The system should contain all of the possible remarks codes supported by the 835 process and are used in the Negative Balance Report to provide a hover over description. Many of the codes are currently Inactive. Should you need to either add a new code or make an existing code active, this is where you would manage it.
Missing/incomplete/invalid procedure date(s).
Missing/incomplete/invalid other procedure date(s).
Missing/incomplete/invalid principal procedure date.
Missing/incomplete/invalid dispensed date.
Missing/incomplete/invalid injury/accident date.
Missing/incomplete/invalid acute manifestation date.
Missing/incomplete/invalid adjudication or payment date.
Missing/incomplete/invalid appliance placement date.
Missing/incomplete/invalid assessment date.
Missing/incomplete/invalid prescribing provider identifier.
Missing/incomplete/invalid assumed or relinquished care date.
Missing/incomplete/invalid authorized to return to work date.
Missing/incomplete/invalid begin therapy date.
Missing/incomplete/invalid certification revision date.
Missing/incomplete/invalid diagnosis date.
Missing/incomplete/invalid disability from date.
Missing/incomplete/invalid disability to date.
Missing/incomplete/invalid discharge hour.
Missing/incomplete/invalid discharge or end of care date.
Missing/incomplete/invalid hearing or vision prescription date.
Claim must be submitted by the provider who rendered the service.
Missing/incomplete/invalid Home Health Certification Period.
Missing/incomplete/invalid last admission period.
Missing/incomplete/invalid last certification date.
Missing/incomplete/invalid last contact date.
Missing/incomplete/invalid last seen/visit date.
Missing/incomplete/invalid last worked date.
Missing/incomplete/invalid last x-ray date.
Missing/incomplete/invalid other insured birth date.
Missing/incomplete/invalid Oxygen Saturation Test date.
Missing/incomplete/invalid patient birth date.
No record of health check prior to initiation of treatment.
Missing/incomplete/invalid patient death date.
Missing/incomplete/invalid physician order date.
Missing/incomplete/invalid prior hospital discharge date.
Missing/incomplete/invalid prior placement date.
Missing/incomplete/invalid re-evaluation date.
Missing/incomplete/invalid referral date.
Missing/incomplete/invalid replacement date.
Missing/incomplete/invalid secondary diagnosis date.
Missing/incomplete/invalid shipped date.
Missing/incomplete/invalid similar illness or symptom date.
Incorrect claim form/format for this service.
Missing/incomplete/invalid subscriber birth date.
Missing/incomplete/invalid surgery date.
Missing/incomplete/invalid test performed date.
Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.
Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.
Date range not valid with units submitted.
Missing/incomplete/invalid oral cavity designation code.
Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer.
You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.
The administration method and drug must be reported to adjudicate this service.
Program integrity/utilization review decision.
Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
Service date outside of the approved treatment plan service dates.
Not covered when performed with, or subsequent to, a non-covered service.
Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
The number of Days or Units of Service exceeds our acceptable maximum.
Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice.
You must appeal the determination of the previously adjudicated claim.
Missing/incomplete/invalid tooth number/letter.
Billing exceeds the rental months covered/approved by the payer.
Only reasonable and necessary maintenance/service charges are covered.
It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your behalf.
Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.
Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.
Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.
Payment based on a processed replacement claim.
Missing/incomplete/invalid prescription quantity.
Claim level information does not match line level information.
The original claim has been processed, submit a corrected claim.
Missing/incomplete/invalid patient identifier.
Not covered when deemed cosmetic.
Records indicate that the referenced body part/tooth has been removed in a previous procedure.
Notification of admission was not timely according to published plan procedures.
This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
Missing/incomplete/invalid prescription number.
Duplicate prescription number submitted.
Procedure code is not compatible with tooth number/letter.
This service/report cannot be billed separately.
Missing emergency department records.
Incomplete/invalid emergency department records.
Missing progress notes/report.
Incomplete/invalid progress notes/report.
Missing laboratory report.
Incomplete/invalid laboratory report.
Benefits are not available for incomplete service(s)/undelivered item(s).
Missing elective consent form.
Incomplete/invalid elective consent form.
Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.
Missing radiology film(s)/image(s).
Missing periodontal charting.
Incomplete/invalid periodontal charting.
Missing facility certification.
Incomplete/invalid facility certification.
This service is only covered when the donor’s insurer(s) do not provide coverage for the service.
