Remittance Advice Remarks Codes

M1

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

Start: 01/01/1997

M2

Not paid separately when the patient is an inpatient.

Start: 01/01/1997

M3

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

Start: 01/01/1997

M4

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

M5

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

Start: 01/01/1997

M6

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.

Start: 01/01/1997 | Last Modified: 03/01/2009

Notes: (Modified 4/1/07, 3/1/2009)

M7

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

Start: 01/01/1997 | Last Modified: 11/01/2016

Notes: (Modified 11/1/2016)

M8

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

Start: 01/01/1997

M9

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

M10

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

Start: 01/01/1997

M11

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

Start: 01/01/1997

M12

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

Start: 01/01/1997

M13

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

Start: 01/01/1997 | Last Modified: 06/30/2007

Notes: (Modified 6/30/03)

M14

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

Start: 01/01/1997

M15

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

Start: 01/01/1997

M16

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

Start: 01/01/1997 | Last Modified: 04/01/2007

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

M17

Alert: Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions.

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

M18

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

Start: 01/01/1997 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

M19

Missing oxygen certification/re-certification.

Start: 01/01/1997 | Last Modified: 02/28/2003

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

M20

Missing/incomplete/invalid HCPCS.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M21

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M22

Missing/incomplete/invalid number of miles traveled.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M23

Missing invoice.

Start: 01/01/1997 | Last Modified: 08/01/2005

Notes: (Modified 8/1/05)

M24

Missing/incomplete/invalid number of doses per vial.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M25

The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.

Start: 01/01/1997 | Last Modified: 11/01/2010

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

M26

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

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

Start: 01/01/1997 | Last Modified: 11/05/2007

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

M27

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

Start: 01/01/1997 | Last Modified: 08/01/2007

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

M28

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

Start: 01/01/1997

M29

Missing operative note/report.

Start: 01/01/1997 | Last Modified: 07/01/2008

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

M30

Missing pathology report.

Start: 01/01/1997 | Last Modified: 08/01/2004

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

M31

Missing radiology report.

Start: 01/01/1997 | Last Modified: 08/01/2004

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

M32

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

M36

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

Start: 01/01/1997

M37

Not covered when the patient is under age 35.

Start: 01/01/1997 | Last Modified: 03/08/2011

Notes: (Modified 3/8/11)

M38

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.

Start: 01/01/1997 | Last Modified: 07/01/2015

Notes: (Modified 7/1/15)

M39

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.

Start: 01/01/1997 | Last Modified: 07/01/2015

Notes: (Modified 2/1/04, 4/1/07, 11/1/09, 11/1/12, 7/1/15) Related to N563

M40

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

Start: 01/01/1997

M41

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

Start: 01/01/1997

M42

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

Start: 01/01/1997

M44

Missing/incomplete/invalid condition code.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M45

Missing/incomplete/invalid occurrence code(s).

Start: 01/01/1997 | Last Modified: 12/02/2004

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

M46

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

Start: 01/01/1997 | Last Modified: 12/02/2004

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

M47

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).

Start: 01/01/1997 | Last Modified: 07/01/2015

Notes: (Modified 2/28/03, 7/1/15)

M49

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M50

Missing/incomplete/invalid revenue code(s).

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M51

Missing/incomplete/invalid procedure code(s).

Start: 01/01/1997 | Last Modified: 12/02/2004

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

M52

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M53

Missing/incomplete/invalid days or units of service.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M54

Missing/incomplete/invalid total charges.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M55

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

Start: 01/01/1997

M56

Missing/incomplete/invalid payer identifier.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M59

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M60

Missing Certificate of Medical Necessity.

Start: 01/01/1997 | Last Modified: 08/01/2004

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

M61

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

Start: 01/01/1997

M62

Missing/incomplete/invalid treatment authorization code.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M64

Missing/incomplete/invalid other diagnosis.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M65

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

Start: 01/01/1997

M66

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

Start: 01/01/1997

M67

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

Start: 01/01/1997 | Last Modified: 12/02/2004

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

M69

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

Start: 01/01/1997 | Last Modified: 02/01/2004

Notes: (Modified 2/1/04)

M70

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

Start: 01/01/1997 | Last Modified: 08/01/2007

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

M71

Total payment reduced due to overlap of tests billed.

Start: 01/01/1997

M73

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

Start: 01/01/1997 | Last Modified: 08/01/2004

Notes: (Modified 8/1/04)

M74

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

Start: 01/01/1997 | Last Modified: 12/02/2004

Notes: (Modified 12/2/04)

M75

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

Start: 01/01/1997 | Last Modified: 11/05/2007

Notes: (Modified 11/5/07)

M76

Missing/incomplete/invalid diagnosis or condition.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M77

Missing/incomplete/invalid/inappropriate place of service.

Start: 01/01/1997 | Last Modified: 03/14/2014

Notes: (Modified 2/28/03, 3/1/2014, 3/14/2014)

M79

Missing/incomplete/invalid charge.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M80

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

Start: 01/01/1997 | Last Modified: 10/31/2002

Notes: (Modified 10/31/02)

M81

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

Start: 01/01/1997 | Last Modified: 02/01/2004

Notes: (Modified 2/1/04)

M82

Service is not covered when patient is under age 50.

Start: 01/01/1997

M83

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

Start: 01/01/1997

M84

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

Start: 01/01/1997 | Last Modified: 03/14/2014

Notes: (Modified 2/1/04, 3/14/2014)

M85

Subjected to review of physician evaluation and management services.

Start: 01/01/1997

M86

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

Start: 01/01/1997 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

M87

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

Start: 01/01/1997

M89

Not covered more than once under age 40.

Start: 01/01/1997

M90

Not covered more than once in a 12 month period.

Start: 01/01/1997

M91

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

Start: 01/01/1997

M93

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

Start: 01/01/1997

M94

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

Start: 01/01/1997

M95

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

Start: 01/01/1997

M96

The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.

Start: 01/01/1997

M97

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

Start: 01/01/1997

M99

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M100

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

Start: 01/01/1997

M102

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

Start: 01/01/1997

M103

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

Start: 01/01/1997

M104

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

Start: 01/01/1997

M105

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

Start: 01/01/1997

M107

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

Start: 01/01/1997

M109

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

Start: 01/01/1997

M111

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

Start: 01/01/1997

M112

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

Start: 01/01/1997 | Last Modified: 11/05/2007

Notes: (Modified 11/5/07)

M113

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

Start: 01/01/1997 | Last Modified: 11/05/2007

Notes: (Modified 11/5/07)

M114

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

Start: 01/01/1997 | Last Modified: 11/05/2007

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

M115

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

Start: 01/01/1997 | Last Modified: 11/05/2007

Notes: (Modified 11/5/2007)

M116

Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.

Start: 01/01/1997 | Last Modified: 03/08/2011

Notes: (Modified 2/1/04, 3/15/11)

M117

Not covered unless submitted via electronic claim.

Start: 01/01/1997 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

M119

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

Start: 01/01/1997 | Last Modified: 04/01/2007

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

M121

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

Start: 01/01/1997

M122

Missing/incomplete/invalid level of subluxation.

