aethelwulffe wrote on Monday, January 05, 2015:
Seems like some new adjustment codes are mashing up the AR tables via ERA import not recognizing them.
Adjustment Code 141 was the first:
parse_era.inc.php
else if ($segid == ‘CAS’ && $out[‘loopid’] == ‘2110’) {
$i = count($out[‘svc’]) - 1;
for ($k = 2; $k < 20; $k += 3) {
if (!$seg[$k]) break;
if (($seg[1] == ‘CO’) && ($seg[$k+1] < 0) && ($seg[$k] != ‘144’)) { // Adjustment code 144 is Incentive adjustment which is negative.
$out[‘warnings’] .= "Negative Contractual Obligation adjustment " .
“seems wrong. Inverting, but should be checked!\n”;
$seg[$k+1] = 0 - $seg[$k+1];
}
$j = count($out[‘svc’][$i][‘adj’]);
$out[‘svc’][$i][‘adj’][$j] = array();
$out[‘svc’][$i][‘adj’][$j][‘group_code’] = $seg[1];
$out[‘svc’][$i][‘adj’][$j][‘reason_code’] = $seg[$k];
$out[‘svc’][$i][‘adj’][$j][‘amount’] = $seg[$k+1];
// Note: $seg[$k+2] is “quantity”. A value here indicates a change to
// the number of units of service. We’re ignoring that for now.
}
}
Now I am seeing stuff like this:
CLP2498-1033791900**HMN344FHE0195011*E
CASOA133*90
…in the ERA’s
Per WPC information on CAS OA 133
The disposition of the claim/service is pending further review. (Use only with Group Code OA). This change effective 3/1/2015: The disposition of this service line is pending further review. (Use only with Group Code OA). NOTE: Use of this code requires a reversal and correction when the service line is finalized (use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837).
I take it we need to ignore claims with CASOA133*90, or add reason 133 like the above…I believe that SHOULD take care of that one issue. Problem is, there are lots of adjustment codes: http://www.wpc-edi.com/reference/codelists/healthcare/claim-adjustment-reason-codes/
Some seem to indicate (144 and 259 I believe) that they are positive adjustments that would be read as negative balances.