Basics of Remittance Advice Remark Codes (RARC)

Remittance Advice Remark Codes (RARC) provide additional information about an adjustment already described by a CARC and communicate information about remittance processing. Remittance advice remark codes are important codes that are used by healthcare providers and insurance companies to communicate important information about medical claims. These codes provide important information about why a claim was rejected, what additional information is needed to process a claim, and what actions healthcare providers or insurance companies need to take to resolve an issue.

There are a variety of reasons why a claim may be rejected, and remittance advice remark codes are essential in providing clear and concise information about the cause of the rejection. For example, a claim may be rejected due to a coding error, incomplete or missing information, or a lack of documentation. These codes help healthcare providers and insurance companies quickly identify the issue and take the necessary steps to resolve it.

Remittance Advice Remark Codes (RARC) codes list

M1 X-ray not taken within the past 12 months or near enough to the start of treatment.
Start: 01/01/1997

M2 Not paid separately when the patient is an inpatient.
Start: 01/01/1997

M3 Equipment is the same or similar to equipment already being used.
Start: 01/01/1997

M4 Alert: This is the last monthly installment payment for this durable medical equipment.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

M5 Monthly rental payments can continue until the earlier of the 15th month from the first rental month, or the month when the equipment is no longer needed.
Start: 01/01/1997

M6 Alert: You must furnish and service this item for any period of medical need for the remainder of the reasonable useful lifetime of the equipment.
Start: 01/01/1997 | Last Modified: 03/01/2009
Notes: (Modified 4/1/07, 3/1/2009)

M7 No rental payments after the item is purchased, returned or after the total of issued rental payments equals the purchase price.
Start: 01/01/1997 | Last Modified: 11/01/2016
Notes: (Modified 11/1/2016)

M8 We do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen.
Start: 01/01/1997

M9 Alert: This is the tenth rental month. You must offer the patient the choice of changing the rental to a purchase agreement.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

M10 Equipment purchases are limited to the first or the tenth month of medical necessity.
Start: 01/01/1997

M11 DME, orthotics and prosthetics must be billed to the DME carrier who services the patient’s zip code.
Start: 01/01/1997

M12 Diagnostic tests performed by a physician must indicate whether purchased services are included on the claim.
Start: 01/01/1997

M13 Only one initial visit is covered per specialty per medical group.
Start: 01/01/1997 | Last Modified: 06/30/2007
Notes: (Modified 6/30/03)

M14 No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.
Start: 01/01/1997

M15 Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.
Start: 01/01/1997

M16 Alert: Please see our web site, mailings, or bulletins for more details concerning this policy/procedure/decision.
Start: 01/01/1997 | Last Modified: 04/01/2007Notes: (Reactivated 4/1/04, Modified 11/18/05, 4/1/07)

M17 Alert: Payment approved as you did not know, and could not reasonably have been expected to know, that this would not normally have been covered for this patient. In the future, you will be liable for charges for the same service(s) under the same or similar conditions.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

M18 Certain services may be approved for home use. Neither a hospital nor a Skilled Nursing Facility (SNF) is considered to be a patient’s home.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

M19 Missing oxygen certification/re-certification.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N234

M20 Missing/incomplete/invalid HCPCS.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M21 Missing/incomplete/invalid place of residence for this service/item provided in a home.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M22 Missing/incomplete/invalid number of miles traveled.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M23 Missing invoice.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)

M24 Missing/incomplete/invalid number of doses per vial.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M25 The information furnished does not substantiate the need for this level of service. If you believe the service should have been fully covered as billed, or if you did not know and could not reasonably have been expected to know that we would not pay for this level of service, or if you notified the patient in writing in advance that we would not pay for this level of service and he/she agreed in writing to pay, ask us to review your claim within 120 days of the date of this notice. If you do not request an appeal, we will, upon application from the patient, reimburse him/her for the amount you have collected from him/her in excess of any deductible and coinsurance amounts. We will recover the reimbursement from you as an overpayment.
Start: 01/01/1997 | Last Modified: 11/01/2010Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07, 11/1/10)

M26 The information furnished does not substantiate the need for this level of service. If you have collected any amount from the patient for this level of service/any amount that exceeds the limiting charge for the less extensive service, the law requires you to refund that amount to the patient within 30 days of receiving this notice.

The requirements for refund are in 1824(I) of the Social Security Act and 42CFR411.408. The section specifies that physicians who knowingly and willfully fail to make appropriate refunds may be subject to civil monetary penalties and/or exclusion from the program. If you have any questions about this notice, please contact this office.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 10/1/02, 6/30/03, 8/1/05, 11/5/07. Also refer to N356)

M27 Alert: The patient has been relieved of liability of payment of these items and services under the limitation of liability provision of the law. The provider is ultimately liable for the patient’s waived charges, including any charges for coinsurance, since the items or services were not reasonable and necessary or constituted custodial care, and you knew or could reasonably have been expected to know, that they were not covered. You may appeal this determination. You may ask for an appeal regarding both the coverage determination and the issue of whether you exercised due care. The appeal request must be filed within 120 days of the date you receive this notice. You must make the request through this office.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 10/1/02, 8/1/05, 4/1/07, 8/1/07)

M28 This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.
Start: 01/01/1997

M29 Missing operative note/report.
Start: 01/01/1997 | Last Modified: 07/01/2008
Notes: (Modified 2/28/03, 7/1/2008) Related to N233

M30 Missing pathology report.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 2/28/03) Related to N236

M31 Missing radiology report.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 2/28/03) Related to N240

M32 Alert: This is a conditional payment made pending a decision on this service by the patient’s primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

M36 This is the 11th rental month. We cannot pay for this until you indicate that the patient has been given the option of changing the rental to a purchase.
Start: 01/01/1997

M37 Not covered when the patient is under age 35.
Start: 01/01/1997 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)

M38 Alert: The patient is liable for the charges for this service as they were informed in writing before the service was furnished that we would not pay for it and the patient agreed to be responsible for the charges.
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 7/1/15)

M39 Alert: The patient is not liable for payment of this service as the advance notice of non-coverage you provided the patient did not comply with program requirements.
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 2/1/04, 4/1/07, 11/1/09, 11/1/12, 7/1/15) Related to N563

M40 Claim must be assigned and must be filed by the practitioner’s employer.
Start: 01/01/1997

M41 We do not pay for this as the patient has no legal obligation to pay for this.
Start: 01/01/1997

M42 The medical necessity form must be personally signed by the attending physician.
Start: 01/01/1997

M44 Missing/incomplete/invalid condition code.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M45 Missing/incomplete/invalid occurrence code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N299

M46 Missing/incomplete/invalid occurrence span code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N300

M47 Missing/incomplete/invalid Payer Claim Control Number. Other terms exist for this element including, but not limited to, Internal Control Number (ICN), Claim Control Number (CCN), Document Control Number (DCN).
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 2/28/03, 7/1/15)

M49 Missing/incomplete/invalid value code(s) or amount(s).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M50 Missing/incomplete/invalid revenue code(s).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M51 Missing/incomplete/invalid procedure code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N301

M52 Missing/incomplete/invalid ‘from’ date(s) of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M53 Missing/incomplete/invalid days or units of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M54 Missing/incomplete/invalid total charges.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M55 We do not pay for self-administered anti-emetic drugs that are not administered with a covered oral anti-cancer drug.
Start: 01/01/1997

M56 Missing/incomplete/invalid payer identifier.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M59 Missing/incomplete/invalid ‘to’ date(s) of service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M60 Missing Certificate of Medical Necessity.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 6/30/03) Related to N227

M61 We cannot pay for this as the approval period for the FDA clinical trial has expired.
Start: 01/01/1997

M62 Missing/incomplete/invalid treatment authorization code.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M64 Missing/incomplete/invalid other diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M65 One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.
Start: 01/01/1997

M66 Our records indicate that you billed diagnostic tests subject to price limitations and the procedure code submitted includes a professional component. Only the technical component is subject to price limitations. Please submit the technical and professional components of this service as separate line items.
Start: 01/01/1997

M67 Missing/incomplete/invalid other procedure code(s).
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N302

M69 Paid at the regular rate as you did not submit documentation to justify the modified procedure code.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)

M70 Alert: The NDC code submitted for this service was translated to a HCPCS code for processing, but please continue to submit the NDC on future claims for this item.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/2007, 8/1/07)

M71 Total payment reduced due to overlap of tests billed.
Start: 01/01/1997

M73 The HPSA/Physician Scarcity bonus can only be paid on the professional component of this service. Rebill as separate professional and technical components.
Start: 01/01/1997 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04)

M74 This service does not qualify for a HPSA/Physician Scarcity bonus payment.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)

M75 Multiple automated multichannel tests performed on the same day combined for payment.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)

M76 Missing/incomplete/invalid diagnosis or condition.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M77 Missing/incomplete/invalid/inappropriate place of service.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/28/03, 3/1/2014, 3/14/2014)

M79 Missing/incomplete/invalid charge.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M80 Not covered when performed during the same session/date as a previously processed service for the patient.
Start: 01/01/1997 | Last Modified: 10/31/2002
Notes: (Modified 10/31/02)

M81 You are required to code to the highest level of specificity.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)

M82 Service is not covered when patient is under age 50.
Start: 01/01/1997

M83 Service is not covered unless the patient is classified as at high risk.
Start: 01/01/1997

M84 Medical code sets used must be the codes in effect at the time of service.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/1/04, 3/14/2014)

M85 Subjected to review of physician evaluation and management services.
Start: 01/01/1997

M86 Service denied because payment already made for same/similar procedure within set time frame.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

M87 Claim/service(s) subjected to CFO-CAP prepayment review.
Start: 01/01/1997

M89 Not covered more than once under age 40.
Start: 01/01/1997

M90 Not covered more than once in a 12 month period.
Start: 01/01/1997

M91 Lab procedures with different CLIA certification numbers must be billed on separate claims.
Start: 01/01/1997

M93 Information supplied supports a break in therapy. A new capped rental period began with delivery of this equipment.
Start: 01/01/1997

M94 Information supplied does not support a break in therapy. A new capped rental period will not begin.
Start: 01/01/1997

M95 Services subjected to Home Health Initiative medical review/cost report audit.
Start: 01/01/1997

M96 The technical component of a service furnished to an inpatient may only be billed by that inpatient facility. You must contact the inpatient facility for technical component reimbursement. If not already billed, you should bill us for the professional component only.
Start: 01/01/1997

M97 Not paid to practitioner when provided to patient in this place of service. Payment included in the reimbursement issued the facility.
Start: 01/01/1997

M99 Missing/incomplete/invalid Universal Product Number/Serial Number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M100 We do not pay for an oral anti-emetic drug that is not administered for use immediately before, at, or within 48 hours of administration of a covered chemotherapy drug.
Start: 01/01/1997

M102 Service not performed on equipment approved by the FDA for this purpose.
Start: 01/01/1997

M103 Information supplied supports a break in therapy. However, the medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will begin with the delivery of this equipment.
Start: 01/01/1997

M104 Information supplied supports a break in therapy. A new capped rental period will begin with delivery of the equipment. This is the maximum approved under the fee schedule for this item or service.
Start: 01/01/1997

M105 Information supplied does not support a break in therapy. The medical information we have for this patient does not support the need for this item as billed. We have approved payment for this item at a reduced level, and a new capped rental period will not begin.
Start: 01/01/1997

M107 Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded 36.5%.
Start: 01/01/1997

M109 We have provided you with a bundled payment for a teleconsultation. You must send 25 percent of the teleconsultation payment to the referring practitioner.
Start: 01/01/1997

M111 We do not pay for chiropractic manipulative treatment when the patient refuses to have an x-ray taken.
Start: 01/01/1997

M112 Reimbursement for this item is based on the single payment amount required under the DMEPOS Competitive Bidding Program for the area where the patient resides.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)

M113 Our records indicate that this patient began using this item/service prior to the current contract period for the DMEPOS Competitive Bidding Program.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)

M114 This service was processed in accordance with rules and guidelines under the DMEPOS Competitive Bidding Program or a Demonstration Project. For more information regarding these projects, contact your local contractor.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 8/1/06, 11/5/07)

M115 This item is denied when provided to this patient by a non-contract or non-demonstration supplier.
Start: 01/01/1997 | Last Modified: 11/05/2007
Notes: (Modified 11/5/2007)

M116 Processed under a demonstration project or program. Project or program is ending and additional services may not be paid under this project or program.
Start: 01/01/1997 | Last Modified: 03/08/2011
Notes: (Modified 2/1/04, 3/15/11)

M117 Not covered unless submitted via electronic claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

M119 Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 2/28/03, 4/1/04)

M121 We pay for this service only when performed with a covered cryosurgical ablation.
Start: 01/01/1997

M122 Missing/incomplete/invalid level of subluxation.
Start: 01/01/1997 | Last Modified: 02/28/2006
Notes: (Modified 2/28/03)

M123 Missing/incomplete/invalid name, strength, or dosage of the drug furnished.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M124 Missing indication of whether the patient owns the equipment that requires the part or supply.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N230

M125 Missing/incomplete/invalid information on the period of time for which the service/supply/equipment will be needed.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M126 Missing/incomplete/invalid individual lab codes included in the test.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M127 Missing patient medical record for this service.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N237

M129 Missing/incomplete/invalid indicator of x-ray availability for review.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 2/28/03, 6/30/03)

M130 Missing invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N231

M131 Missing physician financial relationship form.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N239

M132 Missing pacemaker registration form.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N235

M133 Claim did not identify who performed the purchased diagnostic test or the amount you were charged for the test.
Start: 01/01/1997

