Health | Health Care Claim Status Code Description |
Adj. Reason | Adjustment Reason Code Description | MMIS | MMIS Edit Code Description |
| 0 | Cannot provide further status electronically. | 19 | Claim denied because this is a work-related injury/illness and thus the liability of the Workers Compensation Carrier. | 8210 | WORKER'S COMP - PROVIDER |
| 0 | Cannot provide further status electronically. | 96 | Non-covered charge(s). | X160 | PART-B CHARGES BILLED BY NH PROVIDER ARE NOT COVERED BY MEDICAID (LT). |
| 1 | For more detailed information, see remittance advice. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 606 | MISSING OR INVALID PAYER DATE |
| 1 | For more detailed information, see remittance advice. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 609 | PART A CROSSOVER SPANS 20020501 |
| 1 | For more detailed information, see remittance advice. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 643 | INVALID OTHER COVERAGE CODE |
| 1 | For more detailed information, see remittance advice. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 807 | INVALID TPL ADJUDICATION DATE |
| 1 | For more detailed information, see remittance advice. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 808 | TPL ADJUDUCATION DATE CANNOT BE A FUTURE DATE |
| 1 | For more detailed information, see remittance advice. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4252 | DIAGNOSIS CODE 10-24 NOT ON FILE |
| 1 | For more detailed information, see remittance advice. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | X116 | RECOUPMENT - THIS AMOUNT IS WITHHELD FROM YOUR CHECK |
| 1 | For more detailed information, see remittance advice. | 105 | TAX WITHHOLDING. | X117 | REFUND CHECK AMOUNT CREDITED TO YOUR IRS YEAR TOTAL. |
| 1 | For more detailed information, see remittance advice. | 105 | TAX WITHHOLDING. | X118 | RETURNED CHECK AMOUNT CREDITED TO YOUR IRS YEAR TOTAL. |
| 1 | For more detailed information, see remittance advice. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | X119 | PAYMENT AMOUNT APPLIED TO RECEIVABLE. |
| 7 | Claim may be reconsidered at a future date. | 18 | Duplicate claim/service. | 5754 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS PATIE NT |
| 7 | Claim may be reconsidered at a future date. | 18 | Duplicate claim/service. | 5755 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS PATIE NT |
| 8 | No payment due to contract/plan provisions. | 18 | Duplicate claim/service. | 6646 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 8 | No payment due to contract/plan provisions. | 18 | Duplicate claim/service. | 6671 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS RECIP IENT. |
| 8 | No payment due to contract/plan provisions. | 18 | Duplicate claim/service. | 6672 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS PATIE NT |
| 8 | No payment due to contract/plan provisions. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | X059 | MATERNITY WAIVER/CARE CLAIM MUST BE BILLED BY CONTRACT PROVIDER |
| 8 | No payment due to contract/plan provisions. | 96 | Non-covered charge(s). | X424 | MEDICAID HAS NO LIABILITY FOR THIS CLAIM SINCE MEDICARE/MEDICAID DAYS RUN CONCU RRENTLY |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X489 | THE LIMIT FOR THESE SERVICES HAS BEEN REACHED FOR THIS WAIVER YEAR. |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X559 | INPATIENT/OUTPATIENT/ASC VISITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X560 | OUTPATIENT VISITS HAVE BEEN EXCEEDED FOR THIS CALENDAR YEAR. |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X564 | THIS AMBULANCE SERVICE PROCEDURE CODE IS LIMITED TO FOUR UNITS PER CALENDAR MON TH. |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X571 | DIALYSIS ULTRAFILTRATION CODES Z5256 AND Z5266 ARE LIMITED TO A TOTAL OF 3 PER RECIPIENT. |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X574 | MORE THAN ONE CONTACT LENS FITTING CANNOT BE BILLED FOR THE SAME DATE OF SERVIC E. |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X587 | PROCEDURE LIMITED TO 720 HOURS PER CALENDAR YEAR. |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X593 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X618 | DENTAL SERVICE LIMITED TO ONCE PER TOOTH/PER LIFETIME. |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X619 | PROCEDURE CODE LIMITED TO ONCE EVERY SIX MONTHS |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X620 | PROPHYLAXIS IS LIMITED TO ONCE EVERY 6 MONTHS |
| 8 | No payment due to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X806 | BATTERIES MAY NOT BE PURCAHSED WITHIN 60 (SIXTY) DAYS OF PURCHASE OF HEARING AI D |
| 8 | No payment due to contract/plan provisions. | 132 | Prearranged demonstration project adjustment. | X953 | SPECIAL ADJUSTMENTS - PLEASE REFER TO OUR MINI MESSAGE INCLUDED IN YOUR EXPLANA TION OF PAYMENT. |
| 9 | No payment will be made for this claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7241 | SMARTSUSPENSE DENIAL |
| 9 | No payment will be made for this claim. | 30 | Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. | 9003 | NO PAYMENT MADE-TPL IS MORE THAN THE ALLOWED AMOUNT. |
| 9 | No payment will be made for this claim. | 42 | Charges exceed our fee schedule or maximum allowable amount. | X089 | MEDICARE PAID AMOUNT EQUAL TO 100%. |
| 9 | No payment will be made for this claim. | 96 | Non-covered charge(s). | X098 | SERVICE NOT COVERED BY MEDICAID. |
| 9 | No payment will be made for this claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X102 | SERVICE(S) PAST THE MAXIMUM MEDICAID FILING LIMIT |
| 9 | No payment will be made for this claim. | 96 | Non-covered charge(s). | X281 | TPL PAY AND LIST EDIT. |
| 9 | No payment will be made for this claim. | 96 | Non-covered charge(s). | X370 | THE ASSISTANT SURGEON'S FEE FOR THIS PROCEDURE IS NOT COVERED. |
| 9 | No payment will be made for this claim. | 96 | Non-covered charge(s). | X764 | THIS PROCEDURE CODE IS NOT COVERED WHEN BILLED WITH MEDICAL PSYCHOTHERAPY CODES |
| 9 | No payment will be made for this claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X824 | SALPINGECTOMY WILL NOT BE PAID ON THE SAME DAY AS A TUBAL LIGATION |
| 9 | No payment will be made for this claim. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X833 | EMERGENCY ROOM VISIT/INITIAL HOSPITAL VISIT MAY NOT BE BILLED ON THE SAME DAY |
| 9 | No payment will be made for this claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X839 | PROFESSIONAL COMPONENTS AND HOSPITAL VISITS MAY NOT BE BILLED ON THE SAME DAY |
| 9 | No payment will be made for this claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X845 | EPSDT VISION SCREEN AND EXTERNAL OCULAR PHOTOGRAPHY NOT COVERED ON THE SAME DAY |
| 9 | No payment will be made for this claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X846 | PREVOCATIONAL SERVICES AND SUPPORTED EMPLOYMENT SHALL NOT BE PAID ON THE SAME D AY |
| 9 | No payment will be made for this claim. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | X848 | THE PAYMENT FOR THIS SERVICE WAS PREVIOUSLY MADE TO ANOTHER PROVIDER OR TO ANOT HER NUMBER FOR THIS PROVIDER |
| 9 | No payment will be made for this claim. | 97 | Payment is included in the allowance for another service/procedure. | X849 | THIS PROCEDURE CANNOT BE BILLED IN ADDITION TO THE DELIVERY CODE BILLED |
| 9 | No payment will be made for this claim. | 97 | Payment is included in the allowance for another service/procedure. | X850 | BIOPSY OF OVARY MAY NOT BE BILLED WITH ANOTHER EXAM ON THE SAME DAY |
| 9 | No payment will be made for this claim. | 97 | Payment is included in the allowance for another service/procedure. | X851 | EXPLORATORY LAP/LYSIS OF ADHESIONS MAY NOT BE BILLED ON THE SAME DAY WITH OTHER RELATED SURGERY |
| 9 | No payment will be made for this claim. | 97 | Payment is included in the allowance for another service/procedure. | X852 | THIS X-RAY PROCEDURE MAY NOT BE BILLED WITHIN 30 (THIRTY) DAYS OF A ROOT CANAL |
| 9 | No payment will be made for this claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X853 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY AS Z5270, Z5271 OR Z5272 |
| 9 | No payment will be made for this claim. | 97 | Payment is included in the allowance for another service/procedure. | X854 | PALLIATIVE (EMERGENCY)TREATMENT MAY NOT BE BILLED WITH DEFINITIVE TREATMENT OR OTHER EMERGECNY PROCEDURES ON THE SAME DAY. |
| 9 | No payment will be made for this claim. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X855 | THE SAME PHYSICAIN MAY NOT BILL HOSPITAL VISIT AND DISCHARGE VISIT ON THE SAME DAY |
| 9 | No payment will be made for this claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X927 | OTC PRODUCT NOT COVERED FOR LTC RECIPIENT |
| 10 | All originally submitted procedure codes have been combined. | 97 | Payment is included in the allowance for another service/procedure. | X729 | VENIPUNCTURE AND LAB CODES ARE NOT ALLOWED ON THE SAME DAY. |
| 10 | All originally submitted procedure codes have been combined. | 97 | Payment is included in the allowance for another service/procedure. | X733 | THIS SERVICE IS INCLUDED IN THE FACILITY FEE |
| 11 | Some originally submitted procedure codes have been combined. | 97 | Payment is included in the allowance for another service/procedure. | X865 | HOSPITAL ADMISSION/VISITS MAY NOT BE BILLED ON OR AFTER OB GLOBAL |
| 12 | One or more originally submitted procedure codes have been combined. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 5352 | CLAIMS HISTORY SHOWS TOOTH HAS BEEN EXTRACTED. |
| 12 | One or more originally submitted procedure codes have been combined. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 5353 | CLAIMS HISTORY SHOWS TOOTH HAS BEEN EXTRACTED. |
| 12 | One or more originally submitted procedure codes have been combined. | 97 | Payment is included in the allowance for another service/procedure. | 5642 | ROUTINE ANCILLARY SERVICES ASSOCIATED WITH AN ABORTION ARE COVERED IN THE TOTAL ABORTION COST AND ARE NOT REIMBURSABLE SEPARATELY |
| 12 | One or more originally submitted procedure codes have been combined. | 97 | Payment is included in the allowance for another service/procedure. | 5643 | ROUTINE ANCILLARY SERVICES ASSOCIATED WITH AN ABORTION ARE COVERED IN THE TOTAL ABORTION COST AND ARE NOT REIMBURSABLE SEPARATELY |
| 12 | One or more originally submitted procedure codes have been combined. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7215 | PROCEDURE CODE IS INCIDENTAL |
| 12 | One or more originally submitted procedure codes have been combined. | 97 | Payment is included in the allowance for another service/procedure. | X105 | THIS SERVICE IS INCLUDED IN THE FACILITY FEE (REVENUE CODE 450). |
| 12 | One or more originally submitted procedure codes have been combined. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X857 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 12 | One or more originally submitted procedure codes have been combined. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X858 | COMPONENTS OF A URINALYSIS MAY NOT BE BILLED ON THE SAME DAY AS URINALYSIS |
| 12 | One or more originally submitted procedure codes have been combined. | 97 | Payment is included in the allowance for another service/procedure. | X861 | ANTEPARTUM, POSTPARTUM CARE/VAGINAL DELIVERY MAY NOT BE BILLED WITH GLOBAL OB C ARE |
| 12 | One or more originally submitted procedure codes have been combined. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X866 | COMPONENETS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 12 | One or more originally submitted procedure codes have been combined. | 119 | Benefit maximum for this time period has been reached. | X881 | PROCEDURE CODE IS LIMITED TO ONE IN A SERIES |
| 12 | One or more originally submitted procedure codes have been combined. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X882 | COMPONENETS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 12 | One or more originally submitted procedure codes have been combined. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X883 | SUBSEQUENT CRITICAL CARE NOT VALID WITHOUT INITAL CARE. |
| 15 | One or more originally submitted procedure code have been modified. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6645 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 15 | One or more originally submitted procedure code have been modified. | 6 | The procedure code is inconsistent with the patient's age. | 7212 | PROCEDURE ADDED DUE TO ALTERNATE CODE REPLACEMENT (AGE) |
| 15 | One or more originally submitted procedure code have been modified. | 7 | The procedure code is inconsistent with the patient's gender. | 7214 | PROCEDURE ADDED DUE TO ALTERNATE CODE REPLACEMENT (SEX) |
| 15 | One or more originally submitted procedure code have been modified. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7217 | PROCEDURE CODE HAS BEEN REBUNDLED |
| 15 | One or more originally submitted procedure code have been modified. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7218 | PROCEDURE ADDED DUE TO REBUNDLING |
| 15 | One or more originally submitted procedure code have been modified. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7238 | PROCEDURE ADDED DUE TO DUPLICATE REBUNDLING |
| 15 | One or more originally submitted procedure code have been modified. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7245 | PROCEDURE ADDED DUE TO NEW VISIT FREQUENCY CODE REPLACEMENT |
| 15 | One or more originally submitted procedure code have been modified. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7246 | PROCEDURE REPLACED DUE TO INTENSITY OF SERVICE REPLACEMENT |
| 15 | One or more originally submitted procedure code have been modified. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7247 | PROCEDURE ADDED DUE TO INTENSITY OF SERVICE REPLACEMENT |
| 15 | One or more originally submitted procedure code have been modified. | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7256 | MODIFIER 51 INVALID FOR PRIMARY PROCEDURE |
| 15 | One or more originally submitted procedure code have been modified. | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7257 | MODIFIER 51 MISSING FOR NON-PRIMARY PROCEDURE |
| 15 | One or more originally submitted procedure code have been modified. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X955 | THE CLAIM HAS BEEN ADJUSTED TO REFLECT CHANGES IN THE NUMBER OF UNITS BILLED AN D PAID. |
| 15 | One or more originally submitted procedure code have been modified. | 58 | Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. | X956 | THIS CLAIM HAS BEEN ADJUSTED TO REFLECT A CHANGE IN THE TYPE OF SERVICE. |
| 15 | One or more originally submitted procedure code have been modified. | B20 | Payment adjusted because procedure/service was partially or fully furnished by another provider. | X957 | THIS PAYMENT HAS BEEN RECOUPED TO ENABLE PAYMENT TO THE CORRECT PROVIDER. |
| 18 | Entity received claim/encounter, but returned invalid status. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X997 | CLAIM CONTAINS 15 OR MORE ERRORS AND THEREFORE CAN NOT BE PROCESSED AS BILLED |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 435 | MEDICARE BLOOD DEDUCTIBLE AMOUNT INVALID |
| 20 | Accepted for processing. | 100 | PAYMENT MADE TO PATIENT/INSURED/RESPONSIBLE PARTY. | 545 | PHARMACY CLAIM FILED BEYOND 365-DAY FILING |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 554 | HEADER BILLED DATE IS PRIOR TO DATES OF SERVICE |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 565 | HEADER PAID AMOUNT IS GREATER THAN BILLED AMOUNT |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 589 | ADJUSTMENT HAS AUTO DENIAL |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 595 | MANUALLY SUSPEND FOR REVIEW |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 826 | TYPE OF BILL INVALID FOR CLAIM TYPE |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1024 | BILLING PROVIDER NOT LISTED AS RECIPIENT LTC PROV |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1960 | NPI REQUIRED: ATTENDING PROVIDER (HEALTHCARE) |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1961 | NPI REQUIRED: OPERATING PROVIDER (HEALTHCARE) |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 2011 | PHARMCY MEDICAL/NON-MEDICAL SUPPL. AND ROUTINE DME |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 2590 | SYSTEM ERROR - COULD NOT ASSIGN TPL INPUT CODE |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 2591 | SYSTEM ERROR - COULD NOT ASSIGN TPL INPUT CODE |
| 20 | Accepted for processing. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 3001 | PA NOT FOUND ON DATABASE |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 3010 | OUT OF STATE PROVIDER REQUIRES PRIOR AUTHORIZATION |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 3019 | PA CUTBACK PERFORMED |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 3021 | DRG REQUIRES PA |
| 20 | Accepted for processing. | 6 | The procedure code is inconsistent with the patient's age. | 3100 | CLAIM AND PA PRESCRIBING PROV DON'T MATCH |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3104 | PA REQUIRED FOR CERTAIN TRANSPORTATION SERVICES |
| 20 | Accepted for processing. | 101 | Predetermination: anticipated payment upon completion of services or claim adjudication. | 3599 | MANUAL PRICING REQUIRED |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3800 | SERVICE COVERAGE HAS NOT BEEN DETERMINED |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3997 | BPA-RR-DRG - ANY HDR DIAGNOSIS RESTRICTION |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3998 | BPA-RR-REV - OTHER HDR DIAGNOSIS RESTRICTION |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3999 | BPA-RR-PROC - OTHER HDR DIAGNOSIS RESTRICTION |
| 20 | Accepted for processing. | 133 | The disposition of this claim/service is pending further review. | 4014 | NO PRICING SEGMENT IS ON FILE. |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 4015 | PASARR ASSESSMENT PROCEDURE FOR REVIEW |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 4027 | DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 4077 | NON-COVERED REVENUE CODE |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 4099 | DRG NOT ON FILE |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 4113 | UNIT DOSE PACKAGING COVERED FOR LTC RESIDENTS ONLY |
| 20 | Accepted for processing. | 133 | The disposition of this claim/service is pending further review. | 4114 | PRICING BEING REVIEWED |
| 20 | Accepted for processing. | 133 | The disposition of this claim/service is pending further review. | 4127 | CANNOT PRIORITIZE RECIPIENT'S PROGRAMS |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 4130 | PAYER HIERARCHY NOT FOUND |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 4131 | NO BENEFIT PLANS ASSOCIATED TO PAYER |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 4132 | DRG GROUPER UNABLE TO ASSIGN DRG FOR PRICING |
| 20 | Accepted for processing. | 6 | The procedure code is inconsistent with the patient's age. | 4164 | INACTIVE DRUG |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 4195 | PROCEDURE RESTRICTION FOR COVERED REV CODE |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 4200 | CLAIM PRICED AT ZERO |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 4208 | CLIA NUMBER NOT EFFECTIVE FOR ENTIRE SVC PERIOD |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4210 | BPA-RR-REV - ANY HDR DIAGNOSIS RESTRICTION |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 4246 | ADJUSTMENT NET PAID AMOUNT EXCEEDS THE CASH RECEIPT BALANCE |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4315 | BPA-PC-PROC - ANY HDR DIAGNOSIS RESTRICTION |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4745 | BPA-RP-PROC - DIAGNOSIS RESTRICTION |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 4967 | GENDER RESTRICTION FOR COVERED REV CODE |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5326 | CORE BUILDUP NOT COVERED WITH OTHER RESTORATION |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5327 | CORE BUILDUP NOT COVERED WITH OTHER RESTORATION |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5328 | TWO RESTORATIONS NOT COVERED FOR THE SAME TOOTH NUMBER. |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5329 | TWO RESTORATIONS NOT COVERED FOR THE SAME TOOTH NUMBER. |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5330 | TWO RESTORATIONS NOT COVERED FOR THE SAME TOOTH NUMBER SAME DATE OF SERVICE. |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5331 | TWO RESTORATIONS NOT COVERED FOR THE SAME TOOTH NUMBER SAME DATE OF SERVICE. |
| 20 | Accepted for processing. | 97 | Payment is included in the allowance for another service/procedure. | 5334 | PALLIATIVE (EMERGENCY)TREATMENT MAY NOT BE BILLED WITH DEFINITIVE TREATMENT OR OTHER EMERGECNY PROCEDURES ON THE SAME DAY. |
| 20 | Accepted for processing. | 97 | Payment is included in the allowance for another service/procedure. | 5335 | PALLIATIVE (EMERGENCY)TREATMENT MAY NOT BE BILLED WITH DEFINITIVE TREATMENT OR OTHER EMERGECNY PROCEDURES ON THE SAME DAY. |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5451 | HOME HEALTH PROVIDERS CANNOT BILL INPATIENT AND OUTPATIENT SERVICES ON THE SAME CLAIM. |
| 20 | Accepted for processing. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 5506 | PROVIDER MAY NOT BILL FOR NEWBORN RESUSCITATION UNLESS LIFE THREATENING |
| 20 | Accepted for processing. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 5507 | PROVIDER MAY NOT BILL FOR NEWBORN RESUSCITATION UNLESS LIFE THREATENING |
| 20 | Accepted for processing. | 119 | Benefit maximum for this time period has been reached. | 6154 | MAXIMUN UNIT LIMIT HAS BEEN EXCEEDED. |
| 20 | Accepted for processing. | 119 | Benefit maximum for this time period has been reached. | 6200 | THIS PROCEDURE IS LIMITED TO SIXTEEN (16) UNITS PER CALENDAR YEAR. |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6283 | REVENUE CODES 170 -171 MUST NOT EXCEED 10 UNITS UNDER MOTHER'S NUMBER. |
| 20 | Accepted for processing. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6290 | MULTIPLE URINALYSIS TESTS CANNOT BE BILLED ON THE SAME DAY |
| 20 | Accepted for processing. | 119 | Benefit maximum for this time period has been reached. | 6291 | SPECIMEN COLLECTION FEE IS LIMITED TO ONE PER DAY |
| 20 | Accepted for processing. | 119 | Benefit maximum for this time period has been reached. | 6400 | SPECIMEN COLLECTION FEE IS LIMITED TO ONE PER DAY |
| 20 | Accepted for processing. | 119 | Benefit maximum for this time period has been reached. | 6650 | THE LIMIT FOR THESE SERVICES HAS BEEN REACHED FOR THIS CONTRACT YEAR |
| 20 | Accepted for processing. | 119 | Benefit maximum for this time period has been reached. | 6651 | UNITS BILLED FOR PROCEDURE CODE EXCEED MAXIMUM UNITS ALLOWED |
| 20 | Accepted for processing. | 119 | Benefit maximum for this time period has been reached. | 6652 | UNITS BILLED FOR PROCEDURE CODE EXCEED MAXIMUM UNITS ALLOWED |
| 20 | Accepted for processing. | 133 | The disposition of this claim/service is pending further review. | 6674 | CLAIM STILL IN PROCESS. PLEASE DO NOT REBILL. |
| 20 | Accepted for processing. | 6 | The procedure code is inconsistent with the patient's age. | 7200 | MISCELLANEOUS CLAIMCHECK ERROR |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7240 | SMARTSUSPENSE SUSPEND |
| 20 | Accepted for processing. | 35 | Benefit maximum has been reached. | 7260 | MORE THAN 40 LINES WERE ELIGIBLE FOR CLAIMCHECK PROCESSING |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 7287 | DIAGNOSIS IS ELIGIBLE FOR WORKER'S COMPENSATION/AUTO PAYOR |
| 20 | Accepted for processing. | 133 | The disposition of this claim/service is pending further review. | 7288 | SMARTSUSPENSE FLAG |
| 20 | Accepted for processing. | 133 | The disposition of this claim/service is pending further review. | 7289 | SMARTSUSPENSE MONITOR |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7500 | REVIEW CLAIM FOR PAY-TO- PROVIDER |
| 20 | Accepted for processing. | 133 | The disposition of this claim/service is pending further review. | 7509 | REVIEW CLAIMS FOR THIS PROVIDER |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8000 | PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO BILLING ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8001 | PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO CHANGE IN OTHER. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8002 | PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO CHANGE IN MEDICARE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8003 | PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO KEYING ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8004 | PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO PATIENT LIABILITY. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8005 | PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO SPENDDOWN. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8006 | PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO MISCELLANEOUS ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8007 | PROVIDER REQUESTED CLAIM ADJUSTMENT DUE TO BILLING ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8008 | PROVIDER REQUESTED CLAIM ADJUSTMENT DUE TO MISC. OR UNSPECIFIED ERROR |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8019 | PROVIDER REQUESTED A FULL OFFSET DUE TO A MISCELLANEOUS OR UNSPECIFIED ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8020 | SURS INITIATED A FULL OFFSET DUE TO A DUPLICATE PAYMENT. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8021 | SURS INITIATED A FULL OFFSET DUE TO WRONG PROVIDER. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8022 | SURS INITIATED A FULL OFFSET DUE TO WRONG RECIPIENT NUMBER. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8023 | SURS INITIATED A FULL OFFSET DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8024 | SURS INITIATED A FULL OFFSET DUE TO WRONG UNITS OF SERVICE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8025 | SURS INITIATED A FULL OFFSET DUE TO WRONG PATIENT LIABILITY AMOUNT. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8026 | SURS INITIATED A FULL OFFSET DUE TO PAYMENT IN FULL FROM ANOTHER INSURANCE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8027 | SURS INITIATED A FULL OFFSET DUE TO PAYMENT IN FULL FROM MEDICARE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8028 | SURS INITIATED A FULL OFFSET DUE TO WRONG DATE(S) OF SERVICE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8039 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8040 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8041 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8042 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8043 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8045 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8046 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8047 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 8048 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8049 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8050 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8059 | PROVIDER SENT A FULL REFUND DUE TO MISCELLANEOUS OR UNSPECIFIED ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8060 | PROVIDER SENT REFUND DUE TO BILLING ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8061 | PROVIDER SENT REFUND DUE TO CLAIMS PROCESSING ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8062 | PROVIDER SENT REFUND DUE TO DUPLICATE PAYMENT. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8063 | PROVIDER SENT REFUND DUE TO EFT DEPOSIT ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8064 | PROVIDER SENT REFUND DUE TO MEDICARE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8065 | PROVIDER SENT REFUND DUE TO OFMQ REVIEW. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8066 | PROVIDER SENT REFUND DUE TO OTHER INSURANCE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8067 | PROVIDER SENT REFUND DUE TO SURS REVIEW. |
| 20 | Accepted for processing. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 8068 | PROVIDER SENT REFUND PAYMENT DUE TO SURS REVIEW. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8069 | PROVIDER SENT REFUND DUE TO LEGAL SETTLEMENT. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8081 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8082 | NON-CLAIM SPECIFIC REFUND DUE TO BILLING ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8083 | NON-CLAIM SPECIFIC REFUND DUE TO OTHER INSURANCE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8084 | NON-CLAIM SPECIFIC REFUND DUE TO SURS. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8085 | NON-CLAIM SPECIFIC REFUND DUE TO MISC OR UNSPECIFIED ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8086 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8087 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 8088 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8099 | AGENCY REQUESTED REFUND DUE TO LEGAL SETTLEMENT |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8100 | AGENCY REQUESTED REFUND DUE TO MEDICAID FRAUD. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8104 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8119 | AGENCY INITIATED OFFSET DUE TO DISPROPORTIONATE SHARE ADJUS |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8120 | AGENCY INITIATED OFFSET DUE TO DRUG REBATE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8121 | AGENCY INITIATED OFFSET DUE TO FINANCIAL MANAGEMENT DIVISION REVIEW |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8122 | AGENCY INITIATED OFFSET DUE TO FQHC |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8123 | AGENCY INITIATED OFFSET DUE TO JUVENILE JUSTICE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8124 | AGENCY INITIATED OFFSET DUE TO KEYING ERROR |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8125 | AGENCY INITIATED OFFSET DUE TO LEGAL SETTLEMENT. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8126 | AGENCY INITIATED OFFSET DUE TO MEDICAID FRAUD. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8127 | AGENCY INITIATED OFFSET DUE TO MEDICAL REVIEW. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8141 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8142 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8143 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8144 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8145 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8146 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8147 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8159 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO MEDICAL AUTHORIZATION |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8160 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO MEDICARE |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8161 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO OTHER INSURANCE |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8162 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO PATIENT LIABILITY. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8163 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO PROCESSING ERROR |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8164 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO RATE CHANGE |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8165 | AGENCY INITIATED ADDTNL PYMNT DUE TO MISC OR UNSPEC ERROR |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8166 | EDS INITIATED ADDITIONAL PAYMENT DUE TO PROCESSING ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8167 | EDS INITIATED ADJUSTMENTS DUE TO PROCESSING ERROR. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8179 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8180 | MASS ADJUSTMENT - INPATIENT HOSPITAL RATE CHANGE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8181 | MASS ADJUSTMENT - OUTPATIENT HOSPITAL RATE CHANGE |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8182 | MASS ADJUSTMENT- INDIAN HOSPITAL RATE CHANGE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8183 | MASS ADJUSTMENT - RURAL HEALTH CLINIC RATE CHANGE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8184 | MASS ADJUSTMENT - PROCEDURE CODE RATE CHANGE |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8185 | MASS ADJUSTMENT - RETROACTIVE RATE CHANGE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8186 | MASS ADJUSTMENT PROVIDER BILLING ERROR (RATE CHANGE). |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8187 | MASS ADJUSTMENT - OTHER REQUEST |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8199 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8200 | CORRECTION TO A PRIOR CLAIM |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8201 | DUPLICATE PAYMENT |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8202 | CLAIM BILLED IN ERROR |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8203 | BILLED UNDER WRONG RECIPIENT |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8204 | PRIMARY INSURANCE PAYMENT RECEIVED |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8205 | PROVIDER TO REBILL |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8206 | DUE TO MEDICARE PRIMARY |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8207 | RECOUPMENT OTHER |
| 20 | Accepted for processing. | 23 | Payment adjusted because charges have been paid by another payer. | 8220 | FULL REFUND |
| 20 | Accepted for processing. | 23 | Payment adjusted because charges have been paid by another payer. | 8221 | PARTIAL REFUND |
| 20 | Accepted for processing. | 23 | Payment adjusted because charges have been paid by another payer. | 8222 | SAVE FOR FUTURE USE |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8223 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8224 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8225 | CAPITATION - DEATH OF RECIPIENT |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8226 | CAPITATION - RECIPIENT INCARCERATED |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8229 | CAPITATION - FAMILY PLANNING |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8230 | CAPITATION - INCORRECT RATE CATEGORY |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8231 | CAPITATION - DEMOGRAPHIC CHANGE |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8232 | CAPITATION - OTHER |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8233 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8234 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 63 | Correction to a prior claim. | 8299 | ADJUSTMENT TO CROSSOVER PAID PRIOR TO AIM IMPLEMENTATION DATE. THIS CLAIM HAS BEEN MANUALLY PRICED USING THE MEDICARE COINSURANCE, DEDUCTIBLE, AND PSYCHE RED |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8300 | A PAYOUT HAS BEEN ESTABLISHED FOR THE PROVIDER. THE REIMBURSEMENT IS INCLUDED IN THE CHECKWRITE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8301 | A PAYOUT HAS BEEN ESTABLISHED FOR THE PROVIDER. THE REIMBURSEMENT HAS BEEN EXC LUDED FROM THE CHECKWRITE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8302 | A PAYOUT IS DUE TO THE PROVIDER AS A RESULT OF OVER REFUND. THE REIMBURSEMENT IS INCLUDED IN THE CHECKWRITE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8303 | A PAYOUT IS DUE TO THE PROVIDER AS A RESULT OF OVER PAYMENT. THE REIMBURSEMENT HAS BEEN EXCLUDED FROM THE CHECKWRITE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8304 | PAYOUT DUE TO ADVANCE. PAYMENT INCLUDED IN CHECKWRITE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8305 | PAYOUT DUE TO ADVANCE. PAYMENT EXCLUDED FROM CHECKWRITE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8306 | CHECK RECEIVED BY EDS FOR CLAIM ADJUSTMENT ON A PREVIOUSLY ADJUSTED CLAIM. AMO UNT OF REFUND BEING RETURNED TO PROVIDER. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8307 | PAYOUT EXCLUDED FROM CHECKWRITE. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8321 | PAYOUT DUE TO PATIENT SPENDDOWN ERROR |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8322 | PAYOUT DUE TO ENHANCED RATE-OUT OF STATE RTC SERVICES |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8323 | PAYOUT DUE TO NON-EMERGENCY TRANSPORTATION |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8324 | PAYOUT DUE TO OTHER PROGRAM. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8325 | PAYOUT DUE TO GAS SURCHARGE. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8326 | PAYOUT DUE TO CORRECTION TO ACCOUNTS RECEIVABLE PROCESSED. |
