Roviyas

This loop is required only if current insurance sequence > 1. i.e. for secondary, tertiary, etc.

Say for example, if the current insurance is secondary, then we should run this loop for the primary insurance. If the current insurance is tertiary, then we should run this loop for the primary and then secondary insurance. And also so on. In general, take the sequence number of the current insurance, and run this loop for all the previous sequence insurance.

We need to repeat this loop for each line item in the claim.

When submitting coordination of benefits (COB) claims to Secondary Payer, the prior payer’s payment information must be included in the 837 claim file. There is important edit takes places in COB Claims at line item level for balancing the amounts.This edit is to verify that each charge line balances with the payment information at the line level. An example of line level balancing is below. The data in red provides an example of how the line level must balance.
 
Service Level (Loop 2400) line item charge amount Professional (SV102) or line item charge amount Institutional (SV203) = the sum of all other payer service line paid amounts (SVD02) at the service level (Loop 2430) + the sum of all the service line adjustments (CAS03) at the service level (Loop 2430)
 
Line level balancing:
SV1*HC:90834*137*UN*1***1:2:3
DTP*472*D8*20130513
SVD*99726*47.28*HC:90834**1
CAS*CO*45*77.86
CAS*PR*2*11.86
137 = 47.28 + 77.86 + 11.86

If there is balancing issue, then you will receive “Secondary Claim Information Missing or Invalid - Each line must balance; Line Charge Amount = Line Sum Of Adjustment Amounts + Line Payer Paid Amount”

2430 Line Adjudication Info - SVD Segment

2430 Line Adjustment CAS - Deductible

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2430	CAS	Line Adjustment	ID	3		S	CAS
		Element Separator	AN	1			*
	CAS01	Claim Adjustment Group Code	ID	1/2	1033	R	PR
		Available link for download Read more » Posted by Unknown at 5:46 PM Email ThisBlogThis!Share to XShare to FacebookShare to Pinterest Labels: 2430, 5010, 837, adjudication, documentation, edi, information, line, loop, professional Saturday, January 28, 2017 EDI 270–5010 Documentation–2000B Information Receiver Name EDI 270–5010 Documentation–2000B Information Receiver Name 2000B Information Receiver Name Use this segment to identify an entity by name and/or identification number. This NM1 loop is used to identify the eligibility/benefit information receiver (e.g., provider, medical group, employer, IPA, or hospital). Loop Seg ID Segment Name Format Length Ref# Req Value Header NM1 Submitter Name ID 3 R NM1 Element Separator AN 1 * NM101 Entity Identifier Code ID 2/3 98 R See Below for valid values Element Separator AN 1 * NM102 Entity Type qualifier ID 1/1 1065 R 2 (See below for more Information) Element Separator AN 1 * NM103 Name Last or Organization Name AN 1/60 1035 R Practice Name Element Separator AN 1 * NM104 Name First AN 1/35 1036 Not used Element Separator AN 1 * NM105 Name Middle AN 1/25 1037 Not Used Element Separator AN 1 * NM106 Name Prefix AN 1/10 1038 Not used Element Separator AN 1 * NM107 Name Suffix AN 1/10 1039 Not Used Element Separator AN 1 * NM108 Identification code Qualifier ID 1/2 66 R XX (See below for more information) Element Separator AN 1 * NM109 Identification code AN 2/80 67 R NPI Number Segment Terminator ~                   Sample NM1*1P*2*Bella Vista Health Center*****XX*1306849724~ Segment Structure NM101 - Entity Identifier Code Code qualifying the type of entity Code Definition 1P Provider 2B Third-Party Administrator 36 Employer 80 Hospital FA Facility GP Gateway Provider P5 Plan Sponsor PR Payer   NM102 - Entity Type Qualifier Code qualifying the type of entity Code Definition 1 Available link for download Read more » Posted by Unknown at 11:21 PM Email ThisBlogThis!Share to XShare to FacebookShare to Pinterest Labels: 270–5010, documentation–2000b, edi, information, name, receiver Older Posts Home Subscribe to: Posts (Atom)