Remittance Advice Remark Codes

X-ray not taken within the past 12 months or near enough to the start of treatment.

Start: 1/1/1997

Not paid separately when the patient is an inpatient.

Start: 1/1/1997

Equipment is the same or similar to equipment already being used.

Start: 1/1/1997

Alert: This is the last monthly installment payment for this durable medical equipment.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.

Start: 1/1/1997

Alert: You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for every 6 month period after the end of the 15th paid rental month or the end of the warranty period.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price.

Start: 1/1/1997

We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.

Start: 1/1/1997

Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Equipment purchases are limited to the first or the tenth month of medical necessity.

Start: 1/1/1997

DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.

Start: 1/1/1997

Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.

Start: 1/1/1997

Only one initial visit is covered per specialty per medical group.

Start: 1/1/1997 | Last Modified: 6/30/2007

Note: (Modified 6/30/03)

No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.

Start: 1/1/1997

Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.

Start: 1/1/1997

Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Reactivated 4/1/04, Modified 11/18/05, 4/1/07)

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.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient's home.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Missing oxygen certification/re-certification.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N234

Missing/incomplete/invalid HCPCS.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid place of residence for this service/item provided in a home.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid number of miles traveled.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing invoice.

Start: 1/1/1997 | Last Modified: 8/1/2005

Note: (Modified 8/1/05)

Missing/incomplete/invalid number of doses per vial.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

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 a 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.

Start: 1/1/1997 | Last Modified: 11/5/2007

Note: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07)

The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service /any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice.

The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.

Start: 1/1/1997 | Last Modified: 11/5/2007

Note: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356)

Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office.

Start: 1/1/1997 | Last Modified: 8/1/2007

Note: (Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07)

This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.

Start: 1/1/1997

Missing operative note/report.

Start: 1/1/1997 | Last Modified: 7/1/2008

Note: (Modified 2/28/03, 7/1/2008) Related to N233

Missing pathology report.

Start: 1/1/1997 | Last Modified: 8/1/2004

Note: (Modified 8/1/04, 2/28/03) Related to N236

Missing radiology report.

Start: 1/1/1997 | Last Modified: 8/1/2004

Note: (Modified 8/1/04, 2/28/03) Related to N240

Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing/incomplete/invalid UPIN for the ordering/referring/performing provider.

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using M68

Claim lacks the CLIA certification number.

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using MA120

Missing/incomplete/invalid pre-operative photos or visual field results.

Start: 1/1/1997 | Stop: 2/5/2005

Note: Consider using N178

This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase.

Start: 1/1/1997

Service not covered when the patient is under age 35.

Start: 1/1/1997

The patient is liable for the charges for this service as you informed the patient in writing before the service was furnished that we would not pay for it, and the patient agreed to pay.

Start: 1/1/1997

Alert: The patient is not liable for payment for this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 2/1/04, 4/1/07)

Claim must be assigned and must be filed by the practitioner's employer.

Start: 1/1/1997

We do not pay for this as the patient has no legal obligation to pay for this.

Start: 1/1/1997

The medical necessity form must be personally signed by the attending physician.

Start: 1/1/1997

Payment for this service previously issued to you or another provider by another carrier/intermediary.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using Reason Code 23

Missing/incomplete/invalid condition code.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid occurrence code(s).

Start: 1/1/1997 | Last Modified: 12/2/2004

Note: (Modified 12/2/04) Related to N299

Missing/incomplete/invalid occurrence span code(s).

Start: 1/1/1997 | Last Modified: 12/2/2004

Note: (Modified 12/2/04) Related to N300

Missing/incomplete/invalid internal or document control number.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Payment for services furnished to hospital inpatients (other than professional services of physicians) can only be made to the hospital. You must request payment from the hospital rather than the patient for this service.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using M97

Missing/incomplete/invalid value code(s) or amount(s).

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid revenue code(s).

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid procedure code(s).

Start: 1/1/1997 | Last Modified: 12/2/2004

Note: (Modified 12/2/04) Related to N301

Missing/incomplete/invalid “from” date(s) of service.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid days or units of service.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid total charges.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.

Start: 1/1/1997

Missing/incomplete/invalid payer identifier.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid provider identifier.

Start: 1/1/1997 | Stop: 6/2/2005

Missing/incomplete/invalid claim information. Resubmit claim after corrections.

Start: 1/1/1997 | Stop: 2/5/2005

Missing/incomplete/invalid “to” date(s) of service.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing Certificate of Medical Necessity.

Start: 1/1/1997 | Last Modified: 8/1/2004

Note: (Modified 8/1/04, 6/30/03) Related to N227

We cannot pay for this as the approval period for the FDA clinical trial has expired.

Start: 1/1/1997

Missing/incomplete/invalid treatment authorization code.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

We do not pay for more than one of these on the same day.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using M86

Missing/incomplete/invalid other diagnosis.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.

Start: 1/1/1997

Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items.

Start: 1/1/1997

Missing/incomplete/invalid other procedure code(s).

Start: 1/1/1997 | Last Modified: 12/2/2004

Note: (Modified 12/2/04) Related to N302

Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification.

Start: 1/1/1997 | Stop: 6/2/2005

Paid at the regular rate as you did not submit documentation to justify the modified procedure code.

Start: 1/1/1997 | Last Modified: 2/1/2004

Note: (Modified 2/1/04)

Alert: The NDC code submitted for this service was translated to a HCPCS code for processing, but please continue to submit the NDC on future claims for this item.

Start: 1/1/1997 | Last Modified: 8/1/2007

Note: (Modified 4/1/2007, 8/1/07)

Total payment reduced due to overlap of tests billed.

Start: 1/1/1997

Did not enter full 8-digit date (MM/DD/CCYY).

Start: 1/1/1997 | Stop: 10/16/2003

Note: Consider using MA52

The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.

Start: 1/1/1997 | Last Modified: 8/1/2004

Note: (Modified 8/1/04)

This service does not qualify for a HPSA/Physician Scarcity bonus payment.

Start: 1/1/1997 | Last Modified: 12/2/2004

Note: (Modified 12/2/04)

Multiple automated multichannel tests performed on the same day combined for payment.

Start: 1/1/1997 | Last Modified: 11/5/2007

Note: (Modified 11/5/07)

Missing/incomplete/invalid diagnosis or condition.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid place of service.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid HCPCS modifier.

Start: 1/1/1997 | Stop: 5/18/2006 | Last Modified: 2/28/2003

Note: (Modified 2/28/03,) Consider using Reason Code 4

Missing/incomplete/invalid charge.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Not covered when performed during the same session/date as a previously processed service for the patient.

Start: 1/1/1997 | Last Modified: 10/31/2002

Note: (Modified 10/31/02)

You are required to code to the highest level of specificity.

Start: 1/1/1997 | Last Modified: 2/1/2004

Note: (Modified 2/1/04)

Service is not covered when patient is under age 50.

Start: 1/1/1997

Service is not covered unless the patient is classified as at high risk.

Start: 1/1/1997

Medical code sets used must be the codes in effect at the time of service

Start: 1/1/1997 | Last Modified: 2/1/2004

Note: (Modified 2/1/04)

Subjected to review of physician evaluation and management services.

Start: 1/1/1997

Service denied because payment already made for same/similar procedure within set time frame.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Claim/service(s) subjected to CFO-CAP prepayment review.

Start: 1/1/1997

We cannot pay for laboratory tests unless billed by the laboratory that did the work.

