explanation code translation table - connecticare code translation table ansi claims ......

Explanation Code Translation Table

The following table provides descriptions of ANSI Claims Adjustment Codes and the corresponding ConnectiCare Explanation Codes.

ANSI Claims Adj Code ANSI Claims Adjustment Code Description

ConnectiCare EX Code ConnectiCare EX Code Description

01 Deductible Amount LNCHARGES APPLIED TO CALENDAR YEAR OSTOMY SUPPLY/EQUIPMENT DEDUCTIBLE

01 Deductible Amount T5CHARGES APPLIED TO CONTRACT YEAR DEDUCTIBLE

01 Deductible Amount M5CHARGE APPLIED TO DME CALENDAR YEAR DEDUCTIBLE

01 Deductible Amount LKCHARGES APPLIED TO CALENDAR YEAR DISPOSABLE SUPPLY DEDUCTIBLE

01 Deductible Amount LJCHARGES APPLIED TO CALENDAR YEAR DME DEDUCTIBLE

01 Deductible Amount L4CHARGES APPLIED TO CALENDAR YEAR DEDUCTIBLE

01 Deductible Amount D2THIS CHARGE APPLIED TO THE CALENDAR YEAR DEDUCTIBLE

01 Deductible Amount D6CHARGES APPLIED TO CALENDAR YEAR DEDUCTIBLE

02 Coinsurance Amount O2COINSURANCE AMOUNT HAS BEEN APPLIED TO CAL YEAR OUT-OF-POCKET

02 Coinsurance Amount K8CHARGES APPLIED TO OUT OF POCKET MAXIMUM

02 Coinsurance Amount 6HCHARGES APPLIED TO IN-NETWORK CALENDAR YEAR OUT-OF-POCKET.

02 Coinsurance Amount L6CHARGES APPLIED TO CALENDAR YEAR OUT-OF-POCKET

02 Coinsurance Amount E6 COINSURANCE AMOUNT HAS BEEN APPLIED

02 Coinsurance Amount T7CHARGES APPLIED TO CONTRACT YEAR OUT-OF-POCKET

04The procedure code is inconsistent with the modifier used or a required modifier is missing. M9

MODIFIER 22 DOES NOT APPEAR APPROPRIATE BASED ON REVIEW OF DOCUMENTATION

04The procedure code is inconsistent with the modifier used or a required modifier is missing. OT

BILATERAL IS INHERENT IN THIS CPT CODE, RESUBMIT 1 UNIT WITHOUT MODIFIER

04The procedure code is inconsistent with the modifier used or a required modifier is missing. A0

DENIED - PLEASE RESUBMIT WITH MODIFIER APPROPRIATE FOR MIDLEVEL PROVIDER

05The procedure code/bill type is inconsistent with the place of service. CE

CC - DENIED - DIAGNOSIS AND PROCEDURE COMBINATION NOT VALID

05The procedure code/bill type is inconsistent with the place of service. 0W

CI - PROCEDURE CODE ISN'T PAYABLE FOR THIS LOCATION

05The procedure code/bill type is inconsistent with the place of service. N2

DENIED - SERVICES RENDERED NOT COVERED IN THIS PLACE OF SERVICE.

05The procedure code/bill type is inconsistent with the place of service. OP

DENIED - PROCEDURE NOT COVERED IN THIS PLACE OF SERVICE

05The procedure code/bill type is inconsistent with the place of service. 9Y

DENY-NOT ALLOWED IN OFFICE LOCATION, MEMBER NOT LIABLE

05The procedure code/bill type is inconsistent with the place of service. IV

LOCATION CODE AND PROCEDURE CODE DO NOT MATCH, PLEASE RESUBMIT CLAIM

05The procedure code/bill type is inconsistent with the place of service. 4K

CI - TECHNICAL SERVICES NOT PAYABLE TO MD PROVIDERS FOR THIS LOCATION

05The procedure code/bill type is inconsistent with the place of service. 4C

LOCATION DOES NOT MATCH SERVICES ON FILE-PLEASE RESUBMIT CORRECT CODING

05The procedure code/bill type is inconsistent with the place of service. ZJ

CLAIM DENIED. PROVIDER MUST RESUBMIT WITH VALID DRG NUMBER.

05The procedure code/bill type is inconsistent with the place of service. A7

DENY, USE 99213 FOR OFFICE, 99431 FOR INPATIENT

06The procedure/revenue code is inconsistent with the patient's age. BU

CC - PROCEDURE OR DIAGNOSIS NOT VALID FOR MEMBER'S AGE

06The procedure/revenue code is inconsistent with the patient's age. CA PROCEDURE NOT VALID FOR MEMBER'S AGE

07The procedure/revenue code is inconsistent with the patient's gender. BY

PROCEDURE IS NOT VALID FOR MEMBER'S GENDER

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07The procedure/revenue code is inconsistent with the patient's gender. BS

CC - PROCEDURE OR DIAGNOSIS NOT VALID FOR MEMBER'S GENDER

09 The diagnosis is inconsistent with the patient's age. BXMEMBER'S AGE IS NOT VALID FOR SECONDARY DIAGNOSIS

11 The diagnosis is inconsistent with the procedure. UB DENIED - PLEASE RESUBMIT AS URGENT CARE

11 The diagnosis is inconsistent with the procedure. I3PER CFC IPA, PROCEDURE LEVEL NOT VALID FOR DIAGNOSIS

11 The diagnosis is inconsistent with the procedure. 95

INCONSISTENT/INVALID DIAG/PROCEDURE/MODIFIER/DRG. RESUBMIT CORRECTED CLM

11 The diagnosis is inconsistent with the procedure. 4HCI-INCONSISTENT/INVALID DIAGNOSIS - RESUBMIT CORRECTED CLAIM

13 The date of death precedes the date of service. 3DDENIED - SERVICE POSTDATES MEMBERS DEATH

15

Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. FY THE AUTHORIZATION NUMBER IS NOT ON FILE.

15

Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. 9C

DATE OF SERVICE IS NOT WITHIN THE DATE RANGE OF THE AUTHORIZATION

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate D0

DENIED - RESUBMIT WITH DRUG NAME AND DOSAGE OR CORRECT HCPCS CODE

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate IU

PLEASE RESUBMIT SUPPLIES WITH APPROPRIATE HCPCS CODE

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate B8

MORE INFO NEEDED-PLEASE SUBMIT DETAIL SHEET W/ D.O.S. FOR PART. HOSP PRG

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate JK

DENIED- PLEASE SUBMIT A COPY OF THE PURCHASE INVOICE.

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate HO

DENIED-OFFICE NOTES NEEDED FOR CONSIDERATION OF BENEFITS ON THIS CLAIM.

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate SE

CC - PLEASE SUBMIT CLINICAL DOCUMENTATION FOR REVIEW

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate RD

DENIED-REFERRING PHYSICIAN CANNOT BE IDENTIFIED ON CLAIM

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate 93

PLEASE RESUBMIT WITH COMPLETE PROVIDER INFORMATION

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate NR

REFERRING PROVIDER INFO FROM REFERRAL NEEDED

16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate FN

MORE SPECIFIC/CORRECTED BILLING INFOREQ.CONTACT PROV REL AT 860-674-5850

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16


CORRECTED BILLING INFO.IS REQUIRED. PLEASE CALL 1-800-828-3407.

16


PLEASE SUBMIT CLINICAL DOCUMENTATION FOR REVIEW

17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. 5A

DENIED-CLINICAL DOCU. IS ILLEGIBLE AND THEREFORE CONSIDERED NOT DONE.

17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. 59

BENEFITS WILL BE RECONSIDERED UPON RECEIPT OF REQUESTED DOCUMENTATION

17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. RX

CLAIM WILL BE RECONSIDERED UPON RECEIPT OF REQUESTED DOCUMENTATION

17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. UG

DENIED - PLEASE RESUBMIT WITH APPROPRIATE URGENT CARE ID NUMBER

17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. 3E

DENIED - ER/URGENT CARE - QUESTIONNAIRE REQUESTED WAS NEVER RECEIVED

18 Duplicate claim/service. 36 DENIED - DUPLICATE CLAIM.

18 Duplicate claim/service. HEDENIED-ORIGINAL CLAIM SUBMISSION WAS PREVIOUSLY DENIED

18 Duplicate claim/service. 16 DENIED-DUPLICATE CLAIM18 Duplicate claim/service. 0Q CI - DENIED-DUPLICATE CLAIM

18 Duplicate claim/service. HDDENIED-ORIGINAL CLAIM SUBMISSION IS PENDING FURTHER REVIEW

19

Claim denied because this is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier. 31

DENIED-INFORMATION INDICATES CLAIM QUALIFIES FOR WORKER'S COMPENSATION.

20Claim denied because this injury/illness is covered by the liability carrier. KZ PLEASE FORWARD TO APPROPRIATE CARRIER

21Claim denied because this injury/illness is the liability of the no-fault carrier. 68 CHARGE WAS APPLIED TO NO-FAULT BENEFIT.

