Service Line Adjudication Information

The Line Adjudication Information that is displayed on this page may only be populated if Other Payer Information has been entered on the Other Payers tab. If no Other Payers have been listed for this claim, the Line Adjudication information for each Service Line will be blank.

However, if Other Payers have been entered, and Line Adjudication Information has been received for any or all Service Lines, the details will be displayed on this page. You may navigate through the Adjudications for each individual Service Line using the Next Line Adjudication>> control, or view a summary table of All Line Adjudications for this Service Line.

Line Adjudication Information

Other Payer Name: The Payer Name selected must match one of those entered on the Other Payer tab. All subsequent data entered applies to the Adjudication for this Service Line and Payer combination.

Service Line Paid Amount: The dollar amount paid towards this Service Line by this Payer. The total of all the Service Line Paid Amounts on this claim for an individual payer does not need to add up to the Other Payer Paid Amount on the Other Payer tab for the selected payer.

Paid HCPCS Code & Modifiers:  The Health Care Financing Administration Common Procedural Coding System identifier for the product/service. The HCPCS code value is required for all claims. Optionally, up to 4 modifiers identifying special circumstances related to the performance of the service may be entered for each code. Note: If entered, the Modifier must be a 2 character code.

Paid Units of Service: The original billed units of service.

Date Claim Paid: Service adjudication or payment date must be entered. The date may not be greater than the current date. The format is: MM/DD/YYYY and may either be entered in the field or selected from the calendar available by pressing the button to the right of the field.

Claim Adjustment Group: The general category of the payment adjustment. A maximum of 5 Claim Adjustment Groups are allowed.

Reason Code: The detailed reason the adjustment was made. This is directly correlated to the Claim Adjustment Group. The Claim Adjustment Group/Reason Code combination may not be entered more than once. If an Adjustment Amount or Adjustment Quantity is entered, a Reason Code is required.

Adjustment Amount: The monetary amount of the adjustment. An Adjustment Amount is required when a Reason Code is entered.

Adjustment Quantity: The units of service being adjusted.

When you have completed entering/reviewing the Line Adjudication details for a Service Line, you may return to the Main Service Line page by clicking Close Details or you may return to any of the tabs to review or continue entering information.

Click here for the controls located at the bottom of the page.