| 20 | Accepted for processing. | 52 | The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. | 8327 | PAYOUT DUE TO DHS/DDSD SUPPORTED LIVING PROGRAM AUDIT. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8328 | PAYOUT DUE TO DHS/DDSD AUDIT |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8329 | PAYOUT PROCESSED FROM STATE ONLY FUNDS |
| 20 | Accepted for processing. | 30 | Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. | 8330 | PAYOUT DUE TO ELIGIBILITY NOT ON FILE. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8331 | PAYOUT DUE TO CLAIM TOO OLD TO PROCESS |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8332 | PAYOUT DUE TO MISCELLANEOUS OR UNSPECIFIED REASON. |
| 20 | Accepted for processing. | 85 | Interest amount. | 8336 | RETROACTIVE INTEREST PAYMENT |
| 20 | Accepted for processing. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | 8399 | THIS ACTION IS THE RESULT OF A STOP PAYMENT. A MANUAL CHECK HAS BEEN ISSUED. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8400 | ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED . THE AMOUNT WILL BE DEDUCTED FROM YO UR FUTURE PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8401 | DUE TO A CHECK ADVANCE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8402 | DUE TO AN IRS LIEN, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WIL L BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8403 | DUE TO A GARNISHMENT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8404 | DUE TO A LIABILITY & CASUALTY LIEN, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED . THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8405 | DUE TO A LIEN, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8406 | DUE TO TAX ASSESSMENT (31%), AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE A MOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8407 | RELEASE OF LIEN RECEIVED BY LIEN HOLDER |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8408 | DECREASE TO ORIGINAL LIEN AMOUNT. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8409 | INCREASE TO ORIGINAL LIEN AMOUNT |
| 20 | Accepted for processing. | 85 | Interest amount. | 8410 | SAVE FOR FUTURE USE |
| 20 | Accepted for processing. | 29 | The time limit for filing has expired. | 8411 | SAVE FOR FUTURE USE |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8412 | SAVE FOR FUTURE USE |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8413 | SAVE FOR FUTURE USE |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8414 | SAVE FOR FUTURE USE |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8415 | SAVE FOR FUTURE USE . |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8419 | SAVE FOR FUTURE USE |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8420 | AS THE RESULT OF AN AUDIT DIVISION REVIEW, AN ACCOUNTS RECEIVABLE HAS BEEN ESTA BLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8421 | AS THE RESULT OF CLAIMS PROCESSING ERROR, AN ACCOUNTS RECEIVABLE HAS BEEN ESTAB LISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8424 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO DHS/CHILD WELFARE. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8427 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO DRUG REBATE.. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8428 | AS THE RESULT OF A FINANCIAL MANAGEMENT REVIEW, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8429 | AS THE RESULT OF A LEGAL SETTLEMENT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHE D. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8430 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO LONG TERM CARE FACILITY CLAI M PROCESSING ERROR. |
| 20 | Accepted for processing. | 85 | Interest amount. | 8431 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO MANAGED CARE ADJUSTMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8432 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO MEDICAID FRAUD. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8433 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO MEDICAL DIVISION REVIEW. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8434 | AS THE RESULT OF AN OFMQ REVIEW, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. T HE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8435 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO PATIENT LIABILITY ERROR. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8436 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO PATIENT SPENDDOWN ERROR. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8437 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO PHARMACY DIVISION REVIEW. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8438 | AS THE RESULT OF A SURS AUDIT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8439 | AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO THIRD PARTY LIABILITY. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8440 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8441 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8442 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8443 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8444 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8445 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8446 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8447 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8448 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8449 | SAVE FOR FUTURE USE. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8451 | DUE TO AN ADJUSTMENT SUBMITTED BY PROVIDER FOR A CLAIM TOO OLD TO PROCESS, AN A CCOUNT RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR P AYMENTS. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8500 | PAYMENT WITHHELD DUE TO A LIEN THAT WAS ESTABLISHED FROM A COURT ORDER. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8501 | PAYMENT WITHHELD DUE TO AN IRS LEVY ESTABLISHED. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8502 | PAYMENT WITHHELD DUE TO A LIEN THAT WAS ESTABLISHED FROM OTHER LEGAL ENTITY. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8510 | CYCLE ACTIVITY |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8511 | DECREASE TO ORIGINAL LIEN AMOUNT RECEIVED BY LIEN HOLDER. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8512 | DECREASE TO ORIGINAL LIEN AMOUNT DUE TO PAYMENT RECEIVED. |
| 20 | Accepted for processing. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8513 | INCREASE TO ORIGINAL LIEN AMOUNT RECEIVED BY LIEN HOLDER. |
| 20 | Accepted for processing. | 123 | Payer refund due to overpayment. | 8514 | RELEASE OF LIEN RECEIVED BY LIEN HOLDER. |
| 20 | Accepted for processing. | A1 | Claim denied charges. | 8515 | THIS CLAIM HAS BEEN DENIED DUE TO A POS REVERSAL TRANSACTION. |
| 20 | Accepted for processing. | 133 | The disposition of this claim/service is pending further review. | 8998 | CLAIM BEING REVIEWED |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9500 | COVERED DAYS ON THIS CLAIM HAVE BEEN SYSTEMATICALLY REDUCED TO MEET THE ALLOWED |
| 20 | Accepted for processing. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9501 | PRICING ADJUSTMENT - MEDICARE IP PRICING APPLIED |
| 20 | Accepted for processing. | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | 9907 | TPL AMOUNT APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9908 | PRICING ADJUSTMENT - PHARMACY PRICING APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9910 | PHARMACY DISPENSING FEE APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9911 | PRICING ADJUSTMENT - LONG TERM CARE PRICING APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9916 | PRICING ADJUSTMENT - UCC RATE PRICING APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9917 | PRICING ADJUSTMENT - PREVAILING FEE PRICING APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9918 | PRICING ADJUSTMENT - MAX FEE PRICING APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9919 | PRICING ADJUSTMENT - PROVIDER LOC PRICING APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9921 | PRICING ADJUSTMENT - PA PRICING APPLIED |
| 20 | Accepted for processing. | 142 | Claim adjusted by the monthly Medicaid patient liability amount. | 9922 | PAYMENT REDUCED DUE TO PATIENT LIABILITY DEDUCTION. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9930 | PRICING ADJUSTMENT - ENCOUNTER RATE PRICING APPLIED |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9935 | PRICING ADJUSTMENT - MAX FLAT FEE PRICING APPLIED |
| 20 | Accepted for processing. | 142 | Claim adjusted by the monthly Medicaid patient liability amount. | 9996 | PAYMENT REDUCED DUE TO PATIENT LIABILITY DEDUCTION. |
| 20 | Accepted for processing. | 142 | Claim adjusted by the monthly Medicaid patient liability amount. | 9997 | PERSONAL RESOURCES DEDUCTED FROM THE CLAIM ARE A RESULT OF PREVIOUS RESOURCES C OLLECTED FOR THE RECIPIENT IN THE SAME MONTH. |
| 20 | Accepted for processing. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9998 | CLAIM WAS PRICED IN ACCORDANCE WITH MEDICAID POLICY |
| 20 | Accepted for processing. | 92 | Claim Paid in full. | 9999 | PROCESSED PER MEDICAID POLICY |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 210 | BRAND MEDICALLY NECESSARY INDICATOR INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 350 | THE NUMBER OF DETAILS IS NOT EQUAL TO THE SUBMITTED DETAIL COUNT. |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 363 | PRINCIPAL ICD9 PROCEDURE CODE IS INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 366 | FIRST OTHER PROCEDURE CODE INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 369 | SECOND OTHER PROCEDURE CODE INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 372 | THIRD OTHER PROCEDURE CODE INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 375 | FOURTH OTHER PROCEDURE CODE INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 378 | FIFTH OTHER PROCEDURE CODE INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 455 | DENTAL PREDETERMINATION OF BENEFITS NOT ALLOWED |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 456 | INVALID PROCEDURE TYPE ACC. TO PROCEDURE QUALIFIER |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 457 | INVALID PRINCIPAL/OTHER PROCEDURE TYPE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 460 | THE ATTACHMENT TYPE IS NOT VALID. |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 473 | ICD9 PROCEDURE 7-24 INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 476 | DETAIL ATTENDING PHYSICIAN ID INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 477 | DETAIL FIRST OTHER PHYSICIAN ID INVALID |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 480 | THE ATTACHMENT TYPE IS NOT VALID. |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 510 | 1ST OCCURRENCE SPAN FROM DATE IS AFTER THE TO DATE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 511 | 2ND OCCURRENCE SPAN FROM DATE IS AFTER THE TO DATE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 526 | DETAIL DATES NOT WITHIN HEADER DATES |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 581 | SPAN THRU DATE LESS THAN SPAN FROM DATE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 599 | ATTACHMENT CONTROL NUMBER MISSING |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 603 | ATTACHMENT BEING SENT BY PROVIDER FOR AN ELECTRONIC CLAIM. |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 605 | FROM DATE IS AFTER TO DATE FOR SPAN OCC. 3-24 |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 607 | ATTACHMENT BEING SENT BY PROVIDER FOR AN ELECTRONIC CLAIM. |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 652 | MISSING OR INVALID OTHER PAYER COVERAGE TYPE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1007 | RENDERING PROVIDER IDENTIFIER NOT ON FILE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1018 | CLINIC RATE NOT ON FILE FOR HOSPITAL |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1051 | RENDERING PROVIDER NOT ON PROVIDER DATABASE (HDR) |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1052 | OTHER-2 (REFERRING) PROVIDER ID NOT ON FILE - DTL |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1053 | OTHER-1 (OPERATING) PROVIDER ID NOT ON FILE - DTL |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1055 | DTL REFERRING PROV NOT ON FILE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1058 | NO PAY TO PROVIDER RECORD FOR CROSSOVER CLAIM |
| 21 | Missing or invalid information. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 4000 | MORE THAN TWO SURGICAL UNITS ON THE CLAIM |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4053 | PRINCIPAL PROCEDURE CODE NOT ON FILE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4054 | FIRST OTHER PROCEDURE CODE NOT ON FILE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4055 | SECOND OTHER PROCEDURE CODE NOT ON FILE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4056 | THIRD OTHER PROCEDURE CODE NOT ON FILE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4057 | FOURTH OTHER PROCEDURE CODE NOT ON FILE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4058 | FIFTH OTHER PROCEDURE CODE NOT ON FILE |
| 21 | Missing or invalid information. | 96 | Non-covered charge(s). | 4089 | MISSING OR INVALID SURGERY CODE-PLEASE VERIFY TO SEE IF HCPC CODE CAN BE BILLED WITH THE SURGERY REVENUE CODE AND RESUBMIT |
| 21 | Missing or invalid information. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 4095 | NONSURGICAL SERVICES ARE NOT REIMBURSED INDIVIDUAL |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4128 | ICD9 PROCEDURE 7-24 NOT ON FILE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4237 | INVALID TYPE OF LEAVE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4240 | THIS PROCEDURE MUST BE BILLED SEPARATELY EACH DATE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4251 | DECIMAL UNITS NOT BILLABLE FOR PROCEDURE. |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5202 | CHEMOTHERAPY ADMINISTRATION FEE MAY NOT BE BILLED ON THES AME DAY AS THIS PROCE DURE |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5203 | CHEMOTHERAPY ADMINISTRATION FEE MAY NOT BE BILLED ON THES AME DAY AS THIS PROCE DURE |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5204 | VENIPUNCTURE AND LAB CODES ARE NOT ALLOWED ON THE SAME DAY. |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5205 | VENIPUNCTURE AND LAB CODES ARE NOT ALLOWED ON THE SAME DAY. |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5208 | ADMINISTRATION FEE MAY NOT BE BILLED ON THE SAME DAY AS THIS PROCEDURE CODE. |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5209 | ADMINISTRATION FEE MAY NOT BE BILLED ON THE SAME DAY AS THIS PROCEDURE CODE. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5210 | OUTPATIENT CHEMOTHERAPY AND EMERGENCY DEPARTMENT SERVICE CODES MAY NOT BE BILLE D ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5211 | OUTPATIENT CHEMOTHERAPY AND EMERGENCY DEPARTMENT SERVICE CODES MAY NOT BE BILLE D ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5214 | PROCEDURE CODE NOT ALLOWED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5232 | DAILY MANAGEMENT OF AN EPIDURAL OR SUBARACHNOID CATHETER MAYNOT BE BILLED ON TH E SAME DAY AS A PROCEDURE FOR CATHETHER PLACEMENT. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5233 | DAILY MANAGEMENT OF AN EPIDURAL OR SUBARACHNOID CATHETER MAYNOT BE BILLED ON TH E SAME DAY AS A PROCEDURE FOR CATHETHER PLACEMENT. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5262 | PROCEDURE CODES 92553, 92556 AND 92557 CANNOT BE BILLED ON THE SAME DAY BY THE SAME OR DIFFERENT PROVIDER |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5270 | CLINIC CODES Z5145-Z5149 CANNOT BE BILLED ON THE SAME DAY WITH SAME UNIQUE NUMB ER AS 99241-99245 AND 99281-99285 ER AS 99241-99245 AND 99281-99286 ER AS 99241-99245 AND 99281-99287 |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5271 | CLINIC CODES AND E&M CODES CANNOT BE BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5280 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5281 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5282 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5283 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5284 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | 119 | Benefit maximum for this time period has been reached. | 5338 | ORAL EXAM EVALUATIONS ARE LIMITED TO ONE PER DAY. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5354 | TEMPORARY FILLING NOT PAYABLE ON SAME DATE OF SERVICE AS DEFINITIVE FILLING |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5355 | TEMPORARY FILLING NOT PAYABLE ON SAME DATE OF SERVICE AS DEFINITIVE FILLING |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5436 | SALPINGECTOMY WILL NOT BE PAID ON THE SAME DAY AS A TUBAL LIGATION |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5437 | SALPINGECTOMY WILL NOT BE PAID ON THE SAME DAY AS A TUBAL LIGATION |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5472 | CHEMISTRY PROFILE AND CHEMICAL PANEL CANNOT BE BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5473 | CHEMISTRY PROFILE AND CHEMICAL PANEL CANNOT BE BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5474 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5475 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5476 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5477 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5478 | COMPONENTS OF A URINALYSIS MAY NOT BE BILLED ON THE SAME DAY AS URINALYSIS |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5479 | COMPONENTS OF A URINALYSIS MAY NOT BE BILLED ON THE SAME DAY AS URINALYSIS |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5480 | COMPONENETS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5481 | COMPONENETS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5482 | COMPONENETS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5483 | COMPONENETS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 5484 | LAB SERVICES MUST BE BILLED WITH COMBINATION CODE. SEE CPT. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 5486 | CHEMISTRY PROFILES MUST BE BILLED USING ONE MULTICHANNEL TEST CODE |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5488 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | 18 | Duplicate claim/service. | 5500 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | 18 | Duplicate claim/service. | 5501 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5502 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5503 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5512 | PRENATAL VISIT NOT BE COVERED ON THE SAME DAY AS POSTPARTUM VISIT. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5513 | PRENATAL VISIT NOT BE COVERED ON THE SAME DAY AS POSTPARTUM VISIT. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5600 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY AS CRITICAL CARE |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5601 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY AS CRITICAL CARE |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5602 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5603 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5610 | PROCEDURE CODES 95115, 95117 OR Z4998 SHALL NOT BE PAID ON THE SAME DAY AS PROC EDURE CODES 95120 - 95134. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5611 | PROFESSIONAL SERVICES ARE INCLUDED IN THE PROVISION OF THE EXTRACT. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5612 | PROCEDURE CODES 95120-95134 WILL NOT BE PAID ON THE SAME DAY AS PROCEDURE CODES 95135-95170 95135-95171 95135-95172 |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5613 | PROCEDURE CODES 95120-95134 WILL NOT BE PAID ON THE SAME DAY AS PROCEDURE CODES 95135-95170 95135-95171 95135-95172 |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5614 | PROCEDURE NOT COVERED WHEN BILLED WITH PROCEDURE CODES 90918-90947 |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5615 | PROCEDURE NOT COVERED WHEN BILLED WITH PROCEDURE CODES 90918-90947 |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5616 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY AS CRITICAL CARE |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5617 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY AS CRITICAL CARE |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5618 | THE SAME PHYSICIAN MAY NOT BILL INTUBATION AND NEWBORN RESUSCITATION ON THE SAM E DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5619 | THE SAME PHYSICIAN MAY NOT BILL INTUBATION AND NEWBORN RESUSCITATION ON THE SAM E DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5620 | STANDBY/RESUCITATION/ATTENDANCE AT DELIVERY CANNOT BE BILLEDTOGETHER. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5621 | STANDBY/RESUCITATION/ATTENDANCE AT DELIVERY CANNOT BE BILLED TOGETHER. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5622 | ELECTROSHOCK THERAPY MAY NOT BE ON THE SAME DAY AS A HOSPITAL VISIT |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5623 | ELECTROSHOCK THERAPY MAY NOT BE ON THE SAME DAY AS A HOSPITAL VISIT |
| 21 | Missing or invalid information. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5624 | EMERGENCY ROOM VISIT/INITIAL HOSPITAL VISIT MAY NOT BE BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5625 | EMERGENCY ROOM VISIT/INITIAL HOSPITAL VISIT MAY NOT BE BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5626 | PROFESSIONAL COMPONENTS AND HOSPITAL VISITS MAY NOT BE BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5627 | PROFESSIONAL COMPONENTS AND HOSPITAL VISITS MAY NOT BE BILLED ON THE SAME DAY |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5630 | INCIDENTAL SURGERY MAY NOT BE BILLED WITH DEFINITIVE SURGERY ON THE SAME DAY. |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5631 | INCIDENTAL SURGERY MAY NOT BE BILLED WITH DEFINITIVE SURGERY ON THE SAME DAY. |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5632 | EXPLORATORY LAP/LYSIS OF ADHESIONS MAY NOT BE BILLED ON THE SAME DAY WITH OTHER RELATED SURGERY |
| 21 | Missing or invalid information. | 97 | Payment is included in the allowance for another service/procedure. | 5633 | INCIDENTAL SURGERY NOT COVERED WITH DEFINITIVE SURGERY ON THE SAME DAY |
| 21 | Missing or invalid information. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5634 | THE SAME PHYSICAIN MAY NOT BILL HOSPITAL VISIT AND DISCHARGE VISIT ON THE SAME DAY |
| 21 | Missing or invalid information. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5635 | THE SAME PHYSICAIN MAY NOT BILL HOSPITAL VISIT AND DISCHARGE VISIT ON THE SAME DAY |
| 21 | Missing or invalid information. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5640 | SUBSEQUENT HOSPITAL CARE MAY NOT BE BILLED ON SAME DAY AS INITIAL HOSPITAL CARE |
| 21 | Missing or invalid information. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5641 | SUBSEQUENT HOSPITAL CARE MAY NOT BE BILLED ON SAME DAY AS INITIAL HOSPITAL CARE |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5648 | PROCEDURE CODES NOT ALLOWED ON THE SAME DAY (95130- 95134) |
| 21 | Missing or invalid information. | 18 | Duplicate claim/service. | 5658 | A CARDIOLOGIST OR A RADIOLOGIST CANNOT BILL THIS PROCEDURE CODE ON THE SAME DAY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5791 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5802 | PREVOCATIONAL SERVICES AND SUPPORTED EMPLOYMENT SHALL NOT BE PAID ON THE SAME D AY |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5803 | PREVOCATIONAL SERVICES AND SUPPORTED EMPLOYMENT SHALL NOT BE PAID ON THE SAME D AY |
| 21 | Missing or invalid information. | 119 | Benefit maximum for this time period has been reached. | 6180 | THE ALLOWED LENS LIMITATION HAS BEEN EXCEEDED |
| 21 | Missing or invalid information. | 14 | The date of birth follows the date of service. | 7262 | DOB CANNOT BE GREATER THAN DATE OF SERVICE |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7263 | DOS REQUIRED FOR PROCEDURE |
| 21 | Missing or invalid information. | 110 | BILLING DATE PREDATES SERVICE DATE. | 7264 | DOS CANNOT BE A FUTURE DATE |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7279 | INVALID AMOUNT CHARGED |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X030 | UNIT(S) BILLED IS MISSING OR INVALID. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X044 | MEDICARE PAID AMOUNT IS MISSING OR INVALID. |
| 21 | Missing or invalid information. | 2 | Coinsurance Amount | X047 | THE COINSURANCE AMOUNT IS INVALID. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X051 | PATIENT STATUS INVALID. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X057 | TEN UNITS OF CODE Z5294 MUST BE BILLED PRIOR TO ANY UNITS OF Z5295. |
| 21 | Missing or invalid information. | 8 | The procedure code is inconsistent with the provider type. | X064 | INVALID PROCEDURE FOR FQHC CROSSOVER CLAIMS |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X099 | MEDICARE DEDUCTIBLE AMOUNT IS INVALID. |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X103 | THERAPY CODE PAYABLE ONLY WITH THERAPEUTIC TREATMENT. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X123 | ORAL CAVITY DESIGNATION CODE INVALID |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X151 | REVENUE/PROCEDURE CODE/NDC IS INVALID FOR DOS. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X152 | PROCEDURE CODE, REVENUE CODE, OR NDC IS NOT ON MEDICAIDS' FILE. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X295 | PRODUCTION PROVIDER CANNOT BILL CLAIMS FOR TEST RECIPIENT/TEST PROVIDER CANNOT BILL CLAIMS FOR PRODUCTION RECIPIENT |
| 21 | Missing or invalid information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X447 | DAILY MANAGEMENT OF AN EPIDURAL OR SUBARACHNOID CATHETER MAYNOT BE BILLED ON TH E SAME DAY AS A PROCEDURE FOR CATHETHER PLACEMENT. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X612 | CHANGING THE RESPONSE FROM 3 (INVALID) TO A BLANK |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X909 | THE CLAIM NET CHARGE IS MISSING, CALCULATED INCORRECTLY OR EQUAL TO ZERO |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X910 | EPSDT INDICATOR IS INVALID. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X915 | EMPLOYMENT INDICATOR INVALID. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X918 | OCCURRENCE CODE 1, 2, 3, 4 OR 5 IS NOT BETWEEN FROM AND TO DATES OF SERVICE. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X919 | THE OCCURRENCE DATES ARE INVALID OR A FUTURE DATE. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X920 | OCCURRANCE DATE 1, 2, 3, 4, OR 5 IS NOT BETWEEN FROM AND TO DOS. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X921 | CONDITION CODES ARE INVALID. REFER TO ALABAMA MEDICAID GUIDELINES. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X923 | SURGERY, OCCURRENCE, AND/OR CONDITION COUNT IS MISSING OR INVALID. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X924 | OCCURRENCE SPAN CODE IS INVALID. |
| 21 | Missing or invalid information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X925 | OCCURRENCE SPAN DATE IS INVALID. |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X931 | MISSING/INVALID SERVICE PROVIDER ID QUALIFIER |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X932 | MISSING/INVALID INSURANCE SEGMENT |
| 21 | Missing or invalid information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X933 | MISSING/INVALID CLAIM SEGMENT |
| 24 | Entity not approved as an electronic submitter. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X220 | PROVIDER HAS NOT BEEN APPROVED TO BILL ELECTRONIC MEDIA CLAIMS. |
| 26 | Entity not found. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 202 | BILLING PROVIDER ID IN INVALID FORMAT |
| 26 | Entity not found. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 206 | PRESCRIBING PROVIDER NUMBER NOT IN VALID FORMAT |
| 26 | Entity not found. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 231 | CLAIM WAS FILED WITHOUT SERVICING PROVIDER |
| 26 | Entity not found. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 381 | ATTENDING PHYSICIAN PROVIDER NUMBER MISSING |
| 26 | Entity not found. | 100 | PAYMENT MADE TO PATIENT/INSURED/RESPONSIBLE PARTY. | 1027 | REFERRING PROVIDER NOT FOUND |
| 26 | Entity not found. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1054 | ATTENDING PROVIDER NOT FOUND |
| 29 | Subscriber and policy number/contract number mismatched. | 31 | Claim denied as patient cannot be identified as our insured. | X250 | THE RECIPIENT'S 13-DIGIT MEDICAID NUMBER IS MISSING OR INVALID |
| 30 | Subscriber and subscriber id mismatched. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X025 | UNBORN RECIPIENT'S MEDICAID NUMBER SHOULD BE USED ONLY FOR INFANT SERVICES |
| 30 | Subscriber and subscriber id mismatched. | 31 | Claim denied as patient cannot be identified as our insured. | X256 | THE RECIPIENT'S 13-DIGIT MEDICAID NUMBER IS MISSING OR INVALID |
| 31 | Subscriber and policyholder name mismatched. | 140 | Patient/Insured health identification number and name do not match. | X259 | THE RECIPIENT NAME ON THIS CLAIM DOES NOT MATCH THE NAME ON FILE FOR MEDICAID N UMBER SHOWN |
| 32 | Subscriber and policy number/contract number not found. | 140 | Patient/Insured health identification number and name do not match. | X393 | RECIPIENT'S MEDICAID NUMBER DOES NOT MATCH THE MEDICAID NUMBER ON THE PA FILE. |
| 33 | Subscriber and subscriber id not found. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 238 | RECIPIENT NAME IS MISSING |
| 35 | Claim/encounter not found. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 3018 | STOP LOSS THRESHOLD REACHED - ENCOUNTER CLAIMS |
| 35 | Claim/encounter not found. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X952 | PREVIOUSLY ALERTED CLAIM CANNOT BE OVERRIDDEN. |
| 38 | Awaiting next periodic adjudication cycle. | 133 | The disposition of this claim/service is pending further review. | X427 | CLAIM STILL IN PROCESS. PLEASE DO NOT REBILL. |
| 38 | Awaiting next periodic adjudication cycle. | 96 | Non-covered charge(s). | X998 | CLAIM HAS BEEN SUSPENDED TEMPORARILY AND WILL RELEASE NEXT CYCLE. |
| 38 | Awaiting next periodic adjudication cycle. | 96 | Non-covered charge(s). | X999 | THIS ERROR IS ON AUTO-RECYCLE |
| 39 | Charges for pregnancy deferred until delivery. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X090 | GLOBAL DELIVERY PROCEDURE CODE CANNOT BE SPAN DATED. USE DATE OF DELIVERY. |
| 41 | Special handling required at payer site. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X038 | PRICING FILE INDICATES ZERO PRICE. CALL EDS. |
| 41 | Special handling required at payer site. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X251 | RECIPIENT HAS AN UNUSABLE RECORD. CONTACT EDS. |
| 41 | Special handling required at payer site. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X954 | THE CLAIM HAS BEEN ADJUSTED TO REFLECT A CHANGE IN CODES AS BILLED. |
| 46 | Internal review/audit. | 133 | The disposition of this claim/service is pending further review. | X426 | CLAIM IN PROCESS DUE TO REVIEW OF CLAIM HISTORY. PLEASE DO NOT RESUBMIT. |
| 46 | Internal review/audit. | 133 | The disposition of this claim/service is pending further review. | X430 | PLEASE DO NOT REBILL. CLAIM IS BEING REVIEWED BY MEDICAL CONSULTANT. |
| 46 | Internal review/audit. | 96 | Non-covered charge(s). | X977 | ADJUSTMENT/RECOUPMENT DUE TO SURVEILLANCE/UTILIZATION REVIEW. |
| 48 | Referral/authorization. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 3003 | PROCEDURE REQUIRES PRIOR AUTHORIZATION |
| 48 | Referral/authorization. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 3006 | PRIOR AUTH UNITS/AMOUNTS USED |
| 48 | Referral/authorization. | 15 | Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. | X023 | ORGAN TRANSPLANTS (EXCEPT CORNEA) REQUIRE PRIOR AUTHORIZATION. CONTACT ALABAMA MEDICIAD. |
| 48 | Referral/authorization. | 38 | Services not provided or authorized by designated (network) providers. | X107 | RECIPIENT ENROLLED IN THE PATIENT 1ST PROGRAM; SERVICES REQUIRE REFERRAL FROM P MP. |
| 48 | Referral/authorization. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X233 | THE REFERRING PROVIDER IS NOT ON FILE OR IS NOT A VALID REFERRING PROVIDER. |
| 48 | Referral/authorization. | 15 | Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. | X389 | CLAIM WAS DENIED BECAUSE EDS HAD NO RECORD OF THE PRIOR AUTHORIZATION. |
| 48 | Referral/authorization. | 15 | Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. | X390 | PROVIDER NUMBER ON CLAIM DOES NOT MATCH PROVIDER NUMBER ON PA FILE. |
| 48 | Referral/authorization. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | X391 | THE DOS SPANS A PA CHANGE. CALL EDS PROVIDER ASSISTANCE CENTER AT 1-800-688-798 9 FOR ASSISTANCE. |
| 48 | Referral/authorization. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | X392 | UNITS OF SERVICE EXCEED THE AUTHORIZED UNITS ON THE PA FILE. |
| 48 | Referral/authorization. | 15 | Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. | X397 | PRIOR AUTHORIZATION NUMBER SHOWN ON THE CLAIM IS INVALID. |
| 48 | Referral/authorization. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | X398 | CLAIM ALLOWED CHARGE IS MORE THAN THE AUTHORIZED AMOUNT ON THE PA FILE. |
| 48 | Referral/authorization. | 15 | Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. | X399 | SERVICE REQUIRES PA. |
| 48 | Referral/authorization. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | X420 | QTY DISPENSED EXCEEDS UNITS/DAY PA(PA BEGIN DATE). |
| 48 | Referral/authorization. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X902 | MEDICAID BILLING AUTHORIZATION FORM (XIX - TPD - 1 - 76) IS REQUIRED FOR THIS C LAIM |
| 49 | Pending provider accreditation review. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X218 | PERFORMING PROVIDER IDENTIFIED FOR PURGE. CALL EDS AT 1-888-223-3630 TO UPDATE YOUR RECORDS. |
| 49 | Pending provider accreditation review. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X219 | BILLING PROVIDER IDENTIFIED FOR PURGE. CALL EDS AT 1-888-223-3630 TO UPDATE YOU R RECORDS. |
| 50 | Claim waiting for internal provider verification. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | 1049 | BILLING PROVIDER ENROLLMENT STATUS INVALID |
| 50 | Claim waiting for internal provider verification. | 133 | The disposition of this claim/service is pending further review. | X425 | PROVIDER ELIGIBILITY DETERMINATIN IS BEING MADE. PLEASE DO NOT REBILL. |
| 52 | Investigating existence of other insurance coverage. | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | 2507 | THIS PATIENT HAS TWO COVERAGE TYPES |
| 52 | Investigating existence of other insurance coverage. | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | 2512 | HMO CO-PAY/NO TPL OR MEDICARE COVERAGE |
| 52 | Investigating existence of other insurance coverage. | B20 | Payment adjusted because procedure/service was partially or fully furnished by another provider. | 7251 | PROCEDURE IS ELIGIBLE FOR WORKER'S COMPENSATION/AUTO PAYOR |
