Dental Claim Detail (Basic Claim Info Tab) Page

You use the Dental Claim Detail page of Claims Inquiry to view a claim in ND MMIS.

The Basic Claim Info tab contains the following panels:

• Claim Data
• Submitter Information
• Provider Information
• Member Information
• Other Insurance Information
• Claim Information
• Claim Data
• Basic Line Item Information

You can open or close certain panels. Click (the plus sign) beside a panel to open the panel. Click (the minus sign) to close the panel.

Field Descriptions

The fields on this tab are defined in the X12N documentation published by the Washington Publishing Company (WPC).

The Claim Data fields are described in the Dental Claim Detail (Main Tab) Page topic.

Version as of 5/16/14.