Files > 835 LINE LEVEL ADJUSTMENTS

parent
361.1
name
835 LINE LEVEL ADJUSTMENTS
number
361.115
Fields
#NameLocationTypeDetailsIndexDescription
.01adjustment sequence #0;1NUMERICBThis is a sequence # for the adjustment. It has no value to the COB process.
.02payer id code0;2FREE TEXT
.03amount paid0;3NUMERICThis is the amount that was actually paid on this procedure.
.04procedure0;4FREE TEXTThis is the procedure for which payment was considered.
.09description0;9FREE TEXTThis is the procedure description as reported on the EOB.
.1revenue code0;10POINTER399.2This is the revenue code that is associated with the procedure being billed.
.11paid units of service(+)0;11NUMERICThis is the number of units of service that were actually reimbursed.
.12referenced line #0;12NUMERICACThis is the line # on the original bill that is referenced by this adjustment. If bundling or unbundling has occurred, this is the line # that has the actual adjustment information attached to it.
.13allowed amount0;13NUMERICThis is the amount MEDICARE will allow for this service line
.14per diem amount0;14NUMERICThis is the per diem amount reported by MEDICARE for this service line.
.15original procedure0;15FREE TEXTIf this adjustment indicates bundling or unbundling occurred (paid procedure was not the original submitted procedure), this is the procedure that was originally sent for payment on the claim. This field will only have data in it if the procedure was part of a bundling or unbundling process.
.16service date from0;16DATE-TIMEThis is the first date of service for the claim.
.17service date to0;17DATE-TIMEThis is the last date of service for the claim.
.18procedure type0;18FREE TEXTThis is the code representing the type of procedure as reported in this record.
1adjustments1;0MULTIPLE361.1151This is the list of line level adjustments, including general category of adjustment, reason code, amount and quantity.
2paid modifiers2;0MULTIPLE361.1152
4line item remark4;0MULTIPLE361.1154

Error: Invalid Global File Type: 361.115