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Back  RFI # 931: 2400 LOOP SV107 - 2 - 4010

Formal vs. Informal Help Informal Formal

Submitter

Denise Page

Description

We are now sending our providers a "WARNING" on the Health Care Diagnosis Code value could not be verified because of missing pointers. Value of sub-element HI05-02 cannot be verified because there were no pointers to this code.

One of our providers is telling us that the interpretation of the guides say these segments are situational and they do not have to point all of their dx code to a service line.

Our interpretation is that if they send more than one dx code, they have to point them to a service line.

SV107-2, SV107-3, SV107-4

I would like to get your interpretaions as to the requirements of these segment and elements.

Denise Page
888-224-3341 option #3
Blue Cross of Idaho Clearinghouse

Submitter Assigned Keywords

Diagnosis Code Pointer

Response

There is no 837 implementation guide requirement that every diagnosis code in the 2300 HI Diagnosis Code segment must be "pointed to" by a service line Diagnosis Code Pointer (SV107). In terms of the implementation guide, there can be reported diagnosis codes that do not relate to any of the services reported in the claim.
Submission 12/24/2009
Status Date 2/26/2010
Status F - Final
Primary References
Document 004010X098a1
Section837
Page405
Set IDSV107
Loop2400
Segment PositionSV107