About Martin’s Point Health Care Electronic Remittance Advices (ERAs/835s)
Electronic remittance advices (ERAs/835s) save time and money, allow for faster payment postings and provide more detailed information regarding claim adjudications and adjustments. Once you sign up for Martin’s Point ERAs through your claims clearing house, we will phase out your paper copies over a four week period. You’ll know that your four week transition has begun when you see the following message on your paper remittance advice: Paper remittance advices will end in four weeks. After that, you will see similar messages each week until your final paper remittance advice indicates: Final paper remittance advice.
From that point forward, your Martin’s Point Generations Advantage and/or US Family Health Plan remittance advices will be sent electronically only, through your claims clearing house. Electronic claims submission and remittance will soon be required for all payers and providers. Thank you for taking the lead on this front. The following resources are available if you have questions about one of our ERAs:
• Provider Portal: Use this tool to review detailed claim adjudication and adjustment information. Paper remittance advices are limited toone claim adjustment reason code (CARC) but the portal will show additional CARCs, if applicable. To use this tool, visitwww.providerview.martinspoint.org or call 1‐888‐732‐7364 to create a username and password. Then access the tool atwww.martinspoint.org/For‐Providers/Claims.
• Provider Inquiry: If you still have questions after consulting the provider portal, please call our Provider Inquiry Team at 1‐888‐732‐7364.
• Electronic Remittance Advice (ERA/835) Provider Guide: Below is a searchable list of industry‐standard claim adjustment reason codes(CARCs) and the corresponding Martin’s Point claims editing rules and remarks.
Electronic Remittance Advice (ERA/835) Provider Guide Version: December 12, 2016
This document maps industry‐standard claim and remittance advice codes to the corresponding claims editing descriptions that appear on Martin’s Point 835 files. To search for a specific code, press your “CTRL” and “F” keys at the same time and type the code it into the “Find” box.
Definitions: • Claim Adjustment Reason Code (CARC): CARCs communicate an adjustment―the reason why a claim or service line was paid differently
than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code. Not all CARCS have a corresponding RARC. In these situations, the CARC supplies sufficient information about the claim adjustment we have made.
• Remit Advice Reason Code (RARC): RARCs provide additional explanation for an adjustment already described by a CARC and may conveyinformation about remittance processing. There are two types of RARCs, supplemental and informational. The majority of the RARCs aresupplemental; these are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation foran adjustment already described by a CARC. The second type of RARC is informational; these RARCs are all prefaced with Alert: and areoften referred to as Alerts. Alerts are used to convey information about remittance processing and are never related to a specificadjustment or CARC.
• Martin’s Point Rule Description: This column provides further information that corresponds to specific CARCS and pertains to our paymentpolicies and rules. Our claims editing processes are closely aligned with correct coding and billing criteria established by the Centers forMedicare and Medicaid Services (CMS). There are some exceptions, usually based on our health plan benefit design. For example, ourmembers have access to important preventive services such as annual physicals and eye exams at $0 copay. But overall, we adhere closelyto Medicare claim editing practices. We also apply Medicare Local Coverage Determination (LCD) rules to claims for services rendered toGenerations Advantage members in Maine and New Hampshire. (LCD rules do not apply to USFHP claims.) LCD rules can be found on thelocal carrier’s website or by contacting them directly. Following are the local carriers for Maine and New Hampshire:
o Medicare Parts A & B: National Government Services, Inc. www.ngsmedicare.com/ngs/portal/ngsmedicare/welcomeo Durable Medical Equipment (DME): NHIC, Corp. www.medicarenhic.com/dme/mrlcdcurrent.aspx
If you receive a claim denial and, upon research and review of the documentation, you feel a corrected claim is in order, you may submit a corrected claim with the appropriate additional information. Before doing so, please review our electronic corrected claim guidelines at www.martinspoint.org/for‐providers/claims. Electronic submission will speed processing time. Please be sure to include the claim number and the patient control number from the original claim to help ensure efficient reprocessing. For more information about Medicare coding and billing criteria, please visit www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd.
Questions? Please visit www.martinspoint.org/for‐providers/claims or call 1‐888‐732‐7364.
CARC CARC Description Martin's Point Rule Description RARC RARC Description 1 Deductible Amount 915 ‐ REMIT deductibles 10 The diagnosis is inconsistent with the patient's gender.
Changed as of 2/00 915 ‐ Sex conflict; patient's sex and diagnosis are inconsistent
10 The diagnosis is inconsistent with the patient's gender. Changed as of 2/00
915 ‐ Sex conflict; patient's sex and diagnosis are inconsistent
10 The diagnosis is inconsistent with the patient's gender. Changed as of 2/00
6018 ‐ Sex conflict; patient's sex and diagnosis are inconsistent
10 The diagnosis is inconsistent with the patient's gender. Changed as of 2/00
6039 ‐ Sex conflict; patient's sex and diagnosis are inconsistent
10 The diagnosis is inconsistent with the patient's gender. Changed as of 2/00
9140 ‐ (DASC2) Patient gender inconsistent with diagnosis
MA39 Missing/incomplete/invalid gender.
100 Payment made to patient/insured/responsible party. 915 ‐ Member received payment from Third Party Insurance, seek reimbursement from member.
107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Changed as of 6/03
9240 ‐ (mAP) Medicare Deny Add‐On Procedure
N122 Add‐on code cannot be billed by itself.
107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Changed as of 6/03
9247 ‐ Add‐on procedure without primary procedure
N122 Add‐on code cannot be billed by itself.
107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Changed as of 6/03
6210 ‐ FQHC claim lacks required qualifying visit code
N324 Missing/incomplete/invalid last seen/visit date.
107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Changed as of 6/03
918 ‐ Connect requires claim review
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
915 ‐ No COB entered with a secondary enrollment
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
915 ‐ TPA has changed, Bill to Patient Advocates LLC, PO Box 1959, Gray, ME 04039
N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
915 ‐ Pays Under Pharmacy Benefit
N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
11 The diagnosis is inconsistent with the procedure. 816 ‐ Claim Check: Diag to Procedure Audit
11 The diagnosis is inconsistent with the procedure. 9232 ‐ (LBI/LCI) Missing or Invalid LCD Diagnosis
N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
11 The diagnosis is inconsistent with the procedure. 815 ‐ Claim Check: Intensity of Service Audit
M25 The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
11 The diagnosis is inconsistent with the procedure. 330 ‐ Invalid diagnosis code for benefit
M64 Missing/incomplete/invalid other diagnosis.
11 The diagnosis is inconsistent with the procedure. 9232 ‐ (LBI/LCI) Missing or Invalid LCD Diagnosis
M64 Missing/incomplete/invalid other diagnosis.
110 Billing date predates service date. 9007 ‐ iCES Future Date of Service Error
110 Billing date predates service date. 824 ‐ Claim Check: Future Date of Service Error
110 Billing date predates service date. 915 ‐ Cannot bill for future date of service
111 Not covered unless the provider accepts assignment. 915 ‐ We received a claim for health care services to a GA/USFHP member during a time our records indicate you opted out of participation in
Medicare/Tricare. Federal law prohibits us from paying your claim and you may not bill our member for payment.
114 Procedure/product not approved by the Food and Drug Administration.
6191 ‐ CLIENT CUSTOM EDIT
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
9243 ‐ Maximum frequency exceeded
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
9222 ‐ (BFR/LCFR) LCD Frequency Exceeded
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
9520 ‐ (mDFh) Maximum Frequency in History
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
116 ‐ Annual Benefit Amount Exceeded
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
200 ‐ Benefit Day Limit Exceeded
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
206 ‐ Benefit Visit Limit Exceeded
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
207 ‐ Benefit Dollar Limit Exceeded
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
915 ‐ Only one family planning visit allowed per date of service.
M86 Service denied because payment already made for same/similar procedure within set time frame.
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
915 ‐ Limited service exceeded. M86 Service denied because payment already made for same/similar procedure within set time frame.
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
915 ‐ Services exceed Psych benefit.
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
915 ‐ Benefit Visit Limit Exceeded
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
915 ‐ Benefit Dollar Limit Exceeded
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
915 ‐ If prenatal care and OB procedure is on paid history within 270 days, same provider, related or unrelated diag, claim is rejected.
M86 Service denied because payment already made for same/similar procedure within set time frame.
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
915 ‐ If postnatal and an OB proc. are on same claim or paid history, and postnatal care is within 45 days of post ob proc., same prov, related or unrelated diag, claim is denied.
M86 Service denied because payment already made for same/similar procedure within set time frame.
119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04
915 ‐ A payment cannot be made for more than three physical therapy procedures.
M86 Service denied because payment already made for same/similar procedure within set time frame.
129 Payment denied ‐ Prior processing information appears incorrect. Changed as of 2/01
132 ‐ Sum of Individual Coinsured Charges Exceeds Maximum
M58 Missing/incomplete/invalid claim information. Resubmit claim after corrections.
13 The date of death precedes the date of service. 915 ‐ Services billed after date of death.
13 The date of death precedes the date of service. 915 ‐ SERVICE RESPONSIBILITY OF LAB CORP ONLY
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
131 Claim specific negotiated discount. New as of 2/97 915 ‐ Negotiated Rate Payment
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ NMD Exceptions
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ If major surgery is performed same day as major/minor surgery, same POS, already paid on history and prov are same or different. Claim is pended
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ If assistant surgery is performed on the same day as another asst surgery, on the same claim or paid history, same POS and the prov are different. Pend claim.
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ If anesthesia is performed on the same day, same POS as anesthesia no the same claim and the prov are the same or different, pay 100% of time and base unit allowance for greater procedure and 100% of time for each lesser procedure. Pend claim.
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Preexisting Condition May Exist
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Claim requires manual processing
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Manually Pended Claim
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Provider has Alert/Memos
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Provider Watch flag has been set for review
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Benefit Requires Manual Review
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Contract Term Requires Manual Review
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Provider on Pay Hold
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ HSS Service Invocation failed
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Failed during preparation of HSS Service Request message.
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Failed while handling HSS Service Response.
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Failed during insertion of Claim Edit based on HSS Service Response.
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Failed duing update of claim line manual contract amount.
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ New Member Letter
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Requires manual processing.
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ REMIT retro termed Pre‐X
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Authorization Line Manually Pended
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Authorization Status Manually Set
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ REMIT Qualifying claim not finalized – reversed determining claim
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ REMIT finalized qualifying claim – reversed determining claim
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Code requires manual pricing
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ No available APC/fee schedule rate
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Invalid payment status from Grouper
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Missing or invalid fee schedule type
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ HSS Service Call Failure
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error accessing PAYER file
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error accessing rate calculator file
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Missing rate calculator record
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error accessing Grouper program
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error accessing Pricer program
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ 00027 Only incidental services reported (claim rejection)
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error accessing rate or weight file
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error opening Grouper or Pricer in batch mode
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error opening ACE report file
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error loading Editor program
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Benefit Restriction Message
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Plan Restriction Message
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Initialization error
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ error allocating memory
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Parameter passing error
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Unable to load Optimizer
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Initialization error
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error opening DRG table
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error reading CC exclusion table
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error closing CC exclusion table
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Error opening CC exclusion table
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ I/O error on table
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ HAC editor not found
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Service submitted for FI/MAC review (condition code 20)
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Questionable covered service
133 The disposition of this claim/service is pending further review. Changed as of 10/99
915 ‐ Member has an active restriction on enrollment
133 The disposition of this claim/service is pending further review. Changed as of 10/99
210 ‐ Member NOT enrolled on DOS
N30 Patient ineligible for this service.
133 The disposition of this claim/service is pending further review. Changed as of 10/99
340 ‐ HHPPS Multiple HIPPS codes detected on episode claim
133 The disposition of this claim/service is pending further review. Changed as of 10/99
613 ‐ Claim Requires Manual Processing
133 The disposition of this claim/service is pending further review. Changed as of 10/99
9174 ‐ (011SFR) Claim submitted for review (Cond Code 20)
133 The disposition of this claim/service is pending further review. Changed as of 10/99
111 ‐ Provider Watch
133 The disposition of this claim/service is pending further review. Changed as of 10/99
105 ‐ Provider on Pay hold
135 Claim denied. Interim bills cannot be processed. New as of 10/98
915 ‐ Cannot Accept Interim Billing
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
135 Claim denied. Interim bills cannot be processed. New as of 10/98
915 ‐ Intermim Claim with no Initial Claim
140 Patient/Insured health identification number and name do not match. New as of 6/99
915 ‐ Incorrect Plan ID code. MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
140 Patient/Insured health identification number and name do not match. New as of 6/99
915 ‐ Incorrect AHCCCS ID code. MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
141 Claim adjustment because the claim spans eligible and ineligible periods of coverage. Changed as of 6/00
218 ‐ Member Lost Eligibility During Date Span
146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/02.
523 ‐ Diagnosis code does not exist
146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/02.
525 ‐ Diagnosis code is not valid on DOS
146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/02.
6035 ‐ Code invalid; not found on table of valid ICD‐9‐CM codes
M76 Missing/incomplete/invalid diagnosis or condition.
146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/02.
6036 ‐ Invalid code, unnecessary 4th digit
M76 Missing/incomplete/invalid diagnosis or condition.
146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/02.
6037 ‐ Invalid code, missing 4th digit
M76 Missing/incomplete/invalid diagnosis or condition.
146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/02.
6025 ‐ Invalid code for dates, missing 4th/5th digit
M76 Missing/incomplete/invalid diagnosis or condition.
146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/02.
6031 ‐ Unacceptable principal diagnosis
MA63 Missing/incomplete/invalid principal diagnosis.
146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/02.
915 ‐ Primary ICD9 Diagnostic Code Required
MA63 Missing/incomplete/invalid principal diagnosis.
147 Provider contracted/negotiated rate expired or not on file. New as of 6/02
915 ‐ Provider is Not Credentialed
147 Provider contracted/negotiated rate expired or not on file. New as of 6/02
915 ‐ W/O contractual agreement.
147 Provider contracted/negotiated rate expired or not on file. New as of 6/02
346 ‐ Unable to locate fee schedule
147 Provider contracted/negotiated rate expired or not on file. New as of 6/02
101 ‐ No active provider contract
147 Provider contracted/negotiated rate expired or not on file. New as of 6/02
102 ‐ Provider not active for Plan on DOS
147 Provider contracted/negotiated rate expired or not on file. New as of 6/02
9177 ‐ (024DOR) Date out of OCE range
148 Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete. New as of 6/02
915 ‐ Electronic Claim has COB N4 Missing/incomplete/invalid prior insurance carrier EOB.
148 Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete. New as of 6/02
915 ‐ Reprocessed due to updated OHI, please bill other insurance as appropriate
N4 Missing/incomplete/invalid prior insurance carrier EOB.
149 Lifetime benefit maximum has been reached for this service/benefit category. New as of 10/02
117 ‐ Lifetime Benefit Max Exceeded
149 Lifetime benefit maximum has been reached for this service/benefit category. New as of 10/02
123 ‐ Individual Lifetime Visits Exceeded
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/01
608 ‐ UM is not for same Provider
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/01
606 ‐ UM Not found M62 Missing/incomplete/invalid treatment authorization code.
