EOB Codes and Descriptions - Kymmis.com

More documents

Recommendations

Info

KYEOB398399MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONThe procedure code isinconsistent with the modifierused or a required modifier ismissing.HIPAAREMARKHIPAA REMARK CODEDESCRIPTIONCLAIM/DETAIL DENIED. THE PROCEDURECODE MODIFIER IS MISSING OR INVALID. 398 4M78Missing/incomplete/invalid HCPCSmodifier.CLAIM/DETAIL DENIED. THIS SERVICE NOTCOVERED FOR THIS RECIPIENT. 399 96 Non-covered charge(s). N30 Recipient is ineligible for this service403404409410411412413414415416417PLEASE GIVE THE DATE(S) OF SURGERYAND RETURN THE INVOICE TO THIS OFFICE. 403 16NURSING FACILITY PRIOR AUTHORIZATIONNOT ON FILE - RECYCLE FOR EDIT 332. 104, 404 62INVALID PROVIDER TYPE BILLED ON CLAIMFORM. 009 52133Claim/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.The disposition of thisclaim/service is pending furtherreview.The referring/prescribing/rendering provider is not eligibleto refer/prescribe/ order/performFORMAT INVALID FOR ELECTRONIC CLAIMS.PLEASE CONTACT ECS HELP DESK AT 1-800-205-4696. 009, 410 A1 Claim denied charges. M60MA31Missing/incomplete/invalid beginningand ending dates of the period billed.the service billed. N34 Incorrect claim form for this service.Rejected without appeal rights due toinvalid CMN form or format.Resubmit with completed, OMBapprovedform or in an approvedformat.DUE TO THE END OF YOUR FISCAL YEAR,PLEASE REBILL THESE MULTIPLE MONTHSOF SERVICE ON SEPARATE INVOICES - ONEINVOICE FOR EACH MONTH. 411 A1 Claim denied charges. N74DETAIL DENIED. ONLY ONE DATE OFSERVICE ALLOWED PER DETAIL. 412 96 Non-covered charge(s). N20Resubmit with multiple claims, eachclaim covering services provided inonly one calendar month.Service not payable with otherservice rendered on the same date.Patient not enrolled in the billingproviders managed care plan on thedate of service.RECIPIENT NOT ENROLLED IN MANAGEDCARE DURING DATES OF SERVICE. 413 96 Non-covered charge(s). N52Payment for charges adjusted.Charges are covered under aRECIPIENT ENROLLED IN MANAGED CAREcapitation agreement/ managedDURING DATES OF SERVICE. 414 24 care plan N30 Recipient ineligible for this service.FFS CLAIM HAS A MANAGED CAREPROVIDER TYPE. 415 24Payment for charges adjusted.Charges are covered under acapitation agreement/ managedcare planPayment for charges adjusted.Charges are covered under acapitation agreement/ managedcare planCAPITATION RATE NOT WITHIN DATES OFSERVICE. 416 24CLAIM DENIED. INVALID OR MISSINGCAPITATION INDICATOR. 417 A1 Claim denied charges.N65Procedure code or procedure ratecount cannot be determined, or wasnot on file, for the date of service/provider.418 CLAIM DENIED. INVALID ENCOUNTER TYPE. 418 A1 Claim denied charges.419 CLAIM DENIED. INVALID ENC RECEIPT DATE. 419 A1 Claim denied charges.420CLAIM DENIED. INVALID ENC PAYMENTAMOUNT. 420 A1 Claim denied charges.421CLAIM DENIED. INVALID ENC PAYMENTDATE. 421 A1 Claim denied charges.422CLAIM DENIED. INVALID ENC ADJUSTMENTTCN. 422 A1 Claim denied charges.423CLAIM DENIED. INVALID RECIP NOT ELIGFOR PHYSICAL. 423 A1 Claim denied charges. N30 Recipient ineligible for this service424CLAIM DENIED. INVALID RECIP NOT ELIGFOR BEHAVIORAL. 424 A1 Claim denied charges. N30 Recipient ineligible for this service425DETAIL DENIED. ENCOUNTER-ONLYPROCEDURE CODE. THIS PROCEDURECODE IS NOT PAYABLE FOR FEE-FOR-SERVICE CLAIMS. 425 A1 Claim denied charges. M67Missing/incomplete/invalid otherprocedure code(s) and/or date(s).427428429CLAIM DENIED. RESUBMIT AN ADJUSTMENTON RELATED PAID CLAIM WITHJUSTIFICATION FOR DUPLICATED SERVICE. 490 97Payment is included in theallowance for anotherservice/procedure.M86Service denied because paymentalready made for similar procedurewithin set time frame.We do not pay for more than one ofthese on the same day.M63FFS NOT ALLOWED, RECIP ELIGIBLE FORBEHAVIORAL HEALTH MANAGED CARE. 428 A1 Claim denied charges. N30 Recipient ineligible for this serviceCLAIM DENIED. PARTNERSHIP NUMMISMATCH 429 A1 Claim denied charges.Page 22 of 46 Date: 3/30/2005
