Medicare 835 Denial reason codes and solution

835 Denail Codes, reason and solutions

Adj. Reason Code	Adj. Reason Code Description	Remark Code	Remark Code Descripton	Exception Code Descripton
3	Co-payment Amount			CRITICAL FIELD CHANGE-REVERIFY SPENDDOWN
				SPDWN: TOTAL RECIP LIAB
4	The procedure code is inconsistent with the modifier used or a required modifier is missing.	N157	Transportation to/from this destination is not covered.	INVALID DESTINATION MODIFIER
4	The procedure code is inconsistent with the modifier used or a required modifier is missing.			INV PICKUP LOCATION MODIFIER
				MODIFIER NOT AUTHORIZED FOR CLAIM TYPE
				INVALID PROCEDURE CODE MODIFIER
				EMERG TRANS MUST HAVE VAL MOD
				PROCEDURE REQUIRES MODIFIER
				MISSING DESTINATION MODIFIER
5	The procedure code/bill type is inconsistent with the place of service.	M77	Missing/incomplete/invalid place of service.	PLACE OF SERVICE MUST BE OFFICE
5	The procedure code/bill type is inconsistent with the place of service.	MA30	Missing/incomplete/invalid type of bill.	INVALID INPATIENT TYPE OF BILL
5	The procedure code/bill type is inconsistent with the place of service.	N472	Payment for this service has been issued to another provider.	PAID OUTPATIENT TRIAGE FEE
5	The procedure code/bill type is inconsistent with the place of service.			POS/PROC CONFLICT
				ONLY COVERED THROUGH A FQHC
				INVALID BILL TYPE
6	The procedure/revenue code is inconsistent with the patient's age.	N129	Not eligible due to the patient's age.	SERVICE LIMITED BY AGE
6	The procedure/revenue code is inconsistent with the patient's age.			INV RECIP AGE/PROC (REF FILE)
				PROC AGE RELATED REPLACED W/ PROPER CODE
7	The procedure/revenue code is inconsistent with the patient's gender.			0NV RECIP SEX/PROC (REF FILE)
				NDC NOT PAYABLE FOR GENDER
				PROCEDURE CODE IS GENDER SPECIFIC
8	The procedure code is inconsistent with the provider type/specialty (taxonomy).			PROC CD NT PAYABLE TO PROV TYP
				PROC / PROV TYPE CONFLICT
				PROC CD NOT PAYABLE TO FQHC
9	The diagnosis is inconsistent with the patient's age.			RECIP AGE/DIAG-CONFLICT
				AGE/DIAG CONFLICT
10	The diagnosis is inconsistent with the patient's gender.			INV RECIP SEX/DIAG (REF FILE)
				SEX/DIAG CONFLICT
11	The diagnosis is inconsistent with the procedure.			DIAGNOSIS IS INCONSISTENT WITH PROC
				DX INDICATES NORM DEL NOT AN EMERGENCY
13	The date of death precedes the date of service.			PATIENT HAS EXPIRED
				PATIENT EXPIRED WHILE ON MEDICARE
15	The authorization number is missing, invalid, or does not apply to the billed services or provider.	M53	Missing/incomplete/invalid days or units of service.	INVALID PA UNITS OF SERVICE
15	The authorization number is missing, invalid, or does not apply to the billed services or provider.	M64	Missing/incomplete/invalid other diagnosis.	DIAG ON PA NOT 290-319.99
				DIAG/CLAIM NE DAIG/PA
15	The authorization number is missing, invalid, or does not apply to the billed services or provider.	N351	Service date outside of the approved treatment plan service dates.	TAD DATES NOT EQUAL TO DATES ON 10A
15	The authorization number is missing, invalid, or does not apply to the billed services or provider.	N54	Claim information is inconsistent with pre-certified/authorized services.	NAME/ID ON TAD NE NAME/ID ON 10A
				DRG ON CLM NOT DRG ON PA
				PROC ON CLAIM NE PROC ON MI706