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/01
618 ‐ Provider's group does not match authorized group
N54 Claim information is inconsistent with pre‐ certified/authorized services.
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/01
622 ‐ Place of Service does not Match Authorized
N54 Claim information is inconsistent with pre‐ certified/authorized services.
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/01
617 ‐ Provider's specialty does not match authorized specialty
N95 This provider type/provider specialty may not bill this service.
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/01
915 ‐ Prior authorization not for same member
N54 Claim information is inconsistent with pre‐ certified/authorized services.
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/01
915 ‐ Prior authorization not for same member.
N54 Claim information is inconsistent with pre‐ certified/authorized services.
15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/01
915 ‐ Prior authorization is not for same provider.
N54 Claim information is inconsistent with pre‐ certified/authorized services.
151 Payment adjusted because the payer deems the information submitted does not support this many services. New as of 10/02
9246 ‐ (mMUE/MUEf/sMUE) Medically Unlikely‐ Exceeds Allowed Units
N431 Service is not covered with this procedure.
152 Payment adjusted because the payer deems the information submitted does not support this length of service. New as of 10/02
915 ‐ Invalid length of stay MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Record does not meet criteria for any DRG in MDC
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Record does not meet criteria for any DRG in MDC
N213 Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid age in years on admission or age in days
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid age in years on admission or age in days
MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Inappropriate specification of bilateral procedure
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ invalid admission source MA42 Missing/incomplete/invalid admission source.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid nursery level MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid discharge status MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Illogical principal diagnosis (PDX)
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid principal diagnosis (PDX)
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid date or fromdate > thrudate
M52 Missing/incomplete/invalid "from" date(s) of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid date or fromdate > thrudate
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid operation code M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid operation code MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid patient type MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Outpatient claim contains unacceptable errors
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Outpatient claim contains unacceptable errors
N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ From date greater than thru date
M52 Missing/incomplete/invalid "from" date(s) of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Outpatient Classification
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Outpatient Classification
N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Condition code 21 M44 Missing/incomplete/invalid condition code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Condition code 21 MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid from‐thru dates MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Date out of OCE range MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Date out of OCE range N345 Date range not valid with units submitted.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid procedure code M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ This is a clinical trial claim and it is missing the required diagnosis code.
M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Late charge/ corrected claim received. Denied to allow corrections.
MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Late charge/ corrected claim received. Denied to allow corrections.
N693 Alert: This reversal is due to a cancellation of the claim by the provider.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ No Charges Submitted on Claim Line
M54 Missing/incomplete/invalid total charges.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Code invalid; not found on table of valid ICD‐9‐CM codes
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid code, unnecessary 4th/5th digit
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid code missing 4th/5th digit
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Code invalid M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid code for dates, unnecessary 4th/5th digit
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid code for dates, missing 4th/5th digit
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid age in days at discharge
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid age in days at discharge
N50 Missing/incomplete/invalid discharge information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Sex invalid; not 1 or 2, M or F
MA39 Missing/incomplete/invalid gender.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Code is duplicate of principal diagnosis
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Code is duplicate of another secondary diagnosis
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Diagnosis cannot be used as principal
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ “E” Code as principal MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Manifestation code as principal
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Non‐Specific code as principal
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Questionable admission MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Questionable admission MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Unacceptable principal diagnosis
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Unacceptable principal diagnosis; requires secondary dX
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Present On Admission indicator required but not submitted
N434 Missing/Incomplete/Invalid Present on Admission indicator.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Present On Admission indicator required but is not valid
N434 Missing/Incomplete/Invalid Present on Admission indicator.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ A Present on Admission Indicator (POA) has been applied to a Diagnosis Code that does not require one per Medicare/Tricare OPPS guidelines
N434 Missing/Incomplete/Invalid Present on Admission indicator.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Code invalid; not found on table of valid ICD‐9‐CM codes
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid code, unnecessary 4th digit
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid code, missing 4th digit
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Same Provider As Surgeon/Asst Surgeon Invalid
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Same Provider As Surgeon/Asst Surgeon Invalid
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to processing error
MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to processing error
N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to processing error‐QNXT
MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to processing error‐QNXT
N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Appeal MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Appeal N691 Alert: This reversal is due to a patient submitted appeal.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Reconsideration MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Reconsideration N690 Alert: This reversal is due to a provider submitted appeal.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Unable to determine which history claim to adjust based off the claim number provided and/or information provided.
N380 The original claim has been processed, submit a corrected claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claims Recovery Project N432 Adjustment based on a Recovery Audit.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Insufficient services on day of partial hospitalization.
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Insufficient services on day of partial hospitalization.
MA32 Missing/incomplete/invalid number of covered days during the billing period.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ The member has not exhausted their Part A benefits. Martin’s Point does not adhere to this limitation. Please submit a corrected inpatient claim with your room and board charges.
M54 Missing/incomplete/invalid total charges.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Corrected Claim MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Corrected Claim N694 Alert: This reversal is due to a resubmission/change to the claim by the provider.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ No Assessment Date Submitted on Claim
N309 Missing/incomplete/invalid assessment date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid value for OPCODE1 M45 Missing/incomplete/invalid occurrence code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid value for OPCODE1 MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid value for PATTYPE MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid value for PATTYPE MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claim billed with two different individual NPI’s
MA102 Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ This is a clinical trial claim and it is missing the required clinical trial number
MA50 Missing/incomplete/invalid Investigational Device Exemption number for FDA‐approved clinical trial services.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ This is a clinical trial claim and it is missing the required Condition code.
M44 Missing/incomplete/invalid condition code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Insured/Patient information submitted (Name, DOB, Gender, Member ID)
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Rebill with a valid HIPPS code
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ The procedure code billed is not recognized by Tricare. An alternate code is available.
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ The procedure code billed is not recognized by Medicare. An alternate code is available.
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Denied‐ Please provide a description of service
N350 Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Description of Service & a Prior Authorization is Required
N225 Incomplete/invalid documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Insured/Member ID N382 Missing/incomplete/invalid patient identifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Gender MA39 Missing/incomplete/invalid gender.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid DOB MA52 Missing/incomplete/invalid date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ File with FFS Medicare First MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ File with FFS Medicare First N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Patient Name not matching name on file.
MA36 Missing/incomplete/invalid patient name.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Provider termed from affiliation for DOS billed
N198 Rendering provider must be affiliated with the pay‐to provider.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Provider credentials required for reimbursement.
M143 The provider must update license information with the payer.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ HCPC/CPT Code not Valid on a UB Claim
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ EOB needed from Primary Insurance
N4 Missing/incomplete/invalid prior insurance carrier EOB.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Accept Assignment Box 27 on claim needs to be completed.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ EOB does not match claim N4 Missing/incomplete/invalid prior insurance carrier EOB.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid units for modifier M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Payment included in composite rate
N95 This provider type/provider specialty may not bill this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid HCPCS code M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid modifier for pricing M78 Missing/incomplete/invalid HCPCS modifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Admit Diagnosis MA65 Missing/incomplete/invalid admitting diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claim returned to provider for correction (RTP)
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid units for this modifier
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ ZIP code missing or inv (for Ambulance)
MA29 Missing/incomplete/invalid provider name, city, state, or zip code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid units for revenue code
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Trauma response cc code without rev code 068X and CPT 99291
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claim lacks allowed procedure code
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claim lacks required radiolabeled product
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ G0379 only allowed with G0378
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ G0379 only allowed with G0378
N357 Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Revenue code not recognized by Medicare
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claim lacks required device code
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Incorrect billing of blood and blood products
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Incorrect billing of blood and blood products
N750 Incomplete/invalid Blood Gas Report.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Units greater than one for bilateral proC billed with mod 50
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Multiple observations overlap in time
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Multiple observations overlap in time
N20 Service not payable with other service rendered on the same date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Code 2 of a code pair allowed with modifier
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid revenue code M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Codes G0378 and G0379 only allowed with bill type 13x
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Codes G0378 and G0379 only allowed with bill type 13x
MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Code 2 of a code pair that is not allowed by NCCI
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Code 2 of a code pair that is not allowed by NCCI
N345 Date range not valid with units submitted.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Terminated bilateral procedure
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ implanted/administered not consistent with implant/procedure
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Transf or blood product exchange w/o spec of blood product
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Transf or blood product exchange w/o spec of blood product
N750 Incomplete/invalid Blood Gas Report.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Obs rev code on line item with non‐obs HCPCS code
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ HCPC Code not Valid on a HCFA Claim
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Revenue center requires HCPCS code
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ REMIT Claim with Enrollment Status Change
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ REMIT Claim with External Enrollment Coverage Type Change
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ REMIT LOI Records Added or Changed
N696 Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ REMIT E/R Claim reversed due to receipt of inpatient claim.
M2 Not paid separately when the patient is an inpatient.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ REMIT retro term enrollment
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ REMIT denied claim with valid enrollment
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Pricing cannot be determined based on units billed
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Servicing provider required on claim
N257 Missing/incomplete/invalid billing provider/supplier primary identifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Skin substitute application procedure without appropriate skin substitute product code
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Resubmit With Operative Report/Medical Records
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ "Medical Records required, fax records to 207‐828‐7857 ATTN HMD"
N225 Incomplete/invalid documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ A valid HCPC code available for NDC number.
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ ABA Therapy codes need to be billed on a separate claim.
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ ABA Therapy codes need to be billed on a separate claim.
N61 Rebill services on separate claims.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Need breakout of Anesthesia time for the MD and CRNA
N29 Missing documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Service not rendered in place of service billed
N38 Missing/incomplete/invalid place of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Incorrect Billing MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Incorrect Billing N34 Incorrect claim form/format for this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Bill with a valid J‐Code M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Incomplete claim form. M58 Missing/incomplete/invalid claim information. Resubmit claim after corrections.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Submit appropriate claim form
N34 Incorrect claim form/format for this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Non Contracted Code, Use corresponding S Code
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ EOB is Missing Information. N4 Missing/incomplete/invalid prior insurance carrier EOB.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invoice does not match services billed
N354 Incomplete/invalid invoice
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Unable to determine patient responsibility based upon the submitted EOB.
N4 Missing/incomplete/invalid prior insurance carrier EOB.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Please resubmit with remit remark code key.
MA69 Missing/incomplete/invalid remarks.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid ICD9 Procedure Code
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid ICD‐9 Diagnosis Code
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Diagnosis not valid for Benefit
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Pay and Educate M17 Alert: Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Pay and Educate N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Service only payable as inpatient.
N38 Missing/incomplete/invalid place of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Explanation of Benefits illegible. Please submit legible Explanation of Benefits.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ The Medical Records Submitted are not for the Rendering Provider on the claim.
N225 Incomplete/invalid documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Resubmit claim with Medicare FQHC/Rural Health per diem rate sheet
N66 Missing/incomplete/invalid documentation.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Type of Bill for a Corrected Claim
MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Type of Bill for a Corrected Claim
MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid billing. Please report the appropriate HCPCS G code.
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid/Missing occurrence code
M44 Missing/incomplete/invalid condition code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Place of Service M77 Missing/incomplete/invalid place of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid billing ‐multiple service locations billed on one claim
N93 A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Paid Incorrect Provider MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Paid Incorrect Provider N694 Alert: This reversal is due to a resubmission/change to the claim by the provider.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Approved Provider Service for Provider
N95 This provider type/provider specialty may not bill this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Therapy Threshold not met MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Therapy Threshold not met N486 Incomplete/invalid Physical Therapy Certification.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claim Doesn't have any Service Lines
M79 Missing/incomplete/invalid charge.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Ambulance Run Report Doesn’t match units billed on claim.
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Patient not enrolled with plan.
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ CPT code invalid on DOS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ No response to COB inquiry.
N245 Incomplete/invalid plan information for other insurance
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Revenue code missing / invalid.
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ DOS incorrect. MA52 Missing/incomplete/invalid date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Incorrect Discharge Status Submitted
N50 Missing/incomplete/invalid discharge information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Treatment Authorization Needed
M62 Missing/incomplete/invalid treatment authorization code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Procedure code not on file. M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Diagnosis code not on file. M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Diagnostic Pointer Missing or Invalid
M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Member ID number invalid.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Category of service invalid.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Member not enrolled on DOS.
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Member was not enrolled with this Medical Group on DOS .
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Resubmit claim with Medicare EOB.
N4 Missing/incomplete/invalid prior insurance carrier EOB.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Resubmit with primary EOB. N4 Missing/incomplete/invalid prior insurance carrier EOB.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Primary Diagnosis Required MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Triage only ‐ not life threatening.
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Triage only ‐ not life threatening.
N358 Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ No Attending Physician ID (Outpatient)
M68 Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Negative charge on claim line
M54 Missing/incomplete/invalid total charges.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Admit Hour N46 Missing/incomplete/invalid admission hour.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Discharge Hour N317 Missing/incomplete/invalid discharge hour.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claim Doesn't have any Service Lines
M79 Missing/incomplete/invalid charge.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Provider requires a specialty code
N270 Missing/incomplete/invalid other provider primary identifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ PCP is solely responsible for services
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ PCP is solely responsible for services
N450 Covered only when performed by the primary treating physician or the designee.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Services are not eligible with diagnosis provided by physician.
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Service is not related to direct treatment of an illness or injury.
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Service is not related to direct treatment of an illness or injury.
N576 Services not related to the specific incident/claim/accident/loss being reported.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Discharge Status Required for Inpatient and SNF Claims
MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Missing Primary Diagnosis MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Admit Type Required MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Discharge Status Required MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Member has no active enrollment on DOS
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid CPT/HCPCS M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ No Enrollment N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Accomodation Days MA32 Missing/incomplete/invalid number of covered days during the billing period.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Admit Date Required for Inpatient Claim
MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Attending Physician Required for Inpatient Claims
N31 Missing/incomplete/invalid prescribing provider identifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Bill Type MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Revenue Code Requires HCPCS and/or Modifier
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Physicians Assistant requires Modifier 80 or 27
M78 Missing/incomplete/invalid HCPCS modifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ CRNA requires Modifier AA M78 Missing/incomplete/invalid HCPCS modifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Line Date of Service MA52 Missing/incomplete/invalid date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Start Date M52 Missing/incomplete/invalid "from" date(s) of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid End Date M59 Missing/incomplete/invalid "to" date(s) of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Discharge Status MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid Revenue Code for Bill Type
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid HCPCS for Revenue Code
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Transferred to Patient Advocates for processing; Expect payment determination from Patient Advocates
N196 Alert: Patient eligible to apply for other coverage which may be primary.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Rendering and billing provider NPIs cannot match
N433 Resubmit this claim using only your National Provider Identifier (NPI)
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ No rendering provider NPI billed on HCFA
N433 Resubmit this claim using only your National Provider Identifier (NPI)
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Not valid for SNF N106 Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Occurrence Code 55 and the date of death must be present when patient discharge status 20, 40, 41, or 42 is present
M44 Missing/incomplete/invalid condition code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Another service line for the same DOS is missing information to process this line
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ OPPS Claim Denial‐Return to Provider
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ OPPS Claim Denial‐Return to Provider
N142 The original claim was denied. Resubmit a new claim, not a replacement claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Resubmit Claim to OptumHealth
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Resubmit Claim to OptumHealth
N196 Alert: Patient eligible to apply for other coverage which may be primary.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ No Enrollment N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ NDC Number is missing or Invalid
M119 Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Bill to Pharmacare MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Bill to Pharmacare N196 Alert: Patient eligible to apply for other coverage which may be primary.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Billing with invalid NPI for provider submitted on claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Mental Health NPI number Missing or invalid for Mental Health Services billed on claim.
