Monday, August 7, 2017

Top 50 Billing Error Reason Codes With Common Resolutions

Description Common Resolutions 

0453 Enrolled in HMO or an Encounter Claim for F. F. S. Verify the enrollee eligibility and bill the claim to the appropriate

0302 Duplicate of History File Record, Same Provider, Same Dates of Service Provider has already received payment for this date of service. Review your prior remittance to identify the payment, which has already been made. If you can’t locate the previous payment call the Provider Helpline *Note- make sure the prior remittance’s provider number matches the number of the remit with the denied claim

0301 Duplicate Payment Request-Same Provider, Same Dates of Service Provider has already received payment for this date of service. Review your prior remittances to identify the payment, which has already been made. If you can’t locate the previous payment call the Provider Helpline *Note- make sure the prior remittance’s provider number matches the number of the remittance with the denied claim

0318 Enrollee not eligible on DOS Claim will deny if the client is not eligible during dates of service billed. Check enrollee eligibility status through MediCall to verify eligibility on the date of service being rendered. If the enrollee is not eligible no payment will be received from Virginia Medicaid. If upon verification you find that the client is now eligible on that date of service resubmit the claim.

1393 No Srvc Taxonomy Code on the Claim Verify that the servicing provider taxonomy code was on the claim.

0309 Services Not Covered Verify the client’s eligibility on our Medicall system. If the client is eligible, contact the Provider Helpline to verify that the client is enrolled in the program for which services were billed.

0313 Enrollee is covered by private insurance, refer to third party information of this R/A

Our system indicates that there is a primary carrier, which needs to be billed prior to Medicaid. This carrier is now listed on your remittance advice under the claims information for that particular client. Please refer to this other coverage information which should be billed as primary.

*NOTE: If the client states there is no other coverage then they will need to contact their case worker at the Department of Social Services to have this information corrected

0732 Servicing Provider Invalid Verify the 10 digit number entered for the servicing provider.

0155 Procedure Requires Authorization The procedure/revenue code billed requires a preauthorization and there is no PA number on the claim. You must get preauthorization from the appropriate area depending on the service being provided. The preauthorization number received is required on the claim.

0039 Qualified Medicare Beneficiary Only Enrollee. Medicaid coverage limited to deductible and coinsurance.

Qualified Medicare Beneficiary (QMB) Only clients are eligible only for payment of Medicare premiums, deductibles, and coinsurance. If a QMB Only claim is denied by Medicare then there will be no reimbursement by Medicaid.

0983 Enrollee Not on File Verify the enrollee’s Medicaid ID number.

0456 Enrollee Not Covered for this ServiceVerify the enrollee is covered for the service you are billing.

0485 Authorization by Medallion PCP Not Indicated The members primary care provider must authorize services

0308 Your payment request was filedpast the filing time limit without acceptable documentation

Virginia Medicaid is mandated by federal regulations to require the initial submission of all claims (including accident cases) within 12 months from the date of service. Medicaid is not authorized to make payment on claims submitted after the 12 month timely filing limit, except under the conditions listed in the Providers Manual Chapter V pgs 2-3. For additional details regarding the timely filing regulations, please reference the appropriate Provider Manual, Chapter 5 0022 Servicing Provider is Not Eligible to Bill this Payment Request Type

The servicing provider billed on the claim is not eligible to bill this claim.

1357 NPI Servicing Provider Not on File

Verify the 10 digit NPI entered for the servicing provider.

0385 Re-bill on Title XVIII Invoice If the claim is being submitted to Medicaid for deductible and coinsurance secondary to Medicare’s payment, and the claim to Medicare was submitted in a CMS-1500 format, then the claim to Medicaid must be submitted on a Title XVIII claim format.

0028 Admit Date Missing or Invalid UB 04–. The admit date must be numeric without any dashes or slashes.

0367 This enrollee is covered by Medicare part B, Rebill on Title 18 Medicaid requires claims be submitted on a Title 18 for Medicare Part B deductible and coinsurance. See Medicaid Memo dated 3/18/04.

0161 Authorization Not Valid for Dates of Service

The payment request's from and thru dates of service must fall within the PA's begin and end dates. CMS – 1500 and UB-04: Please verify the correct PA number was entered.

0731 Servicing Provider Not Eligible on DOS

The servicing provider was not eligible on the date of service. Contact Provider Enrollment Unit.

0370 Wrong Procedure Code Billed Check your claim to verify that the correct/valid procedure code was billed, if you feel the code is correct call the Provider Helpline to verify the code billed

0757 Servicing Provider Can Not be a Group Provider

The servicing provider number used on your claim can’t be a group NPI number.

