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Back  RFI # 315: APPROVED AM0UNT FOR 837

Formal vs. Informal Help Informal Formal

Submitter

CHERYL FINCHER

Description

The 837P guide identifies a COB related Approved Amount and an Allowed Amount at the 2320 loop AMT segments and then a COB related Approved Amount at the 2400 loop. Is there a requirement for balancing from the 2400 loop Approved Amount to the 2320 loop and (if so) which claim level AMT segment (Approved or Allowed amount) would be part of the balancing?

Submitter Assigned Keywords

APPROVED ALLOWED

Response

There is no requirement that the 2400 loop balance to the 2320 loop as it relates to the COB Approved Amount. The 2320 COB Approved Amount must be the total approved amount for the claim. The 2400 COB Approved Amount, if used must be the approved amount for the service line. While it is logical that the sum of the 2400 COB Approved Amounts at the Service Line level equal the 2320 COB Approved Amount, there is no such requirement in the Implementation Guide.
Submission 8/29/2005
Status Date 11/11/2005
Status F - Final
Primary References
Document x098A1
Section3
Page316
Set ID837P
Table2
Loop2320
Segment Position300
Segment IDAMT
Industry NameApproved Amount & Allowed Amount
Secondary References
RFI ID 280
Document x098A1
Section3
Page462
Set ID837P
Table2
Loop2400
Segment Position475
Segment IDAMT
Industry NameApproved Amount