EOB CODE EOB CODE DESCRIPTION ADJUSTMENT REASON CODE ADJUSTMENT REASON CODE DESCRIPTION REMARK CODE REMARK CODE DESCRIPTION 0201 BILLING PROVIDER ID NUMBER MISSING 206 NATIONAL PROVIDER IDENTIFIER - MISSING N280 MISSING/INCOMPLETE/INVALID PAY-TO PROVIDER PRIMARY IDENTIFIER 0202 BILLING PROVIDER ID IN INVALID FORMAT 206 NATIONAL PROVIDER IDENTIFIER - MISSING N280 MISSING/INCOMPLETE/INVALID PAY-TO PROVIDER PRIMARY IDENTIFIER 0203 MEMBER I.D. NUMBER MISSING/INVALID 31 PATIENT CANNOT BE IDENTIFIED AS OUR INSURED N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 0204 HOSPITAL DISCHARGE DATE INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M59 "MISSING/INCOMPLETE/INVALID ""TO"" DATE(S) OF SERVICE" 0205 PRESCRIBING PRACTITIONER S LICENSE NO. MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M143 THE PROVIDER MUST UPDATE LICENSE INFORMATION WITH THE PAYER 0206 PRESCRIBING PRACTITIONR LICENSE NO. FORMAT INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M143 THE PROVIDER MUST UPDATE LICENSE INFORMATION WITH THE PAYER 0208 PREGNANCY INDICATOR INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 0210 BRAND MEDICALLY NECESSARY INDICATOR INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0211 REFILL INDICATOR INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0212 PRESCRIPTION NUMBER IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N388 MISSING/INCOMPLETE/INVALID PRESCRIPTION NUMBER 0213 DATE PRESCRIBED IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N57 MISSING/INCOMPLETE/INVALID PRESCRIBING DATE. 0214 DATE PRESCRIBED IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N57 MISSING/INCOMPLETE/INVALID PRESCRIBING DATE. 0215 DATE DISPENSED IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N304 MISSING/INCOMPLETE/INVALID DISPENSED DATE. 0216 DATE DISPENSED IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N304 MISSING/INCOMPLETE/INVALID DISPENSED DATE. 0217 NDC MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 0218 NDC INVALID FORMAT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 0219 QUANTITY DISPENSED IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N378 MISSING/INCOMPLETE/INVALID PRESCRIPTION QUANTITY. 0220 QUANTITY DISPENSED IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N378 MISSING/INCOMPLETE/INVALID PRESCRIPTION QUANTITY. 0221 DAYS SUPPLY MISSING 154 PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS DAY'S SUPPLY M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0222 DAYS SUPPLY INVALID 154 PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS DAY'S SUPPLY M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0223 "PROC CODE REQUIRES DIAGNOSIS CODE, NONE FOUND ON CLAIM 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0224 DIAGNOSIS TREATMENT INDICATOR INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0225 MISSING PRESCRIBING PROVIDER NUMBER 206 NATIONAL PROVIDER IDENTIFIER - MISSING N318 MISSING/INCOMPLETE/INVALID PRESCRIBING PROVIDER IDENTIFIER 0226 REFERRAL PROV ID REQUIRED FOR PROCEDURE GROUP 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " N286 MISSING/INCOMPLETE/INVALID REFERRING PROVIDER PRIMARY IDENTIFIER 0227 THIRD PARTY PAYMENT AMOUNT INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA04 SECONDARY PAYMENT CANNOT BE CONSIDERED WITHOUT THE IDENTITY OF OR PAYMENT INFORMATION FROM THE PRIMARY PAYER. THE INFORMATION WAS EITHER NOT REPORTED OR WAS ILLEGIBLE 0228 BILLING PROVIDER SIGNATURE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA70 MISSING/INCOMPLETE/INVALID PROVIDER REPRESENTATIVE SIGNATURE 0229 SOURCE OF ADMISSION MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA42 MISSING/INCOMPLETE/INVALID ADMISSION SOURCE 0231 RENDERING PROVIDER NUMBER IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER 0233 UNITS OF SERVICE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE 0234 PROCEDURE CODE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M51 MISSING/INCOMPLETE/INVALID PROCEDURE CODE(S) 0235 PROCEDURE CODE NOT IN VALID FORMAT 181 PROCEDURE CODE INVALID ON DATE OF SERVICE M51 MISSING/INCOMPLETE/INVALID PROCEDURE CODE(S) 0236 DETAIL DOS DIFFERENT THAN THE HEADER DOS A1 CLAIM/SERVICE DENIED N379 CLAIM LEVEL INFORMATION DOES NOT MATCH LINE LEVEL INFORMATION 0237 OUTPATIENT CLAIMS CANNOT SPAN DATES A1 CLAIM/SERVICE DENIED N301 MISSING/INCOMPLETE/INVALID PROCEDURE DATE(S) 0238 MEMBER NAME IS MISSING A1 CLAIM/SERVICE DENIED MA36 MISSING/INCOMPLETE/INVALID PATIENT NAME 0239 "THE DETAIL ""TO"" DATE OF SERVICE IS MISSING 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M59 "MISSING/INCOMPLETE/INVALID ""TO"" DATE(S) OF SERVICE" 0240 "THE DETAIL ""TO"" DATE IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M59 "MISSING/INCOMPLETE/INVALID ""TO"" DATE(S) OF SERVICE" 0241 ACCIDENT INDICATOR IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0242 SECONDARY DIAGNOSIS CODE INVALID FORMAT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0243 MISSING MEDICARE PAID DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N307 MISSING/INCOMPLETE/INVALID ADJUDICATION OR PAYMENT DATE. 0244 THIRD DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0245 MISSING OCCURRENCE CODE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M45 MISSING/INCOMPLETE/INVALID OCCURRENCE CODE(S). 0246 FOURTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0248 PLACE OF SERVICE IS MISSING OR BLANK 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 0249 PLACE OF SERVICE IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 0250 CLAIM HAS NO DETAILS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N379 CLAIM LEVEL INFORMATION DOES NOT MATCH LINE LEVEL INFORMATION. 0251 FIRST MODIFIER NOT COVERED 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 0252 SECOND MODIFIER NOT COVERED 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 0253 THIRD MODIFIER NOT COVERED 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 0254 BILLING PROVIDER LOCATION CODE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 0255 BILLING PROVIDER LOCATION CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 0256 MISSING MEDICARE PAID DATE - DETAIL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N307 MISSING/INCOMPLETE/INVALID ADJUDICATION OR PAYMENT DATE. 0257 PLACE OF SERVICE IS INVALID - DETAIL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE 0258 PRIMARY DIAGNOSIS CODE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0259 DATE BILLED IS MISSING/INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED 0260 UNITS OF SERVICE NOT IN VALID FORMAT A1 CLAIM/SERVICE DENIED M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE 0261 TOOTH NUMBER MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N37 MISSING/INCOMPLETE/INVALID TOOTH NUMBER/LETTER 0262 TOOTH NUMBER INVALID A1 CLAIM/SERVICE DENIED N37 MISSING/INCOMPLETE/INVALID TOOTH NUMBER/LETTER 0263 TOOTH SURFACE CODE INVALID A1 CLAIM/SERVICE DENIED N75 MISSING/INCOMPLETE/INVALID TOOTH SURFACE INFORMATION 0264 DETAIL FROM DATE OF SERVICE IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M52 "MISSING/INCOMPLETE/INVALID ""FROM"" DATE(S) OF SERVICE" 0265 DETAIL FROM DATE OF SERVICE IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M52 "MISSING/INCOMPLETE/INVALID ""FROM"" DATE(S) OF SERVICE" 0266 INSUFFICIENT NUMBER OF VALID TOOTH SURFACE CODES 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N75 MISSING/INCOMPLETE/INVALID TOOTH SURFACE INFORMATION 0268 BILLED AMOUNT MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M54 MISSING/INCOMPLETE/INVALID TOTAL CHARGES 0269 DETAIL BILLED AMOUNT INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N379 CLAIM LEVEL INFORMATION DOES NOT MATCH LINE LEVEL INFORMATION 0270 HEADER TOTAL BILLED AMOUNT MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M79 MISSING/INCOMPLETE/INVALID CHARGE 0271 HEADER TOTAL BILLED AMOUNT INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M79 MISSING/INCOMPLETE/INVALID CHARGE 0272 PRIMARY DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 0273 TYPE OF BILL MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 0274 TYPE OF BILL CODE INVALID A1 CLAIM/SERVICE DENIED MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 0275 ADMIT DATE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA40 MISSING/INCOMPLETE/INVALID ADMISSION DATE. 0276 ADMIT DATE INVALID A1 CLAIM/SERVICE DENIED MA40 MISSING/INCOMPLETE/INVALID ADMISSION DATE. 0277 ADMIT HOUR INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N46 MISSING/INCOMPLETE/INVALID ADMISSION HOUR. 0278 ADMIT TYPE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA41 MISSING/INCOMPLETE/INVALID ADMISSION TYPE. 0279 INVALID TYPE OF ADMISSION 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA41 MISSING/INCOMPLETE/INVALID ADMISSION TYPE. 0280 PATIENT STATUS IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA43 MISSING/INCOMPLETE/INVALID PATIENT STATUS. 0281 PATIENT STATUS IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA43 MISSING/INCOMPLETE/INVALID PATIENT STATUS. 0282 COVERED DAYS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA32 MISSING/INCOMPLETE/INVALID NUMBER OF COVERED DAYS DURING THE BILLING PERIOD. 0283 COVERED DAYS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA32 MISSING/INCOMPLETE/INVALID NUMBER OF COVERED DAYS DURING THE BILLING PERIOD. 0284 PRIMARY CONDITION CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M44 MISSING/INCOMPLETE/INVALID CONDITION CODE. 0285 SECOND CONDITON CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M44 MISSING/INCOMPLETE/INVALID CONDITION CODE. 0286 THIRD CONDITION CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M44 MISSING/INCOMPLETE/INVALID CONDITION CODE. 0287 FOURTH CONDITION CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M44 MISSING/INCOMPLETE/INVALID CONDITION CODE. 0288 FIFTH CONDITION CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M44 MISSING/INCOMPLETE/INVALID CONDITION CODE. 0289 SIXTH CONDITION CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M44 MISSING/INCOMPLETE/INVALID CONDITION CODE. 0290 SEVENTH CONDITION CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M44 MISSING/INCOMPLETE/INVALID CONDITION CODE. 0291 REVENUE CODE 183 REQUIRES OSC = 74 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M46 MISSING/INCOMPLETE/INVALID OCCURRENCE SPAN CODE(S). 0292 REVENUE CODE 185 REQUIRES OSC = 71 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 0301 301 PAYER RESPONSIBILTY/OTHER PAYER COUNT MISMATCH A1 CLAIM/SERVICE IS DENIED MA04 SECONDARY PAYMENT CANNOT BE CONSIDERED WITHOUT THE IDENTITY OF OR PAYMENT INFORMATION FROM THE PRIMARY PAYER. THE INFORMATION WAS EITHER NOT REPORTED OR WAS ILLEGIBLE. 0302 INSURED GROUP NAME (HSN TYPE) IS MISSING OR INVALID A1 CLAIM/SERVICE IS DENIED MA04 SECONDARY PAYMENT CANNOT BE CONSIDERED WITHOUT THE IDENTITY OF OR PAYMENT INFORMATION FROM THE PRIMARY PAYER. THE INFORMATION WAS EITHER NOT REPORTED OR WAS ILLEGIBLE. 0303 DESTINATION PAYER ID MUST BE 995 95 PLAN PROCEDURES NOT FOLLOWED M56 MISSING/INCOMPLETE/INVALID PAYER IDENTIFIER 0304 PYR RESPONSIB AND INSURED GRP NAME NOT COMPATIBLE A1 CLAIM/SERVICE DENIED MA04 SECONDARY PAYMENT CANNOT BE CONSIDERED WITHOUT THE IDENTITY OF OR PAYMENT INFORMATION FROM THE PRIMARY PAYER. THE INFORMATION WAS EITHER NOT REPORTED OR WAS ILLEGIBLE. 0305 G1 REF REQUIRED WHEN HSN INSURED GROUP IS CA OR MH 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0308 AID CAT MUST BE HB WHEN INSURED GROUP IS BD 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0309 AID CAT MUST BE HC OR HD WHEN INSURED GROUP IS CA 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0310 AID CAT MUST BE HA WHEN INSURED GROUP IS MH 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0315 HSN PARTIAL CLM PAT RESPONSIBILITY AMT NOT PRESENT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N58 MISSING/INCOMPLETE/INVALID PATIENT LIABILITY AMOUNT 0320 INVALID TOB FOR HSN A1 CLAIM/SERVICE DENIED MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 0327 HSN MH CLAIM SUBMISSION >18 MONTHS FROM LDOS 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION 0330 HSN BD CLAIM SUBMISSION <= 120 DAYS FROM DOS 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0335 OCCURRENCE CODE A2 REQUIRED ON HSN BD CLAIM 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0339 REVENUE CODE IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 0340 REVENUE CODE IS INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 0343 CERTIFICATION CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N474 INCOMPLETE/INVALID CERTIFICATION 0347 PAYER PRIOR PAYMENT IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA04 SECONDARY PAYMENT CANNOT BE CONSIDERED WITHOUT THE IDENTITY OF OR PAYMENT INFORMATION FROM THE PRIMARY PAYER. THE INFORMATION WAS EITHER NOT REPORTED OR WAS ILLEGIBLE. 0350 NO. OF DETAILS NOT EQUAL TO SUBMITTED DETAIL COUNT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N379 CLAIM LEVEL INFORMATION DOES NOT MATCH LINE LEVEL INFORMATION. 0351 REFILL NOT ALLOWED FOR NARCOTIC DRUGS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0355 FIFTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0356 SIXTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0357 SEVENTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0358 EIGHTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0359 NINTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0360 TENTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 0361 ELEVENTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 0362 TWELFTH DIAGNOSIS CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 0363 PRINCIPAL ICD9 PROCEDURE CODE IS INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA66 MISSING/INCOMPLETE/INVALID PRINCIPAL PROCEDURE CODE. 0365 PRINCIPAL PROCEDURE DATE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N301 MISSING/INCOMPLETE/INVALID PROCEDURE DATE(S). 0366 FIRST OTHER PROCEDURE CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M67 MISSING/INCOMPLETE/INVALID OTHER PROCEDURE CODE(S). 0368 FIRST OTHER PROCEDURE DATE INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N301 MISSING/INCOMPLETE/INVALID PROCEDURE DATE(S). 0369 SECOND OTHER PROCEDURE CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M67 MISSING/INCOMPLETE/INVALID OTHER PROCEDURE CODE(S). 0371 SECOND OTHER PROCEDURE DATE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N301 MISSING/INCOMPLETE/INVALID PROCEDURE DATE(S). 0372 THIRD OTHER PROCEDURE CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M67 MISSING/INCOMPLETE/INVALID OTHER PROCEDURE CODE(S). 0375 FOURTH OTHER PROCEDURE CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M67 MISSING/INCOMPLETE/INVALID OTHER PROCEDURE CODE(S). 0378 FIFTH OTHER PROCEDURE CODE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M67 MISSING/INCOMPLETE/INVALID OTHER PROCEDURE CODE(S). 0382 ATTENDING PHYSICIAN ID INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N253 MISSING/INCOMPLETE/INVALID ATTENDING PROVIDER PRIMARY IDENTIFIER. 0383 FIRST OTHER PHYSICIAN ID INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0389 REVENUE CODE REQUIRES A CORRESPONDING HCPCS/CPT4 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M20 MISSING/INCOMPLETE/INVALID HCPCS. 0391 MEDICARE DEDUCTIBLE AMOUNT MISSING-DETAIL 1 DEDUCTIBLE AMOUNT N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0392 MEDICARE PAID AMOUNT NOT NUMERIC-DETAIL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0393 MEDICARE DEDUCTIBLE AMOUNT MISSING 1 DEDUCTIBLE AMOUNT N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0394 MEDICARE CO-INSURANCE AMOUNT MISSING 2 COINSURANCE AMOUNT N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0395 "HEADER STATEMENT COVERS PERIOD ""FROM"" DATE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M52 "MISSING/INCOMPLETE/INVALID ""FROM"" DATE(S) OF SERVICE" 0396 "HEADER STATEMENT COVERS PERIOD ""FROM"" DATE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M52 "MISSING/INCOMPLETE/INVALID ""FROM"" DATE(S) OF SERVICE" 0397 "HEADER STMT COVERS PERIOD ""THROUGH"" DATE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M59 "MISSING/INCOMPLETE/INVALID ""TO"" DATE(S) OF SERVICE" 0398 "STATEMENT COVERS PERIOD ""THROUGH"" DATE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M59 "MISSING/INCOMPLETE/INVALID ""TO"" DATE(S) OF SERVICE" 0400 DETAIL UNITS OF SERVICE MUST BE GREATER THAN ZERO 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0401 PRESENT ON ADMISSION INDICATOR MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 0402 PRESENT ON ADMISSION INDICATOR INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 0403 PRESENT ON ADMISSION IND PRESENT WHERE NOT ALLOWED 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 0405 PAID PAPE WITH 0 ALLOWED UNITS B13 PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT M86 SERVICE DENIED BECAUSE PAYMENT ALREADY MADE FOR SAME/SIMILAR PROCEDURE WITHIN SET TIME FRAME 0427 ACCIDENT DATE INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0431 DEDUCTIBLE AMOUNT INVALID-DETAIL 1 DEDUCTIBLE AMOUNT N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0432 COINSURANCE AMOUNT INVALID-DETAIL 2 COINSURANCE AMOUNT N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0433 MEDICARE DEDUCTIBLE AMOUNT INVALID 1 DEDUCTIBLE AMOUNT N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0434 MEDICARE COINSURANCE AMOUNT INVALID 2 COINSURANCE AMOUNT N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0436 TOTAL MEDICARE ALLOWED AMOUNT INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0437 MEDICARE PSYCH ADJUSTMENT AMOUNT INVALID 122 PSYCHIATRIC REDUCTION. N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0438 TOTAL MEDICARE ALLOWED AMOUNT INVALID-DETAIL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0439 PSYCH ADJUSTMENT (PR122) AMOUNT INVALID-DETAIL 122 PSYCHIATRIC REDUCTION. N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0440 MCARE PAID 100% OF CLAIM-HEADER 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 0441 MCARE PAID 100% OF CLAIM-DETAIL 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 0442 MEDICARE PAID AMOUNT NOT NUMERIC-HEADER 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0443 MEDICARE PAID AMOUNT NOT NUMERIC-DETAIL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 0444 MEDICARE APPROVED AMOUNT = 0 - HEADER A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0445 MEDICARE APPROVED AMOUNT = 0 - DETAIL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0450 INVALID QUADRANT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0452 DTL RENDERING/PERFORMING PROVIDER SERV LOC MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 0453 HDR RENDERING/PERFORMING PROVIDER SERV LOC MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 0454 INVALID ASSIGNMENT CODE 111 NOT COVERED UNLESS THE PROVIDER ACCEPTS ASSIGNMENT. - - 0456 INVALID PROCEDURE TYPE ACC. TO PROCEDURE QUALIFIER 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0457 INVALID PRINCIPAL/OTHER PROCEDURE TYPE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0458 DIAGNOSIS CODE 10 - 24 INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 0459 DETAIL DIAGNOSIS TREATMENT INDICATOR INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0461 VALUE CODE IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M49 MISSING/INCOMPLETE/INVALID VALUE CODE(S) OR AMOUNT(S). 0462 VALUE CODE AMOUNT IS MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M49 MISSING/INCOMPLETE/INVALID VALUE CODE(S) OR AMOUNT(S). 0463 VALUE CODE AMOUNT IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M49 MISSING/INCOMPLETE/INVALID VALUE CODE(S) OR AMOUNT(S). 0471 CONDITION CODE 8-24 INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M44 MISSING/INCOMPLETE/INVALID CONDITION CODE. 0473 ICD9 PROCEDURE 7-24 INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M67 MISSING/INCOMPLETE/INVALID OTHER PROCEDURE CODE(S). 0474 ICD-9 PROCEDURE 7-24 OR DATE MISSING 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N301 MISSING/INCOMPLETE/INVALID PROCEDURE DATE(S). 0475 ICD9 PROCEDURE 7-24 DATE IS INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N301 MISSING/INCOMPLETE/INVALID PROCEDURE DATE(S). 0476 DETAIL ATTENDING PHYSICIAN ID IS INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N253 MISSING/INCOMPLETE/INVALID ATTENDING PROVIDER PRIMARY IDENTIFIER. 0477 "DETAIL FIRST ""OTHER PHYSICIAN"" ID IS INVALID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N270 MISSING/INCOMPLETE/INVALID OTHER PROVIDER PRIMARY IDENTIFIER. 0478 0478-BILL CPT CODES TO MASSHEALTH ON CMS 1500 FORM A1 CLAIM/SERVICE DENIED N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 0481 MLOA DAYS GREATER THAN HEADER DAYS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0484 LOA OSC DATES CANNOT SPAN ACROSS DIFFERENT MONTHS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N74 "RESUBMIT WITH MULTIPLE CLAIMS, EACH CLAIM COVERING SERVICES PROVIDED IN ONLY ONE CALENDAR MONTH. " 0485 TO DATE IS LESS THAN FROM DATE FOR OCCUR SPAN 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0486 MLOA DAYS AND DAYS BETWEEN FROM AND TO DOS NOT EQUAL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0487 NMLOA DAYS AND DAYS BETWEEN FROM AND TO DOS NOT SAME 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0488 MLOA OSC DAYS SPANNED > DETAIL FROM AND TO DOS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0489 THE OCCURRENCE SPAN FROM DATE IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N300 MISSING/INCOMPLETE/INVALID OCCURRENCE SPAN DATE(S) 0490 THE OCCURRENCE SPAN TO DATE IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N300 MISSING/INCOMPLETE/INVALID OCCURRENCE SPAN DATE(S) 0491 DIFFERENT MLOA DAYS CANNOT OVERLAP FROM AND TO DAYS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0492 DIFFERENT NMLOA DAYS CANT OVERLAP FROM AND TO DAYS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0493 MLOA AND NMLOA DAYS CANT OVERLAP FROM AND TO DAYS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0494 OCCURRENCE SPAN LOA DATES NOT WITHIN CLAIM DATES 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N300 MISSING/INCOMPLETE/INVALID OCCURRENCE SPAN DATE(S) 0495 "THIS LTC CLAIM HAS LOA DAYS, BUT PROVIDER TYPE WRONG 96 NON-COVERED CHARGE(S). N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 0496 OCCURRENCE SPAN FROM DATE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N300 MISSING/INCOMPLETE/INVALID OCCURRENCE SPAN DATE(S) 0497 OCCURRENCE SPAN TO DATE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N300 MISSING/INCOMPLETE/INVALID OCCURRENCE SPAN DATE(S) 0498 THE OCCURRENCE CODE IS INVALID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M46 MISSING/INCOMPLETE/INVALID OCCURRENCE SPAN CODE(S). 