Originally posted by: SystemAdmin

Has anyone received the following error processing 837s through the compliance_check map?

SEGMENT At position: 75  SV1 
{Professional Service
}  in loop 2400 TYPE 3: error ELEMENT SV102 
{Monetary Amount
} TYPE 3: error Error Code: 010 
{Total Out of Balance
} Error Description: 34776 2400 SV102 = SUM(2430 SVD02) + SUM(2430 CAS Adj) Data Content: 35

The input data is valid in another supplier's HIPAA Level 3 validator and has been received successfully from two major TPAs for years. It appears that the map is attempting to balance the SV102 in a way that may not agree with the HIPAA IG. I'm having a hard time expressing the issue and figuring out how to communicate it to IBM Support.

Any insight would be appreciated.

Jim
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Originally posted by: dharvie

The balancing section of the TR3 has the following statement:L
"The calculation for each 2430 loop is as follows: {sum of Loop ID-2430 CAS Service Line Adjustments} plus {Loop ID-2430 SVD02 Service Line Paid Amount} = {Loop ID-2400 SV102 Line Item Charge Amount}".
The error you received is based on that requirement.
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Originally posted by: SystemAdmin

I understand that part as the TR3 conveniently provides the formula. I believe I have uncovered the issue.

For 4010 837Ps, balancing was not required between the SV102 & the sum of the SVD loop Monetary Amounts. So when I converted some perfectly valid 4010 837Ps into 5010 837Ps errors were generated in WTX when there were Tertiary Payers with service line level adjustments.

The reason is that the submitters of the 4010 837Ps had used a formula equivalent of
( SUM(CAS03, CAS06, etc.) + SVD02 ) where SVD01 = NM109:2330B (Other Payer) to populate the SV102. However, WTX 5010 compliance check map uses the rule: SV102 = SUM(CAS03, CAS06, etc.) + SVD02. The two will not be equivalent when there is a tertiary payer with service line adjustments.
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Originally posted by: DianeC

Well, we have found issues with other transactions from this pack. We had to get a fix for the 270 & now, we're going to have to raise questions about the 820. There are discrepancies btw what IBM has coded & what's in the TR3. Doesn't seem as though whoever put the trees together put much thought into double-checking (testing) what they did. As rep has said many times - looks like we're debugging their software for them.
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Originally posted by: SystemAdmin

We found an error involving the SBR05 where the pack indicated it was always mandatory when it was only required when the Payer was Medicare. IBM Support provided five updated type trees within 2-3 days. I found that to be an excellent response.

I don't know how you would check everything in the HIPAA Pack prior to release to the client base. It's complexity pretty much precludes extensive testing of every IG/TR3 requirement.
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