SVD Service Line Adjudication

Opt

AtMax 1

To convey service line adjudication information for coordination of benefits between the initial payers of a health care claim and all subsequent payers

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1138	Payer Responsibility Sequence Number Code	Mandatory	ID	1/1	AtMax 1
2	782	Monetary Amount	Mandatory	Decimal	1/18	AtMax 1
C003Composite Medical Procedure IdentifierOpt AtMax 1
4	234	Product/Service ID	Opt	Alphanumeric	1/80	AtMax 1
5	380	Quantity	Opt	Decimal	1/15	AtMax 1
6	554	Assigned Number	Opt	Number	1/6	AtMax 1

Element Details

ID1138

NamePayer Responsibility Sequence Number Code

LengthMin 1 / Max 1

Position1

RequirementMandatory

Codes

<>G
Payer Responsibility Ten
<>P
Primary
<>N
Unconfirmed
<>A
Payer Responsibility Four
<>D
Payer Responsibility Seven
<>T
Tertiary
<>O
Noncapitated Agreement
<>B
Payer Responsibility Five
<>R
Non-specified
<>E
Payer Responsibility Eight
<>U
Unknown
<>H
Payer Responsibility Eleven
<>C
Payer Responsibility Six
<>S
Secondary
<>F
Payer Responsibility Nine

EDI Dictionary

SVD Service Line Adjudication

Elements

Element Details