Section title: Requests for Interpretation
RFI #
2439
Service Window on 837D
Description

What is the best place to capture “service window” information on 837 Dental claim – for ex: dental hygienist worked from 8:30 AM to 9 AM.
It may be needed to capture this information to address some fraud claims.

Some of the considered places are:
- loop 2300, segment NTE "Claim Note"
- loop 2400 or 2300, segment K3 "File Information"

Response

The current transaction does not have a specific segment to report this type of data. The NTE segment is reserved for discretionary provider usage. 

The payer is not allowed to require any data to be sent in the NTE.  The K3 is only allowed for X12 approved use cases and is related to legislative or regulatory emergencies.

RFI Recommendation

An attachment for each claim may be used to report this information.   

You may submit an X12 maintenance request, if there is a business need not supported in a published TR3, for consideration in a future version of the TR3.

DOCUMENT ID
005010X224A2