EOB Codes and Descriptions - Kymmis.com

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KYEOB019MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESCLAIM/DETAIL DENIED. PROCEDURE/NDCMISSING/INVALID. 019 B18HIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTIONPayment denied because thisprocedure code/ modifier wasinvalid on the date of service orclaim submission. M20 Missing/incomplete/invalid HCPCS.020021022Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedMEDICARE DOCUMENTATION NOTATTACHED. 020, 256 16using remittance advice remarkscodes whenever appropriate. N29CLAIM DENIED. PHYSICIAN ON REPORT ANDPHYSICIAN BILLING DO NOT MATCH. 355 A1 Claim denied charges. M29A1 Claim denied charges. MA102COVERED DAYS ARE NOT EQUAL TOACCOMMODATION UNITS. 022 A1 Claim denied charges. MA32M53MA31Missingdocumentation/orders/notes/summary/report/invoice.Missing/incomplete/invalid operativereport.Missing/incomplete/invalid name orprovider identifier for therendering/referring/ordering/supervising provider.Missing/incomplete/invalid number ofcovered days during the billingperiod.Missing/incomplete/invalid days orunits of service.Missing/incomplete/invalid beginningand ending dates of the period billed.023024025026027Missing/incomplete/invalid indicationCLAIM DENIED. NO PHYSICIAN PATIENTCONTACT. 355 A1 Claim denied charges. M136that the service was supervised orevaluated by a physician.THE DETAIL BILLED AMOUNT IS MISSING ORINVALID. 024 A1 Claim denied charges. M79 Missing/incomplete/invalid charge.Informational notice. No paymentissued for this claim with this notice.Payment issued to the hospital by itsCLAIM SUBMITTED FOR INFORMATIONALintermediary for all services for thisPURPOSE ONLY. NO PAYMENT IS TO BENewborn's services are covered inencounter under a demonstrationMADE. 025 128 the mother's Allowance.MA80 project.Claim/service denied because theCLAIM DENIED. LONG TERM CARErelated or qualifying claim/serviceSUPPLEMENTAL BILLING MUST BEwas not previously paid orSUBMITTED AS AN ADJUSTMENT. 026 107 identified on this claim. N34 Incorrect claim form for this service.Missing/incomplete/invalid claimCLAIM DENIED. RESUBMIT AN ADJUSTMENTinformation. Resubmit claim afterON RELATED PAID CLAIM. 480, 490 A1 Claim denied charges. M58 corrections.028CLAIM/DETAIL DENIED. DATA ILLEGIBLE.PLEASE RESUBMIT. 355 A1 Claim denied charges. M58N34Incorrect claim form for this service.Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.029CLAIM REQUIRES DOCUMENTATION.PLEASE RESUBMIT ON PAPER. DEPENDENT 180, 181, 182, 183, 232, 256,ON SPECIFIC PROCEDURE CODE ANDCRITERIA SET FOR REVIEW.355, 374, 654, 846, 858, 860,861, 862, 883, 884, 885, 886 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N29Missingdocumentation/orders/notes/summary/report/invoice.030CLAIM/DETAIL DENIED. DETAIL NUMBER OFSERVICES MISSING. 030 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.M53Missing/incomplete/invalid days orunits of service.Claim/service lacks informationwhich is needed for adjudication.Additional information is supplied031CLAIM DENIED. LEVEL OF CARE MISSING.PLEASE CORRECT AND RESUBMIT. 031 16using remittance advice remarkscodes whenever appropriate. M58NUMBER OF UNITS BILLED LESS THAN 30033 FOR INSULIN SYRINGES 033 A1 Claim denied charges. M53034 DENIED BY MEDICARE. 034 96 Non-covered charge(s).DETAIL DENIED. THIS SERVICE NOTThis (these) service(s) is (are) not035 PAYABLE ON THIS DATE OF SERVICE 035 46 covered.N2003603703896 Non-covered charge(s). MA66CLAIM DENIED. ONLY 1 DATE OF SERVICEALLOWED PER CLAIM FORM. 036 A1 Claim denied charges. N20MODEL WAIVER 1 RECIPIENT LIMITED TO 24HOURS OF NURSING SERVICES PER DATEBenefit maximum for this timeOF SERVICE. 682 119 period has been reached.M139CLAIM DETAIL DENIED. REVENUE CODEINVALID FOR PLACE OF SERVICE 038 96 Non-covered charge(s). M77Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalid days orunits of service.Service not payable with otherservice rendered on the same date.Missing/incomplete/invalid principalprocedure code or date.Service not payable with otherservice rendered on the same date.Denied services exceed the coveragelimit for the demonstration.Missing/incomplete/invalid place ofservice.Page 2 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOB039040041042MMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESMEDICAID DESCRIPTIONTHIS PROCEDURE CODE IS LIMITED TOTWO UNITS OF SERVICE PER DATE OFSERVICE. 