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Claims Processing Updates

Page last updated: 4/10/2025

We know insurance payments are vital to your business and want to make sure you have the cash flow you need. We'll update this page regularly as we have more information about claims, eligibilities, and ERAs.

Latest Updates

Important News for Delta Dental of Arkansas Individual Plan Providers

Delta Dental of Arkansas -  Individual (under Payor ID: ARIND) is currently undergoing a TPA migration. This process began on 04/02 and their new TPA will be ready to intake claims for this plan on 04/15 under their new Payor ID: WDENC.

  • To minimize provider impact, the Henry Schein One clearinghouse partner is now holding these claims as of 04/10. If you have submitted claims between 04/02-04/10, we will be resubmitting these to the new TPA on 04/15 for processing. Any attachments that have been sent during this time will also be made available to the new TPA.
  • Starting April 15, 2025, please submit your claims under Payor ID: WDENC.
  • If you were previously approved for WDENC ERAs, these should continue without interruption. If you were previously enrolled for Delta Dental of Michigan ERAs but are not enrolled for WDENC ERAs, please complete the enrollment process to continue receiving ERAs for Delta Dental of Arkansas – Individual. 

 

"The Payor Does Not Support Attachments” Rejection Message 

If you receive attachment rejections with a message stating, "The Payor Does Not Support Attachments", make sure to check the Payer ID you are using for the claim and compare it to the Henry Schein One Payer List: 

Payor IDs do change periodically, and several were updated as a result of the Change Healthcare Cyber Incident with the legacy Payor ID being deactivated on the Henry Schein One end.

When a Payor ID not supported by Henry Schein One is received (either an ID that has never been supported or has been deactivated by Henry Schein One), an attempt is made to 'map' the submitted Payor ID to the Supported Payor ID.

If this is unsuccessful, the Payor ID will be changed from the Submitted Payor ID to our "generic" Payor ID 06126. Payor ID 06126 does not support attachments and as a result, attachments on any claim associated with Payor ID 06126 will be rejected. 

 

DentaQuest (Payer ID CX014) Claim Rejections

Rejected Claims “ ENTITYS NATIONAL PROVIDER IDENTIFIER (NPI) BILLING PROVIDER| 85” and/or  “ENTITYS NATIONAL PROVIDER IDENTIFIER (NPI) BILLING PROVIDER ENTITY NOT AFFILIATED RENDERING PROVIDER”

On 3/3/2025 DentaQuest applied an edit on claim verifications which resulted in claims rejections with the above message. We have received notification that they rolled this code back as of this morning 3/6/2025.

With the assistance of HS One’s Vendor partner, all claims for this payer from 3/3/2025 - 3/6/2025 that received one of the rejections noted above have been resubmitted to DentaQuest on your behalf for processing. Please give the payer 1-2 days for claim status responses.

There is nothing that your practice will need to do for these claims at this time. 

Important Notice for Dentrix version 25.2 and 25.3 Users*: 

“Rejected: “Claim did not pass clearinghouse validation and could not be processed.”

We recently released code that causes two letters and/or symbols to be added within the TOO segments when three or more surfaces are included on the same procedure (example M:O:Lâ ).

This issue would cause your claims to be rejected with a message of “Rejected: “Claim did not pass clearinghouse validation and could not be processed.” Please note: this error could also be occurring for other issues. This is specific to Dentrix version 25.2 and 25.3 users that have three or more surfaces on their claim.

*This issue has been fixed as of the evening of 3/5/2025.

Important Claim Notice for Careington -
Payer ID 60601

Careington has informed us of a claims processing delay due to a system upgrade that went into effect on January 3, 2025. They are currently working through claims received since that date and expect to be caught up within the next two weeks.

If you need a status update on a claim, you can contact Careington directly by phone at 1-866-636-9188. You’ll need to provide the following information:

✔️ Member Name
✔️ Date of Birth
✔️ Date of Service
✔️ Subscriber Number

Let their team know you’re requesting a claim status update.

Henry Schein One is working to improve the stability and reliability of your claims processing. We plan to start the following improvements on Monday, January 27, 2025.

Practice management systems that will be affected:

  • Dentrix eClaims users
  • Dentrix Enterprise eClaims users
  • Specialty eClaims users

What you may see or encounter with these initial improvements:

  • We will be enforcing a 5.5-minute claim delay where we will automatically disconnect your submission request. You will see the following message: “100- Claim processing took longer than expected please check your confirmation reports and resubmit if necessary.”
  • Duplicate claim rejections - If you have more than one computer used to process claims, and those computers are delivering at the same time, you may see up-front claim rejections or if we received a duplicate claim. Note: Duplicate claims that HS One rejects will not be billed.
    You should no longer have the need to contact our support team to reset your account due to processing time-outs.

