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Back  RFI # 618: 835 Line Level CAS Segments

Formal vs. Informal Help Informal Formal


Jennifer McMullin


Are CAS Segments REQUIRED at a line level for professional claims? The segment USAGE indicates SITUATIONAL, however section 2.2.1 states the following:

835 IG Page p. 19 Section 2.2.1 and section 2.2.4 p. 23-24

"Although the service payment information is optional, it is REQUIRED for all professional claims or anytime payment adjustments are related to specific line items from the original submitted claim. When used, the submitted service charge minus the sum of all monetary adjustments must equal the amount paid for this service line"

Does the above mentioned statement only apply to SVC segments or does it also apply to CAS segments?

Submitter Assigned Keywords



This issue is explicitly addressed in guide 004010X091. All of section 2.2.1 relates to balancing. Balancing for a service line involves the SVC and 2110 loop CAS segments. When the service payment does not equal the service charge, the CAS segment is required in order to balance. Anytime that there are service specific adjustments, the CAS segment is required. If the service specific payment equals the service charge and there are no service specific adjustments, then the service is balanced without a CAS segment, and no CAS segment is necessary.
Submission 12/20/2007
Status Date 12/21/2007
Status F - Final
Primary References
Document 004010X091A1
Set ID835