Denial code
|
Description
|
111C
|
State-supplied serum or services billed with modifier SL (state-supplied vaccine)
|
115C
|
Member not eligible on date of service (DOS) — retraction
|
116C
|
Duplicate payment — retraction
|
120C
|
Other coverage primary — recovery
|
127C
|
Overpayment retraction — AIM or KSN audit
|
900C
|
Resubmit to third-party liability carrier
|
901C
|
Noncovered benefit — resubmit to MassHealth
|
902C
|
Covered under specialty pharmacy benefit
|
903C
|
Incidental procedure
|
904C
|
Invalid Current Procedural Terminology (CPT) code for point of service (POS)
|
905C
|
Unknown dates of service and/or bad dates
|
906C
|
Address does not match address on file — Contact your provider representative
|
907C
|
Payment included in case rate
|
908C
|
Deny motor vehicle accident (MVA) — $2,000 personal injury protection (PIP) must be exhausted
|
909C
|
Emergency room (ER) included in inpatient (IP) rate
|
910C
|
Service included in observation rate
|
911C
|
Payment included in payment amount per episode (PAPE) rate previously paid for this DOS
|
912C
|
Professional charges included in IP rate
|
913C
|
Resubmit with manufacturer’s invoice
|
914C
|
Service not eligible for incentive payment
|
915C
|
Separate reimbursement not allowed — mutually exclusive
|
916C
|
Resubmit with appropriate modifier
|
917C
|
Post-operative services included in global rate
|
918C
|
Deny MVA — $8,000 PIP and MedPay must be exhausted
|
919C
|
Resubmit to workers' compensation carrier
|
920C
|
Duplicate claim submission
|
921C
|
Service not eligible for incentive payment
|
922C
|
Sales tax nonreimbursable
|
923C
|
Provider not contracted for services rendered
|
924C
|
Code replaced with appropriate code for service
|
925C
|
Claim previously paid
|
927C
|
Procedure (PX) component previously paid
|
928C
|
Serious reportable event — nonreimbursable service; member not responsible
|
929C
|
Vaccine administration billed without vaccine — resubmit with serum
|
930C
|
Authorized as observation
|
933C
|
Payment included in per diem
|
934C
|
Resubmit with Current Procedural Terminology (CPT) and/or Healthcare Common Procedure Coding System (HCPCS) detail
|
935C
|
Invalid procedure code for DOS
|
937C
|
Resubmit with valid diagnosis (DX) code
|
938C
|
Resubmit with valid CPT code
|
939C
|
No charges submitted for services rendered
|
940C
|
Resubmit with valid anesthesia code
|
941C
|
Services billed not specified on authorization
|
942C
|
Resubmit with anesthesia time
|
944C
|
Age, procedure, and/or DX conflict
|
945C
|
Gender, procedure, and/or DX conflict
|
946C
|
Information requested on another line
|
947C
|
Units exceed authorization
|
948C
|
Other insurance is primary
|
949C
|
Unlisted procedure code — documentation required
|
950C
|
Service not authorized
|
951C
|
Invalid PX and/or modifier combination
|
952C
|
Resubmit with medical records
|
953C
|
Resubmit with primary carrier Explanation of Payment (EOP)
|
954C
|
Medical records reviewed — PX denied
|
955C
|
Authorization denied
|
956C
|
Payment included in global rate
|
957C
|
Service billed in error
|
958C
|
Resubmit with itemization by DOS
|
959C
|
Authorization denied
|
960C
|
An updated W-9 is required to process your claim
|
961C
|
Resubmit invoice with cost per unit
|
962C
|
Resubmit with clinical information
|
963C
|
Cosmetic procedure
|
964C
|
Invalid member ID # for this patient
|
965C
|
Temporary code nonreimbursable — Bill with appropriate codes
|
966C
|
Resubmit with valid ICD-9 operation code
|
967C
|
Paid by auto carrier
|
968C
|
Paid by workers' compensation
|
969C
|
Paid by third party
|
970C
|
Filing limit exceeded
|
971C
|
Observation included in IP stay
|
972C
|
Primary carrier paid maximum
|
973C
|
MedPay must be exhausted
|
974C
|
Member not assigned to primary care provider (PCP) — service not authorized
|
976C
|
Adjustment request not received within 60 days of EOP
|
977C
|
Item purchase price exceeded
|
978C
|
Benefit limit reached
|
979C
|
Reviewed adjustment request — filing denial upheld
|
980C
|
Benefit not covered
|
981C
|
Visit not indicated for separate reimbursement
|
982C
|
Rebundled to primary procedure
|
983C
|
Resubmit with operative report
|
985C
|
Resubmit with capped rental modifier
|
986C
|
New patient (PT) evaluation and management (E&M) not allowed for established patient
|
987C
|
Pre-operative services included in global rate
|
989C
|
Invalid code for DOS
|
990C
|
Member not eligible on DOS
|
991C
|
Resubmit with valid revenue code
|
992C
|
Resubmit with correct POS
|
993C
|
Resubmit with rendering physician name
|
994C
|
Assistant surgeon not required for procedure
|
995C
|
Professional services must be billed on a CMS 1500 Form
|
996C
|
Invalid bill type — resubmit corrected claim with valid bill type
|
997C
|
Facility charges must be submitted on a UB04 Form
|
998C
|
Invalid PX and/or DX combination claim check adjustment
|
999
|
Precertification received in third trimester
|
GLBL
|
Not separately reimbursable — included in global fee
|
MX
|
Maximum benefit reached
|
NC
|
Not a covered service
|
NR
|
Not a reimbursable code
|
T
|
Member not eligible on DOS
|
UNIT
|
Incorrect units for services billed
|