📝 Overview
When an ERA is processed, insurance payers include adjustment codes that explain how each payment was calculated — what was paid, what was written off, and what the patient owes. Reason code behaviors tell ChiroHD how to translate those codes into specific allocations on the EOB. Most common reason codes are already mapped in ChiroHD. This article covers what to do when they're not, or when your office wants a different allocation than the default. Reason code behaviors are managed at the network level and require admin permissions to access and modify.
How Adjustments Work in ERAs
Understanding Adjustment Terms:
Group Code — who is financially responsible for the amount
Reason Code — a numeric code explaining why the adjustment was made
Dollar Amount — how much was adjusted
Real Life Examples:
A code like CO-45 means the payer is signaling a contractual obligation (CO) for reason code 45 ("charge exceeds fee schedule").
PR - 2 means the payer is deciding this is Patient Responsibility (PR) for reason code 2 ("Coinsurance").
ChiroHD reads that combination and applies the mapped behavior.
Navigating to Reason Code Behaviors
Navigate to your System Dashboard, Insurance Tab, Reason Code Behaviors.
The page shows all mapped reason codes, organized by group code category.
Understanding the Page Layout
At the top of the Reason Code Behaviors page, five tabs correspond to the five group code categories:
Contractual Obligation
Patient Responsibility
Correction Or Reversal
Other Adjustment
Payer Initiated Deductions
Select a tab to see all mapped reason codes within that group and the behavior assigned to each.
To the right, toggle between Default Behaviors (ChiroHD's built-in mappings) and Custom Behaviors (overrides created by your organization). On the Custom Behaviors tab, the table also shows the Location and Third Party Payer associated with each custom rule, if applicable.
Two Scenarios — Know Which One You're In
Before creating or escalating, determine which situation applies:
Creating a Custom Reason Code Behavior
On the Custom Behaviors tab, click Create Behavior.
In the Create Reason Code Behavior modal, fill in:
Group Code — select the appropriate group code category
Reason Code — select the numeric reason code
Behavior — choose how ChiroHD should allocate amounts when this code appears
Optionally, use Select third party payer to scope this behavior to a specific payer. If no payer is selected, the behavior applies to all payers whenever that Group Code + Reason Code combination appears.
Click Submit.
Additional Fields by Behavior Type
If you select Write-Off: a Write off reason field appears. You must choose a reason (such as Insurance Write-Off, Account Write-Off, Hardship, etc.) — this is required before you can submit.
If you select Rejection (Denial): an Action field appears with two options:
Leave as insurance — the remaining balance stays under insurance responsibility on the patient ledger
Set to patient responsibility — the remaining balance shifts to the patient after the EOB is finalized
Choose based on how your office handles denials for this code.
Scope of Custom Behaviors
Custom behaviors can be scoped in two ways:
All payers — if no payer is selected when creating the behavior, it applies to every payer that sends that Group Code + Reason Code combination
Specific payer — if you select a payer, the behavior only applies to ERAs from that payer
Troubleshooting Tip: When troubleshooting unexpected allocations, check the Location and Third Party Payer columns in the Custom Behaviors view to confirm whether an existing custom rule is overriding the default.
Attempt Reprocess ERA After Creating or Updating a Behavior
Custom behaviors take effect on the next ERA processing run — they do not retroactively update already-processed EOBs.
To apply a new behavior to an ERA that previously failed or allocated incorrectly:
Navigate to your Live Location, Insurance Tab to the Insurance Dashboard.
Find the affected ERA in the Failed tab (or the affected EOB in EOB History).
Click Attempt reprocess ERA.
ChiroHD re-runs the ERA with the updated behavior mapping. If all errors are resolved, the ERA moves out of Failed and the resulting EOB(s) appear in Pending EOBs for your team to review and finalize.
✅ Key Takeaways
Reason code behaviors control how ERA adjustments are allocated on EOBs.
For secondary billing: ERA auto-fills adjustments; manual EOB entry requires staff to enter them.
Most codes are already mapped — use the X12 reason code list as a reference for unfamiliar codes.
Unknown codes with no behavior at all → escalate to ChiroHD support.
Codes with behaviors you want to change → create a custom reason code behavior.
Custom behaviors can be scoped to a specific payer or applied to all payers.
Always reprocess the affected ERA or EOB after updating a behavior.
📌 Conclusion
In this article, we covered how reason code behaviors work, why adjustment data matters for secondary billing, when to create a custom behavior vs. when to escalate to engineering, how to create a custom behavior, and what happens after you update one.