EOB Codes and Descriptions - Kymmis.com

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KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOB361MMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESMEDICAID DESCRIPTIONGENERAL OPHTHALMOLOGICAL SERVICESNOT PAYABLE ON THE SAME DATE OFSERVICE AS SPECIAL OPHTHALMOLOGICALSERVICES. 361, 362 97HIPAA ADJ RSN CODEDESCRIPTIONPayment is included in theallowance for anotherservice/procedure.HIPAAREMARKN20M86HIPAA REMARK CODEDESCRIPTIONService not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.362363PATIENT LIABILITY APPLIED TO ALLOWEDAMOUNT FOR THIS CLAIM. 362 142ROOT REMOVAL NOT PAYABLE ON SAMEDATE OF SERVICE AS THE TOOTHEXTRACTION 364, 365 97364 PAYMENT REDUCED BY OTHER INSURANCE 23Claim adjusted by the monthlyMedicaid patient liability amount.Payment is included in theallowance for anotherservice/procedure.Payment adjusted becausecharges have been paid byanother payer.N20M86Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.365 FEE ADJUSTED TO MAXIMUM ALLOWABLE. 42Charges exceed our fee scheduleor maximum allowable amount.N14Payment based on a contractualamount or agreement, fee schedule,or maximum allowable amount.366367368369370371372373CLAIM DENIED. BILLED AMOUNT MAY NOTEXCEED $50.00 PER UNIT OF SERVICE. 366 42THIS SERVICE PAID COINSURANCE AND/ORDEDUCTIBLE. 367 119PROVIDER IS NOT ELIGIBLE TO BILL FORHOME HEALTH SUPPLIES AND/OR VISITS. 368 B7ORIGINAL PSYCHIATRIC EVALUATION ANDREGULAR HOSPITAL ADMISSION NOTPAYABLE ON SAME DATE OF SERVICE. 309, 407 97PAYMENT MODE NOT FOUND FOR BILLINGPROVIDER 370 B7REIMBURSEMENT RATE NOT FOUND FORDATE OF SERVICE 371 B7HOSPITAL FOLLOW-UP VISITS ANDORIGINAL PSYCHIATRIC DIAGNOSTICEVALUATION AND/OR FOLLOW-UPPSYCHIATRIC CARE ARE NOT ALLOWEDFOR SAME DATE OF SERVICE. 373, 408 97UNITS OF SERVICE HAVE BEEN REDUCEDTO THE REMAINING PRIOR AUTHORIZEDQUANTITY. 539 62Charges exceed our fee scheduleor maximum allowable amount.Benefit maximum for this timeperiod has been reached.This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.Payment is included in theallowance for anotherservice/procedure.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.Payment is included in theallowance for anotherservice/procedure.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.M139MA125N65N20M86N65N65N20M86Denied services exceed the coveragelimit for the demonstration.Per legislation governing thisprogram, payment constitutespayment in full.Procedure code or procedure ratecount cannot be determined, or wasnot on file, for the date of service/provider.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Procedure code or procedure ratecount cannot be determined, or wasnot on file, for the date of service/provider.Procedure code or procedure ratecount cannot be determined, or wasnot on file, for the date of service/provider.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.374REPAYMENT PORTION OF THISADJUSTMENT HAS BEEN DENIED.RECOUPMENT IS UNDER FINANCIAL ITEMS. 374 A1 Claim denied charges.376 CLAIM DENIED. MAC FIELD INVALID. 376 A1 Claim denied charges.377RECIPIENT INCOME/PATIENT LIABILITYDEDUCTION NOT APPLICABLE FOR THISCLAIM. 377 42Charges exceed our fee scheduleor maximum allowable amount.379 PAID BY MEDICAID 42Charges exceed our fee scheduleor maximum allowable amount.MA125Per legislation governing thisprogram, payment constitutespayment in full.380CO-PAY WAS DEDUCTED FROMREIMBURSEMENT. 3 Co-payment Amount. N14Payment based on a contractualamount or agreement, fee schedule,or maximum allowable amount.381CERTAIN SPECIFIED PROCEDURES ARENOT REIMBURSABLE FOR THE SAME DATEOF SERVICE AS EMERGENCY ROOM VISIT 381, 382 97Payment is included in theallowance for anotherservice/procedure.N20M86Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Page 20 of 46 Date: 3/30/2005
