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Wednesday, May 26, 2010

Medicaid denial code M list

Medicaid Denial Codes -10

M134 Performed by a facility/supplier in which the provider has a financial interest. Note: (Modified 6/30/03)

M135 Missing/incomplete/invalid plan of treatment. Note: (Modified 2/28/03)

M136 Missing/incomplete/invalid indication that the service was supervised or evaluated by a
physician. Note: (Modified 2/28/03)

M137 Part B coinsurance under a demonstration project.
M138 Patient identified as a demonstration participant but the patient was not enrolled in the
demonstration at the time services were rendered. Coverage is limited to demonstration participants.
M139 Denied services exceed the coverage limit for the demonstration.
M140 Service not covered until after the patient’s 50th birthday, i.e., no coverage prior to the day after the 50th birthday Note: (Deactivated eff. 1/30/2004) Consider using M82
M141 Missing physician certified plan of care. Note: (Modified 2/28/03) Related to N238
M142 Missing American Diabetes Association Certificate of Recognition. Note: (Modified 2/28/03) Related to N226
M143 We have no record that you are licensed to dispensed drugs in the State where located.
M144 Pre-/post-operative care payment is included in the allowance for the surgery/procedure.

MA01 If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.
Note: (Modified 10/31/02, 6/30/03, 8/1/05)

MA02 If you do not agree with this determination, you have the right to appeal. You must file
a written request for an appeal within 120 days of the date you receive this notice. Decisions made by a Quality Improvement Organization (QIO) must be appealed to that QIO within 60 days.
Note: (Modified 10/31/02, 6/30/03, 8/1/05)

MA03 If you do not agree with the approved amounts and $100 or more is in dispute (less deductible and coinsurance), you may ask for a hearing within six months of the date of this notice. To meet the $100, you may combine amounts on other claims that have been denied, including reopened appeals if you received a revised decision. You must appeal each claim on time. At the reconsideration, you must present any new evidence which could affect our decision.
Note: (Modified 10/31/02, 6/30/03, 8/1/05)

MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.

MA05 Incorrect admission date patient status or type of bill entry on claim. Note: (Deactivated eff. 10/16/03) Consider using MA30, MA40 or MA43

MA06 Missing/incomplete/invalid beginning and/or ending date(s). Note: (Deactivated eff. 8/1/04) Consider using MA31

MA07 The claim information has also been forwarded to Medicaid for review.

MA08 You should also submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information as the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.

MA09 Claim submitted as unassigned but processed as assigned. You agreed to accept assignment for all claims.

MA10 The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient.

MA11 Payment is being issued on a conditional basis. If no-fault insurance, liability insurance, Workers' Compensation, Department of Veterans Affairs, or a group health plan for employees and dependents also covers this claim, a refund may be due us. Please contact us if the patient is covered by any of these sources. Note: (Deactivated eff. 1/31/2004) Consider using M32

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