M134 Performed by a facility/supplier in which the provider has a financial interest.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

M135 Missing/incomplete/invalid plan of treatment.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M136 Missing/incomplete/invalid indication that the service was supervised or evaluated by a physician.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

M137 Part B coinsurance under a demonstration project or pilot program.
Start: 01/01/1997 | Last Modified: 11/01/2012
Notes: (Modified 11/1/12)

M138 Patient identified as a demonstration participant but the patient was not enrolled in the demonstration at the time services were rendered. Coverage is limited to demonstration participants.
Start: 01/01/1997

M139 Denied services exceed the coverage limit for the demonstration.
Start: 01/01/1997

M141 Missing physician certified plan of care.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N238

M142 Missing American Diabetes Association Certificate of Recognition.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N226

M143 The provider must update license information with the payer.
Start: 01/01/1997 | Last Modified: 12/01/2006
Notes: (Modified 12/1/06)

M144 Pre-/post-operative care payment is included in the allowance for the surgery/procedure.
Start: 01/01/1997

MA01 Alert: If you do not agree with what we approved for these services, you may appeal our decision. To make sure that we are fair to you, we require another individual that did not process your initial claim to conduct the appeal. However, in order to be eligible for an appeal, you must write to us within 120 days of the date you received this notice, unless you have a good reason for being late.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07)

MA02 Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07)

MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
Start: 01/01/1997

MA07 Alert: The claim information has also been forwarded to Medicaid for review.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA08 Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA09 Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.
Start: 01/01/1997 | Last Modified: 11/01/2015
Notes: (Modified 11/1/2014, 11/1/2015)

MA10 Alert: The patient’s payment was in excess of the amount owed. You must refund the overpayment to the patient.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA12 You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).
Start: 01/01/1997

MA13 Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA14 Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/07, 8/1/07)

MA15 Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA16 The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.
Start: 01/01/1997

MA17 We are the primary payer and have paid at the primary rate. You must contact the patient’s other insurer to refund any excess it may have paid due to its erroneous primary payment.
Start: 01/01/1997

MA18 Alert: The claim information is also being forwarded to the patient’s supplemental insurer. Send any questions regarding supplemental benefits to them.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA19 Alert: Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondary claim directly to that insurer.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA20 Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

MA21 SSA records indicate mismatch with name and sex.
Start: 01/01/1997

MA22 Payment of less than $1.00 suppressed.
Start: 01/01/1997

MA23 Demand bill approved as result of medical review.
Start: 01/01/1997

MA24 Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

MA25 A patient may not elect to change a hospice provider more than once in a benefit period.
Start: 01/01/1997

MA26 Alert: Our records indicate that you were previously informed of this rule.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA27 Missing/incomplete/invalid entitlement number or name shown on the claim.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA28 Alert: Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA30 Missing/incomplete/invalid type of bill.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA32 Missing/incomplete/invalid number of covered days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA33 Missing/incomplete/invalid non-covered days during the billing period.
Start: 01/01/1997 | Last Modified: 03/01/2022
Notes: (Modified 2/28/03, 3/1/2022)

MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA35 Missing/incomplete/invalid number of lifetime reserve days.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA36 Missing/incomplete/invalid patient name.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA37 Missing/incomplete/invalid patient’s address.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA39 Missing/incomplete/invalid gender.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA40 Missing/incomplete/invalid admission date.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA41 Missing/incomplete/invalid admission type.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA42 Missing/incomplete/invalid admission source.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA43 Missing/incomplete/invalid patient status.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA44 Alert: No appeal rights. Adjudicative decision based on law.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA45 Alert: As previously advised, a portion or all of your payment is being held in a special account.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA46 Alert: The new information was considered but additional payment will not be issued.
Start: 01/01/1997 | Last Modified: 11/01/2015
Notes: (Modified 3/1/2009, 11/1/2015)

MA47 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.
Start: 01/01/1997

MA48 Missing/incomplete/invalid name or address of responsible party or primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA50 Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.
Start: 01/01/1997 | Last Modified: 03/01/2014
Notes: (Modified 2/28/03, 3/1/2014)

MA53 Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)

MA54 Physician certification or election consent for hospice care not received timely.
Start: 01/01/1997

MA55 Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
Start: 01/01/1997

MA56 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.
Start: 01/01/1997

MA57 Patient submitted written request to revoke his/her election for religious non-medical health care services.
Start: 01/01/1997
MA58 Missing/incomplete/invalid release of information indicator.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA59 Alert: The patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA60 Missing/incomplete/invalid patient relationship to insured.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA61 Missing/incomplete/invalid social security number.
Start: 01/01/1997 | Last Modified: 03/01/2018
Notes: (Modified 2/28/03, 3/1/2018)

MA62 Alert: This is a telephone review decision.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/07, 8/1/07)

MA63 Missing/incomplete/invalid principal diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA64 Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
Start: 01/01/1997

MA65 Missing/incomplete/invalid admitting diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA66 Missing/incomplete/invalid principal procedure code.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N303

MA67 Alert: Correction to a prior claim.
Start: 01/01/1997 | Last Modified: 11/01/2015
Notes: (Modified 11/1/2015)

MA68 Alert: We did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to assure correct and timely routing of the claim.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA69 Missing/incomplete/invalid remarks.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA70 Missing/incomplete/invalid provider representative signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA71 Missing/incomplete/invalid provider representative signature date.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA72 Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA73 Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.
Start: 01/01/1997

MA74 Alert: This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 7/1/15)

MA75 Missing/incomplete/invalid patient or authorized representative signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA76 Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03, 2/1/04)

MA77 Alert: The patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient’s payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

MA79 Billed in excess of interim rate.
Start: 01/01/1997

MA80 Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project.
Start: 01/01/1997

MA81 Missing/incomplete/invalid provider/supplier signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA83 Did not indicate whether we are the primary or secondary payer.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)

MA84 Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.
Start: 01/01/1997
MA88 Missing/incomplete/invalid insured’s address and/or telephone number for the primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA89 Missing/incomplete/invalid patient’s relationship to the insured for the primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA90 Missing/incomplete/invalid employment status code for the primary insured.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03).

MA91 Alert: This determination is the result of the appeal you filed.
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 7/1/15)

MA92 Missing plan information for other insurance.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04) Related to N245

MA93 Non-PIP (Periodic Interim Payment) claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

MA94 Did not enter the statement ‘Attending physician not hospice employee’ on the claim form to certify that the rendering physician is not an employee of the hospice.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Reactivated 4/1/04, Modified 8/1/05)

MA96 Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
Start: 01/01/1997
MA97 Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
Start: 01/01/1997 | Last Modified: 02/29/2008
Notes: (Modified 2/29/08)

MA99 Missing/incomplete/invalid Medigap information.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA100 Missing/incomplete/invalid date of current illness or symptoms.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/28/03, 3/30/05, 3/14/2014)

MA103 Hemophilia Add On.
Start: 01/01/1997

MA106 PIP (Periodic Interim Payment) claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

MA107 Paper claim contains more than three separate data items in field 19.
Start: 01/01/1997

MA108 Paper claim contains more than one data item in field 23.
Start: 01/01/1997
MA109 Claim processed in accordance with ambulatory surgical guidelines.
Start: 01/01/1997

MA110 Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA111 Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory’s name and address.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA112 Missing/incomplete/invalid group practice information.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA113 Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.
Start: 01/01/1997
MA114 Missing/incomplete/invalid information on where the services were furnished.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA115 Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA116 Did not complete the statement ‘Homebound’ on the claim to validate whether laboratory services were performed at home or in an institution.
Start: 01/01/1997
Notes: (Reactivated 4/1/04)

MA117 This claim has been assessed a $1.00 user fee.
Start: 01/01/1997

MA118 Alert: No Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance and/or deductible are applicable.
Start: 01/01/1997 | Last Modified: 11/01/2014

MA120 Missing/incomplete/invalid CLIA certification number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

MA121 Missing/incomplete/invalid x-ray date.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)

MA122 Missing/incomplete/invalid initial treatment date.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)

MA123 Your center was not selected to participate in this study, therefore, we cannot pay for these services.
Start: 01/01/1997
MA125 Per legislation governing this program, payment constitutes payment in full.
Start: 01/01/1997
MA126 Pancreas transplant not covered unless kidney transplant performed.
Start: 10/12/2001
MA128 Missing/incomplete/invalid FDA approval number.
Start: 10/12/2001 | Last Modified: 03/30/2005
Notes: (Modified 2/28/03, 3/30/05)
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
Start: 10/12/2001
MA131 Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim.
Start: 10/12/2001
MA132 Adjustment to the pre-demonstration rate.
Start: 10/12/2001
MA133 Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
Start: 10/12/2001
MA134 Missing/incomplete/invalid provider number of the facility where the patient resides.
Start: 10/12/2001

N1 Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract, plan benefit documents or jurisdiction statutes. Refer to the URL provided in the ERA for the payer website to access the appeals process guidelines.
Start: 01/01/2000 | Last Modified: 07/01/2018
Notes: (Modified 2/28/03, 4/1/07, 7/15/13, 7/1/18)

N2 This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
Start: 01/01/2000

N3 Missing consent form.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N228

N4 Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.
Start: 01/01/2000 | Last Modified: 03/06/2012
Notes: (Modified 2/28/03, 3/6/2012)

N5 EOB received from previous payer. Claim not on file.
Start: 01/01/2000

N6 Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N7 Alert: Processing of this claim/service has included consideration under Major Medical provisions.
Start: 01/01/2000 | Last Modified: 07/15/2013
Notes: (Modified 7/15/13)
N8 Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
Start: 01/01/2000

N9 Adjustment represents the estimated amount a previous payer may pay.
Start: 01/01/2000 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)

N10 Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.
Start: 01/01/2000 | Last Modified: 03/01/2015
Notes: (Modified 10/31/02, 7/1/08, 7/15/13, 3/1/2015)

N11 Denial reversed because of medical review.
Start: 01/01/2000

N12 Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.
Start: 01/01/2000 | Last Modified: 08/01/2007
Notes: (Modified 8/1/07)

N13 Payment based on professional/technical component modifier(s).
Start: 01/01/2000

N15 Services for a newborn must be billed separately.
Start: 01/01/2000

N16 Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
Start: 01/01/2000

N19 Procedure code incidental to primary procedure.
Start: 01/01/2000

N20 Service not payable with other service rendered on the same date.
Start: 01/01/2000

N21 Alert: Your line item has been separated into multiple lines to expedite handling.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 8/1/05, 4/1/07)

N22 Alert: This procedure code was added/changed because it more accurately describes the services rendered.
Start: 01/01/2000 | Last Modified: 07/01/2015
Notes: (Modified 10/31/02, 2/28/03, 7/1/15)

N23 Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 8/13/01, 4/1/07)

N24 Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N25 This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan.
Start: 01/01/2000

N26 Missing itemized bill/statement.
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 2/28/03, 7/1/2008) Related to N232

N27 Missing/incomplete/invalid treatment number.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N28 Consent form requirements not fulfilled.
Start: 01/01/2000

N30 Patient ineligible for this service.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N31 Missing/incomplete/invalid prescribing provider identifier.
Start: 01/01/2000 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)

N32 Claim must be submitted by the provider who rendered the service.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

N33 No record of health check prior to initiation of treatment.
Start: 01/01/2000

N34 Incorrect claim form/format for this service.
Start: 01/01/2000 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)

N35 Program integrity/utilization review decision.
Start: 01/01/2000

N36 Claim must meet primary payer’s processing requirements before we can consider payment.
Start: 01/01/2000
N37 Missing/incomplete/invalid tooth number/letter.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N39 Procedure code is not compatible with tooth number/letter.
Start: 01/01/2000
N40 Missing radiology film(s)/image(s).
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 2/1/04, 7/1/08) Related to N242
N42 Missing mental health assessment.
Start: 01/01/2000 | Last Modified: 11/01/2014
N43 Bed hold or leave days exceeded.
Start: 01/01/2000

N45 Payment based on authorized amount.
Start: 01/01/2000

N46 Missing/incomplete/invalid admission hour.
Start: 01/01/2000

N47 Claim conflicts with another inpatient stay.
Start: 01/01/2000

N48 Claim information does not agree with information received from other insurance carrier.
Start: 01/01/2000

N49 Court ordered coverage information needs validation.
Start: 01/01/2000

N50 Missing/incomplete/invalid discharge information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N51 Electronic interchange agreement not on file for provider/submitter.
Start: 01/01/2000

N52 Patient not enrolled in the billing provider’s managed care plan on the date of service.
Start: 01/01/2000

N53 Missing/incomplete/invalid point of pick-up address.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N54 Claim information is inconsistent with pre-certified/authorized services.
Start: 01/01/2000

N55 Procedures for billing with group/referring/performing providers were not followed.
Start: 01/01/2000

N56 Procedure code billed is not correct/valid for the services billed or the date of service billed.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N57 Missing/incomplete/invalid prescribing date.
Start: 01/01/2000 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N304

N58 Missing/incomplete/invalid patient liability amount.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N59 Alert: Please refer to your provider manual for additional program and provider information.
Start: 01/01/2000 | Last Modified: 11/01/2015
Notes: (Modified 4/1/07, 11/1/09, 11/1/2015)

N61 Rebill services on separate claims.
Start: 01/01/2000

N62 Dates of service span multiple rate periods. Resubmit separate claims.
Start: 01/01/2000 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)

N63 Rebill services on separate claim lines.
Start: 01/01/2000

N64 The ‘from’ and ‘to’ dates must be different.
Start: 01/01/2000

N65 Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N67 Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient’s admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.
Start: 01/01/2000

