Claim Adjustment Reason Codes - Palmetto GBA

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ReasonCodesN365N366N367N368N369N370N371N372N373DescriptionThis procedure code is not payable. It is for reporting/informationpurposes only.Start: 04/01/2006Requested information not provided. The claim will be reopened if theinformation previously requested is submitted within one year after thedate of this denial notice.Start: 04/01/2006Alert: The claim information has been forwarded to a ConsumerSpending Account processor for review; for example, flexible spendingaccount or health savings account.Start: 04/01/2006 | Last Modified: 07/01/2008Notes: (Modified 4/1/07, 11/5/07, 7/1/08)You must appeal the determination of the previously adjudicated claim.Start: 04/01/2006Alert: Although this claim has been processed, it is deficient accordingto state legislation/regulation.Start: 04/01/2006Billing exceeds the rental months covered/approved by the payer.Start: 08/01/2006Alert: title of this equipment must be transferred to the patient.Start: 08/01/2006Only reasonable and necessary maintenance/service charges arecovered.Start: 08/01/2006It has been determined that another payer paid the services as primarywhen they were not the primary payer. Therefore, we are refunding tothe payer that paid as primary on your behalf.Start: 12/01/200672
ReasonCodesN374N375N376N377N378N379N380N381N382N383N384DescriptionPrimary Medicare Part A insurance has been exhausted and a Part BRemittance Advice is required.Start: 12/01/2006Missing/incomplete/invalid questionnaire/information required todetermine dependent eligibility.Start: 12/01/2006Subscriber/patient is assigned to active military duty, therefore primarycoverage may be TRICARE.Start: 12/01/2006Payment based on a processed replacement claim.Start: 12/01/2006 | Last Modified: 11/05/2007Notes: (Modified 11/5/07)Missing/incomplete/invalid prescription quantity.Start: 12/01/2006Claim level information does not match line level information.Start: 12/01/2006The original claim has been processed, submit a corrected claim.Start: 04/01/2007Consult our contractual agreement for restrictions/billing/paymentinformation related to these charges.Start: 04/01/2007Missing/incomplete/invalid patient identifier.Start: 04/01/2007Services deemed cosmetic are not coveredStart: 04/01/2007Records indicate that the referenced body part/tooth has been removedin a previous procedure.Start: 04/01/200773
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Medicare Specific Remark CodesLast
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ReasonCodesM20M21M22M23M24M25Descri
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ReasonDescriptionCodesM29 Missing o
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ReasonCodesM50M51M52M53M54M55M56M59
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ReasonCodesM112M113M114M115M116M117
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ReasonCodesM127M129M130M131M132M133
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ReasonCodesMA01MA02MA04MA07MA08MA09
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ReasonCodesMA17MA18MA19MA20MA21MA22
Page 22 and 23: ReasonCodesMA32MA33MA34MA35MA36MA37
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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