Submitting Claims When the Billed Amount Exceeds $99,999.99

The Health Care Claim: Professional (837P) can be found on the CEDI - Technical Specifications website and contains information regarding the X12 837 Professional claim format including Medicare specific information and requirements. This is intended to be used in addition to the other X12 837P reference documents. This document clarifies and specifies data content when exchanging transactions electronically with Medicare.

One general rule pertaining to an 837P (Part B (DME) electronic claim) transaction is the maximum number of characters submitted in any dollar amount field is seven characters. Claims containing a dollar amount more than 99,999.99 will be rejected.

Claims for services that exceed this amount will have to be submitted on separate claims as follows:

Claim 1

  • Submit the service with an acceptable dollar amount (< 9999999.) See example below, splitting total. (Do not use dollar signs, decimals, dashes, commas for dollar amounts.)
  • In the narrative field, identify this as, "Claim 1 of 2; Dollar amount exceeds charge line amount."

Claim 2

  • Enter the charge as the remaining dollar amount from the total split.
  • In the narrative field, identify this as, "Claim 2 of 2; Remaining dollar amount from Claim 1 amount exceeds charge line amount."

You must note in the narrative the reason why the claim is split this way. It will deny as a duplicate without the narrative.

  • Narrative must be added in loop 2400 (line note), segment NTE02 (NTE01=ADD) of the ANSI X12N, version 5010A1 professional electronic claim format or on Item 19 of the paper claim form in the narrative field

Also, when splitting the charge of the service, be sure the dollar amounts are slightly different, as this will prevent the system from assuming the two claims are an exact duplicate.

Example: If the charge for a service is $100,000.00, submit the charge on Claim 1 as 5200000; on Claim 2 submit the charge as 4800000. Ensure the narrative is added as above. (Do not use dollar signs, decimals, dashes, commas for dollar amounts.)


Last Updated Sep 26 , 2022