KYEOBKENTUCKY EOB/ESC CROSSWALK TO HIPAAHIPAAADJ RSNCODESMMIS EXCEPTIONMEDICAID DESCRIPTIONCODE(S)CLAIM DENIED. ENCOUNTER, INV. TCN TOCREDIT 430 A1 Claim denied charges.HIPAA ADJ RSN CODEDESCRIPTION430This provider was notcertified/eligible to be paid for thisprocedure/ service on this date of431 RESERVED FOR MANAGED CARE. 431 B7 service.CLAIM DENIED. SEQ# MISMATCH ACROSS432 CLAIM. 432 A1 Claim denied charges.CLAIM DENIED. VOID/RESUB INVALID FOR433 XOVER. 433 A1 Claim denied charges.434 RESERVED FOR MANAGED CARE. 434 A1 Claim denied charges.435 RESERVED FOR MANAGED CARE. 435436 RESERVED FOR MANAGED CARE. 436437440441442443CLAIM DENIED. CERTAIN OUTPATIENTHOSPITAL CHARGES ARE NOT PAYABLEWITHIN 3 DAYS PRIOR TO AN INPATIENTHOSPITAL ADMISSION (AND VICE VERSA). 437 97REVENUE CODE 582 LIMITED TO 4 UNITSPER CALENDAR WEEK (SUNDAY THROUGHSATURDAY) 440 119PROCEDURE CODES 99244 AND 99245 ARELIMITED CUMULATIVELY TO ONE UNIT PERDAY PER RECIPIENT 441 97THIS PROCEDURE CODE IS NOT PAYABLEON THE SAME DATE OF SERVICE ASPROCEDURE CODES 99244 AND 99245 442 97PROCEDURE CODES 99244 AND 99245 ARENOT PAYABLE ON THE SAME DATE OFSERVICE AS CERTAIN OTHER TITLE VPROCEDURE CODES 443 97PLEASE CORRECT INVALID OR MISSING NDCPayment is included in theallowance for anotherservice/procedure.Benefit maximum for this timeperiod has been reached.Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.HIPAAREMARKHIPAA REMARK CODEDESCRIPTION444 NUMBER. 444 A1 Claim denied charges. M119 National Drug code (NDC) needed.PROCEDURE CODE 99244 IS LIMITED TOONE PER FIVE YEARS, PER RECIPIENT, PERBenefit maximum for this time445 PROVIDER 445 119 period has been reached.PROCEDURE CODE 99245 IS LIMITED TOONE PER FIVE YEARS, PER RECIPIENT, PERBenefit maximum for this time446 PROVIDER 446 119 period has been reached.Benefit maximum for this time447 X0079 LIMITED TO 8 UNITS PER DAY 447 119 period has been reached.The disposition of thisRECIPIENT NOT ON ELIGIBILITY FILE -claim/service is pending further448 SUSPEND FOR EDIT 250. 248 133 review. N30 Recipient ineligible for this service.449450THE RECIPIENT ELIGIBILITY MAID NUMBERON THE MEDICAID CARD ATTACHED WITHYOUR CLAIM IS INCORRECT. 249 31CLAIM DETAIL DENIED. ASSESSMENTPROCEDURES ARE LIMITED TO ONE (1) PERRECIPIENT, PER PROVIDER DURING THERECIPIENT'S ASSESSMENT PERIOD ON THEPRIOR AUTHORIZATION FILE FOR THE CASEMANAGEMENT. 450 119Claim denied as patient cannot beidentified as our insured.Benefit maximum for this timeperiod has been reached.MA61N55Missing/incomplete/invalid socialsecurity number or health insuranceclaim numberProcedures for billing withgroup/referring/performing providerswere not followed.451CLAIM DETAIL DENIED. UNABLE TO APPLYASSESSMENT PROCEDURE LIMITATION DUETO NO CASE MANAGEMENT ON PRIORAUTHORIZATION FILE. CONTACT PRO. 451 62Payment denied/reduced forabsence of, or exceeded, precertification/authorization.M139N10Denied services exceed the coveragelimit for the demonstration.Claim/service adjusted based on thefindings of a revieworganization/professionalconsult/manual adjudication /medicalor dental advisor.452 X0080 LIMITED TO 12 UNITS PER WEEK 452 119X0061, X0088, X0089 AND X0103 LIMITED TO453 1 UNIT, CUMULATIVELY, PER DAY 453 119454 X0079 LIMITED TO 32 UNITS PER DAY. 454 119THIS PROCEDURE CODE LIMITED TO 48455 UNITS PER DAY. 455 119THIS PROCEDURE CODE LIMITED TO 16456 UNITS PER DAY. 456 119457 X0100 AND X0101 LIMITED TO ONE UNIT. 457 119458 X0063 LIMITED TO $150.00 PER DAY. 458 119CLAIM/DETAIL DENIED. PROCEDURES WITHGT MODIFIER ARE LIMITED TO FOUR (4) PER459 CALENDAR YEAR. 459 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.N54Claim information is inconsistent withpre-certified/authorized services.Page 23 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 and 12: KYEOB200201202203KENTUCKY EOB/ESC C
Page 15 and 16: KYEOB273KENTUCKY EOB/ESC CROSSWALK
Page 19 and 20: KYEOB343344345MEDICAID DESCRIPTIONK
Page 21: KYEOB382KENTUCKY EOB/ESC CROSSWALK
Page 25 and 26: KYEOB482483MEDICAID DESCRIPTIONKENT
Page 29 and 30: KYEOB555556MEDICAID DESCRIPTIONKENT
Page 31 and 32: KYEOBMEDICAID DESCRIPTIONKENTUCKY E
Page 37 and 38: KYEOB741742743744745746747748749KEN

EOB Codes and Descriptions - Kymmis.com

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?