0500 DATE PRESCRIBED AFTER BILLING DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N57 MISSING/INCOMPLETE/INVALID PRESCRIBING DATE. 0502 DATE DISPENSED EARLIER THAN DATE PRESCRIBED 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N304 MISSING/INCOMPLETE/INVALID DISPENSED DATE. 0503 DATE DISPENSED AFTER BILLING DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N304 MISSING/INCOMPLETE/INVALID DISPENSED DATE. 0506 ICN DATE PRIOR TO DATE BILLED 110 BILLING DATE PREDATES SERVICE DATE. MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0507 "THE DETAIL ""FROM"" DATE IS AFTER THE ""TO"" DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M52 "MISSING/INCOMPLETE/INVALID ""FROM"" DATE(S) OF SERVICE" 0508 TOTAL CHARGE DOES NOT EQUAL THE SUM OF ALL DETAILS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M54 MISSING/INCOMPLETE/INVALID TOTAL CHARGES. 0512 CLAIM PAST 12 MONTH FILING LIMIT 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0514 HEADER THRU DATE OF SERVICE AFTER ICN DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA32 MISSING/INCOMPLETE/INVALID NUMBER OF COVERED DAYS DURING THE BILLING PERIOD 0518 COVERED DAYS EXCEED STATEMENT PERIOD 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA32 MISSING/INCOMPLETE/INVALID NUMBER OF COVERED DAYS DURING THE BILLING PERIOD. 0519 "ADMIT DATE IS AFTER STATEMENT PERIOD ""FROM"" DATE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M52 "MISSING/INCOMPLETE/INVALID ""FROM"" DATE(S) OF SERVICE" 0520 INVALID REVENUE CODE/PROCEDURE CODE COMBINATION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N56 PROCEDURE CODE BILLED IS NOT CORRECT/VALID FOR THE SERVICES BILLED OR THE DATE OF SERVICE BILLED. 0521 THRU DOS LATER THAN DISCHARGE DATE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N318 MISSING/INCOMPLETE/INVALID DISCHARGE OR END OF CARE DATE. 0526 HEADER FROM DOS IS AFTER HEADER THROUGH DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0527 DETAIL FROM DATE OF SERVICE IS AFTER ICN DATE 110 BILLING DATE PREDATES SERVICE DATE. MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0529 SURGERY DATE IS BEFORE THE ADMIT DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0530 SURGERY DATE IS AFTER THE DISCHARGE DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0532 REVENUE CODE/PROVIDER SPECIALTY MISMATCH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 0542 MEMBER INELIGIBLE SERV DATE 177 PATIENT-HAS NOT MET THE REQUIRED ELIGIBILITY REQUIREMENTS. N30 PATIENT INELIGIBLE FOR THIS SERVICE. 0545 FINAL DEADLINE EXCEEDED 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0550 ADJUSTMENT FAILED 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N380 "THE ORIGINAL CLAIM HAS BEEN PROCESSED, SUBMIT A CORRECTED CLAIM. " 0551 DISPOSITION AMT FOR ADJUSTMENT IS LESS THAN ZERO B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. MA22 PAYMENT OF LESS THAN $1.00 SUPPRESSED. 0552 PROVIDER MAY NOT ADJUST GENERATED ATP/PAPE CLAIM B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0553 ADJUSTMENT NPI TRANSLATION ISSUE A1 CLAIM/SERVICE DENIED N516 RECORDS INDICATE A MISMATCH BETWEEN THE SUBMITTED NPI AND EIN 0554 HEADER BILLED DATE IS PRIOR TO DATES OF SERVICE 110 BILLING DATE PREDATES SERVICE DATE. MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0555 CLAIM PAST 24 MONTH FILING DEADLINE- DETAIL 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0556 CLAIM PAST 24 MONTH FILING DEADLINE- HEADER 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0557 COINS AND DEDUCT AMT MISSING - DTL 2 COINSURANCE AMOUNT N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0558 COINSURANCE AND DEDUCT AMT MISSING 2 COINSURANCE AMOUNT N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0559 M-CARE COIN AMT GREATER THAN M-CARE PAID AMT-HDR   2 COINSURANCE AMOUNT N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0560 M-CARE COIN AMT GREATER THAN M-CARE PAID AMT-HDR   2 COINSURANCE AMOUNT N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0568 HEADER DISCHARGE DATE IS LESS THAN ADMIT DATE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N50 MISSING/INCOMPLETE/INVALID DISCHARGE INFORMATION. 0569 HDR DTE OF ACCIDENT GREATER THAN LAST DTE OF SERV 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0570 HEADER TOTAL DAYS LESS THAN COVERED DAYS A1 CLAIM/SERVICE DENIED M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0571 DETAIL SURGICAL PROCEDURE MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M51 MISSING/INCOMPLETE/INVALID PROCEDURE CODE(S) 0572 ROOM AND BOARD DAYS CONFLICT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA32 MISSING/INCOMPLETE/INVALID NUMBER OF COVERED DAYS DURING THE BILLING PERIOD. 0574 SERV DATES ARE NOT IN SAME MONTH-HEADER 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N74 "RESUBMIT WITH MULTIPLE CLAIMS, EACH CLAIM COVERING SERVICES PROVIDED IN ONLY ONE CALENDAR MONTH. " 0575 SURGERY DTE CANNOT BE OUTSIDE HDR DATES OF SERVICE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N341 MISSING/INCOMPLETE/INVALID SURGERY DATE. 0576 CLAIM HAS THIRD-PARTY PAYMENT 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS - - 0577 SERV DATES ARE NOT IN SAME MONTH-DETAIL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0585 ADMIT DATE NOT EQ TO 1ST DATE OF SERV FOR REV/DIAG COMBINATION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0589 SUSPEND ADJUSTMENT FOR REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0590 DAYS OVERLAPP FISCAL YEAR END/BEGIN DATES 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0594 UNITS/DOS CONFLICT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0599 ATTACHMENT CONTROL NUMBER MISSING 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0600 UNITS NOT EQUAL TO QUADRANTS BILLED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0601 TEETH NOT BILLABLE WITH QUADRANTS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0602 UNITS NOT EQUAL TO TEETH BILLED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0610 LOC NOT COMPATIBLE WITH LEAVE DAYS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0616 COMPONENT OF STAY EXCEEDED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0617 MEMBER AGE/PROGRAM CONFLICT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N30 PATIENT INELIGIBLE FOR THIS SERVICE. 0618 NO OUTLIER DAYS FOR HSNI 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M45 MISSING/INCOMPLETE/INVALID OCCURRENCE CODE(S). 0619 INVALID TYPE OF CLAIM FOR HSNI 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M45 MISSING/INCOMPLETE/INVALID OCCURRENCE CODE(S). 0620 OCCURRENCE CODE 47 FDOS IS INVALID FOR HSNI 69 DAY OUTLIER AMOUNT - - 0621 MISSING/INVALID K3 SEGMENT FOR HSN 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0622 INVALID INSURED GROUP NAME/K3 RECORD TYPE FOR HSN A1 CLAIM/SERVICE DENIED N229 INCOMPLETE/INVALID CONTRACT INDICATOR 0623 INVALID K3 REFERENCE ID FOR HSN A1 CLAIM/SERVICE DENIED N229 INCOMPLETE/INVALID CONTRACT INDICATOR 0624 INVALID K3 TERMS DISCOUNT FOR HSN RECORD TYPE 06 A1 CLAIM/SERVICE DENIED N205 INFORMATION PROVIDED WAS ILLEGIBLE 0625 INVALID K3 PARTIAL START DATE FOR HSN 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT - - 0626 INVALID INSURED GROUP NAME/K3 RECORD TYPE FOR HSN A1 CLAIM/SERVICE DENIED N229 INCOMPLETE/INVALID CONTRACT INDICATOR 0627 INVALID INSURED GROUP NAME/K3 REFERENCE ID FOR HSN 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0629 INVALID K3 WRITE-OFF DATE FOR HSN 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N229 INCOMPLETE/INVALID CONTRACT INDICATOR 0630 K3 ESTIMATED AMOUNT DUE IS NOT VALID FOR HSN A1 CLAIM/SERVICE DENIED N448 THIS DRUG/SERVICE/SUPPLY IS NOT INCLUDED IN THE FEE SCHEDULE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT 0634 A3 OCC CODE REPORTED, HSN CLAIM MUST BE PRIMARY" 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0636 B3 OCC CODE REPORTED, HSN CLAIM MUST BE SECONDARY" 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0637 C3 OCC CODE REPORTED, HSN CLAIM MUST BE TERTIARY+" 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES - - 0643 INVALID OTHER COVERAGE CODE B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 0700 MULTIPLE PRIMARY ENDOSCOPIC FAMILIES CANNOT BE BILLED 125 SUBMISSION/BILLING ERROR(S). M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCEDURE. SEPARATE PAYMENT IS NOT ALLOWED. 0701 NO PRIMARY SURGICAL PROCEDURE INDICATED 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 0702 ENDOSCOPIC PRICE AMOUNT LESS THAN ZERO. 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA22 PAYMENT OF LESS THAN $1.00 SUPPRESSED. 0703 ENDO FAMILY MIXED PRIMARY/SECONDARY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0799 INVALID DISPENSE STATUS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0800 HCPCS REQUIRES NDC 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 0801 SPECIAL HANDLING EDIT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0802 SPECIAL HANDLING EDIT WITH CRITICAL ERROR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0803 GENERIC SPECIAL HANDLING 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0804 GENERIC SPECIAL PAY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0805 INVALID SPECIAL HANDLING CODE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0806 NOTE REQUIRED FOR PREEMPTIVE ESC - DETAIL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0807 NOTE REQUIRED FOR PREEMPTIVE ESC - HEADER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0808 CLERK ID REQUIRED FOR PREEMPTIVE ESC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0809 CLERK ID REQUIRED FOR PREEMPTIVE ESC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0810 INVALID SUBMITTER ID 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N257 MISSING/INCOMPLETE/INVALID BILLING PROVIDER/SUPPLIER PRIMARY IDENTIFIER. 0811 INVALID SUBMITTER ID/BILLING PROVIDER COMBINATION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N257 MISSING/INCOMPLETE/INVALID BILLING PROVIDER/SUPPLIER PRIMARY IDENTIFIER. 0812 NO PCC SELECTED 242 SERVICES NOT PROVIDED BY NETWORK/PRIMARY CARE PROVIDERS. N270 MISSING/INCOMPLETE/INVALID OTHER PROVIDER PRIMARY IDENTIFIER. 0813 SPECIAL PAY PRICED AT ZERO 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0814 HIC NUMBER NOT PRESENT ON CLAIM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 0815 TYPE OF BILL MUST MATCH PATIENT STATUS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 0816 DISALLOW ROOM AND BOARD FOR LATE CHARGES 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 0817 INVALID DISCHARGE DATE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N50 MISSING/INCOMPLETE/INVALID DISCHARGE INFORMATION. 0818 SPCL HANDLING 90 DAY WAIVER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0819 SUSPEND CLAIM FOR TPL REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0820 NDC GIVEN WITH NO/INVALID UNITS FOR HCPCS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0821 NDC GIVEN WITH NO/INVALID MEASUREMENT FOR HCPCS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 0822 NDC GIVEN WITH NO/INVALID UNIT PRICE FOR HCPCS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0823 NO PCC SELECTED 24 CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN N52 PATIENT NOT ENROLLED IN THE BILLING PROVIDER'S MANAGED CARE PLAN ON THE DATE OF SERVICE 0828 CLAIM/ APPEAL IS UNDER REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA91 THIS DETERMINATION IS THE RESULT OF THE APPEAL YOU FILED 0829 NCCI APPEAL/SPECIAL HANDLE UNDER REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA91 THIS DETERMINATION IS THE RESULT OF THE APPEAL YOU FILED 0830 GROUPER UNABLE TO ASSIGN DRG TO CLAIM A8 UNGROUPABLE DRG. - - 0831 3M GRP - DIAGNOSIS CODE CANNOT BEUSED AS PRINCIPAL DIAGNOSIS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 0832 3M GRP - RECORD DOES NOT MEET CRITERIA FOR ANY DRG 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N208 MISSING/INCOMPLETE/INVALID DRG CODE 0833 3M GRP - INVALID AGE IN YEARS OR ADMISSION AGE IN DAY 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N129 NOT ELIGIBLE DUE TO THE PATIENT'S AGE. 0834 3M GRP - INVALID SEX 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA39 MISSING/INCOMPLETE/INVALID GENDER. 0835 3M GRP - INVALID DISCHARGE STATUS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N50 MISSING/INCOMPLETE/INVALID DISCHARGE INFORMATION. 0836 3M GRP - INVALID BIRTH WEIGHT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N207 MISSING/INCOMPLETE/INVALID WEIGHT. 0837 3M GRP - INVALID DISCHARGE AGE IN DAYS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N50 MISSING/INCOMPLETE/INVALID DISCHARGE INFORMATION. 0838 3M GRP - INVALID PRINCIPAL DIAGNOSIS 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 0839 3M GRP - GESTATIONAL AGE/BIRTH WEIGHT CONFLICT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N207 MISSING/INCOMPLETE/INVALID WEIGHT. 0850 BILLING DEADLINE EXCEEDED - DETAIL 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0851 REBILL: ORIGINAL CLAIM DEADLINE EXCEEDED 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0852 BILLING DEADLINE EXCEEDED - HEADER 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0853 FINAL DEADLINE EXCEEDED - DETAIL 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0854 TIMELY FILING - ORIGINAL ICN NOT FOUND 29 THE TIME LIMIT FOR FILING HAS EXPIRED. M47 MISSING/INCOMPLETE/INVALID INTERNAL OR DOCUMENT CONTROL NUMBER. 0855 FINAL DEADLINE EXCEEDED - HEADER 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0856 DATE OF SERVICE EXCEEDS 36 MONTHS - DETAIL 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0857 DATE OF SERVICE EXCEEDS 36 MONTHS - HEADER 29 THE TIME LIMIT FOR FILING HAS EXPIRED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0861 MEMBER MUST APPLY BEFORE ADMIN DAYS START 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N30 PATIENT INELIGIBLE FOR THIS SERVICE. 0862 EMERGENCY INDICATOR/POS MISMATCH 58 TREATMENT WAS DEEMED BY THE PAYER TO HAVE BEEN RENDERED IN AN INAPPROPRIATE OR INVALID PLACE OF SERVICE. M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 0870 INVALID START/STOP TIME A1 CLAIM/SERVICE DENIED N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0871 VOID / ORIGINAL $ AMOUNT CONFLICT A1 CLAIM/SERVICE DENIED M79 MISSING/INCOMPLETE/INVALID CHARGE. 0872 MONTH/YEAR MISMATCH ON ADJUSTMENT A1 CLAIM/SERVICE DENIED MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 0873 NDC SUBMITTED ON INVALID PROCEDURE A1 CLAIM/SERVICE DENIED N161 THIS DRUG/SERVICE/SUPPLY IS COVERED ONLY WHEN THE ASSOCIATED SERVICE IS COVERED 0874 PRESCRIPTION INVALID FOR COMPOUND DRUG 176 PRESCRIPTION IS NOT CURRENT - - 0875 PROCEDURE INVALID FOR COMPOUND DRUG A1 CLAIM/SERVICE DENIED N56 PROCEDURE CODE BILLED IS NOT CORRECT/VALID FOR THE SERVICES BILLED OR THE DATE OF SERVICE BILLED 0876 INVALID PRODUCT QUALIFIER A1 CLAIM/SERVICE DENIED N59 PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION 0877 INVALID PRESCRIPTION QUALIFIER 175 PRESCRIPTION IS INCOMPLETE N59 PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION 0878 INVALID PRESCRIPTION QUALIFIER/ID COMBINATION A1 CLAIM/SERVICE DENIED N388 MISSING/INCOMPLETE/INVALID PRESCRIPTION NUMBER 0879 INVALID PRESCRIPTION QUALIFIER/ID COMBINATION 175 PRESCRIPTION IS INCOMPLETE N388 MISSING/INCOMPLETE/INVALID PRESCRIPTION NUMBER 0880 INVALID PRESCRIPTION ID 175 PRESCRIPTION IS INCOMPLETE N388 MISSING/INCOMPLETE/INVALID PRESCRIPTION NUMBER 0881 INVALID PRESCRIPTION DATE 175 PRESCRIPTION IS INCOMPLETE N59 PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION 0882 PRESCRIPTION DATE GREATER THAN CLAIM DATE 176 PRESCRIPTION IS NOT CURRENT N59 PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION 0886 "ATTACHMENT REQUIRED-PODIATRIC, SUSPEND FOR REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART " 0888 DCN INVALID FOR ATTACHMENT CROSS-REFERENCE A1 CLAIM/SERVICE DENIED M47 MISSING/INCOMPLETE/INVALID INTERNAL OR DOCUMENT CONTROL NUMBER 0889 CLAIM ATTACHMENT REQUIRED FOR PODIATRIC SERVICE A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART" 0890 EDI TRANS TYPE IS 31 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0891 EDI TRANS TYPE IS RP 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0900 PROVIDER TYPE/SPECIALTY GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE 0902 PROCEDURE CODE GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M51 MISSING/INCOMPLETE/INVALID PROCEDURE CODE(S) 0903 OCCURRENCE CODE GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M45 MISSING/INCOMPLETE/INVALID OCCURRENCE CODE(S). 0904 VALUE CODE GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M49 MISSING/INCOMPLETE/INVALID VALUE CODE(S) OR AMOUNT(S). 0905 REVENUE CODE GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 0906 DIAGNOSIS GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 0907 ICD-9 PROCEDURE GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M67 MISSING/INCOMPLETE/INVALID OTHER PROCEDURE CODE(S). 0908 MODIFIER GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0909 PATIENT STATUS GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA43 MISSING/INCOMPLETE/INVALID PATIENT STATUS. 0910 BENEFIT PLAN GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 0911 CLAIM IN PROCESS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0912 PROVIDER LOC GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0913 SPECIAL HANDLING GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0914 TYPE OF BILL GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 0915 COUNTY CODE GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0916 ZIP CODE GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 0917 PLACE OF SERVICE GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 0918 MEMBER LOC GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0919 ESC GROUP EMPTY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 0930 2ND OCCURRENCE POSITION NOT = 22 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M45 MISSING/INCOMPLETE/INVALID OCCURRENCE CODE(S). 0931 2ND OCCURRENCE OCDE = 22 BUT AMOUNT = 0 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M45 MISSING/INCOMPLETE/INVALID OCCURRENCE CODE(S). 0932 2ND OCCURRENCE AMOUNT > 0 BUT OSC NOT 22 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M45 MISSING/INCOMPLETE/INVALID OCCURRENCE CODE(S). 0933 INP CLM BUT RATE ID NOT 71 OR ADM TYPE NE ELCTV[3] 147 PROVIDER CONTRACTED/NEGOTIATED RATE EXPIRED OR NOT ON FILE. - - 0935 UB92 CLAIM BUT NO PATIENT ACCT NUMBER (MRN) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N237 INCOMPLETE/INVALID PATIENT MEDICAL RECORD FOR THIS SERVICE. 0936 MEMBER ENROL/PCCP CNFLCT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 0937 DETAIL CANNOT SPAN DATES 125 SUBMISSION/BILLING ERROR(S) N345 DATE RANGE NOT VALID WITH UNITS SUBMITTED 0999 CLAIM SELECTED FOR MASSPRO EXTRACT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N35 PROGRAM INTEGRITY/UTILIZATION REVIEW DECISION. 1000 BILLING PROVIDER I.D. NUMBER NOT ON FILE. 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N280 MISSING/INCOMPLETE/INVALID PAY-TO PROVIDER PRIMARY IDENTIFIER 1001 COB-BENEFIT PLAN 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 1002 DTL PERFORMING PROVIDER NOT ELIGIBLE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 1003 BILLING PROV NOT ELIGIBLE AT SERVICE LOCATION FOR PROGRAM BILLED B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. - - 1007 DETAIL RENDERING PROVIDER I.D. NOT ON FILE B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1010 RENDERING PROVIDER NOT A MEMBER OF BILLING GROUP 185 THE RENDERING PROVIDER IS NOT ELIGIBLE TO PERFORM THE SERVICE BILLED. - - 1012 RENDERING PROV SPECLTY NOT ELIGIBLE TO RENDER PROCEDURE 185 THE RENDERING PROVIDER IS NOT ELIGIBLE TO PERFORM THE SERVICE BILLED. N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 1013 PROV ASSIGNMENT NOT ACCEPTED 111 NOT COVERED UNLESS THE PROVIDER ACCEPTS ASSIGNMENT. - - 1014 INVALID ASSIGNMENT INDICATOR 111 NOT COVERED UNLESS THE PROVIDER ACCEPTS ASSIGNMENT. - - 1018 PROVIDER RATE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 1019 NO PROVIDER LEVEL OF CARE RATE ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 1020 ATTENDING PHYSICIAN ID NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N253 MISSING/INCOMPLETE/INVALID ATTENDING PROVIDER PRIMARY IDENTIFIER. 1021 FIRST OTHER PHYSICIAN ID NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N270 MISSING/INCOMPLETE/INVALID OTHER PROVIDER PRIMARY IDENTIFIER. 1023 LEVEL OF CARE BILLED NOT ON FILE FOR THIS PROVIDER 186 LEVEL OF CARE CHANGE ADJUSTMENT. N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 1024 BILLING PROVIDER NOT LISTED AS MEMBER LTC PROVIDER B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N141 THE PATIENT WAS NOT RESIDING IN A LONG-TERM CARE FACILITY DURING ALL OR PART OF THE SERVICE DATES BILLED. 