630, 672 119CLAIM/DETAIL DENIED. TYPE OF BILLINVALID OR MISSING. 040, 050, 480 5DRUG MANAGEMENT AND MEDICALPSYCHOTHERAPY NOT ALLOWED FORSAME DATE OF SERVICE, PROVIDER,RECIPIENT. 331, 403 97CLAIM DENIED. COINSURANCE AND/ORDEDUCTIBLE GREATER ON CLAIM THANEOMB. 042 45HIPAA ADJ RSN CODEDESCRIPTIONBenefit maximum for this timeperiod has been reached.The procedure code/bill type isinconsistent with the place ofservice.Payment is included in theallowance for anotherservice/procedure.Charges exceed your contracted/legislated fee arrangement.HIPAAREMARKM53MA30N20M86N4HIPAA REMARK CODEDESCRIPTIONMissing/incomplete/invalid days orunits of service.Missing/incomplete/invalid type ofbill.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Missing/incomplete/invalid priorinsurance carrier EOB.043044CLAIM DENIED. VOUCHER NUMBER MISSINGOR INVALID. 043 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N29CLAIM DETAIL DENIED. REVENUE CODEMISSING OR INVALID 044 96 Non-covered charge(s). M50045 TYPE OF BILL INVALID FOR PROVIDER TYPE. 355 A1 Claim denied charges. MA30CLAIM DENIED. HCPCS CODE BILLEDINVALID/OBSOLETE. RESUBMIT WITH046 CORRECT CODE. 046 A1 Claim denied charges. M51N27Missing/incomplete/invalid treatmentnumber.Missingdocumentation/orders/notes/summary/report/invoice.Missing/incomplete/invalid revenuecode(s).Missing/incomplete/invalid type ofbill.Missing/incomplete/invalid procedurecode(s) and/or rates.047048PROFESSIONAL COMPONENT BILLED. CLAIMMANUALLY PRICED TO MAXIMUMALLOWABLE 047 42CLAIM DENIED. MEDICARE PAID PATIENT,REFER TO DMS PROVIDER SERVICESMANUAL AND RESUBMIT. 048 100Charges exceed our fee scheduleor maximum allowable amount.Payment made topatient/insured/responsible party.N14N13M58Payment based on a contractualamount or agreement, fee schedule,or maximum allowable amount.Payment based on professional/technical component modifier(s).Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.049129CLAIM/DETAIL DENIED. MEDICARE PAIDAMOUNT GREATER THAN OR EQUAL TOTOTAL BILLED AMOUNT. 049 23Payment denied - Prior processinginformation appears incorrect.Payment adjusted becausecharges have been paid byanother payer.05005105205305405505605705842Charges exceed our fee scheduleor maximum allowable amount.CLAIM DENIED. PLEASE CORRECT COVEREDDAYS FIELD AND RESUBMIT 050 A1 Claim denied charges. MA32MA31PATIENT CONDITION/STATUS CODEMISSING, INVALID, OR INVALID FOR TYPE OFBILL. 051 A1 Claim denied charges. M44ERROR ON CLAIM RELATED TO DOLLARAMOUNTS -CLAIM IN PROCESS. 052 133The disposition of thisclaim/service is pending furtherreview.CLAIM/DENIED. NET BILLED NOT EQUAL TOTOTAL BILLED MINUS OTHER INSURANCE. 053 A1 Claim denied charges.CLAIM DENIED. OTHER INSURANCE AMOUNTMUST BE MANUALLY COMPUTED FOR THISCLAIM 054 A1 Claim denied charges.CLAIM DENIED TOTAL DETAIL CHARGESNOT EQUAL TO TOTAL BILLED. 055 A1 Claim denied charges. M54CLAIM/DETAIL DENIED. ASSISTANTSURGEON SERVICES NOT PAYABLE FOR AMultiple physicians/ assistants areVAGINAL DELIVERY. 179 54 not covered in this case.N55INVALID TYPE OF BILL FOR CORF/ORFPROVIDER SPECIALTY. 015 A1 Claim denied charges. MA30CLAIM/DETAIL DENIED. ONLY ONE DATE OFSERVICE ALLOWED PER DETAIL. 011 A1 Claim denied charges. N63N4M53Missing/incomplete/invalid priorinsurance carrier EOB.Missing/incomplete/invalid number ofcovered days during the billingperiod.Missing/incomplete/invalid days orunits of service.Missing/incomplete/invalid beginningand ending dates of the period billed.Missing/incomplete/invalid conditioncode.Missing/incomplete/invalid totalcharges.Missing/incomplete/invalid totalcharges.Procedures for billing withgroup/referring/performing providerswere not followed.Missing/incomplete/invalid type ofbill.Rebill services on separate claimlines.Page 3 of 46 Date: 3/30/2005
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Page 5 and 6: KYEOB079080081082083084KENTUCKY EOB
Page 7 and 8: KYEOB114115116117118119KENTUCKY EOB
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Page 11 and 12: KYEOB200201202203KENTUCKY EOB/ESC C
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Page 21 and 22: KYEOB382KENTUCKY EOB/ESC CROSSWALK
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