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

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

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

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

Code Description
0000 CLAIM PAID AS BILLED
0001 CLAIM PENDED FOR EXAMINER REVIEW
0002 CLAIM CORRECTION FORM SENT TO PROVIDER-WAITING FOR PROVIDER RESPONSE
0003 CLAIM PENDED - WAITING FOR ATTACHMENT
0004 ADJUSTMENT CLAIM PENDED FOR EXAMINER REVIEW.
0008 NDC VS. AGE RESTRICTION.
0012 INVALID DIAGNOSIS OR HEADER CODE-PLEASE VERIFY AND RESUBMIT
0013 PROCEDURE CODE NOT USED BY INDIANA HEALTH COVERAGE-PLEASE VERIFY AND RESUBMIT.
0014 MEMBER NUMBER INVALID-PLEASE CHECK MEMBER'S I.D. CARD AND RESUBMIT.
0015 MEMBER NAME AND NUMBER DISAGREE-PLEASE CHECK MEMBER'S I.D. CARD AND RESUBMIT.
0027 THE THIRD PARTY PAYMENT AMOUNT IS INVALID-IF A THIRD PARTY INSURANCE CARRIER WAS BILLED THEN THE THIRD PARTY PAYMENT AMOUNT SHOULD BE THE NUMBER "0" OR THE ACTUAL AMOUNT PAID. PLEASE VERIFY AND RESUBMIT.
0029 Admission Source Code is invalid.
0044 THE FROM DATE OF SERVICE IS NOT IN THE CORRECT FORMAT. THE CORRECT FORMAT IS MMDDYY. PLEASE CORRECT AND RESUBMIT.
0047 THE TO DATE OF SERVICE IS NOT IN THE CORRECT FORMAT. THE CORRECT FORMAT IS MMDDYY. PLEASE CORRECT AND RESUBMIT.
0100 THE EIGHTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0101 EIGHTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0102 THE NINETEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0103 THE NINETEENTH OTHER PROCEDURE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0104 NINETEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0105 THE TWENTIETH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0106 THE TWENTIETH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0107 TWENTIETH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0108 THE TWENTY-FIRST OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0109 THE TWENTY-FIRST OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0110 TWENTY-FIRST OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0111 THE TWENTY-SECOND OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0112 THE TWENTY-SECOND OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0113 THE TWENTY-SECOND OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0114 THE TWENTY-THIRD OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0115 THE TWENTY-THIRD OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0116 TWENTY-THIRD OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0117 THE TWENTY-FOURTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0118 THE TWENTY-FOURTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0119 TWENTY-FOURTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0120 ELECTRONIC VOID OF PREVIOUSLY PROCESSED CLAIM
0121 CLAIM NOT PROCESSED DUE TO A REPLACEMENT CLAIM.
0122 INVALID REPLACEMENT/VOID ORIGINAL CLAIM DENIED/SUSPENDED
0123 RESERVED FOR PE (PRESEUMPTIVE ELIGIBILITY)
0124 RESERVED FOR PE (PRESUMPTIVE ELIGIBILITY)
0198 THE REFERRING NPI SUBMITTED IS NOT IN A VALID FORMAT. PLEASE VERIFY AND RESUBMIT.
0199 BILLED DATE MISSING OR INVALID
0200 PRESCRIBER NPI IS LINKED TO PHARMACY TYPE/SPECIALTY. PLEASE VERY AND RESUBMIT.
0201 BILLING LPI/NPI IS MISSING; PLEASE PROVIDE AND RESUBMIT
0202 PROVIDER NUMBER IS NOT IN A VALID FORMAT. THE CORRECT FORMAT FOR A LPI IS NINE NUMERIC CHARACTERS AND AN ALPHA SUFFIX. THE CORRECT FORMAT FOR AN NPI IS TEN NUMERIC CHARACTERS. PLEASE VERIFY AND RESUBMIT.
0203 MEMBER I.D. NUMBER IS MISSING-PLEASE PROVIDE AND RESUBMIT.
0204 MEMBER I.D. NUMBER IS NOT A VALID FORMAT-PLEASE CHECK MEMBER'S I.D. CARD AND RESUBMIT.
0205 THE PRESCRIBING PRACTITIONER'S NPI IS MISSING. PLEASE PROVIDE AND RESUBMIT.
0206 PRESCRIBING PRACTITIONER'S NPI IS NOT IN A VALID FORMAT. NPI SHOULD BE TEN DIGIT NUMERIC. PLEASE CONTACT PRACTITIONER TO VERIFY AND RESUBMIT.
0207 INVALID EMERGENCY INDICATOR CODE. IF THIS WAS AN EMERGENCY, IT SHOULD BE Y FOR YES OR N FOR NO. PLEASE VERIFY AND RESUBMIT.
0208 INVALID PREGNANCY INDICATOR CODE. IT SHOULD BE P IF THE PATIENT IS PREGNANT AND IF THE PATIENT IS NOT PREGNANT, THE FIELD SHOULD BE LEFT BLANK. PLEASE VERIFY AND RESUBMIT.
0209 NURSING FACILITY INDICATOR INVALID-IF THE PATIENT IS IN A NURSING FACILITY, IT SHOULD BE Y FOR YES AND IF NOT, IT SHOULD BE N FOR NO. PLEASE VERIFY AND RESUBMIT.
0210 DISPENSED AS WRITTEN CODE INVALID-THE VALID VALUES ARE 0,1,2,3,4,5,8,9. FOR FURTHER INFORMATION, PLEASE SEE THE PHARMACY CHAPTER IN YOUR PROVIDER MANUAL. PLEASE VERIFY AND RESUBMIT.
0211 REFILL INDICATOR IS INVALID. THE VALID VALUES ARE 2 DIGIT NUMBERS FROM 00 TO 99. PLEASE VERIFY AND RESUBMIT.
0212 PRESCRIPTION NUMBER IS MISSING-THE PRESCRIPTION NUMBER CAN BE UP TO TEN ALPHA AND/OR NUMERIC CHARACTERS. PLEASE PROVIDE AND RESUBMIT.
0213 DATE PRESCRIBED IS MISSING. THE PROPER FORMAT IS MMDDYY -EXAMPLE, 011295. PLEASE PROVIDE AND RESUBMIT.
0214 DATE PRESCRIBED IS NOT IN A VALID FORMAT. THE PROPER FORMAT IS MMDDYY-EXAMPLE, 011295. PLEASE VERIFY AND RESUBMIT.
0215 DATE DISPENSED IS MISSING. THE PROPER FORMAT IS MMDDYY-EXAMPLE, 011295. PLEASE PROVIDE AND RESUBMIT.
0216 DATE DISPENSED IS NOT IN A VALID FORMAT. THE PROPER FORMAT IS MMDDYY-EXAMPLE,011295. PLEASE VERIFY AND RESUBMIT.
0217 NDC NUMBER IS MISSING OR NOT ON FILE-AN NDC NUMBER CAN BE UP TO ELEVEN NUMERIC CHARACTERS. FOR FURTHER INFORMATION, SEE THE PHARMACY CHAPTER IN YOUR PROVIDER MANUAL. PLEASE PROVIDE AND RESUBMIT.
0218 NDC NUMBER IS NOT IN A VALID FORMAT-AN NDC NUMBER CAN BE UP TO ELEVEN NUMERIC CHARACTERS. FOR FURTHER INFORMATION, SEE THE PHARMACY CHAPTER IN YOUR PROVIDER MANUAL. PLEASE VERIFY AND RESUBMIT.
0219 THE QUANTITY DISPENSED OR ADMINISTERED INFORMATION IS MISSING. IT SHOULD INDICATE THE QUANTITY OF THE ITEM DISPENSED AS WELL AS THE UNIT OF MEASURE (F2, GR, UN OR ML). PLEASE PROVIDE AND RESUBMIT.
0220 THE QUANTITY DISPENSED INFORMATION IS MISSING/INVALID. IT SHOULD INDICATE THE QUANTITY OF THE ITEM DISPENSED AS WELL AS THE UNIT OF MEASURE (EA, GM, ML). PLEASE VERIFY AND RESUBMIT.
0221 THE ESTIMATED DAYS SUPPLY INFORMATION IS MISSING-IT CAN BE UP TO 999 DAYS. PLEASE PROVIDE AND RESUBMIT.
0222 THE ESTIMATED DAYS SUPPLY IS NOT VALID-IT SHOULD BE A NUMERIC CHARACTER FROM 1 TO 999 DAYS. PLEASE VERIFY AND RESUBMIT.
0223 THE DIAGNOSIS INDICATOR IS MISSING-THE CODES MUST REFERENCE AT LEAST ONE OF THE CORRESPONDING APPLICABLE DIAGNOSIS CODES ENTERED IN FIELD 21. PLEASE PROVIDE AND RESUBMIT.
0224 THE DIAGNOSIS INDICATOR IS NOT IN THE CORRECT FORMAT-THE NUMBER(S) MUST REFERENCE AT LEAST ONE OF THE CORRESPONDING APPLICABLE DIAGNOSIS CODES ENTERED IN FIELD 21. PLEASE VERIFY AND RESUBMIT.
0225 THE ESTIMATED DAYS SUPPLY IS NOT VALID-IT SHOULD BE A NUMBER BETWEEN 0 AND 999. PLEASE VERIFY AND RESUBMIT.
0226 THIS CLAIM REQUIRES A VALID REFERRING PHYSICAN NUMBER. PLEASE CONSULT REFERRING PHYSICIAN AND RESUBMIT.
0227 THE THIRD PARTY PAYMENT AMOUNT IS INVALID-IF A THIRD PARTY INSURANCE CARRIER WAS BILLED THEN THE THIRD PARTY PAYMENT AMOUNT SHOULD BE THE NUMBER 0 OR THE ACTUL AMOUNT PAID. PLEASE VERIFY AND RESUBMIT.
0228 YOUR CLAIM WAS RECEIVED WITHOUT A VALID SIGNATURE AND THERE IS NO RECORD THAT A CERTIFICATION FORM HAS BEEN RECEIVED TO UPDATE YOUR PROVIDER FILE. THIS CLAIM MUST BE SIGNED BEFORE RESUBMITTING FOR PAYMENT. PLEASE COMPLETE THE PROVIDER CERTIFICATION FORM ATTACHED TO BULLETIN BT200103 SO THAT FUTURE STANDARD PAPER CLAIMS WITHOUT A SIGNATURE WILL NOT BE DENIED FOR EDIT 228.
0229 INVALID PREGNANCY INDICATOR CODE-IT SHOULD BE P IS THE PATIENT IS PREGNANT AND IF NOT PREGNANT, THE FIELD SHOULD BE LEFT BLANK. PLEASE VERIFY AND RESUBMIT.
0230 INVALID EMERGENCY INDICATOR CODE-IF IT WAS AN EMERGENCY IT SHOULD BE Y FOR YES AND IF NOT, IT SHOULD BE N FOR NO. PLEASE VERIFY AND RESUBMIT.
0231 RENDERING NPI IS MISSING. PLEASE PROVIDE AND RESUBMIT.
0232 RENDERING PROVIDER NUMBER IS INVALID- THE NPI AND/OR THE NINE DIGIT NUMBER MUST BE USED AND MUST BE IN FIELD 24J. PLEASE VERIFY AND RESUBMIT.
0233 THE UNITS OF SERVICE IS MISSING OR NOT A VALID FORMAT. THE UNITS SHOULD BE A WHOLE NUMBER FROM 1 TO 9999 WITH NO DECIMALS. PLEASE PROVIDE AND RESUBMIT.
0234 THE PROCEDURE CODE FOR THE DETAIL LINE ITEM(S) IS MISSING. PLEASE USE A HCPC OR CPT CODE AND THE APPROPRIATE MODIFIERS WHEN NECESSARY. PLEASE PROVIDE AND REUBMIT.
0235 THE PROCEDURE CODE IS NOT IN A VALID FORMAT. PLEASE USE A CPT OR HCPC CODE AND THE APPROPRIATE MODIFIERS WHEN NECESSARY. PLEASE VERIFY AND RESUBMIT.
0236 THE DETAIL LINE, FROM DATE OF SERVICE IS MISSING. THE CORRECT FORMAT IS MMDDYY. PLEASE PROVIDE AND RESUBMIT.
0237 THE DETAIL LINE, FROM DATE OF SERVICE IS NOT IN THE CORRECT FORMAT. THE CORRECT FORMAT IS MMDDYY. PLEASE VERIFY AND RESUBMIT.
0238 MEMBER'S NAME MISSING-THE MEMBER'S NAME SHOULD REFLECT THE NAME LISTED ON THE MEMBER'S I.D. CARD. PLEASE CHECK MEMBER'S I.D. CARD AND RESUBMIT.
0239 THE DETAIL LINE, TO DATE OF SERVICE IS MISSING. PLEASE PROVIDE AND RESUBMIT.
0240 THE DETAIL LINE, TO DATE OF SERVICE IS NOT IN THE CORRECT FORMAT. THE CORRECT FORMAT IS MMDDYY. PLEASE VERIFY AND RESUBMIT.
0241 ACCIDENT INDICATOR IS INVALID-PLEASE CHECK THE YES OR NO BLOCK AND INDICATE THE TWO DIGIT ALPHA CODE FOR THE STATE IN WHICH THE ACCIDENT OCCURRED. PLEASE VERIFY AND RESUBMIT.
0242 THE SECONDARY DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. IT SHOULD BE THREE TO SEVEN ALPHA NUMERIC DIGITS-PLEASE VERIFY AND RESUBMIT.
0243 CLAIMS WITH `FROM AND THROUGH' DATES SPANNING OVER THE ICD-10 EFFECTIVE DATE OF OCTOBER 1, 2015 CANNOT BE BILLED ON ONE CLAIM. PLEASE SEPARATE THE DATES AND RESUBMIT.
0244 THE THIRD DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT-IT SHOULD BE THREE TO SEVEN ALPHA NUMERIC DIGITS. PLEASE VERIFY AND RESUBMIT.
0245 ICD VERSION INDICATOR ON THE CLAIM DOES NOT MATCH ONE OR MORE OF THE DIAGNOSIS CODES BILLED ON THE CLAIM. PLEASE VERIFY AND RESUBMIT.
0246 THE FOURTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT-IT SHOULD BE THREE TO SEVEN ALPHA NUMERIC DIGITS. PLEASE VERIFY AND RESUBMIT.
0247 RESERVED FOR FUTURE USE
0248 THE PLACE OF SERVICE CODE IS MISSING-THE CORRECT FORMAT SHOULD BE TWO NUMERIC DIGITS BETWEEN 11 AND 99. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0249 THE PLACE OF SERVICE CODE IS INVALID-THE CORRECT FORMAT SHOULD BE TWO DIGITS. PLEASE VERIFY AND RESUBMIT.
0250 YOUR CLAIM WAS SUBMITTED WITHOUT ANY VALID DETAIL LINES-PLEASE VERIFY AND RESUBMIT.
0251 THE FIRST MODIFIER IS NOT VALID-PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0252 THE SECOND MODIFIER IS NOT VALID-PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0253 THE THIRD MODIFIER IS NOT VALID-PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0254 BILLING PROVIDERS LOCATION CODE MISSING-PLEASE PROVIDE AND RESUBMIT.
0255 BILLING PROVIDERS LOCATION CODE IS INVALID-THE LOCATION CODE SHOULD BE AN ALPH A SUFFIX. PLEASE PROVIDE AND RESUBMIT.
0256 THIS SERVICE IS NOT PAYABLE-MEMBER SPENDDOWN LIABILITY NOT MET. PLEASE VERIFY AND RESUBMIT WITH DPW FORM 8A WHEN NECESSARY.
0257 THIS SERVICE IS NOT PAYABLE-MEMBER SPENDDOWN LIABILITY NOT MET. PLEASE VERIFY AND RESUBMIT WITH DPW FORM 8A WHEN NECESSARY.
0258 PRIMARY DIAGNOSIS CODE IS MISSING-PLEASE PROVIDE AND RESUBMIT.
0259 THE FOURTH MODIFIER SUBMITTED IS INVALID. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0260 UNITS OF SERVICE BILLED IS INVALID-PLEASE VERIFY AND RESUBMIT.
