Jim you might think about using adjustment reason code of 101 Predetermination: anticipated payment upon completion of services or claim adjudication. in the claim level CAS segment. This is what we are considering, rejecting the claim with this code and the claim charge.
Mike Winston Trigon ISD Ext 44521 [EMAIL PROTECTED] This message, including files attached to it, may contain confidential information that is intended only for the use of the ADDRESSEE(S) named above. If you are not the intended recipient, you are hereby notified that any dissemination or copying of the information is strictly prohibited. If you have received this message in error, please notify the sender immediately and delete the message from your system. Thank you. > -----Original Message----- > From: Jan Root [SMTP:[EMAIL PROTECTED]] > Sent: Wednesday, January 16, 2002 2:17 PM > To: [EMAIL PROTECTED] > Subject: Re: Predetermination of Dental Benefits > > Jim > You are correct that there is not a good way to do this in the 835. You > might > try using code '110 - Billing date predates service date' in the claim > level CAS > but I can see that it would be quite a stretch.... > > I would suggest that you contact the Codes Maintenance Committee and > request a > new Adjustment Reason Codes. You might also want to request a new Claim > Status > Reason Codes if you think you might need this to respond to a claim status > inquiry (the same committee handles both code lists). This could be a > pre-adjudication rejection. Requests for new codes can be made at > http://www.wpc-edi.com/conferences/crc.html. Login and go to the February > 2002 > Issues and Agenda topic under Issues & Requests (you might have to hit the > 'more' > button at the bottom of the list). > > j > > "J.G." wrote: > > > 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. ********************************************************************** 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.
