Jim, I recommend the use of the 997 Segment with an error message on the at the Subscriber level indicating that you do not do predetermination of benefits. I copied the following from the 837 Dental Implementation Guide
Functional Acknowledgment, 997 The Functional Acknowledgment Transaction Set, 997, has been designed to allow trading partners to establish a comprehensive control function as a part of their business exchange process. This acknowledgment process facilitates control of EDI. There is a one-to-one correspondence between a 997 and a functional group. Segments within the 997 can identify the acceptance or rejection of the functional group, transaction sets or segments. Please contact me if you want to discuss this further. Hope Furtado Corporate Information Architect TM Floyd & Company (800)780-1170 ext 129 [EMAIL PROTECTED] > -----Original Message----- > From: J.G. [SMTP:[EMAIL PROTECTED]] > Sent: Tuesday, January 15, 2002 8:38 PM > To: [EMAIL PROTECTED] > Subject: Predetermination of Dental Benefits > > > 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 > > > > > ********************************************************************** > To be removed from this list, send a message to: > [EMAIL PROTECTED] > Please note that it may take up to 72 hours to process your request. ********************************************************************** To be removed from this list, send a message to: [EMAIL PROTECTED] Please note that it may take up to 72 hours to process your request.
