12/13/2011 EOB EOB CODE DESCRIPTION "CLAIM STATUS CODE" CLAIM STATUS CODE DESCRIPTION "ENTITY ID CODE" ENTITY ID CODE DESCRIPTION CODE 0201 BILLING PROVIDER ID NUMBER MISSING 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) 85 BILLING PROVIDER 0202 BILLING PROVIDER ID IN INVALID FORMAT 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) 85 BILLING PROVIDER 0203 MEMBER I.D. NUMBER MISSING/INVALID 26 ENTITY NOT FOUND QC PATIENT 0204 HOSPITAL DISCHARGE DATE INVALID 190 HOSPITAL DISCHARGE DATE - - 0205 PRESCRIBING PRACTITIONER S LICENSE NO. MISSING 142 ENTITY'S LICENSE/CERTIFICATION NUMBER 1T "PHYSICIAN, CLINIC OR GROUP PRACTICE" 0206 PRESCRIBING PRACTITIONR LICENSE NO. FORMAT INVALID 142 ENTITY'S LICENSE/CERTIFICATION NUMBER 1T "PHYSICIAN, CLINIC OR GROUP PRACTICE" 0208 PREGNANCY INDICATOR INVALID 254 PRIMARY DIAGNOSIS CODE - - 0210 BRAND MEDICALLY NECESSARY INDICATOR INVALID 382 DID PROVIDER AUTHORIZE GENERIC OR BRAND NAME DISPENSING? - - 0211 REFILL INDICATOR INVALID 403 ENTITY REFERRAL NOTES/ORDERS/PRESCRIPTION 85 BILLING PROVIDER 0212 PRESCRIPTION NUMBER IS MISSING 219 PRESCRIPTION NUMBER - - 0213 DATE PRESCRIBED IS MISSING 214 ORIGINAL DATE OF PRESCRIPTION/ORDERS/REFERRAL - - 0214 DATE PRESCRIBED IS INVALID 214 ORIGINAL DATE OF PRESCRIPTION/ORDERS/REFERRAL - - 0215 DATE DISPENSED IS MISSING 214 ORIGINAL DATE OF PRESCRIPTION/ORDERS/REFERRAL - - 0216 DATE DISPENSED IS INVALID 214 ORIGINAL DATE OF PRESCRIPTION/ORDERS/REFERRAL - - 0217 NDC MISSING 218 NDC NUMBER - - 0218 NDC INVALID FORMAT 218 NDC NUMBER - - 0219 QUANTITY DISPENSED IS MISSING 403 ENTITY REFERRAL NOTES/ORDERS/PRESCRIPTION - - 0220 QUANTITY DISPENSED IS INVALID 403 ENTITY REFERRAL NOTES/ORDERS/PRESCRIPTION - - 0221 DAYS SUPPLY MISSING 723 DRUG DAYS SUPPLY - - 0222 DAYS SUPPLY INVALID 723 DRUG DAYS SUPPLY - - 0223 "PROC CODE REQUIRES DIAGNOSIS CODE, NONE FOUND ON CLAIM " 255 DIAGNOSIS CODE - - 0224 DIAGNOSIS TREATMENT INDICATOR INVALID 477 DIAGNOSIS CODE POINTER IS MISSING OR INVALID - - 0225 MISSING PRESCRIBING PROVIDER NUMBER 153 ENTITY'S ID NUMBER 1P PROVIDER 0226 REFERRAL PROV ID REQUIRED FOR PROCEDURE GROUP 132 ENTITY'S MEDICAID PROVIDER ID DN REFERRING PROVIDER 0227 THIRD PARTY PAYMENT AMOUNT INVALID 182 ALLOWABLE/PAID FROM OTHER ENTITIES COVERAGE P4 PRIOR INSURANCE CARRIER 0228 BILLING PROVIDER SIGNATURE MISSING 466 ENTITIES ORIGINAL SIGNATURE 85 BILLING PROVIDER 0229 SOURCE OF ADMISSION MISSING 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" T4 TRANSFER POINT - USED TO IDENTIFY THE GEOGRAPHIC LOCATION WHERE A PATIENT IS TRANSFERRED 0231 RENDERING PROVIDER NUMBER IS MISSING 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) SJ SERVICE PROVIDER 0233 UNITS OF SERVICE MISSING 476 MISSING OR INVALID UNITS OF SERVICE - - 0234 PROCEDURE CODE MISSING 454 PROCEDURE CODE FOR SERVICES RENDERED - - 0235 PROCEDURE CODE NOT IN VALID FORMAT 454 PROCEDURE CODE FOR SERVICES RENDERED - - 0236 DETAIL DOS DIFFERENT THAN THE HEADER DOS 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0237 OUTPATIENT CLAIMS CANNOT SPAN DATES 188 STATEMENT FROM-THROUGH DATES - - 0238 MEMBER NAME IS MISSING 125 ENTITY'S NAME IL INSURED OR SUBSCRIBER 0239 "THE DETAIL ""TO"" DATE OF SERVICE IS MISSING " 187 DATE(S) OF SERVICE - - 0240 "THE DETAIL ""TO"" DATE IS INVALID " 187 DATE(S) OF SERVICE - - 0241 ACCIDENT INDICATOR IS INVALID 365 IS SERVICE THE RESULT OF AN ACCIDENT? - - 0242 SECONDARY DIAGNOSIS CODE INVALID FORMAT 255 DIAGNOSIS CODE - - 0243 MISSING MEDICARE PAID DATE 554 DATE CLAIM PAID - - 0244 THIRD DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0245 MISSING OCCURRENCE CODE 719 NUBC OCCURRENCE CODE(S) - - 0246 FOURTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0248 PLACE OF SERVICE IS MISSING OR BLANK 249 PLACE OF SERVICE - - 0249 PLACE OF SERVICE IS INVALID 249 PLACE OF SERVICE - - 0250 CLAIM HAS NO DETAILS 123 ADDITIONAL INFORMATION REQUESTED FROM ENTITY IN INSURER 0251 FIRST MODIFIER NOT COVERED 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 0252 SECOND MODIFIER NOT COVERED 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 0253 THIRD MODIFIER NOT COVERED 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 0254 BILLING PROVIDER LOCATION CODE MISSING 249 PLACE OF SERVICE 85 BILLING PROVIDER 0255 BILLING PROVIDER LOCATION CODE INVALID 249 PLACE OF SERVICE 85 BILLING PROVIDER 0256 MISSING MEDICARE PAID DATE - DETAIL 554 DATE CLAIM PAID - - 0257 PLACE OF SERVICE IS INVALID - DETAIL 249 PLACE OF SERVICE - - 0258 PRIMARY DIAGNOSIS CODE MISSING 254 PRIMARY DIAGNOSIS CODE - - 0259 DATE BILLED IS MISSING/INVALID 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0260 UNITS OF SERVICE NOT IN VALID FORMAT 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 0261 TOOTH NUMBER MISSING 244 TOOTH NUMBER OR LETTER - - 0262 TOOTH NUMBER INVALID 244 TOOTH NUMBER OR LETTER - - 0263 TOOTH SURFACE CODE INVALID 240 TOOTH SURFACE(S) INVOLVED - - 0264 DETAIL FROM DATE OF SERVICE IS MISSING 187 DATE(S) OF SERVICE - - 0265 DETAIL FROM DATE OF SERVICE IS INVALID 187 DATE(S) OF SERVICE - - 0266 INSUFFICIENT NUMBER OF VALID TOOTH SURFACE CODES 240 TOOTH SURFACE(S) INVOLVED - - 0268 BILLED AMOUNT MISSING 178 SUBMITTED CHARGES - - 0269 DETAIL BILLED AMOUNT INVALID 178 SUBMITTED CHARGES - - 0270 HEADER TOTAL BILLED AMOUNT MISSING 178 SUBMITTED CHARGES - - 0271 HEADER TOTAL BILLED AMOUNT INVALID 178 SUBMITTED CHARGES - - 0272 PRIMARY DIAGNOSIS CODE INVALID 254 PRIMARY DIAGNOSIS CODE - - 0273 TYPE OF BILL MISSING 228 TYPE OF BILL FOR UB-92 CLAIM - - 0274 TYPE OF BILL CODE INVALID 228 TYPE OF BILL FOR UB-92 CLAIM - - 0275 ADMIT DATE MISSING 189 HOSPITAL ADMISSION DATE - - 0276 ADMIT DATE INVALID 189 HOSPITAL ADMISSION DATE - - 0277 ADMIT HOUR INVALID 230 HOSPITAL ADMISSION HOUR - - 0278 ADMIT TYPE MISSING 231 HOSPITAL ADMISSION TYPE - - 0279 INVALID TYPE OF ADMISSION 231 HOSPITAL ADMISSION TYPE - - 0280 PATIENT STATUS IS MISSING 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" QC PATIENT 0281 PATIENT STATUS IS INVALID 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" QC PATIENT 0282 COVERED DAYS MISSING 456 COVERED DAY(S) - - 0283 COVERED DAYS INVALID 456 COVERED DAY(S) - - 0284 PRIMARY CONDITION CODE INVALID 460 NUBC CONDITION CODE(S) - - 0285 SECOND CONDITON CODE INVALID 460 NUBC CONDITION CODE(S) - - 0286 THIRD CONDITION CODE INVALID 460 NUBC CONDITION CODE(S) - - 0287 FOURTH CONDITION CODE INVALID 460 NUBC CONDITION CODE(S) - - 0288 FIFTH CONDITION CODE INVALID 460 NUBC CONDITION CODE(S) - - 0289 SIXTH CONDITION CODE INVALID 460 NUBC CONDITION CODE(S) - - 0290 SEVENTH CONDITION CODE INVALID 460 NUBC CONDITION CODE(S) - - 0291 REVENUE CODE 183 REQUIRES OSC = 74 455 REVENUE CODE FOR SERVICES RENDERED - - 0292 REVENUE CODE 185 REQUIRES OSC = 71 455 REVENUE CODE FOR SERVICES RENDERED - - 0339 REVENUE CODE IS MISSING 455 REVENUE CODE FOR SERVICES RENDERED - - 0340 REVENUE CODE IS INVALID 455 REVENUE CODE FOR SERVICES RENDERED - - 0343 CERTIFICATION CODE INVALID 252 AUTHORIZATION/CERTIFICATION NUMBER - - 0347 PAYER PRIOR PAYMENT IS INVALID 286 OTHER PAYER'S EXPLANATION BENEFITS/PAYMENT INFO - - 0350 NO. OF DETAILS NOT EQUAL TO SUBMITTED DETAIL COUNT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0351 REFILL NOT ALLOWED FOR NARCOTIC DRUGS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0355 FIFTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0356 SIXTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0357 SEVENTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0358 EIGHTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0359 NINTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0360 TENTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0361 ELEVENTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0362 TWELFTH DIAGNOSIS CODE INVALID 255 DIAGNOSIS CODE - - 0363 PRINCIPAL ICD9 PROCEDURE CODE IS INVALID 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0365 PRINCIPAL PROCEDURE DATE INVALID 486 PRINCIPLE PROCEDURE DATE - - 0366 FIRST OTHER PROCEDURE CODE INVALID 490 OTHER PROCEDURE CODE FOR SERVICE(S) RENDERED - - 0368 FIRST OTHER PROCEDURE DATE INVALID 492 OTHER PROCEDURE DATE - - 0369 SECOND OTHER PROCEDURE CODE INVALID 490 OTHER PROCEDURE CODE FOR SERVICE(S) RENDERED - - 0371 SECOND OTHER PROCEDURE DATE INVALID 492 OTHER PROCEDURE DATE - - 0372 THIRD OTHER PROCEDURE CODE INVALID 490 OTHER PROCEDURE CODE FOR SERVICE(S) RENDERED - - 0375 FOURTH OTHER PROCEDURE CODE INVALID 490 OTHER PROCEDURE CODE FOR SERVICE(S) RENDERED - - 0378 FIFTH OTHER PROCEDURE CODE INVALID 490 OTHER PROCEDURE CODE FOR SERVICE(S) RENDERED - - 0382 ATTENDING PHYSICIAN ID INVALID 153 ENTITY'S ID NUMBER 71 ATTENDING PHYSICIAN 0383 FIRST OTHER PHYSICIAN ID INVALID 153 ENTITY'S ID NUMBER 73 OTHER PHYSICIAN 0389 REVENUE CODE REQUIRES A CORRESPONDING HCPCS/CPT4 507 HCPCS - - 0391 MEDICARE DEDUCTIBLE AMOUNT MISSING-DETAIL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0392 MEDICARE PAID AMOUNT NOT NUMERIC-DETAIL 655 TOTAL MEDICARE PAID AMOUNT - - 0393 MEDICARE DEDUCTIBLE AMOUNT MISSING 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0394 MEDICARE CO-INSURANCE AMOUNT MISSING 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0395 "HEADER STATEMENT COVERS PERIOD ""FROM"" DATE MISSING " 188 STATEMENT FROM-THROUGH DATES - - 0396 "HEADER STATEMENT COVERS PERIOD ""FROM"" DATE INVALID " 188 STATEMENT FROM-THROUGH DATES - - 0397 "HEADER STMT COVERS PERIOD ""THROUGH"" DATE MISSING " 188 STATEMENT FROM-THROUGH DATES - - 0398 "STATEMENT COVERS PERIOD ""THROUGH"" DATE INVALID " 188 STATEMENT FROM-THROUGH DATES - - 0400 DETAIL UNITS OF SERVICE MUST BE GREATER THAN ZERO 476 MISSING OR INVALID UNITS OF SERVICE - - 0401 PRESENT ON ADMISSION INDICATOR MISSING 688 PRESENT ON ADMISSION INDICATOR FOR REPORTED DIAGNOSIS CODES - - 0402 PRESENT ON ADMISSION INDICATOR INVALID 688 PRESENT ON ADMISSION INDICATOR FOR REPORTED DIAGNOSIS CODES - - 0403 PRESENT ON ADMISSION IND PRESENT WHERE NOT ALLOWED 688 PRESENT ON ADMISSION INDICATOR FOR REPORTED DIAGNOSIS CODES - - 0405 PAID PAPE WITH 0 ALLOWED UNITS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0427 ACCIDENT DATE INVALID 727 ACCIDENT DATE - - 0431 DEDUCTIBLE AMOUNT INVALID-DETAIL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0432 COINSURANCE AMOUNT INVALID-DETAIL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0433 MEDICARE DEDUCTIBLE AMOUNT INVALID 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0434 MEDICARE COINSURANCE AMOUNT INVALID 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0436 TOTAL MEDICARE ALLOWED AMOUNT INVALID 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0437 MEDICARE PSYCH ADJUSTMENT AMOUNT INVALID 519 ADJUSTMENT AMOUNT - - 0438 TOTAL MEDICARE ALLOWED AMOUNT INVALID-DETAIL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0439 PSYCH ADJUSTMENT (PR122) AMOUNT INVALID-DETAIL 519 ADJUSTMENT AMOUNT - - 0440 MCARE PAID 100% OF CLAIM-HEADER 591 MEDICARE PAID AT 100% AMOUNT - - 0441 MCARE PAID 100% OF CLAIM-DETAIL 591 MEDICARE PAID AT 100% AMOUNT - - 0442 MEDICARE PAID AMOUNT NOT NUMERIC-HEADER 182 ALLOWABLE/PAID FROM OTHER ENTITIES COVERAGE P4 PRIOR INSURANCE CARRIER 0443 MEDICARE PAID AMOUNT NOT NUMERIC-DETAIL 182 ALLOWABLE/PAID FROM OTHER ENTITIES COVERAGE P4 PRIOR INSURANCE CARRIER 0444 MEDICARE APPROVED AMOUNT = 0 - HEADER 655 TOTAL MEDICARE PAID AMOUNT - - 0445 MEDICARE APPROVED AMOUNT = 0 - DETAIL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0450 INVALID QUADRANT 242 "TOOTH NUMBERS, SURFACES, QUADRANTS INVOLVED" - - 0452 DTL RENDERING/PERFORMING PROVIDER SERV LOC MISSING 138 ENTITY'S SITE ID 82 RENDERING PROVIDER 0453 HDR RENDERING/PERFORMING PROVIDER SERV LOC MISSING 138 ENTITY'S SITE ID 82 RENDERING PROVIDER 0454 INVALID ASSIGNMENT CODE 360 BENEFITS ASSIGNMENT CERTIFICATION INDICATOR - - 0456 INVALID PROCEDURE TYPE ACC. TO PROCEDURE QUALIFIER 250 TYPE OF SERVICE - - 0457 INVALID PRINCIPAL/OTHER PROCEDURE TYPE 250 TYPE OF SERVICE - - 0458 DIAGNOSIS CODE 10 - 24 INVALID 255 DIAGNOSIS CODE - - 0459 DETAIL DIAGNOSIS TREATMENT INDICATOR INVALID 658 TREATMENT CODE - - 0461 VALUE CODE IS INVALID 725 NUBC VALUE CODE(S) - - 0462 VALUE CODE AMOUNT IS MISSING 725 NUBC VALUE CODE(S) - - 0463 VALUE CODE AMOUNT IS INVALID 725 NUBC VALUE CODE(S) - - 0471 CONDITION CODE 8-24 INVALID 460 NUBC CONDITION CODE(S) - - 0473 ICD9 PROCEDURE 7-24 INVALID 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0474 ICD-9 PROCEDURE 7-24 OR DATE MISSING 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0475 ICD9 PROCEDURE 7-24 DATE IS INVALID 492 OTHER PROCEDURE DATE - - 0476 DETAIL ATTENDING PHYSICIAN ID IS INVALID 153 ENTITY'S ID NUMBER 71 ATTENDING PHYSICIAN 0477 "DETAIL FIRST ""OTHER PHYSICIAN"" ID IS INVALID " 153 ENTITY'S ID NUMBER 72 OPERATING PHYSICIAN 0478 0478-BILL CPT CODES TO MASSHEALTH ON CMS 1500 FORM 276 UB-92/HCFA-1450/HCFA-1500 CLAIM FORM - - 0481 MLOA DAYS GREATER THAN HEADER DAYS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0484 LOA OSC DATES CANNOT SPAN ACROSS DIFFERENT MONTHS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0485 TO DATE IS LESS THAN FROM DATE FOR OCCUR SPAN 722 NUBC OCCURRENCE SPAN CODE DATE(S) - - 0486 MLOA DAYS AND DAYS BETWEEN FROM AND TO DOS NOT EQUAL 188 STATEMENT FROM-THROUGH DATES - - 0487 NMLOA DAYS AND DAYS TWEEN FROM AND TO DOS NOT SAME 188 STATEMENT FROM-THROUGH DATES - - 0488 MLOA OSC DAYS SPANNED > DETAIL FROM AND TO DOS 188 STATEMENT FROM-THROUGH DATES - - 0489 THE OCCURRENCE SPAN FROM DATE IS INVALID 722 NUBC OCCURRENCE SPAN CODE DATE(S) - - 0490 THE OCCURRENCE SPAN TO DATE IS INVALID 722 NUBC OCCURRENCE SPAN CODE DATE(S) - - 0491 DIFFERNT MLOA DAYS CANNOT OVERLAP FROM AND TO DAYS 187 DATE(S) OF SERVICE - - 0492 DIFFERNT NMLOA DAYS CANT OVERLAP FROM AND TO DAYS 187 DATE(S) OF SERVICE - - 0493 MLOA AND NMLOA DAYS CANT OVERLAP FROM AND TO DAYS 187 DATE(S) OF SERVICE - - 0494 OCCURRENCE SPAN LOA DATES NOT WITHIN CLAIM DATES 722 NUBC OCCURRENCE SPAN CODE DATE(S) - - 0495 "THIS LTC CLAIM HAS LOA DAYS, BUT PROV TYPE WRONG " 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0496 OCCURRENCE SPAN FROM DATE MISSING 722 NUBC OCCURRENCE SPAN CODE DATE(S) - - 0497 OCCURRENCE SPAN TO DATE MISSING 722 NUBC OCCURRENCE SPAN CODE DATE(S) - - 0498 THE OCCURRENCE CODE IS INVALID 719 NUBC OCCURRENCE CODE(S) - - 0500 DATE PRESCRIBED AFTER BILLING DATE 214 ORIGINAL DATE OF PRESCRIPTION/ORDERS/REFERRAL - - 0502 DATE DISPENSED EARLIER THAN DATE PRESCRIBED 214 ORIGINAL DATE OF PRESCRIPTION/ORDERS/REFERRAL - - 0503 DATE DISPENSED AFTER BILLING DATE 214 ORIGINAL DATE OF PRESCRIPTION/ORDERS/REFERRAL - - 0506 ICN DATE PRIOR TO DATE BILLED 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0507 "THE DETAIL ""FROM"" DATE IS AFTER THE ""TO"" DATE " 188 STATEMENT FROM-THROUGH DATES - - 0508 TOTAL CHARGE DOES NOT EQUAL THE SUM OF ALL DETAILS 178 SUBMITTED CHARGES - - 0509 NET BILLED OUT OF BALANCE 400 CLAIM IS OUT OF BALANCE - - 0512 CLAIM PAST 12 MONTH FILING LIMIT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0514 HEADER THRU DATE OF SERVICE AFTER ICN DATE 187 DATE(S) OF SERVICE - - 0518 COVERED DAYS EXCEED STATEMENT PERIOD 456 COVERED DAY(S) - - 0519 "ADMIT DATE IS AFTER STATEMENT PERIOD ""FROM"" DATE " 187 DATE(S) OF SERVICE - - 0520 INVALID REVENUE CODE/PROCEDURE CODE COMBINATION 455 REVENUE CODE FOR SERVICES RENDERED - - 0521 THRU DOS LATER THAN DISCHARGE DATE 187 DATE(S) OF SERVICE - - 0526 HEADER FROM DOS IS AFTER HEADER THROUGH DATE 187 DATE(S) OF SERVICE - - 0527 DETAIL FROM DATE OF SERVICE IS AFTER ICN DATE 187 DATE(S) OF SERVICE - - 0529 SURGERY DATE IS BEFORE THE ADMIT DATE 665 SURGERY DATE - - 0530 SURGERY DATE IS AFTER THE DISCHARGE DATE 665 SURGERY DATE - - 0532 REVENUE CODE/PROVIDER SPECIALTY MISMATCH 455 REVENUE CODE FOR SERVICES RENDERED - - 0542 MEMBER INELIGIBLE SERV DATE 88 ENTITY NOT ELIGIBLE FOR BENEFIT FOR SUBMITTEDDATES OF SERVICE IL INSURED OR SUBSCRIBER 0545 FINAL DEADLINE EXCEEDED 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0550 ADJUSTMENT FAILED 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0551 DISPOSITION AMT FOR ADJUSTMENT IS LESS THAN ZERO 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0552 PROVIDER MAY NOT ADJUST GENERATED ATP/PAPE CLAIM 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0554 HEADER BILLED DATE IS PRIOR TO DATES OF SERVICE 187 DATE(S) OF SERVICE - - 0555 CLAIM PAST 24 MONTH FILING DEADLINE- DETAIL 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0556 CLAIM PAST 24 MONTH FILING DEADLINE- HEADER 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0557 COINS AND DEDUCT AMT MISSING - DTL 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0558 COINSURANCE AND DEDUCT AMT MISSING 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0559 M-CARE COIN AMT GREATER THAN M-CARE PAID AMT-HDR   