Stream: CARIN IG for Blue Button®
Topic: C4BBEOB Inpatient 'adjdctn_amt'
Denise Bower (May 06 2021 at 15:37):
The rule states the following;
adjudication.amount (populate only if item.adjudication is not available): Eligible amount = submitted amount - the noncovered amount - discount. The subscriber pays the member liability = deductible + coinsurance + copay + noncovered. (part of the member liability may have already been paid to the provider as paidbypatient). The eligible amount - the member liability is the payment amount to the provider (paidtoprovider) or the subscriber (paidtopatient)
Will there ever be a situation where we would not have dollars at the line level? Is there a difference between no dollars and zero dollars?
Last updated: Apr 12 2022 at 19:14 UTC
