P4 (335) ADJUSTMENT REASON (161.91)

Name	Value
CODE	P4
STATUS EFFECTIVE DATE	2013-11-01 00:00:00 STATUS: ACTIVE FEE USE: APPLICABLE
DESCRIPTION EFFECTIVE DATE	DESCRIPTION: Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only
ASSOCIATED SUSPEND CODE	File: 161.27, IEN: 4
SUSPENSION DESCRIPTION	Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only
REMITTANCE REMARK
CORE SCENARIO	Billed Service Not Covered
ADJUSTMENT GROUP