Error Codes and Explanations for Legacy MMIS
Code
Description
001
The copayment review amount has been reached.
002
The claim payment amount is less than the copayment amount.
003
The pay-to provider number entered on the claim is invalid. If it is now over 90 days from the 
date of service, you can request a 90-day waiver. 
004
The member identification number is either missing or invalid. Verify the RID number through 
REVS. If it is now over 90 days from the date of service, you can request a 90-day waiver.
005
The accident type code is either missing or invalid.
006
The to-date of service entered on the claim is invalid for consecutive dates of service.
007
The member identification number is either missing or invalid. Verify the RID number through 
REVS. If it is now over 90 days from the date of service, you can request a 90-day waiver.
008
The prior-authorization number entered on the claim is invalid.
009
The member's Medicare identification number is either missing or invalid. Verify the HIC 
number through REVS. 
010
The member identification number is either missing or invalid. Verify the RID number through 
REVS.
011
The servicing provider number entered on the claim is invalid.
012
The procedure code is either missing or invalid. 
013
Partial copayment applied.
014
The usual fee is either missing or invalid.
015
The other paid amount entered on the claim is invalid. 
016
MassHealth use only
017
MassHealth use only
018
There was a submission error on the claim.
019
MassHealth use only
020
MassHealth use only
021
The action code is either missing or invalid.
022
The level-of-care code is either missing or invalid.
023
MassHealth use only
024
The patient status code entered on the claim conflicts with the type-of-bill code entered on the 
claim.
025
The revenue code entered on the claim conflicts with the type-of-bill code entered on the claim.
026
The patient status code is either missing or invalid.
027
The billing date is either missing or invalid.
028
The admission date is either missing or invalid.
029
The date of birth is either missing or invalid. Correct the date of birth entered on the POPS 
transaction.
030
The Medicare number on the Medicare/Medicaid crossover claim does not match the Medicare 
number listed on the MassHealth eligibility file. Verify the member’s recipient identification 
(RID) and health insurance claim (HIC) numbers through REVS.
031
The gender code is either missing or invalid. Correct the gender code entered on the POPS 
transaction.
032
The other coverage code is either missing or invalid. Correct the other coverage code entered on 
the POPS transaction.
033
The total charge is either missing or invalid.
034
The primary payer date is either missing or invalid. Correct the primary payer date entered on 
the POPS transaction.
035
Medicare made full payment on the claim. Additional payment will not be made by MassHealth.
036
Medicare denied this claim; therefore, the claim must be billed on a MassHealth claim form with 
the Medicare EOB as an attachment.
037
MassHealth use only
038
The place-of-service code is either missing or invalid.
039
MassHealth use only
040
MassHealth use only
041
The first or last name is either missing or invalid. Correct the first or last name entered on the 
POPS transaction.
042
The compound drug code is either missing or invalid.
043
The patient-paid amount entered on the claim is invalid.
044
The NDC is either missing or invalid. Correct the NDC entered on the POPS transaction.
045
The procedure code entered on the claim does not have a determined rate on file.
046
MassHealth use only
047
MassHealth use only
048
A HCPCS procedure code is required for dates of service on or after 04/01/91.
049
The procedure code modifier entered on the claim is not covered by MassHealth.
050
The procedure code modifier entered on the claim is invalid.
051
The procedure code modifier entered on the claim cannot be billed with the service code entered 
on the claim.
052
The admit-from code is either missing or invalid.
053
The procedure code modifier entered on the claim is not covered by MassHealth.
054
The dates of service, patient status, and covered days entered on the claim conflict.
055
The number of days is either missing or invalid.
056
The prescription number is either missing or invalid. Correct the prescription number entered on 
the POPS transaction.
057
The member is restricted to a primary pharmacy. The number of days’ supply entered on the 
POPS transaction exceeds the maximum number allowed.
058
A less costly method of service or treatment is available.
059
MassHealth use only
060
This service is not payable by MassHealth.
061
A report containing a higher level of detail must be submitted.
062
The procedure code entered on the claim is incorrect for this service.
063
The procedure code modifier entered on the claim is incorrect for this service.
064
The date filled is either missing or invalid. Correct the filled date entered on the POPS 
transaction.
065
This service is a component of a primary procedure for which payment has been made. This 
component will not be paid separately.
066
The days’ supply is either missing or invalid. Correct the days’ supply entered on the POPS 
transaction.
067
Payment for this service has been made to another physician.
068
The date filled conflicts with the claim media. Submit this claim as a POPS transaction.
069
MassHealth use only
070
The provider did not accept Medicare assignment. MassHealth will not pay for services when 
assignment is not accepted.
071
The provider does not have access to the POPS system.
072
From and to dates of service are not allowed for this service. Enter a single date of service on 
the claim or bill another service code.
073
MassHealth use only
074
The drug certification code entered on the claim is invalid.
075
MassHealth use only
076
MassHealth use only
077
The date filled is before the effective dates on the NDC standard package size record.
078
A CLIA certification number is not on file. Contact MassHealth Provider Enrollment and 
Credentialing.
079
The date of service entered on the claim is before the effective date of CLIA certification.
080
The date of service entered on the claim is after the expiration date of CLIA certification.
081
The CLIA certification information on file does not allow for payment for this service.
082
The date of accident is either missing or invalid.
083
MassHealth use only
084
MassHealth use only
085
MassHealth use only
086
The member’s Senior Pharmacy Program benefits have been exhausted.
087
MassHealth use only
088
The value code entered on the claim conflicts with the patient status code entered on the claim.
089
The type of admission entered on the claim is invalid.
096
This claim is a duplicate of a previously paid claim.
097
MassHealth use only
098
A claim for the extraction of this tooth was previously paid.
099
The procedure code entered on the claim is incorrect for this service.
100
This claim is a potential duplicate of a claim previously paid for similar services. 
101
This claim is a potential duplicate of a claim previously paid for similar services. 
102
This is a duplicate TCN. Pharmacy providers use this information to reverse a previously paid 
claim.
103
This claim is a duplicate of a previously paid claim.
104
The total number of allowed visits for this procedure has been exceeded.
105
The combination of this procedure and at least one other, submitted either on the same claim 
form or on a previous claim form, for the same member, on the same date of service, to the same 
provider is not allowed.
106
Payment of an office visit and surgical procedure for the same member, on the same date of 
service, to the same provider is not allowed. A claim for one of these services has been 
previously paid.
107
This claim is a potential duplicate of a claim previously paid for similar services. 
108
This claim is a potential duplicate of a claim previously paid for similar services (applicable to 
long term care claims.)
109
Payment of multiple visits for the same member, on the same date of service, to the same 
provider is not allowed. A claim for a visit on this date of service has been previously paid.
110
The combination of this procedure and at least one other, submitted either on the same claim 
form or on a previous claim form, for the same member, on the same date of service, to the same 
provider is not allowed.
111
This claim is a duplicate of a claim previously paid for medical services for the same date of 
service.
112
This claim is a duplicate of a claim previously paid as a Medicare/MassHealth crossover claim 
for the same date of service.
113
This claim is a duplicate of a claim previously paid for the same date of service.
114
This service is a component of a comprehensive procedure for which payment has been made. 
This component will not be paid separately.
115
This component of a comprehensive service has already been paid.
116
The combination of this procedure and at least one other comprehensive and bundling procedure 
submitted either on the same claim form or on a previous claim form, for the same member, on 
the same date of service, to the same provider is not allowed.
119
This claim requires review. 
120
The Certification for Payable Abortion form requires review. 
121
The Hysterectomy Information form requires review. 
122
The Sterilization Consent form requires review. 
123
This claim requires review. 
124
The NDC requires review.
125
This void transaction requires review.
126
This claim requires medical review. 
127
The procedure code entered on the claim is not covered by MassHealth.
128
The NDC is not covered by MassHealth.
129
The provider specialty information on file does not permit payment for the procedure code 
entered on the claim.
130
The provider specialty information on file does not permit payment for this procedure.
131
The diagnosis code is missing. The procedure code entered on the claim requires that a diagnosis 
code be entered on the claim.
132
The procedure requires review of a report. 
134
The shoe prescription form attachment was not submitted with the claim.
135
The procedure code modifier is missing. The procedure code entered on the claim requires a 
procedure code modifier.
136
The procedure code modifier entered on the claim does not match the procedure code modifier 
on the prior authorization.
137
The NDC was not covered by MassHealth on the date of service.
