EOB Codes and Descriptions - Kymmis.com

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KYEOB886MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESCLAIM DENIED. INAPPROPRIATEPROCEDURE CODE BILLED. 862, 886 B18888 GMIS-VISIT IS WITHIN THE POST OP RANGE. 888 97CLAIM/DETAIL DENIED. THIS PROCEDURECODE IS NOT PAYABLE IF BILLED WITH A889 SUBSTANCE ABUSE DIAGNOSIS CODE. 889 11CLAIM/DETAIL DENIED. THIS PROCEDURE ISNOT PAYABLE IF BILLED WITHOUT ONE OFTHE DESIGNATED PREGNANCY DIAGNOSIS890 CODES. 890 11CLAIM/DETAIL DENIED. THIS PROCEDURECODE NOT PAYABLE IF BILLED WITHOUTONE OF THE DESIGNATED SUBSTANCE891 ABUSE DIAGNOSIS CODES. 891 11893894895UNITS OF SERVICE GREATER THAN THEREMAINING PRIOR AUTHORIZED AMOUNT. 893 62DETAIL DENIED. THE PRIOR AUTHORIZEDAMOUNT FOR THIS PROCEDURE HAS BEENMET. 894 62RELATED HISTORY OF MORE THAN 25TCNS. 895HIPAA ADJ RSN CODEDESCRIPTIONPayment denied because thisprocedure code/ modifier wasinvalid on the date of service orclaim submission.Payment is included in theallowance for anotherservice/procedure.The diagnosis is inconsistent withthe procedure.The diagnosis is inconsistent withthe procedure.The diagnosis is inconsistent withthe procedure.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.HIPAAREMARK896CLAIM HAS FAILED MORE THAN 24 ERRORCODES. PLEASE CORRECT AND RESUBMIT. 896 A1 Claim denied charges. M58This provider was notCLAIM DENIED TO PROVIDER NUMBERcertified/eligible to be paid for this99999997 FOR REBATCH OR RETURNprocedure/ service on this date of897 REASONS. 897 B7 service.M57898 TOO MANY CLAIMS IN CYCLE 898899 DENIED PER PROVIDER REQUEST 899 A1 Claim denied charges.THE RX NUMBER MUST BE COMPLETED TOPROCESS YOUR CLAIM. PLEASE COMPLETE900 AND RESUBMIT YOUR CLAIM. 900 A1 Claim denied charges. M58DRUG QUANTITY IS REQUIRED. COMPLETETHE MISSING INFORMATION AND RESUBMIT901 YOUR CLAIM. 901 A1 Claim denied charges. M123M67M144MA63N56N56M139M139M53HIPAA REMARK CODEDESCRIPTIONMissing/incomplete/invalid otherprocedure code(s) and/or date(s).Pre-/post-operative care payment isincluded in the allowance for surgery/ procedure.Missing/incomplete/invalid principaldiagnosis.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Denied services exceed the coveragelimit for the demonstration.Denied services exceed the coveragelimit for the demonstration.Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalid provideridentifier.Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalid name,strength, or dosage of the drugfurnished.Missing/incomplete/invalid days orunits of service.902CLAIM DENIED. DRUG QUANTITY BILLEDFOR ESTABLISHED MINIMUM/ MAXIMUMQUANTITIES. 902 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.M53Missing/incomplete/invalid days orunits of service.903CLAIM DENIED. DRUG DAYS SUPPLYMISSING OR INVALID. 903 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.M53Missing/incomplete/invalid days orunits of service.904CLAIM DENIED. NDC IS RATED DESI FORCLAIM DATE OF SERVICE. 904 N60A valid NDC is required for paymentof drug claim effective Oct 2002905906CLAIM CREDIT QUANTITY MUST BE EQUALTO OR LOWER THAN ORIGINAL CLAIMQUANTITY, PLEASE RESUBMIT. 905 107PRESCRIBING PROVIDER'S LICENSENUMBER MISSING INVALID OR NOT ON KYMEDICAID FILE. 906 B757Payment 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.Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.MA66M58M53N31Incomplete/invalid principalprocedure code and/or date.Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalid days orunits of service.Missing/incomplete/invalidprescribing/referring/attendingprovider license number.Page 42 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOB907MEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESCLAIM DENIED. NDC IS TERMINATED OROBSOLETE. 907 B18HIPAA ADJ RSN CODEDESCRIPTIONPayment denied because thisprocedure code/ modifier wasinvalid on the date of service orclaim submission.HIPAAREMARKN60HIPAA REMARK CODEDESCRIPTIONA valid NDC is required for paymentof drug claim effective Oct 2002908909910911CLAIM\DETAIL IS DENIED. THE RECIPIENT ISIN A NURSING FACILITY ON THE DATE OFSERVICE. 