📝 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 by default. This article covers how to find and review those mappings, and how to create custom behaviors when your office needs something different.
Reason code behaviors are managed at the network level and require admin permissions to access and modify.
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.
How Reason Codes and Adjustments Work
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.
Understanding the Create Reason Code Behavior 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.
Creating a Custom Reason Code Behavior
On the Custom Behaviors tab, click Create Behavior.
In the Create Reason Code Behavior modal, fill in all the following categories:
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.
Scoping a Behavior to a Specific Payer
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.
After creating the Reason Code Behaviors, please see our other resources on Processing EOBs/ERAs: Denials Adjustments and Reason Code Behaviors to see how to use this feature in ChiroHD.
✅ Key Takeaways
Reason code behaviors control how ERA adjustment codes are allocated on EOBs
Most codes are already mapped by default — custom behaviors are for exceptions or office-specific preferences
Custom behaviors can be scoped to a specific payer or applied to all payers
If you select Write-Off as a behavior, a write-off reason is required
If you select Rejection, choose whether the balance stays with insurance or moves to the patient
📌 Conclusion
Reason code behaviors are the bridge between what a payer sends and how ChiroHD records it on an EOB. Setting them up correctly — and knowing when to create a custom rule — ensures your EOBs reflect the right allocations without manual corrections. Once your behaviors are configured, head to our other resources to learn how to apply them during processing and resolve any items that end up in the Processing / EOB Issues tab.