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May 13, 2024 20:03
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status_code | status_label | |
---|---|---|
0 | Cannot provide further status electronically. | |
1 | For more detailed information, see remittance advice. | |
2 | More detailed information in letter. | |
3 | Claim has been adjudicated and is awaiting payment cycle. | |
4 | This is a subsequent request for information from the original request. | |
5 | This is a final request for information. | |
6 | Balance due from the subscriber. | |
7 | Claim may be reconsidered at a future date. | |
8 | No payment due to contract/plan provisions. | |
9 | No payment will be made for this claim. | |
10 | All originally submitted procedure codes have been combined. | |
11 | Some originally submitted procedure codes have been combined. | |
12 | One or more originally submitted procedure codes have been combined. | |
13 | All originally submitted procedure codes have been modified. | |
14 | Some all originally submitted procedure codes have been modified. | |
15 | One or more originally submitted procedure code have been modified. | |
16 | Claim/encounter has been forwarded to entity. Usage: This code requires use of an Entity Code. | |
17 | Claim/encounter has been forwarded by third party entity to entity. Usage: This code requires use of an Entity Code. | |
18 | Entity received claim/encounter, but returned invalid status. Usage: This code requires use of an Entity Code. | |
19 | Entity acknowledges receipt of claim/encounter. Usage: This code requires use of an Entity Code. | |
20 | Accepted for processing. | |
21 | Missing or invalid information. Usage: At least one other status code is required to identify the missing or invalid information. | |
22 | ... before entering the adjudication system. | |
23 | Returned to Entity. Usage: This code requires use of an Entity Code. | |
24 | Entity not approved as an electronic submitter. Usage: This code requires use of an Entity Code. | |
25 | Entity not approved. Usage: This code requires use of an Entity Code. | |
26 | Entity not found. Usage: This code requires use of an Entity Code. | |
27 | Policy canceled. | |
28 | Claim submitted to wrong payer. | |
29 | Subscriber and policy number/contract number mismatched. | |
30 | Subscriber and subscriber id mismatched. | |
31 | Subscriber and policyholder name mismatched. | |
32 | Subscriber and policy number/contract number not found. | |
33 | Subscriber and subscriber id not found. | |
34 | Subscriber and policyholder name not found. | |
35 | Claim/encounter not found. | |
37 | Predetermination is on file, awaiting completion of services. | |
38 | Awaiting next periodic adjudication cycle. | |
39 | Charges for pregnancy deferred until delivery. | |
40 | Waiting for final approval. | |
41 | Special handling required at payer site. | |
42 | Awaiting related charges. | |
44 | Charges pending provider audit. | |
45 | Awaiting benefit determination. | |
46 | Internal review/audit. | |
47 | Internal review/audit - partial payment made. | |
48 | Referral/authorization. | |
49 | Pending provider accreditation review. | |
50 | Claim waiting for internal provider verification. | |
51 | Investigating occupational illness/accident. | |
52 | Investigating existence of other insurance coverage. | |
53 | Claim being researched for Insured ID/Group Policy Number error. | |
54 | Duplicate of a previously processed claim/line. | |
55 | Claim assigned to an approver/analyst. | |
56 | Awaiting eligibility determination. | |
57 | Pending COBRA information requested. | |
59 | Information was requested by a non-electronic method. Usage: At least one other status code is required to identify the requested information. | |
60 | Information was requested by an electronic method. Usage: At least one other status code is required to identify the requested information. | |
61 | Eligibility for extended benefits. | |
64 | Re-pricing information. | |
65 | Claim/line has been paid. | |
66 | Payment reflects usual and customary charges. | |
67 | Payment made in full. | |
68 | Partial payment made for this claim. | |
69 | Payment reflects plan provisions. | |
70 | Payment reflects contract provisions. | |
71 | Periodic installment released. | |
72 | Claim contains split payment. | |
73 | Payment made to entity, assignment of benefits not on file. Usage: This code requires use of an Entity Code. | |
78 | Duplicate of an existing claim/line, awaiting processing. | |
81 | Contract/plan does not cover pre-existing conditions. | |
83 | No coverage for newborns. | |
84 | Service not authorized. | |
85 | Entity not primary. Usage: This code requires use of an Entity Code. | |
86 | Diagnosis and patient gender mismatch. | |
87 | Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code) | |
88 | Entity not eligible for benefits for submitted dates of service. Usage: This code requires use of an Entity Code. | |
89 | Entity not eligible for dental benefits for submitted dates of service. Usage: This code requires use of an Entity Code. | |
90 | Entity not eligible for medical benefits for submitted dates of service. Usage: This code requires use of an Entity Code. | |
91 | Entity not eligible/not approved for dates of service. Usage: This code requires use of an Entity Code. | |
92 | Entity does not meet dependent or student qualification. Usage: This code requires use of an Entity Code. | |
93 | Entity is not selected primary care provider. Usage: This code requires use of an Entity Code. | |
94 | Entity not referred by selected primary care provider. Usage: This code requires use of an Entity Code. | |
95 | Requested additional information not received. | |
96 | No agreement with entity. Usage: This code requires use of an Entity Code. | |
