Section title: Requests for Interpretation
Service Date - 6020 275 X314 - Additional Information to Support a Health Care Claim or Encounter

The 6020 X314  requires either the Service Date at the 1000D or the 2100A Loop depending on situational rule. However for Dental Predeterminations, there is not a Service Date. What date is supposed to be entered in this case when there isn't a true service date? The 5010 Dental 837 doesn't require a Service Date for Predeterminations.

Clarification:  The Dental pre-determination claim (837) doesn’t require a service date because the service date isn’t known but if supporting documentation is needed to determine if the pre-determination will be covered, a service date is required on the Claim Attachment (275). What service date should be entered the attachment (x314) since one is required yet not known.

RFI Response

The 006020X314 guide's situational rules does require a service date to be sent either at the claim or service line level.

However, this business need was identified and has been updated in the next versions of the guide, 007030X341 and 008010X341.  The Situational rule in the 2100A DTP segment, Service line Service Date states “Required when the date of service is not reported at the claim level (1000D) and service line information is present.  If not required by this implementation guide, do not send.

RFI Recommendation

If willing Trading Partners agree to use the 6020X314 transaction for this business function, they will need to determine appropriate use of the DTP Segment within the guidelines of the TR3.  A similar recommendation is also mentioned in RFI 1516.