N275 Missing/incomplete/invalid other payer purchased service provider identifier. M56 Missing/incomplete/invalid payer identifier. 89 Professional fees removed from charges. appropriate specific adjustment code. N69 PPS (Prospective Payment System) code changed by claims processing system. Physicians must report services correctly. N98 Patient must have had a successful test stimulation in order to support subsequent primary payment. N255 Missing/incomplete/invalid billing provider taxonomy. Note: MA23 Demand bill approved as result of medical review. extensive) service/item. supplier or taken while the patient is on oxygen. MA27 Missing/incomplete/invalid entitlement number or name shown on the claim. support this level of service. M106 Information supplied does not support a break in therapy. urgent condition for which care has not been rendered. Note: (New Code 12/2/04) Note: Inactive for 004030, since 6/99. 010 The diagnosis is inconsistent with the patients gender. 3005: Denied due to The Member's First Name Is Missing Or Incorrect. Note: (Deactivated eff. Note: (Modified 12/2/04) Related to N301 9 The diagnosis is inconsistent with the patients age. N326 Missing/incomplete/invalide last x-ray date. for this service; or If you notified the patient in writing before providing the service N137 The provider acting on the Members behalf, may file an appeal with the Payer. Note: (Modified 2/28/03) You will be notified HSP and entered into item #32 on the claim form. M61 We cannot pay for this as the approval period for the FDA clinical trial has expired. Use code 96. Note: Inactive as of version 5010. Note: Inactive for 003040 Note: (Modified 8/1/04, 2/28/03) Related to N240 identification number. demonstration project. N221 Missing Admitting History and Physical report. to know that we would not pay for this level of service, or if you notified the patient in can provide the necessary care. These codes provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or convey information about remittance processing. Additional information is MA96 Claim rejected. JavaScript is disabled. N119 This service is not paid if billed once every 28 days, and the patient has spent 5 or MA129 This provider was not certified for this procedure on this date of service. Note: New as of 6/99 021 INVALID FORMER REFNO FORMER REFERENCE NUMBER MISSING OR INVALID 2 16 M47 464 No additional rights to appeal this decision, above those rights already N264 Missing/incomplete/invalid ordering provider name. 173 Payment adjusted because this service was not prescribed by a physician difference between our allowed amount total and the amount paid by the patient. All our content are education purpose only. N36 Claim must meet primary payers processing requirements before we can consider Note: (Modified 6/30/03) Note: (Deactivated eff. hellcat vs p938; simple small front yard landscaping ideas low maintenance; jenny's super stretchy bind off in the round; senate democratic media center Note: (New Code 12/2/04) N294 Missing/incomplete/invalid service facility primary address. Note: Inactive for 004030, since 6/99. N314 Missing/incomplete/invalid diagnosis date. Note: (New Code 10/31/02) D5 Claim/service denied. M8 We do not accept blood gas tests results when the test was conducted by a medical 014 IMM COMPL MISS/INVLD IMMUN COMPLETE AND CURRENT FOR THIS AGE PATIENT MISSING 133 021 331 564 Note: Changed as of 2/01 N279 Missing/incomplete/invalid pay-to provider name. Note: (Deactivated eff. Note: (Modified 2/1/04) Related to N242 3 Co-payment Amount 133 The disposition of this claim or service is pending further review. N116 This payment is being made conditionally because the service was provided in the Medicaid denial reason code list | Medicare denial codes, reason 1 Deductible Amount. filed for this patient. 