RFI Browser

Back  RFI # 1402: 005010X223A2 DTP 2300 vs 2400

Formal vs. Informal Help Informal Formal

Submitter

Peter Pizzano

Description

In the TR3 for the 5010 837 transaction for institutional claims, the DTP segment for service date (qualifier 434) in the 2300 loop is marked as required. The DTP segment for service date (qualifier 472) is marked as situational and has as the situational reason:

'Required on outpatient service lines where a drug is not being billed and the Statement Covers Period is greater than one day.
OR
Required on service lines where a drug is being billed and the payer’s adjudication is known to be impacted by the drug duration or the date the prescription was written.
If not required by this implementation guide, do not send.'

Can the insurance company (NGS in this case) require us to submit the service date DTP in the 2400 loop when the date range in the 2300 loop is one day or should this segment remain blank due to the situational logic above?

Response

For non-Drug related service lines the Service Date in Loop 2400 must only be used when the Statement Dates (Statement Covers Period) is greater than one day.
Submission 9/9/2011
Status Date 10/24/2011
Status F - Final
Primary References
Document 005010X223
Section2.4
Page433
Loop2400
Segment Position4550
Segment IDDTP
Element Position03
Industry NameService Date