English constants removal from translations

[system]

bradymiller wrote on Monday, May 04, 2009:

hey,

Rod found a cluster (about 1500) of english constants that are highly specific to US billing concentrated in 3 files in the billing directory (adjustment_reason_codes.php, claim_status_codes.php, remark_codes.php).  We are going to delete them from the translation table as long as nobody sees any international use for them.  I have pasted the list below. Please respond in the following thread:
https://sourceforge.net/forum/forum.php?thread_id=3130655&forum_id=202506

-brady

“Not otherwise classified” or “unlisted” procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service
… before entering the adjudication system.
A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
A mental health facility is responsible for payment of outside providers who furnish these services/supplies to residents.
A new/revised/renewed certificate of medical necessity is needed.
A patient may not elect to change a hospice provider more than once in a benefit period.
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.
A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents.
Accepted for processing.
Accident date, state, description and cause.
According to our agreement, you must waive the deductible and/or coinsurance amounts.
Add-on code cannot be billed by itself.
Additional information has been requested from another provider involved in the care of this member. The charges will be reconsidered upon receipt of that information.
Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.
Additional information requested from entity.
Additional information/explanation will be sent separately
Additional payment approved based on payer-initiated review/audit.
Adjudication or Payment Date
Adjusted Repriced Claim Reference Number
Adjusted Repriced Line item Reference Number
Adjustment Amount
Adjustment amount represents collection against receivable created in prior overpayment
Adjustment Quantity
Adjustment Reason Code
Adjustment represents the estimated amount a previous payer may pay.
Adjustment to the pre-demonstration rate.
Admitting diagnosis.
ADSM-III-R code for services rendered.
Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.
Alert: in the near future we are implementing new policies/procedures that would affect this determination.
All current diagnoses
All originally submitted procedure codes have been combined.
All originally submitted procedure codes have been modified.
Allowable/paid from primary coverage.
Allowed amount adjusted. Multiple automated multichannel tests performed on the same day combined for payment.
Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test
Ambulance certification/documentation.
Ambulance Run Sheet
Amount entity has paid.
Amount must be greater than zero
Anatomical location for joint injection.
Anatomical location.
Anesthesia Modifying Units
Anesthesia Unit Count
Arterial Blood Gas Quantity
As previously advised, a portion or all of your payment is being held in a special account.
At the policyholder’s request these claims cannot be submitted electronically.
Attachment Control Number
Attending physician report.
Authorization/certification (include period covered).
Authorization/certification number.
Awaiting benefit determination.
Awaiting eligibility determination.
Awaiting next periodic adjudication cycle.
Awaiting related charges.
Awaiting spend down determination
Balance due from the subscriber.
Bed hold or leave days exceeded.
Begin Therapy Date
Benefit maximum for this time period or occurrence has been reached
Benefits adjusted. Plan procedures not followed
Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.
Billed in excess of interim rate.
Billing date predates service date
Blood Deductible
Bridgework information.
Brief medical history as related to service(s)
Bundled or Unbundled Line Number
Business Application Currently Not Available
Can patient operate controls of bed?
Cannot process HMO claims
Cannot process individual insurance policy claims.
Cannot provide further status electronically.
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.
Certification Condition Indicator
Certification Period Projected Visit Count
Certification Revision Date
Charges adjusted as penalty for failure to obtain second surgical opinion
Charges applied to deductible.
Charges are adjusted based on multiple diagnostic imaging procedure rules.
Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules
Charges do not meet qualifications for emergent/urgent care
Charges exceed our fee schedule or maximum allowable amount
Charges exceed the post-transplant coverage limit.
Charges exceed your contracted/ legislated fee arrangement
Charges for outpatient services with this proximity to inpatient services are not covered
Charges for pregnancy deferred until delivery.
Charges pending provider audit.
Charges processed under a Point of Service benefit
Charges reduced for ESRD network support
Chiropractic certification.
Chiropractic treatment plan.
Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
Claim adjusted by the monthly Medicaid patient liability amount
Claim Adjusted. Plan procedures of a prior payer were not followed
Claim adjustment because the claim spans eligible and ineligible periods of coverage
Claim Adjustment Indicator
Claim assigned to an approver/analyst.
Claim being researched for Insured ID/Group Policy Number error.
Claim combined with other claim(s).
Claim conflicts with another inpatient stay.
Claim contains split payment.
Claim denied as patient cannot be identified as our insured
Claim denied because this injury/illness is covered by the liability carrier
Claim denied because this injury/illness is the liability of the no-fault carrier
Claim denied because this is a work-related injury/illness and thus the liability of the Workers Compensation Carrier
Claim denied because this is not a work related injury/illness and thus not the liability of the workers’ compensation carrier
Claim denied charges
Claim denied. Insured has no coverage for newborns
Claim denied. Insured has no dependent coverage
Claim denied. Interim bills cannot be processed
Claim denied; ungroupable DRG
Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
Claim Disproportinate Share Amount
Claim DRG Amount
Claim DRG Outlier Amount
Claim ESRD Payment Amount
Claim Frequency Code
Claim has been adjudicated and is awaiting payment cycle.
Claim Indirect Teaching Amount
Claim information does not agree with information received from other insurance carrier.
Claim information is inconsistent with pre-certified/authorized services.
Claim is out of balance
Claim lacks prior payer payment information
Claim may be reconsidered at a future date.
Claim MSP Pass-through Amount
Claim must be assigned and must be filed by the practitioner’s employer.
Claim must be submitted by the provider who rendered the service.
Claim must meet primary payer’s processing requirements before we can consider payment.
Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor
Claim not found, claim should have been submitted to/through ‘entity’
Claim or Encounter Identifier
Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
Claim PPS Capital Amount
Claim PPS Capital Outlier Amount
Claim processed in accordance with ambulatory surgical guidelines.
Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
Claim requires pricing information.
Claim requires signature-on-file indicator.
Claim specific negotiated discount
Claim submission fee
Claim Submission Reason Code
Claim submitted as unassigned but processed as assigned. You agreed to accept assignment for all claims.
Claim submitted to incorrect payer.
Claim submitted to wrong payer.
Claim submitter’s identifier (patient account number) is missing
Claim Total Denied Charge Amount
Claim waiting for internal provider verification.
Claim was processed as adjustment to previous claim.
Claim.
Claim/encounter has been forwarded by third party entity to entity.
Claim/encounter has been forwarded to entity.
Claim/encounter not found.
Claim/line has been paid.
Claim/line is capitated.
Claim/service adjusted based on the findings of a review organization/professional consult/manual adjudication/medical or dental advisor.
Claim/Service adjusted because the attachment referenced on the claim was not received
Claim/Service adjusted because the attachment referenced on the claim was not received in a timely fashion
Claim/Service denied because a more specific taxonomy code is required for adjudication.
Claim/service denied because procedure/treatment has not been deemed “proven to be effective” by the payer
Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer
Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim
Claim/service denied. Appeal procedures not followed or time limits not met
Claim/Service has invalid non-covered days
Claim/Service has missing diagnosis information
Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate
Claim/Service lacks Physician/Operative or other supporting documentation
Claim/Service missing service/product information
Claim/service not covered/reduced because alternative services were available, and should have been utilized
Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete
Claim/service(s) subjected to CFO-CAP prepayment review.
