Form preview

Get the free Dental Electronic Remittance Setup

Get Form
This document is used by dental practices to set up electronic remittance advice (ERAs) with relevant payer organizations. It collects necessary provider and practice information for processing.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign dental electronic remittance setup

Edit
Edit your dental electronic remittance setup form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your dental electronic remittance setup form via URL. You can also download, print, or export forms to your preferred cloud storage service.

Editing dental electronic remittance setup online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use the services of a skilled PDF editor, follow these steps below:
1
Create an account. Begin by choosing Start Free Trial and, if you are a new user, establish a profile.
2
Prepare a file. Use the Add New button. Then upload your file to the system from your device, importing it from internal mail, the cloud, or by adding its URL.
3
Edit dental electronic remittance setup. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.
4
Save your file. Select it from your records list. Then, click the right toolbar and select one of the various exporting options: save in numerous formats, download as PDF, email, or cloud.
With pdfFiller, it's always easy to work with documents.

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out dental electronic remittance setup

Illustration

How to fill out Dental Electronic Remittance Setup

01
Gather required information: Collect details like your dental practice's tax ID, NPI number, and banking information.
02
Access the Electronic Remittance Setup form: Log in to your dental billing software or the designated electronic claims portal.
03
Fill out the form: Enter your practice details, including name, address, and contact information in the appropriate sections.
04
Input financial details: Provide your banking information for direct deposits, including account number and routing number.
05
Review terms and conditions: Read through the terms for electronic remittance and ensure you agree with them.
06
Submit the form: After all fields are completed, submit the form electronically as instructed on the portal.
07
Confirmation: Wait for confirmation of your setup from your billing software or the claims portal, which may take a few days.

Who needs Dental Electronic Remittance Setup?

01
Dental practices that wish to receive electronic payments and remittances from insurance companies.
02
Dentists who want to streamline their billing processes and reduce paperwork.
03
Offices managing multiple insurance claims that would benefit from automated remittance tracking.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.6
Satisfied
47 Votes

People Also Ask about

Remittances are typically sent using an electronic payment service or money transfer app. To send a remittance via wire transfer or ACH transfer, go to a bank, credit union, or website and provide the recipient's banking information (account number, bank name, and routing number).
The Medi-Cal Dental Program's Electronic Data Interchange (EDI) program is an efficient alternative to sending paper claims. It will provide more efficient tracking of the Medi-Cal Dental Program claims with faster responses to requests for authorization and payment.
A Provider Remittance Advice (PRA) is a summary of reimbursements made on all claims submitted. An Electronic Remittance Advice (ERA) is an electronic data interchange (EDI) version of a medical insurance explanation of payment.
What is an example of a remittance advice? Remittance advice example: “Dear [Name], Please be advised that payment of [sum] has been made in respect of invoice [number and reference], via [method of payment], on [date]. Please confirm receipt and contact us if there are any discrepancies.
An EFT is an electronic funds transfer where the claim is deposited directly into a dental provider's bank account. It eliminates the need to take anything to the bank to be deposited and cuts down on the amount of staff time needed to process claim payments.
So, what is remittance advice? In short, remittance advice is a proof of payment document sent by a customer to a business. Generally, it's used when a customer wants to let a business know when an invoice has been paid. In a sense, remittance slips are equivalent to cash register receipts.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

Dental Electronic Remittance Setup is a process that allows dental providers to receive electronic remittance advice (ERA) from insurance companies, detailing payments and adjustments directly into their practice management systems.
Dental providers who wish to receive electronic payments and remittance information from insurers must file for Dental Electronic Remittance Setup.
To fill out Dental Electronic Remittance Setup, providers need to complete a setup form provided by their billing software or insurer, inputting necessary information such as practice details, billing information, and payer IDs.
The purpose of Dental Electronic Remittance Setup is to streamline the payment process, reduce paperwork, enhance efficiency in billing practices, and ensure quicker access to payment information.
The information that must be reported on Dental Electronic Remittance Setup typically includes provider information, the payers' details, transaction types, and any necessary identifiers linked to the insurance claims.
Fill out your dental electronic remittance setup online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.