Remark and Denial Codes
Remark | Denial | Description |
CDD | DEFINITE DUPLICATE CLAIM | |
CRS | CODE SUPERCEDED-AMA CPT GUIDELINES | |
CRT | CODE SUPERCEDED-AMA CPT GUIDELINES-DENIED | |
F47 | PAYMENT REFLECTS COB, IF $0, MAXIMUM LIABILITY WAS MET | |
F50 | CLAIM ADJ - THIRD PARTY DENIED OR BENEFITS EXHAUSTED | |
I02 | X02 | ILLEGIBLE RECORDS SUBMITTED; REFILE |
I04 | X04 | CORRECT NDC CODE REQUIRED FOR CONSIDERATION |
I05 | X05 | INVALID/DELETED CODE, MODIFIER OR DESCRIPTION |
I06 | X06 | ITEMIZED BILL/DATES OF SERVICE/CHARGES/ INVOICE REQUIRED |
I08 | X08 | DIAGNOSIS INVALID/MISSING/DELETED REQUIRED 4TH/5TH DIGIT |
I10 | E-CODE CANNOT BE USED AS PRIMARY DIAGNOSIS | |
I11 | X11 | EOB FROM PRIMARY CARRIER REQUIRED |
I18 | PAID BILLED CHARGES | |
I19 | X19 | CARRIER OF SERVICE-HORIZON HEALTHCARE DENTAL SERVICE |
I22 | X22 | RESUBMIT WITH VISIT CODES & CHARGES |
I24 | X24 | CARRIER OF SERVICE-DAVIS VISION |
I26 | X26 | EXHAUSTION OF BENEFITS |
I27 | X27 | SUBMIT MEDICAL RECORDS TO HORIZON NJ HEALTH APPEALS UNIT |
I28 | REPROCESSED-CLAIM SUBJECT TO INTEREST | |
I30 | X30 | SERVICE EXCEEDS LIFETIME LIMITATION |
I37 | X37 | RESUBMIT WITH APPROPRIATE MODIFIER AND/OR TIME UNITS |
I42 | X42 | ILLEGIBLE/INCOMPLETE/INAPPROPRIATE REFERRAL RECEIVED |
I43 | X43 | BI-LATERAL PROCEDURE PREVIOUSLY PAID WITH MODIFIER “50” |
I44 | X44 | RESUBMIT WITH ICD/9 PRINCIPLE PROCEDURE CODE |
I47 | X47 | NON CONTRACTED LEVEL OF CARE |
I48 | Z48 | RESUBMIT TO PRIMARY CARRIER FOR APPEALS PROCESS |
I64 | X64 | CAPITATED TO ANOTHER PROVIDER |
I65 | DUPLICATE CLAIM-PREVIOUSLY DENIED APPROPRIATELY | |
I68 | INVALID PLACE OF SERVICE FOR PROCEDURE | |
I83 | X83 | MOTHER’S BILL NOT RECEIVED – REFILE |
I98 | TOTAL BILLED STILL UNDER CONSIDERATION | |
N02 | REDUNDANT PROCEDURE DISALLOW | |
N06 | ASSISTANT SURGEON DISALLOW | |
Q17 | ADMINISTRATIVE OVERTURN | |
R00 | X00 | PAYMENT INCLUDED IN OTHER BILLED SERVICES |
R01 | X01 | NO PRECERT/AUTHORIZATION OR REFERRAL |
R07 | X07 | RECEIVED AFTER TIMELY FILING TIME LIMIT |
R09 | X09 | REQUESTED HOSPITAL DOCUMENTS NOT RECEIVED |
R10 | X10 | NOT ENROLLED ON DATE OF SERVICE |
R15 | SUBSET/INCIDENTAL PROCEDURE DISALLOW | |
R18 | RESUBMIT WITH ICD PRINCIPAL PROCEDURE, HCPCS OR CPT CODE | |
R37 | COMBINED PAYMENT-MOTHER & BABY | |
R38 | CONTRACTED FEE | |
R39 | X39 | DUPLICATE CLAIM PREVIOUSLY PAID AT CORRECT RATE OR CAPITATION |
R40 | X40 | DUPLICATE CLAIM-ORIGINAL STILL UNDER CONSIDERATION |
R42 | DRG PAYMENT | |
R43 | INTERIM BILL PAYMENT | |
R44 | MULTIPLE SURGICAL REDUCTION | |
R45 | X45 | COMPLETE MED RECORDS REQUIRED FOR CONSIDERATION; REFILE |
R46 | X46 | OVER MAX PROCEDURE/BENEFIT LIMIT (All LOBs) |
R47 | PAYMENT REFLECTS COORDINATION OF BENEFITS, IF $0, MAX LIABILITY MET | |
