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Back  RFI # 2239: 2110 AMT*B6 COB allowed

Formal vs. Informal Help Informal Formal

Submitter

Barber Meg

Description

In subsequent payer reporting situations where we are not the primary payer, how should the 2110 AMT*B6 be populated for the following example
Charge 100
Prior payer allowed 75, (CO 45 for 25, PR 3 for $10, paid 65)
EX1: As we are secondary payer would only have allowed 70, so we paid up to 70 and we pay only $5 with a CO 45 of $5 advising why we did not pay the full $10 coming to us) What should the AMT*B6 value be $70 or $5. ( note we would report the CAS as OA 23 for $90 and CO 45 for 5.
EX2 As we are secondary payer would only have allowed 75, so we paid up to 75 and we pay only $10. What should the AMT*B6 value be $70 or $5. ( note we would report the CAS as OA 23 for $90 and CO 45 for 5.

Submitter Assigned Keywords

AMT*B6 COB line allowed

Response

In the 005010X221A1 guide, the note for the B6 qualifier in Loop 2110 AMT SERVICE SUPPLEMENTAL AMOUNT, explicitly states “Allowed amount is the amount the payer deems payable prior to considering patient responsibility.”
The AMT would not be reduced because of a prior payer’s payment. So for EX1, the AMT*B6 would be $70, and for EX2 the AMT*B6 would be $75. 005010X221A1The note for the B6 qualifier in Loop 2110 AMT SERVICE SUPPLEMENTAL AMOUNT, explicitly states “Allowed amount is the amount the payer deems payable prior to considering patient responsibility.”

The AMT would not be reduced because of a prior payer’s payment. So for EX1, the AMT*B6 would be $70, and for EX2 the AMT*B6 would be $75.
Submission 10/2/2017
Status Date 1/11/2018
Status F - Final
Primary References
Document 005010X221
Section1.10.2.1
Page38
Loop2110