Remittance Advice Remark Codes (RARC)
Remittance Advice Remark Codes add detail to a claim adjustment, such as which field was missing or which policy applied. They usually appear alongside a reason code on the ERA. Select a code for its meaning and what to do next.
M remark codes
- M1 X-ray not taken within the past 12 months or near enough to the start of treatment.
- M2 Not paid separately when the patient is an inpatient.
- M3 Equipment is the same or similar to equipment already being used.
- M4 Alert: This is the last monthly installment payment for this durable medical equipment.
- M5 Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
- M6 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.
- M7 No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.
- M8 We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
- M9 Alert: This is the tenth rental month.
- M10 Equipment purchases are limited to the first or the tenth month of medical necessity.
- M11 DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.
- M12 Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
- M13 Only one initial visit is covered per specialty per medical group.
- M14 No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.
- M15 Separately billed services/tests have been bundled as they are considered components of the same procedure.
- M16 Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
- 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…
- M18 Certain services may be approved for home use.
- M19 Missing oxygen certification/re-certification.
- M20 Missing/incomplete/invalid HCPCS.
- M21 Missing/incomplete/invalid place of residence for this service/item provided in a home.
- M22 Missing/incomplete/invalid number of miles traveled.
- M23 Missing invoice.
- M24 Missing/incomplete/invalid number of doses per vial.
- M25 The information furnished does not substantiate the need for this level of service.
- M26 The information furnished does not substantiate the need for this level of service.
- 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.
- M28 This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
- M29 Missing operative note/report.
- M30 Missing pathology report.
- M31 Missing radiology report.
- M32 Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer.
- M33 Deactivated 2004 Missing/incomplete/invalid UPIN for the ordering/referring/performing provider.
- M34 Deactivated 2004 Claim lacks the CLIA certification number.
- M35 Deactivated 2005 Missing/incomplete/invalid pre-operative photos or visual field results.
- M36 This is the 11th rental month.
- M37 Not covered when the patient is under age 35.
- 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…
- 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…
- M40 Claim must be assigned and must be filed by the practitioner's employer.
- M41 We do not pay for this as the patient has no legal obligation to pay for this.
- M42 The medical necessity form must be personally signed by the attending physician.
- M43 Deactivated 2004 Payment for this service previously issued to you or another provider by another carrier/intermediary.
- M44 Missing/incomplete/invalid condition code.
- M45 Missing/incomplete/invalid occurrence code(s).
- M46 Missing/incomplete/invalid occurrence span code(s).
- M47 Missing/incomplete/invalid Payer Claim Control Number.
- M48 Deactivated 2004 Payment for services furnished to hospital inpatients (other than professional services of physicians) can only be made to the hospital.
- M49 Missing/incomplete/invalid value code(s) or amount(s).
- M50 Missing/incomplete/invalid revenue code(s).
- M51 Missing/incomplete/invalid procedure code(s).
- M52 Missing/incomplete/invalid 'from' date(s) of service.
- M53 Missing/incomplete/invalid days or units of service.
- M54 Missing/incomplete/invalid total charges.
- M55 We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
- M56 Missing/incomplete/invalid payer identifier.
- M57 Deactivated 2005 Missing/incomplete/invalid provider identifier.
- M58 Deactivated 2005 Missing/incomplete/invalid claim information.
- M59 Missing/incomplete/invalid 'to' date(s) of service.
- M60 Missing Certificate of Medical Necessity.
- M61 We cannot pay for this as the approval period for the FDA clinical trial has expired.
- M62 Missing/incomplete/invalid treatment authorization code.
- M63 Deactivated 2004 We do not pay for more than one of these on the same day.
- M64 Missing/incomplete/invalid other diagnosis.
- M65 One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated.
- M66 Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component.
- M67 Missing/incomplete/invalid other procedure code(s).
- M68 Deactivated 2005 Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification.
- M69 Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
- M70 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…
- M71 Total payment reduced due to overlap of tests billed.
- M72 Deactivated 2003 Did not enter full 8-digit date (MM/DD/CCYY).
- M73 The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service.
- M74 This service does not qualify for a HPSA/Physician Scarcity bonus payment.
- M75 Multiple automated multichannel tests performed on the same day combined for payment.
- M76 Missing/incomplete/invalid diagnosis or condition.
- M77 Missing/incomplete/invalid/inappropriate place of service.
- M78 Deactivated 2006 Missing/incomplete/invalid HCPCS modifier.
- M79 Missing/incomplete/invalid charge.
- M80 Not covered when performed during the same session/date as a previously processed service for the patient.
- M81 You are required to code to the highest level of specificity.
- M82 Service is not covered when patient is under age 50.
- M83 Service is not covered unless the patient is classified as at high risk.
- M84 Medical code sets used must be the codes in effect at the time of service.
- M85 Subjected to review of physician evaluation and management services.
- M86 Service denied because payment already made for same/similar procedure within set time frame.
- M87 Claim/service(s) subjected to CFO-CAP prepayment review.
- M88 Deactivated 2004 We cannot pay for laboratory tests unless billed by the laboratory that did the work.
- M89 Not covered more than once under age 40.
- M90 Not covered more than once in a 12 month period.
- M91 Lab procedures with different CLIA certification numbers must be billed on separate claims.
- M92 Deactivated 2004 Services subjected to review under the Home Health Medical Review Initiative.
- M93 Information supplied supports a break in therapy.
- M94 Information supplied does not support a break in therapy.
- M95 Services subjected to Home Health Initiative medical review/cost report audit.
- M96 The technical component of a service furnished to an inpatient may only be billed by that inpatient facility.
- M97 Not paid to practitioner when provided to patient in this place of service.
- M98 Deactivated 2004 Begin to report the Universal Product Number on claims for items of this type.
- M99 Missing/incomplete/invalid Universal Product Number/Serial Number.
- M100 We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered…
- M101 Deactivated 2004 Begin to report a G1-G5 modifier with this HCPCS.
- M102 Service not performed on equipment approved by the FDA for this purpose.
- M103 Information supplied supports a break in therapy.
- M104 Information supplied supports a break in therapy.
- M105 Information supplied does not support a break in therapy.
- M106 Deactivated 2004 Information supplied does not support a break in therapy.
- M107 Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
- M108 Deactivated 2005 Missing/incomplete/invalid provider identifier for the provider who interpreted the diagnostic test.
- M109 We have provided you with a bundled payment for a teleconsultation.
- M110 Deactivated 2005 Missing/incomplete/invalid provider identifier for the provider from whom you purchased interpretation services.
- M111 We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
- M112 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.
- M113 Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
- M114 This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project.
- M115 This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
- M116 Processed under a demonstration project or program.
- M117 Not covered unless submitted via electronic claim.
- M118 Deactivated 2011 Letter to follow containing further information.
- M119 Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
- M120 Deactivated 2005 Missing/incomplete/invalid provider identifier for the substituting physician who furnished the service(s) under a reciprocal billing or locum tenens…
- M121 We pay for this service only when performed with a covered cryosurgical ablation.
- M122 Missing/incomplete/invalid level of subluxation.
- M123 Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
- M124 Missing indication of whether the patient owns the equipment that requires the part or supply.
- M125 Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
- M126 Missing/incomplete/invalid individual lab codes included in the test.
- M127 Missing patient medical record for this service.
- M128 Deactivated 2005 Missing/incomplete/invalid date of the patient's last physician visit.
- M129 Missing/incomplete/invalid indicator of x-ray availability for review.
- M130 Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
- M131 Missing physician financial relationship form.
- M132 Missing pacemaker registration form.
- M133 Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
- M134 Performed by a facility/supplier in which the provider has a financial interest.
- M135 Missing/incomplete/invalid plan of treatment.
- M136 Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
- M137 Part B coinsurance under a demonstration project or pilot program.
- M138 Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered.
- M139 Denied services exceed the coverage limit for the demonstration.
- M140 Deactivated 2004 Service not covered until after the patient's 50th birthday, i.e., no coverage prior to the day after the 50th birthday
- M141 Missing physician certified plan of care.
- M142 Missing American Diabetes Association Certificate of Recognition.
- M143 The provider must update license information with the payer.
- M144 Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
MA remark codes
- MA01 Alert: If you do not agree with what we approved for these services, you may appeal our decision.
- MA02 Alert: If you do not agree with this determination, you have the right to appeal.
- MA03 Deactivated 2006 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…
- MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer.
- MA05 Deactivated 2003 Incorrect admission date patient status or type of bill entry on claim.
- MA06 Deactivated 2004 Missing/incomplete/invalid beginning and/or ending date(s).
