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Back  RFI # 2044: CAS OA*94 vs CAS CO*94

Formal vs. Informal Help Informal Formal

Submitter

Paulette Turner-Coleman

Description

Is it compliant to use CAS*CO*94 with a negative $ amount when we pay in excess of billed charges. Our provider is indicating that we should be using CAS*CO*94 instead of CAS*OA*94.

Response

In the 005010X221A1, in section 1.10.2.6 on Procedure Code Bundling and Unbundling and in section 1.10.2.13 Secondary Payment Reporting Considerations, the use of the group code OA with the CARC of 94 is explicitly stated. In those cases, the use of CO with 94 would be inappropriate.

In cases other than these two, the guide does allow Claim Adjustment Group Codes of CO and OA with Claim Adjustment Reason Code 94. The specifics of the business dictate which codes would be used. If paying in excess of the submitted charge is because of "a joint payer/payee contractual agreement or a regulatory requirement", then CO would be required.
Submission 5/5/2015
Status Date 9/21/2015
Status F - Final
Primary References
Document 005010X221A1
Section1.10.2.4