23Payment adjusted because charges have been paid by another payer. 22

MEMBERS ALTERNATE COVERAGE IS SECONDARY

23Payment adjusted because charges have been paid by another payer. 23

MEMBERS ALTERNATE COVERAGE IS UNAVAILABLE

24

Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. 08

AMOUNT ALLOWED BASED ON PROVIDER'S CAPITATED SERVICE CONTRACT

24

Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. 28

SERVICE INCLUDED IN PROVIDER'S CAPITATED SERVICE CONTRACT

24

Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. JO DENIED, SERVICE IS CAPITATED

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24

Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan. NE

CAPITATED SERVICES BY NEW ENGLAND EYE CARE

26 Expenses incurred prior to coverage. CNDENIED - THE CONTRACT IS INELIGIBLE AT THE TIME OF SERVICE.

27 Expenses incurred after coverage terminated. GYDENIED - THE GROUP IS INELIGIBLE DURING AUTHORIZATION PERIOD.

27 Expenses incurred after coverage terminated. 65DENIED-SERVICE DATE BEYOND PREM PD TO DATE PLUS GRACE PER FOR DIR PAY GR

27 Expenses incurred after coverage terminated. HADENIED - THE SUBSCRIBER IS INELIGIBLE AT THE TIME OF SERVICE.

27 Expenses incurred after coverage terminated. GWDENIED-THE CONTRACT IS INELIGIBLE DURING AUTHORIZED PERIOD.

27 Expenses incurred after coverage terminated. VLCCI NO LONGER ADMINISTERS THIS PLAN. CONTACT YOUR EMPLOYER.

27 Expenses incurred after coverage terminated. CSDENIED - THE GROUP IS INELIGIBLE AT THE TIME OF SERVICE.

27 Expenses incurred after coverage terminated. NWTHIS GROUP HAS TERMINATED, SUBMIT ALL CLAIMS TO YOUR BENEFITS OFFICE

27 Expenses incurred after coverage terminated. 39DENIED - PATIENT IS NOT ELIGIBLE ON CLAIM DATE OF SERVICE.

27 Expenses incurred after coverage terminated. JZCLAIM NOT ELIGIBLE FOR PAYMENT - THIS GROUP HAS TERMINATED.

27 Expenses incurred after coverage terminated. GUDENIED-THE MEMBER IS INELIGIBLE DURING AUTHORIZED PERIOD.

27 Expenses incurred after coverage terminated. 64DENIED-SERVICE DATE BEYOND PREM PD TO DATE PLUS GRACE PER FOR COBRA GRPS

27 Expenses incurred after coverage terminated. GXDENIED-THE DIVISION IS INELIGIBLE DURING AUTHORIZED PERIOD.

27 Expenses incurred after coverage terminated. CPDENIED - THE DIVISION IS INELIGIBLE AT THE TIME OF SERVICE.

29 The time limit for filing has expired. 30RECEIVED PAST FILING LIMIT - PARTICIPATING PROVIDER CANNOT BILL MEMBER

29 The time limit for filing has expired. B2DATES OF SERVICE PRIOR TO 1/1/92 CANNOT BE PROCESSED ON AMISYS

29 The time limit for filing has expired. 0ADENIED-CLAIM SUBMITTED PAST FILING LIMIT. PAR PROVIDER CANNOT BILL MBR.

29 The time limit for filing has expired. P8 DENIED CLAIM SUBMITTED PAST FILING LIMIT

30

Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. WR

SERVICES ARE NOT PAYABLE UNTIL 91ST DAY OF CONFINEMENT

30

Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. C4

DENIED-GROUP/INDIVIDUAL NON PAYMENT OF PREMIUM

30

Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. PC DENIED-MEMBER DID NOT SELECT A PCP

30

Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. C3

DENIED-OVERAGE DEPENDENT VERIFICATION HAS NOT BEEN RECEIVED

31Claim denied as patient cannot be identified as our insured. CR

DENIED - THE GROUP DOES NOT HAVE A GROUP-SPAN RECORD.

31Claim denied as patient cannot be identified as our insured. CM

DENIED - THE CONTRACT RECORD IS NOT ON FILE.

31Claim denied as patient cannot be identified as our insured. CT

DENIED - NO DIVISION-SPAN RECORD EXIST FOR MEMBER'S DIVISION#.

31Claim denied as patient cannot be identified as our insured. CQ DENIED - THE GROUP RECORD IS NOT ON FILE.

31Claim denied as patient cannot be identified as our insured. CO

DENIED - THE DIVISION RECORD IS NOT ON FILE.

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31Claim denied as patient cannot be identified as our insured. 91

MEMBER ID NUMBER WITH ORIGINAL CLAIM IS NOT ON FILE.

31Claim denied as patient cannot be identified as our insured. FT MEMBER IS NOT ON FILE.

31Claim denied as patient cannot be identified as our insured. GZ

DENIED - THE SUBSCRIBER'S RECORDS COULD NOT BE FOUND.

32Our records indicate that this dependent is not an eligible dependent as defined. OB

DENIED - DEPENDENT NOT ELIGIBLE FOR SERVICES

34Claim denied. Insured has no coverage for newborns. C6

NEWBORN HAS NOT BEEN FORMALLY ADDED, PLEASE CALL CUSTOMER RELATIONS

35 Lifetime benefit maximum has been reached. SCCHIRO FEE SCHEDULE MAXIMUM PER DAY HAS BEEN MET-MEMBER MAY NOT BE BILLED

35 Lifetime benefit maximum has been reached. 70LIFETIME ALLERGY TESTING MAX EXHAUSTED --MEMBER CANNOT BE BILLED.

35 Lifetime benefit maximum has been reached. PTPT FEE SCHEDULE MAXIMUM PER DAY HAS BEEN MET-MEMBER MAY NOT BE BILLED

35 Lifetime benefit maximum has been reached. 6DDENIED - EARLY INTERVENTION SERVICES LIFETIME MAX EXHAUSTED

35 Lifetime benefit maximum has been reached. 81DENIED-BENEFIT LIFETIME MAXIMUM EXHAUSTED

35 Lifetime benefit maximum has been reached. 14DENIED-BENEFIT LIMITS HAVE BEEN EXCEEDED

35 Lifetime benefit maximum has been reached. 13DENIED-BENEFIT LIMITS HAVE BEEN EXCEEDED

35 Lifetime benefit maximum has been reached. PBCONTRACT DAILY MAXIMUM HAS BEEN MET-MEMBER CANNOT BE BILLED

35 Lifetime benefit maximum has been reached. 15DENIED-BENEFIT LIFETIME MAX.EXCEEDED MEMBER CANNOT BE BILLED.

38Services not provided or authorized by designated (network/primary care) providers. BO REFERRING PROVIDER IS NOT INPLAN.

38Services not provided or authorized by designated (network/primary care) providers. TR

DENIED. TRANSPLANTS REQUIRE PRE-AUTHORIZATION. MEMBER MAY BE BILLED.

38Services not provided or authorized by designated (network/primary care) providers. NA DENIED-SERVICES ARE AVAILABLE IN PLAN

38Services not provided or authorized by designated (network/primary care) providers. K5 DENY SERVICES NOT AUTHORIZED

38Services not provided or authorized by designated (network/primary care) providers. ND

DENIED-PRIOR AUTHORIZATION REQUIRED FOR MEDICAL EQUIPMENT/SUPPLIES.

38Services not provided or authorized by designated (network/primary care) providers. K7

DENY UNAUTHORIZED NON PARTICIPATING PROVIDER MEMBER MAY BE BILLED

38Services not provided or authorized by designated (network/primary care) providers. MB

PRIOR AUTH REQUIRED IN AN OUTPATIENT SETTING - MEMBER CANNOT BE BILLED

38Services not provided or authorized by designated (network/primary care) providers. R9

SERVICES DENIED, NO AUTHORIZATION OR PRE-CERTIFICATION RECEIVED

38Services not provided or authorized by designated (network/primary care) providers. 8F

CLAIM DENIED. REQUIRED REFERRAL NOT RECEIVED. MEMBER MAY BE BILLED.

38Services not provided or authorized by designated (network/primary care) providers. RF

PAYMENT REVERSED, NON-REFERRED SERVICES, MEMBER MAY BE BILLED

38Services not provided or authorized by designated (network/primary care) providers. PO NO AFFILIATION WITH PTPN AFTER 9/30/98

38Services not provided or authorized by designated (network/primary care) providers. 83

AN ADMISSION AUTHORIZATION IS NOT ON FILE.

38Services not provided or authorized by designated (network/primary care) providers. 3Y

DENIED-NO PRIOR AUTHORIZATION RECEIVED-MEMBER CANNOT BE BILLED

38Services not provided or authorized by designated (network/primary care) providers. 6F


38Services not provided or authorized by designated (network/primary care) providers. US

MEDICAL RECORDS & EXPLANATION NEEDED IN ORDER TO PROCESS UNAUTH SERVICES

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38Services not provided or authorized by designated (network/primary care) providers. 6G


38Services not provided or authorized by designated (network/primary care) providers. 3W

DENIED - ANESTHESIA PROCEDURE REQUIRED PRE-AUTH - IN NETWORK PROVIDER

38Services not provided or authorized by designated (network/primary care) providers. 3U

DENIED - LAB PROCEDURE REQUIRED PREAUTH - IN NETWORK PROVIDER

38Services not provided or authorized by designated (network/primary care) providers. 17

DENIED-INPATIENT/PROCEDURE REQUIRE CERTIFICATION.

