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Back  RFI # 1818: Illogical Date - Responses

Formal vs. Informal Help Informal Formal

Submitter

Peggy Billhartz

Description

We, as a Payer, are receiving multiple claims from Providers with Valid Dates that are illogical for payment, such as 05/10/2230 and/or 01/01/0001 and/or 12/31/9999. When a response transaction is created, such as an 835, 277, or 277CA, the translator software is rejecting the EDI response for the date not having a century of 19, 20, or 21.

Would we, as a Payer, be complaint, if we generate an EDI response transaction (835/277/277CA) with Dates of Service (e.g., 05/10/2230, 01/01/0001, 12/31/9999) that are currently stored in our database, even if they are illogical dates?

Is it mentioned somewhere in the TR3s or HIPAA regulations that dates have to have 19, 20, or 21 century?

Submitter Assigned Keywords

835, 277, 277CA Illogical Dates

Response

This question references multiple technical reports by transaction, but always related to dates that were received in a claim. The TR3s returning claim dates to the provider identify the related information using descriptions including the terms "Claim Dates" or "Service Dates" or "Service Line Dates". The basic requirement is to return the date received in that prior claim transaction. There is no requirement that the date be 'logical'. Therefore, returning the dates as received on the claim, even if they are illogical dates, is required by the guides.

The guides do not impose any requirement that the century in any claim or service dates be 19, 20 or 21.

ASC X12 can't address any HIPAA regulations that may or may not be related to this issue.

X12C agrees with this response (August 8th, 2013).

Recommendation

Health plans also have the option to identify claims that contain illogical dates on the front end using the Health Care Claim Acknowledgement (277). The illogical date still needs to be included as part of the edit/rejection transaction, but eliminates the issue for the 835.
Submission 6/27/2013
Status Date 8/13/2013
Status F - Final
Primary References
Document 005010X212
Section277 2200