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Back  RFI # 1578: 835 claim versus line dates

Formal vs. Informal Help Informal Formal

Submitter

Ranah Anani

Description

In the incoming 837, the provider is submitting service line dates but does not supply claim level date.

The provider is stating that since they supplied a service line date in the 837, that in the corresponding 835, we are required to supply service line dates in the 2110 loop. We maintain that since we are sending claim level dates in the 835 and they are the same as the service line dates, we are not required to supply the line level dates.

From reading the TR3, it states that if the 2100 loop contains the claim dates then the 2100 Loop does NOT require the service line dates.
The guide states that it is situational and cannot be required by the receiver unless the dates are either not supplied in the 2100 loop or the dates are not the same as the 2100 dates supplied at the claim level.

Submitter Assigned Keywords

835 service line dates claim level dates

Response

The TR3 Notes for the 2100 DTM - Statement From or To Date segment states (note 1) the dates at the claim level apply to the entire claim, including all service lines and (note 3) when claim dates are provided, service dates are not required, but if used override the claim dates for individual service lines.

The segment situational rule for the 2110 DTM - Service Date segment states the segment is required when the claim level Statement From or Through Dates are not supplied or the service dates are not the same as reported at the claim level. If not required by this implementation guide, may be provided at the sender's discretion. but cannot be required by the receiver.

None of the rules make a reference to the dates reported in the 837 claim.

Therefore if the claim level dates are reported then the service level line dates are not required, unless they are different than the claim dates.
Submission 4/29/2012
Status Date 6/29/2012
Status F - Final
Primary References
Document 005010X221
Section2.3.1
Page194
Table2
Loop2110
Segment Position0800
Segment IDDTM