Claim Adjustment Reason Codes - Palmetto GBA

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ReasonCodesMA125MA126MA128MA130MA131MA132MA133MA134N1DescriptionPer legislation governing this program, payment constitutes payment infull.Start: 01/01/1997Pancreas transplant not covered unless kidney transplant performed.Start: 10/12/2001Missing/incomplete/invalid FDA approval number.Start: 10/12/2001 | Last Modified: 03/30/2005Notes: (Modified 2/28/03, 3/30/05)Your claim contains incomplete and/or invalid information, and noappeal rights are afforded because the claim is unprocessable. Pleasesubmit a new claim with the complete/correct information.Start: 10/12/2001Physician already paid for services in conjunction with thisdemonstration claim. You must have the physician withdraw that claimand refund the payment before we can process your claim.Start: 10/12/2001Adjustment to the pre-demonstration rate.Start: 10/12/2001Claim overlaps inpatient stay. Rebill only those services renderedoutside the inpatient stay.Start: 10/12/2001Missing/incomplete/invalid provider number of the facility where thepatient resides.Start: 10/12/2001Alert: You may appeal this decision in writing within the required timelimits following receipt of this notice by following the instructionsincluded in your contract or plan benefit documents.Start: 01/01/2000 | Last Modified: 04/01/2007Notes: (Modified 2/28/03, 4/1/07)32
ReasonCodesN2N3N4N5N6N7N8N9DescriptionThis allowance has been made in accordance with the most appropriatecourse of treatment provision of the plan.Start: 01/01/2000Missing consent form.Start: 01/01/2000 | Last Modified: 02/28/2003Notes: (Modified 2/28/03) Related to N228Missing/incomplete/invalid prior insurance carrier EOB.Start: 01/01/2000 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)EOB received from previous payer. Claim not on file.Start: 01/01/2000Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered carethan the amount Medicare would have allowed if the patient wereenrolled in Medicare Part A and/or Medicare Part B.Start: 01/01/2000 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)Processing of this claim/service has included consideration under MajorMedical provisions.Start: 01/01/2000Crossover claim denied by previous payer and complete claim data notforwarded. Resubmit this claim to this payer to provide adequate datafor adjudication.Start: 01/01/2000Adjustment represents the estimated amount a previous payer may pay.Start: 01/01/2000 | Last Modified: 11/18/2005Notes: (Modified 11/18/05)33
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Page 34 and 35: ReasonCodesN10N11N12N13N15N16N19N20
Page 44 and 45: ReasonCodesN103N104N105N106N107Desc
Page 46 and 47: ReasonCodesN115N116N117N118N119Desc
Page 48 and 49: ReasonCodesN125DescriptionPayment h
Page 50 and 51: ReasonCodesN137N138N139DescriptionA
Page 52 and 53: ReasonCodesN148N149N150N151N152N153
Page 70 and 71: ReasonCodesN355DescriptionAlert: Th
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ReasonCodesN486N487N488N489N490N491
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ReasonCodesN509N510N511N512N513N514
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Claim Adjustment Reason Codes - Palmetto GBA

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