| # |
Action |
Proposed Description |
Notes |
| 1 |
Changed Code 100 |
Payment made to patient/insured/responsible party/employer. |
Changed Code Description Effective 1/27/08 |
| 2 |
Changed Code 151 |
Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. |
Changed Code Description Effective 1/27/08 |
| 3 |
Changed Code 193 |
Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.
|
Changed Code Description Effective 1/27/08 |
| 4 |
New Code 214 |
Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. (Note: To be used for Workers' Compensation only) |
New Code Effective 1/27/08 |
| 5 |
New Code 215 |
Based on subrogation of a third party settlement |
New Code Effective 1/27/08 |
| 6 |
New Code 216 |
Based on the findings of a review organization |
New Code Effective 1/27/08 |
| 7 |
New Code 217 |
Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. (Note: To be used for Workers' Compensation only) |
New Code Effective 1/27/08 |
| 8 |
New Code 218 |
Based on entitlement to benefits (Note: To be used for Workers' Compensation only) |
New Code Effective 1/27/08 |
| 9 |
New Code 219 |
Based on extent of injury (Note: To be used for Workers' Compensation only) |
New Code Effective 1/27/08 |
| 10 |
New Code 220 |
The applicable fee schedule does not contain the billed code. Please resubmit a bill with the appropriate fee schedule code(s) that best describe the service(s) provided and supporting documentation if required. (Note: To be used for Workers' Compensation only) |
New Code Effective 1/27/08 |
| 11 |
New Code 221 |
Workers' Compensation claim is under investigation. (Note: To be used for Workers' Compensation only. Claim pending final resolution) |
New Code Effective 1/27/08 |
| 12 |
New Code D22 |
Reimbursement was adjusted for the reasons to be provided in separate correspondence. (Note: To be used for Workers' Compensation only) - Temporary code to be added for timeframe only until 01/01/2009. Another code to be established and/or for 06/2008 meeting for a revised code to replace or strategy to use another existing code |
New Code Effective 1/27/08. End Date 1/1/09 |
| 13 |
Not needed |
On the same day, reimbursement for this report is included with reimbursement for other services, therefore, a separate payment is denied. |
Use code #97 with appropriate remarks code. M-86 modified to add report |
| 14 |
Withdrawn |
This report does not fall under the jurisdictional guidelines for a separately reimbursable report |
Remittance Advice Rremark Code to be requested instead |
| 15 |
Withdrawn |
Service not reimbursable under an outpatient facility fee schedule. Charges are reimbursed according to the applicable fee schedule. |
Remittance Advice Rremark Code to be requested instead |
| 16 |
Not needed |
Additional payment made on appeal/reconsideration. |
|
| 17 |
Not needed |
Denial based on subrogation of a third party settlement. |
|
| 18 |
Not needed |
Payment of interest/penalty to provider. |
AMT in CLP is to be used. PLB is then used for the financial transaction. – Reference front-matter – section 1.10.2.9 - 5010 |
| 19 |
Not needed |
The applicable fee schedule does not contain the billed code. An allowance has been made based on a comparable service. |
Use SVC01 and SVC06 as specified in the guide. |
| 20 |
Not needed |
The applicable fee schedule indicates this service has a relative value of zero, therefore, no payment is due. |
Use W1 instead |
| 21 |
Not needed |
The charge was denied as the report/documentation does not indicate that the service was performed. |
Use code 112 |
| 22 |
Not needed |
This service is normally part of a panel. Reimbursement is made under the appropriate panel code. |
Per front matter of the guide – must use 97 and 94 in bundling and unbundling.
1.10.2.6 – 5010 guide If straight panel paid/adjusted as appropriate.
|
| 23 |
Not needed |
No separate payment was made because the value of the service is included within the value of another service performed on the same day. |
Per front matter of the guide – must use 97 and 94 in bundling and unbundling. |
| 24 |
Not needed |
The workers' compensation claim has not been accepted and the mandatory medical reimbursements have been made. Should the claim be accepted, your bill will then be reconsidered. The determination must be made by the stated jurisdictional time frame from the date of injury. |
Use code 138 and utilize remittance remark codes for time frame. |
| 25 |
Not needed |
Until the employee’s claim is accepted or rejected, liability for medical treatment is limited according to jurisdictional guidelines. Your bill is being partially paid as this payment will complete the mandatory reimbursement limit per jurisdictional guidelines. Should the claim be accepted, the remainder of your bill will then be reconsidered. Acceptance or denial of the claim must be made no later than the jurisdictional stated time frame from the date of injury. |
Use code 119 |
Comments (0)
You don't have permission to comment on this page.