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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 Segment

Seq#	DataElement	Description	Must Implement	Flags	Cardinality	Length	C.LEN	Vocabulary	DataType
ADJ
1	02003	Provider Adjustment Number	SHALL		[1..1]				EI
2	02004	Payer Adjustment Number	SHALL		[1..1]				EI
3	02005	Adjustment Sequence Number	SHALL		[1..1]	[1..4]			SI
4	02006	Adjustment Category	SHALL		[1..1]			0564 Adjustment Category Code	CWE
5	02007	Adjustment Amount			[0..0]				CP
6	02008	Adjustment Quantity			[0..1]			0560	CQ
7	02009	Adjustment Reason PA	MAY True: False:	C	[1..1] [0..1]			0565 Provider Adjustment Reason Code	CWE
8	02010	Adjustment Description		#	[0..1]		250		ST
9	02011	Original Value		=	[0..1]		16		NM
10	02012	Substitute Value		=	[0..1]		16		NM
11	02013	Adjustment Action			[0..1]			0569 Adjustment Action	CWE
12	02014	Provider Adjustment Number Cross Reference			[0..1]				EI
13	02015	Provider Product/Service Line Item Number Cross Reference			[0..1]				EI
14	02016	Adjustment Date	SHALL		[1..1]				DTM
15	02017	Responsible Organization			[0..1]				XON

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.