| M1 |
X-ray
not taken within the past 12 months or near enough to the start of
treatment. |
| M2 |
Not
paid separately when the patient is an inpatient. |
| M3 |
Equipment
is the same or similar to equipment already being used. |
| M4 |
This
is the last monthly installment payment for this durable medical
equipment. |
| M5 |
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. |
| M6 |
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 every 6
month period after the end of the 15th paid rental month or the end of
the warranty period. |
| M7 |
No
rental payments after the item is purchased, or after the total of
issued rental payments equals the purchase price. |
| M8 |
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. |
| M9 |
This
is the tenth rental month. You must offer the patient the choice of
changing the rental to a purchase agreement. |
| M10 |
Equipment
purchases are limited to the first or the tenth month of medical
necessity. |
| M11 |
DME,
orthotics and prosthetics must be billed to the DME carrier who services
the patient's zip code. |
| M12 |
Diagnostic
tests performed by a physician must indicate whether purchased services
are included on the claim. |
| M13 |
Only
one initial visit is covered per specialty per medical group. |
| M14 |
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. |
| M15 |
Separately
billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed. |
| M16 |
Please
see our web site, mailings, or bulletins for more details concerning
this policy/procedure/decision. |
| M18 |
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. |
| M19 |
Missing
oxygen certification/re-certification. |
| M20 |
Missing/incomplete/invalid
HCPCS. |
| M21 |
Missing/incomplete/invalid
place of residence for this service/item provided in a home. |
| M22 |
Missing/incomplete/invalid
number of miles traveled. |
| M23 |
Missing
invoice. |
| M24 |
Missing/incomplete/invalid
number of doses per vial. |
| M28 |
This
does not qualify for payment under Part B when Part A coverage is
exhausted or not otherwise available. |
| M29 |
Missing
operative report. |
| M30 |
Missing
pathology report. |
| M31 |
Missing
radiology report. |
| M33 |
Missing/incomplete/invalid
UPIN for the ordering/referring/performing provider. |
| M34 |
Claim
lacks the CLIA certification number. |
| M35 |
Missing/incomplete/invalid
pre-operative photos or visual field results. |
| M36 |
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. |
| M37 |
Service
not covered when the patient is under age 35. |
| M38 |
The
patient is liable for the charges for this service as you informed the
patient in writing before the service was furnished that we would not
pay for it, and the patient agreed to pay. |
| M39 |
The
patient is not liable for payment for this service as the advance notice
of non-coverage you provided the patient did not comply with program
requirements. |
| M40 |
Claim
must be assigned and must be filed by the practitioner's employer. |
| M41 |
We
do not pay for this as the patient has no legal obligation to pay for
this. |
| M42 |
The
medical necessity form must be personally signed by the attending
physician. |
| M43 |
Payment
for this service previously issued to you or another provider by another
carrier/intermediary. |
| M44 |
Missing/incomplete/invalid
condition code. |
| M45 |
Missing/incomplete/invalid
occurrence code(s). |
| M46 |
Missing/incomplete/invalid
occurrence span code(s). |
| M47 |
Missing/incomplete/invalid
internal or document control number. |
| M48 |
Payment
for services furnished to hospital inpatients (other than professional
services of physicians) can only be made to the hospital. You must
request payment from the hospital rather than the patient for this
service. |
| M49 |
Missing/incomplete/invalid
value code(s) or amount(s). |
| M50 |
Missing/incomplete/invalid
revenue code(s). |
| M51 |
Missing/incomplete/invalid
procedure code(s). |
| M52 |
Missing/incomplete/invalid
“from” date(s) of service. |
| M53 |
Missing/incomplete/invalid
days or units of service. |
| M54 |
Missing/incomplete/invalid
total charges. |
| M55 |
We
do not pay for self-administered anti-emetic drugs that are not
administered with a covered oral anti-cancer drug. |
| M56 |
Missing/incomplete/invalid
payer identifier. |
| M57 |
Missing/incomplete/invalid
provider identifier. |
| M58 |
Missing/incomplete/invalid
claim information. Resubmit claim after corrections. |
| M59 |
Missing/incomplete/invalid
“to” date(s) of service. |
| M60 |
Missing
Certificate of Medical Necessity. |
| M61 |
We
cannot pay for this as the approval period for the FDA clinical trial
has expired. |
| M62 |
