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Formal vs. Informal Help Informal Formal

Submitter

Deepti Dabral

Description

Can you please confirm the usage of following newly added segment? Not sure in what situation it is required. Please clarify.

- 2320 AMT*A8 (COB TOTAL NONCOVERED AMOUNT)
For secondary claim, will this segment needs to be generated when Primary Payer didn’t make any payment or adjustment?

Response

This segment is required when the destination payer's cost avoidance policy allows providers to bypass claim submission to the otherwise prior payer identified in Loop ID-2330B. It is used when the Primary Payer is not billed because that payer's cost avoidance policy allows providers to bypass submitting the claim to them and send it directly to the secondary payer.
Submission 3/25/2010
Status Date 5/21/2010
Status F - Final
Primary References
Document 005010X222
Section2.4
Page316
Set ID837