Monday, May 24, 2010

Medicaid denial reason code list

Medicaid Claim Denial Codes

1  Deductible Amount

2  Coinsurance Amount

3  Co-payment Amount

4  The procedure code is inconsistent with the modifier used or a required modifier is missing.

5  The procedure code/bill type is inconsistent with the place of service.

6  The procedure/revenue code is inconsistent with the patient's age.

7  The procedure/revenue code is inconsistent with the patient's gender.

8  The procedure code is inconsistent with the provider type/specialty (taxonomy).

9  The diagnosis is inconsistent with the patient's age.

10  The diagnosis is inconsistent with the patient's gender.

11 The diagnosis is inconsistent with the procedure.

12 The diagnosis is inconsistent with the provider type.

13 The date of death precedes the date of service.

14 The date of birth follows the date of service.

15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.

 16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate Note: Changed as of 2/02

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.
Note: Changed as of 2/02

18 Duplicate claim/service.

19 Claim denied because this is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.

20 Claim denied because this injury/illness is covered by the liability carrier.

21 Claim denied because this injury/illness is the liability of the no-fault carrier.

22 Payment adjusted because this care may be covered by another payer per coordination of benefits.

23 Payment adjusted due to the impact of prior payer(s) adjudication including payments
and/or adjustments

24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.

25 Payment denied. Your Stop loss deductible has not been met.

26 Expenses incurred prior to coverage.

27 Expenses incurred after coverage terminated.

28 Coverage not in effect at the time the service was provided. Note: Inactive for 004010, since 6/98. Redundant to codes 26&27.

29 The time limit for filing has expired.

30 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Note: Changed as of 2/01. This code will be deactivated on 2/1/2006.

31 Claim denied as patient cannot be identified as our insured.

32 Our records indicate that this dependent is not an eligible dependent as defined.

33 Claim denied. Insured has no dependent coverage.

34 Claim denied. Insured has no coverage for newborns.

35 Lifetime benefit maximum has been reached.
Note: Changed as of 10/02

36 Balance does not exceed co-payment amount.
Note: Inactive for 003040

37 Balance does not exceed deductible.
Note: Inactive for 003040

38 Services not provided or authorized by designated (network/primary care) providers.
Note: Changed as of 6/03

39 Services denied at the time authorization/pre-certification was requested.

40 Charges do not meet qualifications for emergent/urgent care.

41 Discount agreed to in Preferred Provider contract.
Note: Inactive for 003040

42 Charges exceed our fee schedule or maximum allowable amount.

43 Gramm-Rudman reduction.

44 Prompt-pay discount.

45 Charges exceed your contracted/ legislated fee arrangement.

46 This (these) service(s) is (are) not covered.
Note: Inactive for 004010, since 6/00. Use code 96.

47 This (these) diagnosis(es) is (are) not covered, missing, or are invalid.
Note: Changed as of 6/00. This code will be deactivated on 2/1/2006.

48 This (these) procedure(s) is (are) not covered.
Note: Inactive for 004010, since 6/00. Use code 96.

49 These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.

50 These are non-covered services because this is not deemed a `medical necessity' by the payer.

51 These are non-covered services because this is a pre-existing condition

52 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
Note: Changed as of 10/98. This code will be deactivated on 2/1/2006.

53 Services by an immediate relative or a member of the same household are not covered.

54 Multiple physicians/assistants are not covered in this case .

55 Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer.

56 Claim/service denied because procedure/treatment has not been deemed `proven to
be effective' by the payer.

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.
Note: Inactive for 004050. Split into codes 150, 151, 152, 153 and 154.

58 Payment adjusted because treatment was deemed by the payer to have been rendered
in an inappropriate or invalid place of service.
Note: Changed as of 2/01

59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules.
Note: Changed as of 6/00

60 Charges for outpatient services with this proximity to inpatient services are not
covered.

61 Charges adjusted as penalty for failure to obtain second surgical opinion.
Note: Changed as of 6/00

62 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.
Note: Changed as of 2/01

63 Correction to a prior claim.
Note: Inactive for 003040

64 Denial reversed per Medical Review.
Note: Inactive for 003040

65 Procedure code was incorrect. This payment reflects the correct code.

66 Blood Deductible.

67 Lifetime reserve days. (Handled in QTY, QTY01=LA)
Note: Inactive for 003040

68 DRG weight. (Handled in CLP12)
Note: Inactive for 003040

69 Day outlier amount.

70 Cost outlier - Adjustment to compensate for additional costs.
Note: Changed as of 6/01

71 Primary Payer amount.
Note: Deleted as of 6/00. Use code 23.

72 Coinsurance day. (Handled in QTY, QTY01=CD)
Note: Inactive for 003040

73 Administrative days.
Note: Inactive for 003050

74 Indirect Medical Education Adjustment.

75 Direct Medical Education Adjustment.

76 Disproportionate Share Adjustment.

77 Covered days. (Handled in QTY, QTY01=CA)
Note: Inactive for 003040

78 Non-Covered days/Room charge adjustment.

79 Cost Report days. (Handled in MIA15)
Note: Inactive for 003050

80 Outlier days. (Handled in QTY, QTY01=OU)
Note: Inactive for 003050

81 Discharges.
Note: Inactive for 003040

82 PIP days.
Note: Inactive for 003040

83 Total visits.
Note: Inactive for 003040

84 Capital Adjustment. (Handled in MIA)
Note: Inactive for 003050

85 Interest amount.

86 Statutory Adjustment.
Note: Inactive for 004010, since 6/98. Duplicative of code 45.

87 Transfer amount.

88 Adjustment amount represents collection against receivable created in prior overpayment.
Note: Inactive for 004050.

89 Professional fees removed from charges.

90 Ingredient cost adjustment.

91 Dispensing fee adjustment.

92 Claim Paid in full.
Note: Inactive for 003040

93 No Claim level Adjustments.
Note: Inactive for 004010, since 2/99. In 004010, CAS at the claim level is optional.

94 Processed in Excess of charges.

95 Benefits adjusted. Plan procedures not followed. Note: Changed as of 6/00

96 Non-covered charge(s).

97 Payment is included in the allowance for another service/procedure. Note: Changed as of 2/99

98 The hospital must file the Medicare claim for this inpatient non-physician service. Note: Inactive for 003040

99 Medicare Secondary Payer Adjustment Amount. Note: Inactive for 003040

100 Payment made to patient/insured/responsible party.

101 Predetermination: anticipated payment upon completion of services or claim adjudication. Note: Changed as of 2/99

102 Major Medical Adjustment.

103 Provider promotional discount (e.g., Senior citizen discount).
Note: Changed as of 6/01

104 Managed care withholding.

105 Tax withholding.

106 Patient payment option/election not in effect.

107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Note: Changed as of 6/03

108 Payment adjusted because rent/purchase guidelines were not met. Note: Changed as of 6/02

109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.

110 Billing date predates service date.

111 Not covered unless the provider accepts assignment.

112 Payment adjusted as not furnished directly to the patient and/or not documented.
Note: Changed as of 2/01

113 Payment denied because service/procedure was provided outside the United States or
as a result of war. Note: Changed as of 2/01; Inactive for version 004060. Use Codes 157, 158 or 159.

114 Procedure/product not approved by the Food and Drug Administration.

115 Payment adjusted as procedure postponed or canceled. Note: Changed as of 2/01

116 Payment denied. The advance indemnification notice signed by the patient did not
comply with requirements. Note: Changed as of 2/01

117 Payment adjusted because transportation is only covered to the closest facility that can provide the necessary care. Note: Changed as of 2/01

118 Charges reduced for ESRD network support.

119 Benefit maximum for this time period or occurrence has been reached. Note: Changed as of 2/04

120 Patient is covered by a managed care plan. Note: Inactive for 004030, since 6/99. Use code 24.

121 Indemnification adjustment.

122 Psychiatric reduction.

123 Payer refund due to overpayment.
Note: Inactive for 004030, since 6/99. Refer to implementation guide for proper handling of reversals.

124 Payer refund amount - not our patient. Note: Inactive for 004030, since 6/99. Refer to implementation guide for proper handling of reversals.

125 Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate.
Note: Changed as of 2/02

126 Deductible -- Major Medical
Note: New as of 2/97

127 Coinsurance -- Major Medical
Note: New as of 2/97

128 Newborn's services are covered in the mother's Allowance. Note: New as of 2/97




Alabama Medicaid Denial codes.

