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Back  RFI # 1442: Part A Outpatient Service Line

Formal vs. Informal Help Informal Formal

Submitter

Gerilyn Parfitt

Description

Am hoping someone can provide direction on 5010 changes with Part A outpatient claims dates of service.

On closer review of the X12 spec for this DTP segment I now see that in 4010 it said:

Required on outpatient claims when revenue, procedure, HIEC or drug
codes are reported in the SV2 segment.

But in 5010 it now reads:

Required on outpatient service lines where a drug is not being billed and
the Statement Covers Period is greater than one day.



These service lines dates of service are key in our processing and adjudication of claims.

Under 5010 do I now need to cover the possibility of NOT receiving service line dates of service for Part A outpatient claims? More specifically, when the claim statement date is one day, to default the service line dates of service (if none provided) to the statement date?

Submitter Assigned Keywords

DOS, DTP

Response

This issue is explicitly addressed in guide 005010X223. The situational rule for the 2400 loop Service Date segment reads "Required on outpatient service lines where a drug is not being billed and the Statement Covers Period is greater that one day. ... If not required by this implementation guide, do not send."

The intent here is that if the Statement Covers Period is a single date, then that date applies to every service line and reporting it at the 2400 loop is redundant. You are correct - there are times when you will not receive this date on the service line itself, and the Statement Covers Period from the claim level is the default that must be carried to the service line as the Service Date.
Submission 10/28/2011
Status Date 12/8/2011
Status F - Final
Primary References
Document 005010X223
SectionSpec
Loop2400
Segment PositionDTP