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Sunday, February 6, 2011

Medicare denial code CO 16, M67, M76, M79, MA120, MA 130, N10

CO - 16 denial and remark code. Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT)

This denial code is just intimation that claims has been denied for lack of some information and it always come with other rejection code as given below. Check these codes and take the correction action according the denial.




Remark
Code

Remark Code Description Exception Code Description
M67
Missing/incomplete/invalid other procedure code(s)
and/or date(s).
MISSING ICD9 SURGICAL CODE
MISSING ICD9CM SURGICAL CODE
M76
Missing/incomplete/invalid diagnosis or condition.
MISSING DIAGNOSIS INDICATOR
M79
Missing/incomplete/invalid charge.
MISSING SUBMITTED CHARGE
INVALID EXTRA CHARGE AMOUNT
INV ALLOWED CHRG AMT -PHARMACY
MA120
Missing/incomplete/invalid CLIA certification number.
MISSING OR INVALID CLIA 
CERTIFICATE #
CLIA CERT# NOT MATCHED 1ST OR
2ND CYCLES
CLIA CERTIFICATE# NOT MATCHED
 3RD CYCLE.
CLIA CERTIFICATE INVALID FOR 
PROC ON DOS
MA130
Your claim contains incomplete and/or invalid
information, and no appeal rights are afforded because the claim is unprocessable
CANNOT CALCULATE PAYMENT 
- BAD DATA
MA31
Missing/incomplete/invalid beginning and ending dates of the period billed.
MSSNG DOS OR SCREENING DATE
MA32
Missing/incomplete/invalid number of covered days during the billing period.
MISSING COVERED DAYS
COV DAYS, UNITS OF SVC ERROR
MA33
Missing/incomplete/invalid noncovered days during the billing period.
TAD CONF WITH UB-82 OR X-OVER
MA36
Missing/incomplete/invalid patient name.
RECIPIENT NAME MISSING
MISSING DATA ENTRY RECIP NAME
MA39
Missing/incomplete/invalid gender.
INVALID NEWBORN SEX CODE
MA40
Missing/incomplete/invalid admission date.
MISSING ADMISSION DATE
MA58
Missing/incomplete/invalid release of information indicator.
RELEASE OF INFORMATION NOT 
SIGNED
MA63
Missing/incomplete/invalid principal diagnosis.
MISSING PRIMARY DIAGNOSIS
MISSING OR INVALID ICD-9 
CODE (PHARMACY)
MA81
Missing/incomplete/invalid provider/supplier signature.
NO ADMINISTRATOR SIGNATURE
N10
Payment based on findings of a review organization/professional consult/manual adjudication/medical or dental advisor.
PROC REQUIRES MANUAL PRICING
N152
Missing/incomplete/invalid replacement claim information.
MISSING CREDIT TCN
REPLACEMENT CLAIM
 (ORIG CLAIM NOT FOUND)
N153
Missing/incomplete/invalid room and board rate.
REPLACEMENT/VOID RECEIVED
 FOR CLAIM
N208
MIssing/incomplete/invalid DRG code.
MISSING DRG
N253
Missing/incomplete/invalid attending provider primary identifier.
INVALID ADMITTING LICENSE NO
N261
Missing/incomplete/invalid operating provider name.
MISSING SURGEON NAME OR
 LIC NO
N29
Missing documentation/orders/notes/summary/
report/chart.
MODIFIER REQUIRES MANUAL 
REVIEW
PROC REQUIRES MANUAL REVIEW
INSUF DATA TO MAKE DETERMIN.
EMERGENCY CLIENT ONLY
N291
Missing/incomplete/invalid rendering provider secondary identifier.
MISSING SERVICING LICENSE
 NUMBER
N297
Missing/incomplete/invalid supervising provider primary identifier.
INVALID SUPRV PROV CHK DIGIT
N305
Missing/incomplete/invalid accident date.
INV ACCIDENT IND - MED CLAIM
N31
Missing/incomplete/invalid prescribing/referring/
attending provider license number.
POS PRESCRIBER FIELD HAS DR 
NAME (ALPHA)
