| COB Rsn Code | Enter the HIPAA-compliant reason code to automatically populate the Coordination of Benefits Information window on the Payment Entry screen. Entering a COB reason code enables you to use the proprietary code for the transaction and the HIPAA-compliant code for the claim. This field can be used instead of or in conjunction with the default COB reason code in the Payer master file. |
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| Line Item | Select this button if the reason code is returned by the payer at the charge or CPT4 code level. These reason codes are available for selection in the Line Item Reasons column at the bottom of the Payment Entry screen. |
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| Claim Level | Select this button if the reason code is returned by the payer at the claim level and it applies to the entire transaction. These reason codes are available for selection in the Claim Reasons field at the top of the Payment Entry screen under the Claim Level Codes list |
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| Adjudication | Select this button if the reason code is returned by the payer at the claim level and it applies to the entire transaction. Adjudication reason codes typically contain additional information regarding the settlement of a claim. These reason codes are available for selection in the Claim Reasons field at the top of the Payment Entry screen under the Adjudication Codes list.
Note: The Override Line Item Codes check box must be selected if the Adjudication reason code should override Line Item reason codes when manually posting payments.
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| Remark | Select this button if the reason code is returned by the payer at the charge or CPT4 code level. Remark reason codes typically contain additional information regarding the settlement of a specific line item on a claim. These reason codes are available for selection in the Line Item Reasons column at the bottom of the Payment Entry screen. |
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| Force Item Rebill | Flags line items with the reason code to rebill to the current payer.
Note: This option applies to Line Item reason codes only.
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| Write Off Remaining Balance | Adjusts the remaining balance to $0.00 for line items with a reason code. The adjustment occurs when the transaction batch is posted.
Note: This option applies to Line Item reason codes only. ERA uses the Adjustment Code selected below to make the adjustment. Manual payment entry uses the Write Off Remaining Payer Balance adjustment code selected in Transactions of Practice Preferences to make the adjustment.
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| Display on Patient Statements | Prints the reason code description next to line items with the reason code on patient statements.
Note: This option applies to Line Item reason codes only.
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| Override Line Item Codes | Allows the Adjudication reason code to override Line Item reason codes when manually posting payments.
Note: This option is not used with ERA.
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| Skip Adjustment Code | Select from the following list:
- Do not skip adjustment (default): Posts an adjustment to line items with the reason code as per the ERA file.
- Skip ERA Adjustment: Skips posting an adjustment to line items with the reason code, regardless of the information in the ERA file.
- Use $0 Adj Amount: Posts a $0.00 adjustment to line items with the reason code, regardless of the information in the ERA file.
- Write Off ERA Adjustment: Writes off line item patient balances that are created from the PR reason code. This option is available only for PR reason codes with a Code Type of Line Item.
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| Default for Contract < > Payment Allowed Amount | Defaults the reason code onto line items when the allowed amount posted does not equal the allowed amount defined for the CPT4 in the contract. This can be selected for a custom user defined reason code used to track differences in contract and actual allowed amounts.
Note: If you want to ensure that the remaining balance of respective transactions remain in the same payer bucket to follow up with the primary payer, you can select one of the following options in the Transaction Status field as applicable:
- None
- Deny
- Appeal
- Settled moved to primary
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| Default for Contract <> ERA Payment Amount | Configures the patient response codes (PR) in the Patient Response Code field, when you want to compare the Electronic Remittance Advice (ERA) payment amount and the selected PR codes amount with the contractual reimbursement amount for the transaction. This can be selected for a custom user-defined reason code used to track differences in contract and actual allowed amounts.
Note: If you want to ensure that the remaining balance of respective transactions remain in the same payer bucket to follow up with the primary payer, you can select one of the following options in the Transaction Status field as applicable:
- None
- Deny
- Appeal
- Settled moved to primary
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| Default for ERA Credit Balance Creation | Defaults the reason code onto line items when a credit or negative balance is created from an ERA transaction. This can be selected for a custom user-defined reason code used to track credit balances created from the ERA posting process.
Note: If you want to ensure that the remaining balance of respective transactions remains in the same payer bucket to follow up with the primary payer, you can select one of the following options in the Transaction Status field as applicable:
- None
- Deny
- Appeal
- Settled moved to primary
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| Transaction Detail Status | Select a transaction status to default to line items when the reason code is used.
Note: This option applies to Line Item reason codes only.
- Appeal: Leaves the remaining line item balance in the current payer bucket in Balance Control. A new claim is not created. For example, use to appeal a payment received on a line item.
- Deny: Leaves the remaining line item balance in the current payer bucket in Balance Control. A new claim is not created. For example, use to appeal a payment denial received on a line item.
- Forwarded to Secondary: Moves the remaining line item balance to the secondary payer bucket in Balance Control. A new claim is not created for the secondary payer.
- Forwarded to Tertiary: Moves the remaining line item balance to the tertiary payer bucket in Balance Control. A new claim is not created for the tertiary payer.
- None: Leaves the remaining line item balance in the current payer bucket in Balance Control. A new claim is not created. For example, use to prevent a credit balance created from an overpayment on a line item from moving to the next payer.
- Rebill: Leaves the remaining line item balance in the current payer bucket in Balance Control. A new claim is created for the current payer. For example, use to rebill the current payer for a line item.
- Settled moved to self: Moves the remaining line item balance to the patient bucket in Balance Control. A statement is created for the balance to the guarantor.
- Settled moved to primary: Moves the remaining line item balance to the primary payer bucket in Balance Control. A new claim is created for the primary payer.
- Settled moved to secondary: Moves the remaining line item balance to the secondary payer bucket in Balance Control. A new claim is created for the secondary payer.
- Settled moved to tertiary: Moves the remaining line item balance to the tertiary payer bucket in Balance Control. A new claim is created for the tertiary payer.
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| Adjustment Code | Select an adjustment transaction code to be used to adjust the remaining balance to $0.00 for line items with the reason code.
Note: The Write Off Remaining Balance check box must also be selected. ERA uses this Adjustment Code to make the adjustment. Manual payment entry uses the Write Off Remaining Payer Balance adjustment code selected in Transactions of Practice Preferences to make the adjustment.
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| Reason Code Subgrouping 1 and 2 | Select 1 or 2 subgroupings for the reason code on reports. Subgroupings are labeled in Enterprise Preferences > General. Subgroupings are created in File Maintenance > Master Lists.
Note: Subgroupings are designed and used for reporting purposes, not for use with ERA.
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