I'm also interested in how to populate SV5 in the 837P addendum. We're a
large DME provider, but so far I'm not aware of any payers who are looking
for this segment. In the Draft 837 4050 version, the Situational Note
changes to "Required when necessary to report both the rental and purchase
price info for DME. This is not used for claims where the provider is
reporting only the rental price or only the purchase price" Currently we
only provide the rental or purchase price, so I'm thinking we won't need to
populate the segment until a payer wants both.
Are there any payers out there who are expecting this segment to be
populated?
"Snyder, Caterina"
<Caterina.Snyder@misysheal To: "WEDI SNIP
Transactions Workgroup List"
thcare.com>
<[EMAIL PROTECTED]>
cc:
02/04/2003 05:07 PM Subject: Addenda 837P
questions about NDC and DME
Please respond to "Snyder,
Caterina"
Our organization is in review of the Addenda for professional claims (837P)
from a technical perspective and are trying to get a better handle on the
billing scenarios relating to the below. Any responses from the
payer/provider community would be helpful to be able to better understand
how this will be implemented industry wide. Questions have been posed to
CMS
for guidance relating to Medicare Part B implementation on the below;
However, they cannot comment or provide guidance at this time since the
Addenda has not yet been published in the Federal Register.
DME
Rental and/or Purchase Amounts: Do these represent the price for the
provider or the price that the patient/payer is being billed for the
rental/purchase DME? If it is the amount that the patient/payer is being
billed, can billing scenarios as to how the purchase price would differ
from
the amount being billed in SV102 be shared?
NDC
Drug Unit Price: Does this represent the price for the practice or the
price
that the patient/payer is being billed?
Drug Unit Count: How does this value differ from the units ( Units or
International Units) reported in the SV104? Can billing scenarios be shared
relating to this element?
Thank you in advance for any information members can share.
Caterina Snyder
Special Projects
Misys Healthcare Systems
(formerly Medic Computer Systems, LLC.)
*[EMAIL PROTECTED]
* (800) 347-3473 ext. 2856
FAX (208) 247-1139
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