About Martin s Point Health Care Electronic Remittance Advices (ERAs/835s)

Transcription

1 About Martin s Point Health Care Electronic Remittance Advices (ERAs/835s) Electronic remittance advices (ERAs/835s) save time and money, allow for faster payment postings and provide more detailed information regarding claim adjudications and adjustments. Once you sign up for Martin s Point ERAs through your claims clearing house, we will phase out your paper copies over a four week period. You ll know that your four week transition has begun when you see the following message on your paper remittance advice: Paper remittance advices will end in four weeks. After that, you will see similar messages each week until your final paper remittance advice indicates: Final paper remittance advice. From that point forward, your Martin s Point Generations Advantage and/or US Family Health Plan remittance advices will be sent electronically only, through your claims clearing house. Electronic claims submission and remittance will soon be required for all payers and providers. Thank you for taking the lead on this front. The following resources are available if you have questions about one of our ERAs: Provider Portal: Use this tool to review detailed claim adjudication and adjustment information. Paper remittance advices are limited to one claim adjustment reason code (CARC) but the portal will show additional CARCs, if applicable. To use this tool, visit or call to create a username and password. Then access the tool at Providers/Claims. Provider Inquiry: If you still have questions after consulting the provider portal, please call our Provider Inquiry Team at Electronic Remittance Advice (ERA/835) Provider Guide: Below is a searchable list of industry standard claim adjustment reason codes (CARCs) and the corresponding Martin s Point claims editing rules and remarks.

2 Electronic Remittance Advice (ERA/835) Provider Guide Version: December 12, 2016 This document maps industry standard claim and remittance advice codes to the corresponding claims editing descriptions that appear on Martin s Point 835 files. To search for a specific code, press your CTRL and F keys at the same time and type the code it into the Find box. Definitions: Claim Adjustment Reason Code (CARC): CARCs communicate an adjustment the reason why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code. Not all CARCS have a corresponding RARC. In these situations, the CARC supplies sufficient information about the claim adjustment we have made. Remit Advice Reason Code (RARC): RARCs provide additional explanation for an adjustment already described by a CARC and may convey information about remittance processing. There are two types of RARCs, supplemental and informational. The majority of the RARCs are supplemental; these are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation for an adjustment already described by a CARC. The second type of RARC is informational; these RARCs are all prefaced with Alert: and are often referred to as Alerts. Alerts are used to convey information about remittance processing and are never related to a specific adjustment or CARC. Martin s Point Rule Description: This column provides further information that corresponds to specific CARCS and pertains to our payment policies and rules. Our claims editing processes are closely aligned with correct coding and billing criteria established by the Centers for Medicare and Medicaid Services (CMS). There are some exceptions, usually based on our health plan benefit design. For example, our members have access to important preventive services such as annual physicals and eye exams at $0 copay. But overall, we adhere closely to Medicare claim editing practices. We also apply Medicare Local Coverage Determination (LCD) rules to claims for services rendered to Generations Advantage members in Maine and New Hampshire. (LCD rules do not apply to USFHP claims.) LCD rules can be found on the local carrier s website or by contacting them directly. Following are the local carriers for Maine and New Hampshire: o Medicare Parts A & B: National Government Services, Inc. o Durable Medical Equipment (DME): NHIC, Corp. If you receive a claim denial and, upon research and review of the documentation, you feel a corrected claim is in order, you may submit a corrected claim with the appropriate additional information. Before doing so, please review our electronic corrected claim guidelines at providers/claims. Electronic submission will speed processing time. Please be sure to include the claim number and the patient control number from the original claim to help ensure efficient reprocessing. For more information about Medicare coding and billing criteria, please visit Questions? Please visit providers/claims or call

