Claim Adjustment Reason Codes - Palmetto GBA

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ReasonCodesN385N386N387N388N389N390N391N392N393DescriptionNotification of admission was not timely according to published planprocedures.Start: 04/01/2007 | Last Modified: 11/05/2007Notes: (Modified 11/5/07)This decision was based on a National Coverage Determination (NCD).An NCD provides a coverage determination as to whether a particularitem or service is covered. A copy of this policy is available athttp://www.cms.hhs.gov/mcd/search.asp. If you do not have webaccess, you may contact the contractor to request a copy of the NCD.Start: 04/01/2007Alert: Submit this claim to the patient's other insurer for potentialpayment of supplemental benefits. We did not forward the claiminformation.Start: 04/01/2007 | Last Modified: 03/01/2009Notes: (Modified 3/1/2009)Missing/incomplete/invalid prescription numberStart: 08/01/2007Duplicate prescription number submitted.Start: 08/01/2007This service/report cannot be billed separately.Start: 08/01/2007 | Last Modified: 07/01/2008Notes: (Modified 7/1/08)Missing emergency department records.Start: 08/01/2007Incomplete/invalid emergency department records.Start: 08/01/2007Missing progress notes/report.Start: 08/01/2007 | Last Modified: 07/01/2008Notes: (Modified 7/1/08)74
ReasonCodesN394N395N396N397N398N399N400N401N402N403N404N405DescriptionIncomplete/invalid progress notes/report.Start: 08/01/2007 | Last Modified: 07/01/2008Notes: (Modified 7/1/08)Missing laboratory report.Start: 08/01/2007Incomplete/invalid laboratory report.Start: 08/01/2007Benefits are not available for incomplete service(s)/undelivered item(s).Start: 08/01/2007Missing elective consent form.Start: 08/01/2007Incomplete/invalid elective consent form.Start: 08/01/2007Alert: Electronically enabled providers should submit claimselectronically.Start: 08/01/2007Missing periodontal charting.Start: 08/01/2007Incomplete/invalid periodontal charting.Start: 08/01/2007Missing facility certification.Start: 08/01/2007Incomplete/invalid facility certification.Start: 08/01/2007This service is only covered when the donor's insurer(s) do not providecoverage for the service.Start: 08/01/200775
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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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Page 24 and 25: ReasonCodesMA53MA54MA55MA56MA57MA58
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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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