(Reason Code) Adjustment Excluded

If you receive a [Reason Code] Adjustment Excluded (i.e. CO-50 adjustment excluded), this means that the payer did not pay for the CPT code listed on the Error Report. Important: The system did not post payments or adjustments for the charge and the balance was left open to the insurance.

The next step is to determine if this is a true denial or if the procedure code should be adjusted off. 

  • Denial: If this is a denial, the charge should be left open so it can be worked, therefore no action is needed. It will appear on the Zero Pay report for follow-up and rebilling.
  • Adjustment: If this should be adjusted, navigate to the Batch Adjustment page and adjust off the open charge. This ensures the charges aren't aging infinitely. 

Update Reason Code

If you would like the adjustment to post automatically instead of being excluded when releasing 835s (so you don't have to manually adjust off the charge each time), follow this process. The Adjustment Reason Codes are industry standard. You can tie them to specific payers or update the exclude checkbox as needed to ensure your payments post correctly.

    1. Navigate to Payments and select Claim Adjustment Reason Codes - Company Payer Override
    2. Click New.
    3. Use the magnifying glass icons to locate the Claim Adjustment Reason Code and Payer. 
    4. Check the Is Excluded checkbox if you do not want the adjustment to post for this reason code and payer. This means it will appear on your Error Report.
    5. Uncheck the Is Excluded checkbox if you want the adjustment to post. This means it won't appear on your Error Report.
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