| 52 | Investigating existence of other insurance coverage. | B20 | Payment adjusted because procedure/service was partially or fully furnished by another provider. | 7252 | DIAGNOSIS 1 HAS BEEN DETECTED AS BEING ELIGIBLE FOR THIRD PARTY PAYOR BY CLAIMC |
| 52 | Investigating existence of other insurance coverage. | B20 | Payment adjusted because procedure/service was partially or fully furnished by another provider. | 7253 | DIAGNOSIS 2 HAS BEEN DETECTED AS BEING ELIGIBLE FOR THIRD PARTY PAYOR BY CLAIMC |
| 52 | Investigating existence of other insurance coverage. | B20 | Payment adjusted because procedure/service was partially or fully furnished by another provider. | 7254 | DIAGNOSIS 3 HAS BEEN DETECTED AS BEING ELIGIBLE FOR THIRD PARTY PAYOR BY CLAIMC |
| 52 | Investigating existence of other insurance coverage. | B20 | Payment adjusted because procedure/service was partially or fully furnished by another provider. | 7255 | DIAGNOSIS 4 HAS BEEN DETECTED AS BEING ELIGIBLE FOR THIRD PARTY PAYOR BY CLAIMC |
| 52 | Investigating existence of other insurance coverage. | B20 | Payment adjusted because procedure/service was partially or fully furnished by another provider. | 7285 | PROCEDURE IS ELIGIBLE FOR WORKER'S COMPENSATION/AUTO PAYOR |
| 52 | Investigating existence of other insurance coverage. | B20 | Payment adjusted because procedure/service was partially or fully furnished by another provider. | 7286 | DIAGNOSIS IS ELIGIBLE FOR WORKER'S COMPENSATION/AUTO PAYOR |
| 52 | Investigating existence of other insurance coverage. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | X428 | THIRD PARTY LIABILITY SUSPECT. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5000 | OUR RECORDS SHOW THIS SERVICE HAS ALREADY BEEN PAID FOR THE DATE OF SERVICE BIL LED. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5001 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5010 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5012 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5013 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5014 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5015 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5016 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5020 | SUSPECT DUPLICATE OF ANOTHER PHARMACY CLAIM. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5021 | EXACT DUPLICATE OF ANOTHER PHARMACY CLAIM. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 5022 | DUPLICATE RX CODE FOR SAME DATE OF SERVICE. |
| 54 | Duplicate of a previously processed claim/line. | 97 | Payment is included in the allowance for another service/procedure. | 5460 | PROCEDURE CODE IS PART OF THE OUTPATIENT SURGICAL PROCEDURE REIMBURSEMENT. |
| 54 | Duplicate of a previously processed claim/line. | 97 | Payment is included in the allowance for another service/procedure. | 5461 | PROCEDURE CODE IS PART OF THE OUTPATIENT SURGICAL PROCEDURE REIMBURSEMENT. |
| 54 | Duplicate of a previously processed claim/line. | 97 | Payment is included in the allowance for another service/procedure. | 5608 | SAME PROVIDER CANNOT BILL APPLICATION/REMOVAL/REPAIR OF CAST FOR THE SAME RECIP IENT. |
| 54 | Duplicate of a previously processed claim/line. | 97 | Payment is included in the allowance for another service/procedure. | 5609 | SAME PROVIDER CANNOT BILL APPLICATION/REMOVAL/REPAIR OF CAST FOR THE SAME RECIP IENT. |
| 54 | Duplicate of a previously processed claim/line. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | 5628 | THE PAYMENT FOR THIS SERVICE WAS PREVIOUSLY MADE TO ANOTHER PROVIDER OR TO ANOT HER NUMBER FOR THIS PROVIDER |
| 54 | Duplicate of a previously processed claim/line. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | 5629 | THE PAYMENT FOR THIS SERVICE WAS PREVIOUSLY MADE TO ANOTHER PROVIDER OR TO ANOT HER NUMBER FOR THIS PROVIDER |
| 54 | Duplicate of a previously processed claim/line. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5650 | ONLY ONE OUTPATIENT OBSERVATION VISIT MAY BE BILLED PER DAY |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | 5654 | PROCEDURE CODE IS LIMITED TO ONE IN A SERIES |
| 54 | Duplicate of a previously processed claim/line. | 96 | Non-covered charge(s). | 5730 | THIS PROCEDURE CODE IS NOT COVERED WHEN BILLED WITH MEDICAL PSYCHOTHERAPY CODES |
| 54 | Duplicate of a previously processed claim/line. | 96 | Non-covered charge(s). | 5731 | THIS PROCEDURE CODE IS NOT COVERED WHEN BILLED WITH MEDICAL PSYCHOTHERAPY CODES |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | 5815 | VISION AND HEARING SCREENING MUST BE BILLED WITH A REGULAR SCREENING AND ARE LI MITED TO ONCE PER YEAR |
| 54 | Duplicate of a previously processed claim/line. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5830 | PROCEDURE IS NOT PAYABLE WHEN BILLED WITHOUT A PAID ROOT CANAL FOR THE SAME TOO TH NUMBER. |
| 54 | Duplicate of a previously processed claim/line. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5831 | MEDICAID'S RECORD DO NOT SHOW A ROOT CANAL PAYMENT THEREFORE THIS PROCEDURE COD E IS NOT COVERED. |
| 54 | Duplicate of a previously processed claim/line. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5832 | MEDICAID'S RECORD DO NOT SHOW A ROOT CANAL PAYMENT THEREFORE THIS PROCEDURE COD E IS NOT COVERED. |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | 6030 | NEW PATIENT CODE Z5147 MAY ONLY BE BILLED ONCE PER LIFETIME PER RECIPIENT |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | 6204 | INITIAL VISIT IS LIMITED TO ONE PER RECIPIENT, PER PROVIDER, PER LIFETIME |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | 6653 | PROCEDURE LIMITED TO 1080 HOURS,PER WAIVER YEAR OCTOBER 1 - SEPTEMBER 30. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 7233 | DUPLICATE DENIED - INCLUDES UNILATERAL OR BILATERAL |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 7234 | DENIED DUPLICATE - IS BILATERAL |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 7235 | DENIED DUPLICATE - CAN ONLY BE DONE XX TIMES IN LIFETIME |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 7236 | DENIED DUPLICATE - CAN ONLY BE DONE XX TIMES IN A DAY |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 7237 | DENIED DUPLICATE (REBUNDLED) |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | 7267 | ONLY ONE PROVIDER ALLOWED FOR CURRENT PROCEDURES |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X490 | PHARMACY CLAIM-EXACT DUP |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X491 | PHARMACY CLAIM-SUSPECT DUP OF HISTORY CLAIM OR ANOTHER DETAIL. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X493 | DRUG PRESCRIPTION/REFILL NUMBER SUSPECT. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X501 | OUR RECORDS SHOW THIS SERVICE HAS ALREADY BEEN PAID FOR THE DATE OF SERVICE BIL LED. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X503 | PROCEDURE CODE CANNOT BE BILLED MORE THAN SIX(6) TIMES WITH THE SAME MODIFIER. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X505 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X511 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X513 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X515 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X531 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X532 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X535 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X544 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X545 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X546 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S) OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X548 | OUR RECORDS SHOW THIS SERVICE FOR THE DATE(S)OF SERVICE BILLED IS A DUPLICATE. |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | X597 | A SCREENING/ASSESSMENT HAS ALREADY BEEN PAID FOR THIS RECIPIENT FOR THIS CALEND AR YEAR. |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | X802 | NEWBORN CODE MAY NOT BE BILLED MORE THAN ONCE |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | X809 | MONAURAL EARMOLDS ARE LIMITED TO ONE EVERY FOUR MONTHS. |
| 54 | Duplicate of a previously processed claim/line. | 119 | Benefit maximum for this time period has been reached. | X810 | HEARING AID REPAIR IS LIMITED TO ONCE EVERY SIX MONTHS |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X828 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS RECIP IENT. |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X835 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS PATIE NT |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X841 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS PATIE NT |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X843 | RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS RECIPIENT . |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X844 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS RECIP IENT |
| 54 | Duplicate of a previously processed claim/line. | 18 | Duplicate claim/service. | X970 | THIS CLAIM HAS BEEN RECOUPED/ADJUSTED DUE TO A DUPLICATE PAYMENT. |
| 55 | Claim assigned to an approver/analyst. | 11 | The diagnosis is inconsistent with the procedure. | 7243 | DIAGNOSIS TO PROCEDURE COMPARISON PROCEDURE SUSPENDED |
| 64 | Re-pricing information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X968 | CLAIM ADJUSTED TO RELECT A RATE CHANGE. |
| 64 | Re-pricing information. | 96 | Non-covered charge(s). | X979 | CLAIM ADJUSTED TO CORRECT ERRONEOUS COPAY DEDUCTION |
| 65 | Claim/line has been paid. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9502 | PRICING ADJUSTMENT - MEDICARE PART B HEADER PRICING APPLIED |
| 65 | Claim/line has been paid. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9503 | PRICING ADJUSTMENT - MEDICARE HEADER PRICING APPLIED |
| 65 | Claim/line has been paid. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9504 | PRICING ADJUSTMENT - MEDICARE HEADER COINSURANCE + DEDUCTIBLE PRICING APPLIED |
| 65 | Claim/line has been paid. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9505 | PRICING ADJUSTMENT - MEDICARE LONG TERM CARE PRICING APPLIED |
| 65 | Claim/line has been paid. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9506 | PRICING ADJUSTMENT - MEDICARE DETAIL COINSURANCE + DEDUCTIBLE PRICING APPLIED |
| 65 | Claim/line has been paid. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9507 | PRICING ADJUSTMENT - MEDICARE PART B DETAIL 1 PRICING APPLIED |
| 65 | Claim/line has been paid. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9508 | PRICING ADJUSTMENT - MEDICARE PART B DETAIL 2 PRICING APPLIED |
| 65 | Claim/line has been paid. | 18 | Duplicate claim/service. | X502 | THIS CLAIM OR SERVICE WAS PREVIOUSLY PAID ON DATE INDICATED |
| 65 | Claim/line has been paid. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | X504 | THE CLAIM OR SERVICE WAS PREVIOUSLY PAID ON DATE INDICATED |
| 65 | Claim/line has been paid. | 18 | Duplicate claim/service. | X512 | THIS CLAIM OR SERVICE WAS PREVIOUSLY PAID ON DATE INDICATED |
| 65 | Claim/line has been paid. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | X521 | THIS CLAIM OR SERVICE WAS PREVIOUSLY PAID ON DATE INDICATED |
| 65 | Claim/line has been paid. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | X524 | THE PAYMENT FOR THIS SERVICE WAS PREVIOUSLY MADE TO ANOTHER PROVIDER OR TO ANOT HER NUMBER FOR THE SAME PROVIDER |
| 65 | Claim/line has been paid. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | X528 | THIS CLAIM OR SERVICE WAS PREVIOUSLY PAID ON DATE INDICATED |
| 65 | Claim/line has been paid. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | X547 | THIS CLAIM OR SERVICE WAS PREVIOUSLY PAID ON DATE INDICATED |
| 65 | Claim/line has been paid. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | X549 | THIS CLAIM OR SERVICE WAS PREVIOUSLY PAID ON DATE INDICATED |
| 65 | Claim/line has been paid. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X625 | POST-CATARACT FOLLOW-UP CARE HAS BEEN PAID TO THE SURGEON ORPOST-CATARACT FOLLO W-UP CARE CANNOT BE PAID UNTIL THE SURGEON HAS BEEN PAID. CONTACT THE SURGEON |
| 67 | Payment made in full. | 23 | Payment adjusted because charges have been paid by another payer. | X068 | THIS SERVICE WAS COVERED IN FULL BY MEDICARE. |
| 67 | Payment made in full. | 42 | Charges exceed our fee schedule or maximum allowable amount. | X354 | ENCOUNTER RATE PAID, IF ANY, REPRESENTS THE MAXIMUM PAYMENT ALLOWED BY MEDICAID . |
| 67 | Payment made in full. | 42 | Charges exceed our fee schedule or maximum allowable amount. | X357 | PAYMENT AMOUNT, IF ANY, REPRESENTS THE MAXIMUM PAYMENT ALLOWED BY MEDICAID. |
| 67 | Payment made in full. | 42 | Charges exceed our fee schedule or maximum allowable amount. | X360 | PAYMENT AMOUNT IF ANY REPRESENTS THE MAXIMUM PAYMENT ALLOWED BY MEDICAID. |
| 67 | Payment made in full. | 42 | Charges exceed our fee schedule or maximum allowable amount. | X367 | PAID IN FULL BY MEDICAID. |
| 67 | Payment made in full. | 59 | Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. | X884 | REGIONAL ANESTHESIA PAYMENT IS 50% OF LEVEL III PRICE |
| 68 | Partial payment made for this claim. | 42 | Charges exceed our fee schedule or maximum allowable amount. | 9000 | THE SUBMITTED CHARGE EXCEEDS THE ALLOWED CHARGE. CLAIM PAID AT THE MEDICAID PROGRAM ALLOWED AMOUNT. |
| 68 | Partial payment made for this claim. | 3 | Co-payment Amount | 9001 | REIMBURSEMENT REDUCED BY THE RECIPIENT'S CO-PAYMENT AMOUNT. |
| 69 | Payment reflects plan provisions. | 3 | Co-payment Amount | X361 | PAYMENT HAS BEEN REDUCED OR DENIED DUE TO THE APPLICATION OFCOPAY. |
| 69 | Payment reflects plan provisions. | 23 | Payment adjusted because charges have been paid by another payer. | X362 | COPAY AND MEDICARE AND OTHER THIRD PARTY PAYMENTS HAVE REDUCED/DENIED PAYMENT. |
| 69 | Payment reflects plan provisions. | 42 | Charges exceed our fee schedule or maximum allowable amount. | X363 | PAYMENT, IF ANY, REPRESENTS THE ALLOWANCE MADE BY MEDICAID AFTER CONSIDERING ME DICARE LIABILITY. |
| 69 | Payment reflects plan provisions. | 23 | Payment adjusted because charges have been paid by another payer. | X364 | MEDICAID ALLOWED AMOUNT REDUCED BY OTHER INSURANCE AMOUNT. |
| 69 | Payment reflects plan provisions. | 42 | Charges exceed our fee schedule or maximum allowable amount. | X365 | FEE ADJUSTED TO MAXIMUM ALLOWABLE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5300 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5301 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5302 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5303 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5304 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5305 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5306 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5307 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5308 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5309 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5310 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5311 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5312 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5313 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5314 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5315 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5316 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5317 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5318 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5319 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5320 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5321 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5322 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5323 | PULP THERAPY COMBINATION NOT ALLOWED |
| 70 | Payment reflects contract provisions. | 96 | Non-covered charge(s). | 7216 | VISIT PROCEDURE CODE IS NOT INDICATED FOR SEPARATE REIMBURSEMENT |
| 70 | Payment reflects contract provisions. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7219 | PROCEDURE IS MUTUALLY EXCLUSIVE |
| 70 | Payment reflects contract provisions. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | 7220 | PROCEDURE IS WITHIN THE NUMBER OF DAYS PRE-OP RANGE |
| 70 | Payment reflects contract provisions. | B13 | Previously paid. Payment for this claim/service may have been provided in a previous payment. | 7221 | PROCEDURE IS WITHIN THE NUMBER OF DAYS POST-OP RANGE |
| 70 | Payment reflects contract provisions. | 11 | The diagnosis is inconsistent with the procedure. | 7242 | DIAGNOSIS TO PROCEDURE COMPARISON PROCEDURE DENIED |
| 70 | Payment reflects contract provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7244 | MEDICAL VISIT DENIED |
| 70 | Payment reflects contract provisions. | 11 | The diagnosis is inconsistent with the procedure. | 7248 | INTENSITY OF PROCEDURE WAS FOUND TO BE HIGHER THAN EXPECTED BASED ON DIAGNOSIS |
| 70 | Payment reflects contract provisions. | 18 | Duplicate claim/service. | 7249 | PROCEDURE SHOULD BE REVIEWED AS POSSIBLE MULTIPLE COMPONENT |
| 70 | Payment reflects contract provisions. | 18 | Duplicate claim/service. | 7250 | PROCEDURE SHOULD BE REVIEWED AS POSSIBLE DUPLICATE COMPONENT |
| 70 | Payment reflects contract provisions. | 11 | The diagnosis is inconsistent with the procedure. | 7281 | DIAGNOSIS TO PROCEDURE COMPARISON PROCEDURE |
| 70 | Payment reflects contract provisions. | 11 | The diagnosis is inconsistent with the procedure. | 7282 | INTENSITY OF PROCEDURE WAS FOUND TO BE HIGHER THAN EXPECTED BASED ON DIAGNOSIS |
| 70 | Payment reflects contract provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7283 | PROCEDURE SHOULD BE REVIEWED AS POSSIBLE MULTIPLE COMPONENT |
| 70 | Payment reflects contract provisions. | 133 | The disposition of this claim/service is pending further review. | 7284 | PROCEDURE SHOULD BE REVIEWED AS POSSIBLE DUPLICATE COMPONENT |
| 70 | Payment reflects contract provisions. | 42 | Charges exceed our fee schedule or maximum allowable amount. | X730 | ESWL PRICING |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X737 | UNITS ON THIS CLAIM HAVE BEEN SYSTEMATICALLY REDUCED TO MEET THE BENEFIT LIMIT |
| 70 | Payment reflects contract provisions. | 119 | Benefit maximum for this time period has been reached. | X760 | INITIAL VISIT IS LIMITED TO ONE PER RECIPIENT, PER PROVIDER, PER LIFETIME |
| 70 | Payment reflects contract provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X769 | SECONDARY SURGICAL PROCEDURE WITHIN THE SAME INCISION PAID AT 50% OF MEDICAID A LLOWED |
| 72 | Claim contains split payment. | 35 | Benefit maximum has been reached. | 7259 | SPLIT DECISION WAS RENDERED ON EXPANSION OF UNITS |
| 72 | Claim contains split payment. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X070 | ENCOUNTER RATE PROCEDURES AND FEE-FOR-SERVICE PROCEDURES CANNOT BE BILLED ON TH E SAME CLAIM. SPLIT BILL. |
| 72 | Claim contains split payment. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X314 | CLAIM CANNOT SPAN CALENDAR MONTHS. SPLIT BILL CLAIM FOR EACHMONTH. |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 97 | Payment is included in the allowance for another service/procedure. | 5606 | PAYMENT MADE FOR SIMILAR PROCEDURE |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 97 | Payment is included in the allowance for another service/procedure. | 5607 | PAYMENT MADE FOR SIMILAR PROCEDURE |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 119 | Benefit maximum for this time period has been reached. | 5652 | ONLY ONE INITIAL NICU PROCEDURE MAY BE BILLED PER HOSPITAL STAY. |
| 78 | Duplicate of an existing claim/line, awaiting processing. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5660 | ONLY ONE HOSPITAL ADMISSION MAY BE BILLED PER HOSPITAL STAY |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 18 | Duplicate claim/service. | 7239 | PROCEDURE IS A POSSIBLE DUPLICATE |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 18 | Duplicate claim/service. | X520 | SERVICE PREVIOUSLY BILLED, THE ORIGINAL CLAIM IS CURRENTLY IN PROCESS |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 18 | Duplicate claim/service. | X523 | PRIOR CLAIM WITH THIS PRESCRIPTION/REFILL NUMBER IS IN PROCESS |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 18 | Duplicate claim/service. | X527 | SERVICE PREVIOUSLY BILLED, THE ORIGINAL CLAIM IS CURRETNLY IN PROCESS |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 18 | Duplicate claim/service. | X533 | SERVICE PREVIOUSLY BILLED, THE ORIGINAL CLAIM IS CURRENTLY IN PROCESS |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 18 | Duplicate claim/service. | X543 | SERVICE PREVIOUSLY BILLED, THE ORIGINAL CLAIM IS CURRENTLY IN PROCESS |
| 78 | Duplicate of an existing claim/line, awaiting processing. | 119 | Benefit maximum for this time period has been reached. | X808 | MONAURAL HEARING AID BATTERIES ARE LIMITED TO ONE PACKAGE EVERY TWO MONTHS. |
| 84 | Service not authorized. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 3002 | NDC REQUIRES PA |
| 84 | Service not authorized. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 3312 | DAYS SUPPLY IS GREATER THAN MAXIMUM DAYS SUPPLY |
| 84 | Service not authorized. | 15 | Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. | 6052 | CODE, SERVICE, PROCEDURE, NDC OR STAY REQUIRES PRIOR AUTHORIZATION |
| 84 | Service not authorized. | 96 | Non-covered charge(s). | X069 | DENTAL SEALANTS ARE NOT PAYABLE FOR THIS RECIPIENT OR TOOTH NUMBER. |
| 84 | Service not authorized. | 96 | Non-covered charge(s). | X084 | SERVICE BILLED IS NOT COVERED FOR A SOBRA ELIGIBLE RECIPIENT |
| 84 | Service not authorized. | 96 | Non-covered charge(s). | X086 | RECIPIENT NOT ELIGIBLE FOR TARGETED CASE MANAGEMENT. |
| 84 | Service not authorized. | 96 | Non-covered charge(s). | X111 | INPATIENT/OUTPATIENT NON-COVERED REVENUE CODES FOR EPSDT REFERRED CLAIMS. |
| 84 | Service not authorized. | 5 | The procedure code/bill type is inconsistent with the place of service. | X113 | THE PROCEDURE CODE IS NOT COVERED WHEN PROVIDED BY AN AMBULATORY SURGICAL CENTE R. |
| 84 | Service not authorized. | 6 | The procedure code is inconsistent with the patient's age. | X114 | SERVICE NON-PAYABLE FOR RECIPIENT LESS THAN SIX MONTHS OF AGE. |
| 84 | Service not authorized. | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | X248 | ELIGIBLE FOR MEDICARE ONLY - NO MEDICAID BENEFITS |
| 84 | Service not authorized. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X276 | RECIPIENT IS NOT ELIGIBLE FOR WAIVERED SERVICES ACCORDING TO THE LTC FILE. |
| 84 | Service not authorized. | 5 | The procedure code/bill type is inconsistent with the place of service. | X285 | PROCEDURE BILLED NOT COVERED FOR FQHC FACILITY |
| 84 | Service not authorized. | 5 | The procedure code/bill type is inconsistent with the place of service. | X292 | THIS TYPE OF SERVICE AND/OR PROCEDURE CODE IS INVALID FOR A RADIOLOGY FACILITY. |
| 84 | Service not authorized. | 96 | Non-covered charge(s). | X368 | THIS SERVICE IS NOT COVERED BY MEDICAID. |
| 84 | Service not authorized. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X681 | THIS SERVICE IS NOT ALLOWED ON THE SAME DAY AS DAY TREATMENT |
| 84 | Service not authorized. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X682 | THIS SERVICE IS NOT ALLOWED ON THE SAME DAY AS DAY TREATMENT |
| 84 | Service not authorized. | 15 | Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. | X827 | CODE, SERVICE, PROCEDURE, NDC OR STAY REQUIRES PRIOR AUTHORIZATION |
| 84 | Service not authorized. | 97 | Payment is included in the allowance for another service/procedure. | X864 | HYSTERECTOMY ANCILLARY CODES MAY NOT BE PAID IN ADDITION TO THE HYSTERECTOMY P ROCEDURE CODE |
| 84 | Service not authorized. | 97 | Payment is included in the allowance for another service/procedure. | X879 | ADMINISTRATION FEE MAY NOT BE BILLED ON THE SAME DAY AS THIS PROCEDURE CODE. |
| 85 | Entity not primary. | 129 | Payment denied - Prior processing information appears incorrect. | 2504 | FILE SHOWS OTHER INSURANCE, SUBMIT TO OTHER CARRIER |
| 85 | Entity not primary. | 129 | Payment denied - Prior processing information appears incorrect. | 2505 | RECIPIENT COVERED BY PRIVATE INSURANC(W/ATTACHMNT) |
| 85 | Entity not primary. | 129 | Payment denied - Prior processing information appears incorrect. | 2506 | INSURANCE DENIAL REQUIRED |
| 85 | Entity not primary. | 129 | Payment denied - Prior processing information appears incorrect. | 2508 | RECIPIENT COVERED BY PRIVATE INSURANCE (PHARMACY) |
| 85 | Entity not primary. | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | X176 | THIRD PARTY FILE INDICATES MEDICARE COMPREHENSIVE INSURANCE FOR RECIPIENT. |
| 86 | Diagnosis and patient gender mismatch. | 10 | The diagnosis is inconsistent with the patient's gender. | X196 | PRIMARY DIAGNOSIS IS INVALID FOR RECIPIENT'S SEX. |
| 86 | Diagnosis and patient gender mismatch. | 10 | The diagnosis is inconsistent with the patient's gender. | X197 | OTHER DIAGNOSIS IS INVALID FOR RECIPIENT'S SEX. |
| 86 | Diagnosis and patient gender mismatch. | 10 | The diagnosis is inconsistent with the patient's gender. | X206 | THE DETAIL DIAGNOSIS IS INVALID FOR THE RECIPIENT'S SEX. |
| 86 | Diagnosis and patient gender mismatch. | 9 | The diagnosis is inconsistent with the patient's age. | X207 | THE DETAIL DIAGNOSIS CODE IS INVALID FOR RECIPIENT'S AGE. |
| 87 | Denied: Entity not found. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 203 | RECIPIENT I.D. NUMBER MISSING |
| 87 | Denied: Entity not found. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1000 | NO PAY-TO PROVIDER RECORD |
| 88 | Entity not eligible for benefits for submitted dates of service. | 110 | BILLING DATE PREDATES SERVICE DATE. | 503 | DATE DISPENSED AFTER BILLING DATE |
| 88 | Entity not eligible for benefits for submitted dates of service. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 506 | DATE DISPENSED AFTER ICN DATE |
| 88 | Entity not eligible for benefits for submitted dates of service. | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | 2007 | QMB RECIPIENT ELIGIBLE FOR CROSSOVER ONLY |
| 88 | Entity not eligible for benefits for submitted dates of service. | 100 | PAYMENT MADE TO PATIENT/INSURED/RESPONSIBLE PARTY. | 2045 | ITEM NOT PAYABLE IN LONG TERM CARE FACILITY |
| 88 | Entity not eligible for benefits for submitted dates of service. | 6 | The procedure code is inconsistent with the patient's age. | 3304 | NON-COVERED SVC FOR RECIPIENT < 6 MONTHS OLD |
| 88 | Entity not eligible for benefits for submitted dates of service. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | 4203 | DENIAL MODIFIER SUBMITTED ON CLAIM |
| 88 | Entity not eligible for benefits for submitted dates of service. | 97 | Payment is included in the allowance for another service/procedure. | 5206 | THIS SERVICE IS INCLUDED IN THE FACILITY FEE |
| 88 | Entity not eligible for benefits for submitted dates of service. | 97 | Payment is included in the allowance for another service/procedure. | 5207 | THIS SERVICE IS INCLUDED IN THE FACILITY FEE |
| 88 | Entity not eligible for benefits for submitted dates of service. | 96 | Non-covered charge(s). | X017 | A SLIMB/QWDI(DISABLED WORKER) AID CATEGORIES 92,93,94 AND 97 IS NOT ELIGIBLE FO R MEDICAID SERVICES. |
| 88 | Entity not eligible for benefits for submitted dates of service. | 96 | Non-covered charge(s). | X040 | PROCEDURE CODE LIMITED TO QMB OR EPSDT RELATED CLAIMS. |
| 88 | Entity not eligible for benefits for submitted dates of service. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | X263 | RECORDS SHOW THIS RECIPIENT IS PARTIALLY INELIGIBLE FOR MEDICAID FOR DETAIL DAT E(S) OF SERVICE. |
| 88 | Entity not eligible for benefits for submitted dates of service. | 119 | Benefit maximum for this time period has been reached. | X813 | PROCEDURE IS LIMITED TO ONE (1) EVERY FOUR CALENDAR YEARS. |
| 90 | Entity not eligible for medical benefits for submitted dates of service. | 38 | Services not provided or authorized by designated (network) providers. | 1010 | PERFORMING PROVIDER NOT IN BILLING GROUP |
| 90 | Entity not eligible for medical benefits for submitted dates of service. | 96 | Non-covered charge(s). | X134 | PLAN FIRST RECIPIENT IS ONLY ELIGIBLE FOR PLAN FIRST SERVICES |
| 91 | Entity not eligible/not approved for dates of service. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X228 | DATES OF SERVICE ARE NOT WITHIN APPROVED PROVIDER ENROLLMENTPERIOD. |
| 93 | Entity is not selected primary care provider. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | 1816 | MATERNITY CARE MUST BE PERFORMED BY DISTRICT PROV |
| 94 | Entity not referred by selected primary care provider. | 38 | Services not provided or authorized by designated (network) providers. | 1050 | SERVICE NOT REFERRED BY PRIMARY CARE CASE MANAGER |
| 94 | Entity not referred by selected primary care provider. | 38 | Services not provided or authorized by designated (network) providers. | 1820 | PATIENT FIRST CLAIM REQUIRES A REFERRAL |
| 94 | Entity not referred by selected primary care provider. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X108 | PROCEDURE CODE Z5449 REQUIRES A REFERRAL FROM A PARTICIPATING MEDICAID DENTAL P ROVIDER. |
| 96 | No agreement with entity. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X304 | THE OPERATING PHYSICIANS LICENSE NUMBER IS MISSING OR NOT ON FILE. |
| 97 | Patient eligibility not found with entity. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | 1818 | WAIVER PROVIDER MISMATCH |
| 97 | Patient eligibility not found with entity. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X272 | PROVIDER DOES NOT MATCH PROVIDER ON LTC FILE FOR THIS RECIPIENT. |
| 100 | Pre-certification penalty taken. | 63 | Correction to a prior claim. | 8101 | SAVE FOR FUTURE USE. |
| 100 | Pre-certification penalty taken. | 63 | Correction to a prior claim. | 8102 | SAVE FOR FUTURE USE. |
| 100 | Pre-certification penalty taken. | 63 | Correction to a prior claim. | 8103 | SAVE FOR FUTURE USE. |
| 100 | Pre-certification penalty taken. | 63 | Correction to a prior claim. | 8105 | SAVE FOR FUTURE USE. |
| 100 | Pre-certification penalty taken. | 63 | Correction to a prior claim. | 8106 | SAVE FOR FUTURE USE. |
| 100 | Pre-certification penalty taken. | 63 | Correction to a prior claim. | 8107 | SAVE FOR FUTURE USE. |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8030 | PROVIDER REQUESTED OFFSET DUE TO BILLING ERROR. |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8031 | PROVIDER REQUESTED OFFSET DUE TO OTHER INSURANCE. |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8032 | PROVIDER REQUESTED OFFSET DUE MEDICARE. |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8033 | PROVIDER REQUESTED OFFSET DUE TO PATIENT LIABILITY. |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8034 | PROVIDER REQUESTED OFFSET DUE TO SPENDDOWN. |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8035 | PROVIDER REQUESTED OFFSET DUE TO AUTO LIABILITY. |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8036 | PROVIDER REQUESTED OFFSET DUE TO WORKERS COMP |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8037 | PROVIDER REQUESTED CLAIM VOID DUE TO BILLING ERROR. |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8038 | PROVIDER REQUESTED OFFSET DUE TO MISCELLANEOUS OR UNSPECIFIED ERROR |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8070 | PROVIDER SENT REFUND DUE TO MEDICAID FRAUD. |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8071 | PROVIDER SENT REFUND PAYMENT DUE TO MEDICAID FRAUD. |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8072 | PROVIDER SENT REFUND DUE TO AUTO LIABILITY. |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8073 | PROVIDER SENT REFUND DUE TO WORKERS COMP. |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8074 | PROVIDER SENT REFUND FOR CLAIM NOT IN HISTORY. |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8075 | PROVIDER SENT REFUND DUE TO MISCELLANEOUS OR UNSPECIFIED ERROR. |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8079 | CONVERTED CLAIM WAS GENERATED FOR A FULL REFUND |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8080 | CONVERTED CLAIM WAS GENERATED FOR A PARTIAL REFUND |
| 101 | Claim was processed as adjustment to previous claim. | 100 | PAYMENT MADE TO PATIENT/INSURED/RESPONSIBLE PARTY. | 8090 | AGENCY REQUESTED REFUND DUE TO ACCOUNTS RECEIVABLE |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8091 | AGENCY REQUESTED REFUND DUE TO AUDIT DIVISION REVIEW |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8092 | AGENCY REQUESTED REFUND DUE TO BILLING ERROR |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8093 | AGENCY REQUESTED REFUND DUE TO CLAIMS PROCESSING ERROR |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8094 | AGENCY REQUESTED REFUND DUE TO WRONG PROVIDER PAID/EFT ERROR |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8095 | AGENCY REQUESTED REFUND DUE TO MEDICARE |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8136 | EDS INITIATED ADJUSTMENTS DUE TO PROCESSING ERROR |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8150 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO CALL CENTER |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8151 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO CLAIMS RESOLUTION |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8152 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO DHS/CHILD WELFARE |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8153 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO DHS/DDSD |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8155 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO FINANCIAL MANAGEMENT REVIEW |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8156 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO FQHC |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8157 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO KEYING ERROR |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 8158 | AGENCY INITIATED ADDITIONAL PAYMENT DUE TO MEDICAL REVIEW |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8213 | INCOME PENSION TRUST RECOVERIES |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8215 | ABSENT PARENTS |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8216 | TPL ERROR |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8217 | DUE TO MISCELLANEOUS OR UNSPECIFIED REASON |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8240 | ADJUSTMENT GENERATED DUE TO SURS REVIEW |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8241 | ADJUSTMENT GENERATED DUE TO CHANGE IN PATIENT LIABILITY |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8242 | ADJUSTMENT GENERATED DUE TO RATE CHANGE |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8246 | POINT OF SALE REVERSAL |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 8422 | AS THE RESULT OF A COST SETTLEMENT REVIEW, AN ACCOUNTS RECEIVABLE HAS BEEN ESTA BLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9011 | CLAIM TREATED AS AN ADJUSTMENT. NO MEDICAID ID ON THE CLAIM. |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9012 | CLAIM TREATED AS AN ADJUSTMENT. CROSSOVER CLAIM WITH NO MEDICARE PROVIDER NUMB |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9013 | CLAIM TREATED AS AN ADJUSTMENT. HEADER KEY SECTION OF CLAIM IS MISSING. |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9014 | CLAIM TREATED AS AN ADJUSTMENT. CLAIM LACKS ORIGINAL ICN. |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9015 | CLAIM TREATED AS AN ADJUSTMENT. BENEFICIARY NOT FOUND ON T_RE_BASE. |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9016 | CLAIM TREATED AS AN ADJUSTMENT. BILLING PROVIDER NOT FOUND ON T_PR_PROV. |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9017 | CLAIM TREATED AS AN ADJUSTMENT. ORIGINAL ICN NOT FOUND ON T_HIST_DIRECTORY. |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9018 | CLAIM TREATED AS AN ADJUSTMENT. CLAIM HAS ALREADY BEEN ADJUSTED. |