908 60CLAIM DETAIL DENIED. ANCILLARYSERVICES NOT AUTHORIZED BY THE PRO. 909 62CLAIM DENIED. SUBMITTED LEVEL OF CARESERVICES NOT AUTHORIZED BY THE PRO. 910 62MODIFIER INVALID FOR PROCEDURE CODEBILLED. 911 4Charges for outpatient serviceswith this proximity to inpatientservices are not covered.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.Payment denied/reduced forabsence of, or exceeded, precertification/authorization.The procedure code isinconsistent with the modifierused or a required modifier ismissing.MA101N54N54M78A SNF is responsible for payment ofoutside providers who furnish theseservices/supplies to residents.Claim information is inconsistent withpre-certified/authorized servicesClaim information is inconsistent withpre-certified/authorized servicesMissing/incomplete/invalid HCPCSmodifier.913914CLAIM DENIED. DAYS SUPPLY EXCEEDS 32DAYS. 913 57CLAIM DENIED. HEADER COVERED DAYSGREATER THAN THE 14 DAY MAXIMUMALLOWED. 005 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.M53MA32M53Missing/incomplete/invalid days orunits of service.Missing/incomplete/invalid number ofcovered days during the billingperiod.Missing/incomplete/invalid days orunits of service.915916917918919CLAIM/DETAIL DENIED. THE NON-COVEREDAMOUNT CANNOT BE GREATER THAN THEBILLED AMOUNT. 915 42CLAIM/DETAIL DENIED. EPSDT SPECIALSERVICES CLAIMS NOT PAYABLE FOR THISCharges exceed our fee scheduleor maximum allowable amount.MA31M54Missing/incomplete/invalid beginningand ending dates of the period billed.Missing/incomplete/invalid totalcharges.RECIPIENT. 916 96 Non-covered charge(s). N30 Recipient ineligible for this service.CLAIM/DETAIL DENIED. SCREENINGPROCEDURE CODE INVALID FORThe procedure/revenue code isMissing/incomplete/invalid principalRECIPIENT'S AGE. 917 6 inconsistent with the patient's age. MA66 procedure code or date.CLAIM/DETAIL DENIED. THE DETAIL DATESOF SERVICE ARE NOT EQUAL TO OR WITHINTHE HEADER DATES OF SERVICE. 918 A1 Claim denied charges. MA31DETAIL DENIED. THIS SERVICE IS NOTPAYABLE BEYOND THE BIRTH MONTH OFTHE RECIPIENT'S 21ST BIRTHDAY. 919 6The procedure/revenue code isinconsistent with the patient's age.Missing/incomplete/invalid beginningand ending dates of the period billed.921922923924CLAIM DENIED. THIRD PARTY LIABILITYAMOUNT IS EQUAL TO MEDICARE PAIDAMOUNT OR GREATER THAN HEADERCOINSURANCE PLUS HEADER DEDUCTIBLE. 921 42Charges exceed our fee scheduleor maximum allowable amount.THIS SERVICE WAS NOT PAID BY MEDICARE.MEDICAID PAYMENT CAN ONLY BE MADEFROM A PAID MEDICARE EOMB. 122 96 Non-covered charge(s). N8CLAIM DENIED. A NINE-BYTE, ALL-NUMERICTAX ID-NUMBER MUST BE ENTERED IN THEPATIENT'S ACCOUNT NUMBER FIELD ONTHE CLAIM. 923 A1 Claim denied charges. MA113CLAIM DENIED. DISPROPORTIONATE SHAREHOSPITAL CLAIMS WHICH SPAN ARECIPIENT'S 6TH BIRTHDAY MUST BE SPLITBILLED. PLEASE REFER TO THE BILLINGINSTRUCTIONS IN YOUR PROVIDERMANUAL. 124 A1 Claim denied charges. N59N48N63Claim information does not agreewith information received from otherinsurance carrier.Crossover claim denied by previouspayer and complete claim data notforwarded. Resubmit this claim tothis payer to provide adequate datafor adjudication.Incomplet/invalid taxpayeridentification number (TIN) submittedby you per the Internal RevenueService. Your claims cannot beprocessed without your correct TIN,and you may not bill the patientpending correction of your TIN.There are no appeas rights forunprocessable claims, buy you mayresubmit this claims after you havenotified this office of your correct TIN.Please refer to your provider manualfor additional program and providerinformation.Rebill services on separate claimlines.Page 43 of 46 Date: 3/30/2005
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Page 5 and 6: KYEOB079080081082083084KENTUCKY EOB
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EOB Codes and Descriptions - Kymmis.com

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