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Back  RFI # 386: Units of Service in 4010A1 835

Formal vs. Informal Help Informal Formal

Submitter

Krupla David

Description

I have an issue I am researching concerning units of service in the 835 ERA file.

A claim was submitted with 32 units of service. The claim was denied for payment. The remit file contains a 0 for SVC05 (Units of Service Paid Count) and a 32 for SVC07 (Original Units of Service Count). The SVC05 entry in the IG says that 0 is assumed to be a 1, making it read that we denied 1 unit for payment. Our paper remit does not show the SVC07 value, nor does the Medicare Remit Easy Print, so the provider is left with something that makes it look like 1 unit of service was submitted.

My interpretation of the SVC05 is that it was intended to be "processed" units, more than "paid" units. If I am correct, then we would return a denied claim for 32 billed units as having had 32 units denied (SVC05 = 32).

Is my interpretation correct?

Thanks for your assistance,

David J Krupla
Region B DMERC EDI Helpdesk Analyst
1-317-595-4906

Submitter Assigned Keywords

Units of Service in 4010A1 835

Response

This issue is explicitly addressed in guide 004010X091. The note for SVC05 states "Use this number for the paid units of service. If not present, the value is assumed to be one." If SVC05 contains no value, the default is 1. If SVC05 contains a "0", then the paid units is zero. SVC05 is NOT the processed units. The contents reported in your example are correct for the business identified. Zero units were paid (SVC05) and 32 units were submitted (SVC07).

Denied units would be reported in the service level CAS segment in the appropriate Adjustment Quantity (i.e. CAS04). The CAS04 note reads "This element may be used only when the units of service are being adjusted. A positive number decreases paid units, and a negative value increases paid units."
Submission 2/14/2006
Status Date 3/1/2006
Status F - Final
Primary References
Document 004010X091
Section3
Page142
Set ID?
Loop2110
Segment IDSVC
Element Position05
Industry NameQuantity