This segment describes Provider and/or Payer adjustments to a Product/Service Line Item or Response Summary. These include surcharges such as tax, dispensing fees and mark ups.
X12 REF: Similar to CAS segment, with a few new fields.
HL7 Attribute Table - ADJ - Adjustment
| Base Framework | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Seq# | Data Element | Description | Flags | Implement | Cardinality | Length | C.LEN | Vocabulary | Data Type | |
 ADJ | ||||||||||
  | 1 | 02003 | Provider Adjustment Number | SHOULD | [1..1] | EI Entity Identifier | ||||
| 2 | 02004 | Payer Adjustment Number | SHOULD | [1..1] | EI Entity Identifier | ||||
| 3 | 02005 | Adjustment Sequence Number | SHOULD | [1..1] | [1..4] | SI Sequence ID | |||
| 4 | 02006 | Adjustment Category | SHOULD | [1..1] | ex.:AdjustmentCategoryCode (CD) | CWE Coded with Exceptions | |||
| 5 | 02007 | Adjustment Amount | MAY | [0..1] | CP Composite Price | ||||
| 6 | 02008 | Adjustment Quantity | MAY | [0..1] | ex.:QuantityUnits (CD) | CQ Composite Quantity with Units | |||
 | 7 | 02009 | Adjustment Reason PA | C Condition defined for this element | MAY | [0..1] | ex.:ProviderAdjustmentReasonCode (CD) | CWE Coded with Exceptions | ||
| 8 | 02010 | Adjustment Description | = Truncation allowed. | MAY | [0..1] | 250 | ST String Data | ||
| 9 | 02011 | Original Value | = Truncation not allowed! | MAY | [0..1] | 16 | NM Numeric | ||
| 10 | 02012 | Substitute Value | = Truncation not allowed! | MAY | [0..1] | 16 | NM Numeric | ||
| 11 | 02013 | Adjustment Action | MAY | [0..1] | ex.:AdjustmentAction (CD) | CWE Coded with Exceptions | |||
| 12 | 02014 | Provider Adjustment Number Cross Reference | MAY | [0..1] | EI Entity Identifier | ||||
| 13 | 02015 | Provider Product/Service Line Item Number Cross Reference | MAY | [0..1] | EI Entity Identifier | ||||
| 14 | 02016 | Adjustment Date | SHOULD | [1..1] | DTM Date/Time | ||||
 | 15 | 02017 | Responsible Organization | MAY | [0..1] | XON Extended Composite Name and Identification Number for Organizations | ||||
The root for the expression is on the segment.
| Seq. | Referenced Elements | Introduction | Invariant | Comment |
|---|---|---|---|---|
| 1 | ADJ-7 | ? |
| Seq# | Data Element | Description | Flags | Implement | Cardinality | Length | C.LEN | Vocabulary | Data Type | |
|---|---|---|---|---|---|---|---|---|---|---|
| ADJ | ||||||||||
| 1 | 02003 | Provider Adjustment Number | SHALL | [1..1] | EI Entity Identifier | ||||
| 2 | 02004 | Payer Adjustment Number | SHALL | [1..1] | EI Entity Identifier | ||||
| 3 | 02005 | Adjustment Sequence Number | SHALL | [1..1] | [1..4] | SI Sequence ID | |||
| 4 | 02006 | Adjustment Category | SHALL | [1..1] | ex.:AdjustmentCategoryCode (CD) hl7VS-adjustmentCategoryCode (VS) adjustmentCategory (CS) | CWE Coded with Exceptions | |||
| 5 | 02007 | Adjustment Amount | MAY | [0..1] | CP Composite Price | ||||
| 6 | 02008 | Adjustment Quantity | MAY | [0..1] | ex.:QuantityUnits (CD) hl7VS-quantityUnits (VS) | CQ Composite Quantity with Units | |||
| 7 | 02009 | Adjustment Reason PA | C Condition defined for this element | MAY | [0..1] | ex.:ProviderAdjustmentReasonCode (CD) hl7VS-providerAdjustmentReasonCode (VS) providerAdjustmentReason (CS) | CWE Coded with Exceptions | ||
| 8 | 02010 | Adjustment Description | = Truncation allowed. | MAY | [0..1] | 250 | ST String Data | ||
| 9 | 02011 | Original Value | = Truncation not allowed! | MAY | [0..1] | 16 | NM Numeric | ||
| 10 | 02012 | Substitute Value | = Truncation not allowed! | MAY | [0..1] | 16 | NM Numeric | ||
| 11 | 02013 | Adjustment Action | MAY | [0..1] | ex.:AdjustmentAction (CD) hl7VS-adjustmentAction (VS) adjustmentAction (CS) | CWE Coded with Exceptions | |||
| 12 | 02014 | Provider Adjustment Number Cross Reference | MAY | [0..1] | EI Entity Identifier | ||||
