Claim Level Adjustments (CAS) - Registry Setting

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Specify whether or not to include prior payments in Claim Level Adjustment (2320-CAS) and/or Service Level Adjustment (2430-CAS) when billing tertiary or subsequent guarantors.

'1' adds the field 'Include Prior Payer Paid Amount in Claim Level Adjustments/Service Level Adjustments (2320/2430-CAS)' to the Guarantor/Program Billing Defaults form.

 The prior payment will only be included in the Claim Level Adjustment (2320-CAS) and/or Service Level Adjustment (2430-CAS) when billing the tertiary or any subsequent guarantor. The Coordination of Benefits (COB) information for the secondary or any subsequent guarantor will report any prior payment amounts (2320-AMT*D - Payer Paid Amount) as CAS adjustments with Group Code 'CO - Contractual Obligations' and Reason Code '23 - The impact of prior payer(s) adjudication including payments and/or adjustments'.

'2' adds the following fields to the Guarantor/Program Billing Defaults form:

• Create CAS Segment For Prior Guarantor(s) For Non-Covered Charges
• Claim Adjustment Group Code
• Claim Adjustment Reason Code

These fields allow the user to indicate if a CAS segment should be created when there is at least one service in the claim that doesn't distribute to the guarantor being displayed at 2320.

 This logic only applies when the chosen guarantor is secondary or tertiary, as determined by financial eligibility order
Because 2320 is a Claim Level segment, if both values are used and there are any services for a prior guarantor that have liability and have payments, the payment amount will be seen in the CAS-03 segment along with the mapped Group Code and Reason Code from the Posting/Adjustment Codes Definition instead of the codes defined in Guarantor/Program Billing Default and a 0 amount for CAS-03.

'0' removes all of the fields from the form.