CAS Claims Adjustment

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

Position: CAS-01 · Element: 1033 · Name: Claim Adjustment Group Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 2 · Repeat: -

Code identifying the general category of payment adjustment

Position: CAS-02 · Element: 1034 · Name: Claim Adjustment Reason Code · Type: Identifier (ID) · Requirement: Mandatory · Min: 1 · Max: 5 · Repeat: -

Code identifying the detailed reason the adjustment was made

Position: CAS-03 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Mandatory · Min: 1 · Max: 18 · Repeat: -

Monetary amount

CAS03 is the amount of adjustment.

When the submitted charges are paid in full, the value for CAS03 should be zero.

Position: CAS-04 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Optional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

CAS04 is the units of service being adjusted.

Position: CAS-05 · Element: 1034 · Name: Claim Adjustment Reason Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 5 · Repeat: -

Code identifying the detailed reason the adjustment was made

L050607: If CAS-05 is present, then at least one of CAS-06 or CAS-07 is required

Position: CAS-06 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 18 · Repeat: -

Monetary amount

C0605: If CAS-06 is present, then CAS-05 is required

CAS06 is the amount of the adjustment.

Position: CAS-07 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

C0705: If CAS-07 is present, then CAS-05 is required

CAS07 is the units of service being adjusted.

Position: CAS-08 · Element: 1034 · Name: Claim Adjustment Reason Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 5 · Repeat: -

Code identifying the detailed reason the adjustment was made

L080910: If CAS-08 is present, then at least one of CAS-09 or CAS-10 is required

Position: CAS-09 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 18 · Repeat: -

Monetary amount

C0908: If CAS-09 is present, then CAS-08 is required

CAS09 is the amount of the adjustment.

Position: CAS-10 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

C1008: If CAS-10 is present, then CAS-08 is required

CAS10 is the units of service being adjusted.

Position: CAS-11 · Element: 1034 · Name: Claim Adjustment Reason Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 5 · Repeat: -

Code identifying the detailed reason the adjustment was made

L111213: If CAS-11 is present, then at least one of CAS-12 or CAS-13 is required

Position: CAS-12 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 18 · Repeat: -

Monetary amount

C1211: If CAS-12 is present, then CAS-11 is required

CAS12 is the amount of the adjustment.

Position: CAS-13 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

C1311: If CAS-13 is present, then CAS-11 is required

CAS13 is the units of service being adjusted.

Position: CAS-14 · Element: 1034 · Name: Claim Adjustment Reason Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 5 · Repeat: -

Code identifying the detailed reason the adjustment was made

L141516: If CAS-14 is present, then at least one of CAS-15 or CAS-16 is required

Position: CAS-15 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 18 · Repeat: -

Monetary amount

C1514: If CAS-15 is present, then CAS-14 is required

CAS15 is the amount of the adjustment.

Position: CAS-16 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

C1614: If CAS-16 is present, then CAS-14 is required

CAS16 is the units of service being adjusted.

Position: CAS-17 · Element: 1034 · Name: Claim Adjustment Reason Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 5 · Repeat: -

Code identifying the detailed reason the adjustment was made

L171819: If CAS-17 is present, then at least one of CAS-18 or CAS-19 is required

Position: CAS-18 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 18 · Repeat: -

Monetary amount

C1817: If CAS-18 is present, then CAS-17 is required

CAS18 is the amount of the adjustment.

Position: CAS-19 · Element: 380 · Name: Quantity · Type: Decimal number (R) · Requirement: Conditional · Min: 1 · Max: 15 · Repeat: -

Numeric value of quantity

C1917: If CAS-19 is present, then CAS-17 is required

CAS19 is the units of service being adjusted.