This service is only covered when the recipient’s insurer(s) do not provide coverage for the service.
You are not an approved submitter for this transmission format.
This payer does not cover deductibles assessed by a previous payer.
This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident.
Not covered unless the prescription changes.
This service is allowed one time in a 6-month period.
This service is allowed 2 times in a 12-month period.
This service is allowed 2 times in a benefit year.
This service is allowed 4 times in a 12-month period.
This service is allowed 1 time in an 18-month period.
This service is allowed 1 time in a 3-year period.
This service is allowed 1 time in a 5-year period.
Misrouted claim. See the payer’s claim submission instructions.
Claim payment was the result of a payer’s retroactive adjustment due to a retroactive rate change.
Missing mental health assessment.
Claim payment was the result of a payer’s retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.
Claim payment was the result of a payer’s retroactive adjustment due to a review organization decision.
Claim payment was the result of a payer’s retroactive adjustment due to a payer’s contract incentive program.
Claim payment was the result of a payer’s retroactive adjustment due to a non standard program.
Patient does not reside in the geographic area required for this type of payment.
Statutorily excluded service(s).
No coverage when self-administered.
Payment for eyeglasses or contact lenses can be made only after cataract surgery.
Not covered when performed in this place of service.
Not covered when considered routine.
Bed hold or leave days exceeded.
Procedure code is inconsistent with the units billed.
Not covered with this procedure.
Resubmit this claim using only your National Provider Identifier (NPI).
Missing/Incomplete/Invalid Present on Admission indicator.
Exceeds number/frequency approved /allowed within time period without support documentation.
The injury claim has not been accepted and a mandatory medical reimbursement has been made.
This jurisdiction only accepts paper claims.
Missing anesthesia physical status report/indicators.
Incomplete/invalid anesthesia physical status report/indicators.
This missed/cancelled appointment is not covered.
Payment based on an alternate fee schedule.
Missing/incomplete/invalid total time or begin/end time.
Missing document for actual cost or paid amount.
Incomplete/invalid document for actual cost or paid amount.
Payment is based on a generic equivalent as required documentation was not provided.
This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.
Payment based on a comparable drug/service/supply.
Payment based on authorized amount.
Covered only when performed by the primary treating physician or the designee.
Missing Admission Summary Report.
Incomplete/invalid Admission Summary Report.
Missing Consultation Report.
Incomplete/invalid Consultation Report.
Missing Physician Order.
Incomplete/invalid Physician Order.
Missing Diagnostic Report.
Incomplete/invalid Diagnostic Report.
Missing Discharge Summary.
Missing/incomplete/invalid admission hour.
Incomplete/invalid Discharge Summary.
Missing Nursing Notes.
Incomplete/invalid Nursing Notes.
Missing support data for claim.
Incomplete/invalid support data for claim.
Missing Physical Therapy Notes/Report.
Incomplete/invalid Physical Therapy Notes/Report.
Missing Tests and Analysis Report.
Incomplete/invalid Report of Tests and Analysis Report.
Claim conflicts with another inpatient stay.
This payment will complete the mandatory medical reimbursement limit.
Missing/incomplete/invalid HIPPS Rate Code.
Payment for this service has been issued to another provider.
Missing completed referral form.
Incomplete/invalid completed referral form.
Missing Dental Models.
Incomplete/invalid Dental Models.
Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
Claim information does not agree with information received from other insurance carrier.
Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
Missing Physical Therapy Certification.
Incomplete/invalid Physical Therapy Certification.
Missing Prosthetics or Orthotics Certification.
Incomplete/invalid Prosthetics or Orthotics Certification.
Missing referral form.
Court ordered coverage information needs validation.
Incomplete/invalid referral form.
Missing/Incomplete/Invalid Exclusionary Rider Condition.
Missing Doctor First Report of Injury.
Incomplete/invalid Doctor First Report of Injury.
Missing Supplemental Medical Report.
Incomplete/invalid Supplemental Medical Report.
Missing Medical Permanent Impairment or Disability Report.
Incomplete/invalid Medical Permanent Impairment or Disability Report.
Missing Medical Legal Report.
EOB received from previous payer. Claim not on file.
Missing/incomplete/invalid discharge information.
Incomplete/invalid Medical Legal Report.
Missing Vocational Report.
Incomplete/invalid Vocational Report.
