EOB Codes and Descriptions - Kymmis.com

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KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOB283284285MEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESOUR RECORDS INDICATE RECIPIENT HASMEDICARE PART B, PLEASE BILL MEDICARE. 283 109OUR RECORDS INDICATE THAT THISRECIPIENT IS ELIGIBLE FOR HOSPICECOVERAGE BY MEDICARE. PLEASE BILLMEDICARE FIRST. 284 109REGIONAL ANESTHESIA PROCEDURECODES MAY NOT BE BILLED USING TYPE OFSERVICE 07, MODIFIER AG, OR MORE THANONE UNIT OF SERVICE PER DATE OFSERVICE. 185 4HIPAA ADJ RSN CODEDESCRIPTIONClaim not covered by thispayer/contractor. You must sendthe claim to the correctpayer/contractor.Claim not covered by thispayer/contractor. You must sendthe claim to the correctpayer/contractor.The procedure code isinconsistent with the modifierused or a required modifier ismissing.HIPAA HIPAA REMARK CODEREMARKDESCRIPTIONOur records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondaryMA64 payers.Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information wasMA04 either not reported or was illegible.Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondaryMA64 payers.Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information wasMA04 either not reported or was illegible.Did not indicate whether we are theprimary or secondary payer. Refer toItem 11 in the HCFA-1500MA83 instructions for assistance.N56Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.286287288289290THIS PROCEDURE CODE IS LIMITED TO ONEUNIT OF SERVICE PER DATE OF SERVICE. 186, 635 57PROFESSIONAL COMPONENT REVENUECODE MUST BE BILLED WITH THECORRESPONDING TECHNICAL COMPONENTREVENUE CODE. 187 107PROFESSIONAL COMPONENT REVENUECODE MUST BE BILLED WITHCORRESPONDING TECHNICAL REVENUECODE. CHARGES MOVED TO NON-COVERED. 187 107RENDERING PROVIDER NUMBER MISSINGOR INVALID . 289 B7248, 249, 250, 251, 252, 253,PENDING CONFIRMATION OF RECIPIENT 254, 259, 290, 291, 310, 399,ELIGIBILITY.494 133Payment denied/reduced becausethe payer deems the informationsubmitted does not support thislevel of service, this manyservices, this length of service,this dosage, or this day's supply.Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.The disposition of thisclaim/service is pending furtherreview.M63M66M66M57We do not pay for more than one ofthese on the same day.Our records indicate that you billeddiagnostic tests subject to pricelimitations and the procedure codesubmitted includes a professionalcomponent. Only the technicalcomponent is subject to pricelimitations. Please submit thetechnical and professionalcomponents of this service asseparate line items.Our records indicate that you billeddiagnostic tests subject to pricelimitations and the procedure codesubmitted includes a professionalcomponent. Only the technicalcomponent is subject to pricelimitations. Please submit thetechnical and professionalcomponents of this service asseparate line items.Missing/incomplete/invalid provideridentifier.291292293PENDING POSSIBLE OTHER INSURANCEINVOLVEMENT. 291, 462, 467 22CLAIM SUSPENDED FOR BUY-IN ELIGIBILITYREVIEW. 292 133CLAIM SUSPENDED FOR ELIGIBILITYREVIEW. 910 133Payment adjusted because thiscare may be covered by anotherpayer per coordination of benefits.The disposition of thisclaim/service is pending furtherreview.The disposition of thisclaim/service is pending furtherreview.294KENPAC RECIPIENT. REFERRING PROVIDERNUMBER IS MISSING OR IS NOT THEKENPAC PRIMARY PHYSICIAN/CLINICNUMBER FOR THE DATE(S) OF SERVICE. 290 38Services not provided orauthorized by designated(network/primary care) providers.M68Missing/incomplete/invalid attendingor referring physician identification.Page 16 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOBMEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAA HIPAA REMARK CODEREMARKDESCRIPTIONMissing/incomplete/invalid providerM57 identifier.295296BILLING OR REFERRING KENPAC PROVIDERNUMBER IS MISSING OR IS NOT THEKENPAC PHYSICIAN/CLINIC FOR DATE(S)BILLED. KENPAC REFERRING PROVIDERNUMBER SHOULD BE ENTERED IN FIELD 19. 291 38CLAIM DENIED. TYPE OF SERVICE DOESNOT MATCH PROCEDURE MODIFIER. 