Fields in question: 2100 DTM02 Claim Date and 2110 DTM02 Service Date A provider submits a paper claim but does not include the date. The provider also enrolled to receive the 835 rather than an RA. The MMIS keys the claim and places a default date in the date of service (CCYYMMDD) field (i.e. 00010507 or 99990507). The claim is denied in adjudication. Upon the xml being generated this service date (eg. 00010507 or 99990507) is populated in the date field. The xml fails translation/compliance check due to the invalid date keyed by MMIS. NOTE: MMIS does not have a preprocessor. 1. Can an invalid date be keyed when a paper claim has no service date but the provider elects the 835? 2. What recommendations from X12 should be followed when a provider submits a paper claim without a date but elects to receive an 835? 3. Can a default service date be used on any inbound or outbound X12 transaction?
We cannot answer questions 1, 2 or the first half of number 3 as those are system limitations that are beyond X12Ns control and would have to be decided by the management of the company and their business procedures for maintaining compliance.
The preferred recommendation would be to return paper claims when there is incomplete or invalid claims data. However, recognizing that all payers may not be able to accommodate this practice, it is the opinion of the 835 work group that when the date of service is missing and the payer brings the claim into their adjudication system, that 19000101 be returned. The recommended default in 5010 for pre-determinations is to return 19000101 as the date of service.