claim_coordination_of_benefits_adjustment
Lists the adjustments that have been performed on a claim during the process of adjudication. Only used for Coordination of Benefits according to the EDI spec, but may be used for repricing with the primary payer (from 2320 loop). (https://www.ehealthinsurance.com/resources/individual-and-family/coordination-of-benefits)
Foreign Keys:adjustment_reason_code=>claim_adjustment_reason_code_lookup.codeclaim_coordination_of_benefits_id=>claim_coordination_of_benefits.claim_coordination_of_benefits_id
claim_coordination_of_benefits_claim_cob_id_idx-claim_coordination_of_benefits_id
| Column | Data Type | Nullable | Indexed | Description |
|---|---|---|---|---|
adjustment_reason_code | text | No | No | Provides the specific reason for the adjustment. From Loop 2320 CAS03. See also https://x12.org/codes/claim-adjustment-reason-codes Generated through expression: |
adjustment_amount | numeric | Yes | No | An amount added to or removed from the billed amount. For example, in order to specify the copayment amount of $25, there would be an adjustment_group of 'PR', adjustment_reason of '3' and an adjustment_amount of 25.00. Positive amounts subtract from the billed amount while negative amounts add to the billed amount (e.g. a late payment charge). See section 1.4.4.1 and 1.4.4.2 in the 837i and 837p spec for additional details on adjustments and balancing. Generated through expression: |
adjustment_quantity | numeric | Yes | No | An amount added to or subtracted from the claim quantity and can be used to explain why a claim was paid at a certain amount. Positive amounts subtract from the quantity while negative amounts add to the quantity. Since quantity does not usually apply at the claim level, it is rare to have a claim-level quantity adjustment. From Loop 2320 CAS07. Generated through expression: |
claim_coordination_of_benefits_id | bigint | No | Yes | Links to the coordination of benefits record this is adjusting. Generated through expression: |
adjustment_group | claim_adjustment_group_type | No | No | Indicates the type of adjustment being made to the claim. Could include Contractual Obligations (CO), Correction and Reversals (CR), Other adjustments (OA), Payor Initiated Reductions (PI), or Patient Responsibility (PR). From loop 2320 CAS01. Generated through expression: |