Section title: Requests for Interpretation
RFI #
1408
277CA claim date for POB
Description

Claim level service date is required to be sent in 277CA, loop 2200D, segment DTP, DTP01 = 472.
What date should be sent for 837 Dental claim with predermination of benefits that does not have service date?

RFI Response

This business need was not addressed in the 005010X214 Guide. However it will be addressed in the next published version of the 277 Claim Acknowledgment Guide.

RFI Recommendation

In order to acknowledge status of predetermination of benefits claims using the 005010X214 and pass syntax and IG structure editing, the workgroup recommends populating the 2200D Claim Level Service Date with the current date or the same date as status is issued.
The main identifier a provider should use for tracking or matching a 277CA status with the specific 837 claim data is the value returned in the 2200D Claim Status Tracking Number TRN Segment. The TRN value in the 277CA must be the same value as submitted in the CLM01 of the 837.
This work-around for predetermination of benefits claims can be documented in your EDI Companion Guide.

DOCUMENT ID
005010X214