Missing Work Status Report.
Incomplete/invalid Work Status Report.
Plan distance requirements have not been met.
Electronic interchange agreement not on file for provider/submitter.
Records indicate a mismatch between the submitted NPI and EIN.
Resubmit a new claim with the requested information.
No separate payment for accessories when furnished for use with oxygen equipment.
Invalid combination of HCPCS modifiers.
Patient not enrolled in the billing provider’s managed care plan on the date of service.
Mismatch between the submitted provider information and the provider information stored in our system.
Duplicate of a claim processed, or to be processed, as a crossover claim.
The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid.
Based on policy this payment constitutes payment in full.
These services are not covered when performed within the global period of another service.
Not qualified for recovery based on employer size.
We processed this claim as the primary payer prior to receiving the recovery demand.
Patient is entitled to benefits for Institutional Services only.
Patient is entitled to benefits for Professional Services only.
Missing/incomplete/invalid point of pick-up address.
Not Qualified for Recovery based on enrollment information.
Not qualified for recovery based on direct payment of premium.
Not qualified for recovery based on disability and working status.
Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.
This is an individual policy, the employer does not participate in plan sponsorship.
Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.
We are not changing the prior payer’s determination of patient responsibility, which you may collect, as this service is not covered by us.
We have examined claims history and no records of the services have been found.
A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
Claim information is inconsistent with pre-certified/authorized services.
Payment adjusted based on the interrupted stay policy.
Mismatch between the submitted insurance type code and the information stored in our system.
Missing income verification.
Incomplete/invalid income verification.
Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.
A refund request (Frequency Type Code 8) was processed previously.
Procedures for billing with group/referring/performing providers were not followed.
Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.
Payment adjusted to reverse a previous withhold/bonus amount.
Missing/Incomplete/Invalid Family Planning Indicator.
Missing medication list.
Incomplete/invalid medication list.
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected.
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received.
This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located.
Procedure code billed is not correct/valid for the services billed or the date of service billed.
The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.
The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission.
The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.
Patient did not meet the inclusion criteria for the demonstration project or pilot program.
Not covered when considered preventative.
Not covered when performed for the reported diagnosis.
Missing/incomplete/invalid prescribing date.
Missing/incomplete/invalid credentialing data.
This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider.
Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.
Services not related to the specific incident/claim/accident/loss being reported.
Personal Injury Protection (PIP) Coverage.
Coverages do not apply to this loss.
Medical Payments Coverage (MPC).
Missing/incomplete/invalid patient liability amount.
Determination based on the provisions of the insurance policy.
Investigation of coverage eligibility is pending.
Benefits suspended pending the patient’s cooperation.
Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.
Not covered based on the insured’s noncompliance with policy or statutory conditions.
Benefits are no longer available based on a final injury settlement.
The injured party does not qualify for benefits.
Policy benefits have been exhausted.
The patient has instructed that medical claims/bills are not to be paid.
Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by the use of a drug.
Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).
Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
Not covered based on failure to attend a scheduled Independent Medical Exam (IME).
Records reflect the injured party did not complete an Application for Benefits for this loss.
Records reflect the injured party did not complete an Assignment of Benefits for this loss.
Records reflect the injured party did not complete a Medical Authorization for this loss.
Adjusted based on a medical/dental provider’s apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.
Health care policy coverage is primary.
Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.
Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B.
Adjusted based on the applicable fee schedule for the region in which the service was rendered.
In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale System applicable to Hawaii.
Adjusted based on the Redbook maximum allowance.
This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage.
In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers’ Compensation Board Schedule of Medical Fees, pursuant to Regulation 83 and / or Appendix 17-C of 11 NYCRR.
This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.
Service provided for non-compensable condition(s).
The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6.
80% of the provider’s billed amount is being recommended for payment according to Act 6.
Rebill services on separate claims.
Claim in litigation. Contact insurer for more information.
Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
This enrollee is in the second or third month of the advance premium tax credit grace period.
Coverage terminated for non-payment of premium.
Dates of service span multiple rate periods. Resubmit separate claims.
Charges for Jurisdiction required forms, reports, or chart notes are not payable.
Not covered based on the date of injury/accident.
Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
The associated Workers’ Compensation claim has been withdrawn.
Missing/Incomplete/Invalid Workers’ Compensation Claim Number.
