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There are four types of reason codes as described below. The type of code that is used is determined by the payer. Different payers may return the same code as either a Line Item code or a Claim Level code. If this occurs, it is possible to have the same code in the Reason Code Library with two different code types to ensure that the ERA 835 file processes correctly. Adjudication codes are always claim level codes. Remark codes are always line item level codes. Reason codes that are imported “on-the-fly” are automatically flagged as either Line Item or Claim Level, depending on how they are returned by the payer in the ERA file.
Line Item:
Line Item reason codes are returned by the payer at the charge, or CPT® 4 code, level. They are available for selection in the Line Item Reasons column at the bottom of the Payment Entry window. They display in the Reason column in the sub-tab.
Claim Level:
Claim Level reason codes are returned by the payer at the claim level and apply to the entire transaction. They are available for selection in the Clm Reasons field at the top of the Payment Entry window under the Claim Level Codes list.
Adjudication:
Adjudication reason codes are returned by the payer at the claim level and apply to the entire transaction. They are available for selection in the Clm Reasons field at the top of the Payment Entry window under the Adjudication Codes list.
Remark:
Remark reason codes are returned by the payer at the charge, or CPT4 code, level. They are available for selection in the Line Item Reasons column at the bottom of the Payment Entry window. They display in the Reason column in the sub-tab.