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Back  RFI # 1705: 5010-835 Interest Payment

Formal vs. Informal Help Informal Formal

Submitter

Van Barriger Janet

Description

The front matter of the 5010-835 TR3 does not discuss payer interest payments to a provider using the Service Payment Loop 2110. 1.10.2.9 on page 32 of the TR3 only references that interest payments should be indentified in the Claim Payment Loop 2100.
Would it be appropriate for a payer to send the interest payment information to a provider in the Service Payment Loop 2110 using the CAS segments? The payer is not sending any PLB segments in the file either.

Response

Section 1.10.2.9 states in the summary fourth bullet "If any interest responsibility and/or prompt pay discounts are extended to the patient, then report the data in the CAS segment, which impacts CLP04, Claim Payment Amount. In this case, do not report the data in the AMT and PLB segments."

Otherwise, that section requires that net interest payments per contractual agreement between the payer and provider are reported at the PLB level with adjustment code ā€œL6ā€ where they do not distort the adjudication shown in CAS segments at the claim or service levels. For specific claims, and reversal and corrections for original claims that paid interest, claim-specific information must be conveyed in the Claim Supplemental Information Segment (2100 AMT) using code ā€œIā€ for interest. AMT segments do not influence balancing the Claim or Service Payment loops or balancing the 835 for benefits payments on behalf of the patient.

Section 1.10.2 states "...These solutions may not be the only possible solutions within an ASC X12 835 transaction. They are, however, the only solutions for the business situations identified that are compliant with this implementation guide. Creation of 835 transactions that are not consistent with the information here is prohibited under this implementation."

Therefore, service specific reporting of interest is not permitted in the Service Payment loop using the CAS segment unless the patient is also responsible for the payment of interest on the service.
Submission 11/12/2012
Status Date 2/19/2013
Status F - Final
Primary References
Document 005010X221
Section1.10.2.9
Page31-3
Set ID835
Table2
Loop2110
Segment Position0900
Segment IDCAS
Element Position02