1026 PRESCRIBING PHYSICIAN LICENSE NUMBER NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M143 THE PROVIDER MUST UPDATE LICENSE INFORMATION WITH THE PAYER. 1027 HEADER REFERRING PHYSICIAN ID NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N286 MISSING/INCOMPLETE/INVALID REFERRING PROVIDER PRIMARY IDENTIFIER. 1032 BILLING PROVIDER NOT ELIGIBLE TO BILL THIS CLAIM TYPE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 1036 RENDERING PROVIDER NOT ELIGIBLE TO BILL THIS CLAIM TYPE B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1037 FACILITY PROVIDER NUMBER NOT ON FILE B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N278 MISSING/INCOMPLETE/INVALID OTHER PAYER SERVICE FACILITY PROVIDER IDENTIFIER. 1040 BILLING PROVIDER ON REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 1041 BILLING PROVIDER ON REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 1050 SERVICE CANNOT BE REFERRED BY THE SAME BILLING PROVIDER 183 THE REFERRING PROVIDER IS NOT ELIGIBLE TO REFER THE SERVICE BILLED. N55 PROCEDURES FOR BILLING WITH GROUP/REFERRING/PERFORMING PROVIDERS WERE NOT FOLLOWED. 1051 HEADER RENDERING PROVIDER ID NOT VALID B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1053 DETAIL FIRST OTHER PHYSICIAN ID NUMBER NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N270 MISSING/INCOMPLETE/INVALID OTHER PROVIDER PRIMARY IDENTIFIER. 1054 DETAIL ATTENDING PHYSICIAN ID NUMBER NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N253 MISSING/INCOMPLETE/INVALID ATTENDING PROVIDER PRIMARY IDENTIFIER. 1055 DETAIL REFERRING PROV NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N286 MISSING/INCOMPLETE/INVALID REFERRING PROVIDER PRIMARY IDENTIFIER. 1058 UNABLE TO CROSSWALK ATTENDING/OTHER1/OTHER2 MEDICARE PROVIDER ID B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE N280 MISSING/INCOMPLETE/INVALID PAY-TO PROVIDER PRIMARY IDENTIFIER 1060 UNABLE TO CROSSWALK RENDERING MEDICARE PROVIDER ID B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1062 UNABLE TO CROSSWALK DETAIL RENDERING MEDICARE PROV 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N291 MISSING/INCOMPLETE/INVALID RENDING PROVIDER SECONDARY IDENTIFIER. 1063 UNABLE TO CROSSWALK BILLING MEDICARE PROVIDER ID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N259 MISSING/INCOMPLETE/INVALID BILLING PROVIDER/SUPPLIER SECONDARY IDENTIFIER. 1064 HEADER REFERRING PROVIDER CANNOT BE SAME AS BILLING 183 THE REFERRING PROVIDER IS NOT ELIGIBLE TO REFER THE SERVICE BILLED. N55 PROCEDURES FOR BILLING WITH GROUP/REFERRING/PERFORMING PROVIDERS WERE NOT FOLLOWED. 1065 DETAIL REFERRING PROVIDER CANNOT BE SAME AS BILLING 183 THE REFERRING PROVIDER IS NOT ELIGIBLE TO REFER THE SERVICE BILLED. N55 PROCEDURES FOR BILLING WITH GROUP/REFERRING/PERFORMING PROVIDERS WERE NOT FOLLOWED. 1066 BILLING PROVIDER NOT A VALID BILLER B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N259 MISSING/INCOMPLETE/INVALID BILLING PROVIDER/SUPPLIER SECONDARY IDENTIFIER. 1067 RENDERING EQUALS BILLING AND NOT A VALID BILLER B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N55 PROCEDURES FOR BILLING WITH GROUP/REFERRING/PERFORMING PROVIDERS WERE NOT FOLLOWED. 1068 REFERRING PROVIDER REQUIRED FOR INDEPENDENT CERTIFICATION B7 THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR THIS PROCEDURE/SERVICE ON THIS DATE OF SERVICE. N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1069 REFERRING PROVIDERCANNOT BE SAME AS RENDERING-HEADER 183 THE REFERRING PROVIDER IS NOT ELIGIBLE TO REFER THE SERVICE BILLED. N55 PROCEDURES FOR BILLING WITH GROUP/REFERRING/PERFORMING PROVIDERS WERE NOT FOLLOWED. 1070 REFERRING PROVIDER CANNOT BE SAME AS RENDERING-DETAIL 183 THE REFERRING PROVIDER IS NOT ELIGIBLE TO REFER THE SERVICE BILLED. N55 PROCEDURES FOR BILLING WITH GROUP/REFERRING/PERFORMING PROVIDERS WERE NOT FOLLOWED. 1071 PATIENT STILL IN THE HOSPITAL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA43 MISSING/INCOMPLETE/INVALID PATIENT STATUS. 1073 BILLING PROVIDER OUT OF STATE CONTIGUOUS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N79 SERVICE BILLED IS NOT COMPATIBLE WITH PATIENT LOCATION INFORMATION. 1074 BILLING PROVIDER OUT OF STATE NON-CONTIGUOUS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N79 SERVICE BILLED IS NOT COMPATIBLE WITH PATIENT LOCATION INFORMATION. 1100 ADJUST: FORMER TCN INCORRECT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N380 "THE ORIGINAL CLAIM HAS BEEN PROCESSED, SUBMIT A CORRECTED CLAIM. " 1101 INVALID ADJUSTMENT FORMER TCN A1 CLAIM/SERVICE DENIED M47 MISSING/INCOMPLETE/INVALID INTERNAL OR DOCUMENT CONTROL NUMBER. 1104 REBILL : ORIGINAL CLAIM PAID 18 EXACT DUPLICATE CLAIM/SERVICE. M86 SERVICE DENIED BECAUSE PAYMENT ALREADY MADE FOR SAME/SIMILAR PROCEDURE WITHIN SET TIME FRAME. 1108 THIS ADJUSTMENT CLAIM IS ALREADY ON HOLD B13 PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT. - - 1111 ITEM/SERVICE(S) PROVIDED NOT MOST COST EFFECTIVE 56 PROCEDURE/TREATMENT HAS NOT BEEN DEEMED `PROVEN TO BE EFFECTIVE' BY THE PAYER. - - 1116 SHOE PRESCRIPTION FORM MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N29 MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/CHART. 1117 PROC REQ REPORT/ RPT MISSING 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N29 MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/CHART. 1119 BILLING RID CONFLICT 31 PATIENT CANNOT BE IDENTIFIED AS OUR INSURED. N30 PATIENT INELIGIBLE FOR THIS SERVICE. 1120 CLAIM REQUIRES DOCUMENTATION (CAF EDIT) 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N29 MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/CHART. 1121 STERILIZATION FORM INCOMPLETE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N228 INCOMPLETE/INVALID CONSENT FORM. 1122 STERILIZATION REGS NOT MET B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N228 INCOMPLETE/INVALID CONSENT FORM. 1123 CLAIM NOT LEGIBLE B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N205 INFORMATION PROVIDED WAS ILLEGIBLE 1125 INCIDENTAL PROC NOT COVERED A1 CLAIM/SERVICE DENIED N19 PROCEDURE CODE INCIDENTAL TO PRIMARY PROCEDURE. 1126 CHARGES NOT ITEMIZED 97 THE BENEFIT FOR THIS SERVICE IS INCLUDED IN THE PAYMENT/ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE THAT HAS ALREADY BEEN ADJUDICATED. M79 MISSING/INCOMPLETE/INVALID CHARGE. 1127 HYSTERECTOMY REGS NOT MET 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N228 INCOMPLETE/INVALID CONSENT FORM. 1130 INVALID STERILIZATION FORM 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N228 INCOMPLETE/INVALID CONSENT FORM. 1132 CLAIMS REQ SPECIAL HANDLING 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1134 UR LETTER NOT ACCEPTABLE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N225 "INCOMPLETE/INVALID DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 1135 CLAIM CONTAINS MEDICARE PART B COVERED CHARGES 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 1136 NOT AN ACCEPTABLE ATTACHMENT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N225 "INCOMPLETE/INVALID DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 1139 INVALID ABORTION FORM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N228 INCOMPLETE/INVALID CONSENT FORM. 1140 ABORTION FORM INCOMPLETE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N228 INCOMPLETE/INVALID CONSENT FORM. 1146 DUPE PREPAY REVIEW CLAIM OR RESUBMISSION ERROR 18 EXACT DUPLICATE CLAIM/SERVICE. - - 1149 PA# NOT ON FILE 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " - - 1150 IDENTIFY/DESCRIBE PROCEDURE WHEN BILLING AN UNLISTED CODE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N350 MISSING/INCOMPLETE/INVALID DESCRIPTION OF SERVICE FOR A NOT OTHERWISE CLASSIFIED (NOC) CODE OR AN UNLISTED PROCEDURE. 1151 COPAY EXEMPT - AGE 3 CO-PAYMENT AMOUNT - - 1152 ASST SURG NOT COV FOR PROC 185 THE RENDERING PROVIDER IS NOT ELIGIBLE TO PERFORM THE SERVICE BILLED. - - 1153 UR DENIED ADMISSION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N350 MISSING/INCOMPLETE/INVALID DESCRIPTION OF SERVICE FOR A NOT OTHERWISE CLASSIFIED (NOC) CODE OR AN UNLISTED PROCEDURE. 1514 INCORRECT PROC CODE FOR SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N56 PROCEDURE CODE BILLED IS NOT CORRECT/VALID FOR THE SERVICES BILLED OR THE DATE OF SERVICE BILLED. 1515 PROCEDURE CODE/ INVOICE CONFLICT (PHARM) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 1516 INCORRECT REVENUE CODE FOR SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 1517 CLAIM MEDICAL NECESSITY FORM ERROR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N227 INCOMPLETE/INVALID CERTIFICATE OF MEDICAL NECESSITY. 1518 SERVICE PROVIDED REQUIRES A MORE DETAILED REPORT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N225 "INCOMPLETE/INVALID DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 1519 INAPPROPRIATE PROCEDURE CODE FOR SERVICE BILLED A1 CLAIM/SERVICE DENIED N56 PROCEDURE CODE BILLED IS NOT CORRECT/VALID FOR THE SERVICES BILLED OR THE DATE OF SERVICE BILLED. 1520 PAYMENT INCLUDED IN PRIMARY PROCEDURE A1 CLAIM/SERVICE DENIED M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCEDURE. SEPARATE PAYMENT IS NOT-ALLOWED. 1521 PAYMENT MADE TO ANOTHER PHYSICIAN B20 PROCEDURE/SERVICE WAS PARTIALLY OR FULLY FURNISHED BY ANOTHER PROVIDER. - - 1522 REPORT NOT LEGIBLE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N205 INFORMATION PROVIDED WAS ILLEGIBLE 1523 HYSTERECTOMY FORM INCOMPLETE A1 CLAIM/SERVICE DENIED N228 INCOMPLETE/INVALID CONSENT FORM. 1524 INVALID HYSTERECTOMY FORM 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N228 INCOMPLETE/INVALID CONSENT FORM. 1525 ABORTION REGS NOT MET 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N228 INCOMPLETE/INVALID CONSENT FORM. 1526 MEDICAL RECORD NOT SUBMITTED TO PREPAYMENT REVIEW 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N102 THIS CLAIM HAS BEEN DENIED WITHOUT REVIEWING THE MEDICAL RECORD BECAUSE THE REQUESTED RECORDS WERE NOT RECEIVED OR WERE NOT RECEIVED-TIMELY. 1527 MEDICAL RECORD INCOMPLETE AS DETERMINED BY PREPAY REVIEW A1 CLAIM/SERVICE DENIED N237 INCOMPLETE/INVALID PATIENT MEDICAL RECORD FOR THIS SERVICE. 1528 MLOA DAYS NOT INDICATED ON CLAIM FORM 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 1530 INVALID PRESCRIBING PROVIDER TRANS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 1662 BILLING PROVIDER I.D. NUMBER NOT 0N FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N257 MISSING/INCOMPLETE/INVALID BILLING PROVIDER/SUPPLIER PRIMARY IDENTIFIER. 1801 NEED REFERRING PROVIDER FOR RADIOLOGY SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N286 MISSING/INCOMPLETE/INVALID REFERRING PROVIDER PRIMARY IDENTIFIER. 1802 MEDICARE ANCILLARY SERVICES PRICED AT ZERO 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1803 RECYCLE MEDICARE PART A CLAIMS WITH TOB 111 OR 114 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1804 DENY MEDICARE PART A INTERIM STAY CLAIMS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1805 BILLING PROVIDER ID WAS TRANSLATED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1806 CROSSOVER PRICING PERFORMED - HEADER (PAY) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1807 CROSSOVER PRICING PERFORMED - DETAIL (PAY) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1808 UNABLE TO PERFORM CROSSOVER PRICING - HEADER (DENY) A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 1809 UNABLE TO PERFORM CROSSOVER PRICING - DETAIL (DENY) A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 1900 INVALID TAXONOMY CODE - BILLING PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N255 MISSING/INCOMPLETE/INVALID BILLING PROVIDER TAXONOMY. 1901 INVALID TAXONOMY CODE-HEADER PERFORMING PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N288 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER TAXONOMY. 1906 INVALID TAXONOMY FOR PROVIDER TYPE/SPECIALTY - BILLING 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 1907 INVALID TAXONOMY FOR PROVIDER TYPE/SPECIALTY - HEADER PERFORMING PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 1912 TAXONOMY CODE MISSING - BILLING PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N255 MISSING/INCOMPLETE/INVALID BILLING PROVIDER TAXONOMY. 1913 TAXONOMY CODE MISSING - HEADER PERFORMING PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N288 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER TAXONOMY. 1919 INVALID TAXONOMY CODE - DETAIL PERFORMING PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N288 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER TAXONOMY. 1921 INVALID TAXONOMY FOR PROVIDER TYPE/SPECIALTY - DETAIL PERFORMING PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 1925 TAXONOMY CODE MISSING - DETAIL PERFORMING PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N288 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER TAXONOMY. 1927 NPI REQUIRED HEALTHCARE=Y BILLING PROV 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N433 RESUBMIT THIS CLAIM USING ONLY YOUR NATIONAL PROVIDER IDENTIFIER (NPI) 1928 NPI REQUIRED HEALTHCARE=Y PERFORMING PROV 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N433 RESUBMIT THIS CLAIM USING ONLY YOUR NATIONAL PROVIDER IDENTIFIER (NPI) 1929 NPI DEACTIVATION DUE TO FRAUD 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N270 MISSING/INCOMPLETE/INVALID OTHER PROVIDER PRIMARY IDENTIFIER. 1930 "NPI DEACTIVATION DUE TO DEATH, DISBANDMENT, OR OTHER " 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1934 DTL NPI REQUIRED HEALTHCARE=Y PERFORMING PROVIDER 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N433 RESUBMIT THIS CLAIM USING ONLY YOUR NATIONAL PROVIDER IDENTIFIER (NPI) 1936 INVALID BILLING PROVIDER SPECIFIED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N257 MISSING/INCOMPLETE/INVALID BILLING PROVIDER/SUPPLIER PRIMARY IDENTIFIER. 1937 INVALID PERFORMING PROVIDER SPECIFIED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1943 INVALID DTL PERFORMING PROVIDER SPECIFIED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1945 MULT SAK PROV LOCS FOR BILLING PROV SPEC 208 NATIONAL PROVIDER IDENTIFIER - NOT MATCHED - - 1946 MULT SAK PROV LOCS FOR PERFORMING PROV SPEC 208 NATIONAL PROVIDER IDENTIFIER - NOT MATCHED - - 1949 MULT SAK PROV LOCS FOR RENDERING PROV SPEC 208 NATIONAL PROVIDER IDENTIFIER - NOT MATCHED - - 1950 NPI SUBMISSION ERROR 207 NATIONAL PROVIDER IDENTIFIER - INVALID FORMAT N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 1952 MULTIPLE SAK PROVIDER LOCATIONS FOR DETAIL PERFORMING PROVIDER SPEC 208 NATIONAL PROVIDER IDENTIFIER - NOT MATCHED - - 1954 BILLING PROV ID NOT NPI BUT THERE IS NPI ON FILE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N433 RESUBMIT THIS CLAIM USING ONLY YOUR NATIONAL PROVIDER IDENTIFIER (NPI) 1960 BILLING PROVIDER ON REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1961 RENDERING PROVIDER ON REVIEW - HEADER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1962 RENDERING PROVIDER ON REVIEW - DETAIL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 1995 RENDER/DISPENS/PERFORM PROV ID IN OLD FORMAT - HDR 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1997 UNABLE TO POPULATE DTL PERFORMING PROV ID WITH HDR 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 1999 HEADER BILLING PROVIDER ID IN OLD FORMAT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N257 MISSING/INCOMPLETE/INVALID BILLING PROVIDER/SUPPLIER PRIMARY IDENTIFIER. 2000 INVALID SEX A1 CLAIM/SERVICE DENIED MA39 MISSING/INCOMPLETE/INVALID GENDER. 2001 MEMBER ID NUMBER NOT ON FILE 31 PATIENT CANNOT BE IDENTIFIED AS OUR INSURED. N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 2002 MEMBER NOT ELIGIBLE FOR HEADER DATE OF SERVICE 31 PATIENT CANNOT BE IDENTIFIED AS OUR INSURED. N30 PATIENT INELIGIBLE FOR THIS SERVICE. 2003 MEMBER INELIGIBLE ON DETAIL DATE OF SERVICE 31 PATIENT CANNOT BE IDENTIFIED AS OUR INSURED. N30 PATIENT INELIGIBLE FOR THIS SERVICE. 2004 MULTIPLE AID CATEGORY CODES COVER HEADER SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2005 MULTIPLE AID CATEGORY CODES COVER DETAIL SERVICE 177 PATIENT-HAS NOT MET THE REQUIRED ELIGIBILITY REQUIREMENTS. - - 2006 CLAIMS SUBMITTED WITH LEGACY MEMBER ID 31 PATIENT CANNOT BE IDENTIFIED AS OUR INSURED. N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 2007 QMB MEMBER- BILL MEDICARE FIRST 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2008 MEMBER LEVEL OF CARE NOT ON FILE 186 PAYMENT ADJUSTED SINCE THE LEVEL OF CARE CHANGED. THIS CHANGE TO BE EFFECTIVE 4/1/2008: LEVEL OF CARE CHANGE ADJUSTMENT. - - 2009 ERROR WITH HSN ELIGIBILITY WEB SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2011 PHARMCY MEDICAL/NON-MEDICAL SUPPL. AND ROUTINE DME 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2014 "MENTAL HLTH/SUBSTANCE ABUSE ONLY, BILL PARTNERSHIP " 109 CLAIM NOT COVERED BY THIS PAYER/CONTRACTOR. YOU MUST SEND THE CLAIM TO THE CORRECT PAYER/CONTRACTOR. - - 2017 MEMBER SERVICES COVERED BY MCO PLAN 24 CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN. N30 PATIENT INELIGIBLE FOR THIS SERVICE. 2018 MEMBER IS INROLLED IN HOSPICE B9 SERVICES NOT COVERED BECAUSE THE PATIENT IS ENROLLED IN A HOSPICE. THIS CHANGE TO BE EFFECTIVE 4/1/2008: PATIENT IS ENROLLED IN A HO-SPICE. - - 2037 MEMBER ID IS INACTIVE 31 PATIENT CANNOT BE IDENTIFIED AS OUR INSURED. N30 PATIENT INELIGIBLE FOR THIS SERVICE. 2041 MEMBER# ON CLAIM AND PA MISMATCH 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA36 MISSING/INCOMPLETE/INVALID PATIENT NAME. 2043 MEMBER IS ON REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2044 CLAIM INDICATES MEMBER EXPIRED 13 THE DATE OF DEATH PRECEDES THE DATE OF SERVICE. N330 MISSING/INCOMPLETE/INVALID PATIENT DEATH DATE. 2049 LTC/HOSPICE CONFLICT B9 PATIENT IS ENROLLED IN A HOSPICE. - - 2051 MEMBER NOT CODED FOR LTC 150 PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS LEVEL OF SERVICE. N147 "LONG TERM CARE CASE MIX OR PER DIEM RATE CANNOT BE DETERMINED BECAUSE THE PATIENT ID NUMBER IS MISSING, INCOMPLETE, OR INVALID ON TH-E ASSIGNMENT REQUEST. " 2052 LEVEL OF CARE/AID CAT CONFLICT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N30 PATIENT INELIGIBLE FOR THIS SERVICE. 2053 LTC/CASE MIX CONFLICT 150 PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS LEVEL OF SERVICE. N180 THIS ITEM OR SERVICE DOES NOT MEET THE CRITERIA FOR THE CATEGORY UNDER WHICH IT WAS BILLED. 2055 SUPPLEMENTAL ADULT SERVICE/LTC RECIPIENT CONFLICT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 2056 MEMBER NOT CODED FOR CASEMIX 150 PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS LEVEL OF SERVICE. N30 PATIENT INELIGIBLE FOR THIS SERVICE. 2057 DOS SPAN MONTHS-FILE SEPARATE CLAIMS FOR EACH MNTH A1 CLAIM/SERVICE DENIED N61 REBILL SERVICES ON SEPARATE CLAIMS. 2500 MEMBER IS COVERED BY OTHER INSURANCE-PAY 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2501 MEMBER IS COVERED BY OTHER INSURANCE - PAY AND CHASE 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2502 MEMBER IS COVERED BY OTHER INSURANCE - DENY 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2503 MEMBER IS COVERED BY OTHER INSURANCE - PAY & CHASE 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2504 MEMBER IS COVERED BY OTHER INSURANCE - SUSPEND A1 CLAIM/SERVICE DENIED MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 2505 MEMBER COVERED BY MEDICARE-DENY 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 2509 MEMBER COVERED BY MEDICARE B (PHARMACY) - PROVIDER SHOULD BILL THROUGH POPS 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2510 MEMBER MEDICAL SUPPORT BYPASS – DTL 96 NON-COVERED CHARGE(S). M16 "PLEASE SEE OUR WEB SITE, MAILINGS OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 2511 CANNOT DETERMINE TPL PRICING METHOD 133 THE DISPOSITION OF THIIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2512 DUPLICATE CAS AT HEADER AND DETAIL A1 CLAIM/SERVICE DENIED M16 "PLEASE SEE OUR WEB SITE, MAILINGS OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 2513 TPL ADJUDICATION DATE NOT PRESENT- DETAIL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N307 MISSING/INCOMPLETE/INVALID ADJUDICATION OR PAYMENT DATE. 2514 TPL ADJUDICATION DATE NOT PRESENT-HEADER 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N307 MISSING/INCOMPLETE/INVALID ADJUDICATION OR PAYMENT DATE. 2515 OTHER INSURER REQUIRES ADDITIONAL DATA A1 CLAIM/SERVICE DENIED N36 CLAIM MUST MEET PRIMARY PAYER'S PROCESSING REQUIREMENTS BEFORE WE CAN CONSIDER PAYMENT 2516 MEDICAID IS ALWAYS FINAL PAYOR 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA64 OUR RECORDS INDICATE THAT WE SHOULD BE THE THIRD PAYER FOR THIS CLAIM. WE CANNOT PROCESS THIS CLAIM UNTIL WE HAVE RECEIVED PAYMENT-INFORMATION FROM THE PRIMARY AND SECONDARY PAYERS. 2517 TPL REVIEW - CLM/EOB DIFFER 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. N245 INCOMPLETE/INVALID PLAN INFORMATION FOR OTHER INSURANCE 2518 OTHER PAYER HAS BUNDLED DETAILS 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCEDURE. SEPARATE PAYMENT IS NOT ALLOWED. 2519 CLAIM POTENTIALLY COVERED BY MEDICARE 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2520 "MEMBER IS COVERED BY OTHER INSURANCE-PAY,HEADER " 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2521 MEMBER IS COVERED BY OTHER INSURANCE - PAY AND REPORT 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2522 MEMBER IS COVERED BY OTHER INSURANCE - DENY (HDR) 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2523 "MEMBER IS COVERED BY OTHER INSURANCE - PAY, CHASE, HDR " 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 2524 "MEMBER IS COVERED BY OTHER INSURANCE - SUSPEND, HDR" 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 2525 MEMBER COVERED BY MEDICARE - DENY (HDR) 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2526 ZERO TPL AMOUNT AND NO ADJ RSN CODE - HEADER 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N8 CROSSOVER CLAIM DENIED BY PREVIOUS PAYER AND COMPLETE CLAIM DATA NOT FORWARDED. RESUBMIT THIS CLAIM TO THIS PAYER TO PROVIDE ADEQUATE DATA FOR ADJUDICATION. 