RFI Browser

Back  RFI # 2278: Bundled zero-charge service

Formal vs. Informal Help Informal Formal

Submitter

Cindy Monarch

Description

We would appreciate validation of 835 Service Payment information that should reported for a bundled service line with a zero-charge amount. An example follows below; please note the in this example the 2nd and the 3rd (zero-charge amount) service lines are bundled to the 1st service, and the 1st service is approved to pay at $100.

SVC*HC:80050*290.55*100**1~
DTM*472*20180313~
CAS*OA*94*-206~
CAS*CO*45*396.55~
REF*6R*EX001~
AMT*B6*100~
SVC*HC:80050*206*0**1*HC:84453~
DTM*472*20180313~
CAS*CO*97*206~
REF*6R*EX002~
SVC*HC:80050*0*0**1*HC:85025~
DTM*472*20180313~
REF*6R*EX003~

The 3rd service line (zero-charge) is considered payable (bundled) so it must be reported on the 835; a CAS segment with CARC*97 for the 3rd service line is not required (2110 CAS situational rules are not being met); and the zero-charge service line should reflect the adjudicated service in SVC01-2 and the submitted service in SVC06-2.

Please let us know if our interpretation is correct. Thank you.

Submitter Assigned Keywords

835 bundled zero charge service

Response

Your example is correct except for the units in the bundled service lines. Service lines 2 and 3 should reflect 0 units in SVC05, and 1 unit in SVC07. In addition, CAS04 for service line 2 should include the units as well.

The situational note for the CAS segment explicitly states, “Required when dollar amounts are being adjusted specific to the service or when the paid amount for a service line (SVC03) is different than the original submitted charge amount for the service (SVC02). If not required by this implementation guide, do not send.” Since there is no adjustment and SVC03 and SVC02 are the same, a CAS segment can’t be sent.

Then for the procedure codes, section 1.10.2.6 explicitly states “Report all procedures as paying on the changed (bundled) procedure code, and reference the original submitted code in SVC06.” This is also correctly reflected in your examples.
Submission 3/22/2018
Status Date 7/6/2018
Status F - Final
Primary References
Document 005010X221
Section1.10.2.6
Set ID835
Loop2110
Segment Position0900
Segment IDCAS