| X12

Remittance Advice Remark Codes

Code List ID

411

Code List Scope Statement

These codes provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or convey information about remittance processing.

Code List Maintained By

CMS

Code List Updated Date

Tue, 07/01/2025 - 12:00

Code List Table

M1	X-ray not taken within the past 12 months or near enough to the start of treatment. Start: 01/01/1997
M2	Not paid separately when the patient is an inpatient. Start: 01/01/1997
M3	Equipment is the same or similar to equipment already being used. Start: 01/01/1997
M4	Alert: This is the last monthly installment payment for this durable medical equipment. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
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. Start: 01/01/1997
M6	Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment. Start: 01/01/1997 \| Last Modified: 03/01/2009 Notes: (Modified 4/1/07, 3/1/2009)
M7	No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price. Start: 01/01/1997 \| Last Modified: 11/01/2016 Notes: (Modified 11/1/2016)
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. Start: 01/01/1997
M9	Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
M10	Equipment purchases are limited to the first or the tenth month of medical necessity. Start: 01/01/1997
M11	DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code. Start: 01/01/1997
M12	Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim. Start: 01/01/1997
M13	Only one initial visit is covered per specialty per medical group. Start: 01/01/1997 \| Last Modified: 06/30/2007 Notes: (Modified 6/30/03)
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. Start: 01/01/1997
M15	Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed. Start: 01/01/1997
M16	Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Reactivated 4/1/04, Modified 11/18/05, 4/1/07)
M17	Alert: Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
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. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
M19	Missing oxygen certification/re-certification. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N234
M20	Missing/incomplete/invalid HCPCS. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M21	Missing/incomplete/invalid place of residence for this service/item provided in a home. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M22	Missing/incomplete/invalid number of miles traveled. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M23	Missing invoice. Start: 01/01/1997 \| Last Modified: 08/01/2005 Notes: (Modified 8/1/05)
M24	Missing/incomplete/invalid number of doses per vial. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M25	The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment. Start: 01/01/1997 \| Last Modified: 11/01/2010 Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07, 11/1/10)
M26	The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service/any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice. The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office. Start: 01/01/1997 \| Last Modified: 11/05/2007 Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356)
M27	Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office. Start: 01/01/1997 \| Last Modified: 08/01/2007 Notes: (Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07)
M28	This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available. Start: 01/01/1997
M29	Missing operative note/report. Start: 01/01/1997 \| Last Modified: 07/01/2008 Notes: (Modified 2/28/03, 7/1/2008) Related to N233
M30	Missing pathology report. Start: 01/01/1997 \| Last Modified: 08/01/2004 Notes: (Modified 8/1/04, 2/28/03) Related to N236
M31	Missing radiology report. Start: 01/01/1997 \| Last Modified: 08/01/2004 Notes: (Modified 8/1/04, 2/28/03) Related to N240
M32	Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
M33	Missing/incomplete/invalid UPIN for the ordering/referring/performing provider. Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using M68
M34	Claim lacks the CLIA certification number. Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using MA120
M35	Missing/incomplete/invalid pre-operative photos or visual field results. Start: 01/01/1997 \| Stop: 02/05/2005 Notes: Consider using N178
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. Start: 01/01/1997
M37	Not covered when the patient is under age 35. Start: 01/01/1997 \| Last Modified: 03/08/2011 Notes: (Modified 3/8/11)
M38	Alert: The patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not pay for it and the patient agreed to be responsible for the charges. Start: 01/01/1997 \| Last Modified: 07/01/2015 Notes: (Modified 7/1/15)
M39	Alert: The patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with program requirements. Start: 01/01/1997 \| Last Modified: 07/01/2015 Notes: (Modified 2/1/04, 4/1/07, 11/1/09, 11/1/12, 7/1/15) Related to N563
M40	Claim must be assigned and must be filed by the practitioner's employer. Start: 01/01/1997
M41	We do not pay for this as the patient has no legal obligation to pay for this. Start: 01/01/1997
M42	The medical necessity form must be personally signed by the attending physician. Start: 01/01/1997
M43	Payment for this service previously issued to you or another provider by another carrier/intermediary. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using Reason Code 23
M44	Missing/incomplete/invalid condition code. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M45	Missing/incomplete/invalid occurrence code(s). Start: 01/01/1997 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04) Related to N299
M46	Missing/incomplete/invalid occurrence span code(s). Start: 01/01/1997 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04) Related to N300
M47	Missing/incomplete/invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN). Start: 01/01/1997 \| Last Modified: 07/01/2015 Notes: (Modified 2/28/03, 7/1/15)
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. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using M97
M49	Missing/incomplete/invalid value code(s) or amount(s). Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M50	Missing/incomplete/invalid revenue code(s). Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M51	Missing/incomplete/invalid procedure code(s). Start: 01/01/1997 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04) Related to N301
M52	Missing/incomplete/invalid 'from' date(s) of service. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M53	Missing/incomplete/invalid days or units of service. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M54	Missing/incomplete/invalid total charges. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M55	We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug. Start: 01/01/1997
M56	Missing/incomplete/invalid payer identifier. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M57	Missing/incomplete/invalid provider identifier. Start: 01/01/1997 \| Stop: 06/02/2005
M58	Missing/incomplete/invalid claim information. Resubmit claim after corrections. Start: 01/01/1997 \| Stop: 02/05/2005
M59	Missing/incomplete/invalid 'to' date(s) of service. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M60	Missing Certificate of Medical Necessity. Start: 01/01/1997 \| Last Modified: 08/01/2004 Notes: (Modified 8/1/04, 6/30/03) Related to N227
M61	We cannot pay for this as the approval period for the FDA clinical trial has expired. Start: 01/01/1997
M62	Missing/incomplete/invalid treatment authorization code. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M63	We do not pay for more than one of these on the same day. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using M86
M64	Missing/incomplete/invalid other diagnosis. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
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. Start: 01/01/1997
M66	Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items. Start: 01/01/1997
M67	Missing/incomplete/invalid other procedure code(s). Start: 01/01/1997 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04) Related to N302
M68	Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification. Start: 01/01/1997 \| Stop: 06/02/2005
M69	Paid at the regular rate as you did not submit documentation to justify the modified procedure code. Start: 01/01/1997 \| Last Modified: 02/01/2004 Notes: (Modified 2/1/04)
M70	Alert: The 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. Start: 01/01/1997 \| Last Modified: 08/01/2007 Notes: (Modified 4/1/2007, 8/1/07)
M71	Total payment reduced due to overlap of tests billed. Start: 01/01/1997
M72	Did not enter full 8-digit date (MM/DD/CCYY). Start: 01/01/1997 \| Stop: 10/16/2003 Notes: Consider using MA52
M73	The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components. Start: 01/01/1997 \| Last Modified: 08/01/2004 Notes: (Modified 8/1/04)
M74	This service does not qualify for a HPSA/Physician Scarcity bonus payment. Start: 01/01/1997 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04)
M75	Multiple automated multichannel tests performed on the same day combined for payment. Start: 01/01/1997 \| Last Modified: 11/05/2007 Notes: (Modified 11/5/07)
M76	Missing/incomplete/invalid diagnosis or condition. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M77	Missing/incomplete/invalid/inappropriate place of service. Start: 01/01/1997 \| Last Modified: 03/14/2014 Notes: (Modified 2/28/03, 3/1/2014, 3/14/2014)
M78	Missing/incomplete/invalid HCPCS modifier. Start: 01/01/1997 \| Stop: 05/18/2006 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03,) Consider using Reason Code 4
M79	Missing/incomplete/invalid charge. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M80	Not covered when performed during the same session/date as a previously processed service for the patient. Start: 01/01/1997 \| Last Modified: 10/31/2002 Notes: (Modified 10/31/02)
M81	You are required to code to the highest level of specificity. Start: 01/01/1997 \| Last Modified: 02/01/2004 Notes: (Modified 2/1/04)
M82	Service is not covered when patient is under age 50. Start: 01/01/1997
M83	Service is not covered unless the patient is classified as at high risk. Start: 01/01/1997
M84	Medical code sets used must be the codes in effect at the time of service. Start: 01/01/1997 \| Last Modified: 03/14/2014 Notes: (Modified 2/1/04, 3/14/2014)
M85	Subjected to review of physician evaluation and management services. Start: 01/01/1997
M86	Service denied because payment already made for same/similar procedure within set time frame. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
M87	Claim/service(s) subjected to CFO-CAP prepayment review. Start: 01/01/1997
M88	We cannot pay for laboratory tests unless billed by the laboratory that did the work. Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using Reason Code B20
M89	Not covered more than once under age 40. Start: 01/01/1997
M90	Not covered more than once in a 12 month period. Start: 01/01/1997
M91	Lab procedures with different CLIA certification numbers must be billed on separate claims. Start: 01/01/1997
M92	Services subjected to review under the Home Health Medical Review Initiative. Start: 01/01/1997 \| Stop: 08/01/2004
M93	Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment. Start: 01/01/1997
M94	Information supplied does not support a break in therapy. A new capped rental period will not begin. Start: 01/01/1997
M95	Services subjected to Home Health Initiative medical review/cost report audit. Start: 01/01/1997
M96	The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only. Start: 01/01/1997
M97	Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility. Start: 01/01/1997
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. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using M99
M99	Missing/incomplete/invalid Universal Product Number/Serial Number. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
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. Start: 01/01/1997
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. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using M78
M102	Service not performed on equipment approved by the FDA for this purpose. Start: 01/01/1997
M103	Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment. Start: 01/01/1997
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. Start: 01/01/1997
M105	Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin. Start: 01/01/1997
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. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using MA 31
M107	Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%. Start: 01/01/1997
M108	Missing/incomplete/invalid provider identifier for the provider who interpreted the diagnostic test. Start: 01/01/1997 \| Stop: 06/02/2005
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. Start: 01/01/1997
M110	Missing/incomplete/invalid provider identifier for the provider from whom you purchased interpretation services. Start: 01/01/1997 \| Stop: 06/02/2005
M111	We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken. Start: 01/01/1997
M112	Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides. Start: 01/01/1997 \| Last Modified: 11/05/2007 Notes: (Modified 11/5/07)
M113	Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program. Start: 01/01/1997 \| Last Modified: 11/05/2007 Notes: (Modified 11/5/07)
M114	This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor. Start: 01/01/1997 \| Last Modified: 11/05/2007 Notes: (Modified 8/1/06, 11/5/07)
M115	This item is denied when provided to this patient by a non-contract or non-demonstration supplier. Start: 01/01/1997 \| Last Modified: 11/05/2007 Notes: (Modified 11/5/2007)
M116	Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program. Start: 01/01/1997 \| Last Modified: 03/08/2011 Notes: (Modified 2/1/04, 3/15/11)
M117	Not covered unless submitted via electronic claim. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
M118	Letter to follow containing further information. Start: 01/01/1997 \| Stop: 01/01/2011 \| Last Modified: 11/01/2009 Notes: Consider using N202
M119	Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC). Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 2/28/03, 4/1/04)
M120	Missing/incomplete/invalid provider identifier for the substituting physician who furnished the service(s) under a reciprocal billing or locum tenens arrangement. Start: 01/01/1997 \| Stop: 06/02/2005
M121	We pay for this service only when performed with a covered cryosurgical ablation. Start: 01/01/1997
M122	Missing/incomplete/invalid level of subluxation. Start: 01/01/1997 \| Last Modified: 02/28/2006 Notes: (Modified 2/28/03)
M123	Missing/incomplete/invalid name, strength, or dosage of the drug furnished. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M124	Missing indication of whether the patient owns the equipment that requires the part or supply. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N230
M125	Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M126	Missing/incomplete/invalid individual lab codes included in the test. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M127	Missing patient medical record for this service. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N237
M128	Missing/incomplete/invalid date of the patient's last physician visit. Start: 01/01/1997 \| Stop: 06/02/2005
M129	Missing/incomplete/invalid indicator of x-ray availability for review. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 2/28/03, 6/30/03)
M130	Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N231
M131	Missing physician financial relationship form. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N239
M132	Missing pacemaker registration form. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N235
M133	Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test. Start: 01/01/1997
M134	Performed by a facility/supplier in which the provider has a financial interest. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
M135	Missing/incomplete/invalid plan of treatment. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M136	Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
M137	Part B coinsurance under a demonstration project or pilot program. Start: 01/01/1997 \| Last Modified: 11/01/2012 Notes: (Modified 11/1/12)
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. Start: 01/01/1997
M139	Denied services exceed the coverage limit for the demonstration. Start: 01/01/1997
M140	Service not covered until after the patient's 50th birthday, i.e., no coverage prior to the day after the 50th birthday Start: 01/01/1997 \| Stop: 01/30/2004 Notes: Consider using M82
M141	Missing physician certified plan of care. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N238
M142	Missing American Diabetes Association Certificate of Recognition. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N226
M143	The provider must update license information with the payer. Start: 01/01/1997 \| Last Modified: 12/01/2006 Notes: (Modified 12/1/06)
M144	Pre-/post-operative care payment is included in the allowance for the surgery/procedure. Start: 01/01/1997
MA01	Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07)
MA02	Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07)
MA03	If you do not agree with the approved amounts and $100 or more is in dispute (less deductible and coinsurance), you may ask for a hearing within six months of the date of this notice. To meet the $100, you may combine amounts on other claims that have been denied, including reopened appeals if you received a revised decision. You must appeal each claim on time. Start: 01/01/1997 \| Stop: 10/01/2006 \| Last Modified: 11/18/2005 Notes: Consider using MA02 (Modified 10/31/02, 6/30/03, 8/1/05, 11/18/05)
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. Start: 01/01/1997
MA05	Incorrect admission date patient status or type of bill entry on claim. Start: 01/01/1997 \| Stop: 10/16/2003 Notes: Consider using MA30, MA40 or MA43
MA06	Missing/incomplete/invalid beginning and/or ending date(s). Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using MA31
MA07	Alert: The claim information has also been forwarded to Medicaid for review. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA08	Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA09	Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement. Start: 01/01/1997 \| Last Modified: 11/01/2015 Notes: (Modified 11/1/2014, 11/1/2015)
MA10	Alert: The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA11	Payment is being issued on a conditional basis. If no-fault insurance, liability insurance, Workers' Compensation, Department of Veterans Affairs, or a group health plan for employees and dependents also covers this claim, a refund may be due us. Please contact us if the patient is covered by any of these sources. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using M32
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). Start: 01/01/1997
MA13	Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA14	Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services. Start: 01/01/1997 \| Last Modified: 08/01/2007 Notes: (Modified 4/1/07, 8/1/07)
MA15	Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
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. Start: 01/01/1997
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. Start: 01/01/1997
MA18	Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA19	Alert: 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. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
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. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
MA21	SSA records indicate mismatch with name and sex. Start: 01/01/1997
MA22	Payment of less than $1.00 suppressed. Start: 01/01/1997
MA23	Demand bill approved as result of medical review. Start: 01/01/1997
MA24	Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
MA25	A patient may not elect to change a hospice provider more than once in a benefit period. Start: 01/01/1997
MA26	Alert: Our records indicate that you were previously informed of this rule. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA27	Missing/incomplete/invalid entitlement number or name shown on the claim. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA28	Alert: Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA29	Missing/incomplete/invalid provider name, city, state, or zip code. Start: 01/01/1997 \| Stop: 06/02/2005
MA30	Missing/incomplete/invalid type of bill. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA31	Missing/incomplete/invalid beginning and ending dates of the period billed. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA32	Missing/incomplete/invalid number of covered days during the billing period. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA33	Missing/incomplete/invalid non-covered days during the billing period. Start: 01/01/1997 \| Last Modified: 03/01/2022 Notes: (Modified 2/28/03, 3/1/2022)
MA34	Missing/incomplete/invalid number of coinsurance days during the billing period. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA35	Missing/incomplete/invalid number of lifetime reserve days. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA36	Missing/incomplete/invalid patient name. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA37	Missing/incomplete/invalid patient's address. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA38	Missing/incomplete/invalid birth date. Start: 01/01/1997 \| Stop: 06/02/2005
MA39	Missing/incomplete/invalid gender. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA40	Missing/incomplete/invalid admission date. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA41	Missing/incomplete/invalid admission type. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA42	Missing/incomplete/invalid admission source. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA43	Missing/incomplete/invalid patient status. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA44	Alert: No appeal rights. Adjudicative decision based on law. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA45	Alert: As previously advised, a portion or all of your payment is being held in a special account. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA46	Alert: The new information was considered but additional payment will not be issued. Start: 01/01/1997 \| Last Modified: 11/01/2015 Notes: (Modified 3/1/2009, 11/1/2015)
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. Start: 01/01/1997
MA48	Missing/incomplete/invalid name or address of responsible party or primary payer. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA49	Missing/incomplete/invalid six-digit provider identifier for home health agency or hospice for physician(s) performing care plan oversight services. Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using MA76
MA50	Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number. Start: 01/01/1997 \| Last Modified: 03/01/2014 Notes: (Modified 2/28/03, 3/1/2014)
MA51	Missing/incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory. Start: 01/01/1997 \| Stop: 02/05/2005 Notes: Consider using MA120
MA52	Missing/incomplete/invalid date. Start: 01/01/1997 \| Stop: 06/02/2005
MA53	Missing/incomplete/invalid Competitive Bidding Demonstration Project identification. Start: 01/01/1997 \| Last Modified: 02/01/2004 Notes: (Modified 2/1/04)
MA54	Physician certification or election consent for hospice care not received timely. Start: 01/01/1997
MA55	Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services. Start: 01/01/1997
MA56	Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount. Start: 01/01/1997
MA57	Patient submitted written request to revoke his/her election for religious non-medical health care services. Start: 01/01/1997
MA58	Missing/incomplete/invalid release of information indicator. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA59	Alert: 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. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA60	Missing/incomplete/invalid patient relationship to insured. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA61	Missing/incomplete/invalid social security number. Start: 01/01/1997 \| Last Modified: 03/01/2018 Notes: (Modified 2/28/03, 3/1/2018)
MA62	Alert: This is a telephone review decision. Start: 01/01/1997 \| Last Modified: 08/01/2007 Notes: (Modified 4/1/07, 8/1/07)
MA63	Missing/incomplete/invalid principal diagnosis. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
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. Start: 01/01/1997
MA65	Missing/incomplete/invalid admitting diagnosis. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA66	Missing/incomplete/invalid principal procedure code. Start: 01/01/1997 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04) Related to N303
MA67	Alert: Correction to a prior claim. Start: 01/01/1997 \| Last Modified: 11/01/2015 Notes: (Modified 11/1/2015)
MA68	Alert: 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. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA69	Missing/incomplete/invalid remarks. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA70	Missing/incomplete/invalid provider representative signature. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA71	Missing/incomplete/invalid provider representative signature date. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA72	Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
MA73	Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care. Start: 01/01/1997
MA74	Alert: This payment replaces an earlier payment for this claim that was either lost, damaged or returned. Start: 01/01/1997 \| Last Modified: 07/01/2015 Notes: (Modified 7/1/15)
MA75	Missing/incomplete/invalid patient or authorized representative signature. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA76	Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03, 2/1/04)
MA77	Alert: 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. Start: 01/01/1997 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
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. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using MA59
MA79	Billed in excess of interim rate. Start: 01/01/1997
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. Start: 01/01/1997
MA81	Missing/incomplete/invalid provider/supplier signature. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA82	Missing/incomplete/invalid provider/supplier billing number/identifier or billing name, address, city, state, zip code, or phone number. Start: 01/01/1997 \| Stop: 06/02/2005
MA83	Did not indicate whether we are the primary or secondary payer. Start: 01/01/1997 \| Last Modified: 08/01/2005 Notes: (Modified 8/1/05)
MA84	Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy. Start: 01/01/1997
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. Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using MA92
MA86	Missing/incomplete/invalid group or policy number of the insured for the primary coverage. Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using MA92
MA87	Missing/incomplete/invalid insured's name for the primary payer. Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using MA92
MA88	Missing/incomplete/invalid insured's address and/or telephone number for the primary payer. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA89	Missing/incomplete/invalid patient's relationship to the insured for the primary payer. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA90	Missing/incomplete/invalid employment status code for the primary insured. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03).
MA91	Alert: This determination is the result of the appeal you filed. Start: 01/01/1997 \| Last Modified: 07/01/2015 Notes: (Modified 7/1/15)
MA92	Missing plan information for other insurance. Start: 01/01/1997 \| Last Modified: 02/01/2004 Notes: (Modified 2/1/04) Related to N245
MA93	Non-PIP (Periodic Interim Payment) claim. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
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. Start: 01/01/1997 \| Last Modified: 08/01/2005 Notes: (Reactivated 4/1/04, Modified 8/1/05)
MA95	A not otherwise classified or unlisted procedure code(s) was billed but a narrative description of the procedure was not entered on the claim. Refer to item 19 on the HCFA-1500. Start: 01/01/1997 \| Stop: 01/01/2004 \| Last Modified: 02/28/2003 Notes: (Deactivated 2/28/2003) (Erroneous description corrected 9/2/2008) Consider using M51
MA96	Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan. Start: 01/01/1997
MA97	Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number. Start: 01/01/1997 \| Last Modified: 02/29/2008 Notes: (Modified 2/29/08)
MA98	Claim Rejected. Does not contain the correct Medicare Managed Care Demonstration contract number for this beneficiary. Start: 01/01/1997 \| Stop: 10/16/2003 Notes: Consider using MA97
MA99	Missing/incomplete/invalid Medigap information. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA100	Missing/incomplete/invalid date of current illness or symptoms. Start: 01/01/1997 \| Last Modified: 03/14/2014 Notes: (Modified 2/28/03, 3/30/05, 3/14/2014)
MA101	A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents. Start: 01/01/1997 \| Stop: 01/01/2011 \| Last Modified: 06/30/2003 Notes: Consider using N538
MA102	Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider. Start: 01/01/1997 \| Stop: 08/01/2004 Notes: Consider using M68
MA103	Hemophilia Add On. Start: 01/01/1997
MA104	Missing/incomplete/invalid date the patient was last seen or the provider identifier of the attending physician. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using M128 or M57
MA105	Missing/incomplete/invalid provider number for this place of service. Start: 01/01/1997 \| Stop: 06/02/2005
MA106	PIP (Periodic Interim Payment) claim. Start: 01/01/1997 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
MA107	Paper claim contains more than three separate data items in field 19. Start: 01/01/1997
MA108	Paper claim contains more than one data item in field 23. Start: 01/01/1997
MA109	Claim processed in accordance with ambulatory surgical guidelines. Start: 01/01/1997
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. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA111	Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA112	Missing/incomplete/invalid group practice information. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA113	Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN. Start: 01/01/1997
MA114	Missing/incomplete/invalid information on where the services were furnished. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA115	Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA). Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA116	Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution. Start: 01/01/1997 Notes: (Reactivated 4/1/04)
MA117	This claim has been assessed a $1.00 user fee. Start: 01/01/1997
MA118	Alert: No Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance and/or deductible are applicable. Start: 01/01/1997 \| Last Modified: 11/01/2014
MA119	Provider level adjustment for late claim filing applies to this claim. Start: 01/01/1997 \| Stop: 05/01/2008 \| Last Modified: 11/05/2007 Notes: Consider using Reason Code B4
MA120	Missing/incomplete/invalid CLIA certification number. Start: 01/01/1997 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
MA121	Missing/incomplete/invalid x-ray date. Start: 01/01/1997 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04)
MA122	Missing/incomplete/invalid initial treatment date. Start: 01/01/1997 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04)
MA123	Your center was not selected to participate in this study, therefore, we cannot pay for these services. Start: 01/01/1997
MA124	Processed for IME only. Start: 01/01/1997 \| Stop: 01/31/2004 Notes: Consider using Reason Code 74
MA125	Per legislation governing this program, payment constitutes payment in full. Start: 01/01/1997
MA126	Pancreas transplant not covered unless kidney transplant performed. Start: 10/12/2001
MA127	Reserved for future use. Start: 10/12/2001 \| Stop: 06/02/2005
MA128	Missing/incomplete/invalid FDA approval number. Start: 10/12/2001 \| Last Modified: 03/30/2005 Notes: (Modified 2/28/03, 3/30/05)
MA129	This provider was not certified for this procedure on this date of service. Start: 10/12/2001 \| Stop: 01/31/2004 \| Last Modified: 01/31/2004 Notes: Consider using MA120 and Reason Code B7
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. Start: 10/12/2001
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. Start: 10/12/2001
MA132	Adjustment to the pre-demonstration rate. Start: 10/12/2001
MA133	Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay. Start: 10/12/2001
MA134	Missing/incomplete/invalid provider number of the facility where the patient resides. Start: 10/12/2001
N1	Alert: 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, plan benefit documents or jurisdiction statutes. Refer to the URL provided in the ERA for the payer website to access the appeals process guidelines. Start: 01/01/2000 \| Last Modified: 07/01/2018 Notes: (Modified 2/28/03, 4/1/07, 7/15/13, 7/1/18)
N2	This allowance has been made in accordance with the most appropriate course of treatment provision of the plan. Start: 01/01/2000
N3	Missing consent form. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03) Related to N228
N4	Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB. Start: 01/01/2000 \| Last Modified: 03/06/2012 Notes: (Modified 2/28/03, 3/6/2012)
N5	EOB received from previous payer. Claim not on file. Start: 01/01/2000
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. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N7	Alert: Processing of this claim/service has included consideration under Major Medical provisions. Start: 01/01/2000 \| Last Modified: 07/15/2013 Notes: (Modified 7/15/13)
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. Start: 01/01/2000
N9	Adjustment represents the estimated amount a previous payer may pay. Start: 01/01/2000 \| Last Modified: 11/18/2005 Notes: (Modified 11/18/05)
N10	Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review. Start: 01/01/2000 \| Last Modified: 03/01/2015 Notes: (Modified 10/31/02, 7/1/08, 7/15/13, 3/1/2015)
N11	Denial reversed because of medical review. Start: 01/01/2000
N12	Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare. Start: 01/01/2000 \| Last Modified: 08/01/2007 Notes: (Modified 8/1/07)
N13	Payment based on professional/technical component modifier(s). Start: 01/01/2000
N14	Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount. Start: 01/01/2000 \| Stop: 10/01/2007 Notes: Consider using Reason Code 45
N15	Services for a newborn must be billed separately. Start: 01/01/2000
N16	Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage. Start: 01/01/2000
N17	Per admission deductible. Start: 01/01/2000 \| Stop: 08/01/2004 Notes: Consider using Reason Code 1
N18	Payment based on the Medicare allowed amount. Start: 01/01/2000 \| Stop: 01/31/2004 Notes: Consider using N14
N19	Procedure code incidental to primary procedure. Start: 01/01/2000
N20	Service not payable with other service rendered on the same date. Start: 01/01/2000
N21	Alert: Your line item has been separated into multiple lines to expedite handling. Start: 01/01/2000 \| Last Modified: 04/01/2007 Notes: (Modified 8/1/05, 4/1/07)
N22	Alert: This procedure code was added/changed because it more accurately describes the services rendered. Start: 01/01/2000 \| Last Modified: 07/01/2015 Notes: (Modified 10/31/02, 2/28/03, 7/1/15)
N23	Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions. Start: 01/01/2000 \| Last Modified: 04/01/2007 Notes: (Modified 8/13/01, 4/1/07)
N24	Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
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. Start: 01/01/2000
N26	Missing itemized bill/statement. Start: 01/01/2000 \| Last Modified: 07/01/2008 Notes: (Modified 2/28/03, 7/1/2008) Related to N232
N27	Missing/incomplete/invalid treatment number. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N28	Consent form requirements not fulfilled. Start: 01/01/2000
N29	Missing documentation/orders/notes/summary/report/chart. Start: 01/01/2000 \| Stop: 03/01/2016 \| Last Modified: 03/01/2014 Notes: (Modified 2/28/03, 8/1/05, 3/1/2014) Related to N225, Explicit RARCs have been approved, this non-specific RARC will be deactivated in March 2016.
N30	Patient ineligible for this service. Start: 01/01/2000 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
N31	Missing/incomplete/invalid prescribing provider identifier. Start: 01/01/2000 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04)
N32	Claim must be submitted by the provider who rendered the service. Start: 01/01/2000 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
N33	No record of health check prior to initiation of treatment. Start: 01/01/2000
N34	Incorrect claim form/format for this service. Start: 01/01/2000 \| Last Modified: 11/18/2005 Notes: (Modified 11/18/05)
N35	Program integrity/utilization review decision. Start: 01/01/2000
N36	Claim must meet primary payer's processing requirements before we can consider payment. Start: 01/01/2000
N37	Missing/incomplete/invalid tooth number/letter. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N38	Missing/incomplete/invalid place of service. Start: 01/01/2000 \| Stop: 02/05/2005 Notes: Consider using M77
N39	Procedure code is not compatible with tooth number/letter. Start: 01/01/2000
N40	Missing radiology film(s)/image(s). Start: 01/01/2000 \| Last Modified: 07/01/2008 Notes: (Modified 2/1/04, 7/1/08) Related to N242
N41	Authorization request denied. Start: 01/01/2000 \| Stop: 10/16/2003 Notes: Consider using Reason Code 39
N42	Missing mental health assessment. Start: 01/01/2000 \| Last Modified: 11/01/2014
N43	Bed hold or leave days exceeded. Start: 01/01/2000
N44	Payer's share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority. Start: 01/01/2000 \| Stop: 10/16/2003 Notes: Consider using Reason Code 137
N45	Payment based on authorized amount. Start: 01/01/2000
N46	Missing/incomplete/invalid admission hour. Start: 01/01/2000
N47	Claim conflicts with another inpatient stay. Start: 01/01/2000
N48	Claim information does not agree with information received from other insurance carrier. Start: 01/01/2000
N49	Court ordered coverage information needs validation. Start: 01/01/2000
N50	Missing/incomplete/invalid discharge information. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N51	Electronic interchange agreement not on file for provider/submitter. Start: 01/01/2000
N52	Patient not enrolled in the billing provider's managed care plan on the date of service. Start: 01/01/2000
N53	Missing/incomplete/invalid point of pick-up address. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N54	Claim information is inconsistent with pre-certified/authorized services. Start: 01/01/2000
N55	Procedures for billing with group/referring/performing providers were not followed. Start: 01/01/2000
N56	Procedure code billed is not correct/valid for the services billed or the date of service billed. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N57	Missing/incomplete/invalid prescribing date. Start: 01/01/2000 \| Last Modified: 12/02/2004 Notes: (Modified 12/2/04) Related to N304
N58	Missing/incomplete/invalid patient liability amount. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N59	Alert: Please refer to your provider manual for additional program and provider information. Start: 01/01/2000 \| Last Modified: 11/01/2015 Notes: (Modified 4/1/07, 11/1/09, 11/1/2015)
N60	A valid NDC is required for payment of drug claims effective October 02. Start: 01/01/2000 \| Stop: 01/31/2004 Notes: Consider using M119
N61	Rebill services on separate claims. Start: 01/01/2000
N62	Dates of service span multiple rate periods. Resubmit separate claims. Start: 01/01/2000 \| Last Modified: 03/08/2011 Notes: (Modified 3/8/11)
N63	Rebill services on separate claim lines. Start: 01/01/2000
N64	The 'from' and 'to' dates must be different. Start: 01/01/2000
N65	Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N66	Missing/incomplete/invalid documentation. Start: 01/01/2000 \| Stop: 02/05/2005 Notes: Consider using N29 or N225.
N67	Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient's admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim. Start: 01/01/2000
N68	Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days. Start: 01/01/2000
N69	Alert: PPS (Prospective Payment System) code changed by claims processing system. Start: 01/01/2000 \| Last Modified: 11/01/2015 Notes: (Modified 6/30/03, 7/1/12, 11/1/2015)
N70	Consolidated billing and payment applies. Start: 01/01/2000 \| Last Modified: 11/05/2007 Notes: (Modified 2/28/02, 11/5/07)
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. Start: 01/01/2000 \| Last Modified: 06/30/2003 Notes: (Modified 2/21/02, 6/30/03)
N72	PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records. Start: 01/01/2000 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
N73	A Skilled Nursing Facility is responsible for payment of outside providers who furnish these services/supplies under arrangement to its residents. Start: 01/01/2000 \| Stop: 01/31/2004 Notes: Consider using MA101 or N200
N74	Resubmit with multiple claims, each claim covering services provided in only one calendar month. Start: 01/01/2000
N75	Missing/incomplete/invalid tooth surface information. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N76	Missing/incomplete/invalid number of riders. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N77	Missing/incomplete/invalid designated provider number. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N78	The necessary components of the child and teen checkup (EPSDT) were not completed. Start: 01/01/2000
N79	Service billed is not compatible with patient location information. Start: 01/01/2000
N80	Missing/incomplete/invalid prenatal screening information. Start: 01/01/2000 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N81	Procedure billed is not compatible with tooth surface code. Start: 01/01/2000
N82	Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement. Start: 01/01/2000
N83	No appeal rights. Adjudicative decision based on the provisions of a demonstration project. Start: 01/01/2000
N84	Alert: Further installment payments are forthcoming. Start: 01/01/2000 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07, 8/1/07)
N85	Alert: This is the final installment payment. Start: 01/01/2000 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07, 8/1/07)
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. Start: 01/01/2000
N87	Home use of biofeedback therapy is not covered. Start: 01/01/2000
N88	Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care. Start: 01/01/2000 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N89	Alert: 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. Start: 01/01/2000 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N90	Covered only when performed by the attending physician. Start: 01/01/2000
