Donna
Note 1 (and 2 for that matter) are primarily syntax reminders. They are saying: you must use the LX segment to get to any claim/line data in the 835. It is possible to send an 835 that has only PLB information - the LX segment (hence the entire 2000 loop) is situational.
CAS segments do NOT identify what was paid. They identify the adjustments (not the same thing). You can get paid amounts from various segments CLP or SVC) but not from CAS segments.
The TS segments are reporting segments. They report certain totals. Sometimes those are 'we paid this much' types of totals. But, they are not part of balancing (although one would like them to be accurate).
Notice that the TS segments are situational - you can skip them entirely (and hence, skip the way they force you to sort the data below them). As I understand it the TS segments were primarily designed (and intended to be used) by Medicare (notice the segment note on TS2).
Hope this helps.
j
"Hayward, Donna M B230" wrote:
Note 1 of the LX Segment in Loop 2000 references "In the event that
claim/service information must be sorted,,,," The TS3 Segment notes
further reference the sort criteria as provider by bill type by fiscal
period.If the need for a sort is business driven and we have no need, would the
purpose of the TS3 and TS2 Segments be to identify dollars that are
considered and the CAS Segment to identify dollars that are actually paid?
I'm slightly confused as to purpose of each segment as Code Source 139:
Claim Adjustment Reason Codes indicated for usage in the CAS Segment are
very similar, if not in many cases the same, as data elements TS306 thru
TS24.Could someone clarify? Thank you...
Donna M. Hayward
A CIGNA HealthCare - EDI GATEWAY HIPAA Project Manager
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