104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0560 M-CARE COINSURANCE AMT GREATER THAN THE AMOUNT PAID 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0568 HEADER DISCHARGE DATE IS LESS THAN ADMIT DATE 190 HOSPITAL DISCHARGE DATE - - 0569 HDR DTE OF ACCIDENT GREATER THAN LAST DTE OF SERV 727 ACCIDENT DATE - - 0570 HEADER TOTAL DAYS LESS THAN COVERED DAYS 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 0571 DETAIL SURGICAL PROCEDURE MISSING 666 SURGICAL PROCEDURE CODE - - 0572 ROOM AND BOARD DAYS CONFLICT 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 0574 SERV DATES ARE NOT IN SAME MONTH-HEADER 188 STATEMENT FROM-THROUGH DATES - - 0575 SURGERY DTE CANNOT BE OUTSIDE HDR DATES OF SERVICE 187 DATE(S) OF SERVICE - - 0576 CLAIM HAS THIRD-PARTY PAYMENT 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0577 SERV DATES ARE NOT IN SAME MONTH-DETAIL 187 DATE(S) OF SERVICE - - 0585 ADMIT DATE NOT EQ TO 1ST DATE OF SERV FOR REV/DIAG COMB 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0589 SUSPEND ADJUSTMENT FOR REVIEW 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0590 DAYS OVERLAPP FISCAL YEAR END/BEGIN DATES 188 STATEMENT FROM-THROUGH DATES - - 0594 UNITS/DOS CONFLICT 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 0599 ATTACHMENT CONTROL NUMBER MISSING 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0600 UNITS NOT EQUAL TO QUADRANTS BILLED 242 "TOOTH NUMBERS, SURFACES, QUADRANTS INVOLVED" - - 0601 TEETH NOT BILLABLE WITH QUADRANTS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0602 UNITS NOT EQUAL TO TEETH BILLED 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0610 LOC NOT COMPATIBLE WITH LEAVE DAYS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0616 COMPONENT OF STAY EXCEEDED 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0617 MEMBER AGE/PROGRAM CONFLICT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0643 INVALID OTHER COVERAGE CODE 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 0700 MULTIPLE PRIMARY ENDOSCOPIC FAMILIES CANNOT BE BILLED 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0701 NO PRIMARY SURGICAL PROCEDURE INDICATED 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 0702 ENDOSCOPIC PRICE AMOUNT LESS THAN ZERO 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0703 ENDO FAMILY MIXED PRIMARY/SECONDARY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0799 INVALID DISPENSE STATUS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0800 HCPCS REQUIRES NDC 218 NDC NUMBER - - 0801 SPECIAL HANDLING EDIT 41 SPECIAL HANDLING REQUIRED AT PAYER SITE - - 0802 SPECIAL HANDLING EDIT WITH CRITICAL ERROR 41 SPECIAL HANDLING REQUIRED AT PAYER SITE - - 0803 GENERIC SPECIAL HANDLING 41 SPECIAL HANDLING REQUIRED AT PAYER SITE - - 0804 GENERIC SPECIAL PAY 41 SPECIAL HANDLING REQUIRED AT PAYER SITE - - 0805 INVALID SPECIAL HANDLING CODE 41 SPECIAL HANDLING REQUIRED AT PAYER SITE - - 0806 NOTE REQUIRED FOR PREEMPTIVE ESC - DETAIL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0807 NOTE REQUIRED FOR PREEMPTIVE ESC - HEADER 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0808 CLERK ID REQUIRED FOR PREEMPTIVE ESC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0809 CLERK ID REQUIRED FOR PREEMPTIVE ESC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0810 INVALID SUBMITTER ID 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0811 INVALID SUBMITTER ID/BILLING PROVIDER COMBINATION 104 PROCESSED ACCORDING TO PLAN PROVISIONS 85 BILLING PROVIDER 0812 NO PCC SELECTED 93 ENTITY IS NOT SELECTED PRIMARY CARE PROVIDER 1P PROVIDER 0813 SPECIAL PAY PRICED AT ZERO 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0814 HIC NUMBER NOT PRESENT ON CLAIM 33 SUBSCRIBER AND SUBSCRIBER ID NOT FOUND - - 0815 TYPE OF BILL MUST MATCH PATIENT STATUS 228 TYPE OF BILL FOR UB-92 CLAIM - - 0816 DISALLOW ROOM AND BOARD FOR LATE CHARGES 455 REVENUE CODE FOR SERVICES RENDERED - - 0817 INVALID DISCHARGE DATE 190 HOSPITAL DISCHARGE DATE - - 0818 SPCL HANDLING 90 DAY WAIVER 41 SPECIAL HANDLING REQUIRED AT PAYER SITE - - 0819 SUSPEND CLAIM FOR TPL REVIEW 52 INVESTIGATING EXISTENCE OTHER INSUR COVERAGE - - 0820 NDC GIVEN WITH NO/INVALID UNITS FOR HCPCS 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 0821 NDC GIVEN WITH NO/INVALID MEASUREMENT FOR HCPCS 659 UNIT OR BASIS OF MEASUREMENT CODE - - 0822 NDC GIVEN WITH NO/INVALID UNIT PRICE FOR HCPCS 644 SERVICE LINE RATE - - 0823 NO PCC SELECTED 107 PROCESSED ACCORDING TO CONTRACT PROVISIONS - - 0828 CLAIM/ APPEAL IS UNDER REVIEW 46 INTERNAL REVIEW/AUDIT - - 0829 NCCI APPEAL/SPECIAL HANDLE UNDER REVIEW 46 INTERNAL REVIEW/AUDIT - - 0830 GROUPER UNABLE TO ASSIGN DRG TO CLAIM 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0831 3M GRP - DIAGNOSIS CODE CANNOT BEUSED AS PRINCIPAL DIAGNOSIS 255 DIAGNOSIS CODE - - 0832 3M GRP - RECORD DOES NOT MEET CRITERIA FOR ANY DRG 256 DRG CODE(S) - - 0833 3M GRP - INVALID AGE IN YEARS OR ADMISSION AGE IN DAY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0834 3M GRP - INVALID SEX 157 ENTITY'S GENDER IL INSURED OR SUBSCRIBER 0835 3M GRP - INVALID DISCHARGE STATUS 234 PATIENT DISCHARGE STATUS - - 0836 3M GRP - INVALID BIRTH WEIGHT 273 WEIGHT - - 0837 3M GRP - INVALID DISCHARGE AGE IN DAYS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0838 3M GRP - INVALID PRINCIPAL DIAGNOSIS 254 PRIMARY DIAGNOSIS CODE - - 0839 3M GRP - GESTATIONAL AGE/BIRTH WEIGHT CONFLICT 273 WEIGHT - - 0850 BILLING DEADLINE EXCEEDED - DETAIL 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0851 REBILL: ORIGINAL CLAIM DEADLINE EXCEEDED 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0852 BILLING DEADLINE EXCEEDED - HEADER 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0853 FINAL DEADLINE EXCEEDED - DETAIL 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0854 TIMELY FILING - ORIGINAL ICN NOT FOUND 559 DOCUMENT CONTROL IDENTIFIER - - 0855 FINAL DEADLINE EXCEEDED - HEADER 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0856 DATE OF SERVICE EXCEEDS 36 MONTHS - DETAIL 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0857 DATE OF SERVICE EXCEEDS 36 MONTHS - HEADER 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0861 MEMBER MUST APPLY BEFORE ADMIN DAYS START 91 ENTITY NOT ELIGIBLE/NOT APPROVED DATES OF SRV QC PATIENT 0862 EMERGENCY INDICATOR/POS MISMATCH 471 WERE SERVICES RELATED TO AN EMERGENCY? - - 0870 INVALID START/STOP TIME 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0871 VOID / ORIGINAL $ AMOUNT CONFLICT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0872 MONTH/YEAR MISMATCH ON ADJUSTMENT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0873 NDC SUBMITTED ON INVALID PROCEDURE 218 NDC NUMBER - - 0874 PRESCRIPTION INVALID FOR COMPOUND DRUG 282 COPY OF PRESCRIPTION - - 0875 PROCEDURE INVALID FOR COMPOUND DRUG 454 PROCEDURE CODE FOR SERVICES RENDERED - - 0876 INVALID PRODUCT QUALIFIER 218 NDC NUMBER - - 0877 INVALID PRESCRIPTION QUALIFIER 219 PRESCRIPTION NUMBER - - 0878 INVALID PRESCRIPTION QUALIFIER/ID COMBINATION 219 PRESCRIPTION NUMBER - - 0879 INVALID PRESCRIPTION QUALIFIER/ID COMBINATION 219 PRESCRIPTION NUMBER - - 0880 INVALID PRESCRIPTION ID 219 PRESCRIPTION NUMBER - - 0881 INVALID PRESCRIPTION DATE 403 ENTITY REFERRAL NOTES/ORDERS/PRESCRIPTION 1P PROVIDER 0882 PRESCRIPTION DATE GREATER THAN CLAIM DATE 214 ORIGINAL DATE OF PRESCRIPTION/ORDERS/REFERRAL - - 0886 "ATTACHMENT REQUIRED-PODIATRIC, SUSPEND FOR REVIEW " 297 MEDICAL NOTES/REPORTS - - 0888 DCN INVALID FOR ATTACHMENT CROSS-REFERENCE 559 DOCUMENT CONTROL IDENTIFIER - - 0889 CLAIM ATTACHMENT REQUIRED FOR PODIATRIC SERVICE 585 DENIED CHARGE OR NON-COVERED CHARGE - - 0890 EDI TRANS TYPE IS 31 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0891 EDI TRANS TYPE IS RP 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0900 PROVIDER TYPE/SPEC GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0902 PROCEDURE CODE GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0903 OCCURRENCE CODE GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0904 VALUE CODE GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0905 REVENUE CODE GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0906 DIAGNOSIS GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0907 ICD-9 PROCEDURE GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0908 MODIFIER GROUP EMPTY 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 0909 PATIENT STATUS GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0910 BENEFIT PLAN GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0911 CLAIM IN PROCESS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0912 PROVIDER LOC GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0913 SPECIAL HANDLING GROUP EMPTY 41 SPECIAL HANDLING REQUIRED AT PAYER SITE - - 0914 TYPE OF BILL GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0915 COUNTY CODE GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0916 ZIP CODE GROUP EMPTY 500 ENTITY'S POSTAL/ZIP CODE FE MAIL ADDRESS 0917 PLACE OF SERVICE GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0918 MEMBER LOC GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0919 ESC GROUP EMPTY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 0930 2ND OCCURRENCE POSITION NOT = 22 719 NUBC OCCURRENCE CODE(S) - - 0931 2ND OCCURRENCE OCDE = 22 BUT AMOUNT = 0 719 NUBC OCCURRENCE CODE(S) - - 0932 2ND OCCURRENCE AMOUNT > 0 BUT OSC NOT 22 719 NUBC OCCURRENCE CODE(S) - - 0933 INP CLM BUT RATE ID NOT 71 OR ADM TYPE NE ELCTV[3] 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 0935 UB92 CLAIM BUT NO PATIENT ACCT NUMBER (MRN) 478 CLAIM SUBMITTER'S IDENTIFIER (PATIENT ACCOUNTNUMBER) IS MISSING - - 0936 MEMBER ENROL/PCCP CNFLCT 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 0937 DETAIL CANNOT SPAN DATES 188 STATEMENT FROM-THROUGH DATES - - 0999 CLAIM SELECTED FOR MASSPRO EXTRACT 99 PRE-TREATMENT REVIEW - - 1000 BILLING PROVIDER I.D. NUMBER NOT ON FILE. 26 ENTITY NOT FOUND 85 BILLING PROVIDER 1001 COB-BENEFIT PLAN 550 COORDINATION OF BENEFITS CODE 2B THIRD-PARTY ADMINISTRATOR 1002 DTL PERFORMING PROVIDER NOT ELIGIBLE 550 COORDINATION OF BENEFITS CODE 2B THIRD-PARTY ADMINISTRATOR 1003 BILLING PROV NOT ELIG AT SERV LOC FOR PROG BILLED 88 ENTITY NOT ELIGIBLE FOR BENEFIT FOR SUBMITTEDDATES OF SERVICE 85 BILLING PROVIDER 1007 DETAIL RENDERING PROVIDER I.D. NOT ON FILE 26 ENTITY NOT FOUND SJ SERVICE PROVIDER 1010 RENDERING PROVIDER NOT A MEMBER OF BILLING GROUP 153 ENTITY'S ID NUMBER 82 RENDERING PROVIDER 1012 RENDERING PROV SPECLTY NOT ELIG TO RENDER PROCEDURE 145 ENTITY'S SPECIALTY CODE 82 RENDERING PROVIDER 1013 PROV ASSIGNMENT NOT ACCEPTED 589 MEDICARE ASSIGNMENT CODE - - 1014 INVALID ASSIGNMENT INDICATOR 589 MEDICARE ASSIGNMENT CODE - - 1018 PROVIDER RATE NOT ON FILE 499 NO RATE ON FILE WITH THE PAYER FOR THIS SERVICE FOR THIS ENTITY 1P PROVIDER 1019 NO PROVIDER LEVEL OF CARE RATE ON FILE 499 NO RATE ON FILE WITH THE PAYER FOR THIS SERVICE FOR THIS ENTITY 1P PROVIDER 1020 ATTENDING PHYSICIAN ID NOT ON FILE 26 ENTITY NOT FOUND 71 ATTENDING PHYSICIAN 1021 FIRST OTHER PHYSICIAN ID NOT ON FILE 153 ENTITY'S ID NUMBER 73 OTHER PHYSICIAN 1023 LEVEL OF CARE BILLED NOT ON FILE FOR THIS PROVIDER 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 1024 BILLING PROVIDER NOT LISTED AS MEMBER LTC PROV 91 ENTITY NOT ELIGIBLE/NOT APPROVED DATES OF SRV 85 BILLING PROVIDER 1026 PRESCRIBING PHYSICIAN LICENSE NUMBER NOT ON FILE 142 ENTITY'S LICENSE/CERTIFICATION NUMBER 71 ATTENDING PHYSICIAN 1027 HEADER REFERRING PHYSICIAN ID NOT ON FILE 26 ENTITY NOT FOUND DN REFERRING PROVIDER 1032 BILLING PROVIDER NOT ELIGIBLE TO BILL THIS CLM TYP 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" 85 BILLING PROVIDER 1036 RENDERING PROVIDER NOT ELIGIBLE TO BILL THIS CLM TYPE 91 ENTITY NOT ELIGIBLE/NOT APPROVED DATES OF SRV 82 RENDERING PROVIDER 1037 FACILITY PROVIDER NUMBER NOT ON FILE 26 ENTITY NOT FOUND 2D MISCELLANEOUS HEALTHCARE FACILITY 1040 BILLING PROVIDER ON REVIEW 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 1041 BILLING PROVIDER ON REVIEW 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 1050 SERVICE CANNOT BE REFERRED BY THE SAME BILLING PRO 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" 85 BILLING PROVIDER 1051 HEADER RENDERING PROVIDER ID NOT VALID 26 ENTITY NOT FOUND SJ SERVICE PROVIDER 1053 DETAIL FIRST OTHER PHYSICIAN ID NUMBER NOT ON FILE 26 ENTITY NOT FOUND 73 OTHER PHYSICIAN 1054 DETAIL ATTENDING PHYSICIAN ID NUMBER NOT ON FILE 26 ENTITY NOT FOUND 71 ATTENDING PHYSICIAN 1055 DETAIL REFERRING PROV NOT ON FILE 26 ENTITY NOT FOUND DN REFERRING PROVIDER 1058 UNABLE TO CROSSWALK ATTENDING/OTHER1/OTHER2 MEDICARE PROVIDER ID 132 ENTITY'S MEDICAID PROVIDER ID 73 OTHER PHYSICIAN 1060 UNABLE TO CROSSWALK RENDERING MEDICARE PROVIDER ID 132 ENTITY'S MEDICAID PROVIDER ID SJ SERVICE PROVIDER 1062 UNABLE TO CROSSWALK DETAIL RENDERING MEDICARE PROV 26 ENTITY NOT FOUND SJ SERVICE PROVIDER 1063 UNABLE TO CROSSWALK BILLING MEDICARE PROVIDER ID 26 ENTITY NOT FOUND 85 BILLING PROVIDER 1064 HEADER REFERRING PROVIDER CANNOT BE SAME AS BILLIN 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" DN REFERRING PROVIDER 1065 DETAIL REFERRING PROVIDER CANNOT BE SAME AS BILLING 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" DN REFERRING PROVIDER 1066 BILLING PROVIDER NOT A VALID BILLER 91 ENTITY NOT ELIGIBLE/NOT APPROVED DATES OF SRV 85 BILLING PROVIDER 1067 RENDERING EQUALS BILLING AND NOT A VALID BILLER 132 ENTITY'S MEDICAID PROVIDER ID SJ SERVICE PROVIDER 1068 REFERRING PROVIDER REQUIRED FOR INDEPENDENT CERTIF 26 ENTITY NOT FOUND DN REFERRING PROVIDER 1069 REFERRING PROV CANNOT BE SAME AS RENDERING-HEADER 153 ENTITY'S ID NUMBER DN REFERRING PROVIDER 1070 REFERRING PROV CANNOT BE SAME AS RENDERING-DETAIL 153 ENTITY'S ID NUMBER DN REFERRING PROVIDER 1071 PATIENT STILL IN THE HOSPITAL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" QC PATIENT 1073 BILLING PROVIDER OUT OF STATE CONTIGUOUS 585 DENIED CHARGE OR NON-COVERED CHARGE - - 1074 BILLING PROVIDER OUT OF STATE NON-CONTIGUOUS 585 DENIED CHARGE OR NON-COVERED CHARGE - - 1100 ADJUST: FORMER TCN INCORRECT 495 REQUESTS FOR RE-ADJUDICATION MUST REFERENCE THE NEWLY ASSIGNED PAYER CLAIM CONTROL NUMBER FOR THIS PREVIOUSLY ADJUSTED CLAIM. CORRECT THE PAYER CLAIM CONTROL NUMBER AND RE-SUBMIT - - 1101 INVALID ADJUSTMENT FORMER TCN 464 PAYER ASSIGNED CONTROL NUMBER - - 1104 REBILL : ORIGINAL CLAIM PAID 65 CLAIM/LINE HAS BEEN PAID - - 1108 THIS ADJUSTMENT CLAIM IS ALREADY ON HOLD 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 1111 ITEM/SERVICE(S) PROVIDED NOT MOST COST EFFECTIVE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISNS - - 1116 SHOE PRESCRIPTION FORM MISSING 294 SUPPORTING DOCUMENTATION - - 1117 PROC REQ REPORT/ RPT MISSING 295 ATTENDING PHYSICIAN REPORT - - 1119 BILLING RID CONFLICT 26 ENTITY NOT FOUND QC PATIENT 1120 CLAIM REQUIRES DOCUMENTATION (CAF EDIT) 295 ATTENDING PHYSICIAN REPORT - - 1121 STERILIZATION FORM INCOMPLETE 294 SUPPORTING DOCUMENTATION - - 1122 STERILIZATION REGS NOT MET 294 SUPPORTING DOCUMENTATION - - 1123 CLAIM NOT LEGIBLE 481 CLAIM/SUBMISSION FORMAT IS INVALID - - 1125 INCIDENTAL PROC NOT COVERED 454 PROCEDURE CODE FOR SERVICES RENDERED - - 1126 CHARGES NOT ITEMIZED 178 SUBMITTED CHARGES - - 1127 HYSTERECTOMY REGS NOT MET 294 SUPPORTING DOCUMENTATION - - 1130 INVALID STERILIZATION FORM 294 SUPPORTING DOCUMENTATION - - 1132 CLAIMS REQ SPECIAL HANDLING 41 SPECIAL HANDLING REQUIRED AT PAYER SITE - - 1134 UR LETTER NOT ACCEPTABLE 295 ATTENDING PHYSICIAN REPORT - - 1135 CLAIM CONTAINS MEDICARE PART B COVERED CHARGES 590 MEDICARE COVERAGE INDICATOR - - 1136 NOT AN ACCEPTABLE ATTACHMENT 295 ATTENDING PHYSICIAN REPORT - - 1139 INVALID ABORTION FORM 294 SUPPORTING DOCUMENTATION - - 1140 ABORTION FORM INCOMPLETE 294 SUPPORTING DOCUMENTATION - - 1146 DUPE PREPAY REVIEW CLAIM OR RESUBMISSION ERROR 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 1149 PA# NOT ON FILE 252 ENTITY'S AUTHORIZATION/CERTIFICATION NUMBER 1P PROVIDER 1150 IDENT/DSCR PROC WHEN BILLING AN UNLISTED CODE 454 PROCEDURE CODE FOR SERVICES RENDERED - - 1151 COPAY EXEMPT - AGE 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 1152 ASST SURG NOT COV FOR PROC 154 RELATIONSHIP OF SURGEON & ASSISTANT SURGEON - - 1153 UR DENIED ADMISSION 435 NOTICE OF ADMISSION - - 1514 INCORRECT PROC CODE FOR SERVICE 454 PROCEDURE CODE FOR SERVICES RENDERED - - 1515 PROCEDURE CODE/ INVOICE CONFLICT (PHARM) 454 PROCEDURE CODE FOR SERVICES RENDERED - - 1516 INCORRECT REV CODE FOR SERV 455 REVENUE CODE FOR SERVICES RENDERED - - 1517 CLAIM MED NECESS FORM ERROR 294 SUPPORTING DOCUMENTATION - - 1518 SERVICE PROVIDED REQUIRES A MORE DETAILED REPORT 294 SUPPORTING DOCUMENTATION - - 1519 INAPPROPRIATE PROCEDURE CODE FOR SERVICE