Why do we need to choose the remark code CO, OA, PI & PR to post the insurance payments?

Remark codes generally assign responsibility for the adjustment amounts. 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. Generally, these adjustments are considered a write-off for the provider.
  • 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, but there is no supporting contract between the provider and payer.
  • PR (Patient Responsibility): It is used for deductible, coinsurance and copay when the adjustments represent an amount that should be billed to the patient or the secondary insurance.

When you post the insurance payments manually in the Billing > Live claims feed screen, please make sure to set the correct remark code to take an appropriate action.

 

Was this article helpful?
0 out of 0 found this helpful
Have more questions? Submit a request

Comments

Powered by Zendesk