N433 Resubmit this claim using only your National Provider Identifier (NPI)
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ The billing group NPI in Box 33A is not valid or missing for the dates of service on the claim.
M57 Missing/incomplete/invalid provider identifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Denied‐Benefit Requires submission by member
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Denied‐Benefit Requires submission by member
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Claim cannot be submitted with any negative charges
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ If you have any questions concerning this claim, please call your provider or member inquiry number. Located on the back of your ID card.
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ If you have any questions concerning this claim, please call your provider or member inquiry number. Located on the back of your ID card.
N508 Alert: This real time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Missing/Invalid Value Code M49 Missing/incomplete/invalid value code(s) or amount(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Submit to Patient Advocates
N418 Misrouted claim. See the payer's claim submission instructions.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Coverage change during pregnancy/Resubmit covered services.
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Coverage change during pregnancy/Resubmit covered services.
N196 Alert: Patient eligible to apply for other coverage which may be primary.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Diagnosis Code on Claim does not Match Term
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Admit type does not match admit source
MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Other agency may be responsible for payment
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Other agency may be responsible for payment
N193 Specific federal/state/local program may cover this service through another payer.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Admit type requires 450 revcode
MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Admission source required MA42 Missing/incomplete/invalid admission source.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid patient status for bill type
MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Surgical procedure requires HCPCS
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Admit type required for 11x bill type
MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Invalid ICD‐9 procedure code
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Insufficient Units For Date Span
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Final Episode claim never received, anticipated claim retracted per 60 day CMS guideline.
N560 The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Missing/Incomplete/Invalid Investigational Device Exemption number for FDA‐approved clinical trial services.
MA50 Missing/incomplete/invalid Investigational Device Exemption number for FDA‐approved clinical trial services.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Service Requires a diagnosis for both the underlying cause as well as a systemic disease.
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Re‐Processed Claim from Denial
MA67 Correction to a prior claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Re‐Processed Claim from Denial
N11 Denial reversed because of medical review.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Resubmit with run sheet Time/Milage
N29 Missing documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Please bill with the appropriate RUG Code.
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ MaineSense does not accept Split Billing. Payment is included in Professional Charges. Member is held Harmless.
M96 The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ MaineSense does not accept Split Billing. Payment is included in Professional Charges. Member is held Harmless.
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Denied‐Awaiting Third Party Liability Information/ MVA
MA64 Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Denied‐Awaiting Third Party Liability Information/ PL
MA64 Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6033 ‐ Present On Admission indicator required but not submitted
N434 Missing/Incomplete/Invalid Present on Admission indicator.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6034 ‐ Present On Admission indicator required but is not valid
N434 Missing/Incomplete/Invalid Present on Admission indicator.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
551 ‐ Diagnosis Requires POA Indicator for Inpatient Claim
N434 Missing/Incomplete/Invalid Present on Admission indicator.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9519 ‐ (mDEY) Physician Order or Prescription Required
N455 Missing Physician Order.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
308 ‐ Invalid Admit Hour (0 ‐‐ 23) N46 Missing/incomplete/invalid admission hour.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
990 ‐ Missing Claim Information N463 Missing support data for claim.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
335 ‐ HIPPS RUGS DOS is not within assessment modifier time period
N471 Missing/incomplete/invalid HIPPS Rate Code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
336 ‐ HIPPS RUGS billed amount should not have a dollar amount
N471 Missing/incomplete/invalid HIPPS Rate Code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
306 ‐ Discharge status is required for inpatient and SNF claims
N50 Missing/incomplete/invalid discharge information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9031 ‐ Invalid procedure code N569 Not covered when performed for the reported diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9477 ‐ (038IIP) No implant procedure for implanted device
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9211 ‐ Billed service requires device code
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9216 ‐ (076TRC) Trauma code billed without rev 068x and CPT 99291
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6091 ‐ implanted/administered not consistent with implant/procedure
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6120 ‐ Claim lacks allowed procedure code
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6097 ‐ Obs rev code on line item with non‐obs HCPCS code
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6115 ‐ Claim lacks required device code
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6119 ‐ Trauma response cc code without rev code 068X and CPT 99291
N59 Please refer to your provider manual for additional program and provider information.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6135 ‐ Payment included in composite rate
N95 This provider type/provider specialty may not bill this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
113 ‐ Specialty code required for provider
N95 This provider type/provider specialty may not bill this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6196 ‐ CLIENT CUSTOM EDIT N750 Incomplete/invalid Blood Gas Report.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6180 ‐ E/M condition not met and line item date for code G0244
N431 Service is not covered with this procedure.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
991 ‐ Claim Document or Information Not Received
N66 Missing/incomplete/invalid documentation.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9462 ‐ (mM54/mM55/mM56/mM78) Payment adjusted based on modifier
N701 Payment adjusted based on the Value‐based Payment Modifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6216 ‐ Only mental health education and training services provided
N731 Incomplete/Invalid mental health assessment.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9036 ‐ (DOB/DOBf) Missing or Invalid Date of Birth
N329 Missing/incomplete/invalid patient birth date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
635 ‐ Invalid Claim Form Type N34 Incorrect claim form/format for this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9024 ‐ (ASD) ANESTHESIA SECONDARY PROCEDURE
N250 Missing/incomplete/invalid assistant surgeon secondary identifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9239 ‐ (LRD/LCRD) LCD Review/Request Documents
N29 Missing documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
163 ‐ Benefit requires documentation
N29 Missing documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9130 ‐ (OCCf) Invalid Occurrence Code
N299 Missing/incomplete/invalid occurrence date(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9148 ‐ Age invalid; not in range 0‐ 124 years
N30 Patient ineligible for this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9178 ‐ (025AGE) Age is non‐ numeric or outside 0‐124 years range
N30 Patient ineligible for this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6203 ‐ Mental health code not approved for partial hosp program
N20 Service not payable with other service rendered on the same date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6204 ‐ Mental health service not payable outside the p/h program
N20 Service not payable with other service rendered on the same date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
224 ‐ Benefit Requires Manual Review
N225 Incomplete/invalid documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
225 ‐ Contract Term Requires Manual Review
N225 Incomplete/invalid documentation/orders/notes/summary/report/ chart.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6182 ‐ CLIENT CUSTOM EDIT N357 Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
128 ‐ Remaining visits less than date span. Units not allocated.
N362 The number of Days or Units of Service exceeds our acceptable maximum.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9027 ‐ (BPS) MISSING OR INVALID POS
N38 Missing/incomplete/invalid place of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9223 ‐ (BPO) Missing Required LCD Place of Service
N38 Missing/incomplete/invalid place of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
162 ‐ Contract term requires documentation
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6157 ‐ Code2 of column1/column2 CCI edit
N386 This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6166 ‐ Code2 of col1/col2 CCI edit, allow appropriate modifier
N386 This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6218 ‐ Service provided prior to date of (NCD) approval
N386 This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6206 ‐ Service provided on or after effective date of NCD rule
N386 This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9244 ‐ Medicare add‐on procedure without primary procedure
N122 Add‐on code cannot be billed by itself.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6006 ‐ No rates or weights (no matching record)
N19 Procedure code incidental to primary procedure.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9149 ‐ (DIBW) Invalid newborn birth weight (not within 200‐ 9000 gm)
N207 Missing/incomplete/invalid weight.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9235 ‐ (LBS/LCS) Missing Required LCD Secondary Diagnosis
M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9236 ‐ (LBT/LCT) Missing Required LCD Tertiary Diagnosis
M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9181 ‐ (029NMH) Partial hospitalization‐non‐mental health diagnosis
M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
512 ‐ Invalid Thru DOS M59 Missing/incomplete/invalid "to" date(s) of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6121 ‐ Claim lacks required radiolabeled product
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9464 ‐ (mMP5) Operative report required for number of procedures
M29 Missing operative note/report.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9126 ‐ Missing or invalid condition code
M44 Missing/incomplete/invalid condition code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9193 ‐ (046PHC)Cond code 41 invalid for TOB‐partial hospitalization
M44 Missing/incomplete/invalid condition code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9190 ‐ (042MMV) Multiple visits same day/rev w/o cond code G0
M44 Missing/incomplete/invalid condition code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
291 ‐ Invalid Condition Code on DOS
M44 Missing/incomplete/invalid condition code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9234 ‐ (LBP/LCP) Missing Required LCD Primary Diagnosis
M76 Missing/incomplete/invalid diagnosis or condition.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9198 ‐ (055NRS) Non‐reportable code for site of service
M77 Missing/incomplete/invalid place of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
659 ‐ Invalid Place of Service Code
M77 Missing/incomplete/invalid place of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9171 ‐ (001ICM) Invalid diagnosis code
M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9150 ‐ Missing or invalid diagnosis
M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
538 ‐ Diagnosis Pointer Required on Srvce Line for Diagnosis Codes
M64 Missing/incomplete/invalid other diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6120 ‐ Claim lacks allowed procedure code
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6083 ‐ Inappropriate specification of bilateral procedure
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6090 ‐ Terminated bilateral procedure
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9097 ‐ (MB2) Medicare bilateral adjustment does not apply
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
521 ‐ Procedure code not found or invalid for date of service
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
174 ‐ Procedure code on claim does NOT match terms valid procedure
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6209 ‐ Skin application procedure w/o appropriate skin product code
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6186 ‐ Code not recognized by the OPPS, alternate may be available
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9205 ‐ (062CNR) Invalid OPPS code; alternate code may be available
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9476 ‐ Terminated procedure is bilateral or multiple units
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9155 ‐ (DNSP) Claim O.R. procedures nonspecific
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9157 ‐ (DPCB) Proposed alternate closed biopsy code
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9164 ‐ Missing, invalid, or inappropriate procedure
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9031 ‐ Invalid procedure code M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9191 ‐ (043TBP) Blood transfusion billed with no blood product
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9166 ‐ (DPNC2) Invalid open biopsy code
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9201 ‐ (058OAP) HCPCS G0379 only allowed with G0378
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9217 ‐ (077DPC/LNAP1)Device billed without allowed procedure code
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9218 ‐ (078DNM) Claim lacks required radiopharmaceutical
M51 Missing/incomplete/invalid procedure code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
511 ‐ Invalid From DOS M52 Missing/incomplete/invalid "from" date(s) of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
128 ‐ Remaining visits less than date span. Units not allocated.
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
338 ‐ HIPPS RUGS length of stay not in sync with accommodation day
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
204 ‐ Invalid accommodation days
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6127 ‐ Invalid units for this modifier
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6131 ‐ Invalid units for revenue code
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6134 ‐ Invalid units for modifier M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9214 ‐ (074UBP) Invalid units for bilateral procedure with mod 50
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9184 ‐ (032PHS) Insufficient services for partial hosp. < 3 days
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9185 ‐ (033PHM) LOS > 3 but mental health services < 57%
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9186 ‐ (034PHN) LOS > 3; partial hospitalization criteria not met
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9037 ‐ (DTU) DATES OF SERVICE TO UNITS DISCREPANCY
M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9013 ‐ Units Expansion Detected M53 Missing/incomplete/invalid days or units of service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6205 ‐ Charge exceeds token charge ($1.01)
M54 Missing/incomplete/invalid total charges.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
303 ‐ Claim Total Mismatch M54 Missing/incomplete/invalid total charges.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
107 ‐ Negative charge on claim line
M54 Missing/incomplete/invalid total charges.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
819 ‐ Claim Check: Claim Stop audit
M58 Missing/incomplete/invalid claim information. Resubmit claim after corrections.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
916 ‐ Claim does not have any service lines
M58 Missing/incomplete/invalid claim information. Resubmit claim after corrections.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
305 ‐ Primary diagnosis code is required
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6029 ‐ Non‐Specific code as principal
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9485 ‐ (067SPA/068PCD/(069SOP) DOS outside approval window
MA06 Missing/incomplete/invalid beginning and/or ending date(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
195 ‐ Date of Onset is Missing on Claim
MA100 Missing/incomplete/invalid date of current illness or symptoms
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6188 ‐ Activity therapy can only be billed on partial hosp
MA125 Per legislation governing this program, payment constitutes payment in full.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9127 ‐ Missing or invalid From or Thru date
MA52 Missing/incomplete/invalid date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9025 ‐ (BDS/023BDS) Invalid claim or line DOS
MA52 Missing/incomplete/invalid date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9054 ‐ (ICM/ICMf) Missing Principal Diagnosis Code
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9160 ‐ (DPDI3) Non‐specific code cannot be used as principle DX
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9161 ‐ (DPDI4) Principal DX indicates questionable admission
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9163 ‐ Unacceptable principal DX w/o required secondary DX
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6183 ‐ Clinical trial requires diag code V707 not be primary diag
MA63 Missing/incomplete/invalid principal diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9221 ‐ (BCC/LCC) LCD Code to Code Missing or Invalid
N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9152 ‐ (DIS) Sex invalid; not 1 or 2, M or F
MA39 Missing/incomplete/invalid gender.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9079 ‐ Missing patient gender MA39 Missing/incomplete/invalid gender.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9179 ‐ (026SEX) Patient gender not F or M (alpha) or 0‐2 (numeric)
MA39 Missing/incomplete/invalid gender.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9115 ‐ (MVM) MEDICARE VENTILATOR MANAGEMENT
N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6141 ‐ Invalid Admit Diagnosis MA65 Missing/incomplete/invalid admitting diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9169 ‐ (DXE1) E‐code used as admit diagnosis
MA65 Missing/incomplete/invalid admitting diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9170 ‐ (DXE2) Invalid admit DX (cannot be manifestation code)
MA65 Missing/incomplete/invalid admitting diagnosis.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
301 ‐ Invalid or missing admission date
MA40 Missing/incomplete/invalid admission date.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
316 ‐ Admit type does not match admit source
MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
518 ‐ Admit type required for 11x bill type
MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9134 ‐ (TOAf) Missing or Invalid Type of Admission (Inpatient)
MA41 Missing/incomplete/invalid admission type.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9133 ‐ Missing or invalid source of admission
MA42 Missing/incomplete/invalid admission source.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
328 ‐ Admission Source Required MA42 Missing/incomplete/invalid admission source.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9132 ‐ Missing or invalid patient status code
MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9151 ‐ (DIDS) Invalid discharge disposition / patient status.
MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9210 ‐ (070CA) Modifier CA requires patient status code 20
MA43 Missing/incomplete/invalid patient status.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9078 ‐ (PRZ) PROVIDER ZIP IS EMPTY
MA29 Missing/incomplete/invalid provider name, city, state, or zip code.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9135 ‐ (TOBf/LTOB) Missing or Invalid Type of Bill
MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6177 ‐ CLIENT CUSTOM EDIT MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9206 ‐ (063OPH)OT code only valid for partial hospitalization claim
MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9207 ‐ (064TPH)AT code only valid for partial hospitalization claim
MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9196 ‐ (053OTB) Codes G0378 and G0379 only allowed with 13x or 85x
MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
175 ‐ Bill type on claim does NOT match contract term
MA30 Missing/incomplete/invalid type of bill.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
335 ‐ HIPPS RUGS DOS is not within assessment modifier time period
MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6074 ‐ Invalid from‐thru dates MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6140 ‐ Invalid modifier for pricing M78 Missing/incomplete/invalid HCPCS modifier.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
336 ‐ HIPPS RUGS billed amount should not have a dollar amount
M79 Missing/incomplete/invalid charge.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
107 ‐ Negative charge on claim line
M79 Missing/incomplete/invalid charge.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9012 ‐ Review Billed Amount and/or Units
M79 Missing/incomplete/invalid charge.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9195 ‐ (052OCN) Invalid DX, reason or units for Observation billing
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9128 ‐ (IPAf) Invalid Other Procedure Code and/or Date (Inpatient)
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9129 ‐ (IPPf) Missing Principal Procedure Code and/or Date
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9131 ‐ (OSCf) Invalid Occurrence Span Code and/or Dates
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
267 ‐ COB: LOI No Response or Outdated ‐ Pursue and Pay
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
214 ‐ Bill Type does NOT match Benefit
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6076 ‐ Invalid procedure code
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6092 ‐ MUP that would be allowed if modifier were present
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6129 ‐ ZIP code missing or inv (for Ambulance)
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6130 ‐ Device intensive procedure without device
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
811 ‐ Claim Check: Pre‐Op Audit M144 Pre‐/post‐operative care payment is included in the allowance for the surgery/procedure.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
812 ‐ Claim Check: Post‐Op Audit M144 Pre‐/post‐operative care payment is included in the allowance for the surgery/procedure.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9209 ‐ (066CMP) Code requires manual pricing
M116 Paid under the Competitive Bidding Demonstration project. Project is ending, and future services may not be paid under this project.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
1001 ‐ Invalid NDC Code M119 Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
623 ‐ NDC Code Mismatch on UM M119 Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6187 ‐ OT code only billed on partial hospitalization claims
M125 Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
829 ‐ Claim Check: Split Lines/Unit Exp/Mult Modifiers/Modifier‐51
M16 Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6136 ‐ Invalid HCPCS code M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
507 ‐ Revenue Code Requires HCPCS
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
508 ‐ Invalid Modifier Code on Date of Service
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9500 ‐ Invalid HCPCS M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9529 ‐ (mUBh) Medicare Other Unbundle in History
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9252 ‐ Incorrect billing of rev code with HCPCS
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9465 ‐ HCPCS not valid for line DOS
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9192 ‐ (044ORC) Invalid HCPCS billed with Observation rev code
M20 Missing/incomplete/invalid HCPCS.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
289 ‐ Invalid Occurrence Code on DOS
M45 Missing/incomplete/invalid occurrence code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
290 ‐ Invalid Occurrence Span Code on DOS
M46 Missing/incomplete/invalid occurrence span code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
990 ‐ Missing Claim Information M47 Missing/incomplete/invalid internal or document control number.
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
292 ‐ Invalid Value Code on DOS M49 Missing/incomplete/invalid value code(s) or amount(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9136 ‐ Missing or invalid value code
M49 Missing/incomplete/invalid value code(s) or amount(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9189 ‐ (041IRC) Rev code not valid ‐ Medicare Outpatient PPS
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9208 ‐ (065RNM) Invalid revenue code under Medicare OPPS
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
9508 ‐ Missing, invalid, or inappropriate revenue code
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6189 ‐ CLIENT CUSTOM EDIT M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6211 ‐ Incorrect revenue code reported for FQHC payment code
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
337 ‐ HIPPS RUG rate code requires rehabilitation therapy
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
505 ‐ Invalid Revenue Code M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
345 ‐ Detail line REV code not 0023
M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6094 ‐ Invalid revenue code M50 Missing/incomplete/invalid revenue code(s).
16 Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate. Changed as of 2/02
6142 ‐ ACE Edit Return to Provider
164 Claim/Service adjusted because the attachment referenced on the claim was not received in a timely fashion. New as of 6/04
967 ‐ COB claim exceeds submission window
166 These services were submitted after this payers responsibility for processing claims under this plan ended. New as of 2/05
915 ‐ Submitted to plan in error. MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
166 These services were submitted after this payers responsibility for processing claims under this plan ended. New as of 2/05
915 ‐ Submit to Patient Advocates
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ REMIT Claim was opened or adjusted based on request by NxPBA
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ REMIT Claim was reversed or voided by Post Connect Adjust
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Prior authorization is awaiting medical review.
M85 Subjected to review of physician evaluation and management services.
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted Due to Retro‐ Authorization on file.
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to retro rate update‐QNXT
N419 Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change.
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to contract assignment error‐QNXT
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to benefit clarification/reconfiguration‐ QNXT
N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to Special Project/Business Decision.
N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjusted due to processing error‐CES
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Adjust to authorized level of care.
M58 Missing/incomplete/invalid claim information. Resubmit claim after corrections.
17 Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. Changed as of 2/02
915 ‐ Reprocessing claim/Sending to Judge Advocates Office
170 Payment is denied when performed/billed by this type of provider. New as of 6/05
915 ‐ Rural Health and FQHC claims need to be submitted on a CMS1500.
N34 Incorrect claim form/format for this service.
170 Payment is denied when performed/billed by this type of provider. New as of 6/05
915 ‐ Provider not contracted for service.
170 Payment is denied when performed/billed by this type of provider. New as of 6/05
9020 ‐ (ANE) ANES PERFORMED BY NON‐ANESTHETIST
170 Payment is denied when performed/billed by this type of provider. New as of 6/05
114 ‐ Provider does not match required type
N521 Mismatch between the submitted provider information and the provider information stored in our system.
170 Payment is denied when performed/billed by this type of provider. New as of 6/05
152 ‐ Provider type does not match type required by benefit
N95 This provider type/provider specialty may not bill this service.
171 Payment is denied when performed/billed by this type of provider in this type of facility. New as of 6/05
915 ‐ Invalid Bill Type for Provider Billed.
171 Payment is denied when performed/billed by this type of provider in this type of facility. New as of 6/05
915 ‐ Invalid facility type or county
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
171 Payment is denied when performed/billed by this type of provider in this type of facility. New as of 6/05
915 ‐ FQHC claims for Evaluation and Management (E/M) codes are required to be billed on a UB‐ 04 form
M97 Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
172 Payment is adjusted when performed/billed by a provider of this specialty. New as of 6/05
154 ‐ Benefit requires Specialty Code not found on Provider
N95 This provider type/provider specialty may not bill this service.
177 Payment denied because the patient has not met the required eligibility requirements. New as of 6/05
421 ‐ No other enrollment exists for service line dates
N650 This policy was not in effect for this date of loss. No coverage is available.
177 Payment denied because the patient has not met the required eligibility requirements. New as of 6/05
201 ‐ No enrollment exists for claim start date
N650 This policy was not in effect for this date of loss. No coverage is available.
177 Payment denied because the patient has not met the required eligibility requirements. New as of 6/05
217 ‐ Member has an active restriction on enrollment
177 Payment denied because the patient has not met the required eligibility requirements. New as of 6/05
915 ‐ Patient not enrolled with Plan.
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
177 Payment denied because the patient has not met the required eligibility requirements. New as of 6/05
915 ‐ Not eligible for service under plan
18 Duplicate claim/service. 915 ‐ Payment for this procedure is included with the payment made for the surgical procedure.
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 915 ‐ Payment for this consultation is included in the payment for anesthesia. No separate payment can be made.
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 915 ‐ Payment for this procedure is included with the payment made for medical treatment rendered on the same day by a different provider.
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 915 ‐ Payment for prenatal and postnatal care is included in the payment for the obstetrical procedure. No additional payment can be made.
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 915 ‐ Duplicate Claim (Member/DOS)
18 Duplicate claim/service. 915 ‐ Duplicate Claim Line(Member/DOS/CPT(Rev))
18 Duplicate claim/service. 915 ‐ This is a duplicate of a claim that has been previously processed.
18 Duplicate claim/service. 915 ‐ Duplicate Claim (Provider/Member/DOS)
18 Duplicate claim/service. 915 ‐ Duplicate Line on Same Claim
18 Duplicate claim/service. 915 ‐ Duplicate to a denied service.
18 Duplicate claim/service. 915 ‐ Med visit on same day as a type “T” or “S” proc w/o mod 25 for a minor procedure or mod 57 for major procedures.
N20 Service not payable with other service rendered on the same date.
18 Duplicate claim/service. 519 ‐ Duplicate Claim Line (Same Member/DOS/CPT(Rev))
18 Duplicate claim/service. 813 ‐ Claim Check: Medical Visit 18 Duplicate claim/service. 826 ‐ Claim Check: Duplicates 18 Duplicate claim/service. 9034 ‐ (DCP) DUPLICATE CLAIM
BY PROVIDER
18 Duplicate claim/service. 9038 ‐ (DUP/DUPIf/DUPOf) Possible Duplicate Claim
18 Duplicate claim/service. 522 ‐ Duplicate Claim Line (Same Provider/Member/DOS/CPT(Rev) )
N522 Duplicate of a claim processed, or to be processed, as a crossover claim.
18 Duplicate claim/service. 834 ‐ Claim Check: Procedure has a Day Limit; Limit Exceeded
N20 Service not payable with other service rendered on the same date.
18 Duplicate claim/service. 6087 ‐ Med visit on same day as a type “T” or “S” proc w/o mod 25
N20 Service not payable with other service rendered on the same date.
18 Duplicate claim/service. 9156 ‐ (DPBC) Bilateral procedures identified
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 9153 ‐ (DMBP) Multiple different bilateral joint procedures
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 9521 ‐ (mEV) Same day Procedure as History Claim for same Condition
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 831 ‐ Claim Check: Proc has unilateral or bilateral Performance
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 832 ‐ Claim Check: Procedure is a bilateral Code; Duplicate found
M86 Service denied because payment already made for same/similar procedure within set time frame.
18 Duplicate claim/service. 833 ‐ Claim Check: Procedure has a Lifetime Limit; Limit Exceeded
N117 This service is paid only once in a patient's lifetime.
181 Payment adjusted because this procedure code was invalid on the date of service. New as of 6/05
6143 ‐ CLIENT CUSTOM EDIT M51 Missing/incomplete/invalid procedure code(s).
181 Payment adjusted because this procedure code was invalid on the date of service. New as of 6/05
504 ‐ Invalid CPT/HCPCS code M51 Missing/incomplete/invalid procedure code(s).
181 Payment adjusted because this procedure code was invalid on the date of service. New as of 6/05
158 ‐ Invalid Service Code on DOS
182 Payment adjusted because the procedure modifier was invalid on the date of service. New as of 6/05. Modified on 8/8/2005
6159 ‐ CLIENT CUSTOM EDIT
182 Payment adjusted because the procedure modifier was invalid on the date of service. New as of 6/05. Modified on 8/8/2005
6088 ‐ Invalid modifier N519 Invalid combination of HCPCS modifiers.
185 The rendering provider is not eligible to perform the service billed. New as of 6/05
150 ‐ No contract term found for service
185 The rendering provider is not eligible to perform the service billed. New as of 6/05
915 ‐ Provider not credentialed ‐ Do not bill member
185 The rendering provider is not eligible to perform the service billed. New as of 6/05
915 ‐ Same Provider as Anesthesiologist/CRNA is Invalid
185 The rendering provider is not eligible to perform the service billed. New as of 6/05
915 ‐ Provider's specialty does not match authorized specialty
N95 This provider type/provider specialty may not bill this service.
185 The rendering provider is not eligible to perform the service billed. New as of 6/05
915 ‐ Provider's group does not match authorized group
N95 This provider type/provider specialty may not bill this service.
185 The rendering provider is not eligible to perform the service billed. New as of 6/05
915 ‐ Provider's network does not match authorized network
N95 This provider type/provider specialty may not bill this service.
185 The rendering provider is not eligible to perform the service billed. New as of 6/05
915 ‐ Provider's participation status does not match authorized
N95 This provider type/provider specialty may not bill this service.
185 The rendering provider is not eligible to perform the service billed. New as of 6/05
915 ‐ Provider type does not match authorized provider type
N95 This provider type/provider specialty may not bill this service.
188 This product/procedure is only covered when used according to FDA recommendations. New as of 6/05
915 ‐ Service provided prior to FDA approval
188 This product/procedure is only covered when used according to FDA recommendations. New as of 6/05
6111 ‐ Service provided prior to FDA approval
189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service. New as of 6/05
827 ‐ Claim Check: Obsolete/Invalid Codes (proc/modifier/diag)
189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service. New as of 6/05
9202 ‐ Obsolete – (059CTD) Clinical trial requires DX V707 (nonprim
19 Claim denied because this is a work‐related injury/illness and thus the liability of the Worker's Compensation Carrier.
9154 ‐ (DMSP) Possible secondary payer to Auto, Work Comp (Dx)
19 Claim denied because this is a work‐related injury/illness and thus the liability of the Worker's Compensation Carrier.
9147 ‐ (DDSP/004MSA) Possible secondary payer to Auto, Work Comp
19 Claim denied because this is a work‐related injury/illness and thus the liability of the Worker's Compensation Carrier.
366 ‐ Workers Compensation Claim
19 Claim denied because this is a work‐related injury/illness and thus the liability of the Worker's Compensation Carrier.
915 ‐ Denied‐Workers Comp Claim
19 Claim denied because this is a work‐related injury/illness and thus the liability of the Worker's Compensation Carrier.
915 ‐ Denied: Workmens Compensation.
19 Claim denied because this is a work‐related injury/illness and thus the liability of the Worker's Compensation Carrier.
915 ‐ Denied‐ Bill third party insurance
19 Claim denied because this is a work‐related injury/illness and thus the liability of the Worker's Compensation Carrier.
915 ‐ Denied‐ Bill personel liability carrier
194 Payment adjusted when anesthesia is performed by the operating physician, the assistant surgeon or the attending physician. New as of 2/06
9490 ‐ (105AON/105hAON) Anesthesia billed by operating physician
195 Payment denied/reduced due to a refund issued to an erroneous priority payer for this claim/service. New as of 2/06
915 ‐ Provider Requested Takeback
197 Precertification/authorization/notification absent. 915 ‐ Authorization Amount overrides Contract Amount
N45 Payment based on authorized amount.
197 Precertification/authorization/notification absent. 915 ‐ REMIT retro auth change N54 Claim information is inconsistent with pre‐ certified/authorized services.
197 Precertification/authorization/notification absent. 915 ‐ Authorization does not match claim dates
N54 Claim information is inconsistent with pre‐ certified/authorized services.
197 Precertification/authorization/notification absent. 915 ‐ Prior authorization is closed.
N54 Claim information is inconsistent with pre‐ certified/authorized services.