BILLED 454 PROCEDURE CODE FOR SERVICES RENDERED - - 1520 PAYMENT INCLUDED IN PRIMARY PROCEDURE 12 ONE OR MORE ORIGINALLY SUBMITTED PROCEDURE CODES HAVE BEEN COMBINED - - 1521 PAYMENT MADE TO ANOTHER PHYSICIAN 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 1522 REPORT NOT LEGIBLE 294 SUPPORTING DOCUMENTATION - - 1523 HYSTERECTOMY FORM INCOMPLETE 294 SUPPORTING DOCUMENTATION - - 1524 INVALID HYSTERECTOMY FORM 294 SUPPORTING DOCUMENTATION - - 1525 ABORTION REGS NOT MET 294 SUPPORTING DOCUMENTATION - - 1526 MEDICAL RECORD NOT SUBMITTED TO PREPAYMENT REVIEW 297 MEDICAL NOTES/REPORTS - - 1527 MED REC INCOMPLETE AS DETERMINED BY PREPAY REVIEW 297 MEDICAL NOTES/REPORTS - - 1528 MLOA DAYS NOT INDICATED ON CLAIM FORM 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 1530 INVALID PRESCRIBING PROV TRANS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 1662 BILLING PROVIDER I.D. NUMBER NOT 0N FILE 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) 85 BILLING PROVIDER 1801 NEED REFERRING PROVIDER FOR RADIOLOGY SERVICE 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) DN REFERRING PROVIDER 1802 MCARE PART B PRICED AT 0 FOR TOB 12X 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 1803 HOLD MCARE PART A CLAIMS WITH TOB 111 OR 114 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 1804 DENY CLAIM TYPE A WITH TOB 112 OR 113 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 1805 BILLING PROVIDER ID WAS TRANSLATED 153 ENTITY'S ID NUMBER 85 BILLING PROVIDER 1806 CROSSOVER PRICING PERFORMED - HEADER (PAY) 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 1807 CROSSOVER PRICING PERFORMED - DETAIL (PAY) 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 1808 UNABLE TO PERFORM CROSSOVER PRICING - HEADER (DENY) 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 1809 UNABLE TO PERFORM CROSSOVER PRICING - DETAIL (DENY) 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 1900 INVALID TAXONOMY CODE - BILLING PROVIDER 145 ENTITY'S SPECIALTY CODE 85 BILLING PROVIDER 1901 INVALID TAXONOMY CODE-HEADER PERFORMING PROVIDER 145 ENTITY'S SPECIALTY CODE SJ SERVICE PROVIDER 1906 INVALID TAXONOMY FOR PROVIDER TYPE/SPEC - BILLING 145 ENTITY'S SPECIALTY CODE 85 BILLING PROVIDER 1907 INVALID TAXONOMY FOR PROVIDER TYPE/SPEC - HEADER P 145 ENTITY'S SPECIALTY CODE SJ SERVICE PROVIDER 1912 TAXONOMY CODE MISSING - BILLING PROVIDER 145 ENTITY'S SPECIALTY CODE 85 BILLING PROVIDER 1913 TAXONOMY CODE MISSING - HEADER PERFORMING PROVIDER 145 ENTITY'S SPECIALTY CODE SJ SERVICE PROVIDER 1919 INVALID TAXONOMY CODE - DETAIL PERFORMING PROVIDER 145 ENTITY'S SPECIALTY CODE SJ SERVICE PROVIDER 1921 INVALID TAXONOMY FOR PROVIDER TYPE/SPEC - DETAIL P 145 ENTITY'S SPECIALTY CODE SJ SERVICE PROVIDER 1925 TAXONOMY CODE MISSING - DETAIL PERFORMING PROVIDER 145 ENTITY'S SPECIALTY CODE SJ SERVICE PROVIDER 1927 NPI REQUIRED HEALTHCARE=Y BILLING PROV 145 ENTITY'S SPECIALTY CODE 85 BILLING PROVIDER 1928 NPI REQUIRED HEALTHCARE=Y PERFORMING PROV 145 ENTITY'S SPECIALTY CODE SJ SERVICE PROVIDER 1929 NPI DEACTIVATION DUE TO FRAUD 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) 1P PROVIDER 1930 "NPI DEACTIVATION DUE TO DEATH, DISBANDMENT, OR OTHER " 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) 1P PROVIDER 1934 DTL NPI REQUIRED HEALTHCARE=Y PERFORMING PROV 145 ENTITY'S SPECIALTY CODE SJ SERVICE PROVIDER 1936 INVALID BILLING PROVIDER SPECIFIED 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) 85 BILLING PROVIDER 1937 INVALID PERFORMING PROVIDER SPECIFIED 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) SJ SERVICE PROVIDER 1943 INVALID DTL PERFORMING PROVIDER SPECIFIED 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) SJ SERVICE PROVIDER 1945 MULT SAK PROV LOCS FOR BILLING PROV SPEC 249 PLACE OF SERVICE 85 BILLING PROVIDER 1946 MULT SAK PROV LOCS FOR PERFORMING PROV SPEC 249 PLACE OF SERVICE SJ SERVICE PROVIDER 1949 MULT SAK PROV LOCS FOR RENDERING PROV SPEC 249 PLACE OF SERVICE SJ SERVICE PROVIDER 1950 NPI SUBMISSION ERROR 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 1952 MULT SAK PROV LOCS FOR DTL PERFORM PROV SPEC 249 PLACE OF SERVICE SJ SERVICE PROVIDER 1954 BILLING PROV ID NOT NPI BUT THERE IS NPI ON FILE 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) 85 BILLING PROVIDER 1960 BILLING PROVIDER ON REVIEW 46 INTERNAL REVIEW/AUDIT 85 BILLING PROVIDER 1961 RENDERING PROVIDER ON REVIEW - HEADER 46 INTERNAL REVIEW/AUDIT SJ SERVICE PROVIDER 1962 RENDERING PROVIDER ON REVIEW - DETAIL 46 INTERNAL REVIEW/AUDIT SJ SERVICE PROVIDER 1995 RENDER/DISPENS/PERFORM PROV ID IN OLD FORMAT - HDR 132 ENTITY'S MEDICAID PROVIDER ID SJ SERVICE PROVIDER 1997 UNABLE TO POPULATE DTL PERFORMING PROV ID WITH HDR 562 ENTITY'S NATIONAL PROVIDER IDENTIFIER (NPI) SJ SERVICE PROVIDER 1999 HEADER BILLING PROVIDER ID IN OLD FORMAT 132 ENTITY'S MEDICAID PROVIDER ID 85 BILLING PROVIDER 2000 INVALID SEX 57 PENDING COBRA INFORMATION REQUESTED - - 2001 MEMBER ID NUMBER NOT ON FILE 26 ENTITY NOT FOUND QC PATIENT 2002 MEMBER NOT ELIGIBLE FOR HEADER DATE OF SERVICE 88 ENTITY NOT ELIGIBLE FOR BENEFIT FOR SUBMITTEDDATES OF SERVICE QC PATIENT 2003 MEMBER INELIGIBLE ON DETAIL DATE OF SERVICE 88 ENTITY NOT ELIGIBLE FOR BENEFIT FOR SUBMITTEDDATES OF SERVICE QC PATIENT 2004 MULTIPLE AID CATEGORY CODES COVER HEADER SERVICE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 2005 MULTIPLE AID CATEGORY CODES COVER DETAIL SERVICE 105 CLAIM/LINE IS CAPITATED - - 2006 CLAIMS SUBMITTED WITH LEGACY MEMBER ID 132 ENTITY'S MEDICAID PROVIDER ID IL INSURED OR SUBSCRIBER 2007 QMB MEMBER- BILL MEDICARE FIRST 52 INVESTIGATING EXISTENCE OTHER INSUR COVERAGE - - 2008 MEMBER LEVEL OF CARE NOT ON FILE 21 MISSING OR INVALID INFORMATION - - 2011 PHARMCY MEDICAL/NON-MEDICAL SUPPL. AND ROUTINE DME 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2014 "MENTAL HLTH/SUBSTANCE ABUSE ONLY, BILL PARTNERSHIP " 116 CLAIM SUBMITTED TO INCORRECT PAYER - - 2017 MEMBER SERVICES COVERED BY MCO PLAN 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISNS 13 CONTRACTED SERVICE PROVIDER 2018 MEMBER IS INROLLED IN HOSPICE 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2037 MEMBER ID IS INACTIVE 56 AWAITING ELIGIBILITY DETERMINATION QC PATIENT 2041 MEMBER# ON CLAIM AND PA MISMATCH 26 ENTITY NOT FOUND QC PATIENT 2043 MEMBER IS ON REVIEW 46 INTERNAL REVIEW/AUDIT QC PATIENT 2044 CLAIM INDICATES MEMBER EXPIRED 159 ENTITY'S DATE OF DEATH QC PATIENT 2049 LTC/HOSPICE CONFLICT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2051 MEMBER NOT CODED FOR LTC 91 ENTITY NOT ELIGIBLE/NOT APPROVED DATES OF SRV QC PATIENT 2052 LEVEL OF CARE/AID CAT CONFLICT 91 ENTITY NOT ELIGIBLE/NOT APPROVED DATES OF SRV QC PATIENT 2053 LTC/CASE MIX CONFLICT 91 ENTITY NOT ELIGIBLE/NOT APPROVED DATES OF SRV QC PATIENT 2055 SUPPLEMENTAL ADULT SERVICE/LTC RECIPIENT CONFLICT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2056 MEMBER NOT CODED FOR CASEMIX 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2057 DOS SPAN MONTHS-FILE SEPARATE CLAIMS FOR EACH MNTH 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2500 MEMBER IS COVERED BY OTHER INSURANCE-PAY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" QC PATIENT 2501 MEMBER IS COVERED BY OTHER INSURANCE - PAY AND 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2502 MEMBER IS COVERED BY OTHER INSURANCE - DENY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2503 MEMBER IS COVERED BY OTHER INSURANCE - PAY & CHASE 52 INVESTIGATING EXISTENCE OTHER INSUR COVERAGE - - 2504 MEMBER IS COVERED BY OTHER INSURANCE - SUSPEND 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" QC PATIENT 2505 MEMBER COVERED BY MEDICARE-DENY 585 DENIED CHARGE OR NON-COVERED CHARGE - - 2509 MEMBER COVERED BY MEDICARE B (PHARMACY) - PROVIDER SHOULD BILL THROUGH POPS 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" QC PATIENT 2510 MEMBER MEDICAL SUPPORT BYPASS – DTL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2511 CANNOT DETERMINE TPL PRICING METHOD 0 CANNOT PROVIDE FURTHER STATUS ELECTRONICALLY - - 2512 DUPLICATE CAS AT HEADER AND DETAIL 639 RESPONSIBILITY AMOUNT - - 2513 TPL ADJUDICATION DATE NOT PRESENT- DETAIL 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2514 TPL ADJUDICATION DATE NOT PRESENT-HEADER 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2515 OTHER INSURER REQUIRES ADDITIONAL DATA 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" P4 PRIOR INSURANCE CARRIER 2516 MEDICAID IS ALWAYS FINAL PAYOR 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2517 TPL REVIEW - CLM/EOB DIFFER 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2518 OTHER PAYER HAS BUNDLED DETAILS 526 BUNDLED OR UNBUNDLED LINE NUMBER P4 PRIOR INSURANCE CARRIER 2519 CLAIM POTENTIALLY COVERED BY MEDICARE 56 AWAITING ELIGIBILITY DETERMINATION - - 2520 "MEMBER IS COVERED BY OTHER INSURANCE-PAY,HEADER " 56 AWAITING ELIGIBILITY DETERMINATION - - 2521 MEMBER IS COVERED BY OTHER INSURANCE - PAY AND REPORT 56 AWAITING ELIGIBILITY DETERMINATION - - 2522 MEMBER IS COVERED BY OTHER INSURANCE - DENY (HDR) 56 AWAITING ELIGIBILITY DETERMINATION - - 2523 MEMBER IS COVERED BY OTHER INSURANCE - PAY (CHASE) 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2524 MEMBER IS COVERED BY OTHER INSURANCE - SUSPEND (HDR) 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2525 MEMBER COVERED BY MEDICARE - DENY (HDR) 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2526 ZERO TPL AMOUNT AND NO ADJ RSN CODE - HEADER 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2527 ZERO TPL AMOUNT AND NO ADJ RSN CODE-DETAIL 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2528 LTC - POTENTIAL MEDICARE IN FIRST 100 DAYS 590 MEDICARE COVERAGE INDICATOR - - 2529 TPL AT HEADER AND NOT AT DETAIL 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2530 INVALID TPL CARRIER CODE 479 OTHER CARRIER PAYER ID IS MISSING OR INVALID P4 PRIOR INSURANCE CARRIER 2531 "MCARE COVERAGE INDICATED ON CLAIM, NOT ON FILE " 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2532 HEBREW REHAB LTC TPL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2533 CARRIER IS 000 AND TPL AMOUNT > 0 - HEADER 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2534 CARRIER IS 000 AND TPL AMOUNT > 0 -DETAIL 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2535 INCORRECT TPL BILLING 286 OTHER PAYER'S EXPLANATN BENEFITS/PAYMENT INFORMATION - - 2536 MCARE# ON CLAIM/FILE CONFLICT 479 OTHER CARRIER PAYER ID IS MISSING OR INVALID - - 2537 INVALID BUNDLED LINE NO ASSIGNED BY OTHER PAYER 526 BUNDLED OR UNBUNDLED LINE NUMBER P4 PRIOR INSURANCE CARRIER 2540 MEDICARE PAID > MEDICAID ALLOWED - HEADER 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2541 MEDICARE PAID > MEDICAID ALLOWED - DETAIL 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2543 MEDICARE PAYMENT OR PATIENT RESPONSIBILITY IS > 0 286 OTHER PAYER'S EXPLANATN BENEFITS/PAYMENT INFORMATION - - 2544 BENEFITS EXHAUSTED REPRICING 705 REPRICED ALLOWED AMOUNT 2545 HEADER AND DETAIL COB PAYMENTS DO NOT BALANCE 400 CLAIM IS OUT OF BALANCE - - 2546 DETAIL COB PAYMENTS DO NOT BALANCE 400 CLAIM IS OUT OF BALANCE - - 2547 HEADER COB PAYMENTS DO NOT BALANCE 400 CLAIM IS OUT OF BALANCE - - 2548 NON COVERED AMT IS NOT EQUAL TO BILLED 596 NON-COVERED CHARGE AMOUNT - - 2549 REMAINING PATIENT LIABILITY PRESENT AT HEADER 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2550 REMAINING PATIENT LIABILITY PRESENT AT DETAIL 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2551 "CLAIM HAS NON-COVERED AMT, HDR IS NOT ELIGIBLE" 596 NON-COVERED CHARGE AMOUNT - - 2553 DETAIL ADJUSTMENT REASON CODE IS NOT ON ARC XREF 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST P4 PRIOR INSURANCE CARRIER 2555 INVALID FILING INDICATOR/CARRIER COMBINATION 480 ENTITY'S CLAIM FILING INDICATOR 1P PROVIDER 2556 LTC - POTENTIAL MEDICARE C IN FIRST 100 DAYS 590 MEDICARE COVERAGE INDICATOR - - 2557 LTC - POTENTIAL PRIVATE INSURANCE IN FIRST 100 DAYS 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2558 OTHER PAYER DENIAL ARC IS NOT ON TABLE - HEADER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 2559 OTHER PAYER DENIAL ARC IS NOT ON TABLE - DETAIL 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 2561 TPL DATA CONFLICT 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" P4 PRIOR INSURANCE CARRIER 2562 BENEFITS EXHAUSTED TPL REPRICING - DETAIL 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2563 DETAIL ADJUSTMENT REASON CODE IS NOT ON ARC XREF 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 2564 MEMBER HAS MEDICARE SUPP INS DTL 2565 CLAIM REQUIRES TPL REVIEW 52 INVESTIGATING EXISTENCE OTHER INSUR COVERAGE - - 2566 MEMBER HAS MEDICARE SUPP INS 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2567 INVALID SUBMITTER FOR COB CLAIM 24 ENTITY NOT APPROVED AS AN ELECTRONIC SUBMITTR 1P PROVIDER 2568 "CLAIM HAS NON-COVERED AMT, DTL IS NOT ELIGIBLE" 596 NON-COVERED CHARGE AMOUNT - - 2569 MEMBER HAS SELF-REPORTED OTHER INSURANCE 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2580 "DETAIL, PROFESSIONAL OVERRIDE EDIT" 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2581 "HEADER, INSTITUTIONAL OVERRIDE EDIT" 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2582 "DETAIL, INSTITUTIONAL OVERRIDE EDIT" 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2583 NON COVERED AMT AND CAS PRESENT FOR PAYER 596 NON-COVERED CHARGE AMOUNT - - 2584 MEMBER MEDICAL SUPPORT BYPASS - HDR 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2585 EOB DATE AT HEADER AND DETAIL 286 OTHER PAYER'S EXPLANATN BENEFITS/PAYMENT INFO - - 2588 HEADER/COMMERCIAL/SUSPEND EDIT FROM THE TPL DENY TAB 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2589 HEADER/MEDICARE/SUSPEND EDIT FROM THE TPL DENY TAB 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2590 DETAIL/COMMERCIAL/PAY EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2591 DETAIL/MEDICARE/PAY EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2592 DETAIL/COMMERCIAL/DENY EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2593 DETAIL/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2594 DETAIL/COMMERCIAL/SUSPEND EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2595 DETAIL/MEDICARE/SUSPEND EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2596 HEADER/COMMERCIAL/PAY EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2597 HEADER/MEDICARE/PAY EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2598 HEADER/COMMERCIAL/DENY EDIT FROM THE TPL DENY TABL 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2599 HEADER/MEDICARE/DENY EDIT FROM THE TPL DENY TABLE 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 2608 MEMBER LOCKED-IN TO SPECIFIC NDC 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2610 NON-COVERED DAYS > 0 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 2612 DMH OR DPH SUBCONTRACTOR NOT AUTHORIZED 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 2613 MANAGED CARE SERVICE 515 MANAGED CARE REVIEW - - 2614 MANAGED CARE SERVICE SHOULD BE PAID BY RMC 515 MANAGED CARE REVIEW - - 2615 SENIOR PHARMACY MUST BE BILLED THROUGH POPS 515 MANAGED CARE REVIEW - - 2616 SERV NOT REIMBURSABLE BY MED ASSISTANCE PROGRAM 585 DENIED CHARGE OR NON-COVERED CHARGE - - 2617 PROC CODE REQUIRES REVIEW OF REPORT 297 MEDICAL NOTES/REPORTS - - 2620 REVENUE CODE REQ REVIEW 455 REVENUE CODE FOR SERVICES RENDERED - - 2621 BILL EXTENDED BENEFITS 88 ENTITY NOT ELIGIBLE FOR BENEFIT FOR SUBMITTEDDATES OF SERVICE QC PATIENT 2622 SERVICE NOT AUTHORIZED BY HMO 515 MANAGED CARE REVIEW - - 2623 PREPAYMENT TECHNICAL DENIAL 46 INTERNAL REVIEW/AUDIT - - 2625 MODIFIER INAPPROPRIATE/INCORRECT FOR SERV BILLED 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 2626 REQUEST FOR 90 DAY WAIVER DENIED 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2627 SERVICE COVERED BY CASE MANAGER 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS 6Y CASE MANAGER 2628 PREPAYMENT FULL DENIAL 84 SERVICE NOT AUTHORIZED - - 2629 PREPAYMENT PARTIAL DENIAL 84 SERVICE NOT AUTHORIZED - - 2630 NO PAS APPROVAL FOUND IN PREPAYMENT 352 ENTITY'S AUTHORIZATION/CERTIFICATION NUMBER X3 UTILIZATION MANAGEMENT ORGANIZATION 2631 MCARE/BILL ALLOW PAID CONFLICT 643 SERVICE LINE PAID AMOUNT - - 2632 BENEFIT CONFLICT 88 ENTITY NOT ELIGIBLE FOR BENEFIT FOR SUBMITTEDDATES OF SERVICE QC PATIENT 2633 PREPAY PREVIOUSLY APPROVED 54 DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE 2634 PREPAY PREVIOUSLY DENIED 84 SERVICE NOT AUTHORIZED 2635 PREPAY DECISION OVERTURNED 54 DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE 2640 NO RESPONSE TO OUR CAF 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 2800 MEMBER NOT TIED TO HOSPICE ON DOS 249 PLACE OF SERVICE - - 2802 NO BENEFIT PROGRAM FOR MEMBER FOUND 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 