Missing/incomplete/invalid
treatment authorization code. |
| M63 |
We
do not pay for more than one of these on the same day. |
| M64 |
Missing/incomplete/invalid
other diagnosis. |
| M65 |
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. |
| M67 |
Missing/incomplete/invalid
other procedure code(s). |
| M68 |
Missing/incomplete/invalid
attending, ordering, rendering, supervising or referring physician
identification. |
| M69 |
Paid
at the regular rate as you did not submit documentation to justify the
modified procedure code. |
| M70 |
NDC
code submitted for this service was translated to a HCPCS code for
processing, but please continue to submit the NDC on future claims for
this item. |
| M71 |
Total
payment reduced due to overlap of tests billed. |
| M72 |
Did
not enter full 8-digit date (MM/DD/CCYY). |
| M73 |
The
HPSA/Physician Scarcity bonus can only be paid on the professional
component of this service. Rebill as separate professional and technical
components. |
| M74 |
This
service does not qualify for a HPSA/Physician Scarcity bonus payment. |
| M75 |
Allowed
amount adjusted. Multiple automated multichannel tests performed on the
same day combined for payment. |
| M76 |
Missing/incomplete/invalid
diagnosis or condition. |
| M77 |
Missing/incomplete/invalid
place of service. |
| M78 |
Missing/incomplete/invalid
HCPCS modifier. |
| M79 |
Missing/incomplete/invalid
charge. |
| M80 |
Not
covered when performed during the same session/date as a previously
processed service for the patient. |
| M81 |
You
are required to code to the highest level of specificity. |
| M82 |
Service
is not covered when patient is under age 50. |
| M83 |
Service
is not covered unless the patient is classified as at high risk. |
| M84 |
Medical
code sets used must be the codes in effect at the time of service |
| M85 |
Subjected
to review of physician evaluation and management services. |
| M86 |
Service
denied because payment already made for same/similar procedure within
set time frame. |
| M87 |
Claim/service(s)
subjected to CFO-CAP prepayment review. |
| M88 |
We
cannot pay for laboratory tests unless billed by the laboratory that did
the work. |
| M89 |
Not
covered more than once under age 40. |
| M90 |
Not
covered more than once in a 12 month period. |
| M91 |
Lab
procedures with different CLIA certification numbers must be billed on
separate claims. |
| M92 |
Services
subjected to review under the Home Health Medical Review Initiative. |
| M93 |
Information
supplied supports a break in therapy. A new capped rental period began
with delivery of this equipment. |
| M94 |
Information
supplied does not support a break in therapy. A new capped rental period
will not begin. |
| M95 |
Services
subjected to Home Health Initiative medical review/cost report audit. |
| M97 |
Not
paid to practitioner when provided to patient in this place of service.
Payment included in the reimbursement issued the facility. |
| M98 |
Begin
to report the Universal Product Number on claims for items of this type.
We will soon begin to deny payment for items of this type if billed
without the correct UPN. |
| M99 |
Missing/incomplete/invalid
Universal Product Number/Serial Number. |
| M100 |
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. |
| M101 |
Begin
to report a G1-G5 modifier with this HCPCS. We will soon begin to deny
payment for this service if billed without a G1-G5 modifier. |
| M102 |
Service
not performed on equipment approved by the FDA for this purpose. |
| M104 |
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. |
| M106 |
Information
supplied does not support a break in therapy. A new capped rental period
will not begin. This is the maximum approved under the fee schedule for
this item or service. |
| M107 |
Payment
reduced as 90-day rolling average hematocrit for ESRD patient exceeded
36.5%. |
| M108 |
Missing/incomplete/invalid
provider identifier for the provider who interpreted the diagnostic
test. |
| M109 |
We
have provided you with a bundled payment for a teleconsultation. You
must send 25 percent of the teleconsultation payment to the referring
practitioner. |
| M110 |
Missing/incomplete/invalid
provider identifier for the provider from whom you purchased
interpretation services. |
| M111 |
We
do not pay for chiropractic manipulative treatment when the patient
refuses to have an x-ray taken. |
| M112 |
The
approved amount is based on the maximum allowance for this item under
the DMEPOS Competitive Bidding Demonstration. |
| M113 |
Our
records indicate that this patient began using this service(s) prior to
the current round of the DMEPOS Competitive Bidding Demonstration.
