Change Request Detail
Type of Request
Professional Claim (HCFA 1500)
DSMO Process Completed
Business Reason
From the response to ASC X12 RFI #1772, "SV2 # of service lines" ...

"Guide 005010X221 (Health Care Claim Payment/Advice) section (Claim Splitting) describes how a health plan may split an incoming claim into multiple claims. This process allows a health plan to receive a single claim with, for example - 50 service lines, and split that into multiple claims, for example 2 claims of 22 service lines and 1 claim of 6 service lines.  So, if the payer can only adjudicate a subset of the 999 service lines (22 as indicated by the RFI submitter) a compliant approach is available."

The explanation above does not seem to exist in any of the version 005010 Health Care Claim TR3s:  005010X222, 005010X223, and 005010X224.  It would be very useful if a generalized version of the above language was directly included into future versions of the Health Care Claim TR3s.
As applicable / appropriate in front matter similar to version 005010X222
DSMO Category
Approve. ASC X12 has already addressed claim and line splits as applied to COB claims in the next version of the Health Care Claims Guides.
Appeal Recommendation