Why Do We Need to Choose the Remark Code CO, OA, PI & PR to Post an Insurance Payment?

   Remark codes assign responsibility for the adjustment amounts.  They tell the system whether to adjust off an amount or transfer it to the patient responsibility column.  The format is always two alpha characters. For convenience, the values and explanations are below:

  • CO (Contractual Obligations): It is used when a contractual agreement between the payer and payee or a regulatory requirement requires an adjustment. These adjustments your in-network adjustments and are not billable to the patient.
  • OA(Other Adjustments): It is used when no other group code applies to the adjustment.
  • PI (Payer Initiated Reductions): It is used by payers when it is believed the adjustment is not the responsibility of the patient.  They will provide additional information regarding this adjustment and can alway
  • PR (Patient Responsibility): Denotes amounts that the payer deems as patient responsibility.  They can include deductible, coinsurance,  copay, max benefits or some denied charges. 

Assigning the correct remark code will allow the system to post the response from the payer correctly so that if next steps are needed (billing a patient or secondary insurance), the correct amounts will be reflected in the appropriate columns (insurance balance vs patient balance).

 

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