Billing > Facility Billing

Does any one have a list of ALL possible 2ndry Group/Adj codes?

(1/3) > >>

Lugoves:
When filing electronic 2ndry claims from an IDTF on a CMS-1500 I typically utilize PR Patient Responsibility and Adjustment code(s) 1 for Deductible Portions, 2 for Co insurance and 3 for Copay. I am also aware of the group codes CO CR OA and PI. My question is are there any other combinations of Group/Adjustment codes? At times I'd like to communicate more accurately to the 2ndry insurance what is going on. For Example, if I know a 2ndry is typically an insurance of 'last resort' how would I code the electronic 2ndry claim to indicate that the Patient is responsible because their coverage terminated with the Primary. Frequently I use CO-45 then PR 1,2 or 3 for typical Copay Co-Ins or Ded that are Patient Responsibility, but I can't find other Group codes to accompany different Adj codes for other circumstances. Thanks in advance for any assistance anyone can provide.

Pay_My_Claims:
there are a lot available that are payor specific

Lugoves:
Well, I guess that helps, I can search each payor's website til I find their 'List' seems like they would have standardized this along with the requirements for electronic billing. Thanks for the reply.

Pay_My_Claims:
not sure why you need that, but every system I have ever used had their own adjustment codes and the ability to create your own. Like I bill for DME so we get denials for included in cost of equip. I can use a code specific for that for audit purposes or i can use the 102 (non allowed0 code that is in our system. It really means the same thing. Why would you want a lot of codes that mean the same??  Just varies by the provider??

PMRNC:
I agree with Charlene, why would you want these? you should have your own set of internal codes used. I always keep in mind one of my favorite sayings "Good data in is good data out"  Meaning the more specific your internal codes are, the better the reports.

I'd think it damn near impossible to standardize these codes since carriers are not required to use the same type of software/database. Nor should we ever expect them to be, as long as the receiving end is NSF we are all good.

Navigation

[0] Message Index

[#] Next page