Explanation of benefits (EOB) codes are displayed on the weekly Remittance Advice (RA).

Scroll through the list below (or use your system’s search command, such as Ctrl+F) to find a particular EOB.

To print the entire EOB list, use your browser’s Print option.

You can also download the list as a text file: EOB.txt.

Code Description
0000 CLAIM PAID AS BILLED
0001 CLAIM PENDED FOR EXAMINER REVIEW
0002 CLAIM CORRECTION FORM SENT TO PROVIDER-WAITING FOR PROVIDER RESPONSE
0003 CLAIM PENDED - WAITING FOR ATTACHMENT
0004 ADJUSTMENT CLAIM PENDED FOR EXAMINER REVIEW.
0008 NDC VS. AGE RESTRICTION.
0012 INVALID DIAGNOSIS OR HEADER CODE-PLEASE VERIFY AND RESUBMIT
0013 PROCEDURE CODE NOT USED BY INDIANA HEALTH COVERAGE-PLEASE VERIFY AND RESUBMIT.
0014 MEMBER NUMBER INVALID-PLEASE CHECK MEMBER'S I.D. CARD AND RESUBMIT.
0015 MEMBER NAME AND NUMBER DISAGREE-PLEASE CHECK MEMBER'S I.D. CARD AND RESUBMIT.
0027 THE THIRD PARTY PAYMENT AMOUNT IS INVALID-IF A THIRD PARTY INSURANCE CARRIER WAS BILLED THEN THE THIRD PARTY PAYMENT AMOUNT SHOULD BE THE NUMBER "0" OR THE ACTUAL AMOUNT PAID. PLEASE VERIFY AND RESUBMIT.
0029 Admission Source Code is invalid.
0044 THE FROM DATE OF SERVICE IS NOT IN THE CORRECT FORMAT. THE CORRECT FORMAT IS MMDDYY. PLEASE CORRECT AND RESUBMIT.
0047 THE TO DATE OF SERVICE IS NOT IN THE CORRECT FORMAT. THE CORRECT FORMAT IS MMDDYY. PLEASE CORRECT AND RESUBMIT.
0100 THE EIGHTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0101 EIGHTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0102 THE NINETEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0103 THE NINETEENTH OTHER PROCEDURE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0104 NINETEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0105 THE TWENTIETH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0106 THE TWENTIETH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0107 TWENTIETH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0108 THE TWENTY-FIRST OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0109 THE TWENTY-FIRST OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0110 TWENTY-FIRST OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0111 THE TWENTY-SECOND OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0112 THE TWENTY-SECOND OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0113 THE TWENTY-SECOND OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0114 THE TWENTY-THIRD OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0115 THE TWENTY-THIRD OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0116 TWENTY-THIRD OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0117 THE TWENTY-FOURTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0118 THE TWENTY-FOURTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0119 TWENTY-FOURTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0120 ELECTRONIC VOID OF PREVIOUSLY PROCESSED CLAIM
0121 CLAIM NOT PROCESSED DUE TO A REPLACEMENT CLAIM.
0122 INVALID REPLACEMENT/VOID ORIGINAL CLAIM DENIED/SUSPENDED
0123 RESERVED FOR PE (PRESEUMPTIVE ELIGIBILITY)
0124 RESERVED FOR PE (PRESUMPTIVE ELIGIBILITY)
0198 THE REFERRING NPI SUBMITTED IS NOT IN A VALID FORMAT. PLEASE VERIFY AND RESUBMIT.
0199 BILLED DATE MISSING OR INVALID
0200 PRESCRIBER NPI IS LINKED TO PHARMACY TYPE/SPECIALTY. PLEASE VERY AND RESUBMIT.
0201 BILLING LPI/NPI IS MISSING; PLEASE PROVIDE AND RESUBMIT
0202 PROVIDER NUMBER IS NOT IN A VALID FORMAT. THE CORRECT FORMAT FOR A LPI IS NINE NUMERIC CHARACTERS AND AN ALPHA SUFFIX. THE CORRECT FORMAT FOR AN NPI IS TEN NUMERIC CHARACTERS. PLEASE VERIFY AND RESUBMIT.
0203 MEMBER I.D. NUMBER IS MISSING-PLEASE PROVIDE AND RESUBMIT.
0204 MEMBER I.D. NUMBER IS NOT A VALID FORMAT-PLEASE CHECK MEMBER'S I.D. CARD AND RESUBMIT.
0205 THE PRESCRIBING PRACTITIONER'S NPI IS MISSING. PLEASE PROVIDE AND RESUBMIT.
0206 PRESCRIBING PRACTITIONER'S NPI IS NOT IN A VALID FORMAT. NPI SHOULD BE TEN DIGIT NUMERIC. PLEASE CONTACT PRACTITIONER TO VERIFY AND RESUBMIT.
0207 INVALID EMERGENCY INDICATOR CODE. IF THIS WAS AN EMERGENCY, IT SHOULD BE Y FOR YES OR N FOR NO. PLEASE VERIFY AND RESUBMIT.
0208 INVALID PREGNANCY INDICATOR CODE. IT SHOULD BE P IF THE PATIENT IS PREGNANT AND IF THE PATIENT IS NOT PREGNANT, THE FIELD SHOULD BE LEFT BLANK. PLEASE VERIFY AND RESUBMIT.
0209 NURSING FACILITY INDICATOR INVALID-IF THE PATIENT IS IN A NURSING FACILITY, IT SHOULD BE Y FOR YES AND IF NOT, IT SHOULD BE N FOR NO. PLEASE VERIFY AND RESUBMIT.
0210 DISPENSED AS WRITTEN CODE INVALID-THE VALID VALUES ARE 0,1,2,3,4,5,8,9. FOR FURTHER INFORMATION, PLEASE SEE THE PHARMACY CHAPTER IN YOUR PROVIDER MANUAL. PLEASE VERIFY AND RESUBMIT.
0211 REFILL INDICATOR IS INVALID. THE VALID VALUES ARE 2 DIGIT NUMBERS FROM 00 TO 99. PLEASE VERIFY AND RESUBMIT.
0212 PRESCRIPTION NUMBER IS MISSING-THE PRESCRIPTION NUMBER CAN BE UP TO TEN ALPHA AND/OR NUMERIC CHARACTERS. PLEASE PROVIDE AND RESUBMIT.
0213 DATE PRESCRIBED IS MISSING. THE PROPER FORMAT IS MMDDYY -EXAMPLE, 011295. PLEASE PROVIDE AND RESUBMIT.
0214 DATE PRESCRIBED IS NOT IN A VALID FORMAT. THE PROPER FORMAT IS MMDDYY-EXAMPLE, 011295. PLEASE VERIFY AND RESUBMIT.
0215 DATE DISPENSED IS MISSING. THE PROPER FORMAT IS MMDDYY-EXAMPLE, 011295. PLEASE PROVIDE AND RESUBMIT.
0216 DATE DISPENSED IS NOT IN A VALID FORMAT. THE PROPER FORMAT IS MMDDYY-EXAMPLE,011295. PLEASE VERIFY AND RESUBMIT.
0217 NDC NUMBER IS MISSING OR NOT ON FILE-AN NDC NUMBER CAN BE UP TO ELEVEN NUMERIC CHARACTERS. FOR FURTHER INFORMATION, SEE THE PHARMACY CHAPTER IN YOUR PROVIDER MANUAL. PLEASE PROVIDE AND RESUBMIT.
0218 NDC NUMBER IS NOT IN A VALID FORMAT-AN NDC NUMBER CAN BE UP TO ELEVEN NUMERIC CHARACTERS. FOR FURTHER INFORMATION, SEE THE PHARMACY CHAPTER IN YOUR PROVIDER MANUAL. PLEASE VERIFY AND RESUBMIT.
0219 THE QUANTITY DISPENSED OR ADMINISTERED INFORMATION IS MISSING. IT SHOULD INDICATE THE QUANTITY OF THE ITEM DISPENSED AS WELL AS THE UNIT OF MEASURE (F2, GR, UN OR ML). PLEASE PROVIDE AND RESUBMIT.
0220 THE QUANTITY DISPENSED INFORMATION IS MISSING/INVALID. IT SHOULD INDICATE THE QUANTITY OF THE ITEM DISPENSED AS WELL AS THE UNIT OF MEASURE (EA, GM, ML). PLEASE VERIFY AND RESUBMIT.
0221 THE ESTIMATED DAYS SUPPLY INFORMATION IS MISSING-IT CAN BE UP TO 999 DAYS. PLEASE PROVIDE AND RESUBMIT.
0222 THE ESTIMATED DAYS SUPPLY IS NOT VALID-IT SHOULD BE A NUMERIC CHARACTER FROM 1 TO 999 DAYS. PLEASE VERIFY AND RESUBMIT.
0223 THE DIAGNOSIS INDICATOR IS MISSING-THE CODES MUST REFERENCE AT LEAST ONE OF THE CORRESPONDING APPLICABLE DIAGNOSIS CODES ENTERED IN FIELD 21. PLEASE PROVIDE AND RESUBMIT.
0224 THE DIAGNOSIS INDICATOR IS NOT IN THE CORRECT FORMAT-THE NUMBER(S) MUST REFERENCE AT LEAST ONE OF THE CORRESPONDING APPLICABLE DIAGNOSIS CODES ENTERED IN FIELD 21. PLEASE VERIFY AND RESUBMIT.
0225 THE ESTIMATED DAYS SUPPLY IS NOT VALID-IT SHOULD BE A NUMBER BETWEEN 0 AND 999. PLEASE VERIFY AND RESUBMIT.
0226 THIS CLAIM REQUIRES A VALID REFERRING PHYSICAN NUMBER. PLEASE CONSULT REFERRING PHYSICIAN AND RESUBMIT.
0227 THE THIRD PARTY PAYMENT AMOUNT IS INVALID-IF A THIRD PARTY INSURANCE CARRIER WAS BILLED THEN THE THIRD PARTY PAYMENT AMOUNT SHOULD BE THE NUMBER 0 OR THE ACTUL AMOUNT PAID. PLEASE VERIFY AND RESUBMIT.
0228 YOUR CLAIM WAS RECEIVED WITHOUT A VALID SIGNATURE AND THERE IS NO RECORD THAT A CERTIFICATION FORM HAS BEEN RECEIVED TO UPDATE YOUR PROVIDER FILE. THIS CLAIM MUST BE SIGNED BEFORE RESUBMITTING FOR PAYMENT. PLEASE COMPLETE THE PROVIDER CERTIFICATION FORM ATTACHED TO BULLETIN BT200103 SO THAT FUTURE STANDARD PAPER CLAIMS WITHOUT A SIGNATURE WILL NOT BE DENIED FOR EDIT 228.
0229 INVALID PREGNANCY INDICATOR CODE-IT SHOULD BE P IS THE PATIENT IS PREGNANT AND IF NOT PREGNANT, THE FIELD SHOULD BE LEFT BLANK. PLEASE VERIFY AND RESUBMIT.
0230 INVALID EMERGENCY INDICATOR CODE-IF IT WAS AN EMERGENCY IT SHOULD BE Y FOR YES AND IF NOT, IT SHOULD BE N FOR NO. PLEASE VERIFY AND RESUBMIT.
0231 RENDERING NPI IS MISSING. PLEASE PROVIDE AND RESUBMIT.
0232 RENDERING PROVIDER NUMBER IS INVALID- THE NPI AND/OR THE NINE DIGIT NUMBER MUST BE USED AND MUST BE IN FIELD 24J. PLEASE VERIFY AND RESUBMIT.
0233 THE UNITS OF SERVICE IS MISSING OR NOT A VALID FORMAT. THE UNITS SHOULD BE A WHOLE NUMBER FROM 1 TO 9999 WITH NO DECIMALS. PLEASE PROVIDE AND RESUBMIT.
0234 THE PROCEDURE CODE FOR THE DETAIL LINE ITEM(S) IS MISSING. PLEASE USE A HCPC OR CPT CODE AND THE APPROPRIATE MODIFIERS WHEN NECESSARY. PLEASE PROVIDE AND REUBMIT.
0235 THE PROCEDURE CODE IS NOT IN A VALID FORMAT. PLEASE USE A CPT OR HCPC CODE AND THE APPROPRIATE MODIFIERS WHEN NECESSARY. PLEASE VERIFY AND RESUBMIT.
0236 THE DETAIL LINE, FROM DATE OF SERVICE IS MISSING. THE CORRECT FORMAT IS MMDDYY. PLEASE PROVIDE AND RESUBMIT.
0237 THE DETAIL LINE, FROM DATE OF SERVICE IS NOT IN THE CORRECT FORMAT. THE CORRECT FORMAT IS MMDDYY. PLEASE VERIFY AND RESUBMIT.
0238 MEMBER'S NAME MISSING-THE MEMBER'S NAME SHOULD REFLECT THE NAME LISTED ON THE MEMBER'S I.D. CARD. PLEASE CHECK MEMBER'S I.D. CARD AND RESUBMIT.
0239 THE DETAIL LINE, TO DATE OF SERVICE IS MISSING. PLEASE PROVIDE AND RESUBMIT.
0240 THE DETAIL LINE, TO DATE OF SERVICE IS NOT IN THE CORRECT FORMAT. THE CORRECT FORMAT IS MMDDYY. PLEASE VERIFY AND RESUBMIT.
0241 ACCIDENT INDICATOR IS INVALID-PLEASE CHECK THE YES OR NO BLOCK AND INDICATE THE TWO DIGIT ALPHA CODE FOR THE STATE IN WHICH THE ACCIDENT OCCURRED. PLEASE VERIFY AND RESUBMIT.
0242 THE SECONDARY DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. IT SHOULD BE THREE TO SEVEN ALPHA NUMERIC DIGITS-PLEASE VERIFY AND RESUBMIT.
0243 CLAIMS WITH `FROM AND THROUGH' DATES SPANNING OVER THE ICD-10 EFFECTIVE DATE OF OCTOBER 1, 2015 CANNOT BE BILLED ON ONE CLAIM. PLEASE SEPARATE THE DATES AND RESUBMIT.
0244 THE THIRD DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT-IT SHOULD BE THREE TO SEVEN ALPHA NUMERIC DIGITS. PLEASE VERIFY AND RESUBMIT.
0245 ICD VERSION INDICATOR ON THE CLAIM DOES NOT MATCH ONE OR MORE OF THE DIAGNOSIS CODES BILLED ON THE CLAIM. PLEASE VERIFY AND RESUBMIT.
0246 THE FOURTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT-IT SHOULD BE THREE TO SEVEN ALPHA NUMERIC DIGITS. PLEASE VERIFY AND RESUBMIT.
0247 RESERVED FOR FUTURE USE
0248 THE PLACE OF SERVICE CODE IS MISSING-THE CORRECT FORMAT SHOULD BE TWO NUMERIC DIGITS BETWEEN 11 AND 99. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0249 THE PLACE OF SERVICE CODE IS INVALID-THE CORRECT FORMAT SHOULD BE TWO DIGITS. PLEASE VERIFY AND RESUBMIT.
0250 YOUR CLAIM WAS SUBMITTED WITHOUT ANY VALID DETAIL LINES-PLEASE VERIFY AND RESUBMIT.
0251 THE FIRST MODIFIER IS NOT VALID-PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0252 THE SECOND MODIFIER IS NOT VALID-PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0253 THE THIRD MODIFIER IS NOT VALID-PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0254 BILLING PROVIDERS LOCATION CODE MISSING-PLEASE PROVIDE AND RESUBMIT.
0255 BILLING PROVIDERS LOCATION CODE IS INVALID-THE LOCATION CODE SHOULD BE AN ALPH A SUFFIX. PLEASE PROVIDE AND RESUBMIT.
0256 THIS SERVICE IS NOT PAYABLE-MEMBER SPENDDOWN LIABILITY NOT MET. PLEASE VERIFY AND RESUBMIT WITH DPW FORM 8A WHEN NECESSARY.
0257 THIS SERVICE IS NOT PAYABLE-MEMBER SPENDDOWN LIABILITY NOT MET. PLEASE VERIFY AND RESUBMIT WITH DPW FORM 8A WHEN NECESSARY.
0258 PRIMARY DIAGNOSIS CODE IS MISSING-PLEASE PROVIDE AND RESUBMIT.
0259 THE FOURTH MODIFIER SUBMITTED IS INVALID. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0260 UNITS OF SERVICE BILLED IS INVALID-PLEASE VERIFY AND RESUBMIT.
0261 THE TOOTH NUMBER OR LETTER IS MISSING-THE TOOTH NUMBER OR LETTER IS REQUIRED FOR EXTRACTION PROCEDURES. PLEASE PROVIDE AND RESUBMIT.
0262 THE TOOTH NUMBER IS INVALID-THE TOOTH NUMBER OR LETTER IS REQUIRED FOR EXTRACTION PROCEDURES. PLEASE VERIFY AND RESUBMIT.
0263 ONE OR MORE OF THE TOOTH SURFACE CODES BILLED IS INVALID. THE MINIMUM NUMBER OF VALID TOOTH SURFACE CODES HAS NOT BEEN MET. VALID TOOTH SURFACE CODES ARE "B, "D", "F", "I", "L", "M", OR "O". PLEASE VERIFY AND RESUBMIT.
0264 THE CONDITION CODE(S) SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0265 THE DATE OF SERVICE IS NOT IN THE CORRECT FORMAT-THE CORRECT FORMAT IS MMDDYY OR DETAIL DOS IS NOT WITHIN THE HEADER DOS. PLEASE VERIFY AND RESUBMIT.
0266 THE NUMBER OF VALID TOOTH SURFACE CODES PRESENT DOES NOT MEET THE MINIMUM NUMBER REQUIRED FOR THE PROCEDURE CODE BILLED.
0267 MULTIPLE TOOTH NUMBERS ARE NOT BILLABLE ON THE SAME DETAIL. PLEASE VERIFY AND RESUBMIT.
0268 THE BILLED AMOUNT IS MISSING-PLEASE PROVIDE AND RESUBMIT.
0269 THE BILLED AMOUNT IS NOT IN A VALID FORMAT PLEASE VERIFY AND RESUBMIT.
0270 THE HEADER BILLED AMOUNT IS MISSING-PLEASE VERIFY AND RESUBMIT.
0271 THE TOTAL AMOUNT IS NOT IN A VALID FORMAT- PLEASE VERIFY AND RESUBMIT.
0272 THE PRIMARY DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT.
0273 THE TYPE OF BILL IS MISSING-PLEASE VERIFY AND RESUBMIT.
0274 THE TYPE OF BILL CODE IS NOT VALID-IT SHOULD BE THREE CHARACTERS. PLEASE VERIFY AND RESUBMIT.
0275 THE ADMIT DATE IS MISSING, PLEASE VERIFY AND RESUBMIT.
0276 ADMIT DATE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0277 THE ADMIT HOUR IS INVALID. PLEASE VERIFY AND RESUBMIT.
0278 THE ADMIT TYPE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0279 THE ADMIT TYPE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0280 THE PATIENT STATUS IS MISSING-PLEASE VERIFY AND RESUBMIT.
0281 PATIENT STATUS IS INVALID. PLEASE VERIFY AND RESUBMIT.
0282 THE NUMBER OF COVERED DAYS IS MISSING FROM YOUR CLAIM-PLEASE PROVIDE AND RESUBMIT.
0283 THE NUMBER OF COVERED DAYS IS NOT IN THE CORRECT FORMAT-IT SHOULD BE THE NUMBER OF DAYS FOR THE STATEMENT COVERS PERIOD. PLEASE VERIFY AND RESUBMIT.
0284 THE PRIMARY CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0285 THE SECOND CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0286 THE THIRD CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0287 THE FOURTH CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0288 THE FIFTH CONDTION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0289 THE SIXTH CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0290 THE SEVENTH CONDITION CODE IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0291 THE PRIMARY OCCURRENCE CODE SUBMITTED IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0292 THE SECOND OCCURRENCE CODE SUBMITTED IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0293 THE THIRD OCCURRENCE CODE SUBMITTED IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0294 THE FOURTH OCCURRENCE CODE SUBMITTED IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0295 THE DATE FOR THE PRIMARY OCCURRENCE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0296 THE DATE FOR THE PRIMARY OCCURRENCE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0297 THE DATE FOR THE SECOND OCCURRENCE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0298 THE DATE FOR THE SECOND OCCURRENCE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0299 THE DATE FOR THE THIRD OCCURRENCE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0300 THE DATE FOR THE THIRD OCCURRENCE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT
0301 THE DATE FOR THE FOURTH OCCURRENCE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0302 THE DATE FOR THE FOURTH OCCURRENCE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0303 PRIMARY VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0304 VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0305 THIRD VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0306 FOURTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0307 FIFTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0308 SIXTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0309 SEVENTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0310 THE EIGHTH VALUE CODE IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0311 NINTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0312 TENTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0313 ELEVENTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0314 TWELFTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0315 VALUE CODE AMOUNT IS MISSING. PLEASE VERIFY AND RESUBMIT.
0316 VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0317 SECOND VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0318 SECOND VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0319 THIRD VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0320 THIRD VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0321 FOURTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0322 FOURTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0323 FIFTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0324 FIFTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0325 SIXTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0326 SIXTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0327 SEVENTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0328 SEVENTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0329 EIGHTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0330 EIGHTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0331 NINTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0332 NINTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0333 TENTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0334 TENTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0335 ELEVENTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0336 ELEVENTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0337 TWELFTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0338 TWELFTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0339 REVENUE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0340 REVENUE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0341 THERE IS NO PRIMARY PAYER ENTERED ON THE CLAIM. PLEASE VERIFY AND RESUBMIT.
0342 THE CERTIFICATION CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0343 THE CERTIFICATION CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0344 THE THIRD PAYER CODE IS NOT VALID. PLEASE VERIFY AND RESUBMIT.
0345 THE PAYER PROVIDER NUMBER IS MISSING-PLEASE VERIFY AND RESUBMIT.
0346 MEDICARE IS INDICATED AS A PRIOR PAYER, BUT NO PRIOR PAYMENT AMOUNT IS INDICATED. PLEASE VERIFY AND RESUBMIT.
0347 PRIOR PAYMENT AMOUNT IS BLANK OR NON-NUMERIC. PLEASE VERIFY AND RESUBMIT.
0348 OTHER INSURANCE IS INDICATED, BUT THE PRIOR PAYMENT AMOUNT IS MISSING OR INVALID. PLEASE VERIFY AND RESUBMIT.
0349 OTHER INSURANCE IS INDICATED, BUT THE PRIOR PAYMENT AMOUNT IS MISSING OR INVALID. PLEASE VERIFY AND RESUBMIT.
0350 THE NUMBER OF CLAIM DETAILS NOT EQUAL TO THE HEADER AMOUNT.
0351 RESERVED FOR FUTURE USE
0352 THE INDIANA HEALTH COVERAGE PROGRAMS ESTIMATED AMOUNT DUE ON THE FIRST PAYER LINE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0353 THE INDIANA HEALTH COVERAGE PROGRAMS ESTIMATED AMOUNT DUE ON THE FIRST PAYER LINE IS NOT VALID. PLEASE VERIFY AMOUNT AND RESUBMIT WITH THE CORRECTED INFORMATION.
0354 THE AMOUNT DUE FROM PATIENT IS NOT VALID. PLEASE VERIFY AMOUNT AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0355 THE FIFTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0356 THE SIXTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0357 THE SEVENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0358 THE EIGHTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0359 THE NINTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0360 THE ADMITTING DIAGNOSIS CODE IS MISSING. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0361 THE ADMITTING DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0362 THE EXTERNAL CAUSE OF INJURY CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0363 THE PRINCIPAL PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0364 THE PRINCIPAL PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0365 THE PRINCIPAL PROCEDURE DATE IS NOT IN THE VALID FORMAT. THE CORRECT FORMAT IS CCYYMMDD. PLEASE VERIFY AND RESUBMIT.
0366 1ST OTHER ICD PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0367 THE FIRST OTHER PROCEDURE CODE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0368 THE FIRST OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. THE CORRECT FORMAT IS CCYYMMDD. PLEASE VERIFY AND RESUBMIT.
0369 THE SECOND OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0370 THE SECOND OTHER PROCEDURE CODE DATE IS MISSING
0371 THE SECOND OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT-PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECT FORMAT OF CCYYMMDD.
0372 THIRD OTHER ICD PROCEDURE CODE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT.
0373 THE THIRD OTHER PROCEDURE DATE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0374 THE THIRD OTHER PROCEDURE DATE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECT FORMAT OF CCYYMMDD.
0375 THE FOURTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT.
0376 THE FOURTH OTHER PROCEDURE DATE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0377 THE FOURTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT-PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECT FORMAT OF CCYYMMDD.
0378 THE FIFTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT.
0379 THE FIFTH OTHER PROCEDURE DATE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0380 THE FIFTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT-PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECT FORMAT OF CCYYMMDD.
0381 ATTENDING PHYSICIAN LICENSE NUMBER IS MISSING-PLEASE VERIFY AND RESUBMIT.
0382 ATTENDING PHYSICIAN LICENSE NUMBER IS INVALID-PLEASE VERIFY AND RESUBMIT.
0383 FIRST OTHER PHYSICIAN LICENSE NUMBER IS INVALID-PLEASE VERIFY AND RESUBMIT.
0384 SECOND OTHER PHYSICIAN LICENSE NUMBER IS INVALID-PLEASE VERIFY AND RESUBMIT.
0385 Members Waiver Liability is not met for the month.
0386 THE DATE OF SERVICE ON THIS CLAIM MATCHES THE MEMBER'S SPENDDOWN/HCBS WAIVER LIABILITY MET DATE FOR THE MONTH. AN 8A FORM IS REQUIRED. POS PROVIDERS MUST SUBMIT THIS CLAIM ON PAPER OR THROUGH ECS.
0387 THIS SERVICE IS NOT PAYABLE. THE MEMBER HAS NOT SATISFIED SPENDDOWN/HCBS WAIVER LIABILITY FOR THE MONTH.
0388 THIS SERVICE IS NOT PAYABLE. THE MEMBER HAS NOT SATISFIED SPENDDOWN/HCBS WAIVER LIABILITY FOR THE MONTH.
0389 THE REVENUE CODE SUBMITTED REQUIRES A CORRESPONDING HCPCS CODE.
0390 RESERVED FOR FUTURE USE
0391 THIS SERVICE NOT PAYABLE, MEMBER IS QMB ALSO AND SPENDDOWN/HCBS WAIVER LIABILITY HAS NOT BEEN MET. ONLY REIMBURSEMENT FOR MEDICARE COINSURANCE AND DEDUCTIBLE IS AVAILABLE. BILL MEDICARE FIRST.
0392 THIS SERVICE NOT PAYABLE, MEMBER IS QMB ALSO AND SPENDDOWN/HCBS WAIVER LIABILITY HAS NOT BEEN MET. ONLY REIMBURSEMENT FOR MEDICARE COINSURANCE AND DEDUCTIBLE IS AVAILABLE. BILL MEDICARE FIRST.
0393 RESERVED FOR FUTURE USE
0394 RESERVED FOR FUTURE USE
0395 THE FROM SERVICE DATE IS MISSING FROM YOUR CLAIM. PLEASE VERIFY AND RESUBMIT.
0396 THE FROM SERVICE DATE ON YOUR CLAIM IS NOT IN THE CORRECT FORMAT. PLEASE ENTER DATE IN MMDDYY FORMAT AND RESUBMIT.
0397 THE THROUGH SERVICE DATE IS MISSING FROM YOUR CLAIM. PLEASE VERIFY AND RESUBMIT.
0398 THE THROUGH SERVICE DATE ON YOUR CLAIM IS NOT IN THE CORRECT FORMAT. PLEASE ENTER DATE IN MMDDYY FORMAT AND RESUBMIT.
0399 THIS CLAIM CANNOT BE PROCESSED FOR PAYMENT. THE REFERRING PROVIDER NUMBER IS NOT IN THE VALID FORMAT. PLEASE ENTER 9 CHARACTER NUMERIC NUMBER AND RESUBMIT.
0400 UNITS OF SERVICE BLANK OR INVALID-PLEASE RESUBMIT WITH WHOLE UNITS.
0401 NET CHARGE IS MISSING OR IS EQUAL TO ZERO. PLEASE VERIFY AND RESUBMIT
0402 EXPECTED DELIVERY DATE NOT IN VALID FORMAT. PLEASE ENTER DATE IN MMDDYY FORMAT AND RESUBMIT.
0403 THE FROM SERVICE DATE IS NOT IN THE CORRECT FORMAT. PLEASE ENTER IN MMDDYY FORMAT AND RESUBMIT.
0404 THE THROUGH SERVICE DATE IS NOT IN THE CORRECT FORMAT. PLEASE ENTER IN MMDDYY FORMAT AND RESUBMIT.
0405 THE FIFTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESUMIT.
0406 THE SIXTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESBMIT.
0407 THE SEVENTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURANCE CODES AND REUBMIT.
0408 THE EIGHTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESBMIT.
0409 OCCURRENCE CODE 9-24 IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESUBMIT.
0410 THE TENTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESUBMIT.
0411 THE DATE FOR THE FIFTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH PROPER DATE IN FORM OF MMDDYY.
0412 THE DATE FOR THE FIFTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH THE PROPER DATE IN FORM OF MMDDYY
0413 THE DATE FOR THE SIXTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH THE PROPER DATE IN FORM OF MMDDYY.
0414 THE DATE FOR THE SIXTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH PROPER DATE IN THE FORM OF MMDDYY.
0415 THE DATE FOR THE SEVENTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH THE PROPER DATE IN FORM OF MMDDYY.
0416 THE DATE FOR THE SEVENTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH THE PROPER DATE IN THE FORM OF MMDDYY.
0417 THE DATE FOR THE EIGHTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH THE PROPER DATE IN FORM OF MMDDYY.
0418 THE DATE FOR THE EIGHTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH THE PROPER DATE IN THE FORM OF MMDDYY.
0419 THE DATE OF SERVICE FOR OCCURRENCE CODE 9-24 IS MISSING. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0420 THE DATE OF SERVICE FOR OCCURRENCE CODE 9-24 IS NOT A VALID DATE. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0421 THE TO DATE OF SERVICE FOR THE NINTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0422 THE TO DATE OF SERVICE FOR THE NINTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0423 THE FROM DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0424 THE FROM DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0425 THE TO DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH THE DATE IN THE FORM OF MMDDYY.
0426 THE TO DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH THE DATE IN THE FORM OF MMDDYY.
0427 THE QUANTITY DISPENSED INFORMATION IS MISSING. PLEASE VERIFY INFORMATION AND RESUBMIT.
0428 THE QUANTITY DISPENSED INFORMATION IS NOT VALID. PLEASE ENTER 5 DIGIT NUMERIC VALUE AND RESUBMIT.
0429 THE TOTAL CHARGES SUBMITTED ARE LESS THAN THE $150.00 MINIMUM FOR THE 590 PROGRAM. CLAIMS LESS THAN $150.00 MUST BE SUBMITTED TO THE FACILITY.
0430 PARTIAL UNITS MAY NOT BE BILLED. PLEASE RESUBMIT IN WHOLE NUMBERS.
0431 PAYMENT HAS BEEN CUTBACK BY THE PATIENT LIABILITY DEVIATION NOTED ON THE CLAIM AND/OR FILE.
0432 INVALID MCO IDENTIFICATION NUMBER-PLEASE VERIFY AND RESUBMIT.
0433 THE DEDUCTIBLE AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES.
0434 THE COINSURANCE AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES.
0435 THE BLOOD DEDUCTIBLE AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES.
0436 THE TOTAL MEDICARE ALLOWED AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES, EXCLUDING ZEROES.
0437 THE PSYCH ADJUSTMENT AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES.
0438 THE PATIENT SPENDDOWN AMOUNT IS NOT IN THE VALID FORMAT-PLEASE VERIFY AND RESUBMIT.
0439 HOSPICE SERVICES BEING BILLED. (MANUAL PAYOUT)
0440 THE MAXIMUM NUMBER OF CLAIM DETAILS HAS BEEN EXCEEDED
0441 THE OCCURANCE SPAN CODE IS MISSING OR INVALID
0442 THE DATE OF SERVICE ON THIS CLAIM MATCHES THE MEMBER'S SPENDDOWN/HCBS WAIVER LIABILITY MET DATE. PLEASE OBTAIN AN 8A FORM FROM THE COUNTY OFFICE.
0443 THE DATE OF SERVICE ON THIS CLAIM MATCHES THE MEMBER'S SPENDDOWN/HCBS WAIVER LIABILITY MET DATE. PLEASE OBTAIN AN 8A FORM FROM THE COUNTY OFFICE.
0444 THE CERTIFICATION CODE IS MISSING. PLEASE SUBMIT ON THE CLAIM CORRECTION FORM. THIS SHOULD BE A TW0-DIGIT CODE.
0445 DIAGNOSIS CODE 10-25 IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0446 THE ELEVENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0447 THE TWELFTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0448 THE THIRTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0449 THE FOURTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0450 THE TOTAL PAID AMOUNT IS LESS THAN THE $150.00 MINIMUM FOR THE 590 PROGRAM. CLAIMS LESS THAN $150.00 MUST BE SUBMITTED TO THE FACILITY.
0451 THE CURRENT DETAIL HAS BEEN DENIED BY THE MCO. DETAIL WILL BE IN FULL FAILURE.
0452 SUBMITTED CHARGE EXCEEDS ALLOWED AMOUNT.
0453 THE SEVENTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0454 THE EIGHTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0455 THE NINETEENTH DIAGNOSIS CODES IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0456 THE TWENTIETH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0457 THE TWENTY-FIRST DIAGNOSIS CODES IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0458 THE TWENTY-SECOND DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0459 THE TWENTY-THIRD DIAGNOSIS CODES IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0460 THE TWENTY-FOURTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0461 THE TWENTY-FIFTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED IFORMATION.
0462 THE SIXTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMI.
0463 THE ICD PROCEDURE DATE 6-24 IS MISSING. PLEASE VERIFY AND RESUBMIT.
0464 ICD PROCEDURE 6-24 DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0465 THE SEVENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0466 THE SEVENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0467 SEVENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0468 ICD PROCEDURE CODE 6-24 IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0469 THE EIGHTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0470 EIGHTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0471 THE NINTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0472 THE NINTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0473 NINTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0474 THE TENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0475 THE TENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0476 TENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0477 THE ELEVENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0478 THE ELEVENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0479 ELEVENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0480 THE TWELFTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0481 THE TWELFTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0482 TWELFTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0483 THE THIRTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0484 THE THIRTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0485 THIRTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0486 THE FOURTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0487 THE FOURTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0488 FOURTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0489 THE FIFTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0490 THE FIFTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0491 FIFTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0492 THE SIXTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0493 THE SIXTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0494 SIXTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0495 THE SEVENTEETH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0496 SEVENTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0497 SEVENTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0498 THE EIGHTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0499 CLAIM DENIED. REQUIRED INFORMATION WAS NOT RETURENED OR RECEIVED WITHIN 45 DAYS.
0500 DATE PRESCRIBED IS AFTER THE BILLING DATE. PLEASE VERIFY PRESCRIBED DATE AND RESUBMIT.
0501 THE DISCHARGE DATE/TIME IS WITHIN 24 HOURS OF THE ADMIT DATE/TIME. PLEASE VERIFY AND RESUBMIT. IF CORRECT, PLEASE REBILL AS AN OUTPATIENT CLAIM.
0502 DISPENSED DATE IS EARLIER THAN PRESCRIBED DATE. PLEASE VERIFY AND RESUBMIT.
0503 CLAIM CANNOT BE BILLED BEFORE THE PRESCRIPTION IS DISPENSED. PLEASE VERIFY DISPENSED DATE AND RESUBMIT.
0504 THE EXPECTED DATE OF DELIVERY IS MISSING-PLEASE SUBMIT WITH PROPER DATE IN FORM OF MMDDYY.
0505 THE THIRD PARTY AMOUNT IS MORE THAN THE TOTAL CLAIM CHARGE; THEREFORE, NO MEDICAID AMOUNT IS PAYABLE.
0506 BILLED DATE ENTERED IS AFTER HP RECEIVED THE CLAIM-PLEASE VERIFY AND RESUBMIT.
0507 THE FROM DATE IS AFTER THE TO DATE OF SERVICE. PLEASE VERIFY AND RESUBMIT.
0508 THE SUM OF THE INDIVIDUAL LINE CHARGES SUBMITTED ON THIS CLAIM DOES NOT EQUAL THE TOTAL CHARGE. PLEASE VERIFY AND RESUBMIT.
0509 THIS CLAIM WAS SUBMITTED WITH AN INCOMPLETE OR INVALID NET CHARGE. THE ESTIMATED AMOUNT DUE MUST EQUAL THE TOTAL OF ALL LINE ITEM CHARGES, LESS ANY TPL AMOUNT, PATIENT PAID (NON-COVERED) CHARGES, AND/OR ANY PATIENT LIABILITY AMOUNT. PLEASE VERIFY AND RESUBMIT.
0510 THE FROM DATE IS AFTER THE TO DATE OF SERVICE FOR THE OCCURRENCE CODE. PLEASE VERIFY AND RESUBMIT.
0511 THE FROM DATE IS AFTER THE TO DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE. PLEASE VERIFY AND RESUBMIT.
0512 YOUR CLAIM WAS FILED PAST THE FILING TIME LIMIT WITHOUT ACCEPTABLE DOCUMENTATION.
0513 MEMBERS NUMBER DOES NOT MATCH THE MEMBERS NAME. PLEASE VERIFY AND RESUBMIT
0514 CLAIM CANNOT BE BILLED BEFORE THE SERVICE IS RENDERED.
0515 THE OVERHEAD FEE IS NOT ON FILE FOR THE DATES OF SERVICE INDICATED. PLEASE VERIFY AND RESUBMIT.
0516 THE OCCURRENCE CODE DATES DO NOT MATCH THE CLAIM DETAIL DATES. PLEASE VERIFY AND RESUBMIT.
0517 THE OCCURRENCE CODE DATES DO NOT MATCH ANY OF THE SERVICE DATES BILLED ON THE DETAIL LINES OF THE CLAIM. PLEASE VERIFY AND RESUBMIT.
0518 THE COVERED DAYS ENTERED DO NOT MATCH THE STATEMENT PERIOD DATES. PLEASE VERIFY AND RESUBMIT.
0519 THE ADMIT DATE MUST BE EQUAL TO OR BEFORE THE STATEMENT PERIOD FROM OR TO DATE. PLEASE VERIFY AND RESUBMIT.
0520 INVALID REVENUE CODE AND PROCEDURE CODE COMBINATION - PLEASE VERIFY AND RESUBMIT.
0521 THE THRU DATE OF SERVICE IS AFTER THE DISCHARGE DATE. PLEASE VERIFY AND RESUBMIT.
0522 THE CLAIM CONTAINS CONFLICTING DISCHARGE INFORMATION, VERIFY PATIENT STATUS CODE AND/OR OCCURRENCE CODE AND RESUBMIT.
0523 THIS CLAIM CANNOT BE SUBMITTED UNTIL AFTER THE SERVICES HAVE BEEN RENDERED.
0524 OCCURRENCE CODE DATE CANNOT BE WITHIN THE OCCURRENCE SPAN DATE-PLEASE VERIFY AND RESUBMIT.
0525 DUPLICATE OCCURRENCE DATES BILLED-ONLY ONE OCCURRENCE CODE MAY BE BILLED PER DATE OF SERVICE. PLEASE VERIFY AND RESUBMIT.
0526 THE STATEMENT COVERS PERIOD FROM DATE IS OUT OF SEQUENCE WITH THE THROUGH DATE. PLEASE VERIFY AND RESUBMIT.
0527 CLAIM CANNOT BE BILLED BEFORE THE SERVICE IS RENDERED
0528 INVALID DISCHARGE STATUS-PLEASE VERIFY AND RESUBMIT.
0529 THE SURGERY DATE IS BEFORE THE ADMISSION DATE-PLEASE VERIFY AND RESUBMIT.
0530 THE SURGERY DATE IS AFTER THE DISCHARGE DATE-PLEASE VERIFY AND RESUBMIT.
0531 THE MODIFIER IDENTIFIES THE TRIMESTER BEING BILLED AND IF A DELIVERY CODE MODIFIER IS MISSING-PLEASE VERIFY AND RESUBMIT.
0532 BILLING PROVIDER'S SPECIALTY IS NOT APPROVED TO BILL THIS REVENUE CODE. PLEASE VERIFY AND RESUBMIT.
0533 PAID AS BILLED.
0534 PROCEDURE CODE NOT CONSISTENT WITH TYPE OF BILL-PLEASE VERIFY AND RESUBMIT.
0535 THE TRIMESTER BILLED DOES NOT CORRESPOND TO THE EXPECTED DELIVERY DATE-PLEASE VERIFY AND RESUBMIT.
0536 MULTIPLE TRIMESTERS ARE BILLED ON THE CLAIM
0537 REFUND AMOUNT IS GREATER THAN THE ADJUSTED AMOUNT.
0538 REFUND AMOUNT IS LESS THAN THE ADJUSTED AMOUNT.
0539 KEYED BUT NOT ACTIVATED
0540 CLAIM KEYED BUT NOT ACTIVATED.
0541 CLAIM ACTIVATED BUT NOT KEYED.
0542 Manager Review of Paid Amount
0543 ADJUSTMENT DENIED BECAUSE OF A FULL REFUND, FULL RECOUPMENT, OR VOIDED CHECK RELATED.
0544 CLAIM IN REVIEW STATUS.
0545 YOUR CLAIM WAS FILED PAST THE FILING TIME LIMIT WITHOUT ACCEPTABLE DOCUMENTATION.
0546 TYPE OF BILL INCOMPATIBLE FOR SERVICE BILLED
0547 HOSPITAL LEAVE DAYS MUST BE BILLED ON THE SAME CLAIM AS THE ACCOMMODATION DAYS-PLEASE VERIFY AND RESUBMIT.
0548 THERAPEUTIC LEAVE DAYS MUST BE BILLED ON THE SAME CLAIM AS THE ACCOMMODATION DAYS-PLEASE VERIFY AND RESUBMIT.
0549 INVALID TYPE OF BILL FOR ANCILLARY SERVICE.
0550 THIS PROCEDURE HAS BEEN REPLACED OR DELETED TO REFLECT APPROPRIATE SERVICES RENDERED.
0551 AN OVERHEAD FEE DID NOT APPEAR ON THE CLAIM FOR DATES OF SERVICE BILLED.
0552 THE DATES BILLED SPAN. IN ORDER TO PROCESS YOUR CLAIM, YOU MUST SPLIT BILL FOR DATES LESS THAN 06/30/95 AND GREATER THAN OR EQUAL TO 07/01/95.
0553 THIRD PARTY PAYMENT/MEDICARE PAYMENT IS MORE THAN THE TOTAL CLAIM PAYMENT. NO INDIANA HEALTH COVERAGE PROGRAM AMOUNT PAYABLE.
0554 DATE BILLED IS PRIOR TO THE DATES OF SERVICE ON THE CLAIM
0555 THE UNITS BILLED MUST EQUAL THE NUMBER OF DAYS INDICATED BY THE DATES OF SERVICE BILLED.
0556 THE DATES OF SERVICE BILLED CANNOT SPAN 180 DAYS FOR THE PROCEDURES BILLED. PLEASE BREAK DOWN THE SERVICES TO A SMALLER PERIOD OF TIME.
0557 SERVICE NOT COVERED BY CAPITATION RATE
0558 COINSURANCE AND DEDUCTIBLE AMOUNT IS MISSING INDICATING THAT THIS IS NOT A CROSSOVER CLAIM.
0559 THE COINSURANCE AMOUNT IS NOT THE CORRECT PERCENTAGE OF THE TOTAL MEDICARE ALLOWED AMOUNT. PLEASE CONTACT YOUR MEDICARE CARRIER FOR AN ADJUSTMENT.
0560 THIS IS NOT A CROSSOVER CLAIM, SINCE MEDICARE HAS NOT MADE A PAYMENT TOWARDS THIS SERVICE. PLEASE FILE ON THE CORRECT CLAIM FORM AND RESUBMIT FOR PROCESSING.
0561 A QUALIFIED MEDICARE BENEFICIARY MEMBER HAS BEEN ENROLLED IN MULTIPLE AID CATEGORIES. PAYMENT IS REFLECTED ACCORDINGLY.
0562 HOSPICE SERVICES HAVE INCOMPATIBLE TYPE OF BILL AND REVENUE CODES BEING BILLED.
0563 HOSPICE UNITS BILLED INCOMPATIBLE WITH ALLOWED UNITS FOR THE HOSPICE REVENUE CODE.
0564 THIS REVENUE CODE IS NOT ALLOWED FOR THIS MEMBER'S ELIGIBILITY.
0565 PAID AMOUNT IS GREATER THAN BILLED AMOUNT.
0566 YOUR CROSSOVER CLAIM HAS NOT BEEN SUBMITTED ON THE CORRECT FORM, VERIFY AND RESUBMIT.
0567 YOUR CLAIM WAS FILED PAST THE FILING TIME WITHOUT ACCEPTABLE DOCUMENTATION. PLEASE RESUBMIT CLAIM WITH PROPER ATTACHMENTS.
0568 YOUR CLAIM WAS FILED PAST THE FILING TIME WITHOUT ACCEPTABLE DOCUMENTATION. PLEASE RESUBMIT YOUR CLAIM WITH PROPER ATTACHMENTS.
0569 RESERVED FOR XOVER TEAM.
0570 EARLY REFILL PRODUR ALERT
0571 HIGH DOSE PRODUR ALERT
0572 THERAPEUTIC DUPE PRODUR ALERT
0573 DRUG/DRUG PRODUR ALERT
0574 CLAIM FILED PAST THE 90 DAY FILING LIMIT
0575 THE FIFTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0576 THE SIXTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0577 PHAMACIST CAN OVERRIDE BY USING NCPDP DUR CODES
0578 LATE REFILL PRO DUR
0579 DRUG/DISEASE PRODUR ALERT
0580 INPATIENT CROSSOVER CLAIMS MUST BE BILLED ON THE UB-92 FORM OR SENT DIRECTLY FROM MEDICARE.
0581 NDC CODES ARE NOT BILLABLE ON HOME HEALTH OR LONG TERM CARE CLAIMS.
0582 THE HEADER PLACE OF SERVICE CODE IS MISSING - THE CORRECT FORMAT SHOULD BE TWO NUMERIC DIGITS BETWEEN 11 AND 99. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0583 THE HEADER PLACE OF SERVICE CODE IS INVALID - THE CORRECT FORMAT SHOULD BE TWO NUMERIC DIGITS BETWEEN 11 AND 99. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0584 DRUG/AGE PRODUR ALERT
0585 DRUG/PREGNANCY PRODUR ALERT
0586 THIS DRUG REQUIRES PRIOR AUTHORIZATION DUE TO PRODUR EDITS
0587 LOW DOSE PRODUR ALERT
0588 THE CLAIM TYPE SELECTED FOR THE ADJUSTMENT DOES NOT MATCH THE CLAIM TYPE OF THE ORIGINAL PAID CLAIM, THEREFORE YOUR CLAIM HAS BEEN DENIED. PLEASE SUBMIT A NEW CLAIM FOR ADJUDICATION.
