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Back  RFI # 781: CLP04 & Prompt Payment Disc

Formal vs. Informal Help Informal Formal

Submitter

Dora Lambert

Description

Our interpretation of the 835 IG is that interest and prompt payment discounts should be reflected in the PLB segment of the 835, and that CLP04 should be the payment amount prior to any discounts or interest.

For prompty payment discounts, one of our providers disagrees with our assessment and thinks the CLP04 should be the amount after the discount is applied. They do, however, agree the CLP04 should not include interest.

For prompt pay discounts, the provider suggests we include a CAS segment with a CO group code and use CARC 44 (prompt pay discount) instead of reflecting the adjustment in the PLB segment. We agree the CAS should be created if the patient is repsonsible for the prompt pay discount amount, however, this is not the case.

Note, we include the AMT segment with a D8 qualifier and the discounted amount for each applicable claim.

Can you clarify if the amount in CLP04 should be the payment amount prior to prompt pay discounts?

Submitter Assigned Keywords

835, CLP04, Prompt Pay Discount

Response

This issue is explicitly addressed in guide 004010X091. Section 2.2.9 specifically identifies that prompt payment discounts are reported in the AMT and PLB segments and not the CAS segment (which would include those amounts in CLP04). The exception is when the interest or discount is expended to the patient. Since you state that this is not the case, the amount in CLP04 must be the payment amount prior to prompt pay discounts.
Submission 5/13/2009
Status Date 5/21/2009
Status F - Final
Primary References
Document 4010X091A1
Section2.2.9
Page29
Set IDPLB
Secondary References
RFI ID 701
Document 401090X091A
Section3
Page91
Set IDCLP