| 101 | Claim was processed as adjustment to previous claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9019 | CLAIM TREATED AS AN ADJUSTMENT. CLAIM IS SCHEDULED TO BE ADJUSTED BY ANOTHER PR |
| 101 | Claim was processed as adjustment to previous claim. | 88 | Adjustment amount represents collection against receivable created in prior overpayment. | 9991 | REFUND AMOUNT LESS THAN ADJUSTED AMOUNT |
| 101 | Claim was processed as adjustment to previous claim. | 123 | Payer refund due to overpayment. | 9992 | REFUND AMOUNT GREATER THAN ADJUSTED AMOUNT |
| 101 | Claim was processed as adjustment to previous claim. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 9995 | ADJUSTMENT DETAIL MANUALLY DENIED |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X333 | CLAIM ADJUDICATED PREVIOUS TO SEPTEMBER 30, 1999 |
| 101 | Claim was processed as adjustment to previous claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X950 | DUR CONFLICT, INTERVENTION, OR OUTCOME CODES ARE INVALID. |
| 101 | Claim was processed as adjustment to previous claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X951 | PREVIOUS DUR ALERTED CLAIM CANNOT BE FOUND. |
| 101 | Claim was processed as adjustment to previous claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X958 | THIS CLAIM HAS BEEN ADJUSTED TO REFLECT A CHANGE IN THE ORIGINAL AMOUNT BILLED. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X959 | THIS CLAIM HAS BEEN RECOUPED TO ENABLE THE PROCESSING OF A CORRECTED BILLING. |
| 101 | Claim was processed as adjustment to previous claim. | 23 | Payment adjusted because charges have been paid by another payer. | X960 | THIS CLAIM HAS BEEN ADJUSTD TO REFLECT PAYMENT BY OTHER INSURANCE. |
| 101 | Claim was processed as adjustment to previous claim. | 1 | DEDUCTIBLE AMOUNT | X961 | THIS CLAIM HAS BEEN ADJUSTED TO REFLECT A CHANGE IN COINSURANCE AND/OR DEDUCTIB LE. |
| 101 | Claim was processed as adjustment to previous claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X962 | OTHER - IF YOU HAVE ANY QUESTIONS RESULTING FROM THIS ADJUSTMENT, PLEASE CONTAC T OUR CORRESPONDENCE/INQUIRY UNIT. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X963 | CLAIM ADJUSTED TO CORRECT THE NUMBER OF RN/AIDE VISITS. |
| 101 | Claim was processed as adjustment to previous claim. | 142 | Claim adjusted by the monthly Medicaid patient liability amount. | X964 | THIS CLAIM HAS BEEN ADJUSTED TO REFLECT CORRECT RECIPIENT RESOURCES. |
| 101 | Claim was processed as adjustment to previous claim. | B12 | Services not documented in patients' medical records. | X965 | THIS CLAIM HAS BEEN ADJUSTED TO MAKE CHANGES TO THE DATES OF SERVICE. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X966 | THIS CLAIM WAS A RETROACTIVE ADJUSTMENT DUE TO RECIPIENT'S ELIGIBILITY. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X967 | THIS CLAIM HAS BEEN RECOUPED TO REFLECT CLAIM PAYMENT BY OTHER INSURANCE. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X969 | CLAIM ADJUSTED OR RECOUPED BECAUSED INPATIENT OR OUTPATIENT VISITS HAVE BEEN EX CEEDED FOR A CALENDAR YEAR. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X971 | REFER QUESTIONS RESULTING FROM THIS RECOUPMENT TO THIRD PARTY, ALABAMA MEDICAID AGENCY AT (334) 242-5253. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X972 | CLAIM ADJUSTED DUE TO THE RECEIPT OF A REFUND CHECK. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X973 | AS A RESULT OF A DRUG REBATE REVIEW, THIS CLAIM HAS BEEN AJUSTED TO CORRECT THE QUANTITY DISPENSED. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X974 | CLAIM ADJUSTED TO REFLECT A CHANGE IN THE REVENUE CODE. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X975 | CLAIM ADJUSTED TO REFLECT A CHANGE IN THE PLACE OF SERVICE. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X976 | CLAIM RECOUPED BECAUSE NO XIX-TPD FORM WAS ATTACHED TO THE ORIGINAL CLAIM. PLE ASE REFILE WITH XIX-TPD. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X978 | CLAIM RECOUPED BECAUSE INPATIENT STAY AND OUTPATIENT VISIT NOT ALLOWED ON SAME DAY. |
| 101 | Claim was processed as adjustment to previous claim. | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | X980 | CLAIM ADJUSTED TO ADD/DELETE MODIFIER. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X981 | CLAIM ADJUSTED/RECOUPED BECAUSE INPATIENT PHYSICIAN DATES OF SERVICE ARE LIMITE D TO 16 PER YEAR. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X982 | AS A RESULT OF THE DRUG REBATE REVIEW, THIS CLAIM HAS BEEN RECOUPED/ADJUSTED TO CORRECT THE NDC. |
| 101 | Claim was processed as adjustment to previous claim. | 119 | Benefit maximum for this time period has been reached. | X983 | CLAIM ADJUSTED/RECOUPED BECAUSE PHYSICIAN OFFICE VISITS HAVE BEEN EXCEEDED FOR CALENDAR YEAR. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X984 | CLAIM ADJUSTED/RECOUPED BECAUSE HOME HEALTH VISITS HAVE BEEN EXCEEDED FOR THE C ALENDAR YEAR. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X985 | CLAIM ADJUSTED OR RECOUPED BECAUSE ASC VISITS HAVE BEEN EXCEEDED FOR THE CALEND AR YEAR. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X986 | CLAIM ADJUSTED/RECOUPED TO CORRECT THE EPSDT REFERRING INFORMATION. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X987 | CLAIM ADJUSTED/RECOUPED BECAUSE RURAL HEALTH VISITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X988 | CLAIM ADJUSTED/RECOUPED BECAUSE FQHC VISITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 101 | Claim was processed as adjustment to previous claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X990 | THIS CLAIM HAS BEEN ADJUSTED TO REFLECT A CHANGE IN THE DISPENSE AS WRITTEN VAL UE CODE. |
| 101 | Claim was processed as adjustment to previous claim. | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | X991 | RECIPIENT HAS BECOME RETROACTIVELY ELIGIBLE FOR MEDICARE FOR BILLED DATES OF SE RVICE BILLED. FILE MEDICARE. |
| 101 | Claim was processed as adjustment to previous claim. | 96 | Non-covered charge(s). | X992 | THIS CLAIM WAS RECOUPED BECAUSE THE PMP DID NOT AUTHORIZE THE REFERRED SERVICE |
| 102 | Newborn's charges processed on mother's claim. | 123 | Payer refund due to overpayment. | 8097 | AGENCY REQUESTED REFUND DUE TO OTHER INSURANCE |
| 102 | Newborn's charges processed on mother's claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X013 | REVENUE CODES 172, 175 OR 179 CANNOT BE BILLED IN CONJUNCTION WITH A NORMAL NEW BORN DIAGNOSIS. |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X109 | OBSERVATION MUST BE BILLED IN CONJUNCTION WITH FACILITY FEE. |
| 103 | Claim combined with other claim(s). | 96 | Non-covered charge(s). | X115 | PAYMENT AMOUNT ADDED TO CLAIMS PAYMENT. |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X687 | CLINIC CODES Z5145-Z5149 CANNOT BE BILLED ON THE SAME DAY WITH SAME UNIQUE NUMB ER AS 99241-99245 AND 99281-99285 |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X691 | POSTPARTUM VISIT WILL NOT BE PAID ON THE SAME DAY AS PRENATAL VISIT |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X696 | PRENATAL VISIT NOT COVERED ON THE SAME DATE AS FAMILY PLANNING. |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X739 | COMBINATION LENS CODES CANNOT BE BILLED FOR THE SAME DATE OF SERVICE. |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X759 | THE SAME PHYSICAIN MAY NOT BILL INTUBATION AND NEWBORN RESUSCITATION ON THE SAM E DAY |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X762 | PROCEDURE CODE Z5183 NOT COVERED ON THE SAME DAY AS Z5185 |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X763 | FAMILY PLANNING COUNSELING NOT COVERED ON THE SAME DAY AS PRENATAL VISIT |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X777 | PROCEDURE CODE NOT ALLOWED WITH A MORE COMPREHENSIVE CODE. |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X784 | PROCEDURE NOT COVERED WHEN BILLED WITH 76805, 76810 OR 76816 ON THE SAME DAY |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X794 | STANDBY/RESUCITATION/ATTENDANCE AT DELIVERY CANNOT BE BILLEDTOGETHER. |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X803 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY BY THE PROVIDER |
| 103 | Claim combined with other claim(s). | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X860 | SCREENING PROVIDER MAY NOT BILL FOR SCREENING EXAM AND INCLUSIVE MEDICAL SERVIC ES ON THE SAME DAY |
| 103 | Claim combined with other claim(s). | 97 | Payment is included in the allowance for another service/procedure. | X868 | LOCAL ANESTHESIA PROCEDURES ARE COVERED IN THE TOTAL OB COST AND MAY NOT BE BIL LED SEPARATELY WITH A DELIVERY PROCEDURE CODE |
| 103 | Claim combined with other claim(s). | 97 | Payment is included in the allowance for another service/procedure. | X873 | ROUTINE ANCILLARY SERVICES ASSOCIATED WITH AN ABORTION ARE COVERED IN THE TOTAL ABORTION COST AND ARE NOT REIMBURSABLE SEPARATELY |
| 103 | Claim combined with other claim(s). | 97 | Payment is included in the allowance for another service/procedure. | X880 | EXPLORATORY LAP/LYSIS OF ADHESIONS MAY NOT BE BILLED ON THE SAME DAY WITH OTHER RELATED SURGERY |
| 103 | Claim combined with other claim(s). | 97 | Payment is included in the allowance for another service/procedure. | X886 | VISUAL FIELDS/TONOMETRY IS COVERED IN THE COMPLETE EYE EXAM |
| 103 | Claim combined with other claim(s). | 97 | Payment is included in the allowance for another service/procedure. | X890 | PROCEDURE CODE IS PART OF THE OUTPATIENT SURGICAL PROCEDURE REIMBURSEMENT. |
| 103 | Claim combined with other claim(s). | 97 | Payment is included in the allowance for another service/procedure. | X895 | ROUTINE PRENATAL LAB, OFFICE/HOSPITAL VISITS MAY NOT BE BILLED WITH GLOBAL OB P ROCEDURE |
| 103 | Claim combined with other claim(s). | 97 | Payment is included in the allowance for another service/procedure. | X896 | POSTPARTUM SERVICES MAY NOT BE BILLED WITH GLOBAL OB ON OR WITHIN 62 DAYS OF DE LIVERY |
| 103 | Claim combined with other claim(s). | 97 | Payment is included in the allowance for another service/procedure. | X898 | THIS PROCEDURE IS PART OF ANOTHER PROCEDURE PERFORMED ON THE SAME DAY |
| 104 | Processed according to plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 8188 | MASS ADJUSTMENT - VOID TRANSACTIONS |
| 104 | Processed according to plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | X695 | PROCEDURE CODE A0330 IS AN INCLUSIVE CODE. ONLY MILEAGE AND RETURN TRIP OXYGEN MAY BE BILLED IN ADDITION. |
| 104 | Processed according to plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | X734 | PROCEDURE NOT COVERED WITH SPECIFIC CODES. |
| 104 | Processed according to plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X751 | FAMILY PLANNING VISIT NOT PAYABLE AFTER STERILIZATION |
| 104 | Processed according to plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X786 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY AS CRITICAL CARE |
| 104 | Processed according to plan provisions. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X989 | THIS CLAIM WAS RECOUPED PER YOUR REQUEST. |
| 104 | Processed according to plan provisions. | 96 | Non-covered charge(s). | X994 | CLAIM RECOUPED BECAUSE RECIPIENT RETROACTIVELY ADDED AS MEMBER OF BAY HEALTH PL AN. FILE CLAIM TO BAY HEALTH PLAN |
| 104 | Processed according to plan provisions. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X995 | CLAIM RECOUPED. PROVIDER MUST RESUBMIT SERVICES ON SEPARATE CLAIMS IN ORDER FO R THE SERVICES TO BE CONSIDERED FOR PAYMENT BY MEDICAID |
| 106 | This amount is not entity's responsibility. | 104 | Managed care withholding. | 8057 | SAVE FOR FUTURE USE. |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 225 | REFERRING PROVIDER - INVALID FORMAT |
| 107 | Processed according to contract/plan provisions. | 17 | Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever | 243 | MISSING MEDICARE PAID DATE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 364 | PRINCIPAL ICD9 PROCEDURE DATE MISSING |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 365 | PRINCIPAL ICD9 PROCEDURE DATE INVALID |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 367 | FIRST OTHER ICD9 PROCEDURE DATE MISSING |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 368 | FIRST OTHER ICD9 PROCEDURE DATE INVALID |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 370 | SECOND OTHER ICD9 PROCEDURE DATE MISSING |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 371 | SECOND OTHER ICD9 PROCEDURE DATE INVALID |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 373 | THIRD OTHER ICD9 PROCEDURE DATE MISSING |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 374 | THIRD OTHER ICD9 PROCEDURE DATE INVALID |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 376 | FOURTH OTHER ICD9 PROCEDURE DATE MISSING |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 377 | FOURTH OTHER ICD9 PROCEDURE DATE INVALID |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 379 | FIFTH OTHER ICD9 PROCEDURE DATE MISSING |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 380 | FIFTH OTHER ICD9 PROCEDURE DATE INVALID |
| 107 | Processed according to contract/plan provisions. | 2 | Coinsurance Amount | 433 | MEDICARE DEDUCTIBLE AMOUNT INVALID |
| 107 | Processed according to contract/plan provisions. | 2 | Coinsurance Amount | 434 | MEDICARE COINSURANCE AMOUNT INVALID |
| 107 | Processed according to contract/plan provisions. | 2 | Coinsurance Amount | 451 | NO CROSSOVER COINSURANCE OR DEDUCTIBLE DUE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 474 | ICD9 PROCEDURE 7-24 OR DATE MISSING |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 475 | ICD9 PROCEDURE 7-24 DATE INVALID |
| 107 | Processed according to contract/plan provisions. | 29 | The time limit for filing has expired. | 512 | SERVICE(S) PAST THE MAXIMUM MEDICAID FILING LIMIT |
| 107 | Processed according to contract/plan provisions. | 29 | The time limit for filing has expired. | 555 | SERVICE(S) PAST THE MAXIMUM MEDICAID FILING LIMIT |
| 107 | Processed according to contract/plan provisions. | 129 | Payment denied - Prior processing information appears incorrect. | 596 | FILE SEPARATE CLAIMS FOR DIFFERENT YEARS |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 675 | ADJ - RECIPIENT ID NOT SUBMITTED |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 676 | ADJ - PROVIDER ID NOT SUBMITTED |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 677 | ADJ - ORIGINAL ICN NOT FOUND |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 678 | ADJ - ORIGINAL ICN NOT SUBMITTED |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 679 | ADJ - REQUEST RECIPIENT ID NOT FOUND |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 680 | ADJ - REQUEST PROVIDER DOES NOT MATCH ORIGINAL |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 681 | ADJ - ORIGINAL ICN NOT FOUND |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 682 | ADJ - ORIGINAL CLAIM HAS ALREADY BEEN ADJUSTED |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 683 | ADJ - ORIG CLM ADJUSTMENT ALREADY IN PROGRESS |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 684 | ADJ - REQUEST RECIPIENT DOES NOT MATCH ORIGINAL |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 685 | ADJ - ORIGINAL CLAIM NOT IN A PAID STATUS |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 833 | CO-INSURANCE AMOUNT DOES NOT BALANCE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 835 | MEDICARE DATA NOT FOUND - FORMAT ERROR |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 923 | RULE OVERLAP IDENTIFIED |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1807 | CROSSOVER ONLY PROVIDER CANNOT BILL CLAIM TYPE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1815 | PERF PROV ENROLL STATUS NOT VALID FOR DOS |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1825 | COBA DENIAL - DO NOT CROSSOVER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1826 | SERVICE FOR MATERNITY WAIVER/CARE RECIPIENT MUST BE BILLED WITH GLOBAL SERVICE FEE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1962 | NPI REQUIRED: REFERRING PROVIDER (HEALTHCARE) |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1974 | TAXONOMY IS INVALID: DTL PERFORMING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1975 | TAXONOMY IS INVALID: DTL REFERRING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1976 | TAXONOMY IS INVALID: DTL OTHER PROVIDER 2 |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1977 | TAXONOMY IS NOT VALID FOR DTL OTHER PROVIDER 2 |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1978 | TAXONOMY IS NOT VALID FOR DTL PERFORMING PROV |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1979 | TAXONOMY IS NOT VALID FOR DTL REFERRING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1980 | TAXONOMY IS NOT VALID FOR BILLING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1981 | TAXONOMY IS NOT VALID FOR PERFORMING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1982 | TAXONOMY IS NOT VALID FOR REFERRING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1983 | TAXONOMY IS NOT VALID FOR FACILITY PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1984 | TAXONOMY IS NOT VALID FOR OTHER PROVIDER 2 |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1985 | TAXONOMY IS INVALID: BILLING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1986 | TAXONOMY IS INVALID: PERFORMING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1987 | TAXONOMY IS INVALID: REFERRING PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1988 | TAXONOMY IS INVALID: FACILITY PROVIDER |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 1989 | TAXONOMY IS INVALID: OTHER PROVIDER 2 |
| 107 | Processed according to contract/plan provisions. | 24 | Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. | 2017 | RECIPIENT SERVICES COVERED BY HMO PLAN |
| 107 | Processed according to contract/plan provisions. | 6 | The procedure code is inconsistent with the patient's age. | 2806 | PREGNANCY INDICATOR IS INVALID FOR RECIPIENT SEX |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 2807 | COBA-NO MEDICAID ID FOR MEDICARE ID |
| 107 | Processed according to contract/plan provisions. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 3000 | PCS PRIOR AUTHORIZATION UNITS USED |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3105 | DAW 1 - NDC WITH GENERIC EQUIVALENT REQUIRES PA |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3309 | PROCEDURE CODE - TYPE OF BILL RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3315 | NURSERY DAYS EXCEED LIMIT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3320 | SERVICE INCLUDED IN FACILITY FEE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4001 | BPA-RP-DIAG - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4002 | BPA-RP-NDC - NO COVERAGE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4016 | BPA-RP-DIAG - PERF PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4017 | BPA-RP-DRG - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4018 | BPA-RP-DRG - PERF PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4021 | BPA-RP-PROC - NO COVERAGE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4023 | BPA-RP-NDC - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4025 | BPA-RP-NDC - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4026 | BPA-RP-NDC - MAX UNIT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4028 | BPA-RP-DIAG - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4029 | BPA-RP-DIAG - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4030 | BPA-RP-DIAG - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4031 | BPA-PC-DIAG - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4034 | BPA-RP-PROC - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4035 | BPA-RP-PROC - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4036 | BPA-RP-PROC - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4044 | BPA-RR-DIAG - NO RULE FOR ASSOC AGE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4045 | BPA-RR - NO RULE FOR BENEFIT PLAN |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4061 | BPA-RR - NO RULE FOR CLAIM TYPE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4062 | BPA-RR - NO RULE FOR COND CODE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4064 | BPA-RP-ICD9 - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4067 | ICD9 PROCEDURE CODE IS NOT COVERED |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4068 | BPA-RR - NO RULE CURR BILL PROV CONTRACT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4070 | BPA-RR-PROC - MODIFIER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4072 | BPA-RR-DRG - NO RULE FOR ADMIT OR HDR DIAGNOSIS |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4073 | BPA-RP-DIAG - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4075 | BPA-RP-ICD9 - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4076 | BPA-RP-NDC - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4093 | BPA-RP-DIAG - DIAG ROLE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4094 | BPA-PC-REV - PROV COUNTY RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4104 | BPA-RP-PROC - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4106 | BPA-RP-REV - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4109 | BPA-PC-DIAG - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4112 | BPA-PC-ICD9 - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4117 | BPA-PC-NDC - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4118 | BPA-PC-PROC - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4136 | BPA-RP-ICD9 - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4138 | BPA-RP-NDC - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4140 | BPA-RP-PROC - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4141 | BPA-RP-PROC - PERF PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4142 | BPA-RP-REV - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4143 | BPA-RP-REV - PERF PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4144 | BPA-PC-DIAG - PERF PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4145 | BPA-PC-DRG - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4146 | BPA-PC-DRG - PERF PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4149 | BPA-PC-PROC - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4150 | BPA-PC-PROC - PERF PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4151 | BPA-PC-REV - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4152 | BPA-PC-REV - PERF PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4154 | BPA-PC-REV - FAMILY PLANNING IND RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4155 | BPA-RR-PROC - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4157 | BPA-PC-DIAG - CURR PROV CONTRACT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4158 | BPA-PC-DRG - CURR PROV CONTRACT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4159 | BPA-PC-ICD9 - CURR PROV CONTRACT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4160 | BPA-PC-NDC - CURR PROV CONTRACT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4161 | BPA-PC-PROC - CURR PROV CONTRACT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4162 | BPA-PC-REV - CURR PROV CONTRACT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4166 | BPA-RR-NDC - NO RULE FOR BENEFIT PLAN |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4167 | BPA-RR-REV - NO RULE FOR BENEFIT PLAN |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4177 | BPA-PC-ICD9 - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4190 | BPA-RP-DRG - ANY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4191 | BPA-PC-DRG - ANY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4192 | BPA-RP-DRG - OTHER DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4194 | BPA-RP-PROC - OTHER DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4219 | BPA-RR-REV - NO RULE FOR TYPE OF BILL |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4224 | BPA-RP-PROC - QUANTITY RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4227 | BPA-RP-REV - NO COVERAGE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4231 | BPA-PC-NDC - MAX UNIT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4244 | BPA-RP-DIAG - NO COVERAGE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4250 | BPA-RR - NO RULE FOR PRIMARY PT/PS BILL/PERF |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4254 | BPA-RP-REV - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4255 | BPA-PC-DRG - ADMIT DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4256 | BPA-RP-PROC - MODIFIER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4257 | BPA-PC-PROC - MODIFIER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4258 | BPA-PC-DRG - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4310 | BPA-PC-PROC - ADMIT DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4311 | BPA-PC-PROC - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4312 | BPA-PC-PROC - PRIMARY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4313 | BPA-PC-PROC - SECONDARY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4314 | BPA-RP-DIAG - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4316 | BPA-PC -ANY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4317 | BPA-PC-ICD9 - ADMIT DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4318 | BPA-PC-ICD9 - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4319 | BPA-PC-ICD9 - ANY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4320 | BPA-PC-REV - ADMIT DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4321 | BPA-PC-REV - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4322 | BPA-PC-REV - ANY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4361 | BPA - DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4362 | BPA-PC-DIAG - TYPE OF BILL RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4363 | BPA-PC-DRG - TYPE OF BILL RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4364 | BPA-PC-ICD9 - TYPE OF BILL RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4371 | BPA-RP-PROC - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4372 | BPA-PC-PROC - SECONDARY HDR DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4373 | BPA-RP-NDC - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4374 | BPA-RP-REV - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4376 | BPA-RP-ICD9 - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4500 | BPA-RR-NDC - ALGI RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4501 | BPA-RR-NDC - NO RULE FOR DISP AS WRITTEN IND |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4502 | BPA-RP-PROC - EPSDT REFERRAL RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4503 | BPA-PC-PROC - EPSDT REFERRAL RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4504 | BPA-RP-NDC - ALGI RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4505 | BPA-RR-PROC - NO RULE FOR URBAN/RURAL IND |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4506 | BPA-PC-DIAG - PERF PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4508 | BPA-PC-PROC - PERF PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4509 | BPA-PC-REV - PERF PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4511 | BPA-RP-DIAG - PERF PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4514 | BPA-RP-PROC - PERF PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4515 | BPA-RP-REV - PERF PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4516 | BPA-PC-DIAG - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4517 | BPA-PC-NDC - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4518 | BPA-PC-ICD9 - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4519 | BPA-PC-PROC - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4520 | BPA-PC-REV - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4521 | BPA-RP-DIAG - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4522 | BPA-RP-NDC - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4523 | BPA-RP-ICD9 - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4524 | BPA-RP-PROC - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4525 | BPA-RP-REV - BILL PROV ALL PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4526 | BPA-PC-PROC - PROV COUNTY RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4527 | BPA-PC-NDC - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4529 | BPA-RP-REV - PROV COUNTY RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4530 | BPA-RR-PROC - SECONDARY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4532 | BPA-RR-ICD9 - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4533 | BPA-RP-REV - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4534 | BPA-RP-DRG - EMERGENCY DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4535 | BPA-RP-ICD9 - EMERGENCY DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4536 | BPA-RP-PROC - EMERGENCY DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4538 | BPA-RP-REV - EMERGENCY DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4539 | BPA-PC-PROC - EMERGENCY DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4540 | BPA-PC-PROC - MIN UNIT RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4541 | BPA-RP-DIAG - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4542 | BPA-RP-DRG - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4545 | BPA-RP-PROC - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4546 | BPA-RP-REV - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4547 | BPA-PC-DIAG - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4548 | BPA-PC-DRG - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4551 | BPA-PC-PROC - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4552 | BPA-PC-REV - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4553 | BPA-RR-DIAG - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4554 | BPA-RR-DRG - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4556 | BPA-RR-NDC - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4557 | BPA-RR-PROC - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4558 | BPA-RR-REV - REFER PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4559 | BPA-RP-DRG - SECONDARY HDR DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4560 | BPA-RP-ICD9 - SECONDARY HDR DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4561 | BPA-RP-REV - SECONDARY HDR DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4562 | BPA-RP-REV - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4563 | BPA-RR - NO RULE CURR PERF PROV CONTRACT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4564 | BPA-RR-PROC - HDR SECONDARY DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4565 | BPA-RR-ICD9 - HDR SECONDARY DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4566 | BPA-RR-REV - HDR SECONDARY DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4580 | BPA-RP-PROC - DIAGNOSIS RESTRICTION - GROUP |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4581 | BPA-PC-PROC - DIAGNOSIS RESTRICTION - GROUP |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4711 | BPA-PC-DIAG - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4712 | BPA-PC-DRG - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4713 | BPA-PC-NDC - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4714 | BPA-PC-PROC - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4715 | BPA-PC-REV - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4716 | BPA-PC-ICD9 - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4721 | BPA-RP-DRG - ADMIT DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4722 | BPA-RP-DRG - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4723 | BPA-RP-ICD9 - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4724 | BPA-RP-ICD9 - ANY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4726 | BPA-RP-ICD9 - ADMIT DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4731 | BPA-RP-PROC - ANY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4732 | BPA-RP-REV - ADMIT DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4733 | BPA-RP-REV - ANY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4734 | BPA-PC-DRG - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4736 | BPA-RP-REV - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4741 | BPA-RP-PROC - ADMIT DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4742 | BPA-RP-PROC - PRIMARY HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4743 | BPA-RP-PROC - SECONDARY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4744 | BPA-RP-PROC - SECONDARY HDR DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4746 | BPA-RP-PROC - PRIMARY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4747 | BPA-PC-ICD9 - HDR SECONDARY DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4748 | BPA-PC-REV - SECONDARY HDR DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4751 | BPA-PC-REV - TYPE OF BILL RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4755 | BPA-PC-PROC - CURRENT BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4756 | BPA-PC-DIAG - CURRENT BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4757 | BPA-PC-REV - CURRENT BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4762 | BPA-PC-ICD9 - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4765 | BPA-RP-ICD9 - NO COVERAGE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4766 | BPA-RP-ICD9 - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4767 | BPA-RP-ICD9 - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4775 | BPA-PC-NDC - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4776 | BPA-PC-DIAG - BILL PROV PRIMARY PT/PS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4801 | BPA-PC-PROC - NO CONTRACT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4802 | BPA-PC-DIAG - NO CONTRACT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4803 | BPA-PC-NDC - NO CONTRACT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4804 | BPA-PC-REV - NO CONTRACT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4805 | BPA-PC-DRG - NO CONTRACT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4806 | BPA-PC-ICD9 - NO CONTRACT |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4821 | BPA-PC-PROC - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4822 | BPA-PC-DIAG - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4831 | BPA-RR - NO REIMB RULE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4835 | BPA-PC-PROC - OTHER DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4871 | BPA-PC-PROC - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4872 | BPA-PC-DIAG - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4873 | BPA-PC-NDC - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4874 | BPA-PC-REV - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4875 | BPA-PC-DRG - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4876 | BPA-PC-ICD9 - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4881 | BPA-PC-DRG - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4882 | BPA-RP-DRG - NO COVERAGE |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4884 | BPA-RP-DRG - AGE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4886 | BPA-RP-DRG - CLAIM TYPE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4887 | BPA-RP-DRG - PLACE OF SERVICE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4900 | BPA-RP-DIAG - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4901 | BPA-RP-DIAG - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4902 | BPA-RP-DIAG - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4904 | BPA-RP-DRG - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4905 | BPA-RP-ICD9 - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4906 | BPA-RP-PROC - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4910 | BPA-PC-DIAG - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4911 | BPA-PC-DIAG - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4912 | BPA-PC-DIAG - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4913 | BPA-XX-DIAG - DIAG ROLE RESTRICTION -PC and RR |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4917 | BPA-PC-DRG - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4920 | BPA-RP-DRG - BENE PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4921 | BPA-RP-DRG - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4922 | BPA-RP-DRG - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4923 | BPA-PC-ICD9 - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4927 | BPA-RP-DIAG - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4928 | BPA-RP-PROC - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4929 | BPA-RP-REV - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4930 | BPA-PC-DRG - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4931 | BPA-PC-DRG - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4933 | BPA-PC-PROC - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4935 | BPA-RP-DRG - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4936 | BPA-PC-DRG - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4937 | BPA-PC-DIAG - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4938 | BPA-PC-PROC - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4939 | BPA-PC-REV - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4940 | BPA-RP-ICD9 - BENE PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4941 | BPA-RP-ICD9 - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4942 | BPA-RP-ICD9 - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4943 | BPA-PC-REV - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4944 | BPA-PC-ICD9 - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4947 | BPA-RR-NDC - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4948 | BPA-RR-PROC - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4949 | BPA-RR-REV - ASSIGNMENT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4950 | BPA-PC-ICD9 - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4951 | BPA-PC-ICD9 - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4952 | BPA-PC-ICD9 - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4953 | BPA-RR-DRG - OTHER DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4960 | BPA-RP-NDC - BENE PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4961 | BPA-RP-PROC - PROV COUNTY RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4962 | BPA-PC-NDC - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4963 | BPA-PC-PROC - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4964 | BPA-PC-REV - GENDER RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4965 | BPA-PC-NDC - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4966 | BPA-RR - DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4970 | BPA-RP-REV - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4971 | BPA-RP-REV - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4972 | BPA-RP-REV - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4973 | BPA-RR-PROC - ANY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4975 | BPA-PC-REV - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4976 | BPA-PC-REV - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4977 | BPA-PC-REV - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4980 | BPA-RP-PROC - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4981 | BPA-RP-PROC - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4982 | BPA-RP-PROC - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4983 | BPA-RR-DRG - OTHER HDR DIAGNOSIS RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4990 | BPA-PC-PROC - BENEFIT PLAN RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4991 | BPA-PC-PROC - CONDITION CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4992 | BPA-PC-PROC - OCCURRENCE CODE RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4993 | BPA-RR-PROC - PRIMARY DTL DIAG RESTRICTION |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5200 | ADMINISTRATION FEE MAY NOT BE BILLED ON THE SAME DAY AS AN OFFICE VISIT AND/OR VACCINE REPLACEMENT |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5201 | ADMINISTRATION FEE MAY NOT BE BILLED ON THE SAME DAY AS AN OFFICE VISIT AND/OR VACCINE REPLACEMENT |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 5260 | BATTERIES MAY NOT BE PURCAHSED WITHIN 60 (SIXTY) DAYS OF PURCHASE OF HEARING AI D |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 5261 | BATTERIES MAY NOT BE PURCAHSED WITHIN 60 (SIXTY) DAYS OF PURCHASE OF HEARING AI D |
