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

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Position

Element

Name

Type

Requirement

Min

Max

Repeat

Claim Adjustment Group Code

Identifier (ID)

Mandatory

1

2

1

Code identifying the general category of payment adjustment

Claim Adjustment Reason Code

Identifier (ID)

Mandatory

1

5

1

Code identifying the detailed reason the adjustment was made

Monetary Amount

Decimal number (R)

Mandatory

1

18

1

Monetary amount

CAS03 is the amount of adjustment.

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

Quantity

Decimal number (R)

Optional

1

15

1

Numeric value of quantity

CAS04 is the units of service being adjusted.

Claim Adjustment Reason Code

Identifier (ID)

Conditional

1

5

1

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

Monetary Amount

Decimal number (R)

Conditional

1

18

1

Monetary amount

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

CAS06 is the amount of the adjustment.

Quantity

Decimal number (R)

Conditional

1

15

1

Numeric value of quantity

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

CAS07 is the units of service being adjusted.

Claim Adjustment Reason Code

Identifier (ID)

Conditional

1

5

1

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

Monetary Amount

Decimal number (R)

Conditional

1

18

1

Monetary amount

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

CAS09 is the amount of the adjustment.

Quantity

Decimal number (R)

Conditional

1

15

1

Numeric value of quantity

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

CAS10 is the units of service being adjusted.

Claim Adjustment Reason Code

Identifier (ID)

Conditional

1

5

1

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

Monetary Amount

Decimal number (R)

Conditional

1

18

1

Monetary amount

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

CAS12 is the amount of the adjustment.

Quantity

Decimal number (R)

Conditional

1

15

1

Numeric value of quantity

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

CAS13 is the units of service being adjusted.

Claim Adjustment Reason Code

Identifier (ID)

Conditional

1

5

1

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

Monetary Amount

Decimal number (R)

Conditional

1

18

1

Monetary amount

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

CAS15 is the amount of the adjustment.

Quantity

Decimal number (R)

Conditional

1

15

1

Numeric value of quantity

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

CAS16 is the units of service being adjusted.

Claim Adjustment Reason Code

Identifier (ID)

Conditional

1

5

1

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

Monetary Amount

Decimal number (R)

Conditional

1

18

1

Monetary amount

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

CAS18 is the amount of the adjustment.

Quantity

Decimal number (R)

Conditional

1

15

1

Numeric value of quantity

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

CAS19 is the units of service being adjusted.