134 Technical fees removed from charges. physician. N340 Missing/incomplete/invalid subscriber birth date. Decisions made by a Quality Improvement Organization (QIO) must be appealed to This code will be deactivated on 2/1/2006. 8/1/04) Consider using Reason Code B20 taxes paid directly to the regulatory authority. M128 Missing/incomplete/invalid date of the patients last physician visit. Note: Changed as of 6/01 Please submit a separate claim for each interpreting payment for this service if billed without a G1-G5 modifier. Offer. 051 INV BLOOD/PINT CHG BLOOD CHARGE PER PINT INVALID 133 021 235 service(s) were rendered in a Health Professional Shortage Area (HPSA). 012 ORG CLM W/ADJ/VD CDE ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID REASON CODE 2 16 MA30 021 521 Separate payment is not allowed. Note: (Modified 2/28/03, 3/30/05) 31 Medical Billing Question and Answer Terms, EVALUATION AND MANAGEMENT CPT code [99201-99499] Full List, Internal Medical Billing Audit how to do. In 004010, CAS at the claim level is optional. D7 Claim/service denied. M5 Monthly rental payments can continue until the earlier of the 15th month from the first Submit paper claims to the RRB carrier: Palmetto GBA, P.O. The advance indemnification notice signed by the patient did not Note: New as of 6/99 Note: New as of 9/03 NEED EOB FOR EACH CARRIER INDICATED ON RESOURCE FILE 1 251 N4 286, 034 22 MOD.NOT JUSTIFIED 22 MOD.SERVICES NOT JUSTIFIED/PAID AT UNMODIFIED RATE 3 150 047, 035 REBILL CORRECT HCPC ASC,OP FAC/PHYS.BILLED DIFF CODE;REBILL CORRECT HCPC 2 16 M20 454, 037 MEDICARE ADJUSTMENT MEDICARE ADJUSTMENT/VOID,ADJUST OR ADJUST MEDICARE CLAI 1 252 N4 101, 038 99297-52 NICU REDUCE 99297-52 NICU PAID AT REDUCED RATE 3 150 628, 039 MOD.NOT USED FOR CLM MODIFIER NOT USED TO PROCESS CLAIM 2 4 N519 453, 040 INV ADMISSION DATE ADMISSION DATE MISSING OR INVALID 2 16 MA40 189, 042 INVALID UB92 BILL CD INVALID UB92 TYPE BILL CODE 2 16 MA30 228, 043 INV ATTENDING PHYS ATTENDING PHYSICIAN NUMBER NOT NUMERIC 2 16 N290 132, 044 INV NATURE OF ADMIT NATURE OF ADMISSION MISSING OR INVALID 2 16 MA41 231, 045 INV PATIENT STATUS PATIENT STATUS CODE INVALID OR MISSING 2 16 MA43 021 431, 046 NOT USED AVAILABLE NOT USED AVAILABLE 2 16 M59 021 387, 047 NOT USED AVAILABLE NOT USED AVAILABLE 2 16 M59 021 387, 048 INVALID/MISS PROC INVALID OR MISSING PROCEDURE CODE 2 16 M51 021 454, 049 INV/CONFLIC SURG DTE INVALID/CONFLICT SURGICAL DATE 2 16 N301 021 666, 050 INV BLOOD NOT REPL BLOOD NOT REPLACED AMOUNT INVALID 133 021 236, 051 INV BLOOD/PINT CHG BLOOD CHARGE PER PINT INVALID 133 021 235, 052 >12 MONTH QTY LIMIT > 12 MONTH QTY LIMIT MD FAX OVERRIDE FORM 866-797-2329 3 198 N351. 6/2/05) List of 82 best WRD meaning forms based on popularity. Note: (Modified 6/30/03) N315 Missing/incomplete/invalid disability from date. Note: (New Code 10/31/02) Medicaid Claim Denial Codes M25 Payment has been adjusted because the information furnished does not substantiate covered as billed, or if you did not know and could not reasonably have been expected test or the amount you were charged for the test. M131 Missing physician financial relationship form. N258 Missing/incomplete/invalid billing provider/supplier address. N163 Medical record does not support code billed per the code definition. Note: (New Code 10/31/02) enrolled in Medicare Part B, the member is responsible for payment of the portion of M111 We do not pay for