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using Reason Code B20

Not covered more than once under age 40.

Start: 1/1/1997

Not covered more than once in a 12 month period.

Start: 1/1/1997

Lab procedures with different CLIA certification numbers must be billed on separate claims.

Start: 1/1/1997

Services subjected to review under the Home Health Medical Review Initiative.

Start: 1/1/1997 | Stop: 8/1/2004

Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.

Start: 1/1/1997

Information supplied does not support a break in therapy. A new capped rental period will not begin.

Start: 1/1/1997

Services subjected to Home Health Initiative medical review/cost report audit.

Start: 1/1/1997

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.

Start: 1/1/1997

Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.

Start: 1/1/1997

Begin to report the Universal Product Number on claims for items of this type. We will soon begin to deny payment for items of this type if billed without the correct UPN.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using M99

Missing/incomplete/invalid Universal Product Number/Serial Number.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug.

Start: 1/1/1997

Begin to report a G1-G5 modifier with this HCPCS. We will soon begin to deny payment for this service if billed without a G1-G5 modifier.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using M78

Service not performed on equipment approved by the FDA for this purpose.

Start: 1/1/1997

Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.

Start: 1/1/1997

Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.

Start: 1/1/1997

Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.

Start: 1/1/1997

Information supplied does not support a break in therapy. A new capped rental period will not begin. This is the maximum approved under the fee schedule for this item or service.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using MA 31

Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.

Start: 1/1/1997

Missing/incomplete/invalid provider identifier for the provider who interpreted the diagnostic test.

Start: 1/1/1997 | Stop: 6/2/2005

We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.

Start: 1/1/1997

Missing/incomplete/invalid provider identifier for the provider from whom you purchased interpretation services.

Start: 1/1/1997 | Stop: 6/2/2005

We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.

Start: 1/1/1997

Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.

Start: 1/1/1997 | Last Modified: 11/5/2007

Note: (Modified 11/5/07)

Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.

Start: 1/1/1997 | Last Modified: 11/5/2007

Note: (Modified 11/5/07)

This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.

Start: 1/1/1997 | Last Modified: 11/5/2007

Note: (Modified 8/1/06, 11/5/07)

This item is denied when provided to this patient by a non-contract or non-demonstration supplier.

Start: 1/1/1997 | Last Modified: 11/5/2007

Note: (Modified 11/5/2007)

Paid under the Competitive Bidding Demonstration project. Project is ending, and future services may not be paid under this project.

Start: 1/1/1997 | Last Modified: 2/1/2004

Note: (Modified 2/1/04)

Not covered unless submitted via electronic claim.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Alert: Letter to follow containing further information.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 2/28/03, 4/1/04)

Missing/incomplete/invalid provider identifier for the substituting physician who furnished the service(s) under a reciprocal billing or locum tenens arrangement.

Start: 1/1/1997 | Stop: 6/2/2005

We pay for this service only when performed with a covered cryosurgical ablation.

Start: 1/1/1997

Missing/incomplete/invalid level of subluxation.

Start: 1/1/1997 | Last Modified: 2/28/2006

Note: (Modified 2/28/03)

Missing/incomplete/invalid name, strength, or dosage of the drug furnished.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing indication of whether the patient owns the equipment that requires the part or supply.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N230

Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid individual lab codes included in the test.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing patient medical record for this service.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N237

Missing/incomplete/invalid date of the patient’s last physician visit.

Start: 1/1/1997 | Stop: 6/2/2005

Missing/incomplete/invalid indicator of x-ray availability for review.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 2/28/03, 6/30/03)

Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N231

Missing physician financial relationship form.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N239

Missing pacemaker registration form.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N235

Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.

Start: 1/1/1997

Performed by a facility/supplier in which the provider has a financial interest.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Missing/incomplete/invalid plan of treatment.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Part B coinsurance under a demonstration project.

Start: 1/1/1997

Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants.

Start: 1/1/1997

Denied services exceed the coverage limit for the demonstration.

Start: 1/1/1997

Service not covered until after the patient’s 50th birthday, i.e., no coverage prior to the day after the 50th birthday

Start: 1/1/1997 | Stop: 1/30/2004

Note: Consider using M82

Missing physician certified plan of care.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N238

Missing American Diabetes Association Certificate of Recognition.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N226

The provider must update license information with the payer.

Start: 1/1/1997 | Last Modified: 12/1/2006

Note: (Modified 12/1/06)

Pre-/post-operative care payment is included in the allowance for the surgery/procedure.

Start: 1/1/1997

Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07)

Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07)

If you do not agree with the approved amounts and $100 or more is in dispute (less deductible and coinsurance), you may ask for a hearing within six months of the date of this notice. To meet the $100, you may combine amounts on other claims that have been denied, including reopened appeals if you received a revised decision. You must appeal each claim on time.

Start: 1/1/1997 | Stop: 10/1/2006 | Last Modified: 11/18/2005

Note: Consider using MA02 (Modified 10/31/02, 6/30/03, 8/1/05, 11/18/05)

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.

Start: 1/1/1997

Incorrect admission date patient status or type of bill entry on claim.

Start: 1/1/1997 | Stop: 10/16/2003

Note: Consider using MA30, MA40 or MA43

Missing/incomplete/invalid beginning and/or ending date(s).

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using MA31

Alert: The claim information has also been forwarded to Medicaid for review.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Claim submitted as unassigned but processed as assigned. You agreed to accept assignment for all claims.

Start: 1/1/1997

Alert: The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Payment is being issued on a conditional basis. If no-fault insurance, liability insurance, Workers' Compensation, Department of Veterans Affairs, or a group health plan for employees and dependents also covers this claim, a refund may be due us. Please contact us if the patient is covered by any of these sources.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using M32

You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).

Start: 1/1/1997

Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services.

Start: 1/1/1997 | Last Modified: 8/1/2007

Note: (Modified 4/1/07, 8/1/07)

Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.

Start: 1/1/1997

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.

Start: 1/1/1997

Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondary claim directly to that insurer.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

SSA records indicate mismatch with name and sex.

Start: 1/1/1997

Payment of less than $1.00 suppressed.

Start: 1/1/1997

Demand bill approved as result of medical review.

Start: 1/1/1997

Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

A patient may not elect to change a hospice provider more than once in a benefit period.

Start: 1/1/1997

Alert: Our records indicate that you were previously informed of this rule.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing/incomplete/invalid entitlement number or name shown on the claim.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Alert: Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing/incomplete/invalid provider name, city, state, or zip code.

Start: 1/1/1997 | Stop: 6/2/2005

Missing/incomplete/invalid type of bill.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid beginning and ending dates of the period billed.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid number of covered days during the billing period.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid non-covered days during the billing period.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid number of coinsurance days during the billing period.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid number of lifetime reserve days.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid patient name.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid patient's address.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid birth date.

Start: 1/1/1997 | Stop: 6/2/2005

Missing/incomplete/invalid gender.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid admission date.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid admission type.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid admission source.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid patient status.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Alert: No appeal rights. Adjudicative decision based on law.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: As previously advised, a portion or all of your payment is being held in a special account.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

The new information was considered, however, additional payment cannot be issued. Please review the information listed for the explanation.

Start: 1/1/1997

Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.

Start: 1/1/1997

Missing/incomplete/invalid name or address of responsible party or primary payer.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid six-digit provider identifier for home health agency or hospice for physician(s) performing care plan oversight services.