| 107 | Processed according to contract/plan provisions. | B15 | Payment adjusted because this procedure/service is not paid separately. | 5324 | WHEN PROPHYLAXIS AND FLUORIDE ARE PERFORMED ON THE SAME DAY,THE COMBINED CODE M UST BE BILLED. |
| 107 | Processed according to contract/plan provisions. | B15 | Payment adjusted because this procedure/service is not paid separately. | 5325 | WHEN PROPHYLAXIS AND FLUORIDE ARE PERFORMED ON THE SAME DAY,THE COMBINED CODE M UST BE BILLED. |
| 107 | Processed according to contract/plan provisions. | 107 | Claim/service denied because the related or qualifying claim/service was not paid or identified on the claim. | 5350 | NO EXTRACTION CODE IN HISTORY IN 180 TIME FRAME. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5400 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY BY THE PROVIDER |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5401 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY BY THE PROVIDER |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5402 | SCREENING PROVIDER MAY NOT BILL FOR SCREENING EXAM AND INCLUSIVE MEDICAL SERVIC ES ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5403 | SCREENING PROVIDER MAY NOT BILL FOR SCREENING EXAM AND INCLUSIVE MEDICAL SERVIC ES ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 5410 | MORE THAN ONE CONTACT LENS FITTING CANNOT BE BILLED FOR THE SAME DATE OF SERVIC E. |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 5411 | MORE THAN ONE CONTACT LENS FITTING CANNOT BE BILLED FOR THE SAME DATE OF SERVIC E. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5412 | PROCEDURE CODE V2020 AND V2025 CANNOT BE BILLED ON THE SAME DAY OF SERVICE. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5413 | PROCEDURE CODE V2020 AND V2025 CANNOT BE BILLED ON THE SAME DAY OF SERVICE. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5414 | EPSDT VISION SCREEN AND EXTERNAL OCULAR PHOTOGRAPHY NOT COVERED ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5415 | EPSDT VISION SCREEN AND EXTERNAL OCULAR PHOTOGRAPHY NOT COVERED ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5438 | COMPREHENSIVE EPSDT SCREENING AND FP VISIT MAY NOT BE BILLED ON THE SAME DAY. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5439 | COMPREHENSIVE EPSDT SCREENING AND FP VISIT MAY NOT BE BILLEDON THE SAME DAY. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5440 | FAMILY PLANNING VISIT NOT PAYABLE AFTER STERILIZATION |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5441 | FAMILY PLANNING VISIT NOT PAYABLE AFTER STERILIZATION |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5516 | ANTEPARTUM, POSTPARTUM CARE/VAGINAL DELIVERY MAY NOT BE BILLED WITH GLOBAL OB C ARE |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5517 | ANTEPARTUM, POSTPARTUM CARE/VAGINAL DELIVERY MAY NOT BE BILLED WITH GLOBAL OB C ARE |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5522 | ROUTINE PRENATAL LAB, OFFICE/HOSPITAL VISITS MAY NOT BE BILLED WITH GLOBAL OB P ROCEDURE |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5523 | ROUTINE PRENATAL LAB, OFFICE/HOSPITAL VISITS MAY NOT BE BILLED WITH GLOBAL OB P ROCEDURE |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5524 | POSTPARTUM SERVICES MAY NOT BE BILLED WITH GLOBAL OB ON OR WITHIN 62 DAYS OF DE LIVERY |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5525 | POSTPARTUM SERVICES MAY NOT BE BILLED WITH GLOBAL OB ON OR WITHIN 62 DAYS OF DE LIVERY |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5636 | HYSTERECTOMY ANCILLARY CODES MAY NOT BE PAID IN ADDITION TO THE HYSTERECTOMY P ROCEDURE CODE |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5637 | HYSTERECTOMY ANCILLARY CODES MAY NOT BE PAID IN ADDITION TO THE HYSTERECTOMY P ROCEDURE CODE |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5638 | HOSPITAL ADMISSION/VISITS MAY NOT BE BILLED ON OR AFTER OB GLOBAL |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5639 | HOSPITAL ADMISSION/VISITS MAY NOT BE BILLED ON OR AFTER OB GLOBAL |
| 107 | Processed according to contract/plan provisions. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5644 | HOSPITAL VISITS AND SUBSEQUENT CRITICAL CARE MAY NOT BE BILLED ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5645 | HOSPITAL VISITS AND SUBSEQUENT CRITICAL CARE MAY NOT BE BILLED ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5661 | SUBSEQUENT CRITICAL CARE NOT VALID WITHOUT INITAL CARE. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5710 | SERVICE CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5711 | SERVICE CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5712 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5713 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 107 | Processed according to contract/plan provisions. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | 5714 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 107 | Processed according to contract/plan provisions. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | 5715 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5716 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPIENT. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5717 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPIENT. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5718 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPENT |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5719 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPENT |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5720 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5721 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5722 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPIENT. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5723 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPIENT. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5724 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5725 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5726 | THIS SERVICE IS NOT ALLOWED ON THE SAME DAY AS DAY TREATMENT |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5727 | THIS SERVICE IS NOT ALLOWED ON THE SAME DAY AS DAY TREATMENT |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5728 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5729 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5732 | THE SAME PROVIDER MAY NOT BILL HOSPITAL VISITS/PSYCHOTHERAPY ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5733 | THE SAME PROVIDER MAY NOT BILL HOSPITAL VISITS/PSYCHOTHERAPY ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5734 | THE SAME PROVIDER MAY NOT BILL PSYCHOTHERAPY/OFFICE VISITS ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5735 | THE SAME PROVIDER MAY NOT BILL PSYCHOTHERAPY/OFFICE VISITS ON THE SAME DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5736 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5738 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPIENT |
| 107 | Processed according to contract/plan provisions. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5740 | INDIVIDUAL THERAPY AND GROUP THERAPY MAY NOT BE BILLED ON THE SAME DAY. |
| 107 | Processed according to contract/plan provisions. | 42 | Charges exceed our fee schedule or maximum allowable amount. | 5760 | ESWL PRICING |
| 107 | Processed according to contract/plan provisions. | 18 | Duplicate claim/service. | 5804 | ONLY ONE TYPE OF RESPITE CARE IS ALLOWED FOR A GIVEN DATE OF SERVICE. |
| 107 | Processed according to contract/plan provisions. | 97 | Payment is included in the allowance for another service/procedure. | 5814 | PROCEDURE NOT COVERED WITH SPECIFIC CODES. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5816 | HIV CODES MUST BE BILLED IN CONJUNCTION WITH FAMILY PLANNING CODES. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5818 | THERAPY CODE PAYABLE ONLY WITH THERAPEUTIC TREATMENT. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5819 | OBSERVATION MUST BE BILLED IN CONJUNCTION WITH FACILITY FEE. |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 6181 | THE ALLOWED LENS LIMITATION HAS BEEN EXCEEDED |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 6182 | THE ALLOWED FRAMES LIMITATION HAS BEEN EXCEEDED |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 6301 | MORE THAN ONE OBSTETRICAL DELIVERY CODE MAY NOT BE BILLED W ITHIN SIX MONTHS |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6303 | MORE THAN ONE OBSTETRICAL DELIVERY CODE MAY NOT BE BILLED WITHIN SIX MONTHS. |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 6310 | THE QUANTITY DISPENSED EXCEEDS THE MAXIMUM QUANTITY ALLOWED FOR THE DRUG CODE P RESCRIBED. |
| 107 | Processed according to contract/plan provisions. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 6311 | QTY DISPENSED EXCEEDS MAX QTY BASED ON PA |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 6401 | OB ULTRASOUND LIMIT HAS BEEN REACHED FOR THIS RECIPIENT. ANY FURTHER WILL REQUI RE PRIOR AUTHORIZATION. |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 6690 | REVENUE CODE 183 IS LIMITED TO 6 DAYS EACH CALENDAR QUARTER. |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | 6691 | REVENUE CODE 184 IS LIMITED TO 14 DAYS PER CALENDAR MONTH |
| 107 | Processed according to contract/plan provisions. | 133 | The disposition of this claim/service is pending further review. | 7000 | CLAIM FAILED A PRODUR ALERT |
| 107 | Processed according to contract/plan provisions. | 175 | PAYMENT DENIED BECAUSE THE PRESCRIPTION IS INCOMPLETE | 7001 | INFORMATIONAL PRODUR ALERT |
| 107 | Processed according to contract/plan provisions. | 6 | The procedure code is inconsistent with the patient's age. | 7002 | CLAIM DENIED FOR PRODUR REASONS |
| 107 | Processed according to contract/plan provisions. | 6 | The procedure code is inconsistent with the patient's age. | 7003 | PRODUR ALERT REQUIRES PA FOR OVERRIDE |
| 107 | Processed according to contract/plan provisions. | 6 | The procedure code is inconsistent with the patient's age. | 7004 | NON-OVERRIDEABLE PRODUR ALERT |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7501 | DOSE DISPENSED ON THE RESPONSE CLAIM IS THE SAME AS ON THE ORIGINAL CLAIM |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7502 | DRUG DISPENSED ON THE RESPONSE CLAIM IS THE SAME AS ON THE ORIGINAL CLAIM |
| 107 | Processed according to contract/plan provisions. | 6 | The procedure code is inconsistent with the patient's age. | 7503 | CONFLICT CODE ON RESPONSE CLAIM DOES NOT MATCH |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7504 | MISSING / INVALID INTERVENTION CODE |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7505 | MISSING/INVALID PRODUR OUTCOME CODE. PLEASE USE 1A-1G, 2A OR 2B. |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7506 | CLAIM CONTAINS A NON-OVERRIDEABLE ALERT |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7507 | VALID OUTCOME CODE OF "NOT FILLED" RECEIVED. RESPONSE ACCEPTED, CLAIM REJECTED |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7508 | QUANTITY DISPENSED ON RESPONSE CLAIM SAME AS ORIGINAL CLAIM |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7510 | OUTCOME CODE INDICATES PRESCRIPTION WAS "FILLED AS IS", BUT CHANGES WERE DETECT ED ON THE RESPONSE CLAIM FOR EITHER THE DAYS SUPPLY, QUANTITY, OR NDC |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7520 | DD ProDUR alert; Unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7521 | DD ProDUR alert; major severity; requires provider override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7522 | DD ProDUR alert; moderate severity; requires provider override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7523 | DD ProDUR alert; minor severity; requires provider override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7524 | DD ProDUR alert; unspecified severity; requires provider override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7525 | HD ProDUR alert; Unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7526 | HD ProDUR alert; major severity; requires provider override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7527 | HD ProDUR alert; moderate severity; requires provider override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7528 | HD ProDUR alert; minor severity; requires provider override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7529 | HD ProDUR alert; unspecified severity; requires provider override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7530 | ER ProDUR alert; Unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7531 | ER ProDUR alert; major severity; requires PA override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7532 | ER ProDUR alert; moderate severity; requires PA override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7533 | ER ProDUR alert; minor severity; requires PA override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7534 | ER ProDUR alert; unspecified severity; requires PA override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7535 | TD ProDUR alert; Unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7536 | TD ProDUR alert; major severity; requires PA override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7537 | TD ProDUR alert; moderate severity; requires PA override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7538 | TD ProDUR alert; minor severity; requires PA override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7539 | TD ProDUR alert; unspecified severity; requires PA override |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7540 | PG ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7541 | PG ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7542 | PG ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7543 | PG ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7544 | PA ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7545 | PA ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7546 | PA ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7547 | PA ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7548 | LD ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7549 | LD ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7550 | LD ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7551 | LD ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7552 | MX ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7553 | MX ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7554 | MX ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7555 | MX ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7556 | MN ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7557 | MN ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7558 | MN ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7559 | MN ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7560 | DA ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7561 | DA ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7562 | DA ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7563 | DA ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7564 | LR ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7565 | LR ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7566 | LR ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7567 | LR ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7568 | ID ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7569 | ID ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7570 | ID ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7571 | ID ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7572 | DC/MC ProDUR alert; unspecified |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7573 | DC/MC ProDUR alert; major severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7574 | DC/MC ProDUR alert; moderate severity; |
| 107 | Processed according to contract/plan provisions. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 7575 | DC/MC ProDUR alert; minor severity; |
| 107 | Processed according to contract/plan provisions. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 9800 | CUTBACK - CLAIM PROCESSED AS AN ENCOUNTER. |
| 107 | Processed according to contract/plan provisions. | 96 | Non-covered charge(s). | X073 | FAMILY PLANNING SERVICE NOT COVERED FOR THIS RECIPIENT. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X613 | PULP THERAPY COMBINATION NOT ALLOWED |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X621 | PULP CAP NOT ALLOWED FOR THIS TOOTH/DATE OF SERVICE. |
| 107 | Processed according to contract/plan provisions. | 119 | Benefit maximum for this time period has been reached. | X623 | FLUORIDE IS LIMITED TO ONCE EVERY 6 MONTHS |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X624 | AN INITIAL VISIT WILL NOT BE PAID ON SAME DATE OF SERVICE ASAN ANNUAL, PERIODIC OR HOME VISIT. |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X791 | THE SAME PHYSICIAN MAY NOT BILL INTUBATION AND NEWBORN RESUSCITATION ON THE SAM E DAY |
| 107 | Processed according to contract/plan provisions. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X893 | MORE THAN ONE OBSTETRICAL DELIVERY CODE MAY NOT BE BILLED WITHIN SIX MONTHS. |
| 109 | Entity not eligible. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 825 | MEDICARE ALLOWED AMOUNT MISSING OR INVALID |
| 109 | Entity not eligible. | 6 | The procedure code is inconsistent with the patient's age. | 1806 | EPSDT REFERRED SVCS RESTRICTED TO RECIPIENTS UNDER |
| 109 | Entity not eligible. | 6 | The procedure code is inconsistent with the patient's age. | 1812 | RECIPIENT / ADMIT AGE GREATER THAN 21 |
| 109 | Entity not eligible. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | 1814 | BILLING PROVIDER NOT VALID FOR DATES OF SERVICE |
| 109 | Entity not eligible. | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 1817 | MATERNITY CARE PROV CAN ONLY BILL MATERNITY SVCS |
| 109 | Entity not eligible. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | 2003 | ITEMIZED SERVICE DATE NOT IN ELIGIBILITY SPAN |
| 109 | Entity not eligible. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | 2077 | RECIPIENT IS NOT ELIGIBLE ALL DATES OF SERVICES |
| 109 | Entity not eligible. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | 2804 | DETAILS COVERED BY MORE THAN ONE PLAN CODE |
| 109 | Entity not eligible. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X225 | DATE OF SERVICE IS NOT WITHIN THE PROVIDER RATE SEGMENTS. |
| 109 | Entity not eligible. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X226 | CLAIM TYPE IS NOT VALID FOR THIS PROVIDER. |
| 109 | Entity not eligible. | 26 | Expenses incurred prior to coverage. | X254 | RECORDS SHOW THIS RECIPIENT IS TOTALLY INELIGIBLE FOR MEDICAID FOR HEADER DATE( S) OF SERVICE. |
| 109 | Entity not eligible. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | X255 | RECORDS SHOW THIS RECIPIENT IS PARTIALLY INELIGIBLE FOR MEDICAID FOR HEADER DAT E(S) OF SERVICE. |
| 109 | Entity not eligible. | 26 | Expenses incurred prior to coverage. | X262 | RECORDS SHOW THIS RECIPIENT IS TOTALLY INELIGIBLE FOR MEDICAID FOR DETAIL DATE( S) OF SERVICE. |
| 110 | Claim requires pricing information. | 96 | Non-covered charge(s). | X075 | PROVIDER NOT ON LEVEL 1 FOR PAC 1 PROCEDURE. |
| 110 | Claim requires pricing information. | 133 | The disposition of this claim/service is pending further review. | X325 | THIS SERVICE IS PENDING APPROVAL AND CODE ASSIGNMENT,CONTACTEDS FOR INFORMATION . |
| 115 | Cannot process HMO claims | 24 | Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. | X279 | CLAIM DENIED. RECIPIENT HAS MEDICARE HMO COVERAGE |
| 117 | Claim requires signature-on-file indicator. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 228 | CLAIMANT SIGNATURE MISSING |
| 117 | Claim requires signature-on-file indicator. | 29 | The time limit for filing has expired. | 556 | SERVICE(S) PAST THE MAXIMUM MEDICAID FILING LIMIT |
| 121 | Service line number greater than maximum allowable for payer. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 247 | MAXIMUM NUMBER OF CLAIM DETAILS EXCEEDED |
| 121 | Service line number greater than maximum allowable for payer. | 96 | Non-covered charge(s). | X041 | ONLY TWENTY THREE LINES ALLOWED PER CLAIM,SPLIT CLAIM AND RESUBMIT ACCORDINGLY. |
| 121 | Service line number greater than maximum allowable for payer. | 119 | Benefit maximum for this time period has been reached. | X577 | UNITS BILLED FOR PROCEDURE CODE EXCEED MAXIMUM UNITS ALLOWED |
| 121 | Service line number greater than maximum allowable for payer. | 119 | Benefit maximum for this time period has been reached. | X579 | INDEPENDENT RURAL HEALTH CLINICS CANNOT BE PAID FOR MORE THAN ONE SERVICE PER D AY. |
| 121 | Service line number greater than maximum allowable for payer. | 97 | Payment is included in the allowance for another service/procedure. | X580 | ADMINISTRATION FEE MAY NOT BE BILLED ON THE SAME DAY AS AN OFFICE VISIT AND/OR VACCINE REPLACEMENT |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 0 | ERROR DISPOSITION SETUP IS INVALID |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 250 | CLAIM HAS NO DETAILS |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 259 | DATE BILLED IS INVALID |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 902 | PROCEDURE CODE GROUP NOT FOUND |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 903 | GROUP NUMBER NOT FOUND IN PLACE OF SERVICE GROUP T |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 904 | GROUP NUMBER NOT FOUND IN MODIFIER GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 905 | GROUP NUMBER NOT FOUND IN LEVEL OF CARE GROUP TABL |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 906 | GROUP NUMBER NOT FOUND IN ICD-9 GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 907 | GROUP NUMBER NOT FOUND IN DRUG GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 909 | GROUP NUMBER NOT FOUND IN DIAGNOSIS GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 910 | BENEFIT PLAN GROUP NOT FOUND |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 911 | INTERNAL PROCESSING ERROR - CONTACT EDS |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 912 | INTERNAL ERROR-DOLLAR DISTRIBUTION |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 913 | GROUP NUMBER NOT FOUND IN REVENUE GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 914 | GROUP NUMBER NOT FOUND IN TYPE OF BILL GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 915 | GROUP NUMBER NOT FOUND IN COUNTY GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 916 | GROUP NOT FOUND IN PROVIDER GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 917 | GROUP NUMBER NOT FOUND IN PROCEDURE GROUP TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 918 | TOOTH SURFACE NUMBER NOT FOUND IN TOOTH SURFACE GR |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 919 | GROUP NUMBER NOT FOUND IN AID CODE TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 920 | DRUG THERAPEUTIC CLASS GROUP NOT FOUND |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 921 | GROUP NUMBER NOT FOUND IN PROVIDER LIST TABLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 922 | TABLE ENTRY MISSING T_MCARE_DEDUCTIBLE |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 2054 | UNABLE TO DETERMINE FUND CODE - DETAIL |
| 122 | Missing/invalid data prevents payer from processing claim. | 6 | The procedure code is inconsistent with the patient's age. | 3102 | ONLINE PA PROCESS TIMEOUT OR INTERFACE PROBLEM |
| 122 | Missing/invalid data prevents payer from processing claim. | 6 | The procedure code is inconsistent with the patient's age. | 3103 | ONLINE PA PROCESS RESPONSE FROM HID HAD ERRORS |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3310 | DISPENSING FEE NOT LOCATED |
| 122 | Missing/invalid data prevents payer from processing claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X045 | THE MEDICARE ALLOWED AMOUNT IS MISSING OR INVALID. |
| 122 | Missing/invalid data prevents payer from processing claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X063 | RECIPIENT'S COUNTY OF RESIDENCE FOR CLAIM DATES OF SERVICE ARE NOT ON FILE. RE SUBMIT. |
| 122 | Missing/invalid data prevents payer from processing claim. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X112 | THERE IS NO PROVIDER NUMBER FOR LONG TERM CARE FILE FOR THISRECIPIENT. |
| 122 | Missing/invalid data prevents payer from processing claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X178 | PROCEDURE MUST BE BILLED WITH CHEMOTHERAPY |
| 122 | Missing/invalid data prevents payer from processing claim. | 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. | X267 | CENSUS DATA IS NOT ON FILE FOR PROVIDER FOR THE PREVIOUS MONTH. |
| 122 | Missing/invalid data prevents payer from processing claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X358 | PHP PROVIDERS MUST HAVE A CURRENT EFT SEGMENT. |
| 122 | Missing/invalid data prevents payer from processing claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X478 | THIS CLAIM DOES NOT CONTAIN REQUIRED DATA TO DETERMINE MEDICAID LIABILITY FOR C OINSURANCE DAYS/LIFETIME RESERVE DAYS |
| 122 | Missing/invalid data prevents payer from processing claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X487 | THIS CLAIM DOES NOT CONTAIN REQUIRED DATA TO DETERMINE MEDICAID LIABILITY FOR C OINSURANCE/LIFETIME RESERVE DAYS |
| 122 | Missing/invalid data prevents payer from processing claim. | 18 | Duplicate claim/service. | X538 | A CARDIOLOGIST OR A RADIOLOGIST CANNOT BILL THIS PROCEDURE CODE ON THE SAME DAY |
| 122 | Missing/invalid data prevents payer from processing claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X912 | DETAIL DOS NOT WITHIN THE HEADER DOS. |
| 122 | Missing/invalid data prevents payer from processing claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X913 | CLAIM CANNOT BE PAID DUE TO ERRORS AT THE DETAIL |
| 122 | Missing/invalid data prevents payer from processing claim. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X929 | DETAIL COUNT MISSING OR INVALID |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X935 | MISSING/INVALID PRODUCT/SERVICE ID QUALIFIER |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X936 | MISSING/INVALID PRESCRIBER SEGMENT |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X937 | MISSING/INVALID PRESCRIBER ID QUALIFIER |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X938 | MISSING/INVALID PRICING SEGMENT |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X939 | MISSING/INVALID OTHER PAYER AMOUNT PAID QUALIFIER |
| 122 | Missing/invalid data prevents payer from processing claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X940 | NON-MATCHED NDC NUMBER ON REVERSAL TXN |
| 122 | Missing/invalid data prevents payer from processing claim. | 96 | Non-covered charge(s). | X941 | RECIPIENT DOES NOT MEET CRITERIA FOR PREGNANCY CO-PAY EXEMPTION. |
| 123 | Additional information requested from entity. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X046 | MEDICARE TOTAL BILLED AMOUNT IS MISSING OR INVALID. |
| 125 | Entity's name. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 513 | NAME ON CLAIM MUST MATCH NAME ON FILE |
| 125 | Entity's name. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 1065 | PROVIDER NAME MISMATCH |
| 126 | Entity's address. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X222 | PROVIDER'S ADDRESS IS INVALID. CONTACT EDS'S PROVIDER ENROLLMENT UNIT. |
| 132 | Entity's Medicaid provider id. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X229 | PROVIDER NUMBER IS INVALID, NOT ON FILE OR NAME/NUMBER DISAGREE. |
| 132 | Entity's Medicaid provider id. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X235 | THE BILLING PROVIDER MUST BE THE GROUP PROVIDER NUMBER |
| 132 | Entity's Medicaid provider id. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X236 | PERFORMING PROVIDER CANNOT BE GROUP PROVIDER NUMBER |
| 142 | Entity's license/certification number. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 226 | ANESTHESIA CLAIMS REQUIRE REFERRING PROVIDER |
| 142 | Entity's license/certification number. | 100 | PAYMENT MADE TO PATIENT/INSURED/RESPONSIBLE PARTY. | 4207 | CLIA NUMBER NOT ON FILE FOR DATES OF SERVICE |
| 142 | Entity's license/certification number. | 5 | The procedure code/bill type is inconsistent with the place of service. | 4212 | BILLING OUT OF CLIA CERTIFICATE TYPE |
| 142 | Entity's license/certification number. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X230 | THE ATTENDING PHYSICIAN'S LICENSE NUMBER IS MISSING OR INVALID. |
| 143 | Entity's state license number. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 230 | MISSING ATTENDING SURGEON PRESCRIBER NUMBER |
| 143 | Entity's state license number. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 802 | MISSING OR INVALID PRESCRIBER ID QUALIFIER |
| 143 | Entity's state license number. | 2 | Coinsurance Amount | 816 | COINSURANCE DAYS NOT NUMERIC |
| 145 | Entity's specialty code. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 1805 | BILLING PROVIDER SPECIALTY NOT FOUND FOR CLAIM DOS |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1900 | TAXONOMY IS INVALID BILLING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1901 | TAXONOMY IS INVALID PREFORMING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1902 | TAXONOMY IS INVALID REFERRING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1903 | TAXONOMY IS INVALID: FACILITY PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1905 | TAXONOMY IS INVALID: OTHER PROVIDER 2 |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1906 | TAXONOMY IS NOT VALID FOR BILLING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1907 | TAXONOMY IS NOT VALID FOR PERFORMING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1908 | TAXONOMY IS NOT VALID FOR REFERRING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1909 | TAXONOMY IS NOT VALID FOR FACILITY PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1911 | TAXONOMY IS NOT VALID FOR OTHER PROVIDER 2 |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1912 | TAXONOMY IS MISSING: BILLING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1913 | TAXONOMY IS MISSING: PERFORMING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1914 | TAXONOMY IS MISSING: REFERRING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1915 | TAXONOMY IS MISSING: FACILITY PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1917 | TAXONOMY IS MISSING: OTHER PROVIDER 2 |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1918 | TAXONOMY IS INVALID: DTL OTHER PROVIDER 2 |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1919 | TAXONOMY IS INVALID: DTL PERFORMING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1920 | TAXONOMY IS INVALID: DTL REFERRING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1921 | TAXONOMY IS MISSING: DTL PERFORMING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1922 | TAXONOMY IS MISSING: DTL REFERRING PROVIDER |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1923 | TAXONOMY IS MISSING: DTL OTHER PROVIDER 2 |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1924 | TAXONOMY IS NOT VALID FOR DTL OTHER PROVIDER 2 |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1925 | TAXONOMY IS NOT VALID FOR DTL PERFORMING PROV |