Therefore, the approved amount is based on the allowance in effect prior
to this round of bidding for this item. |
| M114 |
This
service was processed in accordance with rules and guidelines under the
Competitive Bidding Demonstration Project. If you would like more
information regarding this project, you may phone 1-888-289-0710. |
| M115 |
This
item is denied when provided to this patient by a non-demonstration
supplier. |
| M116 |
Paid
under the Competitive Bidding Demonstration project. Project is ending,
and future services may not be paid under this project. |
| M117 |
Not
covered unless submitted via electronic claim. |
| M118 |
Letter
to follow containing further information. |
| M119 |
Missing/incomplete/invalid/
deactivated/withdrawn National Drug Code (NDC). |
| M120 |
Missing/incomplete/invalid
provider identifier for the substituting physician who furnished the
service(s) under a reciprocal billing or locum tenens arrangement. |
| M121 |
We
pay for this service only when performed with a covered cryosurgical
ablation. |
| M122 |
Missing/incomplete/invalid
level of subluxation. |
| M123 |
Missing/incomplete/invalid
name, strength, or dosage of the drug furnished. |
| M124 |
Missing
indication of whether the patient owns the equipment that requires the
part or supply. |
| M125 |
Missing/incomplete/invalid
information on the period of time for which the service/supply/equipment
will be needed. |
| M126 |
Missing/incomplete/invalid
individual lab codes included in the test. |
| M127 |
Missing
patient medical record for this service. |
| M128 |
Missing/incomplete/invalid
date of the patient’s last physician visit. |
| M129 |
Missing/incomplete/invalid
indicator of x-ray availability for review. |
| M130 |
Missing
invoice or statement certifying the actual cost of the lens, less
discounts, and/or the type of intraocular lens used. |
| M131 |
Missing
physician financial relationship form. |
| M132 |
Missing
pacemaker registration form. |
| M133 |
Claim
did not identify who performed the purchased diagnostic test or the
amount you were charged for the test. |
| M134 |
Performed
by a facility/supplier in which the provider has a financial interest. |
| M135 |
Missing/incomplete/invalid
plan of treatment. |
| M136 |
Missing/incomplete/invalid
indication that the service was supervised or evaluated by a physician. |
| M137 |
Part
B coinsurance under a demonstration project. |
| M138 |
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. |
| M139 |
Denied
services exceed the coverage limit for the demonstration. |
| M140 |
Service
not covered until after the patient’s 50th birthday, i.e., no coverage
prior to the day after the 50th birthday |
| M141 |
Missing
physician certified plan of care. |
| M142 |
Missing
American Diabetes Association Certificate of Recognition. |
| M143 |
We
have no record that you are licensed to dispensed drugs in the State
where located. |
| M144 |
Pre-/post-operative
care payment is included in the allowance for the surgery/procedure. |
| MA04 |
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. |
| MA05 |
Incorrect
admission date patient status or type of bill entry on claim. |
| MA06 |
Missing/incomplete/invalid
beginning and/or ending date(s). |
| MA07 |
The
claim information has also been forwarded to Medicaid for review. |
| MA08 |
You
should also submit this claim to the patient's other insurer for
potential payment of supplemental benefits. We did not forward the claim
information as the supplemental coverage is not with a Medigap plan, or
you do not participate in Medicare. |
| MA09 |
Claim
submitted as unassigned but processed as assigned. You agreed to accept
assignment for all claims. |
| MA10 |
The
patient's payment was in excess of the amount owed. You must refund the
overpayment to the patient. |
| MA12 |
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). |
| MA13 |
You
may be subject to penalties if you bill the patient for amounts not
reported with the PR (patient responsibility) group code. |
| MA15 |
Your
claim has been separated to expedite handling. You will receive a
separate notice for the other services reported. |
| MA16 |
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. |
| MA17 |
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. |
| MA18 |
The
claim information is also being forwarded to the patient's supplemental
insurer. Send any questions regarding supplemental benefits to them. |
| MA19 |
Information
was not sent to the Medigap insurer due to incorrect/invalid information
you submitted concerning that insurer. Please verify your information
