Search Claim Adjustment Codes
Value
a tibble
Details
Claim Adjustment Reason Codes:
X12 External Code Source 139
These codes describe why a claim or service line was paid differently than it was billed and generally assign responsibility for the adjustment amounts.
The Claim Adjustment Group Codes are internal to the X12 standard. The format is always two alpha characters:
CO (Contractual Obligations): Indicates patient is responsible for remaining balance
CR (Corrections and Reversals)
OA (Other Adjustments): Indicates denial is related to other insurance coverage
PI (Payer-Initiated Reductions)
PR (Patient Responsibility): Indicates patient responsibility has been adjusted
Remittance Advice Remark Codes:
X12 External Code Source 411
Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing.
There are two types of RARCs: Supplemental and Informational:
The majority of RARCs are supplemental and, as such, are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation for an adjustment already described by a CARC.
The second type is informational; these are all prefaced with Alert:
and are referred to as Alerts. They are used to convey information about
remittance processing and are never related to a specific adjustment or
CARC.
Examples
search_adjustments(adj_type = "Group")
#> # A tibble: 5 × 8
#> adj_code adj_type adj_description adj_usage adj_notes adj_start_date
#> <chr> <chr> <chr> <chr> <chr> <date>
#> 1 CO Group Contractual Obligations NA NA NA
#> 2 CR Group Corrections and Reversals NA NA NA
#> 3 OA Group Other Adjustments NA NA NA
#> 4 PI Group Payer Initiated Reductio… NA NA NA
#> 5 PR Group Patient Responsibility NA NA NA
#> # ℹ 2 more variables: adj_last_modified <date>, adj_end_date <date>
search_adjustments(adj_type = "CARC")
#> # A tibble: 405 × 8
#> adj_code adj_type adj_description adj_usage adj_notes adj_start_date
#> <chr> <chr> <chr> <chr> <chr> <date>
#> 1 1 CARC Deductible Amount NA NA 1995-01-01
#> 2 2 CARC Coinsurance Amount NA NA 1995-01-01
#> 3 3 CARC Co-payment Amount NA NA 1995-01-01
#> 4 4 CARC The procedure code is i… Refer to… NA 1995-01-01
#> 5 5 CARC The procedure code/type… Refer to… NA 1995-01-01
#> 6 6 CARC The procedure/revenue c… Refer to… NA 1995-01-01
#> 7 7 CARC The procedure/revenue c… Refer to… NA 1995-01-01
#> 8 8 CARC The procedure code is i… Refer to… NA 1995-01-01
#> 9 9 CARC The diagnosis is incons… Refer to… NA 1995-01-01
#> 10 10 CARC The diagnosis is incons… Refer to… NA 1995-01-01
#> 11 11 CARC The diagnosis is incons… Refer to… NA 1995-01-01
#> 12 12 CARC The diagnosis is incons… Refer to… NA 1995-01-01
#> 13 13 CARC The date of death prece… NA NA 1995-01-01
#> 14 14 CARC The date of birth follo… NA NA 1995-01-01
#> 15 15 CARC The authorization numbe… NA NA 1995-01-01
#> 16 16 CARC Claim/service lacks inf… Do not u… NA 1995-01-01
#> 17 17 CARC Requested information w… NA NA 1995-01-01
#> 18 18 CARC Exact duplicate claim/s… NA NA 1995-01-01
#> 19 19 CARC This is a work-related … NA NA 1995-01-01
#> 20 20 CARC This injury/illness is … NA NA 1995-01-01
#> # ℹ 385 more rows
#> # ℹ 2 more variables: adj_last_modified <date>, adj_end_date <date>
search_adjustments(adj_type = "RARC")
#> # A tibble: 1,171 × 8
#> adj_code adj_type adj_description adj_usage adj_notes adj_start_date
#> <chr> <chr> <chr> <chr> <chr> <date>
#> 1 M1 RARC X-ray not taken within … NA NA 1997-01-01
#> 2 M2 RARC Not paid separately whe… NA NA 1997-01-01
#> 3 M3 RARC Equipment is the same o… NA NA 1997-01-01
#> 4 M4 RARC Alert: This is the last… NA (Modifie… 1997-01-01
#> 5 M5 RARC Monthly rental payments… NA NA 1997-01-01
#> 6 M6 RARC Alert: You must furnish… NA (Modifie… 1997-01-01
#> 7 M7 RARC No rental payments afte… NA (Modifie… 1997-01-01
#> 8 M8 RARC We do not accept blood … NA NA 1997-01-01
#> 9 M9 RARC Alert: This is the tent… NA (Modifie… 1997-01-01
#> 10 M10 RARC Equipment purchases are… NA NA 1997-01-01
#> 11 M11 RARC DME, orthotics and pros… NA NA 1997-01-01
#> 12 M12 RARC Diagnostic tests perfor… NA NA 1997-01-01
#> 13 M13 RARC Only one initial visit … NA (Modifie… 1997-01-01
#> 14 M14 RARC No separate payment for… NA NA 1997-01-01
#> 15 M15 RARC Separately billed servi… NA NA 1997-01-01
#> 16 M16 RARC Alert: Please see our w… NA (Reactiv… 1997-01-01
#> 17 M17 RARC Alert: Payment approved… NA (Modifie… 1997-01-01
#> 18 M18 RARC Certain services may be… NA (Modifie… 1997-01-01
#> 19 M19 RARC Missing oxygen certific… NA (Modifie… 1997-01-01
#> 20 M20 RARC Missing/incomplete/inva… NA (Modifie… 1997-01-01
#> # ℹ 1,151 more rows
#> # ℹ 2 more variables: adj_last_modified <date>, adj_end_date <date>