KYEOB382KENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKMEDICAID DESCRIPTIONDETAIL DENIED. BILLED AMOUNT FORIMPLANTABLES MUST BE GREATER THAN$100.00. 355 A1 Claim denied charges. M54HIPAA REMARK CODEDESCRIPTIONMissing/incomplete/invalid totalcharges.383CERTAIN INCIDENTAL SURGERIES ARE NOTREIMBURSABLE FOR THE SAME DATE OFSERVICE AS ABDOMINAL SURGERY. 383, 384 97Payment is included in theallowance for anotherservice/procedure.N20M86Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.384DETAIL DENIED. INVOICE MUST BEATTACHED WHEN BILLING IMPLANTABLES. 384 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N29Missingdocumentation/orders/notes/summary/report/invoice.385386387388CERTAIN INCIDENTAL PROCEDURES ARENOT REIMBURSABLE FOR THE SAME DATEOF SERVICE AS A D.& C. PROCEDURE. 385, 386 97DETAIL DENIED. INVOICE AMOUNT MUSTMATCH BILLED AMOUNT. 355 42CERTAIN INCIDENTAL SURGERIES ANDPELVIC SURGERIES ARE NOTREIMBURSABLE FOR THE SAME DATE OFSERVICE. 387, 388 97Payment is included in theallowance for anotherservice/procedure.Charges exceed our fee scheduleor maximum allowable amount.Payment is included in theallowance for anotherservice/procedure.M86THIS REVENUE CODE IS NOT PAYABLEWHEN BILLED WITH ALL INCLUSIVEANCILLARY REVENUE CODE (240). CHARGESMOVED TO NON-COVERED. 188 96 Non-covered charge(s). M50Payment is included in theallowance for another97 service/procedure.389 PAID CLAIM BASED UPON MEDICAL REVIEW. 670 B5DETAIL DENIED. PROCEDURE CODE X0091NOT PAYABLE ON THE SAME DATE OF391 SERVICE AS X0061, X0088, OR X0089. 391 97Payment adjusted becausecoverage/ program guidelineswere not met or were exceeded.Payment is included in theallowance for anotherservice/procedure.N20M86N29N20N10N20M86Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Missingdocumentation/orders/notes/summary/report/invoice.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Missing/incomplete/invalid revenuecode(s).Claim/service adjusted based on thefindings of a revieworganization/professionalconsult/manual adjudication /medicalor dental advisor.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.392393394DETAIL DENIED. PROCEDURE CODES X0061,X0088, AND X0089 NOT PAYABLE ON THESAME DATE OF SERVICE AS X0091. 392 97CLAIM DENIED. THE PRIMARY DIAGNOSISCODE IS NOT VALID FOR THIS PROVIDERTYPE. 393 12HOURLY RESPITE SERVICES NOT ALLOWEDFOR SAME DATE OF SERVICE AS DAILYRESPITE SERVICES. 394 97Payment is included in theallowance for anotherservice/procedure.The diagnosis is inconsistent withthe provider type.Payment is included in theallowance for anotherservice/procedure.N20M86MA63N20Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Missing/incomplete/invalid principaldiagnosis.Service not payable with otherservice rendered on the same date.395396397THE AMOUNT PAID BY OTHER INSURANCEEQUALS OR EXCEEDS THE AMOUNT OFMEDICAID REIMBURSEMENT FOR THISSERVICE. THE CLAIM IS PAID IN FULL.RECIPIENT SHALL NOT BE BILLED BALANCE. 23DAILY RESPITE SERVICES NOT ALLOWEDFOR SAME DATE OF SERVICE AS HOURLYRESPITE SERVICES. 396 97ACCOMMODATION REVENUE CODES MUSTBE BILLED ON AN INPATIENT CLAIM. 097 5Payment adjusted becausecharges have been paid byanother payer.Payment is included in theallowance for anotherservice/procedure.The procedure code/bill type isinconsistent with the place ofservice.N23N20M86Patient liability may be affected dueto coordination of benefits with othercarriers and/or maximum benefitprovisions.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Page 21 of 46 Date: 3/30/2005
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Page 15 and 16: KYEOB273KENTUCKY EOB/ESC CROSSWALK
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