CRX.002.026

ADJUSTMENT-REASON-CODE

Data Element

DE Number

CRX026

System DE Number

CRX.002.026

File Name

CRX - CLAIM PHARMACY

File Segment Number

CRX00002

File Segment Name

CLAIM-HEADER-RECORD-RX

Last updated

No Updates

Overview Valid Values Related Rules Related DQ Measures Other Instances

Definition	Claim adjustment reason codes communicate why a claim was paid differently than it was billed.
Size	X(3)
FLF Start Position	157
FLF Stop Position	159
Segment Key Field Identifier	Not Applicable
Coding Requirements	1. Value must be in Adjustment Reason Code List (VVL) 2. Value must be 3 characters or less 3. Conditional 4. Value must be populated when the total paid amount is different from the total billed amount

This data element's valid value code set is maintained by a Code Set Maintenance Organization (CSMO), the official licensing organization for specific valid value code sets. The CSMO is the system of record for those specific valid value code sets. While T-MSIS endeavors to be in-sync with CMSO's updates, minor delays may occur but that shouldn't block T-MSIS data submissions using the CSMO's latest version.

Adjustment Reason Code List

Valid Value Code Set	Valid Value Code	Valid Value Name	Valid Value Description	Effective Start Date	Effective End Date

RULE ID	RULE Definition
RULE-6852	The format for ADJUSTMENT-REASON-CODE on a non-denied RX claim was expected to be submitted as X(3).

Measure ID	Measure Name

DE Number	System DE Number	DE Name	File Segment Number	File Segment Name
CIP027	CIP.002.027	ADJUSTMENT-REASON-CODE	CIP00002	CLAIM-HEADER-RECORD-IP
CLT026	CLT.002.026	ADJUSTMENT-REASON-CODE	CLT00002	CLAIM-HEADER-RECORD-LT
COT026	COT.002.026	ADJUSTMENT-REASON-CODE	COT00002	CLAIM-HEADER-RECORD-OT