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Back  RFI # 305: Claim Level Purch. Serv. Prov

Formal vs. Informal Help Informal Formal

Submitter

Kelly Butler

Description

Was it the intent of the 837 workgroup that the Purchased Service Provider when submitted at the claim level apply to the entire claim services billed on that claim, or was it the intent that when submitted at the claim level the Purchased Service Provider applies to all the related purchased service "lines" within that claim? The reason why I ask is because note 1 has the standard verbiage used throughout the guide that the claim level applies to the entire claim except when overridden at the line level, but often providers bill for office visit charges as well as lab charges or other purchased services on the same claim. The purchased service provider would not apply to the office visit charge, only the other services that were purchased. Also NSF 2.0 only allows the purchased service provider at the line level, so when creating a 4010 file from this format it is impossible to move the information to the claim level if note 1 means it applies to the entire claim.

Response

Note 3 on the 2310C NM1 further qualifies Note 1. The effect is that the Purchased Service Provider is being reported because there are purchased services on the claim. This does not mean that all services on the claim were purchased. The service line 2420B Purchased Service Provider would be used when there is more than one Purchased Service entity involved in this claim. Payers who need to know specifically which service lines were purchased would require the 2400 PS1 Purchased Service Information segment in their companion guide. Usage of the PS1 is payer-specific; that is, when needed by the payer for processing.
Submission 8/12/2005
Status Date 11/1/2005
Status F - Final
Primary References
Document 004010X098A1
SectionDetail
Page283
Set ID0
Table2
Loop2310C