Claim/submission format is invalid.
Clearinghouse or Value Added Network Trace
Clinical Laboratory Improvement Amendment
Co-payment Amount
Code was duplicate of code 299
Coinsurance – Major Medical
Coinsurance Amount
Coinsurance and/or deductible amounts apply to a claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. No Medicare payment issued.
Coinsurance Day(s)
Complete medical history.
Complications/mitigating circumstances
Confinement dates.
Consent form requirements not fulfilled.
Consult plan benefit documents for information about restrictions for this service.
Contract Amount
Contract Code
Contract Percentage
Contract Type Code
Contract Version Identifier
Contract/plan does not cover pre-existing conditions.
Contracted funding agreement - Subscriber is employed by the provider of services
Contractual adjustment
Coordination of Benefits Code
Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim.
Coordination of Benefits Total Submitted Charge
Copy of Medicare ID card.
Copy of patient revocation of hospice benefits
Copy of prescription.
Copy of transplant acquisition invoice.
Correction to a prior claim.
Cost outlier - Adjustment to compensate for additional costs
Cost Report Day Count
Court ordered coverage information needs validation.
Coverage has been canceled for this entity.
Covered Amount
Covered Day(s)
Covered only when performed by the attending physician.
Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
Date benefits exhausted
Date Claim Paid
Date dental canal(s) opened and date service completed.
Date entity signed certification/recertification
Date Error, Century Missing
Date home dialysis began
Date of conception and expected date of delivery.
Date of dental appliance placed.
Date of dental appliance prior placement.
Date of dental prior replacement/reason for replacement.
Date of equipment return.
Date of first routine dialysis.
Date of first service for current series/symptom/illness.
Date of Last Menstrual Period (LMP)
Date of last routine dialysis.
Date of most recent medical event necessitating service(s)
Date of onset/exacerbation of illness/condition
Date of previous pacemaker check
Date of the last x-ray.
Date of tooth extraction/evolution.
Date patient last examined by entity
Date post-operative care assumed
Date post-operative care relinquished
Date range not valid with units submitted.
Date(s) dental root canal therapy previously performed.
Date(s) dialysis conducted
Date(s) of blood transfusion(s)
Date(s) of dialysis training provided to patient.
Date(s) of most recent hospitalization related to service
Date(s) of service.
Day outlier amount
Days/units for procedure/revenue code.
De-activate and refer to M51.
Deductible – Major Medical
Deductible Amount
Delay Reason Code
Demand bill approved as result of medical review.
Demonstration Project Identifier
Denial reversed because of medical review.
Denied
Denied services exceed the coverage limit for the demonstration.
Denied: Entity not found.
Dental charting.
Dental impression and seating date.
Dental information.
Dental quadrant/arch.
Dental records for this service.
Dental service narrative needed.
Detailed description of service.
Diagnosis and patient gender mismatch.
Diagnosis code pointer is missing or invalid
Diagnosis code(s) for the services rendered.
Diagnosis code.
Diagnosis Date
Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
Did not complete the statement “Homebound” on the claim to validate whether laboratory services were performed at home or in an institution.
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.
Did not indicate whether we are the primary or secondary payer.
Did provider authorize generic or brand name dispensing?
Direct Medical Education Adjustment
Discharge summary.
Discount Amount
Dispensing fee adjustment
Disproportionate Share Adjustment
DME, orthotics and prosthetics must be billed to the DME carrier who services the patient’s zip code.
Do not resubmit this claim/service.
Document Control Identifier
Documentation from prior claim(s) related to service(s)
Documentation that facility is state licensed and Medicare approved as a surgical facility.
Documentation that provider of physical therapy is Medicare Part B approved.
Does patient condition preclude use of ordinary bed?
Does provider accept assignment of benefits?
DRG code(s).
Drug days supply and dosage.
Drug dispensing units and average wholesale price (AWP).
Drug information.
Drug name, strength and dosage form.
Drug product id number.
Duplicate claim/service
Duplicate of a previously processed claim/line.
Duplicate of an existing claim/line, awaiting processing.
Durable medical equipment certification.
Duration of treatment plan.
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.
E-Code
Effective coverage date(s).
Electronic interchange agreement not on file for provider/submitter.
Electronic request for information.
Eligibility for extended benefits.
Emergency care provided during transport
Emergency room notes/report.
Enteral/parenteral certification.
Entities Middle Name
Entities Original Signature
Entity acknowledges receipt of claim/encounter.
Entity does not meet dependent or student qualification.
Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse
Entity is not selected primary care provider.
Entity not approved as an electronic submitter.
Entity not approved.
Entity not eligible for benefits for submitted dates of service.
Entity not eligible for dental benefits for submitted dates of service.
Entity not eligible for encounter submission
Entity not eligible for medical benefits for submitted dates of service.
Entity not eligible.
Entity not eligible/not approved for dates of service.
Entity not found.
Entity not primary.
Entity not referred by selected primary care provider.
Entity professional qualification for service(s)
Entity received claim/encounter, but returned invalid status.
Entity referral notes/orders/prescription
Entity Signature Date
Entity’s Additional/Secondary Identifier
Entity’s address.
Entity’s administrative services organization id (ASO).
Entity’s anesthesia license number.
Entity’s Blue Cross provider id
Entity’s Blue Shield provider id
Entity’s CHAMPUS provider id.
Entity’s City
Entity’s commercial provider id.
Entity’s Contact Name
Entity’s contract/member number.
Entity’s date of birth
Entity’s date of death
Entity’s drug enforcement agency (DEA) number.
Entity’s employee id.
Entity’s employer address.
Entity’s employer id.
Entity’s employer name, address and phone.
Entity’s employer name.
Entity’s employer phone number.
Entity’s employment status
Entity’s First Name
Entity’s Gender
Entity’s Group Name
Entity’s health industry id number.
Entity’s health insurance claim number (HICN).
Entity’s health maintenance provider id (HMO).
Entity’s id number.
Entity’s Last Name
Entity’s license/certification number.
Entity’s marital status
Entity’s Medicaid provider id.
Entity’s Medicare provider id.
Entity’s name, address, phone and id number.
Entity’s name, address, phone, gender, DOB, marital status, employment status and relation to subscriber.
Entity’s name.
Entity’s National Provider Identifier (NPI)
Entity’s phone number.
Entity’s plan network id.
Entity’s policy number.
Entity’s Postal/Zip Code
Entity’s preferred provider organization id (PPO).
Entity’s qualification degree/designation (e.g. RN,PhD,MD)
Entity’s relationship to patient
Entity’s school address.
Entity’s school name.
Entity’s site id .
Entity’s social security number.
Entity’s specialty code.
Entity’s specialty license number.
Entity’s state license number.
Entity’s State/Province
Entity’s Street Address
Entity’s student status.
Entity’s Tax Amount
Entity’s tax id.
Entity’s UPIN
EOB received from previous payer. Claim not on file.
EPSDT Indicator
Equipment is the same or similar to equipment already being used.
Equipment purchases are limited to the first or the tenth month of medical necessity.
Estimated Claim Due Amount
Exception Code
Exercise notes.
