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Back  RFI # 1950: SVC /835 Required always?

Formal vs. Informal Help Informal Formal

Submitter

Barber Meg

Description

-835 there are two references when SVC is required and contradict
-Page 14 "Although the service payment information is optional, it is REQUIRED for all professional claims or anytime payment adjustments are related to specific line items from the original submitted claim
-Page 186:"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 "
-Page 14 says professional always is requried and Page 186 says required when priced at svs line level. what is correct?
-In some cases I am advised COB (med prime we are secondary) is priced at a 'claim level'
-For Dental, outpatient and Institutional - if we price at a 'claim level' we dont need to send the line 835SVC's /837 lines received? -Can it just be clealy out lined when for each Dental, Outpatient, professional and Inpatient the SVC segment is required?

Submitter Assigned Keywords

835 SVC

Response

Your second citation is from the situational rule of the SVC Service Payment Information segment. This is the governing requirement that defines when to report the SVC segment and the 2110 loop. This situational rule is intended to convey that the SVC is required in the following situations:

(1) all service lines in a professional claim, (2) all service lines in a dental claim, (3) all service lines in an outpatient claim priced at the service line level, and (4) all service lines in a claim whenever payment for any service line of the claim is different than the original submitted charges due to service line specific adjustments.

Your first citation is from §1.10.2.1.1 ‘Service Line Balancing’ in the 005010X221A1 Technical Report Type 3 (TR3). This section defines the balancing requirements for service lines and is not otherwise intended to govern the presence or absence of service level information. However, it does reiterate the requirement for service lines to be reported in professional claims.
Submission 7/15/2014
Status Date 9/10/2014
Status F - Final
Primary References
Document 005010X221
Section2110 SVC
Page186
Set ID835
Loop2110
Segment Position0700
Segment IDSVC
Element Position01
Industry NameService Payment Informaton