| # | 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 LQ:Line Item Remark Code WebMD Kludge | B | |
| 1 | reasons | 1;0 | MULTIPLE | 361.11511 | This is the list of reasons returned for line-level adjustments to the claim. | |
| 2 | payer policy reference | 2;0 | MULTIPLE | 361.11512 | These are the payer policy references listed on the payer web site. Up to 5 payer policy references are allowed on the 835 record. |
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