New or established patient E/M codes are not payable with chiropractic care codes.
Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
Reviews/documentation/notes/summaries/reports/charts not requested.
Rebill services on separate claim lines.
Referral not authorized by attending physician.
Medical Fee Schedule does not list this code. An allowance was made for a comparable service.
Additional anesthesia time units are not allowed.
The allowance is calculated based on anesthesia time units.
The Allowance is calculated based on the anesthesia base units plus time.
Adjusted because this is reimbursable only once per injury.
Consultations are not allowed once treatment has been rendered by the same provider.
Reimbursement has been made according to the home health fee schedule.
Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
Exceeds number/frequency approved/allowed within time period.
Reimbursement has been based on the number of body areas rated.
Adjusted when billed as individual tests instead of as a panel.
The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
Reimbursement has been made according to the bilateral procedure rule.
Reimbursement has been adjusted based on the guidelines for an assistant.
Adjusted based on diagnosis-related group (DRG).
Adjusted based on Stop Loss.
Payment based on invoice.
Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
This policy was not in effect for this date of loss. No coverage is available.
No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
The date of service is before the date of loss.
The date of injury does not match the reported date of loss.
Adjusted based on achievement of maximum medical improvement (MMI).
Payment based on provider’s geographic region.
An interest payment is being made because benefits are being paid outside the statutory requirement.
This should be billed with the appropriate code for these services.
The billed service(s) are not considered medical expenses.
This item is exempt from sales tax.
Sales tax has been included in the reimbursement.
Documentation does not support that the services rendered were medically necessary.
Adjusted based on an agreed amount.
Adjusted based on a legal settlement.
Services by an unlicensed provider are not reimbursable.
Only one evaluation and management code at this service level is covered during the course of care.
Adjusted based on the Medicare fee schedule.
This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
Payment based on a jurisdiction cost-charge ratio.
Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
Not covered unless a pre-requisite procedure/service has been provided.
Additional information is required from the injured party.
Service does not qualify for payment under the Outpatient Facility Fee Schedule.
Missing post-operative images/visual field results.
Incomplete/Invalid post-operative images/visual field results.
Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.
Missing/Incomplete/Invalid date of previous dental extractions.
Missing/Incomplete/Invalid full arch series.
Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
Missing/Incomplete/Invalid prior treatment documentation.
Payment denied as this is a specialty claim submitted as a general claim.
Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
Missing/incomplete/Invalid questionnaire needed to complete payment determination.
Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.
Consolidated billing and payment applies.
Payment adjusted based on the Electronic Health Records (EHR) Incentive Program.
Payment adjusted based on the Value-based Payment Modifier.
Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.
This service is incompatible with previously adjudicated claims or claims in process.
Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims.
Incomplete/Invalid documentation of face-to-face examination.
Missing documentation of face-to-face examination.
Penalty applied based on plan requirements not being met.
PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.
This service is only covered when performed as part of a clinical trial.
Patient must use Workers’ Compensation Set-Aside (WCSA) funds to pay for the medical service or item.
Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.
Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.
A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
A conditional payment is not allowed.
A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
A workers’ compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
Missing patient medical/dental record for this service.
Incomplete/invalid patient medical/dental record for this service.
Incomplete/Invalid mental health assessment.
Services performed at an unlicensed facility are not reimbursable.
Regulatory surcharges are paid directly to the state.
The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury.
Incomplete/invalid Sleep Study Report.
Missing Sleep Study Report.
Incomplete/invalid Vein Study Report.
Missing Vein Study Report.
Resubmit with multiple claims, each claim covering services provided in only one calendar month.
The member’s Consumer Spending Account does not contain sufficient funds to cover the member’s liability for this claim/service.
This is a site neutral payment.
Adjusted because the services may be related to an employment accident.
Adjusted because the services may be related to an auto/other accident.
Missing Ambulance Report.
Incomplete/invalid Ambulance Report.
This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides.
Adjusted because the related hospital charges have not been received.
Missing Blood Gas Report.
Missing/incomplete/invalid tooth surface information.
Incomplete/invalid Blood Gas Report.
Adjusted because the patient is covered under a Medicare Part D plan.
Missing/incomplete/invalid HIPPS Treatment Authorization Code (TAC).
Missing/incomplete/invalid Attachment Control Number.
Missing/incomplete/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form.
Missing/incomplete/invalid ICD Indicator.
