AGAR Guide

RARC

Remittance Advice Remark Codes — additional explanations that accompany adjustments.

1216 codes

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

1137 of 1137 current RARC codes — 79 historical codes hidden; use “Historical” to view them

RARC codes with official descriptions
CodeOfficial description (ASC X12)Lifecycle
M1X-ray not taken within the past 12 months or near enough to the start of treatment.Current
M2Not paid separately when the patient is an inpatient.Current
M3Equipment is the same or similar to equipment already being used.Current
M4ALERTThis is the last monthly installment payment for this durable medical equipment.Current
M5Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.Current
M6ALERTYou must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.Current
M7No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.Current
M8We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.Current
M9ALERTThis is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.Current
M10Equipment purchases are limited to the first or the tenth month of medical necessity.Current
M11DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.Current
M12Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.Current
M13Only one initial visit is covered per specialty per medical group.Current
M14No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.Current
M15Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.Current
M16ALERTPlease see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.Current
M17ALERTPayment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions.Current
M18Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient's home.Current
M19Missing oxygen certification/re-certification.Current
M20Missing/incomplete/invalid HCPCS.Current
M21Missing/incomplete/invalid place of residence for this service/item provided in a home.Current
M22Missing/incomplete/invalid number of miles traveled.Current
M23Missing invoice.Current
M24Missing/incomplete/invalid number of doses per vial.Current
M25The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.Current
M26The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service/any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice. The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.Current
M27ALERTThe patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office.Current
M28This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.Current
M29Missing operative note/report.Current
M30Missing pathology report.Current
M31Missing radiology report.Current
M32ALERTThis is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.Current
M36This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase.Current
M37Not covered when the patient is under age 35.Current
M38ALERTThe patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not pay for it and the patient agreed to be responsible for the charges.Current
M39ALERTThe patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.Current
M40Claim must be assigned and must be filed by the practitioner's employer.Current
M41We do not pay for this as the patient has no legal obligation to pay for this.Current
M42The medical necessity form must be personally signed by the attending physician.Current
M44Missing/incomplete/invalid condition code.Current
M45Missing/incomplete/invalid occurrence code(s).Current
M46Missing/incomplete/invalid occurrence span code(s).Current
M47Missing/incomplete/invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN).Current
M49Missing/incomplete/invalid value code(s) or amount(s).Current
M50Missing/incomplete/invalid revenue code(s).Current
M51Missing/incomplete/invalid procedure code(s).Current
M52Missing/incomplete/invalid 'from' date(s) of service.Current
M53Missing/incomplete/invalid days or units of service.Current
M54Missing/incomplete/invalid total charges.Current
M55We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.Current
M56Missing/incomplete/invalid payer identifier.Current
M59Missing/incomplete/invalid 'to' date(s) of service.Current
M60Missing Certificate of Medical Necessity.Current
M61We cannot pay for this as the approval period for the FDA clinical trial has expired.Current
M62Missing/incomplete/invalid treatment authorization code.Current
M64Missing/incomplete/invalid other diagnosis.Current
M65One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.Current
M66Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items.Current
M67Missing/incomplete/invalid other procedure code(s).Current
M69Paid at the regular rate as you did not submit documentation to justify the modified procedure code.Current
M70ALERTThe NDC code submitted for this service was translated to a HCPCS code for processing, but please continue to submit the NDC on future claims for this item.Current
M71Total payment reduced due to overlap of tests billed.Current
M73The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.Current
M74This service does not qualify for a HPSA/Physician Scarcity bonus payment.Current
M75Multiple automated multichannel tests performed on the same day combined for payment.Current
M76Missing/incomplete/invalid diagnosis or condition.Current
M77Missing/incomplete/invalid/inappropriate place of service.Current
M79Missing/incomplete/invalid charge.Current
M80Not covered when performed during the same session/date as a previously processed service for the patient.Current
M81You are required to code to the highest level of specificity.Current
M82Service is not covered when patient is under age 50.Current
M83Service is not covered unless the patient is classified as at high risk.Current
M84Medical code sets used must be the codes in effect at the time of service.Current
M85Subjected to review of physician evaluation and management services.Current
M86Service denied because payment already made for same/similar procedure within set time frame.Current
M87Claim/service(s) subjected to CFO-CAP prepayment review.Current
M89Not covered more than once under age 40.Current
M90Not covered more than once in a 12 month period.Current
M91Lab procedures with different CLIA certification numbers must be billed on separate claims.Current
M93Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.Current
M94Information supplied does not support a break in therapy. A new capped rental period will not begin.Current
M95Services subjected to Home Health Initiative medical review/cost report audit.Current
M96The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.Current
M97Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.Current
M99Missing/incomplete/invalid Universal Product Number/Serial Number.Current
M100We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug.Current
M102Service not performed on equipment approved by the FDA for this purpose.Current
M103Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.Current
M104Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.Current
M105Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.Current
M107Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.Current
M109We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.Current
M111We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.Current
M112Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.Current
M113Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.Current
M114This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.Current
M115This item is denied when provided to this patient by a non-contract or non-demonstration supplier.Current
M116Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.Current
M117Not covered unless submitted via electronic claim.Current
M119Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).Current
M121We pay for this service only when performed with a covered cryosurgical ablation.Current
M122Missing/incomplete/invalid level of subluxation.Current
M123Missing/incomplete/invalid name, strength, or dosage of the drug furnished.Current
M124Missing indication of whether the patient owns the equipment that requires the part or supply.Current
M125Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.Current
M126Missing/incomplete/invalid individual lab codes included in the test.Current
M127Missing patient medical record for this service.Current
M129Missing/incomplete/invalid indicator of x-ray availability for review.Current
M130Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.Current
M131Missing physician financial relationship form.Current
M132Missing pacemaker registration form.Current
M133Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.Current
M134Performed by a facility/supplier in which the provider has a financial interest.Current
M135Missing/incomplete/invalid plan of treatment.Current
M136Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.Current
M137Part B coinsurance under a demonstration project or pilot program.Current
M138Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants.Current
M139Denied services exceed the coverage limit for the demonstration.Current
M141Missing physician certified plan of care.Current
M142Missing American Diabetes Association Certificate of Recognition.Current
M143The provider must update license information with the payer.Current
M144Pre-/post-operative care payment is included in the allowance for the surgery/procedure.Current
MA01ALERTIf you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.Current
MA02ALERTIf you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice.Current
MA04Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.Current
MA07ALERTThe claim information has also been forwarded to Medicaid for review.Current
MA08ALERTClaim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.Current
MA09ALERTClaim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.Current
MA10ALERTThe patient's payment was in excess of the amount owed. You must refund the overpayment to the patient.Current
MA12You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).Current
MA13ALERTYou may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.Current
MA14ALERTThe patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services.Current
MA15ALERTYour claim has been separated to expedite handling. You will receive a separate notice for the other services reported.Current
MA16The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.Current
MA17We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment.Current
MA18ALERTThe claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.Current
MA19ALERTInformation was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondary claim directly to that insurer.Current
MA20Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.Current
MA21SSA records indicate mismatch with name and sex.Current
MA22Payment of less than $1.00 suppressed.Current
MA23Demand bill approved as result of medical review.Current
MA24Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.Current
MA25A patient may not elect to change a hospice provider more than once in a benefit period.Current
MA26ALERTOur records indicate that you were previously informed of this rule.Current
MA27Missing/incomplete/invalid entitlement number or name shown on the claim.Current
