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Back  RFI # 1820: Application of RFI 1503

Formal vs. Informal Help Informal Formal

Submitter

Michele Tizon

Description

Does the response from RFI #1503 apply beyond the response given for CRC 2400 to include other claim types such as Spinal Manipulation or should the response only apply to CRC 2400?

We are using a validation engine that has applied the response given in 1503 to claims where SBR09 of 2320 is MB and CR208 = A. The new edits are requiring a DTP*453 (Date of Acute Manifesation) even when the destination payer is a commercial payer (SBR09=CI 2000B) Please advise if this is a correct application for RFI#1503.

Submitter Assigned Keywords

Medicare Edits applied to Commercial Claims

Response

RFI #1503 stated "The 005010X222A1 TR3 requires the Hospice Employee Indicator (2400 CRC) on all Medicare claims involving physician services to hospice patients. That requirement applies regardless of whether the destination payer is Medicare or the destination payer is a COB payer subsequent to Medicare." The same concept used in the response to #1503 applies in this situation as well. When Medicare is a payer involved, regardless if the destination, prior or subsequent payer, the condition "and the payer is Medicare" is met and the Acute Manifestation date is sent as long as the other conditions (2300 CR08 = 'A' or 'M' and the claim involves a spinal manipulation) are met as well.
Submission 6/28/2013
Status Date 10/22/2013
Status F - Final
Primary References
Document 005010X222
Section1.1
Page167
Set ID837P
Loop2300
Segment IDDTP