EOB Codes and Descriptions - Kymmis.com

KYEOB321322325KENTUCKY EOB/ESC CROSSWALK TO HIPAAHIPAAADJ RSNCODESMMIS EXCEPTIONMEDICAID DESCRIPTIONCODE(S)EPSDT SCREENING PROCEDURES ARE NOTPAYABLE WITHIN 30 DAYS OF AN EPSDTRELATED PROCEDURES. 321 97EPSDT RELATED PROCEDURES ARE NOTPAYABLE WITHIN 30 DAYS OF AN EPSDTSCREENING PROCEDURES. 322 97CLAIM/DETAIL DENIED. SCREENINGPROCEDURE CODE INVALID FORRECIPIENT'S AGE. 325 6HIPAA ADJ RSN CODEDESCRIPTIONPayment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.The procedure/revenue code isinconsistent with the patient's age.HIPAA HIPAA REMARK CODEREMARKDESCRIPTIONService denied because paymentalready made for similar procedureM86 within set time frame.Service denied because paymentalready made for similar procedureM86 within set time frame.MA66Missing/incomplete/invalid principalprocedure code or date.326327328329330331CLAIM DENIED. BILL/INVOICE MUSTACCOMPANY CLAIM. 326 16PROCEDURE/NDC REQUIRES PRIORAUTHORIZATION. 327, 332, 355, 681, 104 62PRIMARY SURGICAL PROCEDUREREQUIRES PRIOR AUTHORIZATION. 328 62SECONDARY SURGICAL PROCEDUREREQUIRES PRIOR AUTHORIZATION 329 62DETAIL DENIED. DETAIL UNITS BILLEDEXCEED UNITS PRIOR AUTHORIZED. 330 62PAYMENT REDUCED BY AMOUNTPREVIOUSLY PAID. POST OP INCLUDED INPROCEDURE. 331, 371 97Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Payment is included in theallowance for anotherservice/procedure.N29M144Missingdocumentation/orders/notes/summary/report/invoice.Pre-/post-operative care payment isincluded in the allowance for surgery/ procedure.Payment denied/reduced for333NONSTEROIDAL ANTI-INFLAMMATORYDRUGS REQUIRE PRIOR AUTHORIZATION. 333 62absence of, or exceeded, precertification/authorization.334 SUPPLY NOT COVERED ON RENTAL ITEM. 334, 404 96 Non-covered charge(s).D3Claim/service denied becauseinformation to indicate if thepatient owns the equipment thatrequires the part or supply wasmissing.M15Separately billed services/tests havebeen bundled as they are consideredcomponents of the same procedure.Separate payment is not allowed.335 LACKS REPORT TO JUSTIFY HIGHER FEE. 335 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N29Missingdocumentation/orders/notes/summary/report/invoice.33734034134257CATHETERIZATION PROCEDURES80021,80023 AND 80024 NOT ALLOWEDSAME DOS/RECIPIENT/ PROVIDER. 336, 337, 338, 339 97ONLY THREE FOLLOW UP EXAMS ALLOWEDDURING THE SIX MONTH PERIODFOLLOWING THE FITTING OF A HEARINGAID. 340 119AN OFFICE VISIT, ER VISIT ORCONSULTATION ARE NOT PAYABLE ON THESAME DATE OF SERVICE AS A HOSPITALADMISSION. 341 B14AN OFFICE VISIT AND/OR ER VISIT ARE NOTPAYABLE ON THE SAME DATE OF SERVICEAS A CONSULTATION. 342 B14Payment 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 is included in theallowance for anotherservice/procedure.Benefit maximum for this timeperiod has been reached.Payment denied because only onevisit or consultation per physicianper day is covered.Payment denied because only onevisit or consultation per physicianper day is covered.N20M86M139N20M86N20M86Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Denied services exceed the coveragelimit for the demonstration.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Page 18 of 46 Date: 3/30/2005