| 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 |
| 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. |
| 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 THE RISK BASED MANAGED CARE PORTION OF THE HOOSIER HEALTHWISE PROGRAM OR HAS BEEN IDENTIFIED AS A MEMBER OF THE HOOSIER CARE CONNECT PROGRAM. THE MEMBER MUST SEEK CARE FROM THE APPROPRIATE MANAGED CARE ENTITY. |
| 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 |
| 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, PROPHY 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 AND PERIODONTAL MAINTENANCE IS LIMITED TO ONE TREATMENT EVERY 3 MONTHS FOR MEMBERS AGE 3 YRS & OLDER. |
| 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 AND PERIODONTAL MAINTENANCE IS LIMITED TO ONE TREATEMENT EVERY 3 MONTHS FOR MEMBERS AGE 3 YEARS & 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 LIMITED TO ONE TREATMENT EVERY SIX MONTHS FOR MEMBERS AGE ONE TO TWO YEARS.. |
| 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 |
| 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. |
| 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 99408 AND 99409 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. |
| 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 |
| 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. |
| 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. |