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 | 1785 | Claim Adjustment Group Code | Mandatory | Alphanumeric | 1/10 | 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 |
Element Details
ID1785
NameClaim Adjustment Group Code
LengthMin 1 / Max 10
Position1
RequirementMandatory