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Back  RFI # 1501: balance multi 837P SVD loops

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Submitter

Troy Brazier

Description

Clarifiation on balancing multiple SVD loops in an 837P claim. Our compliance checker states that the CAS segment in each svd loop must balance to the amount in the sv102 value. Our business thinks the sum of the cas segments in all the SVD loops should add up to the SV102 amount.
ex 1 our interpretation
SV1*HC:A7005:NU*91.73*UN*2***1~
DTP*472*D8*20111101~
REF*6R*12345678TNPR123456~
NM1*DK*1*NLAST*NFIRST*M***XX*123456789~
N3*4616 N 51ST AVE~
N4*PHOENIX*AZ*85031~
SVD*19003*25.87*HC:A7005:NU**1*1~
CAS*CO*45*13.52~
CAS*PR*2*6.47~
DTP*573*D8*20101222~
SVD*19003*10*HC:A7005:NU**1*1~
CAS*CO*150*35.87~
DTP*573*D8*20101222~


example two compliance checker
SV1*HC:A7005:NU*91.73*UN*2***1~
DTP*472*D8*20111101~
REF*6R*12345678TNPR123456~
NM1*DK*1*NLAST*NFIRST*M***XX*123456789~
N3*4616 N 51ST AVE~
N4*PHOENIX*AZ*85031~
SVD*19003*25.87*HC:A7005:NU**1*1~
CAS*CO*45*13.52~
CAS*PR*2*52.34~
DTP*573*D8*20101222~
SVD*19003*10*HC:A7005:NU**1*1~
CAS*CO*150*81.73~
DTP*573*D8*20101222~

Submitter Assigned Keywords

svd balance

Response

Example 1 in the RFI request is the correct way to submit a secondary claim when the primary payer split a service line. There must be one Line Adjudication Information 2430 loop for each split line as adjudicated by the previous payer. The sum of the split line SVD02 payment amounts plus all CAS adjustment amounts in both 2430 loops must add up to the original charge for the line, which would be in the SV102.

In terms of the example in the RFI, the SV1 and applicable 2430 segments would appear as follows:

SV1*HC:A7005:NU*91.73*UN*2***1~

SVD*19003*25.87*HC:A7005:NU**1*1~

CAS*CO*45*13.52~

CAS*PR*2*6.47~

SVD*19003*10*HC:A7005:NU**1*1~

CAS*CO*150*35.87~

The requestor's compliance checker may be confused due to section 1.4.4.2 in the 837 Implementation Guide that explains balancing for service lines. That section does not address the situation where a line is split or unbundled; although, there is a valid example showing the coding of unbundled lines in section 1.4.1.4. The effect of split and unbundled lines will be added to the balancing section in the next version of the guide.
Submission 1/24/2012
Status Date 6/7/2012
Status F - Final
Primary References
Document 005010X222
Section1.4.4.2
Page35
Set ID837p
Table2
Loop2430
Segment Position5450
Segment IDcas
Element Position03
Component Position1
Industry Namemonetary amount