Expenses incurred after coverage terminated
Expenses incurred prior to coverage
Explain differences between treatment plan and patient’s condition
Explain why hearing loss not correctable by hearing aid
Explain/justify differences between treatment plan and services rendered.
Facility Code Qualifier
Facility point of origin and destination - ambulance.
Family Planning Indicator
Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
Final installment payment.
First consultation/evaluation date.
Fixed Format Information
Flexible spending account payments
For more detailed information, see remittance advice.
Free Form Message Text
Frequency Count
Frequency of service.
Frequency Period
Functional Limitation Code
Further installment payments forthcoming.
Future date
Gramm-Rudman reduction
Has claim been paid?
Has or will blood be replaced?
HCPCS
HCPCS Payable Amount Home Health
Health Savings account payments
Height.
Hemophilia Add On.
HIPPS Rate Code for services Rendered
History and physical.
Home health certification. Please use code 332:4Y
Home health consolidated billing and payment applies.
Home use of biofeedback therapy is not covered.
Homebound Indicator
Homebound status
Hospital admission date.
Hospital admission hour.
Hospital admission source.
Hospital admission type.
Hospital discharge date.
Hospital discharge hour.
Hospital information.
Hospital s room rate.
Hospital s semi-private room rate.
ICD9
If you do not agree with the approved amounts and $100 or more is in dispute (less deductible and coinsurance), you may ask for a hearing within six months of the date of this notice. To meet the $100, you may combine amounts on other claims that have been denied, including reopened appeals if you received a revised decision. You must appeal each claim on time.
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. Decisions made by a Quality Improvement Organization (QIO) must be appealed to that QIO within 60 days.
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.
Immunization Batch Number
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.
Incentive adjustment, e.g. preferred product/service
Incomplete/invalid Admitting History and Physical report.
Incomplete/invalid American Diabetes Association Certificate of Recognition.
Incomplete/invalid Certificate of Medical Necessity.
Incomplete/invalid consent form.
Incomplete/invalid contract indicator.
Incomplete/invalid documentation of benefit to the patient during initial treatment period.
Incomplete/invalid documentation/orders/notes/summary/report/chart.
Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.
Incomplete/invalid invoice
Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Incomplete/invalid itemized bill.
Incomplete/invalid operative report.
Incomplete/invalid oxygen certification/re-certification.
Incomplete/invalid pacemaker registration form.
Incomplete/invalid pathology report.
Incomplete/invalid patient medical record for this service.
Incomplete/invalid physician certified plan of care
Incomplete/invalid physician financial relationship form.
Incomplete/invalid plan information for other insurance
Incomplete/invalid pre-operative photos/visual field results.
Incomplete/invalid radiology report.
Incomplete/invalid Review Organization Approval.
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.
Incomplete/invalid x-ray.
Incomplete/invalid/not approved screening document.
Incorrect claim form/format for this service.
Indemnification adjustment
Indicating why medications cannot be taken orally
Indirect Medical Education Adjustment
Individual test(s) comprising the panel and the charges for each test
Industry Code
Information provided was illegible
Information supplied does not support a break in therapy. A new capped rental period will not begin.
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.
Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.
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.
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.
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.
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.
Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.
Ingredient cost adjustment
Initial certification
Initial evaluation report
Inpatient admission spans multiple rate periods. Resubmit separate claims.
Insurance Type Code
Interest amount
Internal review/audit - partial payment made.
Internal review/audit.
Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used.
Invalid character
Investigating existence of other insurance coverage.
Investigating occupational illness/accident.
Investigational Device Exemption Identifier
Is accident/illness/condition employment related?
Is appliance upper or lower arch & is appliance fixed or removable?
Is drug generic?
Is injury due to auto accident?
Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility?
Is pacemaker temporary or permanent?
Is patient an insulin diabetic?
Is patient confined to bed?
Is patient confined to room?
Is prescribed lenses a result of cataract surgery?
Is prosthesis/crown/inlay placement an initial placement or a replacement?
Is service for orthodontic purposes?
Is service performed for a recurring condition or new condition?
Is service the result of an accident?
Is the dental patient covered by medical insurance?
Is there a release of information signature on file?
Is there an assignment of benefits signature on file?
Is there other insurance?
Itemize non-covered services
Itemized claim by provider.
Itemized claim.
Joint injection site.
Justify services outside composite rate
Lab procedures with different CLIA certification numbers must be billed on separate claims.
Lab/test report/notes/results.
Last Certification Date
Last Worked Date
Late filing penalty
Length invalid for receiver’s application system
Length of medical necessity, including begin date.
Length of time for services rendered.
Length/size of laceration/tumor.
Letter to follow containing further information.
Lifetime benefit maximum has been reached
Lifetime benefit maximum has been reached for this service/benefit category
Lifetime Psychiatric Days Count
Lifetime Reserve Day(s)
Line information.
Line Item Charge Amount
Line Item Control Number
Line Item Denied Charge or Non-covered Charge
Line Note Text
List of all missing teeth (upper and lower).
Loaded miles and charges for transport to nearest facility with appropriate services
Location of durable medical equipment use.
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.
Long term goals
Major Medical Adjustment
Managed Care review
Managed care withholding
Maximum coverage amount met or exceeded for benefit period.
Maximum leave days exhausted
Measurement Reference Identification Code
Medical code sets used must be the codes in effect at the time of service
Medical necessity for non-routine service(s)
Medical necessity for service.
Medical notes/report.
Medical record does not support code billed per the code definition.
Medical Record Number
Medical records to substantiate decision of non-coverage
Medical review attachment/information for service(s)
Medicare Assignment Code
Medicare Claim PPS Capital Cost Outlier Amount
Medicare Claim PPS Capital Day Outlier Amount
Medicare Coverage Indicator
Medicare effective date.
Medicare Paid at 100% Amount
Medicare Paid at 80% Amount
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.
Medicare Section 4081 Indicator
Medicare worksheet.
Medication logs/records (including medication therapy)
Mental Status Code
Method used to obtain test sample
Missing Admitting History and Physical report.
Missing American Diabetes Association Certificate of Recognition.
Missing Certificate of Medical Necessity.
Missing consent form.
Missing contract indicator.
Missing documentation of benefit to the patient during initial treatment period.
Missing documentation/orders/notes/summary/report/chart.
Missing Endodontics treatment history and prognosis
Missing indication of whether the patient owns the equipment that requires the part or supply.
Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Missing invoice.
Missing itemized bill.
Missing operative report.
Missing or invalid information.
Missing or invalid lab indicator
Missing or invalid units of service
Missing oxygen certification/re-certification.
Missing pacemaker registration form.
Missing pathology report.
Missing patient medical record for this service.
Missing physician certified plan of care.
Missing physician financial relationship form.
Missing plan information for other insurance.
Missing pre-operative photos or visual field results.
Missing radiology report.
Missing Review Organization Approval.
Missing screening document.
Missing x-ray.
Missing/incomplete/invalid accident date.
Missing/incomplete/invalid acute manifestation date.
Missing/incomplete/invalid adjudication or payment date.
Missing/incomplete/invalid admission date.
Missing/incomplete/invalid admission hour.
Missing/incomplete/invalid admission source.