Start: 01/01/1997 | Last Modified: 02/28/2006

Notes: (Modified 2/28/03)

M123

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M124

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

Start: 01/01/1997 | Last Modified: 02/28/2003

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

M125

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M126

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M127

Missing patient medical record for this service.

Start: 01/01/1997 | Last Modified: 02/28/2003

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

M129

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

Start: 01/01/1997 | Last Modified: 06/30/2003

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

M130

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

Start: 01/01/1997 | Last Modified: 02/28/2003

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

M131

Missing physician financial relationship form.

Start: 01/01/1997 | Last Modified: 02/28/2003

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

M132

Missing pacemaker registration form.

Start: 01/01/1997 | Last Modified: 02/28/2003

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

M133

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

Start: 01/01/1997

M134

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

Start: 01/01/1997 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

M135

Missing/incomplete/invalid plan of treatment.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M136

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

M137

Part B coinsurance under a demonstration project or pilot program.

Start: 01/01/1997 | Last Modified: 11/01/2012

Notes: (Modified 11/1/12)

M138

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

Start: 01/01/1997

M139

Denied services exceed the coverage limit for the demonstration.

Start: 01/01/1997

M141

Missing physician certified plan of care.

Start: 01/01/1997 | Last Modified: 02/28/2003

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

M142

Missing American Diabetes Association Certificate of Recognition.

Start: 01/01/1997 | Last Modified: 02/28/2003

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

M143

The provider must update license information with the payer.

Start: 01/01/1997 | Last Modified: 12/01/2006

Notes: (Modified 12/1/06)

M144

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

Start: 01/01/1997

MA01

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

Start: 01/01/1997 | Last Modified: 04/01/2007

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

MA02

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

Start: 01/01/1997 | Last Modified: 04/01/2007

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

MA04

Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.

Start: 01/01/1997

MA07

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA08

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA09

Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.

Start: 01/01/1997 | Last Modified: 11/01/2015

Notes: (Modified 11/1/2014, 11/1/2015)

MA10

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA12

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

Start: 01/01/1997

MA13

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA14

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

Start: 01/01/1997 | Last Modified: 08/01/2007

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

MA15

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA16

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

Start: 01/01/1997

MA17

We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment.

Start: 01/01/1997

MA18

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA19

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA20

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

Start: 01/01/1997 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

MA21

SSA records indicate mismatch with name and sex.

Start: 01/01/1997

MA22

Payment of less than $1.00 suppressed.

Start: 01/01/1997

MA23

Demand bill approved as result of medical review.

Start: 01/01/1997

MA24

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

Start: 01/01/1997 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

MA25

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

Start: 01/01/1997

MA26

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA27

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA28

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA30

Missing/incomplete/invalid type of bill.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA31

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA32

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA33

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

Start: 01/01/1997 | Last Modified: 03/01/2022

Notes: (Modified 2/28/03, 3/1/2022)

MA34

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA35

Missing/incomplete/invalid number of lifetime reserve days.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA36

Missing/incomplete/invalid patient name.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA37

Missing/incomplete/invalid patient's address.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA39

Missing/incomplete/invalid gender.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA40

Missing/incomplete/invalid admission date.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA41

Missing/incomplete/invalid admission type.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA42

Missing/incomplete/invalid admission source.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA43

Missing/incomplete/invalid patient status.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA44

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA45

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA46

Alert: The new information was considered but additional payment will not be issued.

Start: 01/01/1997 | Last Modified: 11/01/2015

Notes: (Modified 3/1/2009, 11/1/2015)

MA47

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

Start: 01/01/1997

MA48

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA50

Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.

Start: 01/01/1997 | Last Modified: 03/01/2014

Notes: (Modified 2/28/03, 3/1/2014)

MA53

Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.

Start: 01/01/1997 | Last Modified: 02/01/2004

Notes: (Modified 2/1/04)

MA54

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

Start: 01/01/1997

MA55

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

Start: 01/01/1997

MA56

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

Start: 01/01/1997

MA57

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

Start: 01/01/1997

MA58

Missing/incomplete/invalid release of information indicator.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA59

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA60

Missing/incomplete/invalid patient relationship to insured.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA61

Missing/incomplete/invalid social security number.

Start: 01/01/1997 | Last Modified: 03/01/2018

Notes: (Modified 2/28/03, 3/1/2018)

MA62

Alert: This is a telephone review decision.

Start: 01/01/1997 | Last Modified: 08/01/2007

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

MA63

Missing/incomplete/invalid principal diagnosis.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA64

Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.

Start: 01/01/1997

MA65

Missing/incomplete/invalid admitting diagnosis.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA66

Missing/incomplete/invalid principal procedure code.

Start: 01/01/1997 | Last Modified: 12/02/2004

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

MA67

Alert: Correction to a prior claim.

Start: 01/01/1997 | Last Modified: 11/01/2015

Notes: (Modified 11/1/2015)

MA68

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA69

Missing/incomplete/invalid remarks.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA70

Missing/incomplete/invalid provider representative signature.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA71

Missing/incomplete/invalid provider representative signature date.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA72

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA73

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

Start: 01/01/1997

MA74

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

Start: 01/01/1997 | Last Modified: 07/01/2015

Notes: (Modified 7/1/15)

MA75

Missing/incomplete/invalid patient or authorized representative signature.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA76

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

Start: 01/01/1997 | Last Modified: 02/28/2003

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

MA77

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

Start: 01/01/1997 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

MA79

Billed in excess of interim rate.

Start: 01/01/1997

MA80

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

Start: 01/01/1997

MA81

Missing/incomplete/invalid provider/supplier signature.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA83

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

Start: 01/01/1997 | Last Modified: 08/01/2005

Notes: (Modified 8/1/05)

MA84

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

Start: 01/01/1997

MA88

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA89

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA90

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03).

MA91

Alert: This determination is the result of the appeal you filed.

Start: 01/01/1997 | Last Modified: 07/01/2015

Notes: (Modified 7/1/15)

MA92

Missing plan information for other insurance.

Start: 01/01/1997 | Last Modified: 02/01/2004

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

MA93

Non-PIP (Periodic Interim Payment) claim.

Start: 01/01/1997 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

MA94

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

Start: 01/01/1997 | Last Modified: 08/01/2005

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

MA96

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

Start: 01/01/1997

MA97

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

Start: 01/01/1997 | Last Modified: 02/29/2008

Notes: (Modified 2/29/08)

MA99

Missing/incomplete/invalid Medigap information.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA100

Missing/incomplete/invalid date of current illness or symptoms.

Start: 01/01/1997 | Last Modified: 03/14/2014

Notes: (Modified 2/28/03, 3/30/05, 3/14/2014)

MA103

Hemophilia Add On.

Start: 01/01/1997

MA106

PIP (Periodic Interim Payment) claim.

Start: 01/01/1997 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

MA107

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

Start: 01/01/1997

MA108

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

Start: 01/01/1997

MA109

Claim processed in accordance with ambulatory surgical guidelines.

Start: 01/01/1997

MA110

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA111

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA112

Missing/incomplete/invalid group practice information.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA113

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

Start: 01/01/1997

MA114

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA115

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

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA116

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

Start: 01/01/1997

Notes: (Reactivated 4/1/04)

MA117

This claim has been assessed a $1.00 user fee.