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using MA76

Missing/incomplete/invalid Investigational Device Exemption number for FDA-approved clinical trial services.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory.

Start: 1/1/1997 | Stop: 2/5/2005

Note: Consider using MA120

Missing/incomplete/invalid date.

Start: 1/1/1997 | Stop: 6/2/2005

Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.

Start: 1/1/1997 | Last Modified: 2/1/2004

Note: (Modified 2/1/04)

Physician certification or election consent for hospice care not received timely.

Start: 1/1/1997

Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.

Start: 1/1/1997

Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.

Start: 1/1/1997

Patient submitted written request to revoke his/her election for religious non-medical health care services.

Start: 1/1/1997

Missing/incomplete/invalid release of information indicator.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Alert: The patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing/incomplete/invalid patient relationship to insured.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid social security number or health insurance claim number.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Alert: This is a telephone review decision.

Start: 1/1/1997 | Last Modified: 8/1/2007

Note: (Modified 4/1/07, 8/1/07)

Missing/incomplete/invalid principal diagnosis.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

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.

Start: 1/1/1997

Missing/incomplete/invalid admitting diagnosis.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid principal procedure code.

Start: 1/1/1997 | Last Modified: 12/2/2004

Note: (Modified 12/2/04) Related to N303

Correction to a prior claim.

Start: 1/1/1997

Alert: We did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to assure correct and timely routing of the claim.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing/incomplete/invalid remarks.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid provider representative signature.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid provider representative signature date.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.

Start: 1/1/1997

This payment replaces an earlier payment for this claim that was either lost, damaged or returned.

Start: 1/1/1997

Missing/incomplete/invalid patient or authorized representative signature.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03, 2/1/04)

Alert: The patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient’s payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice.

Start: 1/1/1997 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

The patient overpaid you. You must issue the patient a refund within 30 days for the difference between our allowed amount total and the amount paid by the patient.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using MA59

Billed in excess of interim rate.

Start: 1/1/1997

Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project.

Start: 1/1/1997

Missing/incomplete/invalid provider/supplier signature.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid provider/supplier billing number/identifier or billing name, address, city, state, zip code, or phone number.

Start: 1/1/1997 | Stop: 6/2/2005

Did not indicate whether we are the primary or secondary payer.

Start: 1/1/1997 | Last Modified: 8/1/2005

Note: (Modified 8/1/05)

Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.

Start: 1/1/1997

Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance plan/group/program name or identification number. Enter the Plan ID when effective.

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using MA92

Missing/incomplete/invalid group or policy number of the insured for the primary coverage.

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using MA92

Missing/incomplete/invalid insured's name for the primary payer.

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using MA92

Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid patient's relationship to the insured for the primary payer.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid employment status code for the primary insured.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03).

This determination is the result of the appeal you filed.

Start: 1/1/1997

Missing plan information for other insurance.

Start: 1/1/1997 | Last Modified: 2/1/2004

Note: (Modified 2/1/04) Related to N245

Non-PIP (Periodic Interim Payment) claim.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Did not enter the statement “Attending physician not hospice employee” on the claim form to certify that the rendering physician is not an employee of the hospice.

Start: 1/1/1997 | Last Modified: 8/1/2005

Note: (Reactivated 4/1/04, Modified 8/1/05)

De-activate and refer to M51.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.

Start: 1/1/1997

Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.

Start: 1/1/1997 | Last Modified: 2/29/2008

Note: (Modified 2/29/08)

Claim Rejected. Does not contain the correct Medicare Managed Care Demonstration contract number for this beneficiary.

Start: 1/1/1997 | Stop: 10/16/2003

Note: Consider using MA97

Missing/incomplete/invalid Medigap information.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid date of current illness or symptoms

Start: 1/1/1997 | Last Modified: 3/30/2005

Note: (Modified 2/28/03, 3/30/05)

A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider.

Start: 1/1/1997 | Stop: 8/1/2004

Note: Consider using M68

Hemophilia Add On.

Start: 1/1/1997

Missing/incomplete/invalid date the patient was last seen or the provider identifier of the attending physician.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using M128 or M57

Missing/incomplete/invalid provider number for this place of service.

Start: 1/1/1997 | Stop: 6/2/2005

PIP (Periodic Interim Payment) claim.

Start: 1/1/1997 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Paper claim contains more than three separate data items in field 19.

Start: 1/1/1997

Paper claim contains more than one data item in field 23.

Start: 1/1/1997

Claim processed in accordance with ambulatory surgical guidelines.

Start: 1/1/1997

Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid group practice information.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.

Start: 1/1/1997

Missing/incomplete/invalid information on where the services were furnished.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.

Start: 1/1/1997

Note: (Reactivated 4/1/04)

This claim has been assessed a $1.00 user fee.

Start: 1/1/1997

Coinsurance and/or deductible amounts apply to a claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. No Medicare payment issued.

Start: 1/1/1997

Provider level adjustment for late claim filing applies to this claim.

Start: 1/1/1997 | Stop: 5/1/2008 | Last Modified: 11/5/2007

Note: Consider using Reason Code B4

Missing/incomplete/invalid CLIA certification number.

Start: 1/1/1997 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid x-ray date.

Start: 1/1/1997 | Last Modified: 12/2/2004

Note: (Modified 12/2/04)

Missing/incomplete/invalid initial treatment date.

Start: 1/1/1997 | Last Modified: 12/2/2004

Note: (Modified 12/2/04)

Your center was not selected to participate in this study, therefore, we cannot pay for these services.

Start: 1/1/1997

Processed for IME only.

Start: 1/1/1997 | Stop: 1/31/2004

Note: Consider using Reason Code 74

Per legislation governing this program, payment constitutes payment in full.

Start: 1/1/1997

Pancreas transplant not covered unless kidney transplant performed.

Start: 10/12/2001

Reserved for future use.

Start: 10/12/2001 | Stop: 6/2/2005

Missing/incomplete/invalid FDA approval number.

Start: 10/12/2001 | Last Modified: 3/30/2005

Note: (Modified 2/28/03, 3/30/05)

This provider was not certified for this procedure on this date of service.

Start: 10/12/2001 | Stop: 1/31/2004 | Last Modified: 1/31/2004

Note: Consider using MA120 and Reason Code B7

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.

Start: 10/12/2001

Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim.

Start: 10/12/2001

Adjustment to the pre-demonstration rate.

Start: 10/12/2001

Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.

Start: 10/12/2001

Missing/incomplete/invalid provider number of the facility where the patient resides.

Start: 10/12/2001

Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.

Start: 1/1/2000 | Last Modified: 4/1/2007

Note: (Modified 2/28/03, 4/1/07)

This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.

Start: 1/1/2000

Missing consent form.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03) Related to N228

Missing/incomplete/invalid prior insurance carrier EOB.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

EOB received from previous payer. Claim not on file.

Start: 1/1/2000

Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Processing of this claim/service has included consideration under Major Medical provisions.

Start: 1/1/2000

Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.

Start: 1/1/2000

Adjustment represents the estimated amount a previous payer may pay.

Start: 1/1/2000 | Last Modified: 11/18/2005

Note: (Modified 11/18/05)

Payment based on the findings of a review organization/professional consult/manual adjudication/medical or dental advisor.

Start: 1/1/2000 | Last Modified: 7/1/2008

Note: (Modified 10/31/02, 7/1/08)

Denial reversed because of medical review.

Start: 1/1/2000

Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.

