CAS

Claim Adjustment

Pos: 020

Max: 99

Detail - Optional

Loop: 2100

Elements: 19

	Ref	Id	Element Name	Req	Type	Min/Max	Usage
	CAS01	1033	Claim Adjustment Group Code Description: Code identifying the general category of payment adjustment Evaluate the group codes in CAS01 based on the following order for their applicability to a set of one or more adjustments: PR, CO, PI, CR, OA. See 2.2.4, Claim Adjustment and Service Adjustment Segment Theory, for additional information. (Note: This does not mean that the adjustments must be reported in this order.)	M	ID	1/2	Required

Code

Name

Contractual Obligations

Use this code when a joint payer/payee contractual agreement or a regulatory requirement resulted in an adjustment.

Correction and Reversals

Use this code for corrections and reversals to PRIOR claims. Use when CLP02=22, Reversal of Previous Payment.

Other adjustments

Payor Initiated Reductions

Use this code when, in the opinion of the payer, the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and the payer (i.e., medical review or professional review organization adjustments).

Patient Responsibility

CAS02

1034

Claim Adjustment Reason Code
Description: Code identifying the detailed reason the adjustment was made
Industry: Adjustment Reason Code
CODE SOURCE: 139: Claim Adjustment Reason Code

1/5

Required

CAS03	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount Use this monetary amount for the adjustment amount. A negative amount increases the payment, and a positive amount decreases the payment contained in CLP04.	M	R	1/18	Required
CAS04	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity A positive value decreases the paid units of service, and a negative number increases the paid units. This element may be used only when the units of service are being adjusted.	O	R	1/15	Situational
CAS05	1034	Claim Adjustment Reason Code Description: Code identifying the detailed reason the adjustment was made Industry: Adjustment Reason Code CODE SOURCE: 139: Claim Adjustment Reason Code Used when additional adjustments apply within the group identified in CAS01.	C	ID	1/5	Situational

CAS06	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount See CAS03. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/18	Situational
CAS07	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity See CAS04. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/15	Situational
CAS08	1034	Claim Adjustment Reason Code Description: Code identifying the detailed reason the adjustment was made Industry: Adjustment Reason Code CODE SOURCE: 139: Claim Adjustment Reason Code Used when additional adjustments apply within the group identified in CAS01.	C	ID	1/5	Situational

CAS09	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount See CAS03. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/18	Situational
CAS10	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity See CAS04. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/15	Situational
CAS11	1034	Claim Adjustment Reason Code Description: Code identifying the detailed reason the adjustment was made Industry: Adjustment Reason Code CODE SOURCE: 139: Claim Adjustment Reason Code Used when additional adjustments apply within the group identified in CAS01.	C	ID	1/5	Situational

CAS12	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount See CAS03. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/18	Situational
CAS13	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity See CAS04. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/15	Situational
CAS14	1034	Claim Adjustment Reason Code Description: Code identifying the detailed reason the adjustment was made Industry: Adjustment Reason Code CODE SOURCE: 139: Claim Adjustment Reason Code Used when additional adjustments apply within the group identified in CAS01.	C	ID	1/5	Situational

CAS15	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount See CAS03. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/18	Situational
CAS16	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity See CAS04. 1418 Used when additional adjustments apply within the group identified in CAS01.	C	R	1/15	Situational
CAS17	1034	Claim Adjustment Reason Code Description: Code identifying the detailed reason the adjustment was made Industry: Adjustment Reason Code CODE SOURCE: 139: Claim Adjustment Reason Code Used when additional adjustments apply within the group identified in CAS01.	C	ID	1/5	Situational

	CAS18	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount See CAS03. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/18	Situational
	CAS19	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity See CAS04. Used when additional adjustments apply within the group identified in CAS01.	C	R	1/15	Situational

1.	L050607 - If CAS05 is present, then at least one of CAS06,CAS07 is required
2.	C0605 - If CAS06 is present, then all of CAS05 are required
3.	C0705 - If CAS07 is present, then all of CAS05 are required
4.	L080910 - If CAS08 is present, then at least one of CAS09,CAS10 is required
5.	C0908 - If CAS09 is present, then all of CAS08 are required
6.	C1008 - If CAS10 is present, then all of CAS08 are required
7.	L111213 - If CAS11 is present, then at least one of CAS12,CAS13 is required
8.	C1211 - If CAS12 is present, then all of CAS11 are required
9.	C1311 - If CAS13 is present, then all of CAS11 are required
10.	L141516 - If CAS14 is present, then at least one of CAS15,CAS16 is required
11.	C1514 - If CAS15 is present, then all of CAS14 are required
12.	C1614 - If CAS16 is present, then all of CAS14 are required
13.	L171819 - If CAS17 is present, then at least one of CAS18,CAS19 is required
14.	C1817 - If CAS18 is present, then all of CAS17 are required
15.	C1917 - If CAS19 is present, then all of CAS17 are required

1.	CAS03 is the amount of adjustment.
2.	CAS04 is the units of service being adjusted.
3.	CAS06 is the amount of the adjustment.
4.	CAS07 is the units of service being adjusted.
5.	CAS09 is the amount of the adjustment.
6.	CAS10 is the units of service being adjusted.
7.	CAS12 is the amount of the adjustment.
8.	CAS13 is the units of service being adjusted.
9.	CAS15 is the amount of the adjustment.
10.	CAS16 is the units of service being adjusted.
11.	CAS18 is the amount of the adjustment.
12.	CAS19 is the units of service being adjusted.

Notes:

1. Payers must use this CAS segment to report claim level adjustments that cause the amount paid to differ from the amount originally charged. See 2.2.1, Balancing, and 2.2.4, Claim Adjustment and Service Adjustment Segment Theory, for additional information.
2. See the SVC segment note #2 for details about per diem adjustments.
3. A single CAS segment contains six repetitions of the �adjustment trio� composed of adjustment reason code, adjustment amount, and adjustment quantity. These six adjustment trios are used to report up to six adjustments related to a particular Claim Adjustment Group Code (CAS01). The first adjustment is reported in the first adjustment trio (CAS02-CAS04). If there is a second non-zero adjustment, it is reported in the second adjustment trio (CAS05-CAS07), and so on through the sixth adjustment trio (CAS17-CAS19).

Example:

CAS*PR*1*793~

	ExternalCodeList
	Name: 139
	Description: Claim Adjustment Reason Code

1.	Adjustment information is intended to help the provider balance the remittance information. Adjustment amounts should fully explain the difference between submitted charges and the amount paid.
2.	When the submitted charges are paid in full, the value for CAS03 should be zero.