﻿3/01/16
3.2.2
[1]
Message=Deductible Amount
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[2]
Message=Coinsurance Amount
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[3]
Message=Co-payment Amount
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[4]
Message=The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=2
[5]
Message=The procedure code/bill type is inconsistent with the place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[6]
Message=The procedure/revenue code is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[7]
Message=The procedure/revenue code is inconsistent with the patient's gender. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[8]
Message=The procedure code is inconsistent with the provider type/specialty (taxonomy). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[9]
Message=The diagnosis is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[10]
Message=The diagnosis is inconsistent with the patient's gender. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[11]
Message=The diagnosis is inconsistent with the procedure. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[12]
Message=The diagnosis is inconsistent with the provider type. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[13]
Message=The date of death precedes the date of service.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=2
[14]
Message=The date of birth follows the date of service.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=2
[15]
Message=The authorization number is missing, invalid, or does not apply to the billed services or provider.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=2
[16]
Message=Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 11/1/2013
Note=
Scenario=2
[17]
Message=Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.)
EffDate=1/1/1995
DeactDate= 7/1/2009
Modified= 9/21/2008
Note=
Scenario=
[18]
Message=Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)
EffDate=1/1/1995
DeactDate= 
Modified= 6/2/2013
Note=
Scenario=2
[19]
Message=This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[20]
Message=This injury/illness is covered by the liability carrier.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[21]
Message=This injury/illness is the liability of the no-fault carrier.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[22]
Message=This care may be covered by another payer per coordination of benefits.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[23]
Message=The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2012
Note=
Scenario=
[24]
Message=Charges are covered under a capitation agreement/managed care plan.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=4
[25]
Message=Payment denied. Your Stop loss deductible has not been met.
EffDate=1/1/1995
DeactDate= 4/1/2008
Modified= 
Note=
Scenario=
[26]
Message=Expenses incurred prior to coverage.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[27]
Message=Expenses incurred after coverage terminated.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[28]
Message=Coverage not in effect at the time the service was provided.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Redundant to codes 26&27.
Scenario=
[29]
Message=The time limit for filing has expired.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[30]
Message=Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.
EffDate=1/1/1995
DeactDate= 2/1/2006
Modified= 
Note=
Scenario=
[31]
Message=Patient cannot be identified as our insured.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[32]
Message=Our records indicate that this dependent is not an eligible dependent as defined.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[33]
Message=Insured has no dependent coverage.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[34]
Message=Insured has no coverage for newborns.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[35]
Message=Lifetime benefit maximum has been reached.
EffDate=1/1/1995
DeactDate= 
Modified= 10/31/2002
Note=
Scenario=3
[36]
Message=Balance does not exceed co-payment amount.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[37]
Message=Balance does not exceed deductible.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[38]
Message=Services not provided or authorized by designated (network/primary care) providers.
EffDate=1/1/1995
DeactDate= 1/1/2013
Modified= 6/2/2013
Note=CARC codes 242 and 243 are replacements for this deactivated code
Scenario=
[39]
Message=Services denied at the time authorization/pre-certification was requested.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[40]
Message=Charges do not meet qualifications for emergent/urgent care. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[41]
Message=Discount agreed to in Preferred Provider contract.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[42]
Message=Charges exceed our fee schedule or maximum allowable amount. (Use CARC 45)
EffDate=1/1/1995
DeactDate= 6/1/2007
Modified= 10/31/2006
Note=
Scenario=
[43]
Message=Gramm-Rudman reduction.
EffDate=1/1/1995
DeactDate= 7/1/2006
Modified= 
Note=
Scenario=
[44]
Message=Prompt-pay discount.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[45]
Message=Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Note: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)
EffDate=1/1/1995
DeactDate= 
Modified= 11/1/2015
Note=
Scenario=
[46]
Message=This (these) service(s) is (are) not covered.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 96.
Scenario=
[47]
Message=This (these) diagnosis(es) is (are) not covered, missing, or are invalid.
EffDate=1/1/1995
DeactDate= 2/1/2006
Modified= 
Note=
Scenario=
[48]
Message=This (these) procedure(s) is (are) not covered.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 96.
Scenario=
[49]
Message=This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 11/1/2013
Note=
Scenario=3
[50]
Message=These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[51]
Message=These are non-covered services because this is a pre-existing condition. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[52]
Message=The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
EffDate=1/1/1995
DeactDate= 2/1/2006
Modified= 
Note=
Scenario=
[53]
Message=Services by an immediate relative or a member of the same household are not covered.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[54]
Message=Multiple physicians/assistants are not covered in this case. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[55]
Message=Procedure/treatment/drug is deemed experimental/investigational by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 4/1/2015
Note=
Scenario=3
[56]
Message=Procedure/treatment has not been deemed 'proven to be effective' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[57]
Message=Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=Split into codes 150, 151, 152, 153 and 154.
Scenario=
[58]
Message=Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[59]
Message=Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[60]
Message=Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.
EffDate=1/1/1995
DeactDate= 
Modified= 6/1/2008
Note=
Scenario=3
[61]
Message=Penalty for failure to obtain second surgical opinion. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[62]
Message=Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.
EffDate=1/1/1995
DeactDate= 4/1/2007
Modified= 10/31/2006
Note=
Scenario=
[63]
Message=Correction to a prior claim.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[64]
Message=Denial reversed per Medical Review.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[65]
Message=Procedure code was incorrect. This payment reflects the correct code.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[66]
Message=Blood Deductible.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[67]
Message=Lifetime reserve days. (Handled in QTY, QTY01=LA)
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[68]
Message=DRG weight. (Handled in CLP12)
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[69]
Message=Day outlier amount.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=2
[70]
Message=Cost outlier - Adjustment to compensate for additional costs.
EffDate=1/1/1995
DeactDate= 
Modified= 6/30/2001
Note=
Scenario=
[71]
Message=Primary Payer amount.
EffDate=1/1/1995
DeactDate= 6/30/2000
Modified= 
Note=Use code 23.
Scenario=
[72]
Message=Coinsurance day. (Handled in QTY, QTY01=CD)
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[73]
Message=Administrative days.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[74]
Message=Indirect Medical Education Adjustment.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[75]
Message=Direct Medical Education Adjustment.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[76]
Message=Disproportionate Share Adjustment.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[77]
Message=Covered days. (Handled in QTY, QTY01=CA)
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[78]
Message=Non-Covered days/Room charge adjustment.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[79]
Message=Cost Report days. (Handled in MIA15)
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[80]
Message=Outlier days. (Handled in QTY, QTY01=OU)
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[81]
Message=Discharges.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[82]
Message=PIP days.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[83]
Message=Total visits.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[84]
Message=Capital Adjustment. (Handled in MIA)
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[85]
Message=Patient Interest Adjustment (Use Only Group code PR)
EffDate=1/1/1995
DeactDate= 
Modified= 7/9/2007
Note=Only use when the payment of interest is the responsibility of the patient.
Scenario=
[86]
Message=Statutory Adjustment.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Duplicative of code 45.
Scenario=
[87]
Message=Transfer amount.
EffDate=1/1/1995
DeactDate= 1/1/2012
Modified= 9/20/2009
Note=
Scenario=
[88]
Message=Adjustment amount represents collection against receivable created in prior overpayment.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=
Scenario=
[89]
Message=Professional fees removed from charges.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[90]
Message=Ingredient cost adjustment. Note: To be used for pharmaceuticals only.
EffDate=1/1/1995
DeactDate= 
Modified= 7/1/2009
Note=
Scenario=
[91]
Message=Dispensing fee adjustment.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[92]
Message=Claim Paid in full.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[93]
Message=No Claim level Adjustments.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=As of 004010, CAS at the claim level is optional.
Scenario=
[94]
Message=Processed in Excess of charges.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[95]
Message=Plan procedures not followed.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[96]
Message=Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[97]
Message=The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=4
[98]
Message=The hospital must file the Medicare claim for this inpatient non-physician service.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[99]
Message=Medicare Secondary Payer Adjustment Amount.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[100]
Message=Payment made to patient/insured/responsible party/employer.
EffDate=1/1/1995
DeactDate= 
Modified= 1/27/2008
Note=
Scenario=
[101]
Message=Predetermination: anticipated payment upon completion of services or claim adjudication.
EffDate=1/1/1995
DeactDate= 
Modified= 2/28/1999
Note=
Scenario=
[102]
Message=Major Medical Adjustment.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[103]
Message=Provider promotional discount (e.g., Senior citizen discount).
EffDate=1/1/1995
DeactDate= 
Modified= 6/30/2001
Note=
Scenario=
[104]
Message=Managed care withholding.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[105]
Message=Tax withholding.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[106]
Message=Patient payment option/election not in effect.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[107]
Message=The related or qualifying claim/service was not identified on this claim. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=2
[108]
Message=Rent/purchase guidelines were not met. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[109]
Message=Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
EffDate=1/1/1995
DeactDate= 
Modified= 1/29/2012
Note=
Scenario=3
[110]
Message=Billing date predates service date.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=2
[111]
Message=Not covered unless the provider accepts assignment.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[112]
Message=Service not furnished directly to the patient and/or not documented.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[113]
Message=Payment denied because service/procedure was provided outside the United States or as a result of war.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 2/28/2001
Note=Use Codes 157, 158 or 159.
Scenario=
[114]
Message=Procedure/product not approved by the Food and Drug Administration.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[115]
Message=Procedure postponed, canceled, or delayed.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[116]
Message=The advance indemnification notice signed by the patient did not comply with requirements.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=1
[117]
Message=Transportation is only covered to the closest facility that can provide the necessary care.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[118]
Message=ESRD network support adjustment.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[119]
Message=Benefit maximum for this time period or occurrence has been reached.
EffDate=1/1/1995
DeactDate= 
Modified= 2/29/2004
Note=
Scenario=3
[120]
Message=Patient is covered by a managed care plan.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=Use code 24.
Scenario=
[121]
Message=Indemnification adjustment - compensation for outstanding member responsibility.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[122]
Message=Psychiatric reduction.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[123]
Message=Payer refund due to overpayment.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=Refer to implementation guide for proper handling of reversals.
Scenario=
[124]
Message=Payer refund amount - not our patient.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 6/30/1999
Note=Refer to implementation guide for proper handling of reversals.
Scenario=
[125]
Message=Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=1/1/1995
DeactDate= 11/1/2013
Modified= 9/20/2009
Note=
Scenario=
[126]
Message=Deductible -- Major Medical
EffDate=2/28/1997
DeactDate= 4/1/2008
Modified= 9/30/2007
Note=Use Group Code PR and code 1.
Scenario=
[127]
Message=Coinsurance -- Major Medical
EffDate=2/28/1997
DeactDate= 4/1/2008
Modified= 9/30/2007
Note=Use Group Code PR and code 2.
Scenario=
[128]
Message=Newborn's services are covered in the mother's Allowance.
EffDate=2/28/1997
DeactDate= 
Modified= 
Note=
Scenario=3
[129]
Message=Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=2/28/1997
DeactDate= 
Modified= 1/30/2011
Note=
Scenario=2
[130]
Message=Claim submission fee.
EffDate=2/28/1997
DeactDate= 
Modified= 6/30/2001
Note=
Scenario=
[131]
Message=Claim specific negotiated discount.
EffDate=2/28/1997
DeactDate= 
Modified= 
Note=
Scenario=
[132]
Message=Prearranged demonstration project adjustment.
EffDate=2/28/1997
DeactDate= 
Modified= 
Note=
Scenario=
[133]
Message=The disposition of this service line is pending further review. (Use only with Group Code OA). Note: Use of this code requires a reversal and correction when the service line is finalized (use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837).
EffDate=7/1/2014
DeactDate= 
Modified= 3/1/2015
Note=
Scenario=
[134]
Message=Technical fees removed from charges.
EffDate=10/31/1998
DeactDate= 
Modified= 
Note=
Scenario=
[135]
Message=Interim bills cannot be processed.
EffDate=10/31/1998
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[136]
Message=Failure to follow prior payer's coverage rules. (Use only with Group Code OA)
EffDate=10/31/1998
DeactDate= 
Modified= 7/1/2013
Note=
Scenario=
[137]
Message=Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
EffDate=2/28/1999
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[138]
Message=Appeal procedures not followed or time limits not met.
EffDate=6/30/1999
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[139]
Message=Contracted funding agreement - Subscriber is employed by the provider of services.
EffDate=6/30/1999
DeactDate= 
Modified= 
Note=
Scenario=3
[140]
Message=Patient/Insured health identification number and name do not match.
EffDate=6/30/1999
DeactDate= 
Modified= 
Note=
Scenario=2
[141]
Message=Claim spans eligible and ineligible periods of coverage.
EffDate=6/30/1999
DeactDate= 7/1/2012
Modified= 9/30/2007
Note=
Scenario=
[142]
Message=Monthly Medicaid patient liability amount.
EffDate=6/30/2000
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[143]
Message=Portion of payment deferred.
EffDate=2/28/2001
DeactDate= 
Modified= 
Note=
Scenario=
[144]
Message=Incentive adjustment, e.g. preferred product/service.
EffDate=6/30/2001
DeactDate= 
Modified= 
Note=
Scenario=
[145]
Message=Premium payment withholding
EffDate=6/30/2002
DeactDate= 4/1/2008
Modified= 9/30/2007
Note=Use Group Code CO and code 45.
Scenario=
[146]
Message=Diagnosis was invalid for the date(s) of service reported.
EffDate=6/30/2002
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=2
[147]
Message=Provider contracted/negotiated rate expired or not on file.
EffDate=6/30/2002
DeactDate= 
Modified= 
Note=
Scenario=
[148]
Message=Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=6/30/2002
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=
[149]
Message=Lifetime benefit maximum has been reached for this service/benefit category.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=3
[150]
Message=Payer deems the information submitted does not support this level of service.
EffDate=10/31/2002
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[151]
Message=Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.
EffDate=10/31/2002
DeactDate= 
Modified= 1/27/2008
Note=
Scenario=3
[152]
Message=Payer deems the information submitted does not support this length of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=10/31/2002
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[153]
Message=Payer deems the information submitted does not support this dosage.
EffDate=10/31/2002
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[154]
Message=Payer deems the information submitted does not support this day's supply.
EffDate=10/31/2002
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[155]
Message=Patient refused the service/procedure.
EffDate=6/30/2003
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[156]
Message=Flexible spending account payments. Note: Use code 187.
EffDate=9/30/2003
DeactDate= 10/1/2009
Modified= 1/25/2009
Note=
Scenario=
[157]
Message=Service/procedure was provided as a result of an act of war.
EffDate=9/30/2003
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[158]
Message=Service/procedure was provided outside of the United States.
EffDate=9/30/2003
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[159]
Message=Service/procedure was provided as a result of terrorism.
EffDate=9/30/2003
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[160]
Message=Injury/illness was the result of an activity that is a benefit exclusion.
EffDate=9/30/2003
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[161]
Message=Provider performance bonus
EffDate=2/29/2004
DeactDate= 
Modified= 
Note=
Scenario=
[162]
Message=State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation.
EffDate=2/29/2004
DeactDate= 7/1/2014
Modified= 
Note=Use code P1
Scenario=
[163]
Message=Attachment/other documentation referenced on the claim was not received.
EffDate=6/30/2004
DeactDate= 
Modified= 6/2/2013
Note=
Scenario=1
[164]
Message=Attachment/other documentation referenced on the claim was not received in a timely fashion.
EffDate=6/30/2004
DeactDate= 
Modified= 6/2/2013
Note=
Scenario=1
[165]
Message=Referral absent or exceeded.
EffDate=10/31/2004
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[166]
Message=These services were submitted after this payers responsibility for processing claims under this plan ended.
EffDate=2/28/2005
DeactDate= 
Modified= 
Note=
Scenario=3
[167]
Message=This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/30/2005
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[168]
Message=Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[169]
Message=Alternate benefit has been provided.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[170]
Message=Payment is denied when performed/billed by this type of provider. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/30/2005
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[171]
Message=Payment is denied when performed/billed by this type of provider in this type of facility. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/30/2005
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[172]
Message=Payment is adjusted when performed/billed by a provider of this specialty. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/30/2005
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[173]
Message=Service/equipment was not prescribed by a physician.
EffDate=6/30/2005
DeactDate= 
Modified= 7/1/2013
Note=
Scenario=3
[174]
Message=Service was not prescribed prior to delivery.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[175]
Message=Prescription is incomplete.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=2
[176]
Message=Prescription is not current.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[177]
Message=Patient has not met the required eligibility requirements.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[178]
Message=Patient has not met the required spend down requirements.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[179]
Message=Patient has not met the required waiting requirements. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/30/2005
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[180]
Message=Patient has not met the required residency requirements.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[181]
Message=Procedure code was invalid on the date of service.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=2
[182]
Message=Procedure modifier was invalid on the date of service.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=2
[183]
Message=The referring provider is not eligible to refer the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/30/2005
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[184]
Message=The prescribing/ordering provider is not eligible to prescribe/order the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/30/2005
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[185]
Message=The rendering provider is not eligible to perform the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/30/2005
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[186]
Message=Level of care change adjustment.
