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Back  RFI # 1115: 837P COB claim balancing

Formal vs. Informal Help Informal Formal

Submitter

robert thickens

Description

It is my understanding that the claim balancing equationfor provider to payer to provider COB is 2300 clm_02 = 2320 AMT*D + sum of CAS adjustments in CAS_03,06,09,12,15; 18 and that the AMT*AAE and AMT*B6 do not enter into the equation at all.

Submitter Assigned Keywords

837P COB claim balancing equation

Response

That’s correct. The AMT segments for Approved and Allowed Amounts are for reporting there amounts. These segments only report information and should not be used for any balancing equations.
Submission 7/27/2010
Status Date 9/20/2010
Status F - Final
Primary References
Document 004010X098A1
Section1.4.2
Page17
Set ID837P