Medicaid Claim Denial Codes
1 Deductible Amount
2 Coinsurance Amount
3 Co-payment Amount
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
5 The procedure code/bill type is inconsistent with the place of service.
6 The procedure/revenue code is inconsistent with the patient's age.
7 The procedure/revenue code is inconsistent with the patient's gender.
8 The procedure code is inconsistent with the provider type/specialty (taxonomy).
9 The diagnosis is inconsistent with the patient's age.
10 The diagnosis is inconsistent with the patient's gender.
11 The diagnosis is inconsistent with the procedure.
12 The diagnosis is inconsistent with the provider type.
13 The date of death precedes the date of service.
14 The date of birth follows the date of service.
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate Note: Changed as of 2/02
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate.
Note: Changed as of 2/02
18 Duplicate claim/service.
19 Claim denied because this is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.
20 Claim denied because this injury/illness is covered by the liability carrier.
21 Claim denied because this injury/illness is the liability of the no-fault carrier.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments
and/or adjustments
24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.
25 Payment denied. Your Stop loss deductible has not been met.
26 Expenses incurred prior to coverage.
27 Expenses incurred after coverage terminated.
28 Coverage not in effect at the time the service was provided. Note: Inactive for 004010, since 6/98. Redundant to codes 26&27.
29 The time limit for filing has expired.
30 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Note: Changed as of 2/01. This code will be deactivated on 2/1/2006.
31 Claim denied as patient cannot be identified as our insured.
32 Our records indicate that this dependent is not an eligible dependent as defined.
33 Claim denied. Insured has no dependent coverage.
34 Claim denied. Insured has no coverage for newborns.
35 Lifetime benefit maximum has been reached.
Note: Changed as of 10/02
36 Balance does not exceed co-payment amount.
Note: Inactive for 003040
37 Balance does not exceed deductible.
Note: Inactive for 003040
38 Services not provided or authorized by designated (network/primary care) providers.
Note: Changed as of 6/03
39 Services denied at the time authorization/pre-certification was requested.
40 Charges do not meet qualifications for emergent/urgent care.
41 Discount agreed to in Preferred Provider contract.
Note: Inactive for 003040
42 Charges exceed our fee schedule or maximum allowable amount.
43 Gramm-Rudman reduction.
44 Prompt-pay discount.
45 Charges exceed your contracted/ legislated fee arrangement.
46 This (these) service(s) is (are) not covered.
Note: Inactive for 004010, since 6/00. Use code 96.
47 This (these) diagnosis(es) is (are) not covered, missing, or are invalid.
Note: Changed as of 6/00. This code will be deactivated on 2/1/2006.
48 This (these) procedure(s) is (are) not covered.
Note: Inactive for 004010, since 6/00. Use code 96.
49 These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.
50 These are non-covered services because this is not deemed a `medical necessity' by the payer.
51 These are non-covered services because this is a pre-existing condition
52 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
Note: Changed as of 10/98. This code will be deactivated on 2/1/2006.
53 Services by an immediate relative or a member of the same household are not covered.
54 Multiple physicians/assistants are not covered in this case .
55 Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer.
56 Claim/service denied because procedure/treatment has not been deemed `proven to
be effective' by the payer.
57 Payment denied/reduced because the payer deems the information submitted does not
support this level of service, this many services, this length of service, this dosage, or
this day's supply.
Note: Inactive for 004050. Split into codes 150, 151, 152, 153 and 154.
58 Payment adjusted because treatment was deemed by the payer to have been rendered
in an inappropriate or invalid place of service.
Note: Changed as of 2/01
59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules.
Note: Changed as of 6/00
60 Charges for outpatient services with this proximity to inpatient services are not
covered.
61 Charges adjusted as penalty for failure to obtain second surgical opinion.
Note: Changed as of 6/00
62 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.
Note: Changed as of 2/01
63 Correction to a prior claim.
Note: Inactive for 003040
64 Denial reversed per Medical Review.
Note: Inactive for 003040
65 Procedure code was incorrect. This payment reflects the correct code.
66 Blood Deductible.
67 Lifetime reserve days. (Handled in QTY, QTY01=LA)
Note: Inactive for 003040
68 DRG weight. (Handled in CLP12)
Note: Inactive for 003040
69 Day outlier amount.
70 Cost outlier - Adjustment to compensate for additional costs.
Note: Changed as of 6/01
71 Primary Payer amount.
Note: Deleted as of 6/00. Use code 23.
72 Coinsurance day. (Handled in QTY, QTY01=CD)
Note: Inactive for 003040
73 Administrative days.
Note: Inactive for 003050
74 Indirect Medical Education Adjustment.
75 Direct Medical Education Adjustment.
76 Disproportionate Share Adjustment.
77 Covered days. (Handled in QTY, QTY01=CA)
Note: Inactive for 003040
78 Non-Covered days/Room charge adjustment.
79 Cost Report days. (Handled in MIA15)
Note: Inactive for 003050
80 Outlier days. (Handled in QTY, QTY01=OU)
Note: Inactive for 003050
81 Discharges.
Note: Inactive for 003040
82 PIP days.
Note: Inactive for 003040
83 Total visits.
Note: Inactive for 003040
84 Capital Adjustment. (Handled in MIA)
Note: Inactive for 003050
85 Interest amount.
86 Statutory Adjustment.
Note: Inactive for 004010, since 6/98. Duplicative of code 45.
87 Transfer amount.
88 Adjustment amount represents collection against receivable created in prior overpayment.
Note: Inactive for 004050.
89 Professional fees removed from charges.
90 Ingredient cost adjustment.
91 Dispensing fee adjustment.
92 Claim Paid in full.
Note: Inactive for 003040
93 No Claim level Adjustments.
Note: Inactive for 004010, since 2/99. In 004010, CAS at the claim level is optional.
94 Processed in Excess of charges.
95 Benefits adjusted. Plan procedures not followed. Note: Changed as of 6/00
96 Non-covered charge(s).
97 Payment is included in the allowance for another service/procedure. Note: Changed as of 2/99
98 The hospital must file the Medicare claim for this inpatient non-physician service. Note: Inactive for 003040
99 Medicare Secondary Payer Adjustment Amount. Note: Inactive for 003040
100 Payment made to patient/insured/responsible party.
101 Predetermination: anticipated payment upon completion of services or claim adjudication. Note: Changed as of 2/99
102 Major Medical Adjustment.
103 Provider promotional discount (e.g., Senior citizen discount).
Note: Changed as of 6/01
104 Managed care withholding.
105 Tax withholding.
106 Patient payment option/election not in effect.
107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Note: Changed as of 6/03
108 Payment adjusted because rent/purchase guidelines were not met. Note: Changed as of 6/02
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
110 Billing date predates service date.
111 Not covered unless the provider accepts assignment.
112 Payment adjusted as not furnished directly to the patient and/or not documented.
Note: Changed as of 2/01
113 Payment denied because service/procedure was provided outside the United States or
as a result of war. Note: Changed as of 2/01; Inactive for version 004060. Use Codes 157, 158 or 159.
114 Procedure/product not approved by the Food and Drug Administration.
115 Payment adjusted as procedure postponed or canceled. Note: Changed as of 2/01
116 Payment denied. The advance indemnification notice signed by the patient did not
comply with requirements. Note: Changed as of 2/01
117 Payment adjusted because transportation is only covered to the closest facility that can provide the necessary care. Note: Changed as of 2/01
118 Charges reduced for ESRD network support.
119 Benefit maximum for this time period or occurrence has been reached. Note: Changed as of 2/04
120 Patient is covered by a managed care plan. Note: Inactive for 004030, since 6/99. Use code 24.
121 Indemnification adjustment.
122 Psychiatric reduction.
123 Payer refund due to overpayment.
Note: Inactive for 004030, since 6/99. Refer to implementation guide for proper handling of reversals.
124 Payer refund amount - not our patient. Note: Inactive for 004030, since 6/99. Refer to implementation guide for proper handling of reversals.
125 Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate.
Note: Changed as of 2/02
126 Deductible -- Major Medical
Note: New as of 2/97
127 Coinsurance -- Major Medical
Note: New as of 2/97
128 Newborn's services are covered in the mother's Allowance. Note: New as of 2/97
Alabama Medicaid Denial codes.
Explanation of Benefit (EOB) Codes EOB CODE EOB DESCRIPTION HIPAA ADJUSTMENT REASON CODE HIPAA REMARK CODE
201 INVALID PAY-TO PROVIDER NUMBER 125 N280
202 BILLING PROVIDER ID IN INVALID FORMAT 125 N257
203 RECIPIENT I.D. NUMBER MISSING 31 N382
206 PRESCRIBING PROVIDER NUMBER NOT IN VALID FORMAT 16 N31
210 BRAND MEDICALLY NECESSARY INDICATOR INVALID 125
211 INVALID REFILL INDICATOR VALUE 16
212 MISSING PRESCRIPTION NUMBER 16 N388
215 DATE DISPENSED IS MISSING 16 N304
216 DATE DISPENSED IS INVALID 16 N304
217 MISSING DRUG CODE 16 M119
218 INVALID DRUG CODE 16 M119
219 QUANTITY DISPENSED IS MISSING 16 N378
220 QUANTITY DISPENSED IS INVALID 16 N378
223 MISSING DIAGNOSIS INDICATOR 16 M76
224 DIAGNOSIS TREATMENT INDICATOR INVALID 16 M76
225 REFERRING PROVIDER - INVALID FORMAT 16 N286
226 ANESTHESIA CLAIMS REQUIRE REFERRING PROVIDER 16 N286
228 CLAIMANT SIGNATURE MISSING 16 MA75
229 SOURCE OF ADMISSION MISSING 16 MA42
230 MISSING ATTENDING SURGEON PRESCRIBER NUMBER 16 N262
231 CLAIM WAS FILED WITHOUT SERVICING PROVIDER 16 N290
233 UNITS OF SERVICE MISSING 16 M53
234 PROCEDURE CODE MISSING 16 M51
235 PROCEDURE CODE NOT IN VALID FORMAT 16 M51
238 RECIPIENT NAME IS MISSING 16 MA36
239 DETAIL TO DATE OF SERVICE IS MISSING 16 M59
240 THE DETAIL "TO" DATE IS INVALID 16 M59
For Full list, go to the below Medicaid site.
http://medicaid.alabama.gov/documents/6.0_providers/6.7_manuals/6.7.2_provider_manuals_2010/6.7.2.1_january_2010/6.7.2.1_jan10_j.pdf
Top 50 Billing Error Reason Codes With Common Resolutions
On the following Link you will find the top 50 Error Reason Codes with Common Resolutions for denied claims at Virginia Medicaid. This list has been provided to assist you with resolving these denied claims prior to calling the Helpline. Please print and post this list within your office for easy reference and use. Whenever you are advised to contact the Helpline or MediCall please access the following telephone numbers.
http://www.dmas.virginia.gov/Content_atchs/cb/cb6.pdf
LOUISIANA MEDICAID Denial Code
ERROR CORE SHORT DESCRIPTION LONG DESCRIPTION GRP RSN CODE CODE CLAIM STATUS ADJ REMARK CODE
----------------------------------------------------------------------------------------------------------------------------------
001 INVALID CLM TYP MOD INVALID CLAIM TYPE MODIFIER 2 16 N34 021
002 INVALID PROVIDER NO PROVIDER NUMBER MISSING OR NOT NUMERIC 2 16 N77 021 153
003 RECIPIENT # INVALID RECIPIENT NUMBER INVALID OR LESS THAN 13 DIGITS 3 31 021 153
005 INVAL SERV FROM DATE SERVICE FROM DATE MISSING/INVALID 2 16 M52 021 188
006 INVAL SERV THRU DATE INVALID OR MISSING THRU DATE 2 16 M59 021 188
007 SERV THRU LT SERV FM SERVICE THRU DATE LESS THAN SERVICE FROM DATE 2 16 MA31 021 188
008 SERV FRM GT ENTR DTE SERVICE FROM DATE LATER THAN DATE PROCESSED 2 110 021 188
009 SERV THR GT ENTR DTE SERVICE THRU DATE GREATER THAN DATE OF ENTRY 2 16 MA31 021 188
010 INV PRIOR AUTH DATE PRIOR AUTHORIZATION DATE NOT NUMERIC 133 252
011 INVALID TPL INDICATR TPL INDICATOR NOT Y, N, OR SPACE 2 16 MA92 021 361
012 ORG CLM W/ADJ/VD CDE ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID REASON CODE 2 16 MA30 021 521
013 ORG CLM W ADJ/VD ICN ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID ICN 2 16 MA30 021 584
014 IMM COMPL MISS/INVLD IMMUN COMPLETE AND CURRENT FOR THIS AGE PATIENT MISSING 133 021 331 564
015 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 N305 365
016 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 N305 365
017 NOT USED - AVAILABLE NOT USED - AVAILABLE 133 021 564
020 INVAL/MISS DIAG CODE INVALID OR MISSING DIAGNOSIS CODE 2 16 MA63 255
021 INVALID FORMER REFNO FORMER REFERENCE NUMBER MISSING OR INVALID 2 16 M47 464
022 INVALID BILLED CHRGS BILLED CHARGES MISSING OR NOT NUMERIC 2 16 M79 178
023 INV PARTIAL RECIP RECIPIENT NAME IS MISSING 2 16 MA36 021 504
024 INV BILLING PROV NO BILLING PROVIDER NUMBER NOT NUMERIC 2 16 N257 021 153
025 IMM NOT COMP RSN MIS IMMUN NOT COMPLETE AND CURRENT REASON CODE MISSING 133 021 331 564
026 INVALID TOT DOC CHG TOTAL DOCUMENT CHARGE MISSING OR NOT NUMERIC 2 16 M54 178
027 PROC NEEDS DOCUMENT. PROCEDURE CODE NOT SUBSTANTIATED BY DOCUMENT 3 150 294 287
028 INVAL/MISS PROC CODE INVALID OR MISSING PROCEDURE CODE 2 16 M51 454
029 SERV MORE THAN 12 MO SERVICE MORE THAN 12 MONTHS OLD 3 29 263
030 SERV THRU DT TOO OLD SERV THRU DATE MORE THAN TWO YEARS OLD 3 29 187
031 NOT EMC ELIGIBLE PROVIDER NOT APPROVED FOR EMC BY STATE OFS 3 95 496
032 EOB/CARR.CD MISMATCH EOB(S) ATTACHED/CARRIER CODE DOES NOT MATCH 1 251 N4 286
033 NEED EOB-CARR/RECIP. NEED EOB FOR EACH CARRIER INDICATED ON RESOURCE FILE 1 251 N4 286
034 22 MOD.NOT JUSTIFIED 22 MOD.SERVICES NOT JUSTIFIED/PAID AT UNMODIFIED RATE 3 150 047
035 REBILL CORRECT HCPC ASC,OP FAC/PHYS.BILLED DIFF CODE;REBILL CORRECT HCPC 2 16 M20 454
037 MEDICARE ADJUSTMENT MEDICARE ADJUSTMENT/VOID,ADJUST OR ADJUST MEDICARE CLAI 1 252 N4 101
038 99297-52 NICU REDUCE 99297-52 NICU PAID AT REDUCED RATE 3 150 628
039 MOD.NOT USED FOR CLM MODIFIER NOT USED TO PROCESS CLAIM 2 4 N519 453
040 INV ADMISSION DATE ADMISSION DATE MISSING OR INVALID 2 16 MA40 189
042 INVALID UB92 BILL CD INVALID UB92 TYPE BILL CODE 2 16 MA30 228
043 INV ATTENDING PHYS ATTENDING PHYSICIAN NUMBER NOT NUMERIC 2 16 N290 132
044 INV NATURE OF ADMIT NATURE OF ADMISSION MISSING OR INVALID 2 16 MA41 231
045 INV PATIENT STATUS PATIENT STATUS CODE INVALID OR MISSING 2 16 MA43 021 431
046 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 M59 021 387
047 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 M59 021 387
048 INVALID/MISS PROC INVALID OR MISSING PROCEDURE CODE 2 16 M51 021 454
049 INV/CONFLIC SURG DTE INVALID/CONFLICT SURGICAL DATE 2 16 N301 021 666
050 INV BLOOD NOT REPL BLOOD NOT REPLACED AMOUNT INVALID 133 021 236
051 INV BLOOD/PINT CHG BLOOD CHARGE PER PINT INVALID 133 021 235
052 >12 MONTH QTY LIMIT > 12 MONTH QTY LIMIT MD FAX OVERRIDE FORM 866-797-2329 3 198 N351
EOB EFFDATE EOB DESCRIPTION
---- ---------- -------------------------------------------------------------------------------
0001 19910101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON SOME DATES OF SERVICE
0002 19900101 BILLING PROVIDER NUMBER MISSING OR INVALID
0003 19900101 RECIPIENT NUMBER MISSING OR INVALID
0004 19900101 PROCEDURE INCLUDED IN COMBINED PROCEDURE
0005 19900101 DOCUMENT CONTROL NUMBER IS MISSING OR INVALID
0006 19900101 SERVICE FROM DATE IS MISSING OR INVALID
0007 19900101 SERVICE THRU DATE IS MISSING OR INVALID
0008 19900101 SERVICE "TO" DATE LESS THAN SERVICE "FROM" DATE
0009 19900101 EXCEEDS ONE B-12 INJECTION MONTHLY
0010 19900101 SERVICE DATE GREATER THAN DATE OF RECEIPT
0011 19900101 MATERNITY CLINIC/PHY CONFLICT FOR PRENATAL SERVICE
0012 19900101 TOTAL TPL AMOUNT IS INVALID
0013 19910101 TPL INDICATOR/AMOUNT CONFLICT
0014 19900101 RELATED CAUSE CODE IS INVALID
0015 19900101 ACCIDENT INDICATOR IS INVALID
0016 19900101 FROM DATE OF SERVICE LESS THAN JULY 1, 1996
0017 19910101 PROVIDER SPECIALTY MISMATCH
0018 19900101 DIAGNOSIS CODE IS MISSING OR INVALID
0019 19900101 MUST SPECIFY QUADRANT(Q1,Q2,Q3,Q4)
0020 19900101 YEARLY LIMIT FOR EYE GLASSES EXCEEDED
0021 19900101 MCO/BHO FORMER ICN NON-MATCH FOR VOID/ADJUSTMENT
0022 19900101 BILLED CHARGES MISSING OR INVALID
0023 19900101 PATIENT NAME IS MISSING
0024 19900101 UNITS OF SERVICE OR DAYS COVERED MISSING OR INVALID
0025 19900101 THE UNITS OF SERVICE ARE LESS THAN DAYS BILLED
0026 19900101 EXCEEDS EPSDT CLINIC LIMITS
0027 19900101 EXCEEDS OB ULTRASOUND LIMIT FOR 9 MONTHS
0028 19900101 PROCEDURE CODE OR NDC IS MISSING OR INVALID
0029 19900101 ATTENDING PHYSICIAN/DMRS FACILITY INVALID OR MISSING
0030 19900101 SAME SERV WITH 91/92 HCPC HAS BEEN PAID THIS DATE
0031 19900101 EXCEPTION CODE 031
0032 19900101 MAXIMUM RENTAL PAYMENT
0033 19900101 NO VALID INDEX RATE ON FILE FOR ASC PROVIDER
0034 19900101 SERVICE DATE GREATER THAN DATE OF SYS GEN ICN
0035 19900101 THE 2 PHY VISIT PER MONTH LIMIT HAS BEEN EXCEEDED
0036 19900101 ADD'L HOURS OF TESTING REQUIRE PRIOR AUTHORIZATION
0037 19900101 MAXIMUM PAYMENT MADE
0038 19900101 EXCEEDS OXYGEN LIMITSONE PER MONTH
0039 19910101 FORMER ICN OR MCC ICN IS NOT FOUND FOR VOID/REPLACEMENT
0040 19900101 TOTAL CALCULATED NON-COVERED CHARGES NOT EQUAL TOTAL AS REPORTED
0041 19910101 ACCOMODATION REVENUE CODES NOT ALLOWED
0042 19900101 REVENUE CHARGE MISSING OR INVALID
0043 19900101 ADMISSION DATE INVALID OR MISSING
0044 19900101 PATIENT STATUS CODE IS MISSING OR INVALID
0045 19900101 SURGERY DATE IS INVALID/MISSING
0046 19900101 COVERED DAYS AND FROM/THRU DAYS ARE NOT EQUAL.
