EOB Codes and Descriptions - Kymmis.com

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KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOB537539540MMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESMEDICAID DESCRIPTIONCLAIM/DETAIL DENIED. THIS PROCEDURESHALL NOT BE PAID SEPARATELY WHENTHE GLOBAL SERVICE HAS BEENREPORTED. CONTACT THE DEPT. FORMEDICAID SERVICES FOR CLARIFICATION. 537 97CLAIM/DETAIL DENIED. EPSDT RELATEDSERVICES CLAIM EXCEEDS TOTAL UNITS OFSERVICE PRIOR AUTHORIZED. 539 62HOME HEALTH NURSING VISITS NOTREIMBURSED WHEN PRIVATE DUTYNURSING HAS BEEN AUTHORIZEDTHROUGH EPSDT SPECIAL SERVICES. 540 119HIPAA ADJ RSN CODEDESCRIPTIONPayment is included in theallowance for anotherservice/procedure.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Benefit maximum for this timeperiod has been reached.HIPAAREMARKM15N19M139HIPAA REMARK CODEDESCRIPTIONSeparately billed services/tests havebeen bundled as they are consideredcomponents of the same procedure.Separate payment is not allowed.Procedure code incidental to primaryprocedure.Denied services exceed the coveragelimit for the demonstration.541CAST APPLICATION OR REMOVAL HAS BEENPAID SEPARATE OF SURGERY. PLEASERESUBMIT FOR ADJUSTMENT WITH PAID RAOF CAST APPLICATION OR REMOVAL ANDCORRECTED CLAIM WITH SURGERY CODE. 341, 541 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.M58Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.542DETAIL DENIED. IMPLANTABLES ARELIMITED TO TWO UNITS OF SERVICE PERPROCEDURE, PER RECIPIENT, PER 90 DAYS. 542 119Benefit maximum for this timeperiod has been reached.M139Denied services exceed the coveragelimit for the demonstration.543545546548MULTIPLE SURGERIES FOR SAME DATE OFSERVICE MUST BE BILLED ON SAME CLAIM.YOUR CLAIM IS DENIED AND INSTRUCTIONSFOR SUBMITTING AN ADJUSTMENT AREBEING FORWARDED TO YOU. 501, 543 107MULTIPLE MEDICAL /SURGICALPROCEDURES FOR THE SAME DATE OFSERVICE MUST BE BILLED ON SAME CLAIM.FILE AN ADJUSTMENT TO ADD ADDITIONALPROCEDURES TO RELATED PAID CLAIM. 501 107CLAIM/DETAIL DENIED. PRESCRIPTIONNUMBER REFILL DATE IS GREATER THANSIX (6) MONTHS OLD. 500 29CLAIM/DETAIL DENIED. REVENUE CODE 235MUST BE BILLED IN CONJUNCTION WITHREVENUE CODE 155, 183, AND/OR 185. 548 107Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim. M79 Missing/incomplete/invalid charge.Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim. M79 Missing/incomplete/invalid charge.The time limit for filing hasexpired.Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.MA06M50Missing/incomplete/invalid beginningand/or ending date(s).Missing/incomplete/invalid revenuecode(s).547549550551552CLAIM PAYMENT REDUCED. SPEND DOWNDEDUCTED. N/A 142CLAIM/DETAIL DENIED. THIS PROCEDURESHALL NOT BE PAID SEPARATELY WHENTHE GLOBAL SERVICE HAS BEENREPORTED. CONTACT THE DEPT. FORMEDICAID SERVICES FOR CLARIFICATION. 549 97Claim adjusted by the monthlyMedicaid patient liability amount.Payment is included in theallowance for anotherservice/procedure.N19PROCEDURE CODE 00140 CAN ONLY BEBILLED ALONE OR WITH MONITOREDPROCEDURE CODES FOR THE SAMERECIPIENT, SAME PROVIDER, AND SAMEDATE OF SERVICE. 550 A1 Claim denied charges. M15DISPENSING FEE DEDUCTED. IT WAS PAIDWITH DISPENSING OF THE EMERGENCYSUPPLY 551 97THE STAY DAYS BILLED EXCEEDS THEMAXIMUM NUMBER OF STAY DAYS FOR THISINPATIENT HOSPITAL STAY. 552 119Payment is included in theallowance for anotherservice/procedure.Benefit maximum for this timeperiod has been reached.M15MA32M53Separately billed services/ tests havebeen bundled as they are consideredcomponents of the same procedure.Separate payment is not allowed.Procedure code incidental to primaryprocedure.Separately billed services/ tests havebeen bundled as they are consideredcomponents of the same procedure.Separate payment is not allowed.Missing/incomplete/invalid number ofcovered days during the billingperiod.Missing/incomplete/invalid days orunits of service.553CLAIM DENIED. DRUG REQUIRES PRIORAUTHORIZATION OR FIRST LINE THERAPYINITIATED. 553 62Payment denied/reduced forabsence of, or exceeded, precertification/authorization.MA31N54Missing/incomplete/invalid beginningand ending dates of the period billed.Claim information is inconsistent withpre-certified/authorized services.554THE DATE OF SERVICE AND/OR DOLLARAMOUNTS ON THE CLAIM AND MEDICAREEOMB DO NOT AGREE. PLEASE VERIFY ANDRESUBMIT. 554 57Payment 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.N4Missing/incomplete/invalid priorinsurance carrier EOB.Page 28 of 46 Date: 3/30/2005
