Instructions for Electronic Billing of MSP Claims:
Claim Level Primary Payer Paid Amount
For claim level information, physicians and suppliers must indicate the other payer paid amount for the claim in loop 2320 AMT01 = D (qualifier) and AMT02 the monetary amount. NOTE: All line level payments when added together must equal the total amount paid on the claim.
Claim Level Primary Payer Allowed Amount
For claim level information, physicians and suppliers must indicate the other payer allowed amount for the claim in loop 2320 AMT01 = B6 (qualifier) and AMT02 the allowed amount. NOTE: All line level allowed amounts must equal the total allowed amount on the claim when added together.
Claim Level Obligated to Accept as Payment in Full Amount (OTAF)
For claim level information, physicians and suppliers must indicate the OTAF amount in loop 2300 CN101 = 9 and CN102 = the OTAF amount. This amount must be greater than zero if there is an OTAF amount.
NOTE: All line level OTAF amounts must equal the total OTAF amount on the claim when added together.
Line Level Primary Payer Paid
For line level information, physicians and suppliers must indicate the other payer paid amount for that particular service in loop 2430 SVD02.
Line Level Primary Payer Approved
For line level information, physicians and suppliers must indicate the other payer approved amount for that particular service in loop 2400 AMT01 = AAE (qualifier) and AMT02 the monetary amount.
Line Level Obligated to Accept as Payment in Full Amount (OTAF)
For line level information, physicians and suppliers must indicate the OTAF amount for that service line in loop 2400 CN101 = 9 and CN102 is the OTAF amount. This amount must be greater than zero if there is an OTAF amount.