and submit your secondary claim directly to that insurer. |
| MA20 |
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. |
| MA21 |
SSA
records indicate mismatch with name and sex. |
| MA22 |
Payment
of less than $1.00 suppressed. |
| MA23 |
Demand
bill approved as result of medical review. |
| MA24 |
Christian
Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same
benefit period. |
| MA25 |
A
patient may not elect to change a hospice provider more than once in a
benefit period. |
| MA26 |
Our
records indicate that you were previously informed of this rule. |
| MA27 |
Missing/incomplete/invalid
entitlement number or name shown on the claim. |
| MA29 |
Missing/incomplete/invalid
provider name, city, state, or zip code. |
| MA30 |
Missing/incomplete/invalid
type of bill. |
| MA31 |
Missing/incomplete/invalid
beginning and ending dates of the period billed. |
| MA32 |
Missing/incomplete/invalid
number of covered days during the billing period. |
| MA33 |
Missing/incomplete/invalid
noncovered days during the billing period. |
| MA34 |
Missing/incomplete/invalid
number of coinsurance days during the billing period. |
| MA35 |
Missing/incomplete/invalid
number of lifetime reserve days. |
| MA36 |
Missing/incomplete/invalid
patient name. |
| MA37 |
Missing/incomplete/invalid
patient's address. |
| MA38 |
Missing/incomplete/invalid
birth date. |
| MA39 |
Missing/incomplete/invalid
gender. |
| MA40 |
Missing/incomplete/invalid
admission date. |
| MA41 |
Missing/incomplete/invalid
admission type. |
| MA42 |
Missing/incomplete/invalid
admission source. |
| MA43 |
Missing/incomplete/invalid
patient status. |
| MA44 |
No
appeal rights. Adjudicative decision based on law. |
| MA45 |
As
previously advised, a portion or all of your payment is being held in a
special account. |
| MA46 |
The
new information was considered, however, additional payment cannot be
issued. Please review the information listed for the explanation. |
| MA47 |
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. |
| MA48 |
Missing/incomplete/invalid
name or address of responsible party or primary payer. |
| MA49 |
Missing/incomplete/invalid
six-digit provider identifier for home health agency or hospice for
physician(s) performing care plan oversight services. |
| MA50 |
Missing/incomplete/invalid
Investigational Device Exemption number for FDA-approved clinical trial
services. |
| MA51 |
Missing/incomplete/invalid
CLIA certification number for laboratory services billed by physician
office laboratory. |
| MA52 |
Missing/incomplete/invalid
date. |
| MA53 |
Missing/incomplete/invalid
Competitive Bidding Demonstration Project identification. |
| MA54 |
Physician
certification or election consent for hospice care not received timely. |
| MA55 |
Not
covered as patient received medical health care services, automatically
revoking his/her election to receive religious non-medical health care
services. |
| MA57 |
Patient
submitted written request to revoke his/her election for religious
non-medical health care services. |
| MA58 |
Missing/incomplete/invalid
release of information indicator. |
| MA59 |
The
patient overpaid you for these services. You must issue the patient a
refund within 30 days for the difference between his/her payment and the
total amount shown as patient responsibility on this notice. |
| MA60 |
Missing/incomplete/invalid
patient relationship to insured. |
| MA61 |
Missing/incomplete/invalid
social security number or health insurance claim number. |
| MA62 |
Telephone
review decision. |
| MA63 |
Missing/incomplete/invalid
principal diagnosis. |
| MA64 |
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. |
| MA65 |
Missing/incomplete/invalid
admitting diagnosis. |
| MA66 |
Missing/incomplete/invalid
principal procedure code. |
| MA67 |
Correction
to a prior claim. |
| MA68 |
We
did not crossover this claim because the secondary insurance information
on the claim was incomplete. Please supply complete information or use
the PLANID of the insurer to assure correct and timely routing of the
claim. |
| MA69 |
Missing/incomplete/invalid
remarks. |
| MA70 |
Missing/incomplete/invalid
provider representative signature. |
| MA71 |
Missing/incomplete/invalid
provider representative signature date. |
| MA73 |
Informational
remittance associated with a Medicare demonstration. No payment issued
under fee-for-service Medicare as patient has elected managed care. |
| MA74 |
This
payment replaces an earlier payment for this claim that was either lost,
damaged or returned. |
| MA75 |
Missing/incomplete/invalid
patient or authorized representative signature. |
| MA76 |
Missing/incomplete/invalid