EffDate=6/30/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[187]
Message=Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.)
EffDate=6/30/2005
DeactDate= 
Modified= 1/25/2009
Note=
Scenario=
[188]
Message=This product/procedure is only covered when used according to FDA recommendations.
EffDate=6/30/2005
DeactDate= 
Modified= 
Note=
Scenario=3
[189]
Message='Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service
EffDate=6/30/2005
DeactDate= 
Modified= 
Note=
Scenario=2
[190]
Message=Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.
EffDate=10/31/2005
DeactDate= 
Modified= 
Note=
Scenario=4
[191]
Message=Not a work related injury/illness and thus not the liability of the workers' compensation carrier Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF)
EffDate=10/31/2005
DeactDate= 7/1/2014
Modified= 10/17/2010
Note=Use code P2
Scenario=
[192]
Message=Non standard adjustment code from paper remittance. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment.
EffDate=10/31/2005
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[193]
Message=Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.
EffDate=2/28/2006
DeactDate= 
Modified= 1/27/2008
Note=
Scenario=
[194]
Message=Anesthesia performed by the operating physician, the assistant surgeon or the attending physician.
EffDate=2/28/2006
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[195]
Message=Refund issued to an erroneous priority payer for this claim/service.
EffDate=2/28/2006
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[196]
Message=Claim/service denied based on prior payer's coverage determination.
EffDate=6/30/2006
DeactDate= 2/1/2007
Modified= 
Note=Use code 136.
Scenario=
[197]
Message=Precertification/authorization/notification absent.
EffDate=10/31/2006
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[198]
Message=Precertification/authorization exceeded.
EffDate=10/31/2006
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[199]
Message=Revenue code and Procedure code do not match.
EffDate=10/31/2006
DeactDate= 
Modified= 
Note=
Scenario=2
[200]
Message=Expenses incurred during lapse in coverage
EffDate=10/31/2006
DeactDate= 
Modified= 
Note=
Scenario=3
[201]
Message=Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. (Use only with Group Code PR)  At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=10/31/2006
DeactDate= 
Modified= 9/28/2014
Note=Not for use by Workers' Compensation payers; use code P3 instead.
Scenario=3
[202]
Message=Non-covered personal comfort or convenience services.
EffDate=2/28/2007
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[203]
Message=Discontinued or reduced service.
EffDate=2/28/2007
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=
[204]
Message=This service/equipment/drug is not covered under the patient's current benefit plan
EffDate=2/28/2007
DeactDate= 
Modified= 
Note=
Scenario=3
[205]
Message=Pharmacy discount card processing fee
EffDate=7/9/2007
DeactDate= 
Modified= 
Note=
Scenario=
[206]
Message=National Provider Identifier - missing.
EffDate=7/9/2007
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=2
[207]
Message=National Provider identifier - Invalid format
EffDate=7/9/2007
DeactDate= 
Modified= 6/1/2008
Note=
Scenario=2
[208]
Message=National Provider Identifier - Not matched.
EffDate=7/9/2007
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=2
[209]
Message=Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA)
EffDate=7/9/2007
DeactDate= 
Modified= 7/1/2013
Note=
Scenario=
[210]
Message=Payment adjusted because pre-certification/authorization not received in a timely fashion
EffDate=7/9/2007
DeactDate= 
Modified= 
Note=
Scenario=3
[211]
Message=National Drug Codes (NDC) not eligible for rebate, are not covered.
EffDate=7/9/2007
DeactDate= 
Modified= 
Note=
Scenario=
[212]
Message=Administrative surcharges are not covered
EffDate=11/5/2007
DeactDate= 
Modified= 
Note=
Scenario=3
[213]
Message=Non-compliance with the physician self referral prohibition legislation or payer policy.
EffDate=1/27/2008
DeactDate= 
Modified= 
Note=
Scenario=3
[214]
Message=Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only
EffDate=1/27/2008
DeactDate= 7/1/2014
Modified= 10/17/2010
Note=Use code P4
Scenario=
[215]
Message=Based on subrogation of a third party settlement
EffDate=1/27/2008
DeactDate= 
Modified= 
Note=
Scenario=
[216]
Message=Based on the findings of a review organization
EffDate=1/27/2008
DeactDate= 
Modified= 
Note=
Scenario=
[217]
Message=Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. (Note: To be used for Property and Casualty only)
EffDate=1/27/2008
DeactDate= 7/1/2014
Modified= 9/30/2012
Note=Use code P5
Scenario=
[218]
Message=Based on entitlement to benefits. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only
EffDate=1/27/2008
DeactDate= 7/1/2014
Modified= 10/17/2010
Note=Use code P6
Scenario=
[219]
Message=Based on extent of injury. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF).
EffDate=1/27/2008
DeactDate= 
Modified= 10/17/2010
Note=
Scenario=
[220]
Message=The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. (Note: To be used for Property and Casualty only)
EffDate=1/27/2008
DeactDate= 7/1/2014
Modified= 9/30/2012
Note=Use code P7
Scenario=
[221]
Message=Claim is under investigation. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). (Note: To be used by Property & Casualty only)
EffDate=1/27/2008
DeactDate= 7/1/2014
Modified= 7/1/2013
Note=Use code P8
Scenario=
[222]
Message=Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=6/1/2008
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[223]
Message=Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.
EffDate=6/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[224]
Message=Patient identification compromised by identity theft. Identity verification required for processing this and future claims.
EffDate=6/1/2008
DeactDate= 
Modified= 
Note=
Scenario=3
[225]
Message=Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)
EffDate=6/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[226]
Message=Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=9/21/2008
DeactDate= 
Modified= 7/1/2013
Note=
Scenario=
[227]
Message=Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=9/21/2008
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=
[228]
Message=Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication
EffDate=9/21/2008
DeactDate= 
Modified= 
Note=
Scenario=3
[229]
Message=Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. (Use only with Group Code PR)
EffDate=1/25/2009
DeactDate= 
Modified= 7/1/2013
Note=
Scenario=
[230]
Message=No available or correlating CPT/HCPCS code to describe this service. Note: Used only by Property and Casualty.
EffDate=1/25/2009
DeactDate= 7/1/2014
Modified= 
Note=Use code P9
Scenario=
[231]
Message=Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=7/1/2009
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[232]
Message=Institutional Transfer Amount. Note - Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions.
EffDate=11/1/2009
DeactDate= 
Modified= 
Note=
Scenario=
[233]
Message=Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
EffDate=1/24/2010
DeactDate= 
Modified= 
Note=
Scenario=3
[234]
Message=This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=1/24/2010
DeactDate= 
Modified= 
Note=
Scenario=4
[235]
Message=Sales Tax
EffDate=6/6/2010
DeactDate= 
Modified= 
Note=
Scenario=
[236]
Message=This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.
EffDate=1/30/2011
DeactDate= 
Modified= 7/1/2013
Note=
Scenario=2
[237]
Message=Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=6/5/2011
DeactDate= 
Modified= 
Note=
Scenario=
[238]
Message=Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period. (Use only with Group Code PR)
EffDate=3/1/2012
DeactDate= 
Modified= 7/1/2013
Note=
Scenario=3
[239]
Message=Claim spans eligible and ineligible periods of coverage. Rebill separate claims.
EffDate=3/1/2012
DeactDate= 
Modified= 1/29/2012
Note=
Scenario=3
[240]
Message=The diagnosis is inconsistent with the patient's birth weight. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=6/3/2012
DeactDate= 
Modified= 
Note=
Scenario=2
[241]
Message=Low Income Subsidy (LIS) Co-payment Amount
EffDate=6/3/2012
DeactDate= 
Modified= 
Note=
Scenario=
[242]
Message=Services not provided by network/primary care providers.
EffDate=6/3/2012
DeactDate= 
Modified= 6/2/2013
Note=This code replaces deactivated code 38
Scenario=3
[243]
Message=Services not authorized by network/primary care providers.
EffDate=6/3/2012
DeactDate= 
Modified= 6/2/2013
Note=This code replaces deactivated code 38
Scenario=3
[244]
Message=Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation. To be used for Property & Casualty only.
EffDate=9/30/2012
DeactDate= 7/1/2014
Modified= 
Note=Use code P10
Scenario=
[245]
Message=Provider performance program withhold.
EffDate=9/30/2012
DeactDate= 
Modified= 
Note=
Scenario=
[246]
Message=This non-payable code is for required reporting only.
EffDate=9/30/2012
DeactDate= 
Modified= 
Note=
Scenario=3
[247]
Message=Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.
EffDate=9/30/2012
DeactDate= 
Modified= 
Note=For Medicare Bundled Payment use only, under the Patient Protection and Affordable Care Act (PPACA).
Scenario=
[248]
Message=Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.
EffDate=9/30/2012
DeactDate= 
Modified= 
Note=For Medicare Bundled Payment use only, under the Patient Protection and Affordable Care Act (PPACA).
Scenario=
[249]
Message=This claim has been identified as a readmission. (Use only with Group Code CO)
EffDate=9/30/2012
DeactDate= 
Modified= 
Note=
Scenario=3
[250]
Message=The attachment/other documentation that was received was the incorrect attachment/document. The expected attachment/document is still missing. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).
EffDate=9/30/2012
DeactDate= 
Modified= 6/1/2014
Note=
Scenario=1
[251]
Message=The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).
EffDate=9/30/2012
DeactDate= 
Modified= 6/1/2014
Note=
Scenario=1
[252]
Message=An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).
EffDate=9/30/2012
DeactDate= 
Modified= 6/2/2013
Note=
Scenario=1
[253]
Message=Sequestration - reduction in federal payment
EffDate=6/2/2013
DeactDate= 
Modified= 11/1/2013
Note=
Scenario=
[254]
Message=Claim received by the dental plan, but benefits not available under this plan.  Submit these services to the patient's medical plan for further consideration.
EffDate=6/2/2013
DeactDate= 
Modified= 
Note=
Scenario=3
[255]
Message=The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. (Use only with Group Code OA)
EffDate=6/2/2013
DeactDate= 7/1/2014
Modified= 
Note=Use code P11
Scenario=
[256]
Message=Service not payable per managed care contract.
EffDate=6/2/2013
DeactDate= 
Modified= 
Note=
Scenario=3
[257]
Message=The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)
EffDate=11/1/2013
DeactDate= 
Modified= 6/1/2014
Note=To be used after the first month of the grace period.
Scenario=
[258]
Message=Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=3
[259]
Message=Additional payment for Dental/Vision service utilization.
EffDate=1/26/2014
DeactDate= 
Modified= 
Note=
Scenario=
[260]
Message=Processed under Medicaid ACA Enhanced Fee Schedule
EffDate=1/26/2014
DeactDate= 
Modified= 
Note=
Scenario=
[261]
Message=The procedure or service is inconsistent with the patient's history.
EffDate=6/1/2014
DeactDate= 
Modified= 
Note=
Scenario=3
[262]
Message=Adjustment for delivery cost. Note: To be used for pharmaceuticals only.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[263]
Message=Adjustment for shipping cost. Note: To be used for pharmaceuticals only.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[264]
Message=Adjustment for postage cost. Note: To be used for pharmaceuticals only.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[265]
Message=Adjustment for administrative cost. Note: To be used for pharmaceuticals only.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[266]
Message=Adjustment for compound preparation cost. Note: To be used for pharmaceuticals only.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[267]
Message=Claim/service spans multiple months. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=11/1/2014
DeactDate= 
Modified= 4/1/2015
Note=
Scenario=2
[268]
Message=The Claim spans two calendar years. Please resubmit one claim per calendar year.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=2
[269]
Message=Anesthesia not covered for this service/procedure. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=3
[270]
Message=Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's dental plan for further consideration.
EffDate=7/1/2015
DeactDate= 
Modified= 
Note=
Scenario=3
[271]
Message=Prior contractual reductions related to a current periodic payment as part of a contractual payment schedule when deferred amounts have been previously reported. (Use only with group code OA)
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[272]
Message=Coverage/program guidelines were not met.
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=3
[273]
Message=Coverage/program guidelines were exceeded.
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=3
[274]
Message=Fee/Service not payable per patient Care Coordination arrangement.
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=3
[275]
Message=Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered. (Use only with Group Code PR)
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[276]
Message=Services denied by the prior payer(s) are not covered by this payer.
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=3
[277]
Message=The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=To be used during 31 day SHOP grace period.
Scenario=
[A0]
Message=Patient refund amount.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[A1]
Message=Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=
[A2]
Message=Contractual adjustment.
EffDate=1/1/1995
DeactDate= 1/1/2008
Modified= 2/28/2007
Note=Use Code 45 with Group Code 'CO' or use another appropriate specific adjustment code.
Scenario=
[A3]
Message=Medicare Secondary Payer liability met.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[A4]
Message=Medicare Claim PPS Capital Day Outlier Amount.
EffDate=1/1/1995
DeactDate= 4/1/2008
Modified= 9/30/2007
Note=
Scenario=
[A5]
Message=Medicare Claim PPS Capital Cost Outlier Amount.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[A6]
Message=Prior hospitalization or 30 day transfer requirement not met.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[A7]
Message=Presumptive Payment Adjustment
EffDate=1/1/1995
DeactDate= 7/1/2015
Modified= 
Note=
Scenario=
[A8]
Message=Ungroupable DRG.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=2
[B1]
Message=Non-covered visits.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[B2]
Message=Covered visits.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[B3]
Message=Covered charges.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[B4]
Message=Late filing penalty.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=
[B5]
Message=Coverage/program guidelines were not met or were exceeded.
EffDate=1/1/1995
DeactDate= 5/1/2016
Modified= 11/1/2015
Note=This code has been replaced by 272 and 273.
Scenario=
[B6]
Message=This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty.
EffDate=1/1/1995
DeactDate= 2/1/2006
Modified= 
Note=
Scenario=
[B7]
Message=This provider was not certified/eligible to be paid for this procedure/service on this date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[B8]
Message=Alternative services were available, and should have been utilized. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[B9]
Message=Patient is enrolled in a Hospice.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[B10]
Message=Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=4
[B11]
Message=The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[B12]
Message=Services not documented in patients' medical records.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[B13]
Message=Previously paid. Payment for this claim/service may have been provided in a previous payment.
EffDate=1/1/1995
DeactDate= 
Modified= 
Note=
Scenario=3
[B14]
Message=Only one visit or consultation per physician per day is covered.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[B15]
Message=This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information  REF), if present.
EffDate=1/1/1995
DeactDate= 
Modified= 9/20/2009
Note=
Scenario=3
[B16]
Message='New Patient' qualifications were not met.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[B17]
Message=Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current.
EffDate=1/1/1995
DeactDate= 2/1/2006
Modified= 
Note=
Scenario=
[B18]
Message=This procedure code and modifier were invalid on the date of service.
EffDate=1/1/1995
DeactDate= 3/1/2009
Modified= 9/21/2008
Note=
Scenario=
[B19]
Message=Claim/service adjusted because of the finding of a Review Organization.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[B20]
Message=Procedure/service was partially or fully furnished by another provider.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[B21]
Message=The charges were reduced because the service/care was partially furnished by another physician.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=
Scenario=
[B22]
Message=This payment is adjusted based on the diagnosis.
EffDate=1/1/1995
DeactDate= 
Modified= 2/28/2001
Note=
Scenario=
[B23]
Message=Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test.
EffDate=1/1/1995
DeactDate= 
Modified= 9/30/2007
Note=
Scenario=3
[D1]
Message=Claim/service denied. Level of subluxation is missing or inadequate.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D2]
Message=Claim lacks the name, strength, or dosage of the drug furnished.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D3]
Message=Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D4]
Message=Claim/service does not indicate the period of time for which this will be needed.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D5]
Message=Claim/service denied. Claim lacks individual lab codes included in the test.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D6]
Message=Claim/service denied. Claim did not include patient's medical record for the service.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D7]
Message=Claim/service denied. Claim lacks date of patient's most recent physician visit.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D8]
Message=Claim/service denied. Claim lacks indicator that 'x-ray is available for review.'
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D9]
Message=Claim/service denied. Claim lacks invoice or statement certifying the actual cost of the lens, less discounts or the type of intraocular lens used.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 16 and remark codes if necessary.
Scenario=
[D10]
Message=Claim/service denied. Completed physician financial relationship form not on file.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 17.
Scenario=
[D11]
Message=Claim lacks completed pacemaker registration form.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 17.
Scenario=
[D12]
Message=Claim/service denied. Claim does not identify who performed the purchased diagnostic test or the amount you were charged for the test.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 17.
Scenario=
[D13]
Message=Claim/service denied. Performed by a facility/supplier in which the ordering/referring physician has a financial interest.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 17.
Scenario=
[D14]
Message=Claim lacks indication that plan of treatment is on file.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 17.
Scenario=
[D15]
Message=Claim lacks indication that service was supervised or evaluated by a physician.
EffDate=1/1/1995
DeactDate= 10/16/2003
Modified= 
Note=Use code 17.
Scenario=
[D16]
Message=Claim lacks prior payer payment information.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=Use code 16 with appropriate claim payment remark code [N4].