0261 THE TOOTH NUMBER OR LETTER IS MISSING-THE TOOTH NUMBER OR LETTER IS REQUIRED FOR EXTRACTION PROCEDURES. PLEASE PROVIDE AND RESUBMIT.
0262 THE TOOTH NUMBER IS INVALID-THE TOOTH NUMBER OR LETTER IS REQUIRED FOR EXTRACTION PROCEDURES. PLEASE VERIFY AND RESUBMIT.
0263 ONE OR MORE OF THE TOOTH SURFACE CODES BILLED IS INVALID. THE MINIMUM NUMBER OF VALID TOOTH SURFACE CODES HAS NOT BEEN MET. VALID TOOTH SURFACE CODES ARE "B, "D", "F", "I", "L", "M", OR "O". PLEASE VERIFY AND RESUBMIT.
0264 THE CONDITION CODE(S) SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0265 THE DATE OF SERVICE IS NOT IN THE CORRECT FORMAT-THE CORRECT FORMAT IS MMDDYY OR DETAIL DOS IS NOT WITHIN THE HEADER DOS. PLEASE VERIFY AND RESUBMIT.
0266 THE NUMBER OF VALID TOOTH SURFACE CODES PRESENT DOES NOT MEET THE MINIMUM NUMBER REQUIRED FOR THE PROCEDURE CODE BILLED.
0267 MULTIPLE TOOTH NUMBERS ARE NOT BILLABLE ON THE SAME DETAIL. PLEASE VERIFY AND RESUBMIT.
0268 THE BILLED AMOUNT IS MISSING-PLEASE PROVIDE AND RESUBMIT.
0269 THE BILLED AMOUNT IS NOT IN A VALID FORMAT PLEASE VERIFY AND RESUBMIT.
0270 THE HEADER BILLED AMOUNT IS MISSING-PLEASE VERIFY AND RESUBMIT.
0271 THE TOTAL AMOUNT IS NOT IN A VALID FORMAT- PLEASE VERIFY AND RESUBMIT.
0272 THE PRIMARY DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT.
0273 THE TYPE OF BILL IS MISSING-PLEASE VERIFY AND RESUBMIT.
0274 THE TYPE OF BILL CODE IS NOT VALID-IT SHOULD BE THREE CHARACTERS. PLEASE VERIFY AND RESUBMIT.
0275 THE ADMIT DATE IS MISSING, PLEASE VERIFY AND RESUBMIT.
0276 ADMIT DATE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0277 THE ADMIT HOUR IS INVALID. PLEASE VERIFY AND RESUBMIT.
0278 THE ADMIT TYPE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0279 THE ADMIT TYPE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0280 THE PATIENT STATUS IS MISSING-PLEASE VERIFY AND RESUBMIT.
0281 PATIENT STATUS IS INVALID. PLEASE VERIFY AND RESUBMIT.
0282 THE NUMBER OF COVERED DAYS IS MISSING FROM YOUR CLAIM-PLEASE PROVIDE AND RESUBMIT.
0283 THE NUMBER OF COVERED DAYS IS NOT IN THE CORRECT FORMAT-IT SHOULD BE THE NUMBER OF DAYS FOR THE STATEMENT COVERS PERIOD. PLEASE VERIFY AND RESUBMIT.
0284 THE PRIMARY CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0285 THE SECOND CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0286 THE THIRD CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0287 THE FOURTH CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0288 THE FIFTH CONDTION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0289 THE SIXTH CONDITION CODE SUBMITTED IS NOT A VALID CODE-PLEASE VERIFY AND RESUBMIT.
0290 THE SEVENTH CONDITION CODE IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0291 THE PRIMARY OCCURRENCE CODE SUBMITTED IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0292 THE SECOND OCCURRENCE CODE SUBMITTED IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0293 THE THIRD OCCURRENCE CODE SUBMITTED IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0294 THE FOURTH OCCURRENCE CODE SUBMITTED IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0295 THE DATE FOR THE PRIMARY OCCURRENCE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0296 THE DATE FOR THE PRIMARY OCCURRENCE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0297 THE DATE FOR THE SECOND OCCURRENCE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0298 THE DATE FOR THE SECOND OCCURRENCE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0299 THE DATE FOR THE THIRD OCCURRENCE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0300 THE DATE FOR THE THIRD OCCURRENCE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT
0301 THE DATE FOR THE FOURTH OCCURRENCE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0302 THE DATE FOR THE FOURTH OCCURRENCE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0303 PRIMARY VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0304 VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0305 THIRD VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0306 FOURTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0307 FIFTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0308 SIXTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0309 SEVENTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0310 THE EIGHTH VALUE CODE IS NOT A VALID CODE. PLEASE VERIFY AND RESUBMIT.
0311 NINTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0312 TENTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0313 ELEVENTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0314 TWELFTH VALUE CODE INVALID. PLEASE VERIFY AND RESUBMIT.
0315 VALUE CODE AMOUNT IS MISSING. PLEASE VERIFY AND RESUBMIT.
0316 VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0317 SECOND VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0318 SECOND VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0319 THIRD VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0320 THIRD VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0321 FOURTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0322 FOURTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0323 FIFTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0324 FIFTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0325 SIXTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0326 SIXTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0327 SEVENTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0328 SEVENTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0329 EIGHTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0330 EIGHTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0331 NINTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0332 NINTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0333 TENTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0334 TENTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0335 ELEVENTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0336 ELEVENTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0337 TWELFTH VALUE CODE AMOUNT MISSING. PLEASE VERIFY AND RESUBMIT.
0338 TWELFTH VALUE CODE AMOUNT INVALID. PLEASE VERIFY AND RESUBMIT.
0339 REVENUE CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0340 REVENUE CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0341 THERE IS NO PRIMARY PAYER ENTERED ON THE CLAIM. PLEASE VERIFY AND RESUBMIT.
0342 THE CERTIFICATION CODE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0343 THE CERTIFICATION CODE IS INVALID. PLEASE VERIFY AND RESUBMIT.
0344 THE THIRD PAYER CODE IS NOT VALID. PLEASE VERIFY AND RESUBMIT.
0345 THE PAYER PROVIDER NUMBER IS MISSING-PLEASE VERIFY AND RESUBMIT.
0346 MEDICARE IS INDICATED AS A PRIOR PAYER, BUT NO PRIOR PAYMENT AMOUNT IS INDICATED. PLEASE VERIFY AND RESUBMIT.
0347 PRIOR PAYMENT AMOUNT IS BLANK OR NON-NUMERIC. PLEASE VERIFY AND RESUBMIT.
0348 OTHER INSURANCE IS INDICATED, BUT THE PRIOR PAYMENT AMOUNT IS MISSING OR INVALID. PLEASE VERIFY AND RESUBMIT.
0349 OTHER INSURANCE IS INDICATED, BUT THE PRIOR PAYMENT AMOUNT IS MISSING OR INVALID. PLEASE VERIFY AND RESUBMIT.
0350 THE NUMBER OF CLAIM DETAILS NOT EQUAL TO THE HEADER AMOUNT.
0351 RESERVED FOR FUTURE USE
0352 THE INDIANA HEALTH COVERAGE PROGRAMS ESTIMATED AMOUNT DUE ON THE FIRST PAYER LINE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0353 THE INDIANA HEALTH COVERAGE PROGRAMS ESTIMATED AMOUNT DUE ON THE FIRST PAYER LINE IS NOT VALID. PLEASE VERIFY AMOUNT AND RESUBMIT WITH THE CORRECTED INFORMATION.
0354 THE AMOUNT DUE FROM PATIENT IS NOT VALID. PLEASE VERIFY AMOUNT AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0355 THE FIFTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0356 THE SIXTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0357 THE SEVENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0358 THE EIGHTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0359 THE NINTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0360 THE ADMITTING DIAGNOSIS CODE IS MISSING. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0361 THE ADMITTING DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECTED INFORMATION.
0362 THE EXTERNAL CAUSE OF INJURY CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0363 THE PRINCIPAL PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0364 THE PRINCIPAL PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0365 THE PRINCIPAL PROCEDURE DATE IS NOT IN THE VALID FORMAT. THE CORRECT FORMAT IS CCYYMMDD. PLEASE VERIFY AND RESUBMIT.
0366 1ST OTHER ICD PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0367 THE FIRST OTHER PROCEDURE CODE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0368 THE FIRST OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. THE CORRECT FORMAT IS CCYYMMDD. PLEASE VERIFY AND RESUBMIT.
0369 THE SECOND OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0370 THE SECOND OTHER PROCEDURE CODE DATE IS MISSING
0371 THE SECOND OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT-PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECT FORMAT OF CCYYMMDD.
0372 THIRD OTHER ICD PROCEDURE CODE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT.
0373 THE THIRD OTHER PROCEDURE DATE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0374 THE THIRD OTHER PROCEDURE DATE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECT FORMAT OF CCYYMMDD.
0375 THE FOURTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT.
0376 THE FOURTH OTHER PROCEDURE DATE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0377 THE FOURTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT-PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECT FORMAT OF CCYYMMDD.
0378 THE FIFTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT-PLEASE VERIFY AND RESUBMIT.
0379 THE FIFTH OTHER PROCEDURE DATE IS MISSING-PLEASE VERIFY AND RESUBMIT.
0380 THE FIFTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT-PLEASE VERIFY AND RESUBMIT THE CLAIM WITH THE CORRECT FORMAT OF CCYYMMDD.
0381 ATTENDING PHYSICIAN LICENSE NUMBER IS MISSING-PLEASE VERIFY AND RESUBMIT.
0382 ATTENDING PHYSICIAN LICENSE NUMBER IS INVALID-PLEASE VERIFY AND RESUBMIT.
0383 FIRST OTHER PHYSICIAN LICENSE NUMBER IS INVALID-PLEASE VERIFY AND RESUBMIT.
0384 SECOND OTHER PHYSICIAN LICENSE NUMBER IS INVALID-PLEASE VERIFY AND RESUBMIT.
0385 Members Waiver Liability is not met for the month.
0386 THE DATE OF SERVICE ON THIS CLAIM MATCHES THE MEMBER'S SPENDDOWN/HCBS WAIVER LIABILITY MET DATE FOR THE MONTH. AN 8A FORM IS REQUIRED. POS PROVIDERS MUST SUBMIT THIS CLAIM ON PAPER OR THROUGH ECS.
0387 THIS SERVICE IS NOT PAYABLE. THE MEMBER HAS NOT SATISFIED SPENDDOWN/HCBS WAIVER LIABILITY FOR THE MONTH.
0388 THIS SERVICE IS NOT PAYABLE. THE MEMBER HAS NOT SATISFIED SPENDDOWN/HCBS WAIVER LIABILITY FOR THE MONTH.
0389 THE REVENUE CODE SUBMITTED REQUIRES A CORRESPONDING HCPCS CODE.
0390 RESERVED FOR FUTURE USE
0391 THIS SERVICE NOT PAYABLE, MEMBER IS QMB ALSO AND SPENDDOWN/HCBS WAIVER LIABILITY HAS NOT BEEN MET. ONLY REIMBURSEMENT FOR MEDICARE COINSURANCE AND DEDUCTIBLE IS AVAILABLE. BILL MEDICARE FIRST.
0392 THIS SERVICE NOT PAYABLE, MEMBER IS QMB ALSO AND SPENDDOWN/HCBS WAIVER LIABILITY HAS NOT BEEN MET. ONLY REIMBURSEMENT FOR MEDICARE COINSURANCE AND DEDUCTIBLE IS AVAILABLE. BILL MEDICARE FIRST.
0393 RESERVED FOR FUTURE USE
0394 RESERVED FOR FUTURE USE
0395 THE FROM SERVICE DATE IS MISSING FROM YOUR CLAIM. PLEASE VERIFY AND RESUBMIT.
0396 THE FROM SERVICE DATE ON YOUR CLAIM IS NOT IN THE CORRECT FORMAT. PLEASE ENTER DATE IN MMDDYY FORMAT AND RESUBMIT.
0397 THE THROUGH SERVICE DATE IS MISSING FROM YOUR CLAIM. PLEASE VERIFY AND RESUBMIT.
0398 THE THROUGH SERVICE DATE ON YOUR CLAIM IS NOT IN THE CORRECT FORMAT. PLEASE ENTER DATE IN MMDDYY FORMAT AND RESUBMIT.
0399 THIS CLAIM CANNOT BE PROCESSED FOR PAYMENT. THE REFERRING PROVIDER NUMBER IS NOT IN THE VALID FORMAT. PLEASE ENTER 9 CHARACTER NUMERIC NUMBER AND RESUBMIT.
0400 UNITS OF SERVICE BLANK OR INVALID-PLEASE RESUBMIT WITH WHOLE UNITS.
0401 NET CHARGE IS MISSING OR IS EQUAL TO ZERO. PLEASE VERIFY AND RESUBMIT
0402 EXPECTED DELIVERY DATE NOT IN VALID FORMAT. PLEASE ENTER DATE IN MMDDYY FORMAT AND RESUBMIT.
0403 THE FROM SERVICE DATE IS NOT IN THE CORRECT FORMAT. PLEASE ENTER IN MMDDYY FORMAT AND RESUBMIT.
0404 THE THROUGH SERVICE DATE IS NOT IN THE CORRECT FORMAT. PLEASE ENTER IN MMDDYY FORMAT AND RESUBMIT.
0405 THE FIFTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESUMIT.
0406 THE SIXTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESBMIT.
0407 THE SEVENTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURANCE CODES AND REUBMIT.
0408 THE EIGHTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESBMIT.
0409 OCCURRENCE CODE 9-24 IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESUBMIT.
0410 THE TENTH OCCURRENCE CODE IS NOT A VALID CODE ON THE OCCURRENCE CODE LIST. PLEASE REFERENCE THE PROVIDER MANUAL FOR A VALID LIST OF OCCURRENCE CODES AND RESUBMIT.
0411 THE DATE FOR THE FIFTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH PROPER DATE IN FORM OF MMDDYY.
0412 THE DATE FOR THE FIFTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH THE PROPER DATE IN FORM OF MMDDYY
0413 THE DATE FOR THE SIXTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH THE PROPER DATE IN FORM OF MMDDYY.
0414 THE DATE FOR THE SIXTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH PROPER DATE IN THE FORM OF MMDDYY.
0415 THE DATE FOR THE SEVENTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH THE PROPER DATE IN FORM OF MMDDYY.
0416 THE DATE FOR THE SEVENTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH THE PROPER DATE IN THE FORM OF MMDDYY.
0417 THE DATE FOR THE EIGHTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH THE PROPER DATE IN FORM OF MMDDYY.
0418 THE DATE FOR THE EIGHTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH THE PROPER DATE IN THE FORM OF MMDDYY.
0419 THE DATE OF SERVICE FOR OCCURRENCE CODE 9-24 IS MISSING. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0420 THE DATE OF SERVICE FOR OCCURRENCE CODE 9-24 IS NOT A VALID DATE. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0421 THE TO DATE OF SERVICE FOR THE NINTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0422 THE TO DATE OF SERVICE FOR THE NINTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0423 THE FROM DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0424 THE FROM DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH DATE IN THE FORM OF MMDDYY.
0425 THE TO DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE IS MISSING. PLEASE RESUBMIT WITH THE DATE IN THE FORM OF MMDDYY.
0426 THE TO DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE IS NOT A VALID DATE. PLEASE RESUBMIT WITH THE DATE IN THE FORM OF MMDDYY.
0427 THE QUANTITY DISPENSED INFORMATION IS MISSING. PLEASE VERIFY INFORMATION AND RESUBMIT.
0428 THE QUANTITY DISPENSED INFORMATION IS NOT VALID. PLEASE ENTER 5 DIGIT NUMERIC VALUE AND RESUBMIT.
0429 THE TOTAL CHARGES SUBMITTED ARE LESS THAN THE $150.00 MINIMUM FOR THE 590 PROGRAM. CLAIMS LESS THAN $150.00 MUST BE SUBMITTED TO THE FACILITY.