2527 ZERO TPL AMOUNT AND NO ADJ RSN CODE-DETAIL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N8 CROSSOVER CLAIM DENIED BY PREVIOUS PAYER AND COMPLETE CLAIM DATA NOT FORWARDED. RESUBMIT THIS CLAIM TO THIS PAYER TO PROVIDE ADEQUATE DATA FOR ADJUDICATION. 2528 LTC - POTENTIAL MEDICARE IN FIRST 100 DAYS 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2529 TPL AT HEADER AND NOT AT DETAIL A1 CLAIM/SERVICE DENIED N379 CLAIM LEVEL INFORMATION DOES NOT MATCH LINE LEVEL INFORMATION. 2530 INVALID TPL CARRIER CODE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N4 MISSING/INCOMPLETE/INVALID PRIOR INSURANCE CARRIER EOB. 2531 "MEDICARE COVERAGE INDICATED ON CLAIM, NOT ON FILE " 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N4 MISSING/INCOMPLETE/INVALID PRIOR INSURANCE CARRIER EOB. 2532 HEBREW REHAB LTC TPL 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 2533 CARRIER IS 000 AND TPL AMOUNT > 0 - HEADER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA04 SECONDARY PAYMENT CANNOT BE CONSIDERED WITHOUT THE IDENTITY OF OR PAYMENT INFORMATION FROM THE PRIMARY PAYER. THE INFORMATION WAS EITHER NOT REPORTED OR WAS ILLEGIBLE. 2534 CARRIER IS 000 AND TPL AMOUNT > 0 -DETAIL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N4 MISSING/INCOMPLETE/INVALID PRIOR INSURANCE CARRIER EOB. 2535 INCORRECT TPL BILLING 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS N480 INCOMPLETE/INVALID EXPLANATION OF BENEFITS 2536 MEDICARE# ON CLAIM/FILE CONFLICT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 2537 INVALID BUNDLED LINE NO ASSIGNED BY OTHER PAYER 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCEDURE. SEPARATE PAYMENT IS NOT-ALLOWED. 2540 MEDICARE PAID > MEDICAID ALLOWED - HEADER 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT. - - 2541 MEDICARE PAID > MEDICAID ALLOWED - DETAIL 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT. - - 2543 MEDICARE PAYMENT OR PATIENT RESPONSIBILITY IS > 0 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS - - 2544 BENEFITS EXHAUSTED REPRICING 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS N219 PAYMENT BASED ON PREVIOUS PAYER'S ALLOWED AMOUNT 2545 HEADER AND DETAIL COB PAYMENTS DO NOT BALANCE A1 CLAIM/SERVICE DENIED N379 CLAIM LEVEL INFORMATION DOES NOT MATCH LINE LEVEL INFORMATION. 2546 DETAIL COB PAYMENTS DO NOT BALANCE A1 CLAIM/SERVICE DENIED N379 CLAIM LEVEL INFORMATION DOES NOT MATCH LINE LEVEL INFORMATION. 2547 HEADER COB PAYMENTS DO NOT BALANCE 96 NON-COVERED CHARGE(S). M16 "PLEASE SEE OUR WEB SITE, MAILINGS OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 2548 NON COVERED AMOUNT IS NOT EQUAL TO BILLED 96 NON-COVERED CHARGE(S). M16 "PLEASE SEE OUR WEB SITE, MAILINGS OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 2549 REMAINING PATIENT LIABILITY PRESENT AT HEADER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2550 REMAINING PATIENT LIABILITY PRESENT AT DETAIL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2551 "CLAIM HAS NON-COVERED AMOUNT, HDR IS NOT ELIGIBLE" 96 NON-COVERED CHARGE(S). M16 "PLEASE SEE OUR WEB SITE, MAILINGS OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 2553 DETAIL ADJUSTMENT REASON CODE IS NOT ON ARC XREF 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N4 MISSING/INCOMPLETE/INVALID PRIOR INSURANCE CARRIER EOB. 2555 INVALID FILING INDICATOR/CARRIER COMBINATION A1 CLAIM/SERVICE DENIED N4 MISSING/INCOMPLETE/INVALID PRIOR INSURANCE CARRIER EOB. 2556 LTC - POTENTIAL MEDICARE C IN FIRST 100 DAYS 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2557 LTC - POTENTIAL PRIVATE INSURANCE IN FIRST 100 DAYS 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2558 OTHER PAYER DENIAL ARC IS NOT ON TABLE - HEADER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2559 OTHER PAYER DENIAL ARC IS NOT ON TABLE - DETAIL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2561 TPL DATA CONFLICT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N48 CLAIM INFORMATION DOES NOT AGREE WITH INFORMATION RECEIVED FROM OTHER INSURANCE CARRIER. 2562 BENEFITS EXHAUSTED TPL REPRICING - DETAIL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2563 DETAIL ADJUSTMENT REASON CODE IS NOT ON ARC XREF 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2564 MEMBER HAS MEDICARE SUPP INS DTL A1 CLAIM/SERVICE DENIED N4 MISSING/INCOMPLETE/INVALID PRIOR INSURANCE CARRIER EOB 2565 CLAIM REQUIRES TPL REVIEW 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS. - - 2566 MEMBER HAS MEDICARE SUPPLEMENTAL INSURANCE-DETAIL A1 CLAIM/SERVICE DENIED MA64 OUR RECORDS INDICATE THAT WE SHOULD BE THE THIRD PAYER FOR THIS CLAIM. WE CANNOT PROCESS THIS CLAIM UNTIL WE HAVE RECEIVED PAYMENT-INFORMATION FROM THE PRIMARY AND SECONDARY PAYERS. 2567 INVALID SUBMITTER FOR COB CLAIM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N407 YOU ARE NOT AN APPROVED SUBMITTER FOR THIS TRANSMISSION FORMAT. 2568 "CLAIM HAS NON-COVERED AMOUNT, DETAIL IS NOT ELIGIBLE" 96 NON-COVERED CHARGE(S). M16 "PLEASE SEE OUR WEB SITE, MAILINGS OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 2569 MEMBER HAS SELF-REPORTED OTHER INSURANCE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 2580 "DETAIL, PROFESSIONAL OVERRIDE EDIT" 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2581 "HEADER, INSTITUTIONAL OVERRIDE EDIT" 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2582 "DETAIL, INSTITUTIONAL OVERRIDE EDIT" 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2583 NON COVERED AMT AND CAS PRESENT FOR PAYER 96 NON-COVERED CHARGE(S). M16 "PLEASE SEE OUR WEB SITE, MAILINGS OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 2584 MEMBER MEDICAL SUPPORT BYPASS - HEADER 96 NON-COVERED CHARGE(S). M16 "PLEASE SEE OUR WEB SITE, MAILINGS OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION" 2585 EOB DATE AT HEADER AND DETAIL 22 THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION OF BENEFITS - - 2588 HEADER/COMMERCIAL/SUSPEND EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2589 HEADER/MEDICARE/SUSPEND EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2590 DETAIL/COMMERCIAL/PAY EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2591 DETAIL/MEDICARE/PAY EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2592 DETAIL/COMMERCIAL/DENY EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2593 DETAIL/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2594 DETAIL/COMMERCIAL/SUSPEND EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2595 DETAIL/MEDICARE/SUSPEND EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2596 HEADER/COMMERCIAL/PAY EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2597 HEADER/MEDICARE/PAY EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2598 HEADER/COMMERCIAL/DENY EDIT FROM THE TPL DENY TABL 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2599 HEADER/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 2608 MEMBER LOCKED-IN TO SPECIFIC NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2610 NON-COVERED DAYS > 0 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA33 MISSING/INCOMPLETE/INVALID NONCOVERED DAYS DURING THE BILLING PERIOD. 2612 DMH OR DPH SUBCONTRACTOR NOT AUTHORIZED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2613 MANAGED CARE SERVICE 24 CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN. - - 2614 MANAGED CARE SERVICE SHOULD BE PAID BY RMC 24 CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 2615 SENIOR PHARMACY MUST BE BILLED THROUGH POPS 24 CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN. - - 2616 SERV NOT REIMBURSABLE BY MED ASSISTANCE PROGRAM 96 NON-COVERED CHARGE(S). N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 2617 PROC CODE REQUIRES REVIEW OF REPORT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2620 REVENUE CODE REQ REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2621 BILL EXTENDED BENEFITS A1 CLAIM/SERVICE DENIED MA92 MISSING PLAN INFORMATION FOR OTHER INSURANCE. 2622 SERVICE NOT AUTHORIZED BY HMO 242 SERVICES NOT PROVIDED BY NETWORK/PRIMARY CARE PROVIDERS. - - 2623 PREPAYMENT TECHNICAL DENIAL A1 CLAIM/SERVICE DENIED N10 CLAIM/SERVICE ADJUSTED BASED ON THE FINDINGS OF A REVIEW ORGANIZATION/PROFESSIONAL CONSULT/MANUAL ADJUDICATION/MEDICAL OR DENTAL ADV-ISOR. 2625 MODIFIER INAPPROPRIATE/INCORRECT FOR SERV BILLED 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 2626 REQUEST FOR 90 DAY WAIVER DENIED A1 CLAIM/SERVICE DENIED MA91 THIS DETERMINATION IS THE RESULT OF THE APPEAL YOU FILED. 2627 SERVICE COVERED BY CASE MANAGER 24 CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN. - - 2628 PREPAYMENT FULL DENIAL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N10 CLAIM/SERVICE ADJUSTED BASED ON THE FINDINGS OF A REVIEW ORGANIZATION/PROFESSIONAL CONSULT/MANUAL ADJUDICATION/MEDICAL OR DENTAL ADV-ISOR. 2629 PREPAYMENT PARTIAL DENIAL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N35 PROGRAM INTEGRITY/UTILIZATION REVIEW DECISION. 2630 NO PAS APPROVAL FOUND IN PREPAYMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N10 CLAIM/SERVICE ADJUSTED BASED ON THE FINDINGS OF A REVIEW ORGANIZATION/PROFESSIONAL CONSULT/MANUAL ADJUDICATION/MEDICAL OR DENTAL ADVISOR. 2631 MCARE/BILL ALLOW PAID CONFLICT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N379 CLAIM LEVEL INFORMATION DOES NOT MATCH LINE LEVEL INFORMATION. 2632 BENEFIT CONFLICT A1 CLAIM/SERVICE DENIED N30 PATIENT INELIGIBLE FOR THIS SERVICE. 2633 PREPAY PREVIOUSLY APPROVED 216 BASED ON THE FINDINGS OF A REVIEW ORGANIZATION N10 PAYMENT BASED ON THE FINDINGS OF A REVIEW ORGANIZATION/PROFESSIONAL CONSULT/MANUAL ADJUDICATION/MEDICAL OR DENTAL ADVISOR 2634 PREPAY PREVIOUSLY DENIED 216 BASED ON THE FINDINGS OF A REVIEW ORGANIZATION N10 PAYMENT BASED ON THE FINDINGS OF A REVIEW ORGANIZATION/PROFESSIONAL CONSULT/MANUAL ADJUDICATION/MEDICAL OR DENTAL ADVISOR 2635 PREPAY DECISION OVERTURNED 216 BASED ON THE FINDINGS OF A REVIEW ORGANIZATION N10 PAYMENT BASED ON THE FINDINGS OF A REVIEW ORGANIZATION/PROFESSIONAL CONSULT/MANUAL ADJUDICATION/MEDICAL OR DENTAL ADVISOR 2640 NO RESPONSE TO OUR CAF A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 2800 MEMBER NOT TIED TO HOSPICE ON DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N143 THE PATIENT WAS NOT IN A HOSPICE PROGRAM DURING ALL OR PART OF THE SERVICE DATES BILLED. 2802 NO BENEFIT PROGRAM FOR MEMBER FOUND 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 2803 PROCEDURE IS AGE RESTRICTED 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 2804 PROCEDURE IS INVALID FOR PATIENT SEX A1 CLAIM/SERVICE DENIED MA39 MISSING/INCOMPLETE/INVALID GENDER. 2805 MULTIPLE PPA SEGMENTS ON MEMBER FILE 125 SUBMISSION/BILLING ERROR(S). N23 ALERT: PATIENT LIABILITY MAY BE AFFECTED DUE TO COORDINATION OF BENEFITS WITH OTHER CARRIERS AND/OR MAXIMUM BENEFIT PROVISIONS. 2900 SPAD CLAIM HAS CONTIGUOUS AID CATEGORY COVERAGE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3000 PER UNIT PRICE ON CLAIM DOES NOT MATCH PRIOR AUTHORIZATION 198 PRECERTIFICATION/AUTHORIZATION-EXCEEDED. N54 CLAIM INFORMATION IS INCONSISTENT WITH PRE-CERTIFIED/AUTHORIZED SERVICES. 3001 PA NOT FOUND ON DATABASE A1 CLAIM/SERVICE DENIED M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3002 NDC REQUIRES PA A1 CLAIM/SERVICE DENIED M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3003 PROCEDURE CODE REQUIRES PA 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3004 INVALID PA/PASNUMBER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3005 INVALID PA/PAS NUMBER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3006 PA DOLLARS EXCEEDED 198 PAYMENT ADJUSTED FOR EXCEEDING PRECERTIFICATION/ AUTHORIZATION. THIS CHANGE TO BE EFFECTIVE 4/1/2008: PRECERTIFICATION/AUTHORIZATION-EXCEEDED. - - 3009 PA/PAS NUMBER NOT ON THE DATABASE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3010 OUT OF STATE PROVIDER REQUIRES REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3013 PA NUMBER NOT ON THE DATABASE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3015 MODIFIER ON CLAIM AND PA MISMATCH 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 3022 SELECT FOR MASSPRO PRE-PAYMENT REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N35 PROGRAM INTEGRITY/UTILIZATION REVIEW DECISION. 3023 INVALID RATE ID/PYMNT TYPE COMBINATION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 3024 LINE ITEM NOT FOUND FOR PAS NUMBER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3025 MULTIPLE ACTIVE LINE ITEMS FOR PAS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3026 PAS NOT FOUND ON DATABASE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3027 INVALID PAS NUMBER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3028 NOT ENOUGH UNITS ON PAS 198 PRECERTIFICATION/AUTHORIZATION EXCEEDED. - - 3029 MEMBER ID FOR CLAIM AND PAS DONT MATCH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 3030 ADMISSION DATE FOR CLAIM AND PAS DONT MATCH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA40 MISSING/INCOMPLETE/INVALID ADMISSION DATE. 3031 PROVIDER ID FOR CLAIM AND PA/PAS DO NOT MATCH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N257 MISSING/INCOMPLETE/INVALID BILLING PROVIDER/SUPPLIER PRIMARY IDENTIFIER. 3032 PAS IS REQUIRED A1 CLAIM/SERVICE DENIED M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 3033 PA/PAS IS NOT READY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3034 DUPLICATE CLAIM IN PRE-PAYMENT REVIEW 18 EXACT DUPLICATE CLAIM/SERVICE. - - 3035 CLAIM SELECTED FOR PRE-PAYMENT REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3036 RANDOM PRE-PAYMENT REVIEW PROCESS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3038 PAS NOT REVIEWED BY PRO 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3040 SURGERY/ASSIST USING SAME SERV PROVIDER NUMBER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N290 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER PRIMARY IDENTIFIER. 3041 MEMBER# OR PROV# ON CLAIM AND PA MISMATCH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N54 CLAIM INFORMATION IS INCONSISTENT WITH PRE-CERTIFIED/AUTHORIZED SERVICES. 3101 PA STATUS IS VOID 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " - - 3102 PA STATUS IS DENIED 39 SERVICES DENIED AT THE TIME AUTHORIZATION/PRE-CERTIFICATION WAS REQUESTED. - - 3103 PROCEDURE NOT ON PA 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N54 CLAIM INFORMATION IS INCONSISTENT WITH PRE-CERTIFIED/AUTHORIZED SERVICES. 3104 REVENUE CODE / PA CONFLICT 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 3105 MEMBER# ON CLAIM AND PA MISMATCH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 3107 SERV DATE AFTER PA EXPIRED 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 3108 PA INSUFFICIENT AVAIL UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 3109 PA UNITS PRESENTLY EXHAUSTED 198 PRECERTIFICATION/AUTHORIZATION EXCEEDED. - - 3110 PA EXHUSTED - CANNOT BE USED IN PRICING 198 PRECERTIFICATION/AUTHORIZATION EXCEEDED. - - 3111 PRIOR AUTH PROCEDURE/MODIFIER MISMATCH 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING N519 INVALID COMBINATION OF HCPCS MODIFIERS 3120 REFERRAL REQUIRED ON CLAIM 165 REFERRAL ABSENT OR EXCEEDED. - - 3121 REFERRAL NUMBER INVALID 165 REFERRAL ABSENT OR EXCEEDED. - - 3122 NO MORE UNITS AVAILABLE ON REFERRAL 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 3124 RENDERING PROVIDER DOES NOT MATCH REFERRAL AUTHORIZATION 165 REFERRAL ABSENT OR EXCEEDED. - - 3125 MEMBER IN CLAIM DOES NOT MATCH REFERRAL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 3126 SERVICE DATE IS OUTSIDE REFERRAL AUTHORIZATION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N54 CLAIM INFORMATION IS INCONSISTENT WITH PRE-CERTIFIED/AUTHORIZED SERVICES. 3300 JCODE GIVEN WITH INVALID NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 3301 LTC CLAIM REQUIRES A PATIENT LIABILITY AMOUNT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N58 MISSING/INCOMPLETE/INVALID PATIENT LIABILITY AMOUNT. 3302 UNABLE TO DETERMINE RATE ID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 3303 INVALID PROCEDURE/TOOTH SURFACE COMBINATION 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N75 MISSING/INCOMPLETE/INVALID TOOTH SURFACE INFORMATION. 3304 MANUFACTURERS INVOICE REQUIRED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M23 MISSING INVOICE. 3305 INVALID PATIENT PAY AMOUNT 178 PATIENT HAS NOT MET THE REQUIRED SPEND DOWN REQUIREMENTS. - - 3306 SPAD RATE NOT ALLOWED FOR TRANSFER PATIENT STATUS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 3307 NO PATIENT LIABILITY ON FILE OR ON THE CLAIM 178 PATIENT HAS NOT MET THE REQUIRED SPEND DOWN REQUIREMENTS. - - 3310 CURRENT SUPPLIERS INVOICE REQUIRED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M23 MISSING INVOICE. 3311 ACQUISTION COST MISSING 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M23 MISSING INVOICE. 3312 MAX FEE RELATIVE VALUE MUST BE > 0 ON DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N203 MISSING/INCOMPLETE/INVALID ANESTHESIA TIME/UNITS 3314 POS INVALID FOR RADIOLOGY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 3315 ICD9-CM STERILIZATION PROC REQUIRES ATTACHMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 3316 ICD9-CM HYSTERECTOMY PROC REQUIRES ATTACHMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 3317 ICD9-CM ABORTION PROC REQUIRES ATTACHMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 3318 NON COVRD DAYS MUST BE NUMERIC FOR PROV TYPE 70/74 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 3319 BENEFIT PLAN AGE RESTRICTION ON PRIMARY DIAG 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. - - 3320 BENEFIT PLAN AGE RESTRICTION ON SECOND DIAG 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. - - 3321 BENEFIT PLAN AGE RESTRICTION ON THIRD DIAG 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. - - 3322 BENEFIT PLAN AGE RESTRICTION ON FOURTH DIAG 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. - - 3323 BENEFIT PLAN AGE RESTRICTION ON FIFTH DIAG 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. - - 3324 BENEFIT PLAN AGE RESTRICTION ON SIXTH DIAG 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. - - 3325 BENEFIT PLAN AGE RESTRICTION ON SEVENTH+ DIAG 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. - - 3326 BENEFIT PLAN AGE RESTRICTION ON ADMIT DIAG 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. - - 3327 TYPE OF BILL CANNOT BE CROSS WALKED TO A PLACE OF SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 3335 NO VALID DERIVED RATE ID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 3602 CLAIM AND EOB DIFFER A1 CLAIM/SERVICE DENIED N48 CLAIM INFORMATION DOES NOT AGREE WITH INFORMATION RECEIVED FROM OTHER INSURANCE CARRIER. 