R49 | X49 | PREVIOUS PYMTS EQUAL TO PURCHASE PRICE |
R50 | X50 | SAME PROCEDURE PAID TO A DIFFERENT PROVIDER |
R51 | X51 | SERVICE NOT COVERED |
R53 | X53 | SERVICES WERE NOT PROVIDED |
R55 | BILLED INFORMATION REFLECTS LOWER DEGREE ACUITY/TREATMENT | |
R56 | ADMINISTRATIVE APPROVAL | |
R59 | X59 | AUTHORIZATION/REFERRAL EXPIRED |
R60 | X60 | DATES AND/OR SERVICES OUTSIDE REFERRAL/AUTHORIZATION |
R61 | X61 | NO PCP REFERRAL |
R65 | INTERIM BILL 2ND CYCLE PAYMENT | |
R66 | Z34 | INTERIM BILL FINAL CYCLE PAYMENT |
R67 | X67 | DISCREPANCY WITH LEVEL OF CARE-APPEAL REQUIRED |
R70 | X70 | EPSDT SCREENING DID NOT COMPLY WITH PERIODICITY SCHEDULE |
R71 | X71 | DUPLICATE OF PREVIOUSLY SUBMITTED EPSDT SCREENING |
R72 | X72 | PROVIDER WAS NOT MEMBER’S PCP |
R78 | R78 | MEMBER’S AGE NOT VALID FOR PROCEDURE CODE |
R79 | X79 | SPECIAL PROJECT-ADJUSTMENT |
R81 | X81 | CHARGES CONSIDERED INCLUDED IN INPATIENT ADMISSION |
R84 | X84 | PLEASE OBTAIN INDIVIDUAL PROVIDER ID # |
R86 | X85 | INVALID/MISSING REVENUE CODE ON CLAIM |
R89 | AUTHORIZATION ON FILE FOR TECHNICAL COMPONENT | |
R91 | X91 | INAPPROPRIATE CODING FOR CONTRACT AGREEMENT |
R95 | X95 | CLAIM SUBMITTED WITHOUT PHYSICIAN NAME |
R96 | X96 | EOB/ATTACHMENTS WERE INCOMPLETE/ILLEGIBLE |
R97 | X97 | DATE OF SERVICE CANNOT BE GREATER THAN THE RECEIVED DATE |
X12 | MOTOR VEHICLE ACCIDENT - AUTO CARRIER PRIMARY | |
X13 | WORKERS COMPENSATION PRIMARY CARRIER | |
X21 | BILL THROUGH PHARMACY PROGRAM | |
X25 | INCLUDED IN SETTLEMENT PAYMENT | |
X32 | APPEAL – DENIAL UPHELD | |
X33 | APPEAL – ORIGINAL CLAIM PAYMENT UPHELD | |
X35 | AUTHORIZATION DENIED FOR THIS DATE OF SERVICE | |
X55 | MEMBER AGE NOT VALID FOR DIAGNOSIS CODE | |
X56 | CLINIC CLAIM SUBMITTED WITHOUT PHYSICIAN NAME | |
X57 | THIS “V” DIAGNOSIS CANNOT BE BILLED ALONE | |
X62 | INVALID/MISSING DRG | |
X68 | X68 | INVALID UNITS SUBMITTED |
X77 | INCORRECT PROVIDER NAME/TIN IDENTIFICATION # SUBMITTED | |
X94 | PROVIDER NUMBER SUBMITTED VIA EDI INCORRECT/TERMINATED | |
X78 | X78 | COMBINED PAYMENT – MOTHER AND BABY |
Z19 | Z19 | CARRIER FOR SERVICE-HORIZON BLUE |
Z47 | Z47 | SUBMIT CHARGES TO MA FEE-FOR-SERVICE PROGRAM |
Z50 | SUBMIT CHARGES TO MEDICAID FEE FOR SERVICE PROGRAM | |
Z92 | INVALID OR MISSING PLACE OF SERVICE | |
Z99 | Z99 | CODE NOT PAYABLE FOR PROVIDER SPECIALTY NO FEE ON FILE |
Z55 | NOT AUTHORIZED UNDER CONTRACT TO PROVIDE THIS SERVICE |
These explanation codes represent the current set of codes that are returned to the hospital, physician or health care professional on the remittance advice. Please review the translation grid above before calling the Physician & Health Care Hotline for questions about remittance advice codes.
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