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Back  RFI # 405: COB Payer Paid Amounts

Formal vs. Informal Help Informal Formal

Submitter

Kelly Butler

Description

Can you please explain when the Payer Prior Payment Segment should be used and when the COB Total Medicare Paid Amount Segment should be used on Medicare secondary claims when these segments essentially mean the same thing? It appears that some government payers are requiring one versus the other and are not consistent.

Response

Loop 2320 Payer prior payment segment is used to report the amount paid to provider by a payer. Loop 2320 Coordination of Benefits (COB) Total Medicare Paid Amount segment is used report the amount paid to provider by Medicare.

Note: Loop 2320 Coordination of Benefits (COB) Total Medicare Paid Amount was removed from version 5010 to avoid confusion in the future.

Recommendation

Workgroup recommends that Loop 2320 Coordination of Benefits (COB) Total Medicare Paid Amount segment be used only in payer to payer scenarios. In all other scenarios, report the Previous payor paid amount in loop 2320 Payer Prior Payment.
Submission 4/28/2006
Status Date 6/16/2006
Status F - Final
Primary References
Document 004010x096a1
SectionDetail
Page365
Set ID0
Table2
Loop2320
Segment Position300
Segment IDAMT
Element Position01
Industry NamePayer Prior Payment