3 CARC CARC Description Martin's Point Rule Description RARC RARC Description 1 Deductible Amount 915 REMIT deductibles 10 The diagnosis is inconsistent with the patient's gender. Changed as of 2/ Sex conflict; patient's sex and diagnosis are inconsistent 10 The diagnosis is inconsistent with the patient's gender. Changed as of 2/ Sex conflict; patient's sex and diagnosis are inconsistent 10 The diagnosis is inconsistent with the patient's gender. Changed as of 2/ Sex conflict; patient's sex and diagnosis are inconsistent 10 The diagnosis is inconsistent with the patient's gender. Changed as of 2/ Sex conflict; patient's sex and diagnosis are inconsistent 10 The diagnosis is inconsistent with the patient's gender (DASC2) Patient gender MA39 Missing/incomplete/invalid gender. Changed as of 2/00 inconsistent with diagnosis 100 Payment made to patient/insured/responsible party. 915 Member received payment from Third Party Insurance, seek reimbursement from member. 107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Changed as of 6/ (map) Medicare Deny Add On Procedure N122 Add on code cannot be billed by itself. 107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Changed as of 6/ Add on procedure without primary procedure N122 Add on code cannot be billed by itself. 107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Changed as of 6/ FQHC claim lacks required qualifying visit code N324 Missing/incomplete/invalid last seen/visit date. 107 Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. Changed as of 6/ Connect requires claim review 109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. 109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. 109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. 915 No COB entered with a secondary enrollment 915 TPA has changed, Bill to Patient Advocates LLC, PO Box 1959, Gray, ME Pays Under Pharmacy Benefit MA04 N155 N155 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible. Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records. Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.

4 11 The diagnosis is inconsistent with the procedure. 816 Claim Check: Diag to Procedure Audit 11 The diagnosis is inconsistent with the procedure (LBI/LCI) Missing or Invalid LCD Diagnosis 11 The diagnosis is inconsistent with the procedure. 815 Claim Check: Intensity of Service Audit 11 The diagnosis is inconsistent with the procedure. 330 Invalid diagnosis code for benefit 11 The diagnosis is inconsistent with the procedure (LBI/LCI) Missing or Invalid LCD Diagnosis 110 Billing date predates service date ices Future Date of Service Error 110 Billing date predates service date. 824 Claim Check: Future Date of Service Error 110 Billing date predates service date. 915 Cannot bill for future date of service 111 Not covered unless the provider accepts assignment. 915 We received a claim for health care services to a GA/USFHP member during a time our records indicate you opted out of participation in N115 M25 M64 M64 This 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 or if you do not have web access, you may contact the contractor to request a copy of the LCD. The 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. Missing/incomplete/invalid other diagnosis. Missing/incomplete/invalid other diagnosis.

5 114 Procedure/product not approved by the Food and Drug Administration. 119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/04 Medicare/Tricare. Federal law prohibits us from paying your claim and you may not bill our member for payment CLIENT CUSTOM EDIT 9243 Maximum frequency exceeded 9222 (BFR/LCFR) LCD Frequency Exceeded 9520 (mdfh) Maximum Frequency in History 116 Annual Benefit Amount Exceeded 200 Benefit Day Limit Exceeded 206 Benefit Visit Limit Exceeded 207 Benefit Dollar Limit Exceeded 915 Only one family planning visit allowed per date of service. M86 Service denied because payment already made for same/similar procedure within set time frame. 915 Limited service exceeded. M86 Service denied because payment already made for same/similar procedure within set time frame. 915 Services exceed Psych benefit. 915 Benefit Visit Limit Exceeded 915 Benefit Dollar Limit Exceeded

6 119 Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Benefit maximum for this time period or occurrence has been reached. Changed as of 2/ Payment denied Prior processing information appears incorrect. Changed as of 2/ If prenatal care and OB procedure is on paid history within 270 days, same provider, related or unrelated diag, claim is rejected. 915 If postnatal and an OB proc. are on same claim or paid history, and postnatal care is within 45 days of post ob proc., same prov, related or unrelated diag, claim is denied. 915 A payment cannot be made for more than three physical therapy procedures. 132 Sum of Individual Coinsured Charges Exceeds Maximum M86 M86 M86 M58 Service denied because payment already made for same/similar procedure within set time frame. Service denied because payment already made for same/similar procedure within set time frame. Service denied because payment already made for same/similar procedure within set time frame. Missing/incomplete/invalid claim information. Resubmit claim after corrections. 13 The date of death precedes the date of service. 915 Services billed after date of death. 13 The date of death precedes the date of service. 915 SERVICE RESPONSIBILITY OF LAB CORP ONLY 131 Claim specific negotiated discount. New as of 2/ Negotiated Rate Payment MA130 Your 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. 133 The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ NMD Exceptions 915 If major surgery is performed same day as major/minor surgery, same POS, already paid on history and prov are same or different. Claim is pended 915 If assistant surgery is performed on the same day as another asst surgery, on the same claim or paid history, same POS and the prov are different. Pend claim.