N68 Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.
Start: 01/01/2000

N69 Alert: PPS (Prospective Payment System) code changed by claims processing system.
Start: 01/01/2000 | Last Modified: 11/01/2015
Notes: (Modified 6/30/03, 7/1/12, 11/1/2015)

N70 Consolidated billing and payment applies.
Start: 01/01/2000 | Last Modified: 11/05/2007
Notes: (Modified 2/28/02, 11/5/07)
N71 Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 2/21/02, 6/30/03)
N72 PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N74 Resubmit with multiple claims, each claim covering services provided in only one calendar month.
Start: 01/01/2000

N75 Missing/incomplete/invalid tooth surface information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N76 Missing/incomplete/invalid number of riders.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N77 Missing/incomplete/invalid designated provider number.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N78 The necessary components of the child and teen checkup (EPSDT) were not completed.
Start: 01/01/2000

N79 Service billed is not compatible with patient location information.
Start: 01/01/2000

N80 Missing/incomplete/invalid prenatal screening information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N81 Procedure billed is not compatible with tooth surface code.
Start: 01/01/2000

N82 Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
Start: 01/01/2000

N83 No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
Start: 01/01/2000

N84 Alert: Further installment payments are forthcoming.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07, 8/1/07)
N85 Alert: This is the final installment payment.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07, 8/1/07)
N86 A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
Start: 01/01/2000

N87 Home use of biofeedback therapy is not covered.
Start: 01/01/2000

N88 Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA’s payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N89 Alert: Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remittance advice.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N90 Covered only when performed by the attending physician.
Start: 01/01/2000

N91 Services not included in the appeal review.
Start: 01/01/2000

N92 This facility is not certified for digital mammography.
Start: 01/01/2000

N93 A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
Start: 01/01/2000

N94 Claim/Service denied because a more specific taxonomy code is required for adjudication.
Start: 01/01/2000
N95 This provider type/provider specialty may not bill this service.
Start: 07/31/2001 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N96 Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.
Start: 08/24/2001

N97 Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.
Start: 08/24/2001

N98 Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.
Start: 08/24/2001

N99 Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.
Start: 08/24/2001

N103 Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.
Start: 10/31/2001 | Last Modified: 11/01/2013
Notes: (Modified 6/30/03, 7/1/12, 11/1/13)

N104 This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.gov.
Start: 01/29/2002 | Last Modified: 07/01/2010
Notes: (Modified 10/31/02, 7/1/10)
N105 This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 888-355-9165 for RRB EDI information for electronic claims processing.
Start: 01/29/2002 | Last Modified: 07/01/2017
Notes: (Modified 7/1/2017)
N106 Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.
Start: 01/31/2002

N107 Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.
Start: 01/31/2002

N108 Missing/incomplete/invalid upgrade information.
Start: 01/31/2002 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)

N109 Alert: This claim/service was chosen for complex review.
Start: 02/28/2002 | Last Modified: 07/01/2015
Notes: (Modified 3/1/2009, 7/1/15)

N110 This facility is not certified for film mammography.
Start: 02/28/2002
N111 No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
Start: 02/28/2002

N112 This claim is excluded from your electronic remittance advice.
Start: 02/28/2002

N113 Only one initial visit is covered per physician, group practice or provider.
Start: 04/16/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

N114 During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be.
Start: 05/30/2002

N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
Start: 05/30/2002 | Last Modified: 07/01/2010
Notes: (Modified 4/1/04, 7/1/10)
N116 Alert: This payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency’s (HHA’s) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care.
Start: 06/30/2002 | Last Modified: 11/01/2016
Notes: (Modified 11/1/2016)
N117 This service is paid only once in a patient’s lifetime.
Start: 07/30/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

N118 This service is not paid if billed more than once every 28 days.
Start: 07/30/2002

N119 This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility (SNF) within those 28 days.
Start: 07/30/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

N120 Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.
Start: 08/09/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)

N121 Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered Skilled Nursing Facility (SNF) stay.
Start: 09/09/2002 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 6/30/03)
N122 Add-on code cannot be billed by itself.
Start: 09/12/2002 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
N123 Alert: This is a split service and represents a portion of the units from the originally submitted service.
Start: 09/24/2002 | Last Modified: 03/01/2016
Notes: (Modified 3/1/2016)
N124 Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay.
Start: 09/26/2002

N125 Payment has been (denied for the/made only for a less extensive) service/item because the information furnished does not substantiate the need for the (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice.

The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office.
Start: 09/26/2002 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05. Also refer to N356)

N126 Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported.
Start: 10/17/2002

N127 This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.
Start: 10/31/2007 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04

N128 This amount represents the prior to coverage portion of the allowance.
Start: 10/31/2002
N129 Not eligible due to the patient’s age.
Start: 10/31/2002 | Last Modified: 08/01/2007
Notes: (Modified 8/1/07)

N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
Start: 10/31/2002 | Last Modified: 11/01/2009
Notes: (Modified 4/1/07, 7/1/08, 11/1/09)
N131 Total payments under multiple contracts cannot exceed the allowance for this service.
Start: 10/31/2002

N132 Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N133 Alert: Services for predetermination and services requesting payment are being processed separately.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N134 Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N135 Record fees are the patient’s responsibility and limited to the specified co-payment.
Start: 10/31/2002
N136 Alert: To obtain information on the process to file an appeal in Arizona, call the Department’s Consumer Assistance Office at (602) 912-8444 or (800) 325-2548.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N137 Alert: The provider acting on the Member’s behalf, may file an appeal with the Payer. The provider, acting on the Member’s behalf, may file a complaint with the State Insurance Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 8/1/04, 2/28/03, 4/1/07)
N138 Alert: In the event you disagree with the Dental Advisor’s opinion and have additional information relative to the case, you may submit radiographs to the Dental Advisor Unit at the subscriber’s dental insurance carrier for a second Independent Dental Advisor Review.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N139 Alert: Under 32 CFR 199.13, a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor’s opinion, you may appeal the determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber’s Dental insurance carrier within 90 days from the date of this letter.
Start: 10/31/2002 | Last Modified: 03/01/2017
Notes: (Modified 4/1/07, 3/1/2017)

N140 Alert: You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act as his/her representative and you disagree with the Dental Advisor’s opinion, you may appeal by submitting a copy of this letter, a signed statement explaining the matter in which you disagree, and any relevant information to the subscriber’s Dental insurance carrier within 90 days from the date of this letter.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N141 The patient was not residing in a long-term care facility during all or part of the service dates billed.
Start: 10/31/2002

N142 The original claim was denied. Resubmit a new claim, not a replacement claim.
Start: 10/31/2002

N143 The patient was not in a hospice program during all or part of the service dates billed.
Start: 10/31/2002

N144 The rate changed during the dates of service billed.
Start: 10/31/2002

N146 Missing screening document.
Start: 10/31/2002 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04) Related to N243

N147 Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request.
Start: 10/31/2002

N148 Missing/incomplete/invalid date of last menstrual period.
Start: 10/31/2002

N149 Rebill all applicable services on a single claim.
Start: 10/31/2002

N150 Missing/incomplete/invalid model number.
Start: 10/31/2002

N151 Telephone contact services will not be paid until the face-to-face contact requirement has been met.
Start: 10/31/2002
N152 Missing/incomplete/invalid replacement claim information.
Start: 10/31/2002

N153 Missing/incomplete/invalid room and board rate.
Start: 10/31/2002

N154 Alert: This payment was delayed for correction of provider’s mailing address.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N156 Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N157 Transportation to/from this destination is not covered.
Start: 02/28/2003 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)

N158 Transportation in a vehicle other than an ambulance is not covered.
Start: 02/28/2003

N159 Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
Start: 02/28/2003

N160 The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
Start: 02/28/2003 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)

N161 This drug/service/supply is covered only when the associated service is covered.
Start: 02/28/2003

N162 Alert: Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information will result in a denial of payment in the near future.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N163 Medical record does not support code billed per the code definition.
Start: 02/28/2003
N167 Charges exceed the post-transplant coverage limit.
Start: 02/28/2003
N170 A new/revised/renewed certificate of medical necessity is needed.
Start: 02/28/2003
N171 Payment for repair or replacement is not covered or has exceeded the purchase price.
Start: 02/28/2003
N172 The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
Start: 02/28/2003

N173 No qualifying hospital stay dates were provided for this episode of care.
Start: 02/28/2003

N174 This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group ‘PR’.
Start: 02/28/2003

N175 Missing review organization approval.
Start: 02/28/2003 | Last Modified: 02/29/2008
Notes: (Modified 8/1/04, 2/29/08) Related to N241

N176 Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the United States must provide the service.
Start: 02/28/2003

N177 Alert: We did not send this claim to patient’s other insurer. They have indicated no additional payment can be made.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 6/30/03, 4/1/07)
N178 Missing pre-operative images/visual field results.
Start: 02/28/2003 | Last Modified: 11/01/2013
Notes: (Modified 8/1/04, 11/1/13) Related to N244
N179 Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.
Start: 02/28/2003
N180 This item or service does not meet the criteria for the category under which it was billed.
Start: 02/28/2003
N181 Additional information is required from another provider involved in this service.
Start: 02/28/2003 | Last Modified: 12/01/2006
Notes: (Modified 12/1/06)

N182 This claim/service must be billed according to the schedule for this plan.
Start: 02/28/2003

N183 Alert: This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N184 Rebill technical and professional components separately.
Start: 02/28/2003

N185 Alert: Do not resubmit this claim/service.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N186 Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.
Start: 02/28/2003

N187 Alert: You may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N188 The approved level of care does not match the procedure code submitted.
Start: 02/28/2003

N189 Alert: This service has been paid as a one-time exception to the plan’s benefit restrictions.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N190 Missing contract indicator.
Start: 02/28/2003 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04) Related to N229
N191 The provider must update insurance information directly with payer.
Start: 02/28/2003
N192 Alert: Patient is a Medicaid/Qualified Medicare Beneficiary.
Start: 02/28/2003 | Last Modified: 07/01/2020
N193 Alert: Specific federal/state/local program may cover this service through another payer.
Start: 02/28/2003 | Last Modified: 11/01/2015
Notes: (Modified 11/1/2015)
N194 Technical component not paid if provider does not own the equipment used.
Start: 02/25/2003
N195 The technical component must be billed separately.
Start: 02/25/2003
N196 Alert: Patient eligible to apply for other coverage which may be primary.
Start: 02/25/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N197 The subscriber must update insurance information directly with payer.
Start: 02/25/2003
N198 Rendering provider must be affiliated with the pay-to provider.
Start: 02/25/2003

N199 Additional payment/recoupment approved based on payer-initiated review/audit.
Start: 02/25/2003 | Last Modified: 08/01/2006
Notes: (Modified 8/1/06)

N200 The professional component must be billed separately.
Start: 02/25/2003

N202 Alert: Additional information/explanation will be sent separately.
Start: 06/30/2003 | Last Modified: 11/01/2015
Notes: (Modified 4/1/07, 11/1/09, 3/14/2014, 11/1/2015)

N203 Missing/incomplete/invalid anesthesia time/units.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N204 Services under review for possible pre-existing condition. Send medical records for prior 12 months
Start: 06/30/2003
N205 Information provided was illegible.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N206 The supporting documentation does not match the information sent on the claim.
Start: 06/30/2003 | Last Modified: 03/06/2012
Notes: (Modified 3/6/12)

N207 Missing/incomplete/invalid weight.
Start: 06/30/2003 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)

N208 Missing/incomplete/invalid DRG code.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N209 Missing/incomplete/invalid taxpayer identification number (TIN).
Start: 06/30/2003 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)

N210 Alert: You may appeal this decision.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 4/1/07, 3/14/2014)
N211 Alert: You may not appeal this decision.
Start: 06/30/2003 | Last Modified: 03/14/2014
Notes: (Modified 4/1/07, 3/14/2014)
N212 Charges processed under a Point of Service benefit.
Start: 02/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N213 Missing/incomplete/invalid facility/discrete unit DRG/DRG exempt status information.
Start: 04/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N214 Missing/incomplete/invalid history of the related initial surgical procedure(s).
Start: 04/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N215 Alert: A payer providing supplemental or secondary coverage shall not require a claims determination for this service from a primary payer as a condition of making its own claims determination.
Start: 04/01/2004 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N216 We do not offer coverage for this type of service or the patient is not enrolled in this portion of our benefit package.
Start: 04/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/1/2010, 3/14/2014)

N217 We pay only one site of service per provider per claim.
Start: 08/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N218 You must furnish and service this item for as long as the patient continues to need it. We can pay for maintenance and/or servicing for the time period specified in the contract or coverage manual.
Start: 08/01/2004

N219 Payment based on previous payer’s allowed amount.
Start: 08/01/2004

N220 Alert: See the payer’s web site or contact the payer’s Customer Service department to obtain forms and instructions for filing a provider dispute.
Start: 08/01/2004 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N221 Missing Admitting History and Physical report.
Start: 08/01/2004
N222 Incomplete/invalid Admitting History and Physical report.
Start: 08/01/2004
N223 Missing documentation of benefit to the patient during initial treatment period.
Start: 08/01/2004
N224 Incomplete/invalid documentation of benefit to the patient during initial treatment period.
Start: 08/01/2004
N226 Incomplete/invalid American Diabetes Association Certificate of Recognition.
Start: 08/01/2004
N227 Incomplete/invalid Certificate of Medical Necessity.
Start: 08/01/2004
N228 Incomplete/invalid consent form.
Start: 08/01/2004

N229 Incomplete/invalid contract indicator.
Start: 08/01/2004

N230 Incomplete/invalid indication of whether the patient owns the equipment that requires the part or supply.
Start: 08/01/2004

