Section title: Requests for Interpretation
2320.AMT.D for subsequent payer (837)

Please confirm whether 2320.AMT.D = 0 should be allowed for payer's subsequent to the active payer when 2010AC (Pay To Plan) is NOT present.  Would this be a correct submission given the other payer identified in 2330B has not yet adjudicated the claim?


2000B SBR~P~18~~PAYER A~~~~~ZZ

2320 SBR~S~18~PAYER B~~~~~~12

2320 AMT~D~0

RFI Response

Per the situation rule “Required when the claim has been adjudicated by the payer identified in Loop ID-2330B of this loop.  OR Required when Loop ID-2010AC is present.  In this case the claim is a post payment recovery claim submitted by a subrogate Medicaid agency.  If not required by this implementation guide, do not send,” the COB Payer Paid Amount segment should not be sent since the subsequent payer defined in 2330B has not adjudicated the claim.  When situationally required, it is acceptable to send “0” as the amount paid.


RFI Recommendation

Related RFIs: 1182