KYEOB555556MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESPLEASE ATTACH THE PART B MEDICAREEXPLANATION OF BENEFITS AND REBILL. 555 129CLAIM/DETAIL DENIED. RECIPIENT MUST BEAN INPATIENT IN THE NURSING FACILITY. 556 60HIPAA ADJ RSN CODEDESCRIPTIONPayment denied - Prior processinginformation appears incorrect.Charges for outpatient serviceswith this proximity to inpatientservices are not coveredHIPAA HIPAA REMARK CODEREMARKDESCRIPTIONMissing/incomplete/invalid claiminformation. Resubmit claim afterM58 corrections.M2Not paid separately when patient isan inpatient557CLAIM DENIED. SECOND LINEANTIHISTAMINE NOT PAYABLE WITHIN FIVEDAYS OF A FIRST LINE ANTIHISTAMINE. 557 57558 H0039 LIMITED TO 32 UNITS PER DAY. 119Payment 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.Benefit maximum for this timeperiod has been reached.559560567568569570571572573574575576577578579580581582CLAIM DENIED. THIS CLAIM EXCEEDS THEMONTHLY MAXIMUM UNITS FOR THIS NDC. 559 119Benefit maximum for this timeperiod has been reached.M139Payment denied/reduced forDETAIL DENIED. PRIOR AUTHORIZEDabsence of, or exceeded, precertification/authorization.AMOUNT HAS BEEN EXCEEDED. 560 62M139CLAIM DENIED. NO WAIVER LIABILITYBUCKET FOR MONTH OF SERVICE. 267 A1 Claim denied charges. N58Payment denied/reduced forDETAIL DENIED. PRIOR AUTHORIZEDabsence of, or exceeded, precertification/authorization.AMOUNT HAS BEEN EXCEEDED. 568 62M139DETAIL DENIED. PRIOR AUTHORIZEDAMOUNT HAS BEEN EXCEEDED. 569 62ANCILLARY CHARGES NOT ALLOWED WITHPATIENT REVENUE CODES 180 OR 185. 096 60CLAIM DETAIL DENIED. PROCEDURE CODESX0100, X0101, AND X0102 CANNOT BEBILLED ON THE SAME DATE OF SERVICEFOR THE SAME RECIPIENT BY THE SAME ORDIFFERENT PROVIDER. 577 97Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.DETAIL DENIED. PRIOR AUTHORIZEDAMOUNT HAS BEEN EXCEEDED. 570 62M139PRIOR AUTHORIZATION REQUIRED IF 30DAYS OF THERAPY EXCEEDED DURING ABenefit maximum for this time365 DAY PERIOD. 571 119 period has been reached.DETAIL DENIED. LEAD INVESTIGATION INTHE HOME LIMITED TO TWO (2) SERVICESBenefit maximum for this timePER SIX MONTHS. 572 119 period has been reached.M139DETAIL DENIED. POST HAZARD ABATE INHOME LIMITED TO ONE (1) SERVICE PER 12Benefit maximum for this timeMONTHS. 573 119 period has been reached.M90Payment denied/reduced forCLAIM DENIED. PRIOR AUTHORIZEDabsence of, or exceeded, precertification/authorization.AMOUNT HAS BEEN EXCEEDED. 574 62M139REVENUE CODE INVALID FOR DATES OFSERVICE. 095 A1 Claim denied charges. M50Charges for outpatient serviceswith this proximity to inpatientservices are not covered.M50PRIOR AUTHORIZATION REQUIRED IF 60DAYS OF THERAPY EXCEEDED DURING A 3YEAR PERIOD. 578 11962CLAIM/DETAIL DENIED. REVENUE CODE 581LIMITED TO 80 UNITS PER RECIPIENT PERCALENDAR WEEK (SUNDAY THROUGHSATURDAY). 579 119CLAIM/DETAIL DENIED. THE ANNUALLIMITATION OF $1000.00 PER RECIPIENTFOR MINOR HOME ADAPTATIONS HAS BEENEXCEEDED. 180, 580 45CLAIM/DETAIL DENIED. UNIVERSALPREVENTION PROCEDURE CODES ARELIMITED TO A COMBINED TOTAL OF EIGHTUNITS PER RECIPIENT, PER PREGNANCY. 581 119CLAIM/DETAIL DENIED. SELECTIVEPREVENTION PROCEDURE CODES ARELIMITED TO A COMBINED TOTAL OF 76UNITS PER RECIPIENT, PER PREGNANCY. 582 119Payment is included in theallowance for anotherservice/procedure.Benefit maximum for this timeperiod has been reached.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Benefit maximum for this timeperiod has been reached.Charges exceed your contracted/legislated fee arrangement.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M139N20M86M139M139M139M139Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Missing/incomplete/invalid patientliability amount.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Not covered more than once in a 12month period.Denied services exceed the coveragelimit for the demonstration.Missing/incomplete/invalid revenuecode(s).Missing/incomplete/invalid revenuecode(s).Service 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.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Page 29 of 46 Date: 3/30/2005
Page 1 and 2: KYEOB001002003004KENTUCKY EOB/ESC C
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Page 5 and 6: KYEOB079080081082083084KENTUCKY EOB
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Page 11 and 12: KYEOB200201202203KENTUCKY EOB/ESC C
Page 15 and 16: KYEOB273KENTUCKY EOB/ESC CROSSWALK
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