Download EOB Code Description Rejection Code Group Code Reason ... and more Lecture notes Pharmacy in PDF only on Docsity!
Code Code Code Code Code 001 Denied. Care beyond first 20 visits or 60 days requires authorization.
NULL CO A1, 45 N54, M
002 Denied. Report of Accident (ROA) payable once per claim. Previous payment has been made.
NULL CO B13, A1, 23 N
003 Initial office visit payable 1 time only for same injured worker/provider/diagnosis.
NULL CO B13 M
004 Denied. Physical therapy by the attending doctor is limited to 6 treatments.
NULL CO 35, A1, 45 N
005 Denied. Physical therapy beyond the first 12 treatments requires authorization.
NULL CO A1, 45 M62, N
006 Rental has extended over 30 days. Only short term rental is allowed.
NULL CO 108, 119, 45 NULL
007 Denied. Facet joint injections are limited to 4 per injured worker.
NULL CO 35, A1, 45 N
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.
NULL NULL NULL NULL
017 Denied. Meal receipts must include business name or be accompanied by cash registered receipt.
NULL NULL NULL NULL
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.
NULL NULL NULL NULL
020 This service is payable only once and must be billed as 1 line item and 1 unit of service.
NULL CO 16 M
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.)
NULL PI 109 NULL
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.
NULL CO A1 M62, N
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.
NULL CO A1 N
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.
NULL NULL NULL NULL
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.
NULL CO 226 M
034 Number of hours paid per agreement with L&I Occupational Nurse Consultant.
NULL CO P12 N
035 Paid professional component only. Technical component billed by and paid to another provider.
NULL CO NULL NULL
036 Adjustment/deduction taken to credit base anesthesia units that were billed by you in error.
NULL CR P13 N
037 L&I responsible for payment of this bill. Reimburse payments made by other sources.
NULL CO 19 MA
038 Use modifier -7N with X-ray, lab services, and other allowed diagnostic services performed in conjunction with an IME.
NULL CO 4 M
039 Denied. The legal maximum of $4000 for retraining has been expended.
NULL NULL NULL NULL
Code Code Code Code Code 057 Submit charges for rehab DRG 462 under your facilities separate rehab unit provider number.
NULL CO 8 NULL
058 Denied. E/M code not payable with MPE or impairment rating by same provider/claim/date of service.
NULL CO A1 M
059 Payment adjusted to number of service units authorized by the Claim Manager.
NULL CO P12 N
060 Denied. Please rebill using the correct provider number for these services.
NULL CO 8, A1 N
061 Allowed at combined procedure code rate per L&I published fee schedule.
NULL CO P12, 45 NULL
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.
NULL CO P13 NULL
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.
NULL CR 16 N
066 Denied. The admit and discharge dates are the same. Rebill this service as outpatient service.
NULL CO A1 N64, N173,
MA
067 Adjusted. Examination completed within 6 weeks of a "no show" exam billed to L&I.
NULL CR NULL NULL
069 Denied. The provider is not an approved chiropractic consultant with L&I.
NULL CO B7 NULL
070 Allowable fee set by L&I Chiropractic Consultant based upon review of report.
NULL CO P12 N
071 Denied. Injury occurred while in course of employment subject to Longshore & Harbor Workers Act
NULL CO 109, A1 N
072 Denied. Rebill services under the performing provider's name and provider number and/or NPI.
NULL CO NULL N
073 Payment adjusted per review by Department Occupational Nurse Consultant.
NULL CO P12 N
Code Code Code Code Code 074 Denied. Replacement and repair of this item is not covered by L&I.
NULL CO 96, A1 N
075 Denied. Requested records not rec'd by August(AHS). Injured worker is not to be billed.
NULL CO 226, A1 N
076 Denied. Claim reopened for provisional time-loss only. If/when reopened for medical, rebill.
NULL CO 27, A1 N
077 Procedure billed needs a referral ID on the bill. Contact the referring vocational provider for this number.
NULL NULL NULL NULL
078 Services paid. Claim now closed and no additional benefits are payable.
NULL CO 35 NULL
079 Denied. This is a rebill of an original that is currently under review by utilization review (UR) vendor.
NULL CO 18 NULL
080 Anesthesia services reimbursed under RBRVS are not paid by base and time units.
NULL CO 59 NULL
081 Units adjusted to 24. This procedure's unit value is calculated on a per hour basis.
NULL CO P12 NULL
082 The modifier used requires a report. No report has been received for these services.
NULL CO 16, A1 N
083 When using a group number you must also indicate by provider number which doctor performed services.
NULL CO NULL N
084 Units or payment adjusted to pay maximum allowable amount per day.
NULL CO P12 N
085 Units per injury per time period exceeded. Denied/Adjusted per current fee schedule maximum.
NULL CO P12 N
086 Payment adjusted. Payment of guest convenience items are the injured worker's responsibility.
NULL NULL NULL NULL
087 Units adjusted to correct amount. Only 2 additional visits allowed per day.
NULL CO P12, 45 NULL
088 Referring provider number is missing/not valid for this claim. Contact referring vocational provider for this number.
