Files > REASON CODE

parent

355.141

name

REASON CODE

number

355.1411

Fields

#	Name	Location	Type	Details	Index	Description
.01	reason code(+)	0;1	FREE TEXT		B	This is the Reason Code 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. 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).
1	part a percentage(+)	0;2	NUMERIC			This is the percentage (0-100) that this Type of Plan pays for PART A amounts returned under a Group and Reason code on an MRA. Example, if this plan pays 50% of the Part A Deductible, enter a Group Code of PR in the Group Code multiple, a Reason Code of 1 in the Reason Code multiple, and a 50 in this field.
2	part b percentage(+)	0;3	NUMERIC			This is the percentage (0-100) that this plan pays for PART B amounts returned under a Group and Reason code on an MRA. Example, if this plan pays 75% of Part B Co-payments, enter a Group Code of PR in the Group Code multiple,a Reason Code of 2 in the Reason Code multiple, and a 75 in this field.