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Reason. Code. Remark. Code. 001 Denied. Care beyond first 20 visits or 60 ... CO. 97. M144. 117 The 1st procedure code modifier is either completely invalid.
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Code Code Code Code Code 001 Denied. Care beyond first 20 visits or 60 days requires authorization.
002 Denied. Report of Accident (ROA) payable once per claim. Previous payment has been made.
003 Initial office visit payable 1 time only for same injured worker/provider/diagnosis.
004 Denied. Physical therapy by the attending doctor is limited to 6 treatments.
005 Denied. Physical therapy beyond the first 12 treatments requires authorization.
006 Rental has extended over 30 days. Only short term rental is allowed.
007 Denied. Facet joint injections are limited to 4 per injured worker.
008 Denied. Chemonucleolysis is allowed once in a lifetime only. NULL CO 35, A1, 45 N 009 Maximum 2 service units allowed. NULL CO 45, P12 NULL 010 Maximum 40 hours payable per vocational referral. NULL NULL NULL NULL 011 Maximum 50 hours payable per vocational referral. NULL NULL NULL NULL 012 Maximum 2 hours allowed per vocational referral. NULL NULL NULL NULL 013 Quality or level of service does not meet L&I standards. NULL CO A1 N 014 Maximum 1 service unit allowed for same day/diagnosis. NULL CO P12, 45 NULL 015 Maximum of 2 hours travel wait time allowed. NULL NULL NULL NULL 016 Thank you. Your effort to complete this bill correctly has been appreciated.
017 Denied. Meal receipts must include business name or be accompanied by cash registered receipt.
018 Additional views/units are not payable on MRI's. NULL CO 45 NULL 019 Amount paid is according to hours lost from work per the daily compensation rate.
020 This service is payable only once and must be billed as 1 line item and 1 unit of service.
Code Code Code Code Code 021 Denied. Free parking available at this facility. NULL NULL NULL NULL 022 Consultations not payable to attending physician. NULL CO A1 N 023 Denied. Submit bill to party who requested testimony (e.g. attorney general office, BIIA, etc.)
024 Maximum of 1 hour allowable only. NULL CO P12, 45 NULL 025 Accumulated services have exceeded L&I limit. NULL CO NULL NULL 026 This is an individual interim payment. NULL CO NULL NULL 027 Denied. Not authorized to provide work hardening services. Contact work hardening reviewer at (360)902-4480.
028 A maximum of 1 service unit is allowed. NULL CO P12, 45 NULL 029 Denied. Home nursing travel, holidays, overtime & weekends are considered the providers overhead.
030 A maximum of 300 miles is allowed. NULL CO P12, 45 NULL 031 This was paid at the highest allowable fee for breakfast, lunch or dinner.
032 Denied. The tooth number billed has not been authorized. NULL CO A1, 197 N 033 Lack of correct amount of units on bill can reduce or delay payment.
034 Number of hours paid per agreement with L&I Occupational Nurse Consultant.
035 Paid professional component only. Technical component billed by and paid to another provider.
036 Adjustment/deduction taken to credit base anesthesia units that were billed by you in error.
037 L&I responsible for payment of this bill. Reimburse payments made by other sources.
038 Use modifier -7N with X-ray, lab services, and other allowed diagnostic services performed in conjunction with an IME.
039 Denied. The legal maximum of $4000 for retraining has been expended.
Code Code Code Code Code 057 Submit charges for rehab DRG 462 under your facilities separate rehab unit provider number.
058 Denied. E/M code not payable with MPE or impairment rating by same provider/claim/date of service.
059 Payment adjusted to number of service units authorized by the Claim Manager.
060 Denied. Please rebill using the correct provider number for these services.
061 Allowed at combined procedure code rate per L&I published fee schedule.
062 Fee for visit includes care of the day. NULL CO NULL M 063 Denied. Reopening application is payable only on claims closed over 60 days.
064 Denied. Fee for service includes office call. NULL CO P13 NULL 065 Only one adjustment form should be submitted listing all changes requested to an ICN bill.
066 Denied. The admit and discharge dates are the same. Rebill this service as outpatient service.
067 Adjusted. Examination completed within 6 weeks of a "no show" exam billed to L&I.
069 Denied. The provider is not an approved chiropractic consultant with L&I.
070 Allowable fee set by L&I Chiropractic Consultant based upon review of report.
071 Denied. Injury occurred while in course of employment subject to Longshore & Harbor Workers Act
072 Denied. Rebill services under the performing provider's name and provider number and/or NPI.
073 Payment adjusted per review by Department Occupational Nurse Consultant.
Code Code Code Code Code 074 Denied. Replacement and repair of this item is not covered by L&I.
