Segment
X12 EDI Release 00304
To specify the claim service detail for dental work
Elements
Code identifying the type of facility where services were performed; the first and second position of the uniform bill type or place of service from health care financing administration claim form, or place of treatment from the dental claim form
Code indicating the type of agreement under which the provider is submitting this claim
Codes (7)- DManaged Dental Care Program
- ECivilian Health and Medical Program of the Uniformed Services (CHAMPUS) "External" Partnership Agreement
- HHealth Maintenance Organization (HMO) Agreement
- ICivilian Health and Medical Program of the Uniformed Services (CHAMPUS) "Internal" Partnership Agreement
- NNo Agreement
- PParticipation Agreement
- YPreferred Provider Organization (PPO) Agreement