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Submitter

Jeanne Kirkpatrick

Description

We are looking for clarification on the comment in the response of 835 RFI 1578 that states “None of the rules make a reference to the dates reported in the 837 claim.”

An 837I inpatient claim reported Statement Dates of 9/23/14 to 9/25/14 (no dates at the service lines, but the date of 9/24/14 is reported with the principal and other procedure codes in the HI:BR and BQ segments). We returned an 835 where the from date of 9/23/14 is reported at both the claim level w/qualifier 232 and each of the 12 service lines w/qualifier 472.

Since the comment in the RFI 1578 indicates the 835 rules do not make reference to the 837, and the TR3 rule for DTM in Loops 2100 and 2110 state “If not required by this implementation guide, may be provided at senders discretion, but cannot be required by the receiver”, is the reporting of only the Statement “from” date in the 835 compliant?

835 Example:
Loop 2100
DTM*232*20140923~
Loop 2110 (12 lines)
DTM*472*20140923~

Submitter Assigned Keywords

835 DTM Date of Service DOS

Response

No, your example is not compliant with the 005010221A1 835 Technical Report Type 3 (TR3).

While the 835 TR3 does not reference 837 dates, the TR3 does specify how dates are to be reported. The sender does have more than one compliant way to report dates, but your example is not one of the compliant ways.

As explained below, your 835 example indicates that the Claim Statement Period Start date and Claim Statement Period End date are the same and that all services were performed on the same day. This is not true for the claim in your example.

Explanation: The requirements for reporting dates at the claim and/or service level are specified in the situational rules and TR3 notes for the 2100/DTM – Statement From or To Date segment and the 2110/DTM – Service Date segment.

These rules and notes require the dates to be reported in one of the following ways:
1.Reporting claim level DTM segment(s) that apply to all service lines.
2.Reporting service level DTM segments for each service line.
3.Reporting claim level DTM segment(s) and one or more service level DTM segments. In this scenario, the service line date(s) override the claim level date(s) for the service line where they are reported.

For both the claim and service line levels, the requirements for reporting individual dates are specified in the code value notes of the DTM01 Date Time Qualifier data element in the applicable DTM segment.

If claim level dates are reported, the code value notes require the dates to be reported in one of the following ways:
1.Sending both DTM*232 and DTM*233 to indicate the actual Claim Statement Period Start and Claim Statement Period End dates.
2.Sending only DTM*232 to indicate the Claim Statement Period Start and Claim Statement Period End dates are the same.
3.Sending only DTM*233 to indicate the Claim Statement Period Start and Claim Statement Period End dates are different, but only the end date is reported.

If service line level dates are reported, the code value notes require the dates to be reported in one of the following ways:

If service line level dates are reported, the code value notes require the dates to be reported in one of the following ways:
1.Sending both DTM*150 and DTM*151 to indicate different Service Period Start and Service Period End dates.
2.Sending only DTM*472 to indicate a single day service.

Recommendation

If you opt to send claim level dates, the following examples meet the claim level requirements of the 835 TR3 for your scenario.

835 Example 1:
Loop 2100
DTM*232*20140923~
DTM*233*20140925~

835 Example 2:
Loop 2100
DTM*233*20140925~

If you opt to report service line level dates, the actual start and end date on each service line must be reported, using the appropriate Date Time Qualifier(s).
Submission 5/19/2015
Status Date 8/27/2015
Status F - Final
Primary References
Document 005010X221A1
Section2.4
Loop2100
Segment IDDTM
Secondary References
RFI ID 2535
Document 005010X221A1
Section2.4
Loop2110
Segment IDDTM