AMT

Coordination of Benefits (COB) Patient Responsibility 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
	F2	Patient Responsibility - Actual

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Patient Responsibility Amount
This amount is a crosswalk from CLP05 in the 835 when doing COB.

1/18

Required

Notes:

1. Required if patient is responsible for payment according to another payer’s adjudication. This is the amount of money which is the responsibility of the patient according to the payer identified in this loop (2330B NM1).

Example:

AMT*F2*15~

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