2803 PROCEDURE IS AGE RESTRICTED 585 DENIED CHARGE OR NON-COVERED CHARGE - - 2804 PROCEDURE IS INVALID FOR PATIENT SEX 57 PENDING COBRA INFORMATION REQUESTED - - 2805 MULTIPLE PPA SEGMENTS ON MEMBER FILE 171 "OTHER INSURANCE COVERAGE INFORMATION (HEALTH,LIABILITY, AUTO, ETC.)" - - 2900 SPAD CLAIM HAS CONTIGUOUS AID CATEGORY COVERAGE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3000 PER UNIT PRICE ON CLAIM DOES NOT MATCH PRIOR AUTH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3001 PA NOT FOUND ON DATABASE 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3002 NDC REQUIRES PA 252 AUTHORIZATION/CERTIFICATION NUMBER 85 BILLING PROVIDER 3003 PROCEDURE CODE REQUIRES PA 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3004 INVALID PA/PASNUMBER 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3005 INVALID PA/PAS NUMBER 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3006 PA DOLLARS EXCEEDED 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3009 PA/PAS NUMBER NOT ON THE DATABASE 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3010 OUT OF STATE PROVIDER REQUIRES REVIEW 297 MEDICAL NOTES/REPORTS - - 3013 PA NUMBER NOT ON THE DATABASE 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3015 MODIFIER ON CLAIM AND PA MISMATCH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3022 SELECT FOR MASSPRO PRE-PAYMENT REVIEW 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3023 INVALID RATE ID/PYMNT TYPE COMBINATION 499 NO RATE ON FILE WITH THE PAYER FOR THIS SERVICE FOR THIS ENTITY 1P PROVIDER 3024 LINE ITEM NOT FOUND FOR PAS NUMBER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3025 MULTIPLE ACTIVE LINE ITEMS FOR PAS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3026 PAS NOT FOUND ON DATABASE 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3027 INVALID PAS NUM 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3028 NOT ENOUGH UNITS ON PAS 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3029 MEMBER ID FOR CLAIM AND PAS DONT MATCH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3030 ADMISSION DATE FOR CLAIM AND PAS DONT MATCH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3031 PROVIDER ID FOR CLAIM AND PA/PAS DO NOT MATCH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3032 PAS IS REQUIRED 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3033 PA/PAS IS NOT READY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3034 DUPLICATE CLAIM IN PRE-PAYMENT REVIEW 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 3035 CLAIM SELECTED FOR PRE-PAYMENT REVIEW 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3036 RANDOM PRE-PAYMENT REVIEW PROCESS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3038 PAS NOT REVIEWED BY PRO 99 PRE-TREATMENT REVIEW - - 3039 PAS NOT APPROVED 0 CANNOT PROVIDE FURTHER STATUS ELECTRONICALLY - - 3040 SURGERY/ASSIST USING SAME SERV PROVIDER NUMBER 153 ENTITY'S ID NUMBER 82 RENDERING PROVIDER 3041 MEMBER# OR PROV# ON CLAIM AND PA MISMATCH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3101 PA STATUS IS VOID 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3102 PA STATUS IS DENIED 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3103 PROCEDURE NOT ON PA 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3104 REVENUE CODE / PA CONFLICT 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3105 MEMBER# ON CLAIM AND PA MISMATCH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3107 SERV DATE AFTER PA EXPIRED 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3108 PA INSUFFICIENT AVAIL UNITS 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3109 PA UNITS PRESENTLY EXHAUSTED 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3110 PA EXHUSTED - CANNOT BE USED IN PRICING 252 AUTHORIZATION/CERTIFICATION NUMBER - - 3111 PRIOR AUTH PROCEDURE/MODIFIER MISMATCH 453 PROCEDURE CODE MODIFIERS(S) FOR SERVICE(S) RENDERED - - 3120 REFERRAL REQUIRED ON CLAIM 252 ENTITY'S AUTHORIZATION/CERTIFICATION NUMBER 1P PROVIDER 3121 REFERRAL NUMBER INVALID 252 ENTITY'S AUTHORIZATION/CERTIFICATION NUMBER 1P PROVIDER 3122 NO MORE UNITS AVAILABLE ON REFERRAL 252 ENTITY'S AUTHORIZATION/CERTIFICATION NUMBER 1P PROVIDER 3124 RENDERING PROVIDER DOES NOT MATCH REFERRAL AUTH 252 ENTITY'S AUTHORIZATION/CERTIFICATION NUMBER 1P PROVIDER 3125 MEMBER IN CLAIM DOES NOT MATCH REFERRAL 252 ENTITY'S AUTHORIZATION/CERTIFICATION NUMBER QC PATIENT 3126 SERVICE DATE IS OUTSIDE REFERRAL AUTH 252 ENTITY'S AUTHORIZATION/CERTIFICATION NUMBER 1P PROVIDER 3300 JCODE GIVEN WITH INVALID NDC 218 NDC NUMBER - - 3301 LTC CLAIM REQUIRES A PATIENT LIABILITY AMOUNT 639 RESPONSIBILITY AMOUNT - - 3302 UNABLE TO DETERMINE RATE ID 499 NO RATE ON FILE WITH THE PAYER FOR THIS SERVICE FOR THIS ENTITY 1P PROVIDER 3303 INVALID PROCEDURE/TOOTH SURFACE COMBINATION 240 TOOTH SURFACE(S) INVOLVED - - 3304 MANUFACTURERS INVOICE REQUIRED 294 SUPPORTING DOCUMENTATION - - 3305 INVALID PATIENT PAY AMOUNT 639 RESPONSIBILITY AMOUNT QC PATIENT 3306 SPAD RATE NOT ALLOWED FOR TRANSFER PATIENT STATUS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3307 NO PATIENT LIABILITY ON FILE OR ON THE CLAIM 639 RESPONSIBILITY AMOUNT - - 3310 CURRENT SUPPLIERS INVOICE REQUIRED 294 SUPPORTING DOCUMENTATION - - 3311 ACQUISTION COST MISSING 294 SUPPORTING DOCUMENTATION - - 3312 MAX FEE RELATIVE VALUE MUST BE > 0 ON DOS 523 ANESTHESIA UNIT COUNT - - 3314 "POS, MODIFIER INVALID FOR RADIOLOGY " 249 PLACE OF SERVICE - - 3315 ICD9-CM STERILIZATION PROC REQUIRES ATTACHMENT 294 SUPPORTING DOCUMENTATION - - 3316 ICD9-CM HYSTERECTOMY PROC REQUIRES ATTACHMENT 294 SUPPORTING DOCUMENTATION - - 3317 ICD9-CM ABORTION PROC REQUIRES ATTACHMENT 294 SUPPORTING DOCUMENTATION - - 3318 NON COVRD DAYS MUST BE NUMERIC FOR PROV TYPE 70/74 457 NON-COVERED DAY(S) - - 3319 BENEFIT PLAN AGE RESTRICTION ON PRIMARY DIAG 254 PRIMARY DIAGNOSIS CODE - - 3320 BENEFIT PLAN AGE RESTRICTION ON SECOND DIAG 255 DIAGNOSIS CODE - - 3321 BENEFIT PLAN AGE RESTRICTION ON THIRD DIAG 255 DIAGNOSIS CODE - - 3322 BENEFIT PLAN AGE RESTRICTION ON FOURTH DIAG 255 DIAGNOSIS CODE - - 3323 BENEFIT PLAN AGE RESTRICTION ON FIFTH DIAG 255 DIAGNOSIS CODE - - 3324 BENEFIT PLAN AGE RESTRICTION ON SIXTH DIAG 255 DIAGNOSIS CODE - - 3325 BENEFIT PLAN AGE RESTRICTION ON SEVENTH+ DIAG 255 DIAGNOSIS CODE - - 3326 BENEFIT PLAN AGE RESTRICTION ON ADMIT DIAG 232 ADMITTING DIAGNOSIS - - 3327 TYPE OF BILL CANNOT BE CROSS WALKED TO A PLACE OF SERVICE 228 TYPE OF BILL FOR UB-92 CLAIM - - 3335 NO VALID DERIVED RATE ID 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 3602 CLAIM AND EOB DIFFER 286 OTHER PAYER'S EXPLANATN BENEFITS/PAYMENT INFO - - 4001 BENEFIT PLAN BILL PR TYP RESTRICTION ON DIAGNOSIS 145 ENTITY'S SPECIALTY CODE 85 BILLING PROVIDER 4002 NDC INDICATES A NON-COVERED DRUG ON DOS 596 NON-COVERED CHARGE AMOUNT - - 4003 ATTACH REV ON STERIL/HYST DIAG 294 SUPPORTING DOCUMENTATION - - 4004 NDC NOT ON FILE 218 NDC NUMBER 85 BILLING PROVIDER 4007 NON-COVERED NDC DUE TO CMS TERMINATION 219 PRESCRIPTION NUMBER - - 4009 ALLOWED AMOUNT LESS THAN DRUG CHARGE VARIANCE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST 85 BILLING PROVIDER 4010 MODIFIER REQUIRES MEDICAL REVIEW 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 4011 INVALID MODIFIER/MODIFIER COMBINATION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4012 ABORTION PROCEDURE INDICATED 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4013 PROCEDURE CODE IS NOT COVERED FOR DATE OF SERVICE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4014 NO PRICING SEGMENT ON FILE 454 PROCEDURE CODE FOR SERVICES RENDERED - - 4015 MULTIPLE PRICING MODIFIERS ON CLAIM 628 PRICING METHODOLOGY - - 4016 BENEFIT PLAN PERF PR TYP RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4017 BENEFIT PLAN BILL PR TYP RESTRICTION ON DRG 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4018 BENEFIT PLAN PERF PR TYP RESTRICTION ON DRG 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4019 PROCEDURE CODE REQUIRES ATTACHMENT 294 SUPPORTING DOCUMENTATION - - 4020 PROV CONTRACT UNIT RESTRICTION ON PROCEDURE 452 TOTAL VISITS IN TOTAL NUMBER OF HOURS/DAY ANDTOTAL NUMBER OF HOURS/WEEK - - 4021 PROCEDURE NOT COVERED FOR BENEFIT PLAN 88 ENTITY NOT ELIGIBLE FOR BENEFIT FOR SUBMITTEDDATES OF SERVICE QC PATIENT 4022 ABORTION DIAGNOSIS INDICATED 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4023 GENDER IS NOT ALLOWED FOR COVERED NDC 585 DENIED CHARGE OR NON-COVERED CHARGE QC PATIENT 4024 MAXIMUM NUMBER OF REFILLS HAS BEEN REACHED 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD QH PHYSICIAN 4025 NDC VS. AGE RESTRICTION 585 DENIED CHARGE OR NON-COVERED CHARGE QC PATIENT 4026 NDC VS. DAYS SUPPLY 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 4027 DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE 254 PRIMARY DIAGNOSIS CODE - - 4028 BENEFIT PLAN GENDER RESTRICTION ON DIAGNOSIS 86 DIAGNOSIS AND PATIENT GENDER MISMATCH - - 4029 BENEFIT PLAN POS RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4030 BENEFIT PLAN AGE RESTRICTION ON DIAGNOSIS 255 DIAGNOSIS CODE - - 4031 PROV CONTRACT GENDER RESTRICTION ON DIAGNOSIS 86 DIAGNOSIS AND PATIENT GENDER MISMATCH - - 4032 PROCEDURE CODE NOT ON FILE 454 PROCEDURE CODE FOR SERVICES RENDERED - - 4033 INVALID PROC MOD COMBINATION 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 4034 BENEFIT PLAN AGE RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4035 BENEFIT PLAN GENDER RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4036 PROV CONTRACT POS RESTRICTION ON PROCEDURE 454 PROCEDURE CODE FOR SERVICES RENDERED - - 4037 PROCEDURE CODE VS. DIAGNOSIS RESTRICTION 488 DIAGNOSIS CODE(S) FOR THE SERVICES RENDERED - - 4038 SERVICE NOT COVERED FOR LIMITED BENEFIT PLAN 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4039 DIAGNOSIS CANNOT BE USED AS PRINCIPAL DIAGNOSIS 255 DIAGNOSIS CODE - - 4040 PRIMARY DIAGNOSIS CODE NOT ON FILE 254 PRIMARY DIAGNOSIS CODE - - 4041 SECONDARY DIAGNOSIS CODE NOT ON FILE 255 DIAGNOSIS CODE - - 4042 THIRD DIAGNOSIS CODE NOT ON FILE OR INACTIVE 255 DIAGNOSIS CODE - - 4043 FOURTH DIAGNOSIS CODE NOT ON FILE OR INACTIVE 255 DIAGNOSIS CODE - - 4044 REIMBURSEMENT RULE AGE RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4045 REIMBURSEMENT RULE/BENEFIT PLAN RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4046 NO REIMBURSEMENT RULE FOR RATE ID 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4047 FIFTH DIAGNOSIS CODE NOT ON FILE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4048 SIXTH DIAGNOSIS CODE NOT ON FILE 255 DIAGNOSIS CODE - - 4049 SEVENTH DIAGNOSIS CODE NOT ON FILE 255 DIAGNOSIS CODE - - 4050 EIGHTH DIAGNOSIS CODE NOT ON FILE 255 DIAGNOSIS CODE - - 4051 NINTH DIAGNOSIS CODE NOT ON FILE 255 DIAGNOSIS CODE - - 4052 TENTH DIAGNOSIS CODE NOT ON FILE 255 DIAGNOSIS CODE - - 4053 PRINCIPAL PROCEDURE CODE NOT ON FILE 666 SURGICAL PROCEDURE CODE - - 4054 FIRST OTHER PROCEDURE CODE NOT ON FILE 666 SURGICAL PROCEDURE CODE - - 4055 SECOND OTHER PROCEDURE CODE NOT ON FILE 666 SURGICAL PROCEDURE CODE - - 4056 THIRD OTHER PROCEDURE CODE NOT ON FILE 666 SURGICAL PROCEDURE CODE - - 4057 FOURTH OTHER PROCEDURE CODE NOT ON FILE 666 SURGICAL PROCEDURE CODE - - 4058 FIFTH OTHER PROCEDURE CODE NOT ON FILE 666 SURGICAL PROCEDURE CODE - - 4059 REVENUE CODE NOT ON FILE 455 REVENUE CODE FOR SERVICES RENDERED - - 4060 ELEVENTH DIAGNOSIS CODE NOT ON FILE 255 DIAGNOSIS CODE - - 4061 REIMBURSEMENT RULE CLAIM TYPE RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4062 REIMBURSEMENT RULE COND CODE RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4063 ICD-9-CM PROCEDURE CODE/AGE RESTRICTION 475 PROCEDURE CODE NOT VALID FOR PATIENT AGE QC PATIENT 4064 BENEFIT PLAN GENDER RESTRICTION ON ICD9 PROC 474 PROCEDURE CODE AND PATIENT GENDER MISMATCH - - 4065 ICD9-CM PROCEDURE REQUIRES ATTACHMENT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4066 ICD9-CM PROCEDURE/DIAGNOSIS RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4067 NON-COVERED ICD-9-CM PROCEDURE CODE 666 SURGICAL PROCEDURE CODE - - 4068 REIMBURSEMENT RULE/PROV CONTRACT RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4069 REIMBURSEMENT RULE RESTRICTION ON DIAGNOSIS ROLE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4070 REIMBURSEMENT RULE MODIFIER RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4071 REIMBURSEMENT RULE PAYER RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4072 REIMBURSEMENT RULE TAXONOMY RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4076 TWELFTH DIAGNOSIS CODE NOT ON FILE 255 DIAGNOSIS CODE - - 4077 NON-COVERED REVENUE CODE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4085 INPATIENT PSYCH HOSP FOR MEMBERS AGE 22-64 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4095 REIMBURSEMENT RULE UNIT RESTRICTION 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 4096 MODIFIER 99 NOT ALLOWED 297 MEDICAL NOTES/REPORTS - - 4097 INVALID PROCESSING MODIFIER/RATE NOT FOUND 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4098 FUND CODE FOR AID CAT/LOC NOT FOUND 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4099 DRG NOT ON FILE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4113 UNIT DOSE PACKAGING COVERED FOR LTC RESIDENTS ONLY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4115 NO RBRVS CONVERSION FACTOR 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4117 ICD9 PROCEDURE IS NOT VALID FOR DATES OF SERVICE 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4120 PROCEDURE CODE REQUIRES QUADRANT 242 "TOOTH NUMBERS, SURFACES, QUADRANTS INVOLVED" - - 4128 ICD9 PROCEDURE 7-24 NOT ON FILE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4132 DRG GROUPER UNABLE TO ASSIGN DRG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4135 APC GROUPER UNABLE TO GROUP/PRICE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4136 BENEFIT PLAN BILL PR TYP RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4137 BENEFIT PLAN PERF PR TYP RESTRICTION ON ICD9 PROC 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4138 BILL PROV TYPE SPEC NOT VALID FOR COVERED-NDC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4139 PERF PROV TYPE SPEC NOT VALID FOR COVERED-NDC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4140 BENEFIT PLAN BILL PR TYP RESTRICTION ON PROCEDURE 454 PROCEDURE CODE FOR SERVICES RENDERED - - 4141 BENEFIT PLAN PERF PR TYP RESTRICTION ON PROCEDURE 454 PROCEDURE CODE FOR SERVICES RENDERED - - 4142 BENEFIT PLAN BILL PR TYP RESTRICTION ON REVENUE 455 REVENUE CODE FOR SERVICES RENDERED - - 4143 BENEFIT PLAN PERF PR TYP RESTRICTION ON REVENUE 488 DIAGNOSIS CODE(S) FOR THE SERVICES RENDERED - - 4144 PROV CONTRACT PERF PR TYP RESTRICTION ON DIAGNOSIS 488 DIAGNOSIS CODE(S) FOR THE SERVICES RENDERED - - 4145 PROV CONTRACT BILL PR TYP RESTRICTION ON DRG 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4146 PROV CONTRACT PERF PR TYP RESTRICTION ON DRG 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4147 PROV CONTRACT PERF PR TYP RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4148 PERF PROV TYPE SPEC NOT VALID FOR CONTRACT-NDC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4149 PROV CONTRACT BILL PR TYP RESTRICTION ON PROCEDURE 454 PROCEDURE CODE FOR SERVICES RENDERED - - 4150 PROV CONTRACT PERF PR TYP RESTRICTION ON PROCEDURE 455 REVENUE CODE FOR SERVICES RENDERED - - 4151 PROV CONTRACT BILL PR TYP RESTRICTION ON REVENUE 455 REVENUE CODE FOR SERVICES RENDERED - - 4152 PROV CONTRACT PERF PR TYP RESTRICTION ON REVENUE 455 REVENUE CODE FOR SERVICES RENDERED - - 4153 PRIMARY NDC ON MEDICAL REVIEW FOR PROV. CONTRACT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4155 REIMBURSEMENT RULE POS RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4156 REIMBURSEMENT RULE PROV LOCAT RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4157 PROV CONTRACT/PROV CONTRACT RESTRICT ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4158 PROV CONTRACT/PROV CONTRACT RESTRICT ON DRG 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4159 PROV CONTRACT/PROV CONTRACT RESTRICT ON ICD9 PROC 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4160 PROVIDER CONTRACT RESTRICTION FOR CONTRACT NDC 218 NDC NUMBER - - 4161 PROV CONTRACT/PROV CONTRACT RESTRICT ON PROCEDURE 455 REVENUE CODE FOR SERVICES RENDERED - - 4162 PROV CONTRACT/PROV CONTRACT RESTRICT ON REVENUE 455 REVENUE CODE FOR SERVICES RENDERED - - 4164 INACTIVE DRUG 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4165 MAX DAY RESTRICTION FOR COVERED NDC 218 NDC NUMBER 85 BILLING PROVIDER 4166 REIMBURSEMENT RULE MEMB LOCAT RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4167 PROV CONTRACT UNIT RESTRICTION ON REVENUE 455 REVENUE CODE FOR SERVICES RENDERED - - 4168 BENEFIT PLAN UNIT RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4170 UNITS BILLED