0047 19900101 COVERED DAYS ARE MISSING OR INVALID
0048 19900101 REVENUE CODE IS MISSING OR INVALID
0049 19900101 SOURCE OF ADMISSION IS INVALID OR MISSING
0050 19900101 EXCEPTION CODE 050
0051 19900101 ACCOMMODATION DAYS DO NOT EQUAL TOTAL COVERED DAYS
0052 19900101 HOUR OF ADMISSION IS INVALID OR MISSING
0053 19900101 DATE OF DISCHARGE IS INVALID OR MISSING
0054 19900101 ADMITTING PHYSICIAN INVALID OR MISSING
0055 19900101 TIME OF DISCHARGE IS INVALID OR MISSING
0056 19900101 TYPE OF BILL IS INVALID OR MISSING
0057 19900101 TYPE OF ADMISSION IS INVALID OR MISSING
0058 19900101 INVALID CONDITION CODE
0059 19900101 INVALID NON-COVERED DAYS
0060 19900101 EXCEPTION CODE 060
0061 19900101 OCCURRENCE CODE/DATE IS MISSING OR INVALID
0062 19900101 EXCEPTION CODE 062
0063 19900101 EXCEPTION CODE 063
0064 19900101 EXCEPTION CODE 064
0065 19900101 ACCOMMODATION REVENUE CODE NOT ENTERED FIRST
0066 19900101 EXCEPTION CODE 066
0067 19900101 REVENUE UNITS/MILEAGE ARE INVALID OR MISSING
0068 19900101 TOTAL CHARGE IS MISSING OR INVALID
0069 19900101 DATE OF BIRTH INVALID OR MISSING
0070 19910101 PAID DATE IS INVALID OR MISSING
0071 19900101 PATIENT SEX NOT EQUAL M OR F OR U
0072 19900101 PREVIOUSLY PAID VISUAL EXAM IN 12 MONTHS
0073 19910101 INPATIENT PART B ONLY CHARGE MISSING
0074 19900101 SERVICES NOT COVERED FOR QMB/SLMB RECIPIENTS
0075 19900101 EXCEPTION CODE 075
0076 19900101 EXCEEDS YEARLY FAMILY PLANNING EXAM LIMIT
0077 19900101 MEDICARE CROSSOVER - BILL TENNCARE DIRECTLY
0078 19900101 PREVIOUSLY PAID ONE VISIT ON THIS DAY
0079 19900101 PAY STATUS NOT EQUAL TO PAY OR DENY
0080 19900101 PREVIOUSLY PAID AUDITORY EXAM IN 12 MONTHS
0081 19900101 CHILDRENS DAYS EXCEEDED
0082 19900101 CHILDRENS DAYS EXHAUSTED
0083 19900101 CHILDRENS VISITS EXCEEDED
0084 19900101 CHILDRENS VISITS EXHAUSTED
0085 19900101 CHILDREN DAYS EXCEEDED FOR FISCAL YEAR PA REQUIRED
0086 19900101 CHILDREN DAYS EXCEEDED FOR FISCAL YEAR PA REQUIRED
0087 19910101 HOSPITAL PAYMENTS NOT ALLWED FOR PRESUMPTIVE ELIGIBLES
0088 19900101 EXCEPTION CODE 088
0089 19900101 EXCEPTION CODE 089
0090 19900101 PCS - 1500
0092 19900101 ALIEN-NO REQUEST FOR AUTHORIZATION RECEIVED
0094 19910101 EMERGENCY TREATMENT CODE NOT BILLED
0095 19900101 ANESTHESIA-INVALID OR EXCESSIVE HOURS/MINUTES
0096 19000101 NON-COVERED DAYS CANNOT BE PAID
0098 19900101 HCBW WAIVER HAS DENY/SUSPEND EDIT
0099 19910101 PHARMACIST LICENSE NUMBER MISSING OR INVALID
0100 19900101 KEYING VERIFICATION
0101 19900101 ADP WAIVER HAS DENY/SUSP EDIT
0103 19910101 PLACE OF SERVICE MISSING OR INVALID
0104 19900101 PROCEDURE CODE MODIFIER IS MISSING OR INVALID
0105 19900101 INVALID DIAGNOSIS FOR PROCEDURE
0106 19910101 FAMILY PLANNING CLINIC CODE IS INVALID OR MISSING
0107 19900101 DMRS FACILITY INVALID/MISSING/NOT ELIGIBLE ON DOS
0112 19900101 MISSING TOTAL CHARGE FOR NURSING HOME CLAIMS
0114 19900101 OUTPT HSP PRIOR TO 12/01/99-SUSPEND FOR REVIEW
0117 19900101 INVALID OR MISSING TOOTH CODE OR TOOTH NUMBER
0118 19900101 INVALID SURFACE CODE
0119 19900101 INVALID EMERGENCY INDICATOR
0120 19900101 VISIT PAID IN NORMAL SURGERY FOLLOW-UP PERIOD
0121 19900101 PRESCRIBING PHYSICIAN DEA NUMBER MISSING OR INVALID
0122 19900101 INVALID/MISSING PROVIDER CHECK-DIGIT NUMBER
0123 19900101 NATIONAL DRUG UNITS ARE MISSING OR INVALID
0124 19900101 MISSING FIRST DATE OF SERVICE ON CLAIM
0125 19900101 PRESCRIPTION NUMBER MISSING
0126 19900101 FIRST DATE OF SERV GREATER THAN LAST DATE OF SERV
0127 19900101 ESTIMATED DAYS SUPPLY INVALID
0128 19900101 REFILL CODE MUST BE 00 THROUGH 99
0130 19900101 MCO/BHO TOTAL ALLOWED AMOUNT INVALID
0131 19900101 UNITS EXCEED PROGRAM MAXIMUM FOR HCBS CODE
0132 19900101 MISSING TOTAL CLAIM CHARGE
0133 19900101 INVALID TOTAL CLAIM CHARGE
0134 19900101 INVALID NET CLAIM CHARGE
0136 19900101 REVENUE CODE IS INVALID/NOT ON FILE
0138 19900101 INVALID HCBS TYPE-2 FACILITY NUMBER
0140 19900101 HCPC CODE IS INVALID FOR REVENUE CODE
0142 19900201 1 YR TIMELY FILE HAS BEEN OVERRIDDEN-TF ATTACHED
0143 19900101 REFILLS EXHAUSTED
0144 19900101 INVALID REFILL INDICATOR VALUE
0146 19900101 HCPC/REVENUE CODE MISSING
0148 19900101 PROCEDURE NOT PAYABLE THIS RECIPIENT
0149 19900101 PROC REQUIRES REVIEW FOR RECIPIENT
0150 19900101 MCO/BHO TOTAL PAYMENT IS INVALID OR MISSING
0151 19900101 MISSING PRESCRIBING PROVIDER NUMBER
0152 19900101 MISSING DRUG CODE
0153 19900101 INVALID DRUG CODE
0154 19900101 MISSING PRESCRIPTION NUMBER
0155 19910101 THRU DATE DISAGREES WITH PATIENT STATUS
0156 19900101 MISSING DAYS SUPPLY
0157 19900101 COVERED + NON-COVERED DAYS DOES NOT EQUAL TOTAL DAYS/UNITS BILLED
0158 19900101 ADMIT DATE GREATER THAN FROM DOS
0159 19910101 CLAIM PREVIOUSLY DENIED FOR INVALID PROCEDURE
0160 19900101 ADMIT DATE IS INVALID
0161 19900101 ADMISSION CODE INVALID
0162 19900101 DETAIL SVC DATES INCONSISTENT WITH HEADER DATES
0163 19900101 MISSING DIAGNOSIS CODE
0165 19900101 TOTAL DAYS MISSING OR INVALID
0167 19900101 PATIENT STATUS INVALID OR MISSING
0168 19900101 THERAPEUTIC LEAVE DAYS INVALID
0169 19900101 HOSPITAL LEAVE DAYS INVALID
0170 19910101 NON-COVERED DAYS INVALID
0171 19900101 PHYSICIAN CERTIFICATION DATE IS MISSING OR INVALID
0172 19900101 PHYSICIAN VISIT DATE IS INVALID OR MISSING
0173 19900101 TIME OF DEATH IS INVALID OR MISSING
0174 19910101 VOID PER POLICY REVIEW
0175 19910101 INVALID COVERED DAYS
0176 19910101 INVALID CHARGE BILLED TO MEDICARE
0177 19900101 MEDICARE ALLOWED AMOUNT INVALID OR MISSING
0178 19900101 MEDICARE PAID AMOUNT IS NOT NUMERIC
0179 19900101 DEDUCTIBLE AMOUNT IS MISSING OR INVALID
0180 19900101 BLOOD DEDUCTIBLE AMOUNT INVALID
0181 19900101 COINSURANCE AMOUNT IS MISSING OR INVALID
0182 19900101 PART-A COINSURANCE GREATER MEDICARE PAID AMT
0183 19900101 CASH DEDUCT+ BLOOD DEDUCT+ COINSURANCE MUST NOT EXCEED (MEDICARE ALLOWED - MEDI
0184 19900101 MEDICARE PAID DATE IS AFTER THE ICN DATE
0185 19900101 MEDICARE PAID DATE MISSING OR INVALID
0186 19910101 CROSSOVER CLAIM BILLED INCORRECTLY
0187 19900101 PROCEDURE NOT PAYABLE THIS RECIPIENT
0188 19900101 DIAGNOSIS CODE NOT COVERED BY MEDICAID FOR DATE OF SERVICE
0189 19900101 PROCEDURE REQUIRES MEDICAL REVIEW
0190 19910101 EXCEEDS ALLOWED AMOUNT FOR CALENDAR YEAR
0191 19900101 REIMBURSEMENT REFLECTS LESS THAN A FULL WEEK FOR MEGAVOLTAGE TREATMENT
0192 19900101 TOTAL DAYS ON CLAIM CONFLICT WITH DATES SHOWN
0193 19910101 NO HCBS CODE ENTERED
0194 19900101 AGE IS NOT COVERED INPATIENT PSYCHIATRIC SERVICES
0196 19900101 MISSING ADMISSION DATE
0198 19900101 MISSING ATTENDING SURGEON PRESCRIBER NUMBER
0199 19900101 REFERRING PROVIDER CANNOT BE BILLING PROVIDER
0200 19910101 PROVIDER NOT ON FILE
0201 19900101 PROCEDURE CODE IS NOT IN THE SCOPE OF PROGRAM
0202 19900101 PROVIDER INELIGIBILE FOR SUBMITTING THIS CLAIM TYPE
0203 19900101 PROVIDER NAME/NUMBER MISMATCH
0204 19900101 REBILL FOR PROVIDER ELIGIBLE DAYS ONLY
0205 19900101 PATIENT NOT CERTIFIED
0206 19910101 DATE OF SERVICE SPAN PROVIDER FISCAL YEAR
0207 19900101 RENDERING PROVIDER ON PREPAYMENT REVIEW
0208 19900101 BILLING PROVIDER IS AN OUT OF STATE PROVIDER
0209 19900101 INVALID DESTINATION
0210 19900101 FACILITY PROVIDER SERVICE LOCATION IS MISSING
0211 19900101 SERVICING PROVIDER MISSING/INVALID OR NOT DIFFERENT FROM BILLING PROVIDER
0212 19910101 SERVICING PROVIDER NOT ON FILE
0213 19000101 PREGNANCY INDICATOR INVALID
0214 19910101 ENROLLEE NOT ELIGIBLE FOR MCC/BHO ON DATES OF SERVICE
0215 19910101 MEDICAID RECORDS INDICATE THAT THIS RECIPIENT HAS NOT BEEN APPROVED FOR MEDICAI
0216 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID
0217 19910101 RECIPIENT NOT ELIGIBLE ON DATES OF SERVICE-ATTACHMENT PRESENT
0218 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON DATE(S) OF SERVICE
0219 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON SOME DATES OF SERVICE
0220 19910101 RECIPIENT NOT ELIGIBLE FOR SOME DATES OF SERVICE
0221 19900110 RECIPIENT NAME MISMATCH - ATTACHMENT PRESENT
0222 19900101 RECIPIENT NAME DOES NOT MATCH TENNCARE NUMBER
0223 19910101 RECIPIENT NOT ELIGIBLE FOR DATES OF SERVICE - RECYCLED
0224 19900101 INVALID OCCURRENCE DATE
0225 19900101 RECIPIENT DATE OF DEATH IS PRIOR TO DATE OF SERVICE
0226 19900101 RECIPIENT ON REVIEW
0227 19900101 EXCEPTION CODE 227
0228 19900101 MISSING MEDICARE PAID DATE
0229 19900101 RECIPIENT MEDICAID PLUS MEMBER. CONTACT PHYS ON ID CARD FOR APPROVAL
0230 19900101 NO CROSSOVER COINSURANCE OR DEDUCTIBLE DUE
0231 19910101 PROVIDER PROCEDURE RESTRICTIONS
0232 19900101 PROCEDURE/MODIFIER OR DRUG CODE NOT ON PROCEDURE/FORMULARY FILE
0233 19900101 PROCEDURE/NDC NOT COVERED BY MEDICAID FOR DATE OF SERVICE
0234 19900101 PROCEDURE/FORMULARY AGE RESTRICTION
0235 19900101 PROCEDURE/FORMULARY SEX RESTRICTION
0236 19900101 PROCEDURE/FORMULARY PLACE OF SERVICE RESTRICTION
0237 19900101 PROCEDURE/FORMULARY PROVIDER SPECIALTY RESTRICTION
0238 19900101 ITEMIZED SERVICE DATE NOT IN ELIGIBILITY SPAN
0239 19900101 INVALID OCCURRENCE SPAN CODE
0240 19900101 PROCEDURE/FORMULARY DIAGNOSIS RESTRICTION
0241 19900101 PRICING FILE HAS NO VALID PRICE OR PERCENTAGE OR PER DIEM FOR DOS
0242 19900101 MISSING OCCURRENCE CODE
0243 19910101 PROVIDER NOT CERTIFIED FOR PROCEDURE
0244 19900101 INVALID PAY-TO PROVIDER NUMBER
0251 19910101 RECIPIENT HAS THIRD PARTY RESOURCES - ATTACHMENT PRESENT
0252 19910101 ADMITTING DIANOSIS CODE IS INVALID/NOT ON FILE
0253 19900101 DIAGNOSIS DATE RESTRICTION
0254 19900101 DIAGNOSIS AGE RESTRICTION
0255 19900101 DIAGNOSIS SEX RESTRICTION
0256 19900101 DIAGNOSIS FILE PROCEDURE RESTRICTION
0257 19900101 THIS DIAGNOSIS REQUIRES MEDICAL REVIEW
0258 19900101 RECIPIENT IS NOT ON ELIGIBILITY FILE
0259 19900101 CROSSOVER CLAIM EXCEEDS FILING TIME LIMIT - RESUBMIT WITH PROOF OF TIMELY FILIN
0260 19900101 SLIMB ONLY/NO MEDICAL ELIGIBILITY
0261 19900101 CATEGORY OF SERVICE CANNOT BE DERIVED
0262 19910101 TPL AMOUNT APPEARS TO BE INSUFFICIENT. PLEASE VERIFY
0263 19900101 TPL - RECIPIENT HAS THIRD PARTY RESOURCES
0264 19900101 RECIP IS MEDICARE PART A ELIGIBLE
0265 19900101 RECIP IS MEDICARE PART B ELIGIBLE
0266 19900101 REFERRING PHYSICIAN NUMBER IS MISSING
0267 19000101 HOSPICE XOVER CLAIM SUPER-SUSPEND FOR REVIEW
0268 19900101 CLAIM EXCEEDS FILING TIME LIMIT- RESUBMIT WITH PROOF OF TIMELY FILING
0269 19900101 CLAIM SPANS CALENDAR YEAR
0270 19900101 CLAIM SPANS STATE FISCAL YEAR
0271 19900101 RECIPIENT IS NOT ELIGIBLE ON SERVICE DATE
0272 19900101 ITEMIZED SERVICE DATE NOT IN ELIGIBILITY SPAN
0273 19900101 SUSPENDED FOR RECIPIENT REVIEW
0274 19910101 TOTAL BILLED NOT EQUAL SUM OF ALL LINE CHARGES
0276 19900101 NEWBORN-HCA REVIEW
0277 19900101 LTC ELIGIBILITY ERROR
0278 19900101 DISCHARGE DTE UNEQ TO LTC ELIG
0279 19910101 INVALID LAB PROCEDURE CODE
0281 19900101 PEND FOR MANUAL PRICING
0282 19900101 PHYSICIAN AUDITOR REVIEW-MODIFIER 24
0283 19910101 MANUAL PRICE EXCEEDS ALLOWABLE BUT IS LESS THAN BILLED CHARGE
0284 19910101 MANUAL PRICE EXCEEDS BILLED CHARGES
0285 19910101 UNLISTED PROCEDURE
0287 19910101 STER/HYST/ABOR CONSENT INDICATOR IS MISSING OR INVALID
0288 19910101 PROCEDURE NOT COVERED BY MEDICAID
0289 19910101 JUSTIFICATION OF MEDICAL NECESSITY REQUIRED
0290 19900101 PROCEDURE IS NOT IN THE SCOPE OF THE PROGRAM
0291 19900101 PROCEDURE REQUIRES MEDICAL REVIEW
0292 19900101 PROCEDURE REQUIRES PRIOR AUTHORIZATION
0293 19000101 INCOMP. DOC. AND OR MISSING W9. PLS CONTACT PROV. INQ. AT 1-800-852-2683
0294 19900101 SERVICE NOT COVERED BY MEDICAID
0295 19910101 RECIPIENT HAS TPL RESOURCES BUT NO TYPE OF COVERAGE ON FILE
0296 19910101 CONTACT PARENT FOR PAYMENT
0297 19900101 PAY TO PROVIDER NOT ELIG FOR PAY-THIS DATE OF SERV
0298 19900101 PROVIDER NUMBER IS A GROUP NUMBER
0299 19910101 PEND FOR REVIEW OF MULTIPLE SURGERY
0300 19900101 NO PROVIDER MASTER RECORD
0301 19910101 FRI/SAT ADMISSION DENIED - JUSTIFICATION REQUIRED
0302 19900101 REVENUE CODE NON APPLICABLE FOR MEDICAID
0303 19910101 REVENUE CODE INVALID
0304 19900101 PROVIDER INELIGIBLE ON SERVICE DATE
0305 19910101 VISIT CODE CANNOT BE ALLOWED ON SAME DAY AS CONSULT
0306 19900101 PAY TO PROVIDER IS SUSPENDED
0307 19900101 BILLING OUT OF CLIA CERTIFICATE TYPE
0308 19900101 NO PAY-TO PROVIDER RECORD
0309 19900101 REVIEW CLAIM FOR PAY-TO- PROVIDER
0310 19910101 INPATIENT PSYCHIATRIC AGE RESTRICTION
0311 19910101 AMBULANCE SERVICES BILLED ON OUTPATIENT ENCOUNTER NOT JUSTIFIED
0312 19900101 PAY-TO PROVIDER NOT ENROLLED
0313 19900101 DIAGNOSIS CODE IN SEQUENCE 5TH-24TH INVALID OR NOT ON FILE
0314 19900101 SURGICAL PROCEDURE CODE NOT FOUND
0315 19910101 PEND FOR REVIEW OF GLOBAL SURGERY
0316 19900101 MCC ICN MISSING FROM CLAIM
0317 19900101 INVALID/MISSING MODIFIER FOR THIS PROCEDURE
0318 19900101 DATE OF BIRTH AFTER THE DATE OF SERVICE
0321 19900101 PROCEDURE CODE IS NO LONGER VALID
0322 19900101 DATE OF SERVICE BEFORE PROCEDURE IS PAYABLE
0323 19910101 DATES OF SERVICE SPAN PROVIDER PRICING SEGMENT (NO RATE ON FILE FOR DATES OF SE
0324 19900101 INVALID RECIPIENT SEX FOR THIS DIAGNOSIS
0326 19910101 SURG PROCEDURE CODE IS REQUIRED WITH OPERATING ROOM CHARGES
0328 19900101 PROCEDURE NOT IN SCOPE OF PROGRAM FOR THIS AGE
0329 19900101 INVALID RECIPIENT SEX FOR THIS PROCEDURE