N231 Incomplete/invalid invoice or statement certifying the actual cost of the lens, less discounts, and/or the type of intraocular lens used.
Start: 08/01/2004

N232 Incomplete/invalid itemized bill/statement.
Start: 08/01/2004 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N233 Incomplete/invalid operative note/report.
Start: 08/01/2004 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)

N234 Incomplete/invalid oxygen certification/re-certification.
Start: 08/01/2004

N235 Incomplete/invalid pacemaker registration form.
Start: 08/01/2004

N236 Incomplete/invalid pathology report.
Start: 08/01/2004

N237 Incomplete/invalid patient medical record for this service.
Start: 08/01/2004

N238 Incomplete/invalid physician certified plan of care.
Start: 08/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N239 Incomplete/invalid physician financial relationship form.
Start: 08/01/2004
N240 Incomplete/invalid radiology report.
Start: 08/01/2004
N241 Incomplete/invalid review organization approval.
Start: 08/01/2004 | Last Modified: 02/29/2008
Notes: (Modified 2/29/08)
N242 Incomplete/invalid radiology film(s)/image(s).
Start: 08/01/2004 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N243 Incomplete/invalid/not approved screening document.
Start: 08/01/2004
N244 Incomplete/Invalid pre-operative images/visual field results.
Start: 08/01/2004 | Last Modified: 11/01/2013
Notes: (Modified 11/1/2013)
N245 Incomplete/invalid plan information for other insurance.
Start: 08/01/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N246 State regulated patient payment limitations apply to this service.
Start: 12/02/2004

N247 Missing/incomplete/invalid assistant surgeon taxonomy.
Start: 12/02/2004

N248 Missing/incomplete/invalid assistant surgeon name.
Start: 12/02/2004
N249 Missing/incomplete/invalid assistant surgeon primary identifier.
Start: 12/02/2004

N250 Missing/incomplete/invalid assistant surgeon secondary identifier.
Start: 12/02/2004

N251 Missing/incomplete/invalid attending provider taxonomy.
Start: 12/02/2004
N252 Missing/incomplete/invalid attending provider name.
Start: 12/02/2004

N253 Missing/incomplete/invalid attending provider primary identifier.
Start: 12/02/2004

N254 Missing/incomplete/invalid attending provider secondary identifier.
Start: 12/02/2004
N255 Missing/incomplete/invalid billing provider taxonomy.
Start: 12/02/2004
N256 Missing/incomplete/invalid billing provider/supplier name.
Start: 12/02/2004
N257 Missing/incomplete/invalid billing provider/supplier primary identifier.
Start: 12/02/2004
N258 Missing/incomplete/invalid billing provider/supplier address.
Start: 12/02/2004
N259 Missing/incomplete/invalid billing provider/supplier secondary identifier.
Start: 12/02/2004
N260 Missing/incomplete/invalid billing provider/supplier contact information.
Start: 12/02/2004
N261 Missing/incomplete/invalid operating provider name.
Start: 12/02/2004
N262 Missing/incomplete/invalid operating provider primary identifier.
Start: 12/02/2004
N263 Missing/incomplete/invalid operating provider secondary identifier.
Start: 12/02/2004

N264 Missing/incomplete/invalid ordering provider name.
Start: 12/02/2004

N265 Missing/incomplete/invalid ordering provider primary identifier.
Start: 12/02/2004

N266 Missing/incomplete/invalid ordering provider address.
Start: 12/02/2004

N267 Missing/incomplete/invalid ordering provider secondary identifier.
Start: 12/02/2004

N268 Missing/incomplete/invalid ordering provider contact information.
Start: 12/02/2004

N269 Missing/incomplete/invalid other provider name.
Start: 12/02/2004

N270 Missing/incomplete/invalid other provider primary identifier.
Start: 12/02/2004

N271 Missing/incomplete/invalid other provider secondary identifier.
Start: 12/02/2004

N272 Missing/incomplete/invalid other payer attending provider identifier.
Start: 12/02/2004

N273 Missing/incomplete/invalid other payer operating provider identifier.
Start: 12/02/2004

N274 Missing/incomplete/invalid other payer other provider identifier.
Start: 12/02/2004
N275 Missing/incomplete/invalid other payer purchased service provider identifier.
Start: 12/02/2004
N276 Missing/incomplete/invalid other payer referring provider identifier.
Start: 12/02/2004
N277 Missing/incomplete/invalid other payer rendering provider identifier.
Start: 12/02/2004
N278 Missing/incomplete/invalid other payer service facility provider identifier.
Start: 12/02/2004

N279 Missing/incomplete/invalid pay-to provider name.
Start: 12/02/2004

N280 Missing/incomplete/invalid pay-to provider primary identifier.
Start: 12/02/2004

N281 Missing/incomplete/invalid pay-to provider address.
Start: 12/02/2004
N282 Missing/incomplete/invalid pay-to provider secondary identifier.
Start: 12/02/2004

N283 Missing/incomplete/invalid purchased service provider identifier.
Start: 12/02/2004

N284 Missing/incomplete/invalid referring provider taxonomy.
Start: 12/02/2004
N285 Missing/incomplete/invalid referring provider name.
Start: 12/02/2004
N286 Missing/incomplete/invalid referring provider primary identifier.
Start: 12/02/2004

N287 Missing/incomplete/invalid referring provider secondary identifier.
Start: 12/02/2004

N288 Missing/incomplete/invalid rendering provider taxonomy.
Start: 12/02/2004

N289 Missing/incomplete/invalid rendering provider name.
Start: 12/02/2004

N290 Missing/incomplete/invalid rendering provider primary identifier.
Start: 12/02/2004

N291 Missing/incomplete/invalid rendering provider secondary identifier.
Start: 12/02/2004 | Last Modified: 11/01/2010

N292 Missing/incomplete/invalid service facility name.
Start: 12/02/2004
N293 Missing/incomplete/invalid service facility primary identifier.
Start: 12/02/2004
N294 Missing/incomplete/invalid service facility primary address.
Start: 12/02/2004
N295 Missing/incomplete/invalid service facility secondary identifier.
Start: 12/02/2004
N296 Missing/incomplete/invalid supervising provider name.
Start: 12/02/2004

N297 Missing/incomplete/invalid supervising provider primary identifier.
Start: 12/02/2004

N298 Missing/incomplete/invalid supervising provider secondary identifier.
Start: 12/02/2004

N299 Missing/incomplete/invalid occurrence date(s).
Start: 12/02/2004
N300 Missing/incomplete/invalid occurrence span date(s).
Start: 12/02/2004
N301 Missing/incomplete/invalid procedure date(s).
Start: 12/02/2004

N302 Missing/incomplete/invalid other procedure date(s).
Start: 12/02/2004

N303 Missing/incomplete/invalid principal procedure date.
Start: 12/02/2004

N304 Missing/incomplete/invalid dispensed date.
Start: 12/02/2004

N305 Missing/incomplete/invalid injury/accident date.
Start: 12/02/2004 | Last Modified: 11/01/2016
Notes: (Modified 11/1/2016)

N306 Missing/incomplete/invalid acute manifestation date.
Start: 12/02/2004

N307 Missing/incomplete/invalid adjudication or payment date.
Start: 12/02/2004

N308 Missing/incomplete/invalid appliance placement date.
Start: 12/02/2004

N309 Missing/incomplete/invalid assessment date.
Start: 12/02/2004

N310 Missing/incomplete/invalid assumed or relinquished care date.
Start: 12/02/2004

N311 Missing/incomplete/invalid authorized to return to work date.
Start: 12/02/2004

N312 Missing/incomplete/invalid begin therapy date.
Start: 12/02/2004

N313 Missing/incomplete/invalid certification revision date.
Start: 12/02/2004

N314 Missing/incomplete/invalid diagnosis date.
Start: 12/02/2004
N315 Missing/incomplete/invalid disability from date.
Start: 12/02/2004

N316 Missing/incomplete/invalid disability to date.
Start: 12/02/2004

N317 Missing/incomplete/invalid discharge hour.
Start: 12/02/2004
N318 Missing/incomplete/invalid discharge or end of care date.
Start: 12/02/2004
N319 Missing/incomplete/invalid hearing or vision prescription date.
Start: 12/02/2004
N320 Missing/incomplete/invalid Home Health Certification Period.
Start: 12/02/2004
N321 Missing/incomplete/invalid last admission period.
Start: 12/02/2004

N322 Missing/incomplete/invalid last certification date.
Start: 12/02/2004
N323 Missing/incomplete/invalid last contact date.
Start: 12/02/2004

N324 Missing/incomplete/invalid last seen/visit date.
Start: 12/02/2004
N325 Missing/incomplete/invalid last worked date.
Start: 12/02/2004

N326 Missing/incomplete/invalid last x-ray date.
Start: 12/02/2004
N327 Missing/incomplete/invalid other insured birth date.
Start: 12/02/2004

N328 Missing/incomplete/invalid Oxygen Saturation Test date.
Start: 12/02/2004

N329 Missing/incomplete/invalid patient birth date.
Start: 12/02/2004

N330 Missing/incomplete/invalid patient death date.
Start: 12/02/2004
N331 Missing/incomplete/invalid physician order date.
Start: 12/02/2004

N332 Missing/incomplete/invalid prior hospital discharge date.
Start: 12/02/2004
N333 Missing/incomplete/invalid prior placement date.
Start: 12/02/2004

N334 Missing/incomplete/invalid re-evaluation date.
Start: 12/02/2004 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N335 Missing/incomplete/invalid referral date.
Start: 12/02/2004
N336 Missing/incomplete/invalid replacement date.
Start: 12/02/2004
N337 Missing/incomplete/invalid secondary diagnosis date.
Start: 12/02/2004
N338 Missing/incomplete/invalid shipped date.
Start: 12/02/2004
N339 Missing/incomplete/invalid similar illness or symptom date.
Start: 12/02/2004

N340 Missing/incomplete/invalid subscriber birth date.
Start: 12/02/2004

N341 Missing/incomplete/invalid surgery date.
Start: 12/02/2004

N342 Missing/incomplete/invalid test performed date.
Start: 12/02/2004
N343 Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial start date.
Start: 12/02/2004

N344 Missing/incomplete/invalid Transcutaneous Electrical Nerve Stimulator (TENS) trial end date.
Start: 12/02/2004
N345 Date range not valid with units submitted.
Start: 03/30/2005
N346 Missing/incomplete/invalid oral cavity designation code.
Start: 03/30/2005

N347 Your claim for a referred or purchased service cannot be paid because payment has already been made for this same service to another provider by a payment contractor representing the payer.
Start: 03/30/2005
N348 You chose that this service/supply/drug would be rendered/supplied and billed by a different practitioner/supplier.
Start: 08/01/2005

N349 The administration method and drug must be reported to adjudicate this service.
Start: 08/01/2005

N350 Missing/incomplete/invalid description of service for a Not Otherwise Classified (NOC) code or for an Unlisted/By Report procedure.
Start: 08/01/2005 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)
N351 Service date outside of the approved treatment plan service dates.
Start: 08/01/2005

N352 Alert: There are no scheduled payments for this service. Submit a claim for each patient visit.
Start: 08/01/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N353 Alert: Benefits have been estimated, when the actual services have been rendered, additional payment will be considered based on the submitted claim.
Start: 08/01/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N354 Incomplete/invalid invoice.
Start: 08/01/2005 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N355 Alert: The law permits exceptions to the refund requirement in two cases: – If you did not know, and could not have reasonably been expected to know, that we would not pay for this service; or – If you notified the patient in writing before providing the service that you believed that we were likely to deny the service, and the patient signed a statement agreeing to pay for the service.

If you come within either exception, or if you believe the carrier was wrong in its determination that we do not pay for this service, you should request appeal of this determination within 30 days of the date of this notice. Your request for review should include any additional information necessary to support your position.

If you request an appeal within 30 days of receiving this notice, you may delay refunding the amount to the patient until you receive the results of the review. If the review decision is favorable to you, you do not need to make any refund. If, however, the review is unfavorable, the law specifies that you must make the refund within 15 days of receiving the unfavorable review decision.

The law also permits you to request an appeal at any time within 120 days of the date you receive this notice. However, an appeal request that is received more than 30 days after the date of this notice, does not permit you to delay making the refund. Regardless of when a review is requested, the patient will be notified that you have requested one, and will receive a copy of the determination.