N91	Services not included in the appeal review. Start: 01/01/2000
N92	This facility is not certified for digital mammography. Start: 01/01/2000
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. Start: 01/01/2000
N94	Claim/Service denied because a more specific taxonomy code is required for adjudication. Start: 01/01/2000
N95	This provider type/provider specialty may not bill this service. Start: 07/31/2001 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
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. Start: 08/24/2001
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. Start: 08/24/2001
N98	Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries. Start: 08/24/2001
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. Start: 08/24/2001
N100	PPS (Prospect Payment System) code corrected during adjudication. Start: 09/14/2001 \| Stop: 11/01/2016 \| Last Modified: 11/01/2015 Notes: (Modified 6/30/03, 11/1/2015)
N101	Additional information is needed in order to process this claim. Please resubmit the claim with the identification number of the provider where this service took place. The Medicare number of the site of service provider should be preceded with the letters 'HSP' and entered into item #32 on the claim form. You may bill only one site of service provider number per claim. Start: 10/31/2001 \| Stop: 01/31/2004 \| Last Modified: 03/14/2014 Notes: Consider using MA105 (Modified 3/14/2014)
N102	This claim has been denied without reviewing the medical/dental record because the requested records were not received or were not received timely. Start: 10/31/2001 \| Stop: 07/01/2016 \| Last Modified: 11/01/2013
N103	Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate. Start: 10/31/2001 \| Last Modified: 11/01/2013 Notes: (Modified 6/30/03, 7/1/12, 11/1/13)
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.gov. Start: 01/29/2002 \| Last Modified: 07/01/2010 Notes: (Modified 10/31/02, 7/1/10)
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 888-355-9165 for RRB EDI information for electronic claims processing. Start: 01/29/2002 \| Last Modified: 07/01/2017 Notes: (Modified 7/1/2017)
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. Start: 01/31/2002
N107	Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services. Start: 01/31/2002
N108	Missing/incomplete/invalid upgrade information. Start: 01/31/2002 \| Last Modified: 02/28/2003 Notes: (Modified 2/28/03)
N109	Alert: This claim/service was chosen for complex review. Start: 02/28/2002 \| Last Modified: 07/01/2015 Notes: (Modified 3/1/2009, 7/1/15)
N110	This facility is not certified for film mammography. Start: 02/28/2002
N111	No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated. Start: 02/28/2002
N112	This claim is excluded from your electronic remittance advice. Start: 02/28/2002
N113	Only one initial visit is covered per physician, group practice or provider. Start: 04/16/2002 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
N114	During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be. Start: 05/30/2002
N115	This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD. Start: 05/30/2002 \| Last Modified: 07/01/2010 Notes: (Modified 4/1/04, 7/1/10)
N116	Alert: This payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency's (HHA's) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care. Start: 06/30/2002 \| Last Modified: 11/01/2016 Notes: (Modified 11/1/2016)
N117	This service is paid only once in a patient's lifetime. Start: 07/30/2002 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
N118	This service is not paid if billed more than once every 28 days. Start: 07/30/2002
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. Start: 07/30/2002 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
N120	Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode. Start: 08/09/2002 \| Last Modified: 06/30/2003 Notes: (Modified 6/30/03)
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. Start: 09/09/2002 \| Last Modified: 08/01/2004 Notes: (Modified 8/1/04, 6/30/03)
N122	Add-on code cannot be billed by itself. Start: 09/12/2002 \| Last Modified: 08/01/2005 Notes: (Modified 8/1/05)
N123	Alert: This is a split service and represents a portion of the units from the originally submitted service. Start: 09/24/2002 \| Last Modified: 03/01/2016 Notes: (Modified 3/1/2016)
N124	Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay. Start: 09/26/2002
N125	Payment has been (denied for the/made only for a less extensive) service/item because the information furnished does not substantiate the need for the (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice. The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office. Start: 09/26/2002 \| Last Modified: 08/01/2005 Notes: (Modified 8/1/05. Also refer to N356)
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. Start: 10/17/2002
N127	This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them. Start: 10/31/2007 \| Last Modified: 08/01/2004 Notes: (Modified 8/1/04
N128	This amount represents the prior to coverage portion of the allowance. Start: 10/31/2002
N129	Not eligible due to the patient's age. Start: 10/31/2002 \| Last Modified: 08/01/2007 Notes: (Modified 8/1/07)
N130	Consult plan benefit documents/guidelines for information about restrictions for this service. Start: 10/31/2002 \| Last Modified: 11/01/2009 Notes: (Modified 4/1/07, 7/1/08, 11/1/09)
N131	Total payments under multiple contracts cannot exceed the allowance for this service. Start: 10/31/2002
N132	Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N133	Alert: Services for predetermination and services requesting payment are being processed separately. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N134	Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N135	Record fees are the patient's responsibility and limited to the specified co-payment. Start: 10/31/2002
N136	Alert: 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. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N137	Alert: The provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 8/1/04, 2/28/03, 4/1/07)
N138	Alert: In the event you disagree with the Dental Advisor's opinion and have additional information relative to the case, you may submit radiographs to the Dental Advisor Unit at the subscriber's dental insurance carrier for a second Independent Dental Advisor Review. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N139	Alert: Under 32 CFR 199.13, a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor's opinion, you may appeal the determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter. Start: 10/31/2002 \| Last Modified: 03/01/2017 Notes: (Modified 4/1/07, 3/1/2017)
N140	Alert: You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act as his/her representative and you disagree with the Dental Advisor's opinion, you may appeal by submitting a copy of this letter, a signed statement explaining the matter in which you disagree, and any relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N141	The patient was not residing in a long-term care facility during all or part of the service dates billed. Start: 10/31/2002
N142	The original claim was denied. Resubmit a new claim, not a replacement claim. Start: 10/31/2002
N143	The patient was not in a hospice program during all or part of the service dates billed. Start: 10/31/2002
N144	The rate changed during the dates of service billed. Start: 10/31/2002
N145	Missing/incomplete/invalid provider identifier for this place of service. Start: 10/31/2002 \| Stop: 06/02/2005
N146	Missing screening document. Start: 10/31/2002 \| Last Modified: 08/01/2004 Notes: (Modified 8/1/04) Related to N243
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. Start: 10/31/2002
N148	Missing/incomplete/invalid date of last menstrual period. Start: 10/31/2002
N149	Rebill all applicable services on a single claim. Start: 10/31/2002
N150	Missing/incomplete/invalid model number. Start: 10/31/2002
N151	Telephone contact services will not be paid until the face-to-face contact requirement has been met. Start: 10/31/2002
N152	Missing/incomplete/invalid replacement claim information. Start: 10/31/2002
N153	Missing/incomplete/invalid room and board rate. Start: 10/31/2002
N154	Alert: This payment was delayed for correction of provider's mailing address. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N155	Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N156	Alert: The patient is responsible for the difference between the approved treatment and the elective treatment. Start: 10/31/2002 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N157	Transportation to/from this destination is not covered. Start: 02/28/2003 \| Last Modified: 02/01/2004 Notes: (Modified 2/1/04)
N158	Transportation in a vehicle other than an ambulance is not covered. Start: 02/28/2003
N159	Payment denied/reduced because mileage is not covered when the patient is not in the ambulance. Start: 02/28/2003
N160	The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service. Start: 02/28/2003 \| Last Modified: 02/01/2004 Notes: (Modified 2/1/04)
N161	This drug/service/supply is covered only when the associated service is covered. Start: 02/28/2003
N162	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. Start: 02/28/2003 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N163	Medical record does not support code billed per the code definition. Start: 02/28/2003
N164	Transportation to/from this destination is not covered. Start: 02/28/2003 \| Stop: 01/31/2004 Notes: Consider using N157
N165	Transportation in a vehicle other than an ambulance is not covered. Start: 02/28/2003 \| Stop: 01/31/2004 Notes: Consider using N158)
N166	Payment denied/reduced because mileage is not covered when the patient is not in the ambulance. Start: 02/28/2003 \| Stop: 01/31/2004 Notes: Consider using N159
N167	Charges exceed the post-transplant coverage limit. Start: 02/28/2003
N168	The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service. Start: 02/28/2003 \| Stop: 01/31/2004 Notes: Consider using N160
N169	This drug/service/supply is covered only when the associated service is covered. Start: 02/28/2003 \| Stop: 01/31/2004 Notes: Consider using N161
N170	A new/revised/renewed certificate of medical necessity is needed. Start: 02/28/2003
N171	Payment for repair or replacement is not covered or has exceeded the purchase price. Start: 02/28/2003
N172	The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item. Start: 02/28/2003
N173	No qualifying hospital stay dates were provided for this episode of care. Start: 02/28/2003
N174	This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'. Start: 02/28/2003
N175	Missing review organization approval. Start: 02/28/2003 \| Last Modified: 02/29/2008 Notes: (Modified 8/1/04, 2/29/08) Related to N241
N176	Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the United States must provide the service. Start: 02/28/2003
N177	Alert: We did not send this claim to patient's other insurer. They have indicated no additional payment can be made. Start: 02/28/2003 \| Last Modified: 04/01/2007 Notes: (Modified 6/30/03, 4/1/07)
N178	Missing pre-operative images/visual field results. Start: 02/28/2003 \| Last Modified: 11/01/2013 Notes: (Modified 8/1/04, 11/1/13) Related to N244
N179	Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information. Start: 02/28/2003
N180	This item or service does not meet the criteria for the category under which it was billed. Start: 02/28/2003
N181	Additional information is required from another provider involved in this service. Start: 02/28/2003 \| Last Modified: 12/01/2006 Notes: (Modified 12/1/06)
N182	This claim/service must be billed according to the schedule for this plan. Start: 02/28/2003
N183	Alert: This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits. Start: 02/28/2003 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N184	Rebill technical and professional components separately. Start: 02/28/2003
N185	Alert: Do not resubmit this claim/service. Start: 02/28/2003 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N186	Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance. Start: 02/28/2003
N187	Alert: You may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents. Start: 02/28/2003 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N188	The approved level of care does not match the procedure code submitted. Start: 02/28/2003
N189	Alert: This service has been paid as a one-time exception to the plan's benefit restrictions. Start: 02/28/2003 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N190	Missing contract indicator. Start: 02/28/2003 \| Last Modified: 08/01/2004 Notes: (Modified 8/1/04) Related to N229
N191	The provider must update insurance information directly with payer. Start: 02/28/2003
N192	Alert: Patient is a Medicaid/Qualified Medicare Beneficiary. Start: 02/28/2003 \| Last Modified: 07/01/2020
N193	Alert: Specific federal/state/local program may cover this service through another payer. Start: 02/28/2003 \| Last Modified: 11/01/2015 Notes: (Modified 11/1/2015)
N194	Technical component not paid if provider does not own the equipment used. Start: 02/25/2003
N195	The technical component must be billed separately. Start: 02/25/2003
N196	Alert: Patient eligible to apply for other coverage which may be primary. Start: 02/25/2003 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N197	The subscriber must update insurance information directly with payer. Start: 02/25/2003
N198	Rendering provider must be affiliated with the pay-to provider. Start: 02/25/2003
N199	Additional payment/recoupment approved based on payer-initiated review/audit. Start: 02/25/2003 \| Last Modified: 08/01/2006 Notes: (Modified 8/1/06)
N200	The professional component must be billed separately. Start: 02/25/2003
N201	A mental health facility is responsible for payment of outside providers who furnish these services/supplies to residents. Start: 02/25/2003 \| Stop: 01/01/2011 Notes: Consider using N538
N202	Alert: Additional information/explanation will be sent separately. Start: 06/30/2003 \| Last Modified: 11/01/2015 Notes: (Modified 4/1/07, 11/1/09, 3/14/2014, 11/1/2015)
N203	Missing/incomplete/invalid anesthesia time/units. Start: 06/30/2003 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N204	Services under review for possible pre-existing condition. Send medical records for prior 12 months Start: 06/30/2003
N205	Information provided was illegible. Start: 06/30/2003 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N206	The supporting documentation does not match the information sent on the claim. Start: 06/30/2003 \| Last Modified: 03/06/2012 Notes: (Modified 3/6/12)
N207	Missing/incomplete/invalid weight. Start: 06/30/2003 \| Last Modified: 11/18/2005 Notes: (Modified 11/18/05)
N208	Missing/incomplete/invalid DRG code. Start: 06/30/2003 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N209	Missing/incomplete/invalid taxpayer identification number (TIN). Start: 06/30/2003 \| Last Modified: 07/01/2008 Notes: (Modified 7/1/08)
N210	Alert: You may appeal this decision. Start: 06/30/2003 \| Last Modified: 03/14/2014 Notes: (Modified 4/1/07, 3/14/2014)
N211	Alert: You may not appeal this decision. Start: 06/30/2003 \| Last Modified: 03/14/2014 Notes: (Modified 4/1/07, 3/14/2014)
N212	Charges processed under a Point of Service benefit. Start: 02/01/2004 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N213	Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information. Start: 04/01/2004 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N214	Missing/incomplete/invalid history of the related initial surgical procedure(s). Start: 04/01/2004 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N215	Alert: A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determination. Start: 04/01/2004 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N216	We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package. Start: 04/01/2004 \| Last Modified: 03/14/2014 Notes: (Modified 3/1/2010, 3/14/2014)
N217	We pay only one site of service per provider per claim. Start: 08/01/2004 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N218	You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract or coverage manual. Start: 08/01/2004
N219	Payment based on previous payer's allowed amount. Start: 08/01/2004
N220	Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute. Start: 08/01/2004 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N221	Missing Admitting History and Physical report. Start: 08/01/2004
N222	Incomplete/invalid Admitting History and Physical report. Start: 08/01/2004
N223	Missing documentation of benefit to the patient during initial treatment period. Start: 08/01/2004
N224	Incomplete/invalid documentation of benefit to the patient during initial treatment period. Start: 08/01/2004
N225	Incomplete/invalid documentation/orders/notes/summary/report/chart. Start: 08/01/2004 \| Stop: 03/01/2016 \| Last Modified: 03/01/2014 Notes: (Modified 8/1/05, 3/1/2014) Explicit RARCs have been approved, this non-specific RARC will be deactivated in March 2016.
N226	Incomplete/invalid American Diabetes Association Certificate of Recognition. Start: 08/01/2004
N227	Incomplete/invalid Certificate of Medical Necessity. Start: 08/01/2004
N228	Incomplete/invalid consent form. Start: 08/01/2004
N229	Incomplete/invalid contract indicator. Start: 08/01/2004
N230	Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply. Start: 08/01/2004
N231	Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used. Start: 08/01/2004
N232	Incomplete/invalid itemized bill/statement. Start: 08/01/2004 \| Last Modified: 07/01/2008 Notes: (Modified 7/1/08)
N233	Incomplete/invalid operative note/report. Start: 08/01/2004 \| Last Modified: 07/01/2008 Notes: (Modified 7/1/08)
N234	Incomplete/invalid oxygen certification/re-certification. Start: 08/01/2004
N235	Incomplete/invalid pacemaker registration form. Start: 08/01/2004
N236	Incomplete/invalid pathology report. Start: 08/01/2004
N237	Incomplete/invalid patient medical record for this service. Start: 08/01/2004
N238	Incomplete/invalid physician certified plan of care. Start: 08/01/2004 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N239	Incomplete/invalid physician financial relationship form. Start: 08/01/2004
N240	Incomplete/invalid radiology report. Start: 08/01/2004
N241	Incomplete/invalid review organization approval. Start: 08/01/2004 \| Last Modified: 02/29/2008 Notes: (Modified 2/29/08)
N242	Incomplete/invalid radiology film(s)/image(s). Start: 08/01/2004 \| Last Modified: 07/01/2008 Notes: (Modified 7/1/08)
N243	Incomplete/invalid/not approved screening document. Start: 08/01/2004
N244	Incomplete/Invalid pre-operative images/visual field results. Start: 08/01/2004 \| Last Modified: 11/01/2013 Notes: (Modified 11/1/2013)
N245	Incomplete/invalid plan information for other insurance. Start: 08/01/2004 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N246	State regulated patient payment limitations apply to this service. Start: 12/02/2004
N247	Missing/incomplete/invalid assistant surgeon taxonomy. Start: 12/02/2004
N248	Missing/incomplete/invalid assistant surgeon name. Start: 12/02/2004
N249	Missing/incomplete/invalid assistant surgeon primary identifier. Start: 12/02/2004
N250	Missing/incomplete/invalid assistant surgeon secondary identifier. Start: 12/02/2004
N251	Missing/incomplete/invalid attending provider taxonomy. Start: 12/02/2004
N252	Missing/incomplete/invalid attending provider name. Start: 12/02/2004
N253	Missing/incomplete/invalid attending provider primary identifier. Start: 12/02/2004
N254	Missing/incomplete/invalid attending provider secondary identifier. Start: 12/02/2004
N255	Missing/incomplete/invalid billing provider taxonomy. Start: 12/02/2004
N256	Missing/incomplete/invalid billing provider/supplier name. Start: 12/02/2004
N257	Missing/incomplete/invalid billing provider/supplier primary identifier. Start: 12/02/2004
N258	Missing/incomplete/invalid billing provider/supplier address. Start: 12/02/2004
N259	Missing/incomplete/invalid billing provider/supplier secondary identifier. Start: 12/02/2004
N260	Missing/incomplete/invalid billing provider/supplier contact information. Start: 12/02/2004
N261	Missing/incomplete/invalid operating provider name. Start: 12/02/2004
N262	Missing/incomplete/invalid operating provider primary identifier. Start: 12/02/2004
N263	Missing/incomplete/invalid operating provider secondary identifier. Start: 12/02/2004
N264	Missing/incomplete/invalid ordering provider name. Start: 12/02/2004
N265	Missing/incomplete/invalid ordering provider primary identifier. Start: 12/02/2004
N266	Missing/incomplete/invalid ordering provider address. Start: 12/02/2004
N267	Missing/incomplete/invalid ordering provider secondary identifier. Start: 12/02/2004
N268	Missing/incomplete/invalid ordering provider contact information. Start: 12/02/2004
N269	Missing/incomplete/invalid other provider name. Start: 12/02/2004
N270	Missing/incomplete/invalid other provider primary identifier. Start: 12/02/2004
N271	Missing/incomplete/invalid other provider secondary identifier. Start: 12/02/2004
N272	Missing/incomplete/invalid other payer attending provider identifier. Start: 12/02/2004
N273	Missing/incomplete/invalid other payer operating provider identifier. Start: 12/02/2004
N274	Missing/incomplete/invalid other payer other provider identifier. Start: 12/02/2004
N275	Missing/incomplete/invalid other payer purchased service provider identifier. Start: 12/02/2004
N276	Missing/incomplete/invalid other payer referring provider identifier. Start: 12/02/2004
N277	Missing/incomplete/invalid other payer rendering provider identifier. Start: 12/02/2004
N278	Missing/incomplete/invalid other payer service facility provider identifier. Start: 12/02/2004
N279	Missing/incomplete/invalid pay-to provider name. Start: 12/02/2004
N280	Missing/incomplete/invalid pay-to provider primary identifier. Start: 12/02/2004
N281	Missing/incomplete/invalid pay-to provider address. Start: 12/02/2004
N282	Missing/incomplete/invalid pay-to provider secondary identifier. Start: 12/02/2004
N283	Missing/incomplete/invalid purchased service provider identifier. Start: 12/02/2004
N284	Missing/incomplete/invalid referring provider taxonomy. Start: 12/02/2004
N285	Missing/incomplete/invalid referring provider name. Start: 12/02/2004
N286	Missing/incomplete/invalid referring provider primary identifier. Start: 12/02/2004
N287	Missing/incomplete/invalid referring provider secondary identifier. Start: 12/02/2004
N288	Missing/incomplete/invalid rendering provider taxonomy. Start: 12/02/2004
N289	Missing/incomplete/invalid rendering provider name. Start: 12/02/2004
N290	Missing/incomplete/invalid rendering provider primary identifier. Start: 12/02/2004
N291	Missing/incomplete/invalid rendering provider secondary identifier. Start: 12/02/2004 \| Last Modified: 11/01/2010
N292	Missing/incomplete/invalid service facility name. Start: 12/02/2004
N293	Missing/incomplete/invalid service facility primary identifier. Start: 12/02/2004
N294	Missing/incomplete/invalid service facility primary address. Start: 12/02/2004
N295	Missing/incomplete/invalid service facility secondary identifier. Start: 12/02/2004
N296	Missing/incomplete/invalid supervising provider name. Start: 12/02/2004
N297	Missing/incomplete/invalid supervising provider primary identifier. Start: 12/02/2004
N298	Missing/incomplete/invalid supervising provider secondary identifier. Start: 12/02/2004
N299	Missing/incomplete/invalid occurrence date(s). Start: 12/02/2004
N300	Missing/incomplete/invalid occurrence span date(s). Start: 12/02/2004
N301	Missing/incomplete/invalid procedure date(s). Start: 12/02/2004
N302	Missing/incomplete/invalid other procedure date(s). Start: 12/02/2004
N303	Missing/incomplete/invalid principal procedure date. Start: 12/02/2004
N304	Missing/incomplete/invalid dispensed date. Start: 12/02/2004
N305	Missing/incomplete/invalid injury/accident date. Start: 12/02/2004 \| Last Modified: 11/01/2016 Notes: (Modified 11/1/2016)
N306	Missing/incomplete/invalid acute manifestation date. Start: 12/02/2004
N307	Missing/incomplete/invalid adjudication or payment date. Start: 12/02/2004
N308	Missing/incomplete/invalid appliance placement date. Start: 12/02/2004
N309	Missing/incomplete/invalid assessment date. Start: 12/02/2004
N310	Missing/incomplete/invalid assumed or relinquished care date. Start: 12/02/2004
N311	Missing/incomplete/invalid authorized to return to work date. Start: 12/02/2004
N312	Missing/incomplete/invalid begin therapy date. Start: 12/02/2004
N313	Missing/incomplete/invalid certification revision date. Start: 12/02/2004
N314	Missing/incomplete/invalid diagnosis date. Start: 12/02/2004
N315	Missing/incomplete/invalid disability from date. Start: 12/02/2004
N316	Missing/incomplete/invalid disability to date. Start: 12/02/2004
N317	Missing/incomplete/invalid discharge hour. Start: 12/02/2004
N318	Missing/incomplete/invalid discharge or end of care date. Start: 12/02/2004
N319	Missing/incomplete/invalid hearing or vision prescription date. Start: 12/02/2004
N320	Missing/incomplete/invalid Home Health Certification Period. Start: 12/02/2004
N321	Missing/incomplete/invalid last admission period. Start: 12/02/2004
N322	Missing/incomplete/invalid last certification date. Start: 12/02/2004
N323	Missing/incomplete/invalid last contact date. Start: 12/02/2004
N324	Missing/incomplete/invalid last seen/visit date. Start: 12/02/2004
N325	Missing/incomplete/invalid last worked date. Start: 12/02/2004
N326	Missing/incomplete/invalid last x-ray date. Start: 12/02/2004
N327	Missing/incomplete/invalid other insured birth date. Start: 12/02/2004
N328	Missing/incomplete/invalid Oxygen Saturation Test date. Start: 12/02/2004
N329	Missing/incomplete/invalid patient birth date. Start: 12/02/2004
N330	Missing/incomplete/invalid patient death date. Start: 12/02/2004
N331	Missing/incomplete/invalid physician order date. Start: 12/02/2004
N332	Missing/incomplete/invalid prior hospital discharge date. Start: 12/02/2004
N333	Missing/incomplete/invalid prior placement date. Start: 12/02/2004
N334	Missing/incomplete/invalid re-evaluation date. Start: 12/02/2004 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N335	Missing/incomplete/invalid referral date. Start: 12/02/2004
N336	Missing/incomplete/invalid replacement date. Start: 12/02/2004
N337	Missing/incomplete/invalid secondary diagnosis date. Start: 12/02/2004
N338	Missing/incomplete/invalid shipped date. Start: 12/02/2004
N339	Missing/incomplete/invalid similar illness or symptom date. Start: 12/02/2004
N340	Missing/incomplete/invalid subscriber birth date. Start: 12/02/2004
N341	Missing/incomplete/invalid surgery date. Start: 12/02/2004
N342	Missing/incomplete/invalid test performed date. Start: 12/02/2004
N343	Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date. Start: 12/02/2004
N344	Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date. Start: 12/02/2004
N345	Date range not valid with units submitted. Start: 03/30/2005
N346	Missing/incomplete/invalid oral cavity designation code. Start: 03/30/2005
N347	Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer. Start: 03/30/2005
N348	You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier. Start: 08/01/2005
N349	The administration method and drug must be reported to adjudicate this service. Start: 08/01/2005
N350	Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure. Start: 08/01/2005 \| Last Modified: 07/01/2008 Notes: (Modified 7/1/08)
N351	Service date outside of the approved treatment plan service dates. Start: 08/01/2005
N352	Alert: There are no scheduled payments for this service. Submit a claim for each patient visit. Start: 08/01/2005 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N353	Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim. Start: 08/01/2005 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N354	Incomplete/invalid invoice. Start: 08/01/2005 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N355	Alert: The law permits exceptions to the refund requirement in two cases: - If you did not know, and could not have reasonably been expected to know, that we would not pay for this service; or - If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service. If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position. If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision. The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination. The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days Start: 08/01/2005 \| Last Modified: 04/01/2007 Notes: (Modified 11/18/05, Modified 4/1/07)
N356	Not covered when performed with, or subsequent to, a non-covered service. Start: 08/01/2005 \| Last Modified: 03/08/2011 Notes: (Modified 3/8/11)
N357	Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met. Start: 11/18/2005
N358	Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted. Start: 11/18/2005 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N359	Missing/incomplete/invalid height. Start: 11/18/2005
N360	Alert: Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim. Start: 11/18/2005 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N361	Payment adjusted based on multiple diagnostic imaging procedure rules Start: 11/18/2005 \| Stop: 10/01/2007 \| Last Modified: 12/01/2006 Notes: (Modified 12/1/06) Consider using Reason Code 59
N362	The number of Days or Units of Service exceeds our acceptable maximum. Start: 11/18/2005
N363	Alert: in the near future we are implementing new policies/procedures that would affect this determination. Start: 11/18/2005 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N364	Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts. Start: 11/18/2005 \| Last Modified: 04/01/2007 Notes: (Modified 4/1/07)
N365	This procedure code is not payable. It is for reporting/information purposes only. Start: 04/01/2006 \| Stop: 07/01/2014 Notes: Consider Using CARC 246 or N620
N366	Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice. Start: 04/01/2006
N367	Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account. Start: 04/01/2006 \| Last Modified: 07/01/2008 Notes: (Modified 4/1/07, 11/5/07, 7/1/08)
N368	You must appeal the determination of the previously adjudicated claim. Start: 04/01/2006
N369	Alert: Although this claim has been processed, it is deficient according to state legislation/regulation. Start: 04/01/2006
N370	Billing exceeds the rental months covered/approved by the payer. Start: 08/01/2006
N371	Alert: title of this equipment must be transferred to the patient. Start: 08/01/2006
N372	Only reasonable and necessary maintenance/service charges are covered. Start: 08/01/2006
N373	It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your behalf. Start: 12/01/2006
N374	Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required. Start: 12/01/2006
N375	Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility. Start: 12/01/2006
N376	Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE. Start: 12/01/2006
N377	Payment based on a processed replacement claim. Start: 12/01/2006 \| Last Modified: 11/05/2007 Notes: (Modified 11/5/07)
N378	Missing/incomplete/invalid prescription quantity. Start: 12/01/2006
N379	Claim level information does not match line level information. Start: 12/01/2006
N380	The original claim has been processed, submit a corrected claim. Start: 04/01/2007
N381	Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges. Start: 04/01/2007 \| Last Modified: 07/01/2015 Notes: (Modified 7/1/15)
N382	Missing/incomplete/invalid patient identifier. Start: 04/01/2007
N383	Not covered when deemed cosmetic. Start: 04/01/2007 \| Last Modified: 03/08/2011 Notes: (Modified 3/8/11)
N384	Records indicate that the referenced body part/tooth has been removed in a previous procedure. Start: 04/01/2007
N385	Notification of admission was not timely according to published plan procedures. Start: 04/01/2007 \| Last Modified: 11/05/2007 Notes: (Modified 11/5/07)
N386	This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD. Start: 04/01/2007 \| Last Modified: 07/01/2010 Notes: (Modified 7/1/2010)
N387	Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information. Start: 04/01/2007 \| Last Modified: 03/01/2009 Notes: (Modified 3/1/2009)
N388	Missing/incomplete/invalid prescription number. Start: 08/01/2007 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N389	Duplicate prescription number submitted. Start: 08/01/2007
N390	This service/report cannot be billed separately. Start: 08/01/2007 \| Last Modified: 07/01/2008 Notes: (Modified 7/1/08)
N391	Missing emergency department records. Start: 08/01/2007
N392	Incomplete/invalid emergency department records. Start: 08/01/2007
N393	Missing progress notes/report. Start: 08/01/2007 \| Last Modified: 07/01/2008 Notes: (Modified 7/1/08)
N394	Incomplete/invalid progress notes/report. Start: 08/01/2007 \| Last Modified: 07/01/2008 Notes: (Modified 7/1/08)
N395	Missing laboratory report. Start: 08/01/2007
N396	Incomplete/invalid laboratory report. Start: 08/01/2007
N397	Benefits are not available for incomplete service(s)/undelivered item(s). Start: 08/01/2007
N398	Missing elective consent form. Start: 08/01/2007
N399	Incomplete/invalid elective consent form. Start: 08/01/2007
N400	Alert: Electronically enabled providers should submit claims electronically. Start: 08/01/2007
N401	Missing periodontal charting. Start: 08/01/2007
N402	Incomplete/invalid periodontal charting. Start: 08/01/2007
N403	Missing facility certification. Start: 08/01/2007
N404	Incomplete/invalid facility certification. Start: 08/01/2007
N405	This service is only covered when the donor's insurer(s) do not provide coverage for the service. Start: 08/01/2007
N406	This service is only covered when the recipient's insurer(s) do not provide coverage for the service. Start: 08/01/2007
N407	You are not an approved submitter for this transmission format. Start: 08/01/2007
N408	This payer does not cover deductibles assessed by a previous payer. Start: 08/01/2007
N409	This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident. Start: 08/01/2007
N410	Not covered unless the prescription changes. Start: 08/01/2007 \| Last Modified: 03/08/2011 Notes: (Modified 3/8/11)
N411	This service is allowed one time in a 6-month period. Start: 08/01/2007 \| Last Modified: 07/01/2016 Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N412	This service is allowed 2 times in a 12-month period. Start: 08/01/2007 \| Last Modified: 07/01/2016 Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N413	This service is allowed 2 times in a benefit year. Start: 08/01/2007 \| Last Modified: 07/01/2016 Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N414	This service is allowed 4 times in a 12-month period. Start: 08/01/2007 \| Last Modified: 07/01/2016 Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N415	This service is allowed 1 time in an 18-month period. Start: 08/01/2007 \| Last Modified: 07/01/2016 Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N416	This service is allowed 1 time in a 3-year period. Start: 08/01/2007 \| Last Modified: 07/01/2016 Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N417	This service is allowed 1 time in a 5-year period. Start: 08/01/2007 \| Last Modified: 07/01/2016 Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N418	Misrouted claim. See the payer's claim submission instructions. Start: 08/01/2007
N419	Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change. Start: 08/01/2007
N420	Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery. Start: 08/01/2007
N421	Claim payment was the result of a payer's retroactive adjustment due to a review organization decision. Start: 08/01/2007 \| Last Modified: 05/08/2008 Notes: (Modified 2/29/08, typo fixed 5/8/08)
N422	Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program. Start: 08/01/2007 \| Last Modified: 05/08/2008 Notes: (Typo fixed 5/8/08)
N423	Claim payment was the result of a payer's retroactive adjustment due to a non standard program. Start: 08/01/2007
N424	Patient does not reside in the geographic area required for this type of payment. Start: 08/01/2007
N425	Statutorily excluded service(s). Start: 08/01/2007
N426	No coverage when self-administered. Start: 08/01/2007
N427	Payment for eyeglasses or contact lenses can be made only after cataract surgery. Start: 08/01/2007
N428	Not covered when performed in this place of service. Start: 08/01/2007 \| Last Modified: 03/08/2011 Notes: (Modified 3/8/11)
N429	Not covered when considered routine. Start: 08/01/2007 \| Last Modified: 03/08/2011 Notes: (Modified 3/8/11)
N430	Procedure code is inconsistent with the units billed. Start: 11/05/2007
N431	Not covered with this procedure. Start: 11/05/2007 \| Last Modified: 03/08/2011 Notes: (Modified 3/8/11)
N432	Alert: Adjustment based on a Recovery Audit. Start: 11/05/2007 \| Last Modified: 07/01/2015 Notes: (Modified 7/1/15)
N433	Resubmit this claim using only your National Provider Identifier (NPI). Start: 02/29/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N434	Missing/Incomplete/Invalid Present on Admission indicator. Start: 07/01/2008
N435	Exceeds number/frequency approved /allowed within time period without support documentation. Start: 07/01/2008
N436	The injury claim has not been accepted and a mandatory medical reimbursement has been made. Start: 07/01/2008
N437	Alert: If the injury claim is accepted, these charges will be reconsidered. Start: 07/01/2008
N438	This jurisdiction only accepts paper claims. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N439	Missing anesthesia physical status report/indicators. Start: 07/01/2008
N440	Incomplete/invalid anesthesia physical status report/indicators. Start: 07/01/2008
N441	This missed/cancelled appointment is not covered. Start: 07/01/2008 \| Last Modified: 07/15/2013 Notes: (Modified 7/15/2013)
N442	Payment based on an alternate fee schedule. Start: 07/01/2008
N443	Missing/incomplete/invalid total time or begin/end time. Start: 07/01/2008
N444	Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation. Start: 07/01/2008
N445	Missing document for actual cost or paid amount. Start: 07/01/2008
N446	Incomplete/invalid document for actual cost or paid amount. Start: 07/01/2008
N447	Payment is based on a generic equivalent as required documentation was not provided. Start: 07/01/2008
N448	This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N449	Payment based on a comparable drug/service/supply. Start: 07/01/2008
N450	Covered only when performed by the primary treating physician or the designee. Start: 07/01/2008
N451	Missing Admission Summary Report. Start: 07/01/2008
N452	Incomplete/invalid Admission Summary Report. Start: 07/01/2008
N453	Missing Consultation Report. Start: 07/01/2008
N454	Incomplete/invalid Consultation Report. Start: 07/01/2008
N455	Missing Physician Order. Start: 07/01/2008
N456	Incomplete/invalid Physician Order. Start: 07/01/2008
N457	Missing Diagnostic Report. Start: 07/01/2008
N458	Incomplete/invalid Diagnostic Report. Start: 07/01/2008
N459	Missing Discharge Summary. Start: 07/01/2008
N460	Incomplete/invalid Discharge Summary. Start: 07/01/2008
N461	Missing Nursing Notes. Start: 07/01/2008
N462	Incomplete/invalid Nursing Notes. Start: 07/01/2008
N463	Missing support data for claim. Start: 07/01/2008
N464	Incomplete/invalid support data for claim. Start: 07/01/2008
N465	Missing Physical Therapy Notes/Report. Start: 07/01/2008
N466	Incomplete/invalid Physical Therapy Notes/Report. Start: 07/01/2008
N467	Missing Tests and Analysis Report. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N468	Incomplete/invalid Report of Tests and Analysis Report. Start: 07/01/2008
N469	Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA). Start: 07/01/2008
N470	This payment will complete the mandatory medical reimbursement limit. Start: 07/01/2008
N471	Missing/incomplete/invalid HIPPS Rate Code. Start: 07/01/2008
N472	Payment for this service has been issued to another provider. Start: 07/01/2008
N473	Missing certification. Start: 07/01/2008
N474	Incomplete/invalid certification. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N475	Missing completed referral form. Start: 07/01/2008
N476	Incomplete/invalid completed referral form. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N477	Missing Dental Models. Start: 07/01/2008
N478	Incomplete/invalid Dental Models. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N479	Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer). Start: 07/01/2008
N480	Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer). Start: 07/01/2008
N481	Missing Models. Start: 07/01/2008
N482	Incomplete/invalid Models. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N483	Missing Periodontal Charts. Start: 07/01/2008 \| Stop: 05/01/2015 \| Last Modified: 11/01/2014 Notes: (Modified 11/1/2014)
N484	Incomplete/invalid Periodontal Charts. Start: 07/01/2008 \| Stop: 05/01/2015 \| Last Modified: 11/01/2014 Notes: (Modified 3/14/2014, 11/1/2014)
N485	Missing Physical Therapy Certification. Start: 07/01/2008
N486	Incomplete/invalid Physical Therapy Certification. Start: 07/01/2008
N487	Missing Prosthetics or Orthotics Certification. Start: 07/01/2008
N488	Incomplete/invalid Prosthetics or Orthotics Certification. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N489	Missing referral form. Start: 07/01/2008
N490	Incomplete/invalid referral form. Start: 07/01/2008 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N491	Missing/Incomplete/Invalid Exclusionary Rider Condition. Start: 07/01/2008
N492	Alert: A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge. Start: 07/01/2008
N493	Missing Doctor First Report of Injury. Start: 07/01/2008
N494	Incomplete/invalid Doctor First Report of Injury. Start: 07/01/2008
N495	Missing Supplemental Medical Report. Start: 07/01/2008
N496	Incomplete/invalid Supplemental Medical Report. Start: 07/01/2008
N497	Missing Medical Permanent Impairment or Disability Report. Start: 07/01/2008
N498	Incomplete/invalid Medical Permanent Impairment or Disability Report. Start: 07/01/2008
N499	Missing Medical Legal Report. Start: 07/01/2008
N500	Incomplete/invalid Medical Legal Report. Start: 07/01/2008
N501	Missing Vocational Report. Start: 07/01/2008
N502	Incomplete/invalid Vocational Report. Start: 07/01/2008
N503	Missing Work Status Report. Start: 07/01/2008
N504	Incomplete/invalid Work Status Report. Start: 07/01/2008
N505	Alert: This response includes only services that could be estimated in real-time. No estimate will be provided for the services that could not be estimated in real-time. Start: 11/01/2008 \| Last Modified: 03/01/2017 Notes: (Modified 3/1/2017)
N506	Alert: This is an estimate of the member's liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. This is not a pre-authorization or a guarantee of payment. Start: 11/01/2008
N507	Plan distance requirements have not been met. Start: 11/01/2008
