Dental Claims Clearinghouse: Everything You Should Know

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dental claims clearinghouse

Dental Claims Clearinghouse Automation

An increase in patient account receivable (A/R), denied claims, and delayed reimbursements are common issues for most dental healthcare providers. Dental healthcare is often considered a separate entity from primary healthcare. This perception often impacts the billing and reimbursement of services. In addition, the growing trend relating to increased patients’ responsibility for self-pay and insured patients complicates things even more. As a result, a considerable number of dental claims are often denied or delayed.

A proactive and automated billing system is key to ensuring timely and adequate reimbursement for dental services. Automation also minimizes the risks arising from patient A/R exposure. An effective clearinghouse API can help a dental healthcare provider obtain timely reimbursement for all patient services. The role of clearinghouses in the healthcare industry has expanded significantly, ranging from real-time claim submission and insurance verification to appeals and settlements.

What does a Dental Claims Clearinghouse Do?

A clearinghouse for dental claims is the middle player between dental healthcare and insurance companies. Dental healthcare providers have medical billing software where they upload their claims electronically. An identified clearinghouse scrubs the claims for coding and billing errors before submitting the claims to respective payers for processing.

Upon receiving the claim, insurance companies accept or reject the claim. Upon rejection, a message is sent back to the clearinghouse indicating errors on the claim. Dental healthcare providers receive reimbursement for the services provided if there are no errors. 

Benefits of Claims Automation

With advanced technology in the healthcare industry, every repetitive manual process can be automated for greater efficiency. So automated dental claims offer an opportunity to reduce the lengthy and costly process incurred in filing claims. Here are the benefits of dental claim automation:

Saves Time and Resources

Lengthy and clumsy processes in dental healthcare contribute to poor performance and staff burnout. However, by eliminating manual paperwork, automated claims processing enables productive use of time and financial resources. 

Automation prevents errors incurred in the manual filing and processing of dental claims. Consequently, it reduces claim denials, allowing dental healthcare facility to stock the necessary equipment for efficient care services. 

Streamline Administration Operations

One of the essential benefits of automation is providing improved administrative tasks. For example, dental healthcare providers no longer need to go through disparate medical records, payer edits, and difficult coding. Instead, staff focus on offering quality services to patients. In addition, automation allows a standardized workflow, enabling healthcare administrators to improve operations across their facilities. 

Streamline the Billing Process

Automation not only saves time and resources but also allows dental healthcare providers better clarity and control over claim processing. Automated billing processes provide reliable data to reduce errors and enhance optimum reimbursements. 

Many dental clinics’ claims are denied due to a patient information mismatch. Fortunately, using the robust EHR to provide reliable and accurate data, dental healthcare providers generate accurate patient data before filing a claim. 

Automation Transforms Patient Experience

Patients are often eager to know whether their dental healthcare facilities have been reimbursed for the services offered. Many patients become agitated when they are forced to wait longer due to a lengthy manual process. However, automation reduces patients’ anxiety and improves satisfaction. For instance, real-time billing and fast reimbursement encourage patients to develop relationships with their dental healthcare facility.

Why a Dental Clearinghouse is Essential in Claim Reimbursement

Many dental facilities continue to experience claim denials for unknown reasons. Therefore, it’s always essential to have a partner who understands claims processing better to avoid frustrations. And a dental clearinghouse help remove challenges experienced in the billing process.

In addition, some errors in billing claims are too minor for dental professionals to note. Unfortunately, insurance companies are always looking for such errors to deny reimbursement. This is another reason why dental clearinghouses come in handy. Some of the errors include the following:

  • Inactive coverage — a clearinghouse will immediately flag when the patient’s benefits are inactive
  • Validation errors — missing personal information is often detected by a clearinghouse

Benefits of a Clearinghouse for Dental Claims Processing

Some benefits of a clearinghouse for dental claims processing include:

Secure Data Transfer

A clearinghouse provides a safe avenue for dental clinics to transmit claims to payers through PHI. Research shows that many healthcare organizations lose substantial finances from lost patients’ data. The average cost of lost patient data in healthcare organizations amounts to $355 per record. 


Advanced technology has compelled dental organizations to put everything online rather than sending claims through emails. For instance, prominent healthcare insurance requires dental clinics to submit claims online. Clearinghouses help audit and process claims efficiently. In addition, it saves dental facilities the need to install costly software and hardware. 

Improved Claims Readability

Poor readability on written claims forces insurance companies to deny reimbursements. In addition, it takes time to read handwritten claims, leading to more delays in reimbursements. Fortunately, the clearinghouse’s electronic system has effective eligibility that detects spelling mistakes in electronic and paperwork claims. Clearinghouses detect and edit errors before submitting the claim to insurance companies. 

How to Choose the Best Clearinghouse for Dental Claims

Determining the best dental claims clearinghouse API can be daunting. However, the following qualities can help dental clinics choose the best for them:

Payer List

The insurance list that you constantly bill on must be in the clearinghouse list. The list is often available on clearinghouses’ websites.

Claim Software

Software that integrates with dental clinics is essential in providing efficient services. Additionally, the clearinghouse’s workforce must have adequate knowledge of handling such systems. A clearinghouse disaster may occur when their team cannot integrate their services into your billing system.

Easy-out Contracts

Clearinghouses that offer complicated contracts involving lengthy steps to quit may cause significant problems for your dental company.

Why Choose Apex EDI as Your Dental Claims Clearing API

Delayed reimbursement and denied claims can halt operations at a dental clinic. In addition, correcting errors on denied claims can be time-consuming and tedious for dental healthcare providers. 

Apex EDI can help dental clinics solve billing problems and receive adequate reimbursement promptly. Apex EDI simplifies the claim delivery process through an automatic, efficient, and reliable system. Our software is flexible and easy to integrate with most dental billing systems. The system allows for one-touch claim processing, real-time information eligibility, and claims process reporting.

Our software includes features and custom plans for any healthcare facility. We let you focus on patients’ wellness while we take care of your billing process. So, if you want to improve your dental clinic’s efficiency and increase profits, Apex EDI’s claims software can help achieve your organizational objectives.

Learn more about Apex EDI today and schedule your free demo.



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