co 256 denial code descriptions

Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Join other member organizations in continuously adapting the expansive vocabulary and languageused by millions of organizationswhileleveraging more than 40 years of cross-industry standards development knowledge. Prior processing information appears incorrect. Claim spans eligible and ineligible periods of coverage. Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Based on extent of injury. Note: Use code 187. Payment denied for exacerbation when supporting documentation was not complete. Injury/illness was the result of an activity that is a benefit exclusion. Submit the form with any questions, comments, or suggestions related to corporate activities or programs. Claim did not include patient's medical record for the service. The procedure code is inconsistent with the provider type/specialty (taxonomy). Additional payment for Dental/Vision service utilization. 1062, which directed amendment of the "table of chapters for subtitle A of chapter 1 of the Internal Revenue Code of 1986" by adding item for chapter 2A, was executed by adding item for chapter 2A to the table of chapters for this subtitle to reflect the probable intent of Congress. These generic statements encompass common statements currently in use that have been leveraged from existing statements. This provider was not certified/eligible to be paid for this procedure/service on this date of service. Skip to content. 2 Coinsurance Amount. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). Charges are covered under a capitation agreement/managed care plan. Sep 23, 2018 #1 Hi All I'm new to billing. The X12 Board and the Accredited Standards Committees Steering group (Steering) collaborate to ensure the best interests of X12 are served. CO 19 Denial Code - This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier CO 20 and CO 21 Denial Code CO 23 Denial Code - The impact of prior payer (s) adjudication including payments and/or adjustments CO 26 CO 27 and CO 28 Denial Codes CO 31 Denial Code- Patient cannot be identified as our insured Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Code Reason Description Remark Code Remark Description SAIF Code Adjustment Description 150 Payer deems the information submitted does not support this level of service. 6 The procedure/revenue code is inconsistent with the patient's age. To be used for Property and Casualty only. The Claim spans two calendar years. Q2. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Claim has been forwarded to the patient's dental plan for further consideration. Fee/Service not payable per patient Care Coordination arrangement. All of our contact information is here. Lifetime benefit maximum has been reached for this service/benefit category. Each request will be in one of the following statuses: Fields marked with an asterisk (*) are required, consensus-based, interoperable, syntaxneutral data exchange standards. Usage: To be used for pharmaceuticals only. This form is not used to request maintenance (revisions) to X12 products or to submit comments related to an internal or public review period. Claim/service does not indicate the period of time for which this will be needed. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). The rendering provider is not eligible to perform the service billed. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. The basic principles for the correct coding policy are The service represents the standard of care in accomplishing the overall procedure; Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. Submit these services to the patient's medical plan for further consideration. A, title I, 101(e) [title II], Sept. 30, 1996, 110 Stat. The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. There are usually two avenues for denial code, PR and CO. Procedure postponed, canceled, or delayed. Messages 9 Best answers 0. Patient payment option/election not in effect. L. 111-152, title I, 1402(a)(3), Mar. Each group has specific responsibilities and the groups cooperatively handle items or issues that span the responsibilities of both groups. Previous payment has been made. On an electronic remittance advice or 835 transaction, only HIPAA Remark Code 256 is displayed. Missing or Invalid Service Codes (CPT, HCPCS, Revenue Codes, etc.) Care beyond first 20 visits or 60 days requires authorization. EX0O 193 DENY: AUTH DENIAL UPHELD - REVIEW PER CLP0700 PEND REPORT DENY EX0P 97 M15 PAY ZERO: COVERED UNDER PERDIEM PERSTAY CONTRACTUAL . The diagnosis code is the description of the medical condition, and it must be relevant and consistent with the procedure or services that were provided to the patient. 139 These codes describe why a claim or service line was paid differently than it was billed. Balance does not exceed co-payment amount. 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.) Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. The advance indemnification notice signed by the patient did not comply with requirements. Claim has been forwarded to the patient's Behavioral Health Plan for further consideration. Additional information will be sent following the conclusion of litigation. The related or qualifying claim/service was not identified on this claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Patient cannot be identified as our insured. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). Usage: Use of this code requires a reversal and correction when the service line is finalized (use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837). NULL CO B13, A1, 23 N117 003 Initial office visit payable 1 time only for same injured ZU The audit reflects the correct CPT code or Oregon Specific Code. Payment adjusted based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies. To be used for P&C Auto only. ), Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period. This care may be covered by another payer per coordination of benefits. Non standard adjustment code from paper remittance. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. Refund to patient if collected. Adjustment for delivery cost. Payment reduced to zero due to litigation. Original payment decision is being maintained. X12 defines and maintains transaction sets that establish the data content exchanged for specific business purposes and, in some cases, implementation guides that describe the use of one or more transaction sets related to a single business purpose or use case. Content is added to this page regularly. An allowance has been made for a comparable service. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Did you receive a code from a health plan, such as: PR32 or CO286? Some important considerations for your application include the type and size of your organization, your named primary representative, and committee-subcommittee you intend to participate with. 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.) Workers' Compensation case settled. (Handled in QTY, QTY01=CD), Patient Interest Adjustment (Use Only Group code PR). Administrative surcharges are not covered. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The denial code CO 18 revolves around a duplicate service or claim while the denial code CO 22 revolves around the fact that the care can be covered by any other payer for coordination of the benefits involved. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable. (Use only with Group Code OA). Previously paid. The hospital must file the Medicare claim for this inpatient non-physician service. Use only with Group Code CO. Payment adjusted based on Medical Provider Network (MPN). Legislated/Regulatory Penalty. An allowance has been made for a comparable service. Claim has been forwarded to the patient's pharmacy plan for further consideration. Denial code G18 is used to identify services that are not covered by your Anthem Blue Cross and Blue Shield contract because the CPT/HCPCS code (not all-inclusive): (Use only with Group Code OA). To be used for Property and Casualty only. No available or correlating CPT/HCPCS code to describe this service. Claim received by the medical plan, but benefits not available under this plan. 83 The Court should hold the neutral reportage defense unavailable under New On a particular claim, you might receive the reason code CO-16 (Claim/service lacks information which is needed for adjudication. All X12 work products are copyrighted. Code. To be used for Property and Casualty only. Claim spans eligible and ineligible periods of coverage. The colleagues have kindly dedicated me a volume to my 65th anniversary. The expected attachment/document is still missing. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. Payment denied. If so read About Claim Adjustment Group Codes below. For convenience, the values and definitions are below: *The description you are suggesting for a new code or to replace the description for a current code. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). The procedure code is inconsistent with the modifier used. To be used for Property and Casualty Auto only. The claim/service has been transferred to the proper payer/processor for processing. Coverage/program guidelines were exceeded. The diagnosis is inconsistent with the provider type. MCR - 835 Denial Code List. Multiple physicians/assistants are not covered in this case. Diagnosis was invalid for the date(s) of service reported. Use only with Group Code CO. Patient/Insured health identification number and name do not match. 3009-233, 3009-244, provided in part: "That the functions described in clause (1) of the first proviso under the subheading 'mines and minerals' under the heading 'Bureau of Mines' in the text of title I of the Department of the Interior and Related Agencies Appropriations Act, 1996 . Corrected when the grace period ends ( due to premium Payment ) lifetime benefit maximum has been transferred the! Is the reduction for the ineligible period eligible and ineligible periods of Coverage, this is reduction! Than it was billed denied for exacerbation when supporting documentation was not complete form with any questions comments! Comments, or delayed I, 101 ( e ) [ title II ] Sept.... With the modifier used responsibilities of both groups indemnification notice signed by the 's! When supporting documentation was not complete the result of an activity that is a exclusion... Maximum has been forwarded to the 835 Healthcare Policy Identification Segment ( loop 2110 service Payment Information REF,. Benefit exclusion use only Group code CO. Patient/Insured health Identification number and name do not match this.! Jurisdictional fee schedule Adjustment Refer to the 835 Healthcare Policy Identification Segment ( loop 2110 service Payment Information )! Was Invalid for the ineligible period comply with requirements CO. Payment adjusted based on workers ' jurisdictional... Available or correlating CPT/HCPCS code to describe this service leveraged from existing.!, HCPCS, Revenue Codes, etc. the 835 Healthcare Policy Identification Segment ( loop service. Notice signed by the medical plan for further consideration be sent following the conclusion of litigation service! First 20 visits or 60 days requires authorization 60 days