Monday, May 31, 2010

N1 to N100 denial code appreviations

Medicaid Claim Denial Codes 

N1 - N50

N1 You may appeal this decision in writing within the required time limits following receipt
of this notice by following the instructions included in your contract or plan benefit
Note: (Modified 2/28/03)
N2 This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.
N3 Missing consent form.
Note: (Modified 2/28/03) Related to N228
N4 Missing/incomplete/invalid prior insurance carrier EOB.
Note: (Modified 2/28/03)
N5 EOB received from previous payer. Claim not on file.
N6 Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the
amount Medicare would have allowed if the patient were enrolled in Medicare Part A
and/or Medicare Part B.
Note: (Modified 2/28/03)
N7 Processing of this claim/service has included consideration under Major Medical provisions.
N8 Crossover claim denied by previous payer and complete claim data not forwarded.
Resubmit this claim to this payer to provide adequate data for adjudication.
N9 Adjustment represents the estimated amount the primary payer may have paid.
N10 Claim/service adjusted based on the findings of a review organization/professional
consult/manual adjudication/medical or dental advisor.
Note: (Modified 10/31/02)
N11 Denial reversed because of medical review.
N12 Policy provides coverage supplemental to Medicare. As member does not appear to be
enrolled in Medicare Part B, the member is responsible for payment of the portion of
the charge that would have been covered by Medicare.
N13 Payment based on professional/technical component modifier(s).
N14 Payment based on a contractual amount or agreement, fee schedule, or maximum
allowable amount.
N15 Services for a newborn must be billed separately.
N16 Family/member Out-of-Pocket maximum has been met. Payment based on a higher
N17 Per admission deductible.
Note: (Deactivated eff. 8/1/04) Consider using Reason Code 1
N18 Payment based on the Medicare allowed amount.
Note: (Deactivated eff. 1/31/2004) Consider using N14
N19 Procedure code incidental to primary procedure.
N20 Service not payable with other service rendered on the same date.
N21 Your line item has been separated into multiple lines to expedite handling.
Note: (Modified 8/1/05)
N22 This procedure code was added/changed because it more accurately describes the
services rendered.
Note: (Modified 10/31/02, 2/28/03)
N23 Patient liability may be affected due to coordination of benefits with other carriers
and/or maximum benefit provisions.
Note: (Modified 8/13/01)
N24 Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
Note: (Modified 2/28/03)
N25 This company has been contracted by your benefit plan to provide administrative
claims payment services only. This company does not assume financial risk or
obligation with respect to claims processed on behalf of your benefit plan.
N26 Missing itemized bill.
Note: (Modified 2/28/03) Related to N232
N27 Missing/incomplete/invalid treatment number.
Note: (Modified 2/28/03)
N28 Consent form requirements not fulfilled.
N29 Missing documentation/orders/notes/summary/report/chart.
Note: (Modified 2/28/03, 8/1/05) Related to N225
N30 Patient ineligible for this service.
Note: (Modified 6/30/03)
N31 Missing/incomplete/invalid prescribing provider identifier.
Note: (Modified 12/2/04)
N32 Claim must be submitted by the provider who rendered the service.
Note: (Modified 6/30/03)
N33 No record of health check prior to initiation of treatment.
N34 Incorrect claim form for this service.
N35 Program integrity/utilization review decision.
N36 Claim must meet primary payer’s processing requirements before we can consider
N37 Missing/incomplete/invalid tooth number/letter.
Note: (Modified 2/28/03)
N38 Missing/incomplete/invalid place of service.
Note: (Deactivated eff. 2/5/05) Consider using M77
N39 Procedure code is not compatible with tooth number/letter.
N40 Missing x-ray.
Note: (Modified 2/1/04) Related to N242
N41 Authorization request denied.
Note: (Deactivated eff. 10/16/03) Consider using Reason Code 39
N42 No record of mental health assessment.
N43 Bed hold or leave days exceeded.
N44 Payer’s share of regulatory surcharges, assessments, allowances or health care-related
taxes paid directly to the regulatory authority.
Note: (Deactivated eff. 10/16/03) Consider using Reason Code 137
N45 Payment based on authorized amount.
N46 Missing/incomplete/invalid admission hour.
N47 Claim conflicts with another inpatient stay.
N48 Claim information does not agree with information received from other insurance
N49 Court ordered coverage information needs validation.
N50 Missing/incomplete/invalid discharge information.
Note: (Modified 2/28/03)
N51 Electronic interchange agreement not on file for provider/submitter.
N52 Patient not enrolled in the billing provider's managed care plan on the date of service.
N53 Missing/incomplete/invalid point of pick-up address.
Note: (Modified 2/28/03)
N54 Claim information is inconsistent with pre-certified/authorized services.
N55 Procedures for billing with group/referring/performing providers were not followed.
N56 Procedure code billed is not correct/valid for the services billed or the date of service
Note: (Modified 2/28/03)
N57 Missing/incomplete/invalid prescribing date.
Note: (Modified 12/2/04) Related to N304
N58 Missing/incomplete/invalid patient liability amount.
Note: (Modified 2/28/03)
N59 Please refer to your provider manual for additional program and provider information.
N60 A valid NDC is required for payment of drug claims effective October 02.
Note: (Deactivated eff. 1/31/2004) Consider using M119
N61 Rebill services on separate claims.
N62 Inpatient admission spans multiple rate periods. Resubmit separate claims.
N63 Rebill services on separate claim lines.
N64 The “from” and “to” dates must be different.
N65 Procedure code or procedure rate count cannot be determined, or was not on file, for
the date of service/provider.
Note: (Modified 2/28/03)
N66 Missing/incomplete/invalid documentation.
Note: (Deactivated eff. 2/5/05) Consider using N29 or N225.
N67 Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient’s admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.
N68 Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.