Start: 01/01/1997

MA118

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.

Start: 01/01/1997 | Last Modified: 11/01/2014

MA120

Missing/incomplete/invalid CLIA certification number.

Start: 01/01/1997 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

MA121

Missing/incomplete/invalid x-ray date.

Start: 01/01/1997 | Last Modified: 12/02/2004

Notes: (Modified 12/2/04)

MA122

Missing/incomplete/invalid initial treatment date.

Start: 01/01/1997 | Last Modified: 12/02/2004

Notes: (Modified 12/2/04)

MA123

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

Start: 01/01/1997

MA125

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

Start: 01/01/1997

MA126

Pancreas transplant not covered unless kidney transplant performed.

Start: 10/12/2001

MA128

Missing/incomplete/invalid FDA approval number.

Start: 10/12/2001 | Last Modified: 03/30/2005

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

MA130

Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.

Start: 10/12/2001

MA131

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

Start: 10/12/2001

MA132

Adjustment to the pre-demonstration rate.

Start: 10/12/2001

MA133

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

Start: 10/12/2001

MA134

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

Start: 10/12/2001

N1

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. Refer to the URL provided in the ERA for the payer website to access the appeals process guidelines.

Start: 01/01/2000 | Last Modified: 07/01/2018

Notes: (Modified 2/28/03, 4/1/07, 7/15/13, 7/1/18)

N2

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

Start: 01/01/2000

N3

Missing consent form.

Start: 01/01/2000 | Last Modified: 02/28/2003

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

N4

Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.

Start: 01/01/2000 | Last Modified: 03/06/2012

Notes: (Modified 2/28/03, 3/6/2012)

N5

EOB received from previous payer. Claim not on file.

Start: 01/01/2000

N6

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

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N7

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

Start: 01/01/2000 | Last Modified: 07/15/2013

Notes: (Modified 7/15/13)

N8

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

Start: 01/01/2000

N9

Adjustment represents the estimated amount a previous payer may pay.

Start: 01/01/2000 | Last Modified: 11/18/2005

Notes: (Modified 11/18/05)

N10

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

Start: 01/01/2000 | Last Modified: 03/01/2015

Notes: (Modified 10/31/02, 7/1/08, 7/15/13, 3/1/2015)

N11

Denial reversed because of medical review.

Start: 01/01/2000

N12

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

Start: 01/01/2000 | Last Modified: 08/01/2007

Notes: (Modified 8/1/07)

N13

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

Start: 01/01/2000

N15

Services for a newborn must be billed separately.

Start: 01/01/2000

N16

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

Start: 01/01/2000

N19

Procedure code incidental to primary procedure.

Start: 01/01/2000

N20

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

Start: 01/01/2000

N21

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

Start: 01/01/2000 | Last Modified: 04/01/2007

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

N22

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

Start: 01/01/2000 | Last Modified: 07/01/2015

Notes: (Modified 10/31/02, 2/28/03, 7/1/15)

N23

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

Start: 01/01/2000 | Last Modified: 04/01/2007

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

N24

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

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N25

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

Start: 01/01/2000

N26

Missing itemized bill/statement.

Start: 01/01/2000 | Last Modified: 07/01/2008

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

N27

Missing/incomplete/invalid treatment number.

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N28

Consent form requirements not fulfilled.

Start: 01/01/2000

N30

Patient ineligible for this service.

Start: 01/01/2000 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

N31

Missing/incomplete/invalid prescribing provider identifier.

Start: 01/01/2000 | Last Modified: 12/02/2004

Notes: (Modified 12/2/04)

N32

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

Start: 01/01/2000 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

N33

No record of health check prior to initiation of treatment.

Start: 01/01/2000

N34

Incorrect claim form/format for this service.

Start: 01/01/2000 | Last Modified: 11/18/2005

Notes: (Modified 11/18/05)

N35

Program integrity/utilization review decision.

Start: 01/01/2000

N36

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

Start: 01/01/2000

N37

Missing/incomplete/invalid tooth number/letter.

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N39

Procedure code is not compatible with tooth number/letter.

Start: 01/01/2000

N40

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

Start: 01/01/2000 | Last Modified: 07/01/2008

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

N42

Missing mental health assessment.

Start: 01/01/2000 | Last Modified: 11/01/2014

N43

Bed hold or leave days exceeded.

Start: 01/01/2000

N45

Payment based on authorized amount.

Start: 01/01/2000

N46

Missing/incomplete/invalid admission hour.

Start: 01/01/2000

N47

Claim conflicts with another inpatient stay.

Start: 01/01/2000

N48

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

Start: 01/01/2000

N49

Court ordered coverage information needs validation.

Start: 01/01/2000

N50

Missing/incomplete/invalid discharge information.

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N51

Electronic interchange agreement not on file for provider/submitter.

Start: 01/01/2000

N52

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

Start: 01/01/2000

N53

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

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N54

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

Start: 01/01/2000

N55

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

Start: 01/01/2000

N56

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

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N57

Missing/incomplete/invalid prescribing date.

Start: 01/01/2000 | Last Modified: 12/02/2004

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

N58

Missing/incomplete/invalid patient liability amount.

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N59

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

Start: 01/01/2000 | Last Modified: 11/01/2015

Notes: (Modified 4/1/07, 11/1/09, 11/1/2015)

N61

Rebill services on separate claims.

Start: 01/01/2000

N62

Dates of service span multiple rate periods. Resubmit separate claims.

Start: 01/01/2000 | Last Modified: 03/08/2011

Notes: (Modified 3/8/11)

N63

Rebill services on separate claim lines.

Start: 01/01/2000

N64

The 'from' and 'to' dates must be different.

Start: 01/01/2000

N65

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

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N67

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

Start: 01/01/2000

N68

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.

Start: 01/01/2000

N69

Alert: PPS (Prospective Payment System) code changed by claims processing system.

Start: 01/01/2000 | Last Modified: 11/01/2015

Notes: (Modified 6/30/03, 7/1/12, 11/1/2015)

N70

Consolidated billing and payment applies.

Start: 01/01/2000 | Last Modified: 11/05/2007

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

N71

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

Start: 01/01/2000 | Last Modified: 06/30/2003

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

N72

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

Start: 01/01/2000 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

N74

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

Start: 01/01/2000

N75

Missing/incomplete/invalid tooth surface information.

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N76

Missing/incomplete/invalid number of riders.

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N77

Missing/incomplete/invalid designated provider number.

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N78

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

Start: 01/01/2000

N79

Service billed is not compatible with patient location information.

Start: 01/01/2000

N80

Missing/incomplete/invalid prenatal screening information.

Start: 01/01/2000 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N81

Procedure billed is not compatible with tooth surface code.

Start: 01/01/2000

N82

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

Start: 01/01/2000

N83

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

Start: 01/01/2000

N84

Alert: Further installment payments are forthcoming.

Start: 01/01/2000 | Last Modified: 04/01/2007

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

N85

Alert: This is the final installment payment.

Start: 01/01/2000 | Last Modified: 04/01/2007

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

N86

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

Start: 01/01/2000

N87

Home use of biofeedback therapy is not covered.

