Non standard adjustment code from paper remittance. Reason Code 175: Patient has not met the required spend down requirements. (Use only with Group Code OA). Claim lacks indicator that 'x-ray is available for review.'. At least one Remark Code must be provided (may be comprised of either the Refund to patient if collected. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Service/procedure was provided outside of the United States. Reason Code 115: ESRD network support adjustment. This change effective 7/1/2013: Failure to follow prior payer's coverage rules. Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837), Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. Contracted funding agreement - Subscriber is employed by the provider of services. The related or qualifying claim/service was not identified on this claim. Identity verification required for processing this and future claims. Denial code CO16 is a Contractual Obligation claim adjustment reason code (CARC). Reason Code 259: Adjustment for delivery cost. To be used for Workers' Compensation only. Payment is adjusted when performed/billed by a provider of this specialty. The attachment/other documentation that was received was the incorrect attachment/document. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an Alert). Code. Prearranged demonstration project adjustment. (Use only with Group Codes PR or CO depending upon liability). Lifetime reserve days. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The procedure code/bill type is inconsistent with the place of service. Reason Code 56: Processed based on multiple or concurrent procedure rules. Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. Refund to patient if collected. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Note: Use code 187. This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). Submit these services to the patient's Behavioral Health Plan for further consideration. Service/procedure was provided as a result of terrorism. Per regulatory or other agreement. Claim received by the dental plan, but benefits not available under this plan. ), This change effective 7/1/2013: Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). Webco 256 denial code descriptions. Reason Code 31: Insured has no coverage for new borns. (Use with Group Code CO or OA). Reason Code 88: Dispensing fee adjustment. Reason Code 184: Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.). CO-96 Denial | Medical Billing and Coding Forum - AAPC (Handled in MIA15), Reason Code 77: Outlier days. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. Transportation is only covered to the closest facility that can provide the necessary care. Submit these services to the patient's Pharmacy plan for further consideration. Reason Code 166: Alternate benefit has been provided. Charges are covered under a capitation agreement/managed care plan.
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