GREATER THAN ALLOWED 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4171 UNITS BILLED LESS THAN ALLOWED 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4177 PROV CONTRACT BILL PR TYP RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4180 SECOND DIAG CODE NOT COVERED FOR DATE OF SERVICE 255 DIAGNOSIS CODE - - 4181 THIRD DIAG CODE NOT COVERED FOR DATE OF SERVICE 255 DIAGNOSIS CODE - - 4182 FOURTH DIAG CODE NOT COVERED FOR DATE OF SERVICE 255 DIAGNOSIS CODE - - 4183 FIFTH DIAG CODE NOT COVERED FOR DATE OF SERVICE 255 DIAGNOSIS CODE - - 4184 SIXTH DIAG CODE NOT COVERED FOR DATE OF SERVICE 255 DIAGNOSIS CODE - - 4185 7 - 24 DIAG CODE NOT COVERED FOR DATE OF SERVICE 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4186 ADMIT DIAG CODE NOT COVERED FOR DATE OF SERVICE 232 ADMITTING DIAGNOSIS - - 4187 EMERG DIAG CODE NOT COVERED FOR DATE OF SERVICE 488 DIAGNOSIS CODE(S) FOR THE SERVICES RENDERED - - 4188 DIAGNOSIS CODE NOT COVERED FOR DATE OF SERVICE(DTL) 254 PRIMARY DIAGNOSIS CODE - - 4189 SECOND DIAG CODE NOT COVERED FOR DATE OF SERVICE(DTL) 255 DIAGNOSIS CODE - - 4190 THIRD DIAG CODE NOT COVERED FOR DATE OF SERVICE(DTL) 255 DIAGNOSIS CODE - - 4191 FOURTH DIAG CODE NOT COVERED FOR DATE OF SERVICE(DTL) 255 DIAGNOSIS CODE - - 4192 FIFTH DIAG CODE NOT COVERED FOR DATE OF SERVICE(DTL) 255 DIAGNOSIS CODE - - 4193 SIXTH DIAG CODE NOT COVERED FOR DATE OF SERVICE(DTL) 255 DIAGNOSIS CODE - - 4194 7 - 24 DIAG CODE NOT COVERED FOR DATE OF SERVICE(DTL) 255 DIAGNOSIS CODE - - 4200 CLAIM PRICED AT ZERO 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4203 MODIFIER IS NOT COVERED 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 4207 CLIA NUMBER NOT ON FILE FOR DATES OF SERVICE 142 ENTITY'S LICENSE/CERTIFICATION NUMBER 1X LABORATORY 4208 INVALID CLIA CERTIFICATION/PROCEDURE CODE COMBINAT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4209 NO PRICING SEGMENT FOR PROCEDURE/MODIFIER COMBINAT 499 NO RATE ON FILE WITH THE PAYER FOR THIS SERVICE FOR THIS ENTITY 1P PROVIDER 4210 MILEAGE RATE NOT ON FILE FOR DATE OF SERVICE 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4211 TOOTH NUMBER/PROCEDURE CODE COMBINATION INVALID 244 TOOTH NUMBER OR LETTER - - 4212 INVALID CLIA LAB CODE/PROC CODE/MODIFIER COMBINAT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4214 SERVICE DATE PRIOR TO CLIA CERTIFICATION DATE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4215 CLIA NUMBER TERMINATED 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4222 NDC REQUIRES REVIEW 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4223 BENEFIT PLAN REVIEW RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4224 BENEFIT PLAN UNIT RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4227 REVENUE NOT COVERED FOR BENEFIT PLAN 455 REVENUE CODE FOR SERVICES RENDERED - - 4229 BENEFIT PLAN REVIEW RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4231 MAX UNIT RESTRICTION FOR BILLED NDC 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4232 MAX DAY RESTRICTION FOR BILLED NDC 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" 85 BILLING PROVIDER 4233 DIAGNOSIS REQUIRES ADDITIONAL DOCUMENTATION 297 MEDICAL NOTES/REPORTS - - 4235 IMPROPER MODIFIER FOR PROCEDURE BILLED 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 4236 INVALID USE OF E DIAGNOSIS CODE 254 PRIMARY DIAGNOSIS CODE - - 4237 INVALID TYPE OF LEAVE FOR LTC CLAIM 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4240 PROCEDURE MUST BE BILLED SEPARATELY FOR EACH DOS 188 STATEMENT FROM-THROUGH DATES - - 4244 DIAGNOSIS NOT COVERED FOR BENEFIT PLAN 255 DIAGNOSIS CODE - - 4245 FOURTH MODIFIER NOT COVERED 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 4246 ADJUSTMENT PAID AMOUNT EXCEEDS THE CASH RECEIPT BA 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4248 MISSING MODIFIER FOR THIS PROCEDURE 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 4250 REIMBURSEMENT RULE PROV TYP RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4252 DX CODE 6-24 NOT ON FILE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4253 BENEFIT PLAN REVIEW RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4254 BENEFIT PLAN AGE RESTRICTION ON REVENUE 455 REVENUE CODE FOR SERVICES RENDERED - - 4256 BENEFIT PLAN MODIFIER RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4257 PROV CONTRACT MODIFIER RESTRICTION ON PROCEDURE 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4258 SECONDARY DIAG RESTRICTION FOR BILLED NDC 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4260 MEMBER NOT CODED FOR LTC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4261 MEMBER NOT CODED FOR CASEMIX 91 ENTITY NOT ELIGIBLE/NOT APPROVED DATES OF SRV QC PATIENT 4310 PROV CONTRACT ADMIT DIAG RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4311 PROV CONTRACT EMERG DIAG RESTRICTION ON PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4312 PROV CONTRACT PRIM DTL DIAG RESTRICT ON PROCEDURE 255 DIAGNOSIS CODE - - 4313 PROV CONTRACT PRIM/SEC DTL DIAG RESTRICT ON PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4314 BENEFIT PLAN CLAIM TYPE RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4315 PROV CONTRACT HDR DIAG RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4316 PROV CONTRACT DTL DIAG RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4317 PROV CONTRACT ADMIT DIAG RESTRICTION ON ICD9 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4318 PROV CONTRACT DTL DIAG RESTRICTION ON ICD9 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4319 PROV CONTRACT HDR DIAG RESTRICTION ON ICD9 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4320 PROV CONTRACT ADMIT DIAG RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4321 PROV CONTRACT DTL DIAG RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4322 PROV CONTRACT PRIM/SEC DTL DIAG RESTRICT ON REV 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4362 PROV CONTRACT TOB RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4363 PROV CONTRACT TOB RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4364 PROV CONTRACT TOB RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4365 PROV CONTRACT TOB RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4371 BENEFIT PLAN CLAIM TYPE RESTRICTION ON PROCEDURE 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4373 NDC COVERED BENEFIT CLAIM TYPE RESTRICTION 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4374 BENEFIT PLAN CLAIM TYPE RESTRICTION ON REVENUE 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4376 BENEFIT PLAN CLAIM TYPE RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4711 PROV CONTRACT AGE RESTRICTION ON ADMIT DIAG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4712 PROV CONTRACT AGE RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4714 PROV CONTRACT AGE RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4715 PROV CONTRACT AGE RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4716 AGE RESTRICTION FOR BILLED ICD9 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4721 PROV CONTRACT PRIM/SEC DTL DIAG RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4723 BENEFIT PLAN DTL DIAGNOSIS RESTRICTION ON ICD9 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4724 BENEFIT PLAN PRIM/SEC DTL DIAG RESTRICTION ON ICD9 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4726 BENEFIT PLAN ADMIT DIAG RESTRICTION ON ICD9 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4730 REIMBURSEMENT RULE RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4731 BENEFIT PLAN DTL DIAG RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4732 BENEFIT PLAN ADMIT DIAG RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4733 PROV CONTRACT ADMIT DIAG RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4734 PROV CONTRACT DTL DIAGNOSIS RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4736 BENEFIT PLAN DTL DIAG RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4741 BENEFIT PLAN ADMIT DIAG RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4742 BENEFIT PLAN EMERG DIAG RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4743 BENEFIT PLAN PRIM/SEC DTL DIAG RESTRICT ON PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4744 BENEFIT PLAN PRIM/SEC DTL DIAG RESTRICTION ON REV 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4745 BENEFIT PLAN HDR DIAG RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4746 BENEFIT PLAN PRIM DTL DIAG RESTRICT ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4751 PROV CONTRACT TOB RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4760 PROV CONTRACT REVIEW RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4762 PROV CONTRACT POS RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4765 ICD9 PROC NOT COVERED FOR BENEFIT PLAN 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4766 BENEFIT PLAN AGE RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4767 BENEFIT PLAN POS RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4768 BENEFIT PLAN REVIEW RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4776 PROV CONTRACT BILL PR TYP RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4801 PROCEDURE NOT COVERED BY PROVIDER CONTRACT 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4802 DIAGNOSIS NOT COVERED BY PROVIDER CONTRACT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4804 REVENUE NOT COVERED BY PROVIDER CONTRACT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4805 DRG NOT COVERED BY PROVIDER CONTRACT 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4806 ICD9 PROC NOT COVERED BY PROVIDER CONTRACT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4812 PROV CONTRACT REVIEW RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4813 PROV CONTRACT REVIEW RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4814 PROV CONTRACT REVIEW RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4821 BENEFIT PLAN POS RESTRICTION ON PROCEDURE 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4822 PROV CONTRACT POS RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4825 MIXED HOLIDAY/WEEKEND/WEEKDAY DATES 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4831 NO REIMBURSEMENT RULE FOR SERVICE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4845 PROV CONTRACT REVIEW RESTRICTION ON DRG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4863 NDC COVERED FOR A PORTION OF THE DOS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4866 BENEFIT PLAN POS RESTRICTION ON REVENUE 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4867 PROV CONTRACT POS RESTRICTION ON REVENUE 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4871 PROV CONTRACT CLAIM TYPE RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4872 PROV CONTRACT CLAIM TYPE RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4874 PROV CONTRACT CLAIM TYPE RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4875 PROV CONTRACT CLAIM TYPE RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4876 PROV CONTRACT CLAIM TYPE RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4881 PROV CONTRACT POS RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4882 DRG NOT COVERED FOR BENEFIT PLAN 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4883 BENEFIT PLAN REVIEW RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4884 BENEFIT PLAN AGE RESTRICTION ON DRG 585 DENIED CHARGE OR NON-COVERED CHARGE - - 4886 BENEFIT PLAN CLAIM TYPE RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4887 BENEFIT PLAN POS RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4890 PROV CONTRACT AGE RESTRICTION ON PRIMARY DIAG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4891 PROV CONTRACT AGE RESTRICTION ON SECONDARY DIAG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4892 PROV CONTRACT AGE RESTRICTION ON THIRD DIAG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4893 PROV CONTRACT AGE RESTRICTION ON FOURTH DIAG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4894 PROV CONTRACT AGE RESTRICTION ON FIFTH DIAG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4895 PROV CONTRACT AGE RESTRICTION ON SIXTH DIAG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4896 PROV CONTRACT AGE RESTRICTION ON SEVENTH DIAG 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4900 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4901 BENEFIT PLAN COND CODE RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4902 BENEFIT PLAN OCCUR CODE RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4903 BENEFIT PLAN RESTRICTION ON DIAGNOSIS ROLE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4910 PROV CONTRACT/BENEFIT PLAN RESTRICT ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4911 PROV CONTRACT COND CODE RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4912 PROV CONTRACT OCCUR CODE RESTRICTION ON DIAGNOSIS 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4913 PROV CONTRACT RESTRICTION ON DIAGNOSIS ROLE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4914 PROV CONTRACT OCCUR CODE RESTRICTION ON DRG 719 NUBC OCCURRENCE CODE(S) - - 4920 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4921 BENEFIT PLAN COND CODE RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4922 BENEFIT PLAN OCCUR CODE RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4930 BENEFIT PLAN RESTRICTION FOR CONTRACT DRG 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4931 PROV CONTRACT COND CODE RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4935 BENEFIT PLAN GENDER RESTRICTION ON DRG 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 4936 PROV CONTRACT GENDER RESTRICTION ON DRG 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 4940 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4941 BENEFIT PLAN COND CODE RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4942 BENEFIT PLAN OCCUR CODE RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4944 PROV CONTRACT GENDER RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4950 PROV CONTRACT/BENEFIT PLAN RESTRICT ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4951 PROV CONTRACT COND CODE RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4952 PROV CONTRACT OCCUR CODE RESTRICTION ON ICD9 PROC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4963 PROV CONTRACT GENDER RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4964 PROV CONTRACT GENDER RESTRICTION ON REVENUE 455 REVENUE CODE FOR SERVICES RENDERED - - 4967 BENEFIT PLAN GENDER RESTRICTION ON REVENUE 455 REVENUE CODE FOR SERVICES RENDERED - - 4970 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4971 BENEFIT PLAN COND CODE RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4972 BENEFIT PLAN OCCUR CODE RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4975 PROV CONTRACT/BENEFIT PLAN RESTRICT ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4976 PROV CONTRACT COND CODE RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4977 PROV CONTRACT OCCUR CODE RESTRICTION ON REVENUE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4980 BENEFIT PLAN/BENEFIT PLAN RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4981 BENEFIT PLAN COND CODE RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4982 BENEFIT PLAN OCCUR CODE RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4990 PROV CONTRACT/BENEFIT PLAN RESTRICT ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4991 PROV CONTRACT COND CODE RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4992 PROV CONTRACT OCCUR CODE RESTRICTION ON PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 4999 THIS DRUG NOT COVERED BY MEDICARE PART D 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST 85 BILLING PROVIDER 5000 EXACT DUPLICATE - INPATIENT CLAIM 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5001 SUSPECT DUPLICATE - INPATIENT CLAIM- DIFFERENT PROVIDER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5002 CONFLICT - INPATIENT VS OUTPATIENT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5003 CONFLICT - INPATIENT VS LONG TERM CARE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5004 EXACT DUPLICATE - INPATIENT/LTC CROSSOVER A 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5005 SUSPECT DUPLICATE - INPATIENT/LTC CROSSOVER A 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5006 EXACT DUPLICATE - PHYSICIAN CROSSOVER 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5007 SUSPECT DUPLICATE - PHYSICIAN CROSSOVER- DIFFERENT PROVIDER 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5008 CONFLICT- PHYSICIAN VS CROSSOVER B 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5009 CONFLICT-LONG TERM CARE VS CROSSOVER A 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5010 EXACT DUPLICATE-OUTPATIENT CLAIM 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5011 SUSPECT DUPLICATE-OUTPATIENT CLAIM-DIFFERENT