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Back  RFI # 675: Purchased Service Charges

Formal vs. Informal Help Informal Formal

Submitter

Julia Dunicheva

Description

Purchased Service Charges segments AMT in loop 2300 and PS1 in loop 2400 can be used for non-vision and vision claims.
IG notes say that segment AMT in required when "there are purchased service components to this claim"; but note 2 says that for vision claims it's used when it "is known to impact adjudication or reimbursement".

So would it be compliant with the IG :
- to require usage of segment AMT when loop 2310C is used in a general situation, i.e. vision or non-vision
- to require usage of AMT when segment PS1 is used in loop 2400 in a general situation, i.e. vision or non-vision
- to require usage of loop 2420B when PS1 is used in loop 2400 in a general situation

Submitter Assigned Keywords

Purchased Service Charges

Response

This request questions the three specific relationships between purchased service related segments.

In regard to the first:
Yes, there must be a claim level purchased service amount (2300 AMT) when a claim level Purchased Service Provider (2310C NM1) is submitted. Both are required when the claim includes purchased services.

Second question:
Yes, there must be a claim level purchased service amount (2300 AMT) when a line level purchased service amount (2400 PS1) is submitted. Both are required when the claim includes purchased services.

Third question:
Yes, there must be a line level purchased service provider segment (2420B NM1) when a line level Purchased Service Information segment (2400 PS1) is submitted. Both are required when the service line contains purchased services.
Submission 7/29/2008
Status Date 11/12/2008
Status F - Final
Primary References
Document 004010X098A1
Section3.1
Page31
Set ID837
Loop2300
Segment IDAMT