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Back  RFI # 351: Future Dates

Formal vs. Informal Help Informal Formal

Submitter

Tony Benisch

Description

DTP03 segment 2330B loop--Inst

Can a submitter future date this segment if they know when the claim will be adjudicated? i.e. submitter is sending their Medicare claims, they know the adjusdication date because they can go into the Medicare system and know when the claim will be released from payment floor.

Response

This issue is explicitly addressed in guide 004010X096 in section 1.4.2 and its subsections. Section 1.4.2.1, Model 1, Step 2 begins "Upon receipt of the 835,...". This statement clearly identifies the intent that the Provider receive the remittance advice from the primary payer prior to sending the claim to the secondary payer. The business stated in this request is to send the secondary claim before receipt of the remittance advice. Since the CAS segments and other information from the 835 is required to build the COB loops, the provider needs to wait for the receipt of the 835, before the COB claim can be created.
Submission 11/1/2005
Status Date 12/20/2005
Status F - Final
Primary References
Document 004010x096a1
Section3
Page394
Set ID837I
Table2
Loop2330B
Segment IDDTP
Element Position03
Industry NameClaim Adjudication Date