| 145 | Entity's specialty code. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1926 | TAXONOMY IS NOT VALID FOR DTL REFERRING PROVIDER |
| 145 | Entity's specialty code. | 38 | Services not provided or authorized by designated (network) providers. | X132 | BIRTH CONTROL PILLS MUST BE RECEIVED FROM A PHYSICIAN FOR THE PLAN FIRST PROGRA M |
| 145 | Entity's specialty code. | 38 | Services not provided or authorized by designated (network) providers. | X133 | PLAN FIRST RECIPIENT MUST BE SEEN BY A PLAN FIRST NETWORK PROVIDER |
| 145 | Entity's specialty code. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X154 | PROCEDURE CODE IS NOT COVERED FOR THIS PROVIDER SPECIALTY. |
| 147 | Entity's qualification degree/designation (e.g. RN,PhD,MD) | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X146 | PROCEDURE/REVENUE CODE IS INAPPROPRIATE FOR THIS PROVIDER TYPE. |
| 153 | Entity's id number. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 1803 | BILLING PROVIDER MUST BE GROUP PROVIDER NUMBER |
| 153 | Entity's id number. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7268 | PROVIDER IS REQUIRED FOR HISTORY PROCEDURES |
| 153 | Entity's id number. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7271 | CURRENT PROCEDURE LINES MUST HAVE SAME PROVIDER ID |
| 153 | Entity's id number. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | X106 | ANESTHESIA CLAIMS REQUIRE REFERRING PROVIDER. |
| 153 | Entity's id number. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X224 | ENROLLMENT FILE INDICATES THAT THIS PROVIDER NUMBER IS NOT VALID FOR THESE DATE S OF SERVICE |
| 154 | Relationship of surgeon & assistant surgeon. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 1804 | VERFIY PERFORMING PROVIDER NOT GROUP PROVIDER |
| 158 | Entity's date of birth | 14 | The date of birth follows the date of service. | 2805 | DOS PRIOR TO DOB |
| 158 | Entity's date of birth | 14 | The date of birth follows the date of service. | 7265 | BIRTHDATE CANNOT BE A FUTURE DATE |
| 158 | Entity's date of birth | 6 | The procedure code is inconsistent with the patient's age. | 7266 | AGE CANNOT BE GREATER THAN 124 YEARS |
| 158 | Entity's date of birth | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 7278 | INVALID DATE (DATE OF BIRTH) |
| 161 | Entity's employment status | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X993 | EMPLOYMENT INDICATOR INVALID. |
| 164 | Entity's contract/member number. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 824 | UNBORN RECIPIENT PENDING ELIGIBILITY VERIFICATION |
| 164 | Entity's contract/member number. | 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. | 829 | DAYS SUPPLY > 3 FOR EMERGENCY PHARMACY CLAIM |
| 164 | Entity's contract/member number. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 830 | MEDICARE HDR ALLOW AMNT NOT EQUAL SUM OF DTL ALLOW |
| 164 | Entity's contract/member number. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X237 | THE PERFORMING PROVIDER NUMBER IS NOT ON FILE |
| 164 | Entity's contract/member number. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X238 | PERFORMING PROVIDER IS NOT ASSOCIATED WITH THE GROUP. |
| 171 | Other insurance coverage information (health, liability, auto, etc.). | 23 | Payment adjusted because charges have been paid by another payer. | 576 | CLAIM HAS THIRD-PARTY PAYMENT |
| 171 | Other insurance coverage information (health, liability, auto, etc.). | 96 | Non-covered charge(s). | X011 | RECIPIENT ELIGIBLE FOR BAY HEALTH PLAN. PLEASE FILE TO BAY HEALTH FOR CONSIDERA TION. |
| 171 | Other insurance coverage information (health, liability, auto, etc.). | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X922 | PAYMENT DENIED BECAUSE THIRD PARTY AMOUNT IS GREATER THAN THE TOTAL SUBMITTED C HARGE, MISSING OR IS NOT NUMERIC. |
| 178 | Submitted charges. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 4005 | SUBMITTED TO ALLOWED EXCEEDS PERCENT |
| 178 | Submitted charges. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 4006 | ALLOWED TO SUBMITTED EXCEEDS PERCENT |
| 178 | Submitted charges. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 4009 | ALLOWED TO SUBMITTED EXCEEDS PERCENT |
| 178 | Submitted charges. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 4084 | SUBMITTED TO ALLOWED EXCEEDS PERCENT |
| 178 | Submitted charges. | 97 | Payment is included in the allowance for another service/procedure. | 5230 | SUBSEQUENT PROCEDURE INCLUDED IN PRIMARY ANESTHESIA CHARGE |
| 178 | Submitted charges. | 97 | Payment is included in the allowance for another service/procedure. | 5231 | SUBSEQUENT PROCEDURE INCLUDED IN PRIMARY ANESTHESIA CHARGE |
| 178 | Submitted charges. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5234 | ADDITIONAL PAIN CONTROL PROCEDURES PAID AT 50% OF MEDICAID ALLOWED. |
| 178 | Submitted charges. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5235 | ADDITIONAL PAIN CONTROL PROCEDURES PAID AT 50% OF MEDICAID ALLOWED. |
| 178 | Submitted charges. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5508 | SECONDARY SURGICAL PROCEDURE WITHIN THE SAME INCISION PAID AT 50% OF MEDICAID A LLOWED |
| 178 | Submitted charges. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5509 | SECONDARY SURGICAL PROCEDURE WITHIN THE SAME INCISION PAID AT 50% OF MEDICAID A LLOWED |
| 178 | Submitted charges. | 59 | Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. | 5520 | REGIONAL ANESTHESIA PAYMENT IS 50% OF LEVEL III PRICE |
| 178 | Submitted charges. | 59 | Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. | 5521 | REGIONAL ANESTHESIA PAYMENT IS 50% OF LEVEL III PRICE |
| 178 | Submitted charges. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X110 | INVALID DEDUCTIBLE AMOUNT FOR SKILLED NURSING FACILITY. |
| 182 | Allowable/paid from primary coverage. | 23 | Payment adjusted because charges have been paid by another payer. | X366 | OTHER INSURANCE PAID AN AMOUNT GREATER THAN OR EQUAL TO OURALLOWED AMOUNT. MED ICAID CANNOT MAKE ANY ADDITIONAL PAYMENT. |
| 182 | Allowable/paid from primary coverage. | 23 | Payment adjusted because charges have been paid by another payer. | X369 | THIS SERVICE WAS COVERED IN FULL BY MEDICARE. |
| 186 | Purchase and rental price of durable medical equipment. | 119 | Benefit maximum for this time period has been reached. | X814 | THE PURCHASE OF A HEARING AID STETHOSCOPE IS LIMITED TO ONE EVERY TWO YEARS. |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 201 | INVALID PAY-TO PROVIDER NUMBER |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 216 | DATE DISPENSED IS INVALID |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 239 | DETAIL TO DATE OF SERVICE IS MISSING |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 240 | THE DETAIL "TO" DATE IS INVALID |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 264 | DETAIL FROM DATE OF SERVICE IS MISSING |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 265 | DETAIL FROM DATE OF SERVICE IS INVALID |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 395 | HEADER STATEMENT COVERS PERIOD "FROM" DATE MISSING |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 396 | HEADER STATEMENT COVERS PERIOD "FROM" DATE INVALID |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 507 | FIRST DATE OF SERV GREATER THAN LAST DATE OF SERV |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 514 | DATE RECEIVED FOR PROCESSING-PRIOR TO DATE OF SERV |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 527 | DETAIL FROM DATE OF SERVICE IS AFTER ICN DATE |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 536 | BILLED DATE IS PRIOR TO DATES OF SERVICE |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 537 | HDR FROM DATE OF SERVICE > HDR TO DATE OF SERVICE |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 568 | DISCHARGE DATE IS LESS THAN ADMIT DATE |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 574 | SERVICE DATES ARE NOT IN SAME MONTH |
| 187 | Date(s) of service. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 575 | SURGERY DTE CANNOT BE OUTSIDE HDR DATES OF SERVICE |
| 187 | Date(s) of service. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | 803 | DATED EXCEED SOBRA/QMB ELIGIBILITY |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 812 | ADMIT DATE IS GREATER THAN ICN DATE |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 815 | SURGICAL ICD9 REQUIRES OPERATING PHYSICIAN |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 821 | NON-COVERED DAYS MISSING OR NOT NUMERIC |
| 187 | Date(s) of service. | 29 | The time limit for filing has expired. | X008 | SERVICE(S) PAST THE MAXIMUM MEDICAID FILING LIMIT. |
| 187 | Date(s) of service. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | X093 | CLAIM SPANS MORE THAN ONE MANAGED CARE PLAN. OBTAIN MANAGED CARE DATA AND SPLI T BILL. |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X101 | THE TO DATE IS INVALID OR PRIOR TO THE FROM DATE. |
| 187 | Date(s) of service. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X270 | RECIPIENT IS NOT ON THE LTC ELIGIBILITY FILE FOR THE DATE OF SERVICE. |
| 187 | Date(s) of service. | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | X290 | DOS BILLED IS PRIOR TO PROGRAM BEGIN DATE. |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X308 | THE DETAIL DOS SPANNED THE PROVIDER FISCAL YEAR BEGINNING/END DATES. |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X315 | DATES OF SERVICES CANNOT SPAN CALENDAR FISCAL YEARS.SPLIT BILL CLAIM. |
| 187 | Date(s) of service. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | X317 | KATRINA/RITA CLAIM SPANS PLAN CODES/ELIGIBILITY PERIODS. |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X320 | PSRO/UR DATA IS MISSING OR INVALID. |
| 187 | Date(s) of service. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X322 | DATE OF SURGERY IS MISSING OR INVALID. |
| 187 | Date(s) of service. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X418 | PROVIDER SPECIALTIES WITHIN THE SAME GROUP CANNOT BILL SERVICES FOR THE SAME RE CIPIENT FOR THE SAME DATE OF SERVICE. |
| 188 | Statement from-through dates. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 570 | TOTAL DAYS LESS THAN COVERED DAYS |
| 188 | Statement from-through dates. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X001 | THE FROM DATE OF SERVICE IS INVALID. |
| 188 | Statement from-through dates. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X002 | THE ADMISSION DATE IS INVALID. |
| 188 | Statement from-through dates. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X007 | NUMBER OF DAYS BILLED AND BILLING PERIOD DISAGREE. |
| 188 | Statement from-through dates. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X016 | IP-DOS MUST NOT SPAN 2 CALENDAR YEARS, SPAN A RATE CHANGE, OR EXCEED 99 DAYS. |
| 189 | Hospital admission date. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 813 | MEDICARE PAID DATE > ICN DATE |
| 189 | Hospital admission date. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X009 | THE DISCHARGE DATE IS EARLIER THAN THE ADMISSION DATE. TRANSPORTATION: DESCRIBE OTHER CHARGES. |
| 189 | Hospital admission date. | 119 | Benefit maximum for this time period has been reached. | X892 | INITIAL CRITICAL CARE LIMITED TO ONE PER DAY |
| 214 | Original date of prescription/orders/referral. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 215 | DATE DISPENSED IS MISSING |
| 214 | Original date of prescription/orders/referral. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 500 | DATE PRESCRIBED AFTER BILLING DATE |
| 214 | Original date of prescription/orders/referral. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 502 | DATE DISPENSED EARLIER THAN DATE PRESCRIBED |
| 214 | Original date of prescription/orders/referral. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X904 | DATE PRESCRIBED IS INVALID |
| 214 | Original date of prescription/orders/referral. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X908 | DISPENSE DATE IS EARLIER THAN DATE PRESCRIBED |
| 215 | Date of tooth extraction/evolution. | 107 | Claim/service denied because the related or qualifying claim/service was not paid or identified on the claim. | X611 | NO EXTRACTION CODE IN HISTORY IN 180 TIME FRAME. |
| 215 | Date of tooth extraction/evolution. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X693 | TEMPORARY FILLING NOT PAYABLE ON SAME DATE OF SERVICE AS DEFINITIVE FILLING |
| 216 | Drug information. | 96 | Non-covered charge(s). | X356 | THIS DRUG IS NOT AVAILABLE AS AN INJECTABLE. |
| 216 | Drug information. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X906 | THIS SCHEDULE II DRUG IS NOT REFILLABLE. |
| 218 | NDC number. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 217 | MISSING DRUG CODE |
| 218 | NDC number. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 218 | INVALID DRUG CODE |
| 218 | NDC number. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 3313 | NDC DRUG, PRODUCT IS NOT PREFERRED |
| 218 | NDC number. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 3314 | PHARMACY ONLY - OTC DRUG NOT COVERED FOR LTC RECIP |
| 218 | NDC number. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 3316 | PHARMACY ONLY - NDC IS NOT PAYABLE BY ALABAMA MEDI |
| 218 | NDC number. | 96 | Non-covered charge(s). | 4004 | NDC IS NOT ON FILE |
| 218 | NDC number. | 96 | Non-covered charge(s). | 4007 | NDC IS DEACTIVED AND NOT PAYABLE ON DATE FILLED |
| 219 | Prescription number. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 212 | MISSING PRESCRIPTION NUMBER |
| 219 | Prescription number. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X900 | PRESCRIPTION NUMBER CANNOT BE SPACES OR ZEROES |
| 220 | Drug product id number. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X451 | THIS SCHEDULE II DRUG IS NOT REFILLABLE |
| 221 | Drug days supply and dosage. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 211 | INVALID REFILL INDICATOR VALUE |
| 221 | Drug days supply and dosage. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 219 | QUANTITY DISPENSED IS MISSING |
| 221 | Drug days supply and dosage. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 220 | QUANTITY DISPENSED IS INVALID |
| 221 | Drug days supply and dosage. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 221 | MISSING DAYS SUPPLY |
| 221 | Drug days supply and dosage. | 45 | Charges exceed your contracted/ legislated fee arrangement. | 222 | ESTIMATED DAYS SUPPLY INVALID |
| 221 | Drug days supply and dosage. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 831 | MEDICARE HDR PAID AMNT NOT EQUAL SUM OF DTL PAID |
| 221 | Drug days supply and dosage. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 3311 | REFILL NUMBER EXCEEDS MAXIMUM ALLOWED |
| 221 | Drug days supply and dosage. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4165 | Max Day Restriction for Covered NDC |
| 221 | Drug days supply and dosage. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X125 | DISPENSED DATE INVALID (PH). |
| 221 | Drug days supply and dosage. | 119 | Benefit maximum for this time period has been reached. | X452 | THE QUANTITY DISPENSED IS NOT NUMERIC OR EXCEEDS THE MAXIMUM QUANTITY ALLOWED F OR THE DRUG PRESCRIBED. |
| 221 | Drug days supply and dosage. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X901 | THE QUANTITY DISPENSED IS MISSING OR NOT NUMERIC |
| 221 | Drug days supply and dosage. | 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. | X903 | THE DAYS SUPPLY IS GREATER THAN THE AUTHORIZED DAYS, OR IS INVALID. |
| 221 | Drug days supply and dosage. | 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. | X911 | REFILL NUMBER IS MISSING, GREATER THAN FIVE OR IS GREATER THAN THE REFILL AUTHO RIZATION |
| 222 | Drug dispensing units and average wholesale price (AWP). | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X930 | DISPENSE AS WRITTEN CODE INVALID. |
| 228 | Type of bill for UB-92 claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 273 | TYPE OF BILL MISSING |
| 228 | Type of bill for UB-92 claim. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 274 | TYPE OF BILL CODE INVALID |
| 228 | Type of bill for UB-92 claim. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 1032 | PROVIDER TYPE - CLAIM INPUT CONFLICT |
| 228 | Type of bill for UB-92 claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X018 | HOME HEALTH PROVIDERS CANNOT BILL INPATIENT AND OUTPATIENT SERVICES ON THE SAME CLAIM. |
| 228 | Type of bill for UB-92 claim. | 5 | The procedure code/bill type is inconsistent with the place of service. | X029 | TYPE OF BILL IS INVALID. |
| 228 | Type of bill for UB-92 claim. | 5 | The procedure code/bill type is inconsistent with the place of service. | X081 | PROCEDURE CANNOT BE BILLED WITH A NON-PATIENT VISIT (TYPE OF BILL 141). |
| 229 | Hospital admission source. | 129 | Payment denied - Prior processing information appears incorrect. | 229 | SOURCE OF ADMISSION MISSING |
| 229 | Hospital admission source. | 129 | Payment denied - Prior processing information appears incorrect. | 278 | ADMIT TYPE MISSING |
| 230 | Hospital admission hour. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 275 | ADMIT DATE MISSING |
| 230 | Hospital admission hour. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 276 | ADMIT DATE INVALID |
| 230 | Hospital admission hour. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 277 | INVALID ADMISSION HOUR |
| 230 | Hospital admission hour. | 110 | BILLING DATE PREDATES SERVICE DATE. | 519 | ADMIT DATE GREATER THAN FIRST DATE OF SERVICE |
| 230 | Hospital admission hour. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X914 | THE ADMISSION HOUR FIELD MUST BE NUMERIC AND BETWEEN 00 AND 23. |
| 231 | Hospital admission type. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 279 | INVALID TYPE OF ADMISSION |
| 231 | Hospital admission type. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X066 | ADMIT TYPE IS INVALID AS BILLED. |
| 233 | Hospital discharge hour. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X916 | DISCHARGE HOUR IS INVALID; MUST BE BETWEEN 00 AND 23. |
| 234 | Patient discharge status. | 129 | Payment denied - Prior processing information appears incorrect. | 280 | PATIENT STATUS IS MISSING |
| 234 | Patient discharge status. | 129 | Payment denied - Prior processing information appears incorrect. | 281 | PATIENT STATUS IS INVALID |
| 239 | Dental information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 602 | UNITS NOT EQUAL TO TEETH BILLED |
| 240 | Tooth surface(s) involved. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X126 | THE TOOTH SURFACE ON THE DENTAL REQUEST IS MISSING/INVALID |
| 242 | Tooth numbers, surfaces, and/or quadrants involved. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 261 | MISSING TOOTH NUMBER |
| 242 | Tooth numbers, surfaces, and/or quadrants involved. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 262 | INVALID TOOTH NUMBER |
| 242 | Tooth numbers, surfaces, and/or quadrants involved. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 263 | INVALID TOOTH SURFACE |
| 242 | Tooth numbers, surfaces, and/or quadrants involved. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 266 | MISSING TOOTH SURFACE |
| 242 | Tooth numbers, surfaces, and/or quadrants involved. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 600 | THE NUMBER OF QUADRANTS BILLED ON THE CLAIM IS NOT EQUAL TO THE NUMBER OF UNITS |
| 242 | Tooth numbers, surfaces, and/or quadrants involved. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 601 | TOOTH NUMBERS CANNOT BE BILLED WITH A PROCEDURE THAT REQUIRES QUADRANTS. |
| 242 | Tooth numbers, surfaces, and/or quadrants involved. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4120 | ORAL CAVITY DESIGNATION CODE INVALID |
| 242 | Tooth numbers, surfaces, and/or quadrants involved. | 96 | Non-covered charge(s). | X129 | PROCEDURE NOT COVERED FOR PRIMARY TEETH,THIRD MOLARS OR SUPERNUMERARY. |
| 244 | Tooth number or letter. | 96 | Non-covered charge(s). | 4211 | INVALID TOOTH NUMBER FOR THIS PROCEDURE |
| 244 | Tooth number or letter. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5351 | PULP CAP NOT ALLOWED FOR THIS TOOTH/DATE OF SERVICE. |
| 244 | Tooth number or letter. | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | X122 | PROCEDURE CODE NOT COVERED-PRIME TEETH |
| 244 | Tooth number or letter. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X127 | PROCEDURE NOT VALID FOR PROCEDURE NUMBER. |
| 244 | Tooth number or letter. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X128 | A VALID TOOTH NUMBER IS REQUIRED FOR PROCEDURE. |
| 244 | Tooth number or letter. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X637 | CLAIMS HISTORY SHOWS TOOTH HAS BEEN EXTRACTED. |
| 244 | Tooth number or letter. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X703 | CORE BUILDUP NOT COVERED WITH OTHER RESTORATION |
| 244 | Tooth number or letter. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X704 | TWO RESTORATIONS NOT COVERED FOR THE SAME TOOTH NUMBER. |
| 245 | Dental quadrant/arch. | 11 | The diagnosis is inconsistent with the procedure. | 450 | INVALID QUADRANT |
| 247 | Line information. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 7280 | CLAIM LEVEL PROVIDER OR PROCEDURE LINE PROVIDER IS REQUIRED |
| 248 | Accident date, state, description and cause. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 569 | DATE OF ACCIDENT IS GREATER THAN LAST DATE OF SERV |
| 248 | Accident date, state, description and cause. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X926 | ACCIDENT RELATED INDICATOR IS INVALID. MEDICAL BILLING AUTHORIZATION FORM (XIX- TPD-1-76) IS REQUIRED FOR THIS CLAIM. |
| 249 | Place of service. | 129 | Payment denied - Prior processing information appears incorrect. | 248 | PLACE OF SERVICE IS MISSING OR BLANK |
| 249 | Place of service. | 129 | Payment denied - Prior processing information appears incorrect. | 249 | PLACE OF SERVICE IS INVALID |
| 249 | Place of service. | 5 | The procedure code/bill type is inconsistent with the place of service. | 1819 | INVALID POS FOR FQHC PROVIDER |
| 249 | Place of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X026 | EPSDT-REFERRED THERAPY SERVICES ARE RESTRICTED TO PLACE OF SERVICE "11" OR "99" . |
| 249 | Place of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X062 | FQHC SERVICES BILLED AT POS-21 (INPATIENT HOSPITALS) CANNOT BE BILLED ON THE SA ME CLAIM WITH OTHER FQHC SERVICES. |
| 249 | Place of service. | 5 | The procedure code/bill type is inconsistent with the place of service. | X071 | INVALID PLACE OF SERVICE FOR FQHC PROVIDER |
| 249 | Place of service. | 5 | The procedure code/bill type is inconsistent with the place of service. | X136 | PLACE OF SERVICE IS INVALID. |
| 249 | Place of service. | 58 | Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. | X144 | PLACE OF SERVICE CODE IS NOT VALID FOR PROVIDER TYPE. |
| 249 | Place of service. | 5 | The procedure code/bill type is inconsistent with the place of service. | X148 | PLACE OF SERVICE CODE IS INVALID FOR PROCEDURE. |
| 249 | Place of service. | 5 | The procedure code/bill type is inconsistent with the place of service. | X185 | PROCEDURE NOT COVERED AT POS FOR PROVIDER |
| 252 | Authorization/certification number. | 6 | The procedure code is inconsistent with the patient's age. | 3101 | ONLINE PA DENIED BY HID, NDC REQUIRES PA |
| 252 | Authorization/certification number. | 15 | Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. | X067 | ULTRASOUND FOR MATERNITY WAIVER/CARE RECIPIENT REQUIRES A PA |
| 252 | Authorization/certification number. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | X375 | PRODUCT IS NOT PREFERRED |
| 252 | Authorization/certification number. | 119 | Benefit maximum for this time period has been reached. | X414 | OB ULTRASOUND LIMIT HAS BEEN REACHED FOR THIS RECIPIENT. ANY FURTHER WILL REQUI RE PRIOR AUTHORIZATION. |
| 255 | Diagnosis code. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 258 | MISSING DIAGNOSIS CODE |
| 255 | Diagnosis code. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4226 | DIAGNOSIS MUST BE BILLED AT THE HIGHEST SUBDIVISION |
| 255 | Diagnosis code. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4236 | INVALID USE OF EMERGENCY DIAGNOSIS CODE |
| 255 | Diagnosis code. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6302 | MORE THAN THREE OFFICE VISITS MAY NOT BE BILLED WITH PREGNANCY DIAGNOSIS. |
| 255 | Diagnosis code. | 11 | The diagnosis is inconsistent with the procedure. | 7277 | PROCEDURE LINE DIAGNOSIS MUST BE A VALID CODE |
| 255 | Diagnosis code. | 12 | The diagnosis is inconsistent with the provider type. | X015 | THE DIAGNOSIS CODE IS NOT VALID FOR TRANSPORTATION PROVIDERS. |
| 255 | Diagnosis code. | 9 | The diagnosis is inconsistent with the patient's age. | X194 | PRIMARY DIAGNOSIS IS INVALID FOR RECIPIENT'S AGE. |
| 255 | Diagnosis code. | 9 | The diagnosis is inconsistent with the patient's age. | X195 | OTHER DIAGNOSIS CODE IS INVALID FOR RECIPIENT'S AGE. |
| 255 | Diagnosis code. | 119 | Benefit maximum for this time period has been reached. | X710 | DIAGNOSTIC ASSESSMENTS ARE LIMITED TO ONE ENCOUNTER PER CALENDAR YEAR |
| 258 | Days/units for procedure/revenue code. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X005 | THE SURGICAL DATE IS NOT BETWEEN ADMIT AND THROUGH DATES OF SERVICE. |
| 258 | Days/units for procedure/revenue code. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X022 | COVERED DAYS BILLED ARE INVALID, |
| 258 | Days/units for procedure/revenue code. | 96 | Non-covered charge(s). | X078 | CRITICAL CARE PROCEDURE CANNOT SPAN MORE THAN TWO DAYS. |
| 258 | Days/units for procedure/revenue code. | 141 | Claim adjustment because the claim spans eligible and ineligible periods of coverage. | X082 | DATES EXCEED SOBRA/QMB ELIGIBILITY. OBTAIN SOBRA/QMB DATES AND SPLIT BILL |
| 258 | Days/units for procedure/revenue code. | 110 | BILLING DATE PREDATES SERVICE DATE. | X100 | DETAIL FROM DATE OF SERVICE IS A FUTURE DATE OR INVALID. |
| 258 | Days/units for procedure/revenue code. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X638 | MORE THAN ONE MEDICAL ENCOUNTER (Z5298) CANNOT BE PAID ON THE SAME DATE OF SERV ICE. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X670 | PROCEDURE IS LIMITED TO 130 UNITS A CALENDAR YEAR. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X671 | PROCEDURE CODE IS LIMITED TO 20 (TWENTY) PER CALENDAR MONTH |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X672 | PROCEDURE IS LIMITED TO 104 TIMES A CALENDAR YEAR. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X673 | PROCEDURE IS LIMITED TO 365 TIMES A CALENDAR YEAR. |
| 258 | Days/units for procedure/revenue code. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X689 | ONLY ONE HOSPITAL ADMISSION MAY BE BILLED PER HOSPITAL STAY |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X692 | THIS PROCEDURE IS LIMITED TO 12 UNITS EVERY 24 MONTHS. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X719 | THE PROCEDURE CODE BILLED IS LIMITED TO ONE UNIT PER DAY. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X723 | PROCEDURE CODE IS LIMITED TO 156 UNITS PER CALENDAR YEAR. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X727 | PROCEDURE CODE IS LIMITED TO ONE UNIT PER CALENDAR MONTH. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X728 | PROCEDURE CODE IS LIMITED TO 12 UNITS PER LIFETIME. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X749 | THIS PROCEDURE IS LIMITED TO SIX UNITS PER CALENDAR YEAR. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X750 | THIS PROCEDURE IS LIMITED TO THREE UNITS PER CALENDAR YEAR. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X752 | THE MAXIMUM CARE COORDINATION UNITS HAVE BEEN REACHED FOR THIS RECIPIENT. |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X761 | THIS PROCEDURE CODE IS LIMITED TO ONE EVERY CALENDAR YEAR |
| 258 | Days/units for procedure/revenue code. | 119 | Benefit maximum for this time period has been reached. | X770 | PROCEDURE CODE IS LIMITED TO ONE OCCURANCE EVERY SIX MONTHS |
| 258 | Days/units for procedure/revenue code. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X773 | PROCEDURE CODES 95115, 95117 OR Z4998 SHALL NOT BE PAID ON THE SAME DAY AS PROC EDURE CODES 95120 - 95134. |
| 258 | Days/units for procedure/revenue code. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X774 | PROCEDURE CODES 95120-95134 WILL NOT BE PAID ON THE SAME DAY AS PROCEDURE CODES 95135-95170 |
| 258 | Days/units for procedure/revenue code. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X775 | PROCEDURE CODE NOT ALLOWED ON THE SAME DAY |
| 258 | Days/units for procedure/revenue code. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X785 | PROCEDURE NOT COVERED WHEN BILLED WITH 76805 ON THE SAME DAY |
| 258 | Days/units for procedure/revenue code. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X917 | NON-COVERED DAYS ARE INVALID. |
| 259 | Frequency of service. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 436 | TOTAL MEDICARE ALLOWED AMOUNT INVALID |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5212 | PROCEDURE CODE CANNOT BE BILLED ON THE SAME DAY WITH PROCEDURE CODES Z5181-Z518 5 6 7 |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5213 | PROCEDURE CODE CANNOT BE BILLED ON THE SAME DAY WITH PROCEDURE CODES Z5181-Z518 5 6 7 |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 5236 | QUALIFYING PROCEDURE LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5240 | THIS PROCEDURE IS PART OF ANOTHER PROCEDURE PERFORMED ON THE SAME DAY. |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5241 | THIS PROCEDURE IS PART OF ANOTHER PROCEDURE PERFORMED ON THE SAME DAY. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 5336 | DENTAL RECEMENT OF CROWNS NOT ALLOWED WITHIN 180 DAYS OF CROWN. |
| 259 | Frequency of service. | 18 | Duplicate claim/service. | 5404 | EPSDT VISIT HAS BEEN PAID FOR THIS RECIPIENT FOR THE SAME DATE OF SERVICE. |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5416 | VISUAL FIELDS/TONOMETRY IS COVERED IN THE COMPLETE EYE EXAM |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5417 | VISUAL FIELDS/TONOMETRY IS COVERED IN THE COMPLETE EYE EXAM |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5430 | AN INITIAL VISIT WILL NOT BE PAID ON SAME DATE OF SERVICE ASAN ANNUAL, PERIODIC OR HOME VISIT. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5431 | AN INITIAL VISIT WILL NOT BE PAID ON SAME DATE OF SERVICE ASAN ANNUAL, PERIODIC OR HOME VISIT. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5432 | PRENATAL VISIT NOT COVERED FOR THE SAME DATE OF SERVICE OF FAMILY PLANNING. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5433 | PRENATAL VISIT NOT COVERED FOR THE SAME DATE OF SERVICE OF FAMILY PLANNING. |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5462 | THIS SERVICE IS INCLUDED IN THE FACILITY FEE (REVENUE CODE 450). |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5470 | THIS PROCEDURE IS PART OF ANOTHER PROCEDURE PERFORMED ON THE SAME DAY |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5471 | THIS PROCEDURE IS PART OF ANOTHER PROCEDURE PERFORMED ON THE SAME DAY |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5504 | POSTPARTUM VISIT WILL NOT BE PAID ON THE SAME DAY AS PRENATAL VISIT |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5505 | POSTPARTUM VISIT WILL NOT BE PAID ON THE SAME DAY AS PRENATAL VISIT |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 5510 | PROCEDURE CODE IS LIMITED TO ONE PER RECIPIENT WITHIN SIXTY DAYS OF DELIVERY |
| 259 | Frequency of service. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 5511 | PROCEDURE CODE IS LIMITED TO ONE PER RECIPIENT WITHIN 60 DAYS OF DELIVERY. |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5514 | THIS PROCEDURE CANNOT BE BILLED IN ADDITION TO THE DELIVERY CODE BILLED |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5515 | THIS PROCEDURE CANNOT BE BILLED IN ADDITION TO THE DELIVERY CODE BILLED |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5518 | LOCAL ANESTHESIA PROCEDURES ARE COVERED IN THE TOTAL OB COST AND MAY NOT BE BIL LED SEPARATELY WITH A DELIVERY PROCEDURE CODE |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5519 | LOCAL ANESTHESIA PROCEDURES ARE COVERED IN THE TOTAL OB COST AND MAY NOT BE BIL LED SEPARATELY WITH A DELIVERY PROCEDURE CODE |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5604 | PROCEDURE IS INCLUSIVE IN PRIMARY PROCEDURE. |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5605 | PROCEDURE IS INCLUSIVE IN PRIMARY PROCEDURE. |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | 5656 | THIS PROCEDURE IS PART OF ANOTHER PROCEDURE PERFORMED ON THE SAME DAY |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 5770 | INDEPENDENT RURAL HEALTH CLINICS CANNOT BE PAID FOR MORE THAN ONE SERVICE PER D AY. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 5790 | PHYSICAL THERAPY ELECTRIC STIMULATION CONTRA |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 5792 | BINAURAL HEARING AID BATTERIES ARE LIMITED TO TWO PACKAGES EVERY TWO MONTHS. |
| 259 | Frequency of service. | 18 | Duplicate claim/service. | 5800 | RESIDENTIAL SERVICES AND RESPITE ,PERSONAL CARE/COMPANION CARE NOT ALLOWED FOR THE SAME DOS. |