138
The drug is not covered; however, a prior-authorization number is present that may allow 
coverage in this instance. 
139
The NDC cannot be billed by this pharmacy.
141
The from and through dates of service entered on the claim span both a contractual and non-
contractual period. The claim must be split-billed.
142
The from and through dates of service entered on the claim span months. The claim must be 
split-billed.
143
The from date of service entered on the claim must precede the to date of service entered on the 
claim.
144
From and through dates of service are not allowed. Enter a single date of service on the claim.
145
MassHealth use only
146
MassHealth use only
147
MassHealth use only
148
The patient status code is either missing or invalid.
149
The member for whom you are billing is not enrolled in hospice care.
150
MassHealth use only
151
The ProDUR therapeutic duplication indicates that the prescription being dispensed is a 
duplicate of a previously dispensed (active) prescription. The same provider number and 
different prescriber numbers exist among the previous and current claims.
152
The ProDUR therapeutic duplication indicates that the prescription being dispensed is a 
duplicate of a previously dispensed (active) prescription. The same provider number and 
different prescriber numbers exist among the previous and current claims.
153
The units of service entered on the claim exceed the amount remaining under the prior-
authorization number entered on the claim.
154
The prior-authorization number entered on the claim has been voided.
155
The procedure code modifier entered on the claim is invalid for this provider.
156
The place-of-service code entered on the claim conflicts with the procedure code entered on the 
claim.
157
The procedure code modifier is missing. The procedure code entered on the claim requires a 
procedure code modifier when the place-of-service code entered on the claim indicates an 
inpatient or outpatient hospital setting.
158
The member identification number entered on the claim is not the member identification number 
listed under the prior-authorization number entered on the claim.
159
The provider number entered on the claim is not the provider number listed under the prior-
authorization number entered on the claim.
161
The former TCN entered on the adjustment claim is incorrect.
162
The former TCN entered on the adjustment claim is incorrect. It corresponds to a previously 
denied claim.
163
The amount paid by MassHealth on the voided claim does not match the amount paid by 
MassHealth on the original claim.
164
This returned-check transaction requires review.
165
This voided returned-check transaction requires review.
166
The former TCN entered on the adjustment claim is invalid.
167
This claim is a potential duplicate. An adjustment claim referencing the same former TCN is 
currently in process.
168
This claim is a potential duplicate. A resubmittal claim referencing the same former TCN is 
currently in process.
169
The amount of the returned check transaction exceeds the amount paid by MassHealth on the 
original claim.
170
The month or year of service entered on the adjustment claim does not match the month or year 
of service entered on the original claim.
171
The former TCN entered on the adjustment claim conflicts with the procedure code entered on 
the adjustment claim. The former TCN corresponds to an original claim that was not an EPSDT 
assessment or it corresponds to an original claim that was an EPSDT assessment.
172
The former TCN entered on the resubmittal claim is incorrect. It corresponds to a previously 
paid claim.
173
The ProDUR drug-to-drug interaction code is severity 1. The same provider number and 
different prescriber numbers exist among the previous and current claims.
174
The ProDUR drug-to-drug interaction code is severity 2. The same provider number and 
different prescriber numbers exist among the previous and current claims.
175
The ProDUR drug-to-drug interaction code is severity 1. Different provider numbers and 
different prescriber numbers exist among the previous and current claims.
176
The ProDUR drug-to-drug interaction code is severity 2. Different provider numbers and 
different prescriber numbers exist among the previous and current claims.
178
The procedure code entered on the claim is not covered for this provider.
180
The provider-specific rate is not on file for the date of service entered on the claim. 
181
The provider-specific case-mix rate is not on file for the dates of service entered on the claim.
182
MassHealth use only
183
The provider-specific case-mix rate is not on file for the dates of service entered on the claim.
184
This claim was paid at $0.00 in accordance with MassHealth policy.
185
The report is missing. The procedure code entered on the claim requires review of a report. 
186
This claim requires review. 
187
The procedure code entered on the claim is not covered for members enrolled in this coverage 
type. The member is enrolled in category of assistance 04 (EAEDC).
188
The procedure code entered on the claim is not covered for members enrolled in this coverage 
type.
189
The ProDUR therapeutic overlap conflict code is severity 1. The same provider number and 
different prescriber numbers exist among the previous and current claims.
190
The ProDUR therapeutic overlap conflict code is severity 2. The same provider number and 
different prescriber numbers exist among the previous and current claims.
191
The quantity is either missing or invalid. Correct the drug quantity entered on the POPS 
transaction.
192
The Certification of Medical Necessity form requires review. 
193
The Certification of Medical Necessity is missing. The procedure code entered on the claim 
requires that Certification of medical Necessity form. 
194
The ProDUR therapeutic overlap conflict code is severity 1. Different provider numbers and 
different prescriber numbers exist among the previous and current claims.
195
The ProDUR therapeutic overlap conflict code conflict code is severity 2. Different provider 
numbers and different prescriber numbers exist among the previous and current claims.
196
The ProDUR drug to age conflict code is severity 1. The NDC being billed is contraindicated 
for the member’s age.
197
The compound drug information is either missing or invalid.
198
This claim requires review. 
199
This compound drug claim requires review. 
200
The former TCN on the adjustment claim is missing.
201
The ProDUR therapeutic duplication indicates that the prescription being dispensed is a 
duplicate of a previously dispensed (active) prescription. Different provider numbers exist 
among the previous and current claims.
202
The prior-authorization number entered on the claim is not on file.
203
The member identification number entered on the claim is not on file. Verify the RID number 
through REVS.
204
The member identification number entered on the claim is not on file. Verify the RID number 
through REVS.
205
MassHealth use only
206
The referring provider number entered on the claim is not on file.
207
MassHealth use only
208
The ProDUR drug-to-drug interaction code is severity 1. The same provider number and the 
same prescriber number exist among the previous and current claims.
209
The prescriber number entered on the claim is missing or invalid.
210
This claim requires review. The procedure code entered on the claim normally requires a letter 
of second opinion, but an emergency is indicated. 
211
The ProDUR drug-to-drug interaction code is severity 3. The same provider number exists 
among the previous and current claims.
212
The ProDUR drug-to-drug conflict code is severity 4. The same provider number exists among 
the previous and current claims.
213
The ProDUR drug-to-drug conflict code is severity 5. The same provider number exists among 
the previous and current claims.
214
MassHealth use only
215
The from date of service entered on the claim must precede the to date of service entered on the 
claim.
216
The ProDUR therapeutic duplication indicates that the prescription being dispensed is a 
duplicate of a previously dispensed (active) prescription. The same provider number and the 
same prescriber number exist among the previous and current claims.
217
MassHealth use only
218
MassHealth use only
219
The former TCN entered on the adjustment claim is incorrect. It corresponds to a previously 
adjusted or voided claim.
220
The former TCN entered on the adjustment claim is incorrect. It corresponds to a previously 
denied claim.
221
This returned-money or void transaction cannot be processed. It corresponds to a previously 
adjusted or voided claim.
222
This returned-money or void transaction cannot be processed. It corresponds to a previously 
denied claim.
223
This returned-money or void transaction cannot be processed. The amount on this and the 
matching claim are not equal. 
224
This claim awaits an archive run due to the date of service entered on the claim.
225
This claim was received for processing before the billing date entered on the claim.
226
The procedure code modifier entered on the claim requires review. 
227
This claim was received for processing before the date of service entered on the claim.
228
The billing date entered on the claim must be on or after the date of service entered on the claim.
229
The procedure code entered on the claim is not on file.
230
MassHealth use only
231
MassHealth use only
232
The pay-to provider number entered on the claim is not on file. 
233
The servicing provider number entered on the claim is not on file. 
234
The servicing provider number is missing.
235
This claim requires review. 
236
This claim requires review. 
237
The member has Medicare coverage on the date of service entered on the claim. Submit this 
claim to Medicare.
238
MassHealth use only
239
The NDC entered on the claim is not on file.
240
The NDC entered on the POPS transaction is not on file.
241
The ProDUR therapeutic overlap conflict code is severity 2. The same provider number and 
same prescriber number exist among the previous and current claims.
242
MassHealth use only.
243
MassHealth use only
244
The member identification number entered on the claim is ineligible on the date of service 
entered on the claim. Verify the RID number through REVS.
245
The member identification number entered on the claim is ineligible on the date of service 
entered on the claim. Verify the RID number through REVS.