Explanation of Benefit (EOB) Codes EOB CODE EOB        DESCRIPTION       HIPAA ADJUSTMENT REASON CODE     HIPAA REMARK CODE

201 INVALID PAY-TO PROVIDER NUMBER 125 N280
202 BILLING PROVIDER ID IN INVALID FORMAT 125 N257
203 RECIPIENT I.D. NUMBER MISSING 31 N382
206 PRESCRIBING PROVIDER NUMBER NOT IN VALID FORMAT 16 N31
210 BRAND MEDICALLY NECESSARY INDICATOR INVALID 125
211 INVALID REFILL INDICATOR VALUE 16
212 MISSING PRESCRIPTION NUMBER 16 N388
215 DATE DISPENSED IS MISSING 16 N304
216 DATE DISPENSED IS INVALID 16 N304
217 MISSING DRUG CODE 16 M119
218 INVALID DRUG CODE 16 M119
219 QUANTITY DISPENSED IS MISSING 16 N378
220 QUANTITY DISPENSED IS INVALID 16 N378
223 MISSING DIAGNOSIS INDICATOR 16 M76
224 DIAGNOSIS TREATMENT INDICATOR INVALID 16 M76
225 REFERRING PROVIDER - INVALID FORMAT 16 N286
226 ANESTHESIA CLAIMS REQUIRE REFERRING PROVIDER 16 N286
228 CLAIMANT SIGNATURE MISSING 16 MA75
229 SOURCE OF ADMISSION MISSING 16 MA42
230 MISSING ATTENDING SURGEON PRESCRIBER NUMBER 16 N262
231 CLAIM WAS FILED WITHOUT SERVICING PROVIDER 16 N290
233 UNITS OF SERVICE MISSING 16 M53
234 PROCEDURE CODE MISSING 16 M51
235 PROCEDURE CODE NOT IN VALID FORMAT 16 M51
238 RECIPIENT NAME IS MISSING 16 MA36
239 DETAIL TO DATE OF SERVICE IS MISSING 16 M59
240 THE DETAIL "TO" DATE IS INVALID 16 M59

For Full list, go to the below Medicaid site.


http://medicaid.alabama.gov/documents/6.0_providers/6.7_manuals/6.7.2_provider_manuals_2010/6.7.2.1_january_2010/6.7.2.1_jan10_j.pdf





Top 50 Billing Error Reason Codes With Common Resolutions 

 On the following Link you will find the top 50 Error Reason Codes with Common Resolutions for denied claims at Virginia Medicaid. This list has been provided to assist you with resolving these denied claims prior to calling the Helpline. Please print and post this list within your office for easy reference and use. Whenever you are advised to contact the Helpline or MediCall please access the following telephone numbers.

http://www.dmas.virginia.gov/Content_atchs/cb/cb6.pdf


LOUISIANA MEDICAID Denial Code

ERROR CORE  SHORT DESCRIPTION LONG DESCRIPTION    GRP RSN CODE CODE     CLAIM STATUS    ADJ REMARK  CODE
----------------------------------------------------------------------------------------------------------------------------------

 001 INVALID CLM TYP MOD INVALID CLAIM TYPE MODIFIER 2 16 N34 021
 002 INVALID PROVIDER NO PROVIDER NUMBER MISSING OR NOT NUMERIC 2 16 N77 021 153
 003 RECIPIENT # INVALID RECIPIENT NUMBER INVALID OR LESS THAN 13 DIGITS 3 31 021 153
 005 INVAL SERV FROM DATE SERVICE FROM DATE MISSING/INVALID 2 16 M52 021 188
 006 INVAL SERV THRU DATE INVALID OR MISSING THRU DATE 2 16 M59 021 188
 007 SERV THRU LT SERV FM SERVICE THRU DATE LESS THAN SERVICE FROM DATE 2 16 MA31 021 188
 008 SERV FRM GT ENTR DTE SERVICE FROM DATE LATER THAN DATE PROCESSED 2 110 021 188
 009 SERV THR GT ENTR DTE SERVICE THRU DATE GREATER THAN DATE OF ENTRY 2 16 MA31 021 188
 010 INV PRIOR AUTH DATE PRIOR AUTHORIZATION DATE NOT NUMERIC 133 252
 011 INVALID TPL INDICATR TPL INDICATOR NOT Y, N, OR SPACE 2 16 MA92 021 361
 012 ORG CLM W/ADJ/VD CDE ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID REASON CODE 2 16 MA30 021 521
 013 ORG CLM W ADJ/VD ICN ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID ICN 2 16 MA30 021 584
 014 IMM COMPL MISS/INVLD IMMUN COMPLETE AND CURRENT FOR THIS AGE PATIENT MISSING 133 021 331 564
 015 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 N305 365
 016 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 N305 365
 017 NOT USED - AVAILABLE NOT USED - AVAILABLE 133 021 564
 020 INVAL/MISS DIAG CODE INVALID OR MISSING DIAGNOSIS CODE 2 16 MA63 255
 021 INVALID FORMER REFNO FORMER REFERENCE NUMBER MISSING OR INVALID 2 16 M47 464
 022 INVALID BILLED CHRGS BILLED CHARGES MISSING OR NOT NUMERIC 2 16 M79 178
 023 INV PARTIAL RECIP RECIPIENT NAME IS MISSING 2 16 MA36 021 504
 024 INV BILLING PROV NO BILLING PROVIDER NUMBER NOT NUMERIC 2 16 N257 021 153
 025 IMM NOT COMP RSN MIS IMMUN NOT COMPLETE AND CURRENT REASON CODE MISSING 133 021 331 564
 026 INVALID TOT DOC CHG TOTAL DOCUMENT CHARGE MISSING OR NOT NUMERIC 2 16 M54 178
 027 PROC NEEDS DOCUMENT. PROCEDURE CODE NOT SUBSTANTIATED BY DOCUMENT 3 150 294 287
 028 INVAL/MISS PROC CODE INVALID OR MISSING PROCEDURE CODE 2 16 M51 454
 029 SERV MORE THAN 12 MO SERVICE MORE THAN 12 MONTHS OLD 3 29 263
 030 SERV THRU DT TOO OLD SERV THRU DATE MORE THAN TWO YEARS OLD 3 29 187
 031 NOT EMC ELIGIBLE PROVIDER NOT APPROVED FOR EMC BY STATE OFS 3 95 496
 032 EOB/CARR.CD MISMATCH EOB(S) ATTACHED/CARRIER CODE DOES NOT MATCH 1 251 N4 286
 033 NEED EOB-CARR/RECIP. NEED EOB FOR EACH CARRIER INDICATED ON RESOURCE FILE 1 251 N4 286
 034 22 MOD.NOT JUSTIFIED 22 MOD.SERVICES NOT JUSTIFIED/PAID AT UNMODIFIED RATE 3 150 047
 035 REBILL CORRECT HCPC ASC,OP FAC/PHYS.BILLED DIFF CODE;REBILL CORRECT HCPC 2 16 M20 454
 037 MEDICARE ADJUSTMENT MEDICARE ADJUSTMENT/VOID,ADJUST OR ADJUST MEDICARE CLAI 1 252 N4 101
 038 99297-52 NICU REDUCE 99297-52 NICU PAID AT REDUCED RATE 3 150 628
 039 MOD.NOT USED FOR CLM MODIFIER NOT USED TO PROCESS CLAIM 2 4 N519 453
 040 INV ADMISSION DATE ADMISSION DATE MISSING OR INVALID 2 16 MA40 189
 042 INVALID UB92 BILL CD INVALID UB92 TYPE BILL CODE 2 16 MA30 228
 043 INV ATTENDING PHYS ATTENDING PHYSICIAN NUMBER NOT NUMERIC 2 16 N290 132
 044 INV NATURE OF ADMIT NATURE OF ADMISSION MISSING OR INVALID 2 16 MA41 231
 045 INV PATIENT STATUS PATIENT STATUS CODE INVALID OR MISSING 2 16 MA43 021 431
 046 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 M59 021 387
 047 NOT USED - AVAILABLE NOT USED - AVAILABLE 2 16 M59 021 387
 048 INVALID/MISS PROC INVALID OR MISSING PROCEDURE CODE 2 16 M51 021 454
 049 INV/CONFLIC SURG DTE INVALID/CONFLICT SURGICAL DATE 2 16 N301 021 666
 050 INV BLOOD NOT REPL BLOOD NOT REPLACED AMOUNT INVALID 133 021 236
 051 INV BLOOD/PINT CHG BLOOD CHARGE PER PINT INVALID 133 021 235
 052 >12 MONTH QTY LIMIT > 12 MONTH QTY LIMIT MD FAX OVERRIDE FORM 866-797-2329 3 198 N351



EOB EFFDATE EOB DESCRIPTION
---- ---------- -------------------------------------------------------------------------------
0001 19910101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON SOME DATES OF SERVICE

0002 19900101 BILLING PROVIDER NUMBER MISSING OR INVALID

0003 19900101 RECIPIENT NUMBER MISSING OR INVALID

0004 19900101 PROCEDURE INCLUDED IN COMBINED PROCEDURE

0005 19900101 DOCUMENT CONTROL NUMBER IS MISSING OR INVALID

0006 19900101 SERVICE FROM DATE IS MISSING OR INVALID

0007 19900101 SERVICE THRU DATE IS MISSING OR INVALID

0008 19900101 SERVICE "TO" DATE LESS THAN SERVICE "FROM" DATE

0009 19900101 EXCEEDS ONE B-12 INJECTION MONTHLY

0010 19900101 SERVICE DATE GREATER THAN DATE OF RECEIPT

0011 19900101 MATERNITY CLINIC/PHY CONFLICT FOR PRENATAL SERVICE

0012 19900101 TOTAL TPL AMOUNT IS INVALID

0013 19910101 TPL INDICATOR/AMOUNT CONFLICT

0014 19900101 RELATED CAUSE CODE IS INVALID

0015 19900101 ACCIDENT INDICATOR IS INVALID

0016 19900101 FROM DATE OF SERVICE LESS THAN JULY 1, 1996

0017 19910101 PROVIDER SPECIALTY MISMATCH

0018 19900101 DIAGNOSIS CODE IS MISSING OR INVALID

0019 19900101 MUST SPECIFY QUADRANT(Q1,Q2,Q3,Q4)

0020 19900101 YEARLY LIMIT FOR EYE GLASSES EXCEEDED

0021 19900101 MCO/BHO FORMER ICN NON-MATCH FOR VOID/ADJUSTMENT

0022 19900101 BILLED CHARGES MISSING OR INVALID

0023 19900101 PATIENT NAME IS MISSING

0024 19900101 UNITS OF SERVICE OR DAYS COVERED MISSING OR INVALID

0025 19900101 THE UNITS OF SERVICE ARE LESS THAN DAYS BILLED

0026 19900101 EXCEEDS EPSDT CLINIC LIMITS

0027 19900101 EXCEEDS OB ULTRASOUND LIMIT FOR 9 MONTHS

0028 19900101 PROCEDURE CODE OR NDC IS MISSING OR INVALID

0029 19900101 ATTENDING PHYSICIAN/DMRS FACILITY INVALID OR MISSING

0030 19900101 SAME SERV WITH 91/92 HCPC HAS BEEN PAID THIS DATE

0031 19900101 EXCEPTION CODE 031

0032 19900101 MAXIMUM RENTAL PAYMENT

0033 19900101 NO VALID INDEX RATE ON FILE FOR ASC PROVIDER

0034 19900101 SERVICE DATE GREATER THAN DATE OF SYS GEN ICN
0035 19900101 THE 2 PHY VISIT PER MONTH LIMIT HAS BEEN EXCEEDED

0036 19900101 ADD'L HOURS OF TESTING REQUIRE PRIOR AUTHORIZATION

0037 19900101 MAXIMUM PAYMENT MADE

0038 19900101 EXCEEDS OXYGEN LIMITSONE PER MONTH

0039 19910101 FORMER ICN OR MCC ICN IS NOT FOUND FOR VOID/REPLACEMENT

0040 19900101 TOTAL CALCULATED NON-COVERED CHARGES NOT EQUAL TOTAL AS REPORTED

0041 19910101 ACCOMODATION REVENUE CODES NOT ALLOWED

0042 19900101 REVENUE CHARGE MISSING OR INVALID

0043 19900101 ADMISSION DATE INVALID OR MISSING

0044 19900101 PATIENT STATUS CODE IS MISSING OR INVALID


0045 19900101 SURGERY DATE IS INVALID/MISSING

0046 19900101 COVERED DAYS AND FROM/THRU DAYS ARE NOT EQUAL.

