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No. This note in the SVC is
pretty clear:
Although the
SVC loop is optional, there are times when it should be considered mandatory. Whenever the actual
payment has been reduced due to service
line specific adjustments, the SVC loop is
necessary in order to understand the remittance information. This situation is particularly applicable to
professional and fee-based
services.
Even if you consider
"should be considered mandatory" to by synonymous with "required" (they are
not), the SVC segment is only needed when adjustments reduce the amount
paid.
Correct me if I'm
incorrect, but 835's returning payment information on professional claims are
required to return service line information are they not? Therefore
there has to be SOME service line information, even it's nothing more than one
payment.
Thanks
Dave
David G. Foulke
Software Development
Dairyland Healthcare
Solutions
320-634-5331
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-----Original
Message-----
From: Doug Webb
[mailto:[EMAIL PROTECTED]
Sent: Monday, September 22, 2003 8:16
AM
To: WEDI SNIP Transactions
Workgroup List
Cc: WEDI SNIP
Transactions Workgroup List
Subject: Re: COB
Balancing
Also, how can the Clearinghouse possibly
know what the EOB or 835 you received contained?
As you pointed out, the 837 must
accurately report what was received from the primary
payer.
Requiring service-line level adjustments
when you do not have service-line level information is just plain
wrong.
The opinions expressed here are my
own and not necessarily the opinion of LCMH.
Douglas M. Webb
Computer System
Engineer
Little Company of Mary Hospital & Health Care Centers
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----- Original Message -----
Sent: Monday,
September 22, 2003 07:16 AM
Subject: Re: COB
Balancing
Jenn, what is reported on the
remittance advice is what must be reflected
on the 837 secondary/tertiary
claim(s). The 835 Implementation Guide on
page 20 near the bottom
in the description for Amount 8 the note indicates
the amount can be
transmitted in the Claim Adjustment Segment and/or the
Service Adjustment
Segment. Additionally, the third paragraph on page 21
states "When
the Service Payment Information loop is present, adjustments
are reported
in either (emphasis added) the Claim Adjustment or the Service
Adjustment
Segments but not in both. The example provided basically points
out
that the same adjustment should not be repeated at both the claim
and
service level. Also the IG notes the preference that the
adjustment be
shown at the service level when possible.
I do not
see how a clearinghouse can demand that adjustments be shown at
the
service level if the prior payer reported the adjustments at the
claim
level. At the same time you might as well be prepared to
report service
level adjustments when a payer adjudicates and returns
service level
adjustments.
Robert C. Pozniak
NYS Department of
Health
HIPAA Practice
Group
"Jones,
Jennifer"
<[EMAIL PROTECTED]
To: "WEDI SNIP Transactions Workgroup
List"
ech.com>
<[EMAIL PROTECTED]>
cc:
09/19/2003 03:55
Subject: COB
Balancing
PM
Please respond
to
"Jones,
Jennifer"
I'm sure it is late in the game to asking about
this but I haven't had this
request until recently ?
I have
aClearinghouse who is requesting COB information at both the claim
and
line level.I have not been doing this for other payers so now I'm
forced
to change it (for one situation).
I'm frustrated because I've gotten
this far in the game and been able to
successfully send COB claims with
this information at only the claim level.
Iguess, before I do it, I
want to make sure I should ?
Thanks ---
jenn
____________________
Jennifer Lynne Jones
Sanitas
Product Manager>
Pinpoint Technologies
Boulder, CO
80301
303-801-1829 (Direct)
303-801-0001 (Fax)
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