39Services denied at the time authorization/pre-certification was requested. G0 THIS SERVICE DENIED AFTER MEDICAL REVIEW

39Services denied at the time authorization/pre-certification was requested. H6

CC - SERVICE DENIED BASED ON CLINICAL CODING REVIEW

39Services denied at the time authorization/pre-certification was requested. 49 DENIAL BASED ON MEDICAL REVIEW

39Services denied at the time authorization/pre-certification was requested. 19

DENIED-INPT/PROCEDURE CERTIFICATION DENIED

39Services denied at the time authorization/pre-certification was requested. 7I

DENIED NOT MEDICALLY NECESSARY - MEMBER MAY BE BILLED

39Services denied at the time authorization/pre-certification was requested. UP DENIAL UPHELD - PER IPA MEDICAL DIRECTOR

39Services denied at the time authorization/pre-certification was requested. UQ DENIAL UPHELD - PER CCI MEDICAL DIRECTOR

39Services denied at the time authorization/pre-certification was requested. JI

CC - PROCEDURE DENIED AFTER CLINICAL DOCUMENTATION REVIEW

39Services denied at the time authorization/pre-certification was requested. 2C

SERVICES DENIED AFTER MEDICAL REVIEW - MEMBER CANNOT BE BILLED

40Charges do not meet qualifications for emergent/urgent care. 58

DENIED-DOC SUBMITTED DID NOT REFLECT URGENT/EMERGENT NATURE OF PROCEDURE

40Charges do not meet qualifications for emergent/urgent care. JD DENIED-NON COVERED URGENT CARE VISIT

40Charges do not meet qualifications for emergent/urgent care. 38

DENIED-INAPPROPRIATE USE OF EMERGENCY ROOM BASED ON CLAIM INFORMATION.

42Charges exceed our fee schedule or maximum allowable amount. MR

DENIED - LIMIT FOR MULTIPLE SURGERIES HAS BEEN REACHED

42Charges exceed our fee schedule or maximum allowable amount. 0V

CI - PAYMENT HAS BEEN REDUCED BY USE OF THIS MODIFIER

42Charges exceed our fee schedule or maximum allowable amount. L1

THE MAXIMUM PAYABLE FOR THIS BENEFIT HAS BEEN REACHED.

42Charges exceed our fee schedule or maximum allowable amount. 73

MAXIMUM AMOUNT HAS BEEN PAID FOR THIS SERVICE

42Charges exceed our fee schedule or maximum allowable amount. J5

FEE SCHEDULE DAILY MAXIMUM HAS BEEN MET- MEMBER CANNOT BE BILLED

45Charges exceed your contracted/ legislated fee arrangement. J8

INCLUDED IN UNITED RESOURCE NETWORK CONTRACTUAL RATE

45Charges exceed your contracted/ legislated fee arrangement. TA CASE AGREEMENT-TRANSPLANT GLOBAL FEE

45Charges exceed your contracted/ legislated fee arrangement. 2D

PROVIDER NOT CONTRACTED FOR THIS SERVICE - MEMBER MAY NOT BE BILLED

45Charges exceed your contracted/ legislated fee arrangement. 46

DENIED-SERVICES EXCEED PROVIDER CONTRACT.MEMBER CANNOT BE BILLED.

45Charges exceed your contracted/ legislated fee arrangement. AJ

PROVIDER CONTRACT EXCEEDED-MEMBER CANNOT BE BILLED

45Charges exceed your contracted/ legislated fee arrangement. AZ PROCEDURE IS INCLUDED IN PER DIEM RATE

45Charges exceed your contracted/ legislated fee arrangement. 5P

AMOUNT EXCEEDS CAPITATED SERVICES CONTRACT - MEMBER CANNOT BE BILLED

45Charges exceed your contracted/ legislated fee arrangement. E0

INCLUDED IN CASE RATE - MEMBER CAN NOT BE BILLED.

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45Charges exceed your contracted/ legislated fee arrangement. YY

MAXIMUM CONTRACT AMOUNT HAS BEEN PAID FOR THIS SERVICE.

45Charges exceed your contracted/ legislated fee arrangement. 75

PROVIDER CONTRACT EXCEEDED-MEMBER CANNOT BE BILLED.

45Charges exceed your contracted/ legislated fee arrangement. GL

INCLUDED IN GLOBAL PT FEE - MEMBER CANNOT BE BILLED

45Charges exceed your contracted/ legislated fee arrangement. LM

MAXIMUM CONTRACT AMOUNT HAS BEEN PAID FOR THIS SERVICE

45Charges exceed your contracted/ legislated fee arrangement. TB

INCLUDED IN CASE AGREEMENT TRANSPLANT GLOBAL-MEMBER CAN NOT BE BILLED

45Charges exceed your contracted/ legislated fee arrangement. KX PAYABLE ONLY WITH LEVEL I & II TREATMENTS

45Charges exceed your contracted/ legislated fee arrangement. E9

MODALITIES ARE INCLUDED IN THE ERN CASE RATE- MEMBER CANNOT BE BILLED

46 This (these) service(s) is (are) not covered. WCFIRST 91 DAYS OF CONFINEMENT ARE NOT PAID BY CONNECTICARE FOR WESLEYAN

46 This (these) service(s) is (are) not covered. B3 THE BENEFIT HAS NOT BEEN PURCHASED

47This (these) diagnosis(es) is (are) not covered, missing, or are invalid. 7H

DENIED - TMJ IS NOT COVERED UNDER YOUR PLAN.

49

These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. R8

ROUTINE FOLLOW-UP CARE IN URGENT CARE/WALK-IN IS NOT COVERED

49

These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. 9G

ROUTINE CARE NOT COVERED OUT OF NETWORK

50These are non-covered services because this is not deemed a `medical necessity' by the payer. 3H

DENIED - AMBULANCE (NOT MEDICALLY NECESSARY)

50These are non-covered services because this is not deemed a `medical necessity' by the payer. TH

NOT A COVERED SERVICE-MEDICAL NECESSITY GUIDELINES BEING DEVELOPED

50These are non-covered services because this is not deemed a `medical necessity' by the payer. I1

PER CFC IPA, DENIED-SERVICE NOT MEDICALLY NEC BASED ON CLM INFORMATION

50These are non-covered services because this is not deemed a `medical necessity' by the payer. 54

DENIED-PROCEDURE CONSIDERED COSMETIC IN NATURE. NOT A COVERED BENEFIT.


DENIED-PROC DOES NOT MEET CRITERIA OF MED NEC PROG.PT MAY NOT BE BILLED.


DENIED-SERVICES NOT MEDICALLY NECESSARY BASED ON CLAIM INFORMATION.


DENIED-THIS PROCEDURE DOES NOT APPEAR TO BE MEDICALLY NECESSARY

51These are non-covered services because this is a pre-existing condition PI

DENY,SERVICES RELATED TO A PRE-EXISTING CONDITION.

52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. 94

REFERRING PROVIDER ID NUMBER IS INVALID - MEMBER CANNOT BE BILLED

52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. BL

REFERRING PROVIDER WAS NOT EFFECTIVE AT TIME OF SERVICE

52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. R1

DENIED-REFERRING PHYSICIAN WAS NOT ON CLAIM OR WAS NON-PARTICIPATING

52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. BR

REFERRING PROVIDER NO LONGER PARTICIPATING WITH CONNECTICARE

52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. JQ

DENIED-PROVIDER SPECIALTY CAN NOT DISPENSE DME

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52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. IX

DENIED-REFERRING PROVIDER IS NOT A PARTICIPATING PROVIDER.

52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. JN

DENIED - PROVIDER CANNOT DISPENSE DME OR SUPPLIES

54Multiple physicians/assistants are not covered in this case . 55

CC - ASSISTANT MD IS TYPICALLY NOT REQUIRED FOR THIS PROCEDURE

54Multiple physicians/assistants are not covered in this case . 0Z

CI - ASSISTANT MD IS TYPICALLY NOT REQUIRED FOR THIS PROCEDURE

55

Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer. FQ

DENIED - PROCEDURE IS EXPERIMENTAL/INVESTIGATIONAL.

59Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. AI

AMBULATORY SURGERY PAID ACCORDING TO MEDICARE GROUPINGS

59Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. JX

CC - INFORMATIONAL ONLY, PROCEDURE PROCESSED THROUGH OUR CODING SOFTWARE

59Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. 07 PRICED PER ANESTHESIA CALCULATIONS.

59Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules. PH SURGEON'S REIMBURSEMENT FEE REDUCED

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 9F

BENEFITS REDUCED TO COINSURANCE RATE - REFERRAL OF SERVICE WAS REQUIRED.

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 3X

DENIED - ANESTHESIA PROCEDURE REQUIRED PREAUTH - OUT OF NETWORK PROVIDER

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 41

DENIED-HOSPITAL ADMISSION REQUIRES PRE-AUTHORIZATION.


DENIED - NO PRIOR AUTH/REFERRAL RECEIVED-MEMBER CANNOT BE BILLED

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. L8 CHARGES PAID AT 50% RATE

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 3F

DENIED - UNAUTHORIZED DIALYSIS OUT OF PLAN


BENEFITS REDUCED BY 50% - PRIOR AUTHORIZATION IS REQUIRED

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. PZ

PENALTY APPLIED TO PAYMENT DUE TO ADVANCED NOTIFICATION REQUIREMENTS


DENIED - CERTIFIED LENGTH OF STAY EXCEEDED.