7 133 The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ If anesthesia is performed on the same day, same POS as anesthesia no the same claim and the prov are the same or different, pay 100% of time and base unit allowance for greater procedure and 100% of time for each lesser procedure. Pend claim. 915 Preexisting Condition May Exist 915 Claim requires manual processing 915 Manually Pended Claim 915 Provider has Alert/Memos 915 Provider Watch flag has been set for review 915 Benefit Requires Manual Review 915 Contract Term Requires Manual Review 915 Provider on Pay Hold 915 HSS Service Invocation failed 915 Failed during preparation of HSS Service Request message. 915 Failed while handling HSS Service Response.

8 133 The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ Failed during insertion of Claim Edit based on HSS Service Response. 915 Failed duing update of claim line manual contract amount. 915 New Member Letter 915 Requires manual processing. 915 REMIT retro termed Pre X 915 Authorization Line Manually Pended 915 Authorization Status Manually Set 915 REMIT Qualifying claim not finalized reversed determining claim 915 REMIT finalized qualifying claim reversed determining claim 915 Code requires manual pricing 915 No available APC/fee schedule rate 915 Invalid payment status from Grouper 915 Missing or invalid fee schedule type 915 HSS Service Call Failure

9 133 The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ Error accessing PAYER file 915 Error accessing rate calculator file 915 Missing rate calculator record 915 Error accessing Grouper program 915 Error accessing Pricer program Only incidental services reported (claim rejection) 915 Error accessing rate or weight file 915 Error opening Grouper or Pricer in batch mode 915 Error opening ACE report file 915 Error loading Editor program 915 Benefit Restriction Message 915 Plan Restriction Message 915 Initialization error 915 error allocating memory

10 133 The disposition of this claim/service is pending further review. Changed as of 10/ Parameter passing error 133 The disposition of this claim/service is pending further review. Changed as of 10/ Unable to load Optimizer 133 The disposition of this claim/service is pending further review. Changed as of 10/ Initialization error 133 The disposition of this claim/service is pending further review. Changed as of 10/ Error opening DRG table 133 The disposition of this claim/service is pending further review. Changed as of 10/ Error reading CC exclusion table 133 The disposition of this claim/service is pending further review. Changed as of 10/ Error closing CC exclusion table 133 The disposition of this claim/service is pending further review. Changed as of 10/ Error opening CC exclusion table 133 The disposition of this claim/service is pending further review. Changed as of 10/ I/O error on table 133 The disposition of this claim/service is pending further review. Changed as of 10/ HAC editor not found 133 The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ Service submitted for FI/MAC review (condition code 20) 915 Questionable covered service 133 The disposition of this claim/service is pending further review. Changed as of 10/ Member has an active restriction on enrollment 133 The disposition of this claim/service is pending further review. Changed as of 10/ Member NOT enrolled on DOS N30 Patient ineligible for this service. 133 The disposition of this claim/service is pending further review. Changed as of 10/ HHPPS Multiple HIPPS codes detected on episode claim

11 133 The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ The disposition of this claim/service is pending further review. Changed as of 10/ Claim denied. Interim bills cannot be processed. New as of 10/ Claim denied. Interim bills cannot be processed. New as of 10/ Patient/Insured health identification number and name do not match. New as of 6/ Patient/Insured health identification number and name do not match. New as of 6/ Claim adjustment because the claim spans eligible and ineligible periods of coverage. Changed as of 6/ Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/ Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/ Claim Requires Manual Processing 9174 (011SFR) Claim submitted for review (Cond Code 20) 111 Provider Watch 105 Provider on Pay hold 915 Cannot Accept Interim Billing MA130 Your 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. 915 Intermim Claim with no Initial Claim 915 Incorrect Plan ID code. MA130 Your 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. 915 Incorrect AHCCCS ID code. MA130 Your 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. 218 Member Lost Eligibility During Date Span 523 Diagnosis code does not exist 525 Diagnosis code is not valid on DOS 146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/ Code invalid; not found on table of valid ICD 9 CM codes M76 Missing/incomplete/invalid diagnosis or condition.

