EOB Codes and Descriptions - Kymmis.com

KYEOB200201202203KENTUCKY EOB/ESC CROSSWALK TO HIPAAHIPAAADJ RSNCODESMEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKThe referring/prescribing/rendering provider is not eligible toCLAIM/DETAIL DENIED. PROVIDER ONrefer/prescribe/ order/perform theREVIEW FOR THIS DIAGNOSIS. 200 52 service billed.N35THIS DIAGNOSIS IS NOT PAYABLE FOR THISThe diagnosis is inconsistent withPROVIDER TYPE. 201 12 the provider type.M76REC ARE LIMITED TO 1 EPSDT SCREENINGPER TIME SPAN ACCORDING TO THELifetime benefit maximum hasPERIODICITY SCHEDULE. 654 35 been reached.M139CLAIM/DETAIL DENIED. PROCEDURE CODEMODIFIER AG OR TYPE OF SERVICE 7 OR BNOT ALLOWED FOR DATES OF SERVICEAFTER 12/12/94. 203 A1 Claim denied charges. M78This (these) diagnosis(es) is (are)not covered, missing, or areinvalid.MA63204INVALID DIAGNOSIS CODE. CONTACT THEDEPARTMENT FOR MEDICAID SERVICES. 204 47DIAGNOSIS CODE INVALID FOR PROVIDERThe diagnosis is inconsistent with205 TYPE 205 12 the provider type.M76This provider was notcertified/eligible to be paid for thisCLAIM DENIED. RENDERING PROVIDER ISprocedure/ service on this date of206 NOT ELIGIBLE FOR THE DATE OF SERVICE. 206 B7 service.DETAIL DIAGNOSIS INVALID FOR PATIENT'SThe diagnosis is inconsistent with207 AGE. 207 9 the patient's age.M76THIS PROCEDURE IS NOT COVERED FORThe diagnosis is inconsistent with208 THIS DIAGNOSIS 208 11 the procedure.CLAIM DENIED. MOST ANESTHESIASERVICES MUST BE BILLED USINGANESTHESIA PROCEDURE CODES209 BEGINNING WITH 0. 209 A1 Claim denied charges. N56This (these) diagnosis(es) is (are)CLAIM/DETAIL DENIED. THIRD HEADERnot covered, missing, or are210 DIAGNOSIS ON REVIEW. 210 47 invalid.M64211212213214215216217218CLAIM/DETAIL DENIED. THIRD DIAGNOSIS ISNOT ON FILE. 211 47CLAIM/DETAIL DENIED. DETAIL DIAGNOSISINDICATOR INVALID. 212 47THE FOURTH DIAGNOSIS IS MISSING ORINVALID. PLEASE ENTER THE APPROPRIATEDIAGNOSIS CODE AND RESUBMIT THECLAIM. 213 47CLAIM/DETAIL DENIED. SECONDARYHEADER DIAGNOSIS ON REVIEW. 214 47CLAIM/DETAIL DENIED. RECIPIENT'S AGENOT WITHIN VALID RANGES FOR THIRDDIAGNOSIS. 215 9CLAIM/DETAIL DENIED. THIRD DIAGNOSISNOT VALID FOR RECIPIENT'S SEX. 216 10THE FOURTH DIAGNOSIS IS NOT COVEREDFOR THE RECIPIENT' AGE. 217 9FOURTH DIAGNOSIS IS INVALID FORRECIPIENT'S SEX. 218 10219 FOURTH HEADER DIAGNOSIS ON REVIEW. 219 47SERVICE(S) NOT COVERED BY MEDICAID.PRIMARY DIAGNOSIS CODE INDICATESSUBSTANCE ABUSE/CHEMICAL220 DEPENDENCY. 220 47221222THE PROVIDER IS NOT ELIGIBLE ON DATE(S)OF SERVICE (Provider Has Died) 221 B7THE PROVIDER IS NOT ELIGIBLE ON DATE(S)OF SERVICE (Provider Has Been Cancelled) 222 B7This (these) diagnosis(es) is (are)not covered, missing, or areinvalid.This (these) diagnosis(es) is (are)not covered, missing, or areinvalid.This (these) diagnosis(es) is (are)not covered, missing, or areinvalid.This (these) diagnosis(es) is (are)not covered, missing, or areinvalid.The diagnosis is inconsistent withthe patient's ageThe diagnosis is inconsistent withthe patient's gender.The diagnosis is inconsistent withthe patient's ageThe diagnosis is inconsistent withthe patient's gender.This (these) diagnosis(es) is (are)not covered, missing, or areinvalid.This (these) diagnosis(es) is (are)not covered, missing, or areinvalid.This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.M64M49M58M64M64M76M64M76M64M76M64M64M64HIPAA REMARK CODEDESCRIPTIONProgram integrity/utilization reviewdecision.Missing/incomplete/invalid diagnosisor condition.Denied services exceed the coveragelimit for the demonstration.Missing/incomplete/invalid HCPCSmodifier.Missing/incomplete/invalid principaldiagnosis.Missing/incomplete/invalid diagnosisor condition.Missing/incomplete/invalid diagnosisor condition.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Missing/incomplete/invalid otherdiagnosis.Missing/incomplete/invalid otherdiagnosis.Missing/incomplete/invalid valuecode(s) or amount(s).Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalid otherdiagnosis.Missing/incomplete/invalid otherdiagnosis.Missing/incomplete/invalid diagnosisor condition.Missing/incomplete/invalid otherdiagnosis.Missing/incomplete/invalid diagnosisor condition.Missing/incomplete/invalid otherdiagnosis.Missing/incomplete/invalid diagnosisor condition.Missing/incomplete/invalid otherdiagnosis.Missing/incomplete/invalid otherdiagnosis.Missing/incomplete/invalid otherdiagnosis.Page 11 of 46 Date: 3/30/2005