Claim adjustment reason codes are standard codes used on remittances (ERAs and EOBs) to explain why a payment differs from the billed amount. They are paired with a group code: CO (contractual obligation), PR (patient responsibility), OA (other adjustment) or PI (payer-initiated reduction).
For example, CO-197 means the claim was denied because a required precertification or authorization was missing.
Related terms
- RARC (remittance advice remark code)
- A supplemental code that adds detail to a claim adjustment reason code.
- ERA (835)
- The electronic remittance advice: the payer's electronic explanation of payment.
- Claim denial
- A payer's decision not to pay a claim that it received and processed.