12 146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/ Invalid code, unnecessary 4th digit M76 Missing/incomplete/invalid diagnosis or condition. 146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/ Invalid code, missing 4th digit M76 Missing/incomplete/invalid diagnosis or condition. 146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/ Invalid code for dates, missing 4th/5th digit M76 Missing/incomplete/invalid diagnosis or condition. 146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/ Unacceptable principal diagnosis MA63 Missing/incomplete/invalid principal diagnosis. 146 Payment denied because the diagnosis was invalid for the date(s) of service reported. New as of 6/ Primary ICD9 Diagnostic Code Required MA63 Missing/incomplete/invalid principal diagnosis. 147 Provider contracted/negotiated rate expired or not on file. New as of 6/ Provider contracted/negotiated rate expired or not on file. New as of 6/ Provider contracted/negotiated rate expired or not on file. New as of 6/ Provider contracted/negotiated rate expired or not on file. New as of 6/ Provider contracted/negotiated rate expired or not on file. New as of 6/ Provider contracted/negotiated rate expired or not on file. New as of 6/ Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete. New as of 6/ Provider is Not Credentialed 915 W/O contractual agreement. 346 Unable to locate fee schedule 101 No active provider contract 102 Provider not active for Plan on DOS 9177 (024DOR) Date out of OCE range 915 Electronic Claim has COB N4 Missing/incomplete/invalid prior insurance carrier EOB. 148 Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete. New as of 6/ Reprocessed due to updated OHI, please bill other insurance as appropriate N4 Missing/incomplete/invalid prior insurance carrier EOB. 149 Lifetime benefit maximum has been reached for this service/benefit category. New as of 10/ Lifetime Benefit Max Exceeded 149 Lifetime benefit maximum has been reached for this service/benefit category. New as of 10/ Individual Lifetime Visits Exceeded

13 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/ UM is not for same Provider 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/ UM Not found M62 Missing/incomplete/invalid treatment authorization code. 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/ Provider's group does not match authorized group N54 Claim information is inconsistent with precertified/authorized services. 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/ Place of Service does not Match Authorized N54 Claim information is inconsistent with precertified/authorized services. 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/ Provider's specialty does not match authorized specialty N95 This provider type/provider specialty may not bill this service. 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/ Prior authorization not for same member N54 Claim information is inconsistent with precertified/authorized services. 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/ Prior authorization not for same member. N54 Claim information is inconsistent with precertified/authorized services. 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. Changed as of 2/ Prior authorization is not for same provider. N54 Claim information is inconsistent with precertified/authorized services.

14 151 Payment adjusted because the payer deems the information submitted does not support this many services. New as of 10/ (mmue/muef/smue) Medically Unlikely Exceeds Allowed Units N431 Service is not covered with this procedure. 152 Payment adjusted because the payer deems the information submitted does not support this length of service. New as of 10/ Invalid length of stay MA130 Your 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. 915 Record does not meet criteria for any DRG in MDC 915 Record does not meet criteria for any DRG in MDC MA130 N213 Your 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. Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information 915 Invalid age in years on admission or age in days 915 Invalid age in years on admission or age in days MA130 MA41 Your 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. Missing/incomplete/invalid admission type. 915 Inappropriate specification of bilateral procedure M51 Missing/incomplete/invalid procedure code(s). 915 invalid admission source MA42 Missing/incomplete/invalid admission source.

15 915 Invalid nursery level MA130 Your 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. 915 Invalid discharge status MA43 Missing/incomplete/invalid patient status. 915 Illogical principal diagnosis (PDX) MA63 Missing/incomplete/invalid principal diagnosis. 915 Invalid principal diagnosis (PDX) MA63 Missing/incomplete/invalid principal diagnosis. 915 Invalid date or fromdate > thrudate M52 Missing/incomplete/invalid "from" date(s) of service. 915 Invalid date or fromdate > thrudate MA130 Your 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. 915 Invalid operation code M51 Missing/incomplete/invalid procedure code(s). 915 Invalid operation code MA130 Your 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.

16 915 Invalid patient type MA130 Your 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. 915 Outpatient claim contains unacceptable errors 915 Outpatient claim contains unacceptable errors MA130 N676 Your 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. Service does not qualify for payment under the Outpatient Facility Fee Schedule. 915 From date greater than thru date M52 Missing/incomplete/invalid "from" date(s) of service. 915 Invalid Outpatient Classification 915 Invalid Outpatient Classification MA130 N676 Your 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. Service does not qualify for payment under the Outpatient Facility Fee Schedule. 915 Condition code 21 M44 Missing/incomplete/invalid condition code. 915 Condition code 21 MA130 Your 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.

