We currently have a payer that is rejecting 837P professional claim transactions when there is an Admission and Discharge Date present with the Place of Service Code of 31. Unlike the 837I NUBC Data Specifications for the Type of Bill, the 837P NUCC does not offer an Inpatient/Outpatient designation to the Place of Service codes.
In the code source for the Place of Service Codes, CMS defines the Place of Service ‘31’ with the Place of Service name of “Skilled Nursing Facility” and the Place of Service Description of, “A facility which primarily provides inpatient skilled nursing care and related services to patients who require medical, nursing, or rehabilitative services but does not provide the level of care or treatment available in a hospital.”
The 837P, DTP – Date – Admission, Loop 2300 conditions are listed as follows:
“Required on all ambulance claims when the patient was known to be admitted to the hospital.
Required on all claims involving inpatient medical visits.
If not required by this implementation guide, do not send.”
The 837P, DTP – Date Discharge, Loop 2300 conditions are listed as follows:
“Required for inpatient claims when the patient was discharged from the facility and the discharge date is known. If not required by this implementation guide, do not send.”
The lack of designation to the Place of Service Codes for the 837P has caused confusion and interpretation differences within the industry in correlation with compliant transactions. In the scenario as described should the Admission and Discharge date be allowed to be present on the 837P transaction without rejection?
Designation of Inpatient is not defined in the transaction, so it is outside of X12’s purview.