Barry, The SV1 segment in the 837-P supports HCPCS codes. Since the HCPCS code set includes all of the "ADA" codes, one would simply code the SV1 as: SV1*HC:D7945*5000*UN*1~
This is analogous to the SV3 segment in the 837-D which might look like this: SV3*AD:D7945*5000****1~ There is a real problem if it is necessary to send tooth numbers, surfaces, etc. or other data that appears only in the 837-D, but (apparently) the only kinds of procedures that Medicare would consider do not require that information. Certainly they have never needed it in the past. Presumably, if Medicare needs the additional information, they can ask for it. Tom Drinkard EDIT, Inc. [EMAIL PROTECTED] (678) 795-1251 (voice) (775) 458-6117 (fax) -----Original Message----- From: Barry Dupree [mailto:[EMAIL PROTECTED] Sent: Thursday, March 13, 2003 3:15 PM To: WEDI SNIP Transactions Workgroup List Cc: Stanley Nachimson (E-mail) Subject: RE: 835D or P for Medicare dental claims? Assume for a moment that Medicare did accept the 837D. Based on the previously stated requirement that a diagnosis code be included, the claims would be denied regardless. I'm not sure what this would accomplish for anyone. I am however curious to hear a solution of how exactly one would submit dental procedures for payment on an 837P -----Original Message----- From: Fulton, Rick [mailto:[EMAIL PROTECTED] Sent: Thursday, March 13, 2003 1:14 PM To: WEDI SNIP Transactions Workgroup List Cc: Stanley Nachimson (E-mail) 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. --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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/. These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- The WEDI SNIP listserv to which you are subscribed is not moderated. 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These listservs should not be used for commercial marketing purposes or discussion of specific vendor products and services. They also are not intended to be used as a forum for personal disagreements or unprofessional communication at any time. You are currently subscribed to wedi-transactions as: [EMAIL PROTECTED] To unsubscribe from this list, go to the Subscribe/Unsubscribe form at http://subscribe.wedi.org or send a blank email to [EMAIL PROTECTED] If you need to unsubscribe but your current email address is not the same as the address subscribed to the list, please use the Subscribe/Unsubscribe form at http://subscribe.wedi.org --- 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. 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