ADX

Organization Summary Remittance Level Adjustment

Pos: 210

Max: 1

Detail - Optional

Loop: 2320A

Elements: 2

Ref	Id	Element Name	Req	Type	Min/Max	Usage
ADX01	782	Monetary Amount Description: Monetary amount Health Care Industry: Adjustment Amount	M	R	1/18	Required
ADX02	426	Adjustment Reason Code Description: Code indicating reason for debit or credit memo or adjustment to invoice, debit or credit memo, or payment	M	ID	2/2	Required

Code

Name

Balance Due Declined

Credit for Previous Overpayment

Remittance for Previous Underpayment

Prepaid Benefit or Advances

Information Forthcoming

Detailed information related to the adjustment will be provided through a separate mechanism.

Partial Payment Remitted

Used when the payer does not have sufficient funds to remit the full balance.

Invoice Amount Does Not Match Account Analysis Statement

Used when the invoice does not match the expectation for number or number/type of members and charges.

Promised Adjustment Not Received

Used when an adjustment promised by the payee for a previous invoice has not been reflected on the current invoice.

1.	ADX01 specifies the amount of the adjustment and must be signed if negative. If negative, it reduces the payment amount; if positive, it increases the payment amount.
2.	ADX02 specifies the reason for claiming the adjustment.
3.	ADX03 and ADX04 specify the identification of the adjustment.

Notes:

1. This segment is used to provide an adjustment made at a summary level of a payment.
2. This segment is REQUIRED when the paid amount is different from any invoiced amount. The ADX segment must be used as necessary to fulfill the balancing requirements. See section 2.2.4 for additional information.

Example:

ADX*150*20~