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. KP

PENALTY APPLIED TO PAYMENT DUE TO LACK OF PRE AUTHORIZATION


PEND-SERVICES/BENEFIT NOT AUTHORIZED BY THE PLAN

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 43 DENIED-NO REFERRAL ON FILE

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 8E

REDUCED PAYMENT-NO REFERRAL RECD-MBR MAY BE BILLED UP TO CONTRACTED RATE

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. UA

PAID AT 50%, NO PRE-AUTHORIZATION RECEIVED.

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 3S

DENIED - SKILLED NURSING FACILITY (NOT AUTHORIZED)

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 1C

PAYMENT REVERSED. NON-REFERRED SERVICES, MEMBER MAY BE BILLED.

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. KS

REDUCED RATE NO REFERRAL RCVD MEMBER MAY BE BILLED CONTRACTED RATE

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. JG

DENIED- SERVICE EXCEEDS PRE-AUTHORIZED LIMIT

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62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. R5

CHARGES APPLIED TO $200.00 PENALTY FOR LACK OF PRE-CERTIFICATION

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 1R

DENIED-PROC REQUIRES PRE-AUTH. PROVIDER MUST SUBMIT PRE-OPERATIVE NOTES.

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. B4

PENALTY APPLIED TO PAYMENT DUE TO LACK OF PRE-AUTHORIZATION

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 3N DENIED - HOME HEALTH (NOT AUTHORIZED)

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 4D

NO PRIOR AUTH/REFERRAL RECEIVED - MEMBER MAY BE BILLED

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 3V

DENIED-UNAUTHORIZED NON-PARTICIPATING PROVIDER-MEMBER MAY BE BILLED

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 3Z

DENIED - RADIOLOGY PROCEDURE REQUIRED PREAUTH - OUT OF NETWORK PROVIDER

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. F7

DENIED - UNAUTHORIZED NON-PARTICIPATING PROVIDER

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 6E

PAYMENT FOR THIS SERVICE HAS BEEN REDUCED DUE TO NON RECEIPT OF REFERRAL


DENIED-PRIOR AUTHORIZATION REQUIRED FOR MEDICAL EQUIPMENT/SUPPLIES.


DENIED - UNAUTHORIZED NON-PARTICIPATING PROVIDER-MEMBER MAY BE BILLED

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. HP SERVICE EXCEEDS AUTHORIZED DAYS BY ^.

62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. 4B

DENIED - SERVICE EXCEEDS PRE AUTHORIZATION LIMIT

85 Interest amount. OIPAYMENT WAS DELAYED - INTEREST WAS PAID ON THIS CLAIM

88Adjustment amount represents collection against receivable created in prior overpayment. JM PAYMENT DUE APPLIED TO OVERPAYMENT

88Adjustment amount represents collection against receivable created in prior overpayment. RM

PAID, USED TO OFFSET OUTSTANDING REFUND REQUEST (L&R)

96 Non-covered charge(s). 27 THE SERVICE IS NO LONGER A BENEFIT.96 Non-covered charge(s). 74 DENIED-NOT A COVERED BENEFIT96 Non-covered charge(s). HN THE BENEFIT HAS NOT BEEN PURCHASED.

96 Non-covered charge(s). RGDENIED-NOT A COVERED BENEFIT UNDER YOUR PLAN

96 Non-covered charge(s). 12 DENIED - PROCEDURE IS NOT COVERED.

96 Non-covered charge(s). MVDENIED - PROVIDER MUST BILL WITH THE APPROPRIATE ANESTHESIA CODE

96 Non-covered charge(s). 1B DENIED - NOT COVERED UNDER ERISA PLAN96 Non-covered charge(s). D8 DENIED-NON COVERED DME/SUPPLIES

96 Non-covered charge(s). 26CONTRACT HAS NOT SELECTED THIS SUPPLEMENTAL MEDICAL RIDER.

96 Non-covered charge(s). NCNOT A COVERED PROCEDURE - MEMBER CANNOT BE BILLED

96 Non-covered charge(s). 3QDENIED - SHOE ORTHOTICS NOT A COVERED BENEFIT

96 Non-covered charge(s). H2DENIED - PROCEDURE NOT COVERED. MEMBER CANNOT BE BILLED.

96 Non-covered charge(s). JE DENIED-NON COVERED DENTAL SERVICES

96 Non-covered charge(s). FXTHE PROCEDURE MUST BE A MAJOR SURGICAL PROCEDURE

96 Non-covered charge(s). 25THERE IS NO BASIC OTHER COVERAGE FOR THIS MEDICAL RIDER.

96 Non-covered charge(s). JFDENIED-NON COVERED ORTHOTICS,DME OR SUPPLIES.

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96 Non-covered charge(s). 3PDENIED - ROUTINE FOOT CARE - NOT A COVERED BENEFIT

96 Non-covered charge(s). 3TDENIED - PERSONAL COMFORT ITEMS - NOT A COVERED BENEFIT

96 Non-covered charge(s). 3JDENIED - DENTAL SERVICES ARE NOT A COVERED BENEFIT

96 Non-covered charge(s). 3CNOT A COVERED BENEFIT - MEMBER MAY BE BILLED

96 Non-covered charge(s). 3ANOT A COVERED BENEFIT - MEMBER CANNOT BE BILLED

96 Non-covered charge(s). R6 NON-COVERED DME/SUPPLIES96 Non-covered charge(s). JH NON COVERED HANDLING & DRAWING FEE96 Non-covered charge(s). 34 DENIED-NOT A COVERED BENEFIT

96 Non-covered charge(s). FSTHE PROCEDURE IS NOT A MAJOR SURGICAL PROCEDURE

97Payment is included in the allowance for another service/procedure. G3

CC - INFORMATIONAL ONLY, CORRECTED PROC CODE ADDED BY CODING SOFTWARE

97Payment is included in the allowance for another service/procedure. 37

PAYMENT FOR SERVICE IS INCLUDED IN GLOBAL SURGICAL FEE

97Payment is included in the allowance for another service/procedure. WW

ST RAPHAEL'S HOSPITAL AMBISURG-ANCILLARY'S HISTORY ONLY

97Payment is included in the allowance for another service/procedure. M0

ORAL MEDICATIONS/SUPPLIES INCLUDED IN OFFICE VISIT-MEMBER CANNOT BE BILL

97Payment is included in the allowance for another service/procedure. Y4

CI - MORE APPROPRIATE PROCEDURE HAS BEEN ADDED

97Payment is included in the allowance for another service/procedure. Y3

CI - SERVICE HAS BEEN RECODED BASED ON PREVIOUSLY BILLED SERVICES

97Payment is included in the allowance for another service/procedure. YQ

CI - PROCEDURE IS INCLUDED IN PHYSICIAN VISIT SERVICE.

97Payment is included in the allowance for another service/procedure. 52

DENIED-THIS PROCEDURE IS CONSIDERED PART OF ANOTHER CPT CODE ON CLAIM.

97Payment is included in the allowance for another service/procedure. KM

SVCS ARE INCL IN GLOBAL FEE FOR SOME SURG CODES -MEMBER CANNOT BE BILLED

97Payment is included in the allowance for another service/procedure. SF

CC - PAYMENT FOR SERVICE IS INCLUDED IN GLOBAL SURGICAL FEE

97Payment is included in the allowance for another service/procedure. 0S

CI-THIS SERVICE IS INCLUDED IN A RELATED PROC BILLED BY SAME PROVIDER

97Payment is included in the allowance for another service/procedure. 00 CLAIM LEVEL PRICING DENY

97Payment is included in the allowance for another service/procedure. YZ

CI - PAYMENT FOR SERVICE IS INCLUDED IN GLOBAL SURGICAL FEE

97Payment is included in the allowance for another service/procedure. J3

CC - PAYMENT FOR SERVICE IS INCLUDED IN GLOBAL SURGICAL FEE

97Payment is included in the allowance for another service/procedure. A5 CLAIM CHECK REVIEW

97Payment is included in the allowance for another service/procedure. 9B INFO EX FOR REPLACEMENT SERVICES

97Payment is included in the allowance for another service/procedure. 9A DENY EX FOR REPLACED SERVICES

97Payment is included in the allowance for another service/procedure. 90 HISTORY ONLY


CC - THIS SERVICE IS INCLUDED IN A RELATED PROC BILLED BY SAME PROVIDER


CC - SERVICE AFFECTED BY PROVIDER SPLIT BILLING/RELATED CLAIM

97Payment is included in the allowance for another service/procedure. I2

PER CFC IPA,DENIED-INCLUDED IN GLOBAL FEE OF PRIMARY SURGICAL PROCEDURE

97Payment is included in the allowance for another service/procedure. VP

MEMBER MAY NOT BE BILLED, SERVICE INCLUDED AS PART OF ROUTINE PAYMENT

97Payment is included in the allowance for another service/procedure. LG HISTORY ONLY

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97Payment is included in the allowance for another service/procedure. WA

SERVICE INCLUDED IN GLOBAL AMBULATORY SURGICAL REIMBURSEMENT RATE

97Payment is included in the allowance for another service/procedure. 60 ZERO AMOUNT BILLED. HISTORY ONLY.

