EOB Codes and Descriptions - Kymmis.com

KYEOB343344345MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONCLAIM MASS ADJUSTED DUE TO ARETROACTIVE RATE CHANGE 343 A2 Contractual adjustment. M80AN OFFICE VISIT IS NOT PAYABLE ON THEPayment is included in theSAME DATE OF SERVICE AS ANallowance for anotherEMERGENCY ROOM VISIT. 344 97 service/procedure.N2080020-BLOOD COLLECTION VENIPUNCTURENOT ALLOWED SAME DOS/RECIPIENT/PROVIDER AS 80022-ROUTINEVENIPUNCTURE SINGLE HOMEBOUNDNURSING HOME OR SNF. 345 97Payment is included in theallowance for anotherservice/procedure.HIPAA HIPAA REMARK CODEREMARKDESCRIPTIONNot covered when performed duringthe same session/date as apreviously processed service for thepatient.N20Service not payable with otherservice rendered on the same date.Service not payable with otherservice rendered on the same date.347348349DENTURE RELATED EMERGENCY SERVICES09110 AND UPPER OR LOWER DENTURERELINE 05750 NOT PAYABLE ON SDOS 347 9597ROOM CHARGES REDUCED TO SEMIPRIVATE RATE. 348 78EMERGENCY DENTAL PROCEDURES ANDEXTRACTION PROCEDURES NOT PAYABLEON SDOS. 349, 350 97Benefits adjusted. Planprocedures not followed.Payment is included in theallowance for anotherservice/procedure.Non-Covered days/Room chargeadjustment.Payment is included in theallowance for anotherservice/procedure.M63M63We do not pay for more than one ofthese on the same day.We do not pay for more than one ofthese on the same day.350351DETAIL DENIED. FILLINGS ARE NOTPAYABLE FOR THE SAME TOOTH AND THESAME DATE OF SERVICE AS EMERGENCYSERVICES (09110) OR SEALANTS (01351). 351, 352 97INCORRECT NUMBER OF DAYS COVEREDAND NON-COVERED. 351 78Payment is included in theallowance for anotherservice/procedure.Non-Covered days/Room chargeadjustment.N20M86MA33M53Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Missing/incomplete/invalidnoncovered days during the billingperiod.Missing/incomplete/invalid days orunits of service.352353CLAIM DENIED. INAPPROPRIATEPROCEDURE CODE USED. 355 B8INDIVIDUAL ALLERGY TESTINGPROCEDURES ARE NOT PAYABLE WITHW0308-MAXIMUM ALLOWABLE PER ALLERGYTESTING OF SERVICE. 353, 405 97Claim/service notcovered/reduced becausealternative services wereavailable, and should have beenutilized.Payment is included in theallowance for anotherservice/procedure.MA31N56M71Missing/incomplete/invalid beginningand ending dates of the period billed.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Total payment reduced due tooverlap of tests billed.354355356CLAIM DENIED. LITER FLOW PER MINUTEAND NUMBER OF HOURS MUST BEPRESENT TO PROCESS CLAIM. 355 16FEE ADJUSTED TO MAXIMUM ALLOWABLEAMOUNT 355, 621 B5Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.Payment adjusted becausecoverage/ program guidelineswere not met or were exceeded.CLAIM/DETAIL DENIED AFTER REVIEW BYMEDICAL CONSULTANTS. 355 A1 Claim denied charges. N10N14M85Payment based on a contractualamount or agreement, fee schedule,ormaximum allowable amount.Claim/service adjusted based on thefindings of a revieworganization/professionalconsult/manual adjudication /medicalor dental advisor.Subjected to review of physicianevaluation and managementservices.Missingdocumentation/orders/notes/summary/report/invoice.357 INVOICE MUST HAVE ITEM BILLED NOTED. 357 A1 Claim denied charges. N29Payment adjusted due to asubmission/billing error(s).Additional information is suppliedusing the remittance adviceREFER TO THE ADJUSTMENT REASONremarks codes whenever359 CODE. 359 125 appropriate. MA67 Correction to a prior claim.360 FEE ADJUSTED PER CLAIM CREDIT. 360 88Adjustment amount representscollection against receivablecreated in prior overpayment. MA67 Correction to a prior claim.Page 19 of 46 Date: 3/30/2005