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Back  RFI # 1551: Unbundled Services, Balancing

Formal vs. Informal Help Informal Formal

Submitter

Rachelle Caldwell

Description

When a Service is unbundled, the guide shows that each unbundled service line reflects its own SVD and CAS segments. It also shows that all of the SVD segments and CAS segments associated with the unbundled services by payer A, add up to the total charges refelected in SV102.

The guide also states "Line level balancing occurs independently for each individual Line Adjudication Information loop. In order to balance, the sum of the line level adjustment amounts and line level payments in each Line Adjudication Information loop must balance to the provider’s charge for that line (Loop ID-2400 SV102)". This means that each SVD loop must balance to the value in the SV102.

Please clarify how balancing should be enforced when a service is unbundled to the line item charge amount.

Submitter Assigned Keywords

Balancing unbundled services 2430 loop

Response

The Service Line balancing description in 1.4.4.2 does not apply to unbundled lines; however, a correct description of reporting unbundled lines on a COB 837 is included in section 1.4.1.4 under "Unbundling with COB". The balancing section 1.4.4.2 will be expanded to include unbundled lines in the next version of the TR3. To balance unbundled lines, the payment (SVD02) and adjustment amounts from CAS segments on all of the adjudicated unbundled lines must be added together to balance to the service line charge amount SV102. That is, the unbundled SVD loops must be added together to balance to the SV102.
Submission 3/28/2012
Status Date 5/24/2012
Status F - Final
Primary References
Document 005010X222
Section1.4.1.4
Page25
Set ID837P
Loop 2340