97 | Patient eligibility not found with entity. Usage: This code requires use of an Entity Code. | |
98 | Charges applied to deductible. | |
99 | Pre-treatment review. | |
100 | Pre-certification penalty taken. | |
101 | Claim was processed as adjustment to previous claim. | |
102 | Newborn's charges processed on mother's claim. | |
103 | Claim combined with other claim(s). | |
104 | Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient) | |
105 | Claim/line is capitated. | |
106 | This amount is not entity's responsibility. Usage: This code requires use of an Entity Code. | |
107 | Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services) | |
108 | Coverage has been canceled for this entity. (Use code 27) | |
109 | Entity not eligible. Usage: This code requires use of an Entity Code. | |
110 | Claim requires pricing information. | |
111 | At the policyholder's request these claims cannot be submitted electronically. | |
112 | Policyholder processes their own claims. | |
113 | Cannot process individual insurance policy claims. | |
114 | Claim/service should be processed by entity. Usage: This code requires use of an Entity Code. | |
115 | Cannot process HMO claims | |
116 | Claim submitted to incorrect payer. | |
117 | Claim requires signature-on-file indicator. | |
118 | TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN) | |
119 | TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252) | |
120 | TPO rejected claim/line because claim does not contain enough information. (Use status code 21) | |
121 | Service line number greater than maximum allowable for payer. | |
122 | Missing/invalid data prevents payer from processing claim. (Use CSC Code 21) | |
123 | Additional information requested from entity. Usage: This code requires use of an Entity Code. | |
124 | Entity's name, address, phone and id number. Usage: This code requires use of an Entity Code. | |
125 | Entity's name. Usage: This code requires use of an Entity Code. | |
126 | Entity's address. Usage: This code requires use of an Entity Code. | |
127 | Entity's Communication Number. Usage: This code requires use of an Entity Code. | |
128 | Entity's tax id. Usage: This code requires use of an Entity Code. | |
129 | Entity's Blue Cross provider id. Usage: This code requires use of an Entity Code. | |
130 | Entity's Blue Shield provider id. Usage: This code requires use of an Entity Code. | |
131 | Entity's Medicare provider id. Usage: This code requires use of an Entity Code. | |
132 | Entity's Medicaid provider id. Usage: This code requires use of an Entity Code. | |
133 | Entity's UPIN. Usage: This code requires use of an Entity Code. | |
134 | Entity's TRICARE provider id. Usage: This code requires use of an Entity Code. | |
135 | Entity's commercial provider id. Usage: This code requires use of an Entity Code. | |
136 | Entity's health industry id number. Usage: This code requires use of an Entity Code. | |
137 | Entity's plan network id. Usage: This code requires use of an Entity Code. | |
138 | Entity's site id . Usage: This code requires use of an Entity Code. | |
139 | Entity's health maintenance provider id (HMO). Usage: This code requires use of an Entity Code. | |
140 | Entity's preferred provider organization id (PPO). Usage: This code requires use of an Entity Code. | |
141 | Entity's administrative services organization id (ASO). Usage: This code requires use of an Entity Code. | |
142 | Entity's license/certification number. Usage: This code requires use of an Entity Code. | |
143 | Entity's state license number. Usage: This code requires use of an Entity Code. | |
144 | Entity's specialty license number. Usage: This code requires use of an Entity Code. | |
145 | Entity's specialty/taxonomy code. Usage: This code requires use of an Entity Code. | |
146 | Entity's anesthesia license number. Usage: This code requires use of an Entity Code. | |
147 | Entity's qualification degree/designation (e.g. RN,PhD,MD). Usage: This code requires use of an Entity Code. | |
148 | Entity's social security number. Usage: This code requires use of an Entity Code. | |
149 | Entity's employer id. Usage: This code requires use of an Entity Code. | |
150 | Entity's drug enforcement agency (DEA) number. Usage: This code requires use of an Entity Code. | |
152 | Pharmacy processor number. | |
153 | Entity's id number. Usage: This code requires use of an Entity Code. | |
154 | Relationship of surgeon & assistant surgeon. | |
155 | Entity's relationship to patient. Usage: This code requires use of an Entity Code. | |
156 | Patient relationship to subscriber | |
157 | Entity's Gender. Usage: This code requires use of an Entity Code. | |
158 | Entity's date of birth. Usage: This code requires use of an Entity Code. | |
159 | Entity's date of death. Usage: This code requires use of an Entity Code. | |
160 | Entity's marital status. Usage: This code requires use of an Entity Code. | |
161 | Entity's employment status. Usage: This code requires use of an Entity Code. | |
162 | Entity's health insurance claim number (HICN). Usage: This code requires use of an Entity Code. | |
163 | Entity's policy/group number. Usage: This code requires use of an Entity Code. | |
164 | Entity's contract/member number. Usage: This code requires use of an Entity Code. | |
165 | Entity's employer name, address and phone. Usage: This code requires use of an Entity Code. | |
166 | Entity's employer name. Usage: This code requires use of an Entity Code. | |
167 | Entity's employer address. Usage: This code requires use of an Entity Code. | |
168 | Entity's employer phone number. Usage: This code requires use of an Entity Code. | |
169 | Entity's employer id. | |
170 | Entity's employee id. Usage: This code requires use of an Entity Code. | |
171 | Other insurance coverage information (health, liability, auto, etc.). | |
