CAS

Claim Level Adjustment

Pos: 295

Max: 5

Detail - Optional

Loop: 2320

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 EMC v.6.0 Reference: Record Type 42 Field No. 5	M	ID	1/2	Required

	Code	Name
	CO	Contractual Obligations
	CR	Correction and Reversals
	OA	Other adjustments
	PI	Payor Initiated Reductions
	PR	Patient Responsibility

CAS02

1034

Claim Adjustment Reason Code
Description: Code identifying the detailed reason the adjustment was made
Industry: Adjustment Reason Code
EMC v.6.0 Reference: Record Type 42 Field No. 6

1/5

Required

CAS03	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount EMC v.6.0 Reference: Record Type 42 Field No. 7	M	R	1/18	Required
CAS04	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity EMC v.6.0 Reference: Record Type 42 Field No. 8 Use this number for the units of service 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 EMC v.6.0 Reference: Record Type 42 Field No. 9 Used when additional adjustment information applies to claim.	C	ID	1/5	Situational

CAS06	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount EMC v.6.0 Reference: Record Type 42 Field No. 10 Used when additional adjustment information applies to claim.	C	R	1/18	Situational
CAS07	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity EMC v.6.0 Reference: Record Type 42 Field No. 11 Used when additional adjustment information applies to claim.	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 EMC v.6.0 Reference: Record Type 42 Field No. 12 Used when additional adjustment information applies to claim.	C	ID	1/5	Situational

CAS09	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount EMC v.6.0 Reference: Record Type 42 Field No. 13 Used when additional adjustment information applies to claim.	C	R	1/18	Situational
CAS10	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity EMC v.6.0 Reference: Record Type 42 Field No. 14 Used when additional adjustment information applies to claim.	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 EMC v.6.0 Reference: Record Type 42 Field No. 15 Used when additional adjustment information applies to claim.	C	ID	1/5	Situational

CAS12	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount EMC v.6.0 Reference: Record Type 42 Field No. 16 Used when additional adjustment information applies to claim.	C	R	1/18	Situational
CAS13	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity EMC v.6.0 Reference: Record Type 42 Field No. 17 Used when additional adjustment information applies to claim.	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 EMC v.6.0 Reference: Record Type 42 Field No. 18 Used when additional adjustment information applies to claim.	C	ID	1/5	Situational

CAS15	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount EMC v.6.0 Reference: Record Type 42 Field No. 19 Used when additional adjustment information applies to claim.	C	R	1/18	Situational
CAS16	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity EMC v.6.0 Reference: Record Type 42 Field No. 20 Used when additional adjustment information applies to claim.	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 EMC v.6.0 Reference: Record Type 42 Field No. 21 Used when additional adjustment information applies to claim.	C	ID	1/5	Situational

	CAS18	782	Monetary Amount Description: Monetary amount Industry: Adjustment Amount EMC v.6.0 Reference: Record Type 42 Field No. 22 Used when additional adjustment information applies to claim.	C	R	1/18	Situational
	CAS19	380	Quantity Description: Numeric value of quantity Industry: Adjustment Quantity EMC v.6.0 Reference: Record Type 42 Field No. 23 Used when additional adjustment information applies to claim.	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. Submitter should use this CAS segment to report prior payers claim level adjustments that cause the amount paid to differ from the amount originally charged.
2. Only one Group Code is allowed per CAS. If it is necessary to send more than one Group Code at the claim level, repeat the CAS segment again.
3. Codes and associated amount should come from 835 (Remittance Advice) received on the claim. If no previous payments have been made, omit this segment. See the 835 for definitions of the Group Codes (CAS01).
4. Required if claim has been adjudicated by payer identified in this loop and has claim level adjustment information.
5. To locate the claim adjustment reason codes that are used in CAS02, 05, 08, 11, 14, and 17 see the Washington Publishing Company web site: http://www.wpc-edi.com. Follow the buttons to Code Lists - Claim Adjustment Reason Codes.

Example:

CAS*CO*96*555.52~

	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.