NULL NULL NULL NULL
Code Code Code Code Code 106 Denied. The therapeutic class and the diagnosis on the bill are incompatible.
80 NULL NULL NULL
107 Board charges are allowed for payment of food items only. Other items are not authorized.
NULL NULL NULL NULL
108 Payment of this service has been authorized as a retraining expense.
NULL NULL NULL NULL
109 Deduction taken to reimburse L&I for unauthorized or excess payment of this service.
NULL CR P12, 197 NULL
110 Paid technical component only. Professional component billed by and paid to another provider.
NULL CO P12, 89 NULL
111 The procedure modifier(s) required for the surgery(s) on this bill is either invalid or missing
NULL CO 4 NULL
112 Units of service adjusted to comply with the maximum 40 hours payable for this service.
NULL CO P12 NULL
113 When billing an unlisted procedure code a specific description of service must be on the bill.
NULL CO 16 M51, MA
114 Paid. Condition not accepted but retarding recovery from accepted condition.
NULL CO 20 NULL
115 Units of service for accommodations conflict with the covered dates listed on your bill.
NULL CO 16 N
116 No payment made for this surgical service. It is included in flat fee for major surgery billed.
NULL CO 97 M
117 The 1st procedure code modifier is either completely invalid or invalid for the service dates billed.
NULL CO 4 NULL
118 This service has already been billed by and paid to another provider.
NULL CO B20 NULL
119 Paid on adjunctive treatment basis only. Condition not accepted.
NULL CO 20 NULL
120 Denied. The date of service is required. Submit bill only when service has been completed.
NULL CO 16 MA
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.
15 CO 16 MA
125 Denied. Bill was received in L&I after 90 days from date of service.
NULL CO 29 NULL
126 Payment processed. Future vouchers for travel over 90 days old will be denied.
NULL NULL NULL NULL
127 Denied. The prescription was not written by the recognized attending physician of record.
NULL CO A1,184 N
128 Denied. The prescription was written for a condition unrelated to the industrial injury.
NULL CO 96, A1 N
129 Missing or invalid modifier code was billed. Please note corrected code used in this instance.
NULL CO 4 M
130 Injured worker name was missing from the billing received by L&I.
CD CO 16 MA
131 Denied. The prescribing provider number is missing or invalid.
25 CO 16 N
132 Please list all applicable modifiers in the description field when billing modifier 99.
NULL CO 4 M
133 Denied. Gasoline and/or automotive costs are included in the mileage reimbursement rate.
NULL NULL NULL NULL
134 Allowed at rate established by Washington Administrative Code effective this service date.
NULL CO P12 NULL
135 Denied. Parking receipts were not attached to your billing. Attach receipts to bill and resubmit for further consideration.
NULL NULL NULL NULL
136 Extra views must be billed under -22 modifier per Fee Schedule/WAC 296-23-01005.
NULL CO 4 NULL
137 Procedure code states "minimum of __ views." Additional amount not payable for extra views.
NULL CO P12, 45 NULL
Code Code Code Code Code 156 Days supply missing/invalid. If equipment send bill on Statement for Miscellaneous Services.
19 CO 16 NULL
157 Not responsible for repair or replacement of contacts or glasses not worn at time of injury.
NULL PR 96 NULL
158 Bill paid. You must reimburse the employer the total amount he/she paid for this service.
NULL OA P12 NULL
159 Prescribing provider number on your bill was terminated or associated to a terminated number when the prescription was written.
71 CO 184 NULL
160 Reduced to office call fee for 90030 or ER visit 90350 per our Medical Aid Rules.
NULL CO P12, 45 NULL
161 Denied. Third ICD diagnosis code is invalid for first date of service.
NULL CO 16 M
162 Denied. Fourth ICD diagnosis code is invalid for first date of service.
NULL CO 16 M
163 Not paid. Diagnosis code missing. NULL CO 16 M 164 Denied. Fifth ICD diagnosis code is invalid for first date of service.
