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Back  RFI # 1854: 837P, 2300 DTP*454 requirement

Formal vs. Informal Help Informal Formal

Submitter

Dorrie Speckman

Description

According to the TR3, it would appear that the 2300 DTP*454 (Initial Treatment Date) does not have to be present when the 2300 CR2 segment is present.

The note in the TR3 at the Initial Treatment Date (2300 DTP*454)includes the wording "known to impact" which is not the same as required. We don't have a way to "know" if the date does or does not impact the claims with those conditions.

Question: Should a claim reject if there is a 2300 CR2 segment without a 2300 DTP*454 (Initial Trealment Date) present?

Response

ASC X12 doesn’t dictate when a transaction should or should not reject. See RFI # 1512 for additional information.

As to the guide requirements for the Initial Treatment Date and the CR2 segment, both segments reference the “known to impact adjudication” concept. Both segment situational rules also end with “If not required by this implementation guide, do not send.”

The adjudication impact is not necessarily the same for both segments. A given health plan may require the date or the CR2 information for adjudication, another may need both, and a third’s adjudication may not be impacted by either. There is no statement connecting these two segments, except that both could apply to spinal manipulation services and both are in the 2300 loop.

As a result, there is no requirement established by the guide that the Initial Treatment Date would need to be present anytime the 2300 loop Spinal Manipulation Service Information (CR2) segment is present. The CR2 segment could be present without the Initial Treatment Date, and the Initial Treatment Date could be present on a spinal manipulation claim without the CR2 segment.

See section 1.12.2 of the guide for related information.

Recommendation

In your request you state “We don't have a way to ‘know’". A submitter could determine that a given segment or element with the “known to impact” statement does impact adjudication from communications like:

- A payer’s companion guide

- Prior similar claims/services where the payer requested the related information

- Prior claim/services that were not paid or reduced due to the missing information
Submission 9/11/2013
Status Date 10/7/2013
Status F - Final
Primary References
Document x222.pdf
Section2 Transa
Page165
Set ID837P
Table2
Loop2300