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Back  RFI # 933: Clarification request, #802

Formal vs. Informal Help Informal Formal

Submitter

L C E Wong

Description

Clarification is needed for HIR #802

In the first paragraph, the last sentence reads:

If no tax is being paid, the AMT is not required.

This doesn't identify who would be paying the tax (payer/patient). Do you mean "If no tax is being paid [by any party], the AMT is not required."?

Primary and secondary payers as well as patient payers need to know their responsibility when AMT is submitted. As it reads, AMT tax information can be excluded if it is zero. This information should be passed on so other payers will be able to process the AMT tax.

The final responsibility is the patient payer. As per certain State laws, the AMT tax needs to be shown so that patient knows their AMT responsibility.

Submitter Assigned Keywords

AMT TAX

Response

The AMT Segment amount does not establish any responsibility.

There is a CARC to be used to report a reduction for the Sales Tax for the provider/patient.
There is a CARC to be used to report a reduction for the HealthCare Tax for the provider/patient.
The amount of the service payment in the SVC03 can include the tax and is being paid by the current payer.

This applies to non-Pharmacy remittance advices only.
Submission 12/30/2009
Status Date 7/30/2010
Status F - Final
Primary References
Document 004010X091A1
Section3
Page158
Set ID835