4001 BENEFIT PLAN BILLING PROVIDER TYPE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4002 NDC INDICATES A NON-COVERED DRUG ON DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 4003 ATTACH REV ON STERIL/HYST DIAG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4004 NDC NOT ON FILE A1 CLAIM/SERVICE DENIED M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 4007 NON-COVERED NDC DUE TO CMS TERMINATION 96 NON-COVERED CHARGE(S). M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 4009 ALLOWED AMOUNT LESS THAN DRUG CHARGE VARIANCE 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT. - - 4010 MODIFIER REQUIRES MEDICAL REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4011 INVALID MODIFIER/MODIFIER COMBINATION 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 4012 ABORTION PROCEDURE INDICATED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4013 PROCEDURE CODE IS NOT COVERED FOR DATE OF SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4014 NO PRICING SEGMENT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4015 MULTIPLE PRICING MODIFIERS ON CLAIM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4016 BENEFIT PLAN PERF PR TYP RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4017 BENEFIT PLAN BILL PR TYP RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4018 BENEFIT PLAN PERF PR TYP RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4019 PROCEDURE CODE REQUIRES ATTACHMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 4020 PROV CONTRACT UNIT RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N203 MISSING/INCOMPLETE/INVALID ANESTHESIA TIME/UNITS 4021 PROCEDURE NOT COVERED FOR BENEFIT PLAN 26 EXPENSES INCURRED PRIOR TO COVERAGE M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4022 ABORTION DIAGNOSIS INDICATED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4023 GENDER IS NOT ALLOWED FOR COVERED NDC A1 CLAIM/SERVICE DENIED M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 4024 MAXIMUM NUMBER OF REFILLS HAS BEEN REACHED 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. - - 4025 NDC VS. AGE RESTRICTION 96 NON-COVERED CHARGE(S). M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 4026 NDC VS. DAYS SUPPLY 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. - - 4027 DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 4028 BENEFIT PLAN GENDER RESTRICTION ON DIAGNOSIS 10 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S GENDER. MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 4029 BENEFIT PLAN POS RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4030 BENEFIT PLAN AGE RESTRICTION ON DIAGNOSIS 9 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 4031 PROV CONTRACT GENDER RESTRICTION ON DIAGNOSIS 10 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S GENDER. M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4032 PROCEDURE CODE NOT ON FILE 10 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S GENDER. N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4033 INVALID PROC MOD COMBINATION 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 4034 BENEFIT PLAN AGE RESTRICTION ON PROCEDURE 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4035 BENEFIT PLAN GENDER RESTRICTION ON PROCEDURE 7 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S GENDER. - - 4036 PROV CONTRACT POS RESTRICTION ON PROCEDURE 171 PAYMENT IS DENIED WHEN PERFORMED/BILLED BY THIS TYPE OF PROVIDER IN THIS TYPE OF FACILITY. M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4037 PROCEDURE CODE VS. DIAGNOSIS RESTRICTION 5 THE PROCEDURE CODE/BILL TYPE IS INCONSISTENT WITH THE PLACE OF SERVICE. MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 4038 SERVICE NOT COVERED FOR LIMITED BP 96 NON-COVERED CHARGE(S) M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4039 DIAGNOSIS CANNOT BE USED AS PRINCIPAL DIAGNOSIS 11 THE DIAGNOSIS IS INCONSISTENT WITH THE PROCEDURE. - - 4040 PRIMARY DIAGNOSIS CODE NOT ON FILE 146 DIAGNOSIS WAS INVALID FOR THE DATE(S) OF SERVICE REPORTED MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 4041 SECONDARY DIAGNOSIS CODE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4042 THIRD DIAGNOSIS CODE NOT ON FILE OR INACTIVE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4043 FOURTH DIAGNOSIS CODE NOT ON FILE OR INACTIVE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4044 REIMBURSEMENT RULE AGE RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N129 NOT ELIGIBLE DUE TO THE PATIENT'S AGE. 4045 REIMBURSEMENT RULE/BENEFIT PLAN RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4046 NO REIMBURSEMENT RULE FOR RATE ID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4047 FIFTH DIAGNOSIS CODE NOT ON FILE 146 DIAGNOSIS WAS INVALID FOR THE DATE(S) OF SERVICE REPORTED. M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4048 SIXTH DIAGNOSIS CODE NOT ON FILE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 4049 SEVENTH DIAGNOSIS CODE NOT ON FILE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 4050 EIGHTH DIAGNOSIS CODE NOT ON FILE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 4051 NINTH DIAGNOSIS CODE NOT ON FILE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 4052 TENTH DIAGNOSIS CODE NOT ON FILE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 4053 PRINCIPAL PROCEDURE CODE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4054 FIRST OTHER PROCEDURE CODE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4055 SECOND OTHER PROCEDURE CODE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4056 THIRD OTHER PROCEDURE CODE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4057 FOURTH OTHER PROCEDURE CODE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4058 FIFTH OTHER PROCEDURE CODE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4059 REVENUE CODE NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 4060 ELEVENTH DIAGNOSIS CODE NOT ON FILE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 4061 REIMBURSEMENT RULE CLAIM TYPE RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4062 REIMBURSEMENT RULE COND CODE RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4063 ICD-9-CM PROCEDURE CODE/AGE RESTRICTION 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4064 BENEFIT PLAN GENDER RESTRICTION ON ICD9 PROC 7 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S GENDER. - - 4065 ICD9-CM PROCEDURE REQUIRES ATTACHMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 4066 ICD9-CM PROCEDURE/DIAGNOSIS RESTRICTION 11 THE DIAGNOSIS IS INCONSISTENT WITH THE PROCEDURE. M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4067 NON-COVERED ICD-9-CM PROCEDURE CODE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4068 REIMBURSEMENT RULE/PROV CONTRACT RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4069 REIMBURSEMENT RULE RESTRICTION ON DIAGNOSIS ROLE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4070 REIMBURSEMENT RULE MODIFIER RESTRICTION 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 4071 REIMBURSEMENT RULE PAYER RESTRICTION 96 NON-COVERED CHARGE(S). N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4072 REIMBURSEMENT RULE TAXONOMY RESTRICTION 8 THE PROCEDURE CODE IS INCONSISTENT WITH THE PROVIDER TYPE/SPECIALTY (TAXONOMY). - - 4076 TWELFTH DIAGNOSIS CODE NOT ON FILE 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS CODE 4077 NON-COVERED REVENUE CODE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 4085 INPATIENT PSYCH HOSP FOR MEMBERS AGE 22-64 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4095 REIMBURSEMENT RULE UNIT RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 4096 MODIFIER 99 NOT ALLOWED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4097 INVALID PROCESSING MODIFIER/RATE NOT FOUND 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4098 FUND CODE FOR AID CAT/LOC NOT FOUND 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4099 DRG NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M119 MISSING/INCOMPLETE/INVALID/ DEACTIVATED/WITHDRAWN NATIONAL DRUG CODE (NDC). 4113 UNIT DOSE PACKAGING COVERED FOR LTC RESIDENTS ONLY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4115 NO RBRVS CONVERSION FACTOR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4117 ICD9 PROCEDURE IS NOT VALID FOR DATES OF SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4120 PROCEDURE CODE REQUIRES QUADRANT A1 CLAIM/SERVICE DENIED N75 MISSING/INCOMPLETE/INVALID TOOTH SURFACE INFORMATION. 4128 ICD9 PROCEDURE 7-24 NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M51 MISSING/INCOMPLETE/INVALID PROCEDURE CODE(S) 4132 DRG GROUPER UNABLE TO ASSIGN DRG A8 UNGROUPABLE DRG. - - 4135 APC GROUPER UNABLE TO GROUP/PRICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4136 BENEFIT PLAN BILLING PROVIDER TYPE RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4137 BENEFIT PLAN PERF PR TYP RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4138 BILLING PROVIDER TYPE SPECIALTY NOT VALID FOR COVERED-NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4139 PERFORMING PROVIDER TYPE SPECIALTY NOT VALID FOR COVERED-NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4140 BENEFIT PLAN BILLING PROVIDER TYPE RESTRICTION ON PROCEDURE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4141 BENEFIT PLAN PERFORMING PROVIDER TYPE RESTRICTION ON PROCEDURE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4142 BENEFIT PLAN BILLING PROVIDER TYPE RESTRICTION ON REVENUE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4143 BENEFIT PLAN PERFORMING PROVIDER TYPE RESTRICTION ON REVENUE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4144 PROV CONTRACT PERFORMING PROVIDER TYPE RESTRICTION ON DIAGNOSIS A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4145 PROVIDER CONTRACT BILLING PROVIDER TYPE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4146 PROVIDER CONTRACT PERFORMING PROVIDER TYPE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4147 PROVIDER CONTRACT PERFORMING PROVIDER TYPE RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4148 PERF PROV TYPE SPEC NOT VALID FOR CONTRACT-NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4149 PROVIDER CONTRACT BILLING PROVIDER TYPE RESTRICTION ON PROCEDURE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4150 PROVIDER CONTRACT PERFORMING PROVIDER TYPE RESTRICTION ON PROCEDURE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4151 PROVIDER CONTRACT BILL PROVIDER TYPE RESTRICTION ON REVENUE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4152 PROVIDER CONTRACT PERFORMING PROVIDER TYPE RESTRICTION ON REVENUE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4153 PRIMARY NDC ON MEDICAL REVIEW FOR PROV. CONTRACT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4155 REIMBURSEMENT RULE POS RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4156 REIMBURSEMENT RULE PROV LOCAT RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4157 PROVIDER CONTRACT/PROVIDER CONTRACT RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4158 PROVIDER CONTRACT/PROVIDER CONTRACT RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4159 PROVIDER CONTRACT/PROVIDER CONTRACT RESTRICT ON ICD9 PROCEDURE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4160 PROVIDER CONTRACT RESTRICTION FOR CONTRACT NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4161 PROVIDER CONTRACT/PROVIDER CONTRACT RESTRICT ON PROCEDURE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4162 PROVIDER CONTRACT/PROVIDER CONTRACT RESTRICT ON REVENUE A1 CLAIM/SERVICE DENIED N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4164 INACTIVE DRUG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4165 MAX DAY RESTRICTION FOR COVERED NDC A1 CLAIM/SERVICE DENIED N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 4166 REIMBURSEMENT RULE MEMB LOCAT RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4167 PROV CONTRACT UNIT RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 4168 BENEFIT PLAN UNIT RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4170 UNITS BILLED GREATER THAN ALLOWED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 4171 UNITS BILLED LESS THAN ALLOWED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4177 PROVIDER CONTRACT BILLING PROVIDER TYPE RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4180 SECOND DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4181 THIRD DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4182 FOURTH DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4183 FIFTH DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4184 SIXTH DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4185 7 - 24 DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4186 ADMITTING DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE A1 CLAIM/SERVICE DENIED MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 4187 EMERGENCY DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4188 DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE(DTL) A1 CLAIM/SERVICE DENIED MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 4189 SECOND DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE(DTL) A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4190 THIRD DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE(DTL) A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4191 FOURTH DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE(DTL) A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4192 FIFTH DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE(DTL) A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4193 SIXTH DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE(DTL) A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4194 7 - 24 DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE(DTL) A1 CLAIM/SERVICE DENIED M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4200 CLAIM PRICED AT ZERO 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA22 PAYMENT OF LESS THAN $1.00 SUPPRESSED. 4203 MODIFIER IS NOT COVERED 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 4207 CLIA NUMBER NOT ON FILE FOR DATES OF SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA120 MISSING/INCOMPLETE/INVALID CLIA CERTIFICATION NUMBER. 4208 INVALID CLIA CERTIFICATION/PROCEDURE CODE COMBINAT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA120 MISSING/INCOMPLETE/INVALID CLIA CERTIFICATION NUMBER. 4209 NO PRICING SEGMENT FOR PROCEDURE/MODIFIER COMBINAT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4210 MILEAGE RATE NOT ON FILE FOR DATE OF SERVICE A1 CLAIM/SERVICE DENIED N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 4211 TOOTH NUMBER/PROCEDURE CODE COMBINATION INVALID A1 CLAIM/SERVICE DENIED N37 MISSING/INCOMPLETE/INVALID TOOTH NUMBER/LETTER. 4212 INVALID CLIA LAB CODE/PROC CODE/MODIFIER COMBINAT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA66 MISSING/INCOMPLETE/INVALID PRINCIPAL PROCEDURE CODE. 4214 SERVICE DATE PRIOR TO CLIA CERTIFICATION DATE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA120 MISSING/INCOMPLETE/INVALID CLIA CERTIFICATION NUMBER. 4215 CLIA NUMBER TERMINATED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA120 MISSING/INCOMPLETE/INVALID CLIA CERTIFICATION NUMBER. 4222 NDC REQUIRES REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4223 BENEFIT PLAN REVIEW RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4224 BENEFIT PLAN UNIT RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 4227 REVENUE NOT COVERED FOR BENEFIT PLAN 96 NON-COVERED CHARGE(S). M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 4229 BENEFIT PLAN REVIEW RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4231 MAXIMUM UNIT RESTRICTION FOR BILLED NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4232 MAXIMUM DAY RESTRICTION FOR BILLED NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4233 DIAGNOSIS REQUIRES ADDITIONAL DOCUMENTATION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 4235 IMPROPER MODIFIER FOR PROCEDURE BILLED 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4236 INVALID USE OF E DIAGNOSIS CODE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4237 INVALID TYPE OF LEAVE FOR LTC CLAIM A1 CLAIM/SERVICE DENIED M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 4240 PROCEDURE MUST BE BILLED SEPARATELY FOR EACH DOS A1 CLAIM/SERVICE DENIED N61 REBILL SERVICES ON SEPARATE CLAIMS. 4244 DIAGNOSIS NOT COVERED FOR BENEFIT PLAN 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M64 MISSING/INCOMPLETE/INVALID OTHER DIAGNOSIS 4245 FOURTH MODIFIER NOT COVERED 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 4246 ADJUSTMENT PAID AMOUNT EXCEEDS THE CASH RECEIPT BA 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4248 MISSING MODIFIER FOR THIS PROCEDURE 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 4250 REIMBURSEMENT RULE PROVIDER TYPE RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4252 DX CODE 6-24 NOT ON FILE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4253 BENEFIT PLAN REVIEW RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4254 BENEFIT PLAN AGE RESTRICTION ON REVENUE 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4256 BENEFIT PLAN MODIFIER RESTRICTION ON PROCEDURE 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 4257 PROVIDER CONTRACT MODIFIER RESTRICTION ON PROCEDURE 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 4258 SECONDARY DIAGNOSIS RESTRICTION FOR BILLED NDC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4260 MEMBER NOT CODED FOR LTC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 4261 MEMBER NOT CODED FOR CASEMIX 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N180 THIS ITEM OR SERVICE DOES NOT MEET THE CRITERIA FOR THE CATEGORY UNDER WHICH IT WAS BILLED. 4310 PROVIDER CONTRACT ADMIT DIAG RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA65 MISSING/INCOMPLETE/INVALID ADMITTING DIAGNOSIS. 4311 PROVIDER CONTRACT EMERG DIAG RESTRICTION ON PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA63 MISSING/INCOMPLETE/INVALID PRINCIPAL DIAGNOSIS. 4312 PROVIDER CONTRACT PRIM DTL DIAG RESTRICT ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4313 PROVIDER CONTRACT PRIM/SEC DTL DIAG RESTRICT ON PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4314 BENEFIT PLAN CLAIM TYPE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4315 PROVIDER CONTRACT HDR DIAGNOSIS RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4316 PROVIDER CONTRACT DETAIL DIAGNOSIS RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4317 PROVIDER CONTRACT ADMITTING DIAGNOSIS RESTRICTION ON ICD9 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4318 PROVIDER CONTRACT DETAIL DIAGNOSIS RESTRICTION ON ICD9 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4319 PROVIDER CONTRACT HEADER DIAGNOSIS RESTRICTION ON ICD9 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4320 PROVIDER CONTRACT ADMITTING DIAGNOSIS RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4321 PROVIDER CONTRACT DETAIL DIAGNOSIS RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4322 PROVIDER CONTRACT PRIM/SEC DTL DIAG RESTRICT ON REV 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4362 PROVIDER CONTRACT TOB RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 4363 PROVIDER CONTRACT TOB RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 4364 PROVIDER CONTRACT TOB RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4365 PROVIDER CONTRACT TOB RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4371 BENEFIT PLAN CLAIM TYPE RESTRICTION ON PROCEDURE A1 CLAIM/SERVICE DENIED N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 4373 NDC COVERED BENEFIT CLAIM TYPE RESTRICTION 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4374 BENEFIT PLAN CLAIM TYPE RESTRICTION ON REVENUE A1 CLAIM/SERVICE DENIED N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 4376 BENEFIT PLAN CLAIM TYPE RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 4711 PROVIDER CONTRACT AGE RESTRICTION ON ADMITTING DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4712 PROV CONTRACT AGE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4714 PROVIDER CONTRACT AGE RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4715 PROVIDER CONTRACT AGE RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 4716 AGE RESTRICTION FOR BILLED ICD9 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M51 MISSING/INCOMPLETE/INVALID PROCEDURE CODE(S) 4721 PROVIDER CONTRACT PRIM/SEC DTL DIAG RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4723 BENEFIT PLAN DETAIL DIAGNOSIS RESTRICTION ON ICD9 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4724 BENEFIT PLAN PRIMARY/SECONDARY DETAIL DIAGNOSIS RESTRICTION ON ICD9 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4726 BENEFIT PLAN ADMIT DIAG RESTRICTION ON ICD9 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4730 REIMBURSEMENT RULE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4731 BENEFIT PLAN DETAIL DIAGNOSIS RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4732 BENEFIT PLAN ADMITTING DIAGNOSIS RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4733 PROVIDER CONTRACT ADMITTING DIAGNOSIS RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4734 PROVIDER CONTRACT DETAIL DIAGNOSIS RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4736 BENEFIT PLAN DETAIL DIAGNOSIS RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4741 BENEFIT PLAN ADMITTING DIAGNOSIS RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4742 BENEFIT PLAN EMERGENCY DIAGNOSIS RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4743 BENEFIT PLAN PRIMARY/SECONDARY DETAIL DIAGNOSIS RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4744 BENEFIT PLAN PRIMARY/SECONDARY DETAIL DIAGNOSIS RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4745 BENEFIT PLAN HEADER DIAGNOSIS RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4746 BENEFIT PLAN PRIM DETAIL DIAGNOSIS RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M76 MISSING/INCOMPLETE/INVALID DIAGNOSIS OR CONDITION. 4751 PROVIDER CONTRACT TOB RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA30 MISSING/INCOMPLETE/INVALID TYPE OF BILL. 4760 PROVIDER CONTRACT REVIEW RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4762 PROVIDER CONTRACT POS RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4765 ICD9 PROCEDURE NOT COVERED FOR BENEFIT PLAN 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4766 BENEFIT PLAN AGE RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4767 BENEFIT PLAN POS RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4768 BENEFIT PLAN REVIEW RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4776 PROVIDER CONTRACT BILLING PROVIDER TYPE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N95 THIS PROVIDER TYPE/PROVIDER SPECIALTY MAY NOT BILL THIS SERVICE. 4801 PROCEDURE NOT COVERED BY PROVIDER CONTRACT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N56 PROCEDURE CODE BILLED IS NOT CORRECT/VALID FOR THE SERVICES BILLED OR THE DATE OF SERVICE BILLED. 4802 DIAGNOSIS NOT COVERED BY PROVIDER CONTRACT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4804 REVENUE NOT COVERED BY PROVIDER CONTRACT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M50 MISSING/INCOMPLETE/INVALID REVENUE CODE(S). 4805 DRG NOT COVERED BY PROVIDER CONTRACT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4806 ICD9 PROCEDURE NOT COVERED BY PROVIDER CONTRACT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M51 MISSING/INCOMPLETE/INVALID PROCEDURE CODE(S) 4812 PROVIDER CONTRACT REVIEW RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4813 PROVIDER CONTRACT REVIEW RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4814 PROVIDER CONTRACT REVIEW RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4821 BENEFIT PLAN POS RESTRICTION ON PROCEDURE A1 CLAIM/SERVICE DENIED M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4822 PROVIDER CONTRACT POS RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4825 MIXED HOLIDAY/WEEKEND/WEEKDAY DATES 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M59 "MISSING/INCOMPLETE/INVALID ""TO"" DATE(S) OF SERVICE" 4831 NO REIMBURSEMENT RULE FOR SERVICE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4845 PROVIDER CONTRACT REVIEW RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4863 NDC COVERED FOR A PORTION OF THE DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4866 BENEFIT PLAN POS RESTRICTION ON REVENUE A1 CLAIM/SERVICE DENIED M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4867 PROVIDER CONTRACT POS RESTRICTION ON REVENUE A1 CLAIM/SERVICE DENIED M77 MISSING/INCOMPLETE/INVALID PLACE OF SERVICE. 4871 PROVIDER CONTRACT CLAIM TYPE RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 4872 PROVIDER CONTRACT CLAIM TYPE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 4874 PROVIDER CONTRACT CLAIM TYPE RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 4875 PROVIDER CONTRACT CLAIM TYPE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4876 PROVIDER CONTRACT CLAIM TYPE RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N34 INCORRECT CLAIM FORM/FORMAT FOR THIS SERVICE. 