0430 PARTIAL UNITS MAY NOT BE BILLED. PLEASE RESUBMIT IN WHOLE NUMBERS.
0431 PAYMENT HAS BEEN CUTBACK BY THE PATIENT LIABILITY DEVIATION NOTED ON THE CLAIM AND/OR FILE.
0432 INVALID MCO IDENTIFICATION NUMBER-PLEASE VERIFY AND RESUBMIT.
0433 THE DEDUCTIBLE AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES.
0434 THE COINSURANCE AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES.
0435 THE BLOOD DEDUCTIBLE AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES.
0436 THE TOTAL MEDICARE ALLOWED AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES, EXCLUDING ZEROES.
0437 THE PSYCH ADJUSTMENT AMOUNT IS NOT IN THE VALID FORMAT. PLEASE RESUBMIT IN ALL NUMERIC VALUES.
0438 THE PATIENT SPENDDOWN AMOUNT IS NOT IN THE VALID FORMAT-PLEASE VERIFY AND RESUBMIT.
0439 HOSPICE SERVICES BEING BILLED. (MANUAL PAYOUT)
0440 THE MAXIMUM NUMBER OF CLAIM DETAILS HAS BEEN EXCEEDED
0441 THE OCCURANCE SPAN CODE IS MISSING OR INVALID
0442 THE DATE OF SERVICE ON THIS CLAIM MATCHES THE MEMBER'S SPENDDOWN/HCBS WAIVER LIABILITY MET DATE. PLEASE OBTAIN AN 8A FORM FROM THE COUNTY OFFICE.
0443 THE DATE OF SERVICE ON THIS CLAIM MATCHES THE MEMBER'S SPENDDOWN/HCBS WAIVER LIABILITY MET DATE. PLEASE OBTAIN AN 8A FORM FROM THE COUNTY OFFICE.
0444 THE CERTIFICATION CODE IS MISSING. PLEASE SUBMIT ON THE CLAIM CORRECTION FORM. THIS SHOULD BE A TW0-DIGIT CODE.
0445 DIAGNOSIS CODE 10-25 IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0446 THE ELEVENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0447 THE TWELFTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0448 THE THIRTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0449 THE FOURTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0450 THE TOTAL PAID AMOUNT IS LESS THAN THE $150.00 MINIMUM FOR THE 590 PROGRAM. CLAIMS LESS THAN $150.00 MUST BE SUBMITTED TO THE FACILITY.
0451 THE CURRENT DETAIL HAS BEEN DENIED BY THE MCO. DETAIL WILL BE IN FULL FAILURE.
0452 SUBMITTED CHARGE EXCEEDS ALLOWED AMOUNT.
0453 THE SEVENTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0454 THE EIGHTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0455 THE NINETEENTH DIAGNOSIS CODES IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0456 THE TWENTIETH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0457 THE TWENTY-FIRST DIAGNOSIS CODES IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0458 THE TWENTY-SECOND DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0459 THE TWENTY-THIRD DIAGNOSIS CODES IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0460 THE TWENTY-FOURTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0461 THE TWENTY-FIFTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED IFORMATION.
0462 THE SIXTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMI.
0463 THE ICD PROCEDURE DATE 6-24 IS MISSING. PLEASE VERIFY AND RESUBMIT.
0464 ICD PROCEDURE 6-24 DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0465 THE SEVENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0466 THE SEVENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0467 SEVENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0468 ICD PROCEDURE CODE 6-24 IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0469 THE EIGHTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0470 EIGHTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0471 THE NINTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0472 THE NINTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0473 NINTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0474 THE TENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0475 THE TENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0476 TENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0477 THE ELEVENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0478 THE ELEVENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0479 ELEVENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0480 THE TWELFTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0481 THE TWELFTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0482 TWELFTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0483 THE THIRTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0484 THE THIRTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0485 THIRTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0486 THE FOURTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0487 THE FOURTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0488 FOURTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0489 THE FIFTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0490 THE FIFTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0491 FIFTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0492 THE SIXTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0493 THE SIXTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0494 SIXTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0495 THE SEVENTEETH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0496 SEVENTEENTH OTHER PROCEDURE DATE IS MISSING. PLEASE VERIFY AND RESUBMIT.
0497 SEVENTEENTH OTHER PROCEDURE DATE IS NOT IN THE VALID FORMAT. PLEASE VERIFY AND RESUBMIT THE CLAIM IN THE CORRECT FORMAT.
0498 THE EIGHTEENTH OTHER PROCEDURE CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT.
0499 CLAIM DENIED. REQUIRED INFORMATION WAS NOT RETURENED OR RECEIVED WITHIN 45 DAYS.
0500 DATE PRESCRIBED IS AFTER THE BILLING DATE. PLEASE VERIFY PRESCRIBED DATE AND RESUBMIT.
0501 THE DISCHARGE DATE/TIME IS WITHIN 24 HOURS OF THE ADMIT DATE/TIME. PLEASE VERIFY AND RESUBMIT. IF CORRECT, PLEASE REBILL AS AN OUTPATIENT CLAIM.
0502 DISPENSED DATE IS EARLIER THAN PRESCRIBED DATE. PLEASE VERIFY AND RESUBMIT.
0503 CLAIM CANNOT BE BILLED BEFORE THE PRESCRIPTION IS DISPENSED. PLEASE VERIFY DISPENSED DATE AND RESUBMIT.
0504 THE EXPECTED DATE OF DELIVERY IS MISSING-PLEASE SUBMIT WITH PROPER DATE IN FORM OF MMDDYY.
0505 THE THIRD PARTY AMOUNT IS MORE THAN THE TOTAL CLAIM CHARGE; THEREFORE, NO MEDICAID AMOUNT IS PAYABLE.
0506 BILLED DATE ENTERED IS AFTER HP RECEIVED THE CLAIM-PLEASE VERIFY AND RESUBMIT.
0507 THE FROM DATE IS AFTER THE TO DATE OF SERVICE. PLEASE VERIFY AND RESUBMIT.
0508 THE SUM OF THE INDIVIDUAL LINE CHARGES SUBMITTED ON THIS CLAIM DOES NOT EQUAL THE TOTAL CHARGE. PLEASE VERIFY AND RESUBMIT.
0509 THIS CLAIM WAS SUBMITTED WITH AN INCOMPLETE OR INVALID NET CHARGE. THE ESTIMATED AMOUNT DUE MUST EQUAL THE TOTAL OF ALL LINE ITEM CHARGES, LESS ANY TPL AMOUNT, PATIENT PAID (NON-COVERED) CHARGES, AND/OR ANY PATIENT LIABILITY AMOUNT. PLEASE VERIFY AND RESUBMIT.
0510 THE FROM DATE IS AFTER THE TO DATE OF SERVICE FOR THE OCCURRENCE CODE. PLEASE VERIFY AND RESUBMIT.
0511 THE FROM DATE IS AFTER THE TO DATE OF SERVICE FOR THE TENTH OCCURRENCE CODE. PLEASE VERIFY AND RESUBMIT.
0512 YOUR CLAIM WAS FILED PAST THE FILING TIME LIMIT WITHOUT ACCEPTABLE DOCUMENTATION.
0513 MEMBERS NUMBER DOES NOT MATCH THE MEMBERS NAME. PLEASE VERIFY AND RESUBMIT
0514 CLAIM CANNOT BE BILLED BEFORE THE SERVICE IS RENDERED.
0515 THE OVERHEAD FEE IS NOT ON FILE FOR THE DATES OF SERVICE INDICATED. PLEASE VERIFY AND RESUBMIT.
0516 THE OCCURRENCE CODE DATES DO NOT MATCH THE CLAIM DETAIL DATES. PLEASE VERIFY AND RESUBMIT.
0517 THE OCCURRENCE CODE DATES DO NOT MATCH ANY OF THE SERVICE DATES BILLED ON THE DETAIL LINES OF THE CLAIM. PLEASE VERIFY AND RESUBMIT.
0518 THE COVERED DAYS ENTERED DO NOT MATCH THE STATEMENT PERIOD DATES. PLEASE VERIFY AND RESUBMIT.
0519 THE ADMIT DATE MUST BE EQUAL TO OR BEFORE THE STATEMENT PERIOD FROM OR TO DATE. PLEASE VERIFY AND RESUBMIT.
0520 INVALID REVENUE CODE AND PROCEDURE CODE COMBINATION - PLEASE VERIFY AND RESUBMIT.
0521 THE THRU DATE OF SERVICE IS AFTER THE DISCHARGE DATE. PLEASE VERIFY AND RESUBMIT.
0522 THE CLAIM CONTAINS CONFLICTING DISCHARGE INFORMATION, VERIFY PATIENT STATUS CODE AND/OR OCCURRENCE CODE AND RESUBMIT.
0523 THIS CLAIM CANNOT BE SUBMITTED UNTIL AFTER THE SERVICES HAVE BEEN RENDERED.
0524 OCCURRENCE CODE DATE CANNOT BE WITHIN THE OCCURRENCE SPAN DATE-PLEASE VERIFY AND RESUBMIT.
0525 DUPLICATE OCCURRENCE DATES BILLED-ONLY ONE OCCURRENCE CODE MAY BE BILLED PER DATE OF SERVICE. PLEASE VERIFY AND RESUBMIT.
0526 THE STATEMENT COVERS PERIOD FROM DATE IS OUT OF SEQUENCE WITH THE THROUGH DATE. PLEASE VERIFY AND RESUBMIT.
0527 CLAIM CANNOT BE BILLED BEFORE THE SERVICE IS RENDERED
0528 INVALID DISCHARGE STATUS-PLEASE VERIFY AND RESUBMIT.
0529 THE SURGERY DATE IS BEFORE THE ADMISSION DATE-PLEASE VERIFY AND RESUBMIT.
0530 THE SURGERY DATE IS AFTER THE DISCHARGE DATE-PLEASE VERIFY AND RESUBMIT.
0531 THE MODIFIER IDENTIFIES THE TRIMESTER BEING BILLED AND IF A DELIVERY CODE MODIFIER IS MISSING-PLEASE VERIFY AND RESUBMIT.
0532 BILLING PROVIDER'S SPECIALTY IS NOT APPROVED TO BILL THIS REVENUE CODE. PLEASE VERIFY AND RESUBMIT.
0533 PAID AS BILLED.
0534 PROCEDURE CODE NOT CONSISTENT WITH TYPE OF BILL-PLEASE VERIFY AND RESUBMIT.
0535 THE TRIMESTER BILLED DOES NOT CORRESPOND TO THE EXPECTED DELIVERY DATE-PLEASE VERIFY AND RESUBMIT.
0536 MULTIPLE TRIMESTERS ARE BILLED ON THE CLAIM
0537 REFUND AMOUNT IS GREATER THAN THE ADJUSTED AMOUNT.
0538 REFUND AMOUNT IS LESS THAN THE ADJUSTED AMOUNT.
0539 KEYED BUT NOT ACTIVATED
0540 CLAIM KEYED BUT NOT ACTIVATED.
0541 CLAIM ACTIVATED BUT NOT KEYED.
0542 Manager Review of Paid Amount
0543 ADJUSTMENT DENIED BECAUSE OF A FULL REFUND, FULL RECOUPMENT, OR VOIDED CHECK RELATED.
0544 CLAIM IN REVIEW STATUS.
0545 YOUR CLAIM WAS FILED PAST THE FILING TIME LIMIT WITHOUT ACCEPTABLE DOCUMENTATION.
0546 TYPE OF BILL INCOMPATIBLE FOR SERVICE BILLED
0547 HOSPITAL LEAVE DAYS MUST BE BILLED ON THE SAME CLAIM AS THE ACCOMMODATION DAYS-PLEASE VERIFY AND RESUBMIT.
0548 THERAPEUTIC LEAVE DAYS MUST BE BILLED ON THE SAME CLAIM AS THE ACCOMMODATION DAYS-PLEASE VERIFY AND RESUBMIT.
0549 INVALID TYPE OF BILL FOR ANCILLARY SERVICE.
0550 THIS PROCEDURE HAS BEEN REPLACED OR DELETED TO REFLECT APPROPRIATE SERVICES RENDERED.
0551 AN OVERHEAD FEE DID NOT APPEAR ON THE CLAIM FOR DATES OF SERVICE BILLED.
0552 THE DATES BILLED SPAN. IN ORDER TO PROCESS YOUR CLAIM, YOU MUST SPLIT BILL FOR DATES LESS THAN 06/30/95 AND GREATER THAN OR EQUAL TO 07/01/95.
0553 THIRD PARTY PAYMENT/MEDICARE PAYMENT IS MORE THAN THE TOTAL CLAIM PAYMENT. NO INDIANA HEALTH COVERAGE PROGRAM AMOUNT PAYABLE.
0554 DATE BILLED IS PRIOR TO THE DATES OF SERVICE ON THE CLAIM
0555 THE UNITS BILLED MUST EQUAL THE NUMBER OF DAYS INDICATED BY THE DATES OF SERVICE BILLED.
0556 THE DATES OF SERVICE BILLED CANNOT SPAN 180 DAYS FOR THE PROCEDURES BILLED. PLEASE BREAK DOWN THE SERVICES TO A SMALLER PERIOD OF TIME.
0557 SERVICE NOT COVERED BY CAPITATION RATE
0558 COINSURANCE AND DEDUCTIBLE AMOUNT IS MISSING INDICATING THAT THIS IS NOT A CROSSOVER CLAIM.
0559 THE COINSURANCE AMOUNT IS NOT THE CORRECT PERCENTAGE OF THE TOTAL MEDICARE ALLOWED AMOUNT. PLEASE CONTACT YOUR MEDICARE CARRIER FOR AN ADJUSTMENT.
0560 THIS IS NOT A CROSSOVER CLAIM, SINCE MEDICARE HAS NOT MADE A PAYMENT TOWARDS THIS SERVICE. PLEASE FILE ON THE CORRECT CLAIM FORM AND RESUBMIT FOR PROCESSING.
0561 A QUALIFIED MEDICARE BENEFICIARY MEMBER HAS BEEN ENROLLED IN MULTIPLE AID CATEGORIES. PAYMENT IS REFLECTED ACCORDINGLY.
0562 HOSPICE SERVICES HAVE INCOMPATIBLE TYPE OF BILL AND REVENUE CODES BEING BILLED.
0563 HOSPICE UNITS BILLED INCOMPATIBLE WITH ALLOWED UNITS FOR THE HOSPICE REVENUE CODE.
0564 THIS REVENUE CODE IS NOT ALLOWED FOR THIS MEMBER'S ELIGIBILITY.
0565 PAID AMOUNT IS GREATER THAN BILLED AMOUNT.
0566 YOUR CROSSOVER CLAIM HAS NOT BEEN SUBMITTED ON THE CORRECT FORM, VERIFY AND RESUBMIT.
0567 YOUR CLAIM WAS FILED PAST THE FILING TIME WITHOUT ACCEPTABLE DOCUMENTATION. PLEASE RESUBMIT CLAIM WITH PROPER ATTACHMENTS.
0568 YOUR CLAIM WAS FILED PAST THE FILING TIME WITHOUT ACCEPTABLE DOCUMENTATION. PLEASE RESUBMIT YOUR CLAIM WITH PROPER ATTACHMENTS.
0569 RESERVED FOR XOVER TEAM.
0570 EARLY REFILL PRODUR ALERT
0571 HIGH DOSE PRODUR ALERT
0572 THERAPEUTIC DUPE PRODUR ALERT
0573 DRUG/DRUG PRODUR ALERT
0574 CLAIM FILED PAST THE 90 DAY FILING LIMIT
0575 THE FIFTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0576 THE SIXTEENTH DIAGNOSIS CODE IS NOT IN THE CORRECT FORMAT. PLEASE VERIFY AND RESUBMIT WITH THE CORRECTED INFORMATION.
0577 PHAMACIST CAN OVERRIDE BY USING NCPDP DUR CODES
0578 LATE REFILL PRO DUR
0579 DRUG/DISEASE PRODUR ALERT
0580 INPATIENT CROSSOVER CLAIMS MUST BE BILLED ON THE UB-92 FORM OR SENT DIRECTLY FROM MEDICARE.
0581 NDC CODES ARE NOT BILLABLE ON HOME HEALTH OR LONG TERM CARE CLAIMS.
0582 THE HEADER PLACE OF SERVICE CODE IS MISSING - THE CORRECT FORMAT SHOULD BE TWO NUMERIC DIGITS BETWEEN 11 AND 99. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0583 THE HEADER PLACE OF SERVICE CODE IS INVALID - THE CORRECT FORMAT SHOULD BE TWO NUMERIC DIGITS BETWEEN 11 AND 99. PLEASE REFER TO YOUR PROVIDER MANUAL TO VERIFY AND RESUBMIT.