0330 19910101 FACILITY NOT QUALIFIED FOR LEVEL OF CARE BILLED
0331 19900101 NO PAE AVAILABLE FOR RECIPIENT ADMISSION
0332 19900101 INVALID PROVIDER TYPE FOR THIS PROCEDURE
0333 19910101 LOC NOT AUTHORIZED BY PAE
0334 19900101 NO PATIENT LIABILITY IN EFFECT FOR DATE OF SERVICE
0335 19910101 PATIENT LIABILITY EXCEEDS OR EQUALS ALLOWED AMOUNT
0336 19900101 REFILLS ARE NOT ALLOWED FOR NARCOTIC DRUGS
0337 19910101 D AND C PAYMENT INCLUDED WITH HYSTERECTOMY
0338 19900101 PATIENT LIABILITY CHANGED DURING MONTH
0339 19900101 RECIPIENT CHANGES PATIENT STATUS AFTER HE IS DISCHARGED OR TRANSFERED
0340 19910101 REPROCESSED CLAIM - PAID INCORRECT PER DIEM ON RA 07/21/89
0341 19910101 VOID OF CLAIMS PREVIOUSLY PRICED/PROCESSED INCORRECTLY
0342 19900101 THIS DIAGNOSIS REQUIRES MEDICAL REVIEW
0345 19900101 ATTENDING PROVIDER NOT FOUND
0346 19900101 PHYSICIAN VISIT MUST NOT BE MORE THAN 365 DAYS NO GRACE PERIOD IS GIVEN ON THES
0347 19000101 PHYSICIAN CERTIFICATION DATE EXCEEDS ALLOWABLE DAYS
0348 19900101 PHYSICIAN CERTIFICATION DATE MUST MEET FEDERAL GUIDELINES
0349 19900101 PHYSICIAN RECERTIFICATION DATE EXCEEDS ALLOWABLE DAYS
0350 19000101 THE NUMBER OF DETAILS IS NOT EQUAL TO THE SUBMITTED DETAIL COUNT
0351 19900101 SUBMITTED TO ALLOWED EXCEEDS PERCENT
0352 19900101 ALLOWED TO SUBMITTED EXCEEDS PERCENT
0353 19900101 SPECIALTY REQUIRES/EXCLUDES SPECIFIC MODIFIER
0354 19900101 THIS LAB NOT CERTIFIED TO PROVIDE THIS SERVICE
0356 19900101 PROCEDURE DELETED FROM CPT/HCPS. REFER TO CPT/HCPCS FOR CURRENT CODE
0357 19900101 THIS DRUG REQUIRES PRIOR AUTHORIZATION
0358 19900101 INACTIVE DRUG
0359 19900101 NATIONAL SUPPLIER PROVIDER NUMBER NOT ON FILE, CONTACT MEDICAID
0360 19900101 THIS NATIONAL DRUG CODE IS NOT ON FILE
0361 19910101 ASST. SURGEON NOT MEDICALLY NECESSARY OR JUSTIFIED
0362 19900101 MEDICARE DEDUCTIBLE GREATER THAN MAXIMUM
0363 19910101 ROUTINE PHYSICIAN EXAM NOT COVERED EXCEPT UNDER EPSDT
0365 19910101 PROCEDURE REQUIRES PRIMARY TOOTH CODE(S)
0366 19910101 PROCEDURE REQUIRES PERMANENT TOOTH CODE(S)
0367 19910101 PROCEDURE FILE INDICATES SURFACE CODES(S) REQUIRED
0368 19910101 PROCEDURE/FORMULARY INDICATES TOOTH CODE REQUIRED
0369 19910101 SEALANTS NOT COVERED ON PRIMARY TEETH
0370 19910101 ACCIDENT INDICATOR MISSING OR INVALID
0371 19900101 THIS DIAGNOSIS REQUIRES ADDITIONAL DOCUMENTATION
0372 19900101 ITEM NOT PAYABLE IN LONG TERM CARE FACILITY
0374 19900101 MISSING PRESCRIBER PROVIDER ON DEALER CLAIM
0375 19900101 SERVICE NOT ON EXPLANTION OF MEDICARE PAYMENTS
0377 19900101 RECIPIENT IS INELIGIBLE FOR THIS DRUG
0379 19900101 PROCEDURE CODE MODIFIER REQUIRES MANUAL REVIEW
0383 19900101 MULTIPLE SURGERY REQUIRES REVIEW
0385 19900101 REVENUE CODE NOT ON FILE
0386 19000101 CARRIER CODE INVALID
0387 19000101 ADJ REASON CD 22/23 MISSING/INVALID OR TPL INVALID
0388 19910101 SERVICES OF THIS PROVIDER NOT COVERED BY MEDICAID
0389 19900101 THIS MODIFIER IS ALLOWED FOR CRNA ONLY
0390 19900101 MULTIPLE EXTRACTION REQUIRES APPROPRIATE PROC CODE
0391 19900101 INVALID USE OF E DIAGNOSIS CODE
0392 19910101 UNITS BILLED GREATER THAN COVERED DAYS
0394 19900101 VERIFY RECIPIENTS TPL
0396 19900101 LOC ON CLAIM CONFLICTS WITH LOC ON FILE
0397 19900101 INVALID LTC TERMINATION CODE
0399 19900101 REFERRING PROVIDER I.D. # IS NOT IN A VALID FORMAT
0400 19900101 INVALID LOC DAYS
0401 19900101 INVALID LEAVE DAYS
0402 19900101 INVALID TYPE OF LEAVE
0406 19900101 LTC LEAVE DATES CONFLICT
0407 19900101 THERAPEUTIC DAYS GT THAN 14
0410 19900101 PA IS REQUIRED
0412 19900101 EXCEPTION CODE 412
0413 19900101 LTC BLOCK 13:TOTAL DAYS DO NOT EQUAL FROM/TO DAYS
0414 19900101 WAIVER SERVICES LONG TERM CARE CONFLICT
0416 19900101 AMB SERVICES ORIGIN TO DESTINATION NOT IN SCOPE
0417 19900101 REVIEW AMBULANCE NON ROUTINE DESTINATION
0420 19900101 THIS DRUG NOT PAYABLE FOR RECIPIENT AGE
0421 19900101 THIS DRUG NOT PAYABLE FOR RECIPIENT SEX
0425 19900101 THIS PROCEDURE MUST BE BILLED SEPARATELY EACH DATE
0430 19900101 LTC INVALID RECIP ID NUMBER
0431 19900101 LTC NO PROV MASTER RECORD
0433 19900101 LTC MISSING PROVIDER NUMBER
0434 19900101 LTC INVALID PROV NUM CK-DIGIT
0435 19900101 LTC FIRST DATE OF SERVICE MISSING
0436 19900101 LTC FILING DEADLINE EXCEEDED
0437 19900101 LTC FIRST DATE GREATER LAST DATE
0438 19900101 LTC RECHECK SERVICE DATE
0439 19900101 COINSURANCE NOT A MULTIPLE OF THE MEDICARE DAILY RATE
0443 19900101 LTC RECIP NOT ON ELIG FILE
0444 19900101 LTC RECIPIENT INELIGIBLE ON SERVICE DATES
0445 19900101 LTC RECIPIENT NOT ELIGIBLE ON SERVICE DATES
0446 19900101 LTC RECIP SUSPEND FOR REVIEW
0447 19910101 LIMIT OF 15 HOSPITAL LEAVE DAYS PER HOSPITALIZATION EXCEEDED
0448 19900101 LTC PROVIDER IS INELIGIBLE ON SERVICE DATES
0449 19900101 LTC REVIEW CLAIM FOR PROV
0450 19000101 INVALID QUADRANT
0451 19900101 LTC INV PROVIDER NUMBER
0452 19900101 RENDERING PROVIDER SERVICE LOCATION IS MISSING
0453 19000101 INVALID DIAGNOSIS TREATMENT INDICATOR
0454 19900101 INVALID ASSIGNMENT CODE
0455 19910101 REFILL NOT ALLOWED FOR DRUG CODE BILLED
0456 19900101 INVALID PROCEDURE TYPE
0457 19900101 INVALID PRINCIPAL/OTHER PROCEDURE TYPE
0458 19900101 ALIEN RECIPIENT ON REVIEW
0459 19900101 REVENUE CODES OP401 NEED HCPC CODE
0460 19910101 NOT MEDICAID ELIGIBLE FOR NURSING HOME PAYMENT
0461 19900101 OCCURENCE CODE SPAN MISSING/INVALID
0462 19900101 OCCURENCE SPAN DATE IS MISSING OR INVALID
0463 19900101 NOT MEDICAID ELIGIBLE FOR MEDICARE CROSSOVER PAYMENT
0464 19900101 SPAN DATE CONFLICT WITH DATES OF SERVICE SHOWN
0465 19900101 MEDICAID ALLOWABLE AMOUNT REDUCED BY THIRD PARTY LIABILITY
0466 19900101 MEDICAID ALLOWED REDUCED BY MEDICARE PAYMENT
0467 19900101 OVERLAP DATES FOR SAME LEVEL OF CARE
0468 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION
0469 19900101 LTC RECIPIENT NAME/ID MISMATCH
0470 19900101 CROSS OVER PEND FOR MANUAL PRICE
0471 19900101 NDC IS DEACTIVED AND NOT PAYABLE ON DATE FILLED
0472 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION
0473 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION
0474 19000101 DATE DISPENSED AFTER BILLING DATE
0475 19000101 DATE BILLED AFTER ICN DATE
0476 19900101 MAXIMUM HOSPITAL DAYS FOR THIS ADULT HAS BEEN PAID
0477 19000101 THE DIAGNOSIS CODE IN SEQUENCE 10-24 IS IN AN INVALID FORMAT
0478 19900101 PCS MISSING SUBMITTED CHARGE
0479 19900101 CLIA OUT OF DATE
0480 19910101 PROVIDER NOT ELIGIBLE ON DATES OF SERVICE
0481 19910101 CLAIM PENDED FOR REVIEW OF ATTACHMENTS
0482 19900101 DDSD/NFM PROCEDURE - NOT DDSD/NFM PROVIDER
0483 19900101 DDSD/NFM PROVIDER - NOT DDSD/NFM PROCEDURE
0484 19910101 PREMATURE/NEONATAL NURSERY CARE MUST BE BILLED WITH NEWBORN'S ID
0485 19900101 DATE DISPENSED EARLIER THAN DATE PRESCRIBED
0486 19900101 INPATIENT PSYCHIATRIC NEEDS PRIOR AUTHORIZATION
0487 19900101 PRIMARY DIAG CODE DETOX/NO DETOX REVENUE CODE
0488 19900101 ADMIT DATE DOES NOT EQUAL FIRST DATE OF SERVICE
0489 19900101 NO CLIA - DOS PRIOR TO CLIA EFFECTIVE DATE
0490 19900101 INPATIENT SERVICES ARE NOT COVERED FOR THIS RECIP
0491 19900101 DRUG NOT APPROVED
0492 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0493 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0494 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0495 19900101 NO CLIA - DOS PRIOR TO CLIA EFFECTIVE DATE
0496 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0497 19900101 NO CLIA - DOS PRIOR TO CLIA - EFFECTIVE DATE
0498 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0499 19900101 TPL PAY CHASE IMMUNO SUPPRESS DRUG
0500 19900101 DOCUMENT PEND
0501 19900101 SUSPEND FOR TPL REVIEW
0502 19900101 FILE CLAIM WITH MEDICARE
0503 19900101 THIS PATIENT HAS OTHER INSURANCE
0505 19900101 RETAIN INSURANCE DENIAL 6 MONTHS FOR TPL REVIEW
0507 19900101 EPSDT-MAY HAVE TPL
0508 19900101 TPL PAY AND CHASE PHARMACY
0509 19900101 TPL PAY AND CHASE PRE-NATAL
0510 19900101 THIS PATIENT HAS TWO COVERAGE TYPES
0511 19900101 CLAIM DATA DOES NOT MATCH PRIOR AUTHORIZATION DATA
0515 19910101 RESUBMISSION CODE INVALID
0516 19910101 CCN MISSING ADJUSTMENT/VOIDS
0517 19910101 ADJUSTMENT REPLACED BY THE LATEST ADJUSTMENT
0518 19990101 PROVIDER TYPE - CLAIM INPUT CONFLICT
0519 19900101 DRUG REQUIRES PRIOR AUTHORIZATION
0520 19900101 DRUG QUANTITY PER DAY LIMIT HAS BEEN EXCEEDED
0521 19910101 DUPLICATE ADJUSTMENT RECORDS ENTERED
0522 19900101 RECIPIENT IS NOT ELIGIBLE FOR THESE SERVICES
0524 19910101 CLAIM TO BE ADJUSTED IS THE CREDIT/VOID OF PREVIOUS ADJUSTMENT
0525 19900101 ADJUSTMENT OR VOID INVALID FOR PREVIOUSLY DENIED CLAIMS
0526 19900101 PRIOR AUTHORIZATION NOT ON FILE
0527 19900101 NO UNITS AUTHORIZED-THESE DATES OF SERVICES
0528 19900101 PRIOR AUTHORIZATION UNITS USED
0530 19900101 TIER 2 NSAID NO RECORD OF TIER 1'S ON FILE
0532 19900101 DISEASE STATE MANAGEMENT
0534 19000101 PRODUR DRUG-AGE INTERACTION
0535 19900101 PDUR INGREDIENT DUPLICATION
0536 19900101 INSURANCE EOB DOES NOT MATCH CLAIM - RESUBMIT
0537 19900101 PDUR DRUG-TO-DRUG INTERACTION
0538 19910101 EOB ATTACHMENT INADEQUATE FOR TPL RESOLUTION-RESUBMIT
0539 19000101 PDUR EARLY REFILL ON PRESCRIPTION
0540 19000101 PDUR MINIMUM DURATION OF THERAPY
0541 19900101 PDUR DOSING PRECAUTION-HIGH DOSE
0542 19900101 PDUR DOSING PRECAUTION-LOW DOSE
0543 19910101 ACCEPTABLE THIRD PARTY DENIAL JUSTIFIES PAYMENT
0544 19900101 PDUR MAXIMUM DURATION OF THERAPY
0545 19900101 PDUR LATE REFILL ON PRESCRIPTION
0546 19900101 DRUG DISEASE MARKER
0547 19900101 HMO CO-PAY/RECIPIENT HAS MEDICARE
0548 19900101 PAY TO PROV FOR PROVIDER TYPE 63 MUST BE GROUP
0549 19900101 ADJUSTMENT SUSPEND FOR MANUAL REVIEW
0550 19900101 SERVICE NOT REFERRED BY PRIMARY CARE CASE MANAGER
0552 19900101 PROVIDER NOT ELIGIBLE TO PROVIDE SERVICE/MEDICAID
0553 19900101 SNF/NF PAE EFF DATE MUST NOT BE GREATER THAN 90 DAYS PRIOR ADM/SERV DATE
0555 19000101 CLAIM PAST 24 MONTH FILING - DTL
0556 19900101 RECIPIENT IS NOT WAIVER ELIGIBLE
0557 19000101 CLAIM PAST 24 MONTH FILING - HDR
0560 19900101 RECIPIENT SERVICES COVERED BY HMO PLAN
0561 19900101 PROVIDER INELIGIBLE FOR T19 SERVICES/HMO ONLY
0562 19900101 RECIP PCPCM-CANNOT BILL OP/RHC/FQHC CLINICS RATE
0563 19900101 RECIPIENT NOT ENROLLED IN HMO FOR DOS
0564 19900101 SUPPLEMENTAL DELIVERY PAYMENT DENIAL CODE
0565 19900101 PAID AMOUNT IS GREATER THAN THE BILLED AMOUNT
0566 19900101 EXCEPTION CODE 566
0567 19910101 ROOM AND BOARD CHARGES NON-COVERED--CORRECT AND RESUBMIT
0569 19900101 CC CLAIMS CAN'T PROCESS THRU SYSTEM
0570 19900101 INVALID ELIGIBILITY FOR HMO COPAY
0571 19900101 CLAIMCHECK REBUNDLED
0572 19900101 CC INCIDENTAL TO PRIMARY PROCEDURE
0573 19900101 CC MUTUALLY EXCLUSIVE
0574 19900101 CLAIMCHECK COSMETIC SURGERY
0575 19900101 CLAIMCHECK DUPLICATE
0576 19900101 CC UNLISTED/OBSOLETE/EXPERIMENTAL/UNSPECIFIED
0577 19900101 CLAIMCHECK POSSIBLE DUPLICATE
0578 19900101 CLAIMCHECK PRE-OP/POSTOP
0579 19900101 CC GROUPHEALTH SMARTSUSPENSE SUSPEND
0580 19900101 CLAIMCHECK MEDICAL/EVALUATION VISIT
0581 19900101 RECIPIENT IS LOCKED-IN TO ANOTHER PHYSICIAN
0582 19900101 RECIPIENT IS LOCKED-IN TO ANOTHER PHARMACY
0583 19900101 CLAIMREVIEW NEW VISIT FREQUENCY
0584 19900101 CC GROUPHLTH SMARTSUSPENSE DENY
0587 19900101 CLAIMREVIEW INTENSITY OF SERVICE
0588 19900101 STOP LOSS NOT APPROVED
0589 19900101 CC INVALID MODIFIER/PROCEDURE COMBINATION
0590 19900101 CLAIMCHECK EXCEEDS 40 LINES
0591 19900101 CLAIMREVIEW MULTIPLE/DUPLICATE COMP.BILLING
0592 19900101 CLAIMCEHCK AGE REPLACEMENT
0593 19900101 CLAIMREVIEW DIAGNOSIS TO PROCEDURE
0594 19900101 CLAIMCHECK-BILL EACH DOS ON A SEPARATE LINE
0595 19910101 CLIA REGISTRATION CERTIFICATE NUMBER NOT ON FILE
0597 19900101 CLAIMCHECK MULTIPLE SURGERY
0598 19900101 CC-MULTIPLE SURGERY-DOUBLE MODIFIERS
0599 19900101 ATTACHMENT CONTROL NUMBER MISSING
0600 19900101 UNITS NOT EQUAL TO TEETH BILLED
0601 19900101 PART A CROSSOVER SPANS 20020501
0602 19900101 UNITS NOT EQUAL TO TEETH BILLED
0603 19900101 PROV ID ON CLAIM DOES NOT MATCH PROV ID ON PA
0604 19900101 SERVICE AND/OR DATES DO NOT MATCH PRIOR AUTH
0605 19900101 PRIOR AUTH FUND AND CLAIM FUND DOES NOT MATCH
0606 19900101 PRIOR AUTH UNITS/AMOUNTS USED
0608 19900101 JUSTIFICATION OF MEDICAL NECESSITY REQUIRED FOR THIS PROCEDURE
0609 19900101 CHECK CLAIM ATTACHMENT
0612 19900101 TOOTH NUM ON CLAIM DOES NOT MATCH TOOTH NUM ON PA
0614 19900101 DIAG CODE MISSING/NOT ON FILE-INPATIENT CLAIMS
0615 19900101 PROVIDER RATE NOT ON FILE FOR LEVEL OF CARE
0616 19900101 PROCEDURE NOT COMPENSABLE FOR ASSISTANT SURGEON
0618 19900101 AUTH SERVICES-RECIP NOT ELIG
0619 19900101 RECIP INELIGIBLE PAY (AUTH EXAM) FROM STATE FUND
0620 19900101 MEDICARE ADJUSTED CLAIM-SUBMIT PAPER XOVER CLAIM
0621 19900101 (CASH DEDUCTIBLE + BLOOD DEDUCTIBLE + COINSURANCE) IS GREATER THAN (MEDICARE AL
0622 19900101 MASS CREDIT/ADJ BEING SUSPEND
0625 19900101 FUND CODE UNDETERMINED
0627 19910101 X-OVER AMOUNT BILLED GREATER THAN AMOUNT BILLED TO MEDICARE
0628 19910101 PHYSICIAN VISIT DATE MISSING/INVALID
0629 19900101 PHYSICIAN VISIT DATE DOES NOT MEET FEDERAL REQUIREMENTS
0630 19900101 DIAGNOSIS NOT IN SCOPE OF THE PROGRAM
0631 19900101 DIAGNOSIS NOT IN SCOPE OF CCP PROGRAM
0632 19900101 DIAGNOSIS NOT IN SCOPE OF CN PROGRAM