172 | Other employer name, address and telephone number. | |
173 | Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Usage: This code requires use of an Entity Code. | |
174 | Entity's student status. Usage: This code requires use of an Entity Code. | |
175 | Entity's school name. Usage: This code requires use of an Entity Code. | |
176 | Entity's school address. Usage: This code requires use of an Entity Code. | |
177 | Transplant recipient's name, date of birth, gender, relationship to insured. | |
178 | Submitted charges. | |
179 | Outside lab charges. | |
180 | Hospital s semi-private room rate. | |
181 | Hospital s room rate. | |
182 | Allowable/paid from other entities coverage Usage: This code requires the use of an entity code. | |
183 | Amount entity has paid. Usage: This code requires use of an Entity Code. | |
184 | Purchase price for the rented durable medical equipment. | |
185 | Rental price for durable medical equipment. | |
186 | Purchase and rental price of durable medical equipment. | |
187 | Date(s) of service. | |
188 | Statement from-through dates. | |
189 | Facility admission date | |
190 | Facility discharge date | |
191 | Date of Last Menstrual Period (LMP) | |
192 | Date of first service for current series/symptom/illness. | |
193 | First consultation/evaluation date. | |
194 | Confinement dates. | |
195 | Unable to work dates/Disability Dates. | |
196 | Return to work dates. | |
197 | Effective coverage date(s). | |
198 | Medicare effective date. | |
199 | Date of conception and expected date of delivery. | |
200 | Date of equipment return. | |
201 | Date of dental appliance prior placement. | |
202 | Date of dental prior replacement/reason for replacement. | |
203 | Date of dental appliance placed. | |
204 | Date dental canal(s) opened and date service completed. | |
205 | Date(s) dental root canal therapy previously performed. | |
206 | Most recent date of curettage, root planing, or periodontal surgery. | |
207 | Dental impression and seating date. | |
208 | Most recent date pacemaker was implanted. | |
209 | Most recent pacemaker battery change date. | |
210 | Date of the last x-ray. | |
211 | Date(s) of dialysis training provided to patient. | |
212 | Date of last routine dialysis. | |
213 | Date of first routine dialysis. | |
214 | Original date of prescription/orders/referral. | |
215 | Date of tooth extraction/evolution. | |
216 | Drug information. | |
217 | Drug name, strength and dosage form. | |
218 | NDC number. | |
219 | Prescription number. | |
220 | Drug product id number. (Use code 218) | |
221 | Drug days supply and dosage. | |
222 | Drug dispensing units and average wholesale price (AWP). | |
223 | Route of drug/myelogram administration. | |
224 | Anatomical location for joint injection. | |
225 | Anatomical location. | |
226 | Joint injection site. | |
227 | Hospital information. | |
228 | Type of bill for UB claim | |
229 | Hospital admission source. | |
230 | Hospital admission hour. | |
231 | Hospital admission type. | |
232 | Admitting diagnosis. | |
233 | Hospital discharge hour. | |
234 | Patient discharge status. | |
235 | Units of blood furnished. | |
236 | Units of blood replaced. | |
237 | Units of deductible blood. | |
238 | Separate claim for mother/baby charges. | |
239 | Dental information. | |
240 | Tooth surface(s) involved. | |
241 | List of all missing teeth (upper and lower). | |
242 | Tooth numbers, surfaces, and/or quadrants involved. | |
243 | Months of dental treatment remaining. | |
244 | Tooth number or letter. | |
245 | Dental quadrant/arch. | |
246 | Total orthodontic service fee, initial appliance fee, monthly fee, length of service. | |
247 | Line information. | |
248 | Accident date, state, description and cause. | |
249 | Place of service. | |
250 | Type of service. | |
251 | Total anesthesia minutes. | |
252 | Entity's prior authorization/certification number. Usage: This code requires the use of an Entity Code. | |
253 | Procedure/revenue code for service(s) rendered. Use codes 454 or 455. | |
254 | Principal diagnosis code. | |
255 | Diagnosis code. | |
256 | DRG code(s). | |
257 | ADSM-III-R code for services rendered. | |
258 | Days/units for procedure/revenue code. | |
259 | Frequency of service. | |
260 | Length of medical necessity, including begin date. | |
261 | Obesity measurements. | |
262 | Type of surgery/service for which anesthesia was administered. | |
263 | Length of time for services rendered. | |
264 | Number of liters/minute & total hours/day for respiratory support. | |
265 | Number of lesions excised. | |
266 | Facility point of origin and destination - ambulance. | |
267 | Number of miles patient was transported. | |
268 | Location of durable medical equipment use. | |
269 | Length/size of laceration/tumor. | |
270 | Subluxation location. | |
271 | Number of spine segments. | |
272 | Oxygen contents for oxygen system rental. | |
273 | Weight. | |
274 | Height. | |
275 | Claim. | |
276 | UB04/HCFA-1450/1500 claim form | |
277 | Paper claim. | |
278 | Signed claim form. | |
279 | Claim/service must be itemized | |
280 | Itemized claim by provider. | |
281 | Related confinement claim. | |
282 | Copy of prescription. | |
283 | Medicare entitlement information is required to determine primary coverage | |
284 | Copy of Medicare ID card. | |
285 | Vouchers/explanation of benefits (EOB). | |
286 | Other payer's Explanation of Benefits/payment information. | |
287 | Medical necessity for service. | |
288 | Hospital late charges | |
289 | Reason for late discharge. | |
290 | Pre-existing information. | |
291 | Reason for termination of pregnancy. | |
292 | Purpose of family conference/therapy. | |
293 | Reason for physical therapy. | |
294 | Supporting documentation. Usage: At least one other status code is required to identify the supporting documentation. | |
