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Back  RFI # 149: Zero Pay Claim Payment Segment

Formal vs. Informal Help Informal Formal

Submitter

Andrea Jacobsen

Description

We have a payor who recently changed their process to no longer include CAS segments on denied claims. We are receiving remittance advice remark codes only on claims with non-zero charges. They used to use OA100 to reflect what they paid to the patient, plus other CARC's to reflect any other reductions to the claim from being PIF. Is the use of RARC's only allowable? I believe we are right based on section 2.2.1.1. Help!

Response

This issue is explicitly answered in guide X091, section 2.2.1. There are no exceptions to the balancing requirements. If the original charge was non-zero and the claim specific payment is zero, CAS entries are necessary to achieve balancing as defined in that section and all sub-sections. Use of the situational Remark Code does not alter that requirement.
Submission 11/19/2004
Status Date 12/3/2004
Status F - Final
Primary References
Document 004010X091A1
Section2.2.1.1
Page19
Set IDCAS
Table2
Loop2100
Segment IDCAS
Element Position02