New Error Message on Reject Report HB997ZRJ-A
The following balancing/validation process will be performed for all payers that have made payment prior to Medicare. Ensure within the balancing routine that each payers submitted and paid amount correlate with the appropriate CAS segments.
CLAIM BALANCING CALCULATION FOR PRIMARY/SECONDARY PAYER:
RECORD 575 FIELD 2 = "P" OR "S"
RECORD 585 FIELD 7 = CORRESPONDING PAYERS SUBMITTED CHARGE
(AMT-02-LOOP 2320 QUALIFIER T3)
MINUS:
RECORD 580 AND 660 = SUM OF ALL CLAIM AND LINE LEVEL CAS SEGMENTS
(LOOP 2320/LOOP 2430; CAS03, CAS06, CAS09, CAS12, CAS15, AND CAS18)
EQUALS:
RECORD 585 FIELD 3 = TOTAL PRIMARY PAYERS PAID AMOUNT
(AMT-02 LOOP 2320 QUALIFIER C4)
VALIDATION OF STANDARD ADJUSTMENT REASON CODES PRIMARY/SECONDARY
RECORD 575 FIELD 2 = "P" OR "S"
RECORD 580 AND 660 = ALL CLAIM AND LINE LEVEL CAS SEGMENTS
(LOOP 2320 AND LOOP 2430)]
Page Last Updated: Wednesday, 31-Dec-2008 10:49:00 CST
