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Back  RFI # 1830: AMT*KH and CARC B4

Formal vs. Informal Help Informal Formal

Submitter

Peter Anderson

Description

CARC B4 (Late filing penalty) and Amount Qualifier Code KH (Late Filing Reduction) appear to represent the same amount and would be required in exactly the same circumstances.

Is this true?
If so, why is the redundant AMT segment required for late filing penalties?
If not so, what is the distinction between the two amounts?

Response

The AMT segment is situational and is used to carry the actual amount of the Penalty for each service line. It is used to convey information only and is not used for balancing, but is required when the value is not zero.

The CARC B4 is part of the balancing of the 835 and is used to allow a provider’s system to automatically apply the data based on the CARC/RARC combinations received.

These two would most likely be used together especially when the adjustment and CARC/RARC is at the claim level, but the penalty is at the line level and may impact several lines.

There could also be an AMT segment populated at the service line level with no service line adjustments, and then all the adjustments for the service line AMT segments accumulated in the PLB segment to show the total amount of Penalty for all lines.
Submission 7/26/2013
Status Date 8/30/2013
Status F - Final
Primary References
Document 005010X221A1
Section2.4
Set ID835
Table2
Loop2110
Segment Position1100
Segment IDAMT
Element Position01
Industry NameAmount Qualifier Code
External Code ListCARC
Code ValueB4