eClaims FAQ

Known Issues

There are currently no known issues at this time. If you have an eclaim error or validation error you cannot resolve, please visit the Related Articles section at the bottom of this page or contact Tops Support.

Here are some common eClaims questions answered!

How often should I check the DentalXChange website?

You do not have to check the DentalXChange website at all if you prefer to receive mail communication from Insurance Payers. However, Team Tops recommends checking DentalXChange at least once per day so you can address rejections and errors in a more timely manner. This typically means getting paid sooner!

Why does my claim show as rejected in DentalXChange? It says Clearinghouse Accepted in Tops?

The Clearinghouse Accepted status means DentalXChange has received the claim and has started the process of submitting it to the payer. Clearinghouse Rejected means that the claim never made it to DentalXChange and needs attention. When a claim reflects a Clearinghouse Accepted status in Tops, Tops has submitted the claim to DentalXChange with a bow 🎀 on it. Tops has ensured that validation errors such as formatting, zip codes, electronic payer IDs etc have been addressed and resolved.

Upon receipt of the cleaned up claim, DentalXChange then begins the submission process with the payer. The statuses in DentalXChange will provide you updates on whether the claim needs more information, has been submitted, received, rejected or processed.

Reference the Related Articles section to view a helpful webinar - Streamlining Claims Management with TopsOrtho and DentalXChange.

I see a list of providers when I go to Add/Change Providers. Is that normal?

Yes! Each time your practice submits a claim with any variation of information, such as treating NPI, treating location, etc, DentalXChange will create another provider profile. This is ideal, as you do not want all of your claims to contain information for only one set of provider information. See related article, Default Provider Setting, below to make sure you are not limiting the provider information sent to Insurance Payers.

Can I clean up the proivders listed in DentalXChange menu Add/Change Providers?

Depending on your user permissions in DentalXChange, you may delete provider profiles. We recommend not deleting provider profiles if you have any claims that are awaiting or pending submission. As long as all claims have been submitted, then it is safe to delete providers.

Should I edit and resubmit claims in Tops Ortho or on the DentalXChange website?

You can do either! Please see related article Edit a Claim for Resubmission, below.

The Insurance payer requires that Box 53  of the claim form reflect the treating orthodontist’s name.  What does Tops send to DentalXChange? When I view the claim in Tops Ortho, it says “Signature on File.”

When the claim is e-filed from Tops Ortho, Tops sends the name of the orthodontist assigned to the patient to DentalXChange. To see this, look at the top-right of the patient’s chart. The assigned orthodontist’s name is sent directly to the payer. 

The insurance payer requires that the ortho specialty ID 1223X0400X appear in Box 56a on my claim form.  Why can’t I see it? 

Regardless of the claim form used to generate the claim, when the claim is e-filed, DentalXChange sends the claim to the payer with the specialty ID 1223X0400X for box 56a. The information sent to the payer is not visible in the User Interface of the claim seen in DentalXChange, but is part of the raw data sent to the payer. 

If you need to view the claim in Tops Ortho or print the claim to send to the Insurance Payer, the Specialty ID for box 56a is included in the ADA 2019 claim form.  If the claim generated did not use the ADA 2019 claim form, you can update the form used for the claim directly in the claims Matrix:

1. From Matrix > Claims, locate the claim.
2. Right-click on the claim and select Change Selected Claim’s Form Template.  
3. Chose the ADA 2019 Claim form.
4. Click Use Selected Claim Form.

How does Tops know what to populate for rendering, billing and pay-to on a claim?

Within your Tops database, there are various details that map to both the printed claim form and to what DentalXChange receives if e-filing a claim.

In your Tops database, claim details are broken out into 3 parts:

Rendering, Pay-to and Billing

Rendering Details - Boxes 53-57 of the ADA Claim Form

Rendering details that Tops stores in your Tops database include the rendering/treating location (assigned home office of the patient) and the rendering orthodontist (the assigned orthodontist of the patient). These details from your Tops database will populate the Treating Dentist and Treatment Location Information of a claim, boxes 53-57.

A patient's Treatment Location is based on the location data we have listed in your Tops database. The treating/rendering location that is populated on a claim is based on what location is "assigned" to the patient as their home office. You can locate the assigned location in the top-right corner of the patient's chart, next to their picture. Their assigned location should not be changed during the course of their treatment, even if they have scheduled appointments across multiple locations. Claims will always reflect the assigned location details on claims in Box 56 and Box 57.

The patient's Treating Dentist is their assigned Orthodontist. You can locate the assigned orthodontist in the top-right corner of the patient's chart, next to their picture. Their assigned orthodontist should not be changed during the course of their treatment, even if they are seen by a different doctor chair-side. The Treating Dentist details - Orthodontist Name, Orthodontist NPI, Orthodontist Individual License and the Orthodontist Tax ID (usually the Practice's Tax ID) - populate in Boxes 53-55.

Pay-to Details - Boxes 48-52 of the ADA Claim Form

When generating a claim in Tops, the Pay-to Entity, Pay-to Street Address, Pay-to City, Pay-to State and Pay-to Zip populate Box 48. Additionally, the Pay-to NPI populates in Box 49, the Pay-to license number populates in Box 50, and the Pay-to Tax ID/SSN populates in Box 51. The Pay-to details are stored in your Tops database by orthodontist.

How can you see Pay-to Details?

You can view your Pay-to details in Tops by opening a patient's generated claim form.

The Pay-to Details are not visible in DentalXChange but are sent as raw data to the payer/Insurance.

Billing Details

When generating a claim in Tops, the Billing NPI, Billing license number, and the Billing Tax ID/SSN stored in your Tops database associated with the assigned orthodontist are stored as raw data with the claim.

How can you see Billing Details?

The information is not visible if you open a patient's generated claim in Tops. When claims are e-filed to DentalXChange, the information is sent and can be see on the claim within DentalXChange.

Note: The Billing address that DentalXChange reflects on your submitted claim is pulled from the Pay-to Address. If the Pay-to address is a P.O. Box, then the patient's rendering/treating location is used.