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Back  RFI # 776: 837P AMT 2320 & 2400 Segments

Formal vs. Informal Help Informal Formal

Submitter

Elizabeth Cramer

Description

A Payer is requiring a Provider submit the following 837P Loops: 2320 AMT*AAE (Approved Amt), 2320 AMT*B6 (Allowed Amt) and 2400 AMT*AAE (Allowed Amt) in COB billing situations. The 837P 4010X098 IG Notes for all these segments specifically indicate the following:"Used primarily in payer-to-payer COB situations by the payer who is sending this claim to another payer. Providers do not usually complete this information but may do so if the information is available."

Given these Notes, can a Payer REQUIRE these segments from a Provider?

Response

In the 004010A1X098 Implementation Guide there is no situational usage note that would require a provider to report this information. A provider may report the information if it is available, but it is not required.
Submission 5/4/2009
Status Date 6/15/2009
Status F - Final
Primary References
Document 4010X098
Section3
Page333
Set ID??