MA28ALERTReceipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice.Current
MA30Missing/incomplete/invalid type of bill.Current
MA31Missing/incomplete/invalid beginning and ending dates of the period billed.Current
MA32Missing/incomplete/invalid number of covered days during the billing period.Current
MA33Missing/incomplete/invalid non-covered days during the billing period.Current
MA34Missing/incomplete/invalid number of coinsurance days during the billing period.Current
MA35Missing/incomplete/invalid number of lifetime reserve days.Current
MA36Missing/incomplete/invalid patient name.Current
MA37Missing/incomplete/invalid patient's address.Current
MA39Missing/incomplete/invalid gender.Current
MA40Missing/incomplete/invalid admission date.Current
MA41Missing/incomplete/invalid admission type.Current
MA42Missing/incomplete/invalid admission source.Current
MA43Missing/incomplete/invalid patient status.Current
MA44ALERTNo appeal rights. Adjudicative decision based on law.Current
MA45ALERTAs previously advised, a portion or all of your payment is being held in a special account.Current
MA46ALERTThe new information was considered but additional payment will not be issued.Current
MA47Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.Current
MA48Missing/incomplete/invalid name or address of responsible party or primary payer.Current
MA50Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.Current
MA53Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.Current
MA54Physician certification or election consent for hospice care not received timely.Current
MA55Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.Current
MA56Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.Current
MA57Patient submitted written request to revoke his/her election for religious non-medical health care services.Current
MA58Missing/incomplete/invalid release of information indicator.Current
MA59ALERTThe patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice.Current
MA60Missing/incomplete/invalid patient relationship to insured.Current
MA61Missing/incomplete/invalid social security number.Current
MA62ALERTThis is a telephone review decision.Current
MA63Missing/incomplete/invalid principal diagnosis.Current
MA64Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.Current
MA65Missing/incomplete/invalid admitting diagnosis.Current
MA66Missing/incomplete/invalid principal procedure code.Current
MA67ALERTCorrection to a prior claim.Current
MA68ALERTWe did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to assure correct and timely routing of the claim.Current
MA69Missing/incomplete/invalid remarks.Current
MA70Missing/incomplete/invalid provider representative signature.Current
MA71Missing/incomplete/invalid provider representative signature date.Current
MA72ALERTThe patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice.Current
MA73Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.Current
MA74ALERTThis payment replaces an earlier payment for this claim that was either lost, damaged or returned.Current
MA75Missing/incomplete/invalid patient or authorized representative signature.Current
MA76Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.Current
MA77ALERTThe patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient's payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice.Current
MA79Billed in excess of interim rate.Current
MA80Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project.Current
MA81Missing/incomplete/invalid provider/supplier signature.Current
MA83Did not indicate whether we are the primary or secondary payer.Current
MA84Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.Current
MA88Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.Current
MA89Missing/incomplete/invalid patient's relationship to the insured for the primary payer.Current
MA90Missing/incomplete/invalid employment status code for the primary insured.Current
MA91ALERTThis determination is the result of the appeal you filed.Current
MA92Missing plan information for other insurance.Current
MA93Non-PIP (Periodic Interim Payment) claim.Current
MA94Did not enter the statement 'Attending physician not hospice employee' on the claim form to certify that the rendering physician is not an employee of the hospice.Current
MA96Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.Current
MA97Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.Current
MA99Missing/incomplete/invalid Medigap information.Current
MA100Missing/incomplete/invalid date of current illness or symptoms.Current
MA103Hemophilia Add On.Current
MA106PIP (Periodic Interim Payment) claim.Current
MA107Paper claim contains more than three separate data items in field 19.Current
MA108Paper claim contains more than one data item in field 23.Current
MA109Claim processed in accordance with ambulatory surgical guidelines.Current
MA110Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.Current
MA111Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.Current
MA112Missing/incomplete/invalid group practice information.Current
MA113Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.Current
MA114Missing/incomplete/invalid information on where the services were furnished.Current
MA115Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).Current
MA116Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.Current
MA117This claim has been assessed a $1.00 user fee.Current
MA118ALERTNo Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance and/or deductible are applicable.Current
MA120Missing/incomplete/invalid CLIA certification number.Current
MA121Missing/incomplete/invalid x-ray date.Current
MA122Missing/incomplete/invalid initial treatment date.Current
MA123Your center was not selected to participate in this study, therefore, we cannot pay for these services.Current
MA125Per legislation governing this program, payment constitutes payment in full.Current
MA126Pancreas transplant not covered unless kidney transplant performed.Current
MA128Missing/incomplete/invalid FDA approval number.Current
MA130Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.Current
MA131Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim.Current
MA132Adjustment to the pre-demonstration rate.Current
MA133Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.Current
MA134Missing/incomplete/invalid provider number of the facility where the patient resides.Current
N1ALERTYou may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract, plan benefit documents or jurisdiction statutes. Refer to the URL provided in the ERA for the payer website to access the appeals process guidelines.Current
N2This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.Current
N3Missing consent form.Current
N4Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.Current
N5EOB received from previous payer. Claim not on file.Current
N6Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B.Current
N7ALERTProcessing of this claim/service has included consideration under Major Medical provisions.Current
N8Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.Current
N9Adjustment represents the estimated amount a previous payer may pay.Current
N10Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.Current
N11Denial reversed because of medical review.Current
N12Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.Current
N13Payment based on professional/technical component modifier(s).Current
N15Services for a newborn must be billed separately.Current
N16Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.Current
N19Procedure code incidental to primary procedure.Current
N20Service not payable with other service rendered on the same date.Current
N21ALERTYour line item has been separated into multiple lines to expedite handling.Current
N22ALERTThis procedure code was added/changed because it more accurately describes the services rendered.Current
N23ALERTPatient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.Current
N24Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.Current
N25This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan.Current
N26Missing itemized bill/statement.Current
N27Missing/incomplete/invalid treatment number.Current
N28Consent form requirements not fulfilled.Current
N30Patient ineligible for this service.Current
N31Missing/incomplete/invalid prescribing provider identifier.Current
N32Claim must be submitted by the provider who rendered the service.Current
N33No record of health check prior to initiation of treatment.Current
N34Incorrect claim form/format for this service.Current
N35Program integrity/utilization review decision.Current
N36Claim must meet primary payer's processing requirements before we can consider payment.Current
N37Missing/incomplete/invalid tooth number/letter.Current
N39Procedure code is not compatible with tooth number/letter.Current
N40Missing radiology film(s)/image(s).Current
N42Missing mental health assessment.Current
N43Bed hold or leave days exceeded.Current
N45Payment based on authorized amount.Current
N46Missing/incomplete/invalid admission hour.Current
N47Claim conflicts with another inpatient stay.Current
N48Claim information does not agree with information received from other insurance carrier.Current
N49Court ordered coverage information needs validation.Current
N50Missing/incomplete/invalid discharge information.Current
N51Electronic interchange agreement not on file for provider/submitter.Current
N52Patient not enrolled in the billing provider's managed care plan on the date of service.Current
N53Missing/incomplete/invalid point of pick-up address.Current
N54Claim information is inconsistent with pre-certified/authorized services.Current
N55Procedures for billing with group/referring/performing providers were not followed.Current
N56Procedure code billed is not correct/valid for the services billed or the date of service billed.Current
N57Missing/incomplete/invalid prescribing date.Current
N58Missing/incomplete/invalid patient liability amount.Current
N59ALERTPlease refer to your provider manual for additional program and provider information.Current
N61Rebill services on separate claims.Current
N62Dates of service span multiple rate periods. Resubmit separate claims.Current
N63Rebill services on separate claim lines.Current
N64The 'from' and 'to' dates must be different.Current
N65Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.Current
N67Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient's admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.Current
N68Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.Current
N69ALERTPPS (Prospective Payment System) code changed by claims processing system.Current
N70Consolidated billing and payment applies.Current
N71Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims.Current
N72PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.Current
N74Resubmit with multiple claims, each claim covering services provided in only one calendar month.Current
N75Missing/incomplete/invalid tooth surface information.Current
N76Missing/incomplete/invalid number of riders.Current
N77Missing/incomplete/invalid designated provider number.Current