- MA07 Alert: The claim information has also been forwarded to Medicaid for review.
- MA08 Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
- MA09 Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.
- MA10 Alert: The patient's payment was in excess of the amount owed.
- MA11 Deactivated 2004 Payment is being issued on a conditional basis.
- MA12 You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).
- MA13 Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
- MA14 Alert: The patient is a member of an employer-sponsored prepaid health plan.
- MA15 Alert: Your claim has been separated to expedite handling.
- MA16 The patient is covered by the Black Lung Program.
- MA17 We are the primary payer and have paid at the primary rate.
- MA18 Alert: The claim information is also being forwarded to the patient's supplemental insurer.
- MA19 Alert: Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer.
- MA20 Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of…
- MA21 SSA records indicate mismatch with name and sex.
- MA22 Payment of less than $1.00 suppressed.
- MA23 Demand bill approved as result of medical review.
- MA24 Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
- MA25 A patient may not elect to change a hospice provider more than once in a benefit period.
- MA26 Alert: Our records indicate that you were previously informed of this rule.
- MA27 Missing/incomplete/invalid entitlement number or name shown on the claim.
- 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…
- MA29 Deactivated 2005 Missing/incomplete/invalid provider name, city, state, or zip code.
- MA30 Missing/incomplete/invalid type of bill.
- MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
- MA32 Missing/incomplete/invalid number of covered days during the billing period.
- MA33 Missing/incomplete/invalid non-covered days during the billing period.
- MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
- MA35 Missing/incomplete/invalid number of lifetime reserve days.
- MA36 Missing/incomplete/invalid patient name.
- MA37 Missing/incomplete/invalid patient's address.
- MA38 Deactivated 2005 Missing/incomplete/invalid birth date.
- MA39 Missing/incomplete/invalid gender.
- MA40 Missing/incomplete/invalid admission date.
- MA41 Missing/incomplete/invalid admission type.
- MA42 Missing/incomplete/invalid admission source.
- MA43 Missing/incomplete/invalid patient status.
- MA44 Alert: No appeal rights.
- MA45 Alert: As previously advised, a portion or all of your payment is being held in a special account.
- MA46 Alert: The new information was considered but additional payment will not be issued.
- MA47 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished.
- MA48 Missing/incomplete/invalid name or address of responsible party or primary payer.
- MA49 Deactivated 2004 Missing/incomplete/invalid six-digit provider identifier for home health agency or hospice for physician(s) performing care plan oversight services.
- MA50 Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.
- MA51 Deactivated 2005 Missing/incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory.
- MA52 Deactivated 2005 Missing/incomplete/invalid date.
- MA53 Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
- MA54 Physician certification or election consent for hospice care not received timely.
- MA55 Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
- MA56 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished.
- MA57 Patient submitted written request to revoke his/her election for religious non-medical health care services.
- MA58 Missing/incomplete/invalid release of information indicator.
- MA59 Alert: The patient overpaid you for these services.
- MA60 Missing/incomplete/invalid patient relationship to insured.
- MA61 Missing/incomplete/invalid social security number.
- MA62 Alert: This is a telephone review decision.
- MA63 Missing/incomplete/invalid principal diagnosis.
- MA64 Our records indicate that we should be the third payer for this claim.
- MA65 Missing/incomplete/invalid admitting diagnosis.
- MA66 Missing/incomplete/invalid principal procedure code.
- MA67 Alert: Correction to a prior claim.
- MA68 Alert: We did not crossover this claim because the secondary insurance information on the claim was incomplete.
- MA69 Missing/incomplete/invalid remarks.
- MA70 Missing/incomplete/invalid provider representative signature.
- MA71 Missing/incomplete/invalid provider representative signature date.
- MA72 Alert: The patient overpaid you for these assigned services.
- MA73 Informational remittance associated with a Medicare demonstration.
- MA74 Alert: This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
- MA75 Missing/incomplete/invalid patient or authorized representative signature.
- MA76 Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
- MA77 Alert: The patient overpaid you.
- MA78 Deactivated 2004 The patient overpaid you.
- MA79 Billed in excess of interim rate.
- MA80 Informational notice.
- MA81 Missing/incomplete/invalid provider/supplier signature.
- MA82 Deactivated 2005 Missing/incomplete/invalid provider/supplier billing number/identifier or billing name, address, city, state, zip code, or phone number.
- MA83 Did not indicate whether we are the primary or secondary payer.
- 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…
- MA85 Deactivated 2004 Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance plan/group/program…
- MA86 Deactivated 2004 Missing/incomplete/invalid group or policy number of the insured for the primary coverage.
- MA87 Deactivated 2004 Missing/incomplete/invalid insured's name for the primary payer.
- MA88 Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.
- MA89 Missing/incomplete/invalid patient's relationship to the insured for the primary payer.
- MA90 Missing/incomplete/invalid employment status code for the primary insured.
- MA91 Alert: This determination is the result of the appeal you filed.
- MA92 Missing plan information for other insurance.
- MA93 Non-PIP (Periodic Interim Payment) claim.
- MA94 Did not enter the statement 'Attending physician not hospice employee' on the claim form to certify that the rendering physician is not an employee of the…
- MA95 Deactivated 2004 A not otherwise classified or unlisted procedure code(s) was billed but a narrative description of the procedure was not entered on the claim.
- MA96 Claim rejected.
- MA97 Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
- MA98 Deactivated 2003 Claim Rejected.
- MA99 Missing/incomplete/invalid Medigap information.
- MA100 Missing/incomplete/invalid date of current illness or symptoms.
- MA101 Deactivated 2011 A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents.
- MA102 Deactivated 2004 Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider.
- MA103 Hemophilia Add On.
- MA104 Deactivated 2004 Missing/incomplete/invalid date the patient was last seen or the provider identifier of the attending physician.
- MA105 Deactivated 2005 Missing/incomplete/invalid provider number for this place of service.
- MA106 PIP (Periodic Interim Payment) claim.
- MA107 Paper claim contains more than three separate data items in field 19.
- MA108 Paper claim contains more than one data item in field 23.
- MA109 Claim processed in accordance with ambulatory surgical guidelines.
- MA110 Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.
- MA111 Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.
- MA112 Missing/incomplete/invalid group practice information.
- MA113 Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service.
- MA114 Missing/incomplete/invalid information on where the services were furnished.
- MA115 Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
- MA116 Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.
- MA117 This claim has been assessed a $1.00 user fee.
- MA118 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…
- MA119 Deactivated 2008 Provider level adjustment for late claim filing applies to this claim.
- MA120 Missing/incomplete/invalid CLIA certification number.
- MA121 Missing/incomplete/invalid x-ray date.
- MA122 Missing/incomplete/invalid initial treatment date.
- MA123 Your center was not selected to participate in this study, therefore, we cannot pay for these services.
- MA124 Deactivated 2004 Processed for IME only.
- MA125 Per legislation governing this program, payment constitutes payment in full.
- MA126 Pancreas transplant not covered unless kidney transplant performed.
- MA127 Deactivated 2005 Reserved for future use.
- MA128 Missing/incomplete/invalid FDA approval number.
- MA129 Deactivated 2004 This provider was not certified for this procedure on this date of service.
- MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable.
- MA131 Physician already paid for services in conjunction with this demonstration claim.
- MA132 Adjustment to the pre-demonstration rate.
- MA133 Claim overlaps inpatient stay.
- MA134 Missing/incomplete/invalid provider number of the facility where the patient resides.
N remark codes
- 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…
- N2 This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
- N3 Missing consent form.
- N4 Missing/Incomplete/Invalid prior Insurance Carrier(s)
- N5 EOB received from previous payer.
- 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…
- N7 Alert: Processing of this claim/service has included consideration under Major Medical provisions.
- N8 Crossover claim denied by previous payer and complete claim data not forwarded.
- N9 Adjustment represents the estimated amount a previous payer may pay.
- N10 Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.
- N11 Denial reversed because of medical review.
- N12 Policy provides coverage supplemental to Medicare.
- N13 Payment based on professional/technical component modifier(s).
- N14 Deactivated 2007 Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount.
- N15 Services for a newborn must be billed separately.
- N16 Family/member Out-of-Pocket maximum has been met.
- N17 Deactivated 2004 Per admission deductible.
- N18 Deactivated 2004 Payment based on the Medicare allowed amount.
- N19 Procedure code incidental to primary procedure.
- N20 Service not payable with other service rendered on the same date.
- N21 Alert: Your line item has been separated into multiple lines to expedite handling.
- N22 Alert: This procedure code was added/changed because it more accurately describes the services rendered.