97Payment is included in the allowance for another service/procedure. W9

PAY $0.00-FEE FOR THIS SERVICE IS INCLUDED IN THE PRIMARY PROCEDURE


CC - PROCEDURE REPLACED THROUGH OUR CODING SOFTWARE

100 Payment made to patient/insured/responsible party. MYPHCS PPO - PREFERRED PAR PROVIDER ALLOWABLE APPLIED. MEMBER NOT LIABLE.

100 Payment made to patient/insured/responsible party. JLAMOUNT ALLOWED BASED ON PROVIDER'S DISCOUNTED RATE

100 Payment made to patient/insured/responsible party. MUPAID AT ESTIMATED MEDICARE RATE, ADVISE IF UNACCEPTABLE

100 Payment made to patient/insured/responsible party. 20 FOR REPORTING PURPOSES ONLY.

100 Payment made to patient/insured/responsible party. HC APPROVED BY CASE MANAGEMENT

100 Payment made to patient/insured/responsible party. B7CLAIM HAS BEEN RECODED FOR THE CORRECT BENEFIT/PRICING

100 Payment made to patient/insured/responsible party. HJMEMBER'S ALTERNATE COVERAGE HAS TERMINATED - CONNECTICARE IS PRIMARY

100 Payment made to patient/insured/responsible party. A8AS OF 03/01/2001 PLEASE CALL 888-946-4658 TO AUTHORIZE THIS SERVICE

100 Payment made to patient/insured/responsible party. T6 CONTRACT YEAR DEDUCTIBLE HAS BEEN MET

100 Payment made to patient/insured/responsible party. P4PAY & EDUCATE - INAPPROPRIATE USE OF EMERGENCY ROOM

100 Payment made to patient/insured/responsible party. O1CALENDAR YEAR OUT-OF-POCKET MAXIMUM HAS BEEN MET.

100 Payment made to patient/insured/responsible party. EQ CLAIM REVERSED DUE TO PARTIAL REFUND.

100 Payment made to patient/insured/responsible party. LSCOPAY OR 20% COINSURANCE, WHICHEVER LESS, APPLIED TO THIS SERVICE

100 Payment made to patient/insured/responsible party. W1 CC - POTENTIAL COB PAY EX CODE

100 Payment made to patient/insured/responsible party. W2 CC - PAY-AUDIT COMPONENT BILLING

100 Payment made to patient/insured/responsible party. EKCLAIM DENIAL REVERSED DUE TO APPEAL THROUGH EMERGENCY ROOM APPEAL COMM.

100 Payment made to patient/insured/responsible party. ELCLAIM DENIAL REVERSED DUE TO APPEAL THROUGH GRIEVANCE COMMITTEE.

100 Payment made to patient/insured/responsible party. EM CLAIM DENIAL REVERSED DUE TO APPEAL.

100 Payment made to patient/insured/responsible party. LT EMERGENCY ROOM LETTER SENT TO MEMBER

100 Payment made to patient/insured/responsible party. EP CLAIM REVERSED DUE TO FULL REFUND.

100 Payment made to patient/insured/responsible party. 06

AMT ALLOWED BASED ON PROVIDER'S DISCOUNTED RATE-MEMBER CANNOT BE BILLED

100 Payment made to patient/insured/responsible party. 5BPEND-IF BILLED W/DENTAL PX*RECODE TO D9220,D9221

100 Payment made to patient/insured/responsible party. MMMANUALLY PRICED CLAIMS FOR PRO-AMERICA PROVIDERS

100 Payment made to patient/insured/responsible party. OV OVER FILING LIMIT-PROCESSED TO PAY

100 Payment made to patient/insured/responsible party. NYMANUAL PRICE - NY PROVIDER, PRICING REQUIRED SEE NETWORK OPS FOR RATES

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100 Payment made to patient/insured/responsible party. LECALENDAR YEAR DME DEDUCTIBLE HAS BEEN MET

100 Payment made to patient/insured/responsible party. Q3AS OF 7/1/2000 PREAUTHORIZATION WILL BE REQUIRED FOR THIS SERVICE.

100 Payment made to patient/insured/responsible party. SZFUTURE CLAIMS WITH INCOMPLETE DIAGNOSIS CODES WILL BE DENIED

100 Payment made to patient/insured/responsible party. P3 PAY & EDUCATE - REFERRAL

100 Payment made to patient/insured/responsible party. YUCI - PAYMENT REDUCED 8% SINCE NON-IONIC CONTRAST WAS USED

100 Payment made to patient/insured/responsible party. 29 MANUALLY PRICED BY CLAIMS SPECIALIST

100 Payment made to patient/insured/responsible party. K9 OUT OF POCKET MAXIMUM HAS BEEN MET

100 Payment made to patient/insured/responsible party. YOCLAIMS ADJUSTED - PAID INCORRECT FEE - MASS REVERSAL

100 Payment made to patient/insured/responsible party. PRCLAIMS PENDING FOR PRICING CONFIGURATION IS NOT COMPLETED

100 Payment made to patient/insured/responsible party. OANON-REIMBURSABLE CHARGES, DISCOUNT GIVEN AT TIME OF PURCHASE.

100 Payment made to patient/insured/responsible party. YTCI - SERVICE COUNT HAS BEEN CORRECTED TO ALLOWABLE # OF UNITS

100 Payment made to patient/insured/responsible party. MKAPPEAL PAY & EDUCATE - INNAPPROPRIATE USE OF ER ROOM

100 Payment made to patient/insured/responsible party. T8CONTRACT YEAR OUT-OF-POCKET MAXIMUM HAS BEEN MET

100 Payment made to patient/insured/responsible party. KAPAID IN ACCORDANCE W/ MULTIPLAN INC DISCOUNT RATE AGREEMNT

100 Payment made to patient/insured/responsible party. YLTAX ID AND PROVIDER ID SUBMITTED DO NOT MATCH OUR RECORDS.

100 Payment made to patient/insured/responsible party. HHMEMBER AGE 65 AND NO MEDICARE COVERAGE ON FILE

100 Payment made to patient/insured/responsible party. YKDENIED - SERVICE COUNT HAS BEEN CORRECTED TO ALLOWABLE # OF UNITS

100 Payment made to patient/insured/responsible party. YJ EXCLUDED FROM ICM - SEE CLAIM REMARKS

100 Payment made to patient/insured/responsible party. 3B BIRTH TO THREE MEMBER

100 Payment made to patient/insured/responsible party. UC HCFA REQUIREMENT

100 Payment made to patient/insured/responsible party. J7REPRICED ACCORDING TO UNITED RESOURCE NETWORK CONTRACTUAL AGREEMENT

100 Payment made to patient/insured/responsible party. 21PRICED PER DISCOUNT UP TO MAXIMUM ALLOWABLE

100 Payment made to patient/insured/responsible party. C2INFORMATION SUBMITTED ON CLAIM INDICATES POSSIBLE SUBROGATION

100 Payment made to patient/insured/responsible party. HF DIAGNOSIS NOT PRESENT ON AUTHORIZATION

100 Payment made to patient/insured/responsible party. C1 MVA INVESTIGATION

100 Payment made to patient/insured/responsible party. HYCHP MEMBER - PAID PER SPECIAL ARRANGEMENT

100 Payment made to patient/insured/responsible party. PGCLAIM PROCESSED USING DRG PRICER GROUPER.

100 Payment made to patient/insured/responsible party. RUDENIAL REVERSED - PER IPA MEDICAL DIRECTOR

100 Payment made to patient/insured/responsible party. RNCLAIM DENIAL REVERSED - CASE MANAGER DECISION

100 Payment made to patient/insured/responsible party. MJ APPEAL PAY & EDUCATE REFERRAL

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100 Payment made to patient/insured/responsible party. MQ UP & UP/ AHP CONTRACTUAL ADJUSTMENT

100 Payment made to patient/insured/responsible party. UTPCP AND MEMBER AGREED UTILIZE CCI NETWORK.

100 Payment made to patient/insured/responsible party. G6 THIS IS A PAYABLE SERVICE.

100 Payment made to patient/insured/responsible party. UJPOSP 28899 IS NOT APPLICABLE INFORMATIONAL FOR PROVIDER ONLY

100 Payment made to patient/insured/responsible party. G8 CC - FOLD STATUS-INFO ONLY

100 Payment made to patient/insured/responsible party. UHPOSP 28899 - INFORMATIONAL FOR PROVIDER ONLY

100 Payment made to patient/insured/responsible party. Y2CI - PROCEDURE HAS BEEN REPLACED WITH MORE APPROPRIATE CODE

100 Payment made to patient/insured/responsible party. 2A PAYMENT MUST BE MADE TO THE MEMBER

100 Payment made to patient/insured/responsible party. OCDENIED-NON-PARTICIPATING PROVIDERS ARE NOT COVERED

100 Payment made to patient/insured/responsible party. KK A REFERRAL IS REQUIRED FOR THIS SERVICE

100 Payment made to patient/insured/responsible party. 09AMOUNT ALLOWED BASED ON PROVIDER'S CONTRACTED RATE

100 Payment made to patient/insured/responsible party. KGCLAIM DISCOUNTED PER FEE AGREEMENT THRU ADVANCED FOCUS/JOHN ALDEN LIFE

100 Payment made to patient/insured/responsible party. MX CLAIM PRICED PER MULTIPLAN DISCOUNT

100 Payment made to patient/insured/responsible party. TK PAYMENT OF TAX

100 Payment made to patient/insured/responsible party. RLCLAIM ADJUSTED DUE TO OVERPAYMENT REFUND (L&R)

100 Payment made to patient/insured/responsible party. Q2AS OF 7/1/2000 PREAUTHORIZATION WILL BE REQUIRED FOR THIS SERVICE.