0584 DRUG/AGE PRODUR ALERT
0585 DRUG/PREGNANCY PRODUR ALERT
0586 THIS DRUG REQUIRES PRIOR AUTHORIZATION DUE TO PRODUR EDITS
0587 LOW DOSE PRODUR ALERT
0588 THE CLAIM TYPE SELECTED FOR THE ADJUSTMENT DOES NOT MATCH THE CLAIM TYPE OF THE ORIGINAL PAID CLAIM, THEREFORE YOUR CLAIM HAS BEEN DENIED. PLEASE SUBMIT A NEW CLAIM FOR ADJUDICATION.
0589 THE MEMBER ID SUBMITTED FOR THIS ADJUSTMENT DOES NOT MATCH THE MEMBER ID OF THE ORIGINAL PAID CLAIM, THEREFORE YOUR CLAIM HAS BEEN DENIED. PLEASE SUBMIT A NEW CLAIM FOR ADJUDICATION.
0590 PROCEDURE QUALIFIER SUBMITTED IS NOT VALID. PLEASE VERIFY AND RESUBMIT.
0591 THE CURRENT DETAIL HAS BEEN DENIED BY THE MCO. DETAIL WILL BE IN FULL FAILURE.
0592 THE PROVIDER ID SUBMITTED FOR THIS ADJUSTMENT DOES NOT MATCH THE PROVIDER ID OF THE ORIGINAL PAID CLAIM, THEREFORE, YOUR CLAIM HAS BEEN DENIED. PLEASE SUBMIT A NEW CLAIM FOR ADJUDICATION.
0593 AT LEAST ONE DETAIL SUBMITTED CONTAINS MEDICARE COB DATA RESULTING IN A REVIEW OF ALL DETAIL COB DATA. PLEASE REVIEW TO ENSURE COB DATA FOR DETAIL IN QUESTION DOES NOT CONTAIN ALL ZEROS OR IS MISSING
0594 TYPE OF BILL IS NOT VALID FOR THE CLAIM TYPE SUBMITTED.
0595 THE FROM DATE OR TO DATE OF SERVICE FOR THE OCCURANCE SPAN CODE IS MISSING OR INVALID.
0597 FULL RECOUPMENT DUE TO MEMBER BEING INCARCERATED AND ONLY INPATIENT HOSPITAL SERVICES CAN BE REIMBURSED
0600 MISSING OR INVALID GROUP NUMBER
0601 MISSING OR INVALID COMPOUND CODE
0602 NON MATCHED GROUP NUMBER
0603 NON MATCHED PA/MC NUMBER
0604 CLAIM IN NOT PROCESSED
0605 MISSING OR INVALID PATIENT FIRST NAME
0606 MISSING OR INVALID PAYER DATE
0607 MISSING OR INVALID INGREDIENT COST
0608 NON MATCHED PERSON CODE
0609 NON MATCHED NDC PACKAGE SIZE
0610 NON MATCHED PRIMARY PRESCRIBER
0611 NON MATCHED CLINIC ID
0612 INSTITUTIONALIZED PATIENT NDC NOT COVERED
0613 FILLED BEFORE COVERAGE EFFECTIVE
0614 FILLED AFTER COVERAGE EXPIRED
0615 FILLED AFTER COVERAGE TERMINATED
0616 PRIMARY PRESCRIBER NOT COVERED
0617 REFILLS NOT COVERED
0618 COST EXCEEDS MAXIMUM
0619 REFILL TOO SOON
0620 DRUG DIAGNOSIS MISMATCH
0621 SUBMIT MANUAL REVERSAL
0622 REJECTED CLAIM FEES PAID
0623 MISSING OR INVALID PATIENT PAID AMOUNT
0624 MISSING OR INVALID DUR INTERVENTION CODE
0625 MISSING OR INVALID DUR OUTCOME CODE
0626 PATIENT NOT COVERED IN AID CATEGORY
0627 INVALID LEVEL OF SERVICE IND
0628 FIRST DOS NOT IN RANGE ON PLAN/GROUP
0629 MAIL ORDER PRICES NOT IN GROUP
0630 M/I PRIMARY CARE PROVIDER ID QUALIFIER
0631 CLAIMS EXCEEDING $500 FOR MEMBERS IN 590 PROG REQ PA
0632 TPL DENIAL DATE IS INVALID OR MISSING
0633 DOS ON THE CLAIM MATCHES MEMBER SPENDDOWN/HCBS WAIVER LIABILITY MET DATE FOR THE MONTH. PLEASE OBTAIN AN 8A FORM FROM THE COUNTY OFFICE.
0634 MEMBER ELIGIBLE FOR EMERGENCY SERVICES ONLY
0635 U & C >500%<20%
0636 THE MEMBER IS ENROLLED IN THE RBMC PORTION OF THE HOOSIER HEALTHWISE PROG
0637 CLAIM IS POST DATED.
0638 NDC NOT ON PREFERRED DRUG LIST. PA IS REQUIRED. CALL ACS FOR PA.
0639 NDC VERSUS AGE RESTRICTION. PLEASE VERIFY AND RESUBMIT.
0640 THE REASON FOR SERVICE CODE IS MISSING AND THE DUR INTERVENTION AND/OR OUTCOME CODES ARE PRESENT. REMOVE CODES AND RESUBMIT.
0641 PATIENT REPORTED AS DECEASED
0642 DRUG NOT COVERED DUE TO NO SIGNED REBATE
0643 OTHER COVERAGE CODE IS MISSING OR INVALID
0644 MEMBER COVERED BY PRIVATE INS. BILL PRIOR TO MEDICAID
0645 MEMBER COVERED BY PRIVATE INS. BILL PRIOR TO MEDICAID
0646 PLEASE COORD W/HOSPICE PROV TO DETERMINE IF DRUG IS
0647 PRIOR AUTHORIZATION IN PROGRESS
0648 VALID DEA# REQUIRED SCHED II DRUGS
0649 COMPOUND DRUG CLAIM MUST BE BILLED ON PAPER VIA CMPD DRUG
0650 DOS BEFORE SPENDDOWN DATE
0651 MISSING OR INVALID PRIMARY CARE PROVIDER LAST NAME
0652 MISSING OR INVALID OTHER PAYER COVERAGE TYPE
0653 MISSING OR INVALID OTHER PAYER REJECT COUNT
0654 MISSING OR INVALID OTHER PAYER ID QUALIFIER
0655 MISSING/INVALID OTHER PAYER REJECT CODE
0656 MISSING/INVALID OTHER PAYER ID
0657 MISSING/INVALID DUR/PPS CODE COUNTER
0658 MISSING/INVALID FACILITY ID
0659 MISSING/INVALID DUR/PPS LEVEL OF EFFORT
0660 THIS SERVICE IS NOT PAYABLE. THE MEMBER HAS NOT SATISFIED SPENDDOWN/HCBS WAIVER LIABILITY FOR THE MONTH.
0661 DISPENSED DATE IS EARLIER THAN PRESCRIBED DATE. PLEASE VERIFY AND RESUBMIT.
0662 DRUG NOT COVERED DUE TO NO SIGNED REBATE AGREEMENT.
0663 BILLING PROVIDER NOT ELIGIBLE TO BILL THIS CLAIM TYPE
0664 QUALIFIED MEDICARE BENEFICIARY (QMB) BILL MEDICARE FIRST
0665 THE MEMBER IS ENROLLED IN RISK BASED MANAGED CARE. PLEASE SUBMIT TO APPROPRIATE RISK BASED MANAGED CARE PROCESSOR.
0666 DAY SUPPLY LIMIT FOR PRODUCT OR SERVICE. DAY SUPPLY SUBMITTED IS GREATER THAN DAY SUPPLY ALLOWED.
0667 UNIT DOSE PACKAGING ONLY PAYABLE FOR NURSING HOME MEMBERS
0668 GENERIC DRUG REQUIRED
0669 THE SEGMENT IS A MANDATORY SEGMENT AND THE SEGMENT IDENTIFIER IS MISSING (SPACES) OR IT DOES NOT MATCH ONE OF THE VALID VALUES SPECIFIED FOR THE FIELD.
0670 MISSING/INVALID TRANSACTION COUNT
0671 M/I PROFESSIONAL SERVICE FEE SUBMITTED
0672 THE SERVICE PROVIDER ID QUALIFIER IS MISSING OR DOES NOT MATCH ONE OF THE VALID VALUES SPECIFIED FOR THE FIELD. PLEASE ENSURE THAT '05' IS PRESENT FOR THE SERVICE PROVIDER ID QUALIFIER.
0673 M/I ALTERNATE ID
0674 M/I PATIENT ID QUALIFIER
0675 M/I PATIENT ID
0676 M/I EMPLOYER ID
0677 DISPENSING FEE SUBMITTED
0678 M/I BASIS OF COST DETERMINATION
0679 M/I ORIGINALLY PRESCRIBED PRODUCT/SERVICE CODE
0680 M/I ORIGINALLY PRESCRIBED QUANTITY
0681 A COMPOUND SEGMENT IS PRESENT AND THE COMPOUND INGREDIENT COMPONENT COUNT IS ZEROS. PLEASE VERIFY AND RESUBMIT.
0682 THE COMPOUND INGREDIENT QUANTITY IS MISSING OR ZEROS. PLEASE VERIFY AND RESUBMIT.
0683 M/I COMPOUND INGREDIENT DRUG COST
0684 THE COMPOUND DOSAGE FROM DESCRIPTION CODE IS MISSING OR INVALID. VERIFY AND RESUBMIT.
0685 THE COMPOUND DISPENSING UNIT FORM DOES NOT MATCH ONE OF THE VALID NCPDP VALUES.
0686 THE COMPOUND ROUTE OF ADMINISTRATION DOES NOT MATCH ONE OF THE VALID NCPDP VALUES.
0687 M/I ORIGINALLY PRESCRIBED PRODUCT/SERVICE ID QUALIFIER
0688 SCHEDULED PRESCRIPTION ID NUMBER
0689 THE PRESCRIPTION/SERVICE REFERENCE NUMBER QUALIFIER SHOULD BE '03' TO INDICATE NDC NUMBER.
0690 M/I ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER
0691 M/I ASSOCIATED PRESCRIPTION/SERVICE DATE
0692 M/I PROCEDURE MODIFIER CODE
0693 M/I QUANTITY PRESCRIBED
0694 MISSING OR INVALID FAMILY PLANNING INDICATOR. IF PRODUCT/SERVICE IS USED FOR FAMILY PLANNING, USE A VALUE OF 6, OTHERWISE, USE ZERO OR LEAVE BLANK.
0695 M/I PRIOR AUTHORIZATION NUMBER SUBMITTED
0696 M/I INTERMEDIARY AUTHORIZATION TYPE ID
0697 M/I INTERMEDIARY AUTHORIZATION ID
0698 M/I PROVIDER ID QUALIFIER
0699 THE PRESCRIBER ID QUALIFIER IS INVALID. PLEASE VERIFY THAT IT IS '08' FOR STATE LICENSE NUMBER AND RESUBMIT.
0700 THE PHARMACY PROVIDER ID IS MISSING AND THE PHARMACY PROVIDER ID QUALIFIER IS PRESENT. PLEASE VERIFY AND RESUBMIT WITH THE PHARMACY PROVIDER'S 9-DIGIT PROVIDER NUMBER FOLLOWED BY ONE ALPHA CHARACTER.
0701 M/ PLAN ID
0702 MISSING OR INVALID OTHER PAYER AMOUNT PAID COUNT
0703 MISSING OR INVALID OTHER PAYER AMOUNT PAID QUALIFIER
0704 M/I DISPENSING STATUS
0705 M/I QUANTITY INTENDED TO BE DISPENSED
0706 M/I DAYS SUPPLY INTENDED TO BE DISPENSED
0707 M/I MEASUREMENT TIME
0708 M/I MEASUREMENT DIMENSION
0709 M/I MEASUREMENT UNIT
0710 M/I MEASUREMENT VALUE
0711 M/I PRIMARY CARE PROVIDER LOCATION CODE
0712 M/I DUR CO-AGENT ID
0713 M/I OTHER AMOUNT CLAIMED SUBMITTED COUNT
0714 M/I OTHER AMOOUNT CLAIMED SUBMITTED QUALIFIER
0715 M/I OTHER AMOUNT CLAIM SUBMITTED
0716 M/I DUR CO-AGENT ID QUALIFIER
0717 M/I COUPON TYPE
0718 M/I COUPON NUMBER
0719 M/I COUPON VALUE AMOUNT
0720 PA EXHAUSTED/NOT RENEWABLE
0721 THE TRANSACTION COUNT IS GREATER THAN '4' FOR A BILLING, REVERSAL OR REBILL REQUEST. NO MORE THAN 4 TRANSACTIONS CAN BE SENT PER TRANSMISSION.
0722 MISSING OR INVALID CLAIM SEGMENT.
0723 M/I CLINICAL SEGMENT
0724 MISSING OR INVALID COB SEGMENT. A COB SEGMENT WAS RECEIVED WITH A REVERSAL REQUEST. PLEASE REMOVE THE COB SEGMENT AND RESUBMIT.
0725 MISSING OR INVALID COMPOUND SEGMENT
0726 M/I COUPON SEGMENT
0727 DUR SEGMENT IS MALFORMED OR NOT SENT CORRECTLY. PLEASE VERIFY AND RESUBMIT.
0728 MISSING OR INVALID INSURANCE SEGMENT
0729 MISSING OR INVALID PATIENT SEGMENT
0730 M/I PHARMACY PROVIDER SEGMENT
0731 MISSING OR INVALID PRESCRIBER SEGMENT
0732 MISSING OR INVALID PRICING SEGMENT
0733 M/I PRIOR AUTHORIZATION SEGMENT
0734 MISSING OR INVALID TRANSACTION HEADER SEGMENT. PLEASE VERIFY AND RESUBMIT.
0735 M/I WORKERS COMPENSATION SEGMENT
0736 NON-MATCHED ASSOCIATED PRESCRIPTION/SERVICE DATE
0737 NON-MATCHED EMPLOYER ID
0738 NON-MATCHED OTHER PAYER ID
0739 NON-MATCHED UNIT FORM/ROUTE OF ADMINISTRATION
0740 NON-MATCHED UNIT OF MEASURE TO PRODUCT/SERVICE ID
0741 ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER NOT FOUND
0742 CLINICAL INFORMATION COUNTER OUT OF SEQUENCE
0743 THE COMPOUND INGREDIENT COMPONENT COUNT DOES NOT MATCH THE NUMBER OF COMPOUND PRODUCT ID'S RECEIVED ON A COMPOUND SEGMENT. PLEASE VERIFY THAT THE NUMBER OF INGREDIENTS EQUALS THE NUMBER OF NDCS BILLED IN THE COMPOUND.
0744 THE COORDINATION OF BENEFITS/OTHER PAYMENTS COUNT DOES NOT MATCH THE NUMBER OF COB/OTHER PAYMENT SEGMENTS RECEIVED. PLEASE VERIFY THAT THESE NUMBERS ARE THE SAME AND RESUBMIT.
0745 COUPON EXPIRED
0746 THE DATE OF SERVICE ON THE CLAIM IS BEFORE THE PATIENTS DATE OF BIRTH. PLEASE VERIFY DATES AND RESUBMIT.
0747 DIAGNOSIS CODE COUNT DOES NOT MATCH NUMBER OF REPETITIONS
0748 THE SETS OF DUR/PPS INFORMATION WERE RECEIVED OUT OF NUMERICAL SEQUENCE.
0749 THE CLAIM HAS REPEATING NUMBERS IN A NON-REPEATING FIELD. PLEASE REMOVE NUMBERS AND RESUBMIT.
0750 PREPAYMENT REVIEW DETERMINATION. DOCUMENTATION, AS REQUIRED BY YOUR PREPAYMENT GUIDELINES CRITERIA, DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED.
