How do I fix or resolve code PI-102?

Review the ERA/EOB to understand the major medical adjustment, including the allowed amount, the payer's payment, and the patient responsibility (deductible, coinsurance, copay). Verify the patient's major medical benefit plan details — deductible status, coinsurance rate, and out-of-pocket maximum — via a 270/271 eligibility transaction or the payer portal. Cross-check the adjustment calculation against the plan's major medical provisions to ensure the payer applied the correct deductible, coinsurance, and allowed amount. Bill the patient for any remaining balance (deductible, coinsurance, copay) with a statement showing the payer's adjudication and the patient responsibility portion. If the adjustment appears incorrect — for example, the wrong deductible was applied or the coinsurance rate does not match the plan — file a claim reconsideration with the benefits verification documentation.

PI-102Adjustment CodePatient Responsibility

Code PI-102

Problem Description

Major Medical Adjustment.

Root Cause

The payer has applied a Major Medical adjustment to the claim. This adjustment reflects the adjudication of the claim under the patient's major medical benefit plan rather than a basic or supplemental benefit. Major Medical plans typically cover a broad range of services subject to deductibles, coinsurance, and out-of-pocket maximums. The adjustment indicates that the payer has processed the claim under the major medical provisions, which may include different fee schedules, coverage tiers, or cost-sharing structures than other plan components. The patient may be responsible for deductible, coinsurance, or copay amounts under the major medical benefit.

Resolution Steps

1Review the ERA/EOB to understand the major medical adjustment, including the allowed amount, the payer's payment, and the patient responsibility (deductible, coinsurance, copay).
2Verify the patient's major medical benefit plan details — deductible status, coinsurance rate, and out-of-pocket maximum — via a 270/271 eligibility transaction or the payer portal.
3Cross-check the adjustment calculation against the plan's major medical provisions to ensure the payer applied the correct deductible, coinsurance, and allowed amount.
4Bill the patient for any remaining balance (deductible, coinsurance, copay) with a statement showing the payer's adjudication and the patient responsibility portion.
5If the adjustment appears incorrect — for example, the wrong deductible was applied or the coinsurance rate does not match the plan — file a claim reconsideration with the benefits verification documentation.

EHR Documentation Note

Claim adjusted PI-102 — Major Medical adjustment; verified plan provisions, cross-checked deductible/coinsurance application, and billed patient for remaining balance.

Preventative Action

Verify major medical benefit details during pre-visit eligibility checks and provide patients with estimated cost-sharing amounts before service to set payment expectations.

Related Codes in Patient Responsibility

PR-3

Co-payment Amount

PR-96

Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

PR-204

This service/equipment/drug is not covered under the patient's current benefit plan.

PI-100

Payment made to patient/insured/responsible party.

This directory provides reference information only and does not constitute official legal, medical, or financial billing advice. Always consult the payer's official remittance advice and current coding guidelines.