| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | group code(+) | 0;1 | SET OF CODES | CO:Contractual Obligations CR:Corrections and Reversals OA:Other Adjustments PI:Payor Initiated Reductions PR:Patient Responsibility MM:Medicare Message | B | This is the group code for which this type of plan pays all or a percentage of the adjustments made to the original claim by the payer during adjudication. For example, if there is an entry for Group Code CO, this plan pays all or part of Excess Charges. |
| 1 | reason code | 1;0 | MULTIPLE | 355.1411 | This multiple stores the Reason Code(s) for which, when associated with the correct Group Code, this Type of Plan pays all or a percentage of the adjustments made to the original claim by the payer during adjudication. For example, if there is an entry of Reason Code 1 with the Group Code of PR, then this plan pays all or a percentage of the Patient's Deductable as indicated on the Medicare-equivalent Remittance Advice (MRA). |
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