246
The member identification number entered on the claim is ineligible on the date of service 
entered on the claim. Verify the RID number through REVS.
247
The member has MCO coverage on the date of service entered on the claim. Submit this claim 
to the MCO.
248
The ProDUR therapeutic overlap conflict code is severity 4. The same provider number exists 
among the previous and current claims.
249
The ProDUR therapeutic overlap conflict code is severity 5. The same provider number exists 
among the previous and current claims.
250
The ProDUR early refill conflict code indicates that the member may be noncompliant with the 
prescription because of the timeliness of the refill, which is more than 40 days early.
251
The pay-to provider number entered on the claim is ineligible on the date of service entered on 
the claim.
252
This type of claim form may not be used by this provider.
253
The procedure code entered on the claim is not covered by MassHealth for members of this 
gender.
254
The procedure code entered on the claim is not covered by MassHealth for members of this age.
255
The procedure code entered on the claim requires prior authorization.
256
The procedure code entered on the claim is not the procedure code listed under the prior-
authorization number entered on the claim.
257
The procedure code entered on the claim is incorrect for this service.
258
The procedure code entered on the claim requires that a prior-authorization number be entered 
on the claim.
259
The procedure code entered on the claim cannot be billed on this type of claim form.
260
The procedure code and/or revenue code entered on the claim requires that a prior-authorization 
number be entered on the claim.
261
The ProDUR early refill conflict code indicates that the member may be noncompliant with the 
prescription as determined by the timeliness of the refill, which is from 20 to 40 days early.
262
This claim requires review. 
263
A ProDUR conflict code exists.
264
The ProDUR early refill conflict code indicates that the member may be noncompliant with the 
prescription dispensed as determined by the timeliness of the refill, which is from eight to 10 
days early.
265
MassHealth use only
266
The from and to dates of service entered on the claim span the conversion to HCPCS procedure 
codes. MMPCS codes must be used for services before April 1, 1991. HCPCS procedure codes 
must be used for services on and after April 1, 1991. This claim must be split-billed.
267
The from and to dates of service entered on the claim span state fiscal years. This claim must be 
split-billed.
268
MassHealth use only
269
MassHealth use only
270
MassHealth use only
271
MassHealth use only
272
MassHealth use only
273
The ProDUR drug-to-drug conflict code is severity 1. Different provider numbers and the same 
prescriber number exist among the previous and current claims.
274
The ProDUR drug-to-drug conflict code is severity 2. Different provider numbers and the same 
prescriber number exist among the previous and current claims.
275
The procedure code entered on the claim cannot be billed on this type of claim form.
276
This claim requires review. 
277
The procedure code entered on the claim is not covered by MassHealth on the date of service 
entered on the claim for members enrolled in this coverage type.
278
The procedure code entered on the claim is not covered by MassHealth on the date of service 
entered on the claim.
279
The date of service entered on the claim conflicts with the payment methodology on file for the 
procedure code entered on the claim.
280
The amount paid by Medicare for this claim exceeds the amount allowed by MassHealth for the 
service; therefore, no additional payment will be made by MassHealth.
281
This claim requires review. 
282
This claim requires review. 
283
MassHealth use only
284
The combination of this procedure and at least one other, submitted either on the same claim 
form, or on a previous claim form, for the same member, on the same date of service is not 
allowed. This procedure is paid only when performed independently of other surgical 
procedures.
285
This claim is a potential duplicate of a claim previously paid for similar services. The servicing 
provider number entered on the claim is the same for both the primary and assistant surgeons.
286
The procedure code modifier is missing. The combination of this procedure and at least one 
other submitted either on the same claim form, or on a previous claim form, for the same 
member, on the same date of service requires that a multiple-surgery procedure code modifier be 
entered on this claim.
287
The former TCN entered on the adjustment claim is incorrect. It corresponds to a claim 
previously paid at zero dollars.
288
The combination of this procedure and at least one other, submitted either on the same claim 
form, or on a previous claim form, for the same member, on the same date of service is not 
allowed. This procedure is paid only when performed independently of other procedures.
289
MassHealth use only
290
This claim requires review. 
291
The maximum frequency limitation for the procedure code entered on the claim, for this 
member, has been exceeded. 
292
The number of units entered on the claim exceeds the total cumulative number of units allowed 
for the procedure code entered on the claim.
293
MassHealth use only
294
This claim requires review. 
295
The ProDUR drug-to-drug conflict code is severity 3. Different provider numbers exist among 
the previous and current claims.
296
This claim was received for processing more than 90 days after the date of service entered on 
the claim. You can request a 90-day waiver.
297
The ProDUR drug-to-drug conflict code is severity 4. Different provider numbers exist among 
the previous and current claims.
298
The ProDUR drug-to-drug conflict code is severity 5. Different provider numbers exist among 
the previous and current claims.
299
The ProDUR therapeutic duplication conflict code indicates that the prescription being 
dispensed is a duplicate of a previously dispensed (active) prescription. Different provider 
numbers and the same prescriber numbers exist among the previous and current claims.
300
The ProDUR therapeutic overlap conflict code is severity 1. Different provider numbers and the 
same prescriber number exist among the previous and current claims. 
301
The value code entered on the claim conflicts with the number of covered days entered on the 
claim. A standard payment amount per discharge (SPAD) claim cannot exceed 20 covered days.
302
The value code entered on the claim conflicts with the noncovered days entered on the claim.
303
MassHealth use only
304
This claim requires review. 
305
The ProDUR therapeutic overlap conflict code is severity 2. Different provider numbers and the 
same prescriber number exist among the previous and current claims.
306
The ProDUR therapeutic overlap conflict code is severity 3. Different provider numbers exist 
among the previous and current claims.
307
The ProDUR therapeutic overlap conflict code is severity 4. Different provider numbers exist 
among the previous and current claims.
308
This service is not covered by MassHealth for members of this age.
309
MassHealth use only
310
The principal surgical procedure code entered on the claim is invalid.
311
The principal surgical procedure code entered on the claim is not on file.
312
The principal surgical procedure code entered on the claim is not covered by MassHealth for 
members of this gender.
313
The principal surgical procedure code entered on the claim is not covered by MassHealth for 
members of this age.
314
The principal surgical procedure code entered on the claim is not covered by MassHealth.
315
MassHealth use only
316
The principal surgical procedure code entered on the claim requires review. 
317
The principal surgical procedure code entered on the claim was not covered by MassHealth on 
the from and through dates of service entered on the claim.
318
The ProDUR therapeutic overlap conflict code is severity 5. Different provider numbers exist 
among the previous and current claims. 
319
The principal surgical procedure code is missing.
320
The second surgical procedure code entered on the claim is invalid.
321
The second surgical procedure code entered on the claim is not on file.
322
The second surgical procedure code entered on the claim is not covered by MassHealth for 
members of this gender.
323
The second surgical procedure code entered on the claim is not covered by MassHealth for 
members of this age.
324
The second surgical procedure code entered on the claim is not covered by MassHealth.
325
MassHealth use only
326
The second surgical procedure code entered on the claim requires review. 
327
The second surgical procedure code entered on the claim was not covered by MassHealth on the 
from and through dates of service entered on the claim.
328
MassHealth use only
329
The second surgical procedure code is missing.
330
The third surgical procedure code entered on the claim is invalid.
331
The third surgical procedure code entered on the claim is not on file.
332
The third surgical procedure code entered on the claim is not covered by MassHealth for 
members of this gender.
333
The third surgical procedure code entered on the claim is not covered by MassHealth for 
members of this age.
334
MassHealth use only
335
MassHealth use only
336
The third surgical procedure code entered on the claim requires review. 
337
The third surgical procedure code entered on the claim was not covered by MassHealth on the 
from and through dates of service entered on the claim.
338
MassHealth use only
339
The third surgical procedure code is missing.
340
The eligibility clarification code is either missing or invalid. Correct the eligibility clarification 
code entered on the POPS transaction.
341
The principal surgical procedure date is either missing or invalid. Surgical dates must be in 
MM/DD format.
342
The second surgical procedure date is either missing or invalid. Surgical dates must be in 
MM/DD format.
343
The third surgical procedure date is either missing or invalid. Surgical dates must be in MM/DD 
format.
344
The principal surgical procedure date entered on the claim conflicts with the from and through 
dates of service entered on the claim.
345
The second surgical procedure date entered on the claim conflicts with the from and through 
dates of service entered on the claim.
