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Monday, May 31, 2010

claim denial code list MA 121, MA 122 , M12 - M134

Medicaid Claim Denial Codes

MA121 Missing/incomplete/invalid x-ray date.
MA122 Missing/incomplete/invalid initial treatment date.


Common Reasons for Message

    Initial treatment date in Item 14 is either missing or invalid
    Incorrect qualifier was used on electronic claim

Next Step

    Resubmit claim with initial treatment date Item 14 or electronic equivalent
        Initial treatment date is required on all chiropractic claims involving spinal manipulation
    Resubmit electronic claim with correct qualifier for initial treatment date
        Initial treatment date is submitted in Loop 2300
        Initial treatment date is reported in a DTP segment in format CCYYMMDD

        Qualifier must be submitted as 454

MA 12 - 63

MA12 You have not established that you have the right under the law to bill for services
furnished by the person(s) that furnished this (these) service(s).
MA13 You may be subject to penalties if you bill the patient for amounts not reported with
the PR (patient responsibility) group code.
MA14 Patient is a member of an employer-sponsored prepaid health plan. Services from
outside that health plan are not covered. However, as you were not previously notified
of this, we are paying this time. In the future, we will not pay you for non-plan
services.
MA15 Your claim has been separated to expedite handling. You will receive a separate notice
for the other services reported.
MA16 The patient is covered by the Black Lung Program. Send this claim to the Department
of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.
MA17 We are the primary payer and have paid at the primary rate. You must contact the
patient's other insurer to refund any excess it may have paid due to its erroneous
primary payment.
MA18 The claim information is also being forwarded to the patient's supplemental insurer.
Send any questions regarding supplemental benefits to them.
MA19 Information was not sent to the Medigap insurer due to incorrect/invalid information
you submitted concerning that insurer. Please verify your information and submit your
secondary claim directly to that insurer.
MA20 Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the
use of an urethral catheter for convenience or the control of incontinence.
Note: (Modified 6/30/03)
MA21 SSA records indicate mismatch with name and sex.
MA22 Payment of less than $1.00 suppressed.
MA23 Demand bill approved as result of medical review.
MA24 Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit
period.
Note: (Modified 6/30/03)
MA25 A patient may not elect to change a hospice provider more than once in a benefit
period.
MA26 Our records indicate that you were previously informed of this rule.
MA27 Missing/incomplete/invalid entitlement number or name shown on the claim.
Note: (Modified 2/28/03)
MA28 Receipt of this notice by a physician or supplier who did not accept assignment is for
information only and does not make the physician or supplier a party to the
determination. No additional rights to appeal this decision, above those rights already
provided for by regulation/instruction, are conferred by receipt of this notice.
MA29 Missing/incomplete/invalid provider name, city, state, or zip code.
Note: (Deactivated eff. 6/2/05)
MA30 Missing/incomplete/invalid type of bill.
Note: (Modified 2/28/03)
MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
Note: (Modified 2/28/03)
MA32 Missing/incomplete/invalid number of covered days during the billing period.
Note: (Modified 2/28/03)
MA33 Missing/incomplete/invalid noncovered days during the billing period.
Note: (Modified 2/28/03)
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
Note: (Modified 2/28/03)
MA35 Missing/incomplete/invalid number of lifetime reserve days.
Note: (Modified 2/28/03)
MA36 Missing/incomplete/invalid patient name.
MA37 Missing/incomplete/invalid patient's address.
Note: (Modified 2/28/03)
MA38 Missing/incomplete/invalid birth date.
Note: (Deactivated eff. 6/2/05)
MA39 Missing/incomplete/invalid gender.
Note: (Modified 2/28/03)
MA40 Missing/incomplete/invalid admission date.
Note: (Modified 2/28/03)
MA41 Missing/incomplete/invalid admission type.
Note: (Modified 2/28/03)
MA42 Missing/incomplete/invalid admission source.
Note: (Modified 2/28/03)
MA43 Missing/incomplete/invalid patient status.
Note: (Modified 2/28/03)
MA44 No appeal rights. Adjudicative decision based on law.
MA45 As previously advised, a portion or all of your payment is being held in a special
account.
MA46 The new information was considered, however, additional payment cannot be issued.
Please review the information listed for the explanation.
MA47 Our records show you have opted out of Medicare, agreeing with the patient not to bill
Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The
patient is responsible for payment.
MA48 Missing/incomplete/invalid name or address of responsible party or primary payer.
Note: (Modified 2/28/03)
MA49 Missing/incomplete/invalid six-digit provider identifier for home health agency or
hospice for physician(s) performing care plan oversight services.
Note: (Deactivated eff.8/1/04) Consider using MA76
MA50 Missing/incomplete/invalid Investigational Device Exemption number for FDA-approved
clinical trial services.
Note: (Modified 2/28/03)
MA51 Missing/incomplete/invalid CLIA certification number for laboratory services billed by
physician office laboratory.
Note: (Deactivated eff. 2/5/05) Consider using MA120
MA52 Missing/incomplete/invalid date.
Note: (Deactivated eff. 6/2/05)
MA53 Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
Note: (Modified 2/1/04)
MA54 Physician certification or election consent for hospice care not received timely.
MA55 Not covered as patient received medical health care services, automatically revoking
his/her election to receive religious non-medical health care services.
MA56 Our records show you have opted out of Medicare, agreeing with the patient not to bill
Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The
patient is responsible for payment, but under Federal law, you cannot charge the
patient more than the limiting charge amount.
MA57 Patient submitted written request to revoke his/her election for religious non-medical
health care services.
MA58 Missing/incomplete/invalid release of information indicator.
Note: (Modified 2/28/03)
MA59 The patient overpaid you for these services. You must issue the patient a refund within
30 days for the difference between his/her payment and the total amount shown as
patient responsibility on this notice.
MA60 Missing/incomplete/invalid patient relationship to insured.
Note: (Modified 2/28/03)
MA61 Missing/incomplete/invalid social security number or health insurance claim number.
Note: (Modified 2/28/03)
MA62 Telephone review decision.
MA63 Missing/incomplete/invalid principal diagnosis.
Note: (Modified 2/28/03)

