CRX.003.117

LINE-ADJUSTMENT-REASON-CODE

Data Element

DE Number

CRX117

System DE Number

CRX.003.117

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00003

File Segment Name

CLAIM-LINE-RECORD-RX

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Claim adjustment reason codes communicate why a service line was paid differently than it was billed.
Size	X(3)
FLF Start Position	149
FLF Stop Position	151
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Line 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.

Link to Line 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-6720	If a claim line is a non-denied claim line from an RX file, then the line 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
CIP240	CIP.003.240	LINE-ADJUSTMENT-REASON-CODE	CIP00003	CLAIM-LINE-RECORD-IP
CLT193	CLT.003.193	LINE-ADJUSTMENT-REASON-CODE	CLT00003	CLAIM-LINE-RECORD-LT
COT163	COT.003.163	LINE-ADJUSTMENT-REASON-CODE	COT00003	CLAIM-LINE-RECORD-OT