Change Request Detail
No.
1129
Date
1/27/2011
Submitter
Type of Request
Payment of a Health Care Claim
Status
DSMO Process Completed
Business Reason
Different payer edits can apply to different teeth.  The providers need to know the tooth number used to adjudicate the claim line.  It could differ from what the provider was expecting.  There is no other way in the 835 to communicate this information.  Either calls are generated because of the lack of information or providers  will not accept the 835 because of this difficiency.
Suggestion
Add the ability for payers to return the tooth number in the 835.
DSMO Category
B
Recommendation
Approve. The DSMO recommends that the members of X12 Claims Payment (835) Workgroup work with members of the X12 Dental Caucus to ensure appropriate implementation.
Appeal Recommendation