Start: 1/1/2000 | Last Modified: 8/1/2007

Note: (Modified 8/1/07)

Payment based on professional/technical component modifier(s).

Start: 1/1/2000

Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount.

Start: 1/1/2000 | Stop: 10/1/2007

Note: Consider using Reason Code 45

Services for a newborn must be billed separately.

Start: 1/1/2000

Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.

Start: 1/1/2000

Per admission deductible.

Start: 1/1/2000 | Stop: 8/1/2004

Note: Consider using Reason Code 1

Payment based on the Medicare allowed amount.

Start: 1/1/2000 | Stop: 1/31/2004

Note: Consider using N14

Procedure code incidental to primary procedure.

Start: 1/1/2000

Service not payable with other service rendered on the same date.

Start: 1/1/2000

Alert: Your line item has been separated into multiple lines to expedite handling.

Start: 1/1/2000 | Last Modified: 4/1/2007

Note: (Modified 8/1/05, 4/1/07)

This procedure code was added/changed because it more accurately describes the services rendered.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 10/31/02, 2/28/03)

Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.

Start: 1/1/2000 | Last Modified: 4/1/2007

Note: (Modified 8/13/01, 4/1/07)

Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan.

Start: 1/1/2000

Missing itemized bill/statement.

Start: 1/1/2000 | Last Modified: 7/1/2008

Note: (Modified 2/28/03, 7/1/2008) Related to N232

Missing/incomplete/invalid treatment number.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Consent form requirements not fulfilled.

Start: 1/1/2000

Missing documentation/orders/notes/summary/report/chart.

Start: 1/1/2000 | Last Modified: 8/1/2005

Note: (Modified 2/28/03, 8/1/05) Related to N225

Patient ineligible for this service.

Start: 1/1/2000 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Missing/incomplete/invalid prescribing provider identifier.

Start: 1/1/2000 | Last Modified: 12/2/2004

Note: (Modified 12/2/04)

Claim must be submitted by the provider who rendered the service.

Start: 1/1/2000 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

No record of health check prior to initiation of treatment.

Start: 1/1/2000

Incorrect claim form/format for this service.

Start: 1/1/2000 | Last Modified: 11/18/2005

Note: (Modified 11/18/05)

Program integrity/utilization review decision.

Start: 1/1/2000

Claim must meet primary payer’s processing requirements before we can consider payment.

Start: 1/1/2000

Missing/incomplete/invalid tooth number/letter.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid place of service.

Start: 1/1/2000 | Stop: 2/5/2005

Note: Consider using M77

Procedure code is not compatible with tooth number/letter.

Start: 1/1/2000

Missing radiology film(s)/image(s).

Start: 1/1/2000 | Last Modified: 7/1/2008

Note: (Modified 2/1/04, 7/1/08) Related to N242

Authorization request denied.

Start: 1/1/2000 | Stop: 10/16/2003

Note: Consider using Reason Code 39

No record of mental health assessment.

Start: 1/1/2000

Bed hold or leave days exceeded.

Start: 1/1/2000

Payer’s share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority.

Start: 1/1/2000 | Stop: 10/16/2003

Note: Consider using Reason Code 137

Payment based on authorized amount.

Start: 1/1/2000

Missing/incomplete/invalid admission hour.

Start: 1/1/2000

Claim conflicts with another inpatient stay.

Start: 1/1/2000

Claim information does not agree with information received from other insurance carrier.

Start: 1/1/2000

Court ordered coverage information needs validation.

Start: 1/1/2000

Missing/incomplete/invalid discharge information.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Electronic interchange agreement not on file for provider/submitter.

Start: 1/1/2000

Patient not enrolled in the billing provider's managed care plan on the date of service.

Start: 1/1/2000

Missing/incomplete/invalid point of pick-up address.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Claim information is inconsistent with pre-certified/authorized services.

Start: 1/1/2000

Procedures for billing with group/referring/performing providers were not followed.

Start: 1/1/2000

Procedure code billed is not correct/valid for the services billed or the date of service billed.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid prescribing date.

Start: 1/1/2000 | Last Modified: 12/2/2004

Note: (Modified 12/2/04) Related to N304

Missing/incomplete/invalid patient liability amount.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Alert: Please refer to your provider manual for additional program and provider information.

Start: 1/1/2000 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

A valid NDC is required for payment of drug claims effective October 02.

Start: 1/1/2000 | Stop: 1/31/2004

Note: Consider using M119

Rebill services on separate claims.

Start: 1/1/2000

Inpatient admission spans multiple rate periods. Resubmit separate claims.

Start: 1/1/2000

Rebill services on separate claim lines.

Start: 1/1/2000

The “from” and “to” dates must be different.

Start: 1/1/2000

Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid documentation.

Start: 1/1/2000 | Stop: 2/5/2005

Note: Consider using N29 or N225.

Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient’s admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.

Start: 1/1/2000

Prior payment being canceled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.

Start: 1/1/2000

PPS (Prospective Payment System) code changed by claims processing system. Insufficient visits or therapies.

Start: 1/1/2000 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Consolidated billing and payment applies.

Start: 1/1/2000 | Last Modified: 11/5/2007

Note: (Modified 2/28/02, 11/5/07)

Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims.

Start: 1/1/2000 | Last Modified: 6/30/2003

Note: (Modified 2/21/02, 6/30/03)

PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.

Start: 1/1/2000 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

A Skilled Nursing Facility is responsible for payment of outside providers who furnish these services/supplies under arrangement to its residents.

Start: 1/1/2000 | Stop: 1/31/2004

Note: Consider using MA101 or N200

Resubmit with multiple claims, each claim covering services provided in only one calendar month.

Start: 1/1/2000

Missing/incomplete/invalid tooth surface information.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid number of riders.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Missing/incomplete/invalid designated provider number.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

The necessary components of the child and teen checkup (EPSDT) were not completed.

Start: 1/1/2000

Service billed is not compatible with patient location information.

Start: 1/1/2000

Missing/incomplete/invalid prenatal screening information.

Start: 1/1/2000 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Procedure billed is not compatible with tooth surface code.

Start: 1/1/2000

Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.

Start: 1/1/2000

No appeal rights. Adjudicative decision based on the provisions of a demonstration project.

Start: 1/1/2000

Alert: Further installment payments are forthcoming.

Start: 1/1/2000 | Last Modified: 4/1/2007

Note: (Modified 4/1/07, 8/1/07)

Alert: This is the final installment payment.

Start: 1/1/2000 | Last Modified: 4/1/2007

Note: (Modified 4/1/07, 8/1/07)

A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.

Start: 1/1/2000

Home use of biofeedback therapy is not covered.

Start: 1/1/2000

Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care.

Start: 1/1/2000 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remittance advice.

Start: 1/1/2000 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Covered only when performed by the attending physician.

Start: 1/1/2000

Services not included in the appeal review.

Start: 1/1/2000

This facility is not certified for digital mammography.

Start: 1/1/2000

A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.

Start: 1/1/2000

Claim/Service denied because a more specific taxonomy code is required for adjudication.

Start: 1/1/2000

This provider type/provider specialty may not bill this service.

Start: 7/31/2001 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.

Start: 8/24/2001

Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.

Start: 8/24/2001

Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.

Start: 8/24/2001

Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.

Start: 8/24/2001

PPS (Prospect Payment System) code corrected during adjudication.

