Examples of Claims with the Claim Level Approved Amount Segment
The following examples show the 2320 loop when the claim-level approved amount segment is added to institutional and professional claims. The segment is displayed in bold text.
2320 loop for a professional claim with the claim level approved amount added
The following example shows how the 2320 loop for a professional claim looks with either the Submitter Profile or Payer option set to add the claim level approved amount. Since there is no distinction between the approved amount and the allowed amount in the claim file, the option to add the claim level approved amount adds both the approved amount (AMT*AAE) and allowed amount (AMT*B6) segments in a professional file.
CLM*000100000970*190***11**1*Y*A*Y*O*B******P~ REF*X4*CLIA123~ REF*EA*CP1Z3M3F8R23~ HI*BK*25000~ NM1*82*1*TEAM MD*ROBERT*A***24*404803109~ PRV*PE*ZZ*207QA0505X~ REF*1D*404803109~ SBR*P*18***C1****BL~ AMT*D*138~ AMT*AAE*157~ AMT*B6*157~ DMG*D8*19661013*F~ OI***Y*B**O~ |
2320 loop for an institutional claim with the claim level approved amount added
The following example shows how the 2320 loop looks for an institutional claim with either of the same two options set to add the claim level approved amount. The allowed amount segment is only defined at the claim level for an institutional claim and, therefore, there is no additional 2320 approved amount (AMT*AAE) segment in an institutional file. Also, since the 2320 AMT*B6 has always been added when an allowed amount is present on the transaction, no new segments are added with this option for an institutional claim.
CLM*000100000970*190***73*A*1*Y*A*Y*O*********Y~ DTP*434*RD8*20071130-20071130~ REF*EA*CP1Z3M3ZK5K7~ HI*BK*25000~ NM1*71*1*TEAM MD*ROBERT*A***24*404803109~ REF*1D*404803109~ SBR*P*18*******BL~ AMT*C4*138~ AMT*B6*157~ DMG*D8*19661013*F~ OI***Y***O~ |