HIPAA EDI 837 Dental Quiz

HIPAA EDI 837 Dental Quiz: Test your EDI knowledge

Try an EDI 837 Dental Quiz to check your Health Care EDI knowledge. This practical example and exercise give you a possibility to practice real-world case and find out gaps in your EDI knowledge.

EDI 837 Dental Claim Scenario

Patient MINI DUCK dependent son of DONALD DUCK goes to the dental office OFFICE OF ANTHONY KRUZ DDS for some dental work. He saw Dr. ANTHONY CRUZ on May 16th, 2018. The doctor performed two services, one with code XXX and another one with code YYY. The office is working with a clearing house to generate a 837 file and assign a claim Number 494672314 for future reference.

In this exercise you are going to fill in the blanks (from 1 to 26) to complete the claim, so it can be forwarded to MY BILLING SERVICE for processing.

Information for the 837 Dental Claim

• Submitter – PREMIER BILLING SERVICE, Trading Partner ID (ETIN – Electronic Transmitter Identification Number): PBS5747 also GS02 Sender ID
• Receiver – REPRICER XYZ, Trading Partner ID (ETIN): 66783JJT
• Billing Provider – OFFICE OF ANTHONY KRUZ DDS
  NPI: 1122333344
  Required tax ID for 1099 reporting: 111234567
• Subscriber – DONALD DUCK Member ID : 5554421
• Patient/Dependent – MINI DUCK
• Payer for this Claim – BLUE CROSS Payer ID: 741234
• Patient Account Number in the clinic is DDD0221111-02
• Rendering Provider – ANTHONY CRUZ, NPI: 1122333344
• Principal Diagnosis Code: K00.1- SUPERNUMERARY TEETH
• Other Diagnosis Code: Z01.20 – ENCOUNTER DENTAL EXAM CLEANING W/O ABNORMAL FIND Patient is also seen for Orthodontic treatment, scheduled for 24 months, 17 of which have been already consumed
  The patient has a missing tooth – Tooth # 8
  One of the services is for initial installment of appliance (prosthesis) – Procedure code = 95010
  The dentist will be working on the upper right corner (designation of the oral cavity)
  Dentist will be also working on TOOTH # 12 on surfaces L (Lingual) and O (Occlusal)
• Date of Service(s): May. 16, 2018
• Services billed:
  ADA procedure code, charge amount, units and diagnosis precedence D0120- (Periodic Oral Evaluation – Established Patient – test) $18, 1 unit, diagnosis pointers 1, 2 D0140- (Limited Oral Evaluation – Problem Focused) $60, 1 unit, diagnosis pointers 1, 2
• Claim total: 0$ – Claim will be adjudicated and will be paid according to the fee for service

EDI 837 Dental Claim Mapping