107 (130)    ADJUSTMENT REASON (161.91)

Name Value
CODE 107
STATUS EFFECTIVE DATE
  • 2003-06-01 00:00:00
    STATUS:   ACTIVE
    FEE USE:   APPLICABLE
DESCRIPTION EFFECTIVE DATE
  • DESCRIPTION:   
    The related or qualifying claim/service was not identified on this claim. 
This change to be effective 7/1/2010: The related or qualifying 
claim/service was not identified on this claim. Note: Refer to the 835 
Healthcare Policy Identification Segment (loop 2110 Service Payment 
Information REF), if present.
  • DESCRIPTION:   
    The related or qualifying claim/service was not identified on this claim. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
ASSOCIATED SUSPEND CODE File: 161.27, IEN: 4
SUSPENSION DESCRIPTION 
The related or qualifying claim/service was not identified on this claim. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
REMITTANCE REMARK
CORE SCENARIO Incorrect Claim Data
ADJUSTMENT GROUP