197 Precertification/authorization/notification absent. 915 ‐ Authorization number invalid for DOS.
M62 Missing/incomplete/invalid treatment authorization code.
197 Precertification/authorization/notification absent. 915 ‐ Requires authorized referral.
197 Precertification/authorization/notification absent. 915 ‐ Incorrect authorization number.
M62 Missing/incomplete/invalid treatment authorization code.
197 Precertification/authorization/notification absent. 915 ‐ Requires prior authorization.
M62 Missing/incomplete/invalid treatment authorization code.
197 Precertification/authorization/notification absent. 915 ‐ Prior authorization is denied.
N54 Claim information is inconsistent with pre‐ certified/authorized services.
197 Precertification/authorization/notification absent. 915 ‐ Prior authorization is pended.
M62 Missing/incomplete/invalid treatment authorization code.
197 Precertification/authorization/notification absent. 915 ‐ Prior authorization not found.
M62 Missing/incomplete/invalid treatment authorization code.
197 Precertification/authorization/notification absent. 915 ‐ Claim Tiers Do Not Match Referral
N54 Claim information is inconsistent with pre‐ certified/authorized services.
197 Precertification/authorization/notification absent. 915 ‐ Benefit Requires Prior Authorization
197 Precertification/authorization/notification absent. 915 ‐ Prior Authorization is required after first 12 PT visits.
197 Precertification/authorization/notification absent. 915 ‐ Prior Authorization is required after first 20 PT visits.
197 Precertification/authorization/notification absent. 367 ‐ Contract term requires UM
197 Precertification/authorization/notification absent. 603 ‐ UM is Pended
197 Precertification/authorization/notification absent. 604 ‐ UM is Denied
197 Precertification/authorization/notification absent. 611 ‐ UM has no available units
197 Precertification/authorization/notification absent. 614 ‐ No Available Bed Days on UM
197 Precertification/authorization/notification absent. 616 ‐ UM Service Line Denied
197 Precertification/authorization/notification absent. 619 ‐ Provider's network does not match authorized network
197 Precertification/authorization/notification absent. 205 ‐ Benefit requires UM
197 Precertification/authorization/notification absent. 609 ‐ UM dates do not match Claim
N54 Claim information is inconsistent with pre‐ certified/authorized services.
197 Precertification/authorization/notification absent. 601 ‐ UM is Closed N351 Service date outside of the approved treatment plan service dates.
197 Precertification/authorization/notification absent. 607 ‐ UM is not for same Member
N454 Incomplete/invalid Consultation Report.
197 Precertification/authorization/notification absent. 236 ‐ Benefit requires either a UM or a UM Supporting Document
M62 Missing/incomplete/invalid treatment authorization code.
198 Precertification/authorization exceeded. 915 ‐ Prior authorization has no units available.
N54 Claim information is inconsistent with pre‐ certified/authorized services.
198 Precertification/authorization exceeded. 915 ‐ Prior authorization has insufficent units remaining.
N54 Claim information is inconsistent with pre‐ certified/authorized services.
198 Precertification/authorization exceeded. 915 ‐ Prior authorization cost estimate exceeded.
N54 Claim information is inconsistent with pre‐ certified/authorized services.
198 Precertification/authorization exceeded. 915 ‐ Claim line exceeds available bed days on auth.
198 Precertification/authorization exceeded. 915 ‐ Prior authorization services do not match claim.
N54 Claim information is inconsistent with pre‐ certified/authorized services.
199 Revenue code and Procedure code do not match. 915 ‐ Invalid Revenue Code M50 Missing/incomplete/invalid revenue code(s).
199 Revenue code and Procedure code do not match. 6109 ‐ Revenue code not recognized by Medicare
199 Revenue code and Procedure code do not match. 6173 ‐ CLIENT CUSTOM EDIT
199 Revenue code and Procedure code do not match. 6199 ‐ Trauma code without revenue code 068x and CPT 99291
199 Revenue code and Procedure code do not match. 6170 ‐ Observation Room revenue code require observation HCPCS
199 Revenue code and Procedure code do not match. 901 ‐ Invalid Revenue‐HCPCS for claim line DOS
M50 Missing/incomplete/invalid revenue code(s).
199 Revenue code and Procedure code do not match. 6215 ‐ HCPCS or revenue code missing for partial hospitalization
M20 Missing/incomplete/invalid HCPCS.
199 Revenue code and Procedure code do not match. 6100 ‐ Revenue center requires HCPCS code
M20 Missing/incomplete/invalid HCPCS.
20 Claim denied because this injury/illness is covered by the liability carrier.
263 ‐ Auto Accident indicated on claim ‐ Pursue and Pay
20 Claim denied because this injury/illness is covered by the liability carrier.
818 ‐ Claim Check: TPL Audit N23 Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
203 Discontinued or reduced service. 915 ‐ Reduce to urgent care. 204 This service/equipment/drug is not covered under the
patient’s current benefit plan 202 ‐ No Benefit for Service
204 This service/equipment/drug is not covered under the patient’s current benefit plan
172 ‐ Term does NOT meet date criteria of the claim
204 This service/equipment/drug is not covered under the patient’s current benefit plan
149 ‐ Benefit does NOT meet date criteria of the claim
21 Claim denied because this injury/illness is the liability of the no‐fault carrier.
915 ‐ Denied‐ Bill motor vehicle insurance
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
915 ‐ Denied‐Awaiting Third Party Liability Information
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
915 ‐ Third party liability form never returned
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
915 ‐ Benefit Requires Payment from Primary Ins. First
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
915 ‐ Possible TLP claim/auth MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
915 ‐ Member enrolled in a Clinical Trial, Standard Medicare is Primary.
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
915 ‐ Services need to be billed to the Veterans Administration (VA)
N193 Specific federal/state/local program may cover this service through another payer.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
265 ‐ Other Insurance indicated on claim ‐ Pursue and Pay
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
266 ‐ Other Insurance information unknown ‐ Pursue and Pay
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
262 ‐ Claim requires Pursue and Pay
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
384 ‐ Potential Other Accident N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
420 ‐ Other enrollment exists for service line dates
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
1102 ‐ Accident: LOI No Response or Outdated ‐ Pursue and Pay
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
377 ‐ EOB not received on Claim MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
378 ‐ No COB Amount on claim MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
22 Payment adjusted because this care may be covered by another payer per coordination of benefits. Changed as of 2/01
216 ‐ Member has other coverage;submit to primary insurance first
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
6151 ‐ Units exceed maximum (MUE)
222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
6117 ‐ Units greater than one for bilateral proC billed with mod 50
222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
9255 ‐ (082CET) Charge exceeds token charge
226 Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
915 ‐ Missing/incomplete/invalid assumed or relinquished care date.
N310 Missing/incomplete/invalid assumed or relinquished care date.
227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
403 ‐ Third Party Review N420 Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.
227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
403 ‐ Third Party Review N696 Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
253 ‐ Internal enrollment and COB amounts entered
N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
254 ‐ Medicare non‐allowed claim submitted hard copy
N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ MPHC is Primary, Refund Other Health Insurance
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Service Paid in Full by Primary Carrier
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Refund Medicare MA17 We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Refund Other Health Insurance
MA17 We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Invalid Co‐Insurance Days for 11x Bill Type
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ MPHC is Primary, Refund Medicare.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Electronic claim has COB
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Paid by other insurance. M86 Service denied because payment already made for same/similar procedure within set time frame.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Third Party Insurance Paid‐ Exceeds MPHC Allowable‐ Do not bill member.
N95 This provider type/provider specialty may not bill this service.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Invalid lifetime reserve days MA35 Missing/incomplete/invalid number of lifetime reserve days.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Life reserve days exceed maximum
MA35 Missing/incomplete/invalid number of lifetime reserve days.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Invalid coinsurance days for 21x bill type
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Coinsurance days exceeds covered days
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Coinsurance days missing associated value codes
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Covered days and coinsured days exceed maximum for hospital
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Covered days exceeds maximum for hospital
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Covered days and coinsured days exceed maximum for SNF
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments. Changed as of 2/01, and 6/05
915 ‐ Covered days exceed maximum for SNF
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
231 Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
915 ‐ Mutually exclusive procedure
231 Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
6158 ‐ Medical visit same day significant procedure needs mod 25
231 Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
6085 ‐ Mutually exclusive procedure
231 Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
802 ‐ Claim Check: Mutually Exclusive Service
231 Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
9471 ‐ (019MEP/019hMEP) Mutually exclusive procedures on claim
231 Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
9478 ‐ (039MEO/039hMEO) Mutually exclusive procedures w/o modifier
231 Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
6156 ‐ Mutually exclusive procedure, not allowed even with modifier
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
6171 ‐ CLIENT CUSTOM EDIT M2 Not paid separately when the patient is an inpatient.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
6172 ‐ CLIENT CUSTOM EDIT M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
9114 ‐ (MUN) Medicare Unbundle on Current Line
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
6149 ‐ Separate payment for services is not provided by Medicare
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
9250 ‐ (UNB/sUN/sUNf) Unbundled Procedure on Current Line
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
9483 ‐ (049SIP) Service same day as inpatient‐only procedure
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
9197 ‐ (054MCS) Multiple codes for same service (blood components)
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
9194 ‐ (051MOO) Multiple observations overlap in time
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
6101 ‐ Service on same day as inpatient procedure
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
6106 ‐ Multiple codes for the same service
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
6098 ‐ Inpatient separate procedures not paid
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
6099 ‐ Service is not separately payable
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
915 ‐ Service on same day as inpatient procedure
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
915 ‐ Inpatient separate procedures not paid
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
915 ‐ Service is not separately payable
N20 Service not payable with other service rendered on the same date.
234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
915 ‐ Multiple codes for the same service
N20 Service not payable with other service rendered on the same date.
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
6086 ‐ Code 2 of a code pair that is not allowed by NCCI
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
9086 ‐ (UED) CODING RELATIONSHIP ERROR
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
9087 ‐ (UER) CODING RELATIONSHIP ERROR, REVIEW
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
9088 ‐ (UES) CODING RELATIONSHIP ERROR, SECONDARY
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
6178 ‐ CLIENT CUSTOM EDIT
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
9041 ‐ (HED) CODING RELATIONSHIP ERROR, DENY
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
9042 ‐ (HER) CODING RELATIONSHIP ERROR, REVIEW
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
9043 ‐ (HES) CODING RELATIONSHIP ERROR, SECONDARY
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
9183 ‐ (031PHE) Partial hosp same day as ECT or T‐service
236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
9188 ‐ (036EMS) Extensive mental hlth same day as ECT or T‐ service
239 Claim spans eligible and ineligible periods of coverage. Rebill separate claims.
628 ‐ Claim Line date span crosses calendar/policy year
N74 Resubmit with multiple claims, each claim covering services provided in only one calendar month.
24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. Changed as of 6/00
208 ‐ Benefit Applies to PCP Only N52 Patient not enrolled in the billing provider's managed care plan on the date of service.
24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. Changed as of 6/00
171 ‐ Term Applies to assigned members only
24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. Changed as of 6/00
915 ‐ Additional capitation dollars
24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. Changed as of 6/00
915 ‐ Service is capitated to PCP or IPA
24 Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. Changed as of 6/00
915 ‐ No Employer Fee For Service
240 The diagnosis is inconsistent with the patient's birth weight. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
915 ‐ Invalid birthweight in grams MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
240 The diagnosis is inconsistent with the patient's birth weight. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
915 ‐ Conflicting birthweight MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
240 The diagnosis is inconsistent with the patient's birth weight. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
915 ‐ Non‐specific birthweight as derived from diagnosis codes
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
240 The diagnosis is inconsistent with the patient's birth weight. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
915 ‐ Invalid birthweight; not in range 200‐9000 grams
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
242 Services not provided by network/primary care providers.
915 ‐ Remit PCP claim with PCP change
242 Services not provided by network/primary care providers.
915 ‐ Remit Non PCP claim with PCP change
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
242 Services not provided by network/primary care providers.
915 ‐ Provider is not part of Network required for Benefit
242 Services not provided by network/primary care providers.
211 ‐ Provider is not part of network required for benefit
N95 This provider type/provider specialty may not bill this service.
243 Services not authorized by network/primary care providers.
196 ‐ Benefit requires non‐ contracted (NONPAR) provider
243 Services not authorized by network/primary care providers.
192 ‐ Benefit requires contracted (PAR) provider
243 Services not authorized by network/primary care providers.
915 ‐ Unauthorized provider.
251 The attachment content received did not contain the content required to process this claim or service.
915 ‐ Invoice is Missing M23 Missing invoice.
258 Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service. Start: 11/01/2013
915 ‐ Member was Incarcerated at the time of service, collect from the Federal/State/Local authority as Appropriate.
29 The time limit for filing has expired. 915 ‐ Claim exceeds timely filing limit.
29 The time limit for filing has expired. 915 ‐ Exceeds timely filing limitations for corrected claim.
29 The time limit for filing has expired. 915 ‐ Claim submit time exceeded.
29 The time limit for filing has expired. 915 ‐ Plan not notified in time. 29 The time limit for filing has expired. 541 ‐ Claim Line Submission
Window Exceeded
29 The time limit for filing has expired. 543 ‐ Inpatient Claim Submission Window Exceeded (claim Thru date)
29 The time limit for filing has expired. 311 ‐ Claim exceeds timely filing limit
29 The time limit for filing has expired. 313 ‐ Covered days do not match accommodation revcode days
3 Co‐payment Amount 915 ‐ A $10.00 co‐pay has been taken. A $10.00 cost share has been taken.
3 Co‐payment Amount 915 ‐ CMS pays covered clinical trial services. MP will make a payment if CMS costshare is more than the members costshare as a MP member. CMS costshare for this claim is the same or less than the costshare for MP. Member is responsible for CMS costshare
31 Claim denied as patient cannot be identified as our insured.
915 ‐ Member Not On File
35 Lifetime benefit maximum has been reached. Changed as of 10/02
915 ‐ Lifetime Benefit Max Exceeded
35 Lifetime benefit maximum has been reached. Changed as of 10/02
136 ‐ Plan Lifetime Amount Exceeded
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
245 ‐ Multiple surgeries ‐ claim submitted missing modifier 51
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
407 ‐ Modifier(s) is invalid for Medical Policy
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
6093 ‐ Code 2 of a code pair allowed with modifier
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
6118 ‐ Incorrect billing of modifier FB or FC
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
6165 ‐ Mutually exclusive procedure allow with appropriate modifier
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
6168 ‐ Multiple medical visits, same date, needs condition code G0
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9241 ‐ (mEH) Medicare E/M and Surgery without Modifier ‐ History
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9242 ‐ (mEM) Medicare E/M and Surgery without Modifier
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9233 ‐ (LBM/LCM) Missing LCD Modifier
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9203 ‐ (060MCA) Modifier CA billed with multiple procedures
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9215 ‐ Incorrect billing of modifier FB or FC
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9523 ‐ Required modifier missing
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9479 ‐ (040CCO/040hCCO) Component and comprehensive billed w/o mod
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9474 ‐ (022IMO) HCPCS modifier invalid under OPPS
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9509 ‐ (mANM) Medicare Anesthesia Modifier Missing
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9510 ‐ (mGT) Invalid Modifier‐ Global Test Only Code
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9511 ‐ (mIC) Invalid Modifier‐ Incident To Code
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9512 ‐ (mPC) Invalid Modifier‐ Professional Component Only Code
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9513 ‐ (mPS) Invalid Modifier‐ Physician Service Code
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9514 ‐ (mPI) Invalid Modifier‐ Physician Interpretation Code
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9515 ‐ (mTC) Invalid Modifier‐ Technical Component Only Code
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9469 ‐ (016MBP/017IBP) Invalid specification of bilateral procedure
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9057 ‐ Inappropriate modifier combination
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9058 ‐ (IMO) MODIFIER INVALID
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
6198 ‐ CLIENT CUSTOM EDIT
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
6184 ‐ Use of modifier CA with more than one procedure not allowed
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
6193 ‐ CLIENT CUSTOM EDIT
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9060 ‐ Invalid patient gender for diagnosis code
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9061 ‐ (M26) MOD ‐26 REQUIRED
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9064 ‐ Modifier not appropriate
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
9105 ‐ (MIM) MEDICARE INAPPROPRIATE MODIFIER
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
817 ‐ Claim Check: Cross Provider Total Audit
M78 Missing/incomplete/invalid HCPCS modifier.
