EOP Payment Codes
EOP Payment Codes
| Code | Description |
|---|---|
| 00 | INFORMATIONAL - COB COURT ORDER RULE |
| 01 | PAYABLE - MEMBER SUBMITTED NOT VALID FOR DATE OF SERVICE, # CHANGED |
| 02 | INFORMATIONAL- PRIMARY POLICY HOLDER OF OTHER COVERAGE |
| 03 | INFORMATIONAL - COORDINATION DUE TO ESRD RULE |
| 04 | PAYABLE-PRORATED DRG DUE TO TRANSFER OR READMIT |
| 05 | INFORMATION-HPM IS PRIMARY FOR THIS PATIENT-OTHER CARRIER PAID IN ERROR |
| 06 | INFORMATIONAL - MEDICARE PRIMARY DUE TO DISABILITY |
| 07 | INFORMATIONAL - ESRD COORDINATION RULE, PAYOR OF LAST RESORT |
| 08 | PAYABLE-HPM THIRD PARTY LIABILITY REVIEWED |
| 09 | PAYABLE-BASED ON NPPN REPRICING-DISCOUNT QUESTIONS, CALL 800-557-1656 |
| 0A | INFORMATIONAL-COB BIRTHDAY RULE |
| 0B | PAYABLE - COB REVIEW, PAID DEDUCTIBLE/COINSURANCE UP TO ALLOWED |
| 0C | PAID-PRICED BY NPPN/AHI/HEALTHLINK 800-860-1111 |
| 0D | PAID-PRICED BY INTEGRATED HEALTH CARE MANAGEMENT-AMN 800-860-1111 |
| 0E | PAID-PRICED BY TRPN/MCS 800-860-1111 |
| 0F | PAID-PRICED BY INDIANAHN-PLUS MI 800-860-1111 |
| 0G | INFORMATIONAL-COB GENDER RULE |
| 0H | PAID-PRICED BY IHP-FLHN 800-860-1111 |
| 0I | PAID-PRICED BY SOUTHCARE 800-860-1111 |
| 0J | PAID-PRICED BY HMA/RAN 800-860-1111 |
| 0K | PAID-PRICED BY IHP-MHN 800-860-1111 |
| 0L | PAID-PRICED BY IHP-HCP NETWORK 800-860-1111 |
| 0M | PAID-PRICED BY PHS (HPO/IHG) 800-860-1111 |
| 0N | PAID-PRICED BY MCS/PPONEXT NETWORK 800-860-1111 |
| 0P | PAID-PRICED BY PHS (VHN) NETWORK 800-860-1111 |
| 0Q | PAID-PRICED BY IHP-MR 800-860-1111 |
| 0R | PAID-PRICED BY IHP-NHN 800-860-1111 |
| 0S | PAID-PRICED BY CONCENTRA NETWORK 800-860-1111 |
| 0T | PAID-PRICED BY IHP-CHN 800-860-1111 |
| 0U | PAID-PRICED BY IHP-IHG 800-860-1111 |
| 0V | PAID-PRICED BY IHP-BEE 800-860-1111 |
| 0W | PAID-PRICED BY NPPN/PPONEXT 800-860-1111 |
| 0X | PAID-PRICED BY FIRSTHLTH 800-860-1111 |
| 0Y | PAID-PRICED BY IHP-FLORA HEALTH NETWORK 800-860-1111 |
| 0Z | PAID-PRICED BY TRPN/NPN CONTRACTUAL AGREEMENT 800-860-1111 |
| 10 | PAYABLE-MAXIMUM PAYMENT |
| 11 | PAYABLE-FEE PAID PER MULTIPLE/BILATERAL SURGERY |
| 12 | PAYABLE-PRIVATE ROOM CHARGES REDUCED TO SEMI-PRIVATE |
| 13 | PAYABLE-PER CONSULTANT/TRIBUNAL REVIEW |
| 14 | PAYABLE-PROCEDURE OR REVENUE CODE ADDED OR CHANGED |
| 15 | PAYABLE - COB OTHER CARRIER NOT VALID FOR DATE OF SERVICE |
| 16 | PAYABLE-APPROVED-MEMBER SATISFACTION PLAN |
| 17 | PAYABLE-PHYSICIAN INCENTIVE INCLUDED |
| 18 | PAID-PRICED BY TRPN/HPO 800-860-1111 |
| 19 | PAYABLE-PER NEGOTIATED RATE |
| 1A | PAYABLE-PAID MEDICARE FEE/MEDICAID FEE |
| 1B | PAID-PRICED BY BEECH STREET NETWORK 800-860-1111 |
| 1C | PAYABLE-PAID/PPO DISCOUNT/IF QUESTIONS CALL 972-312-8589 - EXT 458 |
| 1D | ALLOWED AMOUNT MODIFIED UP TO THE PRIMARY CARRIER ALLOWED PER MI COB ACT |
| 1E | PAID-PRICED BY BEECH STREET/BEST CARE NETWORK 800-860-1111 |
| 1F | PAID-PRICED BY BEECH STREET/AMCO NETWORK 800-860-1111 |
| 1G | PAYABLE-REIMBURSEMENT NEGOTIATED THROUGH GLOBAL CLAIMS SERVICES |
| 1H | PAID-PRICED BY BEECH STREET/HEALTHCHOICE NAMCI NETWORK 800-860-1111 |
| 1I | PAID-PRICED BY BEECH STREET/INTER GROUP NETWORK 800-860-1111 |
| 1J | PAID-PRICED BY BEECH STREET/MIDLANDS CHOICE NETWORK 800-860-1111 |
| 1K | PAID-PRICED BY BEECH STREET/PHP NETWORK 800-860-1111 |
| 1L | PAID-PRICED BY BEECH ST/MANAGED HEALTHCARE NW NETWORK 800-860-1111 |
| 1M | PAID-PRICED BY BEECH STREET/PCN NETWORK 800-860-1111 |
| 1N | PAID-PRICED BY BEECH STREET/SIGNATURE NETWORK 800-860-1111 |
| 1P | PAYABLE-PER DIEM RATE |
| 1Q | PAID PER CONTRACTUAL AGREEMENT |
| 1R | PAID-PRICED BY BEECH STREET/IHC NETWORK 800-860-1111 |
| 1S | PAID-PRICED BY BEECH STREET/FIRST CHOICE NETWORK 800-860-1111 |
| 1T | PAID-PRICED BY BEECH STREET/SELECT NET PLUS NETWORK 800-860-1111 |
| 1U | PAID-PRICED BY BEECH STREET/AHC NETWORK 800-860-1111 |
| 1V | PAID-PRICED BY CCN NETWORK 800-860-1111 |
| 1W | PAID-PRICED BY CCN/FIRST CHOICE-SOUND HEALTH NETWORK 800-860-1111 |
| 1X | PAID-PRICED BY CCN/HCVM NETWORK 800-860-1111 |
| 1Y | PAID-PRICED BY EMERALD HEALTH NETWORK 800-860-1111 |
| 1Z | PAID-PRICED BY INDIANA HEALTH NETWORK 800-860-1111 |
| 20 | PAYABLE-LATE FILING APPEAL APPROVED-FINAL DECISION |
| 21 | PAYABLE - SERVICES REVIEWED |
| 22 | PAYABLE-ADDITIONAL CHARGES OR CREDITS TO PREVIOUS CLAIM |
| 23 | PAYABLE-PAID AT DRG RATE |
| 24 | PAYABLE-CHARGES APPLIED TO RISK OR DISCOUNT - LIABILITY OF PROVIDER |
| 25 | PAYABLE-PAID PER MULTIPLAN PPO NEGOTIATED RATE |
| 26 | PAYABLE-PER INVOICE FOR PRICING OR AUDITING |
| 27 | PAYABLE-PAID PER NHBC PPO NEGOTIATED RATE |
| 28 | PAYABLE - PAYMENT REDUCED BY MEDICARE |
| 29 | PAYABLE-SERVICE MANUALLY PAID |
| 2A | INFORMATIONAL-MEDICARE WORKING AGED TEFRA OBRA |
| 2B | PAYABLE - MEDICAID'S REGULATION, PAYOR OF LAST RESORT |
| 2C | DAILY DOLLAR LIMIT ALREADY MET |
| 2D | PAYABLE-PAID AT MANAGED CARE MEDICAID / MEDICARE DRG RATE |
| 2E | PAID-PRICED BY COFINITY 800-860-1111 |
| 2F | PAID-PRICED BY TRPN 800-860-1111 |
| 2G | PAID-PRICED BY TRPN/IHP 800-860-1111 |
| 2H | PAYABLE-CHARGES COMBINED AND PROCEDURE PAID AT BILATERAL RATES |
| 2I | IMMUNIZATION, FOR REPORTING PURPOSES ONLY |
| 2J | PAID-PRICED BY MULTIPLAN 800-860-1111 |
| 2K | PAID-PRICED BY PPONEXT 800-860-1111 |
| 2L | PAID-PRICED BY NPPN 800-860-1111 |
| 2M | PAYABLE-MANAGED CARE MEDICAID/MEDICARE/CHP FEE SCHEDULE |
| 2N | HEALTH ACCESS ENCOUNTER CLAIM ONLY |
| 2O | PAID-PRICED BY HPO/MANAGED HEALTHCARE NW 800-860-1111 |
| 2P | PAID-PRICED BY UPUP/PRO-AMERICA 800-860-1111 |
| 2Q | PAID-PRICED BY NPPN/ACCOUNTABLE 800-860-1111 |
| 2R | PAID-PRICED BY NPPN/DIRECT 800-860-1111 |
| 2S | PAID-PRICED BY GALAXYHN 800-860-1111 |
| 2T | PAID-PRICED BY NPPN/MRI/PROV STRATEGIES 800-860-1111 |