0589 THE MEMBER ID SUBMITTED FOR THIS ADJUSTMENT DOES NOT MATCH THE MEMBER ID OF THE ORIGINAL PAID CLAIM, THEREFORE YOUR CLAIM HAS BEEN DENIED. PLEASE SUBMIT A NEW CLAIM FOR ADJUDICATION.
0590 PROCEDURE QUALIFIER SUBMITTED IS NOT VALID. PLEASE VERIFY AND RESUBMIT.
0591 THE CURRENT DETAIL HAS BEEN DENIED BY THE MCO. DETAIL WILL BE IN FULL FAILURE.
0592 THE PROVIDER ID SUBMITTED FOR THIS ADJUSTMENT DOES NOT MATCH THE PROVIDER ID OF THE ORIGINAL PAID CLAIM, THEREFORE, YOUR CLAIM HAS BEEN DENIED. PLEASE SUBMIT A NEW CLAIM FOR ADJUDICATION.
0593 AT LEAST ONE DETAIL SUBMITTED CONTAINS MEDICARE COB DATA RESULTING IN A REVIEW OF ALL DETAIL COB DATA. PLEASE REVIEW TO ENSURE COB DATA FOR DETAIL IN QUESTION DOES NOT CONTAIN ALL ZEROS OR IS MISSING
0594 TYPE OF BILL IS NOT VALID FOR THE CLAIM TYPE SUBMITTED.
0595 THE FROM DATE OR TO DATE OF SERVICE FOR THE OCCURANCE SPAN CODE IS MISSING OR INVALID.
0597 FULL RECOUPMENT DUE TO MEMBER BEING INCARCERATED AND ONLY INPATIENT HOSPITAL SERVICES CAN BE REIMBURSED
0600 MISSING OR INVALID GROUP NUMBER
0601 MISSING OR INVALID COMPOUND CODE
0602 NON MATCHED GROUP NUMBER
0603 NON MATCHED PA/MC NUMBER
0604 CLAIM IN NOT PROCESSED
0605 MISSING OR INVALID PATIENT FIRST NAME
0606 MISSING OR INVALID PAYER DATE
0607 MISSING OR INVALID INGREDIENT COST
0608 NON MATCHED PERSON CODE
0609 NON MATCHED NDC PACKAGE SIZE
0610 NON MATCHED PRIMARY PRESCRIBER
0611 NON MATCHED CLINIC ID
0612 INSTITUTIONALIZED PATIENT NDC NOT COVERED
0613 FILLED BEFORE COVERAGE EFFECTIVE
0614 FILLED AFTER COVERAGE EXPIRED
0615 FILLED AFTER COVERAGE TERMINATED
0616 PRIMARY PRESCRIBER NOT COVERED
0617 REFILLS NOT COVERED
0618 COST EXCEEDS MAXIMUM
0619 REFILL TOO SOON
0620 DRUG DIAGNOSIS MISMATCH
0621 SUBMIT MANUAL REVERSAL
0622 REJECTED CLAIM FEES PAID
0623 MISSING OR INVALID PATIENT PAID AMOUNT
0624 MISSING OR INVALID DUR INTERVENTION CODE
0625 MISSING OR INVALID DUR OUTCOME CODE
0626 PATIENT NOT COVERED IN AID CATEGORY
0627 INVALID LEVEL OF SERVICE IND
0628 FIRST DOS NOT IN RANGE ON PLAN/GROUP
0629 MAIL ORDER PRICES NOT IN GROUP
0630 M/I PRIMARY CARE PROVIDER ID QUALIFIER
0631 CLAIMS EXCEEDING $500 FOR MEMBERS IN 590 PROG REQ PA
0632 TPL DENIAL DATE IS INVALID OR MISSING
0633 DOS ON THE CLAIM MATCHES MEMBER SPENDDOWN/HCBS WAIVER LIABILITY MET DATE FOR THE MONTH. PLEASE OBTAIN AN 8A FORM FROM THE COUNTY OFFICE.
0634 MEMBER ELIGIBLE FOR EMERGENCY SERVICES ONLY
0635 U & C >500%<20%
0636 THE MEMBER IS ENROLLED IN THE RBMC PORTION OF THE HOOSIER HEALTHWISE PROG
0637 CLAIM IS POST DATED.
0638 NDC NOT ON PREFERRED DRUG LIST. PA IS REQUIRED. CALL ACS FOR PA.
0639 NDC VERSUS AGE RESTRICTION. PLEASE VERIFY AND RESUBMIT.
0640 THE REASON FOR SERVICE CODE IS MISSING AND THE DUR INTERVENTION AND/OR OUTCOME CODES ARE PRESENT. REMOVE CODES AND RESUBMIT.
0641 PATIENT REPORTED AS DECEASED
0642 DRUG NOT COVERED DUE TO NO SIGNED REBATE
0643 OTHER COVERAGE CODE IS MISSING OR INVALID
0644 MEMBER COVERED BY PRIVATE INS. BILL PRIOR TO MEDICAID
0645 MEMBER COVERED BY PRIVATE INS. BILL PRIOR TO MEDICAID
0646 PLEASE COORD W/HOSPICE PROV TO DETERMINE IF DRUG IS
0647 PRIOR AUTHORIZATION IN PROGRESS
0648 VALID DEA# REQUIRED SCHED II DRUGS
0649 COMPOUND DRUG CLAIM MUST BE BILLED ON PAPER VIA CMPD DRUG
0650 DOS BEFORE SPENDDOWN DATE
0651 MISSING OR INVALID PRIMARY CARE PROVIDER LAST NAME
0652 MISSING OR INVALID OTHER PAYER COVERAGE TYPE
0653 MISSING OR INVALID OTHER PAYER REJECT COUNT
0654 MISSING OR INVALID OTHER PAYER ID QUALIFIER
0655 MISSING/INVALID OTHER PAYER REJECT CODE
0656 MISSING/INVALID OTHER PAYER ID
0657 MISSING/INVALID DUR/PPS CODE COUNTER
0658 MISSING/INVALID FACILITY ID
0659 MISSING/INVALID DUR/PPS LEVEL OF EFFORT
0660 THIS SERVICE IS NOT PAYABLE. THE MEMBER HAS NOT SATISFIED SPENDDOWN/HCBS WAIVER LIABILITY FOR THE MONTH.
0661 DISPENSED DATE IS EARLIER THAN PRESCRIBED DATE. PLEASE VERIFY AND RESUBMIT.
0662 DRUG NOT COVERED DUE TO NO SIGNED REBATE AGREEMENT.
0663 BILLING PROVIDER NOT ELIGIBLE TO BILL THIS CLAIM TYPE
0664 QUALIFIED MEDICARE BENEFICIARY (QMB) BILL MEDICARE FIRST
0665 THE MEMBER IS ENROLLED IN RISK BASED MANAGED CARE. PLEASE SUBMIT TO APPROPRIATE RISK BASED MANAGED CARE PROCESSOR.
0666 DAY SUPPLY LIMIT FOR PRODUCT OR SERVICE. DAY SUPPLY SUBMITTED IS GREATER THAN DAY SUPPLY ALLOWED.
0667 UNIT DOSE PACKAGING ONLY PAYABLE FOR NURSING HOME MEMBERS
0668 GENERIC DRUG REQUIRED
0669 THE SEGMENT IS A MANDATORY SEGMENT AND THE SEGMENT IDENTIFIER IS MISSING (SPACES) OR IT DOES NOT MATCH ONE OF THE VALID VALUES SPECIFIED FOR THE FIELD.
0670 MISSING/INVALID TRANSACTION COUNT
0671 M/I PROFESSIONAL SERVICE FEE SUBMITTED
0672 THE SERVICE PROVIDER ID QUALIFIER IS MISSING OR DOES NOT MATCH ONE OF THE VALID VALUES SPECIFIED FOR THE FIELD. PLEASE ENSURE THAT '05' IS PRESENT FOR THE SERVICE PROVIDER ID QUALIFIER.
0673 M/I ALTERNATE ID
0674 M/I PATIENT ID QUALIFIER
0675 M/I PATIENT ID
0676 M/I EMPLOYER ID
0677 DISPENSING FEE SUBMITTED
0678 M/I BASIS OF COST DETERMINATION
0679 M/I ORIGINALLY PRESCRIBED PRODUCT/SERVICE CODE
0680 M/I ORIGINALLY PRESCRIBED QUANTITY
0681 A COMPOUND SEGMENT IS PRESENT AND THE COMPOUND INGREDIENT COMPONENT COUNT IS ZEROS. PLEASE VERIFY AND RESUBMIT.
0682 THE COMPOUND INGREDIENT QUANTITY IS MISSING OR ZEROS. PLEASE VERIFY AND RESUBMIT.
0683 M/I COMPOUND INGREDIENT DRUG COST
0684 THE COMPOUND DOSAGE FROM DESCRIPTION CODE IS MISSING OR INVALID. VERIFY AND RESUBMIT.
0685 THE COMPOUND DISPENSING UNIT FORM DOES NOT MATCH ONE OF THE VALID NCPDP VALUES.
0686 THE COMPOUND ROUTE OF ADMINISTRATION DOES NOT MATCH ONE OF THE VALID NCPDP VALUES.
0687 M/I ORIGINALLY PRESCRIBED PRODUCT/SERVICE ID QUALIFIER
0688 SCHEDULED PRESCRIPTION ID NUMBER
0689 THE PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER SHOULD BE '03' TO INDICATE NDC NUMBER.
0690 M/I ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER
0691 M/I ASSOCIATED PRESCRIPTION/SERVICE DATE
0692 M/I PROCEDURE MODIFIER CODE
0693 M/I QUANTITY PRESCRIBED
0694 MISSING OR INVALID FAMILY PLANNING INDICATOR. IF PRODUCT/SERVICE IS USED FOR FAMILY PLANNING, USE A VALUE OF 6, OTHERWISE, USE ZERO OR LEAVE BLANK.
0695 M/I PRIOR AUTHORIZATION NUMBER SUBMITTED
0696 M/I INTERMEDIARY AUTHORIZATION TYPE ID
0697 M/I INTERMEDIARY AUTHORIZATION ID
0698 M/I PROVIDER ID QUALIFIER
0699 THE PRESCRIBER ID QUALIFIER IS INVALID. PLEASE VERIFY THAT IT IS '08' FOR STATE LICENSE NUMBER AND RESUBMIT.
0700 THE PHARMACY PROVIDER ID IS MISSING AND THE PHARMACY PROVIDER ID QUALIFIER IS PRESENT. PLEASE VERIFY AND RESUBMIT WITH THE PHARMACY PROVIDER'S 9-DIGIT PROVIDER NUMBER FOLLOWED BY ONE ALPHA CHARACTER.
0701 M/ PLAN ID
0702 MISSING OR INVALID OTHER PAYER AMOUNT PAID COUNT
0703 MISSING OR INVALID OTHER PAYER AMOUNT PAID QUALIFIER
0704 M/I DISPENSING STATUS
0705 M/I QUANTITY INTENDED TO BE DISPENSED
0706 M/I DAYS SUPPLY INTENDED TO BE DISPENSED
0707 M/I MEASUREMENT TIME
0708 M/I MEASUREMENT DIMENSION
0709 M/I MEASUREMENT UNIT
0710 M/I MEASUREMENT VALUE
0711 M/I PRIMARY CARE PROVIDER LOCATION CODE
0712 M/I DUR CO-AGENT ID
0713 M/I OTHER AMOUNT CLAIMED SUBMITTED COUNT
0714 M/I OTHER AMOOUNT CLAIMED SUBMITTED QUALIFIER
0715 M/I OTHER AMOUNT CLAIM SUBMITTED
0716 M/I DUR CO-AGENT ID QUALIFIER
0717 M/I COUPON TYPE
0718 M/I COUPON NUMBER
0719 M/I COUPON VALUE AMOUNT
0720 PA EXHAUSTED/NOT RENEWABLE
0721 THE TRANSACTION COUNT IS GREATER THAN '4' FOR A BILLING, REVERSAL OR REBILL REQUEST. NO MORE THAN 4 TRANSACTIONS CAN BE SENT PER TRANSMISSION.
0722 MISSING OR INVALID CLAIM SEGMENT.
0723 M/I CLINICAL SEGMENT
0724 MISSING OR INVALID COB SEGMENT. A COB SEGMENT WAS RECEIVED WITH A REVERSAL REQUEST. PLEASE REMOVE THE COB SEGMENT AND RESUBMIT.
0725 MISSING OR INVALID COMPOUND SEGMENT
0726 M/I COUPON SEGMENT
0727 DUR SEGMENT IS MALFORMED OR NOT SENT CORRECTLY. PLEASE VERIFY AND RESUBMIT.
0728 MISSING OR INVALID INSURANCE SEGMENT
0729 MISSING OR INVALID PATIENT SEGMENT
0730 M/I PHARMACY PROVIDER SEGMENT
0731 MISSING OR INVALID PRESCRIBER SEGMENT
0732 MISSING OR INVALID PRICING SEGMENT
0733 M/I PRIOR AUTHORIZATION SEGMENT
0734 MISSING OR INVALID TRANSACTION HEADER SEGMENT. PLEASE VERIFY AND RESUBMIT.
0735 M/I WORKERS COMPENSATION SEGMENT
0736 NON-MATCHED ASSOCIATED PRESCRIPTION/SERVICE DATE
0737 NON-MATCHED EMPLOYER ID
0738 NON-MATCHED OTHER PAYER ID
0739 NON-MATCHED UNIT FORM/ROUTE OF ADMINISTRATION
0740 NON-MATCHED UNIT OF MEASURE TO PRODUCT/SERVICE ID
0741 ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER NOT FOUND
0742 CLINICAL INFORMATION COUNTER OUT OF SEQUENCE
0743 THE COMPOUND INGREDIENT COMPONENT COUNT DOES NOT MATCH THE NUMBER OF COMPOUND PRODUCT ID'S RECEIVED ON A COMPOUND SEGMENT. PLEASE VERIFY THAT THE NUMBER OF INGREDIENTS EQUALS THE NUMBER OF NDCS BILLED IN THE COMPOUND.
0744 THE COORDINATION OF BENEFITS/OTHER PAYMENTS COUNT DOES NOT MATCH THE NUMBER OF COB/OTHER PAYMENT SEGMENTS RECEIVED. PLEASE VERIFY THAT THESE NUMBERS ARE THE SAME AND RESUBMIT.
0745 COUPON EXPIRED
0746 THE DATE OF SERVICE ON THE CLAIM IS BEFORE THE PATIENTS DATE OF BIRTH. PLEASE VERIFY DATES AND RESUBMIT.
0747 DIAGNOSIS CODE COUNT DOES NOT MATCH NUMBER OF REPETITIONS
0748 THE SETS OF DUR/PPS INFORMATION WERE RECEIVED OUT OF NUMERICAL SEQUENCE.
0749 THE CLAIM HAS REPEATING NUMBERS IN A NON-REPEATING FIELD. PLEASE REMOVE NUMBERS AND RESUBMIT.
0750 PREPAYMENT REVIEW DETERMINATION. DOCUMENTATION, AS REQUIRED BY YOUR PREPAYMENT GUIDELINES CRITERIA, DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED.
0751 PREPAYMENT REVIEW DETERMINATION. DOCUMENTATION SUBMITTED DOES NOT CONTAIN CLINICAL SIGNS/SYMPTOMS TO JUSTIFY MEDICAL NECESSITY OF THIS SERVICE.
0752 PREPAYMENT REVIEW DETERMINATION. ROUTINE SCREENING TESTS ARE NOT COVERED BY THE INDIANA HEALTH COVERAGE PROGRAM.
0753 PREPAYMENT REVIEW DETERMINATION. DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICATION CHARGES SUBMITTED.
0754 PREPAYMENT REVIEW DETERMINATION. DATE OF PROCEDURE IS NOT WITHIN THE SERVICE DATE OF THE CLAIM.
0755 PREPAYMENT REVIEW DETERMINATION. REQUEST FOR RECONSIDERATION IS PAST THE ALLOWABLE FILING LIMIT FOR APPEALS.
0756 PREPAYMENT REVIEW DETERMINATION. PROCEDURE BILLED MUST INCLUDE A COPY OF THE RESULTS.
0757 PREPAYMENT REVIEW DETERMINATION. CONSULTATION BILLED DOES NOT INCLUDE THE NAME OF THE REFERRING PHYSICIAN.
0758 PREPAYMENT REVIEW DETERMINATION. ADMINISTRATIVE NURSING FEES ARE NOT COVERED BY THE INDIANA HEALTH COVERAGE PROGRAM.
0759 PREPAYMENT REVIEW DETERMINATION. REQUIRED DOCUMENTATION IS NOT INCLUDED.
0760 PA REVERSAL OUT OF ORDER
0761 MULTIPLE PARTIALS NOT ALLOWED
0762 DIFFERENT DRUG ENTITY BETWEEN PARTIAL AND COMPLETION
0763 MISMATCHED CARDHOLDER/GROUP ID-PARTIAL TO COMPLETION
0764 THE COMPOUND PRODUCT QUALIFIER IS MISSING OR INVALID. A QUALIFIER OF 01 SHOULD BE BILLED WHEN USING THE UPC CODE A VALUE OF 03 SHOULD BE USED WHEN USING THE NDC NUMBER.
0765 IMPROPER ORDER OF DISPENSING STATUS CODE ON PARTIAL FILL TRANSACTION.
0766 M/I ASSOCIATED PRESCRIPTION/SERVCIE REFERENCE NUMBER ON COMPLETION TRANSACTION.
0767 M/I ASSOCIATED PRESCRIPTION/SERVICE DATE ON COMPLETION TRANSACTION.
0768 ASSOCIATED PARTIAL FILL TRANSACTION NOT OF FILE
0769 PARTIAL FILL TRANSACTION NOT SUPPORTED.
0770 COMPLETION TRANSACTION NOT PERMITTED WITH SAME DATE OF SERVICE AS PARTIAL TRA NSACTION.
0771 PLAN LIMITS EXCEEDED ON INTENDED PARTIAL FILL VALUES.
0772 OUT OF SEQUENCE P REVERSAL ON PARTIAL FILL TRANSACTION.
0773 M/I ASSOCIATED PRESCRIPTION/SERVICE DATE ON PARTIAL TRANSACTION
0774 M/I ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER ON PARTIAL TRANSACTION
0775 MANDATORY DATA ELEMENTS MUST OCCUR BEFORE OPTIONAL DATA ELEMENTS IN A SEGMENT.
0776 OTHER AMOUNT CLAIMED SUBMITTED COUNT DOES NOT MATCH NUMBER OF REPETITIONS.
0777 OTHER PAYER REJECT COUNT DOES NOT MATCH NUMBER OF REPETITIONS.
0778 PROCEDURE MODIFIER CODE COUNT DOES NOT MATCH NUMBER OF REPETITIONS.
0779 PROCEDURE MODIFIER CODE INVALID FOR PRODUCT/SERVICE ID
0780 PRODUCT/SERVICE ID MUST BE ZERO WHEN PRODUCT/SERVICE ID QUALIFIER EQUALS '06'.
0781 PRODUCT/SERVICE NOT APPROPRIATE FOR THIS LOCATION
0782 REPEATING SEGMENT NOT ALLOWED IN SAME TRANSACTION. AN IDENTICAL SEGMENT WAS SUBMITTED ON A SINGLE TRANSACTION. PLEASE REMOVE SEGMENT AND RESUBMIT.
0783 VALUE IN GROSS AMOUNT DUE DOES NOT FOLLOW PRICING FORMULA
0784 M/I PROCEDURE MODIFIER CODE COUNT
0785 THE COMPOUND PRODUCT ID IS MISSING OR IS ZEROS. PLEASE REPLACE WITH VALID VALUE.
0786 M/I DIAGNOSIS CODE COUNT
0787 M/I DIAGNOSIS/PROCEDURE CODE QUALIFIER
0788 M/I CLINICAL INFORMATION COUNTER
0789 M/I MEASUREMENT DATE
0792 REVISED FOR FUTRUE USE
0794 NOT A COMPOUND
0795 EXCEEDS ALLOWED MAX DAILY VOLUME
0796 EXCEEDS ALLOWED MAX DAILY DOSE
0797 EFFECTIVE 10/16/03 ALL PHARMACY CLAIMS MUST BE SUBMITTED IN THE HIPAA COMPLIANT NCPDP VERSION 5.1 CLAIM FORMAT
0798 COMPOUND AMT BILLED > $275.00
0799 DISPENSING STATUS EQUALS P OR C
0800 MISSING OR INVALID COORDINATION OF BENEFITS/OTHER PAYMENT COUNT.
0801 STERILE WATER PRODUCTS FOR INHALATION AND IRRIGATION ARE COVERED IN THE NURSING FACILITY PER DIEM.
0802 PREGNANCY INDICATOR MISSING OR INVALID
0803 MEMBER INELIGIBLE FOR ALL OR A PORTION OF THE SERVICE DATES BILLED. IF NECESSARY PLEASE RESUBMIT AND BREAK OUT SERVICES FOR WHICH THE MEMBER IS ELIGIBLE FROM SERVICES FOR WHICH THE MEMBER IS INELIGIBLE.
0804 TPL AMOUNT IS LESS THAN $0.99 ON A CLAIM FOR COVEREAGE CODE =2
0805 OVERRIDE CODE IS NOT 2 OR 4, BUT THERE IS DATA IN THE COB SEGMENTS LIKE DATE, AMOUNT, COV TYPE
0806 TPL OVERRIDE CODE = 8 AND AMOUNT SUBMITTED/GROSS AMOUNT DUE IS MISSING OR INVALID
0807 TPL OVERRIDE CODE = 8 AND AMOUNT SUBMITTED/GROSS AMOUNT DUE IS NOT EQUAL
0808 HOOSIER RX MEMBER BENEFIT DOLLARS EXHAUSTED
0809 ROUTE TO BIN #001553. CLAIMS MUST BE PROCESSED BY CATAMARAN
0810 NDC UNIT QUALIFIER (UNIT OF MEASURE) IS MISSING/INVALID.
0811 M/I OTHER PAYER AMOUNT PAID
0812 M/I OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT
0813 M/I OTHER PAYER-PATIENT RESPONSIBILITY QUALIFIER
0814 M/I OTHER PAYER-PATIENT RESPONSIBILITY COUNT
0815 TPL REQUIRED AT DETAIL AND MUST SUM TO EQUAL THE HEADER TPL AMOUNT
0863 THE CPT/HCPCS CODE BILLED IS NOT A VALID ENCOUNTER
0884 Service can only be billed on crossover outpatient claim by FQHC/RHC
0885 Provider payment of coinsurance and deductible for non-covered services.
0909 this is a missing eob
0911 CLAIM NOT PROCESSED
0929 CLAIM SUBMITTED SPANS MULTIPLE LEVEL OF CARE PLANS. PLEASE VERIFY AND RE-SUBMIT
0940 THE FROM DATE OF SERVICE FOR THE ELEVENTH OCCURRENCE CODE IS MISSING AND/OR INVALID. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0941 THE TO DATE OF SERVICE FOR THE ELEVENTH OCCURRENCE CODE IS MISSING AND/OR INVALID. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0942 THE FROM DATE IS AFTER THE TO DATE OF SERVICE FOR THE ELEVENTH OCCURRENCE CODE. PLEASE VERIFY AND RESUBMIT.
0943 THE FROM DATE IS AFTER THE TO DATE OF SERVICE FOR THE TWELFTH OCCURRENCE CODE. PLEASE VERIFY AND RESUBMIT.
0944 THE FROM DATE OF SERVICE FOR THE TWELFTH OCCURRENCE CODE IS MISSING AND/OR INVALID. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0945 THE TO DATE OF SERVICE FOR THE TWELFTH OCCURRENCE CODE IS MISSING AND/OR INVALID. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0946 Multiple payers submitted with same payer ID in error
0950 MATCHING EVV DATA NOT FOUND.
0951 MATCHING EVV DATA NOT FOUND.
0952 EVV AGGREGATOR UNITS LESS THAN UNITS SUBMITTED ON THE CLAIM, PROVIDER SHOULD VERIFY EVV AGGREGATOR INFORMATION.
0953 EVV WEB CALL FAILED - RECYCLE
0954 MISSING PARMS FOR EVV WEB CALL
0955 EVV WEB CALL UNSUCCESSFUL
0956 INCORRECTLY FORMATTED EVV REQUEST RECORD
0957 LMP DATE IS MISSING, PROVIDER SHOULD REVIEW SUBMITTED CLAIM AND CORRECT AS NEEDED.
0958 Suspend 7 days-matching EVV data not found
0959 Suspend 7 days - EVV less than claim units
0960 INVALID AREA OF ORAL CAVITY, PLEASE REVISE AND RESUBMIT
1000 BILLING PROVIDERS NUMBER IS NOT ON FILE. PLEASE VERIFY PROVIDER NUMBER AND RE SUBMIT.
1001 BILLING PROVIDER NOT ENROLLED FOR THE PROGRAM BILLED. PLEASE VERIFY AND RESUBMIT.
1002 RENDERING PROVIDER NOT ENROLLED IN THE PROGRAM BILLED . PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1003 BILLING PROVIDER NOT ENROLLED AT THE SERVICE LOCATION SUBMITTED ON THE CLAIM FOR THE PROGRAM BILLED FOR THE DATES OF SERVICE. PLEASE VERIFY PROVIDER NUMBER AND SERVICE LOCATION AND RESUBMIT.
1004 RENDERING PROVIDER NOT ENROLLED AT THE SERVICE LOCATION SUBMITTED ON THE CLAIM FOR THE PROGRAM BILLED FOR THE DATES OF SERVICE. PLEASE VERIFY PROVIDER NUMBER AND SERVICE LOCATION AND RESUBMIT.
1005 SERVICE DATE PRIOR TO RATE APPROVAL DATE. PLEASE VERIFY DATE AND RESUBMIT.
1006 SERVICE DATE BEFORE PROVIDER AUTHORIZED TO BILL ANCILLARY. PLEASE VERIFY DATE AND RESUBMIT.
1007 RENDERING PROVIDER NPI OR MEDICAID ID IS SUBMITTED ON THE CLAIM. PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1008 THE RENDERING PROVIDER MUST BE AN INDIVIDUAL PROVIDER. PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1009 RESERVED FOR FUTURE USE
1010 RENDERING PROVIDER IS NOT AN ELIGIBLE MEMBER OF BILLING GROUP OR THE GROUP PROVIDER NUMBER IS REPORTED AS THE RENDERING PROVIDER. PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1011 THE MEMBER IS ENROLLED IN HOOSIER HEALTHWISE PRIMARY CARE CASE MANAGEMENT PROGRAM. CLAIM MUST HAVE MEMBER'S PRIMARY MEDICAL PROVIDER INFORMATION. PLEASE PROVIDE INFORMATION AND RESUBMIT.
1012 SERVICE AND OR MODIFIER BILLED NOT PAYABLE FOR YOUR PROVIDER TYPE/SPECIALTY.
1013 THE BILLING PROVIDER NUMBER SUBMITTED ON THIS CLAIM HAS NOT BEEN PRIOR AUTHORIZED TO BILL THIS SERVICE FOR THE CHILDREN'S SPECIAL HEALTH CARE SERVICES RECIPIENT SUBMITTED ON THIS CLAIM. PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1014 THE RENDERING PROVIDER NUMBER SUBMITTED ON THIS CLAIM HAS NOT BEEN PRIOR AUTHORIZED TO BILL THIS SERVICE FOR THE CHILDREN'S SPECIAL HEALTH CARE SERVICES RECIPIENT SUBMITTED ON THIS CLAIM. PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1015 THE RENDERING PROVIDER ON THIS CLAIM IS NOT ON THE LIST OF PROVIDERS AUTHORIZED TO RENDER THIS SERVICE FOR THE CHILDREN'S SPECIAL HEALTH CARE SERVICES RECIPIENT SUBMITTED ON THIS CLAIM. PLEASE VERIFY AND RESUBMIT.
1016 THIS MANUFACTURER DOES NOT PARTICIPATE IN THE DRUG REBATE PROGRAM.
1017 NO RATE SEGMENT FOR LEVEL OF CARE(CASE MIX)
1018 NO RATE SEGMENT ON FILE FOR LEVEL OF CARE.
1019 MULTIPLE LEVELS OF CARE PER DIEM ON FILE. PLEASE SPLIT CLAIM TO IDENTIFY DIFFERENT DATES OF SERVICE FOR EACH LEVEL OF CARE AND RESUBMIT.
1020 THE ATTENDING PHYSICIAN ID IS NOT A VALID INDIANA LICENSE NUMBER. PLEASE VERIFY NUMBER AND RESUBMIT.
1021 THE FIRST OTHER PHYSICIAN ID SUBMITTED IS NOT A VALID INDIANA LICENSE NUMBER. PLEASE VERIFY NUMBER AND RESUBMIT.
1022 THE SECOND OTHER PHYSICIAN ID NUMBER SUBMITTED IS NOT A VALID INDIANA LICENSE NUMBER. PLEASE VERIFY NUMBER AND RESUBMIT.
1023 PROVIDER NOT ELIGIBLE TO BILL THIS LEVEL OF CARE
1024 BILLING PROVIDER IS NOT MEMBERS LISTED LONG TERM CARE PROVIDER. PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1025 BILLING PROVIDER NOT ENROLLED FOR THE DATE OF SERVICE.
1026 PRESCRIBING PHYSICIAN LICENSE NUMBER NOT ON FILE. PLEASE VERIFY NUMBER AND RESUBMIT.
1027 REFERRING PHYSICIAN NUMBER NOT ON FILE. PLEASE VERIFY NUMBER AND RESUBMIT.
1028 MODIFIER BILLED NOT PAYABLE FOR THIS PROVIDER'S SPECIALTY. PLEASE VERIFY MODIFIER AND RESUBMIT.
1029 PRESCRIBING PROVIDER NOT ELIGIBLE TO PRESCRIBE THIS NDC.
1030 ANCILLARY SERVICES NOT COVERED.
1031 HIGH RISK PRENATAL CARE MAY ONLY BE RENDERED BY A PHYSICIAN.
1032 BILLING PROVIDER IS NOT ELIGIBLE TO BILL THIS CLAIM TYPE.
1033 PROVIDER DOES NOT HAVE A SPECIALTY IDENTIFIED FOR THE DATES OF SERVICE. CONTACT PROVIDER ENROLLMENT FOR RESOLUTION
1034 PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1035 BILLING PROVIDER IS NOT MEMBERS LISTED HOSPICE PROVIDER. PLEASE VERIFY PROVIDER NUMBER AND RESUBMIT.
1036 RENDERING PROVIDER NOT ELIGIBLE TO BILL ON HCFA CLAIM TYPE
1037 RENDERING/BILLING PROVIDER TYPE/SPECIALTY IS NOT ELIGIBLE FOR PROGRAM BILLED
1038 BILLING PROVIDER SPECIALTY ONLY ALLOWED TO BILL 1915I CODES
1039 SERVICE PROVIDED BY AN OUT-OF-NETWORK PROVIDER
1040 MRO SERVICES CAN ONLY BE BILLED ON A CMS 1500 BY A CMHC
1041 BILLING PROVIDER NOT ELIGIBLE FOR MEMBER'S SPECIFIC WAIVER PROGRAM FOR DATES OF SERVICE BILLED
1042 THE CERTIFICATION CODE IS MISSING FOR MEDICAID SELECT. PLEASE VERIFY AND RESUBMIT.
1043 THE CERTIFICATION CODE IS INVALID FOR MEDICAID SELECT. PLEASE VERIFY AND RESUBMIT.
1044 THE MEMBER IS ENROLLED IN THE MEDICAID SELECT PRIMARY CARE CASE MANAGEMENT PROGRAM. CLAIM MUST HAVE MEMBER'S PRIMARY MEDICAL PROVIDER INFORMATION. PLEASE PROVIDE INFORMATION AND RESUBMIT.
1045 BILLING PROVIDER NOT ELIGIBLE FOR TARGETED CASE MANAGEMENT
1046 SERVICE AND OR MODIFIER BILLED NOT PAYABLE FOR YOUR RENDERING PROVIDER TYPE/SPECIALTY.
1047 THE CERTIFICATION CODE IS MISSING - CARE SELECT. PLEASE VERIFY AND RESUBMIT.
1048 THE CERTIFICATION CODE IS INVALID - CARE SELECT. PLEASE VERIFY AND RESUBMIT.
1049 THE MEMBER IS ENROLLED IN THE CARE SELECT PROGRAM. CLAIM MUST HAVE MEMBER'S PRIMARY MEDICAL PROVIDER INFORMATION. PLEASE PROVIDE INFORMATION AND RESUBMIT.
1050 THE MEMBER IS ENROLLED IN THE CARE SELECT PROGRAM. CARE MANAGEMENT CONFERENCE MUST BE BILLED BY THE MEMBER'S ASSIGNED CARE SELECT PMP OR NURSE PRACTITIONER IN THE SAME GROUP AS THE CARE SELECT PMP.
1051 REVENUE/CONDITION CODE NOT LISTED AS MEMBER LEVEL OF CARE.
1060 PRESCRIPTION LIMITED TO 7 TABLETS FOR 3 DAY TITRATION PURPOSES
1061 RESERVED FOR 1915I CHILD
1098 THE REFERRING NPI SUBMITTED IS NOT IN A VALID FORMAT, OR IS NOT ELIGIBLE FOR THE DOS BILLED. PLEASE VERIFY AND RESUBMIT.
1100 THE BILLING NPI HAS NOT BEEN REPORTED TO THE IHCP. THE NPI MUST BE REPORTED TO THE IHCP VIA THE NPI ONLINE REPORTING TOOL ACCESSIBLE AT WWW.INDIANAMEDICAID.COM.
1101 THE BILLING NPI HAS NOT BEEN REPORTED TO THE IHCP. THE NPI MUST BE REPORTED TO THE IHCP VIA THE NPI ONLINE REPORTING TOOL ACCESSIBLE AT WWW.INDIANAMEDICAID.CM.
1102 THE LPI WAS SUBMITTED ON THE CLAIM WITHOUT AN NPI.
1105 BILLING NPI IS REPORTED TO MULTIPLE LPIS AND PROVIDER HAS SELECTED THIS LOCATION.
1107 THE NPI SUBMITTED ON THE CLAIM DOES NOT CROSSWALK TO THE LPI SUBMITTED ON THE CLAIM.
1108 THE BILLING NPI MISSING OR INVALID PLEASE VERIFY AND RESUBMIT.
1109 THE BILLING NPI IS REPORT TO MULTIPLE SERVICE LOCATIONS. RESUBMIT THE CLAIM WITH THE BILLING PROVIDER SERVICE LOCATION ZIP CODE + 4 AND/OR TAXONOMY CODE.
1110 THE CARE SELECT PMP NPI SUBMITTED ON THE CLAIM HAS NOT BEEN REPORTED TO THE IHCP.
1111 THE CARE SELECT PMP IS REPORTED TO MULTIPLE LPIS. THE TAXONOMY OF THE CARE SELECT PMP MUST BE SUBMITTED ON THE CLAIM IN ADDITION TO THE PMP NPI.
1112 THE REFERRING NPI IS MISSING FROM THE CLAIM.
1117 THE CARE SELECT PMP NPI SUBMITTED ON THE CLAIM DOES NOT CROSSWALK TO THE PMP LPI SUBMITTED ON THE CLAIM.
1118 MISSING/INCOMPLETE/INVALID REFERRING PROVIDER IDENTIFIER.
1119 THE CARE SELECT PMP NPI CROSSWALKS TO MULTIPLE LPIS. RESUBMIT THE CLAIM WITH THE TAXONOMY OF THE CARE SELECT PMP IN ADDITION TO THE PMP NPI.
1120 THE RENDERING PROVIDER NPI OR MEDICAID ID IS SUBMITTED ON THE CLAIM, BUT IS INVALID OR DOES NOT CROSSWALK/NOT REPORTED TO THE IHCP. PLEASE VERIFY AND RESUBMIT.
1121 THE RENDERING PROVIDER NPI SUBMITTED IS REPORTED TO MULTIPLE LPIS. RESUBMIT THE CLAIM WITH THE TAXONOMY OF THE RENDERING PROVIDER IN ADDITION TO THE RENDERING NPI.
1122 MISSING/INCOMPLETE/INVALID RENDERING PROVIDER INDENTIFIER
1127 THE RENDERING NPI SUBMITTED ON THE CLAIM DOES NOT CROSSWALK TO THE RENDERING LPI SUBMITTED ON THE CLAIM.
1128 THE RENDERING NPI DOES NOT CROSSWALK TO AN LPI.
1129 THE RENDERING NPI CROSSWALKS TO MULTIPLE MEDICAID ID'S. RESUBMIT THE CLAIM WITH THE RENDERING PROVIDER IN ADDITION TO THE RENDERING NPI.
1130 THE ORDERING/REFERRING PROVIDER IS NOT ENROLLED IN THE IHCP PROGRAM.
1131 ORDERING/REFERRING PROVIDER IS NOT ENROLLED IN THE IHCP PROGRAM
1132 SPECIALTY 120 OR 212 MISSING OR INVALID REFERRING NPI
1140 THE ATTENDING PHYSICIAN NPI IS SUBMITTED ON THE CLAIM, BUT HAS NOT BEEN REPORTED TO THE IHCP.
1141 THE ATTENDING PHYSICIAN NPI IS REPORTED TO MULTIPLE MEDICAID IDS. RESUBMIT THE CLAIM WITH THE TAXONOMY OF THE ATTENDING PHYSICIAN IN ADDITION TO THE ATTENDING NPI.
1142 MISSING/INCOMPLETE/INVALID ATTENDING PROVIDER IDENTIFIER.
1147 THE ATTENDING PHYSICIAN NPI DOES NOT CROSSWALK TO THE LPI ASSOCIATED WITH THE LICENSE NUMBER SUBMITTED.
1150 THE OPERATING PHYSICIAN NPI HAS NOT BEEN REPORTED TO THE IHCP.
1151 THE OPERATING PHYSICIAN NPI IS REPORTED TO MULTIPLE MEDICAID IDS. RESUBMIT THE CLAIM WITH THE TAXONOMY OF THE OPERATING PHYSICIAN IN ADDITION TO THE OPERATING NPI.
1152 THE OPERATING PHYSICIAN LICENSE NUMBER IS SUBMITTED WITHOUT THE NPI.
1157 THE OPERATING PHYSICIAN NPI DOES NOT CROSSWALK TO THE LPI ASSOCIATED WITH THE LICENSE NUMBER SUBMITTED.
1160 THE PRESCRIBER NPI SUBMITTED ON THE CLAIM IS NOT ON FILE. PLEASE CONTACT THE PRESCRIBER TO VERIFY NUMBER AND RESUBMIT.
1161 THE SERVICE PROVIDER ID QUALIFIER SUBMITTED ON THE CLAIM IS NOT EQUAL TO O1. PLEASE VERIFY AND RESUBMIT.
1162 THE PRESCRIBER ID QUALIFIER SUBMITTED ON THE CLAIM IS NOT EQUAL TO 01. PLEASE VERIFY AND RESUBMIT.
1163 THE SERVICE PROVIDER ID QUALIFIER SUBMITTED ON THE CLAIM IS MISSING. PLEASE VERIFY THAT THE QUALIFIER IS EQUAL TO "01" AND RESUBMIT.
1164 THE PRESCRIBER ID QUALIFIER SUBMITTED ON THE CLAIM IS MISSING. PLEASE VERIFY THAT THE QUALIFIER IS EQUAL TO "01" AND RESUBMIT.
1548 CLAIM DTL THROUGH DOS IS GREATER THAN THE ICN DATE
1564 POSSIBLE ADJUSTMENT TO DRG ASSIGNMENT AND/OR REIMBURSEMENT DUE TO THE PRESENCE OF HOSPITAL ACQUIRED CONDITIONS (HAC)
1962 THE CLASSIFICATION OF THE BILLING PROVIDER IS NOT VALID FOR THE ENTIRE DOS ON THE CLAIM. PLEASE VERIFY AND RESUBMIT.
1964 THE BILLING PROVIDER SUBMITTED ON THE CLAIM IS NOT AUTHORIZED TO BE THE BILLING PROVIDER.
1980 THE CLAIM WAS BILLED WITH A REVENUE CODE THAT REQUIRES THE NURSING FACILITY TO BE IN THE GROUPS OF SCU OR VENTILATOR PROVIDERS
1996 THE RENDERING PROVIDER HAS NOT BEEN ENROLLED WITHIN THE INDIANA HEALTH COVERAGE PROGRAMS.
1997 THIS CLAIM WAS BILLED WITH A RENDERING PROVIDER NUMBER FROM THE PREVIOUS MEDICAID SYSTEM. PLEASE BILL FUTURE CLAIMS WITH THE PROVIDER NUMBER ASSIGNED DURING THE REENROLLMENT PROCESS.
1998 THE BILLING PROVIDER HAS NOT BEEN ENROLLED WITHIN THE INDIANA HEALTH COVERAGE PROGRAMS.
1999 THIS CLAIM WAS BILLED WITH A BILLING PROVIDER NUMBER FROM THE PREVIOUS INDIANA HEALTH COVERAGE PROGRAM. PLEASE BILL FUTURE CLAIMS WITH THE PROVIDER NUMBER ASSIGNED DURING REENROLLMENT PROCESS.
2000 THE GENDER OF THE MEMBER IS NOT ON FILE. PLEASE CONTACT THE COUNTY CASEWORKER TO UPDATE THE MEMBER'S FILE.
2001 MEMBER NUMBER NOT ON FILE. PLEASE VERIFY NUMBER AND RESUBMIT.
2002 DISPENSED DATE PRIOR TO INDIANA HEALTH COVERAGE PROGRAMS ELIGIBILITY DATE
2003 MEMBER NOT ELIGIBLE FOR INDIANA HEALTH COVERAGE PROGRAM BENEFITS FOR DATES OF SERVICE.
2004 MEMBER NOT ELIGIBLE FOR INDIANA HEALTH COVERAGE PROGRAM BENEFITS FOR DATES OF SERVICE.
2005 THIS SERVICE IS NOT PAYABLE FOR PREGNANT AND URGENT CARE ONLY MEMBER'S WITH THE INDICATED DIAGNOSIS.
2006 DIAGNOSIS CODE BILLED IS NOT COVERED FOR THE MEMBER'S BENEFIT PLAN.
2007 QUALIFIED MEDICARE BENEFICIARY (QMB) MEMBER-PLEASE BILL MEDICARE FIRST.
2008 MEMBER NOT ELIGIBLE FOR THIS LEVEL OF CARE FOR DATES OF SERVICE.
2009 MEMBER NOT ELIGIBLE FOR INDIANA HEALTH COVERAGE PROGRAM BENEFITS FOR DATES OF SERVICE.
2010 EMERGENCY SERVICE ONLY MEMBERS ARE ELIGIBLE FOR A PAYMENT ONLY FOR EMERGENCY SERVICES.
2011 MEDICAL AND NON-MEDICAL SUPPLIES AND ROUTINE DME ITEMS ARE COVERED IN THE PER DIEM RATE PAID TO THE LONG TERM CARE FACILITY AND MAY NOT BE BILLED SEPARATELY TO THE IHCP.
2012 THIS SERVICE IS NOT PAYABLE FOR PREGNANT & URGENT CARE MEMBER'S WITH THE INDICATED DIAGNOSIS.
2013 MEMBER NOT ELIGIBLE FOR THIS LEVEL OF CARE FOR DATES OF SERVICE.
2014 PERSONAL RESOURCES COLLECTED DOES NOT AGREE WITH AMOUNT REPORTED BY COUNTY OFFICE. LIABILITY AMOUNT DEDUCTED FROM YOUR CLAIM WAS BASED ON THE AMOUNT REPORTED BY THE COUNTY OFFICE.
2015 THE MEMBER'S AGE IS INVALID FOR THE ADMIT DATE-PLEASE VERIFY AND RESUBMIT.
2016 THE MEMBER'S AGE IS INVALID FOR THE DISCHARGE DATE-PLEASE VERIFY AND RESUBMIT.
2017 THE MEMBER IS ENROLLED IN RISK BASED MANAGED CARE. PLEASE SUBMIT TO APPROPRIATE RISK BASED MANAGED CARE PROCESSOR..
2018 THE MEMBER IS ENROLLED IN THE RISK BASED MANAGED CARE PORTION OF THE HOOSIER HEALTHWISE PROGRAM. THE MEMBER MUST SEEK CARE FROM THE APPROPRIATE MANAGED CARE ORGANIZATION.
