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Back  RFI # 1515: 2320 Remaining Patient Liabili

Formal vs. Informal Help Informal Formal

Submitter

Gale Scott

Description

The usage rule for both 2320:AMT and 2430:AMT for Remaining Patient Liability says it is situational. If the provider agrees with the adjudicated patient responsibility as calculated by the first payer, does this usage rule mandate that the provider complete this segment with a reported amount of zero? I would think that if the reported amount if zero, that it would not be necessary to send the segment. Can this be confirmed?

Submitter Assigned Keywords

Remaining patient liability responsibility

Response

The Remaining patient liability is required when a previous payer has adjudicated this claim, including when that amount is zero. The information is reported in the 2320 AMT if the payer has reported payment information on the claim level or the sender does not have the ability to report on the line level. It is reported in the 2430 AMT if the other payer has reported line level information and the sender can report on the line level. The amount to be reported is explained in TR3 note 1: "In the judgment of the provider, this is the remaining amount to be paid after adjudication by the Other Payer."
Submission 2/1/2012
Status Date 3/12/2012
Status F - Final
Primary References
Document 005010X223
Section2.4
Set ID837
Table2
Loop2320
Segment Position3000
Segment IDAMT
Element Position02