co 256 denial code descriptions

Reason Code 145: Information from another provider was not provided or was insufficient/incomplete. Another code to be established and/or for 06/2008 meeting for a revised code to replace or strategy to use another existing code, This dual eligible patient is covered by Medicare Part D per Medicare Retro-Eligibility. Reason Code 210: Non-compliance with the physician self-referral prohibition legislation or payer policy. Reason Code 236: Claim spans eligible and ineligible periods of coverage. Reason Code 3: The procedure/revenue code is inconsistent with the patient's age. This care may be covered by another payer per coordination of benefits. ), Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period (use Group Code PR). The expected attachment/document is still missing. Diagnosis was invalid for the date(s) of service reported. Requested information was not provided or was insufficient/incomplete. Expenses incurred during lapse in coverage, Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. Precertification/authorization/notification/pre-treatment absent. Usage: To be used for pharmaceuticals only. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Reason Code 100: Provider promotional discount (e.g., Senior citizen discount). Note - Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions. Note: Refer to the835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Reason Code 93: Non-covered charge(s). Procedure/treatment is deemed experimental/investigational by the payer. Reason Code 1: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code. Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Submit these services to the patient's medical plan for further consideration. Reason Code 129: Prearranged demonstration project adjustment. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The procedure code is inconsistent with the modifier used or a required modifier is missing. Are you looking for more than one billing quotes ? The procedure/revenue code is inconsistent with the type of bill. (Use only with Group Code OA). Reason Code 209: Administrative surcharges are not covered. 5 The procedure code/bill type is inconsistent with the place of service. Claim/service does not indicate the period of time for which this will be needed. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). (Use only with Group Codes CO or PI) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Note - Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions. (Use only with Group Code OA). Reason Code 11: The date of birth follows the date of service. The diagnosis is inconsistent with the provider type. Reason Code 254: The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements. The referring provider is not eligible to refer the service billed. We are receiving a denial with the claim adjustment reason code (CARC) PR B9. X12 standards are the workhorse of business to business exchanges proven by the billions of daily transactions within and across many industries including: X12 has developed standards and associated products to facilitate the transmission of electronic business messages for over 40 years. This procedure is not paid separately. WebDENY-NDC UNITS OF MEASURE MISSING OR INVALID 18 33 DENIED - THIS SERVICE IS AN EXACT DUPLICATE OF A PRIOR CLAIM MA67 22 *ADJUSTMENT - DENY, TAKEBACK DUPLICATE PAYMENT 2a ADJUSTMENT - DENIED, THIS IS A DUPLICATE CLAIM M13 N113 lM DENIED - SERVICE LIMITED TO 1 PER 3 YEARS, SAME PROV 239a Prior processing information appears incorrect. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment. Claim lacks indication that plan of treatment is on file. Claim/service lacks information which is needed for adjudication. Deductible waived per contractual agreement. This Payer not liable for claim or service/treatment. Reason Code 130: The disposition of the claim/service is pending further review. This feedback is used to inform X12's decision-making processes, policies, and question and answer resources. The hospital must file the Medicare claim for this inpatient non-physician service. Payment denied because service/procedure was provided outside the United States or as a result of war. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. ), Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. Webco 256 denial code descriptionspan peninsula canary wharf service charge co 256 denial code descriptions. Usage: Use this code when there are member network limitations. This change effective 7/1/2013: This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. House Votes (7) Date Action Motion Vote Vote Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). (Use CARC 45), Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Handled in QTY, QTY01=CD), Patient Interest Adjustment (Use Only Group code PR). Discount agreed to in Preferred Provider contract. Failure to follow prior payer's coverage rules. The attachment/other documentation that was received was incomplete or deficient. For better reference, thats $1.5M in denied claims waiting for resubmission. Reason Code 187: Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. Low Income Subsidy (LIS) Co-payment Amount. Chartered by the American National Standards Institute for more than 40 years, X12 develops and maintains EDI standards and XML schemas which drive business processes globally. Content is added to this page regularly. Reimbursement vs Contract rate updates. Payer deems the information submitted does not support this day's supply. (Use only with Group Code PR) At least on remark code must be provider (may be comprised of either the NCPDP Reject Reason Code or Remittance Advice Remark Code that is not an alert.). Administrative surcharges are not covered. To be used for Workers' Compensation only. Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Information from another provider was not provided or was insufficient/incomplete. This change effective 7/1/2013: Claim is under investigation. Lifetime reserve days. Charges are covered under a capitation agreement/managed care plan. Using this comprehensive reason code list, you can correct and resubmit the claims to payer. The hospital must file the Medicare claim for this inpatient non-physician service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Reason Code 234: Legislated/Regulatory Penalty. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). Reason Code 249: An attachment is required to adjudicate this claim/service. You must send the claim/service to the correct payer/contractor. HIPAA Compliant. Reason Code 114: Transportation is only covered to the closest facility that can provide the necessary care. This payment is adjusted based on the diagnosis. To be used for Property and Casualty only. Refund to patient if collected. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Reason Code 172: Prescription is incomplete. This injury/illness is the liability of the no-fault carrier. To be used for P&C Auto only. Denial code CO16 is a Contractual Obligation claim adjustment reason code (CARC). Not covered unless the provider accepts assignment. Low Income Subsidy (LIS) Co-payment Amount. Claim has been forwarded to the patient's vision plan for further consideration. Usage: Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions. Reason Code 26: The time limit for filing has expired. Reason Code 76: Cost Report days. Reason Code A2: Medicare Claim PPS Capital Cost Outlier Amount. (Use Group Codes PR or CO depending upon liability). Reason Code 33: Balance does not exceed co-payment amount. Ingredient cost adjustment. Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT. Reason Code 52: Procedure/treatment is deemed experimental/investigational by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. ), Reason Code 14: Requested information was not provided or was insufficient/incomplete. Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.

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