| Code |
Modified Narrative |
Implementation Date |
| 121 |
Indemnification adjustment – compensation for outstanding member responsibility. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 192 |
Non standard adjustment code from paper remittance. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment. Start: 10/31/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 206 |
National Provider Identifier – missing. Start: 07/09/2007 | Last Modified: 09/30/2007 |
4/1/2008 |
| 207 |
National Provider identifier – Invalid format Start: 07/09/2007 | Stop: 05/23/2008 | Last Modified: 09/30/2007 |
4/1/2008 |
| 208 |
National Provider Identifier – Not matched. Start: 07/09/2007 | Last Modified: 09/30/2007 |
4/1/2008 |
| 15 |
The authorization number is missing, invalid, or does not apply to the billed services or provider. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 17 |
Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 19 |
This is a work-related injury/illness and thus the liability of the Worker’s Compensation Carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 20 |
This injury/illness is covered by the liability carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 21 |
This injury/illness is the liability of the no-fault carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 22 |
This care may be covered by another payer per coordination of benefits. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 23 |
The impact of prior payer(s) adjudication including payments and/or adjustments. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 24 |
Charges are covered under a capitation agreement/managed care plan. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 31 |
Patient cannot be identified as our insured. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 33 |
Insured has no dependent coverage. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 34 |
Insured has no coverage for newborns. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 55 |
Procedure/treatment is deemed experimental/investigational by the payer. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 56 |
Procedure/treatment has not been deemed `proven to be effective’ by the payer. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 58 |
Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 59 |
Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 61 |
Penalty for failure to obtain second surgical opinion. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 95 |
Plan procedures not followed. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 97 |
The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 107 |
The related or qualifying claim/service was not identified on this claim. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 108 |
Rent/purchase guidelines were not met. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 112 |
Service not furnished directly to the patient and/or not documented. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 115 |
Procedure postponed, canceled, or delayed. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 116 |
The advance indemnification notice signed by the patient did not comply with requirements. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 117 |
Transportation is only covered to the closest facility that can provide the necessary care. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 118 |
ESRD network support adjustment. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 125 |
Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| 129 |
Prior processing information appears incorrect. Start: 02/28/1997 | Last Modified: 09/30/2007 |
4/1/2008 |
| 135 |
Interim bills cannot be processed. Start: 10/31/1998 | Last Modified: 09/30/2007 |
4/1/2008 |
| 136 |
Failure to follow prior payerÕs coverage rules. (Use Group Code OA). Start: 10/31/1998 | Last Modified: 09/30/2007 |
4/1/2008 |
| 137 |
Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. Start: 02/28/1999 | Last Modified: 09/30/2007 |
4/1/2008 |
| 138 |
Appeal procedures not followed or time limits not met. Start: 06/30/1999 | Last Modified: 09/30/2007 |
4/1/2008 |
| 141 |
Claim spans eligible and ineligible periods of coverage. Start: 06/30/1999 | Last Modified: 09/30/2007 |
4/1/2008 |
| 142 |
Monthly Medicaid patient liability amount. Start: 06/30/2000 | Last Modified: 09/30/2007 |
4/1/2008 |
| 146 |
Diagnosis was invalid for the date(s) of service reported. Start: 06/30/2002 | Last Modified: 09/30/2007 |
4/1/2008 |
| 148 |
Information from another provider was not provided or was insufficient/incomplete. Start: 06/30/2002 | Last Modified: 09/30/2007 |
4/1/2008 |
| 150 |
Payer deems the information submitted does not support this level of service. Start: 10/31/2002 | Last Modified: 09/30/2007 |
4/1/2008 |
| 151 |
