Remit Adjustments (REM)

Remit adjustment code processing categorizes adjustment codes and associated dollars into five Remit Categories:

  • Contract Adjustment – The adjustment reflects contractual or regulatory amounts associated to the service provided
  • Bundled Charges - Services integral to accomplishing a procedure are considered inclusive to that procedure and therefore are not separately payable.
  • Prior Payment Adjustment – The adjustment reflects payments made by previous payers and is subtracted from payments being made by the current payer
  • Patient Responsibility – The adjustment reflects the amount assigned to the patient
  • Denial – the payer has determined that the provider cannot be reimbursed for the service

Remit Adjustments (REM) provides trending on the breakdown of each. Summary adjustment tabs show total adjustments by payer and adjustment code for claim- and service-level adjustments. Detail tabs show claim adjustment amounts by patient control number and adjustment reason code at the claim- and service- line level.

Business Use

  • Allows for monitoring of payer reimbursements and denial rates.
  • Provides details into the distribution of the payer adjudication process.

Running the Report

To generate the Remit Adjustments (REM) report:

  1. Click Run on the Remit Adjustments (REM) pod.
  2. Select the option of whether or not to include test claims.
  3. Select one or more CIDs from the values displayed.
  4. Use the calendar function to enter a Payment Date Start.
  5. Use the calendar function to enter a Payment Date End.
  6. Click Run Query.

Tab Views and Field Descriptions

See the following pages for details on these tabs:

This tab is grouped by claim form type and sorted by payer name alphabetically.

Field Description
Claim Form Type UB (Institutional) or 1500 (Professional).
Payer Name of payer designated on the claim.
Total Claim Count Total value billed to Payer.
Total Billed Amount Total value billed to Payer.
Denied Charges Total value of claim charges denied by the indicated payer.
Contractual Adjustments Total value of claim charges listed with a contractual adjustment by the indicated payer.
Bundled Charge Adjustments Total value of claim charges listed as non covered by the indicated payer.
Bundled Charge Adjustments Total amount adjudicated as Bundled Charge Adjustments.
Prior Payment Adjustments Total amount adjudicated as Prior Payment Adjustments.
Patient Responsibility Total amount adjudicated as Patient Responsibility.
Total Payer Payment Total claim payment.

This tab presents the following data:

Field Description
Claim Form Type UB (Institutional) or 1500 (Professional).
Payer Name of payer designated on the claim.
Claim Adj. Group Code Code indicating category of adjustment made on the claim.
Claim Adj. Code Code indicating reason for claim adjustment.
Claim Adj. Information Description of claim adjustment.
Sum of Claim Adj. Amount Dollar amount by which adjustment was made.
Claim Adj. Quantity Number of times claim was adjusted.
Number of Claims Total claim count for the selected payer adjustment code.

This tab presents the following data:

Field Description
Claim Form Type UB (Institutional) or 1500 (Professional).
Payer Name of payer designated on the claim.
Service Line Adj. Group Code indicating category of adjustment made on the service line.
Service Line Adj. Code Code indicating reason for service line adjustment.
Service Line Adj. Info Description of service line adjustment.
Service Line Adj. Amount Dollar amount by which adjustment was made.
Service Line Adj. Qty Number of times service line was adjusted.
Number of Service Lines Remit service line adjustment count for the selected payer adjustment code.

This tab presents the following data:

Field Description
Claim Form Type UB (Institutional) or 1500 (Professional)
Payer Name of payer designated on the claim
Patient Control Nbr Unique number assigned by the facility or the patient.
Claim Adj. Group Code indicating category of adjustment made on the service line.
Claim Adj. Code Code indicating reason for service line adjustment.
Claim Adj. Information Description of service line adjustment.
Sum of Claim  Adj. Amount Dollar amount by which adjustment was made.
Claim Adj. Quantity Number of times service line was adjusted.
Import Date Remit import date.

This tab presents the following data:

Field Description
Claim Form Type UB (Institutional) or 1500 (Professional).
Payer Name of payer designated on the claim.
Patient Control Nbr Unique number assigned by the facility or the patient.
Service Line Adj. Group Code indicating category of adjustment made on the service line.
Service Line Adj. Code Code indicating reason for service line adjustment.
Service Line Adj. Info Description of service line adjustment.
Service Line Adj. Amount Dollar amount by which adjustment was made.
Service Line Adj. Qty Number of times service line was adjusted.
Service Line HCPCS Code HCPCS code associated with the service line adjustment.
Service Line Modifier Code Modifier code associated with the service line adjustment.
Service Line Rev Code Rev code associated with the service line adjustment.
Import Date Remit import date.