AMT

Coordination of Benefits (COB) Patient Paid Amount

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

F5

Patient Amount Paid

AMT02

782

Monetary Amount
Description: Monetary amount
Industry: Other Payer Patient Paid Amount
This amount is a crosswalk from AMT in the 835 (Loop CLP, position 062) when AMT01 = F5.

M

R

1/18

Required

Notes:

1. Required if claim has been adjudicated by the payer indentified in this loop and if this information was included in the remittance advice reporting those adjudication results.
2. The amount carried in this segment is the total amount of money paid by the payer to the patient (rather than to the provider) on this claim.

Example:

AMT*F5*15~