N78The necessary components of the child and teen checkup (EPSDT) were not completed.Current
N79Service billed is not compatible with patient location information.Current
N80Missing/incomplete/invalid prenatal screening information.Current
N81Procedure billed is not compatible with tooth surface code.Current
N82Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.Current
N83No appeal rights. Adjudicative decision based on the provisions of a demonstration project.Current
N84ALERTFurther installment payments are forthcoming.Current
N85ALERTThis is the final installment payment.Current
N86A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.Current
N87Home use of biofeedback therapy is not covered.Current
N88ALERTThis payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care.Current
N89ALERTPayment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remittance advice.Current
N90Covered only when performed by the attending physician.Current
N91Services not included in the appeal review.Current
N92This facility is not certified for digital mammography.Current
N93A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.Current
N94Claim/Service denied because a more specific taxonomy code is required for adjudication.Current
N95This provider type/provider specialty may not bill this service.Current
N96Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.Current
N97Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.Current
N98Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.Current
N99Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.Current
N103Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.Current
N104This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.gov.Current
N105This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 888-355-9165 for RRB EDI information for electronic claims processing.Current
N106Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.Current
N107Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.Current
N108Missing/incomplete/invalid upgrade information.Current
N109ALERTThis claim/service was chosen for complex review.Current
N110This facility is not certified for film mammography.Current
N111No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.Current
N112This claim is excluded from your electronic remittance advice.Current
N113Only one initial visit is covered per physician, group practice or provider.Current
N114During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be.Current
N115This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.Current
N116ALERTThis payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency's (HHA's) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care.Current
N117This service is paid only once in a patient's lifetime.Current
N118This service is not paid if billed more than once every 28 days.Current
N119This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility (SNF) within those 28 days.Current
N120Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.Current
N121Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered Skilled Nursing Facility (SNF) stay.Current
N122Add-on code cannot be billed by itself.Current
N123ALERTThis is a split service and represents a portion of the units from the originally submitted service.Current
N124Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay.Current
N125Payment has been (denied for the/made only for a less extensive) service/item because the information furnished does not substantiate the need for the (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice. The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office.Current
N126Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported.Current
N127This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.Current
N128This amount represents the prior to coverage portion of the allowance.Current
N129Not eligible due to the patient's age.Current
N130Consult plan benefit documents/guidelines for information about restrictions for this service.Current
N131Total payments under multiple contracts cannot exceed the allowance for this service.Current
N132ALERTPayments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.Current
N133ALERTServices for predetermination and services requesting payment are being processed separately.Current
N134ALERTThis represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.Current
N135Record fees are the patient's responsibility and limited to the specified co-payment.Current
N136ALERTTo obtain information on the process to file an appeal in Arizona, call the Department's Consumer Assistance Office at (602) 912-8444 or (800) 325-2548.Current
N137ALERTThe provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority.Current
N138ALERTIn the event you disagree with the Dental Advisor's opinion and have additional information relative to the case, you may submit radiographs to the Dental Advisor Unit at the subscriber's dental insurance carrier for a second Independent Dental Advisor Review.Current
N139ALERTUnder 32 CFR 199.13, a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor's opinion, you may appeal the determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.Current
N140ALERTYou have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act as his/her representative and you disagree with the Dental Advisor's opinion, you may appeal by submitting a copy of this letter, a signed statement explaining the matter in which you disagree, and any relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.Current
N141The patient was not residing in a long-term care facility during all or part of the service dates billed.Current
N142The original claim was denied. Resubmit a new claim, not a replacement claim.Current
N143The patient was not in a hospice program during all or part of the service dates billed.Current
N144The rate changed during the dates of service billed.Current
N146Missing screening document.Current
N147Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request.Current
N148Missing/incomplete/invalid date of last menstrual period.Current
N149Rebill all applicable services on a single claim.Current
N150Missing/incomplete/invalid model number.Current
N151Telephone contact services will not be paid until the face-to-face contact requirement has been met.Current
N152Missing/incomplete/invalid replacement claim information.Current
N153Missing/incomplete/invalid room and board rate.Current
N154ALERTThis payment was delayed for correction of provider's mailing address.Current
N155ALERTOur records do not indicate that other insurance is on file. Please submit other insurance information for our records.Current
N156ALERTThe patient is responsible for the difference between the approved treatment and the elective treatment.Current
N157Transportation to/from this destination is not covered.Current
N158Transportation in a vehicle other than an ambulance is not covered.Current
N159Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.Current
N160The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.Current
N161This drug/service/supply is covered only when the associated service is covered.Current
N162ALERTAlthough your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information will result in a denial of payment in the near future.Current
N163Medical record does not support code billed per the code definition.Current
N167Charges exceed the post-transplant coverage limit.Current
N170A new/revised/renewed certificate of medical necessity is needed.Current
N171Payment for repair or replacement is not covered or has exceeded the purchase price.Current
N172The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.Current
N173No qualifying hospital stay dates were provided for this episode of care.Current
N174This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.Current
N175Missing review organization approval.Current
N176Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the United States must provide the service.Current
N177ALERTWe did not send this claim to patient's other insurer. They have indicated no additional payment can be made.Current
N178Missing pre-operative images/visual field results.Current
N179Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.Current
N180This item or service does not meet the criteria for the category under which it was billed.Current
N181Additional information is required from another provider involved in this service.Current
N182This claim/service must be billed according to the schedule for this plan.Current
N183ALERTThis is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits.Current
N184Rebill technical and professional components separately.Current
N185ALERTDo not resubmit this claim/service.Current
N186Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.Current
N187ALERTYou may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.Current
N188The approved level of care does not match the procedure code submitted.Current
N189ALERTThis service has been paid as a one-time exception to the plan's benefit restrictions.Current
N190Missing contract indicator.Current
N191The provider must update insurance information directly with payer.Current
N192ALERTPatient is a Medicaid/Qualified Medicare Beneficiary.Current
N193ALERTSpecific federal/state/local program may cover this service through another payer.Current
N194Technical component not paid if provider does not own the equipment used.Current
N195The technical component must be billed separately.Current
N196ALERTPatient eligible to apply for other coverage which may be primary.Current
N197The subscriber must update insurance information directly with payer.Current
N198Rendering provider must be affiliated with the pay-to provider.Current
N199Additional payment/recoupment approved based on payer-initiated review/audit.Current
N200The professional component must be billed separately.Current
N202ALERTAdditional information/explanation will be sent separately.Current
N203Missing/incomplete/invalid anesthesia time/units.Current
N204Services under review for possible pre-existing condition. Send medical records for prior 12 monthsCurrent
N205Information provided was illegible.Current
N206The supporting documentation does not match the information sent on the claim.Current
N207Missing/incomplete/invalid weight.Current
N208Missing/incomplete/invalid DRG code.Current
N209Missing/incomplete/invalid taxpayer identification number (TIN).Current
N210ALERTYou may appeal this decision.Current
N211ALERTYou may not appeal this decision.Current
N212Charges processed under a Point of Service benefit.Current
N213Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.Current
N214Missing/incomplete/invalid history of the related initial surgical procedure(s).Current
N215ALERTA payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determination.Current
N216We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.Current
N217We pay only one site of service per provider per claim.Current
N218You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract or coverage manual.Current
N219Payment based on previous payer's allowed amount.Current