Missing/incomplete/invalid point of drop-off address.
Adjusted based on the Federal Indian Fees schedule (MLR).
Adjusted based on the prior authorization decision.
Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013.
Missing/incomplete/invalid number of riders.
This facility is not authorized to receive payment for the service(s).
This provider is not authorized to receive payment for the service(s).
This facility is not certified for Tomosynthesis (3-D) mammography.
The demonstration code is not appropriate for this claim; resubmit without a demonstration code.
Missing/incomplete/invalid Hematocrit (HCT) value.
This payer does not cover co-insurance assessed by a previous payer.
This payer does not cover co-payment assessed by a previous payer.
Incomplete/invalid initial evaluation report.
A lateral diagnosis is required.
Missing/incomplete/invalid designated provider number.
The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received.
Drug supplied not obtained from specialty vendor.
Payment adjusted based on x-ray radiograph on film.
This service is not a covered Telehealth service.
Missing Assignment of Benefits Indicator.
Missing Primary Care Physician Information.
Replacement/Void claims cannot be submitted until the original claim has finalized. Please resubmit once payment or denial is received.
The necessary components of the child and teen checkup (EPSDT) were not completed.
Missing/incomplete/invalid end therapy date.
Missing comprehensive procedure code.
Missing current radiology film/images.
Benefit limitation for the orthodontic active and/or retention phase of treatment.
The third party administrator/review organization did not receive the requested information.
Clinical Trial is not a covered benefit.
Service billed is not compatible with patient location information.
Provider/supplier not accredited for product/service.
Missing history & physical report.
Incomplete/invalid history & physical report.
Payment adjusted based on type of technology used.
Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
Missing/incomplete/invalid prenatal screening information.
Procedure billed is not compatible with tooth surface code.
Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
Home use of biofeedback therapy is not covered.
Adjustment represents the estimated amount a previous payer may pay.
Covered only when performed by the attending physician.
Services not included in the appeal review.
This facility is not certified for digital mammography.
A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
Claim/Service denied because a more specific taxonomy code is required for adjudication.
This provider type/provider specialty may not bill this service.
Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.
Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.
Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.
Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.
Equipment purchases are limited to the first or the tenth month of medical necessity.
We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug.
Service not performed on equipment approved by the FDA for this purpose.
Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.
Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.
Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.
Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
DME, orthotics and prosthetics must be billed to the DME carrier who services the patient’s zip code.
We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.
Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.
This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.
Not covered unless submitted via electronic claim.
Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
We pay for this service only when performed with a covered cryosurgical ablation.
Missing/incomplete/invalid level of subluxation.
Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
Missing indication of whether the patient owns the equipment that requires the part or supply.
Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
Missing/incomplete/invalid individual lab codes included in the test.
Missing patient medical record for this service.
Missing/incomplete/invalid indicator of x-ray availability for review.
Only one initial visit is covered per specialty per medical group.
Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Missing physician financial relationship form.
Missing pacemaker registration form.
Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
Performed by a facility/supplier in which the provider has a financial interest.
Missing/incomplete/invalid plan of treatment.
Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
Part B coinsurance under a demonstration project or pilot program.
Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants.
Denied services exceed the coverage limit for the demonstration.
No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.
Missing physician certified plan of care.
Missing American Diabetes Association Certificate of Recognition.
The provider must update license information with the payer.
Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient’s home.
Missing oxygen certification/re-certification.
Not paid separately when the patient is an inpatient.
Missing/incomplete/invalid place of residence for this service/item provided in a home.
Missing/incomplete/invalid number of miles traveled.
Missing/incomplete/invalid number of doses per vial.
The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
Missing operative note/report.
Equipment is the same or similar to equipment already being used.
Missing pathology report.
Missing radiology report.
This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase.
Not covered when the patient is under age 35.
Claim must be assigned and must be filed by the practitioner’s employer.
We do not pay for this as the patient has no legal obligation to pay for this.
The medical necessity form must be personally signed by the attending physician.
Missing/incomplete/invalid condition code.
Missing/incomplete/invalid occurrence code(s).
Missing/incomplete/invalid occurrence span code(s).
Missing/incomplete/invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN).
Missing/incomplete/invalid value code(s) or amount(s).
Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
Missing/incomplete/invalid revenue code(s).
Missing/incomplete/invalid procedure code(s).