0047 19900101 COVERED DAYS ARE MISSING OR INVALID


0048 19900101 REVENUE CODE IS MISSING OR INVALID

0049 19900101 SOURCE OF ADMISSION IS INVALID OR MISSING

0050 19900101 EXCEPTION CODE 050

0051 19900101 ACCOMMODATION DAYS DO NOT EQUAL TOTAL COVERED DAYS


0052 19900101 HOUR OF ADMISSION IS INVALID OR MISSING

0053 19900101 DATE OF DISCHARGE IS INVALID OR MISSING

0054 19900101 ADMITTING PHYSICIAN INVALID OR MISSING

0055 19900101 TIME OF DISCHARGE IS INVALID OR MISSING

0056 19900101 TYPE OF BILL IS INVALID OR MISSING

0057 19900101 TYPE OF ADMISSION IS INVALID OR MISSING

0058 19900101 INVALID CONDITION CODE

0059 19900101 INVALID NON-COVERED DAYS

0060 19900101 EXCEPTION CODE 060

0061 19900101 OCCURRENCE CODE/DATE IS MISSING OR INVALID

0062 19900101 EXCEPTION CODE 062

0063 19900101 EXCEPTION CODE 063

0064 19900101 EXCEPTION CODE 064

0065 19900101 ACCOMMODATION REVENUE CODE NOT ENTERED FIRST


0066 19900101 EXCEPTION CODE 066

0067 19900101 REVENUE UNITS/MILEAGE ARE INVALID OR MISSING

0068 19900101 TOTAL CHARGE IS MISSING OR INVALID

0069 19900101 DATE OF BIRTH INVALID OR MISSING

0070 19910101 PAID DATE IS INVALID OR MISSING

0071 19900101 PATIENT SEX NOT EQUAL M OR F OR U

0072 19900101 PREVIOUSLY PAID VISUAL EXAM IN 12 MONTHS

0073 19910101 INPATIENT PART B ONLY CHARGE MISSING

0074 19900101 SERVICES NOT COVERED FOR QMB/SLMB RECIPIENTS

0075 19900101 EXCEPTION CODE 075

0076 19900101 EXCEEDS YEARLY FAMILY PLANNING EXAM LIMIT

0077 19900101 MEDICARE CROSSOVER - BILL TENNCARE DIRECTLY

0078 19900101 PREVIOUSLY PAID ONE VISIT ON THIS DAY

0079 19900101 PAY STATUS NOT EQUAL TO PAY OR DENY

0080 19900101 PREVIOUSLY PAID AUDITORY EXAM IN 12 MONTHS

0081 19900101 CHILDRENS DAYS EXCEEDED

0082 19900101 CHILDRENS DAYS EXHAUSTED

0083 19900101 CHILDRENS VISITS EXCEEDED

0084 19900101 CHILDRENS VISITS EXHAUSTED

0085 19900101 CHILDREN DAYS EXCEEDED FOR FISCAL YEAR PA REQUIRED

0086 19900101 CHILDREN DAYS EXCEEDED FOR FISCAL YEAR PA REQUIRED

0087 19910101 HOSPITAL PAYMENTS NOT ALLWED FOR PRESUMPTIVE ELIGIBLES


0088 19900101 EXCEPTION CODE 088

0089 19900101 EXCEPTION CODE 089

0090 19900101 PCS - 1500

0092 19900101 ALIEN-NO REQUEST FOR AUTHORIZATION RECEIVED

0094 19910101 EMERGENCY TREATMENT CODE NOT BILLED

0095 19900101 ANESTHESIA-INVALID OR EXCESSIVE HOURS/MINUTES

0096 19000101 NON-COVERED DAYS CANNOT BE PAID


0098 19900101 HCBW WAIVER HAS DENY/SUSPEND EDIT

0099 19910101 PHARMACIST LICENSE NUMBER MISSING OR INVALID

0100 19900101 KEYING VERIFICATION

0101 19900101 ADP WAIVER HAS DENY/SUSP EDIT

0103 19910101 PLACE OF SERVICE MISSING OR INVALID

0104 19900101 PROCEDURE CODE MODIFIER IS MISSING OR INVALID

0105 19900101 INVALID DIAGNOSIS FOR PROCEDURE

0106 19910101 FAMILY PLANNING CLINIC CODE IS INVALID OR MISSING


0107 19900101 DMRS FACILITY INVALID/MISSING/NOT ELIGIBLE ON DOS

0112 19900101 MISSING TOTAL CHARGE FOR NURSING HOME CLAIMS

0114 19900101 OUTPT HSP PRIOR TO 12/01/99-SUSPEND FOR REVIEW

0117 19900101 INVALID OR MISSING TOOTH CODE OR TOOTH NUMBER


0118 19900101 INVALID SURFACE CODE

0119 19900101 INVALID EMERGENCY INDICATOR

0120 19900101 VISIT PAID IN NORMAL SURGERY FOLLOW-UP PERIOD

0121 19900101 PRESCRIBING PHYSICIAN DEA NUMBER MISSING OR INVALID

0122 19900101 INVALID/MISSING PROVIDER CHECK-DIGIT NUMBER

0123 19900101 NATIONAL DRUG UNITS ARE MISSING OR INVALID


0124 19900101 MISSING FIRST DATE OF SERVICE ON CLAIM

0125 19900101 PRESCRIPTION NUMBER MISSING


0126 19900101 FIRST DATE OF SERV GREATER THAN LAST DATE OF SERV

0127 19900101 ESTIMATED DAYS SUPPLY INVALID


0128 19900101 REFILL CODE MUST BE 00 THROUGH 99

0130 19900101 MCO/BHO TOTAL ALLOWED AMOUNT INVALID

0131 19900101 UNITS EXCEED PROGRAM MAXIMUM FOR HCBS CODE


0132 19900101 MISSING TOTAL CLAIM CHARGE

0133 19900101 INVALID TOTAL CLAIM CHARGE

0134 19900101 INVALID NET CLAIM CHARGE

0136 19900101 REVENUE CODE IS INVALID/NOT ON FILE

0138 19900101 INVALID HCBS TYPE-2 FACILITY NUMBER

0140 19900101 HCPC CODE IS INVALID FOR REVENUE CODE


0142 19900201 1 YR TIMELY FILE HAS BEEN OVERRIDDEN-TF ATTACHED

0143 19900101 REFILLS EXHAUSTED

0144 19900101 INVALID REFILL INDICATOR VALUE

0146 19900101 HCPC/REVENUE CODE MISSING

0148 19900101 PROCEDURE NOT PAYABLE THIS RECIPIENT

0149 19900101 PROC REQUIRES REVIEW FOR RECIPIENT

0150 19900101 MCO/BHO TOTAL PAYMENT IS INVALID OR MISSING

0151 19900101 MISSING PRESCRIBING PROVIDER NUMBER

0152 19900101 MISSING DRUG CODE

0153 19900101 INVALID DRUG CODE

0154 19900101 MISSING PRESCRIPTION NUMBER

0155 19910101 THRU DATE DISAGREES WITH PATIENT STATUS

0156 19900101 MISSING DAYS SUPPLY

0157 19900101 COVERED + NON-COVERED DAYS DOES NOT EQUAL TOTAL DAYS/UNITS BILLED

0158 19900101 ADMIT DATE GREATER THAN FROM DOS

0159 19910101 CLAIM PREVIOUSLY DENIED FOR INVALID PROCEDURE

0160 19900101 ADMIT DATE IS INVALID

0161 19900101 ADMISSION CODE INVALID

0162 19900101 DETAIL SVC DATES INCONSISTENT WITH HEADER DATES

0163 19900101 MISSING DIAGNOSIS CODE

0165 19900101 TOTAL DAYS MISSING OR INVALID

0167 19900101 PATIENT STATUS INVALID OR MISSING

0168 19900101 THERAPEUTIC LEAVE DAYS INVALID

0169 19900101 HOSPITAL LEAVE DAYS INVALID

