EOB Codes and Descriptions - Kymmis.com

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KYEOB223225226MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESTHE PROVIDER IS NOT ELIGIBLE ON DATE(S)OF SERVICE (Provider Has Been Suspended) 223 B7HIPAA ADJ RSN CODEDESCRIPTIONThis provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.HIPAAREMARKHIPAA REMARK CODEDESCRIPTIONMissing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.NO HISTORY MATCH FOUND, PLEASERESUBMIT. 225 107M58CANNOT BE PROCESSED ON THIS CLAIMFORM. 226 A1 Claim denied charges. N34 Incorrect claim form for this service.227 CLAIM OVERLAPS YOUR FISCAL YEAR END. 227 A1 Claim denied charges.228229230231232THE PROVIDER IS NOT ELIGIBLE FOR DATEOF SERVICE. 228 B7CLAIM/DETAIL DENIED. BILLING PROVIDERNUMBER INVALID OR NOT ON PROVIDERFILE. 229 B7THE CLINIC IS NOT ELIGIBLE FOR THE CLAIMDATES OF SERVICE. 230 B7CLAIM/DETAIL DENIED. BILLING PROVIDERNAME DOES NOT MATCH THE NAME ONPROVIDER FILE. 231 B7CLAIM/DETAIL DENIED. ACTION REASONCODE INDICATES PROVIDER IS ON REVIEW. 232 B7233 UPIN MISSING OR INVALID. 233 52234235236237238239240241CLAIM/DETAIL DENIED. REFERRINGPROVIDER FLAG SET TO SUSPEND FORREVIEW. 234 52SERVICE NOT PROVIDED UNDER THEThis 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.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.This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.The referring/prescribing/rendering provider is not eligible torefer/prescribe/ order/perform theservice billed.The referring/prescribing/rendering provider is not eligible torefer/prescribe/ order/perform theservice billed.MEDICAID PROGRAM. 146, 182, 355 96 Non-covered charge(s).PERFORMING PROVIDER NOT ASSOCIATEDWITH THE BILLING PROVIDER. 236 52CLAIM DENIED. CLINIC PROVIDER NUMBERNOT ON FILE. 237 52CLAIM DENIED. BILLINGPHYSICIAN/PROVIDER NOT LISTED ASMEMBER OF CLINIC. 238 B7DETAIL PROVIDER NUMBER INVALID OR NOTON FILE. 239 B7MODIFIER 26 OR 50 CANNOT BE BILLEDWITH THIS PROCEDURE CODE. 240 4PENDING CONFIRMATION OF PROVIDERELIGIBILITY.080, 086, 108, 109, 110, 111,112, 206, 221, 222, 228, 229,289, 301, 829, 241 B7The referring/prescribing/rendering provider is not eligible torefer/prescribe/ order/perform theservice billed.The referring/prescribing/rendering provider is not eligibleto refer/prescribe/ order/performthe service billed.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.The procedure code isinconsistent with the modifierused or a required modifier ismissing.This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.M57M58MA112MA29N35M33N31M57M58N31MA112M57M78Missing/incomplete/invalid provideridentifier.Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalid grouppractice information.Missing/incomplete/invalid providername, city, state, or zip code.Program integrity/utilization reviewdecision.Missing/incomplete/invalid UPIN forthe ordering/referring /performingprovider.Missing/incomplete/invalidprescribing/referring/attendingprovider license number.Missing/incomplete/invalid provideridentifier.Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalidprescribing/referring/attendingprovider license number.Missing/incomplete/invalid grouppractice information.Missing/incomplete/invalid provideridentifier.Missing/incomplete/invalid HCPCSmodifier.Page 12 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOBMEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTION242243244245246248249NO LEVEL 2 PRICING RECORD FOUND FORMODIFIERS TC OR 26. 