Missing/incomplete/invalid admission type.
Missing/incomplete/invalid admitting diagnosis.
Missing/incomplete/invalid anesthesia time/units
Missing/incomplete/invalid appliance placement date.
Missing/incomplete/invalid assessment date.
Missing/incomplete/invalid assistant surgeon name.
Missing/incomplete/invalid assistant surgeon primary identifier.
Missing/incomplete/invalid assistant surgeon secondary identifier.
Missing/incomplete/invalid assistant surgeon taxonomy.
Missing/incomplete/invalid assumed or relinquished care date.
Missing/incomplete/invalid attending provider name.
Missing/incomplete/invalid attending provider primary identifier.
Missing/incomplete/invalid attending provider secondary identifier.
Missing/incomplete/invalid attending provider taxonomy.
Missing/incomplete/invalid authorized to return to work date.
Missing/incomplete/invalid begin therapy date.
Missing/incomplete/invalid beginning and ending dates of the period billed.
Missing/incomplete/invalid billing provider taxonomy.
Missing/incomplete/invalid billing provider/supplier address.
Missing/incomplete/invalid billing provider/supplier contact information.
Missing/incomplete/invalid billing provider/supplier name.
Missing/incomplete/invalid billing provider/supplier primary identifier.
Missing/incomplete/invalid billing provider/supplier secondary identifier.
Missing/incomplete/invalid certification revision date.
Missing/incomplete/invalid charge.
Missing/incomplete/invalid CLIA certification number.
Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
Missing/incomplete/invalid condition code.
Missing/incomplete/invalid date of current illness or symptoms
Missing/incomplete/invalid date of last menstrual period.
Missing/incomplete/invalid days or units of service.
Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or an Unlisted procedure.
Missing/incomplete/invalid designated provider number.
Missing/incomplete/invalid diagnosis date.
Missing/incomplete/invalid diagnosis or condition.
Missing/incomplete/invalid disability from date.
Missing/incomplete/invalid disability to date.
Missing/incomplete/invalid discharge hour.
Missing/incomplete/invalid discharge information.
Missing/incomplete/invalid discharge or end of care date.
Missing/incomplete/invalid dispensed date.
Missing/incomplete/invalid DRG code
Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
Missing/incomplete/invalid employment status code for the primary insured.
Missing/incomplete/invalid entitlement number or name shown on the claim.
Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information
Missing/incomplete/invalid FDA approval number.
Missing/incomplete/invalid gender.
Missing/incomplete/invalid group practice information.
Missing/incomplete/invalid HCPCS.
Missing/incomplete/invalid hearing or vision prescription date.
Missing/incomplete/invalid height.
Missing/incomplete/invalid history of the related initial surgical procedure(s)
Missing/incomplete/invalid Home Health Certification Period.
Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
Missing/incomplete/invalid indicator of x-ray availability for review.
Missing/incomplete/invalid individual lab codes included in the test.
Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
Missing/incomplete/invalid information on where the services were furnished.
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.
Missing/incomplete/invalid initial treatment date.
Missing/incomplete/invalid insured’s address and/or telephone number for the primary payer.
Missing/incomplete/invalid internal or document control number.
Missing/incomplete/invalid Investigational Device Exemption number for FDA-approved clinical trial services.
Missing/incomplete/invalid last admission period.
Missing/incomplete/invalid last certification date.
Missing/incomplete/invalid last contact date.
Missing/incomplete/invalid last seen/visit date.
Missing/incomplete/invalid last worked date.
Missing/incomplete/invalid level of subluxation.
Missing/incomplete/invalid Medicare Managed Care Demonstration contract number.
Missing/incomplete/invalid Medigap information.
Missing/incomplete/invalid model number.
Missing/incomplete/invalid name or address of responsible party or primary payer.
Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
Missing/incomplete/invalid noncovered days during the billing period.
Missing/incomplete/invalid number of coinsurance days during the billing period.
Missing/incomplete/invalid number of covered days during the billing period.
Missing/incomplete/invalid number of doses per vial.
Missing/incomplete/invalid number of lifetime reserve days.
Missing/incomplete/invalid number of miles traveled.
Missing/incomplete/invalid number of riders.
Missing/incomplete/invalid occurrence code(s).
Missing/incomplete/invalid occurrence date(s).
Missing/incomplete/invalid occurrence span code(s).
Missing/incomplete/invalid occurrence span date(s).
Missing/incomplete/invalid operating provider name.
Missing/incomplete/invalid operating provider primary identifier.
Missing/incomplete/invalid operating provider secondary identifier.
Missing/incomplete/invalid oral cavity designation code.
Missing/incomplete/invalid ordering provider address.
Missing/incomplete/invalid ordering provider contact information.
Missing/incomplete/invalid ordering provider name.
Missing/incomplete/invalid ordering provider primary identifier.
Missing/incomplete/invalid ordering provider secondary identifier.
Missing/incomplete/invalid other diagnosis.
Missing/incomplete/invalid other insured birth date.
Missing/incomplete/invalid other payer attending provider identifier.
Missing/incomplete/invalid other payer operating provider identifier.
Missing/incomplete/invalid other payer other provider identifier.
Missing/incomplete/invalid other payer purchased service provider identifier.
Missing/incomplete/invalid other payer referring provider identifier.
Missing/incomplete/invalid other payer rendering provider identifier.
Missing/incomplete/invalid other payer service facility provider identifier.
Missing/incomplete/invalid other procedure code(s).
Missing/incomplete/invalid other procedure date(s).
Missing/incomplete/invalid other provider name.
Missing/incomplete/invalid other provider primary identifier.
Missing/incomplete/invalid other provider secondary identifier.
Missing/incomplete/invalid Oxygen Saturation Test date.
Missing/incomplete/invalid patient birth date.
Missing/incomplete/invalid patient death date.
Missing/incomplete/invalid patient liability amount.
Missing/incomplete/invalid patient name.
Missing/incomplete/invalid patient or authorized representative signature.
Missing/incomplete/invalid patient relationship to insured.
Missing/incomplete/invalid patient status.
Missing/incomplete/invalid patient’s address.
Missing/incomplete/invalid patient’s relationship to the insured for the primary payer.
Missing/incomplete/invalid pay-to provider address.
Missing/incomplete/invalid pay-to provider name.
Missing/incomplete/invalid pay-to provider primary identifier.
Missing/incomplete/invalid pay-to provider secondary identifier.
Missing/incomplete/invalid payer identifier.
Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
Missing/incomplete/invalid physician order date.
Missing/incomplete/invalid place of residence for this service/item provided in a home.
Missing/incomplete/invalid place of service.
Missing/incomplete/invalid plan of treatment.
Missing/incomplete/invalid point of pick-up address.
Missing/incomplete/invalid prenatal screening information.
Missing/incomplete/invalid prescribing date.
Missing/incomplete/invalid prescribing provider identifier.
Missing/incomplete/invalid principal diagnosis.
Missing/incomplete/invalid principal procedure code.
Missing/incomplete/invalid principal procedure date.
Missing/incomplete/invalid prior hospital discharge date.
Missing/incomplete/invalid prior insurance carrier EOB.
Missing/incomplete/invalid prior placement date.
Missing/incomplete/invalid procedure code(s).
