Reason Code Search Tool

Medicare Part A and Part B MAC for Jurisdiction 14; comprised of Colorado, New Mexico, Oklahoma and Texas Claim adjustment reason codes communicate an adjustment on an Explanation of Benefits (EOB), meaning the payer must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code. Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Part B users enter a reason/remark code from their Medicare Remittance Advice (MRA), and a description of the code with an associated solution (in red text) is returned. The Reason Code Search tool offers users the ability to view the narrative for a specific reason code. The database contains the most common reason codes or those that have received the most calls to Customer Service. This is not an all-inclusive listing and additional reason codes will be added as they are identified. Users can choose to view the narrative for a specific reason code or a complete listing of reason codes/narratives. A complete list of ANSI Claim Adjustment Reason Codes and Remittance Advice Remark Codes is available on the WPC Web site.

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