Provider Adjustment Reason Codes

X12 External Code Source 967 10/1/2018 LAST UPDATED

These codes report payment adjustments that are not related to a specific claim, bill, or service.

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01Card interchange fee amount
Start: 10/01/2018
50The amount of the late charge, late claim filing penalty, or Medicare late cost report penalty.
Start: 07/01/2018
51Interest penalty assessment amount based on late filing
Start: 07/01/2018
72Provider refund adjustment amount
This adjustment acknowledges a refund received from a provider for previous overpayment.
Start: 07/01/2018
90Early payment allowance amount
Start: 07/01/2018
AHClaim Transmission fee.
This code is used for transmission fees that are not specific to or dependent upon individual claims.
Start: 07/01/2018
AMLoan repayment adjustment amount
Start: 07/01/2018
APAccelerated adjustment amount
Start: 07/01/2018
B2Rebate adjustment amount
Applies when a provider has remitted an overpayment to a health plan. OR Applies when the health plan requested an overpayment amount and the provider remitted more than the amount requested.
Start: 07/01/2018
B3Recovery adjustment amount
This represents the amount received from the provider for an overpayment based on payments from other payers. This code is not used for other provider refund adjustment amounts.
Start: 07/01/2018
BDBad debt adjustment amount
Start: 07/01/2018
BNBonus amount
Start: 07/01/2018
CRCapitation interest amount
Start: 07/01/2018
CSAdjustment amount, detailed information is provided separately to explain the adjustment.
Start: 10/01/2018
CTCapitation payment amount
Start: 07/01/2018
E3Withholding
Start: 07/01/2018
FBBalance forward amount
Start: 07/01/2018
IPIncentive payment amount
Start: 10/01/2018
L3Penalty amount
Start: 10/01/2018
OBAffiliated provider(s) offset amount
Start: 10/01/2018
PLFinal payment or settlement amount
Start: 10/01/2018
RARetroactive adjustment amount
Start: 10/01/2018
SLFederal student loan garnishment amount
Start: 10/01/2018
WOOverpayment recovery amount
Start: 10/01/2018