Missing/incomplete/invalid procedure date(s).
Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
Missing/incomplete/invalid provider number of the facility where the patient resides.
Missing/incomplete/invalid provider representative signature date.
Missing/incomplete/invalid provider representative signature.
Missing/incomplete/invalid provider/supplier signature.
Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory’s name and address.
Missing/incomplete/invalid purchased service provider identifier.
Missing/incomplete/invalid re-evaluation date
Missing/incomplete/invalid referral date.
Missing/incomplete/invalid referring provider name.
Missing/incomplete/invalid referring provider primary identifier.
Missing/incomplete/invalid referring provider secondary identifier.
Missing/incomplete/invalid referring provider taxonomy.
Missing/incomplete/invalid release of information indicator.
Missing/incomplete/invalid remarks.
Missing/incomplete/invalid rendering provider name.
Missing/incomplete/invalid rendering provider primary identifier.
Missing/incomplete/invalid rendering provider taxonomy.
Missing/incomplete/invalid rending provider secondary identifier.
Missing/incomplete/invalid replacement claim information.
Missing/incomplete/invalid replacement date.
Missing/incomplete/invalid revenue code(s).
Missing/incomplete/invalid room and board rate.
Missing/incomplete/invalid secondary diagnosis date.
Missing/incomplete/invalid service facility name.
Missing/incomplete/invalid service facility primary address.
Missing/incomplete/invalid service facility primary identifier.
Missing/incomplete/invalid service facility secondary identifier.
Missing/incomplete/invalid shipped date.
Missing/incomplete/invalid similar illness or symptom date.
Missing/incomplete/invalid social security number or health insurance claim number.
Missing/incomplete/invalid subscriber birth date.
Missing/incomplete/invalid supervising provider name.
Missing/incomplete/invalid supervising provider primary identifier.
Missing/incomplete/invalid supervising provider secondary identifier.
Missing/incomplete/invalid surgery date.
Missing/incomplete/invalid test performed date.
Missing/incomplete/invalid tooth number/letter.
Missing/incomplete/invalid tooth surface information.
Missing/incomplete/invalid total charges.
Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.
Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.
Missing/incomplete/invalid treatment authorization code.
Missing/incomplete/invalid treatment number.
Missing/incomplete/invalid type of bill.
Missing/incomplete/invalid Universal Product Number/Serial Number.
Missing/incomplete/invalid upgrade information.
Missing/incomplete/invalid value code(s) or amount(s).
Missing/incomplete/invalid weight.
Missing/incomplete/invalid x-ray date.
Missing/incomplete/invalid “from” date(s) of service.
Missing/incomplete/invalid “to” date(s) of service.
Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
Missing/incomplete/invalide last x-ray date.
Missing/invalid data prevents payer from processing claim.
Missing/invalid/incomplete taxpayer identification number (TIN)
Modalities of service
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.
Monthly Treatment Count
Months of dental treatment remaining.
More detailed information in letter.
More information available than can be returned in real time mode. Narrow your current search criteria.
Most recent date of curettage, root planing, or periodontal surgery.
Most recent date pacemaker was implanted.
Most recent pacemaker battery change date.
MRI report.
Multiple physicians/assistants are not covered in this case
Name, dosage and medical justification of contrast material used for radiology procedure
Narrative with pocket depth chart.
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.
NDC number.
Nearest appropriate facility
Need for more than one physician to treat patient
Newborn’s charges processed on mother’s claim.
Newborns services are covered in the mothers Allowance
No agreement with entity.
No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
No appeal rights. Adjudicative decision based on law.
No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
No coverage for newborns.
No payment due to contract/plan provisions.
No payment will be made for this claim.
No qualifying hospital stay dates were provided for this episode of care.
No rate on file with the payer for this service for this entity
No record of health check prior to initiation of treatment.
No record of mental health assessment.
No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price.
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.
Non standard adjustment code from paper remittance advice
Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.
Non-covered Charge Amount
Non-covered charge(s)
Non-Covered Day(s)
Non-Covered days/Room charge adjustment
Non-covered visits
Non-electronic request for information.
Non-payable Professional Component Amount
Non-payable Professional Component Billed Amount
Non-PIP (Periodic Interim Payment) claim.
Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
Not covered more than once in a 12 month period.
Not covered more than once under age 40.
Not covered unless submitted via electronic claim.
Not covered unless the provider accepts assignment
Not covered when performed during the same session/date as a previously processed service for the patient.
Not Our Claim, Forwarded to Additional Payer(s)
Not paid separately when the patient is an inpatient.
Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
Note Reference Code
Notice of Admission
NUBC Condition Code(s)
NUBC Occurrence Code(s) and Date(s)
NUBC Occurrence Span Code(s) and Date(s)
NUBC Value Code(s) and/or Amount(s)
Number of lesions excised.
Number of liters/minute & total hours/day for respiratory support.
Number of miles patient was transported.
Number of patients attending session
Number of spine segments.
Nurse’s notes.
Obesity measurements.
Occupational notes.
Old Capital Amount
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.
One or more originally submitted procedure code have been modified.
One or more originally submitted procedure codes have been combined.
Only one initial visit is covered per physician, group practice or provider.
Only one initial visit is covered per specialty per medical group.
Operative report.
Original date of prescription/orders/referral.
Original payment decision is being maintained. This claim was processed properly the first time
Originator Application Transaction Identifier
Orthodontic Banding Date
Orthodontic Treatment Months Count
Orthodontics treatment plan.
Other Carrier Claim filing indicator is missing or invalid
Other Carrier payer ID is missing or invalid
Other employer name, address and telephone number.
Other insurance coverage information (health, liability, auto, etc.).
Other payer’s Explanation of Benefits/payment information.
Other Procedure Code for Service(s) Rendered
Other Procedure Date
Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
Our records indicate that this dependent is not an eligible dependent as defined
Our records indicate that this patient began using this service(s) prior to the current round of the DMEPOS Competitive Bidding Demonstration. Therefore, the approved amount is based on the allowance in effect prior to this round of bidding for this item.
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.
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.
Our records indicate that you were previously informed of this rule.
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.
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.
Outside lab charges.
Oxygen certification.
Oxygen contents for oxygen system rental.
Oxygen Saturation Qty
Oxygen Test Condition Code
Oxygen Test Date
Pacemaker certification.
Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
Paid From Part A Medicare Trust Fund Amount
Paid From Part B Medicare Trust Fund Amount
Paid Service Unit Count
Paid under the Competitive Bidding Demonstration project. Project is ending, and future services may not be paid under this project.
Pancreas transplant not covered unless kidney transplant performed.
Paper claim contains more than one data item in field 23.
Paper claim contains more than three separate data items in field 19.
Paper claim.
Part B coinsurance under a demonstration project.
Partial payment made for this claim.
Participation Agreement
Past perio treatment history.
Pathology notes/report.
Patient Discharge Facility Type Code
Patient discharge status.
Patient eligibility not found with entity.
Patient eligible to apply for other coverage which may be primary.
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.
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.
Patient ineligible for this service.
Patient is a Medicaid/Qualified Medicare Beneficiary.
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.
Patient is covered by a managed care plan
Patient is not enrolled in this portion of our benefit package
Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
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.