PROVIDER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5012 EXACT DUPLICATE - OUTPATIENT/HOME HEALTH/ CROSSOVER CLAIM 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5013 "SUSPECT DUPLICATE - OUTPATIENT/HOME HEALTH/ CROSSOVER CLAIM" 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5014 EXACT DUPLICATE-OUTPATIENT LAB SERVICES 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5015 SUSPECT DUPLICATE OUTPATIENT LAB SERVICES DIFFERENT PROVIDER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5016 EXACT DUPLICATE OUTPATIENT RADIOLOGICAL SERVICES 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5017 SUSPECT DUPLICATE-OUTPATIENT RADIOLOGY SERVICES 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5018 SUSPECT DUPLICATE OUTPATIENT SURGICAL SERVICES (OPERATION ROOM / AMB SURG CTR) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5019 SUSPECT DUPLICATE OUTPATIENT SERGICAL SERVICES (OPER ROOM/AMB SWG CTR)-DIFFEREN 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5020 SUSPECT DUPLICATE OUTPATIENT PROCEDURE 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5021 SUSPECT DUPLICATE OUTPATIENT PROCEDURE(OPER ROOM/AMB SURG CTR) DIFFERENT PROVID 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5022 SUSPECT DUPLICATE OUTPATIENT PROCEDURES (OPER ROOM/ AMB SURG CTR) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5023 SUSPECT DUPLICATE OUTPATIENT PROCEDURE (OPER ROOM/ AMB SURG CTR) DIFFERENT PROV 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5024 SUSPECT DUPLICATE OUTPATIENT SERGICAL SERVICES 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5025 SUSPECT DUPLICATE OUTPATIENT SERGICAL SERVICES (EMERG ROOM/ CLINIC) DIFFERENT P 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5026 SUSPECT DUPLICATE OUTPATIENT SERGICAL SERVICES EMERGENCY ROOM/ CLINIC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5027 SUSPECT DUPLICATE OUTPATIENT SURGICAL SERVICES- EMERG ROOM/CLINIC- DIFFERENT PR 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5028 OPD EXACT DUP CRITERIA=E- CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5029 OPD SUSPECT DUP CRITERIA=E-CLAIM TYPE O -UB4 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5030 XACT DUPLICATE OUTPATIENT PROCEDURES (OPER ROOM/AMB SURG CTR/EMERG ROOM/CLINIC) 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5031 SUSPECT DUPLICATE OUTPATIENT PROCEDURE (OR/AMB SURG CTR/ER/CLINIC) -DIFFERENT P 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5032 EXACT DUPLICATE-OUTPATIENT PROCEDURES (OPER ROOM / EMERG ROOM/ CLINIC) 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5033 SUSPECT DUPLICATE OUTPATIENT PROCEDURES- DIFFERENT PROVIDER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5034 OPD EXACT DUP CRITERIA=E1-CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5035 OPD SUSPECT DUP CRITERIA=E1-CLAIM TYP O -UB4 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5036 OPD EXACT DUP CRITERIA=F- CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5037 OPD SUSPECT DUP CRITERIA=F- CLAIM TYP O -UB4 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5038 OPD EXACT DUP CRITERIA=F1-CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5039 OPD SUSPECT DUP CRITERIA=F1-CLAIM TYP O -UB4 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5040 OPD EXACT DUP CRITERIA=G-CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5041 OPD SUSPECT DUP CRITERIA=G -CLAIM TYP O -UB4 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5042 OPD EXACT DUP CRITERIA=H-CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5043 OPD SUSPECT DUP CRITERIA=H -CLAIM TYP O -UB4 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5044 EXACT DUPLICATE - PHYSICAN CLAIM 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5045 SUSPECT DUPLICATE-PHYSICIAN CLAIM- DIFFERENT PROVIDER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5046 EXACT DUPLICATE OUTPATIENT PROCEDURES (CLINIC) 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5047 SUSPECT DUPLICATE OUTPATIENT PROCEDURES (CLINIC) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5048 SUSPECT DUPLICATE OUTPATIENT PROCEDURES (CLINIC) 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5049 SUSPECT DUPLICATE OUTPATIENT PROCEDURE (CLINIC) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5050 EXACT DUPLICATE HOME HEALTH CLAIM 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5051 SUSPECT DUPLICATE- HOME HEALTH -DIFFERENT PROVIDER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5052 EXACT DUPLICATE - LONG TERM CARE 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5053 SUSPECT DUPLICATE-LONG TERM CARE-DIFFERENT PROVIDER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5054 OPD EXACT DUP CRITERIA=M-CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5055 OPD SUSPECT DUP CRITERIA=M-CLAIM TYP O -UB4 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5056 DUPLICATE SERVICE (DENTAL ONLY) 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5057 DUPLICATE SERVICE (PHARMACY ONLY) 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE 85 BILLING PROVIDER 5058 OPD EXACT DUP CRITERIA=M1-CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5059 OPD SUSPECT DUP CRITERIA=M1-CLAIM TYP O -UB4 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5060 OPD EXACT DUP CRITERIA=N-CLAIM TYPE O-UB04 INV 03 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5061 OPD SUSPECT DUP CRITERIA=N-CLAIM TYP O -UB04 INV 3 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5062 EXACT DUPLICATE OUTPATIENT PROCEDURES (TREATMENT ROOM) 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 5063 SUSPECT DUPLICATE OUTPATIENT PROCEDURES (TREATMENT ROOM) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5064 CONFLICT: INPATIENT VS. CROSSOVER A 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5065 CONFLICT: HOME HEALTH VS. OUTPATIENT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5066 CONFLICT: HOME VS. PHYSICIAN 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5067 CONFLICT: HOME VS. CROSSOVER B 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5068 CONFLICT: HOME HEALTH VS. CROSSOVER A 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5069 CONFLICT: HOME HEALTH VS. CROSSOVER C 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5070 CONFLICT: OUTPATIENT VS. CROSSOVER C 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5071 PA IS REQUIRED FOR BASIC MEMBERS 84 SERVICE NOT AUTHORIZED - - 5072 CONFLICT: LTC VS. PROV TYPE 58 59 62 63 64 66 68 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5073 CONFLICT: HOSPICE VS. LONG TERM CARE 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5074 EXACT DUPLICATE - DIFFERENT PHYSICIAN CLAIM 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5075 EXACT DUPLICATE - DIFFERENT HOME HEALTH CLAIM 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5076 EXACT DUPLICATE - DIFFERENT CROSSOVER B CLAIM 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5077 LTC MLOA CLAIM SUSP W INP / PART A 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5078 S5160 & S5161 CAN NOT BE BILLED WITH LTC SAME DOS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5079 CONFLICT: LTC VS PHYSICIAN(S5160 & S5161) SAME DOS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5080 SURG/ASSIST SURG SAME DOS SAME PROVIDER 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5081 CONFLICT: ASC FACILITY VS OPD FACILITY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5082 ONE PRIMARY SURGERY PER DAY 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5083 LIMIT 1 SURGICAL CODE WITH DIFFERENT MOD PER DAY 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5084 ASST SURGERY BILATERAL LIMIT MOD 80 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5085 ONE PRIMARY ASSIST SURGERY PER DAY 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5086 ASST SURGERY BILATERAL LIMIT MOD 82 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5087 ASST SURGERY BILATERAL LIMIT MOD 81 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5088 CONFLICT: ASC FACILITY VS. OPD FACILITY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5089 CONFLICT: ASC FACILITY VS. HLHC HOSPITAL 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5090 CONFLICT: ASC FACILITY VS. HLHC FACILITY 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5091 DIFFERENT PROVIDER FROM SAME GROUP NOT ALLOWED 585 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5092 CONFLICT:HOME HEALTH VS. INPATIENT 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5093 CONFLICT:HOME HEALTH VS. LTC 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 5094 MODIFIER 'SG' REQUIRED FOR ALL PROCEDURE CODES 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5096 NCCI CONFLICT WITH ADJUSTED OTH SERV PREV PAID 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5200 PAPE SERVICES SHOULD BE ON SINGLE CLAIM 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5210 ATP SERVICES SHOULD BE ON SINGLE CLAIM 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 5927 NCCI -  ANOTHER SERVICE PREV PAID – SAME CLAIM 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5928 NCCI – ANOTHER SERVICE PREV PAID – OTHER CLAIM 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5929 NCCI – CONFLICT WITH OTHER SERVICE PREV PAID 585 DENIED CHARGE OR NON-COVERED CHARGE - - 5930 MUE UNITS EXCEEDED 585 DENIED CHARGE OR NON-COVERED CHARGE 5935 LABORATORY PANELS DENIED 12 ONE OR MORE ORIGINALLY SUBMITTED PROCEDURE CODES HAVE BEEN COMBINED - - 6000 MANUAL PRICING REQUIRED 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6001 MANUAL PRICING NOT ALLOWED ON ADJUSTMENT 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 6002 INVALID UNIT CODE FOR ANESTHESIA 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 6003 PAID AMOUNT IS LESS THAN MINIMUM THRESHOLD - HDR 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6004 PAID AMOUNT EXCEEDS THRESHOLD - HDR 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6005 COPAY REVIEW AMOUNT WAS REACHED 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6007 PAID AMOUNT LESS THAN MINIMUM THRESHOLD - DTL 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 6008 AMOUNT EXCEEDS MAXIMUM THRESHOLD - DTL 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6018 EXCESSIVE MLOA DAYS TAKEN 498 MAXIMUM LEAVE DAYS EXHAUSTED - - 6019 EXCESSIVE MLOA DAYS TAKEN 498 MAXIMUM LEAVE DAYS EXHAUSTED - - 6021 ATP ELIGIBLE CODE 20 ACCEPTED FOR PROCESSING - - 6022 ATP BUNDLED CLAIM 20 ACCEPTED FOR PROCESSING - - 6020 MLOA DAYS EXCEEDS MAX 263 LENGTH OF TIME FOR SERVICES RENDERED - - 6023 ATP PROCEDURE NOT ON MAX FEE TABLE (PROFESSIONAL) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6024 ATP PROCEDURE NOT ON MAX FEE TABLE (OUTPATIENT) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6025 ATP PROCEDURE NOT ON ATP CODE TABLE (PROFESSIONAL) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6026 ATP PROCEDURE NOT ON ATP CODE TABLE (OUTPATIENT) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6027 NO TPL PRICING METHOD FOUND FOR ATP PRICING FOR PROFESSIONAL CLAIM 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6028 NO TPL PRICING METHOD FOUND FOR ATP PRICING FOR OUTPATIENT CLAIM 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6030 PROVIDER PRICING METHOD NOT FOUND (OUTPATIENT) 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6031 PAPE ELIGIBLE PROCEDURE 20 ACCEPTED FOR PROCESSING - - 6032 SYSTEM GENERATED CLAIM PAYING PAPE PRICE 20 ACCEPTED FOR PROCESSING - - 6040 NMLOA AUDIT 498 MAXIMUM LEAVE DAYS EXHAUSTED - - 6041 NMLOA AUDIT 498 MAXIMUM LEAVE DAYS EXHAUSTED - - 6125 RETURN MONEY VOID / MATCHED CLM ADJUSTED OR VOIDED 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6126 MODIFIER MANUALLY PRICED 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 6140 CLAIM WAS MANUALLY PRICED 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 6760 CLAIM SUSPENDED FOR ATTACHMENT REVIEW 297 MEDICAL NOTES/REPORTS - - 6761 DCN IS INVALID AND ATTACHMENT REQUIRED FOR SERVICE 297 MEDICAL NOTES/REPORTS - - 6762 ATTACHMENT MISSING FOR PODIATRIC SERVICES 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8000 1 CASE CONSULT IN 3 MONTHS = 2 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8001 LIMIT 1 PROC CODE PER MEMBER PER DAY-VARIOUS CODES 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8002 ESRD RELATED SERVICES 1 PER MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8003 PA IS REQUIRED FOR BASIC MEMBERS 585 DENIED CHARGE OR NON-COVERED CHARGE - - 8004 MODIFIER 26 REQUIRED IN HOSPITAL SETTING 585 DENIED CHARGE OR NON-COVERED CHARGE - - 8005 CONTRACEPTIVE INJECTABLE 3MTH. DEPRO-PROVERA 585 DENIED CHARGE OR NON-COVERED CHARGE - - 8006 CONTRACEPTIVE INJECTABLE LUNELLE 1 PER MONTH 585 DENIED CHARGE OR NON-COVERED CHARGE - - 8007 "T1028, 1 ASSESSMENT = 3 COMPONENTS/UNITS PER YEAR " 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8008 "T1024, 3 TEAM MEETINGS = 9 UNITS/COMPONENTS PER YR " 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8009 1 ASSIST AT SURGERY/PER MEMB/PER DAY 585 DENIED CHARGE OR NON-COVERED CHARGE - - 8010 LIMIT 1 ANESTHESIA CODE PER MEMBER PER DAY 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8011 2 MONURAL CODE V5241 DISPENSING FEES IN 5 YEARS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8012 8 VISITS 99402 ALLOWED FOR CHC/FP PER YEAR 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8013 2 REEVALUATIONS (99456-TS) PER YEAR 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8014 PHARMACY CODES - MAX 31 UNITS PER MONTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8015 ORTHOTICS - 1 UNIT IN 1 YEAR FROM DOS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8016 ORTHOTICS 2 UNITS IN 1 YEAR FROM DOS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8017 ORTHOTICS 4 UNITS IN 1 YEAR FROM DOS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8018 ORTHOTICS 3 UNITS IN 6 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8019 ORTHOTICS 6 UNITS IN 1 YEAR 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8020 ORTHOTICS 8 UNITS IN 1 YEAR 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8021 ORTHOTIC 1 UNIT IN 3 YEARS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8022 PROSTHETICS 12 UNITS IN 1 YEAR 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8023 2 STOCKINGS IN 7 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8024 1 LITHIUM ION BATTERY CHARGER IN 2 YEARS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8025 HOME HEALTH PT LIM 20 VIS (120 UNITS) 12 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8026 HOME HEALTH OT LIM 20 VIS (120 UNITS) 12 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8027 HOME HEALTH ST LIM 35 VIS (140 UNITS)12 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8028 DME 1 UNIT IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8029 DME 2 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8030 DME 3 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8031 DME 4 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8032 DME 10 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8033 DME LIMIT 6 UNITS IN 1 MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8034 DME 12 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8035 DME 18 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8036 DME LIMIT 20 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8037 DME LIMIT 30 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8038 DME LIMIT 31 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8039 DME LIMIT 35 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8040 DME LIMIT 40 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8041 DME LIMIT 60 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8042 DME LIMIT 93 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8043 DME LIMIT 100 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8044 DME LIMIT 120 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8045 DME LIMIT 250 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8046 DME LIMIT 720 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8047 DME LIMIT 1000 UNITS IN 1 CALENDAR MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8048 DME LIMIT 1 UNIT IN 3 CALENDAR MONTHS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8049 DME LIMIT 2 UNIT IN 3 CALENDAR MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8050 DME LIMIT 3 UNITS IN 3 MONTHS MOD=KS ONLY 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8051 DME LIMIT 4 UNITS IN 3 CALENDAR MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8052 DME LIMIT 5 UNITS IN 3 MTHS MODIFR KS ONLY 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8053 DME LIMIT 6 UNITS IN 3 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8054 DME LIMIT 15 UNITS IN 3 MTHS MOD KX