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
915 ‐ Invalid Modifier Association
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
915 ‐ CMS guidelines for Modifier 55 not met.
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
915 ‐ Modifier required for CPT/HCPCS
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
915 ‐ Invalid CPT Modifier
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
915 ‐ This is a clinical trial claim and it is missing the required Modifier.
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
915 ‐ Incorrect billing of modifier FB or FC
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
915 ‐ MUP that would be allowed if modifier were present
4 The procedure code is inconsistent with the modifier used or a required modifier is missing.
915 ‐ Invalid modifier
40 Charges do not meet qualifications for emergent/urgent care.
915 ‐ Non‐emergent services. Medical review denial.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Service a part of lab contract.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Service a part of Rx contract.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Included in capitation. N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Billed amount exceeds UCR. N59 Please refer to your provider manual for additional program and provider information.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Not a covered benefit‐ authorization required for private room rate‐ Claim paid up to the semi‐private room rate.
N153 Missing/incomplete/invalid room and board rate.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Denied‐Facility Fees included in professional payment.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Claim amount exceeds maximum allowed during Mass Adjudication
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Claim amount exceeds Maximum allowed
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Out‐of‐Area Claim ‐ Pay at 80%
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Non‐Participating Differential Contract Pricing Applied
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Benefits for the above charges are subject to a reduction because of the modifiers billed.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Payment has been made at 85% of the eligible amount.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Payment has been made at 100% of the eligible amount.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Price UB by CPT billed yes/no
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Claim payment amt exceeds max allowed for mass adjudication
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Claim payment amount exceeds maximum allowed
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Claim payment amt exceeds max allowed for mass adjudication
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Paid in accordance with the PHCS discount rate agreement.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Payment reduced by 10% because authorization was not requested prior to the service event. Do not bill patient for this amount.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ CPT code subject to multiple procedure payment reduction (MPPR)
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Paid in accordance with the MultiPlan discount rate agreement.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ The hospital has by contract agreed to accept as payment in full.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ The payment amount has been reduced by the amount paid by the modifier billed.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ The amount shown as eligible is the maximum amount allowable
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Code not recognized by Medicare
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Line item denial or rejection from ACE edits
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Internal Claim Recovery MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ This history claim was adjusted to pay/deny as recommended by ClaimCheck
MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Denied per APC pricing Methodology
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ No separate payment for ASC. Code not on ASC Fee Schedule.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Service is paid partial Cap and partial Fee for Service.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Pay Exceeds MPHC Allowable‐ Do not bill member
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Claim or claim line paid in excess of the billed charge.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Refund/Received Check
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Refund Initiated by AIM
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Clm Recovery Appeal MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Clm Recovery NA MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Adjustment due to DRG audit
MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ ESRD‐Reimburse Deductible and Co‐insurance only
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ HHC takeback MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Covered days do not match accomodation revcode days
N153 Missing/incomplete/invalid room and board rate.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Non‐covered days less than leave of absence
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Paid in accordance with the PHCS discount rate agreement.
45 Charges exceed your contracted/ legislated fee arrangement.
915 ‐ Paid in accordance with the MultiPlan discount rate agreement.
45 Charges exceed your contracted/ legislated fee arrangement.
9014 ‐ Claim History Issues Detected
MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
9522 ‐ (mFPh) Medicare Global Follow‐Up by Provider in History
MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
9219 ‐ (ASH) Anesthesia Secondary Procedure in History
MA67 Correction to a prior claim.
45 Charges exceed your contracted/ legislated fee arrangement.
190 ‐ Negotiated Rate overriding Provider Contract Rate
N45 Payment based on authorized amount.
45 Charges exceed your contracted/ legislated fee arrangement.
6126 ‐ Line item denial or rejection from ACE edits
45 Charges exceed your contracted/ legislated fee arrangement.
6089 ‐ Code not recognized by Medicare
5 The procedure code/bill type is inconsistent with the place of service.
179 ‐ Location specific term does NOT match claim
5 The procedure code/bill type is inconsistent with the place of service.
185 ‐ Location‐specific benefit does NOT match claim
5 The procedure code/bill type is inconsistent with the place of service.
9071 ‐ (OFS) OFFICE SETTING PROCEDURE
5 The procedure code/bill type is inconsistent with the place of service.
9074 ‐ POS not typical for procedure
5 The procedure code/bill type is inconsistent with the place of service.
662 ‐ Contract for service location on claim was not found
M77 Missing/incomplete/invalid place of service.
5 The procedure code/bill type is inconsistent with the place of service.
915 ‐ Rejected‐POS incompatible with procedure
M77 Missing/incomplete/invalid place of service.
50 These are non‐covered services because this is not deemed a `medical necessity' by the payer.
915 ‐ Medically unlikely edit
50 These are non‐covered services because this is not deemed a `medical necessity' by the payer.
915 ‐ Medical necessity not established for services rendered.
50 These are non‐covered services because this is not deemed a `medical necessity' by the payer.
809 ‐ Claim Check: Unlisted Procedure
N350 Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
50 These are non‐covered services because this is not deemed a `medical necessity' by the payer.
808 ‐ Claim Check: Cosmetic Surgery
50 These are non‐covered services because this is not deemed a `medical necessity' by the payer.
822 ‐ Claim Check: Exceeded 40 Claim Lines
M16 Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
50 These are non‐covered services because this is not deemed a `medical necessity' by the payer.
6132 ‐ Medically unlikely edit
50 These are non‐covered services because this is not deemed a `medical necessity' by the payer.
6146 ‐ CLIENT CUSTOM EDIT
51 These are non‐covered services because this is a pre‐ existing condition
246 ‐ Member has Preexisting Condition on DOS for Diagnosis
51 These are non‐covered services because this is a pre‐ existing condition
247 ‐ Preexisting Condition May Exist
54 Multiple physicians/assistants are not covered in this case .
803 ‐ Claim Check: Assistant Surgeon
54 Multiple physicians/assistants are not covered in this case .
9075 ‐ (PRD) Assist/Co/Team Surgeon Reduction
54 Multiple physicians/assistants are not covered in this case .
9112 ‐ (MTS) TEAM SURGEONS NOT PERMITTED – MEDICARE
54 Multiple physicians/assistants are not covered in this case .
9100 ‐ (MCO) CO‐SURGEONS NOT PERMITTED
54 Multiple physicians/assistants are not covered in this case .
9101 ‐ (MD1) DOCUMENT ASSISTANT AT SURGERY
54 Multiple physicians/assistants are not covered in this case .
9102 ‐ (MD2) DOCUMENT CO‐ SURGEONS – MEDICARE
54 Multiple physicians/assistants are not covered in this case .
9103 ‐ (MD3) DOCUMENT TEAM SURGERY MEDICARE
54 Multiple physicians/assistants are not covered in this case .
9096 ‐ (MAS) NO PAYMENT FOR ASSISTANT SURGEONS
55 Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer.
9059 ‐ (INV) TYPICALLY INVESTIGATIONAL
55 Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer.
810 ‐ Claim Check: Experimental Procedure
55 Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer.
915 ‐ Service appears to be experimental and is not covered by the
58 Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Changed as of 2/01
915 ‐ Inpatient procedure
58 Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Changed as of 2/01
6084 ‐ Inpatient procedure
58 Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Changed as of 2/01
404 ‐ Place of Service invalid for Medical Policy
M16 Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
58 Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Changed as of 2/01
9470 ‐ (018INP) Inpatient only procedure under Medicare
59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. Changed as of 6/00
6197 ‐ Units greater than one for bilateral proc billed w/ mod 50
59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. Changed as of 6/00
800 ‐ Claim Check: Rebundling
59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. Changed as of 6/00
6152 ‐ Multiple bilateral procedures without modifier 50
59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. Changed as of 6/00
6153 ‐ CLIENT CUSTOM EDIT
59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. Changed as of 6/00
6163 ‐ Terminated procedure with bilateral modifier or units > 1
59 Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. Changed as of 6/00
9536 ‐ Procedure reduction scenario identified
N670 This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
6144 ‐ CLIENT CUSTOM EDIT
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
6077 ‐ Procedure and age conflict
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
804 ‐ Claim Check: Age Conflict
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
805 ‐ Claim Check: Age Replacement
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
401 ‐ Age is invalid for Medical Policy
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
168 ‐ Member does NOT meet age criteria for term
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
915 ‐ Procedure and age conflict
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
915 ‐ Age invalid; not in range 0 ‐ 124
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
915 ‐ Benefit has age restrictions N129 Not eligible due to the patient's age.
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
915 ‐ Incorrect age for Nursery charges
N129 Not eligible due to the patient's age.
6 The procedure/revenue code is inconsistent with the patients age. Changed as of 6/02
915 ‐ Age Incorrect for Nursery Charges
60 Charges for outpatient services with this proximity to inpatient services are not covered.
915 ‐ Admit within 24 hours of prior Inpatient stay.
M2 Not paid separately when the patient is an inpatient.
60 Charges for outpatient services with this proximity to inpatient services are not covered.
915 ‐ Admit within 24 hours of prior Inpatient stay.
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
60 Charges for outpatient services with this proximity to inpatient services are not covered.
915 ‐ 3 Day Payment Window M2 Not paid separately when the patient is an inpatient.
60 Charges for outpatient services with this proximity to inpatient services are not covered.
915 ‐ 3 Day Payment Window MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
60 Charges for outpatient services with this proximity to inpatient services are not covered.
998 ‐ Claim ‐ Inpatient claim/UM exists for same DOS as ER claim
M133 Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
60 Charges for outpatient services with this proximity to inpatient services are not covered.
998 ‐ Claim ‐ Inpatient claim/UM exists for same DOS as ER claim
MA133 Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
6042 ‐ Sex invalid; not 1 or 2, M or F
MA39 Missing/incomplete/invalid gender.
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
6078 ‐ Procedure and sex conflict
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
806 ‐ Claim Check: Gender Conflict
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
807 ‐ Claim Check: Gender Replacement
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
6145 ‐ CLIENT CUSTOM EDIT
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
400 ‐ Gender is invalid for Medical Policy
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
9225 ‐ (BSX/LCG) Procedure Not Typical for Patient Sex
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
9168 ‐ (DPSC) Patient gender inconsistent with procedure
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
915 ‐ Procedure and sex conflict
7 The procedure/revenue code is inconsistent with the patients gender. Changed as of 6/02
915 ‐ Invalid sex
8 The procedure code is inconsistent with the provider type/specialty (taxonomy). Changed as of 6/02
915 ‐ Provider does not match required type
8 The procedure code is inconsistent with the provider type/specialty (taxonomy). Changed as of 6/02
9224 ‐ Missing or invalid provider specialty
8 The procedure code is inconsistent with the provider type/specialty (taxonomy). Changed as of 6/02
156 ‐ Provider type does NOT match type required by contract term
8 The procedure code is inconsistent with the provider type/specialty (taxonomy). Changed as of 6/02
151 ‐ Non Contracted Service N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
9 The diagnosis is inconsistent with the patient's age. 6017 ‐ age conflict; patient's age and diagnosis are inconsistent
9 The diagnosis is inconsistent with the patient's age. 6038 ‐ Age conflict; patient's age and diagnosis are inconsistent
9 The diagnosis is inconsistent with the patient's age. 9051 ‐ (IAG/002IAG) Invalid patient age for diagnosis code
9 The diagnosis is inconsistent with the patient's age. 9028 ‐ Patient age invalid for service
9 The diagnosis is inconsistent with the patient's age. 9139 ‐ Patient age inconsistent with diagnosis
9 The diagnosis is inconsistent with the patient's age. 9141 ‐ (DASC3) Patient gender and age inconsistent with diagnosis
9 The diagnosis is inconsistent with the patient's age. 9142 ‐ (DDAS1) Patient age and diagnosis inconsistent
9 The diagnosis is inconsistent with the patient's age. 9143 ‐ (DDAS2) Patient gender and diagnosis inconsistent
9 The diagnosis is inconsistent with the patient's age. 9144 ‐ Patient age and gender inconsistent with diagnosis
9 The diagnosis is inconsistent with the patient's age. 915 ‐ age conflict; patient's age and diagnosis are inconsistent
9 The diagnosis is inconsistent with the patient's age. 915 ‐ patient's age and sex are inconsistent with the patient's dx
9 The diagnosis is inconsistent with the patient's age. 915 ‐ Age and sex conflict
9 The diagnosis is inconsistent with the patient's age. 915 ‐ Age conflict; patient's age and diagnosis are inconsistent
96 Non‐covered charge(s). 915 ‐ Non‐covered for reasons other than statute
N425 Statutorily excluded service(s).
96 Non‐covered charge(s). 915 ‐ Quality Reporting Measure‐ no reimbursement
96 Non‐covered charge(s). 915 ‐ This is not a covered benefit under your Medicare Plan. However, you may have coverage through Northeast Delta Dental as a supplemental benefit. Please contact Delta Dental at 800–260–3788.
96 Non‐covered charge(s). 915 ‐ Non Reimbursable HCPC code
96 Non‐covered charge(s). 915 ‐ Resubmit with Medical Records.
N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Authorization Line Manually Denied
N431 Service is not covered with this procedure.
96 Non‐covered charge(s). 915 ‐ This a non covered service under this benefit.
96 Non‐covered charge(s). 915 ‐ Code not covered by
Medicare. 96 Non‐covered charge(s). 915 ‐ Requires additional
information. N29 Missing
documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Requires anesthesia time. N203 Missing/incomplete/invalid anesthesia time/units
96 Non‐covered charge(s). 915 ‐ Non‐covered based on statutory exclusion
96 Non‐covered charge(s). 915 ‐ Service provider prior to NCD
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 915 ‐ Service provided outside approval period
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 915 ‐ CA modifier requires patient status code 20
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 915 ‐ Mult med vis on same day same rev code w/o cc GO or mod 27
M44 Missing/incomplete/invalid condition code.
