Obligated to Accept Field (OTAF) - JA DME
Obligated to Accept Field (OTAF) for MSP
This is the amount the supplier agreed to accept from the primary payer when the amount is less than the charges but higher than the payment amount; then a Medicare secondary payment is due to the supplier.
There is not a specific column or area on an Explanaiton of Benefit (EOB) that indicates the OTAF amount; however, this amount is determined by other information that is listed on the EOB, such as:
- provider write-off,
- risk amount,
- service benefit credit,
- contractual adjustment,
- provider agreement,
- negotiated savings, or
- an amount that the beneficiary is not liable for.
If the beneficiary were not responsible for any of these amounts, then the OTAF amount would be the same as the amount the primary insurance paid. Using an OTAF amount will indicate that there is a discount that the beneficiary was not responsible for. This may have to be manually calculated, by taking the billed amount minus the discounts/adjustments to calculate the OTAF.
Example: When the allowable billed amount is $100, the primary insurance pays $45, the provider OTAF amount is $50, then Medicare would pay $5 as secondary
Last Updated Tue, 24 Apr 2018 09:46:48 +0000