NextGen Knowledge Center

Reason Code Library Maintenance Field Descriptions

Use the following table to enter reason codes into the library.

FieldDescription
Reason Code LibraryEnter the name for the library.
Hide LibrarySelect this check box to hide the library in the Reason Code List.
Search Method: DescriptionSelect this option to run a search by reason code description.
Search Method: CodeSelect this option to run a search by reason code.
Search for keyphrase anywhere in the itemSelect this check box to search for a string of letters anywhere in the reason code description instead of searching based on the letters at the beginning of the description. This check box is available when you are modifying an existing reason code library.
Type the first letter(s) of the Reason Code to locateEnter the first few letters of the reason code description to display the reason code you are searching for. If you selected the Search for keyphrase anywhere in the item check box, enter letters that occur within the description.
Reason Codes ListLists the reason codes that result from using the Search Method options. The list displays the Code, the Type of code (L = Line Item or Remark, C = Claim Level, Blank = Adjudication) and the Description for each code. Select open menu button and select New to enter a new reason code or select Add Reason Code to add an existing reason code from another library.
CodeEnter the reason code, if applicable.
DescriptionEnter the description of the reason code.
COB Rsn CodeEnter 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.
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.

Claim LevelSelect 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
AdjudicationSelect 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.
RemarkSelect 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.
Force Item RebillSelect this check box to flag line items with the reason code to "Rebill" to the current payer.
Write Off Remaining BalanceSelect this check box to adjust the remaining balance to $0.00 for line items with the reason code. The adjustment occurs when the transaction batch is posted.
Display on Patient StatementsSelect this check box to print the reason code description next to line items with the reason code on patient statements.
Override Line Item CodesSelect this check box to allow the Adjudication reason code to override Line Item reason codes when manually posting payments.
Skip Adjustment CodeSelect one of the following to define how adjustments for the reason code are to be handled: Do not skip adjustment (default): Select this option if an adjustment should be posted to line items with the reason code as per the ERA file. Skip ERA Adjustment: Select this option if an adjustment should not be posted to line items with the reason code, regardless of the information in the ERA file. Use $0 Adj Amount: Select this option if a $0.00 adjustment should be posted to line items with the reason code, regardless of the information in the ERA file. Write Off ERA Adjustment: This option is available only for PR reason codes with a Code Type of Line Item. Select this option to write-off line item patient balances that are created from the PR reason code.
Default for Contract < > Payment Allowed AmountSelect this check box to default 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.
Default for Contract <> ERA Payment AmountSelect this check box and configure the patient response codes (PR) codes 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.

Default for ERA Credit Balance CreationSelect this check box to default 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.
Transaction Detail StatusSelect a transaction status to default to line items when the reason code is used. Select one of the following:
  • Appeal: Select this status to leave 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: Select this status to leave 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: Select this status to move 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: Select this status to move the remaining line item balance to the tertiary payer bucket in Balance Control. A new claim is not created for the tertiary payer.
  • None: Select this status to leave 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: Select this status to leave 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: Select this status to move 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: Select this status to move 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: Select this status to move 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: Select this status to move the remaining line item balance to the tertiary payer bucket in Balance Control. A new claim is created for the tertiary payer.
Adjustment CodeSelect an adjustment transaction code to be used to adjust the remaining balance to $0.00 for line items with the reason code. Notes: 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 Practice Preferences > Transactions to make the adjustment.
Reason Code Subgrouping 1 and 2Select 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.
Hide Reason CodeSelect this check box to hide the reason code in the Reason Codes List.