2019 MEMBER IS NOT ELIGIBLE FOR INDIANA HEALTH COVERAGE PROGRAM BENEFITS.
2020 NO DATA ON PAS FILE FOR DIAGNOSIS OR CONDITION BILLED.
2021 ALLOWED DAYS ON THE PAS FILE FOR THE SERVICE BILLED IS 0.
2022 MEMBER NOT ENROLLED WITH BILLING MANAGED CARE ORGANIZATION.
2023 THE MEMBER IS ENROLLED IN THE HOOSIER HEALTHWISE FOR PERSONS WITH DISABILITIES PROGRAM.
2024 MEMBER NOT ELIGIBLE FOR THIS HOSPICE LEVEL OF CARE FOR THE DATES OF SERVICE.
2025 HOSPICE MEMBER BILLING FOR NON-HOSPICE SERVICES.
2026 MEMBER NOT ELIGIBLE FOR THIS LEVEL OF CARE FOR THE DATES OF SERVICE AND REVENUE CODES BILLED.
2027 HOSPICE MEMBER BEING BILLED FOR NON-HOSPICE SERVICES.
2028 THE CURRENT CLAIM HAS BEEN DENIED BY THE MCE. CLAIM WILL BE IN FULL FAILURE.
2029 MEMBER NOT ELIGIBLE FOR IHCP BENEFITS FOR DATES OF SERVICE.
2031 ONLY FREESTANDING AND DPU FACILITIES ARE ALLOWED TO BILL LEAVE DAYS ON INPATIENT PSYCHIATRIC CLAIMS.
2032 ONLY THERAPEUTIC AND HOSPITAL LEAVE DAYS MAY BE BILLED ON INPATIENT PSYCHIATRIC CLAIMS.
2033 INVALID CLAIM TYPE FOR THE PROGRAM BILLED
2034 MEDICAL AND NON-MEDICAL SUPPLIES AND ROUTINE DME ITEMS ARE COVERED IN THE PER DIEM RATE PAID TO THE LONG TERM CARE FACILITY AND MAY NOT BE BILLED SEPARATELY TO THE IHCP.
2035 PKG C/590 MEMBER NOT ELIGIBLE FOR WAIVER SERVICES
2036 MEMBER INELIGIBLE FOR TARGETED CASE MANAGEMENT
2037 THE MEMBER ID IS VALID BUT IS INACTIVE. PLEASE VERIFY AND RESUBMIT.
2039 MRT AND PASRR CLAIMS SUBMITTED TO PAYER PRIOR TO MRT OR PASRR IMPLEMENTATION DATE OF 6/10/05.
2040 THE MEMBER HAS EXCEEDED THEIR ANNUAL INDIVIDUAL MAXIMUM REIMBURSEMENT LIMITATION OF $300,000.00. PROVIDERS SHALL NOT BE REIMBURSED FOR ANY PORTION OF THE REIMBURSEMENT RATE FOR COVERED SERVICES THAT IS IN EXCESS OF THE ANNUAL OR MAXIMUM COVERAGE LIMITATION.
2041 THE MEMBER HAS EXCEEDED THEIR LIFETIME INDIVIDUAL MAXIMUM REIMBURSEMENT LIMITATION OF $1,000,000.00. PROVIDERS SHALL NOT BE REIMBURSED FOR ANY PORTION OF THE REIMBURSEMENT RATE FOR COVERED SERVICES THAT IS IN EXCESS OF THE ANNUAL OR MAXIMUM COVERAGE LIMITATION.
2042 THE MEMBER IS ENROLLED IN THE HEALTHY INDIANA PLAN. PLEASE SUBMIT CLAIM TO THE APPROPRIATE INSURER FOR THE MEMBER'S DATE OF SERVICE.
2043 THE MEMBER IS ENROLLED IN THE HEALTHY INDIANA PLAN. PLEASE SUBMIT CLAIM TO THE APPROPRIATE INSURER FOR THE MEMBER'S DATE OF SERVICE
2044 EMERGENCY SERVICES ONLY MEMBERS ARE ELIGIBLE FOR A PAYMENT ONLY FOR EMERGENCY SERVICES.
2045 EMERGENCY SERVICES ONLY MEMBERS ARE ELIGIBLE FOR A PAYMENT ONLY FOR EMERGENCY SERVICES.
2047 MEMBERS ARE ELIGIBLE FOR DENTAL EMERGENCY SERVICES ONLY AS LISTED IN IHCP PROVIDER MODULE - DENTAL SERVICES
2048 THE CLAIM SUBMITTED IS DENIED BECAUSE THE SSN FOLLOWING THE 850 DOES NOT MATCH OUR RECORDS. PLEASE VERIFY AND RESUBMIT.
2049 THE CLAIM SUBMITTED IS DENIED BECAUSE THE SSN FOLLOWING THE 800 DOES NOT MATCH OUR RECORDS. PLEASE VERIFY AND RESUBMIT.
2050 PE MBR INVALID FOR DATES OF SERVICE.
2051 PE RID INVALID FOR DATES OF SERVICE. PLEASE VERIFY ELIGIBILITY AND RESUBMIT WITH APPROPRIATE MEMBER ID.
2053 CLAIM TYPES NOT COVERED FOR PE MEMBERS
2054 SERVICES FOR THESE ITEMS SHOULD NOT BE REIMBURSED BY THE MCO/HIP PLAN
2055 THE CLAIM HAS BEEN DENIED. PLEASE RESUBMIT THE MEDICARE ADVANTAGE PLAN CLAIM AS A CROSSOVER CLAIM FOR REIMBURSEMENT CONSIDERATION.
2057 DIAGNOSIS NOT COVERED FOR THE MEMBER'S BENEFIT PLAN
2058 FAMILY PLANNING PROCEDURE/NDC REQUIRED AND/OR FAMILY PLANNING DIAGNOSIS NOT SUBMITTED IN PRIMARY POSITION
2059 INVALID CLAIM TYPE FOR FAMILY PLANNING SERVICES
2060 SERVICES BILLED IS NOT COVERED AS A FAMILY PLANNING SERVICE BENEFIT
2061 RESERVED FOR 1915I CHILD MEMBER RESTRICTED TO PROCEDURE CODES
2064 MEMBER AID CATEGORY NOT FOUND FOR THE DATE OF SERVICE.
2065 The member has been identified as being enrolled in the Non-Emergency Medical Transportation assignment plan. The claim should be billed to the NEMT broker.
2070 Cutback EOB for claims when sufficient funds are not available to pay the full amount
2071 HIP Bridge Account Balance is Zero
2072 The Member's HIP Bridge Account is Locked. Please resubmit the claim for processing.
2100 INVALID MEMBER ID FOR IHCP. CLAIM WILL BE FORWARDED TO HCI PROGRAM FOR PAYMENT.
2101 THE HCI CLAIM HAS BEEN SUBMITTED FOR AN IHCP-ELIGIBLE MEMBER. PLEASE CALL THE HCI PROGRAM AT (317)232-4320 TO VOID THIS CLAIM AND REBILL AS AN IHCP PROGRAM CLAIM.
2440 TEST FOR MEDICARE D (TINA KILLION)
2500 THIS MEMBER IS COVERED BY MEDICARE PART A; THEREFORE, YOU MUST FIRST FILE CLAIMS WITH MEDICARE.
2501 THIS MEMBER IS COVERED BY MEDICARE PART A; THEREFORE, YOU MUST FIRST FILE CLAIMS WITH MEDICARE.
2502 THIS MEMBER IS COVERED BY MEDICARE PART B OR MEDICARE D; THEREFORE, YOU MUST FIRST FILE CLAIMS WITH MEDICARE. IF ALREADY SUBMITTED TO MEDICARE, PLEASE SUBMIT YOUR EOMB.
2503 THIS MEMBER IS COVERED BY MEDICARE PART B OR MEDICARE D; THEREFORE, YOU MUST FIRST FILE CLAIMS WITH MEDICARE.
2504 THIS MEMBER IS COVERED BY PRIVATE INSURANCE WHICH MUST BE BILLED PRIOR TO MEDICAID.
2505 THIS MEMBER IS COVERED BY PRIVATE INSURANCE WHICH MUST BE BILLED PRIOR TO MEDICAID.
2506 THE MEDICARE EOMB INDICATES THAT THE CLAIM WAS FORWARDED TO AN OTHER INSURANCE COMPANY. YOU MUST ATTACH AN EOB FROM THE OTHER INSURANCE COMPANY, PLUS THE MEDICARE EOMB FOR PAYMENT.
2507 THE MEDICARE EOMB REMARK CODE INDICATES THAT THIS CLAIM WAS EITHER DENIED FOR INAPPROPRIATE BILLING, PENDED FOR FURTHER REVIEW, OR COVERED BY ANOTHER INSURANCE COMPANY. YOU MUST ATTACH FINAL RESOLUTION FROM MEDICARE OR THE OTHER INSURANCE COMPANY FOR PAYMENT.
2508 YOUR SERVICE HAS BEEN DENIED. THE CODE BILLED TO MEDICAID WAS NOT THE CODE BILLED TO THE PRIMARY CARRIER/INSURER.
2509 MEDICAID DOES NOT COVER SERVICES THAT ARE DENIED BY THE PRIMARY CARRIER FOR NO AUTHORIZATION FOR OUT OF NETWORK PROVIDERS.
2510 MEMBER IS ELIGIBLE FOR MEDICARE B/D
2511 PACE SERVICES ARE PAID UNDER CAP AGREEMENT
2517 PROVIDER SHOULD CORRECT CLAIM AND REBILL TO PRIMARY PAYER
2518 MEDICAID PAYMENT IS ZERO DUE TO THE PRIMARY PAYMENT AMOUNT EXCEEDING OR EQUALING THE MEDICAID ALLOWABLE AMOUNT
2600 CLAIM DENIED BECAUSE THERE IS MISSING INFORMATION OR THE 8A FORM IS NOT SIGNED
2937 SERVICE MUST BE BILLED ON A MEDICAL CLAIM FORM
2999 THIS CLAIM HAS BEEN BILLED WITH A MEMBER IDENTIFICATION NUMBER WHICH IS NO LONGER ACTIVE FOR BILLING PURPOSES. PLEASE UPDATE YOUR RECORDS.
3000 PAYMENT FOR THIS SERVICE HAS BEEN DENIED OR CUTBACK DUE TO UNITS BILLED EXCEEDING THE UNITS PRIOR AUTHORIZED.
3001 DATES OF SERVICE NOT ON THE P.A. MASTER FILE.
3002 NDC REQUIRES PRIOR AUTHORIZATION, NO APPROVED PA ON FILE.
3003 PROCEDURE CODE REQUIRES PRIOR AUTHORIZATION, NO APPROVED PA ON FILE.
3004 THIS CLAIM COVERS MULTIPLE MONTHS AND SPENDDOWN/HCBS WAIVER LIABILITY HAS NOT BEEN MET FOR ALL MONTHS BILLED ON THE CLAIM.
3005 THIS CLAIM COVERS MULTIPLE MONTHS AND SPENDDOWN/HCBS WAIVER LIABILITY HAS NOT BEEN MET FOR ALL MONTHS BILLED ON THE CLAIM.
3006 PAYMENT FOR THIS SERVICE HAS BEEN DENIED OR CUTBACK DUE TO DOLLARS BILLED EXCEEDING THE DOLLARS PRIOR AUTHORIZED.
3007 NO PRIOR AUTHORIZATION SEGMENT ON FILE FOR THE LEVEL OF CARE.
3008 THERE ARE NO UNITS PRIOR AUTHORIZED ON FILE FOR LEVEL OF CARE.
3009 THIS SERVICE IS NOT PAYABLE, MEMBER IS QMB ALSO AND SPENDDOWN HAS NOT BEEN MET FOR ALL MONTHS BILLED. ONLY REIMBURSEMENT FOR MEDICARE CO-INSURANCE AND DEDUCTIBLE IS AVAILABLE. BILL MEDICARE FIRST.
3010 NON-EMERGENCY OUT OF STATE SERVICES REQUIRE PRIOR AUTHORIZATION.
3011 NON EMERGENCY OUT-OF-STATE SERVICES REQUIRE PRIOR AUTHORIZATION.
3012 TRANSPORTATION EXCEEDING FIFTY MILES REQUIRES PA
3013 DATES OF SERVICE NOT ON P.A. MASTER FILE.
3015 LONG TERM CARE SERVICES PROVIDED OUTSIDE OF INDIANA ARE NON COVERED SERVICES.
3016 HOME HEALTH SERVICES PROVIDED OUTSIDE OF INDIANA ARE NON COVERED SERVICES.
3017 THIS NDC IS NON-PREFERRED ON THE INDIANA MEDICAID PREFERRED DRUG LIST. PRIOR AUTHORIZATION REQUIRED. PLEASE HAVE THE PRESCRIBER CONTACT ACS AT (866)879-0106 FOR PRIOR AUTHORIZATION.
3018 CLAIM SPANS MULTIPLE SPENDDOWN/HCBS WAIVER LIABILITY PERIODS AND SD/WL NOT MET FOR EACH MONTH FOR DIABETIC SUPPLIES.
3019 DATES OF SERVICE FOR SERVICE BILLED NOT ON THE P.A. MASTER FILE. PLEASE REFER TO BULLETIN BT200514, FOR APPROPRIATE BILLING OF MRT SERVICES. PRIOR AUTHORIZATION MAY BE OBTAINED FROM THE MRT UNIT BY CONTACTING (317)-232-2028 (MEDICAL) OR (317) 233-5725 (PSYCHIATRIC).
3020 BRAND NAME MEDICALLY NECESSARY REQUIRES PA, CALL ACS 8668790106
3021 THIS NDC IS NON-PREFERRED ON THE INDIANA MEDICAID PREFERRED DRUG LIST. PRIOR AUTHORIZATION REQUIRED. OMEPRAZOLE 20MG IS PREFERRED OR HAVE PRESCRIBER CONTACT ACS AT (866)879-0106 FOR PRIOR AUTHORIZATION.
3022 THIS NDC IS NON-PREFERRED ON THE INDIANA MEDICAID PREFERRED DRUG LIST. PRIOR AUTHORIZATION REQUIRED. BRAND NAME IS PREFERRED OR HAVE THE PRESCRIBER CONTACT ACS AT (866)879-0106 FOR PRIOR AUTHORIZATION.
3023 THE UPC BILLED IS NON-REIMBURSABLE. PLEASE BILL APPROPRIATE NDC FOR REIMBURSEMENT.
3024 PRIOR AUTHORIZATION REQUIRED FOR A 15 DAY SUPPLY OR MORE OF AN ATYPICAL ANTIPSYCHOTIC MEDICATION. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3025 PRIOR AUTHORIZATION REQUIRED FOR 2 OR MORE OF AN ATYPICAL ANTIPSYCHOTIC MEDICATION. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION. THE USE OF TWO TYPICAL ANTIPSYCHOTICS FOR MORE THAN 60 OF THE PAST 70 DAYS AND ABSENCE OF APPROVAL CRITERIA.
3026 PRIOR AUTHORIZATION REQUIRED FOR DUPLICATE THERAPY OF SSRI AND SNRI ANTI-DEPRESSANT MEDICATIONS. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3027 PRIOR AUTHORIZATION REQUIRED FOR 2 OR MORE OF A TYPICAL ANTIPSYCHOTIC MEDICATION. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION. THE USE OF TWO TYPICAL ANTIPSYCHOTICS FOR MORE THAN 60 OF THE PAST 70 DAYS AND ABSENCE OF APPROVAL CRITERIA.
3028 MRO SERVICE UNITS EXCEED BENEFIT(S)
3029 BENEFITS NOT ELIGIBLE FOR MRO DATES OF SERVICE
3030 PRIOR AUTHORIZATION REQUIRED TO PROMOTE PRUDENT PRESCRIBING OF DRONABINOL. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3031 PRIOR AUTHORIZATION REQUIRED DUE TO OPIATE OVERUTILIZATION. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3032 PRIOR AUTHORIZATION REQUIRED TO PROMOTE PRUDENT PRESCRIBING OF LIDODERM PATCH. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3033 PRIOR AUTHORIZATION REQUIRED TO PROMOTE PRUDENT PRESCRIBING. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3034 THIS NDC IS NON-PREFERRED ON THE INDIANA MEDICAID PREFERRED DRUG LIST. PRIOR AUTHORIZATION IS NOT REQUIRED.
3035 PRIOR AUTHORIZATION REQUIRED FOR FENTANYL PATCHES FOR MEMBERS WITH NO HISTORY OF AN NPO CODE OR DYSPHAGIA IN THE PAST 6 MONTHS OR PROVIDER SUPPLIED INFORMATION THAT THE PATIENT IS NPO.
3036 PRIOR AUTHORIZATION REQUIRED FOR NON-PREFERRED, SHOR-ACTING OPIATE PRODUCTS. TRIAL OF AT LEAST 2 DIFFERENT PREFERRED SHOR-ACTING PRODUCTS (2 DIFFERENT INGREDIENTS) IN THE PAST 6 MONTHS REQUIRED
3037 PRIOR AUTHORIZATION REQUIRED FOR NON-PREFERRED, LONG-ACTING OPIATE PRODUCTS. TRIAL OF AT LEAST 2 DIFFERENT PREFERRED LONG-ACTING PRODUCTS (2 DIFFERENT INGREDIENTS) IN THE PAST 6 MONTHS REQUIRED.
3038 PRIOR AUTHORIZATION REQUIRED FOR PREFERRED, BRAND, LONG-ACTING OPIATE PRODUCTS. TRIAL OF AT LEAST 2 DIFFERENT PREFERRED, GENERIC LONG-ACTING PRODUCTS (2 DIFFERENT INGREDIENTS) IN THE PAST 6 MONTHS REQUIRED.
3039 THIS NDC IS NON-PREFERRED ON THE INDIANA MEDICAID PREFERRED DRUG LIST. PRIOR AUTHORIZATION IS NOT REQUIRED.
3040 PRIOR AUTHORIZATION IS REQUIRED DUE TO THE USE OF TWO STIMULANTS FOR MORE THAN 60 OF THE PAST 70 DAYS AND ABSENCE OF APPROVAL CRITERIA. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3041 PRIOR AUTHORIZATION IS REQUIRED DUE TO THE AVERAGE DAILY DOSE LESS THAN THE MINIMUM EFFECTIVE DOSE AND ABSENCE OF APPROVAL CRITERIA. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3042 PRIOR AUTHORIZATION REQUIRED FOR EFFIENT. HISTORY, AGE, CONCOMBINANT THERAPY OR DIAGNOSIS REQUIREMENT NOT MET.
3043 PRIOR AUTHORIZATION REQUIRED FOR CHANTIX. PATIENT MUST BE >/= 18 YEARS OF AGE, HAVE LESS THAN 12 WEEKS OF SMOKING CESSATION THERAPY IN THE PAST 365 DAYS AND NOT BE ON CURRENT NICOTINE REPLACEMENT THERAPY.
3044 PRIOR AUTHORIZATION IS REQUIRED DUE TO THE USE OF TWO SEDATIVE-HYPNOTICS OR BENZODIAZEPINES FOR MORE THAN 60 OF THE PAST 70 DAYS AND ABSENCE OF APPROVAL CRITERIA. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION
3045 PRIOR AUTHORIZATION REQUIRED FOR COX2/BRAND NSAIDS DUE TO REQUIREMENTS NOT MET.
3046 PRIOR AUTHORIZATION REQUIRED TO PROMOTE PRUDENT PRESCRIBING OF TARGETED IMMUNOMODULATORS. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3047 PRIOR AUTHORIZATION REQUIRED TO PROMOTE PRUDENT PRESCRIBING OF URINARY TRACT ANTISPASMODICS. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3048 PRIOR AUTHORIZATION REQUIRED FOR PULMONARY HYPERTENSIVE. DIAGNOSIS OF PULMONARY HYPERTENSION IS REQUIRED.
3049 PRIOR AUTHORIZATION REQUIRED FOR BILE ACID SEQUESTRANT
3165 NUMBER OF UNITS BILLED EXCEEDS THE NUMBER OF UNITS UNUSED
3166 RESERVED FOR 1915I CHILD PA RESTRICTION
3172 PRIOR AUTHORIZATION REQUIRED FOR MEMBERS WITH NO DIAGNOSIS OF MULTIPLE SCLEROSIS. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3173 PRIOR AUTHORIZATION IS REQUIRED FOR MORE THAN 1 KIT IN THE PAST 28 DAYS AND ABSENCE OF APPROVAL CRITERIA. PLEASE HAVE A PRESCRIBER CALL ACS AT 866-879-0106.
3174 PRIOR AUTHORIZATION IS REQUIRED FOR MORE THAN 1 KIT IN THE PAST 30 DAYS AND ABSENCE OF APPROVAL CRITERIA. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3175 PRIOR AUTHORIZATION REQUIRED FOR BRAND NAME ANTICONVULSANTS. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3176 PRIOR AUTHORIZATION REQUIRED FOR MEMBERS WITH NO DIAGNOSIS OF A SEIZURE DISORDER. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3179 PRIOR AUTHORIZATION REQUIRED FOR AROMATASE INHIBITORS FOR MEMBERS WITH NO DIAGNOSIS OF METASTATIC BREAST CANCER. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3180 PRIOR AUTHORIZATION REQUIRED FOR AMPYRA FOR MEMBERS WITH HISTORY OF USE WITHIN THE PAST 100 DAYS. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3181 PRIOR AUTHORIZATION REQUIRED FOR MS AGENTS WHEN NOT PRESCRIBED BY A NEUROLOGIST. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3182 PRIOR AUTHORIZATION IS REQUIRED FOR MORE THAN 2 TABS PER DAY AND ABSENCE OF APPROVAL CRITERIA. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3183 PRIOR AUTHORIZATION REQUIRED FOR MEMBERS WITH NO DIAGNOSIS OF CROHNS DISEASE IN THE PAST 2 YEARS. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3185 TRIAL OF AT LEAST 28 DAYS OF THERAPY WITH AT LEAST 2 PREFERRED MS AGENTS WITHIN THE LAST 12 MONTHS IS REQUIRED. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3186 TRIAL OF AT LEAST 28 DAYS OF THERAPY WITH BETASERON WITHIN THE PAST 180 DAYS IS REQUIRED. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3188 PRIOR AUTHORIZATION IS REQUIRED FOR MORE THAN 1 CAP PER DAY AND ABSENCE OF APPROVAL CRITERIA. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3190 PRIOR AUTHORIZATION IS REQUIRED FOR MEMBERS WITH NO HISTORY OF DRUG WITHIN SAME THERAPEUTIC CLASS IN THE PAST 30 DAYS. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3191 PRIOR AUTHORIZATION REQUIRED DUE TO MEMBER'S AGE. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3192 PRIOR AUTHORIZATION REQUIRED FOR MEMBERS WITH NO HISTORY OF REQUIRED DIAGNOSIS. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3193 PRIOR AUTHORIZATION REQUIRED FOR MEMBERS WITH NO HISTORY OF REQUIRED THERAPY. PLEASE HAVE PRESCRIBER CALL XEROX AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3194 PRIOR AUTHORIZATION REQUIRED FOR BRILINTA. DIAGNOSIS OF UNSTABLE ANGINA, ST SEGMENT MYOCARDIAL INFARCTION, OR NON-ST SEGMENT MYOCARDIAL INFARCTION AND USAGE OF ASPIRIN 75-100MG IN THE PAST 100 DAYS REQUIRED.
3195 PRIOR AUTHORIZATION REQUIRED FOR LEUKOTRIENE. DIAGNOSIS, AGE, CONCOMITANT THERAPY OR INTOLERANCE REQUIREMENT NOT MET.
3196 PRIOR AUTHORIZATION IS REQUIRED FOR MEMBERS WITH NO HISTORY OF AN APPROVED DPN AGENT IN THE PAST 30 DAYS. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3197 PRIOR AUTHORIZATION REQUIRED DUE TO LIMITATION EXCEEDED. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION
3198 PRIOR AUTHORIZATION REQUIRED FOR BUTRANS PATCHES. PATIENT MUST HAVE A DIAGNOSIS OF MODERATE TO SEVERE PAIN WITH NEED FOR AROUND-THE-CLOCK ANALGESIA FOR AN EXTENDED PERIOD, AND PATIENTS MUST BE NPO OR HAVE DYSPHAGIA.
3199 PRIOR AUTHORIZATION REQUIRED DUE TO DOSE LIMITATION. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3200 PRIOR AUTHORIZATION IS REQUIRED FOR MORE THAN 1 TAB PER DAY AND ABSENCE OF APPROVAL CRITERIA. PLEASE HAVE PRESCRIBER CALL ACS AT 866-879-0106 FOR PRIOR AUTHORIZATION.
3317 THE PROCEDURE BILLED ON THIS DETAIL IS INCLUDED IN THE COMPOSITE RATE REVENUE CODE.
3318 ESRD PROCEDURE REQUIRES ATTACHMENT INDICATING MEDICAL NECESSITY.
3324 THE MODIFIDER BILLED IS NON-COVERED DUE TO CMS TERMINATION
3337 NON-COVERED PROCEDURE DUE TO CMS TERMINATION
3338 SERVICE IS NON COVERED UNDER THE INDIANA HEALTH COVERAGE PROGRAMS
3363 The MCE ID submitted on the encounter claim is not the assigned MCE for the member for the date of service billed. Please verify and resubmit.
3370 Sum of all payors amount is zero for the COB field for the encounter claim. Please verify and resubmit.
3371 The service submitted for the FQHC/RHC encounter claim is not payable when billed with a Notice of Pregnancy (NOP).
3372 Calculated Wrap Around payment amount is zero.
3373 Deny FQHC/RHC claim with T1015 or D9999 procedure code when all other details are submitted with invalid Place of service for FQHC/RHC
3419 ROUTINE FOOT CARE TREATMENTS ARE LIMITED TO SPECIFIC DIAGNOSIS CODES.
3428 Telemedicine services require place of service 02 or 10 and modifier 93 or 95
3429 Inpatient claim has exceeded 60 days of hospital stay.
3436 CASH RECEIPT APPLIED TO PRINCIPAL. DECREASE TO THIS ACCOUNTS RECEIVABLE.
3728 NO PRICING FOUND FOR THE PROCEDURE CODE BASED ON THE MEMBER'S AGE
3758 DIAGNOSIS GROUP RESTRICTION ON PROCEDURE/REVENUE RULE DOES NOT MATCH THE MEMBER BENEFIT PLAN.
3766 NO REIMBURSEMENT RULE FOUND FOR THE PROCEDURE/REVENUE CODE COMBINATION.
3771 MEMBER NOT ELIGIBLE TO RECEIVE SERVICES UNDER THIS BENEFIT PLAN.
3930 PAYMENT IS NOT ALLOWED FOR THE RENDERING OR BILLING PROVIDER TYPE/SPECIALTY PERFORMING THE SERVICE.
4000 MORE THAN TWO SURGICAL UNITS ON THE CLAIM.
4001 A NON-ANESTHESIOLOGIST MAY NOT BILL MEDICAL DIRECTION,
4002 NDC/HRI/UPC INDICATES A NON-REIMBURSABLE ITEM ON DATE OF SERVICE
4003 LESS THAN EFFECTIVE DRUGS ARE NOT COVERED UNDER INDIANA HEALTH COVERAGE PROGRAM
4004 THIS NDC IS NOT ON FILE. PLEASE VERIFY THAT THE NDC WAS FILED CORRECTLY.
4005 THE SUBMITTED CHARGE IS MORE THAN FIVE (5) TIMES THE ALLOWED RATE.
4006 PAID AS BILLED.
4007 NON-COVERED NDC DUE TO CMS TERMINATION - CLAIMS WITH AN NDC THAT HAS BEEN TERMINATED BY CMS, WILL NOT BE REIMBURSABLE
4008 DIAGNOSIS CODE INDICATING POSITIVE OR NEGATIVE RESULTS OF TEST DONE FOR HEALTHWATCH SCREEN IS NEEDED.
4009 DRUG CHARGE LESS THAN 12.5% OF CALCULATED ALLOWED. PLEASE VERIFY THE BILLED QUANTITIES AND CHARGE AMOUNT.
4010 THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THIS BILLING.
4011 INVALID MODIFIER COMBINATION.
4012 CLAIM DENIED FOR ADDITIONAL INFORMATION. IF THE ABORTION WAS PERFORMED FOR THERAPEUTIC OR OTHER INDIANA HEALTH COVERAGE PROGRAM APPROVED PURPOSES, PLEASE RESUBMIT THE CLAIM WITH A PHYSICIAN CERTIFICATION FORM AND MEDICAL RECORD DOCUMENTATION (H & O, DISCHARGE SUMMARY, OP NOTE).
4013 THIS PROCEDURE CODE IS NOT COVERED FOR THIS DATE OF SERVICE.
4014 CLAIM BEING REVIEWED FOR PRICING
4015 THIS CLAIM SHOULD BE SUBMITTED TO IFSSA'S LEVEL OF CARE UNIT. PLEASE VERIFY AND RESUBMIT.
4016 Transportation mileage procedure code is required when waiting time is billed. Please verify and resubmit.
4017 WAITING TIME IS NOT PAYABLE W/LESS THAN 50 MILES
4018 A SECONDARY DIAGNOSIS CODE IS REQUIRED TO INDICATE REFERRED CONDITION WHEN BILLING WITH Z8 MODIFIER. PLEASE VERIFY AND RESUBMIT.
4019 ATTACHMENT REQUIRED FOR SERVICE RENDERED. PLEASE VERIFY AND RESUBMIT.
4020 UNITS BILLED EXCEED ALLOWABLE UNITS FOR THIS SERVICE.
4021 PROCEDURE CODE IS NOT COVERED FOR THE DATES OF SERVICE FOR THE PROGRAM BILLED. PLEASE VERIFY AND RESUBMIT.
4022 CLAIM DENIED FOR ADDITIONAL INFORMATION. IF THE ABORTION WAS PERFORMED FOR THERAPEUTIC OR OTHER INDIANA HEALTH COVERAGE PROGRAM APPROVED PURPOSES, PLEASE RESUBMIT THE CLAIM WITH A PHYSICIAN CERTIFICATION FORM AND MEDICAL RECORD DOCUMENTATION ( H & P, DISCHARGE SUMMARY, OP NOTE).
4023 NDC CODE NOT COMPATIBLE WITH MEMBERS GENDER. PLEASE VERIFY AND RESUBMIT.
4024 MAXIMUM NUMBER OF REFILLS HAS BEEN REACHED. PLEASE VERIFY AND RESUBMIT.
4025 NDC VS AGE RESTRICTION, NDC IS INAPPROPRIATE TO BE USED DUE TO MEMBERS AGE. PLEASE VERIFY AND RESUBMIT.
4026 NDC / DAYS SUPPLY LIMITATIONS. THIS NDC CODE BILLED MAY NOT BE GREATER THAN THE NUMBER OF DAYS ALLOW ON THE NDC FILE. PLEASE VERIFY AND RESUBMIT.
4027 THE DIAGNOSIS CODE IS INVALID OR NO LONGER EFFECTIVE FOR DATES OF SERVICE. PLEASE VERIFY AND RESUBMIT.
4028 DIAGNOSIS CODE NOT COMPATIBLE WITH MEMBER'S GENDER. PLEASE VERIFY AND RESUBMIT.
4029 DIAGNOSIS CODE VS. PLACE OF SERVICE RESTRICTION. DIAGNOSIS CODE IS INVALID PLACE OF SERVICE RESTRICTION. PLEASE VERIFY AND RESUBMIT.
4030 THE DIAGNOSIS GIVEN IS NOT COMPATIBLE WITH THE MEMBER'S AGE. PLEASE VERIFY AND RESUBMIT.
4031 DIAGNOSIS GIVEN NOT COMPATIBLE WITH MEMBER'S GENDER. PLEASE VERIFY AND RESUBMIT.
4032 THE PROCEDURE CODE BILLED IS NOT A VALID PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4033 THE MODIFIER USED IS NOT COMPATIBLE WITH THE PROCEDURE CODE BILLED. PLEASE VERIFY AND RESUBMIT.
4034 SERVICE BILLED NOT COMPATIBLE WITH MEMBER'S AGE. PLEASE VERIFY AND RESUBMIT.
4035 SERVICE BILLED NOT COMPATIBLE WITH MEMBER'S GENDER. PLEASE VERIFY AND RESUBMIT.
4036 THIS PROCEDURE IS NOT PAYABLE WHEN PERFORMED IN THIS PLACE OF SERVICE. PLEASE VERIFY AND RESUBMIT.
4037 THIS PROCEDURE IS NOT CONSISTENT WITH THE DIAGNOSIS BILLED. PLEASE VERIFY AND RESUBMIT.
4038 THIS SERVICE CANNOT BE PAID WITH THE DIAGNOSIS INDICATED. PLEASE VERIFY AND RESUBMIT
4039 THE DIAGNOSIS SUBMITTED AS PRINCIPAL DIAGNOSIS IS NOT VALID AS A PRINCIPAL DIAGNOSIS. PLEASE REFER TO ICD CODING GUIDELINES.
4040 THE PRIMARY DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4041 THE SECONDARY DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4042 THE THIRD DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4043 THE FOURTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4044 TREATMENT FOR THIS DIAGNOSIS IS NOT COVERED WHEN PERFORMED IN THE PLACE OF SERVICE BILLED. PLEASE VERIFY AND RESUBMIT.
4045 THE DIAGNOSIS CODE IS INVALID OR NOT COVERED FOR THE DATES OF SERVICE. PLEASE VERIFY AND RESUBMIT.
4046 THIS DATE OF SERVICE IS PRIOR TO THE PROCEDURE CODE EFFECTIVE. PLEASE VERIFY AND RESUBMIT.
4047 THE FIFTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4048 THE SIXTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4049 THE SEVENTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT
4050 THE EIGHTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4051 THE NINTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4052 THE ADMITTING DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4053 THE PRINCIPAL PROCEDURE CODE BILLED IS NOT A VALID ICD PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4054 THE FIRST OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4055 THE SECOND OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4056 THE THIRD OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4057 THE FOURTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4058 THE FIFTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4059 THE REVENUE CODE BILLED IS NOT A VALID REVENUE CODE. PLEASE VERIFY AND RESUBMIT.
4060 THE EXTERNAL CAUSE OF INJURY CODE BILLED IS NOT A VALID ICD CODE. PLEASE VERIFY AND RESUBMIT.
4061 THIS SERVICE IS NOT PAYABLE, MEMBER IS QMB AND THE SPENDDOWN/HCBS WAIVER LIABILITY HAS NOT BEEN MET FOR EACH MONTH BILLED. ONLY REIMBURSEMENT FOR MEDICARE COINSURANCE AND DEDUCTIBLE IS AVAILABLE. BILL MEDICARE FIRST.
4062 ORGAN TRANSPLANTS ARRE NON-COVERED FOR PACKAGE C. VERIFY AND RESUBMIT.
4063 THE ICD PROCEDURE CODE IS NOT COMPATIBLE WITH THE MEMBER'S AGE. PLEASE VERIFY AND RESUBMIT.
4064 ICD PROCEDURE CODE GIVEN NOT COMPATIBLE WITH MEMBER'S GENDER. PLEASE VE RIFY AND RESUBMIT.
4065 ICD PROCEDURE CODE BILLED REQUIRES AN ATTACHMENT. PLEASE VERIFY AND RESUBMIT.
4066 THIS ICD PROCEDURE CODE IS NOT PAYABLE WHEN USED TO TREAT THE DIAGNOSIS INDICATED. PLEASE VERIFY AND RESUBMIT.
4067 ICD CODE IS NOT EFFECTIVE FOR DOS. PLEASE VERIFY AND RESUBMIT.
4068 MILEAGE AND OTHER SERVICES WILL ONLY BE PAID WHEN BILLED WITH A PAID BASE RATE FOR THE SAME DATE OF SERVICE. PLEASE VERIFY AND RESUBMIT. IF MEDICARE DENIAL, PLEASE SUBMIT A COPY OF THE MEDICARE DENIAL.
4069 MILEAGE NOT PAYABLE FOR MULTIPLE PASSENGER WHEN BASE RATE IS NOT PRESENT.
4070 LOCALIZED SPINE SERIES XRAYS OR XRAYS OF THE JOINTS OR EXTREMITIES ARE REIMBURSABLE ONLY WHEN THE XRAY IS NECESSITATED BY A CONDITION RELATED DIAGNOSIS. THE DIAGNOSIS GIVEN DOES NOT JUSTIFY THE PROCEDURE BILLED.
4071 LABORATORY SERVICES ARE REIMBURSABLE ONLY WHEN THE SERVICE IS NECESSITATED BY A CONDITION RELATED DIAGNOSIS. THE DIAGNOSIS GIVEN DOES NOT JUSTIFY THE PROCEDURE BILLED.
4072 ICD PROCEDURE CODE NOT ALLOWED FOR CLAIM TYPE BILLED PER HIPAA REGULATIONS. PLEASE VERIFY AND RESUBMIT CLAIM AS APPROPRIATE.
4073 CERTIFICATION THAT HYSTERECTOMY WAS PERFORMED UNDER A LIFE THREATENING EMERGENCY SITUATION IS NEEDED. PLEASE RESUBMIT CLAIM WITH APPROPRIATE STATEMENT.
4074 INDIANA HEALTH COVERAGE PROGRAM REIMBURSEMENT IS NOT AVAILABLE FOR STERILIZATION UNLESS THE MEMBER IS 21 YEARS OF AGE OR OLDER AT THE TIME THE INFORMED CONSENT IS SIGNED.
4075 PLEASE RESUBMIT WITH A VALID STERILIZATION CONSENT FORM.
4076 TREATMENT FOR THIS DIAGNOSIS CODE IS NOT A COVERED BENEFIT FOR THE DATE OF SERVICE.
4077 The revenue code billed is not effective for this date of service. Please verify and resubmit.
4078 30 MINUTES OF WAITING TIME IS NOT REIMBURSABLE.
4079 WAITING TIME IS NOT REIMBURSABLE UNLESS THE MEMBER IS TRANSPORTED 50 MILES OR MORE ONE WAY-PLEASE VERIFY AND RESUBMIT.
4080 MILEAGE IS NOT REIMBURSABLE UNLESS THE MEMBER IS TRANSPORTED 11 MILES OR MORE ONE WAY-PLEASE VERIFY AND RESUBMIT.
4081 THE MAXIMUM ALLOWABLE PER DIEM HAS BEEN PAID. ANCILLARIES ARE INCLUDED IN THE ALL-INCLUSIVE PER DIEM RATE AND ARE NOT PAID SEPARATELY.
4082 BED RESERVATIONS IN AN INSTITUTION FOR MENTAL HEALTH DISEASE IS A NON-COVERED SERVICE FOR PACKAGE C. PLEASE VERIFY AND RESUBMIT.
4083 INPATIENT CARE RENDERED IN AN INSTITUTION FOR MENTAL HEALTH DISEASE IS NOT COVERED FOR PACKAGE C. PLEASE VERIFY AND RESUBMIT.
4084 SUBMITTED CHARGE EXCEEDS ALLOWED AMOUNT BY 250%. PLEASE VERIFY THE BILLED QUANTITIES AND CHARGE AMOUNT.
4085 INPATIENT CARE RENDERED IN AN INSTITUTION FOR MENTAL HEALTH DISEASES IS A MEDICAID NON-COVERED SERVICE FOR MEMBER'S AGES 22 THRU 64. PLEASE VERIFY AND RESUBMIT.
4086 RESERVED FOR FUTURE USE.
4087 INVALID OUTPATIENT SERVICE BILLED-THIS TYPE OF PROCEDURE CAN ONLY BE BILLED AS AN INPATIENT SERVICE. PLEASE VERIFY AND RESUBMIT..
4088 INVALID OUTPATIENT SERVICE BILLED-THIS TYPE OF PROCEDURE CAN ONLY BE BILLED AS AN INPATIENT SERVICE. PLEASE VERIFY AND RESUBMIT.
4089 MISSING OR INVALID SURGERY CODE-PLEASE VERIFY TO SEE IF HCPC CODE CAN BE BILLED WITH THE SURGERY REVENUE CODE AND RESUBMIT.
4090 PAYMENT FOR 250, 251, 252, 257, 259, 270-273 and 275-279 DRUG AND SUPPLY REVENUE CODES AND INFUSIONS ARE INCLUDED IN THE TREATMENT ROOM REIMBURSEMENT-PLEASE VERIFY AND RESUBMIT.
4091 ADD ON SERVICES (25X, 270-273 and 275-279, 29X, 37X, 38X, 39X, 62X) ARE ONLY PAYABLE WHEN PERFORMED IN CONJUNCTION WITH A PAID TREATMENT ROOM, EMERGENCY ROOM, OR A STAND ALONE PROCEDURE.
4092 TAKE HOME DRUGS (REVENUE CODE 253) MUST BE BILLED USING A PHARMACY CLAIM FORM WITH A VALID PHARMACY PROVIDER-PLEASE VERIFY AND RESUBMIT.
4093 TRANSPORTATION SERVICES MUST BE FILED ON THE MEDICAL CLAIM FORM USING A NON-HOSPITAL SPECIFIC PROVIDER NUMBER-PLEASE VERIFY AND RESUBMIT.
4094 PROFESSIONAL SERVICES MUST BE BILLED USING A MEDICAL CLAIM FORM USING A NON-HOSPITAL SPECIFIC PROVIDER NUMBER-PLEASE VERIFY AND RESUBMIT.
4095 A NON-SURGICAL SERVICE IS NOT REIMBURSED INDIVIDUALLY IF PERFORMED IN CONJUNCTION WITH AN OUTPATIENT SURGERY-PLEASE VERIFY AND RESUBMIT.
4096 CLAIM BEING REVIEWED.
4097 MODIFIER USED IS NOT A PROCESSING MODIFIER.
4098 PRICING BEING REVIEWED.
4099 PRICING BEING REVIEWED.
4100 PRICING BEING REVIEWED.
4101 NO TRIM POINT FACTOR ON FILE FOR DATES OF SERVICE.
4102 NO MARGINAL COST FACTOR ON FILE FOR DATES OF SERVICE.
4103 THE DRG ASSIGNED HAS A WEIGHT OF ZERO. PLEASE VERIFY THE INFORMATION SUBMITTED ON THE CLAIM AND RESUBMIT.
4104 SERVICE DENIED. MEDICAL NECESSITY FOR USE OF HBO HAS NOT BEEN ADEQUATELY DOCUMENTED. WHEN BILLING REVENUE CODE 413, THE PROPER RECIPIENT DIAGNOSIS IS NEEDED.
4105 PRICING BEING REVIEWED
4106 REVENUE CODE IS NOT AN ACCOMMODATION OR ANCILLARY.
4107 REVENUE CODE OR TYPE OF CLAIM IS NOT APPROPRIATE/NOT COVERED FOR THE TYPE OF SERVICE OR TYPE OF PROVIDER.
4108 THERE IS NO ASC ON FILE FOR THIS PROCEDURE CODE. PLEASE VERIFY THAT THE APPROPRIATE OUTPATIENT SURGERY CODE WAS BILLED.
4109 A VALID CERTIFICATION FORM FOR HYSTERCTOMY IS REQUIRED FOR THE SERVICE RENDERED. PLEASE SUBMIT WITH THE CLAIM CORRECTION FORM.
4110 SERVICE DENIED. THE INTERPRETATION OF NON-ANATOMICAL LABORATORY PROCEDURES, OTHER THAN CONSULTATIVE PATHOLOGY, DO NOT REQUIRE THE SERVICES OF A PHYSICIAN.
4111 PRICING BEING REVIEWED.
4112 THE MAXIMUM NUMBER OF LABORATORY DETAILS ADDED TO THE CLAIM HAS BEEN OBTAINED. MANUAL PRICING REQUIRED.
4113 UNIT DOSE PACKAGING IS ONLY PAYABLE TO NURSING HOME INDICATED MEMBERS.
4114 PRICING BEING REVIEWED.
4115 PRICING BEING REVIEWED.
4116 THE DIAGNOSIS CODE USED IS NOT VALID FOR THE DIAGNOSIS RELATED GROUP. PLEASE VERIFY AND RESUBMIT.
4117 OVER THE COUNTER ITEMS MAY BE BILLED BY PHARMACISTS ONLY.
4118 NONSPECIFIC, NONCOVERED OUTPATIENT PROCEDURE IS NOT PAYABLE. PLEASE VERIFY AND RESUBMIT.
4119 THE REVENUE CODE BILLED IS NOT A CORONARY OR NON CORONARY SERVICE FOR BLOOD PRODUCTS OR RELATED LAB PROCEDURES.
4120 VALUE CODE IS MISSING
4121 D9999 & T1015 MUST BE BILLED WITH A VALID CPT/HCPCS CODE
4122 VALUE CODE MISSING.
4123 THIS SURGICAL PROCEDURE INDICATES THAT THERE ARE NO GLOBAL SURGERY DAYS (POST OPERATIVE CARE DAYS) ASSOCIATED WITH THIS PROCEDURE.
4124 THE CPT/HCPCS CODE BILLED IS NOT A VALID ENCOUNTER
4125 INVALID DIAGNOSIS FOR PRESUMPTIVE ELIGIBILITY. CLAIMS MUST HAVE A VALID PRESUMPTIVE ELIGIBILITY DIAGNOSIS IN ORDER TO RECEIVE PAYMENT.
4126 OTCS NON-COVERED FOR PACKAGE C MEMBERS.
4127 THE BIRTH WEIGHT DIAGNOSIS CODES SUBMITTED ON THIS CLAIM ARE EITHER INVALID OR CONFLICTING. PLEASE VERIFY AND RESUBMIT (FOR CROSSOVERS, SUBMIT AN ADJUSTMENT).
4128 AN UNSPECIFIED ERROR WAS GENERATED BY THE GROUPER. PLEASE VERIFY THE CONTENTS OF THE CLAIM AND RESUBMIT (FOR CROSSOVERS, SUBMIT AN ADJUSTMENT).
4129 THE TWELFTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4130 THE THIRTEENTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4131 THE FOURTEENTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4132 THE FIFTEETH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4133 THE SIXTEENTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AD RESUBMIT.
4134 THE SEVENTEENTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4135 THE EIGHTEENTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4136 THE NINETEENTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4137 THE TWENTIETH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4138 THE TWENTY-FIRST DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4139 THE TWENTY-SECOND DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4140 THE TWENTY-THIRD DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4141 THE TWENTY-FOURTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4142 THE TWENTY-FIFTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4143 ONE OR MORE OF THE OTHER ICD PROCEDURE CODES BILLED IN THE SIXTH THROUGH TWENTY FOURTH POSITION IS NOT VALID. PLEASE VERIFY AND RESUMBIT.
4144 THE SEVENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9-CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4145 THE EIGHTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9-CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4146 THE NINTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9-CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4147 THE TENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9-CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4148 THE ELEVENTH OTHER OTHER CODE BILLEED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4149 THE TWELFTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4150 THE THIRTEENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9-CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4151 THE FOURTEENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4152 THE FIFTEENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4153 THE SIXTEENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4154 THE SEVENTEENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4155 THE EIGHTEENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9-CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4156 THE NINETEENTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4157 THE TWENTIETH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4158 THE TWENTY-FIRST OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4159 THE TWENTY-SECOND OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4160 THE TWENTY-THIRD OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9-CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4161 THE TWENTY-FOURTH OTHER PROCEDURE CODE BILLED IS NOT A VALID ICD-9 CM PROCEDURE CODE. PLEASE VERIFY AND RESUBMIT.