17 915 Invalid from thru dates MA31 Missing/incomplete/invalid beginning and ending dates of the period billed. 915 Date out of OCE range MA130 Your 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. 915 Date out of OCE range N345 Date range not valid with units submitted. 915 Invalid procedure code M51 Missing/incomplete/invalid procedure code(s). 915 This is a clinical trial claim and it is missing the required diagnosis code. M64 Missing/incomplete/invalid other diagnosis. 915 Late charge/ corrected claim received. Denied to allow corrections. MA67 Correction to a prior claim. 915 Late charge/ corrected claim received. Denied to allow corrections. N693 Alert: This reversal is due to a cancellation of the claim by the provider. 915 No Charges Submitted on Claim Line M54 Missing/incomplete/invalid total charges.

18 915 Code invalid; not found on table of valid ICD 9 CM codes M76 Missing/incomplete/invalid diagnosis or condition. 915 Invalid code, unnecessary 4th/5th digit M76 Missing/incomplete/invalid diagnosis or condition. 915 Invalid code missing 4th/5th digit M76 Missing/incomplete/invalid diagnosis or condition. 915 Code invalid M76 Missing/incomplete/invalid diagnosis or condition. 915 Invalid code for dates, unnecessary 4th/5th digit M76 Missing/incomplete/invalid diagnosis or condition. 915 Invalid code for dates, missing 4th/5th digit M76 Missing/incomplete/invalid diagnosis or condition. 915 Invalid age in days at discharge 915 Invalid age in days at discharge MA130 N50 Your 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. Missing/incomplete/invalid discharge information.

19 915 Sex invalid; not 1 or 2, M or F MA39 Missing/incomplete/invalid gender. 915 Code is duplicate of principal diagnosis M76 Missing/incomplete/invalid diagnosis or condition. 915 Code is duplicate of another secondary diagnosis M76 Missing/incomplete/invalid diagnosis or condition. 915 Diagnosis cannot be used as principal MA63 Missing/incomplete/invalid principal diagnosis. 915 E Code as principal MA63 Missing/incomplete/invalid principal diagnosis. 915 Manifestation code as principal MA63 Missing/incomplete/invalid principal diagnosis. 915 Non Specific code as principal MA63 Missing/incomplete/invalid principal diagnosis. 915 Questionable admission MA130 Your 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.

20 915 Questionable admission MA41 Missing/incomplete/invalid admission type. 915 Unacceptable principal diagnosis MA63 Missing/incomplete/invalid principal diagnosis. 915 Unacceptable principal diagnosis; requires secondary dx MA63 Missing/incomplete/invalid principal diagnosis. 915 Present On Admission indicator required but not submitted N434 Missing/Incomplete/Invalid Present on Admission indicator. 915 Present On Admission indicator required but is not valid N434 Missing/Incomplete/Invalid Present on Admission indicator. 915 A Present on Admission Indicator (POA) has been applied to a Diagnosis Code that does not require one per Medicare/Tricare OPPS guidelines 915 Code invalid; not found on table of valid ICD 9 CM codes N434 M76 Missing/Incomplete/Invalid Present on Admission indicator. Missing/incomplete/invalid diagnosis or condition. 915 Invalid code, unnecessary 4th digit M76 Missing/incomplete/invalid diagnosis or condition.

21 915 Invalid code, missing 4th digit M76 Missing/incomplete/invalid diagnosis or condition. 915 Same Provider As Surgeon/Asst Surgeon Invalid M80 Not covered when performed during the same session/date as a previously processed service for the patient. 915 Same Provider As Surgeon/Asst Surgeon Invalid 915 Adjusted due to processing error MA130 MA67 Your 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. Correction to a prior claim. 915 Adjusted due to processing error N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication. 915 Adjusted due to processing error QNXT MA67 Correction to a prior claim. 915 Adjusted due to processing error QNXT N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication. 915 Appeal MA67 Correction to a prior claim.

22 915 Appeal N691 Alert: This reversal is due to a patient submitted appeal. 915 Reconsideration MA67 Correction to a prior claim. 915 Reconsideration N690 Alert: This reversal is due to a provider submitted appeal. 915 Unable to determine which history claim to adjust based off the claim number provided and/or information provided. N380 The original claim has been processed, submit a corrected claim. 915 Claims Recovery Project N432 Adjustment based on a Recovery Audit. 915 Insufficient services on day of partial hospitalization. 915 Insufficient services on day of partial hospitalization. MA130 MA32 Your 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. Missing/incomplete/invalid number of covered days during the billing period. 915 The member has not exhausted their Part A benefits. Martin s Point does not adhere to this limitation. Please submit a corrected inpatient claim with your room and board charges. M54 Missing/incomplete/invalid total charges.