The patient has received a separate notice of this denial decision. The notice advises that he/she may be entitled to a refund of any amounts paid, if you should have known that we would not pay and did not tell him/her. It also instructs the patient to contact our office if he/she does not hear anything about a refund within 30 days
Start: 08/01/2005 | Last Modified: 04/01/2007
Notes: (Modified 11/18/05, Modified 4/1/07)

N356 Not covered when performed with, or subsequent to, a non-covered service.
Start: 08/01/2005 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)

N357 Time frame requirements between this service/procedure/supply and a related service/procedure/supply have not been met.
Start: 11/18/2005

N358 Alert: This decision may be reviewed if additional documentation as described in the contract or plan benefit documents is submitted.
Start: 11/18/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N359 Missing/incomplete/invalid height.
Start: 11/18/2005
N360 Alert: Coordination of benefits has not been calculated when estimating benefits for this pre-determination. Submit payment information from the primary payer with the secondary claim.
Start: 11/18/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N362 The number of Days or Units of Service exceeds our acceptable maximum.
Start: 11/18/2005

N363 Alert: in the near future we are implementing new policies/procedures that would affect this determination.
Start: 11/18/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)

N364 Alert: According to our agreement, you must waive the deductible and/or coinsurance amounts.
Start: 11/18/2005 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N366 Requested information not provided. The claim will be reopened if the information previously requested is submitted within one year after the date of this denial notice.
Start: 04/01/2006

N367 Alert: The claim information has been forwarded to a Consumer Spending Account processor for review; for example, flexible spending account or health savings account.
Start: 04/01/2006 | Last Modified: 07/01/2008
Notes: (Modified 4/1/07, 11/5/07, 7/1/08)
N368 You must appeal the determination of the previously adjudicated claim.
Start: 04/01/2006

N369 Alert: Although this claim has been processed, it is deficient according to state legislation/regulation.
Start: 04/01/2006
N370 Billing exceeds the rental months covered/approved by the payer.
Start: 08/01/2006
N371 Alert: title of this equipment must be transferred to the patient.
Start: 08/01/2006
N372 Only reasonable and necessary maintenance/service charges are covered.
Start: 08/01/2006
N373 It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your behalf.
Start: 12/01/2006

N374 Primary Medicare Part A insurance has been exhausted and a Part B Remittance Advice is required.
Start: 12/01/2006

N375 Missing/incomplete/invalid questionnaire/information required to determine dependent eligibility.
Start: 12/01/2006

N376 Subscriber/patient is assigned to active military duty, therefore primary coverage may be TRICARE.
Start: 12/01/2006

N377 Payment based on a processed replacement claim.
Start: 12/01/2006 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)
N378 Missing/incomplete/invalid prescription quantity.
Start: 12/01/2006
N379 Claim level information does not match line level information.
Start: 12/01/2006

N380 The original claim has been processed, submit a corrected claim.
Start: 04/01/2007

N381 Alert: Consult our contractual agreement for restrictions/billing/payment information related to these charges.
Start: 04/01/2007 | Last Modified: 07/01/2015
Notes: (Modified 7/1/15)

N382 Missing/incomplete/invalid patient identifier.
Start: 04/01/2007

N383 Not covered when deemed cosmetic.
Start: 04/01/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)

N384 Records indicate that the referenced body part/tooth has been removed in a previous procedure.
Start: 04/01/2007

N385 Notification of admission was not timely according to published plan procedures.
Start: 04/01/2007 | Last Modified: 11/05/2007
Notes: (Modified 11/5/07)

N386 This decision was based on a National Coverage Determination (NCD). An NCD provides a coverage determination as to whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd/search.asp. If you do not have web access, you may contact the contractor to request a copy of the NCD.
Start: 04/01/2007 | Last Modified: 07/01/2010
Notes: (Modified 7/1/2010)
N387 Alert: Submit this claim to the patient’s other insurer for potential payment of supplemental benefits. We did not forward the claim information.
Start: 04/01/2007 | Last Modified: 03/01/2009
Notes: (Modified 3/1/2009)
N388 Missing/incomplete/invalid prescription number.
Start: 08/01/2007 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N389 Duplicate prescription number submitted.
Start: 08/01/2007

N390 This service/report cannot be billed separately.
Start: 08/01/2007 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)

N391 Missing emergency department records.
Start: 08/01/2007
N392 Incomplete/invalid emergency department records.
Start: 08/01/2007

N393 Missing progress notes/report.
Start: 08/01/2007 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)

N394 Incomplete/invalid progress notes/report.
Start: 08/01/2007 | Last Modified: 07/01/2008
Notes: (Modified 7/1/08)

N395 Missing laboratory report.
Start: 08/01/2007
N396 Incomplete/invalid laboratory report.
Start: 08/01/2007

N397 Benefits are not available for incomplete service(s)/undelivered item(s).
Start: 08/01/2007
N398 Missing elective consent form.
Start: 08/01/2007

N399 Incomplete/invalid elective consent form.
Start: 08/01/2007

N400 Alert: Electronically enabled providers should submit claims electronically.
Start: 08/01/2007
N401 Missing periodontal charting.
Start: 08/01/2007

N402 Incomplete/invalid periodontal charting.
Start: 08/01/2007
N403 Missing facility certification.
Start: 08/01/2007
N404 Incomplete/invalid facility certification.
Start: 08/01/2007
N405 This service is only covered when the donor’s insurer(s) do not provide coverage for the service.
Start: 08/01/2007
N406 This service is only covered when the recipient’s insurer(s) do not provide coverage for the service.
Start: 08/01/2007

N407 You are not an approved submitter for this transmission format.
Start: 08/01/2007

N408 This payer does not cover deductibles assessed by a previous payer.
Start: 08/01/2007

N409 This service is related to an accidental injury and is not covered unless provided within a specific time frame from the date of the accident.
Start: 08/01/2007

N410 Not covered unless the prescription changes.
Start: 08/01/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)

N411 This service is allowed one time in a 6-month period.
Start: 08/01/2007 | Last Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N412 This service is allowed 2 times in a 12-month period.
Start: 08/01/2007 | Last Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N413 This service is allowed 2 times in a benefit year.
Start: 08/01/2007 | Last Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N414 This service is allowed 4 times in a 12-month period.
Start: 08/01/2007 | Last Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)

N415 This service is allowed 1 time in an 18-month period.
Start: 08/01/2007 | Last Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N416 This service is allowed 1 time in a 3-year period.
Start: 08/01/2007 | Last Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N417 This service is allowed 1 time in a 5-year period.
Start: 08/01/2007 | Last Modified: 07/01/2016
Notes: (Modified 2/1/2009, Reactivated 7/1/2016)
N418 Misrouted claim. See the payer’s claim submission instructions.
Start: 08/01/2007
N419 Claim payment was the result of a payer’s retroactive adjustment due to a retroactive rate change.
Start: 08/01/2007
N420 Claim payment was the result of a payer’s retroactive adjustment due to a Coordination of Benefits or Third Party Liability Recovery.
Start: 08/01/2007

N421 Claim payment was the result of a payer’s retroactive adjustment due to a review organization decision.
Start: 08/01/2007 | Last Modified: 05/08/2008
Notes: (Modified 2/29/08, typo fixed 5/8/08)

N422 Claim payment was the result of a payer’s retroactive adjustment due to a payer’s contract incentive program.
Start: 08/01/2007 | Last Modified: 05/08/2008
Notes: (Typo fixed 5/8/08)

N423 Claim payment was the result of a payer’s retroactive adjustment due to a non standard program.
Start: 08/01/2007
N424 Patient does not reside in the geographic area required for this type of payment.
Start: 08/01/2007

N425 Statutorily excluded service(s).
Start: 08/01/2007
N426 No coverage when self-administered.
Start: 08/01/2007

N427 Payment for eyeglasses or contact lenses can be made only after cataract surgery.
Start: 08/01/2007
N428 Not covered when performed in this place of service.
Start: 08/01/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)

N429 Not covered when considered routine.
Start: 08/01/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N430 Procedure code is inconsistent with the units billed.
Start: 11/05/2007
N431 Not covered with this procedure.
Start: 11/05/2007 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N432 Alert: Adjustment based on a Recovery Audit.
Start: 11/05/2007 | Last Modified: 07/01/2015
Notes: (Modified 7/1/15)
N433 Resubmit this claim using only your National Provider Identifier (NPI).
Start: 02/29/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N434 Missing/Incomplete/Invalid Present on Admission indicator.
Start: 07/01/2008
N435 Exceeds number/frequency approved /allowed within time period without support documentation.
Start: 07/01/2008

N436 The injury claim has not been accepted and a mandatory medical reimbursement has been made.
Start: 07/01/2008
N437 Alert: If the injury claim is accepted, these charges will be reconsidered.
Start: 07/01/2008

N438 This jurisdiction only accepts paper claims.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N439 Missing anesthesia physical status report/indicators.
Start: 07/01/2008

N440 Incomplete/invalid anesthesia physical status report/indicators.
Start: 07/01/2008
N441 This missed/cancelled appointment is not covered.
Start: 07/01/2008 | Last Modified: 07/15/2013
Notes: (Modified 7/15/2013)

N442 Payment based on an alternate fee schedule.
Start: 07/01/2008
N443 Missing/incomplete/invalid total time or begin/end time.
Start: 07/01/2008
N444 Alert: This facility has not filed the Election for High Cost Outlier form with the Division of Workers’ Compensation.
Start: 07/01/2008
N445 Missing document for actual cost or paid amount.
Start: 07/01/2008

N446 Incomplete/invalid document for actual cost or paid amount.
Start: 07/01/2008
N447 Payment is based on a generic equivalent as required documentation was not provided.
Start: 07/01/2008

N448 This drug/service/supply is not included in the fee schedule or contracted/legislated fee arrangement.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N449 Payment based on a comparable drug/service/supply.
Start: 07/01/2008
N450 Covered only when performed by the primary treating physician or the designee.
Start: 07/01/2008

N451 Missing Admission Summary Report.
Start: 07/01/2008

N452 Incomplete/invalid Admission Summary Report.
Start: 07/01/2008
N453 Missing Consultation Report.
Start: 07/01/2008

N454 Incomplete/invalid Consultation Report.
Start: 07/01/2008
N455 Missing Physician Order.
Start: 07/01/2008

N456 Incomplete/invalid Physician Order.
Start: 07/01/2008
N457 Missing Diagnostic Report.
Start: 07/01/2008

N458 Incomplete/invalid Diagnostic Report.
Start: 07/01/2008
N459 Missing Discharge Summary.
Start: 07/01/2008

N460 Incomplete/invalid Discharge Summary.
Start: 07/01/2008
N461 Missing Nursing Notes.
Start: 07/01/2008

N462 Incomplete/invalid Nursing Notes.
Start: 07/01/2008
N463 Missing support data for claim.
Start: 07/01/2008
N464 Incomplete/invalid support data for claim.
Start: 07/01/2008
N465 Missing Physical Therapy Notes/Report.
Start: 07/01/2008
N466 Incomplete/invalid Physical Therapy Notes/Report.
Start: 07/01/2008
N467 Missing Tests and Analysis Report.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N468 Incomplete/invalid Report of Tests and Analysis Report.
Start: 07/01/2008
N469 Alert: Claim/Service(s) subject to appeal process, see section 935 of Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA).
Start: 07/01/2008

N470 This payment will complete the mandatory medical reimbursement limit.
Start: 07/01/2008
N471 Missing/incomplete/invalid HIPPS Rate Code.
Start: 07/01/2008

N472 Payment for this service has been issued to another provider.
Start: 07/01/2008
N473 Missing certification.
Start: 07/01/2008
N474 Incomplete/invalid certification.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N475 Missing completed referral form.
Start: 07/01/2008
N476 Incomplete/invalid completed referral form.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N477 Missing Dental Models.
Start: 07/01/2008
N478 Incomplete/invalid Dental Models.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N479 Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
Start: 07/01/2008
N480 Incomplete/invalid Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).
Start: 07/01/2008

N481 Missing Models.
Start: 07/01/2008
N482 Incomplete/invalid Models.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N485 Missing Physical Therapy Certification.
Start: 07/01/2008
N486 Incomplete/invalid Physical Therapy Certification.
Start: 07/01/2008

N487 Missing Prosthetics or Orthotics Certification.
Start: 07/01/2008
N488 Incomplete/invalid Prosthetics or Orthotics Certification.
Start: 07/01/2008 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N489 Missing referral form.
Start: 07/01/2008
N490 Incomplete/invalid referral form.
Start: 07/01/2008 | Last Modified: 03/14/2014Notes: (Modified 3/14/2014)

N491 Missing/Incomplete/Invalid Exclusionary Rider Condition.
Start: 07/01/2008
N492 Alert: A network provider may bill the member for this service if the member requested the service and agreed in writing, prior to receiving the service, to be financially responsible for the billed charge.
Start: 07/01/2008

N493 Missing Doctor First Report of Injury.
Start: 07/01/2008
N494 Incomplete/invalid Doctor First Report of Injury.
Start: 07/01/2008

N495 Missing Supplemental Medical Report.
Start: 07/01/2008
N496 Incomplete/invalid Supplemental Medical Report.
Start: 07/01/2008
N497 Missing Medical Permanent Impairment or Disability Report.
Start: 07/01/2008
N498 Incomplete/invalid Medical Permanent Impairment or Disability Report.
Start: 07/01/2008
N499 Missing Medical Legal Report.
Start: 07/01/2008
N500 Incomplete/invalid Medical Legal Report.
Start: 07/01/2008

N501 Missing Vocational Report.
Start: 07/01/2008
N502 Incomplete/invalid Vocational Report.
Start: 07/01/2008

N503 Missing Work Status Report.
Start: 07/01/2008
N504 Incomplete/invalid Work Status Report.
Start: 07/01/2008

N505 Alert: This response includes only services that could be estimated in real-time. No estimate will be provided for the services that could not be estimated in real-time.
Start: 11/01/2008 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)

N506 Alert: This is an estimate of the member’s liability based on the information available at the time the estimate was processed. Actual coverage and member liability amounts will be determined when the claim is processed. This is not a pre-authorization or a guarantee of payment.
Start: 11/01/2008

N507 Plan distance requirements have not been met.
Start: 11/01/2008
N508 Alert: This real-time claim adjudication response represents the member responsibility to the provider for services reported. The member will receive an Explanation of Benefits electronically or in the mail. Contact the insurer if there are any questions.
Start: 11/01/2008 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)

N509 Alert: A current inquiry shows the member’s Consumer Spending Account contains sufficient funds to cover the member liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
Start: 11/01/2008
N510 Alert: A current inquiry shows the member’s Consumer Spending Account does not contain sufficient funds to cover the member’s liability for this claim/service. Actual payment from the Consumer Spending Account will depend on the availability of funds and determination of eligible services at the time of payment processing.
Start: 11/01/2008
N511 Alert: Information on the availability of Consumer Spending Account funds to cover the member liability on this claim/service is not available at this time.
Start: 11/01/2008

