They need to use the 837 D (Dental) transaction

-----Original Message-----
From: Tucci-Kaufhold, Ruth A. [mailto:[EMAIL PROTECTED]
Sent: Thursday, March 13, 2003 12:32 PM
To: WEDI SNIP Transactions Workgroup List
Cc: Stanley Nachimson (E-mail)
Subject: RE: 835D or P for Medicare dental claims?


I am concerned Medicare would not be compliant.  

How can Medicare state that they won't accept a HIPAA mandated transaction?
Isn't Medicare a payer too?  

The ADA codes are not included in the 837-P(at least not in the Appendix C
for the v4010 Imp Guide) ... so only those dental codes that are in HCPCS
would be available for payment by Medicare?  Could more detail be given on
this subject?

Ruth Tucci-Kaufhold 
HIPAA Systems Analyst 

Co-Founder MAHI 
UNISYS Corporation 
4050 Innslake Drive 
Suite 202 
Glen Allen, VA  23060 
(804) 346-1138 
(804) 935-1647 (fax) 
N246-1138 
[EMAIL PROTECTED] 



-----Original Message-----
From: Kathleen Simmons [mailto:[EMAIL PROTECTED]
Sent: Thursday, March 13, 2003 6:27 AM
To: WEDI SNIP Transactions Workgroup List
Subject: RE: 835D or P for Medicare dental claims?


That's correct.  Medicare does not cover general dental care, but under our
medical benefits, we do pay for treatment of injuries to the mouth area,
some of
which may be performed by a dentist.  We will not accept the 837-D, only the
837-P.

>>> "Tom Drinkard" <[EMAIL PROTECTED]> 03/12/03 06:11PM >>>
Diana,
As I understand it, Medicare will not accept the 837D, since Medicare
requires the diagnosis code.
So, all Dental claims must be submitted on the 837P.
 
Keep in mind that Medicare processes only 0.25 million Dental claims per
year.
That really isn't very many claims by Medicare standards.  Since
Medicare doesn't really cover Dental procedures, I suspect that the
majority of the claims are those things that cross over between Dental
and Medical such as high-end Oral Surgery procedures.
 
Hopefully someone from CMS will chip in and confirm the above.
 
Tom Drinkard
EDIT, Inc.
[EMAIL PROTECTED] 
(678) 795-1251 (voice)
(775) 458-6117 (fax)

-----Original Message-----
From: Diana Lindsley [mailto:[EMAIL PROTECTED] 
Sent: Wednesday, March 12, 2003 5:04 PM
To: WEDI SNIP Transactions Workgroup List
Subject: 835D or P for Medicare dental claims?



We have heard several different requirements, but have not gotten a
definitive response.  Hopefully, someone on this list will know.  We
have heard that Medicare will require the 837P transaction for dental
claims, which doesn't make much sense to us.  We have also heard that
the 837D can be used.  Does anyone know which will be required?

Diana Lindsley

Project Manager

First Pacific Corp.

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