N220ALERTSee the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.Current
N221Missing Admitting History and Physical report.Current
N222Incomplete/invalid Admitting History and Physical report.Current
N223Missing documentation of benefit to the patient during initial treatment period.Current
N224Incomplete/invalid documentation of benefit to the patient during initial treatment period.Current
N226Incomplete/invalid American Diabetes Association Certificate of Recognition.Current
N227Incomplete/invalid Certificate of Medical Necessity.Current
N228Incomplete/invalid consent form.Current
N229Incomplete/invalid contract indicator.Current
N230Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.Current
N231Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.Current
N232Incomplete/invalid itemized bill/statement.Current
N233Incomplete/invalid operative note/report.Current
N234Incomplete/invalid oxygen certification/re-certification.Current
N235Incomplete/invalid pacemaker registration form.Current
N236Incomplete/invalid pathology report.Current
N237Incomplete/invalid patient medical record for this service.Current
N238Incomplete/invalid physician certified plan of care.Current
N239Incomplete/invalid physician financial relationship form.Current
N240Incomplete/invalid radiology report.Current
N241Incomplete/invalid review organization approval.Current
N242Incomplete/invalid radiology film(s)/image(s).Current
N243Incomplete/invalid/not approved screening document.Current
N244Incomplete/Invalid pre-operative images/visual field results.Current
N245Incomplete/invalid plan information for other insurance.Current
N246State regulated patient payment limitations apply to this service.Current
N247Missing/incomplete/invalid assistant surgeon taxonomy.Current
N248Missing/incomplete/invalid assistant surgeon name.Current
N249Missing/incomplete/invalid assistant surgeon primary identifier.Current
N250Missing/incomplete/invalid assistant surgeon secondary identifier.Current
N251Missing/incomplete/invalid attending provider taxonomy.Current
N252Missing/incomplete/invalid attending provider name.Current
N253Missing/incomplete/invalid attending provider primary identifier.Current
N254Missing/incomplete/invalid attending provider secondary identifier.Current
N255Missing/incomplete/invalid billing provider taxonomy.Current
N256Missing/incomplete/invalid billing provider/supplier name.Current
N257Missing/incomplete/invalid billing provider/supplier primary identifier.Current
N258Missing/incomplete/invalid billing provider/supplier address.Current
N259Missing/incomplete/invalid billing provider/supplier secondary identifier.Current
N260Missing/incomplete/invalid billing provider/supplier contact information.Current
N261Missing/incomplete/invalid operating provider name.Current
N262Missing/incomplete/invalid operating provider primary identifier.Current
N263Missing/incomplete/invalid operating provider secondary identifier.Current
N264Missing/incomplete/invalid ordering provider name.Current
N265Missing/incomplete/invalid ordering provider primary identifier.Current
N266Missing/incomplete/invalid ordering provider address.Current
N267Missing/incomplete/invalid ordering provider secondary identifier.Current
N268Missing/incomplete/invalid ordering provider contact information.Current
N269Missing/incomplete/invalid other provider name.Current
N270Missing/incomplete/invalid other provider primary identifier.Current
N271Missing/incomplete/invalid other provider secondary identifier.Current
N272Missing/incomplete/invalid other payer attending provider identifier.Current
N273Missing/incomplete/invalid other payer operating provider identifier.Current
N274Missing/incomplete/invalid other payer other provider identifier.Current
N275Missing/incomplete/invalid other payer purchased service provider identifier.Current
N276Missing/incomplete/invalid other payer referring provider identifier.Current
N277Missing/incomplete/invalid other payer rendering provider identifier.Current
N278Missing/incomplete/invalid other payer service facility provider identifier.Current
N279Missing/incomplete/invalid pay-to provider name.Current
N280Missing/incomplete/invalid pay-to provider primary identifier.Current
N281Missing/incomplete/invalid pay-to provider address.Current
N282Missing/incomplete/invalid pay-to provider secondary identifier.Current
N283Missing/incomplete/invalid purchased service provider identifier.Current
N284Missing/incomplete/invalid referring provider taxonomy.Current
N285Missing/incomplete/invalid referring provider name.Current
N286Missing/incomplete/invalid referring provider primary identifier.Current
N287Missing/incomplete/invalid referring provider secondary identifier.Current
N288Missing/incomplete/invalid rendering provider taxonomy.Current
N289Missing/incomplete/invalid rendering provider name.Current
N290Missing/incomplete/invalid rendering provider primary identifier.Current
N291Missing/incomplete/invalid rendering provider secondary identifier.Current
N292Missing/incomplete/invalid service facility name.Current
N293Missing/incomplete/invalid service facility primary identifier.Current
N294Missing/incomplete/invalid service facility primary address.Current
N295Missing/incomplete/invalid service facility secondary identifier.Current
N296Missing/incomplete/invalid supervising provider name.Current
N297Missing/incomplete/invalid supervising provider primary identifier.Current
N298Missing/incomplete/invalid supervising provider secondary identifier.Current
N299Missing/incomplete/invalid occurrence date(s).Current
N300Missing/incomplete/invalid occurrence span date(s).Current
N301Missing/incomplete/invalid procedure date(s).Current
N302Missing/incomplete/invalid other procedure date(s).Current
N303Missing/incomplete/invalid principal procedure date.Current
N304Missing/incomplete/invalid dispensed date.Current
N305Missing/incomplete/invalid injury/accident date.Current
N306Missing/incomplete/invalid acute manifestation date.Current
N307Missing/incomplete/invalid adjudication or payment date.Current
N308Missing/incomplete/invalid appliance placement date.Current
N309Missing/incomplete/invalid assessment date.Current
N310Missing/incomplete/invalid assumed or relinquished care date.Current
N311Missing/incomplete/invalid authorized to return to work date.Current
N312Missing/incomplete/invalid begin therapy date.Current
N313Missing/incomplete/invalid certification revision date.Current
N314Missing/incomplete/invalid diagnosis date.Current
N315Missing/incomplete/invalid disability from date.Current
N316Missing/incomplete/invalid disability to date.Current
N317Missing/incomplete/invalid discharge hour.Current
N318Missing/incomplete/invalid discharge or end of care date.Current
N319Missing/incomplete/invalid hearing or vision prescription date.Current
N320Missing/incomplete/invalid Home Health Certification Period.Current
N321Missing/incomplete/invalid last admission period.Current
N322Missing/incomplete/invalid last certification date.Current
N323Missing/incomplete/invalid last contact date.Current
N324Missing/incomplete/invalid last seen/visit date.Current
N325Missing/incomplete/invalid last worked date.Current
N326Missing/incomplete/invalid last x-ray date.Current
N327Missing/incomplete/invalid other insured birth date.Current
N328Missing/incomplete/invalid Oxygen Saturation Test date.Current
N329Missing/incomplete/invalid patient birth date.Current
N330Missing/incomplete/invalid patient death date.Current
N331Missing/incomplete/invalid physician order date.Current
N332Missing/incomplete/invalid prior hospital discharge date.Current
N333Missing/incomplete/invalid prior placement date.Current
N334Missing/incomplete/invalid re-evaluation date.Current
N335Missing/incomplete/invalid referral date.Current
N336Missing/incomplete/invalid replacement date.Current
N337Missing/incomplete/invalid secondary diagnosis date.Current
N338Missing/incomplete/invalid shipped date.Current
N339Missing/incomplete/invalid similar illness or symptom date.Current
N340Missing/incomplete/invalid subscriber birth date.Current
N341Missing/incomplete/invalid surgery date.Current
N342Missing/incomplete/invalid test performed date.Current
N343Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.Current
N344Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.Current
N345Date range not valid with units submitted.Current
N346Missing/incomplete/invalid oral cavity designation code.Current
N347Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer.Current
N348You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.Current
N349The administration method and drug must be reported to adjudicate this service.Current
N350Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.Current
N351Service date outside of the approved treatment plan service dates.Current
N352ALERTThere are no scheduled payments for this service. Submit a claim for each patient visit.Current
N353ALERTBenefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.Current
N354Incomplete/invalid invoice.Current
N355ALERTThe law permits exceptions to the refund requirement in two cases: - If you did not know, and could not have reasonably been expected to know, that we would not pay for this service; or - If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service. If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position. If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision. The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination. The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 daysCurrent
N356Not covered when performed with, or subsequent to, a non-covered service.Current
N357Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.Current
N358ALERTThis decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.Current
N359Missing/incomplete/invalid height.Current
N360ALERTCoordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim.Current
N362The number of Days or Units of Service exceeds our acceptable maximum.Current
N363ALERTin the near future we are implementing new policies/procedures that would affect this determination.Current
N364ALERTAccording to our agreement, you must waive the deductible and/or coinsurance amounts.Current
N366Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice.Current
N367ALERTThe claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account.Current
N368You must appeal the determination of the previously adjudicated claim.Current
N369ALERTAlthough this claim has been processed, it is deficient according to state legislation/regulation.Current
N370Billing exceeds the rental months covered/approved by the payer.Current
N371ALERTtitle of this equipment must be transferred to the patient.Current
N372Only reasonable and necessary maintenance/service charges are covered.Current
N373It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your behalf.Current
N374Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.Current
N375Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.Current
N376Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.Current
N377Payment based on a processed replacement claim.Current