| 13 | 02015 | Provider Product/Service Line Item Number Cross Reference | MAY | [0..1] | EI Entity Identifier | ||||
| 14 | 02016 | Adjustment Date | SHALL | [1..1] | DTM Date/Time | ||||
| 15 | 02017 | Responsible Organization | MAY | [0..1] | XON Extended Composite Name and Identification Number for Organizations | ||||
| Base Framework | Base Standard Profile | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Seq# | Data Element | Description | Flags | Implement | Cardinality | Length | C.LEN | Vocabulary | Data Type | Implement | Vocabulary | |
| ADJ | ||||||||||||
| 1 | 02003 | Provider Adjustment Number | SHOULD | [1..1] | EI Entity Identifier | SHALL | |||||
| 2 | 02004 | Payer Adjustment Number | SHOULD | [1..1] | EI Entity Identifier | SHALL | |||||
| 3 | 02005 | Adjustment Sequence Number | SHOULD | [1..1] | [1..4] | SI Sequence ID | SHALL | ||||
| 4 | 02006 | Adjustment Category | SHOULD | [1..1] | ex.:AdjustmentCategoryCode (CD) | CWE Coded with Exceptions | SHALL | hl7VS-adjustmentCategoryCode (VS) adjustmentCategory (CS) | |||
| 5 | 02007 | Adjustment Amount | MAY | [0..1] | CP Composite Price | MAY | |||||
| 6 | 02008 | Adjustment Quantity | MAY | [0..1] | ex.:QuantityUnits (CD) | CQ Composite Quantity with Units | MAY | hl7VS-quantityUnits (VS) | |||
| 7 | 02009 | Adjustment Reason PA | C Condition defined for this element | MAY | [0..1] | ex.:ProviderAdjustmentReasonCode (CD) | CWE Coded with Exceptions | MAY | hl7VS-providerAdjustmentReasonCode (VS) providerAdjustmentReason (CS) | ||
| 8 | 02010 | Adjustment Description | = Truncation allowed. | MAY | [0..1] | 250 | ST String Data | MAY | |||
| 9 | 02011 | Original Value | = Truncation not allowed! | MAY | [0..1] | 16 | NM Numeric | MAY | |||
| 10 | 02012 | Substitute Value | = Truncation not allowed! | MAY | [0..1] | 16 | NM Numeric | MAY | |||
| 11 | 02013 | Adjustment Action | MAY | [0..1] | ex.:AdjustmentAction (CD) | CWE Coded with Exceptions | MAY | hl7VS-adjustmentAction (VS) adjustmentAction (CS) | |||
| 12 | 02014 | Provider Adjustment Number Cross Reference | MAY | [0..1] | EI Entity Identifier | MAY | |||||
| 13 | 02015 | Provider Product/Service Line Item Number Cross Reference | MAY | [0..1] | EI Entity Identifier | MAY | |||||
| 14 | 02016 | Adjustment Date | SHOULD | [1..1] | DTM Date/Time | SHALL | |||||
| 15 | 02017 | Responsible Organization | MAY | [0..1] | XON Extended Composite Name and Identification Number for Organizations | MAY | |||||
| Base Framework | Base Standard Profile | |||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Seq# | Data Element | Description | Flags | Optionality | Repetition | Length | C.LEN | Table | Data Type | Optionality | Table | |
| ADJ |
||||||||||||
|
1 | 02003 | Provider Adjustment Number | O | EI Entity Identifier |
R | ||||||
|
2 | 02004 | Payer Adjustment Number | O | EI Entity Identifier |
R | ||||||
|
3 | 02005 | Adjustment Sequence Number | O | [1..4] | SI Sequence ID |
R | |||||
|
4 | 02006 | Adjustment Category | O | (0564) | CWE Coded with Exceptions |
R | |||||
|
5 | 02007 | Adjustment Amount | O | CP Composite Price |
|||||||
|
6 | 02008 | Adjustment Quantity | O | CQ Composite Quantity with Units |
(0560) | ||||||
|
7 | 02009 | Adjustment Reason PA | C Condition defined for this element |
O | CWE Coded with Exceptions |
(0565) | |||||
|
8 | 02010 | Adjustment Description | O | 250# | ST String Data |
||||||
|
9 | 02011 | Original Value | O | 16= | NM Numeric |
||||||
|
10 | 02012 | Substitute Value | O | 16= | NM Numeric |
||||||
|
11 | 02013 | Adjustment Action | O | CWE Coded with Exceptions |
(0569) | ||||||
|
12 | 02014 | Provider Adjustment Number Cross Reference | O | EI Entity Identifier |
|||||||
|