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.
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.
Patient not enrolled in the billing provider’s managed care plan on the date of service.
Patient payment option/election not in effect
Patient refund amount
Patient relationship to subscriber
Patient release of information authorization.
Patient Signature Source
Patient submitted written request to revoke his/her election for religious non-medical health care services.
Patient/Insured health identification number and name do not match
Patient’s medical records.
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.
Payer Assigned Claim Control Number
Payer refund amount - not our patient
Payer refund due to overpayment
Payment adjusted as not furnished directly to the patient and/or not documented
Payment adjusted as procedure postponed or canceled
Payment adjusted because “New Patient” qualifications were not met
Payment adjusted because an alternate benefit has been provided
Payment adjusted because coverage/program guidelines were not met or were exceeded
Payment adjusted because procedure/service was partially or fully furnished by another provider
Payment adjusted because rent/purchase guidelines were not met
Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate
Payment adjusted because the patient has not met the required residency requirements
Payment adjusted because the patient has not met the required spend down requirements
Payment adjusted because the patient has not met the required waiting requirements
Payment adjusted because the payer deems the information submitted does not support this days supply
Payment adjusted because the payer deems the information submitted does not support this dosage
Payment adjusted because the payer deems the information submitted does not support this length of service
Payment adjusted because the payer deems the information submitted does not support this level of service
Payment adjusted because the payer deems the information submitted does not support this many services
Payment adjusted because the procedure modifier was invalid on the date of service
Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider
Payment adjusted because this care may be covered by another payer per coordination of benefits
Payment adjusted because this procedure code and modifier were invalid on the date of service
Payment adjusted because this procedure code was invalid on the date of service
Payment adjusted because this procedure/service is not paid separately
Payment adjusted because this service was not prescribed by a physician
Payment adjusted because transportation is only covered to the closest facility that can provide the necessary care
Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service
Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate
Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments
Payment adjusted since the level of care changed
Payment adjusted when anesthesia is performed by the operating physician, the assistant surgeon or the attending physician
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.
Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount.
Payment based on authorized amount.
Payment based on previous payer’s allowed amount.
Payment based on professional/technical component modifier(s).
Payment denied - Prior processing information appears incorrect
Payment denied /reduced for absence of, or exceeded referral
Payment denied as Service(s) have been considered under the patients medical plan. Benefits are not available under this dental plan
Payment denied because only one visit or consultation per physician per day is covered
Payment denied because service/procedure was provided outside the United States or as a result of war
Payment denied because the diagnosis was invalid for the date(s) of service reported
Payment denied because the patient has not met the required eligibility requirements
Payment denied because the prescription is incomplete
Payment denied because the prescription is not current
Payment denied because this provider has failed an aspect of a proficiency testing program
Payment denied because this service was not prescribed prior to delivery
Payment denied. The advance indemnification notice signed by the patient did not comply with requirements
Payment denied. Your Stop loss deductible has not been met
Payment denied/reduced because injury/illness was the result of an activity that is a benefit exclusion
Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
Payment denied/reduced because service/procedure was provided as a result of an act of war
Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this days supply
Payment denied/reduced because the service/procedure was provided as a result of terrorism
Payment denied/reduced because the service/procedure was provided outside of the United States
Payment denied/reduced due to a refund issued to an erroneous priority payer for this claim/service
Payment denied/reduced for absence of, or exceeded, pre-certification/authorization
Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan
Payment for repair or replacement is not covered or has exceeded the purchase price.
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.
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.
Payment has been adjusted because the information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request a appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
Payment has been adjusted because 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.
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.
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.
Payment is adjusted when performed/billed by a provider of this specialty
Payment is denied when performed/billed by this type of provider
Payment is denied when performed/billed by this type of provider in this type of facility
Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay
Payment is included in the allowance for another service/procedure
Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.
Payment made in full.
Payment made to entity, assignment of benefits not on file.
Payment made to patient/insured/responsible party
Payment of less than $1.00 suppressed.
Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
Payment reflects contract provisions.
Payment reflects plan provisions.
Payment reflects usual and customary charges.
Payment/Reduction for Regulatory Surcharges, Assessments, Allowances or Health Related Taxes
Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.
Peer Review Authorization Number
Pended
Pending COBRA information requested.
Pending provider accreditation review.
Per Day Limit Amount
Per legislation governing this program, payment constitutes payment in full.
Performed by a facility/supplier in which the provider has a financial interest.
Periodic installment released.
Periodontal case type diagnosis and recent pocket depth chart with narrative.
Pharmacy processor number.
Physical therapy notes. Please use code 297:6O (6 ‘OH’ - not zero)
Physical/occupational therapy treatment plan. Please use codes 345:6O (6 ‘OH’ - not zero), 6N
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.
Physician certification or election consent for hospice care not received timely.
Physician Contact Date
Physician Order Date
PIP (Periodic Interim Payment) claim.
Place of service.
Plan of teaching
Please refer to your provider manual for additional program and provider information.
Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
Podiatric certification.
Policy canceled.
Policy Compliance Code
Policy Name
Policy provides coverage supplemental to Medicare. As member does not appear to be enrolled in Medicare Part B, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.
Policyholder processes their own claims.
Portion of payment deferred
Postage Claimed Amount
PPS (Prospect Payment System) code corrected during adjudication.
PPS (Prospective Payment System) code changed by claims processing system. Insufficient visits or therapies.
PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.
PPS-Capital DSH DRG Amount
PPS-Capital Exception Amount
PPS-Capital FSP DRG Amount
PPS-Capital HSP DRG Amount
PPS-Capital IME Amount
PPS-Operating Federal Specific DRG Amount
PPS-Operating Hospital Specific DRG Amount
Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
Pre-certification penalty taken.
Pre-existing information.
Pre-Tax Claim Amount
Pre-treatment review.
Pre/post-operative x-rays/photographs.
Prearranged demonstration project adjustment
Predetermination is on file, awaiting completion of services.
Predetermination of Benefits Identifier
Predetermination Pricing Only - No Payment
Predetermination: anticipated payment upon completion of services or claim adjudication
Pregnancy Indicator
Premium payment withholding
Preoperative and post-operative diagnosis
Prescription number.
Presumptive Payment Adjustment
Previously paid. Payment for this claim/service may have been provided in a previous payment
Pricing Methodology
Primary diagnosis code.
Principal Procedure Code for Service(s) Rendered
Principle Procedure Date
Prior hospitalization or 30 day transfer requirement not met
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.
Prior testing, including result(s) and date(s) as related to service(s)
Private duty nursing certification.
Procedure billed is not compatible with tooth surface code.
Procedure code and patient gender mismatch
Procedure code billed is not correct/valid for the services billed or the date of service billed.
Procedure code for services rendered.
Procedure code incidental to primary procedure.
Procedure code is not compatible with tooth number/letter.
Procedure Code Modifier(s) for Service(s) Rendered
Procedure code not valid for patient age
Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
Procedure/product not approved by the Food and Drug Administration
Procedure/revenue code for service(s) rendered. Please use codes 454 or 455.
Procedures for billing with group/referring/performing providers were not followed.
Processed according to contract/plan provisions.
Processed according to plan provisions.