0170 19910101 NON-COVERED DAYS INVALID

0171 19900101 PHYSICIAN CERTIFICATION DATE IS MISSING OR INVALID

0172 19900101 PHYSICIAN VISIT DATE IS INVALID OR MISSING

0173 19900101 TIME OF DEATH IS INVALID OR MISSING

0174 19910101 VOID PER POLICY REVIEW

0175 19910101 INVALID COVERED DAYS

0176 19910101 INVALID CHARGE BILLED TO MEDICARE

0177 19900101 MEDICARE ALLOWED AMOUNT INVALID OR MISSING

0178 19900101 MEDICARE PAID AMOUNT IS NOT NUMERIC

0179 19900101 DEDUCTIBLE AMOUNT IS MISSING OR INVALID

0180 19900101 BLOOD DEDUCTIBLE AMOUNT INVALID

0181 19900101 COINSURANCE AMOUNT IS MISSING OR INVALID

0182 19900101 PART-A COINSURANCE GREATER MEDICARE PAID AMT

0183 19900101 CASH DEDUCT+ BLOOD DEDUCT+ COINSURANCE MUST NOT EXCEED (MEDICARE ALLOWED - MEDI

0184 19900101 MEDICARE PAID DATE IS AFTER THE ICN DATE

0185 19900101 MEDICARE PAID DATE MISSING OR INVALID

0186 19910101 CROSSOVER CLAIM BILLED INCORRECTLY

0187 19900101 PROCEDURE NOT PAYABLE THIS RECIPIENT

0188 19900101 DIAGNOSIS CODE NOT COVERED BY MEDICAID FOR DATE OF SERVICE

0189 19900101 PROCEDURE REQUIRES MEDICAL REVIEW

0190 19910101 EXCEEDS ALLOWED AMOUNT FOR CALENDAR YEAR

0191 19900101 REIMBURSEMENT REFLECTS LESS THAN A FULL WEEK FOR MEGAVOLTAGE TREATMENT

0192 19900101 TOTAL DAYS ON CLAIM CONFLICT WITH DATES SHOWN

0193 19910101 NO HCBS CODE ENTERED

0194 19900101 AGE IS NOT COVERED INPATIENT PSYCHIATRIC SERVICES

0196 19900101 MISSING ADMISSION DATE

0198 19900101 MISSING ATTENDING SURGEON PRESCRIBER NUMBER

0199 19900101 REFERRING PROVIDER CANNOT BE BILLING PROVIDER

0200 19910101 PROVIDER NOT ON FILE

0201 19900101 PROCEDURE CODE IS NOT IN THE SCOPE OF PROGRAM

0202 19900101 PROVIDER INELIGIBILE FOR SUBMITTING THIS CLAIM TYPE

0203 19900101 PROVIDER NAME/NUMBER MISMATCH

0204 19900101 REBILL FOR PROVIDER ELIGIBLE DAYS ONLY

0205 19900101 PATIENT NOT CERTIFIED


0206 19910101 DATE OF SERVICE SPAN PROVIDER FISCAL YEAR

0207 19900101 RENDERING PROVIDER ON PREPAYMENT REVIEW

0208 19900101 BILLING PROVIDER IS AN OUT OF STATE PROVIDER

0209 19900101 INVALID DESTINATION

0210 19900101 FACILITY PROVIDER SERVICE LOCATION IS MISSING


0211 19900101 SERVICING PROVIDER MISSING/INVALID OR NOT DIFFERENT FROM BILLING PROVIDER

0212 19910101 SERVICING PROVIDER NOT ON FILE

0213 19000101 PREGNANCY INDICATOR INVALID

0214 19910101 ENROLLEE NOT ELIGIBLE FOR MCC/BHO ON DATES OF SERVICE

0215 19910101 MEDICAID RECORDS INDICATE THAT THIS RECIPIENT HAS NOT BEEN APPROVED FOR MEDICAI

0216 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID

0217 19910101 RECIPIENT NOT ELIGIBLE ON DATES OF SERVICE-ATTACHMENT PRESENT

0218 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON DATE(S) OF SERVICE

0219 19900101 RECIPIENT NOT ELIGIBLE FOR MEDICAID ON SOME DATES OF SERVICE

0220 19910101 RECIPIENT NOT ELIGIBLE FOR SOME DATES OF SERVICE

0221 19900110 RECIPIENT NAME MISMATCH - ATTACHMENT PRESENT

0222 19900101 RECIPIENT NAME DOES NOT MATCH TENNCARE NUMBER

0223 19910101 RECIPIENT NOT ELIGIBLE FOR DATES OF SERVICE - RECYCLED

0224 19900101 INVALID OCCURRENCE DATE

0225 19900101 RECIPIENT DATE OF DEATH IS PRIOR TO DATE OF SERVICE

0226 19900101 RECIPIENT ON REVIEW

0227 19900101 EXCEPTION CODE 227

0228 19900101 MISSING MEDICARE PAID DATE

0229 19900101 RECIPIENT MEDICAID PLUS MEMBER. CONTACT PHYS ON ID CARD FOR APPROVAL

0230 19900101 NO CROSSOVER COINSURANCE OR DEDUCTIBLE DUE

0231 19910101 PROVIDER PROCEDURE RESTRICTIONS

0232 19900101 PROCEDURE/MODIFIER OR DRUG CODE NOT ON PROCEDURE/FORMULARY FILE

0233 19900101 PROCEDURE/NDC NOT COVERED BY MEDICAID FOR DATE OF SERVICE

0234 19900101 PROCEDURE/FORMULARY AGE RESTRICTION

0235 19900101 PROCEDURE/FORMULARY SEX RESTRICTION

0236 19900101 PROCEDURE/FORMULARY PLACE OF SERVICE RESTRICTION

0237 19900101 PROCEDURE/FORMULARY PROVIDER SPECIALTY RESTRICTION

0238 19900101 ITEMIZED SERVICE DATE NOT IN ELIGIBILITY SPAN

0239 19900101 INVALID OCCURRENCE SPAN CODE

0240 19900101 PROCEDURE/FORMULARY DIAGNOSIS RESTRICTION

0241 19900101 PRICING FILE HAS NO VALID PRICE OR PERCENTAGE OR PER DIEM FOR DOS

0242 19900101 MISSING OCCURRENCE CODE

0243 19910101 PROVIDER NOT CERTIFIED FOR PROCEDURE

0244 19900101 INVALID PAY-TO PROVIDER NUMBER

0251 19910101 RECIPIENT HAS THIRD PARTY RESOURCES - ATTACHMENT PRESENT

0252 19910101 ADMITTING DIANOSIS CODE IS INVALID/NOT ON FILE

0253 19900101 DIAGNOSIS DATE RESTRICTION

0254 19900101 DIAGNOSIS AGE RESTRICTION

0255 19900101 DIAGNOSIS SEX RESTRICTION

0256 19900101 DIAGNOSIS FILE PROCEDURE RESTRICTION


0257 19900101 THIS DIAGNOSIS REQUIRES MEDICAL REVIEW

0258 19900101 RECIPIENT IS NOT ON ELIGIBILITY FILE

0259 19900101 CROSSOVER CLAIM EXCEEDS FILING TIME LIMIT - RESUBMIT WITH PROOF OF TIMELY FILIN

0260 19900101 SLIMB ONLY/NO MEDICAL ELIGIBILITY

0261 19900101 CATEGORY OF SERVICE CANNOT BE DERIVED

0262 19910101 TPL AMOUNT APPEARS TO BE INSUFFICIENT. PLEASE VERIFY

0263 19900101 TPL - RECIPIENT HAS THIRD PARTY RESOURCES

0264 19900101 RECIP IS MEDICARE PART A ELIGIBLE

0265 19900101 RECIP IS MEDICARE PART B ELIGIBLE

0266 19900101 REFERRING PHYSICIAN NUMBER IS MISSING

