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Back  RFI # 892: 5010 837i Discharge hour

Formal vs. Informal Help Informal Formal

Submitter

Joel Prater

Description

In the 5010 837i implementation guide the situational rule for the Discharge Hour (DTP*096 segment in loop 2300) states "Required on all final inpatient claims. If not required by this implementation guide, do not send." Upon reviewing this requirement and in light of the verbiage in section 1.8 of the 837IG titled "Trading Partner Agreements". Would it be acceptable to require this information on an outpatient claim when there is an agreement in place between the payor and provider that this information be provided? Would we be required to accept an outpatient claim via EDI that does not contain this field?

Submitter Assigned Keywords

5010 DTP*096

Response

This issue is explicitly addressed in guide 005010X223. The note on the 2300 loop DTP segment for the Discharge Hour states "Required on all final inpatient claims. If not required by this implementation guide, do not send." Section 1.8 states "A trading partner agreement must not override the specifications in this implementation guide if a transmission is reported in GS08 to be a product of this implementation guide."

While there are instances where a trading partner agreement can provide additional direction, those instructions MUST never override the guide specifications. Any instructions that are not consistent with the Discharge Date situational rule are not allowed. For instance, the discharge date can't be sent on an outpatient claim under any circumstances. Outpatient claims fall into the "do not send" category of the situational rule.
Submission 10/20/2009
Status Date 11/20/2009
Status F - Final
Primary References
Document 005010X223
Section837
Page149
Set ID837