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Back  RFI # 1802: CO45 Adjust as a full writeoff

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Submitter

Paddy Williams

Description

There are payers reporting back a CO45 Adjustment as a full write off amount. NextGen's interpretation is that it is the wrong Adjustment code. Is this compliant?

Response

When the full submitted charge is sent as the CAS*CO*45 amount, the payer is reporting that the fee schedule/maximum allowable or contracted/legislated fee arrangement for the service is $0. If this is not the case, the CO*45 is not appropriate and should not be used. The payer has an obligation to report the Claim Adjustment Reason Code and Claim Adjustment Group Code that accurately identifies the reason for the denial and the proper responsibility for the denied amount.
Submission 5/24/2013
Status Date 10/7/2013
Status F - Final
Primary References
Document 005010X221
Section3
Page7
Set ID835
Table4
Loop2100
Segment Position01
Segment IDCAS
Element Position01
Component Position02
Industry NameClaim Adjustment Group Code
External Code List45 CFR 162.915
Code ValueCO, OA, PR