To be used for P&C Auto only. CODES This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements. Completed physician financial relationship form not on file. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. 03 Co-payment amount. To renewan X12 membership, complete and submit an application form which will be reviewed and verified, then you will be notified of the next steps. Reason Code 37: Charges do not meet qualifications for emergent/urgent care. Usage: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. Reason Code 45: This (these) procedure(s) is (are) not covered. (Note: To be used for Property and Casualty only). Rent/purchase guidelines were not met. Based on payer reasonable and customary fees. Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. Reason Code 170: Service was not prescribed by a physician. Reason Code 7: The diagnosis is inconsistent with the patient's gender. This Payer not liable for claim or service/treatment. Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many service, this length of service, this dosage, or this day's supply. (Use Group Codes PR or CO depending upon liability). Reason Code 62: Procedure code was incorrect. No maximum allowable defined by legislated fee arrangement. Previously paid. This non-payable code is for required reporting only. Applicable federal, state or local authority may cover the claim/service. The information provided does not support the need for this service or item. Claim/service not covered by this payer/contractor. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. Reason Code 160: Attachment referenced on the claim was not received. Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. JETZT SPENDEN. Procedure/treatment is deemed experimental/investigational by the payer. Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Submit these services to the patient's medical plan for further consideration. (Use only with Group Code CO). 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. Edward A. Guilbert Lifetime Achievement Award. The procedure/revenue code is inconsistent with the patient's gender. Patient has not met the required waiting requirements. Reason Code 64: Lifetime reserve days. Reason Code 126: Prior processing information appears incorrect. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF).
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