N378Missing/incomplete/invalid prescription quantity.Current
N379Claim level information does not match line level information.Current
N380The original claim has been processed, submit a corrected claim.Current
N381ALERTConsult our contractual agreement for restrictions/billing/payment information related to these charges.Current
N382Missing/incomplete/invalid patient identifier.Current
N383Not covered when deemed cosmetic.Current
N384Records indicate that the referenced body part/tooth has been removed in a previous procedure.Current
N385Notification of admission was not timely according to published plan procedures.Current
N386This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. Visit CMS.gov and search for Medicare Coverage Database to find a copy of the policy.Current
N387ALERTSubmit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information.Current
N388Missing/incomplete/invalid prescription number.Current
N389Duplicate prescription number submitted.Current
N390This service/report cannot be billed separately.Current
N391Missing emergency department records.Current
N392Incomplete/invalid emergency department records.Current
N393Missing progress notes/report.Current
N394Incomplete/invalid progress notes/report.Current
N395Missing laboratory report.Current
N396Incomplete/invalid laboratory report.Current
N397Benefits are not available for incomplete service(s)/undelivered item(s).Current
N398Missing elective consent form.Current
N399Incomplete/invalid elective consent form.Current
N400ALERTElectronically enabled providers should submit claims electronically.Current
N401Missing periodontal charting.Current
N402Incomplete/invalid periodontal charting.Current
N403Missing facility certification.Current
N404Incomplete/invalid facility certification.Current
N405This service is only covered when the donor's insurer(s) do not provide coverage for the service.Current
N406This service is only covered when the recipient's insurer(s) do not provide coverage for the service.Current
N407You are not an approved submitter for this transmission format.Current
N408This payer does not cover deductibles assessed by a previous payer.Current
N409This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident.Current
N410Not covered unless the prescription changes.Current
N411This service is allowed one time in a 6-month period.Current
N412This service is allowed 2 times in a 12-month period.Current
N413This service is allowed 2 times in a benefit year.Current
N414This service is allowed 4 times in a 12-month period.Current
N415This service is allowed 1 time in an 18-month period.Current
N416This service is allowed 1 time in a 3-year period.Current
N417This service is allowed 1 time in a 5-year period.Current
N418Misrouted claim. See the payer's claim submission instructions.Current
N419Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change.Current
N420Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.Current
N421Claim payment was the result of a payer's retroactive adjustment due to a review organization decision.Current
N422Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program.Current
N423Claim payment was the result of a payer's retroactive adjustment due to a non standard program.Current
N424Patient does not reside in the geographic area required for this type of payment.Current
N425Statutorily excluded service(s).Current
N426No coverage when self-administered.Current
N427Payment for eyeglasses or contact lenses can be made only after cataract surgery.Current
N428Not covered when performed in this place of service.Current
N429Not covered when considered routine.Current
N430Procedure code is inconsistent with the units billed.Current
N431Not covered with this procedure.Current
N432ALERTAdjustment based on a Recovery Audit.Current
N433Resubmit this claim using only your National Provider Identifier (NPI).Current
N434Missing/Incomplete/Invalid Present on Admission indicator.Current
N435Exceeds number/frequency approved /allowed within time period without support documentation.Current
N436The injury claim has not been accepted and a mandatory medical reimbursement has been made.Current
N437ALERTIf the injury claim is accepted, these charges will be reconsidered.Current
N438This jurisdiction only accepts paper claims.Current
N439Missing anesthesia physical status report/indicators.Current
N440Incomplete/invalid anesthesia physical status report/indicators.Current
N441This missed/cancelled appointment is not covered.Current
N442Payment based on an alternate fee schedule.Current
N443Missing/incomplete/invalid total time or begin/end time.Current
N444ALERTThis facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation.Current
N445Missing document for actual cost or paid amount.Current
N446Incomplete/invalid document for actual cost or paid amount.Current
N447Payment is based on a generic equivalent as required documentation was not provided.Current
N448This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.Current
N449Payment based on a comparable drug/service/supply.Current
N450Covered only when performed by the primary treating physician or the designee.Current
N451Missing Admission Summary Report.Current
N452Incomplete/invalid Admission Summary Report.Current
N453Missing Consultation Report.Current
N454Incomplete/invalid Consultation Report.Current
N455Missing Physician Order.Current
N456Incomplete/invalid Physician Order.Current
N457Missing Diagnostic Report.Current
N458Incomplete/invalid Diagnostic Report.Current
N459Missing Discharge Summary.Current
N460Incomplete/invalid Discharge Summary.Current
N461Missing Nursing Notes.Current
N462Incomplete/invalid Nursing Notes.Current
N463Missing support data for claim.Current
N464Incomplete/invalid support data for claim.Current
N465Missing Physical Therapy Notes/Report.Current
N466Incomplete/invalid Physical Therapy Notes/Report.Current
N467Missing Tests and Analysis Report.Current
N468Incomplete/invalid Report of Tests and Analysis Report.Current
N469ALERTClaim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).Current
N470This payment will complete the mandatory medical reimbursement limit.Current
N471Missing/incomplete/invalid HIPPS Rate Code.Current
N472Payment for this service has been issued to another provider.Current
N473Missing certification.Current
N474Incomplete/invalid certification.Current
N475Missing completed referral form.Current
N476Incomplete/invalid completed referral form.Current
N477Missing Dental Models.Current
N478Incomplete/invalid Dental Models.Current
N479Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).Current
N480Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).Current
N481Missing Models.Current
N482Incomplete/invalid Models.Current
N485Missing Physical Therapy Certification.Current
N486Incomplete/invalid Physical Therapy Certification.Current
N487Missing Prosthetics or Orthotics Certification.Current
N488Incomplete/invalid Prosthetics or Orthotics Certification.Current
N489Missing referral form.Current
N490Incomplete/invalid referral form.Current
N491Missing/Incomplete/Invalid Exclusionary Rider Condition.Current
N492ALERTA network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge.Current
N493Missing Doctor First Report of Injury.Current
N494Incomplete/invalid Doctor First Report of Injury.Current
N495Missing Supplemental Medical Report.Current
N496Incomplete/invalid Supplemental Medical Report.Current
N497Missing Medical Permanent Impairment or Disability Report.Current
N498Incomplete/invalid Medical Permanent Impairment or Disability Report.Current
N499Missing Medical Legal Report.Current
N500Incomplete/invalid Medical Legal Report.Current
N501Missing Vocational Report.Current
N502Incomplete/invalid Vocational Report.Current
N503Missing Work Status Report.Current
N504Incomplete/invalid Work Status Report.Current
N505ALERTThis response includes only services that could be estimated in real-time. No estimate will be provided for the services that could not be estimated in real-time.Current
N506ALERTThis is an estimate of the member's liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. This is not a pre-authorization or a guarantee of payment.Current
N507Plan distance requirements have not been met.Current
N508ALERTThis real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions.Current
N509ALERTA current inquiry shows the member's Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.Current
N510ALERTA current inquiry shows the member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.Current
N511ALERTInformation on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time.Current
N512ALERTThis is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.Current
N513ALERTThis is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.Current
N516Records indicate a mismatch between the submitted NPI and EIN.Current
N517Resubmit a new claim with the requested information.Current
N518No separate payment for accessories when furnished for use with oxygen equipment.Current
N519Invalid combination of HCPCS modifiers.Current
N520ALERTPayment made from a Consumer Spending Account.Current
N521Mismatch between the submitted provider information and the provider information stored in our system.Current
N522Duplicate of a claim processed, or to be processed, as a crossover claim.Current
N523The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid.Current
N524Based on policy this payment constitutes payment in full.Current
N525These services are not covered when performed within the global period of another service.Current
N526Not qualified for recovery based on employer size.Current
N527We processed this claim as the primary payer prior to receiving the recovery demand.Current
N528Patient is entitled to benefits for Institutional Services only.Current
N529Patient is entitled to benefits for Professional Services only.Current
N530Not Qualified for Recovery based on enrollment information.Current
N531Not qualified for recovery based on direct payment of premium.Current
N532Not qualified for recovery based on disability and working status.Current
N533Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.Current
N534This is an individual policy, the employer does not participate in plan sponsorship.Current
N535Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.Current
N536We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us.Current
N537We have examined claims history and no records of the services have been found.Current
N538A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.Current
N539ALERTWe processed appeals/waiver requests on your behalf and that request has been denied.Current
N540Payment adjusted based on the interrupted stay policy.Current
N541Mismatch between the submitted insurance type code and the information stored in our system.Current
N542Missing income verification.Current
N543Incomplete/invalid income verification.Current
N544ALERTAlthough this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future.Current
N545Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.Current
N546Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.Current
