Claim Adjustment Reason Codes - Palmetto GBA

ReasonCodesN125DescriptionPayment has been (denied for the/made only for a less extensive)service/item because the information furnished does not substantiatethe need for the (more extensive) service/item. If you have collected anyamount from the patient, you must refund that amount to the patientwithin 30 days of receiving this notice.N126N127N128N129The requirements for a refund are in 1834(a)(18) of the Social SecurityAct (and in 1834(j)(4) and 1879(h) by cross-reference to 1834(a)(18)).Section 1834(a)(18)(B) specifies that suppliers which knowingly andwillfully fail to make appropriate refunds may be subject to civil moneypenalties and/or exclusion from the Medicare program. If you have anyquestions about this notice, please contact this office.Start: 09/26/2002 | Last Modified: 08/01/2005Notes: (Modified 8/1/05. Also refer to N356)Social Security Records indicate that this individual has been deported.This payer does not cover items and services furnished to individualswho have been deported.Start: 10/17/2002This is a misdirected claim/service for a United Mine Workers ofAmerica (UMWA) beneficiary. Please submit claims to them.Start: 10/31/2007 | Last Modified: 08/01/2004Notes: (Modified 8/1/04This amount represents the prior to coverage portion of the allowance.Start: 10/31/2002Not eligible due to the patient's age.Start: 10/31/2002 | Last Modified: 08/01/2007Notes: (Modified 8/1/07)48