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Back  RFI # 802: 835 Tax amounts

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Submitter

Chip Evelsizer

Description

What are the 4010A1 835 requirements for including tax amount information?

The situational note for the line level AMT states "Use this segment only when the value
of specific amounts identified in the AMT01 qualifier are Non-zero." When all or part of the SVC03 includes tax, does the note mean that the amount of the tax MUST be broken out in the AMT? Does the method used for submitting tax on the 837/NCPDP have any impact on how the remittance must report tax back to the provider?

Submitter Assigned Keywords

TAX AMT

Response

For 4010 health claims (837 P/I/D) and all 5010 claims (837 P/I/D and NCPDP D.0), the Tax amount is dependent upon how the provider bills for either the sales or service tax: If the tax amount is billed separately from the charges with HCPCS S9999 or in the NCPDP D.0 tax field(s), you must populate the AMT segment using qualifier T to report the portion of the paid amount that is tax. If no tax is being paid, the AMT is not required.

If the tax amount is billed separately from the charges with HCPCS S9999or in the NCPDP D.0 tax field(s), but the payer bundles the tax amount into service procedure code, in addition to following the bundling rules, you must populate the AMT segment in the primary service line using qualifier T to report the portion of the paid amount that is tax.

continued...

Recommendation

If not billed separately from the service, but the payer knows that the care tax applies (for instance when tax was reported on the original claim or service, or known) and is being included in the payment, the payer must populate the AMT segment using qualifier T to report the portion of the paid amount that is tax.

For current rules on how to handle reporting tax under 4010 from a NCPDP 5.1 claim, please contact NCPDP for current guidance.
Submission 6/17/2009
Status Date 10/16/2009
Status F - Final
Primary References
Document 004010X096A1
Section3
Page158
Set ID835