Missing/incomplete/invalid days or units of service.
Missing/incomplete/invalid total charges.
We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
Missing/incomplete/invalid payer identifier.
Missing Certificate of Medical Necessity.
We cannot pay for this as the approval period for the FDA clinical trial has expired.
Missing/incomplete/invalid treatment authorization code.
Missing/incomplete/invalid other diagnosis.
One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.
Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items.
Missing/incomplete/invalid other procedure code(s).
Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.
Total payment reduced due to overlap of tests billed.
The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.
This service does not qualify for a HPSA/Physician Scarcity bonus payment.
Multiple automated multichannel tests performed on the same day combined for payment.
Missing/incomplete/invalid diagnosis or condition.
Missing/incomplete/invalid/inappropriate place of service.
We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
Not covered when performed during the same session/date as a previously processed service for the patient.
You are required to code to the highest level of specificity.
Service is not covered when patient is under age 50.
Service is not covered unless the patient is classified as at high risk.
Medical code sets used must be the codes in effect at the time of service.
Subjected to review of physician evaluation and management services.
Service denied because payment already made for same/similar procedure within set time frame.
Claim/service(s) subjected to CFO-CAP prepayment review.
Not covered more than once under age 40.
Not covered more than once in a 12 month period.
Lab procedures with different CLIA certification numbers must be billed on separate claims.
Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.
Information supplied does not support a break in therapy. A new capped rental period will not begin.
Services subjected to Home Health Initiative medical review/cost report audit.
The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.
Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
Missing/incomplete/invalid Universal Product Number/Serial Number.
Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
Missing/incomplete/invalid date of current illness or symptoms.
Hemophilia Add On.
PIP (Periodic Interim Payment) claim.
Paper claim contains more than three separate data items in field 19.
Paper claim contains more than one data item in field 23.
Claim processed in accordance with ambulatory surgical guidelines.
Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.
Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory’s name and address.
Missing/incomplete/invalid group practice information.
Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.
Missing/incomplete/invalid information on where the services were furnished.
Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
Did not complete the statement ‘Homebound’ on the claim to validate whether laboratory services were performed at home or in an institution.
This claim has been assessed a $1.00 user fee.
You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).
Missing/incomplete/invalid CLIA certification number.
Missing/incomplete/invalid x-ray date.
Missing/incomplete/invalid initial treatment date.
Your center was not selected to participate in this study, therefore, we cannot pay for these services.
Per legislation governing this program, payment constitutes payment in full.
Pancreas transplant not covered unless kidney transplant performed.
Missing/incomplete/invalid FDA approval number.
Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim.
Adjustment to the pre-demonstration rate.
Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
Missing/incomplete/invalid provider number of the facility where the patient resides.
The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.
We are the primary payer and have paid at the primary rate. You must contact the patient’s other insurer to refund any excess it may have paid due to its erroneous primary payment.
Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.
SSA records indicate mismatch with name and sex.
Payment of less than $1.00 suppressed.
Demand bill approved as result of medical review.
Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
A patient may not elect to change a hospice provider more than once in a benefit period.
Missing/incomplete/invalid entitlement number or name shown on the claim.
Missing/incomplete/invalid type of bill.
Missing/incomplete/invalid beginning and ending dates of the period billed.
Missing/incomplete/invalid number of covered days during the billing period.
Missing/incomplete/invalid noncovered days during the billing period.
Missing/incomplete/invalid number of coinsurance days during the billing period.
Missing/incomplete/invalid number of lifetime reserve days.
Missing/incomplete/invalid patient name.
Missing/incomplete/invalid patient’s address.
Missing/incomplete/invalid admission date.
Missing/incomplete/invalid admission type.
Missing/incomplete/invalid admission source.
Missing/incomplete/invalid patient status.
Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.
Missing/incomplete/invalid name or address of responsible party or primary payer.
Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.
Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
Physician certification or election consent for hospice care not received timely.
Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.
Patient submitted written request to revoke his/her election for religious non-medical health care services.
Missing/incomplete/invalid release of information indicator.
Missing/incomplete/invalid patient relationship to insured.
Missing/incomplete/invalid social security number or health insurance claim number.
Missing/incomplete/invalid principal diagnosis.
Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
Missing/incomplete/invalid admitting diagnosis.
Missing/incomplete/invalid principal procedure code.
Missing/incomplete/invalid provider representative signature.
