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Back  RFI # 1116: 837I Patient Paid Amount

Formal vs. Informal Help Informal Formal

Submitter

John Murray

Description

The 4010A1 version of the 837I (4010x096A1) included the Patient Paid Amount AMT segment (2300 loop, AMT01=F5). This segment was removed in the 837 5010x2223. How then are claim submitters to report amounts paid by the patient? (deductibles, co-pays, etc)

This capability was left in the 5010 versions of both the 837D and 837P. With the increase in real-time processing of claims transactions, and especially with the growth in CDHPs, it is important that this ability be available across all claims transactions.

Submitter Assigned Keywords

claim patient responsibility deductible copay cdhp real time

Response

Patient Paid Amount was removed from version 5010 of the 837I (005010X223A1) to eliminate two ways to report the same information. Patient Paid Amount should be reported using the (Value Information) HI Segment with a value code of FC along with the associated dollar amount.
Submission 7/29/2010
Status Date 9/3/2010
Status F - Final
Primary References
Document 005010X223
Set ID837I
Table2
Loop2300
Segment Position175
Segment IDAMT
External Code List522
Code ValueF5