96 Non‐covered charge(s). 915 ‐ Observation does not meet minimum hours, qualifying dx
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
96 Non‐covered charge(s). 915 ‐ Observation does not meet minimum hours, qualifying dx
N357 Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
96 Non‐covered charge(s). 915 ‐ Service provided on or after effective date of NCD non‐coV
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 915 ‐ Code not recognized by OPPS
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 915 ‐ No payment made on charge amount.
96 Non‐covered charge(s). 915 ‐ Not covered or not covered under the OPPS
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 915 ‐ Well child care is not eligible under the plan.
M79 Missing/incomplete/invalid charge.
96 Non‐covered charge(s). 915 ‐ Annual/Routine Physicals, or routine lab or x‐rays are not excluded.
M79 Missing/incomplete/invalid charge.
96 Non‐covered charge(s). 915 ‐ Routine eye exams are not eligible under the plan.
M79 Missing/incomplete/invalid charge.
96 Non‐covered charge(s). 915 ‐ Not Covered Benefit N431 Service is not covered with this procedure. 96 Non‐covered charge(s). 915 ‐ Not covered by Part B,
Please submit to Part D.
96 Non‐covered charge(s). 915 ‐ Not Valid for Medicare. 96 Non‐covered charge(s). 915 ‐ Quality Reporting Measure‐
Zero Reimbursement
96 Non‐covered charge(s). 915 ‐ No Benefit for Service N431 Service is not covered with this procedure. 96 Non‐covered charge(s). 915 ‐ Itemization Required N29 Missing
documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Measurement codes ‐ used for reporting purposes only
96 Non‐covered charge(s). 915 ‐ Service not a plan benefit. N431 Service is not covered with this procedure. 96 Non‐covered charge(s). 915 ‐ No stat order. N29 Missing
documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Please resubmit claim with ER report.
N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Stat charges are not covered.
N431 Service is not covered with this procedure.
96 Non‐covered charge(s). 915 ‐ N/C. Routine well baby. 96 Non‐covered charge(s). 915 ‐ Resubmit to dental plan. 96 Non‐covered charge(s). 915 ‐ Requires discharge
summary. N29 Missing
documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Member responsible for charges.
96 Non‐covered charge(s). 915 ‐ Please resubmit claim with a copy of the consult report.
N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Resubmit with dialysis reports.
N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Resubmit with OP report. N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Requires H&P. N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Please resubmit claim with physician notes.
N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Itemized statement required.
N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Need ambulance EMS report.
N29 Missing documentation/orders/notes/summary/report/ chart.
96 Non‐covered charge(s). 915 ‐ Service is excluded from benefit plan.
N431 Service is not covered with this procedure.
96 Non‐covered charge(s). 915 ‐ No Reimbursement for Backup Transport.
N158 Transportation in a vehicle other than an ambulance is not covered.
96 Non‐covered charge(s). 915 ‐ Non‐covered days exceed statement‐covered period
96 Non‐covered charge(s). 915 ‐ No Government Pay Procedure Code List‐Code not recognized under TRICARE
96 Non‐covered charge(s). 915 ‐ No Government Pay Procedure Code List‐ Unproven/experimental
96 Non‐covered charge(s). 915 ‐ No Government Pay Procedure Code List‐Excluded by policy or statute
96 Non‐covered charge(s). 915 ‐ Self Administered Drugs are not covered.
96 Non‐covered charge(s). 915 ‐ No payment made for State Supplied Drug.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
96 Non‐covered charge(s). 9165 ‐ (DPNC1) Procedure not covered by Medicare
96 Non‐covered charge(s). 9104 ‐ (MFP) MEDICARE GLOBAL FOLLOWUP BY PROVIDER
96 Non‐covered charge(s). 9106 ‐ (MIN) INJECTION SERVICE – MEDICARE
96 Non‐covered charge(s). 9107 ‐ (MNP) NON‐PHYSICIAN SERVICE – MEDICARE
96 Non‐covered charge(s). 9108 ‐ (MNS/mNE) Medicare Non‐Covered Service
96 Non‐covered charge(s). 9109 ‐ (MNV) NOT VALID FOR
MEDICARE PAYMENT 96 Non‐covered charge(s). 9110 ‐ (MPT) PHYSICAL THERAPY
SERVICE
96 Non‐covered charge(s). 9212 ‐ (072SNB) Service not billable to Medicare FI
96 Non‐covered charge(s). 9534 ‐ Non covered, bundled, restricted, or reporting only
96 Non‐covered charge(s). 9524 ‐ (mMGY) Not Eligible for Payment ‐ Modifier GY present
96 Non‐covered charge(s). 9525 ‐ (mNC) Medicare Non Covered HCPCS Codes and Modifiers
96 Non‐covered charge(s). 9526 ‐ (mPV) Medicare Preventative Vaccines
96 Non‐covered charge(s). 9484 ‐ (050NCE) Service not covered‐Medicare statutory exclusion
96 Non‐covered charge(s). 9466 ‐ (009NCS) Medicare noncovered service indicator
96 Non‐covered charge(s). 9467 ‐ (013NSP) Not covered based on bill type and condition code
96 Non‐covered charge(s). 9475 ‐ (028NRM) Code not recognized by Medicare for OPPS
96 Non‐covered charge(s). 9482 ‐ Revenue code requires HCPCS
96 Non‐covered charge(s). 9245 ‐ Non‐covered service 96 Non‐covered charge(s). 9173 ‐ (010DNY) Claim submitted
for denial (Cond Code 21)
96 Non‐covered charge(s). 9167 ‐ (DPNC3) Medicare covers procedure in limited situation only
96 Non‐covered charge(s). 9187 ‐ (035FMS) Only Mental Health education/training provided
96 Non‐covered charge(s). 9175 ‐ (012QCS)Questionable covered service ‐ Medicare
96 Non‐covered charge(s). 203 ‐ Benefit is excluded from benefit plan
96 Non‐covered charge(s). 374 ‐ Medicare Excluded Service ‐
Other Insurance Dollars on Claim 96 Non‐covered charge(s). 6185 ‐ Service can only be billed
to the DMERC M11 DME, orthotics and prosthetics must be billed to
the DME carrier who services the patient's zip code.
96 Non‐covered charge(s). 6164 ‐ Conflict between implanted device and implanted procedure
M50 Missing/incomplete/invalid revenue code(s).
96 Non‐covered charge(s). 6167 ‐ CLIENT CUSTOM EDIT M50 Missing/incomplete/invalid revenue code(s). 96 Non‐covered charge(s). 9176 ‐ (014ISS) Service not
payable ‐ Medicare Outpatient PPS
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 6138 ‐ Not covered or not covered under the OPPS
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 6124 ‐ Service provided on or after effective date of NCD non‐ coV
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 6112 ‐ Service provider prior to NCD
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 6113 ‐ Service provided outside approval period
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 6114 ‐ CA modifier requires patient status code 20
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 6108 ‐ Code not recognized by OPPS
N59 Please refer to your provider manual for additional program and provider information.
96 Non‐covered charge(s). 6102 ‐ Non‐covered based on statutory exclusion
N643 The services billed are considered Not Covered or Non‐Covered (NC) in the applicable state fee schedule.
96 Non‐covered charge(s). 6212 ‐ Item or service not covered under FQHC PPS
N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
96 Non‐covered charge(s). 6161 ‐ Code not recognized by Medicare for outpatient claims
N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
96 Non‐covered charge(s). 6169 ‐ Blood service without specification of blood product
N750 Incomplete/invalid Blood Gas Report.
96 Non‐covered charge(s). 6155 ‐ CLIENT CUSTOM EDIT N56 Procedure code billed is not correct/valid for the services billed or the date of service billed.
96 Non‐covered charge(s). 155 ‐ Benefit has age restriction N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
96 Non‐covered charge(s). 197 ‐ Procedure code on claim NOT valid for benefit
N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
96 Non‐covered charge(s). 6195 ‐ Service not billable to the MAC
N200 The professional component must be billed separately.
96 Non‐covered charge(s). 6192 ‐ CLIENT CUSTOM EDIT N351 Service date outside of the approved treatment plan service dates.
96 Non‐covered charge(s). 6175 ‐ CLIENT CUSTOM EDIT N20 Service not payable with other service rendered on the same date.
96 Non‐covered charge(s). 6174 ‐ CLIENT CUSTOM EDIT N425 Statutorily excluded service(s). 96 Non‐covered charge(s). 6079 ‐ Non‐covered for reasons
other than statute N425 Statutorily excluded service(s).
96 Non‐covered charge(s). 6176 ‐ Observation does not meet minimum conditions
N357 Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
96 Non‐covered charge(s). 6181 ‐ Observation E/M service criteria are not met
N357 Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
96 Non‐covered charge(s). 6200 ‐ CLIENT CUSTOM EDIT MA66 Missing/incomplete/invalid principal procedure code.
96 Non‐covered charge(s). 6095 ‐ Mult med vis on same day same rev code w/o cc GO or mod 27
M78 Missing/incomplete/invalid HCPCS modifier.
96 Non‐covered charge(s). 6207 ‐ Claim lacks required primary code
M67 Missing/incomplete/invalid other procedure code(s).
96 Non‐covered charge(s). 6208 ‐ Claim lacks required device code or required procedure code
M67 Missing/incomplete/invalid other procedure code(s).
96 Non‐covered charge(s). 6201 ‐ CLIENT CUSTOM EDIT M99 Missing/incomplete/invalid Universal Product Number/Serial Number.
96 Non‐covered charge(s). 6162 ‐ Insufficient partial hospitalization services
MA32 Missing/incomplete/invalid number of covered days during the billing period.
96 Non‐covered charge(s). 911 ‐ Invalid For Male MA39 Missing/incomplete/invalid gender. 96 Non‐covered charge(s). 912 ‐ Invalid For Female MA39 Missing/incomplete/invalid gender. 96 Non‐covered charge(s). 6213 ‐ Device‐dependent
procedure code billed without device code
MA50 Missing/incomplete/invalid Investigational Device Exemption number for FDA‐approved clinical trial services.
96 Non‐covered charge(s). 6194 ‐ CLIENT CUSTOM EDIT MA50 Missing/incomplete/invalid Investigational Device Exemption number for FDA‐approved clinical trial services.
96 Non‐covered charge(s). 6150 ‐ Code indicates a site of service not included in OPPS
M77 Missing/incomplete/invalid place of service.
96 Non‐covered charge(s). 6179 ‐ Non‐reportable for site of M77 Missing/incomplete/invalid place of service.
service 96 Non‐covered charge(s). 6095 ‐ Mult med vis on same day
same rev code w/o cc GO or mod 27
M44 Missing/incomplete/invalid condition code.
96 Non‐covered charge(s). 6147 ‐ Service submitted for MAC review (condition code 20)
M44 Missing/incomplete/invalid condition code.
96 Non‐covered charge(s). 6160 ‐ Invalid date M52 Missing/incomplete/invalid "from" date(s) of service.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
6133 ‐ Service billed as panel M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9180 ‐ (027OIS) All services incidental; no primary submitted
N19 Procedure code incidental to primary procedure.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9249 ‐ (UIN) Unbundle Procedure ‐ Incidental
N19 Procedure code incidental to primary procedure.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
6214 ‐ Incidental services reported only
N19 Procedure code incidental to primary procedure.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9473 ‐ (021EMO) Invalid medical visit same day as procedure
M144 Pre‐/post‐operative care payment is included in the allowance for the surgery/procedure.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9528 ‐ (mUB) Medicare Other Unbundle
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
382 ‐ Global payment allocated M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
801 ‐ Claim Check: Incidental Services
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9228 ‐ (HEX) Unbundled Procedure on Separate Claim is Exclusive
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9229 ‐ (HIN) History Unbundle Procedure ‐ Incidental
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9230 ‐ (HNB) Unbundle History Procedure ‐ Unbundled or Incidental
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9048 ‐ (HUD) UNBUNDLE PROCEDURE, DENY
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9049 ‐ (HUR) UNBUNDLE PROCEDURE, REVIEW
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9050 ‐ (HUS) UNBUNDLE PROCEDURE, SECONDARY
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9113 ‐ (MUH) Unbundled Procedure (per Medicare) on Separate Claim
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9098 ‐ (MBC) MEDICARE BUNDLED CODE
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9099 ‐ (MBI) BUNDLED ITEM OR SERVICE
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9093 ‐ (UUD) UNBUNDLE PROCEDURE, DENY
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9094 ‐ (UUR) UNBUNDLE PROCEDURE, REVIEW
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9095 ‐ (UUS) UNBUNDLE PROCEDURE, SECONDARY
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9076 ‐ (PRE) PRE‐OP PROCEDURE 1 DAY BEFORE SURGERY
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
9248 ‐ (UEX) Unbundled Procedure on Current Line is Exclusive
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
6128 ‐ Incorrect coding of lab panel components (Prior to V0804 )
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ SNF benefit valid within 14 days of inpatient hospital stay
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Provider overlaps global days period
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Services are Inclusive to the Rental Payment
M86 Service denied because payment already made for same/similar procedure within set time frame.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Service included as component of inpatient reimbursement.
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ DRG‐Included in Global Rate/Do Not Bill Patient
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Service included in payment for surgical procedure.
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Service Included In Global Charge
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Services are included in global payment.
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Credit applied for prior RAP payment
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ When multiple procedures are performed on the same day, payment is made based on the highest amount allowed.
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Service billed as panel M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Incorrect coding of lab panel components (Prior to V0804 )
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Due to Contract; CRNA payment included in MD payment.
N20 Service not payable with other service rendered on the same date.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ According to Medicare, payment for this service is already included in the payment for another global service.
M80 Not covered when performed during the same session/date as a previously processed service for the patient.
97 Payment is included in the allowance for another service/procedure. Changed as of 2/99
915 ‐ Included in Per Diem. M80 Not covered when performed during the same session/date as a previously processed service for the patient.
A0 Patient refund amount. 915 ‐ Advanced Payment/Reimburse Member
A0 Patient refund amount. 915 ‐ Member met OOP MAX‐ possible member reimbursement
A1 Claim denied charges. 915 ‐ Device intensive procedure without device
N122 Add‐on code cannot be billed by itself.
A1 Claim denied charges. 915 ‐ Mental health code not app for partial hospital program
N20 Service not payable with other service rendered on the same date.
A1 Claim denied charges. 915 ‐ Mental health service not pay outside the partial hosp prog
N20 Service not payable with other service rendered on the same date.
A1 Claim denied charges. 915 ‐ Non‐Payment/Zero Paid Claim Bill Type
MA30 Missing/incomplete/invalid type of bill.
A1 Claim denied charges. 915 ‐ REMIT contract change N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ REMIT contract term change
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ Nurse Audit/ Unsupported charges
N206 The supporting documentation does not match the claim
A1 Claim denied charges. 915 ‐ Billing two NDC numbers with one HCPC is Invalid
M119 Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
A1 Claim denied charges. 915 ‐ Service should be done by a PAR‐Provider
A1 Claim denied charges. 915 ‐ Service included as component of inpatient DRG reimbursement.
N525 These services are not covered when performed within the global period of another service.
