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Back  RFI # 958: 835 SVC07 for split lines

Formal vs. Informal Help Informal Formal

Submitter

Talitha Pettepher

Description

REFER TO HIR #623 and P. 44 of the X221 TR3 for 835 transaction.

The examples given in the TR3 and the recommendation on HIR 623 show no SVC07 (original units) when a line is split for adjucation and payment for the original line is for partial units.

Are we correct in not reporting SVC07 when the sum of the paid units on all split lines equal the originally submitted units on the original line? We will report LQ*HE*N123.

If the sum of the paid units on the split lines is different from the originally submitted units, then should the originally submitted units be placed in SVC07 on all reported split lines associated with the originally submitted line?

Submitter Assigned Keywords

835 SVC07 Split Lines

Response

This issue is explicitly addressed in guide 005010X221. Section 1.10.2.14.1 states "Sum of split lines' units of service must equal the original submitted units of service with each split line."

Therefore, for each separate split service line, SVC05 identifies the paid units and SVC07 must identify the submitted units THAT WERE SPLIT INTO THAT LINE when different than the paid units for that line. When SVC07 is not present, its value is defaulted to the value in SVC05. The requirement for the presence of SVC07 is specific to the adjudicated service line and not the original service line.

The sum of all of the split lines (SVC07's that are present and default values for when SVC07 is absent) must equal the original submitted units of service.
Submission 2/4/2010
Status Date 2/24/2010
Status F - Final
Primary References
Document 005010X221
Section1.10.2
Page44
Set ID835
Loop2110
Segment IDSVC
Element Position07
Industry NameSubmitted Units