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Back  RFI # 524: Use of the 2430 SVD segment

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Submitter

chuck wilhelm

Description

The 2430 loop is used when applying adjustments to the line level. We have encountered a situation where ALL adjustments were made at the claim level on an inpatient institutional claim but the 837 secondary claims contained 2430 SVD segments containing only the billed amount and reflecting a payer paid amount equal to the full billed amount. When the calculation is done for balancing, the claim level paid amount does not balance with the line level paid amounts reported. The explanation we received was that we should ignore the line level information and use the claim level. We believe that sending the SVD is misleading in this scenario and request an interpretation from the workgroup as to the use of the 2430 loop

Response

The 2430 loop is not required when there are no line level adjustments, and the developers recommend that it not be sent. However, there is not a restriction in the implementation guide that states the loop can not be sent. Sending the loop with no adjustments will not cause a problem for balancing calculations. The calculation should be that for a given prior payer, the sum of all line level payment amounts (Loop ID-2430 SVD02) less any claim level adjustment amounts (Loop ID-2320 CAS adjustments) must balance to the claim level payment amount (Loop ID-2320 AMT02).
Submission 2/26/2007
Status Date 5/7/2007
Status F - Final
Primary References
Document 0040X096A1
Section3.1
Page479
Set ID837
Loop2430
Segment IDSVD
Industry NameService Line Adjudication Information