N547A refund request (Frequency Type Code 8) was processed previously.Current
N548ALERTPatient's calendar year deductible has been met.Current
N549ALERTPatient's calendar year out-of-pocket maximum has been met.Current
N550ALERTYou have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hold in the near future.Current
N551Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.Current
N552Payment adjusted to reverse a previous withhold/bonus amount.Current
N554Missing/Incomplete/Invalid Family Planning Indicator.Current
N555Missing medication list.Current
N556Incomplete/invalid medication list.Current
N557This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected.Current
N558This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received.Current
N559This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located.Current
N560The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.Current
N561The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission.Current
N562The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.Current
N563ALERTMissing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service.Current
N564Patient did not meet the inclusion criteria for the demonstration project or pilot program.Current
N565ALERTThis non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed.Current
N566ALERTThis procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed.Current
N567Not covered when considered preventative.Current
N568ALERTInitial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.Current
N569Not covered when performed for the reported diagnosis.Current
N570Missing/incomplete/invalid credentialing data.Current
N571ALERTPayment will be issued quarterly by another payer/contractor.Current
N572This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.Current
N573ALERTYou have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor.Current
N574Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider.Current
N575Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.Current
N576Services not related to the specific incident/claim/accident/loss being reported.Current
N577Personal Injury Protection (PIP) Coverage.Current
N578Coverages do not apply to this loss.Current
N579Medical Payments Coverage (MPC).Current
N580Determination based on the provisions of the insurance policy.Current
N581Investigation of coverage eligibility is pending.Current
N582Benefits suspended pending the patient's cooperation.Current
N583Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.Current
N584Not covered based on the insured's noncompliance with policy or statutory conditions.Current
N585Benefits are no longer available based on a final injury settlement.Current
N586The injured party does not qualify for benefits.Current
N587Policy benefits have been exhausted.Current
N588The patient has instructed that medical claims/bills are not to be paid.Current
N589Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by the use of a drug.Current
N590Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.Current
N591Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).Current
N592Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.Current
N593Not covered based on failure to attend a scheduled Independent Medical Exam (IME).Current
N594Records reflect the injured party did not complete an Application for Benefits for this loss.Current
N595Records reflect the injured party did not complete an Assignment of Benefits for this loss.Current
N596Records reflect the injured party did not complete a Medical Authorization for this loss.Current
N597Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.Current
N598Health care policy coverage is primary.Current
N599Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.Current
N600Adjusted based on the applicable fee schedule for the region in which the service was rendered.Current
N601In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale System applicable to Hawaii.Current
N602Adjusted based on the Redbook maximum allowance.Current
N603This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage.Current
N604In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers' Compensation Board Schedule of Medical Fees, pursuant to Regulation 83 and / or Appendix 17-C of 11 NYCRR.Current
N605This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.Current
N606The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.Current
N607Service provided for non-compensable condition(s).Current
N608The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6.Current
N60980% of the provider's billed amount is being recommended for payment according to Act 6.Current
N610ALERTPayment based on an appropriate level of care.Current
N611Claim in litigation. Contact insurer for more information.Current
N612Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.Current
N613ALERTAlthough this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.Current
N614ALERTAdditional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).Current
N615ALERTThis enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under 45 CFR 156.270, a Qualified Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.Current
N616ALERTThis enrollee is in the first month of the advance premium tax credit grace period.Current
N617This enrollee is in the second or third month of the advance premium tax credit grace period.Current
N618ALERTThis claim will automatically be reprocessed if the enrollee pays their premiums.Current
N619Coverage terminated for non-payment of premium.Current
N620ALERTThis procedure code is for quality reporting/informational purposes only.Current
N621Charges for Jurisdiction required forms, reports, or chart notes are not payable.Current
N622Not covered based on the date of injury/accident.Current
N623Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.Current
N624The associated Workers' Compensation claim has been withdrawn.Current
N625Missing/Incomplete/Invalid Workers' Compensation Claim Number.Current
N626New or established patient E/M codes are not payable with chiropractic care codes.Current
N628Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.Current
N629Reviews/documentation/notes/summaries/reports/charts not requested.Current
N630Referral not authorized by attending physician.Current
N631Medical Fee Schedule does not list this code. An allowance was made for a comparable service.Current
N633Additional anesthesia time units are not allowed.Current
N634The allowance is calculated based on anesthesia time units.Current
N635The Allowance is calculated based on the anesthesia base units plus time.Current
N636Adjusted because this is reimbursable only once per injury.Current
N637Consultations are not allowed once treatment has been rendered by the same provider.Current
N638Reimbursement has been made according to the home health fee schedule.Current
N639Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.Current
N640Exceeds number/frequency approved/allowed within time period.Current
N641Reimbursement has been based on the number of body areas rated.Current
N642Adjusted when billed as individual tests instead of as a panel.Current
N643The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.Current
N644Reimbursement has been made according to the bilateral procedure rule.Current
N645Mark-up allowance.Current
N646Reimbursement has been adjusted based on the guidelines for an assistant.Current
N647Adjusted based on diagnosis-related group (DRG).Current
N648Adjusted based on Stop Loss.Current
N649Payment based on invoice.Current
N650This policy was not in effect for this date of loss. No coverage is available.Current
N651No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.Current
N652The date of service is before the date of loss.Current
N653The date of injury does not match the reported date of loss.Current
N654Adjusted based on achievement of maximum medical improvement (MMI).Current
N655Payment based on provider's geographic region.Current
N656An interest payment is being made because benefits are being paid outside the statutory requirement.Current
N657This should be billed with the appropriate code for these services.Current
N658The billed service(s) are not considered medical expenses.Current
N659This item is exempt from sales tax.Current
N660Sales tax has been included in the reimbursement.Current
N661Documentation does not support that the services rendered were medically necessary.Current
N662ALERTConsideration of payment will be made upon receipt of a final bill.Current
N663Adjusted based on an agreed amount.Current
N664Adjusted based on a legal settlement.Current
N665Services by an unlicensed provider are not reimbursable.Current
N666Only one evaluation and management code at this service level is covered during the course of care.Current
N667Missing prescription.Current
N668Incomplete/invalid prescription.Current
N669Adjusted based on the Medicare fee schedule.Current
N670This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.Current
N671Payment based on a jurisdiction cost-charge ratio.Current
N672ALERTAmount applied to Health Insurance Offset.Current
N673Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.Current
N674Not covered unless a pre-requisite procedure/service has been provided.Current
N675Additional information is required from the injured party.Current
N676Service does not qualify for payment under the Outpatient Facility Fee Schedule.Current
N677ALERTFilms/Images will not be returned.Current
N678Missing post-operative images/visual field results.Current
N679Incomplete/Invalid post-operative images/visual field results.Current
N680Missing/Incomplete/Invalid date of previous dental extractions.Current
N681Missing/Incomplete/Invalid full arch series.Current
N682Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.Current
N683Missing/Incomplete/Invalid prior treatment documentation.Current
N684Payment denied as this is a specialty claim submitted as a general claim.Current
N685Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.Current
N686Missing/incomplete/Invalid questionnaire needed to complete payment determination.Current
N687ALERTThis reversal is due to a retroactive disenrollment.Current
N688ALERTThis reversal is due to a medical or utilization review decision.Current
N689ALERTThis reversal is due to a retroactive rate change.Current
N690ALERTThis reversal is due to a provider submitted appeal.Current
N691ALERTThis reversal is due to a patient submitted appeal.Current
N692ALERTThis reversal is due to an incorrect rate on the initial adjudication.Current
N693ALERTThis reversal is due to a cancellation of the claim by the provider.Current
N694ALERTThis reversal is due to a resubmission/change to the claim by the provider.Current
N695ALERTThis reversal is due to incorrect patient financial responsibility information on the initial adjudication.Current
N696ALERTThis reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.Current
N697ALERTThis reversal is due to a payer's retroactive contract incentive program adjustment.Current
N698ALERTThis reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment grace period, resulting in loss of coverage.Current