N512 Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time without change to the adjudication.
Start: 11/01/2008
N513 Alert: This is the initial remit of a non-NCPDP claim originally submitted real-time with a change to the adjudication.
Start: 11/01/2008

N516 Records indicate a mismatch between the submitted NPI and EIN.
Start: 03/01/2009
N517 Resubmit a new claim with the requested information.
Start: 03/01/2009
N518 No separate payment for accessories when furnished for use with oxygen equipment.
Start: 03/01/2009
N519 Invalid combination of HCPCS modifiers.
Start: 07/01/2009
N520 Alert: Payment made from a Consumer Spending Account.
Start: 07/01/2009

N521 Mismatch between the submitted provider information and the provider information stored in our system.
Start: 11/01/2009
N522 Duplicate of a claim processed, or to be processed, as a crossover claim.
Start: 11/01/2009 | Last Modified: 03/01/2010

N523 The limitation on outlier payments defined by this payer for this service period has been met. The outlier payment otherwise applicable to this claim has not been paid.
Start: 03/01/2010
N524 Based on policy this payment constitutes payment in full.
Start: 03/01/2010

N525 These services are not covered when performed within the global period of another service.
Start: 03/01/2010

N526 Not qualified for recovery based on employer size.
Start: 03/01/2010
N527 We processed this claim as the primary payer prior to receiving the recovery demand.
Start: 03/01/2010

N528 Patient is entitled to benefits for Institutional Services only.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)
N529 Patient is entitled to benefits for Professional Services only.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)

N530 Not Qualified for Recovery based on enrollment information.
Start: 03/01/2010 | Last Modified: 07/01/2010
Notes: (Modified 7/1/10)
N531 Not qualified for recovery based on direct payment of premium.
Start: 03/01/2010
N532 Not qualified for recovery based on disability and working status.
Start: 03/01/2010
N533 Services performed in an Indian Health Services facility under a self-insured tribal Group Health Plan.
Start: 07/01/2010
N534 This is an individual policy, the employer does not participate in plan sponsorship.
Start: 07/01/2010

N535 Payment is adjusted when procedure is performed in this place of service based on the submitted procedure code and place of service.
Start: 07/01/2010
N536 We are not changing the prior payer’s determination of patient responsibility, which you may collect, as this service is not covered by us.
Start: 07/01/2010
N537 We have examined claims history and no records of the services have been found.
Start: 07/01/2010

N538 A facility is responsible for payment to outside providers who furnish these services/supplies/drugs to its patients/residents.
Start: 07/01/2010

N539 Alert: We processed appeals/waiver requests on your behalf and that request has been denied.
Start: 07/01/2010
N540 Payment adjusted based on the interrupted stay policy.
Start: 11/01/2010

N541 Mismatch between the submitted insurance type code and the information stored in our system.
Start: 11/01/2010
N542 Missing income verification.
Start: 03/08/2011
N543 Incomplete/invalid income verification.
Start: 03/08/2011 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N544 Alert: Although this was paid, you have billed with a referring/ordering provider that does not match our system record. Unless corrected this will not be paid in the future.
Start: 07/01/2011 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N545 Payment reduced based on status as an unsuccessful eprescriber per the Electronic Prescribing (eRx) Incentive Program.
Start: 07/01/2011
N546 Payment represents a previous reduction based on the Electronic Prescribing (eRx) Incentive Program.
Start: 07/01/2011
N547 A refund request (Frequency Type Code 8) was processed previously.
Start: 03/06/2012

N548 Alert: Patient’s calendar year deductible has been met.
Start: 03/06/2012
N549 Alert: Patient’s calendar year out-of-pocket maximum has been met.
Start: 03/06/2012
N550 Alert: You have not responded to requests to revalidate your provider/supplier enrollment information. Your failure to revalidate your enrollment information will result in a payment hold in the near future.
Start: 03/06/2012
N551 Payment adjusted based on the Ambulatory Surgical Center (ASC) Quality Reporting Program.
Start: 03/06/2012

N552 Payment adjusted to reverse a previous withhold/bonus amount.
Start: 03/06/2012
N554 Missing/Incomplete/Invalid Family Planning Indicator.
Start: 07/01/2012 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N555 Missing medication list.
Start: 07/01/2012

N556 Incomplete/invalid medication list.
Start: 07/01/2012
N557 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the specimen was collected.
Start: 07/01/2012

N558 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the equipment was received.
Start: 07/01/2012
N559 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Ordering Physician is located.
Start: 07/01/2012
N560 The pilot program requires an interim or final claim within 60 days of the Notice of Admission. A claim was not received.
Start: 11/01/2012
N561 The bundled claim originally submitted for this episode of care includes related readmissions. You may resubmit the original claim to receive a corrected payment based on this readmission.
Start: 11/01/2012
N562 The provider number of your incoming claim does not match the provider number on the processed Notice of Admission (NOA) for this bundled payment.
Start: 11/01/2012
N563 Alert: Missing required provider/supplier issuance of advance patient notice of non-coverage. The patient is not liable for payment for this service.
Start: 11/01/2012 | Last Modified: 11/01/2015
Notes: Related to M39 (Modified 11/1/2015)

N564 Patient did not meet the inclusion criteria for the demonstration project or pilot program.
Start: 11/01/2012
N565 Alert: This non-payable reporting code requires a modifier. Future claims containing this non-payable reporting code must include an appropriate modifier for the claim to be processed.
Start: 11/01/2012 | Last Modified: 03/01/2013
Notes: (Modified 3/1/13)

N566 Alert: This procedure code requires functional reporting. Future claims containing this procedure code must include an applicable non-payable code and appropriate modifiers for the claim to be processed.
Start: 11/01/2012
N567 Not covered when considered preventative.
Start: 03/01/2013

N568 Alert: Initial payment based on the Notice of Admission (NOA) under the Bundled Payment Model IV initiative.
Start: 03/01/2013
N569 Not covered when performed for the reported diagnosis.
Start: 03/01/2013
N570 Missing/incomplete/invalid credentialing data.
Start: 03/01/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N571 Alert: Payment will be issued quarterly by another payer/contractor.
Start: 03/01/2013
N572 This procedure is not payable unless appropriate non-payable reporting codes and associated modifiers are submitted.
Start: 03/01/2013 | Last Modified: 07/01/2014

N573 Alert: You have been overpaid and must refund the overpayment. The refund will be requested separately by another payer/contractor.
Start: 03/01/2013
N574 Our records indicate the ordering/referring provider is of a type/specialty that cannot order or refer. Please verify that the claim ordering/referring provider information is accurate or contact the ordering/referring provider.
Start: 07/15/2013
N575 Mismatch between the submitted ordering/referring provider name and the ordering/referring provider name stored in our records.
Start: 07/15/2013
N576 Services not related to the specific incident/claim/accident/loss being reported.
Start: 07/15/2013
N577 Personal Injury Protection (PIP) Coverage.
Start: 07/15/2013
N578 Coverages do not apply to this loss.
Start: 07/15/2013
N579 Medical Payments Coverage (MPC).
Start: 07/15/2013

N580 Determination based on the provisions of the insurance policy.
Start: 07/15/2013
N581 Investigation of coverage eligibility is pending.
Start: 07/15/2013
N582 Benefits suspended pending the patient’s cooperation.
Start: 07/15/2013

N583 Patient was not an occupant of our insured vehicle and therefore, is not an eligible injured person.
Start: 07/15/2013
N584 Not covered based on the insured’s noncompliance with policy or statutory conditions.
Start: 07/15/2013

N585 Benefits are no longer available based on a final injury settlement.
Start: 07/15/2013
N586 The injured party does not qualify for benefits.
Start: 07/15/2013
N587 Policy benefits have been exhausted.
Start: 07/15/2013
N588 The patient has instructed that medical claims/bills are not to be paid.
Start: 07/15/2013
N589 Coverage is excluded to any person injured as a result of operating a motor vehicle while in an intoxicated condition or while the ability to operate such a vehicle is impaired by the use of a drug.
Start: 07/15/2013

N590 Missing independent medical exam detailing the cause of injuries sustained and medical necessity of services rendered.
Start: 07/15/2013
N591 Payment based on an Independent Medical Examination (IME) or Utilization Review (UR).
Start: 07/15/2013
N592 Adjusted because this is not the initial prescription or exceeds the amount allowed for the initial prescription.
Start: 07/15/2013

N593 Not covered based on failure to attend a scheduled Independent Medical Exam (IME).
Start: 07/15/2013
N594 Records reflect the injured party did not complete an Application for Benefits for this loss.
Start: 07/15/2013
N595 Records reflect the injured party did not complete an Assignment of Benefits for this loss.
Start: 07/15/2013
N596 Records reflect the injured party did not complete a Medical Authorization for this loss.
Start: 07/15/2013
N597 Adjusted based on a medical/dental provider’s apportionment of care between related injuries and other unrelated medical/dental conditions/injuries.
Start: 07/15/2013 | Last Modified: 11/01/2013
N598 Health care policy coverage is primary.
Start: 07/15/2013

N599 Our payment for this service is based upon a reasonable amount pursuant to both the terms and conditions of the policy of insurance under which the subject claim is being made as well as the Florida No-Fault Statute, which permits, when determining a reasonable charge for a service, an insurer to consider usual and customary charges and payments accepted by the provider, reimbursement levels in the community and various federal and state fee schedules applicable to automobile and other insurance coverages, and other information relevant to the reasonableness of the reimbursement for the service. The payment for this service is based upon 200% of the Participating Level of Medicare Part B fee schedule for the locale in which the services were rendered.
Start: 07/15/2013
N600 Adjusted based on the applicable fee schedule for the region in which the service was rendered.
Start: 07/15/2013

N601 In accordance with Hawaii Administrative Rules, Title 16, Chapter 23 Motor Vehicle Insurance Law payment is recommended based on Medicare Resource Based Relative Value Scale System applicable to Hawaii.
Start: 07/15/2013
N602 Adjusted based on the Redbook maximum allowance.
Start: 07/15/2013
N603 This fee is calculated according to the New Jersey medical fee schedules for Automobile Personal Injury Protection and Motor Bus Medical Expense Insurance Coverage.
Start: 07/15/2013
N604 In accordance with New York No-Fault Law, Regulation 68, this base fee was calculated according to the New York Workers’ Compensation Board Schedule of Medical Fees, pursuant to Regulation 83 and / or Appendix 17-C of 11 NYCRR.
Start: 07/15/2013

N605 This fee was calculated based upon New York All Patients Refined Diagnosis Related Groups (APR-DRG), pursuant to Regulation 68.
Start: 07/15/2013
N606 The Oregon allowed amount for this procedure is based upon the Workers Compensation Fee Schedule (OAR 436-009). The allowed amount has been calculated in accordance with Section 4 of ORS 742.524.
Start: 07/15/2013
N607 Service provided for non-compensable condition(s).
Start: 07/15/2013
N608 The fee schedule amount allowed is calculated at 110% of the Medicare Fee Schedule for this region, specialty and type of service. This fee is calculated in compliance with Act 6.
Start: 07/15/2013
N609 80% of the provider’s billed amount is being recommended for payment according to Act 6.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N610 Alert: Payment based on an appropriate level of care.
Start: 07/15/2013

N611 Claim in litigation. Contact insurer for more information.
Start: 07/15/2013
N612 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction.
Start: 07/15/2013

N613 Alert: Although this was paid, you have billed with an ordering provider that needs to update their enrollment record. Please verify that the ordering provider information you submitted on the claim is accurate and if it is, contact the ordering provider instructing them to update their enrollment record. Unless corrected, a claim with this ordering provider will not be paid in the future.
Start: 07/15/2013
N614 Alert: Additional information is included in the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information).
Start: 07/15/2013

N615 Alert: This enrollee receiving advance payments of the premium tax credit is in the grace period of three consecutive months for non-payment of premium. Under 45 CFR 156.270, a Qualified Health Plan issuer must pay all appropriate claims for services rendered to the enrollee during the first month of the grace period and may pend claims for services rendered to the enrollee in the second and third months of the grace period.
Start: 07/15/2013 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)

N616 Alert: This enrollee is in the first month of the advance premium tax credit grace period.
Start: 07/15/2013
N617 This enrollee is in the second or third month of the advance premium tax credit grace period.
Start: 07/15/2013
N618 Alert: This claim will automatically be reprocessed if the enrollee pays their premiums.
Start: 07/15/2013
N619 Coverage terminated for non-payment of premium.
Start: 07/15/2013
N620 Alert: This procedure code is for quality reporting/informational purposes only.
Start: 07/15/2013
N621 Charges for Jurisdiction required forms, reports, or chart notes are not payable.
Start: 07/15/2013

N622 Not covered based on the date of injury/accident.
Start: 07/15/2013
N623 Not covered when deemed unscientific/unproven/outmoded/experimental/excessive/inappropriate.
Start: 07/15/2013

N624 The associated Workers’ Compensation claim has been withdrawn.
Start: 07/15/2013
N625 Missing/Incomplete/Invalid Workers’ Compensation Claim Number.
Start: 07/15/2013
N626 New or established patient E/M codes are not payable with chiropractic care codes.
Start: 07/15/2013

N628 Out-patient follow up visits on the same date of service as a scheduled test or treatment is disallowed.
Start: 07/15/2013
N629 Reviews/documentation/notes/summaries/reports/charts not requested.
Start: 07/15/2013
N630 Referral not authorized by attending physician.
Start: 07/15/2013