How this may affect your workflow:

  • There should be no change to your claim delivery unless you are processing claims from multiple computers simultaneously.
  • If you encounter issues, please contact our Henry Schein One support team at 1-800-471-2273.

For those using Dentrix, Dentrix Enterprise, and Specialty (OMSVision, PerioVision, or EndoVision)

We are pleased to report that we've restored our electronic medical claim service (aka 837P- Professional claims).

  • If you are registered for our eClaims service and have purchased the Medical Cross Code Pack, you can send both dental and medical claims for your patients through the same service in a streamlined manner.
  • If you are not currently registered for our eClaims service and/or do not have the Medical Cross Code Pack, please contact your sales representative and they will be happy to assist you.

Important Updates

As of 1/1/2025, GEHA (Commercial) Payer ID 44054 and GEHA (FEP) Payer ID 57254 have moved to UMR Payer ID 39026 for processing.

  • Any claims from 1/1/2025–1/13/2025 that were rejected with the status of “PAYER REJECTION—THE TRANSACTION HAS BEEN REJECTED AND HAS NOT BEEN ENTERED INTO THE ADJUDICATION SYSTEM SUBSCRIBER AND POLICY NUMBER /CONTRACT NUMBER NOT FOUND” and other subscriber rejections for these payer IDs have been resubmitted on your behalf. There is nothing additional your office will need to do to get these claims paid.
  • ERA Enrollments: Practices already enrolled for BOTH GEHA and UMR ERAs DO NOT need to complete new enrollments. Practices enrolled for GEHA ERAs but NOT for UMR ERAs WILL NEED to complete ERA enrollment for UMR.

Claim and Attachments Processing to Horizon

When processing claims to Horizon, be sure you are verifying your patient insurance card and selecting the correct payer ID for delivery.

  • Payer ID 22099
    • DeCare - Horizon Blue Cross Blue Shield (Commercial)
    • Horizon BCBSNJ
    • Horizon Commercial
    • Horizon (Subscriber ID with prefix YHV, YKI, & YHZ)
  • Payer ID HNJ01 (PO Box 299 Milwaukee WI 53201)
    • Scion – Horizon NJ Health
    • Horizon NJ Health (Scion)
  • Payer ID HZFEP
    • Horizon FEP (Subscriber ID with prefix R)

Claims and Attachments Processing to United Concordia

Be sure you are verifying your patient insurance card and selecting the correct payer ID for delivery.

  • Payer ID 89070
    • United Concordia Companies, Inc.
    • Blue Cross Blue Shield of Delaware (UCCI)
    • Sun Life Financial (United Concordia) DOS Prior to 1/1/2018
    • Minnesota Blue Cross Dental (UCCI)
    • TRICARE Dental Program (TDP)
    • Blue Cross Blue Shield of North Dakota (UCCI)
    • Blue Cross Blue Shield of North Dakota FEP (UCCI)
    • DE (Delaware) Adult Medicaid
    • Highmark West Virginia (UCCI)
    • Blue Cross Blue Shield of Western New York
    • Blue Shield of Northeastern New York (UCCI)
    • HealthNow Federal (UCCI)
    • Tricare Active Duty Dental Program (UCCI)
  • Payer ID TLY26: Blue Advantage
  • Payer ID UCCAP: Blue Cross Blue Shield of Louisiana Advantage Plus Network
  • Payer ID UCCDP: United Concordia – Dental Plus – PA Blue Shield
  • Payer ID UCCEN: United Concordia (Encounters)
  • Payer ID UCCTR: United Concordia – Tricare Dental Plan

Attachments Processing

In October 2024, Henry Schein One started to migrate our Electronic Attachments processing from Vyne Dental (aka NEA) to DentalXChange. Beginning January 1, 2025, all attachment routing is being processed through DentalXChange.

You may have started to see a new Attachment ID prefix on your attachment reporting from NEA or CHC to DXC.

When looking into Attachments delivered to the payers below, your Attachment ID will show DXC#... However, the payer would have received one of the prefixes below. They should still be able to find your attachment with the Attachment ID we provided you, they would just need to add the prefix that has been asked for in the delivery to them.

  • MetLife | Payer ID 65978: The Payer will see NEA#DXC#.....
  • Denti-Cal | Payer ID 94146: They will see the prefix EHG#....

Resources

Frequently Asked Questions

Claims Processing

I'm receiving claim statuses I've never seen before. What do they mean?

Henry Schein One is currently processing claims with DentalXChange, and you may be seeing some new or unfamiliar claim statuses. Use our updated Tips for Resolving Claim Statuses and Avoiding Claim Rejections document to get info about the most common claim statuses you'll see, what they mean, and what action you can take to resolve them and get tips about things you can do to avoid claim rejections in the future.