N508	Alert: This real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions. Start: 11/01/2008 \| Last Modified: 03/01/2017 Notes: (Modified 3/1/2017)
N509	Alert: A current inquiry shows the member's Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing. Start: 11/01/2008
N510	Alert: A current inquiry shows the member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing. Start: 11/01/2008
N511	Alert: Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time. Start: 11/01/2008
N512	Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication. Start: 11/01/2008
N513	Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication. Start: 11/01/2008
N514	Consult plan benefit documents/guidelines for information about restrictions for this service. Start: 11/01/2008 \| Stop: 01/01/2011 Notes: Consider using N130
N515	Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information. (use N387 instead) Start: 11/01/2008 \| Stop: 10/01/2009
N516	Records indicate a mismatch between the submitted NPI and EIN. Start: 03/01/2009
N517	Resubmit a new claim with the requested information. Start: 03/01/2009
N518	No separate payment for accessories when furnished for use with oxygen equipment. Start: 03/01/2009
N519	Invalid combination of HCPCS modifiers. Start: 07/01/2009
N520	Alert: Payment made from a Consumer Spending Account. Start: 07/01/2009
N521	Mismatch between the submitted provider information and the provider information stored in our system. Start: 11/01/2009
N522	Duplicate of a claim processed, or to be processed, as a crossover claim. Start: 11/01/2009 \| Last Modified: 03/01/2010
N523	The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid. Start: 03/01/2010
N524	Based on policy this payment constitutes payment in full. Start: 03/01/2010
N525	These services are not covered when performed within the global period of another service. Start: 03/01/2010
N526	Not qualified for recovery based on employer size. Start: 03/01/2010
N527	We processed this claim as the primary payer prior to receiving the recovery demand. Start: 03/01/2010
N528	Patient is entitled to benefits for Institutional Services only. Start: 03/01/2010 \| Last Modified: 07/01/2010 Notes: (Modified 7/1/10)
N529	Patient is entitled to benefits for Professional Services only. Start: 03/01/2010 \| Last Modified: 07/01/2010 Notes: (Modified 7/1/10)
N530	Not Qualified for Recovery based on enrollment information. Start: 03/01/2010 \| Last Modified: 07/01/2010 Notes: (Modified 7/1/10)
N531	Not qualified for recovery based on direct payment of premium. Start: 03/01/2010
N532	Not qualified for recovery based on disability and working status. Start: 03/01/2010
N533	Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan. Start: 07/01/2010
N534	This is an individual policy, the employer does not participate in plan sponsorship. Start: 07/01/2010
N535	Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service. Start: 07/01/2010
N536	We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us. Start: 07/01/2010
N537	We have examined claims history and no records of the services have been found. Start: 07/01/2010
N538	A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents. Start: 07/01/2010
N539	Alert: We processed appeals/waiver requests on your behalf and that request has been denied. Start: 07/01/2010
N540	Payment adjusted based on the interrupted stay policy. Start: 11/01/2010
N541	Mismatch between the submitted insurance type code and the information stored in our system. Start: 11/01/2010
N542	Missing income verification. Start: 03/08/2011
N543	Incomplete/invalid income verification. Start: 03/08/2011 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N544	Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future. Start: 07/01/2011 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N545	Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program. Start: 07/01/2011
N546	Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program. Start: 07/01/2011
N547	A refund request (Frequency Type Code 8) was processed previously. Start: 03/06/2012
N548	Alert: Patient's calendar year deductible has been met. Start: 03/06/2012
N549	Alert: Patient's calendar year out-of-pocket maximum has been met. Start: 03/06/2012
N550	Alert: You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hold in the near future. Start: 03/06/2012
N551	Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program. Start: 03/06/2012
N552	Payment adjusted to reverse a previous withhold/bonus amount. Start: 03/06/2012
N553	Payment adjusted based on a Low Income Subsidy (LIS) retroactive coverage or status change. Start: 03/06/2012 \| Stop: 11/01/2012
N554	Missing/Incomplete/Invalid Family Planning Indicator. Start: 07/01/2012 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N555	Missing medication list. Start: 07/01/2012
N556	Incomplete/invalid medication list. Start: 07/01/2012
N557	This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected. Start: 07/01/2012
N558	This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received. Start: 07/01/2012
N559	This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located. Start: 07/01/2012
N560	The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received. Start: 11/01/2012
N561	The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission. Start: 11/01/2012
N562	The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment. Start: 11/01/2012
N563	Alert: Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service. Start: 11/01/2012 \| Last Modified: 11/01/2015 Notes: Related to M39 (Modified 11/1/2015)
N564	Patient did not meet the inclusion criteria for the demonstration project or pilot program. Start: 11/01/2012
N565	Alert: This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed. Start: 11/01/2012 \| Last Modified: 03/01/2013 Notes: (Modified 3/1/13)
N566	Alert: This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed. Start: 11/01/2012
N567	Not covered when considered preventative. Start: 03/01/2013
N568	Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative. Start: 03/01/2013
N569	Not covered when performed for the reported diagnosis. Start: 03/01/2013
N570	Missing/incomplete/invalid credentialing data. Start: 03/01/2013 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N571	Alert: Payment will be issued quarterly by another payer/contractor. Start: 03/01/2013
N572	This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted. Start: 03/01/2013 \| Last Modified: 07/01/2014
N573	Alert: You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor. Start: 03/01/2013
N574	Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider. Start: 07/15/2013
N575	Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records. Start: 07/15/2013
N576	Services not related to the specific incident/claim/accident/loss being reported. Start: 07/15/2013
N577	Personal Injury Protection (PIP) Coverage. Start: 07/15/2013
N578	Coverages do not apply to this loss. Start: 07/15/2013
N579	Medical Payments Coverage (MPC). Start: 07/15/2013
N580	Determination based on the provisions of the insurance policy. Start: 07/15/2013
N581	Investigation of coverage eligibility is pending. Start: 07/15/2013
N582	Benefits suspended pending the patient's cooperation. Start: 07/15/2013
N583	Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person. Start: 07/15/2013
N584	Not covered based on the insured's noncompliance with policy or statutory conditions. Start: 07/15/2013
N585	Benefits are no longer available based on a final injury settlement. Start: 07/15/2013
N586	The injured party does not qualify for benefits. Start: 07/15/2013
N587	Policy benefits have been exhausted. Start: 07/15/2013
N588	The patient has instructed that medical claims/bills are not to be paid. Start: 07/15/2013
N589	Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by the use of a drug. Start: 07/15/2013
N590	Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered. Start: 07/15/2013
N591	Payment based on an Independent Medical Examination (IME) or Utilization Review (UR). Start: 07/15/2013
N592	Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription. Start: 07/15/2013
N593	Not covered based on failure to attend a scheduled Independent Medical Exam (IME). Start: 07/15/2013
N594	Records reflect the injured party did not complete an Application for Benefits for this loss. Start: 07/15/2013
N595	Records reflect the injured party did not complete an Assignment of Benefits for this loss. Start: 07/15/2013
N596	Records reflect the injured party did not complete a Medical Authorization for this loss. Start: 07/15/2013
N597	Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries. Start: 07/15/2013 \| Last Modified: 11/01/2013
N598	Health care policy coverage is primary. Start: 07/15/2013
N599	Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered. Start: 07/15/2013
N600	Adjusted based on the applicable fee schedule for the region in which the service was rendered. Start: 07/15/2013
N601	In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale System applicable to Hawaii. Start: 07/15/2013
N602	Adjusted based on the Redbook maximum allowance. Start: 07/15/2013
N603	This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage. Start: 07/15/2013
N604	In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers' Compensation Board Schedule of Medical Fees, pursuant to Regulation 83 and / or Appendix 17-C of 11 NYCRR. Start: 07/15/2013
N605	This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68. Start: 07/15/2013
N606	The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524. Start: 07/15/2013
N607	Service provided for non-compensable condition(s). Start: 07/15/2013
N608	The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6. Start: 07/15/2013
N609	80% of the provider's billed amount is being recommended for payment according to Act 6. Start: 07/15/2013 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N610	Alert: Payment based on an appropriate level of care. Start: 07/15/2013
N611	Claim in litigation. Contact insurer for more information. Start: 07/15/2013
N612	Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. Start: 07/15/2013
N613	Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future. Start: 07/15/2013
N614	Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information). Start: 07/15/2013
N615	Alert: This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under 45 CFR 156.270, a Qualified Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period. Start: 07/15/2013 \| Last Modified: 03/01/2017 Notes: (Modified 3/1/2017)
N616	Alert: This enrollee is in the first month of the advance premium tax credit grace period. Start: 07/15/2013
N617	This enrollee is in the second or third month of the advance premium tax credit grace period. Start: 07/15/2013
N618	Alert: This claim will automatically be reprocessed if the enrollee pays their premiums. Start: 07/15/2013
N619	Coverage terminated for non-payment of premium. Start: 07/15/2013
N620	Alert: This procedure code is for quality reporting/informational purposes only. Start: 07/15/2013
N621	Charges for Jurisdiction required forms, reports, or chart notes are not payable. Start: 07/15/2013
N622	Not covered based on the date of injury/accident. Start: 07/15/2013
N623	Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate. Start: 07/15/2013
N624	The associated Workers' Compensation claim has been withdrawn. Start: 07/15/2013
N625	Missing/Incomplete/Invalid Workers' Compensation Claim Number. Start: 07/15/2013
N626	New or established patient E/M codes are not payable with chiropractic care codes. Start: 07/15/2013
N627	Service not payable per managed care contract. Start: 07/15/2013 \| Stop: 07/01/2014 Notes: Consider Use CARC 256
N628	Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed. Start: 07/15/2013
N629	Reviews/documentation/notes/summaries/reports/charts not requested. Start: 07/15/2013
N630	Referral not authorized by attending physician. Start: 07/15/2013
N631	Medical Fee Schedule does not list this code. An allowance was made for a comparable service. Start: 07/15/2013
N632	According to the Official Medical Fee Schedule this service has a relative value of zero and therefore no payment is due. Start: 07/15/2013 \| Stop: 07/01/2014 Notes: Consider using W8
N633	Additional anesthesia time units are not allowed. Start: 07/15/2013
N634	The allowance is calculated based on anesthesia time units. Start: 07/15/2013
N635	The Allowance is calculated based on the anesthesia base units plus time. Start: 07/15/2013
N636	Adjusted because this is reimbursable only once per injury. Start: 07/15/2013
N637	Consultations are not allowed once treatment has been rendered by the same provider. Start: 07/15/2013
N638	Reimbursement has been made according to the home health fee schedule. Start: 07/15/2013
N639	Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule. Start: 07/15/2013
N640	Exceeds number/frequency approved/allowed within time period. Start: 07/15/2013
N641	Reimbursement has been based on the number of body areas rated. Start: 07/15/2013
N642	Adjusted when billed as individual tests instead of as a panel. Start: 07/15/2013
N643	The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule. Start: 07/15/2013
N644	Reimbursement has been made according to the bilateral procedure rule. Start: 07/15/2013
N645	Mark-up allowance. Start: 07/15/2013 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N646	Reimbursement has been adjusted based on the guidelines for an assistant. Start: 07/15/2013
N647	Adjusted based on diagnosis-related group (DRG). Start: 07/15/2013
N648	Adjusted based on Stop Loss. Start: 07/15/2013
N649	Payment based on invoice. Start: 07/15/2013
N650	This policy was not in effect for this date of loss. No coverage is available. Start: 07/15/2013
N651	No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss. Start: 07/15/2013
N652	The date of service is before the date of loss. Start: 07/15/2013
N653	The date of injury does not match the reported date of loss. Start: 07/15/2013
N654	Adjusted based on achievement of maximum medical improvement (MMI). Start: 07/15/2013
N655	Payment based on provider's geographic region. Start: 07/15/2013
N656	An interest payment is being made because benefits are being paid outside the statutory requirement. Start: 07/15/2013
N657	This should be billed with the appropriate code for these services. Start: 07/15/2013
N658	The billed service(s) are not considered medical expenses. Start: 07/15/2013
N659	This item is exempt from sales tax. Start: 07/15/2013
N660	Sales tax has been included in the reimbursement. Start: 07/15/2013
N661	Documentation does not support that the services rendered were medically necessary. Start: 07/15/2013
N662	Alert: Consideration of payment will be made upon receipt of a final bill. Start: 07/15/2013
N663	Adjusted based on an agreed amount. Start: 07/15/2013
N664	Adjusted based on a legal settlement. Start: 07/15/2013
N665	Services by an unlicensed provider are not reimbursable. Start: 07/15/2013
N666	Only one evaluation and management code at this service level is covered during the course of care. Start: 07/15/2013
N667	Missing prescription. Start: 07/15/2013 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N668	Incomplete/invalid prescription. Start: 07/15/2013 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N669	Adjusted based on the Medicare fee schedule. Start: 07/15/2013
N670	This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule. Start: 07/15/2013
N671	Payment based on a jurisdiction cost-charge ratio. Start: 07/15/2013
N672	Alert: Amount applied to Health Insurance Offset. Start: 07/15/2013
N673	Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount. Start: 07/15/2013
N674	Not covered unless a pre-requisite procedure/service has been provided. Start: 07/15/2013
N675	Additional information is required from the injured party. Start: 07/15/2013
N676	Service does not qualify for payment under the Outpatient Facility Fee Schedule. Start: 07/15/2013
N677	Alert: Films/Images will not be returned. Start: 11/01/2013
N678	Missing post-operative images/visual field results. Start: 11/01/2013
N679	Incomplete/Invalid post-operative images/visual field results. Start: 11/01/2013
N680	Missing/Incomplete/Invalid date of previous dental extractions. Start: 11/01/2013
N681	Missing/Incomplete/Invalid full arch series. Start: 11/01/2013
N682	Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance. Start: 11/01/2013
N683	Missing/Incomplete/Invalid prior treatment documentation. Start: 11/01/2013
N684	Payment denied as this is a specialty claim submitted as a general claim. Start: 11/01/2013
N685	Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code. Start: 11/01/2013
N686	Missing/incomplete/Invalid questionnaire needed to complete payment determination. Start: 11/01/2013
N687	Alert: This reversal is due to a retroactive disenrollment. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N688	Alert: This reversal is due to a medical or utilization review decision. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N689	Alert: This reversal is due to a retroactive rate change. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N690	Alert: This reversal is due to a provider submitted appeal. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N691	Alert: This reversal is due to a patient submitted appeal. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N692	Alert: This reversal is due to an incorrect rate on the initial adjudication. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N693	Alert: This reversal is due to a cancellation of the claim by the provider. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N694	Alert: This reversal is due to a resubmission/change to the claim by the provider. Start: 11/01/2013
N695	Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication. Start: 11/01/2013
N696	Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N697	Alert: This reversal is due to a payer's retroactive contract incentive program adjustment. Start: 11/01/2013 \| Last Modified: 03/14/2014 Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N698	Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment grace period, resulting in loss of coverage. Start: 11/01/2013 \| Last Modified: 11/01/2015 Notes: To be used with claim/service reversal. (Modified 3/14/2014, 11/1/2015)
N699	Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program. Start: 03/01/2014
N700	Payment adjusted based on the Electronic Health Records (EHR) Incentive Program. Start: 03/01/2014
N701	Payment adjusted based on the Value-based Payment Modifier. Start: 03/01/2014
N702	Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services. Start: 03/01/2014
N703	This service is incompatible with previously adjudicated claims or claims in process. Start: 03/01/2014
N704	Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted. Start: 03/01/2014 \| Last Modified: 03/14/2014 Notes: (Modified 3/14/2014)
N705	Incomplete/invalid documentation. Start: 03/01/2014
N706	Missing documentation. Start: 03/01/2014
N707	Incomplete/invalid orders. Start: 03/01/2014
N708	Missing orders. Start: 03/01/2014
N709	Incomplete/invalid notes. Start: 03/01/2014
N710	Missing notes. Start: 03/01/2014
N711	Incomplete/invalid summary. Start: 03/01/2014
N712	Missing summary. Start: 03/01/2014
N713	Incomplete/invalid report. Start: 03/01/2014
N714	Missing report. Start: 03/01/2014
N715	Incomplete/invalid chart. Start: 03/01/2014
N716	Missing chart. Start: 03/01/2014
N717	Incomplete/Invalid documentation of face-to-face examination. Start: 03/01/2014
N718	Missing documentation of face-to-face examination. Start: 03/01/2014
N719	Penalty applied based on plan requirements not being met. Start: 03/01/2014
N720	Alert: The patient overpaid you. You may need to issue the patient a refund for the difference between the patient's payment and the amount shown as patient responsibility on this notice. Start: 03/01/2014
N721	This service is only covered when performed as part of a clinical trial. Start: 03/01/2014
N722	Patient must use Workers' Compensation Set-Aside (WCSA) funds to pay for the medical service or item. Start: 03/01/2014
N723	Patient must use Liability set-aside (LSA) funds to pay for the medical service or item. Start: 03/01/2014
N724	Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item. Start: 03/01/2014
N725	A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis. Start: 03/01/2014
N726	A conditional payment is not allowed. Start: 03/01/2014
N727	A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis. Start: 03/01/2014
N728	A workers' compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis. Start: 03/01/2014
N729	Missing patient medical/dental record for this service. Start: 11/01/2014
N730	Incomplete/invalid patient medical/dental record for this service. Start: 11/01/2014
N731	Incomplete/Invalid mental health assessment. Start: 11/01/2014
N732	Services performed at an unlicensed facility are not reimbursable. Start: 11/01/2014
N733	Regulatory surcharges are paid directly to the state. Start: 11/01/2014
N734	The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury. Start: 11/01/2014
N735	Adjustment without review of medical/dental record because the requested records were not received or were not received timely. Start: 03/01/2015 \| Stop: 01/01/2016
N736	Incomplete/invalid Sleep Study Report. Start: 03/01/2015
N737	Missing Sleep Study Report. Start: 03/01/2015
N738	Incomplete/invalid Vein Study Report. Start: 03/01/2015
N739	Missing Vein Study Report. Start: 03/01/2015
N740	The member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service. Start: 03/01/2015
N741	This is a site neutral payment. Start: 03/01/2015
N742	Alert: This claim was processed based on one or more ICD-9 codes. The transition to ICD-10 is required by October 1, 2015, for health care providers, health plans, and clearinghouses. More information can be found at http://www.cms.gov/Medicare/Coding/ICD10/ProviderResources.html Start: 03/01/2015 \| Stop: 11/01/2016 \| Last Modified: 11/01/2015 Notes: (Modified 11/1/2015)
N743	Adjusted because the services may be related to an employment accident. Start: 03/01/2015
N744	Adjusted because the services may be related to an auto/other accident. Start: 03/01/2015 \| Last Modified: 03/01/2017 Notes: (Modified 3/1/2017)
N745	Missing Ambulance Report. Start: 03/01/2015
N746	Incomplete/invalid Ambulance Report. Start: 03/01/2015
N747	This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides. Start: 03/01/2015
N748	Adjusted because the related hospital charges have not been received. Start: 03/01/2015
N749	Missing Blood Gas Report. Start: 03/01/2015
N750	Incomplete/invalid Blood Gas Report. Start: 03/01/2015
N751	Adjusted because the patient is covered under a Medicare Part D plan. Start: 03/01/2015 \| Last Modified: 07/01/2017 Notes: (Modified 7/1/2017)
N752	Missing/incomplete/invalid HIPPS Treatment Authorization Code (TAC). Start: 03/01/2015
N753	Missing/incomplete/invalid Attachment Control Number. Start: 07/01/2015
N754	Missing/incomplete/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form. Start: 07/01/2015
N755	Missing/incomplete/invalid ICD Indicator. Start: 07/01/2015 \| Last Modified: 03/01/2016 Notes: (Modified 3/1/2016)
N756	Missing/incomplete/invalid point of drop-off address. Start: 07/01/2015
N757	Adjusted based on the Federal Indian Fees schedule (MLR). Start: 07/01/2015
N758	Adjusted based on the prior authorization decision. Start: 07/01/2015
N759	Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013. Start: 07/01/2015
N760	This facility is not authorized to receive payment for the service(s). Start: 11/01/2015
N761	This provider is not authorized to receive payment for the service(s). Start: 11/01/2015
N762	This facility is not certified for Tomosynthesis (3-D) mammography. Start: 11/01/2015
N763	The demonstration code is not appropriate for this claim; resubmit without a demonstration code. Start: 11/01/2015
N764	Missing/incomplete/invalid Hematocrit (HCT) value. Start: 03/01/2016
N765	This payer does not cover coinsurance assessed by a previous payer. Start: 03/01/2016 \| Last Modified: 03/01/2018 Notes: (Modified 3/1/2018)
N766	This payer does not cover co-payment assessed by a previous payer. Start: 03/01/2016
N767	The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed. Start: 03/01/2016
N768	Incomplete/invalid initial evaluation report. Start: 03/01/2016
N769	A lateral diagnosis is required. Start: 03/01/2016
N770	The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received. Start: 03/01/2016
N771	Alert: Under Federal law you cannot charge more than the limiting charge amount. Start: 07/01/2016
N772	Alert: Rebill urgent/emergent and ancillary services separately. Start: 07/01/2016
N773	Drug supplied not obtained from specialty vendor. Start: 07/01/2016
N774	Alert: Refer to your Third Party Processor Agreement for specific information on fees associated with this payment type. Start: 07/01/2016
N775	Payment adjusted based on x-ray radiograph on film. Start: 11/01/2016
N776	This service is not a covered Telehealth service. Start: 11/01/2016
N777	Missing Assignment of Benefits Indicator. Start: 11/01/2016 \| Last Modified: 03/01/2017 Notes: (Modified 3/1/2017)
N778	Missing Primary Care Physician Information. Start: 11/01/2016
N779	Replacement/Void claims cannot be submitted until the original claim has finalized. Please resubmit once payment or denial is received. Start: 11/01/2016
N780	Missing/incomplete/invalid end therapy date. Start: 11/01/2016
N781	Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer. Start: 11/01/2016 \| Last Modified: 03/01/2018 Notes: (Modified 3/1/2018)
N782	Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance. This amount may be billed to a subsequent payer. Start: 11/01/2016 \| Last Modified: 03/01/2018 Notes: (Modified 3/1/2018)
N783	Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected copayment. This amount may be billed to a subsequent payer. Start: 11/01/2016 \| Last Modified: 03/01/2018 Notes: (Modified 3/1/2018)
N784	Missing comprehensive procedure code. Start: 11/01/2016
N785	Missing current radiology film/images. Start: 11/01/2016
N786	Benefit limitation for the orthodontic active and/or retention phase of treatment. Start: 11/01/2016
N787	Alert: Under 42 CFR 410.43, an eligible Partial Hospitalization Program (PHP) patient/beneficiary requires a minimum of 20 hours of PHP services per week, as evidenced in the plan of care. PHP services must be furnished in accordance with the plan of care. Start: 03/01/2017
N788	Alert: The third-party administrator/review organization did not receive the required information. Start: 03/01/2017 \| Last Modified: 07/01/2018 Notes: (Modified 11/1/2017, 7/1/2018)
N789	Clinical Trial is not a covered benefit. Start: 07/01/2017
N790	Provider/supplier not accredited for product/service. Start: 07/01/2017
N791	Missing history & physical report. Start: 07/01/2017
N792	Incomplete/invalid history & physical report. Start: 07/01/2017
N793	Alert: Starting January 1, 2020, Medicare will ONLY accept claims submitted with the Medicare Beneficiary Identifier (MBI). Medicare will reject any claims submitted with the Health Insurance Claim Number (HICN) with a few exceptions. Please see www.cms.gov/Medicare/New-Medicare-Card/index.html for more information. Start: 07/01/2017 \| Stop: 07/01/2020 \| Last Modified: 11/15/2019 Notes: (Modified 11/1/2017, 7/1/2019, 11/15/2019)
N794	Payment adjusted based on type of technology used. Start: 07/01/2017
N795	Item must be resubmitted as a purchase. Start: 11/01/2017
N796	Missing/incomplete/invalid Hemoglobin (Hb or Hgb) value. Start: 11/01/2017
N797	Missing/incomplete/invalid date qualifier. Start: 11/01/2017
N798	Submit a void request for the original claim and resubmit a new claim. Start: 11/01/2017
N799	Submitted identifier must be an individual identifier, not group identifier. Start: 11/01/2017 \| Last Modified: 03/01/2018 Notes: (Modified 3/1/2018)
N800	Only one service date is allowed per claim. Start: 03/01/2018
N801	Services performed in a Medicare participating or CAH facility under a self-insured tribal Group Health Plan, in accordance with Federal Regulation 42 CFR 136. Start: 03/01/2018
N802	This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Rendering Physician is located. Start: 03/01/2018
N803	Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital. Start: 03/01/2018
N804	Alert: The claim/service was processed through the Outpatient Code Editor (OCE). Start: 07/01/2018
N805	Alert: The claim/service was processed through the Correct Code Editor (CCE). Start: 07/01/2018
N806	Payment is included in the Global transplant allowance. Start: 07/01/2018
N807	Payment adjustment based on the Merit-based Incentive Payment System (MIPS). Start: 07/01/2018
N808	Not covered for this provider type / provider specialty. Start: 07/01/2018
N809	Alert: The fee schedule amount for this service was adjusted based on prior competitive bidding rates. For more information, contact your local contractor. Start: 11/01/2018
N810	Alert: Due to federal, state or local disaster declaration, this claim has been processed at the in-network level of benefit. At the conclusion or expiration of the disaster declaration, network payment rules will be reinstated. Start: 11/01/2018 \| Last Modified: 03/01/2019
N811	Missing Federal Sequestration Reduction from Prior Payer. Start: 11/01/2018
N812	The start service date through end service date cannot span greater than 18 months. Start: 11/01/2018
N815	Missing/Incomplete/Invalid NDC Unit Count Start: 07/01/2019
N816	Missing/Incomplete/Invalid NDC Unit of Measure Start: 07/01/2019
N817	Alert: Applicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 - March 31, 2020. Start: 07/01/2019
N818	Claims Dates of Service do not match Electronic Visit Verification System. Start: 07/01/2019
N819	Patient not enrolled in Electronic Visit Verification System. Start: 07/01/2019
N820	Electronic Visit Verification System units do not meet requirements of visit. Start: 07/01/2019
N821	Electronic Visit Verification System visit not found. Start: 07/01/2019
N822	Missing procedure modifier(s). Start: 07/01/2019 \| Last Modified: 11/01/2019
N823	Incomplete/Invalid procedure modifier(s). Start: 07/01/2019 \| Last Modified: 11/01/2019
N824	Electronic Visit Verification (EVV) data must be submitted through EVV Vendor. Start: 11/01/2019
N825	Early intervention guidelines were not met. Start: 11/01/2019
N826	Patient did not meet the inclusion criteria for the Medicare Shared Savings Program. Start: 11/01/2019
N827	Missing/Incomplete/Invalid Federal Information Processing Standard (FIPS) Code. Start: 11/01/2019
N828	Alert: Payment is suppressed due to a contracted funding. Start: 03/01/2020
N829	Missing/incomplete/invalid Diagnostics Exchange Z-Code Identifier. Start: 03/01/2020
N830	Alert: The charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations. As such, any amount identified with OA, CO, or PI cannot be collected from the member and may be considered provider liability or be billable to a subsequent payer. Any amount the provider collected over the identified PR amount must be refunded to the patient within applicable Federal/State timeframes. Payment amounts are eligible for dispute pursuant to any Federal/State documented appeal/grievance process(es). Start: 03/01/2020 \| Last Modified: 03/01/2022 Notes: (Modified 3/1/2022)
N831	You have not responded to requests to revalidate your provider/supplier enrollment information. Start: 03/01/2020
N832	Duplicate occurrence code/occurrence span code. Start: 07/01/2020
N833	Patient share of cost waived. Start: 07/01/2020
N834	Jurisdiction exempt from sales and health tax charges. Start: 11/01/2020
N835	Unrelated Service/procedure/treatment is reduced. The balance of this charge is the patient's responsibility. Start: 11/01/2020
N836	Provider W9 or Payee Registration not on file. Start: 11/01/2020
N837	Alert: Missing modifier was added. Start: 11/01/2020
N838	Alert: Service/procedure postponed due to a federal, state, or local mandate/disaster declaration. Any amounts applied to deductible or member liability will be applied to the prior plan year from which the procedure was cancelled. Start: 11/01/2020
N839	The procedure code was added/changed because the level of service exceeds the compensable condition(s). Start: 03/01/2021
N840	Worker's compensation claim filed with a different state. Start: 03/01/2021
N841	Alert: North Dakota Administrative Rule 92-01-02-50.3. Start: 03/01/2021
N842	Alert: Patient cannot be billed for charges. Start: 03/01/2021
N843	Missing/incomplete/invalid Core-Based Statistical Area (CBSA) code. Start: 03/01/2021
N844	This claim, or a portion of this claim, was processed in accordance with the Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act. Start: 03/01/2021
N845	Alert: Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act. Start: 03/01/2021
N846	National Drug Code (NDC) supplied does not correspond to the HCPCs/CPT billed. Start: 03/01/2021
N847	National Drug Code (NDC) billed is obsolete. Start: 03/01/2021
N848	National Drug Code (NDC) billed cannot be associated with a product. Start: 03/01/2021
N849	Missing Tooth Clause: Tooth missing prior to the member effective date. Start: 03/01/2021
N850	Missing/incomplete/invalid narrative explaining/describing this service/treatment. Start: 03/01/2021
N851	Payment reduced because services were furnished by a therapy assistant. Start: 07/01/2021
N852	The pay-to and rendering provider tax identification numbers (TINs) do not match Start: 07/01/2021
N853	The number of modalities performed per session exceeds our acceptable maximum. Start: 07/01/2021
N854	Alert: If you have primary other health insurance (OHI) coverage that has denied services, you must exhaust all appeal levels with your primary OHI before we can consider your claim for reimbursement. Start: 07/01/2021
N855	This coverage is subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001. Start: 07/01/2021
N856	This coverage is not subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001. Start: 07/01/2021
N857	This claim has been adjusted/reversed. Refund any collected copayment to the member. Start: 11/01/2021
N858	Alert: State regulations relating to an Out of Network Medical Emergency Care Act were applied to the processing of this claim. Payment amounts are eligible for dispute following the state's documented appeal/ grievance/ arbitration process. Start: 11/01/2021
N859	Alert: The Federal No Surprise Billing Act was applied to the processing of this claim. Payment amounts are eligible for dispute pursuant to any Federal documented appeal/ grievance/ dispute resolution process(es). Start: 11/01/2021 \| Last Modified: 03/01/2022 Notes: (modified 3/1/2022)
N860	Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s). Start: 11/01/2021
N861	Alert: Mismatch between the submitted Patient Liability/Share of Cost and the amount on record for this recipient. Start: 03/01/2022
N862	Alert: Member cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge. Start: 03/01/2022
N863	Alert: This claim is subject to the No Surprises Act (NSA). The amount paid is the final out-of-network rate and was calculated based on an All Payer Model Agreement, in accordance with the NSA. Start: 03/01/2022
N864	Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services. Start: 03/01/2022
N865	Alert: This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient visit to a participating facility. Start: 03/01/2022
N866	Alert: This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services. Start: 03/01/2022
N867	Alert: Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act. Start: 03/01/2022
N868	Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act. Start: 03/01/2022
N869	Alert: Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act. Start: 03/01/2022
N870	Alert: In accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount. Start: 03/01/2022
N871	Alert: This initial payment was calculated based on a specified state law, in accordance with the No Surprises Act. Start: 03/01/2022
N872	Alert: This final payment was calculated based on a specified state law, in accordance with the No Surprises Act. Start: 03/01/2022
N873	Alert: This final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act. Start: 03/01/2022
N874	Alert: This final payment was determined through open negotiation, in accordance with the No Surprises Act. Start: 03/01/2022
N875	Alert: This final payment equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity, in accordance with the No Surprises Act. Start: 03/01/2022
N876	Alert: This item or service is covered under the plan. This is a notice of denial of payment provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate than the amount paid by the patient in cost sharing. Start: 03/01/2022
N877	Alert: This initial payment is provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate. Start: 03/01/2022
N878	Alert: The provider or facility specified that notice was provided and consent to balance bill obtained, but notice and consent was not provided and obtained in a manner consistent with applicable Federal law. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited. Start: 03/01/2022
N879	Alert: The notice and consent to balance bill, and to be charged out-of-network cost sharing, that was obtained from the patient with regard to the billed services, is not permitted for these services. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited. Start: 03/01/2022
N880	Original claim closed due to changes in submitted data. Adjustment claim will be processed under a new claim number. Start: 11/01/2022
N881	Client Obligation, patient responsibility for Home & Community Based Services (HCBS) Start: 11/01/2022
N882	Alert: The out-of-network payment and cost sharing amounts were based on the plan's allowance because the provider or facility obtained the patient's consent to waive the balance billing protections under the No Surprises Act. Start: 11/01/2022
N883	Alert: Processed according to state law Start: 11/01/2022
N884	Alert: The No Surprises Act may apply to this claim. Please contact payer for instructions on how to submit information regarding whether or not the item or service was furnished during a patient visit to a participating facility. Start: 11/01/2022
N885	Alert: This claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements. The payer disagrees with your determination that those requirements apply. You may contact the payer to find out why it disagrees. You may appeal this adverse determination on behalf of the patient through the payer’s internal appeals and external review processes. Start: 11/01/2022
N886	Alert: A Health Care Claim Request for Additional Information (277 RFAI) has been sent. Start: 07/01/2023
N887	Providers not participating in the Medicare Advantage Plan have the right to appeal if the plan has partially or fully denied payment or if the provider believes the plan has not paid the services at the expected Medicare reimbursable rate or type of level/service. Providers may file their appeal in writing within 60 calendar days after the date of the remittance advice. For the plan to review the appeal, the plan will need a completed signed Waiver of Liability Statement. To obtain a Waiver of Liability form, please contact your Medicare Advantage Plan. Once we receive the completed forms, we will give you a decision on your appeal within 60 calendar days. Start: 07/01/2023
N888	Alert: An electronic request for additional information has been sent for this claim. Start: 07/01/2023
N889	Alert: This claim was originally processed in real-time, and we sent a real-time 835 response. Start: 11/01/2023
N890	Electronic Visit Verification Data Element Requirements were not met. Start: 11/01/2023
N891	The maximum allowable payment for this service/procedure was paid by the primary insurance. No further payment due. Start: 11/01/2023
N892	The claim does not meet the criteria for acceptable use of the Delay Reason Code. Start: 11/01/2023
N893	Missing/incomplete/invalid child medical evaluation form/checklist. Start: 03/01/2024
N894	Alert: These payments are made subject to a reservation of rights for the Payor to recoup or otherwise recover all or part of these payments based on any of the following: outcome of pending or future litigation/ new or updated state, federal or regulatory guidance/ any other actions that may affect the Payor's obligation to make these payments. Start: 03/01/2024
N895	Processed based on a negotiated fee schedule for a specialty drug program. Start: 03/01/2024
N896	Missing/incomplete/invalid trauma activation sheet. Start: 07/01/2024
N897	Missing/incomplete/invalid proof of member payment. Start: 07/01/2024
N898	Missing/incomplete/invalid Resource Utilization Group(s) (RUG) code(s). Start: 07/01/2024
N899	Missing Initial Evaluation Report. Start: 07/01/2024
N900	Missing Therapy Notes/Report. Start: 07/01/2024
N901	Incomplete/Invalid Therapy Notes/Report. Start: 07/01/2024
N902	Missing Health Risk Assessment (HRA). Start: 07/01/2024
N903	Incomplete/Invalid Health Risk Assessment (HRA). Start: 07/01/2024
N904	The transportation vendor is responsible for this claim. Start: 07/01/2024
N905	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 not responsible for payment. Start: 03/01/2025
N906	Service is not covered when patient is under age 45. Start: 03/01/2025
N907	No refund because this claim has been identified as 340B-eligible with a ceiling price lower than the maximum fair price. Start: 03/01/2025 Notes: To be used with the Medicare Drug Price Negotiation Program only.
N908	No refund because this drug has been prospectively purchased at the maximum fair price. Start: 03/01/2025 Notes: To be used with the Medicare Drug Price Negotiation Program only.
N909	Refund amount has been calculated using a methodology that differs from the Standard Default Refund Amount calculation ((Wholesale Acquisition Cost minus Maximum Fair Price) times Quantity). Start: 03/01/2025 Notes: To be used with the Medicare Drug Price Negotiation Program only.
N910	A refund cannot be provided for this claim at this time. Contact the manufacturer directly regarding your eligibility. Start: 03/01/2025 Notes: To be used with the Medicare Drug Price Negotiation Program only.
N911	This claim cannot be reimbursed by the manufacturer until the Part D plan submits corrected prescription drug event data to CMS for maximum fair price validation. Start: 03/01/2025 Notes: To be used with the Medicare Drug Price Negotiation Program only.
N912	Our records indicate that this beneficiary did not elect hospice. Start: 07/01/2025
N913	More than one Electronic Visit Verification record exists for the date and time of this service. Start: 07/01/2025
N914	This claim was priced and processed in accordance with California AB-72 Health care coverage. Start: 07/01/2025
N915	Predetermination of services is not allowed under the member's plan. Start: 07/01/2025
N916	The third party will render payment to the provider, and they will reimburse you for covered services. Start: 07/01/2025

