Change Request Detail
No.
858
Date
2/26/2004
Submitter
Type of Request
Dental Claim
Status
DSMO Process Completed
Business Reason
Some states require reimbursement of taxes associated with services provided. 

Change request #239 added a tax amount, but the semantic note to CLM02 was not changed to reflect this additional data element.  Consequently, the tax amount is not included in the claim total.

The unintended consequence is that fees must be increased to include the appropriate taxes forcing the provider to misrepresent charges. 
Suggestion
Change the semantic note to CLM02 to include all amounts claimed, including taxes.
DSMO Category
D
Recommendation
Disapprove.  The DSMO note the solution already exists via the use of the line level tax AMT segment.  Additional clarification notes will be added to provide guidance on how to use the AMT segment for tax amounts and the associated balancing of the claim.
Appeal Recommendation