The procedure code is inconsistent with the modifier used. Missing/incomplete/invalid admission source. Missing/incomplete/invalid admission date. The number of Days or Units of Service exceeds our acceptable maximum.īenefit maximum for this time period or occurrence has been reached.ĭATE OF SERVICE CANNOT SPAN ACROSS MONTHSĭates of service span multiple rate periods. SUSPECT DUPLICATE OUTPATIENT CLAIM (3 DAY WINDOW)
SUSPECT DUPLICATE INPATIENT CLAIM (3-DAY WINDOW EDIT) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Service denied because payment already made for same/similar procedure within set time frame. MORE THAN 1 SERVICE LIMIT FOR SAME SERVICEĬoverage/program guidelines were exceeded. Missing/incomplete/invalid beginning and ending dates of the period billed. SERVICE DATES SPAN MORE THAN ONE DAY OF SERVICE Missing/incomplete/invalid revenue code(s). PATIENT STATUS CONFLICTS WITH TYPE OF BILLĬAPITATION CLAIM BILLED & CLIENT ID IS NOT ENROLLED IN AN CHIP M Our records indicate the patient is not an eligible dependent. Patient not enrolled in the billing provider's managed care plan on the date of service. Missing/incomplete/invalid number of covered days during the billing period.ĬAPITATION CLAIM BILLED & CLIENT ID IS NOT ENROLLED IN AN MCO SUM OF ACCOMMODATION DAYS DOES NOT EQUAL TOTAL COVERED DAYS Missing/incomplete/invalid total charges.
The procedure code is inconsistent with the provider type/specialty (taxonomy). This provider type/provider specialty may not bill this service. This service/equipment/drug is not covered under the patient’s current benefit plan This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement. Missing/incomplete/invalid days or units of service.īENEFICIARY FAMILY PLANNING COE BUT SERVICES ON THE CLAIM IDENTIFY PREGNANCY FOR THE BENEFICIARY SUBMITTED UNITS NOT CONSISTENT WITH DATES OF SERVICE
At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Refer to the 835 Healt Usage: Do not use this code for claims attachment(s)/other documentation. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN).Ĭlaim/service lacks information or has submission/billing error(s). Missing/incomplete/invalid Payer Claim Control Number. FCN NUMBER IS MISSING OR INVALID FOR VOID/ADJUSTMENT REQUEST
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