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Back  RFI # 327: Use of NTE for Denial Desc.

Formal vs. Informal Help Informal Formal

Submitter

kerry zajicek

Description

One of our customers is receiving denials stating if there is a pd amount of $0.00, we must included in the NTE segment the denied narrative information from the primary payer remit.

This is the payors response,

Anytime you want/need to send information to go along with a MSP claim, you can use the NTE segment which is a narrative segment.

Another note as informational is whenever you send an MSP claim and the paid amount is $0.00 you HAVE to include an NTE segment with narrative information as to why there is no payment being made.

Is this an appropriate use of NTE and is it correct to require the secondary claim to be sent this way?

Kerry D. Zajicek
EDI Claims Division
Epic Systems Corporation
5301 Tokay Boulevard
Madison, WI 53711
kerry@epicsystems.com
(608) 271-9000

Response

This is an inappropriate use of the NTE segment. The segment note indicates that the NTE segment may be used if " The information is needed to substantiate the medical treatment and is not supported elsewhere within the claim data set." The information in this example may be carried in the CAS segments, and thus this usage fails the NTE segment requirements.
Submission 9/28/2005
Status Date 11/30/2005
Status F - Final
Primary References
Document 004010X098A1
Section2300 NTE
Page246
Set IDNTE02