MA 64- MA 113

MA64 Our records indicate that we should be the third payer for this claim. We cannot
process this claim until we have received payment information from the primary and
secondary payers.
MA65 Missing/incomplete/invalid admitting diagnosis.
Note: (Modified 2/28/03)
MA66 Missing/incomplete/invalid principal procedure code.
Note: (Modified 12/2/04) Related to N303
MA67 Correction to a prior claim.
MA68 We did not crossover this claim because the secondary insurance information on the
claim was incomplete. Please supply complete information or use the PLANID of the
insurer to assure correct and timely routing of the claim.
MA69 Missing/incomplete/invalid remarks.
Note: (Modified 2/28/03)
MA70 Missing/incomplete/invalid provider representative signature.
Note: (Modified 2/28/03)
MA71 Missing/incomplete/invalid provider representative signature date.
Note: (Modified 2/28/03)
MA72 The patient overpaid you for these assigned services. You must issue the patient a
refund within 30 days for the difference between his/her payment to you and the total
of the amount shown as patient responsibility and as paid to the patient on this notice.
MA73 Informational remittance associated with a Medicare demonstration. No payment
issued under fee-for-service Medicare as patient has elected managed care.
MA74 This payment replaces an earlier payment for this claim that was either lost, damaged
or returned.
MA75 Missing/incomplete/invalid patient or authorized representative signature.
Note: (Modified 2/28/03)
MA76 Missing/incomplete/invalid provider identifier for home health agency or hospice when
physician is performing care plan oversight services.
Note: (Modified 2/28/03, 2/1/04)
MA77 The patient overpaid you. You must issue the patient a refund within 30 days for the
difference between the patient’s payment less the total of our and other payer
payments and the amount shown as patient responsibility on this notice.
MA78 The patient overpaid you. You must issue the patient a refund within 30 days for the
difference between our allowed amount total and the amount paid by the patient.
Note: (Deactivated eff. 1/31/2004) Consider using MA59
MA79 Billed in excess of interim rate.
MA80 Informational notice. No payment issued for this claim with this notice. Payment
issued to the hospital by its intermediary for all services for this encounter under a
demonstration project.
MA81 Missing/incomplete/invalid provider/supplier signature.
Note: (Modified 2/28/03)
MA82 Missing/incomplete/invalid provider/supplier billing number/identifier or billing name,
address, city, state, zip code, or phone number.
Note: (Deactivated eff. 6/2/05)
MA83 Did not indicate whether we are the primary or secondary payer.
Note: (Modified 8/1/05)
MA84 Patient identified as participating in the National Emphysema Treatment Trial but our
records indicate that this patient is either not a participant, or has not yet been
approved for this phase of the study. Contact Johns Hopkins University, the study
coordinator, to resolve if there was a discrepancy.
MA85 Our records indicate that a primary payer exists (other than ourselves); however, you
did not complete or enter accurately the insurance plan/group/program name or
identification number. Enter the PlanID when effective.
Note: (Deactivated eff. 8/1/04) Consider using MA92
MA86 Missing/incomplete/invalid group or policy number of the insured for the primary
coverage.
Note: (Deactivated eff. 8/1/04) Consider using MA92
MA87 Missing/incomplete/invalid insured's name for the primary payer.
Note: (Deactivated eff. 8/1/04) Consider using MA92
MA88 Missing/incomplete/invalid insured's address and/or telephone number for the primary
payer.
Note: (Modified 2/28/03)
MA89 Missing/incomplete/invalid patient's relationship to the insured for the primary payer.
Note: (Modified 2/28/03)
MA90 Missing/incomplete/invalid employment status code for the primary insured.
Note: (Modified 2/28/03).
MA91 This determination is the result of the appeal you filed.
MA92 Missing plan information for other insurance.
Note: (Modified 2/1/04) Related to N245
MA93 Non-PIP (Periodic Interim Payment) claim.
Note: (Modified 6/30/03)
MA94 Did not enter the statement “Attending physician not hospice employee” on the claim
form to certify that the rendering physician is not an employee of the hospice.
Note: (Reactivated 4/1/04, Modified 8/1/05)
MA95 De-activate and refer to M51.
Note: (Modified 2/28/03)
MA96 Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not
enrolled in a Medicare managed care plan.
