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Segment
in
X12 Release 003070

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
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
67
Identification Code
String (AN)
Mandatory
2
20
-
Code identifying a party or other code
SVD01 is the payer identification code.
02
Monetary Amount
Decimal number (R)
Mandatory
1
15
-
Monetary amount
SVD02 is the amount paid for this service line.
03
Composite Medical Procedure Identifier
Composite (composite)
Optional
01
Product/Service ID Qualifier
Identifier (ID)
Mandatory
2
2
-
Code identifying the type/source of the descriptive number used in Product/Service ID (234)
Codes (432)
02
Product/Service ID
String (AN)
Mandatory
1
48
-
Identifying number for a product or service
03
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-03 modifies the value in C003-02.
04
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-04 modifies the value in C003-02.
05
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-05 modifies the value in C003-02.
06
Procedure Modifier
String (AN)
Optional
2
2
-
This identifies special circumstances related to the performance of the service, as defined by trading partners
C003-06 modifies the value in C003-02.
07
Description
String (AN)
Optional
1
80
-
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.
04
Product/Service ID
String (AN)
Optional
1
48
-
Identifying number for a product or service
SVD04 is the revenue code.
05
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
SVD05 is the paid units of service.
06
Assigned Number
Numeric (N0)
Optional
1
6
-
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.
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.
Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.