N699Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.Current
N700Payment adjusted based on the Electronic Health Records (EHR) Incentive Program.Current
N701Payment adjusted based on the Value-based Payment Modifier.Current
N702Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.Current
N703This service is incompatible with previously adjudicated claims or claims in process.Current
N704ALERTYou may not appeal this decision but can resubmit this claim/service with corrected information if warranted.Current
N705Incomplete/invalid documentation.Current
N706Missing documentation.Current
N707Incomplete/invalid orders.Current
N708Missing orders.Current
N709Incomplete/invalid notes.Current
N710Missing notes.Current
N711Incomplete/invalid summary.Current
N712Missing summary.Current
N713Incomplete/invalid report.Current
N714Missing report.Current
N715Incomplete/invalid chart.Current
N716Missing chart.Current
N717Incomplete/Invalid documentation of face-to-face examination.Current
N718Missing documentation of face-to-face examination.Current
N719Penalty applied based on plan requirements not being met.Current
N720ALERTThe patient overpaid you. You may need to issue the patient a refund for the difference between the patient's payment and the amount shown as patient responsibility on this notice.Current
N721This service is only covered when performed as part of a clinical trial.Current
N722Patient must use Workers' Compensation Set-Aside (WCSA) funds to pay for the medical service or item.Current
N723Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.Current
N724Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.Current
N725A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.Current
N726A conditional payment is not allowed.Current
N727A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.Current
N728A workers' compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.Current
N729Missing patient medical/dental record for this service.Current
N730Incomplete/invalid patient medical/dental record for this service.Current
N731Incomplete/Invalid mental health assessment.Current
N732Services performed at an unlicensed facility are not reimbursable.Current
N733Regulatory surcharges are paid directly to the state.Current
N734The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury.Current
N736Incomplete/invalid Sleep Study Report.Current
N737Missing Sleep Study Report.Current
N738Incomplete/invalid Vein Study Report.Current
N739Missing Vein Study Report.Current
N740The member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service.Current
N741This is a site neutral payment.Current
N743Adjusted because the services may be related to an employment accident.Current
N744Adjusted because the services may be related to an auto/other accident.Current
N745Missing Ambulance Report.Current
N746Incomplete/invalid Ambulance Report.Current
N747This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides.Current
N748Adjusted because the related hospital charges have not been received.Current
N749Missing Blood Gas Report.Current
N750Incomplete/invalid Blood Gas Report.Current
N751Adjusted because the patient is covered under a Medicare Part D plan.Current
N752Missing/incomplete/invalid HIPPS Treatment Authorization Code (TAC).Current
N753Missing/incomplete/invalid Attachment Control Number.Current
N754Missing/incomplete/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form.Current
N755Missing/incomplete/invalid ICD Indicator.Current
N756Missing/incomplete/invalid point of drop-off address.Current
N757Adjusted based on the Federal Indian Fees schedule (MLR).Current
N758Adjusted based on the prior authorization decision.Current
N759Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013.Current
N760This facility is not authorized to receive payment for the service(s).Current
N761This provider is not authorized to receive payment for the service(s).Current
N762This facility is not certified for Tomosynthesis (3-D) mammography.Current
N763The demonstration code is not appropriate for this claim; resubmit without a demonstration code.Current
N764Missing/incomplete/invalid Hematocrit (HCT) value.Current
N765This payer does not cover coinsurance assessed by a previous payer.Current
N766This payer does not cover co-payment assessed by a previous payer.Current
N767The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed.Current
N768Incomplete/invalid initial evaluation report.Current
N769A lateral diagnosis is required.Current
N770The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received.Current
N771ALERTUnder Federal law you cannot charge more than the limiting charge amount.Current
N772ALERTRebill urgent/emergent and ancillary services separately.Current
N773Drug supplied not obtained from specialty vendor.Current
N774ALERTRefer to your Third Party Processor Agreement for specific information on fees associated with this payment type.Current
N775Payment adjusted based on x-ray radiograph on film.Current
N776This service is not a covered Telehealth service.Current
N777Missing Assignment of Benefits Indicator.Current
N778Missing Primary Care Physician Information.Current
N779Replacement/Void claims cannot be submitted until the original claim has finalized. Please resubmit once payment or denial is received.Current
N780Missing/incomplete/invalid end therapy date.Current
N781ALERTPatient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer.Current
N782ALERTPatient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance. This amount may be billed to a subsequent payer.Current
N783ALERTPatient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected copayment. This amount may be billed to a subsequent payer.Current
N784Missing comprehensive procedure code.Current
N785Missing current radiology film/images.Current
N786Benefit limitation for the orthodontic active and/or retention phase of treatment.Current
N787ALERTUnder 42 CFR 410.43, an eligible Partial Hospitalization Program (PHP) patient/beneficiary requires a minimum of 20 hours of PHP services per week, as evidenced in the plan of care. PHP services must be furnished in accordance with the plan of care.Current
N788ALERTThe third-party administrator/review organization did not receive the required information.Current
N789Clinical Trial is not a covered benefit.Current
N790Provider/supplier not accredited for product/service.Current
N791Missing history & physical report.Current
N792Incomplete/invalid history & physical report.Current
N794Payment adjusted based on type of technology used.Current
N795Item must be resubmitted as a purchase.Current
N796Missing/incomplete/invalid Hemoglobin (Hb or Hgb) value.Current
N797Missing/incomplete/invalid date qualifier.Current
N798Submit a void request for the original claim and resubmit a new claim.Current
N799Submitted identifier must be an individual identifier, not group identifier.Current
N800Only one service date is allowed per claim.Current
N801Services performed in a Medicare participating or CAH facility under a self-insured tribal Group Health Plan, in accordance with Federal Regulation 42 CFR 136.Current
N802This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Rendering Physician is located.Current
N803Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital.Current
N804ALERTThe claim/service was processed through the Outpatient Code Editor (OCE).Current
N805ALERTThe claim/service was processed through the Correct Code Editor (CCE).Current
N806Payment is included in the Global transplant allowance.Current
N807Payment adjustment based on the Merit-based Incentive Payment System (MIPS).Current
N808Not covered for this provider type / provider specialty.Current
N809ALERTThe fee schedule amount for this service was adjusted based on prior competitive bidding rates. For more information, contact your local contractor.Current
N810ALERTDue to federal, state or local disaster declaration, this claim has been processed at the in-network level of benefit. At the conclusion or expiration of the disaster declaration, network payment rules will be reinstated.Current
N811Missing Federal Sequestration Reduction from Prior Payer.Current
N812The start service date through end service date cannot span greater than 18 months.Current
N815Missing/Incomplete/Invalid NDC Unit CountCurrent
N816Missing/Incomplete/Invalid NDC Unit of MeasureCurrent
N817ALERTApplicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 - March 31, 2020.Current
N818Claims Dates of Service do not match Electronic Visit Verification System.Current
N819Patient not enrolled in Electronic Visit Verification System.Current
N820Electronic Visit Verification System units do not meet requirements of visit.Current
N821Electronic Visit Verification System visit not found.Current
N822Missing procedure modifier(s).Current
N823Incomplete/Invalid procedure modifier(s).Current
N824Electronic Visit Verification (EVV) data must be submitted through EVV Vendor.Current
N825Early intervention guidelines were not met.Current
N826Patient did not meet the inclusion criteria for the Medicare Shared Savings Program.Current
N827Missing/Incomplete/Invalid Federal Information Processing Standard (FIPS) Code.Current
N828ALERTPayment is suppressed due to a contracted funding.Current
N829Missing/incomplete/invalid Diagnostics Exchange Z-Code Identifier.Current
N830ALERTThe charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations. As such, any amount identified with OA, CO, or PI cannot be collected from the member and may be considered provider liability or be billable to a subsequent payer. Any amount the provider collected over the identified PR amount must be refunded to the patient within applicable Federal/State timeframes. Payment amounts are eligible for dispute pursuant to any Federal/State documented appeal/grievance process(es).Current
N831You have not responded to requests to revalidate your provider/supplier enrollment information.Current
N832Duplicate occurrence code/occurrence span code.Current
N833Patient share of cost waived.Current
N834Jurisdiction exempt from sales and health tax charges.Current
N835Unrelated Service/procedure/treatment is reduced. The balance of this charge is the patient's responsibility.Current
N836Provider W9 or Payee Registration not on file.Current
N837ALERTMissing modifier was added.Current
N838ALERTService/procedure postponed due to a federal, state, or local mandate/disaster declaration. Any amounts applied to deductible or member liability will be applied to the prior plan year from which the procedure was cancelled.Current
N839The procedure code was added/changed because the level of service exceeds the compensable condition(s).Current
N840Worker's compensation claim filed with a different state.Current
N841ALERTNorth Dakota Administrative Rule 92-01-02-50.3.Current
N842ALERTPatient cannot be billed for charges.Current
N843Missing/incomplete/invalid Core-Based Statistical Area (CBSA) code.Current
N844This claim, or a portion of this claim, was processed in accordance with the Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act.Current
