Section title: Requests for Interpretation
RFI #
2126
837 Institutional SV207
Description

Our system is defaulting 0 in SV207 if no disallowed amount applicable. Is this acceptable. This is a section from the 5010 TR3 guide: SV207 782 Monetary Amount O 1 R 1/18 Monetary amount SEMANTIC: SV207 is a non-covered service amount. 361 SITUATIONAL RULE: Required if needed to report line specific noncovered charge amount. If not required this implementation guide, do not send. IMPLEMENTATION NAME: Line Item Denied Charge or Non-Covered Charge Amount.

RFI Response

As you note in your request for interpretation description, the 005010X223A2 TR3 explicitly states the SV207 is only required when there is a need to report line specific non-covered charge amounts and if that requirement is not met, the element must not be sent. Therefore, sending a default value of 0 would not be compliant with the TR3.

RFI Recommendation

Please refer to RFI 1512 for guidance on the rejection of transactions that do not fully comply with a TR3.

DOCUMENT ID
005010X223