100 Payment made to patient/insured/responsible party. D1THE PAYMENT ALLOWED AMOUNT IS CALCULATED AUTOMATICALLY

100 Payment made to patient/insured/responsible party. RC COB RECOVERY

100 Payment made to patient/insured/responsible party. 86 PROVIDER ACCEPTS ASSIGNMENT.

100 Payment made to patient/insured/responsible party. X2EMERGENCY/URGENT CARE SERVICES RENDERED.

100 Payment made to patient/insured/responsible party. RAST. RAPHAEL'S HEALTH CARE SYSTEM ADJUSTMENT FACTOR PAYMENT

100 Payment made to patient/insured/responsible party. 4E CI - SERVICE IS CORRECTLY CODED

100 Payment made to patient/insured/responsible party. L7CALENDAR YEAR OUT-OF-POCKET MAXIMUM HAS BEEN MET

100 Payment made to patient/insured/responsible party. R2 PAID AT MAXIMUM ALLOWABLE RATE

100 Payment made to patient/insured/responsible party. LB PAID PER DISCOUNTED LAB RATE

100 Payment made to patient/insured/responsible party. CFPAID-EXTRA CONTRACTUAL AGREEMENT ON FILE

100 Payment made to patient/insured/responsible party. LFCALENDAR YEAR DISPOSABLE SUPPLY DEDUCTIBLE HAS BEEN MET

100 Payment made to patient/insured/responsible party. LHCALENDAR YEAR OSTOMY SUPPLY/EQUIPMENT DEDUCTIBLE HAS BEEN MET

100 Payment made to patient/insured/responsible party. WJ MULTIPLE SURGERY CODE-MANUALLY PRICED

100 Payment made to patient/insured/responsible party. D7 CALENDAR YEAR DEDUCTIBLE HAS BEEN MET

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100 Payment made to patient/insured/responsible party. W3CC - INFORMATIONAL ONLY, ORIGINAL CODE SUBMITTED ON CLAIM

100 Payment made to patient/insured/responsible party. 04 MANUALLY PRICED.

100 Payment made to patient/insured/responsible party. 01 PAID ACCORDING TO AMOUNT BILLED

100 Payment made to patient/insured/responsible party. MFALLOWED FEE AT 110% OF USUAL TO INCLUDE PRIMARY CARE MANAGEMENT FEE

100 Payment made to patient/insured/responsible party. 02 PRICED AT RELATIVE VALUE SCHEDULE.

100 Payment made to patient/insured/responsible party. MDCLAIM DENIAL REVERSED - MEDICAL DIRECTOR DECISION

100 Payment made to patient/insured/responsible party. 03AMOUNT ALLOWED BASED ON PROVIDER'S CONTRACTED FEE SCHEDULE

100 Payment made to patient/insured/responsible party. 6T INFORMATIONAL ONLY

100 Payment made to patient/insured/responsible party. D3YOUR INDIVIDUAL CALENDAR YEAR DEDUCTIBLE HAS BEEN MET

100 Payment made to patient/insured/responsible party. 62 IMCC HISTORY DATA

100 Payment made to patient/insured/responsible party. RTDENIAL REVERSED - PER CCI MEDICAL DIRECTOR

100 Payment made to patient/insured/responsible party. LX SERVICE EXEMPT FROM DEDUCTIBLE

100 Payment made to patient/insured/responsible party. LWMEMBER RESPONSIBILITY CALCULATION BASED ON TOTAL AMOUNT ALLOWED

100 Payment made to patient/insured/responsible party. VHVARIABLE RISK WITHHOLD FOR HARTFORD PHO

100 Payment made to patient/insured/responsible party. E8CLAIM DENIAL REVERSED-REFERRAL REC'D FROM PCP

100 Payment made to patient/insured/responsible party. LVMEMBER RESPONSIBILITY CALCULATION BASED ON TOTAL AMOUNT BILLED

100 Payment made to patient/insured/responsible party. V8 CONNECTICARE 65 IS PRIMARY CARRIER

100 Payment made to patient/insured/responsible party. 89PAYMENT HAS BEEN MADE DIRECTLY TO THE IRS.

100 Payment made to patient/insured/responsible party. Y9CI - BILLED MODIFIER REMOVED-DOESN'T APPLY TO THIS SERVICE

100 Payment made to patient/insured/responsible party. L5 CALENDAR YEAR DEDUCTIBLE HAS BEEN MET

100 Payment made to patient/insured/responsible party. MP AMERICA'S HEALTH PLAN PROVIDER UTILIZED

100 Payment made to patient/insured/responsible party. RPREFERRAL MODIFIED BY PRIMARY CARE PHYSICIAN.PLEASE CALL PCP FOR INFO.

100 Payment made to patient/insured/responsible party. 6ICALENDAR YEAR IN-NETWORK OUT-OF-POCKET MAXIMUM HAS BEEN MET.

104 Managed care withholding. VRVARIABLE RISK WITHHOLD FOR MIDDLESEX PROFESSIONAL SERVICES

104 Managed care withholding. VNVARIABLE RISK WITHHOLD FOR NEW BRITAIN IPA

104 Managed care withholding. VMVARIABLE RISK WITHHOLD FOR MANCHESTER/ROCKVILLE

107

Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim. ON

PAYABLE ONLY WHEN BILLED WITH OTHER SERVICES

108Payment adjusted because rent/purchase guidelines were not met. KR

DENIED - PER CONTRACT MEMBER HAS REACHED CAPPED RENTAL OPTION FOR DME

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. 92

CONNECTICARE IS NOT THE CARRIER FOR THIS BENEFIT

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109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. JT

THIS GROUP HAS TERMINATED, SUBMIT ALL CLAIMS TO NEW CARRIER.

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. NU

PLEASE SUBMIT SERVICE TO NEU'S MH/SA CARRIER PER INFO ON MBR'S ID CARD.

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. KE

DENIED - PLEASE SUBMIT THE MEDICARE EXPLANATION OF BENEFITS

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. KD

DENIED - SUBMIT ALL-INCLUSIVE BILL FOR COB PROCESSING

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. KF

DENIED - PLEASE SUBMIT THE OTHER INSURANCE EXPLANATION OF BENEFITS

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. 0B

SEND CLAIMS TO MENTAL HEALTH VENDOR, CALL CONNECTICARE FOR ASSISTANCE

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. 6A

DENIED-NOT PRIMARY CARRIER. SUBMIT TO THIRD PARTY CARRIER.

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. MH

CCI IS NOT THE CARRIER FOR THIS SERVICE/SUBMIT CLAIM TO PATHWISE


DENIED-CONNECTICARE NOT PRIMARY CARRIER. SUBMIT TO AUTO INS CARRIER.


DENIED-NOT PRIM CARR.SUBMIT TO PARTY RESPONSIBLE FOR THE PERSONAL INJURY


DENIED-NOT PRIM CARR.PT SELF-INS $5,000 DUE TO LACK OF NO-FAULT COVERAGE

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. SD

PLEASE SUBMIT SERVICE TO MH/SA CARRIER PER INFO ON MBR'S ID CARD.

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. 6C

PLEASE SUBMIT CLAIM TO PRO AMERICA FOR PRICING

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. V2

PLEASE SUBMIT SERVICE TO CCI'S VISION CARE VENDOR.

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. HQ

DENIED-PRIM PAYOR IS BASIC/MAJ MED PLAN. BOTH EXPLAIN OF BENEFITS NEEDED

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. H9

DENIED-REBILL VISION VENDOR WITH ROUTINE DIAG OR SUBMIT CLINICAL DOC.

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. V4

CLAIM FORWARDED.SEND FUTURE VISION CLAIMS TO ROCKY MOUNT,NORTH CAROLINA.

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. P7

DENIED - PLEASE SUBMIT LEGIBLE CLINICAL DOCUMENT TO PODIATRIC IPA

109Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. R3

DENIED SERVICES, SUBMIT TO PHARMACY PLAN

110 Billing date predates service date. JVSERVICES NOT YET RENDERED. PLEASE RESUBMIT AFTER SERVICES ARE RENDERED.

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115Payment adjusted as procedure postponed or canceled. 11

OBSOLETE PROCEDURE CODE - MEMBER CANNOT BE BILLED

115Payment adjusted as procedure postponed or canceled. YX

CI - OBSOLETE PROCEDURE CODE-MEMBER CANNOT BE BILLED

119Benefit maximum for this time period has been reached. R4

MAXIMUM NUMBER OF REHABILITATION VISITS PAID FOR THIS CALENDAR YEAR.

119Benefit maximum for this time period has been reached. 88

PHYSICAL THERAPY MAXIMUM HAS BEEN MET - MEMBER CANNOT BE BILLED


BENEFIT MAXIMUM FOR THIS CALENDAR YEAR HAS BEEN EXHAUSTED

119Benefit maximum for this time period has been reached. OE

OSTOMY SUPPLY/EQUIPMENT MAXIMUM FOR CALENDAR YEAR HAS BEEN EXHAUSTED


CALENDAR YEAR MAXIMUM FOR ANTIGENS EXHAUSTED

119Benefit maximum for this time period has been reached. LR

IMPLANT REMOVAL PAYMENT SUBJECT TO $1000.00 YEARLY BENEFIT LIMIT



119Benefit maximum for this time period has been reached. 7A

DENIED ONLY 1 ROUTINE VISION VISIT IS ALLOWED EVERY 2 YEARS.

