Claim Adjustment Reason Codes - Palmetto GBA

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ReasonCodesN406N407N408N409N410N418N419N420N421N422DescriptionThis service is only covered when the recipient's insurer(s) do notprovide coverage for the service.Start: 08/01/2007You are not an approved submitter for this transmission format.Start: 08/01/2007This payer does not cover deductibles assessed by a previous payer.Start: 08/01/2007This service is related to an accidental injury and is not covered unlessprovided within a specific time frame from the date of the accident.Start: 08/01/2007This is not covered unless the prescription changes.Start: 08/01/2007Misrouted claim. See the payer's claim submission instructions.Start: 08/01/2007Claim payment was the result of a payer's retroactive adjustment due toa retroactive rate change.Start: 08/01/2007Claim payment was the result of a payer's retroactive adjustment due toa Coordination of Benefits or Third Party Liability Recovery.Start: 08/01/2007Claim payment was the result of a payer's retroactive adjustment due toa review organization decision.Start: 08/01/2007 | Last Modified: 05/08/2008Notes: (Modified 2/29/08, typo fixed 5/8/08)Claim payment was the result of a payer's retroactive adjustment due toa payer's contract incentive program.Start: 08/01/2007 | Last Modified: 05/08/2008Notes: (Typo fixed 5/8/08)76
ReasonCodesN423N424N425N426N427N428N429N430N431N432N433N434DescriptionClaim payment was the result of a payer's retroactive adjustment due toa non standard program.Start: 08/01/2007Patient does not reside in the geographic area required for this type ofpayment.Start: 08/01/2007Statutorily excluded service(s).Start: 08/01/2007No coverage when self-administered.Start: 08/01/2007Payment for eyeglasses or contact lenses can be made only aftercataract surgery.Start: 08/01/2007Service/procedure not covered when performed in this place of service.Start: 08/01/2007This is not covered since it is considered routine.Start: 08/01/2007Procedure code is inconsistent with the units billed.Start: 11/05/2007Service is not covered with this procedure.Start: 11/05/2007Adjustment based on a Recovery Audit.Start: 11/05/2007Resubmit this claim using only your National Provider Identifier (NPI)Start: 02/29/2008Missing/Incomplete/Invalid Present on Admission indicator.Start: 07/01/200877
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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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Page 26 and 27: ReasonCodesMA68MA69MA70MA71MA72MA73
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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
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Claim Adjustment Reason Codes - Palmetto GBA

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