CIP.002.027

ADJUSTMENT-REASON-CODE

Data Element

DE Number

CIP027

System DE Number

CIP.002.027

File Name

CIP - CLAIM INPATIENT

File Segment Number

CIP00002

File Segment Name

CLAIM-HEADER-RECORD-IP

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Claim adjustment reason codes communicate why a claim was paid differently than it was billed.
Size	X(3)
FLF Start Position	159
FLF Stop Position	161
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Adjustment Reason Code List (VVL) 2. Value must be 3 characters or less 3. Conditional 4. Value must be populated when the total paid amount is different from the total billed amount

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

Adjustment Reason Code List

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-341	If the adjustment reason code is populated on a non-denied claim from an IP file, then the adjustment reason code reported must be found in the list of valid values.
RULE-6743	If a claim line is a non-denied claim line from an IP file, then the adjustment reason code value reported must be compatible with specified T-MSIS picture format: X(3).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CLT026	CLT.002.026	ADJUSTMENT-REASON-CODE	CLT00002	CLAIM-HEADER-RECORD-LT
COT026	COT.002.026	ADJUSTMENT-REASON-CODE	COT00002	CLAIM-HEADER-RECORD-OT
CRX026	CRX.002.026	ADJUSTMENT-REASON-CODE	CRX00002	CLAIM-HEADER-RECORD-RX