075 Denied. Requested records not rec'd by August(AHS). Injured worker is not to be billed.
076 Denied. Claim reopened for provisional time-loss only. If/when reopened for medical, rebill.
077 Procedure billed needs a referral ID on the bill. Contact the referring vocational provider for this number.
078 Services paid. Claim now closed and no additional benefits are payable.
079 Denied. This is a rebill of an original that is currently under review by utilization review (UR) vendor.
080 Anesthesia services reimbursed under RBRVS are not paid by base and time units.
081 Units adjusted to 24. This procedure's unit value is calculated on a per hour basis.
082 The modifier used requires a report. No report has been received for these services.
083 When using a group number you must also indicate by provider number which doctor performed services.
084 Units or payment adjusted to pay maximum allowable amount per day.
085 Units per injury per time period exceeded. Denied/Adjusted per current fee schedule maximum.
086 Payment adjusted. Payment of guest convenience items are the injured worker's responsibility.
087 Units adjusted to correct amount. Only 2 additional visits allowed per day.
088 Referring provider number is missing/not valid for this claim. Contact referring vocational provider for this number.
Code Code Code Code Code 106 Denied. The therapeutic class and the diagnosis on the bill are incompatible.
107 Board charges are allowed for payment of food items only. Other items are not authorized.
108 Payment of this service has been authorized as a retraining expense.
109 Deduction taken to reimburse L&I for unauthorized or excess payment of this service.
110 Paid technical component only. Professional component billed by and paid to another provider.
111 The procedure modifier(s) required for the surgery(s) on this bill is either invalid or missing
112 Units of service adjusted to comply with the maximum 40 hours payable for this service.
113 When billing an unlisted procedure code a specific description of service must be on the bill.
114 Paid. Condition not accepted but retarding recovery from accepted condition.
115 Units of service for accommodations conflict with the covered dates listed on your bill.
116 No payment made for this surgical service. It is included in flat fee for major surgery billed.
117 The 1st procedure code modifier is either completely invalid or invalid for the service dates billed.
118 This service has already been billed by and paid to another provider.
119 Paid on adjunctive treatment basis only. Condition not accepted.
120 Denied. The date of service is required. Submit bill only when service has been completed.
121 Not paid. Provider name and/or number is missing or invalid. NULL CO 16 N
Code Code Code Code Code 122 History adjustment due to consolidation of claim numbers. NULL OA P12 NULL 123 Denied. This service is not payable in advance. 15 CO 110 NULL 124 Denied. The beginning/ending service date is missing or invalid.
125 Denied. Bill was received in L&I after 90 days from date of service.
126 Payment processed. Future vouchers for travel over 90 days old will be denied.
127 Denied. The prescription was not written by the recognized attending physician of record.
128 Denied. The prescription was written for a condition unrelated to the industrial injury.
129 Missing or invalid modifier code was billed. Please note corrected code used in this instance.
130 Injured worker name was missing from the billing received by L&I.
131 Denied. The prescribing provider number is missing or invalid.
132 Please list all applicable modifiers in the description field when billing modifier 99.
133 Denied. Gasoline and/or automotive costs are included in the mileage reimbursement rate.
134 Allowed at rate established by Washington Administrative Code effective this service date.
135 Denied. Parking receipts were not attached to your billing. Attach receipts to bill and resubmit for further consideration.
136 Extra views must be billed under -22 modifier per Fee Schedule/WAC 296-23-01005.
137 Procedure code states "minimum of __ views." Additional amount not payable for extra views.
Code Code Code Code Code 156 Days supply missing/invalid. If equipment send bill on Statement for Miscellaneous Services.
157 Not responsible for repair or replacement of contacts or glasses not worn at time of injury.
158 Bill paid. You must reimburse the employer the total amount he/she paid for this service.
159 Prescribing provider number on your bill was terminated or associated to a terminated number when the prescription was written.
160 Reduced to office call fee for 90030 or ER visit 90350 per our Medical Aid Rules.
161 Denied. Third ICD diagnosis code is invalid for first date of service.
162 Denied. Fourth ICD diagnosis code is invalid for first date of service.
163 Not paid. Diagnosis code missing. NULL CO 16 M 164 Denied. Fifth ICD diagnosis code is invalid for first date of service.
165 Unable to determine referring physician's name and/or provider number.
166 Section of the bill indicating if the old glasses prescription was available was not completed.
167 Denied. Patient status code is missing or invalid for state fund injured workers.
168 Denied. Refraction is not paid when the old prescription is available.
169 Denied. Admitting/Principal ICD diagnosis code is not sufficiently specific.
170 Denied. Second ICD diagnosis code is not sufficiently specific.
171 Denied. Third ICD diagnosis code is not sufficiently specific. NULL CO 16, A1 M
Code Code Code Code Code 172 Type service/procedure code is missing or is an invalid L&I procedure code.
