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Back  RFI # 1507: COB Split Claim Line in 837

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Submitter

Dora Lambert

Description

When constructing an 837 that is to be sent to a secondary payer, what should the 2430 loop look like when the claim was split into two lines by the primary payer, as per the claim splitting instructions in the 835?

Submitter Assigned Keywords

COB Split Claim Line

Response

When a service line is split and adjudicated as two lines by the primary payer, the service line on a subsequent 837 going to a secondary payer must have two Line Adjustment Information 2430 loops. There must be one 2430 loop for each split line as adjudicated by the previous payer.

For example, if the original claim had one line with a charge of $400 for 4 units, and the primary payer split to process with one unit paid on the first line and three units paid on the second line, and contractual obligation adjustments of $20 and $40, the 835 would appear as follows:

CLP*3CL*1*400*340**12*123456789~

SVC*HC:A*100*80**1~

CAS*CO*45*20~

SVC*HC:A*300*260**3~

CAS*CO*45*40~

The 837 to the secondary payer would have one service line, with a SV1 showing the original charge of $400 and 4 units. There would be two 2430 loops, one for each line as split by the primary payer. The 2430 loops would appear as follows:

SVD*payerid*80*HC:A**1~

CAS*CO*45*20~

SVD*payerid*260*HC:A**3~

CAS*CO*45*40~

Note that the sum of the split line SVD02 payment amounts ($80 + $260) plus the CAS adjustment amounts ($20 + $40) adds up to the original charge for the line ($400), which would be in the SV102.
Submission 1/27/2012
Status Date 5/24/2012
Status F - Final
Primary References
Document 005010X222
Section2.3.1
Page480
Set ID837
Table2
Loop2430
Industry NameLine Adjudication Information