Start: 9/14/2001 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Additional information is needed in order to process this claim. Please resubmit the claim with the identification number of the provider where this service took place. The Medicare number of the site of service provider should be preceded with the letters 'HSP' and entered into item #32 on the claim form. You may bill only one site of service provider number per claim.

Start: 10/31/2001 | Stop: 1/31/2004

Note: Consider using MA105

This claim has been denied without reviewing the medical record because the requested records were not received or were not received timely.

Start: 10/31/2001

Social Security records indicate that this patient was a prisoner when the service was rendered. This payer does not cover items and services furnished to an individual while they are in State or local custody under a penal authority, unless under State or local law, the individual is personally liable for the cost of his or her health care while incarcerated and the State or local government pursues such debt in the same way and with the same vigor as any other debt.

Start: 10/31/2001 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.hhs.gov.

Start: 1/29/2002 | Last Modified: 10/31/2002

Note: (Modified 10/31/02)

This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 866-749-4301 for RRB EDI information for electronic claims processing.

Start: 1/29/2002

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.

Start: 1/31/2002

Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.

Start: 1/31/2002

Missing/incomplete/invalid upgrade information.

Start: 1/31/2002 | Last Modified: 2/28/2003

Note: (Modified 2/28/03)

This claim was chosen for complex review and was denied after reviewing the medical records.

Start: 2/28/2002

This facility is not certified for film mammography.

Start: 2/28/2002

No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.

Start: 2/28/2002

This claim is excluded from your electronic remittance advice.

Start: 2/28/2002

Only one initial visit is covered per physician, group practice or provider.

Start: 4/16/2002 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be.

Start: 5/30/2002

This decision was based on a local medical review policy (LMRP) or Local Coverage Determination (LCD).An LMRP/LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at http://www.cms.hhs.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LMRP/LCD.

Start: 5/30/2002 | Last Modified: 4/1/2004

Note: (Modified 4/1/04)

This payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency’s (HHA’s) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care.

Start: 6/30/2002

This service is paid only once in a patient’s lifetime.

Start: 7/30/2002 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

This service is not paid if billed more than once every 28 days.

Start: 7/30/2002

This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility (SNF) within those 28 days.

Start: 7/30/2002 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.

Start: 8/9/2002 | Last Modified: 6/30/2003

Note: (Modified 6/30/03)

Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered Skilled Nursing Facility (SNF) stay.

Start: 9/9/2002 | Last Modified: 8/1/2004

Note: (Modified 8/1/04, 6/30/03)

Add-on code cannot be billed by itself.

Start: 9/12/2002 | Last Modified: 8/1/2005

Note: (Modified 8/1/05)

This is a split service and represents a portion of the units from the originally submitted service.

Start: 9/24/2002

Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay.

Start: 9/26/2002

Payment has been (denied for the/made only for a less extensive) service/item because the information furnished does not substantiate the need for the (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice.

The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office.

Start: 9/26/2002 | Last Modified: 8/1/2005

Note: (Modified 8/1/05. Also refer to N356)

Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported.

Start: 10/17/2002

This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.

Start: 10/31/2007 | Last Modified: 8/1/2004

Note: (Modified 8/1/04

This amount represents the prior to coverage portion of the allowance.

Start: 10/31/2002

Not eligible due to the patient's age.

Start: 10/31/2002 | Last Modified: 8/1/2007

Note: (Modified 8/1/07)

Alert: Consult plan benefit documents/guidelines for information about restrictions for this service.

Start: 10/31/2002 | Last Modified: 7/1/2008

Note: (Modified 4/1/07, 7/1/08)

Total payments under multiple contracts cannot exceed the allowance for this service.

Start: 10/31/2002

Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: Services for predetermination and services requesting payment are being processed separately.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Record fees are the patient's responsibility and limited to the specified co-payment.

Start: 10/31/2002

Alert: To obtain information on the process to file an appeal in Arizona, call the Department's Consumer Assistance Office at (602) 912-8444 or (800) 325-2548.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: The provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 8/1/04, 2/28/03, 4/1/07)

Alert: In the event you disagree with the Dental Advisor's opinion and have additional information relative to the case, you may submit radiographs to the Dental Advisor Unit at the subscriber's dental insurance carrier for a second Independent Dental Advisor Review.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: Under the Code of Federal Regulations, Chapter 32, Section 199.13 a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor's opinion, you may appeal the determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act as his/her representative and you disagree with the Dental Advisor's opinion, you may appeal by submitting a copy of this letter, a signed statement explaining the matter in which you disagree, and any relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

The patient was not residing in a long-term care facility during all or part of the service dates billed.

Start: 10/31/2002

The original claim was denied. Resubmit a new claim, not a replacement claim.

Start: 10/31/2002

The patient was not in a hospice program during all or part of the service dates billed.

Start: 10/31/2002

The rate changed during the dates of service billed.

Start: 10/31/2002

Missing/incomplete/invalid provider identifier for this place of service.

Start: 10/31/2002 | Stop: 6/2/2005

Missing screening document.

Start: 10/31/2002 | Last Modified: 8/1/2004

Note: (Modified 8/1/04) Related to N243

Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request.

Start: 10/31/2002

Missing/incomplete/invalid date of last menstrual period.

Start: 10/31/2002

Rebill all applicable services on a single claim.

Start: 10/31/2002

Missing/incomplete/invalid model number.

Start: 10/31/2002

Telephone contact services will not be paid until the face-to-face contact requirement has been met.

Start: 10/31/2002

Missing/incomplete/invalid replacement claim information.

Start: 10/31/2002

Missing/incomplete/invalid room and board rate.

Start: 10/31/2002

Alert: This payment was delayed for correction of provider's mailing address.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.

Start: 10/31/2002 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Transportation to/from this destination is not covered.

Start: 2/28/2003 | Last Modified: 2/1/2004

Note: (Modified 2/1/04)

Transportation in a vehicle other than an ambulance is not covered.

Start: 2/28/2003

Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.

Start: 2/28/2003

The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.

Start: 2/28/2003 | Last Modified: 2/1/2004

Note: (Modified 2/1/04)

This drug/service/supply is covered only when the associated service is covered.

Start: 2/28/2003

Alert: Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information will result in a denial of payment in the near future.

Start: 2/28/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Medical record does not support code billed per the code definition.

Start: 2/28/2003

Transportation to/from this destination is not covered.

Start: 2/28/2003 | Stop: 1/31/2004

Note: Consider using N157

Transportation in a vehicle other than an ambulance is not covered.

Start: 2/28/2003 | Stop: 1/31/2004

Note: Consider using N158)

Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.

Start: 2/28/2003 | Stop: 1/31/2004

Note: Consider using N159

Charges exceed the post-transplant coverage limit.

Start: 2/28/2003

The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.

Start: 2/28/2003 | Stop: 1/31/2004

Note: Consider using N160

This drug/service/supply is covered only when the associated service is covered.

Start: 2/28/2003 | Stop: 1/31/2004

Note: Consider using N161

A new/revised/renewed certificate of medical necessity is needed.

Start: 2/28/2003

Payment for repair or replacement is not covered or has exceeded the purchase price.

Start: 2/28/2003

The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.

Start: 2/28/2003

No qualifying hospital stay dates were provided for this episode of care.

Start: 2/28/2003

This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.

Start: 2/28/2003

Missing review organization approval.

Start: 2/28/2003 | Last Modified: 2/29/2008

Note: (Modified 8/1/04, 2/29/08) Related to N241

Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the United States must provide the service.

