RFI Browser

Back  RFI # 1468: 835 Sales Tax 5010

Formal vs. Informal Help Informal Formal

Submitter

melissa lighty

Description

What are the requirements for a payer to report Sales Tax at Loop 2100 Claim Payment Information level using either qualifier T - Tax or T2 - Total Claim before Taxes?

Why is qualifier T2 – Total Claim before Taxes an allowable value at Loop 2110 Service Payment Information?

If Sales Tax is reported at Loop 2100 Claim Payment Information is Loop 2110 Service Supplemental Information not required?

If Sales Tax is reported at Loop 2110 Service Supplemental Information is Loop 2100 Claim Payment Information not required?

Does the Sales Tax Dollar Amount received at Loop 2400 Service Line Number in the 837D have to be the same amount reported back out at Loop 2110 Service Payment Information in the 835 transaction?

If Sales Tax Service Lines are created during adjudication is the Service Line required to be reported back on the 835 transaction?

Submitter Assigned Keywords

835 Sales Tax

Response

Qualifier T2 (Total Claim before Taxes) was the most applicable qualifier available in the standard, and the usage note in the gray box defines the use in the 2110 AMT01 as the "service charge".

The reporting of the tax is dependent upon where the tax is paid (claim or service), but not allowed to duplicate at both levels. If tax applied at claim level, the would be reported at the 2100. If applied to the various service lines, then would be reported in the 2110. For pharmacy, the total amount can be reported at the service line, but it's not intended for both to be used unless required by regulation.

If the 837D SV3 indicates (with an AMT) that it includes tax amounts for that service, then the 835 SVC will reflect the original charge amount with the adjudicated decision, and the adjudicated decision will include the amount of tax being paid. That amount will also be reported in AMT, but any reduction in the charged amount, whether tax or service, should be reflected with a CAS.

Service lines that are submitted on the claim MUST be returned on the 835. A CARC code would be used to adjust the taxes according to the adjudication systems determination.
Submission 12/13/2011
Status Date 3/12/2012
Status F - Final
Primary References
Document 005010X221
Set ID835
Loop2100