Group Codes
Group codes appear on the remittance advice with each adjustment and indicate who is responsible for the amount. Four codes are in use today; one historical code appears on pre-005010 documents.
Current codes
COContractual Obligation
The adjustment is the payer's contractual obligation — typically the difference between the billed charge and the contracted rate, or an amount the payer will not pay per the provider contract. This amount is not billable to the patient.
OAOther Adjustment
The adjustment is an 'other' adjustment that does not fit contract (CO) or patient (PR) responsibility. Often seen with duplicate claims and coordination-of-benefits adjustments. Handle case by case based on the accompanying reason code.
PIPayor Initiated Reduction
The adjustment was initiated by the payer — for example a retroactive adjustment, refund, or recoupment. Review the payer's explanation carefully; these often involve overpayment recovery or payment corrections.
PRPatient Responsibility
The patient is financially responsible for the amount — deductible, coinsurance, copayment, or non-covered services for which the patient may be billed per the plan. Verify patient liability rules before billing.