837 Dental Transaction

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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