Any communication or data transiting or stored on this system may be disclosed or used for any lawful Government purpose. An LCD provides a guide to assist in determining whether a particular item or service is covered. PR Patient Responsibility denial code list. Item has met maximum limit for this time period. Denial Code Resolution / Reason Code 16 | Remark Codes MA13 N265 N276 Share Reason Code 16 | Remark Codes MA13 N265 N276 Common Reasons for Denial Item (s) billed did not have a valid ordering physician National Provider Identifier (NPI) registered in Medicare Provider Enrollment, Chain and Ownership System (PECOS) Next Step 65 Procedure code was incorrect. Your Stop loss deductible has not been met. 107 The related or qualifying claim/service was not identified on this claim. 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. P4 Workers Compensation claim adjudicated as non-compensable. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The related or qualifying claim/service was not identified on this claim. End Users do not act for or on behalf of the CMS. P16 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. 149 Lifetime benefit maximum has been reached for this service/benefit category. CO 96- Non-Covered Charges Denial (Not covered under Providers Contract) When the billed Cpt/diagnosis code not listed under the provider's contract then it called Non covered under the provider's plan. Use is limited to use in Medicare, Medicaid, or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Applications are available at the American Dental Association web site, http://www.ADA.org. 255 The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. The Washington Publishing Company publishes the CMS-approved Reason Codes and Remark Codes. Please click here to see all U.S. Government Rights Provisions. The related or qualifying claim/service was not identified on this claim. The sole responsibility for the software, including any CDT and other content contained therein, is with (insert name of applicable entity) or the CMS; and no endorsement by the ADA is intended or implied. you can get the help of coding Because in some cases you can Correct /add the valid code for the claim to be processed. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT"). D2 Claim lacks the name, strength, or dosage of the drug furnished. 170 Payment is denied when performed/billed by this type of provider. PR 33 Claim denied. 78 Non-Covered days/Room charge adjustment. 133 The disposition of the claim/service is pending further review. Denial Code - 183 described as "The referring provider is not eligible to refer the service billed". Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted. Applicable federal, state or local authority may cover the claim/service. 35 Lifetime benefit maximum has been reached. Payment already made for same/similar procedure within set time frame. CMS Disclaimer 250 The attachment/other documentation content received is inconsistent with the expected content. 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. Required fields are marked *. Denial code - 11 described as the "Dx Code is in-consistent with the Px code billed". Missing/incomplete/invalid credentialing data. 144 Incentive adjustment, e.g. An attachment/other documentation is required to adjudicate this claim/service. CPT codes, descriptions and other data only are copyright 2002-2020 American Medical Association (AMA). Additional . All rights reserved. P22 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. 7 The procedure/revenue code is inconsistent with the patients gender. D7 Claim/service denied. Applications are available at the AMA Web site, https://www.ama-assn.org. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Insured has no coverage for newborns. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. 247 Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim. Warning: you are accessing an information system that may be a U.S. Government information system. At any time, and for any lawful Government purpose, the government may monitor, record, and audit your system usage and/or intercept, search and seize any communication or data transiting or stored on this system. AHA copyrighted materials including the UB-04 codes and descriptions may not be removed, copied, or utilized within any software, product, service, solution or derivative work without the written consent of the AHA.