Scenario=
[D17]
Message=Claim/Service has invalid non-covered days.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=Use code 16 with appropriate claim payment remark code.
Scenario=
[D18]
Message=Claim/Service has missing diagnosis information.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=Use code 16 with appropriate claim payment remark code.
Scenario=
[D19]
Message=Claim/Service lacks Physician/Operative or other supporting documentation
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=Use code 16 with appropriate claim payment remark code.
Scenario=
[D20]
Message=Claim/Service missing service/product information.
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=Use code 16 with appropriate claim payment remark code.
Scenario=
[D21]
Message=This (these) diagnosis(es) is (are) missing or are invalid
EffDate=1/1/1995
DeactDate= 6/30/2007
Modified= 
Note=
Scenario=
[D22]
Message=Reimbursement was adjusted for the reasons to be provided in separate correspondence. (Note: To be used for Workers' Compensation only) - Temporary code to be added for timeframe only until 01/01/2009. Another code to be established and/or for 06/2008 meeting for a revised code to replace or strategy to use another existing code
EffDate=1/27/2008
DeactDate= 1/1/2009
Modified= 
Note=
Scenario=
[D23]
Message=This dual eligible patient is covered by Medicare Part D per Medicare Retro-Eligibility.  At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)
EffDate=11/1/2009
DeactDate= 1/1/2012
Modified= 
Note=
Scenario=
[P1]
Message=State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 162
Scenario=
[P2]
Message=Not a work related injury/illness and thus not the liability of the workers' compensation carrier Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 191
Scenario=3
[P3]
Message=Workers' Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. To be used for Workers' Compensation only. (Use only with Group Code PR)
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 201
Scenario=3
[P4]
Message=Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 214
Scenario=3
[P5]
Message=Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 217
Scenario=
[P6]
Message=Based on entitlement to benefits. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 218
Scenario=
[P7]
Message=The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 220
Scenario=2
[P8]
Message=Claim is under investigation. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 221
Scenario=
[P9]
Message=No available or correlating CPT/HCPCS code to describe this service. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 230
Scenario=
[P10]
Message=Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 244
Scenario=
[P11]
Message=The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. To be used for Property and Casualty only. (Use only with Group Code OA)
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code 255
Scenario=
[P12]
Message=Workers' compensation jurisdictional fee schedule adjustment.  Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Workers' Compensation only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W1
Scenario=
[P13]
Message=Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Workers' Compensation only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W2
Scenario=
[P14]
Message=The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W3
Scenario=4
[P15]
Message=Workers' Compensation Medical Treatment Guideline Adjustment. To be used for Workers' Compensation only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W4
Scenario=
[P16]
Message=Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for Workers' Compensation only. (Use with Group Code CO or OA)
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W5
Scenario=3
[P17]
Message=Referral not authorized by attending physician per regulatory requirement. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W6
Scenario=3
[P18]
Message=Procedure is not listed in the jurisdiction fee schedule.  An allowance has been made for a comparable service. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W7
Scenario=
[P19]
Message=Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W8
Scenario=4
[P20]
Message=Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used for Property and Casualty only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code W9
Scenario=3
[P21]
Message=Payment denied based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code Y1
Scenario=3
[P22]
Message=Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code Y2
Scenario=
[P23]
Message=Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=This code replaces deactivated code Y3
Scenario=
[W1]
Message=Workers' compensation jurisdictional fee schedule adjustment.  Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply.
EffDate=2/29/2000
DeactDate= 7/1/2014
Modified= 6/2/2013
Note=Use code P12
Scenario=
[W2]
Message=Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Workers' Compensation only.
EffDate=10/17/2010
DeactDate= 7/1/2014
Modified= 6/2/2013
Note=Use code P13
Scenario=
[W3]
Message=The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. For use by Property and Casualty only.
EffDate=9/30/2012
DeactDate= 7/1/2014
Modified= 
Note=Use code P14
Scenario=
[W4]
Message=Workers' Compensation Medical Treatment Guideline Adjustment.
EffDate=9/30/2012
DeactDate= 7/1/2014
Modified= 
Note=Use code P15
Scenario=
[W5]
Message=Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. (Use with Group Code CO or OA)
EffDate=6/2/2013
DeactDate= 7/1/2014
Modified= 
Note=Use code P16
Scenario=
[W6]
Message=Referral not authorized by attending physician per regulatory requirement.
EffDate=6/2/2013
DeactDate= 7/1/2014
Modified= 
Note=Use code P17
Scenario=
[W7]
Message=Procedure is not listed in the jurisdiction fee schedule.  An allowance has been made for a comparable service.
EffDate=6/2/2013
DeactDate= 7/1/2014
Modified= 
Note=Use code P18
Scenario=
[W8]
Message=Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due.
EffDate=6/2/2013
DeactDate= 7/1/2014
Modified= 
Note=Use code P19
Scenario=
[W9]
Message=Service not paid under jurisdiction allowed outpatient facility fee schedule.
EffDate=6/2/2013
DeactDate= 7/1/2014
Modified= 
Note=Use code P20
Scenario=
[Y1]
Message=Payment denied based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for P&C Auto only.
EffDate=9/30/2012
DeactDate= 7/1/2014
Modified= 6/2/2013
Note=Use code P21
Scenario=
[Y2]
Message=Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for P&C Auto only.
EffDate=9/30/2012
DeactDate= 7/1/2014
Modified= 6/2/2013
Note=Use code P22
Scenario=
[Y3]
Message=Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for P&C Auto only.
EffDate=9/30/2012
DeactDate= 7/1/2014
Modified= 6/2/2013
Note=Use code P23
Scenario=
[COc]
Message=Contractural Obligations
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[CRc]
Message=Correction and Reversals
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[OAc]
Message=Other adjustments
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[PRc]
Message=Patient Responsibility
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[50p]
Message=Late Charge
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[51p]
Message=Interest Penalty Charge
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[72p]
Message=Authorized Return
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[90p]
Message=Early Payment Allowance
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[AMp]
Message=Applied to Borrower's Account
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[APp]
Message=Acceleration of Benefits
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[B2p]
Message=Rebate
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[B3p]
Message=Recovery Allowance
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[BDp]
Message=Bad Debt Adjustment
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[BNp]
Message=Bonus
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[C5p]
Message=Temporary Allowance
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[CRp]
Message=Capitation Interest
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[CSp]
Message=Adjustment
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[CTp]
Message=Capitation Payment
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[CVp]
Message=Capital Passthru
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[CWp]
Message=Certified Registered Nurse Anesthetist Passthru
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[DMp]
Message=Direct Medical Education Passthru
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[E3p]
Message=Withholding
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[FBp]
Message=Forwarding Balance
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[FCp]
Message=Fund Allocation
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[GOp]
Message=Graduate Medical Education Passthru
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[IPp]
Message=Incentive Premium Payment
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[IRp]
Message=Internal Revenue Service Withholding
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[ISp]
Message=Interim Settlement
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[J1p]
Message=Nonreimbursable
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[L3p]
Message=Penalty
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[L6p]
Message=Interest Owed
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[LEp]
Message=Levy
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[LSp]
Message=Lump Sum
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[OAp]
Message=Organ Acquisition Passthru
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[OBp]
Message=Offset for Affiliated Providers
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[PIp]
Message=Periodic Interim Payment
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[PLp]
Message=Payment Final
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[RAp]
Message=Retro-activity Adjustment
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[REp]
Message=Return on Equity
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[SLp]
Message=Student Loan Repayment
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[TLp]
Message=Third Party Liablility
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[WOp]
Message=Overpayment Recovery
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[WUp]
Message=Unspecified Recovery
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[ZZp]
Message=Mutually Defined
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[1s]
Message=Additional Information Required - Missing/Invalid/Incomplete Documentation
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[2s]
Message=Additional Information Required - Missing/Invalid/Incomplete Data from Submitted Claim
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[3s]
Message=Billed Service Not Covered by Health Plan
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[4s]
Message=Benefit for Billed Service Not Separately Payable
EffDate=
DeactDate= 
Modified= 
Note=
Scenario=
[M1]
Message=X-ray not taken within the past 12 months or near enough to the start of treatment.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M2]
Message=Not paid separately when the patient is an inpatient.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M3]
Message=Equipment is the same or similar to equipment already being used.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M4]
Message=Alert: This is the last monthly installment payment for this durable medical equipment.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[M5]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M6]
Message=Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
EffDate=1/1/1997
DeactDate= 
Modified= 3/1/2009
Note=(Modified 4/1/07, 3/1/2009)
Scenario=
[M7]
Message=No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M8]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M9]
Message=Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[M10]
Message=Equipment purchases are limited to the first or the tenth month of medical necessity.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M11]
Message=DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M12]
Message=Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M13]
Message=Only one initial visit is covered per specialty per medical group.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2007
Note=(Modified 6/30/03)
Scenario=
[M14]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M15]
Message=Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M16]
Message=Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Reactivated 4/1/04, Modified 11/18/05, 4/1/07)
Scenario=
[M17]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[M18]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[M19]
Message=Missing oxygen certification/re-certification.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N234
Scenario=
[M20]
Message=Missing/incomplete/invalid HCPCS.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M21]
Message=Missing/incomplete/invalid place of residence for this service/item provided in a home.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M22]
Message=Missing/incomplete/invalid number of miles traveled.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M23]
Message=Missing invoice.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2005
Note=(Modified 8/1/05)
Scenario=
[M24]
Message=Missing/incomplete/invalid number of doses per vial.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M25]
Message=The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice.  If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
EffDate=1/1/1997
DeactDate= 
Modified= 11/1/2010
Note=(Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07, 11/1/10)
Scenario=
[M26]
Message=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. <br /><br />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.
EffDate=1/1/1997
DeactDate= 
Modified= 11/5/2007
Note=(Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356)
Scenario=
[M27]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2007
Note=(Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07)
Scenario=
[M28]
Message=This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M29]
Message=Missing operative note/report.
EffDate=1/1/1997
DeactDate= 
Modified= 7/1/2008
Note=(Modified 2/28/03, 7/1/2008) Related to N233
Scenario=
[M30]
Message=Missing pathology report.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2004
Note=(Modified 8/1/04, 2/28/03) Related to N236
Scenario=
[M31]
Message=Missing radiology report.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2004
Note=(Modified 8/1/04, 2/28/03) Related to N240
Scenario=
[M32]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[M33]
Message=Missing/incomplete/invalid UPIN for the ordering/referring/performing provider.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using M68
Scenario=
[M34]
Message=Claim lacks the CLIA certification number.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using MA120
Scenario=
[M35]
Message=Missing/incomplete/invalid pre-operative photos or visual field results.
EffDate=1/1/1997
DeactDate= 2/5/2005
Modified= 
Note=Consider using N178
Scenario=
[M36]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M37]
Message=Not covered when the patient is under age 35.
EffDate=1/1/1997
DeactDate= 
Modified= 3/8/2011
Note=(Modified 3/8/11)
Scenario=
[M38]
Message=Alert: The patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not pay for it and the patient agreed to be responsible for the charges.
EffDate=1/1/1997
DeactDate= 
Modified= 7/1/2015
Note=(Modified 7/1/15)
Scenario=
[M39]
Message=Alert: The patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.
EffDate=1/1/1997
DeactDate= 
Modified= 7/1/2015
Note=(Modified 2/1/04, 4/1/07, 11/1/09, 11/1/12, 7/1/15) Related to N563
Scenario=
[M40]
Message=Claim must be assigned and must be filed by the practitioner's employer.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M41]
Message=We do not pay for this as the patient has no legal obligation to pay for this.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M42]
Message=The medical necessity form must be personally signed by the attending physician.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M43]
Message=Payment for this service previously issued to you or another provider by another carrier/intermediary.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using Reason Code 23
Scenario=
[M44]
Message=Missing/incomplete/invalid condition code.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M45]
Message=Missing/incomplete/invalid occurrence code(s).
EffDate=1/1/1997
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04) Related to N299
Scenario=
[M46]
Message=Missing/incomplete/invalid occurrence span code(s).
EffDate=1/1/1997
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04) Related to N300
Scenario=
[M47]
Message=Missing/incomplete/invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN).
EffDate=1/1/1997
DeactDate= 
Modified= 7/1/2015
Note=(Modified 2/28/03, 7/1/15)
Scenario=
[M48]
Message=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.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using M97
Scenario=
[M49]
Message=Missing/incomplete/invalid value code(s) or amount(s).
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M50]
Message=Missing/incomplete/invalid revenue code(s).
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M51]
Message=Missing/incomplete/invalid procedure code(s).
EffDate=1/1/1997
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04) Related to N301
Scenario=
[M52]
Message=Missing/incomplete/invalid "from" date(s) of service.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M53]
Message=Missing/incomplete/invalid days or units of service.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M54]
Message=Missing/incomplete/invalid total charges.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M55]
Message=We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M56]
Message=Missing/incomplete/invalid payer identifier.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M57]
Message=Missing/incomplete/invalid provider identifier.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[M58]
Message=Missing/incomplete/invalid claim information.  Resubmit claim after corrections.
EffDate=1/1/1997
DeactDate= 2/5/2005
Modified= 
Note=
Scenario=
[M59]
Message=Missing/incomplete/invalid "to" date(s) of service.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M60]
Message=Missing Certificate of Medical Necessity.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2004
Note=(Modified 8/1/04, 6/30/03) Related to N227
Scenario=
[M61]
Message=We cannot pay for this as the approval period for the FDA clinical trial has expired.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M62]
Message=Missing/incomplete/invalid treatment authorization code.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M63]
Message=We do not pay for more than one of these on the same day.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using M86
Scenario=
[M64]
Message=Missing/incomplete/invalid other diagnosis.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M65]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M66]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M67]
Message=Missing/incomplete/invalid other procedure code(s).
EffDate=1/1/1997
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04) Related to N302
Scenario=
[M68]
Message=Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[M69]
Message=Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
EffDate=1/1/1997
DeactDate= 
Modified= 2/1/2004
Note=(Modified 2/1/04)
Scenario=
[M70]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2007
Note=(Modified 4/1/2007, 8/1/07)
Scenario=
[M71]
Message=Total payment reduced due to overlap of tests billed.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M72]
Message=Did not enter full 8-digit date (MM/DD/CCYY).
EffDate=1/1/1997
DeactDate= 10/16/2003
Modified= 
Note=Consider using MA52
Scenario=
[M73]
Message=The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components. 
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2004
Note=(Modified 8/1/04)
Scenario=
[M74]
Message=This service does not qualify for a HPSA/Physician Scarcity bonus payment.
EffDate=1/1/1997
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04)
Scenario=
[M75]
Message=Multiple automated multichannel tests performed on the same day combined for payment.
EffDate=1/1/1997
DeactDate= 
Modified= 11/5/2007
Note=(Modified 11/5/07)
Scenario=
[M76]
Message=Missing/incomplete/invalid diagnosis or condition.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M77]
Message=Missing/incomplete/invalid/inappropriate place of service.
EffDate=1/1/1997
DeactDate= 
Modified= 3/14/2014
Note=(Modified 2/28/03, 3/1/2014, 3/14/2014)
Scenario=
[M78]
Message=Missing/incomplete/invalid HCPCS modifier.
EffDate=1/1/1997
DeactDate= 5/18/2006
Modified= 2/28/2003
Note=(Modified 2/28/03,) Consider using Reason Code 4
Scenario=
[M79]
Message=Missing/incomplete/invalid charge.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M80]
Message=Not covered when performed during the same session/date as a previously processed service for the patient.
EffDate=1/1/1997
DeactDate= 
Modified= 10/31/2002
Note=(Modified 10/31/02)
Scenario=
[M81]
Message=You are required to code to the highest level of specificity.
EffDate=1/1/1997
DeactDate= 
Modified= 2/1/2004
Note=(Modified 2/1/04)
Scenario=
[M82]
Message=Service is not covered when patient is under age 50.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M83]
Message=Service is not covered unless the patient is classified as at high risk.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M84]
Message=Medical code sets used must be the codes in effect at the time of service.
EffDate=1/1/1997
DeactDate= 
Modified= 3/14/2014
Note=(Modified 2/1/04, 3/14/2014)
Scenario=
[M85]
Message=Subjected to review of physician evaluation and management services.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M86]
Message=Service denied because payment already made for same/similar procedure within set time frame.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[M87]
Message=Claim/service(s) subjected to CFO-CAP prepayment review.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M88]
Message=We cannot pay for laboratory tests unless billed by the laboratory that did the work.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using Reason Code B20
Scenario=
[M89]
Message=Not covered more than once under age 40.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M90]
Message=Not covered more than once in a 12 month period.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M91]
Message=Lab procedures with different CLIA certification numbers must be billed on separate claims.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M92]
Message=Services subjected to review under the Home Health Medical Review Initiative.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=
Scenario=
[M93]
Message=Information supplied supports a break in therapy.  A new capped rental period began with delivery of this equipment.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M94]
Message=Information supplied does not support a break in therapy.  A new capped rental period will not begin.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M95]
Message=Services subjected to Home Health Initiative medical review/cost report audit.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M96]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M97]
Message=Not paid to practitioner when provided to patient in this place of service.  Payment included in the reimbursement issued the facility.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M98]
Message=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.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using M99
Scenario=
[M99]
Message=Missing/incomplete/invalid Universal Product Number/Serial Number.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M100]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M101]
Message=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.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using M78
Scenario=
[M102]
Message=Service not performed on equipment approved by the FDA for this purpose.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M103]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M104]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M105]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M106]
Message=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.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using MA 31
Scenario=
[M107]
Message=Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M108]
Message=Missing/incomplete/invalid provider identifier for the provider who interpreted the diagnostic test.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[M109]
Message=We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner. 
