primary paid more than secondary allowed - Denial

0364 Primary carrier payment equals or exceeds DMAS’ allowed amount

The claim was submitted with COB code indicating there was a primary carrier which paid on this claim and that the primary carrier’s payment to you equaled or exceeded Medicaid’s allowed amount. DMAS will not reimburse you if the primary carrier payment exceeds the Medicaid allowed amount.

0017 Missing Former Reference Number

The original Internal Control Number (ICN) for claims that are being submitted to adjust or void the original PAID claim must be provided.


0077  Adjustment Denied - Original Payment Request Already  Adjusted/Voided

An adjustment or void request cannot be submitted for a payment that has been previously adjusted or voided.

0015 primary Carrier Pay Missing or Invalid

CMS-1500 – our records show there is a primary carrier and no TPL information is on the claim.

UB-04: if claim was submitted with a COB code of ‘83’ (primary carrier billed and paid) under ‘code’, the payment made by the primary carrier must be under ‘amount.”

0352  only Paid Payment Requests Can be Adjusted/Voided

Only paid payment requests can be adjusted or voided. If the claim previously denied, you must submit the claim as a new claim.

0014 Billed Amount Missing or Invalid

CMS-1500 – Billed charges should be on each line. Do not use a decimal point.

UB-04 – The billed charges must be numeric without spaces.