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. Mismatch between the submitted provider information and the provider information stored in our system. Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing. Notes: (Modified 2/28/03, 8/1/05, 3/1/2014) Related to N225, Explicit RARCs have been approved, this non-specific RARC will be deactivated in March 2016. The adjustment request received from the provider has been processed. Your original claim has been adjusted based on the information received.

Paid at the regular rate as you did not submit documentation to justify the modified procedure code. Once we receive the completed forms, we will give you a decision on your appeal within 60 calendar days. The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item. DME, orthotics and prosthetics must be billed to the DME carrier who services the patient's zip code. Data elements are simply the raw data of each transaction, and they function as data fields that comprise the segments within the transaction set. The X12 standard identifies each data element with a reference number as listed in the Data Element Dictionary. In addition, the data element directories for EDIFACT are updated and published every six months by the UNECE (United Nations Economic Commission for Europe). When a U.S. company communicates internationally, these directory updates are crucial for uniformity and for expanding the scope of transaction sets between X12 and UN/EDIFACT. Guidelines for Electronic Interchange of Structured Data Between Computer SystemsWe do not accept blood gas tests results when the test was conducted by a medical supplier or taken while the patient is on oxygen. 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). As the most common EDI standard in the United States, X12 users represent a vast number of businesses and numerous industries. It's especially prominent in the healthcare industry due to HIPPA (Health Insurance Portability and Accountability Act) regulations enacted in 1996. The law requires a national standard for electronic health care transactions. Transaction sets for HIPAA EDI are based on X12. 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.

Information supplied does not support a break in therapy. A new capped rental period will not begin. Information supplied does not support a break in therapy. A new capped rental period will not begin. This is the maximum approved under the fee schedule for this item or service.Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services. 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. Reimbursement has been calculated based on an outpatient per diem or an outpatient factor and/or fee schedule amount.

Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan. Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Usage: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. (Use only with Group Code PR) Services/charges related to the treatment of a hospital-acquired condition or preventable medical error. To use the calculator is as simple as setting the known values and letting the system calculate the rest. This means that you can use this calculator to compute the price per square foot of a property if you know the total price and total square footage.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. Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information. The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. To be used for Property and Casualty only. Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. (Use with Group Code CO or OA)

This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements. Your center was not selected to participate in this study, therefore, we cannot pay for these services. Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Patient submitted written request to revoke his/her election for religious non-medical health care services. Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a comparable service.Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services. 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. Alert: This procedure code was added/changed because it more accurately describes the services rendered.