Payer deems the information submitted does not support this many services. Start: 10/31/2002 | Last Modified: 09/30/2007 |
4/1/2008 |
| 152 |
Payer deems the information submitted does not support this length of service. Start: 10/31/2002 | Last Modified: 09/30/2007 |
4/1/2008 |
| 153 |
Payer deems the information submitted does not support this dosage. Start: 10/31/2002 | Last Modified: 09/30/2007 |
4/1/2008 |
| 154 |
Payer deems the information submitted does not support this day’s supply. Start: 10/31/2002 | Last Modified: 09/30/2007 |
4/1/2008 |
| 155 |
Patient refused the service/procedure. Start: 06/30/2003 | Last Modified: 09/30/2007 |
4/1/2008 |
| 157 |
Service/procedure was provided as a result of an act of war. Start: 09/30/2003 | Last Modified: 09/30/2007 |
4/1/2008 |
| 158 |
Service/procedure was provided outside of the United States. Start: 09/30/2003 | Last Modified: 09/30/2007 |
4/1/2008 |
| 159 |
Service/procedure was provided as a result of terrorism. Start: 09/30/2003 | Last Modified: 09/30/2007 |
4/1/2008 |
| 160 |
Injury/illness was the result of an activity that is a benefit exclusion. Start: 09/30/2003 | Last Modified: 09/30/2007 |
4/1/2008 |
| 163 |
Attachment referenced on the claim was not received. Start: 06/30/2004 | Last Modified: 09/30/2007 |
4/1/2008 |
| 164 |
Attachment referenced on the claim was not received in a timely fashion. Start: 06/30/2004 | Last Modified: 09/30/2007 |
4/1/2008 |
| 165 |
Referral absent or exceeded. Start: 10/31/2004 | Last Modified: 09/30/2007 |
4/1/2008 |
| 168 |
Service(s) have been considered under the patient’s medical plan. Benefits are not available under this dental plan. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 169 |
Alternate benefit has been provided. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 173 |
Service was not prescribed by a physician. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 174 |
Service was not prescribed prior to delivery. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 175 |
Prescription is incomplete. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 176 |
Prescription is not current. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 177 |
Patient has not met the required eligibility requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 178 |
Patient has not met the required spend down requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 179 |
Patient has not met the required waiting requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 180 |
Patient has not met the required residency requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 181 |
Procedure code was invalid on the date of service. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 182 |
Procedure modifier was invalid on the date of service. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 186 |
Level of care change adjustment. Start: 06/30/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 191 |
Not a work related injury/illness and thus not the liability of the workersÕ compensation carrier. Start: 10/31/2005 | Last Modified: 09/30/2007 |
4/1/2008 |
| 194 |
Anesthesia performed by the operating physician, the assistant surgeon or the attending physician. Start: 02/28/2006 | Last Modified: 09/30/2007 |
4/1/2008 |
| 195 |
Refund issued to an erroneous priority payer for this claim/service. Start: 02/28/2006 | Last Modified: 09/30/2007 |
4/1/2008 |
| 197 |
Precertification/authorization/notification absent. Start: 10/31/2006 | Last Modified: 09/30/2007 |
4/1/2008 |
| 198 |
Precertification/authorization exceeded. Start: 10/31/2006 | Last Modified: 09/30/2007 |
4/1/2008 |
| 202 |
Precertification/authorization exceeded. Start: 10/31/2006 | Last Modified: 09/30/2007 |
4/1/2008 |
| 203 |
Discontinued or reduced service. Start: 02/28/2007 | Last Modified: 09/30/2007 |
4/1/2008 |
| A8 |
Ungroupable DRG. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B5 |
Coverage/program guidelines were not met or were exceeded. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B8 |
Alternative services were available, and should have been utilized. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B9 |
Patient is enrolled in a Hospice. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B14 |
Only one visit or consultation per physician per day is covered. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B15 |
This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B16 |
`New Patient’ qualifications were not met. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B18 |
This procedure code and modifier were invalid on the date of service. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B20 |
Procedure/service was partially or fully furnished by another provider. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |
| B23 |
Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. Start: 01/01/1995 | Last Modified: 09/30/2007 |
4/1/2008 |