295 | Attending physician report. | |
296 | Nurse's notes. | |
297 | Medical notes/report. | |
298 | Operative report. | |
299 | Emergency room notes/report. | |
300 | Lab/test report/notes/results. | |
301 | MRI report. | |
302 | Refer to codes 300 for lab notes and 311 for pathology notes | |
303 | Physical therapy notes. Use code 297:6O (6 'OH' - not zero) | |
304 | Reports for service. | |
305 | Radiology/x-ray reports and/or interpretation | |
306 | Detailed description of service. | |
307 | Narrative with pocket depth chart. | |
308 | Discharge summary. | |
309 | Code was duplicate of code 299 | |
310 | Progress notes for the six months prior to statement date. | |
311 | Pathology notes/report. | |
312 | Dental charting. | |
313 | Bridgework information. | |
314 | Dental records for this service. | |
315 | Past perio treatment history. | |
316 | Complete medical history. | |
317 | Patient's medical records. | |
318 | X-rays/radiology films | |
319 | Pre/post-operative x-rays/photographs. | |
320 | Study models. | |
321 | Radiographs or models. (Use codes 318 and/or 320) | |
322 | Recent Full Mouth X-rays | |
323 | Study models, x-rays, and/or narrative. | |
324 | Recent x-ray of treatment area and/or narrative. | |
325 | Recent fm x-rays and/or narrative. | |
326 | Copy of transplant acquisition invoice. | |
327 | Periodontal case type diagnosis and recent pocket depth chart with narrative. | |
328 | Speech therapy notes. Use code 297:6R | |
329 | Exercise notes. | |
330 | Occupational notes. | |
331 | History and physical. | |
332 | Authorization/certification (include period covered). (Use code 252) | |
333 | Patient release of information authorization. | |
334 | Oxygen certification. | |
335 | Durable medical equipment certification. | |
336 | Chiropractic certification. | |
337 | Ambulance certification/documentation. | |
338 | Home health certification. Use code 332:4Y | |
339 | Enteral/parenteral certification. | |
340 | Pacemaker certification. | |
341 | Private duty nursing certification. | |
342 | Podiatric certification. | |
343 | Documentation that facility is state licensed and Medicare approved as a surgical facility. | |
344 | Documentation that provider of physical therapy is Medicare Part B approved. | |
345 | Treatment plan for service/diagnosis | |
346 | Proposed treatment plan for next 6 months. | |
347 | Refer to code 345 for treatment plan and code 282 for prescription | |
348 | Chiropractic treatment plan. (Use 345:QL) | |
349 | Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P | |
350 | Speech pathology treatment plan. Use code 345:6R | |
351 | Physical/occupational therapy treatment plan. Use codes 345:6O (6 'OH' - not zero), 6N | |
352 | Duration of treatment plan. | |
353 | Orthodontics treatment plan. | |
354 | Treatment plan for replacement of remaining missing teeth. | |
355 | Has claim been paid? | |
356 | Was blood furnished? | |
357 | Has or will blood be replaced? | |
358 | Does provider accept assignment of benefits? (Use code 589) | |
359 | Is there a release of information signature on file? (Use code 333) | |
360 | Benefits Assignment Certification Indicator | |
361 | Is there other insurance? | |
362 | Is the dental patient covered by medical insurance? | |
363 | Possible Workers' Compensation | |
364 | Is accident/illness/condition employment related? | |
365 | Is service the result of an accident? | |
366 | Is injury due to auto accident? | |
367 | Is service performed for a recurring condition or new condition? | |
368 | Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility? | |
369 | Does patient condition preclude use of ordinary bed? | |
370 | Can patient operate controls of bed? | |
371 | Is patient confined to room? | |
372 | Is patient confined to bed? | |
373 | Is patient an insulin diabetic? | |
374 | Is prescribed lenses a result of cataract surgery? | |
375 | Was refraction performed? | |
376 | Was charge for ambulance for a round-trip? | |
377 | Was durable medical equipment purchased new or used? | |
378 | Is pacemaker temporary or permanent? | |
379 | Were services performed supervised by a physician? | |
380 | CRNA supervision/medical direction. | |
381 | Is drug generic? | |
382 | Did provider authorize generic or brand name dispensing? | |
383 | Nerve block use (surgery vs. pain management) | |
384 | Is prosthesis/crown/inlay placement an initial placement or a replacement? | |
385 | Is appliance upper or lower arch & is appliance fixed or removable? | |
386 | Orthodontic Treatment/Purpose Indicator | |
387 | Date patient last examined by entity. Usage: This code requires use of an Entity Code. | |
388 | Date post-operative care assumed | |
389 | Date post-operative care relinquished | |
390 | Date of most recent medical event necessitating service(s) | |
391 | Date(s) dialysis conducted | |
392 | Date(s) of blood transfusion(s) | |
393 | Date of previous pacemaker check | |
394 | Date(s) of most recent hospitalization related to service | |
395 | Date entity signed certification/recertification Usage: This code requires use of an Entity Code. | |
396 | Date home dialysis began | |
397 | Date of onset/exacerbation of illness/condition | |
398 | Visual field test results | |
399 | Report of prior testing related to this service, including dates | |
400 | Claim is out of balance | |
401 | Source of payment is not valid | |
402 | Amount must be greater than zero. Usage: At least one other status code is required to identify which amount element is in error. | |
403 | Entity referral notes/orders/prescription. Effective 05/01/2018: Entity referral notes/orders/prescription. Usage: this code requires use of an entity code. | |
404 | Specific findings, complaints, or symptoms necessitating service | |
405 | Summary of services | |
