EOB Codes and Descriptions - Kymmis.com

More documents

Recommendations

Info

KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOB460MMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESMEDICAID DESCRIPTIONTHIS PROCEDURE CODE LIMITED TO 16UNITS PER DAY. 460 119461 XL307 LIMITED TO 80 UNITS PER WEEK. 461 119PROVIDER TYPE/CLAIM TYPE NOT FOUND462 ON MATRIX. 462 119463 PAY TPL CLAIM. 463 119464 PAY AND BILL TPL CLAIM. 464 119465466467RECIPIENT HAS OTHER MEDICALCOVERAGE. BILL OTHER INSURANCE FIRSTOR ATTACH DOCUMENTATION OF DENIALFROM THE INSURANCE CARRIER ANDSUBMIT ON PAPER. 465 16DETAIL DENIED. EARLY INTERVENTION ANDCERTAIN EPSDT-SPECIAL SERVICESPROCEDURES ARE NOT PAYABLE ON THESAME DATE OF SERVICE FOR THE SAMERECIPIENT. 466 97RECIPIENT HAS OTHER MEDICALCOVERAGE. BILL OTHER INSURANCE FIRSTOR ATTACH DOCUMENTATION OF DENIALFROM THE INSURANCE CARRIER. 467 16469 X0096 LIMITED TO 200 PER WEEK. 469 119HIPAA ADJ RSN CODEDESCRIPTIONBenefit 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.Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.Payment is included in theallowance for anotherservice/procedure.Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.Benefit maximum for this timeperiod has been reached.HIPAAREMARKMA64MA04MA83N20M86MA64MA04MA83HIPAA REMARK CODEDESCRIPTIONOur records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information waseither not reported or was illegible.Did not indicate whether we are theprimary or secondary payer. Refer toItem 11 in the HCFA-1500instructions for assistance.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Our records indicate that we shouldbe the third payer for this claim. Wecannot process this claim until wehave received payment informationfrom the primary and secondarypayers.Secondary payment cannot beconsidered without the identity of orpayment information from theprimary payer. The information waseither not reported or was illegible.Did not indicate whether we are theprimary or secondary payer. Refer toItem 11 in the HCFA-1500instructions for assistance.472473476477478479481RECIPIENTS LIMITED TO ONE DRUGCLASS(GPPC) 681200 PRESCRIPTION/REFILLPER DATE OF SERVICE. 471 119MEDICAID REIMBURSEMENT FOR THEI DATEOF SERVICE HAS ALREADY BEEN MADE.CLAIM PAYMENT SET TO ZERO 473 119RECIPIENT IN AN INSTITUTIONAL SETTINGBenefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M63MA125DURING THE SAME DATE OF SERVICE. 476 18 Duplicate claim/service. M2RECIPIENT IN ANOTHER INSTITUTIONALSETTING DURING THE SAME DATES OFSERVICE. 477, 495 18 Duplicate claim/service. MA133YOUR FACILITY HAS PREVIOUSLY BILLEDAND RECEIVED PAYMENT FOR ALL OR APORTION OF THESE DATES OF SERVICE. 477 18 Duplicate claim/service. M43N47CLAIM DENIED. SERVICES FOR THESEDATES OF SERVICE HAVE BEEN PAID TO ANON-HOSPICE PROVIDER. 479 18 Duplicate claim/service. M86CLAIM/DETAIL DENIED. DUPLICATE SERVICEBILLED. 481 18 Duplicate claim/service.M63N20N47We do not pay for more than one ofthese on the same day.Per legislation governing thisprogram, payment constitutespayment in full.Not paid separately when the patientis an inpatient.Claim overlaps inpatient stay. Rebillonly those services rendered outsidethe inpatient stay.Payment for this service previouslyissued to you or another provider byanother carrier / intermediary.Claim conflicts with another inpatientstay.Service denied because paymentalready made for similar procedurewithin set time frame.We do not pay for more than one ofthese on the same day.Service not payable with otherservice rendered on the same date.Claim conflicts with another inpatientstay.Page 24 of 46 Date: 3/30/2005
