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Back  RFI # 1506: Service Date on 837I

Formal vs. Informal Help Informal Formal

Submitter

Jan Powell

Description

In the 837I the Date - Service Date (Loop 2400 DTP03) is situational but is required when a drug is being billed on the service line.

How does X12 suggest confirmation that the line item being billed is a drug?

Would this be only when an National Drug Code (NDC) is populated in Loop 2410 LIN03?

Or would this be based on Revenue Code? or HCPCS code? or HCPCS Status Indicator of "G" for Drugs and Biologicals?

Submitter Assigned Keywords

Service Date

Response

The situational rule states “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.” The HCPCS code on the service line would confirm that a drug is being billed, the presence or absence of the NDC code is irrelevant. HCPCS status indicator is not an element reported on the 837 claim transaction. The segment is only sent, when all conditions in the situational rule are met.
Submission 1/27/2012
Status Date 3/6/2012
Status F - Final
Primary References
Document 005010X223
Section2.4
Page433
Set ID837I
Table2
Loop2400
Segment Position3650
Segment IDLX
Element Position03
Industry NameLine Item Service Date