For the 005010X212 (276/277) transaction, need clarification as to what date should be returned on the 277 2200D DTP03 Claim Service Date (Claim Level Date) for Institutional claims - hospital admit date or the claim-level service date(s)? See the scenario below for details.
A 276 transaction was submitted with the 2200D DTP populated as follows for an institutional claim:
DTP*472*RD8*20220914-20220930
The corresponding 277 response returned a claim with the 2200D DTP segment as follows:
DTP*472*D8*20220613
Per analysis, 6/13/2022 was actually the hospital admit date. However, the line-level service dates ranged from 9/14/2023 - 9/30/2023, which are the correct dates of service for the claim in question. Should the 277 2200D DTP segment have been returned as follows?
DTP*472*RD8*20220914-20220930
The second TR3 Note for the 2200D DTP Claim Service Date segment of the Health Care Claim Status Response (277) states “When reporting a claim level date, use the date from the Information Source’s system for claim matches, otherwise return the date from the 276 status request.” Based on this and noting date search criteria can vary by payer (refer to Section 1.3.2.1 Real Time Limitations and Batch Limitations), it is possible the date of ‘20220613’ returned in 2200D DTP of the 277 is the date the Information Source uses for claim matches. If so, returning this date in 2200D DTP of the 277 is appropriate. If this is not the date used for claim matches, per the TR3 Note the 2200D DTP Claim Service Date from the 276, as listed above of DTP*472*RD8*20220914-20220930, should be returned in the 277 Response.
Follow-up with the Information Source and confirm if the date returned as the Claim Service Date in 2200D DTP segment of the Health Care Claim Status Response (277) is the date the Information Source uses for claim matches.
Related RFIs: 2178, 1208, 1817