The 837 Dental 2000A PRV situational rule states: Required when the Billing Provider is also the Rendering Provider for at least one of the claims in this transaction. If not required by this implementation guide, do not send.
However, the 837 Institutional and Professional claims at the same 2000A PRV state: Required when the payer’s adjudication is known to be impacted by the provider taxonomy code. If not required by this implementation guide, do not send.
Why the difference on the Dental format? This causes a problem for us in our ability to crosswalk NPIs correctly for Dental providers. Your help is greatly appreciated.
We were required to remove the “if needed for adjudication” situational rules from the TR3s after Version 4050. The WG2 professional and institutional participants could not come to a consensus on doing so with this segment situational rule, so they left it as it was. We, the WG2 dental participants, agreed to change the situational rule making the process of determining when to send this segment clear.