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Back  RFI # 453: 2300 CLM Net

Formal vs. Informal Help Informal Formal

Submitter

Keni McMurtry

Description

The 837p IG does not provide specific instruction when it comes to what type of amount should appear in 2300 CLM02. Industry standard, when it comes to Ambulance claims, has always been the Gross Charge total for the claim. Adjustments are not subtracted to form this total.

Recently one carrier has begun requiring Net amount to appear here or they will end up paying the gross amount for the claim and forcing the provider to refund them later. The carrier advised they are aware of the issue and that they will correct it sometime in future. We are not looking for proof they are non-compliant, but we would like to know if there is some clarification we are missing as to amount for that field in order that we, the software vendor, will be able to determine if we should indeed add an option for users to output NET amount in CLM02.

Submitter Assigned Keywords

2300 CLM NET GROSS

Response

The CLM02 is the total claim charge amount. It represents the total billed charges for all of the service lines within the claim in order to create a balanced claim. Any adjustments to the total billed charges should be addressed in the adjudication process and the subsequent remittance advice. If this varied by carrier, it would cause problems with COB claims. The provider would not be able to fulfill their obligation to report the remittance information as they received it and still have a balanced claim.
Submission 9/14/2006
Status Date 11/6/2006
Status F - Final
Primary References
Document 004010X098A1
SectionX12N
Page170
Set ID837p
Loop2300
Segment Position130
Segment IDCLM
Element Position02
Industry NameZOLL Data Systems