CARC

Claim Adjustment Reason Codes — external reference descriptions plus AR Guide guidance.

407 codes

Reference descriptions are external (ASC X12) and shown for lookup. Codes marked “guide” also have AR Guide denial guidance; everything AR Guide writes is labeled separately from reference data.

297 of 297 current CARC codes — 110 historical codes hidden; use “Historical” to view them

CARC codes with official descriptions
Code	Official description (ASC X12)	Lifecycle
1guide	Deductible Amount	Current
2guide	Coinsurance Amount	Current
3guide	Co-payment Amount	Current
4guide	The procedure code is inconsistent with the modifier used. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
5	The procedure code/type of bill is inconsistent with the place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
6	The procedure/revenue code is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
7guide	The procedure/revenue code is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
8	The procedure code is inconsistent with the provider type/specialty (taxonomy). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
9	The diagnosis is inconsistent with the patient's age. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
10	The diagnosis is inconsistent with the patient's gender. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
11guide	The diagnosis is inconsistent with the procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
12guide	The diagnosis is inconsistent with the provider type. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
13	The date of death precedes the date of service.	Current
14	The date of birth follows the date of service.	Current
16guide	Claim/service lacks information or has submission/billing error(s). Usage: Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
18guide	Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)	Current
19	This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.	Current
20	This injury/illness is covered by the liability carrier.	Current
21	This injury/illness is the liability of the no-fault carrier.	Current
22guide	This care may be covered by another payer per coordination of benefits.	Current
23guide	The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)	Current
24	Charges are covered under a capitation agreement/managed care plan.	Current
26	Expenses incurred prior to coverage.	Current
27guide	Expenses incurred after coverage terminated.	Current
29guide	The time limit for filing has expired.	Current
31guide	Patient cannot be identified as our insured.	Current
32	Our records indicate the patient is not an eligible dependent.	Current
33	Insured has no dependent coverage.	Current
34	Insured has no coverage for newborns.	Current
35	Lifetime benefit maximum has been reached.	Current
39	Services denied at the time authorization/pre-certification was requested.	Current
40	Charges do not meet qualifications for emergent/urgent care. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
44	Prompt-pay discount.	Current
45guide	Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Usage: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)	Current
49guide	This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
50guide	These are non-covered services because this is not deemed a 'medical necessity' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
51	These are non-covered services because this is a pre-existing condition. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
53	Services by an immediate relative or a member of the same household are not covered.	Current
54	Multiple physicians/assistants are not covered in this case. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
55guide	Procedure/treatment/drug is deemed experimental/investigational by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
56	Procedure/treatment has not been deemed 'proven to be effective' by the payer. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
58	Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
59	Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
60	Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.	Current
61	Adjusted for failure to obtain second surgical opinion	Current
66	Blood Deductible.	Current
69	Day outlier amount.	Current
70	Cost outlier - Adjustment to compensate for additional costs.	Current
74	Indirect Medical Education Adjustment.	Current
75	Direct Medical Education Adjustment.	Current
76	Disproportionate Share Adjustment.	Current
78	Non-Covered days/Room charge adjustment.	Current
85	Patient Interest Adjustment (Use Only Group code PR)	Current
89	Professional fees removed from charges.	Current
90	Ingredient cost adjustment. Usage: To be used for pharmaceuticals only.	Current
91guide	Dispensing fee adjustment.	Current
94guide	Processed in Excess of charges.	Current
95	Plan procedures not followed.	Current
96guide	Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
97guide	The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
100	Payment made to patient/insured/responsible party.	Current
101	Predetermination: anticipated payment upon completion of services or claim adjudication.	Current
102	Major Medical Adjustment.	Current
103	Provider promotional discount (e.g., Senior citizen discount).	Current
104	Managed care withholding.	Current
105	Tax withholding.	Current
106	Patient payment option/election not in effect.	Current
107guide	The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
108	Rent/purchase guidelines were not met. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
109guide	Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.	Current
110	Billing date predates service date.	Current
111	Not covered unless the provider accepts assignment.	Current
112	Service not furnished directly to the patient and/or not documented.	Current
114	Procedure/product not approved by the Food and Drug Administration.	Current
115	Procedure postponed, canceled, or delayed.	Current
116	The advance indemnification notice signed by the patient did not comply with requirements.	Current
117	Transportation is only covered to the closest facility that can provide the necessary care.	Current
118	ESRD network support adjustment.	Current
119guide	Benefit maximum for this time period or occurrence has been reached.	Current
121guide	Indemnification adjustment - compensation for outstanding member responsibility.	Current
122guide	Psychiatric reduction.	Current
128guide	Newborn's services are covered in the mother's Allowance.	Current
129guide	Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Current
