AMT

Coordination of Benefits (COB) Payer Paid Amount

Pos: 300

Max: 1

Detail - Optional

Loop: 2320

Elements: 2

User Option (Usage): Situational

To indicate the total monetary amount

Element Summary:

	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
	D	Payor Amount Paid

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Payer Paid Amount
This amount is a crosswalk from CLP04 in the 835 when doing COB.

1/18

Required

Notes:

1. Required if claim has been adjudicated by payer identified in this loop. It is acceptable to show “0" amount paid.

Example:

AMT*D*411~

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