Claim Adjustment Reason Code

SAS Name
CLM_ADJUST_RSN_CD

Claim Adjustment Reason Code used to describe why a claim or claim line was paid differently than billed. This field is currently only populated for Direct Contracting (DC), Comprehensive Kidney Care Contracting (CKCC) and Kidney Care First (KCF) model claims.

This is not a comprehensive list of values; refer to website below for current values and descriptions:

Comments

This code set is an external code set maintained by X12 (www.x12.org/codes). This field is not populated prior to 2021..

Code Code value
96 Non-covered charge(s). At least one Remark Code must be provided
119 Benefit maximum for this time period or occurrence has been reached
B9 Patient is enrolled in a Hospice