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Friday, June 10, 2011

Denial code N201, N52, N117, N286, N95, N20 & N30 description

Denial code CO 23, 24, 27, 29, 31, 35,38, 39,40 related remarks code.


Adj. Reason Code
Adj. Reason Code Description
Remark
Code

Remark Code Descripton
Exception Code Descripton
23 The impact of prior payer(s) adjudication including payments and/or adjustments.
SERV PD BY MEDICARE AT 100%
THIRD PTY PD OUTSTANDING ALLOWED
CLAIMS AUX FILE - TPL DATA INCOMPLETE
24 Charges are covered under a capitation agreement/managed care plan.
N201
A mental health facility is responsible for payment of outside providers who furnish these services/supplies to residents.
CAPITATED MENTAL HEALTH
EMERG. MENTAL HEALTH SERVICE
24 Charges are covered under a capitation agreement/managed care plan.
N52
Patient not enrolled in the billing provider's managed care plan on the date of service.
IHC ACCESS CLIENT RECVD SVCS OUT OF PLAN
24 Charges are covered under a capitation agreement/managed care plan.
RECIPIENT ENROLLED IN AN HMO
CLIENT ENROLLED WITH WEBER MACS
CHIROPRATIC CAPITATION
FLEXCARE CLIENT RECD FEE FOR SERVICE
UNI HOME CLIENT RECD FEE FOR SERVICE
IHC ACCESS RECD FEE FOR SERVICE
MOLINA INDEPENDENCE CARE RECEIVED FFS
MOLINA PLUS CLIENT RECD FEE FOR SERVICE
HEALTHY U CLIENT RECD FEE FOR SERVICE
CLIENT IN HMO FOR DATE OF SERV.
IHC ACCESS RECD FEE FOR SERVICE
HMO CLIENT-CK FR DEC/JAN MED CARD
MEDUTAH CLIENT RECD FEE SERVICE
CLIENT ENROLLED IN HMO
CLIENT ENROLLED IN MOLINA
AFC PLUS CLIENT RECD FEE FOR SERVICE
RECIPIENT ENROLLED IN WEBER MACS
27 Expenses incurred after coverage terminated.
RECIP NOT ELIG ON SERV DATE
NOT MEDICAID ELIGIBLE
RECIP NOT ELIG-SPNDWN NOT PAID
INELIG DATES & SPENDDOWN DTS OVERLAP
RECIP NT ELIG-ATMNT MAY BE CVD
29 The time limit for filing has expired.
FILING DEADLINE EXCEEDED
FILING DEADLINE EXCEEDED FOR AGING SVC
DTE OF SERVICE EXCEEDS 3 YEARS
31 Patient cannot be identified as our insured.
N382
Missing/incomplete/invalid patient identifier.
MISSING RECIPIENT ID NUMBER
RECIPIENT ID NUMBER INVALID
RECIP ID NOT ON THE FILE
31 Patient cannot be identified as our insured.
BABY INELIG ON INDIGENT PRGM
ID NOT ON FILE (695)
UMAP CLIENT ID NOT ON FILE
35 Lifetime benefit maximum has been reached.
N117
This service is paid only once in a patient's lifetime.
DENTL LMT-1 INITIAL EXAM PR LIFE
EXCEEDS 1 INITIAL ASSESSMENT FOR TCM
35 Lifetime benefit maximum has been reached.
NON-COVERED FOR MED NEEDY ADULT
38 Services not provided or authorized by designated
(network/primary care) providers.
N286
Missing/incomplete/invalid referring provider primary identifier.
MISSING OR INVALID PCP NAME AND UPIN
38 Services not provided or authorized by designated
(network/primary care) providers.
N95
This provider type/provider specialty may not bill this service.
PROVIDER NOT COVERED IN PLAN
INPT AND OUTPT OBSERVATION NOT COVERED
38 Services not provided or authorized by designated
(network/primary care) providers.
LOCK-IN INCORRECT OVERRIDE AUTHORIZATION
PCP CLIENT WITH INTERIM ELIG (695)
SERVICE UNAUTHORIZED BY MCARE
39 Services denied at the time authorization/
pre-certification was requested.
N30
Patient ineligible for this service.
RECIPIENT REMAINS PRIVATE PAY
RECIPIENT STATUS GOES TO PRIVATE PAY
39 Services denied at the time authorization/
pre-certification was requested.
RECIPIENT TRANSFERED TO A H&CB
39 Services denied at the time authorization/
pre-certification was requested.
FACILITY DIDN'T MEET PATIENT NEED
40 Charges do not meet qualifications for emergent/urgent care.
N20
Service not payable with other service rendered on the same date.
EMERG EXAM/OTHER SERV SAME DOS
40 Charges do not meet qualifications for emergent/urgent care.
ER VISIT FOR PCN CLIENT NOT EMERGENCY
ADMIT NOT EMERGENCY
SVCS DON'T QUALIFY FOR EMERGENCY CARE

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