Further Clarification is needed for the use of the 2430 SVD.
We have an situation where the primary payer made payment with revenue code 509 and adjudicates back via ERA. A Medicare Secondary Claim (MSP) claim is then sent containing the prior payer payment information in the 2430 SVD. The MSP claim received a rejection indicating invalid revenue code. We have been told by the MAC that the revenue code 509 is only allowed on TOB 77X. I am under the understanding that the 2430 SVD information is to be populated based on how the primary payer processed/adjudicated the claim. Should the MAC accept and process this information rather than reject on the front end, as it is X12 837I compliant claim submission?
The response listed above was a first draft of the response. This is the approved response:
Based on the additional information received by the submitter, the submission of the secondary claim was incorrect - the primary and secondary claims should be reported with the same value in SV201. ASC X12 cannot comment on the validity of the adjudication, only on the compliance of the transaction with the guide. Validation of using revenue code 0509 is outside ASC X12 purview. The submitter should contact the NUBC about any restrictions related to the TOB and revenue code.