Missing/incomplete/invalid provider representative signature date.
Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.
Missing/incomplete/invalid patient or authorized representative signature.
Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
Billed in excess of interim rate.
Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project.
Missing/incomplete/invalid provider/supplier signature.
Did not indicate whether we are the primary or secondary payer.
Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.
Missing/incomplete/invalid insured’s address and/or telephone number for the primary payer.
Missing/incomplete/invalid patient’s relationship to the insured for the primary payer.
Missing/incomplete/invalid employment status code for the primary insured.
Missing plan information for other insurance.
Non-PIP (Periodic Interim Payment) claim.
Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
Missing/incomplete/invalid Medigap information.
Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.
Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.
This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.gov.
This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 888-355-9165 for RRB EDI information for electronic claims processing.
Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.
Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.
Missing/incomplete/invalid upgrade information.
Denial reversed because of medical review.
This facility is not certified for film mammography.
No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
This claim is excluded from your electronic remittance advice.
Only one initial visit is covered per physician, group practice or provider.
During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be.
This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
This service is not paid if billed more than once every 28 days.
This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility (SNF) within those 28 days.
Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.
Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.
Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered Skilled Nursing Facility (SNF) stay.
Add-on code cannot be billed by itself.
Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay.
Payment has been (denied for the/made only for a less extensive) service/item because the information furnished does not substantiate the need for the (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice.
Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported.
This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.
This amount represents the prior to coverage portion of the allowance.
Not eligible due to the patient’s age.
Payment based on professional/technical component modifier(s).
Consult plan benefit documents/guidelines for information about restrictions for this service.
Total payments under multiple contracts cannot exceed the allowance for this service.
Record fees are the patient’s responsibility and limited to the specified co-payment.
The patient was not residing in a long-term care facility during all or part of the service dates billed.
The original claim was denied. Resubmit a new claim, not a replacement claim.
The patient was not in a hospice program during all or part of the service dates billed.
The rate changed during the dates of service billed.
Missing screening document.
Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request.
Missing/incomplete/invalid date of last menstrual period.
Rebill all applicable services on a single claim.
Services for a newborn must be billed separately.
Missing/incomplete/invalid model number.
Telephone contact services will not be paid until the face-to-face contact requirement has been met.
Missing/incomplete/invalid replacement claim information.
Missing/incomplete/invalid room and board rate.
Transportation to/from this destination is not covered.
Transportation in a vehicle other than an ambulance is not covered.
Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
This drug/service/supply is covered only when the associated service is covered.
Medical record does not support code billed per the code definition.
Charges exceed the post-transplant coverage limit.
A new/revised/renewed certificate of medical necessity is needed.
Payment for repair or replacement is not covered or has exceeded the purchase price.
The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
No qualifying hospital stay dates were provided for this episode of care.
This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group ‘PR’.
Missing review organization approval.
Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the United States must provide the service.
Missing pre-operative images/visual field results.
Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.
This item or service does not meet the criteria for the category under which it was billed.
Additional information is required from another provider involved in this service.
This claim/service must be billed according to the schedule for this plan.
Rebill technical and professional components separately.
Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.
The approved level of care does not match the procedure code submitted.
Procedure code incidental to primary procedure.
Missing contract indicator.
The provider must update insurance information directly with payer.
Patient is a Medicaid/Qualified Medicare Beneficiary.
Technical component not paid if provider does not own the equipment used.
The technical component must be billed separately.
The subscriber must update insurance information directly with payer.
Rendering provider must be affiliated with the pay-to provider.
Additional payment/recoupment approved based on payer-initiated review/audit.
This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
Service not payable with other service rendered on the same date.
The professional component must be billed separately.
Missing/incomplete/invalid anesthesia time/units.
Services under review for possible pre-existing condition. Send medical records for prior 12 months
Information provided was illegible.
The supporting documentation does not match the information sent on the claim.
Missing/incomplete/invalid DRG code.
Missing/incomplete/invalid taxpayer identification number (TIN).
Charges processed under a Point of Service benefit .
Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.
Missing/incomplete/invalid history of the related initial surgical procedure(s).
We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.
We pay only one site of service per provider per claim.
You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract or coverage manual.
Payment based on previous payer’s allowed amount.
Missing Admitting History and Physical report.
Incomplete/invalid Admitting History and Physical report.
Missing documentation of benefit to the patient during initial treatment period.
