CLM01 in eclaims

[Jorgebon]

Jordan,
I was reading the webpage and noticed that you are now using the the patient number for field CLM01 in eclaims. That got me to thinking because I know that many inscos use that number to identify claims when you call them to inquire about any problems with the claim. So I looked up Cigna's companion guide for dental eclaims and sure enough it says
"The developers of this implementation guide

strongly recommend that submitters use completely unique numbers for this

field for each individual claim."

They do this so that when you call them, they can search for the number and only one claim will show up on their system. I also checked what other eclaim software developers do and found that they use a special date/time number for this field. This number is always unique for each individual claim since it's derived from the date and time down to a tenth of a second. For example, number 201005081639251 means that the claim was made on year 2010, month 05, day 08, hour 16, minutes 39, seconds 25.1. No other claim will have the same number ever, which makes it easier for the insco to look it up in their systems.

I would suggest considering using the same system, and just adding a field for this number in the reports in OD and in the claim in the Account module.
Jorge Bonilla, DMD

[Jorgebon]

I keep thinking about this and the more I think the more problems I find. Imagine if after some time of using OD you want to look up claim number 5678. You may find that patient number 5678 has had forty claims, all with the same number. It doesn't help in making queries and reports and it makes it more difficult than it was until now. As it was, we already had unique numbers for each claim, at least within our own databases.
Jorge Bonilla, DMD

[jordansparks]

Are you talking about this page?:
http://www.opendental.com/manual/eclaim ... ities.html

I've decided to include both the PatNum and the ClaimNum. The presence of the PatNum would allow searching, and the presence of the ClaimNum would ensure uniqueness. The field supports 20 alphanumeric characters, the two numbers will be separated with a forward slash. This will be implemented immediately.

But then there's that pesky requirement by DentiCal that the number be the same on the preauth and on the claim. As far as I'm concerned, they should not have the same number because the submitted claim frequently does not exactly match the preauth in the number of procedures performed. The only way I can think of to satisfy the DentiCal requirement is to add a CLM1 override where the user can type in the number from their preauth if they really need to.

One more twist. For offices using replication, the maximum PatNum or ClaimNum is 9,223,372,036,854,775,807, 19 characters all by itself. The 20 available characters are not enough.

[Jorgebon]

Thanks Jordan. The patient number/claim number combo should work. I'm not sure if the clearinghouses accept the foward slash though. I guess it would be simple fix to remove it if they didn't.
Jorge Bonilla, DMD

[jordansparks]

I'm 95% sure the slash won't be a problem. It's an allowable character in an AN field.

[Jorgebon]

I copied and pasted this from the Cigna D837 Companion Guide:

"2. CIGNA limits the characters that are allowed in data elements to the following:
The letters A through Z (upper case only)
The digits 0 through 9
Spaces
Decimal points in numeric fields defined with the decimal attribute
A hyphen in data elements that require the specification of date ranges"

That's why I have my doubts about the foward slash.
Jorge Bonilla, DMD

[eiscott]

For what it's worth, DentalXChange replaces (but stores) the claim ID received on the claim with a unique claim ID since very few PMS programs supply unique numbers. You are able to search claims by either ID in ClaimConnect so that you will have the unique claim ID availabe if checking on a claim with a Payer.

Hope this helps,

Scott

[jordansparks]

That information has been added to that page in the manual documenting how CLM01 is treated.

[igork]

Dear Dr. Sparks,

Has this features of overwriting claim number for the claims that has a pre-auth approved been implemented?
If it is, how do we enable it?
And where can we see the pre-auth claim number (besides using SQL ).

Many thanks in advance!
Igor Kogan

[jordansparks]

Yes, it already does that. You can't see the claim number. Shouldn't matter.

[igork]

Thank you Dr. Sparks,

My apologies if I wasn't clear with my question.

Are you saying that we can, with the current version of OpenDental, send to Denti-Cal and the claim number will be the same as the pre-auth received?

If this works, it is great! What do we do after we get the pre-auth from Denti-Cal? Do we create a new claim? Do we take the pre-auth request, change it to claim and submit? ...

Please let us know.
Many thanks in advance.

Igor Kogan
Oral Health Care

[jordansparks]

Sorry, I didn't catch on to your question sooner. No, Open Dental cannot currently send the same CLM01 number in both a preauth and a claim. It's a feature request. That page in the manual has been revised.

[igork]

I almost had my hopes up... , plus your tech-support stated that it should work ( -- oh well.
Is this an existing request (I could not find it) or should I submit a new one?

TIA,
Igor

[jordansparks]

The support tech was just repeating what I told them. No, I don't see that feature request listed.