4162 DIAGNOSIS CODE 10-25 IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4163 THE ELEVENTH DIAGNOSIS CODE IS NOT A VALID DIAGNOSIS CODE. PLEASE VERIFY AND RESUBMIT.
4164 MEDICAID REIMBURSES FIRST STEPS UP TO FIRST STEPS ALLOWABLE RATE
4165 MEDICAID IS NOT ELIGIBLE TO REIMBURSE THIS FIRST STEPS SERVICE
4166 DIAGNOSIS CODE NOT COVERED FOR HEALTHY INDIANA PLAN (HIP) PREGNANCY SERVICES
4167 PRIMARY DIAGNOSIS IS NOT COVERED FOR THE BENEFIT PLAN BILLED
4168 INCONTINENCE, OSTOMY AND UROLOGICAL SUPPLIES ARE PROVIDED BY MAIL ORDER THROUGH APPROVED STATE CONTRACTED VENDORS.
4169 DIAGNOSIS CODE NOT COVERED FOR HEALTHY INDIANA PLAN (HIP) PREGNANCY SERVICE
4170 THE POS IS NOT COVERED FOR A MEMBER IN A COUNTY, STATE OR FEDERAL FACILITY.
4171 THIS MCE ID IS NOT ACTIVE WITH THE IHCP FOR THE DATES OF SERVICE SUBMITTED ON THE CLAIM.
4172 CLAIM DENIED DUE TO PROVIDER PREVENTABLE CONDITION. REFER TO FEDERAL REGISTER, VOL.76, NO.108 FOR FURTHER INFORMATION.
4173 THE CPT/HCPCS CODE BILLED IS NOT PAYABLE ACCORDING TO THE PPS REIMBURSEMENT METHODOLOGY.
4179 INCOMPLETE APR DRG ASSIGNMENT, CLAIM TO BE REPROCESSED
4180 WHEN REVENUE CODE 451 IS BILLED ON AN OUTPATIENT OR OUTPATIENT CROSSOVER CLAIM, ALL OTHER SERVICES BILLED ARE NOT PAYABLE
4181 SERVICE DENIED DUE TO A NATIONAL CORRECT CODING (NCCI) EDIT. GO TO HTTPS://WWW.MEDICAID.GOV/MEDICAID/PROGRAM-INTEGRITY/NATIONAL-CORRECT-CODING-INITIATIVE-MEDICAID/INDEX.HTML FOR INFORMATION REGARDING NCCI CODING POLICIES.
4182 SERVICE DENIED DUE TO A NATIONAL CORRECT CODING (NCCI) EDIT. GO TO HTTPS://WWW.MEDICAID.GOV/MEDICAID/PROGRAM-INTEGRITY/NATIONAL-CORRECT-CODING-INITIATIVE-MEDICAID/INDEX.HTML FOR INFORMATION REGARDING NCCI CODING POLICIES.
4183 UNITS OF SERVICE ON THE CLAIM EXCEED THE MEDICALLY UNLIKELY EDIT (MUE) ALLOWED PER DATE OF SERVICE. GO TO HTTPS://WWW.MEDICAID.GOV/MEDICAID/PROGRAM-INTEGRITY/NATIONAL-CORRECT-CODING-INITIATIVE-MEDICAID/INDEX.HTML FOR INFORMATION REGARDING MAXIMUM NUMBER OF UNITS OF SERVICE ALLOWED FOR THE SERVICE BILLED.
4184 CLAIM SUCCESSFULLY PROCESSED THROUGH NCCI EDITING DURING RECYCLE PROCESS. THEREFORE, APPROPRIATE EOB'S WILL BE POSTED APPLICABLE TO CLAIM
4185 THE CLAIM DID NOT PROCESS THROUGH NATIONAL CORRECT CODING INITIATIVE (NCCI) EDITING. THE CLAIM WILL BE REPROCESSED OR ADJUSTED AT A LATER DATE. PLEASE MONITOR FUTURE REMITTANCE ADVICE STATEMENTS FOR PROCESSING ACTIVITY RELATED TO THIS CLAIM.
4186 THIS IS A COMPONENT OF A MORE COMPREHENSIVE SERVICE. PLEASE RESUBMIT CLAIM WITH THE PROCEDURE CODE THAT MOST COMPREHENSIVELY DESCRIBES THE SERVICES PERFORMED.
4187 A DENIED NCCI DETAIL IN HISTORY (EOB 4181, 4182, AND 4183) IS NOT ALLOWED TO BE REPLACED WITH MODIFIERS 25, 58, 59, AND 79 APPENDED. CLAIM MUST BE APPEALED.
4188 NCCI- JENNI
4189 MULTIPLE UNITS OF THE SAME LABORATORY SERVICE ARE NOT PAYABLE FOR THE SAME DATE OF SERVICE, SAME MEMBER AND SAME OR DIFFERENT PROVIDER WITHOUT MEDICAL NECESSITY.
4190 ADD-ON CODES ARE PERFORMED IN ADDITION TO THE PRIMARY SERVICE OR PROCEDURE AND MUST NEVER BE REPORTED AS A STAND-ALONE CODE.
4191 A PRIMARY SERVICE OR PROCEDURE CODE IS LIMITED TO ONE UNIT PER DATE OF SERVICE.
4192 NON ANESTHESIA SERVICES ARE NOT REIMBURSABLE FOR THE ANESTHESIOLOGY PROVIDER SPECIALTY BILLED.
4193 THE SERVICE BILLED IS NOT REIMBURSABLE WHEN PERFORMED BY AN ANESTHESIOLOGIST.
4194 EVALUATION AND MANAGEMENT CODES ARE NOT REIMBURSABLE ON THE SAME DATE OF SURGERY UNLESS THEY ARE DISTINCT AND SEPARATE FROM THE SURGICAL SERVICE
4195 MULTIPLE UNITS OF SERVICE CANNOT BE BILLED WHEN MODIFIER 50 IS APPENDED TO REPRESENT BILATERAL SERVICE
4196 EVALUATION AND MANAGEMENT SERVICES ARE NOT PAYABLE DURING THE PRE OPERATIVE PERIOD UNLESS IT IS SEPARATE AND DISTINCT FROM THE SURGICAL SERVICE.
4197 EVALUATION AND MANAGEMENT SERVICES ARE NOT PAYABLE DURING THE POST OPERATIVE PERIOD UNLESS IT IS SEPARATE AND DISTINCT FROM THE SURGICAL SERVICE.
4199 NO PRICING SEGMENT ON FILE
4200 PRICING BEING REVIEWED.
4201 PAYMENT HAS BEEN CALCULATED ACCORDING TO CURRENT INDIANA HEALTH COVERAGE PROGRAM.
4202 PAYMENT HAS BEEN CALCULATED ACCORDING TO CURRENT INDIANA HEALTH COVERAGE PROGRAM POLICIES.
4203 THIS SERVICE IS A NON-COVERED INDIANA HEALTH COVERAGE PROGRAM SERVICE AS THE RENDERING PROVIDER IS NOT RECOGNIZED BY THE INDIANA HEALTH COVERAGE PROGRAM.
4204 INVALID DIAGNOSIS FOR PROCEDURE CODE/MODIFIER COMBINATION
4205 PRICING BEING REVIEWED.
4206 THE UNITS BILLED ARE 800% GREATER THAN THE NUMBER OF UNITS ANTICIPATED BASED ON THE SUBMITTED CHARGE AND THE DRUG FILE RATE PER UNIT. CHECK THE CLAIM AND REFER TO THE PROVIDER MANUAL FOR UNIT DEFINITIONS.
4207 EFFECTIVE CLIA NUMBER NOT ON FILE FOR DATES OF SERVICE BILLED.
4208 THE PROCEDURE CODE BILLED IS INVALID WITH YOUR CLIA CERTIFICATION ON FILE.
4209 NO MATCHING PRICING SEGMENT FOR THE PROCEDURE/MODIFIER COMBINATION BILLED ON THE CMS 1500 CLAIM FORM. PLEASE REFER TO THE PROVIDER PEOCEDURES MANUAL FOR THE APPROPRIATE USE OF THE MODIFIERS TC, 26, RR, AND NU.
4210 THE PROCEDURE CODE BILLED IS NOT APPROPRIATE FOR DENTAL CLAIMS. PLEASE RESUBMIT YOUR CLAIMS WITH THE APPROPRIATE DENTAL CODE.
4211 THE TOOTH NUMBER BILLED IS NOT VALID WITH THE PROCEDURE CODE BILLED.
4212 THIS SERVICE IS COVERED UNDER THE HOSPICE PROGRAM.
4213 THIS NDC/HRI/UPC CODE SUBMITTED HAS BEEN RE-USED FOR A DIFFERENT PRODUCT, INVALID CODE. PLEASE VALIDATE NDC/HRI/UPC CODE
4215 LEAVE DAYS NOT A COVERED SERVICE FOR THIS BILL TYPE- NURSING FACILITY OCCUPANCY LESS THAN 90%
4216 PROCEDURE CODE NOT ELIGIBLE FOR MEMBER'S WAIVER PROGRAM
4217 WAIVER PROCEDURE CODE REQUIRES WAIVER BILLING PROVIDER
4218 SERVICE BILLED IS NOT ALLOWED ON THIS CLAIM TYPE
4219 COVERED AND NON-COVERED DAYS DO NOT MATCH NUMBER OF ACCOMMODATION DAYS BILLED
4220 A VALID STERILIZATION CONSENT FORM IS REQUIRED FOR THE SERVICE RENDERED. PLEASE SUBMIT WITH THE CLAIM CORRECTION FORM.
4221 THIS CLAIM IS BEING REPROCESSED BY THE IHCP, PLEASE DO NOT RESUBMIT A NEW CLAIM.
4222 THE TAXONOMY CODE SUBMITTED IS NOT VALID. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT
4223 MULTIPLE MATCHES FOR CROSSWALKED PROCEDURE CODE.
4224 THE FIRST MODIFIER IS NOT VALID FOR THE DATES OF SERVICE BILLED. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
4225 THE SECOND MODIFIER IS NOT VALID FOR THE DATES OF SERVICE BILLED. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
4226 THE THIRD MODIFIER IS NOT VALID FOR THE DATES OF SERVICE BILLED. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
4227 THE FOURTH MODIFIER IS NOT VALID FOR THE DATES OF SERVICE BILLED. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
4231 THE IHCP WILL PAY THE LESSER OF THE COINSURANCE PLUS DEDUCTIBLES OR THE MEDICAID ALLOWED AMOUNT MINUS MEDICARE PAID AMOUNT. MEDICAID PAYMENT HAS BEEN CALCULATED AS THE MEDICAID ALLOWED AMOUNT MINUS THE MEDICARE PAYMENT AMOUNT.
4232 INPATIENT PLACE OF SERVICE (21) NOT COVERED FOR PE MEMBER
4233 DATE OF DEATH/DISCHARGE IS NOT COVERED
4234 FIRST, SECOND, THIRD, OR FOURTH MODIFIER NOT VALID FOR CLAIM TYPE
4235 SECOND MODIFIER NOT VALID FOR CLAIM TYPE
4236 THIRD MODIFIER NOT VALID FOR CLAIM TYPE
4237 FOURTH MODIFIER NOT VALID FOR CLAIM TYPE
4238 PROCEDURE CODE NOT COVERED FOR PRESUMPTIVE ELIGIBILITY MEMEBERS
4247 THE MEMBER HAS EXCEEDED THEIR ANNUAL INDIVIDUAL MAXIMUM REIMBURSEMENT LIMITATION OF $300,000.00. PROVIDERS SHALL NOT BE REIMBURSED FOR ANY PORTION OF THE REIMBURSEMENT RATE FOR COVERED SERVICES THAT IS IN EXCESS OF THE ANNUAL OR MAXIMUM COVERAGE LIMITATION.
4248 THE MEMBER HAS EXCEEDED THEIR ANNUAL INDIVIDUAL MAXIMUM REIMBURSEMENT LIMITATION OF 1,000,000.00. PROVIDERS SHALL NOT BE REIMBURSED FOR ANY PORTION OF THE REIMBURSEMENT RATE FOR COVERED SERVICES THAT IS IN EXCESS OF THE ANNUAL OR MAXIMUM COVERAGE LIMITATION.
4250 THE PRINCIPAL DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING, EFFECTIVE OCTOBER 1, 2008.
4251 THE FIRST SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING, EFFECTIVE OCTOBER 1, 2008.
4252 THE SECOND SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4253 THE THIRD SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4254 THE FOURTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4255 THE FIFTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4256 THE SIXTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008,
4257 THE SEVENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4258 THE EIGHTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4259 THE NINTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4260 THE TENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4261 THE ELEVENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4262 THE TWELFTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4263 THE THIRTEENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1,2008.
4264 THE FOURTEENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4265 THE FIFTEENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008
4266 THE SIXTEENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4267 THE SEVENTEENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4268 THE EIGHTEENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4269 THE NINTEENTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4270 THE TWENTIETH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4271 THE TWENTY-FIRST SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4272 THE TWENTY-SECOND SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1,
4273 THE TWENTY-THIRD SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4274 THE TWENTY-FOURTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008
4275 THE TWENTY-FIFTH SECONDARY DIAGNOSIS POA INDICATOR IS NOT IN THE CORRECT FORMAT. PLEASE CHECK ICD OFFICIAL GUIDELINES FOR CODING AND REPORTING EFFECTIVE OCTOBER 1, 2008.
4276 A POA MUST BE ENTERED. A POA OF 1 OR BLANK IS NOT ACCEPTABLE.
4277 WHEN MODIFIER UA IS APPENDED TO DELIVERY CODE 59409, 59514, 59612 OR 59620 THE SERVICE IS DENIED.
4278 THE CLAIM HEADER DATE OF SERVICE IS GREATER THAN THE DATE OF DEATH.
4279 THE CLAIM DETAIL DATE OF SERVICE IS GREATER THAN THE DATE OF DEATH
4280 T1040 Must Be Billed with A Valid CPT/HCPCS Code
4282 CCBHC Encounter code billed without modifier
4300 INVALID NDC TO PROCEDURE CODE COMBINATION
4308 RESERVED FOR FUTURE USE
4309 THE ALLOWED AMOUNT FOR THIS PROCEDURE IS REDUCED BY 10% FOR SUBSEQUENT EXTRACTIONS IN THE SAME TOOTH QUADRANT ON THE SAME DATE OF SERVICE
4315 INACTIVE DRUG STATUS
4340 INCOMPLETE BILLING INFORMATION FOR HOSPICE SIA REVENUE CODES 551/561. REVENUE CODES 551/561 REQUIRE REVENUE CODES 651 OR 650 (653 THRU 12/31/2018) ON SAME DOS, PLUS OCCURRENCE CODE 55 AND MEMBER'S DATE OF DEATH, AND PATIENT DISCHARGE STATUS 20, 40, 41, OR 42.
4341 DOS must be no more than 7 days prior to the date of death
4343 MORE THAN ONE NDC COVERED BENEFIT
4360 DIABETIC TEST STRIPS AND MONITORS ARE LIMITED TO SPECIFIC MANUFACTURERS. PLEASE REFER TO BT20155 FOR MOR INFORMATION.
4363 CLAIM DATES OF SERVICE SPAN MULTIPLE NDC COVERAGE SEGMENTS
4373 INVALID CLAIM TYPE FOR NDC
4401 MODIFIER 50 'BILATERAL' IS INVALID FOR THE PROCEDURE BILLED. PLEASE CORRECT AND RESUBMIT.
4402 DETAIL DENIED, MODIFIER IS NOT REIMBURSED BY THE IHCP
4403 Waiver services denied when member has Transfer of Property penalty
4404 Extended Care Facility services denied when member has Transfer of Property penalty
4405 Missing Family/Attendant Caregiver name and relationship to member
4545 RESERVED FOR FUTURE USE
4801 Procedure code not covered for benefit plan.
4865 SERVICE BILLED NOT ALLOWED FOR THIS CLAIM REGION, CLAIM MUST BE SPECIAL BATCHED WITH PROPER DOCUMENTATION FOR REVIEW AND APPROVAL.
4975 THE SERVICE BILLED IS NOT APPLICABLE FOR THE MEMBER'S BENEFIT PLAN.
5000 THIS IS A DUPLICATE OF ANOTHER CLAIM.
5001 THIS IS A DUPLICATE OF ANOTHER CLAIM.
5002 THIS IS A DUPLICATE OF ANOTHER CLAIM.
5003 THIS IS A DUPLICATE OF ANOTHER CLAIM REVERSAL.
5004 REVERSAL NOT PROCESSED, NO MATCH FOUND ON RX NUMBER AND PROVIDER NUMBER. PLEASE REFER TO YOUR POS MANUAL.
5005 REVERSAL NOT PROCESSED- MULTIPLE MATCHES FOUND WITH SAME RX NUMBER, PROVIDER NUMBER AND DISPENSING DATE. PLEASE REFER TO YOUR POS MANUAL.
5006 REVERSAL NOT PROCESSED, CLAIM OVER 60 DAYS - SUBMIT MANUAL ADJUSTMENT.
5007 THIS IS A DUPLICATE OF ANOTHER CLAIM. IF THIS CLAIM WAS INTENDED TO BE AN ADJUSTMENT, PLEASE SUBMIT THE APPROPRIATE ADJUSTMENT REQUEST FORM.
5008 ORIGINAL ICN NOT PRESENT ON 837 OR NOT FOUND IN HISTORY
5009 INVALID ADJUSTMENT; CLAIM PREVIOUSLY ADJUSTED. PLEASE USE THE MOST RECENT ICN TO PERFORM ANY ADDITIONAL ADJUSTMENTS TO THE CLAIM.
5010 EXACT DUPLICATE - ONLY ONE RESTORATION CODE, PER TOOTH, PER DAY, PER DENTIST WILL BE REIMBURSED
5011 POSSIBLE DUPLICATE - ONLY ONE RESTORATION CODE, PER TOOTH, PER DAY, PER DENTIST WILL BE REIMBURSED
5012 ANCILLARY CHARGES ARE NOT REIMBURSABLE ON AN OUTPATIENT CLAIM, WHEN A SURGICAL PROCEDURE IS PAID BY ASC PRICING. ALL CHARGES ARE INCLUSIVE IN THE ASC PAYMENT.
5013 RESERVED FOR FUTURE USE/POSSIBLE DUPLICATE MRT/PASSR
5014 RESERVED FOR FUTURE USE
5359 THESE CLAIMS HAVE BEEN LINKED TO AN ACTIVE RID.
5752 THE NUMBER OF SERVICES EXCEED MEDICAL POLICY GUIDELINES. PRIOR AUTHORIZATION REQUIRED FOR THIS SERVICE.
6000 THE PAYMENT HAS BEEN CALCULATED ACCORDING TO CURRENT INDIANA HEALTH COVERAGE PROGRAM POLICIES.
6001 PAYMENT FOR COMPLETE PROCEDURE PAYABLE AT A REDUCED AMOUNT WHEN THE TECHNICAL OR PROFESSIONAL COMPONENT HAS BEEN PAID FOR THE SAME DATE OF SERVICE.
6002 REIMBURSEMENT FOR ANESTHESIOLOGIST AND ANY OTHER ANESTHESIA PROVIDER IS NOT PAYABLE UNLESS MEDICAL NECESSITY IS DOCUMENTED. DOCUMENTATION NOT PRESENT OR INSUFFICIENT TO JUSTIFY PAYMENT OF ANESTHESIOLOGIST WHEN AN OTHER PROVIDER HAS BEEN PAID.
6003 PROCEDURE HAS ALREADY PAID IN HISTORY FOR THIS DATE OF SERVICE. ADDITIONAL PAYMENT FOR ANOTHER SAME/SIMILAR PROCEDURE ON THE SAME DATE OF SERVICE FOR THE SAME OR DIFFERENT PROVIDER IS NOT ALLOWED.
6004 INTERMEDIATE (E&M) OFFICE VISIT CODE IS LIMITED TO ONE EVERY 30 DAYS.
6005 EXTENDED OFFICE VISITS ARE LIMITED TO ONE PER 60 DAYS.
6006 NEW PATIENT VISITS ARE LIMITED TO ONE PER MEMBER, PER PROVIDER WITHIN THE LAST THREE YEARS.
6007 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMITS REIMBURSEMENT OF LABORATORY SERVICES TO $400.00 PER MONTH, UNLESS PRIOR AUTHORIZED. PAYMENT REFLECTS REMAINING AMOUNT DUE, IF ANY.
6008 SERVICES INCLUDED IN THE CRITICAL CARE/NEO-NATAL INTENSIVE CARE VISIT CODES ARE NOT SEPARATELY REIMBURSABLE.
6009 SERVICE DENIED. REIMBURSEMENT FOR INPATIENT HOSPITAL CARE IS LIMITED TO ONCE PER DAY
6010 THIS MEMBER HAS PREVIOUSLY RECEIVED A COMPLETE EXAMINATION WITHIN THE PAST YEAR AND NO DOCUMENTATION HAS BEEN SUBMITTED TO MEDICALLLY JUSTIFY THIS EXAMINATION.
6011 PROFESSIONAL OR TECHNICAL COMPONENT NOT SEPARATELY REIMBURSABLE WHEN PAYMENT HAS BEEN MADE FOR THE COMPLETE PROCEDURE ON THE SAME DATE OF SERVICE.
6012 REIMBURSEMENT IS LIMITED TO 30 MEDICAL SERVICES PER MEMBER PER ROLLING CALENDAR YEAR, UNLESS PRIOR AUTHORIZATION FOR ADDITIONAL SERVICES HAS BEEN OBTAINED.
6013 THE NUMBER OF SERVICE(S) PROVIDED FOR THIS MEMBER FOR THIS DATE OF SERVICE EXCEED MEDICAL POLICY.
6014 MEDICAL SERVICES PAYABLE AT A REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAMS ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6015 SURGERY PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6016 SERVICE DENIED. PAYMENT HAS BEEN MADE PREVIOUSLY FOR THE EXTRACTION OF THIS TOOTH.
6017 SERVICE PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6018 COMPONENT IMMUNIZATION PROCEDURE CODES NOT REIMBURSABLE WHEN GLOBAL IMMUNIZATION PROCEDURE HAS BEEN PAID FOR THE SAME RECIPIENT, SAME DATE OF SERVICE.
6019 INITIAL PATIENT VISITS / ESTABLISHED PATIENT VISITS ARE NOT PAYABLE ON THE SAME DATE OF SERVICE AS OLD PROCEDURES W6511 / W6512.
6020 CANNOT BILL ON THE SAME DOS AS Z5114, Z5115, Z5116, Z5117, Z5118, Z5119 OR Z5120
6021 T2022 HA-WRAPAROUND FACILITATION LIMITED TO 1 UNIT PER MONTH
6022 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT PROCEDURES WHEN GLOBAL PROCEDURE HAS BEEN PAID
6023 SURGERY PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT.
6024 REIMBURSEMENT FOR ELECTRONIC PACEMAKER ANALYSIS IS LIMITED TO FREQUENCY STIPULATED IN 405 IAC5-28-6 (1), (2) . DOCUMENTATION NOT PRESENT OR INSUFFICIENT TO JUSTIFY ADDITIONAL SERVICES.
6025 REIMBURSEMENT FOR TRANSTELEPHONIC MONITORING OF PACEMAKER LIMITED TO FREQUENCY STIPULATED IN 405 IAC 5-28-6. DOCUMENTATION NOT PRESENT OR INSUFFICIENT TO JUSTIFY ADDITIONAL SERVICES.
6026 REIMBURSEMENT FOR HOLTER MONITORING IS LIMITED TO ONE EVERY SIX MONTHS. MEDICAL DOCUMENTATION IS REQUIRED FOR MONITORING IN EXCESS OF ONE EVERY SIX MONTHS.
6027 REIMBURSEMENT FOR PROCEDURE CODE BILLED IS LIMITED TO ONCE PER DAY. MAXIMUM REIMBURSEMENT HAS PREVIOUSLY BEEN PAID.
6028 INITIAL AND ESTABLISHED PREVENTATIVE HEALTH (EPSDT) VISIT ARE NOT REIMBURSABLE ON THE SAME DATE OF SERVICE. PLEASE SUBMIT A CORRECTED CLAIM.
6029 EFFECTIVE 4/1/2020, 24 UNIT MAXIMUM FOR SKILLS TRAINING AND DEVELOPMENT FOR ADULT DAY SERVICES INCLUDING INDIVIDUAL, GROUP, FAMILY/COUPLE, WITH AND WITHOUT CONSUMER PRESENT, PRIOR TO 4/1/2020 UNIT MAXIMUM WAS 8 UNITS.
6030 CRITICAL CARE/NEONATAL INTENSIVE CARE VISIT CODES ARE PAYABLE AT A REDUCED AMOUNT WHEN SERVICES INCLUDED IN THE REPORTING OF THE VISIT CODE HAS BEEN PAID FOR THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN THE AMOUNT ALLOWED FOR THE BILLED SERVICE AND THE AMOUNT PAID FOR THE FRAGMENTED SERVICE(S).
6031 GLOBAL IMMUNIZATION NOT PAYABLE WHEN COMPONENT IMMUNIZATION PROCEDURE CODE HAS BEEN PAID FOR THE SAME RECIPIENT AND FOR THE SAME PROVIDER. PLEASE VERIFY AND RESUBMIT.
6032 EXTRACTIONS/SELECT SURGICAL PROCEDURES PAYABLE AT REDUCED AMOUNT WHEN SUTURING PAID FOR THE SAME RECIPIENT ON THE SAME DAY OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE SERVICE BILLED AND THE AMOUNT PREVIOUSLY APID FOR SUTURING.
6033 REIMBURSEMENT IS LIMITED TO TWO TREATMENTS OF PROPHYLAXIS TO INSTITUTIONALIZED RECIPIENTS EVERY SIX (6) MONTHS.
6034 REIMBURSEMENT FOR GLOBAL SURGERY PAYABLE AT A REDUCED AMOUNT WHEN COMPONENTS OF GLOBAL SURGERY HAVE BEEN PREVIOUSLY PAID
6035 SEPARATE REIMBURSEMENT FOR COMPONENTS OF SURGICAL CARE NOT PAYABLE WHEN GLOBAL SURGERY FEE HAS PREVIOUSLY BEEN PAID.
6036 ORAL SURGERY PAYABLE AT REDUCED AMOUNT WHEN APICOECTOMY HAS BEEN PAID FOR THE SAME DAY OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PREVIOUSLY PAID FOR APICOECTOMY.
6037 ONLY ONE ASSISTANT SURGEON MAY BE PAID FOR THE SURGERY BILLED. PAYMENT HAS ALREADY BEEN MADE TO ANOTHER PROVIDER FOR ASSISTANT SURGEON SERVICES.
6038 REIMBURSEMENT FOR ASSISTANT SURGEON SERVICES LIMITED TO TWO ASSISTANTS FOR THE SURGERY BILLED. PAYMENT HAS BEEN MADE TO TWO PROVIDERS FOR ASSISTANT SURGEON SERVICES.
6039 ASSISTANT SURGEON SERVICES NOT REIMBURSABLE WHEN CO-SURGEON HAS BEEN PAID FOR THE SAME DATE OF SERVICE.
6040 CO-SURGEONSERVICES ARE NOT REIMBURSABLE WHEN AN ASSISTANT SURGEON HAS ALREADY BEEN PAID FOR THE SAME DATE OF SERVICE.
6041 ROUTINE EVALUATION AND MANAGEMENT VISITS ARE NOT REIMBURSABLE WHEN BILLED IN CONJUNCTION WITH PRENATAL VISITS
6042 PRENATAL VISITS ARE NOT REIMBURSABLE WHEN BILLED IN CONJUNCTION WITH ROUTINE EVALUATION AND MANAGEMENT VISITS
6043 ANTEPARTUM CARE VISITS LIMITED TO 14 VISITS IN 10 MONTHS UNLESS A MEDICALLY HIGH RISK DIAGNOSIS IS INDICATED.
6044 ONLY THREE PRENATAL VISITS ARE REIMBURSABLE DURING THE SECOND TRIMESTER OF PREGNANCY UNLESS A MEDICALLY HIGH RISK DIAGNOSIS IS INDICATED.
6045 ONLY EIGHT PRENATAL VISITS ARE REIMBURSABLE DURING THE THIRD TRIMESTER OF PREGNANCY UNLESS A MEDICALLY HIGH RISK DIAGNOSIS IS INDICATED.
6046 SERVICES CUTBACK-EXCEEDS ALLOWABLE LEAVE DAYS UNDER THE INDIANA HEALTH COVERAGE PROGRAMS.
6047 SERVICES CUTBACK- EXCEEDS ALLOWABLE THERAPEUTIC LEAVE DAYS UNDER THE INDIANA HEALTH COVERAGE PROGRAMS.
6048 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT ENDOCRINE/NERVOUS/EYE/EAR PROCEDURES WHEN THE GLOBAL PROCEDURE HAS BEEN PAID.
6049 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT INTEGUMENTARY, NEUROMUSCULAR PROCEDURES WHEN GLOBAL PROCEDURE HAS BEEN PAID.
6050 REIMBURSEMENT LIMITED TO TWO CARE COORDINATION REASSESSMENTS PER PREGNANCY
6051 REIMBURSEMENT LIMITED TO 1 CARE COORDINATION INITIAL ASSESSMENT PER PREGNANCY.
6052 REIMBURSEMENT IS LIMITED TO ONE CARE COORDINATION POST PARTUM ASSESSMENT PER PREGNANCY
6053 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMIT CASE MANAGEMENT (Z5950) TO 128 UNITS PER RECIPIENT EVERY 90 DAYS.
6054 AUDIOLOGICAL ASSESSMENTS ARE LIMITED TO ONCE EVERY 3 YEARS PER MEMBER. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL SERVICES
6055 EFFECTIVE 4/1/2020, CARE COORDINATION CASE MANAGEMENT CARE LIMITED TO 400 HOURS PER YEAR. PRIOR TO 4/1/2020, CARE COORDINATION CASE MANAGEMENT CARE IS LIMITED TO 200 HOURS PER YEAR.
6056 REIMBURSEMENT FOR HEARING AID REPAIRS FOR MEMBERS 18 AND OLDER IS LIMITED TO ONCE EVERY TWELVE MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL REPAIRS.
6057 REIMBURSEMENT FOR HEARING AID REPAIRS FOR MEMBERS LESS THAN 18 YEARS OF AGE IS LIMITED TO ONCE EVERY 12 MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL REPAIR.
6058 REIMBURSEMENT FOR HEARING AID EARMOLD REPAIR FOR MEMBERS 18 AND OLDER IS LIMITED TO ONCE EVERY 12 MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL REPAIRS.
6059 REIMBURSEMENT FOR HEARING AID EARMOLD REPAIR FOR MEMBERS LESS THAN 18 YEARS OF AGE IS LIMITED TO ONCE EVERY 12 MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL REPAIRS
6060 REIMBURSEMENT FOR SPEECH EVALUATION IS LIMITED TO ONCE EVERY TWELVE MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL EVALUATIONS.
6061 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT GENITAL URINARY/REPRODUCTIVE SYSTEM PROCEDURES WHEN A GLOBAL GENITAL URINARY/REPRODUCTIVE SYSTEM PROCEDURE HAS BEEN PAID.
6062 DAY CARE SERVICES, ADULT, LIMITED TO 10 UNITS IN A 5 DAY PERIOD
6063 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT RESPIRATORY PROCEDURES WHEN GLOBAL RESPIRATORY PROCEDURE HAS BEEN PAID.
6064 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT MEDICAL SYSTEM PROCEDURES WHEN GLOBAL MEDICAL SYSTEM PROCEDURE HAS BEEN PAID.
6065 THIS ITEM HAS BEEN RENTED UP TO THE INDIANA HEALTH COVERAGE PROGRAM MAXIMUM ALLOWED CHARGE FOR PURCHASE.
6066 TRANSPORTATION (ASSISTED) EXCEEDS ALLOWABLE LIMIT FOR AD
6067 EXCEEDS ALLOWABLE THERAPEUTIC LEAVE DAYS FOR INTERMEDIATE CARE FACILITY PATIENTS UNDER THE INDIANA HEALTH COVERAGE PROGRAMS. MAXIMUM ALLOWABLE DAYS IS 30 PER CALENDAR YEAR.
6068 EXCEEDS ALLOWABLE THERAPEUTIC LEAVE DAYS FOR ICF/IID PATIENTS UNDER THE INDIANA HEALTH COVERAGE PROGRAMS. MAXIMUM ALLOWABLE DAYS IS 60 PER CALENDAR YEAR.
6069 REIMBURSEMENT IS LIMITED TO 50 OFFICE VISITS PER MEMBER PER ROLLING 12 MONTHS UNLESS PRIOR AUTHORIZATION FOR ADDITIONAL SERVICES HAS BEEN OBTAINED.
6070 ONLY FOUR PRENATAL VISITS ARE REIMBURSABLE DURING THE FIRST TRIMESTER OF PREGNANCY UNLESS A MEDICALLY HIGH RISK DIAGNOSIS IS INDICATED.
6071 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT CARDIOVASCULAR/LYMPHATIC SYSTEM PROCEDURES WHEN GLOBAL CARDIOVASCULAR/LYMPHATIC SYSTEM PROCEDURE HAS BEEN PAID.
6072 SERVICE PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA COVERAGE HEALTH PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT FOR THE COMPONENT(S).
6073 NO MORE THAN 120 HOME HEALTH HOURS ALLOWED WITHIN 30 DAYS OF A HOSPITAL DISCHARGE. PRIOR AUTHORIZATION IS REQUIRED FOR ADDITIONAL HOURS.
6074 Z5620 IS LIMITED TO ONE UNIT OF SERVICE PER MEMBER PER MONTH.
6075 Z5699 IS LIMITED TO ONE PER MEMBER PER LIFETIME.
6076 REIMBURSEMENT FOR HOME PROTIME REAGENT STRIPS AND CUVETTES ARE LIMITED TO FOUR (4) UNITS, EACH, PER CALENDAR MONTH.
6077 REIMBURSEMENT FOR SALIVARY ESTRIOL LEVEL TESTS LIMITED TO $425.00 PER PREGNANCY.
6078 SALIVARY ESTRIOL TESTS AND HOME TOCOLYTIC THERAPY NOT BILLABLE WITHIN SIX (6) M
6079 THE PROCEDURE CODE BILLED IS A GLOBAL PROCEDURE AND A COMPONENT OF THAT PROCEDURE HAS ALREADY BEEN PAID. PLEASE VERIFY AND RESUBMIT.
6080 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMITS DME RENTAL OF THIS ITEM TO 15 MONTHS OF CONTINUOUS RENTAL.
6081 RENTAL OR PURCHASE OF DURABLE MEDICAL EQUIPMENT (DME) ITEMS ARE NOT PAYABLE WHEN THE RECIPIENT IS A RESIDENT IN A NURSING FACILITY (ICF OR SNF).
6082 RENTAL OR PURCHASE OF DURABLE MEDICAL EQUIPMENT (DME) ITEMS ARE NOT PAYABLE WHEN THE RECIPIENT IS A RESIDENT IN A NURSING FACILITY (ICF OR SNF).
6083 H0038 HH (Peer Recovery Support) is not payable on the same date as H0038 HW or UB and T1016 HH (Case Management) is not payable on the same date as T1016 HW, UB or UC services.
6084 THE PROCEDURE CODE BILLED IS A COMPONENT OF A GLOBAL PROCEDURE THAT HAS BEEN PAID.
6085 INCONTINENCE SUPPLIES ARE LIMITED TO TOTAL DOLLAR AMOUNT OF $1,950.00 PER ROLLING 12 MONTHS
6086 TRANSPORTATION (NON-ASSISTED) EXCEEDS ALLOWABLE LIMIT FOR AD
6087 WAIVER TRANSP <24 HOUR RES. FIRST TRIP/DAY IS LIMITED TO $276.21 PER MONTH.
6088 WAIVER TRANSP.<24HR. RES. 2ND TRIP/DAY IS LIMITED TO $62.00 PER MONTH.
6089 WAIVER TRANSPORTATION FOR INDIVIDUALS IN DAY SERVICE ONLY LIMITED TO $204.93 A MONTH.
6090 INDIANA MEDICAID BENEFITS ALLOW PAYMENT FOR ONE (1) PODIATRY OFFICE VISIT PER RECIPIENT PER CALENDAR YEAR.
6091 NEW PATIENT PODIATRY OFFICE VISITS ARE REIMBURSED ONCE PER PROVIDER EVERY 3 YRS FOR A NEW PATIENT OFFICE VISIT.
6092 WAIVER TRANSPORTATION DAY SERVICE 2ND TRIP/DAY LIMITED TO $46.00 A MONTH.
6093 WAIVER SERVICES ALLOW ONE UNIT PER DAY UNDER THE INDIANA HEALTH COVERAGE SERVICES
6094 WAIVER SERVICES LIMITED TO FORTY HOURS, PER MONTH UNDER THE INDIANA HEALTH COVERAGE SERVICES
6095 WAIVER SERVICES ALLOW ONE HOUR PER DAY UNDER THE INDIANA HEALTH COVERAGE SERVICES PROGRAM
6096 THE CPT/HCPCS CODE BILLED IS NOT PAYABLE ACCORDING TO THE PPS REIMBURSEMENT METHODOLOGY
6097 TOPICAL APPLICATION OF FLUORIDE AND PROPHYLAXIS WILL NOT BE SEPARATELY REIMBURSED ON THE SAME DATE OF SERVICE. A PAYMENT OF $61.00 WILL BE REIMBURSED FOR THE COMBINATION OF BOTH.
6098 CHIROPRACTIC SERVICES ARE LIMITED TO SPECIFIC PROCEDURE AND DIAGNOSIS CODES.
6099 REIMBURSEMENT IS LIMITED TO NO MORE THAN 50 CHIROPRACTIC SERVICES PER MEMBER PER CALENDAR YEAR. THESE SERVICES COULD INCLUDE UP TO FIVE (5) OFFICE VISITS AND SPINAL MANIPULATION TREATMENTS, OR PHYSICAL MEDICINE TREATMENTS.
6100 REIMBURSEMENT LIMITED TO FIFTY (50) THERAPEUTIC PHYSICAL MEDICINE TREATMENTS BY A CHIROPRACTOR PER RECIPIENT PER YEAR. THE MAXIMUM NUMBER OF SERVICES HAVE BEEN PAID. PRIOR AUTHORIZATION IS REQUIRED FOR ADDITIONAL TREATMENTS.
6101 NEW PATIENT CHIROPRACTIC OFFICE VISITS ARE REIMBURSABLE ONCE PER PROVIDER PER LIFETIME OF THE RECIPIENT.
6102 INDIANA HEATH COVERAGE PROGRAMS REIMBURSEMENT LIMITED TO FIVE CHIROPRACTIC OFFICE VISITS PER YEAR. THIS RECIPIENT HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL VISITS.
6103 COMPONENT SPINE X-RAYS ARE NOT REIMBURSABLE FOR CHIROPRACTORS WHEN A FULL SERIES SPINAL X-RAY HAS BEEN PAID TO A CHIROPRACTOR FOR THE SAME RECIPIENT WITHIN THE SAME CALENDAR YEAR.
6104 REIMBURSEMENT TO CHIROPRACTORS FOR RENTAL OF DME IS LIMITED TO ONE PER MONTH OR A QUANTITY OF ONE(1) UNLESS PRIOR AUTHORIZATION HAS BEEN OBTAINED. MAXIMUM REIMBURSEMENT HAS BEEN PREVIOUSLY PAID.
6105 INDIANA HEALTH COVERAGE PROGRAM REIMBURSEMENT IS LIMITED TO ONE (1) FULL SPINAL X-RAY PER RECIPIENT PER CALENDAR YEAR BY A CHIROPRACTOR. MAXIMUM REIMBURSEMENT HAS BEEN PAID. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL VISITS.
6106 MAXIMUM REIMBURSEMENT FOR ANY COMBINATION OF SPINAL SERIES XRAY COMPONENTS TO A CHIROPRACTOR IS $95.00 PER YEAR.
6107 FULL SERIES SPINAL X-RAY IS PAYABLE AT A REDUCED AMOUNT TO CHIROPRACTORS WHEN COMPONENTS OF SPINAL SERIES X-RAYS HAVE BEEN PAID TO A CHIROPRACTOR IN THE PAST TWELVE (12) MONTHS. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN THE AMOUNT ALLOWED FOR THE FULL SERIES AND THE AMOUNT PREVIOUSLY PAID FOR THE COMPONENT OF THE SERIES X-RAYS.
6108 RADIOLOGY SERVICES PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN THE ALLOWABLE AMOUNT FOR THE PROCEDURE BILLED AND THE AMOUNT PREVIOUSLY PAID TO A CHIROPRACTOR FOR THE COMPONENT(S)
6109 UNSKILLED RESPITE CARE, NOT HOSPICE LIMITED TO 300 UNITS PER YEAR
6110 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT PROCEDURES WHEN GLOBAL PROCEDURE HAS BEEN PAID.
6111 REIMBURSEMENT IS LIMITED TO FIVE CHIROPRACTIC OFFICE VISITS PER YEAR PER MEMBER. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6112 THERAPEUTIC PHYSICAL MEDICINE TREATMENTS ARE LIMITED TO 14 PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6113 DURABLE MEDICAL EQUIPMENT IS LIMITED TO $2,000 PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM AMOUNT ALLOWABLE
6114 REIMBURSEMENT FOR DURABLE MEDICAL EQUIPMENT IS LIMITED TO $5,000 PER MEMBER PER LIFETIME.
6115 REIMBURSEMENT IS LIMITED TO 50 PHYSICAL THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6116 REIMBURSEMENT IS LIMITED TO 50 SPEECH THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6117 REPLACEMENT OF IMPLANTABLE LOOP RECORDERS LIMITED TO ONE EVERY 24 MONTHS.
6118 REIMBURSEMENT IS LIMITED TO 50 OCCUPATIONAL THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6119 REIMBURSEMENT IS LIMITED TO 50 DAYS OF INPATIENT REHABILITATION SERVICES PER RECIPIENT PER CALENDAR YEAR. THIS RECIPIENT HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6120 REIMBURSEMENT IS LIMITED TO 30 VISITS FOR OUTPATIENT MENTAL HEALTH/SUBSTANCE ABUSE SERVICES PER RECIPIENT PER CALENDAR YEAR WITHOUT PRIOR AUTHORIZATION. THIS RECIPIENT HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6121 REIMBURSEMENT IS LIMITED TO 50 VISITS MAXIMUM FOR OUTPATIENT MENTAL HEALTH/SUBSTANCE ABUSE SERVICES PER RECIPIENT, PER CALENDAR YEAR, WITH PRIOR AUTHORIZATION. THIS RECIPIENT HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6122 THERAPEUTIC PHYSICAL MEDICINE TREATMENTS EXCEEDING FOURTEEN (14), UP TO A MAXIMUM OF FIFTY (50), PER RECIPIENT, PER CALENDAR YEAR, REQUIRE PRIOR AUTHORIZATION.
6123 EFFECTIVE 9/13/2019 MAXIMUM REIMBURSEMENT FOR ANY COMBINATION OF SPINAL SERIES XRAY COMPONENTS TO A CHIROPRACTOR IS $62.95 PER YEAR. FOR DATES OF SERVICE 1/1/2016-9/12/2019 $43.75 PER YEAR. FOR DATES OF SERVICE 2/1/2015-12/31/2015 $56.60 PER YEAR. FOR DATES OF SERVICE 10/6/1994-1/31/2015 $44.76 PER YEAR.
6124 REPLACEMENT OF IMPLANTABLE LOOP RECORDERS LIMITED TO ONE EVERY 24 MONTHS.
6125 COGNITIVE REHABILITATION IS LIMITED TO PROCEDURE AND DIAGNOSIS
6126 OBSOLETE - THE IHCP HAS VERIFIED WITH THE MANUFACTURER THAT MSRP PRICING IS AVAILABLE. PLEASE RESUBMIT THE CLAIM WITH THE PROPER DOCUMENTATION.
6127 MAXIMUM AMOUNT EXCEEDED $2000.00 PER YEAR FOR WAIVER COMMUNITY ED/THERAPEUTIC ACTIVITY
6128 MAXIMUM AMOUNT EXCEEDED $545.00 PER MONTH FOR WAIVER RENT/FOOD EXPENSES FOR UNRELATED CAREGIVER
6129 MAXIMUM AMOUNT EXCEEDED $2000.00 PER YEAR FOR WAIVER FAMILY AND CAREGIVER TRAINING
6130 PROCEDURE CODE T1028 U7 HAS A $500.00 ANNUAL CAP
6131 DD TCM DIVERSION LIMITED TO $1835.52 PER 180 DAYS
6132 T2021 U7 IS LIMITED TO 25 HOUR PER MONTH
6133 HCBS PER DIEM IS LIMITED TO ONE PER DAY
6134 T2017 U7 U1 IS LIMITED TO 30 HOURS PER MONTH
6135 T2024 U7 IS LIMITED TO 12 1/4 HOUR UNITS PER YEAR
6136 T2024 U7 TS IS LIMITED TO 12 1/4 HOUR UNITS PER YEAR
6137 PET SCAN IMAGING PROCEDURES LIMITED TO SPECIFIC DIAGNOSIS CODES
6138 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6139 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6140 RADIOIMMUNOTHERAPY SERVICE (78804) IS LIMITED TO ONE PER LIFETIME.
6141 RADIOIMMUNOTHERAPY SERVICE (79403) IS LIMITED TO ONE PER LIFETIME.
6142 RADIOIMMUNOTHERAPY SERVICE A9544 IS LIMITED TO ONE PER LIFETIME
6143 RADIOIMMUNOTHERAPY SERVICE A9545 IS LIMITED TO ONE PER LIFETIME
6144 RADIOIMMUNOTHERAPY SERVICE A9542 IS LIMITED TO ONE PER LIFETIME
6145 RADIOIMMUNOTHERAPY SERVICE A9543 IS LIMITED TO ONE PER LIFETIME
6146 RADIOIMMUNOTHERAPY SERVICE (A9523) IS LIMITED TO ONE UNIT PER 14 DAYS
6147 RADIOIMMUNOTHERAPY SERVICE (G0274) IS LIMITED TO ONE UNIT PER 14 DAYS
6148 RADIOIMMUNOTHERAPY SERVICE (G0273) IS LIMITED TO ONE UNIT PER 14 DAYS
6149 RADIOIMMUNOTHERAPY SERVICE (A9522) IS LIMITED TO ONE UNIT PER 14 DAYS
6150 THE NUMBER OF CONSULTATIONS PROVIDED FOR THIS MEMBER EXCEEDED INDIANA HEALTH COVERAGE PROGRAM POLICY. ADDITIONAL CONSULTATION IS NOT REIMBURSABLE WITHOUT FURTHER DOCUMENTATION.