ONLY 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8055 DME LIMIT 8 UNITS IN 3 MTHS MOD KX ONLY 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8056 DME LIMIT 9 UNITS IN 3 CALENDAR MTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8057 DME LIMIT 10 UNITS IN 6 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8058 DME LIMIT 1 UNIT IN 6 MONTHS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8059 DME LIMIT 2 UNITS IN 6 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8060 DME LIMIT 16 UNITS IN 6 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8061 DME LIMIT 1 UNIT IN 12 MONTHS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8062 DME LIMIT 2 UNITS IN 12 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8063 DME LIMIT 4 UNITS IN 12 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8064 DME LIMIT 8 UNITS IN 12 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8065 DME LIMIT 12 UNITS IN 12 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8066 DME LIMIT 1 UNIT IN 24 MONTHS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8067 DME LIMIT 1 UNIT IN 3 YEARS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8068 DME LIMIT 2 UNITS IN 3 YEARS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8069 DME LIMIT 1 UNIT IN 5 YEARS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8070 LIMIT 27 UNITS PER MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8071 DME LIMIT 36 UNITS PER MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8072 DME LIMIT 12 PER MNTH PER WOUND=108 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8073 DME LIMIT 30 PER MTH PER WOUND=27O UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8074 DME LIMIT 31 PER MTH PER WOUND=279 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8075 DME LIMIT 45 PER MTH PER WOUND=405 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8076 DME LIMIT 60 PER MTH PER WOUND=540 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8077 DME LIMIT 80 PER MTH PER WOUND=720 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8078 DME LIMIT 100 PER MTH PER WOUND=900 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8079 DME LIMIT 160 PER MTH PER WOUND=1440 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8080 DME LIMIT 200 PER MTH PER WOUND=1800 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8081 DME LIMIT 240 PER MTH PER WOUND=2160 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8082 DME LIMIT 100 PER WOUND IN 3 MTHS =900 UNITS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8083 DME LIMIT 11 UNITS PER MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8084 DME LIMIT 150 UNITS PER MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8085 DME LIMIT 124 UNITS PER MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8086 DME LIMIT 15 UNITS PER MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8087 DME LIMIT 90 UNITS PER MONTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8088 SCREENING/INTAKE 8 UNITS T1023 PER MBR PER 12 MTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8089 DAY HABILITATION LIMIT 1 PER DAY EXCEPT MOD-22 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8090 "PA REQUIRED FOR MOBILITY REPAIR OVER $1,000 " 84 SERVICE NOT AUTHORIZED - - 8091 MODIFIER 26 OR TC REQUIRED FOR PROCEDURE CODES IN GROUP 4113 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8092 ORTHOTIC AND PROSTHETIC LIMIT - 4 UNITS PER MEMBER PER YEAR FROM LAST DOS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8093 ORTHOTIC AND PROSTHETIC LIMIT - 6 UNITS PER MEMBER PER YEAR FROM LAST DOS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8094 ORTHOTIC AND PROSTHETIC LIMIT - 8 UNITS PER MEMBER PER YEAR FROM LAST DOS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8095 ORTHOTIC AND PROSTHETIC LIMIT - 12 UNITS PER MEMBER PER YEAR FROM LAST DOS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8096 ORTHOTIC LABOR AND REPAIR CODES REQUIRE PA IF OVER $1000.00 PER MONTH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 8097 PROSTHETIC LABOR AND REPAIR CODES REQUIRE PA IF OVER $1000.00 PER MONTH 252 AUTHORIZATION/CERTIFICATION NUMBER - - 8098 MODIFIER REQUIRED FOR VARIOUS CAPPED RENTAL/PURCHASE CODES. MODIFIERS VALUES KH 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8099 MODIFIER REQUIRED FOR VARIOUS OXYGEN CODES.MODIFIERS VALUES QF QG RR U2. 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8100 TOOTH PREVIOUSLY EXTRACTED 215 DATE OF TOOTH EXTRACTION/EVOLUTION - - 8101 MODIFIER REQUIRED FOR CHRONIC THERAPY SERVICES 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8102 DME SURGICAL CODES REQUIRE ONE OF THE A1 THROUGH A9 MODIFIERS. 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8103 HIT NURSING VISIT CODES 99601 AND 99602 REQUIRE MODIFIER SD. 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8104 DIABETIC SUPPLIES/INFUSION SUPPLIES REQR MODIFIER 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8105 PROFESSIONAL COMPONENT NOT ALLOWED FOR THIS SERVICE. 454 PROCEDURE CODE FOR SERVICES RENDERED - - 8106 ENTERAL PROCEDURE CODES REQUIRE A MODIFIER 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8107 ORTHOTIC AND PROSTHETIC CODES REQUIRE LT/RT MODIFIER 453 PROCEDURE CODE MODIFIER(S) FOR SERV(S) RENDERED - - 8108 PA REQUIRED FOR MONAURAL HEARING AIDS IF COSTS EXCEEDS $550.00 252 AUTHORIZATION/CERTIFICATION NUMBER - - 8109 "PA IS REQUIRED FOR BINAURAL, CROS AND BICROS HEARING AIDS IF COSTS EXCEEDS $1,1" 252 AUTHORIZATION/CERTIFICATION NUMBER - - 8110 ORTHOTIC AND PROSTHETIC LIMIT - 1 UNIT PER MEMBER IN 1 YEAR FROM LAST DOS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8111 ORTHOTIC - PROSTHETIC - LIMIT 2 UNITS PER MEMBER PER YEAR FROM DOS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8112 LIMIT 10 UNITS PER DAY PROC 80100 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8113 LIMIT 13 UNITS PER DAY PROC 80101 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8114 LIMIT 1 UNIT PER DAY - VARIOUS CODES 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8115 TEMP AUDIT 8115 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8116 LIMIT 4 UNITS PER DAY PROC 80102 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8117 TEMP AUDIT 8117 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8118 LIMIT 1 CESAREAN PER DAY (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8119 TEMP AUDIT 8119 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8120 LIMIT 1 LAPAROSCOPIC CHOLECYSTECTOMY PER DAY(SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8121 TEMP AUDIT 8121 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8122 FIRST MONTHS RENTAL OF VARIOUS CAPPED RENTAL CODES LIMIT 1 IN 5 YEARS WITH MODI 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8123 SECOND AND THIRD MONTHS RENTAL OF VARIOUS CAPPED RENTAL CODES LIMIT 2 IN 5 YEAR 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8124 10 MONTHS CAPPED RENTAL ALLOWED IN 5 YEARS FOR VARIOUS CAPPED RENTAL CODES LIMIT 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8125 VARIOUS REPAIR/MOBILITY CODES REQUIRE A MOD. MOD VALUES NU RP RR UB UC UE U1 585 DENIED CHARGE OR NON-COVERED CHARGE - - 8126 "MODIFIER REQUIRED FOR CODES A4450, A4452 AND A5120. MODIFIER VALUES AU AV AW" 585 DENIED CHARGE OR NON-COVERED CHARGE - - 8127 TRANSPORTATION T2003 LIMIT - 2 ONE WAY TRIPS / DAY 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8128 AFC CODE S5140 TF/U5 LIMIT 14 UNITS PER CAL YEAR 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8129 PHARMACY PLACE OF SERVICE 01 NOT ALLOWED 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8130 T4536 T4538 T4539 NOT ALLOWED W DIAPER CODE BILLED 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8131 DME LIMIT 1 UNIT PER MONTH (RENTAL ONLY) 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8132 DME LIMIT 13 UNITS IN 3 YEARS (MOD RR ONLY) 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8133 DME CONFLICT: PURCHASE VS RENTAL IN 3 YEARS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8134 LIMIT 1 IN 3 YEARS ON 1ST MONTH OF CAPPED RENTAL 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8135 2ND & 3RD MONTHS CAPPED RENTAL- LIMIT 2 IN 3 YEARS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8136 LIMIT 10 IN 3 YEARS FOR 10 MONTHS OF CAPPED RENTAL 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8137 DME RENTAL NOT ALLOWED AFTER PURCHASE IN 3 YEARS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8138 DME LIMIT 13 UNITS IN 5 YEARS (MOD RR ONLY) 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8139 DME CONFLICT: PURCHASE VS RENTAL IN 5 YEARS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8140 DME RENTAL NOT ALLOWED AFTER PURCHASE IN 5 YEARS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8141 DME CONFLICT: PURCHASE VS RENTAL IN 1 YEAR 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8142 DME CONFLICT: PURCHASE VS RENTAL IN 24 MONTHS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8143 DME LIMIT 13 UNITS IN 24 MONTHS (MOD RR ONLY) 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8144 NDC CODE - UNITS - AND UNIT DESCRIPTOR REQUIRED 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8145 MAX UNITS 1 PER DAY FOR NON-SCHOOL BASED PROVIDERS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8146 MAX UNITS 3 PER DAY FOR NON-SCHOOL BASED PROVIDERS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8147 MAX UNITS 4 PER DAY FOR NON-SCHOOL BASED PROVIDERS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8148 MAX UNITS 6 PER DAY FOR NON-SCHOOL BASED PROVIDERS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8149 MAX UNITS 7 PER DAY FOR NON-SCHOOL BASED PROVIDERS 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 8150 NEW AND DELETED CODES CANNOT BE BILLED ON THE SAME DAY 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 8156 MODIFIER REQUIRED FOR CODE 96110-NOT PRESENT 453 PROCEDURE CODE MOIDIFIER(S) FOR SERVICE(S) RENDERED - - 8185 MASS ADJUSTMENT - RETROACTIVE RATE CHANGE. 631 REIMBURSEMENT RATE - - 8242 ATP/PAPE ADJUSTMENT/VOID EOB 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8250 INVALID COMBINATION OF PROCEDURES 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8251 SPEECH THERAPY LIMIT 35 VISITS IN 12 MONTHS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8252 INVALID COMBINATION OF PROCEDURES 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8253 VISIT & SURGERY NOT ALLOWED SAME DAY/SAME POS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8254 MULTIPLE VISITS NOT ALLOWED SAME DAY 612 PER DAY LIMIT AMOUNT - - 8255 CHIROPRACTOR MANIPULATION / VISIT = 1 PER DAY 612 PER DAY LIMIT AMOUNT - - 8256 CHIROPRACTOR MANIPULATION / VISIT 20 PER YEAR 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8257 CONFLICT ACUPUNCTURE WITH METHADONE ADMINIST 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8258 MONTHLY ESRD CONFLICTS WITH DAILY ESRD 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8259 MONTHLY ESRD 1 PER MONTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8260 1 LEVEL OF MUNICIPAL MEDICAID STUDENT/DAY 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8261 10 HOURS PDN PER DAY FOR 22 SCHOOL DAYS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8262 MUNI MEDICAID PROCS CONFLICT WITH THERAPY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8263 LAB UNRINALYSIS CONFLICT W/ EACH OTHER ON SAME DAY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8264 OTHER LAB TESTS CONF W/GENERAL HEALTH LAB TESTS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8265 OTHER LAB TESTS CONFLICT W/ OBSTETRIC PANEL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8266 LIPID PANEL CONFLICTS WITH OTHER LAB TESTS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8267 LAB HEMATOLOGY CONFLICT W/EACH OTHER ON SAME DOS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8268 PHYSICAL THERAPY CODES LIMIT 1 HR (4 UNITS) PER DY 612 PER DAY LIMIT AMOUNT - - 8269 OCCUPATIONAL THERAPY LIMIT 1 HR (4 UNITS) PER DAY 612 PER DAY LIMIT AMOUNT - - 8270 SPEECH THERAPY CODES LIMIT 1 HR (4 UNITS) PER DAY 612 PER DAY LIMIT AMOUNT - - 8271 ANTEPARTUM CARE LIMIT 1 OF EITHER CODE PER YEAR 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8272 AMBULANCE ALS CONFLICTS WITH BLS SAME DAY 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8273 2 PAIRS SHOES DURING 12 MONTH PERIOD 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8274 2 MONAURAL HEARING AIDS IN 5 YEARS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8275 1 BINAURAL HEARING AID IN 5 YEARS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8276 1 DISPENSING FEE IN 5 YRS (BILATERAL) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8277 EVAL & MANGMNT CONFLICTS W/TREATMENT PROC SAME DAY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8278 DELIVERY CONFLICTS WITH FETAL STRESS TEST 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 8279 1 NEW PATIENT VISIT WITHIN 3 YEARS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8280 CONSULTATION CONFLICTS W/ REFRACTION 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8281 DIAPERS LIMIT 248 PER MEMB/PER CAL MONTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8282 4 STOCKINGS IN 6 MONTHS PER MEMBER 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8283 OUTPATIENT HOSP SPEECH THERAPY LIMIT 35 VIS 12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8284 OUTPATIENT HOSP PHYSICAL THERAPY LIM 20 VIS/12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8285 OUTPATIENT HOSP OCCUPTNL THERAPY LIM 20 VIS/12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8286 PHYSICIAN PHYSICAL THERAPY LIMIT 20 VISITS/12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8287 PHYSICIAN OCCUPATIONAL THERAPY LIMIT 20 VIS/12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8288 PHYSICIAN SPEECH THERAPY LIMIT 35 VISITS/12 MTHS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8289 SPEECH AND HEARING CENTER SPEECH THERAPY LIMIT 35 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8290 CHRONIC HOSP SPEECH THERAPY LIM 35 VIS OF 1 UNIT 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8291 CHRONIC HOSP SPEECH THERAPY LIM 35 VIS IN 12 MTHS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8292 CHRONIC HOSP OCCUPATIONAL THERAPY 20 VISITS/12MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8293 CHRONIC HOSP PHYSICAL THERAPY LIM 20 VISITS/12MTHS 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8294 REHAB CENTER PHYSICAL THERAPY LIMIT 20 VIS 12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8295 REHAB CENTER OCCUPTNL THERAPY LIMIT 20 VIS 12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8296 REHAB CENTER SPEECH THERAPY LIMIT 35 VISITS 12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8297 PSYCH INPATIENT LIMIT 30 CONSECTV DAYS PER EPISODE 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8298 PSYCH INPATIENT LIMIT 60 DAYS PER CALENDAR YEAR 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8299 OPERATING ROOM CONFLICTS W/AMBULATORY SURGERY 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8300 INDEPENDENT PHYSICAL THERAPY LIMIT 20 VIS 12 MONTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8301 INDEPENDENT OCCUPATIONAL THERAPY LIM 20 VIS 12 MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8302 ADULT & GROUP FOSTER CARE - LIMIT 31 UNITS PER MTH 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8303 "PA REQUIRED FOR EQUIPMENT REPAIR OVER $1,000 " 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8400 NMLOA ALL LOC MAX 15 CUMULATIVE DAYS IN 1 DOS YEAR 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8401 NMLOA ALL LOC MAX 10 CUMULATIVE DAYS IN 1 DOS YEAR 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8500 2 CLAVICULECTOMIES IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8501 2 CLAVICULECTOMIES IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8502 2 CLAVICULECTOMIES IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8503 2 CLAVICULECTOMIES IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8504 2 AMPUTATIONS-WRIST IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8505 2 AMPUTATIONS-WRIST IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8506 2 AMPUTATIONS-WRIST IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8507 10 AMPUTATIONS-METACARPAL IN LIFE (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8508 10 AMPUTATIONS-METACARPAL IN LIFE (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8509 10 AMPUTATIONS-METACARPAL IN LIFE (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8510 10 AMPUTATIONS-METACARPAL IN LIFE (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8511 2 AMPUTATIONS-ANKLE IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8512 2 AMPUTATIONS-ANKLE IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8513 