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Back  RFI # 2126: 837 Institutional SV207

Formal vs. Informal Help Informal Formal

Submitter

Cathy Plattner

Description

Our system is defaulting 0 in SV207 if no disallowed amount applicable. Is this acceptable.

This is a section from the 5010 TR3 guide:
SV207 782 Monetary Amount O 1 R 1/18 Monetary amount
SEMANTIC: SV207 is a non-covered service amount.

361 SITUATIONAL RULE: Required if needed to report line specific noncovered charge amount. If not required this implementation guide, do not send.

IMPLEMENTATION NAME: Line Item Denied Charge or Non-Covered Charge Amount.

Submitter Assigned Keywords

SV207

Response

As you note in your request for interpretation description, the 005010X223A2 TR3 explicitly states the SV207 is only required when there is a need to report line specific non-covered charge amounts and if that requirement is not met, the element must not be sent. Therefore, sending a default value of 0 would not be compliant with the TR3.

Recommendation

Please refer to RFI #1461 for guidance on sending redundant or unnecessary data or when the Situational Rule states “If not required by this implementation guide, do not send”.

Please refer to RFI 1512 for guidance on the rejection of transactions that do not fully comply with a TR3.
Submission 2/10/2016
Status Date 4/28/2016
Status F - Final
Primary References
Document 005010X223
SectionTable 2
Page428
Set ID837i
Table2
Loop2400
Segment PositionSV207
Segment IDSV2
Code Value782