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Back  RFI # 811: 837 - copay in NTE segment

Formal vs. Informal Help Informal Formal

Submitter

Braun Deanna

Description

We have a payer that has requested that we send the copay amount in our outbound 837 professional. They have requested that it be sent in the NTE02 element. They want the value "COPAY" then the actual copay amount followed by any test data we would have normally sent. I told them we could send in the AMT*F5 but they insist on the NTE. This is the patient copay so there is no crossover segments that can be used. I feel this is not a standard request.

Submitter Assigned Keywords

837 copay

Response

This issue is explicitly addressed in guide 004010X098. The note on the 2400 loop NTE segment reads "Required if submitter used a"not otherwise classified" (NOC) procedure code on this service line (use ADD in NTE01). Otherwise, use at providers discretion." Since this payer request is not related to an NOC code, the payer has no authority under the guide to request the usage of this segment for copay information. The usage is entirely at the provider's discretion.

Recommendation

If you want or need to report what the patient paid, then you do so in the patient paid amount AMT.
Submission 7/14/2009
Status Date 9/14/2009
Status F - Final
Primary References
Document 004010X098
Section2
Page488
Set ID837P
Table2
Loop2400
Segment IDNTE