6151 RESERVED FOR FUTURE USE
6152 SURGERY PAYABLE AT A REDUCED AMOUNT WHEN CONSULTATION PREVIOUSLY PAID AND IS RELATED TO THE SURGICAL PROCEDURE BILLED. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE BILLED SURGICAL PROCEDURE AND THE AMOUNT PREVIOUSLY PAID FOR THE CONSULTATION.
6153 ANY COMBINATION OF THERAPY SERVICES ARE NOT TO EXCEED THIRTY UNITS IN 30 DAYS
6154 NO MORE THAN 120 HOME HEALTH THERAPY HOURS WITHIN 30 DAYS OF HOSPITAL DISCHARGE. ANY ADDITIONAL HOURS REQUIRE PRIOR AUTHORIZATION.
6155 NURSING/HOME HEALTH AID SERVICES ARE LIMITED TO 24 UNITS A DAY
6156 PROCEDURE 99140 MUST BE BILLED WITH ANESTHESIA CODE
6157 THERAPIES ARE LIMITED TO 96 UNITS IN ONE DAY
6158 G0461 AND G0462 CANNOT BE REPORTED WITH PROCEDURE CODES 88342 OR 88343.
6160 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6161 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6162 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC PROCEDURE CODES
6163 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6164 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6165 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6166 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6167 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6168 GONADOTROPIN-RELEASING HORMONE AGONISTS LIMITED TO SPECIFIC DIAGNOSIS.
6169 THE MSRP/COST INVOICE SUBMITTED WITH THE CLAIM IS NOT ACCEPTABLE FOR ADJUDICATION. THE PROVIDER CAN RESUBMIT THE CLAIM WITH PROPER DOCUMENTATION.
6170 CLAIM WAS BILLED WITH THE WRONG UNIT OF MEASURE FOR THE DRUG BILLED
6171 ONE MRT SERVICE PER LIFETIME
6172 Z5188 IS LIMITED TO $286.80 PER ROLLING CALENDAR YEAR.
6173 MRT MEDICAL/PSYCH EXAMS CANNOT BE BILLED WITH MEDICAL RECORDS (EXAMS ARE INCLUSIVE)
6174 LIMIT PROCEDURE CODE 90801 SE TO 1.5 UNITS PER ROLLING 12 MONTHS
6175 LIMIT MRT PSYCHOLOGY TESTING TO 2 UNITS PER ROLLING 12 MONTHS
6177 REIMBURSEMENT IS NOT ALLOWED FOR PROCEDURES S3818, S3819, S3822, AND S3823, IF, PAYMENT HAS ALREADY BEEN MADE FOR PROCEDURE CODE S3820
6178 PROCEDURE CODES S3820, S3822, AND S3823 ARE LIMITED TO IDENTIFIED DIAGNOSIS CODES
6179 REIMBURSEMENT FOR PROCEDURE CODES 83891, 83898, 83904, 83912, S3818 AND S3819 IS NOT ALLOWED WHEN BILLED WITH IDENTIFIED DIAGNOSIS CODES
6181 WAIVER SERVICE T2022 U7 U1 IS LIMITED TO 64 UNITS PER MONTH
6182 REIMBURSEMENT FOR COMPREHENSIVE ENVIRONMENTAL LEAD INVESTIGATION INITIAL VISIT (T1029) AND FOLLOW-UP INVESTIGATION (T1029 TS) IS LIMITED TO ONCE EVERY TWELVE ROLLING MONTHS.
6183 J9225 LIMITED TO 1 UNIT PER MEMBER PER 12 MONTHS
6184 99600 U2 TD, UNLISTED HOME VISIT SERVICE OR PROCEDURE (DAILY RATE FOR EACH DAILY READING FOR AN RN) IS LIMITED TO ONE UNIT PER DAY
6185 99600 U2 TD NOT ALLOWED IF HOME HEALTH VISIT FROM AN RN/LPN/LVN ON SAME DATE OF SERVICE
6186 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMITS DME RENTAL OF THIS ITEM TO 6 UNITS IN A 8 MONTH SPAN.
6187 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMITS DME RENTAL OF THIS ITEM TO 10 UNITS IN A 12 MONTH SPAN.
6188 RESERVE FOR ROBOTIC THERAPY
6189 RESERVE FOR JENNI- DIAGNOSIS BILLED IS NOT FOR ROBOTIC THERAPY
6190 RESERVE FOR JENNI ROBOTI THERAPY IS LIMITED TO 6 WEEKS
6193 VEHICLE MAINTENANCE LIMITED TO $500.00 PER YEAR
6194 MILEAGE IS NOT PAYABLE WITH THIS SERVICE
6195 FRAMES INITIAL OR REPAIR/REPLACEMENT- MEMBER OVER 21 YEARS OF AGE
6196 FRAMES INITIAL OR REPLACEMENT- MEMBER 21 YEARS OR YOUNGER
6199 FLUORIDE TREATMENT LIMITED TO ONE TREATMENT EVERY 6 MONTHS
6200 REIMBURSEMENT FOR PANORAMIC OR COMPLETE SERIES X-RAYS REDUCED WHEN PAYMENT HAS BEEN MADE FOR BITEWINGS AND/OR PERIAPICAL X-RAYS ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR BITEWINGS AND/OR PERIAPICAL X-RAYS.
6201 BENEFITS LIMITED TO ONE UPPER DENTURE RELINE PER MEMBER IN A THIRTY-SIX(36) MONTH PERIOD, UNLESS PRIOR AUTHORIZED.
6202 PALLIATIVE TREATMENT IS NOT REIMBURSED WHEN BILLED BY A PROVIDER ON THE SAME DAY OF SERVICE OF EMERGENCY EXAMINATIONS,EXTRACTIONS, GINGIVAL CURETTAGE AND OTHER SURGICAL PROCEDURES.
6203 INDIANA HEALTH COVERAGE PROGRAM BENEFITS DO NOT ALLOW PAYMENT OF DENTURE RELINE AND/OR REBASE PROCEDURES WITHIN SIX (6) YEARS OF THE INITIAL PLACEMENT OF LOWER COMPLETE OR PARTIAL DENTURES.
6204 A PULPOTOMY IS NOT REIMBURSABLE WHEN PERFORMED ON A TOOTH WHICH PREVIOUSLY HAS HAD ROOT CANAL THERAPY.
6205 APICOECTOMY IS NOT REIMBURSABLE WHEN BILLED BY THE SAME PROVIDER ON THE SAME DAY OF SERVICE ON WHICH ORAL SURGERY WAS PERFORMED ON THE SAME TOOTH.
6206 UNSKILLED RESPITE CARE (NOT HOSPICE) LIMITED TO 28 UNITS A DAY
6207 DAY CARE SERVICES, ADULT, LIMITED TO 2 UNITS A DAY
6208 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMIT OCCLUSAL FILMS TO TWO (2) UNITS PER DAY.
6209 FULL MOUTH OR PANOREX X-RAYS ARE LIMITED TO ONCE EVERY THREE YEARS.
6210 BENEFITS LIMITED TO ONE TREATMENT OF PROPHYLAXIS EVERY SIX MONTHS FOR NON-INSTITUTIONAL RECIPIENTS, AGES TWELVE MONTHS THROUGH TWENTY YEARS OF AGE.
6211 PERIODIC OR LIMITED ORAL EVALUATIONS ARE LIMITED TO ONE EVERY 6 MONTHS
6212 INDIANA HEALTH COVERAGE PROGRAM BENEFITS ALLOW PAYMENT FOR ONE TOPICAL APPLICATION OF FLUORIDE EVERY SIX (6) MONTHS. FLOURIDE TREATMENTS ARE LIMITED TO RECIPIENTS 0 THROUGH 20 YEARS OF AGE.
6213 DENTURE ADJUSTMENTS ARE NOT PAYABLE WITHIN SIX (6) MONTHS FROM THE FABRICATION OF THE PROSTHODONTIC.
6214 ROOT CANAL PAYABLE AT A REDUCED AMOUNT WHEN PULPOTOMY PAID FOR THE SAME TOOTH ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR ROOT CANAL AND THE AMOUNT PREVIOUSLY PAID FOR PULPOTOMY.
6215 UNSKILLED RESPITE CARE, NOT HOSPICE; PER 15 MINUTES CANNOT BE BILLED ON SAME DAY AS UNSKILLED RESPITE CARE, NOT HOSPICE; PER DIEM.
6216 BENEFITS LIMITED TO ONE LOWER DENTURE RELINE PER MEMBER IN A THIRTY-SIX (36) MONTH PERIOD, UNLESS PRIOR AUTHORIZED.
6217 GINGIVAL CURETTAGE PAYABLE AT A REDUCED AMOUNT WHEN PERIODONTAL SCALING HAS BEEN PREVIOUSLY PAID FOR THE SAME RECIPIENT THE DAY BEFORE, AFTER, OR ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR GINGIVAL CURRETAGE AND THE AMOUNT PREVIOUSLY PAID FOR PERIODONTAL SCALING.
6218 INDIANA HEALTH COVERAGE PROGRAM BENEFITS ALLOW REIMBURSEMENT FOR ONE (1) PULP CAP OR BASE FILL PER TOOTH, PER RECIPIENT, PER LIFETIME.
6219 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMIT PERIODONTAL SCALING AND PLANNING TO TWO (2) QUADRANTS PER DATE OF SERVICE.
6220 INDIANA HEALTH COVERAGE PROGRAM BENEFITS ALLOW REIMBURSEMENT FOR THREE (3) TOOTH REPLACEMENTS PER DAY. PRIOR AUTHORIZATION IS REQUIRED IF REPLACING MORE THAN THREE (3) TEETH ON THE SAME DATE OF SERVICE.
6221 REIMBURSEMENT LIMITED TO FOUR TREATMENTS OF PERIODONTAL ROOT PLANING/SCALING EVERY TWO (2) YEARS FOR NON-INSTITUTIONALIZED RECIPIENTS BETWEEN THE AGES OF THREE (3) AND TWENTY (20) YEARS.
6222 REIMBURSEMENT IS LIMITED TO FOUR TREATMENTS OF PERIODONTAL ROOT PLANING AND SCALING FOR INSTITUTIONALIZED RECIPIENTS EVERY TWO (2) YEARS REGARDLESS OF AGE.
6223 PERIODONTAL ROOT PLANING/SCALING 4X/LIFETIME/NON-INSTITUTIONAL 21 YRS AND OLDER.
6224 PAYMENT HAS BEEN MADE PREVIOUSLY FOR THE EXTRACTION OF THIS TOOTH
6225 INDIANA HEALTH COVERAGE PROGRAM BENEFITS ALLOW PAYMENT FOR ONE SEALANT TREATMENT PER PREMOLARS AND MOLARS PER LIFETIME.
6226 COMPREHENSIVE/EXTENSIVE ORAL EVALS ARE LIMITED TO ONE PER LIFETIME PER MEMBER PER PROVIDER
6227 SERVICES CONSIDERED EMERGENT ARE PAID AT A REDUCED AMOUNT WHEN PALLIATIVE TREATMENT HAS BEEN PAID ON THE SAME DATE OF SERVICE.
6228 DENTURE RELINE PAID AT A REDUCED AMOUNT WHEN DENTURE REPAIRS HAVE BEEN REIMBURSED ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE CODE BILLED AND THE AMOUNT PAID FOR DENTURE REPAIRS.
6229 INDIANA HEALTH COVERAGE PROGRAMS BENEFITS DO NOT ALLOW PAYMENT OF DENTURE RELINE AND/OR REBASE PROCEDURES WITHIN SIX (6) MONTHS OF THE INITIAL PLACEMENT OF UPPER COMPLETE OR PARTIAL DENTURES.
6230 INDIANA HEALTH COVERAGE PROGRAM BENEFITS DO NOT ALLOW PAYMENT OF DENTURE RELINE AND/OR REBASE PROCEDURES WITHIN SIX (6) MONTHS OF THE INITIAL PLACEMENT OF COMLETE OR PARTIAL DENTURES. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIAN HEALTH COVERAGE PROGRAM'S MAXIMUM ALLOWED CHARGE FOR DENTURES AND THE AMOUNT PEVIOUSLY PAID FOR RELINE AND/OR REBASE OF DENTURES.
6231 D0230 INTRAORAL-PERIAPICAL-EACH ADDITIONAL FILM IS LIMITED TO SEVEN FILMS PER TWELVE MONTHS
6232 PROPHYLAXIS IS LIMITED TO ONE TREATMENT EVERY 6 MONTHS FOR INSTITUTIONAL MEMBERS OF ALL AGES
6233 TOPICAL APPLICATION OF FLUORIDE AND PROPHYLAXIS WILL NOT BE SEPARATELY REIMBURSED ON THE SAME DATE OF SERVICE. A PAYMENT OF $47.75 WILL BE REIMBURSED FOR THE COMBINATION OF BOTH.
6234 SUTURING IS NOT SEPARATELY REIMBURSABLE WHEN PERFORMED WITH EXTRACTIONS AND OTHER SURGICAL PROCEDURES THAT ALREADY INCLUDE SUTURING AS AN INCIDENTAL PROCEDURE
6235 PROPHYLAXIS IS LIMITED TO ONE TREATMENT EVERY 12 MONTHS FOR NON-INSTITUTIONAL MEMBERS 21 YEARS OR OLDER
6236 THE MEMBER HAS EXHAUSTED A BENEFIT LIMIT FOR DENTAL SERVICES. THE LIMIT FOR 21 AND OLDER IS $600 PER YEAR.
6237 COMPREHENSIVE ORAL EXAM-NEW OR ESTABLISHED PATIENT WILL BE LIMITED TO ONE PER LIFETIME, PER MEMBER, PER PROVIDER WITH AN ANNUAL LIMIT OF TWO VISITS.
6238 THE MEMBER HAS EXHAUSTED A BENEFIT LIMIT FOR DENTAL SERVICES. THE LIMIT FOR 21 AND OLDER IS $600 PER YEAR.
6239 MULTIPLE EXTRACTIONS ON SAME DATE OF SERVICE
6240 THE NUMBER OF UNITS ON THE COST INVOICE MUST BE EQUAL OR EXCEED THE NUMBER OF UNITS BILLED ON THE CLAIM. PLEASE VERIFY AND RESUBMIT.
6241 HORIZONTAL BETEWING X-RAYS ARE LIMITED TO FOUR EVERY 12 MONTHS
6242 HORIZONTAL BITEWING X-RAYS ARE LIMITED TO FOUR EVERY 12 MONTHS
6243 D0220 IS LIMITED TO ONE FILM EVERY TWELVE MONTHS
6244 D4355/D4346 LIMITED TO ONCE EVERY 3 YEARS (DTL)
6245 HORIZONTAL BITEWING X-RAYS ARE LIMITED TO FOUR EVERY 12 MONTHS
6246 D0270, D0272, D0273, D0274, D0277 ONE SET OF BITEWINGS IS ALLOWED IN ONE YEAR.
6247 TOPICAL APPLICATION OF FLUORIDE AND PROPHYLAXIS WILL NOT BE SEPARATELY REIMBURSED ON THE SAME DATE OF SERVICE. A PAYMENT OF $70.00 WILL BE REIMBURSED FOR THE COMBINATION OF BOTH.
6248 TOPICAL APPLICATION OF FLUORIDE AND PROPHYLAXIS WILL NOT BE SEPARATELY REIMBURSED ON THE SAME DATE OF SERVICE. A PAYMENT OF $56.75 WILL BE REIMBURSED FOR THE COMBINATION OF BOTH.
6250 ONE UNIT OF SERVICE IS ALLOWED EVERY 28 DAYS. UNITS OF SERVICE FOR THIS PROCEDURE EXCEED THE ALLOWABLE NUMBER OF UNITS. PRIOR AUTHORIZATION REQUIRED FOR ADDITIONAL SERVICES.
6251 UROLOGICAL SUPPLIES (INDWELLING CATHETERS) ARE LIMITED TO TWO PER MONTH UNLESS DOCUMENTATION OF MEDICAL NECESSITY IS ATTACHED.
6252 THE OXYGEN MAXIMUM FEE HAS BEEN PAID FOR THIS MEMBER WITHIN THE 28 DAY PERIOD. ONE UNIT OF OXYGEN IS ALLOWED EVERY 28 DAYS. PRIOR AUTHORIZATION IS REQUIRED FOR ADDITIONAL SERVICES.
6253 LIQUID OR GASEOUS OXYGEN PER POUND HAS BEEN REIMBURSED FOR A DATE OF SERVICE WITHIN 28 DAYS BY THE SAME PROVIDER. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR OXYGEN AND THE AMOUNT PREVIOUSLY PAID FOR GASEOUS OR LIQUID OXYGEN.
6254 EFFECTIVE 4/1/2020, THERAPY SERVICES LIMITED TO 75 HOURS PER YEAR. PRIOR TO 4/1/2020 SERVICES ARE LIMITED TO 24 HOURS PER YEAR.
6255 COMPONENTS OF TREND EVENT MONITOR ARE NOT REIMBURSABLE WHEN TREND EVENT MONITOR HAS BEEN REIMBURSED ON THE SAME DATE OF SERVICE.
6256 TREND EVENT MONITOR IS REIMBURSED A MAXIMUM OF $850.00 PER MONTH AND IS PAYABLE AT A REDUCED AMOUNT WHEN COMPONENTS OF A TREND EVENT MONITOR HAVE BEEN PREVIOUSLY PAID. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR A TREND EVENT MONITOR AND THE AMOUNT PREVIOUSLY PAID FOR RELATED COMPONENTS.
6257 MAXIMUM REIMBURSEMENT FOR OXIMETRY IS $280.00 PER MEMBER PER 30 DAYS. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR OXIMETRY AND THE AMOUNT PREVIOUSLY PAID FOR OXIMETRY.
6258 THERAPEUTIC LEAVE DAYS ARE LIMITED TO 60 PER CALENDAR YEAR FOR MEMBERS RECEIVING INPATIENT PSYCHIATRIC SERVICES.
6260 PARENTERAL/ENTERAL SUPPLY KITS AND ADDITIONAL SUPPLIES MAY BE BILLED WITHIN THE SAME MONTH. UTILIZATION WILL BE RETROSPECTIVELY MONITORED BY THE PROGRAM INTEGRITY REVIEW UNIT.
6261 PARENTERAL/ENTERAL SUPPLY KITS AND ADDITIONAL SUPPLIES MAY BE BILLED WITHIN THE SAME MONTH. UTILIZATION WILL BE RETROSPECTIVELY MONITORED BY THE PROGRAM INTEGRITY UNIT.
6262 PROCEDURE CODE 99051, MUST BE BILLED WITH AN EVALUATION AND MANAGMENT CODE.
6264 DO277 IS LIMITED TO ONE UNIT OF 7-8 VIEWS A YEAR
6265 HORIZONTAL BITEWING X-RAYS ARE LIMITED TO FOUR EVERY 12 MONTHS
6266 VERTICAL BITEWING X-RAYS ARE LIMITED TO 7 TO 8 IMAGES EVERY 12 MONTHS.
6267 LEAVE DAYS FOR PROVIDER SPECIALTY 030-NURSING FACILITY WILL NO LONGER BE REIMBURSED.
6268 ORAL EVALUATION FOR PATIENT UNDER 3 YEARS OF AGE LIMITED ONE PER YEAR
6269 REIMBURSEMENT IS NOT AVAILABLE FOR PODIATRIC DETAILED OR COMPREHENSIVE OFFICE VISITS FOR NEW OR ESTABLISHED PATIENTS.
6270 SMOKING CESSATION COUNSELING SERVICES ARE LIMITED TO 10 UNITS PER MEMBER PER CALENDAR YEAR.
6271 LENSES INITIAL OR REPLACEMENT- MEMBER 21 YEAR OR YOUNGER
6272 LENSES INITIAL REPAIR/REPLACEMENT MEMBER OVER 21 YEARS OF AGE
6273 THE MEMBER HAS EXHAUSTED A BENEFIT LIMIT FOR DENTAL SERVICES. THE LIMIT FOR 21 AND OLDER IS $1,000.00 PER YEAR
6274 THE MEMBER HAS EXHAUSTED A BENEFIT LIMIT FOR DENTAL SERVICES. THE LIMIT FOR 21 AND OLDER IS $1,000.00 PER YEAR.
6275 MULTIPLE DENTAL SEDATION CODES ARE NOT PAYABLE ON THE SAME DATE OF SERVICE.
6276 BREAST CANCER ANALYSIS (BRCA1 & BRCA2) IS NOT PAYABLE WHEN A BREAST CANCER ANALYSIS CODE HAS ALREADY BEEN PAID.
6277 AMBULANCE (ALS OR BLS) OXYGEN IS NOT ALLOWED ON THE SAME DAY AS AMBULANCE ALS TRANSPORT AND VICE VERSA. THE BASE CODE FOR ALS TRANSPORT INCLUDES REIMBURSEMENT FOR OXYGEN AND SUPPLIES.
6278 LIVER ELASTOGRAPHY IS LIMITED TO 1 UNIT PER 6 MONTHS.
6279 LIVER ELASTOGRAPHY NOT PAYABLE WHEN LIVER BIOPSY HAS BEEN REIMBURSED FOR THE RECIPIENT WITHIN THE PREVIOUS 6 MONTHS.
6280 PET SCAN PROCEDURES REFRACTORY SEIZURES LIMITED TO DIAGNOSIS CODES
6281 PET SCAN IMAGING PROCEDURES (SINGLE PULMONARY NODULE, COLORECTAL, ESOPHAGEAL, MELANOMA, NON-SMALL CELL LUNG, LYMPHOMA, OR HEAD AND NECK CANCER), ARE LIMITED TO SPECIFIC DIAGNOSIS CODES.
6282 PET SCAN IMAGING FOR MYOCARDIAL PERFUSION IS LIMITED TO SPECIFIC DIAGNOSIS CODES
6288 PET SCAN IMAGING (BREAST CANCER, WHOLE BODY OR REGIONAL FOR NECK AND HEAD CANCER) ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6289 A PREVIOUSLY PAID LIVER ELASTOGRAPHY SERVICE WITH A DATE OF SERVICE 6 MONTHS OR LESS AFTER THE DATE OF SERVICE OF THE BIOPSY IS BEING RECOUPED. THE LIVER BIOPSY SERVICE WILL BE PAID.
6290 HBO LIMITED BY DIAGNOSIS CODE
6291 REIMBURSEMENT IS LIMITED TO 25 OCCUPATIONAL THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6292 REIMBURSEMENT IS LIMITED TO 25 SPEECH THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE
6293 REIMBURSEMENT IS LIMITED TO 25 PHYSICAL THERAPY TREATMENTS PER MEMBER PER CALANDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6294 PHYSICAL THERAPY SERVICES ARE LIMITED TO 25 VISITS PER YEAR
6295 OCCUPATIONAL THERAPY IS LIMITED TO 25 VISITS PER YEAR
6296 SPEECH THERAPY IS LIMITED TO 25 VISITS PER YEAR
6297 ROUTINE VISION EXAMS LIMITED TO ONE (1) PER TWELVE (12) MONTHS FOR AGES 1 TO 20 YEARS.
6298 ROUTINE VISION EXAMS ARE LIMITED TO ONE (1) PER TWENTY-FOUR (24) MONTHS FOR AGES TWENTY-ONE TO 999 YEARS.
6299 VEP LIMITED TO SPECIFIC DIAGNOSIS CODES
6300 DRUGS LIMITED TO SPECIFIC ESRD DX (DTL)
6301 EFFECTIVE 4/1/2020, THERAPY AND BEHAVIORAL SUPPORT SERVICES IN A GROUP SETTING LIMITED TO 75 HOURS PER YEAR. PRIOR TO 4/1/2020 THE LIMIT IS 30 HOURS PER YEAR
6302 GROUP ADDICTION COUNSELING IS NOT REIMBURSED ON THE SAME DAY AS INTENSIVE OUTPATIENT TREATMENT
6303 INDIVIDUAL AND GROUP SKILLS TRAINING AND DEVELOPMENT IS NOT REIMBURSED ON THE SAME DAY AS A CHILD/ADOLESCENT/ADULT INTENSIVE RESILIENCY SERVICES.
6304 A MEDICAID COMPOSITE RATE REVENUE CODE HAS ALREADY BEEN PAID FOR THE SAME DATE OF SERVICE
6305 PERIODONTAL MAINTENANCE (D4910) NOT ALLOWED WITHOUT A PERIODONTAL SERVICE PAID IN HISTORY.
6306 PROCEDURE REQUIRES CATARACT SURGERY PROCEDURE PAID FOR THE SAME DATE OF SERVICE.
6307 ONCOLOGY COLORECTAL SCREENING, QUANTITATIVE, LIMITED TO ONCE EVERY 3 YEARS
6308 PERIODONTAL MAINTENANCE NOT ALLOWED WITHIN SIX MONTHS OF A PERIODONTAL SERVICE.
6310 PROPHYLAXIS IS LIMITED TO ONE TREATMENT EVERY 6 MONTHS FOR MEMBERS AGED 12 MONTHS THROUGH 20 YEARS OF AGE
6311 A MEDICAID COMPOSITE RATE REVENUE CODE HAS ALREADY BEEN PAID FOR THE SAME DATE OF SERVICE.
6312 ESRD PROCEDURE BEING BILLED IS ALL-INCLUSIVE TO A MEDICAID COMPOSITE RATE REVENUE CODE ALREADY PAID FOR SAME DATE OF SERVICE.
6313 A PREVIOUSLY PAID ESRD PROCEDURE IS BEING RECOUPED AS ALL-INCLUSIVE TO A MEDICAID COMPOSITE RATE REVENUE CODE WHEN BOTH RENDERED ON THE SAME DATE OF SERVICE.
6314 PREVIOUSLY PAID ESRD PROCEDURE NOT PAYABLE ON THE SAME DATE OF SERVICE AS A MEDICAID COMPOSITE RATE REVENUE CODE.
6319 SILVER DIAMINE FLUORIDE (SDF) LIMITED TO 10 TEETH PER DOS, ONE APPLICATION PER TOOTH PER 3 MONTHS
6337 WAIVER CODE T2022 U7 U5 IS LIMITED TO ONE UNIT PER CALENDAR MONTH
6340 TRANSPORTATION (ASSISTED) EXCEEDS ALLOWABLE LIMIT FOR TBI
6341 TRANSPORTATION (NON-ASSISTED) EXCEEDS ALLOWABLE FOR TBI
6342 COMM TRANSITION LIMITED TO $1,000 PER LIFETIME FOR AU, DD
6345 REIMBURSEMENT FOR MATERNITY DELIVERY LIMITED TO ONE PER PREGNANCY
6350 FQHC SERVICES ARE LIMITED TO ONE PER DAY FOR THE SAME PROVIDER, SAME DIAGNOSIS AND SAME RECIPIENT.INACTIVATE THIS AUDIT UNTIL FURTHER NOTICE.
6351 MORE THAN ONE FQHC SERVICE IS PAYABLE PER DAY TO THE SAME PROVIDER, FOR THE SAME RECIPIENT, DIFFERENT DIAGNOSIS, WHEN MEDICAL NECESSITY IS DOCUMENTED. DOCUMENTATION PROVIDED WITH THE CLAIM DOES NOT SUBSTANTIATE MORE THAN ONE SERVICE. NOTE: INACTIVATE THIS AUDIT UNTIL FURTHER NOTICE.
6353 WAIVER CODE T2022 U7 IS LIMITED TO ONE UNIT PER PROVIDER, PER MEMBER, PER MONTH
6355 CCBHC is limited to once per day, same or different provider
6356 MRO not allowed same DOS CCBHC
6360 FIRST STEPS-BILL 92607 TL FOR THE FIRST HOUR OF SERVICE BEFORE BILLING 92608 TL FOR ADDITIONAL MINUTES.
6362 99401 HK-BRIDGE APPOINTMENT-LIMITED BY PROVIDER SPECIALTY
6363 THE HEARING AID DISPENSING FEE IS NOT REIMBURSABLE WITH MANUALLY PRICED HEARING AID CODES, AND SHOULD NOT BE BILLED.
6364 DISPENSING FEES FOR HEARING AIDS ARE LIMITED TO ONE EVERY FIVE YEARS.
6367 81214 OR 81216 WILL NOT PAY IF 81211 HAS EVER PAID
6372 PSYCHOLOGICAL REHABILITATION SERVICES, PER 15 MINUTES, CANNOT BE BILLED ON THE SAME DAY AS BEHAVIORAL HEALTH DAY TREATMENT, PER 1 HOUR.
6373 Annual depression screening limited to one unit per 12 months.
6374 Med application per tooth is billed more than once for the same tooth number within 183 days.
6375 Application Topical Fluoride Varnish (99188), limited to 1 unit per 182 days.
6376 H2014 HW is not payable with a quantity billed greater than 8 units, when H2017 HW has been paid in history for the same member by any provider. Please resubmit with allowed units.
6377 A previously paid H2014 HW with a quantity billed greater than 8 for the same date of service is being recouped. Please resubmit with allowed units.
6382 ROUTINE PREOPERATIVE MEDICAL VISITS PERFORMED ON THE DAY OF SURGERY ARE NOT SEPARATELY PAYABLE. DOCUMENTATION NOT PRESENT OR NOT SUFFICIENT TO JUSTIFY CARE WAS OF A NON-ROUTINE NATURE.
6383 REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6384 ROUTINE PREOPERATIVE MEDICAL VISITS PERFORMED WITHIN ONE DAY PRIOR TO SURGERY ARE NOT SEPARATELY PAYABLE. DOCUMENTATION NOT PRESENT OR NOT SUFFICIENT TO JUSTIFY CARE WAS OF A NON-ROUTINE VISIT.
6386 POSTOPERATIVE MEDICAL VISITS PERFORMED WITHIN 90 DAYS OF SURGERY ARE PAYABLE ONLY FOR A SURGICAL COMPLICATION AND IF DOCUMENTED AS MEDICALLY INDICATED. DOCUMENTATION NOT PRESENT OR DOES NOT JUSTIFY THE VISIT BILLED.
6387 POST OPERATIVE MEDICAL VISITS PERFORMED WITHIN 0-10 DAYS OF SURGERY ARE PAYABLE ONLY FOR A SURGICAL COMPLICATION AND IF DOCUMENTED AS MEDICALLY INDICATED. DOCUMENTATION NOT PRESENT OR DOES NOT JUSTIFY THE VISIT BILLED.
6389 MULTIPLE UNITS OF THE SAME LABORATORY SERVICE ARE NOT PAYABLE FOR THE SAME DATE OF SERVICE, SAME MEMBER AND SAME OR DIFFERENT PROVIDER WITHOUT MEDICAL NECESSITY.
6390 ADD-ON CODES ARE PERFORMED IN ADDITION TO THE PRIMARY SERVICE OR PROCEDURE AND MUST NEVER BE REPORTED AS A STAND-ALONE CODE.
6391 A PRIMARY SERVICE OR PROCEDURE CODE IS LIMITED TO ONE UNIT PER DATE OF SERVICE.
6392 TREATMENT ROOM REVENUE CODES IN THE SAME FAMILY ARE LIMITED TO ONE REVENUE CODE PER DATE OF SERVICE, SAME PROVIDER.
6396 THIS SERVICE IS NOT PAYABLE WITH ANOTHER SERVICE ON THE SAME DATE OF SERVICE DUE TO NATIONAL CORRECT CODING INITIATIVE.
6399 A PREVIOUSLY PAID SERVICE IS BEING RECOUPED PER NATIONAL CORRECT CODING INITIATIVE (NCCI) PROCESSING OF ANOTHER SERVICE ON THE SAME DATE OF SERVICE BY THE SAME PROVIDER.
6400 JOINT INJECTIONS ARE LIMITED TO THREE PER MONTH FOR DATES OF SERVICE PRIOR TO 4/1/03, AND FOUR PER MONTH FOR DATES OF SERVICE ON OR AFTER 4/1/03. RESUBMIT CLAIM WITH DOCUMENTATION OF THE SPECIFIC JOINTS INJECTED AND DATES OF SERVICE FOR THOSE INJECTIONS.
6401 INJECTIONS ARE LIMITED TO TWO PER MONTH. PRIOR AUTHORIZATION IS REQUIRED FOR ADDITIONAL SERVICES.
6402 REIMBURSEMENT FOR VITAMIN B-12 INJECTIONS IS LIMITED TO ONE EVERY 30 DAYS. PRIOR AUTHORIZATION IS REQUIRED FOR ADDITIONAL SERVICES.
6403 MUTUALLY EXCLUSIVE SURGICAL PROCEDURE CODE CANNOT BE PERFORMED DURING SAME OPERATIVE SESSION.
6404 Treatment room services and Injection/administration service procedures are not allowed on the same date of service.
6405 COMPONENT PROCEDURE NOT PAYABLE WHEN COMPREHENSIVE PROCEDURE PAID IN HISTORY
6420 SERVICE BILLED IS LIMITED TO ONE UNIT PER DATE OF SERVICE
6421 SERVICE BILLED IS LIMITED TO TWO UNITS PER DATE OF SERVICE
6422 MAXIMUM OF 12 UNITS PER DAY AND MAXIMUM OF 120 UNITS PER MONTH PER MEMBER HAS BEEN MET.
6423 NON-MEDICAL TRANSPORTATION (T2003 U7 U1) IS LIMITED TO $1,000 PER YEAR
6424 TRAINING AND SUPPORT CODES FOR UNPAID CAREGIVER WILL BE LIMITED TO $500.00 PER YEAR
6425 WAIVER PROCEDURE CODE H2014 U7 IS LIMITED TO 12 UNITS PER DAY
6426 MODIFIERS 50, RT, AND LT, WHIICH WERE BILLED FOR THIS SERVICE, ARE NOT BILLABLE TOGETHER. PLEASE CORRECT AND RESUBMIT.
6427 T1016 EP - CASE MANAGEMENT EACH 15 MINUTES, PROVIDED AS PART OF MEDICAID EARLY PERIODIC SCREENING DIAGNOSIS AND TREATMENT (EPSDT) IS LIMITED TO 26 UNITS PER 12 MONTHS
6430 THIS DENTAL SERVICE IS NOT PAYABLE WITH ANOTHER SERVICE ON THE SAME DATE OF SERVICE.
6490 Multiple Intensive Outpatient Therapy services are not allowed on the same date of service for the same or different provider. Intensive Outpatient Therapy chemical dependency and peer recovery services are not allowed on the same date of service for the same provider.
6491 Peer recovery procedure in excess of 1,460 units is not allowed without prior approval.
6492 Service not allowed same month as paid structured family caregiving.
6494 OBSOLETE DAYS EXCEED UNITS PAID ON THE PER DIEM
6500 RESERVED FOR FUTURE USE.
6501 PSYCHIATRIC DIAGNOSTIC EVALUATION IS LIMITED TO ONCE PER ROLLING 12 MONTHS PER BILLING PROVIDER.
6502 E&M VISITS ARE LIMITED TO 1 PER 90 DAYS PER BILLING PROVIDER.
6503 RESERVED FOR FUTURE USE.
6504 THIS SERVICE IS PAYABLE ONLY WHEN PERFORMED IN CONJUNCTION WITH A SCREENING VENIPUNCTURE
6505 RESERVED FOR FUTURE USE.
6506 THIS CLAIM INDICATES THAT LABORATORY PROCEDURES WERE PERFORMED BOTH IN-HOUSE AND SENT TO AN OUTSIDE LABORATORY. IF PROCEDURE(S) WERE PERFORMED IN-HOUSE SEND A REFUND OR REQUEST AN ADJUSTMENT FOR THE CONVEYANCE PROCEDURE CODE. WHEN NOTIFIED OF THE COMPLETION OF YOUR REFUND OR ADJUSTMENT REQUEST, RESUBMIT A CORRECTED CLAIM.
6507 THIS CLAIM INDICATES THAT LABORATORY PROCEDURES WERE PERFORMED BOTH IN-HOUSE AND SENT TO AN OUTSIDE LABORATORY. IF PROCEDURE(S) WERE SENT OUT, SEND A REFUND OR REQUEST AN ADJUSTMENT FOR THE LABORATORY PROCEDURE(S). WHEN NOTIFIED OF THE COMPLETION OF YOUR REFUND OR ADJUSTMENT REQUEST, RESUBMIT A CORRECTED CLAIM.
6508 SAME DAY DISCHARGE. PLEASE VERIFY DISCHARGE DATE AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
6509 MEMBER CAN NOT BE READMITTED WITHIN 15 DAYS FOR THE SAME DIAGNOSIS CODE PLEASE VERIFY READMISSION CODE AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
6510 RESERVED FOR FUTURE USE.
6511 ONE DISPENSING FEE PER LTC MEMBER PER CALENDAR MONTH.
6513 J9225 LIMITED TO 1 UNIT PER MEMBER PER 12 MONTHS
6514 NOT MORE THAN ONE EMERGENCY ROOM VISIT PER DAY
6515 INPATIENT SERVICES PERFORMED THREE DAYS AFTER OUTPATIENT DOS
6516 OUTPATIENT SERVICES PERFORMED THREE DAYS PRIOR TO INPATIENT ADMISSION
6517 INPATIENT CLAIM DISCHARGE DATE IS THREE DAYS BEFORE THE ADMISSION DATE OF ANOTHER PAID INPATIENT CLAIM
6518 INPATIENT CLAIM ADMIT DATE IS THREE DAYS AFTER THE DISCHARGE DATE OF ANOTHER PAID INPATIENT CLAIM
6519 ANALGESIA-D9230 IS LIMITED TO ONE UNIT PER DAY, PER MEMBER, PER PROVIDER
6522 PROCEDURE CODE T2016 U7 U5 IS NOT PAYABLE WHEN BILLED ON THE SAME DAY AS T2016 U7 U5 UA.
6527 MEDICATION TRAINING AND SUPPORT (INDIVIDUAL OR GROUP) LIMITED TO 182 HOURS PE
6528 WAIVER PROCEDURE CODE T2002 U7 U5 U2 IS LIMITED TO TWO UNITS PER DAY
6529 PROCEDURE CODE T2002 U7 U5 U3 IS LIMITED TO TWO UNITS PER DAY.
6530 G0461 AND G0462 CANNOT BE BILLED W/88342 OR 88343
6539 Treat/no transport (A0998) is not payable with transportation (A4027/A0429) or drug administration (96372 U1/U2) on the same date of service.
6540 Drug codes J3490 and J2310 are not allowed for ambulance providers, without an appropriate admin code (96372 U1, 96372 U2, A0998) is paid in history on the same date of service, same provider.
6550 T1015/CR (COVID clinic visit) is limited to once per day, same or different provider
6555 T1015/CR (COVID clinic visit) is limited to16 units within 30 days, same or different provider
6600 LENSES INITIAL OR REPLACEMENT- MEMBER 18 YEARS OR YOUNGER
6601 FRAMES INITIAL OR REPLACEMENT-MEMBER 18 YEARS OR YOUNGER
6602 RESERVED FOR FUTURE USE.
6603 FRAMES INITIAL OR REPLACEMENT-MEMBER 19 YEARS OR OLDER
6604 LENSES INITIAL OR REPLACEMENT- MEMBER 19 YEARS OR OLDER
6605 FRAME REPLACEMENT IS NOT PAYABLE ON THE SAME DATE OF SERVICE AS A FRAME REPAIR
6606 INDIANA HEALTH COVERAGE PROGRAM BENEFITS DO NOT ALLOW PAYMENT OF FRAME REPLACEMENT PARTS IN EXCESS OF $20.00.
6607 FRAME REPAIR IS NOT PAYABLE ON THE SAME DATE OF SERVICE AS A FRAME REPLACEMENT.
6608 INDIANA HEALTH COVERAGE PROGRAM ALLOWS PAYMENT FOR ONE (1) FRAME REPLACEMENT PER DAY.
6609 THE CLAIM DENIED BECAUSE THE MSRP (MANUFACTURERS SUGGESTED RETAIL PRICE) WAS NOT SUBMITTED WITH THE CLAIM.
6610 ROUTINE VISION EXAMS LIMITED TO ONE(1) PER TWELVE (12) MONTHS FOR AGES 1 TO 19 YEARS.
6611 ROUTINE VISION EXAM LIMITED TO ONE PER TWENTY-FOUR (24) MONTHS FOR AGES 19 TO 999 YEARS.
6612 LIMIT BOTULINUM INJECTIONS TO IDENTIFIED DIAGNOSIS CODES
6615 ASSERTIVE COMMUNITY TREATMENT IS LIMITED TO ONE UNIT PER DAY
6618 PARTIAL HOSPITALIZATION LIMITED TO 1 UNIT PER DAY
6630 TECHNICAL AND PROFESSIONAL COMPONENTS NOT PAYABLE WHEN THE COMPLETE PROCEDURE HAS BEEN PAID FOR THE SAME PROCEDURE ON THE SAME DATE OF SERVICE.
6632 PROCEDURE CODE T2048 IS ONLY REIMBURSABLE FOR RESIDENTIAL CARE FACILITIES WITH A PROVIDER SPECIALTY OF 033.
6633 Z5180/T2048 IS LIMITED TO ONE PSYCH TREATMENT PER DAY
6634 PAYMENT FOR COMPLETE PROCEDURE PAYABLE AT A REDUCED AMOUNT WHEN THE TECHNICAL AND/OR PROFESSIONAL COMPONENT HAS BEEN PAID FOR THE SAME PROCEDURE ON THE SAME DATE OF SERVICE.
6636 MIDLEVEL PRACTITIONER SERVICES ARE NOT SEPERATELY REIMBURSABLE ON THE SAME DAY A PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) PER DIEM SERVICE HAS BEEN PAID.
6637 DRUG ADMINISTRATION IS NOT PAYABLE ON THE SAME DATE OF SERVICE AS AN EVALUATION AND MANAGEMENT SERVICE.
6638 Psychiatric Residential Treatment Facilities service (T2048) is not payable when the member is on medical (T2048/U1) or therapeutic leave (T2048/U2) or with T2048 and no modifiers on the same date of service.
6647 DME RENTAL LIMITED TO 15 UNITS PER LIFETIME
6648 REIMBURSEMENT FOR PER DIEM WAIVER LEVEL OF CARE SERVICES ARE LIMITED TO 31 UNITS PER MONTH.
6649 REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6650 THE NUMBER OF SERVICE(S) PROVIDED EXCEED MEDICAL POLICY GUIDELINES. THIS IS A ONCE-IN-A-LIFETIME PROCEDURE.
6651 ADDITIONAL SURGICAL PROCEDURE(S) ARE PAYABLE AT 50% OF INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE.
6652 A SURGICAL PROCEDURE CODE FOR THE SAME PHYSICIAN FOR THE SAME DATE OF SERVICE HAS BEEN PREVIOUSLY PAID. A REQUEST FOR ADDITIONAL SURGICAL PAYMENT WILL NEED TO BE COMPLETED ON THE IHCP ADJUSTMENT FORM UNDER THE ORIGINAL PAID ICN SO THE APPROPRIATE MULTIPLE SURGERY REDUCTION CAN BE APPLIED.
6653 POSTOPERATIVE MEDICAL VISITS PERFORMED WITHIN 90 DAYS OF SURGERY ARE PAYABLE ONLY FOR A SURGICAL COMPLICATION AND IF DOCUMENTED AS MEDICALLY INDICATED. DOCUMENTATION NOT PRESENT OR DOES NOT JUSTIFY THE VISIT BILLED.
6654 ROUTINE PREOPERATIVE MEDICAL VISITS PERFORMED WITHIN ONE DAY PRIOR TO SURGERY ARE NOT SEPARATELY PAYABLE. DOCUMENTATION NOT PRESENT OR NOT SUFFICIENT TO JUSTIFY CARE WAS OF A NON-ROUTINE VISIT.
6655 REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN IHCP ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6656 POST OPERATIVE MEDICAL VISITS PERFORMED WITHIN 0-10 DAYS OF SURGERY ARE PAYABLE ONLY FOR A SURGICAL COMPLICATION AND IF DOCUMENTED AS MEDICALLY INDICATED. DOCUMENTATION NOT PRESENT OR DOES NOT JUSTIFY THE VISIT BILLED.
6657 ROUTINE PREOPERATIVE MEDICAL VISITS PERFORMED ON THE DAY OF SURGERY ARE NOT SEPARATELY PAYABLE. DOCUMENTATION NOT PRESENT OR NOT SUFFICIENT TO JUSTIFY CARE WAS OF A NON-ROUTINE NATURE.
6658 REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6659 REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6660 POST-OP MEDICAL VISITS PERFORMED WITHIN THE GLOBAL SURGERY PERIOD ARE PAYABLE ONLY FOR A SURGICAL COMPLICATION AND IF DOCUMENTED AS MEDICALLY INDICATED. DOCUMENTATION NOT PRESENT OR DOES NOT JUSTIFY THE VISIT BILLED.
6661 DURAMORPH CAN NOT BE BILLED ON SAME DAY AS SURGERY
6662 POST OPERATIVE CARE DAYS FOR A 10 DAY GLOBAL SURGERY ARE LIMITED TO A MAXIMUM OF 10 UNITS.
6663 POST-OPERATIVE CARE DAYS FOR A 90 DAY GLOBAL SURGERY ARE LIMITED TO A MAXIMUM OF 90 UNITS.
6664 SERVICE PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6665 SURGICAL PROCEDURE BILLED WITH MODIFIER 50 (BILATERAL) PAYABLE AT A REDUCED AMOUNT WHEN SURGICAL PROCEDURE HAS PREVIOUSLY BEEN PAID WITH MODIFIER LT (LEFT) AND/OR RT (RIGHT) FOR THE SAME RECIPIENT. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE UNILATERAL PROCEDURE(S).
