Claim Line Adjustment Group Code 4
CLM_4_REV_CNTR_ANSI_GRP_CDAn American National Standards Institute (ANSI) group code identifying who has financial responsibility for an adjustment to a claim or service line that resulted in it being paid differently than it was billed. This group code works in conjunction with a Claim Adjustment Reason Code (CARC). For example: PR = Patient responsibility (patient is financially liable). CO = Contractual obligations (provider is financially liable).
Field Metadata
- FHIR Resource
- ExplanationOfBenefit
- FHIRPath
- ExplanationOfBenefit.item.adjudication.reason.coding.where(system = 'https://bluebutton.cms.gov/fhir/CodeSystem/ANSI-GRP-CD').code
- Coverage / Claim Type
- HHA
- Hospice
- Inpatient
- Outpatient
- SNF
- Source View
V2_MDCR_CLM_ANSI_SGNTR- Source Column
CLM_4_REV_CNTR_ANSI_GRP_CD- Sources
- NCH
- Profiles
- Basis
- Regular
- CMS
Example
PRNotes
ANSI reason and group codes are unordered.
Mappings
- CCW
REV_CNTR_4TH_ANSI_CD