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Back  RFI # 648: Dental Service Dates in 277

Formal vs. Informal Help Informal Formal

Submitter

Tom Drinkard

Description

On page 171 of the May 2000 Implementation Guide (004010X093), the segment notes for the Claim Service Date are as follows:
1. Use this segment for the institutional claim statement period.
2. Use this segment if the subscriber is the patient.
3. For professional claims this will be the claim from and through date. If
claim level date range is not used then the Line Service Date at 2220D
is required.

(This segment is not refernced in the Addenda.)

The notes do not mention Dental claims. Assuming the Service Line Information loop (Loop ID-2210D) is not present, is the Claim Service Date required for Dental claims?

As a corollary question, is the Claim Service Date required when returning Claim Status for Dental predeterminations?

Submitter Assigned Keywords

Claim Service Date Dental Claims

Response

The 004010X093A1 specifically addresses the use of claim and service dates. The 2200D/E Claim Service Date is required unless the 2210D/E (276) or 2220D/E (277) Service Line Date is used. Dental claims are treated as professional claims as opposed to institutional for the purpose of the 276/277 transaction.
The 004010X093A1 does not specifically address the business function of status on a pre-determination of dental benefits claim. However, if trading partners agree to use the transaction for this business function, then the date segment notes would be applicable to meet syntax structure.

Recommendation

DRAFT - Dental claims have been addressed in the segment rules of version 005010 of the 276/277. The 005010 version guide does not address the function of status on a pre-determination of dental benefits claim. The workgroup requests dental industry representatives bring the business requirements to the Claim Status workgroup so that a standard method of requesting and reporting pre-determination status can be developed within a future version of the guide.
Submission 4/24/2008
Status Date 6/17/2008
Status F - Final
Primary References
Document 004010X093
Section3
Page171
Set ID277
Table2
Loop2200D
Segment Position120
Segment IDDTP
Industry NameClaim Service Date