6666 ANES SRVCS NOT ALLOWED BY PROV BILLING FOR SURG
6667 COMM TRASITION LIMITED TO $2,500 PER LIFETIME FOR AD
6668 WAIVER SERVICES LIMITED TO 2 UNITS PER ROLLING CALENDAR YEAR
6669 WAIVER SERVICES LIMITED TO 12 UNITS PER ROLLING CALENDAR YEAR
6670 WAIVER SERVICES LIMITED TO $600.00 PER ROLLING CALENDAR YEAR
6671 T2024 U7 TS IS LIMITED TO $344.16 PER ROLLING CALENDAR YEAR.
6672 T2024 U7 TS IS LIMITED TO $286.80 PER ROLLING CALENDAR YEAR.
6673 PSYCH PER DIEM MEDICAL LEAVE DAYS CANNOT EXCEED 4 CONSECUTIVE DAYS
6674 PSYCH PER DIEM THERAPEUTIC LEAVE DAYS CANNOT EXCEED 14 DAYS PER YEAR
6675 FOOT REST HANGER BRACKET AND EXTENSION TUBE (K0043 AND K0044) ARE NOT PAYABLE WHEN COMPLETE FOOTREST (K0045) IS PAID
6676 1915I CHILD TRAINING & SUPPORT SERVICE FOR UNPAID CAREGIVER (COMPREHENSIVE COMMUNITY SUPPORT SERVICES, PER 15 MINUTES) LIMITED TO 8 UNITS A DAY
6677 LIMIT PROCEDURE CODE 90801 TO 2 UNITS PER 12 MONTHS PER PROVIDER
6678 LIMIT 90791 OR 90792 TO 2 UNITS, PER PROVIDER PER 12 MONTHS
6679 DURAMORPH NOT PAYABLE ON SAME DAY FOR THE SAME PROVIDER
6680 EVALUATION MANAGEMENT SERVICES AND DELIVERY CARE NOT PAYABLE ON SAME DATE OF SERVICE
6682 WAIVER TRANSPORTATION SERVICE (T2002 U7 U5) IS LIMITED TO 2 UNITS (2 ROUND TRIPS) PER DAY
6684 1915I CHILD TRAINING & SUPPORT SERVICE FOR HOME CARE TRAINING BY A FAMILY CAREGIVER AND HOME CARE TRAINING BY A NON-FAMILY CAREGIVER ARE LIMITED TO $500 A YEAR TOTAL
6691 PROCEDURE CODE MUST BE BILLED WITH ICD DIAGNOSIS CODE IN ORDER TO REIMBURSE FOR PERCUTANEOUS ANGIOPLASTY OF THE CAROTID ARTERY
6692 NON-STERILE GLOVES ARE LIMITED TO 5 UNITS PER MONTH
6693 1915I CHILD HABILITATION SERVICE (INCLUDING SKILLS TRAINING AND DEVELOPMENT, PER 15 MINUTE UNIT) LIMITED TO 120 UNITS (30 HOURS) PER MONTH
6694 1915I CHILD ROUTINE HOURLY RESPITE SERVICE (15 MINUTES PER UNIT) LIMITED TO 39 UNITS A DAY (28 UNITS PRE 7/1/18)
6695 1915I CHILD ROUTINE DAILY RESPITE SERVICE, CHILD RESPITE CRISIS DAILY SERVICE AND CHILD RESPITE DAILY IN MEDICAID CERTIFIED PRTF LIMITED TO 1 UNIT PER DAY. (9115) 1915I CHILD RESPITE CRISIS DAILY SERVICE LIMITED TO ONE UNIT A DAY (9120)1951 I CHILD RESPITE DAILY IN MEDICAID CERTIFIED PRTF LIMITED TO 1 UNIT A DAY
6696 RESPITE CARE SERVICE, PROCEDURE CODE T1005 U7, IS LIMITED TO 27 UNITS PER DAY.
6697 WAIVER PROCEDURE CODE S5151 U7 IS LIMITED TO 29 CONSECUTIVE DAYS PER 6 MONTHS.
6698 T2025 U7 US IS LIMITED TO $2000.00 PER ROLLING CALENDAR YEAR PER MEMBER
6699 WAIVER PROCEDURE CODE, T2003 U7 U1 IS LIMITED TO $2000.00 PER ROLLING CALENDAR YEAR, PER MEMBER
6700 WAIVER PROCEDURE CODE, H2015 U7 U1 IS LIMITED TO 8 UNITS PER DAY
6701 PROCEDURE CODE 93352 WILL ONLY PAY WHEN BILLED ON THE SAME DAY AS 93350 OR 93351
6702 NEWBORN SCREENING IS LIMITED TO ONE PER LIFETIME. INDIANA HEALTH COVERAGE PROGRAM ALLOWS REIMBURSEMENT FOR ONLY ONE NEWBORN SCREENING.
6703 REIMBURSEMENT FOR MATERNITY CARE LIMITED TO ONE PER PREGNANCY.
6704 ONLY ONE FAMILY PLANNING SERVICE ALLOWED WITHIN A 12 MONTH PERIOD.
6705 EFFECTIVE 4/1/2020, ADDICTION COUNSELING LIMITED TO 75 UNITS/HOURS PER YEAR. COMBINED TOTAL OF INDIVIDUAL AND GROUP. PRIOR TO 4/1/2020 LIMIT IS 64 UNITS/HOURS.
6706 URINARY/REPRODUCTIVE SYSTEMS PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6707 WAIVER PROCEDURE CODES T2004 U7 U1 UC AND T2004 U7 U2 UB ARE LIMITED TO $100.00 A MONTH
6708 LIMIT 40 UNITS/DAY FOR AGED & DISABLED AND TBI WAIVER
6709 LIMIT 16 UNITS/DAY FOR DD, AU, SS WAIVER
6710 DIABETIC TEST STRIPS ARE LIMITED TO TWO UNITS PER MONTH
6711 DIABETIC LANCETS ARE LIMITED TO 1 UNIT OF 100 PER MONTH
6712 DIABETIC LANCETS ARE LIMITED TO 2 UNITS OF 100 PER MONTH
6713 DIABETIC TEST STRIPS ARE LIMITED TO 4 UNITS PER MONTH
6714 INCONTINENCE SUPPLIES LIMITED TO $162.50 PER MONTH
6715 DEFINITIVE URINE DRUG TESTING (UDT) IS LIMITED TO 16 PER CALENDAR YEAR WITHOUT A PRIOR AUTHORIZATION.
6716 PRESUMPTIVE URINE DRUG TESTING (UDT) IS LIMITED TO 52 PER CALENDAR YEAR WITHOUT A PRIOR AUTHORIZATION.
6717 WAIVER TRANSPORTATION SERVICE (T2002 U7 U5) IS LIMITED TO ONE ROUND TRIP PER DAY
6718 LIMIT PROCEDURE CODES TO ONE UNIT OF SERVICE EVERY THREE YEARS
6723 1915I CHILD RESPITE CARE SERVICES, UP TO 15 MINUTES AND RESPITE ROUTINE DAILY SERVICE OR RESPITE CRISIS DAILY SERVICE NOT ALLOWED ON THE SAME DAY.
6726 PRESCRIPTION LIMITED TO 7 TABLETS FOR 3 DAY TITRATION PURPOSES
6745 QUANTITY LIMITS EXCEEDED. MAXIMUM 4 PER PRESCRIPTION ALLOWED. PRESCRIBER MUST DEMONSTRATE MEDICAL NECESSITY FOR PRIOR AUTHORIZATION REQUEST TO BE APPROVED.
6746 QUANTITY LIMITS EXCEEDED. MAXIMUM 0.65 PER PRESCRIPTION ALLOWED. PRESCRIBER MUST DEMONSTRATE MEDICAL NECESSITY FOR PRIOR AUTHORIZATION REQUEST TO BE APPROVED.
6747 QUANTITY LIMITS EXCEEDED. MAXIMUM 1 PER PRESCRIPTION ALLOWED. PRESCRIBER MUST DEMONSTRATE MEDICAL NECESSITY FOR PRIOR AUTHORIZATION REQUEST TO BE APPROVED.
6748 HOSPICE RESPITE SERVICES ARE LIMITED TO FIVE DAYS IN A GIVEN PERIOD.
6749 1915I CHILD HABILITATION SERVICE (INCLUDING SKILLS TRAINING AND DEVELOPMENT, PER 15 MINUTE UNIT) LIMITED TO 12 UNITS (3 HOURS) PER DAY
6750 NO MORE THAN 30 HOME HEALTH THERAPY HOURS WITHIN 30 DAYS OF HOSPITAL DISCHARGE. ANY ADDITIONAL HOURS REQUIRE PRIOR AUTHORIZATION.
6751 REIMBURSEMENT FOR HYPERBARIC OXYGEN THERAPY FOR MORE THAN TWO MONTHS REQUIRES DOCUMENTATION OF MEDICAL NECESSITY FOR CONTINUED TREATMENT. DOCUMENTATION IS NOT PRESENT OR INSUFFICIENT TO JUSTIFY ADDITIONAL PAYMENT.
6752 REIMBURSEMENT IS LIMITED TO ONE PHYSICAL THERAPY EVALUATION PER MEMBER PER 12 MONTHS UNLESS PRIOR AUTHORIZATION HAS BEEN OBTAINED.
6753 REIMBURSEMENT IS LIMITED TO ONE OCCUPATIONAL THERAPY EVALUATION PER MEMBER PER 12 MONTHS UNLESS PRIOR AUTHORIZATION HAS BEEN OBTAINED.
6754 REIMBURSEMENT FOR HYPERBARIC OXYGEN THERAPY FOR MORE THAN TWO MONTHS REQUIRES DOCUMENTATION OF MEDICAL NECESSITY FOR CONTINUED TREATMENT. DOCUMENTATION IS NOT PRESENT OR IS INSUFFICIENT TO JUSTIFY ADDITIONAL PAYMENT.
6755 RESERVED FOR FUTURE USE.
6756 REIMBURSEMENT IS NOT AVAILABLE FOR PROPHYLAXIS WHEN PAYMENT HAS PREVIOUSLY BEEN MADE FOR APPLICATION OF FLUORIDE, INCLUDING PROPHYLAXIS.
6757 RENAL DIALYSIS REVENUE CODE- MAXIMUM 31 UNITS/31 DAYS
6758 RENAL DIALYSIS SUPPLIES REVENUE CODE-MAXIMUM 31 UNITS/30 DAY
6768 SERVICES NOT COVERED FOR TELEMEDICINE SERVICES
6800 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMIT TRANSPORTATION FOR HOME VISITS, INITIAL ASSESSMENT TO TWO ROUND TRIPS PER PREGNANCY.
6801 REIMBURSEMENT FOR TRANSPORTATION FOR CARE COORDINATION (REASSESSMENT) LIMITED TO TWO (2) ROUND TRIPS FOR THE SAME RECIPIENT WITHIN SIX (6) MONTHS.
6802 REIMBURSEMENT FOR TRANSPORTATION FOR POST PARTUM ASSESSMENT LIMITED TO ONE ROUND TRIP PER PREGNANCY AND MUST BE COMPLETED WITHIN 60 DAYS OF DELIVERY.
6803 PRIOR AUTHORIZATION REQUIRED FOR TRANSPORTATION SERVICES IN EXCESS OF THE ALLOWED NUMBER MINUS EXEMPTIONS.
6804 MILEAGE NOT REIMBURSEABLE WHEN BILLED WITH TAXI-CAB BASE RATE.
6805 CLAIM CORRECTED/ADJUSTED TO REFLECT INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE REIMBURSEMENT FOR TAXI - BASE (ONLY) WHEN BILLED ON THE SAME DATE OF SERVICE AS MILEAGE.
6806 STEP THERAPY REQ NOT MET-NDC REQ PA
6807 PLAN/PDL LIMITS EXCEEDED-NDC REQUIRES PA
6808 ACETAMINOPHEN LIMITED TO 3GM PER DAY
6809 THERAPEUTIC DUPLICATION-PA REQUIRED
6810 PRIOR AUTHORIZATION REQUIRED FOR 3 OR MORE BENZODIAZEPINE MEDICATIONS
6811 PRIOR AUTHORIZATION REQUIRED FOR 2 OR MORE TRICYCLIC ANTIDEPRESSANT MEDICATIONS
6812 PRIOR AUTHORIZATION REQUIRED FOR 3 OR MORE ATYPICAL OR ANY ANTIPSYCHOTIC MEDICATIONS
6813 PRIOR AUTHORIZATION REQUIRED FOR 2 OR MORE TYPICAL ANTIPSYCHOTIC MEDICATIONS
6814 PRIOR AUTHORIZATION REQUIRED FOR 3 OR MORE ANY ANTIDEPRESSANT MEDICATIONS, EXCLUDING TRAZADONE
6815 REQUIRED TAXONOMY MISSING
6816 MHQAC UTILIZATION QUANTITY PER DAY LIMIT EXCEEDED
6817 MHQAC PA REQUIRED
6818 NDC QUANTITY IS OUTSIDE OF NORMAL BILLING QUANTITY. PLEASE VERIFY THE QUANTITY AND RESUBMIT. IF QUANTITY IS CORRECT PLEASE CALL ACS AT 1-866-879-0106 FOR PRIOR AUTHORIZATION
6819 AMOUNT BILLED IS OUTSIDE OF THE NORMAL BILLING AMOUNT. PLEASE VERIFY THE BILLED AMOUNT IS CORRECT AND RESUBMIT. IF THE BILLED AMOUNT IS CORRECT PLEASE CALL ACS AT 1-866-879-0106 FOR PRIOR AUTHORIZATION.
6820 RESERVED
6821 THERAPY EXCEEDS LIMITATION-PA REQUIRED
6855 REIMBURSEMENT IS LIMITED TO SIX ROUTINE FOOT CARE SERVICES PER CALENDAR YEAR FOR PATIENTS WITH DIABETES MELLITUS, PERIPHERAL VASCULAR DISEASE, OR PERIPHERAL NEUROPATHY, UNLESS PRIOR AUTHORIZATION HAS BEEN OBTAINED.
6856 PEER SUPPORT SERVICES LIMITED TO 130 HOURS PER YEAR
6857 REIMBURSEMENT FOR NON INVASIVE DOPPLER STUDY IS LIMITED TO ONE PER MEMBER PER CALENDAR YEAR.
6858 REIMBURSEMENT LIMITED TO ONE NURSING FACILITY VISIT PER MEMBER PER MONTH. DOCUMENTATION NOT PRESENT OR INSUFFICIENT TO JUSTIFY ADDITIONAL VISITS.
6900 PSYCHIATRIC SERVICES IN EXCESS OF 20 PER ROLLING CALENDAR YEAR REQUIRE AN APPROVED PRIOR AUTHORIZATION.
6901 INFECTIOUS AGENT DETECTION LIMIT 1 PER DAY
6902 PRIOR AUTHORIZATION IS REQUIRED FOR MORE THAN 80 UNITS OF ANY ONE THERAPY OR COMBINATION OF THERAPIES IN ONE YEAR PERIOD.
6903 PRIOR AUTHORIZATION IS REQUIRED FOR MORE THAN 30 OFFICE VISITS FOR MEMBERS PARTICIPATING IN THE PCCM PROGRAM.
6907 THIS MEMBER IS ADHD NAIVE. A CARE MANAGER WILL BE FOLLOWING UP WITH THE DOCTOR REGARDING THE MEMBER'S CARE.
6909 DRUG NAME NOT REPORTED ON CLAIM FORM
6910 DISEASE MANAGEMENT EDUCATION IS LIMITED TO 6 UNITS PER 12 MONTH PERIOD
6911 INTRA-ARTERIAL, INTRA-VENOUS DIAGNOSTIC, THERAPEUTIC INJECTION SERVICES, AND INTRAVENOUS THERAPY FOR SEVERE ALLERGIC DISEASE IS NOT SEPARATELY REIMBURSED WHEN BILLED IN CONJUNCTION WITH IV THERAPY SERVICES.
6915 WAIVER SERVICES ARE LIMITED TO 600 HOURS OR 25 DAYS PER YEAR OR 14 CONSECUTIVE DAYS.
6916 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT PROCEDURES WHEN GLOBAL PROCEDURE HAS BEEN PAID.
6917 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR A GLOBAL PROCEDURE WHEN COMPONENT PROCEDURES HAVE BEEN PAID.
6918 REIMBURSEMENT IS LIMITED TO 16 UNITS OF DIABETES SELF MANAGEMENT TRAINING PER RECIPIENT PER 12 MONTHS UNLESS PRIOR AUTHORIZATION FOR ADDITIONAL SERVICES HAS BEEN OBTAINED.
6919 EXTENDED (E&M) OFFICE VISITS ARE LIMITED TO TWO PER 60 DAYS.
6920 REIMBURSEMENT IS LIMITED TO 8 UNITS OF DIABETES SELF MANAGEMENT TRAINING PER RECIPIENT PER 12 MONTHS
6921 INITIAL DD WAIVER DIAGNOSTIC AND PSYCHIATRIC EVALUATIONS ALLOWED ONCE EVERY SIX (6) MONTHS PER RECIPIENT.
6925 CARE SELECT CARE COORDINATION CONFERENCE IS LIMITED TO 2 UNITS OF SERVICE PER MEMBER, PER ROLLING 12 MONTHS.
6937 LIMIT 2/DAY SEROQUEL
6938 SUPPORTED COMMUNITY ENGAGEMENT SERVICES LIMITED TO 18 HOURS PER MONTH
6939 BPHC CARE COORDINATION SERVICES FOR CASE MANAGEMENT AND SELF-HELP/PEER SERVICES ARE LIMITED TO 12 HOURS IN 6 MONTHS FOR ANY COMBINATION OF SERVICES
6940 LIMIT, MHQAC SEDATIVE HYPNOTIC 2 SPRAYS (0.25 ML) PER DAY
6941 PRIOR AUTHORIZATION REQUIRED FOR TWO OR MORE SSRI AND/OR SNRI ANTIDEPRESSANTS, EXCLUDING BUPROPION, MIRTAZAPINE AND TRAZADONE
6942 PRIOR AUTHORIZATION REQUIRED FOR 2 OR MORE SEDATIVE-HYPNOTICS, INCLUDING TRAZADONE
6997 RESERVED FOR FUTURE USE.
6998 RESERVED FOR FUTURE USE.
6999 RESERVED FOR FUTURE USE.
7000 DENIED FOR PRODUR ALERT
7001 INFORMATIONAL PRODUR ALERT
7002 CLAIM DENIED FOR DUR REASONS
7003 PRODUR ALERT REQUIRES PA
7004 NON-OVERRIDEABLE PRODUR ALERT
7499 DENIED- Medical record documentation signed and dated prior to the date services were rendered.
7500 YOUR CLAIM IS BEING REVIEWED
7501 PRESCIPTION NOT WRITTEN BY VALID LOCK-IN PRESCRIBER.
7502 MEMBER LOCKED IN TO A SPECIFIC PROVIDER
7503 MISSING/INVALID PRODUR CONFLICT CODE. ALERT ON RESPONSE DOES NOT MATCH AN ALERT SET ON THE CLAIM. PLEASE USE APPROPRIATE DD, LD, HD, ER, LR, PA, PG, MC, TD AND RESUBMIT.
7504 MISSING/INVALID PRODUR INTERVENTION CODE. PLEASE USE M0, P0 OR R0 AND RESUBMIT.
7505 MISSING/INVALID PRODUR OUTCOME CODE. PLEASE USE 1A-1G, 2A OR 2B.
7506 RESPONSE CLAIM. ORIGINAL CLAIM POSTED NON-OVERRIDEABLE ALERT.
7507 VALID OUTCOME CODE OF NOT FILLED RECEIVED. RESPONSE ACCEPTED, CLAIM REJECTED.
7508 RESERVED FOR FUTURE USE.
7509 RENDERING PROVIDER ON PREPAYMENT REVIEW
7510 THIS SERVICE MUST BE BILLED TO HP ON THE HCFA-1500 UTILIZING THE APPROPRIATE HCPCS CODE.
7511 DENIED-PROCEDURE CODE BILLED DOES NOT CORRECTLY DESCRIBE SERVICE DOCUMENTED/BILLED.
7512 DENIED-PRIOR AUTHORIZATION NOT RECEVED FOR ITEMS/SERVICES BILLED.
7513 DENIED-DOCUMENTATION DOES NOT SUPPORT LEVEL OF CODE BILLED.
7514 DENIED-ILLEGIBLE DOCUMENTATION.
7515 DENIED- NO DOCUMENTATION SUBMITTED WITH CLAIM AS REQUIRED BY PREPAYMENT REVIEW.
7516 DENIED- PROVIDER WAS PAID FOR THIS SERVICE ON ANOTHER CLAIM SUBMISSION.
7517 DENIED-DOCUMENTATION IS INSUFFICIENT TO SUPPORT CODE BILLED, PER BILLING GUIDELINES.
7518 DENIED-DATE SERVICE/ITEM BILLED DOES NOT MATCH DATE SERVICE/ITEM DOCUMENTED AS RENDERED/DELIVERED.
7519 DENIED-WRITING OVER PREVIOUS ENTRIES TO CORRECT ERRORS IS INAPPROPRIATE. THE MEDICAL RECORD IS A LEGAL DOCUMENT. TO REVISE AN ERROR, DRAW SINGLE LINE THROUGH IT, MAKE CORRECTION, WRITE THE WORD "ERROR" AND DATE ERROR WAS CORRECTED. INITIALS OR SIGNATURE BY STAFF MEMBER PROVIDING SERVICE REQUIRED.
7520 DENIED-DOCUMENTATION NOT AUTHENTICATED.
7521 DENIED-PHYSICIAN CONSULTANT REVIEW DETERMINATION. DOCUMENTATION DOES NOT CONTAIN CLINICAL SIGNS/SYMPTOMS TO SUPPORT MEDICAL NECESSITY OF SERVICE.
7522 DENIED-DOCUMENTATION HAS BEEN MODIFIED WHEN COMPARED TO PREVIOUS CLAIM SUBMISSIONS.
7523 DENIED-DATE OF SERVICE NOT DOCUMENTED OR DOES NOT INCLUDE COMPLETE MONTH/DAY/YEAR.
7524 DENIED- IF AN EVALUATION AND MANAGEMENT (E&M) CODE IS BILLED ON THE SAME DATE OF SERVICE AS AN OFFICE-ADMINISTERED DRUG, A DRUG ADMINISTRATION CODE SHOULD NOT BE BILLED SEPARATELY. REIMBURSEMENT FOR ADMINISTRATION IS INCLUDED IN THE E/M ALLOWED AMOUNT.
7525 DENIED-DOCUMENTATION DOES NOT INCLUDE PATIENT DEMOGRAPHICS.
7526 DENIED- DOCUMENTATION IS AUTHENTICATED, BUT NO DATE OF AUTHENTICATION IS INDICATED.
7527 DENIED-NO PHYSICIAN ORDER.
7528 DENIED-QUANTITY BILLED EXCEEDS QUANTITY ORDERED/ALLOWED.
7529 DENIED-ILLEGIBLE DATE OF SERVICE ON PHYSICIAN ORDER.
7530 DENIED-NO DATE OF SERVICE ON PHYSICIAN ORDER.
7531 DENIED-PHYSICIAN ORDER IS NOT SIGNED AND DATED BY A PHYSICIAN.
7532 DENIED-MISSING OR INVALID MODIFIER.
7533 DENIED-INVALID OR MISSING MEMBER SIGNATURE/NAME.
7534 DENIED-TIME DOCUMENTED DOES NOT SUPPORT UNITS BILLED.
7535 DENIED-PLAN OF CARE NOT DATED BY PHYSICIAN.
7536 DENIED-INVALID OR NO PLAN OF CARE.
7537 DENIED-INVALID OR NO NOTICE OF ACTION.
7538 DENIED-INCORRECT PHYSICIAN NATIONAL PROVIDER IDENTIFIER (NPI).
7539 DENIED-NO PROGRESS NOTE.
7540 DENIED-INCORRECT ELECTRONIC SIGNATURE FORMAT, PLEASE REFER TO RULE 20 IAC 3.
7541 DENIED-INCORRECT OR NO RID (RECIPIENTS IDENTIFICATION) NUMBER.
7542 DENIED-HP (HEWLETT PACKARD) DENIAL.
7543 DENIED-INCORRECT DIAGNOSIS CODE.
7544 DENIED-NO TREATMENT PLAN.
7545 DENIED-NO CREDENTIALS DOCUMENTED AFTER SERVICE PROVIDER'S SIGNATURE.
7546 DENIED-DOCUMENTATION HAS NOT BEEN AUTHENTICATED IN A TIMELY MANNER.
7547 DENIED-RENDERING PROVIDER NOT CERTIFIED TO PROVIDE SERVICE BILLED.
7548 DENIED- NO MEDICAL HISTORY/REVIEW OF SYSTEM FORM SUBMITTED.
7549 DENIED - MEDICAL HISTORY/REVIEW OF SYSTEM FORM IS NOT SIGNED AND/OR DATED BY THE SERVICE PROVIDER.
7550 DENIED-SUBMITTED DOCUMENTATION IS MISSING ONE OR MORE OF THE REQUIRED ELEMENTS OF A MEDICAL OR "OTHER" RECORD FOR MEDICAID PURPOSES. SEE 405 IAC 1-5-1 (B) (1-10) AND PREPAYMENT REVIEW NOTIFICATION & CRITERIA LETTERS.
7551 DENIED-ITEM BILLED (SIZE, QUANTITY, OR PRODUCT TYPE) DOES NOT MATCH OR IS NOT CONSISTENT WITH ITEM ORDERED BY PHYSICIAN.
7552 DENIED-WHEN MEMBER IS UNABLE TO SIGN FOR SERVICES RENDERED, DOCUMENTATION MUST INCLUDE REASON FOR MEMBER'S INABILITY TO SIGN AND ENDORSER'S RELATIONSHIP TO THE MEMBER.
7553 DENIED- NO PROOF OF DELIVERY.
7554 DENIED-DELIVERY TICKET PRINTED AFTER DATE OF SERVICE.
7555 DENIED-INVALID PHYSICIAN ORDER FOR DATE OF SERVICE. PHYSICIAN ORDER APPEARS TO HAVE BEEN OBTAINED AFTER DATE OF SERVICE BILLED. (NOT DOCUMENTED AS VERBAL ORDER).
7556 DENIED- NO DOCUMENTATION OF LABOR PERFORMED TO SUPPORT SERVICE BILLED.
7557 DENIED- PHYICIAN ORDER LACKED FREQUENCY AND TYPE OF TREATMENT FOR WHICH GLOVES HAD BEEN ORDERED AS PART OF PLAN OF CARE.
7558 DENIED-UNABLE TO CONFIRM QUANTITY DELIVERED. UNABLE TO CONFIRM PACKAGING.
7559 DENIED-LABOR DOCUMENTATION DOES NOT SUPPORT UNITS BILLED.
7560 DENIED- UNABLE TO VERIFY ITEMS DELIVERED. NO VENDOR INVOICE.
7561 DENIED- UNABLE TO VERIFY DELIVERY. TRACKING NUMBERS ON VENDOR INVOICE AND UPS/FEDEX INVOICE DON'T MATCH OR NO UPS TRACKING NUMBER/REFERENCE NUMBER ON VENDOR INVOICE.
7562 DENIED- QUANTITY OF ITEM NOT DOCUMENTED ON PHYSICIAN ORDER.
7563 DENIED-UNABLE TO VERIFY QUANTITY DELIVERED. BILLED MORE/ LESS UNITS THAN DELIVERY TICKET LISTS. UNABLE TO CONFIRM COUNT PER PACKAGE.
7564 DENIED-VENDOR INVOICE DOES NOT IDENTIFY HOW MANY ITEMS PER BOX.
7565 DENIED-CLAIM IS PAST THE TIMELY FILING LIMIT.
7566 DENIED-NON COVERED SERVICE(S).
7567 DENIED-CPT OR HCPCS CODE DELETED/NOT VALID.
7568 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7569 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7570 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7571 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7572 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7573 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7574 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7575 DENIED- NO TREATMENT PLAN OR PHYSICIAN OVERSIGHT WITHIN 90 DAYS.
7576 DENIED-NO DOCUMENTATION OF MEDICATION MANAGEMENT.
7577 DENIED-TYPE OF THERAPY, FREQUENCY AND/OR TIME DURATION OF SESSIONS NOT INDICATED ON TREATMENT PLAN.
7578 DENIED- DOCUMENTATION DOES NOT INDICATE INDIVIDUALS PRESENT IN THERAPY SESSION.
7579 DENIED-SERVICE AS DOCUMENTED DOES NOT REPRESENT A BILLABLE/COVERED SERVICE.
7580 DENIED-THE MID-LEVEL PRACTITIONER RENDERING SERVICES IS NOT CREDENTIALED TO ADMINISTER THERAPY SERVICES PER THE IHCP PROVIDER MODULE, MENTAL HEALTH AND ADDICTION SERVICES, PAGE 5.
7581 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7582 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7583 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7584 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7585 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7586 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7587 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7588 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7589 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7590 DENIED-NO PHOTOCOPY OF BITEWING X-RAY.
7591 DENIED-NO PHOTOCOPY OF PERIAPICAL X-RAY.
7592 DENIED- NO PHOTOCOPY OF PANORAMIC X-RAY.
7593 DENIED-NO X-RAY EVIDENT ON PHOTOCOPY.
7594 DENIED- DOCUMENTATION DOES NOT MATCH TOOTH NUMBER BILLED.
7595 DENIED-DOCUMENTATION OF NITROUS OXIDE MUST INCLUDE CONCENTRATION (PERCENTAGE) AND DURATION OF ADMINISTRATION.
7596 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7597 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7598 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7599 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7600 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7601 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7602 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7603 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7604 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7605 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7606 DENIED-UNABLE TO VERIFY ALL REGIONS BILLED.
7607 DENIED-UNABLE TO VERIFY ELECTRICAL MUSCLE STIMULATION, NO TIME INDICATED.
7608 DENIED-UNABLE TO VERIFY VASOPNEUMATIC DEVICE.
7609 DENIED-UNABLE TO VERIFY NEUROMUSCULAR REDUCTION.
7610 DENIED- UNABLE TO VERIFY THERAPEUTIC PROCEDURE, NO TIME INDICATED.
7611 DENIED-MANUAL THERAPY CODES CAN NOT BE BILLED WITH MANIPULATION CODES ON SAME BODY REGION AND SAME DATE OF SERVICE.
7612 DENIED- UNABLE TO VERIFY ULTRASOUND PROCEDURE, NO TIME INDICATED.
7613 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7614 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7615 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7616 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7617 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7618 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7619 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7620 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7621 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7622 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7623 DENIED-DOCUMENTATION DOES NOT SUPPORT QUANTITY OF MILES BILLED.
7624 DENIED-DOCUMENTATION DOES NOT SUPPORT TRANSPORT OF AN ATTENDANT.
7625 DENIED-DOCUMENTATION SUPPORTS ONE-WAY TRIP.
7626 DENIED-DOCUMENTATION DOES NOT SUPPORT WAIT TIME.
7627 DENIED-DRIVER'S NAME NOT DOCUMENTED.
7628 DENIED- WHEN MEMBER IS UNABLE TO SIGN FOR SERVICES RENDERED, DOCUMENTATION MUST INCLUDE REASON FOR MEMBER'S INABILITY TO SIGN.
7629 DENIED-DOCUMENTATION SHOWS MEMBER TRANSPORTED IN SAME VEHICLE WITH OVERLAPPING ODOMETER READINGS AND/OR AT SAME TIME AS ANOTHER MEMBER.
7630 DENIED-DROP-OFF AND/OR PICK-UP TIME(S) ARE NOT DOCUMENTED.
7631 DENIED-PICK-UP AND/OR DROP-OFF ADDRESS(ES) ARE NOT DOCUMENTED.
7632 DENIED-ODOMETER READINGS AND PICK-UP/DROP-OFF TIMES DO NOT AGREE.
7633 DENIED-ODOMETER READING(S) DOCUMENTED INCORRECTLY OR MISSING.
7634 DENIED-DISCREPANCIES FOUND WHEN COMPARING DRIVER'S TICKET AND MEMBER'S FILE.
7635 DENIED-ACCORDING TO MAPPING SOFTWARE, MEMBER RESIDES FEWER MILES FROM PROVIDER'S OFFICE THAN BILLED.
7636 DENIED-VEHICLE USED TO TRANSPORT MEMBER NOT DOCUMENTED.
7637 DENIED-INCORRECT CODING COMBINATION, PLEASE REFER TO THE IHCP PROVIDER MODULE, TRANSPORTATION SERVICES, PAGE 8, TABLE 4 (CODING TRANSPORTATION FOR MULTIPLE PASSENGERS).
7638 DENIED-TRANSPORTATION SERVICES MUST BE BILLED ACCORDING TO LEVEL OF SERVICE NOT PROVIDER'S LEVEL OF RESPONSE OR VEHICLE TYPE.
7639 DENIED- AMBULATORY (CAS) OR NONAMBULATORY (NAS) NOT DOCUMENTED OR DOCUMENTATION CONTAINS CONTRADICTING INFORMATION REGARDING MEMBER'S MOBILITY.
7640 DENIED-PROVIDER IS RESPONSIBLE TO VERIFY MEMBER IS TRANSPORTED TO/FROM A MEDICAID COVERED SERVICE/FACILITY.
7641 DENIED-ONE-WAY OR ROUND TRIP NOT DOCUMENTED.
7642 DENIED-MILEAGE AND OTHER SERVICES WILL ONLY BE PAID WITH A PAID BASE RATE FOR THE SAME DATE OF SERVICE.
7643 DENIED- NAME AND/OR ADDRESS OF MEDICAID PROVIDER MEMBER IS BEING TRANSPORTED TO/FROM IS NOT DOCUMENTED.
7644 DENIED-COMPLETE ADDRESS NOT DOCUMENTED.
7645 DENIED- NAME, RELATIONSHIP, AND SIGNATURE OF ACCOMPANYING PARENT/ATTENDANT MUST BE DOCUMENTED.
7646 DENIED-PICK UP OR DROP-OFF ADDRESS IS NOT VALID.
7647 DENIED-TRANSPORT CONDUCTED OUTSIDE AREA CERTIFIED BY STATE OF INDIANA AND DEPARTMENT OF REVENUE.
7648 DENIED-DOCUMENTATION DOES NOT SUPPORT NUMBER OF UNITS BILLED. A STOP ALONG WAY IS NOT CONSIDERED A SEPARATE TRIP.
7649 DENIED-DOCUMENTATION DOES NOT SUPPORT THE NUMBER OF UNITS BILLED. ONLY ONE TRIP TICKET IS SIGNED BY MEMBER, ONLY ONE UNIT MAY BE REIMBURSABLE.
7650 DENIED-DOCUMENTATION SUBMITTED FOR REVIEW SHOWS PATIENT WAS TRANSPORTED IN THE SAME VEHICLE WITH OVERLAPPING ODOMETER READINGS AS ANOTHER PATIENT.
7651 DENIED-NO CORRESPONDING MEDICAL CLAIM TO SUPPORT REASON FOR TRANSPORT.
7652 DENIED - DATE OF SERVICE WAS PRIOR TO THE PROVIDER'S EDUCATION PROVIDED BY HP FIELD CONSULTANT. DOCUMENTATION WAS CREATED FOR THE PURPOSES OF PREPAYMENT REVIEW.
7653 DENIED - DISCREPANCIES FOUND WEHN COMPARING DRIVER'S TICKETS.
7654 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7655 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7656 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7657 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7658 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7659 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7660 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7661 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7662 DENIED-NO CURRENT TREATMENT PLAN.
7663 DENIED- DOCUMENTATION DOES NOT SUPPORT MEMBER'S PRESENCE AT AFC. (MFP)
7664 DENIED-NO GOAL AND/OR INTERVENTION TECHNIQUE DOCUMENTED. (CA-PRTF)
7665 DENIED - NO DOCUMENTATION OF RENDERING PROVIDER, HANDWRITTEN DATE, OR SIGNATURE OF PROGRESS NOTES. (CA-PRTF)
7666 DENIED-SERVICES RENDERED HAVE OVERLAPPING TIMES, OR TRAVEL TIME BETWEEN APPOINTMENTS IS INSUFFICIENT. (CA-PRTF)
7667 DENIED-DATE OF SERVICE NOT DOCUMENTED ON ATTENDANCE SHEET. (MFP)
7668 DENIED-START AND STOP TIMES ON PROGRESS NOTES DO NOT CORRESPOND WITH TRANSPORTATION ARRIVAL AND DEPARTURE TIMES. (MFP)
7669 DENIED-DOCUMENTATION DOES NOT SUPPORT MEMBER'S PRESENCE AT ADC. (MFP)
7670 DENIED-DAILY RESPITE MUST BE BILLED FOR OVER 7 HOURS BUT NOT OVERNIGHT. HOURLY RESPITE CANNOT BE BILLED FOR MORE THAN 7 HOURS A DAY. (CA-PRTF)
7671 DENIED-DUE TO CONTRADICTING INFORMATION ON THE ACD AND AFC NOTES, THIS ITEM/CLAIM IS BEING DENIED. (MFP)
7672 DENIED- ACCORDING TO THE NOA, DATE(S) OF SERVICE BILLED ARE APPROVED FOR A DIFFERENT PROVIDER.
7673 DENIED-DOCUMENTATION SUBMITTED DOES NOT SUPPORT OVERHEAD AMOUNT BILLED.
7674 DENIED-TIME DOCUMENTED DOES NOT INDICATE IF SERVICES RENDERED IN A.M. OR P.M.
7675 DENIED-DOCUMENTATION DOES NOT LIST TIME-IN OR TIME-OUT.
7676 DENIED-DOCUMENTATION DOES NOT INDICATE WHICH SERVICES ARE BEING PERFORMED.
7677 DENIED-SERVICES RENDERED HAVE OVERLAPPING TIMES
7678 DENIED-WAIVER TRANSPORTATION ALLOWS TWO ONE-WAY TRIPS PER DAY.
7679 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7680 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7681 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7682 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7683 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7684 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7685 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7686 DENIED-NO INDIVIDUALIZED SUPPORT PLAN.
7687 DENIED-DOCUMENTATION DOES NOT SUPPORT RN'S SERVICES.
7688 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7689 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7690 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7691 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7692 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7693 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7694 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7695 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7696 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7697 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7698 DENIED- NO 450 B OR 450 B SA/DE FORM.
7699 DENIED-DATE OF SERVICE IS AFTER DATE PATIENT WAS TRANSFERRED TO ANOTHER IHCP PROVIDER.
7700 DENIED-PROVIDER NUMBER WAS DECERTIFIED BY THE INDIANA STATE DEPARTMENT OF HEALTH (ISDH).
7701 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7702 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7703 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7704 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7705 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7706 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7707 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7708 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7709 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7710 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7711 DENIED-PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, PATIENT'S FULL NAME, IS NOT INCLUDED ON THE PRESCRIPTION.
7712 DENIED- PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, DATE PRESCRIBED, IS NOT INCLUDED ON THE PRESCRIPTION.
7713 DENIED-PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, DRUG NAME, IS NOT INCLUDED ON THE PRESCRIPTION.
7714 DENIED-PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, STRENGTH, IS NOT INCLUDED ON THE PRESCRIPTION.
7715 DENIED- PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, QUANTITY, IS NOT INCLUDED ON THE PRESCRIPTION.
7716 DENIED- PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, DIRECTIONS FOR USE, IS NOT INCLUDED ON THE PRESCRIPTION.
7717 DENIED-PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, REFILLS IF APPLICABLE, IS NOT INCLUDED ON THE PRESCRIPTION.
7718 DENIED-PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, PHYSICIAN'S SIGNATURE, IS NOT INCLUDED ON THE PRESCRIPTION.
7719 DENIED- PLEASE REFER TO BT201024, THE REQUIRED ELEMENT, PHYSICIAN'S INFORMATION, IS NOT INCLUDED ON THE PRESCRIPTION.
7720 DENIED-NO ORIGINAL WRITTEN ORDER OR PRESCRIPTION FORM FROM PRESCRIBER.
7721 DENIED-NO SIGNATURE LOG.
7722 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7723 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7724 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7725 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7726 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7727 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7728 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7729 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7730 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7731 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7732 PREPAYMENT REVIEW EDUCATION-MISSING OR INVALID MODIFIER.
7733 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DOCUMENTATION IS NOT AUTHENTICATED.
7734 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-WHEN A MEMBER IS UNABLE TO SIGN FOR SERVICES RENDERED, THE DOCUMENTATION MUST INCLUDE THE REASON FOR THE MEMBER'S INABILITY TO SIGN AND THE RELATIONSHIP TO THE PATIENT OF THE PERSON SIGNING. DELIVERY TICKETS SHOULD ALSO BE DATED.
7735 PLEASE NOTE: PREPAYMENT REVIEW HAS PROCESSED THIS CLAIM FOR PAYMENT AND IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION- PLEASE REFER TO BT200130 IN REGARDS TO DOCUMENTATION REQUIREMENTS FOR ALL INCONTINENCE SUPPLIES.
7736 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DOCUMENTATION SHOULD NOT BE ALTERED OR CREATED AFTER THE FACT IN ORDER TO OBTAIN PAYMENT FOR CLAIMS SUBMITTED TO PREPAYMENT REVIEW.
7737 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-PHYSICIAN ORDER MUST BE SIGNED AND DATED BY THE ORDERING PHYSICIAN.
7738 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DELIVERY TICKET MUST CONTAIN A FULL ITEM DESCRIPTION (INCLUDING ITEM SIZE AND/OR PACKAGING) IN ORDER TO CONFIRM ITEMS DELIVERED MATCH ITEMS BILLED.
7739 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-INSUFFICIENT DOCUMENTATION TO SUPPORT SERVICES RENDERED. UNABLE TO VERIFY ULTRASOUND PROCEDURE, NO TIME INDICATED.
7740 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-WHEN A MEMBER IS UNABLE TO SIGN THE DRIVER'S TICKET, THE DRIVER'S TICKET MUST INCLUDE THE REASON FOR THE MEMBER'S INABILITY TO SIGN.
7741 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DOCUMENTATION DOES NOT LIST DROP-OFF OR PICK-UP TIMES.
7742 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DOCUMENTATION DOES NOT HAVE A COMPLETE PICK-UP OR DROP-OFF ADDRESS. REFER TO BT200505.
7743 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-WRITING OVER PREVIOUS ENTRIES TO CORRECT ERRORS IS INAPPROPRIATE. THE MEDICAL RECORD IS A LEGAL DOCUMENT. TO REVISE ERROR, DRAW SINGLE LINE THROUGH IT, MAKE CORRECTION, WRITE THE WORD "ERROR" AND THE DATE ERROR WAS CORRECTED. INITIALS OR SIGNATURE BY STAFF MEMBER PROVIDING SERVICE REQUIRED.
7744 PLEASE NOTE: PREPAYMENT REVIEW HAS PROCESSED THIS CLAIM FOR PAYMENT AND IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DOCUMENTATION SUBMITTED DOES NOT LIST THE VEHICLE USED TO TRANSPORT THE MEMBER.
7745 PLEASE NOTE: PREPAYMENT REVIEW HAS PROCESSED THIS CLAIM FOR PAYMENT AND IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DOCUMENTATION SUBMITTED DOES NOT HAVE THE APPROPRIATE ODOMETER READING.
7746 PLEASE NOTE: PREPAYMENT REVIEW HAS PROCESSED THIS CLAIM FOR PAYMENT AND IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-RENDERING PROVIDER'S NAME IS NOT DOCUMENTED, PLEASE REF TO BT200505.
7747 PLEASE NOTE: PREPAYMENT REVIEW HAS PROCESSED THIS CLAIM FOR PAYMENT AND IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-WHEN AN ATTENDANT OR PARENT IS BILLED AS PART OF THE TRANSPORT, THE PARENT OR ATTENDANT MUST ALSO SIGN THE DRIVER'S TICKET.
7748 PLEASE NOTE: PREPAYMENT REVIEW HAS PROCESSED THIS CLAIM FOR PAYMENT AND IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-WHEN A MEMBER PICKS UP MORE THAN ONE PRESCRIPTION, A SIGNATURE IS REQUIRED FOR EACH PRESCRIPTION IN THE SIGNATURE LOG. MISSING SIGNATURES MAY RESULT IN DENIED CLAIMS.
7749 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-NO RID (RECIPIENTS IDENTIFICATION) NUMBER.
7750 PREPAYMENT REVIEW EDUCATION-DOCUMENTATION SHOULD NOT BE ALTERED OR CREATED AFTER THE FACT. DOCUMENTATION OF SERVICES PROVIDED IS CONSIDERED A LEGAL DOCUMENT. THE PROVIDER OF THE SERVICE CAN ADD A LATE ENTRY BY FOLLOWING THESE STEPS: 1) ADD THE MISSING INFORMATION 2) WRITE "LATE ENTRY" NEXT TO THE ADDITION 3) AND THE DATE IT WAS ADDED 4) INITIAL OR SIGN THE ENTRY.
7751 PLEASE NOTE: PREPAYMENT REVIEW HAS PROCESSED THIS CLAIM FOR PAYMENT AND IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION- WHEN A MEMBER IS UNABLE TO SIGN THE SIGNATURE LOG, THE SIGNATURE LOG MUST INCLUDE THE RELATIONSHIP OF THE PERSON SIGNING THE LOG.
7752 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION- WHEN USING PRE-FILLED IN PICK-UP/DROP-OFF TIMES, PLEASE VERIFY THE TIME FILLED IN IS CORRECT.
7753 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-INCORRECT PROCEDURE CODE. REFER TO BT200505, PGS. 8-9 WHEN BILLING ACCOMPANYING PARENT/ATTENDANT OR ADDITIONAL ATTENDANT CODES.
7754 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-BEHAVIOR MANAGEMENT CODES SHOULD BE DOCUMENTED "BY REPORT".
7755 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DOCUMENTATION OF MEDICAL NECESSITY IS REQUIRED FOR EACH SERVICE RENDERED.
7756 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-DOCUMENTATION HAS NOT BEEN AUTHENTICATED IN A TIMELY MANNER.
7757 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-NO CREDENTIALS DOCUMENTED AFTER SERVICE PROVIDER'S SIGNATURE.
7758 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-ADDRESS(ES) IS MISSING A REQUIRED ELEMENT(S). REVIEW DOCUMENTATION REQUIREMENTS IN BT200505, P 13 & 14.
