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Thursday, June 30, 2011

ERA denial code - N390, MA101, N 103, MA31, M86, N435 with description

Denial code 107, 109, 110,115, 119 remark codes


Adj. Reason Code
Adj. Reason Code Description
Remark
Code

Remark Code Descripton
Exception Code Descripton
107 The related or qualifying claim/service was not identified on this claim.
N390
This service/report cannot be billed separately.
PROLONGED SERVICES
MUST HAVE ANESTHESIA SERV
CHEC PROCEDURE CODE NOT FOUND
107 The related or qualifying claim/service was not identified on this claim.
MUST BILL IMMUNIZATION CODE - VFC
MUST BILL WITH D9220
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
MA101
A SNF is responsible for payment of outside providers who furnish these services/supplies to residents.
SERVICES COVERED IN ICF/MR PER DIEM
NH PAID A PORTION OF CLAIM AMOUNT
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
N103
Social Security records indicate that this patient was a prisoner when the service was rendered. This payer does
not cover items and services furnished to an individual while they are in State or local custody under a penal authority, unless under State or local law, the individual is personally liable for the cost of his or her health care while incarcerated and the State or local government pursues such debt in the same way and with the same vigor as any other debt.
ADULT CRIMINAL COURT JURISDICTION
JUVENILE CRIMINAL COURT JURIS.
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
N192
Patient is a Medicaid/Qualified Medicare Beneficiary.
MEDICARE ELIGIBLE CLIENT, BILL PT D PLAN
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
HCBS MUST BE ON TAPE
NOT EXEMPTED SUB ADOPT BILL PMHP OR DHS
MENTAL HEALTH SERVICES
110 Billing date predates service date.
MA31
Missing/incomplete/invalid beginning and ending dates of the period billed.
SVC DATE AFTER CLAIM RECEIVED
110 Billing date predates service date.
INVALID BILLING DATE
LAST DATE OF SERV > BILLING DT
115 Procedure postponed, canceled, or delayed.
RECIPIENT DID NOT ENTER NH FAC.
119 Benefit maximum for this time period or occurrence has been reached.
M123
Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
LONG ACTING NARCOTIC DRUG INTERACTION
119 Benefit maximum for this time period or occurrence has been reached.
M86
Service denied because payment already made for same/similar procedure within set time frame.
HOME HLTH INITIAL VISIT > 1 PER ADMIN
HOME HEALTH SUPPLIES EXCEEDS ALLOWABLE
SERVICE EXCEEDS 6 PER 12 MONTH LIMIT
SERVICE EXCEEDS ONE PER MONTH
LITHOTRIPSY 2 PR 90 DAY LIMIT
LITHOTRIPSY 2 PER 90 DAYS/UB82
HOSPICE - 1 PER DAY LIMIT
EXCEEDS 3 PR 3 CALENDR MNTH LMT
SCHOOL SRVCS - 1 PER DAY
EXCEEDS HCBS 1 PR DY LMT
EXCEEDS 1 CASE MGMT PER DAY
EXCEEDS X-RAY LIMITS
1 PER DAY LIMIT
D7110 1 PR DAY LMT EXCD
119 Benefit maximum for this time period or occurrence has been reached.
M90
Not covered more than once in a 12 month period.
PREVENTIVE HEALTH EXAM - ONE PER YEAR
VISION LIMIT EXCEEDED
119 Benefit maximum for this time period or occurrence has been reached.
N130
Consult plan benefit documents/guidelines for information about restrictions for this service.
PROC CD HAS UNIT LMT
PCN CLIENT PRESCRIPTION LIMIT EXCEEDED
119 Benefit maximum for this time period or occurrence has been reached.
N20
Service not payable with other service rendered on the same date.
EXCEEDS XRAY LIMITS
119 Benefit maximum for this time period or occurrence has been reached.
N362
The number of days or Units of Service exceeds our acceptable maximum.
UNIT LIMIT EXCEEDED
OBSERVATION SERVICES-1 PER 48 HR PERIOD
EXCEEDS RESIDENCE LIMIT
PROC CODE LIMITED TO 12 UNITS PER CAL YR
LMT PR CALENDAR YR EXCEEDED
HOSPICE UNITS EXCEED 5
119 Benefit maximum for this time period or occurrence has been reached.
N435
Exceeds number/frequency approved/allowed within time period without support documentation.
EXCEEDS 10 PER 12 MO. REQ. MANUAL REVIEW
119 Benefit maximum for this time period or occurrence has been reached.
RESPITE CARE LIMIT
EXCEEDS 8 PER 24 MOS
EXCEEDS DENTAL LIMIT-XRAY
DENTAL LIMIT-2 EXAM PER YEAR
EXCEEDS PROPHY LIMIT
EXCEEDS SEALANT LIMIT
EXCEEDS CROWN PREP LIMIT
EXCEEDS CROWN LIMIT
PERINATAL CRE CO-ORD EXCDS 1 PR 30 DYS
RSK ASSMT EXCDS 2 PR 10 MOS
GROUP PRE/POSTNATAL ED EXCDS 8 PR 12 MOS
DIET COUNSL EXCEEDS 14 PER 12 MOS
PSYCHOSOCIAL COUSL EXCEEDS 10 PER 12 MOS
PRE/POSTNATAL HOME VSTS EXCDS 6 PR 12 MS
PRENATAL ASSMENT VSTS EXCDS 1 PR 10 MOS
PRENATAL VISIT EXCDS 3 PR 10 MONS
GLOBAL MTRNTY CRE 1 PR PRGNCY
HIGH RSK MATERNITY GLOBAL-1 PER PREGNCY
HGH RSK PREG CNSULT EXCDS 1 PR 10 MOS
HGH RSK PREG FLLW-UP EXCDS 2 PR 12 MOS
EXCEEDS 2 FOLLOW-UP PHONE CONTACTS SMKG
ORIG LINE DENIED, EXCEEDS UNIT LIMIT

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