EOB Codes and Descriptions - Kymmis.com

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KYEOBMEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONCharges do not meetqualifications for emergent/urgentcare.763SERVICES RENDERED DO NOT MEET DMSCRITERIA FOR DENTAL EMERGENCY. 180 40DIAGNOSIS AND DESCRIPTION OFTREATMENT ARE REQUIRED FOR DENTAL764 EMERGENCY. 180 40765 THERAPEUTIC DUPLICATION. 765 96 Non-covered charge(s).766 ? 96 Non-covered charge(s).767 INGREDIENT DUPLICATION. 767 96 Non-covered charge(s).768 ALCOHOL PRECAUTION. 768 96 Non-covered charge(s).769 BREAST FEEDING PRECAUTION. 769 96 Non-covered charge(s).770 DRUG/FOOD INTERACTION. 770 96 Non-covered charge(s).771 DRUG/LAB CONFLICT. 771 96 Non-covered charge(s).772 CALL HELP DESK (1-800-807-1232). 772 96 Non-covered charge(s).773 INVALID DUR CONFLICT CODE. 773 96 Non-covered charge(s).774 INVALID DUR INTERVENTION CODE. 774 96 Non-covered charge(s).775 INVALID DUR OUTCOME CODE. 775 96 Non-covered charge(s).777791792793794Charges do not meetqualifications for emergent/urgentcare.HIPAAREMARKCLAIM DENIED. PHARMACY CLAIMS MUST BEBILLED THROUGH POS. 777 A1 Claim denied charges. M117CLAIM DETAIL DENIED. REVENUE CODE 580IS LIMITED TO 45 UNITS (HOURS) PER WEEKBenefit maximum for this time(SUNDAY THROUGH SATURDAY). 791 119 period has been reached.M139CLAIM DETAIL DENIED. ONLY ONEOBSTETRICAL VISIT ALLOWED IN AN EIGHTWEEK PERIOD. 792 119CLAIM DETAIL DENIED. ONLY ONECOMPREHENSIVE VISIT ALLOWED EVERY 50WEEKS. 793 119CLAIM/DETAIL DENIED. EPIDURALINJECTIONS FOR CONTROL OF PAIN SHALLBE LIMITED TO 3 INJECTIONS PER 6MONTHS PER RECIPIENT. 794 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.N29M139HIPAA REMARK CODEDESCRIPTIONMissingdocumentation/orders/notes/summary/report/invoice.Not covered unless supplier files anelectronic media claim (EMC).Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.795796CLAIM/DETAIL DENIED. THE MONTHLY(CALENDAR MONTH) LIMITATION FOR THISPROCEDURE CODE HAS BEEN EXCEEDED. 795 119CLAIM/DETAIL DENIED. THE ANNUAL(CALENDAR YEAR) LIMITATION FOR THISPROCEDURE CODE HAS BEEN EXCEEDED. 796 119Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.797 EOB IS NOT ON EXCEPTION CONTROL FILE 797798PROCEDURE CODE XZ299 IS LIMITED TO$150.00 PER CALENDAR MONTH PERRECIPIENT, PER PROVIDER. 798 119Benefit maximum for this timeperiod has been reached.M139Denied services exceed the coveragelimit for the demonstration.799800801REVENUE CODE 270 CANNOT EXCEED$2,000 BILLED AMOUNT PER MONTH.PLEASE RESUBMIT WITH ITEMIZED INVOICEFOR SUPPLIES FOR ENTIRE MONTH. 799 45CLAIM DENIED. PROCEDURE CODES X0074AND X0075 NOT PAYABLE ON SAME DATEOF SERVICE AS X0076. 800 97CLAIM DENIED. PROCEDURE CODE X0076NOT PAYABLE ON THE SAME DATE OFSERVICE AS X0074 OR X0075. 801 97Charges exceed your contracted/legislated fee arrangement.Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.M54N20M86N20M86Missing/incomplete/invalid totalcharges.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.802803PROCEDURE CODE 00150 DISALLOWED BYSAME PROVIDER FOR SAME RECIPIENT ONTHE SAME DATE OF SERVICE ASPROCEDURES 09110 OR 00140. 802, 803 97RECIPIENT APPLIED INCOME NOT CURRENTFOR DOS - RECYCLE FOR EDIT 271. 103, 803 133Payment is included in theallowance for anotherservice/procedure.The disposition of thisclaim/service is pending furtherreview.N20M80M86N23Service not payable with otherservice rendered on the same date.Not covered when performed duringthe same session/date as apreviously processed service for thepatient.Service denied because paymentalready made for similar procedurewithin set time frame.Patient liability may be affected dueto coordination of benefits with othercarriers and/or maximum benefitprovisions.Page 38 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOB808810HIPAAADJ RSNCODESMMIS EXCEPTIONMEDICAID DESCRIPTIONCODE(S)MONTHLY DIALYSIS PROCEDURE CODESARE NOT REIMBURSABLE FOR THE SAMEOR OVERLAPPING DATE OF SERVICE ASDAILY DIALYSIS PROCEDURE CODES. 