N69 PPS (Prospective Payment System) code changed by claims processing system.
Insufficient visits or therapies.
Note: (Modified 6/30/03)
N70 Home health consolidated billing and payment applies.
Note: (Modified 2/28/02)
N71 Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or
ambulance service was processed as an assigned claim. You are required by law to
accept assignment for these types of claims.
Note: (Modified 2/21/02, 6/30/03)
N72 PPS (Prospective Payment System) code changed by medical reviewers. Not supported
by clinical records.
Note: (Modified 6/30/03)
N73 A Skilled Nursing Facility is responsible for payment of outside providers who furnish
these services/supplies under arrangement to its residents.
Note: (Deactivated eff. 1/31/04) Consider using MA101 or N200
N74 Resubmit with multiple claims, each claim covering services provided in only one
calendar month.
N75 Missing/incomplete/invalid tooth surface information.
Note: (Modified 2/28/03)
N76 Missing/incomplete/invalid number of riders.
Note: (Modified 2/28/03)
N77 Missing/incomplete/invalid designated provider number.
Note: (Modified 2/28/03)
N78 The necessary components of the child and teen checkup (EPSDT) were not
N79 Service billed is not compatible with patient location information.
N80 Missing/incomplete/invalid prenatal screening information.
Note: (Modified 2/28/03)
N81 Procedure billed is not compatible with tooth surface code.
N82 Provider must accept insurance payment as payment in full when a third party payer
contract specifies full reimbursement.
N83 No appeal rights. Adjudicative decision based on the provisions of a demonstration
N84 Further installment payments forthcoming.
N85 Final installment payment.
N86 A failed trial of pelvic muscle exercise training is required in order for biofeedback
training for the treatment of urinary incontinence to be covered.
N87 Home use of biofeedback therapy is not covered.
N88 This payment is being made conditionally. An HHA episode of care notice has been
filed for this patient. When a patient is treated under a HHA episode of care,
consolidated billing requires that certain therapy services and supplies, such as this,
be included in the HHA's payment. This payment will need to be recouped from you if
we establish that the patient is concurrently receiving treatment under a HHA episode
of care.
N89 Payment information for this claim has been forwarded to more than one other payer,
but format limitations permit only one of the secondary payers to be identified in this
remittance advice.
N90 Covered only when performed by the attending physician.
N91 Services not included in the appeal review.
N92 This facility is not certified for digital mammography.
N93 A separate claim must be submitted for each place of service. Services furnished at
multiple sites may not be billed in the same claim.
N94 Claim/Service denied because a more specific taxonomy code is required for
N95 This provider type/provider specialty may not bill this service.
Note: (New code 7/31/01, Modified 2/28/03)
N96 Patient must be refractory to conventional therapy (documented behavioral,
pharmacologic and/or surgical corrective therapy) and be an appropriate surgical
candidate such that implantation with anesthesia can occur.
Note: (New code 8/24/01)
N97 Patients with stress incontinence, urinary obstruction, and specific neurologic diseases
(e.g., diabetes with peripheral nerve involvement) which are associated with
secondary manifestations of the above three indications are excluded.
Note: (New code 8/24/01)
N98 Patient must have had a successful test stimulation in order to support subsequent
implantation. Before a patient is eligible for permanent implantation, he/she must
demonstrate a 50 percent or greater improvement through test stimulation.
Improvement is measured through voiding diaries.
Note: (New code 8/24/01)
N99 Patient must be able to demonstrate adequate ability to record voiding diary data such
that clinical results of the implant procedure can be properly evaluated.
Note: (New code 8/24/01)
N100 PPS (Prospect Payment System) code corrected during adjudication.
Note: (New code 9/14/01. Modified 6/30/03)

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