EOB Codes and Descriptions - Kymmis.com

More documents

Recommendations

Info

KYEOB140141142143144145146147148149150151152153154155156157MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESCLAIM PENDING REVIEW. RECIPIENT IS APOTENTIAL LOCK-IN RECIPIENT. 140 38HIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTIONServices not provided orauthorized by designated(network/primary care) providers. N30 Patient ineligible for this service.The disposition of thisclaim/service is pending further133 review.Payment denied because thisprocedure code/ modifier wasPROCEDURE CODE MODIFIERinvalid on the date of service ofMISSING/INVALID. 141 B18 claim submission.M78PREGNANCY INDICATOR FOR REIPIENT AGEOR SEX. 142 A1 Claim denied charges.The procedure code isCLAIM DETAIL DENIED. REVENUE CODEinconsistent with the providerINVALID FOR PROVIDER TYPE 143 8 type/specialty (taxonomy).M50SHOULD BE BILLED BY PROVIDER OFSERVICE. 144 A1 Claim denied charges. N32THIS PROCEDURE IS NOT CERTIFIED FORTHIS LABORATORY. 145, 374 A1 Claim denied charges. MA51This provider was notcertified/eligible to be paid for thisTHIS PROCEDURE IS NOT COVERED FORprocedure/ service on this date ofTHIS PROVIDER TYPE. 146, 374 B7 service.M67The procedure code isinconsistent with the provider8 type/specialty (taxonomy).PROCEDURE CODE IS NOT ALLOWED WITHPROVIDER TYPE MODIFIER. 147 8THIS PROCEDURE IS NOT APPROPRIATEFOR THIS PLACE OF SERVICE. 148 585The procedure code isinconsistent with the providertype/specialty (taxonomy).Payment adjusted becausetreatment was deemed by thepayer to have been rendered in aninappropriate or invalid place ofservice.The procedure code/bill type isinconsistent with the place ofservice.THIS PROCEDURE/NDC IS NOTAPPROPRIATE FOR THE RECIPIENT'S AGE. 149 6The procedure/revenue code isinconsistent with the patient's age. N56The procedure/revenue code isTHIS PROCEDURE IS INVALID FOR THEinconsistent with the patient'sRECIPIENT'S SEX. 150 7 gender.MA66Payment denied because thisprocedure code/ modifier wasCLAIM DENIED. PROCEDURE NDC CODEinvalid on the date of service ofINVALID FOR DATES OF SERVICE 151, 158 B18 claim submission.MA66Payment denied because thisprocedure code/ modifier wasPROCEDURE/NDC/ REVENUE CODE INVALIDinvalid on the date of service ofOR NOT ON FILE. 152 B18 claim submission.M67PROCEDURE CODE INVALID FOR DIAGNOSISThe diagnosis is inconsistent withCODE 153, 181, 182 11 the procedure.MA66The procedure code isinconsistent with the modifierPROCEDURE CODE INVALID FOR PROVIDERused or a required modifier isTYPE MODIFIER. 154 4 missing.MA66PLEASE RESUBMIT WITH APPROPRIATEGROUP PROVIDER NUMBER IN CLINIC FIELDAND/OR INDIVIDUAL PROVIDER NUMBER INBILLING FIELD. 155 A1 Claim denied charges. N55THE INTERIM RATE FOR THIS PROCEDUREHAS NOT BEEN ESTABLISHED FOR THISPROVIDER. 374 A1 Claim denied charges. N65PROCEDURE CODE INVALID FOR PROVIDERSPECIALTY. 157, 374 B6158 CLAIM DENIED DUE TO INJURY DIAGNOSIS. 158 118This payment is adjusted whenperformed/billed by this type ofprovider, by this type of provider inthis type of facility, or by a providerof this specialty.The procedure code isinconsistent with the providertype/specialty (taxonomy).The diagnosis is inconsistent withthe procedure.N56M78N79N56M64Missing/incomplete/invalid HCPCSmodifier.Missing/incomplete/invalid revenuecode(s).Provider performing service mustsubmit claim.Missing/incomplete/invalid CLIAcertification number for laboratoryservices billed by physician officelaboratory.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Missing/incomplete/invalid HCPCSmodifier.Service billed is not compatible withpatient location information.