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Back  RFI # 1486: 5010x223A2 - Admission Date

Formal vs. Informal Help Informal Formal

Submitter

Tamara Leaver

Description

Is it syntactically incorrect to submit the Admission Date on Outpatient claims? In the TR3 guide for Admission date 2300 loop; DTP01 qualifier 435. Situational Rule Required on IP claims, if not required do not send. However, in 1.12.2 of the TR3 guide there are specific instructions about a payer rejecting claims because information was submitted but not used.

It would appear to me that while it's required to send the Admission date on inpatient claims, that we should not be seeing rejections because we are sending the admission date on outpatient claims.

Submitter Assigned Keywords

Admission Date

Response

Section 1.12.2 does not apply to this segment, since the impact on adjudication is not mentioned in the situational rule.

Section 2.2.1.1 governs how compliance with the TR3 is determined. In this case, if a claim is not an inpatient claim, the situational rule specifies that Admission Date not be sent. Section 2.2.1.1 indicates that if a transaction contains a data element when the situational rule states "do not send", the transaction does not comply with the implementation guide. Therefore, reporting the Admission Date for an outpatient claim is not compliant with this TR3.

Refer to RFI 1512, which clarifies the ASC X12 position on rejecting or accepting transactions that do not comply with the governing TR3.
Submission 1/3/2012
Status Date 2/27/2012
Status F - Final
Primary References
Document 005010X223
Section2.4
Page153
Set ID223
Loop2300
Segment Position1350
Segment IDdtp
Element Position01