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Back  RFI # 1555: Line Level Balancing

Formal vs. Informal Help Informal Formal

Submitter

Varun Devrani

Description

Need clarification on Line level balancing for Unbundle scenario for 837P claims.
As per IG section 1.4.4.2, each 2430 line adjudication loop should balance with charge for that line in SV102.
As per example for unbunlde provided in section 1.4.1.4 page 25/26, this blancing rule doesn't hold true. In example it shows that multiple SVD loop (from same SVD01 - Payer ID code) should be use together to balance to line charge.

Becuase of this we have disconnect between two systems. We are receiving information like mentioned in section 1.4.1.4 and it is rejecting as system that accept is designed based on 1.4.4.2.

Example for disconnect as received from external providers. (This is as per section 1.4.1.4 from IG.

SV1*HC:A4450:KX:AU*2.4*UN*20***1
SVD*16003*.72*HC:A4450:AU:KX**10*1
CAS*CO*45*.3
CAS*PR*2*.18
DTP*573*D8*20120321
SVD*16003*0*HC:A4450:AU:KX**10*1
CAS*CO*50*1.2
DTP*573*D8*20120321

Response

There must be one Line Adjudication Information 2430 loop for each unbundled line as adjudicated by the previous payer. The sum of the unbundled 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.

Section 1.4.4.2 in the 837 Implementation Guide 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 3/30/2012
Status Date 5/24/2012
Status F - Final
Primary References
Document 005010X222
Section1.4.1.4