| 2U | PAID-PRICED BY NPPN/NOVANET 800-860-1111 |
| 2V | PROVIDED THROUGH VACCINE REPLACEMENT/VACCINE FOR CHILDREN PROGRAM |
| 2W | PAID-PRICED BY NPPN/HFN 800-860-1111 |
| 2X | PAID-PRICED BY NPPN/BAPTIST HEALTH SERVICES 800-860-1111 |
| 2Y | PAID-PRICED BY NPPN/INTERPLAN 800-860-1111 |
| 2Z | PAID-PRICED BY TRPN/PHS 800-860-1111 |
| 30 | PAID-PRICED BY ELDORADO SERVICES GROUP NEGOTIATION 800-860-1111 |
| 31 | PAID-PRICED BY NPPN/MRI/NATIONAL HOSP NETWORK 800-860-1111 |
| 32 | PAID-PRICED BY NPPN/PHYSICIANS CARE NETWORK 800-860-1111 |
| 33 | PAID-PRICED BY NPPN/TRPN 800-860-1111 |
| 34 | PAID-PRICED BY NPPN/HEALTH MANAGEMENT ASSOC 1-800-860-1111 |
| 35 | PAID-PRICED BY NPPN/OHIO PREFERRED NETWORK 1-800-860-1111 |
| 36 | PAID-PRICED BY NPPN/ARIZONA MEDICAL NETWORK 800-860-1111 |
| 37 | PAID-PRICED BY NPPN/FIRST CHOICE OF MIDWEST 800-860-1111 |
| 38 | PAID-PRICED BY NPPN/PPOIN/PROHEALTH 800-860-1111 |
| 39 | PAID-PRICED BY NPPN/SIGNATURE HEALTH ALLIANCE 800-860-1111 |
| 3A | PAID-PRICED BY NPPN/MEDICAL RESOURCE 800-860-1111 |
| 3B | PAID-PRICED BY TRPN/CCN 800-860-1111 |
| 3C | PAID-PRICED BY NPPN/MRI/GALAXY HEALTH NETWORK 800-860-1111 |
| 3D | PAID-PRICED BY NPPN/COMMUNITY HEALTH PARTNERS 800-860-1111 |
| 3E | PAID-PRICED BY TRPN/GALAXY 800-860-1111 |
| 3F | PAID-PRICED BY NPPN/AMERIAN PPO,INC. 800-860-1111 |
| 3G | PAID-PRICED BY NPPN/INTERGROUP 800-860-1111 |
| 3H | PAID-PRICED BY NPPN/QUALCHOICE OF ARKANSAS 800-860-1111 |
| 3I | PAID-PRICED BY NPPN/UNIVERSAL/NV 800-860-1111 |
| 3J | PAID-PRICED BY NPPN/SIGNATURE HEALTH ALLIANCE OF TENN 800-860-1111 |
| 3K | PAID-PRICED BY USAMCOFN 800-860-1111 |
| 3L | INFORMATIONAL - RETIRED MEDICARE PRIMARY |
| 3M | INFORMATIONAL - RETIRED MEDICARE SECONDARY |
| 3N | PAID-PRICED BY NPPN/AHI/UNICARE 800-860-1111 |
| 3O | PAID-PRICED BY NPPN/GALAXY HEALTH NETWORK 800-860-1111 |
| 3P | PAID-PRICED BY NPPN/PPO/KENTUCKY 800-860-1111 |
| 3Q | PAID-PRICED BY TRPN/FCHN 800-860-1111 |
| 3R | PAID-PRICED BY NPPN/HEALTH POINT PHYS. HOSP. ORG 800-860-1111 |
| 3S | PAID-PRICED BY NPPN/AMCARESRC 800-860-1111 |
| 3T | PAID-PRICED BY NPPN/TRPN-FORTIFIED PROV NETWORK 800-860-1111 |
| 3U | PAID-PRICED BY NPPN/BAYCARE 800-860-1111 |
| 3V | PAID-PRICED BY NPPN/UNIVERSAL/LA 800-860-1111 |
| 3W | PAID-PRICED BY IMSTEXAS NETWORK 800-860-1111 |
| 3X | PAID-PRICED BY NPPN/DIMENSION 800-860-1111 |
| 3Y | PAID-PRICED BY NPPN/RURAL ARIZONA 800-860-1111 |
| 3Z | PAID-PRICED BY NPPN/HEALTH PAYERS ORG(HPO) 800-860-1111 |
| 40 | PAID-PRICED BY HMA 800-860-1111 |
| 41 | PAID-PRICED BY NPPN/HEALTH SPAN NETWORK 800-860-1111 |
| 42 | PAYABLE-PART D DRUG BENEFIT UNDER MEDICARE GUIDELINE |
| 43 | PAID-PRICED BY AMPSFEENEG 800-860-1111 |
| 44 | PAID-PRICED BY NPPN/CHN/NJ 800-860-1111 |
| 45 | PAID-PRICED BY NPPN/TPRN-MANAGED CARE STRAT NETWORK 800-860-1111 |
| 46 | PAID-PRICED BY PRIMEHSPAS-PHS (PSI) NETWORK 800-860-1111 |
| 47 | PAID-PRICED BY IMST TEXAS 800-860-1111 |
| 48 | PAID-PRICED BY INTEGRATED HEALTH PLAN (IHPLAN) 800-860-1111 |
| 49 | PAID-PRICED BY PRIME HEALTH 800-860-1111 |
| 4A | PAID-PRICED BY PRIMEHSPAS-PHS (FPN) 800-860-1111 |
| 4B | PAID-PRICED BY NPPN/INTERPLAN HEALTH GROUP 800-860-1111 |
| 4C | PAID-PRICED BY NPPN/THE INITIAL GROUP 800-860-1111 |
| 4D | PAID-PRICED BY NPPN/TRPN-PRIMARY HEALTH SERVICES 800-860-1111 |
| 4E | PAID-PRICED BY NPPN/AHI/UNICARE 800-860-1111 |
| 4F | PAID-PRICED BY PRIMEHSPAS 800-860-1111 |
| 4G | PAID-PRICED BY INTEGRATED HEALTH PLAN-HPO 800-860-1111 |
| 4H | PAID-PRICED BY INTEGRATED HEALTH PLAN-ghn 800-860-1111 |
| 4I | PAID-PRICED BY INTEGRATED HEALTH PLAN-ihp2 800-860-1111 |
| 4J | PAID-PRICED BY INTEGRATED HEALTH PLAN-NPN 800-860-1111 |
| 4K | PAID-PRICED BY INTEGRATED HEALTH PLAN-psi 800-860-1111 |
| 4L | PAID-PRICED BY INTEGRATED HEALTH PLAN-phn 800-860-1111 |
| 4M | PAID-PRICED BY INTEGRATED HEALTH PLAN-EC 800-860-1111 |
| 4N | PAID-DISCREPANT CHARGES PER NBAS AUDIT/PATIENT NOT RESPONSIBLE |
| 4O | PAYABLE - PAID AT UAW RMBT CONTRACTED RATE |
| 4P | PAYABLE-CLAIM PAID PER AUTHORIZED CODE NOT CODE BILLED |
| 4Q | PAID-PRICED BY INTEGRATED HEALTH PLAN - PPON 800-860-1111 |
| 4R | PAID-PRICED BY INTEGRATED HEALTH PLAN-FOREMOST 800-860-1111 |
| 4S | PAID-PRICED BY INTEGRATED HEALTH PLANIHP 800-860-1111 |
| 4T | PAID-PRICED BY INTEGRATED HEALTH PLAN-FPN 800-860-1111 |
| 4U | PAID-PRICED BY TRPNAFFIL 800-860-1111 |
| 4V | PAID-PRICED BY TRPN/UHN 800-860-1111 |
| 4W | PAID-PRICED BY INTEGRATED HEALTHPLAN-PHS 800-860-1111 |
| 4X | PAID-PRICED BY PRIMEHSPAS-ART/NPN 800-860-1111 |
| 4Y | PAID-PRICED BY NPPN/AMERICAS PPO 800-860-1111 |
| 4Z | PAID-PRICED BY UPANDUP 800-860-1111 |
| 50 | INFORMATIONAL- (PREPAID) - COB COURT ORDER RULE |
| 51 | PAYABLE (PREPAID)-APPROVED-MEMBER SATISFACTION PLAN |
| 52 | ADJUSTED (PREPAID) - THIRD PARTY COB PAYMENT / LIABILITY |
| 53 | PAYABLE (PREPAID)-FIXED RATE PER CONTRACT/DAILY DOLLAR LIMIT ALREADY MET |
| 54 | INFORMATIONAL- (PREPAID) - COB BIRTHDAY RULE |
| 55 | PAYABLE (PREPAID)-MAXIMUM PAYMENT |
| 56 | PAYABLE/ADJUSTED-(PREPAID)PER INT/EXT AUDIT |
| 57 | ADJUSTED (PREPAID)-PER CONTRACTUAL AGREEMENT/CORRECTION |
| 58 | INFORMATIONAL- LATE NOTIFICATION OF ADMISSION PENALTY APPLIED |
| 59 | ADJUSTED-(PREPAID)-PER REVIEW/APPEAL/ISS DEPT |
| 5A | PAYABLE (PREPAID)-CLAIM PAID PER AUTHORIZED CODE NOT CODE BILLED |
| 5B | PAYABLE (PREPAID) - PAID AT APC/MEDICARE/MEDICAID FEE |
| 5C | ADJUSTED (PREPAID)-COPAYMENT |
| 5D | ADJUSTED (PREPAID)-INCORRECT DATA/SEE CORRECTION |
| 5E | ADJUSTED (PREPAID)-MEMBER/PARTICIPANT ELIGIBILITY |
| 5F | PAYABLE - (CAPITATED) - MAXIMUM PAYMENT |
| 5H | COB OBRA (PRE-PAID) MEDICARE PRIMARY |
| 5I | ADJUSTED (PREPAID)-MAX PMT OR INTERNL DATA CORRECTION W/NO CHANGE IN PMT |