7759 PREPAYMENT REVIEW EDUCATION-NO DOCUMENTATION TO VERIFY IF MEMBER IS CAS/AMBULATORY OR NAS/NONAMBULATORY.
7760 PREPAYMENT REVIEW EDUCATION-NO DOCUMENTATION TO VERIFY IF THIS IS ONE-WAY OR ROUND TRIP.
7761 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-INSUFFICIENT DOCUMENTATION TO SUPPORT SERVICES RENDERED. UNABLE TO VERIFY PROCEDURE, DUE TO TIME ELEMENT MISSING.
7762 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION-PHYSICIAN ORDER MUST BE SIGNED AND DATED BY THE SUPERVISING PHYSICIAN.
7763 PREPAYMENT REVIEW DETERMINATION. PHYSICIANS ORDER LACKS SPECIFICITY: FREQUENCY AND/OR TYPE OF TREATMENT NOT DOCUMENTED.
7764 PREPAYMENT REVIEW IS EDUCATING THE PROVIDER CONCERNING FUTURE PAYMENTS REGARDING THIS ISSUE. EDUCATION - DOCUMENTATION SUPPORTS A HIGHER LEVEL OF CARE; CLAIM POSSIBLY UNDERCODED.
7765 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7766 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7770 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7771 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7772 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7773 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7774 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7775 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7776 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7777 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7778 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7779 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7800 DENIED-INCORRECT NUMBER OF DRUG CLASSES BILLED.
7801 DENIED-MISSING COMPLETE CONSULTATION REPORT.
7802 DENIED-PROVIDER CAN BILL ONLY ONE SERVICE PER DAY, PER MEMBER.
7803 DENIED-DIAGNOSIS LACKS APPROPRIATE V CODE.
7804 DENIED-V CODE NEEDS ADDITIONAL DIAGNOSIS CODE TO SHOW MEDICAL NECESSITY.
7805 DENIED-PHYSICIAN'S ORDER DOES NOT CLEARLY DEFINE REQUEST FOR PROCEDURE.
7806 DENIED-MEDICAL REVIEW/CONSULT MUST BE A SEPARATE WRITTEN REPORT PREPARED AND AUTHENTICATED BY AN MD.
7807 DENIED-SERVICE/PROCEDURE/ITEM BILLED IS NOT REQUESTED ON PHYSICIAN ORDER.
7808 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7809 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7810 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7811 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7812 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7813 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7814 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7815 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7816 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7817 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7818 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
7819 RESERVED FOR PROGRAM INTEGRITY DEPARTMENT
8000 PROVIDER REQUESTED FULL OFFSET DUE TO DUPLICATE PAYMENT.
8001 PROVIDER REQUESTED FULL OFFSET DUE TO WRONG PROVIDER PAID.
8002 PROVIDER REQUESTED A FULL OFFSET DUE TO WRONG MEMBER NUMBER BILLED.
8003 PROVIDER REQUESTED A FULL OFFSET DUE TO A WRONG NDC/PROCEDURE CODE/MODIFIER CODE.
8004 PROVIDER REQUESTED A FULL OFFSET DUE TO WRONG UNITS OF SERVICE.
8005 PROVIDER REQUESTED A FULL OFFSET DUE TO INCORRECT PATIENT LIABILITY AMOUNT.
8006 PROVIDER REQUESTED A FULL OFFSET DUE TO PAYMENT IN FULL FROM ANOTHER INSURANCE.
8007 PROVIDER REQUESTED A FULL OFFSET DUE TO PAYMENT IN FULL FROM MEDICARE.
8008 PROVIDER REQUESTED A FULL OFFSET DUE TO INCORRECT DATE(S) OF SERVICE.
8009 FULL RECOUPMENT DUE TO WAIVER REVIEW
8010 FULL RECOUPMENT DUE TO HOSPICE REVIEW
8011 CHECK RELATED ADJUSTMENTS FOR APPEALED OVERPAYMENT FINDINGS-PARTIAL RECOUPMENT
8012 CHECK RELATED ADJUSTMENTS FOR APPEALED OVERPAYMENT FINDINGS-FULL RECOUPMENT
8015 EVV POST PAYMENT REVIEW RECOUPMENT-FULL RECOUPMENT
8016 EVV POST PAYMENT REVIEW RECOUPMENT-PARTIAL RECOUPMENT
8019 PROVIDER REQUESTED A FULL OFFSET DUE TO A MISCELLANEOUS OR UNSPECIFIED ERROR.
8020 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO A DUPLICATE PAYMENT.
8021 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO WRONG PROVIDER.
8022 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO WRONG MEMBER NUMBER.
8023 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE
8024 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO WRONG UNITS OF SERVICE.
8025 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO WRONG PATIENT LIABILITY AMOUNT.
8026 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO PAYMENT IN FULL FROM ANOTHER INSURANCE.
8027 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO PAYMENT IN FULL FROM MEDICARE.
8028 PROGRAM INTEGRITY INITIATED A FULL OFFSET DUE TO WRONG DATE(S) OF SERVICE.
8039 PROGRAM INTEGRITY INITIATED FULL OFFSET DUE TO A MISCELLANEOUS OR UNSPECIFIED ERROR.
8040 PROVIDER SENT A FULL REFUND DUE TO DUPLICATE PAYMENT.
8041 PROVIDER SENT A FULL REFUND DUE TO NOT THEIR PATIENT.
8042 PROVIDER SENT A FULL REFUND DUE TO WRONG MEMBER NUMBER.
8043 PROVIDER SENT A FULL REFUND DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE.
8044 PROVIDER SENT A FULL REFUND DUE TO WRONG UNITS OF SERVICE.
8045 PROVIDER SENT A FULL REFUND DUE TO PAYMENT IN FULL FROM ANOTHER INSURANCE.
8046 PROVIDER SENT A FULL REFUND DUE TO PAYMENT IN FULL FROM MEDICARE.
8047 PROVIDER SENT A FULL REFUND DUE TO WRONG DATE(S) OF SERVICE.
8048 PROVIDER SENT A FULL REFUND DUE TO THE WRONG PATIENT LIABILITY AMOUNT.
8049 PROVIDER SENT A FULL REFUND DUE TO THE WRONG SUBMITTED CHARGE (BILLED) AMOUNT.
8050 PROVIDER SENT A FULL REFUND DUE TO THE WRONG ELECTRONIC FUND TRANSFER SENT TO PROVIDER
8051 FULL RECOUPMENT DUE TO WAIVER REVIEW
8052 FULL RECOUPMENT DUE TO HOSPICE REVIEW
8059 PROVIDER SENT A FULL REFUND DUE TO MISCELLANEOUS OR UNSPECIFIED ERROR.
8060 MYERS & STAUFFER/PAYMENT INTEGRITY PROGRAM REQUESTED A FULL CLAIM RECOUPMENT
8061 ACS/PBM REQUESTED A FULL CLAIM RECOUPMENT.
8062 PROGRAM INTEGRITY REQUESTED A FULL REFUND DUE TO WRONG MEMBER NUMBER.
8063 PROGRAM INTEGRITY REQUESTED A FULL REFUND DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE.
8064 PROGRAM INTEGRITY REQUESTED A FULL REFUND DUE TO WRONG UNITS OF SERVICE.
8065 PROGRAM INTEGRITY REQUESTED A FULL REFUND DUE TO PAYMENT IN FULL FROM ANOTHER INSURANCE.
8066 PROGRAM INTEGRITY REQUESTED A FULL REFUND DUE TO PAYMENT IN FULL FROM MEDICARE.
8067 PROGRAM INTEGRITY REQUESTED A FULL REFUND DUE TO WRONG SERVICE DATE(S).
8068 GAINWELL TECHNOLOGIES REQUESTED A FULL REFUND DUE TO WRONG PATIENT LIABILITY AMOUNT.
8069 PROGRAM INTEGRITY REQUESTED A FULL REFUND DUE TO WRONG CHARGE BILLED
8070 HWT REQUESTED A FULL CLAIM RECOUPMENT
8071 HWT REQUESTED A PARTIAL CLAIM RECOUPMENT
8072 FULL OFFSET REQUESTED BY HWT
8073 PARTIAL OFFSET REQUESTED BY HWT
8074 FULL RECOUPMENT CHECK RELATED INITIATED BY CARS
8075 RECOUPED DUE TO RETROACTIVE PACE SYSTEM UPDATE THIS CARE MAY BE COVERED BY ANOTHER PAYER PER COORDINATION BENEFITS
8079 PROGRAM INTEGRITY REQUESTED A FULL REFUND DUE TO A MISCELLANEOUS ERROR.
8080 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO WRONG MEMBER NUMBER.
8081 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE.
8082 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO WRONG UNITS OF SERVICE.
8083 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO WRONG SERVICE DATE(S).
8084 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO WRONG PATIENT LIABILITY.
8085 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO OTHER INSURANCE.
8086 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO MEDICARE.
8087 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO WRONG SUBMITTED CHARGE (BILLED) AMOUNT.
8088 PLEASE SUBMIT A COPY OF MEDICARE DENIAL.
8099 PROVIDER REQUESTED ADDITIONAL PAYMENT DUE TO MISCELLANEOUS ERROR.
8100 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO WRONG MEMBER NUMBER.
8101 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE.
8102 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO WRONG UNIT OF SERVICE.
8103 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO WRONG PATIENT LIABILITY AMOUNT.
8104 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO WRONG SUBMITTED CHARGE.
8105 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO WRONG SERVICE DATE(S).
8106 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO PAYMENT FROM ANOTHER INSURANCE
8107 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO PAYMENT FROM MEDICARE.
8119 GAINWELL TECHNOLOGIES INITIATED ADDITIONAL PAYMENT DUE TO MISCELLANEOUS ERROR.
8120 PROVIDER REQUESTED PARTIAL OFFSET DUE TO DUPLICATE PAYMENT.
8121 PROVIDER REQUESTED PARTIAL OFFSET DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE.
8122 PROVIDER REQUESTED PARTIAL OFFSET DUE TO WRONG UNITS OF SERVICE.
8123 PROVIDER REQUESTED PARTIAL OFFSET DUE TO WRONG PATIENT LIABILITY AMOUNT.
8124 PROVIDER REQUESTED PARTIAL OFFSET DUE TO PAYMENT FROM ANOTHER INSURANCE.
8125 PROVIDER REQUESTED PARTIAL OFFSET DUE TO PAYMENT FROM MEDICARE.
8126 PROVIDER REQUESTED PARTIAL OFFSET DUE TO WRONG SERVICE DATE(S).
8127 PROVIDER REQUESTED PARTIAL OFFSET DUE TO WRONG SUBMITTED CHARGE.
8128 PARTIAL RECOUPMENT DUE TO WAIVER REVIEW
8129 PARTIAL RECOUPMENT DUE TO HOSPICE REVIEW
8139 PROVIDER REQUESTED PARTIAL OFFSET DUE TO MISCELLANEOUS ERROR.
8140 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO DUPLICATE PAYMENT.
8141 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE
8142 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO WRONG UNITS OF SERVICE.
8143 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO WRONG PATIENT LIABILITY AMOUNT.
8144 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO PAYMENT FROM ANOTHER INSURANCE.
8145 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO PAYMENT FROM MEDICARE.
8146 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO WRONG SERVICE DATE(S).
8147 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO WRONG SUBMITTED CHARGE.
8159 PROGRAM INTEGRITY INITIATED PARTIAL OFFSET DUE TO MISCELLANEOUS ERROR.
8160 PROVIDER SENT PARTIAL REFUND DUE TO DUPLICATE PAYMENT.
8161 PROVIDER SENT PARTIAL REFUND DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE.
8162 PROVIDER SENT PARTIAL REFUND DUE TO WRONG UNITS OF SERVICE.
8163 PROVIDER SENT PARTIAL REFUND DUE TO WRONG PATIENT LIABILITY AMOUNT.
8164 PROVIDER SENT PARTIAL REFUND DUE TO PAYMENT FROM ANOTHER INSURANCE.
8165 PROVIDER SENT PARTIAL REFUND DUE TO PAYMENT FROM MEDICARE.
8166 PROVIDER SENT PARTIAL REFUND DUE TO WRONG SERVICE DATE(S).
8167 PROVIDER SENT PARTIAL REFUND DUE TO WRONG SUBMITTED CHARGE.
8168 PARTIAL RECOUPMENT DUE TO WAIVER REVIEW
8169 PARTIAL RECOUPMENT DUE TO HOSPICE REVIEW
8179 PROVIDER SENT PARTIAL REFUND DUE TO MISCELLANEOUS ERROR.
8180 MYERS & STAUFFER/PAYMENT INTEGRITY PROGRAM REQUESTED A PARTIAL CLAIM RECOUPMENT.
8181 PROGRAM INTEGRITY HAS REQUESTED A PARTIAL CLAIM RECOUPMENT
8182 PROGRAM INTEGRITY REQUESTED PARTIAL REFUND DUE TO WRONG UNITS OF SERVICE.
8183 PROGRAM INTEGRITY REQUESTED PARTIAL REFUND DUE TO WRONG PATIENT LIABILITY AMOUNT.
8184 PROGRAM INTEGRITY REQUESTED PARTIAL REFUND DUE TO PAYMENT FROM ANOTHER INSURANCE.
8185 PROGRAM INTEGRITY REQUESTED PARTIAL REFUND DUE TO PAYMENT FROM MEDICARE.
8186 PROGRAM INTEGRITY REQUESTED PARTIAL REFUND DUE TO WRONG SERVICE DATE(S).
8187 PROGRAM INTEGRITY REQUESTED PARTIAL REFUND DUE TO WRONG CHARGE (BILLED) AMOUNT.
8188 ACS/PBM HAS REQUESTED A PARTIAL REFUND DUE TO AUDIT OVERPAYMENT
8190 PARTIAL RECOUPMENT CHECK RELATED INITIATED BY CARS
8193 AUTOMATIC ADJUSTMENTS FOR RETROACTIVE CHANGES IN MEMBERS DATE OF DEATH
8199 PROGRAM INTEGRITY REQUESTED PARTIAL REFUND DUE TO MISCELLANEOUS ERROR.
8200 FULL OFFSET INITIATED BY THE PROGRAM INTEGRITY UNIT.
8201 FULL OFFSET REQUESTED BY MYERS & STAUFFER/PAYMENT INTEGRITY PROGRAM.
8202 PARTIAL OFFSET INITIATED BY THE PROGRAM INTEGRITY UNIT.
8203 PARTIAL OFFSET REQUESTED BY MYERS & STAUFFER/PAYMENT INTEGRITY PROGRAM
8204 FULL RECOUPMENT NON-CHECK RELATED INITIATED BY CARS
8205 PARTIAL RECOUPMENT NON-CHECK RELATED INITIATED BY CARS
8220 NON-CLAIM SPECIFIC REFUND DUE TO PAYMENT FROM ANOTHER INSURANCE.
8221 NON-CLAIM SPECIFIC REFUND DUE TO PAYMENT FROM MEDICARE.
8222 NON-CLAIM SPECIFIC REFUND DUE TO SPECIAL PROJECTS INITIATED BY THE TPL UNIT.
8223 NON-CLAIM SPECIFIC REFUND DUE TO PROGRAM INTEGRITY AUDIT.
8224 NON-CLAIM REFUND-AUDIT INTEREST
8225 NON - CLAIM REFUND - RETURNED MEDS FROM NURSING HOMES.
8226 CHECK RECEIVED BY GAINWELL TECHNOLOGIES FROM PROVIDER FOR CLAIM NOT IN HISTORY.
8228 NON-CLAIM REFUND-RETURNED MEDICAL EDUCATION PAYMENT
8229 NON-CLAIM REFUND-UNSPECIFIED
8230 VOID TRANSACTION-MASS ADJUSTMENT.
8231 RETROACTIVE RATE CHANGE (LONG TERM CARE)/MASS ADJUSTMENT
8232 HOSPITAL RATE CHANGE-MASS ADJUSTMENT
8233 PRICING CHANGE-MASS ADJUSTMENT
8234 OTHER REQUEST FOR MASS ADJUSTMENT.
8235 ADJUSTMENT PERFORMED BY PRUDENTRX
8236 SPENDDOWN/HCBS WAIVER LIABILITY END OF MONTH BALANCING?MASS VOID/REPLACEMENT.
8237 Retroactive rate change(patient liability) mass adjustment
8238 Recoupment due to identification of TPL or Medicare benefits under the HMS disallowance process.
8241 HIP BRIDGE MEMBER EXPENDITURE VOID
8242 HIP BRIDGE PROVIDER EXPENDITURE VOID
8243 EXPENDITURE VOID - NO PREVIOUS CASH RECEIPT
8244 LIEN_VOID
8245 DISPOSITION TO TRACK INVALID TRANSACTION CODE
8251 NON-CLAIM SPECIFIC REFUND DUE TO UNCLAIMED PROOORTY CHECK INTEREST.
8252 NON-CLAIM SPECIFIC REFUND DUE TO UNCLAIMED PROPERTY CHECK HEALTH INSURANCE CARRIER.
8253 NON-CLAIM SPECIFIC REFUND DUE TO HOSPITAL ASSESSMENT FEE CHECK TRANSFERRED TO FSSA.
8254 NON-CLAIM SPECIFIC REFUND DUE TO ESTATE RECOVERY CHECK TRANSFERRED TO FSSA.
8255 NON-CLAIM SPECIFIC REFUND DUE TO A MEMBER REFUND.
8276 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW TRANSITIONAL ADULT MALES AGE 19 AND YOUNGER CATEGORY.
8277 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW TRANSITIONAL ADULT MALES AGE 20 AND OLDER CATEGORY.
8278 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW TRANSITIONAL ADULT FEMALES AGE 19 AND YOUNGER CATEGORY.
8279 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW TRANSITIONAL ADULT FEMALES AGE 20 AND OLDER CATEGORY.
8287 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR HCC ADULT.
8288 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR HCC CHILDREN.
8289 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR HCC WARDS AND FOSTERS.
8291 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW DELIVERY CASE AGE 19 AND UNDER CATEGORY.
8292 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW DELIVERY CASE AGE 20 AND OVER CATEGORY.
8293 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW DELIVERY CASE CHIP 1 AND UNDER CATEGORY.
8294 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW PREGNANT FEMALES AGE 19 AND YOUNGER CATEGORY.
8295 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW PREGNANT FEMALES AGE 20 AND OVER CATEGORY.
8296 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW PREGNANT FEMALES CHIP1 CATEGORY.
8299 ADJUSTMENT TO CROSSOVER PAID PRIOR TO AIM IMPLEMENTATION DATE. THIS CLAIM HAS BEEN MANUALLY PRICED USING THE MEDICARE COINSURANCE, DEDUCTIBLE, AND PSYCHE REDUCTION AMOUNTS AS BASIS FOR REIMBURSEMENT.
8300 A PAYOUT HAS BEEN ESTABLISHED FOR THE PROVIDER. THE REIMBURSEMENT IS INCLUDED IN THE CHECKWRITE.
8301 A PAYOUT HAS BEEN ESTABLISHED FOR THE PROVIDER. THE REIMBURSEMENT HAS BEEN EXCLUDED FROM THE CHECKWRITE.
8302 A PAYOUT IS DUE TO THE PROVIDER AS A RESULT OF OVER REFUND. THE REIMBURSEMENT IS INCLUDED IN THE CHECKWRITE.
8303 A PAYOUT IS DUE TO THE PROVIDER AS A RESULT OF OVER PAYMENT. THE REIMBURSEMENT HAS BEEN EXCLUDED FROM THE CHECKWRITE.
8304 PAYOUT DUE TO ADVANCE. PAYMENT INCLUDED IN CHECKWRITE.
8305 PAYOUT DUE TO ADVANCE. PAYMENT EXCLUDED FROM CHECKWRITE.
8306 CHECK RECEIVED BY GAINWELL TECHNOLOGIES FOR CLAIM ADJUSTMENT ON A PREVIOUSLY ADJUSTED CLAIM. AMOUNT OF REFUND BEING RETURNED TO PROVIDER.
8307 PAYOUT EXCLUDED FROM CHECKWRITE.
8318 FIRST STEPS OUTSIDE OF AIM MANUAL CHECK
8319 QI-2 BUY-IN PAY
8320 FIRST STEPS OUTSIDE OF AIM SYSTEM CHECK
8321 HIPP EXPENDITURE INCLUDED IN CHECKWRITE.
8322 HIPP EXPENDITURE EXCLUDED FROM CHECKWRITE.
8323 TPL HEALTH EXPENDITURE INCLUDED IN CHECKWRITE.
8324 TPL HEALTH EXPENDITURE EXCLUDED FROM CHECKWRITE.
8325 TPL CASUALTY EXPENDITURE EXCLUDED FROM CHECKWRITE.
8326 TPL CASUALTY EXPENDITURE EXCLUDED FROM CHECKWRITE.
8327 BILLING AND/OR RENDERING PROVIDER NUMBER NOT VALID FOR WAIVER SERVICES BILLED.
8328 USED FOR 4012
8329 RESERVED FOR FUTURE USE
8330 THIS SERVICE NOT PAYABLE. MEMBER IS QMB ALSO AND SPENDDOWN/HCBS WAIVER LIABILITY HAS NOT BEEN MET FOR ALL MONTHS BILLED. ONLY REIMBURSEMENT FOR COINSURANCE AD DEDUCTIBLE ON CLAIMS CROSSING OVER FROM MEDICARE IS AVAILABLE.
8331 REFUND TO PROVIDER EXCLUDED FROM CHECKWRITE
8332 REFUND TO PROVIDER INCLUDED IN CHECKWRITE
8333 SYSTEM CHECK WRITE TO PROVIDER FOR INCREASED REIMBURSEMENT OF ACA-PCP EVALUATION AND MANAGEMENT.
8334 ESP FUND REQUEST OUTSIDE OF AIM MANUAL CHECK
8335 CONV ADM FEE MANUAL
8336 RETROACTIVE INTEREST PAYMENT
8337 FQHC/RHC INTERIM SETTLEMENT FROM MYER AND STAUFFER.
8338 FQHC/RHC FINAL COST SETTLEMENT PAYMENT.
8339 DUE TO A MONTHLY QUALITY ASSESSMENT RATE DECREASE, AN EXPENDITURE HAS BEEN GENERATED WITH A SYSTEM CHECK.
8340 DUE TO A MONTHLY TAX ASSESSMENT RATE DECREASE, AN EXPENDITURE HAS BEEN GENERATED WITH A SYSTEM CHECK
8341 DUE TO A MONTHLY QUALITY ASSESSMENT RATE DECREASE, AN EXPENDITURE HAS BEEN GENERATED WITH A MANUAL CHECK
8342 FIRST STEPS COVANSYS CONVERSION REFUND
8343 FIRST STEPS OVERPAYMENT MANUAL CHECK
8344 FIRST STEPS OVERPAYMENT SYSTEM CHECK
8345 MFP OPAY MAN
8346 FIRST STEPS COST PARTICIPATION PAYMENT
8347 PRTF OPAY MAN
8348 PRTF OPAY SYS
8349 MFP OPAY SYS
8350 EXPENDITURE VOID
8351 ADMIN FEE EXPENDITURE VOID
8352 CAPITATION EXPENDITURE VOID
8353 CLAIM INTEREST VOID
8354 BACKUP WITHHOLDING - VOID
8355 CHIP EXPENDITURE VOID
8356 M.E.D WORKS EXPENDITURE VOID
8357 ESP FUND REQUEST OUTSIDE OF AIM SYSTEM CHECK
8358 DISEASE FEE EXPENDITURE VOID
8359 ESP ADMIN FEE EXPENDITURE VOID
8360 POWER ACCOUNT EXPENDITURE VOID
8361 HIP CAPITATION EXPENDITURE VOID
8362 DSH PAYMENT OUTSIDE OF AIM SYSTEM CHECK
8363 DSH PAYMENT OUTSIDE OF AIM MANUAL CHECK
8364 SUPPLEMENTAL PAYMENT OUTSIDE OF AIM SYSTEM CHECK
8365 SUPPLEMENTAL PAYMENT OUTSIDE OF AIM MANUAL CHECK
8366 GME PAYMENT OUTSIDE OF AIM SYSTEM CHECK
8367 GME PAYMENT OUTSIDE OF AIM MANUAL CHECK
8368 NON-ASSISTANCE PAYMENT OUTSIDE OF AIM SYSTEM CHECK
8369 NON-ASSISTANCE PAYMENT OUTSIDE OF AIM MANUAL CHECK
8370 SUPPLEMENTAL PAYMENT OUTPATIENT HOSPITAL SERVICES OUTSIDE OF AIM SYSTEM CHECK
8371 SUPPLEMENTAL PAYMENT OUTPATIENT HOSPITAL SERVICES OUTSIDE OF AIM MANUAL CHECK
8372 IHCP SYSTEM PAYMENT ADJUSTMENT BASED ON MEDICAL EDUCATION
8373 IHCP MANUAL PAYMENT ADJUSTMENT BASED ON MEDICAL EDUCATION
8374 EHR INCENTIVE PAYMENT-SYSTEM
8375 EHR INCENTIVE PAYMENT - MANUAL
8376 A PAYOUT IS DUE TO THE PROVIDER AS A RESULT OF AN OVER REFUND OF THE APPLICATION FEE. THE REIMBURSEMENT IS INCLUDED IN THE CHECKWRITE.
8377 A PAYOUT IS DUE TO THE PROVIDER AS A RESULT OF AN OVER REFUND OF THE APPLICATION FEE. THE REIMBURSEMENT IS EXCLUDED FROM THE CHECKWRITE.
8378 EHR ADJUSTED INCENTIVE PAYMENT (CREDIT) - SYSTEM
8379 DUE TO A MONTHLY HOSPITAL ASSESSMENT RATE DECREASE, AN EXPENDITURE HAS BEEN GENERATED WITH A SYSTEM CHECK.
8380 DUE TO A MONTHLY HOSPITAL ASSESSMENT RATE DECREASE, AN EXPENDITURE HAS BEEN GENERATED WITH A MANUAL CHECK.
8381 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE CARETAKER.
8382 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE CHILDREN.
8383 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE PREGNANCY.
8384 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH CHIP I.
8385 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH CHIP II.
8386 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH PRESUMPTIVE ELIGIBILITY.
8387 A PAYOUT IS DUE TO MCE AS A RESULT OF PAY FOR PERFORMANCE.
8388 A PAYOUT IS DUE TO THE MCE AS A RESULT OF REBATE RECONCILIATION.
8389 A PAYOUT IS DUE TO THE MCE AS A RESULT OF STOP LOSS.
8390 A PAYOUT IS DUE TO THE MCE AS A RESULT OF A MISCELLANEOUS MCE.
8391 SYSTEM CHECK WRITE FOR FIXED AND CONTINGENCY FEES.
8392 MANUAL CHECK WRITE FOR FIXED AND CONTINGENCY FEES.
8393 MANUAL CHECK WRITE TO PROVIDER FOR INCREASED REIMBURSEMENT OF ACA-PCP EVALUATION AND MANAGEMENT.
8394 SYSTEM CHECK WRITE TO PROVIDER FOR INCREASED REIMBURSEMENT OF ACA-PCP VACCINE ADMINISTRATION CODES.
8395 MANUAL CHECK WRITE TO PROVIDER FOR INCREASED REIMBURSEMENT OF ACA-PCP VACCINE ADMINISTRATION CODES.
8396 SYSTEM CHECK WRITE TO MCE FOR INCREASED REIMBURSEMENT OF ACA-PCP EVALUATION AND MANAGEMENT.
8397 MANUAL CHECK WRITE TO MCE FOR INCREASED REIMBURSEMENT OF ACA-PCP EVALUATION AND MANAGEMENT.
8398 STOP PAYMENT AND SYSTEM CHECK REISSUE
8399 THIS ACTION IS THE RESULT OF A STOP PAYMENT. A MANUAL CHECK HAS BEEN ISSUED.
8400 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED . THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8401 AS THE RESULT OF A LESS THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8402 AS THE RESULT OF A FRAUD AUDIT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8403 INTEREST RECOUPMENT DUE TO WAIVER REVIEW
8404 DUE TO A REQUEST FROM IFSSA, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8405 DUE TO A MONTHLY TAX ASSESSMENT RATE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8406 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8407 AN ACCOUNTS RECEIVABLE HAS BEEN CONVERTED, THUS ESTABLISHING THIS ACCOUNTS RECEIVABLE. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8408 DUE TO A TPL SPECIAL PROJECT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8409 DUE TO A DRUG REBATE ACTION, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8410 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A LESS THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8411 DUE TO AN ADJUSTMENT SUBMITTED BY THE PROVIDER OLDER THAN 3 YEARS FROM THE DATE OF SERVICE, NO RECIPIENT, OR DATES OF SERVICE INFORMATION CAN BE VISIBLE ON YOUR REMITTANCE ADVICE. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8412 DUE TO A NON-RISK RELATED CHECK ADVANCE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8413 DUE TO A RISK RELATED CHECK ADVANCE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8414 DUE TO AN ADJUSTMENT SUBMITTED BY THE PROVIDER FOR RETURNED MEDICINES, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8415 DUE TO CIVIL PENALTIES SUBMITTED BY THE ISDH, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8416 ACCOUNTS RECEIVABLE - RESULT OF RETRO-RATE ADJUSTMENT
8417 MANUAL SETUP - BANNING OF NEW ADMISSIONS
8418 A/R MANUAL SETUP- OVERPAYMENTS IDENTIFIED BY LONG TERM AUDITOR
8419 DUE TO A TRANSFER OF ACCOUNT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8420 A RISK RELATED ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8421 DUE TO A TAX ASSESSMENT RATE INCREASE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8422 AS A RESULT OF A PIP AUDIT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8423 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST AMOUNTS OWED FROM A PIP AUDIT. THIS AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8424 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8425 AS A RESULT OF A PBM AUDIT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8426 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST AMOUNTS OWED FROM A PBM AUDIT. THIS AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8427 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8428 THIS IS A RECONCILIATION OF THE TAX ASSESSMENT RATES FROM JULY 1994-DECEMBER 1998
8429 DUE TO A MONTHLY TAX ASSESSMENT RECONCILIATION RATE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS
8430 AS A RESULT OF A HWT AUDIT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED.
8431 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST AMOUNTS OWED FROM A HWT AUDIT. THIS AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8432 THIS ACCOUNTS RECEIVABLE WAS INCREASED BY THE DIRECTION OF THE PROGRAM INTEGRITY UNIT.
8433 MISCELLANEOUS INCREASE TO THIS ACCOUNTS RECEIVABLE.
8434 THIS ACCOUNTS RECEIVABLE WAS DECREASED BY THE DIRECTION OF THE STATE MEDICAL ASSISTANCE OFFICE.
8435 THIS ACCOUNTS RECEIVABLE WAS DECREASED BY THE DIRECTION OF THE PROGRAM INTEGRITY UNIT.
8436 A CASH RECEIPT WAS APPLIED TO THE PRINCIPAL AND HAS DECREASED THIS ACCOUNTS RECEIVABLE.
8437 AN OVER REFUND HAS BEEN APPLIED AND DECREASED THIS ACCOUNTS RECEIVABLE.
8438 LIQUIDATING ACCOUNTS RECEIVABLE HAS DECREASED THIS ACCOUNTS RECEIVABLE.
8439 THIS ACCOUNTS RECEIVABLE WAS DECREASED BY A MISCELLANEOUS ACTION.
8440 THIS ACCOUNTS RECEIVABLE HAS BEEN WRITTEN OFF.
8441 A CLAIM OFFSET WAS APPLIED TO THE PRINCIPAL AND DECREASED THIS ACCOUNTS RECEIVABLE.
8442 A CASH RECEIPT WAS APPLIED TO THE INTEREST AND DECREASED THIS ACCOUNTS RECEIVABLE.
8443 THIS ACCOUNTS RECEIVABLE WAS INCREASED BY THE DIRECTION OF THE TPL UNIT.
8444 THIS ACCOUNTS RECEIVABLE WAS DECREASED BY THE DIRECTION OF THE TPL UNIT.
8445 THIS ACCOUNTS RECEIVABLE WAS ESTABLISHED FOR THE WRONG PROVIDER. WE HAVE CORRECTED THE ACTION AND DECREASED THIS ACCOUNTS RECEIVABLE.
8446 A STOP PAYMENT CHECK WAS APPLIED AND DECREASED THIS ACCOUNTS RECEIVABLE.
8447 THIS ACCOUNTS RECEIVABLE WAS INCREASED BY THE DIRECTION OF THE DRUG REBATE UNIT.
8448 THIS ACCOUNTS RECEIVABLE WAS DECREASED BY THE DIRECTION OF THE DRUG REBATE UNIT.
8449 THIS ACCOUNTS RECEIVABLE WAS INCREASED DUE TO DRUG REBATE INTEREST BEING APPLIED.
8450 ACCOUNTS RECEIVABLE RE-ESTABLISHMENT DUE TO VOIDED CHECK
8451 A CLAIM OFFSET WAS APPLIED TO THE INTEREST AND DECREASED THIS ACCOUNTS RECEIVABLE.
8452 RATE REDUCTION - STATE WITHHOLDING
8453 DUE TO A DISPROPORTIONATE SHARE HOSPITAL OVERPAYMENT (PRINCIPAL), AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED
8454 DUE TO A DISPROPORTIONATE SHARE HOSPITAL OVERPAYMENT (INTEREST), AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED
8455 A/R DECREASE - CA- PRTF CLAIM OFFSET APPLIED
8456 A/R DECREASE-MFP CLAIM OFFSET APPLIED
8457 A/R DECREASE-POWER ACCOUNT OFFSET APPLIED
8460 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. MANUAL SET UP (PASSR)
8461 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. MANUAL SET UP (MRT)
8462 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. MANUAL SET UP (HOOSIER RX)
8463 DUE TO A MONTHLY QUALITY ASSESSMENT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8464 DUE TO A MONTHLY QUALITY ASSESSMENT RATE INCREASE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED
8465 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. MANUAL SET UP (MCO)
8466 A/R - MANUAL SETUP (FIRST STEPS)
8467 A/R-MANUAL SETUP (CARS)
8468 A/R - MANUAL SETUP (CARS INTEREST)
8469 A/R- RESULT OF CA-PRTF CLAIM ADJUSTMENT
8470 A/R - RESULT OF CA- PRTF CLAIM ADJUSTMENT (RISK)
8471 A/R - RESULT OF CA- PRTF RETRO RATE ADJUSTMENT
8472 A/R - RESULT OF MFP CLAIM ADJUSTMENT
8473 A/R - RESULT OF MFP CLAIM ADJUSTMENT (RISK)
8474 A/R - RESULT OF MFP RETRO RATE ADJUSTMENT
8475 A/R -MANUAL SETUP (CA-PRTF)
8476 A/R- MANUAL SETUP (MFP)
8477 A/R-MANUAL SETUP (HIP STATE CONTRIBUTION CHANGE)
8478 A/R-MANUAL SETUP (HIP PLAN CHANGE-STATE AMT)
8479 A/R-MANUAL SETUP (HIP PLAN CHANGE-MEMBER AMT)
8488 AS A RESULT OF A VOID/REPLACEMENT OF AN ENCOUNTER CLAIM WITH MEDICAL EDUCATION, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8489 AN EXPENDITURE OFFSET WAS APPLIED TO THE PRINCIPAL AND DECREASED THIS ACCOUNTS RECEIVABLE
8490 DUE TO A REQUEST SUBMITTED BY THE PROVIDER TO RECOUP MEDICAL EDUCATION PAYMENTS. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8491 AS THE RESULT OF A LESS THAN 1 YEAR RAC AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8492 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A LESS THAN 1 YEAR RAC AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8493 A/R CREATED FOR THE RECOVERY OF AN OVERPAYMENT RELATED TO AN EHR INCENTIVE PAYMENT.
8494 DUE TO A MONTHLY HOSPITAL ASSESSMENT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8495 DUE TO A MONTHLY HOSPITAL ASSESSMENT RATE INCREASE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED.
8496 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO A CLAIM ADJUSTMENT INVOLVINGA DOC INMATE. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8497 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO A MANUAL ADJUSTMENT INVOLVING A DOC INMATE. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8498 ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. MANUAL SET UP (NEMT)
8499 DUE TO THE NEMT CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED.
8500 PAYMENT WITHHELD DUE TO A LIEN THAT WAS ESTABLISHED FROM A COURT ORDER.
8501 PAYMENT WITHHELD DUE TO AN IRS LEVY ESTABLISHED.
8502 PAYMENT WITHHELD DUE TO A LIEN THAT WAS ESTABLISHED FROM OTHER LEGAL ENTITY.
8503 BACKUP WITHHOLDING - LIEN
8504 AS THE RESULT OF A LESS THAN 1 YEAR MIC AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8505 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A LESS THAN 1 YEAR MIC AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYEMTNS.
8506 AS THE RESULT OF A GREATER THAN 1 YEAR MIC AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8507 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A GREATER THAN 1 YEAR MIC AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYEMTNS.
8508 AS THE RESULT OF A LESS THAN 1 YEAR OIG AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYEMTNS.
8509 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A LESS THAN 1 YEAR OIG AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8510 CYCLE ACTIVITY
8511 DECREASE TO ORIGINAL LIEN AMOUNT RECEIVED BY LIEN HOLDER.
8512 DECREASE TO ORIGINAL LIEN AMOUNT DUE TO PAYMENT RECEIVED.
8513 INCREASE TO ORIGINAL LIEN AMOUNT RECEIVED BY LIEN HOLDER.
8514 RELEASE OF LIEN RECEIVED BY LIEN HOLDER.
8515 VOID OF A PREVIOUSLY PROCESSED CLAIM
8516 CLAIM HAS BEEN ELECTRONICALLY VOIDED
8517 CLAIM HAS BEEN ELECTRONICALLY REPLACED
8518 DUE TO ELECTRONIC VISIT VERIFICATION PASS-THROUGH COST A MANUALLY GENERATED AC COUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTUR E PAYMENTS.
8519 DUE TO ELECTRONIC VISIT VERIFICATION PASS-THROUGH COST A SYSTEM GENERATED ACCO UNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS
8520 DRUG REBATE APPLICATION
8521 DRUG REBATE CREDIT
8522 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A LESS THAN 1 YEAR DISCOVERY MIC RECOVERY AUDIT.
8523 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A GREATER THAN 1 YEAR DISCOVERY MIC RECOVERY AUDIT.
8524 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A LESS THAN 1 YEAR DISCOVERY OIG RECOVERY AUDIT.
8525 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A GREATER THAN 1 YEAR DISCOVERY OIG RECOVERY AUDIT.
8526 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A LESS THAN 1 YEAR DISCOVERY PERM RECOVERY AUDIT.
8527 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A GREATER THAN 1 YEAR DISCOVERY PERM RECOVERY AUDIT.
8528 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A LESS THAN 1 YEAR DISCOVERY RAC RECOVERY AUDIT.
8529 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A GREATER THAN 1 YEAR DISCOVERY RAC RECOVERY AUDIT.
8530 MCO CAPITATION PAYMENT FROM MANAGED CARE
8531 BACKUP WITHHOLDING - TAX
8532 CA-PRTF WITHHOLDING
8533 PCCM ADMINISTRATIVE FEE PAYMENT FROM MANAGED CARE
8534 MFP WITHHOLD
8535 CLAIMS INTEREST PAID IN THIS REMITTANCE ADVICE
8536 CHECK WAS VOIDED OR STOPPED AND REISSUED DUE TO BEING DESTROYED.
8537 CHECK WAS VOIDED DUE TO THE PAYMENT RECEIVED WAS INCORRECT.
8538 CHECK WAS VOIDED DUE TO PAYMENT WAS MADE TO THE INCORRECT PROVIDER.
8539 CHECK WAS VOIDED DUE TO THE PAYMENT WAS A DUPLICATE OF A PREVIOUS PAYMENT.
8540 CHECK WAS VOIDED DUE TO THE PAYMENT WAS MADE TO THE INCORRECT PROVIDER NUMBER.
8541 CHECK WAS VOIDED DUE TO THE PAYMENT WAS MADE TO THE INCORRECT SERVICE LOCATION.
8542 CHECK WAS VOIDED DUE TO THE CHECK WAS STALE-DATED.
8543 CHECK WAS VOIDED DUE TO UNSPECIFIED REASON.
8544 CHECK WAS VOIDED DUE TO THE PROVIDER RECEIVED A NEW TAX ID.
8545 CHECK WAS VOIDED DUE TO THE PAYMENTS WERE FOR THE INCORRECT PROCEDURE CODE.
8546 CHECK WAS VOIDED AND REISSUED DUE TO A FAILED EFT.
8547 CHECK WAS VOIDED DUE TO THE PAYMENT IS OUTSTANDING.
8548 CHECK WAS STOPPED AND REISSUED. CHECK WAS PRESENT.
8549 CHECK WAS STOPPED AND REISSUED. CHECK WAS NOT PRESENT.
8550 POWER ACCOUNT PAYMENT
8551 HIP CAPITATION PAYMENT
8552 DISEASE FEE PAYMENT
8553 ESP ADMIN FEE PAYMENT
8554 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A LESS THAN 1 YEAR DISCOVERY PROGRAM INTEGRITY RECOVERY AUDIT.
8555 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A GREATER THAN 1 YEAR DISCOVERY PROGRAM INTEGRITY RECOVERY AUDIT.
8556 CHECK VOID - FIRST STEPS
8557 VOID/REISSUE - FIRST STEPS
8558 STOP/REISSUE - FIRST STEPS
8559 CHECK VOID - PRTF
8560 VOID/REISSUE - PRTF
8561 STOP/REISSUE - PRTF
8562 CHECK VOID - MFP
8563 VOID/REISSUE - MFP
8564 STOP/REISSUE -MFP
8565 CLAIM OFFSET WAS APPLIED TO AN AR SETUP DUE TO A LESS THAN 1 YEAR AUDIT RECOVERY.
8566 CLAIM OFFSET WAS APPLIED TO AN AR SETUP DUE TO A GREATER THAN 1 YEAR AUDIT RECOVERY.
8567 AS THE RESULT OF A GREATER THAN 1 YEAR OIG AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8568 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A GREATER THAN 1 YEAR OIG AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8569 AS THE RESULT OF A LESS THAN 1 YEAR PERM AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8570 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A LESS THAN 1 YEAR PERM AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8571 AS THE RESULT OF A GREATER THAN 1 YEAR PERM AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8572 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A GREATER THAN 1 YEAR PERM AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYEMTNS.
8573 AS THE RESULT OF A GREATER THAN 1 YEAR RAC AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8574 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A GREATER THAN 1 YEAR RAC AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8575 AS THE RESULT OF A GREATER THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8576 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A GREATER THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYEMTNS.
8577 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT THE OVERPAYMENT MADE TO THE PROVIDER FOR THE ACA-PCP EVALUATION.
8578 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT THE OVERPAYMENT MADE TO THE PROVIDER FOR THE ACA-PCP VACCINE.
8579 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT THE OVERPAYMENT MADE TO THE MCE FOR THE ACA-PCP EVALUATION AND
8580 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT THE OVERPAYMENT MADE TO THE MCE FOR THE ACA-PCP VACCINE.
8581 AR SETUP DUE TO OVERPAYMENT ACA-PCP MCE EVALUATION AND MANAGEMENT DIFFERENCE BETWEEN MCE PAYMENT AND MEDICARE RATE
8582 AR SETUP DUE TO OVERPAYMENT ACA-PCP MCE VACCINE CODE DIFFERENCE BETWEEN MCE PAYMENT AND MEDICARE RATE
8583 AR - MANUAL SETUP (AMB SYSCPE OVERPAY)
8584 AR - MANUAL SETUP (AMB MANCPE OVERPAY)
8585 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW CARETAKER CATEGORY.
8586 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW CHILD CATEGORY.
8587 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW PREGNANCY CATEGORY.
8588 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW CHIPI CATEGORY.
8589 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW CHIPII CATEGORY.
8590 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HHW PE CATEGORY.
8591 DUE TO THE MANAGED CARE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) CAPITATION RECONCILIATION PROCESS, AN OVERPAYMENT HAS BEEN IDENTIFIED AND AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED.
8592 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HIP STATE PLAN BASIC.
8593 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HIP STATE PLAN PLUS.
8594 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HIP PLAN BASIC.
8595 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HIP PLAN PLUS.
8596 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR THE HIP HOSPITAL PRESUMTIVE ELIGIBILITY
8597 A MANUAL GENERATED HIP LINK OUT-OF-POCKET ADJUSTMENT HAS BEEN ESTABLISHED FROM THE PROVIDER.
8598 A SYSTEM GENERATED HIP LINK OUT-OF-POCKET ADJUSTMENT HAS BEEN ESTABLISHED FROMTHE PROVIDER
8600 IFSSA MEDICAID AUTHORIZED HOLD
8604 GRADUATE MEDICAL EDUCATION RECOUPMENT
8605 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION RECOUPMENT FOR NEW ADULT GROUP
8606 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION RECOUPMENT FOR MEDICALLY FRAIL
8607 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION RECOUPMENT FOR LOW-INCOME PARE NT-CARETAKER
8608 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION RECOUPMENT FOR PRESUMPTIVE ELI GIBILITY
8609 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION RECOUPMENT FOR PREGNANCY
8610 IFSSA 590 AUTHORIZED HOLD
8620 CSHCS AUTHORIZED HOLD
8621 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS ACUTE DUAL GRADUATE MEDICAL EDUCATION RECOUPMENT.
8622 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS ACUTE NON-DUAL GRADUATE MEDICAL EDUCATION RECOUPMENT.
8623 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS LTSS DUAL GRADUATE MEDICAL EDUCATION RECOUPMENT.
8624 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS LTSS NON-DUAL GRADUATE MEDICAL EDUCATION RECOUPMENT.
8625 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS LTSS NET ZERO DAYS NON-DUAL GRADUATE MEDICAL EDUCATION RECOUPMENT.
8626 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS LTSS NET ZERO DAYS DUAL GRADUATE MEDICAL EDUCATION RECOUPMENT.
8630 ARCH AUTHORIZED HOLD
8631 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS ACUTE DUAL WRAP SERVICES RECOUPMENT.
8632 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS ACUTE NON-DUAL WRAP SERVICES RECOUPMENT.
8633 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS LTSS DUAL WRAP SERVICES RECOUPMENT.
8634 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS LTSS NON-DUAL WRAP SERVICES RECOUPMENT.
8635 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS LTSS NET ZERO DAYS NON-DUAL WRAP SERVICES RECOUPMENT.