- N23 Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
- N24 Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
- N25 This company has been contracted by your benefit plan to provide administrative claims payment services only.
- N26 Missing itemized bill/statement.
- N27 Missing/incomplete/invalid treatment number.
- N28 Consent form requirements not fulfilled.
- N29 Deactivated 2016 Missing documentation/orders/notes/summary/report/chart.
- N30 Patient ineligible for this service.
- N31 Missing/incomplete/invalid prescribing provider identifier.
- N32 Claim must be submitted by the provider who rendered the service.
- N33 No record of health check prior to initiation of treatment.
- N34 Incorrect claim form/format for this service.
- N35 Program integrity/utilization review decision.
- N36 Claim must meet primary payer's processing requirements before we can consider payment.
- N37 Missing/incomplete/invalid tooth number/letter.
- N38 Deactivated 2005 Missing/incomplete/invalid place of service.
- N39 Procedure code is not compatible with tooth number/letter.
- N40 Missing radiology film(s)/image(s).
- N41 Deactivated 2003 Authorization request denied.
- N42 Missing mental health assessment.
- N43 Bed hold or leave days exceeded.
- N44 Deactivated 2003 Payer's share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority.
- N45 Payment based on authorized amount.
- N46 Missing/incomplete/invalid admission hour.
- N47 Claim conflicts with another inpatient stay.
- N48 Claim information does not agree with information received from other insurance carrier.
- N49 Court ordered coverage information needs validation.
- N50 Missing/incomplete/invalid discharge information.
- N51 Electronic interchange agreement not on file for provider/submitter.
- N52 Patient not enrolled in the billing provider's managed care plan on the date of service.
- N53 Missing/incomplete/invalid point of pick-up address.
- N54 Claim information is inconsistent with pre-certified/authorized services.
- N55 Procedures for billing with group/referring/performing providers were not followed.
- N56 Procedure code billed is not correct/valid for the services billed or the date of service billed.
- N57 Missing/incomplete/invalid prescribing date.
- N58 Missing/incomplete/invalid patient liability amount.
- N59 Alert: Please refer to your provider manual for additional program and provider information.
- N60 Deactivated 2004 A valid NDC is required for payment of drug claims effective October 02.
- N61 Rebill services on separate claims.
- N62 Dates of service span multiple rate periods.
- N63 Rebill services on separate claim lines.
- N64 The 'from' and 'to' dates must be different.
- N65 Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
- N66 Deactivated 2005 Missing/incomplete/invalid documentation.
- N67 Professional provider services not paid separately.
- N68 Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service.
- N69 Alert: PPS (Prospective Payment System) code changed by claims processing system.
- N70 Consolidated billing and payment applies.
- N71 Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim.
- N72 PPS (Prospective Payment System) code changed by medical reviewers.
- N73 Deactivated 2004 A Skilled Nursing Facility is responsible for payment of outside providers who furnish these services/supplies under arrangement to its residents.
- N74 Resubmit with multiple claims, each claim covering services provided in only one calendar month.
- N75 Missing/incomplete/invalid tooth surface information.
- N76 Missing/incomplete/invalid number of riders.
- N77 Missing/incomplete/invalid designated provider number.
- N78 The necessary components of the child and teen checkup (EPSDT) were not completed.
- N79 Service billed is not compatible with patient location information.
- N80 Missing/incomplete/invalid prenatal screening information.
- N81 Procedure billed is not compatible with tooth surface code.
- N82 Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
- N83 No appeal rights.
- N84 Alert: Further installment payments are forthcoming.
- N85 Alert: This is the final installment payment.
- N86 A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
- N87 Home use of biofeedback therapy is not covered.
- N88 Alert: This payment is being made conditionally.
- 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…
- N90 Covered only when performed by the attending physician.
- N91 Services not included in the appeal review.
- N92 This facility is not certified for digital mammography.
- N93 A separate claim must be submitted for each place of service.
- N94 Claim/Service denied because a more specific taxonomy code is required for adjudication.
- N95 This provider type/provider specialty may not bill this service.
- N96 Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical…
- N97 Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are…
- N98 Patient must have had a successful test stimulation in order to support subsequent implantation.
- N99 Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.
- N100 Deactivated 2016 PPS (Prospect Payment System) code corrected during adjudication.
- N101 Deactivated 2004 Additional information is needed in order to process this claim.
- N102 Deactivated 2016 This claim has been denied without reviewing the medical/dental record because the requested records were not received or were not received timely.
- N103 Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered.
- N104 This claim/service is not payable under our claims jurisdiction area.
- N105 This is a misdirected claim/service for an RRB beneficiary.
- N106 Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF.
- N107 Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim.
- N108 Missing/incomplete/invalid upgrade information.
- N109 Alert: This claim/service was chosen for complex review.
- N110 This facility is not certified for film mammography.
- N111 No appeal right except duplicate claim/service issue.
- N112 This claim is excluded from your electronic remittance advice.
- N113 Only one initial visit is covered per physician, group practice or provider.
- 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…
- N115 This decision was based on a Local Coverage Determination (LCD).
- 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…
- N117 This service is paid only once in a patient's lifetime.
- N118 This service is not paid if billed more than once every 28 days.
- N119 This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility…
- N120 Payment is subject to home health prospective payment system partial episode payment adjustment.
- 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…
- N122 Add-on code cannot be billed by itself.
- N123 Alert: This is a split service and represents a portion of the units from the originally submitted service.
- 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…
- 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…
- N126 Social Security Records indicate that this individual has been deported.
- N127 This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary.
- N128 This amount represents the prior to coverage portion of the allowance.
- N129 Not eligible due to the patient's age.
- N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
- N131 Total payments under multiple contracts cannot exceed the allowance for this service.
- 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.
- N133 Alert: Services for predetermination and services requesting payment are being processed separately.
- N134 Alert: This represents your scheduled payment for this service.
- N135 Record fees are the patient's responsibility and limited to the specified co-payment.
- 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.
- N137 Alert: The provider acting on the Member's behalf, may file an appeal with the Payer.
- 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…
- N139 Alert: Under 32 CFR 199.13, a non-participating provider is not an appropriate appealing party.
- N140 Alert: You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party.
- N141 The patient was not residing in a long-term care facility during all or part of the service dates billed.
- N142 The original claim was denied.
- N143 The patient was not in a hospice program during all or part of the service dates billed.
- N144 The rate changed during the dates of service billed.
- N145 Deactivated 2005 Missing/incomplete/invalid provider identifier for this place of service.
- N146 Missing screening document.
- N147 Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request.
- N148 Missing/incomplete/invalid date of last menstrual period.
- N149 Rebill all applicable services on a single claim.
- N150 Missing/incomplete/invalid model number.
- N151 Telephone contact services will not be paid until the face-to-face contact requirement has been met.
- N152 Missing/incomplete/invalid replacement claim information.
- N153 Missing/incomplete/invalid room and board rate.
- N154 Alert: This payment was delayed for correction of provider's mailing address.
- N155 Alert: Our records do not indicate that other insurance is on file.
- N156 Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.
- N157 Transportation to/from this destination is not covered.
- N158 Transportation in a vehicle other than an ambulance is not covered.
- N159 Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
- N160 The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
- N161 This drug/service/supply is covered only when the associated service is covered.
- N162 Alert: Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification.
- N163 Medical record does not support code billed per the code definition.
- N164 Deactivated 2004 Transportation to/from this destination is not covered.
- N165 Deactivated 2004 Transportation in a vehicle other than an ambulance is not covered.
- N166 Deactivated 2004 Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
- N167 Charges exceed the post-transplant coverage limit.
- N168 Deactivated 2004 The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
- N169 Deactivated 2004 This drug/service/supply is covered only when the associated service is covered.
- N170 A new/revised/renewed certificate of medical necessity is needed.
- N171 Payment for repair or replacement is not covered or has exceeded the purchase price.
- N172 The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
- N173 No qualifying hospital stay dates were provided for this episode of care.
- N174 This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.
- N175 Missing review organization approval.
- N176 Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters.
- N177 Alert: We did not send this claim to patient's other insurer.
- N178 Missing pre-operative images/visual field results.
- N179 Additional information has been requested from the member.
- N180 This item or service does not meet the criteria for the category under which it was billed.
- N181 Additional information is required from another provider involved in this service.
- N182 This claim/service must be billed according to the schedule for this plan.
- N183 Alert: This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be…
- N184 Rebill technical and professional components separately.
- N185 Alert: Do not resubmit this claim/service.
- N186 Non-Availability Statement (NAS) required for this service.
- 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…
- N188 The approved level of care does not match the procedure code submitted.
