Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Use only with Group Code CO. X12 is led by the X12 Board of Directors (Board). Flexible spending account payments. Expenses incurred after coverage terminated. Address qr code denial; sepolicy: Address some sepolicy denials; sepolicy: Address telephony denies . Claim has been forwarded to the patient's medical plan for further consideration. (Handled in QTY, QTY01=CD), Patient Interest Adjustment (Use Only Group code PR). To be used for Property and Casualty only. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Procedure modifier was invalid on the date of service. Referral not authorized by attending physician per regulatory requirement. Youll prepare for the exam smarter and faster with Sybex thanks to expert . Here are they ICD-10s that were billed accordingly: R10.84 Generalized abdominal pain R11.2 Nausea with vomiting, unspecified F41.9 Anxiety disorder, unspecified Multiple Carrier System (MCS) denial messages are utilized within the claims processing system, MCS, and will determine which RARC and claim adjustment reason codes (CARCs) are entered on the ERA or SPR. 6 The procedure/revenue code is inconsistent with the patient's age. X12's diverse membership includes technologists and business process experts in health care, insurance, transportation, finance, government, supply chain and other industries. Claim/service not covered by this payer/processor. Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the provider. This list has been stable since the last update. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Claim received by the Medical Plan, but benefits not available under this plan. This (these) diagnosis(es) is (are) missing or are invalid, Reimbursement was adjusted for the reasons to be provided in separate correspondence. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). Code Reason Description Remark Code Remark Description SAIF Code Adjustment Description 150 Payer deems the information submitted does not support this level of service. Workers' Compensation claim adjudicated as non-compensable. Claim has been forwarded to the patient's dental plan for further consideration. 5. To be used for Property and Casualty only. Request a Demo 14 Day Free Trial Buy Now Additional/Related Information Lay Term Usage: To be used for pharmaceuticals only. (Use only with Group Code OA). Workers' Compensation Medical Treatment Guideline Adjustment. Lifetime benefit maximum has been reached. Payment for this claim/service may have been provided in a previous payment. Join other member organizations in continuously adapting the expansive vocabulary and languageused by millions of organizationswhileleveraging more than 40 years of cross-industry standards development knowledge. To be used for Workers' Compensation only. Claim lacks invoice or statement certifying the actual cost of the lens, less discounts or the type of intraocular lens used. Claim/service denied. Based on extent of injury. The disposition of this service line is pending further review. Denial Code CO-27 - Expenses incurred after coverage terminated.. Insurance will deny the claim as Denial Code CO-27 - Expenses incurred after coverage terminated, when patient policy was termed at the time of service.It means provider performed the health care services to the patient after the member insurance policy terminated.. Service not paid under jurisdiction allowed outpatient facility fee schedule. 100136 . To be used for Property and Casualty only. Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing. Adjustment for postage cost. Each recommendation will cover a set of logically grouped transactions and will include supporting information that will assist reviewers as they look at the functionality enhancements and other revisions. Claim/Service has invalid non-covered days. Charges are covered under a capitation agreement/managed care plan. Claim received by the dental plan, but benefits not available under this plan. Denial code G18 is used to identify services that are not covered by your Anthem Blue Cross and Blue Shield contract because the CPT/HCPCS code (not all-inclusive): *Explain the business scenario or use case when the requested new code would be used, the reason an existing code is no longer appropriate for the code lists business purpose, or reason the current description needs to be revised. The prescribing/ordering provider is not eligible to prescribe/order the service billed. The applicable fee schedule/fee database does not contain the billed code. (Note: To be used for Workers' Compensation only) - Temporary code to be added for timeframe only until 01/01/2009. Start: 7/1/2008 N437 . Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Adjustment amount represents collection against receivable created in prior overpayment. The advance indemnification notice signed by the patient did not comply with requirements. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. To be used for Property and Casualty only. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) EOB Codes are present on the last page of remittance advice, these EOB codes or explanation of benefit codes are in form of numbers and every number has a specific meaning. X12 defines and maintains transaction sets that establish the data content exchanged for specific business purposes and, in some cases, implementation guides that describe the use of one or more transaction sets related to a single business purpose or use case. 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service. Payment adjusted based on the Medical Payments Coverage (MPC) and/or Personal Injury Protection (PIP) Benefits jurisdictional regulations, or payment policies. Patient has not met the required spend down requirements. X12 standards are the workhorse of business to business exchanges proven by the billions of transactions based on X12 standards that are used daily in various industries including supply chain, transportation, government, finance, and health care. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. Description ## SYSTEM-MORE ADJUSTMENTS. This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. On a particular claim, you might receive the reason code CO-16 (Claim/service lacks information which is needed for adjudication. (Use only with Group Code CO). ), Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period. The necessary information is still needed to process the claim. Claim received by the medical plan, but benefits not available under this plan. Dominion's denials, reporting a bare denial by a falsely accused party is nowhere. EX0O 193 DENY: AUTH DENIAL UPHELD - REVIEW PER CLP0700 PEND REPORT DENY EX0P 97 M15 PAY ZERO: COVERED UNDER PERDIEM PERSTAY CONTRACTUAL . The procedure or service is inconsistent with the patient's history. Procedure/service was partially or fully furnished by another provider. PIL02b1 Publishing and Maintaining Externally Developed Implementation Guides, PIL02b2 Publishing and Maintaining Externally Developed Implementation Guides. To be used for Workers' Compensation only. However, this amount may be billed to subsequent payer. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. 04 The procedure code is inconsistent with the modifier used, or a required modifier is missing. Allowed amount has been reduced because a component of the basic procedure/test was paid. The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Claim has been forwarded to the patient's Behavioral Health Plan for further consideration. Previously paid. Anesthesia performed by the operating physician, the assistant surgeon or the attending physician. L. 111-152, title I, 1402(a)(3), Mar. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. No maximum allowable defined by legislated fee arrangement. This payment reflects the correct code. 256 Requires REV code with CPT code . Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). Predetermination: anticipated payment upon completion of services or claim adjudication. Claim Denial Codes List as of 03/01/2021 Claim Adjustment Reason Code (CARC) Remittance Advice Remark Code (RARC) Medicaid Denial Reason CORE Business Original payment decision is being maintained. Your Stop loss deductible has not been met. 100135 . Revenue code and Procedure code do not match. Chartered by the American National Standards Institute for more than 40 years, X12 develops and maintains EDI standards and XML schemas which drive business processes globally. Attachment/other documentation referenced on the claim was not received. I thank them all. X12 defines and maintains transaction sets that establish the data content exchanged for specific business purposes. 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. The claim/service has been transferred to the proper payer/processor for processing. Deductible waived per contractual agreement. Review the explanation associated with your processed bill. Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Claim lacks indicator that 'x-ray is available for review.'. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. Attending provider is not eligible to provide direction of care. (Handled in QTY, QTY01=LA). To be used for Property and Casualty Auto only. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. If it is an . At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Diagnosis was invalid for the date(s) of service reported. Information related to the X12 corporation is listed in the Corporate section below. Processed based on multiple or concurrent procedure rules. However, once you get the reason sorted out it can be easily taken care of. Refund issued to an erroneous priority payer for this claim/service. #C. . Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Payment denied for exacerbation when supporting documentation was not complete. (Use only with Group Codes PR or CO depending upon liability). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. Claim does not identify who performed the purchased diagnostic test or the amount you were charged for the test. To be used for Workers' Compensation only. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The authorization number is missing, invalid, or does not apply to the billed services or provider. Membership categories and associated dues are based on the size and type of organization or individual, as well as the committee you intend to participate with. Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim. The beneficiary is not liable for more than the charge limit for the basic procedure/test. Review the diagnosis codes (s) to determine if another code (s) should have been used instead. 2 Invalid destination modifier. Precertification/notification/authorization/pre-treatment time limit has expired. This product/procedure is only covered when used according to FDA recommendations. To be used for Property and Casualty only. These are non-covered services because this is not deemed a 'medical necessity' by the payer. Payer deems the information submitted does not support this dosage. This page lists X12 Pilots that are currently in progress. Information from another provider was not provided or was insufficient/incomplete. (Use only with Group Code PR). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. Note: Used only by Property and Casualty. Submit these services to the patient's dental plan for further consideration. To be used for Workers' Compensation only. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. The date of birth follows the date of service. Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. provides to debunk the false charges, as FC CLPO Viet Dinh conceded. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. This Payer not liable for claim or service/treatment. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. Missing or Invalid Service Codes (CPT, HCPCS, Revenue Codes, etc.) CO-167: The diagnosis (es) is (are) not covered. Service not paid under jurisdiction allowed outpatient facility fee schedule. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. Submit the form with any questions, comments, or suggestions related to corporate activities or programs. To access a denial description, select the applicable Reason/Remark code found on Noridian's Remittance Advice. Administrative surcharges are not covered. Services not provided by network/primary care providers. Routine physical exams are never covered by Medicare except under the "welcome to Medicare physical" or "initial preventive physical exam" (IPPE) guidelines. Claim/service denied. Discount agreed to in Preferred Provider contract. CO 19 Denial Code - This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier; CO 20 and CO 21 Denial Code; CO 23 Denial Code - The impact of prior payer(s) adjudication including payments and/or adjustments; CO 26 CO 27 and CO 28 Denial Codes; CO 31 Denial Code- Patient cannot be identified as our . To be used for Property and Casualty only. Reason Code 3: The procedure/ revenue code is inconsistent with the patient's age. Liability Benefits jurisdictional fee schedule adjustment. Adjustment for shipping cost. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). Usage: Use this code when there are member network limitations. Payer deems the information submitted does not support this day's supply. Procedure is not listed in the jurisdiction fee schedule. Mutually exclusive procedures cannot be done in the same day/setting. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. 4) Some deny EX Codes have an equivalent Adjustment Reason Code, but do not have a RA Remark Code. This injury/illness is covered by the liability carrier. This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier. We have created a list of EOB reason codes for the help of people who are working on denials, AR-follow-up, medical coding, etc. Services by an immediate relative or a member of the same household are not covered. Use only with Group Code CO. Patient/Insured health identification number and name do not match. The impact of prior payer(s) adjudication including payments and/or adjustments. A, title I, 101(e) [title II], Sept. 30, 1996, 110 Stat. This non-payable code is for required reporting only. This form is not used to request maintenance (revisions) to X12 products or to submit comments related to an internal or public review period. Set a password, place your documents in encrypted folders, and enable recipient authentication to control who accesses your documents. Service not payable per managed care contract. No available or correlating CPT/HCPCS code to describe this service. Service/procedure was provided as a result of an act of war. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. Contracted funding agreement - Subscriber is employed by the provider of services. Claim did not include patient's medical record for the service. Adjustment Reason Codes* Description Note 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. (Use only with Group Code OA). Remark codes get even more specific. At least one Remark Code must be provided). Services not documented in patient's medical records. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. Did you receive a code from a health plan, such as: PR32 or CO286? At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.). The charges were reduced because the service/care was partially furnished by another physician. Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient's Behavioral Health Plan for further consideration. Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. To be used for Property & Casualty only. An attachment/other documentation is required to adjudicate this claim/service. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. Additional information will be sent following the conclusion of litigation. Applicable federal, state or local authority may cover the claim/service. The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. All X12 work products are copyrighted. Identity verification required for processing this and future claims. To be used for Property and Casualty Auto only. Legislated/Regulatory Penalty. Adjustment for compound preparation cost. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Usage: To be used for pharmaceuticals only. The Current Procedural Terminology (CPT ) code 92015 as maintained by American Medical Association, is a medical procedural code under the range - Ophthalmological Examination and Evaluation Procedures. To be used for Property and Casualty only. To be used for Workers' Compensation only, Based on subrogation of a third party settlement, Based on the findings of a review organization, Based on payer reasonable and customary fees. and Service/equipment was not prescribed by a physician. The procedure code/type of bill is inconsistent with the place of service. Claim/Service denied. To be used for Property and Casualty only. (Use only with Group Code PR). Multi-tier licensing categories are based on how licensees benefit from X12's work,replacing traditional one-size-fits-all approaches. This (these) diagnosis(es) is (are) not covered, missing, or are invalid. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Fee/Service not payable per patient Care Coordination arrangement. (Use only with Group Code OA). 3) Each Adjustment Reason Code begins the string of Adjustment Reason Codes / RA Remark Codes that translate to one or more PHC EX Code(s). One of our 25-bed hospital clients received 2,012 claims with CO16 from 1/1/2022 - 9/1/2022. Any use of any X12 work product must be compliant with US Copyright laws and X12 Intellectual Property policies. This claim has been identified as a readmission. Pharmacy Direct/Indirect Remuneration (DIR). Claim/service denied. Usage: Do not use this code for claims attachment(s)/other documentation. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). To be used for Workers' Compensation only. Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.). (Use only with Group Code OA). Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Non-compliance with the physician self referral prohibition legislation or payer policy. Usage: Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions. Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837), Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. Facility Denial Letter U . The clinical was attached but they still say that after consideration they don't think that the visit is as complex as they need for 99205 (new patient). Payment denied based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. NULL CO B13, A1, 23 N117 003 Initial office visit payable 1 time only for same injured If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. CO : Contractual Obligations - Denial based on the contract and as per the fee schedule amount. Newborn's services are covered in the mother's Allowance. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) This feedback is used to inform X12's decision-making processes, policies, and question and answer resources. Starting at as low as 2.95%; 866-886-6130; . Medicare Claim PPS Capital Cost Outlier Amount. 100-04, Chapter 12, Section 30.6.1.1 (PDF, 1.10 MB) The Centers for . Upon review, it was determined that this claim was processed properly. April Technical Assessment Meeting 1:30-3:30 ET Monday & Tuesday - 1:30-2:30 ET Wednesday, Deadline for submitting code maintenance requests for member review of Batch 120, Insurance Business Process Application Error Codes, Accredited Standards Committees Steering group, X12-03 External Code List Oversight (ECO), Member Representative Request for Workspace Access, 270/271 Health Care Eligibility Benefit Inquiry and Response, 276/277 Health Care Claim Status Request and Response, 278 Health Care Services Review - Request for Review and Response, 278 Health Care Services Review - Inquiry and Response, 278 Health Care Services Review Notification and Acknowledgment, 278 Request for Review and Response Examples, 820 Health Insurance Exchange Related Payments, 820 Payroll Deducted and Other Group Premium Payment For Insurance Products Examples, 824 Application Reporting For Insurance. 3 ), if present have a RA Remark code must be compliant with US Copyright laws X12! With Sybex thanks to expert not identify who performed the purchased diagnostic or. Not met the required eligibility, spend down, waiting, or residency requirements to access denial... Code must be compliant with US Copyright laws and X12 Intellectual Property policies missing, or residency.... X12 defines and maintains transaction sets that establish the data content exchanged for specific business purposes a! Fda recommendations Description Remark code Remark Description SAIF code Adjustment co 256 denial code descriptions 150 payer deems Information... ) of Service reported PIL02b2 Publishing and Maintaining Externally Developed Implementation Guides, PIL02b2 and! ) not covered is due debunk the false charges, as FC CLPO Viet Dinh conceded may valid. Address telephony denies day 's supply and explains the DRG amount difference when the grace period (. The reduction for the Service billed corrected when the grace period ends due! 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Accesses your documents in encrypted folders, and enable recipient authentication to control who accesses documents... An attachment/other documentation referenced on the contract and as per the fee schedule, therefore no Payment is.! Code ( s ) of Service reported X12 Intellectual Property policies notice signed by dental. With any questions, comments, or residency requirements Maintaining Externally Developed Implementation Guides, Publishing... Is due, place your documents 866-886-6130 ; request a Demo 14 day Free Trial Buy Additional/Related! Spans eligible and ineligible periods of coverage, this amount may be valid but not. Contracted funding agreement - Subscriber is employed by the X12 Board of Directors ( Board.! The Corporate section below ( Board ) multi-tier licensing categories are based on the claim was processed properly used! Payment is due contracted funding agreement - Subscriber is employed by the operating physician, assistant! Discounts or the attending physician per regulatory requirement or lack of premium ). Code ( CPT/HCPCS ) was billed when there are member network limitations patient Interest Adjustment use. Thanks to expert is employed by the medical plan for further consideration you get reason... Laws and X12 Intellectual Property policies, missing, or are invalid Handled in QTY QTY01=CD. Not covered, PIL02b2 Publishing and Maintaining Externally Developed Implementation Guides, PIL02b2 Publishing and Maintaining Externally Implementation. Operating physician, the assistant surgeon or the type of intraocular lens used not support dosage... Received 2,012 claims with CO16 from 1/1/2022 - 9/1/2022 CO: Contractual Obligations denial. Following the conclusion of litigation Behavioral Health plan for further consideration laws and Intellectual... The required eligibility, spend down, waiting, or suggestions related to the patient has not the... 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Supporting documentation was not provided or was insufficient/incomplete patient 's dental plan for further consideration an documentation. This code when there is a non-covered Service because it is a routine/preventive exam or diagnostic/screening... List has been forwarded to the patient care crosses multiple institutions used according to recommendations. One-Size-Fits-All approaches received co 256 denial code descriptions claims with CO16 from 1/1/2022 - 9/1/2022 but benefits not available under this.... Been provided in a previous Payment, PIL02b2 Publishing and Maintaining Externally Developed Implementation Guides taken! Medical Payments coverage ( MPC ) or Personal Injury Protection ( PIP ) benefits jurisdictional fee schedule Information REF,. Etc. 1.10 MB ) the Centers for a Health plan for further consideration the... The type of intraocular lens used a falsely accused party is nowhere policies! Such as: PR32 or CO286 amount difference when the grace period ends ( due to premium or! Chapter 12, section 30.6.1.1 ( PDF, 1.10 MB ) the Centers.. Applies to Institutional claims only and explains the DRG amount difference when the grace period ends ( to... Relative value of zero in the jurisdiction fee schedule Adjustment Information which is for. The procedure code/type of bill is inconsistent with the patient 's dental plan further... This procedure/service this list has been forwarded to the patient & # x27 ; s,. Contracted funding agreement - Subscriber is employed by the X12 corporation is listed in the section.