Claim Denial Codes List as of 03/01/2021

1 CodeDescriptionCodeDescriptionUC Modifier/Condition Code missing2 Invalid pickup location destination not authorized for Claim Modifier is missing or invalid for particular waiver or invalid modifier2 Invalid Procedure to modifier2 Invalid modifier for procedure code. See provider manual, section 2 for modifier modifier for transport2 Procedure requires modifier. Please rebill with correct destination modifier2 History procedure incidental to other current not covered by Medicaid when service provided in outpatient - was for routine bill type3 Service billed not compatible with patient location. Procedure is payable only if client lives in a rural county (not Weber, Davis, Utah, Salt Lake)3 Place of service must be of service limit for procedure3 Invalid place of service for procedure.

2 Only covered through a Procedure is not appropriate for patients Recipient age for procedure services are for clients age 20 or under. Do not bill with mother s ID and B procedure code is age related or free vaccine is available through VFC service is not a covered benefit for a person over 21 years of code is inconsistent with patients age, replaced with appropriate procedure/revenue code is inconsistent with the patient's eligible due to the patient's recipients 21 and over, this procedure must be performed in conjunction with an gender invalid for is sex specific. Client is the wrong sex for procedure. Verify ID#.3 The procedure code is inconsistent with the patient s gender. Replaced with appropriate procedure code is inconsistent with the provider type/specialty (taxonomy).

3 Proc cd not payable to FQHC3 Procedure code not payable to provider type. See manual sections 2, 7 and office lab services procedure code for age conflicts with the age limit for the on preadmission form 10A is inconsistent with patient age. Call preadmission is sex specific. Recipient is opposite sex for on preadmission request - form 10A is for male/female only, call preadmission Denial Codes Listas of 03/01/2021 Claim Adjustment Reason Code (CARC)Remittance Advice Remark Code (RARC)Medicaid Denial Reason COREB usinessScenario5 The procedure code/type of bill is inconsistent with the place of procedure code/type of bill is inconsistent with the place of place of procedure code is inconsistent with the modifier procedure code is inconsistent with the modifier combination of HCPCS procedure code is inconsistent with the provider type/specialty (taxonomy).

4 N95 This provider type/provider specialty may not bill this diagnosis is inconsistent with the patient's procedure/revenue code is inconsistent with the patient's procedure/revenue code is inconsistent with the patient's diagnosis is inconsistent with the patient's is catch all DRG3 Procedure and Diagnosis combination not inpatient psychiatric care must have prior authorization and use psych procedure Codes - see MIB 87-423 The diagnosis is inconsistent with procedure3 Diagnosis does not indicate necessity for emergency Inconsistent with Procedure - ESRD3 Diagnosis Inconsistent with Procedure - Non-ESRD3 Diagnosis is inconsistent with has expired while on Medicare2 ESRD requires CPT-4 code2 Revenue code must be billed with correct CPT-4 procedure lacks information or has submission/billing error(s).

5 Do not use this code for claims attachment(s)/other number of miles number of miles2No match found on history adjustment2 Invalid document number2 Missing revenue revenue code - code not on lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other procedure code(s).Missing procedure code - please bill with correct date of service greater than last date of first date of service2PA start date greater than end date2 Missing units of prior authorization units of service2On size error, can t compute2 Units are greater than number of service days2 Units required for revenue prior authorization estimated days of stay2 Service exceed 100 lines for date2 Missing total Claim charge. Please rebill with correct of item(s) and total charge are not equal.

6 Please correct and total non/covered charge2 Sum of items exceeds total amount is greater than total net charge amount216 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other "to" date(s) of last date of service2 Missing ICD-9 surgical Incidental services reported OCE 272 Missing diagnosis code2 Missing a related diagnosis2 All Diagnosis Invalid216 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other place of place of service2No charge submitted on this line. Please rebill with correct extra charge amount2 Invalid allowed charge amount2 Submitted charge not equal the rate times the unit(s)211 The diagnosis is inconsistent with the diagnosis is inconsistent with the should be billed with the appropriate code for these date of death precedes the date of lacks information or has submission/billing error(s).

7 Do not use this code for claims attachment(s)/other revenue code(s).16 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other "from" date(s) of lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other 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).16 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other other procedure code(s).16 Claim /service lacks information or has submission/billing error(s).

8 Do not use this code for claims attachment(s)/other diagnosis or condition16 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other days or units of lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other total lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other admin drug Codes require NDC2 PDL Drug - Non Preferred216 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other name, strength, or dosage of the drug code must be billed in exact multiples of the package lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other individual lab Codes included in the Panels Have Been Unbundled2 Point of Sale crossover Claim missing/invalid other payer information regarding primary payer amount216 Claim /service lacks information or has submission/billing error(s).

9 Do not use this code for claims attachment(s)/other type of inpatient type of of service missing please rebill with correct each surgery by single date of service2 First date of service greater than last2 Invalid action date incorrect dates in boxes 14 through day less than covered days2 Total days billed is not equal to the dates of service covered total days2 Covered days in field 7 does not equal covered units of room and board in field total days billed216 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other Missing/incomplete/invalid noncovered days during the billing was in hospital for all/part of the date(s) of service on Claim - indicate hospital leave name missing2 Baby s first name name missing216 Claim /service lacks information or has submission/billing error(s).

10 Do not use this code for claims attachment(s)/other sex code2 Admit date after 1st service date2 Missing admission lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other admission type of admission216 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other admission source or type of admission216 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other patient patient status216 Claim /service lacks information or has submission/billing error(s). Do not use this code for claims attachment(s)/other release of information of information not lacks information or has submission/billing error(s).