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Back  RFI # 655: Patient Paid Amount

Formal vs. Informal Help Informal Formal

Submitter

Bob Resh

Description

The 837P defines the Other Payer Patient Paid amount as "The amount carried in this segment is the total amount of money paid by the payer to the patient". It also defines this as the amount conved in the 835 when AMT01 equals "F5" (Patient Amount Paid). The 835 defines this "F5" amount as "the amount the patient has already paid". These are two different things entirely. What should be reported in the 837P here? The amount that the patient paid or the amount that the patient was paid? The amount that the patient was paid would be reported in the 835 by a CAS segment with adjustment code "100" (Payment made to patient/insured/responsible party/employer).

Submitter Assigned Keywords

F5

Response

The Coordination of Benefits (COB) Patient Paid Amount segment in the 2320 loop of the 837P is the amount paid on this claim by the previous payer to the patient. The note on the AMT02 data element in this segment referencing a crosswalk from the 835 loop 2100 AMT with a F5 qualifier is in conflict with the segment note, and is incorrect.

Recommendation

The amount in the 835 loop 2100 AMT with a F5 qualifier is the amount that the patient has paid to the provider. In the 837P, that amount is reported in the loop 2300 AMT with a F5 qualifier.
Submission 5/21/2008
Status Date 7/23/2008
Status F - Final
Primary References
Document 004010X098A1
Section3
Page322
Set ID837P
Table2
Loop2320
Segment Position300
Segment IDAMT
Element Position2
Industry NameOther Payer Patient Paid Amount
Code ValueF5
Secondary References
RFI ID 593
Document 004010X091A1
Section3
Page135
Set ID835
Table2
Loop2100
Segment Position062
Segment IDAMT
Element Position2
Industry NameClaim Supplemental Information Amount
Code ValueF5