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M110]
Message=Missing/incomplete/invalid provider identifier for the provider from whom you purchased interpretation services.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[M111]
Message=We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M112]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 11/5/2007
Note=(Modified 11/5/07)
Scenario=
[M113]
Message=Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
EffDate=1/1/1997
DeactDate= 
Modified= 11/5/2007
Note=(Modified 11/5/07)
Scenario=
[M114]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 11/5/2007
Note=(Modified 8/1/06, 11/5/07)
Scenario=
[M115]
Message=This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
EffDate=1/1/1997
DeactDate= 
Modified= 11/5/2007
Note=(Modified 11/5/2007)
Scenario=
[M116]
Message=Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.
EffDate=1/1/1997
DeactDate= 
Modified= 3/8/2011
Note=(Modified 2/1/04, 3/15/11)
Scenario=
[M117]
Message=Not covered unless submitted via electronic claim.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[M118]
Message=Letter to follow containing further information.
EffDate=1/1/1997
DeactDate= 1/1/2011
Modified= 11/1/2009
Note=Consider using N202
Scenario=
[M119]
Message=Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 2/28/03, 4/1/04)
Scenario=
[M120]
Message=Missing/incomplete/invalid provider identifier for the substituting physician who furnished the service(s) under a reciprocal billing or locum tenens arrangement.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[M121]
Message=We pay for this service only when performed with a covered cryosurgical ablation.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M122]
Message=Missing/incomplete/invalid level of subluxation.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2006
Note=(Modified 2/28/03)
Scenario=
[M123]
Message=Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M124]
Message=Missing indication of whether the patient owns the equipment that requires the part or supply.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N230
Scenario=
[M125]
Message=Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M126]
Message=Missing/incomplete/invalid individual lab codes included in the test.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M127]
Message=Missing patient medical record for this service.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N237
Scenario=
[M128]
Message=Missing/incomplete/invalid date of the patient's last physician visit.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[M129]
Message=Missing/incomplete/invalid indicator of x-ray availability for review.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 2/28/03, 6/30/03)
Scenario=
[M130]
Message=Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N231
Scenario=
[M131]
Message=Missing physician financial relationship form.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N239
Scenario=
[M132]
Message=Missing pacemaker registration form.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N235
Scenario=
[M133]
Message=Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M134]
Message=Performed by a facility/supplier in which the provider has a financial interest.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[M135]
Message=Missing/incomplete/invalid plan of treatment.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M136]
Message=Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[M137]
Message=Part B coinsurance under a demonstration project or pilot program.
EffDate=1/1/1997
DeactDate= 
Modified= 11/1/2012
Note=(Modified 11/1/12)
Scenario=
[M138]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M139]
Message=Denied services exceed the coverage limit for the demonstration.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[M140]
Message=Service not covered until after the patient's 50th birthday, i.e., no coverage prior to the day after the 50th birthday
EffDate=1/1/1997
DeactDate= 1/30/2004
Modified= 
Note=Consider using M82
Scenario=
[M141]
Message=Missing physician certified plan of care.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N238
Scenario=
[M142]
Message=Missing American Diabetes Association Certificate of Recognition.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N226
Scenario=
[M143]
Message=The provider must update license information with the payer.
EffDate=1/1/1997
DeactDate= 
Modified= 12/1/2006
Note=(Modified 12/1/06)
Scenario=
[M144]
Message=Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA01]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07)
Scenario=
[MA02]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07)
Scenario=
[MA03]
Message=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.
EffDate=1/1/1997
DeactDate= 10/1/2006
Modified= 11/18/2005
Note=Consider using MA02 (Modified 10/31/02, 6/30/03, 8/1/05, 11/18/05)
Scenario=
[MA04]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA05]
Message=Incorrect admission date patient status or type of bill entry on claim.  
EffDate=1/1/1997
DeactDate= 10/16/2003
Modified= 
Note=Consider using MA30, MA40 or MA43
Scenario=
[MA06]
Message=Missing/incomplete/invalid beginning and/or ending date(s).
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using MA31
Scenario=
[MA07]
Message=Alert: The claim information has also been forwarded to Medicaid for review.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA08]
Message=Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA09]
Message=Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.
EffDate=1/1/1997
DeactDate= 
Modified= 11/1/2015
Note=(Modified 11/1/2014, 11/1/2015)
Scenario=
[MA10]
Message=Alert: The patient's payment was in excess of the amount owed.  You must refund the overpayment to the patient.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA11]
Message=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.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using M32
Scenario=
[MA12]
Message=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).
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA13]
Message=Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA14]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2007
Note=(Modified 4/1/07, 8/1/07)
Scenario=
[MA15]
Message=Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA16]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA17]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA18]
Message=Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA19]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA20]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[MA21]
Message=SSA records indicate mismatch with name and sex.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA22]
Message=Payment of less than $1.00 suppressed.  
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA23]
Message=Demand bill approved as result of medical review.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA24]
Message=Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period. 
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[MA25]
Message=A patient may not elect to change a hospice provider more than once in a benefit period.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA26]
Message=Alert: Our records indicate that you were previously informed of this rule.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA27]
Message=Missing/incomplete/invalid entitlement number or name shown on the claim.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA28]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA29]
Message=Missing/incomplete/invalid provider name, city, state, or zip code.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[MA30]
Message=Missing/incomplete/invalid type of bill.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA31]
Message=Missing/incomplete/invalid beginning and ending dates of the period billed.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA32]
Message=Missing/incomplete/invalid number of covered days during the billing period.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA33]
Message=Missing/incomplete/invalid noncovered days during the billing period.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA34]
Message=Missing/incomplete/invalid number of coinsurance days during the billing period.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA35]
Message=Missing/incomplete/invalid number of lifetime reserve days.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA36]
Message=Missing/incomplete/invalid patient name.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA37]
Message=Missing/incomplete/invalid patient's address.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA38]
Message=Missing/incomplete/invalid birth date.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[MA39]
Message=Missing/incomplete/invalid gender.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA40]
Message=Missing/incomplete/invalid admission date.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA41]
Message=Missing/incomplete/invalid admission type.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA42]
Message=Missing/incomplete/invalid admission source.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA43]
Message=Missing/incomplete/invalid patient status.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA44]
Message=Alert: No appeal rights. Adjudicative decision based on law.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA45]
Message=Alert: As previously advised, a portion or all of your payment is being held in a special account.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA46]
Message=Alert: The new information was considered but additional payment will not be issued.
EffDate=1/1/1997
DeactDate= 
Modified= 11/1/2015
Note=(Modified 3/1/2009, 11/1/2015)
Scenario=
[MA47]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA48]
Message=Missing/incomplete/invalid name or address of responsible party or primary payer.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA49]
Message=Missing/incomplete/invalid six-digit provider identifier for home health agency or hospice for physician(s) performing care plan oversight services.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using MA76
Scenario=
[MA50]
Message=Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.
EffDate=1/1/1997
DeactDate= 
Modified= 3/1/2014
Note=(Modified  2/28/03, 3/1/2014)
Scenario=
[MA51]
Message=Missing/incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory.
EffDate=1/1/1997
DeactDate= 2/5/2005
Modified= 
Note=Consider using MA120
Scenario=
[MA52]
Message=Missing/incomplete/invalid date.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[MA53]
Message=Missing/incomplete/invalid Competitive Bidding Demonstration Project identification. 
EffDate=1/1/1997
DeactDate= 
Modified= 2/1/2004
Note=(Modified 2/1/04)
Scenario=
[MA54]
Message=Physician certification or election consent for hospice care not received timely.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA55]
Message=Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA56]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA57]
Message=Patient submitted written request to revoke his/her election for religious non-medical health care services.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA58]
Message=Missing/incomplete/invalid release of information indicator.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA59]
Message=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. 
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA60]
Message=Missing/incomplete/invalid patient relationship to insured.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA61]
Message=Missing/incomplete/invalid social security number or health insurance claim number.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA62]
Message=Alert: This is a telephone review decision.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2007
Note=(Modified 4/1/07, 8/1/07)
Scenario=
[MA63]
Message=Missing/incomplete/invalid principal diagnosis.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA64]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA65]
Message=Missing/incomplete/invalid admitting diagnosis.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA66]
Message=Missing/incomplete/invalid principal procedure code.
EffDate=1/1/1997
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04) Related to N303
Scenario=
[MA67]
Message=Alert: Correction to a prior claim.
EffDate=1/1/1997
DeactDate= 
Modified= 11/1/2015
Note=(Modified 11/1/2015)
Scenario=
[MA68]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA69]
Message=Missing/incomplete/invalid remarks.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA70]
Message=Missing/incomplete/invalid provider representative signature.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA71]
Message=Missing/incomplete/invalid provider representative signature date.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA72]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA73]
Message=Informational remittance associated with a Medicare demonstration.  No payment issued under fee-for-service Medicare as patient has elected managed care.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA74]
Message=Alert: This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
EffDate=1/1/1997
DeactDate= 
Modified= 7/1/2015
Note=(Modified 7/1/15)
Scenario=
[MA75]
Message=Missing/incomplete/invalid patient or authorized representative signature.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA76]
Message=Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03, 2/1/04)
Scenario=
[MA77]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[MA78]
Message=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.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using MA59
Scenario=
[MA79]
Message=Billed in excess of interim rate.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA80]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA81]
Message=Missing/incomplete/invalid provider/supplier signature.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA82]
Message=Missing/incomplete/invalid provider/supplier billing number/identifier or billing name, address, city, state, zip code, or phone number.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[MA83]
Message=Did not indicate whether we are the primary or secondary payer.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2005
Note=(Modified 8/1/05)
Scenario=
[MA84]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA85]
Message=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 PlanID when effective.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using MA92
Scenario=
[MA86]
Message=Missing/incomplete/invalid group or policy number of the insured for the primary coverage.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using MA92
Scenario=
[MA87]
Message=Missing/incomplete/invalid insured's name for the primary payer.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using MA92
Scenario=
[MA88]
Message=Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA89]
Message=Missing/incomplete/invalid patient's relationship to the insured for the primary payer.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA90]
Message=Missing/incomplete/invalid employment status code for the primary insured.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03).
Scenario=
[MA91]
Message=Alert: This determination is the result of the appeal you filed.
EffDate=1/1/1997
DeactDate= 
Modified= 7/1/2015
Note=(Modified 7/1/15)
Scenario=
[MA92]
Message=Missing plan information for other insurance.
EffDate=1/1/1997
DeactDate= 
Modified= 2/1/2004
Note=(Modified 2/1/04) Related to N245
Scenario=
[MA93]
Message=Non-PIP (Periodic Interim Payment) claim.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[MA94]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 8/1/2005
Note=(Reactivated 4/1/04, Modified 8/1/05)
Scenario=
[MA95]
Message=A not otherwise classified or unlisted procedure code(s) was billed but a narrative description of the procedure was not entered on the claim.  Refer to item 19 on the HCFA-1500.
EffDate=1/1/1997
DeactDate= 1/1/2004
Modified= 2/28/2003
Note=(Deactivated 2/28/2003) (Erroneous description corrected 9/2/2008) Consider using M51
Scenario=
[MA96]
Message=Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA97]
Message=Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
EffDate=1/1/1997
DeactDate= 
Modified= 2/29/2008
Note=(Modified 2/29/08)
Scenario=
[MA98]
Message=Claim Rejected. Does not contain the correct Medicare Managed Care Demonstration contract number for this beneficiary.
EffDate=1/1/1997
DeactDate= 10/16/2003
Modified= 
Note=Consider using MA97
Scenario=
[MA99]
Message=Missing/incomplete/invalid Medigap information.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA100]
Message=Missing/incomplete/invalid date of current illness or symptoms.
EffDate=1/1/1997
DeactDate= 
Modified= 3/14/2014
Note=(Modified 2/28/03, 3/30/05, 3/14/2014)
Scenario=
[MA101]
Message=A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents.
EffDate=1/1/1997
DeactDate= 1/1/2011
Modified= 6/30/2003
Note=Consider using N538
Scenario=
[MA102]
Message=Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider.
EffDate=1/1/1997
DeactDate= 8/1/2004
Modified= 
Note=Consider using M68
Scenario=
[MA103]
Message=Hemophilia Add On.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA104]
Message=Missing/incomplete/invalid date the patient was last seen or the provider identifier of the attending physician.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using M128 or M57
Scenario=
[MA105]
Message=Missing/incomplete/invalid provider number for this place of service.
EffDate=1/1/1997
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[MA106]
Message=PIP (Periodic Interim Payment) claim.
EffDate=1/1/1997
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[MA107]
Message=Paper claim contains more than three separate data items in field 19.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA108]
Message=Paper claim contains more than one data item in field 23.  
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA109]
Message=Claim processed in accordance with ambulatory surgical guidelines.  
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA110]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA111]
Message=Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA112]
Message=Missing/incomplete/invalid group practice information.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA113]
Message=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.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA114]
Message=Missing/incomplete/invalid information on where the services were furnished.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA115]
Message=Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA116]
Message=Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=(Reactivated 4/1/04)
Scenario=
[MA117]
Message=This claim has been assessed a $1.00 user fee.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA118]
Message=Alert: No Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance and/or deductible are applicable.
EffDate=1/1/1997
DeactDate= 
Modified= 11/1/2014
Note=
Scenario=
[MA119]
Message=Provider level adjustment for late claim filing applies to this claim.
EffDate=1/1/1997
DeactDate= 5/1/2008
Modified= 11/5/2007
Note=Consider using Reason Code B4
Scenario=
[MA120]
Message=Missing/incomplete/invalid CLIA certification number.
EffDate=1/1/1997
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[MA121]
Message=Missing/incomplete/invalid x-ray date.
EffDate=1/1/1997
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04)
Scenario=
[MA122]
Message=Missing/incomplete/invalid initial treatment date.
EffDate=1/1/1997
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04)
Scenario=
[MA123]
Message=Your center was not selected to participate in this study, therefore, we cannot pay for these services.
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA124]
Message=Processed for IME only.
EffDate=1/1/1997
DeactDate= 1/31/2004
Modified= 
Note=Consider using Reason Code 74
Scenario=
[MA125]
Message=Per legislation governing this program, payment constitutes payment in full. 
EffDate=1/1/1997
DeactDate= 
Modified= 
Note=
Scenario=
[MA126]
Message=Pancreas transplant not covered unless kidney transplant performed.
EffDate=10/12/2001
DeactDate= 
Modified= 
Note=
Scenario=
[MA127]
Message=Reserved for future use.
EffDate=10/12/2001
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[MA128]
Message=Missing/incomplete/invalid FDA approval number.
EffDate=10/12/2001
DeactDate= 
Modified= 3/30/2005
Note=(Modified 2/28/03, 3/30/05)
Scenario=
[MA129]
Message=This provider was not certified for this procedure on this date of service.
EffDate=10/12/2001
DeactDate= 1/31/2004
Modified= 1/31/2004
Note=Consider using MA120 and Reason Code B7
Scenario=
[MA130]
Message=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.
EffDate=10/12/2001
DeactDate= 
Modified= 
Note=
Scenario=
[MA131]
Message=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.
EffDate=10/12/2001
DeactDate= 
Modified= 
Note=
Scenario=
[MA132]
Message=Adjustment to the pre-demonstration rate.
EffDate=10/12/2001
DeactDate= 
Modified= 
Note=
Scenario=
[MA133]
Message=Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
EffDate=10/12/2001
DeactDate= 
Modified= 
Note=
Scenario=
[MA134]
Message=Missing/incomplete/invalid provider number of the facility where the patient resides. 
EffDate=10/12/2001
DeactDate= 
Modified= 
Note=
Scenario=
[N1]
Message=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, plan benefit documents or jurisdiction statutes.
EffDate=1/1/2000
DeactDate= 
Modified= 7/15/2013
Note=(Modified 2/28/03, 4/1/07, 7/15/13)
Scenario=
[N2]
Message=This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N3]
Message=Missing consent form.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03) Related to N228
Scenario=
[N4]
Message=Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB. 
EffDate=1/1/2000
DeactDate= 
Modified= 3/6/2012
Note=(Modified 2/28/03, 3/6/2012)
Scenario=
[N5]
Message=EOB received from previous payer.  Claim not on file.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N6]
Message=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.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N7]
Message=Alert: Processing of this claim/service has included consideration under Major Medical provisions.
