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Back  RFI # 1279: 835 SVC05/07 usage for IP

Formal vs. Informal Help Informal Formal

Submitter

Jan Klimper

Description

If an adjudication system returns service level detail for inpatient claims, can the SVC05 = the number of covered/paid days and SVC07 = the original number of days billed?

Submitter Assigned Keywords

SVC 835 Inpatient Covered Non-Covered

Response

See Section 1.10.2.4.1 for guidance. Generally, service lines are not provided on inpatient claims. If the adjustment is NOT service line specific, then the claim level instructions provide the direction. If the adjustment IS service specific, then the service level is where the adjustment belongs. Non-covered days should be reported at the claim level with CARC 78 in the CAS02, and the number of non-covered days in CAS04.
Submission 3/22/2011
Status Date 6/9/2011
Status F - Final
Primary References
Document 005010X221
Section2110 Svc
Page186
Set IDSVC