| 259 | Frequency of service. | 18 | Duplicate claim/service. | 5801 | RESIDENTIAL SERVICES AND RESPITE ,PERSONAL CARE/COMPANION CARE NOT ALLOWED FOR THE SAME DOS. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5817 | REVENUE CODES 170 -171 MUST NOT EXCEED 10 UNITS UNDER MOTHER'S NUMBER. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6001 | THIS AMBULANCE SERVICE PROCEDURE CODE IS LIMITED TO FOUR UNITS PER CALENDAR MON TH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6010 | INPATIENT/OUTPATIENT/ASC VISITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6020 | HEARING AID REPAIR IS LIMITED TO TWO EVERY SIX MONTHS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6021 | MONAURAL HEARING AID BATTERIES ARE LIMITED TO ONE PACKAGE EVERY TWO MONTHS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6022 | MONAURAL EARMOLDS ARE LIMITED TO ONE EVERY FOUR MONTHS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6023 | HEARING AID REPAIR IS LIMITED TO ONCE EVERY SIX MONTHS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6024 | THE PURCHASE OF A HEARING AID STETHOSCOPE IS LIMITED TO ONE EVERY TWO YEARS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6025 | EARMOLDS ARE LIMITED TO TWO EVERY FOUR MONTHS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6026 | BINAURAL HEARING AID BATTERIES ARE LIMITED TO TWO PACKAGES EVERY TWO MONTHS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6041 | THE CALENDAR YEAR LIMIT HAS BEEN EXCEEDED FOR THIS PROCEDURE |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6042 | PROCEDURE LIMITED TO ONCE EVERY 30 DAYS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6043 | THE CALENDAR YEAR LIMIT HAS BEEN EXCEEDED FOR THIS PROCEDURE |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6044 | EMERGENCY ORAL EXAM (D0140) LIMITED TO ONCE PER CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6045 | DENTAL SERVICE LIMITED TO ONCE PER TOOTH/PER LIFETIME. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6046 | PROCEDURE CODE LIMITED TO ONCE EVERY SIX MONTHS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6047 | PROPHYLAXIS IS LIMITED TO ONCE EVERY 6 MONTHS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6048 | FLUORIDE IS LIMITED TO ONCE EVERY 6 MONTHS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6049 | PROCEDURE LIMITED TO TWO PER LIFETIME PER TOOTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6050 | PROCEDURE CODE IS LIMITED TO ONE OCCURANCE EVERY SIX MONTHS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6051 | FULL SERIES/PANORAMIC X-RAYS ARE LIMITED TO ONE EVERY THREE CALENDAR YEARS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6053 | COMPREHENSIVE DENTAL EXAM MAY ONLY BE BILLED ONCE PER LIFETIME PER PROVIDER. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6100 | PROCEDURE IS LIMITED TO SIXTY (60) PER CALENDAR MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6101 | PROCEDURE IS LIMITED TO TWENTY (20) PER CALENDAR MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6102 | PROCEDURE IS LIMITED TO ONE (1) EVERY FIVE YEARS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6103 | PROCEDURE IS LIMITED TO THIRTY (30) PER MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6104 | PROCEDURE CODE IS LIMITED TO ONE-HUNDRED (100) PER MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6105 | PROCEDURE IS LIMITED TO 60 (SIXTY) TIMES PER CALENDAR MONTH |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6106 | PROCEDURE IS LIMITED TO 30 (THIRTY) PER MONTH |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6107 | PROCEDURE CODE IS LIMITED TO 40 (FORTY) PER CALENDAR MONTH |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6108 | PROCEDURE IS LIMITED TO 1 (ONE) EVERY TWO YEARS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6109 | PROCEDURE CODE IS LIMTED TO 100 PER MONTH |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6110 | THE LIMIT OF TWO UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6111 | THE LIMIT OF THREE UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6112 | THE LIMIT OF TWO UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6113 | PROCEDURE IS LIMITED TO 30 (THIRTY) PER MONTH |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6114 | PROCEDURE IS LIMITED TO TWO PER YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6115 | MEDICAL SUPPLIES LIMIT IS $1,800.00 PER WAIVER YEAR, 02/22-02/21. THE LIMIT HA S BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6116 | PROCEDURE IS LIMITED TO ONE (1) EVERY FOUR CALENDAR YEARS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6117 | THE LIMIT OF THREE UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6118 | THE LIMIT OF TWO UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6119 | PROCEDURE IS LIMITED TO 1 (ONE) EVERY TWO YEARS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6120 | THIS PROCEDURE CODE IS LIMITED TO ONE PER MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6121 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6122 | LEG BAGS ARE LIMITED TO TWO PER MONTH |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6123 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6124 | PROCEDURE IS LIMITED TO ONE (1) EVERY THREE YEARS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6125 | CATHETERS, CATHETER TRAYS, AND DRAINAGE BAGS ARE LIMITED TO TWO PER MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6126 | PROCEDURE IS LIMITED TO ONE HUNDRED TWENTY (120) PER CALENDAR MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6150 | VISION AND HEARING SCREENING ONE PER YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6151 | INITIAL SCREENING IS LIMITED TO ONCE PER LIFETIME |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6152 | EPSDT SCREENING LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6153 | EPSDT SCREENING LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6155 | EPSDT SCREENING LIMIT HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6183 | THE ALLOWED EYE EXAM LIMITATION HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6184 | THE ALLOWED FITTING LIMITATION HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6201 | FAMILY PLANNING PERIODIC FOLLOW-UP IS LIMITED TO FOUR (4) VISITS PER YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6202 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6205 | THIS PROCEDURE CODE IS LIMITED TO ONE EVERY CALENDAR YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6206 | PROCEDURE CODE 11795 IS LIMITED TO ONE EVERY 365 DAYS AND PROCEDURE CODE 11977 CANNOT BE BILLED WITHIN 60 MONTHS OF INSERTION |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6208 | PROCEDURE IS LIMITED TO ONE SERVICE EVERY 70 DAYS. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6230 | MORE THAN ONE MEDICAL ENCOUNTER (Z5298) CANNOT BE PAID ON THE SAME DATE OF SERV ICE. |
| 259 | Frequency of service. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 6231 | MORE THAN ONE DENTAL ENCOUNTER (D9430)CANNOT BE PAID ON THE SAME DATE OF SERVIC E. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6240 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6241 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6242 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6243 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6244 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6245 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6246 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6247 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6248 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6249 | HBO LIMIT HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6280 | THE LIMIT FOR THESE SERVICES HAS BEEN REACHED FOR THE CALENDAR YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6281 | OUTPATIENT VISITS HAVE BEEN EXCEEDED FOR THIS CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6282 | INPATIENT DAYS HAVE BEEN EXEEDED FOR THIS CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6300 | THIS PROCEDURE IS LIMITED TO 12 UNITS EVERY 24 MONTHS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6312 | MONTHLY SCRIPT LIMIT EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6402 | SCREENING MAMMOGRAPHY IS LIMITED TO ONE PER YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6403 | THE LIMIT FOR THESE SERVICES HAS BEEN REACHED FOR THE CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6404 | PROCEDURE IS LIMITED TO ONCE EVERY THIRTY(30) DAYS BY THE SAME BILLING PROVIDER |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6405 | PROCEDURE CODE IS LIMITED TO ONE OCCURENCE EVERY SIX MONTHS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6406 | NEWBORN CODE MAY NOT BE BILLED MORE THAN ONCE |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6407 | THE SAME PROVIDER MAY NOT BILL MORE THAN ONE NEW PATIENT OFFICE VISIT PER RECIP IENT IN A THREE YEAR PERIOD. |
| 259 | Frequency of service. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | 6408 | PHYSICIAN IS LIMITED TO ONE VISIT PER DAY PER RECIPIENT |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6409 | REQUESTED INPATIENT HOSPITAL SERVICES EXCEED LIMIT OF 16 |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6410 | PHYSICIAN OFFICE VISIT LIMITATION HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6411 | INITIAL CRITICAL CARE LIMITED TO ONE PER DAY |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6412 | ER AND CRITICAL CARE CODE ONE PER CLAIM. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6510 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6511 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6512 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6513 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6514 | THIS PROCEDURE IS LIMITED TO 5 UNITS PER YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6515 | THIS PROCEDURE IS LIMITED TO ONE EPISODE A YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6516 | THIS PROCEDURE IS LIMITED TO 52 UNITS PER YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6517 | THIS PROCEDURE IS LIMITED TO 10 (TEN) UNITS PER YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6518 | PROCEDURE CODE IS LIMITED TO 104 UNITS A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6519 | PROCEDURE CODE IS LIMITED TO 104 TIMES PER YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6520 | PROCEDURE CODE IS LIMITED TO 104 TIMES A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6521 | THIS PROCEDURE IS LIMITED TO 365 EPISODES A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6522 | THIS PROCEDURE IS LIMITED TO 52 UNITS A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6523 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALDEAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6524 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6525 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6526 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6527 | BENEFITS HAVE BEEN EXCEEDEF FOR THE CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6528 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6529 | PROCEDURE IS LIMITED TO 260 UNITS A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6530 | PROCEDURE IS LIMITED TO 8 UNITS A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6531 | PROCEDURE CODE IS LIMITED TO 312 UNITS A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6532 | PROCEDURE IS LIMITED TO 1040 UNITS A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6533 | PROCEDURE IS LIMITED TO 1040 UNITS A YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6534 | PROCEDURE IS LIMITED TO 2016 UNITS A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6535 | PROCEDURE IS LIMITED TO 130 UNITS A CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6536 | PROCEDURE IS LIMITED TO 104 TIMES A CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6537 | PROCEDURE IS LIMITED TO 365 TIMES A CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6538 | YEARLY LIMIT FOR CRISIS INTERVENTION HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6539 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6540 | PSYCHOTHERAPY SERVICES ARE LIMITED TO 12 (TWELVE) PER CALENDAR YEAR AT PLACE OF SERVICE "21" (INPATIENT) |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6541 | DIAGNOSTIC ASSESSMENTS ARE LIMITED TO ONE ENCOUNTER PER CALENDAR YEAR |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6542 | PROCEDURE IS LIMITED TO 4160 UNITS A YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6610 | DIALYSIS ULTRAFILTRATION CODES Z5256 AND Z5266 ARE LIMITED TO A TOTAL OF 3 PER RECIPIENT. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6611 | PROCEDURE CODE IS LIMITED TO 156 UNITS PER CALENDAR YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6612 | PROCEDURE CODE IS LIMITED TO ONE UNIT PER CALENDAR MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6613 | PROCEDURE CODE IS LIMITED TO 12 UNITS PER LIFETIME. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6630 | THIS PROCEDURE CODE IS LIMITED TO ONE PER CALENDAR MONTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6640 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6641 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6642 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6643 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6644 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6647 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6670 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6673 | PROCEDURE IS LIMITED TO ONE (1) EVERY TWO YEARS. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | 6999 | UNITS ON THIS CLAIM HAVE BEEN SYSTEMATICALLY REDUCED TO MEET THE BENEFIT LIMIT |
| 259 | Frequency of service. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | 9400 | THE NUMBER OF SERVICES EXCEED MEDICAL POLICY GUIDELINES. PRIOR AUTHORIZATION R EQUIRED FOR ADDITIONAL SERVICES. |
| 259 | Frequency of service. | 18 | Duplicate claim/service. | X628 | EPSDT VISIT HAS BEEN PAID FOR THIS RECIPIENT FOR THE SAME DATE OF SERVICE. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X629 | COMPREHENSIVE EPSDT SCREENING AND FP VISIT MAY NOT BE BILLEDON THE SAME DAY. |
| 259 | Frequency of service. | 18 | Duplicate claim/service. | X632 | ONLY ONE TYPE OF RESPITE CARE IS ALLOWED FOR A GIVEN DATE OF SERVICE. |
| 259 | Frequency of service. | 18 | Duplicate claim/service. | X633 | RESIDENTIAL HABILITATION,RESPITE CARE PERSONAL CARE/ COMPANION CARE SERVICE NOT ALLOWED FOR THE SAME DOS. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X639 | VACCINE CANNOT BE BILLED ON THE SAME DAY |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X663 | PROCEDURE CODES 92553, 92556 AND 92557 CANNOT BE BILLED ON THE SAME DAY BY THE SAME OR DIFFERENT PROVIDER |
| 259 | Frequency of service. | 96 | Non-covered charge(s). | X664 | PROCEDURE CODE V2020 AND V2025 CANNOT BE BILLED ON THE SAME DAY OF SERVICE. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X667 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 259 | Frequency of service. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X668 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X669 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPIENT |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X674 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPIENT. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X677 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPENT |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X678 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X679 | SERVICES CANNOT BE BILLED ON THE SAME DAY FOR THE SAME RECIPIENT. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X680 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X685 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER. |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | X686 | CHEMOTHERAPY ADMINISTRATION FEE MAY NOT BE BILLED ON THES AME DAY AS THIS PROCE DURE |
| 259 | Frequency of service. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X688 | MORE THAN ONE DENTAL ENCOUNTER (D9430)CANNOT BE PAID ON THE SAME DATE OF SERVIC E. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X694 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X699 | PROCEDURE IS LIMITED TO ONCE EVERY THIRTY(30) DAYS BY THE SAME BILLING PROVIDER |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X701 | PROCEDURE LIMITED TO TWO PER LIFETIME PER TOOTH. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X702 | DENTAL RECEMENT OF CROWNS NOT ALLOWED WITHIN 180 DAYS OF CROWN. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X705 | TWO RESTORATIONS NOT COVERED FOR THE SAME TOOTH NUMBER SAME DATE OF SERVICE. |
| 259 | Frequency of service. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X711 | INDIVIDUAL THERAPY AND GROUP THERAPY MAY NOT BE BILLED ON THE SAME DAY. |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | X732 | PAYMENT MADE FOR SIMILAR PROCEDURE |
| 259 | Frequency of service. | 18 | Duplicate claim/service. | X738 | OUR RECORDS INDICATE THAT THIS SERVICE HAS ALREADY BEEN PERFORMED ON THIS PATIE NT |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X753 | MORE THAN ONE OBSTETRICAL DELIVERY CODE MAY NOT BE BILLED W ITHIN SIX MONTHS |
| 259 | Frequency of service. | 97 | Payment is included in the allowance for another service/procedure. | X754 | THIS PROCEDURE IS PART OF ANOTHER PROCEDURE PERFORMED ON THE SAME DAY |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X776 | PROCEDURE CODES NOT ALLOWED ON THE SAME DAY (95130- 95134) |
| 259 | Frequency of service. | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X778 | ONLY ONE OUTPATIENT OBSERVATION VISIT MAY BE BILLED PER DAY |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X780 | PROCEDURE CODE IS LIMITED TO ONE PER RECIPIENT WITHIN SIXTY DAYS OF DELIVERY |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X788 | PROCEDURE CODE 11795 IS LIMITED TO ONE EVERY 365 DAYS AND PROCEDURE CODE 11977 CANNOT BE BILLED WITHIN 60 MONTHS OF INSERTION |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X789 | ONLY ONE INITIAL NICU PROCEDURE MAY BE BILLED PER HOSPITAL STAY. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X790 | PROCEDURE IS LIMITED TO TWO PER YEAR. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X793 | HEARING AID REPAIR IS LIMITED TO TWO EVERY SIX MONTHS. |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X796 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X800 | PROCEDURE CODE IS LIMITED TO ONE OCCURENCE EVERY SIX MONTHS |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X807 | PROCEDURE LIMITED TO ONE SERVICE DURING 60 (SIXTY) DAY POSTPARTUM PERIOD. |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X830 | SPECIMEN COLLECTION FEE IS LIMITED TO ONE PER DAY |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X837 | PROCEDURE CODE IS LIMITED TO ONE IN A SERIES |
| 259 | Frequency of service. | 119 | Benefit maximum for this time period has been reached. | X838 | SPECIMEN COLLECTION FEE IS LIMITED TO ONE PER DAY |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X840 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 259 | Frequency of service. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X847 | MORE THAN THREE OFFICE VISITS MAY NOT BE BILLED WITH PREGNANCY DIAGNOSIS. |
| 263 | Length of time for services rendered. | 97 | Payment is included in the allowance for another service/procedure. | X888 | POST-OPERATIVE PHYSICAIN SERVICES FOR THE SAME DIAGNOSIS MAY NOT BE BILLED WITH IN 90 DAYS OF SURGERY |
| 263 | Length of time for services rendered. | 97 | Payment is included in the allowance for another service/procedure. | X894 | POST-OPERATIVE PHYSICIAN SERVICES FOR THE SAME DIAGNOSIS MAY NOT BE BILLED WITH IN 62 DAYS OF SURGERY |
| 264 | Number of liters/minute & total hours/day for respiratory support. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X743 | PROVIDER MAY NOT BILL FOR NEWBORN RESUSCITATION UNLESS LIFE THREATENING |
| 275 | Claim. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 2057 | RECIPIENT PARTIALLY ELIGIBILE - HEADER |
| 275 | Claim. | 96 | Non-covered charge(s). | X163 | THIS PROCEDURE CODE IS NOT COVERED FOR NON-MEDICARE RELATED CLAIMS. |
| 283 | Medicare worksheet. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 827 | NON COVERED AMOUNT IS GREATER THAN COVERED AMOUNT |
| 283 | Medicare worksheet. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 900 | PROVIDER TYPE SPECIALITY GROUP NOT FOUND |
| 283 | Medicare worksheet. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 901 | GROUP NUMBER NOT FOUND IN PROVIDER GROUP TABLE |
| 286 | Other payer's Explanation of Benefits/payment information. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 227 | THIRD PARTY PAYMENT AMOUNT INVALID |
| 286 | Other payer's Explanation of Benefits/payment information. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | 2500 | RECIPIENT COVERED BY MEDICARE A (NO ATTACHMENT) |
| 286 | Other payer's Explanation of Benefits/payment information. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | 2501 | RECIPIEINT COVERED BY MEDICARE A (WITH ATTACHMENT |
| 286 | Other payer's Explanation of Benefits/payment information. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | 2502 | RECIPIENT COVERED BY MEDICARE B (NO ATTACHMENT) |
| 286 | Other payer's Explanation of Benefits/payment information. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | 2503 | RECIPIENT COVERED BY MEDICARE B (WITH ATTACHMENT) |
| 286 | Other payer's Explanation of Benefits/payment information. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | 2509 | FILE CLAIM WITH MEDICARE |
| 286 | Other payer's Explanation of Benefits/payment information. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | 2514 | RECIPIENT COVERED BY MEDICARE(A AND B), NO MED D) |
| 286 | Other payer's Explanation of Benefits/payment information. | 109 | Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. | 2550 | RECIPIENT ENROLLED IN MEDICARE ADVANTAGE PLAN |
| 294 | Supporting documentation. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4233 | DIAGNOSIS REQUIRES ADDITIONAL DOCUMENTATION |
| 294 | Supporting documentation. | 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. | X179 | STERILIZATION DENIED BECAUSE DOCUMENTATION DOES NOT MEET HHS/MEDICAID REQUIREME NTS. |
| 294 | Supporting documentation. | 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. | X180 | HYSTERECTOMY DENIED BECAUSE DOCUMENTATION DOES NOT MEET HHS/MEDICAID REQUIREMEN TS. |
| 294 | Supporting documentation. | 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. | X181 | ABORTION DENIED BECAUSE DOCUMENTATION DOES NOT MEET HHS/MEDICAD REQUIREMENTS. |
| 294 | Supporting documentation. | 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. | X182 | NO CONSENT FORM ON FILE FOR RECIPIENT AND DATE OF SURGERY. |
| 300 | Lab/test report/notes/results. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X742 | LAB SERVICES MUST BE BILLED WITH COMBINATION CODE. SEE CPT. |
| 300 | Lab/test report/notes/results. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X758 | CHEMISTRY PROFILES MUST BE BILLED USING ONE MULTICHANNEL TEST CODE |
| 300 | Lab/test report/notes/results. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X812 | CHEMISTRY PROFILE AND CHEMICAL PANEL CANNOT BE BILLED ON THE SAME DAY |
| 300 | Lab/test report/notes/results. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X818 | MULTIPLE URINALYSIS TESTS CANNOT BE BILLED ON THE SAME DAY |
| 349 | Psychiatric treatment plan. Please use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X815 | ELECTROSHOCK THERAPY MAY NOT BE ON THE SAME DAY AS A HOSPITAL VISIT |
| 361 | Is there other insurance? | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 832 | OTHER PAYER AMOUNT PAID QUALIFIER INVALID |
| 361 | Is there other insurance? | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | 2510 | HMO CO-PAY/RECIPIENT HAS TPL |
| 361 | Is there other insurance? | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | 2511 | HMO CO-PAY/RECIPIENT HAS MEDICARE |
| 361 | Is there other insurance? | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X173 | TPL POLICY NUMBER AND INSURANCE COMPANY NAME REQUIRED |
| 361 | Is there other insurance? | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | X280 | RECIPIENT HAS OTHER MEDICAL COVERAGE; FILE THIRD PARTY CARRIER FIRST. |
| 361 | Is there other insurance? | 22 | Payment adjusted because this care may be covered by another payer per coordination of benefits. | X282 | RECIPIENT HAS MEDICARE COVERAGE - BILL MEDICARE FIRST. |
| 364 | Is accident/illness/condition employment related? | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X174 | ACCIDENT INDICATOR OCCURRENCE CODE REQUIRED. |
| 399 | Report of prior testing related to this service, including dates | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X826 | MULTIPLE CHEMISTRY TEST CANNOT BE BILLED ON THE SAME DAY. PLEASE REBILL WITH A PPROPRIATE CHEMISTRY PROFILE. |
| 400 | Claim is out of balance | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 271 | INVALID TOTAL CLAIM CHARGE |
| 400 | Claim is out of balance | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 508 | TOTAL CHARGE DOES NOT EQUAL THE SUM OF ALL DETAILS |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X003 | THE THROUGH DATE OF SERVICE IS INVALID. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X004 | THE TOTAL NON-COVERED CHARGE IS INVALID. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X006 | SUBMITTED CHARGE FOR THE LINE ITEM IS EQUAL TO OR LESS THAN NONCOVERED CHARGE. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X028 | HEADER PAID AMOUNT CANNOT BE GREATER THAN SPECIFIED DOLLAR AMOUNT |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X031 | UNITS (TOTAL DAYS) X RATE DOES NOT EQUAL THE TOTAL ACCOMMODATION CHARGE. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X036 | SUBMITTED RATE, UNITS, AND TOTAL CHARGE DO NOT BALANCE. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X052 | MEDICARE HEADER ALLOWED AMOUNT DOES NOT EQUAL THE SUM OF DETAIL MEDICARE ALLOWE D AMOUNTS. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X053 | NET BILLED AMOUNT NOT EQUAL TO SUM OF DETAIL CHARGES LESS TPL AMOUNT. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X054 | THE SUM OF THE DETAIL NONCOVERED CHARGE DOES NOT EQUAL THE HEADER NONCOVERED CH ARGE. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X055 | BILLED AMOUNT NOT EQUAL TO SUM OF THE DETAIL CHARGE AMOUNTS. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X056 | THE MEDICARE HEADER PAID AMOUNT DOES NOT EQUAL THE SUM OF THE DETAIL MEDICARE P AID AMOUNTS. |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X310 | THE CLAIM LINE ITEM AND/OR TOTAL CHARGE IS MISSING, NOT NUMERIC OR CALCULATED I NCORRECTLY |
| 400 | Claim is out of balance | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X311 | THE NON-COVERED CHARGE AMOUNT IS INVALID. |
| 402 | Amount must be greater than zero | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 268 | BILLED AMOUNT INVALID |
| 402 | Amount must be greater than zero | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 269 | DETAIL BILLED AMOUNT MISSING OR INVALID FORMAT |
| 402 | Amount must be greater than zero | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 270 | MISSING TOTAL CLAIM CHARGE |
| 402 | Amount must be greater than zero | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X043 | BILLED AMOUNT MUST BE NUMERIC AND GREATER THAN ZERO. |
| 417 | Prior testing, including result(s) and date(s) as related to service(s) | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X831 | COMPONENTS OF A CBC MAY NOT BE BILLED ON THE SAME DAY AS A COMPLETE CBC |
| 421 | Medical review attachment/information for service(s) | 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. | 2800 | STERILIZATION DENIED BECAUSE DOCUMENTATION DOES NOT MEET HHS/MEDICAID REQUIREME NTS. |
| 421 | Medical review attachment/information for service(s) | 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. | 2801 | HYSTERECTOMY DENIED BECAUSE DOCUMENTATION DOES NOT MEET HHS/MEDICAID REQUIREMEN TS. |
| 421 | Medical review attachment/information for service(s) | 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. | 2802 | ABORTION DENIED BECAUSE DOCUMENTATION DOES NOT MEET HHS/MEDICAID REQUIREMENTS. |
| 424 | Statement of non-coverage including itemized bill | 119 | Benefit maximum for this time period has been reached. | X816 | THE LIMIT OF THREE UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE |
| 424 | Statement of non-coverage including itemized bill | 119 | Benefit maximum for this time period has been reached. | X817 | THE LIMIT OF TWO UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE |
| 424 | Statement of non-coverage including itemized bill | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X934 | PRODUCT/SERVICE NOT COVERED |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X630 | UNITS BILLED FOR PROCEDURE CODE EXCEED MAXIMUM UNITS ALLOWED |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X683 | YEARLY LIMIT FOR CRISIS INTERVENTION HAS BEEN EXCEEDED |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X684 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X697 | THE LIMIT FOR THESE SERVICES HAS BEEN REACHED FOR THE CALENDAR YEAR. |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X698 | THE LIMIT FOR THESE SERVICES HAS BEEN REACHED FOR THE CALENDAR YEAR |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X707 | INITIAL SCREENING IS LIMITED TO ONCE PER LIFETIME,PER PROVIDER. |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X708 | PSYCHOTHERAPY SERVICES ARE LIMITED TO 12 (TWELVE) PER CALENDAR YEAR AT PLACE OF SERVICE "21" (INPATIENT) |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X741 | MHSP CLINIC VISIT LIMIT HAS BEEN EXCEEDED |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X744 | EPSDT SCREENING LIMIT HAS BEEN EXCEEDED |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X745 | EPSDT SCREENING LIMIT HAS BEEN EXCEEDED |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X746 | HOSPITALIZATION DAY TREATMENT (Z5431) IS LIMITED TO 60 UNITS PER YEAR |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X768 | PROCEDURE IS LIMITED TO 31 (THIRTYONE) PER MONTH |
| 432 | Date benefits exhausted | 119 | Benefit maximum for this time period has been reached. | X772 | ORAL EXAM EVALUATIONS ARE LIMITED TO ONE PER DAY. |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X021 | OUTPATIENT PHYSICAL THERAPY CANNOT BE BILLED IN CONJUNCTION WITH ANY OTHER SERV ICE. |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | 119 | Benefit maximum for this time period has been reached. | X417 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | 97 | Payment is included in the allowance for another service/procedure. | X421 | SUBSEQUENT PROCEDURE INCLUDED IN PRIMARY ANESTHESIA CHARGE |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X476 | LAB SERVICES MUST BE BILLED WITH COMBINATION CODE. SEE CPT. |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X766 | MEDICAID'S RECORD DO NOT SHOW A ROOT CANAL PAYMENT THEREFORE THIS PROCEDURE COD E IS NOT COVERED. |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | 119 | Benefit maximum for this time period has been reached. | X767 | PROCEDURE LIMITED TO 624 UNITS PER CALENDAR YEAR |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X779 | PROCEDURE CODE CANNOT BE BILLED ON THE SAME DAY WITH PROCEDURE CODES Z5181-Z518 5 |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X781 | PRENATAL VISIT NOT BE COVERED ON THE SAME DAY AS POSTPARTUM VISIT. |
| 448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X782 | PRENATAL VISIT NOT COVERED FOR THE SAME DATE OF SERVICE OF FAMILY PLANNING. |
| 452 | Total visits in total number of hours/day and total number of hours/week | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X665 | SERVICES CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 452 | Total visits in total number of hours/day and total number of hours/week | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X666 | SERVICE CANNOT BE BILLED ON THE SAME DAY BY THE SAME PROVIDER |
| 452 | Total visits in total number of hours/day and total number of hours/week | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X792 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 452 | Total visits in total number of hours/day and total number of hours/week | 119 | Benefit maximum for this time period has been reached. | X859 | THE SAME PROVIDER MAY NOT BILL MORE THAN ONE NEW PATIENT OFFICE VISIT PER RECIP IENT IN A THREE YEAR PERIOD. |
| 452 | Total visits in total number of hours/day and total number of hours/week | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X867 | SUBSEQUENT HOSPITAL CARE MAY NOT BE BILLED ON SAME DAY AS INITIAL HOSPITAL CARE |
| 452 | Total visits in total number of hours/day and total number of hours/week | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X870 | THE SAME PROVIDER MAY NOT BILL HOSPITAL VISITS/PSYCHOTHERAPY ON THE SAME DAY |
| 452 | Total visits in total number of hours/day and total number of hours/week | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X871 | THE SAME PROVIDER MAY NOT BILL PSYCHOTHERAPY/OFFICE VISITS ON THE SAME DAY |
| 452 | Total visits in total number of hours/day and total number of hours/week | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X872 | PROCEDURE IS LIMITED TO ONE SERVICE AT THE TIME OF OR WITHIN THIRTY DAYS PRIOR TO NORPLANT INSERTION |
| 452 | Total visits in total number of hours/day and total number of hours/week | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X878 | PHYSICIAN IS LIMITED TO ONE VISIT PER DAY PER RECIPIENT |
| 452 | Total visits in total number of hours/day and total number of hours/week | B14 | Payment denied because only one visit or consultation per physician per day is covered. | X885 | HOSPITAL VISITS AND SUBSEQUENT CRITICAL CARE MAY NOT BE BILLED ON THE SAME DAY |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 251 | FIRST MODIFIER INVALID FOR DATE OF SERVICE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 252 | SECOND MODIFIER INVALID FOR DATE OF SERVICE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 253 | THIRD MODIFIER INVALID FOR DATE OF SERVICE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 133 | The disposition of this claim/service is pending further review. | 4010 | MODIFIER REQUIRES MEDICAL REVIEW |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 4011 | INVALID MODIFIER COMBINATION |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 4097 | INVALID/MISSING MODIFIER FOR THIS PROCEDURE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 4245 | FOURTH MODIFIER INVALID FOR DATE OF SERVICE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5750 | PROCEDURE NOT COVERED WHEN BILLED WITH 76805, 76810 OR 76816 ON THE SAME DAY |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5751 | PROCEDURE NOT COVERED WHEN BILLED WITH 76805, 76810 OR 76816 ON THE SAME DAY |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5752 | PROCEDURE NOT COVERED WHEN BILLED WITH 76805 ON THE SAME DAY |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5753 | PROCEDURE NOT COVERED WHEN BILLED WITH 76805 ON THE SAME DAY |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | 5811 | HEARING AND VISION SCREENING REQUIRE EP MODIFIER. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5812 | POST-CATARACT FOLLOW-UP CARE HAS BEEN PAID TO THE SURGEON ORPOST-CATARACT FOLLO W-UP CARE CANNOT BE PAID UNTIL THE SURGEON HAS BEEN PAID. CONTACT THE SURGEON |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 5813 | POST-CATARACT FOLLOW-UP CARE HAS BEEN PAID TO THE SURGEON ORPOST-CATARACT FOLLO W-UP CARE CANNOT BE PAID UNTIL THE SURGEON HAS BEEN PAID. CONTACT THE SURGEON |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6207 | THESE NORPLANT SERVICES MUST BE BILLED USING THE APPROPRIATE COMBINATION CODE O NLY. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 18 | Duplicate claim/service. | 6677 | PROCEDURE CODE CANNOT BE BILLED MORE THAN SIX(6) TIMES WITH THE SAME MODIFIER. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7258 | REVIEW MODIFIER 51 |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7269 | MODIFIER NOT VALID FOR THIS PROCEDURE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7270 | INVALID MODIFIER/PROCEDURE CODE COMBINATION |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7290 | MODIFIER 51 DELETED FOR PRIMARY PROCEDURE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7291 | MODIFIER 51 ADDED FOR NON-PRIMARY PROCEDURE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | X014 | THIS SERVICE REQUIRES AN APPROPRIATE MODIFIER. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | X027 | THE MODIFIER MAY ONLY BE BILLED ON MEDICARE-RELATED CLAIMS |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | X032 | MODIFIER NOT EFFECTIVE FOR THIS DATE OF SERVICE. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | X034 | CATARACT SERVICES REQUIRE PROPER MODIFIER TO BE BILLED. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X058 | SERVICE FOR MATERNITY WAIVER/CARE RECIPIENT MUST BE BILLED WITH GLOBAL SERVICE FEE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | X060 | MATERNITY WAIVER SERVICE MODIFIER NOT BILLED CORRECTLY |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X061 | INJECTABLE AND NON-INJECTABLE PROCEDURES CANNOT BE BILLED TOGETHER. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | X145 | MODIFIER IS INVALID. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | X147 | INVALID MODIFIER FOR PROCEDURE |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X155 | PROCEDURE/REVENUE CODE IS INVALID FOR CLAIM TYPE. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X156 | PROCEDURE CODE IS ON REVIEW FOR THE PROVIDER. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | X283 | MODIFIER BILLED IS NOT VALID FOR THE PROCEDURE CODE BILLED. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | X326 | INJECTABLE IS CURRENTLY ON THE LIST. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | X355 | PROCEDURE CODE MISSING/INVALID OR THE MODIFIER INVALID. |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | X359 | BILL THE APPROPRIATE LAPAROSCOPIC CODE WITH MODIFIER 22 |
