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Back  RFI # 1814: Multiple SVD loops

Formal vs. Informal Help Informal Formal

Submitter

Medina Gema

Description

We have two translators, one accepts the sceanrio that follows one rejects it. When adding all payments and adjustments in the multiple iterations it balances back to the SV102. When a service line is split shouldn't the SVD06 be populated to point back in the LX it corresponds to? Is this service line compliant?
LX*1~
SV1*HC:95004*500*UN*50***1~
DTP*472*D8*20130423~
REF*6R*ZZZZZ01OK9~
SVD*04402*243.04*HC:95004:::::**50~
DTP*573*D8*20130611~
SVD*04402*0*HC:95004:::::**50~
CAS*CO*45*190~
DTP*573*D8*20130611~
SVD*04402*0*HC:95004:::::**50~
CAS*CO*223*4.96~
DTP*573*D8*20130611~
SVD*04402*0*HC:95004:::::**50~
CAS*PR*2*62~
DTP*573*D8*20130611~
AMT*EAF*66.96~

Response

The SVD06 Situational Rule states "Required when payer bundled this service line. If not required by this implementation guide, do not send." The SVD06 must not be sent when a service line is split. Your example of splitting a service line does not make business sense. The split lines in your example all show 50 units, the same as the original line.

Recommendation

The SVD05 in the 837 was designed to function as the SVC05 does in the 835. However, there is no requirement in the 837 to do so.

The 835 in section 1.10.2.14.1 states:

Line Splitting:

A submitted service line would be split into multiple lines.

Adjudicated Procedure code may or may not be the same as the submitted procedure code across split service lines in the SVC Segment.

The sum of the split line units must equal the total submitted units from the original service line.

Your example does not appear to support a split claim. The following is an example of what we think the example is showing:

LX*1~
SV1*HC:95004*500*UN*50***1~
DTP*472*D8*20130423~
REF*6R*ZZZZZ01OK9~
SVD*04402*243.04*HC:95004**50~
CAS*CO*45*190**223*4.96~
CAS*PR*2*62~
DTP*573*D8*20130611~
AMT*EAF*66.96~
Submission 6/21/2013
Status Date 8/1/2013
Status F - Final
Primary References
Document 005010x222A1
Section1.4.1.4