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Submitter

Elitsa Nedyalkova

Description

The 5010 Ig states that reversing the original claim payment is accomplished with code 22, "reversal of previous payment" and original Claim Adjustment group codes in CAS01. Which group code should be used? Is it appropriate to use PI -Payer Initiated Reductions?

Response

This issue is explicitly addressed in guide 005010X221. Section 1.10.2.8 states "Reverse the original payment, restoring the patient accounting system to the pre-posting balance for this patient." and "Send original Claim Adjustment group codes in CAS01".

The CR group code is no longer available in the 5010X221 TR3. Therefore, the Claim Adjustment Group Codes used in the reversal MUST be the same Claim Adjustment Group Codes that were used in the original payment that is being reversed.

There is no single Claim Adjustment Group Code that is always used. See the example in section 1.10.2.8.
Submission 8/7/2009
Status Date 9/14/2009
Status F - Final
Primary References
Document 005010X221
Section2.8
Page30
Set ID1