Incomplete/invalid documentation of benefit to the patient during initial treatment period.
Incomplete/invalid American Diabetes Association Certificate of Recognition.
Incomplete/invalid Certificate of Medical Necessity.
Incomplete/invalid consent form.
Incomplete/invalid contract indicator.
Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.
Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Incomplete/invalid itemized bill/statement.
Incomplete/invalid operative note/report.
Incomplete/invalid oxygen certification/re-certification.
Incomplete/invalid pacemaker registration form.
Incomplete/invalid pathology report.
Incomplete/invalid patient medical record for this service.
Incomplete/invalid physician certified plan of care.
Incomplete/invalid physician financial relationship form.
Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
Incomplete/invalid radiology report.
Incomplete/invalid review organization approval.
Incomplete/invalid radiology film(s)/image(s).
Incomplete/invalid/not approved screening document.
Incomplete/Invalid pre-operative images/visual field results.
Incomplete/invalid plan information for other insurance .
State regulated patient payment limitations apply to this service.
Missing/incomplete/invalid assistant surgeon taxonomy.
Missing/incomplete/invalid assistant surgeon name.
Missing/incomplete/invalid assistant surgeon primary identifier.
This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan.
Missing/incomplete/invalid assistant surgeon secondary identifier.
Missing/incomplete/invalid attending provider taxonomy.
Missing/incomplete/invalid attending provider name.
Missing/incomplete/invalid attending provider primary identifier.
Missing/incomplete/invalid attending provider secondary identifier.
Missing/incomplete/invalid billing provider taxonomy.
Missing/incomplete/invalid billing provider/supplier name.
Missing/incomplete/invalid billing provider/supplier primary identifier.
Missing/incomplete/invalid billing provider/supplier address.
Missing/incomplete/invalid billing provider/supplier secondary identifier.
Missing itemized bill/statement.
Missing/incomplete/invalid billing provider/supplier contact information.
Missing/incomplete/invalid operating provider name.
Missing/incomplete/invalid operating provider primary identifier.
Missing/incomplete/invalid operating provider secondary identifier.
Missing/incomplete/invalid ordering provider name.
Missing/incomplete/invalid ordering provider primary identifier.
Missing/incomplete/invalid ordering provider address.
Missing/incomplete/invalid ordering provider secondary identifier.
Missing/incomplete/invalid ordering provider contact information.
Missing/incomplete/invalid other provider name.
Missing/incomplete/invalid treatment number.
Missing/incomplete/invalid other provider primary identifier.
Missing/incomplete/invalid other provider secondary identifier.
Missing/incomplete/invalid other payer attending provider identifier.
Missing/incomplete/invalid other payer operating provider identifier.
Missing/incomplete/invalid other payer other provider identifier.
Missing/incomplete/invalid other payer purchased service provider identifier.
Missing/incomplete/invalid other payer referring provider identifier.
Missing/incomplete/invalid other payer rendering provider identifier.
Missing/incomplete/invalid other payer service facility provider identifier.
Missing/incomplete/invalid pay-to provider name.
Consent form requirements not fulfilled.
Missing/incomplete/invalid pay-to provider primary identifier.
Missing/incomplete/invalid pay-to provider address.
Missing/incomplete/invalid pay-to provider secondary identifier.
Missing/incomplete/invalid purchased service provider identifier.
Missing/incomplete/invalid referring provider taxonomy.
Missing/incomplete/invalid referring provider name.
Missing/incomplete/invalid referring provider primary identifier.
Missing/incomplete/invalid referring provider secondary identifier.
Missing/incomplete/invalid rendering provider taxonomy.
Missing/incomplete/invalid rendering provider name.
Missing/incomplete/invalid rendering provider primary identifier.
Missing/incomplete/invalid rendering provider secondary identifier.
Missing/incomplete/invalid service facility name.
Missing/incomplete/invalid service facility primary identifier.
Missing/incomplete/invalid service facility primary address.
Missing/incomplete/invalid service facility secondary identifier.
Missing/incomplete/invalid supervising provider name.
Missing/incomplete/invalid supervising provider primary identifier.
Missing/incomplete/invalid supervising provider secondary identifier.
Missing/incomplete/invalid occurrence date(s).
Missing consent form.
Patient ineligible for this service.
Missing/incomplete/invalid occurrence span date(s).