Claim Adjustment Reason Codes - Palmetto GBA

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ReasonCodesN188N189N190N191N192N193N194N195N196N197N198DescriptionThe approved level of care does not match the procedure codesubmitted.Start: 02/28/2003Alert: This service has been paid as a one-time exception to the plan'sbenefit restrictions.Start: 02/28/2003 | Last Modified: 04/01/2007Notes: (Modified 4/1/07)Missing contract indicator.Start: 02/28/2003 | Last Modified: 08/01/2004Notes: (Modified 8/1/04) Related to N229The provider must update insurance information directly with payer.Start: 02/28/2003Patient is a Medicaid/Qualified Medicare Beneficiary.Start: 02/28/2003Specific federal/state/local program may cover this service throughanother payer.Start: 02/28/2003Technical component not paid if provider does not own the equipmentused.Start: 02/25/2003The technical component must be billed separately.Start: 02/25/2003Alert: Patient eligible to apply for other coverage which may be primary.Start: 02/25/2003 | Last Modified: 04/01/2007Notes: (Modified 4/1/07)The subscriber must update insurance information directly with payer.Start: 02/25/2003Rendering provider must be affiliated with the pay-to provider.Start: 02/25/200356
ReasonCodesN199N200N201N202N203N204N205N206N207N208N209DescriptionAdditional payment/recoupment approved based on payer-initiatedreview/audit.Start: 02/25/2003 | Last Modified: 08/01/2006Notes: (Modified 8/1/06)The professional component must be billed separately.Start: 02/25/2003A mental health facility is responsible for payment of outside providerswho furnish these services/supplies to residents.Start: 02/25/2003Additional information/explanation will be sent separatelyStart: 06/30/2003 | Last Modified: 11/01/2009Notes: (Modified 4/1/07, 11/1/09)Missing/incomplete/invalid anesthesia time/unitsStart: 06/30/2003Services under review for possible pre-existing condition. Send medicalrecords for prior 12 monthsStart: 06/30/2003Information provided was illegibleStart: 06/30/2003The supporting documentation does not match the claimStart: 06/30/2003Missing/incomplete/invalid weight.Start: 06/30/2003 | Last Modified: 11/18/2005Notes: (Modified 11/18/05)Missing/incomplete/invalid DRG codeStart: 06/30/2003Missing/incomplete/invalid taxpayer identification number (TIN).Start: 06/30/2003 | Last Modified: 07/01/2008Notes: (Modified 7/1/08)57
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Medicare Specific Remark CodesLast
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ReasonCodesM20M21M22M23M24M25Descri
Page 6 and 7: ReasonDescriptionCodesM29 Missing o
Page 8 and 9: ReasonCodesM50M51M52M53M54M55M56M59
Page 14 and 15: ReasonCodesM112M113M114M115M116M117
Page 16 and 17: ReasonCodesM127M129M130M131M132M133
Page 18 and 19: ReasonCodesMA01MA02MA04MA07MA08MA09
Page 30 and 31: ReasonDescriptionCodesMA108 Paper c
Page 32 and 33: ReasonCodesMA125MA126MA128MA130MA13
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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Claim Adjustment Reason Codes - Palmetto GBA

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