0633 19900101 DIAGNOSIS NOT IN SCOPE OF MN PROGRAM
0634 19000101 DETAIL ATTENDING PHYSICIAN ID INVALID
0635 19000101 DETAIL FIRST OTHER PHYSICIAN ID INVALID
0637 19900101 CLAIM PROCESSES MORE THAN 1 YEAR AFTER DATE OF SERVICE AND MORE THAN 183 DAYS A
0638 19900101 DRUG REQUIRES MEDICAL REVIEW/CN
0639 19900101 DRUG REQUIRES MEDICAL REVIEW/MN
0642 19900101 INVALID PROVIDER NUMBER
0643 19900101 ABORTION REQUIRES REVIEW
0644 19900101 PROCEDURE CODE MODIFIER NOT PAYABLE
0645 19900101 NOT MEDICAID ELIGIBLE FOR MEDICARE CROSSOVER PAYMENT
0646 19900101 PROVIDER RATE NOT ON FILE
0648 19900101 CC SITE SPECIFIC MODIFIER-FILE ON SEPARATE LINE
0649 19910101 HOSPICE CLAIM PREVIOUSLY PAID FOR DATES OF SERVICE
0650 19900101 MISSING 224 REVENUE/INVALID UNITS ON LATE DISCHARGE
0651 19900101 INVALID TREATMENT DIAGNOSIS INDICATOR
0652 19900101 PCS-INVALID NET CLAIM CHARGE
0653 19900101 PAID IN FULL BY MEDICARE
0654 19900101 RECIPIENT ID IS INVALID FOR AUTH EXAM PAY STATE FD
0655 19910101 DENIED BY MEDICARE
0656 19910101 MEDICARE PAYMENT EXCEEDS MEDICAID MAXIMUM ALLOWABLE
0657 19900101 POTENTIAL DISABILITY CLAIM
0658 19910101 NEWBORN CARE LIMITED TO 2 SUBSEQUENT VISITS
0659 19900101 DATE OVER 1 YR MORE THAN 90 DAYS AFTER MEDICARE PD
0662 19900101 LINE FAILURE - CLAIM DENIED
0663 19900101 PCS-PROVIDER NUMBER IS NOT ON PROVIDER FILE
0664 19900101 PCS OVER 31 DAYS BILLED
0665 19900101 PCS MISSING PROVIDER NUMBER
0666 19910101 HOSPITAL INPATIENT SERVICE CANNOT BE PAID ON SAME DAY AS OBSERVATION
0667 19900101 PCS-INVALID PROVIDER NUMBER CHECK DIGIT
0668 19900101 PCS MISSING FIRST DATE OF SERVICE
0669 19900101 PCS FILING DEADLINE EXCEEDED
0670 19900101 PCS FIRST DATE OF SERVICE GREATER THAN LAST DATE
0671 19900101 PCS SERVICE DATE IS GREATER THAN RECEIVED DATE
0672 19900101 PCS MISSING RECIPIENT NUMBER
0673 19900101 SUBMIT PAPER CLAIM
0674 19900101 PCS MISSING TOTAL CLAIM CHARGE
0675 19900101 PCS INVALID TOTAL CLAIM CHARGE
0676 19900101 PCS RECIPIENT NOT ON ELIGIBILITY FILE
0677 19900101 PCS RECIPIENT INELIGIBLE ON DATE OF SERVICE
0678 19900101 PCS ITEMIZED SERVICE DATE NOT IN RECIP ELIG SPAN
0679 19900101 PCS SUSPEND FOR RECIPIENT REVIEW
0680 19900101 PCS PROVIDER IS SUSPENDED
0681 19900101 PROVIDER INELIGIBLE ON DATE OF SERVICE
0682 19900101 PCS REVIEW CLAIM FOR PROVIDER
0683 19900101 EXCEEDS 1 PROCEDURE PER TOOTH
0684 19900101 PCS INVALID PROVIDER NUMBER
0687 19900101 EXCEEDS LIFETIME LIMIT FOR ORTHODONTICS
0688 19900101 EXCEEDS $750 PER FY FOR DENTAL PROCEDURES REQUIRING PRIOR APPROVAL
0691 19900101 PCS-NO UNITS OF SERVICE
0696 19900101 CROSSOVER PART A NOT PAYABLE MEDICALLY NEEDY
0698 19500101 COINSURANCE IS NOT A MULTIPLE OF THE MEDICARE DAILY RATE
0699 19900101 INSTITUTIONAL CROSSOVER TYPE MISSING OR INVALID
0700 19900101 PROCEDURE EXCEEDS LIFETIME LIMITATION
0701 19900101 PHYSICAN SIGNED CONSENT FORM BEFORE STERILIZATION
0702 19900101 DATE OF SURGERY ON CONSENT FORM IS NOT ON CLAIM
0703 19900101 RECIPIENT UNDER 21 WHEN SHE SIGNED CONSENT FORM
0704 19900101 REQUIRES ADDRESS FOR FACILITY FOR STERILIZATION
0705 19900101 STERILIZATION CONSENT FORM IS NOT LEGIBLE
0706 19900101 DATE ON THE CONSENT FORM IS NOT LEGIBLE
0707 19900101 STERILIZATION/HYSTERECTOMY CONSENT FORM IS MISSING
0708 19900101 PATIENT NAME ON CONSENT FORM DOES NOT MATCH CLAIM
0709 19900101 CONSENT LESS THAN 30 DAYS BEFORE STERILIZATION
0710 19900101 CONSENT MORE THAN 180 DAYS BEFORE STERILIZATION
0711 19900101 STERILIZATION CONSENT FORM NOT DATED BY PHYSICIAN
0712 19900101 CONSENT FORM IS NOT SIGNED BY THE RECIPIENT
0713 19900101 CONSENT FORM IS NOT SIGNED BY THE COUNSELOR
0714 19900101 CONSENT FORM DOES NOT HAVE DATE COUNSELOR SIGNED
0715 19900101 STERILIZATION CONSENT FORM IS INCOMPLETE
0716 19900101 HYSTERECTOMY CONSENT FORM REQUIRED
0717 19900101 STERILIZATION CONSENT FORM NOT SIGNED BY PHYSICIAN
0718 19900101 EMERGENCY PROCEDURE CODE IS INVALID/NOT ON FILE
0719 19900101 REFILE CLAIM WITH OPERATIVE REPORT
0720 19900101 INCORRECT RECIPIENT DATE OF BIRTH ON CONSENT FORM
0721 19900101 FURTHER DESCRIPTION OF SERVICE REQUIRED
0722 19900101 STRENGTH AND DOSAGE OF INJECTION MEDICATION REQ
0723 19900101 SERVICES REQ DOCUMENTATION FOR MEDICAL NECESSITY
0724 19900101 REFILE CLAIM WITH CONSULTATION/PROGRESS NOTES
0725 19900101 SERVICE NOT COVERED AS BILLED
0726 19900101 REFERRING PHYSICIAN REQUIRED
0727 19900101 ANOTHER PROVIDER HAS BEEN PAID FOR THESE SERVICES
0728 19900101 SERVICES ARE NOT AUTHORIZED
0729 19900101 DENIED AFTER SPECIAL REVIEW
0730 19900101 HYSTERECTOMY CONSENT FORM SIGNED AFTER SURGERY
0731 19900101 HEALTH CARE AUTHORITY WILL PROCESS CLAIM
0732 19900101 COUNSELOR SIGNED CONSENT FORM PRIOR TO RECIPIENT
0733 19910101 HCBS/ICF FOR SAME OR OVERLAPPING DATES OF SERVICE
0734 19910101 HCBS/INPATIENT HOSPITAL/SNF FOR SAME OR OVERLAPPINNG DATES OF SERVICE
0735 19900101 RECIPIENT INELIGIBLE ON SERVICE DATES
0736 19900101 MODIFIER ADDED/DELETED DUE TO MEDICAL REVIEW
0737 19900101 INVALID MODIFIER FOR THIS PROCEDURE
0738 19900101 INVALID PROCEDURE CODE USE VALID CPT OR HCPC CODE
0739 19900101 ONE AMBULATORY SURGERY ALLOWED PER DAY
0740 19900101 INVALID CODE FOR NARRATIVE DESCRIPTION
0741 19900101 INVALID SUBMITTED CHARGE
0742 19900101 AUTHORIZED PHYSICAL REQUIRES ABCDM-16
0743 19900101 EXCEPTION CODE 743
0744 19900101 AUTHORIZED PHYSICAL DOES NOT MATCH ABCDM-16
0745 19900101 REQUESTED ADDITIONAL INFORMATION NOT RECEIVED
0746 19900101 DENTAL X-RAYS ARE REQUIRED
0747 19900101 SERVICES ARE INCLUDED IN TOTAL PAID OB CARE
0748 19900101 PROCEDURE IS AN INCIDENTAL TO PAID MAJOR SURGERY
0749 19900101 OUTSIDE THE GUIDELINES OF THE MEDICAL PROGRAM
0750 19900101 EXCEEDS SUPPLY LIMIT/1 MONTH WITHIN 12 MONTHS
0751 19900101 EXCEPTION CODE 751
0752 19900101 PER PHY MANUAL-USE 99202 ANTEPART WHEN NOT TOT. OB
0753 19900101 PROCEDURE IS INCIDENTAL MAJOR PROCEDURE ON CLAIM
0754 19900101 REFILE USING ""RECIPIENT AREA"" IN SQ CM
0755 19900101 REFILE CLAIM WITH PROOF OF TIMELY FILING ATTACHED
0756 19900101 EXCEPTION CODE 756
0757 19900101 TAKE HOME MEDICATION IS NOT PAYABLE
0758 19900101 PROVIDER NAME DOES NOT MATCH PROVIDER NUMBER
0759 19900101 NEEDS COUNTY ADMIN AND/OR PROVIDER SIGNATURE
0760 19900101 RECIPIENT IS DECEASED THIS DATE OF SERVICE
0761 19900101 NAME ON SUBMITTED CLAIM DOES NOT MATCH DHS FILE
0762 19900101 FILE AN ASSIGNED MEDICARE CLAIM ON THIS PATIENT
0763 19900101 EXCEEDS MULTI-CHANNEL TEST LIMIT BLOOD ANALYZER CODE REQUIRED
0764 19900101 DUPLICATE OF PAID CLAIM
0765 19900101 INVALID HYSTERECTOMY CONSENT FORM
0766 19900101 STERILIZATION/HYSTERECTOMY CONSENT FORM IS INVALID
0767 19900101 EXCEPTION CODE 767
0768 19900101 REQUEST ADJUSTMENT TO PAID CLAIM-PER MANUAL
0769 19900101 PAYMENT CORRECTED/SPENDDOWN-ADM12-HIST ONLY ADJUST
0770 19900101 INSURANCE PAYMENT MORE THAN ALLOWABLE
0771 19900101 SERVICE NOT PAYABLE THIS DATE OF SERVICE
0772 19900101 TYPE OF BILL-CLAIM CONFLICT
0773 19900101 AUTHORIZED ROOM SERVICES ARE NOT ON CLAIM
0774 19900101 EXCEPTION CODE 774
0775 19900101 CLAIM HAS BEEN FORWARED TO HCA
0777 19900101 SHOW MEDICARE PART B PAYMENTS
0778 19900101 HEALTH CARE AUTHORITY PROCESSED ADM12
0779 19900101 ELIGIBILITY PROBLEM PROCESSED BY DHS
0780 19900101 RESUBMIT WITH APPROPRIATE VALUE CODE AND UNITS
0781 19900101 ANOTHER DDS PAID THIS SERVICE IN PREVIOUS 12 MONTH
0782 19900101 PART OF INPATIENT HOSPITAL CHARGES
0783 19900101 PROCEDURE INCLUDED IN OFFICE CALL
0785 19900101 ANOTHER PHARMACY PAID FOR THIS PRESCRIPTION
0786 19900101 SAME NDC/DATE PAID THIS PHARM
0787 19900101 THERAPEUTIC LEAVE DAYS ARE NON-COVERED
0788 19900101 MAXIMUM OF 60 THERAPEUTIC LEAVE DAYS EXCEEDED FOR FISCAL YEAR
0789 19900101 PROCEDURE NOT APPLICABLE FOR DIAGNOSIS SHOWN
0790 19900101 ABCDM-16/CLAIM PROV CONFLICT
0791 19900101 INVALID DIAGNOSIS FOR DESCRIPTION
0792 19900101 STERILIZATION CONSENT REQUIRED
0793 19900101 SERVICE/SUPPLY INCLUDED IN AMBULANCE TRIP CHARGE
0794 19900101 PAID CLAIM INCLUDED THIS PROCEDURE
0795 19900101 CC MUTUALLY EXCLUSIVE
0796 19900101 PATIENT HAS PRIVATE INSURANCE
0797 19900101 RECIP TB ELIG ONLY-CLAIM REQUIRES TB DIAGNOSIS
0798 19900101 REFILE WITH MEDICARE RECHECK HIC NUMBER
0799 19900101 EXCEPTION CODE 799
0800 19900101 PHARMACY-EXACT DUPLICATE OF ANOTHER CLAIM
0801 19910101 SERVICE NOT ALLOWED DURING INPATIENT/SNF/ICF STAY
0802 19900101 PHARMACY-POSSIBLE CONFLICT OF ANOTHER CLAIM
0803 19900101 DENTAL-EXACT DUPLICATE OF ANOTHER CLAIM
0804 19900101 DENTAL-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0806 19900101 PRACTITIONER-EXACT DUPLICATE OF ANOTHER CLAIM
0807 19900101 PRACTITIONER-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0810 19910101 SNF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0812 19900101 CROSSOVER-EXACT DUPLICATE OF ANOTHER CLAIM
0813 19900101 EXCEPTION CODE 813
0814 19900101 CROSSOVER-POSSIBLE CONFLICT OF ANOTHER CLAIM
0815 19900101 LTC-EXACT DUPLICATE OF ANOTHER CLAIM IN SYSTEM
0816 19900101 LTC-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0820 19910101 INPATIENT/ICF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0821 19900101 PCS-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0822 19900101 EXCEPTION CODE 822
0823 19910101 ICF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0824 19900101 OUTPATIENT-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0826 19900101 HOME HEALTH-EXACT DUPLICATE OF ANOTHER CLAIM
0827 19900101 EXCEPTION CODE 827
0828 19910101 CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0829 19900101 INPATIENT-EXACT DUPLICATE OF ANOTHER CLAIM
0830 19910101 MEDICARE CROSSOVER PREVIOUSLY PAID - BILL PART A MEDICARE
0831 19910101 SNF/HOME HEALTH/DME SERVICE PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0832 19900101 TRANSPORTATION-EXACT DUPLICATE OF ANOTHER CLAIM
0833 19910101 HCBS PREVIOUSLY PROCESSED FOR SAME DATES OF SERVICE
0835 19910101 RECIPIENT IS PART B ELIGIBLE - BILL MEDICARE
0836 19910101 PROFESSIONAL XOVER CONFLICT W/ CMS1500 ENCOUNTERS
0838 19900101 LAB/XRAY-EXACT DUPLICATE OF ANOTHER CLAIM
0839 19900101 LAB/XRAY-POSSIBLE DUPLICATE OF ANOTHER CLAIM
Medicare Managed care - Adjustment Reason Codes
Code Description
01 Notification of Death of Beneficiary
02 Retroactive Enrollment
03 Retroactive Disenrollment
04 Correction to Enrollment Date
05 Correction to Disenrollment Date
06 Correction to Part A Entitlement
07 Retroactive Hospice Status
08 Retroactive ESRD Status
09 Retroactive Institutional Status
10 Retroactive Medicaid Status
11 Retroactive Change to State County Code
12 Date of Death Correction
13 Date of Birth Correction
14 Correction to Sex Code
15 Obsolete
16 Obsolete
17 For APPS use only
18 Part C Rate Change
19 Correction to Part B Entitlement
20 Retroactive Working Aged Status
21 Retroactive NHC Status
22 Disenrolled Due to Prior ESRD
23 Demo Factor Adjustment
24 Obsolete
25 Part C Risk Adj Factor Change/Recon
26 Mid-year Part C Risk Adj Factor Change
27 Retroactive Change to Congestive Heart Failure (CHF) Payment
28 Retroactive Change to BIPA Part B Premium Reduction Amount
29 Retroactive Change to Hospice Rate
30 Retroactive Change to Basic Part D Premium
31 Retroactive Change to Part D Low Income Status
32 Retroactive Change to Estimated Cost-Sharing Amount
33 Retroactive Change to Estimated Reinsurance Amount
34 Retroactive Change Basic Part C Premium
35 Retroactive Change to Rebate Amount
36 Part D Rate Change
37 Part D Risk Adjustment Factor Change
38 Part C Segment ID Change
41 Part D Risk Adjustment Factor Change (ongoing)
42 Retroactive MSP Status
44 Retroactive correction of previously failed Payment (affects Part C and D)
45 Disenroll for Failure to Pay Part D IRMAA Premium – Reported for Pt C and Pt D
46 Correction of Part D Eligibility – Reported for Pt D
50 Payment adjustment due to Beneficiary Merge
60 Part C Payment Adjustments created as a result of the RAS overpayment file processing
61 Part D Payment Adjustments created as a result of the RAS overpayment file processing
65 Confirmed Incarceration – Reported for Pt C and Pt D
66 Not Lawfully Present
90 System of Record History Alignment
94 Special Payment Adjustment Due to Clean-Up
Full list of Denial code.
https://www.lamedicaid.com/provweb1/Forms/Error_Code/ERROR_CODE.pdf
1 Deductible Amount
2 Coinsurance Amount
3 Co-payment Amount
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
5 The procedure code/bill type is inconsistent with the place of service.
6 The procedure/revenue code is inconsistent with the patient's age.
7 The procedure/revenue code is inconsistent with the patient's gender.
8 The procedure code is inconsistent with the provider type/specialty (taxonomy).
9 The diagnosis is inconsistent with the patient's age.
10 The diagnosis is inconsistent with the patient's gender.
11 The diagnosis is inconsistent with the procedure.
12 The diagnosis is inconsistent with the provider type.
13 The date of death precedes the date of service.
14 The date of birth follows the date of service.
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate Note: Changed as of 2/02
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate.
