EOB Codes and Descriptions - Kymmis.com

More documents

Recommendations

Info

KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOBMEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTION621DETAIL DENIED. MAXIMUM DOLLAR AMOUNTFOR COMMUNITY BASED SERVICESRESPITE SERVICE HAS BEEN EXCEEDED. 621, 691, 692 45Charges exceed your contracted/legislated fee arrangement.M139Denied services exceed the coveragelimit for the demonstration.622623DETAIL DENIED. ANNUAL LIMIT OF $500.00FOR MINOR HOME ADAPTATIONS. 622 45RECIPIENT ALLOWED 14 SINGLE INTRAORALPERIAPICAL RADIOGRAPHS PER 12 MOSPER PROVIDER. 623 119Charges exceed your contracted/legislated fee arrangement.Benefit maximum for this timeperiod has been reached.M139Denied services exceed the coveragelimit for the demonstration.624625CLAIM DENIED. THIS PROCEDURE ALLOWEDONE PER DOS PER TOOTH PER PROVIDER. 624 119CLAIM DENIED/RECIPIENT ALLOWED 3REPAIRS INCLUDING REPLACEMENTS OFONE TOOTH PER 12 MONTHS. 625, 627 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M139M139Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.626627CLAIM DENIED. ONLY 14 DAYS SERVICEALLOWED PER ADMISSION PER RECIPIENT. 626 119CLAIM DENIED. RECIPIENT ALLOWED 3REPAIRS TO BROKEN DENTURES PER 12MONTHS. 626 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M139M139Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.629631633RECIPIENT ALLOWED 1 LOWERTRANSITIONAL APPLIANCE PER 12 MONTHS. 629 119RECIPIENTS ARE LIMITED TO ONE DENTURERELINING PER 12 MONTHS. 631 119CLAIM DENIED. BRAND NECESSARY PRIORAUTHORIZATION REQUIRED. NO MATCHINGBRAND NECESSARY PRIOR AUTHORIZATIONON FILE FOR THIS CLAIM. 633 62Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.M90M90Not covered more than once in a 12month period.Not covered more than once in a 12month period.634635636637638640641MAXIMUM $300.00 ALLOWED PERMONTH/RECIPIENT FOR TANK OXYGEN. 634 45AIS/MR DAILY CODE LIMITED TO ONE UNITPER DATE OF SERVICE PER RECIPIENT. 635 119PROFESSIONAL FEE FOR DISPENSINGINITIAL PAIR OF EYEGLASSES ALLOW ONE /12 MOS / RECIPIENT. 636 119CLAIM DENIED. RECIPIENT LIMITED TO 3FETAL TESTS/12 MONTHS. IF UNUSUALCIRCUMSTANCES, SEND CLAIMDOCUMENTATION TO DMS FOR REVIEW. 637 119ANNUAL FAMILY PLANNING VISITS ARELIMITED TO ONE PER RECIPIENT PER 9MONTHS PER CLINIC. 638 119Charges exceed your contracted/legislated fee arrangement.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.THIS DETAIL WAS MANUALLY PRICED AFTERREVIEW BY CONSULTANTS. 355 A2 Contractual adjustment. N10Payment denied/reduced forPRIOR AUTHORIZATION DOES NOT MATCHabsence of, or exceeded, precertification/authorization.FOR THIS CLAIM/DETAIL. 641 62N54M139M63M90N29M139Denied services exceed the coveragelimit for the demonstration.We do not pay for more than one ofthese on the same day.Not covered more than once in a 12month period.Missingdocumentation/orders/notes/summary/report/invoice.Denied services exceed the coveragelimit for the demonstration.Claim/service adjusted based on thefindings of a revieworganization/professionalconsult/manual adjudication /medicalor dental advisor.Claim information is inconsistent withpre-certified/authorized services.642644645THIS PROCEDURE IS LIMITED TO ONE PER12 MONTHS PER RECIPIENT PER PROVIDER. 642, 643, 663 119RECIPIENTS ARE LIMITED TO ONE (1)OPTHAMOLOGICAL EXAMINATION PERPROVIDER PER 12 MONTHS. 644, 664 119NEW PATIENT HOME MEDICAL SERVICESLIMITED TO ONE PER RECIPIENT PERPROVIDER PER 12 MONTHS. 645, 665 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M90M90M90Not covered more than once in a 12month period.Not covered more than once in a 12month period.Not covered more than once in a 12month period.646648649ESTABLISHED PATIENT MEDICAL SERVICESLIMITED TO ONE PER RECIPIENT PERPROVIDER PER 12 MONTHS. 646, 666 119RECIP ARE LMTD ON INITIAL PREVENTATIVECARE VISITS TO 1 PER PROV PER 12MONTHS. 648 119RECIP LMTD 1 INITIAL OPTHALMOLOGICALSERVICE PER PROV PER 12 MONTHS. 649, 669 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M90M90M90Not covered more than once in a 12month period.Not covered more than once in a 12month period.Not covered more than once in a 12month period.650652ROUTINE NEWBORN CARE IS PAYABLEONLY ONCE PER INFANT. 650 119CLAIM DENIED. BIFOCAL OR SINGLE VISIONLENSES ARE LIMITED TO FOUR PER 12MONTHS. 