173 Denied. The admission date and the service dates are incompatible.
174 Denied. L&I did not authorize these services by this provider for this claim.
175 Service prior to April 1, 1986 must be billed as a separate line item.
176 Denied. Fourth ICD diagnosis code is not sufficiently specific. NULL CO 16, A1 M
177 Denied. Fifth ICD diagnosis code is not sufficiently specific. NULL CO 16, A1 M 178 Denied. First diagnosis code denotes a non-industrial condition or is not sufficiently specific
179 Admit type is invalid. Valid admit types are 1,2,3, and 4. NULL CO 16 MA 180 Denied. Principal procedure date is more than 2 days prior to the bill's first covered date.
181 Denied. Principal diagnosis denotes a non-industrial condition or is not sufficiently specific.
182 Incorrect revenue code billed for this service. NULL CO 16, A1 M 183 The units of service are missing or invalid. NULL CO 16, A1 M 184 Charge is missing or $0.00; invalid (rate X days not equal to charge); or CPT category 2 code.
185 The admission date is missing. NULL CO 16, A1 MA 186 Denied. The provider has already been paid for this service under his individual L&I provider number.
187 Denied. The clinic has already been paid for this service under the clinic's L&I provider number.
188 Denied. Second diagnosis denotes a non-industrial condition or is not sufficiently specific.
189 Denied. Third diagnosis denotes a non-industrial condition or is not sufficiently specific.
Code Code Code Code Code 207 Denied. Each provider must bill charges separately. NULL CO 16 N 208 Please note the prescribing physician's new provider number and use it on future bills.
209 This provider is not authorized to provide this service. M5 CO A1 N 210 This transaction is a transfer of the credit portion of the interim payment.
211 Injured worker paid at L&I rate. Please reimburse the provider for this service.
212 Denied. This is a self-insured claim number. NULL CO 109, A1 N625, N 213 Inpatient bill adjusted to augment DRG database. NULL CO P12 NULL 214 Denied. The CPT procedure code submitted is not a valid code from the outpatient fee schedule.
215 Submit w/valid revenue code or if service is for lab, radiology, or PT use CPT procedure code.
216 NDC invalid for service date billed. NULL CO 16, A1 M 217 The revenue code was missing from the bill. NULL CO 16, A1 M50, M 218 Interest penalty as a result of overpayment. NULL CO 85 NULL 219 Denied. This procedure is considered nonstandard and is not payable by L&I.
220 Denied. Bill not submitted in a timely manner patient is not responsible for this charge.
221 Denied. Only 1office call per day is permitted after the first 3 days of treatment.
222 Denied. Effective January 1, 1987, $.36 tape billing fee is no longer payable by L&I.
223 This credit is taken due to a warrant cancellation. NULL CR P12 NULL 224 The 1st procedure code modifier is not a valid payment modifier in conjunction with the procedure billed.
225 Denied. The noncovered line item charge exceeds the line item billed charge.
Code Code Code Code Code 226 Denied. Bill type invalid for this provider type. Correct bill type/provider number & resubmit.
227 Paid as one hour. Supply time span for psychiatric exam in remarks on future bills.
228 Adjusted. On future bills indicate in remarks if psychiatrist was panel member and number of hours.
229 When billing unlisted procedure code, specific description of service must be in remarks.
230 This item must be billed by NDC on the Statement for Pharmacy Services bill form.
231 When billing -22 modifier, you must explain the nature of the additional services in remarks.
232 You must list all applicable modifiers in remarks when billing modifier -99.
233 The diagnosis supplied on your bill has been denied under this claim number.
234 Paid at non-Washington percent of allowed charge (POAC) per WAC 296-23A-0230.
235 Denied. Primary and/or secondary diagnosis has been denied under this claim number.
236 Bill remarks do not pertain to bill payment and have delayed processing.
237 Remarks do not justify -22 modifier. Submit paper adjustment with justification.
238 Inpatient admission not medically necessary per L&I Medical Consultant. Paid at 50%.
239 Prior authorization not obtained for inpatient admission. Paid at half of allowable fee.
240 Time lost from work is payable only when an examination is requested by L&I.
Code Code Code Code Code 258 Credit taken to offset previous payment made by gross adjustment.
259 Denied. Claim number/injured worker name mismatch. Call 1- 800-831-5227 to confirm claim number before rebilling.
260 Service was for concurrent treatment which has not been authorized for this injury.
261 Generically priced. Prescribing doctor hasn't submitted justification to issue brand name drug.
262 ICD procedure code(s) invalid for first date of service. Correct and resubmit.
263 Denied. Duplicate claim number. Contact L&I local office for the correct number.
264 Claim not yet allowed. Bill on hold for claim decision. Do not send rebill, adjustment or appeal until you receive notice of payment decision.