Note: Changed as of 2/02
18 Duplicate claim/service.
19 Claim denied because this is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.
20 Claim denied because this injury/illness is covered by the liability carrier.
21 Claim denied because this injury/illness is the liability of the no-fault carrier.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments
and/or adjustments
24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.
25 Payment denied. Your Stop loss deductible has not been met.
26 Expenses incurred prior to coverage.
27 Expenses incurred after coverage terminated.
28 Coverage not in effect at the time the service was provided. Note: Inactive for 004010, since 6/98. Redundant to codes 26&27.
29 The time limit for filing has expired.
30 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Note: Changed as of 2/01. This code will be deactivated on 2/1/2006.
31 Claim denied as patient cannot be identified as our insured.
32 Our records indicate that this dependent is not an eligible dependent as defined.
33 Claim denied. Insured has no dependent coverage.
34 Claim denied. Insured has no coverage for newborns.
35 Lifetime benefit maximum has been reached.
Note: Changed as of 10/02
36 Balance does not exceed co-payment amount.
Note: Inactive for 003040
37 Balance does not exceed deductible.
Note: Inactive for 003040
38 Services not provided or authorized by designated (network/primary care) providers.
Note: Changed as of 6/03
39 Services denied at the time authorization/pre-certification was requested.
40 Charges do not meet qualifications for emergent/urgent care.
41 Discount agreed to in Preferred Provider contract.
Note: Inactive for 003040
42 Charges exceed our fee schedule or maximum allowable amount.
43 Gramm-Rudman reduction.
44 Prompt-pay discount.
45 Charges exceed your contracted/ legislated fee arrangement.
46 This (these) service(s) is (are) not covered.
Note: Inactive for 004010, since 6/00. Use code 96.
47 This (these) diagnosis(es) is (are) not covered, missing, or are invalid.
Note: Changed as of 6/00. This code will be deactivated on 2/1/2006.
48 This (these) procedure(s) is (are) not covered.
Note: Inactive for 004010, since 6/00. Use code 96.
49 These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.
50 These are non-covered services because this is not deemed a `medical necessity' by the payer.
51 These are non-covered services because this is a pre-existing condition
52 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
Note: Changed as of 10/98. This code will be deactivated on 2/1/2006.
53 Services by an immediate relative or a member of the same household are not covered.
54 Multiple physicians/assistants are not covered in this case .
55 Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer.
56 Claim/service denied because procedure/treatment has not been deemed `proven to
be effective' by the payer.
57 Payment denied/reduced because the payer deems the information submitted does not
support this level of service, this many services, this length of service, this dosage, or
this day's supply.
Note: Inactive for 004050. Split into codes 150, 151, 152, 153 and 154.
58 Payment adjusted because treatment was deemed by the payer to have been rendered
in an inappropriate or invalid place of service.
Note: Changed as of 2/01
59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules.
Note: Changed as of 6/00
60 Charges for outpatient services with this proximity to inpatient services are not
covered.
61 Charges adjusted as penalty for failure to obtain second surgical opinion.
Note: Changed as of 6/00
62 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.
Note: Changed as of 2/01
63 Correction to a prior claim.
Note: Inactive for 003040
64 Denial reversed per Medical Review.
Note: Inactive for 003040
65 Procedure code was incorrect. This payment reflects the correct code.
66 Blood Deductible.
67 Lifetime reserve days. (Handled in QTY, QTY01=LA)
Note: Inactive for 003040
68 DRG weight. (Handled in CLP12)
Note: Inactive for 003040
69 Day outlier amount.
70 Cost outlier - Adjustment to compensate for additional costs.
Note: Changed as of 6/01
71 Primary Payer amount.
Note: Deleted as of 6/00. Use code 23.
72 Coinsurance day. (Handled in QTY, QTY01=CD)
Note: Inactive for 003040
73 Administrative days.
Note: Inactive for 003050
74 Indirect Medical Education Adjustment.
75 Direct Medical Education Adjustment.
76 Disproportionate Share Adjustment.
77 Covered days. (Handled in QTY, QTY01=CA)
Note: Inactive for 003040
78 Non-Covered days/Room charge adjustment.
79 Cost Report days. (Handled in MIA15)
Note: Inactive for 003050
80 Outlier days. (Handled in QTY, QTY01=OU)
Note: Inactive for 003050
81 Discharges.
Note: Inactive for 003040
82 PIP days.
Note: Inactive for 003040
83 Total visits.
Note: Inactive for 003040
84 Capital Adjustment. (Handled in MIA)
Note: Inactive for 003050
85 Interest amount.
86 Statutory Adjustment.
Note: Inactive for 004010, since 6/98. Duplicative of code 45.
87 Transfer amount.
88 Adjustment amount represents collection against receivable created in prior overpayment.
Note: Inactive for 004050.
89 Professional fees removed from charges.
90 Ingredient cost adjustment.
91 Dispensing fee adjustment.
92 Claim Paid in full.
Note: Inactive for 003040
93 No Claim level Adjustments.
Note: Inactive for 004010, since 2/99. In 004010, CAS at the claim level is optional.
94 Processed in Excess of charges.
95 Benefits adjusted. Plan procedures not followed. Note: Changed as of 6/00
96 Non-covered charge(s).
97 Payment is included in the allowance for another service/procedure. Note: Changed as of 2/99
98 The hospital must file the Medicare claim for this inpatient non-physician service. Note: Inactive for 003040
99 Medicare Secondary Payer Adjustment Amount. Note: Inactive for 003040
100 Payment made to patient/insured/responsible party.
101 Predetermination: anticipated payment upon completion of services or claim adjudication. Note: Changed as of 2/99
102 Major Medical Adjustment.
103 Provider promotional discount (e.g., Senior citizen discount).
Note: Changed as of 6/01
104 Managed care withholding.
105 Tax withholding.
106 Patient payment option/election not in effect.
107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Note: Changed as of 6/03
108 Payment adjusted because rent/purchase guidelines were not met. Note: Changed as of 6/02
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
110 Billing date predates service date.
111 Not covered unless the provider accepts assignment.
112 Payment adjusted as not furnished directly to the patient and/or not documented.
Note: Changed as of 2/01
113 Payment denied because service/procedure was provided outside the United States or
as a result of war. Note: Changed as of 2/01; Inactive for version 004060. Use Codes 157, 158 or 159.
114 Procedure/product not approved by the Food and Drug Administration.
115 Payment adjusted as procedure postponed or canceled. Note: Changed as of 2/01
116 Payment denied. The advance indemnification notice signed by the patient did not
comply with requirements. Note: Changed as of 2/01
117 Payment adjusted because transportation is only covered to the closest facility that can provide the necessary care. Note: Changed as of 2/01
118 Charges reduced for ESRD network support.
119 Benefit maximum for this time period or occurrence has been reached. Note: Changed as of 2/04
120 Patient is covered by a managed care plan. Note: Inactive for 004030, since 6/99. Use code 24.
121 Indemnification adjustment.
122 Psychiatric reduction.
123 Payer refund due to overpayment.
Note: Inactive for 004030, since 6/99. Refer to implementation guide for proper handling of reversals.
124 Payer refund amount - not our patient. Note: Inactive for 004030, since 6/99. Refer to implementation guide for proper handling of reversals.
125 Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate.
Note: Changed as of 2/02
126 Deductible -- Major Medical
Note: New as of 2/97
127 Coinsurance -- Major Medical
Note: New as of 2/97
128 Newborn's services are covered in the mother's Allowance. Note: New as of 2/97
Alabama Medicaid Denial codes.
Explanation of Benefit (EOB) Codes EOB CODE EOB DESCRIPTION HIPAA ADJUSTMENT REASON CODE HIPAA REMARK CODE
201 INVALID PAY-TO PROVIDER NUMBER 125 N280
202 BILLING PROVIDER ID IN INVALID FORMAT 125 N257
203 RECIPIENT I.D. NUMBER MISSING 31 N382
206 PRESCRIBING PROVIDER NUMBER NOT IN VALID FORMAT 16 N31
210 BRAND MEDICALLY NECESSARY INDICATOR INVALID 125
211 INVALID REFILL INDICATOR VALUE 16
212 MISSING PRESCRIPTION NUMBER 16 N388
215 DATE DISPENSED IS MISSING 16 N304
216 DATE DISPENSED IS INVALID 16 N304
217 MISSING DRUG CODE 16 M119
218 INVALID DRUG CODE 16 M119
219 QUANTITY DISPENSED IS MISSING 16 N378
220 QUANTITY DISPENSED IS INVALID 16 N378
223 MISSING DIAGNOSIS INDICATOR 16 M76
224 DIAGNOSIS TREATMENT INDICATOR INVALID 16 M76
225 REFERRING PROVIDER - INVALID FORMAT 16 N286
226 ANESTHESIA CLAIMS REQUIRE REFERRING PROVIDER 16 N286
228 CLAIMANT SIGNATURE MISSING 16 MA75
229 SOURCE OF ADMISSION MISSING 16 MA42
230 MISSING ATTENDING SURGEON PRESCRIBER NUMBER 16 N262
231 CLAIM WAS FILED WITHOUT SERVICING PROVIDER 16 N290
233 UNITS OF SERVICE MISSING 16 M53
234 PROCEDURE CODE MISSING 16 M51
235 PROCEDURE CODE NOT IN VALID FORMAT 16 M51
238 RECIPIENT NAME IS MISSING 16 MA36
239 DETAIL TO DATE OF SERVICE IS MISSING 16 M59
240 THE DETAIL "TO" DATE IS INVALID 16 M59
For Full list, go to the below Medicaid site.
http://medicaid.alabama.gov/documents/6.0_providers/6.7_manuals/6.7.2_provider_manuals_2010/6.7.2.1_january_2010/6.7.2.1_jan10_j.pdf
Top 50 Billing Error Reason Codes With Common Resolutions
On the following Link you will find the top 50 Error Reason Codes with Common Resolutions for denied claims at Virginia Medicaid. This list has been provided to assist you with resolving these denied claims prior to calling the Helpline. Please print and post this list within your office for easy reference and use. Whenever you are advised to contact the Helpline or MediCall please access the following telephone numbers.
http://www.dmas.virginia.gov/Content_atchs/cb/cb6.pdf
LOUISIANA MEDICAID Denial Code
ERROR CORE SHORT DESCRIPTION LONG DESCRIPTION GRP RSN CODE CODE CLAIM STATUS ADJ REMARK CODE
----------------------------------------------------------------------------------------------------------------------------------
001 INVALID CLM TYP MOD INVALID CLAIM TYPE MODIFIER 2 16 N34 021
002 INVALID PROVIDER NO PROVIDER NUMBER MISSING OR NOT NUMERIC 2 16 N77 021 153
003 RECIPIENT # INVALID RECIPIENT NUMBER INVALID OR LESS THAN 13 DIGITS 3 31 021 153
005 INVAL SERV FROM DATE SERVICE FROM DATE MISSING/INVALID 2 16 M52 021 188
006 INVAL SERV THRU DATE INVALID OR MISSING THRU DATE 2 16 M59 021 188
007 SERV THRU LT SERV FM SERVICE THRU DATE LESS THAN SERVICE FROM DATE 2 16 MA31 021 188
008 SERV FRM GT ENTR DTE SERVICE FROM DATE LATER THAN DATE PROCESSED 2 110 021 188
009 SERV THR GT ENTR DTE SERVICE THRU DATE GREATER THAN DATE OF ENTRY 2 16 MA31 021 188
010 INV PRIOR AUTH DATE PRIOR AUTHORIZATION DATE NOT NUMERIC 133 252
011 INVALID TPL INDICATR TPL INDICATOR NOT Y, N, OR SPACE 2 16 MA92 021 361
012 ORG CLM W/ADJ/VD CDE ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID REASON CODE 2 16 MA30 021 521
013 ORG CLM W ADJ/VD ICN ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID ICN 2 16 MA30 021 584
014 IMM COMPL MISS/INVLD IMMUN COMPLETE AND CURRENT FOR THIS AGE PATIENT MISSING 133 021 331 564
015 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 N305 365
016 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 N305 365
017 NOT USED - AVAILABLE NOT USED - AVAILABLE 133 021 564
020 INVAL/MISS DIAG CODE INVALID OR MISSING DIAGNOSIS CODE 2 16 MA63 255
021 INVALID FORMER REFNO FORMER REFERENCE NUMBER MISSING OR INVALID 2 16 M47 464
022 INVALID BILLED CHRGS BILLED CHARGES MISSING OR NOT NUMERIC 2 16 M79 178
023 INV PARTIAL RECIP RECIPIENT NAME IS MISSING 2 16 MA36 021 504
024 INV BILLING PROV NO BILLING PROVIDER NUMBER NOT NUMERIC 2 16 N257 021 153
025 IMM NOT COMP RSN MIS IMMUN NOT COMPLETE AND CURRENT REASON CODE MISSING 133 021 331 564
026 INVALID TOT DOC CHG TOTAL DOCUMENT CHARGE MISSING OR NOT NUMERIC 2 16 M54 178
027 PROC NEEDS DOCUMENT. PROCEDURE CODE NOT SUBSTANTIATED BY DOCUMENT 3 150 294 287
028 INVAL/MISS PROC CODE INVALID OR MISSING PROCEDURE CODE 2 16 M51 454
029 SERV MORE THAN 12 MO SERVICE MORE THAN 12 MONTHS OLD 3 29 263
030 SERV THRU DT TOO OLD SERV THRU DATE MORE THAN TWO YEARS OLD 3 29 187
031 NOT EMC ELIGIBLE PROVIDER NOT APPROVED FOR EMC BY STATE OFS 3 95 496
032 EOB/CARR.CD MISMATCH EOB(S) ATTACHED/CARRIER CODE DOES NOT MATCH 1 251 N4 286
033 NEED EOB-CARR/RECIP. NEED EOB FOR EACH CARRIER INDICATED ON RESOURCE FILE 1 251 N4 286
034 22 MOD.NOT JUSTIFIED 22 MOD.SERVICES NOT JUSTIFIED/PAID AT UNMODIFIED RATE 3 150 047
035 REBILL CORRECT HCPC ASC,OP FAC/PHYS.BILLED DIFF CODE;REBILL CORRECT HCPC 2 16 M20 454
037 MEDICARE ADJUSTMENT MEDICARE ADJUSTMENT/VOID,ADJUST OR ADJUST MEDICARE CLAI 1 252 N4 101
038 99297-52 NICU REDUCE 99297-52 NICU PAID AT REDUCED RATE 3 150 628
039 MOD.NOT USED FOR CLM MODIFIER NOT USED TO PROCESS CLAIM 2 4 N519 453
040 INV ADMISSION DATE ADMISSION DATE MISSING OR INVALID 2 16 MA40 189
042 INVALID UB92 BILL CD INVALID UB92 TYPE BILL CODE 2 16 MA30 228
043 INV ATTENDING PHYS ATTENDING PHYSICIAN NUMBER NOT NUMERIC 2 16 N290 132
044 INV NATURE OF ADMIT NATURE OF ADMISSION MISSING OR INVALID 2 16 MA41 231
045 INV PATIENT STATUS PATIENT STATUS CODE INVALID OR MISSING 2 16 MA43 021 431
046 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 M59 021 387
047 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 M59 021 387
048 INVALID/MISS PROC INVALID OR MISSING PROCEDURE CODE 2 16 M51 021 454
049 INV/CONFLIC SURG DTE INVALID/CONFLICT SURGICAL DATE 2 16 N301 021 666
050 INV BLOOD NOT REPL BLOOD NOT REPLACED AMOUNT INVALID 133 021 236
051 INV BLOOD/PINT CHG BLOOD CHARGE PER PINT INVALID 133 021 235
052 >12 MONTH QTY LIMIT > 12 MONTH QTY LIMIT MD FAX OVERRIDE FORM 866-797-2329 3 198 N351
EOB EFFDATE EOB DESCRIPTION
---- ---------- -------------------------------------------------------------------------------
0001 19910101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON SOME DATES OF SERVICE
0002 19900101 BILLING PROVIDER NUMBER MISSING OR INVALID
0003 19900101 RECIPIENT NUMBER MISSING OR INVALID
0004 19900101 PROCEDURE INCLUDED IN COMBINED PROCEDURE
0005 19900101 DOCUMENT CONTROL NUMBER IS MISSING OR INVALID
0006 19900101 SERVICE FROM DATE IS MISSING OR INVALID
0007 19900101 SERVICE THRU DATE IS MISSING OR INVALID
0008 19900101 SERVICE "TO" DATE LESS THAN SERVICE "FROM" DATE
0009 19900101 EXCEEDS ONE B-12 INJECTION MONTHLY
0010 19900101 SERVICE DATE GREATER THAN DATE OF RECEIPT
0011 19900101 MATERNITY CLINIC/PHY CONFLICT FOR PRENATAL SERVICE
0012 19900101 TOTAL TPL AMOUNT IS INVALID
0013 19910101 TPL INDICATOR/AMOUNT CONFLICT
0014 19900101 RELATED CAUSE CODE IS INVALID
0015 19900101 ACCIDENT INDICATOR IS INVALID
0016 19900101 FROM DATE OF SERVICE LESS THAN JULY 1, 1996
0017 19910101 PROVIDER SPECIALTY MISMATCH
0018 19900101 DIAGNOSIS CODE IS MISSING OR INVALID
0019 19900101 MUST SPECIFY QUADRANT(Q1,Q2,Q3,Q4)
0020 19900101 YEARLY LIMIT FOR EYE GLASSES EXCEEDED
0021 19900101 MCO/BHO FORMER ICN NON-MATCH FOR VOID/ADJUSTMENT
0022 19900101 BILLED CHARGES MISSING OR INVALID
0023 19900101 PATIENT NAME IS MISSING
0024 19900101 UNITS OF SERVICE OR DAYS COVERED MISSING OR INVALID
0025 19900101 THE UNITS OF SERVICE ARE LESS THAN DAYS BILLED
0026 19900101 EXCEEDS EPSDT CLINIC LIMITS
0027 19900101 EXCEEDS OB ULTRASOUND LIMIT FOR 9 MONTHS
0028 19900101 PROCEDURE CODE OR NDC IS MISSING OR INVALID
0029 19900101 ATTENDING PHYSICIAN/DMRS FACILITY INVALID OR MISSING
0030 19900101 SAME SERV WITH 91/92 HCPC HAS BEEN PAID THIS DATE
0031 19900101 EXCEPTION CODE 031
0032 19900101 MAXIMUM RENTAL PAYMENT
0033 19900101 NO VALID INDEX RATE ON FILE FOR ASC PROVIDER
0034 19900101 SERVICE DATE GREATER THAN DATE OF SYS GEN ICN
0035 19900101 THE 2 PHY VISIT PER MONTH LIMIT HAS BEEN EXCEEDED
0036 19900101 ADD'L HOURS OF TESTING REQUIRE PRIOR AUTHORIZATION
0037 19900101 MAXIMUM PAYMENT MADE
0038 19900101 EXCEEDS OXYGEN LIMITSONE PER MONTH
0039 19910101 FORMER ICN OR MCC ICN IS NOT FOUND FOR VOID/REPLACEMENT
0040 19900101 TOTAL CALCULATED NON-COVERED CHARGES NOT EQUAL TOTAL AS REPORTED
0041 19910101 ACCOMODATION REVENUE CODES NOT ALLOWED
0042 19900101 REVENUE CHARGE MISSING OR INVALID
0043 19900101 ADMISSION DATE INVALID OR MISSING
0044 19900101 PATIENT STATUS CODE IS MISSING OR INVALID
0045 19900101 SURGERY DATE IS INVALID/MISSING
0046 19900101 COVERED DAYS AND FROM/THRU DAYS ARE NOT EQUAL.