Code List Notes

Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. Each RARC identifies a specific message as shown in the Remittance Advice Remark Code List. There are two types of RARCs, supplemental and informational. The majority of the RARCs are supplemental; these are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation for an adjustment already described by a CARC. The second type of RARC is informational; these RARCs are all prefaced with Alert: and are often referred to as Alerts. Alerts are used to convey information about remittance processing and are never related to a specific adjustment or CARC.

Code List Filters Block Reference

Filter by code:

Filter codes by status:

Code List Accordions

Electronic Mailing List to Track Requests

You can subscribe to an electronic mailing list to monitor RARC change requests, ask questions, and track progress.

To subscribe, go here: lists.x12.org.

Click on the vertical ellipsis:

Public Lists

Click on Subscribe to this list:

Select Subscribe to this list

E-mail is required, name is not, click Subscribe:

Subscribe form

You will receive an email from the electronic mailing list to confirm your email address. Once confirmed, you will receive all email sent to the list. If you reply to an email it will be sent to all subscribers.

Review the Mailing List Archive

You can also view all emails ever sent to the list with a web interface. To do so, register here: lists.x12.org. Click the "Hi, Guest" image in the top right corner:

Hi Guest Image

And then Sign up for a new account:

You will receive an email to verify your address for this service. Click the "Verify Email Address" button. Once confirmed, you will see the screen shot below:

My Lists

Click the vertical ellipsis to view available options, for the most part you'll select "View the archives."

Harmony Options

The archives screen is shown below:

Empathy

You can post a new thread, unsubscribe from the list, search the list, find threads by month, and sort by most recent and most activity. Click a thread to see all posts in the order they were submitted. You can reply to the thread after selecting that thread.

Maintenance Request Form

Read more about Remittance Advice Remark Codes

Provider Taxonomy Codes

Code List ID

682

Code List Scope Statement

These codes define the health care service provider type, classification, and area of specialization.

Code List Maintained By

NUCC

Code List Updated Date

Tue, 07/01/2025 - 12:00

Code List Notes

Online Provider Taxonomy code lookup

This code list is a National Uniform Claim Committee (NUCC) property.

Read more about Provider Taxonomy Codes

Provider Adjustment Reason Codes

Code List ID

967

Code List Scope Statement

These codes report payment adjustments that are not related to a specific claim, bill, or service.

Code List Maintained By

CMG01

Code List Updated Date

Tue, 07/01/2025 - 12:00

Code List Table

01	Card interchange fee amount Start: 10/01/2018
02	Advanced or accelerated payment recoupment amount Start: 03/01/2019
03	Claim transmission fee amount Start: 03/01/2019
04	Real-time adjudication resulting in a payment that will follow separately. Start: 04/11/2019
05	Penalty amount withheld due to reports that were not filed Start: 04/11/2019
06	Penalty amount withheld due to reports that were filed incorrectly Start: 04/11/2019
07	Non-Internal Revenue Service third-party withholding amount unrelated to a federal payment levy program Start: 11/01/2019
08	Penalty Withholding for Bankruptcy/Termination Start: 11/01/2019
10	Non-claims-based interim payment of the provider's cost settlement amounts for capital expense. Start: 11/01/2024
11	Domestic N95 Respirator Procurement Passthrough Start: 09/17/2024 \| Stop: 12/18/2024
12	Non-claims-based payment of a manual invoice for temporary payment allowance or settlement for an amount due to the payee which cannot be paid via normal processes. Start: 03/01/2025
13	Supply chain cost pass-through Start: 03/01/2025
14	Non-claims-based interim payment of the provider's cost settlement amount for Direct Graduate Medical Education expense Start: 07/01/2025
15	Non-claims-based interim lump sum payment of the provider's cost settlement amount for non-physician anesthetists expense Start: 07/01/2025
16	Non-claims-based interim payment of the provider's cost settlement amount for organ acquisition expense Start: 07/01/2025
17	Non-claims-based interim payment of the provider's cost settlement amount for Return on Equity (ROE) expense Start: 07/01/2025
18	Non-claims-based interim payment of the provider's cost settlement amount for direct medical education expense Start: 07/01/2025
50	The amount of the late charge, late claim filing penalty, or Medicare late cost report penalty. Start: 07/01/2018
51	Late filing interest penalty assessment amount Start: 07/01/2018 \| Last Modified: 03/01/2019
72	Provider refund amount This adjustment acknowledges a refund received from a provider for previous overpayment. Start: 07/01/2018 \| Last Modified: 03/01/2019
90	Early payment allowance amount Start: 07/01/2018
AH	Claim transmission fee amount This code is used for transmission fees that are not specific to or dependent upon individual claims. Start: 07/01/2018 \| Last Modified: 03/01/2019
AM	Loan repayment amount Start: 07/01/2018 \| Last Modified: 03/01/2019
AP	Advanced or accelerated payment amount Start: 07/01/2018 \| Last Modified: 04/11/2019
B2	Rebate amount Applies when a provider has remitted an over payment to a health plan in excess of the amount requested by the health plan. Start: 07/01/2018 \| Last Modified: 03/01/2019
B3	Recovery amount This represents the amount received from the provider for an overpayment based on payments from other payers. This code is not used for other provider refund adjustment amounts. Start: 07/01/2018 \| Last Modified: 03/01/2019
BD	Bad debt amount Start: 07/01/2018 \| Last Modified: 03/01/2019
BN	Bonus amount Start: 07/01/2018
CR	Capitation interest amount Start: 07/01/2018
CS	Adjustment amount, detailed information is provided separately to explain the adjustment. Start: 10/01/2018
CT	Capitation payment amount Start: 07/01/2018
E3	Withholding amount Start: 07/01/2018 \| Last Modified: 03/01/2019
FB	Non-claim related balance forward amount Start: 07/01/2018 \| Last Modified: 03/01/2019
FC	Allocation of prepaid funds against which deductions are drawn as services are provided. Start: 03/01/2019
FR	Claim-related balance forward amount Start: 03/01/2019
HM	Hemophilia clotting factor add-on payment amount Start: 03/01/2019
IP	Incentive payment amount Start: 10/01/2018
IR	Internal Revenue Service 1099 withholding amount Start: 03/01/2019
IS	Lump sum based on an interim rate Start: 04/11/2019
J1	Amount not reimbursed based on a demonstration program or other limitation that prevents issuance of payment. Start: 03/01/2019
L3	Penalty amount Start: 10/01/2018
L6	Interest amount Start: 03/01/2019
LE	Internal Revenue Service non-1099 withholding amount Start: 03/01/2019
OB	Affiliated provider(s) offset amount Start: 10/01/2018
PI	Periodic Interim Payment (PIP) lump sum amount Start: 03/01/2019
PL	Final payment or settlement amount Start: 10/01/2018
RA	Retroactive adjustment amount Start: 10/01/2018
SL	Student loan garnishment amount Start: 10/01/2018 \| Last Modified: 03/01/2019
TL	Third party liability determination amount Start: 03/01/2019
WO	Overpayment recovery amount Start: 10/01/2018
WU	Non-Internal Revenue Service withholding amount related to a federal payment levy program Start: 11/01/2019

Code List Filters Block Reference

Filter by code:

Filter codes by status:

Maintenance Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

Received
The request has been submitted but is not yet under review.
Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
In Process
The CMG has initiated their decision process.
On Hold
The CMG has initiated their decision process but cannot complete it at this time.
CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.

Status last Reviewed: 7/1/2025

Num.	Date	Requested Description	Type	Code	Status
135	6/20/2023	Non-claims-based interim payment of the provider's cost settlement amount for direct medical education expense	New	18	Applied
136	6/20/2023	Non-claims-based interim payment of the provider's cost settlement amount for Direct Graduate Medical Education expense	New	14	Applied
137	6/20/2023	Non-claims-based interim lump sum payment of the provider's cost settlement amount for non-physician anesthetists expense	New	15	Applied
138	6/20/2023	Non-claims-based interim payment of the provider's cost settlement amount for organ acquisition expense	New	16	Applied
139	6/20/2023	Non-claims based interim payment of the provider's cost settlement amount for Return on Equity expense	New	17	Applied

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

*The description you are suggesting for a new code or to replace the description for a current code.

*Explain the business scenario or use case when the requested new code would be used, the reason an existing code is no longer appropriate for the code list’s business purpose, or reason the current description needs to be revised.

Read more about Provider Adjustment Reason Codes

Payment Type Codes

Code List Scope Statement

These codes identify the type and purpose for a payment amount.