0751 PREPAYMENT REVIEW DETERMINATION. DOCUMENTATION SUBMITTED DOES NOT CONTAIN CLINICAL SIGNS/SYMPTOMS TO JUSTIFY MEDICAL NECESSITY OF THIS SERVICE.
0752 PREPAYMENT REVIEW DETERMINATION. ROUTINE SCREENING TESTS ARE NOT COVERED BY THE INDIANA HEALTH COVERAGE PROGRAM.
0753 PREPAYMENT REVIEW DETERMINATION. DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICATION CHARGES SUBMITTED.
0754 PREPAYMENT REVIEW DETERMINATION. DATE OF PROCEDURE IS NOT WITHIN THE SERVICE DATE OF THE CLAIM.
0755 PREPAYMENT REVIEW DETERMINATION. REQUEST FOR RECONSIDERATION IS PAST THE ALLOWABLE FILING LIMIT FOR APPEALS.
0756 PREPAYMENT REVIEW DETERMINATION. PROCEDURE BILLED MUST INCLUDE A COPY OF THE RESULTS.
0757 PREPAYMENT REVIEW DETERMINATION. CONSULTATION BILLED DOES NOT INCLUDE THE NAME OF THE REFERRING PHYSICIAN.
0758 PREPAYMENT REVIEW DETERMINATION. ADMINISTRATIVE NURSING FEES ARE NOT COVERED BY THE INDIANA HEALTH COVERAGE PROGRAM.
0759 PREPAYMENT REVIEW DETERMINATION. REQUIRED DOCUMENTATION IS NOT INCLUDED.
0760 PA REVERSAL OUT OF ORDER
0761 MULTIPLE PARTIALS NOT ALLOWED
0762 DIFFERENT DRUG ENTITY BETWEEN PARTIAL AND COMPLETION
0763 MISMATCHED CARDHOLDER/GROUP ID-PARTIAL TO COMPLETION
0764 THE COMPOUND PRODUCT QUALIFIER IS MISSING OR INVALID. A QUALIFIER OF 01 SHOULD BE BILLED WHEN USING THE UPC CODE A VALUE OF 03 SHOULD BE USED WHEN USING THE NDC NUMBER.
0765 IMPROPER ORDER OF DISPENSING STATUS CODE ON PARTIAL FILL TRANSACTION.
0766 M/I ASSOCIATED PRESCRIPTION/SERVCIE REFERENCE NUMBER ON COMPLETION TRANSACTION.
0767 M/I ASSOCIATED PRESCRIPTION/SERVICE DATE ON COMPLETION TRANSACTION.
0768 ASSOCIATED PARTIAL FILL TRANSACTION NOT OF FILE
0769 PARTIAL FILL TRANSACTION NOT SUPPORTED.
0770 COMPLETION TRANSACTION NOT PERMITTED WITH SAME DATE OF SERVICE AS PARTIAL TRA NSACTION.
0771 PLAN LIMITS EXCEEDED ON INTENDED PARTIAL FILL VALUES.
0772 OUT OF SEQUENCE P REVERSAL ON PARTIAL FILL TRANSACTION.
0773 M/I ASSOCIATED PRESCRIPTION/SERVICE DATE ON PARTIAL TRANSACTION
0774 M/I ASSOCIATED PRESCRIPTION/SERVICE REFERENCE NUMBER ON PARTIAL TRANSACTION
0775 MANDATORY DATA ELEMENTS MUST OCCUR BEFORE OPTIONAL DATA ELEMENTS IN A SEGMENT.
0776 OTHER AMOUNT CLAIMED SUBMITTED COUNT DOES NOT MATCH NUMBER OF REPETITIONS.
0777 OTHER PAYER REJECT COUNT DOES NOT MATCH NUMBER OF REPETITIONS.
0778 PROCEDURE MODIFIER CODE COUNT DOES NOT MATCH NUMBER OF REPETITIONS.
0779 PROCEDURE MODIFIER CODE INVALID FOR PRODUCT/SERVICE ID
0780 PRODUCT/SERVICE ID MUST BE ZERO WHEN PRODUCT/SERVICE ID QUALIFIER EQUALS '06'.
0781 PRODUCT/SERVICE NOT APPROPRIATE FOR THIS LOCATION
0782 REPEATING SEGMENT NOT ALLOWED IN SAME TRANSACTION. AN IDENTICAL SEGMENT WAS SUBMITTED ON A SINGLE TRANSACTION. PLEASE REMOVE SEGMENT AND RESUBMIT.
0783 VALUE IN GROSS AMOUNT DUE DOES NOT FOLLOW PRICING FORMULA
0784 M/I PROCEDURE MODIFIER CODE COUNT
0785 THE COMPOUND PRODUCT ID IS MISSING OR IS ZEROS. PLEASE REPLACE WITH VALID VALUE.
0786 M/I DIAGNOSIS CODE COUNT
0787 M/I DIAGNOSIS/PROCEDURE CODE QUALIFIER
0788 M/I CLINICAL INFORMATION COUNTER
0789 M/I MEASUREMENT DATE
0792 REVISED FOR FUTRUE USE
0794 NOT A COMPOUND
0795 EXCEEDS ALLOWED MAX DAILY VOLUME
0796 EXCEEDS ALLOWED MAX DAILY DOSE
0797 EFFECTIVE 10/16/03 ALL PHARMACY CLAIMS MUST BE SUBMITTED IN THE HIPAA COMPLIANT NCPDP VERSION 5.1 CLAIM FORMAT
0798 COMPOUND AMT BILLED > $275.00
0799 DISPENSING STATUS EQUALS P OR C
0800 MISSING OR INVALID COORDINATION OF BENEFITS/OTHER PAYMENT COUNT.
0801 STERILE WATER PRODUCTS FOR INHALATION AND IRRIGATION ARE COVERED IN THE NURSING FACILITY PER DIEM.
0802 PREGNANCY INDICATOR MISSING OR INVALID
0803 MEMBER INELIGIBLE FOR ALL OR A PORTION OF THE SERVICE DATES BILLED. IF NECESSARY PLEASE RESUBMIT AND BREAK OUT SERVICES FOR WHICH THE MEMBER IS ELIGIBLE FROM SERVICES FOR WHICH THE MEMBER IS INELIGIBLE.
0804 TPL AMOUNT IS LESS THAN $0.99 ON A CLAIM FOR COVEREAGE CODE =2
0805 OVERRIDE CODE IS NOT 2 OR 4, BUT THERE IS DATA IN THE COB SEGMENTS LIKE DATE, AMOUNT, COV TYPE
0806 TPL OVERRIDE CODE = 8 AND AMOUNT SUBMITTED/GROSS AMOUNT DUE IS MISSING OR INVALID
0807 TPL OVERRIDE CODE = 8 AND AMOUNT SUBMITTED/GROSS AMOUNT DUE IS NOT EQUAL
0808 HOOSIER RX MEMBER BENEFIT DOLLARS EXHAUSTED
0809 ROUTE TO BIN #001553. CLAIMS MUST BE PROCESSED BY CATAMARAN
0810 NDC UNIT QUALIFIER (UNIT OF MEASURE) IS MISSING/INVALID.
0811 M/I OTHER PAYER AMOUNT PAID
0812 M/I OTHER PAYER-PATIENT RESPONSIBILITY AMOUNT
0813 M/I OTHER PAYER-PATIENT RESPONSIBILITY QUALIFIER
0814 M/I OTHER PAYER-PATIENT RESPONSIBILITY COUNT
0815 TPL REQUIRED AT DETAIL AND MUST SUM TO EQUAL THE HEADER TPL AMOUNT
0863 THE CPT/HCPCS CODE BILLED IS NOT A VALID ENCOUNTER
0884 Service can only be billed on crossover outpatient claim by FQHC/RHC
0885 Medicare Only 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.
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
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
4545 RESERVED FOR FUTURE USE
4801 Procedure code not covered for benefit plan.
4865 SERVICE BILLED NOT ALLOWED FOR THIS CLAIM REGION, CLAIM MUST BE SPECIAL BATCHED WITH PROPER DOCUMENTATION FOR REVIEW AND APPROVAL.
4975 THE SERVICE BILLED IS NOT APPLICABLE FOR THE MEMBER'S BENEFIT PLAN.
5000 THIS IS A DUPLICATE OF ANOTHER CLAIM.
5001 THIS IS A DUPLICATE OF ANOTHER CLAIM.
5002 THIS IS A DUPLICATE OF ANOTHER CLAIM.
5003 THIS IS A DUPLICATE OF ANOTHER CLAIM REVERSAL.
5004 REVERSAL NOT PROCESSED, NO MATCH FOUND ON RX NUMBER AND PROVIDER NUMBER. PLEASE REFER TO YOUR POS MANUAL.
5005 REVERSAL NOT PROCESSED- MULTIPLE MATCHES FOUND WITH SAME RX NUMBER, PROVIDER NUMBER AND DISPENSING DATE. PLEASE REFER TO YOUR POS MANUAL.
5006 REVERSAL NOT PROCESSED, CLAIM OVER 60 DAYS - SUBMIT MANUAL ADJUSTMENT.
5007 THIS IS A DUPLICATE OF ANOTHER CLAIM. IF THIS CLAIM WAS INTENDED TO BE AN ADJUSTMENT, PLEASE SUBMIT THE APPROPRIATE ADJUSTMENT REQUEST FORM.
5008 ORIGINAL ICN NOT PRESENT ON 837 OR NOT FOUND IN HISTORY
5009 INVALID ADJUSTMENT; CLAIM PREVIOUSLY ADJUSTED. PLEASE USE THE MOST RECENT ICN TO PERFORM ANY ADDITIONAL ADJUSTMENTS TO THE CLAIM.
5010 EXACT DUPLICATE - ONLY ONE RESTORATION CODE, PER TOOTH, PER DAY, PER DENTIST WILL BE REIMBURSED
5011 POSSIBLE DUPLICATE - ONLY ONE RESTORATION CODE, PER TOOTH, PER DAY, PER DENTIST WILL BE REIMBURSED
5012 ANCILLARY CHARGES ARE NOT REIMBURSABLE ON AN OUTPATIENT CLAIM, WHEN A SURGICAL PROCEDURE IS PAID BY ASC PRICING. ALL CHARGES ARE INCLUSIVE IN THE ASC PAYMENT.
5013 RESERVED FOR FUTURE USE/POSSIBLE DUPLICATE MRT/PASSR
5014 RESERVED FOR FUTURE USE
5359 THESE CLAIMS HAVE BEEN LINKED TO AN ACTIVE RID.
5752 THE NUMBER OF SERVICES EXCEED MEDICAL POLICY GUIDELINES. PRIOR AUTHORIZATION REQUIRED FOR THIS SERVICE.
6000 THE PAYMENT HAS BEEN CALCULATED ACCORDING TO CURRENT INDIANA HEALTH COVERAGE PROGRAM POLICIES.
6001 PAYMENT FOR COMPLETE PROCEDURE PAYABLE AT A REDUCED AMOUNT WHEN THE TECHNICAL OR PROFESSIONAL COMPONENT HAS BEEN PAID FOR THE SAME DATE OF SERVICE.
6002 REIMBURSEMENT FOR ANESTHESIOLOGIST AND ANY OTHER ANESTHESIA PROVIDER IS NOT PAYABLE UNLESS MEDICAL NECESSITY IS DOCUMENTED. DOCUMENTATION NOT PRESENT OR INSUFFICIENT TO JUSTIFY PAYMENT OF ANESTHESIOLOGIST WHEN AN OTHER PROVIDER HAS BEEN PAID.
6003 PROCEDURE HAS ALREADY PAID IN HISTORY FOR THIS DATE OF SERVICE. ADDITIONAL PAYMENT FOR ANOTHER SAME/SIMILAR PROCEDURE ON THE SAME DATE OF SERVICE FOR THE SAME OR DIFFERENT PROVIDER IS NOT ALLOWED.
6004 INTERMEDIATE (E&M) OFFICE VISIT CODE IS LIMITED TO ONE EVERY 30 DAYS.
6005 EXTENDED OFFICE VISITS ARE LIMITED TO ONE PER 60 DAYS.
6006 NEW PATIENT VISITS ARE LIMITED TO ONE PER MEMBER, PER PROVIDER WITHIN THE LAST THREE YEARS.
6007 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMITS REIMBURSEMENT OF LABORATORY SERVICES TO $400.00 PER MONTH, UNLESS PRIOR AUTHORIZED. PAYMENT REFLECTS REMAINING AMOUNT DUE, IF ANY.
6008 SERVICES INCLUDED IN THE CRITICAL CARE/NEO-NATAL INTENSIVE CARE VISIT CODES ARE NOT SEPARATELY REIMBURSABLE.
6009 SERVICE DENIED. REIMBURSEMENT FOR INPATIENT HOSPITAL CARE IS LIMITED TO ONCE PER DAY
6010 THIS MEMBER HAS PREVIOUSLY RECEIVED A COMPLETE EXAMINATION WITHIN THE PAST YEAR AND NO DOCUMENTATION HAS BEEN SUBMITTED TO MEDICALLLY JUSTIFY THIS EXAMINATION.
6011 PROFESSIONAL OR TECHNICAL COMPONENT NOT SEPARATELY REIMBURSABLE WHEN PAYMENT HAS BEEN MADE FOR THE COMPLETE PROCEDURE ON THE SAME DATE OF SERVICE.
6012 REIMBURSEMENT IS LIMITED TO 30 MEDICAL SERVICES PER MEMBER PER ROLLING CALENDAR YEAR, UNLESS PRIOR AUTHORIZATION FOR ADDITIONAL SERVICES HAS BEEN OBTAINED.
6013 THE NUMBER OF SERVICE(S) PROVIDED FOR THIS MEMBER FOR THIS DATE OF SERVICE EXCEED MEDICAL POLICY.
6014 MEDICAL SERVICES PAYABLE AT A REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAMS ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6015 SURGERY PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6016 SERVICE DENIED. PAYMENT HAS BEEN MADE PREVIOUSLY FOR THE EXTRACTION OF THIS TOOTH.
6017 SERVICE PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT(S).
6018 COMPONENT IMMUNIZATION PROCEDURE CODES NOT REIMBURSABLE WHEN GLOBAL IMMUNIZATION PROCEDURE HAS BEEN PAID FOR THE SAME RECIPIENT, SAME DATE OF SERVICE.
6019 INITIAL PATIENT VISITS / ESTABLISHED PATIENT VISITS ARE NOT PAYABLE ON THE SAME DATE OF SERVICE AS OLD PROCEDURES W6511 / W6512.
6020 CANNOT BILL ON THE SAME DOS AS Z5114, Z5115, Z5116, Z5117, Z5118, Z5119 OR Z5120
6021 T2022 HA-WRAPAROUND FACILITATION LIMITED TO 1 UNIT PER MONTH
6022 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT PROCEDURES WHEN GLOBAL PROCEDURE HAS BEEN PAID
6023 SURGERY PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR THE COMPONENT.
6024 REIMBURSEMENT FOR ELECTRONIC PACEMAKER ANALYSIS IS LIMITED TO FREQUENCY STIPULATED IN 405 IAC5-28-6 (1), (2) . DOCUMENTATION NOT PRESENT OR INSUFFICIENT TO JUSTIFY ADDITIONAL SERVICES.
6025 REIMBURSEMENT FOR TRANSTELEPHONIC MONITORING OF PACEMAKER LIMITED TO FREQUENCY STIPULATED IN 405 IAC 5-28-6. DOCUMENTATION NOT PRESENT OR INSUFFICIENT TO JUSTIFY ADDITIONAL SERVICES.
6026 REIMBURSEMENT FOR HOLTER MONITORING IS LIMITED TO ONE EVERY SIX MONTHS. MEDICAL DOCUMENTATION IS REQUIRED FOR MONITORING IN EXCESS OF ONE EVERY SIX MONTHS.
6027 REIMBURSEMENT FOR PROCEDURE CODE BILLED IS LIMITED TO ONCE PER DAY. MAXIMUM REIMBURSEMENT HAS PREVIOUSLY BEEN PAID.
6028 INITIAL AND ESTABLISHED PREVENTATIVE HEALTH (EPSDT) VISIT ARE NOT REIMBURSABLE ON THE SAME DATE OF SERVICE. PLEASE SUBMIT A CORRECTED CLAIM.
