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Back  RFI # 1341: HSA CAS segments

Formal vs. Informal Help Informal Formal

Submitter

Cathi Anderson

Description

When reporting patient responsibility dollars assumed by an HSA or FSA account in the CAS segment, when the funds in the HSA are insufficient, the entire amount is non-covered, which of the following would be appropriate given the following criteria:

Charge $1500.00
Provider discount 375.00
Patient liability (Deductible) 650.00
Payment from PSA 475.00

CLP*xxxxxxxxxx*1*1500*475*650*12*2011xxxxxxxxxxxxx~
CAS*PR*187*-475**1*1125

OR
CLP*xxxxxxxxxx*1*1500*475*650*12*2011xxxxxxxxxxxxx~
CAS*PR*187*-475**1*475~

Perhaps another more accurate method could be suggested. thanks.

Submitter Assigned Keywords

HSA CAS savings accounts

Response

If we are interpreting the PSA amount correctly then this is how it should be reported.

Charge $1500
Provider discount $375
1500 - 375 = 1125 (Pt Liab - Ded - PR1)
Of the $1125 (PR1), the HSA pays $475 (neg. PR187) reducing the $1125 Pt Resp. to a final (net) Pt Resp amount of $650. (CLP05)


CLP*XX*1*1500*475*650*12*9999999999~
CAS*CO*45*375~
CAS*PR*1*1125**187*-475~


If we've misinterpreted your question or your scenario feel free to re-inquire.
Submission 6/27/2011
Status Date 10/4/2011
Status F - Final
Primary References
Document 005010X221
Section2.4
Table2
Loop2110
Segment Position0200
Segment IDCAS
Element Position03
Industry Namemonetary amount