Remark Denial Description
CDD DEFINITE DUPLICATE CLAIM
CRS CODE SUPERCEDED-AMA CPT GUIDELINES
CRT CODE SUPERCEDED-AMA CPT GUIDELINES-DENIED
F47 PAYMENT REFLECTS COB, IF $0, MAXIMUM LIABILITY WAS MET
F50 CLAIM ADJ - THIRD PARTY DENIED OR BENEFITS EXHAUSTED
I02 X02 ILLEGIBLE RECORDS SUBMITTED; REFILE
I04 X04 CORRECT NDC CODE REQUIRED FOR CONSIDERATION
I05 X05 INVALID/DELETED CODE, MODIFIER OR DESCRIPTION
I06 X06 ITEMIZED BILL/DATES OF SERVICE/CHARGES/ INVOICE REQUIRED
I08 X08 DIAGNOSIS INVALID/MISSING/DELETED REQUIRED 4TH/5TH DIGIT
I10 E-CODE CANNOT BE USED AS PRIMARY DIAGNOSIS
I11 X11 EOB FROM PRIMARY CARRIER REQUIRED
I18 PAID BILLED CHARGES
I19 X19 CARRIER OF SERVICE-HORIZON HEALTHCARE DENTAL SERVICE
I22 X22 RESUBMIT WITH VISIT CODES & CHARGES
I24 X24 CARRIER OF SERVICE-DAVIS VISION
I26 X26 EXHAUSTION OF BENEFITS
I27 X27 SUBMIT MEDICAL RECORDS TO HORIZON NJ HEALTH APPEALS UNIT
I28 REPROCESSED-CLAIM SUBJECT TO INTEREST
I30 X30 SERVICE EXCEEDS LIFETIME LIMITATION
I37 X37 RESUBMIT WITH APPROPRIATE MODIFIER AND/OR TIME UNITS
I42 X42 ILLEGIBLE/INCOMPLETE/INAPPROPRIATE REFERRAL RECEIVED
I43 X43 BI-LATERAL PROCEDURE PREVIOUSLY PAID WITH MODIFIER “50”
I44 X44 RESUBMIT WITH ICD/9 PRINCIPLE PROCEDURE CODE
I47 X47 NON CONTRACTED LEVEL OF CARE
I48 Z48 RESUBMIT TO PRIMARY CARRIER FOR APPEALS PROCESS
I64 X64 CAPITATED TO ANOTHER PROVIDER
I65 DUPLICATE CLAIM-PREVIOUSLY DENIED APPROPRIATELY
I68 INVALID PLACE OF SERVICE FOR PROCEDURE
I83 X83 MOTHER’S BILL NOT RECEIVED – REFILE
I98 TOTAL BILLED STILL UNDER CONSIDERATION
N02 REDUNDANT PROCEDURE DISALLOW
N06 ASSISTANT SURGEON DISALLOW
Q17 ADMINISTRATIVE OVERTURN
R00 X00 PAYMENT INCLUDED IN OTHER BILLED SERVICES
R01 X01 NO PRECERT/AUTHORIZATION OR REFERRAL
R07 X07 RECEIVED AFTER TIMELY FILING TIME LIMIT
R09 X09 REQUESTED HOSPITAL DOCUMENTS NOT RECEIVED
R10 X10 NOT ENROLLED ON DATE OF SERVICE
R15 SUBSET/INCIDENTAL PROCEDURE DISALLOW
R18 RESUBMIT WITH ICD PRINCIPAL PROCEDURE, HCPCS OR CPT CODE
R37 COMBINED PAYMENT-MOTHER & BABY
R38 CONTRACTED FEE
R39 X39 DUPLICATE CLAIM PREVIOUSLY PAID AT CORRECT RATE OR CAPITATION
R40 X40 DUPLICATE CLAIM-ORIGINAL STILL UNDER CONSIDERATION
R42 DRG PAYMENT
R43 INTERIM BILL PAYMENT
R44 MULTIPLE SURGICAL REDUCTION
R45 X45 COMPLETE MED RECORDS REQUIRED FOR CONSIDERATION; REFILE
R46 X46 OVER MAX PROCEDURE/BENEFIT LIMIT (All LOBs)
R47 PAYMENT REFLECTS COORDINATION OF BENEFITS, IF $0, MAX LIABILITY MET
R49 X49 PREVIOUS PYMTS EQUAL TO PURCHASE PRICE
R50 X50 SAME PROCEDURE PAID TO A DIFFERENT PROVIDER
R51 X51 SERVICE NOT COVERED
R53 X53 SERVICES WERE NOT PROVIDED
R55 BILLED INFORMATION REFLECTS LOWER DEGREE ACUITY/TREATMENT