provider identifier for home health agency or hospice when physician is
performing care plan oversight services. |
| MA77 |
The
patient overpaid you. You must issue the patient a refund within 30 days
for the difference between the patient’s payment less the total of our
and other payer payments and the amount shown as patient responsibility
on this notice. |
| MA78 |
The
patient overpaid you. You must issue the patient a refund within 30 days
for the difference between our allowed amount total and the amount paid
by the patient. |
| MA79 |
Billed
in excess of interim rate. |
| MA80 |
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. |
| MA81 |
Missing/incomplete/invalid
provider/supplier signature. |
| MA82 |
Missing/incomplete/invalid
provider/supplier billing number/identifier or billing name, address,
city, state, zip code, or phone number. |
| MA83 |
Did
not indicate whether we are the primary or secondary payer. |
| MA85 |
Our
records indicate that a primary payer exists (other than ourselves);
however, you did not complete or enter accurately the insurance
plan/group/program name or identification number. Enter the PlanID when
effective. |
| MA86 |
Missing/incomplete/invalid
group or policy number of the insured for the primary coverage. |
| MA87 |
Missing/incomplete/invalid
insured's name for the primary payer. |
| MA88 |
Missing/incomplete/invalid
insured's address and/or telephone number for the primary payer. |
| MA89 |
Missing/incomplete/invalid
patient's relationship to the insured for the primary payer. |
| MA90 |
Missing/incomplete/invalid
employment status code for the primary insured. |
| MA91 |
This
determination is the result of the appeal you filed. |
| MA92 |
Missing
plan information for other insurance. |
| MA93 |
Non-PIP
(Periodic Interim Payment) claim. |
| MA94 |
Did
not enter the statement “Attending physician not hospice employee”
on the claim form to certify that the rendering physician is not an
employee of the hospice. |
| MA95 |
De-activate
and refer to M51. |
| MA96 |
Claim
rejected. Coded as a Medicare Managed Care Demonstration but patient is
not enrolled in a Medicare managed care plan. |
| MA97 |
Missing/incomplete/invalid
Medicare Managed Care Demonstration contract number. |
| MA98 |
Claim
Rejected. Does not contain the correct Medicare Managed Care
Demonstration contract number for this beneficiary. |
| MA99 |
Missing/incomplete/invalid
Medigap information. |
| MA100 |
Missing/incomplete/invalid
date of current illness or symptoms |
| MA101 |
A
Skilled Nursing Facility (SNF) is responsible for payment of outside
providers who furnish these services/supplies to residents. |
| MA102 |
Missing/incomplete/invalid
name or provider identifier for the rendering/referring/ ordering/
supervising provider. |
| MA103 |
Hemophilia
Add On. |
| MA104 |
Missing/incomplete/invalid
date the patient was last seen or the provider identifier of the
attending physician. |
| MA105 |
Missing/incomplete/invalid
provider number for this place of service. |
| MA106 |
PIP
(Periodic Interim Payment) claim. |
| MA107 |
Paper
claim contains more than three separate data items in field 19. |
| MA108 |
Paper
claim contains more than one data item in field 23. |
| MA109 |
Claim
processed in accordance with ambulatory surgical guidelines. |
| MA110 |
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. |
| MA111 |
Missing/incomplete/invalid
purchase price of the test(s) and/or the performing laboratory's name
and address. |
| MA112 |
Missing/incomplete/invalid
group practice information. |
| MA114 |
Missing/incomplete/invalid
information on where the services were furnished. |
| MA115 |
Missing/incomplete/invalid
physical location (name and address, or PIN) where the service(s) were
rendered in a Health Professional Shortage Area (HPSA). |
| MA116 |
Did
not complete the statement "Homebound" on the claim to
validate whether laboratory services were performed at home or in an
institution. |
| MA117 |
This
claim has been assessed a $1.00 user fee. |
| MA118 |
Coinsurance
and/or deductible amounts apply to a claim for services or supplies
furnished to a Medicare-eligible veteran through a facility of the
Department of Veterans Affairs. No Medicare payment issued. |
| MA119 |
Provider
level adjustment for late claim filing applies to this claim. |
| MA120 |
Missing/incomplete/invalid
CLIA certification number. |
| MA121 |
Missing/incomplete/invalid
x-ray date. |
| MA122 |
Missing/incomplete/invalid
initial treatment date. |
| MA123 |
Your
center was not selected to participate in this study, therefore, we
cannot pay for these services. |
