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Back  RFI # 1208: 276 005010x212 2210D/DTP

Formal vs. Informal Help Informal Formal

Submitter

CHERYL KELLY

Description

We would like to inquire whether this particular scenario was previously discussed by the 276/277 Workgroup:
In a batch 276 Claims status inquiry test file, we provided a 2210D/DTP Service line date that was outside of the date range provided at the 2200D/DTP Claim Service date. Our validator did not return an edit for this scenario and the vendor's reason was that the 276/277 005010x212 TR3 did not specify that the 2200D/DTP Claim Service date should encompass the Service Line dates, and therefore, an edit was not created. It is our business expectation that the Claim Service date range should encompass the dates that are sent at the Line level. Our vendor recommends that we include a custom edit into our validation process to address this scenario.
Example:
DTP{472{RD8{20100629-20100629 >2200D/DTP Claim level DOS
SVC{HC|88300|26{80.00{{{{{1
REF{FJ{1
DTP{472{RD8{20100601-20100601 >2210D/DTP Line level DOS; 06/01/10 is before 06/29/10

Submitter Assigned Keywords

276 005010x212 2200D DTP Claim Service date 2210D DTP Service Line date

Response

This issue is explicitly addressed in the 005010X212 TR3 relative to Professional claims. The Claim Service date should encompass the dates that are sent at the Line level based on the Loop 2200D DTP - Claim Service Date TR3 note which indicates: TR3 Notes: 1. For professional claims, this date is derived from the service level dates. Although the 276/277 guide does not explicitly state that the service dates must be within the span of the claim dates, the 005010X212 guide authors' expectation for both Dental and Institutional claim status inquiries would be that the service dates fall within the claim dates.

Recommendation

The guide does not address software validation edits that should or should not occur. Those edits may vary by trading partners and/or search criteria.
The workgroup will enhance the TR3 note in a future version to include guidance on the institutional and dental claims.
Submission 12/8/2010
Status Date 2/25/2011
Status F - Final
Primary References
Document 005010x212
Section2.4
Page97
Set ID276
Table2
Loop2210D
Segment IDDTP
Element Position03
Industry NameSTATE OF AZ/AHCCCS