0756 Billing Provider is not a Group Provider

The billing provider must be enrolled as a group provider. Contact Provider Enrollment

0730 Servicing Provider Not a Member of the Group

The servicing provider is not a member of the group provider, Contact Provider Enrollment

0480 Not CLIA Certified to perform procedure

Check that the CLIA number used on the claim is certified to perform the procedure.

0129 Revenue Code Not Covered UB 04 – Verify that the revenue code being billed is valid for the provider type and service

0026 Covered Days Missing or Invalid

UB 04 – Value code 80, enter the number of covered days for inpatient hospitalization or the number of days for re-occurring out-patient claims. The format for value code is digit: do not format the number of covered or non-covered days as dollar and cents.

0004 Enrollee ID Missing or Not in Valid Format

Verify the enrollee number for eligibility. The twelve digit enrollee number should appear as it is on the Medicaid Card.
0734 Covered Days Entered is greater than the Statement Period The covered days entered cannot exceed the difference between the from and thru dates.

1370 Invalid Present on Admission Flag

This requirement only applies to inpatient facility claims. The locator for the POA is right after the diagnosis code. A POA indicator is required for the primary, secondary and the external reason code. Review all diagnosis codes on the claim to assure the POA indicator was used. For more detail, please refer to the Hospital Manual, Chapter 5

0157 Approved Authorization Not on File The procedure billed requires authorization and the authorization is not on file. Verify that the authorization number on the claim is the correct authorization for the service billed.

0162 Number of procedures exceeds number authorized The number of units or visits billed is greater than the number of units or visits authorized on the PA

0191 Provider Referral Required The procedure code entered on the CMS-1500 or the revenue code on the UB-04 requires a referral, Verify the correct provider number is entered correctly on the claim.

0178 Invalid Diagnosis Code The primary diagnosis is not valid. Please verify that the diagnosis code is valid and is in the correct format.

0179 Invalid Discharge Status for Type Bill UB-04 –Enter the code indicating the disposition or discharge status of
the patient at the end service for the period covered on this bill (If the third position of type of bill is 2 or 3 the discharge status should be 30. If the third position of type of bill is 1 or 4 the discharge status should not be 30.

0014 Billed Amount Missing or Invalid CMS-1500 – Billed charges should be on each line. Do not use a decimal point.

UB-04 – The billed charges must be numeric without spaces.

0017 Missing Former Reference Number The original Internal Control Number (ICN) for claims that are being submitted to adjust or void the original PAID claim must be provided.

0055 The Type of Bill Missing or Invalid UB 04 –Type of Bill - Enter the code as appropriate

0077 Adjustment Denied - Original Payment Request Already Adjusted/Voided

An adjustment or void request cannot be submitted for a payment that has been previously adjusted or voided.

0110 Diagnosis Code Does Not Agree with Age The diagnosis given is not compatible with the enrollee's age.

0119 Service Period Not Equal Accommodation Days UB 04 - If a revenue code(s) is billed for accommodation or room and
board, the service units billed for the revenue code(s) must be equal to the number of days covered by the from-thru dates of service for the payment request.

0158 Enrollee Disagrees with Authorization

The authorization number used on the claim is not for the same enrollee as billed.

0160 Procedure Disagrees with Authorization The procedure billed on the claim is not the same procedure that has been authorized.

0352 Only Paid Payment Requests Can be Adjusted/Voided Only paid payment requests can be adjusted or voided. If the claim
previously denied, you must submit the claim as a new c laim.

0364 Primary carrier payment equals or exceeds DMAS’ allowed amount The claim was submitted with COB code indicating there was a primary carrier which paid on this claim and that the primary carrier’s payment to you equaled or exceeded Medicaid’s allowed amount. DMAS will not reimburse you if the primary carrier payment exceeds the Medicaid allowed amount.

0035 Missing/Invalid Type of Accommodation Code UB 92 –,Enter the total number of covered accommodation days or
ancillary units of service where appropriate. Th s number is equal to the number of covered days.

0352 Only Paid Payment Requests Can be Adjusted/Voided Only paid payment requests can be adjusted or voided. If the claim previously denied, you must submit the claim as a new claim.

0015 Primary Carrier Pay Missing or Invalid

CMS-1500 – our records show there is a primary carrier and no TPLinformation is on the claim.

UB-04: if claim was submitted with a COB code of ‘83’ (primary carrier billed and paid) under ‘code’, the payment made by the primary carrier must be under ‘amount.”

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