0047 19900101 COVERED DAYS ARE MISSING OR INVALID
0048 19900101 REVENUE CODE IS MISSING OR INVALID
0049 19900101 SOURCE OF ADMISSION IS INVALID OR MISSING
0050 19900101 EXCEPTION CODE 050
0051 19900101 ACCOMMODATION DAYS DO NOT EQUAL TOTAL COVERED DAYS
0052 19900101 HOUR OF ADMISSION IS INVALID OR MISSING
0053 19900101 DATE OF DISCHARGE IS INVALID OR MISSING
0054 19900101 ADMITTING PHYSICIAN INVALID OR MISSING
0055 19900101 TIME OF DISCHARGE IS INVALID OR MISSING
0056 19900101 TYPE OF BILL IS INVALID OR MISSING
0057 19900101 TYPE OF ADMISSION IS INVALID OR MISSING
0058 19900101 INVALID CONDITION CODE
0059 19900101 INVALID NON-COVERED DAYS
0060 19900101 EXCEPTION CODE 060
0061 19900101 OCCURRENCE CODE/DATE IS MISSING OR INVALID
0062 19900101 EXCEPTION CODE 062
0063 19900101 EXCEPTION CODE 063
0064 19900101 EXCEPTION CODE 064
0065 19900101 ACCOMMODATION REVENUE CODE NOT ENTERED FIRST
0066 19900101 EXCEPTION CODE 066
0067 19900101 REVENUE UNITS/MILEAGE ARE INVALID OR MISSING
0068 19900101 TOTAL CHARGE IS MISSING OR INVALID
0069 19900101 DATE OF BIRTH INVALID OR MISSING
0070 19910101 PAID DATE IS INVALID OR MISSING
0071 19900101 PATIENT SEX NOT EQUAL M OR F OR U
0072 19900101 PREVIOUSLY PAID VISUAL EXAM IN 12 MONTHS
0073 19910101 INPATIENT PART B ONLY CHARGE MISSING
0074 19900101 SERVICES NOT COVERED FOR QMB/SLMB RECIPIENTS
0075 19900101 EXCEPTION CODE 075
0076 19900101 EXCEEDS YEARLY FAMILY PLANNING EXAM LIMIT
0077 19900101 MEDICARE CROSSOVER - BILL TENNCARE DIRECTLY
0078 19900101 PREVIOUSLY PAID ONE VISIT ON THIS DAY
0079 19900101 PAY STATUS NOT EQUAL TO PAY OR DENY
0080 19900101 PREVIOUSLY PAID AUDITORY EXAM IN 12 MONTHS
0081 19900101 CHILDRENS DAYS EXCEEDED
0082 19900101 CHILDRENS DAYS EXHAUSTED
0083 19900101 CHILDRENS VISITS EXCEEDED
0084 19900101 CHILDRENS VISITS EXHAUSTED
0085 19900101 CHILDREN DAYS EXCEEDED FOR FISCAL YEAR PA REQUIRED
0086 19900101 CHILDREN DAYS EXCEEDED FOR FISCAL YEAR PA REQUIRED
0087 19910101 HOSPITAL PAYMENTS NOT ALLWED FOR PRESUMPTIVE ELIGIBLES
0088 19900101 EXCEPTION CODE 088
0089 19900101 EXCEPTION CODE 089
0090 19900101 PCS - 1500
0092 19900101 ALIEN-NO REQUEST FOR AUTHORIZATION RECEIVED
0094 19910101 EMERGENCY TREATMENT CODE NOT BILLED
0095 19900101 ANESTHESIA-INVALID OR EXCESSIVE HOURS/MINUTES
0096 19000101 NON-COVERED DAYS CANNOT BE PAID
0098 19900101 HCBW WAIVER HAS DENY/SUSPEND EDIT
0099 19910101 PHARMACIST LICENSE NUMBER MISSING OR INVALID
0100 19900101 KEYING VERIFICATION
0101 19900101 ADP WAIVER HAS DENY/SUSP EDIT
0103 19910101 PLACE OF SERVICE MISSING OR INVALID
0104 19900101 PROCEDURE CODE MODIFIER IS MISSING OR INVALID
0105 19900101 INVALID DIAGNOSIS FOR PROCEDURE
0106 19910101 FAMILY PLANNING CLINIC CODE IS INVALID OR MISSING
0107 19900101 DMRS FACILITY INVALID/MISSING/NOT ELIGIBLE ON DOS
0112 19900101 MISSING TOTAL CHARGE FOR NURSING HOME CLAIMS
0114 19900101 OUTPT HSP PRIOR TO 12/01/99-SUSPEND FOR REVIEW
0117 19900101 INVALID OR MISSING TOOTH CODE OR TOOTH NUMBER
0118 19900101 INVALID SURFACE CODE
0119 19900101 INVALID EMERGENCY INDICATOR
0120 19900101 VISIT PAID IN NORMAL SURGERY FOLLOW-UP PERIOD
0121 19900101 PRESCRIBING PHYSICIAN DEA NUMBER MISSING OR INVALID
0122 19900101 INVALID/MISSING PROVIDER CHECK-DIGIT NUMBER
0123 19900101 NATIONAL DRUG UNITS ARE MISSING OR INVALID
0124 19900101 MISSING FIRST DATE OF SERVICE ON CLAIM
0125 19900101 PRESCRIPTION NUMBER MISSING
0126 19900101 FIRST DATE OF SERV GREATER THAN LAST DATE OF SERV
0127 19900101 ESTIMATED DAYS SUPPLY INVALID
0128 19900101 REFILL CODE MUST BE 00 THROUGH 99
0130 19900101 MCO/BHO TOTAL ALLOWED AMOUNT INVALID
0131 19900101 UNITS EXCEED PROGRAM MAXIMUM FOR HCBS CODE
0132 19900101 MISSING TOTAL CLAIM CHARGE
0133 19900101 INVALID TOTAL CLAIM CHARGE
0134 19900101 INVALID NET CLAIM CHARGE
0136 19900101 REVENUE CODE IS INVALID/NOT ON FILE
0138 19900101 INVALID HCBS TYPE-2 FACILITY NUMBER
0140 19900101 HCPC CODE IS INVALID FOR REVENUE CODE
0142 19900201 1 YR TIMELY FILE HAS BEEN OVERRIDDEN-TF ATTACHED
0143 19900101 REFILLS EXHAUSTED
0144 19900101 INVALID REFILL INDICATOR VALUE
0146 19900101 HCPC/REVENUE CODE MISSING
0148 19900101 PROCEDURE NOT PAYABLE THIS RECIPIENT
0149 19900101 PROC REQUIRES REVIEW FOR RECIPIENT
0150 19900101 MCO/BHO TOTAL PAYMENT IS INVALID OR MISSING
0151 19900101 MISSING PRESCRIBING PROVIDER NUMBER
0152 19900101 MISSING DRUG CODE
0153 19900101 INVALID DRUG CODE
0154 19900101 MISSING PRESCRIPTION NUMBER
0155 19910101 THRU DATE DISAGREES WITH PATIENT STATUS
0156 19900101 MISSING DAYS SUPPLY
0157 19900101 COVERED + NON-COVERED DAYS DOES NOT EQUAL TOTAL DAYS/UNITS BILLED
0158 19900101 ADMIT DATE GREATER THAN FROM DOS
0159 19910101 CLAIM PREVIOUSLY DENIED FOR INVALID PROCEDURE
0160 19900101 ADMIT DATE IS INVALID
0161 19900101 ADMISSION CODE INVALID
0162 19900101 DETAIL SVC DATES INCONSISTENT WITH HEADER DATES
0163 19900101 MISSING DIAGNOSIS CODE
0165 19900101 TOTAL DAYS MISSING OR INVALID
0167 19900101 PATIENT STATUS INVALID OR MISSING
0168 19900101 THERAPEUTIC LEAVE DAYS INVALID
0169 19900101 HOSPITAL LEAVE DAYS INVALID
0170 19910101 NON-COVERED DAYS INVALID
0171 19900101 PHYSICIAN CERTIFICATION DATE IS MISSING OR INVALID
0172 19900101 PHYSICIAN VISIT DATE IS INVALID OR MISSING
0173 19900101 TIME OF DEATH IS INVALID OR MISSING
0174 19910101 VOID PER POLICY REVIEW
0175 19910101 INVALID COVERED DAYS
0176 19910101 INVALID CHARGE BILLED TO MEDICARE
0177 19900101 MEDICARE ALLOWED AMOUNT INVALID OR MISSING
0178 19900101 MEDICARE PAID AMOUNT IS NOT NUMERIC
0179 19900101 DEDUCTIBLE AMOUNT IS MISSING OR INVALID
0180 19900101 BLOOD DEDUCTIBLE AMOUNT INVALID
0181 19900101 COINSURANCE AMOUNT IS MISSING OR INVALID
0182 19900101 PART-A COINSURANCE GREATER MEDICARE PAID AMT
0183 19900101 CASH DEDUCT+ BLOOD DEDUCT+ COINSURANCE MUST NOT EXCEED (MEDICARE ALLOWED - MEDI
0184 19900101 MEDICARE PAID DATE IS AFTER THE ICN DATE
0185 19900101 MEDICARE PAID DATE MISSING OR INVALID
0186 19910101 CROSSOVER CLAIM BILLED INCORRECTLY
0187 19900101 PROCEDURE NOT PAYABLE THIS RECIPIENT
0188 19900101 DIAGNOSIS CODE NOT COVERED BY MEDICAID FOR DATE OF SERVICE
0189 19900101 PROCEDURE REQUIRES MEDICAL REVIEW
0190 19910101 EXCEEDS ALLOWED AMOUNT FOR CALENDAR YEAR
0191 19900101 REIMBURSEMENT REFLECTS LESS THAN A FULL WEEK FOR MEGAVOLTAGE TREATMENT
0192 19900101 TOTAL DAYS ON CLAIM CONFLICT WITH DATES SHOWN
0193 19910101 NO HCBS CODE ENTERED
0194 19900101 AGE IS NOT COVERED INPATIENT PSYCHIATRIC SERVICES
0196 19900101 MISSING ADMISSION DATE
0198 19900101 MISSING ATTENDING SURGEON PRESCRIBER NUMBER
0199 19900101 REFERRING PROVIDER CANNOT BE BILLING PROVIDER
0200 19910101 PROVIDER NOT ON FILE
0201 19900101 PROCEDURE CODE IS NOT IN THE SCOPE OF PROGRAM
0202 19900101 PROVIDER INELIGIBILE FOR SUBMITTING THIS CLAIM TYPE
0203 19900101 PROVIDER NAME/NUMBER MISMATCH
0204 19900101 REBILL FOR PROVIDER ELIGIBLE DAYS ONLY
0205 19900101 PATIENT NOT CERTIFIED
0206 19910101 DATE OF SERVICE SPAN PROVIDER FISCAL YEAR
0207 19900101 RENDERING PROVIDER ON PREPAYMENT REVIEW
0208 19900101 BILLING PROVIDER IS AN OUT OF STATE PROVIDER
0209 19900101 INVALID DESTINATION
0210 19900101 FACILITY PROVIDER SERVICE LOCATION IS MISSING
0211 19900101 SERVICING PROVIDER MISSING/INVALID OR NOT DIFFERENT FROM BILLING PROVIDER
0212 19910101 SERVICING PROVIDER NOT ON FILE
0213 19000101 PREGNANCY INDICATOR INVALID
0214 19910101 ENROLLEE NOT ELIGIBLE FOR MCC/BHO ON DATES OF SERVICE
0215 19910101 MEDICAID RECORDS INDICATE THAT THIS RECIPIENT HAS NOT BEEN APPROVED FOR MEDICAI
0216 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID
0217 19910101 RECIPIENT NOT ELIGIBLE ON DATES OF SERVICE-ATTACHMENT PRESENT
0218 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON DATE(S) OF SERVICE
0219 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON SOME DATES OF SERVICE
0220 19910101 RECIPIENT NOT ELIGIBLE FOR SOME DATES OF SERVICE
0221 19900110 RECIPIENT NAME MISMATCH - ATTACHMENT PRESENT
0222 19900101 RECIPIENT NAME DOES NOT MATCH TENNCARE NUMBER
0223 19910101 RECIPIENT NOT ELIGIBLE FOR DATES OF SERVICE - RECYCLED
0224 19900101 INVALID OCCURRENCE DATE
0225 19900101 RECIPIENT DATE OF DEATH IS PRIOR TO DATE OF SERVICE
0226 19900101 RECIPIENT ON REVIEW
0227 19900101 EXCEPTION CODE 227
0228 19900101 MISSING MEDICARE PAID DATE
0229 19900101 RECIPIENT MEDICAID PLUS MEMBER. CONTACT PHYS ON ID CARD FOR APPROVAL
0230 19900101 NO CROSSOVER COINSURANCE OR DEDUCTIBLE DUE
0231 19910101 PROVIDER PROCEDURE RESTRICTIONS
0232 19900101 PROCEDURE/MODIFIER OR DRUG CODE NOT ON PROCEDURE/FORMULARY FILE
0233 19900101 PROCEDURE/NDC NOT COVERED BY MEDICAID FOR DATE OF SERVICE
0234 19900101 PROCEDURE/FORMULARY AGE RESTRICTION
0235 19900101 PROCEDURE/FORMULARY SEX RESTRICTION
0236 19900101 PROCEDURE/FORMULARY PLACE OF SERVICE RESTRICTION
0237 19900101 PROCEDURE/FORMULARY PROVIDER SPECIALTY RESTRICTION
0238 19900101 ITEMIZED SERVICE DATE NOT IN ELIGIBILITY SPAN
0239 19900101 INVALID OCCURRENCE SPAN CODE
0240 19900101 PROCEDURE/FORMULARY DIAGNOSIS RESTRICTION
0241 19900101 PRICING FILE HAS NO VALID PRICE OR PERCENTAGE OR PER DIEM FOR DOS
0242 19900101 MISSING OCCURRENCE CODE
0243 19910101 PROVIDER NOT CERTIFIED FOR PROCEDURE
0244 19900101 INVALID PAY-TO PROVIDER NUMBER
0251 19910101 RECIPIENT HAS THIRD PARTY RESOURCES - ATTACHMENT PRESENT
0252 19910101 ADMITTING DIANOSIS CODE IS INVALID/NOT ON FILE
0253 19900101 DIAGNOSIS DATE RESTRICTION
0254 19900101 DIAGNOSIS AGE RESTRICTION
0255 19900101 DIAGNOSIS SEX RESTRICTION
0256 19900101 DIAGNOSIS FILE PROCEDURE RESTRICTION
0257 19900101 THIS DIAGNOSIS REQUIRES MEDICAL REVIEW
0258 19900101 RECIPIENT IS NOT ON ELIGIBILITY FILE
0259 19900101 CROSSOVER CLAIM EXCEEDS FILING TIME LIMIT - RESUBMIT WITH PROOF OF TIMELY FILIN
0260 19900101 SLIMB ONLY/NO MEDICAL ELIGIBILITY
0261 19900101 CATEGORY OF SERVICE CANNOT BE DERIVED
0262 19910101 TPL AMOUNT APPEARS TO BE INSUFFICIENT. PLEASE VERIFY
0263 19900101 TPL - RECIPIENT HAS THIRD PARTY RESOURCES
0264 19900101 RECIP IS MEDICARE PART A ELIGIBLE
0265 19900101 RECIP IS MEDICARE PART B ELIGIBLE
0266 19900101 REFERRING PHYSICIAN NUMBER IS MISSING
0267 19000101 HOSPICE XOVER CLAIM SUPER-SUSPEND FOR REVIEW
0268 19900101 CLAIM EXCEEDS FILING TIME LIMIT- RESUBMIT WITH PROOF OF TIMELY FILING
0269 19900101 CLAIM SPANS CALENDAR YEAR
0270 19900101 CLAIM SPANS STATE FISCAL YEAR
0271 19900101 RECIPIENT IS NOT ELIGIBLE ON SERVICE DATE
0272 19900101 ITEMIZED SERVICE DATE NOT IN ELIGIBILITY SPAN
0273 19900101 SUSPENDED FOR RECIPIENT REVIEW
0274 19910101 TOTAL BILLED NOT EQUAL SUM OF ALL LINE CHARGES
0276 19900101 NEWBORN-HCA REVIEW
0277 19900101 LTC ELIGIBILITY ERROR
0278 19900101 DISCHARGE DTE UNEQ TO LTC ELIG
0279 19910101 INVALID LAB PROCEDURE CODE
0281 19900101 PEND FOR MANUAL PRICING
0282 19900101 PHYSICIAN AUDITOR REVIEW-MODIFIER 24
0283 19910101 MANUAL PRICE EXCEEDS ALLOWABLE BUT IS LESS THAN BILLED CHARGE
0284 19910101 MANUAL PRICE EXCEEDS BILLED CHARGES
0285 19910101 UNLISTED PROCEDURE
0287 19910101 STER/HYST/ABOR CONSENT INDICATOR IS MISSING OR INVALID
0288 19910101 PROCEDURE NOT COVERED BY MEDICAID
0289 19910101 JUSTIFICATION OF MEDICAL NECESSITY REQUIRED
0290 19900101 PROCEDURE IS NOT IN THE SCOPE OF THE PROGRAM
0291 19900101 PROCEDURE REQUIRES MEDICAL REVIEW
0292 19900101 PROCEDURE REQUIRES PRIOR AUTHORIZATION
0293 19000101 INCOMP. DOC. AND OR MISSING W9. PLS CONTACT PROV. INQ. AT 1-800-852-2683
0294 19900101 SERVICE NOT COVERED BY MEDICAID
0295 19910101 RECIPIENT HAS TPL RESOURCES BUT NO TYPE OF COVERAGE ON FILE
0296 19910101 CONTACT PARENT FOR PAYMENT
0297 19900101 PAY TO PROVIDER NOT ELIG FOR PAY-THIS DATE OF SERV
0298 19900101 PROVIDER NUMBER IS A GROUP NUMBER
0299 19910101 PEND FOR REVIEW OF MULTIPLE SURGERY
0300 19900101 NO PROVIDER MASTER RECORD
0301 19910101 FRI/SAT ADMISSION DENIED - JUSTIFICATION REQUIRED
0302 19900101 REVENUE CODE NON APPLICABLE FOR MEDICAID
0303 19910101 REVENUE CODE INVALID
0304 19900101 PROVIDER INELIGIBLE ON SERVICE DATE
0305 19910101 VISIT CODE CANNOT BE ALLOWED ON SAME DAY AS CONSULT
0306 19900101 PAY TO PROVIDER IS SUSPENDED
0307 19900101 BILLING OUT OF CLIA CERTIFICATE TYPE
0308 19900101 NO PAY-TO PROVIDER RECORD
0309 19900101 REVIEW CLAIM FOR PAY-TO- PROVIDER
0310 19910101 INPATIENT PSYCHIATRIC AGE RESTRICTION
0311 19910101 AMBULANCE SERVICES BILLED ON OUTPATIENT ENCOUNTER NOT JUSTIFIED
0312 19900101 PAY-TO PROVIDER NOT ENROLLED
0313 19900101 DIAGNOSIS CODE IN SEQUENCE 5TH-24TH INVALID OR NOT ON FILE
0314 19900101 SURGICAL PROCEDURE CODE NOT FOUND
0315 19910101 PEND FOR REVIEW OF GLOBAL SURGERY
0316 19900101 MCC ICN MISSING FROM CLAIM
0317 19900101 INVALID/MISSING MODIFIER FOR THIS PROCEDURE
0318 19900101 DATE OF BIRTH AFTER THE DATE OF SERVICE
0321 19900101 PROCEDURE CODE IS NO LONGER VALID
0322 19900101 DATE OF SERVICE BEFORE PROCEDURE IS PAYABLE
