RFI #
1059
276/277 - AMT 2200D/E Loops
Description
Can you explain to me the reasoning behind the AMT not being required any longer at the 2200D loop if the subscriber is the patient? And also, why it is not required at the 2200E loop if not in the 2210E loop?
RFI Response
The 2200D/E AMT segments in the 005010X212 Guide are Situational to allow for the business use case of a more open claim status request based on dates of service. As the Situational Rule indicates, the AMT segment is required when the provider wants the claim status request limited to a claim with a specific charge amount. The TR3 note indicates not all payers retain the total claim charge as submitted. For example on a split claim, the charge is changed and the result would be the claim is not located in the system.