N845ALERTNebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act.Current
N846National Drug Code (NDC) supplied does not correspond to the HCPCs/CPT billed.Current
N847National Drug Code (NDC) billed is obsolete.Current
N848National Drug Code (NDC) billed cannot be associated with a product.Current
N849Missing Tooth Clause: Tooth missing prior to the member effective date.Current
N850Missing/incomplete/invalid narrative explaining/describing this service/treatment.Current
N851Payment reduced because services were furnished by a therapy assistant.Current
N852The pay-to and rendering provider tax identification numbers (TINs) do not matchCurrent
N853The number of modalities performed per session exceeds our acceptable maximum.Current
N854ALERTIf you have primary other health insurance (OHI) coverage that has denied services, you must exhaust all appeal levels with your primary OHI before we can consider your claim for reimbursement.Current
N855This coverage is subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.Current
N856This coverage is not subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.Current
N857This claim has been adjusted/reversed. Refund any collected copayment to the member.Current
N858ALERTState regulations relating to an Out of Network Medical Emergency Care Act were applied to the processing of this claim. Payment amounts are eligible for dispute following the state's documented appeal/ grievance/ arbitration process.Current
N859ALERTThe Federal No Surprise Billing Act was applied to the processing of this claim. Payment amounts are eligible for dispute pursuant to any Federal documented appeal/ grievance/ dispute resolution process(es).Current
N860ALERTThe Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).Current
N861ALERTMismatch between the submitted Patient Liability/Share of Cost and the amount on record for this recipient.Current
N862ALERTMember cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge.Current
N863ALERTThis claim is subject to the No Surprises Act (NSA). The amount paid is the final out-of-network rate and was calculated based on an All Payer Model Agreement, in accordance with the NSA.Current
N864ALERTThis claim is subject to the No Surprises Act provisions that apply to emergency services.Current
N865ALERTThis claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient visit to a participating facility.Current
N866ALERTThis claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services.Current
N867ALERTCost sharing was calculated based on a specified state law, in accordance with the No Surprises Act.Current
N868ALERTCost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.Current
N869ALERTCost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act.Current
N870ALERTIn accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount.Current
N871ALERTThis initial payment was calculated based on a specified state law, in accordance with the No Surprises Act.Current
N872ALERTThis final payment was calculated based on a specified state law, in accordance with the No Surprises Act.Current
N873ALERTThis final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.Current
N874ALERTThis final payment was determined through open negotiation, in accordance with the No Surprises Act.Current
N875ALERTThis final payment equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity, in accordance with the No Surprises Act.Current
N876ALERTThis item or service is covered under the plan. This is a notice of denial of payment provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate than the amount paid by the patient in cost sharing.Current
N877ALERTThis initial payment is provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate.Current
N878ALERTThe provider or facility specified that notice was provided and consent to balance bill obtained, but notice and consent was not provided and obtained in a manner consistent with applicable Federal law. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited.Current
N879ALERTThe notice and consent to balance bill, and to be charged out-of-network cost sharing, that was obtained from the patient with regard to the billed services, is not permitted for these services. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited.Current
N880Original claim closed due to changes in submitted data. Adjustment claim will be processed under a new claim number.Current
N881Client Obligation, patient responsibility for Home & Community Based Services (HCBS)Current
N882ALERTThe out-of-network payment and cost sharing amounts were based on the plan's allowance because the provider or facility obtained the patient's consent to waive the balance billing protections under the No Surprises Act.Current
N883ALERTProcessed according to state lawCurrent
N884ALERTThe No Surprises Act may apply to this claim. Please contact payer for instructions on how to submit information regarding whether or not the item or service was furnished during a patient visit to a participating facility.Current
N885ALERTThis claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements. The payer disagrees with your determination that those requirements apply. You may contact the payer to find out why it disagrees. You may appeal this adverse determination on behalf of the patient through the payer’s internal appeals and external review processes.Current
N886ALERTA Health Care Claim Request for Additional Information (277 RFAI) has been sent.Current
N887Providers not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not paid the services at the expected Medicare reimbursable rate or type of level/service. Providers may file their appeal in writing within 60 calendar days after the date of the remittance advice. For the plan to review the appeal, the plan will need a completed signed Waiver of Liability Statement. To obtain a Waiver of Liability form, please contact your Medicare Advantage Plan. Once we receive the completed forms, we will give you a decision on your appeal within 60 calendar days.Current
N888ALERTAn electronic request for additional information has been sent for this claim.Current
N889ALERTThis claim was originally processed in real-time, and we sent a real-time 835 response.Current
N890Electronic Visit Verification Data Element Requirements were not met.Current
N891The maximum allowable payment for this service/procedure was paid by the primary insurance. No further payment due.Current
N892The claim does not meet the criteria for acceptable use of the Delay Reason Code.Current
N893Missing/incomplete/invalid child medical evaluation form/checklist.Current
N894ALERTThese payments are made subject to a reservation of rights for the Payor to recoup or otherwise recover all or part of these payments based on any of the following: outcome of pending or future litigation/ new or updated state, federal or regulatory guidance/ any other actions that may affect the Payor's obligation to make these payments.Current
N895Processed based on a negotiated fee schedule for a specialty drug program.Current
N896Missing/incomplete/invalid trauma activation sheet.Current
N897Missing/incomplete/invalid proof of member payment.Current
N898Missing/incomplete/invalid Resource Utilization Group(s) (RUG) code(s).Current
N899Missing Initial Evaluation Report.Current
N900Missing Therapy Notes/Report.Current
N901Incomplete/Invalid Therapy Notes/Report.Current
N902Missing Health Risk Assessment (HRA).Current
N903Incomplete/Invalid Health Risk Assessment (HRA).Current
N904The transportation vendor is responsible for this claim.Current
N905Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is not responsible for payment.Current
N906Service is not covered when patient is under age 45.Current
N907No refund because this claim has been identified as 340B-eligible with a ceiling price lower than the maximum fair price.Current
N908No refund because this drug has been prospectively purchased at the maximum fair price.Current
N909Refund amount has been calculated using a methodology that differs from the Standard Default Refund Amount calculation ((Wholesale Acquisition Cost minus Maximum Fair Price) times Quantity).Current
N910A refund cannot be provided for this claim at this time. Contact the manufacturer directly regarding your eligibility.Current
N911This claim cannot be reimbursed by the manufacturer until the Part D plan submits corrected prescription drug event data to CMS for maximum fair price validation.Current
N912Our records indicate that this beneficiary did not elect hospice.Current
N913More than one Electronic Visit Verification record exists for the date and time of this service.Current
N914This claim was priced and processed in accordance with California AB-72 Health care coverage.Current
N915Predetermination of services is not allowed under the member's plan.Current
N916The third party will render payment to the provider, and they will reimburse you for covered services.Current
N917Alternative refund amount has been calculated because the maximum fair price is below the 340B ceiling price.Current
N918No refund because CMS excludes prescription drug event records when a compound code indicates it is for a compounded drug.Current
N919Family/member out-of-pocket maximum has been met.Current
N920Payment to the provider has been placed on hold as a result of active contract (re)negotiation.Current
N921The time limit for filing a reconsideration or appeal has expired.Current
N922Missing primary care dentist information.Current
N923Not Denied - The Medicare Advantage Organization (MAO) made a payment responsibility determination.Current
N924Pending (Not Denied) - The Medicare Advantage Organization (MAO) has not yet made a payment responsibility determination for the service at the time the encounter record was submitted.Current
N925Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for the service at the time the encounter record was submitted.Current
N926Partially Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for one or more service lines, but not all, at the time the encounter record was submitted.Current
N927Missing/Incomplete/Invalid x-ray.Current
N928Missing/Incomplete/Invalid bitewing or periapical x-ray.Current
N929Missing/Incomplete/Invalid photo(s).Current
N930Missing/Incomplete/Invalid quadrant identifier.Current
N931Missing/Incomplete/Invalid pre- and/or post-operative bitewing or periapical x-ray.Current
N932Missing/Incomplete/Invalid pre- and/or post-operative full mouth x-ray.Current
N933Missing/Incomplete/Invalid pre- and/or post-operative photo(s).Current
N934Missing/Incomplete/Invalid full mouth x-ray.Current
N935ALERTPatient is no longer a Medicaid/Qualified Medicare Beneficiary.Current
N936This service code has been identified as the secondary or tertiary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.Current
N937The service line denial threshold was exceeded.Current
N938ALERTDo not resubmit. This claim will be automatically reprocessed.Current
N939ALERTYou may contact us for a peer-to-peer review.Current
N940Missing/Incomplete/Invalid pre- and/or post-operative x-ray.Current