130	Claim submission fee.	Current
131guide	Claim specific negotiated discount.	Current
132	Prearranged demonstration project adjustment.	Current
133	The disposition of this service line is pending further review. (Use only with Group Code OA). Usage: Use of this code requires a reversal and correction when the service line is finalized (use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837).	Current
134	Technical fees removed from charges.	Current
135	Interim bills cannot be processed.	Current
136	Failure to follow prior payer's coverage rules. (Use only with Group Code OA)	Current
137	Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.	Current
139	Contracted funding agreement - Subscriber is employed by the provider of services. Use only with Group Code CO.	Current
140	Patient/Insured health identification number and name do not match.	Current
142	Monthly Medicaid patient liability amount.	Current
143	Portion of payment deferred.	Current
144guide	Incentive adjustment, e.g. preferred product/service.	Current
146	Diagnosis was invalid for the date(s) of service reported.	Current
147	Provider contracted/negotiated rate expired or not on file.	Current
148	Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Current
149	Lifetime benefit maximum has been reached for this service/benefit category.	Current
150guide	Payer deems the information submitted does not support this level of service.	Current
151guide	Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.	Current
152	Payer deems the information submitted does not support this length of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
153	Payer deems the information submitted does not support this dosage.	Current
154	Payer deems the information submitted does not support this day's supply.	Current
155guide	Patient refused the service/procedure.	Current
157	Service/procedure was provided as a result of an act of war.	Current
158	Service/procedure was provided outside of the United States.	Current
159	Service/procedure was provided as a result of terrorism.	Current
160	Injury/illness was the result of an activity that is a benefit exclusion.	Current
161	Provider performance bonus	Current
163guide	Attachment/other documentation referenced on the claim was not received.	Current
164	Attachment/other documentation referenced on the claim was not received in a timely fashion.	Current
166	These services were submitted after this payers responsibility for processing claims under this plan ended.	Current
167guide	This (these) diagnosis(es) is (are) not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
169	Alternate benefit has been provided.	Current
170guide	Payment is denied when performed/billed by this type of provider. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
171	Payment is denied when performed/billed by this type of provider in this type of facility. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
172	Payment is adjusted when performed/billed by a provider of this specialty. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
173	Service/equipment was not prescribed by a physician.	Current
174guide	Service was not prescribed prior to delivery.	Current
175	Prescription is incomplete.	Current
176guide	Prescription is not current.	Current
177guide	Patient has not met the required eligibility requirements.	Current
178	Patient has not met the required spend down requirements.	Current
179	Patient has not met the required waiting requirements. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
180guide	Patient has not met the required residency requirements.	Current
181	Procedure code was invalid on the date of service.	Current
182	Procedure modifier was invalid on the date of service.	Current
183	The referring provider is not eligible to refer the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
184	The prescribing/ordering provider is not eligible to prescribe/order the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
185	The rendering provider is not eligible to perform the service billed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
186	Level of care change adjustment.	Current
187	Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.)	Current
188	This product/procedure is only covered when used according to FDA recommendations.	Current
189	'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service	Current
190	Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.	Current
192	Non standard adjustment code from paper remittance. Usage: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment.	Current
193	Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.	Current
194	Anesthesia performed by the operating physician, the assistant surgeon or the attending physician.	Current
195	Refund issued to an erroneous priority payer for this claim/service.	Current
197guide	Precertification/authorization/notification/pre-treatment absent.	Current
198	Precertification/notification/authorization/pre-treatment exceeded.	Current
199guide	Revenue code and Procedure code do not match.	Current
200guide	Expenses incurred during lapse in coverage	Current
201guide	Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. (Use only with Group Code PR) At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Current
202guide	Non-covered personal comfort or convenience services.	Current
203	Discontinued or reduced service.	Current
204guide	This service/equipment/drug is not covered under the patient's current benefit plan	Current
205	Pharmacy discount card processing fee	Current
206guide	National Provider Identifier - missing.	Current
207	National Provider identifier - Invalid format	Current
208guide	National Provider Identifier - Not matched.	Current
209guide	Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA)	Current
210guide	Payment adjusted because pre-certification/authorization not received in a timely fashion	Current
211	National Drug Codes (NDC) not eligible for rebate, are not covered.	Current
212guide	Administrative surcharges are not covered	Current
213guide	Non-compliance with the physician self referral prohibition legislation or payer policy.	Current
215	Based on subrogation of a third party settlement	Current
216	Based on the findings of a review organization or the payer's findings.	Current
219	Based on extent of injury. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF).	Current
222	Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
223	Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.	Current