MA97 Missing/incomplete/invalid Medicare Managed Care Demonstration contract number.
Note: (Modified 2/28/03)
MA98 Claim Rejected. Does not contain the correct Medicare Managed Care Demonstration
contract number for this beneficiary.
Note: (Deactivated eff. 10/16/03) Consider using MA97
MA99 Missing/incomplete/invalid Medigap information.
Note: (Modified 2/28/03)
MA100 Missing/incomplete/invalid date of current illness or symptoms
Note: (Modified 2/28/03, 3/30/05)
MA101 A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who
furnish these services/supplies to residents.
Note: (Modified 6/30/03)
MA102 Missing/incomplete/invalid name or provider identifier for the rendering/referring/
ordering/ supervising provider.
Note: (Deactivated eff. 8/1/04) Consider using M68
MA103 Hemophilia Add On.
MA104 Missing/incomplete/invalid date the patient was last seen or the provider identifier of
the attending physician.
Note: (Deactivated eff. 1/31/2004) Consider using M128 or M57
MA105 Missing/incomplete/invalid provider number for this place of service.
Note: (Deactivated eff. 6/2/05)
MA106 PIP (Periodic Interim Payment) claim.
Note: (Modified 6/30/03)
MA107 Paper claim contains more than three separate data items in field 19.
MA108 Paper claim contains more than one data item in field 23.
MA109 Claim processed in accordance with ambulatory surgical guidelines.
MA110 Missing/incomplete/invalid information on whether the diagnostic test(s) were
performed by an outside entity or if no purchased tests are included on the claim.
Note: (Modified 2/28/03)
MA111 Missing/incomplete/invalid purchase price of the test(s) and/or the performing
laboratory's name and address.
Note: (Modified 2/28/03)
MA112 Missing/incomplete/invalid group practice information.
Note: (Modified 2/28/03)
MA113 Incomplete/invalid taxpayer identification number (TIN) submitted by you per the
Internal Revenue Service. Your claims cannot be processed without your correct TIN,
and you may not bill the patient pending correction of your TIN. There are no appeal
rights for unprocessable claims, but you may resubmit this claim after you have
notified this office of your correct TIN.
MA114 Missing/incomplete/invalid information on where the services were furnished.
Note: (Modified 2/28/03)
MA115 Missing/incomplete/invalid physical location (name and address, or PIN) where the
service(s) were rendered in a Health Professional Shortage Area (HPSA).
Note: (Modified 2/28/03)
MA116 Did not complete the statement "Homebound" on the claim to validate whether
laboratory services were performed at home or in an institution.
Note: (Reactivated 4/1/04)
MA117 This claim has been assessed a $1.00 user fee.
MA118 Coinsurance and/or deductible amounts apply to a claim for services or supplies
furnished to a Medicare-eligible veteran through a facility of the Department of
Veterans Affairs. No Medicare payment issued.
MA119 Provider level adjustment for late claim filing applies to this claim.
MA120 Missing/incomplete/invalid CLIA certification number.
Note: (Modified 2/28/03)
MA121 Missing/incomplete/invalid x-ray date.
Note: (Modified 12/2/04)
MA122 Missing/incomplete/invalid initial treatment date.
Note: (Modified 12/2/04)
MA123 Your center was not selected to participate in this study, therefore, we cannot pay for
these services.
MA124 Processed for IME only.
Note: (Deactivated eff. 1/31/2004) Consider using Reason Code 74
MA125 Per legislation governing this program, payment constitutes payment in full.
MA126 Pancreas transplant not covered unless kidney transplant performed.
Note: (New Code 10/12/01)
MA127 Reserved for future use.
Note: (Deactivated eff. 6/2/05)
MA128 Missing/incomplete/invalid FDA approval number.
Note: (Modified 2/28/03, 3/30/05)
MA129 This provider was not certified for this procedure on this date of service.
Note: (Deactivated eff. 1/31/2004) Consider using MA120 and Reason Code B7
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are
afforded because the claim is unprocessable. Please submit a new claim with the
complete/correct information.
MA131 Physician already paid for services in conjunction with this demonstration claim. You
must have the physician withdraw that claim and refund the payment before we can
process your claim.
MA132 Adjustment to the pre-demonstration rate.
MA133 Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient
stay.
MA134 Missing/incomplete/invalid provider number of the facility where the patient resides.

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