KYEOB482483MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAHIPAAADJ RSNCODESMMIS EXCEPTIONCODE(S)470, 472, 473, 474, 475, 480,481, 483, 484, 485, 486, 488,490 18 Duplicate claim/service.HIPAA ADJ RSN CODEDESCRIPTIONCLAIM/DETAIL DENIED. DUPLICATE SERVICEBILLED.DUPLICATE ANESTHESIA SERVICE BILLEDBY PHYSICIAN AND NURSE ANESTHETIST. 487 18 Duplicate claim/service.HIPAAREMARKHIPAA REMARK CODEDESCRIPTION484ONLY ONE ANESTHESIA ALLOWED PER DOSPER RECIPIENT. 487 119Benefit maximum for this timeperiod has been reached.M139M63Denied services exceed the coveragelimit for the demonstration.We do not pay for more than one ofthese on the same day.486487DETAIL PLACE OF SERVICE NOT COVEREDTHROUGH THE PODIATRY PROGRAM. 093 96 Non-covered charge(s). N38ROUTINE FOOT CARE IS NOT PAYABLE FORThe diagnosis is inconsistent withTHIS DIAGNOSIS. 094 11 the procedure.Missing/incomplete/invalid place ofservice.489490CLAIM DENIED. THIS SERVICE WASPREVIOUSLY PAID TO ANOTHER PROVIDER. 489 B13CONSECUTIVE OUTPATIENT SERVICES ARENON-PAYABLE DURING A HOSPITALINPATIENT STAY. 590 60Previously paid. Payment for thisclaim/service may have beenprovided in a previous payment.Charges for outpatient serviceswith this proximity to inpatientservices are not covered.M86M63N20N47Service denied because paymentalready made for similar procedurewithin set time frame.We do not pay for more than one ofthese on the same day.Service not payable with otherservice rendered on the same date.Claim conflicts with another inpatientstay.491CLAIM DENIED. RECIPIENT IN ANOTHERINSTITUTIONAL SETTING DURING THE SAMEDATES OF SERVICE. 491 B13Previously paid. Payment for thisclaim/service may have beenprovided in a previous payment.MA133N47Claim overlaps inpatient stay. Rebillonly those services rendered outsidethe inpatient stay.Claim conflicts with another inpatientstay.492DCBS RECIPIENTS MAY NOT RECEIVE TITLEV SERVICES AND IMPACT PLUS/CHMCSERVICES ON THE SAME DATE OF SERVICE. 492 97Payment is included in theallowance for anotherservice/procedure.493494496497498DCBS RECIPIENTS MAY NOT RECEIVE THESAME DCBS MENTAL HEALTH SERVICESFROM TWO DIFFERENT SUB-PROVIDERSON THE SAME DATE OF SERVICE. 493 97DETAIL DENIED. THIS SERVICE IS NOTPAYABLE BEYOND THE BIRTH MONTH OFTHE RECIPIENT'S 18TH BIRTHDAY. 494 6ONLY ONE (1) ANESTHESIA\IV SEDATIONALLOWED PER DATE OF SERVICE PERRECIPIENT. 496 119CLAIM/DENIED. RESUBMIT AN ADJUSTMENTON UNISYS ADJUSTMENT REQUEST FORM. 497 138CLAIM DENIED. ONLY ONE PAYMENTALLOWED PER RECIPIENT, PER DATE OFSERVICE. 498 35Payment is included in theallowance for anotherservice/procedure.The procedure/revenue code isinconsistent with the patient's age.Benefit maximum for this timeperiod has been reached.M63We do not pay for more than one ofthese on the same day.Claim/service denied. Appealprocedures not followed or timelimits not met. N34 Incorrect claim form for this service.Lifetime benefit maximum hasbeen reached.M63We do not pay for more than one ofthese on the same day.499 CLAIM PENDING REVIEW OF HISTORY.The following exceptioncodes apply to this EOB: 130-131, 139, 302, 304, 306, 308-309, 311-318, 321-324, 326,331, 334-335, 337-339, 341-343, 347-352, 358, 360-365,373, 381-388, 391-392, 394,396, 400-404, 406-408, 441-442, 445-446, 466, 468, 471,474, 477-484, 486-493, 495-496, 498, 501, 533-534, 537,539-540, 542, 548-553, 556,560, 569-570, 579-592, 606,641, 643, 651-662, 667-668,670, 672, 674-677, 680-683,685-686, 688-693, 695, 697-698, 701-710, 712-714, 722,724, 729-730, 732-735, 737-740, 742-744, 747, 749, 791,798-819, 820, 822-823, 825-827, 846, 852-860, 862-863,879-880, 883-885, 887 133The disposition of thisclaim/service is pending furtherreview.Page 25 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 and 22: KYEOB382KENTUCKY EOB/ESC CROSSWALK
Page 23: KYEOBKENTUCKY EOB/ESC CROSSWALK TO
Page 29 and 30: KYEOB555556MEDICAID DESCRIPTIONKENT
Page 31 and 32: KYEOBMEDICAID DESCRIPTIONKENTUCKY E
Page 37 and 38: KYEOB741742743744745746747748749KEN

EOB Codes and Descriptions - Kymmis.com

Create successful ePaper yourself

Delete template?

Save as template?