652 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M139M139Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Page 32 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOBMEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTION653654655656657658659660CLAIM/DETAIL DENIED. A PRESCRIPTIONCAN ONLY BE BILLED 6 TIMES. 653 119RECIPIENT ALLOWED FILLINGS FOR UP TOFIVE SURFACES PER TOOTH PER DOS PERPROVIDER. 654 119MAXIMUM OF 14 CONSECUTIVE HOSPITALRESERVE DAYS ALLOWED PER RECIPIENTPER PROVIDER. 655 119MAXIMUM OF 15 NON-HOSPITAL RESERVEDAYS ALLOWED PER RECIPIENT PERCALENDAR YEAR. 656 119MAXIMUM OF 45 HOSPITAL RESERVE DAYSALLOWED PER RECIPIENT PER CALENDARYEAR. 657 119MAXIMUM OF 15 CONSECUTIVE HOSPITALRESERVE DAYS ALLOWED PER RECIPIENTPER PROVIDER. 658 119MAXIMUM OF 30 CONSECUTIVE RESERVEDAYS ALLOWED PER RECIPIENT PERPROVIDER. 659 119MAXIMUM OF 45 RESERVE DAYS PERRECIPIENT PER PROVIDER PER CALENDARYEAR. 660 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M139M139Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Benefit maximum for this timeperiod has been reached. N43 Bed hold or leave days exceeded.Benefit maximum for this timeperiod has been reached. N43 Bed hold or leave days exceeded.Benefit maximum for this timeperiod has been reached. N43 Bed hold or leave days exceeded.Benefit maximum for this timeperiod has been reached. N43 Bed hold or leave days exceeded.Benefit maximum for this timeperiod has been reached. N43 Bed hold or leave days exceeded.Benefit maximum for this timeperiod has been reached. N43 Bed hold or leave days exceeded.661CLAIM DENIED. READMISSION WITHIN 30DAYS OF LAST DISCHARGE DATE/THROUGHDATE. PLEASE RESUBMIT WITH MEDICALDOCUMENTATION. 670 119Benefit maximum for this timeperiod has been reached.N29Missingdocumentation/orders/notes/summary/report/invoice.66266566666716A MAXIMUM OF 14 INPATIENT HOSPITALDAYS PER ADMISSION AND READMISSIONPER RECIPIENT. 662 119VENIPUNCTURE/ CATHETERIZATIONPROCEDURES 80020, 80022, 80023, 80024,36415 NOT ALLOWED SAME DOS/CLAIM/DETAIL DENIED. PROVIDER NOT CLIACERTIFIED TO BILL NON-WAVERED OR NON-MICROSCOPY LAB CODE. 512 B7THIS PROCEDURE IS LIMITED TO ONESERVICE PER RECIPIENT PER SAME DATEOF SERVICE. 661, 662, 667 119Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.Benefit maximum for this timeperiod has been reached.RECIPIENT/PROVIDER. 635 96 Non-covered charge(s). N20This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.MA51Benefit maximum for this timeperiod has been reached.M139M63Denied services exceed the coveragelimit for the demonstration.Service not payable with otherservice rendered on the same date.Missing/incomplete/invalid CLIAcertification number for laboratoryservices billed by physician officelaboratory.We do not pay for more than one ofthese on the same day.668PROCEDURE CODE XR000 IS LIMITED TO NOMORE THAN 2 UNITS OF SERVICE PER DATEOF SERVICE. 668 57119Payment denied/reduced becausethe payer deems the informationsubmitted does not support thislevel of service, this manyservices, this length of service,this dosage, or this days supply.Benefit maximum for this timeperiod has been reached.M139Denied services exceed the coveragelimit for the demonstration.669670DAYS REDUCED, A MAXIMUM OF 14CONSECUTIVE HOSPITAL RESERVE DAYSALLOWED PER RECIPIENT,PER PROVIDER. 669 119DAYS REDUCED, A MAXIMUM OF 15 NON-HOSPITAL RESERVE DAYS ALLOWED PERRECIPIENT,PER PROVIDER,PER CALENDARYEAR. 670 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.M139N43M139N43Denied services exceed the coveragelimit for the demonstration.Bed hold or leave days exceeded.Denied services exceed the coveragelimit for the demonstration.Bed hold or leave days exceeded.671MEDICAID WILL PAY FOR ONLY ONECARDIAC CATHETER PROCEDURE PER DAY. 671 119Benefit maximum for this timeperiod has been reached.673 CPT LEVEL CODE MISSING OR INVALID. 673 A1 Claim denied charges.674PROCEDURE CODE V5020 IS LIMITED TOTHREE PER RECIPIENT PER PROVIDER PERSIX MONTHS. 674 119Benefit maximum for this timeperiod has been reached.675DAYS REDUCED, A MAXIMUM OF 45 TOTALDAYS PER RECIPIENT, PER PROVIDER, PERCALENDAR QUARTER. 675 119Benefit maximum for this timeperiod has been reached.M139M139Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Page 33 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 and 24: KYEOBKENTUCKY EOB/ESC CROSSWALK TO
Page 25 and 26: KYEOB482483MEDICAID DESCRIPTIONKENT
Page 29 and 30: KYEOB555556MEDICAID DESCRIPTIONKENT
Page 31: 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?