Claim Adjustment Reason Codes - Palmetto GBA

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ReasonCodesN10N11N12N13N15N16N19N20N21DescriptionPayment based on the findings of a review organization/professionalconsult/manual adjudication/medical or dental advisor.Start: 01/01/2000 | Last Modified: 07/01/2008Notes: (Modified 10/31/02, 7/1/08)Denial reversed because of medical review.Start: 01/01/2000Policy provides coverage supplemental to Medicare. As the memberdoes not appear to be enrolled in the applicable part of Medicare, themember is responsible for payment of the portion of the charge thatwould have been covered by Medicare.Start: 01/01/2000 | Last Modified: 08/01/2007Notes: (Modified 8/1/07)Payment based on professional/technical component modifier(s).Start: 01/01/2000Services for a newborn must be billed separately.Start: 01/01/2000Family/member Out-of-Pocket maximum has been met. Payment basedon a higher percentage.Start: 01/01/2000Procedure code incidental to primary procedure.Start: 01/01/2000Service not payable with other service rendered on the same date.Start: 01/01/2000Alert: Your line item has been separated into multiple lines to expeditehandling.Start: 01/01/2000 | Last Modified: 04/01/2007Notes: (Modified 8/1/05, 4/1/07)34
ReasonCodesN22N23N24N25N26N27N28N29DescriptionThis procedure code was added/changed because it more accuratelydescribes the services rendered.Start: 01/01/2000 | Last Modified: 02/28/2003Notes: (Modified 10/31/02, 2/28/03)Alert: Patient liability may be affected due to coordination of benefitswith other carriers and/or maximum benefit provisions.Start: 01/01/2000 | Last Modified: 04/01/2007Notes: (Modified 8/13/01, 4/1/07)Missing/incomplete/invalid Electronic Funds Transfer (EFT) bankinginformation.Start: 01/01/2000 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)This company has been contracted by your benefit plan to provideadministrative claims payment services only. This company does notassume financial risk or obligation with respect to claims processed onbehalf of your benefit plan.Start: 01/01/2000Missing itemized bill/statement.Start: 01/01/2000 | Last Modified: 07/01/2008Notes: (Modified 2/28/03, 7/1/2008) Related to N232Missing/incomplete/invalid treatment number.Start: 01/01/2000 | Last Modified: 02/28/2003Notes: (Modified 2/28/03)Consent form requirements not fulfilled.Start: 01/01/2000Missing documentation/orders/notes/summary/report/chart.Start: 01/01/2000 | Last Modified: 08/01/2005Notes: (Modified 2/28/03, 8/1/05) Related to N22535
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Page 32 and 33: ReasonCodesMA125MA126MA128MA130MA13
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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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ReasonCodesN509N510N511N512N513N514
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Claim Adjustment Reason Codes - Palmetto GBA

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