EOB Codes and Descriptions - Kymmis.com

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KYEOB925926927928931KENTUCKY EOB/ESC CROSSWALK TO HIPAAHIPAAADJ RSNCODESMMIS EXCEPTIONMEDICAID DESCRIPTIONCODE(S)CLAIM/ DETAIL DENIED. VENIPUNCTUREAND ARTERIAL PUNCTURE NOT ALLOWEDON SAME DATE OF SERVICE AS OTHERMONITORED PROCEDURES. 925 97CLAIMS/DETAIL DENIED. THIS SERVICE NOTPAYABLE ON THE SAME DATEOF SERVICE AS VENIPUNCTURE ANDARTERIAL PUNCTURE.926 97HIPAA ADJ RSN CODEDESCRIPTIONPayment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.HIPAAREMARKCLAIM DENIED. THE CLINIC NUMBER MUSTBE ENTERED. 927 A1 Claim denied charges. MA82DETAIL DENIED. A VALID 5-DIGIT MODIFIERMUST BE ENTERED. 928 4CLAIM DENIED. COMPOUND CODE MISSINGOR INVALID. 931 B18The procedure code isinconsistent with the modifierused or a required modifier ismissing.Payment denied because thisprocedure code/ modifier wasinvalid on the date of service orclaim submission.933CLAIM DENIED. UNIT DOSE INDICATORMISSING OR INVALID. 933 A1 Claim denied charges. M123935 DRUG INCOMPATIBILITY ALERT. 751 96 Non-covered charge(s).944 LOW DOSE ALERT. 752 96 Non-covered charge(s).945 HIGH DOSE ALERT. 753 96 Non-covered charge(s).946 LATE REFILL. 755 96 Non-covered charge(s).947 MINIMUM DURATION ALERT. 756 96 Non-covered charge(s).948 MAXIMUM DURATION ALERT. 757 96 Non-covered charge(s).949 DRUG ALLERGY ALERT. 758 96 Non-covered charge(s).MA112M78N60HIPAA REMARK CODEDESCRIPTIONMissing/incomplete/invalidprovider/supplier billingnumber/identifier or billing name,address, city, state, zip code, orphone number.Missing/incomplete/invalid grouppractice information.Missing/incomplete/invalid HCPCSmodifier.A valid NDC is required for paymentof drug claim effective Oct 2002Missing/incomplete/invalid name,strength, or dosage of the drugfurnished.950951952953954955956957958CLAIM DENIED. THIS SERVICE IS NOTPAYABLE FOR PSYCHIATRIC RESIDENTIALTREATMENT FACILITY RECIPIENTS. 950 96 Non-covered charge(s). N30 Recipient ineligible for this service.THIS SERVICE IS NOT COVERED BYMEDICAID. 959 96 Non-covered charge(s).REIMBURSEMENT FOR THIS SERVICE ISINCLUDED IN THE TOTAL PAYMENTAMOUNT. 952 B15CLAIM DETAIL DENIED. ONLY ONE UNIT OFSERVICE ALLOWED PER MODIFIER. 953 119CLAIM DETAIL DENIED. THE PROCEDURECODE MODIFIER IS MISSING OR INVALID. 954 4CLAIM/DETAIL DENIED. PROVIDERSPECIALTY INVALID FOR MODIFIER GT. 955 B18THIS PROFESSIONAL CANNOT BILL THISPROCEDURE CODE. 956 8CMHC PROCEDURES X0054 OR X0152PAYABLE ONLY WHEN BILLED WITHANOTHER CMHC PROCEDURE CODE 957 107EFFECTIVE WITH DATES OF SERVICE ONOR AFTER 070193, A FIVE- DIGIT MODIFIERMUST BE BILLED ON COMMUNITY MENTALHEALTH CENTER CLAIMS. 958 4Payment adjusted because thisprocedure/service is not paidseparately.Benefit maximum for this timeperiod has been reached.The procedure code isinconsistent with the modifierused or a required modifier ismissing.Payment denied because thisprocedure code/ modifier wasinvalid on the date of service orclaim submission.The procedure code isinconsistent with the providertype/specialty (taxonomy).Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.The procedure code isinconsistent with the modifierused or a required modifier ismissing.M63M78N95N95N56M78We do not pay for more than one ofthese on the same day.Missing/incomplete/invalid HCPCSmodifier.This provider type/provider specialtymay not bill this service.This provider type/provider specialtymay not bill this service.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Missing/incomplete/invalid HCPCSmodifier.959 PRIOR ADVERSE DRUG REACTION. 759 96 Non-covered charge(s).960THIS REVENUE CODE IS NOT PAYABLEWHEN BILLED WITH ALL INCLUSIVEACCOMMODATION REVENUE CODE 100.CHARGES MOVED TO NON-COVERED. 960 97Payment is included in theallowance for anotherservice/procedure.THIS REVENUE CODE IS NOT PAYABLEWHEN BILLED WITH ALL INCLUSIVEREVENUE CODE 101 AND ALL INCLUSIVEPayment is included in theANCILLARY REVENUE CODE 240. CHARGESallowance for another961 MOVED TO NON-COVERED. 961 97 service/procedure.962 PREGNANCY ALERT. 763 96 Non-covered charge(s).963 DRUG/GENDER ALERT. 764 96 Non-covered charge(s).N34M50M50Incorrect claim form for this service.Missing/incomplete/invalid revenuecode(s).Missing/incomplete/invalid revenuecode(s).Page 44 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOBMEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTION964965966967968969970971972973974CLAIM DENIED. PSYCHIATRIC RESIDENTIALTREATMENT FACILITY SERVICES ARE NOTPAYABLE TO RECIPIENTS OVER AGE 21. 