Since the 2200D DTP03 field (Response Due Date) is a required field, what date should be put in this field if a member's health plan is covered by a state mandate wherein a date is not required? See https://www.tdi.texas.gov/hprovider/ppsb418faq.html under "Requests For Additional information" :
Q: If a carrier requests additional information from the treating provider, and the treating provider never sends the information, what happens to the claim?
A: When a carrier requests additional information from the treating physician or provider, the payment deadline stops. Until the carrier receives the information requested or a response that the physician or provider does not have the requested information, the claim may remain in a pended status.
A fully insured Commercial member in Texas has a claim go into a pend status due to missing information (e.g., an op report) needed to complete adjudication. A 277RFAI is generated to be sent to the provider requesting this information, but because of the state mandate, there is no time frame for a reply and the claim could remain in a pend status indefinitely. Therefore, what date should be sent in 2200D DTP03 since it is a required field?
The TR3 note for Loop ID 2200D DTP – Response Due Date segment of the Health Care Claim Request for Additional Information (277) implementation guide states “Should this date pass without the requested information being supplied by the Information Receiver, the payer may decide to allow the claim to proceed through the adjudication process based upon the information already received.” This statement supports it is the payer’s decision regarding what will occur (i.e., claim will process or continue to pend) should the requested information not be received by the defined Response Due Date. It is also the payer’s decision regarding what date to report as the Response Due Date in DTP03. Both of these fall outside of the purview of X12. The payer should ensure the date identified is a valid date expressed in the defined format of CCYYMMDD (as per the DTP02 Date Time Period Format Qualifier of ‘D8’) and not an invalid default date (e.g., 99991231).A fully insured Commercial member in Texas has a claim go into a pend status due to missing information (e.g., an op report) needed to complete adjudication. A 277RFAI is generated to be sent to the provider requesting this information, but because of the state mandate, there is no time frame for a reply and the claim could remain in a pend status indefinitely. Therefore, what date should be sent in 2200D DTP03 since it is a required field?
It is recommended the payer utilize a companion guide to assist with providers’ understanding regarding the Response Due Date reported in Loop ID 2200D DTP03. Additionally, If this is functionality that is needed for your business and not currently supported in a published TR3, please submit an X12 maintenance request at https://x12.org/resources/forms/maintenance-requests.