23 915 Corrected Claim MA67 Correction to a prior claim. 915 Corrected Claim N694 Alert: This reversal is due to a resubmission/change to the claim by the provider. 915 No Assessment Date Submitted on Claim N309 Missing/incomplete/invalid assessment date. 915 Invalid value for OPCODE1 M45 Missing/incomplete/invalid occurrence code(s). 915 Invalid value for OPCODE1 MA130 Your 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. 915 Invalid value for PATTYPE MA130 Your 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. 915 Invalid value for PATTYPE MA43 Missing/incomplete/invalid patient status. 915 Claim billed with two different individual NPI s MA102 Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider.

24 915 This is a clinical trial claim and it is missing the required clinical trial number MA50 Missing/incomplete/invalid Investigational Device Exemption number for FDA approved clinical trial services. 915 This is a clinical trial claim and it is missing the required Condition code. M44 Missing/incomplete/invalid condition code. 915 Invalid Insured/Patient information submitted (Name, DOB, Gender, Member ID) 915 Rebill with a valid HIPPS code 915 The procedure code billed is not recognized by Tricare. An alternate code is available. M51 Missing/incomplete/invalid procedure code(s). 915 The procedure code billed is not recognized by Medicare. An alternate code is available. M51 Missing/incomplete/invalid procedure code(s). 915 Denied Please provide a description of service N350 Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure. 915 Description of Service & a Prior Authorization is Required N225 Incomplete/invalid documentation/orders/notes/summary/report/ chart.

25 915 Invalid Insured/Member ID N382 Missing/incomplete/invalid patient identifier. 915 Invalid Gender MA39 Missing/incomplete/invalid gender. 915 Invalid DOB MA52 Missing/incomplete/invalid date. 915 File with FFS Medicare First MA130 Your 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. 915 File with FFS Medicare First N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records. 915 Patient Name not matching name on file. MA36 Missing/incomplete/invalid patient name. 915 Provider termed from affiliation for DOS billed N198 Rendering provider must be affiliated with the pay to provider. 915 Provider credentials required for reimbursement. M143 The provider must update license information with the payer.

26 915 HCPC/CPT Code not Valid on a UB Claim M20 Missing/incomplete/invalid HCPCS. 915 EOB needed from Primary Insurance N4 Missing/incomplete/invalid prior insurance carrier EOB. 915 Accept Assignment Box 27 on claim needs to be completed. 915 EOB does not match claim N4 Missing/incomplete/invalid prior insurance carrier EOB. 915 Invalid units for modifier M53 Missing/incomplete/invalid days or units of service. 915 Payment included in composite rate N95 This provider type/provider specialty may not bill this service. 915 Invalid HCPCS code M20 Missing/incomplete/invalid HCPCS. 915 Invalid modifier for pricing M78 Missing/incomplete/invalid HCPCS modifier.

27 915 Invalid Admit Diagnosis MA65 Missing/incomplete/invalid admitting diagnosis. 915 Claim returned to provider for correction (RTP) 915 Invalid units for this modifier MA130 M53 Your 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. Missing/incomplete/invalid days or units of service. 915 ZIP code missing or inv (for Ambulance) MA29 Missing/incomplete/invalid provider name, city, state, or zip code. 915 Invalid units for revenue code M53 Missing/incomplete/invalid days or units of service. 915 Trauma response cc code without rev code 068X and CPT N59 Please refer to your provider manual for additional program and provider information. 915 Claim lacks allowed procedure code N59 Please refer to your provider manual for additional program and provider information. 915 Claim lacks required radiolabeled product M51 Missing/incomplete/invalid procedure code(s).

28 915 G0379 only allowed with G G0379 only allowed with G0378 MA130 N357 Your 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. Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met. 915 Revenue code not recognized by Medicare M50 Missing/incomplete/invalid revenue code(s). 915 Claim lacks required device code N59 Please refer to your provider manual for additional program and provider information. 915 Incorrect billing of blood and blood products 915 Incorrect billing of blood and blood products MA130 N750 Your 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. Incomplete/invalid Blood Gas Report. 915 Units greater than one for bilateral proc billed with mod 50 M53 Missing/incomplete/invalid days or units of service. 915 Multiple observations overlap in time MA130 Your 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.

