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Back  RFI # 344: CAS Zero Dollar Amount

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Submitter

Carol Lewis

Description

We reviewed the sections referred to in HIR277; however, there is an associated comment on CAS03 - COMMENT: When the submitted charges are paid in full, the value for CAS03 should be zero. The comment clearly supports that zero dollar amount is valid.

The following is an example of a business reason to submit a CAS trio with zero dollar amounts:

On institutional claims, we may receive zero charge lines where we received an out patient claim listing 2 -surgeries performed on the same day. The second surgery is listed with revenue code Y3600 and zero for the charge. All charges for the Surgery room are found under the first surgery. The zero charge line is built to report the HCPC for the surgery. This particular line was denied with E696. Since this line had a disposition of 500 (system denial) the CAS segment is built using the line charge amount.

Please review this situation and your earlier decision ruling that zero dollar amounts should not be submitted in a CAS segment trio.

Submitter Assigned Keywords

CAS03 CAS Zero Dollar Amount

Response

The comment referenced is part of the X12 standard from when the Claim Level CAS segment was Mandatory. The Comment has subsequently been removed from the X12 standard.

The implementation guide provides further restrictions than those of the base X12 standard. As written, the guide does not allow for zero dollar amount CAS entries. We stand behind our response in HIR # 277. If your system generates $0 CAS segments, then you must suppress them before sending your 835.
Submission 10/21/2005
Status Date 12/6/2005
Status F - Final
Primary References
Document 004010X091A1
SectionN/A
Page95
Set ID835
Table2
Loop2100
Segment Position020
Segment IDCAS
Element Position03
Industry NameAdjustment Amount
Secondary References
RFI ID 307
Document 004010X091A1
SectionN/A
Page148
Set ID835
Table2
Loop2110
Segment Position090
Segment IDCAS
Element Position03
Industry NameAdjustment Amount