4881 PROVIDER CONTRACT POS RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4882 DRG NOT COVERED FOR BENEFIT PLAN 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4883 BENEFIT PLAN REVIEW RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4884 BENEFIT PLAN AGE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 4886 BENEFIT PLAN CLAIM TYPE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4887 BENEFIT PLAN POS RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4890 PROVIDER CONTRACT AGE RESTRICTION ON PRIMARY DIAG 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4891 PROVIDER CONTRACT AGE RESTRICTION ON SECONDARY DIAG 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4892 PROVIDER CONTRACT AGE RESTRICTION ON THIRD DIAG 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4893 PROVIDER CONTRACT AGE RESTRICTION ON FOURTH DIAG 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4894 PROVIDER CONTRACT AGE RESTRICTION ON FIFTH DIAG 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4895 PROVIDER CONTRACT AGE RESTRICTION ON SIXTH DIAG 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4896 PROVIDER CONTRACT AGE RESTRICTION ON SEVENTH DIAG 6 THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. - - 4900 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4901 BENEFIT PLAN CONDITION CODE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4902 BENEFIT PLAN OCCURENCE CODE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4903 BENEFIT PLAN RESTRICTION ON DIAGNOSIS ROLE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4910 PROVIDER CONTRACT/BENEFIT PLAN RESTRICTION ON DIAGNOSIS 33 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4911 PROVIDER CONTRACT CONDITION CODE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4912 PROVIDER CONTRACT OCCURENCE CODE RESTRICTION ON DIAGNOSIS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4913 PROVIDER CONTRACT RESTRICTION ON DIAGNOSIS ROLE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4920 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4921 BENEFIT PLAN COND CODE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4922 BENEFIT PLAN OCCUR CODE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4930 BENEFIT PLAN RESTRICTION FOR CONTRACT DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4931 PROVIDER CONTRACT COND CODE RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4935 BENEFIT PLAN GENDER RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4936 PROVIDER CONTRACT GENDER RESTRICTION ON DRG 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4940 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4941 BENEFIT PLAN COND CODE RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4942 BENEFIT PLAN OCCUR CODE RESTRICTION ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4944 PROVIDER CONTRACT GENDER RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4950 PROVIDER CONTRACT/BENEFIT PLAN RESTRICT ON ICD9 PROC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4951 PROVIDER CONTRACT CONDITION CODE RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4952 PROVIDER CONTRACT OCCURENCE CODE RESTRICTION ON ICD9 PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4963 PROVIDER CONTRACT GENDER RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4964 PROVIDER CONTRACT GENDER RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4967 BENEFIT PLAN GENDER RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW MA39 MISSING/INCOMPLETE/INVALID GENDER. 4970 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4971 BENEFIT PLAN COND CODE RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4972 BENEFIT PLAN OCCUR CODE RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4975 PROVIDER CONTRACT/BENEFIT PLAN RESTRICT ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4976 PROVIDER CONTRACT CONDITION CODE RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4977 PROVIDER CONTRACT OCCURENCE CODE RESTRICTION ON REVENUE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4980 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4981 BENEFIT PLAN CONDITION CODE RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4982 BENEFIT PLAN OCCURENCE CODE RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4990 PROVIDER CONTRACT/BENEFIT PLAN RESTRICT ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4991 PROVIDER CONTRACT COND CODE RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4992 PROVIDER CONTRACT OCCUR CODE RESTRICTION ON PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 4999 THIS DRUG NOT COVERED BY MEDICARE PART D 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5000 EXACT DUPLICATE - INPATIENT CLAIM 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5001 SUSPECT DUPLICATE - INPATIENT CLAIM- DIFFERENT PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5002 CONFLICT - INPATIENT VS OUTPATIENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5003 CONFLICT - INPATIENT VS LONG TERM CARE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5004 EXACT DUPLICATE - INPATIENT/LTC CROSSOVER A 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5005 SUSPECT DUPLICATE - INPATIENT/LTC CROSSOVER A 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5006 EXACT DUPLICATE - PHYSICIAN CROSSOVER 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5007 SUSPECT DUPLICATE - PHYSICIAN CROSSOVER- DIFFERENT PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5008 CONFLICT- PHYSICIAN VS CROSSOVER B 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5009 CONFLICT-LONG TERM CARE VS CROSSOVER A 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5010 EXACT DUPLICATE-OUTPATIENT CLAIM 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5011 SUSPECT DUPLICATE-OUTPATIENT CLAIM-DIFFERENT PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5012 EXACT DUPLICATE - OUTPATIENT/HOMEHEALTH CROSSOVER C 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5013 SUSPECT DUPLICATE - OUTPATIENT/HOMEHEALTH CROSSOVER C 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5014 EXACT DUPLICATE-OUTPATIENT LAB SERVICES 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5015 SUSPECT DUPLICATE OUTPATIENT LAB SERVICES DIFFERENT PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5016 EXACT DUPLICATE OUTPATIENT RADIOLOGICAL SERVICES 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5017 SUSPECT DUPLICATE-OUTPATIENT RADIOLOGY SERVICES 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5018 SUSPECT DUPLICATE OUTPATIENT SURGICAL SERVICES (OPERATION ROOM / AMB SURG CTR) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5019 SUSPECT DUPLICATE OUTPATIENT SERGICAL SERVICES (OPER ROOM/AMB SWG CTR)-DIFFEREN 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5020 SUSPECT DUPLICATE OUTPATIENT PROCEDURE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5021 SUSPECT DUPLICATE OUTPATIENT PROCEDURE(OPER ROOM/AMB SURG CTR) DIFFERENT PROVID 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5022 SUSPECT DUPLICATE OUTPATIENT PROCEDURES (OPER ROOM/ AMB SURG CTR) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5023 SUSPECT DUPLICATE OUTPATIENT PROCEDURE (OPER ROOM/ AMB SURG CTR) DIFFERENT PROV 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5024 SUSPECT DUPLICATE OUTPATIENT SERGICAL SERVICES 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5025 SUSPECT DUPLICATE OUTPATIENT SERGICAL SERVICES (EMERG ROOM/ CLINIC) DIFFERENT P 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5026 SUSPECT DUPLICATE OUTPATIENT SERGICAL SERVICES EMERGENCY ROOM/ CLINIC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5027 SUSPECT DUPLICATE OUTPATIENT SURGICAL SERVICES- EMERG ROOM/CLINIC- DIFFERENT PR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5028 OPD EXACT DUP CRITERIA=E- CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5029 OPD SUSPECT DUP CRITERIA=E-CLAIM TYPE O -UB4 INV 03 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5030 XACT DUPLICATE OUTPATIENT PROCEDURES (OPER ROOM/AMB SURG CTR/EMERG ROOM/CLINIC) 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5031 SUSPECT DUPLICATE OUTPATIENT PROCEDURE (OR/AMB SURG CTR/ER/CLINIC) -DIFFERENT P 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5032 EXACT DUPLICATE-OUTPATIENT PROCEDURES (OPER ROOM / EMERG ROOM/ CLINIC) 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5033 SUSPECT DUPLICATE OUTPATIENT PROCEDURES- DIFFERENT PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5034 OPD EXACT DUP CRITERIA=E1-CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5035 OPD SUSPECT DUP CRITERIA=E1-CLAIM TYP O -UB4 INV 3 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5036 OPD EXACT DUP CRITERIA=F- CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5037 OPD SUSPECT DUP CRITERIA=F- CLAIM TYP O -UB4 INV 3 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5038 OPD EXACT DUP CRITERIA=F1-CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5039 OPD SUSPECT DUP CRITERIA=F1-CLAIM TYP O -UB4 INV 3 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5040 OPD EXACT DUP CRITERIA=G-CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5041 OPD SUSPECT DUP CRITERIA=G -CLAIM TYP O -UB4 INV 3 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5042 OPD EXACT DUP CRITERIA=H-CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5043 OPD SUSPECT DUP CRITERIA=H -CLAIM TYP O -UB4 INV 3 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5044 EXACT DUPLICATE - PHYSICAN CLAIM 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5045 SUSPECT DUPLICATE-PHYSICIAN CLAIM- DIFFERENT PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5046 EXACT DUPLICATE OUTPATIENT PROCEDURES (CLINIC) 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5047 SUSPECT DUPLICATE OUTPATIENT PROCEDURES (CLINIC) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5048 SUSPECT DUPLICATE OUTPATIENT PROCEDURES (CLINIC) 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5049 SUSPECT DUPLICATE OUTPATIENT PROCEDURE (CLINIC) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5050 EXACT DUPLICATE HOME HEALTH CLAIM 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5051 SUSPECT DUPLICATE- HOME HEALTH -DIFFERENT PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5052 EXACT DUPLICATE - LONG TERM CARE 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5053 SUSPECT DUPLICATE-LONG TERM CARE-DIFFERENT PROVIDER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5054 OPD EXACT DUP CRITERIA=M-CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5055 OPD SUSPECT DUP CRITERIA=M-CLAIM TYP O -UB4 INV 3 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5056 DUPLICATE SERVICE (DENTAL ONLY) 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5057 DUPLICATE SERVICE (PHARMACY ONLY) 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5058 OPD EXACT DUP CRITERIA=M1-CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5059 OPD SUSPECT DUP CRITERIA=M1-CLAIM TYP O -UB4 INV 3 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5060 OPD EXACT DUP CRITERIA=N-CLAIM TYPE O-UB04 INV 03 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5061 OPD SUSPECT DUP CRITERIA=N-CLAIM TYP O -UB04 INV 3 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5062 EXACT DUPLICATE OUTPATIENT PROCEDURES (TREATMENT ROOM) 18 EXACT DUPLICATE CLAIM/SERVICE. - - 5063 SUSPECT DUPLICATE OUTPATIENT PROCEDURES (TREATMENT ROOM) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5064 CONFLICT: INPATIENT VS. CROSSOVER A 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M2 NOT PAID SEPARATELY WHEN THE PATIENT IS AN INPATIENT. 5065 CONFLICT: HOME HEALTH VS. OUTPATIENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5066 CONFLICT: HOME VS. PHYSICIAN 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5067 CONFLICT: HOME VS. CROSSOVER B 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5068 CONFLICT: HOME HEALTH VS. CROSSOVER A 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5069 CONFLICT: HOME HEALTH VS. CROSSOVER C 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5070 CONFLICT: OUTPATIENT VS. CROSSOVER C 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5071 PA IS REQUIRED FOR BASIC MEMBERS 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " - - 5072 CONFLICT: LTC VS. PROV TYPE 58 59 62 63 64 66 68 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5073 CONFLICT: HOSPICE VS. LONG TERM CARE 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5074 EXACT DUPLICATE - DIFFERENT PHYSICIAN CLAIM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5075 EXACT DUPLICATE - DIFFERENT HOME HEALTH CLAIM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5076 EXACT DUPLICATE - DIFFERENT CROSSOVER B CLAIM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5077 LTC MLOA CLAIM SUSP W INP / PART A 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5078 S5160 & S5161 CAN NOT BE BILLED WITH LTC SAME DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5079 CONFLICT: LTC VS PHYSICIAN(S5160 & S5161) SAME DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5080 SURG/ASSIST SURG SAME DOS SAME PROVIDER A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5081 CONFLICT: ASC FACILITY VS OPD FACILITY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 5082 ONE PRIMARY SURGERY PER DAY A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5083 LIMIT 1 SURGICAL CODE WITH DIFFERENT MOD PER DAY A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5084 ASST SURGERY BILATERAL LIMIT MOD 80 A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5085 ONE PRIMARY ASSIST SURGERY PER DAY A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5086 ASST SURGERY BILATERAL LIMIT MOD 82 A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5087 ASST SURGERY BILATERAL LIMIT MOD 81 A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5088 CONFLICT: ASC FACILITY VS. OPD FACILITY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5089 CONFLICT: ASC FACILITY VS. HLHC HOSPITAL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5090 CONFLICT: ASC FACILITY VS. HLHC FACILITY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5091 DIFFERENT PROVIDER FROM SAME GROUP NOT ALLOWED A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5092 CONFLICT:HOME HEALTH VS. INPATIENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5093 CONFLICT:HOME HEALTH VS. LTC 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 5096 NCCI CONFLICT WITH ADJUSTED OTH SERV PREV PAID B13 PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT - - 5200 PAPE SERVICES SHOULD BE ON SINGLE CLAIM 107 "THE RELATED OR QUALIFYING CLAIM/SERVICE WAS NOT IDENTIFIED ON THIS CLAIM. NOTE: REFER TO THE 835 HEALTHCARE POLICY IDENTIFICATION SEGMENT (LOOP 2110 SERVICE PAYMENT INFORMATION REF), IF PRESENT" N149 REBILL ALL APPLICABLE SERVICES ON A SINGLE CLAIM 5210 ATP SERVICES SHOULD BE ON SINGLE CLAIM 107 "THE RELATED OR QUALIFYING CLAIM/SERVICE WAS NOT IDENTIFIED ON THIS CLAIM. NOTE: REFER TO THE 835 HEALTHCARE POLICY IDENTIFICATION SEGMENT (LOOP 2110 SERVICE PAYMENT INFORMATION REF), IF PRESENT" N149 REBILL ALL APPLICABLE SERVICES ON A SINGLE CLAIM 5927 NCCI -  ANOTHER SERVICE PREV PAID – SAME CLAIM B13 PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT - - 5928 NCCI – ANOTHER SERVICE PREV PAID – OTHER CLAIM B13 PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT - - 5929 NCCI – CONFLICT WITH OTHER SERVICE PREV PAID B13 PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT - - 5930 MUE UNITS EXCEEDED A1 CLAIM/SERVICE DENIED N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 5935 LABORATORY PANELS DENIED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCEDURE. SEPARATE PAYMENT IS NOT ALLOWED. 6000 MANUAL PRICING REQUIRED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 6001 MANUAL PRICING NOT ALLOWED ON ADJUSTMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 6002 INVALID UNIT CODE FOR ANESTHESIA 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 6003 PAID AMOUNT IS LESS THAN MINIMUM THRESHOLD - HDR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 6004 PAID AMOUNT EXCEEDS THRESHOLD - HDR 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT. - - 6005 COPAY REVIEW AMOUNT WAS REACHED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 6007 PAID AMOUNT LESS THAN MINIMUM THRESHOLD - DTL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 6008 AMOUNT EXCEEDS MAXIMUM THRESHOLD - DTL 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT. - - 6018 EXCESSIVE MLOA DAYS TAKEN 119 EXCESSIVE MLOA DAYS TAKEN N43 BED HOLD OR LEAVE DAYS EXCEEDED. 6019 EXCESSIVE MLOA DAYS TAKEN 119 EXCESSIVE MLOA DAYS TAKEN N43 BED HOLD OR LEAVE DAYS EXCEEDED. 6020 MLOA DAYS EXCEEDS MAX 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N43 BED HOLD OR LEAVE DAYS EXCEEDED. 6021 ATP ELIGIBLE CODE 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCDEDURE. SEPARATE PAYMENT IS NOT ALLOWED. 6022 ATP BUNDLED CLAIM 59 PROCESSED BASED ON MULTIPLE OR CONCURRENT PROCEDURE RULES M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCDEDURE. SEPARATE PAYMENT IS NOT ALLOWED. 6023 ATP PROCEDURE NOT ON MAX FEE TABLE (PROFESSIONAL) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 6024 ATP PROCEDURE NOT ON MAX FEE TABLE (OUTPATIENT) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 6025 ATP PROCEDURE NOT ON ATP CODE TABLE (PROFESSIONAL) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 6026 ATP PROCEDURE NOT ON ATP CODE TABLE (OUTPATIENT) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 6027 NO TPL PRICING METHOD FOUND FOR ATP PRICING FOR PROFESSIONAL CLAIM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 6028 NO TPL PRICING METHOD FOUND FOR ATP PRICING FOR OUTPATIENT CLAIM 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 6030 PROVIDER PRICING METHOD NOT FOUND (OUTPATIENT) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 6031 PAPE ELIGIBLE PROCEDURE 97 "THE BENEFIT FOR THIS SERVICE IS INCLUDED IN THE PAYMENT/ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE THAT HAS ALREADY BEEN ADJUDICATED. NOTE: REFER TO THE 835 HEALTHCARE POLICY IDENTIFICATION SEGMENT (LOOP 2110 SERVICE PAYMENT INFORMATION REF), IF PRESENT." M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCEDURE. SEPARATE PAYMENT IS NOT-ALLOWED. 6032 SYSTEM GENERATED CLAIM PAYING PAPE PRICE 97 "THE BENEFIT FOR THIS SERVICE IS INCLUDED IN THE PAYMENT/ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE THAT HAS ALREADY BEEN ADJUDICATED. NOTE: REFER TO THE 835 HEALTHCARE POLICY IDENTIFICATION SEGMENT (LOOP 2110 SERVICE PAYMENT INFORMATION REF), IF PRESENT." M15 SEPARATELY BILLED SERVICES/TESTS HAVE BEEN BUNDLED AS THEY ARE CONSIDERED COMPONENTS OF THE SAME PROCEDURE. SEPARATE PAYMENT IS NOT-ALLOWED. 6040 NMLOA AUDIT 119 EXCESSIVE MLOA DAYS TAKEN N43 BED HOLD OR LEAVE DAYS EXCEEDED. 6041 NMLOA AUDIT 119 EXCESSIVE MLOA DAYS TAKEN N43 BED HOLD OR LEAVE DAYS EXCEEDED. 6125 RETURN MONEY VOID / MATCHED CLM ADJUSTED OR VOIDED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 6126 MODIFIER MANUALLY PRICED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N65 "PROCEDURE CODE OR PROCEDURE RATE COUNT CANNOT BE DETERMINED, OR WAS NOT ON FILE, FOR THE DATE OF SERVICE/PROVIDER. " 6140 CLAIM WAS MANUALLY PRICED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 6760 CLAIM SUSPENDED FOR ATTACHMENT REVIEW 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 6761 DCN IS INVALID AND ATTACHMENT REQUIRED FOR SERVICE A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 6762 ATTACHMENT MISSING FOR PODIATRIC SERVICES 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 7751 DENIED AFTER REVIEW OF NCCI/MUE REQUEST A1 CLAIM/SERVICE DENIED MA46 THE NEW INFORMATION WAS CONSIDERED BUT ADDITIONAL PAYMENT WILL NOT BE ISSUED 7752 INSUFFICIENT INFORMATION FOR NCCI/MUE REQUEST 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N225 INCOMPLETE/INVALID DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPOR/CHART 7753 DUPLICATE NCCI/MUE REQUEST 18 EXACT DUPLICATE CLAIM/SERVICE. - - 7754 DENIED AS PPC 223 SERVICES/CHARGES RELATED TO THE TREATMENT OF A HOSPITAL-ACQUIRED CONDITION OR PREVENTABLE MEDICAL ERROR - - 8000 1 CASE CONSULT IN 3 MONTHS = 2 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8001 LIMIT 1 PROC CODE PER MEMBER PER DAY-VARIOUS CODES 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8002 ESRD RELATED SERVICES 1 PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8003 PA IS REQUIRED FOR BASIC MEMBERS 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 8004 MODIFIER 26 REQUIRED IN HOSPITAL SETTING 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING M53 MISSING/INCOMPLETE/INVALID DAYS OR UNITS OF SERVICE. 8005 CONTRACEPTIVE INJECTABLE 3MTH. DEPRO-PROVERA A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8006 CONTRACEPTIVE INJECTABLE LUNELLE 1 PER MONTH A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8007 "T1028, 1 ASSESSMENT = 3 COMPONENTS/UNITS PER YEAR " 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8008 "T1024, 3 TEAM MEETINGS = 9 UNITS/COMPONENTS PER YR " 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8009 1 ASSIST AT SURGERY/PER MEMB/PER DAY 54 MULTIPLE PHYSICIANS/ASSISTANTS ARE NOT COVERED IN THIS CASE . N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8010 LIMIT 1 ANESTHESIA CODE PER MEMBER PER DAY 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8011 2 MONURAL CODE V5241 DISPENSING FEES IN 5 YEARS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8012 8 VISITS 99402 ALLOWED FOR CHC/FP PER YEAR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8013 2 REEVALUATIONS (99456-TS) PER YEAR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8014 PHARMACY CODES - MAX 31 UNITS PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 8015 ORTHOTICS - 1 UNIT IN 1 YEAR FROM DOS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. M90 NOT COVERED MORE THAN ONCE IN A 12 MONTH PERIOD. 