Can I chime in with one small addition? In the Dental 837 there is the option of using the Line Item Control Number to identify specific service lines in the claim/encounter. This is a situational REF in the 837. The provider can label each line "1", "2", "3", etc. (you don't need to use a big number). If the provider puts a Line control number in the 837 service lines, the payer must keep it associated with the correct service line and return it in the 835. Using this REF would allow the provider to identify specific lines (specific payments) without having the tooth information in the 835. So, the final exchange could look something like this:
837 CLM01 = 467834463 (a number unique to this particular claim) Line 1: Tooth 30, Charge $40, Control Number 1 Line 2: Tooth 12, Charge $40, Control Number 2 Line 3: Tooth 6, Charge $40, Control Number 3 Line 4: Tooth 23, Charge $40, Control Number 4 Line 5: Tooth 15, Charge $40, Control Number 5 835 CLP01 = 467834463 Line 1: Charge $40, Paid $35 control number 4 Line 2: Charge $40, Paid $35, control number 3 Line 3: Charge $40, Paid $24, control number 1 Line 4: Charge $40, Paid $27, control number 2 Line 5: charge $40, Paid $35, control number 5 The provider know that control number 5 refers to tooth 15, control number 2 = tooth 12, etc. Does that help? Jan Kepa Zubeldia wrote: > Bruce, > > I am not sure we are talking about the same things... The claim allows > you to specify up to 32 teeth, and up to 5 surfaces per tooth. All in > the TOO segment. And one of these multi-teeth-multi-surface description > sets for each service. It is all there in the claim. > > The remittance advice refers to the service in the claim, but there is > no need to echo all the TOO segments back with the payment. The > provider already knows about them. > > Does it make more sense now? > > Kepa > > Bruce Silverman wrote: > > > > No > > > > In the dental world where many teeth are included on a claim > > and many variations in benefits can occur, teeth numbers > > and surfaces are very important > > > > Bruce Silverman > > Sr. VP, Claims & Customer Service > > Delta Dental Plan of New Jersey > > > > >>> Kepa Zubeldia <[EMAIL PROTECTED]> 11/30/01 > > 10:27pm >>> > > Greg, > > > > Further explanation. The tooth number is filed in the claim > > and does > > NOT need to be returned in the 835. There is no reason to > > change the > > tooth number from that filed in the claim, and there is no > > reason to > > communicate the tooth number back to the provider, since > > the provider > > already knows and already sent it in the claim. > > > > Does that make sense? > > > > Kepa > > > > [EMAIL PROTECTED] wrote: > > > > > > We have been analyzing implementing Dental 835 and > > have found there is no > > > field to accomodate Tooth Number at the Procedure level > > on the 835 spec. > > > > > > Has anyone else encountered this problem? Did you find a > > solution? > > > > > > This is an issue for us as duplicate procedures could occur > > on different teeth. > > > > > > thanks > > > > > > Greg Monroe > > > Wellpoint > > > EDI Technical Specialist > > > [EMAIL PROTECTED] > > > (818) 234-1024 > > > > > > > > ********************************************************************** > > > To be removed from this list, go to: > > http://snip.wedi.org/unsubscribe.cfm?list=business > > > and enter your email address. > > > > ********************************************************************** > > To be removed from this list, go to: > > http://snip.wedi.org/unsubscribe.cfm?list=business > > and enter your email address. > > > > ********************************************************************** > > To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?list=business > > and enter your email address. > > ********************************************************************** > To be removed from this list, go to: >http://snip.wedi.org/unsubscribe.cfm?list=business > and enter your email address. ********************************************************************** To be removed from this list, go to: http://snip.wedi.org/unsubscribe.cfm?list=business and enter your email address.
