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Back  RFI # 1408: 277CA claim date for POB

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Submitter

Julia Dunicheva

Description

Claim level service date is required to be sent in 277CA, loop 2200D, segment DTP, DTP01 = 472.
What date should be sent for 837 Dental claim with predermination of benefits that does not have service date?

Response

This business need was not addressed in the 005010X214 Guide. However it will be addressed in the next published version of the 277 Claim Acknowledgment Guide.

Recommendation

In order to acknowledge status of predetermination of benefits claims using the 005010X214 and pass syntax and IG structure editing, the workgroup recommends populating the 2200D Claim Level Service Date with the current date or the same date as status is issued.
The main identifier a provider should use for tracking or matching a 277CA status with the specific 837 claim data is the value returned in the 2200D Claim Status Tracking Number TRN Segment. The TRN value in the 277CA must be the same value as submitted in the CLM01 of the 837.
This work-around for predetermination of benefits claims can be documented in your EDI Companion Guide.
Submission 9/15/2011
Status Date 11/16/2011
Status F - Final
Primary References
Document 005010X214
Section2.4
Page89
Set ID277
Loop2200D
Segment IDDTP