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Back  RFI # 1849: Admit Hour for mult day OP clm

Formal vs. Informal Help Informal Formal

Submitter

tom keith

Description

I am wanting to deterimine if we are out of compliance because the State requires admit hours for multi same day services for OP/ER claims. I knwo that the TR3 for 837I states that the DTP is only allowed for IP services. But is it a critical compliance issue if we do allow it for our claims and still require the provider to include the admit hour. I know that the G0 condition code is an option, but we are in the process of developing a new system that would handle this issue.
Thank you

Response

The Loop 2300 DTP Admission Date/Hour situational usage rule reads “Required on inpatient claims. If not required by this implementation guide, do not send.” Therefore, sending this segment on an outpatient claim (See Section 1.12.6 for how IP v. OP designation is defined within the TR3) is not compliant with the TR3.

Related to your question regarding allowing or accepting the transaction as described. X12’s position on accepting non-compliant transactions is stated in the response to RFI 1512 and is stated below:

ASC X12 does not govern the receiver's actions when receiving a transaction that is not compliant with the specified implementation guide. Section 2.2.1.1 in TR3s published by the ASC X12 Insurance Subcommittee makes this clear with the statement "The receiver will handle non-compliant transactions based on its business process and any applicable regulations."

Related to your question regarding requiring that this data be sent:

"Per the ASC X12 Intellectual Property Use (see http://store.x12.org/store/ip-use), inclusion of a requirement as described for the Admission Date/Hour in a supplemental document (companion guide) violates the Must Not provisions:

'Contradict, countermand or duplicate any requirement of the associated TR3'

and

Add, modify or delete any requirements, including loop, segment or element names, notes or rules, examples, appendix, or code list subsets from Section 2'."

Recommendation

If a regulatory agency concludes it has a legislative requirement not met elsewhere in the TR3 the administering agency can request a review by the appropriate X12N Work Group for approval to use the K3 segment to meet this need.
Submission 9/3/2013
Status Date 11/12/2013
Status F - Final
Primary References
Document 005010x223A2
Section2.4
Page153
Loop2300
Segment Position1251
Segment IDDTP
Element Position03