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Back  RFI # 1801: 835 SVC06-01

Formal vs. Informal Help Informal Formal

Submitter

Ward Lori

Description

On the 835 we are reporting the procedure code not used in adjudcation in the SVC06-03 and note the procedure code is an "AD" code as provided on the original 837. If SVC06-01 does not contain one of the four qualifiers (ER, HC, IV, WK) our validation engine rejects the code as expected. The ADA has not adopted procedure codes for dental claims. Therefore, how are we expected to report this back on the 835?
1. We have no valid qualifier to use in the SVC06-01.
2. Without a valid qualifier, the procedure information will reject also.

Submitter Assigned Keywords

835 SVC06-01 SVC06-03

Response

If the adjudicated procedure code differs from the submitted code, the submitted code is reported in SVC06-02. The procedure code in SVC06-02 is qualified by SVC06-01. One of the allowable qualifier codes is AD. Therefore, when qualifier AD is submitted in the 837, AD should be returned in SVC06-01.

The ADA CDT codes, identified by code source 135, are dental procedure codes and are appropriate for use in SVC06-02.
Submission 5/23/2013
Status Date 7/9/2013
Status F - Final
Primary References
Document 005010X221
SectionTable 2