Examples of Claims with the Claim Level Adjustment Amount Segment
The following examples show the 2320 loop when the claim-level adjustment amount segment is added to institutional and professional claims. The segment is displayed in bold text.
2320 loop for a professional claim with the claim level adjustment amount added
The following example shows how the 2320 loop for a professional claim looks with either the Submitter Profile or Payer option set to add the claim level adjustment amounts. Claim level CAS segments are grouped under the adjustment reason group code (e.g. CO, PR, CR, or PI). When the same group code (PR3, PR1) contain specific multiple reason codes, these codes are combined in the same CAS segment.
For example, reason codes PR1 and PR3 would be combined in the same CAS segment like this: CAS*PR*3*20**1*100~, with each reason code paired with the corresponding amount.
CLM*000100000970*190***11**1*Y*A*Y*O*B******P~ REF*EA*CP1Z3M36NVOA~ HI*BK*25000~ NM1*82*1*TEAM MD*ROBERT*A***24*404803109~ REF*1D*404803109~ SBR*P*18***C1****BL~ CAS*CO*47*33~ CAS*PR*3*19~ AMT*D*138~ AMT*B6*157~ DMG*D8*19661013*F~ OI***Y*B**O~ |
2320 loop for an institutional claim with the claim level adjustment amount added
The following example shows how the 2320 loop looks for an institutional claim with either of the same options set to add the claim level adjustment amounts. An institutional claim follows the same reason code grouping for the CAS segments as the professional file. All reason codes with the same group code (e.g. CO, CR, PR, PI) will be grouped in the same CAS segment: CAS*PR*3*20**1*100~
CLM*000100000970*190***73*A*1*Y*A*Y*O*********Y~ DTP*434*RD8*20071130-20071130~ REF*EA*CP1Z3M3ZC8IW~ HI*BK*25000~ NM1*71*1*TEAM MD*ROBERT*A***24*404803109~ REF*1D*404803109~ SBR*P*18*******BL~ CAS*CO*47*33~ CAS*PR*3*19~ AMT*C4*138~ AMT*B6*157~ DMG*D8*19661013*F~ OI***Y***O~ |