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Back  RFI # 1565: 837 2320 CAS OA 225 Interest

Formal vs. Informal Help Informal Formal

Submitter

Laurie Dean

Description

If the interest payment for an 837 encounter version 005010X222A1 is submitted as a positive amount in loop 2320 CAS segment Claredi has the following error:
H31312 The Payer Paid Amount does not equal the line level payment amounts less the adjustment amounts.
If the interest payment for an encounter version 005010X222A1 is submitted as a positive amount in loop 2320 CAS segment Claredi does not produce an error.
We need clarification on the following
How should an interest payment be reported in an 837 in loop 2320 CAS Segment?
Should the interest payment be reported as a negative or positive amount?
Should the interest payment be submitted in an 837?
IF the interest payment should be reported in an 837 we need clear direction on the format required.

Response

The interest should be reported as the provider received it in the 835. Normally, that means that interest will not be reported in a CAS segment, and therefore would not be reported in the claim to a secondary payer. Normally, the interest is paid using the PLB segment of the 835. See guide 005010X221A1 (835) section 1.10.2.9. If the interest is reported in a CAS adjustment in the 835 (using CARC 85 (Patient Interest Adjustment (Use Only Group Code PR)), then that adjustment would be reported in the 837 using the CAS segment. According to guide 005010X222A1 section 1.4.4.1, balancing to the claim payment involves the subtraction of adjustments from the service line payment total. A positive dollar amount for the interest would reduce the payment for a claim. A negative dollar amount would increase the payment on the claim. As a result, reporting the payment of interest by a prior payer would require a negative dollar amount in order to balance.
Submission 4/13/2012
Status Date 5/24/2012
Status F - Final
Primary References
Document 005010X222
Section2320 CAS