224	Patient identification compromised by identity theft. Identity verification required for processing this and future claims.	Current
225	Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)	Current
226	Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Current
227	Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Current
228	Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication	Current
229	Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Usage: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. (Use only with Group Code PR)	Current
231	Mutually exclusive procedures cannot be done in the same day/setting. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
232guide	Institutional Transfer Amount. Usage: Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions.	Current
233guide	Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.	Current
234guide	This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Current
235	Sales Tax	Current
236guide	This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.	Current
237	Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Current
238guide	Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period. (Use only with Group Code PR)	Current
239guide	Claim spans eligible and ineligible periods of coverage. Rebill separate claims.	Current
240guide	The diagnosis is inconsistent with the patient's birth weight. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
241	Low Income Subsidy (LIS) Co-payment Amount	Current
242guide	Services not provided by network/primary care providers.	Current
243guide	Services not authorized by network/primary care providers.	Current
245guide	Provider performance program withhold.	Current
246guide	This non-payable code is for required reporting only.	Current
247	Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.	Current
248	Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.	Current
249	This claim has been identified as a readmission. (Use only with Group Code CO)	Current
250	The attachment/other documentation that was received was the incorrect attachment/document. The expected attachment/document is still missing. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).	Current
251	The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).	Current
252	An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).	Current
253guide	Sequestration - reduction in federal payment	Current
254guide	Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient's medical plan for further consideration.	Current
256	Service not payable per managed care contract.	Current
257	The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)	Current
258	Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service.	Current
259	Additional payment for Dental/Vision service utilization.	Current
260	Processed under Medicaid ACA Enhanced Fee Schedule	Current
261	The procedure or service is inconsistent with the patient's history.	Current
262	Adjustment for delivery cost. Usage: To be used for pharmaceuticals only.	Current
263	Adjustment for shipping cost. Usage: To be used for pharmaceuticals only.	Current
264	Adjustment for postage cost. Usage: To be used for pharmaceuticals only.	Current
265	Adjustment for administrative cost. Usage: To be used for pharmaceuticals only.	Current
266	Adjustment for compound preparation cost. Usage: To be used for pharmaceuticals only.	Current
267	Claim/service spans multiple months. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)	Current
268	The Claim spans two calendar years. Please resubmit one claim per calendar year.	Current
269	Anesthesia not covered for this service/procedure. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
270	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's dental plan for further consideration.	Current
271	Prior contractual reductions related to a current periodic payment as part of a contractual payment schedule when deferred amounts have been previously reported. (Use only with Group Code OA)	Current
272guide	Coverage/program guidelines were not met.	Current
273	Coverage/program guidelines were exceeded.	Current
274	Fee/Service not payable per patient Care Coordination arrangement.	Current
275guide	Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered. (Use only with Group Code PR)	Current
276	Services denied by the prior payer(s) are not covered by this payer.	Current
277	The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)	Current
278	Performance program proficiency requirements not met. (Use only with Group Codes CO or PI) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
279	Services not provided by Preferred network providers. Usage: Use this code when there are member network limitations. For example, using contracted providers not in the member's 'narrow' network.	Current
280	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's Pharmacy plan for further consideration.	Current
281	Deductible waived per contractual agreement. Use only with Group Code CO.	Current
282	The procedure/revenue code is inconsistent with the type of bill. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
283	Attending provider is not eligible to provide direction of care.	Current
284	Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the billed services.	Current
285	Appeal procedures not followed	Current
286	Appeal time limits not met	Current
287	Referral exceeded	Current
288guide	Referral absent	Current
289	Services considered under the dental and medical plans, benefits not available.	Current
290	Claim received by the dental plan, but benefits not available under this plan. Claim has been forwarded to the patient's medical plan for further consideration.	Current
291guide	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's dental plan for further consideration.	Current
292guide	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's pharmacy plan for further consideration.	Current
293guide	Payment made to employer.	Current
294guide	Payment made to attorney.	Current
295	Pharmacy Direct/Indirect Remuneration (DIR)	Current
296	Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the provider.	Current
297	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's vision plan for further consideration.	Current
298	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's vision plan for further consideration.	Current
299	The billing provider is not eligible to receive payment for the service billed.	Current
300	Claim received by the Medical Plan, but benefits not available under this plan. Claim has been forwarded to the patient's Behavioral Health Plan for further consideration.	Current
