ADJ
Adjustment
This segment describes Provider and/or Payer adjustments to a Product/Service Line Item or Response Summary. These include surcharges such as tax, dispensing fees and mark ups.
X12 REF: Similar to CAS segment, with a few new fields.
RRequiredOOptionalCConditionalWWithdrawn|#Date/Time*Backward compat.+Filler
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| C.Len | Element | v2.5 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | ..73 | - | EI | R | 1 | - | 02003 | ADJ-1 | Provider Adjustment Number | NEW |
| 2 | ..73 | - | EI | R | 1 | - | 02004 | ADJ-2 | Payer Adjustment Number | NEW |
| 3 | ..4 | - | SI | R | 1 | - | 02005 | ADJ-3 | Adjustment Sequence Number | NEW |
| 4 | ..4 | - | IS | R | 1 | 0564 | 02006 | ADJ-4 | Adjustment Category | NEW |
| 5 | ..254 | - | CP | O | 1 | - | 02007 | ADJ-5 | Adjustment Amount | NEW |
| 6 | ..222 | - | CQ | O | 1 | 0560 | 02008 | ADJ-6 | Adjustment Quantity | NEW |
| 7 | ..211 | - | CWE | C | 1 | 0565 | 02009 | ADJ-7 | Adjustment Reason PA | NEW |
| 8 | ..250 | - | ST | O | 1 | - | 02010 | ADJ-8 | Adjustment Description | NEW |
| 9 | ..250 | - | NM | O | 1 | - | 02011 | ADJ-9 | Original Value | NEW |
| 10 | ..250 | - | NM | O | 1 | - | 02012 | ADJ-10 | Substitute Value | NEW |
| 11 | ..4 | - | IS | O | 1 | 0569 | 02013 | ADJ-11 | Adjustment Action | NEW |
| 12 | ..73 | - | EI | O | 1 | - | 02014 | ADJ-12 | Provider Adjustment Number Cross Reference | NEW |
| 13 | ..73 | - | EI | O | 1 | - | 02015 | ADJ-13 | Provider Product/Service Line Item Number Cross Reference | NEW |
| 14 | ..26 | - | DTM | R | 1 | - | 02016 | ADJ-14 | Adjustment Date | NEW |
| 15 | ..183 | - | XON | O | 1 | - | 02017 | ADJ-15 | Responsible Organization | NEW |
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