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid principalprocedure code or date.Procedure for billing with group /referring / performing providers werenot followed.Procedure code or procedure ratecount cannot be determined, or wasnot on file, for the date of service/provider.Procedure code billed is notcorrect/valid for the services billed orthe date of service billed.Missing/incomplete/invalid otherdiagnosis.Page 8 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOBMEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTION159160161162164165166167168169170171172173174175176177MORE THAN ONE VISIT PER DETAIL DATEOF SERVICE NOT ALLOWED. EACH VISITMUST BE BILLED AS SEPARATE LINE ITEMS. 159 96 Non-covered charge(s). N63PROCEDURE INVALID FOR TOOTH NUMBERINDICATED. 160 A1 Claim denied charges. N39CLAIM DENIED. REVENUE CODE INVALIDFOR DATE OF SERVICE 161 B18Payment denied because thisprocedure code/ modifier wasinvalid on the date of service orclaim submission.CLAIM DENIED. ANTINEOPLASTIC DRUGSAND CHEMOTHERAPY ADMIN ARE PAYABLEONLY IF THE DIAGNOSIS IS MALIGNANCY. 162 96 Non-covered charge(s).11The diagnosis is inconsistent withthe procedure.PRIMARY SURGICAL PROCEDURE CODEMISSING OR NOT ON FILE. 164 A1 Claim denied charges. MA66SECONDARY SURGICAL PROCEDURE CODEMISSING OR NOT ON FILE. 165 A1 Claim denied charges. M67CLAIM/DETAIL DENIED. PRIMARY SURGICALPROCEDURE CODE INVALID FORRECIPIENT'S AGE. 166 6The procedure/revenue code isinconsistent with the patient's age.SECONDARY SURGICAL PROCEDURE CODEINVALID FOR RECIPIENTS AGE. 167 6The procedure/revenue code isinconsistent with the patient's age. M67The procedure/revenue code isPRIMARY SURGICAL PROCEDURE CODEinconsistent with the patient'sINVALID FOR RECIPIENTS SEX. 168 7 gender.MA66The procedure/revenue code isSECONDARY SURGICAL PROCEDURE CODEinconsistent with the patient'sINVALID FOR RECIPIENTS SEX 169 7 gender.M67PRIMARY SURGICAL PROCEDURE CODEINVALID FOR DATE OF SERVICE. 170 A1 Claim denied charges. MA66SECONDARY SURGICAL PROCEDURE CODEINVALID FOR DATE OF SERVICE. 171 A1 Claim denied charges. M67PRIMARY SURGICAL PROCEDURE CODEThe diagnosis is inconsistent withINVALID FOR DIAGNOSIS CODE 172 11 the procedure.MA66SECONDARY SURGICAL PROCEDURE CODEThe diagnosis is inconsistent withINVALID FOR DIAGNOSIS CODE 173 11 the procedure.M67PROVIDER ON REVIEW FOR PRIMARYSURGICAL PROCEDURE 174 A1 Claim denied charges. MA66The referring/prescribing/rendering provider is not eligible toPROVIDER ON REVIEW FOR SECONDARYrefer/prescribe/ order/perform theSURGICAL PROCEDURE 175 52 service billed.PRIMARY SURGICAL PROCEDURE CODEINDICATED AS ON REVIEW 176 A1 Claim denied charges. MA66SECONDARY SURGICAL PROCEDURE CODEINDICATED AS ON REVIEW 177 A1 Claim denied charges. M67M50MA66Rebill services on separate claimlines.Procedure code is not compatiblewith tooth number/letter.Missing/incomplete/invalid revenuecode(s).Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).178EXPECTED DATE OF DELIVERY MUST BE ATLEAST 30 DAYS FROM DATE OF CONSENT. 181 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N3N28Missing/incomplete/invalid consentform.Consent form requirements notfulfilled.179180CLAIM DENIED-PLEASE RESUBMIT CLAIMWITH REPORT OF PROCEDUREPERFORMED. 179 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N29DETAIL PROCEDURE INDICATE AS ONREVIEW. 180 96 Non-covered charge(s). M67MA07Missingdocumentation/orders/notes/summary/report/invoice.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).The claim information has also beenforwarded to Medicaid for review181RESUBMIT WITH FEDERAL STERILIZATIONCONSENT FORM ATTACHED. 181 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N3N28Missing/incomplete/invalid consentform.Consent form requirements notfulfilled.Page 9 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: 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
Page 37 and 38: KYEOB741742743744745746747748749KEN

EOB Codes and Descriptions - Kymmis.com

Create successful ePaper yourself

Delete template?

Save as template?