Start: 01/01/2000

N88

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

Start: 01/01/2000 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N89

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

Start: 01/01/2000 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N90

Covered only when performed by the attending physician.

Start: 01/01/2000

N91

Services not included in the appeal review.

Start: 01/01/2000

N92

This facility is not certified for digital mammography.

Start: 01/01/2000

N93

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

Start: 01/01/2000

N94

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

Start: 01/01/2000

N95

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

Start: 07/31/2001 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N96

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

Start: 08/24/2001

N97

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

Start: 08/24/2001

N98

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

Start: 08/24/2001

N99

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

Start: 08/24/2001

N103

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.

Start: 10/31/2001 | Last Modified: 11/01/2013

Notes: (Modified 6/30/03, 7/1/12, 11/1/13)

N104

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.

Start: 01/29/2002 | Last Modified: 07/01/2010

Notes: (Modified 10/31/02, 7/1/10)

N105

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 888-355-9165 for RRB EDI information for electronic claims processing.

Start: 01/29/2002 | Last Modified: 07/01/2017

Notes: (Modified 7/1/2017)

N106

Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.

Start: 01/31/2002

N107

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

Start: 01/31/2002

N108

Missing/incomplete/invalid upgrade information.

Start: 01/31/2002 | Last Modified: 02/28/2003

Notes: (Modified 2/28/03)

N109

Alert: This claim/service was chosen for complex review.

Start: 02/28/2002 | Last Modified: 07/01/2015

Notes: (Modified 3/1/2009, 7/1/15)

N110

This facility is not certified for film mammography.

Start: 02/28/2002

N111

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

Start: 02/28/2002

N112

This claim is excluded from your electronic remittance advice.

Start: 02/28/2002

N113

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

Start: 04/16/2002 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

N114

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

Start: 05/30/2002

N115

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

Start: 05/30/2002 | Last Modified: 07/01/2010

Notes: (Modified 4/1/04, 7/1/10)

N116

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

Start: 06/30/2002 | Last Modified: 11/01/2016

Notes: (Modified 11/1/2016)

N117

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

Start: 07/30/2002 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

N118

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

Start: 07/30/2002

N119

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

Start: 07/30/2002 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

N120

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

Start: 08/09/2002 | Last Modified: 06/30/2003

Notes: (Modified 6/30/03)

N121

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

Start: 09/09/2002 | Last Modified: 08/01/2004

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

N122

Add-on code cannot be billed by itself.

Start: 09/12/2002 | Last Modified: 08/01/2005

Notes: (Modified 8/1/05)

N123

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

Start: 09/24/2002 | Last Modified: 03/01/2016

Notes: (Modified 3/1/2016)

N124

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

Start: 09/26/2002

N125

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

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

Start: 09/26/2002 | Last Modified: 08/01/2005

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

N126

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

Start: 10/17/2002

N127

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

Start: 10/31/2007 | Last Modified: 08/01/2004

Notes: (Modified 8/1/04

N128

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

Start: 10/31/2002

N129

Not eligible due to the patient's age.

Start: 10/31/2002 | Last Modified: 08/01/2007

Notes: (Modified 8/1/07)

N130

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

Start: 10/31/2002 | Last Modified: 11/01/2009

Notes: (Modified 4/1/07, 7/1/08, 11/1/09)

N131

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

Start: 10/31/2002

N132

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N133

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N134

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N135

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

Start: 10/31/2002

N136

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N137

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

Start: 10/31/2002 | Last Modified: 04/01/2007

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

N138

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N139

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

Start: 10/31/2002 | Last Modified: 03/01/2017

Notes: (Modified 4/1/07, 3/1/2017)

N140

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N141

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

Start: 10/31/2002

N142

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

Start: 10/31/2002

N143

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

Start: 10/31/2002

N144

The rate changed during the dates of service billed.

Start: 10/31/2002

N146

Missing screening document.

Start: 10/31/2002 | Last Modified: 08/01/2004

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

N147

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

Start: 10/31/2002

N148

Missing/incomplete/invalid date of last menstrual period.

Start: 10/31/2002

N149

Rebill all applicable services on a single claim.

Start: 10/31/2002

N150

Missing/incomplete/invalid model number.

Start: 10/31/2002

N151

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

Start: 10/31/2002

N152

Missing/incomplete/invalid replacement claim information.

Start: 10/31/2002

N153

Missing/incomplete/invalid room and board rate.

Start: 10/31/2002

N154

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N155

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N156

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

Start: 10/31/2002 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N157

Transportation to/from this destination is not covered.

Start: 02/28/2003 | Last Modified: 02/01/2004

Notes: (Modified 2/1/04)

N158

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

Start: 02/28/2003

N159

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

Start: 02/28/2003

N160

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

Start: 02/28/2003 | Last Modified: 02/01/2004

Notes: (Modified 2/1/04)

N161

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

Start: 02/28/2003

N162

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

Start: 02/28/2003 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N163

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

Start: 02/28/2003

N167

Charges exceed the post-transplant coverage limit.

Start: 02/28/2003

N170

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

Start: 02/28/2003

N171

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

Start: 02/28/2003

N172

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

Start: 02/28/2003

N173

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

Start: 02/28/2003

N174

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

Start: 02/28/2003

N175

Missing review organization approval.

Start: 02/28/2003 | Last Modified: 02/29/2008

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

N176

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

Start: 02/28/2003

N177

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

Start: 02/28/2003 | Last Modified: 04/01/2007

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

N178

Missing pre-operative images/visual field results.

Start: 02/28/2003 | Last Modified: 11/01/2013

Notes: (Modified 8/1/04, 11/1/13) Related to N244

N179

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

Start: 02/28/2003

N180

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

Start: 02/28/2003

N181

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

Start: 02/28/2003 | Last Modified: 12/01/2006

Notes: (Modified 12/1/06)

N182

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

Start: 02/28/2003

N183

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

Start: 02/28/2003 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N184

Rebill technical and professional components separately.

Start: 02/28/2003

N185

Alert: Do not resubmit this claim/service.

Start: 02/28/2003 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N186

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

Start: 02/28/2003

N187

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

Start: 02/28/2003 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N188

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

Start: 02/28/2003

N189

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

Start: 02/28/2003 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N190

Missing contract indicator.

Start: 02/28/2003 | Last Modified: 08/01/2004

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

N191

The provider must update insurance information directly with payer.

Start: 02/28/2003

N192

Alert: Patient is a Medicaid/Qualified Medicare Beneficiary.

Start: 02/28/2003 | Last Modified: 07/01/2020

N193

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

Start: 02/28/2003 | Last Modified: 11/01/2015

Notes: (Modified 11/1/2015)

N194

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

Start: 02/25/2003

N195

The technical component must be billed separately.

Start: 02/25/2003

N196

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

Start: 02/25/2003 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N197

The subscriber must update insurance information directly with payer.

Start: 02/25/2003

N198

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

Start: 02/25/2003

N199

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

Start: 02/25/2003 | Last Modified: 08/01/2006

Notes: (Modified 8/1/06)

N200

The professional component must be billed separately.

Start: 02/25/2003

N202

Alert: Additional information/explanation will be sent separately.