NULL CO 16 M
165 Unable to determine referring physician's name and/or provider number.
NULL CO 16 N285, N
166 Section of the bill indicating if the old glasses prescription was available was not completed.
NULL CO 16 NULL
167 Denied. Patient status code is missing or invalid for state fund injured workers.
NULL CO 16 MA
168 Denied. Refraction is not paid when the old prescription is available.
NULL CO 96 NULL
169 Denied. Admitting/Principal ICD diagnosis code is not sufficiently specific.
NULL CO 16, A1 M
170 Denied. Second ICD diagnosis code is not sufficiently specific.
NULL CO 16, A1 M
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.
NULL CO 16 MA
173 Denied. The admission date and the service dates are incompatible.
NULL OA 16, A1 MA40,
MA
174 Denied. L&I did not authorize these services by this provider for this claim.
NULL CO A1, 197 N
175 Service prior to April 1, 1986 must be billed as a separate line item.
NULL NULL NULL NULL
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
NULL CO 16, A1 M
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.
NULL CO 26, A1 MA
181 Denied. Principal diagnosis denotes a non-industrial condition or is not sufficiently specific.
NULL CO 16, A1 MA
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.
DU CO 16, A1 M
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.
NULL CO 18 M
187 Denied. The clinic has already been paid for this service under the clinic's L&I provider number.
NULL CO 18 M
188 Denied. Second diagnosis denotes a non-industrial condition or is not sufficiently specific.
NULL CO 16, A1 M
189 Denied. Third diagnosis denotes a non-industrial condition or is not sufficiently specific.
NULL CO 16, A1 M
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.
NULL CO 16 NULL
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.
NULL CR P12 NULL
211 Injured worker paid at L&I rate. Please reimburse the provider for this service.
NULL NULL NULL NULL
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.
NULL CO 16, A1 M
215 Submit w/valid revenue code or if service is for lab, radiology, or PT use CPT procedure code.
NULL CO 16, A1 M50, M
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.
NULL CO 56 N
220 Denied. Bill not submitted in a timely manner patient is not responsible for this charge.
NULL CO 29 NULL
221 Denied. Only 1office call per day is permitted after the first 3 days of treatment.
NULL CO 96, B1 M
222 Denied. Effective January 1, 1987, $.36 tape billing fee is no longer payable by L&I.
NULL NULL NULL NULL
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.
NULL CO 4 M
225 Denied. The noncovered line item charge exceeds the line item billed charge.
NULL CO 96, A1 M
Code Code Code Code Code 226 Denied. Bill type invalid for this provider type. Correct bill type/provider number & resubmit.
NULL CO 16 N34, MA
227 Paid as one hour. Supply time span for psychiatric exam in remarks on future bills.
NULL CO P12, 122 N
228 Adjusted. On future bills indicate in remarks if psychiatrist was panel member and number of hours.
NULL CR P12, 122 N
229 When billing unlisted procedure code, specific description of service must be in remarks.
NULL CO 16 MA
230 This item must be billed by NDC on the Statement for Pharmacy Services bill form.
NULL CO 16 M119, N
231 When billing -22 modifier, you must explain the nature of the additional services in remarks.
NULL CO 16 MA69, M
232 You must list all applicable modifiers in remarks when billing modifier -99.
NULL CO 16 MA
233 The diagnosis supplied on your bill has been denied under this claim number.
NULL CO A1, 167 N569, M
234 Paid at non-Washington percent of allowed charge (POAC) per WAC 296-23A-0230.
NULL CO P12 NULL
235 Denied. Primary and/or secondary diagnosis has been denied under this claim number.
NULL CO A1, 167 MA63, M
236 Bill remarks do not pertain to bill payment and have delayed processing.
NULL CO 133 MA
237 Remarks do not justify -22 modifier. Submit paper adjustment with justification.
NULL CO A1 N
238 Inpatient admission not medically necessary per L&I Medical Consultant. Paid at 50%.
NULL CO P12, 197 N
239 Prior authorization not obtained for inpatient admission. Paid at half of allowable fee.
NULL CO 197 NULL
240 Time lost from work is payable only when an examination is requested by L&I.
NULL NULL NULL NULL
Code Code Code Code Code 258 Credit taken to offset previous payment made by gross adjustment.
NULL CR P12 NULL
259 Denied. Claim number/injured worker name mismatch. Call 1- 800-831-5227 to confirm claim number before rebilling.
62 CO 31 MA61,
MA
260 Service was for concurrent treatment which has not been authorized for this injury.
NULL CO 197 M80, N
261 Generically priced. Prescribing doctor hasn't submitted justification to issue brand name drug.
NULL CO P12 N
262 ICD procedure code(s) invalid for first date of service. Correct and resubmit.
NULL CO 16 MA
263 Denied. Duplicate claim number. Contact L&I local office for the correct number.
7 CO 18 NULL
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.
67 CO 133 NULL
265 Denied. Service rendered after date of pension and no treatment order has been authorized.
NULL CO 27, A1 N578, N
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.