29 915 Multiple observations overlap in time N20 Service not payable with other service rendered on the same date. 915 Code 2 of a code pair allowed with modifier M50 Missing/incomplete/invalid revenue code(s). 915 Invalid revenue code M50 Missing/incomplete/invalid revenue code(s). 915 Codes G0378 and G0379 only allowed with bill type 13x 915 Codes G0378 and G0379 only allowed with bill type 13x MA130 MA30 Your 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. Missing/incomplete/invalid type of bill. 915 Code 2 of a code pair that is not allowed by NCCI 915 Code 2 of a code pair that is not allowed by NCCI MA130 N345 Your 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. Date range not valid with units submitted. 915 Terminated bilateral procedure M51 Missing/incomplete/invalid procedure code(s).

30 915 implanted/administered not consistent with implant/procedure N59 Please refer to your provider manual for additional program and provider information. 915 Transf or blood product exchange w/o spec of blood product 915 Transf or blood product exchange w/o spec of blood product MA130 N750 Your 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. Incomplete/invalid Blood Gas Report. 915 Obs rev code on line item with non obs HCPCS code N59 Please refer to your provider manual for additional program and provider information. 915 HCPC Code not Valid on a HCFA Claim M20 Missing/incomplete/invalid HCPCS. 915 Revenue center requires HCPCS code M20 Missing/incomplete/invalid HCPCS. 915 REMIT Claim with Enrollment Status Change N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package 915 REMIT Claim with External Enrollment Coverage Type Change N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package

31 915 REMIT LOI Records Added or Changed N696 Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment. 915 REMIT E/R Claim reversed due to receipt of inpatient claim. M2 Not paid separately when the patient is an inpatient. 915 REMIT retro term enrollment N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package 915 REMIT denied claim with valid enrollment N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package 915 Pricing cannot be determined based on units billed M53 Missing/incomplete/invalid days or units of service. 915 Servicing provider required on claim N257 Missing/incomplete/invalid billing provider/supplier primary identifier. 915 Skin substitute application procedure without appropriate skin substitute product code M51 Missing/incomplete/invalid procedure code(s). 915 Resubmit With Operative Report/Medical Records N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package

32 915 "Medical Records required, fax records to ATTN HMD" N225 Incomplete/invalid documentation/orders/notes/summary/report/ chart. 915 A valid HCPC code available for NDC number. M20 Missing/incomplete/invalid HCPCS. 915 ABA Therapy codes need to be billed on a separate claim. 915 ABA Therapy codes need to be billed on a separate claim. MA130 N61 Your 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. Rebill services on separate claims. 915 Need breakout of Anesthesia time for the MD and CRNA N29 Missing documentation/orders/notes/summary/report/ chart. 915 Service not rendered in place of service billed N38 Missing/incomplete/invalid place of service. 915 Incorrect Billing MA130 Your 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. 915 Incorrect Billing N34 Incorrect claim form/format for this service.

33 915 Bill with a valid J Code M20 Missing/incomplete/invalid HCPCS. 915 Incomplete claim form. M58 Missing/incomplete/invalid claim information. Resubmit claim after corrections. 915 Submit appropriate claim form N34 Incorrect claim form/format for this service. 915 Non Contracted Code, Use corresponding S Code M20 Missing/incomplete/invalid HCPCS. 915 EOB is Missing Information. N4 Missing/incomplete/invalid prior insurance carrier EOB. 915 Invoice does not match services billed N354 Incomplete/invalid invoice 915 Unable to determine patient responsibility based upon the submitted EOB. N4 Missing/incomplete/invalid prior insurance carrier EOB. 915 Please resubmit with remit remark code key. MA69 Missing/incomplete/invalid remarks.

34 915 Invalid ICD9 Procedure Code M51 Missing/incomplete/invalid procedure code(s). 915 Invalid ICD 9 Diagnosis Code M76 Missing/incomplete/invalid diagnosis or condition. 915 Diagnosis not valid for Benefit M76 Missing/incomplete/invalid diagnosis or condition. 915 Pay and Educate M17 Alert: Payment 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. 915 Pay and Educate N381 Consult our contractual agreement for restrictions/billing/payment information related to these charges. 915 Service only payable as inpatient. N38 Missing/incomplete/invalid place of service. 915 Explanation of Benefits illegible. Please submit legible Explanation of Benefits. 915 The Medical Records Submitted are not for the Rendering Provider on the claim. N225 Incomplete/invalid documentation/orders/notes/summary/report/ chart.