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EDI 837 Dental. Version 005010X224A2 Example:  One Claim with 12 Procedure Codes ISA*00*          *00*          *ZZ*submitterID    *ZZ*receiverID     *230726*0323*^*00501*263232200*1*T*: GS*HC*submitterID*receiverID*20230726*0323*2632322*X*005010X224A2 ST*837*0001*005010X224A2 BHT*0019*00*0001*20230726*0323*CH NM1*41*2*Demo Practice*****46*submitterID PER*IC*John*TE*2025550170 NM1*40*2*MyClearingHouse*****46*receiverID HL*1**20*1 PRV*BI*PXC*208500000X NM1*85*2*Get ..read more

EDI 837 Dental. Version 005010X224A2 Example:  Orthodontic treatment plan ISA*00*          *00*          *ZZ*123456789012345*ZZ*123456789012346*080503*1705*>*00501*000010216*0*T*: GS*HC*1234567890*1234567890*20080503*1705*20213*X*005010X224A2 ST*837*0322*005010X224A2 BHT*0019*00*0123*20061123*1023*CH NM1*41*2*JOHN DOE*****46*940001 PER*IC*SALLY*TE*7175555555 NM1*40*2*KEY INSURANCE COMPANY*****46*999996666 HL*1**20*1 PRV*BI*PXC*1223G0001X NM1*85*1*JOHN*DOE****XX*2345678901 N3*123 TOOTH DRIVE N4*MI ..read more

  EDI 837 Professional. Version 005010X222A1 Example 12:   Billing Provider Complete Information  ->  Bill with Group NPI ISA*00*          *00*          *ZZ*111134         *01*zirmed         *200218*0749*^*00501*796000000*0*P*: GS*HC*111134*zirmed*20200218*0749*796*X*005010X222A1 ST*837*0001*005010X222A1 BHT*0019*00*0001*20200218*0749*CH NM1*41*2*Demo Practice*****46*111134 PER*IC*William Richard*TE*2 ..read more

Corrected claims can be submitted electronically as an EDI 837 transaction with the appropriate frequency code as follows. Code Description 1 Indicates the claim is an original claim 7 Indicates the new claim is a replacement or corrected claim – the information present on this bill represents a complete replacement of the previously issued bill. 8 Indicates the claim is a voided/cancelled claim This value should be passed in the Claim Segment CLM  in CLM05- as shown here CLM*10421*100.00***11:B:7*Y*A*Y*Y*P When submitting claims noted with claim frequency code 7 or 8, the ..read more

What is Assignment of Benefits ? An assignment of benefits is a legal contract used to transfer the rights to benefits under a health care plan from the insured to the health care provider. If there is an assignment of benefits, the health plan will pay its portion  of the fee (the benefits) directly to the provider. It eliminates the need for the insured to pay the provider in full and then seek reimbursement of the allowed amount under the policy. This agreement is signed by the patient as a request to pay the designated amount to the health care provider for the health benefits he/sh ..read more

  What is claims processing? Claims processing is an intricate workflow involving 20+ checkpoints that every claim must go through before it’s approved. If a claim makes it through all these checkpoints without issues, the insurance company approves it and processes any insurance payments. If it doesn’t, it gets denied or sent back for more information. What happens to a claim after it gets submitted? The easiest way to understand claims processing is to follow a claim through the system.       ..read more

How to iterate over a Map using for loop in Go ? 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 package main   import "fmt"   func main() {     fmt.Println("Welcome to goLang Maps")       languages := make(map[string]string)     languages["JS"] = "Javascript"     languages["JA"] = "Java"     languages["PY"] = "Python"       for key, element := range languages {         fmt.Println("Key:", key, "=>", "Element:", element)  &nb ..read more

EDI 837 Professional. Version 005010X222A1 Billing for Physician Administered Drugs and NDC Reporting Providers are required to report the National Drug Code (NDC) supplemental information in addition to the procedure code (CPT or HCPCS) when billing for a physician administered drug on the electronic and paper claim formats. When billing  physician administered drugs, in addition to the appropriate CPT or HCPCS codes, the following must be reported on the claim: • the 11-digit NDC number; • the unit price (EDI only); • the 2-digit unit of measure code, e.g. GR (Gram), ML (Milliliter ..read more

Claims rejections occur when the clearinghouse or the payer stop a claim from entering their processing system. This is typically due to missing, incomplete, outdated, or incorrect information included in the claim. When claims fail to enter the payer’s processing system, providers do not receive an explanation of benefits or remittance advice for the rejection. Depending on the processor, providers may or may not receive a rejection notice from the clearinghouse or other electronic system. When the statuses of claims go unmonitored, rejections can pose an especially problematic effect for pr ..read more