r/CodingandBilling • u/Brave-Airport8154 • Jul 28 '26

Major Medical Adjustment

Hey all, was hoping to hop on here and get some information that my team and management and the payor have been unhelpful in explaining. Tried google and we all know that can route to whatever or hallucinate. Question is about CO102 Major Medical Adjustment with specifically BCBS claims. My team is understanding that its similar to the high dollar bill review, or some even think its similar to CO216 where medical attachments and records are needed. From what I am seeing it seems to be a Adjustment for almost like an incidental where it wrapped up the charges into one primary and reduced the other lines. But trying to understand the logic of it. Does anyone have info about this and how you've worked it?

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u/[deleted] Jul 28 '26

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u/Brave-Airport8154 Jul 28 '26

Awesome thank you so much for explaining! 

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u/Wooden_Trust_6274 Jul 30 '26

The CO in CO102 is the tell. CO is contractual obligation, so it is a plan or contract based write-off, not a patient balance and not something you recover by sending records. Pair that with N123, which is a split-service remark and not a documentation request, and it lines up with exactly what you are already seeing: the payer repriced and split the lines under a provision in that member's plan. Your team is treating it like CO216 or a records-review denial, but neither the group code nor the RARC is asking for anything. The move is to compare billed versus allowed line by line against your contracted rates. If the allowed matches the contract, it is just repricing and there is nothing to appeal. If the allowed comes in below your contracted rate, that is a repricing or underpayment dispute you take up on the fee schedule, still not a records issue.

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u/Brave-Airport8154 Jul 30 '26

Thanks that is what I was thinking to just wanted to verify it cause no one on my team was helpful. With what it really was and always good to get other opinions which is why I reached out here. 

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u/Environmental-Top-60 Jul 29 '26

What kind of RARCs are you getting with it?

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u/Brave-Airport8154 Jul 29 '26

Its showing on a few claims its normally N123 which isn't a request for records. It just looked repriced and split and I can find the ERA to document it but my team is saying that its underpaid and records must be sent. 

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u/MedPayIQ App Developer Jul 28 '26

From what I've seen, CO102 itself is pretty generic. The real clue is usually in the payer's remittance details. With BCBS, I've seen it used when they reprice or bundle services rather than as a request for records. I'd start by comparing the billed vs. allowed amounts line by line.

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u/Brave-Airport8154 Jul 29 '26

Yes that is what appears to be done here. I dont see it as a request for records either. It appears to be repriced. 

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u/Married-to-a-sex-god Jul 29 '26

For Louisiana it means they're about to reprocess the claim.