| MA124 |
Processed
for IME only. |
| MA125 |
Per
legislation governing this program, payment constitutes payment in full. |
| MA126 |
Pancreas
transplant not covered unless kidney transplant performed. |
| MA127 |
Reserved
for future use. |
| MA128 |
Missing/incomplete/invalid
FDA approval number. |
| MA129 |
This
provider was not certified for this procedure on this date of service. |
| MA130 |
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. |
| MA131 |
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. |
| MA132 |
Adjustment
to the pre-demonstration rate. |
| MA133 |
Claim
overlaps inpatient stay. Rebill only those services rendered outside the
inpatient stay. |
| MA134 |
Missing/incomplete/invalid
provider number of the facility where the patient resides. |
| N1 |
You
may appeal this decision in writing within the required time limits
following receipt of this notice by following the instructions included
in your contract or plan benefit documents. |
| N2 |
This
allowance has been made in accordance with the most appropriate course
of treatment provision of the plan. |
| N3 |
Missing
consent form. |
| N4 |
Missing/incomplete/invalid
prior insurance carrier EOB. |
| N5 |
EOB
received from previous payer. Claim not on file. |
| N6 |
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. |
| N7 |
Processing
of this claim/service has included consideration under Major Medical
provisions. |
| N8 |
Crossover
claim denied by previous payer and complete claim data not forwarded.
Resubmit this claim to this payer to provide adequate data for
adjudication. |
| N9 |
Adjustment
represents the estimated amount a previous payer may pay. |
| N10 |
Claim/service
adjusted based on the findings of a review organization/professional
consult/manual adjudication/medical or dental advisor. |
| N11 |
Denial
reversed because of medical review. |
| N12 |
Policy
provides coverage supplemental to Medicare. As member does not appear to
be enrolled in Medicare Part B, the member is responsible for payment of
the portion of the charge that would have been covered by Medicare. |
| N13 |
Payment
based on professional/technical component modifier(s). |
| N14 |
Payment
based on a contractual amount or agreement, fee schedule, or maximum
allowable amount. |
| N15 |
Services
for a newborn must be billed separately. |
| N16 |
Family/member
Out-of-Pocket maximum has been met. Payment based on a higher
percentage. |
| N17 |
Per
admission deductible. |
| N18 |
Payment
based on the Medicare allowed amount. |
| N19 |
Procedure
code incidental to primary procedure. |
| N20 |
Service
not payable with other service rendered on the same date. |
| N21 |
Your
line item has been separated into multiple lines to expedite handling. |
| N22 |
This
procedure code was added/changed because it more accurately describes
the services rendered. |
| N23 |
Patient
liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions. |
| N24 |
Missing/incomplete/invalid
Electronic Funds Transfer (EFT) banking information. |
| N25 |
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. |
| N26 |
Missing
itemized bill. |
| N27 |
Missing/incomplete/invalid
treatment number. |
| N28 |
Consent
form requirements not fulfilled. |
| N29 |
Missing
documentation/orders/notes/summary/report/chart. |
| N30 |
Patient
ineligible for this service. |
| N31 |
Missing/incomplete/invalid
prescribing provider identifier. |
| N32 |
Claim
must be submitted by the provider who rendered the service. |
| N33 |
No
record of health check prior to initiation of treatment. |
| N34 |
Incorrect
claim form/format for this service. |
| N35 |
Program
integrity/utilization review decision. |
| N36 |
Claim
must meet primary payer’s processing requirements before we can
consider payment. |
| N37 |
Missing/incomplete/invalid
tooth number/letter. |
| N38 |
Missing/incomplete/invalid
place of service. |
| N39 |
Procedure
code is not compatible with tooth number/letter. |
| N40 |
Missing
x-ray. |
| N41 |
Authorization
request denied. |
| N42 |
No
record of mental health assessment. |
| N43 |
Bed
hold or leave days exceeded. |
| N44 |
Payer’s
share of regulatory surcharges, assessments, allowances or health
care-related taxes paid directly to the regulatory authority. |
| N45 |
Payment
based on authorized amount. |
| N46 |
Missing/incomplete/invalid
admission hour. |
| N47 |
Claim
conflicts with another inpatient stay. |
| N48 |
Claim
information does not agree with information received from other
insurance carrier. |
| N49 |
Court
ordered coverage information needs validation. |
| N50 |
Missing/incomplete/invalid
