The key lines
- Billed amount: what you charged
- Allowed amount: what the payer says the service is worth under your contract
- Paid amount: what the payer actually paid
- Patient responsibility: deductible, coinsurance or copay the patient owes
- Adjustments: amounts written off, with reason codes
Reason codes
Claim adjustment reason codes say why an amount wasn't paid. Remark codes add detail. Together they tell you whether to fix, appeal or bill the patient.
What to look for
Check the allowed amount against your contract, and check that the units paid match the units billed. Underpaid units are one of the easiest losses to miss.
This article is general information, not billing, legal or tax advice. Payer rules change; always check current guidance.
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