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Monday, May 24, 2010

Medicaid Claim Denial Codes - List 2

Medicaid Claim Denial Codes

129 Payment denied - Prior processing information appears incorrect.
Note: Changed as of 2/01
130 Claim submission fee.
Note: Changed as of 6/01
131 Claim specific negotiated discount.
Note: New as of 2/97
132 Prearranged demonstration project adjustment.
Note: New as of 2/97
133 The disposition of this claim/service is pending further review.
Note: Changed as of 10/99
134 Technical fees removed from charges.
Note: New as of 10/98
135 Claim denied. Interim bills cannot be processed.
Note: New as of 10/98
136 Claim Adjusted. Plan procedures of a prior payer were not followed.
Note: Changed as of 6/00
137 Payment/Reduction for Regulatory Surcharges, Assessments, Allowances or Health
Related Taxes.
Note: New as of 2/99
138 Claim/service denied. Appeal procedures not followed or time limits not met.
Note: New as of 6/99
139 Contracted funding agreement - Subscriber is employed by the provider of services.
Note: New as of 6/99
140 Patient/Insured health identification number and name do not match.
Note: New as of 6/99
141 Claim adjustment because the claim spans eligible and ineligible periods of coverage.
Note: Changed as of 6/00
142 Claim adjusted by the monthly Medicaid patient liability amount.
Note: New as of 6/00
143 Portion of payment deferred.
Note: New as of 2/01
144 Incentive adjustment, e.g. preferred product/service.
Note: New as of 6/01
145 Premium payment withholding
Note: New as of 6/02
146 Payment denied because the diagnosis was invalid for the date(s) of service reported.
Note: New as of 6/02
147 Provider contracted/negotiated rate expired or not on file.
Note: New as of 6/02
148 Claim/service rejected at this time because information from another provider was not
provided or was insufficient/incomplete.
Note: New as of 6/02
149 Lifetime benefit maximum has been reached for this service/benefit category.
Note: New as of 10/02
150 Payment adjusted because the payer deems the information submitted does not
support this level of service.
Note: New as of 10/02
151 Payment adjusted because the payer deems the information submitted does not
support this many services.
Note: New as of 10/02
152 Payment adjusted because the payer deems the information submitted does not
support this length of service.
Note: New as of 10/02
153 Payment adjusted because the payer deems the information submitted does not
support this dosage.
Note: New as of 10/02
154 Payment adjusted because the payer deems the information submitted does not
support this day's supply.

155 This claim is denied because the patient refused the service/procedure.
Note: New as of 6/03
156 Flexible spending account payments
Note: New as of 9/03
157 Payment denied/reduced because service/procedure was provided as a result of an act
of war.
Note: New as of 9/03
158 Payment denied/reduced because the service/procedure was provided outside of the
United States.
Note: New as of 9/03
159 Payment denied/reduced because the service/procedure was provided as a result of
terrorism.
Note: New as of 9/03
160 Payment denied/reduced because injury/illness was the result of an activity that is a
benefit exclusion.
Note: New as of 9/03
161 Provider performance bonus
Note: New as of 2/04
162 State-mandated Requirement for Property and Casualty, see Claim Payment Remarks
Code for specific explanation.
Note: New as of 2/04
163 Claim/Service adjusted because the attachment referenced on the claim was not
received.
Note: New as of 6/04
164 Claim/Service adjusted because the attachment referenced on the claim was not
received in a timely fashion.
Note: New as of 6/04
165 Payment denied /reduced for absence of, or exceeded referral
Note: New as of 10/04
166 These services were submitted after this payers responsibility for processing claims
under this plan ended.
Note: New as of 2/05
167 This (these) diagnosis(es) is (are) not covered.
Note: New as of 6/05
168 Payment denied as Service(s) have been considered under the patient's medical plan.
Benefits are not available under this dental plan
Note: New as of 6/05
169 Payment adjusted because an alternate benefit has been provided
Note: New as of 6/05
170 Payment is denied when performed/billed by this type of provider.
Note: New as of 6/05
171 Payment is denied when performed/billed by this type of provider in this type of
facility.
Note: New as of 6/05
172 Payment is adjusted when performed/billed by a provider of this specialty
Note: New as of 6/05
173 Payment adjusted because this service was not prescribed by a physician
Note: New as of 6/05
174 Payment denied because this service was not prescribed prior to delivery
Note: New as of 6/05
175 Payment denied because the prescription is incomplete
Note: New as of 6/05
176 Payment denied because the prescription is not current
Note: New as of 6/05
177 Payment denied because the patient has not met the required eligibility requirements
Note: New as of 6/05
178 Payment adjusted because the patient has not met the required spend down requirements.
179 Payment adjusted because the patient has not met the required waiting requirements
Note: New as of 6/05
180 Payment adjusted because the patient has not met the required residency
requirements
Note: New as of 6/05
181 Payment adjusted because this procedure code was invalid on the date of service
Note: New as of 6/05
182 Payment adjusted because the procedure modifier was invalid on the date of service
Note: New as of 6/05. Modified on 8/8/2005
183 The referring provider is not eligible to refer the service billed.
Note: New as of 6/05
184 The prescribing/ordering provider is not eligible to prescribe/order the service billed.
Note: New as of 6/05
185 The rendering provider is not eligible to perform the service billed.
Note: New as of 6/05
186 Payment adjusted since the level of care changed
Note: New as of 6/05
187 Health Savings account payments
Note: New as of 6/05
188 This product/procedure is only covered when used according to FDA recommendations.
Note: New as of 6/05
189 "Not otherwise classified" or "unlisted" procedure code (CPT/HCPCS) was billed when
there is a specific procedure code for this procedure/service
Note: New as of 6/05

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