What are EOB Claim Adjustment Group Codes?

A Claim Adjustment Group Code consists of two alpha characters that assign the responsibility of a Claim Adjustment on the insurance Explanation of Benefits.

These 5 EOB Claim Adjustment Group Codes are:

CO Contractual Obligation

CR Corrections and Reversal

OA Other Adjustment

PI Payer Initiated Reductions

PR Patient Responsibility

These Group Codes are combined with Claim Adjustment Reason Codes that can be numeric or alpha-numeric, ranging from 1 to W2. Claim Adjustment Reason Codes are associated with an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code.

Top 5 examples of EOB Claim Adjustments are:

CO-45 indicates claim amount that must be written off based on payer contracted fee schedule.

CO-97 indicates the benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated.

OA-23 indicates the impact of prior payer(s) adjudication including payments and/or adjustments.

PR-1 indicates amount applied to patient deductible.

PR-2 indicates amount applied to patient co-insurance.

For a complete list of claim adjustment reason codes, visit Washington Publishing Company's website by clicking here.

Revenue Cycle Management: Accomplished.

START BILLING BETTER WITH SHAVARA

Revenue Cycle Management: Accomplished.

START BILLING BETTER WITH SHAVARA

by Shavara

Shavara has the accumulated 'experience capital', the market know-how, the intricacies of coding, billing and connectivity that we have 'learned'. It is the basis of the work we do in Catalysis - Shavara's Professional Services Engagements.

ThinkCatalysis
Revenue Cycle Management: solved.

What is Catalysis?

To "catalyze" is to rapidly advance by applying powerful tools and industry expertise. Catalysis becomes the process to gain access to the power, apply it to solve gaps and vulnerabilities - then rapidly advance. Shavara possesses the tools to apply Catalysis via collaborative engagements. Our infinite targets are the enterprise organizations: Hospitals, clearinghouse processors, Insurance companies (payers), and large physician practices, peppered throughout the Healthcare system that all share equally the challenges, pitfalls, inefficiencies, ineffectiveness, and the deliberate speed-bumps placed there by bureaucrats to slow down the revenue cycle.

What are the costs of these speed-bumps to the Healthcare system? The costs are in the billions.

Inefficiencies / ineffectiveness / inaccuracies in coding and billing mean:

a higher cost of money due to extended A/Rs
a higher cost of operating due to the number of additional staff required to research and chase down A/Rs
a decline in the quality and calibre of care - care outcomes due to the necessity of placing so much cost on the administrative and operational side of the equation

Therefore, solving this eliminates and holds the potential to improve organizational effectiveness, reduce the cost of healthcare and improve healthcare outcomes.

So, who is Shavara? What is that old lamp on the corner of the desk?

That lamp holds wisdom. The cumulative potential of that wisdom holds the potential to dramatically impact operational effectiveness and improve healthcare outcomes.

For Information on Catalysis contact Shavara's Services Division