Code List Maintained By

CMS

Code List Updated Date

Mon, 03/01/2021 - 12:00

Code List Table

ADM	Administrative Fees used for a debt owed by the payee. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. The Administrative Fee is $15. Negative Amounts Only Start: 11/01/2015 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
APTC	Advance Payment of Premium Tax Credit. RMR04 will be positive. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
APTCADJ	Advance Payment of Premium Tax Credit Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
APTCMADJ	APTC Manual Adjustment. Used to show APTC manual adjustment when enrollment group level information is not applicable. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
BAL	When an AR invoice is split between multiple HIX 820 reports, this adjustment balances the reports. Negative Amounts & Positive Amounts Start: 10/01/2013 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
CSR	Advance Payment of Cost Sharing Reduction. RMR04 will be positive. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
CSRADJ	Advance Payment of Cost Sharing Reduction Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
CSRMADJ	CSR Manual Adjustment. Used to show CSR manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
CSRN	Cost Sharing Reduction Reconciliation. Negative Amounts & Positive Amounts Start: 01/01/2015 \| Last Modified: 05/01/2017 Notes: CMS Exchange Markets
CSRNADJ	Cost Sharing Reduction Reconciliation Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
DDVC	Default Data Validation Charge or Allocation Payment. If DDVC is the Payment Type Code, a corresponding Report Type Code of DDVCRPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts Start: 02/01/2021 Notes: All Markets
DEBTADJ	Payee's debt amount covered by an affiliate's payment. RMR04 will be positive. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. When used to report that a prior debt was covered, RMR04 with the payment type code of BAL will also be used. Start: 10/01/2013 \| Last Modified: 11/01/2014 \| Stop: 05/01/2015 Notes: CMS
DEPENDENTPREM	Dependent responsible premium amount. RMR04 will be positive. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
DEPENDENTPREMADJCANCEL	Dependent premium amount adjustment due to cancellation. RMR04 will positive or negative Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
DEPENDENTPREMADJNSF	Dependent responsible premium amount due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
DEPENDENTPREMADJTERMINATE	Dependent responsible premium amount due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYEEPREM	Employee responsible premium amount. RMR04 will be positive. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYEEPREMADJCANCEL	Employee responsible premium amount adjustment due to cancellation. RMR04 will be positive or negative Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYEEPREMADJNSF	Employee responsible premium amount adjustment due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYEEPREMADJTERMINATE	Employee responsible premium amount adjustment due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYERPREM	Employer responsible premium amount. RMR04 will be positive. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYERPREMADJCANCEL	Employer responsible premium amount adjustment due to cancellation. RMR04 will be positive or negative Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYERPREMADJNSF	Employer responsible premium amount adjustment due to non-sufficient funds. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EMPLOYERPREMADJTERMINATE	Employer responsible premium amount adjustment due to the termination of a policy. RMR04 will be positive or negative. Start: 11/01/2014 \| Last Modified: 11/01/2015 Notes: CMS SHOP Market Only
EXTLOAN	Payment Offsets For Co-op Loan. Negative Amounts Only Start: 10/18/2016 Notes: CMS Co-ops Only
HCRPC	High Cost Risk Pool Contribution Amount. Negative Amounts & Positive Amounts Start: 08/01/2019 Notes: All Markets
HCRPP	High Cost Risk Pool Payment Amount. Negative Amounts & Positive Amounts Start: 08/01/2019 Notes: All Markets
HCRPPYREF	High Cost Risk Pool Refund For Prior Fiscal Years. Positive Amounts Only Start: 08/01/2019 Notes: All Markets
HCRPADMIN	High Cost Risk Pool Refund of Admin Charge. Positive Amounts Only Start: 08/01/2019 Notes: All Markets
HCRPINT	High Cost Risk Pool Refund of Interest Charge. Positive Amounts Only Start: 08/01/2019 Notes: All Markets
INT	Interest charges for a debt owed by the payee. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. The Secretary of Treasury certifies and updates an interest rate on a quarterly basis. Negative Amounts Only Start: 11/01/2015 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
INVOICE	Used to show a total amount that will be billed or otherwise collected. Only used when BPR02 would otherwise be negative. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 10/01/2013 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
PEN	Penalty charges for a debt owed by the payee. The Treasury will add additional administrative fees of up to 30 percent and accrue the required penalty charge of 6 percent per year on any amount outstanding. Interest will continue to accrue. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 11/01/2015 \| Last Modified: 05/01/2017 Notes: CMS All Programs and Relevant Markets
RA	Risk Adjustment Charge or Payment. If RA is the Payment Type Code, a corresponding Report Type Code of RARPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts Start: 01/01/2015 \| Last Modified: 03/01/2021 Notes: All Markets
RAADJ	Risk Adjustment Payment or Charge Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
RAAR	Risk Adjustment Administration Fee Refund. A Risk Adjustment Admin Fee is only charged if an Issuer does not pay their RA Charges within 30 days. Positive Amounts Only Start: 10/01/2015 \| Last Modified: 05/01/2017 Notes: All Markets
RACR	Risk Adjustment Refund For Prior Fiscal Years. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAD	Risk Adjustment Default Charge or Allocation Payment. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts Start: 05/01/2015 \| Last Modified: 03/01/2021 Notes: All Markets
RADV	Risk Adjustment Data Validation Adjustment Charge or Payment. If RADV is the Payment Type Code, a corresponding Report Type Code of RADVRPT will also be included. (Invoice Number and specific detail may be provided in the Document Control Number in the payment reports effective July 2017). Negative Amounts & Positive Amounts Start: 02/01/2021 Notes: All Markets
RAIR	Risk Adjustment Interest Charge Refund. A Risk Adjustment Interest Charge is only assessed if an Issuer does not pay their RA Charges within 30 days. Negative Amounts & Positive Amounts Start: 10/01/2015 \| Last Modified: 05/01/2017 Notes: All Markets
RAREF	Risk Adjustment Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUF	Risk Adjustment User Fee. Negative Amounts Only Start: 01/01/2015 \| Last Modified: 05/01/2017 Notes: All Markets
RAUFADJ	Risk Adjustment User Fee Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
RAUFAR	Risk Adjustment User Fee Refund of admin charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUFIR	Risk Adjustment User Fee Refund of interest charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUFR	Risk Adjustment User Fee Refund. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUFR2PY	Risk Adjustment User Fee Refund. Positive Amounts Only Start: 10/18/2016 \| Last Modified: 08/01/2018 \| Stop: 09/30/2018 Notes: All Markets
RAUFREF	Risk Adjustment User Fee refund for current fiscal year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RAUFRN	Risk Adjustment User Fee Refund. Positive Amounts Only Start: 05/01/2015 \| Last Modified: 08/01/2018 \| Stop: 09/30/2018 Notes: All Markets
RC	Risk Corridor Program payment or charge amount. Negative Amounts & Positive Amounts Start: 01/01/2015 \| Last Modified: 05/01/2017 Notes: CMS Exchange Markets
RC15	Risk Corridors Charges. Negative Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets
RCADJ	Risk Corridor Adjustment. RMR04 will be positive or negative. Start: 01/01/2015 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
RCAR	Risk Corridors Refund Of Admin Charge. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets
RCCR15	Risk Corridors Refund For Prior Fiscal Years. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets
RCCR16	Risk Corridors Refund For Current Fiscal Year. Positive Amounts Only Start: 10/18/2016 Notes: CMS Exchange Markets
RCIR	Risk Corridors Refund Of Interest Charge. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
RCREF	Risk Corridors Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
REDUCED	Payment reduced to cover a debt owed by the payee. RMR04 will be negative. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Negative Amounts Only Start: 10/01/2013 \| Last Modified: 05/01/2017 Notes: CMS Exchange Markets
RIC	Reinsurance Contribution Amount. Negative Amounts & Positive Amounts Start: 06/01/2014 \| Last Modified: 05/01/2017 Notes: All Markets
RICADJ	Reinsurance Contribution Adjustment. RMR04 will be positive or negative. Start: 06/01/2014 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
RICAR	Reinsurance Contribution Refund Of Admin Charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RICIR	Reinsurance Contribution Refund Of Interest Charge. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RICR	Reinsurance Contribution Refund For Prior Fiscal Years. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RICREF	Reinsurance Contribution Refund For Current Fiscal Year. Positive Amounts Only Start: 05/01/2015 Notes: All Markets
RIP	Reinsurance Payment Amount. Negative Amounts & Positive Amounts Start: 06/01/2014 \| Last Modified: 05/01/2017 Notes: CMS Individual Market Only
RIPADJ	Reinsurance Payment Adjustment. RMR04 will be positive or negative. Start: 06/01/2014 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
SHOPUF	Federally-facilitated Marketplace User Fee for SHOP plans. (SHOP HIX 820 Trace Number may be provided in the Document Control Number in the payment reports). Negative Amounts & Positive Amounts Start: 10/01/2013 \| Last Modified: 05/01/2017 Notes: CMS SHOP Market
SHOPUFADJ	Federally-facilitated Marketplace User Fee Adjustment for SHOP plans. RMR04 will be positive or negative. This code will not be used. Start: 10/01/2013 \| Last Modified: 11/01/2015 \| Stop: 11/01/2015 Notes: CMS Individual Market Only
SHOPUFMADJ	Federally-facilitated Marketplace User Fee Manual Adjustment for SHOP Plans. Start: 10/01/2013 \| Last Modified: 11/01/2015 \| Stop: 11/01/2015 Notes: CMS Individual Market Only
UF	Federally-facilitated Marketplace User Fee. RMR04 will be negative. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
UFADJ	Federally-facilitated Marketplace User Fee Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
UFAR	FFM User Fee refund of admin charges. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
UFIR	FFM User Fee Refund of interest charges. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
UFMADJ	Federally-facilitated Marketplace User Fee Manual Adjustment. Used to show user fee manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Start: 10/01/2013 \| Last Modified: 11/01/2015 Notes: CMS Individual Market Only
UFR	Federally-facilitated Marketplace User Fee Adjustment related to providing contraceptive care coverage. This is a program-level code only and no enrollment group (policy) level information will be provided with this code. Positive Amounts Only Start: 11/01/2015 \| Last Modified: 05/01/2017 Notes: CMS Exchange Markets
UFR2PY	FFM User Fee Refund. Positive Amounts Only Start: 10/18/2016 \| Last Modified: 08/01/2018 \| Stop: 09/30/2018 Notes: CMS Exchange Markets
UFRP	FFM User Fee Refund. Positive Amounts Only Start: 05/01/2015 Notes: CMS Exchange Markets
UFRPN	FFM User Fee Refund. Positive Amounts Only Start: 05/01/2015 \| Last Modified: 08/01/2018 \| Stop: 09/30/2018 Notes: CMS Exchange Markets
COMM	Any commissions withheld by the Exchange. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only
COMMADJ	Any commissions adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
DEDUCT	Deductible amount due to the Payer. RMR04 will be positive or negative. Start: 10/01/2015 Notes: SBM Only
INTPREM	Initial premium payment received by the Exchange from the customer. This amount will be the gross premium received from the customer. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
MDCAID	State Medicaid Subsidy. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
MDCAIDADJ	State Medicaid Subsidy Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
MISC	Used to indicate miscellaneous amounts (i.e. write-offs, etc.) RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
MRF	Marketplace-Related Fee. This is the amount that is being paid not attributable to an individual coverage but at a plan or carrier level. If negative, the fee was withheld from carrier payments. If positive, the fee was paid to the carrier. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
MRFADJ	Adjustments to a previously sent MRF. The MRFADJ is not attributable to an individual coverage level but at a plan or carrier level. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
NONPAYADJ	Code use to indicate an adjustment is being made due to a NSF or stop payment. Amount will always be negative. Start: 10/01/2013 Notes: SBM Only
OPMUF	OPM Multi-State Plan user fee. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only
OPMUFADJ	OPM Multi-State Plan user fee manual adjustment. Used to show user fee manual adjustment when enrollment group level information is not provided. RMR04 will be positive or negative and may be reversed in the future. Start: 10/01/2013 Notes: SBM Only
PREM	Premium payment amount received for the enrollment group for coverage (excluding APTC and Exchange-Related Fees). RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
PREMADJ	Adjustments to premium payment amount received for the enrollment group for coverage (excluding APTC and Marketplace-Related Fees). RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
PREMALL	Premium payment amount received for the enrollment group for coverage (including APTC and Marketplace-Related Fees). RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
PREMALLADJ	Adjustments to premium payment amount received for the enrollment group for coverage (including APTC and Marketplace-Related Fees). RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
REFUND	Total refunded amount sent back to the customer. RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only
RETURN	Total returned payment (i.e. returned due to non-sufficient funds). RMR04 will be negative. Start: 10/01/2013 Notes: SBM Only
SBMUF	State Based Marketplace User Fee. RMR04 will be negative. Start: 05/01/2015 Notes: SBM Only
SBMUFADJ	State Based Marketplace User Fee Adjustment. RMR04 will be positive or negative. Start: 05/01/2015 Notes: SBM Only
SMAND	State Mandate Benefit Subsidy. RMR04 will be positive. Start: 10/01/2013 Notes: SBM Only
SMANDADJ	State Mandate Benefit Subsidy Adjustment. RMR04 will be positive or negative. Start: 10/01/2013 Notes: SBM Only
TPP	Money paid by a third party payer as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only
TPPADJ	Adjustments to Money paid by a third party payer as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only
TRIBE	Money paid by a registered Tribe as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only
TRIBEADJ	Adjustments to Money paid by a registered Tribe as a subsidy to Subscriber coverage in the individual market. Start: 10/01/2013 Notes: SBM Only
WRITEOFF	Write off amount Start: 06/01/2014 Notes: SBM Only

Code List Notes

Exchange Payment Type codes are transmitted in 005010X306, loop 2300, RMR02. They identify the type and purpose for the payment amount transmitted in ASC X12 005010X306, loop 2300, RMR04.

Note:

Catastrophic is included in Individual Market and Merged is Individual and Small Group Markets combined.
All markets include both on and off exchange issuers.
Exchange markets include Individual/Small Group/Catastrophic/Merged.
Specific transaction detail may be provided in the Document Control Number in the payment reports effective July 2017.

Code List Filters Block Reference

Code List Filters

Filter by code:

Filter codes by status:

Read more about Payment Type Codes

Industry Specific Remark Codes

Code List ID

973

Code List Scope Statement

These codes convey information about remittance processing or further explain an adjustment already described by a Claim Adjustment Reason Code (CARC) from ECL 139.

Code List Maintained By

CMG01

Code List Updated Date

Mon, 06/01/2020 - 12:00

Code List Table

01	The injured employee or other party has not signed the required attestation document therefore Florida Statute 440.105(7) requires that benefits and payments be suspended until such signature is obtained. Start: 06/01/2020
02	Coverage based on a property and casualty Excess Insurance policy which is governed by state statute or regulation. Start: 06/01/2020
03	Reimbursement based on the treating hospital's designation as a lien hospital with billing precedence. Start: 06/01/2020
04	Reimbursement based on state-specific Workers' Compensation requirements for timely submission of bills for services rendered. Start: 06/01/2020
05	Reimbursement based on a state-specific Workers' Compensation limitation that the procedure code be billed only once, regardless of the number of limbs tested. Start: 06/01/2020
06	The provider's preliminary notice of injury and treatment was not furnished by the close of the third business day following the first treatment in accordance with Florida Statute Section 440.13(4)(a), therefore this claim is not considered valid. Start: 06/01/2020

Code List Filters Block Reference

Filter by code:

Filter codes by status:

Maintenance Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

Received
The request has been submitted but is not yet under review.
Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
In Process
The CMG has initiated their decision process.
On Hold
The CMG has initiated their decision process but cannot complete it at this time.
CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.

Status Last Reviewed: 7/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

*The description you are suggesting for a new code or to replace the description for a current code.

Read more about Industry Specific Remark Codes

Insurance Descriptor Codes

Code List ID

979

Code List Scope Statement

These codes describe, identify, or clarify the insurance being reported in an eligibility and benefits response.

Code List Maintained By

CMG01

Code List Updated Date

Tue, 07/01/2025 - 12:00

Code List Table

01	Short Term Insurance Start: 11/01/2022
02	TRICARE Start: 11/01/2024
03	Medicare and Medicaid Dual Eligible Start: 11/01/2024
D	Disability Insurance Start: 05/17/2018
M	Medicare Advantage Point of Service (POS) Plan that excludes Part D coverage Start: 05/17/2018
12	Medicare is secondary, Working Aged Beneficiary or Spouse with employer group health plan is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
13	Medicare is secondary, End-Stage Renal Disease Beneficiary in the mandated coordination period with an employer's group health plan is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
14	Medicare is secondary, no-fault insurance, including auto, is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
15	Medicare is secondary, Worker's Compensation is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
16	Medicare is secondary, Public Health Service (PHS) or Other Federal Agency is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
17	Dental Insurance Start: 05/17/2018
18	Vision Insurance Start: 05/17/2018
19	Prescription Drug Insurance Start: 05/17/2018
41	Medicare is secondary, Black Lung is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
42	Medicare is secondary, Veteran's Administration is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
43	Medicare is secondary, Disabled Beneficiary Under Age 65 with a large group health plan (LGHP) is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
47	Medicare is secondary, other liability insurance is primary Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
48	Medicaid Start: 11/01/2023
49	Medicare and Medicaid Dual Eligible. Start: 07/01/2024
AP	Automobile Insurance Start: 05/17/2018
C1	Commercial Insurance Start: 05/17/2018
CO	Beneficiary is under Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
EP	Exclusive Provider Organization (EPO) Plan Start: 05/17/2018
HB	Health Insurance Exchange (HIX) Bronze Start: 05/17/2018
HD	High Deductible Health Plan (HDHP) Start: 05/17/2018
HG	Health Insurance Exchange (HIX) Gold Start: 05/17/2018
HM	Health Maintenance Organization (HMO) Plan Start: 05/17/2018
HP	Health Insurance Exchange (HIX) Platinum Start: 05/17/2018
HS	Health Insurance Exchange (HIX) Silver An individual eligible for Medicare for whom Medicaid pays only Medicare premiums. Start: 05/17/2018
IN	Indemnity Plan Gives a subscriber the choice to select any provider. Payment is fixed percentage of the cost for covered care after satisfying an annual deductible. Start: 05/17/2018
LC	Long Term Care Insurance Coverage designed to help pay for some or all long term care costs, reducing the risk that a policy-holder would need to deplete all of his or her assets to pay for long term care. Start: 05/17/2018
LI	Life Insurance Start: 05/17/2018
LT	Impacted by litigation Start: 07/19/2018 Technical Note: Although this code does not conform to the intended use of this code list as defined in the list's description, it is being grandfathered in as part of the conversion from an internal code list to an external code list. In the future, requested codes must conform to the list's defined purpose to be approved.
MA	Medicare Part A Start: 05/17/2018
MB	Medicare Part B Start: 05/17/2018
MD	Medicare Part D Start: 05/17/2018
ME	Medicare Advantage Preferred Provider Organization (PPO) Plan that excludes Part D Coverage Start: 05/17/2018
MJ	Medicare Advantage Health Maintenance Organization (HMO) Plan that includes Part D Coverage Start: 05/17/2018
MK	Medicare Advantage Health Maintenance Organization (HMO) Risk Plan that includes Part D Coverage Start: 05/17/2018
ML	Medicare Advantage Indemnity Plan that includes Part D Coverage Start: 05/17/2018
MM	Medicare Advantage Preferred Provider Organization (PPO) Plan that includes Part D Coverage Start: 05/17/2018
MN	Medicare Advantage Indemnity Plan that excludes Part D coverage Start: 05/17/2018
MO	Medicare Advantage Point of Service (POS) Plan that includes Part D Coverage Start: 05/17/2018
MR	Medicare Advantage Health Maintenance Organization (HMO) Risk Plan that excludes Part D coverage Start: 05/17/2018
MT	Medicare Advantage Health Maintenance Organization (HMO) Plan that excludes Part D coverage Start: 05/17/2018
OA	Open Access Point of Service Plan (POS) Plan Start: 05/17/2018
PE	Property Insurance - Personal Start: 05/17/2018
PR	Preferred Provider Organization (PPO) Plan Start: 05/17/2018
PS	Point of Service (POS) Plan Start: 05/17/2018
RP	Property Insurance - Real Start: 05/17/2018
SA	Set Aside Arrangement Set aside funds arrangement that exists for patients that are identified for Insurance Type Code 14, 15 or 47. Start: 11/01/2023
SP	Supplemental Insurance An insurance policy intended to cover non-covered charges of another insurance policy. Start: 05/17/2018
WC	Workers Compensation Insurance Coverage provides medical treatment, rehabilitation, lost wages and related expenses arising from a job related injury or disease. Start: 05/17/2018
WU	Wrap-Up Insurance A Workers Compensation Policy written for a specific job site, which will include or cover more than one insured. Start: 05/17/2018

Code List Filters Block Reference

Filter by code:

Filter codes by status:

Maintenance Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

Received
The request has been submitted but is not yet under review.
Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
In Process
The CMG has initiated their decision process.
On Hold
The CMG has initiated their decision process but cannot complete it at this time.
CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.

Status last Reviewed: 7/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

*The description you are suggesting for a new code or to replace the description for a current code.

Read more about Insurance Descriptor Codes

Insurance Business Process Application Error Codes

Code List ID

895

Code List Scope Statement

These codes report application warnings and errors for insurance business processes.

