Insurance > Claim Adjustment Reason Codes

Key Info  
Purpose:

Review claim adjustment reason codes which are used to explain why a claim was adjusted and not paid in full.
Related Module(s):

Insurance, EDI Claims / Remittance
Accessed From:

Maintenance > Insurance > Claim Adjustment Reason Codes
Window(s):

Claim Adjustment Reason Codes

Dependencies: Adjustment Codes

Claim Adjustment Reason Codes Window

Claim adjustment reason codes are standardized HIPAA X12N codes that explain why a claim was adjusted and not paid in full.

Important: If you want to enable Intelli-adjustments, you must create default Intelli-adjustment rules by adding a default Adjustment Process and Adjustment Code to each claim Adjustment Reason Code you want to use. When a file is processed for an insurance company that uses Intelli-adjustments, it uses the created rule. For more information refer to the EDI Remittance Setup Guide.

The Claim Adjustment Reason Codes window allows you to review and manage these reason codes.

Note: Several types of predefined HIPAA (X12N) standardized codes are required for the EDI Remittance module. These are loaded by axiUm Support at the time of installation. You are responsible for any changes required after installation.

Field Description
Code

A text field that indicates the unique code that identifies the claim adjustment reason.
Description

A text field that indicates the description that displays in axiUm.
Inactive A check box that, when selected, indicates this code is inactive and not in use.
Type

A drop-down list that indicates the type of reason code (as defined by the HIPAA X12N code):

  • Deductible
  • Co-Ins
  • Co-Pay
  • Other
Group Code

A drop-down list that indicates the type of group code (as defined by the HIPAA X12N code):

  • CO: Contractual Obligations
  • CR: Correction & Reversals
  • OA: Other Adjustments
  • PI: Payor Initiated Reductions
  • PR: Patient Responsibility
Adjustment Process

A drop-down list that indicates the auto-adjustment process:

  • None (leave balance)
  • Transfer to Patient
  • Write-off

    Important: This field should only be completed if you are enabling intelli-adjustments.

Adjustment Code

Note: This field is only enabled if an Adjustment Process is entered.

A text field that indicates the adjustment code used for this intelli-adjustment rule.

The ellipsis is used to display the Adjustment Codes window and select an adjustment code.

Tip: We recommend you select an adjustment code that is unique to a group of reason codes.

Example: PLR – Patient Limited reached.
Task Procedure
Add Claim Adjustment Reason Codes
  1. Click the Clear Data () icon.
  2. Complete the fields as necessary and click the Add a new Record () icon.
Edit Claim Adjustment Reason Codes
  1. Select a listed entry.
  2. Make any necessary changes and click the Modify Record () icon.
Delete Claim Adjustment Reason Codes
  1. Select a listed entry and click the Delete Record () icon.
  2. When prompted, click Yes to confirm the deletion.
Preview/Print Report
  1. (Optional) To preview the Claim Adjustment Reasons report, click the Preview Report () icon.
  2. To print the Claim Adjustment Reasons report, click the Print Report () icon.

    3. Note: The Claim Adjustment Reasons report uses the careason.rpt file.