Oklahoma Medicaid Management Information System Guides For The 837 Dental Transaction
The ASC X12 837 Dental transaction is the electronic equivalent of the ADA 2012 paper claim form. Key Notes:
- No more than 50 service lines are allowed per claim.
- Providers must use the 10-digit NPI as the billing/pay- to, referral, and rendering provider ID.
- The PAT segment, Loop 2000C and 2010CA, is no longer needed unless billing a claim for a newborn. Every SoonerCare subscriber, except newborns, have their own SoonerCare ID number. When the subscriber and the patient are the same person, omit the PAT information in Loop 2000C and 2010CA.
- The SoonerCare numbers to be sent on claims should follow this format:
- Providers – 100000000A (nine digits with one alpha character at the end for a total of 10 characters)
- Subscribers – 123456789 (nine digits)
- The tooth quadrant in field SV30401 must be listed.
- The TOO segment must be populated indicating tooth number and surface code.
- No more than 5,000 claims per transaction.
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