R56 ADMINISTRATIVE APPROVAL
R59 X59 AUTHORIZATION/REFERRAL EXPIRED
R60 X60 DATES AND/OR SERVICES OUTSIDE REFERRAL/AUTHORIZATION
R61 X61 NO PCP REFERRAL
R65 INTERIM BILL 2ND CYCLE PAYMENT
R66 Z34 INTERIM BILL FINAL CYCLE PAYMENT
R67 X67 DISCREPANCY WITH LEVEL OF CARE-APPEAL REQUIRED
R70 X70 EPSDT SCREENING DID NOT COMPLY WITH PERIODICITY SCHEDULE
R71 X71 DUPLICATE OF PREVIOUSLY SUBMITTED EPSDT SCREENING
R72 X72 PROVIDER WAS NOT MEMBER’S PCP
R78 R78 MEMBER’S AGE NOT VALID FOR PROCEDURE CODE
R79 X79 SPECIAL PROJECT-ADJUSTMENT
R81 X81 CHARGES CONSIDERED INCLUDED IN INPATIENT ADMISSION
R84 X84 PLEASE OBTAIN INDIVIDUAL PROVIDER ID #
R86 X85 INVALID/MISSING REVENUE CODE ON CLAIM
R89 AUTHORIZATION ON FILE FOR TECHNICAL COMPONENT
R91 X91 INAPPROPRIATE CODING FOR CONTRACT AGREEMENT
R95 X95 CLAIM SUBMITTED WITHOUT PHYSICIAN NAME
R96 X96 EOB/ATTACHMENTS WERE INCOMPLETE/ILLEGIBLE
R97 X97 DATE OF SERVICE CANNOT BE GREATER THAN THE RECEIVED DATE
X12 MOTOR VEHICLE ACCIDENT - AUTO CARRIER PRIMARY
X13 WORKERS COMPENSATION PRIMARY CARRIER
X21 BILL THROUGH PHARMACY PROGRAM
X25 INCLUDED IN SETTLEMENT PAYMENT
X32 APPEAL – DENIAL UPHELD
X33 APPEAL – ORIGINAL CLAIM PAYMENT UPHELD
X35 AUTHORIZATION DENIED FOR THIS DATE OF SERVICE
X55 MEMBER AGE NOT VALID FOR DIAGNOSIS CODE
X56 CLINIC CLAIM SUBMITTED WITHOUT PHYSICIAN NAME
CDD DEFINITE DUPLICATE CLAIM
CRS CODE SUPERCEDED-AMA CPT GUIDELINES
CRT CODE SUPERCEDED-AMA CPT GUIDELINES-DENIED
F47 PAYMENT REFLECTS COB, IF $0, MAXIMUM LIABILITY WAS MET
F50 CLAIM ADJ - THIRD PARTY DENIED OR BENEFITS EXHAUSTED
I02 X02 ILLEGIBLE RECORDS SUBMITTED; REFILE
I04 X04 CORRECT NDC CODE REQUIRED FOR CONSIDERATION
I05 X05 INVALID/DELETED CODE, MODIFIER OR DESCRIPTION
I06 X06 ITEMIZED BILL/DATES OF SERVICE/CHARGES/ INVOICE REQUIRED
I08 X08 DIAGNOSIS INVALID/MISSING/DELETED REQUIRED 4TH/5TH DIGIT
I10 E-CODE CANNOT BE USED AS PRIMARY DIAGNOSIS
I11 X11 EOB FROM PRIMARY CARRIER REQUIRED
I18 PAID BILLED CHARGES
I19 X19 CARRIER OF SERVICE-HORIZON HEALTHCARE DENTAL SERVICE
I22 X22 RESUBMIT WITH VISIT CODES & CHARGES
I24 X24 CARRIER OF SERVICE-DAVIS VISION
I26 X26 EXHAUSTION OF BENEFITS
I27 X27 SUBMIT MEDICAL RECORDS TO HORIZON NJ HEALTH APPEALS UNIT
I28 REPROCESSED-CLAIM SUBJECT TO INTEREST
I30 X30 SERVICE EXCEEDS LIFETIME LIMITATION
I37 X37 RESUBMIT WITH APPROPRIATE MODIFIER AND/OR TIME UNITS
I42 X42 ILLEGIBLE/INCOMPLETE/INAPPROPRIATE REFERRAL RECEIVED
I43 X43 BI-LATERAL PROCEDURE PREVIOUSLY PAID WITH MODIFIER “50”
I44 X44 RESUBMIT WITH ICD/9 PRINCIPLE PROCEDURE CODE
I47 X47 NON CONTRACTED LEVEL OF CARE
I48 Z48 RESUBMIT TO PRIMARY CARRIER FOR APPEALS PROCESS
I64 X64 CAPITATED TO ANOTHER PROVIDER
