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 | v2.6 | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| 1 | - | - | EI | R | 1 | - | 02003 | ADJ-1 | Provider Adjustment Number | Length |
| 2 | - | - | EI | R | 1 | - | 02004 | ADJ-2 | Payer Adjustment Number | Length |
| 3 | 1..4 | - | SI | R | 1 | - | 02005 | ADJ-3 | Adjustment Sequence Number | Min Length |
| 4 | - | - | CWE | R | 1 | 0564 | 02006 | ADJ-4 | Adjustment Category | 2 |
| 5 | - | - | CP | O | 5 | - | 02007 | ADJ-5 | Adjustment Amount | 2 |
| 6 | - | - | CQ | O | 1 | 0560 | 02008 | ADJ-6 | Adjustment Quantity | Length |
| 7 | - | - | CWE | C | 1 | 0565 | 02009 | ADJ-7 | Adjustment Reason PA | Length |
| 8 | - | 250# | ST | O | 1 | - | 02010 | ADJ-8 | Adjustment Description | 2 |
| 9 | - | 16= | NM | O | 1 | - | 02011 | ADJ-9 | Original Value | 2 |
| 10 | - | 16= | NM | O | 1 | - | 02012 | ADJ-10 | Substitute Value | 2 |
| 11 | - | - | CWE | O | 1 | 0569 | 02013 | ADJ-11 | Adjustment Action | 2 |
| 12 | - | - | EI | O | 1 | - | 02014 | ADJ-12 | Provider Adjustment Number Cross Reference | Length |
| 13 | - | - | EI | O | 1 | - | 02015 | ADJ-13 | Provider Product/Service Line Item Number Cross Reference | Length |
| 14 | - | - | DTM | R | 1 | - | 02016 | ADJ-14 | Adjustment Date | Length |
| 15 | - | - | XON | O | 1 | - | 02017 | ADJ-15 | Responsible Organization | Length |
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