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Back  RFI # 2269: 837P Multiple Place of Service

Formal vs. Informal Help Informal Formal

Submitter

Kathy Brandsen

Description

Is it proper use to use multiple POS to determine the reason for a bed hold day in Assisted Living billing?

Example, a Medicaid payer is requiring 2 different POS (12 - Home/Therapeutic and 31 - Hospital) in determining the reason for a bed hold while the resident is not at the facility overnight. The hospital and home POS have different addresses than what the billing provider (Assisted Living Facility) has which means a Service Facility Location is required [Situational Rule: Required when the location of health care service is different than that
carried in Loop ID-2010AA (Billing Provider)].

How is this entered in the Service Facility loop when there can be 3 different POS on the claim?

Submitter Assigned Keywords

837p Multiple POS Place of Service

Response

The 837 professional TR3 (005010X222A1) provides for exactly one Place of Service Code per service line. This code is reported in SV105 (or CLM05-1 if SV105 is not present). The Place of Service Code identifies where the services were, or may be, performed.

Although there is only one Place of Service Code, there are multiple addresses that can be reported. The Billing Provider Address is required in loop 2010AA. The Patient Address is required in loop 2010CA (or 2010BA if loop 2000C is not present). If the Service Facility Location Address is different than the Billing Provider Address, the Service Facility Location Address must also be reported in loop 2420C (or 2310C if 2420C is not present).

Each claim service line accommodates one Place of Service Code and one Facility Service Facility Location. The service location is only sent at the service line when the location where services were rendered is different from the location of the billing provider or the service location reported at the claim level.

Recommendation

Please verify with your Medicaid payer that the professional format is appropriate for billing bed hold days at an Assisted Living Facility. We expect the institutional format to be used for this type of bill.
Submission 2/12/2018
Status Date 4/6/2018
Status F - Final
Primary References
Document 005010X222A1
Section2.4
Page351
Set ID837P
Loop2400
Segment Position3700
Segment IDSV1
Element Position05
Industry NameFacility Code Value
Secondary References
RFI ID 2752
Document 005010X222A1
Section2.4