- N189 Alert: This service has been paid as a one-time exception to the plan's benefit restrictions.
- N190 Missing contract indicator.
- N191 The provider must update insurance information directly with payer.
- N192 Alert: Patient is a Medicaid/Qualified Medicare Beneficiary.
- N193 Alert: Specific federal/state/local program may cover this service through another payer.
- N194 Technical component not paid if provider does not own the equipment used.
- N195 The technical component must be billed separately.
- N196 Alert: Patient eligible to apply for other coverage which may be primary.
- N197 The subscriber must update insurance information directly with payer.
- N198 Rendering provider must be affiliated with the pay-to provider.
- N199 Additional payment/recoupment approved based on payer-initiated review/audit.
- N200 The professional component must be billed separately.
- N201 Deactivated 2011 A mental health facility is responsible for payment of outside providers who furnish these services/supplies to residents.
- N202 Alert: Additional information/explanation will be sent separately.
- N203 Missing/incomplete/invalid anesthesia time/units.
- N204 Services under review for possible pre-existing condition.
- N205 Information provided was illegible.
- N206 The supporting documentation does not match the information sent on the claim.
- N207 Missing/incomplete/invalid weight.
- N208 Missing/incomplete/invalid DRG code.
- N209 Missing/incomplete/invalid taxpayer identification number (TIN).
- N210 Alert: You may appeal this decision.
- N211 Alert: You may not appeal this decision.
- N212 Charges processed under a Point of Service benefit.
- N213 Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.
- N214 Missing/incomplete/invalid history of the related initial surgical procedure(s).
- 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…
- N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.
- N217 We pay only one site of service per provider per claim.
- N218 You must furnish and service this item for as long as the patient continues to need it.
- N219 Payment based on previous payer's allowed amount.
- 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.
- N221 Missing Admitting History and Physical report.
- N222 Incomplete/invalid Admitting History and Physical report.
- N223 Missing documentation of benefit to the patient during initial treatment period.
- N224 Incomplete/invalid documentation of benefit to the patient during initial treatment period.
- N225 Deactivated 2016 Incomplete/invalid documentation/orders/notes/summary/report/chart.
- N226 Incomplete/invalid American Diabetes Association Certificate of Recognition.
- N227 Incomplete/invalid Certificate of Medical Necessity.
- N228 Incomplete/invalid consent form.
- N229 Incomplete/invalid contract indicator.
- N230 Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.
- N231 Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
- N232 Incomplete/invalid itemized bill/statement.
- N233 Incomplete/invalid operative note/report.
- N234 Incomplete/invalid oxygen certification/re-certification.
- N235 Incomplete/invalid pacemaker registration form.
- N236 Incomplete/invalid pathology report.
- N237 Incomplete/invalid patient medical record for this service.
- N238 Incomplete/invalid physician certified plan of care.
- N239 Incomplete/invalid physician financial relationship form.
- N240 Incomplete/invalid radiology report.
- N241 Incomplete/invalid review organization approval.
- N242 Incomplete/invalid radiology film(s)/image(s).
- N243 Incomplete/invalid/not approved screening document.
- N244 Incomplete/Invalid pre-operative images/visual field results.
- N245 Incomplete/invalid plan information for other insurance.
- N246 State regulated patient payment limitations apply to this service.
- N247 Missing/incomplete/invalid assistant surgeon taxonomy.
- N248 Missing/incomplete/invalid assistant surgeon name.
- N249 Missing/incomplete/invalid assistant surgeon primary identifier.
- N250 Missing/incomplete/invalid assistant surgeon secondary identifier.
- N251 Missing/incomplete/invalid attending provider taxonomy.
- N252 Missing/incomplete/invalid attending provider name.
- N253 Missing/incomplete/invalid attending provider primary identifier.
- N254 Missing/incomplete/invalid attending provider secondary identifier.
- N255 Missing/incomplete/invalid billing provider taxonomy.
- N256 Missing/incomplete/invalid billing provider/supplier name.
- N257 Missing/incomplete/invalid billing provider/supplier primary identifier.
- N258 Missing/incomplete/invalid billing provider/supplier address.
- N259 Missing/incomplete/invalid billing provider/supplier secondary identifier.
- N260 Missing/incomplete/invalid billing provider/supplier contact information.
- N261 Missing/incomplete/invalid operating provider name.
- N262 Missing/incomplete/invalid operating provider primary identifier.
- N263 Missing/incomplete/invalid operating provider secondary identifier.
- N264 Missing/incomplete/invalid ordering provider name.
- N265 Missing/incomplete/invalid ordering provider primary identifier.
- N266 Missing/incomplete/invalid ordering provider address.
- N267 Missing/incomplete/invalid ordering provider secondary identifier.
- N268 Missing/incomplete/invalid ordering provider contact information.
- N269 Missing/incomplete/invalid other provider name.
- N270 Missing/incomplete/invalid other provider primary identifier.
- N271 Missing/incomplete/invalid other provider secondary identifier.
- N272 Missing/incomplete/invalid other payer attending provider identifier.
- N273 Missing/incomplete/invalid other payer operating provider identifier.
- N274 Missing/incomplete/invalid other payer other provider identifier.
- N275 Missing/incomplete/invalid other payer purchased service provider identifier.
- N276 Missing/incomplete/invalid other payer referring provider identifier.
- N277 Missing/incomplete/invalid other payer rendering provider identifier.
- N278 Missing/incomplete/invalid other payer service facility provider identifier.
- N279 Missing/incomplete/invalid pay-to provider name.
- N280 Missing/incomplete/invalid pay-to provider primary identifier.
- N281 Missing/incomplete/invalid pay-to provider address.
- N282 Missing/incomplete/invalid pay-to provider secondary identifier.
- N283 Missing/incomplete/invalid purchased service provider identifier.
- N284 Missing/incomplete/invalid referring provider taxonomy.
- N285 Missing/incomplete/invalid referring provider name.
- N286 Missing/incomplete/invalid referring provider primary identifier.
- N287 Missing/incomplete/invalid referring provider secondary identifier.
- N288 Missing/incomplete/invalid rendering provider taxonomy.
- N289 Missing/incomplete/invalid rendering provider name.
- N290 Missing/incomplete/invalid rendering provider primary identifier.
- N291 Missing/incomplete/invalid rendering provider secondary identifier.
- N292 Missing/incomplete/invalid service facility name.
- N293 Missing/incomplete/invalid service facility primary identifier.
- N294 Missing/incomplete/invalid service facility primary address.
- N295 Missing/incomplete/invalid service facility secondary identifier.
- N296 Missing/incomplete/invalid supervising provider name.
- N297 Missing/incomplete/invalid supervising provider primary identifier.
- N298 Missing/incomplete/invalid supervising provider secondary identifier.
- N299 Missing/incomplete/invalid occurrence date(s).
- N300 Missing/incomplete/invalid occurrence span date(s).
- N301 Missing/incomplete/invalid procedure date(s).
- N302 Missing/incomplete/invalid other procedure date(s).
- N303 Missing/incomplete/invalid principal procedure date.
- N304 Missing/incomplete/invalid dispensed date.
- N305 Missing/incomplete/invalid injury/accident date.
- N306 Missing/incomplete/invalid acute manifestation date.
- N307 Missing/incomplete/invalid adjudication or payment date.
- N308 Missing/incomplete/invalid appliance placement date.
- N309 Missing/incomplete/invalid assessment date.
- N310 Missing/incomplete/invalid assumed or relinquished care date.
- N311 Missing/incomplete/invalid authorized to return to work date.
- N312 Missing/incomplete/invalid begin therapy date.
- N313 Missing/incomplete/invalid certification revision date.
- N314 Missing/incomplete/invalid diagnosis date.
- N315 Missing/incomplete/invalid disability from date.
- N316 Missing/incomplete/invalid disability to date.
- N317 Missing/incomplete/invalid discharge hour.
- N318 Missing/incomplete/invalid discharge or end of care date.
- N319 Missing/incomplete/invalid hearing or vision prescription date.
- N320 Missing/incomplete/invalid Home Health Certification Period.
- N321 Missing/incomplete/invalid last admission period.
- N322 Missing/incomplete/invalid last certification date.
- N323 Missing/incomplete/invalid last contact date.
- N324 Missing/incomplete/invalid last seen/visit date.
- N325 Missing/incomplete/invalid last worked date.
- N326 Missing/incomplete/invalid last x-ray date.
- N327 Missing/incomplete/invalid other insured birth date.
- N328 Missing/incomplete/invalid Oxygen Saturation Test date.
