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Back  RFI # 1464: 837P/837I- SV101-7 Description

Formal vs. Informal Help Informal Formal

Submitter

Gloria Davis

Description

There seems to be some confusion of when the SV101-7 is required to be sent on a service. I am finding that payers are requiring both the SV101-7 and the NDC in the 2410 LIN/CTP. I would expect that the first part of the situational rule in the SV101-7 addresses this but I have gotten response back from a payer that they are using the second part of the situational rule to require the SV101-7. This seems to me as unneeded information since the NDC gives the information of what service is for. Can you please confirm that if an NDC is sent in the 2410 LIN/CTP that the SV101-7 should not be sent?

Submitter Assigned Keywords

SV101-7, Description, Not Otherwise Classified, NOC

Response

This is explicitly addressed in version 005010X222A1 and 005010X223A2 of the 837 professional and institutional TR3, the second part of the situational rule is satisfied when using a non-specific procedure code by sending SV101-7/SV202-7. The presence of the NDC code in the 2410 loop has no bearing on the usage requirements for SV101-7/SV202-7.

Recommendation

RECOMMENDATION - When a non-specific drug procedure code is billed in SV101-2/SV202-2 and the NDC is provided in loop 2410, the NDC code or a description must be submitted in the SV101-7/SV202-7.
Submission 12/6/2011
Status Date 2/27/2012
Status F - Final
Primary References
Document 005010X222
Section2.4
Page354
Table2
LoopSV1
Segment Position01-7
Segment ID352
Industry NameDescription
Secondary References
RFI ID 1922
Document 005010X223
Section2
Page429
Set ID837I
Table2
Loop2400
Segment Position3750
Segment IDSV2
Element Position01
Component Position07
Industry NameProcedure Description