Claims

The treatment strategy text for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The coverage policy identifier for a financial modification. Used as a unique reference to identify and track the adjustment across healthcare systems. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The chosen display name for a financial modification. Used to display and describe the adjustment in a human-readable format. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The cost value for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The primary designation flag for a financial modification. Used to track the current state or condition of the adjustment. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

A ranking field in claims adjudication or PBM systems that determines the sequence in which multiple financial modifications are applied to a single transaction. Ensures correct ordering of coordination of benefits, contractual adjustments, and member cost-sharing calculations within payment processing engines.

The heart rate value for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The numeric count or volume associated with a financial modification applied to a claim or remittance record. Used in 835 EDI transactions, EHR billing modules, and claims adjudication systems to track the number of units affected by a specific adjustment, such as units reversed or reprocessed.

The ethnic classification for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The per-unit monetary value applied during a financial modification to a claim or remittance line item. Used in fee schedule reconciliation, PBM reimbursement systems, and 835 EDI remittance processing to calculate adjusted reimbursement amounts based on contracted or corrected unit pricing.

The assessment value for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The proportional value for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

Code sourced from the ANSI X12 835 transaction set explaining why a payer adjusted or denied a claim. Maps to CAS segment reason codes in EHR billing, claims adjudication, and remittance processing systems to support resubmission and appeals workflows.

The receipt date for a financial modification. Used to track temporal information related to adjustment received date. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

An external identifier or pointer linking a financial modification back to its originating transaction, payer contract, or regulatory requirement. Used in claims adjudication systems, 835 EDI workflows, and EHR billing platforms to maintain traceability between original claim records and their corresponding adjustment entries for audit purposes.

The condition end date for a financial modification. Used to track temporal information related to adjustment resolution date. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The breathing rate value for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The body systems assessment for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The update iteration number for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.

The danger level assessment for a financial modification. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for adjustment management and reporting.