0267 19000101 HOSPICE XOVER CLAIM SUPER-SUSPEND FOR REVIEW

0268 19900101 CLAIM EXCEEDS FILING TIME LIMIT- RESUBMIT WITH PROOF OF TIMELY FILING

0269 19900101 CLAIM SPANS CALENDAR YEAR

0270 19900101 CLAIM SPANS STATE FISCAL YEAR

0271 19900101 RECIPIENT IS NOT ELIGIBLE ON SERVICE DATE

0272 19900101 ITEMIZED SERVICE DATE NOT IN ELIGIBILITY SPAN

0273 19900101 SUSPENDED FOR RECIPIENT REVIEW

0274 19910101 TOTAL BILLED NOT EQUAL SUM OF ALL LINE CHARGES

0276 19900101 NEWBORN-HCA REVIEW

0277 19900101 LTC ELIGIBILITY ERROR

0278 19900101 DISCHARGE DTE UNEQ TO LTC ELIG

0279 19910101 INVALID LAB PROCEDURE CODE

0281 19900101 PEND FOR MANUAL PRICING

0282 19900101 PHYSICIAN AUDITOR REVIEW-MODIFIER 24

0283 19910101 MANUAL PRICE EXCEEDS ALLOWABLE BUT IS LESS THAN BILLED CHARGE

0284 19910101 MANUAL PRICE EXCEEDS BILLED CHARGES

0285 19910101 UNLISTED PROCEDURE

0287 19910101 STER/HYST/ABOR CONSENT INDICATOR IS MISSING OR INVALID

0288 19910101 PROCEDURE NOT COVERED BY MEDICAID


0289 19910101 JUSTIFICATION OF MEDICAL NECESSITY REQUIRED

0290 19900101 PROCEDURE IS NOT IN THE SCOPE OF THE PROGRAM

0291 19900101 PROCEDURE REQUIRES MEDICAL REVIEW


0292 19900101 PROCEDURE REQUIRES PRIOR AUTHORIZATION

0293 19000101 INCOMP. DOC. AND OR MISSING W9. PLS CONTACT PROV. INQ. AT 1-800-852-2683

0294 19900101 SERVICE NOT COVERED BY MEDICAID

0295 19910101 RECIPIENT HAS TPL RESOURCES BUT NO TYPE OF COVERAGE ON FILE


0296 19910101 CONTACT PARENT FOR PAYMENT

0297 19900101 PAY TO PROVIDER NOT ELIG FOR PAY-THIS DATE OF SERV

0298 19900101 PROVIDER NUMBER IS A GROUP NUMBER

0299 19910101 PEND FOR REVIEW OF MULTIPLE SURGERY

0300 19900101 NO PROVIDER MASTER RECORD

0301 19910101 FRI/SAT ADMISSION DENIED - JUSTIFICATION REQUIRED

0302 19900101 REVENUE CODE NON APPLICABLE FOR MEDICAID

0303 19910101 REVENUE CODE INVALID

0304 19900101 PROVIDER INELIGIBLE ON SERVICE DATE

0305 19910101 VISIT CODE CANNOT BE ALLOWED ON SAME DAY AS CONSULT

0306 19900101 PAY TO PROVIDER IS SUSPENDED

0307 19900101 BILLING OUT OF CLIA CERTIFICATE TYPE

0308 19900101 NO PAY-TO PROVIDER RECORD

0309 19900101 REVIEW CLAIM FOR PAY-TO- PROVIDER

0310 19910101 INPATIENT PSYCHIATRIC AGE RESTRICTION

0311 19910101 AMBULANCE SERVICES BILLED ON OUTPATIENT ENCOUNTER NOT JUSTIFIED

0312 19900101 PAY-TO PROVIDER NOT ENROLLED

0313 19900101 DIAGNOSIS CODE IN SEQUENCE 5TH-24TH INVALID OR NOT ON FILE

0314 19900101 SURGICAL PROCEDURE CODE NOT FOUND

0315 19910101 PEND FOR REVIEW OF GLOBAL SURGERY

0316 19900101 MCC ICN MISSING FROM CLAIM


0317 19900101 INVALID/MISSING MODIFIER FOR THIS PROCEDURE

0318 19900101 DATE OF BIRTH AFTER THE DATE OF SERVICE

0321 19900101 PROCEDURE CODE IS NO LONGER VALID

0322 19900101 DATE OF SERVICE BEFORE PROCEDURE IS PAYABLE

0323 19910101 DATES OF SERVICE SPAN PROVIDER PRICING SEGMENT (NO RATE ON FILE FOR DATES OF SE

0324 19900101 INVALID RECIPIENT SEX FOR THIS DIAGNOSIS

0326 19910101 SURG PROCEDURE CODE IS REQUIRED WITH OPERATING ROOM CHARGES

0328 19900101 PROCEDURE NOT IN SCOPE OF PROGRAM FOR THIS AGE

0329 19900101 INVALID RECIPIENT SEX FOR THIS PROCEDURE

0330 19910101 FACILITY NOT QUALIFIED FOR LEVEL OF CARE BILLED

0331 19900101 NO PAE AVAILABLE FOR RECIPIENT ADMISSION

0332 19900101 INVALID PROVIDER TYPE FOR THIS PROCEDURE

0333 19910101 LOC NOT AUTHORIZED BY PAE

0334 19900101 NO PATIENT LIABILITY IN EFFECT FOR DATE OF SERVICE

0335 19910101 PATIENT LIABILITY EXCEEDS OR EQUALS ALLOWED AMOUNT

0336 19900101 REFILLS ARE NOT ALLOWED FOR NARCOTIC DRUGS

0337 19910101 D AND C PAYMENT INCLUDED WITH HYSTERECTOMY

0338 19900101 PATIENT LIABILITY CHANGED DURING MONTH

0339 19900101 RECIPIENT CHANGES PATIENT STATUS AFTER HE IS DISCHARGED OR TRANSFERED

0340 19910101 REPROCESSED CLAIM - PAID INCORRECT PER DIEM ON RA 07/21/89

0341 19910101 VOID OF CLAIMS PREVIOUSLY PRICED/PROCESSED INCORRECTLY

0342 19900101 THIS DIAGNOSIS REQUIRES MEDICAL REVIEW

0345 19900101 ATTENDING PROVIDER NOT FOUND

0346 19900101 PHYSICIAN VISIT MUST NOT BE MORE THAN 365 DAYS NO GRACE PERIOD IS GIVEN ON THES

0347 19000101 PHYSICIAN CERTIFICATION DATE EXCEEDS ALLOWABLE DAYS

0348 19900101 PHYSICIAN CERTIFICATION DATE MUST MEET FEDERAL GUIDELINES

0349 19900101 PHYSICIAN RECERTIFICATION DATE EXCEEDS ALLOWABLE DAYS

0350 19000101 THE NUMBER OF DETAILS IS NOT EQUAL TO THE SUBMITTED DETAIL COUNT

0351 19900101 SUBMITTED TO ALLOWED EXCEEDS PERCENT

0352 19900101 ALLOWED TO SUBMITTED EXCEEDS PERCENT

0353 19900101 SPECIALTY REQUIRES/EXCLUDES SPECIFIC MODIFIER

0354 19900101 THIS LAB NOT CERTIFIED TO PROVIDE THIS SERVICE

0356 19900101 PROCEDURE DELETED FROM CPT/HCPS. REFER TO CPT/HCPCS FOR CURRENT CODE

0357 19900101 THIS DRUG REQUIRES PRIOR AUTHORIZATION

0358 19900101 INACTIVE DRUG

0359 19900101 NATIONAL SUPPLIER PROVIDER NUMBER NOT ON FILE, CONTACT MEDICAID

0360 19900101 THIS NATIONAL DRUG CODE IS NOT ON FILE

0361 19910101 ASST. SURGEON NOT MEDICALLY NECESSARY OR JUSTIFIED

0362 19900101 MEDICARE DEDUCTIBLE GREATER THAN MAXIMUM

0363 19910101 ROUTINE PHYSICIAN EXAM NOT COVERED EXCEPT UNDER EPSDT

0365 19910101 PROCEDURE REQUIRES PRIMARY TOOTH CODE(S)

0366 19910101 PROCEDURE REQUIRES PERMANENT TOOTH CODE(S)