6029 EFFECTIVE 4/1/2020, 24 UNIT MAXIMUM FOR SKILLS TRAINING AND DEVELOPMENT FOR ADULT DAY SERVICES INCLUDING INDIVIDUAL, GROUP, FAMILY/COUPLE, WITH AND WITHOUT CONSUMER PRESENT, PRIOR TO 4/1/2020 UNIT MAXIMUM WAS 8 UNITS.
6030 CRITICAL CARE/NEONATAL INTENSIVE CARE VISIT CODES ARE PAYABLE AT A REDUCED AMOUNT WHEN SERVICES INCLUDED IN THE REPORTING OF THE VISIT CODE HAS BEEN PAID FOR THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN THE AMOUNT ALLOWED FOR THE BILLED SERVICE AND THE AMOUNT PAID FOR THE FRAGMENTED SERVICE(S).
6031 GLOBAL IMMUNIZATION NOT PAYABLE WHEN COMPONENT IMMUNIZATION PROCEDURE CODE HAS BEEN PAID FOR THE SAME RECIPIENT AND FOR THE SAME PROVIDER. PLEASE VERIFY AND RESUBMIT.
6032 EXTRACTIONS/SELECT SURGICAL PROCEDURES PAYABLE AT REDUCED AMOUNT WHEN SUTURING PAID FOR THE SAME RECIPIENT ON THE SAME DAY OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE SERVICE BILLED AND THE AMOUNT PREVIOUSLY APID FOR SUTURING.
6033 REIMBURSEMENT IS LIMITED TO TWO TREATMENTS OF PROPHYLAXIS TO INSTITUTIONALIZED RECIPIENTS EVERY SIX (6) MONTHS.
6034 REIMBURSEMENT FOR GLOBAL SURGERY PAYABLE AT A REDUCED AMOUNT WHEN COMPONENTS OF GLOBAL SURGERY HAVE BEEN PREVIOUSLY PAID
6035 SEPARATE REIMBURSEMENT FOR COMPONENTS OF SURGICAL CARE NOT PAYABLE WHEN GLOBAL SURGERY FEE HAS PREVIOUSLY BEEN PAID.
6036 ORAL SURGERY PAYABLE AT REDUCED AMOUNT WHEN APICOECTOMY HAS BEEN PAID FOR THE SAME DAY OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PREVIOUSLY PAID FOR APICOECTOMY.
6037 ONLY ONE ASSISTANT SURGEON MAY BE PAID FOR THE SURGERY BILLED. PAYMENT HAS ALREADY BEEN MADE TO ANOTHER PROVIDER FOR ASSISTANT SURGEON SERVICES.
6038 REIMBURSEMENT FOR ASSISTANT SURGEON SERVICES LIMITED TO TWO ASSISTANTS FOR THE SURGERY BILLED. PAYMENT HAS BEEN MADE TO TWO PROVIDERS FOR ASSISTANT SURGEON SERVICES.
6039 ASSISTANT SURGEON SERVICES NOT REIMBURSABLE WHEN CO-SURGEON HAS BEEN PAID FOR THE SAME DATE OF SERVICE.
6040 CO-SURGEONSERVICES ARE NOT REIMBURSABLE WHEN AN ASSISTANT SURGEON HAS ALREADY BEEN PAID FOR THE SAME DATE OF SERVICE.
6041 ROUTINE EVALUATION AND MANAGEMENT VISITS ARE NOT REIMBURSABLE WHEN BILLED IN CONJUNCTION WITH PRENATAL VISITS
6042 PRENATAL VISITS ARE NOT REIMBURSABLE WHEN BILLED IN CONJUNCTION WITH ROUTINE EVALUATION AND MANAGEMENT VISITS
6043 ANTEPARTUM CARE VISITS LIMITED TO 14 VISITS IN 10 MONTHS UNLESS A MEDICALLY HIGH RISK DIAGNOSIS IS INDICATED.
6044 ONLY THREE PRENATAL VISITS ARE REIMBURSABLE DURING THE SECOND TRIMESTER OF PREGNANCY UNLESS A MEDICALLY HIGH RISK DIAGNOSIS IS INDICATED.
6045 ONLY EIGHT PRENATAL VISITS ARE REIMBURSABLE DURING THE THIRD TRIMESTER OF PREGNANCY UNLESS A MEDICALLY HIGH RISK DIAGNOSIS IS INDICATED.
6046 SERVICES CUTBACK-EXCEEDS ALLOWABLE LEAVE DAYS UNDER THE INDIANA HEALTH COVERAGE PROGRAMS.
6047 SERVICES CUTBACK- EXCEEDS ALLOWABLE THERAPEUTIC LEAVE DAYS UNDER THE INDIANA HEALTH COVERAGE PROGRAMS.
6048 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT ENDOCRINE/NERVOUS/EYE/EAR PROCEDURES WHEN THE GLOBAL PROCEDURE HAS BEEN PAID.
6049 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT INTEGUMENTARY, NEUROMUSCULAR PROCEDURES WHEN GLOBAL PROCEDURE HAS BEEN PAID.
6050 REIMBURSEMENT LIMITED TO TWO CARE COORDINATION REASSESSMENTS PER PREGNANCY
6051 REIMBURSEMENT LIMITED TO 1 CARE COORDINATION INITIAL ASSESSMENT PER PREGNANCY.
6052 REIMBURSEMENT IS LIMITED TO ONE CARE COORDINATION POST PARTUM ASSESSMENT PER PREGNANCY
6053 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMIT CASE MANAGEMENT (Z5950) TO 128 UNITS PER RECIPIENT EVERY 90 DAYS.
6054 AUDIOLOGICAL ASSESSMENTS ARE LIMITED TO ONCE EVERY 3 YEARS PER MEMBER. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL SERVICES
6055 EFFECTIVE 4/1/2020, CARE COORDINATION CASE MANAGEMENT CARE LIMITED TO 400 HOURS PER YEAR. PRIOR TO 4/1/2020, CARE COORDINATION CASE MANAGEMENT CARE IS LIMITED TO 200 HOURS PER YEAR.
6056 REIMBURSEMENT FOR HEARING AID REPAIRS FOR MEMBERS 18 AND OLDER IS LIMITED TO ONCE EVERY TWELVE MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL REPAIRS.
6057 REIMBURSEMENT FOR HEARING AID REPAIRS FOR MEMBERS LESS THAN 18 YEARS OF AGE IS LIMITED TO ONCE EVERY 12 MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL REPAIR.
6058 REIMBURSEMENT FOR HEARING AID EARMOLD REPAIR FOR MEMBERS 18 AND OLDER IS LIMITED TO ONCE EVERY 12 MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL REPAIRS.
6059 REIMBURSEMENT FOR HEARING AID EARMOLD REPAIR FOR MEMBERS LESS THAN 18 YEARS OF AGE IS LIMITED TO ONCE EVERY 12 MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL REPAIRS
6060 REIMBURSEMENT FOR SPEECH EVALUATION IS LIMITED TO ONCE EVERY TWELVE MONTHS. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL EVALUATIONS.
6061 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT GENITAL URINARY/REPRODUCTIVE SYSTEM PROCEDURES WHEN A GLOBAL GENITAL URINARY/REPRODUCTIVE SYSTEM PROCEDURE HAS BEEN PAID.
6062 DAY CARE SERVICES, ADULT, LIMITED TO 10 UNITS IN A 5 DAY PERIOD
6063 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT RESPIRATORY PROCEDURES WHEN GLOBAL RESPIRATORY PROCEDURE HAS BEEN PAID.
6064 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT MEDICAL SYSTEM PROCEDURES WHEN GLOBAL MEDICAL SYSTEM PROCEDURE HAS BEEN PAID.
6065 THIS ITEM HAS BEEN RENTED UP TO THE INDIANA HEALTH COVERAGE PROGRAM MAXIMUM ALLOWED CHARGE FOR PURCHASE.
6066 TRANSPORTATION (ASSISTED) EXCEEDS ALLOWABLE LIMIT FOR AD
6067 EXCEEDS ALLOWABLE THERAPEUTIC LEAVE DAYS FOR INTERMEDIATE CARE FACILITY PATIENTS UNDER THE INDIANA HEALTH COVERAGE PROGRAMS. MAXIMUM ALLOWABLE DAYS IS 30 PER CALENDAR YEAR.
6068 EXCEEDS ALLOWABLE THERAPEUTIC LEAVE DAYS FOR ICF/IID PATIENTS UNDER THE INDIANA HEALTH COVERAGE PROGRAMS. MAXIMUM ALLOWABLE DAYS IS 60 PER CALENDAR YEAR.
6069 REIMBURSEMENT IS LIMITED TO 50 OFFICE VISITS PER MEMBER PER ROLLING 12 MONTHS UNLESS PRIOR AUTHORIZATION FOR ADDITIONAL SERVICES HAS BEEN OBTAINED.
6070 ONLY FOUR PRENATAL VISITS ARE REIMBURSABLE DURING THE FIRST TRIMESTER OF PREGNANCY UNLESS A MEDICALLY HIGH RISK DIAGNOSIS IS INDICATED.
6071 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT CARDIOVASCULAR/LYMPHATIC SYSTEM PROCEDURES WHEN GLOBAL CARDIOVASCULAR/LYMPHATIC SYSTEM PROCEDURE HAS BEEN PAID.
6072 SERVICE PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA COVERAGE HEALTH PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT FOR THE COMPONENT(S).
6073 NO MORE THAN 120 HOME HEALTH HOURS ALLOWED WITHIN 30 DAYS OF A HOSPITAL DISCHARGE. PRIOR AUTHORIZATION IS REQUIRED FOR ADDITIONAL HOURS.
6074 Z5620 IS LIMITED TO ONE UNIT OF SERVICE PER MEMBER PER MONTH.
6075 Z5699 IS LIMITED TO ONE PER MEMBER PER LIFETIME.
6076 REIMBURSEMENT FOR HOME PROTIME REAGENT STRIPS AND CUVETTES ARE LIMITED TO FOUR (4) UNITS, EACH, PER CALENDAR MONTH.
6077 REIMBURSEMENT FOR SALIVARY ESTRIOL LEVEL TESTS LIMITED TO $425.00 PER PREGNANCY.
6078 SALIVARY ESTRIOL TESTS AND HOME TOCOLYTIC THERAPY NOT BILLABLE WITHIN SIX (6) M
6079 THE PROCEDURE CODE BILLED IS A GLOBAL PROCEDURE AND A COMPONENT OF THAT PROCEDURE HAS ALREADY BEEN PAID. PLEASE VERIFY AND RESUBMIT.
6080 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMITS DME RENTAL OF THIS ITEM TO 15 MONTHS OF CONTINUOUS RENTAL.
6081 RENTAL OR PURCHASE OF DURABLE MEDICAL EQUIPMENT (DME) ITEMS ARE NOT PAYABLE WHEN THE RECIPIENT IS A RESIDENT IN A NURSING FACILITY (ICF OR SNF).
6082 RENTAL OR PURCHASE OF DURABLE MEDICAL EQUIPMENT (DME) ITEMS ARE NOT PAYABLE WHEN THE RECIPIENT IS A RESIDENT IN A NURSING FACILITY (ICF OR SNF).
6083 H0038 HH (Peer Recovery Support) is not payable on the same date as H0038 HW or UB and T1016 HH (Case Management) is not payable on the same date as T1016 HW, UB or UC services.
6084 THE PROCEDURE CODE BILLED IS A COMPONENT OF A GLOBAL PROCEDURE THAT HAS BEEN PAID.
6085 INCONTINENCE SUPPLIES ARE LIMITED TO TOTAL DOLLAR AMOUNT OF $1,950.00 PER ROLLING 12 MONTHS
6086 TRANSPORTATION (NON-ASSISTED) EXCEEDS ALLOWABLE LIMIT FOR AD
6087 WAIVER TRANSP <24 HOUR RES. FIRST TRIP/DAY IS LIMITED TO $276.21 PER MONTH.
6088 WAIVER TRANSP.<24HR. RES. 2ND TRIP/DAY IS LIMITED TO $62.00 PER MONTH.
6089 WAIVER TRANSPORTATION FOR INDIVIDUALS IN DAY SERVICE ONLY LIMITED TO $204.93 A MONTH.
6090 INDIANA MEDICAID BENEFITS ALLOW PAYMENT FOR ONE (1) PODIATRY OFFICE VISIT PER RECIPIENT PER CALENDAR YEAR.
6091 NEW PATIENT PODIATRY OFFICE VISITS ARE REIMBURSED ONCE PER PROVIDER EVERY 3 YRS FOR A NEW PATIENT OFFICE VISIT.
6092 WAIVER TRANSPORTATION DAY SERVICE 2ND TRIP/DAY LIMITED TO $46.00 A MONTH.
6093 WAIVER SERVICES ALLOW ONE UNIT PER DAY UNDER THE INDIANA HEALTH COVERAGE SERVICES
6094 WAIVER SERVICES LIMITED TO FORTY HOURS, PER MONTH UNDER THE INDIANA HEALTH COVERAGE SERVICES
6095 WAIVER SERVICES ALLOW ONE HOUR PER DAY UNDER THE INDIANA HEALTH COVERAGE SERVICES PROGRAM
6096 THE CPT/HCPCS CODE BILLED IS NOT PAYABLE ACCORDING TO THE PPS REIMBURSEMENT METHODOLOGY
6097 TOPICAL APPLICATION OF FLUORIDE AND PROPHYLAXIS WILL NOT BE SEPARATELY REIMBURSED ON THE SAME DATE OF SERVICE. A PAYMENT OF $61.00 WILL BE REIMBURSED FOR THE COMBINATION OF BOTH.
6098 CHIROPRACTIC SERVICES ARE LIMITED TO SPECIFIC PROCEDURE AND DIAGNOSIS CODES.
6099 REIMBURSEMENT IS LIMITED TO NO MORE THAN 50 CHIROPRACTIC SERVICES PER MEMBER PER CALENDAR YEAR. THESE SERVICES COULD INCLUDE UP TO FIVE (5) OFFICE VISITS AND SPINAL MANIPULATION TREATMENTS, OR PHYSICAL MEDICINE TREATMENTS.
6100 REIMBURSEMENT LIMITED TO FIFTY (50) THERAPEUTIC PHYSICAL MEDICINE TREATMENTS BY A CHIROPRACTOR PER RECIPIENT PER YEAR. THE MAXIMUM NUMBER OF SERVICES HAVE BEEN PAID. PRIOR AUTHORIZATION IS REQUIRED FOR ADDITIONAL TREATMENTS.
6101 NEW PATIENT CHIROPRACTIC OFFICE VISITS ARE REIMBURSABLE ONCE PER PROVIDER PER LIFETIME OF THE RECIPIENT.
6102 INDIANA HEATH COVERAGE PROGRAMS REIMBURSEMENT LIMITED TO FIVE CHIROPRACTIC OFFICE VISITS PER YEAR. THIS RECIPIENT HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL VISITS.
6103 COMPONENT SPINE X-RAYS ARE NOT REIMBURSABLE FOR CHIROPRACTORS WHEN A FULL SERIES SPINAL X-RAY HAS BEEN PAID TO A CHIROPRACTOR FOR THE SAME RECIPIENT WITHIN THE SAME CALENDAR YEAR.
6104 REIMBURSEMENT TO CHIROPRACTORS FOR RENTAL OF DME IS LIMITED TO ONE PER MONTH OR A QUANTITY OF ONE(1) UNLESS PRIOR AUTHORIZATION HAS BEEN OBTAINED. MAXIMUM REIMBURSEMENT HAS BEEN PREVIOUSLY PAID.
6105 INDIANA HEALTH COVERAGE PROGRAM REIMBURSEMENT IS LIMITED TO ONE (1) FULL SPINAL X-RAY PER RECIPIENT PER CALENDAR YEAR BY A CHIROPRACTOR. MAXIMUM REIMBURSEMENT HAS BEEN PAID. PRIOR AUTHORIZATION IS REQUIRED FOR PAYMENT OF ADDITIONAL VISITS.