808, 809 97HEMODIALYSIS PROCEDURE CODES ARENOT REIMBURSABLE FOR THE SAME OROVERLAPPING DATES OF SERVICE ASEVALUATION AND MANAGEMENTPROCEDURE CODES. 810, 811 97HIPAA ADJ RSN CODEDESCRIPTIONPayment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.HIPAAREMARKN20N20HIPAA REMARK CODEDESCRIPTIONService not payable with otherservice rendered on the same date.Service not payable with otherservice rendered on the same date.812814815816818ADDITIONAL SURGICAL PROCEDURES ARENOT PAYABLE ON SAME DATE OF SERVICEBY SAME PROVIDER FOR SAME RECIPIENTWHEN BILLING PROCEDURE 07910. 812, 813 97CLAIM DETAIL DENIED. THIS PROCEDURECODE NOT PAYABLE ON THE SAME DATEOF SERVICE AS X0063, X0096, OR XL307. 814 97CLAIM DETAIL DENIED. THIS PROCEDURECODE NOT PAYABLE ON THE SAME DATEOF SERVICE AS COMMUNITY RESIDENTIALSERVICES. 815 97CAST REMOVAL OR REPAIR HAS BEEN PAIDWITH APPLICATION OF CAST. IFUNRELATED PROCEDURES, SEND CLAIMWITH DOCUMENTATION OF UNRELATEDPROCEDURES TO THE DMS FOR REVIEW. 816, 817 97VENIPUNCTURE OR ARTERIAL PUNCTURE ISNOT ALLOWED ON THE SAME DATE OFSERVICE AS OTHER MONITOREDPROCEDURES. 551, 818, 819 97Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.N20M86N20M86N20M86M86M63N20M86Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.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.Service denied because paymentalready made for similar procedurewithin set time frame.820821822824825826827BILLING OR REFERRING KENPAC PROVIDERNUMBER IS MISSING OR IS NOT THEKENPAC PHYSICIAN/CLINIC FOR DATE(S)BILLED. KENPAC REFERRING PROVIDERNUMBER SHOULD BE ENTERED IN FIELD 19. 820 M68CLAIM DETAIL DENIED. LIMITATIONEXCEEDED, PRIOR AUTHORIZATIONREQUIRED. 821 62X-RAY PROCEDURE NOT ALLOWED WITHIN12 MONTHS OF (00210) INTRAORALCOMPLETE SERIES. 822, 823 119DETAIL DENIED. PROCEDURE CODE 08670NOT PAYABLE WITHIN 24 MONTHS OFCERTAIN OTHER PROCEDURE CODES IFBILLED FOR THE SAME RECIPIENT BY THESAME PROVIDER. 824 119DETAIL DENIED. THIS PROCEDURE CODENOT PAYABLE WITHIN 24 MONTHS OF 08670IF BILLED FOR THE SAME RECIPIENT BY THESAME PROVIDER. 825 97PROCEDURE CODE 09110 NOT PAYABLE IFPAYMENT HAS BEEN MADE FOR OTHERDENTAL PROCEDURE CODES FOR THESAME DATE OF SERVICE. 826 97THIS PROCEDURE CODE IS NOT PAYABLE IFPAYMENT HAS BEEN MADE FORPROCEDURE CODE 09110 FOR THE SAMEDATE OF SERVICE. 827 97Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Benefit maximum for this timeperiod has been reached.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.M57M86M86M86N20M86N20Missing/incomplete/invalid attendingor referring physician identification.Missing/incomplete/invalid provideridentifier.Service denied because paymentalready made for similar procedurewithin set time frame.Service denied because paymentalready made for same/similarprocedure within set time frame.Service denied because paymentalready made for similar procedurewithin set time frame.Service not payable with otherservice rendered on the same date.Service denied because paymentalready made for similar procedurewithin set time frame.Service not payable with otherservice rendered on the same date.Page 39 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 and 32: KYEOBMEDICAID DESCRIPTIONKENTUCKY E
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