- N329 Missing/incomplete/invalid patient birth date.
- N330 Missing/incomplete/invalid patient death date.
- N331 Missing/incomplete/invalid physician order date.
- N332 Missing/incomplete/invalid prior hospital discharge date.
- N333 Missing/incomplete/invalid prior placement date.
- N334 Missing/incomplete/invalid re-evaluation date.
- N335 Missing/incomplete/invalid referral date.
- N336 Missing/incomplete/invalid replacement date.
- N337 Missing/incomplete/invalid secondary diagnosis date.
- N338 Missing/incomplete/invalid shipped date.
- N339 Missing/incomplete/invalid similar illness or symptom date.
- N340 Missing/incomplete/invalid subscriber birth date.
- N341 Missing/incomplete/invalid surgery date.
- N342 Missing/incomplete/invalid test performed date.
- N343 Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.
- N344 Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.
- N345 Date range not valid with units submitted.
- N346 Missing/incomplete/invalid oral cavity designation code.
- 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…
- N348 You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.
- N349 The administration method and drug must be reported to adjudicate this service.
- N350 Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
- N351 Service date outside of the approved treatment plan service dates.
- N352 Alert: There are no scheduled payments for this service.
- N353 Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.
- N354 Incomplete/invalid invoice.
- 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…
- N356 Not covered when performed with, or subsequent to, a non-covered service.
- N357 Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
- N358 Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
- N359 Missing/incomplete/invalid height.
- N360 Alert: Coordination of benefits has not been calculated when estimating benefits for this pre-determination.
- N361 Deactivated 2007 Payment adjusted based on multiple diagnostic imaging procedure rules
- N362 The number of Days or Units of Service exceeds our acceptable maximum.
- N363 Alert: in the near future we are implementing new policies/procedures that would affect this determination.
- N364 Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.
- N365 Deactivated 2014 This procedure code is not payable.
- N366 Requested information not provided.
- N367 Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings…
- N368 You must appeal the determination of the previously adjudicated claim.
- N369 Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.
- N370 Billing exceeds the rental months covered/approved by the payer.
- N371 Alert: title of this equipment must be transferred to the patient.
- N372 Only reasonable and necessary maintenance/service charges are covered.
- N373 It has been determined that another payer paid the services as primary when they were not the primary payer.
- N374 Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.
- N375 Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.
- N376 Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.
- N377 Payment based on a processed replacement claim.
- N378 Missing/incomplete/invalid prescription quantity.
- N379 Claim level information does not match line level information.
- N380 The original claim has been processed, submit a corrected claim.
- N381 Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.
- N382 Missing/incomplete/invalid patient identifier.
- N383 Not covered when deemed cosmetic.
- N384 Records indicate that the referenced body part/tooth has been removed in a previous procedure.
- N385 Notification of admission was not timely according to published plan procedures.
- N386 This decision was based on a National Coverage Determination (NCD).
- N387 Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits.
- N388 Missing/incomplete/invalid prescription number.
- N389 Duplicate prescription number submitted.
- N390 This service/report cannot be billed separately.
- N391 Missing emergency department records.
- N392 Incomplete/invalid emergency department records.
- N393 Missing progress notes/report.
- N394 Incomplete/invalid progress notes/report.
- N395 Missing laboratory report.
- N396 Incomplete/invalid laboratory report.
- N397 Benefits are not available for incomplete service(s)/undelivered item(s).
- N398 Missing elective consent form.
- N399 Incomplete/invalid elective consent form.
- N400 Alert: Electronically enabled providers should submit claims electronically.
- N401 Missing periodontal charting.
- N402 Incomplete/invalid periodontal charting.
- N403 Missing facility certification.
- N404 Incomplete/invalid facility certification.
- N405 This service is only covered when the donor's insurer(s) do not provide coverage for the service.
- N406 This service is only covered when the recipient's insurer(s) do not provide coverage for the service.
- N407 You are not an approved submitter for this transmission format.
- N408 This payer does not cover deductibles assessed by a previous payer.
- 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.
- N410 Not covered unless the prescription changes.
- N411 This service is allowed one time in a 6-month period.
- N412 This service is allowed 2 times in a 12-month period.
- N413 This service is allowed 2 times in a benefit year.
- N414 This service is allowed 4 times in a 12-month period.
- N415 This service is allowed 1 time in an 18-month period.
- N416 This service is allowed 1 time in a 3-year period.
- N417 This service is allowed 1 time in a 5-year period.
- N418 Misrouted claim.
- N419 Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change.
- N420 Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.
- N421 Claim payment was the result of a payer's retroactive adjustment due to a review organization decision.
- N422 Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program.
- N423 Claim payment was the result of a payer's retroactive adjustment due to a non standard program.
- N424 Patient does not reside in the geographic area required for this type of payment.
- N425 Statutorily excluded service(s).
- N426 No coverage when self-administered.
- N427 Payment for eyeglasses or contact lenses can be made only after cataract surgery.
- N428 Not covered when performed in this place of service.
- N429 Not covered when considered routine.
- N430 Procedure code is inconsistent with the units billed.
- N431 Not covered with this procedure.
- N432 Alert: Adjustment based on a Recovery Audit.
- N433 Resubmit this claim using only your National Provider Identifier (NPI).
- N434 Missing/Incomplete/Invalid Present on Admission indicator.
- N435 Exceeds number/frequency approved /allowed within time period without support documentation.
- N436 The injury claim has not been accepted and a mandatory medical reimbursement has been made.
- N437 Alert: If the injury claim is accepted, these charges will be reconsidered.
- N438 This jurisdiction only accepts paper claims.
- N439 Missing anesthesia physical status report/indicators.
- N440 Incomplete/invalid anesthesia physical status report/indicators.
- N441 This missed/cancelled appointment is not covered.
- N442 Payment based on an alternate fee schedule.
- N443 Missing/incomplete/invalid total time or begin/end time.
- N444 Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation.
- N445 Missing document for actual cost or paid amount.
- N446 Incomplete/invalid document for actual cost or paid amount.
- N447 Payment is based on a generic equivalent as required documentation was not provided.
- N448 This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.
- N449 Payment based on a comparable drug/service/supply.
- N450 Covered only when performed by the primary treating physician or the designee.
- N451 Missing Admission Summary Report.
- N452 Incomplete/invalid Admission Summary Report.
- N453 Missing Consultation Report.
- N454 Incomplete/invalid Consultation Report.
- N455 Missing Physician Order.
- N456 Incomplete/invalid Physician Order.
- N457 Missing Diagnostic Report.
- N458 Incomplete/invalid Diagnostic Report.
- N459 Missing Discharge Summary.
- N460 Incomplete/invalid Discharge Summary.
- N461 Missing Nursing Notes.
- N462 Incomplete/invalid Nursing Notes.
- N463 Missing support data for claim.
- N464 Incomplete/invalid support data for claim.
- N465 Missing Physical Therapy Notes/Report.
- N466 Incomplete/invalid Physical Therapy Notes/Report.
- N467 Missing Tests and Analysis Report.
- N468 Incomplete/invalid Report of Tests and Analysis Report.
- N469 Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
- N470 This payment will complete the mandatory medical reimbursement limit.
- N471 Missing/incomplete/invalid HIPPS Rate Code.
- N472 Payment for this service has been issued to another provider.
- N473 Missing certification.
- N474 Incomplete/invalid certification.
- N475 Missing completed referral form.
- N476 Incomplete/invalid completed referral form.
- N477 Missing Dental Models.
- N478 Incomplete/invalid Dental Models.
- N479 Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
- N480 Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
- N481 Missing Models.
- N482 Incomplete/invalid Models.
- N483 Deactivated 2015 Missing Periodontal Charts.
- N484 Deactivated 2015 Incomplete/invalid Periodontal Charts.
- N485 Missing Physical Therapy Certification.
- N486 Incomplete/invalid Physical Therapy Certification.
- N487 Missing Prosthetics or Orthotics Certification.
- N488 Incomplete/invalid Prosthetics or Orthotics Certification.
- N489 Missing referral form.
- N490 Incomplete/invalid referral form.
- N491 Missing/Incomplete/Invalid Exclusionary Rider Condition.
- 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…
- N493 Missing Doctor First Report of Injury.
- N494 Incomplete/invalid Doctor First Report of Injury.
- N495 Missing Supplemental Medical Report.
- N496 Incomplete/invalid Supplemental Medical Report.
- N497 Missing Medical Permanent Impairment or Disability Report.
- N498 Incomplete/invalid Medical Permanent Impairment or Disability Report.
- N499 Missing Medical Legal Report.
