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Back  RFI # 2163: 835 - SVC05 vs 837 SVD05

Formal vs. Informal Help Informal Formal

Submitter

Betty Westbrook

Description

The SVC05 “Units of Service Paid Count/Quantity” in the 835 guide state “If not present, the value is assumed to be one.” however, the 837 guide for the SVD05 “Paid Service Unit Count/Quantity” indicate “When paid units are not present on the remittance advice, use the original billed units.”

The discrepancy between these guides have caused confusion and interpretation differences within the industry in correlation with compliant transactions. Can X12 define the proper use of each of these data segments in correlation to one another when the original billed units are greater than one? For example if the 835 SVC05 is blank, is it most appropriate to use the original billed units on the 837 SVD05 or revert to the assumption of 1?

Response

The 837 guide is intended to operate with both the 835 and a paper remittance advice. When the remittance information is sent in an 835, the paid units of service are always known, as a default has been included for SVC05 in guide 005010X221A1. When the related 835 SVC05 is empty, the SVD05 in the next 837 would contain "1".

The instruction in the 837, therefore, only applies when the previous payer supplied the provider with a non-835 remittance advice that did not include a paid units of service count.
Submission 7/12/2016
Status Date 8/25/2016
Status F - Final
Primary References
Document 005010X223
Section2.4
Secondary References
RFI ID 2639
Document 005010X221
Section2.4