RFI Browser

Back  RFI # 1157: 835 SVC07 to 3 Decimals

Formal vs. Informal Help Informal Formal

Submitter

David Bennett

Description

This may seem like a frivolous question, but with 5010 possibly being held to more scrutiny as far as compliance, I would like the guide authors to weigh in:
Both the 837 and the 835 allow for units to carry up to 3 numbers to the right of the decimal. IF a provider were to send in a unit count of 1.755, and the payer's system truncates or rounds because their database only stores 2 positions to the right, would the fact that the adjudicated units were 1.75 or 1.76 as opposed to 1.755 require that SVC07 be returned with the original value?
IF SVC07 were required because the adjudicated amount actually was different from the original and the original came in with 3 positions to the right and the payer's system only handles 2 positions, could this be a compliance issue since the payer can only send back the original quantity truncated or rounded to 2 positions.

Submitter Assigned Keywords

SVC07

Response

This issue is explicitly addressed in guide 005010X221. The note on SVC07 states "Required when the paid units of service provided in SVC05 is different from the submitted units of service from the original claim. If not required by this implementation guide, do not send." There is no qualification as to the degree of difference between the paid units in SVC05 and the submitted units from the original claim.

Therefore, even if the reason for the difference is rounding, if the paid units is not the same as the submitted units SVC07 must be populated with the submitted units.
Submission 9/23/2010
Status Date 10/11/2010
Status F - Final
Primary References
Document 005010X221
Section2.4
Pageunkn
Set ID835
Table2
Loop2110
Segment Position0700
Segment IDSVC
Element Position07
Industry NameOriginal Units of Service Count
Secondary References
RFI ID 1064
Document 005010X222
Section2.4
Pageunk
Set ID837
Table2
Loop2400
Segment Position3700
Segment IDSV1
Element Position04
Industry NameService Unit Count