discharge information. |
| N51 |
Electronic
interchange agreement not on file for provider/submitter. |
| N52 |
Patient
not enrolled in the billing provider's managed care plan on the date of
service. |
| N53 |
Missing/incomplete/invalid
point of pick-up address. |
| N54 |
Claim
information is inconsistent with pre-certified/authorized services. |
| N55 |
Procedures
for billing with group/referring/performing providers were not followed. |
| N56 |
Procedure
code billed is not correct/valid for the services billed or the date of
service billed. |
| N57 |
Missing/incomplete/invalid
prescribing date. |
| N58 |
Missing/incomplete/invalid
patient liability amount. |
| N59 |
Please
refer to your provider manual for additional program and provider
information. |
| N60 |
A
valid NDC is required for payment of drug claims effective October 02. |
| N61 |
Rebill
services on separate claims. |
| N62 |
Inpatient
admission spans multiple rate periods. Resubmit separate claims. |
| N63 |
Rebill
services on separate claim lines. |
| N64 |
The
“from” and “to” dates must be different. |
| N65 |
Procedure
code or procedure rate count cannot be determined, or was not on file,
for the date of service/provider. |
| N66 |
Missing/incomplete/invalid
documentation. |
| N69 |
PPS
(Prospective Payment System) code changed by claims processing system.
Insufficient visits or therapies. |
| N70 |
Home
health consolidated billing and payment applies. |
| N71 |
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. |
| N72 |
PPS
(Prospective Payment System) code changed by medical reviewers. Not
supported by clinical records. |
| N73 |
A
Skilled Nursing Facility is responsible for payment of outside providers
who furnish these services/supplies under arrangement to its residents. |
| N74 |
Resubmit
with multiple claims, each claim covering services provided in only one
calendar month. |
| N75 |
Missing/incomplete/invalid
tooth surface information. |
| N76 |
Missing/incomplete/invalid
number of riders. |
| N77 |
Missing/incomplete/invalid
designated provider number. |
| N78 |
The
necessary components of the child and teen checkup (EPSDT) were not
completed. |
| N79 |
Service
billed is not compatible with patient location information. |
| N80 |
Missing/incomplete/invalid
prenatal screening information. |
| N81 |
Procedure
billed is not compatible with tooth surface code. |
| N82 |
Provider
must accept insurance payment as payment in full when a third party
payer contract specifies full reimbursement. |
| N83 |
No
appeal rights. Adjudicative decision based on the provisions of a
demonstration project. |
| N84 |
Further
installment payments forthcoming. |
| N85 |
Final
installment payment. |
| N86 |
A
failed trial of pelvic muscle exercise training is required in order for
biofeedback training for the treatment of urinary incontinence to be
covered. |
| N87 |
Home
use of biofeedback therapy is not covered. |
| N89 |
Payment
information for this claim has been forwarded to more than one other
payer, but format limitations permit only one of the secondary payers to
be identified in this remittance advice. |
| N90 |
Covered
only when performed by the attending physician. |
| N91 |
Services
not included in the appeal review. |
| N92 |
This
facility is not certified for digital mammography. |
| N93 |
A
separate claim must be submitted for each place of service. Services
furnished at multiple sites may not be billed in the same claim. |
| N94 |
Claim/Service
denied because a more specific taxonomy code is required for
adjudication. |
| N95 |
This
provider type/provider specialty may not bill this service. |
| N96 |
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. |
| N97 |
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. |
| N99 |
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. |
| N100 |
PPS
(Prospect Payment System) code corrected during adjudication. |
| N102 |
This
claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely. |
| N104 |
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.hhs.gov. |
| N105 |
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 866-749-4301 for RRB EDI information for electronic claims
processing. |
| N106 |
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. |
| N107 |
Services
furnished to Skilled Nursing Facility (SNF) inpatients must be billed on
the inpatient claim. They cannot be billed separately as outpatient
services. |
| N108 |
Missing/incomplete/invalid
upgrade information. |
| N109 |
This
claim was chosen for complex review and was denied after reviewing the
medical records. |
| N110 |
This
facility is not certified for film mammography. |