Processed as Primary
Processed as Primary, Forwarded to Additional Payer(s)
Processed as Secondary
Processed as Secondary, Forwarded to Additional Payer(s)
Processed as Tertiary
Processed as Tertiary, Forwarded to Additional Payer(s)
Processed in Excess of charges
Processing of this claim/service has included consideration under Major Medical provisions.
Professional fees removed from charges
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.
Prognosis
Program integrity/utilization review decision.
Progress notes for the six months prior to statement date.
Projected date to discontinue service(s)
Prompt-pay discount
Property Casualty Claim Number
Proposed treatment plan for next 6 months.
Provide condition/functional status at time of service
Provider contracted/negotiated rate expired or not on file
Provider level adjustment for late claim filing applies to this claim.
Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
Provider performance bonus
Provider promotional discount (e.g., Senior citizen discount)
Psychiatric reduction
Psychiatric treatment plan. Please use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 ‘OH’ - not zero), 5P
Purchase and rental price of durable medical equipment.
Purchase price for the rented durable medical equipment.
Purchase Service Charge
Purpose of family conference/therapy.
Radiographs or models.
Re-pricing information.
Real-Time requests not supported by the information holder, do not resubmit
Real-Time requests not supported by the information holder, resubmit as batch request
Reason for late discharge.
Reason for late hospital charges.
Reason for physical therapy.
Reason for termination of pregnancy.
Reason for transport by ambulance
Reasons for more than one transfer per entitlement period
Rebill all applicable services on a single claim.
Rebill services on separate claim lines.
Rebill services on separate claims.
Rebill technical and professional components separately.
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.
Received, but not in process
Recent fm x-rays and/or narrative.
Recent fm x-rays.
Recent x-ray of treatment area and/or narrative.
Record fees are the patient’s responsibility and limited to the specified co-payment.
Refer to code 345 for treatment plan and code 282 for prescription
Refer to codes 300 for lab notes and 311 for pathology notes
Referral/authorization.
Referring CLIA Number
Reimbursement Rate
Reject Reason Code
Related Causes Code
Related confinement claim.
Relationship of surgeon & assistant surgeon.
Remark Code
Rendering provider must be affiliated with the pay-to provider.
Rental price for durable medical equipment.
Report of prior testing related to this service, including dates
Reports for service.
Repriced Approved Ambulatory Patient Group
Repriced Line Item Reference Number
Repriced Saving Amount
Repricing Per Diem or Flat Rate Amount
Requested additional information not received.
Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice.
Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit.
Responsibility Amount
Resubmit with multiple claims, each claim covering services provided in only one calendar month.
Return to work dates.
Returned to Entity.
Revenue code for services rendered.
Reversal of Previous Payment
Reviewed
Route of drug/myelogram administration.
Sales Tax Amount
Sales tax not paid
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.
See the payer’s web site or contact the payer’s Customer Service department to obtain forms and instructions for filing a provider dispute.
Separate claim for mother/baby charges.
Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
Service Adjudication or Payment Date
Service Authorization Exception Code
Service billed is not compatible with patient location information.
Service date outside of the approved treatment plan service dates.
Service denied because payment already made for same/similar procedure within set time frame.
Service is not covered unless the patient is classified as at high risk.
Service is not covered when patient is under age 50.
Service line number greater than maximum allowable for payer.
Service Line Paid Amount
Service Line Rate
Service not authorized.
Service not covered when the patient is under age 35.
Service not payable with other service rendered on the same date.
Service not performed on equipment approved by the FDA for this purpose.
Service Tax Amount
Services by an immediate relative or a member of the same household are not covered
Services denied at the time authorization/pre-certification was requested
Services for a newborn must be billed separately.
Services for predetermination and services requesting payment are being processed separately.
Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.
Services not covered because the patient is enrolled in a Hospice
Services not documented in patients medical records
Services not included in the appeal review.
Services not provided or authorized by designated (network/primary care) providers
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.
Services subjected to Home Health Initiative medical review/cost report audit.
Services under review for possible pre-existing condition. Send medical records for prior 12 months
Ship, Delivery or Calendar Pattern Code
Shipped Date
Short term goals
Should be handled by entity.
Signed claim form.
Similar Illness or Symptom Date
Size, depth, amount, and type of drainage wounds
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.
Skilled Nursing Facility Indicator
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.
Social Security records indicate that this patient was a prisoner when the service was rendered. This payer does not cover items and services furnished to an individual while they are in State or local custody under a penal authority, unless under State or local law, the individual is personally liable for the cost of his or her health care while incarcerated and the State or local government pursues such debt in the same way and with the same vigor as any other debt.
Some all originally submitted procedure codes have been modified.
Some originally submitted procedure codes have been combined.
Source of payment is not valid
Special handling required at payer site.
Special Program Indicator
Specific federal/state/local program may cover this service through another payer.
Specific findings, complaints, or symptoms necessitating service
Speech pathology treatment plan. Please use code 345:6R
Speech therapy notes. Please use code 297:6R
SSA records indicate mismatch with name and sex.
State Industrial Accident Provider Number
State regulated patient payment limitations apply to this service.
State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation
Statement from-through dates.
Statement of non-coverage including itemized bill
Study models, x-rays, and/or narrative.
Study models.
Subjected to review of physician evaluation and management services.
Subluxation location.
Submitted charges.
Submitter not approved for electronic claim submissions on behalf of this entity
Subscriber and policy number/contract number mismatched.
Subscriber and policy number/contract number not found.
Subscriber and policyholder name mismatched.
Subscriber and policyholder name not found.
Subscriber and subscriber id mismatched.
Subscriber and subscriber id not found.
Summary of services
Supporting documentation.
Surgery Date
Surgical Procedure Code
Suspended
Suspended - investigation with field
Suspended - return with material
Suspended - review pending
Tax withholding
Technical component not paid if provider does not own the equipment used.
Technical fees removed from charges
Telephone contact services will not be paid until the face-to-face contact requirement has been met.
Telephone review decision.
Terms Discount Percentage
Test Performed Date
The administration method and drug must be reported to adjudicate this service.
The approved amount is based on the maximum allowance for this item under the DMEPOS Competitive Bidding Demonstration.
The approved level of care does not match the procedure code submitted.
The claim information has also been forwarded to Medicaid for review.
The claim information has been forwarded to a Health Savings Account processor for review.
The claim information is also being forwarded to the patient’s supplemental insurer. Send any questions regarding supplemental benefits to them.
The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor
The date of birth follows the date of service
The date of death precedes the date of service
The diagnosis is inconsistent with the patients age
The diagnosis is inconsistent with the patients gender
The diagnosis is inconsistent with the procedure
The diagnosis is inconsistent with the provider type
The disposition of this claim/service is pending further review
The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.
The law permits exceptions to the refund requirement in two cases: - If you did not know, and could not have reasonably been expected to know, that we would not pay for this service; or - If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service. If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position. If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision. The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination. The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days
The medical necessity form must be personally signed by the attending physician.
The necessary components of the child and teen checkup (EPSDT) were not completed.
The new information was considered, however, additional payment cannot be issued. Please review the information listed for the explanation.
The number of Days or Units of Service exceeds our acceptable maximum.
