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Remittance Advice Remark Codes • ASC X12 External Code Source 411LAST UPDATED 11/1/2014

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. Each RARC identifies a specific message as shown in the Remittance Advice Remark Code List. There are two types of RARCs, supplemental and informational. The majority of the RARCs are supplemental; these are generally referred to as RARCs without further distinction. Supplemental RARCs provide additional explanation for an adjustment already described by a CARC. The second type of RARC is informational; these RARCs are all prefaced with Alert: and are often referred to as Alerts. Alerts are used to convey information about remittance processing and are never related to a specific adjustment or CARC.

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Schedule
The Remittance Advice Remark Code List is updated tri-annually in March, July, and November.

M1X-ray not taken within the past 12 months or near enough to the start of treatment.
Start: 01/01/1997
M2Not paid separately when the patient is an inpatient.
Start: 01/01/1997
M3Equipment is the same or similar to equipment already being used.
Start: 01/01/1997
M4Alert: This is the last monthly installment payment for this durable medical equipment.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M5Monthly 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.
Start: 01/01/1997
M6Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
Start: 01/01/1997 | Last Modified: 03/01/2009
Notes: (Modified 4/1/07, 3/1/2009)
M7No rental payments after the item is purchased, or after the total of issued rental payments equals the purchase price.
Start: 01/01/1997
M8We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
Start: 01/01/1997
M9Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M10Equipment purchases are limited to the first or the tenth month of medical necessity.
Start: 01/01/1997
M11DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code.
Start: 01/01/1997
M12Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
Start: 01/01/1997
M13Only one initial visit is covered per specialty per medical group.
Start: 01/01/1997 | Last Modified: 06/30/2007
Notes: (Modified 6/30/03)
M14No 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.
Start: 01/01/1997
M15Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
Start: 01/01/1997
M16Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Reactivated 4/1/04, Modified 11/18/05, 4/1/07)
M17Alert: 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 patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M18Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient's home.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M19Missing oxygen certification/re-certification.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N234
M20Missing/incomplete/invalid HCPCS.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M21Missing/incomplete/invalid place of residence for this service/item provided in a home.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M22Missing/incomplete/invalid number of miles traveled.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M23Missing invoice.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
M24Missing/incomplete/invalid number of doses per vial.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M25The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
Start: 01/01/1997 | Last Modified: 11/01/2010
Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07, 11/1/10)
M26The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service /any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice.

The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356)
M27Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient's waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07)
M28This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
Start: 01/01/1997
M29Missing operative note/report.
Start: 01/01/1997 | Last Modified: 07/01/2008
Notes: (Modified 2/28/03, 7/1/2008) Related to N233
M30Missing pathology report.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 2/28/03) Related to N236
M31Missing radiology report.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 2/28/03) Related to N240
M32Alert: This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
M33Missing/incomplete/invalid UPIN for the ordering/referring/performing provider.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using M68
M34Claim lacks the CLIA certification number.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA120
M35Missing/incomplete/invalid pre-operative photos or visual field results.
Start: 01/01/1997 | Stop: 02/05/2005
Notes: Consider using N178
M36This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase.
Start: 01/01/1997
M37Not covered when the patient is under age 35.
Start: 01/01/1997 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
M38The patient is liable for the charges for this service as you informed the patient in writing before the service was furnished that we would not pay for it, and the patient agreed to pay.
Start: 01/01/1997
M39The patient is not liable for payment for this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.
Start: 01/01/1997 | Last Modified: 11/01/2012
Notes: (Modified 2/1/04, 4/1/07, 11/1/09, 11/1/12) Related to N563
M40Claim must be assigned and must be filed by the practitioner's employer.
Start: 01/01/1997
M41We do not pay for this as the patient has no legal obligation to pay for this.
Start: 01/01/1997
M42The medical necessity form must be personally signed by the attending physician.
Start: 01/01/1997
M43Payment for this service previously issued to you or another provider by another carrier/intermediary.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using Reason Code 23
M44Missing/incomplete/invalid condition code.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M45Missing/incomplete/invalid occurrence code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N299
M46Missing/incomplete/invalid occurrence span code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N300
M47Missing/incomplete/invalid internal or document control number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M48Payment for services furnished to hospital inpatients (other than professional services of physicians) can only be made to the hospital. You must request payment from the hospital rather than the patient for this service.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M97
M49Missing/incomplete/invalid value code(s) or amount(s).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M50Missing/incomplete/invalid revenue code(s).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M51Missing/incomplete/invalid procedure code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N301
M52Missing/incomplete/invalid “from” date(s) of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M53Missing/incomplete/invalid days or units of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M54Missing/incomplete/invalid total charges.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M55We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
Start: 01/01/1997
M56Missing/incomplete/invalid payer identifier.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M57Missing/incomplete/invalid provider identifier.
Start: 01/01/1997 | Stop: 06/02/2005
M58Missing/incomplete/invalid claim information. Resubmit claim after corrections.
Start: 01/01/1997 | Stop: 02/05/2005
M59Missing/incomplete/invalid “to” date(s) of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M60Missing Certificate of Medical Necessity.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 6/30/03) Related to N227
M61We cannot pay for this as the approval period for the FDA clinical trial has expired.
Start: 01/01/1997
M62Missing/incomplete/invalid treatment authorization code.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M63We do not pay for more than one of these on the same day.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M86
M64Missing/incomplete/invalid other diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M65One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.
Start: 01/01/1997
M66Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items.
Start: 01/01/1997
M67Missing/incomplete/invalid other procedure code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N302
M68Missing/incomplete/invalid attending, ordering, rendering, supervising or referring physician identification.
Start: 01/01/1997 | Stop: 06/02/2005
M69Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
M70Alert: 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 item.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/2007, 8/1/07)
M71Total payment reduced due to overlap of tests billed.
Start: 01/01/1997
M72Did not enter full 8-digit date (MM/DD/CCYY).
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA52
M73The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04)
M74This service does not qualify for a HPSA/Physician Scarcity bonus payment.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
M75Multiple automated multichannel tests performed on the same day combined for payment.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M76Missing/incomplete/invalid diagnosis or condition.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M77Missing/incomplete/invalid/inappropriate place of service.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/28/03, 3/1/2014, 3/14/2014)
M78Missing/incomplete/invalid HCPCS modifier.
Start: 01/01/1997 | Stop: 05/18/2006 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03,) Consider using Reason Code 4
M79Missing/incomplete/invalid charge.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M80Not covered when performed during the same session/date as a previously processed service for the patient.
Start: 01/01/1997 | Last Modified: 10/31/2002
Notes: (Modified 10/31/02)
M81You are required to code to the highest level of specificity.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
M82Service is not covered when patient is under age 50.
Start: 01/01/1997
M83Service is not covered unless the patient is classified as at high risk.
Start: 01/01/1997
M84Medical code sets used must be the codes in effect at the time of service.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/1/04, 3/14/2014)
M85Subjected to review of physician evaluation and management services.
Start: 01/01/1997
M86Service denied because payment already made for same/similar procedure within set time frame.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M87Claim/service(s) subjected to CFO-CAP prepayment review.
Start: 01/01/1997
M88We cannot pay for laboratory tests unless billed by the laboratory that did the work.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using Reason Code B20
M89Not covered more than once under age 40.
Start: 01/01/1997
M90Not covered more than once in a 12 month period.
Start: 01/01/1997
M91Lab procedures with different CLIA certification numbers must be billed on separate claims.
Start: 01/01/1997
M92Services subjected to review under the Home Health Medical Review Initiative.
Start: 01/01/1997 | Stop: 08/01/2004
M93Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.
Start: 01/01/1997
M94Information supplied does not support a break in therapy. A new capped rental period will not begin.
Start: 01/01/1997
M95Services subjected to Home Health Initiative medical review/cost report audit.
Start: 01/01/1997
M96The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.
Start: 01/01/1997
M97Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
Start: 01/01/1997
M98Begin to report the Universal Product Number on claims for items of this type. We will soon begin to deny payment for items of this type if billed without the correct UPN.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M99
M99Missing/incomplete/invalid Universal Product Number/Serial Number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M100We 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 chemotherapy drug.
Start: 01/01/1997
M101Begin to report a G1-G5 modifier with this HCPCS. We will soon begin to deny payment for this service if billed without a G1-G5 modifier.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M78
M102Service not performed on equipment approved by the FDA for this purpose.
Start: 01/01/1997
M103Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.
Start: 01/01/1997
M104Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.
Start: 01/01/1997
M105Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.
Start: 01/01/1997
M106Information supplied does not support a break in therapy. A new capped rental period will not begin. This is the maximum approved under the fee schedule for this item or service.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using MA 31
M107Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
Start: 01/01/1997
M108Missing/incomplete/invalid provider identifier for the provider who interpreted the diagnostic test.
Start: 01/01/1997 | Stop: 06/02/2005
M109We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
Start: 01/01/1997
M110Missing/incomplete/invalid provider identifier for the provider from whom you purchased interpretation services.
Start: 01/01/1997 | Stop: 06/02/2005
M111We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
Start: 01/01/1997
M112Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M113Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
M114This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 8/1/06, 11/5/07)
M115This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/2007)
M116Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.
Start: 01/01/1997 | Last Modified: 03/08/2011
Notes: (Modified 2/1/04, 3/15/11)
M117Not covered unless submitted via electronic claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M118Letter to follow containing further information.
Start: 01/01/1997 | Stop: 01/01/2011 | Last Modified: 11/01/2009
Notes: Consider using N202
M119Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 2/28/03, 4/1/04)
M120Missing/incomplete/invalid provider identifier for the substituting physician who furnished the service(s) under a reciprocal billing or locum tenens arrangement.
Start: 01/01/1997 | Stop: 06/02/2005
M121We pay for this service only when performed with a covered cryosurgical ablation.
Start: 01/01/1997
M122Missing/incomplete/invalid level of subluxation.
Start: 01/01/1997 | Last Modified: 02/28/2006
Notes: (Modified 2/28/03)
M123Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M124Missing indication of whether the patient owns the equipment that requires the part or supply.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N230
M125Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M126Missing/incomplete/invalid individual lab codes included in the test.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M127Missing patient medical record for this service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N237
M128Missing/incomplete/invalid date of the patient’s last physician visit.
Start: 01/01/1997 | Stop: 06/02/2005
M129Missing/incomplete/invalid indicator of x-ray availability for review.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 2/28/03, 6/30/03)
M130Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N231
M131Missing physician financial relationship form.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N239
M132Missing pacemaker registration form.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N235
M133Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
Start: 01/01/1997
M134Performed by a facility/supplier in which the provider has a financial interest.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
M135Missing/incomplete/invalid plan of treatment.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M136Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
M137Part B coinsurance under a demonstration project or pilot program.
Start: 01/01/1997 | Last Modified: 11/01/2012
Notes: (Modified 11/1/12)
M138Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants.
Start: 01/01/1997
M139Denied services exceed the coverage limit for the demonstration.
Start: 01/01/1997
M140Service not covered until after the patient’s 50th birthday, i.e., no coverage prior to the day after the 50th birthday
Start: 01/01/1997 | Stop: 01/30/2004
Notes: Consider using M82
M141Missing physician certified plan of care.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N238
M142Missing American Diabetes Association Certificate of Recognition.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N226
M143The provider must update license information with the payer.
Start: 01/01/1997 | Last Modified: 12/01/2006
Notes: (Modified 12/1/06)
M144Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
Start: 01/01/1997
MA01Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07)
MA02Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07)
MA03If 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 the date of this notice. To meet the $100, you may combine amounts on other claims that have been denied, including reopened appeals if you received a revised decision. You must appeal each claim on time.
Start: 01/01/1997 | Stop: 10/01/2006 | Last Modified: 11/18/2005
Notes: Consider using MA02 (Modified 10/31/02, 6/30/03, 8/1/05, 11/18/05)
MA04Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
Start: 01/01/1997
MA05Incorrect admission date patient status or type of bill entry on claim.
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA30, MA40 or MA43
MA06Missing/incomplete/invalid beginning and/or ending date(s).
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA31
MA07Alert: The claim information has also been forwarded to Medicaid for review.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA08Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA09Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.
Start: 01/01/1997 | Last Modified: 11/01/2014
MA10Alert: The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA11Payment is being issued on a conditional basis. If no-fault insurance, liability insurance, Workers' Compensation, Department of Veterans Affairs, or a group health plan for employees and dependents also covers this claim, a refund may be due us. Please contact us if the patient is covered by any of these sources.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M32
MA12You 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).
Start: 01/01/1997
MA13Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA14Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/07, 8/1/07)
MA15Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA16The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.
Start: 01/01/1997
MA17We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment.
Start: 01/01/1997
MA18Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA19Alert: Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondary claim directly to that insurer.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA20Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA21SSA records indicate mismatch with name and sex.
Start: 01/01/1997
MA22Payment of less than $1.00 suppressed.
Start: 01/01/1997
MA23Demand bill approved as result of medical review.
Start: 01/01/1997
MA24Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA25A patient may not elect to change a hospice provider more than once in a benefit period.
Start: 01/01/1997
MA26Alert: Our records indicate that you were previously informed of this rule.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA27Missing/incomplete/invalid entitlement number or name shown on the claim.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA28Alert: 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 party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA29Missing/incomplete/invalid provider name, city, state, or zip code.
Start: 01/01/1997 | Stop: 06/02/2005
MA30Missing/incomplete/invalid type of bill.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA31Missing/incomplete/invalid beginning and ending dates of the period billed.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA32Missing/incomplete/invalid number of covered days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA33Missing/incomplete/invalid noncovered days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA34Missing/incomplete/invalid number of coinsurance days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA35Missing/incomplete/invalid number of lifetime reserve days.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA36Missing/incomplete/invalid patient name.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA37Missing/incomplete/invalid patient's address.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA38Missing/incomplete/invalid birth date.
Start: 01/01/1997 | Stop: 06/02/2005
MA39Missing/incomplete/invalid gender.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA40Missing/incomplete/invalid admission date.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA41Missing/incomplete/invalid admission type.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA42Missing/incomplete/invalid admission source.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA43Missing/incomplete/invalid patient status.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA44Alert: No appeal rights. Adjudicative decision based on law.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA45Alert: As previously advised, a portion or all of your payment is being held in a special account.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA46The new information was considered but additional payment will not be issued.
Start: 01/01/1997 | Last Modified: 03/01/2009
Notes: (Modified 3/1/2009)
MA47Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.
Start: 01/01/1997
MA48Missing/incomplete/invalid name or address of responsible party or primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA49Missing/incomplete/invalid six-digit provider identifier for home health agency or hospice for physician(s) performing care plan oversight services.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA76
MA50Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.
Start: 01/01/1997 | Last Modified: 03/01/2014
Notes: (Modified 2/28/03, 3/1/2014)
MA51Missing/incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory.
Start: 01/01/1997 | Stop: 02/05/2005
Notes: Consider using MA120
MA52Missing/incomplete/invalid date.
Start: 01/01/1997 | Stop: 06/02/2005
MA53Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
MA54Physician certification or election consent for hospice care not received timely.
Start: 01/01/1997
MA55Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
Start: 01/01/1997
MA56Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.
Start: 01/01/1997
MA57Patient submitted written request to revoke his/her election for religious non-medical health care services.
Start: 01/01/1997
MA58Missing/incomplete/invalid release of information indicator.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA59Alert: The patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA60Missing/incomplete/invalid patient relationship to insured.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA61Missing/incomplete/invalid social security number or health insurance claim number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA62Alert: This is a telephone review decision.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/07, 8/1/07)
MA63Missing/incomplete/invalid principal diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA64Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
Start: 01/01/1997
MA65Missing/incomplete/invalid admitting diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA66Missing/incomplete/invalid principal procedure code.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N303
MA67Correction to a prior claim.
Start: 01/01/1997
MA68Alert: We did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to assure correct and timely routing of the claim.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA69Missing/incomplete/invalid remarks.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA70Missing/incomplete/invalid provider representative signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA71Missing/incomplete/invalid provider representative signature date.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA72Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA73Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.
Start: 01/01/1997
MA74This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
Start: 01/01/1997
MA75Missing/incomplete/invalid patient or authorized representative signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA76Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03, 2/1/04)
MA77Alert: The patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient’s payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA78The patient overpaid you. You must issue the patient a refund within 30 days for the difference between our allowed amount total and the amount paid by the patient.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using MA59
MA79Billed in excess of interim rate.
Start: 01/01/1997
MA80Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project.
Start: 01/01/1997
MA81Missing/incomplete/invalid provider/supplier signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA82Missing/incomplete/invalid provider/supplier billing number/identifier or billing name, address, city, state, zip code, or phone number.
Start: 01/01/1997 | Stop: 06/02/2005
MA83Did not indicate whether we are the primary or secondary payer.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
MA84Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.
Start: 01/01/1997
MA85Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance plan/group/program name or identification number. Enter the PlanID when effective.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA86Missing/incomplete/invalid group or policy number of the insured for the primary coverage.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA87Missing/incomplete/invalid insured's name for the primary payer.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA88Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA89Missing/incomplete/invalid patient's relationship to the insured for the primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA90Missing/incomplete/invalid employment status code for the primary insured.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03).
MA91This determination is the result of the appeal you filed.
Start: 01/01/1997
MA92Missing plan information for other insurance.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04) Related to N245
MA93Non-PIP (Periodic Interim Payment) claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA94Did 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 hospice.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Reactivated 4/1/04, Modified 8/1/05)
MA95A not otherwise classified or unlisted procedure code(s) was billed but a narrative description of the procedure was not entered on the claim. Refer to item 19 on the HCFA-1500.
Start: 01/01/1997 | Stop: 01/01/2004 | Last Modified: 02/28/2003
Notes: (Deactivated 2/28/2003) (Erroneous description corrected 9/2/2008) Consider using M51
MA96Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
Start: 01/01/1997
MA97Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
Start: 01/01/1997 | Last Modified: 02/29/2008
Notes: (Modified 2/29/08)
MA98Claim Rejected. Does not contain the correct Medicare Managed Care Demonstration contract number for this beneficiary.
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA97
MA99Missing/incomplete/invalid Medigap information.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA100Missing/incomplete/invalid date of current illness or symptoms.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/28/03, 3/30/05, 3/14/2014)
MA101A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents.
Start: 01/01/1997 | Stop: 01/01/2011 | Last Modified: 06/30/2003
Notes: Consider using N538
MA102Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using M68
MA103Hemophilia Add On.
Start: 01/01/1997
MA104Missing/incomplete/invalid date the patient was last seen or the provider identifier of the attending physician.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M128 or M57
MA105Missing/incomplete/invalid provider number for this place of service.
Start: 01/01/1997 | Stop: 06/02/2005
MA106PIP (Periodic Interim Payment) claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA107Paper claim contains more than three separate data items in field 19.
Start: 01/01/1997
MA108Paper claim contains more than one data item in field 23.
Start: 01/01/1997
MA109Claim processed in accordance with ambulatory surgical guidelines.
Start: 01/01/1997
MA110Missing/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.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA111Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA112Missing/incomplete/invalid group practice information.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA113Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.
Start: 01/01/1997
MA114Missing/incomplete/invalid information on where the services were furnished.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA115Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA116Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.
Start: 01/01/1997
Notes: (Reactivated 4/1/04)
MA117This claim has been assessed a $1.00 user fee.
Start: 01/01/1997
MA118Alert: No Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance and/or deductible are applicable.
Start: 01/01/1997 | Last Modified: 11/01/2014
MA119Provider level adjustment for late claim filing applies to this claim.
Start: 01/01/1997 | Stop: 05/01/2008 | Last Modified: 11/05/2007
Notes: Consider using Reason Code B4
MA120Missing/incomplete/invalid CLIA certification number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA121Missing/incomplete/invalid x-ray date.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
MA122Missing/incomplete/invalid initial treatment date.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
MA123Your center was not selected to participate in this study, therefore, we cannot pay for these services.
Start: 01/01/1997
MA124Processed for IME only.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using Reason Code 74
MA125Per legislation governing this program, payment constitutes payment in full.
Start: 01/01/1997
MA126Pancreas transplant not covered unless kidney transplant performed.
Start: 10/12/2001
MA127Reserved for future use.
Start: 10/12/2001 | Stop: 06/02/2005
MA128Missing/incomplete/invalid FDA approval number.
Start: 10/12/2001 | Last Modified: 03/30/2005
Notes: (Modified 2/28/03, 3/30/05)
MA129This provider was not certified for this procedure on this date of service.
Start: 10/12/2001 | Stop: 01/31/2004 | Last Modified: 01/31/2004
Notes: Consider using MA120 and Reason Code B7
MA130Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
Start: 10/12/2001
MA131Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim.
Start: 10/12/2001
MA132Adjustment to the pre-demonstration rate.
Start: 10/12/2001
MA133Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
Start: 10/12/2001
MA134Missing/incomplete/invalid provider number of the facility where the patient resides.
Start: 10/12/2001
N1Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract, plan benefit documents or jurisdiction statutes.
Start: 01/01/2000 | Last Modified: 07/15/2013
Notes: (Modified 2/28/03, 4/1/07, 7/15/13)
N2This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
Start: 01/01/2000
N3Missing consent form.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N228
N4Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.
Start: 01/01/2000 | Last Modified: 03/06/2012
Notes: (Modified 2/28/03, 3/6/2012)
N5EOB received from previous payer. Claim not on file.
Start: 01/01/2000
N6Under 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 A and/or Medicare Part B.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N7Alert: Processing of this claim/service has included consideration under Major Medical provisions.
Start: 01/01/2000 | Last Modified: 07/15/2013
Notes: (Modified 7/15/13)
N8Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
Start: 01/01/2000
N9Adjustment represents the estimated amount a previous payer may pay.
Start: 01/01/2000 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)
N10Payment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.
Start: 01/01/2000 | Last Modified: 07/15/2013
Notes: (Modified 10/31/02, 7/1/08, 7/15/13)
N11Denial reversed because of medical review.
Start: 01/01/2000
N12Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.
Start: 01/01/2000 | Last Modified: 08/01/2007
Notes: (Modified 8/1/07)
N13Payment based on professional/technical component modifier(s).
Start: 01/01/2000
N14Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount.
Start: 01/01/2000 | Stop: 10/01/2007
Notes: Consider using Reason Code 45
N15Services for a newborn must be billed separately.
Start: 01/01/2000
N16Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
Start: 01/01/2000
N17Per admission deductible.
Start: 01/01/2000 | Stop: 08/01/2004
Notes: Consider using Reason Code 1
N18Payment based on the Medicare allowed amount.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using N14
N19Procedure code incidental to primary procedure.
Start: 01/01/2000
N20Service not payable with other service rendered on the same date.
Start: 01/01/2000
N21Alert: Your line item has been separated into multiple lines to expedite handling.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 8/1/05, 4/1/07)
N22This procedure code was added/changed because it more accurately describes the services rendered.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 10/31/02, 2/28/03)
N23Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 8/13/01, 4/1/07)
N24Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N25This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan.
Start: 01/01/2000
N26Missing itemized bill/statement.
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 2/28/03, 7/1/2008) Related to N232
N27Missing/incomplete/invalid treatment number.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N28Consent form requirements not fulfilled.
Start: 01/01/2000
N29Missing documentation/orders/notes/summary/report/chart.
Start: 01/01/2000 | Stop: 03/01/2016 | Last Modified: 03/01/2014
Notes: (Modified 2/28/03, 8/1/05, 3/1/2014) Related to N225, Explicit RARCs have been approved, this non-specific RARC will be deactivated in March 2016.
N30Patient ineligible for this service.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N31Missing/incomplete/invalid prescribing provider identifier.
Start: 01/01/2000 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
N32Claim must be submitted by the provider who rendered the service.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N33No record of health check prior to initiation of treatment.
Start: 01/01/2000
N34Incorrect claim form/format for this service.
Start: 01/01/2000 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)
N35Program integrity/utilization review decision.
Start: 01/01/2000
N36Claim must meet primary payer’s processing requirements before we can consider payment.
Start: 01/01/2000
N37Missing/incomplete/invalid tooth number/letter.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N38Missing/incomplete/invalid place of service.
Start: 01/01/2000 | Stop: 02/05/2005
Notes: Consider using M77
N39Procedure code is not compatible with tooth number/letter.
Start: 01/01/2000
N40Missing radiology film(s)/image(s).
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 2/1/04, 7/1/08) Related to N242
N41Authorization request denied.
Start: 01/01/2000 | Stop: 10/16/2003
Notes: Consider using Reason Code 39
N42Missing mental health assessment.
Start: 01/01/2000 | Last Modified: 11/01/2014
N43Bed hold or leave days exceeded.
Start: 01/01/2000
N44Payer’s share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority.
Start: 01/01/2000 | Stop: 10/16/2003
Notes: Consider using Reason Code 137
N45Payment based on authorized amount.
Start: 01/01/2000
N46Missing/incomplete/invalid admission hour.
Start: 01/01/2000
N47Claim conflicts with another inpatient stay.
Start: 01/01/2000
N48Claim information does not agree with information received from other insurance carrier.
Start: 01/01/2000
N49Court ordered coverage information needs validation.
Start: 01/01/2000
N50Missing/incomplete/invalid discharge information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N51Electronic interchange agreement not on file for provider/submitter.
Start: 01/01/2000
N52Patient not enrolled in the billing provider's managed care plan on the date of service.
Start: 01/01/2000
N53Missing/incomplete/invalid point of pick-up address.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N54Claim information is inconsistent with pre-certified/authorized services.
Start: 01/01/2000
N55Procedures for billing with group/referring/performing providers were not followed.
Start: 01/01/2000
N56Procedure code billed is not correct/valid for the services billed or the date of service billed.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N57Missing/incomplete/invalid prescribing date.
Start: 01/01/2000 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N304
N58Missing/incomplete/invalid patient liability amount.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N59Please refer to your provider manual for additional program and provider information.
Start: 01/01/2000 | Last Modified: 11/01/2009
Notes: (Modified 4/1/07, 11/1/09)
N60A valid NDC is required for payment of drug claims effective October 02.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using M119
N61Rebill services on separate claims.
Start: 01/01/2000
N62Dates of service span multiple rate periods. Resubmit separate claims.
Start: 01/01/2000 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N63Rebill services on separate claim lines.
Start: 01/01/2000
N64The “from” and “to” dates must be different.
Start: 01/01/2000
N65Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N66Missing/incomplete/invalid documentation.
Start: 01/01/2000 | Stop: 02/05/2005
Notes: Consider using N29 or N225.
N67Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient’s admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.
Start: 01/01/2000
N68Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.
Start: 01/01/2000
N69PPS (Prospective Payment System) code changed by claims processing system.
Start: 01/01/2000 | Last Modified: 07/01/2012
Notes: (Modified 6/30/03, 7/1/12)
N70Consolidated billing and payment applies.
Start: 01/01/2000 | Last Modified: 11/05/2007
Notes: (Modified 2/28/02, 11/5/07)
N71Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 2/21/02, 6/30/03)
N72PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N73A Skilled Nursing Facility is responsible for payment of outside providers who furnish these services/supplies under arrangement to its residents.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using MA101 or N200
N74Resubmit with multiple claims, each claim covering services provided in only one calendar month.
Start: 01/01/2000
N75Missing/incomplete/invalid tooth surface information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N76Missing/incomplete/invalid number of riders.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N77Missing/incomplete/invalid designated provider number.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N78The necessary components of the child and teen checkup (EPSDT) were not completed.
Start: 01/01/2000
N79Service billed is not compatible with patient location information.
Start: 01/01/2000
N80Missing/incomplete/invalid prenatal screening information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N81Procedure billed is not compatible with tooth surface code.
Start: 01/01/2000
N82Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
Start: 01/01/2000
N83No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
Start: 01/01/2000
N84Alert: Further installment payments are forthcoming.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07, 8/1/07)
N85Alert: This is the final installment payment.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07, 8/1/07)
N86A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
Start: 01/01/2000
N87Home use of biofeedback therapy is not covered.
Start: 01/01/2000
N88Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N89Alert: 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 be identified in this remittance advice.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N90Covered only when performed by the attending physician.
Start: 01/01/2000
N91Services not included in the appeal review.
Start: 01/01/2000
N92This facility is not certified for digital mammography.
Start: 01/01/2000
N93A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
Start: 01/01/2000
N94Claim/Service denied because a more specific taxonomy code is required for adjudication.
Start: 01/01/2000
N95This provider type/provider specialty may not bill this service.
Start: 07/31/2001 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N96Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.
Start: 08/24/2001
N97Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.
Start: 08/24/2001
N98Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.
Start: 08/24/2001
N99Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.
Start: 08/24/2001
N100PPS (Prospect Payment System) code corrected during adjudication.
Start: 09/14/2001 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N101Additional information is needed in order to process this claim. Please resubmit the claim with the identification number of the provider where this service took place. The Medicare number of the site of service provider should be preceded with the letters 'HSP' and entered into item #32 on the claim form. You may bill only one site of service provider number per claim.
Start: 10/31/2001 | Stop: 01/31/2004 | Last Modified: 03/14/2014
Notes: Consider using MA105 (Modified 3/14/2014)
N102This claim has been denied without reviewing the medical/dental record because the requested records were not received or were not received timely.
Start: 10/31/2001 | Last Modified: 11/01/2013
N103Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.
Start: 10/31/2001 | Last Modified: 11/01/2013
Notes: (Modified 6/30/03, 7/1/12, 11/1/13)
N104This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.gov.
Start: 01/29/2002 | Last Modified: 07/01/2010
Notes: (Modified 10/31/02, 7/1/10)
N105This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 866-749-4301 for RRB EDI information for electronic claims processing.
Start: 01/29/2002
N106Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.
Start: 01/31/2002
N107Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.
Start: 01/31/2002
N108Missing/incomplete/invalid upgrade information.
Start: 01/31/2002 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N109This claim/service was chosen for complex review and was denied after reviewing the medical records.
Start: 02/28/2002 | Last Modified: 03/01/2009
Notes: (Modified 3/1/2009)
N110This facility is not certified for film mammography.
Start: 02/28/2002
N111No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
Start: 02/28/2002
N112This claim is excluded from your electronic remittance advice.
Start: 02/28/2002
N113Only one initial visit is covered per physician, group practice or provider.
Start: 04/16/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N114During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be.
Start: 05/30/2002
N115This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
Start: 05/30/2002 | Last Modified: 07/01/2010
Notes: (Modified 4/1/04, 7/1/10)
N116This 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 episode of care. When a patient is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency’s (HHA’s) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care.
Start: 06/30/2002
N117This service is paid only once in a patient’s lifetime.
Start: 07/30/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N118This service is not paid if billed more than once every 28 days.
Start: 07/30/2002
N119This 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 (SNF) within those 28 days.
Start: 07/30/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N120Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.
Start: 08/09/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N121Medicare 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 Facility (SNF) stay.
Start: 09/09/2002 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 6/30/03)
N122Add-on code cannot be billed by itself.
Start: 09/12/2002 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
N123This is a split service and represents a portion of the units from the originally submitted service.
Start: 09/24/2002
N124Payment 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 extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay.
Start: 09/26/2002
N125Payment 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 extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice.

The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office.
Start: 09/26/2002 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05. Also refer to N356)
N126Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported.
Start: 10/17/2002
N127This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.
Start: 10/31/2007 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04
N128This amount represents the prior to coverage portion of the allowance.
Start: 10/31/2002
N129Not eligible due to the patient's age.
Start: 10/31/2002 | Last Modified: 08/01/2007
Notes: (Modified 8/1/07)
N130Consult plan benefit documents/guidelines for information about restrictions for this service.
Start: 10/31/2002 | Last Modified: 11/01/2009
Notes: (Modified 4/1/07, 7/1/08, 11/1/09)
N131Total payments under multiple contracts cannot exceed the allowance for this service.
Start: 10/31/2002
N132Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N133Alert: Services for predetermination and services requesting payment are being processed separately.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N134Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N135Record fees are the patient's responsibility and limited to the specified co-payment.
Start: 10/31/2002
N136Alert: 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.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N137Alert: The provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 8/1/04, 2/28/03, 4/1/07)
N138Alert: 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 Dental Advisor Unit at the subscriber's dental insurance carrier for a second Independent Dental Advisor Review.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N139Alert: Under the Code of Federal Regulations, Chapter 32, Section 199.13 a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor's opinion, you may appeal the determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N140Alert: You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act as his/her representative and you disagree with the Dental Advisor's opinion, you may appeal by submitting a copy of this letter, a signed statement explaining the matter in which you disagree, and any relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N141The patient was not residing in a long-term care facility during all or part of the service dates billed.
Start: 10/31/2002
N142The original claim was denied. Resubmit a new claim, not a replacement claim.
Start: 10/31/2002
N143The patient was not in a hospice program during all or part of the service dates billed.
Start: 10/31/2002
N144The rate changed during the dates of service billed.
Start: 10/31/2002
N145Missing/incomplete/invalid provider identifier for this place of service.
Start: 10/31/2002 | Stop: 06/02/2005
N146Missing screening document.
Start: 10/31/2002 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04) Related to N243
N147Long 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.
Start: 10/31/2002
N148Missing/incomplete/invalid date of last menstrual period.
Start: 10/31/2002
N149Rebill all applicable services on a single claim.
Start: 10/31/2002
N150Missing/incomplete/invalid model number.
Start: 10/31/2002
N151Telephone contact services will not be paid until the face-to-face contact requirement has been met.
Start: 10/31/2002
N152Missing/incomplete/invalid replacement claim information.
Start: 10/31/2002
N153Missing/incomplete/invalid room and board rate.
Start: 10/31/2002
N154Alert: This payment was delayed for correction of provider's mailing address.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N155Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N156Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N157Transportation to/from this destination is not covered.
Start: 02/28/2003 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
N158Transportation in a vehicle other than an ambulance is not covered.
Start: 02/28/2003
N159Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
Start: 02/28/2003
N160The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
Start: 02/28/2003 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
N161This drug/service/supply is covered only when the associated service is covered.
Start: 02/28/2003
N162Alert: Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information will result in a denial of payment in the near future.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N163Medical record does not support code billed per the code definition.
Start: 02/28/2003
N164Transportation to/from this destination is not covered.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N157
N165Transportation in a vehicle other than an ambulance is not covered.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N158)
N166Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N159
N167Charges exceed the post-transplant coverage limit.
Start: 02/28/2003
N168The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N160
N169This drug/service/supply is covered only when the associated service is covered.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N161
N170A new/revised/renewed certificate of medical necessity is needed.
Start: 02/28/2003
N171Payment for repair or replacement is not covered or has exceeded the purchase price.
Start: 02/28/2003
N172The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
Start: 02/28/2003
N173No qualifying hospital stay dates were provided for this episode of care.
Start: 02/28/2003
N174This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.
Start: 02/28/2003
N175Missing review organization approval.
Start: 02/28/2003 | Last Modified: 02/29/2008
Notes: (Modified 8/1/04, 2/29/08) Related to N241
N176Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the United States must provide the service.
Start: 02/28/2003
N177Alert: We did not send this claim to patient’s other insurer. They have indicated no additional payment can be made.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 6/30/03, 4/1/07)
N178Missing pre-operative images/visual field results.
Start: 02/28/2003 | Last Modified: 11/01/2013
Notes: (Modified 8/1/04, 11/1/13) Related to N244
N179Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.
Start: 02/28/2003
N180This item or service does not meet the criteria for the category under which it was billed.
Start: 02/28/2003
N181Additional information is required from another provider involved in this service.
Start: 02/28/2003 | Last Modified: 12/01/2006
Notes: (Modified 12/1/06)
N182This claim/service must be billed according to the schedule for this plan.
Start: 02/28/2003
N183Alert: This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N184Rebill technical and professional components separately.
Start: 02/28/2003
N185Alert: Do not resubmit this claim/service.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N186Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.
Start: 02/28/2003
N187Alert: You may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N188The approved level of care does not match the procedure code submitted.
Start: 02/28/2003
N189Alert: This service has been paid as a one-time exception to the plan's benefit restrictions.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N190Missing contract indicator.
Start: 02/28/2003 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04) Related to N229
N191The provider must update insurance information directly with payer.
Start: 02/28/2003
N192Patient is a Medicaid/Qualified Medicare Beneficiary.
Start: 02/28/2003
N193Specific federal/state/local program may cover this service through another payer.
Start: 02/28/2003
N194Technical component not paid if provider does not own the equipment used.
Start: 02/25/2003
N195The technical component must be billed separately.
Start: 02/25/2003
N196Alert: Patient eligible to apply for other coverage which may be primary.
Start: 02/25/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N197The subscriber must update insurance information directly with payer.
Start: 02/25/2003
N198Rendering provider must be affiliated with the pay-to provider.
Start: 02/25/2003
N199Additional payment/recoupment approved based on payer-initiated review/audit.
Start: 02/25/2003 | Last Modified: 08/01/2006
Notes: (Modified 8/1/06)
N200The professional component must be billed separately.
Start: 02/25/2003
N201A mental health facility is responsible for payment of outside providers who furnish these services/supplies to residents.
Start: 02/25/2003 | Stop: 01/01/2011
Notes: Consider using N538
N202Additional information/explanation will be sent separately.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 4/1/07, 11/1/09, 3/14/2014)
N203Missing/incomplete/invalid anesthesia time/units.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N204Services under review for possible pre-existing condition. Send medical records for prior 12 months
Start: 06/30/2003
N205Information provided was illegible.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N206The supporting documentation does not match the information sent on the claim.
Start: 06/30/2003 | Last Modified: 03/06/2012
Notes: (Modified 3/6/12)
N207Missing/incomplete/invalid weight.
Start: 06/30/2003 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)
N208Missing/incomplete/invalid DRG code.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N209Missing/incomplete/invalid taxpayer identification number (TIN).
Start: 06/30/2003 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N210Alert: You may appeal this decision.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 4/1/07, 3/14/2014)
N211Alert: You may not appeal this decision.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 4/1/07, 3/14/2014)
N212Charges processed under a Point of Service benefit .
Start: 02/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N213Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.
Start: 04/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N214Missing/incomplete/invalid history of the related initial surgical procedure(s).
Start: 04/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N215Alert: A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determination.
Start: 04/01/2004 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N216We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.
Start: 04/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/1/2010, 3/14/2014)
N217We pay only one site of service per provider per claim.
Start: 08/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N218You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract or coverage manual.
Start: 08/01/2004
N219Payment based on previous payer's allowed amount.
Start: 08/01/2004
N220Alert: See the payer's web site or contact the payer's Customer Service department to obtain forms and instructions for filing a provider dispute.
Start: 08/01/2004 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N221Missing Admitting History and Physical report.
Start: 08/01/2004
N222Incomplete/invalid Admitting History and Physical report.
Start: 08/01/2004
N223Missing documentation of benefit to the patient during initial treatment period.
Start: 08/01/2004
N224Incomplete/invalid documentation of benefit to the patient during initial treatment period.
Start: 08/01/2004
N225Incomplete/invalid documentation/orders/notes/summary/report/chart.
Start: 08/01/2004 | Stop: 03/01/2016 | Last Modified: 03/01/2014
Notes: (Modified 8/1/05, 3/1/2014) Explicit RARCs have been approved, this non-specific RARC will be deactivated in March 2016.
N226Incomplete/invalid American Diabetes Association Certificate of Recognition.
Start: 08/01/2004
N227Incomplete/invalid Certificate of Medical Necessity.
Start: 08/01/2004
N228Incomplete/invalid consent form.
Start: 08/01/2004
N229Incomplete/invalid contract indicator.
Start: 08/01/2004
N230Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.
Start: 08/01/2004
N231Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Start: 08/01/2004
N232Incomplete/invalid itemized bill/statement.
Start: 08/01/2004 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N233Incomplete/invalid operative note/report.
Start: 08/01/2004 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N234Incomplete/invalid oxygen certification/re-certification.
Start: 08/01/2004
N235Incomplete/invalid pacemaker registration form.
Start: 08/01/2004
N236Incomplete/invalid pathology report.
Start: 08/01/2004
N237Incomplete/invalid patient medical record for this service.
Start: 08/01/2004
N238Incomplete/invalid physician certified plan of care.
Start: 08/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N239Incomplete/invalid physician financial relationship form.
Start: 08/01/2004
N240Incomplete/invalid radiology report.
Start: 08/01/2004
N241Incomplete/invalid review organization approval.
Start: 08/01/2004 | Last Modified: 02/29/2008
Notes: (Modified 2/29/08)
N242Incomplete/invalid radiology film(s)/image(s).
Start: 08/01/2004 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N243Incomplete/invalid/not approved screening document.
Start: 08/01/2004
N244Incomplete/Invalid pre-operative images/visual field results.
Start: 08/01/2004 | Last Modified: 11/01/2013
Notes: (Modified 11/1/2013)
N245Incomplete/invalid plan information for other insurance .
Start: 08/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N246State regulated patient payment limitations apply to this service.
Start: 12/02/2004
N247Missing/incomplete/invalid assistant surgeon taxonomy.
Start: 12/02/2004
N248Missing/incomplete/invalid assistant surgeon name.
Start: 12/02/2004
N249Missing/incomplete/invalid assistant surgeon primary identifier.
Start: 12/02/2004
N250Missing/incomplete/invalid assistant surgeon secondary identifier.
Start: 12/02/2004
N251Missing/incomplete/invalid attending provider taxonomy.
Start: 12/02/2004
N252Missing/incomplete/invalid attending provider name.
Start: 12/02/2004
N253Missing/incomplete/invalid attending provider primary identifier.
Start: 12/02/2004
N254Missing/incomplete/invalid attending provider secondary identifier.
Start: 12/02/2004
N255Missing/incomplete/invalid billing provider taxonomy.
Start: 12/02/2004
N256Missing/incomplete/invalid billing provider/supplier name.
Start: 12/02/2004
N257Missing/incomplete/invalid billing provider/supplier primary identifier.
Start: 12/02/2004
N258Missing/incomplete/invalid billing provider/supplier address.
Start: 12/02/2004
N259Missing/incomplete/invalid billing provider/supplier secondary identifier.
Start: 12/02/2004
N260Missing/incomplete/invalid billing provider/supplier contact information.
Start: 12/02/2004
N261Missing/incomplete/invalid operating provider name.
Start: 12/02/2004
N262Missing/incomplete/invalid operating provider primary identifier.
Start: 12/02/2004
N263Missing/incomplete/invalid operating provider secondary identifier.
Start: 12/02/2004
N264Missing/incomplete/invalid ordering provider name.
Start: 12/02/2004
N265Missing/incomplete/invalid ordering provider primary identifier.
Start: 12/02/2004
N266Missing/incomplete/invalid ordering provider address.
Start: 12/02/2004
N267Missing/incomplete/invalid ordering provider secondary identifier.
Start: 12/02/2004
N268Missing/incomplete/invalid ordering provider contact information.
Start: 12/02/2004
N269Missing/incomplete/invalid other provider name.
Start: 12/02/2004
N270Missing/incomplete/invalid other provider primary identifier.
Start: 12/02/2004
N271Missing/incomplete/invalid other provider secondary identifier.
Start: 12/02/2004
N272Missing/incomplete/invalid other payer attending provider identifier.
Start: 12/02/2004
N273Missing/incomplete/invalid other payer operating provider identifier.
Start: 12/02/2004
N274Missing/incomplete/invalid other payer other provider identifier.
Start: 12/02/2004
N275Missing/incomplete/invalid other payer purchased service provider identifier.
Start: 12/02/2004
N276Missing/incomplete/invalid other payer referring provider identifier.
Start: 12/02/2004
N277Missing/incomplete/invalid other payer rendering provider identifier.
Start: 12/02/2004
N278Missing/incomplete/invalid other payer service facility provider identifier.
Start: 12/02/2004
N279Missing/incomplete/invalid pay-to provider name.
Start: 12/02/2004
N280Missing/incomplete/invalid pay-to provider primary identifier.
Start: 12/02/2004
N281Missing/incomplete/invalid pay-to provider address.
Start: 12/02/2004
N282Missing/incomplete/invalid pay-to provider secondary identifier.
Start: 12/02/2004
N283Missing/incomplete/invalid purchased service provider identifier.
Start: 12/02/2004
N284Missing/incomplete/invalid referring provider taxonomy.
Start: 12/02/2004
N285Missing/incomplete/invalid referring provider name.
Start: 12/02/2004
N286Missing/incomplete/invalid referring provider primary identifier.
Start: 12/02/2004
N287Missing/incomplete/invalid referring provider secondary identifier.
Start: 12/02/2004
N288Missing/incomplete/invalid rendering provider taxonomy.
Start: 12/02/2004
N289Missing/incomplete/invalid rendering provider name.
Start: 12/02/2004
N290Missing/incomplete/invalid rendering provider primary identifier.
Start: 12/02/2004
N291Missing/incomplete/invalid rendering provider secondary identifier.
Start: 12/02/2004 | Last Modified: 11/01/2010
N292Missing/incomplete/invalid service facility name.
Start: 12/02/2004
N293Missing/incomplete/invalid service facility primary identifier.
Start: 12/02/2004
N294Missing/incomplete/invalid service facility primary address.
Start: 12/02/2004
N295Missing/incomplete/invalid service facility secondary identifier.
Start: 12/02/2004
N296Missing/incomplete/invalid supervising provider name.
Start: 12/02/2004
N297Missing/incomplete/invalid supervising provider primary identifier.
Start: 12/02/2004
N298Missing/incomplete/invalid supervising provider secondary identifier.
Start: 12/02/2004
N299Missing/incomplete/invalid occurrence date(s).
Start: 12/02/2004
N300Missing/incomplete/invalid occurrence span date(s).
Start: 12/02/2004
N301Missing/incomplete/invalid procedure date(s).
Start: 12/02/2004
N302Missing/incomplete/invalid other procedure date(s).
Start: 12/02/2004
N303Missing/incomplete/invalid principal procedure date.
Start: 12/02/2004
N304Missing/incomplete/invalid dispensed date.
Start: 12/02/2004
N305Missing/incomplete/invalid accident date.
Start: 12/02/2004
N306Missing/incomplete/invalid acute manifestation date.
Start: 12/02/2004
N307Missing/incomplete/invalid adjudication or payment date.
Start: 12/02/2004
N308Missing/incomplete/invalid appliance placement date.
Start: 12/02/2004
N309Missing/incomplete/invalid assessment date.
Start: 12/02/2004
N310Missing/incomplete/invalid assumed or relinquished care date.
Start: 12/02/2004
N311Missing/incomplete/invalid authorized to return to work date.
Start: 12/02/2004
N312Missing/incomplete/invalid begin therapy date.
Start: 12/02/2004
N313Missing/incomplete/invalid certification revision date.
Start: 12/02/2004
N314Missing/incomplete/invalid diagnosis date.
Start: 12/02/2004
N315Missing/incomplete/invalid disability from date.
Start: 12/02/2004
N316Missing/incomplete/invalid disability to date.
Start: 12/02/2004
N317Missing/incomplete/invalid discharge hour.
Start: 12/02/2004
N318Missing/incomplete/invalid discharge or end of care date.
Start: 12/02/2004
N319Missing/incomplete/invalid hearing or vision prescription date.
Start: 12/02/2004
N320Missing/incomplete/invalid Home Health Certification Period.
Start: 12/02/2004
N321Missing/incomplete/invalid last admission period.
Start: 12/02/2004
N322Missing/incomplete/invalid last certification date.
Start: 12/02/2004
N323Missing/incomplete/invalid last contact date.
Start: 12/02/2004
N324Missing/incomplete/invalid last seen/visit date.
Start: 12/02/2004
N325Missing/incomplete/invalid last worked date.
Start: 12/02/2004
N326Missing/incomplete/invalid last x-ray date.
Start: 12/02/2004
N327Missing/incomplete/invalid other insured birth date.
Start: 12/02/2004
N328Missing/incomplete/invalid Oxygen Saturation Test date.
Start: 12/02/2004
N329Missing/incomplete/invalid patient birth date.
Start: 12/02/2004
N330Missing/incomplete/invalid patient death date.
Start: 12/02/2004
N331Missing/incomplete/invalid physician order date.
Start: 12/02/2004
N332Missing/incomplete/invalid prior hospital discharge date.
Start: 12/02/2004
N333Missing/incomplete/invalid prior placement date.
Start: 12/02/2004
N334Missing/incomplete/invalid re-evaluation date.
Start: 12/02/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N335Missing/incomplete/invalid referral date.
Start: 12/02/2004
N336Missing/incomplete/invalid replacement date.
Start: 12/02/2004
N337Missing/incomplete/invalid secondary diagnosis date.
Start: 12/02/2004
N338Missing/incomplete/invalid shipped date.
Start: 12/02/2004
N339Missing/incomplete/invalid similar illness or symptom date.
Start: 12/02/2004
N340Missing/incomplete/invalid subscriber birth date.
Start: 12/02/2004
N341Missing/incomplete/invalid surgery date.
Start: 12/02/2004
N342Missing/incomplete/invalid test performed date.
Start: 12/02/2004
N343Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.
Start: 12/02/2004
N344Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.
Start: 12/02/2004
N345Date range not valid with units submitted.
Start: 03/30/2005
N346Missing/incomplete/invalid oral cavity designation code.
Start: 03/30/2005
N347Your 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 contractor representing the payer.
Start: 03/30/2005
N348You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.
Start: 08/01/2005
N349The administration method and drug must be reported to adjudicate this service.
Start: 08/01/2005
N350Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
Start: 08/01/2005 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N351Service date outside of the approved treatment plan service dates.
Start: 08/01/2005
N352Alert: There are no scheduled payments for this service. Submit a claim for each patient visit.
Start: 08/01/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N353Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.
Start: 08/01/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N354Incomplete/invalid invoice.
Start: 08/01/2005 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N355Alert: 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 would not pay for this service; or - If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service.

If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position.

If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision.

The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination.

The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days
Start: 08/01/2005 | Last Modified: 04/01/2007
Notes: (Modified 11/18/05, Modified 4/1/07)
N356Not covered when performed with, or subsequent to, a non-covered service.
Start: 08/01/2005 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N357Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
Start: 11/18/2005
N358Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
Start: 11/18/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N359Missing/incomplete/invalid height.
Start: 11/18/2005
N360Alert: Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim.
Start: 11/18/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N361Payment adjusted based on multiple diagnostic imaging procedure rules
Start: 11/18/2005 | Stop: 10/01/2007 | Last Modified: 12/01/2006
Notes: (Modified 12/1/06) Consider using Reason Code 59
N362The number of Days or Units of Service exceeds our acceptable maximum.
Start: 11/18/2005
N363Alert: in the near future we are implementing new policies/procedures that would affect this determination.
Start: 11/18/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N364Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.
Start: 11/18/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N365This procedure code is not payable. It is for reporting/information purposes only.
Start: 04/01/2006 | Stop: 07/01/2014
Notes: Consider Using CARC 246 or N620
N366Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice.
Start: 04/01/2006
N367Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account.
Start: 04/01/2006 | Last Modified: 07/01/2008
Notes: (Modified 4/1/07, 11/5/07, 7/1/08)
N368You must appeal the determination of the previously adjudicated claim.
Start: 04/01/2006
N369Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.
Start: 04/01/2006
N370Billing exceeds the rental months covered/approved by the payer.
Start: 08/01/2006
N371Alert: title of this equipment must be transferred to the patient.
Start: 08/01/2006
N372Only reasonable and necessary maintenance/service charges are covered.
Start: 08/01/2006
N373It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your behalf.
Start: 12/01/2006
N374Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.
Start: 12/01/2006
N375Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.
Start: 12/01/2006
N376Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.
Start: 12/01/2006
N377Payment based on a processed replacement claim.
Start: 12/01/2006 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
N378Missing/incomplete/invalid prescription quantity.
Start: 12/01/2006
N379Claim level information does not match line level information.
Start: 12/01/2006
N380The original claim has been processed, submit a corrected claim.
Start: 04/01/2007
N381Consult our contractual agreement for restrictions/billing/payment information related to these charges.
Start: 04/01/2007
N382Missing/incomplete/invalid patient identifier.
Start: 04/01/2007
N383Not covered when deemed cosmetic.
Start: 04/01/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N384Records indicate that the referenced body part/tooth has been removed in a previous procedure.
Start: 04/01/2007
N385Notification of admission was not timely according to published plan procedures.
Start: 04/01/2007 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
N386This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
Start: 04/01/2007 | Last Modified: 07/01/2010
Notes: (Modified 7/1/2010)
N387Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information.
Start: 04/01/2007 | Last Modified: 03/01/2009
Notes: (Modified 3/1/2009)
N388Missing/incomplete/invalid prescription number.
Start: 08/01/2007 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N389Duplicate prescription number submitted.
Start: 08/01/2007
N390This service/report cannot be billed separately.
Start: 08/01/2007 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N391Missing emergency department records.
Start: 08/01/2007
N392Incomplete/invalid emergency department records.
Start: 08/01/2007
N393Missing progress notes/report.
Start: 08/01/2007 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N394Incomplete/invalid progress notes/report.
Start: 08/01/2007 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N395Missing laboratory report.
Start: 08/01/2007
N396Incomplete/invalid laboratory report.
Start: 08/01/2007
N397Benefits are not available for incomplete service(s)/undelivered item(s).
Start: 08/01/2007
N398Missing elective consent form.
Start: 08/01/2007
N399Incomplete/invalid elective consent form.
Start: 08/01/2007
N400Alert: Electronically enabled providers should submit claims electronically.
Start: 08/01/2007
N401Missing periodontal charting.
Start: 08/01/2007
N402Incomplete/invalid periodontal charting.
Start: 08/01/2007
N403Missing facility certification.
Start: 08/01/2007
N404Incomplete/invalid facility certification.
Start: 08/01/2007
N405This service is only covered when the donor's insurer(s) do not provide coverage for the service.
Start: 08/01/2007
N406This service is only covered when the recipient's insurer(s) do not provide coverage for the service.
Start: 08/01/2007
N407You are not an approved submitter for this transmission format.
Start: 08/01/2007
N408This payer does not cover deductibles assessed by a previous payer.
Start: 08/01/2007
N409This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident.
Start: 08/01/2007
N410Not covered unless the prescription changes.
Start: 08/01/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N411This service is allowed one time in a 6-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)
Start: 08/01/2007 | Stop: 02/01/2009
N412This service is allowed 2 times in a 12-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)
Start: 08/01/2007 | Stop: 02/01/2009
N413This service is allowed 2 times in a benefit year. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)
Start: 08/01/2007 | Stop: 02/01/2009
N414This service is allowed 4 times in a 12-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)
Start: 08/01/2007 | Stop: 02/01/2009
N415This service is allowed 1 time in an 18-month period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)
Start: 08/01/2007 | Stop: 02/01/2009
N416This service is allowed 1 time in a 3-year period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)
Start: 08/01/2007 | Stop: 02/01/2009
N417This service is allowed 1 time in a 5-year period. (This temporary code will be deactivated on 2/1/09. Must be used with Reason Code 119.)
Start: 08/01/2007 | Stop: 02/01/2009
N418Misrouted claim. See the payer's claim submission instructions.
Start: 08/01/2007
N419Claim payment was the result of a payer's retroactive adjustment due to a retroactive rate change.
Start: 08/01/2007
N420Claim payment was the result of a payer's retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.
Start: 08/01/2007
N421Claim payment was the result of a payer's retroactive adjustment due to a review organization decision.
Start: 08/01/2007 | Last Modified: 05/08/2008
Notes: (Modified 2/29/08, typo fixed 5/8/08)
N422Claim payment was the result of a payer's retroactive adjustment due to a payer's contract incentive program.
Start: 08/01/2007 | Last Modified: 05/08/2008
Notes: (Typo fixed 5/8/08)
N423Claim payment was the result of a payer's retroactive adjustment due to a non standard program.
Start: 08/01/2007
N424Patient does not reside in the geographic area required for this type of payment.
Start: 08/01/2007
N425Statutorily excluded service(s).
Start: 08/01/2007
N426No coverage when self-administered.
Start: 08/01/2007
N427Payment for eyeglasses or contact lenses can be made only after cataract surgery.
Start: 08/01/2007
N428Not covered when performed in this place of service.
Start: 08/01/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N429Not covered when considered routine.
Start: 08/01/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N430Procedure code is inconsistent with the units billed.
Start: 11/05/2007
N431Not covered with this procedure.
Start: 11/05/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N432Adjustment based on a Recovery Audit.
Start: 11/05/2007
N433Resubmit this claim using only your National Provider Identifier (NPI).
Start: 02/29/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N434Missing/Incomplete/Invalid Present on Admission indicator.
Start: 07/01/2008
N435Exceeds number/frequency approved /allowed within time period without support documentation.
Start: 07/01/2008
N436The injury claim has not been accepted and a mandatory medical reimbursement has been made.
Start: 07/01/2008
N437Alert: If the injury claim is accepted, these charges will be reconsidered.
Start: 07/01/2008
N438This jurisdiction only accepts paper claims.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N439Missing anesthesia physical status report/indicators.
Start: 07/01/2008
N440Incomplete/invalid anesthesia physical status report/indicators.
Start: 07/01/2008
N441This missed/cancelled appointment is not covered.
Start: 07/01/2008 | Last Modified: 07/15/2013
Notes: (Modified 7/15/2013)
N442Payment based on an alternate fee schedule.
Start: 07/01/2008
N443Missing/incomplete/invalid total time or begin/end time.
Start: 07/01/2008
N444Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation.
Start: 07/01/2008
N445Missing document for actual cost or paid amount.
Start: 07/01/2008
N446Incomplete/invalid document for actual cost or paid amount.
Start: 07/01/2008
N447Payment is based on a generic equivalent as required documentation was not provided.
Start: 07/01/2008
N448This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N449Payment based on a comparable drug/service/supply.
Start: 07/01/2008
N450Covered only when performed by the primary treating physician or the designee.
Start: 07/01/2008
N451Missing Admission Summary Report.
Start: 07/01/2008
N452Incomplete/invalid Admission Summary Report.
Start: 07/01/2008
N453Missing Consultation Report.
Start: 07/01/2008
N454Incomplete/invalid Consultation Report.
Start: 07/01/2008
N455Missing Physician Order.
Start: 07/01/2008
N456Incomplete/invalid Physician Order.
Start: 07/01/2008
N457Missing Diagnostic Report.
Start: 07/01/2008
N458Incomplete/invalid Diagnostic Report.
Start: 07/01/2008
N459Missing Discharge Summary.
Start: 07/01/2008
N460Incomplete/invalid Discharge Summary.
Start: 07/01/2008
N461Missing Nursing Notes.
Start: 07/01/2008
N462Incomplete/invalid Nursing Notes.
Start: 07/01/2008
N463Missing support data for claim.
Start: 07/01/2008
N464Incomplete/invalid support data for claim.
Start: 07/01/2008
N465Missing Physical Therapy Notes/Report.
Start: 07/01/2008
N466Incomplete/invalid Physical Therapy Notes/Report.
Start: 07/01/2008
N467Missing Tests and Analysis Report.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N468Incomplete/invalid Report of Tests and Analysis Report.
Start: 07/01/2008
N469Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Start: 07/01/2008
N470This payment will complete the mandatory medical reimbursement limit.
Start: 07/01/2008
N471Missing/incomplete/invalid HIPPS Rate Code.
Start: 07/01/2008
N472Payment for this service has been issued to another provider.
Start: 07/01/2008
N473Missing certification.
Start: 07/01/2008
N474Incomplete/invalid certification.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N475Missing completed referral form.
Start: 07/01/2008
N476Incomplete/invalid completed referral form.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N477Missing Dental Models.
Start: 07/01/2008
N478Incomplete/invalid Dental Models.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N479Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
Start: 07/01/2008
N480Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
Start: 07/01/2008
N481Missing Models.
Start: 07/01/2008
N482Incomplete/invalid Models.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N483Missing Periodontal Charts.
Start: 07/01/2008 | Stop: 05/01/2015 | Last Modified: 11/01/2014
Notes: (Modified 11/1/2014)
N484Incomplete/invalid Periodontal Charts.
Start: 07/01/2008 | Stop: 05/01/2015 | Last Modified: 11/01/2014
Notes: (Modified 3/14/2014, 11/1/2014)
N485Missing Physical Therapy Certification.
Start: 07/01/2008
N486Incomplete/invalid Physical Therapy Certification.
Start: 07/01/2008
N487Missing Prosthetics or Orthotics Certification.
Start: 07/01/2008
N488Incomplete/invalid Prosthetics or Orthotics Certification.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N489Missing referral form.
Start: 07/01/2008
N490Incomplete/invalid referral form.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N491Missing/Incomplete/Invalid Exclusionary Rider Condition.
Start: 07/01/2008
N492Alert: 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 be financially responsible for the billed charge.
Start: 07/01/2008
N493Missing Doctor First Report of Injury.
Start: 07/01/2008
N494Incomplete/invalid Doctor First Report of Injury.
Start: 07/01/2008
N495Missing Supplemental Medical Report.
Start: 07/01/2008
N496Incomplete/invalid Supplemental Medical Report.
Start: 07/01/2008
N497Missing Medical Permanent Impairment or Disability Report.
Start: 07/01/2008
N498Incomplete/invalid Medical Permanent Impairment or Disability Report.
Start: 07/01/2008
N499Missing Medical Legal Report.
Start: 07/01/2008
N500Incomplete/invalid Medical Legal Report.
Start: 07/01/2008
N501Missing Vocational Report.
Start: 07/01/2008
N502Incomplete/invalid Vocational Report.
Start: 07/01/2008
N503Missing Work Status Report.
Start: 07/01/2008
N504Incomplete/invalid Work Status Report.
Start: 07/01/2008
N505Alert: This response includes only services that could be estimated in real time. No estimate will be provided for the services that could not be estimated in real time.
Start: 11/01/2008
N506Alert: This is an estimate of the member’s liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. This is not a pre-authorization or a guarantee of payment.
Start: 11/01/2008
N507Plan distance requirements have not been met.
Start: 11/01/2008
N508Alert: This real time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions.
Start: 11/01/2008
N509Alert: A current inquiry shows the member’s Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
Start: 11/01/2008
N510Alert: 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. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
Start: 11/01/2008
N511Alert: Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time.
Start: 11/01/2008
N512Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.
Start: 11/01/2008
N513Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.
Start: 11/01/2008
N514Consult plan benefit documents/guidelines for information about restrictions for this service.
Start: 11/01/2008 | Stop: 01/01/2011
Notes: Consider using N130
N515Alert: Submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information. (use N387 instead)
Start: 11/01/2008 | Stop: 10/01/2009
N516Records indicate a mismatch between the submitted NPI and EIN.
Start: 03/01/2009
N517Resubmit a new claim with the requested information.
Start: 03/01/2009
N518No separate payment for accessories when furnished for use with oxygen equipment.
Start: 03/01/2009
N519Invalid combination of HCPCS modifiers.
Start: 07/01/2009
N520Alert: Payment made from a Consumer Spending Account.
Start: 07/01/2009
N521Mismatch between the submitted provider information and the provider information stored in our system.
Start: 11/01/2009
N522Duplicate of a claim processed, or to be processed, as a crossover claim.
Start: 11/01/2009 | Last Modified: 03/01/2010
N523The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid.
Start: 03/01/2010
N524Based on policy this payment constitutes payment in full.
Start: 03/01/2010
N525These services are not covered when performed within the global period of another service.
Start: 03/01/2010
N526Not qualified for recovery based on employer size.
Start: 03/01/2010
N527We processed this claim as the primary payer prior to receiving the recovery demand.
Start: 03/01/2010
N528Patient is entitled to benefits for Institutional Services only.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)
N529Patient is entitled to benefits for Professional Services only.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)
N530Not Qualified for Recovery based on enrollment information.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)
N531Not qualified for recovery based on direct payment of premium.
Start: 03/01/2010
N532Not qualified for recovery based on disability and working status.
Start: 03/01/2010
N533Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.
Start: 07/01/2010
N534This is an individual policy, the employer does not participate in plan sponsorship.
Start: 07/01/2010
N535Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.
Start: 07/01/2010
N536We are not changing the prior payer's determination of patient responsibility, which you may collect, as this service is not covered by us.
Start: 07/01/2010
N537We have examined claims history and no records of the services have been found.
Start: 07/01/2010
N538A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
Start: 07/01/2010
N539Alert: We processed appeals/waiver requests on your behalf and that request has been denied.
Start: 07/01/2010
N540Payment adjusted based on the interrupted stay policy.
Start: 11/01/2010
N541Mismatch between the submitted insurance type code and the information stored in our system.
Start: 11/01/2010
N542Missing income verification.
Start: 03/08/2011
N543Incomplete/invalid income verification.
Start: 03/08/2011 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N544Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future.
Start: 07/01/2011 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N545Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
Start: 07/01/2011
N546Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.
Start: 07/01/2011
N547A refund request (Frequency Type Code 8) was processed previously.
Start: 03/06/2012
N548Alert: Patient's calendar year deductible has been met.
Start: 03/06/2012
N549Alert: Patient's calendar year out-of-pocket maximum has been met.
Start: 03/06/2012
N550Alert: You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hold in the near future.
Start: 03/06/2012
N551Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.
Start: 03/06/2012
N552Payment adjusted to reverse a previous withhold/bonus amount.
Start: 03/06/2012
N553Payment adjusted based on a Low Income Subsidy (LIS) retroactive coverage or status change.
Start: 03/06/2012 | Stop: 11/01/2012
N554Missing/Incomplete/Invalid Family Planning Indicator.
Start: 07/01/2012 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N555Missing medication list.
Start: 07/01/2012
N556Incomplete/invalid medication list.
Start: 07/01/2012
N557This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected.
Start: 07/01/2012
N558This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received.
Start: 07/01/2012
N559This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located.
Start: 07/01/2012
N560The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.
Start: 11/01/2012
N561The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission.
Start: 11/01/2012
N562The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.
Start: 11/01/2012
N563Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service.
Start: 11/01/2012
Notes: Related to M39
N564Patient did not meet the inclusion criteria for the demonstration project or pilot program.
Start: 11/01/2012
N565Alert: This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed.
Start: 11/01/2012 | Last Modified: 03/01/2013
Notes: (Modified 3/1/13)
N566Alert: This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed.
Start: 11/01/2012
N567Not covered when considered preventative.
Start: 03/01/2013
N568Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.
Start: 03/01/2013
N569Not covered when performed for the reported diagnosis.
Start: 03/01/2013
N570Missing/incomplete/invalid credentialing data.
Start: 03/01/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N571Alert: Payment will be issued quarterly by another payer/contractor.
Start: 03/01/2013
N572This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
Start: 03/01/2013 | Last Modified: 07/01/2014
N573Alert: You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor.
Start: 03/01/2013
N574Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider.
Start: 07/15/2013
N575Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.
Start: 07/15/2013
N576Services not related to the specific incident/claim/accident/loss being reported.
Start: 07/15/2013
N577Personal Injury Protection (PIP) Coverage.
Start: 07/15/2013
N578Coverages do not apply to this loss.
Start: 07/15/2013
N579Medical Payments Coverage (MPC).
Start: 07/15/2013
N580Determination based on the provisions of the insurance policy.
Start: 07/15/2013
N581Investigation of coverage eligibility is pending.
Start: 07/15/2013
N582Benefits suspended pending the patient's cooperation.
Start: 07/15/2013
N583Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.
Start: 07/15/2013
N584Not covered based on the insured's noncompliance with policy or statutory conditions.
Start: 07/15/2013
N585Benefits are no longer available based on a final injury settlement.
Start: 07/15/2013
N586The injured party does not qualify for benefits.
Start: 07/15/2013
N587Policy benefits have been exhausted.
Start: 07/15/2013
N588The patient has instructed that medical claims/bills are not to be paid.
Start: 07/15/2013
N589Coverage 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 vehicle is impaired by the use of a drug.
Start: 07/15/2013
N590Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
Start: 07/15/2013
N591Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).
Start: 07/15/2013
N592Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
Start: 07/15/2013
N593Not covered based on failure to attend a scheduled Independent Medical Exam (IME).
Start: 07/15/2013
N594Records reflect the injured party did not complete an Application for Benefits for this loss.
Start: 07/15/2013
N595Records reflect the injured party did not complete an Assignment of Benefits for this loss.
Start: 07/15/2013
N596Records reflect the injured party did not complete a Medical Authorization for this loss.
Start: 07/15/2013
N597Adjusted based on a medical/dental provider's apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.
Start: 07/15/2013 | Last Modified: 11/01/2013
N598Health care policy coverage is primary.
Start: 07/15/2013
N599Our 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 claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.
Start: 07/15/2013
N600Adjusted based on the applicable fee schedule for the region in which the service was rendered.
Start: 07/15/2013
N601In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale System applicable to Hawaii.
Start: 07/15/2013
N602Adjusted based on the Redbook maximum allowance.
Start: 07/15/2013
N603This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage.
Start: 07/15/2013
N604In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers' Compensation Board Schedule of Medical Fees, pursuant to Regulation 83 and / or Appendix 17-C of 11 NYCRR.
Start: 07/15/2013
N605This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
Start: 07/15/2013
N606The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.
Start: 07/15/2013
N607Service provided for non-compensable condition(s).
Start: 07/15/2013
N608The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6.
Start: 07/15/2013
N60980% of the provider's billed amount is being recommended for payment according to Act 6.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N610Alert: Payment based on an appropriate level of care.
Start: 07/15/2013
N611Claim in litigation. Contact insurer for more information.
Start: 07/15/2013
N612Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
Start: 07/15/2013
N613Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.
Start: 07/15/2013
N614Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).
Start: 07/15/2013
N615Alert: This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under the Code of Federal Regulations, Title 45, Part 156.270, a Qualified Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.
Start: 07/15/2013
N616Alert: This enrollee is in the first month of the advance premium tax credit grace period.
Start: 07/15/2013
N617This enrollee is in the second or third month of the advance premium tax credit grace period.
Start: 07/15/2013
N618Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.
Start: 07/15/2013
N619Coverage terminated for non-payment of premium.
Start: 07/15/2013
N620Alert: This procedure code is for quality reporting/informational purposes only.
Start: 07/15/2013
N621Charges for Jurisdiction required forms, reports, or chart notes are not payable.
Start: 07/15/2013
N622Not covered based on the date of injury/accident.
Start: 07/15/2013
N623Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
Start: 07/15/2013
N624The associated Workers' Compensation claim has been withdrawn.
Start: 07/15/2013
N625Missing/Incomplete/Invalid Workers' Compensation Claim Number.
Start: 07/15/2013
N626New or established patient E/M codes are not payable with chiropractic care codes.
Start: 07/15/2013
N627Service not payable per managed care contract.
Start: 07/15/2013 | Stop: 07/01/2014
Notes: Consider Use CARC 256
N628Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
Start: 07/15/2013
N629Reviews/documentation/notes/summaries/reports/charts not requested.
Start: 07/15/2013
N630Referral not authorized by attending physician.
Start: 07/15/2013
N631Medical Fee Schedule does not list this code. An allowance was made for a comparable service.
Start: 07/15/2013
N632According to the Official Medical Fee Schedule this service has a relative value of zero and therefore no payment is due.
Start: 07/15/2013 | Stop: 07/01/2014
Notes: Consider using W8
N633Additional anesthesia time units are not allowed.
Start: 07/15/2013
N634The allowance is calculated based on anesthesia time units.
Start: 07/15/2013
N635The Allowance is calculated based on the anesthesia base units plus time.
Start: 07/15/2013
N636Adjusted because this is reimbursable only once per injury.
Start: 07/15/2013
N637Consultations are not allowed once treatment has been rendered by the same provider.
Start: 07/15/2013
N638Reimbursement has been made according to the home health fee schedule.
Start: 07/15/2013
N639Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
Start: 07/15/2013
N640Exceeds number/frequency approved/allowed within time period.
Start: 07/15/2013
N641Reimbursement has been based on the number of body areas rated.
Start: 07/15/2013
N642Adjusted when billed as individual tests instead of as a panel.
Start: 07/15/2013
N643The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
Start: 07/15/2013
N644Reimbursement has been made according to the bilateral procedure rule.
Start: 07/15/2013
N645Mark-up allowance.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N646Reimbursement has been adjusted based on the guidelines for an assistant.
Start: 07/15/2013
N647Adjusted based on diagnosis-related group (DRG).
Start: 07/15/2013
N648Adjusted based on Stop Loss.
Start: 07/15/2013
N649Payment based on invoice.
Start: 07/15/2013
N650This policy was not in effect for this date of loss. No coverage is available.
Start: 07/15/2013
N651No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
Start: 07/15/2013
N652The date of service is before the date of loss.
Start: 07/15/2013
N653The date of injury does not match the reported date of loss.
Start: 07/15/2013
N654Adjusted based on achievement of maximum medical improvement (MMI).
Start: 07/15/2013
N655Payment based on provider's geographic region.
Start: 07/15/2013
N656An interest payment is being made because benefits are being paid outside the statutory requirement.
Start: 07/15/2013
N657This should be billed with the appropriate code for these services.
Start: 07/15/2013
N658The billed service(s) are not considered medical expenses.
Start: 07/15/2013
N659This item is exempt from sales tax.
Start: 07/15/2013
N660Sales tax has been included in the reimbursement.
Start: 07/15/2013
N661Documentation does not support that the services rendered were medically necessary.
Start: 07/15/2013
N662Alert: Consideration of payment will be made upon receipt of a final bill.
Start: 07/15/2013
N663Adjusted based on an agreed amount.
Start: 07/15/2013
N664Adjusted based on a legal settlement.
Start: 07/15/2013
N665Services by an unlicensed provider are not reimbursable.
Start: 07/15/2013
N666Only one evaluation and management code at this service level is covered during the course of care.
Start: 07/15/2013
N667Missing prescription.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N668Incomplete/invalid prescription.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N669Adjusted based on the Medicare fee schedule.
Start: 07/15/2013
N670This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
Start: 07/15/2013
N671Payment based on a jurisdiction cost-charge ratio.
Start: 07/15/2013
N672Alert: Amount applied to Health Insurance Offset.
Start: 07/15/2013
N673Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
Start: 07/15/2013
N674Not covered unless a pre-requisite procedure/service has been provided.
Start: 07/15/2013
N675Additional information is required from the injured party.
Start: 07/15/2013
N676Service does not qualify for payment under the Outpatient Facility Fee Schedule.
Start: 07/15/2013
N677Alert: Films/Images will not be returned.
Start: 11/01/2013
N678Missing post-operative images/visual field results.
Start: 11/01/2013
N679Incomplete/Invalid post-operative images/visual field results.
Start: 11/01/2013
N680Missing/Incomplete/Invalid date of previous dental extractions.
Start: 11/01/2013
N681Missing/Incomplete/Invalid full arch series.
Start: 11/01/2013
N682Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
Start: 11/01/2013
N683Missing/Incomplete/Invalid prior treatment documentation.
Start: 11/01/2013
N684Payment denied as this is a specialty claim submitted as a general claim.
Start: 11/01/2013
N685Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
Start: 11/01/2013
N686Missing/incomplete/Invalid questionnaire needed to complete payment determination.
Start: 11/01/2013
N687Alert: This reversal is due to a retroactive disenrollment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N688Alert: This reversal is due to a medical or utilization review decision.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N689Alert: This reversal is due to a retroactive rate change.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N690Alert: This reversal is due to a provider submitted appeal.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N691Alert: This reversal is due to a patient submitted appeal.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N692Alert: This reversal is due to an incorrect rate on the initial adjudication.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N693Alert: This reversal is due to a cancellation of the claim by the provider.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N694Alert: This reversal is due to a resubmission/change to the claim by the provider.
Start: 11/01/2013
N695Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
Start: 11/01/2013
N696Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N697Alert: This reversal is due to a payer's retroactive contract incentive program adjustment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N698Alert: This reversal is due to non-payment of the Health Insurance Exchange premiums by the end of the premium payment grace period, resulting in loss of coverage.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N699Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.
Start: 03/01/2014
N700Payment adjusted based on the Electronic Health Records (EHR) Incentive Program.
Start: 03/01/2014
N701Payment adjusted based on the Value-based Payment Modifier.
Start: 03/01/2014
N702Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.
Start: 03/01/2014
N703This service is incompatible with previously adjudicated claims or claims in process.
Start: 03/01/2014
N704Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted.
Start: 03/01/2014 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N705Incomplete/invalid documentation.
Start: 03/01/2014
N706Missing documentation.
Start: 03/01/2014
N707Incomplete/invalid orders.
Start: 03/01/2014
N708Missing orders.
Start: 03/01/2014
N709Incomplete/invalid notes.
Start: 03/01/2014
N710Missing notes.
Start: 03/01/2014
N711Incomplete/invalid summary.
Start: 03/01/2014
N712Missing summary.
Start: 03/01/2014
N713Incomplete/invalid report.
Start: 03/01/2014
N714Missing report.
Start: 03/01/2014
N715Incomplete/invalid chart.
Start: 03/01/2014
N716Missing chart.
Start: 03/01/2014
N717Incomplete/Invalid documentation of face-to-face examination.
Start: 03/01/2014
N718Missing documentation of face-to-face examination.
Start: 03/01/2014
N719Penalty applied based on plan requirements not being met.
Start: 03/01/2014
N720Alert: The patient overpaid you. You may need to issue the patient a refund for the difference between the patient’s payment and the amount shown as patient responsibility on this notice.
Start: 03/01/2014
N721This service is only covered when performed as part of a clinical trial.
Start: 03/01/2014
N722Patient must use Workers' Compensation Set-Aside (WCSA) funds to pay for the medical service or item.
Start: 03/01/2014
N723Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.
Start: 03/01/2014
N724Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.
Start: 03/01/2014
N725A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
Start: 03/01/2014
N726A conditional payment is not allowed.
Start: 03/01/2014
N727A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
Start: 03/01/2014
N728A workers' compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
Start: 03/01/2014
N729Missing patient medical/dental record for this service.
Start: 11/01/2014
N730Incomplete/invalid patient medical/dental record for this service.
Start: 11/01/2014
N731Incomplete/Invalid mental health assessment.
Start: 11/01/2014
N732Services performed at an unlicensed facility are not reimbursable.
Start: 11/01/2014
N733Regulatory surcharges are paid directly to the state.
Start: 11/01/2014
N734The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury.
Start: 11/01/2014