| N111 |
No
appeal right except duplicate claim/service issue. This service was
included in a claim that has been previously billed and adjudicated. |
| N112 |
This
claim is excluded from your electronic remittance advice. |
| N113 |
Only
one initial visit is covered per physician, group practice or provider. |
| N117 |
This
service is paid only once in a patient’s lifetime. |
| N118 |
This
service is not paid if billed more than once every 28 days. |
| N119 |
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. |
| N120 |
Payment
is subject to home health prospective payment system partial episode
payment adjustment. Patient was transferred/discharged/readmitted during
payment episode. |
| N121 |
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. |
| N122 |
Add-on
code cannot be billed by itself. |
| N123 |
This
is a split service and represents a portion of the units from the
originally submitted service. |
| N126 |
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. |
| N127 |
This
is a misdirected claim/service for a United Mine Workers of America (UMWA)
beneficiary. Please submit claims to them. |
| N128 |
This
amount represents the prior to coverage portion of the allowance. |
| N129 |
This
amount represents the dollar amount not eligible due to the patient's
age. |
| N130 |
Consult
plan benefit documents for information about restrictions for this
service. |
| N131 |
Total
payments under multiple contracts cannot exceed the allowance for this
service. |
| N132 |
Payments
will cease for services rendered by this US Government debarred or
excluded provider after the 30 day grace period as previously notified. |
| N133 |
Services
for predetermination and services requesting payment are being processed
separately. |
| N134 |
This
represents your scheduled payment for this service. If treatment has
been discontinued, please contact Customer Service. |
| N135 |
Record
fees are the patient's responsibility and limited to the specified
co-payment. |
| N136 |
To
obtain information on the process to file an appeal in Arizona, call the
Department's Consumer Assistance Office at (602) 912-8444 or (800)
325-2548. |
| N141 |
The
patient was not residing in a long-term care facility during all or part
of the service dates billed. |
| N142 |
The
original claim was denied. Resubmit a new claim, not a replacement
claim. |
| N143 |
The
patient was not in a hospice program during all or part of the service
dates billed. |
| N144 |
The
rate changed during the dates of service billed. |
| N145 |
Missing/incomplete/invalid
provider identifier for this place of service. |
| N146 |
Missing
screening document. |
| N147 |
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. |
| N148 |
Missing/incomplete/invalid
date of last menstrual period. |
| N149 |
Rebill
all applicable services on a single claim. |
| N150 |
Missing/incomplete/invalid
model number. |
| N151 |
Telephone
contact services will not be paid until the face-to-face contact
requirement has been met. |
| N152 |
Missing/incomplete/invalid
replacement claim information. |
| N153 |
Missing/incomplete/invalid
room and board rate. |
| N154 |
This
payment was delayed for correction of provider's mailing address. |
| N155 |
Our
records do not indicate that other insurance is on file. Please submit
other insurance information for our records. |
| N156 |
The
patient is responsible for the difference between the approved treatment
and the elective treatment. |
| N157 |
Transportation
to/from this destination is not covered. |
| N158 |
Transportation
in a vehicle other than an ambulance is not covered. |
| N159 |
Payment
denied/reduced because mileage is not covered when the patient is not in
the ambulance. |
| N160 |
The
patient must choose an option before a payment can be made for this
procedure/ equipment/ supply/ service. |
| N161 |
This
drug/service/supply is covered only when the associated service is
covered. |
| N162 |
This
is an alert. Although your claim was paid, you have billed for a
test/specialty not included in your Laboratory Certification. Your
failure to correct the laboratory certification information will result
in a denial of payment in the near future. |
| N163 |
Medical
record does not support code billed per the code definition. |
| N164 |
Transportation
to/from this destination is not covered. |
| N165 |
Transportation
in a vehicle other than an ambulance is not covered. |
| N166 |
Payment
denied/reduced because mileage is not covered when the patient is not in
the ambulance. |
| N167 |
Charges
exceed the post-transplant coverage limit. |
| N168 |
|