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ADJ - Adjustment Segment

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] CWE
5 02007 Adjustment Amount [0..0] CP
6 02008 Adjustment Quantity [0..1] CQ
7

02009 Adjustment Reason PA MAY
True:
False:
C
[1..1]
[0..1]
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] 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

ADJ-1: Provider Adjustment Number (EI) 02003

Definition: Unique Adjustment Number assigned by the Provider Application.

ADJ-2: Payer Adjustment Number (EI) 02004

Definition: Unique Adjustment Number assigned by the Payer Application.

ADJ-3: Adjustment Sequence Number (SI) 02005

Definition: Unique sequence number for this adjustment – starts with 1, then 2, etc., for each unique adjustment for the Product/Service Line Item.

ADJ-4: Adjustment Category (CWE) 02006

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.

ADJ-5: Adjustment Amount (CP) 02007

Definition: Adjustment amount, such as taxes, deductibles, previously paid amount.

ADJ-6: Adjustment Quantity (CQ) 02008

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.

ADJ-7: Adjustment Reason PA (CWE) 02009

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.

ADJ-8: Adjustment Description (ST) 02010

Definition: Description of adjustment, such as client instructions.

ADJ-9: Original Value (NM) 02011

Definition: Original value of data item noted in this adjustment.

ADJ-10: Substitute Value (NM) 02012

Definition: Substituted value of data item noted in this adjustment.

ADJ-11: Adjustment Action (CWE) 02013

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.

ADJ-12: Provider Adjustment Number Cross Reference (EI) 02014

Definition: Unique Provider Adjustment Number assigned by the Provider Application that is referenced by this Payer Adjustment.

ADJ-13: Provider Product/Service Line Item Number Cross Reference (EI) 02015

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.

ADJ-14: Adjustment Date (DTM) 02016

Definition: Date/Time adjustment was made. May also be synonymous with Adjudication Date.

ADJ-15: Responsible Organization (XON) 02017

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.