e-Claim Insurance Payer ID and Payer Model
When creating or updating an Employer Policy, the Insurance Company section requires entry of both the e-Claim Insurance Payer ID and the e-Claim Insurance Payer Model.
e-Claim Insurance Payer ID
The e-Claim Insurance Payer ID is required if you plan to e-file claims.
When submitting an e-Claim through Tops, DentalXChange uses the selected Insurance e-Payer ID to correctly identify the insurance company for claim submission. Using the correct Payer ID is essential for successful claim processing.
To locate the Payer ID:
- In the Employer Policy record, click the e-Claim Insurance Payer List link.
- You will be redirected to the DentalXChange website.
- Search for the insurance company.
Important:
- Search using the full company name.
- Avoid abbreviations, as the search function does not recognize them.
Example:
- Search Delta Dental of Pennsylvania
- Not Delta Dental of PA
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Once the correct Payer ID is located, update the Employer Policy record in Tops.
While the insurance company may provide a Payer ID during verification, DentalXChange may use a different, unique Payer ID. Always verify that the ID matches the one listed in DentalXChange - especially if you are new to e-filing with Tops and DentalXChange.
e-Claim Insurance Payer Model
When e-filing from Tops, the e-Claim Insurance Payer Model must also be completed in the Employer Policy record.
Use the drop-down menu to select the appropriate model:
- Blue Cross/Blue Shield – For BCBS payers
- Commercial Insurance Co – All payers except Delta Dental, BCBS, or Medicaid
- Delta Dental – All Delta Dental payers
- Medicaid – Medicaid payers
Why locking the details is important
Insurance Company details in the Employer Policy record - along with Employer details - should be locked once they are created or corrected.
Any changes made to the Employer Policy record will affect all patients who have ever used the policy. This includes patients whose policy is no longer active.
If an employee:
- Changes groups within the same insurance company
- Changes insurance providers within the same company
- Changes jobs and obtains new insurance
If an employee’s insurance changes, you must:
- Create a new Policy Holder record
- Either link the new policy holder to an existing Employer Policy record, or create a new Employer Policy record if one does not already exist
Think of the Policy Holder and linked Employer Policy record like an insurance card. When someone receives new insurance, they do not alter their old card — they receive a completely new one.
The original Policy Holder and Employer Policy relationship must remain unchanged to preserve historical accuracy. Existing claims are tied to the original policy details, and modifying those records can impact all past claims associated with that policy.
For more information, reference the article below Change Employer Policy.