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Ruth, Rick:
The reason that Medicare doesn't accept 387D is that they
don't pay for anything that's on it. Dental work that they do pay for is
billable on the 387P.
The real question is when they reject the
claim -- If their initial front end is rejecting, they are mixing business rules
and IG syntax in the same process. While this practice is not forbidden,
making clear that the rejection is a Business Rules rejection rather than a
Non-Complient rejection seems to me to be a Good Idea.
See the discussion threads over the last week or so relating
to separating syntax checking (X12 Rejection) from business rules (EOB
Rejection).
The opinions expressed here are my own and not necessarily the opinion of
LCMH.
Douglas M. Webb Computer System Engineer Little Company of Mary
Hospital & Health Care Centers [EMAIL PROTECTED]
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----- Original Message -----
Sent: Thursday, March 13, 2003 12:14
PM
Subject: RE: 835D or P for Medicare
dental claims?
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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