We at MassHealth are also trying to figure out how to calculate the 'other
carrier allowed amount' at the service line level.
I'd greatly appreciate your help in determining the details of how the
'other carrier allowed amount' can be calculated from the CAS segments at
the service line level.
Regards,
Anita Mahesh,
MassHealth.
-----Original Message-----
From: Jan Root [SMTP:[EMAIL PROTECTED]]
Sent: Monday, January 28, 2002 2:15 PM
To: [EMAIL PROTECTED]
Cc: [EMAIL PROTECTED]
Subject: Re: COB / 837 Question
Susan
See below for the 837 professional:
"Scardina, Susan" wrote:
> Has anyone found fields in the 837I, 837P, and 837D (at the
service line,
> not the claim header) to map the following information?
>
> - The other carrier allowed amount
Page 334 for claim level. This can also be calculated from the CAS.
>
> - The other carrier paid amount
Page 332 for claim level. See SVD02, page 55 for this amount at the
line level.
>
> - The other carrier deductible amount
This must be calculated from the CAS information. See code
"1-Deductible".
>
> - The other carrier ineligible amount
This must be calculated from the CAS. There are various codes that
would apply.
Hope this helps.
Jan Root
>
>
> Thanks,
>
> Susan Scardina
> Product Manager
> TriZetto
>
>
>
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