CAS Claims Adjustment

To supply adjustment reason codes and amounts as needed for an entire claim or for a particular service within the claim being paid

Position
Element
Name
Type
Requirement
Min
Max
Repeat
CAS01
Claim Adjustment Group Code
Identifier (ID)
Mandatory
1
2
1
Code identifying the general category of payment adjustment
CAS02
Claim Adjustment Reason Code
Identifier (ID)
Mandatory
1
5
1
Code identifying the detailed reason the adjustment was made
CAS03
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
CAS03 is the amount of adjustment.
When the submitted charges are paid in full, the value for CAS03 should be zero.
CAS04
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CAS04 is the units of service being adjusted.
CAS05
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L050607: If CAS-05 is present, then at least one of CAS-06 or CAS-07 is required
CAS06
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C0605: If CAS-06 is present, then CAS-05 is required
CAS06 is the amount of the adjustment.
CAS07
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C0705: If CAS-07 is present, then CAS-05 is required
CAS07 is the units of service being adjusted.
CAS08
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L080910: If CAS-08 is present, then at least one of CAS-09 or CAS-10 is required
CAS09
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C0908: If CAS-09 is present, then CAS-08 is required
CAS09 is the amount of the adjustment.
CAS10
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C1008: If CAS-10 is present, then CAS-08 is required
CAS10 is the units of service being adjusted.
CAS11
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L111213: If CAS-11 is present, then at least one of CAS-12 or CAS-13 is required
CAS12
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C1211: If CAS-12 is present, then CAS-11 is required
CAS12 is the amount of the adjustment.
CAS13
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C1311: If CAS-13 is present, then CAS-11 is required
CAS13 is the units of service being adjusted.
CAS14
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L141516: If CAS-14 is present, then at least one of CAS-15 or CAS-16 is required
CAS15
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C1514: If CAS-15 is present, then CAS-14 is required
CAS15 is the amount of the adjustment.
CAS16
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C1614: If CAS-16 is present, then CAS-14 is required
CAS16 is the units of service being adjusted.
CAS17
Claim Adjustment Reason Code
Identifier (ID)
Conditional
1
5
1
Code identifying the detailed reason the adjustment was made
L171819: If CAS-17 is present, then at least one of CAS-18 or CAS-19 is required
CAS18
Monetary Amount
Decimal number (R)
Conditional
1
18
1
Monetary amount
C1817: If CAS-18 is present, then CAS-17 is required
CAS18 is the amount of the adjustment.
CAS19
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
C1917: If CAS-19 is present, then CAS-17 is required
CAS19 is the units of service being adjusted.

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