RFI Browser

Back  RFI # 251: 837D missing 2320 CAS segment.

Formal vs. Informal Help Informal Formal

Submitter

Brian Kitts

Description

Please provide an intepretation for this 'undocumented' validation for the 4010A1 837D IG. As a validator, we are being requested to report this situation as an error.

While not explicitly defined in the 4010A1 837D IG, if there is a 2320 AMT segment with AMT01 = "D", there should be a corresponding CAS amount to account for it. An error should be reported if, for example, there is an 2320 AMT segment with AMT01=D(Payor Amount Paid) and AMT02=120.00 and there is no CAS statement.

Submitter Assigned Keywords

837D missing 2320 CAS segment

Response

This issue is explicitly addressed in guide 004010X097. Note 4 on the 2320 CAS segment reads "Required if the claim has been adjudicated by payer identified in this loop and has claim level adjustment information. " The note on the referenced 2030 AMT segment (AMT01=D) states "Required if claim has been adjudicated by payer identified in this loop."

The additional requirement on the CAS, "and has claim level adjustment information", indicates that there are cases where the AMT segment will be present without the CAS segment. That will be when the claim has no claim level adjustment information. No error exists just because there is an AMT segment without a CAS segment.
Submission 5/2/2005
Status Date 5/3/2005
Status F - Final
Primary References
Document 004010X097A1
Section2320?
Page210
Set IDdetail
Loop2320
Segment IDCAS
Element Position03
Industry NameAdjustment Amount