Section title: Requests for Interpretation
RFI #
2358
Clarification on 275
Description

The 2100A DTP Situational Rule in the 275 (5010) states: "Required when the date of service is not reported at the claim level. If not required by this implementation guide, do not send."

In the 275 TR3, there does not seem to be a "claim level" outlined. Is the "claim level" being referenced on the 2100A DTP situational rule the 1000D Patient Name Loop DTP? Or is this truly referencing the claim date of service on the 837? If the former, the TR3 should be corrected in a future version to accurately refer to the "patient name loop" DTP and remove the term "claim level"; if the latter then it should refer specifically to the claim transaction's DTPs

Response

The claim level date is the DTP found in loop-ID 1000D.  The name of that segment is Claim Service Date.  The situational rule at loop-ID 2100A DTP is referring to that date, not a date in the 837.

RFI Recommendation

In subsequent versions of the guide, the 2100A DTP Situational Rule has been updated to reference the claim level date as Loop 1000D.

DOCUMENT ID
005010X210