242 16PROCEDURE CODE Y2870 INVALID FORDATES OF SERVICE 10/15/94 AND AFTERFOR THIS PROVIDER TYPE. 243 8PROVIDER HAS NOT MET ALLREQUIREMENTS FOR BILLING OTHERLABORATORY AND X-RAY SERVICES. 244 B7Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.The procedure code isinconsistent with the providertype/specialty (taxonomy).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.THESE SERVICES MAY BE BILLED ONLY BY ARECIPIENT'S HOSPICE PROVIDER. 245 B7N3280022-ROUTINE VENIPUNCTURE SINGLEHOMEBOUND NURSING HOME OR SNF NOTALLOWED SAME DOS/RECIPIENT/PROVIDERAS 80020-BLOOD COLLECTIONVENIPUNCTURE. 346 96 Non-covered charge(s). N20CLAIM DENIED. SURGEON AND ASSISTANTSURGEON BILLING NOT ALLOWED ON SAMEFORM. 248 54Multiple physicians/ assistants arenot covered in this case.PAYMENT REDUCED BECAUSE OURRECORDS SHOW RECIPIENT WAS NOT I NFACILITY FOR ALL OF THE TOTAL BILLEDDAYS. 249 A1 Claim denied charges. MA32N65M67M86M53Procedure code or procedure ratecount cannot be determined, or wasnot on file, for the date of service/provider.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Provider performing service mustsubmit claim.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for same/similarprocedure within set time frame.Missing/incomplete/invalid number ofcovered days during the billingperiod.Missing/incomplete/invalid days orunits of service.250251THIS RECIPIENT IS NOT ON OUR ELIGIBILITYFILE. PLEASE VERIFY RECIPIENT MAIDNUMBER. 250 31INCORRECT RECIPIENT IDENTIFICATIONNUMBER. 251 31Claim denied as patient cannot beidentified as our insured.Claim denied as patient cannot beidentified as our insured.MA31N32Missing/incomplete/invalid beginningand ending dates of the period billed.Provider performing service mustsubmit claim.252253254255256RECIPIENT NAME ON CLAIM DOES NOTMATCH RECIPIENT NAME ON THE MEDICAIDELIGIBILITY DATABASE FOR THE MAIDNUMBER SUBMITTED ON YOUR CLAIM. 252 140OUR RECORDS INDICATE THE RECIPIENTWAS DECEASED PRIOR TO THE ENDINGDATE OF SERVICE. 253 13THE RECIPIENT IS NOT ELIGIBLE ON THECLAIM SERVICE DATES. 254, 259, 265 2627Patient/insured healthidentification number and namedo not match.RECIPIENT HAS MEDICARE PART B. PLEASEBILL MEDICARE FOR THESE SUPPLIES. 255 96 Non-covered charge(s). MA64OUR RECORDS INDICATE THAT THISRECIPIENT MAY BE ELIGIBLE FORMEDICARE. PLEASE BILL MEDICARE FIRST.IF MEDICARE DENIES THIS SERVICE,RESUBMIT WITH PROOF OF DENIAL. 256 22MA36Missing/incomplete/invalid patientname.The date of death precedes thedate of service.Expenses incurred prior tocoverage. N30 Recipient ineligible for this service.Expenses incurred after coverageterminated.Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Payment adjusted because thiscare may be covered by anotherpayer per coordination of benefits.MA04MA83MA64Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information waseither not reported or was illegible.Did not indicate whether we are theprimary or secondary payer. Refer toItem 11 in the HCFA-1500instructions for assistance.Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Page 13 of 46 Date: 3/30/2005
Page 1 and 2: KYEOB001002003004KENTUCKY EOB/ESC C
Page 3 and 4: KENTUCKY EOB/ESC CROSSWALK TO HIPAA
Page 5 and 6: KYEOB079080081082083084KENTUCKY EOB
Page 7 and 8: KYEOB114115116117118119KENTUCKY EOB
Page 11: KYEOB200201202203KENTUCKY EOB/ESC C
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EOB Codes and Descriptions - Kymmis.com

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