CAS Claims Adjustment

Opt

AtMax 99

To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid

Elements

Position	Element	Name		Type	Min/Max	Repeat

1	1033	Claim Adjustment Group Code	Mandatory	ID	1/2	AtMax 1
2	1034	Claim Adjustment Reason Code	Mandatory	ID	1/5	AtMax 15
3	782	Monetary Amount	Mandatory	Decimal	1/18	AtMax 1
4	380	Quantity	Opt	Decimal	1/15	AtMax 1
5	1034	Claim Adjustment Reason Code	Rel	ID	1/5	AtMax 1
6	782	Monetary Amount	Rel	Decimal	1/18	AtMax 1
7	380	Quantity	Rel	Decimal	1/15	AtMax 1
8	1034	Claim Adjustment Reason Code	Rel	ID	1/5	AtMax 1
9	782	Monetary Amount	Rel	Decimal	1/18	AtMax 1
10	380	Quantity	Rel	Decimal	1/15	AtMax 1
11	1034	Claim Adjustment Reason Code	Rel	ID	1/5	AtMax 1
12	782	Monetary Amount	Rel	Decimal	1/18	AtMax 1
13	380	Quantity	Rel	Decimal	1/15	AtMax 1
14	1034	Claim Adjustment Reason Code	Rel	ID	1/5	AtMax 1
15	782	Monetary Amount	Rel	Decimal	1/18	AtMax 1
16	380	Quantity	Rel	Decimal	1/15	AtMax 1
17	1034	Claim Adjustment Reason Code	Rel	ID	1/5	AtMax 1
18	782	Monetary Amount	Rel	Decimal	1/18	AtMax 1
19	380	Quantity	Rel	Decimal	1/15	AtMax 1

ID1033

NameClaim Adjustment Group Code

LengthMin 1 / Max 2

Position1

RequirementMandatory

Codes