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Claim Line Adjustment Group Code 4

CLM_4_REV_CNTR_ANSI_GRP_CD

AN 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 

PR

Notes

ANSI reason and group codes are unordered.

Mappings

CCW
  • REV_CNTR_4TH_ANSI_CD

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