2 AMPUTATIONS-ANKLE IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8514 2 AMPUTATION-FOOT (MID) IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8515 2 AMPUTATION-FOOT (MID) IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8516 2 AMPUTATION-FOOT (MID) IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8517 2 AMPUTATION-FOOT (TRN) IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8518 2 AMPUTATION-FOOT (TRN) IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8519 2 AMPUTATION-FOOT (TRN) IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8520 1 EPIGLOTTIDECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8521 1 EPIGLOTTIDECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8522 1 EPIGLOTTIDECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8523 1 EPIGLOTTIDECTOMY IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8524 1 COLPECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8525 1 COLPECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8526 1 COLPECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8527 1 TRACHELECTOMY (CERVIECTOMY) IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8528 1 TRACHELECTOMY (CERVIECTOMY) IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8529 1 TRACHELECTOMY (CERVIECTOMY) IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8530 1 TRACHELECTOMY (CERVIECTOMY) IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8531 1 THYROIDECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8532 1 THYROIDECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8533 1 THYROIDECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8534 1 EVALUATION (99456) PER PROVIDER IN LIFETIME 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8535 2 MASTECTOMIES IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8536 2 MASTECTOMIES IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8537 2 MASTECTOMIES IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8538 2 MASTECTOMIES IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8539 1 MASTECTOMY IN LIFETIME-MOD 50 (INACTIVE) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8540 1 MASTECTOMY IN LIFETIME-MOD 50 (INACTIVE) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8541 10 AMPUTATIONS-FINGER IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8542 10 AMPUTATIONS-FINGER IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8543 10 AMPUTATIONS-FINGER IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8544 2 AMPUTATIONS-ARM IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8545 2 AMPUTATIONS-ARM IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8546 2 AMPUTATIONS-ARM IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8547 2 AMPUTATIONS FOREARM-THRU RADIUS & ULNA (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8548 2 AMPUTATIONS FOREARM-THRU RADIUS & ULNA (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8549 2 AMPUTATIONS FOREARM-THRU RADIUS & ULNA (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8550 2 AMPUTATIONS-LEG IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8551 2 AMPUTATIONS-LEG IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8552 2 AMPUTATIONS-LEG IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8553 2 AMPUTATIONS LEG- TIBIA & FIBULA- LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8554 2 AMPUTATIONS LEG- TIBIA & FIBULA- LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8555 2 AMPUTATIONS LEG- TIBIA & FIBULA- LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8556 1 LARYNGECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8557 1 LARYNGECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8558 1 LARYNGECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8559 1 HEMILARYNGECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8560 1 HEMILARYNGECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8561 1 HEMILARYNGECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8562 1 TOTAL PNEUMONECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8563 1 TOTAL PNEUMONECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8564 1 TOTAL PNEUMONECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8565 1 GLOSSECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8566 1 GLOSSECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8567 1 GLOSSECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8568 1 APPENDECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8569 1 APPENDECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8570 1 APPENDECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8571 1 TOTAL GASTRECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8572 1 TOTAL GASTRECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8573 1 TOTAL GASTRECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8574 1 AMPUTATION-PENIS IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8575 1 AMPUTATION-PENIS IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8576 1 AMPUTATION-PENIS IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8577 1 CIRCUMCISION IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8578 1 CIRCUMCISION IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8579 1 CIRCUMCISION IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8580 1 CIRCUMCISION IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8581 2 ORCHIECTOMIES-UNILAT IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8582 2 ORCHIECTOMIES-UNILAT IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8583 2 ORCHIECTOMIES-UNILAT IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8584 2 ORCHIECTOMIES-UNILAT IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8585 1 ORCHIECTOMY- BILATERAL IN LIFETIME (INACTIVE) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8586 1 ORCHIECTOMY- BILATERAL IN LIFETIME (INACTIVE) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8587 1 PROSTATECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8588 1 PROSTATECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8589 1 PROSTATECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8590 1 VULVECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8591 1 VULVECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8592 1 VULVECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8593 1 VULVECTOMY IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8594 1 EXCISION OF CERVICAL STUMP IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8595 1 EXCISION OF CERVICAL STUMP IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8596 1 EXCISION OF CERVICAL STUMP IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8597 1 TRACHELECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8598 1 TRACHELECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8599 1 TRACHELECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8600 1 TRACHELECTOMY IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8601 1 HYSTERECTOMY IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8602 1 HYSTERECTOMY IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8603 1 HYSTERECTOMY IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8604 2 ADRENALECTOMIES IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8605 2 ADRENALECTOMIES IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8606 2 ADRENALECTOMIES IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8607 1 ADRENALECTOMY IN LIFETIME (INACTIVE) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8608 2 COMPLETE IRIDECTOMIES IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8609 2 COMPLETE IRIDECTOMIES IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8610 2 COMPLETE IRIDECTOMIES IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8611 2 COMPLETE IRIDECTOMIES IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8612 1 PALATOPLASTY FOR CLEFT PALATE IN LIFETIME (SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8613 1 PALATOPLASTY FOR CLEFT PALATE IN LIFETIME (ASSIST SURG) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8614 1 PALATOPLASTY FOR CLEFT PALATE IN LIFETIME (OPD FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 8615 1 PALATOPLASTY FOR CLEFT PALATE IN LIFETIME (ASC FACILITY) 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 9000 PHARMACY ALLOWED AMOUNT IS LESS THAN BILLED AMOUNT 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 9001 REIMBURSEMENT REDUCED BY THE RECIPIENT'S CO-PAYMENT AMOUNT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9002 PRICING METHOD MISSING/INVALID FOR CLAIM TYPE 585 DENIED CHARGE OR NON-COVERED CHARGE - - 9005 CLAIM PAYMENT AMOUNT LESS THAN COPAY AMOUNT 66 PAYMENT REFLECTS USUAL AND CUSTOMARY CHARGES - - 9010 MEMBER HAS MET COPAY CAP 639 RESPONSIBILITY AMOUNT QC PATIENT 9011 CO-PAYMENT INCLUSION CRITERIA NOT MET 639 RESPONSIBILITY AMOUNT - - 9013 MEMBER CALENDAR COINSURANCE LIMIT EXCEEDED 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 9015 AT LEAST ONE DETAIL IS IN DENIED STATUS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9016 CLAIM DENIED BECAUSE ALL DETAILS DENIED 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9020 CRITICAL EDIT IS RECYCLED TO A PAY EDIT 0 CANNOT PROVIDE FURTHER STATUS ELECTRONICALLY - - 9050 COLLECTION FROM TITLE 18(MEDICARE PART-A) FOR SERVICES PREVIOUSLY PAID BY MCARE 550 COORDINATION OF BENEFITS CODE - - 9051 COLLECTION FROM TITLE 18(MEDICARE PART-B) FOR SERVICES PREVIOUSLY PAID BY MCARE 550 COORDINATION OF BENEFITS CODE - - 9052 COLLECTION FROM ANY HEALTH INSURANCES 550 COORDINATION OF BENEFITS CODE - - 9053 "COLLECTION FROM CASUALTY INSURANCE, WORKMANS COMP, OR TORT LIABILITY CLAIMS " 550 COORDINATION OF BENEFITS CODE - - 9054 COLLECTION FROM ESTATE OF DECEASED MEMBER 550 COORDINATION OF BENEFITS CODE - - 9055 MANUAL ADJUSTMENT 101 CLAIM PROCESSED AS ADJUSTMENT TO PREVIOUS CLM - - 9056 GENERAL MASS ADJUSTMENT 101 CLAIM PROCESSED AS ADJUSTMENT TO PREVIOUS CLM - - 9057 PAID TO WRONG PROVIDER 153 ENTITY'S ID NUMBER 1P PROVIDER 9058 PAID FOR WRONG MEMBER 153 ENTITY'S ID NUMBER QC PATIENT 9059 PROVIDER BILLED SERVICE PRIOR TO SERVICE DATE/SERVICE NOT DELIVERED 187 DATE(S) OF SERVICE - - 9060 DUPLICATE PAYMENT RETURNED DUE TO AN ERRONEOUS DUPLICATE PAYMENT FOR SAME DATE 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 9061 DUPLICATE PAYMENT - PROVIDER BILLED TWICE 54 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM/LINE - - 9062 COLLECTION FROM CREDIT BALANCE ON MEMBERS ACCOUNTS 631 REIMBURSEMENT RATE - - 9063 PROVIDER PAID MORE THAN BILLED 631 REIMBURSEMENT RATE - - 9064 PROVIDER ONLY PERFORMED COMPONENT OF SERVICE BILLED 631 REIMBURSEMENT RATE - - 9065 OTHER 55 CLAIM ASSIGNED TO AN APPROVER/ANALYST - - 9066 PATIENT PAID AMOUNT DISCREPANCY 639 RESPONSIBILITY AMOUNT - - 9067 COLLECTION FROM TITLE 18 WHEN PART A OR B CANNOT BE DETERMINED 550 COORDINATION OF BENEFITS CODE - - 9068 LEAVE OF ABSENCE DAYS WERE EITHER NOT INDICATED OR INCORRECT 258 DAYS/UNITS FOR PROCEDURE/REVENUE CODE - - 9069 OUTPATIENT CLAIM WAS BILLED DURING AN INPATIENT STAY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9070 OUTPATIENT CLAIM WAS BILLED DURING AN INPATIENT STAY - SAME FACILITY 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9071 LONG TERM CARE CLAIM WAS BILLED DURING A HOSPICE SEGMENT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9072 CLAIM WAS PAID AN INCORRECT PRICE 183 AMOUNT ENTITY HAS PAID - - 9073 MEDICAL RECORD WAS NOT SUBMITTED FOR POST-PAYMENT REVIEW 294 SUPPORTING DOCUMENTATION - - 9074 MEDICAL NECESSITY WAS NOT DETERMINED BY POST-PAYMENT REVIEW 287 MEDICAL NECESSITY FOR SERVICE - - 9075 CLAIM WAS VOIDED AFTER MEDICAL REVIEW 46 INTERNAL REVIEW/AUDIT - - 9076 ADJUSTMENT DUE TO RETROACTIVE MANAGED CARE ENROLLMENT 101 CLAIM PROCESSED AS ADJUSTMENT TO PREVIOUS CLM - - 9077 CLAIM REJECTED BY MASSHEALTH 104 PROCESSED ACCORDING TO PLAN PROVISIONS 9084 MANUAL ADJUSTMENT BY BATCH 101 CLAIM PROCESSED AS ADJUSTMENT TO PREVIOUS CLM - - 9100 90 DAY WAIVER DENIED. THE MASSHEALTH REMITTANCE ADVICE REFERENCED IN YOUR LETTER IS MISSING 46 INTERNAL REVIEW/AUDIT - - 9103 90 DAY WAIVER DENIED. THE MASSHEALTH REMITTANCE ADVICE PROVIDED DOES NOT PERTAIN TO THE CLAIMS SUBMITTED 46 INTERNAL REVIEW/AUDIT - - 9106 90 DAY WAIVER DENIED. THE MASSHEALTH REMITTANCE ADVICE PROVIDED BELONGS TO A CLAIM THAT IS IN SUSPENSE 46 INTERNAL REVIEW/AUDIT - - 9109 90 DAY WAIVER DENIED. THE MASSHEALTH REMITTANCE ADVICE PROVIDED BELONGS TO A CLAIM THAT HAS ALREADY PAID 46 INTERNAL REVIEW/AUDIT - - 9112 90 DAY WAIVER DENIED. THE EXPLANATION OF BENEFITS (EOB) FROM THE OTHER INSURER IS MISSING 46 INTERNAL REVIEW/AUDIT - - 9115 90 DAY WAIVER DENIED. A COPY OF THE RETROACTIVE ENROLLMENT NOTICE IS MISSING 46 INTERNAL REVIEW/AUDIT - - 9118 90 DAY WAIVER DENIED. DOCUMENTATION PROVIDED DOES NOT MATCH THE NAME(S) AND/OR DATES OF SERVICE(S) ON THE CLAIMS 46 INTERNAL REVIEW/AUDIT - - 9121 90 DAY WAIVER DENIED. A COPY OF THE REGISTRATION/ ADMISSION FORM THAT REFLECTS MASSHEALTH INFORMATION WAS NOT PROVIDED ON THE SERVICE DATE IS MISSING OR INCOMPLETE 46 INTERNAL REVIEW/AUDIT - - 9124 90 DAY WAIVER DENIED. A COPY OF A STATEMENT/BILL SENT TO THE MEMBER IS MISSING 46 INTERNAL REVIEW/AUDIT - - 9127 90 DAY WAIVER DENIED. A COPY OF THE RETROACTIVE PRIOR AUTHORIZATION NOTICE IS MISSING 46 INTERNAL REVIEW/AUDIT - - 9130 90 DAY WAIVER DENIED. A COPY OF THE RETROACTIVE PRE-ADMISSION SCREENING NOTICEIS MISSING 46 INTERNAL REVIEW/AUDIT - - 9133 90 DAY WAIVER DENIED. A COPY OF THE NOTIFICATION OF BIRTH (NOB) OR ENROLLMENT NOTICE IS MISSING 46 INTERNAL REVIEW/AUDIT - - 9136 90 DAY WAIVER DENIED. A COPY OF THE PIP EXHAUSTION NOTICE IS MISSING 46 INTERNAL REVIEW/AUDIT - - 9139 90 DAY WAIVER DENIED. THE SERVICE DATE EXCEEDS ONE YEAR 46 INTERNAL REVIEW/AUDIT - - 9142 90 DAY WAIVER DENIED. THE SERVICE DATE EXCEEDS 18 MONTHS 46 INTERNAL REVIEW/AUDIT - - 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 46 INTERNAL REVIEW/AUDIT - - 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 46 INTERNAL REVIEW/AUDIT - - 9151 90 DAY WAIVER DENIED. A COPY OF THE ELIGIBILITY VERIFICATION PRINTOUT REFERENCED IN YOUR LETTER IS MISSING 46 INTERNAL REVIEW/AUDIT - - 9154 90 DAY WAIVER DENIED. REQUEST DOES NOT COMPLY WITH MASSHEALTH REGULATIONS 46 INTERNAL REVIEW/AUDIT - - 9157 90 DAY WAIVER DENIED. THE MEMBER'S ID WAS NOT CHANGED 46 INTERNAL REVIEW/AUDIT - - 9160 90 DAY WAIVER DENIED. THE ORIGINAL EDI CLAIM(S) WERE NOT RECEIVED TIMELY 46 INTERNAL REVIEW/AUDIT - - 9163 90 DAY WAIVER DENIED. THE ORIGINAL EDI CLAIM(S) WERE RECEIVED TIMELY AND CAN BE RESUBMITTED 46 INTERNAL REVIEW/AUDIT - - 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 46 INTERNAL REVIEW/AUDIT - - 9700 CLAIM WAS DENIED DUE TO A POS REVERSAL 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9701 MEMBER LINKING CLAIM ADJUSTMENT 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9702 PROVIDER RECOUPED CLAIM 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9800 MAXIMUM PAYMENT ALLOWED FOR HMO/COV 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 9875 NON-MEDICAL LEAVE DAYS LIMIT EXCEEDED 483 MAXIMUM COVERAGE AMOUNT MET OR EXCEEDED FOR BENEFIT PERIOD - - 9901 REIMBURSEMENT LIMITED TO ONE SET OF FRAMES PER YEAR FOR RECIPIENTS 18 YEARS 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 9905 PRICE REDUCED TO SPAD PAYMENT 66 PAYMENT REFLECTS USUAL AND CUSTOMARY CHARGES - - 9907 TPL AMOUNT APPLIED 20 ACCEPTED FOR PROCESSING - - 9908 PHARMACY PRICING APPLIED 104 PROCESSED ACCORDING TO PLAN PROVISIONS - - 9909 50 PERCENT OF AMOUNT BILLED APPLIED 20 ACCEPTED FOR PROCESSING - - 9910 PHARMACY DISPENSING FEE APPLIED 20 ACCEPTED FOR PROCESSING - - 9911 PRICING ADJUSTMENT - LONG TERM CARE PRICING APPLIED 0 CANNOT PROVIDE FURTHER STATUS ELECTRONICALLY - - 9916 UCC RATE PRICING APPLIED 20 ACCEPTED FOR PROCESSING - - 9918 PRICING ADJUSTMENT - MAX FEE PRICING APPLIED 20 ACCEPTED FOR PROCESSING - - 9919 PROVIDER LEVEL OF CARE PRICING APPLIED 20 ACCEPTED FOR PROCESSING - - 9920 RBRVS (RESOURCE-BASED RELATIVE VALUE SCALE) PRICING APPLIED 20 ACCEPTED FOR PROCESSING - - 9921 PA (PRIOR AUTHORIZATION) PRICING APPLIED 20 ACCEPTED FOR PROCESSING - - 9922 SPENDDOWN DEDUCTIBLE APPLIED 20 ACCEPTED FOR PROCESSING - - 9926 CLAIM HAS CUTBACK AMOUNT 20 ACCEPTED FOR PROCESSING - - 9928 COB-TPL COST SAVINGS 1 "FOR MORE DETAILED INFORMATION, SEE REMITTANCE ADVICE" - - 9932 PRICING ADJUSTMENT - DRG PRICING APPLIED 107 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS - - 9933 AMOUNT CUTBACK DUE TO APC PRICING 66 PAYMENT REFLECTS USUAL AND CUSTOMARY CHARGES - - 9997 PERSONAL RESOURCES DEDUCTED FROM THE CLAIM ARE A RESULT OF PREVIOUS RESOURCES COLLECTED FOR THE RECIPIENT IN THE SAME MONTH 639 RESPONSIBILITY AMOUNT - - 9998 CLAIM WAS PRICED IN ACCORDANCE WITH CURRENT HEALTH COVERAGE PROGRAM POLICIES 66 PAYMENT REFLECTS USUAL AND CUSTOMARY CHARGES - -