RFI #
1115
837P COB claim balancing
Description
It is my understanding that the claim balancing equationfor provider to payer to provider COB is 2300 clm_02 = 2320 AMT*D + sum of CAS adjustments in CAS_03,06,09,12,15; 18 and that the AMT*AAE and AMT*B6 do not enter into the equation at all.
RFI Response
That’s correct. The AMT segments for Approved and Allowed Amounts are for reporting there amounts. These segments only report information and should not be used for any balancing equations.
DOCUMENT ID
4010x098A1