406 | Brief medical history as related to service(s) | |
407 | Complications/mitigating circumstances | |
408 | Initial certification | |
409 | Medication logs/records (including medication therapy) | |
410 | Explain differences between treatment plan and patient's condition | |
411 | Medical necessity for non-routine service(s) | |
412 | Medical records to substantiate decision of non-coverage | |
413 | Explain/justify differences between treatment plan and services rendered. | |
414 | Necessity for concurrent care (more than one physician treating the patient) | |
415 | Justify services outside composite rate | |
416 | Verification of patient's ability to retain and use information | |
417 | Prior testing, including result(s) and date(s) as related to service(s) | |
418 | Indicating why medications cannot be taken orally | |
419 | Individual test(s) comprising the panel and the charges for each test | |
420 | Name, dosage and medical justification of contrast material used for radiology procedure | |
421 | Medical review attachment/information for service(s) | |
422 | Homebound status | |
423 | Prognosis | |
424 | Statement of non-coverage including itemized bill | |
425 | Itemize non-covered services | |
426 | All current diagnoses | |
427 | Emergency care provided during transport | |
428 | Reason for transport by ambulance | |
429 | Loaded miles and charges for transport to nearest facility with appropriate services | |
430 | Nearest appropriate facility | |
431 | Patient's condition/functional status at time of service. | |
432 | Date benefits exhausted | |
433 | Copy of patient revocation of hospice benefits | |
434 | Reasons for more than one transfer per entitlement period | |
435 | Notice of Admission | |
436 | Short term goals | |
437 | Long term goals | |
438 | Number of patients attending session | |
439 | Size, depth, amount, and type of drainage wounds | |
440 | why non-skilled caregiver has not been taught procedure | |
441 | Entity professional qualification for service(s) | |
442 | Modalities of service | |
443 | Initial evaluation report | |
444 | Method used to obtain test sample | |
445 | Explain why hearing loss not correctable by hearing aid | |
446 | Documentation from prior claim(s) related to service(s) | |
447 | Plan of teaching | |
448 | Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used. | |
449 | Projected date to discontinue service(s) | |
450 | Awaiting spend down determination | |
451 | Preoperative and post-operative diagnosis | |
452 | Total visits in total number of hours/day and total number of hours/week | |
453 | Procedure Code Modifier(s) for Service(s) Rendered | |
454 | Procedure code for services rendered. | |
455 | Revenue code for services rendered. | |
456 | Covered Day(s) | |
457 | Non-Covered Day(s) | |
458 | Coinsurance Day(s) | |
459 | Lifetime Reserve Day(s) | |
460 | NUBC Condition Code(s) | |
461 | NUBC Occurrence Code(s) and Date(s) | |
462 | NUBC Occurrence Span Code(s) and Date(s) | |
463 | NUBC Value Code(s) and/or Amount(s) | |
464 | Payer Assigned Claim Control Number | |
465 | Principal Procedure Code for Service(s) Rendered | |
466 | Entity's Original Signature. Usage: This code requires use of an Entity Code. | |
467 | Entity Signature Date. Usage: This code requires use of an Entity Code. | |
468 | Patient Signature Source | |
469 | Purchase Service Charge | |
470 | Was service purchased from another entity? Usage: This code requires use of an Entity Code. | |
471 | Were services related to an emergency? | |
472 | Ambulance Run Sheet | |
473 | Missing or invalid lab indicator | |
474 | Procedure code and patient gender mismatch | |
475 | Procedure code not valid for patient age | |
476 | Missing or invalid units of service | |
477 | Diagnosis code pointer is missing or invalid | |
478 | Claim submitter's identifier | |
479 | Other Carrier payer ID is missing or invalid | |
480 | Entity's claim filing indicator. Usage: This code requires use of an Entity Code. | |
481 | Claim/submission format is invalid. | |
482 | Date Error, Century Missing | |
483 | Maximum coverage amount met or exceeded for benefit period. | |
484 | Business Application Currently Not Available | |
485 | More information available than can be returned in real time mode. Narrow your current search criteria. This change effective September 1, 2017: More information available than can be returned in real-time mode. Narrow your current search criteria. | |
486 | Principal Procedure Date | |
487 | Claim not found, claim should have been submitted to/through 'entity'. Usage: This code requires use of an Entity Code. | |
488 | Diagnosis code(s) for the services rendered. | |
489 | Attachment Control Number | |
490 | Other Procedure Code for Service(s) Rendered | |
491 | Entity not eligible for encounter submission. Usage: This code requires use of an Entity Code. | |
492 | Other Procedure Date | |
493 | Version/Release/Industry ID code not currently supported by information holder | |
494 | Real-Time requests not supported by the information holder, resubmit as batch request This change effective September 1, 2017: Real-time requests not supported by the information holder, resubmit as batch request | |
495 | Requests for re-adjudication must reference the newly assigned payer claim control number for this previously adjusted claim. Correct the payer claim control number and re-submit. | |
496 | Submitter not approved for electronic claim submissions on behalf of this entity. Usage: This code requires use of an Entity Code. | |
497 | Sales tax not paid | |
498 | Maximum leave days exhausted | |
499 | No rate on file with the payer for this service for this entity Usage: This code requires use of an Entity Code. | |
500 | Entity's Postal/Zip Code. Usage: This code requires use of an Entity Code. | |