8636 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A PATHWAYS LTSS NET ZERO DAYS DUAL WRAP SERVICES RECOUPMENT.
8640 MRT AUTHORIZED HOLD
8641 PATHWAYS ACUTE DUAL GRADUATE MEDICAL EDUCATION LUMP-SUM PAYMENT.
8642 PATHWAYS ACUTE NON-DUAL GRADUATE MEDICAL EDUCATION LUMP-SUM PAYMENT.
8643 PATHWAYS LTSS DUAL GRADUATE MEDICAL EDUCATION LUMP-SUM PAYMENT.
8644 PATHWAYS LTSS NON-DUAL GRADUATE MEDICAL EDUCATION LUMP-SUM PAYMENT.
8645 PATHWAYS LTSS NET ZERO DAYS NON-DUAL GRADUATE MEDICAL EDUCATION LUMP-SUM PAYMENT.
8646 PATHWAYS LTSS NET ZERO DAYS DUAL GRADUATE MEDICAL EDUCATION LUMP-SUM PAYMENT.
8651 PATHWAYS ACUTE DUAL WRAP SERVICES LUMP-SUM PAYMENT.
8652 PATHWAYS ACUTE NON-DUAL WRAP SERVICES LUMP-SUM PAYMENT.
8653 PATHWAYS LTSS DUAL WRAP SERVICES LUMP-SUM PAYMENT.
8654 PATHWAYS LTSS NON-DUAL WRAP SERVICES LUMP-SUM PAYMENT.
8655 PATHWAYS LTSS NET ZERO DAYS NON-DUAL WRAP SERVICES LUMP-SUM PAYMENT.
8656 PATHWAYS LTSS NET ZERO DAYS DUAL WRAP SERVICES LUMP-SUM PAYMENT.
8670 FIRST STEPS PAYMENT HOLD
8671 AS THE RESULT OF A LESS THAN 1 YEAR CREDIT BALANCE AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8672 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A LESS THAN 1 YEAR CREDIT BALANCE AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8673 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A LESS THAN 1 YEAR DISCOVERY CREDIT BALANCE RECOVERY AUDIT.
8674 ACCOUNTS RECEIVABLE SETUP AS A RESULT OF A GREATER THAN 1 YEAR DISCOVERY CREDIT BALANCE RECOVERY AUDIT.
8675 AS THE RESULT OF A GREATER THAN 1 YEAR CREDIT BALANCE AUDIT DISCOVERY AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8676 THIS ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT INTEREST OWED DUE TO A GREATER THAN 1 YEAR CREDIT BALANCE AUDIT DISCOVERY. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8677 AS A RESULT OF A VOID/REPLACEMENT OF AN ENCOUNTER CLAIM WITH PATHWAYS MEDICAL EDUCATION, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS.
8678 AS A RESULT OF A VOID/REPLACEMENT OF A PHYSICIAN CLAIM WITH PATHWAYS WRAP AROUND PAYMENTS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENT.
8679 AS A RESULT OF A VOID/REPLACEMENT OF A DENTAL CLAIM WITH PATHWAYS WRAP AROUND PAYMENTS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENT.
8681 AS A RESULT OF A VOID/REPLACEMENT OF AN ENCOUNTER CLAIM WITH WRAP AROUND PAYMENTS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENT.
8682 DUE TO A REQUEST SUBMITTED TO RECOUP WRAP AROUND PAYMENTS ASSOCIATED WITH AN ENCOUNTER CLAIM, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BEDEDUCTED FROM YOUR FUTURE PAYMENT.
8683 AS A RESULT OF A VOID/REPLACEMENT OF A DENTAL CLAIM WITH WRAP AROUND PAYMENTS, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENT.
8684 DUE TO A REQUEST SUBMITTED TO RECOUP WRAP AROUND PAYMENTS ASSOCIATED WITH A DENTAL CLAIM, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENT.
8686 A SYSTEM GENERATED ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT AN OVERPAYMENT MADE TO A HIP BRIDGE MEMBER.
8687 A MANUAL ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT AN OVERPAYMENT MADE TO A HIP BRIDGE MEMBER.
8688 A SYSTEM GENERATED ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT AN OVERPAYMENT MADE TO A HIP BRIDGE PROVIDER.
8689 A MANUAL ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED TO COLLECT AN OVERPAYMENT MADE TP A HIP BRIDGE PROVIDER.
8691 A NON-ASSISTANCE ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED.
8693 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A QAF RATE ADJUSTMENT
8694 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A NURSING FACILITY LUMP SUM SETTLEMENT DUE TO COMPLIANCE REVIEW.
8695 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR AN ICF-IID LUMP SUM SETTLEMENT DUE TO COMPLIANCE REVIEW.
8696 AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED FOR A LUMP SUM SETTLEMENT DUE TO MDS REVIEW.
8697 DUE TO A REQUEST SUBMITTED TO RECOUP PATHWAYS MEDICAL EDUCATION PAYMENTS ASSOCIATED WITH AN ENCOUNTER CLAIM, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM FUTURE PAYMENTS.
8698 DUE TO A REQUEST SUBMITTED TO RECOUP PATHWAYS WRAP AROUND PAYMENTS ASSOCIATED WITH A PHYSICIAN CLAIM, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENT.
8699 DUE TO A REQUEST SUBMITTED TO RECOUP PATHWAYS WRAP AROUND PAYMENTS ASSOCIATED WITH A DENTAL CLAIM, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENT.
8700 POWER ACCOUNT WITHHOLDINGS
8701 HIP CAPITATION WITHHOLDINGS
8702 A PAYOUT IS DUE TO THE HIP MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HEALTHY INDIANA PLAN STATE PLAN BASIC.
8703 A PAYOUT IS DUE TO THE HIP MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HEALTHY INDIANA PLAN STATE PLAN PLUS.
8704 A PAYOUT IS DUE TO THE HIP MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HEALTHY INDIANA PLAN STATE PLAN BASIC.
8705 A PAYOUT IS DUE TO THE HIP MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HEALTHY INDIANA PLAN STATE PLAN PLUS.
8706 A PAYOUT IS DUE TO THE HIP MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HEALTHY INDIANA PLAN HOSPITAL PRESUMPTIVE ELIGIBILITY ADULTS.
8707 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HCC ADULT CATEGORY.
8708 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HCC CHILDREN CATEGORY.
8709 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HCC WARDS AND FOSTERS CATEGORY.
8710 SYSTEM CHECK WRITE TO MCE FOR INCREASED REIMBURSEMENT OF ACA-PCP VACCINE ADMINISTRATION CODES.
8711 MANUAL CHECK WRITE TO MCE FOR INCREASED REIMBURSEMENT OF ACA-PCP VACCINE ADMINISTRATION CODES.
8712 DSH 2007 SYSTEM PAYMENT
8713 DSH 2007 SYSTEM CPE PAYMENT
8714 DSH 2007 MANUAL CHECK
8715 DSH 2007 MANUAL CPE CHECK
8716 DSH 2008 SYSTEM PAYMENT
8717 DSH 2008 SYSTEM CPE PAYMENT
8718 DSH 2008 MANUAL CHECK
8719 DSH 2008 MANUAL CPE CHECK
8720 DSH 2009 SYSTEM PAYMENT
8721 DSH 2009 SYSTEM CPE PAYMENT
8722 DSH 2009 MANUAL CHECK
8723 DSH 2009 MANUAL CPE CHECK
8724 DSH 2010 SYSTEM PAYMENT
8725 DSH 2010 SYSTEM CPE PAYMENT
8726 DSH 2010 MANUAL CHECK
8727 DSH 2010 MANUAL CPE CHECK
8728 DSH 2011 SYSTEM PAYMENT
8729 DSH 2011 SYSTEM CPE PAYMENT
8730 DSH 2011 MANUAL CHECK
8731 DSH 2011 MANUAL CPE CHECK
8732 DSH 2012 SYSTEM PAYMENT
8733 DSH 2012 SYSTEM CPE PAYMENT
8734 DSH 2012 MANUAL CHECK
8735 DSH 2012 MANUAL CPE CHECK
8736 DSH 2013 SYSTEM PAYMENT
8737 DSH 2013 SYSTEM CPE PAYMENT
8738 DSH 2013 MANUAL CHECK
8739 DSH 2013 MANUAL CPE CHECK
8740 DSH 2014 SYSTEM PAYMENT
8741 DSH 2014 SYSTEM CPE PAYMENT
8742 DSH 2014 MANUAL CHECK
8743 DSH 2014 MANUAL CPE CHECK
8744 SUPPLEMENTAL PAYMENT SYSTEM CPE
8745 SUPPLEMENTAL PAYMENT MANUAL CPE
8746 SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM
8747 SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM CPE
8748 SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL
8749 SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL CPE
8750 HIP ADULTS SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM
8751 HIP ADULTS SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM CPE
8752 HIP ADULTS SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL
8753 HIP ADULTS SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL CPE
8754 HIP CARETAKERS SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM
8755 HIP CARETAKERS SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM CPE
8756 HIP CARETAKERS SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL
8757 HIP CARETAKERS SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL CPE
8758 HHW CARETAKERS SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM
8759 HHW CARETAKERS SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM CPE
8760 HHW CARETAKERS SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL
8761 HHW CARETAKERS SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL CPE
8762 HHW PREGNANCY SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM
8763 HHW PREGNANCY SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM CPE
8764 HHW PREGNANCY SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL
8765 HHW PREGNANCY SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL CPE
8766 HHW CHILDREN SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM
8767 HHW CHILDREN SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM CPE
8768 HHW CHILDREN SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL
8769 HHW CHILDREN SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL CPE
8770 CHIP I SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM
8771 CHIP I SUPPLEMENTAL OUTPATIENT PAYMENT SYSTEM CPE
8772 CHIP I SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL
8773 CHIP I SUPPLEMENTAL OUTPATIENT PAYMENT MANUAL CPE
8774 AMBPMT SYSTEM CPE
8775 AMBPMT MANUAL CPE
8776 SYSTEM SETUP ACA-PCP MCE EVALUATION AND MANAGEMENT DIFFERENCE BETWEEN MCE PAYMENT AND MEDICARE RATE
8777 MANUAL SETUP ACA-PCP MCE FOR EVALUATION AND MANAGEMENT DIFFERENCE BETWEEN MCE PAYMENT AND MEDICARE RATE
8778 SYSTEM SETUP ACA-PCP MCE VACCINE CODE DIFFERENCE BETWEEN MCE PAYMENT AND MEDICARE RATE
8779 MANUAL SETUP ACA-PCP MCE VACCINE CODE DIFFERENCE BETWEEN MCE PAYMENT AND MEDICARE RATE
8780 PAYOUT IS DUE TO AN ELECTRONIC VISIT VERIFICATION PASS-THROUGH COST REFUND.
8781 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW CARETAKER CATEGORY.
8782 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW CHILD CATEGORY.
8783 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW PREGNANCY CATEGORY.
8784 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW CHIPI CATEGORY.
8785 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW CHIPII CATEGORY.
8786 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW PE CATEGORY.
8787 DUE TO THE MANAGED CARE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) CAPITATION RECONCILIATION PROCESS, AN UNDERPAYMENT HAS BEEN IDENTIFIED AND AN EXPENDITURE HAS BEEN GENERATED WITH A SYSTEM CHECK.
8788 DUE TO THE MANAGED CARE PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) CAPITATION RECONCIATION PROCESS, AN UNDERPAYMENT HAS BEEN IDENTIFIED AND AN EXPENDITURE HAS BEEN GENERATED WITH A MANUAL CHECK.
8789 PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY (PACE) CAPITATION PAYMENT
8790 A NON-CLAIM RELATED SYSTEMATIC PAYOUT TO THE PROVIDER FOR A DOC INMATE.
8791 A NON-CLAIM RELATED MANUAL PAYOUT TO THE PROVIDER FOR A DOC INMATE.
8792 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HIP STATE PLAN BASIC.
8793 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HIP STATE PLAN PLUS.
8794 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR HIP PLAN BASIC.
8795 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR HIP PLAN PLUS.
8796 DUE TO THE HEALTHY INDIANA PLAN HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR HIP HOSPITAL PRESUMPTIVE ELIGIBILITY ADULT.
8797 A SYSTEM GENERATED HIP LINK OUT-OF-POCKET PAYMENT HAS BEEN ESTABLISHED TO THE PROVIDER FOR THE EMPLOYEE.
8798 A MANUAL GENERATED HIP LINK OUT-OF-POCKET PAYMENT HAS BEEN ESTABLISHED TO THE PROVIDER FOR THE EMPLOYEE.
8799 A PAYOUT HAS BEEN ESTABLISHED. MANUAL SET UP (NEMT)
8800 MIC
8801 OIG
8802 PERM
8803 RAC
8804 PROGRAM INTEGRITY
8805 PROVIDER SENT A FULL REFUND DUE TO A MIC LESS THAN 1 YEAR AUDIT DISCOVERY.
8806 PROVIDER SENT A PARTIAL REFUND DUE TO A MIC LESS THAN 1 YEAR AUDIT DISCOVERY.
8807 PROVIDER SENT A FULL REFUND DUE TO A MIC GREATER THAN 1 YEAR AUDIT DISCOVERY.
8808 PROVIDER SENT A PARTIAL REFUND DUE TO A MIC GREATER THAN 1 YEAR AUDIT DISCOVERY.
8809 PROVIDER SENT A FULL REFUND DUE TO A OIG LESS THAN 1 YEAR AUDIT DISCOVERY.
8810 PROVIDER SENT A PARTIAL REFUND DUE TO A OIG LESS THAN 1 YEAR AUDIT DISCOVERY.
8811 PROVIDER SENT A FULL REFUND DUE TO A OIG GREATER THAN 1 YEAR AUDIT DISCOVERY.
8812 PROVIDER SENT A PARTIAL REFUND DUE TO A OIG GREATER THAN 1 YEAR AUDIT DISCOVERY.
8813 PROVIDER SENT A FULL REFUND DUE TO A PERM LESS THAN 1 YEAR AUDIT DISCOVERY.
8814 PROVIDER SENT A PARTIAL REFUND DUE TO A PERM LESS THAN 1 YEAR AUDIT DISCOVERY.
8815 PROVIDER SENT A FULL REFUND DUE TO A PERM GREATER THAN 1 YEAR AUDIT DISCOVERY.
8816 PROVIDER SENT A PARTIAL REFUND DUE TO A PERM GREATER THAN 1 YEAR AUDIT DISCOVERY.
8817 PROVIDER SENT A FULL REFUND DUE TO A RAC LESS THAN 1 YEAR AUDIT DISCOVERY.
8818 PROVIDER SENT A PARTIAL REFUND DUE TO A RAC LESS THAN 1 YEAR AUDIT DISCOVERY.
8819 PROVIDER SENT A FULL REFUND DUE TO A RAC GREATER THAN 1 YEAR AUDIT DISCOVERY.
8820 PROVIDER SENT A PARTIAL REFUND DUE TO A RAC GREATER THAN 1 YEAR AUDIT DISCOVERY.
8821 PROVIDER SENT A FULL REFUND DUE TO A PROGRAM INTEGRITY LESS THAN 1 YEAR AUDIT DISCOVERY.
8822 PROVIDER SENT A PARTIAL REFUND DUE TO A PROGRAM INTEGRITY LESS THAN 1 YEAR AUDIT DISCOVERY.
8823 PROVIDER SENT A FULL REFUND DUE TO A PROGRAM INTEGRITY GREATER THAN 1 YEAR AUDIT DISCOVERY.
8824 PROVIDER SENT A PARTIAL REFUND DUE TO A PROGRAM INTEGRITY GREATER THAN 1 YEAR AUDIT DISCOVERY.
8825 PROVIDER REQUESTED FULL OFFSET DUE TO A LESS THAN 1 YEAR MIC AUDIT DISCOVERY.
8826 PROVIDER REQUESTED FULL OFFSET DUE TO A GREATER THAN 1 YEAR MIC AUDIT DISCOVERY.
8827 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A LESS THAN 1 YEAR MIC AUDIT DISCOVERY.
8828 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A GREATER THAN 1 YEAR MIC AUDIT DISCOVERY.
8829 PROVIDER REQUESTED PAYMENT DUE TO A LESS THAN 1 YEAR MIC AUDIT DISCOVERY.
8830 PROVIDER REQUESTED PAYMENT DUE TO A GREATER THAN 1 YEAR MIC AUDIT DISCOVERY.
8831 PROVIDER REQUESTED FULL OFFSET DUE TO A LESS THAN 1 YEAR OIG AUDIT DISCOVERY.
8832 PROVIDER REQUESTED FULL OFFSET DUE TO A GREATER THAN 1 YEAR OIG AUDIT DISCOVERY.
8833 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A LESS THAN 1 YEAR OIG AUDIT DISCOVERY.
8834 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A GREATER THAN 1 YEAR OIG AUDIT DISCOVERY.
8835 PROVIDER REQUESTED PAYMENT DUE TO A LESS THAN 1 YEAR OIG AUDIT DISCOVERY.
8836 PROVIDER REQUESTED PAYMENT DUE TO A GREATER THAN 1 YEAR OIG AUDIT DISCOVERY.
8837 PROVIDER REQUESTED FULL OFFSET DUE TO A LESS THAN 1 YEAR PERM AUDIT DISCOVERY.
8838 PROVIDER REQUESTED FULL OFFSET DUE TO A GREATER THAN 1 YEAR PERM AUDIT DISCOVERY.
8839 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A LESS THAN 1 YEAR PERM AUDIT DISCOVERY.
8840 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A GREATER THAN 1 YEAR PERM AUDIT DISCOVERY.
8841 PROVIDER REQUESTED PAYMENT DUE TO A LESS THAN 1 YEAR PERM AUDIT DISCOVERY.
8842 PROVIDER REQUESTED PAYMENT DUE TO A GREATER THAN 1 YEAR PERM AUDIT DISCOVERY.
8843 PROVIDER REQUESTED FULL OFFSET DUE TO A LESS THAN 1 YEAR RAC AUDIT DISCOVERY.
8844 PROVIDER REQUESTED FULL OFFSET DUE TO A GREATER THAN 1 YEAR RAC AUDIT DISCOVERY.
8845 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A LESS THAN 1 YEAR RAC AUDIT DISCOVERY.
8846 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A GREATER THAN 1 YEAR RAC AUDIT DISCOVERY.
8847 PROVIDER REQUESTED PAYMENT DUE TO A LESS THAN 1 YEAR RAC AUDIT DISCOVERY.
8848 PROVIDER REQUESTED PAYMENT DUE TO A GREATER THAN 1 YEAR RAC AUDIT DISCOVERY.
8849 PROVIDER REQUESTED FULL OFFSET DUE TO A LESS THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY.
8850 PROVIDER REQUESTED FULL OFFSET DUE TO A GREATER THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY.
8851 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A LESS THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY.
8852 PROVIDER REQUESTED PARTIAL OFFSET DUE TO A GREATER THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY.
8853 PROVIDER REQUESTED PAYMENT DUE TO A LESS THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY.
8854 PROVIDER REQUESTED PAYMENT DUE TO A GREATER THAN 1 YEAR PROGRAM INTEGRITY AUDIT DISCOVERY.
8855 PROVIDER SENT A FULL REFUND DUE TO A CREDIT BALANCE LESS THAN 1 YEAR AUDIT DISCOVERY.
8856 PROVIDER SENT A PARTIAL REFUND DUE TO A CREDIT BALANCE LESS THAN 1 YEAR AUDIT DISCOVERY.
8857 PROVIDER SENT A FULL REFUND DUE TO A CREDIT BALANCE GREATER THAN 1 YEAR AUDIT DISCOVERY.
8858 PROVIDER SENT A PARTIAL REFUND DUE TO A CREDIT BALANCE GREATER THAN 1 YEAR AUDIT DISCOVERY.
8860 DSH 2015 SYSTEM PAYMENT
8861 DSH 2015 SYSTEM CPE PAYMENT
8862 DSH 2015 MANUAL CHECK
8863 DSH 2015 MANUAL CPE CHECK
8864 DSH 2016 SYSTEM PAYMENT
8865 DSH 2016 SYSTEM CPE PAYMENT
8866 DSH 2016 MANUAL CHECK
8867 DSH 2016 MANUAL CPE CHECK
8869 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HCC ADULT CATEGORY.
8870 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HCC CHILDREN CATEGORY.
8871 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HCC WARDS AND FOSTERS CATEGORY.
8872 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE TRANSITIONAL ADULT MALES AGE 19 AND YOUNGER CATEGORY.
8873 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE TRANSITIONAL ADULT MALES AGE 20 AND OLDER CATEGORY.
8874 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE TRANSITIONAL ADULT FEMALES AGE 19 AND YOUNGER CATEGORY.
8875 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE TRANSITIONAL ADULT FEMALES AGE 20 AND OLDER CATEGORY.
8876 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW TRANSITIONAL ADULT MALES AGE 19 AND YOUNGER CATEGORY.
8877 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW TRANSITIONAL ADULT MALES AGE 20 AND OLDER CATEGORY.
8878 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW TRNASITIONAL ADULT FEMALES AGE 19 AND YOUNGER CATEGORY.
8879 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW TRANSITIONAL ADULT FEMALES AGE 20 AND OLDER CATEGORY.
8881 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE DELIVERY CASE AGE 19 AND UNDER CATEGORY.
8882 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE DELIVERY CASE AGE 20 AND OLDER CATEGORY.
8883 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE DELIVERY CASE CHIP 1 CATEGORY.
8884 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHSIWE PREGNANT FEMALES AGE 19 AND UNDER CATEGORY.
8885 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPTIAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE PREGNANT FEMALES AGE 20 AND OLDER CATEGORY.
8886 A PAYOUT IS DUE TO THE MCE AS A RESULT OF HOSPITAL ASSESSMENT FEES ASSOCIATED WITH HOOSIER HEALTHWISE PREGNANT FEMALES CHIP 1 CATEGORY.
8887 A SYSTEM GENERATED EXPENDITURE HAS BEEN ESTABLISHED FOR A PATHWAYS MEDICAL EDUCATION PAYMENT.
8888 A SYSTEM GENERATED EXPENDITURE HAS BEEN ESTABLISHED FOR A FQHC-RHC PATHWAYS PHYSICIAN PAYMENT.
8889 A SYSTEM GENERATED EXPENDITURE HAS BEEN ESTABLISHED FOR A FQHC-RHC PATHWAYS DENTAL PAYMENT.
8891 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW DELIVERY CASE AGE 19 AND UNDER CATEGORY.
8892 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW DLEIVERY CASE AGE 20 AND OLDER CATEGORY.
8893 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW DELIVERY CASE CHIP1 CATEGORY.
8894 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW PREGNANT FEMALES AGE 19 AND UNDER CATEGORY.
8895 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW PREGNANT FEMALES AGE 20 AND OLDER CATEGORY.
8896 DUE TO THE MANAGED CARE HOSPITAL ASSESSMENT FEE CAPITATION RECONCILIATION PROCESS, AN EXPENDITURE HAS BEEN GENERATED FOR THE HHW PREGNANT FEMALES CHIP1 CATEGORY.
8897 A MANUALLY CREATED EXPENDITURE HAS BEEN ESTABLISHED FOR A PATHWAYS MEDICAL EDUCATION PAYMENT.
8898 A MANUALLY CREATED EXPENDITURE HAS BEEN ESTABLISHED FOR A FQHC-RHC PATHWAYS PHYSICIAN PAYMENT.
8899 A MANUALLY CREATED EXPENDITURE HAS BEEN ESTABLISHED FOR A FQHC-RHC PATHWAYS DENTAL PAYMENT.
8904 A SYSTEM GENERATED HIP LINK PREMIUM PAYMENT HAS BEEN ESTABLISHED FOR THE EMPLOYEE TO ASSIST WITH MONTHLY INSURANCE PREMIUM PAYMENTS.
8905 A MANUAL HIP LINK PREMIUM PAYMENT HAS BEEN ESTABLISHED FOR THE EMPLOYEE TO ASSIST WITH MONTHLY INSURANCE PREMIUM PAYMENTS.
8906 A SYSTEM GENERATED HIP LINK OUT-OF-POCKET PAYMENT HAS BEEN ESTABLISHED TO THE EMPLOYEE FOR NON-IHCP PROVIDER PAYMENT.
8907 A MANUAL HIP LINK OUT-OF-POCKET PAYMENT HAS BEEN ESTABLISHED TO THE EMPLOYEE FOR NON-IHCP PROVIDER PAYMENT.
8918 A payout is due to MCE as a result of pay for performance for Hoosier Care Connect Adult.
8919 A payout is due to MCE as a result of pay for performance for Hoosier Care Connect Child.
8920 A payout is due to MCE as a result of pay for performance for Hoosier Care Connect Foster.
8921 A payout is due to MCE as a result of pay for performance for Healthy Indiana Plan New Adult.
8922 A payout is due to MCE as a result of pay for performance for Healthy Indiana Plan Medically Frail.
8923 A payout is due to MCE as a result of pay for performance for Healthy Indiana Plan Low Income Parent Caretaker.
8924 A payout is due to MCE as a result of payout for performance for Healthy Indiana Plan Presumptive Eligibility.
8925 A payout is due to MCE as a result of pay for performance for Hoosier Healthwise CHIP I.
8926 A payout is due to MCE as a result of pay for performance for Hoosier Healthwise CHIP II.
8927 A payout is due to MCE as a result of pay for performance for Hoosier Healthwise Medicaid.
8928 A PAYMENT IS DUE TO THE MCE FOR NEWLY ELIGIBLE MEMBERS.
8931 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION PAYMENT FOR NEW ADULT GROUP
8932 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION PAYMENT FOR MEDICALLY FRAIL.
8933 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION PAYMENT FOR LOW-INCOME PARENT-CARETAKER.
8934 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION PAYMENT FOR PRESUMPTIVE ELIGIBILITY.
8935 HEALTHY INDIANA PLAN GRADUATE MEDICAL EDUCATION PAYMENT FOR PREGNANCY.
8936 A SYSTEN GENERATED EXPENDITURE HAS BEEN ESTABLISHED FOR A HIP BRIDGE MEMBER.
8937 A MANUAL EXPENDITURE HAS BEEN ESTABLISHED FOR A HIP BRIDGE MEMBER.
8938 A SYSTEM GENERATED EXPENDITURE HAS BEEN ESTABLISHED FOR A HIP BRIDGE PROVIDER.
8939 A MANUAL EXPENDITURE HAD BEEN ESTABLISHED FOR A HIP BRIDGE PROVIDER.
8941 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR HOOSIER HEALTHWISE
8942 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR CHILDRENS HEALTH INSURANCE PROGRAM
8943 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR MEDICAID FEE FOR SERVICE
8944 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR HOOSIER CARE CONNECT ADULT
8945 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR HOOSIER CARE CONNECT CHILD
8946 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR HOOSIER CARE CONNECT FOSTER
8947 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR HEALTHY INDIANA PLAN NEW ADULT
8948 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR HEALTHY INDIANA PLAN FRAIL
8949 PHYSICIAN FACULTY ACCESS TO CARE PAYMENT FOR HEALTHY INDIANA PLAN OTHER
8951 FQHC-RHC DENTAL PAYMENT
8952 AN EXPENDITURE HAS BEEN GENERATED DUE TO A MIC AUDIT.
8953 AN EXPENDITURE HAS BEEN GENERATED DUE TO AN OIG AUDIT.
8954 AN EXPENDITURE HAS BEEN GENERATED DUE TO A PERM AUDIT.
8955 AN EXPENDITURE HAS BEEN GENERATED DUE TO A CREDIT BALANCE AUDIT.
8956 AN EXPENDITURE HAS BEEN GENERATED DUE TO A PROGRAM INTEGRITY AUDIT
8959 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HOOSIER CARE CONNECT ADULT.
8960 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HOOSIER CARE CONNECT CHILDREN.
8961 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HOOSIER CARE CONNECT FOSTERS.
8962 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HEALTHY INDIANA PLAN NEWLY ELIGIBLE.
8963 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HEALTHY INDIANA PLAN MEDICALLY FRAIL.
8964 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HEALTHY INDIANA PLAN LOW INCOME PARENT CARETAKERS.
8965 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HEALTHY INDIANA PLAN PREGNANT WOMEN.
8966 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HEALTHY INDIANA PLAN PRESUMPTIVE ELIGIBILITY.
8967 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HOOSIER HEALTHWISE CHILD.
8968 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HOOSIER HEALTHWISE MOTHER.
8969 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE FOR HOOSIER HEALTHWISE CHILDRENS HEALTH INSURANCE PROGRAM.
8970 A PAYOUT IS DUE TO NON-EMERGENCY MEDICAL TRANSPORTATION (NEMT) AS A RESULT OF PAY FOR PERFORMANCE.
8971 A SYSTEM GENERATED EXPENDITURE HAS BEEN CREATED FOR A HOME AND COMMUNITY BASED SERVICES STABILIZATION PAYMENT.
8972 A SYSTEM GENERATED EXPENDITURE HAS BEEN CREATED FOR A HOME HEALTH PAYMENT DUE TO AN INCREASE APPROVED BY THE INDIANA GENERAL ASSEMBLY.
8973 ARP35 PARTICIPANT STIPEND FOR EMPLOYMENT TRANSFORMATION COLLABORATIVE
8974 ARP35 PARTICIPANT STIPEND FOR LEADERSHIP NETWORK ON EMPLOYMENT INNOVATION
8975 ARP35 TRANSFORMATION GRANT - EMPLOYMENT TRANSFORMATION COLLABORATIVE
8976 ARP35 TRANSFORMATION GRANT - LEADERSHIP NETWORK ON EMPLOYMENT INNOVATION
8977 ARP30 DDRS PILOTS AND INNOVATION PROJECTS DEVELOPMENT FUNDS
8978 ARP30 DDRS PILOTS AND INNOVATION PROJECTS
8979 ARP29 OPEN FUTURE LEARNING MODULES DSP STIPENDS
8980 AN EXPENDITURE HAS BEEN CREATED FOR THE BARIATRIC AMBULANCE GRANT PROGRAM
8981 AN EXPENDITURE HAS BEEN CREATED FOR THE APR42 - WHEELCHAIR LIFT GRANT.
8982 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP39 SEC9817 HCBS PAYMENT.
8983 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP81 PROVIDER READINESS GRANT PAYMENT.
8984 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP33 CMO TRAINING PAYMENT.
8985 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP73 DURABLE MEDICAL EQUIPMENT STABILIZATION PAYMENT.
8986 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP75 AGED AND DISABLED WAIVER WORKFORCE SURVEY INCENTIVE PAYMENT.
8987 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP84 SETTINGS RULE REMEDIATION GRANT PAYMENT.
8988 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP12 CAREGIVER SURVEY INCENTIVE PAYMENT.
8989 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP89 WORKFORCE INVESTMENT GRANT PAYMENT.
8990 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP31 DIVISION OF DISABILITY AND REHABILITATIVE SERVICES WAIVER.
8991 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP39 NON-EMERGENCY MEDICAL TRANSPORTATION PAYMENT.
8992 AN EXPENDITURE HAS BEEN CREATED FOR AN ARP 1E NEW PROVIDER STIPEND.
8993 AN EXPENDITURE HAS BEEN CREATED FOR QAF RATE ADJUSTMENT
8994 AN EXPENDITURE HAS BEEN CREATED FOR A NURSING FACILITY LUMP SUM SETTLEMENT DUE TO COMPLIANCE REVIEW.
8995 AN EXPENDITURE HAS BEEN CREATED FOR AN ICF-IID LUMP SUM SETTLEMENT DUE TO COMPLIANCE REVIEW.
8996 AN EXPENDITURE HAS BEEN CREATED FOR A LUMP SUM SETTLEMENT DUE TO MDS REVIEW.
8998 CLAIM BEING REVIEWED
8999 ADJUSTMENT TO CROSSOVER PAID PRIOR TO 1/1/95. THIS CLAIM HAS BEEN MANUALLY PRICED USING THE MEDICARE COINSURANCE, DEDUCTIBLE, AND PSYCHE REDUCTION AMOUNTS.
9000 PRICING ADJUSTMENT - THE SUBMITTED CHARGE EXCEEDS THE ALLOWED CHARGE. CLAIM PAID AT THE PROGRAM ALLOWED AMOUNT.
9001 PRICING ADJUSTMENT - REIMBURSEMENT REDUCED BY THE MEMBER'S COPAYMENT AMOUNT.
9002 ADDITIONAL SURGICAL PROCEDURE(S) ARE PAYABLE AT 50% OF INDIANA HEALTH COVERAGE
9003 PRICING ADJUSTMENT - THIRD PARTY LIABILITY AMOUNT APPLIED IS GREATER THAN THE AMOUNT PAID BY THE PROGRAM.
9004 PRICING ADJUSTMENT - AMOUNT PAID IS ZERO.
9005 THIS CLAIM IS ELIGIBLE FOR ELECTRONIC SUBMISSION. UP TO A $1.10 REDUCTION HAS BEEN APPLIED TO THIS CLAIM PAYMENT.
9006 ACCESS PAYMENT INCLUDED.
9007 ACCESS PAYMENT NOT AVAILABLE FOR DATE OF SERVICE ON THIS DATE OF PROCESS.
9008 PRICING ADJUSTMENT - PAYMENT AMOUNT DECREASED BASED ON PAY FOR PERFORMANCE POLICY.
9009 DETAIL INCLUDES OVERHEAD FEE
9010 ACTUAL ITEMIZED COST INVOICE MUST BE SUBMITTED WHEN BILLING THIS PROCEDURE CODE. PLEASE RESUBMIT WITH AN INVOICE.
9011 THIS ITEM/SERVICE SHOULD NOT BE BILLED WITH THIS PROCEDURE CODE.
9012 A PROCEDURE CODE IS REQUIRED WHEN BILLING THIS REVENUE CODE. PLEASE RESUBMIT WITH A PROCEDURE CODE.
9013 MEDICAID PAYMENT IS ZERO DUE TO THE MEDICARE PAYMENT AMOUNT EXCEEDING OR EQUALING THE MEDICAID ALLOWABLE AMOUNT
9014 LINE ITEM SUBMITTED WITH UNCLEAR ITEMIZATION. PLEASE RESUBMIT WITH APPROPRIATE AND/OR ADDITIONAL INFORMATION. ELECTRONIC MEDICARE PART B CLAIMS SUBMITTED FOR SERVICES THAT REQUIRE MANUAL PRICING MUST BE BILLED ON PAPER WITH AN ITEMIZED COST INVOICE
9015 IHCP ALWD AMT IS ADJUSTED BY SD/WL PAYMENT
9016 SERVICE DENIED MEDICAL NECESSITY DOCUMENTATION MUST BE PROVIDED WITH CLAIM STATING REASON FOR MEDICAL NECESSITY.
9018 NO PAYMENT MADE, SD/WL IS > IHCP ALLOWED
9019 FORCE BALANCE FOR SPENDDOWN/WAIVER LIABILITY
9020 SERVICE PAID IN ACCORDANCE WITH PROGRAM REQUIREMENTS.
9021 NURSING FACILITY ENHANCED FEE FOR COVID POSITIVE MEMBERS
9022 UNITS CUT BACK TO ONE. ONLY ONE UNIT PER DETAIL IS ALLOWED WHEN BILLING AN ESRD COMPOSITE RATE REVENUE CODE.
9024 THE CLAIM REQUIRES BOTH MSRP AND A COST INVOICE FOR PROCESSING, PLEASE RESUBMIT.
9025 SPECIAL CARE UNIT(SCU) ENHANCED FEE FOR QUALIFYING RESIDENTS
9026 VENTILATOR ENHANCED FEE FOR QUALIFYING RESIDENTS
9027 Revenue code date of service is outside the date of service span for the per diem.
9028 Attendant care and home and community services cannot be billed in the same month as structured family care (SFC).
9032 HOSPITAL ASSESSMENT FEE (HDR)
9033 HOSPITAL ASSESSMENT FEE (DTL)
9040 REIMBURSEMENT IS FOR THE VFC (VACCINE FOR CHILDRENS PROGRAM) VACCINE ADMINISTRATION FEE ONLY
9041 IHCP PAYMENT ADJUSTMENT BASED ON CAPITAL COST RATE
9042 IHCP PAYMENT ADJUSTMENT BASED ON MEDICAL EDUCATION
9043 IHCP ADJUSTMENT BASED ON DRG WEIGHT TIMES THE BASE AMT
9044 REDUCED RATE DUE TO TRANSFER OR DEATH
9045 ALLOWED AMOUNT AS DRG LEVEL OF CARE RATE
9046 Out of State Children's Hospital additional payment.
9050 EPSDT PRICING
9051 IHCP PAYMENT ADJUSTMENT BASED ON OUTLIER AMOUNT
9053 ANESTHESIA EPIDUAL AND VAGINAL DELIVERY PRICING
9054 ANESTHESIA PRICING
9061 ENCOUNTER CLAIMS ARE REPORTED WITH A ZERO PAYMENT AMOUNT
9064 HOSPICE PRICING (RATE ON FILE)
9070 THE AMOUNT BILLED IS LESS THAN THE IHCP ALLOWED AMOUNT.
9071 RATE REDUCTION/ HOSPICE EPISODE > 60 DAYS
9072 Hospice penalty rate reduction has been applied
9073 Hospice penalty rate reduction has been applied in addition to rate reduction/hospice episode > 60 days
9090 REIMBURSEMENT REDUCTION ON ALLOWED AMOUNT
9091 THE IHCP PAYMENT IS BASED ON THE LESSOR OF THE BILLED OR ALLOWED AMOUNT.
9094 REIMBURSEMENT BASED ON BILATERAL PRICING
9175 CLAIM DENIED. MEMBERS SIGNATURE AND DATE OF SIGNATURE IN THE MEMBERS SECTION OF THE CONSENT FORM ARE IN ERROR AND ARE NON CORRECTABLE FIELDS.
9605 HOSPITAL LEAVE DAYS ARE LIMITED TO 15 PER HOSPITALIZATION. THE PATIENT SHOULD BE DISCHARGED AND READMITTED FOLLOWING THE HOSPITAL STAY.
9651 SURGERIES ON THE SAME DATE OF SERVICE, IN THE EXCESS OF TWO, ARE PAID AT 25 PERCENT OF THE INDIANA HEALTH COVERAGE PROGRAM'S ALLOWED.
9801 CLAIM PAID AT PER DIEM RATE
9802 CLAIM PAID AT % OF BILLED CHARGES
9803 PRICING ADJUSTMENT - MEDICARE BENEFITS ARE EXHAUSTED. CLAIM PAID AT PROGRAM ALLOWED RATE.
9804 DISPENSING FEE DENIED. MISSING OR INVALID LEVEL OF EFFORT SUBMITTED AND/OR REASON FOR SERVICE, PROFESSIONAL SERVICE, OR RESULT OF SERVICE CODE BILLED IN ERROR.
9805 PRICING ADJUSTMENT - PAYMENT REDUCED DUE TO THE INPATIENT OR OUTPATIENT DEDUCTIBLE.
9806 PRICING ADJUSTMENT - PAYMENT REDUCED DUE TO BENEFIT PLAN LIMITATIONS.
9807 HEADER BILLING PROVIDER USED AS DETAIL PERFORMING PROVIDER
9808 HEADER PERFORMING PROVIDER USED AS DETAIL PERFORMING PROVIDER
9809 PRICING ADJUSTMENT - MAXIMUM ALLOWABLE FEE PRICING USED.
9810 REPACKAGING ALLOWANCE APPLIED.
9811 PHARMACEUTICAL CARE RATE APPLIED.
9812 LEVEL OF EFFORT DISPENSING FEE APPLIED.
9813 TRADITIONAL DISPENSING FEE APPLIED.
9814 DIAGNOSIS REQUIRED FOR PHARMACEUTICAL CARE. TRADITIONAL DISPENSING FEE MAY BE ALLOWED.
9815 REFER TO THE DME AREA OF THE ONLINE HANDBOOK FOR CLAIMS SUBMISSION REQUIREMENTS FOR COMPRESSION GARMENTS. THE TOPIC OF REQUIREMENTS FOR COMPRESSION GARMENTS CAN BE FOUND IN THE CLAIMS SECTION, SUBMISSION CHAPTER.
9816 PRICING ADJUSTMENT - PAYMENT AMOUNT INCREASED BASED ON HOSPITAL ACCESS PAYMENT POLICIES.
9817 BILLING PROVIDER NUMBER WAS USED TO ADJUDICATE THE SERVICE(S)
9818 REPACKAGING ALLOWANCE IS NOT ALLOWED FOR UNIT DOSE NDCS.
9819 EAPG PRICING APPLIED.
9900 THE NATIONAL DRUG CODE (NDC) WAS REIMBURSED AT A GENERIC RATE.
9902 PRICING ADJUSTMENT - INPATIENT PER-DIEM PRICING.
9905 PRICING ADJUSTMENT - MEDICARE PRICING INFORMATION
9906 PRICING ADJUSTMENT - MEDICARE PRICING CUTBACKS APPLIED.
9907 PRICING ADJUSTMENT - THIRD PARTY LIABILITY DEDUCTIBLE AMOUNT APPLIED.
9908 PHARMACY PRICING APPLIED.
9909 PRICING ADJUSTMENT - PAID ACCORDING TO PROGRAM POLICY.
9910 PHARMACY DISPENSING FEE APPLIED.
9911 PRICING ADJUSTMENT - LONG TERM CARE PRICING APPLIED.
9912 PRICING ADJUSTMENT - AMBULATORY SURGERY PRICING APPLIED.
9914 PRICING ADJUSTMENT - REVENUE CODE FLAT RATE PRICING APPLIED.
9915 PRICING ADJUSTMENT - MEDICARE CROSSOVER CLAIM CUTBACK APPLIED.
9916 PRICING ADJUSTMENT - USUAL & CUSTOMARY CHARGE (UCC) RATE PRICING APPLIED.
9918 PRICING ADJUSTMENT - MAXIMUM ALLOWABLE FEE PRICING APPLIED.
9919 PRICING ADJUSTMENT - PROVIDER LEVEL OF CARE (LOC) PRICING APPLIED.
9920 PRICING ADJUSTMENT - RESOURCE BASED RELATIVE VALUE SCALE (RBRVS) PRICING APPLIED.
9921 PRICING ADJUSTMENT - PRIOR AUTHORIZATION PRICING APPLIED.
9922 PRICING ADJUSTMENT - SPENDDOWN DEDUCTIBLE APPLIED.
9923 PRICING ADJUSTMENT - PATIENT LIABILITY DEDUCTION APPLIED.
9926 PRICING ADJUSTMENT - CLAIM HAS PRICING CUTBACK AMOUNT APPLIED.
9927 RESERVED FOR FUTURE USE.
9928 PRICING ADJUSTMENT - AMOUNT PAID IS ZERO
9929 PRICING ADJUSTMENT - ANESTHESIA PRICING APPLIED.
9932 PRICING ADJUSTMENT - DRG PRICING APPLIED.
9933 PRICING ADJUSTMENT - AMBULATORY PAYMENT CLASSIFICATION (APC) PRICING APPLIED.
9934 PRESCRIPTION REDUCTION APPLIED.
9935 PRICING ADJUSTMENT - MAXIMUM FLAT FEE PRICING APPLIED.
9936 PRICING ADJUSTMENT - MAXIMUM FLAT FEE LEVEL 2 PRICING APPLIED.
9937 PRICING ADJUSTMENT - USUAL & CUSTOMARY CHARGE (UCC) FLAT FEE PRICING APPLIED.
9938 PRICING ADJUSTMENT - USUAL & CUSTOMARY CHARGE (UCC) FLAT FEE LEVEL 2 PRICING APPLIED.
9940 MEDICARE PART A PAYMENT NOT AVAILABLE OR DEPLETED.
9941 PRICING ADJUSTMENT--UB92 HOSPICE LTC PRICING
9942 QUANTITY REDUCED BASED ON DHS POLICY
9943 SENIORCARE COST SHARE AND/OR OTHER INSURANCE PAID AMOUNT APPLIED.
9944 PRICING ADJUSTMENT - INCENTIVE PRICING
9945 THE IHCP WILL PAY THE LESSER OF THE COINSURANCE PLUS DEDUCTIBLES OR THE MEDICAID ALLOWED AMOUNT MINUS MEDICARE PAID AMOUNT. MEDICAID PAYMENT HAS BEEN CALCULATED AS THE MEDICAID ALLOWED AMOUNT MINUS THE MEDICARE PAYMENT AMOUNT.
9946 PRICING ADJUSTMENT: REIMBURSEMENT AMOUNT IS THE DIFFERENCE BETWEEN THE MEDICARE ALLOWED AMOUNT AND THE FORWARDHEALTH REIMBURSEMENT AMOUNT.
9947 PRICING ADJUSTMENT: MEDICARE DEDUCTIBLE, COINSURANCE AND/OR COPAYMENT PAID IN FULL
9948 NDC WAS REIMBURSED AT AWP RATE.
9949 NDC WAS REIMBURSED AT SMAC RATE.
9950 NDC WAS REIMBURSED AT EMAC RATE.
9951 NDC WAS REIMBURSED AT BRAND WAC RATE.
9952 NDC WAS REIMBURSED AT GENERIC WAC RATE.
9953 HMO ENCOUNTER DETAIL MANUALLY PRICED.
9954 COST SHARE FOR ENCOUNTER PROCESSING BYPASSED.
9955 MEMBER IS NOT ENROLLED MANAGED CARE.
9956 SERVICES HAVE BEEN CARVED OUT OF HMO ENCOUNTER PROCESSING
9957 THIS SERVICE IS NOT REIMBURSABLE FOR THE MANAGED CARE ENCOUNTER CLAIM FOR THE MEMBER'S BENEFIT PLAN.
9958 MEMBER IS NOT ENROLLED IN WISCONSIN MEDICAID OR BADGERCARE PLUS, THEREFORE, THE ENCOUNTER CANNOT BE PROCESSED
9959 THE ALLOWED AMOUNT FOR THIS PROCEDURE IS REDUCED BY 10% FOR SUBSEQUENT EXTRACT IONS IN THE SAME TOOTH QUADRANT ON THE SAME DATE OF SERVICE.
9997 SUPERSUSPENDED FOR MISSING DISPOSITION
9998 CLAIM WAS PRICED IN ACCORDANCE WITH CURRENT INDIANA HEALTH COVERAGE PROGRAM POLICIES.
9999 PROCESSED PER POLICY.

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