EffDate=1/1/2000
DeactDate= 
Modified= 7/15/2013
Note=(Modified 7/15/13)
Scenario=
[N8]
Message=Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N9]
Message=Adjustment represents the estimated amount a previous payer may pay.
EffDate=1/1/2000
DeactDate= 
Modified= 11/18/2005
Note=(Modified 11/18/05)
Scenario=
[N10]
Message=Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.
EffDate=1/1/2000
DeactDate= 
Modified= 3/1/2015
Note=(Modified 10/31/02, 7/1/08, 7/15/13, 3/1/2015)
Scenario=
[N11]
Message=Denial reversed because of medical review.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N12]
Message=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.
EffDate=1/1/2000
DeactDate= 
Modified= 8/1/2007
Note=(Modified 8/1/07)
Scenario=
[N13]
Message=Payment based on professional/technical component modifier(s).
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N14]
Message=Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount.
EffDate=1/1/2000
DeactDate= 10/1/2007
Modified= 
Note=Consider using Reason Code 45
Scenario=
[N15]
Message=Services for a newborn must be billed separately.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N16]
Message=Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N17]
Message=Per admission deductible.
EffDate=1/1/2000
DeactDate= 8/1/2004
Modified= 
Note=Consider using Reason Code 1
Scenario=
[N18]
Message=Payment based on the Medicare allowed amount.
EffDate=1/1/2000
DeactDate= 1/31/2004
Modified= 
Note=Consider using N14
Scenario=
[N19]
Message=Procedure code incidental to primary procedure.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N20]
Message=Service not payable with other service rendered on the same date.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N21]
Message=Alert: Your line item has been separated into multiple lines to expedite handling.
EffDate=1/1/2000
DeactDate= 
Modified= 4/1/2007
Note=(Modified 8/1/05, 4/1/07)
Scenario=
[N22]
Message=Alert: This procedure code was added/changed because it more accurately describes the services rendered.
EffDate=1/1/2000
DeactDate= 
Modified= 7/1/2015
Note=(Modified 10/31/02, 2/28/03, 7/1/15)
Scenario=
[N23]
Message=Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
EffDate=1/1/2000
DeactDate= 
Modified= 4/1/2007
Note=(Modified 8/13/01, 4/1/07)
Scenario=
[N24]
Message=Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N25]
Message=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.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N26]
Message=Missing itemized bill/statement.
EffDate=1/1/2000
DeactDate= 
Modified= 7/1/2008
Note=(Modified 2/28/03, 7/1/2008) Related to N232
Scenario=
[N27]
Message=Missing/incomplete/invalid treatment number.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N28]
Message=Consent form requirements not fulfilled.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N29]
Message=Missing documentation/orders/notes/summary/report/chart.
EffDate=1/1/2000
DeactDate= 3/1/2016
Modified= 3/1/2014
Note=(Modified 2/28/03, 8/1/05, 3/1/2014) Related to N225, Explicit RARCs have been approved, this non-specific RARC will be deactivated in March 2016.
Scenario=
[N30]
Message=Patient ineligible for this service.
EffDate=1/1/2000
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[N31]
Message=Missing/incomplete/invalid prescribing provider identifier.
EffDate=1/1/2000
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04)
Scenario=
[N32]
Message=Claim must be submitted by the provider who rendered the service.
EffDate=1/1/2000
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[N33]
Message=No record of health check prior to initiation of treatment.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N34]
Message=Incorrect claim form/format for this service.
EffDate=1/1/2000
DeactDate= 
Modified= 11/18/2005
Note=(Modified 11/18/05)
Scenario=
[N35]
Message=Program integrity/utilization review decision.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N36]
Message=Claim must meet primary payer's processing requirements before we can consider payment.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N37]
Message=Missing/incomplete/invalid tooth number/letter.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N38]
Message=Missing/incomplete/invalid place of service.
EffDate=1/1/2000
DeactDate= 2/5/2005
Modified= 
Note=Consider using M77
Scenario=
[N39]
Message=Procedure code is not compatible with tooth number/letter.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N40]
Message=Missing radiology film(s)/image(s).
EffDate=1/1/2000
DeactDate= 
Modified= 7/1/2008
Note=(Modified 2/1/04, 7/1/08) Related to N242
Scenario=
[N41]
Message=Authorization request denied.
EffDate=1/1/2000
DeactDate= 10/16/2003
Modified= 
Note=Consider using Reason Code 39
Scenario=
[N42]
Message=Missing mental health assessment.
EffDate=1/1/2000
DeactDate= 
Modified= 11/1/2014
Note=
Scenario=
[N43]
Message=Bed hold or leave days exceeded.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N44]
Message=Payer's share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority.
EffDate=1/1/2000
DeactDate= 10/16/2003
Modified= 
Note=Consider using Reason Code 137
Scenario=
[N45]
Message=Payment based on authorized amount.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N46]
Message=Missing/incomplete/invalid admission hour.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N47]
Message=Claim conflicts with another inpatient stay.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N48]
Message=Claim information does not agree with information received from other insurance carrier.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N49]
Message=Court ordered coverage information needs validation.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N50]
Message=Missing/incomplete/invalid discharge information.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N51]
Message=Electronic interchange agreement not on file for provider/submitter.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N52]
Message=Patient not enrolled in the billing provider's managed care plan on the date of service.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N53]
Message=Missing/incomplete/invalid point of pick-up address.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N54]
Message=Claim information is inconsistent with pre-certified/authorized services.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N55]
Message=Procedures for billing with group/referring/performing providers were not followed.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N56]
Message=Procedure code billed is not correct/valid for the services billed or the date of service billed.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N57]
Message=Missing/incomplete/invalid prescribing date.
EffDate=1/1/2000
DeactDate= 
Modified= 12/2/2004
Note=(Modified 12/2/04) Related to N304
Scenario=
[N58]
Message=Missing/incomplete/invalid patient liability amount.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N59]
Message=Alert: Please refer to your provider manual for additional program and provider information.
EffDate=1/1/2000
DeactDate= 
Modified= 11/1/2015
Note=(Modified 4/1/07, 11/1/09, 11/1/2015)
Scenario=
[N60]
Message=A valid NDC is required for payment of drug claims effective October 02.
EffDate=1/1/2000
DeactDate= 1/31/2004
Modified= 
Note=Consider using M119
Scenario=
[N61]
Message=Rebill services on separate claims.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N62]
Message=Dates of service span multiple rate periods. Resubmit separate claims.
EffDate=1/1/2000
DeactDate= 
Modified= 3/8/2011
Note=(Modified 3/8/11)
Scenario=
[N63]
Message=Rebill services on separate claim lines.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N64]
Message=The "from" and "to" dates must be different.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N65]
Message=Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N66]
Message=Missing/incomplete/invalid documentation.
EffDate=1/1/2000
DeactDate= 2/5/2005
Modified= 
Note=Consider using N29 or N225.
Scenario=
[N67]
Message=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.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N68]
Message=Prior payment being cancelled 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.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N69]
Message=Alert: PPS (Prospective Payment System) code changed by claims processing system. 
EffDate=1/1/2000
DeactDate= 
Modified= 11/1/2015
Note=(Modified 6/30/03, 7/1/12, 11/1/2015)
Scenario=
[N70]
Message=Consolidated billing and payment applies.
EffDate=1/1/2000
DeactDate= 
Modified= 11/5/2007
Note=(Modified 2/28/02, 11/5/07)
Scenario=
[N71]
Message=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.
EffDate=1/1/2000
DeactDate= 
Modified= 6/30/2003
Note=(Modified 2/21/02, 6/30/03)
Scenario=
[N72]
Message=PPS (Prospective Payment System)  code changed by medical reviewers.  Not supported by clinical records. 
EffDate=1/1/2000
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[N73]
Message=A Skilled Nursing Facility is responsible for payment of outside providers who furnish these services/supplies under arrangement to its residents.
EffDate=1/1/2000
DeactDate= 1/31/2004
Modified= 
Note=Consider using MA101 or N200
Scenario=
[N74]
Message=Resubmit with multiple claims, each claim covering services provided in only one calendar month.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N75]
Message=Missing/incomplete/invalid tooth surface information.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N76]
Message=Missing/incomplete/invalid number of riders.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N77]
Message=Missing/incomplete/invalid designated provider number.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N78]
Message=The necessary components of the child and teen checkup (EPSDT) were not completed.  
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N79]
Message=Service billed is not compatible with patient location information.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N80]
Message=Missing/incomplete/invalid prenatal screening information.
EffDate=1/1/2000
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N81]
Message=Procedure billed is not compatible with tooth surface code.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N82]
Message=Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N83]
Message=No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N84]
Message=Alert: Further installment payments are forthcoming.
EffDate=1/1/2000
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07, 8/1/07)
Scenario=
[N85]
Message=Alert: This is the final installment payment.
EffDate=1/1/2000
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07, 8/1/07)
Scenario=
[N86]
Message=A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N87]
Message=Home use of biofeedback therapy is not covered.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N88]
Message=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.
EffDate=1/1/2000
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N89]
Message=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.
EffDate=1/1/2000
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N90]
Message=Covered only when performed by the attending physician.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N91]
Message=Services not included in the appeal review.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N92]
Message=This facility is not certified for digital mammography.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N93]
Message=A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N94]
Message=Claim/Service denied because a more specific taxonomy code is required for adjudication.
EffDate=1/1/2000
DeactDate= 
Modified= 
Note=
Scenario=
[N95]
Message=This provider type/provider specialty may not bill this service.
EffDate=7/31/2001
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N96]
Message=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.
EffDate=8/24/2001
DeactDate= 
Modified= 
Note=
Scenario=
[N97]
Message=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.
EffDate=8/24/2001
DeactDate= 
Modified= 
Note=
Scenario=
[N98]
Message=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.
EffDate=8/24/2001
DeactDate= 
Modified= 
Note=
Scenario=
[N99]
Message=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.
EffDate=8/24/2001
DeactDate= 
Modified= 
Note=
Scenario=
[N100]
Message=PPS (Prospect Payment System) code corrected during adjudication.
EffDate=9/14/2001
DeactDate= 11/1/2016
Modified= 11/1/2015
Note=(Modified 6/30/03, 11/1/2015)
Scenario=
[N101]
Message=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.
EffDate=10/31/2001
DeactDate= 1/31/2004
Modified= 3/14/2014
Note=Consider using MA105 (Modified 3/14/2014)
Scenario=
[N102]
Message=This claim has been denied without reviewing the medical/dental record because the requested records were not received or were not received timely.
EffDate=10/31/2001
DeactDate= 7/1/2016
Modified= 11/1/2013
Note=
Scenario=
[N103]
Message=Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This  payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.
EffDate=10/31/2001
DeactDate= 
Modified= 11/1/2013
Note=(Modified 6/30/03, 7/1/12, 11/1/13)
Scenario=
[N104]
Message=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.gov.
EffDate=1/29/2002
DeactDate= 
Modified= 7/1/2010
Note=(Modified 10/31/02, 7/1/10)
Scenario=
[N105]
Message=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.
EffDate=1/29/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N106]
Message=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.
EffDate=1/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N107]
Message=Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.
EffDate=1/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N108]
Message=Missing/incomplete/invalid upgrade information.
EffDate=1/31/2002
DeactDate= 
Modified= 2/28/2003
Note=(Modified 2/28/03)
Scenario=
[N109]
Message=Alert: This claim/service was chosen for complex review.
EffDate=2/28/2002
DeactDate= 
Modified= 7/1/2015
Note=(Modified 3/1/2009, 7/1/15)
Scenario=
[N110]
Message=This facility is not certified for film mammography.
EffDate=2/28/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N111]
Message=No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
EffDate=2/28/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N112]
Message=This claim is excluded from your electronic remittance advice.
EffDate=2/28/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N113]
Message=Only one initial visit is covered per physician, group practice or provider.
EffDate=4/16/2002
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[N114]
Message=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.
EffDate=5/30/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N115]
Message=This decision was based on a Local Coverage Determination (LCD).  An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
EffDate=5/30/2002
DeactDate= 
Modified= 7/1/2010
Note=(Modified 4/1/04, 7/1/10)
Scenario=
[N116]
Message=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.
EffDate=6/30/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N117]
Message=This service is paid only once in a patient's lifetime.
EffDate=7/30/2002
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[N118]
Message=This service is not paid if billed more than once every 28 days.
EffDate=7/30/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N119]
Message=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.
EffDate=7/30/2002
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[N120]
Message=Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.
EffDate=8/9/2002
DeactDate= 
Modified= 6/30/2003
Note=(Modified 6/30/03)
Scenario=
[N121]
Message=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.
EffDate=9/9/2002
DeactDate= 
Modified= 8/1/2004
Note=(Modified 8/1/04, 6/30/03)
Scenario=
[N122]
Message=Add-on code cannot be billed by itself.
EffDate=9/12/2002
DeactDate= 
Modified= 8/1/2005
Note=(Modified 8/1/05)
Scenario=
[N123]
Message=Alert: This is a split service and represents a portion of the units from the originally submitted service.
EffDate=9/24/2002
DeactDate= 
Modified=3/1/2016 
Note=(Modified 3/1/2016)
Scenario=
[N124]
Message=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.
EffDate=9/26/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N125]
Message=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.
EffDate=9/26/2002
DeactDate= 
Modified= 8/1/2005
Note=(Modified 8/1/05. Also refer to N356)
Scenario=
[N126]
Message=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.
EffDate=10/17/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N127]
Message=This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.
EffDate=10/31/2007
DeactDate= 
Modified= 8/1/2004
Note=(Modified 8/1/04
Scenario=
[N128]
Message=This amount represents the prior to coverage portion of the allowance.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N129]
Message=Not eligible due to the patient's age.
EffDate=10/31/2002
DeactDate= 
Modified= 8/1/2007
Note=(Modified 8/1/07)
Scenario=
[N130]
Message=Consult plan benefit documents/guidelines for information about restrictions for this service.
EffDate=10/31/2002
DeactDate= 
Modified= 11/1/2009
Note=(Modified 4/1/07, 7/1/08, 11/1/09)
Scenario=
[N131]
Message=Total payments under multiple contracts cannot exceed the allowance for this service.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N132]
Message=Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N133]
Message=Alert: Services for predetermination and services requesting payment are being processed separately.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N134]
Message=Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N135]
Message=Record fees are the patient's responsibility and limited to the specified co-payment.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N136]
Message=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.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N137]
Message=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.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified  8/1/04, 2/28/03, 4/1/07)
Scenario=
[N138]
Message=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.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N139]
Message=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.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N140]
Message=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.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N141]
Message=The patient was not residing in a long-term care facility during all or part of the service dates billed.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N142]
Message=The original claim was denied.  Resubmit a new claim, not a replacement claim.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N143]
Message=The patient was not in a hospice program during all or part of the service dates billed.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N144]
Message=The rate changed during the dates of service billed.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N145]
Message=Missing/incomplete/invalid provider identifier for this place of service.
EffDate=10/31/2002
DeactDate= 6/2/2005
Modified= 
Note=
Scenario=
[N146]
Message=Missing screening document.
EffDate=10/31/2002
DeactDate= 
Modified= 8/1/2004
Note=(Modified  8/1/04) Related to N243
Scenario=
[N147]
Message=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.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N148]
Message=Missing/incomplete/invalid date of last menstrual period.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N149]
Message=Rebill all applicable services on a single claim.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N150]
Message=Missing/incomplete/invalid model number.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N151]
Message=Telephone contact services will not be paid until the face-to-face contact requirement has been met.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N152]
Message=Missing/incomplete/invalid replacement claim information.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N153]
Message=Missing/incomplete/invalid room and board rate.
EffDate=10/31/2002
DeactDate= 
Modified= 
Note=
Scenario=
[N154]
Message=Alert: This payment was delayed for correction of provider's mailing address.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N155]
Message=Alert: Our records do not indicate that other insurance is on file.  Please submit other insurance information for our records.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N156]
Message=Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.
EffDate=10/31/2002
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N157]
Message=Transportation to/from this destination is not covered.
EffDate=2/28/2003
DeactDate= 
Modified= 2/1/2004
Note=(Modified 2/1/04)
Scenario=
[N158]
Message=Transportation in a vehicle other than an ambulance is not covered.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N159]
Message=Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N160]
Message=The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
EffDate=2/28/2003
DeactDate= 
Modified= 2/1/2004
Note=(Modified 2/1/04)
Scenario=
[N161]
Message=This drug/service/supply is covered only when the associated service is covered.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N162]
Message=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.
EffDate=2/28/2003
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N163]
Message=Medical record does not support code billed per the code definition.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N164]
Message=Transportation to/from this destination is not covered.
EffDate=2/28/2003
DeactDate= 1/31/2004
Modified= 
Note=Consider using N157
Scenario=
[N165]
Message=Transportation in a vehicle other than an ambulance is not covered.
EffDate=2/28/2003
DeactDate= 1/31/2004
Modified= 
Note=Consider using N158)
Scenario=
[N166]
Message=Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
EffDate=2/28/2003
DeactDate= 1/31/2004
Modified= 
Note=Consider using N159
Scenario=
[N167]
Message=Charges exceed the post-transplant coverage limit.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N168]
Message=The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
EffDate=2/28/2003
DeactDate= 1/31/2004
Modified= 
Note=Consider using N160
Scenario=
[N169]
Message=This drug/service/supply is covered only when the associated service is covered.