501 | Entity's State/Province. Usage: This code requires use of an Entity Code. | |
502 | Entity's City. Usage: This code requires use of an Entity Code. | |
503 | Entity's Street Address. Usage: This code requires use of an Entity Code. | |
504 | Entity's Last Name. Usage: This code requires use of an Entity Code. | |
505 | Entity's First Name. Usage: This code requires use of an Entity Code. | |
506 | Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Usage: This code requires use of an Entity Code. | |
507 | HCPCS | |
508 | ICD9 Usage: At least one other status code is required to identify the related procedure code or diagnosis code. | |
509 | External Cause of Injury Code. | |
510 | Future date. Usage: At least one other status code is required to identify the data element in error. | |
511 | Invalid character. Usage: At least one other status code is required to identify the data element in error. | |
512 | Length invalid for receiver's application system. Usage: At least one other status code is required to identify the data element in error. | |
513 | HIPPS Rate Code for services Rendered | |
514 | Entity's Middle Name Usage: This code requires use of an Entity Code. | |
515 | Managed Care review | |
516 | Other Entity's Adjudication or Payment/Remittance Date. Usage: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary. | |
517 | Adjusted Repriced Claim Reference Number | |
518 | Adjusted Repriced Line item Reference Number | |
519 | Adjustment Amount | |
520 | Adjustment Quantity | |
521 | Adjustment Reason Code | |
522 | Anesthesia Modifying Units | |
523 | Anesthesia Unit Count | |
524 | Arterial Blood Gas Quantity | |
525 | Begin Therapy Date | |
526 | Bundled or Unbundled Line Number | |
527 | Certification Condition Indicator | |
528 | Certification Period Projected Visit Count | |
529 | Certification Revision Date | |
530 | Claim Adjustment Indicator | |
531 | Claim Disproportinate Share Amount | |
532 | Claim DRG Amount | |
533 | Claim DRG Outlier Amount | |
534 | Claim ESRD Payment Amount | |
535 | Claim Frequency Code | |
536 | Claim Indirect Teaching Amount | |
537 | Claim MSP Pass-through Amount | |
538 | Claim or Encounter Identifier | |
539 | Claim PPS Capital Amount | |
540 | Claim PPS Capital Outlier Amount | |
541 | Claim Submission Reason Code | |
542 | Claim Total Denied Charge Amount | |
543 | Clearinghouse or Value Added Network Trace | |
544 | Clinical Laboratory Improvement Amendment (CLIA) Number | |
545 | Contract Amount | |
546 | Contract Code | |
547 | Contract Percentage | |
548 | Contract Type Code | |
549 | Contract Version Identifier | |
550 | Coordination of Benefits Code | |
551 | Coordination of Benefits Total Submitted Charge | |
552 | Cost Report Day Count | |
553 | Covered Amount | |
554 | Date Claim Paid | |
555 | Delay Reason Code | |
556 | Demonstration Project Identifier | |
557 | Diagnosis Date | |
558 | Discount Amount | |
559 | Document Control Identifier | |
560 | Entity's Additional/Secondary Identifier. Usage: This code requires use of an Entity Code. | |
561 | Entity's Contact Name. Usage: This code requires use of an Entity Code. | |
562 | Entity's National Provider Identifier (NPI). Usage: This code requires use of an Entity Code. | |
563 | Entity's Tax Amount. Usage: This code requires use of an Entity Code. | |
564 | EPSDT Indicator | |
565 | Estimated Claim Due Amount | |
566 | Exception Code | |
567 | Facility Code Qualifier | |
568 | Family Planning Indicator | |
569 | Fixed Format Information | |
570 | Free Form Message Text | |
571 | Frequency Count | |
572 | Frequency Period | |
573 | Functional Limitation Code | |
574 | HCPCS Payable Amount Home Health | |
575 | Homebound Indicator | |
576 | Immunization Batch Number | |
577 | Industry Code | |
578 | Insurance Type Code | |
579 | Investigational Device Exemption Identifier | |
580 | Last Certification Date | |
581 | Last Worked Date | |
582 | Lifetime Psychiatric Days Count | |
583 | Line Item Charge Amount | |
584 | Line Item Control Number | |
585 | Denied Charge or Non-covered Charge | |
586 | Line Note Text | |
587 | Measurement Reference Identification Code | |
588 | Medical Record Number | |
589 | Provider Accept Assignment Code | |
590 | Medicare Coverage Indicator | |
591 | Medicare Paid at 100% Amount | |
592 | Medicare Paid at 80% Amount | |
593 | Medicare Section 4081 Indicator | |
594 | Mental Status Code | |
595 | Monthly Treatment Count | |
596 | Non-covered Charge Amount | |
597 | Non-payable Professional Component Amount | |
598 | Non-payable Professional Component Billed Amount | |
599 | Note Reference Code | |
600 | Oxygen Saturation Qty | |
601 | Oxygen Test Condition Code | |
602 | Oxygen Test Date | |
603 | Old Capital Amount | |
604 | Originator Application Transaction Identifier | |
605 | Orthodontic Treatment Months Count | |
606 | Paid From Part A Medicare Trust Fund Amount | |
607 | Paid From Part B Medicare Trust Fund Amount | |
608 | Paid Service Unit Count | |
609 | Participation Agreement | |
610 | Patient Discharge Facility Type Code | |
611 | Peer Review Authorization Number | |
612 | Per Day Limit Amount | |
613 | Physician Contact Date | |
614 | Physician Order Date | |
615 | Policy Compliance Code | |
616 | Policy Name | |
617 | Postage Claimed Amount | |
618 | PPS-Capital DSH DRG Amount | |
619 | PPS-Capital Exception Amount | |
620 | PPS-Capital FSP DRG Amount | |
621 | PPS-Capital HSP DRG Amount | |
622 | PPS-Capital IME Amount | |
623 | PPS-Operating Federal Specific DRG Amount | |
624 | PPS-Operating Hospital Specific DRG Amount | |
625 | Predetermination of Benefits Identifier | |
626 | Pregnancy Indicator | |
627 | Pre-Tax Claim Amount | |
628 | Pricing Methodology | |
629 | Property Casualty Claim Number | |
630 | Referring CLIA Number | |
631 | Reimbursement Rate | |