chiropractic manipulative treatment when the patient refuses to information only and does not make the physician or supplier a party to the MA15 Your claim has been separated to expedite handling. N149 Rebill all applicable services on a single claim. The state Medicaid agency is required to send written denial notice to the applicant. Services from -, 001 INVALID CLM TYP MOD INVALID CLAIM TYPE MODIFIER 2 16 N34 021, 002 INVALID PROVIDER NO PROVIDER NUMBER MISSING OR NOT NUMERIC 2 16 N77 021 153, 003 RECIPIENT # INVALID RECIPIENT NUMBER INVALID OR LESS THAN 13 DIGITS 3 31 021 153, 005 INVAL SERV FROM DATE SERVICE FROM DATE MISSING/INVALID 2 16 M52 021 188, 006 INVAL SERV THRU DATE INVALID OR MISSING THRU DATE 2 16 M59 021 188, 007 SERV THRU LT SERV FM SERVICE THRU DATE LESS THAN SERVICE FROM DATE 2 16 MA31 021 188, 008 SERV FRM GT ENTR DTE SERVICE FROM DATE LATER THAN DATE PROCESSED 2 110 021 188, 009 SERV THR GT ENTR DTE SERVICE THRU DATE GREATER THAN DATE OF ENTRY 2 16 MA31 021 188, 010 INV PRIOR AUTH DATE PRIOR AUTHORIZATION DATE NOT NUMERIC 133 252, 011 INVALID TPL INDICATR TPL INDICATOR NOT Y, N, OR SPACE 2 16 MA92 021 361, 012 ORG CLM W/ADJ/VD CDE ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID REASON CODE 2 16 MA30 021 521, 013 ORG CLM W ADJ/VD ICN ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID ICN 2 16 MA30 021 584, 014 IMM COMPL MISS/INVLD IMMUN COMPLETE AND CURRENT FOR THIS AGE PATIENT MISSING 133 021 331 564, 015 NOT USED AVAILABLE NOT USED AVAILABLE 2 16 N305 365, 016 NOT USED AVAILABLE NOT USED AVAILABLE 2 16 N305 365, 017 NOT USED AVAILABLE NOT USED AVAILABLE 133 021 564, 020 INVAL/MISS DIAG CODE INVALID OR MISSING DIAGNOSIS CODE 2 16 MA63 255, 021 INVALID FORMER REFNO FORMER REFERENCE NUMBER MISSING OR INVALID 2 16 M47 464, 022 INVALID BILLED CHRGS BILLED CHARGES MISSING OR NOT NUMERIC 2 16 M79 178, 023 INV PARTIAL RECIP RECIPIENT NAME IS MISSING 2 16 MA36 021 504, 024 INV BILLING PROV NO BILLING PROVIDER NUMBER NOT NUMERIC 2 16 N257 021 153, 025 IMM NOT COMP RSN MIS IMMUN NOT COMPLETE AND CURRENT REASON CODE MISSING 133 021 331 564, 026 INVALID TOT DOC CHG TOTAL DOCUMENT CHARGE MISSING OR NOT NUMERIC 2 16 M54 178, 027 PROC NEEDS DOCUMENT. 35 Lifetime benefit maximum has been reached. Payment Use code 16 and remark codes if necessary. Whether an applicant is required to request the appeal in writing or not will depend on state rules (and should be included in the notice). 142 Claim adjusted by the monthly Medicaid patient liability amount. 3004: Denied due to The Member's Last Name Is Incorrect. Note: (Deactivated eff. Note: (Modified 2/28/03) approved payment for this item at a reduced level, and a new capped rental period will writing, to act as his/her representative and you disagree with the Dental Advisors D4 Claim/service does not indicate the period of time for which this will be needed. N274 Missing/incomplete/invalid other payer other provider identifier. 043 INV ATTENDING PHYS ATTENDING PHYSICIAN NUMBER NOT NUMERIC 2 16 N290 132 M55 We do not pay for self-administered anti-emetic drugs that are not administered with a Note: Changed as of 6/03 comply with requirements. Note: (Modified 2/28/03) PDF Medicaid NCCI 2021 Coding Policy Manual - Chap1GenCodingPrin MA102 Missing/incomplete/invalid name or provider identifier for the rendering/referring/ equipment that requires the part or supply was missing. Modified 6/30/03) Assuming this requirement is met, the primary factor for determining eligibility is income, which is based on the Modified Adjusted Gross Income (MAGI). 