346
The third surgical procedure date entered on the claim conflicts with the from and through dates 
of service entered on the claim.
347
The gender code is either missing or invalid. Correct the gender code entered on the POPS 
transaction.
348
The gross amount due is either missing or invalid. Correct the gross amount due entered on the 
POPS transaction.
349
MassHealth use only
350
Documentation is missing. The procedure code entered on the claim requires supporting 
documentation. 
351
The Sterilization Consent form is missing. The procedure code entered on the claim requires a 
Sterilization Consent form. 
352
The Sterilization Consent form is incomplete.
353
The Sterilization Consent form is not completed in accordance with state and federal 
regulations.
354
This claim is illegible.
355
The report is illegible. 
356
MassHealth use only
357
MassHealth use only
358
This claim requires review. 
359
This claim requires review. 
360
A request for additional information was made, the additional information was not received.
361
This service is a component of a comprehensive procedure for which payment has been made. 
This incidental procedure will not be paid separately.
362
The authorized signature is missing on the Claim Correction form.
363
The authorized signature is missing.
364
A usual and customary fee must be entered on the claim for each procedure or revenue code 
entered on the claim.
365
Two Claim Correction forms were completed, but the returned information is incorrect.
366
MassHealth use only
367
The Hysterectomy Information form is not completed in accordance with state and federal 
regulations.
368
The Hysterectomy Information form is missing. The procedure code entered on the claim 
requires a Hysterectomy Information form. 
369
The Hysterectomy Information form is incomplete.
370
The Hysterectomy Information form is not acceptable, according to current MassHealth 
regulations.
371
The Sterilization Consent form is not acceptable, according to current MassHealth regulations.
372
MassHealth use only
373
The member has Medicare supplemental insurance coverage on the date of service entered on 
the claim. Submit this claim to the supplemental insurer.
374
The member's Medicare identification number entered on the claim conflicts with the member's 
Medicare identification number on the member eligibility file. Verify the HIC number through 
REVS.
375
The Medicare deductible amount is not numeric. Verify the deductible amount reported by 
Medicare. 
376
The Medicare coinsurance amount is not numeric. Verify the coinsurance amount reported by 
Medicare. 
377
The Medicare type of service code entered on the claim is invalid.
378
MassHealth use only
379
MassHealth use only
380
MassHealth use only
381
The Medicare pay-to-provider number is invalid.
382
MassHealth use only
383
MassHealth use only
384
MassHealth use only
385
The Medicare provider number entered on the claim is not on the MassHealth provider file. 
Contact MassHealth Customer Services Provider Enrollment.
386
The NDC entered on the claim is not on file on the date filled.
387
This claim requires review. 
388
This claim requires review. 
389
This claim requires review. 
390
The number of noncovered days entered on the claim is invalid.
391
MassHealth use only
392
This claim requires review.
393
This claim requires review. 
394
This claim requires review. 
395
This claim requires review. 
396
This claim requires review. 
397
This claim requires review. 
398
This claim requires review. 
399
The diagnosis code entered on the claim is invalid on the date of service entered on the claim.
400
The diagnosis code is either missing or invalid.
401
The diagnosis code entered on the claim is not on file.
402
The diagnosis code entered on the claim is not covered by MassHealth for members of this 
gender.
403
The diagnosis code entered on the claim is not covered by MassHealth for members of this age.
404
The diagnosis code entered on the claim is not covered by MassHealth.
405
MassHealth use only
406
MassHealth use only
407
The diagnosis code entered on the claim conflicts with the procedure code entered on the claim.
408
The diagnosis code entered on the claim must be more specific.
409
The ProDUR therapeutic overlap conflict code is severity 1. The same provider number and the 
same prescriber number exist among the previous and current claims.
410
The primary diagnosis code is either missing or invalid.
411
The primary diagnosis code entered on the claim is not on file.
412
The primary diagnosis code entered on the claim is not covered by MassHealth for members of 
this gender.
413
The primary diagnosis code entered on the claim is not covered by MassHealth for members of 
this age.
414
The primary diagnosis code entered on the claim is not covered by MassHealth.
415
MassHealth use only 
416
The primary diagnosis code entered on the claim requires review. 
417
The primary diagnosis code entered on the claim is invalid on the date of service entered on the 
claim.
418
MassHealth use only
420
The second diagnosis code entered on the claim is invalid.
421
The second diagnosis code entered on the claim is not on file.
422
The second diagnosis code entered on the claim is not covered by MassHealth for members of 
this gender.
423
The second diagnosis code entered on the claim is not covered by MassHealth for members of 
this age.
424
MassHealth use only
425
MassHealth use only 
426
The second diagnosis code entered on the claim requires review. 
427
The second diagnosis code entered on the claim is invalid on the date of service entered on the 
claim.
428
MassHealth use only
429
The ProDUR therapeutic overlap conflict code is severity 1. The same provider number and the 
same prescriber number exist among the previous and current claims.
430
The third diagnosis code entered on the claim is invalid.
431
The third diagnosis code entered on the claim is not on file.
432
The third diagnosis code entered on the claim is not covered by MassHealth for members of this 
gender.
433
The third diagnosis code entered on the claim is not covered by MassHealth for members of this 
age.
434
MassHealth use only
435
MassHealth use only 
436
The third diagnosis code entered on the claim requires review. 
437
The third diagnosis code entered on the claim is invalid on the date of service entered on the 
claim.
438
MassHealth use only
440
The fourth diagnosis code entered on the claim is invalid.
441
The fourth diagnosis code entered on the claim is not on file.
442
The fourth diagnosis code entered on the claim is not covered by MassHealth for members of 
this gender.
443
The fourth diagnosis code entered on the claim is not covered by MassHealth for members of 
this age.
444
MassHealth use only
445
MassHealth use only 
446
The fourth diagnosis code entered on the claim requires review. 
447
The fourth diagnosis code entered on the claim is invalid on the date of service entered on the 
claim.
448
MassHealth use only
449
The level-of-service code is either missing or invalid.
450
The fifth diagnosis code entered on the claim is invalid.
451
The fifth diagnosis code entered on the claim is not on file.
452
The fifth diagnosis code entered on the claim is not covered by MassHealth for members of this 
gender.
453
The fifth diagnosis code entered on the claim is not covered by MassHealth for members of this 
age.
454
MassHealth use only
455
MassHealth use only 
456
This fifth diagnosis code entered on the claim requires review. 
457
The fifth diagnosis code entered on the claim is invalid on the date of service entered on the 
claim.
458
MassHealth use only
459
The revenue code entered on the claim is not the revenue code listed under the prior-
authorization number entered on the claim.
460
The revenue code units are missing.
461
The HCPCS laboratory procedure code is missing. The revenue code entered on the claim 
requires a HCPCS laboratory procedure code be entered on the claim.
462
The procedure code entered on the claim is not required.
463
The revenue code entered on the claim conflicts with the procedure code entered on the claim.
464
The units of service are missing.
465
MassHealth use only
466
MassHealth use only 
467
The revenue code entered on the claim is incorrect for the service entered on the claim.
468
The revenue code entered on the claim was not covered by MassHealth on the date of service 
entered on the claim.
469
The revenue code entered on the claim was not covered by MassHealth for this coverage type on 
the date of service entered on the claim.
470
The revenue code entered on the claim was not covered by MassHealth for this coverage type on 
the date of service entered on the claim.
471
The revenue code entered on the claim is not covered by MassHealth for members enrolled in 
this coverage type.
472
The revenue code entered on the claim was not covered by MassHealth for this coverage type on 
the date of service entered on the claim.
473
The revenue code entered on the claim was not covered by MassHealth for this coverage type on 
the date of service entered on the claim.
474
Revenue codes 360-369 entered on the claim are not covered by MassHealth on the same date of 
service entered on the claim when billed with revenue codes 490-499.
475
The revenue code entered on the claim is not on file for the date of service entered on the claim.
476
The revenue code entered on the claim was not covered by MassHealth on the date of service 
entered on the claim.
477
The revenue code pricing entered on the claim requires review. 
478
The revenue code entered on the claim is not covered by MassHealth for members enrolled in 
this coverage type.
479
The revenue code entered on the claim does not have a rate on file.
480
The revenue code entered on the claim was not covered by MassHealth on the date of service 
entered on the claim.
481
Enter the procedure code description on the claim when billing an unlisted procedure code.
482
Pharmacy claims must be billed through POPS.
