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Back  RFI # 1419: 5010 837I 2320 AMT*D

Formal vs. Informal Help Informal Formal

Submitter

Dora Lambert

Description

Is the 2320 COB Payer Paid Amount, AMT*D3, required when a claim has been sent to the destination payer that is also the secondary payer?

Also, the 2320 DTP*573 is present (indicates the remittance date of the prior payer is present). Doesn't the DTP*573 satisfy the requirement in the AMT situational rule making it a required segment?

Submitter Assigned Keywords

5010 837I 2320 AMT COB Segment

Response

Logically if the value in Loop ID 2000B/SBR01 is S (Secondary) and Loop ID 2320/SBR01 is P (Primary) then the payer reported in Loop ID 2330B performed some type of adjudication on the claim.

The Payer Paid Amount is required if the payer identified in Loop ID 2330B of this instance of the 2320 adjudicated the claim.

The existence of Claim Check or Remittance Date (DTP*573) would be a clear indication that payer adjudication has occurred. However, the Loop ID 2320 Claim Check or Remittance Date is not used when the 2430 loop is present on the claim.
Submission 9/27/2011
Status Date 10/24/2011
Status F - Final
Primary References
Document 005010X223
Section2.3
Page364
Set ID837
Table2
Loop2320
Segment Position2300
Segment IDAMT
Element Position52