Bill, you need multiple 2320- 2330 Loops when there are multiple payers.
Each payer will be identified by the 2320 in order of payer responsibility
primary, secondary, and tertiary for three or more payers involved with
payment of the claim. Each 2320 must have the 2330 Loop. See note 3 in
the Other Subscriber Information (SBR) segment of Loop 2320.
Robert C. Pozniak
NYS Department of Health
HIPAA Practice Group
One CSC Way
(518) 257-4511 fax (518) 257-4510
[EMAIL PROTECTED]
Bill
<[EMAIL PROTECTED] To: "WEDI SNIP Transactions
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com> <[EMAIL PROTECTED]>
cc:
04/04/2003 01:26 Subject: 837P COB compliancy question
PM
Please respond to
Bill
Hi,
�I'm having a problem understanding some compliancy issues regarding COB
rules.
in the 4010a 837P the 2430 SVD01 says "SVD01 identifies the payer which
adjudicated the corrsponding service line and must match DE 67 in the NM109
position 325 for the payer"
the problem is the word 'corresponding' because if you see below we have a
situation where we have 2 payers and then 2 SVD's for each LX so the SVD
won't ever match up 1-to-1 with the NM109 hence the compliance error??
Is the data just structured incorrectly? or is it a compliancy issue?
BTW: this is sample data
thanks
Bill Swaney
HIPAA Consultant
NM1*PR*2*SMITH*****PI*9012345918341~
CLM*2.1.2.4*2100.00***23::1*Y*C*Y*N~
HI*BK:41030~
SBR*P*19*28161*CARPENTER KAREN*C1****CI~
CAS*PR*1*10.00~
DMG*D8*19630601*F~
OI***Y*C**Y~
NM1*IL*1*NIXON*RICHARD****MI*527471882~
NM1*PR*2*payer name*****PI*101~
SBR*S*19*398161*STEEL S UNION*C1****CI~
CAS*PR*1*10.00~
DMG*D8*19630601*F~
OI***Y*C**Y~
NM1*IL*1*NIXON*JANE****MI*527471999~
NM1*PR*2*payer name*****PI*027~
LX*1~
SV1*HC:93501*1000.00*UN*1***1~
DTP*472*D8*20021018~
SVD*101*0*HC:93530**1*2~
DTP*573*D8*20021202~
SVD*027*0*HC:93530**1*2~
DTP*573*D8*20021202~
LX*2~
SV1*HC:93530*900.00*UN*1***1~
DTP*472*D8*20021018~
SVD*101*950*HC:93530**1~
CAS*PR*1*10.00~
DTP*573*D8*20021202~
SVD*027*150*HC:93530**1~
DTP*573*D8*20021212~
LX*3~
SV1*HC:93503*200.00*UN*1***1~
DTP*472*D8*20021018~
SVD*101*0*HC:93530**1*2~
DTP*573*D8*20021202~
SVD*027*0*HC:93530**1*2~
DTP*573*D8*20021212~
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