- N500 Incomplete/invalid Medical Legal Report.
- N501 Missing Vocational Report.
- N502 Incomplete/invalid Vocational Report.
- N503 Missing Work Status Report.
- N504 Incomplete/invalid Work Status Report.
- N505 Alert: This response includes only services that could be estimated in real-time.
- N506 Alert: This is an estimate of the member's liability based on the information available at the time the estimate was processed.
- N507 Plan distance requirements have not been met.
- N508 Alert: This real-time claim adjudication response represents the member responsibility to the provider for services reported.
- N509 Alert: A current inquiry shows the member's Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service.
- 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.
- 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.
- N512 Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.
- N513 Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.
- N514 Deactivated 2011 Consult plan benefit documents/guidelines for information about restrictions for this service.
- N515 Deactivated 2009 Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits.
- N516 Records indicate a mismatch between the submitted NPI and EIN.
- N517 Resubmit a new claim with the requested information.
- N518 No separate payment for accessories when furnished for use with oxygen equipment.
- N519 Invalid combination of HCPCS modifiers.
- N520 Alert: Payment made from a Consumer Spending Account.
- N521 Mismatch between the submitted provider information and the provider information stored in our system.
- N522 Duplicate of a claim processed, or to be processed, as a crossover claim.
- N523 The limitation on outlier payments defined by this payer for this service period has been met.
- N524 Based on policy this payment constitutes payment in full.
- N525 These services are not covered when performed within the global period of another service.
- N526 Not qualified for recovery based on employer size.
- N527 We processed this claim as the primary payer prior to receiving the recovery demand.
- N528 Patient is entitled to benefits for Institutional Services only.
- N529 Patient is entitled to benefits for Professional Services only.
- N530 Not Qualified for Recovery based on enrollment information.
- N531 Not qualified for recovery based on direct payment of premium.
- N532 Not qualified for recovery based on disability and working status.
- N533 Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.
- N534 This is an individual policy, the employer does not participate in plan sponsorship.
- N535 Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.
- 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.
- N537 We have examined claims history and no records of the services have been found.
- N538 A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
- N539 Alert: We processed appeals/waiver requests on your behalf and that request has been denied.
- N540 Payment adjusted based on the interrupted stay policy.
- N541 Mismatch between the submitted insurance type code and the information stored in our system.
- N542 Missing income verification.
- N543 Incomplete/invalid income verification.
- N544 Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record.
- N545 Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx)
- N546 Payment represents a previous reduction based on the Electronic Prescribing (eRx)
- N547 A refund request (Frequency Type Code 8) was processed previously.
- N548 Alert: Patient's calendar year deductible has been met.
- N549 Alert: Patient's calendar year out-of-pocket maximum has been met.
- N550 Alert: You have not responded to requests to revalidate your provider/supplier enrollment information.
- N551 Payment adjusted based on the Ambulatory Surgical Center (ASC)
- N552 Payment adjusted to reverse a previous withhold/bonus amount.
- N553 Deactivated 2012 Payment adjusted based on a Low Income Subsidy (LIS) retroactive coverage or status change.
- N554 Missing/Incomplete/Invalid Family Planning Indicator.
- N555 Missing medication list.
- N556 Incomplete/invalid medication list.
- N557 This claim/service is not payable under our service area.
- N558 This claim/service is not payable under our service area.
- N559 This claim/service is not payable under our service area.
- N560 The pilot program requires an interim or final claim within 60 days of the Notice of Admission.
- N561 The bundled claim originally submitted for this episode of care includes related readmissions.
- 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.
- N563 Alert: Missing required provider/supplier issuance of advance patient notice of non-coverage.
- N564 Patient did not meet the inclusion criteria for the demonstration project or pilot program.
- N565 Alert: This non-payable reporting code requires a modifier.
- N566 Alert: This procedure code requires functional reporting.
- N567 Not covered when considered preventative.
- N568 Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.
- N569 Not covered when performed for the reported diagnosis.
- N570 Missing/incomplete/invalid credentialing data.
- N571 Alert: Payment will be issued quarterly by another payer/contractor.
- N572 This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
- N573 Alert: You have been overpaid and must refund the overpayment.
- N574 Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer.
- N575 Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.
- N576 Services not related to the specific incident/claim/accident/loss being reported.
- N577 Personal Injury Protection (PIP)
- N578 Coverages do not apply to this loss.
- N579 Medical Payments Coverage (MPC).
- N580 Determination based on the provisions of the insurance policy.
- N581 Investigation of coverage eligibility is pending.
- N582 Benefits suspended pending the patient's cooperation.
- N583 Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.
- N584 Not covered based on the insured's noncompliance with policy or statutory conditions.
- N585 Benefits are no longer available based on a final injury settlement.
- N586 The injured party does not qualify for benefits.
- N587 Policy benefits have been exhausted.
- N588 The patient has instructed that medical claims/bills are not to be paid.
- 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…
- N590 Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
- N591 Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).
- N592 Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
- N593 Not covered based on failure to attend a scheduled Independent Medical Exam (IME).
- N594 Records reflect the injured party did not complete an Application for Benefits for this loss.
- N595 Records reflect the injured party did not complete an Assignment of Benefits for this loss.
- N596 Records reflect the injured party did not complete a Medical Authorization for this loss.
- N597 Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.
- N598 Health care policy coverage is primary.
- 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…
- N600 Adjusted based on the applicable fee schedule for the region in which the service was rendered.
- N601 In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based…
- N602 Adjusted based on the Redbook maximum allowance.
- N603 This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance…
- 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…
- N605 This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
- N606 The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009).
- N607 Service provided for non-compensable condition(s).
- N608 The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service.
- N609 80% of the provider's billed amount is being recommended for payment according to Act 6.
- N610 Alert: Payment based on an appropriate level of care.
- N611 Claim in litigation.
- N612 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
- N613 Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record.
- N614 Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).
- 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.
- N616 Alert: This enrollee is in the first month of the advance premium tax credit grace period.
- N617 This enrollee is in the second or third month of the advance premium tax credit grace period.
- N618 Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.
- N619 Coverage terminated for non-payment of premium.
- N620 Alert: This procedure code is for quality reporting/informational purposes only.
- N621 Charges for Jurisdiction required forms, reports, or chart notes are not payable.
- N622 Not covered based on the date of injury/accident.
- N623 Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
- N624 The associated Workers' Compensation claim has been withdrawn.
- N625 Missing/Incomplete/Invalid Workers' Compensation Claim Number.
- N626 New or established patient E/M codes are not payable with chiropractic care codes.
- N627 Deactivated 2014 Service not payable per managed care contract.
- N628 Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
- N629 Reviews/documentation/notes/summaries/reports/charts not requested.
- N630 Referral not authorized by attending physician.
- N631 Medical Fee Schedule does not list this code.
- N632 Deactivated 2014 According to the Official Medical Fee Schedule this service has a relative value of zero and therefore no payment is due.
- N633 Additional anesthesia time units are not allowed.
- N634 The allowance is calculated based on anesthesia time units.
- N635 The Allowance is calculated based on the anesthesia base units plus time.
- N636 Adjusted because this is reimbursable only once per injury.
- N637 Consultations are not allowed once treatment has been rendered by the same provider.
- N638 Reimbursement has been made according to the home health fee schedule.
- N639 Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
- N640 Exceeds number/frequency approved/allowed within time period.
- N641 Reimbursement has been based on the number of body areas rated.
- N642 Adjusted when billed as individual tests instead of as a panel.
- N643 The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
- N644 Reimbursement has been made according to the bilateral procedure rule.
- N645 Mark-up allowance.
- N646 Reimbursement has been adjusted based on the guidelines for an assistant.
- N647 Adjusted based on diagnosis-related group (DRG).
- N648 Adjusted based on Stop Loss.
- N649 Payment based on invoice.
- N650 This policy was not in effect for this date of loss.
- N651 No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
- N652 The date of service is before the date of loss.
- N653 The date of injury does not match the reported date of loss.
- N654 Adjusted based on achievement of maximum medical improvement (MMI).
- N655 Payment based on provider's geographic region.
- N656 An interest payment is being made because benefits are being paid outside the statutory requirement.
- N657 This should be billed with the appropriate code for these services.
- N658 The billed service(s) are not considered medical expenses.
- N659 This item is exempt from sales tax.
- N660 Sales tax has been included in the reimbursement.
- N661 Documentation does not support that the services rendered were medically necessary.
- N662 Alert: Consideration of payment will be made upon receipt of a final bill.
- N663 Adjusted based on an agreed amount.
- N664 Adjusted based on a legal settlement.
