eClaims with Rejected by Clearing House Status

See below to find out when you can address these claims on your own, and when you should reach out to Tops Support.

1. Go to Matrix > Claims.
2. Open the dropdown menu on the top left and select Unpaid Claims.
3. Open the dropdown menu on the top right and select the Rejected by Clearing House status filter.
4. Each claim will display a yellow caution sign icon; hover your mouse over the caution sign icon to reveal the reason for the rejection.

• If the message states Operation Successful with validation errors and the explanation is displayed, note the error and correct it in the Tops Ortho chart.
  • Refresh the Claims Matrix from the Unpaid Claims view and Rejected by Clearing House status filter selected.
  • A new error may appear, depending on how many errors the claim contains. Once you have corrected all the errors and refreshed, the claim will no longer appear under the filter Rejected by Clearing House.
  • Change the status filter from Rejected by Clearing House to Open Claims Only. The claim will now appear with an Open status. Note: As of Tops Ortho version 9.11.1, the resolved claim will move back to the Unsent Ready-to-File view with an Open status.
  • Once it is in Open status, check the box next to the claim and click e-File Checked Claims to submit it again!

    • In Tops v.9.11.0. - After resolving errors from claims that reflected a Clearinghouse Rejected status, the claims will be removed from the Rejected by Clearinghouse filter and reflect an Open status. You can locate the claim(s) either in the Unpaid Claims with Open Status Only, or you can locate these claims in Unsent Ready to File, updating the filters to All Submission Values, Open Claims Only.

      (NOTE: There is a current claim-flow issue that Tops developers are working to resolve. After submitting any eClaims that have been previously rejected and resolved, the claims do not disappear from your Unsent Ready-to-File count or the list of claims found in Unsent Ready-to-File, All Submission Values. The claims, however, will accurately reflect their status (i.e. Payer Accepted) and their submission date.

• If the message states DXC eClaim Group ID, then your Group ID in TopsOrtho > Practice Setup > eClaim is not valid. The Group ID is also referred to as the Account # in DentalXChange. It should be preceded by a – which Tops auto-populates. Make sure to tab out of the GroupID field to populate the hyphen. Example: -12345

• If the message states Invalid User i.e. ( ); verify your Login ID and Password in TopsOrtho > Practice Setup > eClaim. The Login ID is your DentalXChange username. The Password is your DentalXChange password.

• If the message states Operation Failed but does not display a reason for the rejection, this means the claim never made it to DentalXChange. In this situation, please contact Tops Support at 770.627.2527 for assistance.

• If the message states Malformed Document Sent, it means that the claim did not match DentalXChange's required formatting. Ensure that the format is correct and all required data is present. One example of a malformed document error is too many characters in a field. If you cannot make the necessary edits in the Tops Ortho chart, please contact Tops Support at 770.627.2527 for assistance.

• If the message states Operation Successful, Validation Errors <No additional detail> it means that the claim reached DentalXChange without any general formatting errors, but DentalXChange identified errors regarding the payer requirements. Since no explanation is given, please contact Tops Support at 770.627.2527 for assistance.

• If the message states Invalid PMS i.e ( ); it either means you have not selected Tops as the Practice Management System in the Account settings of your DentalXChange account; or the username and password for the DentalXChange account is associated with more than one account number. In this case, your practice will need to create a new username and password associated with the account. To do this, DentalXChange will need to allow permissions. A ticket, call or email will need to be submitted to DentalXChange to start this process.

• If there is no indicator or message, but there is a Clearinghouse Rejected status, please contact Tops at 770.627.2527.