CA1 Claim Adjudication

To specify the adjudication codes for a claim service item

Position
Element
Name
Type
Requirement
Min
Max
Repeat
CA1-01
Payment Status Code
Identifier (ID)
Mandatory
1
1
-
Code indicating the result of insurance claim payment processing by another payor
CA1-02
Claim Adjustment Reason Code
Identifier (ID)
Optional
1
5
-
Code identifying the detailed reason the adjustment was made.
CA1-03
Claim Adjustment Reason Code
Identifier (ID)
Optional
1
5
-
Code identifying the detailed reason the adjustment was made.
CA1-04
Claim Adjustment Reason Code
Identifier (ID)
Optional
1
5
-
Code identifying the detailed reason the adjustment was made.

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