301	Claim received by the Medical Plan, but benefits not available under this plan. Submit these services to the patient's Behavioral Health Plan for further consideration.	Current
302	Precertification/notification/authorization/pre-treatment time limit has expired.	Current
303	Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered for Qualified Medicare and Medicaid Beneficiaries. (Use only with Group Code CO)	Current
304	Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient's hearing plan for further consideration.	Current
305	Claim received by the medical plan, but benefits not available under this plan. Claim has been forwarded to the patient's hearing plan for further consideration.	Current
306	Type of bill is inconsistent with the patient status. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
307	Medicare Maximum Fair Price Standard Default Refund Amount Adjustment. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: To be used only for the Medicare Drug Price Negotiation Program.	Current
308	Payment is adjusted due to contracted funding agreement between the payer and provider.	Current
A0	Patient refund amount.	Current
A1	Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Use this code only when a more specific Claim Adjustment Reason Code is not available.	Current
A5	Medicare Claim PPS Capital Cost Outlier Amount.	Current
A6	Prior hospitalization or 30 day transfer requirement not met.	Current
A8	Ungroupable DRG.	Current
B1	Non-covered visits.	Current
B4	Late filing penalty.	Current
B7	This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
B8	Alternative services were available, and should have been utilized. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
B9	Patient is enrolled in a Hospice.	Current
B10	Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.	Current
B11	The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.	Current
B12	Services not documented in patient's medical records.	Current
B13	Previously paid. Payment for this claim/service may have been provided in a previous payment.	Current
B14	Only one visit or consultation per physician per day is covered.	Current
B15	This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.	Current
B16	'New Patient' qualifications were not met.	Current
B20	Procedure/service was partially or fully furnished by another provider.	Current
B22	This payment is adjusted based on the diagnosis.	Current
B23	Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test.	Current
P1	State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. To be used for Property and Casualty only.	Current
P2	Not a work related injury/illness and thus not the liability of the workers' compensation carrier Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only.	Current
P3	Workers' Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. To be used for Workers' Compensation only. (Use only with Group Code PR)	Current
P4	Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only	Current
P5	Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. To be used for Property and Casualty only.	Current
P6	Based on entitlement to benefits. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Property and Casualty only.	Current
P7	The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. To be used for Property and Casualty only.	Current
P8	Claim is under investigation. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Property and Casualty only.	Current
P9	No available or correlating CPT/HCPCS code to describe this service. To be used for Property and Casualty only.	Current
P10	Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation. To be used for Property and Casualty only.	Current
P11	The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. To be used for Property and Casualty only. (Use only with Group Code OA)	Current
P12	Workers' compensation jurisdictional fee schedule adjustment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Workers' Compensation only.	Current
P13	Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Workers' Compensation only.	Current
P14	The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To be used for Property and Casualty only.	Current
P15	Workers' Compensation Medical Treatment Guideline Adjustment. To be used for Workers' Compensation only.	Current
P16	Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for Workers' Compensation only. (Use with Group Code CO or OA)	Current
P17	Referral not authorized by attending physician per regulatory requirement. To be used for Property and Casualty only.	Current
P18	Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a comparable service. To be used for Property and Casualty only.	Current
P19	Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. To be used for Property and Casualty only.	Current
P20	Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used for Property and Casualty only.	Current
P21	Payment denied based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits jurisdictional regulations, or payment policies. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.	Current
P22	Payment adjusted based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits jurisdictional regulations, or payment policies. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.	Current
P23	Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.	Current
P24	Payment adjusted based on Preferred Provider Organization (PPO). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty only. Use only with Group Code CO.	Current
P25	Payment adjusted based on Medical Provider Network (MPN). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty only. (Use only with Group Code CO).	Current
P26	Payment adjusted based on Voluntary Provider network (VPN). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty only. (Use only with Group Code CO).	Current
P27	Payment denied based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.	Current
P28	Payment adjusted based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.	Current
P29	Liability Benefits jurisdictional fee schedule adjustment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.	Current
P30	Payment denied for exacerbation when supporting documentation was not complete. To be used for Property and Casualty only.	Current
P31	Payment denied for exacerbation when treatment exceeds time allowed. To be used for Property and Casualty only.	Current
P32	Payment adjusted due to Apportionment.	Current