Start: 06/30/2003 | Last Modified: 11/01/2015

Notes: (Modified 4/1/07, 11/1/09, 3/14/2014, 11/1/2015)

N203

Missing/incomplete/invalid anesthesia time/units.

Start: 06/30/2003 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N204

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

Start: 06/30/2003

N205

Information provided was illegible.

Start: 06/30/2003 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N206

The supporting documentation does not match the information sent on the claim.

Start: 06/30/2003 | Last Modified: 03/06/2012

Notes: (Modified 3/6/12)

N207

Missing/incomplete/invalid weight.

Start: 06/30/2003 | Last Modified: 11/18/2005

Notes: (Modified 11/18/05)

N208

Missing/incomplete/invalid DRG code.

Start: 06/30/2003 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N209

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

Start: 06/30/2003 | Last Modified: 07/01/2008

Notes: (Modified 7/1/08)

N210

Alert: You may appeal this decision.

Start: 06/30/2003 | Last Modified: 03/14/2014

Notes: (Modified 4/1/07, 3/14/2014)

N211

Alert: You may not appeal this decision.

Start: 06/30/2003 | Last Modified: 03/14/2014

Notes: (Modified 4/1/07, 3/14/2014)

N212

Charges processed under a Point of Service benefit.

Start: 02/01/2004 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N213

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

Start: 04/01/2004 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N214

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

Start: 04/01/2004 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N215

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

Start: 04/01/2004 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N216

We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.

Start: 04/01/2004 | Last Modified: 03/14/2014

Notes: (Modified 3/1/2010, 3/14/2014)

N217

We pay only one site of service per provider per claim.

Start: 08/01/2004 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N218

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

Start: 08/01/2004

N219

Payment based on previous payer's allowed amount.

Start: 08/01/2004

N220

Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.

Start: 08/01/2004 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N221

Missing Admitting History and Physical report.

Start: 08/01/2004

N222

Incomplete/invalid Admitting History and Physical report.

Start: 08/01/2004

N223

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

Start: 08/01/2004

N224

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

Start: 08/01/2004

N226

Incomplete/invalid American Diabetes Association Certificate of Recognition.

Start: 08/01/2004

N227

Incomplete/invalid Certificate of Medical Necessity.

Start: 08/01/2004

N228

Incomplete/invalid consent form.

Start: 08/01/2004

N229

Incomplete/invalid contract indicator.

Start: 08/01/2004

N230

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

Start: 08/01/2004

N231

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

Start: 08/01/2004

N232

Incomplete/invalid itemized bill/statement.

Start: 08/01/2004 | Last Modified: 07/01/2008

Notes: (Modified 7/1/08)

N233

Incomplete/invalid operative note/report.

Start: 08/01/2004 | Last Modified: 07/01/2008

Notes: (Modified 7/1/08)

N234

Incomplete/invalid oxygen certification/re-certification.

Start: 08/01/2004

N235

Incomplete/invalid pacemaker registration form.

Start: 08/01/2004

N236

Incomplete/invalid pathology report.

Start: 08/01/2004

N237

Incomplete/invalid patient medical record for this service.

Start: 08/01/2004

N238

Incomplete/invalid physician certified plan of care.

Start: 08/01/2004 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N239

Incomplete/invalid physician financial relationship form.

Start: 08/01/2004

N240

Incomplete/invalid radiology report.

Start: 08/01/2004

N241

Incomplete/invalid review organization approval.

Start: 08/01/2004 | Last Modified: 02/29/2008

Notes: (Modified 2/29/08)

N242

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

Start: 08/01/2004 | Last Modified: 07/01/2008

Notes: (Modified 7/1/08)

N243

Incomplete/invalid/not approved screening document.

Start: 08/01/2004

N244

Incomplete/Invalid pre-operative images/visual field results.

Start: 08/01/2004 | Last Modified: 11/01/2013

Notes: (Modified 11/1/2013)

N245

Incomplete/invalid plan information for other insurance.

Start: 08/01/2004 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N246

State regulated patient payment limitations apply to this service.

Start: 12/02/2004

N247

Missing/incomplete/invalid assistant surgeon taxonomy.

Start: 12/02/2004

N248

Missing/incomplete/invalid assistant surgeon name.

Start: 12/02/2004

N249

Missing/incomplete/invalid assistant surgeon primary identifier.

Start: 12/02/2004

N250

Missing/incomplete/invalid assistant surgeon secondary identifier.

Start: 12/02/2004

N251

Missing/incomplete/invalid attending provider taxonomy.

Start: 12/02/2004

N252

Missing/incomplete/invalid attending provider name.

Start: 12/02/2004

N253

Missing/incomplete/invalid attending provider primary identifier.

Start: 12/02/2004

N254

Missing/incomplete/invalid attending provider secondary identifier.

Start: 12/02/2004

N255

Missing/incomplete/invalid billing provider taxonomy.

Start: 12/02/2004

N256

Missing/incomplete/invalid billing provider/supplier name.

Start: 12/02/2004

N257

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

Start: 12/02/2004

N258

Missing/incomplete/invalid billing provider/supplier address.

Start: 12/02/2004

N259

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

Start: 12/02/2004

N260

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

Start: 12/02/2004

N261

Missing/incomplete/invalid operating provider name.

Start: 12/02/2004

N262

Missing/incomplete/invalid operating provider primary identifier.

Start: 12/02/2004

N263

Missing/incomplete/invalid operating provider secondary identifier.

Start: 12/02/2004

N264

Missing/incomplete/invalid ordering provider name.

Start: 12/02/2004

N265

Missing/incomplete/invalid ordering provider primary identifier.

Start: 12/02/2004

N266

Missing/incomplete/invalid ordering provider address.

Start: 12/02/2004

N267

Missing/incomplete/invalid ordering provider secondary identifier.

Start: 12/02/2004

N268

Missing/incomplete/invalid ordering provider contact information.

Start: 12/02/2004

N269

Missing/incomplete/invalid other provider name.

Start: 12/02/2004

N270

Missing/incomplete/invalid other provider primary identifier.

Start: 12/02/2004

N271

Missing/incomplete/invalid other provider secondary identifier.

Start: 12/02/2004

N272

Missing/incomplete/invalid other payer attending provider identifier.

Start: 12/02/2004

N273

Missing/incomplete/invalid other payer operating provider identifier.

Start: 12/02/2004

N274

Missing/incomplete/invalid other payer other provider identifier.

Start: 12/02/2004

N275

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

Start: 12/02/2004

N276

Missing/incomplete/invalid other payer referring provider identifier.

Start: 12/02/2004

N277

Missing/incomplete/invalid other payer rendering provider identifier.

Start: 12/02/2004

N278

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

Start: 12/02/2004

N279

Missing/incomplete/invalid pay-to provider name.

Start: 12/02/2004

N280

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

Start: 12/02/2004

N281

Missing/incomplete/invalid pay-to provider address.

Start: 12/02/2004

N282

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

Start: 12/02/2004

N283

Missing/incomplete/invalid purchased service provider identifier.

Start: 12/02/2004

N284

Missing/incomplete/invalid referring provider taxonomy.