Is there anything I can do to help avoid claim rejections?

Yes! We want to help you get paid as fast as possible, so we've developed a few claim tips you can use to help avoid rejections. Follow our tips for avoiding claim rejections to help your claims get to the payors faster.

Clearinghouse Information

How is a clearinghouse involved in the claims process? What does that process look like?

We've created an infographic to illustrate the journey of a claim and explain important points along the way. View the infographic to get a better understanding of the claim process.

What clearinghouse is Henry Schein One using to process my claims?

We'll continue to process claims in the way that's best for our customers. We're always monitoring the landscape, and we have options for claims partners. We're currently processing claims and ERAs with DentalXChange. We'll monitor the situation and make adjustments to our process as necessary to best serve you.

You don't need to change the way you process dental claims. We'll make adjustments for you. We've matched payors and payor IDs on our side so that you can continue processing with the claim and payor settings you already have.

Payor Enrollment

I've heard that some payors have special enrollment requirements. How can I find out if a payor I work with has these requirements?

If a payor you work with is not listed, they may require special enrollment. We've added a Special Enrollment Forms page to help you enroll with payors who have special requirements for claims and/or ERAs.

Please note: You must follow all the instructions on the special enrollment forms. Some payors, including Denti-Cal, require you to notify DentalXChange when you receive your payor approval. When you receive confirmation from the payor that your enrollment was received, email hs1enrollment@dentalxchange.com and include the approval message from the payor as an attachment.

I'm getting a claim status that says "Payer requests enrollment for EDI submission." What does that mean?

This error means that the payer on that claim requires special enrollment that isn't complete. This happens for one of three reasons:

  • Your practice hasn't completed the special enrollment forms.
  • The payer hasn't approved your enrollment. (Timeline for approval varies by payer from as little as 1-3 days to a maximum of 3 months.)
  • DentalXChange hasn't received your payer enrollment confirmation.

To fix this error you just need to complete the special enrollment steps for that payer.

  1. Visit the special enrollment site and click Enroll in Claims.
  2. Select the payer(s) you want to enroll with and follow the instructions.
  3. IMPORTANT: When you receive confirmation from the payer that your enrollment was received, email hs1enrollment@dentalxchange.com and include the approval message from the payer as an attachment.

Once DentalXChange has received your approval confirmation they'll be able to submit claims to that payer on your behalf.

For information about other common claims statuses and how to resolve them, read our Steps for Resolving Claims Statuses tip sheet.

ERAs (Electronic Remittance Advice)

How does the ERA enrollment process work?

We've set up a multi-payer ERA Enrollment Service powered by DentalXChange at no additional cost to you.

New to ERAs?

Dentrix users: Visit  https://www.dentrix.com/products/eservices/eclaims/eeob for information regarding the enrollment process via Henry Schein One and DentalXChange.

Dentrix Ascend users: Visit https://hsps.pro/DentrixAscend/Help/Enrolling_locations_in_the_ERA_service_for_the_first_time.htm for information regarding the enrollment process via Henry Schein One and DentalXChange.

Dentrix Enterprise users: Visit https://www.dentrixenterprise.com/products/addons/era for information regarding the enrollment process via Henry Schein One and DentalXChange.

Payor Enrollments

  • Each payor has a different turnaround time for processing ERA enrollments, which in some cases is up to 30 business days. This timeline is set by the payor. It’s important to start your enrollment as soon as possible. 
  • ERA enrollment doesn't change the way you recieve payments. You'll still need t owork with payors directly to set up EFT payments.
  • See which payors participate in the ERAs with our clearinghouse:
  • Visit the enrollment page and click Enroll in ERAs. Fill out the online form to start your ERA enrollment process.
  • Please do not select "All Payors" on the enrollment form as this will delay the enrollment steps. Only select the payors you are actually processing to and wish to receive ERAs from.
  • Once your enrollment is complete, DentalXChange will deliver ERAs to your Henry Schein One practice management system multiple times per day. You'll receive ERAs the same way you received them previously.

Insurance Eligibility Verification

Can I check eligibilities?

We're pleased to report that we've resumed processing insurance eligibility requests for Dentrix, Dentrix Enterprise, and Dentrix Ascend for many payors through DentalXChange. This includes both real-time and batch eligibility requests for future appointments. Please resume submitting eligibility requests as you normally would.

Please note that you may not get responses from all the payors you work with as they might not be enrolled through DentalXChange. As additional payors are available through our clearinghouse partners we will add them to the payor list on this page.

You'll see some formatting changes in the new eligibility reports. Click the links below to see examples of the formatting changes.

Dentrix Ascend:

Dentrix and Dentrix Enterprise: