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Health Care Claim Status Codes

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Last Update 11/29/2009 - All

Health Care Claim Status Codes - All

Health Care Claim Status Codes convey the staus of an entire claim or a specific service line.

0Cannot provide further status electronically.
Start: 01/01/1995
1For more detailed information, see remittance advice.
Start: 01/01/1995
2More detailed information in letter.
Start: 01/01/1995
3Claim has been adjudicated and is awaiting payment cycle.
Start: 01/01/1995
4This is a subsequent request for information from the original request.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
5This is a final request for information.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
6Balance due from the subscriber.
Start: 01/01/1995
7Claim may be reconsidered at a future date.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
8No payment due to contract/plan provisions.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
9No payment will be made for this claim.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
10All originally submitted procedure codes have been combined.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
11Some originally submitted procedure codes have been combined.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
12One or more originally submitted procedure codes have been combined.
Start: 01/01/1995 | Last Modified: 06/30/2001
13All originally submitted procedure codes have been modified.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
14Some all originally submitted procedure codes have been modified.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
15One or more originally submitted procedure code have been modified.
Start: 01/01/1995 | Last Modified: 06/30/2001
16Claim/encounter has been forwarded to entity.
Start: 01/01/1995
17Claim/encounter has been forwarded by third party entity to entity.
Start: 01/01/1995
18Entity received claim/encounter, but returned invalid status.
Start: 01/01/1995
19Entity acknowledges receipt of claim/encounter.
Start: 01/01/1995 | Last Modified: 06/30/2001
20Accepted for processing.
Start: 01/01/1995 | Last Modified: 06/30/2001
21Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information.
Start: 01/01/1995 | Last Modified: 07/09/2007
22... before entering the adjudication system.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
23Returned to Entity.
Start: 01/01/1995 | Last Modified: 06/30/2001
24Entity not approved as an electronic submitter.
Start: 01/01/1995 | Last Modified: 06/30/2001
25Entity not approved.
Start: 01/01/1995 | Last Modified: 06/30/2001
26Entity not found.
Start: 01/01/1995 | Last Modified: 06/30/2001
27Policy canceled.
Start: 01/01/1995 | Last Modified: 06/30/2001
28Claim submitted to wrong payer.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
29Subscriber and policy number/contract number mismatched.
Start: 01/01/1995
30Subscriber and subscriber id mismatched.
Start: 01/01/1995
31Subscriber and policyholder name mismatched.
Start: 01/01/1995
32Subscriber and policy number/contract number not found.
Start: 01/01/1995
33Subscriber and subscriber id not found.
Start: 01/01/1995
34Subscriber and policyholder name not found.
Start: 01/01/1995
35Claim/encounter not found.
Start: 01/01/1995
37Predetermination is on file, awaiting completion of services.
Start: 01/01/1995
38Awaiting next periodic adjudication cycle.
Start: 01/01/1995
39Charges for pregnancy deferred until delivery.
Start: 01/01/1995
40Waiting for final approval.
Start: 01/01/1995
41Special handling required at payer site.
Start: 01/01/1995
42Awaiting related charges.
Start: 01/01/1995
44Charges pending provider audit.
Start: 01/01/1995
45Awaiting benefit determination.
Start: 01/01/1995
46Internal review/audit.
Start: 01/01/1995
47Internal review/audit - partial payment made.
Start: 01/01/1995
48Referral/authorization.
Start: 01/01/1995 | Last Modified: 02/28/2001
49Pending provider accreditation review.
Start: 01/01/1995
50Claim waiting for internal provider verification.
Start: 01/01/1995
51Investigating occupational illness/accident.
Start: 01/01/1995
52Investigating existence of other insurance coverage.
Start: 01/01/1995
53Claim being researched for Insured ID/Group Policy Number error.
Start: 01/01/1995
54Duplicate of a previously processed claim/line.
Start: 01/01/1995
55Claim assigned to an approver/analyst.
Start: 01/01/1995
56Awaiting eligibility determination.
Start: 01/01/1995
57Pending COBRA information requested.
Start: 01/01/1995
59Non-electronic request for information.
Start: 01/01/1995
60Electronic request for information.
Start: 01/01/1995
61Eligibility for extended benefits.
Start: 01/01/1995
64Re-pricing information.
Start: 01/01/1995
65Claim/line has been paid.
Start: 01/01/1995
66Payment reflects usual and customary charges.
Start: 01/01/1995
67Payment made in full.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
68Partial payment made for this claim.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
69Payment reflects plan provisions.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
70Payment reflects contract provisions.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
71Periodic installment released.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
72Claim contains split payment.
Start: 01/01/1995
73Payment made to entity, assignment of benefits not on file.
Start: 01/01/1995
78Duplicate of an existing claim/line, awaiting processing.
Start: 01/01/1995
81Contract/plan does not cover pre-existing conditions.
Start: 01/01/1995
83No coverage for newborns.
Start: 01/01/1995
84Service not authorized.
Start: 01/01/1995
85Entity not primary.
Start: 01/01/1995
86Diagnosis and patient gender mismatch.
Start: 01/01/1995 | Last Modified: 02/28/2000
87Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
88Entity not eligible for benefits for submitted dates of service.
Start: 01/01/1995
89Entity not eligible for dental benefits for submitted dates of service.
Start: 01/01/1995
90Entity not eligible for medical benefits for submitted dates of service.
Start: 01/01/1995
91Entity not eligible/not approved for dates of service.
Start: 01/01/1995
92Entity does not meet dependent or student qualification.
Start: 01/01/1995
93Entity is not selected primary care provider.
Start: 01/01/1995
94Entity not referred by selected primary care provider.
Start: 01/01/1995
95Requested additional information not received.
Start: 01/01/1995 | Last Modified: 07/09/2007
Notes: If known, the payer must report a second claim status code identifying the requested information.
96No agreement with entity.
Start: 01/01/1995
97Patient eligibility not found with entity.
Start: 01/01/1995
98Charges applied to deductible.
Start: 01/01/1995
99Pre-treatment review.
Start: 01/01/1995
100Pre-certification penalty taken.
Start: 01/01/1995
101Claim was processed as adjustment to previous claim.
Start: 01/01/1995
102Newborn's charges processed on mother's claim.
Start: 01/01/1995
103Claim combined with other claim(s).
Start: 01/01/1995
104Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient)
Start: 01/01/1995 | Last Modified: 06/01/2008
105Claim/line is capitated.
Start: 01/01/1995
106This amount is not entity's responsibility.
Start: 01/01/1995
107Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)
Start: 01/01/1995 | Last Modified: 06/01/2008
108Coverage has been canceled for this entity. (Use code 27)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
109Entity not eligible.
Start: 01/01/1995
110Claim requires pricing information.
Start: 01/01/1995
111At the policyholder's request these claims cannot be submitted electronically.
Start: 01/01/1995
112Policyholder processes their own claims.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
113Cannot process individual insurance policy claims.
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
114Claim/service should be processed by entity.
Start: 01/01/1995 | Last Modified: 01/27/2008
115Cannot process HMO claims
Start: 01/01/1995 | Last Modified: 01/27/2008 | Stop: 07/01/2008
116Claim submitted to incorrect payer.
Start: 01/01/1995
117Claim requires signature-on-file indicator.
Start: 01/01/1995
118TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
119TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
120TPO rejected claim/line because claim does not contain enough information. (Use status code 21)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
121Service line number greater than maximum allowable for payer.
Start: 01/01/1995
122Missing/invalid data prevents payer from processing claim. (Use CSC Code 21)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
123Additional information requested from entity.
Start: 01/01/1995
124Entity's name, address, phone and id number.
Start: 01/01/1995
125Entity's name.
Start: 01/01/1995
126Entity's address.
Start: 01/01/1995
127Entity's phone number. This change to be effective 7/1/2010: Entity's Communication Number.
Start: 01/01/1995 | Last Modified: 09/20/2009
128Entity's tax id.
Start: 01/01/1995
129Entity's Blue Cross provider id
Start: 01/01/1995
130Entity's Blue Shield provider id
Start: 01/01/1995
131Entity's Medicare provider id.
Start: 01/01/1995
132Entity's Medicaid provider id.
Start: 01/01/1995
133Entity's UPIN
Start: 01/01/1995
134Entity's CHAMPUS provider id.
Start: 01/01/1995
135Entity's commercial provider id.
Start: 01/01/1995
136Entity's health industry id number.
Start: 01/01/1995
137Entity's plan network id.
Start: 01/01/1995
138Entity's site id .
Start: 01/01/1995
139Entity's health maintenance provider id (HMO).
Start: 01/01/1995
140Entity's preferred provider organization id (PPO).
Start: 01/01/1995 | Last Modified: 06/30/2001
141Entity's administrative services organization id (ASO).
Start: 01/01/1995
142Entity's license/certification number.
Start: 01/01/1995
143Entity's state license number.
Start: 01/01/1995
144Entity's specialty license number.
Start: 01/01/1995
145Entity's specialty/taxonomy code.
Start: 01/01/1995 | Last Modified: 09/30/2007
146Entity's anesthesia license number.
Start: 01/01/1995
147Entity's qualification degree/designation (e.g. RN,PhD,MD)
Start: 02/28/1997
148Entity's social security number.
Start: 01/01/1995
149Entity's employer id.
Start: 01/01/1995
150Entity's drug enforcement agency (DEA) number.
Start: 01/01/1995
152Pharmacy processor number.
Start: 01/01/1995
153Entity's id number.
Start: 01/01/1995
154Relationship of surgeon & assistant surgeon.
Start: 01/01/1995
155Entity's relationship to patient
Start: 01/01/1995
156Patient relationship to subscriber
Start: 01/01/1995
157Entity's Gender
Start: 01/01/1995
158Entity's date of birth
Start: 01/01/1995
159Entity's date of death
Start: 01/01/1995
160Entity's marital status
Start: 01/01/1995
161Entity's employment status
Start: 01/01/1995
162Entity's health insurance claim number (HICN).
Start: 01/01/1995
163Entity's policy number.
Start: 01/01/1995
164Entity's contract/member number.
Start: 01/01/1995
165Entity's employer name, address and phone.
Start: 01/01/1995
166Entity's employer name.
Start: 01/01/1995
167Entity's employer address.
Start: 01/01/1995
168Entity's employer phone number.
Start: 01/01/1995
169Entity's employer id.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
170Entity's employee id.
Start: 01/01/1995
171Other insurance coverage information (health, liability, auto, etc.).
Start: 01/01/1995
172Other employer name, address and telephone number.
Start: 01/01/1995
173Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber.
Start: 01/01/1995 | Last Modified: 02/28/2000
174Entity's student status.
Start: 01/01/1995
175Entity's school name.
Start: 01/01/1995
176Entity's school address.
Start: 01/01/1995
177Transplant recipient's name, date of birth, gender, relationship to insured.
Start: 01/01/1995 | Last Modified: 02/28/2000
178Submitted charges.
Start: 01/01/1995
179Outside lab charges.
Start: 01/01/1995
180Hospital s semi-private room rate.
Start: 01/01/1995
181Hospital s room rate.
Start: 01/01/1995
182Allowable/paid from primary coverage.
Start: 01/01/1995
183Amount entity has paid.
Start: 01/01/1995
184Purchase price for the rented durable medical equipment.
Start: 01/01/1995
185Rental price for durable medical equipment.
Start: 01/01/1995
186Purchase and rental price of durable medical equipment.
Start: 01/01/1995
187Date(s) of service.
Start: 01/01/1995
188Statement from-through dates.
Start: 01/01/1995
189Facility admission date
Start: 01/01/1995 | Last Modified: 10/31/2006
190Facility discharge date
Start: 01/01/1995 | Last Modified: 10/31/2006
191Date of Last Menstrual Period (LMP)
Start: 02/28/1997
192Date of first service for current series/symptom/illness.
Start: 01/01/1995
193First consultation/evaluation date.
Start: 02/28/1997
194Confinement dates.
Start: 01/01/1995
195Unable to work dates. This change to be effective 7/1/2010: Unable to work dates/Disability Dates.
Start: 01/01/1995 | Last Modified: 09/20/2009
196Return to work dates.
Start: 01/01/1995
197Effective coverage date(s).
Start: 01/01/1995
198Medicare effective date.
Start: 01/01/1995
199Date of conception and expected date of delivery.
Start: 01/01/1995
200Date of equipment return.
Start: 01/01/1995
201Date of dental appliance prior placement.
Start: 01/01/1995
202Date of dental prior replacement/reason for replacement.
Start: 01/01/1995
203Date of dental appliance placed.
Start: 01/01/1995
204Date dental canal(s) opened and date service completed.
Start: 01/01/1995
205Date(s) dental root canal therapy previously performed.
Start: 01/01/1995
206Most recent date of curettage, root planing, or periodontal surgery.
Start: 01/01/1995
207Dental impression and seating date.
Start: 01/01/1995
208Most recent date pacemaker was implanted.
Start: 01/01/1995
209Most recent pacemaker battery change date.
Start: 01/01/1995
210Date of the last x-ray.
Start: 01/01/1995
211Date(s) of dialysis training provided to patient.
Start: 01/01/1995
212Date of last routine dialysis.
Start: 01/01/1995
213Date of first routine dialysis.
Start: 01/01/1995
214Original date of prescription/orders/referral.
Start: 02/28/1997
215Date of tooth extraction/evolution.
Start: 01/01/1995
216Drug information.
Start: 01/01/1995
217Drug name, strength and dosage form.
Start: 01/01/1995
218NDC number.
Start: 01/01/1995
219Prescription number.
Start: 01/01/1995
220Drug product id number.
Start: 01/01/1995
221Drug days supply and dosage.
Start: 01/01/1995
222Drug dispensing units and average wholesale price (AWP).
Start: 01/01/1995
223Route of drug/myelogram administration.
Start: 01/01/1995
224Anatomical location for joint injection.
Start: 01/01/1995
225Anatomical location.
Start: 01/01/1995
226Joint injection site.
Start: 01/01/1995
227Hospital information.
Start: 01/01/1995
228Type of bill for UB claim
Start: 01/01/1995 | Last Modified: 10/31/2006
229Hospital admission source.
Start: 01/01/1995
230Hospital admission hour.
Start: 01/01/1995
231Hospital admission type.
Start: 01/01/1995
232Admitting diagnosis.
Start: 01/01/1995
233Hospital discharge hour.
Start: 01/01/1995
234Patient discharge status.
Start: 01/01/1995
235Units of blood furnished.
Start: 01/01/1995
236Units of blood replaced.
Start: 01/01/1995
237Units of deductible blood.
Start: 01/01/1995
238Separate claim for mother/baby charges.
Start: 01/01/1995
239Dental information.
Start: 01/01/1995
240Tooth surface(s) involved.
Start: 01/01/1995
241List of all missing teeth (upper and lower).
Start: 01/01/1995
242Tooth numbers, surfaces, and/or quadrants involved.
Start: 01/01/1995
243Months of dental treatment remaining.
Start: 01/01/1995
244Tooth number or letter.
Start: 01/01/1995
245Dental quadrant/arch.
Start: 01/01/1995
246Total orthodontic service fee, initial appliance fee, monthly fee, length of service.
Start: 01/01/1995
247Line information.
Start: 01/01/1995
248Accident date, state, description and cause.
Start: 01/01/1995
249Place of service.
Start: 01/01/1995
250Type of service.
Start: 01/01/1995
251Total anesthesia minutes.
Start: 01/01/1995
252Authorization/certification number.
Start: 01/01/1995
253Procedure/revenue code for service(s) rendered. Use codes 454 or 455.
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
254Primary diagnosis code.
Start: 01/01/1995
255Diagnosis code.
Start: 01/01/1995
256DRG code(s).
Start: 01/01/1995
257ADSM-III-R code for services rendered.
Start: 01/01/1995
258Days/units for procedure/revenue code.
Start: 01/01/1995
259Frequency of service.
Start: 01/01/1995
260Length of medical necessity, including begin date.
Start: 02/28/1997
261Obesity measurements.
Start: 01/01/1995
262Type of surgery/service for which anesthesia was administered.
Start: 01/01/1995
263Length of time for services rendered.
Start: 01/01/1995
264Number of liters/minute & total hours/day for respiratory support.
Start: 01/01/1995
265Number of lesions excised.
Start: 01/01/1995
266Facility point of origin and destination - ambulance.
Start: 01/01/1995
267Number of miles patient was transported.
Start: 01/01/1995
268Location of durable medical equipment use.
Start: 01/01/1995
269Length/size of laceration/tumor.
Start: 01/01/1995
270Subluxation location.
Start: 01/01/1995
271Number of spine segments.
Start: 01/01/1995
272Oxygen contents for oxygen system rental.
Start: 01/01/1995
273Weight.
Start: 01/01/1995
274Height.
Start: 01/01/1995
275Claim.
Start: 01/01/1995
276UB04/HCFA-1450/1500 claim form
Start: 01/01/1995 | Last Modified: 10/31/2006
277Paper claim.
Start: 01/01/1995
278Signed claim form.
Start: 01/01/1995
279Itemized claim.
Start: 01/01/1995
280Itemized claim by provider.
Start: 01/01/1995
281Related confinement claim.
Start: 01/01/1995
282Copy of prescription.
Start: 01/01/1995
283Medicare entitlement information is required to determine primary coverage
Start: 01/01/1995 | Last Modified: 01/27/2008
284Copy of Medicare ID card.
Start: 01/01/1995
285Vouchers/explanation of benefits (EOB).
Start: 01/01/1995
286Other payer's Explanation of Benefits/payment information.
Start: 01/01/1995
287Medical necessity for service.
Start: 01/01/1995
288Reason for late hospital charges.
Start: 01/01/1995
289Reason for late discharge.
Start: 01/01/1995
290Pre-existing information.
Start: 01/01/1995
291Reason for termination of pregnancy.
Start: 01/01/1995
292Purpose of family conference/therapy.
Start: 01/01/1995
293Reason for physical therapy.
Start: 01/01/1995
294Supporting documentation.
Start: 01/01/1995
295Attending physician report.
Start: 01/01/1995
296Nurse's notes.
Start: 01/01/1995
297Medical notes/report.
Start: 02/28/1997
298Operative report.
Start: 01/01/1995
299Emergency room notes/report.
Start: 01/01/1995
300Lab/test report/notes/results.
Start: 02/28/1997
301MRI report.
Start: 01/01/1995
302Refer to codes 300 for lab notes and 311 for pathology notes
Start: 01/01/1995 | Stop: 01/31/1997
303Physical therapy notes. Use code 297:6O (6 'OH' - not zero)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
304Reports for service.
Start: 01/01/1995
305X-ray reports/interpretation.
Start: 01/01/1995
306Detailed description of service.
Start: 01/01/1995
307Narrative with pocket depth chart.
Start: 01/01/1995
308Discharge summary.
Start: 01/01/1995
309Code was duplicate of code 299
Start: 01/01/1995 | Stop: 01/31/1997
310Progress notes for the six months prior to statement date.
Start: 01/01/1995
311Pathology notes/report.
Start: 01/01/1995
312Dental charting.
Start: 01/01/1995
313Bridgework information.
Start: 01/01/1995
314Dental records for this service.
Start: 01/01/1995
315Past perio treatment history.
Start: 01/01/1995
316Complete medical history.
Start: 01/01/1995
317Patient's medical records.
Start: 01/01/1995
318X-rays.
Start: 01/01/1995
319Pre/post-operative x-rays/photographs.
Start: 02/28/1997
320Study models.
Start: 01/01/1995
321Radiographs or models.
Start: 01/01/1995
322Recent fm x-rays.
Start: 01/01/1995
323Study models, x-rays, and/or narrative.
Start: 01/01/1995
324Recent x-ray of treatment area and/or narrative.
Start: 01/01/1995
325Recent fm x-rays and/or narrative.
Start: 01/01/1995
326Copy of transplant acquisition invoice.
Start: 01/01/1995
327Periodontal case type diagnosis and recent pocket depth chart with narrative.
Start: 01/01/1995
328Speech therapy notes. Use code 297:6R
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
329Exercise notes.
Start: 01/01/1995
330Occupational notes.
Start: 01/01/1995
331History and physical.
Start: 01/01/1995 | Last Modified: 08/01/2007
332Authorization/certification (include period covered). (Use code 252)
Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
333Patient release of information authorization.
Start: 01/01/1995
334Oxygen certification.
Start: 01/01/1995
335Durable medical equipment certification.
Start: 01/01/1995
336Chiropractic certification.
Start: 01/01/1995
337Ambulance certification/documentation.
Start: 01/01/1995
338Home health certification. Use code 332:4Y
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
339Enteral/parenteral certification.
Start: 01/01/1995
340Pacemaker certification.
Start: 01/01/1995
341Private duty nursing certification.
Start: 01/01/1995
342Podiatric certification.
Start: 01/01/1995
343Documentation that facility is state licensed and Medicare approved as a surgical facility.
Start: 01/01/1995
344Documentation that provider of physical therapy is Medicare Part B approved.
Start: 01/01/1995
345Treatment plan for service/diagnosis
Start: 01/01/1995
346Proposed treatment plan for next 6 months.
Start: 01/01/1995
347Refer to code 345 for treatment plan and code 282 for prescription
Start: 01/01/1995 | Stop: 01/31/1997
348Chiropractic treatment plan. (Use 345:QL)
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 01/01/2008
349Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
350Speech pathology treatment plan. Use code 345:6R
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
351Physical/occupational therapy treatment plan. Use codes 345:6O (6 'OH' - not zero), 6N
Start: 01/01/1995 | Last Modified: 07/09/2007 | Stop: 02/28/1997
352Duration of treatment plan.
Start: 01/01/1995
353Orthodontics treatment plan.
Start: 01/01/1995
354Treatment plan for replacement of remaining missing teeth.
Start: 01/01/1995
355Has claim been paid?
Start: 01/01/1995
356Was blood furnished?
Start: 01/01/1995
357Has or will blood be replaced?
Start: 01/01/1995
358Does provider accept assignment of benefits?
Start: 01/01/1995
359Is there a release of information signature on file?
Start: 01/01/1995
360Is there an assignment of benefits signature on file?
Start: 01/01/1995
361Is there other insurance?
Start: 01/01/1995
362Is the dental patient covered by medical insurance?
Start: 01/01/1995
363Will worker's compensation cover submitted charges?
Start: 01/01/1995
364Is accident/illness/condition employment related?
Start: 01/01/1995
365Is service the result of an accident?
Start: 01/01/1995
366Is injury due to auto accident?
Start: 01/01/1995
367Is service performed for a recurring condition or new condition?
Start: 01/01/1995
368Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility?
Start: 01/01/1995
369Does patient condition preclude use of ordinary bed?
Start: 01/01/1995
370Can patient operate controls of bed?
Start: 01/01/1995
371Is patient confined to room?
Start: 01/01/1995
372Is patient confined to bed?
Start: 01/01/1995
373Is patient an insulin diabetic?
Start: 01/01/1995
374Is prescribed lenses a result of cataract surgery?
Start: 01/01/1995
375Was refraction performed?
Start: 01/01/1995
376Was charge for ambulance for a round-trip?
Start: 01/01/1995
377Was durable medical equipment purchased new or used?
Start: 01/01/1995
378Is pacemaker temporary or permanent?
Start: 01/01/1995
379Were services performed supervised by a physician?
Start: 01/01/1995
380Were services performed by a CRNA under appropriate medical direction?
Start: 01/01/1995 | Last Modified: 10/31/1999
381Is drug generic?
Start: 01/01/1995
382Did provider authorize generic or brand name dispensing?
Start: 01/01/1995
383Was nerve block used for surgical procedure or pain management?
Start: 01/01/1995
384Is prosthesis/crown/inlay placement an initial placement or a replacement?
Start: 01/01/1995
385Is appliance upper or lower arch & is appliance fixed or removable?
Start: 01/01/1995
386Is service for orthodontic purposes?
Start: 01/01/1995
387Date patient last examined by entity
Start: 02/28/1997
388Date post-operative care assumed
Start: 02/28/1997
389Date post-operative care relinquished
Start: 02/28/1997
390Date of most recent medical event necessitating service(s)
Start: 02/28/1997
391Date(s) dialysis conducted
Start: 02/28/1997
392Date(s) of blood transfusion(s)
Start: 02/28/1997
393Date of previous pacemaker check
Start: 02/28/1997
394Date(s) of most recent hospitalization related to service
Start: 02/28/1997
395Date entity signed certification/recertification
Start: 02/28/1997
396Date home dialysis began
Start: 02/28/1997
397Date of onset/exacerbation of illness/condition
Start: 02/28/1997
398Visual field test results
Start: 02/28/1997
399Report of prior testing related to this service, including dates
Start: 02/28/1997
400Claim is out of balance
Start: 02/28/1997
401Source of payment is not valid
Start: 02/28/1997
402Amount must be greater than zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 02/28/1997 | Last Modified: 09/20/2009
403Entity referral notes/orders/prescription
Start: 02/28/1997
404Specific findings, complaints, or symptoms necessitating service
Start: 02/28/1997
405Summary of services
Start: 02/28/1997
406Brief medical history as related to service(s)
Start: 02/28/1997
407Complications/mitigating circumstances
Start: 02/28/1997
408Initial certification
Start: 02/28/1997
409Medication logs/records (including medication therapy)
Start: 02/28/1997
410Explain differences between treatment plan and patient's condition
Start: 02/28/1997
411Medical necessity for non-routine service(s)
Start: 02/28/1997
412Medical records to substantiate decision of non-coverage
Start: 02/28/1997
413Explain/justify differences between treatment plan and services rendered.
Start: 02/28/1997
414Need for more than one physician to treat patient
Start: 02/28/1997
415Justify services outside composite rate
Start: 02/28/1997
416Verification of patient's ability to retain and use information
Start: 02/28/1997
417Prior testing, including result(s) and date(s) as related to service(s)
Start: 02/28/1997
418Indicating why medications cannot be taken orally
Start: 02/28/1997
419Individual test(s) comprising the panel and the charges for each test
Start: 02/28/1997
420Name, dosage and medical justification of contrast material used for radiology procedure
Start: 02/28/1997
421Medical review attachment/information for service(s)
Start: 02/28/1997
422Homebound status
Start: 02/28/1997
423Prognosis
Start: 02/28/1997 | Last Modified: 07/09/2007 | Stop: 01/01/2008
424Statement of non-coverage including itemized bill
Start: 02/28/1997
425Itemize non-covered services
Start: 02/28/1997
426All current diagnoses
Start: 02/28/1997
427Emergency care provided during transport
Start: 02/28/1997
428Reason for transport by ambulance
Start: 02/28/1997
429Loaded miles and charges for transport to nearest facility with appropriate services
Start: 02/28/1997
430Nearest appropriate facility
Start: 02/28/1997
431Provide condition/functional status at time of service
Start: 02/28/1997
432Date benefits exhausted
Start: 02/28/1997
433Copy of patient revocation of hospice benefits
Start: 02/28/1997
434Reasons for more than one transfer per entitlement period
Start: 02/28/1997
435Notice of Admission
Start: 02/28/1997
436Short term goals
Start: 02/28/1997
437Long term goals
Start: 02/28/1997
438Number of patients attending session
Start: 02/28/1997
439Size, depth, amount, and type of drainage wounds
Start: 02/28/1997
440why non-skilled caregiver has not been taught procedure
Start: 02/28/1997
441Entity professional qualification for service(s)
Start: 02/28/1997
442Modalities of service
Start: 02/28/1997
443Initial evaluation report
Start: 02/28/1997
444Method used to obtain test sample
Start: 02/28/1997
445Explain why hearing loss not correctable by hearing aid
Start: 02/28/1997
446Documentation from prior claim(s) related to service(s)
Start: 02/28/1997
447Plan of teaching
Start: 02/28/1997
448Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used.
Start: 02/28/1997 | Last Modified: 09/20/2009 | Stop: 04/01/2011
449Projected date to discontinue service(s)
Start: 02/28/1997
450Awaiting spend down determination
Start: 02/28/1997
451Preoperative and post-operative diagnosis
Start: 02/28/1997
452Total visits in total number of hours/day and total number of hours/week
Start: 02/28/1997
453Procedure Code Modifier(s) for Service(s) Rendered
Start: 02/28/1997
454Procedure code for services rendered.
Start: 02/28/1997
455Revenue code for services rendered.
Start: 02/28/1997
456Covered Day(s)
Start: 02/28/1997
457Non-Covered Day(s)
Start: 02/28/1997
458Coinsurance Day(s)
Start: 02/28/1997
459Lifetime Reserve Day(s)
Start: 02/28/1997
460NUBC Condition Code(s)
Start: 02/28/1997
461NUBC Occurrence Code(s) and Date(s)
Start: 02/28/1997
462NUBC Occurrence Span Code(s) and Date(s)
Start: 02/28/1997
463NUBC Value Code(s) and/or Amount(s)
Start: 02/28/1997
464Payer Assigned Claim Control Number
Start: 02/28/1997 | Last Modified: 10/31/2004
465Principal Procedure Code for Service(s) Rendered
Start: 02/28/1997
466Entities Original Signature
Start: 02/28/1997
467Entity Signature Date
Start: 02/28/1997
468Patient Signature Source
Start: 02/28/1997
469Purchase Service Charge
Start: 02/28/1997
470Was service purchased from another entity?
Start: 02/28/1997
471Were services related to an emergency?
Start: 02/28/1997
472Ambulance Run Sheet
Start: 02/28/1997
473Missing or invalid lab indicator
Start: 06/30/1998
474Procedure code and patient gender mismatch
Start: 06/30/1998 | Last Modified: 02/29/2000
475Procedure code not valid for patient age
Start: 06/30/1998 | Last Modified: 02/29/2000
476Missing or invalid units of service
Start: 06/30/1998
477Diagnosis code pointer is missing or invalid
Start: 06/30/1998
478Claim submitter's identifier (patient account number) is missing
Start: 06/30/1998
479Other Carrier payer ID is missing or invalid
Start: 06/30/1998
480Other Carrier Claim filing indicator is missing or invalid
Start: 06/30/1998
481Claim/submission format is invalid.
Start: 10/31/1998
482Date Error, Century Missing
Start: 02/28/1999 | Last Modified: 09/20/2009 | Stop: 10/01/2010
483Maximum coverage amount met or exceeded for benefit period.
Start: 06/30/1999
484Business Application Currently Not Available
Start: 02/29/2000
485More information available than can be returned in real time mode. Narrow your current search criteria.
Start: 02/28/2001
486Principal Procedure Date
Start: 10/31/2001 | Last Modified: 07/01/2009
487Claim not found, claim should have been submitted to/through 'entity'
Start: 02/28/2002
488Diagnosis code(s) for the services rendered.
Start: 06/30/2002
489Attachment Control Number
Start: 10/31/2002
490Other Procedure Code for Service(s) Rendered
Start: 02/28/2003
491Entity not eligible for encounter submission
Start: 02/28/2003
492Other Procedure Date
Start: 02/28/2003
493Version/Release/Industry ID code not currently supported by information holder
Start: 02/28/2003
494Real-Time requests not supported by the information holder, resubmit as batch request
Start: 02/28/2003
495Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit.
Start: 10/31/2003
496Submitter not approved for electronic claim submissions on behalf of this entity
Start: 02/29/2004
497Sales tax not paid
Start: 06/30/2004
498Maximum leave days exhausted
Start: 06/30/2004
499No rate on file with the payer for this service for this entity
Start: 06/30/2004
500Entity's Postal/Zip Code
Start: 06/30/2004
501Entity's State/Province
Start: 06/30/2004
502Entity's City
Start: 06/30/2004
503Entity's Street Address
Start: 06/30/2004
504Entity's Last Name
Start: 06/30/2004
505Entity's First Name
Start: 06/30/2004
506Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse
Start: 06/30/2004
507HCPCS
Start: 10/31/2004
508ICD9 This change to be effective 04/01/2010: ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code.
Start: 10/31/2004 | Last Modified: 07/01/2009
509E-Code
Start: 10/31/2004
510Future date. This change to be effective 7/1/2010: Future date. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
511Invalid character. This change to be effective 7/1/2010: Invalid character. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
512Length invalid for receiver's application system. This change to be effective 7/1/2010: Length invalid for receiver's application system. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
513HIPPS Rate Code for services Rendered
Start: 10/31/2004
514Entities Middle Name
Start: 10/31/2004
515Managed Care review
Start: 10/31/2004
516Adjudication or Payment Date. This change to be effective 7/1/2010: Other Entity's Adjudication or Payment/Remittance Date. Note: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary.
Start: 10/31/2004 | Last Modified: 11/29/2009
517Adjusted Repriced Claim Reference Number
Start: 10/31/2004
518Adjusted Repriced Line item Reference Number
Start: 10/31/2004
519Adjustment Amount
Start: 10/31/2004
520Adjustment Quantity
Start: 10/31/2004
521Adjustment Reason Code
Start: 10/31/2004
522Anesthesia Modifying Units
Start: 10/31/2004
523Anesthesia Unit Count
Start: 10/31/2004
524Arterial Blood Gas Quantity
Start: 10/31/2004
525Begin Therapy Date
Start: 10/31/2004
526Bundled or Unbundled Line Number
Start: 10/31/2004
527Certification Condition Indicator
Start: 10/31/2004
528Certification Period Projected Visit Count
Start: 10/31/2004
529Certification Revision Date
Start: 10/31/2004
530Claim Adjustment Indicator
Start: 10/31/2004
531Claim Disproportinate Share Amount
Start: 10/31/2004
532Claim DRG Amount
Start: 10/31/2004
533Claim DRG Outlier Amount
Start: 10/31/2004
534Claim ESRD Payment Amount
Start: 10/31/2004
535Claim Frequency Code
Start: 10/31/2004
536Claim Indirect Teaching Amount
Start: 10/31/2004
537Claim MSP Pass-through Amount
Start: 10/31/2004
538Claim or Encounter Identifier
Start: 10/31/2004
539Claim PPS Capital Amount
Start: 10/31/2004
540Claim PPS Capital Outlier Amount
Start: 10/31/2004
541Claim Submission Reason Code
Start: 10/31/2004
542Claim Total Denied Charge Amount
Start: 10/31/2004
543Clearinghouse or Value Added Network Trace
Start: 10/31/2004
544Clinical Laboratory Improvement Amendment
Start: 10/31/2004
545Contract Amount
Start: 10/31/2004
546Contract Code
Start: 10/31/2004
547Contract Percentage
Start: 10/31/2004
548Contract Type Code
Start: 10/31/2004
549Contract Version Identifier
Start: 10/31/2004
550Coordination of Benefits Code
Start: 10/31/2004
551Coordination of Benefits Total Submitted Charge
Start: 10/31/2004
552Cost Report Day Count
Start: 10/31/2004
553Covered Amount
Start: 10/31/2004
554Date Claim Paid
Start: 10/31/2004
555Delay Reason Code
Start: 10/31/2004
556Demonstration Project Identifier
Start: 10/31/2004
557Diagnosis Date
Start: 10/31/2004
558Discount Amount
Start: 10/31/2004
559Document Control Identifier
Start: 10/31/2004
560Entity's Additional/Secondary Identifier
Start: 10/31/2004
561Entity's Contact Name
Start: 10/31/2004
562Entity's National Provider Identifier (NPI)
Start: 10/31/2004
563Entity's Tax Amount
Start: 10/31/2004
564EPSDT Indicator
Start: 10/31/2004
565Estimated Claim Due Amount
Start: 10/31/2004
566Exception Code
Start: 10/31/2004
567Facility Code Qualifier
Start: 10/31/2004
568Family Planning Indicator
Start: 10/31/2004
569Fixed Format Information
Start: 10/31/2004
570Free Form Message Text
Start: 10/31/2004
571Frequency Count
Start: 10/31/2004
572Frequency Period
Start: 10/31/2004
573Functional Limitation Code
Start: 10/31/2004
574HCPCS Payable Amount Home Health
Start: 10/31/2004
575Homebound Indicator
Start: 10/31/2004
576Immunization Batch Number
Start: 10/31/2004
577Industry Code
Start: 10/31/2004
578Insurance Type Code
Start: 10/31/2004
579Investigational Device Exemption Identifier
Start: 10/31/2004
580Last Certification Date
Start: 10/31/2004
581Last Worked Date
Start: 10/31/2004
582Lifetime Psychiatric Days Count
Start: 10/31/2004
583Line Item Charge Amount
Start: 10/31/2004
584Line Item Control Number
Start: 10/31/2004
585Denied Charge or Non-covered Charge
Start: 10/31/2004 | Last Modified: 07/09/2007
586Line Note Text
Start: 10/31/2004
587Measurement Reference Identification Code
Start: 10/31/2004
588Medical Record Number
Start: 10/31/2004
589Medicare Assignment Code
Start: 10/31/2004
590Medicare Coverage Indicator
Start: 10/31/2004
591Medicare Paid at 100% Amount
Start: 10/31/2004
592Medicare Paid at 80% Amount
Start: 10/31/2004
593Medicare Section 4081 Indicator
Start: 10/31/2004
594Mental Status Code
Start: 10/31/2004
595Monthly Treatment Count
Start: 10/31/2004
596Non-covered Charge Amount
Start: 10/31/2004
597Non-payable Professional Component Amount
Start: 10/31/2004
598Non-payable Professional Component Billed Amount
Start: 10/31/2004
599Note Reference Code
Start: 10/31/2004
600Oxygen Saturation Qty
Start: 10/31/2004
601Oxygen Test Condition Code
Start: 10/31/2004
602Oxygen Test Date
Start: 10/31/2004
603Old Capital Amount
Start: 10/31/2004
604Originator Application Transaction Identifier
Start: 10/31/2004
605Orthodontic Treatment Months Count
Start: 10/31/2004
606Paid From Part A Medicare Trust Fund Amount
Start: 10/31/2004
607Paid From Part B Medicare Trust Fund Amount
Start: 10/31/2004
608Paid Service Unit Count
Start: 10/31/2004
609Participation Agreement
Start: 10/31/2004
610Patient Discharge Facility Type Code
Start: 10/31/2004
611Peer Review Authorization Number
Start: 10/31/2004
612Per Day Limit Amount
Start: 10/31/2004
613Physician Contact Date
Start: 10/31/2004
614Physician Order Date
Start: 10/31/2004
615Policy Compliance Code
Start: 10/31/2004
616Policy Name
Start: 10/31/2004
617Postage Claimed Amount
Start: 10/31/2004
618PPS-Capital DSH DRG Amount
Start: 10/31/2004
619PPS-Capital Exception Amount
Start: 10/31/2004
620PPS-Capital FSP DRG Amount
Start: 10/31/2004
621PPS-Capital HSP DRG Amount
Start: 10/31/2004
622PPS-Capital IME Amount
Start: 10/31/2004
623PPS-Operating Federal Specific DRG Amount
Start: 10/31/2004
624PPS-Operating Hospital Specific DRG Amount
Start: 10/31/2004
625Predetermination of Benefits Identifier
Start: 10/31/2004
626Pregnancy Indicator
Start: 10/31/2004
627Pre-Tax Claim Amount
Start: 10/31/2004
628Pricing Methodology
Start: 10/31/2004
629Property Casualty Claim Number
Start: 10/31/2004
630Referring CLIA Number
Start: 10/31/2004
631Reimbursement Rate
Start: 10/31/2004
632Reject Reason Code
Start: 10/31/2004
633Related Causes Code
Start: 10/31/2004
634Remark Code
Start: 10/31/2004
635Repriced Approved Ambulatory Patient Group
Start: 10/31/2004
636Repriced Line Item Reference Number
Start: 10/31/2004
637Repriced Saving Amount
Start: 10/31/2004
638Repricing Per Diem or Flat Rate Amount
Start: 10/31/2004
639Responsibility Amount
Start: 10/31/2004
640Sales Tax Amount
Start: 10/31/2004
641Service Adjudication or Payment Date. Note: Use code 516.
Start: 10/31/2004 | Last Modified: 09/20/2009 | Stop: 10/01/2010
642Service Authorization Exception Code
Start: 10/31/2004
643Service Line Paid Amount
Start: 10/31/2004
644Service Line Rate
Start: 10/31/2004
645Service Tax Amount
Start: 10/31/2004
646Ship, Delivery or Calendar Pattern Code
Start: 10/31/2004
647Shipped Date
Start: 10/31/2004
648Similar Illness or Symptom Date
Start: 10/31/2004
649Skilled Nursing Facility Indicator
Start: 10/31/2004
650Special Program Indicator
Start: 10/31/2004
651State Industrial Accident Provider Number
Start: 10/31/2004
652Terms Discount Percentage
Start: 10/31/2004
653Test Performed Date
Start: 10/31/2004
654Total Denied Charge Amount
Start: 10/31/2004
655Total Medicare Paid Amount
Start: 10/31/2004
656Total Visits Projected This Certification Count
Start: 10/31/2004
657Total Visits Rendered Count
Start: 10/31/2004
658Treatment Code
Start: 10/31/2004
659Unit or Basis for Measurement Code
Start: 10/31/2004
660Universal Product Number
Start: 10/31/2004
661Visits Prior to Recertification Date Count CR702
Start: 10/31/2004
662X-ray Availability Indicator
Start: 10/31/2004
663Entity's Group Name
Start: 10/31/2004
664Orthodontic Banding Date
Start: 10/31/2004
665Surgery Date
Start: 10/31/2004
666Surgical Procedure Code
Start: 10/31/2004
667Real-Time requests not supported by the information holder, do not resubmit
Start: 02/28/2005
668Missing Endodontics treatment history and prognosis
Start: 06/30/2005
669Dental service narrative needed.
Start: 10/31/2005
670Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts
Start: 06/30/2006 | Last Modified: 02/28/2007
671Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts
Start: 06/30/2006 | Last Modified: 02/28/2007
672Other Payer's payment information is out of balance
Start: 10/31/2006
673Patient Reason for Visit
Start: 10/31/2006
674Authorization exceeded
Start: 10/31/2006
675Facility admission through discharge dates
Start: 10/31/2006
676Entity possibly compensated by facility
Start: 10/31/2006
677Entity not affiliated
Start: 10/31/2006
678Revenue code and patient gender mismatch
Start: 10/31/2006
679Submit newborn services on mother's claim
Start: 10/31/2006
680Entity's Country
Start: 10/31/2006
681Claim currency not supported
Start: 10/31/2006
682Cosmetic procedure
Start: 02/28/2007
683Awaiting Associated Hospital Claims
Start: 02/28/2007
684Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Note: Only for use to reject claims or status requests in transactions that were 'accepted with errors' on a 997 or 999 Acknowledgement.)
Start: 11/05/2007
685Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit.
Start: 01/27/2008
686The claim/ encounter has completed the adjudication cycle and the entire claim has been voided
Start: 01/27/2008
687Claim estimation can not be completed in real time. Do not resubmit.
Start: 01/27/2008
688Present on Admission Indicator for reported diagnosis code(s).
Start: 01/27/2008
689Entity was unable to respond within the expected time frame.
Start: 06/01/2008
690Multiple claims or estimate requests cannot be processed in real time.
Start: 06/01/2008
691Multiple claim status requests cannot be processed in real time.
Start: 06/01/2008
692Contracted funding agreement-Subscriber is employed by the provider of services
Start: 09/21/2008
693Amount must be greater than or equal to zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 01/25/2009
694Amount must not be equal to zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 01/25/2009
695Entity's Country Subdivision Code.
Start: 01/25/2009
696Claim Adjustment Group Code.
Start: 01/25/2009
697Invalid Decimal Precision. Note: At least one other status code is required to identify the data element in error.
Start: 07/01/2009
698Form Type Identification
Start: 07/01/2009
699Question/Response from Supporting Documentation Form
Start: 07/01/2009
700ICD10. Note: At least one other status code is required to identify the related procedure code or diagnosis code.
Start: 07/01/2009
701Initial Treatment Date
Start: 07/01/2009
702Repriced Claim Reference Number
Start: 11/01/2009
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