| 5J | PAYABLE (PREPAID)-PAYMENT REDUCED DUE TO ACQUIRED CONDITION |
| 5K | ADJUSTED (PREPAID)-PAYMENT REDUCED DUE TO HOSPITAL ACQUIRED CONDITION |
| 5L | ADJUSTED (PREPAID)-PER CONSULTANT REVIEW/APPEAL/MED AUDIT |
| 5M | PAYABLE (PREPAID) PRORATED DRG DUE TO TRANSFER OR READMIT |
| 5N | INFORMATIONAL-COB (PREPAID PPG) PAYOR OF LAST RESORT |
| 5O | PAYABLE-COB (PREPAID PPG) PRIMARY POLICY HOLDER |
| 5P | ADJUSTED (PREPAID)-DUPLICATE/SAME PROCEDURE PREVIOUSLY PAID |
| 5Q | PAYABLE (CAPITATED)-FIXED RATE PER CONTRACT/DAILY $ LIMIT ALREADY MET |
| 5R | ADJUSTED (PREPAID)-PER REFERRAL/AUTH POLICY |
| 5S | ADJUSTED (PREPAID)-NO OTHER CARRIER LIABILITY |
| 5T | PAYABLE-(PREPAID)REPLACED/REBUNDLED |
| 5U | ADJUSTED-PREPAID ORIGINALLY PROCESSED TO INCORRECT PROVIDER/AFFIL |
| 5V | ADJUSTED (PREPAID) - PERSONAL INJURY CASE/SUBROGATION/LEIN |
| 5W | ADJUSTED (PREPAID)-INCORRECT BILLING VERIFIED BY HEALTHPLUS |
| 5X | ADJUSTED-PREPAID-CONTRACT CHG/CORRECTION/MBR RESPONSIBILITY DOES NOT CHG |
| 5Y | INFORMATIONAL-COB (PREPAID PPG) ESRD MEDICARE PRIMARY |
| 5Z | ADJUSTED (PREPAID)-PAID IN ERROR-OTHER COVERAGE LIABLE |
| 60 | INFORMATIONAL- (PREPAID - NON PPG)- COURT ORDER RULE |
| 61 | PAYABLE (PREPAID NON PPG)-APPROVED-MEMBER SATISFACTION PLAN |
| 62 | ADJUSTED (PREPAID-NON PPG)-THIRD PARTY COB PAYMENT / LIABILITY |
| 63 | PAYABLE (PREPAID-NON PPG)-FIXED RATE PER CONTRACT/DAILY $ LIMIT BEEN MET |
| 64 | INFORMATIONAL- (PREPAID - NON PPG) -COB BIRTHDAY RULE |
| 65 | PAYABLE (PREPAID NON PPG)-MAXIMUM PAYMENT |
| 66 | PAYABLE/ADJUSTED-(PREPAID-NON-PPG)PER INT/EXT AUDIT |
| 67 | ADJUSTED (PREPAID-NON PPG)-PER CONTRACTUAL AGREEMENT/CORRECTION |
| 69 | ADJUSTED (PREPAID NON-PPG)-PER REVIEW/APPEAL/ISS DEPT |
| 6A | PAYABLE (PREPAID NON PPG)-CLAIM PAID PER AUTHORIZED CODE NOT CODE BILLED |
| 6B | PAYABLE (PREPAID NON-PPG) - PAID AT APC/MEDICARE/MEDICAID FEE |
| 6C | ADJUSTED (PREPAID-NON PPG)-COPAYMENT |
| 6D | ADJUSTED (PREPAID-NON PPG)-INCORRECT DATA/SEE CORRECTION |
| 6E | ADJUSTED (PREPAID-NON PPG)-MEMBER/PARTICIPANT ELIGIBILITY |
| 6G | INFORMATIONAL - (PREPAID NON PPG) PAYOR OF LAST RESORT |
| 6H | COB (NON PPG) OBRA MEDICARE PRIMARY |
| 6I | ADJUSTED (PREPAID-NON PPG)-MAX PMT OR INTERNL DATA CORR W/NO CHG IN PMT |
| 6J | PAYABLE (PREPAID NON PPG)-PAYMENT REDUCED DUE TO ACQUIRED CONDITION |
| 6K | ADJUSTED (PREPAID NON-PPG)-PAYMT REDUCED DUE TO HOSP ACQUIRED CONDITION |
| 6L | ADJUSTED (PREPAID-NON PPG)-PER CONSULTANT REVIEW/APPEAL/MED AUDIT |
| 6M | PAYABLE (PREPAID-NON PPG) PRORATED DRG DUE TO TRANSFER OR READMIT |
| 6N | EOB (NON PPG) ESRD MEDICARE PRIMARY |
| 6P | ADJUSTED (PREPAID-NON PPG)-DUPLICATE/SAME PROCEDURE PREVIOUSLY PAID |
| 6Q | PAYABLE-(PREPAID NON-PPG)REPLACED/REBUNDLED |
| 6R | ADJUSTED (PREPAID-NON PPG)-PER REFERRAL/AUTH POLICY |
| 6S | ADJUSTED (PREPAID-NON PPG)-NOT OTHER CARRIER LIABILITY |
| 6T | ADJUSTED (PREPAID-NON PPG)-REFUND RECEIVED RETRO ELIGIBILITY CHANGE |
| 6U | ADJUSTED-PREPAID NON PPG-ORIGINALLY PROCESSED TO INCORRECT PROV/AFFIL |
| 6V | ADJUSTED (PREPAID NON PPG)-PERSONAL INJURY CASE/SUBROGATION/LEIN |
| 6W | ADJUSTED (PREPAID-NON PPG)-INCORRECT BILLING VERIFIED BY PROVIDER |
| 6X | ADJUSTED-PREPAY-NON PPG/CONTRACT CHG/CORRECTION/MBR RESPONS DOES NOT CHG |
| 6Y | COB (NON PPG) PRIMARY POLICY HOLDER |
| 6Z | ADJUSTED (PREPAID NON PPG)-PAID IN ERROR-OTHER COVERAGE LIABLE |
| 7D | ADJUSTED (NON-FFS)-DENIED - INCORRECT DATA - SEE CORRECTION |
| 7E | ADJUSTED-(PREPAID)-DENIED PER REVIEW/APPEAL/ISS DEPT |
| 7J | ADJUSTED (NON-FFS)-DENIED-PAYMENT REDUCED DUE TO ACQUIRED CONDITION |
| 7K | ADJUSTED (PREPAID)-DENIED PAYMENT REDUCED DUE TO HOSP ACQUIRED CONDITION |
| 7L | ADJUSTED (NON FFS)-DENIED-PER CONSULTANT REVIEW/APPEAL/MED AUDIT |
| 7U | ADJUSTED-PREPAID-DENIED-ORIGINALLY PROCESSED TO INCORRECT PROV/AFFIL |
| 7W | ADJUSTED (NON FFS)-DENIED-INCORRECT BILLING VERIFIED BY HEALTHPLUS |
| 7Z | ADJUSTED (NON FFS) DENIED - PAID IN ERROR, OTHER COVERAGE LIABILITY |
| 8B | INFORMATIONAL - RETIRED MEDICARE PRIMARY |
| 8C | INFORMATIONAL - RETIRED MEDICARE SECONDARY |
| 8D | ADJUSTED (NON FFS-NON PPG)-DENIED - INCORRECT DATA - SEE CORRECTION |
| 8E | ADJUSTED-(PREPAID-NON PPG)-DENIED PER REVIEW/APPEAL/ISS DEPT |
| 8J | ADJUSTED (NON-FFS/PPG)-DENIED-PAYMENT REDUCED DUE TO ACQUIRED CONDITION |
| 8K | ADJUSTED(PREPAY NONPPG)-DENIED PAYMT REDUCED DUE TO HOSP ACQUIRED CONDIT |
| 8L | ADJUSTED (NON FFS-NON PPG)-DENIED-PER CONSULTANT REVIEW/APPEAL/MED AUDIT |
| 8U | ADJUSTED-NON FFS-NON PPG-ORIGINALLY PROCESSED TO INCORRECT PROV/AFFIL |
| 8W | ADJUSTED (NON FFS-NON PPG)-DENIED-INCORRECT BILLING VERIFIED BY PROV |
| 8X | ADJUSTED (NON FFS-NON PPG)-DENIED PRIVATE ROOM CHARGES |
| 8Z | ADJUSTED (NON FFS NON PPG)DENIED-PAID IN ERROR,OTHER CARRIER LIABILITY |
| 91 | PAID-PRICED BY ONENET 800-860-1111 |
| 92 | PAID-PRICED BY HYGEIA/FIRST HEALTH 800-860-1111 |
| 93 | PAID-PRICED BY NPPN/Interplan Health Group-TX 800-860-1111 |
| 94 | PAID-PRICED BY IHP/TLC 800-860-1111 |
| 95 | PAID-PRICED THROUGH ONE OF THE GLOBALCARE NETWORKS |
| 96 | PAID-PRICED BY INDEPENDENT MEDICAL SYSTEMS 800-860-1111 |
| 97 | PAID-TEXAS TRUE CHOICE 800-860-1111 |
| 98 | PAID-PRICED BY IHP-DENTEMAX 800-860-1111 |
| 99 | PAID-PRICED BY HEALTH PAYORS ORGANIZATION 800-860-1111 |
| 9A | PAID-PRICED BY IHP-NATIONAL HOSP NETWORK 800-860-1111 |
| 9B | PAID-PRICED BY IHP-RURAL ARIZONA NETWORK 800-860-1111 |
| 9C | PAID-PRICED BY NPPN/HPO/PRIMARY HEALTH SVCS. 800-860-1111 |
| 9D | PAID-PRICED BY DEVON HEALTH NETWORK 1-800-860-1111 |
| 9E | PAID-PRICED BY NPPN/PRIME HEALTH SERVICES 800-860-1111 |
| 9F | PRICED BY IHP-HFN 800-860-1111 |
| 9G | PAID-PRICED BY FORTIFIED PROVIDER NETWORK 800-860-1111 |
| 9H | PAID-PRICED BY HYGEIA 800-860-1111 |
| 9I | PAID-PRICED BY HPO/IHG 800-860-1111 |
| 9J | PAID-PAYMENT REDUCED DUE TO ACQUIRED CONDITION |
| 9K | PAID-PRICED BY NPPN/MEDICAL RESOURCE/NPPN 800-860-1111 |
| 9L | PAID-PRICED BY INTERPLAN HEALTH GROUP 800-860-1111 |
| 9M | PAID-PRICED BY PHCS HEALTHY DIRECTIONS 800-860-1111 |
| 9N | PAID-PRICED BY HMA/ARIZONA MEDICAL NETWORK 800-860-1111 |
| 9O | PAID-PRICED BY GLOBALCARE ARBITRATION 800-860-1111 |
| 9P | PAID-PRICED BY ENCORE HEALTH NETWORK 800-860-1111 |
| 9Q | PAID-PRICED BY HPO/COMPETITIVE HEALTH NETWORK 800-860-1111 |
| 9R | PAID-PRICED BY NOVANET 800-860-1111 |
| 9S | PAID-PRICED BY PMCS 800-860-1111 |
| 9T | PAID-PRICED BY NPPN/CONSUMER HEALTH NET-CT 800-860-1111 |
| 9U | PAYABLE-REPLACED/REBUNDLED |
| 9V | PAID-PRICED BY CMN/PHCS 800-860-1111 |
| 9W | PAID-PRICED BY IHG/HPO 800-860-1111 |
| 9X | PAID-PRICED BY HEALTHSMART/HPO 800-860-1111 |
| 9Y | PAID-PRICED BY INITIALGRP\BAPTIST HEALTH NET 800-866-1111 |
| 9Z | PAID-PRICED BY CORECHOICE 800-860-1111 |
| A3 | ADJUSTED-REFUND RECEIVED-GMIS APPEAL OR AUDIT |
| A4 | ADJUSTED-DRG AMOUNT PRORATED ACCORDING TO DAILY DRG RATE |
| A5 | ADJUSTED-PER FACILITY PREAUTHORIZATION POLICY |
| A6 | ADJUSTED-PROCEDURE CODE ADDED OR CHANGED |
| A7 | ADJUSTED-DRG RATE |
| A8 | ADJUSTED - NO MONEY RECEIVED, INTERNAL ADJUST ONLY |
| A9 | ADJUSTED-REFUND RECEIVED |
| AA | ADJUSTED-DUPLICATE/SAME PROCEDURE PREVIOUSLY PAID |
| AB | ADJUSTED-ORIGINALLY PROCESSED TO INCORRECT PROVIDER / AFFILIATION |
| AC | ADJUSTED-COPAYMENT |
| AD | ADJUSTED-INCORRECT DATA-SEE CORRECTION |
| AE | ADJUSTED-MEMBER/PARTICIPANT ELIGIBILITY |
| AF | ADJUSTED-SERVICE NOT COVERED AS A BENEFIT OF MEMBERS CONTRACT |
| AG | ADJUSTED-PER CONSULTANT REVIEW/COB VENDOR |
| AH | ADJUSTED-PROVIDER REQUESTED - BILLED IN ERROR |
| AI | ADJUSTED-MAX PAYMENT OR INTERNAL DATA CORRECTION W/NO CHANGE IN PAYMENT |
| AJ | ADJUSTED-DENIED-PAYMENT REDUCED DUE TO ACQUIRED CONDITION |
| AK | ADJUSTED-PAYMENT REDUCED DUE TO HOSPITAL ACQUIRED CONDITION |
| AL | ADJUSTED-PER CONSULTANT REVIEW/APPEAL/MED AUDIT |
| AM | ADJUSTED-PER CONTRACT CHANGE/CORRECTION/MBR RESPONSIBILITY DOES NOT CHG |
| AO | ADJUSTED-INCORRECT BILLING VERIFIED BY HEALTHPLUS |
| AP | ADJUSTED-PAID IN ERROR, MONEY RECOVERED FROM PROVIDER |
| AQ | ADJUSTED-PER CREDENTIALING POLICY |
| AR | ADJUSTED-PER REFERRAL/AUTH POLICY |
| AS | ADJUSTED-NOT OTHER CARRIER LIABILITY |
| AT | ADJUSTED-ERROR IN REPORTING OF SERVICE QUANTITY |
| AU | ADJUSTED-INCLUDED IN ANOTHER PROC/SERVICE OR PER CONTRACT |
| AW | ADJUSTED-PREVIOUSLY PROCESSED UNDER INCORRECT MEMBER/PARTICIPANT # |
| AX | ADJUSTED-PRIVATE ROOM CHARGE(S) POLICY |
| AY | ADJUSTED - PER NEGOTIATED AGREEMENT |
| AZ | ADJUSTED-PAID IN ERROR-OTHER CARRIER LIABILITY |
| B1 | ADJUSTED- THIRD PARTY COB PAYMENT RECEIVED |
| B2 | ADJUSTED-THIRD PARTY COB PAYMENT TO PROVIDER |
| B7 | ADJUSTED-PER CONTRACTUAL AGREEMENT/CORRECTION |
| B8 | ADJUSTED-PER LATE FILING APPEAL COMMITTEE |
| B9 | ADJUSTED-ANOTHER ADMISSION REIMBURSED AT STANDARD DRG RATE METHODOLOGY |
| BA | ADJUSTED-APPROVED PER MEMBER SATISFACTION |
| BB | ADJUSTED-CLAIM REVIEWED/APPEAL APPROVED |
| BC | ADJUSTED-BALANCE TO CONTRACT/ORIGINALLY PAID HPM RATES TO PROVIDER |
| BE | ADJUSTED-PAID PER REVIEW/APPEAL/ISS DEPT |
| BH | ADJUSTED-FEE REDUCED-MULTIPLE/BILATERAL SURGERY |
| BI | ADJUSTED-ACCORDING TO HPO NEGOTIATED AGREEMENT |
| BJ | AUTO ADJUSTED - PER CONTRACTUAL AGREEMENT |
| BT | ADJUSTED-REFUND RECEIVED-RETRO ELIGIBILITY CHANGE |
| BV | ADJUSTED-PERSONAL INJURY CASE/SUBROGATION/LEIN |
| C1 | PAID-PRICED BY IHP-PRIME HEALTH SERVICES 800-860-1111 |
| C2 | PAID-PRICED BY IHP-UNIVERSAL HEALTH NETWORK 800-860-1111 |
| C3 | PAID-PRICED BY THE INITIAL GROUP 800-860-1111 |
| C4 | PAID-PRICED BY IHP-IGS 800-860-1111 |
| C5 | PAID-PRICED BY VIANT NEGOTIATED RATE 800-860-1111 |
| C6 | PAID-PRICED BY CORVEL 800-860-1111 |
| C7 | PAID-PRICED BY HealthEOS 800-860-1111 |
| C8 | PAID-PRICED BY NPPN/DENTEMAX 800-860-1111 |
| C9 | PAID-PRICED BY NPPN/COALLITION AMERICA(CAD) 800-860-1111 |
| CA | PAID-PRICED BY SIGNATURE HEALTH ALLIANCE 800-860-1111 |
| CB | PAID-PRICED BY PSI 800-860-1111 |
| CC | PAID-PRICED BY NPPN/USA MCO 800-860-1111 |
| CD | PAID-PRICED BY HPO/PRIMARY HEALTH SERVICES 800-860-1111 |
| CE | PAID-PRICED BY NPPN/PLANCARE AMERICA (PCA) 800-860-1111 |
| CF | PAID-PRICED BY INTERGROUP SERVICES CORP 800-860-1111 |
| CG | PAID-PRICED BY MULTIPLAN/VIANT NEGOTIATION 800-860-1111 |
| CH | PAID-PRICED BY DEVON FEE NEGOTIATION 800-860-1111 |
| CI | PAID-PRICED BY HEALTHSMART 800-860-1111 |
| CJ | PAID-PRICED BY CMN 800-860-1111 |
| CK | PAID-PRICED BY AZFOUND 800-860-1111 |
| CL | PAID-PRICED BY AMERICAS PPO 800-860-1111 |
| CM | PAID-PRICED BY BGFH SINGLE SOURCE 800-860-1111 |
| CN | PAID - PRICED BY AMERICAN PPO 800-860-1111 |
| CO | PAID - PRICED BY FEDMED/AMHN/IHP APP 800-860-1111 |
| CQ | PAID-PRICED BY IHP-FEDMED 800-860-1111 |
| CZ | INFORMATIONAL - DEPENDANT OF PRIMARY POLICY |
| D0 | DENIED-CONSENT FORM PROCEDURE NOT FOLLOWED |
| D1 | DENIED-PROVIDER RESPONSIBLE FOR COST OF SERVICE |
| D2 | OTHER CARRIER PAID MAXIMUM ALLOWED - NO PATIENT LIABILITY |
| D3 | DENIED-BILL THE SECONDARY CARRIER-HPM IS TERTIARY |
| D4 | DENIED-REFERRAL REQUIRED/NOT IN PLACE FOR SVCS BILLED-MEMBER RESPONSIBLE |
| D5 | DENIED-AUTH INVALID FOR PROCEDURE/DIAGNOSIS/SURGERY OR LOCATION REPORTED |
| D6 | DENIED-AUTHORIZATION NOT ISSUED BY MEMBER'S PRIMARY PHYSICIAN |
| D7 | DENIED-BENEFIT COVERED BY COMMUNITY MENTAL HEALTH OR STATE MEDICAID |
| D8 | DENIED-FACILITY SERVICES NOT AUTHORIZED-MEMBER LIABILITY |
| D9 | DENIED-ADMISSION DEEMED RELATED, RESUBMIT CORRECTED COMBINED CLAIM |
| DA | DENIED-IMAGE DESTROYED - PLEASE REBILL |
| DB | DENIED-SERVICE NOT PAYABLE BASED ON INFORMATION RECEIVED |
| DC | DENIED-NOT PAYABLE PER PROVIDER CONTRACT |
| DD | DENIED-MEMBER INELIGIBLE ON DATE OF SERVICE |
| DE | DENIED-SERVICES FOR THIS VISION DIAGNOSIS ARE NOT PAYABLE |
| DF | DENIED-FACILITY SVCS NOT AUTHORIZED OR MEMBER NOT ELIG ON DATE OF ADMIT |
| DG | DENIED-BILL COMPLETE INPATIENT SPAN, INCLUDING LEAVE DAYS, AS ONE |
| DH | DENIED-ADMISSION REPORTED EXCEEDS DAYS AUTHORIZED |
| DI | DENIED-SERVICE, PROCEDURE OR DIAGNOSIS NOT PAYABLE |
| DJ | DENIED-PATIENT NAME AND CONTRACT # REPORTED DO NOT AGREE |
| DK | DENIED-BEYOND CONTRACT FILING PERIOD FOR CLAIM |
| DL | DENIED-CODE NOT APPROPRIATE FOR SERV BILLED OR LACKS SUPPORTING HCPC/CPT |
| DM | DENIED-PERIOD OF CARE/# OF SERVICES OMITTED ON CLAIM OR APPEAR INCORRECT |
| DN | DENIED-SERVICE NOT COVERED AS A BENEFIT OF MEMBER'S CONTRACT |
| DO | DENIED-FACILITY SRVS NOT AUTHORIZED--MEMBER NOT RESPONSIBLE FOR CHARGES |
| DP | DENIED-PROCEDURE NOT PAYABLE IN LOCATION REPORTED |
| DQ | DENIED-PROCEDURE BILLED REQUIRES APPROVED CREDENTIALS |
| DR | DENIED-PER MEDICAL CONSULTANT OR PEER REVIEW |
| DS | PROCEDURE NOT REIMBURSED SEPARATELY |
| DT | DENIED-DOESN'T MEET RADIOLOGY MEDICAL NECESSITY-PROVIDER RESPONSIBLE |
| DU | DENIED-SAME PROCEDURE PREVIOUSLY PAID |
| DV | DENIED-ITEMIZATION, INVOICE, DOCUMENTATION OR ELECTRONIC REMARK NEEDED |
| DW | DENIED-MAXIMUM SERVICES PREVIOUSLY PROVIDED |
| DX | DENIED-PROCEDURE CODE NOT PAYABLE OR INVALID FOR DIAGNOSIS REPORTED |
| DY | DENIED-RENTAL/MAINTENANCE NOT PAYABLE FOR DME ITEM |
| DZ | DENIED-SERVICES MUST BE OBTAINED FROM CONTRACTING PROVIDER |
| E0 | DENIED-CLAIM LACKS CHARGES FOR SERVICES |
| E1 | DENIED-WORKERS COMPENSATION LIABLE |
| E2 | DENIED-OTHER COVERAGE LIABLE |
| E3 | DENIED-AUTO COVERAGE LIABLE |
| E4 | DENIED - INACTIVE PROVIDER#, USE ACTIVE PROVIDER# |
| E5 | DENIED-CLAIM LACKS CORRECT PATIENT NAME AND/OR BIRTH DATE |
| E6 | DENIED-MEMBER NAME/NUMBER REPORTED UNKNOWN/NEWBORN NOT ENROLLED |
| E7 | DENIED-LOCATION OF SERVICE NOT REPORTED OR APPEARS INCORRECT |
| E8 | DENIED-DATE OF SERVICE NOT REPORTED OR APPEARS INCORRECT |
| E9 | DENIED-ICD9 DIAG/PROC CODE MISSING OR INVALID |
| EA | DENIED - INCORRECT OR MISSING HPM PROVIDER NUMBER BILLED |
| EB | DENIED-NOT BILLING ACCORDING TO STANDARDIZED BILLING GUIDELINES |
| EC | CHARGES APPLIED TO COPAY/COINSURANCE/DEDUCTIBLE-LIABILITY OF MEMBER |
| ED | DENIED-A8,A9 VALUE CODES REQUIRED FOR ESRD PRICING |
| EE | DENIED-PROCEDURE MODIFIER NOT REPORTED OR APPEARS INCORRECT |
| EF | DENIED-CLAIM LACKS ADMITTING OR REFERRING PHYSICIAN NAME |
| EG | DENIED-INCLUDED IN PREVIOUS SETTLEMENT |
| EH | DENIED-PROCEDURE CODE ISN'T VALID-REBILL WITH CORRECT CODE |
| EI | DENIED-CHARGES APPEAR TO INDICATE ERROR IN BILLING |
| EJ | DENIED-NETWORK REVIEW ALLOWS ZERO DUE TO MUTUALLY EXCLUSIVE RULE |
| EK | DENIED-SERVICE INAPPROPRIATE FOR PATIENT GENDER |
| EL | DENIED-MASTER MEDICAL VOUCHER REQUIRED |
| EM | DENIED-SERVICE INAPPROPRIATE FOR PATIENT AGE |
| EN | DENIED-PART D BENEFIT-MBR RESPONSIBLE BUT CAN SUBMIT FOR REIMBURSEMENT |
| EO | DENIED-DED/CO-PAY/VALUE CODE AND/OR PAY REPORTED IS MISSING OR INCORRECT |
| EP | DENIED-MEMBER HAS NOT SELECTED PCP ON D.O.S./HAS DIFFERENT PCP ON D.O.S. |
| EQ | DENIED-PROCEDURE/MODIFIER BILLED AND QUANTITY MUST CORRESPOND |
| ER | DENIED-ANESTHESIA TIME NOT REPORTED IN MINUTES/OR APPREARS INCORRECT |
| ES | DENIED-ANOTHER CLAIM IS IN PROCESS |
| ET | DENIED-DIAGNOSIS INAPPROPRIATE FOR PAITENT GENDER |
| EU | DENIED-NO ORIGINAL CLM TO ATTACH LATE CHARGES,ADJ OR REPLACEMENT CLM TO |
| EV | DENIED-OTHER COVERAGE LIABLE-PERSONAL INJURY CASE |
| EW | DENIED-BREAKDOWN OF DATES AND/OR CHARGES REQUIRED FOR CORRECT PROCESSING |
| EX | DENIED-LATE NOTIFICATION OF ADMISSION |
| EY | DENIED-DISCREPANCY BETWEEN COB VOUCHER SUBITTED & CLAIM |
| EZ | DENIED-OTHER CARRIER VOUCHER REQUIRED |
| F0 | DENIED-ONLY PAYABLE WHEN PERFORMED BY PCP |
| F1 | DENIED-NO PRIOR AUTH ON FILE/RADIOLOGY SERVICE - PROVIDER RESPONSIBILITY |
| F2 | DENIED - ISDA CRITERIA NOT MET FOR PRE-OP DAY |
| F3 | DENIED - ISDA CRITERIA FOR SERVICE(S) NOT MET |
| F4 | DENIED-REFERRAL EXISTS, BUT THE VISITS HAVE BEEN USED |
| F5 | DENIED-HEALTHPLUS IS NO LONGER THE INSURANCE CARRIER-CONTACT EMPLOYER |
| F6 | DENIED-ICD9 PROCEDURE OR CPT CODE MISSING OR APPEARS INCORRECT |
| F7 | DENIED-SERVICE REQUIRES DRS ORDER, NDC# & DOSAGE/NDC# IS INVALID |
| F8 | DENIED - LATE CHARGES NOT ALLOWED - BILL REPLACEMENT CLAIM |
| F9 | RENTAL PAYMENT EQUALS OR EXCEEDS PURCHASE PRICE OR PREVIOUSLY PURCHASED |
| FA | DENIED - MAX MAINTENANCE PREVIOUSLY PAID / NOT PAYABLE ON PURCHASED ITEM |
| FB | DENIED-SALES TAX NOT PAYABLE DUE TO NON-PROFIT STATUS |
| FC | DENIED-RUG/CMG CODE REQUIRED BUT NOT SUPPLIED ON BILL |
| FD | DENIED-NO VALID AUTHORIZATION TO ORDERING PHYSICIAN FOR DATE OF SERVICE |
| FE | DENIED-AUTHORIZATION DENIED, SERVICES AVAILABLE IN-PLAN |
| FF | DENIED-INCORRECT BILLING - VERIFIED BY HEALTHPLUS |
| FG | DENIED-TECHNICAL SURGICAL ASSISTANT NOT ALLOWED FOR THIS SERVICE |
| FH | DENIED-MEMBER SUFFIX IS MISSING OR APPEARS INCORRECT |
| FI | DENIED-INPATIENT AUTHORIZATION INVALID-PATIENT NOT ADMITTED |
| FJ | DENIED-NUMBER OF SERVICES BILLED DON'T CORRESPOND WITH DATES |
| FK | DENIED-REFERRAL LACKS MEDICAL INFORMATION NECESSARY FOR REVIEW |
| FL | NOT REIMBURSABLE-SERVICE LINE ERROR PER APC OUTPATIENT CODE EDITOR |
| FM | INFORMATION COLLECTED FOR QUALITY IMPROVEMENT ACTIVITIES |
| FN | CHARGES CAPTURED FOR INFORMATIONAL PURPOSE ONLY |
| FO | DENIED-BILL JVHL (JOINT VENTURE HOSPITAL LABORATORIES) |
| FP | Deny-NPI billed does not match NPI/Taxonomy on record |
| FQ | INCLUDED IN ANOTHER PROCEDURE OR SERVICE |
| FR | DENIED - DUE TO AN EXTERNAL AUDIT A REPLACEMENT CLAIM CANNOT BE BILLED |
| FS | DENIED-MEMBER MUST FILE FOR MEDICARE PER MEDICAID COMPLIANCE |
| FT | NO PATIENT LIABILITY-PRIMARY INS PAYMENT = OR EXCEEDS HPM ALLOWED AMT |
| FV | DENIED-INCLUDED IN FACILITY DRG OR PER DIEM PAYMENT |
| FW | DENIED-THIS SURGERY PROC CODE NOT PAYABLE IN THIS LOCATION PER POLICY |
| FX | DENIED-PARTIAL SERVICES NOT COVERED-REBILL W/O UNAUTHORIZED SERVICES |
| FY | DENIED-COUNTY HEALTH PLAN DOES NOT COORDINATE. HPM IS NOT RESPONSIBLE. |
| FZ | DENIED - PER APC OUTPATIENT CODE EDITOR |
| G0 | DENIED- INVALID/BLANK POA BILLED |
| G1 | DENIED-MEMBER NOT ELIGIBLE FOR FULL SPAN-REPORT SPECIFIC DATE OF SERVICE |
| G2 | DENIED - TYPE OF BILL ERROR |
| G3 | DENIED - REBILL OTHER CARRIER - ADDITIONAL INFORMATION REQUIRED |
| G4 | DENIED-REFERRAL EXISTS BUT VISITS USED/RADIOLOGY-PROVIDER RESPONSIBILITY |
| G5 | DENIED-MEDICARE WILL SEND CROSSOVER CLAIM TO HPM ELECTRONICALLY |
| G6 | DENIED-NO FEE ISSUED BY CARE/CAID OR CODE NOT PAYABLE BY CARE/CAID |
| G7 | DENIED - REPORT OTHER CARRIER PAYMENT AND REBILL ELECTRONICALLY |
| G8 | DENIED-INSUFFICIENT OTHER INS PAYMENT INFO-REBILL PAPER CLAIM W/ VOUCHER |
| G9 | DENIED - PREVIOUSLY PAID THROUGH CAPITATION |
| GA | DENIED-CODE NOT AUTHED BY CARECORE, SEE ADDED SERVICE LINE FOR PAYMENT |
| GB | DENIED-HEALTHPLUS PAID PRIMARY |
| GC | DENIED-PREVIOUSLY PROCESSED/DIFFERENT PROVIDER# SAME/DIFFERENT ADDRESS |
| GD | DENIED-SVCS MUST BE OBTAINED BY CONTRACTING PROVIDER-CALL/1-800-332-9161 |
| GE | DENIED-SERVICING PROVIDER SHOULD BILL HPM DIRECTLY--NOT THROUGH VSP |
| GF | DENIED-MEMBER CONTRACT# CHANGED - NEW AUTHORIZATION NEEDED |
| GG | DENIED-BILL TO THE APPROPRIATE MEDICARE CARRIER FIRST |
| GH | DENIED-ALL CLAIMS DENY DUE TO NO MEMBER RESPONSE TO COB INQUIRY |
| GI | DENIED-REFERRAL EXISTS,BUT VISITS USED/RADIOLOGY/MEMBER RESPONSIBILITY |
| GJ | DENIED-THIS PROCEDURE IS ONLY PAYABLE THROUGH THE PHARMACY SYSTEM |
| GK | DENIED-MEDICARE DENIED THIS SERVICE - REFER TO MEDICARE EOMB CODE |
| GL | DENIED-INCLUDED IN GLOBAL SURGICAL FEE |
| GM | DENIED-MEDICARE HAS FULL RESPONSIBILITY FOR THIS SERVICE |
| GN | DENIED-RESUBMIT CLAIM WITH MEDICARE'S ORIGINAL PAYMENT/DENIAL |
| GO | DENIED-MODIFIER APPEARS INCORRECT, ITEM PREVIOUSLY PURCHASED |
| GP | MEDICARE PAID SERVICE IN FULL |
| GQ | DENIED - MEMBER RESPONSIBLE FOR MEDICARE COINSURANCE |
| GR | DENIED-PROCEDURE NOT INDICATED FOR SEPARATE REIMBURSEMENT |
| GS | DENIED-SERVICE INAPPROPRIATE FOR PATIENT GENDER |
| GT | DENIED-CLAIM REVIEW-SERVICE INAPPROPRIATE FOR PAIENT AGE |
| GU | DENIED-ASK HOSP CONTRACT MGR/POSSIBLE PAY UNDER GHP PREPD HOSP AGREEMENT |
| GV | DENIED-COURT ORDERED TREATMENT NOT COVERED |
| GW | DENIED-PROCEDURE MUTUALLY EXCLUSIVE TO ANOTHER PROCEDURE |
| GX | DENIED-INCIDENTAL PROCEDURE NOT PAYABLE |
| GY | DENIED-PROCEDURE REBUNDLED TO ANOTHER PROCEDURE |
| GZ | DENIED - BILL MDCH DIRECTLY FOR THESE PROCEDURE CODES |
| H1 | DENIED - PROV. TERMINATED DUE TO LICENSE REVOCATION |
| H2 | DENIED BILL QUEST (CAP ARRANGEMENT-SHP & BHP EFF 02/14/09) |
| H3 | DENIED-TIN/ADDRESS DOESN'T MATCH HPM RECORD-CHANGE FORM REQUIRED |
| H4 | DENIED - RUG/CMG/HIPPS CODE REQUIRED |
| H5 | DENIED-PREGNANCY RELATED SERVICES ARE NOT A COVERED BENEFIT |
| H6 | DENIED-PRIOR AUTH REQ;NOT IN PLACE FOR SERV BILLED,MEMBER RESPONSIBLE |
| H7 | DENIED-PRIOR AUTH REQ;NOT IN PLACE FOR SERV BILLED,PROVIDER RESPONSIBLE |
| H8 | DENIED-MEDICAL CRITERIA NOT MET - MEMBER RESPONSIBLE |
| H9 | DENIED-MEDICAL CRITERIA NOT MET - PROVIDER RESPONSIBLE |
| HA | DENIED-DIABETIC TEST STRIPS OR LANCETS LACKING CORRECT MODIFIER(S) |
| HB | DENIED-OTHR CARRIER DETERMINES THIS SERVICE NOT PAYABLE REFER TO VOUCHER |
| HC | DENIED-ADD ON CODE NOT PAYABLE W/O CORRECT PRIMARY PX |
| HD | DENY-BILL GENESEE COUNTY HEALTH DEPARTMENT/BCCCP |
| HE | DENIED-SAME PROCEDURE PREVIOUSLY PAID |
| HF | DENIED-ITEMIZATION,INVOICE,DOCUMENTATION/ELECTRONIC REMARK NEEDED |
| HG | DENIED-PROCEDURE/MODIFIER BILLED AND QUANTITY MUST CORRESPOND |
| HH | DENIED-SEVERITY CODE MISSING/INCORRECT |
| HI | DENIED- EPISODE TIMING MISSING/INCORRECT |
| HJ | DENIED-PART D VACCINE MEMBER RESPONSIBLE FOR EXCESS CHARGES |
| HK | DENIED-SOURCE CODE MISSING/INCORRECT |
| HM | DENIED - NOT PAYABLE TO YOUR PROVIDER SPECIALITY |
| HN | DENIED-SRV PROVIDED BY A NON-PAR MEDICARE PROV. SRV NOT COVERED |
| HO | DENIED-INVALID PROC/MODIFIER COMBINATION |
| HP | DENIED-INCLUDED IN ANOTHER PROCEDURE OR SERVICE |
| HQ | DENIED-PROCEDURE MUTUALLY EXCLUSIVE TO ANOTHER PROCEDURE |
| HR | DENIED-SEND ITEMIZED BILL TO MEMBER TO PURSUE PART D PAYMENT |
| HS | DENIED-CBSA MISSING OR INCORRECT |
| HT | DENIED-5010 DATA CONVERSION ISSUE, PLEASE REBILL |
| J0 | PAID-PRICED BY INTEGRATED HEALTH PLAN-MMPP 800-860-1111 |
| J1 | PAID-PRICED BY NPPN/INTERWEST-TRADITIONAL 800-860-1111 |
| J2 | PAID-PRICED BY IHP-ARIZONA MEDICAL NETWORK 800-860-1111 |
| J3 | PAID-PRICED BY INTEGRATED HEALTH CARE MANAGEMENT 800-860-1111 |
| J4 | PAID-PRICED BY PRIMEHSPAS-HMN 800-860-1111 |
| J5 | PAID-PRICED BY PRIMEHSPAS-PSI 800-860-1111 |
| J6 | PAID-PRICED BY PRIMEHSPAS-IHP-HPO 800-860-1111 |
| J7 | PAID-PRICED BY NPPN/HPO/INTEGRATED HLTH PLAN 800-860-1111 |
| J8 | PAID-PRICED BY INTEGRATED HEALTH PLAN-PHS1 800-860-1111 |
| J9 | PAID-PRICED BY PRIMEHSPAS-PHS(HPO) 800-860-1111 |
| JA | PAID-PRICED BY INTEGRATED HEALTH PLAN-NHP 800-860-1111 |
| JB | PAID-PRICED BY INTEGRATED HEALTH PLAN-HCD 800-860-1111 |
| JC | PAID-PRICED BY TRPNDIRECT 800-860-1111 |