EffDate=2/28/2003
DeactDate= 1/31/2004
Modified= 
Note=Consider using N161
Scenario=
[N170]
Message=A new/revised/renewed certificate of medical necessity is needed.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N171]
Message=Payment for repair or replacement is not covered or has exceeded the purchase price.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N172]
Message=The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N173]
Message=No qualifying hospital stay dates were provided for this episode of care.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N174]
Message=This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N175]
Message=Missing review organization approval.
EffDate=2/28/2003
DeactDate= 
Modified= 2/29/2008
Note=(Modified 8/1/04, 2/29/08) Related to N241
Scenario=
[N176]
Message=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.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N177]
Message=Alert: We did not send this claim to patient's other insurer. They have indicated no additional payment can be made.
EffDate=2/28/2003
DeactDate= 
Modified= 4/1/2007
Note=(Modified 6/30/03, 4/1/07)
Scenario=
[N178]
Message=Missing pre-operative images/visual field results.
EffDate=2/28/2003
DeactDate= 
Modified= 11/1/2013
Note=(Modified 8/1/04, 11/1/13) Related to N244
Scenario=
[N179]
Message=Additional information has been requested from the member.  The charges will be reconsidered upon receipt of that information.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N180]
Message=This item or service does not meet the criteria for the category under which it was billed.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N181]
Message=Additional information is required from another provider involved in this service.
EffDate=2/28/2003
DeactDate= 
Modified= 12/1/2006
Note=(Modified 12/1/06)
Scenario=
[N182]
Message=This claim/service must be billed according to the schedule for this plan.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N183]
Message=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.
EffDate=2/28/2003
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N184]
Message=Rebill technical and professional components separately.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N185]
Message=Alert: Do not resubmit this claim/service.
EffDate=2/28/2003
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N186]
Message=Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N187]
Message=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.
EffDate=2/28/2003
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N188]
Message=The approved level of care does not match the procedure code submitted.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N189]
Message=Alert: This service has been paid as a one-time exception to the plan's benefit restrictions.
EffDate=2/28/2003
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N190]
Message=Missing contract indicator.
EffDate=2/28/2003
DeactDate= 
Modified= 8/1/2004
Note=(Modified 8/1/04) Related to N229
Scenario=
[N191]
Message=The provider must update insurance information directly with payer.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N192]
Message=Patient is a Medicaid/Qualified Medicare Beneficiary.
EffDate=2/28/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N193]
Message=Alert: Specific federal/state/local program may cover this service through another payer.
EffDate=2/28/2003
DeactDate= 
Modified= 11/1/2015
Note=(Modified 11/1/2015)
Scenario=
[N194]
Message=Technical component not paid if provider does not own the equipment used.
EffDate=2/25/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N195]
Message=The technical component must be billed separately.
EffDate=2/25/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N196]
Message=Alert: Patient eligible to apply for other coverage which may be primary.
EffDate=2/25/2003
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N197]
Message=The subscriber must update insurance information directly with payer.
EffDate=2/25/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N198]
Message=Rendering provider must be affiliated with the pay-to provider.
EffDate=2/25/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N199]
Message=Additional payment/recoupment approved based on payer-initiated review/audit.
EffDate=2/25/2003
DeactDate= 
Modified= 8/1/2006
Note=(Modified 8/1/06)
Scenario=
[N200]
Message=The professional component must be billed separately.
EffDate=2/25/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N201]
Message=A mental health facility is responsible for payment of outside providers who furnish these services/supplies to residents.
EffDate=2/25/2003
DeactDate= 1/1/2011
Modified= 
Note=Consider using N538
Scenario=
[N202]
Message=Alert: Additional information/explanation will be sent separately.
EffDate=6/30/2003
DeactDate= 
Modified= 11/1/2015
Note=(Modified 4/1/07, 11/1/09, 3/14/2014, 11/1/2015)
Scenario=
[N203]
Message=Missing/incomplete/invalid anesthesia time/units.
EffDate=6/30/2003
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N204]
Message=Services under review for possible pre-existing condition. Send medical records for prior 12 months
EffDate=6/30/2003
DeactDate= 
Modified= 
Note=
Scenario=
[N205]
Message=Information provided was illegible.
EffDate=6/30/2003
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N206]
Message=The supporting documentation does not match the information sent on the claim. 
EffDate=6/30/2003
DeactDate= 
Modified= 3/6/2012
Note=(Modified 3/6/12)
Scenario=
[N207]
Message=Missing/incomplete/invalid weight.
EffDate=6/30/2003
DeactDate= 
Modified= 11/18/2005
Note=(Modified 11/18/05)
Scenario=
[N208]
Message=Missing/incomplete/invalid DRG code.
EffDate=6/30/2003
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N209]
Message=Missing/incomplete/invalid taxpayer identification number (TIN).
EffDate=6/30/2003
DeactDate= 
Modified= 7/1/2008
Note=(Modified 7/1/08)
Scenario=
[N210]
Message=Alert: You may appeal this decision.
EffDate=6/30/2003
DeactDate= 
Modified= 3/14/2014
Note=(Modified 4/1/07, 3/14/2014)
Scenario=
[N211]
Message=Alert: You may not appeal this decision.
EffDate=6/30/2003
DeactDate= 
Modified= 3/14/2014
Note=(Modified 4/1/07, 3/14/2014)
Scenario=
[N212]
Message=Charges processed under a Point of Service benefit .
EffDate=2/1/2004
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N213]
Message=Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.
EffDate=4/1/2004
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N214]
Message=Missing/incomplete/invalid history of the related initial surgical procedure(s).
EffDate=4/1/2004
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N215]
Message=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.
EffDate=4/1/2004
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N216]
Message=We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.
EffDate=4/1/2004
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/1/2010, 3/14/2014)
Scenario=
[N217]
Message=We pay only one site of service per provider per claim.
EffDate=8/1/2004
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N218]
Message=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.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N219]
Message=Payment based on previous payer's allowed amount.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N220]
Message=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.
EffDate=8/1/2004
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N221]
Message=Missing Admitting History and Physical report.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N222]
Message=Incomplete/invalid Admitting History and Physical report.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N223]
Message=Missing documentation of benefit to the patient during initial treatment period.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N224]
Message=Incomplete/invalid documentation of benefit to the patient during initial treatment period.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N225]
Message=Incomplete/invalid documentation/orders/notes/summary/report/chart.
EffDate=8/1/2004
DeactDate= 3/1/2016
Modified= 3/1/2014
Note=(Modified 8/1/05, 3/1/2014) Explicit RARCs have been approved, this non-specific RARC will be deactivated in March 2016.
Scenario=
[N226]
Message=Incomplete/invalid American Diabetes Association Certificate of Recognition.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N227]
Message=Incomplete/invalid Certificate of Medical Necessity.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N228]
Message=Incomplete/invalid consent form.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N229]
Message=Incomplete/invalid contract indicator.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N230]
Message=Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N231]
Message=Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N232]
Message=Incomplete/invalid itemized bill/statement.
EffDate=8/1/2004
DeactDate= 
Modified= 7/1/2008
Note=(Modified 7/1/08)
Scenario=
[N233]
Message=Incomplete/invalid operative note/report.
EffDate=8/1/2004
DeactDate= 
Modified= 7/1/2008
Note=(Modified 7/1/08)
Scenario=
[N234]
Message=Incomplete/invalid oxygen certification/re-certification.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N235]
Message=Incomplete/invalid pacemaker registration form.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N236]
Message=Incomplete/invalid pathology report.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N237]
Message=Incomplete/invalid patient medical record for this service.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N238]
Message=Incomplete/invalid physician certified plan of care.
EffDate=8/1/2004
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N239]
Message=Incomplete/invalid physician financial relationship form.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N240]
Message=Incomplete/invalid radiology report.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N241]
Message=Incomplete/invalid review organization approval.
EffDate=8/1/2004
DeactDate= 
Modified= 2/29/2008
Note=(Modified 2/29/08)
Scenario=
[N242]
Message=Incomplete/invalid radiology film(s)/image(s).
EffDate=8/1/2004
DeactDate= 
Modified= 7/1/2008
Note=(Modified 7/1/08)
Scenario=
[N243]
Message=Incomplete/invalid/not approved screening document.
EffDate=8/1/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N244]
Message=Incomplete/Invalid pre-operative  images/visual field results.
EffDate=8/1/2004
DeactDate= 
Modified= 11/1/2013
Note=(Modified 11/1/2013)
Scenario=
[N245]
Message=Incomplete/invalid plan information for other insurance .
EffDate=8/1/2004
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N246]
Message=State regulated patient payment limitations apply to this service.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N247]
Message=Missing/incomplete/invalid assistant surgeon taxonomy.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N248]
Message=Missing/incomplete/invalid assistant surgeon name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N249]
Message=Missing/incomplete/invalid assistant surgeon primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N250]
Message=Missing/incomplete/invalid assistant surgeon secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N251]
Message=Missing/incomplete/invalid attending provider taxonomy.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N252]
Message=Missing/incomplete/invalid attending provider name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N253]
Message=Missing/incomplete/invalid attending provider primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N254]
Message=Missing/incomplete/invalid attending provider secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N255]
Message=Missing/incomplete/invalid billing provider taxonomy.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N256]
Message=Missing/incomplete/invalid billing provider/supplier name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N257]
Message=Missing/incomplete/invalid billing provider/supplier primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N258]
Message=Missing/incomplete/invalid billing provider/supplier address.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N259]
Message=Missing/incomplete/invalid billing provider/supplier secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N260]
Message=Missing/incomplete/invalid billing provider/supplier contact information.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N261]
Message=Missing/incomplete/invalid operating provider name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N262]
Message=Missing/incomplete/invalid operating provider primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N263]
Message=Missing/incomplete/invalid operating provider secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N264]
Message=Missing/incomplete/invalid ordering provider name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N265]
Message=Missing/incomplete/invalid ordering provider primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N266]
Message=Missing/incomplete/invalid ordering provider address.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N267]
Message=Missing/incomplete/invalid ordering provider secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N268]
Message=Missing/incomplete/invalid ordering provider contact information.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N269]
Message=Missing/incomplete/invalid other provider name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N270]
Message=Missing/incomplete/invalid other provider primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N271]
Message=Missing/incomplete/invalid other provider secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N272]
Message=Missing/incomplete/invalid other payer attending provider identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N273]
Message=Missing/incomplete/invalid other payer operating provider identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N274]
Message=Missing/incomplete/invalid other payer other provider identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N275]
Message=Missing/incomplete/invalid other payer purchased service provider identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N276]
Message=Missing/incomplete/invalid other payer referring provider identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N277]
Message=Missing/incomplete/invalid other payer rendering provider identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N278]
Message=Missing/incomplete/invalid other payer service facility provider identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N279]
Message=Missing/incomplete/invalid pay-to provider name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N280]
Message=Missing/incomplete/invalid pay-to provider primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N281]
Message=Missing/incomplete/invalid pay-to provider address.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N282]
Message=Missing/incomplete/invalid pay-to provider secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N283]
Message=Missing/incomplete/invalid purchased service provider identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N284]
Message=Missing/incomplete/invalid referring provider taxonomy.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N285]
Message=Missing/incomplete/invalid referring provider name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N286]
Message=Missing/incomplete/invalid referring provider primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N287]
Message=Missing/incomplete/invalid referring provider secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N288]
Message=Missing/incomplete/invalid rendering provider taxonomy.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N289]
Message=Missing/incomplete/invalid rendering provider name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N290]
Message=Missing/incomplete/invalid rendering provider primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N291]
Message=Missing/incomplete/invalid rendering provider secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 11/1/2010
Note=
Scenario=
[N292]
Message=Missing/incomplete/invalid service facility name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N293]
Message=Missing/incomplete/invalid service facility primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N294]
Message=Missing/incomplete/invalid service facility primary address.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N295]
Message=Missing/incomplete/invalid service facility secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N296]
Message=Missing/incomplete/invalid supervising provider name.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N297]
Message=Missing/incomplete/invalid supervising provider primary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N298]
Message=Missing/incomplete/invalid supervising provider secondary identifier.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N299]
Message=Missing/incomplete/invalid occurrence date(s).
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N300]
Message=Missing/incomplete/invalid occurrence span date(s).
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N301]
Message=Missing/incomplete/invalid procedure date(s).
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N302]
Message=Missing/incomplete/invalid other procedure date(s).
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N303]
Message=Missing/incomplete/invalid principal procedure date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N304]
Message=Missing/incomplete/invalid dispensed date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N305]
Message=Missing/incomplete/invalid accident date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N306]
Message=Missing/incomplete/invalid acute manifestation date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N307]
Message=Missing/incomplete/invalid adjudication or payment date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N308]
Message=Missing/incomplete/invalid appliance placement date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N309]
Message=Missing/incomplete/invalid assessment date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N310]
Message=Missing/incomplete/invalid assumed or relinquished care date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N311]
Message=Missing/incomplete/invalid authorized to return to work date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N312]
Message=Missing/incomplete/invalid begin therapy date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N313]
Message=Missing/incomplete/invalid certification revision date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N314]
Message=Missing/incomplete/invalid diagnosis date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N315]
Message=Missing/incomplete/invalid disability from date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N316]
Message=Missing/incomplete/invalid disability to date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N317]
Message=Missing/incomplete/invalid discharge hour.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N318]
Message=Missing/incomplete/invalid discharge or end of care date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N319]
Message=Missing/incomplete/invalid hearing or vision prescription date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N320]
Message=Missing/incomplete/invalid Home Health Certification Period.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N321]
Message=Missing/incomplete/invalid last admission period.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N322]
Message=Missing/incomplete/invalid last certification date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N323]
Message=Missing/incomplete/invalid last contact date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N324]
Message=Missing/incomplete/invalid last seen/visit date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N325]
Message=Missing/incomplete/invalid last worked date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N326]
Message=Missing/incomplete/invalid last x-ray date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N327]
Message=Missing/incomplete/invalid other insured birth date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N328]
Message=Missing/incomplete/invalid Oxygen Saturation Test date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N329]
Message=Missing/incomplete/invalid patient birth date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N330]
Message=Missing/incomplete/invalid patient death date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N331]
Message=Missing/incomplete/invalid physician order date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N332]
Message=Missing/incomplete/invalid prior hospital discharge date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N333]
Message=Missing/incomplete/invalid prior placement date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N334]
Message=Missing/incomplete/invalid re-evaluation date.
EffDate=12/2/2004
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N335]
Message=Missing/incomplete/invalid referral date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N336]
Message=Missing/incomplete/invalid replacement date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N337]
Message=Missing/incomplete/invalid secondary diagnosis date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N338]
Message=Missing/incomplete/invalid shipped date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N339]
Message=Missing/incomplete/invalid similar illness or symptom date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N340]
Message=Missing/incomplete/invalid subscriber birth date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N341]
Message=Missing/incomplete/invalid surgery date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N342]
Message=Missing/incomplete/invalid test performed date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N343]
Message=Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N344]
Message=Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.
EffDate=12/2/2004
DeactDate= 
Modified= 
Note=
Scenario=
[N345]
Message=Date range not valid with units submitted. 
EffDate=3/30/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N346]
Message=Missing/incomplete/invalid oral cavity designation code.
EffDate=3/30/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N347]
Message=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. 
EffDate=3/30/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N348]
Message=You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.
EffDate=8/1/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N349]
Message=The administration method and drug must be reported to adjudicate this service. 
EffDate=8/1/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N350]
Message=Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
EffDate=8/1/2005
DeactDate= 
Modified= 7/1/2008
Note=(Modified 7/1/08)
Scenario=
[N351]
Message=Service date outside of the approved treatment plan service dates.
EffDate=8/1/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N352]
Message=Alert: There are no scheduled payments for this service. Submit a claim for each patient visit.
EffDate=8/1/2005
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N353]
Message=Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.
EffDate=8/1/2005
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N354]
Message=Incomplete/invalid invoice.
EffDate=8/1/2005
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N355]
Message=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
EffDate=8/1/2005
DeactDate= 
Modified= 4/1/2007
Note=(Modified 11/18/05, Modified 4/1/07)
Scenario=
[N356]
Message=Not covered when performed with, or subsequent to, a non-covered service.
EffDate=8/1/2005
DeactDate= 
Modified= 3/8/2011
Note=(Modified 3/8/11)
Scenario=
[N357]
Message=Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
EffDate=11/18/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N358]
Message=Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
EffDate=11/18/2005
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N359]
Message=Missing/incomplete/invalid height.
EffDate=11/18/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N360]
Message=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.
EffDate=11/18/2005
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N361]
Message=Payment adjusted based on multiple diagnostic imaging procedure rules
EffDate=11/18/2005
DeactDate= 10/1/2007
Modified= 12/1/2006
Note=(Modified 12/1/06) Consider using Reason Code 59
Scenario=
[N362]
Message=The number of Days or Units of Service exceeds our acceptable maximum.