632 | Reject Reason Code | |
633 | Related Causes Code (Accident, auto accident, employment) | |
634 | Remark Code | |
635 | Repriced Ambulatory Patient Group Code | |
636 | Repriced Line Item Reference Number | |
637 | Repriced Saving Amount | |
638 | Repricing Per Diem or Flat Rate Amount | |
639 | Responsibility Amount | |
640 | Sales Tax Amount | |
641 | Service Adjudication or Payment Date. Note: Use code 516. | |
642 | Service Authorization Exception Code | |
643 | Service Line Paid Amount | |
644 | Service Line Rate | |
645 | Service Tax Amount | |
646 | Ship, Delivery or Calendar Pattern Code | |
647 | Shipped Date | |
648 | Similar Illness or Symptom Date | |
649 | Skilled Nursing Facility Indicator | |
650 | Special Program Indicator | |
651 | State Industrial Accident Provider Number | |
652 | Terms Discount Percentage | |
653 | Test Performed Date | |
654 | Total Denied Charge Amount | |
655 | Total Medicare Paid Amount | |
656 | Total Visits Projected This Certification Count | |
657 | Total Visits Rendered Count | |
658 | Treatment Code | |
659 | Unit or Basis for Measurement Code | |
660 | Universal Product Number | |
661 | Visits Prior to Recertification Date Count CR702 | |
662 | X-ray Availability Indicator | |
663 | Entity's Group Name. Usage: This code requires use of an Entity Code. | |
664 | Orthodontic Banding Date | |
665 | Surgery Date | |
666 | Surgical Procedure Code | |
667 | Real-Time requests not supported by the information holder, do not resubmit This change effective September 1, 2017: Real-time requests not supported by the information holder, do not resubmit | |
668 | Missing Endodontics treatment history and prognosis | |
669 | Dental service narrative needed. | |
670 | Funds applied from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts | |
671 | Funds may be available from a consumer spending account such as consumer directed/driven health plan (CDHP), Health savings account (H S A) and or other similar accounts | |
672 | Other Payer's payment information is out of balance | |
673 | Patient Reason for Visit | |
674 | Authorization exceeded | |
675 | Facility admission through discharge dates | |
676 | Entity possibly compensated by facility. Usage: This code requires use of an Entity Code. | |
677 | Entity not affiliated. Usage: This code requires use of an Entity Code. | |
678 | Revenue code and patient gender mismatch | |
679 | Submit newborn services on mother's claim | |
680 | Entity's Country. Usage: This code requires use of an Entity Code. | |
681 | Claim currency not supported | |
682 | Cosmetic procedure | |
683 | Awaiting Associated Hospital Claims | |
684 | Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Usage: Only for use to reject claims or status requests in transactions that were 'accepted with errors' on a 997 or 999 Acknowledgement.) | |
685 | Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit. This change effective September 1, 2017: Claim could not complete adjudication in real-time. Claim will continue processing in a batch mode. Do not resubmit. | |
686 | The claim/ encounter has completed the adjudication cycle and the entire claim has been voided | |
687 | Claim estimation can not be completed in real time. Do not resubmit. This change effective September 1, 2017: Claim predetermination/estimation could not be completed in real-time. Do not resubmit. | |
688 | Present on Admission Indicator for reported diagnosis code(s). | |
689 | Entity was unable to respond within the expected time frame. Usage: This code requires use of an Entity Code. | |
690 | Multiple claims or estimate requests cannot be processed in real time. This change effective September 1, 2017: Multiple claims or estimate requests cannot be processed in real-time. | |
691 | Multiple claim status requests cannot be processed in real time. This change effective September 1, 2017: Multiple claim status requests cannot be processed in real-time. | |
692 | Contracted funding agreement-Subscriber is employed by the provider of services | |
693 | Amount must be greater than or equal to zero. Usage: At least one other status code is required to identify which amount element is in error. | |
694 | Amount must not be equal to zero. Usage: At least one other status code is required to identify which amount element is in error. | |
695 | Entity's Country Subdivision Code. Usage: This code requires use of an Entity Code. | |
696 | Claim Adjustment Group Code. | |
697 | Invalid Decimal Precision. Usage: At least one other status code is required to identify the data element in error. | |
698 | Form Type Identification | |
699 | Question/Response from Supporting Documentation Form | |
700 | ICD10. Usage: At least one other status code is required to identify the related procedure code or diagnosis code. | |
701 | Initial Treatment Date | |
702 | Repriced Claim Reference Number | |
703 | Advanced Billing Concepts (ABC) code | |
704 | Claim Note Text | |
705 | Repriced Allowed Amount | |
706 | Repriced Approved Amount | |
707 | Repriced Approved Ambulatory Patient Group Amount | |
708 | Repriced Approved Revenue Code | |
709 | Repriced Approved Service Unit Count | |
710 | Line Adjudication Information. Usage: At least one other status code is required to identify the data element in error. | |
711 | Stretcher purpose | |
712 | Obstetric Additional Units | |
713 | Patient Condition Description | |
714 | Care Plan Oversight Number | |
715 | Acute Manifestation Date | |
716 | Repriced Approved DRG Code | |
717 | This claim has been split for processing. | |
718 | Claim/service not submitted within the required timeframe (timely filing). | |
719 | NUBC Occurrence Code(s) | |
720 | NUBC Occurrence Code Date(s) | |
721 | NUBC Occurrence Span Code(s) | |
722 | NUBC Occurrence Span Code Date(s) | |
723 | Drug days supply | |
