RFI #
1279
835 SVC05/07 usage for IP
Description
If an adjudication system returns service level detail for inpatient claims, can the SVC05 = the number of covered/paid days and SVC07 = the original number of days billed?
RFI Response
See Section 1.10.2.4.1 for guidance. Generally, service lines are not provided on inpatient claims. If the adjustment is NOT service line specific, then the claim level instructions provide the direction. If the adjustment IS service specific, then the service level is where the adjustment belongs. Non-covered days should be reported at the claim level with CARC 78 in the CAS02, and the number of non-covered days in CAS04.
DOCUMENT ID
005010X221