- 22 Nov 2024
- 86 Minutos para leer
- Impresión
- OscuroLigero
- PDF
Remittance Advice Remarks Codes
- Actualizado en 22 Nov 2024
- 86 Minutos para leer
- Impresión
- OscuroLigero
- PDF
Remittance Advice Remarks Codes (RARCs) are standardized codes used in healthcare billing to provide additional explanations for claim adjustments, denials, or payment delays. They accompany Electronic Remittance Advices (ERAs) or Standard Paper Remittance Advices (SPRs) to clarify payment decisions and guide providers on next steps. Often paired with Claim Adjustment Reason Codes (CARCs), RARCs can indicate informational messages, correction needs, or requests for additional documentation. Examples include codes explaining bundled services or patient ineligibility. These codes help streamline communication between insurers and healthcare providers.
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 |