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Back  RFI # 913: 837D 5010 Request for K3 Use

Formal vs. Informal Help Informal Formal

Submitter

Theresa Jansen

Description

We have a business need for a Dental Readiness Classification (DRC) code that indicates the status of the Active Duty Service Member's (ADSM) dental health. The determination of the status of the member's dental health is done by the dentist evaluating the patient to determine what DRC code applies at that time. There are 3 DRC codes: Class 1 (DRC1) - ADSMs with current dental examinations who donot require dental treatment or reevaluation, Class 2 (DRC2) - ADSMs with current dental examinations whose oral conditions are unlikely to result in dental emergencies within 12 months and Class 3 (DRC3) – ADSMs who require urgent or emergent dental treatment. I request that WG2 approve the usage of the claim level K3 segment in the 5010 837D TR3, for the reporting of the DRC code. Public Law 109-163 set the requirement to report Dental Readiness for ADSMs. The above request provides the details. I also suggest the following formats for reporting the DRC code in the K3 segment: K3*DRC1~ (for DRC 1) and so on.

Response

This HIR was presented to WG2 at the January trimester meeting in Seattle. WG2 reviewed the request and found no other method to meet this requirement in the 837D 5010 TR3. WG2 also agreed that the following reporting format should be used for reporting the DRC in the claim level K3 segment: K3*DRC1~ (for DRC 1), K3*DRC2~ (for DRC 2) and so on. Therefore, based on the information provided in the HIR request and the fact that no other method is available, WG2 approved the use of the K3 segment in the 5010 837D TR3 for reporting the DRC code.
Submission 11/25/2009
Status Date 3/26/2010
Status F - Final
Primary References
Document 005010X224
Section2.4
Page177
Set IDK3