Start: 2/28/2003

Alert: We did not send this claim to patient’s other insurer. They have indicated no additional payment can be made.

Start: 2/28/2003 | Last Modified: 4/1/2007

Note: (Modified 6/30/03, 4/1/07)

Missing pre-operative photos or visual field results.

Start: 2/28/2003 | Last Modified: 8/1/2004

Note: (Modified 8/1/04) Related to N244

Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.

Start: 2/28/2003

This item or service does not meet the criteria for the category under which it was billed.

Start: 2/28/2003

Additional information is required from another provider involved in this service.

Start: 2/28/2003 | Last Modified: 12/1/2006

Note: (Modified 12/1/06)

This claim/service must be billed according to the schedule for this plan.

Start: 2/28/2003

Alert: This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits.

Start: 2/28/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Rebill technical and professional components separately.

Start: 2/28/2003

Alert: Do not resubmit this claim/service.

Start: 2/28/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.

Start: 2/28/2003

Alert: You may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.

Start: 2/28/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

The approved level of care does not match the procedure code submitted.

Start: 2/28/2003

Alert: This service has been paid as a one-time exception to the plan's benefit restrictions.

Start: 2/28/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing contract indicator.

Start: 2/28/2003 | Last Modified: 8/1/2004

Note: (Modified 8/1/04) Related to N229

The provider must update insurance information directly with payer.

Start: 2/28/2003

Patient is a Medicaid/Qualified Medicare Beneficiary.

Start: 2/28/2003

Specific federal/state/local program may cover this service through another payer.

Start: 2/28/2003

Technical component not paid if provider does not own the equipment used.

Start: 2/25/2003

The technical component must be billed separately.

Start: 2/25/2003

Alert: Patient eligible to apply for other coverage which may be primary.

Start: 2/25/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

The subscriber must update insurance information directly with payer.

Start: 2/25/2003

Rendering provider must be affiliated with the pay-to provider.

Start: 2/25/2003

Additional payment/recoupment approved based on payer-initiated review/audit.

Start: 2/25/2003 | Last Modified: 8/1/2006

Note: (Modified 8/1/06)

The professional component must be billed separately.

Start: 2/25/2003

A mental health facility is responsible for payment of outside providers who furnish these services/supplies to residents.

Start: 2/25/2003

Alert: Additional information/explanation will be sent separately

Start: 6/30/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing/incomplete/invalid anesthesia time/units

Start: 6/30/2003

Services under review for possible pre-existing condition. Send medical records for prior 12 months

Start: 6/30/2003

Information provided was illegible

Start: 6/30/2003

The supporting documentation does not match the claim

Start: 6/30/2003

Missing/incomplete/invalid weight.

Start: 6/30/2003 | Last Modified: 11/18/2005

Note: (Modified 11/18/05)

Missing/incomplete/invalid DRG code

Start: 6/30/2003

Missing/incomplete/invalid taxpayer identification number (TIN).

Start: 6/30/2003 | Last Modified: 7/1/2008

Note: (Modified 7/1/08)

Alert: You may appeal this decision

Start: 6/30/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: You may not appeal this decision

Start: 6/30/2003 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Charges processed under a Point of Service benefit

Start: 2/1/2004

Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information

Start: 4/1/2004

Missing/incomplete/invalid history of the related initial surgical procedure(s)

Start: 4/1/2004

Alert: A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determination.

Start: 4/1/2004 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Patient is not enrolled in this portion of our benefit package

Start: 4/1/2004

We pay only one site of service per provider per claim

Start: 8/1/2004

You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract or coverage manual.

Start: 8/1/2004

Payment based on previous payer's allowed amount.

Start: 8/1/2004

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.

Start: 8/1/2004 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing Admitting History and Physical report.

Start: 8/1/2004

Incomplete/invalid Admitting History and Physical report.

Start: 8/1/2004

Missing documentation of benefit to the patient during initial treatment period.

Start: 8/1/2004

Incomplete/invalid documentation of benefit to the patient during initial treatment period.

Start: 8/1/2004

Incomplete/invalid documentation/orders/notes/summary/report/chart.

Start: 8/1/2004 | Last Modified: 8/1/2005

Note: (Modified 8/1/05)

Incomplete/invalid American Diabetes Association Certificate of Recognition.

Start: 8/1/2004

Incomplete/invalid Certificate of Medical Necessity.

Start: 8/1/2004

Incomplete/invalid consent form.

Start: 8/1/2004

Incomplete/invalid contract indicator.

Start: 8/1/2004

Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.

Start: 8/1/2004

Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.

Start: 8/1/2004

Incomplete/invalid itemized bill/statement.

Start: 8/1/2004 | Last Modified: 7/1/2008

Note: (Modified 7/1/08)

Incomplete/invalid operative note/report.

Start: 8/1/2004 | Last Modified: 7/1/2008

Note: (Modified 7/1/08)

Incomplete/invalid oxygen certification/re-certification.

Start: 8/1/2004

Incomplete/invalid pacemaker registration form.

Start: 8/1/2004

Incomplete/invalid pathology report.

Start: 8/1/2004

Incomplete/invalid patient medical record for this service.

Start: 8/1/2004

Incomplete/invalid physician certified plan of care

Start: 8/1/2004

Incomplete/invalid physician financial relationship form.

Start: 8/1/2004

Incomplete/invalid radiology report.

Start: 8/1/2004

Incomplete/invalid review organization approval.

Start: 8/1/2004 | Last Modified: 2/29/2008

Note: (Modified 2/29/08)

Incomplete/invalid radiology film(s)/image(s).

Start: 8/1/2004 | Last Modified: 7/1/2008

Note: (Modified 7/1/08)

Incomplete/invalid/not approved screening document.

Start: 8/1/2004

Incomplete/invalid pre-operative photos/visual field results.

Start: 8/1/2004

Incomplete/invalid plan information for other insurance

Start: 8/1/2004

State regulated patient payment limitations apply to this service.

Start: 12/2/2004

Missing/incomplete/invalid assistant surgeon taxonomy.

Start: 12/2/2004

Missing/incomplete/invalid assistant surgeon name.

Start: 12/2/2004

Missing/incomplete/invalid assistant surgeon primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid assistant surgeon secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid attending provider taxonomy.

Start: 12/2/2004

Missing/incomplete/invalid attending provider name.

Start: 12/2/2004

Missing/incomplete/invalid attending provider primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid attending provider secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid billing provider taxonomy.

Start: 12/2/2004

Missing/incomplete/invalid billing provider/supplier name.

Start: 12/2/2004

Missing/incomplete/invalid billing provider/supplier primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid billing provider/supplier address.

Start: 12/2/2004

Missing/incomplete/invalid billing provider/supplier secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid billing provider/supplier contact information.

Start: 12/2/2004

Missing/incomplete/invalid operating provider name.

Start: 12/2/2004

Missing/incomplete/invalid operating provider primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid operating provider secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid ordering provider name.

Start: 12/2/2004

Missing/incomplete/invalid ordering provider primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid ordering provider address.

Start: 12/2/2004

Missing/incomplete/invalid ordering provider secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid ordering provider contact information.

Start: 12/2/2004

Missing/incomplete/invalid other provider name.

Start: 12/2/2004

Missing/incomplete/invalid other provider primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid other provider secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid other payer attending provider identifier.

