Companion Documents
For information or assistance, contact the N.D. Department of Human Services' Medical Services Division at (701) 328-2321 or at dhsmed@nd.gov.
- 835 Health Care Payment and Remittance Advice for HIPAA Transactions 9-06 (33kb pdf)
- 837 Dental Companion Documents for HIPAA Transactions 9-06 (39kb pdf)
- 837 Professional Companion Documents for HIPAA Transactions 9-06 (94kb pdf)
- 837 Institutional Companion Document for HIPAA Transactions 9-06 (121kb pdf)
- 270 Health Care Eligibility Benefit Inquiry (18kb pdf)
- 271 Health Care Eligibility Benefit Response (28kb pdf)
- 276 Health Care Claim Status Request (20kb pdf)
- 277 Health Care Claim Status Response (24kb pdf)
- 278 Health Care Services Review - Request for Review and Response 9-06 (65kb pdf)
Top of page 
Back to previous page
