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Back  RFI # 998: Clarification of HIR 277

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Submitter

Janice Cunningham

Description

I need it specifically stated if reporting zero as an amount in a CAS segment noncompliant as well inconsistent with the guide. I referred a payor to HIR 277 for clarification and their response is that while sending zero amounts is inconsistent it still compliant. I need a clarification for the sake of the payor.

Submitter Assigned Keywords

CAS zero amount clarification

Response

This issue is explicitly stated in guide 004010X091. Section 1.1.2 states "If adopted under HIPAA, the X12N 835 Health Care Claims Payment Advice transaction cannot be implemented except as described in this Implementation Guide."

Therefore, anything that is not consistent with the implementation guide is not compliant with the implementation guide.

Since HIR # 277 has already established that sending zero as the adjustment amount in a CAS segment is inconsistent with the guide, that makes sending a zero dollar adjustment non-compliant with the guide.

Please refer to disclaimer on the Portal home page referring to interpretation of HIPAA compliance.
Submission 3/23/2010
Status Date 5/21/2010
Status F - Final
Primary References
Document 004010X091
Section1
Set ID835
Table2
Loop2100
Segment IDCAS