ADJ - Adjustment Segment

This segment describes Provider and/or Payer adjustments to a Product/Service Line Item or Response Summary. These include surcharges such as tax, dispensing fees and mark ups.

X12 REF: Similar to CAS segment, with a few new fields.

HL7 Attribute Table - ADJ - Adjustment Segment

Seq#	Data Element Name	DataType	Usage	Vocabulary	Cardinality	Item #	Length	C.LEN	Flags
ADJ
1	Provider Adjustment Number	EI	R		[1..1]	02003
2	Payer Adjustment Number	EI	R		[1..1]	02004
3	Adjustment Sequence Number	SI	R		[1..1]	02005	[1..4]
4	Adjustment Category	CWE	R	0564 Adjustment Category Code	[1..1]	02006
5	Adjustment Amount	CP	O		[0..0]	02007
6	Adjustment Quantity	CQ	O	0560 Quantity Units	[0..1]	02008
7	Adjustment Reason PA	CWE	C	0565 Provider Adjustment Reason Code	[0..1]	02009
8	Adjustment Description	ST	O		[0..1]	02010		250	#
9	Original Value	NM	O		[0..1]	02011		16	#
10	Substitute Value	NM	O		[0..1]	02012		16	#
11	Adjustment Action	CWE	O	0569 Adjustment Action	[0..1]	02013
12	Provider Adjustment Number Cross Reference	EI	O		[0..1]	02014
13	Provider Product/Service Line Item Number Cross Reference	EI	O		[0..1]	02015
14	Adjustment Date	DTM	R		[1..1]	02016
15	Responsible Organization	XON	O		[0..1]	02017

ADJ-1: Provider Adjustment Number (EI) 02003

Definition: Unique Adjustment Number assigned by the Provider Application.

ADJ-2: Payer Adjustment Number (EI) 02004

Definition: Unique Adjustment Number assigned by the Payer Application.

ADJ-3: Adjustment Sequence Number (SI) 02005

Definition: Unique sequence number for this adjustment – starts with 1, then 2, etc., for each unique adjustment for the Product/Service Line Item.

ADJ-4: Adjustment Category (CWE) 02006

Definition: Indicates the category of adjustment and is used to assist in determining which table is used for Adjustment Reason. Refer to User-defined Table 0564 – Adjustment Category Code in Chapter 2C, Code Tables, for suggested values.

ADJ-5: Adjustment Amount (CP) 02007

Definition: Adjustment amount, such as taxes, deductibles, previously paid amount.

ADJ-6: Adjustment Quantity (CQ) 02008

Definition: Adjustment quantity.

X12 REF: table 673 Quantity Qualifier. New values from X12 673 can be added as required. Refer to User-defined Table 0560 – Quantity Units in Chapter 2C, Code Tables, for suggested values.

ADJ-7: Adjustment Reason PA (CWE) 02009

Definition: Reason for this adjustment. Codes used to explain a Provider adjustment to a Product/Service Group or Product/Service Line Item by a Provider. Refer to User-defined Table 0565 – Provider Adjustment Reason Code in Chapter 2C, Code Tables, for suggested values.

ADJ-8: Adjustment Description (ST) 02010

Definition: Description of adjustment, such as client instructions.

ADJ-9: Original Value (NM) 02011

Definition: Original value of data item noted in this adjustment.

ADJ-10: Substitute Value (NM) 02012

Definition: Substituted value of data item noted in this adjustment.

ADJ-11: Adjustment Action (CWE) 02013

Definition: Action requested of party that receives this adjustment. Refer to User-defined Table 0569 – Adjustment Action in Chapter 2C, Code Tables, for suggested values.

ADJ-12: Provider Adjustment Number Cross Reference (EI) 02014

Definition: Unique Provider Adjustment Number assigned by the Provider Application that is referenced by this Payer Adjustment.

ADJ-13: Provider Product/Service Line Item Number Cross Reference (EI) 02015

Definition: Unique Provider Product/Service Line Item Number assigned by the Provider Application that is referenced by this Payer Adjustment; used for groups with multiple line items that need to be singled out by a Payer Adjustment.

ADJ-14: Adjustment Date (DTM) 02016

Definition: Date/Time adjustment was made. May also be synonymous with Adjudication Date.

ADJ-15: Responsible Organization (XON) 02017

Definition: Business organization that is responsible for the adjustment (e.g., Payer organization); can be used for a Payment/Remittance Advice for 1 Payee from multiple Payers.