Start: 12/2/2004

Missing/incomplete/invalid other payer operating provider identifier.

Start: 12/2/2004

Missing/incomplete/invalid other payer other provider identifier.

Start: 12/2/2004

Missing/incomplete/invalid other payer purchased service provider identifier.

Start: 12/2/2004

Missing/incomplete/invalid other payer referring provider identifier.

Start: 12/2/2004

Missing/incomplete/invalid other payer rendering provider identifier.

Start: 12/2/2004

Missing/incomplete/invalid other payer service facility provider identifier.

Start: 12/2/2004

Missing/incomplete/invalid pay-to provider name.

Start: 12/2/2004

Missing/incomplete/invalid pay-to provider primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid pay-to provider address.

Start: 12/2/2004

Missing/incomplete/invalid pay-to provider secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid purchased service provider identifier.

Start: 12/2/2004

Missing/incomplete/invalid referring provider taxonomy.

Start: 12/2/2004

Missing/incomplete/invalid referring provider name.

Start: 12/2/2004

Missing/incomplete/invalid referring provider primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid referring provider secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid rendering provider taxonomy.

Start: 12/2/2004

Missing/incomplete/invalid rendering provider name.

Start: 12/2/2004

Missing/incomplete/invalid rendering provider primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid rending provider secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid service facility name.

Start: 12/2/2004

Missing/incomplete/invalid service facility primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid service facility primary address.

Start: 12/2/2004

Missing/incomplete/invalid service facility secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid supervising provider name.

Start: 12/2/2004

Missing/incomplete/invalid supervising provider primary identifier.

Start: 12/2/2004

Missing/incomplete/invalid supervising provider secondary identifier.

Start: 12/2/2004

Missing/incomplete/invalid occurrence date(s).

Start: 12/2/2004

Missing/incomplete/invalid occurrence span date(s).

Start: 12/2/2004

Missing/incomplete/invalid procedure date(s).

Start: 12/2/2004

Missing/incomplete/invalid other procedure date(s).

Start: 12/2/2004

Missing/incomplete/invalid principal procedure date.

Start: 12/2/2004

Missing/incomplete/invalid dispensed date.

Start: 12/2/2004

Missing/incomplete/invalid accident date.

Start: 12/2/2004

Missing/incomplete/invalid acute manifestation date.

Start: 12/2/2004

Missing/incomplete/invalid adjudication or payment date.

Start: 12/2/2004

Missing/incomplete/invalid appliance placement date.

Start: 12/2/2004

Missing/incomplete/invalid assessment date.

Start: 12/2/2004

Missing/incomplete/invalid assumed or relinquished care date.

Start: 12/2/2004

Missing/incomplete/invalid authorized to return to work date.

Start: 12/2/2004

Missing/incomplete/invalid begin therapy date.

Start: 12/2/2004

Missing/incomplete/invalid certification revision date.

Start: 12/2/2004

Missing/incomplete/invalid diagnosis date.

Start: 12/2/2004

Missing/incomplete/invalid disability from date.

Start: 12/2/2004

Missing/incomplete/invalid disability to date.

Start: 12/2/2004

Missing/incomplete/invalid discharge hour.

Start: 12/2/2004

Missing/incomplete/invalid discharge or end of care date.

Start: 12/2/2004

Missing/incomplete/invalid hearing or vision prescription date.

Start: 12/2/2004

Missing/incomplete/invalid Home Health Certification Period.

Start: 12/2/2004

Missing/incomplete/invalid last admission period.

Start: 12/2/2004

Missing/incomplete/invalid last certification date.

Start: 12/2/2004

Missing/incomplete/invalid last contact date.

Start: 12/2/2004

Missing/incomplete/invalid last seen/visit date.

Start: 12/2/2004

Missing/incomplete/invalid last worked date.

Start: 12/2/2004

Missing/incomplete/invalid last x-ray date.

Start: 12/2/2004

Missing/incomplete/invalid other insured birth date.

Start: 12/2/2004

Missing/incomplete/invalid Oxygen Saturation Test date.

Start: 12/2/2004

Missing/incomplete/invalid patient birth date.

Start: 12/2/2004

Missing/incomplete/invalid patient death date.

Start: 12/2/2004

Missing/incomplete/invalid physician order date.

Start: 12/2/2004

Missing/incomplete/invalid prior hospital discharge date.

Start: 12/2/2004

Missing/incomplete/invalid prior placement date.

Start: 12/2/2004

Missing/incomplete/invalid re-evaluation date

Start: 12/2/2004

Missing/incomplete/invalid referral date.

Start: 12/2/2004

Missing/incomplete/invalid replacement date.

Start: 12/2/2004

Missing/incomplete/invalid secondary diagnosis date.

Start: 12/2/2004

Missing/incomplete/invalid shipped date.

Start: 12/2/2004

Missing/incomplete/invalid similar illness or symptom date.

Start: 12/2/2004

Missing/incomplete/invalid subscriber birth date.

Start: 12/2/2004

Missing/incomplete/invalid surgery date.

Start: 12/2/2004

Missing/incomplete/invalid test performed date.

Start: 12/2/2004

Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.

Start: 12/2/2004

Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.

Start: 12/2/2004

Date range not valid with units submitted.

Start: 3/30/2005

Missing/incomplete/invalid oral cavity designation code.

Start: 3/30/2005

Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer.

Start: 3/30/2005

You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.

Start: 8/1/2005

The administration method and drug must be reported to adjudicate this service.

Start: 8/1/2005

Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.

Start: 8/1/2005 | Last Modified: 7/1/2008

Note: (Modified 7/1/08)

Service date outside of the approved treatment plan service dates.

Start: 8/1/2005

Alert: There are no scheduled payments for this service. Submit a claim for each patient visit.

Start: 8/1/2005 | Last Modified: 4/1/5007

Note: (Modified 4/1/07)

Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.

Start: 8/1/2005 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Incomplete/invalid invoice

Start: 8/1/2005

Alert: The law permits exceptions to the refund requirement in two cases: - If you did not know, and could not have reasonably been expected to know, that we would not pay for this service; or - If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service.

If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position.

If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision.

The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination.

The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days

Start: 8/1/2005 | Last Modified: 4/1/2007

Note: (Modified 11/18/05, Modified 4/1/07)

This service is not covered when performed with, or subsequent to, a non-covered service.

Start: 8/1/2005

Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.

Start: 11/18/2005

Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.

Start: 11/18/2005 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Missing/incomplete/invalid height.

Start: 11/18/2005

Alert: Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim.

Start: 11/18/2005 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Payment adjusted based on multiple diagnostic imaging procedure rules

Start: 11/18/2005 | Stop: 10/1/2007 | Last Modified: 12/1/2006

Note: (Modified 12/1/06) Consider using Reason Code 59

The number of Days or Units of Service exceeds our acceptable maximum.

Start: 11/18/2005

Alert: in the near future we are implementing new policies/procedures that would affect this determination.

Start: 11/18/2005 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.

Start: 11/18/2005 | Last Modified: 4/1/2007

Note: (Modified 4/1/07)

This procedure code is not payable. It is for reporting/information purposes only.

Start: 4/1/2006

Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice.

Start: 4/1/2006

Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account.

Start: 4/1/2006 | Last Modified: 7/1/2008

Note: (Modified 4/1/07, 11/5/07, 7/1/08)

You must appeal the determination of the previously adjudicated claim.