I65 DUPLICATE CLAIM-PREVIOUSLY DENIED APPROPRIATELY
I68 INVALID PLACE OF SERVICE FOR PROCEDURE
I83 X83 MOTHER’S BILL NOT RECEIVED – REFILE
I98 TOTAL BILLED STILL UNDER CONSIDERATION
N02 REDUNDANT PROCEDURE DISALLOW
N06 ASSISTANT SURGEON DISALLOW
Q17 ADMINISTRATIVE OVERTURN
R00 X00 PAYMENT INCLUDED IN OTHER BILLED SERVICES
R01 X01 NO PRECERT/AUTHORIZATION OR REFERRAL
R07 X07 RECEIVED AFTER TIMELY FILING TIME LIMIT
R09 X09 REQUESTED HOSPITAL DOCUMENTS NOT RECEIVED
R10 X10 NOT ENROLLED ON DATE OF SERVICE
R15 SUBSET/INCIDENTAL PROCEDURE DISALLOW
R18 RESUBMIT WITH ICD PRINCIPAL PROCEDURE, HCPCS OR CPT CODE
R37 COMBINED PAYMENT-MOTHER & BABY
R38 CONTRACTED FEE
R39 X39 DUPLICATE CLAIM PREVIOUSLY PAID AT CORRECT RATE OR CAPITATION
R40 X40 DUPLICATE CLAIM-ORIGINAL STILL UNDER CONSIDERATION
R42 DRG PAYMENT
R43 INTERIM BILL PAYMENT
R44 MULTIPLE SURGICAL REDUCTION
R45 X45 COMPLETE MED RECORDS REQUIRED FOR CONSIDERATION; REFILE
R46 X46 OVER MAX PROCEDURE/BENEFIT LIMIT (All LOBs)
R47 PAYMENT REFLECTS COORDINATION OF BENEFITS, IF $0, MAX LIABILITY MET
R49 X49 PREVIOUS PYMTS EQUAL TO PURCHASE PRICE
R50 X50 SAME PROCEDURE PAID TO A DIFFERENT PROVIDER
R51 X51 SERVICE NOT COVERED
R53 X53 SERVICES WERE NOT PROVIDED
R55 BILLED INFORMATION REFLECTS LOWER DEGREE ACUITY/TREATMENT
R56 ADMINISTRATIVE APPROVAL
R59 X59 AUTHORIZATION/REFERRAL EXPIRED
R60 X60 DATES AND/OR SERVICES OUTSIDE REFERRAL/AUTHORIZATION
R61 X61 NO PCP REFERRAL
R65 INTERIM BILL 2ND CYCLE PAYMENT
R66 Z34 INTERIM BILL FINAL CYCLE PAYMENT
R67 X67 DISCREPANCY WITH LEVEL OF CARE-APPEAL REQUIRED
R70 X70 EPSDT SCREENING DID NOT COMPLY WITH PERIODICITY SCHEDULE
R71 X71 DUPLICATE OF PREVIOUSLY SUBMITTED EPSDT SCREENING
R72 X72 PROVIDER WAS NOT MEMBER’S PCP
R78 R78 MEMBER’S AGE NOT VALID FOR PROCEDURE CODE
R79 X79 SPECIAL PROJECT-ADJUSTMENT
R81 X81 CHARGES CONSIDERED INCLUDED IN INPATIENT ADMISSION
R84 X84 PLEASE OBTAIN INDIVIDUAL PROVIDER ID #
R86 X85 INVALID/MISSING REVENUE CODE ON CLAIM
R89 AUTHORIZATION ON FILE FOR TECHNICAL COMPONENT
R91 X91 INAPPROPRIATE CODING FOR CONTRACT AGREEMENT
R95 X95 CLAIM SUBMITTED WITHOUT PHYSICIAN NAME
R96 X96 EOB/ATTACHMENTS WERE INCOMPLETE/ILLEGIBLE
R97 X97 DATE OF SERVICE CANNOT BE GREATER THAN THE RECEIVED DATE
X12 MOTOR VEHICLE ACCIDENT - AUTO CARRIER PRIMARY
X13 WORKERS COMPENSATION PRIMARY CARRIER
X21 BILL THROUGH PHARMACY PROGRAM
X25 INCLUDED IN SETTLEMENT PAYMENT
X32 APPEAL – DENIAL UPHELD
X33 APPEAL – ORIGINAL CLAIM PAYMENT UPHELD
X35 AUTHORIZATION DENIED FOR THIS DATE OF SERVICE
X55 MEMBER AGE NOT VALID FOR DIAGNOSIS CODE
X56 CLINIC CLAIM SUBMITTED WITHOUT PHYSICIAN NAME
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