| | | | | | | | | | | |
| | _Ref_ | Id | _________Element Name__________ | Req | Type | Min/Max | | |
| | CAS01 | 1033 | Claim Adjustment Group Code | M | ID | 1/2 | | |
| | | | Description: Code identifying the general category of payment adjustment |
| | | | | Code | Name_______________________________ |
| | | | | CO | Contractual Obligations |
| | | | | CR | Correction and Reversals |
| | | | | OA | Other adjustments |
| | | | | PI | Payor Initiated Reductions |
| | | | | PR | Patient Responsibility |
| | CAS02 | 1034 | Claim Adjustment Reason Code | M | ID | 1/5 | | |
| | | | Description: Code identifying the detailed reason the adjustment was made |
| | CAS03 | 782 | Monetary Amount | M | R | 1/18 | | |
| | | | Description: Monetary amount |
| | CAS04 | 380 | Quantity | O | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
| | CAS05 | 1034 | Claim Adjustment Reason Code | C | ID | 1/5 | | |
| | | | Description: Code identifying the detailed reason the adjustment was made |
| | CAS06 | 782 | Monetary Amount | C | R | 1/18 | | |
| | | | Description: Monetary amount |
| | CAS07 | 380 | Quantity | C | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
| | CAS08 | 1034 | Claim Adjustment Reason Code | C | ID | 1/5 | | |
| | | | Description: Code identifying the detailed reason the adjustment was made |
| | CAS09 | 782 | Monetary Amount | C | R | 1/18 | | |
| | | | Description: Monetary amount |
| | CAS10 | 380 | Quantity | C | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
| | CAS11 | 1034 | Claim Adjustment Reason Code | C | ID | 1/5 | | |
| | | | Description: Code identifying the detailed reason the adjustment was made |
| | CAS12 | 782 | Monetary Amount | C | R | 1/18 | | |
| | | | Description: Monetary amount |
| | CAS13 | 380 | Quantity | C | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
| | CAS14 | 1034 | Claim Adjustment Reason Code | C | ID | 1/5 | | |
| | | | Description: Code identifying the detailed reason the adjustment was made |
| | CAS15 | 782 | Monetary Amount | C | R | 1/18 | | |
| | | | Description: Monetary amount |
| | CAS16 | 380 | Quantity | C | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
| | CAS17 | 1034 | Claim Adjustment Reason Code | C | ID | 1/5 | | |
| | | | Description: Code identifying the detailed reason the adjustment was made |
| | CAS18 | 782 | Monetary Amount | C | R | 1/18 | | |
| | | | Description: Monetary amount |
| | CAS19 | 380 | Quantity | C | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