6106 MAXIMUM REIMBURSEMENT FOR ANY COMBINATION OF SPINAL SERIES XRAY COMPONENTS TO A CHIROPRACTOR IS $95.00 PER YEAR.
6107 FULL SERIES SPINAL X-RAY IS PAYABLE AT A REDUCED AMOUNT TO CHIROPRACTORS WHEN COMPONENTS OF SPINAL SERIES X-RAYS HAVE BEEN PAID TO A CHIROPRACTOR IN THE PAST TWELVE (12) MONTHS. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN THE AMOUNT ALLOWED FOR THE FULL SERIES AND THE AMOUNT PREVIOUSLY PAID FOR THE COMPONENT OF THE SERIES X-RAYS.
6108 RADIOLOGY SERVICES PAYABLE AT REDUCED AMOUNT WHEN RELATED COMPONENTS HAVE BEEN PAID FOR THE SAME RECIPIENT ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN THE ALLOWABLE AMOUNT FOR THE PROCEDURE BILLED AND THE AMOUNT PREVIOUSLY PAID TO A CHIROPRACTOR FOR THE COMPONENT(S)
6109 UNSKILLED RESPITE CARE, NOT HOSPICE LIMITED TO 300 UNITS PER YEAR
6110 SEPARATE REIMBURSEMENT IS NOT AVAILABLE FOR COMPONENT PROCEDURES WHEN GLOBAL PROCEDURE HAS BEEN PAID.
6111 REIMBURSEMENT IS LIMITED TO FIVE CHIROPRACTIC OFFICE VISITS PER YEAR PER MEMBER. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6112 THERAPEUTIC PHYSICAL MEDICINE TREATMENTS ARE LIMITED TO 14 PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6113 DURABLE MEDICAL EQUIPMENT IS LIMITED TO $2,000 PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM AMOUNT ALLOWABLE
6114 REIMBURSEMENT FOR DURABLE MEDICAL EQUIPMENT IS LIMITED TO $5,000 PER MEMBER PER LIFETIME.
6115 REIMBURSEMENT IS LIMITED TO 50 PHYSICAL THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6116 REIMBURSEMENT IS LIMITED TO 50 SPEECH THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6117 REPLACEMENT OF IMPLANTABLE LOOP RECORDERS LIMITED TO ONE EVERY 24 MONTHS.
6118 REIMBURSEMENT IS LIMITED TO 50 OCCUPATIONAL THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6119 REIMBURSEMENT IS LIMITED TO 50 DAYS OF INPATIENT REHABILITATION SERVICES PER RECIPIENT PER CALENDAR YEAR. THIS RECIPIENT HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6120 REIMBURSEMENT IS LIMITED TO 30 VISITS FOR OUTPATIENT MENTAL HEALTH/SUBSTANCE ABUSE SERVICES PER RECIPIENT PER CALENDAR YEAR WITHOUT PRIOR AUTHORIZATION. THIS RECIPIENT HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6121 REIMBURSEMENT IS LIMITED TO 50 VISITS MAXIMUM FOR OUTPATIENT MENTAL HEALTH/SUBSTANCE ABUSE SERVICES PER RECIPIENT, PER CALENDAR YEAR, WITH PRIOR AUTHORIZATION. THIS RECIPIENT HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6122 THERAPEUTIC PHYSICAL MEDICINE TREATMENTS EXCEEDING FOURTEEN (14), UP TO A MAXIMUM OF FIFTY (50), PER RECIPIENT, PER CALENDAR YEAR, REQUIRE PRIOR AUTHORIZATION.
6123 EFFECTIVE 9/13/2019 MAXIMUM REIMBURSEMENT FOR ANY COMBINATION OF SPINAL SERIES XRAY COMPONENTS TO A CHIROPRACTOR IS $62.95 PER YEAR. FOR DATES OF SERVICE 1/1/2016-9/12/2019 $43.75 PER YEAR. FOR DATES OF SERVICE 2/1/2015-12/31/2015 $56.60 PER YEAR. FOR DATES OF SERVICE 10/6/1994-1/31/2015 $44.76 PER YEAR.
6124 REPLACEMENT OF IMPLANTABLE LOOP RECORDERS LIMITED TO ONE EVERY 24 MONTHS.
6125 COGNITIVE REHABILITATION IS LIMITED TO PROCEDURE AND DIAGNOSIS
6126 OBSOLETE - THE IHCP HAS VERIFIED WITH THE MANUFACTURER THAT MSRP PRICING IS AVAILABLE. PLEASE RESUBMIT THE CLAIM WITH THE PROPER DOCUMENTATION.
6127 MAXIMUM AMOUNT EXCEEDED $2000.00 PER YEAR FOR WAIVER COMMUNITY ED/THERAPEUTIC ACTIVITY
6128 MAXIMUM AMOUNT EXCEEDED $545.00 PER MONTH FOR WAIVER RENT/FOOD EXPENSES FOR UNRELATED CAREGIVER
6129 MAXIMUM AMOUNT EXCEEDED $2000.00 PER YEAR FOR WAIVER FAMILY AND CAREGIVER TRAINING
6130 PROCEDURE CODE T1028 U7 HAS A $500.00 ANNUAL CAP
6131 DD TCM DIVERSION LIMITED TO $1835.52 PER 180 DAYS
6132 T2021 U7 IS LIMITED TO 25 HOUR PER MONTH
6133 HCBS PER DIEM IS LIMITED TO ONE PER DAY
6134 T2017 U7 U1 IS LIMITED TO 30 HOURS PER MONTH
6135 T2024 U7 IS LIMITED TO 12 1/4 HOUR UNITS PER YEAR
6136 T2024 U7 TS IS LIMITED TO 12 1/4 HOUR UNITS PER YEAR
6137 PET SCAN IMAGING PROCEDURES LIMITED TO SPECIFIC DIAGNOSIS CODES
6138 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6139 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6140 RADIOIMMUNOTHERAPY SERVICE (78804) IS LIMITED TO ONE PER LIFETIME.
6141 RADIOIMMUNOTHERAPY SERVICE (79403) IS LIMITED TO ONE PER LIFETIME.
6142 RADIOIMMUNOTHERAPY SERVICE A9544 IS LIMITED TO ONE PER LIFETIME
6143 RADIOIMMUNOTHERAPY SERVICE A9545 IS LIMITED TO ONE PER LIFETIME
6144 RADIOIMMUNOTHERAPY SERVICE A9542 IS LIMITED TO ONE PER LIFETIME
6145 RADIOIMMUNOTHERAPY SERVICE A9543 IS LIMITED TO ONE PER LIFETIME
6146 RADIOIMMUNOTHERAPY SERVICE (A9523) IS LIMITED TO ONE UNIT PER 14 DAYS
6147 RADIOIMMUNOTHERAPY SERVICE (G0274) IS LIMITED TO ONE UNIT PER 14 DAYS
6148 RADIOIMMUNOTHERAPY SERVICE (G0273) IS LIMITED TO ONE UNIT PER 14 DAYS
6149 RADIOIMMUNOTHERAPY SERVICE (A9522) IS LIMITED TO ONE UNIT PER 14 DAYS
6150 THE NUMBER OF CONSULTATIONS PROVIDED FOR THIS MEMBER EXCEEDED INDIANA HEALTH COVERAGE PROGRAM POLICY. ADDITIONAL CONSULTATION IS NOT REIMBURSABLE WITHOUT FURTHER DOCUMENTATION.
6151 RESERVED FOR FUTURE USE
6152 SURGERY PAYABLE AT A REDUCED AMOUNT WHEN CONSULTATION PREVIOUSLY PAID AND IS RELATED TO THE SURGICAL PROCEDURE BILLED. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE BILLED SURGICAL PROCEDURE AND THE AMOUNT PREVIOUSLY PAID FOR THE CONSULTATION.
6153 ANY COMBINATION OF THERAPY SERVICES ARE NOT TO EXCEED THIRTY UNITS IN 30 DAYS
6154 NO MORE THAN 120 HOME HEALTH THERAPY HOURS WITHIN 30 DAYS OF HOSPITAL DISCHARGE. ANY ADDITIONAL HOURS REQUIRE PRIOR AUTHORIZATION.
6155 NURSING/HOME HEALTH AID SERVICES ARE LIMITED TO 24 UNITS A DAY
6156 PROCEDURE 99140 MUST BE BILLED WITH ANESTHESIA CODE
6157 THERAPIES ARE LIMITED TO 96 UNITS IN ONE DAY
6158 G0461 AND G0462 CANNOT BE REPORTED WITH PROCEDURE CODES 88342 OR 88343.
6160 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6161 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6162 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC PROCEDURE CODES
6163 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6164 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6165 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6166 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6167 PET SCAN IMAGING PROCEDURES ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6168 GONADOTROPIN-RELEASING HORMONE AGONISTS LIMITED TO SPECIFIC DIAGNOSIS.
6169 THE MSRP/COST INVOICE SUBMITTED WITH THE CLAIM IS NOT ACCEPTABLE FOR ADJUDICATION. THE PROVIDER CAN RESUBMIT THE CLAIM WITH PROPER DOCUMENTATION.
6170 CLAIM WAS BILLED WITH THE WRONG UNIT OF MEASURE FOR THE DRUG BILLED
6171 ONE MRT SERVICE PER LIFETIME
6172 Z5188 IS LIMITED TO $286.80 PER ROLLING CALENDAR YEAR.
6173 MRT MEDICAL/PSYCH EXAMS CANNOT BE BILLED WITH MEDICAL RECORDS (EXAMS ARE INCLUSIVE)
6174 LIMIT PROCEDURE CODE 90801 SE TO 1.5 UNITS PER ROLLING 12 MONTHS
6175 LIMIT MRT PSYCHOLOGY TESTING TO 2 UNITS PER ROLLING 12 MONTHS
6177 REIMBURSEMENT IS NOT ALLOWED FOR PROCEDURES S3818, S3819, S3822, AND S3823, IF, PAYMENT HAS ALREADY BEEN MADE FOR PROCEDURE CODE S3820
6178 PROCEDURE CODES S3820, S3822, AND S3823 ARE LIMITED TO IDENTIFIED DIAGNOSIS CODES
6179 REIMBURSEMENT FOR PROCEDURE CODES 83891, 83898, 83904, 83912, S3818 AND S3819 IS NOT ALLOWED WHEN BILLED WITH IDENTIFIED DIAGNOSIS CODES
6181 WAIVER SERVICE T2022 U7 U1 IS LIMITED TO 64 UNITS PER MONTH
6182 REIMBURSEMENT FOR COMPREHENSIVE ENVIRONMENTAL LEAD INVESTIGATION INITIAL VISIT (T1029) AND FOLLOW-UP INVESTIGATION (T1029 TS) IS LIMITED TO ONCE EVERY TWELVE ROLLING MONTHS.
6183 J9225 LIMITED TO 1 UNIT PER MEMBER PER 12 MONTHS
6184 99600 U2 TD, UNLISTED HOME VISIT SERVICE OR PROCEDURE (DAILY RATE FOR EACH DAILY READING FOR AN RN) IS LIMITED TO ONE UNIT PER DAY
6185 99600 U2 TD NOT ALLOWED IF HOME HEALTH VISIT FROM AN RN/LPN/LVN ON SAME DATE OF SERVICE
6186 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMITS DME RENTAL OF THIS ITEM TO 6 UNITS IN A 8 MONTH SPAN.
6187 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMITS DME RENTAL OF THIS ITEM TO 10 UNITS IN A 12 MONTH SPAN.
6188 RESERVE FOR ROBOTIC THERAPY
6189 RESERVE FOR JENNI- DIAGNOSIS BILLED IS NOT FOR ROBOTIC THERAPY
6190 RESERVE FOR JENNI ROBOTI THERAPY IS LIMITED TO 6 WEEKS
6193 VEHICLE MAINTENANCE LIMITED TO $500.00 PER YEAR
6194 MILEAGE IS NOT PAYABLE WITH THIS SERVICE
6195 FRAMES INITIAL OR REPAIR/REPLACEMENT- MEMBER OVER 21 YEARS OF AGE
6196 FRAMES INITIAL OR REPLACEMENT- MEMBER 21 YEARS OR YOUNGER
6199 FLUORIDE TREATMENT LIMITED TO ONE TREATMENT EVERY 6 MONTHS
6200 REIMBURSEMENT FOR PANORAMIC OR COMPLETE SERIES X-RAYS REDUCED WHEN PAYMENT HAS BEEN MADE FOR BITEWINGS AND/OR PERIAPICAL X-RAYS ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE BILLED AND THE AMOUNT PAID FOR BITEWINGS AND/OR PERIAPICAL X-RAYS.
6201 BENEFITS LIMITED TO ONE UPPER DENTURE RELINE PER MEMBER IN A THIRTY-SIX(36) MONTH PERIOD, UNLESS PRIOR AUTHORIZED.
6202 PALLIATIVE TREATMENT IS NOT REIMBURSED WHEN BILLED BY A PROVIDER ON THE SAME DAY OF SERVICE OF EMERGENCY EXAMINATIONS,EXTRACTIONS, GINGIVAL CURETTAGE AND OTHER SURGICAL PROCEDURES.
6203 INDIANA HEALTH COVERAGE PROGRAM BENEFITS DO NOT ALLOW PAYMENT OF DENTURE RELINE AND/OR REBASE PROCEDURES WITHIN SIX (6) YEARS OF THE INITIAL PLACEMENT OF LOWER COMPLETE OR PARTIAL DENTURES.
6204 A PULPOTOMY IS NOT REIMBURSABLE WHEN PERFORMED ON A TOOTH WHICH PREVIOUSLY HAS HAD ROOT CANAL THERAPY.
6205 APICOECTOMY IS NOT REIMBURSABLE WHEN BILLED BY THE SAME PROVIDER ON THE SAME DAY OF SERVICE ON WHICH ORAL SURGERY WAS PERFORMED ON THE SAME TOOTH.
6206 UNSKILLED RESPITE CARE (NOT HOSPICE) LIMITED TO 28 UNITS A DAY
6207 DAY CARE SERVICES, ADULT, LIMITED TO 2 UNITS A DAY
6208 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMIT OCCLUSAL FILMS TO TWO (2) UNITS PER DAY.
6209 FULL MOUTH OR PANOREX X-RAYS ARE LIMITED TO ONCE EVERY THREE YEARS.
6210 BENEFITS LIMITED TO ONE TREATMENT OF PROPHYLAXIS EVERY SIX MONTHS FOR NON-INSTITUTIONAL RECIPIENTS, AGES TWELVE MONTHS THROUGH TWENTY YEARS OF AGE.
6211 PERIODIC OR LIMITED ORAL EVALUATIONS ARE LIMITED TO ONE EVERY 6 MONTHS
6212 INDIANA HEALTH COVERAGE PROGRAM BENEFITS ALLOW PAYMENT FOR ONE TOPICAL APPLICATION OF FLUORIDE EVERY SIX (6) MONTHS. FLOURIDE TREATMENTS ARE LIMITED TO RECIPIENTS 0 THROUGH 20 YEARS OF AGE.
6213 DENTURE ADJUSTMENTS ARE NOT PAYABLE WITHIN SIX (6) MONTHS FROM THE FABRICATION OF THE PROSTHODONTIC.
6214 ROOT CANAL PAYABLE AT A REDUCED AMOUNT WHEN PULPOTOMY PAID FOR THE SAME TOOTH ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR ROOT CANAL AND THE AMOUNT PREVIOUSLY PAID FOR PULPOTOMY.
6215 UNSKILLED RESPITE CARE, NOT HOSPICE; PER 15 MINUTES CANNOT BE BILLED ON SAME DAY AS UNSKILLED RESPITE CARE, NOT HOSPICE; PER DIEM.
6216 BENEFITS LIMITED TO ONE LOWER DENTURE RELINE PER MEMBER IN A THIRTY-SIX (36) MONTH PERIOD, UNLESS PRIOR AUTHORIZED.
6217 GINGIVAL CURETTAGE PAYABLE AT A REDUCED AMOUNT WHEN PERIODONTAL SCALING HAS BEEN PREVIOUSLY PAID FOR THE SAME RECIPIENT THE DAY BEFORE, AFTER, OR ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR GINGIVAL CURRETAGE AND THE AMOUNT PREVIOUSLY PAID FOR PERIODONTAL SCALING.