SERVICING LICENSE NOT ON FILE
MISSING OR INVALID PRESCRIBER
LICENSE #
INV REFER LIC NO.-CHEC RELATED
MSSNG REFER PROV NAME OR LIC#
N318
Missing/incomplete/invalid discharge or end of care date.
INVALID DISCHARGE DATE
NO DISCH DATE-SERV ENDS MID MONTH
N329
Missing/incomplete/invalid patient birth date.
MISSING BIRTHDATE- ID/B SUFFIX
N330
Missing/incomplete/invalid patient death date.
INVALID DATE OF DEATH
N341
Missing/incomplete/invalid surgery date.
MISSING DATE OF SURGERY
N349
The administration method and drug must be reported to adjudicate this service.
M/I COMPOUND ROUTE OF
 ADMINISTRATION
M/I COMPOUND DISPENSING
 UNIT FORM INDCTR
N351
Service date outside of the approved treatment plan service dates.
SURG DATE NOT WITHIN DOS
N358
Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
MODIFIER REQUIRES MANUAL
 REVIEW
EMERGENCY ONLY CLIENT
N362
The number of days or Units of Service exceeds our acceptable maximum.
INV PA ESTIMATED DAYS OF STAY
N37
Missing/incomplete/invalid tooth number/letter.
MISSING TOOTH NUMBER
BILATERALLY MISSING TEETH 
CLM LACKS INFO
N378
Missing/incomplete/invalid prescription quantity.
MISSING DRUG QUANTITY
M/I QUANTITY INTENDED TO 
BE DISPENSED
M/I DAYS SUPPLY INTENDED TO BE
 DISPENSED
M/I COMPOUND INGREDIENT 
QUANTITY
N382
Missing/incomplete/invalid patient identifier.
ID WITH B SUFFIX-CHECK BIRTHDT
N388
Missing/incomplete/invalid prescription number.
MISSING PRESCRIPTION NUMBER
N43
Bed hold or leave days exceeded.
INV THERAP LEAVE DAYS-PREADMIT
N50
Missing/incomplete/invalid discharge information.
DISCH DTE CONFLICTS WITH DEST
INVLD/MSSNG DSCHRG DESTINATION
RECIPIENT HAS BEEN DISCHARGED
RECIPIENT DISCHARGED 
WHILE ON MCARE
RECIPIENT TRANSFERED TO A HOSP
RECIPIENT TRANSFERED ELSEWHERE
DISCHARGE BEFORE FIRST SVC DT
N530
Our records indicate a mismatch in enrollment information for this patient.
ELIG FILE MISSING NAME OR RACE
N57
Missing/incomplete/invalid prescribing/dispensed date.
INVALID DISPENSING DATE
N58
Missing/incomplete/invalid patient liability amount.
RESERVED AMT GTR THAN SPDN
SUSPENDED CROSSOVER
N75
Missing/incomplete/invalid tooth surface information.
MISSING TOOTH SURFACE
N95
This provider type/provider specialty may not bill this service.
CASE MNGMNT FEE - INV COS


MA120 Missing/incomplete/invalid CLIA certification number.


Common Reasons for Message

    CLIA certification number billed in Item 23 of CMS-1500 Claim Form (or electronic equivalent) was either missing or invalid
    Incorrect qualifier was used on electronic claim

Next Step

    Resubmit claim with valid CLIA certification number in Item 23 of CMS-1500 Claim Form
        CLIA numbers are 10 digits with letter "D" in third  position
    Resubmit with valid qualifier or CLIA certificate number on Electronic Claim
        Qualifier to indicate CLIA certification number must be submitted as X4

        Review EDI training document This link will take you to an external website. on billing laboratory claims electronically

Claim Submission Tips

    Apply for CLIA Certification This link will take you to an external website. prior to rendering lab services
    Review codes This link will take you to an external website. that require a CLIA certification number
    Qualifier is only required on electronic claims

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