Claim Adjustment Reason Codes - Palmetto GBA

ReasonCodesMA53MA54MA55MA56MA57MA58MA59DescriptionMissing/incomplete/invalid Competitive Bidding Demonstration Projectidentification.Start: 01/01/1997 | Last Modified: 02/01/2004Notes: (Modified 2/1/04)Physician certification or election consent for hospice care not receivedtimely.Start: 01/01/1997Not covered as patient received medical health care services,automatically revoking his/her election to receive religious non-medicalhealth care services.Start: 01/01/1997Our records show you have opted out of Medicare, agreeing with thepatient not to bill Medicare for services/tests/supplies furnished. Asresult, we cannot pay this claim. The patient is responsible for payment,but under Federal law, you cannot charge the patient more than thelimiting charge amount.Start: 01/01/1997Patient submitted written request to revoke his/her election for religiousnon-medical health care services.Start: 01/01/1997Missing/incomplete/invalid release of information indicator.Start: 01/01/1997 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)Alert: The patient overpaid you for these services. You must issue thepatient a refund within 30 days for the difference between his/herpayment and the total amount shown as patient responsibility on thisnotice.Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Modified 4/1/07)24