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Tesia Clearinghouse

Trends in Dental Claims: Excellus BlueCross BlueShield

An inside look at payer and provider relations.

Posted by Jason Penrod on Mar 26, 2019

One of the major benefits of Renaissance owning its clearinghouse, Tesia, is that we often have the opportunity to speak directly to payers to get an idea of how we can work together to help practices. We recently spoke with Melissa Gottusso, the Provider Relations Manager for Excellus BlueCross BlueShield to find out what trends they are seeing in claims rejections.

Can you start by describing what you do for Excellus?

I am the Provider Relations Manager for our dental group. My day-to-day consists of working with my team to deliver a satisfying provider experience. This includes, but is not limited to: attending meetings with my team, handling calls, and researching claims.

Why do practices call your support team for help?

Practices will typically call in because of a rejected claim. If the practice receives a rejection because of an invalid ID number or “Provider Not Found,” they tend to call to try to get a quick resolution.

What’s one of the biggest myths about payers you’d like to bust?

A common misconception that providers have is that payers purposely hold up or deny claims to delay payment to the provider. There’s no advantage for a payer to do this and it creates a bad experience for our customers, their patients.

What is the most common reason claims are rejected?

The most common reason is typically the member ID is not valid. Excellus recently migrated to a new dental claim platform and some of our practices have continued to bill with the old member IDs.

What steps can a provider take before calling about a rejected claim?

With Excellus, providers don’t currently have the option to use our web portal for this, but if they were to get a rejection, they could make sure the claim conforms to the ADA claim guidelines and ensure they have the correct member information.

What is the most impactful behavior practices can adopt to help get their claims processed faster?

The most important thing our practices can do is adhere to the ADA claim billing guidelines, as well as ensuring that billing with accurate and up-to-date member information. This would cut down on their number of rejections.

What are the top three things that you wish providers knew?

As I mentioned before, following the ADA claim billing guidelines would help the providers reduce rejections. Some providers may not have to deal with an accidental injury often, so knowing how to properly file those claims would be helpful. Also, I wish providers knew that they can send attachments electronically with their claims through Remote Lite.

Do you think real-time claims benefit the provider?

I think real-time claims can benefit both the provider and the payer, as the adjudication is completed “real-time” giving the provider an immediate outcome. That prevents any delays for both the provider and payer.