483
The claim must be billed as mental health/substance abuse only. Bill the MassHealth Behavioral 
Health Partnership.
484
The member’s coverage type is buy in/subsidy only.
485
MassHealth use only
486
The procedure code entered on the claim is not covered for members enrolled in this coverage 
type. The member is enrolled in MassHealth Basic. 
487
The procedure code entered on the claim is not covered for the member’s coverage type.
488
The procedure code entered on the claim is not covered for members enrolled in this coverage 
type. The member is enrolled in MassHealth Limited.
489
The procedure code entered on the claim is not covered for members enrolled in this coverage 
type. The member is enrolled in MassHealth Family Assistance.
490
The EOB requires review. 
491
The EOB requires review. 
492
The EONMB requires review. 
493
The Utilization Review letter is incomplete.
494
The services entered on the claim contain a combination of Medicare Parts A and B charges. 
This claim must be split-billed according to crossover claim guidelines.
495
The EOB requires review. 
496
The documentation requires review. 
497
The EOB requires review. 
498
The EOB requires review. 
499
The EOB requires review. 
500
MassHealth use only
501
MassHealth use only
502
The prescription origin is either invalid or conflicts with other prescription information. Correct 
the prescription origin entered on the POPS transaction.
503
The EOB requires review. 
504
This adjustment claim requires review. 
505
MassHealth use only
506
The first TPL carrier code entered on the claim is invalid.
507
MassHealth use only
508
MassHealth use only
509
The former TCN entered on the resubmittal claim is invalid. Correct the former TCN entered on 
the resubmittal claim.
510
MassHealth use only
511
This claim requires review. 
512
The former TCN entered on the resubmittal claim is invalid.
513
The former TCN entered on the resubmittal claim is invalid. The original claim submission was 
received for processing more than 90 days after the billing deadline. You may request a 90-day 
waiver.
514
MassHealth use only 
515
The resubmittal entry entered on the claim requires a former TCN be entered on the claim.
516
The member has other health insurance.
517
Attachment carrier code conflict.
518
MassHealth use only
519
This returned-money or void transaction requires review.
520
This claim has been denied after medical review. 
521
The from date of service is either missing or invalid.
522
The member identification number entered on the claim is ineligible on the date of service 
entered on the claim. Verify the RID number through REVS.
523
The member identification number entered on the claim is not on the eligibility file. Verify the 
RID number/eligibility through REVS.
524
This claim requires review. 
525
MassHealth use only
526
MassHealth use only
527
MassHealth use only
528
The EOB is missing. The claim requires that an EOB is attached or the claim may be billed 
electronically using the COB transaction. 
529
MassHealth use only
530
The NDC entered on the POPS transaction is incomplete. Correct the NDC entered on the 
POPS transaction.
531
The supplier’s invoice is missing. The procedure code entered on the claim requires a supplier’s 
invoice. 
532
The acquisition cost is missing.
533
The interim bills are not payable by MassHealth.
534
The discharge bills are not payable by MassHealth.
535
MassHealth use only
536
The managed care referral number entered on the claim does not match the member’s PCC 
entered on the claim, or the managed care referral number entered on the claim is invalid.
537
The managed care referral number is missing.
538
The time of admission entered on the claim indicates that the referral number entered on the 
claim is invalid when the urgent-care referral number is entered on the claim.
539
The mental-health or substance-abuse treatment service entered on the claim must be billed to 
the Massachusetts Behavioral Health Partnership.
540
The mental-health/substance-abuse services entered on the claim must be billed to the 
Massachusetts Behavioral Health Partnership. This claim contains both medical and mental-
health/substance-abuse services.
541
MassHealth use only
542
The procedure code entered on the claim requires that the place of service indicates the 
emergency department when the after-hours or no-callback referral number is entered on the 
claim. 
543
This claim requires review. The procedure code entered on the claim requires that an indication 
of an emergency and place of service indicating the emergency department be entered on the 
claim. 
544
The member has MCO coverage, and therefore, is required to have this service provided by the 
member’s PCC.
545
MassHealth use only
546
MassHealth use only
547
The member has MCO coverage, and therefore, is required to have this service provided by th 
member’s PCC.
548
The member has MCO coverage, was seen in the emergency department, and a screening was 
provided. Additional inappropriate emergency-department screening services that were provided 
conflict with the MCO guidelines.
549
The same prescriber and pharmacy DEA numbers are invalid. Correct the prescriber and 
pharmacy DEA numbers entered on the POPS transaction.
550
The NDC entered on the POPS transaction is not covered by MassHealth for members of this 
age.
551
The NDC entered on the POPS transaction is not the NDC listed under the prior-authorization 
number entered on the claim.
552
The days’ supply entered on the POPS transaction exceeds the amount allowed by the NDC.
553
The date filled entered on the POPS transaction must be on or after the date the prescription was 
written.
554
The refill date entered on the POPS transaction is more than six months after the date the 
prescription was written.
555
The location code entered on the POPS transaction conflicts with the place-of-service 
requirements of the NDC.
556
The member's gender entered on the POPS transaction conflicts with the gender requirements of 
the NDC.
557
MassHealth use only
558
The date the prescription was written is either missing or invalid. Correct the date the 
prescription was written entered on the POPS transaction.
559
The authorized number of refills entered on the POPS transaction exceeds the amount allowed.
560
The member is in a Medical Services Control program that restricts a member to a specific 
provider for the dispensing of drugs.
561
The prescriber DEA number is either missing or invalid. Correct the prescriber DEA number 
entered on the POPS transaction.
562
The type of prescription is either missing or invalid. Correct the type of prescription entered on 
the POPS transaction.
563
The authorized number of refills is either missing or invalid. Correct the authorized number of 
refills entered on the POPS transaction.
564
The authorized number of refills is either missing or invalid. Correct the authorized number of 
refills entered on the POPS transaction.
565
The number of refills entered on the POPS transaction exceeds the amount allowed.
566
MassHealth use only
567
Prior authorization is required for the NDC. The NDC entered on the POPS transaction requires 
that prior authorization be obtained.
568
The prior authorization for the NDC is invalid.
569
The days’ supply entered on the POPS transaction is less than the minimum amount allowed of 
the NDC.
570
The quantity entered on the POPS transaction is less than the minimum amount allowed of the 
NDC.
571 
The quantity entered on the POPS transaction exceeds the amount allowed of the NDC.
572
MassHealth use only
573
The member identification number entered on the claim is ineligible for this coverage type. 
Verify the RID number/eligibility through REVS.
574
This provider is not authorized by MassHealth to perform the services entered on the claim.
575
The provider number entered on the claim is not on the MassHealth provider file. Contact 
MassHealth Provider Enrollment.
576
MassHealth use only
577
The processor control number is either missing or invalid. Correct the processor control number 
entered on the POPS transaction.
578
The prior-authorization number or medical certification code is either missing or invalid. 
Correct the prior authorization or medical certification code entered on the POPS transaction.
579
MassHealth use only
580
MassHealth use only
581
MassHealth use only
582
MassHealth use only
583
The ProDUR conflict code is either missing or invalid. Correct the ProDUR conflict code 
entered on the POPS transaction.
584
The ProDUR intervention code is either missing or invalid. Correct the ProDUR intervention 
code entered on the POPS transaction.
585
The ProDUR outcome code is either missing or invalid. Correct the ProDUR outcome code 
entered on the POPS transaction.
586
MassHealth use only
587
MassHealth use only
588
MassHealth use only
589
MassHealth use only
590
The procedure code entered on the claim exceeds the amount allowed, unless a prior-
authorization number is entered on the claim.
591
The procedure code entered on the claim exceeds the amount allowed.
592
MassHealth use only
593
The procedure code entered on the claim requires review. 
594
The procedure code entered on the claim conflicts with services billed on previous and current 
claims provided on the same date of service entered on the claim.
595
The procedure billed on the claim has been paid on previous or current claims.
596
MassHealth use only
597
The procedure code entered on the claim was previously paid for a new-patient or initial-visit. 
An established-patient or periodic-patient procedure code must be billed to MassHealth.
598
The procedure codes entered on the claim cannot be billed for the same member, on the same 
date of service entered on the claim.
599
The ProDUR override code is invalid. Correct the ProDUR override code entered on the POPS 
transaction.
600
The procedure code entered on the claim was not covered by MassHealth for members enrolled 
in this coverage type on the date of service entered on the claim.