6218 INDIANA HEALTH COVERAGE PROGRAM BENEFITS ALLOW REIMBURSEMENT FOR ONE (1) PULP CAP OR BASE FILL PER TOOTH, PER RECIPIENT, PER LIFETIME.
6219 INDIANA HEALTH COVERAGE PROGRAM BENEFITS LIMIT PERIODONTAL SCALING AND PLANNING TO TWO (2) QUADRANTS PER DATE OF SERVICE.
6220 INDIANA HEALTH COVERAGE PROGRAM BENEFITS ALLOW REIMBURSEMENT FOR THREE (3) TOOTH REPLACEMENTS PER DAY. PRIOR AUTHORIZATION IS REQUIRED IF REPLACING MORE THAN THREE (3) TEETH ON THE SAME DATE OF SERVICE.
6221 REIMBURSEMENT LIMITED TO FOUR TREATMENTS OF PERIODONTAL ROOT PLANING/SCALING EVERY TWO (2) YEARS FOR NON-INSTITUTIONALIZED RECIPIENTS BETWEEN THE AGES OF THREE (3) AND TWENTY (20) YEARS.
6222 REIMBURSEMENT IS LIMITED TO FOUR TREATMENTS OF PERIODONTAL ROOT PLANING AND SCALING FOR INSTITUTIONALIZED RECIPIENTS EVERY TWO (2) YEARS REGARDLESS OF AGE.
6223 PERIODONTAL ROOT PLANING/SCALING 4X/LIFETIME/NON-INSTITUTIONAL 21 YRS AND OLDER.
6224 PAYMENT HAS BEEN MADE PREVIOUSLY FOR THE EXTRACTION OF THIS TOOTH
6225 INDIANA HEALTH COVERAGE PROGRAM BENEFITS ALLOW PAYMENT FOR ONE SEALANT TREATMENT PER PREMOLARS AND MOLARS PER LIFETIME.
6226 COMPREHENSIVE/EXTENSIVE ORAL EVALS ARE LIMITED TO ONE PER LIFETIME PER MEMBER PER PROVIDER
6227 SERVICES CONSIDERED EMERGENT ARE PAID AT A REDUCED AMOUNT WHEN PALLIATIVE TREATMENT HAS BEEN PAID ON THE SAME DATE OF SERVICE.
6228 DENTURE RELINE PAID AT A REDUCED AMOUNT WHEN DENTURE REPAIRS HAVE BEEN REIMBURSED ON THE SAME DATE OF SERVICE. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR THE PROCEDURE CODE BILLED AND THE AMOUNT PAID FOR DENTURE REPAIRS.
6229 INDIANA HEALTH COVERAGE PROGRAMS BENEFITS DO NOT ALLOW PAYMENT OF DENTURE RELINE AND/OR REBASE PROCEDURES WITHIN SIX (6) MONTHS OF THE INITIAL PLACEMENT OF UPPER COMPLETE OR PARTIAL DENTURES.
6230 INDIANA HEALTH COVERAGE PROGRAM BENEFITS DO NOT ALLOW PAYMENT OF DENTURE RELINE AND/OR REBASE PROCEDURES WITHIN SIX (6) MONTHS OF THE INITIAL PLACEMENT OF COMLETE OR PARTIAL DENTURES. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIAN HEALTH COVERAGE PROGRAM'S MAXIMUM ALLOWED CHARGE FOR DENTURES AND THE AMOUNT PEVIOUSLY PAID FOR RELINE AND/OR REBASE OF DENTURES.
6231 D0230 INTRAORAL-PERIAPICAL-EACH ADDITIONAL FILM IS LIMITED TO SEVEN FILMS PER TWELVE MONTHS
6232 PROPHYLAXIS AND PERIODONTAL MAINTENANCE IS LIMITED TO ONE TREATMENT EVERY SIX MONTHS FOR INSTITUTIONALIZED MEMBERS.
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 12 MONTHS FOR NON-INSTITUTIONAL MEMBERS 21 YEARS OR OLDER.
6236 THE MEMBER HAS EXHAUSTED A BENEFIT LIMIT FOR DENTAL SERVICES. THE LIMIT FOR 21 AND OLDER IS $600 PER YEAR.
6237 COMPREHENSIVE ORAL EXAM-NEW OR ESTABLISHED PATIENT WILL BE LIMITED TO ONE PER LIFETIME, PER MEMBER, PER PROVIDER WITH AN ANNUAL LIMIT OF TWO VISITS.
6238 THE MEMBER HAS EXHAUSTED A BENEFIT LIMIT FOR DENTAL SERVICES. THE LIMIT FOR 21 AND OLDER IS $600 PER YEAR.
6239 MULTIPLE EXTRACTIONS ON SAME DATE OF SERVICE
6240 THE NUMBER OF UNITS ON THE COST INVOICE MUST BE EQUAL OR EXCEED THE NUMBER OF UNITS BILLED ON THE CLAIM. PLEASE VERIFY AND RESUBMIT.
6241 HORIZONTAL BETEWING X-RAYS ARE LIMITED TO FOUR EVERY 12 MONTHS
6242 HORIZONTAL BITEWING X-RAYS ARE LIMITED TO FOUR EVERY 12 MONTHS
6243 D0220 IS LIMITED TO ONE FILM EVERY TWELVE MONTHS
6244 D4355/D4346 LIMITED TO ONCE EVERY 3 YEARS (DTL)
6245 HORIZONTAL BITEWING X-RAYS ARE LIMITED TO FOUR EVERY 12 MONTHS
6246 D0270, D0272, D0273, D0274, D0277 ONE SET OF BITEWINGS IS ALLOWED IN ONE YEAR.
6247 TOPICAL APPLICATION OF FLUORIDE AND PROPHYLAXIS WILL NOT BE SEPARATELY REIMBURSED ON THE SAME DATE OF SERVICE. A PAYMENT OF $70.00 WILL BE REIMBURSED FOR THE COMBINATION OF BOTH.
6248 TOPICAL APPLICATION OF FLUORIDE AND PROPHYLAXIS WILL NOT BE SEPARATELY REIMBURSED ON THE SAME DATE OF SERVICE. A PAYMENT OF $56.75 WILL BE REIMBURSED FOR THE COMBINATION OF BOTH.
6250 ONE UNIT OF SERVICE IS ALLOWED EVERY 28 DAYS. UNITS OF SERVICE FOR THIS PROCEDURE EXCEED THE ALLOWABLE NUMBER OF UNITS. PRIOR AUTHORIZATION REQUIRED FOR ADDITIONAL SERVICES.
6251 UROLOGICAL SUPPLIES (INDWELLING CATHETERS) ARE LIMITED TO TWO PER MONTH UNLESS DOCUMENTATION OF MEDICAL NECESSITY IS ATTACHED.
6252 THE OXYGEN MAXIMUM FEE HAS BEEN PAID FOR THIS MEMBER WITHIN THE 28 DAY PERIOD. ONE UNIT OF OXYGEN IS ALLOWED EVERY 28 DAYS. PRIOR AUTHORIZATION IS REQUIRED FOR ADDITIONAL SERVICES.
6253 LIQUID OR GASEOUS OXYGEN PER POUND HAS BEEN REIMBURSED FOR A DATE OF SERVICE WITHIN 28 DAYS BY THE SAME PROVIDER. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR OXYGEN AND THE AMOUNT PREVIOUSLY PAID FOR GASEOUS OR LIQUID OXYGEN.
6254 EFFECTIVE 4/1/2020, THERAPY SERVICES LIMITED TO 75 HOURS PER YEAR. PRIOR TO 4/1/2020 SERVICES ARE LIMITED TO 24 HOURS PER YEAR.
6255 COMPONENTS OF TREND EVENT MONITOR ARE NOT REIMBURSABLE WHEN TREND EVENT MONITOR HAS BEEN REIMBURSED ON THE SAME DATE OF SERVICE.
6256 TREND EVENT MONITOR IS REIMBURSED A MAXIMUM OF $850.00 PER MONTH AND IS PAYABLE AT A REDUCED AMOUNT WHEN COMPONENTS OF A TREND EVENT MONITOR HAVE BEEN PREVIOUSLY PAID. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR A TREND EVENT MONITOR AND THE AMOUNT PREVIOUSLY PAID FOR RELATED COMPONENTS.
6257 MAXIMUM REIMBURSEMENT FOR OXIMETRY IS $280.00 PER MEMBER PER 30 DAYS. REIMBURSEMENT REFLECTS THE DIFFERENCE BETWEEN INDIANA HEALTH COVERAGE PROGRAM'S ALLOWABLE FOR OXIMETRY AND THE AMOUNT PREVIOUSLY PAID FOR OXIMETRY.
6258 THERAPEUTIC LEAVE DAYS ARE LIMITED TO 60 PER CALENDAR YEAR FOR MEMBERS RECEIVING INPATIENT PSYCHIATRIC SERVICES.
6260 PARENTERAL/ENTERAL SUPPLY KITS AND ADDITIONAL SUPPLIES MAY BE BILLED WITHIN THE SAME MONTH. UTILIZATION WILL BE RETROSPECTIVELY MONITORED BY THE PROGRAM INTEGRITY REVIEW UNIT.
6261 PARENTERAL/ENTERAL SUPPLY KITS AND ADDITIONAL SUPPLIES MAY BE BILLED WITHIN THE SAME MONTH. UTILIZATION WILL BE RETROSPECTIVELY MONITORED BY THE PROGRAM INTEGRITY UNIT.
6262 PROCEDURE CODE 99051, MUST BE BILLED WITH AN EVALUATION AND MANAGMENT CODE.
6264 DO277 IS LIMITED TO ONE UNIT OF 7-8 VIEWS A YEAR
6265 HORIZONTAL BITEWING X-RAYS ARE LIMITED TO FOUR EVERY 12 MONTHS
6266 VERTICAL BITEWING X-RAYS ARE LIMITED TO 7 TO 8 IMAGES EVERY 12 MONTHS.
6267 LEAVE DAYS FOR PROVIDER SPECIALTY 030-NURSING FACILITY WILL NO LONGER BE REIMBURSED.
6268 ORAL EVALUATION FOR PATIENT UNDER 3 YEARS OF AGE LIMITED ONE PER YEAR
6269 REIMBURSEMENT IS NOT AVAILABLE FOR PODIATRIC DETAILED OR COMPREHENSIVE OFFICE VISITS FOR NEW OR ESTABLISHED PATIENTS.
6270 SMOKING CESSATION COUNSELING SERVICES ARE LIMITED TO 10 UNITS PER MEMBER PER CALENDAR YEAR.
6271 LENSES INITIAL OR REPLACEMENT- MEMBER 21 YEAR OR YOUNGER
6272 LENSES INITIAL REPAIR/REPLACEMENT MEMBER OVER 21 YEARS OF AGE
6273 THE MEMBER HAS EXHAUSTED A BENEFIT LIMIT FOR DENTAL SERVICES. THE LIMIT FOR 21 AND OLDER IS $1,000.00 PER YEAR
6274 THE MEMBER HAS EXHAUSTED A BENEFIT LIMIT FOR DENTAL SERVICES. THE LIMIT FOR 21 AND OLDER IS $1,000.00 PER YEAR.
6275 MULTIPLE DENTAL SEDATION CODES ARE NOT PAYABLE ON THE SAME DATE OF SERVICE.
6276 BREAST CANCER ANALYSIS (BRCA1 & BRCA2) IS NOT PAYABLE WHEN A BREAST CANCER ANALYSIS CODE HAS ALREADY BEEN PAID.
6277 AMBULANCE (ALS OR BLS) OXYGEN IS NOT ALLOWED ON THE SAME DAY AS AMBULANCE ALS TRANSPORT AND VICE VERSA. THE BASE CODE FOR ALS TRANSPORT INCLUDES REIMBURSEMENT FOR OXYGEN AND SUPPLIES.
6278 LIVER ELASTOGRAPHY IS LIMITED TO 1 UNIT PER 6 MONTHS.
6279 LIVER ELASTOGRAPHY NOT PAYABLE WHEN LIVER BIOPSY HAS BEEN REIMBURSED FOR THE RECIPIENT WITHIN THE PREVIOUS 6 MONTHS.
6280 PET SCAN PROCEDURES REFRACTORY SEIZURES LIMITED TO DIAGNOSIS CODES
6281 PET SCAN IMAGING PROCEDURES (SINGLE PULMONARY NODULE, COLORECTAL, ESOPHAGEAL, MELANOMA, NON-SMALL CELL LUNG, LYMPHOMA, OR HEAD AND NECK CANCER), ARE LIMITED TO SPECIFIC DIAGNOSIS CODES.
6282 PET SCAN IMAGING FOR MYOCARDIAL PERFUSION IS LIMITED TO SPECIFIC DIAGNOSIS CODES
6288 PET SCAN IMAGING (BREAST CANCER, WHOLE BODY OR REGIONAL FOR NECK AND HEAD CANCER) ARE LIMITED TO SPECIFIC DIAGNOSIS CODES
6289 A PREVIOUSLY PAID LIVER ELASTOGRAPHY SERVICE WITH A DATE OF SERVICE 6 MONTHS OR LESS AFTER THE DATE OF SERVICE OF THE BIOPSY IS BEING RECOUPED. THE LIVER BIOPSY SERVICE WILL BE PAID.
6290 HBO LIMITED BY DIAGNOSIS CODE
6291 REIMBURSEMENT IS LIMITED TO 25 OCCUPATIONAL THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6292 REIMBURSEMENT IS LIMITED TO 25 SPEECH THERAPY TREATMENTS PER MEMBER PER CALENDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE
6293 REIMBURSEMENT IS LIMITED TO 25 PHYSICAL THERAPY TREATMENTS PER MEMBER PER CALANDAR YEAR. THIS MEMBER HAS RECEIVED THE MAXIMUM NUMBER ALLOWABLE.
6294 PHYSICAL THERAPY SERVICES ARE LIMITED TO 25 VISITS PER YEAR
6295 OCCUPATIONAL THERAPY IS LIMITED TO 25 VISITS PER YEAR
6296 SPEECH THERAPY IS LIMITED TO 25 VISITS PER YEAR
6297 ROUTINE VISION EXAMS LIMITED TO ONE (1) PER TWELVE (12) MONTHS FOR AGES 1 TO 20 YEARS.
6298 ROUTINE VISION EXAMS ARE LIMITED TO ONE (1) PER TWENTY-FOUR (24) MONTHS FOR AGES TWENTY-ONE TO 999 YEARS.
6299 VEP LIMITED TO SPECIFIC DIAGNOSIS CODES
6300 DRUGS LIMITED TO SPECIFIC ESRD DX (DTL)
6301 EFFECTIVE 4/1/2020, THERAPY AND BEHAVIORAL SUPPORT SERVICES IN A GROUP SETTING LIMITED TO 75 HOURS PER YEAR. PRIOR TO 4/1/2020 THE LIMIT IS 30 HOURS PER YEAR
6302 GROUP ADDICTION COUNSELING IS NOT REIMBURSED ON THE SAME DAY AS INTENSIVE OUTPATIENT TREATMENT
6303 INDIVIDUAL AND GROUP SKILLS TRAINING AND DEVELOPMENT IS NOT REIMBURSED ON THE SAME DAY AS A CHILD/ADOLESCENT/ADULT INTENSIVE RESILIENCY SERVICES.
6304 A MEDICAID COMPOSITE RATE REVENUE CODE HAS ALREADY BEEN PAID FOR THE SAME DATE OF SERVICE
6305 PERIODONTAL MAINTENANCE (D4910) NOT ALLOWED WITHOUT A PERIODONTAL SERVICE PAID IN HISTORY.
6306 PROCEDURE REQUIRES CATARACT SURGERY PROCEDURE PAID FOR THE SAME DATE OF SERVICE.
6307 ONCOLOGY COLORECTAL SCREENING, QUANTITATIVE, LIMITED TO ONCE EVERY 3 YEARS
6308 PERIODONTAL MAINTENANCE NOT ALLOWED WITHIN SIX MONTHS OF A PERIODONTAL SERVICE.
6310 PROPHYLAXIS AND PERIODONTAL MAINTENANCE LIMITED TO ONE TREATMENT EVERY SIX MONTHS FOR NON-INSTITUTIONALIZED MEMBERS OVER AGE TWELVE MONTHS TO TWENTY-ONE 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.
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