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