Provider Adjustment Reason Codes

Maintence Request Status 6/19/2018 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
20 3/26/2018 Late Charge New code 50 In Process
21 3/26/2018 Interest Penalty Charge New code 51 In Process
22 3/26/2018 Authorized Return New code 72 In Process
23 3/26/2018 Authorized Return New code 72 In Process
24 3/26/2018 Early Payment Allowance New code 90 In Process
25 3/26/2018 Origination Fee New code AH In Process
26 3/26/2018 Applied to Borrower’s Account New code AM In Process
27 3/26/2018 Acceleration of Benefits New code AP In Process
28 3/26/2018 Acceleration of Benefits New code AP In Process
29 3/26/2018 Rebate New code B2 In Process
30 3/26/2018 Recovery Allowance New code B3 In Process
31 3/26/2018 Bad Debt Adjustment New code BD In Process
32 3/26/2018 Bonus New code BN In Process
33 3/26/2018 Temporary Allowance New code C5 In Process
34 3/26/2018 Capitation Interest New code CR In Process
35 3/26/2018 Adjustment New code CS In Process
36 3/26/2018 Capitation Payment New code CT In Process
37 3/26/2018 Capital Passthru New code CV In Process
38 3/26/2018 Certified Registered Nurse Anesthetist Passthru New code CW In Process
39 3/26/2018 Direct Medical Education Passthru New code DM In Process
40 3/26/2018 Withholding New code E3 In Process
41 3/26/2018 Forwarding Balance New code FB In Process
42 3/26/2018 Fund Allocation New code FC In Process
43 3/26/2018 Graduate Medical Education Passthru New code GO In Process
44 3/26/2018 Hemophilia Clotting Factor Supplement New code HM In Process
45 3/26/2018 Incentive Premium Payment New code IP In Process
46 3/26/2018 Internal Revenue Service Withholding New code IR In Process
47 3/26/2018 Interim Settlement New code IS In Process
48 3/26/2018 Nonreimbursable New code J1 In Process
49 3/26/2018 Penalty New code L3 In Process
50 3/26/2018 Interest Owed New code L6 In Process
51 3/26/2018 Levy New code LE In Process
52 3/26/2018 Lump Sum New code LS In Process
53 3/26/2018 Organ Acquisition Passthru New code OA In Process
54 3/26/2018 Offset for Affiliated Providers New code OB In Process
55 3/26/2018 Periodic Interim Payment New code PI In Process
56 3/26/2018 Payment Final New code PL In Process
57 3/26/2018 Retro-activity Adjustment New code RA In Process
58 3/26/2018 Return on Equity New code RE In Process
59 3/26/2018 Student Loan Repayment New code SL In Process
60 3/26/2018 Third Party Liability New code TL In Process
61 3/26/2018 Overpayment Recovery New code WO In Process
62 3/26/2018 Unspecified Recovery New code WU In Process
63 3/26/2018 Forward Recovery Amount New code FR In Process
64 3/26/2018 Card Interchange Fees New code In Process
65 3/26/2018 Withholding New code In Process
66 3/26/2018 Levy New code In Process
67 3/26/2018 Real-time Adjustment New code In Process