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Back  RFI # 601: Missing Date of Service

Formal vs. Informal Help Informal Formal

Submitter

Allen Carol

Description

We have a situation where a paper claim comes in with no date of service. The claim is adjudicated and denied. Based on a previous HIR 366 response I would expect that your first recommendation would be to reject the claim up front. That is not very realistic and we cannot always control how we receive claims. We would like to return the claim electronically to the provider and not have to resort to paper.

Is there a default date that the workgroup might recommend in this case for the date of service? In 5010 we recommended a default date of 19000101 to get around the issue of no service date for predeterminations.

Same question applies to 2100 Claim DOS or 2110 Service Line DOS.

Response

The preferred recommendation would be to return paper claims when there is incomplete or invalid claims data. However, recognizing that all payers may not be able to accommodate this practice, it is the opinion of the 835 work group that when the date of service is missing and the payer brings the claim into their adjudication system, that 19000101 be returned.

The recommended default in 5010 for pre-determinations is to return 19000101 as the date of service.
Submission 9/6/2007
Status Date 11/29/2007
Status F - Final
Primary References
Document 004010X091A1
Section3
Page130
Set ID835
Table2
Loop2100
Segment Position050
Segment IDDTM
Element Position02
Industry NameDate of Service