964 6CLAIM DENIED. CHILDREN'S TARGETEDCASE MANAGEMENT SERVICES ARE NOTPAYABLE TO RECIPIENTS OVER AGE 20. 965 6CLAIM DENIED. ADULT TARGETED CASEMANAGEMENT SERVICES ARE NOTPAYABLE TO RECIPIENTS UNDER AGE 18. 966 6CLAIM DENIED. REIMBURSEMENT FOR THISREVENUE CODE IS LIMITED TO TWO UNITSOF SERVICE PER DAY. 967 119CLAIM DENIED. REIMBURSEMENT FOR THISREVENUE CODE IS LIMITED TO ONE UNIT OFSERVICE PER DAY. 968 119THIS PROCEDURE CODE REQUIRES THEENTRY OF A VALID QUADRANT CODE IN THEThe procedure/revenue code isinconsistent with the patient's age.The procedure/revenue code isinconsistent with the patient's age.The procedure/revenue code isinconsistent with the patient's age.Benefit maximum for this timeperiod has been reached.Benefit maximum for this timeperiod has been reached.TOOTH NUMBER FIELD. 969 A1 Claim denied charges. M58THIS PROCEDURE REQUIRES THE ENTRYOF A VALID ARCH CODE IN THE TOOTHNUMBER FIELD. 970 A1 Claim denied charges. M58Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedLITER FLOW PER MINUTE AND/OR NUMBEROF HOURS MISSING OR INVALID. 971 16using remittance advice remarkscodes whenever appropriate. M125CLAIM DENIED. PROCEDURE CODES FORMILEAGE, OXYGEN, AND SUPPLIES MUSTMATCH THE BASE RATE CATEGORY. 972 A1 Claim denied charges. M51N65PROCEDURE CODE 02951 IS LIMITED TOBenefit maximum for this timeONE TOOTH PER DETAIL. 973 119 period has been reached.M53DUPLICATE TOOTH NUMBERS ARE NOTALLOWED ON THE SAME DETAIL FORPROCEDURE CODE 04211. 974 18 Duplicate claim/service. M53M53M63N63Missing/incomplete/invalid days orunits of service.We do not pay for more than one ofthese on the same day.Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalid claiminformation. Resubmit claim aftercorrections.Missing/incomplete/invalidinformation on the period of time forwhich the service/supply/equipmentwill be needed.Missing/incomplete/invalid procedurecode(s) and/or rates.Procedure code or procedure ratecount cannot be determined, or wasnot on file, for the date of service/provider.Missing/incomplete/invalid days orunits of service.Missing/incomplete/invalid days orunits of service.Rebill services on separate claimlines.975UNITS MUST EQUAL NUMBER OF TEETHPER DETAIL FOR PROCEDURE CODE 04211. 975 A1 Claim denied charges. M53PIN RETENTION THERAPY PROCEDURE02951 IS LIMITED TO PERMANENT MOLARS976 ONLY. 976 A1 Claim denied charges. N56The referring/prescribing/rendering provider is not eligible torefer/prescribe/ order/perform the977 TYPE OF BILL INVALID FOR PROVIDER TYPE. 977 52 service billed.MA30978979981982CLAIM DENIED. ONLY ONE BASE RATEPROCEDURE CODE ALLOWED PER CLAIM. 978 A1 Claim denied charges. N56CLAIM DENIED. EMERGENCYTRANSPORTATION CLAIMS WITH DATES OFSERVICE ON OR AFTER 7/1/95 MUST BESUBMITTED ON PAPER. 979 A1 Claim denied charges. N56PROVIDER NOT ALLOWED TO BILL CLAIMSON PAPER. 981 A1 Claim denied charges. M117CLAIM/DETAIL DENIED. VACCINEPROCEDURE CODE MUST BE BILLED USINGThe procedure code isMODIFIER 26 FOR ADMINISTRATION TOinconsistent with the modifierINDICATE VACCINE OBTAINED FROMused or a required modifier isPRIVATE SOURCE. 982 4 missing.M78Missing/incomplete/invalid days orunits of service.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Missing/incomplete/invalid type ofbill.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.Not covered unless supplier files anelectronic media claim (EMC).Missing/incomplete/invalid HCPCSmodifier.984985MEDICARE EOMB DOES NOT INDICATE THATCOINSURANCE AND DEDUCTIBLE AMOUNTSARE DUE. 984 16DETAIL DENIED. THIS PROCEDURE LIMITEDTO TWO UNITS OF SERVICE. 985 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.N48M53Claim information does not agreewith information received from otherinsurance carrier.Missing/incomplete/invalid days orunits of service.986DETAIL DENIED. PROCEDURE CODE A0420MUST ALSO BE BILLED WHEN AN EXTRAMILEAGE PROCEDURE CODE IS BILLEDWITH A ROUND TRIP PROCEDURE CODE. 986 107Claim/service denied because therelated or qualifying claim/servicewas not previously paid oridentified on this claim.N56Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Page 45 of 46 Date: 3/30/2005
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Page 5 and 6: KYEOB079080081082083084KENTUCKY EOB
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