Start: 12/02/2004

N285

Missing/incomplete/invalid referring provider name.

Start: 12/02/2004

N286

Missing/incomplete/invalid referring provider primary identifier.

Start: 12/02/2004

N287

Missing/incomplete/invalid referring provider secondary identifier.

Start: 12/02/2004

N288

Missing/incomplete/invalid rendering provider taxonomy.

Start: 12/02/2004

N289

Missing/incomplete/invalid rendering provider name.

Start: 12/02/2004

N290

Missing/incomplete/invalid rendering provider primary identifier.

Start: 12/02/2004

N291

Missing/incomplete/invalid rendering provider secondary identifier.

Start: 12/02/2004 | Last Modified: 11/01/2010

N292

Missing/incomplete/invalid service facility name.

Start: 12/02/2004

N293

Missing/incomplete/invalid service facility primary identifier.

Start: 12/02/2004

N294

Missing/incomplete/invalid service facility primary address.

Start: 12/02/2004

N295

Missing/incomplete/invalid service facility secondary identifier.

Start: 12/02/2004

N296

Missing/incomplete/invalid supervising provider name.

Start: 12/02/2004

N297

Missing/incomplete/invalid supervising provider primary identifier.

Start: 12/02/2004

N298

Missing/incomplete/invalid supervising provider secondary identifier.

Start: 12/02/2004

N299

Missing/incomplete/invalid occurrence date(s).

Start: 12/02/2004

N300

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

Start: 12/02/2004

N301

Missing/incomplete/invalid procedure date(s).

Start: 12/02/2004

N302

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

Start: 12/02/2004

N303

Missing/incomplete/invalid principal procedure date.

Start: 12/02/2004

N304

Missing/incomplete/invalid dispensed date.

Start: 12/02/2004

N305

Missing/incomplete/invalid injury/accident date.

Start: 12/02/2004 | Last Modified: 11/01/2016

Notes: (Modified 11/1/2016)

N306

Missing/incomplete/invalid acute manifestation date.

Start: 12/02/2004

N307

Missing/incomplete/invalid adjudication or payment date.

Start: 12/02/2004

N308

Missing/incomplete/invalid appliance placement date.

Start: 12/02/2004

N309

Missing/incomplete/invalid assessment date.

Start: 12/02/2004

N310

Missing/incomplete/invalid assumed or relinquished care date.

Start: 12/02/2004

N311

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

Start: 12/02/2004

N312

Missing/incomplete/invalid begin therapy date.

Start: 12/02/2004

N313

Missing/incomplete/invalid certification revision date.

Start: 12/02/2004

N314

Missing/incomplete/invalid diagnosis date.

Start: 12/02/2004

N315

Missing/incomplete/invalid disability from date.

Start: 12/02/2004

N316

Missing/incomplete/invalid disability to date.

Start: 12/02/2004

N317

Missing/incomplete/invalid discharge hour.

Start: 12/02/2004

N318

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

Start: 12/02/2004

N319

Missing/incomplete/invalid hearing or vision prescription date.

Start: 12/02/2004

N320

Missing/incomplete/invalid Home Health Certification Period.

Start: 12/02/2004

N321

Missing/incomplete/invalid last admission period.

Start: 12/02/2004

N322

Missing/incomplete/invalid last certification date.

Start: 12/02/2004

N323

Missing/incomplete/invalid last contact date.

Start: 12/02/2004

N324

Missing/incomplete/invalid last seen/visit date.

Start: 12/02/2004

N325

Missing/incomplete/invalid last worked date.

Start: 12/02/2004

N326

Missing/incomplete/invalid last x-ray date.

Start: 12/02/2004

N327

Missing/incomplete/invalid other insured birth date.

Start: 12/02/2004

N328

Missing/incomplete/invalid Oxygen Saturation Test date.

Start: 12/02/2004

N329

Missing/incomplete/invalid patient birth date.

Start: 12/02/2004

N330

Missing/incomplete/invalid patient death date.

Start: 12/02/2004

N331

Missing/incomplete/invalid physician order date.

Start: 12/02/2004

N332

Missing/incomplete/invalid prior hospital discharge date.

Start: 12/02/2004

N333

Missing/incomplete/invalid prior placement date.

Start: 12/02/2004

N334

Missing/incomplete/invalid re-evaluation date.

Start: 12/02/2004 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N335

Missing/incomplete/invalid referral date.

Start: 12/02/2004

N336

Missing/incomplete/invalid replacement date.

Start: 12/02/2004

N337

Missing/incomplete/invalid secondary diagnosis date.

Start: 12/02/2004

N338

Missing/incomplete/invalid shipped date.

Start: 12/02/2004

N339

Missing/incomplete/invalid similar illness or symptom date.

Start: 12/02/2004

N340

Missing/incomplete/invalid subscriber birth date.

Start: 12/02/2004

N341

Missing/incomplete/invalid surgery date.

Start: 12/02/2004

N342

Missing/incomplete/invalid test performed date.

Start: 12/02/2004

N343

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

Start: 12/02/2004

N344

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

Start: 12/02/2004

N345

Date range not valid with units submitted.

Start: 03/30/2005

N346

Missing/incomplete/invalid oral cavity designation code.

Start: 03/30/2005

N347

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

Start: 03/30/2005

N348

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

Start: 08/01/2005

N349

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

Start: 08/01/2005

N350

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

Start: 08/01/2005 | Last Modified: 07/01/2008

Notes: (Modified 7/1/08)

N351

Service date outside of the approved treatment plan service dates.

Start: 08/01/2005

N352

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

Start: 08/01/2005 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N353

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

Start: 08/01/2005 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N354

Incomplete/invalid invoice.

Start: 08/01/2005 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N355

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

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

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

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

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

Start: 08/01/2005 | Last Modified: 04/01/2007

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

N356

Not covered when performed with, or subsequent to, a non-covered service.

Start: 08/01/2005 | Last Modified: 03/08/2011

Notes: (Modified 3/8/11)

N357

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

Start: 11/18/2005

N358

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

Start: 11/18/2005 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N359

Missing/incomplete/invalid height.

Start: 11/18/2005

N360

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

Start: 11/18/2005 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N362

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

Start: 11/18/2005

N363

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

Start: 11/18/2005 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N364

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

Start: 11/18/2005 | Last Modified: 04/01/2007

Notes: (Modified 4/1/07)

N366

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

Start: 04/01/2006

N367

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

Start: 04/01/2006 | Last Modified: 07/01/2008

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

N368

You must appeal the determination of the previously adjudicated claim.

Start: 04/01/2006

N369

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

Start: 04/01/2006

N370

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

Start: 08/01/2006

N371

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

Start: 08/01/2006

N372

Only reasonable and necessary maintenance/service charges are covered.

Start: 08/01/2006

N373

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

Start: 12/01/2006

N374

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

Start: 12/01/2006

N375

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

Start: 12/01/2006

N376

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

Start: 12/01/2006

N377

Payment based on a processed replacement claim.

Start: 12/01/2006 | Last Modified: 11/05/2007

Notes: (Modified 11/5/07)

N378

Missing/incomplete/invalid prescription quantity.

Start: 12/01/2006

N379

Claim level information does not match line level information.