The original claim was denied. Resubmit a new claim, not a replacement claim.
The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. You, the provider, are 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.
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.
The patient is liable for the charges for this service as you informed the patient in writing before the service was furnished that we would not pay for it, and the patient agreed to pay.
The patient is not liable for payment for this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.
The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
The patient is responsible for the difference between the approved treatment and the elective treatment.
The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
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.
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.
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.
The patient was not in a hospice program during all or part of the service dates billed.
The patient was not residing in a long-term care facility during all or part of the service dates billed.
The patient’s payment was in excess of the amount owed. You must refund the overpayment to the patient.
The prescribing/ordering provider is not eligible to prescribe/order the service billed
The procedure code is inconsistent with the modifier used or a required modifier is missing
The procedure code is inconsistent with the provider type/specialty (taxonomy)
The procedure code/bill type is inconsistent with the place of service
The procedure/revenue code is inconsistent with the patients age
The procedure/revenue code is inconsistent with the patients gender
The professional component must be billed separately.
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.
The provider must update insurance information directly with payer.
The rate changed during the dates of service billed.
The referring provider is not eligible to refer the service billed
The rendering provider is not eligible to perform the service billed
The subscriber must update insurance information directly with payer.
The supporting documentation does not match the claim
The technical component must be billed separately.
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.
The time limit for filing has expired
The “from” and “to” dates must be different.
There are no scheduled payments for this service. Submit a claim for each patient visit.
These are non-covered services because this is a pre-existing condition
These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam
These are non-covered services because this is not deemed a “medical necessity” by the payer
These services were submitted after this payers responsibility for processing claims under this plan ended
This (these) diagnosis(es) is (are) missing or are invalid
This (these) diagnosis(es) is (are) not covered
This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
This amount is not entity’s responsibility.
This amount represents the dollar amount not eligible due to the patient’s age.
This amount represents the prior to coverage portion of the allowance.
This claim has been assessed a $1.00 user fee.
This claim has been denied without reviewing the medical record because the requested records were not received or were not received timely.
This claim is denied because the patient refused the service/procedure
This claim is excluded from your electronic remittance advice.
This claim was chosen for complex review and was denied after reviewing the medical records.
This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.hhs.gov.
This claim/service must be billed according to the schedule for this plan.
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.
This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
This decision was based on a local medical review policy (LMRP) or Local Coverage Determination (LCD).An LMRP/LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at http://www.cms.hhs.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LMRP/LCD.
This determination is the result of the appeal you filed.
This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
This drug/service/supply is covered only when the associated service is covered.
This facility is not certified for digital mammography.
This facility is not certified for film mammography.
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.
This is a final request for information.
This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.
This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 866-749-4301 for RRB EDI information for electronic claims processing.
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.
This is a split service and represents a portion of the units from the originally submitted service.
This is a subsequent request for information from the original request.
This is an 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.
This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group “PR”.
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.
This is the last monthly installment payment for this durable medical equipment.
This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
This item is denied when provided to this patient by a non-demonstration supplier.
This item or service does not meet the criteria for the category under which it was billed.
This payment is adjusted based on the diagnosis
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.
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.
This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
This payment was delayed for correction of provider’s mailing address.
This procedure code is not payable. It is for reporting/information purposes only.
This procedure code was added/changed because it more accurately describes the services rendered.
This product/procedure is only covered when used according to FDA recommendations
This provider type/provider specialty may not bill this service.
This provider was not certified/eligible to be paid for this procedure/service on this date of service
This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.
This service does not qualify for a HPSA/Physician Scarcity bonus payment.
This service has been paid as a one-time exception to the plan’s benefit restrictions.
This service is not covered when performed with, or subsequent to, a non-covered service.
This service is not paid if billed more than once every 28 days.
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.
This service is paid only once in a patient’s lifetime.
This service was processed in accordance with rules and guidelines under the Competitive Bidding Demonstration Project. If you would like more information regarding this project, you may phone 1-888-289-0710.
Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
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.
Tooth number or letter.
Tooth numbers, surfaces, and/or quadrants involved.
Tooth surface(s) involved.
Total anesthesia minutes.
Total Denied Charge Amount
Total Medicare Paid Amount
Total orthodontic service fee, initial appliance fee, monthly fee, length of service.
Total payment reduced due to overlap of tests billed.
Total payments under multiple contracts cannot exceed the allowance for this service.
Total visits in total number of hours/day and total number of hours/week
Total Visits Projected This Certification Count
Total Visits Rendered Count
TPO rejected claim/line because certification information is missing
TPO rejected claim/line because claim does not contain enough information
TPO rejected claim/line because payer name is missing.
Transfer amount
Transplant recipient’s name, date of birth, gender, relationship to insured.
Transportation in a vehicle other than an ambulance is not covered.
Transportation to/from this destination is not covered.
Treatment Code
Treatment plan for replacement of remaining missing teeth.
Treatment plan for service/diagnosis
Type of bill for UB-92 claim.
Type of service.
Type of surgery/service for which anesthesia was administered.
UB-92/HCFA-1450/HCFA-1500 claim form.
Unable to work dates.
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.
Under the Code of Federal Regulations, Chapter 32, Section 199.13 a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor’s opinion, you may appeal the determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber’s Dental insurance carrier within 90 days from the date of this letter.
Unit or Basis for Measurement Code
Units of blood furnished.
Units of blood replaced.
Units of deductible blood.
Universal Product Number
Verification of patient’s ability to retain and use information
Version/Release/Industry ID code not currently supported by information holder
Visits Prior to Recertification Date Count CR702
Visual field test results
Vouchers/explanation of benefits (EOB).
Waiting for final approval.
Was blood furnished?
Was charge for ambulance for a round-trip?
Was durable medical equipment purchased new or used?
Was nerve block used for surgical procedure or pain management?
Was refraction performed?
Was service purchased from another entity?
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.
We cannot pay for this as the approval period for the FDA clinical trial has expired.
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.
We did not send this claim to patient’s other insurer. They have indicated no additional payment can be made.
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.
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.
We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
We do not pay for this as the patient has no legal obligation to pay for this.
We have no record that you are licensed to dispensed drugs in the State where located.
We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
We pay for this service only when performed with a covered cryosurgical ablation.
We pay only one site of service per provider per claim
Weight.
Were services performed by a CRNA under appropriate medical direction?
Were services performed supervised by a physician?
Were services related to an emergency?
why non-skilled caregiver has not been taught procedure
Will worker’s compensation cover submitted charges?
Workers Compensation State Fee Schedule Adjustment
X-ray Availability Indicator
X-ray not taken within the past 12 months or near enough to the start of treatment.
X-ray reports/interpretation.
X-rays.
You are required to code to the highest level of specificity.
You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.
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.
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).
You may appeal this decision
You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.
You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
You may not appeal this decision
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.
You must appeal the determination of the previously ajudicated claim.
You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for every 6 month period after the end of the 15th paid rental month or the end of the warranty period.
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.
You should also submit this claim to the patient’s other insurer for potential payment of supplemental benefits. We did not forward the claim information as the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
Your center was not selected to participate in this study, therefore, we cannot pay for these services.
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.
Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer.
Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
Your line item has been separated into multiple lines to expedite handling.
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.