RAS Reason Adjustment

To supply Claim Adjustment Reason Codes and amounts as needed for an entire claim or for a particular service within the claim being paid

Position: RAS-01 · Element: 782 · Name: Monetary Amount · Type: Decimal number (R) · Requirement: Mandatory · Min: 1 · Max: 18 · Repeat: 1

Monetary amount

RAS01 is the amount of adjustment.

Position: RAS-02 · Element: 1785 · Name: Claim Adjustment Group Code · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 10 · Repeat: 1

Code identifying the general category of payment adjustment.

RAS-03 C058 Adjustment Reason Composite (composite) Mandatory 15

Position: 01 · 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: 02 · Element: 1270 · Name: Code List Qualifier Code · Type: Identifier (ID) · Requirement: Conditional · Min: 1 · Max: 3 · Repeat: -

Code identifying a specific industry code list

P0203: If either C058-02 or C058-03 is present, then the other is required

C05802 qualifies C05803, C05804, C05805, C05806 and C05807.

Position: 03 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

Position: 04 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C0403: If C058-04 is present, then C058-03 is required

Position: 05 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C0504: If C058-05 is present, then C058-04 is required

Position: 06 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C0605: If C058-06 is present, then C058-05 is required

Position: 07 · Element: 1271 · Name: Industry Code · Type: String (AN) · Requirement: Optional · Min: 1 · Max: 30 · Repeat: -

Code indicating a code from a specific industry code list

C0706: If C058-07 is present, then C058-06 is required

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

Numeric value of quantity

RAS04 is the units of service being adjusted.