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Back  RFI # 726: 004010X091A1 CAS Claim / PLB

Formal vs. Informal Help Informal Formal

Submitter

Anne Adams

Description

Principal requested a CARC for Late Payment Penalty (not interest) and the committee rejected. Please provide guidance as to how the data should be communicated on the 835.
Previous options considered:
Adjustment codes 44 and 45, each of these are in use today for Principal 835 communication (PPO Discount and Prompt Pay Discount)
Adjustment codes 103 and 131, denotes discount option - Late Payment penalty we are required to pay the provider.
Adjustment codes 144 and 161, special bonus - we're attempting to communicate a payer penalty.

Submitter Assigned Keywords

Payer Penalty / 835

Response

The workgroup recommends using the PLB segment to report the additional payment. To be forward compatible with 5010, the workgroup also recommends using qualifier CS and reporting the CLP01 value (CLM01 from 837) of the claim in PLB03-2.
Submission 1/26/2009
Status Date 4/13/2009
Status F - Final
Primary References
Document 004010X091
Section3
Set ID835
Table3
Loop2100
Segment IDCAS
Secondary References
RFI ID 650
Document 004010x091
Section3
Set ID835
Table3
Segment IDPLB