724 | Drug dosage. This change effective 5/01/2017: Drug Quantity | |
725 | NUBC Value Code(s) | |
726 | NUBC Value Code Amount(s) | |
727 | Accident date | |
728 | Accident state | |
729 | Accident description | |
730 | Accident cause | |
731 | Measurement value/test result | |
732 | Information submitted inconsistent with billing guidelines. Usage: At least one other status code is required to identify the inconsistent information. | |
733 | Prefix for entity's contract/member number. | |
734 | Verifying premium payment | |
735 | This service/claim is included in the allowance for another service or claim. | |
736 | A related or qualifying service/claim has not been received/adjudicated. | |
737 | Current Dental Terminology (CDT) Code | |
738 | Home Infusion EDI Coalition (HEIC) Product/Service Code | |
739 | Jurisdiction Specific Procedure or Supply Code | |
740 | Drop-Off Location | |
741 | Entity must be a person. Usage: This code requires use of an Entity Code. | |
742 | Payer Responsibility Sequence Number Code | |
743 | Entity's credential/enrollment information. Usage: This code requires use of an Entity Code. | |
744 | Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. | |
745 | Identifier Qualifier Usage: At least one other status code is required to identify the specific identifier qualifier in error. | |
746 | Duplicate Submission Usage: use only at the information receiver level in the Health Care Claim Acknowledgement transaction. | |
747 | Hospice Employee Indicator | |
748 | Corrected Data Usage: Requires a second status code to identify the corrected data. | |
749 | Date of Injury/Illness | |
750 | Auto Accident State or Province Code | |
751 | Ambulance Pick-up State or Province Code | |
752 | Ambulance Drop-off State or Province Code | |
753 | Co-pay status code. | |
754 | Entity Name Suffix. Usage: This code requires the use of an Entity Code. | |
755 | Entity's primary identifier. Usage: This code requires the use of an Entity Code. | |
756 | Entity's Received Date. Usage: This code requires the use of an Entity Code. | |
757 | Last seen date. | |
758 | Repriced approved HCPCS code. | |
759 | Round trip purpose description. | |
760 | Tooth status code. | |
761 | Entity's referral number. Usage: This code requires the use of an Entity Code. | |
762 | Locum Tenens Provider Identifier. Code must be used with Entity Code 82 - Rendering Provider | |
763 | Ambulance Pickup ZipCode | |
764 | Professional charges are non covered. | |
765 | Institutional charges are non covered. | |
766 | Services were performed during a Health Insurance Exchange (HIX) premium payment grace period. | |
767 | Qualifications for emergent/urgent care | |
768 | Service date outside the accidental injury coverage period. | |
769 | DME Repair or Maintenance | |
770 | Duplicate of a claim processed or in process as a crossover/coordination of benefits claim. | |
771 | Claim submitted prematurely. Please resubmit after crossover/payer to payer COB allotted waiting period. | |
772 | The greatest level of diagnosis code specificity is required. | |
773 | One calendar year per claim. | |
774 | Experimental/Investigational | |
775 | Entity Type Qualifier (Person/Non-Person Entity). Usage: this code requires use of an entity code. | |
776 | Pre/Post-operative care | |
777 | Processed based on multiple or concurrent procedure rules. | |
778 | Non-Compensable incident/event. Usage: To be used for Property and Casualty only. | |
779 | Service submitted for the same/similar service within a set timeframe. | |
780 | Lifetime benefit maximum | |
781 | Claim has been identified as a readmission | |
782 | Second surgical opinion | |
783 | Federal sequestration adjustment | |
784 | Electronic Visit Verification criteria do not match. | |
785 | Missing/Invalid Sterilization/Abortion/Hospital Consent Form. | |
786 | Submit claim to the third party property and casualty automobile insurer. | |
787 | Resubmit a new claim, not a replacement claim. | |
788 | Submit these services to the patient's Pharmacy Plan for further consideration. This definition will change on 7/1/2023 to: Submit these services to the Pharmacy plan/processor for further consideration/adjudication. | |
789 | Submit these services to the patient's Medical Plan for further consideration. | |
790 | Submit these services to the patient's Dental Plan for further consideration. | |
791 | Submit these services to the patient's Vision Plan for further consideration. | |
792 | Submit these services to the patient's Behavioral Health Plan for further consideration. | |
793 | Submit these services to the patient's Property and Casualty Plan for further consideration. | |
794 | Claim could not complete adjudication in real time. Resubmit as a batch request. | |
795 | Claim submitted prematurely. Please provide the prior payer's final adjudication. | |
796 | Procedure code not valid for date of service. | |
797 | Entity's TRICARE provider id. Usage: This code requires use of an Entity Code. | |
798 | Claim predetermination/estimation could not be completed in real time. Claim requires manual review upon submission. Do not resubmit. | |
799 | Resubmit a replacement claim, not a new claim. | |
800 | Entity's required reporting has been forwarded to the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. | |
801 | Entity's required reporting was accepted by the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. | |
802 | Entity's required reporting was rejected by the jurisdiction. Usage: This code requires use of an Entity Code. To be used for Property and Casualty only. | |
803 | Provider reporting has been rejected due to non-compliance with the jurisdiction's mandated registration. To be used for Property and Casualty only. |
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