SVD Service Line Adjudication

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

Position: SVD-01 · Element: 67 · Name: Identification Code · Type: String (AN) · Requirement: Mandatory · Min: 2 · Max: 20 · Repeat: -

Code identifying a party or other code.

SVD01 is the payer identification code.

Position: SVD-02 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Mandatory · Min: 1 · Max: 15 · Repeat: -

Monetary amount.

SVD02 is the amount paid for this service line.

SVD-03 C003 Composite Medical Procedure Identifier Composite (composite) Optional

Position: 01 · Element: 235 · Name: Product/Service ID Qualifier · Type: Identifier (ID) · Requirement: Mandatory · Min: 2 · Max: 2 · Repeat: -

Code identifying the type/source of the descriptive number used in Product/Service ID (234).

Position: 02 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 40 · Repeat: -

Identifying number for a product or service.

Position: 03 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

C003-03 modifies the value in C003-02.

Position: 04 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

C003-04 modifies the value in C003-02.

Position: 05 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

C003-05 modifies the value in C003-02.

Position: 06 · Element: 1339 · Name: Procedure Modifier · Type: String (AN) · Requirement: Optional · Min: 2 · Max: 2 · Repeat: -

This identifies special circumstances related to the performance of the service, as defined by trading partners

C003-06 modifies the value in C003-02.

Position: 07 · Element: 352 · Name: Description · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 80 · Repeat: -

A free-form description to clarify the related data elements and their content.

C003-07 is the description of the procedure identified in C003-02.

Position: SVD-04 · Element: 234 · Name: Product/Service ID · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 40 · Repeat: -

Identifying number for a product or service.

SVD04 is the revenue code.

Position: SVD-05 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity.

SVD05 is the paid units of service.

Position: SVD-06 · Element: 554 · Name: Assigned Number · Type: Numeric (N0) · Requirement: Optional · Min: 1 · Max: 6 · Repeat: -

Number assigned for differentiation within a transaction set.

SVD06 is only used for bundling of service lines. It references the LX Assigned Number of the service line into which this service line was bundled.