N631 Medical Fee Schedule does not list this code. An allowance was made for a comparable service.
Start: 07/15/2013
N633 Additional anesthesia time units are not allowed.
Start: 07/15/2013
N634 The allowance is calculated based on anesthesia time units.
Start: 07/15/2013

N635 The Allowance is calculated based on the anesthesia base units plus time.
Start: 07/15/2013
N636 Adjusted because this is reimbursable only once per injury.
Start: 07/15/2013

N637 Consultations are not allowed once treatment has been rendered by the same provider.
Start: 07/15/2013
N638 Reimbursement has been made according to the home health fee schedule.
Start: 07/15/2013
N639 Reimbursement has been made according to the inpatient rehabilitation facilities fee schedule.
Start: 07/15/2013
N640 Exceeds number/frequency approved/allowed within time period.
Start: 07/15/2013
N641 Reimbursement has been based on the number of body areas rated.
Start: 07/15/2013
N642 Adjusted when billed as individual tests instead of as a panel.
Start: 07/15/2013
N643 The services billed are considered Not Covered or Non-Covered (NC) in the applicable state fee schedule.
Start: 07/15/2013
N644 Reimbursement has been made according to the bilateral procedure rule.
Start: 07/15/2013
N645 Mark-up allowance.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N646 Reimbursement has been adjusted based on the guidelines for an assistant.
Start: 07/15/2013
N647 Adjusted based on diagnosis-related group (DRG).
Start: 07/15/2013
N648 Adjusted based on Stop Loss.
Start: 07/15/2013

N649 Payment based on invoice.
Start: 07/15/2013
N650 This policy was not in effect for this date of loss. No coverage is available.
Start: 07/15/2013
N651 No Personal Injury Protection/Medical Payments Coverage on the policy at the time of the loss.
Start: 07/15/2013

N652 The date of service is before the date of loss.
Start: 07/15/2013
N653 The date of injury does not match the reported date of loss.
Start: 07/15/2013
N654 Adjusted based on achievement of maximum medical improvement (MMI).
Start: 07/15/2013
N655 Payment based on provider’s geographic region.
Start: 07/15/2013

N656 An interest payment is being made because benefits are being paid outside the statutory requirement.
Start: 07/15/2013
N657 This should be billed with the appropriate code for these services.
Start: 07/15/2013
N658 The billed service(s) are not considered medical expenses.
Start: 07/15/2013
N659 This item is exempt from sales tax.
Start: 07/15/2013
N660 Sales tax has been included in the reimbursement.
Start: 07/15/2013
N661 Documentation does not support that the services rendered were medically necessary.
Start: 07/15/2013

N662 Alert: Consideration of payment will be made upon receipt of a final bill.
Start: 07/15/2013
N663 Adjusted based on an agreed amount.
Start: 07/15/2013
N664 Adjusted based on a legal settlement.
Start: 07/15/2013

N665 Services by an unlicensed provider are not reimbursable.
Start: 07/15/2013
N666 Only one evaluation and management code at this service level is covered during the course of care.
Start: 07/15/2013
N667 Missing prescription.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N668 Incomplete/invalid prescription.
Start: 07/15/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N669 Adjusted based on the Medicare fee schedule.
Start: 07/15/2013

N670 This service code has been identified as the primary procedure code subject to the Medicare Multiple Procedure Payment Reduction (MPPR) rule.
Start: 07/15/2013
N671 Payment based on a jurisdiction cost-charge ratio.
Start: 07/15/2013
N672 Alert: Amount applied to Health Insurance Offset.
Start: 07/15/2013
N673 Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.
Start: 07/15/2013

N674 Not covered unless a pre-requisite procedure/service has been provided.
Start: 07/15/2013
N675 Additional information is required from the injured party.
Start: 07/15/2013
N676 Service does not qualify for payment under the Outpatient Facility Fee Schedule.
Start: 07/15/2013

N677 Alert: Films/Images will not be returned.
Start: 11/01/2013
N678 Missing post-operative images/visual field results.
Start: 11/01/2013

N679 Incomplete/Invalid post-operative images/visual field results.
Start: 11/01/2013
N680 Missing/Incomplete/Invalid date of previous dental extractions.
Start: 11/01/2013

N681 Missing/Incomplete/Invalid full arch series.
Start: 11/01/2013
N682 Missing/Incomplete/Invalid history of prior periodontal therapy/maintenance.
Start: 11/01/2013
N683 Missing/Incomplete/Invalid prior treatment documentation.
Start: 11/01/2013
N684 Payment denied as this is a specialty claim submitted as a general claim.
Start: 11/01/2013
N685 Missing/Incomplete/Invalid Prosthesis, Crown or Inlay Code.
Start: 11/01/2013
N686 Missing/incomplete/Invalid questionnaire needed to complete payment determination.
Start: 11/01/2013

N687 Alert: This reversal is due to a retroactive disenrollment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N688 Alert: This reversal is due to a medical or utilization review decision.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)

N689 Alert: This reversal is due to a retroactive rate change.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)

N690 Alert: This reversal is due to a provider submitted appeal.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N691 Alert: This reversal is due to a patient submitted appeal.
Start: 11/01/2013 | Last Modified: 03/14/2014

Notes: To be used with claim/service reversal. (Modified 3/14/2014)
N692 Alert: This reversal is due to an incorrect rate on the initial adjudication.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)

N693 Alert: This reversal is due to a cancellation of the claim by the provider.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)
N694 Alert: This reversal is due to a resubmission/change to the claim by the provider.
Start: 11/01/2013
N695 Alert: This reversal is due to incorrect patient financial responsibility information on the initial adjudication.
Start: 11/01/2013
N696 Alert: This reversal is due to a Coordination of Benefits or Third Party Liability Recovery retroactive adjustment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)

N697 Alert: This reversal is due to a payer’s retroactive contract incentive program adjustment.
Start: 11/01/2013 | Last Modified: 03/14/2014
Notes: To be used with claim/service reversal. (Modified 3/14/2014)

N698 Alert: This reversal is due to non-payment of the health insurance premiums (Health Insurance Exchange or other) by the end of the premium payment grace period, resulting in loss of coverage.
Start: 11/01/2013 | Last Modified: 11/01/2015
Notes: To be used with claim/service reversal. (Modified 3/14/2014, 11/1/2015)
N699 Payment adjusted based on the Physician Quality Reporting System (PQRS) Incentive Program.
Start: 03/01/2014

N700 Payment adjusted based on the Electronic Health Records (EHR) Incentive Program.
Start: 03/01/2014
N701 Payment adjusted based on the Value-based Payment Modifier.
Start: 03/01/2014
N702 Decision based on review of previously adjudicated claims or for claims in process for the same/similar type of services.
Start: 03/01/2014
N703 This service is incompatible with previously adjudicated claims or claims in process.
Start: 03/01/2014
N704 Alert: You may not appeal this decision but can resubmit this claim/service with corrected information if warranted.
Start: 03/01/2014 | Last Modified: 03/14/2014
Notes: (Modified 3/14/2014)

N705 Incomplete/invalid documentation.
Start: 03/01/2014
N706 Missing documentation.
Start: 03/01/2014

N707 Incomplete/invalid orders.
Start: 03/01/2014
N708 Missing orders.
Start: 03/01/2014
N709 Incomplete/invalid notes.
Start: 03/01/2014
N710 Missing notes.
Start: 03/01/2014

N711 Incomplete/invalid summary.
Start: 03/01/2014
N712 Missing summary.
Start: 03/01/2014

N713 Incomplete/invalid report.
Start: 03/01/2014
N714 Missing report.
Start: 03/01/2014

N715 Incomplete/invalid chart.
Start: 03/01/2014
N716 Missing chart.
Start: 03/01/2014
N717 Incomplete/Invalid documentation of face-to-face examination.
Start: 03/01/2014
N718 Missing documentation of face-to-face examination.
Start: 03/01/2014

N719 Penalty applied based on plan requirements not being met.
Start: 03/01/2014
N720 Alert: The patient overpaid you. You may need to issue the patient a refund for the difference between the patient’s payment and the amount shown as patient responsibility on this notice.
Start: 03/01/2014

N721 This service is only covered when performed as part of a clinical trial.
Start: 03/01/2014
N722 Patient must use Workers’ Compensation Set-Aside (WCSA) funds to pay for the medical service or item.
Start: 03/01/2014

N723 Patient must use Liability set-aside (LSA) funds to pay for the medical service or item.
Start: 03/01/2014
N724 Patient must use No-Fault set-aside (NFSA) funds to pay for the medical service or item.
Start: 03/01/2014
N725 A liability insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
Start: 03/01/2014
N726 A conditional payment is not allowed.
Start: 03/01/2014
N727 A no-fault insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
Start: 03/01/2014
N728 A workers’ compensation insurer has reported having ongoing responsibility for medical services (ORM) for this diagnosis.
Start: 03/01/2014
N729 Missing patient medical/dental record for this service.
Start: 11/01/2014

N730 Incomplete/invalid patient medical/dental record for this service.
Start: 11/01/2014
N731 Incomplete/Invalid mental health assessment.
Start: 11/01/2014
N732 Services performed at an unlicensed facility are not reimbursable.
Start: 11/01/2014

N733 Regulatory surcharges are paid directly to the state.
Start: 11/01/2014
N734 The patient is eligible for these medical services only when unable to work or perform normal activities due to an illness or injury.
Start: 11/01/2014
N736 Incomplete/invalid Sleep Study Report.
Start: 03/01/2015

N737 Missing Sleep Study Report.
Start: 03/01/2015
N738 Incomplete/invalid Vein Study Report.
Start: 03/01/2015

N739 Missing Vein Study Report.
Start: 03/01/2015
N740 The member’s Consumer Spending Account does not contain sufficient funds to cover the member’s liability for this claim/service.
Start: 03/01/2015

N741 This is a site neutral payment.
Start: 03/01/2015
N743 Adjusted because the services may be related to an employment accident.
Start: 03/01/2015

N744 Adjusted because the services may be related to an auto/other accident.
Start: 03/01/2015 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)
N745 Missing Ambulance Report.
Start: 03/01/2015

N746 Incomplete/invalid Ambulance Report.
Start: 03/01/2015
N747 This is a misdirected claim/service. Submit the claim to the payer/plan where the patient resides.
Start: 03/01/2015
N748 Adjusted because the related hospital charges have not been received.
Start: 03/01/2015
N749 Missing Blood Gas Report.
Start: 03/01/2015

N750 Incomplete/invalid Blood Gas Report.
Start: 03/01/2015
N751 Adjusted because the patient is covered under a Medicare Part D plan.
Start: 03/01/2015 | Last Modified: 07/01/2017
Notes: (Modified 7/1/2017)

N752 Missing/incomplete/invalid HIPPS Treatment Authorization Code (TAC).
Start: 03/01/2015
N753 Missing/incomplete/invalid Attachment Control Number.
Start: 07/01/2015

N754 Missing/incomplete/invalid Referring Provider or Other Source Qualifier on the 1500 Claim Form.
Start: 07/01/2015
N755 Missing/incomplete/invalid ICD Indicator.
Start: 07/01/2015 | Last Modified: 03/01/2016
Notes: (Modified 3/1/2016)

N756 Missing/incomplete/invalid point of drop-off address.
Start: 07/01/2015
N757 Adjusted based on the Federal Indian Fees schedule (MLR).
Start: 07/01/2015
N758 Adjusted based on the prior authorization decision.
Start: 07/01/2015
N759 Payment adjusted based on the National Electrical Manufacturers Association (NEMA) Standard XR-29-2013.
Start: 07/01/2015

N760 This facility is not authorized to receive payment for the service(s).
Start: 11/01/2015
N761 This provider is not authorized to receive payment for the service(s).
Start: 11/01/2015
N762 This facility is not certified for Tomosynthesis (3-D) mammography.
Start: 11/01/2015

N763 The demonstration code is not appropriate for this claim; resubmit without a demonstration code.
Start: 11/01/2015
N764 Missing/incomplete/invalid Hematocrit (HCT) value.
Start: 03/01/2016
N765 This payer does not cover coinsurance assessed by a previous payer.
Start: 03/01/2016 | Last Modified: 03/01/2018
Notes: (Modified 3/1/2018)
N766 This payer does not cover co-payment assessed by a previous payer.
Start: 03/01/2016
N767 The Medicaid state requires provider to be enrolled in the member’s Medicaid state program prior to any claim benefits being processed.
Start: 03/01/2016

N768 Incomplete/invalid initial evaluation report.
Start: 03/01/2016
N769 A lateral diagnosis is required.
Start: 03/01/2016

N770 The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received.
Start: 03/01/2016
N771 Alert: Under Federal law you cannot charge more than the limiting charge amount.
Start: 07/01/2016
N772 Alert: Rebill urgent/emergent and ancillary services separately.
Start: 07/01/2016

N773 Drug supplied not obtained from specialty vendor.
Start: 07/01/2016
N774 Alert: Refer to your Third Party Processor Agreement for specific information on fees associated with this payment type.
Start: 07/01/2016

N775 Payment adjusted based on x-ray radiograph on film.
Start: 11/01/2016
N776 This service is not a covered Telehealth service.
Start: 11/01/2016

N777 Missing Assignment of Benefits Indicator.
Start: 11/01/2016 | Last Modified: 03/01/2017
Notes: (Modified 3/1/2017)
N778 Missing Primary Care Physician Information.
Start: 11/01/2016
N779 Replacement/Void claims cannot be submitted until the original claim has finalized. Please resubmit once payment or denial is received.
Start: 11/01/2016
N780 Missing/incomplete/invalid end therapy date.
Start: 11/01/2016
N781 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected deductible. This amount may be billed to a subsequent payer.
Start: 11/01/2016 | Last Modified: 03/01/2018
Notes: (Modified 3/1/2018)

