Get the free 837 Dental/ADA Version 2012 Claim Form - Department of Public ... - dpw state pa

Pennsylvania Promise Provider Handbook 837 Dental/ADA Version 2012 Claim Form January 2014, Version 2.11 This document contains confidential and proprietary information of the Pennsylvania Promise

How to fill out 837 dentalada version 2012

1. To fill out the 837 dentalada version 2012, you will need the necessary information and documentation related to dental services provided.
2. Start by completing the general information section, which includes details such as the name, address, and contact information of the dental provider.
3. Next, you will need to provide the patient's information, including their name, date of birth, and insurance details, if applicable.
4. Fill out the procedure section by listing the dental services rendered, including the date of the service, procedure codes, and any relevant diagnosis codes.
5. Make sure to accurately report the charges and fees associated with each procedure performed.
6. If any supporting documentation is required, such as X-rays or treatment plans, ensure that they are properly attached or referenced in the appropriate section.
7. Finally, review the completed form for any errors or missing information before submitting it electronically or by mail.

Who needs 837 dentalada version 2012?

1. Dental providers and practitioners who offer dental services and bill for them may need to use the 837 dentalada version 2012 form.
2. Dental billing staff responsible for submitting claims to insurance companies or other third-party payers on behalf of dental providers also need to be familiar with this form.
3. Insurance companies and other entities involved in processing dental claims may also use the 837 dentalada version 2012 to accurately assess and adjudicate dental claims.

For pdfFiller’s FAQs

What is 837 dentalada version claim?

The 837 dentalada version claim is a standard electronic format for submitting dental insurance claims to insurance carriers.

Who is required to file 837 dentalada version claim?

Dental providers or their billing representatives are required to file 837 dentalada version claim.

How to fill out 837 dentalada version claim?

The 837 dentalada version claim can be filled out using a compatible billing software or by manually entering the required information into the designated fields.

What is the purpose of 837 dentalada version claim?

The purpose of the 837 dentalada version claim is to transmit dental insurance claims electronically to streamline the claims submission process and improve accuracy and efficiency.

What information must be reported on 837 dentalada version claim?

The 837 dentalada version claim must include patient information, provider information, insurance information, diagnosis codes, treatment procedures, fees, and any additional supporting documentation as required by the insurance carrier.

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