0323 19910101 DATES OF SERVICE SPAN PROVIDER PRICING SEGMENT (NO RATE ON FILE FOR DATES OF SE
0324 19900101 INVALID RECIPIENT SEX FOR THIS DIAGNOSIS
0326 19910101 SURG PROCEDURE CODE IS REQUIRED WITH OPERATING ROOM CHARGES
0328 19900101 PROCEDURE NOT IN SCOPE OF PROGRAM FOR THIS AGE
0329 19900101 INVALID RECIPIENT SEX FOR THIS PROCEDURE
0330 19910101 FACILITY NOT QUALIFIED FOR LEVEL OF CARE BILLED
0331 19900101 NO PAE AVAILABLE FOR RECIPIENT ADMISSION
0332 19900101 INVALID PROVIDER TYPE FOR THIS PROCEDURE
0333 19910101 LOC NOT AUTHORIZED BY PAE
0334 19900101 NO PATIENT LIABILITY IN EFFECT FOR DATE OF SERVICE
0335 19910101 PATIENT LIABILITY EXCEEDS OR EQUALS ALLOWED AMOUNT
0336 19900101 REFILLS ARE NOT ALLOWED FOR NARCOTIC DRUGS
0337 19910101 D AND C PAYMENT INCLUDED WITH HYSTERECTOMY
0338 19900101 PATIENT LIABILITY CHANGED DURING MONTH
0339 19900101 RECIPIENT CHANGES PATIENT STATUS AFTER HE IS DISCHARGED OR TRANSFERED
0340 19910101 REPROCESSED CLAIM - PAID INCORRECT PER DIEM ON RA 07/21/89
0341 19910101 VOID OF CLAIMS PREVIOUSLY PRICED/PROCESSED INCORRECTLY
0342 19900101 THIS DIAGNOSIS REQUIRES MEDICAL REVIEW
0345 19900101 ATTENDING PROVIDER NOT FOUND
0346 19900101 PHYSICIAN VISIT MUST NOT BE MORE THAN 365 DAYS NO GRACE PERIOD IS GIVEN ON THES
0347 19000101 PHYSICIAN CERTIFICATION DATE EXCEEDS ALLOWABLE DAYS
0348 19900101 PHYSICIAN CERTIFICATION DATE MUST MEET FEDERAL GUIDELINES
0349 19900101 PHYSICIAN RECERTIFICATION DATE EXCEEDS ALLOWABLE DAYS
0350 19000101 THE NUMBER OF DETAILS IS NOT EQUAL TO THE SUBMITTED DETAIL COUNT
0351 19900101 SUBMITTED TO ALLOWED EXCEEDS PERCENT
0352 19900101 ALLOWED TO SUBMITTED EXCEEDS PERCENT
0353 19900101 SPECIALTY REQUIRES/EXCLUDES SPECIFIC MODIFIER
0354 19900101 THIS LAB NOT CERTIFIED TO PROVIDE THIS SERVICE
0356 19900101 PROCEDURE DELETED FROM CPT/HCPS. REFER TO CPT/HCPCS FOR CURRENT CODE
0357 19900101 THIS DRUG REQUIRES PRIOR AUTHORIZATION
0358 19900101 INACTIVE DRUG
0359 19900101 NATIONAL SUPPLIER PROVIDER NUMBER NOT ON FILE, CONTACT MEDICAID
0360 19900101 THIS NATIONAL DRUG CODE IS NOT ON FILE
0361 19910101 ASST. SURGEON NOT MEDICALLY NECESSARY OR JUSTIFIED
0362 19900101 MEDICARE DEDUCTIBLE GREATER THAN MAXIMUM
0363 19910101 ROUTINE PHYSICIAN EXAM NOT COVERED EXCEPT UNDER EPSDT
0365 19910101 PROCEDURE REQUIRES PRIMARY TOOTH CODE(S)
0366 19910101 PROCEDURE REQUIRES PERMANENT TOOTH CODE(S)
0367 19910101 PROCEDURE FILE INDICATES SURFACE CODES(S) REQUIRED
0368 19910101 PROCEDURE/FORMULARY INDICATES TOOTH CODE REQUIRED
0369 19910101 SEALANTS NOT COVERED ON PRIMARY TEETH
0370 19910101 ACCIDENT INDICATOR MISSING OR INVALID
0371 19900101 THIS DIAGNOSIS REQUIRES ADDITIONAL DOCUMENTATION
0372 19900101 ITEM NOT PAYABLE IN LONG TERM CARE FACILITY
0374 19900101 MISSING PRESCRIBER PROVIDER ON DEALER CLAIM
0375 19900101 SERVICE NOT ON EXPLANTION OF MEDICARE PAYMENTS
0377 19900101 RECIPIENT IS INELIGIBLE FOR THIS DRUG
0379 19900101 PROCEDURE CODE MODIFIER REQUIRES MANUAL REVIEW
0383 19900101 MULTIPLE SURGERY REQUIRES REVIEW
0385 19900101 REVENUE CODE NOT ON FILE
0386 19000101 CARRIER CODE INVALID
0387 19000101 ADJ REASON CD 22/23 MISSING/INVALID OR TPL INVALID
0388 19910101 SERVICES OF THIS PROVIDER NOT COVERED BY MEDICAID
0389 19900101 THIS MODIFIER IS ALLOWED FOR CRNA ONLY
0390 19900101 MULTIPLE EXTRACTION REQUIRES APPROPRIATE PROC CODE
0391 19900101 INVALID USE OF E DIAGNOSIS CODE
0392 19910101 UNITS BILLED GREATER THAN COVERED DAYS
0394 19900101 VERIFY RECIPIENTS TPL
0396 19900101 LOC ON CLAIM CONFLICTS WITH LOC ON FILE
0397 19900101 INVALID LTC TERMINATION CODE
0399 19900101 REFERRING PROVIDER I.D. # IS NOT IN A VALID FORMAT
0400 19900101 INVALID LOC DAYS
0401 19900101 INVALID LEAVE DAYS
0402 19900101 INVALID TYPE OF LEAVE
0406 19900101 LTC LEAVE DATES CONFLICT
0407 19900101 THERAPEUTIC DAYS GT THAN 14
0410 19900101 PA IS REQUIRED
0412 19900101 EXCEPTION CODE 412
0413 19900101 LTC BLOCK 13:TOTAL DAYS DO NOT EQUAL FROM/TO DAYS
0414 19900101 WAIVER SERVICES LONG TERM CARE CONFLICT
0416 19900101 AMB SERVICES ORIGIN TO DESTINATION NOT IN SCOPE
0417 19900101 REVIEW AMBULANCE NON ROUTINE DESTINATION
0420 19900101 THIS DRUG NOT PAYABLE FOR RECIPIENT AGE
0421 19900101 THIS DRUG NOT PAYABLE FOR RECIPIENT SEX
0425 19900101 THIS PROCEDURE MUST BE BILLED SEPARATELY EACH DATE
0430 19900101 LTC INVALID RECIP ID NUMBER
0431 19900101 LTC NO PROV MASTER RECORD
0433 19900101 LTC MISSING PROVIDER NUMBER
0434 19900101 LTC INVALID PROV NUM CK-DIGIT
0435 19900101 LTC FIRST DATE OF SERVICE MISSING
0436 19900101 LTC FILING DEADLINE EXCEEDED
0437 19900101 LTC FIRST DATE GREATER LAST DATE
0438 19900101 LTC RECHECK SERVICE DATE
0439 19900101 COINSURANCE NOT A MULTIPLE OF THE MEDICARE DAILY RATE
0443 19900101 LTC RECIP NOT ON ELIG FILE
0444 19900101 LTC RECIPIENT INELIGIBLE ON SERVICE DATES
0445 19900101 LTC RECIPIENT NOT ELIGIBLE ON SERVICE DATES
0446 19900101 LTC RECIP SUSPEND FOR REVIEW
0447 19910101 LIMIT OF 15 HOSPITAL LEAVE DAYS PER HOSPITALIZATION EXCEEDED
0448 19900101 LTC PROVIDER IS INELIGIBLE ON SERVICE DATES
0449 19900101 LTC REVIEW CLAIM FOR PROV
0450 19000101 INVALID QUADRANT
0451 19900101 LTC INV PROVIDER NUMBER
0452 19900101 RENDERING PROVIDER SERVICE LOCATION IS MISSING
0453 19000101 INVALID DIAGNOSIS TREATMENT INDICATOR
0454 19900101 INVALID ASSIGNMENT CODE
0455 19910101 REFILL NOT ALLOWED FOR DRUG CODE BILLED
0456 19900101 INVALID PROCEDURE TYPE
0457 19900101 INVALID PRINCIPAL/OTHER PROCEDURE TYPE
0458 19900101 ALIEN RECIPIENT ON REVIEW
0459 19900101 REVENUE CODES OP401 NEED HCPC CODE
0460 19910101 NOT MEDICAID ELIGIBLE FOR NURSING HOME PAYMENT
0461 19900101 OCCURENCE CODE SPAN MISSING/INVALID
0462 19900101 OCCURENCE SPAN DATE IS MISSING OR INVALID
0463 19900101 NOT MEDICAID ELIGIBLE FOR MEDICARE CROSSOVER PAYMENT
0464 19900101 SPAN DATE CONFLICT WITH DATES OF SERVICE SHOWN
0465 19900101 MEDICAID ALLOWABLE AMOUNT REDUCED BY THIRD PARTY LIABILITY
0466 19900101 MEDICAID ALLOWED REDUCED BY MEDICARE PAYMENT
0467 19900101 OVERLAP DATES FOR SAME LEVEL OF CARE
0468 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION
0469 19900101 LTC RECIPIENT NAME/ID MISMATCH
0470 19900101 CROSS OVER PEND FOR MANUAL PRICE
0471 19900101 NDC IS DEACTIVED AND NOT PAYABLE ON DATE FILLED
0472 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION
0473 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION
0474 19000101 DATE DISPENSED AFTER BILLING DATE
0475 19000101 DATE BILLED AFTER ICN DATE
0476 19900101 MAXIMUM HOSPITAL DAYS FOR THIS ADULT HAS BEEN PAID
0477 19000101 THE DIAGNOSIS CODE IN SEQUENCE 10-24 IS IN AN INVALID FORMAT
0478 19900101 PCS MISSING SUBMITTED CHARGE
0479 19900101 CLIA OUT OF DATE
0480 19910101 PROVIDER NOT ELIGIBLE ON DATES OF SERVICE
0481 19910101 CLAIM PENDED FOR REVIEW OF ATTACHMENTS
0482 19900101 DDSD/NFM PROCEDURE - NOT DDSD/NFM PROVIDER
0483 19900101 DDSD/NFM PROVIDER - NOT DDSD/NFM PROCEDURE
0484 19910101 PREMATURE/NEONATAL NURSERY CARE MUST BE BILLED WITH NEWBORN'S ID
0485 19900101 DATE DISPENSED EARLIER THAN DATE PRESCRIBED
0486 19900101 INPATIENT PSYCHIATRIC NEEDS PRIOR AUTHORIZATION
0487 19900101 PRIMARY DIAG CODE DETOX/NO DETOX REVENUE CODE
0488 19900101 ADMIT DATE DOES NOT EQUAL FIRST DATE OF SERVICE
0489 19900101 NO CLIA - DOS PRIOR TO CLIA EFFECTIVE DATE
0490 19900101 INPATIENT SERVICES ARE NOT COVERED FOR THIS RECIP
0491 19900101 DRUG NOT APPROVED
0492 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0493 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0494 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0495 19900101 NO CLIA - DOS PRIOR TO CLIA EFFECTIVE DATE
0496 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0497 19900101 NO CLIA - DOS PRIOR TO CLIA - EFFECTIVE DATE
0498 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE
0499 19900101 TPL PAY CHASE IMMUNO SUPPRESS DRUG
0500 19900101 DOCUMENT PEND
0501 19900101 SUSPEND FOR TPL REVIEW
0502 19900101 FILE CLAIM WITH MEDICARE
0503 19900101 THIS PATIENT HAS OTHER INSURANCE
0505 19900101 RETAIN INSURANCE DENIAL 6 MONTHS FOR TPL REVIEW
0507 19900101 EPSDT-MAY HAVE TPL
0508 19900101 TPL PAY AND CHASE PHARMACY
0509 19900101 TPL PAY AND CHASE PRE-NATAL
0510 19900101 THIS PATIENT HAS TWO COVERAGE TYPES
0511 19900101 CLAIM DATA DOES NOT MATCH PRIOR AUTHORIZATION DATA
0515 19910101 RESUBMISSION CODE INVALID
0516 19910101 CCN MISSING ADJUSTMENT/VOIDS
0517 19910101 ADJUSTMENT REPLACED BY THE LATEST ADJUSTMENT
0518 19990101 PROVIDER TYPE - CLAIM INPUT CONFLICT
0519 19900101 DRUG REQUIRES PRIOR AUTHORIZATION
0520 19900101 DRUG QUANTITY PER DAY LIMIT HAS BEEN EXCEEDED
0521 19910101 DUPLICATE ADJUSTMENT RECORDS ENTERED
0522 19900101 RECIPIENT IS NOT ELIGIBLE FOR THESE SERVICES
0524 19910101 CLAIM TO BE ADJUSTED IS THE CREDIT/VOID OF PREVIOUS ADJUSTMENT
0525 19900101 ADJUSTMENT OR VOID INVALID FOR PREVIOUSLY DENIED CLAIMS
0526 19900101 PRIOR AUTHORIZATION NOT ON FILE
0527 19900101 NO UNITS AUTHORIZED-THESE DATES OF SERVICES
0528 19900101 PRIOR AUTHORIZATION UNITS USED
0530 19900101 TIER 2 NSAID NO RECORD OF TIER 1'S ON FILE
0532 19900101 DISEASE STATE MANAGEMENT
0534 19000101 PRODUR DRUG-AGE INTERACTION
0535 19900101 PDUR INGREDIENT DUPLICATION
0536 19900101 INSURANCE EOB DOES NOT MATCH CLAIM - RESUBMIT
0537 19900101 PDUR DRUG-TO-DRUG INTERACTION
0538 19910101 EOB ATTACHMENT INADEQUATE FOR TPL RESOLUTION-RESUBMIT
0539 19000101 PDUR EARLY REFILL ON PRESCRIPTION
0540 19000101 PDUR MINIMUM DURATION OF THERAPY
0541 19900101 PDUR DOSING PRECAUTION-HIGH DOSE
0542 19900101 PDUR DOSING PRECAUTION-LOW DOSE
0543 19910101 ACCEPTABLE THIRD PARTY DENIAL JUSTIFIES PAYMENT
0544 19900101 PDUR MAXIMUM DURATION OF THERAPY
0545 19900101 PDUR LATE REFILL ON PRESCRIPTION
0546 19900101 DRUG DISEASE MARKER
0547 19900101 HMO CO-PAY/RECIPIENT HAS MEDICARE
0548 19900101 PAY TO PROV FOR PROVIDER TYPE 63 MUST BE GROUP
0549 19900101 ADJUSTMENT SUSPEND FOR MANUAL REVIEW
0550 19900101 SERVICE NOT REFERRED BY PRIMARY CARE CASE MANAGER
0552 19900101 PROVIDER NOT ELIGIBLE TO PROVIDE SERVICE/MEDICAID
0553 19900101 SNF/NF PAE EFF DATE MUST NOT BE GREATER THAN 90 DAYS PRIOR ADM/SERV DATE
0555 19000101 CLAIM PAST 24 MONTH FILING - DTL
0556 19900101 RECIPIENT IS NOT WAIVER ELIGIBLE
0557 19000101 CLAIM PAST 24 MONTH FILING - HDR
0560 19900101 RECIPIENT SERVICES COVERED BY HMO PLAN
0561 19900101 PROVIDER INELIGIBLE FOR T19 SERVICES/HMO ONLY
0562 19900101 RECIP PCPCM-CANNOT BILL OP/RHC/FQHC CLINICS RATE
0563 19900101 RECIPIENT NOT ENROLLED IN HMO FOR DOS
0564 19900101 SUPPLEMENTAL DELIVERY PAYMENT DENIAL CODE
0565 19900101 PAID AMOUNT IS GREATER THAN THE BILLED AMOUNT
0566 19900101 EXCEPTION CODE 566
0567 19910101 ROOM AND BOARD CHARGES NON-COVERED--CORRECT AND RESUBMIT
0569 19900101 CC CLAIMS CAN'T PROCESS THRU SYSTEM
0570 19900101 INVALID ELIGIBILITY FOR HMO COPAY
0571 19900101 CLAIMCHECK REBUNDLED
0572 19900101 CC INCIDENTAL TO PRIMARY PROCEDURE
0573 19900101 CC MUTUALLY EXCLUSIVE
0574 19900101 CLAIMCHECK COSMETIC SURGERY
0575 19900101 CLAIMCHECK DUPLICATE
0576 19900101 CC UNLISTED/OBSOLETE/EXPERIMENTAL/UNSPECIFIED
0577 19900101 CLAIMCHECK POSSIBLE DUPLICATE
0578 19900101 CLAIMCHECK PRE-OP/POSTOP
0579 19900101 CC GROUPHEALTH SMARTSUSPENSE SUSPEND
0580 19900101 CLAIMCHECK MEDICAL/EVALUATION VISIT
0581 19900101 RECIPIENT IS LOCKED-IN TO ANOTHER PHYSICIAN
0582 19900101 RECIPIENT IS LOCKED-IN TO ANOTHER PHARMACY
0583 19900101 CLAIMREVIEW NEW VISIT FREQUENCY
0584 19900101 CC GROUPHLTH SMARTSUSPENSE DENY
0587 19900101 CLAIMREVIEW INTENSITY OF SERVICE
0588 19900101 STOP LOSS NOT APPROVED
0589 19900101 CC INVALID MODIFIER/PROCEDURE COMBINATION
0590 19900101 CLAIMCHECK EXCEEDS 40 LINES
0591 19900101 CLAIMREVIEW MULTIPLE/DUPLICATE COMP.BILLING
0592 19900101 CLAIMCEHCK AGE REPLACEMENT
0593 19900101 CLAIMREVIEW DIAGNOSIS TO PROCEDURE
0594 19900101 CLAIMCHECK-BILL EACH DOS ON A SEPARATE LINE
0595 19910101 CLIA REGISTRATION CERTIFICATE NUMBER NOT ON FILE
0597 19900101 CLAIMCHECK MULTIPLE SURGERY
0598 19900101 CC-MULTIPLE SURGERY-DOUBLE MODIFIERS
0599 19900101 ATTACHMENT CONTROL NUMBER MISSING
0600 19900101 UNITS NOT EQUAL TO TEETH BILLED
0601 19900101 PART A CROSSOVER SPANS 20020501
0602 19900101 UNITS NOT EQUAL TO TEETH BILLED
0603 19900101 PROV ID ON CLAIM DOES NOT MATCH PROV ID ON PA
0604 19900101 SERVICE AND/OR DATES DO NOT MATCH PRIOR AUTH
0605 19900101 PRIOR AUTH FUND AND CLAIM FUND DOES NOT MATCH
0606 19900101 PRIOR AUTH UNITS/AMOUNTS USED
0608 19900101 JUSTIFICATION OF MEDICAL NECESSITY REQUIRED FOR THIS PROCEDURE
0609 19900101 CHECK CLAIM ATTACHMENT
0612 19900101 TOOTH NUM ON CLAIM DOES NOT MATCH TOOTH NUM ON PA
0614 19900101 DIAG CODE MISSING/NOT ON FILE-INPATIENT CLAIMS
0615 19900101 PROVIDER RATE NOT ON FILE FOR LEVEL OF CARE
0616 19900101 PROCEDURE NOT COMPENSABLE FOR ASSISTANT SURGEON
0618 19900101 AUTH SERVICES-RECIP NOT ELIG
0619 19900101 RECIP INELIGIBLE PAY (AUTH EXAM) FROM STATE FUND
