Adjustments & variances

Outcome

You read every CAS row correctly, you know which adjustments route to patient AR vs contract AR, and you can defend a variance with the right reference (contract, fee schedule, payer policy).

Prerequisites

Scope	What it lets you do
billing.receivable.read	View the Adjustments tab
billing.receivable.write	Tag, route, accept
billing.contract.read	Cross-reference contracted fee schedule

CAS taxonomy

The group code says who's on the hook for this dollar:

Group	Routes to	Common pairs
CO (Contractual)	Contractual write-off	CO-45 fee-schedule diff.
PR (Patient responsibility)	Patient AR	PR-1 deductible, PR-2 coinsurance, PR-3 copay.
OA (Other adjustment)	Various	OA-23 impact-of-prior-payer (COB).
CR (Correction)	Reversals	Replaces an earlier adjustment.
PI (Payer-initiated)	Various	PI-50 not deemed medically necessary.

What the platform does on Post

For each line, by group:

Group	Effect
CO	Writes remittance_adjustment row; reduces claim balance.
PR	Writes patient-AR entry; reduces claim balance toward patient.
OA-23	Records impact-of-prior-payer; informational; no balance shift.
OA* (other)	Tagged for follow-up.
CR	Reverses the prior matching adjustment (must reference).
PI	Same as CO/OA depending on tenant config.

The Adjustments tab surfaces the per-line CAS list and the resulting routing. You can re-tag if your tenant has the override scope.

Variance categories

A variance is a difference between expected and posted. The platform computes expected from your contract; the difference is flagged.

Variance	Pattern	Defensibility
Fee-schedule diff	CO-45 ≠ contract delta	Defendable when contract is current.
Modifier downcode	Paid amount lower; CARC explains	Defendable via CARC list.
Bundling	CO-97 reduces a line	Defendable per CCI.
Auth missing	CO-197 zero-pay	Triggers auto-correct.
Patient deductible	PR-1 higher than expected	Confirm member's deductible status.
Coinsurance	PR-2 higher than expected	Same.

Reading the line drill-down

Per line:

Section	Meaning
Service line	SVC*HC:99213*100*60.
Adjustments	CAS*CO*45*40 etc.
Remarks	LQ*HE*M16 (RARC).
AMT*F2	Allowed amount.
AMT*B6	Allowed amount per service.
DTM*150 / 151	Service date range.

Hover any code chip for the human description; click for the reference (9.3 — CARC/RARC).

Tagging variances

For variances you accept (after 4.5 — Exceptions), tags help reporting:

Tag	Use
contract-drift	Payer is paying off-contract.
payer-error	Payer made a calculation mistake.
expected	The variance is expected and recurring.
escalate	Worth a supervisor review.

The tag aggregates on the dashboard's Variance trends widget — see 8.1 — Billing dashboards.

Validation

Check	Expected
PR-* rows route to patient AR on post	Yes.
CO-45 reduces claim balance and writes adjustment row	Yes.
OA-23 is informational, no balance change	Yes.
Tag persists across closed receivables	Yes.

Troubleshooting

Symptom	Cause	Fix
PR-2 posted at $0.00	Member has secondary that absorbed	Check the COB ladder; secondary 835 will reconcile.
CO-45 larger than expected	Contract is stale	Tenant Manual → Payers; ask admin to refresh fee schedule.
Multiple CR rows	Payer is reversing earlier adjudication	Ensure each CR points at a prior receivable; out-of-order can confuse the reconciliation.
PI-* adjustments unrecognized	Payer-specific reason	Hover for the description; treat per the description.

Where to next

• 4.7 — Export & trace — pull a variance report for an appeal.
• 5.2 — Read a CARC / RARC — when an adjustment is really a denial.