Change Request Detail
No.
843
Date
9/25/2003
Submitter
Type of Request
Payment of a Health Care Claim
Status
DSMO Process Completed
Business Reason
The insured date of birth as a required field should be situational. This information is not always known by the patient, especially during emergency situations. There is no easy mechanism to obtain this information (for example - on the insurance card, etc.) Bills are rejected or delayed if this information is required, therefore holding up payment.
Suggestion
Make subscriber birthdate situational. Pages 115 and 388. Segment: DMG02.
DSMO Category
B
Recommendation
Approved.  A future version of all three claim guides will change the usage note for the Subscriber Demographic Information segment (Loop ID-2000B) to "Required when the patient is the same person as the subscriber;  if not required, then may be sent at the submitter's discretion."
The usage notes for the Other Insured Demographic Segment (Loop ID-2320) will be changed to the following: "Required when the Entity Type Qualifier in the Other Subscriber Name segment (Loop ID-2330A) has a value of '1' (Person) and the information is available.  If not required, then do not send."
Appeal Recommendation