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Back  RFI # 1758: 835 claim level adjustment

Formal vs. Informal Help Informal Formal

Submitter

Jeanne Kirkpatrick

Description

The 5010 835 TR3 mentions for Loop 2100 SVC, that it is 'Required for all service lines in a professional, dental or outpatient claim priced at the service line level or whenever payment for any service line of the claim is different than the original submitted charges due to service line specific adjustments (excluding cases where the only service specific adjustment is for room per diem). And in the Notes it states: 'The exception to the situational rule occurs with institutional claims when the room per diem is the only service line adjustment. In this instance, a claim level CAS adjustment to the per diem is appropriate (i.e., CAS*CO*78*25~).'

So my question is, for institutional claims, can the exception to the rule also apply to DRG claims, to allow for a claim level adjustment and not return each service line?

Submitter Assigned Keywords

835 DRG adjustments

Response

RFI 1608 indicates that "if there are no service specific adjustments on an institutional inpatient claim, excluding room per diem, and the claim is not paid in full, then sending the 2110 loop is inconsistent with the implementation guide." RFI 1230 indicates, "The DRG would be reported at the claim level (when applicable)." Therefore, it is valid to adjust the DRG at the claim level. See section 1.10.2.4.1 of the guide for additional information.
Submission 2/27/2013
Status Date 4/25/2013
Status F - Final
Primary References
Document 005010X221
Section1.10.2.6
Loop2110
Segment PositionSVC
Secondary References
RFI ID 2228
Document 005010X221
Section1.10.2.4