Claim POS versus Service Line POS

Claim POS versus Service Line POS

There are differences between paper and electronic claims when it comes to Place of Service (POS) codes.
  • On paper claims, the POS code goes in Item 24B at the Service Line level.
  • For electronic claims, however, there is a POS code for the overall claim (in element CLM.05-1) and there is also a POS code for each Service Line (in element SV1.05). This provides the option to have the Service Line POS for one or more Service Lines be different from the Claim POS.
  • In ProviderSuite, the Claim POS (CLM.05-1) is determined by the POS Code configured for the Facility selected on Claim-General. The Service Line POS is set on Claim-Details along with the other Service Line details like CPT and Charges. (When starting a new claim, the Service Line POS defaults to the same POS as the Facility selected on Claim-General, but it can be changed by selecting a different Service Line-specific Facility/POS.)
For example, the following claim has a Claim-General Facility with POS 11 but has a Service Line POS of 02 on Claim-Details. In the EDI file, the POS 11 appears in CLM segment and the POS 02 appears in SV1 segment. (POS is highlighted in red below)
CLM*B92702*150.00***11:B:1*Y*A*Y*Y~
SV1*HC:90837:GT*150.00*UN*1*02**1~
Note: some payers may have restrictions on when a Claim POS may differ from a Service Line POS. For example, for a claim with a single service line, the payer may require that the Claim POS and Service Line POS must match. 

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