ISA*00*          *00*          *01*621570852      *ZZ*               *071104*1209*U*00401*000000001*0*P*|
GS*SP*00*00*20071104*1209*1*X*004010WPC2
ST*841*0001
SPI*00***WPC*CLAIM ADJUSTMENT REASON CODES
RDT***171*20071104
N1*0F*WASHINGTON PUBLISHING COMPANY
HL*1**I
SPI*00*ZZ*1*Deductible Amount
RDT***196*19950101
SPI*00*ZZ*2*Coinsurance Amount
RDT***196*19950101
SPI*00*ZZ*3*Co-payment Amount
RDT***196*19950101
SPI*00*ZZ*4*The procedure code is inconsistent with the modifier used or a required modifier is missing.
RDT***196*19950101
SPI*00*ZZ*5*The procedure code/bill type is inconsistent with the place of service.
RDT***196*19950101
SPI*00*ZZ*6*The procedure/revenue code is inconsistent with the patient's age.
RDT***196*19950101
RDT***912*20020630
SPI*00*ZZ*7*The procedure/revenue code is inconsistent with the patient's gender.
RDT***196*19950101
RDT***912*20020630
SPI*00*ZZ*8*The procedure code is inconsistent with the provider type/specialty (taxonomy).
RDT***196*19950101
RDT***912*20020630
SPI*00*ZZ*9*The diagnosis is inconsistent with the patient's age.
RDT***196*19950101
SPI*00*ZZ*10*The diagnosis is inconsistent with the patient's gender.
RDT***196*19950101
RDT***912*20000229
SPI*00*ZZ*11*The diagnosis is inconsistent with the procedure.
RDT***196*19950101
SPI*00*ZZ*12*The diagnosis is inconsistent with the provider type.
RDT***196*19950101
SPI*00*ZZ*13*The date of death precedes the date of service.
RDT***196*19950101
SPI*00*ZZ*14*The date of birth follows the date of service.
RDT***196*19950101
SPI*00*ZZ*15*Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provide
RDT***196*19950101
RDT***912*20070930
MSG*r. This change to be effective 4/1/2008: The authorization number is missing, invalid, or does not apply to the billed services or provider.
SPI*00*ZZ*16*Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of eit
RDT***196*19950101
RDT***912*20060630
MSG*her the Remittance Advice Remark Code or NCPDP Reject Reason Code.)