Claim Adjustment Reason Codes - Palmetto GBA

ReasonCodesMA01MA02MA04MA07MA08MA09DescriptionAlert: If you do not agree with what we approved for these services, youmay appeal our decision. To make sure that we are fair to you, werequire another individual that did not process your initial claim toconduct the appeal. However, in order to be eligible for an appeal, youmust write to us within 120 days of the date you received this notice,unless you have a good reason for being late.Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07)Alert: If you do not agree with this determination, you have the right toappeal. You must file a written request for an appeal within 180 days ofthe date you receive this notice.Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07)Secondary payment cannot be considered without the identity of orpayment information from the primary payer. The information was eithernot reported or was illegible.Start: 01/01/1997Alert: The claim information has also been forwarded to Medicaid forreview.Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Modified 4/1/07)Alert: Claim information was not forwarded because the supplementalcoverage is not with a Medigap plan, or you do not participate inMedicare.Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Modified 4/1/07)Claim submitted as unassigned but processed as assigned. You agreedto accept assignment for all claims.Start: 01/01/199718