Start: 4/1/2006

Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.

Start: 4/1/2006

Billing exceeds the rental months covered/approved by the payer.

Start: 8/1/2006

Alert: title of this equipment must be transferred to the patient.

Start: 8/1/2006

Only reasonable and necessary maintenance/service charges are covered.

Start: 8/1/2006

It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your behalf.

Start: 12/1/2006

Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.

Start: 12/1/2006

Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.

Start: 12/1/2006

Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.

Start: 12/1/2006

Payment based on a processed replacement claim.

Start: 12/1/2006 | Last Modified: 11/5/2007

Note: (Modified 11/5/07)

Missing/incomplete/invalid prescription quantity.

Start: 12/1/2006

Claim level information does not match line level information.

Start: 12/1/2006

The original claim has been processed, submit a corrected claim.

Start: 4/1/2007

Consult our contractual agreement for restrictions/billing/payment information related to these charges.

Start: 4/1/2007

Missing/incomplete/invalid patient identifier.

Start: 4/1/2007

Services deemed cosmetic are not covered

Start: 4/1/2007

Records indicate that the referenced body part/tooth has been removed in a previous procedure.

Start: 4/1/2007

Notification of admission was not timely according to published plan procedures.

Start: 4/1/2007 | Last Modified: 11/5/2007

Note: (Modified 11/5/07)

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 http://www.cms.hhs.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.

Start: 4/1/2007

You should submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information.

Start: 4/1/2007

Missing/incomplete/invalid prescription number

Start: 8/1/2007

Duplicate prescription number submitted.

Start: 8/1/2007

This service/report cannot be billed separately.

Start: 8/1/2007 | Last Modified: 7/1/2008

Note: (Modified 7/1/08)

Missing emergency department records.

Start: 8/1/2007

Incomplete/invalid emergency department records.

Start: 8/1/2007

Missing progress notes/report.

Start: 8/1/2007 | Last Modified: 7/1/2008

Note: (Modified 7/1/08)

Incomplete/invalid progress notes/report.

Start: 8/1/2007 | Last Modified: 7/1/2008

Note: (Modified 7/1/08)

Missing laboratory report.

Start: 8/1/2007

Incomplete/invalid laboratory report.

Start: 8/1/2007

Benefits are not available for incomplete service(s)/undelivered item(s).

Start: 8/1/2007

Missing elective consent form.

Start: 8/1/2007

Incomplete/invalid elective consent form.

Start: 8/1/2007

Alert: Electronically enabled providers should submit claims electronically.

Start: 8/1/2007

Missing periodontal charting.

Start: 8/1/2007

Incomplete/invalid periodontal charting.

Start: 8/1/2007

Missing facility certification.

Start: 8/1/2007

Incomplete/invalid facility certification.

Start: 8/1/2007

This service is only covered when the donor's insurer(s) do not provide coverage for the service.

Start: 8/1/2007

This service is only covered when the recipient's insurer(s) do not provide coverage for the service.

Start: 8/1/2007

You are not an approved submitter for this transmission format.

Start: 8/1/2007

This payer does not cover deductibles assessed by a previous payer.

Start: 8/1/2007

This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident.

Start: 8/1/2007

This is not covered unless the prescription changes.

Start: 8/1/2007

This service is allowed one time in a 6-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)

Start: 8/1/2007 | Stop: 2/1/2009

This service is allowed 2 times in a 12-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)

Start: 8/1/2007 | Stop: 2/1/2009

This service is allowed 2 times in a benefit year. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)

Start: 8/1/2007 | Stop: 2/1/2009

This service is allowed 4 times in a 12-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)

Start: 8/1/2007 | Stop: 2/1/2009

This service is allowed 1 time in an 18-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)

Start: 8/1/2007 | Stop: 2/1/2009

This service is allowed 1 time in a 3-year period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)

Start: 8/1/2007 | Stop: 2/1/2009

This service is allowed 1 time in a 5-year period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)

Start: 8/1/2007 | Stop: 2/1/2009

Misrouted claim. See the payer's claim submission instructions.

Start: 8/1/2007

Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change.

Start: 8/1/2007

Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.

Start: 8/1/2007

Claim payment was the result of a payer's retroactive adjustment due to a review organization decision.

Start: 8/1/2007 | Last Modified: 5/8/2008

Note: (Modified 2/29/08, typo fixed 5/8/08)

Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program.

Start: 8/1/2007 | Last Modified: 5/8/2008

Note: (Typo fixed 5/8/08)

Claim payment was the result of a payer's retroactive adjustment due to a non standard program.

Start: 8/1/2007

Patient does not reside in the geographic area required for this type of payment.

Start: 8/1/2007

Statutorily excluded service(s).

Start: 8/1/2007

No coverage when self-administered.

Start: 8/1/2007

Payment for eyeglasses or contact lenses can be made only after cataract surgery.

Start: 8/1/2007

Service/procedure not covered when performed in this place of service.

Start: 8/1/2007

This is not covered since it is considered routine.

Start: 8/1/2007

Procedure code is inconsistent with the units billed.

Start: 11/5/2007

Service is not covered with this procedure.

Start: 11/5/2007

Adjustment based on a Recovery Audit.

Start: 11/5/2007

Resubmit this claim using only your National Provider Identifier (NPI)

Start: 2/29/2008

Missing/Incomplete/Invalid Present on Admission indicator.

Start: 7/1/2008

Exceeds number/frequency approved /allowed within time period without support documentation.

Start: 7/1/2008

The injury claim has not been accepted and a mandatory medical reimbursement has been made.

Start: 7/1/2008

Alert: If the injury claim is accepted, these charges will be reconsidered.

Start: 7/1/2008

This jurisdiction only accepts paper claims

Start: 7/1/2008

Missing anesthesia physical status report/indicators.

Start: 7/1/2008

Incomplete/invalid anesthesia physical status report/indicators.

Start: 7/1/2008

This missed appointment is not covered.

Start: 7/1/2008

Payment based on an alternate fee schedule.

Start: 7/1/2008

Missing/incomplete/invalid total time or begin/end time.

Start: 7/1/2008

Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation.

Start: 7/1/2008

Missing document for actual cost or paid amount.

Start: 7/1/2008

Incomplete/invalid document for actual cost or paid amount.

Start: 7/1/2008

Payment is based on a generic equivalent as required documentation was not provided.

Start: 7/1/2008

This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement

Start: 7/1/2008

Payment based on a comparable drug/service/supply.

Start: 7/1/2008

Covered only when performed by the primary treating physician or the designee.

Start: 7/1/2008

Missing Admission Summary Report.

Start: 7/1/2008

Incomplete/invalid Admission Summary Report.

Start: 7/1/2008

Missing Consultation Report.

Start: 7/1/2008

Incomplete/invalid Consultation Report.

Start: 7/1/2008

Missing Physician Order.

Start: 7/1/2008

Incomplete/invalid Physician Order.

Start: 7/1/2008

Missing Diagnostic Report.

Start: 7/1/2008

Incomplete/invalid Diagnostic Report.

Start: 7/1/2008

Missing Discharge Summary.

Start: 7/1/2008

Incomplete/invalid Discharge Summary.

Start: 7/1/2008

Missing Nursing Notes.

Start: 7/1/2008

Incomplete/invalid Nursing Notes.

Start: 7/1/2008

Missing support data for claim.

Start: 7/1/2008

Incomplete/invalid support data for claim.

Start: 7/1/2008