Oxford Denial Codes and their descriptions - Oxford Health Plans
Oxford Denial Codes and their descriptions - Oxford Health Plans
Oxford Denial Codes and their descriptions - Oxford Health Plans
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<strong>Oxford</strong> <strong>Denial</strong> <strong>and</strong> Adjustment <strong>Codes</strong> — <strong>and</strong> Their Descriptions<br />
Please remember to save the last page of your remittance advice, as that page contains the<br />
explanation of any denial or adjustment codes that apply to the claims listed on the<br />
remittance advice.<br />
If you do not have the last page of a remittance advice, we have listed some of our<br />
adjustment <strong>and</strong> denial codes – with <strong>descriptions</strong> – below.<br />
If you need a description of a code not listed here, you can get this information on<br />
our Web site by checking the status of a claim, <strong>and</strong> then clicking on the denial or<br />
adjustment code.<br />
<strong>Denial</strong> <strong>Codes</strong><br />
D1<br />
D2<br />
D3<br />
D3A<br />
D3B<br />
D4<br />
D7<br />
D8<br />
D9<br />
D11<br />
D13<br />
D14<br />
D16B<br />
D18<br />
D19<br />
D20<br />
Not a covered benefit<br />
Not authorized by <strong>Oxford</strong><br />
Review member information<br />
Services Prior to Effective Date<br />
Services after Termination Date<br />
Duplicate of Claim Already Processed<br />
Maximum Covered Benefits Exceeded<br />
Maternity Benefits Paid at Delivery<br />
Need EOB From Primary Carrier<br />
Included in Primary Procedure Fee<br />
Insufficient Info to Process Item<br />
Part of Global Payment to Hospital<br />
Diagnosis Inconsistent with services<br />
Not a Covered Dependent<br />
Ineligible Provider<br />
Additional Info Requested/Not Received
D22<br />
D25<br />
D26<br />
D27<br />
D29<br />
D35E<br />
D38<br />
D41<br />
D42<br />
D46<br />
D91<br />
D94<br />
D99<br />
D107<br />
TBIL<br />
TCOD<br />
TCPS<br />
TECC<br />
TFD1<br />
TIDX<br />
Services not Authorized by PCP<br />
COB Workers Comp Liable<br />
Auto Insurance Liable<br />
No Payment for In-Office Lab Tests<br />
An Itemized Bill is Required<br />
Notes Needed for OrthoNet Review<br />
Medical Necessity not Demonstrated<br />
No authorization- Medicare LOB<br />
COB Questionnaire Required<br />
Not Covered by Original Medicare<br />
Not payable when billed alone<br />
Max Number of Services Exceeded<br />
Filing Deadline Has Passed<br />
Requested Info Not Received<br />
Resubmit with Correct Quantity <strong>and</strong>/or Modifier<br />
Included in Primary Procedure Fee<br />
Included in Primary Procedure Fee<br />
Diagnosis Inconsistent with Services<br />
Filing Deadline has passed<br />
Billed Invalid DX/CPT/Modifier/Place<br />
TMAT Maternity Benefits Paid at Delivery<br />
TMAX Maximum Number of Services Exceeded<br />
TMF1<br />
Maximum Number of Services Exceeded
TMF3<br />
TUNL<br />
T100<br />
T120<br />
T939<br />
Need Medical Documentation<br />
Need Medical Documentation<br />
Duplicate of Claim Already Processed<br />
Duplicate of Claim Already Processed<br />
Invalid DX for Service<br />
Adjustment <strong>Codes</strong><br />
A5<br />
A37<br />
A45D<br />
A46<br />
A64<br />
A90<br />
Correcting Maximum amount eligible<br />
Paid at Agreed or contracted rate<br />
Non-par Covering Doctor Paid In-Plan<br />
Reimbursement as Medicare Part B<br />
MultiPlan Provider Network Rate<br />
United Contracted Rate Applied
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