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Back  RFI # 2178: 276/277 Claim Service Dates

Formal vs. Informal Help Informal Formal

Submitter

Deb McCachern

Description

Please give clarification on how the Information Source is to use the Claim Service Date Range in a 276 (2200D/E DPT) to locate a claim/claims on their system, in the absence of other specific search criteria (such as the Patient Control Number).

If a claim service date range is submitted in the 276 2200D/E DTP, should the Information Source return only those claims with service dates that exactly match the specified range? Or, should the Information Source return all claims with service dates that fall within the range?

Submitter Assigned Keywords

claim service dates

Response

1.3.2.1 Under Real Time Limitations and Batch Limitations states "Date search criteria may vary by payer. This includes date ranges or available history."

That same section states under Real Time Limitations "The 277 may return multiple responses depending on the specificity of the request criteria and the payer's system capabilities."

Section 1.4 states "However, when the 276 does not uniquely identify the claim within the payer's system, the response may include multiple claims that meet the parameters supplied by the requester."

Therefore, if a claim service date range is received, an Information Source may respond with all claims that fall within that range. However, any given Information Source may have different capabilities, allowing for only returning claims with an exact match of the date range. Since the objective of the transaction is to provide the Information Receiver with status information to avoid inquiries using other methods, the Information Source should endeavor to respond with all claims within the date range, but is not required to do so.
Submission 10/31/2016
Status Date 12/9/2016
Status F - Final
Primary References
Document 005010X212
Section2
Loop2200D
Segment IDDTP