RFI Browser

Back  RFI # 623: Unbundling SVC Segments

Formal vs. Informal Help Informal Formal

Submitter

Jennifer McMullin

Description

Consider the following unbundling scenario:

• Hospital claim is received with one service line
• REV code "A" with 5 units @ $100 charge
• The service line is unbundled such that 2 units pay under the submitted rev code "A" at $20 and the remaining 3 units pay under a new Revenue code "B" at $50

In this scenario, how should the SVC and CAS segments look when reporting originally submitted Rev Code (SVC06) and adjudicated with Rev Code (SVC01) as well as split units?

This is my guess on how we should be outputting these segments. Am I close?

SVC*NU:A*100*20**2**5
SVC*NU:B*0*50**3*NU:A*5
CAS*CO*131*30~

Submitter Assigned Keywords

SVC Unbundling

Response

This issue is not explicitly addressed in guide 004010X091.
The 005010X221 guide contains explicit instructions for unbundling and is structurally complaint with the current guide on this issue.

Recommendation

See section 1.10.2.14.1 (Service Line Splitting) in guide 005010X221 for instructions. That guide's instructions will result in (assuming a contract):

SVC*NU:A*40*20**2~
CAS*CO*45*20~
REF*CE*(line item control # from claim or line item sequence #)~
LQ*HE*N123~
SVC*NU:B*60*50**3*NU:A~
CAS*CO*45*10~
REF*CE*(line item control # from claim or line item sequence #)~
LQ*HE*N123~

Where N123 means "This is a split service and represents a portion of the units from the originally submitted service."
Only directly related segments are shown above.
Submission 1/24/2008
Status Date 3/11/2008
Status F - Final
Primary References
Document 004010X091A1
Section2.2.6
Page25
Set ID835