Section title: Requests for Interpretation
RFI #
1116
837I Patient Paid Amount
Description

The 4010A1 version of the 837I (4010x096A1) included the Patient Paid Amount AMT segment (2300 loop, AMT01=F5). This segment was removed in the 837 5010x2223. How then are claim submitters to report amounts paid by the patient? (deductibles, co-pays, etc)

This capability was left in the 5010 versions of both the 837D and 837P. With the increase in real-time processing of claims transactions, and especially with the growth in CDHPs, it is important that this ability be available across all claims transactions.

RFI Response

Patient Paid Amount was removed from version 5010 of the 837I (005010X223A1) to eliminate two ways to report the same information. Patient Paid Amount should be reported using the (Value Information) HI Segment with a value code of FC along with the associated dollar amount.

DOCUMENT ID
005010X223