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Segment
in
X12 Release 005040

CAS Claims Adjustment

To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1033
Claim Adjustment Group Code
Identifier (ID)
Mandatory
1
2
1
Code identifying the general category of payment adjustment
Codes (9)
02
Claim Adjustment Reason Code
Identifier (ID)
Mandatory
1
5
15
Code identifying the detailed reason the adjustment was made
03
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
CAS03 is the amount of adjustment.
04
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CAS04 is the units of service being adjusted.
05
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L050607
06
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C0605
CAS06 is the amount of the adjustment.
07
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C0705
CAS07 is the units of service being adjusted.
08
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L080910
09
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C0908
CAS09 is the amount of the adjustment.
10
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C1008
CAS10 is the units of service being adjusted.
11
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L111213
12
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C1211
CAS12 is the amount of the adjustment.
13
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C1311
CAS13 is the units of service being adjusted.
14
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L141516
15
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C1514
CAS15 is the amount of the adjustment.
16
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C1614
CAS16 is the units of service being adjusted.
17
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L171819
18
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C1817
CAS18 is the amount of the adjustment.
19
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C1917
CAS19 is the units of service being adjusted.
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.