- N665 Services by an unlicensed provider are not reimbursable.
- N666 Only one evaluation and management code at this service level is covered during the course of care.
- N667 Missing prescription.
- N668 Incomplete/invalid prescription.
- N669 Adjusted based on the Medicare fee schedule.
- N670 This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
- N671 Payment based on a jurisdiction cost-charge ratio.
- N672 Alert: Amount applied to Health Insurance Offset.
- N673 Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
- N674 Not covered unless a pre-requisite procedure/service has been provided.
- N675 Additional information is required from the injured party.
- N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
- N677 Alert: Films/Images will not be returned.
- N678 Missing post-operative images/visual field results.
- N679 Incomplete/Invalid post-operative images/visual field results.
- N680 Missing/Incomplete/Invalid date of previous dental extractions.
- N681 Missing/Incomplete/Invalid full arch series.
- N682 Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
- N683 Missing/Incomplete/Invalid prior treatment documentation.
- N684 Payment denied as this is a specialty claim submitted as a general claim.
- N685 Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
- N686 Missing/incomplete/Invalid questionnaire needed to complete payment determination.
- N687 Alert: This reversal is due to a retroactive disenrollment.
- N688 Alert: This reversal is due to a medical or utilization review decision.
- N689 Alert: This reversal is due to a retroactive rate change.
- N690 Alert: This reversal is due to a provider submitted appeal.
- N691 Alert: This reversal is due to a patient submitted appeal.
- N692 Alert: This reversal is due to an incorrect rate on the initial adjudication.
- N693 Alert: This reversal is due to a cancellation of the claim by the provider.
- N694 Alert: This reversal is due to a resubmission/change to the claim by the provider.
- N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
- N696 Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
- N697 Alert: This reversal is due to a payer's retroactive contract incentive program adjustment.
- 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…
- N699 Payment adjusted based on the Physician Quality Reporting System (PQRS)
- N700 Payment adjusted based on the Electronic Health Records (EHR)
- N701 Payment adjusted based on the Value-based Payment Modifier.
- N702 Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.
- N703 This service is incompatible with previously adjudicated claims or claims in process.
- N704 Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted.
- N705 Incomplete/invalid documentation.
- N706 Missing documentation.
- N707 Incomplete/invalid orders.
- N708 Missing orders.
- N709 Incomplete/invalid notes.
- N710 Missing notes.
- N711 Incomplete/invalid summary.
- N712 Missing summary.
- N713 Incomplete/invalid report.
- N714 Missing report.
- N715 Incomplete/invalid chart.
- N716 Missing chart.
- N717 Incomplete/Invalid documentation of face-to-face examination.
- N718 Missing documentation of face-to-face examination.
- N719 Penalty applied based on plan requirements not being met.
- N720 Alert: The patient overpaid you.
- N721 This service is only covered when performed as part of a clinical trial.
- N722 Patient must use Workers' Compensation Set-Aside (WCSA) funds to pay for the medical service or item.
- N723 Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.
- N724 Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.
- N725 A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
- N726 A conditional payment is not allowed.
- N727 A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
- N728 A workers' compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
- N729 Missing patient medical/dental record for this service.
- N730 Incomplete/invalid patient medical/dental record for this service.
- N731 Incomplete/Invalid mental health assessment.
- N732 Services performed at an unlicensed facility are not reimbursable.
- N733 Regulatory surcharges are paid directly to the state.
- N734 The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury.
- N735 Deactivated 2016 Adjustment without review of medical/dental record because the requested records were not received or were not received timely.
- N736 Incomplete/invalid Sleep Study Report.
- N737 Missing Sleep Study Report.
- N738 Incomplete/invalid Vein Study Report.
- N739 Missing Vein Study Report.
- N740 The member's Consumer Spending Account does not contain sufficient funds to cover the member's liability for this claim/service.
- N741 This is a site neutral payment.
- N742 Deactivated 2016 Alert: This claim was processed based on one or more ICD-9 codes.
- N743 Adjusted because the services may be related to an employment accident.
- N744 Adjusted because the services may be related to an auto/other accident.
- N745 Missing Ambulance Report.
- N746 Incomplete/invalid Ambulance Report.
- N747 This is a misdirected claim/service.
- N748 Adjusted because the related hospital charges have not been received.
- N749 Missing Blood Gas Report.
- N750 Incomplete/invalid Blood Gas Report.
- N751 Adjusted because the patient is covered under a Medicare Part D plan.
- N752 Missing/incomplete/invalid HIPPS Treatment Authorization Code (TAC).
- N753 Missing/incomplete/invalid Attachment Control Number.
- N754 Missing/incomplete/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form.
- N755 Missing/incomplete/invalid ICD Indicator.
- N756 Missing/incomplete/invalid point of drop-off address.
- N757 Adjusted based on the Federal Indian Fees schedule (MLR).
- N758 Adjusted based on the prior authorization decision.
- N759 Payment adjusted based on the National Electrical Manufacturers Association (NEMA)
- N760 This facility is not authorized to receive payment for the service(s).
- N761 This provider is not authorized to receive payment for the service(s).
- N762 This facility is not certified for Tomosynthesis (3-D) mammography.
- N763 The demonstration code is not appropriate for this claim; resubmit without a demonstration code.
- N764 Missing/incomplete/invalid Hematocrit (HCT) value.
- N765 This payer does not cover coinsurance assessed by a previous payer.
- N766 This payer does not cover co-payment assessed by a previous payer.
- N767 The Medicaid state requires provider to be enrolled in the member's Medicaid state program prior to any claim benefits being processed.
- N768 Incomplete/invalid initial evaluation report.
- N769 A lateral diagnosis is required.
- N770 The adjustment request received from the provider has been processed.
- N771 Alert: Under Federal law you cannot charge more than the limiting charge amount.
- N772 Alert: Rebill urgent/emergent and ancillary services separately.
- N773 Drug supplied not obtained from specialty vendor.
- N774 Alert: Refer to your Third Party Processor Agreement for specific information on fees associated with this payment type.
- N775 Payment adjusted based on x-ray radiograph on film.
- N776 This service is not a covered Telehealth service.
- N777 Missing Assignment of Benefits Indicator.
- N778 Missing Primary Care Physician Information.
- N779 Replacement/Void claims cannot be submitted until the original claim has finalized.
- N780 Missing/incomplete/invalid end therapy date.
- N781 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary.
- N782 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary.
- N783 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary.
- N784 Missing comprehensive procedure code.
- N785 Missing current radiology film/images.
- N786 Benefit limitation for the orthodontic active and/or retention phase of treatment.
- 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…
- N788 Alert: The third-party administrator/review organization did not receive the required information.
- N789 Clinical Trial is not a covered benefit.
- N790 Provider/supplier not accredited for product/service.
- N791 Missing history & physical report.
- N792 Incomplete/invalid history & physical report.
- N793 Deactivated 2020 Alert: Starting January 1, 2020, Medicare will ONLY accept claims submitted with the Medicare Beneficiary Identifier (MBI).
- N794 Payment adjusted based on type of technology used.
- N795 Item must be resubmitted as a purchase.
- N796 Missing/incomplete/invalid Hemoglobin (Hb or Hgb) value.
- N797 Missing/incomplete/invalid date qualifier.
- N798 Submit a void request for the original claim and resubmit a new claim.
- N799 Submitted identifier must be an individual identifier, not group identifier.
- N800 Only one service date is allowed per claim.
- 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.
- N802 This claim/service is not payable under our service area.
- N803 Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital.
- N804 Alert: The claim/service was processed through the Outpatient Code Editor (OCE).
- N805 Alert: The claim/service was processed through the Correct Code Editor (CCE).
- N806 Payment is included in the Global transplant allowance.
- N807 Payment adjustment based on the Merit-based Incentive Payment System (MIPS).
- N808 Not covered for this provider type / provider specialty.
- N809 Alert: The fee schedule amount for this service was adjusted based on prior competitive bidding rates.
- N810 Alert: Due to federal, state or local disaster declaration, this claim has been processed at the in-network level of benefit.
- N811 Missing Federal Sequestration Reduction from Prior Payer.
- N812 The start service date through end service date cannot span greater than 18 months.
- N815 Missing/Incomplete/Invalid NDC Unit Count
- N816 Missing/Incomplete/Invalid NDC Unit of Measure
- 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.
- N818 Claims Dates of Service do not match Electronic Visit Verification System.
- N819 Patient not enrolled in Electronic Visit Verification System.
- N820 Electronic Visit Verification System units do not meet requirements of visit.
- N821 Electronic Visit Verification System visit not found.
