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Back  RFI # 1791: 277-STC02

Formal vs. Informal Help Informal Formal

Submitter

Ward Lori

Description

A provider submitted a paper claim with no date of service. MMIS is keying a date of service (00010101 or 99990101). When claim status is requested, MMIS is not returning a date in the 2200D STC02, EDI is rejecting as the 2220D and STC02 are both required.
1. When a paper claim is received but the provider elects to participate in 276/277, can a default date be used?
2. If not, what recommendations can X12 make to address the "no service date present on the original claim"?
NOTE: MMIS has denied the claim due to invalid date.

Submitter Assigned Keywords

277 2200D STC02 invalid or missing date

Response

This issue of default dates is not specifically addressed in the 005010X212 (276/277). The preferred recommendation would be to have payers return paper claims when there is incomplete or invalid claims data, especially when that missing or invalid data creates syntax and data errors for claims reported in downstream transactions (ex. 276/277, 835). It is however recognized that not all payers are able to accommodate this practice and therefore setting a valid default date, such as 19000101, is acceptable for use in the transactions.

The Status Information Effective Date (STC02) is a Required element in the Claim (2200D/E) and Service (2220D/E) Level STC Segments. This element is defined in Appendix E (Data Element Glossary) as ‘The date that the status information is effective.’ In the instance where a ‘claim not found’ status is returned, the STC02 value would be reported as the current system date (i.e. the date the 'claim not found' status was determined). The STC02 value should not be an arbitrary default date or left blank and not be reported.

Recommendation

Trading Partners should be made aware of a payer’s practice to set default service dates in their system, as it may impact the effectiveness of identifying claims in the payer’s system and accurately responding with status in the 276/277 Claim Status Request and Response.

Identifying the use of default service dates in the payer’s system, when a service date was erroneously not submitted on a paper claim, would allow providers to perform an inquiry on claims using the default date and payers to respond with status for those claims.

The 276 transaction requires either a claim or service date be reported. If a claim is not found in the payer’s system based on the submitted dates, the claim and/or service dates reported in the 276 would be echoed back in the 277 response to indicate a claim or service was not found for the requested service dates.
Submission 5/14/2013
Status Date 6/24/2013
Status F - Final
Primary References
Document 005010X212
SectionTable 2
Page138
Loop2200D
Segment Position1000
Segment IDSTC
Element Position02