Is California using only the latest approved ANSI adjustment reason codes?
No, the California DWC/WCIS has adopted the ANSI adjustment reason codes in the IAIABC EDI Implementation Guide for Medical Bill Payment Records, Release 1, July 4, 2002 and the claim adjustment reason codes published by the Washington Publishing Company. Q: If the group code and the reason code are the same for two adjustments (two line items in the same bill), is it necessary to have one CAS segment displaying the sum of two adjustments or are two CAS segments acceptable? A: Each line adjustment should be reported separately. Q: If a provider sends a bill with multiple lines and one of the lines on the bill was previously received and processed/paid, should the duplicate line be reported to the WCIS? Should the duplicate line be submitted with ANSI reason code “18” (duplicate) and zero amount paid? A: Yes, report the duplicate line. The amount paid would be zero. The claim adjustment reason code of 18 is acceptable or perhaps a 97 or a B13, depending on the specific circumstances of