Code List Maintained By

CMG02

Code List Updated Date

Fri, 07/12/2024 - 12:00

Code List Table

E001	Missing/Invalid submitter identifier Start: 05/01/2004
W001	Missing/Invalid submitter identifier Start: 05/01/2004
E002	Missing/Invalid receiver identifier Start: 05/01/2004
W002	Missing/Invalid receiver identifier Start: 05/01/2004
E003	Missing/Invalid member identifier Start: 05/01/2004
W003	Missing/Invalid member identifier Start: 05/01/2004
E004	Missing/Invalid subscriber identifier Start: 05/01/2004
W004	Missing/Invalid subscriber identifier Start: 05/01/2004
E005	Missing/Invalid patient identifier Start: 05/01/2004
W005	Missing/Invalid patient identifier Start: 05/01/2004
E006	Missing/Invalid plan sponsor identifier Start: 05/01/2004
W006	Missing/Invalid plan sponsor identifier Start: 05/01/2004
E007	Missing/invalid payee identifier Start: 05/01/2004
W007	Missing/invalid payee identifier Start: 05/01/2004
E008	Missing/Invalid TPA/broker identifier Start: 05/01/2004
W008	Missing/Invalid TPA/broker identifier Start: 05/01/2004
E009	Missing/Invalid premium receiver identifier Start: 05/01/2004
W009	Missing/Invalid premium receiver identifier Start: 05/01/2004
E010	Missing/Invalid premium payer identifier Start: 05/01/2004
W010	Missing/Invalid premium payer identifier Start: 05/01/2004
E011	Missing/Invalid payer identifier Start: 05/01/2004
W011	Missing/Invalid payer identifier Start: 05/01/2004
E012	Missing/Invalid billing provider identifier Start: 05/01/2004
W012	Missing/Invalid billing provider identifier Start: 05/01/2004
E013	Missing/Invalid pay to provider identifier Start: 05/01/2004
W013	Missing/Invalid pay to provider identifier Start: 05/01/2004
E014	Missing/Invalid rendering provider identifier Start: 05/01/2004
W014	Missing/Invalid rendering provider identifier Start: 05/01/2004
E015	Missing/Invalid supervising provider identifier Start: 05/01/2004
W015	Missing/Invalid supervising provider identifier Start: 05/01/2004
E016	Missing/Invalid attending provider identifier Start: 05/01/2004
W016	Missing/Invalid attending provider identifier Start: 05/01/2004
E017	Missing/Invalid other provider identifier Start: 05/01/2004
W017	Missing/Invalid other provider identifier Start: 05/01/2004
E018	Missing/Invalid operating provider identifier Start: 05/01/2004
W018	Missing/Invalid operating provider identifier Start: 05/01/2004
E019	Missing/Invalid referring provider identifier Start: 05/01/2004
W019	Missing/Invalid referring provider identifier Start: 05/01/2004
E020	Missing/Invalid purchased service provider identifier Start: 05/01/2004
W020	Missing/Invalid purchased service provider identifier Start: 05/01/2004
E021	Missing/Invalid service facility identifier Start: 05/01/2004
W021	Missing/Invalid service facility identifier Start: 05/01/2004
E022	Missing/Invalid ordering provider identifier Start: 05/01/2004
W022	Missing/Invalid ordering provider identifier Start: 05/01/2004
E023	Missing/Invalid assistant surgeon identifier Start: 05/01/2004
W023	Missing/Invalid assistant surgeon identifier Start: 05/01/2004
E024	Amount/Quantity out of balance Start: 05/01/2004
W024	Amount/Quantity out of balance Start: 05/01/2004
E025	Duplicate Start: 05/01/2004
W025	Duplicate Start: 05/01/2004
E026	Billing date predates service date Start: 05/01/2004
W026	Billing date predates service date Start: 05/01/2004
E027	Business application currently not available Start: 05/01/2004
W027	Business application currently not available Start: 05/01/2004
E028	Sender not authorized for this transaction Start: 05/01/2004
W028	Sender not authorized for this transaction Start: 05/01/2004
E029	Number of errors exceeds permitted threshold Start: 05/01/2004
W029	Number of errors exceeds permitted threshold Start: 05/01/2004
E030	Required loop missing Start: 05/01/2004
W030	Required loop missing Start: 05/01/2004
E031	Required segment missing Start: 05/01/2004
W031	Required segment missing Start: 05/01/2004
E032	Required element missing Start: 05/01/2004
W032	Required element missing Start: 05/01/2004
E033	Situational required loop is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
W033	Situational required loop is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
E034	Situational required segment is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
W034	Situational required segment is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
E035	Situational required element is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
W035	Situational required element is missing Start: 05/01/2004 \| Last Modified: 11/20/2008
E036	Data too long Start: 05/01/2004
W036	Data too long Start: 05/01/2004
E037	Data too short Start: 05/01/2004
W037	Data too short Start: 05/01/2004
E038	Invalid external code value Start: 05/01/2004
W038	Invalid external code value Start: 05/01/2004
E039	Data value out of sequence Start: 05/01/2004
W039	Data value out of sequence Start: 05/01/2004
E040	"Not Used" data element present Start: 05/01/2004
W040	"Not Used" data element present Start: 05/01/2004
E041	Too many sub-elements in composite Start: 05/01/2004
W041	Too many sub-elements in composite Start: 05/01/2004
E042	Unexpected segment Start: 05/01/2004
W042	Unexpected segment Start: 05/01/2004
E043	Missing data Start: 05/01/2004
W043	Missing data Start: 05/01/2004
E044	Out of range Start: 05/01/2004
W044	Out of range Start: 05/01/2004
E045	Invalid date Start: 05/01/2004
W045	Invalid date Start: 05/01/2004
E046	Not matching Start: 05/01/2004
W046	Not matching Start: 05/01/2004
E047	Invalid combination Start: 05/01/2004
W047	Invalid combination Start: 05/01/2004
E048	Customer identification number does not exist Start: 05/01/2004
W048	Customer identification number does not exist Start: 05/01/2004
E049	Duplicate batch Start: 05/01/2004
W049	Duplicate batch Start: 05/01/2004
E050	Incorrect data Start: 05/01/2004
W050	Incorrect data Start: 05/01/2004
E051	Incorrect date Start: 05/01/2004
W051	Incorrect date Start: 05/01/2004
E052	Duplicate transmission Start: 05/01/2004
W052	Duplicate transmission Start: 05/01/2004
E053	Invalid claim amount Start: 05/01/2004
W053	Invalid claim amount Start: 05/01/2004
E054	Invalid identification code Start: 05/01/2004
W054	Invalid identification code Start: 05/01/2004
E055	Missing or invalid issuer identification Start: 05/01/2004
W055	Missing or invalid issuer identification Start: 05/01/2004
E056	Missing or invalid item quantity Start: 05/01/2004
W056	Missing or invalid item quantity Start: 05/01/2004
E057	Missing or invalid item identification Start: 05/01/2004
W057	Missing or invalid item identification Start: 05/01/2004
E058	Missing or unauthorized transaction type code Start: 05/01/2004
W058	Missing or unauthorized transaction type code Start: 05/01/2004
E059	Unknown claim number Start: 05/01/2004
W059	Unknown claim number Start: 05/01/2004
E060	Bin segment contentes not in MIME format Start: 05/01/2004
W060	Bin segment contents not in MIME format Start: 05/01/2004
E061	Missing/invalid MIME header Start: 05/01/2004
W061	Missing/Invalid MIME header Start: 05/01/2004
E062	Missing/Invalid MIME boundary Start: 05/01/2004
W062	Missing/Invalid MIME boundary Start: 05/01/2004
E063	Missing/Invalid MIME transfer encoding Start: 05/01/2004
W063	Missing/Invalid MIME transfer encoding Start: 05/01/2004
E064	Missing/Invalid MIME content type Start: 05/01/2004
W064	Missing/Invalid MIME content type Start: 05/01/2004
E065	Missing/Invalid MIME content disposition (filename) Start: 05/01/2004
W065	Missing/Invalid MIME content disposition (filename) Start: 05/01/2004
E066	Missing/Invalid file name extension Start: 05/01/2004
W066	Missing/Invalid file name extension Start: 05/01/2004
E067	Invalid MIME base64 encoding Start: 05/01/2004
W067	Invalid MIME base64 encoding Start: 05/01/2004
E068	Invalid MIME quoted-printable encoding Start: 05/01/2004
W068	Invalid MIME quoted-printable encoding Start: 05/01/2004
E069	Missing/Invalid MIME line terminator (should be CR+LF) Start: 05/01/2004
W069	Missing/Invalid MIME line terminator (should be CR+LF) Start: 05/01/2004
E070	Missing/Invalid "end of MIME" headers Start: 05/01/2004
W070	Missing/Invalid "end of MIME" headers Start: 05/01/2004
E071	Missing/Invalid CDA in first MIME body parts Start: 05/01/2004
W071	Missing/Invalid CDA in first MIME body parts Start: 05/01/2004
E072	Missing/Invalid XML tag Start: 05/01/2004
W072	Missing/Invalid XML tag Start: 05/01/2004
E073	Unrecoverable XML error Start: 05/01/2004
W073	Unrecoverable XML error Start: 05/01/2004
E074	Invalid Data format for HL7 data type Start: 05/01/2004
W074	Invalid Data format for HL7 data type Start: 05/01/2004
E075	Missing/Invalid required LOINC answer part(s) in the CDA Start: 05/01/2004
W075	Missing/Invalid required LOINC answer part(s) in the CDA Start: 05/01/2004
E076	Missing/Invalid Provider information in the CDA Start: 05/01/2004
W076	Missing/Invalid Provider information in the CDA Start: 05/01/2004
E077	Missing/Invalid Patient information in the CDA Start: 05/01/2004
W077	Missing/Invalid Patient information in the CDA Start: 05/01/2004
E078	Missing/Invalid Attachment Control information in the CDA Start: 05/01/2004
W078	Missing/Invalid Attachment Control information in the CDA Start: 05/01/2004
E079	Missing/Invalid LOINC Start: 05/01/2004
W079	Missing/Invalid LOINC Start: 05/01/2004
E080	Missing/Invalid LOINC Modifier Start: 05/01/2004
W080	Missing/Invalid LOINC Modifier Start: 05/01/2004
E081	Missing/Invalid LOINC code for this attachment type Start: 05/01/2004
W081	Missing/Invalid LOINC code for this attachment type Start: 05/01/2004
E082	Missing/Invalid LOINC Modifier for this attachment type Start: 05/01/2004
W082	Missing/Invalid LOINC Modifier for this attachment type Start: 05/01/2004
E083	Situational prohibited element is present Start: 05/01/2004 \| Last Modified: 11/20/2008
W083	Situational prohibited element is present Start: 05/01/2004 \| Last Modified: 11/20/2008
E084	Duplicate qualifier value in repeated segment within a single loop Start: 05/01/2009
W084	Duplicate qualifier value in repeated segment within a single loop Start: 05/01/2009
E085	Situational required composite element is missing Start: 05/01/2009
W085	Situational required composite element is missing Start: 05/01/2009
E086	Situational required repeating element is missing Start: 05/01/2009
W086	Situational required repeating element is missing Start: 05/01/2009
E087	Situational prohibited loop is present Start: 05/01/2009
W087	Situational prohibited loop is present Start: 05/01/2009
E088	Situational prohibited segment is present Start: 05/01/2009
W088	Situational prohibited segment is present Start: 05/01/2009
E089	Situational prohibited composite element is present Start: 05/01/2009
W089	Situational prohibited composite element is present Start: 05/01/2009
E090	Situational prohibited repeating element is present Start: 05/01/2009
W090	Situational prohibited repeating element is present Start: 05/01/2009
E091	Transaction successfully received but not processed as applicable business function not performed. Start: 01/30/2011
W091	Transaction successfully received but not processed as applicable business function not performed. Start: 01/30/2011
E092	Missing/Invalid required SNOMED CT answer part(s) in the CDA Start: 06/05/2011
W092	Missing/Invalid required SNOMED CT answer part(s) in the CDA Start: 06/05/2011
E093	Matching Policy Information/Document not found. Start: 06/01/2014
W093	Matching Policy Information/Document not found. Start: 06/01/2014
E094	Financial Assistance not permitted across multiple marketplaces - Double Dip Check Edit Identified. Start: 06/01/2014
W094	Financial Assistance not permitted across multiple marketplaces - Double Dip Check Edit Identified. Start: 06/01/2014
E095	Business Process transaction out of sequence. Start: 01/25/2015
W095	Business Process transaction out of sequence. Start: 01/25/2015
E096	Advanced Premium Tax Credit is more than Total Premium. Start: 01/25/2015
W096	Advanced Premium Tax Credit is more than Total Premium. Start: 01/25/2015
E097	Marketplace, Off Market Variant. Start: 01/25/2015
W097	Marketplace, Off Market Variant. Start: 01/25/2015
E098	Maintenance Type Code Start: 07/01/2015
W098	Maintenance Type Code Start: 07/01/2015
E099	Maintenance Reason Code Start: 07/01/2015
W099	Maintenance Reason Code Start: 07/01/2015
E100	Additional Maintenance Reason Code Start: 07/01/2015
W100	Additional Maintenance Reason Code Start: 07/01/2015
E101	Enrollment Group member(s) count on transaction does not match Enrollment Group member(s) count found on file of record Start: 07/01/2015
W101	Enrollment Group member(s) count on transaction does not match Enrollment Group member(s) count found on file of record Start: 07/01/2015
E102	Effective Start Date Start: 07/01/2015
W102	Effective Start Date Start: 07/01/2015
E103	Advanced Payment for Tax Credit (APTC) Start: 07/01/2015
W103	Advanced Payment for Tax Credit (APTC) Start: 07/01/2015
E104	Total Individual Responsibility Amount Start: 07/01/2015
W104	Total Individual Responsibility Amount Start: 07/01/2015
E105	Other Payment Amount 1 Start: 07/01/2015
W105	Other Payment Amount 1 Start: 07/01/2015
E106	Other Payment Amount 2 Start: 07/01/2015
W106	Other Payment Amount 2 Start: 07/01/2015
E107	Total Premium Amount Start: 07/01/2015
W107	Total Premium Amount Start: 07/01/2015
E108	Individual Premium Amount Start: 07/01/2015
W108	Individual Premium Amount Start: 07/01/2015
E109	Total Employer Responsibility Amount Start: 07/01/2015
W109	Total Employer Responsibility Amount Start: 07/01/2015
E110	Financial Date Precedes Premium Date Start: 07/01/2015
W110	Financial Date Precedes Premium Date Start: 07/01/2015
E111	Exceeds Unique Start Date(s) Start: 07/01/2015
W111	Exceeds Unique Start Date(s) Start: 07/01/2015
E112	Exceeds Allowable Changes Start: 07/01/2015
W112	Exceeds Allowable Changes Start: 07/01/2015
E113	Cost Sharing Reduction (CSR) Date precedes the Total Premium Amount Effective Start Date Start: 07/01/2015
W113	Cost Sharing Reduction (CSR) Date precedes the Total Premium Amount Effective Start Date Start: 07/01/2015
E114	Renewal Transaction cannot be processed as it is outside of allocated time period Start: 07/01/2015
W114	Renewal Transaction cannot be processed as it is outside of allocated time period Start: 07/01/2015
E115	Financial Amounts Unchanged by newly reported data Start: 07/01/2015
W115	Financial Amounts Unchanged by newly reported data Start: 07/01/2015
E116	Effective Start Date does not align with Previous Effective End Date Start: 07/01/2015
W116	Effective Start Date does not align with Previous Effective End Date Start: 07/01/2015
E117	Duplicate Payment of Advanced Premium Tax Credit Start: 08/24/2015
W117	Duplicate Payment of Advanced Premium Tax Credit Start: 08/24/2015
E118	Duplicate Payment of Cost Sharing Reduction Start: 08/24/2015
W118	Duplicate Payment of Cost Sharing Reduction Start: 08/24/2015
E119	Duplicate Payment of User Fee Start: 08/24/2015
W119	Duplicate Payment of User Fee Start: 08/24/2015
E120	Missing Payment of Advanced Premium Tax Credit Start: 08/24/2015
W120	Missing Payment of Advanced Premium Tax Credit Start: 08/24/2015
E121	Missing Payment of Cost Sharing Reduction Start: 08/24/2015
W121	Missing Payment of Cost Sharing Reduction Start: 08/24/2015
E122	Missing Payment of User Fee Start: 08/24/2015
W122	Missing Payment of User Fee Start: 08/24/2015
E123	Advanced Premium Tax Credit (APTC) Payment Mismatch - The Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) APTC amount and the Health Plan APTC amount are equal but do not match the APTC payment amount received Start: 08/24/2015
W123	Advanced Premium Tax Credit (APTC) Payment Mismatch - The Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) APTC amount and the Health Plan APTC amount are equal but do not match the APTC payment amount received Start: 08/24/2015
E124	Cost Shared Reduction (CSR) Payment Mismatch - The Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) CSR amount and the Health Plan CSR amount are equal but do not match the CSR payment amount received Start: 08/24/2015
W124	Cost Shared Reduction (CSR) Payment Mismatch - The Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) CSR amount and the Health Plan CSR amount are equal but do not match the CSR payment amount received Start: 08/24/2015
E125	User Fee Payment Mismatch - The calculated Federally Facilitated Marketplace (FFM) User Fee amount and the calculated Health Plan User Fee amount are equal but do not match the User Fee payment amount received Start: 08/24/2015
W125	User Fee Payment Mismatch - The calculated Federally Facilitated Marketplace (FFM) User Fee amount and the calculated Health Plan User Fee amount are equal but do not match the User Fee payment amount received Start: 08/24/2015
E126	Effectuation Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
W126	Effectuation Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
E127	Cancel Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
W127	Cancel Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
E128	Termination Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
W128	Termination Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
E129	Maintenance Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
W129	Maintenance Transaction cannot be processed as it is outside of allocated time period Start: 03/01/2016
E130	Policy level cancel/terminations shall not contain health coverage information Start: 03/01/2016
W130	Policy level cancel/terminations shall not contain health coverage information Start: 03/01/2016
E131	Dependent/Member not included in current coverage Start: 07/01/2016
W131	Dependent/Member not included in current coverage Start: 07/01/2016
E132	The data in the transaction does not match the exchange/marketplace type Start: 07/01/2017
W132	The data in the transaction does not match the exchange/marketplace type Start: 07/01/2017
E133	Policy Cancelled - cannot be processed Start: 07/01/2017
W133	Policy Cancelled - cannot be processed Start: 07/01/2017
E134	Policy Non-Effectuated - cannot be processed Start: 07/01/2017
W134	Policy Non-Effectuated - cannot be processed Start: 07/01/2017
E135	Policy ID Start: 07/01/2017
W135	Policy ID Start: 07/01/2017
E136	Subscriber ID Start: 07/01/2017
W136	Subscriber ID Start: 07/01/2017
E137	Member ID Start: 07/01/2017
W137	Member ID Start: 07/01/2017
E138	No Longer Eligible (NLE) Start: 07/01/2017
W138	No Longer Eligible (NLE) Start: 07/01/2017
E139	Exchange Assigned Start: 07/01/2017
W139	Exchange Assigned Start: 07/01/2017
E140	Issuer Assigned Start: 07/01/2017
W140	Issuer Assigned Start: 07/01/2017
E141	Issuer Prior Assigned Start: 07/01/2017
W141	Issuer Prior Assigned Start: 07/01/2017
E142	Action results already match current information on file Start: 07/01/2017
W142	Action results already match current information on file Start: 07/01/2017
E143	Action results do not match current information on file Start: 07/01/2017
W143	Action results do not match current information on file Start: 07/01/2017
E144	Cancellation Transaction Start: 07/01/2017
W144	Cancellation Transaction Start: 07/01/2017
E145	Initial Enrollment Transaction Start: 07/01/2017
W145	Initial Enrollment Transaction Start: 07/01/2017
E146	Maintenance Transaction Start: 07/01/2017
W146	Maintenance Transaction Start: 07/01/2017
E147	Reinstatement Transaction Start: 07/01/2017
W147	Reinstatement Transaction Start: 07/01/2017
E148	Termination Transaction Start: 07/01/2017
W148	Termination Transaction Start: 07/01/2017
E149	Email Address Start: 07/01/2017
W149	Email Address Start: 07/01/2017
E150	Mailing Address Start: 07/01/2017
W150	Mailing Address Start: 07/01/2017
E151	Telephone Number Start: 07/01/2017
W151	Telephone Number Start: 07/01/2017
E152	Consumer executed voluntary withdrawal of coverage Start: 11/01/2017
W152	Consumer executed voluntary withdrawal of coverage Start: 11/01/2017
E153	Unable to be processed causing a gap or overlap in coverage dates Start: 11/01/2017
W153	Unable to be processed causing a gap or overlap in coverage dates Start: 11/01/2017
E154	Invoke the Enrollment Resolution and Reconciliation (ER&R) manual process Start: 11/01/2017
W154	Invoke the Enrollment Resolution and Reconciliation (ER&R) manual process Start: 11/01/2017
E155	Marketplace Coverage in Effect Start: 11/01/2017
W155	Marketplace Coverage in Effect Start: 11/01/2017
E156	Reinstatement transaction cannot be processed as it is outside of the allocated time period Start: 11/01/2017
W156	Reinstatement transaction cannot be processed as it is outside of the allocated time period Start: 11/01/2017
E157	Coverage Start Date Start: 11/01/2017
W157	Coverage Start Date Start: 11/01/2017
E158	Coverage End Date Start: 11/01/2017
W158	Coverage End Date Start: 11/01/2017
E159	Dependent/Member shall not be included in Policy Level Start: 03/01/2018
W159	Dependent/Member shall not be included in Policy Level Start: 03/01/2018
E160	One day coverage Start: 07/01/2018
W160	One day coverage Start: 07/01/2018
E161	Invalid Start: 07/01/2018
W161	Invalid Start: 07/01/2018
E162	Eligibility Begin Date Start: 06/02/2019
W162	Eligibility Begin Date Start: 06/02/2019
E163	Associated submission not found Start: 12/01/2020
W163	Associated submission not found Start: 12/01/2020
E164	Exceeds Receiver Allowed Occurrences Start: 12/01/2020
W164	Exceeds Receiver Allowed Occurrences Start: 12/01/2020
E165	HL7 US Realm Header Legal Authenticator data is missing Start: 07/01/2021
W165	HL7 US Realm Header Legal Authenticator data is missing Start: 07/01/2021
E166	HL7 US Realm Header Author data is missing Start: 07/01/2021
W166	HL7 US Realm Header Author data is missing Start: 07/01/2021
E167	HL7 US Realm Header SetID data is missing Start: 07/01/2021
W167	HL7 US Realm Header SetID data is missing Start: 07/01/2021
E168	HL7 US Realm Header VersionNumber data is missing Start: 07/01/2021
W168	HL7 US Realm Header VersionNumber data is missing Start: 07/01/2021
E169	HL7 C-CDA Structured document sections name data is missing Start: 07/01/2021
W169	HL7 C-CDA Structured document sections name data is missing Start: 07/01/2021
E170	HL7 C-CDA Structured document sections title data is missing Start: 07/01/2021
W170	HL7 C-CDA Structured document sections title data is missing Start: 07/01/2021
E171	HL7 C-CDA Structured document narrative block (text) data is missing Start: 07/01/2021
W171	HL7 C-CDA Structured document narrative block (text) data is missing Start: 07/01/2021
E172	HL7 C-CDA Unstructured document LOINC Code is missing Start: 07/01/2021
W172	HL7 C-CDA Unstructured document LOINC Code is missing Start: 07/01/2021
E173	HL7 C-CDA Unstructured document contained a reference to a URL or URI Start: 07/01/2021
W173	HL7 C-CDA Unstructured document contained a reference to a URL or URI Start: 07/01/2021
E174	HL7 C-CDA Unstructured document @mediaType (MIME type) is missing Start: 07/01/2021
W174	HL7 C-CDA Unstructured document @mediaType (MIME type) is missing Start: 07/01/2021
E175	HL7 C-CDA Unstructured document included more than 1 @mediaType (MIME type) Start: 07/01/2021
W175	HL7 C-CDA Unstructured document included more than 1 @mediaType (MIME type) Start: 07/01/2021
E176	HL7 C-CDA Unstructured document Base64 encoding does not meet the RFC 4648 requirements Start: 07/01/2021
W176	HL7 C-CDA Unstructured document Base64 encoding does not meet the RFC 4648 requirements Start: 07/01/2021
E177	HL7 C-CDA Unstructured document compression does not meet the RFC 1951 requirements Start: 07/01/2021
W177	HL7 C-CDA Unstructured document compression does not meet the RFC 1951 requirements Start: 07/01/2021
E178	HL7 C-CDA LOINC code does not match the LOINC code in the request Start: 07/01/2021
W178	HL7 C-CDA LOINC code does not match the LOINC code in the request Start: 07/01/2021
E179	HL7 Attachment Control Number is missing Start: 07/01/2021
W179	HL7 Attachment Control Number is missing Start: 07/01/2021
E180	Missing Billing provider affiliation for the Rendering provider(s). Start: 11/01/2022
W180	Missing Billing provider affiliation for the Rendering provider(s). Start: 11/01/2022
E181	Invalid affiliation between Rendering and Billing providers. Start: 11/01/2022
W181	Invalid affiliation between Rendering and Billing providers. Start: 11/01/2022
E182	System Delay-No Additional Action Required Start: 11/01/2022
W182	System Delay-No Additional Action Required Start: 11/01/2022
E183	System Delay-Resubmission Required Start: 11/01/2022
W183	System Delay-Resubmission Required Start: 11/01/2022
E184	Fully Subsidized Policy - Policy's total premium is provided for by the Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) Start: 07/11/2024
W184	Fully Subsidized Policy - Policy's total premium is provided for by the Federally Facilitated Marketplace (FFM) or State Based Marketplace (SBM) Start: 07/11/2024

Code List Filters Block Reference

Filter by code:

Filter codes by status:

Maintenance Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

Received
The request has been submitted but is not yet under review.
Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
In Process
The CMG has initiated their decision process.
On Hold
The CMG has initiated their decision process but cannot complete it at this time.
CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.

Status last Reviewed: 7/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

*The description you are suggesting for a new code or to replace the description for a current code.

Read more about Insurance Business Process Application Error Codes

Service Review Decision Reason Codes

Code List ID

886

Code List Scope Statement

These codes communicate the reason for the health care services review outcome.

Code List Maintained By

CMG01

Code List Updated Date

Mon, 08/01/2022 - 12:00

Code List Table

01	Price Authorization Expired Start: 01/10/2001
02	Price authorization no longer required Start: 01/10/2001
03	Product not on the price authorization Start: 01/10/2001
04	Authorized Quantity Exceeded Start: 01/10/2001
05	Special Cost Incorrect Start: 01/10/2001
06	No Credit Allowed Start: 01/10/2001
07	Administrative Cancellation Start: 01/10/2001
08	Unit resale higher than authorized Start: 01/10/2001
09	Out of Network Start: 01/10/2001
0A	Testing not Included Start: 01/10/2001
0B	Request Forwarded To and Decision Response Forthcoming From an External Review Organization Start: 01/10/2001
0C	Authorization/Access Restrictions Start: 01/10/2001
0D	Requires PCP authorization Start: 01/10/2001
0E	Provider is Not Primary Care Physician Start: 01/10/2001
0F	Not Medically Necessary Start: 01/10/2001
0G	Level of Care Not Appropriate Start: 01/10/2001
0H	Certification Not Required for this Service Start: 01/10/2001
0J	Certification Responsibility of External Review Organization Start: 01/10/2001
0K	Primary Care Service Start: 01/10/2001
0L	Exceeds Plan Maximums Start: 01/10/2001
0M	Non-covered Service Start: 01/10/2001
0N	No Prior Approval Start: 01/10/2001
0P	Requested Information Not Received Start: 01/10/2001
0Q	Duplicate Request Start: 01/10/2001
0R	Service Inconsistent with Diagnosis Start: 01/10/2001
0S	Pre-existing Condition Start: 01/10/2001
0T	Experimental Service or Procedure Start: 01/10/2001
0U	Additional Patient Information required Start: 01/10/2001
0V	Requires Medical Review Start: 01/10/2001
0W	Disposition pending review Start: 01/10/2001
0X	Service Inconsistent with Provider Type Start: 01/10/2001
0Y	Service inconsistent with Patient's Age Start: 01/10/2001
0Z	Service inconsistent with Patient's Gender Start: 01/10/2001
10	Product/service/procedure delivery pattern (e.g., units, days, visits, weeks, hours, months) Start: 01/10/2001
11	Pricing Start: 01/10/2001
12	Patient is restricted to specific provider Start: 01/10/2001
13	Service authorized for another provider Start: 01/10/2001
14	Plan/contractual guidelines not followed Start: 01/10/2001
15	Plan/contractual geographic restriction Start: 01/10/2001
16	Inappropriate facility type Start: 01/10/2001
17	Time limits not met Start: 02/01/2002
18	Notification received Start: 06/01/2002
19	Cosmetic Start: 06/01/2002
20	Once in a lifetime restriction applies Start: 02/01/2004
21	Transport Request Denied Start: 06/01/2004
22	Ambulance Certification Segment information doesn't correspond to Transport Address Segment Start: 06/01/2004
23	Mileage cannot be computed based on data submitted Start: 06/01/2004
24	Computed mileage is inconsistent with transport information or service units submitted Start: 06/01/2004
25	Services were not considered due to other errors in the request. Start: 06/06/2010
26	Missing Provider Role Start: 06/05/2011
27	Patient is currently in a Health Insurance Exchange premium payment grace period -- first month. Usage: Use only for Individual Market Qualified Health Plans. Start: 06/01/2014 \| Last Modified: 07/01/2017
28	Patient is currently in a Health Insurance Exchange premium payment grace period -- second month. Usage: Use only for Individual Market Qualified Health Plans. Start: 06/01/2014 \| Last Modified: 07/01/2017
29	Patient is currently in a Health Insurance Exchange premium payment grace period -- third month. Usage: Use only for Individual Market Qualified Health Plans. Start: 06/01/2014 \| Last Modified: 07/01/2017
30	Initial Utilization Review In Progress Start: 11/01/2017
31	Escalated Utilization Review in Progress Start: 11/01/2017
32	Excluded benefit, a service which is specifically excluded from the benefit plan. Start: 10/01/2020
33	Appeal Denied Start: 03/01/2022
34	Payer-initiated Void Start: 03/01/2022
35	The documentation submitted is not legible. Start: 03/01/2022
36	Signed documentation is required to support medical necessity. Start: 03/01/2022
37	A signed Order or Intent-to-Order is required. Start: 03/01/2022
38	A physician certification statement is required. Start: 03/01/2022
39	An order that supports this service is required. Start: 03/01/2022
40	The supporting documentation does not match the patient identified in the preauthorization request. Start: 03/01/2022
41	The supporting documentation does not support the number of units requested. Start: 03/01/2022
42	A nutritional status assessment is required. Start: 03/01/2022
43	Initial and repeated wound measurements are required. Start: 03/01/2022
44	Documentation of conservative treatment failure is required. Start: 03/01/2022
45	Documentation of a diabetes diagnosis is required. Start: 03/01/2022
46	Documentation that treatment is an adjunct to conventional therapy is required. Start: 03/01/2022
47	Documentation of measurable signs of improvement is required. Start: 08/01/2022
48	Documentation of a diabetic wound classification is required. Start: 08/01/2022
49	Patient was not admitted within the authorized timeframe. Start: 08/01/2022

Code List Filters Block Reference

Filter by code:

Filter codes by status:

Maintenance Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

Received
The request has been submitted but is not yet under review.
Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
In Process
The CMG has initiated their decision process.
On Hold
The CMG has initiated their decision process but cannot complete it at this time.
CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.

Status Last Reviewed: 7/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

*The description you are suggesting for a new code or to replace the description for a current code.

Read more about Service Review Decision Reason Codes

Claim Status Codes

Code List ID

508

Code List Scope Statement

These codes convey the status of an entire claim or a specific service line.

