I see the repeat loop for 2400 sv2 has a max of 999 lines. I am a provider that has a payer restricting the reporting of only 22 service lines. Can a payer force this restriction on all providers due to their system? Should they be compliant with the 999 as specified in the 837I transaction set specs?
Guide 005010X223 explicitly allows the submission of 999 2400 loops per claim. Section 1.4.1.1 (Coordination of Benefits Data Models - Detail) identifies that the claim/service detail is not changed when sending a claim to subsequent payers. Only payer specific content is moved between sections and adjudication information is added.
Guide 005010X221 (Health Care Claim Payment/Advice) section 1.10.2.11 (Claim Splitting) explicitly allows a health plan to split an incoming claim into multiple claims. This process allows a health plan to receive a single claim with, for example - 50 service lines, and split that into multiple claims, for example 2 claims of 22 service lines and 1 claim of 6 service lines.
As a result, restricting the number of services lines that can be submitted by a provider to less than what is allowed by loop 2400 is inconsistent with the COB requirements as well as being unnecessary due to the remittance advice instructions.
HIPAA policy aspects of this question must be addressed with OESS.