| JD | PAID-PRICED BY HFN20 800-860-1111 |
| JE | PAID-PRICED BY IHP-BEECHSTREET 800-860-1111 |
| JF | PAID-PRICED BY IHP-EVOLUTIONS HEALTH SYSTEM 800-860-1111 |
| JG | PAID-PRICED BY IHP-INTERPLAN HEALTH GROUP NETWORK 800-860-1111 |
| JH | PAID-PRICED BY NPPN/ACCOUNTABLE HEALTH PLAN 800-860-1111 |
| JI | PAID-PRICED BY PRIME HEALTH SERVICES EOB 800-860-1111 |
| JJ | PAID-PRICED BY PHS(HPO) PRIME HEALTH - HPO 800-860-1111 |
| JK | PAID-PRICED BY TRPN/HFN 800-860-1111 |
| JL | PAID-PRICED BY THREE RIVERS AFFILIATE 800-860-1111 |
| JM | PAID-PRICED BY NPPN/MRI/NATIONAL PROV NETWORK-800-860-1111 |
| JN | PAID-PRICED BY PHS(PSI) 800-860-1111 |
| JO | PAID-PRICED BY IHP HEALTH FIRST NETWORK 800-860-1111 |
| JP | PAID-PRICED BY NPPN/PREFERRED MENTAL HLTHNTWK/800-860-1111 |
| JQ | PAID-PRICED BY PHS(CCO) 800-860-1111 |
| JR | PAID-PRICED BY TRPN/MCS/PPONEXT 800-860-1111 |
| JS | PAID-PRICED BY PHS 800-860-1111 |
| JT | PAID-PRICED BY HMA/HMN 800-860-1111 |
| JU | PAID-PRICED BY IHP-FORTIFIED PROVIDER NTWK 800-860-1111 |
| JV | PAID-PRICED BY HFN 800-860-1111 |
| JW | PAID-PRICED BY THREE RIVERS PROVIDER NETWORK/MCS/PPONEXT 800-860-1111 |
| JX | PAID-PRICED BY NPPN AC 800-860-1111 |
| JY | PAID-PRICED BY IHP-HEALTH MANAGEMENT NETWORK 800-860-1111 |
| JZ | PAID-PRICED BY HPO/MIDWEST MEDICAL PROVIDERS 800-860-1111 |
| N3 | PEND-RUN CLAIM THRU DESKTOP PRICER, PAYS 103% |
| NB | PEND-RUN CLAIM THRU DESKTOP PRICER, PAYS 125% |
| NC | PEND-RUN CLAIM THRU DESKTOP PRICER, PAYS 179% |
| P0 | PENDED-DRG RATE FILE ERROR |
| P1 | PENDED-PROCEDURE REQUIRES APPROVAL BY MEDICAL DIRECTOR |
| P2 | PENDED-REVIEW BY SKILLED CARE/CASE MANAGEMENT SERVICES |
| P3 | PENDED-REVIEW FOR RATE-I C PROCEDURE |
| P4 | PENDED-REVIEW OF CLAIMCHECK EDIT BY CLAIMS DEPT |
| P5 | PENDED-RESEARCH OF REFERRAL INFORMATION BY CLAIMS |
| P6 | PENDED-REVIEW OF CODING OR FURTHER RESEARCH BY CLAIMS DEPT |
| P7 | PENDED-REVIEW FOR COORDINATION OF BENEFITS |
| P8 | PENDED-REVIEW OF ELIGIBILITY BY ENROLLMENT |
| P9 | PENDED-REVIEW OF AUTHORIZATION DATA BY MEDICAL DIVISION |
| PA | PENDED-GENESYS PRICING/SURGERIES WITH NO FEE/CLAIM GOES TO DISCOUNT |
| PB | PENDED-DME REVIEW |
| PC | PENDED-CLAIMS DEPT PROVIDER REVIEW |
| PD | PENDED-REVIEW OF DOCUMENTATION BY HEHAVIORAL HEALTH DEPARTMENT |
| PE | PENDED-REVIEW OF NEWBORN ENROLLMENT/ELIGIBILITY |
| PF | PENDED-REVIEW REFERRING PROVIDER HAS BEEN TERMED |
| PG | PENDED-PNM GLOBALCARE STATUS CHANGE |
| PH | PENDED-REQUIRES PHARMACY PRICING |
| PI | PENDED-NPI-PROVIDER CONFIGURATION REVIEW |
| PJ | PENDED-REVIEW BY CLAIM SUPPORT TEAM AND/OR GLOBALCARE |
| PK | PENDED - REVIEW ICD-9 PROC CODE FOR PPG RECIPROCITY |
| PL | PENDED-REPLACEMENT CLAIM |
| PM | PENDED-SERVICE NEEDS ILLNESS (CI) CODE OF D5/DME SIX POINT PLAN PRICING |
| PN | PENDED-REVIEW FOR DRG OR DAILY DRG PAYMENT |
| PO | PENDED-TPP AMT/VOUCHER APPLIED, NO OTHER COVERAGE LOADED |
| PP | PENDED-QUALITY ASSURANCE REVIEW |
| PQ | PENDED-CLAIMS DEPT REVIEW OF REFERRAL/AUTHORIZATION REQUIRED |
| PR | PENDED - NPPN PRICING |
| PS | PENDED-A & G FINANCIAL PRICING |
| PT | PENDED-COST OR HI-DAY OUTLIER REVIEW |
| PU | PENDED-RESEARCH OCCURRENCE,VALUE OR CONDITION CODE REPORTED AS LIABILITY |
| PV | PENDED-REVIEW BY SBM/UR OFFICE |
| PW | PENDED-RESEARCHING FOR WORKMENS COMP LIABILITY |
| PX | PENDED-COVERAGE CHANGE DURING PERIOD OF CONFINEMENT |
| PY | PENDED-GLOBAL CLAIMS SERVICES PRICING |
| PZ | PENDED-ADJUSTORS HOLDING TEMPORARILY FOR FURTHER INFORMATION |
| QW | PENDED-GLOBALCARE DQ OVERRIDE |
| S0 | PENDED - PROVIDER WILL NEGOTIATE DIRECTLY W/HPM ON A CASE BY CASE BASIS |
| S1 | PENDED-PEND TEAM REVIEW |
| S2 | PEND-REVIEW BY INSURANCE SERVICES SPECIALIST/CLAIMS DEPT |
| S3 | PENDED-BENEFIT LIMIT REVIEW |
| S4 | PENDED-POSSIBLE DUPLICATE |
| S5 | PENDED- REQUIRES REVIEW FOR INVOICE |
| S6 | PENDED-RESEARCHING FOR OTHER HEALTH INSURANCE |
| S7 | PENDED-REQUIRES FILING PERIOD REVIEW |
| S8 | PENDED-TAX ID# DOES NOT MATCH HPM PIN# |
| S9 | PENDED-DENTAL CLAIM REQUIRING REPORT OR X-RAY |
| SA | PENDED-PROVIDER ON REVIEW, MEDICAL AUDIT |
| SB | PENDED-RESEARCHING DIVORCE DECREE OR COURT ORDER |
| SC | PENDED-INPATIENT REHAB OR SNF REQUIRES PRICING |
| SD | PENDED-NEW ENROLLEE-PRE-EXIST CONDITION REVIEW (GLS) |
| SE | PENDED - DRG# IS REQUIRED FOR DRG PRICING |
| SF | PENDED-TOTAL NUMBER OF DAYS EXCEED THE COVERAGE PERIOD |
| SG | PENDED-MICROFILM NEEDED TO PROPERLY PROCESS CLAIM |
| SH | PENDED-POSSIBLE INCORRECT PROVIDER NUMBER ENTERED |
| SI | PENDED-REFERRAL REQUIRED TO ORDERING/ADMITTING PHYSICIAN |
| SJ | PENDED-CASE MANAGEMENT REVIEW |
| SK | NO APC/FEE SCHEDULE ON FILE OR INVALID PAYMENT STATUS |
| SL | PENDED-FACILITY FIXED RATE |
| SM | PENDED-I.S. CONFIG TEAM - REVIEW BENEFIT CONFIGURATION |
| SN | PENDED-PROVIDER ON REVIEW PEND CLAIM TO ADJUSTORS |
| SO | PENDED-CASE MANAGEMENT REVIEW-SBM |
| SP | PENDED-CLAIMS DEPT REVIEW-CHECK LOC,CI,CORRECT PROVIDER,ETC. |
| SQ | PENDED-INCORRECT MODIFIER/CAUSE OF ILLNESS FOR CLAIM |
| SR | PENDED-CLAIM DATA POINTS REVIEWED/CORRECTED AND STILL PENDS SM |
| SS | PENDED-REQUIRES RESEARCH BY CLAIMS DEPARTMENT |
| ST | PENDED-DME FOR REVIEW - TCR BENEFIT SPECIALIST |
| SU | PENDED-REQUIRES RESEARCH BY PROVIDER SERVICES (SBM) |
| SV | PENDED - NEEDS RESOLUTION BY EDI TEAM LEADER |
| SW | PENDED-RESEARCH NEEDED BY PROVIDER SVCS SPECIALIST COORDINATOR |
| SX | PENDED-REQUIRES PEND AND EDIT REVIEW |
| SY | PENDED-REQUIRES RESEARCH BY INSURANCE SERVICES DIRECTOR OR AUDIT MANAGER |
| SZ | PENDED-CLAIM REQUIRES DEVELOPMENT OR ADDITIONAL INFORMATION |
| T0 | PENDED-OTHER INSURANCE INFORMATION SHOULD BE CHANGED OR TERMINATED |
| T1 | PENDED-PNM PROVIDER REVIEW |
