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Back  RFI # 1824: 276/277 SVC03 for pend status

Formal vs. Informal Help Informal Formal

Submitter

kena gwinn

Description

When responding at the line level, element SVC03 in Loops 2220D/E is required.

SVC 03 represents the Line Item Payment amount.

When a pending status is being returned at the claim and/or line level does the TR3 state what the required monetary amount to populate in the SVC03 element?

Is it against the current 5010 TR3 requirements to return a paid amount great than zero in the SVC03 when the claim is in a pended status?

Submitter Assigned Keywords

SVC03

Response

The 005010X212 TR3 does not define the required amount for SVC03 (Line Item Payment Amount) as being zero, when the status being reported for the claim and service is Pending. As identified in Section 1.4.4 - Payer's System Status Locations, a payer's response capability for claim status in the a pended location will vary from payer to payer, as well as their determination of when a claim is in a pended versus finalized status. The Claim Payment Amount (2200D/E - STC05) includes a note indicating ‘Some payers are able to provide the adjudicated payment amount prior to the remittance being issued.’ Therefore, the guide does not prohibit a payer from reporting an amount greater than zero in the SVC03 element, when a claim/service has not finalized through a payer’s payment cycle (i.e. a Check or EFT produced), the payer still considers the claim/service to be in a pending state and the payer knows the amount that will be paid on the service line.
Submission 7/5/2013
Status Date 8/5/2013
Status F - Final
Primary References
Document 005010X212
Section2.6
Page160
Set ID277
Loop2220D
Segment Position1800
Segment IDSVC
Element Position03
Industry NameMonetary Amountt