RE: 271 loop 2110C EB

[Tom Drinkard]

Joan, The answer to your questions is that there is no clear-cut answer. For co-insurance percentages, you could list the 500 or so procedure codes in individual EB segments. For deductibles, many have chosen to show the deductible applying to EB03 = 35. Most dental offices would know whether or not to apply the deductible to preventive and diagnostic procedures.  You can list separate deductible information (and maximums) under the Service Type for Orthodontia.   The best you can do is to review the options available and choose how to express the information you want to express.  This same philosophy would apply to specific benefits for exams, cleanings, full-mouth x-rays, etc.  There is no service type for the above benefits.  Some payers have chosen to select a single procedure code in each group and express the benefits for that code.  These payers would be implying that the benefit extends to all eligible procedures in the group.   For example, exams could be expressed as EB*A*FAM*41*****1.00*****AD:D0120~ HSD*FL*1***34*6~ This could be interpreted as Exams are covered at 100% and limited to one every six months.   There is free-form text available in EB05 (50 characters) and up to 10 Message segment per EB loop, where each Message segment is up to 264 characters.  I would strongly urge you to avoid free-form text, since it will make your response HIPAA-compliant, but non-standard.  Since your response would be non-standard, it would be less useful to automated systems for implementation.  The end result would be that there may be less usage of the automated Eligibility process.   Hope this helps.   Tom Drinkard EDIT, Inc. [EMAIL PROTECTED] (678) 795-1251 (voice) (775) 458-6117 (fax)   -----Original Message----- From: Joan Perry [mailto:[EMAIL PROTECTED]] Sent: Thursday, September 26, 2002 6:20 PM To: [EMAIL PROTECTED] Subject: 271 loop 2110C EB   When giving dental co-insurance percents for benefits, our plans are set up by preventive, basic, major, and ortho categories. The EB03 segment in this loop does not list these values. Instead it lists the CDT-3 categories. Unfortunately we have plans that do not follow these completely. For example, our plans list some CDT-3 Periodontic services as basic and others as major. I am looking for suggestions on how to respond on the 271 for these.      Also, how do you report a deductible that applies to basic and major only?       ****************************************************************                   Please Note The information in this E-mail message is legally privileged and confidential information intended only for the use of the individual(s) named above. If you, the reader of this message, are not the intended recipient, you are hereby notified that you should not further disseminate, distribute, or forward this E-mail message. If you have received this E-mail in error, please notify the sender. Thank you *****************************************************************     ********************************************************************** 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.   ==================   The WEDI SNIP listserv to which you are subscribed is not moderated.  The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP.  If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.   ********************************************************************** 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. ===================================================== The WEDI SNIP listserv to which you are subscribed is not moderated. The discussions on this listserv therefore represent the views of the individual participants, and do not necessarily represent the views of the WEDI Board of Directors nor WEDI SNIP. If you wish to receive an official opinion, post your question to the WEDI SNIP Issues Database at http://snip.wedi.org/tracking/. Posting of advertisements or other commercial use of this listserv is specifically prohibited.