601
The procedure code entered on the claim was not covered by MassHealth for members enrolled 
in this coverage type on the date of service entered on the claim.
602
The procedure code entered on the claim is not covered by MassHealth for members enrolled in 
this coverage type.
603
The procedure code entered on the claim is not on file for members enrolled in this coverage type 
on the date of service entered on the claim.
604
The procedure code entered on the claim is not covered by MassHealth for members enrolled in 
this coverage type.
605
The service entered on the claim is not payable by MassHealth to municipally-based health 
services providers.
606
The NDC entered on the POPS transaction was not covered by MassHealth on the date of 
service entered on the claim.
607
The NDC entered on the POPS transaction was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
608
The NDC entered on the POPS transaction is not covered by MassHealth for members enrolled 
in this coverage type.
609
The NDC entered on the POPS transaction was not covered by MassHealth on the date of 
service for members enrolled in this coverage type.
610
The NDC entered on the POPS transaction is not covered by MassHealth for members enrolled 
in this coverage type.
611
The NDC entered on the POPS transaction was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
612
The NDC entered on the POPS transaction is not covered by MassHealth for members enrolled 
in this coverage type.
614
Prior authorization is required for anti-ulcer drugs. The NDC entered on the POPS transaction 
requires that prior authorization be obtained.
615
MassHealth use only
616
Prior authorization is required for Ceradase. The NDC entered on the POPS transaction requires 
that prior authorization be obtained.
617
Prior authorization is required for Neupogen. The NDC entered on the POPS transaction 
requires that prior authorization be obtained.
618
Prior authorization is required for Prolast. The NDC entered on the POPS transaction requires 
that prior authorization be obtained.
619
The primary diagnosis code entered on the claim was not covered by MassHealth on the date of 
service entered on the claim.
620
The primary diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
621
The primary diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
622
The primary diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
623
The primary diagnosis code entered on the claim is not covered by MassHealth for members in 
this coverage type.
624
The primary diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
625
The primary diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
626
The second diagnosis code entered on the claim was not covered by MassHealth on the date of 
service entered on the claim.
627
The second diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
628
The second diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
629
The second diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
630
The second diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
631
The second diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
632
The second diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
633
The third diagnosis code entered on the claim was not covered by MassHealth on the date of 
service entered on the claim.
634
The third diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
635
The third diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
636
The third diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
637
The third diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
638
The third diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
639
The third diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
640
The fourth diagnosis code entered on the claim was not covered by MassHealth on the date of 
service entered on the claim.
641
The fourth diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
642
The fourth diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
643
The fourth diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
644
The fourth diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
645
The fourth diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
646
The fourth diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
647
The fifth diagnosis code entered on the claim was not covered by MassHealth on the date of 
service entered on the claim.
648
The fifth diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
649
The fifth diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
650
The fifth diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
651
The fifth diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
652
The fifth diagnosis code entered on the claim was not covered by MassHealth for members 
enrolled in this coverage type on the date of service entered on the claim.
653
The fifth diagnosis code entered on the claim is not covered by MassHealth for members 
enrolled in this coverage type.
654
The procedure code modifiers entered on the claim require review. 
655
The admission hour is either missing or invalid.
656
This claim requires review. 
657
The 90-day waiver request has been denied. 
658
MassHealth use only
659
The procedure code modifier entered on the claim does not have a rate on file for the date of 
service entered on the claim.
660
MassHealth use only
661
The pharmacy dispensing fee entered on the POPS transaction is not on file for the date of 
service entered on the claim.
662
The mileage service entered on the claim does not have a rate on file for the date of service 
entered on the claim.
663
MassHealth use only
664
Prior authorization is required for Pulmozym. The NDC entered on the POPS transaction 
requires that prior authorization be obtained.
665
MassHealth use only
666
Prior authorization is required for immunity drugs. The NDC entered on the POPS transaction 
requires that prior authorization be obtained.
667
The NDC entered on the POPS transaction requires prior authorization.
668
MassHealth use only
668
Prior authorization is required for antihistamines. The NDC entered on the POPS transaction 
requires that prior authorization be obtained.
669
The NDC billed on the claim requires review. 
670
Prior authorization is required for immunity drugs. The NDC entered on the POPS transaction 
requires that prior authorization be obtained.
671
Prior authorization is required for this prescription. The NDC entered on the POPS transaction 
requires that prior authorization be obtained.
673
The number of MLOA days are missing.
674
The from and to dates of service entered on the claim conflict as the member is coded for in 
long-term care.
675
The number of MLOA and NMLOA days entered on the claim are not payable by MassHealth 
for this provider type.
676
The MLOA from and to dates entered on the claim in the first occurrence span months. The 
claim must be split-billed.
677
The MLOA to date entered on the claim in the first occurrence must be on or after the MLOA 
from date entered on the claim.
678
The number of MLOA days entered on the claim in the first occurrence conflicts with the from 
and to dates of service entered on the claim.
679
The NDC entered on the POPS transaction requires prior authorization.
680
The MLOA from and to dates entered on the claim in the first occurrence span months. The 
claim must be split-billed.
681
The NMLOA to date entered on the claim in the first occurrence must be on or after the 
NMLOA from date entered on the claim.
682
The number of NMLOA days entered on the claim in the first occurrence conflicts with the from 
and to dates of service entered on the claim.
683
MassHealth use only
684
The number of MLOA days in the first occurrence is either missing or invalid.
685
The MLOA from date in the first occurrence is either missing or invalid.
686
The MLOA to date in the first occurrence is either missing or invalid.
687
The number of NMLOA days in the first occurrence is either missing or invalid.
688
The NMLOA from date in the first occurrence is either missing or invalid.
689
The NMLOA to date in the first occurrence is either missing or invalid.
690
MassHealth use only
691
The number of MLOA days in the second occurrence is either missing or invalid.
692
The MLOA from date in the second occurrence is either missing or invalid.
693
The MLOA to date in the second occurrence is either missing or invalid.
694
The number of NMLOA days in the second occurrence is either missing or invalid.
695
The NMLOA from date in the second occurrence is either missing or invalid.
696
The NMLOA to date in the second occurrence is either missing or invalid.
697
The number of MLOA days in the third occurrence is either missing or invalid.
698
The MLOA from date in the third occurrence is either missing or invalid.
699
The MLOA to date in the third occurrence is either missing or invalid.
700
The number of NMLOA days in the third occurrence is either missing or invalid.
701
The NMLOA from date in the third occurrence is either missing or invalid.
702
The NMLOA to date in the third occurrence is either missing or invalid.
703
MassHealth use only
704
The number of consecutive MLOA days entered on the claim exceeds the amount allowed.
705
The MLOA from and to dates entered on the claim are invalid.
706
The number of NMLOA days entered on the claim exceeds the amount allowed.
707
The NMLOA from and to dates entered on the claim are invalid.
708
The MLOA and NMLOA from and to dates of service entered on the claim are invalid.
709
The MLOA from and to dates entered on the claim in the second occurrence span months. The 
claim must be split-billed.
710
The MLOA to date entered on the claim in the second occurrence must be on or after the MLOA 
from date entered on the claim.
711
The number of MLOA days entered on the claim in the second occurrence conflicts with the 
from and to dates of service entered on the claim.
712
The number of consecutive NMLOA days entered on the claim exceeds the amount allowed.
713
The NMLOA from and to dates entered on the claim in the second occurrence span months. The 
claim must be split-billed.
714
The NMLOA to date entered on the claim in the second occurrence must be on or after the 
NMLOA from date entered on the claim.
715
The number of NMLOA days entered on the claim in the second occurrence conflicts with the 
from and to dates of service entered on the claim.
716
MassHealth use only
717
The MLOA from and to dates entered on the claim in the third occurrence span months. This 
claim must be split-billed.
718
The MLOA to date entered on the claim in the third occurrence must be on or after the MLOA 
from date entered on the claim.
719
The number of MLOA days entered on the claim in the third occurrence conflicts with the from 
and to dates of service entered on the claim.
720
MassHealth use only
721
The NMLOA from and to dates entered on the claim in the third occurrence span months. This 
claim must be split-billed.
722
The NMLOA to date entered on the claim in the third occurrence conflicts with the NMLOA 
from date entered on the claim.
723
The number of NMLOA days entered on the claim in the third occurrence conflicts with the 
from and to dates of service entered on the claim.