296 4297 RECIPIENT IS NOT ELIGIBLE FOR HOSPICE. 297 28A1RECIPIENT IS NOT ELIGIBLE FOR HOSPICE298 FOR BILLED DATES OF SERVICE. 298 28A1HOSPICE RECIPIENT. OUR FILES SHOWRECIPIENT IS COVERED BY ANOTHERHOSPICE PROVIDER FOR BILLED DATE(S)299 OF SERVICE. 299 B9SERVICE PAYS ZERO FOR PRIMARY CARE300 AND RURAL HEALTH CLAIMS 119301Services not provided orauthorized by designated(network/primary care) providers.The procedure code isinconsistent with the modifierused or a required modifier ismissing.Coverage not in effect at the timeM68M57MA66Missing/incomplete/invalid attendingor referring physician identification.Missing/incomplete/invalid provideridentifier.Missing/incomplete/invalid principalprocedure code or date.the service was provided. N30 Recipient ineligible for this service.Claim denied charges.Coverage not in effect at the timethe service was provided. N30 Recipient ineligible for this service.Claim denied charges.Services not covered because thepatient is enrolled in a Hospice. N30 Recipient ineligible for this service.Benefit maximum for this timeperiod has been reached.Procedures for billing withgroup/referring/performing providerswere not followed.RENDERING PROVIDER NOT LISTED AS AMEMBER OF THE BILLING GROUP. 301 A1 Claim denied charges. N55303THIS SERVICE MUST BE BILLED FOR AMINIMUM OF 8 UNITS PER DATE OFSERVICE. 303 57Payment denied/reduced becausethe payer deems the informationsubmitted does not support thislevel of service, this manyservices, this length of service,this dosage, or this day's supply.M53Missing/incomplete/invalid days orunits of service.304305OFFICE EMERGENCY NOT COVERED SAMEDATE OF SERVICE AS ANORPLANT/REMOVAL 347, 348 57CLAIM/DETAIL DENIED. THIS PROCEDURECODE IS INVALID FOR THE PROVIDERPROFESSIONAL CODE (1ST DIGIT OFMODIFIER). 305 B18Payment denied/reduced becausethe payer deems the informationsubmitted does not support thislevel of service, this manyservices, this length of service,this dosage, or this day's supply.Payment denied because thisprocedure code/ modifier wasinvalid on the date of service ofclaim submission.N20M86N56Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.306307A HOSPICE RECIPIENT - RECYCLE FOR EDIT298. 106, 306 B9CLAIM/DETAIL DENIED. THIS PROCEDURECODE IS NOT PAYABLE UNLESS BILLED INCONJUNCTION WITH OTHER DESIGNATEDPROCEDURES. 307 107Services not covered because thepatient is enrolled in a Hospice. N30 Recipient ineligible for this service.Claim/service denied because therelated or qualifying claim/serviceProcedure code billed is notwas not previously paid orcorrect/valid for the services billed oridentified on this claim.N56 the date of service billed.308310311DETAIL DENIED. REQUIREDDOCUMENTATION IS MISSING OR DOES NOTVERIFY THAT MEDICAL ASSISTANCE WASPROVIDED. 180 16NEW ADMISSION NOT PAYABLE BECAUSEClaim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.OF NON-COMPLIANCE 310 96 Non-covered charge(s). MA41CORRECTED PAYMENT PER ADJUSTMENTREQUEST. 125M29Missing/incomplete/invalid operativereport.Missing/incomplete/invalidaddmission type.Payment adjusted due to asubmission/billing error(s).Additional information is suppliedusing the remittance adviceremarks codes wheneverappropriate. MA67 Correction to a prior claim.316319CLAIM/DETAIL PAID. CLAIMS HISTORYREFLECTS THE TOOTH NUMBERPREVIOUSLY EXTRACTED. PLEASE CHECKRECORDS AND VERIFY TOOTH NUMBER. 316, 400 18 Duplicate claim/service. N39INCORRECT PROVIDER NUMBERSUBMITTED - PAYMENT DELAYED. 319 133The disposition of thisclaim/service is pending furtherreview.M57Procedure code is not compatiblewith tooth number/letter.Missing/incomplete/invalid provideridentifier.Page 17 of 46 Date: 3/30/2005
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Page 11 and 12: KYEOB200201202203KENTUCKY EOB/ESC C
Page 15: KYEOB273KENTUCKY EOB/ESC CROSSWALK
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Page 21 and 22: KYEOB382KENTUCKY EOB/ESC CROSSWALK
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Page 25 and 26: KYEOB482483MEDICAID DESCRIPTIONKENT
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Page 31 and 32: KYEOBMEDICAID DESCRIPTIONKENTUCKY E
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