filled

• Fee is now posted to ledger and will be removed from the Fees page

• Click New Claim
• The code will show here with the Insurance

Assigned vs Non- Assigned

• If the payment is elected to be received by the Office from the Insurance select Assigned.
• If the payment is elected to be received by the Patient from the Insurance select Non-Assigned
• Click the code and select Create Claim to create the claim form

• Claim form will show for review
• You can add attachments if needed see this article. This Attachments functionality is added in version 12.338 and higher and Only .jpg, .png, and .gif files can be attached.
• Select Submit E-Claim

• If the E-Claim was elected to be Assigned and paid to the Office the claim will have Signature on file for both the Parent/Guardian and Subscriber (insured individual)

• If the E-Claim was elected to be Non-Assigned and paid to the Subscriber the claim will only have the Signature on File for the Parent and Guardian and not the subscriber

Upload Claim

• You can view the E-Claims that are pending and ready to send
• Insurance Tools> View Current E-Claims

• To send all E-Claims that are ready to go
• Insurance tools> Upload Claims
• A progress bar will show and notify when complete

Error Sending Claim

If the upload fails Verify that you DentalxChange Password and login are correct, 

• Verify that you TDO login information is correct
• Setup> Site Configuration>Electronic Claim Setup

• Type in the correct Username and Password 

• Click Login to open the DentalxChange website to verify the correct information
• Then Select OK in TDO to have the updated Password saved and repeat the Upload process to send Electronic Claims

Article ID: 613
Created: August 14, 2016
Last Updated: October 12, 2023
Author: TDO KB [web_admin@tdo4endo.com]

Online URL: https://kb.tdo4endo.com/article.php?id=613