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Who is Involved in Electronic Claims Submission?

Who is Involved in Electronic Claims Submission?

The Dentist

The dental office submits claims electronically, either via a software vendor, or directly to a clearinghouse.

The Vendor

The practice management system vendor is responsible for your software and its upkeep. They forward your electronic claims to the clearinghouse. This team provides any updates when needed and provides daily technical support. Some vendors also have clearinghouse capabilities.

The Clearinghouse

The clearinghouse is responsible for the transmission of the claims to Delta Dental and the other carriers who accept claims electronically. At the clearinghouse, claims are reviewed for completion to ensure they are ready to send to each carrier. Some clearinghouses also have vendor capabilities.

Northeast Delta Dental receives electronic claims from the following clearinghouses:
(You may wish to call them for more information.)

Electronic Insurance Service (EIS) (vendor/clearinghouse) - 800-576-6412
ENVOY-NEIC - 800-366-5716
MedE America (vendor/clearinghouse) - 888-416-0673
SoftRix - 800-366-5477
Tesia Clearinghouse, LLC - 800-724-7240 - NOTE: Northeast Delta Dental accepts electronic attachments from Tesia Clearinghouse, LLC ONLY.

Payer/carrier

Northeast Delta Dental, or a commercial dental insurance company, that makes payment on claims submitted for dental services rendered to its subscribers is considered a payer/carrier. Your software vendor should be able to provide you with a list of all the different carriers that accept electronic claims