Start: 12/01/2006

N380

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

Start: 04/01/2007

N381

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

Start: 04/01/2007 | Last Modified: 07/01/2015

Notes: (Modified 7/1/15)

N382

Missing/incomplete/invalid patient identifier.

Start: 04/01/2007

N383

Not covered when deemed cosmetic.

Start: 04/01/2007 | Last Modified: 03/08/2011

Notes: (Modified 3/8/11)

N384

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

Start: 04/01/2007

N385

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

Start: 04/01/2007 | Last Modified: 11/05/2007

Notes: (Modified 11/5/07)

N386

This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.

Start: 04/01/2007 | Last Modified: 07/01/2010

Notes: (Modified 7/1/2010)

N387

Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information.

Start: 04/01/2007 | Last Modified: 03/01/2009

Notes: (Modified 3/1/2009)

N388

Missing/incomplete/invalid prescription number.

Start: 08/01/2007 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N389

Duplicate prescription number submitted.

Start: 08/01/2007

N390

This service/report cannot be billed separately.

Start: 08/01/2007 | Last Modified: 07/01/2008

Notes: (Modified 7/1/08)

N391

Missing emergency department records.

Start: 08/01/2007

N392

Incomplete/invalid emergency department records.

Start: 08/01/2007

N393

Missing progress notes/report.

Start: 08/01/2007 | Last Modified: 07/01/2008

Notes: (Modified 7/1/08)

N394

Incomplete/invalid progress notes/report.

Start: 08/01/2007 | Last Modified: 07/01/2008

Notes: (Modified 7/1/08)

N395

Missing laboratory report.

Start: 08/01/2007

N396

Incomplete/invalid laboratory report.

Start: 08/01/2007

N397

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

Start: 08/01/2007

N398

Missing elective consent form.

Start: 08/01/2007

N399

Incomplete/invalid elective consent form.

Start: 08/01/2007

N400

Alert: Electronically enabled providers should submit claims electronically.

Start: 08/01/2007

N401

Missing periodontal charting.

Start: 08/01/2007

N402

Incomplete/invalid periodontal charting.

Start: 08/01/2007

N403

Missing facility certification.

Start: 08/01/2007

N404

Incomplete/invalid facility certification.

Start: 08/01/2007

N405

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

Start: 08/01/2007

N406

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

Start: 08/01/2007

N407

You are not an approved submitter for this transmission format.

Start: 08/01/2007

N408

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

Start: 08/01/2007

N409

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

Start: 08/01/2007

N410

Not covered unless the prescription changes.

Start: 08/01/2007 | Last Modified: 03/08/2011

Notes: (Modified 3/8/11)

N411

This service is allowed one time in a 6-month period.

Start: 08/01/2007 | Last Modified: 07/01/2016

Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N412

This service is allowed 2 times in a 12-month period.

Start: 08/01/2007 | Last Modified: 07/01/2016

Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N413

This service is allowed 2 times in a benefit year.

Start: 08/01/2007 | Last Modified: 07/01/2016

Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N414

This service is allowed 4 times in a 12-month period.

Start: 08/01/2007 | Last Modified: 07/01/2016

Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N415

This service is allowed 1 time in an 18-month period.

Start: 08/01/2007 | Last Modified: 07/01/2016

Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N416

This service is allowed 1 time in a 3-year period.

Start: 08/01/2007 | Last Modified: 07/01/2016

Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N417

This service is allowed 1 time in a 5-year period.

Start: 08/01/2007 | Last Modified: 07/01/2016

Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N418

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

Start: 08/01/2007

N419

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

Start: 08/01/2007

N420

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

Start: 08/01/2007

N421

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

Start: 08/01/2007 | Last Modified: 05/08/2008

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

N422

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

Start: 08/01/2007 | Last Modified: 05/08/2008

Notes: (Typo fixed 5/8/08)

N423

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

Start: 08/01/2007

N424

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

Start: 08/01/2007

N425

Statutorily excluded service(s).

Start: 08/01/2007

N426

No coverage when self-administered.

Start: 08/01/2007

N427

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

Start: 08/01/2007

N428

Not covered when performed in this place of service.

Start: 08/01/2007 | Last Modified: 03/08/2011

Notes: (Modified 3/8/11)

N429

Not covered when considered routine.

Start: 08/01/2007 | Last Modified: 03/08/2011

Notes: (Modified 3/8/11)

N430

Procedure code is inconsistent with the units billed.

Start: 11/05/2007

N431

Not covered with this procedure.

Start: 11/05/2007 | Last Modified: 03/08/2011

Notes: (Modified 3/8/11)

N432

Alert: Adjustment based on a Recovery Audit.

Start: 11/05/2007 | Last Modified: 07/01/2015

Notes: (Modified 7/1/15)

N433

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

Start: 02/29/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N434

Missing/Incomplete/Invalid Present on Admission indicator.

Start: 07/01/2008

N435

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

Start: 07/01/2008

N436

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

Start: 07/01/2008

N437

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

Start: 07/01/2008

N438

This jurisdiction only accepts paper claims.

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N439

Missing anesthesia physical status report/indicators.

Start: 07/01/2008

N440

Incomplete/invalid anesthesia physical status report/indicators.

Start: 07/01/2008

N441

This missed/cancelled appointment is not covered.

Start: 07/01/2008 | Last Modified: 07/15/2013

Notes: (Modified 7/15/2013)

N442

Payment based on an alternate fee schedule.

Start: 07/01/2008

N443

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

Start: 07/01/2008

N444

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

Start: 07/01/2008

N445

Missing document for actual cost or paid amount.

Start: 07/01/2008

N446

Incomplete/invalid document for actual cost or paid amount.

Start: 07/01/2008

N447

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

Start: 07/01/2008

N448

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

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N449

Payment based on a comparable drug/service/supply.

Start: 07/01/2008

N450

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

Start: 07/01/2008

N451

Missing Admission Summary Report.

Start: 07/01/2008

N452

Incomplete/invalid Admission Summary Report.

Start: 07/01/2008

N453

Missing Consultation Report.

Start: 07/01/2008

N454

Incomplete/invalid Consultation Report.

Start: 07/01/2008

N455

Missing Physician Order.

Start: 07/01/2008

N456

Incomplete/invalid Physician Order.

Start: 07/01/2008

N457

Missing Diagnostic Report.

Start: 07/01/2008

N458

Incomplete/invalid Diagnostic Report.

Start: 07/01/2008

N459

Missing Discharge Summary.

Start: 07/01/2008

N460

Incomplete/invalid Discharge Summary.

Start: 07/01/2008

N461

Missing Nursing Notes.

Start: 07/01/2008

N462

Incomplete/invalid Nursing Notes.

Start: 07/01/2008

N463

Missing support data for claim.

Start: 07/01/2008

N464

Incomplete/invalid support data for claim.

Start: 07/01/2008

N465

Missing Physical Therapy Notes/Report.

Start: 07/01/2008

N466

Incomplete/invalid Physical Therapy Notes/Report.

Start: 07/01/2008

N467

Missing Tests and Analysis Report.

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N468

Incomplete/invalid Report of Tests and Analysis Report.