| 453 | Procedure Code Modifier(s) for Service(s) Rendered | B18 | PAYMENT ADJUSTED BECAUSE THIS PROCEDURE CODES/MODIFIER WAS INVALID ON THE DATE OF SERVICE | X438 | HEARING AND VISION SCREENING REQUIRE EP MODIFIER. |
| 454 | Procedure code for services rendered. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 234 | PROCEDURE CODE MISSING |
| 454 | Procedure code for services rendered. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 235 | PROCEDURE CODE NOT IN VALID FORMAT |
| 454 | Procedure code for services rendered. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 571 | SURGICAL PROCEDURE MISSING |
| 454 | Procedure code for services rendered. | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | 1001 | BILLING PROVIDER NOT ENROLLED FOR DATES OF SERVICE |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 3307 | FQHC/PBRHC FFS/ENCOUNTER PROCEDURE CONFLICT |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | 4013 | PROCEDURE CODE IS NO LONGER VALID |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | 4032 | PROCEDURE CODE IS MISSING/NOT ON FILE |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | 4046 | DATE OF SERVICE BEFORE PROCEDURE IS PAYABLE |
| 454 | Procedure code for services rendered. | 119 | Benefit maximum for this time period has been reached. | 6203 | THIS PROCEDURE IS LIMITED TO ONE PER POSTPARTUM PERIOD. |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | 7207 | PROCEDURE IS CLASSIFIED AS A COSMETIC PROCEDURE |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | 7208 | PROCEDURE IS AN UNLISTED PROCEDURE |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | 7209 | PROCEDURE IS CLASSIFIED AS EXPERIMENTAL |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | 7210 | PROCEDURE IS CLASSIFIED AS OBSOLETE |
| 454 | Procedure code for services rendered. | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7222 | PROCEDURE DOES NOT REQUIRE AN ASSISTANT SURGEON |
| 454 | Procedure code for services rendered. | 4 | The procedure code is inconsistent with the modifier used or a required modifier is missing. | 7223 | PROCEDURE MAY NOT REQUIRE AN ASSISTANT SURGEON |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | 7261 | INVALID PROCEDURE CODE |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | X012 | NO LEVEL III BASE VALUE FOR ANESTHESIA FOR DATES OF SERVICE BILLED |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X019 | HIV CODES MUST BE BILLED IN CONJUNCTION WITH FAMILY PLANNING CODES. |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X020 | FAMILY PLANNING PROCEDURE Z5190 MUST BE BILLED WITH Z5195. |
| 454 | Procedure code for services rendered. | 96 | Non-covered charge(s). | X072 | PROVIDER/PROCEDURE CODE NOT ON LEVEL I PRICING FILE. |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X079 | PROCEDURE CODE NOT VALID FOR RENAL DIALYSIS FACILITY. |
| 454 | Procedure code for services rendered. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X087 | DIFFERENT TARGETED CASE MANAGEMENT PROCEDURE CODES MUST BE BILLED ON SEPERATE C LAIMS. |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X104 | ER AND CRITICAL CARE CODE ONE PER CLAIM. |
| 454 | Procedure code for services rendered. | 38 | Services not provided or authorized by designated (network) providers. | X131 | SERVICE IS ONLY COVERED UNDER THE PLAN FIRST PROGRAM |
| 454 | Procedure code for services rendered. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X135 | PROCEDURE RESTRICTED TO TECHNOLOGY ASSISTED WAIVER RECIPIENTS. |
| 454 | Procedure code for services rendered. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | X158 | RECIPIENT ELIGIBLE FOR EMERGENCY SERVICES ONLY |
| 454 | Procedure code for services rendered. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X161 | PROCEDURE CODE OR REVENUE CODE IS INVALID. |
| 454 | Procedure code for services rendered. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X175 | OPERATION OR DELIVERY REQUIRES SURGICAL PROCEDURE CODE. |
| 454 | Procedure code for services rendered. | 119 | Benefit maximum for this time period has been reached. | X411 | PROCEDURE IS LIMITED TO 1 (ONE) EVERY TWO YEARS |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X449 | PHYSICIAN VISIT CODES/PRIMARY ANESTHESIA CODES MAY NOT BE BILLED WITHIN 3 DAYS OR ON SAME DAY OF EACH OTHER. |
| 454 | Procedure code for services rendered. | 97 | Payment is included in the allowance for another service/procedure. | X576 | THIS PROCEDURE IS PART OF ANOTHER PROCEDURE PERFORMED ON THE SAME DAY. |
| 454 | Procedure code for services rendered. | 119 | Benefit maximum for this time period has been reached. | X592 | VISION AND HEARING SCREENING MUST BE BILLED WITH A REGULAR SCREENING AND ARE LI MITED TO ONCE PER YEAR |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X600 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X601 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X602 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X603 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X604 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X605 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X606 | PULP THERAPY COMBINATION NOT ALLOWED IN THIS CASE |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X607 | PULP THERAPY COMBINATION NOT ALLOWED |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X608 | PULP THERAPY COMBINATION NOT ALLOWED |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X609 | PULP THERAPY COMBINATION NOT ALLOWED |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X610 | PULP THERAPY COMBINATION NOT ALLOWED |
| 454 | Procedure code for services rendered. | 119 | Benefit maximum for this time period has been reached. | X617 | EMERGENCY ORAL EXAM (D0140) LIMITED TO ONCE PER CALENDAR YEAR. |
| 454 | Procedure code for services rendered. | 119 | Benefit maximum for this time period has been reached. | X622 | THIS PROCEDURE IS LIMITED TO ONE PER POSTPARTUM PERIOD. |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X626 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X627 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X676 | PROCEDURE CANNOT BE BILLED ON THE SAME DAY AS CRITICAL CARE |
| 454 | Procedure code for services rendered. | 97 | Payment is included in the allowance for another service/procedure. | X731 | PROCEDURE IS INCLUSIVE IN PRIMARY PROCEDURE. |
| 454 | Procedure code for services rendered. | 97 | Payment is included in the allowance for another service/procedure. | X735 | SAME PROVIDER CANNOT BILL APPLICATION/REMOVAL/REPAIR OF CAST FOR THE SAME RECIP IENT. |
| 454 | Procedure code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X897 | OUTPATIENT CHEMOTHERAPY AND EMERGENCY DEPARTMENT SERVICE CODES MAY NOT BE BILLE D ON THE SAME DAY |
| 455 | Revenue code for services rendered. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 339 | REVENUE CODE IS MISSING |
| 455 | Revenue code for services rendered. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 340 | REVENUE CODE IS INVALID |
| 455 | Revenue code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 3300 | NEONATAL REVENUE - DIAGNOSIS CODE MISMATCH |
| 455 | Revenue code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 3302 | PROCEDURE AND REVENUE CODE COMBINATION NOT VALID |
| 455 | Revenue code for services rendered. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4059 | REVENUE CODE NOT ON FILE |
| 455 | Revenue code for services rendered. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 4225 | INVALID INPATIENT REVENUE CODE |
| 455 | Revenue code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X010 | EMERGENCY FACILTY PROCEDURE CODES MAY BE BILLED WITH REVENUE CODE 450 ONLY. |
| 455 | Revenue code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X033 | REVENUE CODES 170 - 171 ARE VALID FOR THE MOTHER'S NUMBER. REVENUE CODES 172, 1 75 OR 179 ARE VALID FOR THE BABY'S NUMBER. |
| 455 | Revenue code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X037 | REVENUE CODES 170 -171 MUST NOT EXCEED 10 UNITS UNDER MOTHER'S NUMBER. |
| 455 | Revenue code for services rendered. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X097 | PROCEDURE AND REVENUE CODE COMBINATION NOT VALID |
| 455 | Revenue code for services rendered. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X164 | ACCOMMODATION REVENUE CODE IS NOT PRESENT ON INPATIENT CLAIM OR CLAIM DENIED BE CAUSE COVERED CHARGES FOR DAYS BILLED EQUAL NON-COVERED CHARGES. |
| 456 | Covered Day(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 282 | MISSING COVERED DAYS |
| 456 | Covered Day(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 397 | HEADER STMT COVERS PERIOD "THROUGH" DATE MISSING |
| 456 | Covered Day(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 398 | STATEMENT COVERS PERIOD "THROUGH" DATE INVALID |
| 456 | Covered Day(s) | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X319 | COVERED DAYS ARE GREATER THAN CERTIFIED DAYS. REFILE ONLY FOR CERTIFIED DAYS U P TO MEDICAID'S LIMITATION. |
| 457 | Non-Covered Day(s) | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 822 | SURGICAL REVENUE CODE REQUIRES ICD9 SURGERY CODE |
| 457 | Non-Covered Day(s) | 97 | Payment is included in the allowance for another service/procedure. | 5332 | THIS X-RAY PROCEDURE MAY NOT BE BILLED WITHIN 30 (THIRTY) DAYS OF A ROOT CANAL |
| 457 | Non-Covered Day(s) | 97 | Payment is included in the allowance for another service/procedure. | 5333 | THIS X-RAY PROCEDURE MAY NOT BE BILLED WITHIN 30 (THIRTY) DAYS OF A ROOT CANAL |
| 457 | Non-Covered Day(s) | 119 | Benefit maximum for this time period has been reached. | 5434 | PROCEDURE LIMITED TO ONE SERVICE DURING 60 (SIXTY) DAY POSTPARTUM PERIOD. |
| 457 | Non-Covered Day(s) | 97 | Payment is included in the allowance for another service/procedure. | 5646 | POST-OPERATIVE PHYSICAIN SERVICES FOR THE SAME DIAGNOSIS MAY NOT BE BILLED WITH IN 62 DAYS OF SURGERY |
| 457 | Non-Covered Day(s) | 97 | Payment is included in the allowance for another service/procedure. | 5647 | POST-OPERATIVE PHYSICAIN SERVICES FOR THE SAME DIAGNOSIS MAY NOT BE BILLED WITH IN 62 DAYS OF SURGERY |
| 457 | Non-Covered Day(s) | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | 6209 | PROCEDURE LIMITED TO ONE SERVICE DURING 60 (SIXTY) DAY POSTPARTUM PERIOD. |
| 457 | Non-Covered Day(s) | 14 | The date of birth follows the date of service. | X183 | DATE OF SERVICE IS PRIOR TO RECIPIENT'S DATE OF BIRTH |
| 458 | Coinsurance Day(s) | 2 | Coinsurance Amount | 817 | INVALID COINSURANCE DAYS |
| 458 | Coinsurance Day(s) | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 818 | LIFETIME RESERVE DAYS NOT NUMERIC |
| 458 | Coinsurance Day(s) | 2 | Coinsurance Amount | X094 | COINSURANCE DAYS BILLED ARE MISSING OR INVLAID. |
| 458 | Coinsurance Day(s) | 96 | Non-covered charge(s). | X096 | COINSURANCE DAYS AND/OR LIFETIME RESERVE DAYS CANNOT BE GREATER THAN COVERED DA YS. |
| 459 | Lifetime Reserve Day(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 809 | VERIFY LIFETIME RESERVE AND COINS DAYS TO COV DAYS |
| 459 | Lifetime Reserve Day(s) | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 819 | LIFETIME RESERVE DAYS > MAX ALLOWED |
| 459 | Lifetime Reserve Day(s) | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 820 | FROM DOS AND TO DOS MAY NOT SPAN THE FISCAL YEAR |
| 459 | Lifetime Reserve Day(s) | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X095 | LIFETIME RESERVE DAYS ARE INVALID |
| 460 | NUBC Condition Code(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 284 | PRIMARY CONDITION CODE INVALID |
| 460 | NUBC Condition Code(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 285 | SECOND CONDITON CODE INVALID |
| 460 | NUBC Condition Code(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 286 | THIRD CONDITION CODE INVALID |
| 460 | NUBC Condition Code(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 287 | FOURTH CONDITION CODE INVALID |
| 460 | NUBC Condition Code(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 288 | FIFTH CONDITION CODE INVALID |
| 460 | NUBC Condition Code(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 289 | SIXTH CONDITION CODE INVALID |
| 460 | NUBC Condition Code(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 290 | SEVENTH CONDITION CODE INVALID |
| 460 | NUBC Condition Code(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 471 | CONDITION CODE 8-24 INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 245 | MISSING OCCURRENCE CODE |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 291 | PRIMARY OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 292 | SECOND OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 293 | THIRD OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 294 | FOURTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 295 | DATE FOR PRIMARY OCCURRENCE CODE MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 296 | DATE FOR PRIMARY OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 297 | DATE FOR SECOND OCCURRENCE CODE MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 298 | DATE FOR SECOND OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 299 | DATE FOR THIRD OCCURRENCE CODE MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 300 | DATE FOR THIRD OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 301 | DATE FOR FOURTH OCCURRENCE CODE MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 302 | DATE FOR FOURTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 405 | FIFTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 406 | SIXTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 407 | SEVENTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 408 | EIGHTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 409 | FIRST OCCURRENCE SPAN CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 410 | SECOND OCCURRENCE SPAN CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 411 | DATE FOR FIFTH OCCURRENCE CODE MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 412 | DATE FOR FIFTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 413 | DATE FOR SIXTH OCCURRENCE CODE MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 414 | DATE FOR SIXTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 415 | DATE FOR SEVENTH OCCURRENCE CODE MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 416 | DATE FOR SEVENTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 417 | DATE FOR EIGHTH OCCURRENCE CODE MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 418 | DATE FOR EIGHTH OCCURRENCE CODE INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 464 | OCCURRENCE CODE 9-24 INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 465 | DATE FOR OCCURRENCE CODE 9-24 MISSING |
| 461 | NUBC Occurrence Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 466 | DATE FOR OCCURRENCE CODE 9-24 INVALID |
| 461 | NUBC Occurrence Code(s) and Date(s) | 129 | Payment denied - Prior processing information appears incorrect. | 467 | OCCURRENCE SPAN CODE 9-24 INVALID |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 419 | FROM DTE OF SERV FOR FIRST OCCUR SPAN CODE MISSING |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 420 | FROM DTE OF SERV FOR FIRST OCCUR SPAN CODE INVALID |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 421 | TO DTE OF SERV FOR FIRST OCCUR SPAN CODE MISSING |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 422 | TO DTE OF SERV FOR FIRST OCCUR SPAN CODE INVALID |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 423 | FROM DAT OF SERV FOR 2ND OCCUR SPAN CODE MISSING |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 424 | FROM DTE OF SERV FOR 2ND OCCUR SPAN CODE INVALID |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 425 | TO DTE OF SERV FOR 2ND OCCUR SPAN CODE MISSING |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 426 | TO DTE OF SERV FOR 2ND OCCUR SPAN CODE INVALID |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 468 | FROM DATE OF SERVICE FOR SPAN CODE 3-24 MISSING |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 469 | FROM DATE OF SERVICE FOR SPAN CODE 3-24 INVALID |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 470 | TO DATE OF SERVICE FOR SPAN CODE 3-24 MISSING |
| 462 | NUBC Occurrence Span Code(s) and Date(s) | 92 | Claim Paid in full. | 472 | TO DATE OF SERVICE FOR SPAN CODE 3-24 INVALID |
| 463 | NUBC Value Code(s) and/or Amount(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 461 | VALUE CODE IS INVALID |
| 463 | NUBC Value Code(s) and/or Amount(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 462 | VALUE CODE AMOUNT IS MISSING |
| 463 | NUBC Value Code(s) and/or Amount(s) | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 463 | VALUE CODE AMOUNT IS INVALID |
| 465 | Principal Procedure Code for Service(s) Rendered | B15 | Payment adjusted because this procedure/service is not paid separately. | X635 | WHEN PROPHYLAXIS AND FLUORIDE ARE PERFORMED ON THE SAME DAY,THE COMBINDE CODE M UST BE BILLED. |
| 465 | Principal Procedure Code for Service(s) Rendered | B15 | Payment adjusted because this procedure/service is not paid separately. | X636 | WHEN PROPHYLAXIS AND FLUORIDE ARE PERFORMED ON THE SAME DAY,THE COMBINED CODE M UST BE BILLED. REQUEST RECOUPMENT OF PREVIOUS PAID CLAIM BEFORE FILING THE COM BINED CODE. |
| 465 | Principal Procedure Code for Service(s) Rendered | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X795 | THESE NORPLANT SERVICES MUST BE BILLED USING THE APPROPRIATE COMBINATION CODE O NLY. |
| 471 | Were services related to an emergency? | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X905 | EMERGENCY INDICATOR IS INVALID |
| 473 | Missing or invalid lab indicator | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | X088 | CLIA NUMBER NOT ON FILE/INVALID OR PROVIDER NOT AUTHORIZED TO BILL PROCEDURE CO DE. |
| 474 | Procedure code and patient gender mismatch | 7 | The procedure code is inconsistent with the patient's gender. | 3319 | NDC IS INAPPROPRIATE FOR RECIPIENT SEX |
| 474 | Procedure code and patient gender mismatch | 7 | The procedure code is inconsistent with the patient's gender. | 7205 | PROCEDURE IS NOT INDICATED FOR A MALE |
| 474 | Procedure code and patient gender mismatch | 7 | The procedure code is inconsistent with the patient's gender. | 7206 | PROCEDURE IS NOT INDICATED FOR A FEMALE |
| 474 | Procedure code and patient gender mismatch | 7 | The procedure code is inconsistent with the patient's gender. | 7213 | PROCEDURE IS INVALID FOR PATIENT'S SEX |
| 474 | Procedure code and patient gender mismatch | 10 | The diagnosis is inconsistent with the patient's gender. | X150 | THIS SERVICE IS NOT REIMBURSABLE FOR A RECIPIENT OF THIS SEX. |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | 3318 | NDC NOT APPROPRIATE FOR RECIPIENT AGE. |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | 7201 | PROCEDURE IS A NEWBORN PROCEDURE; AGE SHOULD BE LESS THAN 1 YEAR |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | 7202 | PROCEDURE IS A PEDIATRIC PROCEDURE; AGE SHOULD BE 1-17 YEARS |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | 7203 | PROCEDURE IS A MATERNITY PROCEDURE; AGE SHOULD BE 12-55 YEARS |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | 7204 | PROCEDURE IS AN ADULT PROCEDURE; AGE SHOULD BE OVER 14 YEARS |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | 7211 | PROCEDURE IS INVALID FOR PATIENT'S AGE |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | X042 | EPSDT REFERRED SERVICES ARE RESTRICTED TO RECIPIENTS UNDER 21 ON THE DATE OF SE RVICE. |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | X149 | PROCEDURE/REVENUE CODE/NDC IS NOT COVERED FOR RECIPIENT'S AGE. |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | X184 | SERVICE NOT COVERED FOR RECIPIENT AGE |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | X264 | SERVICE IS NOT COVERED FOR RECIPIENT UNDER 65 YEARS OF AGE. |
| 475 | Procedure code not valid for patient age | 6 | The procedure code is inconsistent with the patient's age. | X265 | RECIPIENT MUST BE 21 YEARS OF AGE OR YOUNGER AS OF ADMISSION DATESHOWN IN FL-15 . |
| 476 | Missing or invalid units of service | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 233 | UNITS OF SERVICE MISSING |
| 476 | Missing or invalid units of service | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 260 | UNITS OF SERVICE NOT IN VALID FORMAT |
| 476 | Missing or invalid units of service | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 283 | COVERED DAYS INVALID |
| 476 | Missing or invalid units of service | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 400 | DETAIL UNITS OF SERVICE MUST BE GREATER THAN ZERO |
| 476 | Missing or invalid units of service | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 573 | TOTAL DAYS ON CLAIM CONFLICT WITH DATES SHOWN |
| 476 | Missing or invalid units of service | 119 | Benefit maximum for this time period has been reached. | X162 | UNITS BILLED EXCEED MAXIMUM ALLOWED PER DAY. |
| 477 | Diagnosis code pointer is missing or invalid | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 223 | MISSING DIAGNOSIS INDICATOR |
| 477 | Diagnosis code pointer is missing or invalid | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | 224 | DIAGNOSIS TREATMENT INDICATOR INVALID |
| 481 | Claim/submission format is invalid. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X130 | INVALID CLAIM TYPE FOR PLAN FIRST PROGRAM |
| 481 | Claim/submission format is invalid. | 62 | Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. | X159 | INVALID CLAIM TYPE FOR EMERGENCY SERVICES RECIPIENT |
| 481 | Claim/submission format is invalid. | 16 | Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate | X506 | CLAIMS ADJUSTED BY MEDICARE MUST BE SUBMITTED TO EDS ADJUSTMENT UNIT WITH PROPE R DOCUMENTATION. |
| 481 | Claim/submission format is invalid. | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | X507 | CLAIMS ADJUSTED BY MEDICARE MUST BE SUBMITTED TO EDS ADJUSTMENT UNIT |
| 481 | Claim/submission format is invalid. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X529 | TEN UNITS OF CODE Z5294 MUST BE BILLED PRIOR TO ANY UNITS OFZ5295 |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | 6260 | NUMBER OF HOME HEALTH VISITS EXCEED LIMIT |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 142 | Claim adjusted by the monthly Medicaid patient liability amount. | X371 | RECIPIENT RESOURCES EXCEED THE MEDICAID ALLOWED AMOUNT. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 142 | Claim adjusted by the monthly Medicaid patient liability amount. | X372 | PATIENT RESOURCES EXCEED THE MEDICAID ALLOWED AMOUNT |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X400 | PROCEDURE IS LIMITED TO SIXTY (60)PER CALENDAR MONTH. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X401 | PROCEDURE IS LIMITED TO TWENTY (20) PER CALENDAR MONTH. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X402 | PROCEDURE IS LIMITED TO ONE (1) EVERY FIVE (5) YEARS. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X403 | PROCEDURE IS LIMITED TO THIRTY (30) PER MONTH. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X404 | PROCEDURE IS LIMITED TO ONE HUNDRED TWENY (120) PER CALENDAR MONTH. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X405 | PROCEDURE CODE IS LIMITED TO ONE-HUNDRED (100) PER MONTH. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X406 | REVENUE CODE 183 IS LIMITED TO 6 DAYS EACH CALENDAR QUARTER. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X407 | PROCEDURE IS LIMITED TO 60 (SIXTY) TIMES PER CALENDAR MONTH |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X408 | PROCEDURE IS LIMITED TO 30 (THIRTY) PER MONTH |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X409 | PROCEDURE CODE IS LIMITED TO 40 (FORTY) PER CALENDAR MONTH |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X410 | THIS PROCEDURE IS LIMITED TO SIXTEEN (16) UNITS PER CALENDAR YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X412 | FAMILY PLANNING PERIODIC FOLLOW-UP IS LIMITED TO FOUR (4) VISITS PER YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X413 | PROCEDURE CODE IS LIMTED TO 2 PER MONTH |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X415 | SCREENING MAMMOGRAPHY IS LIMITED TO ONE PER YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X416 | THE LIMIT OF TWO UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X422 | REVENUE CODE 184 IS LIMITED TO 14 DAYS PER CALENDAR MONTH |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X423 | MAXIMUM QUANTITY EXCEEDED FOR 30 DAY PERIOD. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X436 | HBO LIMIT HAS BEEN EXCEEDED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X437 | VISION AND HEARING SCREENING ONE PER YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X441 | NUMBER OF HOME HEALTH VISITS EXCEED LIMIT |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X442 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X443 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X444 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X445 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X448 | QUALIFYING PROCEDURE LIMIT HAS BEEN EXCEEDED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X483 | THE LIMIT OF THREE UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X484 | THE LIMIT OF THREE (3) UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X485 | THE LIMIT OF TWO UNITS PER MONTH HAS BEEN EXCEEDED FOR THIS PROCEDURE. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X492 | MONTHLY SCRIPT LIMIT EXCEEDED (MIN/MAX). |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X539 | THIS PROCEDURE CODE IS LIMITED TO ONE PER CALENDAR MONTH. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 18 | Duplicate claim/service. | X542 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 483 | Maximum coverage amount met or exceeded for benefit period. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X552 | PROCEDURE CODE NOT COVERED WHEN BILLED ON THE SAME DAY |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X631 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X634 | PROCEDURE LIMITED TO 4320 UNITS,PER FISCAL YEAR OCTOBER 1 - SEPTEMBER 30. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X641 | THIS PROCEDURE IS LIMITED TO ONE EPISODE A YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X642 | THIS PROCEDURE IS LIMITED TO 52 UNITS PER YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X643 | THIS PROCEDURE IS LIMITED TO 10 (TEN) UNITS PER YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X644 | PROCEDURE CODE IS LIMITED TO 104 UNITS A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X645 | PROCEDURE CODE IS LIMITED TO 104 TIMES PER YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X646 | PROCEDURE CODE IS LIMITED TO 104 TIMES A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X647 | THIS PROCEDURE IS LIMITED TO 365 EPISODES A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X648 | THIS PROCEDURE IS LIMITED TO 52 UNITS A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X649 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALDEAR YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X650 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X651 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X652 | BENEFITS HAVE BEEN EXCEEDEF OR THE CALENDAR YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X653 | PROCEDURE IS LIMITED TO 130 UNITS A YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X654 | BENEFITS HAVE BEEN EXCEEDEF FOR THE CALENDAR YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X655 | PROCEDURE IS LIMITED TO 260 UNITS A YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X656 | BENEFITS HAVE BEEN EXCEEDED FOR THE CALENDAR YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X657 | PROCEDURE IS LIMITED TO 260 UNITS A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X658 | PROCEDURE IS LIMITED TO 8 UNITS A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X659 | PROCEDURE CODE IS LIMITED TO 312 UNITS A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X660 | PROCEDURE IS LIMITED TO 1040 UNITS A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X661 | PROCEDURE IS LIMITED TO 1040 UNITS A YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X662 | PROCEDURE IS LIMITED TO 2016 UNITS A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X712 | PROCEDURE IS LIMITED TO 4160 UNITS A YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X718 | NEW PATIENT CODE Z5147 MAY ONLY BE BILLED ONCE PER LIFETIME PER RECIPIENT |
| 483 | Maximum coverage amount met or exceeded for benefit period. | B5 | Payment adjusted because coverage/program guidelines were not met or were exceeded. | X736 | COVERED DAYS ON THIS CLAIM HAVE BEEN SYSTEMATICALLY REDUCED TO MEET THE ALLOWED COVERED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X771 | MAXIMUN UNIT LIMIT HAS BEEN EXCEEDED. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X797 | MEDICAL SUPPLIES LIMIT IS $1,800.00 PER WAIVER YEAR, 02/22-02/21. THE LIMIT HA S BEEN EXCEEDED. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X799 | REQUESTED INPATIENT HOSPITAL SERVICES PARTIALLY EXCEED LIMITOF 16. REBILL FOR REMAINING DAYS |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X801 | THE ALLOWED LENS LIMITATION HAS BEEN EXCEEDED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X804 | THE ALLOWED FRAMES LIMITATION HAS BEEN EXCEEDED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X805 | THE ALLOWED EYE EXAM LIMITATION HAS BEEN EXCEEDED. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X819 | PROCEDURE IS LIMITED TO 1 (ONE) EVERY TWO YEARS |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X820 | THE ALLOWED FITTING LIMITATION HAS BEEN EXCEEDED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X821 | EPSDT SCREENING LIMIT HAS BEEN EXCEEDED. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X822 | THIS PROCEDURE CODE IS LIMITED TO ONE PER MONTH. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X823 | FULL SERIES/PANORAMIC X-RAYS ARE LIMITED TO ONE EVERY THREE CALENDAR YEARS |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X825 | PROCEDURE IS LIMITED TO ONE SERVICE EVERY 70 DAYS. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X829 | EARMOLDS ARE LIMITED TO TWO EVERY FOUR MONTHS. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X832 | BINAURAL HEARING AID BATTERIES ARE LIMITED TO TWO PACKAGES EVERY TWO MONTHS. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X842 | COMPREHENSIVE DENTAL EXAM MAY ONLY BE BILLED ONCE PER LIFETIME PER PROVIDER. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X856 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X862 | LEG BAGS ARE LIMITED TO TWO PER MONTH |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X863 | THE YEARLY LIMIT FOR THIS PROCEDURE HAS BEEN EXCEEDED |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X869 | FAMILY PLANNING PERIODIC REVISIT IS LIMITED TO 4-6 VISITS PER CALENDAR YEAR |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X874 | PROCEDURE IS LIMITED TO ONE (1) EVERY TWO YEARS. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X875 | INPATIENT DAYS HAVE BEEN EXEEDED FOR THIS CALENDAR YEAR. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X877 | PROCEDURE IS LIMITED TO ONE (1) EVERY THREE YEARS. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X887 | CATHETERS, CATHETER TRAYS, AND DRAINAGE BAGS ARE LIMITED TO TWO PER MONTH. |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X889 | REQUESTED INPATIENT HOSPITAL SERVICES EXCEED LIMIT OF 16 |
| 483 | Maximum coverage amount met or exceeded for benefit period. | 119 | Benefit maximum for this time period has been reached. | X891 | PHYSICIAN OFFICE VISIT LIMITATION HAS BEEN EXCEEDED |
| 516 | Adjudication or Payment Date | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 814 | DETAIL TO DATE OF SERVICE > ICN DATE |
| 553 | Covered Amount | 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. | 828 | RECIPIENT NUMBER MISSING OR INVALID |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1927 | NPI REQUIRED HEALTHCARE=Y BILLING PROV |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1928 | NPI REQUIRED HEALTHCARE=Y PREMING PROV |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1929 | NPI REQUIRED HEALTHCARE=Y REFERRING PROV |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1930 | NPI REQUIRED HEALTHCARE=Y FACILITY PROV |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1931 | NPI REQUIRED HEALTHCARE=Y RENDERING PROV |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1932 | NPI REQUIRED: OTHER PROVIDER 2 (HEALTHCARE) |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1933 | NPI REQUIRED: DTL OTHER PROVIDER 2 (HEALTHCARE) |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1934 | DTL NPI REQUIRED HEALTHCARE=Y PERFORMING PROV |
| 562 | Entitys National Provider Identifier (NPI) | 45 | Charges exceed your contracted/ legislated fee arrangement. | 1935 | DTL NPI REQUIRED HEALTHCARE=Y REFERRING PROV |
| 562 | Entitys National Provider Identifier (NPI) | B7 | This provider was not certified/eligible to be paid for this procedure/service on this date of service. | 1996 | THE RENDERING PROVIDER IS NOT ENROLLED IN THE MEDICAID PROGRAM. |
| 562 | Entitys National Provider Identifier (NPI) | 92 | Claim Paid in full. | 1999 | PROVIDER ID IS INVALID, IS NOT ON FILE OR NAME/NUMBER DISAGREE. |
| 565 | Estimated Claim Due Amount | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 3306 | HEADER PAID AMOUNT EXCEEDS SPECIFIED DOLLAR AMOUNT |
| 583 | Line Item Charge Amount | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 801 | DTL RATE * DTL UNITS NOT EQUAL DTL BILLED AMOUNT |
| 585 | Line Item Denied Charge or Non-covered Charge | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 805 | NONCOVERED CHARGE IS NOT NUMERIC |
| 591 | Medicare Paid at 100% Amount | 42 | Charges exceed our fee schedule or maximum allowable amount. | 3303 | MEDICARE PAID AMOUNT EQUAL 100% |
| 626 | Pregnancy Indicator | 45 | Charges exceed your contracted/ legislated fee arrangement. | 208 | PREGNANCY INDICATOR INVALID |
| 639 | Responsibility Amount | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 810 | INVALID DEDUCTIBLE AMT - SKILLED NURSING FACILITY |
| 639 | Responsibility Amount | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 811 | HEADER FROM DATE OF SERVICE > ICN DATE |
| 644 | Service Line Rate | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 800 | DETAIL RATE NOT NUMERIC |
| 655 | Total Medicare Paid Amount | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 806 | MEDICARE PAID AMOUNT MISSING OR INVALID |
| 666 | Surgical Procedure Code | 125 | Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. | 823 | RECIPIENT CHECK DIGIT IS MISSING OR INVALID |