119Benefit maximum for this time period has been reached. 7C

MAXIMUM REHAB VISITS FOR THIS CONDITION HAS BEEN EXHAUSTED

119Benefit maximum for this time period has been reached. V1 MAXIMUM SKILLED NURSING BENEFIT USED



119Benefit maximum for this time period has been reached. L9

MAXIMUM HOME HEALTH CARE VISITS PAID FOR THIS CALENDAR YEAR


CALENDAR YEAR REHAB THERAPY MAXIMUM HAS BEEN EXHAUSTED

119Benefit maximum for this time period has been reached. 7G

DENIED, EYEWEAR MAXIMUM EXHAUSTED FOR THIS 12 MONTH PERIOD

119Benefit maximum for this time period has been reached. 7F

DENIED, BENEFIT ALLOWS FOR 2 EYE EXAMS PER 12 MONTH PERIOD

119Benefit maximum for this time period has been reached. 7D

EYEWEAR MAXIMUM HAS BEEN EXHAUSTED FOR THIS YEAR

119Benefit maximum for this time period has been reached. 7E

VISION BENEFIT FOR THIS YEAR HAS BEEN EXHAUSTED

119Benefit maximum for this time period has been reached. M1

MAXIMUM NUMBER OF SESSIONS USED FOR THIS CALENDAR YEAR


CHIRO FEE SCHEDULE DAILY MAXIMUM HAS BEEN MET- MEMBER CANNOT BE BILLED

119Benefit maximum for this time period has been reached. KL

MAXIMUM BENEFIT HAS BEEN EXHAUSTED FOR THIS BENEFIT PERIOD


MAXIMUM AMBULANCE BENEFIT HAS BEEN PAID

119Benefit maximum for this time period has been reached. 9S

DENIED - BENEFIT LIMITS HAVE BEEN EXCEEDED.

119Benefit maximum for this time period has been reached. 1M

DENIED-THIS SERVICE CAN ONLY BE BILLED/PAID ONCE PER MONTH.

119Benefit maximum for this time period has been reached. PF

TWO YEAR ALLERGY TESTING MAXIMUM EXHAUSTED


DENIED-BENEFIT LIMITS HAVE BEEN EXCEEDED

119Benefit maximum for this time period has been reached. 8A

DME MAXIMUM FOR THIS CALENDAR YEAR HAS BEEN EXHAUSTED

119Benefit maximum for this time period has been reached. 3K

DENIED - MEMBER HAS EXHAUSTED HEARING AID BENEFIT

119Benefit maximum for this time period has been reached. K4 MAXIMUM BENEFIT REACHED

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119Benefit maximum for this time period has been reached. KH

THE 2 CALENDAR YEAR MAXIMUM HAS BEEN MET.


$300.00 CALENDAR YEAR SUPPLY MAX HAS BEEN MET


MAXIMUM NUMBER OF IN PATIENT DAYS PAID FOR THIS CALENDAR YEAR

119Benefit maximum for this time period has been reached. K3

DENIED BENEFIT MAXIMUM FOR SKILLED NURSING HAS BEEN MET

119Benefit maximum for this time period has been reached. 6B

DENIED - EARLY INTERVENTION SERVICES CALENDAR YEAR MAX EXHAUSTED

119Benefit maximum for this time period has been reached. 3G

DENIED - INPATIENT PSYCHIATRIC - MEMBER HAS REACHED MAXIMUM BENEFIT


SKILLED NURSING DAYS FOR BENEFIT PERIOD EXCEEDED.

119Benefit maximum for this time period has been reached. 7B

DENIED-LIMIT ONE VISION MAXIMUM PER CONTRACT YEAR

119Benefit maximum for this time period has been reached. K2

CALENDAR YEAR CHIRO THERAPY MAXIMUM HAS BEEN EXHAUSTED


DME SUPPLY MAXIMUM FOR THIS CALENDAR YEAR HAS BEEN EXHAUSTED

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. 0U

CI - THIS DIAGNOSIS DOESN'T MATCH THIS PROCEDURE

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. 98

CLAIM CANNOT BE ACCEPTED ELECTRONICALLY.PLEASE RESUBMIT CLAIM ON PAPER.

125


CODING NOT WITHIN CONTRACT - MEMBER CANNOT BE BILLED

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. VC

PLEASE RESUBMIT WITH ALLOWABLE ALLERGY SERVICE CPT CODE.

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. YW

CI - PROCEDURE NOT VALID FOR MEMBER'S AGE OR GENDER

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. PA

DENIED - PLEASE RESUBMIT WITH PROVIDER SITE NUMBER.

125


ONLY ONE DATE OF SERVICE CAN BE ACCEPTED PER CLAIM LINE.RESUBMIT CLAIM.

125


CLAIM COORDINATED WITH PAYMENT MADE BY PRIMARY CARRIER

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. P9

DENIED - PLEASE RESUBMIT WITH APPROPRIATE HCPCS CODE

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. HG

DENIED - PROCEDURE CODE IS NO LONGER VALID.PLEASE CORRECT AND RESUBMIT.

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125


DENIED-SUBMITTED CLAIM & PRIMARY EXPLANATION OF BENEFITS DO NOT MATCH

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. 4G

CI-PROCEDURE IS INCORRECT BASED ON THIS,OR PREVIOUSLY BILLED CLAIMS

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. D9

OBSOLETE DIAGNOSIS CODE - MEMBER CANNOT BE BILLED

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. PD

PLEASE RESUBMIT CLAIM WITH CPT-4/HCPC CODE.

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. Y7

CI - THIS PROCEDURE IS NOT TYPICALLY BILLED FOR THIS DIAGNOSIS

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. 4I

CI-DUPLICATE OF A PREVIOUSLY PAID NEW OR SOON TO BE OBSOLETE PROC CODE

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. 0T

CI-SERVICE AT FACILITY LOCATION ISN'T PAYABLE TO MD.FACILITY BILLS THIS

125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. L3

CANNOT BILL DISCHARGE DAY, PLEASE RE-BILL WITH CORRECTED DAYS

131 Claim specific negotiated discount. 05AMOUNT ALLOWED BASED ON PROVIDER'S DISCOUNTED RATE

131 Claim specific negotiated discount. URPAID IN ACCORDANCE WITH UNITED RESOURCE NETWORK DISCOUNT AGREEMENT

131 Claim specific negotiated discount. TFPAID ACCORDING TO ENVISIONCARE ALLIANCE, INC. NEGOTIATED DISCOUNT.

131 Claim specific negotiated discount. TDPAID IN ACCORDANCE WITH NEGOTIATED TRANSPLANT DISCOUNT.

136Claim Adjusted. Plan procedures of a prior payer were not followed. FL CLAIM ADJUSTED

148

Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete. UN

DENIED - PLEASE RESUBMIT WITH APPROPRIATE PROVIDER IDENTIFICATION NUMBER

150

Payment adjusted because the payer deems the information submitted does not support this level of service. 3M

DENIED - HOME HEALTH (MEMBER NOT HOMEBOUND)

150

Payment adjusted because the payer deems the information submitted does not support this level of service. 3R

DENIED - SKILLED NURSING FACILITY (CUSTODIAL CARE OR NOT DAILY SNF CARE)

150

Payment adjusted because the payer deems the information submitted does not support this level of service. 3I

DENIED-CHIRO-DOES NOT MEET BENEFIT CRITERIA FOR CHIROPRATIC COVERAGE

150

Payment adjusted because the payer deems the information submitted does not support this level of service. WS

DENY-PLEASE RESUBMIT WITH DENTAL HCPCS CODE OR CLINICAL DOCUMENTATION.

150

Payment adjusted because the payer deems the information submitted does not support this level of service. 3L

DENIED - HOME HEALTH (DOES NOT MEET SKILLED NURSING GUIDELINES)

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151

Payment adjusted because the payer deems the information submitted does not support this many services. YS

CI - BILLED PROCEDURES EXCEEDS NUMBER OF UNITS ALLOWED

151

Payment adjusted because the payer deems the information submitted does not support this many services. H7

CC - BILLED PROCEDURES EXCEEDS # OF UNITS ALLOWED

151

Payment adjusted because the payer deems the information submitted does not support this many services. Z9

DENIED - THIS SERVICE CAN BE BILLED / PAID 1 UNIT PER DATE OF SERVICE

A0 Patient refund amount. A6 REIMBURSEMENT FOR COPAY

A1 Claim denied charges. B5DENIED-NON PARTICIPATING VISION VENDOR PROVIDER-NO BENEFITS ARE PAYABLE.

A2 Contractual adjustment. FECLAIM ADJUSTED - INCORRECT DEDUCTIBLE TAKEN.

A2 Contractual adjustment. AOADJUSTMENT FACTOR FOR MIDDLESEX PROFESSIONAL SERVICES

A2 Contractual adjustment. ET CLAIM ADJUSTED - SERVICES PAID IN ERROR

A2 Contractual adjustment. FGVOID CHECK - PAYMENT MADE TO INCORRECT PROVIDER

A2 Contractual adjustment. EUCLAIM ADJUSTED - INCORRECT DATE OF SERVICES.

