Our plan includes both medical as well as limited dental coverage.  We do
not do any predetermination of benefits today.  If a provider calls in we
tell them we don't predetermine benefits.  If they send in a paper form we
respond with a form letter telling them we don't predetermine benefits.  If
they ask specific questions on the phone, they may get some additional
information, but nothing that should be close to an actual predetermination.

The 837 Dental Claim transaction allows for a predetermination request.  The
835 Remittance Advice allows for a response.  However, I don't see a way to
indicate that we don't perform predeterminations.  Is there a way to do this
in the 835, or is there another way to respond to this?

Jim Griffin
Business Systems Analyst
CNA




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