| T2 | PENDED-DRG# BILLED DIFFERENT THAN DRG# ASSIGNED BY DRG GROUPER |
| T3 | PENDED-REVIEW BY PROVIDER SERVICES DEPT (GLS) |
| T4 | WARNING-POSSIBLE FIXED FEE SURG/TIER ER/OBSER UNIT PERDIEM |
| T5 | WARNING - ROUTE TO SUPERVISOR TO CHECK FOR UNIT PRICE |
| T6 | PENDED-RESEARCHING FOR MOTOR VEHICLE LIABILITY |
| T7 | PENDED-INJURY DIAGNOSIS REVIEW FOR THIRD PARTY LIABILITY |
| T8 | PENDED-REQUIRES REVIEW FOR HOSPICE COVERAGE |
| T9 | PENDED-REVIEW OF BILLED CHARGES FOR APPROPRIATENESS |
| TA | PENDED-HEALTHPLUS PARTNERS AUTHORIZATION REVIEW |
| TB | WARNING - REFER TO MODIFIER MATRIX CHART |
| TC | PENDED-RESEARCHING FOR OTHER PARTY LIABILITY |
| TD | PENDED-NEW ENROLLEE-PRE-EXIST CONDITION REVIEW (SBM) |
| TE | PENDED-MODIFIER PRICING OR REVIEW |
| TF | PENDED-REVIEW OF ELIGIBILITY BY ENROLLMENT/AR |
| TG | AUTO RECOMMENDED TO CASE MANAGEMENT (DUE TO TOTAL DOLLAR LIMIT ON CLAIM) |
| TH | WARNING-AUTH REQ'D TO ORDERING/ADMITTING PHYSICIAN |
| TI | PENDED - PRE-NEGOTIATED AGREEMENT - SEE REMARK |
| TJ | AUTO RECOMMENDED TO CASE MGMT (DUE TO DX/LOC/PROC) INFO ONLY - AUTH'S |
| TK | PENDED-RESEARCHING INJURY DIAGNOSIS FOR LIABILITY |
| TL | PENDED - REVIEW OF PROVIDER / ON-CALL SITUATION |
| TM | PENDED-RESEARCHING FOR MEDICARE PRIMARY INSURANCE |
| TN | WARNING - FACILITY CLAIM - USE MOTHER'S ID# FOR BABY |
| TO | STAT 18 ADJUSTMENT UNKNOWN EXPLAIN CODE |
| TP | PENDED-MULTIPLAN PRICING |
| TQ | PENDED-GFR-MED DIRECTOR REVIEW-COSMETIC/MEDICAL NECESSITY |
| TR | WARNING - PROCESS ON RX SIDE |
| TS | PEND-DUAL HPM COVERAGE - PROCESS UNDER PRIMARY HPM ID# |
| TT | PENDED-NO OTHER INSURANCE RECORD & CLAIM HAS ATTACHED VOUCHER OR REMARK |
| TU | PENDED-INACTIVE AFFILIATION RESEARCH BY MEDICAL MANAGEMENT |
| TV | PENDED-TCR-MED DIRECTOR REVIEW-COSMETIC/MEDICAL NECESSITY |
| TW | PENDED - I.S. CONFIGURATION |
| TX | PENDED - RESEARCH BY MEDICAID DEPARTMENT |
| TY | PENDED - REVIEW BY SAGINAW MARKETING DEPARTMENT |
| TZ | PENDED-MULTIPLE SVC PROVIDER AFFILIATIONS QUALIFY (ERROR#CLCLS0120 05) |
| V | VOID OTHER |
| V1 | VOID - OTHER |
| V8 | DENIED-CURRENT LINE REPLACED BY NEW LINE W/MOD 51 ADDED/REMOVED |
| V9 | DENIED-MULTI-UNIT LINE DENIED FOR MORE THAN ONE REASON |
| VA | VOID ADJUSTMENT |
| VL | VOIDED - ADVANCE METPATH LABORATORY |
| VM | VOIDED - NOT A CLAIM BUT A STATEMENT SENT BY MEMBER |
| VN | VOID CLAIM NUMBER |
| VP | VOID PHARMACY CLAIM |
| VQ | VOIDED - LATE CHARGES ADDED TO ORIGINAL CLAIM |
| VR | VOID-CLAIM RETURNED TO PROVIDER-INCORRECT BILLING |
| VS | VOID STATUS CLAIM |
| VV | VOID-UNREPORTED ADJUSTMENT LINE |
| VZ | VOID-ANESTHESIA CLAIM REUTRNED TO PROVIDER-INCORRECT BILLING |
| W0 | PENDED-RESEARCH OF CARECORE REFERRAL FOR OB ULTRASOUND PROCEDURES |
| W1 | PENDED-SURGERY CUTS - APPLY "Z" MODIFIERS |
| W2 | WARNING-CHECK MEMBER CONTRACT SPANS - SPLIT CLAIM IF APPROPRIATE |
| W3 | PENDED -TIME UNITS REQUIRED WITH ANESTHESIA MODIFIER |
| W4 | PEND-RUN CLAIM THRU DESKTOP PRICER |
| W5 | PENDED-ERROR BETWEEN AMISYS AND CLAIMCHECK-USE RVTP TO RESET CLM |
| W6 | WARNING-SEE INDICATOR REMARK OR AUTH REMARK FOR INSTRUCTIONS |
| W7 | PENDED FOR REVIEW OF EOMB CODE |
| W8 | WARNING-IF INVOICE ATTACHED, USE MODIFIER PC |
| W9 | PENDED-TAX IDENTIFICATION NUMBER NEEDED ON W9 FORM |
| WA | PENDED-INTERNAL PEND, RSET CLAIM FOR EXACT MESSAGE |
| WB | PENDED-REVIEW FOR GLOBAL SURGICAL POLICY |
| WC | PENDED-INTERNAL PEND-MULTIPLE AUTHS APPLY - PLEASE CHOOSE APPROPRIATELY |
| WD | WARNING-ICD9 PROCEDURE FOR USE ON INPAT HEADER ONLY - NOT SERVICE LINE |
| WE | PENDED-RESEARCH AND APPLY APPROPRIATE COPAY IF NEEDED |
| WF | WARNING-INDIVIDUAL ANTEPARTUM CARE REQUIRES REVIEW |
| WG | PENDED - PCP AFFILIATION NOT FOUND |
| WH | PENDED - PCP IS NOT EFFECTIVE AT TIME OF SERVICE |
| WI | PENDED - THE MEMBER DOES NOT HAVE A MEMBER-SPAN RECORD |
| WJ | PENDED-RESEARCH TO BE DONE BY REFERENCE AND CONTROL COMMITTEE |
| WK | PENDED - FOR APC GROUPING |
| WL | PENDED - OUTPATIENT CLAIM EDIT PRIOR TO APC GROUPING |
| WM | PENDED-PEND TO MEDICAL AUDIT FOR MEMBER ON REVIEW |
| WN | PENDED-PEND AND EDIT TEAM REVIEW |
| WO | PENDED-TO DETERMINE IF PROVIDER IS IN GLOBALCARE NETWORK |
| WP | PENDED-VERIFY PROV#, MODIFIER, ETC TO DETERMINE ENTRY ERROR AND CORRECT |
| WQ | PENDED- PENDED FOR NETWORK REVIEW |
| WR | PENDED-APPLY HENRY FORD BARIATRIC ALL INCLUSIVE OR DRG RATE |
| WS | PENDED FOR INPATIENT PPS PRICING |
| WT | PENDED-PHARMACY REVIEW FOR INJECTABLE VS PHARMACY |
| WU | PENDED-PEND SPEC CONFIRM PROC REC'D PRIOR APPR'L BY PLAN MED DIRECTOR |
| WV | PENDED-RESEARCH FOR CARECORE REFERRAL--REPLACE THE AUTOMATED REFERRAL |
| WW | PENDED - I.S. CONFIGURATION PRICING |
| WX | PENDED-HISTORICAL CLAIM CHECK EDIT (SEE REMARK) |
| WY | WARNING-DATE OF SERVICE PRIOR TO 1/1/93-REMOVE "CI" CODE |
| WZ | WARNING-HOSP CLM-CI CODE OF Z8 OR Z7 NEEDED BASED ON MEDICARE VOUCHER |
| XC | ADJUSTED-DENIED OTHER CARRIER PAYMENT EXCEEDS MEDICAID ALLOWABLE AMOUNT |
| XD | ADJUSTED-DENIED - INCORRECT DATA - SEE CORRECTION |
| XE | ADJUSTED-DENIED PER REVIEW/APPEAL ISS/DEPT |
| XG | ADJUSTED-DENIED-PER CONSULTANT REVIEW/COB VENDOR |
| XH | ADJUSTED-DENIED - PROVIDER REQUESTED - BILLED IN ERROR |
| XL | ADJUSTED-DENIED-PER CONSULTANT REVIEW/APPEAL/MED AUDIT |
| XO | ADJUSTED-DENIED-INCORRECT BILLING VERIFIED BY HEALTHPLUS |
| XR | ADJUSTED-DENIED-REFUND REQUESTED BY ADJUSTOR TEAM |
| XW | ADJUSTED-DENIED-PREV PROCESSED UNDER INCORRECT MEMBER/PARTICIPANT # |
| XZ | ADJ-DENIED-PAID IN ERROR-OTHER CARRIER LIABLE-NO REFUND REC'D FROM PROV |
| Y1 | ADJUSTED-DENIED-NOT ELIGIBLE ON DATE OF SERVICE - MEMBER LIABLE |
| YB | ADJUSTED-DENIED-ORIGINALLY PROCESSED TO INCORRECT PROVIDER/AFFILIATITION |
| YM | DENIED-SERVICES REVERSED BY MEDIMPACT |