EffDate=11/18/2005
DeactDate= 
Modified= 
Note=
Scenario=
[N363]
Message=Alert: in the near future we are implementing new policies/procedures that would affect this determination.
EffDate=11/18/2005
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N364]
Message=Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.
EffDate=11/18/2005
DeactDate= 
Modified= 4/1/2007
Note=(Modified 4/1/07)
Scenario=
[N365]
Message=This procedure code is not payable. It is for reporting/information purposes only.
EffDate=4/1/2006
DeactDate= 7/1/2014
Modified= 
Note=Consider Using CARC 246 or N620
Scenario=
[N366]
Message=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.
EffDate=4/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N367]
Message=Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account.
EffDate=4/1/2006
DeactDate= 
Modified= 7/1/2008
Note=(Modified 4/1/07, 11/5/07, 7/1/08)
Scenario=
[N368]
Message=You must appeal the determination of the previously adjudicated claim.
EffDate=4/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N369]
Message=Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.
EffDate=4/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N370]
Message=Billing exceeds the rental months covered/approved by the payer.
EffDate=8/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N371]
Message=Alert: title of this equipment must be transferred to the patient.
EffDate=8/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N372]
Message=Only reasonable and necessary maintenance/service charges are covered.
EffDate=8/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N373]
Message=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.
EffDate=12/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N374]
Message=Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.
EffDate=12/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N375]
Message=Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.
EffDate=12/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N376]
Message=Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.
EffDate=12/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N377]
Message=Payment based on a processed replacement claim.
EffDate=12/1/2006
DeactDate= 
Modified= 11/5/2007
Note=(Modified 11/5/07)
Scenario=
[N378]
Message=Missing/incomplete/invalid prescription quantity.
EffDate=12/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N379]
Message=Claim level information does not match line level information.
EffDate=12/1/2006
DeactDate= 
Modified= 
Note=
Scenario=
[N380]
Message=The original claim  has been processed, submit a corrected claim.
EffDate=4/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N381]
Message=Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.
EffDate=4/1/2007
DeactDate= 
Modified= 7/1/2015
Note=(Modified 7/1/15)
Scenario=
[N382]
Message=Missing/incomplete/invalid patient identifier.
EffDate=4/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N383]
Message=Not covered when deemed cosmetic.
EffDate=4/1/2007
DeactDate= 
Modified= 3/8/2011
Note=(Modified 3/8/11)
Scenario=
[N384]
Message=Records indicate that the referenced body part/tooth has been removed in a previous procedure. 
EffDate=4/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N385]
Message=Notification of admission was not timely according to published plan procedures.
EffDate=4/1/2007
DeactDate= 
Modified= 11/5/2007
Note=(Modified 11/5/07)
Scenario=
[N386]
Message=This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
EffDate=4/1/2007
DeactDate= 
Modified= 7/1/2010
Note=(Modified 7/1/2010)
Scenario=
[N387]
Message=Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information.
EffDate=4/1/2007
DeactDate= 
Modified= 3/1/2009
Note=(Modified 3/1/2009)
Scenario=
[N388]
Message=Missing/incomplete/invalid prescription number.
EffDate=8/1/2007
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N389]
Message=Duplicate prescription number submitted.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N390]
Message=This service/report cannot be billed separately.
EffDate=8/1/2007
DeactDate= 
Modified= 7/1/2008
Note=(Modified 7/1/08)
Scenario=
[N391]
Message=Missing emergency department records.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N392]
Message=Incomplete/invalid emergency department records.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N393]
Message=Missing progress notes/report.
EffDate=8/1/2007
DeactDate= 
Modified= 7/1/2008
Note=(Modified 7/1/08)
Scenario=
[N394]
Message=Incomplete/invalid progress notes/report.
EffDate=8/1/2007
DeactDate= 
Modified= 7/1/2008
Note=(Modified 7/1/08)
Scenario=
[N395]
Message=Missing laboratory report.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N396]
Message=Incomplete/invalid laboratory report.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N397]
Message=Benefits are not available for incomplete service(s)/undelivered item(s).
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N398]
Message=Missing elective consent form.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N399]
Message=Incomplete/invalid elective consent form.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N400]
Message=Alert: Electronically enabled providers should submit claims electronically.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N401]
Message=Missing periodontal charting. 
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N402]
Message=Incomplete/invalid periodontal charting.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N403]
Message=Missing facility certification.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N404]
Message=Incomplete/invalid facility certification.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N405]
Message=This service is only covered when the donor's insurer(s) do not provide coverage for the service.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N406]
Message=This service is only covered when the recipient's insurer(s) do not provide coverage for the service.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N407]
Message=You are not an approved submitter for this transmission format.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N408]
Message=This payer does not cover deductibles assessed by a previous payer. 
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N409]
Message=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. 
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N410]
Message=Not covered unless the prescription changes.
EffDate=8/1/2007
DeactDate= 
Modified= 3/8/2011
Note=(Modified 3/8/11)
Scenario=
[N411]
Message=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.) 
EffDate=8/1/2007
DeactDate= 2/1/2009
Modified= 
Note=
Scenario=
[N412]
Message=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.) 
EffDate=8/1/2007
DeactDate= 2/1/2009
Modified= 
Note=
Scenario=
[N413]
Message=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.)
EffDate=8/1/2007
DeactDate= 2/1/2009
Modified= 
Note=
Scenario=
[N414]
Message=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.) 
EffDate=8/1/2007
DeactDate= 2/1/2009
Modified= 
Note=
Scenario=
[N415]
Message=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.) 
EffDate=8/1/2007
DeactDate= 2/1/2009
Modified= 
Note=
Scenario=
[N416]
Message=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.) 
EffDate=8/1/2007
DeactDate= 2/1/2009
Modified= 
Note=
Scenario=
[N417]
Message=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.)
EffDate=8/1/2007
DeactDate= 2/1/2009
Modified= 
Note=
Scenario=
[N418]
Message=Misrouted claim.  See the payer's claim submission instructions.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N419]
Message=Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N420]
Message=Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N421]
Message=Claim payment was the result of a payer's retroactive adjustment due to a review organization decision.
EffDate=8/1/2007
DeactDate= 
Modified= 5/8/2008
Note=(Modified 2/29/08, typo fixed 5/8/08)
Scenario=
[N422]
Message=Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program.
EffDate=8/1/2007
DeactDate= 
Modified= 5/8/2008
Note=(Typo fixed 5/8/08)
Scenario=
[N423]
Message=Claim payment was the result of a payer's retroactive adjustment due to a non standard program.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N424]
Message=Patient does not reside in the geographic area required for this type of payment.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N425]
Message=Statutorily excluded service(s).
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N426]
Message=No coverage when self-administered.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N427]
Message=Payment for eyeglasses or contact lenses can be made only after cataract surgery.
EffDate=8/1/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N428]
Message=Not covered when performed in this place of service.
EffDate=8/1/2007
DeactDate= 
Modified= 3/8/2011
Note=(Modified 3/8/11)
Scenario=
[N429]
Message=Not covered when considered routine.
EffDate=8/1/2007
DeactDate= 
Modified= 3/8/2011
Note=(Modified 3/8/11)
Scenario=
[N430]
Message=Procedure code is inconsistent with the units billed.
EffDate=11/5/2007
DeactDate= 
Modified= 
Note=
Scenario=
[N431]
Message=Not covered with this procedure.
EffDate=11/5/2007
DeactDate= 
Modified= 3/8/2011
Note=(Modified 3/8/11)
Scenario=
[N432]
Message=Alert: Adjustment based on a Recovery Audit.
EffDate=11/5/2007
DeactDate= 
Modified= 7/1/2015
Note=(Modified 7/1/15)
Scenario=
[N433]
Message=Resubmit this claim using only your National Provider Identifier (NPI).
EffDate=2/29/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N434]
Message=Missing/Incomplete/Invalid Present on Admission indicator.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N435]
Message=Exceeds number/frequency approved /allowed within time period without support documentation.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N436]
Message=The injury claim has not been accepted and a mandatory medical reimbursement has been made.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N437]
Message=Alert: If the injury claim is accepted, these charges will be reconsidered.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N438]
Message=This jurisdiction only accepts paper claims.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N439]
Message=Missing anesthesia physical status report/indicators.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N440]
Message=Incomplete/invalid anesthesia physical status report/indicators.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N441]
Message=This missed/cancelled appointment is not covered.
EffDate=7/1/2008
DeactDate= 
Modified= 7/15/2013
Note=(Modified 7/15/2013)
Scenario=
[N442]
Message=Payment based on an alternate fee schedule.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N443]
Message=Missing/incomplete/invalid total time or begin/end time.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N444]
Message=Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N445]
Message=Missing document for actual cost or paid amount.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N446]
Message=Incomplete/invalid document for actual cost or paid amount.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N447]
Message=Payment is based on a generic equivalent as required documentation was not provided.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N448]
Message=This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N449]
Message=Payment based on a comparable drug/service/supply.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N450]
Message=Covered only when performed by the primary treating physician or the designee.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N451]
Message=Missing Admission Summary Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N452]
Message=Incomplete/invalid Admission Summary Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N453]
Message=Missing Consultation Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N454]
Message=Incomplete/invalid Consultation Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N455]
Message=Missing Physician Order.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N456]
Message=Incomplete/invalid Physician Order.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N457]
Message=Missing Diagnostic Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N458]
Message=Incomplete/invalid Diagnostic Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N459]
Message=Missing Discharge Summary.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N460]
Message=Incomplete/invalid Discharge Summary.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N461]
Message=Missing Nursing Notes.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N462]
Message=Incomplete/invalid Nursing Notes.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N463]
Message=Missing support data for claim.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N464]
Message=Incomplete/invalid support data for claim.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N465]
Message=Missing Physical Therapy Notes/Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N466]
Message=Incomplete/invalid Physical Therapy Notes/Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N467]
Message=Missing Tests and Analysis Report.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N468]
Message=Incomplete/invalid Report of Tests and Analysis Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N469]
Message=Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N470]
Message=This payment will complete the mandatory medical reimbursement limit.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N471]
Message=Missing/incomplete/invalid HIPPS Rate Code.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N472]
Message=Payment for this service has been issued to another provider.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N473]
Message=Missing certification.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N474]
Message=Incomplete/invalid certification.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N475]
Message=Missing completed referral form.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N476]
Message=Incomplete/invalid completed referral form.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N477]
Message=Missing Dental Models.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N478]
Message=Incomplete/invalid Dental Models.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N479]
Message=Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N480]
Message=Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N481]
Message=Missing Models.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N482]
Message=Incomplete/invalid Models.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N483]
Message=Missing Periodontal Charts.
EffDate=7/1/2008
DeactDate= 5/1/2015
Modified= 11/1/2014
Note=(Modified 11/1/2014)
Scenario=
[N484]
Message=Incomplete/invalid Periodontal Charts.
EffDate=7/1/2008
DeactDate= 5/1/2015
Modified= 11/1/2014
Note=(Modified 3/14/2014, 11/1/2014)
Scenario=
[N485]
Message=Missing Physical Therapy Certification.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N486]
Message=Incomplete/invalid Physical Therapy Certification.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N487]
Message=Missing Prosthetics or Orthotics Certification.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N488]
Message=Incomplete/invalid Prosthetics or Orthotics Certification.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N489]
Message=Missing referral form.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N490]
Message=Incomplete/invalid referral form.
EffDate=7/1/2008
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N491]
Message=Missing/Incomplete/Invalid Exclusionary Rider Condition.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N492]
Message=Alert: A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N493]
Message=Missing Doctor First Report of Injury.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N494]
Message=Incomplete/invalid Doctor First Report of Injury.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N495]
Message=Missing Supplemental Medical Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N496]
Message=Incomplete/invalid Supplemental Medical Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N497]
Message=Missing Medical Permanent Impairment or Disability Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N498]
Message=Incomplete/invalid Medical Permanent Impairment or Disability Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N499]
Message=Missing Medical Legal Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N500]
Message=Incomplete/invalid Medical Legal Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N501]
Message=Missing Vocational Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N502]
Message=Incomplete/invalid Vocational Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N503]
Message=Missing Work Status Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N504]
Message=Incomplete/invalid Work Status Report.
EffDate=7/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N505]
Message=Alert: This response includes only services that could be estimated in real time. No estimate will be provided for the services that could not be estimated in real time.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N506]
Message=Alert: This is an estimate of the member's liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. This is not a pre-authorization or a guarantee of payment.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N507]
Message=Plan distance requirements have not been met.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N508]
Message=Alert: This real time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail.  Contact the insurer if there are any questions.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N509]
Message=Alert: A current inquiry shows the member's Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service.  Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N510]
Message=Alert: A current inquiry shows the member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N511]
Message=Alert: Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N512]
Message=Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N513]
Message=Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.
EffDate=11/1/2008
DeactDate= 
Modified= 
Note=
Scenario=
[N514]
Message=Consult plan benefit documents/guidelines for information about restrictions for this service.
EffDate=11/1/2008
DeactDate= 1/1/2011
Modified= 
Note=Consider using N130
Scenario=
[N515]
Message=Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information. (use N387 instead)
EffDate=11/1/2008
DeactDate= 10/1/2009
Modified= 
Note=
Scenario=
[N516]
Message=Records indicate a mismatch between the submitted NPI and EIN.
EffDate=3/1/2009
DeactDate= 
Modified= 
Note=
Scenario=
[N517]
Message=Resubmit a new claim with the requested information.
EffDate=3/1/2009
DeactDate= 
Modified= 
Note=
Scenario=
[N518]
Message=No separate payment for accessories when furnished for use with oxygen equipment.
EffDate=3/1/2009
DeactDate= 
Modified= 
Note=
Scenario=
[N519]
Message=Invalid combination of HCPCS modifiers.
EffDate=7/1/2009
DeactDate= 
Modified= 
Note=
Scenario=
[N520]
Message=Alert: Payment made from a Consumer Spending Account.
EffDate=7/1/2009
DeactDate= 
Modified= 
Note=
Scenario=
[N521]
Message=Mismatch between the submitted provider information and the provider information stored in our system.
EffDate=11/1/2009
DeactDate= 
Modified= 
Note=
Scenario=
[N522]
Message=Duplicate of a claim processed, or to be processed, as a crossover claim.
EffDate=11/1/2009
DeactDate= 
Modified= 3/1/2010
Note=
Scenario=
[N523]
Message=The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid.
EffDate=3/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N524]
Message=Based on policy this payment constitutes payment in full.
EffDate=3/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N525]
Message=These services are not covered when performed within the global period of another service.
EffDate=3/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N526]
Message=Not qualified for recovery based on employer size.
EffDate=3/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N527]
Message=We processed this claim as the primary payer prior to receiving the recovery demand.
EffDate=3/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N528]
Message=Patient is entitled to benefits for Institutional Services only.
EffDate=3/1/2010
DeactDate= 
Modified= 7/1/2010
Note=(Modified 7/1/10)
Scenario=
[N529]
Message=Patient is entitled to benefits for Professional Services only.
EffDate=3/1/2010
DeactDate= 
Modified= 7/1/2010
Note=(Modified 7/1/10)
Scenario=
[N530]
Message=Not Qualified for Recovery based on enrollment information.
EffDate=3/1/2010
DeactDate= 
Modified= 7/1/2010
Note=(Modified 7/1/10)
Scenario=
[N531]
Message=Not qualified for recovery based on direct payment of premium.
EffDate=3/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N532]
Message=Not qualified for recovery based on disability and working status.
EffDate=3/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N533]
Message=Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.
EffDate=7/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N534]
Message=This is an individual policy, the employer does not participate in plan sponsorship.
EffDate=7/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N535]
Message=Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.
EffDate=7/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N536]
Message=We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us.
EffDate=7/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N537]
Message=We have examined claims history and no records of the services have been found.
EffDate=7/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N538]
Message=A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
EffDate=7/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N539]
Message=Alert: We processed appeals/waiver requests on your behalf and that request has been denied.
EffDate=7/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N540]
Message=Payment adjusted based on the interrupted stay policy.
EffDate=11/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N541]
Message=Mismatch between the submitted insurance type code and the information stored in our system.
EffDate=11/1/2010
DeactDate= 
Modified= 
Note=
Scenario=
[N542]
Message=Missing income verification.
EffDate=3/8/2011
DeactDate= 
Modified= 
Note=
Scenario=
[N543]
Message=Incomplete/invalid income verification.
EffDate=3/8/2011
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N544]
Message=Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future.
EffDate=7/1/2011
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N545]
Message=Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
EffDate=7/1/2011
DeactDate= 
Modified= 
Note=
Scenario=
[N546]
Message=Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.
EffDate=7/1/2011
DeactDate= 
Modified= 
Note=
Scenario=
[N547]
Message=A refund request (Frequency Type Code 8) was processed previously.
EffDate=3/6/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N548]
Message=Alert: Patient's calendar year deductible has been met.
EffDate=3/6/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N549]
Message=Alert: Patient's calendar year out-of-pocket maximum has been met.
