Change Request Detail
No.
1187
Date
3/5/2013
Submitter
Type of Request
Payment of a Health Care Claim
Status
DSMO Process Completed
Business Reason
For version 005010, an inconsistency exists in instructions for using the claim level AMT segment when reporting secondary payments.  Section 1.10.2.13, page 39, states, "Report the claim coverage amount or service allowed amount in the claim level AMT segment using qualifier AU (claim level) or B6 (service level) in AMT01."  However, no qualifier value B6 is listed for the claim level AMT segment at position number 620, pages 182-183.

Also note that the examples in section 3.3, starting on page 232, use an AMT01 qualifier value of AU for service line adjustments; however, no qualifier value of AU is listed for the service line level AMT segment at position number 1100, pages 211-212.
Suggestion
Correct inconsistencies where and as applicable.
DSMO Category
C
Recommendation
Approve. Inconsistencies between the front matter, implementation detail and examples will be corrected in a future version.
Appeal Recommendation