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Sub-Field: 162.37112

Package: Fee Basis

FEE BASIS PAYMENT(#162)-->162.01-->162.02-->162.03-->162.371-->162.3711-->162.37112

Sub-Field: 162.37112


Information

Parent File Name Number Package
162.3711 LINE ADJUSTMENT 162.37112 Fee Basis

Details

Field # Name Loc Type Details
.01 CLAIM ADJUSTMENT GROUP CODE 0;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<1) X
    MAXIMUM LENGTH: 2
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-2 characters in length.
  • DESCRIPTION:  
    Claim Adjustment Group Code.
  • CROSS-REFERENCE:  162.37112^B
    1)= S ^FBAAC(DA(6),1,DA(5),1,DA(4),1,DA(3),11,DA(2),1,DA(1),2,"B",$E(X,1,30),DA)=""
    2)= K ^FBAAC(DA(6),1,DA(5),1,DA(4),1,DA(3),11,DA(2),1,DA(1),2,"B",$E(X,1,30),DA)
1.01 ADJ REASON CODE 1 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<1) X
    MAXIMUM LENGTH: 5
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-5 characters in length.
  • DESCRIPTION:  
    Adjustment Reason Code.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS02 Adjustment Reason Code.
1.02 ADJ REASON CODE 2 1;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<1) X
    MAXIMUM LENGTH: 5
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-5 characters in length.
  • DESCRIPTION:  
    Adjustment Reason Code.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS05 Adjustment Reason Code.
1.03 ADJ REASON CODE 3 1;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<1) X
    MAXIMUM LENGTH: 5
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-5 characters in length.
  • DESCRIPTION:  
    Adjustment Reason Code.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS08 Adjustment Reason Code.
1.04 ADJ REASON CODE 4 1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<1) X
    MAXIMUM LENGTH: 5
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-5 characters in length.
  • DESCRIPTION:  
    Adjustment Reason Code.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS11 Adjustment Reason Code.
1.05 ADJ REASON CODE 5 1;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<1) X
    MAXIMUM LENGTH: 5
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-5 characters in length.
  • DESCRIPTION:  
    Adjustment Reason Code.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS14 Adjustment Reason Code.
1.06 ADJ REASON CODE 6 1;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>5!($L(X)<1) X
    MAXIMUM LENGTH: 5
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-5 characters in length.
  • DESCRIPTION:  
    Adjustment Reason Code.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS17 Adjustment Reason Code.
2.01 ADJ AMOUNT 1 2;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
    MAXIMUM LENGTH: 18
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    Adjustment Amount.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS03 Adjustment Amount.
2.02 ADJ AMOUNT 2 2;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
    MAXIMUM LENGTH: 18
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    Adjustment Amount.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS06 Adjustment Amount.
2.03 ADJ AMOUNT 3 2;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
    MAXIMUM LENGTH: 18
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    Adjustment Amount.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS09 Adjustment Amount.
2.04 ADJ AMOUNT 4 2;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
    MAXIMUM LENGTH: 18
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    Adjustment Amount.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS12 Adjustment Amount.
2.05 ADJ AMOUNT 5 2;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
    MAXIMUM LENGTH: 18
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    Adjustment Amount.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS15 Adjustment Amount.
2.06 ADJ AMOUNT 6 2;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<1) X
    MAXIMUM LENGTH: 18
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-18 characters in length.
  • DESCRIPTION:  
    Adjustment Amount.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS18 Adjustment Amount.
3.01 ADJ QUANTITY 1 3;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
    MAXIMUM LENGTH: 15
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Adjustment Quantity.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS04 Adjustment Quantity.
3.02 ADJ QUANTITY 2 3;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
    MAXIMUM LENGTH: 15
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Adjustment Quantity.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS07 Adjustment Quantity.
3.03 ADJ QUANTITY 3 3;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
    MAXIMUM LENGTH: 15
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Adjustment Quantity.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS10 Adjustment Quantity.
3.04 ADJ QUANTITY 4 3;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
    MAXIMUM LENGTH: 15
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Adjustment Quantity.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS13 Adjustment Quantity.
3.05 ADJ QUANTITY 5 3;5 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
    MAXIMUM LENGTH: 15
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Adjustment Quantity.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS16 Adjustment Quantity.
3.06 ADJ QUANTITY 6 3;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
    MAXIMUM LENGTH: 15
  • LAST EDITED:  JUL 06, 2017
  • HELP-PROMPT:  Answer must be 1-15 characters in length.
  • DESCRIPTION:  
    Adjustment Quantity.
  • TECHNICAL DESCR:  
    X12, #2400, Service Line Number, 2430 Line Adjudication Information, CAS Line Adjustment, CAS19 Adjustment Quantity.
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