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The following table lists each option available in the Reason Codes Library with a description of how it works and how it may be used.
| Reason Code Option | How it Works | How it is Used |
|---|---|---|
| Force Item Rebill | Select this check box to flag line items with the reason code to "Rebill" to the current payer.
| When trends are identified for a reason code that always require rebilling. |
| Write Off Remaining Balance | Select 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.
| Sometimes used with payers of last resort, such as Medicaid.
|
| Display on Patient Statements | Select this check box to print the reason code description next to line items with the reason code on patient statements.
| Only applies when sending detailed statements. |
| Override Line Item Codes | Select this check box to allow the Adjudication reason code to override Line Item reason codes when manually posting payments.
| Adjudication codes are at the claim level. This option is used when claim level adjustments are returned, to override the default line item codes when manually posting payments. |
| Default for Contract <> Payments Allowed Amount | Select 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 CPT® 4 in the contract. This can be selected for a custom 'user defined' reason code used to track differences in contract and actual allowed amounts. | Used to compare the allowed amount posted from the payer to the allowed amount defined in the contract in File Maintenance. |
| Default for Contract <> ERA Payment Amount | Select 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.
| compares and tracks the ERA payment amount with the contractual reimbursement amount. |
| Default for ERA Credit Balance Creation | Select 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. | The reason code is added to a transaction when a credit or negative balance is created from the ERA Posting process. A worklog task can be created from the reason code instructing the user to review why the credit balance was created. |
| Skip Adjustment Code: | ||
| Do not skip adjustment | Select this option if an adjustment should be posted to line items with the reason code as per the ERA file. This is the default setting. | Allows an automatic adjustment to be posted. Example: CO45 Charge exceeds contract amount. |
| 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. | Prevents an automatic adjustment from being posted. Example: CO10 Diagnosis inconsistent with patient's gender. |
| 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. | Allows a $0.00 adjustment to be posted. For example, when claim level adjustments need to post that may have already been posted from a Contract in File Maintenance prior to importing 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. | Can be used with payers, such as Medicaid, to write-off a patient balance. Example: PR3 Co-payment Amount |
| Transaction Detail Status | Select a transaction status to default to line items when the reason code is used.
| Changes the normal progression of moving the balance to the next responsible payer. |
| 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.
| To allow reporting on a specific reason code with a special transaction code. Example: CO24 Charge covered under capitation.
|
| Reason Code Subgrouping 1 and 2 | Select 1 or 2 subgroupings for the reason code on reports. Subgroupings are labeled in . Subgroupings are created in .
| Select the subgroup that indicated the type of reason code for reporting purposes. |