Provider Adjustment Reason Codes

Maintence Request Status 11/1/2018 LAST UPDATED

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

The list below shows the status of change requests which are in process. The list is updated on the first of each month.

Each request will be in one of the following statuses:

  1. Received
    The request has been submitted but is not yet under review.
  2. Triaged
    Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
  3. In Process
    The CMG has initiated their decision process.
  4. On Hold
    The CMG has initiated their decision process but cannot complete it at this time.
  5. CMG Approved
    The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
  6. CMG Disapproved
    The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.
Num. Date Requested Description Type Code Status
33 3/26/2018 Temporary Allowance New code C5 On Hold
37 3/26/2018 Capital Passthru New code CV In Process
38 3/26/2018 Certified Registered Nurse Anesthetist Passthru New code CW On Hold
39 3/26/2018 Direct Medical Education Passthru New code DM On Hold
42 3/26/2018 Fund Allocation New code FC On Hold
43 3/26/2018 Graduate Medical Education Passthru New code GO On Hold
44 3/26/2018 Hemophilia Clotting Factor Supplement New code HM On Hold
46 3/26/2018 Internal Revenue Service Withholding New code IR On Hold
47 3/26/2018 Interim Settlement New code IS On Hold
48 3/26/2018 Nonreimbursable New code J1 On Hold
50 3/26/2018 Interest Owed New code L6 On Hold
51 3/26/2018 Levy New code LE On Hold
52 3/26/2018 Lump Sum New code LS On Hold
53 3/26/2018 Organ Acquisition Passthru New code OA On Hold
55 3/26/2018 Periodic Interim Payment New code PI On Hold
58 3/26/2018 Return on Equity New code RE On Hold
60 3/26/2018 Third Party Liability New code TL On Hold
62 3/26/2018 Unspecified Recovery New code WU On Hold
63 3/26/2018 Forward Recovery Amount New code FR In Process
66 3/26/2018 Levy New code On Hold
67 3/26/2018 Real-time Adjustment New code On Hold
69 10/16/2018 Accelerated/advance payment recoupment New code In Process
70 10/16/2018 Penalty withholding amount for unfiled or incorrectly filed reports New code In Process
71 10/16/2018 Penalty Withholding for Bankruptcy/Termination New code Triaged
72 10/16/2018 Void re-issue activity. Included re-issue invoices, debit memos and interest information as a result of federal/state/local mandates. Prerequisite for use of this code requires advance provider outreach. New code Triaged
73 11/1/2018 Claim transmission fee Revision to an existing code AH Triaged