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Proposed description |
Notes |
1 |
Documentation of unlisted or “by report” BR code was not received. Please resubmit your bill with the appropriate supporting documentation. |
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2 |
Documentation of unlisted or "by report" BR code was not sufficiently documented in the attachments submitted. We are unable to make a payment without supplementary documentation giving a clearer description of the service. Please resubmit your bills with additional supporting documentation. |
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3 |
The documentation does not support the level of service billed. Reimbursement was made for a code that is supported by the description of the service in documentation submitted with the billing. |
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4 |
Reimbursement denied as this service requires prior authorization and none was identified. |
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5 |
The charge for both the technical and professional component of this service have already been paid to another provider. |
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6 |
Documentation indicating the amount of time or begin/end time for this service is required. Documentation was not submitted or did not include the time information. |
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7 |
Missing/incomplete/insufficient requested documentation |
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8 |
Reimbursement for physical therapy assessment or evaluation codes are denied. Provider is not eligible for reimbursement. |
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9 |
Documentation supporting reimbursement for both test and measurements and evaluation and management or assessment and evaluation on the same day is required in accordance with jurisdictional guidelines |
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10 |
Charge exceeds the maximum number of physical therapy modalities in a single visit. Reimbursement is made in accordance with the applicable fee schedule. |
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11 |
Reimbursement denied for physical medicine extended time service. Charges billed without the "initial 30 minutes" base code. |
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12 |
Charges for assessment and evaluation charge is denied. Services are reimbursable once within a 30 day period. The provider has billed for a physical therapy evaluation within the last 30 days. |
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13 |
Reimbursement for physical medicine procedures, including Chiropractic Manipulation and acupuncture codes are denied. Charges exceed the maximum time allowed per visit without prior authorization. |
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14 |
Reimbursement for physical medicine procedures, including Chiropractic Manipulation and Acupuncture codes are denied. Charges exceed the maximum number of modalities allowed per visit without prior authorization. |
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15 |
Reimbursement denied based on jurisdictional guidelines regarding multiple services (cascade). |
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16 |
Reimbursement based on jurisdictional guidelines regarding multiple services (cascade). |
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17 |
Reimbursement for evaluation and management service in addition to physical medicine/acupuncture service provided during the same visit is made in accordance with the applicable fee schedule. |
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18 |
Reimbursement denied. Documentation not submitted or does not support follow-up evaluation and management visit and physical medicine treatment in the same visit. |
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19 |
Reimbursement denied. Provider is not eligible for reimbursement of evaluation and management services. |
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20 |
Reimbursement of the initial casting service is included within the value of a fracture or dislocation reduction service. |
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21 |
Reimbursement is denied. The visit or service billed, occurred within the global surgical period and is not separately reimbursable. |
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22 |
Reimbursement for additional arthroscopic services were reduced in accordance with the applicable surgery guidelines. |
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23 |
Reimbursement for the initial evaluation and management charge was reduced. Reimbursement is made using code 99025 in accordance with surgical guidelines. |
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24 |
Reimbursement for assistant surgeon services are reduced in accordance with surgical guidelines |
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25 |
Reimbursement for surgical assistant services are reduced in accordance with surgical guidelines. |
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26 |
Reimbursement for assistant surgeon services are denied as not normally warranted for this procedure according to surgical guidelines |
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27 |
Reimbursement for multiple surgeon services is not warranted for this procedure according to surgical guidelines. Please provide documentation that supports the need for multiple surgeons. |
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28 |
Reimbursement for service is denied. Administration of local anesthetic is included in the surgical service in accordance with surgical guidelines. |
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29 |
Reimbursement for anesthesia is reduced . Modifier -47 was used to indicate regional anesthesia administered by the surgeon. Time units are not reimbursed in accordance with surgery guidelines. |
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30 |
Patient’s physical status/condition not identified. Please provide documentation using ASA Physical Status indicators. |
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31 |
Reimbursement for evaluation and management service is denied. Documentation does not support a separate significant, identifiable service performed with other services provided on the same day. |
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32 |
Reimbursement for services denied. The billed service does not meet the requirements of a consultation |
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33 |
Reimbursement for services denied. Documentation provided does not support prolonged evaluation and management service. |
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34 |
Reimbursement reduced. Reimbursement is based on a generic equivalent as “No Substitution” documentation was not provided. |
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35 |
Reimbursement for dispensing fee is denied. Dispensing fee is not applicable for over-the-counter medication or medication administered at the time of a visit. |
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36 |
Reimbursement for this item was based on the documented actual cost. |
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37 |
Reimbursement for progress report charges are denied. Charges are reimbursable to the primary treating physician or his/her designee. |
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38 |
The Permanent and Stationary Report charge was disallowed as you are not the Primary Treating Physician or his/her designee. |
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39 |
Reimbursement for additional documentation is denied as duplicate documentation was not requested |
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40 |
No payment is being made for missed appointment, as none is necessarily owed |
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41 |
No reimbursement is being made as this procedure is not usually performed in an outpatient surgical facility. Prior authorization is required but was not submitted. |
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42 |
Service not paid under outpatient facility fee schedule. |
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43 |
This facility has not filed the Election for High Cost Outlier form with the Division of Workers' Compensation. The bill will be reimbursed using the regular reimbursement methodology. |
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44 |
Missing Admission Summary |
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45 |
Missing Prescription Order |
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46 |
Missing Physician Order |
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47 |
Missing Diagnostic Report |
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48 |
Missing Discharge Summary |
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49 |
Missing Nursing Notes |
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50 |
Missing Support Data for Claim |
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51 |
Missing Physical Therapy Notes |
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52 |
Missing Report of Tests and Analysis Report |
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53 |
Missing Doctor First Report of Injury |
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54 |
Missing Supplemental Medical Report |
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55 |
Missing Medical Permanent Impairment |
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56 |
Missing Medical Legal Report |
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57 |
Missing Vocational Report |
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58 |
Missing Work Status Report |
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59 |
Missing Consultation Report |
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60 |
Missing Permanent Disability Report |
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61 |
Missing Itemized Statement |
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62 |
Medical necessity denial. You may submit a request for an appeal/reconsideration. |
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63 |
Appeal/reconsideration denied based on medical necessity. |
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64 |
Reimbursement is denied as there is a visit limitation on Physical Therapy, Chiropractic and Occupational Therapy encounters without prior authorization for additional visits. If you object contact the Utilization Review unit." |
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65 |
According to the Fee Schedule this service has a relative value of zero and therefore no payment is due. |
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66 |
Payment is denied as the service was provided outside the designated Network. |
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67 |
The applicable fee schedule does not contain the billed code. An allowance has been made based on a comparable service. |
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68 |
The applicable fee schedule does not contain the billed code. No payment is being made at this time. Please resubmit a bill with the appropriate fee schedule code(s) that best describe the service(s) provided and supporting documentation if required. |
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