8016 ORTHOTICS 2 UNITS IN 1 YEAR FROM DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8017 ORTHOTICS 4 UNITS IN 1 YEAR FROM DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8018 ORTHOTICS 3 UNITS IN 6 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8019 ORTHOTICS 6 UNITS IN 1 YEAR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8020 ORTHOTICS 8 UNITS IN 1 YEAR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8021 ORTHOTIC 1 UNIT IN 3 YEARS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8022 PROSTHETICS 12 UNITS IN 1 YEAR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8023 2 STOCKINGS IN 7 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8024 1 LITHIUM ION BATTERY CHARGER IN 2 YEARS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8025 HOME HEALTH PT LIM 20 VIS (120 UNITS) 12 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8026 HOME HEALTH OT LIM 20 VIS (120 UNITS) 12 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8027 HOME HEALTH ST LIM 35 VIS (140 UNITS)12 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8028 DME 1 UNIT IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8029 DME 2 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8030 DME 3 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8031 DME 4 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8032 DME 10 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8033 DME LIMIT 6 UNITS IN 1 MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8034 DME 12 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8035 DME 18 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8036 DME LIMIT 20 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8037 DME LIMIT 30 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8038 DME LIMIT 31 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8039 DME LIMIT 35 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8040 DME LIMIT 40 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8041 DME LIMIT 60 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8042 DME LIMIT 93 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8043 DME LIMIT 100 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8044 DME LIMIT 120 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8045 DME LIMIT 250 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8046 DME LIMIT 720 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8047 DME LIMIT 1000 UNITS IN 1 CALENDAR MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8048 DME LIMIT 1 UNIT IN 3 CALENDAR MONTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8049 DME LIMIT 2 UNIT IN 3 CALENDAR MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8050 DME LIMIT 3 UNITS IN 3 MONTHS MOD=KS ONLY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8051 DME LIMIT 4 UNITS IN 3 CALENDAR MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8052 DME LIMIT 5 UNITS IN 3 MTHS MODIFR KS ONLY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8053 DME LIMIT 6 UNITS IN 3 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8054 DME LIMIT 15 UNITS IN 3 MTHS MOD KX ONLY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8055 DME LIMIT 8 UNITS IN 3 MTHS MOD KX ONLY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8056 DME LIMIT 9 UNITS IN 3 CALENDAR MTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8057 DME LIMIT 10 UNITS IN 6 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8058 DME LIMIT 1 UNIT IN 6 MONTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8059 DME LIMIT 2 UNITS IN 6 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8060 DME LIMIT 16 UNITS IN 6 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8061 DME LIMIT 1 UNIT IN 12 MONTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8062 DME LIMIT 2 UNITS IN 12 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8063 DME LIMIT 4 UNITS IN 12 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8064 DME LIMIT 8 UNITS IN 12 MONTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8065 DME LIMIT 12 UNITS IN 12 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8066 DME LIMIT 1 UNIT IN 24 MONTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8067 DME LIMIT 1 UNIT IN 3 YEARS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8068 DME LIMIT 2 UNITS IN 3 YEARS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8069 DME LIMIT 1 UNIT IN 5 YEARS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8070 LIMIT 27 UNITS PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8071 DME LIMIT 36 UNITS PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8072 DME LIMIT 12 PER MNTH PER WOUND=108 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8073 DME LIMIT 30 PER MTH PER WOUND=27O UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8074 DME LIMIT 31 PER MTH PER WOUND=279 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8075 DME LIMIT 45 PER MTH PER WOUND=405 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8076 DME LIMIT 60 PER MTH PER WOUND=540 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8077 DME LIMIT 80 PER MTH PER WOUND=720 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8078 DME LIMIT 100 PER MTH PER WOUND=900 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8079 DME LIMIT 160 PER MTH PER WOUND=1440 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8080 DME LIMIT 200 PER MTH PER WOUND=1800 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8081 DME LIMIT 240 PER MTH PER WOUND=2160 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8082 DME LIMIT 100 PER WOUND IN 3 MTHS =900 UNITS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8083 DME LIMIT 11 UNITS PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8084 DME LIMIT 150 UNITS PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8085 DME LIMIT 124 UNITS PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8086 DME LIMIT 15 UNITS PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8087 DME LIMIT 90 UNITS PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8088 SCREENING/INTAKE 8 UNITS T1023 PER MBR PER 12 MTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 8089 DAY HABILITATION LIMIT 1 PER DAY EXCEPT MOD-22 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8090 "PA REQUIRED FOR MOBILITY REPAIR OVER $1,000 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " - - 8091 MODIFIER 26 OR TC REQUIRED FOR PROCEDURE CODES IN GROUP 4113 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8092 ORTHOTIC AND PROSTHETIC LIMIT - 4 UNITS PER MEMBER PER YEAR FROM LAST DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8093 ORTHOTIC AND PROSTHETIC LIMIT - 6 UNITS PER MEMBER PER YEAR FROM LAST DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8094 ORTHOTIC AND PROSTHETIC LIMIT - 8 UNITS PER MEMBER PER YEAR FROM LAST DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8095 ORTHOTIC AND PROSTHETIC LIMIT - 12 UNITS PER MEMBER PER YEAR FROM LAST DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8096 ORTHOTIC LABOR AND REPAIR CODES REQUIRE PA IF OVER $1000.00 PER MONTH 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 8097 PROSTHETIC LABOR AND REPAIR CODES REQUIRE PA IF OVER $1000.00 PER MONTH 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 8098 MODIFIER REQUIRED FOR VARIOUS CAPPED RENTAL/PURCHASE CODES. MODIFIERS VALUES KH 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8099 MODIFIER REQUIRED FOR VARIOUS OXYGEN CODES.MODIFIERS VALUES QF QG RR U2. 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8100 TOOTH PREVIOUSLY EXTRACTED A1 CLAIM/SERVICE DENIED N384 RECORDS INDICATE THAT THE REFERENCED BODY PART/TOOTH HAS BEEN REMOVED IN A PREVIOUS PROCEDURE. 8101 MODIFIER REQUIRED FOR CHRONIC THERAPY SERVICES 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8102 DME SURGICAL CODES REQUIRE ONE OF THE A1 THROUGH A9 MODIFIERS. 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8103 HIT NURSING VISIT CODES 99601 AND 99602 REQUIRE MODIFIER SD. 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8104 DIABETIC SUPPLIES/INFUSION SUPPLIES REQR MODIFIER 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8105 PROFESSIONAL COMPONENT NOT ALLOWED FOR THIS SERVICE. 8 THE PROCEDURE CODE IS INCONSISTENT WITH THE PROVIDER TYPE/SPECIALTY (TAXONOMY). - - 8106 ENTERAL PROCEDURE CODES REQUIRE A MODIFIER 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8107 ORTHOTIC AND PROSTHETIC CODES REQUIRE LT/RT MODIFIER 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8108 PA REQUIRED FOR MONAURAL HEARING AIDS IF COSTS EXCEEDS $550.00 197 PRECERTIFICATION/AUTHORIZATION/NOTIFICATION ABSENT. M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 8109 "PA IS REQUIRED FOR BINAURAL, CROS AND BICROS HEARING AIDS IF COSTS EXCEEDS $1,1" 197 PRECERTIFICATION/AUTHOR-IZATION/NOTIFICATION ABSENT. M62 MISSING/INCOMPLETE/INVALID TREATMENT AUTHORIZATION CODE. 8110 ORTHOTIC AND PROSTHETIC LIMIT - 1 UNIT PER MEMBER IN 1 YEAR FROM LAST DOS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8111 ORTHOTIC - PROSTHETIC - LIMIT 2 UNITS PER MEMBER PER YEAR FROM DOS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8112 LIMIT 10 UNITS PER DAY PROC 80100 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8113 LIMIT 13 UNITS PER DAY PROC 80101 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8114 LIMIT 1 UNIT PER DAY - VARIOUS CODES 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8115 DME LIMIT 2 UNITS IN 5 YEARS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8116 LIMIT 4 UNITS PER DAY PROC 80102 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8117 LIMIT ONE DIAPER CODES PER MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8118 LIMIT 1 CESAREAN PER DAY (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8119 DME LIMIT 225 UNITS IN 1 MONTH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8120 LIMIT 1 LAPAROSCOPIC CHOLECYSTECTOMY PER DAY(SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8121 ADULT DAY CARE SERVICE LIMIT 1 PER DAY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8122 FIRST MONTHS RENTAL OF VARIOUS CAPPED RENTAL CODES LIMIT 1 IN 5 YEARS WITH MODI 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8123 SECOND AND THIRD MONTHS RENTAL OF VARIOUS CAPPED RENTAL CODES LIMIT 2 IN 5 YEAR 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8124 10 MONTHS CAPPED RENTAL ALLOWED IN 5 YEARS FOR VARIOUS CAPPED RENTAL CODES LIMI 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8125 VARIOUS REPAIR/MOBILITY CODES REQUIRE A MOD. MOD VALUES NU RP RR UB UC UE U1. 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8126 "MODIFIER REQUIRED FOR CODES A4450, A4452 AND A5120. MODIFIER VALUES AU AV AW. 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR A REQUIRED MODIFIER IS MISSING - - 8127 TRANSPORTATION T2003 LIMIT - 2 ONE WAY TRIPS / DAY 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8128 AFC CODE S5140 TF/U5 LIMIT 14 UNITS PER CAL YEAR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8129 PHARMACY PLACE OF SERVICE 01 NOT ALLOWED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8130 T4536 T4538 T4539 NOT ALLOWED W DIAPER CODE BILLED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8131 DME LIMIT 1 UNIT PER MONTH (RENTAL ONLY) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8132 DME LIMIT 13 UNITS IN 3 YEARS (MOD RR ONLY) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8133 DME CONFLICT: PURCHASE VS RENTAL IN 3 YEARS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8134 LIMIT 1 IN 3 YEARS ON 1ST MONTH OF CAPPED RENTAL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8135 2ND & 3RD MONTHS CAPPED RENTAL- LIMIT 2 IN 3 YEARS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8136 LIMIT 10 IN 3 YEARS FOR 10 MONTHS OF CAPPED RENTAL 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8137 DME RENTAL NOT ALLOWED AFTER PURCHASE IN 3 YEARS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8138 DME LIMIT 13 UNITS IN 5 YEARS (MOD RR ONLY) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8139 DME CONFLICT: PURCHASE VS RENTAL IN 5 YEARS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8140 DME RENTAL NOT ALLOWED AFTER PURCHASE IN 5 YEARS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8141 DME CONFLICT: PURCHASE VS RENTAL IN 1 YEAR 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8142 DME CONFLICT: PURCHASE VS RENTAL IN 24 MONTHS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8143 DME LIMIT 13 UNITS IN 24 MONTHS (MOD RR ONLY) 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8144 NDC CODE - UNITS - & UNIT DESCRIPTOR REQUIRED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8145 MAX UNITS 1 PER DAY FOR NON-SCHOOL BASED PROVIDERS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8146 MAX UNITS 3 PER DAY FOR NON-SCHOOL BASED PROVIDERS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8147 MAX UNITS 4 PER DAY FOR NON-SCHOOL BASED PROVIDERS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8148 MAX UNITS 6 PER DAY FOR NON-SCHOOL BASED PROVIDERS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8149 MAX UNITS 7 PER DAY FOR NON-SCHOOL BASED PROVIDERS 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 8150 NEW AND DELETED CODES CANNOT BE BILLED ON SAME DAY B13 PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT. M86 SERVICE DENIED BECAUSE PAYMENT ALREADY MADE FOR SAME/SIMILAR PROCEDURE WITHIN SET TIME FRAME. 8156 MODIFIER REQUIRED FOR CODE 96110-NOT PRESENT 4 THE PROCEDURE CODE IS INCONSISTENT WITH THE MODIFIER USED OR THE REQUIRED MODIFIER IS MISSING - - 8175 SERVICE PROVIDED ON THE SAME DAY OF A GLOBAL SURGICAL PROCEDURE IS INCLUDED IN FEE AMT 97 THE BENEFIT FOR THIS SERVICE IS INCLUDED IN THE PAYMENT/ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE THAT HAS ALREADY BEEN ADJUDICATED N525 THESE SERVICES ARE NOT COVERED WHEN PERFORMED WITHIN THE GLOBAL PERIOD OF ANOTHER SERVICE 8176 SERVICE PROVIDED ON THE DAY OF & DURING 10 DAY GLOBAL SURGICAL PROCEDURE INCLUDED 97 THE BENEFIT FOR THIS SERVICE IS INCLUDED IN THE PAYMENT/ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE THAT HAS ALREADY BEEN ADJUDICATED N525 THESE SERVICES ARE NOT COVERED WHEN PERFORMED WITHIN THE GLOBAL PERIOD OF ANOTHER SERVICE 8177 SERVICE PROVIDED DAY BEFORE & DURING 90 DAY GLOBAL SURGICAL PROCEDURE INCLUDED 97 THE BENEFIT FOR THIS SERVICE IS INCLUDED IN THE PAYMENT/ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE THAT HAS ALREADY BEEN ADJUDICATED N525 THESE SERVICES ARE NOT COVERED WHEN PERFORMED WITHIN THE GLOBAL PERIOD OF ANOTHER SERVICE 8185 MASS ADJUSTMENT - RETROACTIVE RATE CHANGE. B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 8242 ATP/PAPE ADJUSTMENT/VOID B13 PREVIOUSLY PAID. PAYMENT FOR THIS CLAIM/SERVICE MAY HAVE BEEN PROVIDED IN A PREVIOUS PAYMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 8250 INVALID COMBINATION OF PROCEDURES 96 NON-COVERED CHARGE(S). N56 PROCEDURE CODE BILLED IS NOT CORRECT/VALID FOR THE SERVICES BILLED OR THE DATE OF SERVICE BILLED. 8251 SPEECH THERAPY LIMIT 35 VISITS IN 12 MONTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8252 INVALID COMBINATION OF PROCEDURES 96 NON-COVERED CHARGE(S). N431 SERVICE IS NOT COVERED WITH THIS PROCEDURE. 8253 VISIT & SURGERY NOT ALLOWED SAME DAY/SAME POS 96 NON-COVERED CHARGE(S). N431 SERVICE IS NOT COVERED WITH THIS PROCEDURE. 8254 MULTIPLE VISITS NOT ALLOWED SAME DAY 96 NON-COVERED CHARGE(S). M86 SERVICE DENIED BECAUSE PAYMENT ALREADY MADE FOR SAME/SIMILAR PROCEDURE WITHIN SET TIME FRAME. 8255 CHIROPRACTOR MANIPULATION / VISIT = 1 PER DAY 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8256 CHIROPRACTOR MANIPULATION / VISIT 20 PER YEAR 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8257 CONFLICT ACUPUNCTURE WITH METHADONE ADMINIST 96 NON-COVERED CHARGE(S). N431 SERVICE IS NOT COVERED WITH THIS PROCEDURE. 8258 MONTHLY ESRD CONFLICTS WITH DAILY ESRD 96 NON-COVERED CHARGE(S). N431 SERVICE IS NOT COVERED WITH THIS PROCEDURE. 8259 MONTHLY ESRD 1 PER MONTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8260 1 LEVEL OF MUNICIPAL MEDICAID STUDENT/DAY 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8261 10 HOURS PDN PER DAY FOR 22 SCHOOL DAYS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. - - 8262 MUNI MEDICAID PROCS CONFLICT WITH THERAPY 96 NON-COVERED CHARGE(S). N431 SERVICE IS NOT COVERED WITH THIS PROCEDURE. 8263 LAB UNRINALYSIS CONFLICT W/ EACH OTHER ON SAME DAY 96 NON-COVERED CHARGE(S). N20 SERVICE NOT PAYABLE WITH OTHER SERVICE RENDERED ON THE SAME DATE. 8264 OTHER LAB TESTS CONF W/GENERAL HEALTH LAB TESTS 96 NON-COVERED CHARGE(S). N20 SERVICE NOT PAYABLE WITH OTHER SERVICE RENDERED ON THE SAME DATE. 8265 OTHER LAB TESTS CONFLICT W/ OBSTETRIC PANEL 96 NON-COVERED CHARGE(S). N20 SERVICE NOT PAYABLE WITH OTHER SERVICE RENDERED ON THE SAME DATE. 8266 LIPID PANEL CONFLICTS WITH OTHER LAB TESTS 96 NON-COVERED CHARGE(S). N20 SERVICE NOT PAYABLE WITH OTHER SERVICE RENDERED ON THE SAME DATE. 8267 LAB HEMATOLOGY CONFLICT W/EACH OTHER ON SAME DOS 96 NON-COVERED CHARGE(S). N20 SERVICE NOT PAYABLE WITH OTHER SERVICE RENDERED ON THE SAME DATE. 8268 PHYSICAL THERAPY CODES LIMIT 1 HR (4 UNITS) PER DY 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8269 OCCUPATIONAL THERAPY LIMIT 1 HR (4 UNITS) PER DAY 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8270 SPEECH THERAPY CODES LIMIT 1 HR (4 UNITS) PER DAY 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8271 ANTEPARTUM CARE LIMIT 1 OF EITHER CODE PER YEAR 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8272 AMBULANCE ALS CONFLICTS WITH BLS SAME DAY 96 NON-COVERED CHARGE(S). N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8273 2 PAIRS SHOES DURING 12 MONTH PERIOD 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. - - 8274 2 MONAURAL HEARING AIDS IN 5 YEARS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8275 1 BINAURAL HEARING AID IN 5 YEARS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8276 1 DISPENSING FEE IN 5 YRS (BILATERAL) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8277 EVAL & MANGMNT CONFLICTS W/TREATMENT PROC SAME DAY 96 NON-COVERED CHARGE(S). N20 SERVICE NOT PAYABLE WITH OTHER SERVICE RENDERED ON THE SAME DATE. 8278 DELIVERY CONFLICTS WITH FETAL STRESS TEST 96 NON-COVERED CHARGE(S). N20 SERVICE NOT PAYABLE WITH OTHER SERVICE RENDERED ON THE SAME DATE. 8279 1 NEW PATIENT VISIT WITHIN 3 YEARS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8280 CONSULTATION CONFLICTS W/ REFRACTION 96 NON-COVERED CHARGE(S). N20 SERVICE NOT PAYABLE WITH OTHER SERVICE RENDERED ON THE SAME DATE. 8281 DIAPERS LIMIT 248 PER MEMB/PER CAL MONTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8282 4 STOCKINGS IN 6 MONTHS PER MEMBER 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8283 OUTPATIENT HOSP SPEECH THERAPY LIMIT 35 VIS 12 MTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8284 OUTPATIENT HOSP PHYSICAL THERAPY LIM 20 VIS/12 MTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8285 OUTPATIENT HOSP OCCUPTNL THERAPY LIM 20 VIS/12 MTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8286 PHYSICIAN PHYSICAL THERAPY LIMIT 20 VISITS/12 MTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8287 PHYSICIAN OCCUPATIONAL THERAPY LIMIT 20 VIS/12 MTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8288 PHYSICIAN SPEECH THERAPY LIMIT 35 VISITS/12 MTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8289 SPEECH AND HEARING CENTER SPEECH THERAPY LIMIT 35 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8290 CHRONIC HOSP SPEECH THERAPY LIM 35 VIS OF 1 UNIT 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8291 CHRONIC HOSP SPEECH THERAPY LIM 35 VIS IN 12 MTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8292 CHRONIC HOSP OCCUPATIONAL THERAPY 20 VISITS/12 MTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8293 CHRONIC HOSP PHYSICAL THERAPY LIM 20 VISITS/12 MTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8294 REHAB CENTER PHYSICAL THERAPY LIMIT 20 VIS 12 MTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8295 REHAB CENTER OCCUPTNL THERAPY LIMIT 20 VIS 12 MTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8296 REHAB CENTER SPEECH THERAPY LIMIT 35 VISITS 12 MTHS 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8297 PSYCH INPATIENT LIMIT 30 CONSECUTIVE DAYS PER EPISODE 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8298 PSYCH INPATIENT LIMIT 60 DAYS PER CALENDAR YEAR 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8299 OPERATING ROOM CONFLICTS W/AMBULATORY SURGERY 96 NON-COVERED CHARGE(S). N431 SERVICE IS NOT COVERED WITH THIS PROCEDURE. 