Claim/service denied. This change effective 7/1/2013: Service/equipment was not prescribed by a physician. Predetermination: anticipated payment upon completion of services or claim adjudication. Reason Code 222: Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837), Reason Code 223: Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. This Payer not liable for claim or service/treatment. Description. Reason Code 154: Service/procedure was provided as a result of an act of war. (For example, multiple surgery or diagnostic imaging, concurrent anesthesia.) Service not paid under jurisdiction allowed outpatient facility fee schedule. Claim received by the Medical Plan, but benefits not available under this plan. Workers' Compensation Medical Treatment Guideline Adjustment. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT. 073. (Use only with Group Code PR) At least on remark code must be provider (may be comprised of either the NCPDP Reject Reason Code or Remittance Advice Remark Code that is not an alert.). Reason Code 140: Portion of payment deferred. Note: To be used for pharmaceuticals only. Reason Code 179: Procedure modifier was invalid on the date of service. (Use only with Group Code OA). The impact of prior payer(s) adjudication including payments and/or adjustments. The qualifying other service/procedure has not been received/adjudicated. It will not be updated until there are new requests. Note: Use code 187. Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many service, this length of service, this dosage, or this day's supply. Reason Code 90: No Claim level Adjustments. The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements. Reason Code 28: Patient cannot be identified as our insured. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. Additional information will be sent following the conclusion of litigation. Reason Code 158: Provider performance bonus. Based on industry feedback, X12 is using a phased approach for the recommendations rather than presenting the entire catalog of adopted and mandated transactions at once. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). Reason Code 263: Adjustment for compound preparation cost. co 256 denial code descriptions Remark Code: N130. Claim/Service missing service/product information. Reason Code 52: Procedure/treatment is deemed experimental/investigational by the payer. Using this comprehensive reason code list, you can correct and resubmit the claims to payer. Reason Code 71: Indirect Medical Education Adjustment. Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Procedure/treatment has not been deemed 'proven to be effective' by the payer. Precertification/authorization/notification/pre-treatment absent. Claim/service denied. Indemnification adjustment - compensation for outstanding member responsibility. Reason Code 136: Contracted funding agreement - Subscriber is employed by the provider of services. Payment for this claim/service may have been provided in a previous payment. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Reason Code 143: Diagnosis was invalid for the date(s) of service reported. At least one Remark Code must be provided (may be comprised of either the Claim received by the dental plan, but benefits not available under this plan. No available or correlating CPT/HCPCS code to describe this service. Sequestration - reduction in federal payment. These codes generally assign responsibility Reason Code 208: National Drug Codes (NDC) not eligible for rebate, are not covered. Workers' Compensation claim adjudicated as non-compensable. Reason Code 147: Payer deems the information submitted does not support this level of service. ), Reason Code 15: Duplicate claim/service. Claim/service denied. Coverage not in effect at the time the service was provided. co 256 denial code descriptions
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