Start: 07/01/2008

N469

Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).

Start: 07/01/2008

N470

This payment will complete the mandatory medical reimbursement limit.

Start: 07/01/2008

N471

Missing/incomplete/invalid HIPPS Rate Code.

Start: 07/01/2008

N472

Payment for this service has been issued to another provider.

Start: 07/01/2008

N473

Missing certification.

Start: 07/01/2008

N474

Incomplete/invalid certification.

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N475

Missing completed referral form.

Start: 07/01/2008

N476

Incomplete/invalid completed referral form.

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N477

Missing Dental Models.

Start: 07/01/2008

N478

Incomplete/invalid Dental Models.

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N479

Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).

Start: 07/01/2008

N480

Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).

Start: 07/01/2008

N481

Missing Models.

Start: 07/01/2008

N482

Incomplete/invalid Models.

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N485

Missing Physical Therapy Certification.

Start: 07/01/2008

N486

Incomplete/invalid Physical Therapy Certification.

Start: 07/01/2008

N487

Missing Prosthetics or Orthotics Certification.

Start: 07/01/2008

N488

Incomplete/invalid Prosthetics or Orthotics Certification.

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N489

Missing referral form.

Start: 07/01/2008

N490

Incomplete/invalid referral form.

Start: 07/01/2008 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N491

Missing/Incomplete/Invalid Exclusionary Rider Condition.

Start: 07/01/2008

N492

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.

Start: 07/01/2008

N493

Missing Doctor First Report of Injury.

Start: 07/01/2008

N494

Incomplete/invalid Doctor First Report of Injury.

Start: 07/01/2008

N495

Missing Supplemental Medical Report.

Start: 07/01/2008

N496

Incomplete/invalid Supplemental Medical Report.

Start: 07/01/2008

N497

Missing Medical Permanent Impairment or Disability Report.

Start: 07/01/2008

N498

Incomplete/invalid Medical Permanent Impairment or Disability Report.

Start: 07/01/2008

N499

Missing Medical Legal Report.

Start: 07/01/2008

N500

Incomplete/invalid Medical Legal Report.

Start: 07/01/2008

N501

Missing Vocational Report.

Start: 07/01/2008

N502

Incomplete/invalid Vocational Report.

Start: 07/01/2008

N503

Missing Work Status Report.

Start: 07/01/2008

N504

Incomplete/invalid Work Status Report.

Start: 07/01/2008

N505

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.

Start: 11/01/2008 | Last Modified: 03/01/2017

Notes: (Modified 3/1/2017)

N506

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.

Start: 11/01/2008

N507

Plan distance requirements have not been met.

Start: 11/01/2008

N508

Alert: This real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions.

Start: 11/01/2008 | Last Modified: 03/01/2017

Notes: (Modified 3/1/2017)

N509

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.

Start: 11/01/2008

N510

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.

Start: 11/01/2008

N511

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.

Start: 11/01/2008

N512

Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.

Start: 11/01/2008

N513

Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.

Start: 11/01/2008

N516

Records indicate a mismatch between the submitted NPI and EIN.

Start: 03/01/2009

N517

Resubmit a new claim with the requested information.

Start: 03/01/2009

N518

No separate payment for accessories when furnished for use with oxygen equipment.

Start: 03/01/2009

N519

Invalid combination of HCPCS modifiers.

Start: 07/01/2009

N520

Alert: Payment made from a Consumer Spending Account.

Start: 07/01/2009

N521

Mismatch between the submitted provider information and the provider information stored in our system.

Start: 11/01/2009

N522

Duplicate of a claim processed, or to be processed, as a crossover claim.

Start: 11/01/2009 | Last Modified: 03/01/2010

N523

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.

Start: 03/01/2010

N524

Based on policy this payment constitutes payment in full.

Start: 03/01/2010

N525

These services are not covered when performed within the global period of another service.

Start: 03/01/2010

N526

Not qualified for recovery based on employer size.

Start: 03/01/2010

N527

We processed this claim as the primary payer prior to receiving the recovery demand.

Start: 03/01/2010

N528

Patient is entitled to benefits for Institutional Services only.

Start: 03/01/2010 | Last Modified: 07/01/2010

Notes: (Modified 7/1/10)

N529

Patient is entitled to benefits for Professional Services only.

Start: 03/01/2010 | Last Modified: 07/01/2010

Notes: (Modified 7/1/10)

N530

Not Qualified for Recovery based on enrollment information.

Start: 03/01/2010 | Last Modified: 07/01/2010

Notes: (Modified 7/1/10)

N531

Not qualified for recovery based on direct payment of premium.

Start: 03/01/2010

N532

Not qualified for recovery based on disability and working status.

Start: 03/01/2010

N533

Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.

Start: 07/01/2010

N534

This is an individual policy, the employer does not participate in plan sponsorship.

Start: 07/01/2010

N535

Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.

Start: 07/01/2010

N536

We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us.

Start: 07/01/2010

N537

We have examined claims history and no records of the services have been found.

Start: 07/01/2010

N538

A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.

Start: 07/01/2010

N539

Alert: We processed appeals/waiver requests on your behalf and that request has been denied.

Start: 07/01/2010

N540

Payment adjusted based on the interrupted stay policy.

Start: 11/01/2010

N541

Mismatch between the submitted insurance type code and the information stored in our system.

Start: 11/01/2010

N542

Missing income verification.

Start: 03/08/2011

N543

Incomplete/invalid income verification.

Start: 03/08/2011 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N544

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.

Start: 07/01/2011 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N545

Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.

Start: 07/01/2011

N546

Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.

Start: 07/01/2011

N547

A refund request (Frequency Type Code 8) was processed previously.

Start: 03/06/2012

N548

Alert: Patient's calendar year deductible has been met.

Start: 03/06/2012

N549

Alert: Patient's calendar year out-of-pocket maximum has been met.

Start: 03/06/2012

N550

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.

Start: 03/06/2012

N551

Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.

Start: 03/06/2012

N552

Payment adjusted to reverse a previous withhold/bonus amount.

Start: 03/06/2012

N554

Missing/Incomplete/Invalid Family Planning Indicator.

Start: 07/01/2012 | Last Modified: 03/14/2014

Notes: (Modified 3/14/2014)

N555

Missing medication list.

Start: 07/01/2012

N556

Incomplete/invalid medication list.

Start: 07/01/2012

N557

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.

Start: 07/01/2012

N558

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.

Start: 07/01/2012

N559

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.

Start: 07/01/2012

N560

The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.

Start: 11/01/2012

N561

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.

Start: 11/01/2012

N562

The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.

Start: 11/01/2012

N563

Alert: Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service.

Start: 11/01/2012 | Last Modified: 11/01/2015

Notes: Related to M39 (Modified 11/1/2015)

N564

Patient did not meet the inclusion criteria for the demonstration project or pilot program.

Start: 11/01/2012

N565

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.

Start: 11/01/2012 | Last Modified: 03/01/2013

Notes: (Modified 3/1/13)

N566

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.

Start: 11/01/2012

N567

Not covered when considered preventative.

Start: 03/01/2013

N568

Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.

Start: 03/01/2013

N569

Not covered when performed for the reported diagnosis.

Start: 03/01/2013