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: Payer Claim Adjustment Type Codes - XML Representation

Active as of 2022-11-10

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<CodeSystem xmlns="http://hl7.org/fhir">
  <id value="payer-claim-adjustment-type"/>
  <text>
    <status value="generated"/>
    <div xmlns="http://www.w3.org/1999/xhtml"><p>This code system <code>http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type</code> defines the following codes:</p><table class="codes"><tr><td style="white-space:nowrap"><b>Code</b></td><td><b>Display</b></td><td><b>Definition</b></td></tr><tr><td style="white-space:nowrap">1<a name="payer-claim-adjustment-type-1"> </a></td><td>Adjustment (positive or negative adjustment)</td><td>An adjustment is a claim line where one or more of the financial fields display the difference between the original amount and the final amount. Any financial not being adjusted should be zero as well as any quantity.</td></tr><tr><td style="white-space:nowrap">2<a name="payer-claim-adjustment-type-2"> </a></td><td>Void (void, reversal or back-out)</td><td>A void is a claim line where all financials and quantities are negated</td></tr><tr><td style="white-space:nowrap">3<a name="payer-claim-adjustment-type-3"> </a></td><td>Original or Replacement (original, resubmit or replacement)</td><td>An original or replacement claim line where all financials and quantities are positive and supplements a void claim line</td></tr><tr><td style="white-space:nowrap">4<a name="payer-claim-adjustment-type-4"> </a></td><td>Bulk Adjustment (gross or bulk adjustment)</td><td>Adjustments (positive or negative) that aren't tied to a particular service at the claim-line level.  Examples include, but aren't limited to, value-based reimbursement payments to providers, Drug Rebates, etc.</td></tr><tr><td style="white-space:nowrap">B<a name="payer-claim-adjustment-type-B"> </a></td><td>Adjustment Debit</td><td>Claim adjustments are sometimes required to correct erroneous payments made to providers. Adjustments may need to be made for a range of reasons, for example, recording of an incorrect procedure code, listing of a wrong place of service, data entry errors etc. A claim adjustment debit increases the balance due to the provider due to an underpayment made in error.</td></tr><tr><td style="white-space:nowrap">C<a name="payer-claim-adjustment-type-C"> </a></td><td>Adjustment Credit</td><td>Claim adjustments are sometimes required to correct erroneous payments made to providers. Adjustments may need to be made for a range of reasons, for example, recording of an incorrect procedure code, listing of a wrong place of service, data entry errors etc. A claim adjustment credit decreased the balance due to the provider due to an overpayment made in error.</td></tr></table></div>
  </text>
  <url
       value="http://linuxforhealth.org/fhir/cdm/CodeSystem/payer-claim-adjustment-type"/>
  <version value="8.0.0"/>
  <name value="PayerClaimAdjustmentTypeCodeSystem"/>
  <title value="Payer Claim Adjustment Type Codes"/>
  <status value="active"/>
  <date value="2022-11-10T16:00:46+00:00"/>
  <publisher value="LinuxForHealth Team"/>
  <description value="Payer codes for the type of adjustment for the claim"/>
  <jurisdiction>
    <coding>
      <system value="urn:iso:std:iso:3166"/>
      <code value="US"/>
    </coding>
  </jurisdiction>
  <caseSensitive value="true"/>
  <content value="complete"/>
  <count value="6"/>
  <concept>
    <code value="1"/>
    <display value="Adjustment (positive or negative adjustment)"/>
    <definition
                value="An adjustment is a claim line where one or more of the financial fields display the difference between the original amount and the final amount. Any financial not being adjusted should be zero as well as any quantity."/>
  </concept>
  <concept>
    <code value="2"/>
    <display value="Void (void, reversal or back-out)"/>
    <definition
                value="A void is a claim line where all financials and quantities are negated"/>
  </concept>
  <concept>
    <code value="3"/>
    <display
             value="Original or Replacement (original, resubmit or replacement)"/>
    <definition
                value="An original or replacement claim line where all financials and quantities are positive and supplements a void claim line"/>
  </concept>
  <concept>
    <code value="4"/>
    <display value="Bulk Adjustment (gross or bulk adjustment)"/>
    <definition
                value="Adjustments (positive or negative) that aren't tied to a particular service at the claim-line level.  Examples include, but aren't limited to, value-based reimbursement payments to providers, Drug Rebates, etc."/>
  </concept>
  <concept>
    <code value="B"/>
    <display value="Adjustment Debit"/>
    <definition
                value="Claim adjustments are sometimes required to correct erroneous payments made to providers. Adjustments may need to be made for a range of reasons, for example, recording of an incorrect procedure code, listing of a wrong place of service, data entry errors etc. A claim adjustment debit increases the balance due to the provider due to an underpayment made in error."/>
  </concept>
  <concept>
    <code value="C"/>
    <display value="Adjustment Credit"/>
    <definition
                value="Claim adjustments are sometimes required to correct erroneous payments made to providers. Adjustments may need to be made for a range of reasons, for example, recording of an incorrect procedure code, listing of a wrong place of service, data entry errors etc. A claim adjustment credit decreased the balance due to the provider due to an overpayment made in error."/>
  </concept>
</CodeSystem>