A1 Claim denied charges. 915 ‐ Claim was billed as a clinical trial, Martin’s Point has not been notified that the member is enrolled in a clinical trial. Please re‐bill appropriately.
N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package
A1 Claim denied charges. 915 ‐ Professional services should be billed on CMS1500
N34 Incorrect claim form/format for this service.
A1 Claim denied charges. 915 ‐ Service unit out of range for procedure
N430 Procedure code is inconsistent with the units billed.
A1 Claim denied charges. 915 ‐ We received a claim for health care services to a GA member during a time our records indicate your license to practice was censured, reprimanded, and/or placed on probation. We cannot pay your claim and you may not bill our member for payment.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ We received a claim for health care services to a MaineSense member during a time our records indicate your license to practice was censured, reprimanded, and/or placed on probation. We cannot pay your claim and you may not bill our member for payment
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ We received a claim for health care services to a USFHP member during a time our records indicate your license to practice was censured, reprimanded, or placed on probation. We cannot pay your claim and you may not bill our member for payment.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ Provider Not on File N253 Missing/incomplete/invalid attending provider primary identifier.
A1 Claim denied charges. 915 ‐ Part of OptumHealth's Global Negotiation
N525 These services are not covered when performed within the global period of another service.
A1 Claim denied charges. 915 ‐ Claim denied manually A1 Claim denied charges. 915 ‐ Generate 1500 From EPSDT
Form N34 Incorrect claim form/format for this service.
A1 Claim denied charges. 915 ‐ Claim Total Mismatch M79 Missing/incomplete/invalid charge. A1 Claim denied charges. 915 ‐ Benefit Applies to PCP Only N381 Consult our contractual agreement for
restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ Invalid For Male MA39 Missing/incomplete/invalid gender. A1 Claim denied charges. 915 ‐ Invalid For Female MA39 Missing/incomplete/invalid gender. A1 Claim denied charges. 915 ‐ Incidental Procedure N19 Procedure code incidental to primary procedure.
A1 Claim denied charges. 915 ‐ Provider Incomplete N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ No Contract Term found for Service
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ Referral Required by Contract
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ No Active Provider Contract N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ Provider Not Active for Plan on DOS
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ Authorization line item denied.
N41 Authorization request denied.
A1 Claim denied charges. 915 ‐ Place of service does not match authorized
N428 Service/procedure not covered when performed in this place of service.
A1 Claim denied charges. 915 ‐ Maintenance Benefit Max has been exceeded.
N372 Only reasonable and necessary maintenance/service charges are covered.
A1 Claim denied charges. 915 ‐ Plan not advised in 72 hrs. Medical review denial.
A1 Claim denied charges. 915 ‐ Claim has been denied. At DOS, assigned to other PCP.
A1 Claim denied charges. 915 ‐ The Provider is not a member of the UHC PPO Network.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ DME rental costs have exceeded purchase price.
M7 No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price.
A1 Claim denied charges. 915 ‐ Included in OB package. N252 Missing/incomplete/invalid attending provider name.
A1 Claim denied charges. 915 ‐ Split billing required. N61 Rebill services on separate claims. A1 Claim denied charges. 915 ‐ Included in other
procedure. N20 Service not payable with other service rendered
on the same date. A1 Claim denied charges. 915 ‐ Assistant surgeon not
covered. M86 Service denied because payment already made
for same/similar procedure within set time frame.
A1 Claim denied charges. 915 ‐ Member Not Eligible on Date of Service
N30 Patient ineligible for this service.
A1 Claim denied charges. 915 ‐ We received a claim for health care services to a GA member during a time our records indicate you were sanctioned and excluded from participation in Medicare. Federal law prohibits us from paying your claim and you may not bill our member for payment.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ We received a claim for health care services to a MaineSense member during a time our records indicate you were sanctioned and excluded
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
from participation in Medicare. We cannot pay your claim and you may not bill our member for payment.
A1 Claim denied charges. 915 ‐ We received a claim for services to a USFHP member during a time our records indicate you were sanctioned and excluded from participation in TRICARE. Federal law prohibits us from paying your claim and you may not bill our member for payment.
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 915 ‐ Final bill Received A1 Claim denied charges. 915 ‐ A Medicare Set Aside
Account exist for the services rendered on this claim. Please bill responsible administrator.
MA48 Missing/incomplete/invalid name or address of responsible party or primary payer.
A1 Claim denied charges. 9480 ‐ (045SNA) Medicare separate procedure
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
A1 Claim denied charges. 9491 ‐ (106SLP/106hSLP) Lab panel billed as separate services
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
A1 Claim denied charges. 9527 ‐ (mSPh) Medicare Post‐Op Surgery By Provider in History
M144 Pre‐/post‐operative care payment is included in the allowance for the surgery/procedure.
A1 Claim denied charges. 9111 ‐ (MSP) MEDICARE POST‐OP SURGERY BY PROVIDER
M144 Pre‐/post‐operative care payment is included in the allowance for the surgery/procedure.
A1 Claim denied charges. 9077 ‐ (PRH) PRE‐OP PROC IN HISTORY 1 DAY B4 SURGERY
M144 Pre‐/post‐operative care payment is included in the allowance for the surgery/procedure.
A1 Claim denied charges. 641 ‐ Multiple Instances of Revenue Code 0024 on Claim
M50 Missing/incomplete/invalid revenue code(s).
A1 Claim denied charges. 408 ‐ Line failed for Medical Policy Rule
M16 Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
A1 Claim denied charges. 9008 ‐ External Claim Editing Bypassed
A1 Claim denied charges. 294 ‐ Claim Line Overlaps Contract Affiliation Term Date
A1 Claim denied charges. 296 ‐ Claim Line Overlaps Contract Term Termination Date
A1 Claim denied charges. 9089 ‐ (UID) INCIDENTAL PROCEDURE, DENY
N19 Procedure code incidental to primary procedure.
A1 Claim denied charges. 9090 ‐ (UIR) INCIDENTAL PROCEDURE, REVIEW
N19 Procedure code incidental to primary procedure.
A1 Claim denied charges. 9091 ‐ (UIS) INCIDENTAL PROCEDURE, SECONDARY
N19 Procedure code incidental to primary procedure.
A1 Claim denied charges. 9253 ‐ (080MHA) Service not approved for partial hospitalization
N188 The approved level of care does not match the procedure code submitted.
A1 Claim denied charges. 9044 ‐ (HID) INCIDENTAL PROCEDURE, DENY
N19 Procedure code incidental to primary procedure.
A1 Claim denied charges. 9045 ‐ (HIR) INCIDENTAL PROCEDURE, REVIEW
N19 Procedure code incidental to primary procedure.
A1 Claim denied charges. 9046 ‐ (HIS) INCIDENTAL PROCEDURE, SECONDARY
N19 Procedure code incidental to primary procedure.
A1 Claim denied charges. 917 ‐ Manually‐altered pay amount
N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 921 ‐ Claim manually priced with no balance checks or validation
N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 347 ‐ RAP has more than one detail line
N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 348 ‐ Line #1 date must equal episode start date
N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 235 ‐ Override Reimburse Member option
N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 258 ‐ Emergency Claim does not match Emergency Benefit
N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 341 ‐ HH PPS No Rap present for claim
N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 130 ‐ Program Watch N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 127 ‐ Sponsor Watch N220 Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
A1 Claim denied charges. 402 ‐ Maximum units exceeded for Medical Policy
N362 The number of Days or Units of Service exceeds our acceptable maximum.
A1 Claim denied charges. 170 ‐ Claim and contract term type of service do NOT match
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
A1 Claim denied charges. 6082 ‐ Service unit out of range for procedure
N430 Procedure code is inconsistent with the units billed.
A1 Claim denied charges. 9254 ‐ (081MHP) Service only valid for partial hospitalization
N20 Service not payable with other service rendered on the same date.
A1 Claim denied charges. 6122 ‐ Mental health code not app for partial hospital program
N20 Service not payable with other service rendered on the same date.
A1 Claim denied charges. 6123 ‐ Mental health service not pay outside the partial hosp prog
N20 Service not payable with other service rendered on the same date.
A1 Claim denied charges. 9182 ‐ (030PHI)Insufficient services‐day of partial hospitalization
N20 Service not payable with other service rendered on the same date.
A1 Claim denied charges. 9030 ‐ (COS) TYPICALLY COSMETIC PROCEDURE
N383 Services deemed cosmetic are not covered
A1 Claim denied charges. 9256 ‐ (083NCD) Service provided on or after end of NCD coverage
N386 This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
A1 Claim denied charges. 9032 ‐ Patient gender invalid for service
MA39 Missing/incomplete/invalid gender.
A1 Claim denied charges. 9220 ‐ (BAG/LCAG) Inappropriate Age for LCD
N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
A1 Claim denied charges. 9237 ‐ (LDY/LCDY) LCD Deny N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
A1 Claim denied charges. 9458 ‐ (LCD) LCD Part B policy requirements not met for procedure
N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
A1 Claim denied charges. 194 ‐ Restrict Benefit by Date of ONSET
N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
A1 Claim denied charges. 173 ‐ Diagnosis on claim does NOT match terms valid range
MA63 Missing/incomplete/invalid principal diagnosis.
A1 Claim denied charges. 6028 ‐ Manifestation code as principal
MA63 Missing/incomplete/invalid principal diagnosis.
A1 Claim denied charges. 9068 ‐ (NPD) NOT A PRIMARY DIAGNOSIS
MA63 Missing/incomplete/invalid principal diagnosis.
A1 Claim denied charges. 9162 ‐ Unacceptable principal MA63 Missing/incomplete/invalid principal diagnosis.
diagnosis A1 Claim denied charges. 9172 ‐ (005EPD) E‐diagnosis code
invalid as principal diagnosis MA63 Missing/incomplete/invalid principal diagnosis.
A1 Claim denied charges. 9158 ‐ E‐code cannot be used as principal diagnosis
MA63 Missing/incomplete/invalid principal diagnosis.
A1 Claim denied charges. 9159 ‐ Manifestation code cannot be used as principle DX
MA63 Missing/incomplete/invalid principal diagnosis.
A1 Claim denied charges. 9145 ‐ Diagnosis code duplicate of claim principal diagnosis
MA63 Missing/incomplete/invalid principal diagnosis.
A1 Claim denied charges. 9138 ‐ Admit diagnosis invalid MA65 Missing/incomplete/invalid admitting diagnosis. A1 Claim denied charges. 9257 ‐ (mDT) Medicare
Diagnostic Testing in Hospital Setting
M77 Missing/incomplete/invalid place of service.
A1 Claim denied charges. 169 ‐ Claim and contract term modifiers do NOT match
M78 Missing/incomplete/invalid HCPCS modifier.
A1 Claim denied charges. 9146 ‐ Diagnosis code duplicate of other secondary diagnosis
M64 Missing/incomplete/invalid other diagnosis.
A1 Claim denied charges. 9137 ‐ (LDDX01) Diagnosis denied by Medicare
M64 Missing/incomplete/invalid other diagnosis.
a1 Claim denied charges. 6125 ‐ No available APC/fee schedule rate
a1 Claim denied charges. 6116 ‐ Incorrect billing of blood and blood products
B1 Non‐covered visits. 915 ‐ Medical review denial. B10 Allowed amount has been reduced because a
component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
9463 ‐ (mMP/MPh) Medicare Multiple Procedure Reduction
B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
9460 ‐ (mDR/mDRh) Medicare Diagnostic Radiology Reduction
B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
9461 ‐ (mER/mERh) Medicare Multiple Endoscopy Reduction
B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
9472 ‐ (020CCP/020hCCP) Component billed with comprehensive code
B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
9026 ‐ Bilateral procedure reduction
B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
9065 ‐ Multiple procedure reductions
B13 Previously paid. Payment for this claim/service may have been provided in a previous payment.
915 ‐ CPT codes billed include bundled and unbundled
M50 Missing/incomplete/invalid revenue code(s).
B13 Previously paid. Payment for this claim/service may have been provided in a previous payment.
915 ‐ CPT codes billed include bundled and unbundled CPTs
M50 Missing/incomplete/invalid revenue code(s).
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
915 ‐ Services not separately payable under OPPS
M86 Service denied because payment already made for same/similar procedure within set time frame.
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
915 ‐ Team Surgeon not covered N20 Service not payable with other service rendered on the same date.
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
915 ‐ Co‐Surgeon not Covered N20 Service not payable with other service rendered on the same date.
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
915 ‐ Co‐Surgeon Not Covered N20 Service not payable with other service rendered on the same date.
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
915 ‐ Team Surgeon Not Covered N20 Service not payable with other service rendered on the same date.
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
915 ‐ Assistant surgeon not allowed
N20 Service not payable with other service rendered on the same date.
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
915 ‐ Co‐surgeon not allowed N20 Service not payable with other service rendered on the same date.
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
915 ‐ Team surgeon not allowed N20 Service not payable with other service rendered on the same date.
B15 Payment adjusted because this procedure/service is not paid separately. Changed as of 2/01
9481 ‐ (047SSP) Service is not separately payable per Medicare
M86 Service denied because payment already made for same/similar procedure within set time frame.
B16 Payment adjusted because ̀ New Patient' qualifications were not met. Changed as of 2/01
9070 ‐ (NPT) NEW PATIENT CODE FOR EST PATIENT
B16 Payment adjusted because ̀ New Patient' qualifications were not met. Changed as of 2/01
814 ‐ Claim Check: New Visit E&M Audit
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
271 ‐ Benefit Restriction Group Validation Failed
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
6202 ‐ Incorrect billing of revenue code with HCPCS code
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
272 ‐ Member does not have coverage code required on benefit
N30 Patient ineligible for this service.
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
915 ‐ Coverage Period Insufficient for Benefit Coverage
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
915 ‐ Provider doesn't meet criteria required to provide service
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
915 ‐ No Contract with Provider N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
915 ‐ No Provider Affiliation with Health Plan
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
915 ‐ Service Not Covered by Contract with Provider
N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges.
B5 Payment adjusted because coverage/program guidelines were not met or were exceeded. Changed as of 2/01
915 ‐ Non‐Payment adjustment‐ information adjusted due to requirements of the Department of Defense.
B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. Changed as of 10/98
915 ‐ Provider type does not match term
B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. Changed as of 10/98
405 ‐ Provider Type is invalid for Medical Policy
N95 This provider type/provider specialty may not bill this service.
B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. Changed as of 10/98
406 ‐ Physician specialty is invalid for Medical Policy
N95 This provider type/provider specialty may not bill this service.
B9 Services not covered because the patient is enrolled in a Hospice.
915 ‐ Hospice related services are not separately reimbursable, only non‐hospice related services are.
M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
B9 Services not covered because the patient is enrolled in a Hospice.
915 ‐ Hospice claims require Original Medicare Explanation of Benefits (EOB)
N479 Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
P2 Not a work related injury/illness and thus not the liability of the workers' compensation carrier Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only. Start: 11/01/2013 Notes: This code replaces deactivated code 191
915 ‐ No Third Party Involvement
P2 Not a work related injury/illness and thus not the liability of the workers' compensation carrier Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only. Start: 11/01/2013 Notes: This code replaces deactivated code 191
915 ‐ No Third Party Involvement or Exhausted
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