Denial code 107, 109, 110,115, 119 remark codes
| Adj. Reason Code | Adj. Reason Code Description | Remark Code | Remark Code Descripton | Exception Code Descripton |
| 107 | The related or qualifying claim/service was not identified on this claim. | N390 | This service/report cannot be billed separately. | PROLONGED SERVICES |
| MUST HAVE ANESTHESIA SERV | ||||
| CHEC PROCEDURE CODE NOT FOUND | ||||
| 107 | The related or qualifying claim/service was not identified on this claim. | MUST BILL IMMUNIZATION CODE - VFC | ||
| MUST BILL WITH D9220 | ||||
| 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | MA101 | A SNF is responsible for payment of outside providers who furnish these services/supplies to residents. | SERVICES COVERED IN ICF/MR PER DIEM |
| NH PAID A PORTION OF CLAIM AMOUNT | ||||
| 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | N103 | Social Security records indicate that this patient was a prisoner when the service was rendered. This payer does not cover items and services furnished to an individual while they are in State or local custody under a penal authority, unless under State or local law, the individual is personally liable for the cost of his or her health care while incarcerated and the State or local government pursues such debt in the same way and with the same vigor as any other debt. | ADULT CRIMINAL COURT JURISDICTION |
| JUVENILE CRIMINAL COURT JURIS. | ||||
| 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | N192 | Patient is a Medicaid/Qualified Medicare Beneficiary. | MEDICARE ELIGIBLE CLIENT, BILL PT D PLAN |
| 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | HCBS MUST BE ON TAPE | ||
| NOT EXEMPTED SUB ADOPT BILL PMHP OR DHS | ||||
| MENTAL HEALTH SERVICES | ||||
| 110 | Billing date predates service date. | MA31 | Missing/incomplete/invalid beginning and ending dates of the period billed. | SVC DATE AFTER CLAIM RECEIVED |
| 110 | Billing date predates service date. | INVALID BILLING DATE | ||
| LAST DATE OF SERV > BILLING DT | ||||
| 115 | Procedure postponed, canceled, or delayed. | RECIPIENT DID NOT ENTER NH FAC. | ||
| 119 | Benefit maximum for this time period or occurrence has been reached. | M123 | Missing/incomplete/invalid name, strength, or dosage of the drug furnished. | LONG ACTING NARCOTIC DRUG INTERACTION |
| 119 | Benefit maximum for this time period or occurrence has been reached. | M86 | Service denied because payment already made for same/similar procedure within set time frame. | HOME HLTH INITIAL VISIT > 1 PER ADMIN |
| HOME HEALTH SUPPLIES EXCEEDS ALLOWABLE | ||||
| SERVICE EXCEEDS 6 PER 12 MONTH LIMIT | ||||
| SERVICE EXCEEDS ONE PER MONTH | ||||
| LITHOTRIPSY 2 PR 90 DAY LIMIT | ||||
| LITHOTRIPSY 2 PER 90 DAYS/UB82 | ||||
| HOSPICE - 1 PER DAY LIMIT | ||||
| EXCEEDS 3 PR 3 CALENDR MNTH LMT | ||||
| SCHOOL SRVCS - 1 PER DAY | ||||
| EXCEEDS HCBS 1 PR DY LMT | ||||
| EXCEEDS 1 CASE MGMT PER DAY | ||||
| EXCEEDS X-RAY LIMITS | ||||
| 1 PER DAY LIMIT | ||||
| D7110 1 PR DAY LMT EXCD | ||||
| 119 | Benefit maximum for this time period or occurrence has been reached. | M90 | Not covered more than once in a 12 month period. | PREVENTIVE HEALTH EXAM - ONE PER YEAR |
| VISION LIMIT EXCEEDED | ||||
| 119 | Benefit maximum for this time period or occurrence has been reached. | N130 | Consult plan benefit documents/guidelines for information about restrictions for this service. | PROC CD HAS UNIT LMT |
| PCN CLIENT PRESCRIPTION LIMIT EXCEEDED | ||||
| 119 | Benefit maximum for this time period or occurrence has been reached. | N20 | Service not payable with other service rendered on the same date. | EXCEEDS XRAY LIMITS |
| 119 | Benefit maximum for this time period or occurrence has been reached. | N362 | The number of days or Units of Service exceeds our acceptable maximum. | UNIT LIMIT EXCEEDED |
| OBSERVATION SERVICES-1 PER 48 HR PERIOD | ||||
| EXCEEDS RESIDENCE LIMIT | ||||
| PROC CODE LIMITED TO 12 UNITS PER CAL YR | ||||
| LMT PR CALENDAR YR EXCEEDED | ||||
| HOSPICE UNITS EXCEED 5 | ||||
| 119 | Benefit maximum for this time period or occurrence has been reached. | N435 | Exceeds number/frequency approved/allowed within time period without support documentation. | EXCEEDS 10 PER 12 MO. REQ. MANUAL REVIEW |
| 119 | Benefit maximum for this time period or occurrence has been reached. | RESPITE CARE LIMIT | ||
| EXCEEDS 8 PER 24 MOS | ||||
| EXCEEDS DENTAL LIMIT-XRAY | ||||
| DENTAL LIMIT-2 EXAM PER YEAR | ||||
| EXCEEDS PROPHY LIMIT | ||||
| EXCEEDS SEALANT LIMIT | ||||
| EXCEEDS CROWN PREP LIMIT | ||||
| EXCEEDS CROWN LIMIT | ||||
| PERINATAL CRE CO-ORD EXCDS 1 PR 30 DYS | ||||
| RSK ASSMT EXCDS 2 PR 10 MOS | ||||
| GROUP PRE/POSTNATAL ED EXCDS 8 PR 12 MOS | ||||
| DIET COUNSL EXCEEDS 14 PER 12 MOS | ||||
| PSYCHOSOCIAL COUSL EXCEEDS 10 PER 12 MOS | ||||
| PRE/POSTNATAL HOME VSTS EXCDS 6 PR 12 MS | ||||
| PRENATAL ASSMENT VSTS EXCDS 1 PR 10 MOS | ||||
| PRENATAL VISIT EXCDS 3 PR 10 MONS | ||||
| GLOBAL MTRNTY CRE 1 PR PRGNCY | ||||
| HIGH RSK MATERNITY GLOBAL-1 PER PREGNCY | ||||
| HGH RSK PREG CNSULT EXCDS 1 PR 10 MOS | ||||
| HGH RSK PREG FLLW-UP EXCDS 2 PR 12 MOS | ||||
| EXCEEDS 2 FOLLOW-UP PHONE CONTACTS SMKG | ||||
| ORIG LINE DENIED, EXCEEDS UNIT LIMIT |
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