ASC X12 004010

1129 Adjustment Reason Code Characteristic
TYPE=ID MIN=1 MAX=2

Specifies an additional characteristic of the adjustment reason


1        Primary Disability - Frozen
2        Primary Disability - Non-frozen
3        Dependent Disability - Frozen
4        Dependent Disability - Non-frozen
5        Retirement - Frozen
6        Retirement - Non-frozen
7        Permanent
8        Temporary
9        Canadian
10       Joint
11       Deferred
12       Eligible
13       Applied
14       Receiving
15       Defense Medical Evaluation
16       Delayed Reporting Penalty (Insured)
17       Engineering Services
18       Expert Test (Trial)
19       Expert Fees and Expenses (excluding tests and testimony)
22       Fee Schedule Savings
23       Fatal
24       Permanent Total
25       Permanent Total Supplemental
26       Permanent Partial Scheduled
27       Permanent Partial Unscheduled
28       Temporary Total
29       Temporary Partial
30       Employer Liability
31       Permanent Partial Disfigurement
32       Employer Paid
34       Funeral Expenses
35       Penalties
36       Interest
37       Employer's Legal Expenses
38       Claimant's Legal Expenses
39       Payments to Physicians
40       Hospital Costs
41       Other Medical
42       Vocational Rehabilitation Evaluation
43       Vocational Rehabilitation Education
44       Other Vocational Rehabilitation
45       Total Temporary Catastrophic
46       Unknown Payment Type
57       Vocational Rehabilitation Maintenance
58       Claim Value Recovery
60       Deductible Recovery
61       Additional Living Expense
62       Alternative Dispute Resolution Services
63       Anesthesiologist
64       Annuity
65       Attorney Expenses
66       Attorney Fees
67       Auto Liability Subrogation
69       Not Eligible
71       Catastrophic Benefits
72       Central Index Bureau Filing Fees
73       Chiropractor
74       Indemnity Reserves
75       Medical Reserves
76       Expense Reserves
77       Vocational Rehabilitation Reserves
78       Indemnity Payments
79       Medical Payments
80       Expense Payments
81       Vocational Rehabilitation Payments
82       Claim Payment
83       Claim Reserve
84       Bodily Injury Payment
85       Bodily Injury Reserve
86       Property Damage Payment
87       Property Damage Reserve
88       Comprehensive Payment
89       Comprehensive Reserve
90       Collision Payment
91       Collision Reserve
92       Salvage
93       Expert Witness Fees
94       Claimant Legal Expense
95       Claimant Medical Evaluation
96       Commercial Photographers
97       Mandated Medical Exam
98       Death Benefits
99       Defense Attorney Fees and Expenses
A1       Funeral Benefits
A2       Hearing Attendance or Representation Fees
A3       Hospital - Inpatient Charges
A4       Hospital - Outpatient Charges
A5       Hospital Bill Audit
A6       Impairment Income Benefits
A7       Independent Adjustor Expense
A8       Independent Medical Exam
A9       Legal Expenses - Miscellaneous
B1       Liability Settlement
B2       Life Pension
B3       Lump Sum Remarriage Payment
B4       Lump Sum Settlement Amount
B5       Major Case of Individual Case Reporting
B6       Medical Equipment
B7       Peer Review Board Expenses
B8       Medical Management Services
B9       Medical Records or Reports
C1       Medical Rehabilitation
C2       Medical Test (Trial)
C3       No-fault benefit or expense (Non-Workers Compensation)
C4       Nursing Care
C5       Extended Care Facility
C6       State Fund - Other
C7       Penalties Paid on Medical Benefits
C8       Penalties Paid on Indemnity Benefits
C9       Pension Indemnity Benefit
D1       Permanent Partial Disfigurement
D2       Personal Property or Contents
D3       Pharmacy
D4       Photographs other than Commercial
D5       Physiotherapy
D6       PPO (Preferred Provider Organization) Fees or Expenses
D7       Product Liability Subrogation
D8       Property Adjustment
D9       Provider Bill Audit Expense
E1       Radiology
E2       Time and Expense Fees
E3       Scheduled Award
E4       Social Security
E5       State Second Injury Fund
E6       State Supplemental Fund
E7       Supplemental Permanent Total Benefits
F1       Testing Lab
F2       Third Party Contribution
F3       Transportation - Other
F4       Transportation - Medical Treatment
F5       Treating or Panel Physician
F6       Utilization Review - Hospital
F7       Utilization Review - Physician
F8       Unallocated Indemnity
F9       Unallocated Medical
G2       Witness Fees and Expenses - Other than Expert Witness
G3       Vocational Rehabilitation Training
G4       Appraisal Fees
G5       Autopsy Fees
G6       Surveillance Special Investigation Fees and Expenses
G7       Temporary Income Benefits
G8       State Fund - Other
G9       Federal Second Injury Fund
H2       Federal Supplemental Fund
H3       Flat Rate