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Back  RFI # 323: TS320

Formal vs. Informal Help Informal Formal

Submitter

Debby Roggenbuck

Description

Can we use the TS320 for Professional services fee for Medicare Part D and/or NON-Medicare Part D?

Submitter Assigned Keywords

Medicare Part D; Professional Services Fee

Response

This issue is explicitly addressed in guide 004010X091. Note 1 on the TS3 segment states "Only Medicare Part A should use the data elements in TS306-24." While this is not an prohibition, it indicates the intent that TS3-20 not be used outside of Medicare Part A claims. In addition, the note on TS3-20 states "The professional component amount must also be reported in the CAS segment with a Claim Adjustment Reason Code value of 89." This indicates that the professional component amount totalled in TS3-20 is NOT being paid as part of the claims within the specific 2000 loop of the 835. If that does not match your business situation, then usage of TS3-20 is not appropriate.

Recommendation

Since future versions of the 835 implementation guide explicitly prohibit usage of TS3-20 by other than Medicare Part A, usage by any payer other than Medicare Part A under the current guide is NOT recommended.
Submission 9/12/2005
Status Date 11/11/2005
Status F - Final
Primary References
Document 004010X091A1
SectionASC X12N
Page80
Set ID835
Table2
Loop2000
Segment IDTS3
Element Position20