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Back  RFI # 611: SVC Segment

Formal vs. Informal Help Informal Formal


Jennifer McMullin


An 837 is submitted with both a procedure code and a revenue code on a single service line. The health plan has negotiated a contract with the provider that allows them to manually enter an NDC code once the claim has been loaded in the system. The claim is adjudicated and pays off of the NDC code, not the revenue code or procedure code that was submitted. In this scenario, how should the SVC in the 835 be populated? SV101 = NDC Code and SV06 = Blank? The NDC code was added, not corrected so our assumption is that SVC06 would be blank.

Submitter Assigned Keywords



This issue is explicitly addressed in guide 004010X091. SVC01 contains the "adjudicated Medical Procedure Code.” For the scenario described, SVC01 contains the NDC code, SVC04 contains the Revenue Code (if considered during adjudication) and SVC06 contains the procedure code.
Submission 10/31/2007
Status Date 11/2/2007
Status F - Final
Primary References
Document 004010X091A1
Set ID835