0367 19910101 PROCEDURE FILE INDICATES SURFACE CODES(S) REQUIRED

0368 19910101 PROCEDURE/FORMULARY INDICATES TOOTH CODE REQUIRED

0369 19910101 SEALANTS NOT COVERED ON PRIMARY TEETH

0370 19910101 ACCIDENT INDICATOR MISSING OR INVALID

0371 19900101 THIS DIAGNOSIS REQUIRES ADDITIONAL DOCUMENTATION

0372 19900101 ITEM NOT PAYABLE IN LONG TERM CARE FACILITY

0374 19900101 MISSING PRESCRIBER PROVIDER ON DEALER CLAIM

0375 19900101 SERVICE NOT ON EXPLANTION OF MEDICARE PAYMENTS

0377 19900101 RECIPIENT IS INELIGIBLE FOR THIS DRUG

0379 19900101 PROCEDURE CODE MODIFIER REQUIRES MANUAL REVIEW

0383 19900101 MULTIPLE SURGERY REQUIRES REVIEW

0385 19900101 REVENUE CODE NOT ON FILE

0386 19000101 CARRIER CODE INVALID

0387 19000101 ADJ REASON CD 22/23 MISSING/INVALID OR TPL INVALID

0388 19910101 SERVICES OF THIS PROVIDER NOT COVERED BY MEDICAID

0389 19900101 THIS MODIFIER IS ALLOWED FOR CRNA ONLY

0390 19900101 MULTIPLE EXTRACTION REQUIRES APPROPRIATE PROC CODE

0391 19900101 INVALID USE OF E DIAGNOSIS CODE

0392 19910101 UNITS BILLED GREATER THAN COVERED DAYS

0394 19900101 VERIFY RECIPIENTS TPL

0396 19900101 LOC ON CLAIM CONFLICTS WITH LOC ON FILE

0397 19900101 INVALID LTC TERMINATION CODE

0399 19900101 REFERRING PROVIDER I.D. # IS NOT IN A VALID FORMAT

0400 19900101 INVALID LOC DAYS

0401 19900101 INVALID LEAVE DAYS

0402 19900101 INVALID TYPE OF LEAVE

0406 19900101 LTC LEAVE DATES CONFLICT

0407 19900101 THERAPEUTIC DAYS GT THAN 14

0410 19900101 PA IS REQUIRED

0412 19900101 EXCEPTION CODE 412

0413 19900101 LTC BLOCK 13:TOTAL DAYS DO NOT EQUAL FROM/TO DAYS

0414 19900101 WAIVER SERVICES LONG TERM CARE CONFLICT

0416 19900101 AMB SERVICES ORIGIN TO DESTINATION NOT IN SCOPE

0417 19900101 REVIEW AMBULANCE NON ROUTINE DESTINATION

0420 19900101 THIS DRUG NOT PAYABLE FOR RECIPIENT AGE

0421 19900101 THIS DRUG NOT PAYABLE FOR RECIPIENT SEX

0425 19900101 THIS PROCEDURE MUST BE BILLED SEPARATELY EACH DATE

0430 19900101 LTC INVALID RECIP ID NUMBER

0431 19900101 LTC NO PROV MASTER RECORD

0433 19900101 LTC MISSING PROVIDER NUMBER

0434 19900101 LTC INVALID PROV NUM CK-DIGIT

0435 19900101 LTC FIRST DATE OF SERVICE MISSING

0436 19900101 LTC FILING DEADLINE EXCEEDED

0437 19900101 LTC FIRST DATE GREATER LAST DATE

0438 19900101 LTC RECHECK SERVICE DATE

0439 19900101 COINSURANCE NOT A MULTIPLE OF THE MEDICARE DAILY RATE

0443 19900101 LTC RECIP NOT ON ELIG FILE

0444 19900101 LTC RECIPIENT INELIGIBLE ON SERVICE DATES

0445 19900101 LTC RECIPIENT NOT ELIGIBLE ON SERVICE DATES

0446 19900101 LTC RECIP SUSPEND FOR REVIEW

0447 19910101 LIMIT OF 15 HOSPITAL LEAVE DAYS PER HOSPITALIZATION EXCEEDED

0448 19900101 LTC PROVIDER IS INELIGIBLE ON SERVICE DATES

0449 19900101 LTC REVIEW CLAIM FOR PROV

0450 19000101 INVALID QUADRANT

0451 19900101 LTC INV PROVIDER NUMBER

0452 19900101 RENDERING PROVIDER SERVICE LOCATION IS MISSING

0453 19000101 INVALID DIAGNOSIS TREATMENT INDICATOR

0454 19900101 INVALID ASSIGNMENT CODE

0455 19910101 REFILL NOT ALLOWED FOR DRUG CODE BILLED

0456 19900101 INVALID PROCEDURE TYPE

0457 19900101 INVALID PRINCIPAL/OTHER PROCEDURE TYPE

0458 19900101 ALIEN RECIPIENT ON REVIEW

0459 19900101 REVENUE CODES OP401 NEED HCPC CODE

0460 19910101 NOT MEDICAID ELIGIBLE FOR NURSING HOME PAYMENT

0461 19900101 OCCURENCE CODE SPAN MISSING/INVALID

0462 19900101 OCCURENCE SPAN DATE IS MISSING OR INVALID

0463 19900101 NOT MEDICAID ELIGIBLE FOR MEDICARE CROSSOVER PAYMENT

0464 19900101 SPAN DATE CONFLICT WITH DATES OF SERVICE SHOWN

0465 19900101 MEDICAID ALLOWABLE AMOUNT REDUCED BY THIRD PARTY LIABILITY

0466 19900101 MEDICAID ALLOWED REDUCED BY MEDICARE PAYMENT

0467 19900101 OVERLAP DATES FOR SAME LEVEL OF CARE

0468 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION

0469 19900101 LTC RECIPIENT NAME/ID MISMATCH

0470 19900101 CROSS OVER PEND FOR MANUAL PRICE

0471 19900101 NDC IS DEACTIVED AND NOT PAYABLE ON DATE FILLED

0472 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION

0473 19900101 NAME ON CLAIM MUST MATCH DHS IDENTIFICATION

0474 19000101 DATE DISPENSED AFTER BILLING DATE

0475 19000101 DATE BILLED AFTER ICN DATE

0476 19900101 MAXIMUM HOSPITAL DAYS FOR THIS ADULT HAS BEEN PAID

0477 19000101 THE DIAGNOSIS CODE IN SEQUENCE 10-24 IS IN AN INVALID FORMAT

0478 19900101 PCS MISSING SUBMITTED CHARGE

0479 19900101 CLIA OUT OF DATE

0480 19910101 PROVIDER NOT ELIGIBLE ON DATES OF SERVICE

0481 19910101 CLAIM PENDED FOR REVIEW OF ATTACHMENTS

0482 19900101 DDSD/NFM PROCEDURE - NOT DDSD/NFM PROVIDER

0483 19900101 DDSD/NFM PROVIDER - NOT DDSD/NFM PROCEDURE

0484 19910101 PREMATURE/NEONATAL NURSERY CARE MUST BE BILLED WITH NEWBORN'S ID

0485 19900101 DATE DISPENSED EARLIER THAN DATE PRESCRIBED

0486 19900101 INPATIENT PSYCHIATRIC NEEDS PRIOR AUTHORIZATION

0487 19900101 PRIMARY DIAG CODE DETOX/NO DETOX REVENUE CODE

0488 19900101 ADMIT DATE DOES NOT EQUAL FIRST DATE OF SERVICE

0489 19900101 NO CLIA - DOS PRIOR TO CLIA EFFECTIVE DATE

0490 19900101 INPATIENT SERVICES ARE NOT COVERED FOR THIS RECIP

0491 19900101 DRUG NOT APPROVED

0492 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE

0493 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE

0494 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE

0495 19900101 NO CLIA - DOS PRIOR TO CLIA EFFECTIVE DATE

0496 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE

0497 19900101 NO CLIA - DOS PRIOR TO CLIA - EFFECTIVE DATE

0498 19900101 NO CLIA-DOS PRIOR TO CLIA EFFECTIVE DATE

0499 19900101 TPL PAY CHASE IMMUNO SUPPRESS DRUG

0500 19900101 DOCUMENT PEND

0501 19900101 SUSPEND FOR TPL REVIEW

0502 19900101 FILE CLAIM WITH MEDICARE

0503 19900101 THIS PATIENT HAS OTHER INSURANCE

0505 19900101 RETAIN INSURANCE DENIAL 6 MONTHS FOR TPL REVIEW

0507 19900101 EPSDT-MAY HAVE TPL

0508 19900101 TPL PAY AND CHASE PHARMACY

0509 19900101 TPL PAY AND CHASE PRE-NATAL

0510 19900101 THIS PATIENT HAS TWO COVERAGE TYPES

0511 19900101 CLAIM DATA DOES NOT MATCH PRIOR AUTHORIZATION DATA

0515 19910101 RESUBMISSION CODE INVALID

0516 19910101 CCN MISSING ADJUSTMENT/VOIDS

0517 19910101 ADJUSTMENT REPLACED BY THE LATEST ADJUSTMENT

0518 19990101 PROVIDER TYPE - CLAIM INPUT CONFLICT

0519 19900101 DRUG REQUIRES PRIOR AUTHORIZATION

0520 19900101 DRUG QUANTITY PER DAY LIMIT HAS BEEN EXCEEDED

0521 19910101 DUPLICATE ADJUSTMENT RECORDS ENTERED

0522 19900101 RECIPIENT IS NOT ELIGIBLE FOR THESE SERVICES

0524 19910101 CLAIM TO BE ADJUSTED IS THE CREDIT/VOID OF PREVIOUS ADJUSTMENT

0525 19900101 ADJUSTMENT OR VOID INVALID FOR PREVIOUSLY DENIED CLAIMS

0526 19900101 PRIOR AUTHORIZATION NOT ON FILE

0527 19900101 NO UNITS AUTHORIZED-THESE DATES OF SERVICES

0528 19900101 PRIOR AUTHORIZATION UNITS USED

0530 19900101 TIER 2 NSAID NO RECORD OF TIER 1'S ON FILE

0532 19900101 DISEASE STATE MANAGEMENT

0534 19000101 PRODUR DRUG-AGE INTERACTION

0535 19900101 PDUR INGREDIENT DUPLICATION

0536 19900101 INSURANCE EOB DOES NOT MATCH CLAIM - RESUBMIT

0537 19900101 PDUR DRUG-TO-DRUG INTERACTION

0538 19910101 EOB ATTACHMENT INADEQUATE FOR TPL RESOLUTION-RESUBMIT

0539 19000101 PDUR EARLY REFILL ON PRESCRIPTION

0540 19000101 PDUR MINIMUM DURATION OF THERAPY

