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Back  RFI # 1460: 837 COB CAS adjustments

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Submitter

Kim Peters

Description

Is the provider required to send CAS adjustment segments at the claim level on 837 claims even if the only adjustments are at the line level? The claim was submitted with primary having no lines or CAS segments but secondary incluede the lines and CAS.

SBR*P*18*EM529683******CI~
AMT*D*0~
OI***Y***Y~
NM1*IL*1*member****MI*member id~
NM1*PR*2*UNKNOWN*****PI*99999~
DTP*573*D8*20111027~
SBR*S*18*529683**12****MB~
AMT*D*37.23~
OI***Y***Y~
MOA***MA01*MA18~
NM1*IL*1*last name*first*J***MI*member id~
N3*19145 address~
N4*TAMPA*FL*336473092~
NM1*PR*2*X*****PI*09102~
N3*P.O. BOX 2360~
N4*JACKSONVILLE*FL*32231~
REF*F8*ID~
LX*1~
SV1*HC:99211:25::::NOT OTHERWISE CLASSIFIED*23*UN*1*22**1~
DTP*472*D8*20110919~
REF*6R*LX#01~
SVD*09102*7.46*HC:99211:25**1~
CAS*CO*150*13.68~
CAS*PR*2*1.86~
DTP*573*D8*20111110~

Submitter Assigned Keywords

COB primary

Response

The submitter is not required to use claim level adjustment segment (2320 CAS) if all adjustment amounts are reported on the line level (2430 CAS).


The submitter is required to send a claim level adjustment segment if the payer identified in the loop has applied a claim level adjustment. It is also required that for each payer the payer payment amount equals the sum of all line level payments minus all claim level (2320 loop) adjustments. See section 1.4.4 for information on balancing claims using adjustments.
Submission 12/2/2011
Status Date 1/13/2012
Status F - Final
Primary References
Document 005010X223
Section2320
Page358