EffDate=3/6/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N550]
Message=Alert: You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hold in the near future.
EffDate=3/6/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N551]
Message=Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.
EffDate=3/6/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N552]
Message=Payment adjusted to reverse a previous withhold/bonus amount. 
EffDate=3/6/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N553]
Message=Payment adjusted based on a Low Income Subsidy (LIS) retroactive coverage or status change.
EffDate=3/6/2012
DeactDate= 11/1/2012
Modified= 
Note=
Scenario=
[N554]
Message=Missing/Incomplete/Invalid Family Planning Indicator.
EffDate=7/1/2012
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N555]
Message=Missing medication list. 
EffDate=7/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N556]
Message=Incomplete/invalid medication list. 
EffDate=7/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N557]
Message=This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected. 
EffDate=7/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N558]
Message=This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received. 
EffDate=7/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N559]
Message=This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located. 
EffDate=7/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N560]
Message=The pilot program requires an interim or final claim within 60 days of the Notice of  Admission. A claim was not received.
EffDate=11/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N561]
Message=The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission.
EffDate=11/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N562]
Message=The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.
EffDate=11/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N563]
Message=Alert: Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service.
EffDate=11/1/2012
DeactDate= 
Modified= 11/1/2015
Note=Related to M39 (Modified 11/1/2015)
Scenario=
[N564]
Message=Patient did not meet the inclusion criteria for the demonstration project or pilot program.
EffDate=11/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N565]
Message=Alert: This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed.
EffDate=11/1/2012
DeactDate= 
Modified= 3/1/2013
Note=(Modified 3/1/13)
Scenario=
[N566]
Message=Alert: This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed.
EffDate=11/1/2012
DeactDate= 
Modified= 
Note=
Scenario=
[N567]
Message=Not covered when considered preventative.
EffDate=3/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N568]
Message=Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.
EffDate=3/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N569]
Message=Not covered when performed for the reported diagnosis.
EffDate=3/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N570]
Message=Missing/incomplete/invalid credentialing data.
EffDate=3/1/2013
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N571]
Message=Alert: Payment will be issued quarterly by another payer/contractor.
EffDate=3/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N572]
Message=This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
EffDate=3/1/2013
DeactDate= 
Modified= 7/1/2014
Note=
Scenario=
[N573]
Message=Alert: You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor.
EffDate=3/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N574]
Message=Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N575]
Message=Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N576]
Message=Services not related to the specific incident/claim/accident/loss being reported.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N577]
Message=Personal Injury Protection (PIP) Coverage.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N578]
Message=Coverages do not apply to this loss.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N579]
Message=Medical Payments Coverage (MPC).
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N580]
Message=Determination based on the provisions of the insurance policy.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N581]
Message=Investigation of coverage eligibility is pending.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N582]
Message=Benefits suspended pending the patient's cooperation.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N583]
Message=Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N584]
Message=Not covered based on the insured's noncompliance with policy or statutory conditions.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N585]
Message=Benefits are no longer available based on a final injury settlement.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N586]
Message=The injured party does not qualify for benefits.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N587]
Message=Policy benefits have been exhausted.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N588]
Message=The patient has instructed that medical claims/bills are not to be paid.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N589]
Message=Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by the use of a drug.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N590]
Message=Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N591]
Message=Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N592]
Message=Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N593]
Message=Not covered based on failure to attend  a scheduled Independent Medical Exam (IME).
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N594]
Message=Records reflect the injured party did not complete an Application for Benefits for this loss.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N595]
Message=Records reflect the injured party did not complete an Assignment of Benefits for this loss.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N596]
Message=Records reflect the injured party did not complete a Medical Authorization for this loss.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N597]
Message=Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.
EffDate=7/15/2013
DeactDate= 
Modified= 11/1/2013
Note=
Scenario=
[N598]
Message=Health care policy coverage is primary.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N599]
Message=Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N600]
Message=Adjusted based on the applicable fee schedule for the region in which the service was rendered.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N601]
Message=In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale System applicable to Hawaii.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N602]
Message=Adjusted based on the Redbook maximum allowance.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N603]
Message=This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N604]
Message=In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers' Compensation Board Schedule of Medical Fees, pursuant to Regulation 83 and / or Appendix 17-C of 11 NYCRR.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N605]
Message=This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N606]
Message=The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009).  The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N607]
Message=Service provided for non-compensable condition(s).
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N608]
Message=The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service.  This fee is calculated in compliance with Act 6.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N609]
Message=80% of the provider's billed amount is being recommended for payment according to Act 6.
EffDate=7/15/2013
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N610]
Message=Alert: Payment based on an appropriate level of care.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N611]
Message=Claim in litigation.  Contact insurer for more information.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N612]
Message=Medical provider not authorized/certified to provide treatment to  injured workers in this jurisdiction.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N613]
Message=Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N614]
Message=Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N615]
Message=Alert: This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under the Code of Federal Regulations, Title 45, Part 156.270, a Qualified Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N616]
Message=Alert: This enrollee is in the first month of the advance premium tax credit grace period.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N617]
Message=This enrollee is in the second or third month of the advance premium tax credit grace period.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N618]
Message=Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N619]
Message=Coverage terminated for non-payment of premium.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N620]
Message=Alert: This procedure code is for quality reporting/informational purposes only.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N621]
Message=Charges for Jurisdiction required forms, reports, or chart notes are not payable.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N622]
Message=Not covered based on the date of injury/accident.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N623]
Message=Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N624]
Message=The associated Workers' Compensation claim has been withdrawn.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N625]
Message=Missing/Incomplete/Invalid Workers' Compensation Claim Number.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N626]
Message=New or established patient E/M codes are not payable with chiropractic care codes.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N627]
Message=Service not payable per managed care contract.
EffDate=7/15/2013
DeactDate= 7/1/2014
Modified= 
Note=Consider Use CARC 256
Scenario=
[N628]
Message=Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N629]
Message=Reviews/documentation/notes/summaries/reports/charts not requested.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N630]
Message=Referral not authorized by attending physician.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N631]
Message=Medical Fee Schedule does not list this code. An allowance was made for a comparable service.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N632]
Message=According to the Official Medical Fee Schedule this service has a relative value of zero and therefore no payment is due.
EffDate=7/15/2013
DeactDate= 7/1/2014
Modified= 
Note=Consider using W8
Scenario=
[N633]
Message=Additional anesthesia time units are not allowed.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N634]
Message=The allowance is calculated based on anesthesia time units.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N635]
Message=The Allowance is calculated based on the anesthesia base units plus time.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N636]
Message=Adjusted because this is reimbursable only once per injury.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N637]
Message=Consultations are not allowed once treatment has been rendered by the same provider.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N638]
Message=Reimbursement has been made according to the home health fee schedule.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N639]
Message=Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N640]
Message=Exceeds number/frequency approved/allowed within time period.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N641]
Message=Reimbursement has been based on the number of body areas rated.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N642]
Message=Adjusted when billed as individual tests instead of as a panel.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N643]
Message=The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N644]
Message=Reimbursement has been made according to the bilateral procedure rule.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N645]
Message=Mark-up allowance.
EffDate=7/15/2013
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N646]
Message=Reimbursement has been adjusted based on the guidelines for an assistant.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N647]
Message=Adjusted based on diagnosis-related group (DRG).
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N648]
Message=Adjusted based on Stop Loss.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N649]
Message=Payment based on invoice.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N650]
Message=This policy was not in effect for this date of loss. No coverage is available.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N651]
Message=No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N652]
Message=The date of service is before the date of loss.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N653]
Message=The date of injury does not match the reported date of loss.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N654]
Message=Adjusted based on achievement of maximum medical improvement (MMI).
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N655]
Message=Payment based on provider's geographic region.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N656]
Message=An interest payment is being made because benefits are being paid outside the statutory requirement.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N657]
Message=This should be billed with the appropriate code for these services.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N658]
Message=The billed service(s) are not considered medical expenses.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N659]
Message=This item is exempt from sales tax.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N660]
Message=Sales tax has been included in the reimbursement.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N661]
Message=Documentation does not support that the services rendered were medically necessary.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N662]
Message=Alert: Consideration of payment will be made upon receipt of a final bill.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N663]
Message=Adjusted based on an agreed amount.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N664]
Message=Adjusted based on a legal settlement.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N665]
Message=Services by an unlicensed provider are not reimbursable.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N666]
Message=Only one evaluation and management code at this service level is covered during the course of care.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N667]
Message=Missing prescription.
EffDate=7/15/2013
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N668]
Message=Incomplete/invalid prescription.
EffDate=7/15/2013
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N669]
Message=Adjusted based on the Medicare fee schedule.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N670]
Message=This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N671]
Message=Payment based on a jurisdiction cost-charge ratio.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N672]
Message=Alert: Amount applied to Health Insurance Offset.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N673]
Message=Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N674]
Message=Not covered unless a pre-requisite procedure/service has been provided.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N675]
Message=Additional information is required from the injured party.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N676]
Message=Service does not qualify for payment under the Outpatient Facility Fee Schedule.
EffDate=7/15/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N677]
Message=Alert: Films/Images will not be returned.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N678]
Message=Missing post-operative images/visual field results.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N679]
Message=Incomplete/Invalid post-operative images/visual field results.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N680]
Message=Missing/Incomplete/Invalid date of previous dental extractions.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N681]
Message=Missing/Incomplete/Invalid full arch series.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N682]
Message=Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N683]
Message=Missing/Incomplete/Invalid prior treatment documentation.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N684]
Message=Payment denied as this is a specialty claim submitted as a general claim.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N685]
Message=Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N686]
Message=Missing/incomplete/Invalid questionnaire needed to complete payment determination.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N687]
Message=Alert: This reversal is due to a retroactive disenrollment.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=To be used with claim/service reversal. (Modified 3/14/2014)
Scenario=
[N688]
Message=Alert: This reversal is due to a medical or utilization review decision.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=To be used with claim/service reversal. (Modified 3/14/2014)
Scenario=
[N689]
Message=Alert: This reversal is due to a retroactive rate change.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=To be used with claim/service reversal. (Modified 3/14/2014)
Scenario=
[N690]
Message=Alert: This reversal is due to a provider submitted appeal.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=To be used with claim/service reversal. (Modified 3/14/2014)
Scenario=
[N691]
Message=Alert: This reversal is due to a patient submitted appeal.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=To be used with claim/service reversal. (Modified 3/14/2014)
Scenario=
[N692]
Message=Alert: This reversal is due to an incorrect rate on the initial adjudication.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=To be used with claim/service reversal. (Modified 3/14/2014)
Scenario=
[N693]
Message=Alert: This reversal is due to a cancellation of the claim by the provider.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N694]
Message=Alert: This reversal is due to a resubmission/change to the claim by the provider.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N695]
Message=Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
EffDate=11/1/2013
DeactDate= 
Modified= 
Note=
Scenario=
[N696]
Message=Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=To be used with claim/service reversal. (Modified 3/14/2014)
Scenario=
[N697]
Message=Alert: This reversal is due to a payer's retroactive contract incentive program adjustment.
EffDate=11/1/2013
DeactDate= 
Modified= 3/14/2014
Note=To be used with claim/service reversal. (Modified 3/14/2014)
Scenario=
[N698]
Message=Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment grace period, resulting in loss of coverage.
EffDate=11/1/2013
DeactDate= 
Modified= 11/1/2015
Note=To be used with claim/service reversal. (Modified 3/14/2014, 11/1/2015)
Scenario=
[N699]
Message=Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N700]
Message=Payment adjusted based on the Electronic Health Records (EHR) Incentive Program.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N701]
Message=Payment adjusted based on the Value-based Payment Modifier.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N702]
Message=Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N703]
Message=This service is incompatible with previously  adjudicated claims or claims in process.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N704]
Message=Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted.
EffDate=3/1/2014
DeactDate= 
Modified= 3/14/2014
Note=(Modified 3/14/2014)
Scenario=
[N705]
Message=Incomplete/invalid documentation.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N706]
Message=Missing documentation.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N707]
Message=Incomplete/invalid orders.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N708]
Message=Missing orders.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N709]
Message=Incomplete/invalid notes.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N710]
Message=Missing notes.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N711]
Message=Incomplete/invalid summary.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N712]
Message=Missing summary.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N713]
Message=Incomplete/invalid report.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N714]
Message=Missing report.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N715]
Message=Incomplete/invalid chart.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N716]
Message=Missing chart.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N717]
Message=Incomplete/Invalid documentation of face-to-face examination.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N718]
Message=Missing documentation of face-to-face examination.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N719]
Message=Penalty applied based on plan requirements not being met.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N720]
Message=Alert: The patient overpaid you. You may need to issue the patient a refund for the difference between the patient's payment and the amount shown as patient responsibility on this notice.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N721]
Message=This service is only covered when performed as part of a clinical trial.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N722]
Message=Patient must use Workers' Compensation Set-Aside (WCSA) funds to pay for the medical service or item.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N723]
Message=Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N724]
Message=Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N725]
Message=A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N726]
Message=A conditional payment is not allowed.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N727]
Message=A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N728]
Message=A workers' compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
EffDate=3/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N729]
Message=Missing patient medical/dental record for this service.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N730]
Message=Incomplete/invalid patient medical/dental record for this service.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N731]
Message=Incomplete/Invalid mental health assessment.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N732]
Message=Services performed at an unlicensed facility are not reimbursable.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N733]
Message=Regulatory surcharges are paid directly to the state.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N734]
Message=The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury.
EffDate=11/1/2014
DeactDate= 
Modified= 
Note=
Scenario=
[N735]
Message=Adjustment without review of medical/dental record because the requested records were not received or were not received timely.
EffDate=3/1/2015
DeactDate= 1/1/2016
Modified= 
Note=
Scenario=
[N736]
Message=Incomplete/invalid Sleep Study Report.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N737]
Message=Missing Sleep Study Report.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N738]
Message=Incomplete/invalid Vein Study Report.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N739]
Message=Missing Vein Study Report.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N740]
Message=The member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N741]
Message=This is a site neutral payment.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N742]
Message=Alert: This claim was processed based on one or more ICD-9 codes. The transition to ICD-10 is required by October 1, 2015, for health care providers, health plans, and clearinghouses. More information can be found at http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html
EffDate=3/1/2015
DeactDate= 11/1/2016
Modified= 11/1/2015
Note=(Modified 11/1/2015)
Scenario=
[N743]
Message=Adjusted because the services may be related to an employment accident.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N744]
Message=Adjusted because the services may be related to an auto accident.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N745]
Message=Missing Ambulance Report.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N746]
Message=Incomplete/invalid Ambulance Report.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N747]
Message=This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N748]
Message=Adjusted because the related hospital charges have not been received.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N749]
Message=Missing Blood Gas Report.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N750]
Message=Incomplete/invalid Blood Gas Report.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N751]
Message=Adjusted because the drug is covered under a Medicare Part D plan.
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N752]
Message=Missing/incomplete/invalid HIPPS Treatment Authorization Code (TAC).
EffDate=3/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N753]
Message=Missing/incomplete/invalid Attachment Control Number.
EffDate=7/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N754]
Message=Missing/incomplete/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form.
EffDate=7/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N755]
Message=Missing/incomplete/invalid ICD Indicator.
EffDate=7/1/2015
DeactDate= 
Modified=3/1/2016 
Note=(Modified 3/1/2016)
Scenario=
[N756]
Message=Missing/incomplete/invalid point of drop-off address.
EffDate=7/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N757]
Message=Adjusted based on the Federal Indian Fees schedule (MLR).
EffDate=7/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N758]
Message=Adjusted based on the prior authorization decision.
EffDate=7/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N759]
Message=Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013.
EffDate=7/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N760]
Message=This facility is not authorized to receive payment for the service(s).
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N761]
Message=This provider is not authorized to receive payment for the service(s).
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N762]
Message=This facility is not certified for Tomosynthesis (3-D) mammography.
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N763]
Message=The demonstration code is not appropriate for this claim; resubmit without a demonstration code.
EffDate=11/1/2015
DeactDate= 
Modified= 
Note=
Scenario=
[N764]
Message=Missing/incomplete/invalid Hematocrit (HCT) value.
EffDate=3/1/2016
DeactDate= 
Modified= 
Note=
Scenario=
[N765]
Message=This payer does not cover co-insurance assessed by a previous payer
EffDate=3/1/2016
DeactDate= 
Modified= 
Note=
Scenario=
[N766]
Message=This payer does not cover co-payment assessed by a previous payer.
EffDate=3/1/2016
DeactDate= 
Modified= 
Note=
Scenario=
[N767]
Message=The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed.
EffDate=3/1/2016
DeactDate= 
Modified= 
Note=
Scenario=
[N768]
Message=Incomplete/invalid initial evaluation report.
EffDate=3/1/2016
DeactDate= 
Modified= 
Note=
Scenario=
[N769]
Message=A lateral diagnosis is required.
EffDate=3/1/2016
DeactDate= 
Modified= 
Note=
Scenario=
[N770]
Message=The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received.
EffDate=3/1/2016
DeactDate= 
Modified= 
Note=
Scenario=