8300 INDEPENDENT PHYSICAL THERAPY LIMIT 20 VIS 12 MONTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8301 INDEPENDENT OCCUPATIONAL THERAPY LIM 20 VIS 12 MTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8302 ADULT & GROUP FOSTER CARE - LIMIT 31 UNITS PER MTH 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8303 "PA REQUIRED FOR EQUIPMENT REPAIR OVER $1,000 15 "THE AUTHORIZATION NUMBER IS MISSING, INVALID, OR DOES NOT APPLY TO THE BILLED SERVICES OR PROVIDER " - - 8400 NMLOA ALL LOC MAX 15 CUMULATIVE DAYS IN 1 DOS YEAR 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8401 NMLOA ALL LOC MAX 10 CUMULATIVE DAYS IN 1 DOS YEAR 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8500 2 CLAVICULECTOMIES IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8501 2 CLAVICULECTOMIES IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8502 2 CLAVICULECTOMIES IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8503 2 CLAVICULECTOMIES IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8504 2 AMPUTATIONS-WRIST IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8505 2 AMPUTATIONS-WRIST IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8506 2 AMPUTATIONS-WRIST IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8507 10 AMPUTATIONS-METACARPAL IN LIFE (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8508 10 AMPUTATIONS-METACARPAL IN LIFE (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8509 10 AMPUTATIONS-METACARPAL IN LIFE (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8510 10 AMPUTATIONS-METACARPAL IN LIFE (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8511 2 AMPUTATIONS-ANKLE IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8512 2 AMPUTATIONS-ANKLE IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8513 2 AMPUTATIONS-ANKLE IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8514 2 AMPUTATION-FOOT (MID) IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8515 2 AMPUTATION-FOOT (MID) IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8516 2 AMPUTATION-FOOT (MID) IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8517 2 AMPUTATION-FOOT (TRN) IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8518 2 AMPUTATION-FOOT (TRN) IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8519 2 AMPUTATION-FOOT (TRN) IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8520 1 EPIGLOTTIDECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8521 1 EPIGLOTTIDECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8522 1 EPIGLOTTIDECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8523 1 EPIGLOTTIDECTOMY IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8524 1 COLPECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8525 1 COLPECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8526 1 COLPECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8527 1 TRACHELECTOMY (CERVIECTOMY) IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8528 1 TRACHELECTOMY (CERVIECTOMY) IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8529 1 TRACHELECTOMY (CERVIECTOMY) IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8530 1 TRACHELECTOMY (CERVIECTOMY) IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8531 1 THYROIDECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8532 1 THYROIDECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8533 1 THYROIDECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8534 1 EVALUATION (99456) PER PROVIDER IN LIFETIME 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8535 2 MASTECTOMIES IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8536 2 MASTECTOMIES IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8537 2 MASTECTOMIES IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8538 2 MASTECTOMIES IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8539 1 MASTECTOMY IN LIFETIME-MOD 50 (INACTIVE) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8540 1 MASTECTOMY IN LIFETIME-MOD 50 (INACTIVE) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8541 10 AMPUTATIONS-FINGER IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8542 10 AMPUTATIONS-FINGER IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8543 10 AMPUTATIONS-FINGER IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8544 2 AMPUTATIONS-ARM IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8545 2 AMPUTATIONS-ARM IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8546 2 AMPUTATIONS-ARM IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8547 2 AMPUTATIONS FOREARM-THRU RADIUS & ULNA (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8548 2 AMPUTATIONS FOREARM-THRU RADIUS & ULNA (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8549 2 AMPUTATIONS FOREARM-THRU RADIUS & ULNA (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8550 2 AMPUTATIONS-LEG IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8551 2 AMPUTATIONS-LEG IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8552 2 AMPUTATIONS-LEG IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8553 2 AMPUTATIONS LEG- TIBIA & FIBULA- LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8554 2 AMPUTATIONS LEG- TIBIA & FIBULA- LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8555 2 AMPUTATIONS LEG- TIBIA & FIBULA- LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8556 1 LARYNGECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8557 1 LARYNGECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8558 1 LARYNGECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8559 1 HEMILARYNGECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8560 1 HEMILARYNGECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8561 1 HEMILARYNGECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8562 1 TOTAL PNEUMONECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8563 1 TOTAL PNEUMONECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8564 1 TOTAL PNEUMONECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8565 1 GLOSSECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8566 1 GLOSSECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8567 1 GLOSSECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8568 1 APPENDECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8569 1 APPENDECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8570 1 APPENDECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8571 1 TOTAL GASTRECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8572 1 TOTAL GASTRECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8573 1 TOTAL GASTRECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8574 1 AMPUTATION-PENIS IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8575 1 AMPUTATION-PENIS IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8576 1 AMPUTATION-PENIS IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8577 1 CIRCUMCISION IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8578 1 CIRCUMCISION IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8579 1 CIRCUMCISION IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8580 1 CIRCUMCISION IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8581 2 ORCHIECTOMIES-UNILAT IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8582 2 ORCHIECTOMIES-UNILAT IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8583 2 ORCHIECTOMIES-UNILAT IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8584 2 ORCHIECTOMIES-UNILAT IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8585 1 ORCHIECTOMY- BILATERAL IN LIFETIME (INACTIVE) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8586 1 ORCHIECTOMY- BILATERAL IN LIFETIME (INACTIVE) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8587 1 PROSTATECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8588 1 PROSTATECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8589 1 PROSTATECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8590 1 VULVECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8591 1 VULVECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8592 1 VULVECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8593 1 VULVECTOMY IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8594 1 EXCISION OF CERVICAL STUMP IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8595 1 EXCISION OF CERVICAL STUMP IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8596 1 EXCISION OF CERVICAL STUMP IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8597 1 TRACHELECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8598 1 TRACHELECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8599 1 TRACHELECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8600 1 TRACHELECTOMY IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8601 1 HYSTERECTOMY IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8602 1 HYSTERECTOMY IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8603 1 HYSTERECTOMY IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8604 2 ADRENALECTOMIES IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8605 2 ADRENALECTOMIES IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8606 2 ADRENALECTOMIES IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8607 1 ADRENALECTOMY IN LIFETIME (INACTIVE) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8608 2 COMPLETE IRIDECTOMIES IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8609 2 COMPLETE IRIDECTOMIES IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8610 2 COMPLETE IRIDECTOMIES IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8611 2 COMPLETE IRIDECTOMIES IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8612 1 PALATOPLASTY FOR CLEFT PALATE IN LIFETIME (SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8613 1 PALATOPLASTY FOR CLEFT PALATE IN LIFETIME (ASSIST SURG) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8614 1 PALATOPLASTY FOR CLEFT PALATE IN LIFETIME (OPD FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 8615 1 PALATOPLASTY FOR CLEFT PALATE IN LIFETIME (ASC FACILITY) 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 9000 PHARMACY ALLOWED AMOUNT IS LESS THAN BILLED AMOUNT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 9001 REIMBURSEMENT REDUCED BY THE RECIPIENT'S CO-PAYMENT AMOUNT. 3 CO-PAYMENT AMOUNT - - 9002 PRICING METHOD MISSING/INVALID FOR CLAIM TYPE A1 CLAIM/SERVICE DENIED N10 CLAIM/SERVICE ADJUSTED BASED ON THE FINDINGS OF A REVIEW ORGANIZATION/PROFESSIONAL CONSULT/MANUAL ADJUDICATION/MEDICAL OR DENTAL ADV-ISOR. 9005 CLAIM PAYMENT AMOUNT LESS THAN COPAY AMOUNT 3 CO-PAYMENT AMOUNT - - 9010 MEMBER HAS MET COPAY CAP 3 CO-PAYMENT AMOUNT - - 9011 CO-PAYMENT INCLUSION CRITERIA NOT MET 3 CO-PAYMENT AMOUNT N59 ALERT: PLEASE REFER TO YOUR PROVIDER MANUAL FOR ADDITIONAL PROGRAM AND PROVIDER INFORMATION. 9013 MEMBER CALENDAR COINSURANCE LIMIT EXCEEDED 2 COINSURANCE AMOUNT - - 9015 AT LEAST ONE DETAIL IS IN DENIED STATUS A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 9016 CLAIM DENIED BECAUSE ALL DETAILS DENIED A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION." 9020 CRITICAL EDIT IS RECYCLED TO A PAY EDIT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 9050 COLLECTION FROM TITLE 18(MEDICARE PART-A) FOR SERVICES PREVIOUSLY PAID BY MCARE B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N420 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A COORDINATION OF BENEFITS OR THIRD PARTY LIABILITY RECOVERY 9051 COLLECTION FROM TITLE 18(MEDICARE PART-B) FOR SERVICES PREVIOUSLY PAID BY MCARE B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N420 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A COORDINATION OF BENEFITS OR THIRD PARTY LIABILITY RECOVERY 9052 COLLECTION FROM ANY HEALTH INSURANCES B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N420 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A COORDINATION OF BENEFITS OR THIRD PARTY LIABILITY RECOVERY 9053 "COLLECTION FROM CASUALTY INSURANCE, WORKMANS COMP, OR TORT LIABILITY CLAIMS " B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N420 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A COORDINATION OF BENEFITS OR THIRD PARTY LIABILITY RECOVERY 9054 COLLECTION FROM ESTATE OF DECEASED MEMBER B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N420 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A COORDINATION OF BENEFITS OR THIRD PARTY LIABILITY RECOVERY 9055 MANUAL ADJUSTMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9056 GENERAL MASS ADJUSTMENT 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9057 PAID TO WRONG PROVIDER B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED N280 MISSING/INCOMPLETE/INVALID PAY-TO PROVIDER PRIMARY IDENTIFIER 9058 PAID FOR WRONG MEMBER B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N382 MISSING/INCOMPLETE/INVALID PATIENT IDENTIFIER. 9059 PROVIDER BILLED SERVICE PRIOR TO SERVICE DATE/SERVICE NOT DELIVERED B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. MA31 MISSING/INCOMPLETE/INVALID BEGINNING AND ENDING DATES OF THE PERIOD BILLED. 9060 DUPLICATE PAYMENT RETURNED DUE TO AN ERRONEOUS DUPLICATE PAYMENT FOR SAME DATE B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. - - 9061 DUPLICATE PAYMENT - PROVIDER BILLED TWICE B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. M86 SERVICE DENIED BECAUSE PAYMENT ALREADY MADE FOR SAME/SIMILAR PROCEDURE WITHIN SET TIME FRAME. 9062 COLLECTION FROM CREDIT BALANCE ON MEMBERS ACCOUNTS 129 PRIOR PROCESSING INFORMATION APPEARS INCORRECT. - - 9063 PROVIDER PAID MORE THAN BILLED 129 PRIOR PROCESSING INFORMATION APPEARS INCORRECT. - - 9064 PROVIDER ONLY PERFORMED COMPONENT OF SERVICE BILLED 203 PAYMENT ADJUSTED FOR DISCONTINUED OR REDUCED SERVICE. THIS CHANGE TO BE EFFECTIVE 4/1/2008: DISCONTINUED OR REDUCED SERVICE. - - 9065 OTHER 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 9066 PATIENT PAID AMOUNT DISCREPANCY 178 PATIENT HAS NOT MET THE REQUIRED SPEND DOWN REQUIREMENTS. - - 9067 COLLECTION FROM TITLE 18 WHEN PART A OR B CANNOT BE DETERMINED 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. - - 9068 LEAVE OF ABSENCE DAYS WERE EITHER NOT INDICATED OR INCORRECT 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N43 BED HOLD OR LEAVE DAYS EXCEEDED. 9069 OUTPATIENT CLAIM WAS BILLED DURING AN INPATIENT STAY 60 CHARGES FOR OUTPATIENT SERVICES WITH THIS PROXIMITY TO INPATIENT SERVICES ARE NOT COVERED. - - 9070 OUTPATIENT CLAIM WAS BILLED DURING AN INPATIENT STAY - SAME FACILITY 60 CHARGES FOR OUTPATIENT SERVICES WITH THIS PROXIMITY TO INPATIENT SERVICES ARE NOT COVERED. - - 9071 LONG TERM CARE CLAIM WAS BILLED DURING A HOSPICE SEGMENT B9 PATIENT IS ENROLLED IN A HOSPICE. - - 9072 CLAIM WAS PAID AN INCORRECT PRICE 129 PRIOR PROCESSING INFORMATION APPEARS INCORRECT. - - 9073 MEDICAL RECORD WAS NOT SUBMITTED FOR POST-PAYMENT REVIEW 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION M127 MISSING PATIENT MEDICAL RECORD FOR THIS SERVICE. 9074 MEDICAL NECESSITY WAS NOT DETERMINED BY POST-PAYMENT REVIEW 50 THESE ARE NON-COVERED SERVICES BECAUSE THIS IS NOT DEEMED A `MEDICAL NECESSITY' BY THE PAYER. - - 9075 CLAIM WAS VOIDED AFTER MEDICAL REVIEW 216 BASED ON THE FINDINGS OF A REVIEW ORGANIZATION N10 CLAIM/SERVICE ADJUSTED BASED ON THE FINDINGS OF A REVIEW ORGANIZATION/PROFESSIONAL CONSULT/MANUAL ADJUDICATION/MEDICAL OR DENTAL ADV-ISOR. 9076 ADJUSTMENT DUE TO RETROACTIVE MANAGED CARE ENROLLMENT 24 CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN. - - 9077 CLAIM REJECTED BY MH 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N517 RESUBMIT A NEW CLAIM WITH THE REQUESTED INFORMATION 9078 PROVIDER BILLED INCORRECTLY 16 CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION N517 RESUBMIT A NEW CLAIM WITH THE REQUESTED INFORMATION 9084 MANUAL ADJUSTMENT BY BATCH 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9100 90 DAY WAIVER DENIED. THE MASSHEALTH REMITTANCE ADVICE REFERENCED IN YOUR LETTER IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9102 THE 90 DAY WAIVER REQUEST FORM IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9103 90 DAY WAIVER DENIED. THE MASSHEALTH REMITTANCE ADVICE PROVIDED DOES NOT PERTAIN TO THE CLAIMS SUBMITTED A1 CLAIM/SERVICE DENIED N206 THE SUPPORTING DOCUMENTATION DOES NOT MATCH THE CLAIM 9106 90 DAY WAIVER DENIED. THE MASSHEALTH REMITTANCE ADVICE PROVIDED BELONGS TO A CLAIM THAT IS IN SUSPENSE A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9109 90 DAY WAIVER DENIED. THE MASSHEALTH REMITTANCE ADVICE PROVIDED BELONGS TO A CLAIM THAT HAS ALREADY PAID A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9112 90 DAY WAIVER DENIED. THE EXPLANATION OF BENEFITS (EOB) FROM THE OTHER INSURER A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9115 90 DAY WAIVER DENIED. A COPY OF THE RETROACTIVE ENROLLMENT NOTICE IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9118 90 DAY WAIVER DENIED. DOCUMENTATION PROVIDED DOES NOT MATCH THE NAME(S) AND/OR DATES OF SERVICE(S) ON THE CLAIMS A1 CLAIM/SERVICE DENIED N206 THE SUPPORTING DOCUMENTATION DOES NOT MATCH THE CLAIM 9121 90 DAY WAIVER DENIED. A COPY OF THE REGISTRATION/ ADMISSION FORM THAT REFLECTS REFLECTS MASSHEALTH INFORMATION WAS NOT PROVIDED ON THE SERVICE DATE IS MISSING OR INCOMPLETE A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9124 90 DAY WAIVER DENIED. A COPY OF A STATEMENT/BILL SENT TO THE MEMBER IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9127 90 DAY WAIVER DENIED. A COPY OF THE RETROACTIVE PRIOR AUTHORIZATION NOTICE IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9130 90 DAY WAIVER DENIED. A COPY OF THE RETROACTIVE PRE-ADMISSION SCREENING NOTICE IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9133 90 DAY WAIVER DENIED. A COPY OF THE NOTIFICATION OF BIRTH (NOB) OR ENROLLMENT NOTICE IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9136 90 DAY WAIVER DENIED. A COPY OF THE PIP EXHAUSTION NOTICE IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9139 90 DAY WAIVER DENIED. THE SERVICE DATE EXCEEDS ONE YEAR 193 ORIGINAL PAYMENT DECISION IS BEING MAINTAINED. THIS CLAIM WAS PROCESSED PROPERLY THE FIRST TIME. - - 9142 90 DAY WAIVER DENIED. THE SERVICE DATE EXCEEDS 18 MONTHS 193 ORIGINAL PAYMENT DECISION IS BEING MAINTAINED. THIS CLAIM WAS PROCESSED PROPERLY THE FIRST TIME. - - 9145 90 DAY WAIVER DENIED. 90 DAY WAIVER IS NOT REQUIRED BECAUSE THIS IS AN ADJUSTMENT TO A PREVIOUSLY PAID CLAIM. REFER TO THE BILLING INSTRUCTIONS FOR INFORMATION REGARDING THE SUBMISSION OF ADJUSTMENT CLAIMS 193 ORIGINAL PAYMENT DECISION IS BEING MAINTAINED. THIS CLAIM WAS PROCESSED PROPERLY THE FIRST TIME. - - 9148 90 DAY WAIVER DENIED. 90 DAY WAIVER IS NOT REQUIRED BECAUSE THIS IS A RESUBMITTAL CLAIM. REFER TO THE BILLING INSTRUCTIONS FOR INFORMATION REGARDING THE RESUBMISSION OF CLAIMS 193 ORIGINAL PAYMENT DECISION IS BEING MAINTAINED. THIS CLAIM WAS PROCESSED PROPERLY THE FIRST TIME. - - 9151 90 DAY WAIVER DENIED. A COPY OF THE ELIGIBILITY VERIFICATION PRINTOUT REFERENCED IN YOUR LETTER IS MISSING A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9154 90 DAY WAIVER DENIED. REQUEST DOES NOT COMPLY WITH MASSHEALTH REGULATIONS A1 CLAIM/SERVICE DENIED M16 "ALERT: PLEASE SEE OUR WEB SITE, MAILINGS, OR BULLETINS FOR MORE DETAILS CONCERNING THIS POLICY/PROCEDURE/DECISION " 9157 90 DAY WAIVER DENIED. THE MEMBERS RID WAS NOT CHANGED 193 ORIGINAL PAYMENT DECISION IS BEING MAINTAINED. THIS CLAIM WAS PROCESSED PROPERLY THE FIRST TIME. - - 9160 90 DAY WAIVER DENIED. THE ORIGINAL EDI CLAIM(S) WERE NOT RECEIVED TIMELY 193 ORIGINAL PAYMENT DECISION IS BEING MAINTAINED. THIS CLAIM WAS PROCESSED PROPERLY THE FIRST TIME. - - 9163 90 DAY WAIVER DENIED. THE ORIGINAL EDI CLAIM(S) WERE RECEIVED TIMELY AND CAN BE RESUBMITTED 193 ORIGINAL PAYMENT DECISION IS BEING MAINTAINED. THIS CLAIM WAS PROCESSED PROPERLY THE FIRST TIME. - - 9166 90 DAY WAIVER DENIED. THE ORIGINAL EDI CLAIM(S) REFERENCED IN YOUR LETTER COULD NOT BE LOCATED. PLEASE RESUBMIT TO THE 90 DAY WAIVERS UNIT WITH ADDITIONAL DOCUMENTATION A1 CLAIM/SERVICE DENIED N29 "MISSING DOCUMENTATION/ORDERS/NOTES/SUMMARY/REPORT/ CHART. " 9700 CLAIM WAS DENIED DUE TO A POS REVERSAL B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. - - 9701 MEMBER LINKING CLAIM ADJUSTMENT B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9702 PROVIDER RECOUPED CLAIM B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9800 MAXIMUM PAYMENT ALLOWED FOR HMO/COV 24 CHARGES ARE COVERED UNDER A CAPITATION AGREEMENT/MANAGED CARE PLAN. - - 9875 NON-MEDICAL LEAVE DAYS LIMIT EXCEEDED 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 9901 REIMBURSEMENT LIMITED TO ONE SET OF FRAMES PER YEAR FOR RECIPIENTS 18 YEARS OF AGE AND YOUNGER UNLESS REPAIRS OR REPLACEMENT IS DUE TO EXTENUATING CIRCUMSTANCES BEYOND THE RECIPIENT CONTROL. DOCUMENTATION RECEIVED DOES NOT INDICATE EXTENUATING CIRCUMSTANCES 119 BENEFIT MAXIMUM FOR THIS TIME PERIOD OR OCCURRENCE HAS BEEN REACHED. N362 THE NUMBER OF DAYS OR UNITS OF SERVICE EXCEEDS OUR ACCEPTABLE MAXIMUM. 9905 PRICE REDUCED TO SPAD PAYMENT 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9907 TPL AMOUNT APPLIED 23 THE IMPACT OF PRIOR PAYER(S) ADJUDICATION INCLUDING PAYMENTS AND/OR ADJUSTMENTS. N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9908 PHARMACY PRICING APPLIED 133 THE DISPOSITION OF THIS CLAIM/SERVICE IS PENDING FURTHER REVIEW - - 9909 50 PERCENT OF AMOUNT BILLED APPLIED B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9910 PHARMACY DISPENSING FEE APPLIED 91 DISPENSING FEE ADJUSTMENT. - - 9911 PRICING ADJUSTMENT - LONG TERM CARE PRICING APPLIED B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. - - 9916 UCC RATE PRICING APPLIED 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9918 PRICING ADJUSTMENT - MAX FEE PRICING APPLIED 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9919 PROVIDER LEVEL OF CARE PRICING APPLIED 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9920 RBRVS (RESOURCE-BASED RELATIVE VALUE SCALE) PRICING APPLIED B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. - - 9921 PA (PRIOR AUTHORIZATION) PRICING APPLIED 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9922 SPENDDOWN DEDUCTIBLE APPLIED 1 DEDUCTIBLE AMOUNT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9926 CLAIM HAS CUTBACK AMOUNT B5 COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED. - - 9928 COB-TPL COST SAVINGS 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9932 PRICING ADJUSTMENT - DRG PRICING APPLIED 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9933 AMOUNT CUTBACK DUE TO APC PRICING 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE. 9997 PERSONAL RESOURCES DEDUCTED FROM THE CLAIM ARE A RESULT OF PREVIOUS 1 DEDUCTIBLE AMOUNT - - 9998 CLAIM WAS PRICED IN ACCORDANCE WITH CURRENT HEALTH COVERAGE PROGRAM POLICIES. 45 CHARGE EXCEEDS FEE SCHEDULE/MAXIMUM ALLOWABLE OR CONTRACTED/LEGISLATED FEE ARRANGEMENT N419 CLAIM PAYMENT WAS THE RESULT OF A PAYER'S RETROACTIVE ADJUSTMENT DUE TO A RETROACTIVE RATE CHANGE.