11/07/2023 |
3.16.0 |
CLT.002.025 |
UPDATE |
Segment key field identifier |
Not Applicable |
4 |
11/07/2023 |
3.16.0 |
CLT.002.025 |
UPDATE |
Coding requirement |
Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’ |
1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’ |
08/15/2023 |
3.12.0 |
CLT.002.025 |
UPDATE |
Coding requirement |
1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory |
Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory6. If value is in [‘0’, ‘5’, ‘6’ ], then associated Adjustment ICN must not be populated7. If value is in [‘4’, ‘1’] then Adjustment ICN must be populated8. Value must equal ‘1’, when associated Claim Status equals ‘686’ |
08/07/2023 |
3.11.0 |
CLT.002.025 |
UPDATE |
Coding requirement |
1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim (CE) value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim (CE) value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory |
1. Value must be in Adjustment Indicator List (VVL)2. If associated Type of Claim value is in [ 1, 3, 5, A, C, E, U, W, Y ], then value must be in [ 0, 1, 4 ]3. If associated Type of Claim value is '4, D, X', then value must be in [ 5, 6 ]4. Value must be 1 character5. Mandatory |
10/02/2020
|
2.4.0 |
LINE-NUM-ADJ
LINE-ADJUSTMENT-IND
|
UPDATE |
Data Dictionary |
|DE No|Data Element Name|Coding Requirement|CR No| |CIP238|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number. |Not Applicable| |CIP239|LINE-ADJUSTMENT-IND|If there is a line adjustment number, then there must be a line-adjustment indicator.|CIP239-0002| |CLT191|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.|CLT191-0002| |CLT192|LINE-ADJUSTMENT-IND|If there is a line adjustment number, then there must be a line-adjustment indicator.|CLT192-0002| |CLT192|LINE-ADJUSTMENT-IND|If there is a line adjustment reason, then there must be a line adjustment indicator.|CLT192-0003 |COT161|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.|COT161-0002| |COT162|LINE-ADJUSTMENT-IND|If there is a line adjustment number, then there must be a line-adjustment indicator.|COT162-0002| |COT162|LINE-ADJUSTMENT-IND|If there is a line adjustment reason, then there must be a line adjustment indicator.|COT162-003| |CRX115|LINE-NUM-ADJ|This field should be 8-filled, left blank or space-filled if the ADJUSTMENT-INDICATOR = 0. Otherwise, if there is a line adjustment indicator, then there should be a line adjustment number.|CRX115-002| |CRX116|LINE-ADJUSTMENT-IND|If there is a line adjustment number, then there must be a line-adjustment indicator.|CRX116-002| |
|DE No|Data Element Name|Coding Requirement|CR No| |CIP238|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.|Not Applicable| |CIP239|LINE-ADJUSTMENT-IND|Not Applicable.|CIP239-0002| |CLT191|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.|CLT191-0002| |CLT192|LINE-ADJUSTMENT-IND|Not Applicable.|CLT192-0002| |CLT192|LINE-ADJUSTMENT-IND|Not Applicable.|CLT192-0003 |COT161|LINE-NUM-ADJ|This field should be left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.|COT161-0002| |COT162|LINE-ADJUSTMENT-IND|Not Applicable.|COT162-0002| |COT162|LINE-ADJUSTMENT-IND|Not Applicable.|COT162-003| |CRX115|LINE-NUM-ADJ|This field should be 8-filled, left blank or space-filled if the ADJUSTMENT-INDICATOR = 0.|CRX115-002| |CRX116|LINE-ADJUSTMENT-IND|Not Applicable.|CRX116-002| |
11/23/2018
|
2.3.0 |
ADJUSTMENT-IND
|
UPDATE |
Data Dictionary - Valid Values |
N/A |
Valid values for ADJUSTMENT-IND has been updated per T-MSIS DD 2.1.
As per DD 2.1 the Valid values are:
0 Original Claim/Encounter/Payment 1 Void/Reversal/Cancel of a prior submission 4 Replacement/Resubmission of a previously paid/approved claim/encounter/payment 5 Credit Gross Adjustment 6 Debit Gross Adjustment |