0541 19900101 PDUR DOSING PRECAUTION-HIGH DOSE

0542 19900101 PDUR DOSING PRECAUTION-LOW DOSE

0543 19910101 ACCEPTABLE THIRD PARTY DENIAL JUSTIFIES PAYMENT

0544 19900101 PDUR MAXIMUM DURATION OF THERAPY

0545 19900101 PDUR LATE REFILL ON PRESCRIPTION

0546 19900101 DRUG DISEASE MARKER

0547 19900101 HMO CO-PAY/RECIPIENT HAS MEDICARE

0548 19900101 PAY TO PROV FOR PROVIDER TYPE 63 MUST BE GROUP

0549 19900101 ADJUSTMENT SUSPEND FOR MANUAL REVIEW

0550 19900101 SERVICE NOT REFERRED BY PRIMARY CARE CASE MANAGER

0552 19900101 PROVIDER NOT ELIGIBLE TO PROVIDE SERVICE/MEDICAID

0553 19900101 SNF/NF PAE EFF DATE MUST NOT BE GREATER THAN 90 DAYS PRIOR ADM/SERV DATE

0555 19000101 CLAIM PAST 24 MONTH FILING - DTL

0556 19900101 RECIPIENT IS NOT WAIVER ELIGIBLE

0557 19000101 CLAIM PAST 24 MONTH FILING - HDR

0560 19900101 RECIPIENT SERVICES COVERED BY HMO PLAN

0561 19900101 PROVIDER INELIGIBLE FOR T19 SERVICES/HMO ONLY

0562 19900101 RECIP PCPCM-CANNOT BILL OP/RHC/FQHC CLINICS RATE

0563 19900101 RECIPIENT NOT ENROLLED IN HMO FOR DOS

0564 19900101 SUPPLEMENTAL DELIVERY PAYMENT DENIAL CODE

0565 19900101 PAID AMOUNT IS GREATER THAN THE BILLED AMOUNT

0566 19900101 EXCEPTION CODE 566

0567 19910101 ROOM AND BOARD CHARGES NON-COVERED--CORRECT AND RESUBMIT

0569 19900101 CC CLAIMS CAN'T PROCESS THRU SYSTEM

0570 19900101 INVALID ELIGIBILITY FOR HMO COPAY

0571 19900101 CLAIMCHECK REBUNDLED

0572 19900101 CC INCIDENTAL TO PRIMARY PROCEDURE

0573 19900101 CC MUTUALLY EXCLUSIVE

0574 19900101 CLAIMCHECK COSMETIC SURGERY

0575 19900101 CLAIMCHECK DUPLICATE

0576 19900101 CC UNLISTED/OBSOLETE/EXPERIMENTAL/UNSPECIFIED

0577 19900101 CLAIMCHECK POSSIBLE DUPLICATE

0578 19900101 CLAIMCHECK PRE-OP/POSTOP

0579 19900101 CC GROUPHEALTH SMARTSUSPENSE SUSPEND

0580 19900101 CLAIMCHECK MEDICAL/EVALUATION VISIT

0581 19900101 RECIPIENT IS LOCKED-IN TO ANOTHER PHYSICIAN

0582 19900101 RECIPIENT IS LOCKED-IN TO ANOTHER PHARMACY

0583 19900101 CLAIMREVIEW NEW VISIT FREQUENCY

0584 19900101 CC GROUPHLTH SMARTSUSPENSE DENY

0587 19900101 CLAIMREVIEW INTENSITY OF SERVICE

0588 19900101 STOP LOSS NOT APPROVED

0589 19900101 CC INVALID MODIFIER/PROCEDURE COMBINATION

0590 19900101 CLAIMCHECK EXCEEDS 40 LINES

0591 19900101 CLAIMREVIEW MULTIPLE/DUPLICATE COMP.BILLING

0592 19900101 CLAIMCEHCK AGE REPLACEMENT

0593 19900101 CLAIMREVIEW DIAGNOSIS TO PROCEDURE

0594 19900101 CLAIMCHECK-BILL EACH DOS ON A SEPARATE LINE

0595 19910101 CLIA REGISTRATION CERTIFICATE NUMBER NOT ON FILE

0597 19900101 CLAIMCHECK MULTIPLE SURGERY

0598 19900101 CC-MULTIPLE SURGERY-DOUBLE MODIFIERS

0599 19900101 ATTACHMENT CONTROL NUMBER MISSING

0600 19900101 UNITS NOT EQUAL TO TEETH BILLED

0601 19900101 PART A CROSSOVER SPANS 20020501

0602 19900101 UNITS NOT EQUAL TO TEETH BILLED

0603 19900101 PROV ID ON CLAIM DOES NOT MATCH PROV ID ON PA

0604 19900101 SERVICE AND/OR DATES DO NOT MATCH PRIOR AUTH

0605 19900101 PRIOR AUTH FUND AND CLAIM FUND DOES NOT MATCH

0606 19900101 PRIOR AUTH UNITS/AMOUNTS USED

0608 19900101 JUSTIFICATION OF MEDICAL NECESSITY REQUIRED FOR THIS PROCEDURE

0609 19900101 CHECK CLAIM ATTACHMENT

0612 19900101 TOOTH NUM ON CLAIM DOES NOT MATCH TOOTH NUM ON PA

0614 19900101 DIAG CODE MISSING/NOT ON FILE-INPATIENT CLAIMS

0615 19900101 PROVIDER RATE NOT ON FILE FOR LEVEL OF CARE

0616 19900101 PROCEDURE NOT COMPENSABLE FOR ASSISTANT SURGEON

0618 19900101 AUTH SERVICES-RECIP NOT ELIG

0619 19900101 RECIP INELIGIBLE PAY (AUTH EXAM) FROM STATE FUND

0620 19900101 MEDICARE ADJUSTED CLAIM-SUBMIT PAPER XOVER CLAIM

0621 19900101 (CASH DEDUCTIBLE + BLOOD DEDUCTIBLE + COINSURANCE) IS GREATER THAN (MEDICARE AL

0622 19900101 MASS CREDIT/ADJ BEING SUSPEND


0625 19900101 FUND CODE UNDETERMINED

0627 19910101 X-OVER AMOUNT BILLED GREATER THAN AMOUNT BILLED TO MEDICARE

0628 19910101 PHYSICIAN VISIT DATE MISSING/INVALID

0629 19900101 PHYSICIAN VISIT DATE DOES NOT MEET FEDERAL REQUIREMENTS

0630 19900101 DIAGNOSIS NOT IN SCOPE OF THE PROGRAM

0631 19900101 DIAGNOSIS NOT IN SCOPE OF CCP PROGRAM


0632 19900101 DIAGNOSIS NOT IN SCOPE OF CN PROGRAM

0633 19900101 DIAGNOSIS NOT IN SCOPE OF MN PROGRAM

0634 19000101 DETAIL ATTENDING PHYSICIAN ID INVALID

0635 19000101 DETAIL FIRST OTHER PHYSICIAN ID INVALID

0637 19900101 CLAIM PROCESSES MORE THAN 1 YEAR AFTER DATE OF SERVICE AND MORE THAN 183 DAYS A

0638 19900101 DRUG REQUIRES MEDICAL REVIEW/CN

0639 19900101 DRUG REQUIRES MEDICAL REVIEW/MN

0642 19900101 INVALID PROVIDER NUMBER

0643 19900101 ABORTION REQUIRES REVIEW

0644 19900101 PROCEDURE CODE MODIFIER NOT PAYABLE

0645 19900101 NOT MEDICAID ELIGIBLE FOR MEDICARE CROSSOVER PAYMENT

0646 19900101 PROVIDER RATE NOT ON FILE

0648 19900101 CC SITE SPECIFIC MODIFIER-FILE ON SEPARATE LINE

0649 19910101 HOSPICE CLAIM PREVIOUSLY PAID FOR DATES OF SERVICE

0650 19900101 MISSING 224 REVENUE/INVALID UNITS ON LATE DISCHARGE

0651 19900101 INVALID TREATMENT DIAGNOSIS INDICATOR

0652 19900101 PCS-INVALID NET CLAIM CHARGE

0653 19900101 PAID IN FULL BY MEDICARE

0654 19900101 RECIPIENT ID IS INVALID FOR AUTH EXAM PAY STATE FD

0655 19910101 DENIED BY MEDICARE

0656 19910101 MEDICARE PAYMENT EXCEEDS MEDICAID MAXIMUM ALLOWABLE

0657 19900101 POTENTIAL DISABILITY CLAIM

0658 19910101 NEWBORN CARE LIMITED TO 2 SUBSEQUENT VISITS

0659 19900101 DATE OVER 1 YR MORE THAN 90 DAYS AFTER MEDICARE PD

0662 19900101 LINE FAILURE - CLAIM DENIED

0663 19900101 PCS-PROVIDER NUMBER IS NOT ON PROVIDER FILE

0664 19900101 PCS OVER 31 DAYS BILLED

0665 19900101 PCS MISSING PROVIDER NUMBER

0666 19910101 HOSPITAL INPATIENT SERVICE CANNOT BE PAID ON SAME DAY AS OBSERVATION

0667 19900101 PCS-INVALID PROVIDER NUMBER CHECK DIGIT

0668 19900101 PCS MISSING FIRST DATE OF SERVICE

0669 19900101 PCS FILING DEADLINE EXCEEDED

0670 19900101 PCS FIRST DATE OF SERVICE GREATER THAN LAST DATE

0671 19900101 PCS SERVICE DATE IS GREATER THAN RECEIVED DATE

0672 19900101 PCS MISSING RECIPIENT NUMBER

0673 19900101 SUBMIT PAPER CLAIM


0674 19900101 PCS MISSING TOTAL CLAIM CHARGE

0675 19900101 PCS INVALID TOTAL CLAIM CHARGE

0676 19900101 PCS RECIPIENT NOT ON ELIGIBILITY FILE

0677 19900101 PCS RECIPIENT INELIGIBLE ON DATE OF SERVICE

0678 19900101 PCS ITEMIZED SERVICE DATE NOT IN RECIP ELIG SPAN

0679 19900101 PCS SUSPEND FOR RECIPIENT REVIEW

0680 19900101 PCS PROVIDER IS SUSPENDED

0681 19900101 PROVIDER INELIGIBLE ON DATE OF SERVICE

0682 19900101 PCS REVIEW CLAIM FOR PROVIDER

0683 19900101 EXCEEDS 1 PROCEDURE PER TOOTH

0684 19900101 PCS INVALID PROVIDER NUMBER

0687 19900101 EXCEEDS LIFETIME LIMIT FOR ORTHODONTICS

0688 19900101 EXCEEDS $750 PER FY FOR DENTAL PROCEDURES REQUIRING PRIOR APPROVAL

0691 19900101 PCS-NO UNITS OF SERVICE

0696 19900101 CROSSOVER PART A NOT PAYABLE MEDICALLY NEEDY

0698 19500101 COINSURANCE IS NOT A MULTIPLE OF THE MEDICARE DAILY RATE

0699 19900101 INSTITUTIONAL CROSSOVER TYPE MISSING OR INVALID

0700 19900101 PROCEDURE EXCEEDS LIFETIME LIMITATION

0701 19900101 PHYSICAN SIGNED CONSENT FORM BEFORE STERILIZATION

0702 19900101 DATE OF SURGERY ON CONSENT FORM IS NOT ON CLAIM

0703 19900101 RECIPIENT UNDER 21 WHEN SHE SIGNED CONSENT FORM

0704 19900101 REQUIRES ADDRESS FOR FACILITY FOR STERILIZATION