NULL PI 109 NULL
268 Denied. Travel expense must be billed to L&I within 12 months of the date of travel.
NULL NULL NULL NULL
269 All ICD operating room procedure codes are non-specific. Correct and resubmit.
NULL CO 16, A1 M
270 Injured worker's age invalid for diagnosis. Correct and resubmit.
NULL CO 9 NULL
271 Denied. Sum of line item charges does not equal total billed charge. Correct and resubmit.
NULL CO 16 M
272 Please note when billing this procedure code enter 001 in bill's units of service field.
NULL CO P12 M
Code Code Code Code Code 273 Please note the provider number. Use this number to bill for psychiatric unit services.
NULL CO 16 N
274 Please note the provider number. Use this number to bill for alcohol unit service.
NULL CO 16 N
275 Denied as duplicate. The service(s) where paid under your previous provider number.
NULL CO 18, A1 N
276 Denied. The diagnosis listed on your billing has not been accepted as related to this injury.
M1 CO 96, A1 M76, M
277 Denied. Authorization of this procedure, drug or service has been denied under this claim number
70 CO 39 NULL
278 Denied. L&I notification of cancellation was provided within 3 days of examination.
NULL CO 96, B1 NULL
279 Deduction taken for bills previously paid on a claim which has subsequently been rejected.
NULL CR P12 NULL
280 Denied. Claim number billed is not active. Call 1-800-831- 5227 to confirm the claim number before rebilling.
52 CO 31 NULL
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.
NULL CO A8 NULL
285 Not referred by the attending physician of record and L&I authorization not obtained.
NULL CO A1, 197 N
286 Denied. The CPT code for the surgical procedure performed must be listed on the billing.
NULL CO 16, A1 M
287 Denied. This is an electronic bill. The clearinghouse is not authorized to submit bills for this provider. Call 360-902-
NULL CO A1 N
288 Bill returned to provider with new provider application form. Previous application was not returned.
NULL CO 16 N
Code Code Code Code Code 305 This transaction has been taken to correct the file per a special request.
NULL CO P12, 137 NULL
306 Current charges are being processed. Submit an itemized billing for the balance forward amounts
NULL CO 16 N
307 Corrections to this bill (ICN) have been made per your request.
NULL CO 129 MA
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.
NULL CO 18, B13 NULL
310 Denied. Service was before or after the dates authorized for the pain clinic program.
NULL CO A1 N
311 Denied. A pain program has not been authorized for this injured worker.
NULL CO A1, 197 N683, N
312 This transaction cancels interim payment credit balance for this provider number.
NULL CR P12 NULL
313 This transaction reflects interim payment credit balance refund and corrects year to date info.
NULL CR P12 NULL
314 This transaction reduces the interim payment credit balance for this provider number.
NULL CR P12 NULL
315 This travel related expense is denied in accordance with L&I policy.
NULL NULL NULL NULL
316 This is a history adjustment to correct an error in firm number and class.
NULL OA P12 NULL
317 Denied. The principal, admitting or patient's reason for visit diagnosis code denotes a non-industrial condition or is not sufficiently specific.
70 CO A1 M
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.
NULL CO 16 M
320 Note claim number and your provider number. These are required on all bills sent to the L&I.
NULL CO 16 N290,
MA
Code Code Code Code Code 321 Revenue code(s) invalid for date(s) of service billed. Rebill with correct codes.
NULL CO 16 M
322 Denied. Service is in violation of specific restrictions imposed by the Department of Licensing.
NULL CO A1 N
323 This procedure code wasn't valid at time of service. Refer to the latest fee schedule revision.
NULL CO 181 M
324 Denied. Bill and reports indicate services were provided for a new injury/incident.
NULL CO A1 N
325 An adjusted bill paid without deducting the original bill. This is a corrective action.
NULL CR 129 MA
326 Denied. This service or drug is not allowed for treatment of industrial injuries.
70 CO 96, A1 N
327 Denied. No report received from the attending doctor to justify authorization of this service.
NULL CO 226, A1 N
328 Denied. Injured worker age and/or sex invalid for this procedure or diagnosis.
NULL CO 6, 7, 9, 10 NULL
329 This adjustment is the result of an independent audit of charges for the service(s).
NULL CR 216 NULL
330 Denied. This procedure was not included as a part of the approved program for this provider.
NULL CO B5 NULL
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.
NULL CO 171 N
333 Do not bill several procedures/diagnoses/dates in one line. These will be denied in the future.
NULL CO 16 N
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.
NULL CO 16 N
336 Provider number, NPI and/or name used were incorrect. Note correction(s) and use on future billings.
NULL CO 16 N