A2 Contractual adjustment. 1E CLAIM ADJUSTED PER IPA/ EK

A2 Contractual adjustment. ERCLAIM ADJUSTED - DENIED IN ERROR DUE TO ELIGIBILITY ISSUE

A2 Contractual adjustment. EVCLAIM ADJUSTED - PAID INCORRECT NUMBER OF SERVICES.

A2 Contractual adjustment. EGCLAIM ADJUSTED - PAYMENT MADE TO INCORRECT PROVIDER

A2 Contractual adjustment. EHCLAIM ADJUSTED - PAYMENT MADE TO INCORRECT MEMBER

A2 Contractual adjustment. FFCLAIM ADJUSTED - INCORRECT CO-INSURANCE TAKEN.

A2 Contractual adjustment. F8STATISTICAL CLAIM ADJUSTMENT DUE TO FUND

A2 Contractual adjustment. FDCLAIM ADJUSTED - INCORRECT CO-PAYMENT TAKEN.

A2 Contractual adjustment. FBCLAIM ADJUSTED - PAID DUE TO ADDITIONAL INFORMATION RECEIVED FROM MEMBER

A2 Contractual adjustment. EXCLAIM ADJUSTED - DUE TO CHANGE IN HOSPITAL PER DIEM RATE.

A2 Contractual adjustment. F4 ADJUSTMENT FACTOR PAYMENT

A2 Contractual adjustment. I5PER CFC IPA, CLAIM ADJUSTED, SERVICES PAID IN ERROR

A2 Contractual adjustment. EZCLAIM ADJUSTED - ADDITIONAL CHARGES RECEIVED

A2 Contractual adjustment. EYCLAIM ADJUSTED - DUE TO CHANGE IN FEE SCHEDULE.

A2 Contractual adjustment. FCCLAIM ADJUSTED - PAID DUE TO ADDITIONAL INFO RECEIVED FROM PROVIDER.

A2 Contractual adjustment. FACLAIM ADJUSTED - PAID - REFERRING PHYSICIAN INFORMATION RECEIVED.

A2 Contractual adjustment. H3

HARTFORD PHYSICIAN HOSPITAL ORGANIZATION ADJUSTMENT FACTOR PAYMENT

A2 Contractual adjustment. ESCLAIM ADJUSTED - DENIED IN ERROR SERVICES WERE APPROVED

A2 Contractual adjustment. FIVOID CHECK - PAID INCORRECT FEES/CHARGES.

A2 Contractual adjustment. FJVOID CHECK - DUPLICATE PAYMENT MADE TO PROVIDER

A2 Contractual adjustment. FK VOID CHECK - CHECK LOST/NOT RECEIVED.

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A2 Contractual adjustment. FHVOID CHECK - PAYMENT MADE TO INCORRECT SUBSCRIBER

A2 Contractual adjustment. EW CLAIM ADJUSTED - MISSING CLAIM LINE(S).

A2 Contractual adjustment. 0MADJUSTMENT FACTOR FOR MANCHESTER/ROCKVILLE

A2 Contractual adjustment. 0H ADJUSTMENT FACTOR FOR HARTFORD PHOA2 Contractual adjustment. VD THIS TRANSACTION HAS BEEN VOIDED.

A2 Contractual adjustment. I4PER CFC IPA, CLAIM ADJUSTED, PAID INCORRECT FEE

A2 Contractual adjustment. M7

ST MARY'S PHYSICIAN HOSPITAL ORGANIZATION ADJUSTMENT FACTOR PAYMENT

A2 Contractual adjustment. RV REVERSAL OF VOIDA2 Contractual adjustment. 0N ADJUSTMENT FACTOR FOR NEW BRITAIN IPAA2 Contractual adjustment. 1K CLAIM ADJUSTED PER IPA/ LSA2 Contractual adjustment. EO STATISTICAL ADJUSTMENT PER FINANCE

A2 Contractual adjustment. ENCLAIM ADJUSTED - INCORRECTLY PAID AS PRIMARY CARRIER

A2 Contractual adjustment. EJCLAIM ADJUSTED - DUPLICATE CLAIM PAYMENT

A2 Contractual adjustment. EICLAIM ADJUSTED - PAYMENT BASED ON INCORRECT FEE

A2 Contractual adjustment. 99 DELETED CLAIM LINE.

B11

The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. TX

TAX DENIED - CCI WILL REIMBURSE THE N.Y. TAX DIRECTLY TO THE STATE

B11

The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. TE

PLEASE SUBMIT CLAIM TO ENVISIONCARE ALLIANCE, INC.

B11

The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. BV

ROUTINE VISION - CLAIM HAS BEEN FORWARDED TO VENDOR FOR PROCESSING.

B11

The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. U3

CLAIM WILL BE FORWARDED TO YALE MSO FOR PROCESSING

B11

The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. TC PLEASE SUBMIT CLAIM TO URN.

B11

The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. 0C

CLAIM HAS BEEN FORWARDED TO CCI'S MENTAL HEALTH/SUBSTANCE ABUSE CARRIER.

B11

The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. OH

ROUTINE VISION - CLAIM HAS BEEN FORWARDED TO VENDOR FOR PROCESSING.

B12Services not documented in patients' medical records. RJ

SERVICE DENIED NOT ON CLINICAL DOCUMENTATION

B15Payment adjusted because this procedure/service is not paid separately. I8

DENIED-SERVICES INCLUDED IN FACILITY PER DIEM. SUBMIT TO FACILITY.

B15Payment adjusted because this procedure/service is not paid separately. Y8

CI-VISIT ISN'T IDENTIFIED AS BEING SEPARATE FROM OTHER VISIT SAME DATE

B15Payment adjusted because this procedure/service is not paid separately. 0R

CI - THE FREQUENCY OF THIS PROCEDURE EXCEEDS CLINICAL RECOMMENDATIONS

B15Payment adjusted because this procedure/service is not paid separately. 56

DENIED-CHARGES ARE INCLUDED IN GLOBAL FEE OF PRIMARY CHARGES

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B15Payment adjusted because this procedure/service is not paid separately. YR

CI-SERVICE IS NOT TYPICALLY PERFORMED ALONG WITH OTHER SERVICES BILLED

B15Payment adjusted because this procedure/service is not paid separately. JY

CC-THIS SERVICE ISN'T TYPICALLY PERFORMED ALONG WITH OTHER SERVS BILLED

B15Payment adjusted because this procedure/service is not paid separately. JB

DENIED-PROCEDURE IS MUTUALLY EXCLUSIVE TO ANOTHER PROCEDURE ON CLAIM

B15Payment adjusted because this procedure/service is not paid separately. JA

CC - THIS SERVICE IS INCLUDED IN A RELATED PROC BILLED ON SEPARATE CLAIM

B15Payment adjusted because this procedure/service is not paid separately. 4J

CI - SAME/SIMILAR SERVICE WAS RECENTLY BILLED FOR THIS CONDITION

B18

Payment denied because this procedure code/modifier was invalid on the date of service or claim submission. IY

UNLISTED PROC CODE NOT ACCEPTABLE-PLEASE REBILL WITH APPROPRIATE CODE

B19Claim/service adjusted because of the finding of a Review Organization. A4 DENIED AFTER REVIEW

B19Claim/service adjusted because of the finding of a Review Organization. RK

SERVICE RECODED BASED ON REVIEW OF DOCUMENTATION

B22 This payment is adjused based on the diagnosis. CGTHIS PROCEDURE IS NOT VALID FOR SECONDARY DIAGNOSIS

B6

This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. IW

PAYMENT FOR SERVICE EXCLUDED UNDER CONTRACT - MEMBER CANNOT BE BILLED

B6

This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. 5C

CO SURGEON IS TYPICALLY NOT REQUIRED FOR THIS PROCEDURE

B6

This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. 4F

CI - CO-SURGEON IS TYPICALLY NOT REQUIRED FOR THIS PROCEDURE

B6

This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. 40

PAYMENT FOR SERVICE EXCLUDED UNDER CONTRACT - MEMBER CANNOT BE BILLED

B6

This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. Y5

CI - THIS SERVICE IS NOT TYPICALLY PAYABLE FOR YOUR SPECIALTY

B6

This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. Y6

CI - SURGEON AND SURGICAL ASSIST CANNOT BE THE SAME PROVIDER

B6

This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. YP

CI - MORE THAN 1 ASSISTANT MD IS NOT ALLOWED FOR THIS SERVICE

B7This provider was not certified/eligible to be paid for this procedure/service on this date of service. 4A

PROVIDER NO LONGER PARTICIPATING WITH CONNECTICARE

B7This provider was not certified/eligible to be paid for this procedure/service on this date of service. JC

DENIED-PROCEDURE CODE NOT ON PROVIDER'S CONTRACTED FEE SCHEDULE

B7This provider was not certified/eligible to be paid for this procedure/service on this date of service. JP

DENIED, PROCEDURE NOT ON PROVIDER FEE SCHEDULE MEMBER CANNOT BE BILLED.

B9Services not covered because the patient is enrolled in a Hospice. MT

DENIED - MEMBER ELECTED HOSPICE. SUBMIT TO CARRIER/INTERMEDIARY.

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explanation code translation table - connecticare code translation table ansi claims ......

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