RFI Browser

Back  RFI # 1811: 837 Multi CAS w/same Group

Formal vs. Informal Help Informal Formal

Submitter

Jeanne Kirkpatrick

Description

I would like clarification as to whether an 837 can have more than one CAS segment with the same Group code when the first CAS has not reported all six iterations?

The 837 TR3 Rule for 2320 and 2430 state:
'A single CAS segment contains six repetitions of the “adjustment
trio” composed of adjustment reason code, adjustment amount, and
adjustment quantity. These six adjustment trios are used to report up
to six adjustments related to a particular Claim Adjustment Group
Code (CAS01). The first non-zero adjustment is reported in the first
adjustment trio (CAS02-CAS04). If there is a second non-zero
adjustment, it is reported in the second adjustment trio (CAS05-
CAS07), and so on through the sixth adjustment trio (CAS17-CAS19)'. It does not say must use like the front matter on pg 22 of the 835 TR3 does. The 837 TR3 does not have front-matter detail.

Submitter Assigned Keywords

837 CAS Group Codes Adjustment Trio

Response

The CAS segments in the 837 were designed to function as they do in the 835 to report adjustments. The intent of the TR3 is that the six iterations (trios) of the Adjustment Reason Code related to the Claim Adjustment Group Code should be exhausted before repeating a second iteration of the CAS segment using the same Adjustment Group Code, however there is no requirement to do so."

Recommendation:

When using the CAS segments, follow the requirements outlined in the 835 TR3 to use all six iterations of the "adjustment trios" before creating a new CAS segment for the same Claim Adjustment Group Code."
Submission 6/11/2013
Status Date 7/19/2013
Status F - Final
Primary References
Document 005010X223
SectionNo Sect