0620 19900101 MEDICARE ADJUSTED CLAIM-SUBMIT PAPER XOVER CLAIM
0621 19900101 (CASH DEDUCTIBLE + BLOOD DEDUCTIBLE + COINSURANCE) IS GREATER THAN (MEDICARE AL
0622 19900101 MASS CREDIT/ADJ BEING SUSPEND
0625 19900101 FUND CODE UNDETERMINED
0627 19910101 X-OVER AMOUNT BILLED GREATER THAN AMOUNT BILLED TO MEDICARE
0628 19910101 PHYSICIAN VISIT DATE MISSING/INVALID
0629 19900101 PHYSICIAN VISIT DATE DOES NOT MEET FEDERAL REQUIREMENTS
0630 19900101 DIAGNOSIS NOT IN SCOPE OF THE PROGRAM
0631 19900101 DIAGNOSIS NOT IN SCOPE OF CCP PROGRAM
0632 19900101 DIAGNOSIS NOT IN SCOPE OF CN PROGRAM
0633 19900101 DIAGNOSIS NOT IN SCOPE OF MN PROGRAM
0634 19000101 DETAIL ATTENDING PHYSICIAN ID INVALID
0635 19000101 DETAIL FIRST OTHER PHYSICIAN ID INVALID
0637 19900101 CLAIM PROCESSES MORE THAN 1 YEAR AFTER DATE OF SERVICE AND MORE THAN 183 DAYS A
0638 19900101 DRUG REQUIRES MEDICAL REVIEW/CN
0639 19900101 DRUG REQUIRES MEDICAL REVIEW/MN
0642 19900101 INVALID PROVIDER NUMBER
0643 19900101 ABORTION REQUIRES REVIEW
0644 19900101 PROCEDURE CODE MODIFIER NOT PAYABLE
0645 19900101 NOT MEDICAID ELIGIBLE FOR MEDICARE CROSSOVER PAYMENT
0646 19900101 PROVIDER RATE NOT ON FILE
0648 19900101 CC SITE SPECIFIC MODIFIER-FILE ON SEPARATE LINE
0649 19910101 HOSPICE CLAIM PREVIOUSLY PAID FOR DATES OF SERVICE
0650 19900101 MISSING 224 REVENUE/INVALID UNITS ON LATE DISCHARGE
0651 19900101 INVALID TREATMENT DIAGNOSIS INDICATOR
0652 19900101 PCS-INVALID NET CLAIM CHARGE
0653 19900101 PAID IN FULL BY MEDICARE
0654 19900101 RECIPIENT ID IS INVALID FOR AUTH EXAM PAY STATE FD
0655 19910101 DENIED BY MEDICARE
0656 19910101 MEDICARE PAYMENT EXCEEDS MEDICAID MAXIMUM ALLOWABLE
0657 19900101 POTENTIAL DISABILITY CLAIM
0658 19910101 NEWBORN CARE LIMITED TO 2 SUBSEQUENT VISITS
0659 19900101 DATE OVER 1 YR MORE THAN 90 DAYS AFTER MEDICARE PD
0662 19900101 LINE FAILURE - CLAIM DENIED
0663 19900101 PCS-PROVIDER NUMBER IS NOT ON PROVIDER FILE
0664 19900101 PCS OVER 31 DAYS BILLED
0665 19900101 PCS MISSING PROVIDER NUMBER
0666 19910101 HOSPITAL INPATIENT SERVICE CANNOT BE PAID ON SAME DAY AS OBSERVATION
0667 19900101 PCS-INVALID PROVIDER NUMBER CHECK DIGIT
0668 19900101 PCS MISSING FIRST DATE OF SERVICE
0669 19900101 PCS FILING DEADLINE EXCEEDED
0670 19900101 PCS FIRST DATE OF SERVICE GREATER THAN LAST DATE
0671 19900101 PCS SERVICE DATE IS GREATER THAN RECEIVED DATE
0672 19900101 PCS MISSING RECIPIENT NUMBER
0673 19900101 SUBMIT PAPER CLAIM
0674 19900101 PCS MISSING TOTAL CLAIM CHARGE
0675 19900101 PCS INVALID TOTAL CLAIM CHARGE
0676 19900101 PCS RECIPIENT NOT ON ELIGIBILITY FILE
0677 19900101 PCS RECIPIENT INELIGIBLE ON DATE OF SERVICE
0678 19900101 PCS ITEMIZED SERVICE DATE NOT IN RECIP ELIG SPAN
0679 19900101 PCS SUSPEND FOR RECIPIENT REVIEW
0680 19900101 PCS PROVIDER IS SUSPENDED
0681 19900101 PROVIDER INELIGIBLE ON DATE OF SERVICE
0682 19900101 PCS REVIEW CLAIM FOR PROVIDER
0683 19900101 EXCEEDS 1 PROCEDURE PER TOOTH
0684 19900101 PCS INVALID PROVIDER NUMBER
0687 19900101 EXCEEDS LIFETIME LIMIT FOR ORTHODONTICS
0688 19900101 EXCEEDS $750 PER FY FOR DENTAL PROCEDURES REQUIRING PRIOR APPROVAL
0691 19900101 PCS-NO UNITS OF SERVICE
0696 19900101 CROSSOVER PART A NOT PAYABLE MEDICALLY NEEDY
0698 19500101 COINSURANCE IS NOT A MULTIPLE OF THE MEDICARE DAILY RATE
0699 19900101 INSTITUTIONAL CROSSOVER TYPE MISSING OR INVALID
0700 19900101 PROCEDURE EXCEEDS LIFETIME LIMITATION
0701 19900101 PHYSICAN SIGNED CONSENT FORM BEFORE STERILIZATION
0702 19900101 DATE OF SURGERY ON CONSENT FORM IS NOT ON CLAIM
0703 19900101 RECIPIENT UNDER 21 WHEN SHE SIGNED CONSENT FORM
0704 19900101 REQUIRES ADDRESS FOR FACILITY FOR STERILIZATION
0705 19900101 STERILIZATION CONSENT FORM IS NOT LEGIBLE
0706 19900101 DATE ON THE CONSENT FORM IS NOT LEGIBLE
0707 19900101 STERILIZATION/HYSTERECTOMY CONSENT FORM IS MISSING
0708 19900101 PATIENT NAME ON CONSENT FORM DOES NOT MATCH CLAIM
0709 19900101 CONSENT LESS THAN 30 DAYS BEFORE STERILIZATION
0710 19900101 CONSENT MORE THAN 180 DAYS BEFORE STERILIZATION
0711 19900101 STERILIZATION CONSENT FORM NOT DATED BY PHYSICIAN
0712 19900101 CONSENT FORM IS NOT SIGNED BY THE RECIPIENT
0713 19900101 CONSENT FORM IS NOT SIGNED BY THE COUNSELOR
0714 19900101 CONSENT FORM DOES NOT HAVE DATE COUNSELOR SIGNED
0715 19900101 STERILIZATION CONSENT FORM IS INCOMPLETE
0716 19900101 HYSTERECTOMY CONSENT FORM REQUIRED
0717 19900101 STERILIZATION CONSENT FORM NOT SIGNED BY PHYSICIAN
0718 19900101 EMERGENCY PROCEDURE CODE IS INVALID/NOT ON FILE
0719 19900101 REFILE CLAIM WITH OPERATIVE REPORT
0720 19900101 INCORRECT RECIPIENT DATE OF BIRTH ON CONSENT FORM
0721 19900101 FURTHER DESCRIPTION OF SERVICE REQUIRED
0722 19900101 STRENGTH AND DOSAGE OF INJECTION MEDICATION REQ
0723 19900101 SERVICES REQ DOCUMENTATION FOR MEDICAL NECESSITY
0724 19900101 REFILE CLAIM WITH CONSULTATION/PROGRESS NOTES
0725 19900101 SERVICE NOT COVERED AS BILLED
0726 19900101 REFERRING PHYSICIAN REQUIRED
0727 19900101 ANOTHER PROVIDER HAS BEEN PAID FOR THESE SERVICES
0728 19900101 SERVICES ARE NOT AUTHORIZED
0729 19900101 DENIED AFTER SPECIAL REVIEW
0730 19900101 HYSTERECTOMY CONSENT FORM SIGNED AFTER SURGERY
0731 19900101 HEALTH CARE AUTHORITY WILL PROCESS CLAIM
0732 19900101 COUNSELOR SIGNED CONSENT FORM PRIOR TO RECIPIENT
0733 19910101 HCBS/ICF FOR SAME OR OVERLAPPING DATES OF SERVICE
0734 19910101 HCBS/INPATIENT HOSPITAL/SNF FOR SAME OR OVERLAPPINNG DATES OF SERVICE
0735 19900101 RECIPIENT INELIGIBLE ON SERVICE DATES
0736 19900101 MODIFIER ADDED/DELETED DUE TO MEDICAL REVIEW
0737 19900101 INVALID MODIFIER FOR THIS PROCEDURE
0738 19900101 INVALID PROCEDURE CODE USE VALID CPT OR HCPC CODE
0739 19900101 ONE AMBULATORY SURGERY ALLOWED PER DAY
0740 19900101 INVALID CODE FOR NARRATIVE DESCRIPTION
0741 19900101 INVALID SUBMITTED CHARGE
0742 19900101 AUTHORIZED PHYSICAL REQUIRES ABCDM-16
0743 19900101 EXCEPTION CODE 743
0744 19900101 AUTHORIZED PHYSICAL DOES NOT MATCH ABCDM-16
0745 19900101 REQUESTED ADDITIONAL INFORMATION NOT RECEIVED
0746 19900101 DENTAL X-RAYS ARE REQUIRED
0747 19900101 SERVICES ARE INCLUDED IN TOTAL PAID OB CARE
0748 19900101 PROCEDURE IS AN INCIDENTAL TO PAID MAJOR SURGERY
0749 19900101 OUTSIDE THE GUIDELINES OF THE MEDICAL PROGRAM
0750 19900101 EXCEEDS SUPPLY LIMIT/1 MONTH WITHIN 12 MONTHS
0751 19900101 EXCEPTION CODE 751
0752 19900101 PER PHY MANUAL-USE 99202 ANTEPART WHEN NOT TOT. OB
0753 19900101 PROCEDURE IS INCIDENTAL MAJOR PROCEDURE ON CLAIM
0754 19900101 REFILE USING ""RECIPIENT AREA"" IN SQ CM
0755 19900101 REFILE CLAIM WITH PROOF OF TIMELY FILING ATTACHED
0756 19900101 EXCEPTION CODE 756
0757 19900101 TAKE HOME MEDICATION IS NOT PAYABLE
0758 19900101 PROVIDER NAME DOES NOT MATCH PROVIDER NUMBER
0759 19900101 NEEDS COUNTY ADMIN AND/OR PROVIDER SIGNATURE
0760 19900101 RECIPIENT IS DECEASED THIS DATE OF SERVICE
0761 19900101 NAME ON SUBMITTED CLAIM DOES NOT MATCH DHS FILE
0762 19900101 FILE AN ASSIGNED MEDICARE CLAIM ON THIS PATIENT
0763 19900101 EXCEEDS MULTI-CHANNEL TEST LIMIT BLOOD ANALYZER CODE REQUIRED
0764 19900101 DUPLICATE OF PAID CLAIM
0765 19900101 INVALID HYSTERECTOMY CONSENT FORM
0766 19900101 STERILIZATION/HYSTERECTOMY CONSENT FORM IS INVALID
0767 19900101 EXCEPTION CODE 767
0768 19900101 REQUEST ADJUSTMENT TO PAID CLAIM-PER MANUAL
0769 19900101 PAYMENT CORRECTED/SPENDDOWN-ADM12-HIST ONLY ADJUST
0770 19900101 INSURANCE PAYMENT MORE THAN ALLOWABLE
0771 19900101 SERVICE NOT PAYABLE THIS DATE OF SERVICE
0772 19900101 TYPE OF BILL-CLAIM CONFLICT
0773 19900101 AUTHORIZED ROOM SERVICES ARE NOT ON CLAIM
0774 19900101 EXCEPTION CODE 774
0775 19900101 CLAIM HAS BEEN FORWARED TO HCA
0777 19900101 SHOW MEDICARE PART B PAYMENTS
0778 19900101 HEALTH CARE AUTHORITY PROCESSED ADM12
0779 19900101 ELIGIBILITY PROBLEM PROCESSED BY DHS
0780 19900101 RESUBMIT WITH APPROPRIATE VALUE CODE AND UNITS
0781 19900101 ANOTHER DDS PAID THIS SERVICE IN PREVIOUS 12 MONTH
0782 19900101 PART OF INPATIENT HOSPITAL CHARGES
0783 19900101 PROCEDURE INCLUDED IN OFFICE CALL
0785 19900101 ANOTHER PHARMACY PAID FOR THIS PRESCRIPTION
0786 19900101 SAME NDC/DATE PAID THIS PHARM
0787 19900101 THERAPEUTIC LEAVE DAYS ARE NON-COVERED
0788 19900101 MAXIMUM OF 60 THERAPEUTIC LEAVE DAYS EXCEEDED FOR FISCAL YEAR
0789 19900101 PROCEDURE NOT APPLICABLE FOR DIAGNOSIS SHOWN
0790 19900101 ABCDM-16/CLAIM PROV CONFLICT
0791 19900101 INVALID DIAGNOSIS FOR DESCRIPTION
0792 19900101 STERILIZATION CONSENT REQUIRED
0793 19900101 SERVICE/SUPPLY INCLUDED IN AMBULANCE TRIP CHARGE
0794 19900101 PAID CLAIM INCLUDED THIS PROCEDURE
0795 19900101 CC MUTUALLY EXCLUSIVE
0796 19900101 PATIENT HAS PRIVATE INSURANCE
0797 19900101 RECIP TB ELIG ONLY-CLAIM REQUIRES TB DIAGNOSIS
0798 19900101 REFILE WITH MEDICARE RECHECK HIC NUMBER
0799 19900101 EXCEPTION CODE 799
0800 19900101 PHARMACY-EXACT DUPLICATE OF ANOTHER CLAIM
0801 19910101 SERVICE NOT ALLOWED DURING INPATIENT/SNF/ICF STAY
0802 19900101 PHARMACY-POSSIBLE CONFLICT OF ANOTHER CLAIM
0803 19900101 DENTAL-EXACT DUPLICATE OF ANOTHER CLAIM
0804 19900101 DENTAL-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0806 19900101 PRACTITIONER-EXACT DUPLICATE OF ANOTHER CLAIM
0807 19900101 PRACTITIONER-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0810 19910101 SNF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0812 19900101 CROSSOVER-EXACT DUPLICATE OF ANOTHER CLAIM
0813 19900101 EXCEPTION CODE 813
0814 19900101 CROSSOVER-POSSIBLE CONFLICT OF ANOTHER CLAIM
0815 19900101 LTC-EXACT DUPLICATE OF ANOTHER CLAIM IN SYSTEM
0816 19900101 LTC-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0820 19910101 INPATIENT/ICF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0821 19900101 PCS-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0822 19900101 EXCEPTION CODE 822
0823 19910101 ICF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0824 19900101 OUTPATIENT-POSSIBLE DUPLICATE OF ANOTHER CLAIM
0826 19900101 HOME HEALTH-EXACT DUPLICATE OF ANOTHER CLAIM
0827 19900101 EXCEPTION CODE 827
0828 19910101 CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0829 19900101 INPATIENT-EXACT DUPLICATE OF ANOTHER CLAIM
0830 19910101 MEDICARE CROSSOVER PREVIOUSLY PAID - BILL PART A MEDICARE
0831 19910101 SNF/HOME HEALTH/DME SERVICE PREVIOUSLY PAID FOR SAME DATE OF SERVICE
0832 19900101 TRANSPORTATION-EXACT DUPLICATE OF ANOTHER CLAIM
0833 19910101 HCBS PREVIOUSLY PROCESSED FOR SAME DATES OF SERVICE
0835 19910101 RECIPIENT IS PART B ELIGIBLE - BILL MEDICARE
0836 19910101 PROFESSIONAL XOVER CONFLICT W/ CMS1500 ENCOUNTERS
0838 19900101 LAB/XRAY-EXACT DUPLICATE OF ANOTHER CLAIM
0839 19900101 LAB/XRAY-POSSIBLE DUPLICATE OF ANOTHER CLAIM
Medicare Managed care - Adjustment Reason Codes
Code Description
01 Notification of Death of Beneficiary
02 Retroactive Enrollment
03 Retroactive Disenrollment
04 Correction to Enrollment Date
05 Correction to Disenrollment Date
06 Correction to Part A Entitlement
07 Retroactive Hospice Status
08 Retroactive ESRD Status
09 Retroactive Institutional Status
10 Retroactive Medicaid Status
11 Retroactive Change to State County Code
12 Date of Death Correction
13 Date of Birth Correction
14 Correction to Sex Code
15 Obsolete
16 Obsolete
17 For APPS use only
18 Part C Rate Change
19 Correction to Part B Entitlement
20 Retroactive Working Aged Status
21 Retroactive NHC Status
22 Disenrolled Due to Prior ESRD
23 Demo Factor Adjustment
24 Obsolete
25 Part C Risk Adj Factor Change/Recon
26 Mid-year Part C Risk Adj Factor Change
27 Retroactive Change to Congestive Heart Failure (CHF) Payment
28 Retroactive Change to BIPA Part B Premium Reduction Amount
29 Retroactive Change to Hospice Rate
30 Retroactive Change to Basic Part D Premium
31 Retroactive Change to Part D Low Income Status
32 Retroactive Change to Estimated Cost-Sharing Amount
33 Retroactive Change to Estimated Reinsurance Amount
34 Retroactive Change Basic Part C Premium
35 Retroactive Change to Rebate Amount
36 Part D Rate Change
37 Part D Risk Adjustment Factor Change
38 Part C Segment ID Change
41 Part D Risk Adjustment Factor Change (ongoing)
42 Retroactive MSP Status
44 Retroactive correction of previously failed Payment (affects Part C and D)
45 Disenroll for Failure to Pay Part D IRMAA Premium – Reported for Pt C and Pt D
46 Correction of Part D Eligibility – Reported for Pt D
50 Payment adjustment due to Beneficiary Merge
60 Part C Payment Adjustments created as a result of the RAS overpayment file processing
61 Part D Payment Adjustments created as a result of the RAS overpayment file processing
65 Confirmed Incarceration – Reported for Pt C and Pt D
66 Not Lawfully Present
90 System of Record History Alignment
94 Special Payment Adjustment Due to Clean-Up
Full list of Denial code.
https://www.lamedicaid.com/provweb1/Forms/Error_Code/ERROR_CODE.pdf
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