- N822 Missing procedure modifier(s).
- N823 Incomplete/Invalid procedure modifier(s).
- N824 Electronic Visit Verification (EVV) data must be submitted through EVV Vendor.
- N825 Early intervention guidelines were not met.
- N826 Patient did not meet the inclusion criteria for the Medicare Shared Savings Program.
- N827 Missing/Incomplete/Invalid Federal Information Processing Standard (FIPS)
- N828 Alert: Payment is suppressed due to a contracted funding.
- N829 Missing/incomplete/invalid Diagnostics Exchange Z-Code Identifier.
- N830 Alert: The charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations.
- N831 You have not responded to requests to revalidate your provider/supplier enrollment information.
- N832 Duplicate occurrence code/occurrence span code.
- N833 Patient share of cost waived.
- N834 Jurisdiction exempt from sales and health tax charges.
- N835 Unrelated Service/procedure/treatment is reduced.
- N836 Provider W9 or Payee Registration not on file.
- N837 Alert: Missing modifier was added.
- N838 Alert: Service/procedure postponed due to a federal, state, or local mandate/disaster declaration.
- N839 The procedure code was added/changed because the level of service exceeds the compensable condition(s).
- N840 Worker's compensation claim filed with a different state.
- N841 Alert: North Dakota Administrative Rule 92-01-02-50.3.
- N842 Alert: Patient cannot be billed for charges.
- N843 Missing/incomplete/invalid Core-Based Statistical Area (CBSA) code.
- 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…
- N845 Alert: Nebraska Legislative LB997 July 24, 2020 - Out of Network Emergency Medical Care Act.
- N846 National Drug Code (NDC) supplied does not correspond to the HCPCs/CPT billed.
- N847 National Drug Code (NDC) billed is obsolete.
- N848 National Drug Code (NDC) billed cannot be associated with a product.
- N849 Missing Tooth Clause: Tooth missing prior to the member effective date.
- N850 Missing/incomplete/invalid narrative explaining/describing this service/treatment.
- N851 Payment reduced because services were furnished by a therapy assistant.
- N852 The pay-to and rendering provider tax identification numbers (TINs) do not match
- N853 The number of modalities performed per session exceeds our acceptable maximum.
- 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…
- N855 This coverage is subject to the exclusive jurisdiction of ERISA (1974), U.S.C.
- N856 This coverage is not subject to the exclusive jurisdiction of ERISA (1974), U.S.C.
- N857 This claim has been adjusted/reversed.
- N858 Alert: State regulations relating to an Out of Network Medical Emergency Care Act were applied to the processing of this claim.
- N859 Alert: The Federal No Surprise Billing Act was applied to the processing of this claim.
- N860 Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).
- N861 Alert: Mismatch between the submitted Patient Liability/Share of Cost and the amount on record for this recipient.
- 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.
- N863 Deactivated 2026 Alert: This claim is subject to the No Surprises Act (NSA).
- N864 Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services.
- N865 Alert: This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient…
- N866 Alert: This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services.
- N867 Alert: Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act.
- N868 Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
- N869 Alert: Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act.
- 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…
- N871 Alert: This initial payment was calculated based on a specified State law, in accordance with the No Surprises Act.
- N872 Alert: This final payment was calculated based on a specified State law, in accordance with the No Surprises Act.
- N873 Alert: This final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
- N874 Alert: This final payment was determined through open negotiation, in accordance with the No Surprises Act.
- N875 Alert: This final payment equals the amount selected as the out-of-network rate for an item or service under the Federal independent dispute resolution…
- N876 Alert: This item or service is covered under the plan or coverage, but no payment is made by the plan or coverage.
- N877 Alert: This initial payment is provided in accordance with the No Surprises Act.
- 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…
- 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…
- N880 Original claim closed due to changes in submitted data.
- N881 Client Obligation, patient responsibility for Home & Community Based Services (HCBS)
- 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…
- N883 Alert: Processed according to state law
- N884 Alert: The No Surprises Act may apply to this claim.
- N885 Alert: This claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements.
- N886 Alert: A Health Care Claim Request for Additional Information (277 RFAI) has been sent.
- 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…
- N888 Alert: An electronic request for additional information has been sent for this claim.
- N889 Alert: This claim was originally processed in real-time, and we sent a real-time 835 response.
- N890 Electronic Visit Verification Data Element Requirements were not met.
- N891 The maximum allowable payment for this service/procedure was paid by the primary insurance.
- N892 The claim does not meet the criteria for acceptable use of the Delay Reason Code.
- N893 Missing/incomplete/invalid child medical evaluation form/checklist.
- 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…
- N895 Processed based on a negotiated fee schedule for a specialty drug program.
- N896 Missing/incomplete/invalid trauma activation sheet.
- N897 Missing/incomplete/invalid proof of member payment.
- N898 Missing/incomplete/invalid Resource Utilization Group(s) (RUG) code(s).
- N899 Missing Initial Evaluation Report.
- N900 Missing Therapy Notes/Report.
- N901 Incomplete/Invalid Therapy Notes/Report.
- N902 Missing Health Risk Assessment (HRA).
- N903 Incomplete/Invalid Health Risk Assessment (HRA).
- N904 The transportation vendor is responsible for this claim.
- N905 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished.
- N906 Service is not covered when patient is under age 45.
- N907 No refund because this claim has been identified as 340B-eligible with a ceiling price lower than the maximum fair price.
- N908 No refund because this drug has been prospectively purchased at the maximum fair price.
- N909 Refund amount has been calculated using a methodology that differs from the Standard Default Refund Amount calculation ((Wholesale Acquisition Cost minus…
- N910 A refund cannot be provided for this claim at this time.
- 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…
- N912 Our records indicate that this beneficiary did not elect hospice.
- N913 More than one Electronic Visit Verification record exists for the date and time of this service.
- N914 This claim was priced and processed in accordance with California AB-72 Health care coverage.
- N915 Predetermination of services is not allowed under the member's plan.
- N916 The third party will render payment to the provider, and they will reimburse you for covered services.
- N917 Alternative refund amount has been calculated because the maximum fair price is below the 340B ceiling price.
- N918 No refund because CMS excludes prescription drug event records when a compound code indicates it is for a compounded drug.
- N919 Family/member out-of-pocket maximum has been met.
- N920 Payment to the provider has been placed on hold as a result of active contract (re)negotiation.
- N921 The time limit for filing a reconsideration or appeal has expired.
- N922 Missing primary care dentist information.
- N923 Not Denied - The Medicare Advantage Organization (MAO) made a payment responsibility determination.
- N924 Pending (Not Denied) - The Medicare Advantage Organization (MAO) has not yet made a payment responsibility determination for the service at the time the…
- N925 Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for the service at the time the encounter record was…
- N926 Partially Denied - The Medicare Advantage Organization (MAO) determined that it had no payment responsibility for one or more service lines, but not all, at…
- N927 Missing/Incomplete/Invalid x-ray.
- N928 Missing/Incomplete/Invalid bitewing or periapical x-ray.
- N929 Missing/Incomplete/Invalid photo(s).
- N930 Missing/Incomplete/Invalid quadrant identifier.
- N931 Missing/Incomplete/Invalid pre- and/or post-operative bitewing or periapical x-ray.
- N932 Missing/Incomplete/Invalid pre- and/or post-operative full mouth x-ray.
- N933 Missing/Incomplete/Invalid pre- and/or post-operative photo(s).
- N934 Missing/Incomplete/Invalid full mouth x-ray.
- N935 Alert: Patient is no longer a Medicaid/Qualified Medicare Beneficiary.
- N936 This service code has been identified as the secondary or tertiary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
- N937 The service line denial threshold was exceeded.
- N938 Alert: Do not resubmit.
- N939 Alert: You may contact us for a peer-to-peer review.
- N940 Missing/Incomplete/Invalid pre- and/or post-operative x-ray.
- N941 Potentially fraudulent findings.
- N942 Missing/Invalid Patient Health Plan ID Number.
- N943 Alert: Under the circumstances furnished, this item or service is not subject to the surprise billing provisions of the No Surprises Act.
- N944 Alert: This item or service is covered under the plan or coverage, but no payment is made by the plan or coverage.
- N945 Alert: Any dispute regarding this payment amount is governed by a specified State law, in accordance with the No Surprises Act.
- N946 This service is allowed once in a 24-month period.
- N947 Alert: The original claim payment decision is being maintained.
- N948 Alert: The original claim payment decision is being maintained.
- N949 Claim lines not billed in correct order per Medicaid/Medicare billing guidelines.