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The Medicare Approved Amount is not reported in an 837 claim, it is calculated based on the Medicare Paid amount and the Coinsurance and Deductible amounts.
In Coordination of Benefits, if the prior payer adjudicated the claim at the claim level and provided claim level adjustments, it is required to send the claim-level adjustment CAS segment (Loop-ID 2320). However, if the claim was adjudicated at the line level, then a line-level CAS segment is required (Loop-ID 2430).
Please review the notes for the CAS segment in Loop-ID 2320 and 2430 in your Companion Guide for the 837 Institutional, Professional, or Dental. Also review the sections for coinsurance and deductibles in your Supplemental Companion Guide. |
