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Back  RFI # 554: 835 SVC01, 04, and 06

Formal vs. Informal Help Informal Formal

Submitter

Jennifer McMullin

Description

Consider the following scenario. An 837 is submitted with both a procedure code and a revenue code on a single service line. The claim is adjudicated and pays off of the revenue code, not the prodedure code. In this scenario, how should the SVC in the 835 be populated? SV101 = Revenue Code and SV04 = Blank OR SV101 = Procedure Code and SV04 = Revenue Code. Again, the key thing to remember is that the claim paid off of the revenue code, not the procedure code.

Submitter Assigned Keywords

835 SVC

Response

DRAFT - SVC04 is only required when an NUBC revenue code was considered during adjudication IN ADDITION to a procedure code already identified in SVC01. Since only the Revenue Code was considered in the adjudication of the service, SVC01 would contain the Revenue Code and SVC04 would not
be used.
SVC06 is not required in this scenario since the submitted codes were not change during adjudication.
Submission 5/2/2007
Status Date 7/2/2007
Status F - Final
Primary References
Document 004010X091A1
SectionLOOP2110
Page140
Set ID835
Table2
Loop2110
Segment Position070
Segment IDSVC