Step 3: Medical Billing Course Registration Complete

Congratulations on taking the awesome leap into medical billing for dentists! You will help so many more patients while increasing your revenue and growth potential. Here is your prerequisite “to do” list.

Get Started:

The most important goal of the course is to ensure you can successfully file simple medical claims for reimbursement. You must have basic tasks competed to do this quickly and seamlessly and include the following:

1. Credentialing with CAQH as a non-participating medical provider for commercial plans. As a dentist, this is done through the ADA web site: https://ebusiness.ada.org/login/loginCAQH.aspx?PO3ORGAPICODE=CAQHPRW89798928.
2. You must have available your ADA number (all dentists have this regardless of membership in the ADA). If you do not know your login, just follow the prompts to obtain your ADA number and establish another password. Update your profile and submit credentials.
3. Once you go to submit credentials, you will get sent to the CAQH Pro-View page. Follow the steps on the page. Contact support or helpdesk for CAQH if you have any issues. We cannot help you with this portion and please remember CAQH Pro-View is not the same as CAQH Enroll Hub.
4. Establish a Facility NPI (Type 2) for your organization, especially if there are multiple providers in your practice. If you are a single doctor, you can technically submit claims under your individual NPI (Type I).
5. As a provider, you already have an assigned NPI. The facility NPI follows the facility/office while the individual NPI follows the doctor. When using the Type 2 NPI for billing, payments will go to the organization and not the provider. Your W9 form should match the name of the business entity and the Type 2 NPI applicant.
6. Go to NPPES.cms.hhs.org and register your facility for a type 2 group. You can usually use the same taxonomy as the Type 1 NPI. In your Availity,com business profile, I suggest using Dentist, Oral Maxillofacial Surgery (1223S0112X) taxonomy as your primary and include any other taxonomy that best describes procedures you may submit (general, endo, ortho, pedo, sleep, radiology, etc). In CAQH, you can only select one taxonomy, so please select the one that best describes what you do overall, i.e, Dentist, General Practice 1223G0001X.
7. We are going to focus on using one primary resource for filing claims, although there are several ways to do so as will be discussed in the course. For this purpose, we will use www.Availity.com.
8. Go to the site and register. Once registered, contact Availity.com support and let them know you are a dentist filing medical claims and need access to file both MEDICAL and DENTAL insurances. Otherwise, you will not be able to file medical claims through this portal. For those of you already using Availity for dental claims, you can skip registering, and simply contact support as noted above.
9. To confirm in Availity.com that you are registered for medical and dental, just go to the Payer Spaces tab along the top of the landing page and check to make sure you see medical and dental insurance plans available to select.

Collect Medical Cards:

1. Ask every patient for a copy of their medical card. Sample verbiage, “Some of the treatment in the mouth may be covered by your medical insurance and reduce your out-of-pocket expenses.”
2. Update your medical history forms to reflect that patients are giving you permission to file claims to both their dental and medical companies on their behalf.

Access to Your Practice Management System:

1. Regardless of whether you use Eaglesoft, OpenDental, Dentrix, or other, please have access to a recent exam or emergency treatment for any patient for whom you have collected medical card information through your secure practice management software.  Bring your laptop with secure online access to file a medical claim real-time, charger, and any other pertinent items for convenience for in-person learning.
2. Make sure medical insurance information has been correctly entered into your system as you normally would.

If you are unable to get these items completed by the course date, it is no problem.  If you are a student and you don’t have any of the requested information, no worries. You will still get an awesome experience and learn how to incorporate medical billing into your practice to increase revenue and help more patients. Also, we usually host an added-value recap that allows you to ask any other questions not answered for you 2-4 weeks post-course.

Lastly, one week prior to the virtual course, you will receive a copy of the slides and additional instructions.  All training is from 8:30-3:30 with two 10-minute breaks and 30 minutes for lunch. This allows the instructor and the students to stretch, use the restroom, and grab a bite to eat to maintain brain strength. PLEASE adhere to all course instructions when received.

Come ready to learn, grow, and thrive.

Dr. Tontra Lowe

Director of Education