0705 19900101 STERILIZATION CONSENT FORM IS NOT LEGIBLE

0706 19900101 DATE ON THE CONSENT FORM IS NOT LEGIBLE

0707 19900101 STERILIZATION/HYSTERECTOMY CONSENT FORM IS MISSING

0708 19900101 PATIENT NAME ON CONSENT FORM DOES NOT MATCH CLAIM

0709 19900101 CONSENT LESS THAN 30 DAYS BEFORE STERILIZATION

0710 19900101 CONSENT MORE THAN 180 DAYS BEFORE STERILIZATION

0711 19900101 STERILIZATION CONSENT FORM NOT DATED BY PHYSICIAN

0712 19900101 CONSENT FORM IS NOT SIGNED BY THE RECIPIENT

0713 19900101 CONSENT FORM IS NOT SIGNED BY THE COUNSELOR

0714 19900101 CONSENT FORM DOES NOT HAVE DATE COUNSELOR SIGNED

0715 19900101 STERILIZATION CONSENT FORM IS INCOMPLETE

0716 19900101 HYSTERECTOMY CONSENT FORM REQUIRED

0717 19900101 STERILIZATION CONSENT FORM NOT SIGNED BY PHYSICIAN

0718 19900101 EMERGENCY PROCEDURE CODE IS INVALID/NOT ON FILE

0719 19900101 REFILE CLAIM WITH OPERATIVE REPORT

0720 19900101 INCORRECT RECIPIENT DATE OF BIRTH ON CONSENT FORM

0721 19900101 FURTHER DESCRIPTION OF SERVICE REQUIRED

0722 19900101 STRENGTH AND DOSAGE OF INJECTION MEDICATION REQ

0723 19900101 SERVICES REQ DOCUMENTATION FOR MEDICAL NECESSITY

0724 19900101 REFILE CLAIM WITH CONSULTATION/PROGRESS NOTES

0725 19900101 SERVICE NOT COVERED AS BILLED

0726 19900101 REFERRING PHYSICIAN REQUIRED

0727 19900101 ANOTHER PROVIDER HAS BEEN PAID FOR THESE SERVICES

0728 19900101 SERVICES ARE NOT AUTHORIZED

0729 19900101 DENIED AFTER SPECIAL REVIEW

0730 19900101 HYSTERECTOMY CONSENT FORM SIGNED AFTER SURGERY

0731 19900101 HEALTH CARE AUTHORITY WILL PROCESS CLAIM

0732 19900101 COUNSELOR SIGNED CONSENT FORM PRIOR TO RECIPIENT

0733 19910101 HCBS/ICF FOR SAME OR OVERLAPPING DATES OF SERVICE

0734 19910101 HCBS/INPATIENT HOSPITAL/SNF FOR SAME OR OVERLAPPINNG DATES OF SERVICE

0735 19900101 RECIPIENT INELIGIBLE ON SERVICE DATES

0736 19900101 MODIFIER ADDED/DELETED DUE TO MEDICAL REVIEW

0737 19900101 INVALID MODIFIER FOR THIS PROCEDURE

0738 19900101 INVALID PROCEDURE CODE USE VALID CPT OR HCPC CODE

0739 19900101 ONE AMBULATORY SURGERY ALLOWED PER DAY

0740 19900101 INVALID CODE FOR NARRATIVE DESCRIPTION

0741 19900101 INVALID SUBMITTED CHARGE

0742 19900101 AUTHORIZED PHYSICAL REQUIRES ABCDM-16

0743 19900101 EXCEPTION CODE 743

0744 19900101 AUTHORIZED PHYSICAL DOES NOT MATCH ABCDM-16

0745 19900101 REQUESTED ADDITIONAL INFORMATION NOT RECEIVED

0746 19900101 DENTAL X-RAYS ARE REQUIRED

0747 19900101 SERVICES ARE INCLUDED IN TOTAL PAID OB CARE

0748 19900101 PROCEDURE IS AN INCIDENTAL TO PAID MAJOR SURGERY

0749 19900101 OUTSIDE THE GUIDELINES OF THE MEDICAL PROGRAM

0750 19900101 EXCEEDS SUPPLY LIMIT/1 MONTH WITHIN 12 MONTHS

0751 19900101 EXCEPTION CODE 751

0752 19900101 PER PHY MANUAL-USE 99202 ANTEPART WHEN NOT TOT. OB

0753 19900101 PROCEDURE IS INCIDENTAL MAJOR PROCEDURE ON CLAIM

0754 19900101 REFILE USING ""RECIPIENT AREA"" IN SQ CM

0755 19900101 REFILE CLAIM WITH PROOF OF TIMELY FILING ATTACHED

0756 19900101 EXCEPTION CODE 756

0757 19900101 TAKE HOME MEDICATION IS NOT PAYABLE

0758 19900101 PROVIDER NAME DOES NOT MATCH PROVIDER NUMBER

0759 19900101 NEEDS COUNTY ADMIN AND/OR PROVIDER SIGNATURE

0760 19900101 RECIPIENT IS DECEASED THIS DATE OF SERVICE

0761 19900101 NAME ON SUBMITTED CLAIM DOES NOT MATCH DHS FILE

0762 19900101 FILE AN ASSIGNED MEDICARE CLAIM ON THIS PATIENT

0763 19900101 EXCEEDS MULTI-CHANNEL TEST LIMIT BLOOD ANALYZER CODE REQUIRED

0764 19900101 DUPLICATE OF PAID CLAIM

0765 19900101 INVALID HYSTERECTOMY CONSENT FORM

0766 19900101 STERILIZATION/HYSTERECTOMY CONSENT FORM IS INVALID

0767 19900101 EXCEPTION CODE 767

0768 19900101 REQUEST ADJUSTMENT TO PAID CLAIM-PER MANUAL

0769 19900101 PAYMENT CORRECTED/SPENDDOWN-ADM12-HIST ONLY ADJUST

0770 19900101 INSURANCE PAYMENT MORE THAN ALLOWABLE

0771 19900101 SERVICE NOT PAYABLE THIS DATE OF SERVICE


0772 19900101 TYPE OF BILL-CLAIM CONFLICT

0773 19900101 AUTHORIZED ROOM SERVICES ARE NOT ON CLAIM

0774 19900101 EXCEPTION CODE 774

0775 19900101 CLAIM HAS BEEN FORWARED TO HCA

0777 19900101 SHOW MEDICARE PART B PAYMENTS

0778 19900101 HEALTH CARE AUTHORITY PROCESSED ADM12

0779 19900101 ELIGIBILITY PROBLEM PROCESSED BY DHS

0780 19900101 RESUBMIT WITH APPROPRIATE VALUE CODE AND UNITS

0781 19900101 ANOTHER DDS PAID THIS SERVICE IN PREVIOUS 12 MONTH

0782 19900101 PART OF INPATIENT HOSPITAL CHARGES

0783 19900101 PROCEDURE INCLUDED IN OFFICE CALL

0785 19900101 ANOTHER PHARMACY PAID FOR THIS PRESCRIPTION

0786 19900101 SAME NDC/DATE PAID THIS PHARM

0787 19900101 THERAPEUTIC LEAVE DAYS ARE NON-COVERED

0788 19900101 MAXIMUM OF 60 THERAPEUTIC LEAVE DAYS EXCEEDED FOR FISCAL YEAR

0789 19900101 PROCEDURE NOT APPLICABLE FOR DIAGNOSIS SHOWN

0790 19900101 ABCDM-16/CLAIM PROV CONFLICT

0791 19900101 INVALID DIAGNOSIS FOR DESCRIPTION

0792 19900101 STERILIZATION CONSENT REQUIRED

0793 19900101 SERVICE/SUPPLY INCLUDED IN AMBULANCE TRIP CHARGE

0794 19900101 PAID CLAIM INCLUDED THIS PROCEDURE

0795 19900101 CC MUTUALLY EXCLUSIVE

0796 19900101 PATIENT HAS PRIVATE INSURANCE

0797 19900101 RECIP TB ELIG ONLY-CLAIM REQUIRES TB DIAGNOSIS

0798 19900101 REFILE WITH MEDICARE RECHECK HIC NUMBER

0799 19900101 EXCEPTION CODE 799

0800 19900101 PHARMACY-EXACT DUPLICATE OF ANOTHER CLAIM

0801 19910101 SERVICE NOT ALLOWED DURING INPATIENT/SNF/ICF STAY

0802 19900101 PHARMACY-POSSIBLE CONFLICT OF ANOTHER CLAIM

0803 19900101 DENTAL-EXACT DUPLICATE OF ANOTHER CLAIM

0804 19900101 DENTAL-POSSIBLE DUPLICATE OF ANOTHER CLAIM

0806 19900101 PRACTITIONER-EXACT DUPLICATE OF ANOTHER CLAIM


0807 19900101 PRACTITIONER-POSSIBLE DUPLICATE OF ANOTHER CLAIM

0810 19910101 SNF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE

0812 19900101 CROSSOVER-EXACT DUPLICATE OF ANOTHER CLAIM

0813 19900101 EXCEPTION CODE 813

0814 19900101 CROSSOVER-POSSIBLE CONFLICT OF ANOTHER CLAIM

0815 19900101 LTC-EXACT DUPLICATE OF ANOTHER CLAIM IN SYSTEM

0816 19900101 LTC-POSSIBLE DUPLICATE OF ANOTHER CLAIM

0820 19910101 INPATIENT/ICF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE

0821 19900101 PCS-POSSIBLE DUPLICATE OF ANOTHER CLAIM

0822 19900101 EXCEPTION CODE 822


0823 19910101 ICF CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE

0824 19900101 OUTPATIENT-POSSIBLE DUPLICATE OF ANOTHER CLAIM

0826 19900101 HOME HEALTH-EXACT DUPLICATE OF ANOTHER CLAIM

0827 19900101 EXCEPTION CODE 827

0828 19910101 CLAIM PREVIOUSLY PAID FOR SAME DATE OF SERVICE

0829 19900101 INPATIENT-EXACT DUPLICATE OF ANOTHER CLAIM

0830 19910101 MEDICARE CROSSOVER PREVIOUSLY PAID - BILL PART A MEDICARE

0831 19910101 SNF/HOME HEALTH/DME SERVICE PREVIOUSLY PAID FOR SAME DATE OF SERVICE

0832 19900101 TRANSPORTATION-EXACT DUPLICATE OF ANOTHER CLAIM

0833 19910101 HCBS PREVIOUSLY PROCESSED FOR SAME DATES OF SERVICE

0835 19910101 RECIPIENT IS PART B ELIGIBLE - BILL MEDICARE

0836 19910101 PROFESSIONAL XOVER CONFLICT W/ CMS1500 ENCOUNTERS

0838 19900101 LAB/XRAY-EXACT DUPLICATE OF ANOTHER CLAIM

0839 19900101 LAB/XRAY-POSSIBLE DUPLICATE OF ANOTHER CLAIM


Full list of Denial code.

https://www.lamedicaid.com/provweb1/Forms/Error_Code/ERROR_CODE.pdf







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