Code List Maintained By

CMG03

Code List Updated Date

Sat, 03/01/2025 - 12:00

Code List Table

0	Cannot provide further status electronically. Start: 01/01/1995
1	For more detailed information, see remittance advice. Start: 01/01/1995
2	More detailed information in letter. Start: 01/01/1995
3	Claim has been adjudicated and is awaiting payment cycle. Start: 01/01/1995
4	This is a subsequent request for information from the original request. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
5	This is a final request for information. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
6	Balance due from the subscriber. Start: 01/01/1995
7	Claim may be reconsidered at a future date. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
8	No payment due to contract/plan provisions. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
9	No payment will be made for this claim. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
10	All originally submitted procedure codes have been combined. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
11	Some originally submitted procedure codes have been combined. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
12	One or more originally submitted procedure codes have been combined. Start: 01/01/1995 \| Last Modified: 06/30/2001
13	All originally submitted procedure codes have been modified. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
14	Some all originally submitted procedure codes have been modified. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
15	One or more originally submitted procedure code have been modified. Start: 01/01/1995 \| Last Modified: 06/30/2001
16	Claim/encounter has been forwarded to entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
17	Claim/encounter has been forwarded by third party entity to entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
18	Entity received claim/encounter, but returned invalid status. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
19	Entity acknowledges receipt of claim/encounter. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
20	Accepted for processing. Start: 01/01/1995 \| Last Modified: 06/30/2001
21	Missing or invalid information. Usage: At least one other status code is required to identify the missing or invalid information. Start: 01/01/1995 \| Last Modified: 07/01/2017
22	... before entering the adjudication system. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
23	Returned to Entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
24	Entity not approved as an electronic submitter. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
25	Entity not approved. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
26	Entity not found. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
27	Policy canceled. Start: 01/01/1995 \| Last Modified: 06/30/2001
28	Claim submitted to wrong payer. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
29	Subscriber and policy number/contract number mismatched. Start: 01/01/1995
30	Subscriber and subscriber id mismatched. Start: 01/01/1995
31	Subscriber and policyholder name mismatched. Start: 01/01/1995
32	Subscriber and policy number/contract number not found. Start: 01/01/1995
33	Subscriber and subscriber id not found. Start: 01/01/1995
34	Subscriber and policyholder name not found. Start: 01/01/1995
35	Claim/encounter not found. Start: 01/01/1995
37	Predetermination is on file, awaiting completion of services. Start: 01/01/1995
38	Awaiting next periodic adjudication cycle. Start: 01/01/1995
39	Charges for pregnancy deferred until delivery. Start: 01/01/1995
40	Waiting for final approval. Start: 01/01/1995
41	Special handling required at payer site. Start: 01/01/1995
42	Awaiting related charges. Start: 01/01/1995
44	Charges pending provider audit. Start: 01/01/1995
45	Awaiting benefit determination. Start: 01/01/1995
46	Internal review/audit. Start: 01/01/1995
47	Internal review/audit - partial payment made. Start: 01/01/1995
48	Referral/authorization. Start: 01/01/1995 \| Last Modified: 02/28/2001 \| Stop: 01/01/2012 Notes: Refer to codes 252 and 761.
49	Pending provider accreditation review. Start: 01/01/1995
50	Claim waiting for internal provider verification. Start: 01/01/1995
51	Investigating occupational illness/accident. Start: 01/01/1995
52	Investigating existence of other insurance coverage. Start: 01/01/1995
53	Claim being researched for Insured ID/Group Policy Number error. Start: 01/01/1995
54	Duplicate of a previously processed claim/line. Start: 01/01/1995
55	Claim assigned to an approver/analyst. Start: 01/01/1995
56	Awaiting eligibility determination. Start: 01/01/1995
57	Pending COBRA information requested. Start: 01/01/1995
59	Information was requested by a non-electronic method. Usage: At least one other status code is required to identify the requested information. Start: 01/01/1995 \| Last Modified: 07/01/2017
60	Information was requested by an electronic method. Usage: At least one other status code is required to identify the requested information. Start: 01/01/1995 \| Last Modified: 07/01/2017
61	Eligibility for extended benefits. Start: 01/01/1995
64	Re-pricing information. Start: 01/01/1995
65	Claim/line has been paid. Start: 01/01/1995
66	Payment reflects usual and customary charges. Start: 01/01/1995
67	Payment made in full. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
68	Partial payment made for this claim. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
69	Payment reflects plan provisions. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
70	Payment reflects contract provisions. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
71	Periodic installment released. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
72	Claim contains split payment. Start: 01/01/1995
73	Payment made to entity, assignment of benefits not on file. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
78	Duplicate of an existing claim/line, awaiting processing. Start: 01/01/1995
81	Contract/plan does not cover pre-existing conditions. Start: 01/01/1995
83	No coverage for newborns. Start: 01/01/1995
84	Service not authorized. Start: 01/01/1995
85	Entity not primary. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
86	Diagnosis and patient gender mismatch. Start: 01/01/1995 \| Last Modified: 02/28/2000
87	Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code) Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
88	Entity not eligible for benefits for submitted dates of service. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
89	Entity not eligible for dental benefits for submitted dates of service. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
90	Entity not eligible for medical benefits for submitted dates of service. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
91	Entity not eligible/not approved for dates of service. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
92	Entity does not meet dependent or student qualification. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
93	Entity is not selected primary care provider. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
94	Entity not referred by selected primary care provider. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
95	Requested additional information not received. Usage: At least one other status code is required to identify the requested information. Start: 01/01/1995 \| Last Modified: 11/01/2024
96	No agreement with entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
97	Patient eligibility not found with entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
98	Charges applied to deductible. Start: 01/01/1995
99	Pre-treatment review. Start: 01/01/1995
100	Pre-certification penalty taken. Start: 01/01/1995
101	Claim was processed as adjustment to previous claim. Start: 01/01/1995
102	Newborn's charges processed on mother's claim. Start: 01/01/1995
103	Claim combined with other claim(s). Start: 01/01/1995
104	Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient) Start: 01/01/1995 \| Last Modified: 06/01/2008
105	Claim/line is capitated. Start: 01/01/1995
106	This amount is not entity's responsibility. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
107	Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services) Start: 01/01/1995 \| Last Modified: 06/01/2008
108	Coverage has been canceled for this entity. (Use code 27) Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
109	Entity not eligible. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
110	Claim requires pricing information. Start: 01/01/1995
111	At the policyholder's request these claims cannot be submitted electronically. Start: 01/01/1995
112	Policyholder processes their own claims. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
113	Cannot process individual insurance policy claims. Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
114	Claim/service should be processed by entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
115	Cannot process HMO claims Start: 01/01/1995 \| Last Modified: 01/27/2008 \| Stop: 07/01/2008
116	Claim submitted to incorrect payer. Start: 01/01/1995
117	Claim requires signature-on-file indicator. Start: 01/01/1995
118	TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN) Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
119	TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252) Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
120	TPO rejected claim/line because claim does not contain enough information. (Use status code 21) Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
121	Service line number greater than maximum allowable for payer. Start: 01/01/1995
122	Missing/invalid data prevents payer from processing claim. (Use CSC Code 21) Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
123	Additional information requested from entity. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
124	Entity's name, address, phone and id number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
125	Entity's name. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
126	Entity's address. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
127	Entity's Communication Number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
128	Entity's tax id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
129	Entity's Blue Cross provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
130	Entity's Blue Shield provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
131	Entity's Medicare provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
132	Entity's Medicaid provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
133	Entity's UPIN. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
134	Entity's TRICARE provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 03/01/2022
135	Entity's commercial provider id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
136	Entity's health industry id number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
137	Entity's plan network id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
138	Entity's site id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 03/01/2025
139	Entity's health maintenance provider id (HMO). Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
140	Entity's preferred provider organization id (PPO). Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
141	Entity's administrative services organization id (ASO). Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
142	Entity's license/certification number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
143	Entity's state license number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
144	Entity's specialty license number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
145	Entity's specialty/taxonomy code. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
146	Entity's anesthesia license number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
147	Entity's qualification degree/designation (e.g. RN,PhD,MD). Usage: This code requires use of an Entity Code. Start: 02/28/1997 \| Last Modified: 07/01/2017
148	Entity's social security number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
149	Entity's employer id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
150	Entity's drug enforcement agency (DEA) number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
152	Processor Control Number Start: 01/01/1995 \| Last Modified: 11/01/2024
153	Entity's id number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
154	Relationship of surgeon & assistant surgeon. Start: 01/01/1995
155	Entity's relationship to patient. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
156	Patient relationship to subscriber Start: 01/01/1995
157	Entity's Gender. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
158	Entity's date of birth. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
159	Entity's date of death. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
160	Entity's marital status. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
161	Entity's employment status. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
162	Entity's health insurance claim number (HICN). Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
163	Entity's policy/group number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
164	Entity's contract/member number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
165	Entity's employer name, address and phone. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
166	Entity's employer name. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
167	Entity's employer address. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
168	Entity's employer phone number. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
169	Entity's employer id. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
170	Entity's employee id. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
171	Other insurance coverage information (health, liability, auto, etc.). Start: 01/01/1995
172	Other employer name, address and telephone number. Start: 01/01/1995
173	Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
174	Entity's student status. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
175	Entity's school name. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
176	Entity's school address. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
177	Transplant recipient's name, date of birth, gender, relationship to insured. Start: 01/01/1995 \| Last Modified: 02/28/2000
178	Total Claim Charge Amount Start: 01/01/1995 \| Last Modified: 11/01/2024
179	Outside lab charges. Start: 01/01/1995
180	Hospital's semi-private room rate. Start: 01/01/1995 \| Last Modified: 11/01/2024
181	Hospital's room rate. Start: 01/01/1995 \| Last Modified: 11/01/2024
182	Allowable/paid from other entities coverage Usage: This code requires the use of an entity code. Start: 01/01/1995 \| Last Modified: 07/01/2017
183	Amount entity has paid. Usage: This code requires use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
184	Purchase price for the rented durable medical equipment. Start: 01/01/1995
185	Rental price for durable medical equipment. Start: 01/01/1995
186	Purchase and rental price of durable medical equipment. Start: 01/01/1995
187	Date(s) of service. Start: 01/01/1995
188	Statement from-through dates. Start: 01/01/1995
189	Facility admission date Start: 01/01/1995 \| Last Modified: 10/31/2006
190	Facility discharge date Start: 01/01/1995 \| Last Modified: 10/31/2006
191	Date of Last Menstrual Period (LMP) Start: 02/28/1997
192	Date of first service for current series/symptom/illness. Start: 01/01/1995
193	First consultation/evaluation date. Start: 02/28/1997
194	Confinement dates. Start: 01/01/1995
195	Unable to work dates/Disability Dates. Start: 01/01/1995 \| Last Modified: 09/20/2009
196	Return to work dates. Start: 01/01/1995
197	Effective coverage date(s). Start: 01/01/1995
198	Medicare effective date. Start: 01/01/1995
199	Date of conception and expected date of delivery. Start: 01/01/1995
200	Date of equipment return. Start: 01/01/1995
201	Date of dental appliance prior placement. Start: 01/01/1995
202	Date of dental prior replacement/reason for replacement. Start: 01/01/1995
203	Date of dental appliance placed. Start: 01/01/1995
204	Date dental canal(s) opened and date service completed. Start: 01/01/1995
205	Date(s) dental root canal therapy previously performed. Start: 01/01/1995
206	Most recent date of curettage, root planing, or periodontal surgery. Start: 01/01/1995
207	Dental impression and seating date. Start: 01/01/1995
208	Most recent date pacemaker was implanted. Start: 01/01/1995
209	Most recent pacemaker battery change date. Start: 01/01/1995
210	Date of the last x-ray. Start: 01/01/1995
211	Date(s) of dialysis training provided to patient. Start: 01/01/1995
212	Date of last routine dialysis. Start: 01/01/1995
213	Date of first routine dialysis. Start: 01/01/1995
214	Original date of prescription/orders/referral. Start: 02/28/1997
215	Date of tooth extraction/evolution. Start: 01/01/1995
216	Drug information. Start: 01/01/1995
217	Drug name, strength and dosage form. Start: 01/01/1995
218	NDC number. Start: 01/01/1995
219	Prescription number. Start: 01/01/1995
220	Drug product id number. (Use code 218) Start: 01/01/1995 \| Last Modified: 10/17/2010 \| Stop: 07/01/2011
221	Drug days supply and dosage. Start: 01/01/1995 \| Last Modified: 01/24/2010 \| Stop: 01/01/2012
222	Drug dispensing units and average wholesale price (AWP). Start: 01/01/1995
223	Route of drug/myelogram administration. Start: 01/01/1995
224	Anatomical location for joint injection. Start: 01/01/1995
225	Anatomical location. Start: 01/01/1995
226	Joint injection site. Start: 01/01/1995
227	Hospital information. Start: 01/01/1995
228	Type of bill for UB claim Start: 01/01/1995 \| Last Modified: 10/31/2006
229	Hospital admission source. Start: 01/01/1995
230	Hospital admission hour. Start: 01/01/1995
231	Hospital admission type. Start: 01/01/1995
232	Admitting diagnosis. Start: 01/01/1995
233	Hospital discharge hour. Start: 01/01/1995
234	Patient discharge status. Start: 01/01/1995
235	Units of blood furnished. Start: 01/01/1995
236	Units of blood replaced. Start: 01/01/1995
237	Units of deductible blood. Start: 01/01/1995
238	Separate claim for mother/baby charges. Start: 01/01/1995
239	Dental information. Start: 01/01/1995
240	Tooth surface(s) involved. Start: 01/01/1995
241	List of all missing teeth (upper and lower). Start: 01/01/1995
242	Tooth numbers, surfaces, and/or quadrants involved. Start: 01/01/1995
243	Months of dental treatment remaining. Start: 01/01/1995
244	Tooth number or letter. Start: 01/01/1995
245	Dental quadrant/arch. Start: 01/01/1995
246	Total orthodontic service fee, initial appliance fee, monthly fee, length of service. Start: 01/01/1995
247	Line information. Start: 01/01/1995
248	Accident date, state, description and cause. Start: 01/01/1995 \| Last Modified: 01/24/2010 \| Stop: 01/01/2012
249	Place of service. Start: 01/01/1995
250	Type of service. Start: 01/01/1995
251	Total anesthesia minutes. Start: 01/01/1995
252	Entity's prior authorization/certification number. Usage: This code requires the use of an Entity Code. Start: 01/01/1995 \| Last Modified: 07/01/2017
253	Procedure/revenue code for service(s) rendered. Use codes 454 or 455. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 02/28/1997
254	Principal diagnosis code. Start: 01/01/1995 \| Last Modified: 01/30/2011
255	Diagnosis code. Start: 01/01/1995
256	DRG code(s). Start: 01/01/1995
257	ADSM-III-R code for services rendered. Start: 01/01/1995
258	Days/units for procedure/revenue code. Start: 01/01/1995
259	Frequency of service. Start: 01/01/1995
260	Length of medical necessity, including begin date. Start: 02/28/1997
261	Obesity measurements. Start: 01/01/1995
262	Type of surgery/service for which anesthesia was administered. Start: 01/01/1995
263	Length of time for services rendered. Start: 01/01/1995
264	Number of liters/minute & total hours/day for respiratory support. Start: 01/01/1995
265	Number of lesions excised. Start: 01/01/1995
266	Facility point of origin and destination - ambulance. Start: 01/01/1995
267	Number of miles patient was transported. Start: 01/01/1995
268	Location of durable medical equipment use. Start: 01/01/1995
269	Length/size of laceration/tumor. Start: 01/01/1995
270	Subluxation location. Start: 01/01/1995
271	Number of spine segments. Start: 01/01/1995
272	Oxygen contents for oxygen system rental. Start: 01/01/1995
273	Weight. Start: 01/01/1995
274	Height. Start: 01/01/1995
275	Claim. Start: 01/01/1995
276	UB04/HCFA-1450/1500 claim form Start: 01/01/1995 \| Last Modified: 10/31/2006
277	Paper claim. Start: 01/01/1995
278	Signed claim form. Start: 01/01/1995 \| Stop: 11/01/2011
279	Claim/service must be itemized Start: 01/01/1995 \| Last Modified: 10/17/2010
280	Itemized claim by provider. Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 279
281	Related confinement claim. Start: 01/01/1995
282	Copy of prescription. Start: 01/01/1995
283	Medicare entitlement information is required to determine primary coverage Start: 01/01/1995 \| Last Modified: 01/27/2008
284	Copy of Medicare ID card. Start: 01/01/1995
285	Vouchers/explanation of benefits (EOB). Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 286
286	Other payer's Explanation of Benefits/payment information. Start: 01/01/1995
287	Medical necessity for service. Start: 01/01/1995
288	Hospital late charges Start: 01/01/1995 \| Last Modified: 10/17/2010
289	Reason for late discharge. Start: 01/01/1995 \| Stop: 11/01/2011
290	Pre-existing information. Start: 01/01/1995
291	Reason for termination of pregnancy. Start: 01/01/1995
292	Purpose of family conference/therapy. Start: 01/01/1995
293	Reason for physical therapy. Start: 01/01/1995
294	Supporting documentation. Usage: At least one other status code is required to identify the supporting documentation. Start: 01/01/1995 \| Last Modified: 07/01/2017
295	Attending physician report. Start: 01/01/1995
296	Nurse's notes. Start: 01/01/1995
297	Medical notes/report. Start: 02/28/1997
298	Operative report. Start: 01/01/1995
299	Emergency room notes/report. Start: 01/01/1995
300	Lab/test report/notes/results. Start: 02/28/1997
301	MRI report. Start: 01/01/1995
302	Refer to codes 300 for lab notes and 311 for pathology notes Start: 01/01/1995 \| Stop: 01/31/1997
303	Physical therapy notes. Use code 297:6O (6 'OH' - not zero) Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 02/28/1997
304	Reports for service. Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to codes 297, 298, 299, 300
305	Radiology/x-ray reports and/or interpretation Start: 01/01/1995 \| Last Modified: 01/30/2011
306	Detailed description of service. Start: 01/01/1995
307	Narrative with pocket depth chart. Start: 01/01/1995
308	Discharge summary. Start: 01/01/1995
309	Code was duplicate of code 299 Start: 01/01/1995 \| Stop: 01/31/1997
310	Progress notes for the six months prior to statement date. Start: 01/01/1995
311	Pathology notes/report. Start: 01/01/1995
312	Dental charting. Start: 01/01/1995
313	Bridgework information. Start: 01/01/1995
314	Dental records for this service. Start: 01/01/1995
315	Past perio treatment history. Start: 01/01/1995
316	Complete medical history. Start: 01/01/1995
317	Patient's medical records. Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
318	X-rays/radiology films Start: 01/01/1995 \| Last Modified: 10/17/2010
319	Pre/post-operative x-rays/photographs. Start: 02/28/1997
320	Study models. Start: 01/01/1995
321	Radiographs or models. (Use codes 318 and/or 320) Start: 01/01/1995 \| Last Modified: 10/17/2010 \| Stop: 07/01/2011
322	Recent Full Mouth X-rays Start: 01/01/1995 \| Last Modified: 10/17/2010
323	Study models, x-rays, and/or narrative. Start: 01/01/1995
324	Recent x-ray of treatment area and/or narrative. Start: 01/01/1995
325	Recent fm x-rays and/or narrative. Start: 01/01/1995
326	Copy of transplant acquisition invoice. Start: 01/01/1995
327	Periodontal case type diagnosis and recent pocket depth chart with narrative. Start: 01/01/1995
328	Speech therapy notes. Use code 297:6R Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 02/28/1997
329	Exercise notes. Start: 01/01/1995
330	Occupational notes. Start: 01/01/1995
331	History and physical. Start: 01/01/1995 \| Last Modified: 08/01/2007
332	Authorization/certification (include period covered). (Use code 252) Start: 02/28/1997 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
333	Patient release of information authorization. Start: 01/01/1995
334	Oxygen certification. Start: 01/01/1995
335	Durable medical equipment certification. Start: 01/01/1995
336	Chiropractic certification. Start: 01/01/1995
337	Ambulance certification/documentation. Start: 01/01/1995
338	Home health certification. Use code 332:4Y Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 02/28/1997
339	Enteral/parenteral certification. Start: 01/01/1995
340	Pacemaker certification. Start: 01/01/1995
341	Private duty nursing certification. Start: 01/01/1995
342	Podiatric certification. Start: 01/01/1995
343	Documentation that facility is state licensed and Medicare approved as a surgical facility. Start: 01/01/1995
344	Documentation that provider of physical therapy is Medicare Part B approved. Start: 01/01/1995
345	Treatment plan for service/diagnosis Start: 01/01/1995
346	Proposed treatment plan for next 6 months. Start: 01/01/1995
347	Refer to code 345 for treatment plan and code 282 for prescription Start: 01/01/1995 \| Stop: 01/31/1997
348	Chiropractic treatment plan. (Use 345:QL) Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
349	Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 02/28/1997
350	Speech pathology treatment plan. Use code 345:6R Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 02/28/1997
351	Physical/occupational therapy treatment plan. Use codes 345:6O (6 'OH' - not zero), 6N Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 02/28/1997
352	Duration of treatment plan. Start: 01/01/1995
353	Orthodontics treatment plan. Start: 01/01/1995
354	Treatment plan for replacement of remaining missing teeth. Start: 01/01/1995
355	Has claim been paid? Start: 01/01/1995 \| Stop: 11/01/2011
356	Was blood furnished? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 235
357	Has or will blood be replaced? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 236
358	Does provider accept assignment of benefits? (Use code 589) Start: 01/01/1995 \| Last Modified: 10/17/2010 \| Stop: 07/01/2011
359	Is there a release of information signature on file? (Use code 333) Start: 01/01/1995 \| Last Modified: 10/17/2010 \| Stop: 07/01/2011
360	Benefits Assignment Certification Indicator Start: 01/01/1995 \| Last Modified: 10/17/2010
361	Is there other insurance? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to codes 171 and 550
362	Is the dental patient covered by medical insurance? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 171
363	Possible Workers' Compensation Start: 01/01/1995 \| Last Modified: 10/17/2010
364	Is accident/illness/condition employment related? Start: 01/01/1995
365	Is service the result of an accident? Start: 01/01/1995
366	Is injury due to auto accident? Start: 01/01/1995
367	Is service performed for a recurring condition or new condition? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 397
368	Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 676
369	Does patient condition preclude use of ordinary bed? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to codes 287, 335
370	Can patient operate controls of bed? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to codes 287, 335
371	Is patient confined to room? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527
372	Is patient confined to bed? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527
373	Is patient an insulin diabetic? Start: 01/01/1995 \| Stop: 11/01/2011
374	Is prescribed lenses a result of cataract surgery? Start: 01/01/1995
375	Was refraction performed? Start: 01/01/1995
376	Was charge for ambulance for a round-trip? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 453
377	Was durable medical equipment purchased new or used? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to codes 184, 185, 186, 335
378	Is pacemaker temporary or permanent? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 340
379	Were services performed supervised by a physician? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to codes 453, 454, 666 & procedure code
380	CRNA supervision/medical direction. Start: 01/01/1995 \| Last Modified: 10/17/2010
381	Is drug generic? Start: 01/01/1995 \| Stop: 11/01/2011 Notes: Refer to code 216
382	Did provider authorize generic or brand name dispensing? Start: 01/01/1995
383	Nerve block use (surgery vs. pain management) Start: 01/01/1995 \| Last Modified: 10/17/2010
384	Is prosthesis/crown/inlay placement an initial placement or a replacement? Start: 01/01/1995
385	Is appliance upper or lower arch & is appliance fixed or removable? Start: 01/01/1995
386	Orthodontic Treatment/Purpose Indicator Start: 01/01/1995 \| Last Modified: 10/17/2010
387	Date patient last examined by entity. Usage: This code requires use of an Entity Code. Start: 02/28/1997 \| Last Modified: 07/01/2017
388	Date post-operative care assumed Start: 02/28/1997
389	Date post-operative care relinquished Start: 02/28/1997
390	Date of most recent medical event necessitating service(s) Start: 02/28/1997
391	Date(s) dialysis conducted Start: 02/28/1997
392	Date(s) of blood transfusion(s) Start: 02/28/1997 \| Stop: 11/01/2011
393	Date of previous pacemaker check Start: 02/28/1997 \| Stop: 11/01/2011
394	Date(s) of most recent hospitalization related to service Start: 02/28/1997
395	Date entity signed certification/recertification Usage: This code requires use of an Entity Code. Start: 02/28/1997 \| Last Modified: 07/01/2017
396	Date home dialysis began Start: 02/28/1997
397	Date of onset/exacerbation of illness/condition Start: 02/28/1997
398	Visual field test results Start: 02/28/1997
399	Report of prior testing related to this service, including dates Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 417
400	Claim is out of balance Start: 02/28/1997
401	Source of payment is not valid Start: 02/28/1997
402	Amount must be greater than zero. Usage: At least one other status code is required to identify which amount element is in error. Start: 02/28/1997 \| Last Modified: 07/01/2017
403	Entity referral notes/orders/prescription. Usage: this code requires use of an entity code. Start: 02/28/1997 \| Last Modified: 11/01/2024
404	Specific findings, complaints, or symptoms necessitating service Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to codes 287, 488
405	Summary of services Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 306
406	Brief medical history as related to service(s) Start: 02/28/1997
407	Complications/mitigating circumstances Start: 02/28/1997
408	Initial certification Start: 02/28/1997
409	Medication logs/records (including medication therapy) Start: 02/28/1997
410	Explain differences between treatment plan and patient's condition Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
411	Medical necessity for non-routine service(s) Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 287
412	Medical records to substantiate decision of non-coverage Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
413	Explain/justify differences between treatment plan and services rendered. Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
414	Necessity for concurrent care (more than one physician treating the patient) Start: 02/28/1997 \| Last Modified: 10/17/2010
415	Justify services outside composite rate Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 287
416	Verification of patient's ability to retain and use information Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
417	Prior testing, including result(s) and date(s) as related to service(s) Start: 02/28/1997
418	Indicating why medications cannot be taken orally Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
419	Individual test(s) comprising the panel and the charges for each test Start: 02/28/1997
420	Name, dosage and medical justification of contrast material used for radiology procedure Start: 02/28/1997
421	Medical review attachment/information for service(s) Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
422	Homebound status Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 575
423	Prognosis Start: 02/28/1997 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
424	Statement of non-coverage including itemized bill Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 279 & 286
425	Itemize non-covered services Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 279 & 286
426	All current diagnoses Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 255, 232 & 488
427	Emergency care provided during transport Start: 02/28/1997 \| Stop: 11/01/2011
428	Reason for transport by ambulance Start: 02/28/1997
429	Loaded miles and charges for transport to nearest facility with appropriate services Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to codes 267, 178, 430
430	Nearest appropriate facility Start: 02/28/1997
431	Patient's condition/functional status at time of service. Start: 02/28/1997 \| Last Modified: 10/17/2010
432	Date benefits exhausted Start: 02/28/1997
433	Copy of patient revocation of hospice benefits Start: 02/28/1997
434	Reasons for more than one transfer per entitlement period Start: 02/28/1997
435	Notice of Admission Start: 02/28/1997
436	Short term goals Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 345
437	Long term goals Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 345
438	Number of patients attending session Start: 02/28/1997 \| Stop: 11/01/2011
439	Size, depth, amount, and type of drainage wounds Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes
440	why non-skilled caregiver has not been taught procedure Start: 02/28/1997 \| Stop: 11/01/2011
441	Entity professional qualification for service(s). Usage: This code requires the use of an Entity Code.” Start: 02/28/1997 \| Last Modified: 11/01/2024
442	Modalities of service Start: 02/28/1997
443	Initial evaluation report Start: 02/28/1997
444	Method used to obtain test sample Start: 02/28/1997 \| Stop: 11/01/2011
445	Explain why hearing loss not correctable by hearing aid Start: 02/28/1997 \| Stop: 11/01/2011 Notes: Refer to code 287
446	Documentation from prior claim(s) related to service(s) Start: 02/28/1997 \| Stop: 11/01/2011
447	Plan of teaching Start: 02/28/1997 \| Stop: 11/01/2011
448	Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used. Start: 02/28/1997 \| Last Modified: 01/24/2010 \| Stop: 01/01/2012
449	Projected date to discontinue service(s) Start: 02/28/1997
450	Awaiting spend down determination Start: 02/28/1997
451	Preoperative and post-operative diagnosis Start: 02/28/1997
452	Total visits in total number of hours/day and total number of hours/week Start: 02/28/1997
453	Procedure Code Modifier(s) for Service(s) Rendered Start: 02/28/1997
454	Procedure code for services rendered. Start: 02/28/1997
455	Revenue code for services rendered. Start: 02/28/1997
456	Covered Day(s) Start: 02/28/1997
457	Non-Covered Day(s) Start: 02/28/1997
458	Coinsurance Day(s) Start: 02/28/1997
459	Lifetime Reserve Day(s) Start: 02/28/1997
460	NUBC Condition Code(s) Start: 02/28/1997
461	NUBC Occurrence Code(s) and Date(s) Start: 02/28/1997 \| Last Modified: 01/24/2010 \| Stop: 01/01/2012
462	NUBC Occurrence Span Code(s) and Date(s) Start: 02/28/1997 \| Last Modified: 01/24/2010 \| Stop: 01/01/2012
463	NUBC Value Code(s) and/or Amount(s) Start: 02/28/1997 \| Last Modified: 01/24/2010 \| Stop: 01/01/2012
464	Payer Assigned Claim Control Number Start: 02/28/1997 \| Last Modified: 10/31/2004
465	Principal Procedure Code for Service(s) Rendered Start: 02/28/1997
466	Entity's Original Signature. Usage: This code requires use of an Entity Code. Start: 02/28/1997 \| Last Modified: 07/01/2017
467	Entity Signature Date. Usage: This code requires use of an Entity Code. Start: 02/28/1997 \| Last Modified: 07/01/2017
468	Patient Signature Source Start: 02/28/1997
469	Purchase Service Charge Start: 02/28/1997
470	Was service purchased from another entity? Usage: This code requires use of an Entity Code. Start: 02/28/1997 \| Last Modified: 07/01/2017
471	Were services related to an emergency? Start: 02/28/1997
472	Ambulance Run Sheet Start: 02/28/1997
473	Missing or invalid lab indicator Start: 06/30/1998
474	Procedure code and patient gender mismatch Start: 06/30/1998 \| Last Modified: 02/29/2000
475	Procedure code not valid for patient age Start: 06/30/1998 \| Last Modified: 02/29/2000
476	Missing or invalid units of service Start: 06/30/1998
477	Diagnosis code pointer is missing or invalid Start: 06/30/1998
478	Claim submitter's identifier Start: 06/30/1998 \| Last Modified: 01/24/2010
479	Other Carrier payer ID is missing or invalid Start: 06/30/1998
480	Entity's claim filing indicator. Usage: This code requires use of an Entity Code. Start: 06/30/1998 \| Last Modified: 07/01/2017
481	Claim/submission format is invalid. Start: 10/31/1998
482	Date Error, Century Missing Start: 02/28/1999 \| Last Modified: 09/20/2009 \| Stop: 10/01/2010
483	Maximum coverage amount met or exceeded for benefit period. Start: 06/30/1999
484	Business Application Currently Not Available Start: 02/29/2000
485	More information available than can be returned in real-time mode. Narrow your current search criteria. Start: 02/28/2001 \| Last Modified: 11/01/2024
486	Principal Procedure Date Start: 10/31/2001 \| Last Modified: 07/01/2009
487	Claim not found, claim should have been submitted to/through 'entity'. Usage: This code requires use of an Entity Code. Start: 02/28/2002 \| Last Modified: 07/01/2017
488	Diagnosis code(s) for the services rendered. Start: 06/30/2002
489	Attachment Control Number Start: 10/31/2002
490	Other Procedure Code for Service(s) Rendered Start: 02/28/2003
491	Entity not eligible for encounter submission. Usage: This code requires use of an Entity Code. Start: 02/28/2003 \| Last Modified: 07/01/2017
492	Other Procedure Date Start: 02/28/2003
493	Version/Release/Industry ID code not currently supported by information holder Start: 02/28/2003
494	Real-time requests not supported by the information holder, resubmit as batch request. Start: 02/28/2003 \| Last Modified: 11/01/2024
495	Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit. Start: 10/31/2003
496	Submitter not approved for electronic claim submissions on behalf of this entity. Usage: This code requires use of an Entity Code. Start: 02/29/2004 \| Last Modified: 07/01/2017
497	Sales tax not paid Start: 06/30/2004
498	Maximum leave days exhausted Start: 06/30/2004
499	No rate on file with the payer for this service for this entity Usage: This code requires use of an Entity Code. Start: 06/30/2004 \| Last Modified: 07/01/2017
500	Entity's Postal/Zip Code. Usage: This code requires use of an Entity Code. Start: 06/30/2004 \| Last Modified: 07/01/2017
501	Entity's State/Province. Usage: This code requires use of an Entity Code. Start: 06/30/2004 \| Last Modified: 07/01/2017
502	Entity's City. Usage: This code requires use of an Entity Code. Start: 06/30/2004 \| Last Modified: 07/01/2017
503	Entity's Street Address. Usage: This code requires use of an Entity Code. Start: 06/30/2004 \| Last Modified: 07/01/2017
504	Entity's Last Name. Usage: This code requires use of an Entity Code. Start: 06/30/2004 \| Last Modified: 07/01/2017
505	Entity's First Name. Usage: This code requires use of an Entity Code. Start: 06/30/2004 \| Last Modified: 07/01/2017
506	Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Usage: This code requires use of an Entity Code. Start: 06/30/2004 \| Last Modified: 07/01/2017
507	HCPCS Start: 10/31/2004
508	ICD9 Usage: At least one other status code is required to identify the related procedure code or diagnosis code. Start: 10/31/2004 \| Last Modified: 07/01/2017
509	External Cause of Injury Code. Start: 10/31/2004 \| Last Modified: 03/01/2016
510	Future date. Usage: At least one other status code is required to identify the data element in error. Start: 10/31/2004 \| Last Modified: 07/01/2017
511	Invalid character. Usage: At least one other status code is required to identify the data element in error. Start: 10/31/2004 \| Last Modified: 07/01/2017
512	Length invalid for receiver's application system. Usage: At least one other status code is required to identify the data element in error. Start: 10/31/2004 \| Last Modified: 07/01/2017
513	HIPPS Rate Code for services rendered Start: 10/31/2004 \| Last Modified: 11/01/2024
514	Entity's Middle Name Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
515	Managed Care review Start: 10/31/2004
516	Other Entity's Adjudication or Payment/Remittance Date. Usage: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary. Start: 10/31/2004 \| Last Modified: 07/01/2017
517	Adjusted Repriced Claim Reference Number Start: 10/31/2004
518	Adjusted Repriced Line item Reference Number Start: 10/31/2004
519	Adjustment Amount Start: 10/31/2004
520	Adjustment Quantity Start: 10/31/2004
521	Adjustment Reason Code Start: 10/31/2004
522	Anesthesia Modifying Units Start: 10/31/2004
523	Anesthesia Unit Count Start: 10/31/2004
524	Arterial Blood Gas Quantity Start: 10/31/2004
525	Begin Therapy Date Start: 10/31/2004
526	Bundled or Unbundled Line Number Start: 10/31/2004
527	Certification Condition Indicator Start: 10/31/2004
528	Certification Period Projected Visit Count Start: 10/31/2004
529	Certification Revision Date Start: 10/31/2004
530	Claim Adjustment Indicator Start: 10/31/2004
531	Claim Disproportinate Share Amount Start: 10/31/2004
532	Claim DRG Amount Start: 10/31/2004
533	Claim DRG Outlier Amount Start: 10/31/2004
534	Claim ESRD Payment Amount Start: 10/31/2004
535	Claim Frequency Code Start: 10/31/2004
536	Claim Indirect Teaching Amount Start: 10/31/2004
537	Claim MSP Pass-through Amount Start: 10/31/2004
538	Claim or Encounter Identifier Start: 10/31/2004
539	Claim PPS Capital Amount Start: 10/31/2004
540	Claim PPS Capital Outlier Amount Start: 10/31/2004
541	Claim Submission Reason Code Start: 10/31/2004
542	Claim Total Denied Charge Amount Start: 10/31/2004
543	Clearinghouse or Value Added Network Trace Start: 10/31/2004
544	Clinical Laboratory Improvement Amendment (CLIA) Number Start: 10/31/2004 \| Last Modified: 03/01/2018
545	Contract Amount Start: 10/31/2004
546	Contract Code Start: 10/31/2004
547	Contract Percentage Start: 10/31/2004
548	Contract Type Code Start: 10/31/2004
549	Contract Version Identifier Start: 10/31/2004
550	Coordination of Benefits Code Start: 10/31/2004
551	Coordination of Benefits Total Submitted Charge Start: 10/31/2004
552	Cost Report Day Count Start: 10/31/2004
553	Covered Amount Start: 10/31/2004
554	Date Claim Paid Start: 10/31/2004
555	Delay Reason Code Start: 10/31/2004
556	Demonstration Project Identifier Start: 10/31/2004
557	Diagnosis Date Start: 10/31/2004
558	Discount Amount Start: 10/31/2004
559	Document Control Identifier Start: 10/31/2004
560	Entity's Additional/Secondary Identifier. Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
561	Entity's Contact Name. Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
562	Entity's National Provider Identifier (NPI). Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
563	Entity's Tax Amount. Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
564	EPSDT Indicator Start: 10/31/2004
565	Estimated Claim Due Amount Start: 10/31/2004
566	Exception Code Start: 10/31/2004
567	Facility Code Qualifier Start: 10/31/2004
568	Family Planning Indicator Start: 10/31/2004
569	Fixed Format Information Start: 10/31/2004
570	Free Form Message Text Start: 10/31/2004 \| Stop: 01/01/2013
571	Frequency Count Start: 10/31/2004
572	Frequency Period Start: 10/31/2004
573	Functional Limitation Code Start: 10/31/2004
574	HCPCS Payable Amount Home Health Start: 10/31/2004
575	Homebound Indicator Start: 10/31/2004
576	Immunization Batch Number Start: 10/31/2004
577	Industry Code Start: 10/31/2004
578	Insurance Type Code Start: 10/31/2004
579	Investigational Device Exemption Identifier Start: 10/31/2004
580	Last Certification Date Start: 10/31/2004
581	Last Worked Date Start: 10/31/2004
582	Lifetime Psychiatric Days Count Start: 10/31/2004
583	Line Item Charge Amount Start: 10/31/2004
584	Line Item Control Number Start: 10/31/2004
585	Denied Charge or Non-covered Charge Start: 10/31/2004 \| Last Modified: 07/09/2007
586	Line Note Text Start: 10/31/2004
587	Measurement Reference Identification Code Start: 10/31/2004
588	Medical Record Number Start: 10/31/2004
589	Provider Accept Assignment Code Start: 10/31/2004 \| Last Modified: 10/17/2010
590	Medicare Coverage Indicator Start: 10/31/2004
591	Medicare Paid at 100% Amount Start: 10/31/2004
592	Medicare Paid at 80% Amount Start: 10/31/2004
593	Medicare Section 4081 Indicator Start: 10/31/2004
594	Mental Status Code Start: 10/31/2004
595	Monthly Treatment Count Start: 10/31/2004
596	Non-covered Charge Amount Start: 10/31/2004
597	Non-payable Professional Component Amount Start: 10/31/2004
598	Non-payable Professional Component Billed Amount Start: 10/31/2004
599	Note Reference Code Start: 10/31/2004
600	Oxygen Saturation Qty Start: 10/31/2004
601	Oxygen Test Condition Code Start: 10/31/2004
602	Oxygen Test Date Start: 10/31/2004
603	Old Capital Amount Start: 10/31/2004
604	Originator Application Transaction Identifier Start: 10/31/2004
605	Orthodontic Treatment Months Count Start: 10/31/2004
606	Paid From Part A Medicare Trust Fund Amount Start: 10/31/2004
607	Paid From Part B Medicare Trust Fund Amount Start: 10/31/2004
608	Paid Service Unit Count Start: 10/31/2004
609	Participation Agreement Start: 10/31/2004
610	Patient Discharge Facility Type Code Start: 10/31/2004
611	Peer Review Authorization Number Start: 10/31/2004
612	Per Day Limit Amount Start: 10/31/2004
613	Physician Contact Date Start: 10/31/2004
614	Physician Order Date Start: 10/31/2004
615	Policy Compliance Code Start: 10/31/2004
616	Policy Name Start: 10/31/2004
617	Postage Claimed Amount Start: 10/31/2004
618	PPS-Capital DSH DRG Amount Start: 10/31/2004
619	PPS-Capital Exception Amount Start: 10/31/2004
620	PPS-Capital FSP DRG Amount Start: 10/31/2004
621	PPS-Capital HSP DRG Amount Start: 10/31/2004
622	PPS-Capital IME Amount Start: 10/31/2004
623	PPS-Operating Federal Specific DRG Amount Start: 10/31/2004
624	PPS-Operating Hospital Specific DRG Amount Start: 10/31/2004
625	Predetermination of Benefits Identifier Start: 10/31/2004
626	Pregnancy Indicator Start: 10/31/2004
627	Pre-Tax Claim Amount Start: 10/31/2004
628	Pricing Methodology Start: 10/31/2004
629	Property Casualty Claim Number Start: 10/31/2004
630	Referring CLIA Number Start: 10/31/2004
631	Reimbursement Rate Start: 10/31/2004
632	Reject Reason Code Start: 10/31/2004
633	Related Causes Code (Accident, auto accident, employment) Start: 10/31/2004 \| Last Modified: 10/17/2010
634	Remark Code Start: 10/31/2004
635	Repriced Ambulatory Patient Group Code Start: 10/31/2004
636	Repriced Line Item Reference Number Start: 10/31/2004
637	Repriced Saving Amount Start: 10/31/2004
638	Repricing Per Diem or Flat Rate Amount Start: 10/31/2004
639	Responsibility Amount Start: 10/31/2004
640	Sales Tax Amount Start: 10/31/2004
641	Service Adjudication or Payment Date. Note: Use code 516. Start: 10/31/2004 \| Last Modified: 09/20/2009 \| Stop: 10/01/2010
642	Service Authorization Exception Code Start: 10/31/2004
643	Service Line Paid Amount Start: 10/31/2004
644	Service Line Rate Start: 10/31/2004
645	Service Tax Amount Start: 10/31/2004
646	Ship, Delivery or Calendar Pattern Code Start: 10/31/2004
647	Shipped Date Start: 10/31/2004
648	Similar Illness or Symptom Date Start: 10/31/2004
649	Skilled Nursing Facility Indicator Start: 10/31/2004
650	Special Program Indicator Start: 10/31/2004
651	State Industrial Accident Provider Number Start: 10/31/2004
652	Terms Discount Percentage Start: 10/31/2004
653	Test Performed Date Start: 10/31/2004
654	Total Denied Charge Amount Start: 10/31/2004
655	Total Medicare Paid Amount Start: 10/31/2004
656	Total Visits Projected This Certification Count Start: 10/31/2004
657	Total Visits Rendered Count Start: 10/31/2004
658	Treatment Code Start: 10/31/2004
659	Unit or Basis for Measurement Code Start: 10/31/2004
660	Universal Product Number Start: 10/31/2004
661	Visits Prior to Recertification Date Count CR702 Start: 10/31/2004
662	X-ray Availability Indicator Start: 10/31/2004
663	Entity's Group Name. Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
664	Orthodontic Banding Date Start: 10/31/2004
665	Surgery Date Start: 10/31/2004
666	Surgical Procedure Code Start: 10/31/2004
667	Real-time requests not supported by the information holder, do not resubmit. Start: 02/28/2005 \| Last Modified: 11/01/2024
668	Missing Endodontics treatment history and prognosis Start: 06/30/2005
669	Dental service narrative needed. Start: 10/31/2005
670	Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts Start: 06/30/2006 \| Last Modified: 02/28/2007
671	Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts Start: 06/30/2006 \| Last Modified: 02/28/2007
672	Other Payer's payment information is out of balance Start: 10/31/2006
673	Patient Reason for Visit Start: 10/31/2006
674	Authorization exceeded Start: 10/31/2006
675	Facility admission through discharge dates Start: 10/31/2006
676	Entity possibly compensated by facility. Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
677	Entity not affiliated. Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
678	Revenue code and patient gender mismatch Start: 10/31/2006
679	Submit newborn services on mother's claim Start: 10/31/2006
680	Entity's Country. Usage: This code requires use of an Entity Code. Start: 10/31/2004 \| Last Modified: 07/01/2017
681	Claim currency not supported Start: 10/31/2006
682	Cosmetic procedure Start: 02/28/2007
683	Awaiting Associated Hospital Claims Start: 02/28/2007
684	Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. Usage: Only for use to reject claims or status requests in transactions that were 'accepted with errors' on a 997 or 999 Acknowledgement. Start: 11/05/2007 \| Last Modified: 11/01/2024
685	Claim could not complete adjudication in real-time. Claim will continue processing in a batch mode. Do not resubmit. Start: 01/27/2008 \| Last Modified: 11/01/2024
686	The claim/ encounter has completed the adjudication cycle and the entire claim has been voided Start: 01/27/2008
687	Claim predetermination/estimation could not be completed in real-time. Do not resubmit. Start: 01/27/2008 \| Last Modified: 11/01/2024
688	Present on Admission Indicator for reported diagnosis code(s). Start: 01/27/2008
689	Entity was unable to respond within the expected time frame. Usage: This code requires use of an Entity Code. Start: 06/01/2008 \| Last Modified: 07/01/2017
690	Multiple claims or estimate requests cannot be processed in real-time. Start: 06/01/2008 \| Last Modified: 11/01/2024
691	Multiple claim status requests cannot be processed in real-time. Start: 06/01/2008 \| Last Modified: 11/01/2024
692	Contracted funding agreement, subscriber is employed by the provider of services. Start: 09/21/2008 \| Last Modified: 11/01/2024
693	Amount must be greater than or equal to zero. Usage: At least one other status code is required to identify which amount element is in error. Start: 01/25/2009 \| Last Modified: 07/01/2017
694	Amount must not be equal to zero. Usage: At least one other status code is required to identify which amount element is in error. Start: 01/25/2009 \| Last Modified: 07/01/2017
695	Entity's Country Subdivision Code. Usage: This code requires use of an Entity Code. Start: 01/25/2009 \| Last Modified: 07/01/2017
696	Claim Adjustment Group Code. Start: 01/25/2009
697	Invalid Decimal Precision. Usage: At least one other status code is required to identify the data element in error. Start: 07/01/2009 \| Last Modified: 07/01/2017
698	Form Type Identification Start: 07/01/2009
699	Question/Response from Supporting Documentation Form Start: 07/01/2009
700	ICD10. Usage: At least one other status code is required to identify the related procedure code or diagnosis code. Start: 07/01/2009 \| Last Modified: 07/01/2017
701	Initial Treatment Date Start: 07/01/2009
702	Repriced Claim Reference Number Start: 11/01/2009
703	Advanced Billing Concepts (ABC) code Start: 01/24/2010
704	Claim Note Text Start: 01/24/2010
705	Repriced Allowed Amount Start: 01/24/2010
706	Repriced Approved Amount Start: 01/24/2010
707	Repriced Approved Ambulatory Patient Group Amount Start: 01/24/2010
708	Repriced Approved Revenue Code Start: 01/24/2010
709	Repriced Approved Service Unit Count Start: 01/24/2010
710	Line Adjudication Information. Usage: At least one other status code is required to identify the data element in error. Start: 01/24/2010 \| Last Modified: 07/01/2017
711	Stretcher purpose Start: 01/24/2010
712	Obstetric Additional Units Start: 01/24/2010
713	Patient Condition Description Start: 01/24/2010
714	Care Plan Oversight Number Start: 01/24/2010
715	Acute Manifestation Date Start: 01/24/2010
716	Repriced Approved DRG Code Start: 01/24/2010
717	This claim has been split for processing. Start: 01/24/2010
718	Claim/service not submitted within the required timeframe (timely filing). Start: 01/24/2010
719	NUBC Occurrence Code(s) Start: 01/24/2010
720	NUBC Occurrence Code Date(s) Start: 01/24/2010
721	NUBC Occurrence Span Code(s) Start: 01/24/2010
722	NUBC Occurrence Span Code Date(s) Start: 01/24/2010
723	Drug days supply Start: 01/24/2010
724	Drug Quantity Start: 01/24/2010 \| Last Modified: 11/01/2024
725	NUBC Value Code(s) Start: 01/24/2010
726	NUBC Value Code Amount(s) Start: 01/24/2010
727	Accident date Start: 01/24/2010
728	Accident state Start: 01/24/2010
729	Accident description Start: 01/24/2010
730	Accident cause Start: 01/24/2010
731	Measurement value/test result Start: 01/24/2010
732	Information submitted inconsistent with billing guidelines. Usage: At least one other status code is required to identify the inconsistent information. Start: 01/24/2010 \| Last Modified: 07/01/2017
733	Prefix for entity's contract/member number. Usage: This code requires the use of an Entity Code. Start: 01/24/2010 \| Last Modified: 11/01/2024
734	Verifying premium payment Start: 06/06/2010
735	This service/claim is included in the allowance for another service or claim. Start: 06/06/2010
736	A related or qualifying service/claim has not been received/adjudicated. Start: 06/06/2010
737	Current Dental Terminology (CDT) Code Start: 06/06/2010
738	Home Infusion EDI Coalition (HEIC) Product/Service Code Start: 06/06/2010
739	Jurisdiction Specific Procedure or Supply Code Start: 06/06/2010
740	Drop-Off Location Start: 06/06/2010
741	Entity must be a person. Usage: This code requires use of an Entity Code. Start: 06/06/2010 \| Last Modified: 07/01/2017
742	Payer Responsibility Sequence Number Code Start: 06/06/2010
743	Entity's credential/enrollment information. Usage: This code requires use of an Entity Code. Start: 10/17/2010 \| Last Modified: 07/01/2017
744	Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. Start: 10/17/2010
745	Identifier Qualifier Usage: At least one other status code is required to identify the specific identifier qualifier in error. Start: 10/17/2010 \| Last Modified: 07/01/2017
746	Duplicate Submission Usage: use only at the information receiver level in the Health Care Claim Acknowledgement transaction. Start: 10/17/2010 \| Last Modified: 07/01/2017
747	Hospice Employee Indicator Start: 10/17/2010
748	Corrected Data Usage: Requires a second status code to identify the corrected data. Start: 10/17/2010 \| Last Modified: 07/01/2017
749	Date of Injury/Illness Start: 10/17/2010
750	Auto Accident State or Province Code Start: 10/17/2010 \| Last Modified: 01/30/2011
751	Ambulance Pick-up State or Province Code Start: 10/17/2010 \| Last Modified: 01/30/2011
752	Ambulance Drop-off State or Province Code Start: 10/17/2010 \| Last Modified: 01/30/2011
753	Co-pay status code. Start: 01/30/2011
754	Entity Name Suffix. Usage: This code requires the use of an Entity Code. Start: 01/30/2011 \| Last Modified: 07/01/2017
755	Entity's primary identifier. Usage: This code requires the use of an Entity Code. Start: 01/30/2011 \| Last Modified: 07/01/2017
756	Entity's Received Date. Usage: This code requires the use of an Entity Code. Start: 01/30/2011 \| Last Modified: 07/01/2017
757	Last seen date. Start: 01/30/2011
758	Repriced approved HCPCS code. Start: 01/30/2011
759	Round trip purpose description. Start: 01/30/2011
760	Tooth status code. Start: 01/30/2011
761	Entity's referral number. Usage: This code requires the use of an Entity Code. Start: 01/30/2011 \| Last Modified: 07/01/2017
762	Locum Tenens Provider Identifier. Code must be used with Entity Code 82 - Rendering Provider Start: 01/20/2013
763	Ambulance Pickup ZipCode Start: 01/20/2013
764	Professional charges are non covered. Start: 06/02/2013
765	Institutional charges are non covered. Start: 06/02/2013
766	Services were performed during a Health Insurance Exchange (HIX) premium payment grace period. Start: 11/01/2013
767	Qualifications for emergent/urgent care Start: 01/26/2014
768	Service date outside the accidental injury coverage period. Start: 01/26/2014
769	DME Repair or Maintenance Start: 06/01/2014
770	Duplicate of a claim processed or in process as a crossover/coordination of benefits claim. Start: 09/28/2014
771	Claim submitted prematurely. Please resubmit after crossover/payer to payer COB allotted waiting period. Start: 09/28/2014
772	The greatest level of diagnosis code specificity is required. Start: 03/01/2016
773	One calendar year per claim. Start: 11/01/2016
774	Experimental/Investigational Start: 11/01/2016
775	Entity Type Qualifier (Person/Non-Person Entity). Usage: this code requires use of an entity code. Start: 07/01/2017
776	Pre/Post-operative care Start: 07/01/2017
777	Processed based on multiple or concurrent procedure rules. Start: 07/01/2017
778	Non-Compensable incident/event. Usage: To be used for Property and Casualty only. Start: 07/01/2017
779	Service submitted for the same/similar service within a set timeframe. Start: 11/01/2017
780	Lifetime benefit maximum Start: 11/01/2017
781	Claim has been identified as a readmission Start: 11/01/2017
782	Second surgical opinion Start: 03/01/2018
783	Federal sequestration adjustment Start: 11/01/2018
784	Electronic Visit Verification criteria do not match. Start: 03/01/2019
785	Missing/Invalid Sterilization/Abortion/Hospital Consent Form. Start: 07/01/2019
786	Submit claim to the third party property and casualty automobile insurer. Start: 07/01/2019
787	Resubmit a new claim, not a replacement claim. Start: 07/01/2019
788	Submit these services to the Pharmacy plan/processor for further consideration/adjudication. Start: 07/01/2019 \| Last Modified: 11/01/2024
789	Submit these services to the patient's Medical Plan for further consideration. Start: 07/01/2019
790	Submit these services to the patient's Dental Plan for further consideration. Start: 07/01/2019
791	Submit these services to the patient's Vision Plan for further consideration. Start: 07/01/2019
792	Submit these services to the patient's Behavioral Health Plan for further consideration. Start: 07/01/2019
793	Submit these services to the patient's Property and Casualty Plan for further consideration. Start: 07/01/2019
794	Claim could not complete adjudication in real time. Resubmit as a batch request. Start: 11/01/2020
795	Claim submitted prematurely. Please provide the prior payer's final adjudication. Start: 11/01/2020
796	Procedure code not valid for date of service. Start: 11/01/2021
797	Entity's TRICARE provider id. Usage: This code requires use of an Entity Code. Start: 11/01/2021 \| Last Modified: 03/01/2022 \| Stop: 03/01/2022
798	Claim predetermination/estimation could not be completed in real time. Claim requires manual review upon submission. Do not resubmit. Start: 08/01/2022
799	Resubmit a replacement claim, not a new claim. Start: 08/01/2022
800	Entity's required reporting has been forwarded to the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. Start: 03/01/2023
801	Entity's required reporting was accepted by the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. Start: 03/01/2023
802	Entity's required reporting was rejected by the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. Start: 03/01/2023
803	Provider reporting has been rejected due to non-compliance with the jurisdiction's mandated registration. To be used for Property and Casualty only. Start: 03/01/2023
804	Exceeds inquiry limit for batch. Start: 07/01/2024
805	Mammography Certification Number Start: 07/01/2024
806	Residential county does not match the county of the service location. Start: 07/01/2024
807	Health Risk Assessment Start: 07/01/2024
808	Manifestation diagnosis code cannot be billed as a Principal Diagnosis. Start: 11/01/2024