724
MassHealth use only
725
The prescription clarification code is either missing or invalid. Correct the prescription 
clarification code entered on the POPS transaction.
726
The member is not coded for residence with this long-term-care provider on the dates of service 
entered on the claim.
727
The member is not coded for long-term care.
728
The level-of-care code entered on the claim is not covered by MassHealth.
729
The patient-paid amount entered on the claim is incorrect.
730
The dates of service, number of days, and patient-status codes entered on the claim conflict.
731
The MLOA from and to dates entered on the claim in the first occurrence conflict with the from 
and to dates of service entered on the claim.
732
The MLOA from and to dates entered on the claim in the second occurrence conflict with the 
from and to dates of service entered on the claim.
733
The MLOA from and to dates entered on the claim in the third occurrence conflict with the from 
and to dates of service entered on the claim.
734
The NMLOA from and to dates entered on the claim in the first occurrence conflict with the 
from and to dates of service entered on the claim.
735
The NMLOA from and to dates entered on the claim in the second occurrence conflict with the 
from and to dates of service entered on the claim.
736
The NMLOA from and to dates entered on the claim in the third occurrence conflict with the 
from and to dates of service entered on the claim.
737
MassHealth use only
738
The member is not coded for residence with this long-term-care provider.
739
The member is not coded for long-term care.
740
The management minutes code is either missing or invalid.
741
The member is not coded for this casemix code. The casemix code refers to the level of 
functioning for the member.
742
The member is not coded for this casemix code. The casemix code refers to the level of 
functioning for the member.
743
MassHealth use only
744
MassHealth use only
745
MassHealth use only
747
The usual charge is either missing or invalid. Correct the usual charge entered on the POPS 
transaction.
748
The total charge is missing.
749
The total charge is required.
750
A referring provider number is required for chiropractor services.
751
The diagnosis code entered on the claim requires review. 
752
The HID targeted-drug supply entered on the POPS transaction has reached the emergency 
amount allowed.
753
The from date of service entered on the claim must be on or after the admission date entered on 
the claim.
754
The Certification for Payable Abortion form requires review. 
755
Certification for Payable Abortion form missing. The procedure code entered on the claim 
requires a Certification for Payable Abortion form. 
756
The Certification for Payable Abortion form is incomplete.
757
The Certification for Payable Abortion form is not completed in accordance with state and 
federal regulations.
758
The Medical Necessity form is incomplete.
759
MassHealth use only
760
The MLOA and/or NMLOA entered on the claim is invalid for long-term-care contractual 
providers.
761
Long-term-care contractual providers are not casemix providers.
765
The pay-to provider number entered on the claim is not a group provider number. 
766
The member is restricted to a case-management program.
767
The servicing provider entered on the claim is not a member of the group practice as indicated 
by the pay-to provider number entered on the claim.
768
MassHealth use only
769
The number of days entered on the claim conflicts with the units of service entered on the claim.
770
The days or units entered on the claim exceed the amount allowed for the procedure code entered 
on the claim.
771
The prior-authorization number entered on the claim was denied.
772
The procedure code modifier entered on the claim is invalid for the procedure code entered on 
the claim.
773
This claim requires review. 
774
The anesthesia units entered on the claim exceed the amount allowed for the procedure code 
entered on the claim.
775
The procedure code entered on the claim requires review. 
776
The percentage-of-charge rate entered on the claim is not on file.
777
The date of service entered on the claim must precede the expiration date of the prior-
authorization number entered.
778
The prior-authorization number entered on the claim is not on file.
779
The primary diagnosis code entered on the claim is not valid as a primary diagnosis code.
780
Second Surgical Opinion letter missing. The procedure code entered on the claim requires a 
Second Surgical Opinion letter. 
781
The Second Surgical Opinion letter does not meet State regulations. 
782
The incentive days entered on the claim conflict with the incentive days on file.
783
The incentive rate entered on the claim conflicts with the incentive rate on file.
784
MassHealth use only
785
MassHealth use only
786
MassHealth use only
787
MassHealth use only
788
MassHealth use only
789
MassHealth use only
790
MassHealth use only
791
MassHealth use only
792
MassHealth use only
793
MassHealth use only
794
MassHealth use only
795
MassHealth use only
796
MassHealth use only
797
MassHealth use only
798
MassHealth use only
799
MassHealth use only 
800
MassHealth use only
801
The location code is either missing or invalid. Correct the location code entered on the POPS 
transaction.
802
The Medical Necessity form requires review. 
803
MassHealth use only
804
The number of miles is missing.
805
MassHealth use only
806
MassHealth use only
807
The time of service is either missing or invalid.
808
The number of minutes of waiting time is missing.
809
The number of minutes of waiting time entered on the claim is not payable by MassHealth if the 
number of miles entered on the claim is less than 40.
810
The servicing provider entered on the claim is ineligible on the date of service entered on the 
claim.
811
The servicing provider entered on the claim requires review. 
812
The diagnosis code entered on the claim requires review. 
813
The procedure code entered on the claim requires review. 
814
The procedure code entered on the claim is not covered by MassHealth for surgical assistant 
services.
815
MassHealth use only
816
The immunization status box must be checked on this MassHealth claim form.
817
The clinical evaluation box must be checked on this MassHealth claim form.
818
The clinical evaluation box indicates a need for further diagnosis or treatment, but the results 
boxes are blank or the results boxes are complete, but the clinical evaluation box does not 
indicate a need for further diagnosis or treatment.
819
The referral information is missing.
820
The assessment status box must be checked on this MassHealth claim form.
821
The assessment status entry entered on the claim indicates every test or screening required under 
the EPSDT protocol was performed, but the procedure code modifier is for an incomplete 
assessment or the assessment status box indicates that every test or screening was not 
performed, but the procedure code modifier is for an initial or complete assessment.
822
This claim requires review. 
823
This claim must indicate whether any test results are still unknown after 30 days.
824
This claim indicates that test results are unknown after 30 days, but the claim was billed less 
than 30 days from the date of service entered on the claim.
825
The patient status-code indicator entered on the claim is invalid.
826
The member entered on the claim does not have MCO coverage.
827
There is a conflict between the HMO provider and member.
828
The premium amount is either missing or invalid.
831
One of the following conditions exists. (1)  The claim with one or more possible Medicare Part 
B-covered items was paid with an override. The pharmacy should submit the claim to Medicare 
and rebill within 90 days, if override Other Coverage 4 was used. (2)  The claim with one or 
more possible Medicare Part B-covered items was paid as the primary insurance, since the 
payment amount is not over $5. 
832
MassHealth use only
833
MassHealth use only
834
MassHealth use only
835
The member has Medicare Part D benefits, which limits MassHealth benefits.
836
One of the following conditions exists. (1)  The submitted copayment amount (gross amount 
due) for the Medicare Part D copayment exceeds the $5 limit. (2)  Patients in long-term-care are 
not subject to a copayment. The claim was submitted for a member enrolled in long term care.
837
This claim was denied because it exceeded the 36-month deadline from the date of service 
entered on the claim.
840
The member has Medicare Part D eligibility and one of the following conditions exists. (1) The 
MassHealth wrap provisions have been exceeded (that is, the member has already received two 
or more fills for a given drug). (2)  The claim for services during the Medicare Part D wrap 
period was denied because the limits were exceeded for the first claim (that is, the supply is 
greater than 30 days). (3)  The claim for services during the Medicare Part D wrap period was 
denied because limits were exceeded for the second claim (that is, the supply is greater than 
three days).
841
MassHealth use only
842
MassHealth use only
845
This claim requires review.
847
This claim must be submitted on paper to MassHealth.
849
The TPL procedure code entered on the claim is not on file on the date of service entered on the 
claim.
850
The procedure code modifier entered on the claim requires a servicing provider number be 
entered on the claim.
851
The procedure code entered on the claim does not have a rate on file.
852
The anesthesia units are not on file on the date of service entered on the claim.
853
The premium type entered on the claim conflicts with the premium type on file.
854
The premium type entered on the claim is not on file.
855
The premium type entered on the claim is invalid.
856
Services must be billed on a daily basis.
857
Services must be billed on a monthly basis.
858
The MCO payment method must be included in the support table.
859
MassHealth use only
860
This claim requires review. 
861
The admission date entered on the claim must be on or after the application date entered on the 
claim.
862
The 837 replacement claim was submitted without a void transaction.
871
The procedure code entered on the claim requires a quadrant designation be entered on the 
claim.
