Segment
X12 EDI Release 00303
To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid
Elements
  • CAS011033Claim Adjustment Group Code
    ID
    M必须(Mandatory)

    Code identifying the general category of payment adjustment.

    Codes (7)
  • CAS021034Claim Adjustment Reason Code
    ID
    M必须(Mandatory)
    Min 1 / Max 5

    Code identifying the detailed reason the adjustment was made.

  • CAS03782Monetary Amount
    R
    M必须(Mandatory)
    Min 1 / Max 15

    Monetary amount.

  • CAS04380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • CAS051034Claim Adjustment Reason Code
    ID
    O可选(Optional)
    Min 1 / Max 5

    Code identifying the detailed reason the adjustment was made.

  • CAS06782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • CAS07380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • CAS081034Claim Adjustment Reason Code
    ID
    O可选(Optional)
    Min 1 / Max 5

    Code identifying the detailed reason the adjustment was made.

  • CAS09782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • CAS10380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • CAS111034Claim Adjustment Reason Code
    ID
    O可选(Optional)
    Min 1 / Max 5

    Code identifying the detailed reason the adjustment was made.

  • CAS12782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • CAS13380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • CAS141034Claim Adjustment Reason Code
    ID
    O可选(Optional)
    Min 1 / Max 5

    Code identifying the detailed reason the adjustment was made.

  • CAS15782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • CAS16380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.

  • CAS171034Claim Adjustment Reason Code
    ID
    O可选(Optional)
    Min 1 / Max 5

    Code identifying the detailed reason the adjustment was made.

  • CAS18782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 15

    Monetary amount.

  • CAS19380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity.