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Back  RFI # 349: 835 - Balancing IME Amounts

Formal vs. Informal Help Informal Formal

Submitter

Artis D'Ann

Description

We are receiving 835s from our Medicare FI where they are reporting the Indirect Medical Educational (IME) amounts in the TS206 and MIA18; however, the 835 IG indicates that MIA13 is the "PPS-Capital IME Amount", while MIA18 is the "Claim Indirect Teaching Amount". Our 3rd Party HIPAA testing service indicates that the amounts in TS206 and MIA13 should balance. How shouldthe IME amounts balance in the 835?

Submitter Assigned Keywords

835, IME

Response

The amounts reported in the 835, if present, must balance at three different levels; specifically at the service line, the claim, and the transaction levels. The balancing at the service level involves the SVC and CAS segments. Claim level balancing involves the CLP and (claim) CAS segments, in addition to the service level balancing, if present. Finally the transaction balancing involves the BPR, CLP, and PLB segments.

MIA18, MIA13, and TS206 do not impact the integrity of the financial transaction and therefore are not part of the balancing requirements of the 835. They are solely informational elements used to convey additional detail to the provider.

TS206 is the total IME while MIA18 is the IME amount for the claim. Consequently there is an implied expectation that the sum of MIA18's within the 835 would equal the amount reported in TS206 even though it is not a requirement that it does balance.

There is no balancing relationship, real or implied, between TS206 and MIA13.
Submission 10/26/2005
Status Date 12/6/2005
Status F - Final
Primary References
Document 004010X091A1
Section3
Page118
Set ID835
Table2