872
The procedure code entered on the claim conflicts with the tooth number entered on the claim.
873
The tooth number is either missing or invalid.
874
The tooth-surface code is either missing or invalid.
875
The procedure code entered on the claim requires a tooth number be entered on the claim.
876
The procedure code entered on the claim requires a tooth-surface code be entered on the claim.
877
The tooth number entered on the claim conflicts with the tooth-surface code entered on the 
claim.
878
The tooth number or tooth-surface code entered on the claim is not covered by MassHealth for 
the procedure code entered on the claim.
879
The procedure code entered on the claim conflicts with the quadrant designation entered on the 
claim.
880
The tooth number entered on the claim is invalid for the procedure code entered on the claim.
881
The tooth-surface code entered on the claim is invalid for the procedure code entered on the 
claim.
884
This claim has been denied for medical necessity. 
885
This claim is either considered a duplicate or is a submission error. 
886
The medical records are missing. The procedure code entered on the claim requires the medical 
records. 
887
The medical record is incomplete.
888
The final billing deadline has been exceeded.
889
The fiscal year for the date of service entered on the claim is closed.
890
Invalid procedure code for Line A.
891
The EPSDT-assessment procedure code must be billed on line A of this claim form.
892
The procedure code entered on the claim requires a modifier when billed with the place-of-
service code entered on the claim.
893
The procedure code entered on the claim requires that the name and provider number of the 
referring provider be entered on the claim.
894
MassHealth use only
895
The procedure code entered on the claim does not have a rate on file. 
896
The health plan coverage is under review.
897
The explanation of benefits (EOB) attachment requires further review for the billing deadline. 
898
This claim requires review. 
899
The date of service entered on the claim must be on or after the MMIS claims processing date 
entered on the claim.
900
The pay-to provider number entered on the claim is a billing agency.
901
The NDC file must indicate a standard package size for this item.
902
The provider must have the appropriate specialty code on file to be paid by MassHealth for this 
drug entered on the POPS transaction.
903
The authorized drug quantity for the NDC on the prior-authorization record has been exhausted.
904
The authorized drug quantity for the NDC on the prior-authorization record has been partially 
exhausted.
905
No refills are authorized for Schedule II drugs.
906 
The prescription type entered on the POPS transaction conflicts with DEA service restrictions 
entered on the POPS transaction.
907
The prescription type entered on the POPS transaction conflicts with the days supply entered on 
the POPS transaction.
908
MassHealth use only
909
The NDC file must include a MAC price for this NDC.
910
A temporary recipient identification (RID) number is assigned to this member. 
911
The authorized units for the procedure code on the prior-authorization record have been partially 
exhausted.
912
The number of units entered on the claim conflicts with the number of units authorized on the 
prior-authorization record.
913
The claim requires review.
914
The prior-authorization transaction entered on the claim requires review. 
915
The prior-authorization transaction entered on the claim has been deleted.
916
MassHealth use only
917
MassHealth use only
918
MassHealth use only
919
This claim requires prepayment review. 
920
MassHealth use only
921
A temporary recipient identification (RID) number is assigned to this member.
922 
This claim requires prepayment review. 
923
The claim has been denied after prepayment review by MassHealth.
924
The procedure code entered on the claim must be billed on a MassHealth claim form.
925
The prior-authorization number is missing.
926
MassHealth use only
927
The waiting time entered on the claim is not payable by MassHealth if the round-trip mileage 
entered on the claim is less than 40.
928
The transportation service entered on the claim requires review. 
929
The emergency ambulance services waiting time entered on the claim must exceed 60 minutes.
930
The value code (spend down rate) entered on the claim is invalid.
931
The value code (spend down rate) entered on the claim must be a numeric value.
932
The value code (spend down rate) is invalid for the rate on file.
933
MassHealth use only
934
The NDC entered on the POPS transaction is not on file for the date of service entered on the 
claim.
935
MassHealth use only
936
The type of bill is either missing or invalid.
937
The number of covered days entered on the claim conflicts with the service units entered on the 
claim.
938
A revenue code entered on the claim is not on file for the date of service entered on the claim.
939
The provider rate is either missing or invalid.
940
One or more of the revenue codes entered on the claim are not covered by MassHealth.
941
The member's age on the date of service entered on the claim conflicts with the age requirements 
of the revenue code entered on the claim.
942
The member's gender conflicts with the gender requirements of the revenue code entered on the 
claim.
943
The revenue code is either missing or invalid.
944
The revenue code entered on the claim conflicts with the rate identification on file.
945
The Second Surgical Opinion letter requires review. 
946
The claim tranaction control number is invalid. 
947
The claim assignment indicator is invalid. 
948
The claim does not indicate if the Medicare payment was Part A or B. 
949
The service units entered on the claim must be a numeric value.
950
The EOB does not match the information on file. 
951
The Medicare type of service code must be entered in item 24C of the HCFA-1500 claim form.
952
The amount billed to Medicare entered on the claim must be a numeric value.
953
The amount Medicare allowed entered on the claim must be a numeric value.
954
The amount Medicare paid entered on the claim must be a numeric value.
955
The amount billed to Medicare entered on the claim must be a numeric value.
956
The amount Medicare allowed entered on the claim must be a numeric value.
957
The amount Medicare paid entered on the claim must be a numeric value.
958
The Medicare amounts billed, allowed, and paid entered on the claim conflict.
959
The Medicare amounts billed, allowed, and paid entered on the claim conflict.
960
A copy of the original Medicare claim must be submitted with the Medicare EOMB.
961
MassHealth use only
962
The Medicare EOB must be submitted.
963
The rate identification code entered on the claim conflicts with the admission date entered on the 
claim.
964
The rate identification code entered on the claim conflicts with the treatment authorization code 
entered on the claim.
965
MassHealth use only
966
The dates of service entered on the claim must be within the approval range.
967
MassHealth use only
968
This claim has already been reversed.
969
The preoperative days were denied during preadmission screening.
970
The preadmission screening number is missing.
971
The preadmission screening number entered on the claim is either invalid or not on file.
972
The preadmission screening number entered on the claim conflicts with the preadmission 
screening record.
973
MassPRO has determined that the principal procedure code entered on the claim must be 
performed in another setting.
974
The member identification number entered on the claim conflicts with the member identification 
number on the preadmission screening record. Verify the RID number through REVS.
975
The admission date entered on the claim conflicts with the admission date on the preadmission 
screening record.
976
The pay-to provider number entered on the claim conflicts with the provider number on the 
preadmission screening record.
977
The admission date entered on the claim was denied during utilization review. 
978
MassHealth use only
979
The preadmission screening number entered on the claim is inactive on the dates of service 
entered on the claim.
980
MassHealth use only
981
The EOB requires TPL review. 
982
The EOB does not match the information on the claim. 
983
The member is enrolled in an MCO plan and the service provided is covered by the MCO.
984
This medical service entered on the claim is covered by the CommonHealth program, which is 
the member’s MCO plan.
985
The service entered on the claim is not covered by the member’s CommonHealth program.
986
The out-of-state medical services entered on the claim are not covered by the CommonHealth 
program, except in the case of emergency.
987
The out-of-state medical services entered on the claim are not covered by the CommonHealth 
program, except in the case of emergency.
988
This adjustment claim requires review. 
989
Because this member has changed benefit programs, your adjustment request has been denied. 
In order to process your claim correctly, the original paid claim must be voided and a new claim 
submitted for processing under the new benefit program.
990
The from and through dates of service entered on the claim conflict with member eligibility 
dates. Verify the RID number/eligibility through REVS.
991
MassHealth use only
992
MassHealth use only
993
The date of service entered on the claim must be on or after the date MassHealth became 
responsible for MCB claims.
994
The member is a Qualified Medicare Beneficiary and is covered for Medicare coinsurance and 
deductible claims only.
995
The claim to be reversed has been denied. Please confirm the TCN entered on the claim and 
other relevant data before attempting another reversal.
996
The type of service is either missing or invalid. This claim is for Medicare Part A.
997
The claim to be reversed cannot be located on the system. Please confirm the TCN entered on 
the claim and other relevant data before attempting another reversal.
998
Because this member’s aid category has changed, your adjustment request has been denied. In 
order to process your claim correctly, the original paid claim must be voided and a new claim 
submitted for processing under the new benefit program.
999
This adjustment claim is unknown and does not match the former TCN.























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