Section title: Requests for Interpretation
RFI #
2333
0 Billed Detail Line CAS
Description

Oregon Medicaid requires Managed Care plans to report all services provided on behalf of their clients. This includes service lines with no dollar amount. This business need also requires that our Managed Care submitters be able to reject liability on zero dollar services. We are hoping to determine whether our Managed Care plans can submit CAS on zero billed amounts to reject liability so the claim header will reflect rejected liability. As it stands, zero billed amount detail lines without CAS show in a paid status at the header. Previous RFI indicate that CAS should not be sent with monetary amount = 0. If x12 stands by those analyses we request that a recommendation be made for an alternative method to convey rejected liability for zero dollar details.

Response

The 005010X221A1 Health Care Claim Payment/Advice  addresses reporting of encounters in Section 1.10.2.19. Payment of zero dollar services is reported using Claim Adjustment Reason Code 94 with a negative dollar amount to represent the allowed amount for that service.

The reporting of prior claim adjudication and payment for subsequent claims submission or reporting purposes is populated based on the prior 835 information.

DOCUMENT ID
005010X224A2