052 The referring or prescribing or rendering provider is not eligible to refer or prescribe or order or perform the service billed. Note: (New Code 2/28/03) 120 Patient is covered by a managed care plan. 70 Cost outlier Adjustment to compensate for additional costs. Double click it to see the full image. N334 Missing/incomplete/invalid re-evaluation date Claim lacks invoice or statement certifying the actual cost of the For example, they may have been lost or misinterpreted by the person reviewing the application. 8/1/04) Consider using M68 The process for appealing a denial will vary depending on the state, but there are some basic federal rules that states must follow. To advance the health, wellness and independence of those we serve. N351 Service date outside of the approved treatment plan service dates. A8 Claim denied; ungroupable DRG Note: New as of 9/03 MA112 Missing/incomplete/invalid group practice information. of Labor, Federal Black Lung Program, P.O. Note: (New Code 10/31/02) Note: (Modified 2/1/04) Claim does not identify who performed the purchased diagnostic Note: (New Code 12/2/04) illegible. 156 Flexible spending account payments Resubmit claim after corrections. Note: (Modified 2/28/03) make the request through this office. Note: (New Code 4/1/04) 1/31/04) Consider using N161 MA50 Missing/incomplete/invalid Investigational Device Exemption number for FDA-approved M140 Service not covered until after the patients 50th birthday, i.e., no coverage prior to complete/correct information. of the 15th paid rental month or the end of the warranty period. for RRB EDI information for electronic claims processing. Note: (New Code 12/2/04) 184 The prescribing/ordering provider is not eligible to prescribe/order the service billed. 1/31/04) Consider using N158) Note: (New Code 12/2/04) MA128 Missing/incomplete/invalid FDA approval number. remark code [M32, M33]. Note: (New Code 10/31/02) Note: (Modified 2/28/03, 8/1/05) Related to N225 At the reconsideration, you must present any new evidence MA71 Missing/incomplete/invalid provider representative signature date. Note: (New Code 8/1/05) N353 Benefits have been estimated, when the actual services have been rendered, In addition, a doctor licensed to practice in the Note: (Modified 2/28/03) documents. N267 Missing/incomplete/invalid ordering provider secondary identifier. Note: (New Code 10/31/02) 12 The diagnosis is inconsistent with the provider type. M21 Missing/incomplete/invalid place of residence for this service/item provided in a home. Note: (New Code 12/2/04) N282 Missing/incomplete/invalid pay-to provider secondary identifier. MA84 Patient identified as participating in the National Emphysema Treatment Trial but our Note: (Modified 2/28/03) Note: (Deactivated eff. Note: (Modified 12/2/04) Plan procedures not followed. use of an urethral catheter for convenience or the control of incontinence. MA74 This payment replaces an earlier payment for this claim that was either lost, damaged N228 Incomplete/invalid consent form. Send any questions regarding supplemental benefits to them. Note: (New Code 2/28/03) Note: New as of 6/02 Note: (Modified 2/28/03) Related to N234 Note: (Deactivated eff. hb```b``fg`e`bb@ !P0gU/0'2|: ^Q~Bfk B,MDX~p{%M/lp;0I1r |%Q_~a7y,q'{"v.J.)eqy.l=$(>`G9::\h~T~._fsd1ujYQHBJV,XtD/@+2+yH.clY_*vQQIm*k)|-z\HjnjQG# -wm]pGn\S`sr=@gE,j yP of this, we are paying this time. This is the maximum approved under the fee schedule for this item or Note: New as of 10/02 we establish that the patient is concurrently receiving treatment under a HHA episode N38 Missing/incomplete/invalid place of service. N26 Missing itemized bill. WRD Meanings | What Does WRD Stand For? - All Acronyms