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Welfare Health Plans, Inc.
837D Claims/Encounter Data
Transaction GuideWELLCARE EDI TRANSACTION SET
837D X12N HEALTH CARE
CLAIM / ENCOUNTER DENTAL
ASC X12N (004010×097A1)
Companion GuideInbound
837
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How to fill out 837d claimsencounter data
How to fill out 837d claimsencounter data:
01
Start by gathering all necessary information for the claim, including patient demographics, insurance information, and healthcare provider details.
02
Begin filling out the claim form by entering the patient's personal information, such as name, date of birth, and address.
03
Proceed to input the insurance details, including the policy number, group number, and any applicable authorization or referral numbers.
04
Next, provide the healthcare provider's information, including their name, National Provider Identifier (NPI), and contact details.
05
Move on to entering the specific encounter data, such as the date of service, diagnosis codes, and procedure codes, accurately following the coding guidelines and using the appropriate code sets (e.g., CPT, ICD-10).
06
Include any additional information required for the claim, such as modifiers, place of service, and anesthesia minutes, if applicable.
07
Double-check all entered information for accuracy and completeness before submitting the claim.
Who needs 837d claimsencounter data:
01
Healthcare providers: Medical professionals and facilities need the 837d claimsencounter data to submit claims for reimbursement from insurance companies.
02
Insurance companies: Payers require the 837d claimsencounter data to process and evaluate reimbursement requests from healthcare providers.
03
Government agencies: Entities like Medicaid or Medicare may use the 837d claimsencounter data for auditing and regulatory purposes.
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What is 837d claimsencounter data?
837d claimsencounter data refers to the format for submitting healthcare claims and encounter information electronically.
Who is required to file 837d claimsencounter data?
Healthcare providers, clearinghouses, and health plans are required to file 837d claimsencounter data.
How to fill out 837d claimsencounter data?
837d claimsencounter data is filled out using specific codes and standards outlined by the HIPAA transaction regulations.
What is the purpose of 837d claimsencounter data?
The purpose of 837d claimsencounter data is to streamline the processing of healthcare claims and encounters between healthcare entities.
What information must be reported on 837d claimsencounter data?
Information such as patient demographics, procedures performed, diagnosis codes, and insurance information must be reported on 837d claimsencounter data.
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