Code List Filters Block Reference

Filter by code:

Filter codes by status:

Maintenance Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

Received
The request has been submitted but is not yet under review.
Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
In Process
The CMG has initiated their decision process.
On Hold
The CMG has initiated their decision process but cannot complete it at this time.
CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.

Status last Reviewed: 7/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

*The description you are suggesting for a new code or to replace the description for a current code.

Read more about Claim Status Codes

Claim Status Category Codes

Code List ID

507

Code List Scope Statement

These codes organize the Claim Status Codes (ECL 508) into logical groupings.

Code List Maintained By

CMG03

Code List Updated Date

Tue, 03/03/2020 - 12:00

Code List Table

Supplemental
X0	Supplemental Messages Start: 01/01/1995 \| Stop: 10/16/2003
Acknowledgements
A0	Acknowledgement/Forwarded-The claim/encounter has been forwarded to another entity. Start: 01/01/1995
A1	Acknowledgement/Receipt-The claim/encounter has been received. This does not mean that the claim has been accepted for adjudication. Start: 01/01/1995
A2	Acknowledgement/Acceptance into adjudication system-The claim/encounter has been accepted into the adjudication system. Start: 01/01/1995
A3	Acknowledgement/Returned as unprocessable claim-The claim/encounter has been rejected and has not been entered into the adjudication system. Start: 01/01/1995
A4	Acknowledgement/Not Found-The claim/encounter can not be found in the adjudication system. Start: 01/01/1995
A5	Acknowledgement/Split Claim-The claim/encounter has been split upon acceptance into the adjudication system. Start: 02/28/2002
A6	Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected. Start: 10/31/2002
A7	Acknowledgement/Rejected for Invalid Information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Start: 10/31/2002
A8	Acknowledgement/Rejected for relational field in error. Start: 10/31/2004
Data Reporting Acknowledgments
DR01	Acknowledgement/Receipt - The claim/encounter has been received. This does not mean the claim has been accepted into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgement Transaction. Start: 07/01/2018
DR02	Acknowledgement/Acceptance into the data reporting/processing system - The claim/encounter has been accepted into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR03	Acknowledgement/Returned as unprocessable claim - The claim/encounter has been rejected and has not been entered into the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR04	Acknowledgement/Not Found - The claim/encounter can not be found in the data reporting/processing system. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR05	Acknowledgement/Rejected for Missing Information - The claim/encounter is missing the information specified in the Status details and has been rejected. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR06	Acknowledgment/Rejected for invalid information - The claim/encounter has invalid information as specified in the Status details and has been rejected. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR07	Acknowledgement/Rejected for relational field in error. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
DR08	Acknowledgement/Warning - The claim/encounter has been accepted into the data reporting/processing system but has received a warning as specified in the Status details. Usage: Can only be used in the Data Reporting Acknowledgment Transaction. Start: 07/01/2018
Pending
P0	Pending: Adjudication/Details-This is a generic message about a pended claim. A pended claim is one for which no remittance advice has been issued, or only part of the claim has been paid. Start: 01/01/1995
P1	Pending/In Process-The claim or encounter is in the adjudication system. Start: 01/01/1995
P2	Pending/Payer Review-The claim/encounter is suspended and is pending review (e.g. medical review, repricing, Third Party Administrator processing). Start: 01/01/1995 \| Last Modified: 01/27/2008
P3	Pending/Provider Requested Information - The claim or encounter is waiting for information that has already been requested from the provider. (Usage: A Claim Status Code identifying the type of information requested, must be reported) Start: 01/01/1995 \| Last Modified: 07/01/2017
P4	Pending/Patient Requested Information - The claim or encounter is waiting for information that has already been requested from the patient. (Usage: A status code identifying the type of information requested must be sent) Start: 01/01/1995 \| Last Modified: 07/01/2017
P5	Pending/Payer Administrative/System hold Start: 10/31/2006
Finalized
F0	Finalized-The claim/encounter has completed the adjudication cycle and no more action will be taken. Start: 01/01/1995
F1	Finalized/Payment-The claim/line has been paid. Start: 01/01/1995
F2	Finalized/Denial-The claim/line has been denied. Start: 01/01/1995
F3	Finalized/Revised - Adjudication information has been changed Start: 02/28/2001
F3F	Finalized/Forwarded-The claim/encounter processing has been completed. Any applicable payment has been made and the claim/encounter has been forwarded to a subsequent entity as identified on the original claim or in this payer's records. Start: 01/01/1995
F3N	Finalized/Not Forwarded-The claim/encounter processing has been completed. Any applicable payment has been made. The claim/encounter has NOT been forwarded to any subsequent entity identified on the original claim. Start: 01/01/1995
F4	Finalized/Adjudication Complete - No payment forthcoming-The claim/encounter has been adjudicated and no further payment is forthcoming. Start: 01/01/1995
F5	Finalized/Cannot Process Start: 01/01/1995 \| Stop: 10/16/2003
Requests for additional information
R0	Requests for additional Information/General Requests-Requests that don't fall into other R-type categories. Start: 01/01/1995
R1	Requests for additional Information/Entity Requests-Requests for information about specific entities (subscribers, patients, various providers). Start: 01/01/1995
R3	Requests for additional Information/Claim/Line-Requests for information that could normally be submitted on a claim. Start: 01/01/1995 \| Last Modified: 02/28/1998
R4	Requests for additional Information/Documentation-Requests for additional supporting documentation. Examples: certification, x-ray, notes. Start: 01/01/1995 \| Last Modified: 02/28/1998
R5	Request for additional information/more specific detail-Additional information as a follow up to a previous request is needed. The original information was received but is inadequate. More specific/detailed information is requested. Start: 01/01/1995 \| Last Modified: 06/30/1998
R6	Requests for additional information – Regulatory requirements Start: 02/28/2007
R7	Requests for additional information – Confirm care is consistent with Health Plan policy coverage Start: 02/28/2007
R8	Requests for additional information – Confirm care is consistent with health plan coverage exceptions Start: 02/28/2007
R9	Requests for additional information – Determination of medical necessity Start: 02/28/2007
R10	Requests for additional information – Support a filed grievance or appeal Start: 02/28/2007
R11	Requests for additional information – Pre-payment review of claims Start: 02/28/2007
R12	Requests for additional information – Clarification or justification of use for specified procedure code Start: 02/28/2007
R13	Requests for additional information – Original documents submitted are not readable. Used only for subsequent request(s). Start: 02/28/2007
R14	Requests for additional information – Original documents received are not what was requested. Used only for subsequent request(s). Start: 02/28/2007
R15	Requests for additional information – Workers Compensation coverage determination. Start: 02/28/2007
R16	Requests for additional information – Eligibility determination Start: 02/28/2007
R17	Replacement of a Prior Request. Used to indicate that the current attachment request replaces a prior attachment request. Start: 01/20/2013
General
RQ	General Questions (Yes/No Responses)-Questions that may be answered by a simple 'yes' or 'no'. Start: 01/01/1995 \| Last Modified: 07/09/2007 \| Stop: 01/01/2008
Error
E0	Response not possible - error on submitted request data Start: 01/01/1995 \| Last Modified: 02/28/2002
E1	Response not possible - System Status Start: 02/29/2000
E2	Information Holder is not responding; resubmit at a later time. Start: 06/30/2003
E3	Correction required - relational fields in error. Start: 01/24/2010
E4	Trading partner agreement specific requirement not met: Data correction required. (Usage: A status code identifying the type of information requested must be sent) Start: 01/30/2011 \| Last Modified: 07/01/2017
Searches
D0	Data Search Unsuccessful - The payer is unable to return status on the requested claim(s) based on the submitted search criteria. Start: 01/01/1995 \| Last Modified: 09/20/2009

Code List Filters Block Reference

Filter by code:

Filter codes by status:

Maintenance Request Status

The list below shows the status of change requests which are in process.

Each request will be in one of the following statuses:

Received
The request has been submitted but is not yet under review.
Pending
Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
In Process
The CMG has initiated their decision process.
On Hold
The CMG has initiated their decision process but cannot complete it at this time.
CMG Approved
The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
CMG Disapproved
The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.

Status Last Reviewed: 7/1/2025

Num.	Date	Requested Description	Type	Code	Status
No current requests. This list has been stable since the last update. It will not be updated until there are new requests.

Maintenance Request Form

Claim Status Category Codes

Fields marked with an asterisk (*) are required

Name

Request Type

Current Code Value

*The description you are suggesting for a new code or to replace the description for a current code.

Read more about Claim Status Category Codes

Subscribe to

Feedback

X12 Members List

Membership Benefits

Membership Categories

Membership Application

Renew Membership

Glass

Licensing Program

External Code Lists

Technical Reports

All X12 Transaction Sets

By Industry

Intellectual Property Use

About X12

neX12

Officers

Liaisons

Industry Groups and Caucuses

Awards

Terms, Policies, and Licenses

News

X12 Blog

Meetings

Important Dates

Release Schedule

X12 Recommendations to NCVHS

Feedback

Policies and Procedures

Forms

Meeting Minutes

Requests for Interpretation

Info Center

X12 EDI Standard Examples

Transaction Flow

Membership & Licensing Help

Contact Us

Follow @x12standards

Note:

Code List Filters

Maintenance Request Status

Maintenance Request Status

Claim Status Category Codes