Reason Code 33: Balance does not exceed co-payment amount. Patient payment option/election not in effect. Service/procedure was provided outside of the United States. 04 The procedure code is inconsistent with the modifier used, or a required modifier is missing. To be used for Property and Casualty only. Denial Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The diagnosis is inconsistent with the patient's age. Payment adjusted based on Preferred Provider Organization (PPO). Patient identification compromised by identity theft. This (these) service(s) is (are) not covered. Legislated/Regulatory Penalty. Claim received by the dental plan, but benefits not available under this plan. Lifetime benefit maximum has been reached for this service/benefit category. The rendering provider is not eligible to perform the service billed. Payment denied because service/procedure was provided outside the United States or as a result of war. Failure to follow prior payer's coverage rules. Reason Code 12: The authorization number is missing, invalid, or does not apply to the billed services or provider. Adjustment amount represents collection against receivable created in prior overpayment. 2670. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Usage: To be used for pharmaceuticals only. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. Claim received by the medical plan, but benefits not available under this plan. A: Health Care Claims Adjustment Reason Codes Note: 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. Refund to patient if collected. (Use only with Group code OA), Payment adjusted because pre-certification/authorization not received in a timely fashion. Medicare Secondary Payer Adjustment Amount. This is not patient specific. ), Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO). This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lace of premium payment). Note: Refer to the835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Service(s) have been considered under the patient's medical plan. For convenience, the values and definitions are below: *The description you are suggesting for a new code or to replace the description for a current code. Webco 256 denial code descriptionshouses for rent by owner in calhoun, ga; co 256 denial code descriptionsjim jon prokes cause of death; co 256 denial code descriptionscafe patachou nutrition information co 256 denial code descriptions. This change effective 7/1/2013: 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. This claim has been identified as a resubmission. WebAdjustment Reason Codes* Description Note 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. Claim/service denied based on prior payer's coverage determination. The diagnosis is inconsistent with the patient's age. Credentialing Service for Various Practices: : The date of death precedes the date of service. co 256 denial code descriptions .
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