13 | 02015 | Provider Product/Service Line Item Number Cross Reference | O | EI Entity Identifier |
|||||||
|
14 | 02016 | Adjustment Date | O | DTM Date/Time |
R | ||||||
|
15 | 02017 | Responsible Organization | O | XON Extended Composite Name and Identification Number for Organizations |
|||||||
| Seq# | Data Element | Description | Optionality | Repetition | Length | C.LEN | Table | Data Type | |
|---|---|---|---|---|---|---|---|---|---|
| ADJ |
|||||||||
|
1 | 02003 | Provider Adjustment Number | R | EI Entity Identifier |
||||
|
2 | 02004 | Payer Adjustment Number | R | EI Entity Identifier |
||||
|
3 | 02005 | Adjustment Sequence Number | R | [1..4] | SI Sequence ID |
|||
|
4 | 02006 | Adjustment Category | R | (0564) | CWE Coded with Exceptions |
|||
|
5 | 02007 | Adjustment Amount | O | CP Composite Price |
||||
|
6 | 02008 | Adjustment Quantity | O | (0560) | CQ Composite Quantity with Units |
|||
|
7 | 02009 | Adjustment Reason PA | C | (0565) | CWE Coded with Exceptions |
|||
|
8 | 02010 | Adjustment Description | O | 250# | ST String Data |
|||
|
9 | 02011 | Original Value | O | 16= | NM Numeric |
|||
|
10 | 02012 | Substitute Value | O | 16= | NM Numeric |
|||
|
11 | 02013 | Adjustment Action | O | (0569) | CWE Coded with Exceptions |
|||
|
12 | 02014 | Provider Adjustment Number Cross Reference | O | EI Entity Identifier |
||||
|
13 | 02015 | Provider Product/Service Line Item Number Cross Reference | O | EI Entity Identifier |
||||
|
14 | 02016 | Adjustment Date | R | DTM Date/Time |
||||
|
15 | 02017 | Responsible Organization | O | XON Extended Composite Name and Identification Number for Organizations |
||||
Definition: Unique Adjustment Number assigned by the Provider Application.
Definition: Unique Adjustment Number assigned by the Payer Application.
Definition: Unique sequence number for this adjustment - starts with 1, then 2, etc., for each unique adjustment for the Product/Service Line Item.
Definition: Indicates the category of adjustment and is used to assist in determining which table is used for Adjustment Reason. Refer to User-defined Table 0564 - Adjustment Category Code in Chapter 2C, Code Tables, for suggested values.
Definition: Adjustment amount, such as taxes, deductibles, previously paid amount.
Definition: Adjustment quantity.
X12 REF: table 673 Quantity Qualifier. New values from X12 673 can be added as required. Refer to User-defined Table 0560 - Quantity Units in Chapter 2C, Code Tables, for suggested values.
Definition: Reason for this adjustment. Codes used to explain a Provider adjustment to a Product/Service Group or Product/Service Line Item by a Provider. Refer to User-defined Table 0565 - Provider Adjustment Reason Code in Chapter 2C, Code Tables, for suggested values.
Definition: Description of adjustment, such as client instructions.
Definition: Original value of data item noted in this adjustment.
Definition: Substituted value of data item noted in this adjustment.
Definition: Action requested of party that receives this adjustment. Refer to User-defined Table 0569 - Adjustment Action in Chapter 2C, Code Tables, for suggested values.
Definition: Unique Provider Adjustment Number assigned by the Provider Application that is referenced by this Payer Adjustment.
Definition: Unique Provider Product/Service Line Item Number assigned by the Provider Application that is referenced by this Payer Adjustment; used for groups with multiple line items that need to be singled out by a Payer Adjustment.
Definition: Date/Time adjustment was made. May also be synonymous with Adjudication Date.
Definition: Business organization that is responsible for the adjustment (e.g., Payer organization); can be used for a Payment/Remittance Advice for 1 Payee from multiple Payers.
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