265 Denied. Service rendered after date of pension and no treatment order has been authorized.
266 Per contract- "Free" trial of transcutaenous nerve stimulator. NULL CO 108 NULL 267 Denied. This is a medical contract claim. Submit your bill to the employer contract carrier.
268 Denied. Travel expense must be billed to L&I within 12 months of the date of travel.
269 All ICD operating room procedure codes are non-specific. Correct and resubmit.
270 Injured worker's age invalid for diagnosis. Correct and resubmit.
271 Denied. Sum of line item charges does not equal total billed charge. Correct and resubmit.
272 Please note when billing this procedure code enter 001 in bill's units of service field.
Code Code Code Code Code 273 Please note the provider number. Use this number to bill for psychiatric unit services.
274 Please note the provider number. Use this number to bill for alcohol unit service.
275 Denied as duplicate. The service(s) where paid under your previous provider number.
276 Denied. The diagnosis listed on your billing has not been accepted as related to this injury.
277 Denied. Authorization of this procedure, drug or service has been denied under this claim number
278 Denied. L&I notification of cancellation was provided within 3 days of examination.
279 Deduction taken for bills previously paid on a claim which has subsequently been rejected.
280 Denied. Claim number billed is not active. Call 1-800-831- 5227 to confirm the claim number before rebilling.
281 Denied. The date of service is prior to the date of injury. 65 CO 26 NULL 282 Your bill must be held pending adjudication of this claim. NULL CO 133 NULL 283 Bill did not exceed L&I high cost outlier thresholds. NULL CO P12, 45 NULL 284 DRG cannot be assigned. Check age, sex, patient status, procedure & diagnosis codes & resubmit.
285 Not referred by the attending physician of record and L&I authorization not obtained.
286 Denied. The CPT code for the surgical procedure performed must be listed on the billing.
287 Denied. This is an electronic bill. The clearinghouse is not authorized to submit bills for this provider. Call 360-902-
288 Bill returned to provider with new provider application form. Previous application was not returned.
Code Code Code Code Code 305 This transaction has been taken to correct the file per a special request.
306 Current charges are being processed. Submit an itemized billing for the balance forward amounts
307 Corrections to this bill (ICN) have been made per your request.
308 Denied. This service is not an authorized vocational expense. NULL NULL NULL NULL 309 Charges previously paid for this date. If this is not a duplicate submit adjustment to paid bill.
310 Denied. Service was before or after the dates authorized for the pain clinic program.
311 Denied. A pain program has not been authorized for this injured worker.
312 This transaction cancels interim payment credit balance for this provider number.
313 This transaction reflects interim payment credit balance refund and corrects year to date info.
314 This transaction reduces the interim payment credit balance for this provider number.
315 This travel related expense is denied in accordance with L&I policy.
316 This is a history adjustment to correct an error in firm number and class.
317 Denied. The principal, admitting or patient's reason for visit diagnosis code denotes a non-industrial condition or is not sufficiently specific.
318 Denied. Office visit includes manipulation. NULL CO 97, B15 NULL 319 Revenue code, cover dates or prior authorization (PA) number are incompatible with the type of bill. Rebill.
320 Note claim number and your provider number. These are required on all bills sent to the L&I.
Code Code Code Code Code 321 Revenue code(s) invalid for date(s) of service billed. Rebill with correct codes.
322 Denied. Service is in violation of specific restrictions imposed by the Department of Licensing.
323 This procedure code wasn't valid at time of service. Refer to the latest fee schedule revision.
324 Denied. Bill and reports indicate services were provided for a new injury/incident.
325 An adjusted bill paid without deducting the original bill. This is a corrective action.
326 Denied. This service or drug is not allowed for treatment of industrial injuries.
327 Denied. No report received from the attending doctor to justify authorization of this service.
328 Denied. Injured worker age and/or sex invalid for this procedure or diagnosis.
329 This adjustment is the result of an independent audit of charges for the service(s).
330 Denied. This procedure was not included as a part of the approved program for this provider.
331 Please refer to the billing instructions provided by L&I. NULL NULL NULL NULL 332 Denied. The type of service and/or procedure is not authorized for this provider type.
333 Do not bill several procedures/diagnoses/dates in one line. These will be denied in the future.
334 These services were not medically necessary. NULL CO 50 NULL 335 Please note the payee number. You must use this number when billing for pain clinic services.
336 Provider number, NPI and/or name used were incorrect. Note correction(s) and use on future billings.