837 Dental Healthcare Claim

EDI 837 Dental Healthcare Claim Technical Environment Guidelines (Washington State Medicaid)

EDI 837 Dental Healthcare Claim technical guides are to be used by members/technical staff of trading partners who are responsible for electronic transaction/file exchanges.

Completion of the testing process must occur prior to submitting electronic transactions in production to ProviderOne. EDI 837 Dental Healthcare Claim testing is conducted to ensure the following levels of HIPAA compliance:

  1. Level 1 – Syntactical integrity: Testing of the EDI 837 Dental Healthcare Claim file for valid segments, segment order, element attributes, testing for numeric values in numeric data elements, validation of X12 or NCPDP syntax, and compliance with X12 and NCPDP rules.
  2. Level 2 – Syntactical requirements: Testing for HIPAA Implementation Guide-specific syntax requirements, such as limits on repeat counts, used and not used qualifiers, codes, elements and segments. It will also include testing for HIPAA required or intra-segment situational data elements, testing for non-medical code sets as laid out in the Implementation Guide, and values and codes noted in the Implementation Guide via an X12 code list or table. Additional testing may be required in the future to verify any changes made to the ProviderOne system. Changes to the formats may also require additional testing. Assistance is available throughout the testing process.

Trading Partner Testing Procedures

  1. The Trading Partner completes the Trading Partner Agreement and submits the signed agreement to HCA.
  2. The trading partner is assigned a Submitter ID, Domain, Logon User ID and password.
  3. The trading partner submits all HIPAA test files through the ProviderOne web portal or Secure File Transfer Protocol (SFTP).
  4. The trading partner downloads acknowledgements for the test file from the ProviderOne web portal or SFTP.
  5. If ProviderOne system generates a positive TA1 and positive 999 acknowledgements, the file is successfully accepted. The trading partner is then approved to send 837 HIPAA files in production.
  6. If the test file generates a negative TA1 or negative 999 acknowledgments, then the submission is unsuccessful and the file is rejected. The trading partner needs to resolve all the errors reported on the negative TA1 or negative 999 and resubmit the file for test. Trading partners will continue to test in the testing environment until they receive a positive TA1 and positive 999.

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