AMT

Payer Prior Payment

Pos: 300	Max: 1
Detail - Optional
Loop: 2320	Elements: 2

Ref

Id

Element Name

Req

Type

Min/Max

Usage

AMT01

522

Amount Qualifier Code
Description: Code to qualify amount

M

ID

1/3

Required

Code

Name

C4

Prior Payment - Actual

Description: Amount paid in reality at an earlier time

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Other Payer Patient Paid Amount
UB-92 Ref. [UB-Name]: 54 (A-C) [Prior Payments - Payers and Patient]
EMC v.6.0 Reference: Record Type 30 Field No. 25 (Sequence 01-03)

M

R

1/18

Required

Notes:

1. The amount this payer has paid to the provider towards this bill.
2. This segment is required when the present payer has paid an amount to the provider towards this bill.

Example:

AMT*C4*150~