N782 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected coinsurance. This amount may be billed to a subsequent payer.
Start: 11/01/2016 | Last Modified: 03/01/2018
Notes: (Modified 3/1/2018)

N783 Alert: Patient is a Medicaid/ Qualified Medicare Beneficiary. Review your records for any wrongfully collected copayment. This amount may be billed to a subsequent payer.
Start: 11/01/2016 | Last Modified: 03/01/2018
Notes: (Modified 3/1/2018)
N784 Missing comprehensive procedure code.
Start: 11/01/2016

N785 Missing current radiology film/images.
Start: 11/01/2016
N786 Benefit limitation for the orthodontic active and/or retention phase of treatment.
Start: 11/01/2016

N787 Alert: Under 42 CFR 410.43, an eligible Partial Hospitalization Program (PHP) patient/beneficiary requires a minimum of 20 hours of PHP services per week, as evidenced in the plan of care. PHP services must be furnished in accordance with the plan of care.
Start: 03/01/2017
N788 Alert: The third-party administrator/review organization did not receive the required information.
Start: 03/01/2017 | Last Modified: 07/01/2018
Notes: (Modified 11/1/2017, 7/1/2018)
N789 Clinical Trial is not a covered benefit.
Start: 07/01/2017

N790 Provider/supplier not accredited for product/service.
Start: 07/01/2017
N791 Missing history & physical report.
Start: 07/01/2017
N792 Incomplete/invalid history & physical report.
Start: 07/01/2017

N794 Payment adjusted based on type of technology used.
Start: 07/01/2017
N795 Item must be resubmitted as a purchase.
Start: 11/01/2017
N796 Missing/incomplete/invalid Hemoglobin (Hb or Hgb) value.
Start: 11/01/2017
N797 Missing/incomplete/invalid date qualifier.
Start: 11/01/2017
N798 Submit a void request for the original claim and resubmit a new claim.
Start: 11/01/2017

N799 Submitted identifier must be an individual identifier, not group identifier.
Start: 11/01/2017 | Last Modified: 03/01/2018
Notes: (Modified 3/1/2018)
N800 Only one service date is allowed per claim.
Start: 03/01/2018

N801 Services performed in a Medicare participating or CAH facility under a self-insured tribal Group Health Plan, in accordance with Federal Regulation 42 CFR 136.
Start: 03/01/2018
N802 This claim/service is not payable under our service area. The claim must be filed to the Payer/Plan in whose service area the Rendering Physician is located.
Start: 03/01/2018
N803 Submission of the claim for the service rendered is the responsibility of the Contracted Medical Group or Hospital.
Start: 03/01/2018

N804 Alert: The claim/service was processed through the Outpatient Code Editor (OCE).
Start: 07/01/2018
N805 Alert: The claim/service was processed through the Correct Code Editor (CCE).
Start: 07/01/2018
N806 Payment is included in the Global transplant allowance.
Start: 07/01/2018

N807 Payment adjustment based on the Merit-based Incentive Payment System (MIPS).
Start: 07/01/2018
N808 Not covered for this provider type / provider specialty.
Start: 07/01/2018
N809 Alert: The fee schedule amount for this service was adjusted based on prior competitive bidding rates. For more information, contact your local contractor.
Start: 11/01/2018
N810 Alert: Due to federal, state or local disaster declaration, this claim has been processed at the in-network level of benefit. At the conclusion or expiration of the disaster declaration, network payment rules will be reinstated.
Start: 11/01/2018 | Last Modified: 03/01/2019

N811 Missing Federal Sequestration Reduction from Prior Payer.
Start: 11/01/2018
N812 The start service date through end service date cannot span greater than 18 months.
Start: 11/01/2018
N815 Missing/Incomplete/Invalid NDC Unit Count
Start: 07/01/2019
N816 Missing/Incomplete/Invalid NDC Unit of Measure
Start: 07/01/2019
N817 Alert: Applicable laboratories are required to collect and report private payor data and report that data to CMS between January 1, 2020 – March 31, 2020.
Start: 07/01/2019

N818 Claims Dates of Service do not match Electronic Visit Verification System.
Start: 07/01/2019
N819 Patient not enrolled in Electronic Visit Verification System.
Start: 07/01/2019
N820 Electronic Visit Verification System units do not meet requirements of visit.
Start: 07/01/2019

N821 Electronic Visit Verification System visit not found.
Start: 07/01/2019
N822 Missing procedure modifier(s).
Start: 07/01/2019 | Last Modified: 11/01/2019

N823 Incomplete/Invalid procedure modifier(s).
Start: 07/01/2019 | Last Modified: 11/01/2019
N824 Electronic Visit Verification (EVV) data must be submitted through EVV Vendor.
Start: 11/01/2019

N825 Early intervention guidelines were not met.
Start: 11/01/2019
N826 Patient did not meet the inclusion criteria for the Medicare Shared Savings Program.
Start: 11/01/2019
N827 Missing/Incomplete/Invalid Federal Information Processing Standard (FIPS) Code.
Start: 11/01/2019
N828 Alert: Payment is suppressed due to a contracted funding.
Start: 03/01/2020

N829 Missing/incomplete/invalid Diagnostics Exchange Z-Code Identifier.
Start: 03/01/2020

N830 Alert: The charge[s] for this service was processed in accordance with Federal/ State, Balance Billing/ No Surprise Billing regulations. As such, any amount identified with OA, CO, or PI cannot be collected from the member and may be considered provider liability or be billable to a subsequent payer. Any amount the provider collected over the identified PR amount must be refunded to the patient within applicable Federal/State timeframes. Payment amounts are eligible for dispute pursuant to any Federal/State documented appeal/grievance process(es).
Start: 03/01/2020 | Last Modified: 03/01/2022
Notes: (Modified 3/1/2022)
N831 You have not responded to requests to revalidate your provider/supplier enrollment information.
Start: 03/01/2020
N832 Duplicate occurrence code/occurrence span code.
Start: 07/01/2020
N833 Patient share of cost waived.
Start: 07/01/2020

N834 Jurisdiction exempt from sales and health tax charges.
Start: 11/01/2020
N835 Unrelated Service/procedure/treatment is reduced. The balance of this charge is the patient’s responsibility.
Start: 11/01/2020

N836 Provider W9 or Payee Registration not on file.
Start: 11/01/2020
N837 Alert: Missing modifier was added.
Start: 11/01/2020
N838 Alert: Service/procedure postponed due to a federal, state, or local mandate/disaster declaration. Any amounts applied to deductible or member liability will be applied to the prior plan year from which the procedure was cancelled.
Start: 11/01/2020

N839 The procedure code was added/changed because the level of service exceeds the compensable condition(s).
Start: 03/01/2021
N840 Worker’s compensation claim filed with a different state.
Start: 03/01/2021

N841 Alert: North Dakota Administrative Rule 92-01-02-50.3.
Start: 03/01/2021

N842 Alert: Patient cannot be billed for charges.
Start: 03/01/2021
N843 Missing/incomplete/invalid Core-Based Statistical Area (CBSA) code.
Start: 03/01/2021

N844 This claim, or a portion of this claim, was processed in accordance with the Nebraska Legislative LB997 July 24, 2020 – Out of Network Emergency Medical Care Act.
Start: 03/01/2021
N845 Alert: Nebraska Legislative LB997 July 24, 2020 – Out of Network Emergency Medical Care Act.
Start: 03/01/2021

N846 National Drug Code (NDC) supplied does not correspond to the HCPCs/CPT billed.
Start: 03/01/2021

N847 National Drug Code (NDC) billed is obsolete.
Start: 03/01/2021
N848 National Drug Code (NDC) billed cannot be associated with a product.
Start: 03/01/2021
N849 Missing Tooth Clause: Tooth missing prior to the member effective date.
Start: 03/01/2021

N850 Missing/incomplete/invalid narrative explaining/describing this service/treatment.
Start: 03/01/2021
N851 Payment reduced because services were furnished by a therapy assistant.
Start: 07/01/2021
N852 The pay-to and rendering provider tax identification numbers (TINs) do not match
Start: 07/01/2021
N853 The number of modalities performed per session exceeds our acceptable maximum.
Start: 07/01/2021
N854 Alert: If you have primary other health insurance (OHI) coverage that has denied services, you must exhaust all appeal levels with your primary OHI before we can consider your claim for reimbursement.
Start: 07/01/2021
N855 This coverage is subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.
Start: 07/01/2021

N856 This coverage is not subject to the exclusive jurisdiction of ERISA (1974), U.S.C. SEC 1001.
Start: 07/01/2021
N857 This claim has been adjusted/reversed. Refund any collected copayment to the member.
Start: 11/01/2021

N858 Alert: State regulations relating to an Out of Network Medical Emergency Care Act were applied to the processing of this claim. Payment amounts are eligible for dispute following the state’s documented appeal/ grievance/ arbitration process.
Start: 11/01/2021
N859 Alert: The Federal No Surprise Billing Act was applied to the processing of this claim. Payment amounts are eligible for dispute pursuant to any Federal documented appeal/ grievance/ dispute resolution process(es).
Start: 11/01/2021 | Last Modified: 03/01/2022
Notes: (modified 3/1/2022)

N860 Alert: The Federal No Surprise Billing Act Qualified Payment Amount (QPA) was used to calculate the member cost share(s).
Start: 11/01/2021

N861 Alert: Mismatch between the submitted Patient Liability/Share of Cost and the amount on record for this recipient.
Start: 03/01/2022

N862 Alert: Member cost share is in compliance with the No Surprises Act, and is calculated using the lesser of the QPA or billed charge.
Start: 03/01/2022

N863 Alert: This claim is subject to the No Surprises Act (NSA). The amount paid is the final out-of-network rate and was calculated based on an All Payer Model Agreement, in accordance with the NSA.
Start: 03/01/2022

N864 Alert: This claim is subject to the No Surprises Act provisions that apply to emergency services.
Start: 03/01/2022

N865 Alert: This claim is subject to the No Surprises Act provisions that apply to nonemergency services furnished by nonparticipating providers during a patient visit to a participating facility.
Start: 03/01/2022

N866 Alert: This claim is subject to the No Surprises Act provisions that apply to services furnished by nonparticipating providers of air ambulance services.
Start: 03/01/2022

N867 Alert: Cost sharing was calculated based on a specified state law, in accordance with the No Surprises Act.
Start: 03/01/2022

N868 Alert: Cost sharing was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
Start: 03/01/2022

N869 Alert: Cost sharing was calculated based on the qualifying payment amount, in accordance with the No Surprises Act.
Start: 03/01/2022

N870 Alert: In accordance with the No Surprises Act, cost sharing was based on the billed amount because the billed amount was lower than the qualifying payment amount.
Start: 03/01/2022

N871 Alert: This initial payment was calculated based on a specified state law, in accordance with the No Surprises Act.
Start: 03/01/2022

N872 Alert: This final payment was calculated based on a specified state law, in accordance with the No Surprises Act.
Start: 03/01/2022

N873 Alert: This final payment was calculated based on an All-Payer Model Agreement, in accordance with the No Surprises Act.
Start: 03/01/2022

N874 Alert: This final payment was determined through open negotiation, in accordance with the No Surprises Act.
Start: 03/01/2022

N875 Alert: This final payment equals the amount selected as the out-of-network rate by a Federal Independent Dispute Resolution Entity, in accordance with the No Surprises Act.
Start: 03/01/2022

N876 Alert: This item or service is covered under the plan. This is a notice of denial of payment provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate than the amount paid by the patient in cost sharing.
Start: 03/01/2022

N877 Alert: This initial payment is provided in accordance with the No Surprises Act. The provider or facility may initiate open negotiation if they desire to negotiate a higher out-of-network rate.
Start: 03/01/2022

N878 Alert: The provider or facility specified that notice was provided and consent to balance bill obtained, but notice and consent was not provided and obtained in a manner consistent with applicable Federal law. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited.
Start: 03/01/2022

N879 Alert: The notice and consent to balance bill, and to be charged out-of-network cost sharing, that was obtained from the patient with regard to the billed services, is not permitted for these services. Thus, cost sharing and the total amount paid have been calculated based on the requirements under the No Surprises Act, and balance billing is prohibited.
Start: 03/01/2022

N880 Original claim closed due to changes in submitted data. Adjustment claim will be processed under a new claim number.
Start: 11/01/2022

N881 Client Obligation, patient responsibility for Home & Community Based Services (HCBS)
Start: 11/01/2022

N882 Alert: The out-of-network payment and cost sharing amounts were based on the plan’s allowance because the provider or facility obtained the patient’s consent to waive the balance billing protections under the No Surprises Act.
Start: 11/01/2022

N883 Alert: Processed according to state law
Start: 11/01/2022

N884 Alert: The No Surprises Act may apply to this claim. Please contact payer for instructions on how to submit information regarding whether or not the item or service was furnished during a patient visit to a participating facility.
Start: 11/01/2022

N885 Alert: This claim was not processed in accordance with the No Surprises Act cost-sharing or out-of-network payment requirements. The payer disagrees with your determination that those requirements apply. You may contact the payer to find out why it disagrees. You may appeal this adverse determination on behalf of the patient through the payer’s internal appeals and external review processes.
Start: 11/01/2022

Reference:

https://x12.org/codes/remittance-advice-remark-codes