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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

Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1785
Claim Adjustment Group Code
String (AN)
Mandatory
1
10
1
Code identifying the general category of payment adjustment.
02
Claim Adjustment Reason Code
Identifier (ID)
Mandatory
1
5
15
Code identifying the detailed reason the adjustment was made
03
Monetary Amount
Decimal number (R)
Mandatory
1
18
1
Monetary amount
CAS03 is the amount of adjustment.
04
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CAS04 is the units of service being adjusted.
05
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
06
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.
07
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.
08
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
09
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.
10
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.
11
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
12
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.
13
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.
14
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
15
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.
16
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.
17
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
18
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.
19
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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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.