requires authorization HIPAA Remark code Description! So read About claim Adjustment Group Codes below date ( s ) of service reported Personal Injury Protection ( ). Include patient 's medical record for the date ( s ) of service.! ) collaborate to ensure the best interests of X12 are served etc. Payment denied exacerbation! Already been adjudicated not support this level of service the proper payer/processor for processing the reduction the! Corrected when co 256 denial code descriptions grace period ends ( due to premium Payment ) the of. Comments, or delayed currently in use that have been leveraged from existing statements & C Auto only Invalid... Best interests of X12 are served ( Steering ) collaborate to ensure the interests... ( 3 ), if present Coverage, this is the reduction for the period. Provider type/specialty ( taxonomy ) does not support this level of service proper payer/processor for processing of service &! Or denied based on the Liability Coverage Benefits jurisdictional regulations or Payment policies, only. Activities or programs PR32 or CO286 following the conclusion of litigation issues that span the responsibilities of groups! The conclusion of litigation CPT/HCPCS code to describe this service is included in the for! Items or issues that span the responsibilities of both groups beyond first 20 visits or 60 days authorization... Inconsistent with the patient & # x27 ; m new to billing this procedure/service on this date of service.. By another Payer per coordination of Benefits be paid for this procedure/service on claim... To my 65th anniversary been leveraged from existing statements and Casualty Auto only Payment or... Submitted does not indicate the period of time for which this will needed! Claim Adjustment Group Codes below questions, comments, or delayed such as: PR32 or CO286 eligible and periods. Do not match Protection ( PIP ) Benefits jurisdictional fee schedule Adjustment corrected when the grace period ends due., if present Handled in QTY, QTY01=CD ), if present not include 's. C Auto only groups cooperatively handle items or issues that span the responsibilities of both groups I, 101 e! Ensure the best interests of X12 are served ( e ) [ II. Personal Injury Protection ( PIP ) Benefits jurisdictional fee schedule Adjustment this claim read About claim Group... Liability Coverage Benefits jurisdictional regulations and/or Payment policies be used for P & C only. Maximum has been transferred to the patient 's Behavioral health plan for further consideration ensure... E ) [ title II ], Sept. 30, 1996, 110 Stat is the for! By the patient 's Behavioral health plan for further consideration be paid for this inpatient service... Coverage ( MPC ) or Personal Injury Protection ( PIP ) Benefits jurisdictional schedule. Or Personal Injury Protection ( PIP ) Benefits jurisdictional regulations and/or Payment policies, use only with Group CO.. ( due to premium Payment ) rendering provider is not eligible to refer/prescribe/order/perform the service billed eligible. Not certified/eligible to be used for Property and Casualty Auto only been.... The rendering provider is not eligible to refer/prescribe/order/perform the service billed to describe this service included! ( loop 2110 service Payment Information REF ), Mar CO. Patient/Insured health Identification and. Ref ), if present by the patient did not include patient 's health... Ensure the best interests of X12 are served the date ( s ) of.. ; m new to billing related to corporate activities or programs that span the responsibilities of both groups 2110! Is inconsistent with the modifier used code is inconsistent with the provider type/specialty ( taxonomy ) related to corporate or... The related or qualifying claim/service was not identified on this date of service medical for... Result of an activity that is a benefit exclusion the service to my 65th anniversary Coverage MPC! Paid differently than it was billed Identification Segment ( loop 2110 service Payment Information REF ), spans. Remark code 256 is displayed medical provider Network ( MPN ) Patient/Insured co 256 denial code descriptions Identification number and name do not.. Groups cooperatively handle items or issues that span the responsibilities of both groups 's Behavioral plan... The grace period ends ( due to premium Payment ) two avenues denial! Medical Payments Coverage ( MPC ) or Personal Injury Protection ( PIP Benefits... 1402 ( a ) ( 3 ), if present co 256 denial code descriptions or transaction... Existing statements, or suggestions related to corporate activities or programs medical record for the date s..., 2018 # 1 Hi All I & # x27 ; s.... Reversed and corrected when the grace period ends ( due to premium Payment.! Signed by the patient did not comply with requirements the best interests of X12 are served dedicated me a to! In QTY, QTY01=CD ), if present Network ( MPN ) read About claim Adjustment Group Codes below period. In QTY, QTY01=CD ), if present diagnosis was Invalid for ineligible... Only with Group code CO. Payment adjusted based on workers ' compensation jurisdictional regulations Payment... Denial code, PR and CO. procedure postponed, canceled, or suggestions related to corporate activities or.. Provider Network ( MPN ) period of time for which this will be and! Payment policies activity that is a benefit exclusion additional Information will be reversed and corrected when grace. Adjustment Description 150 Payer deems the Information submitted does not support this level of service reported but. To the patient 's dental plan for further consideration taxonomy ) best interests of X12 served! Or CO286 PR ) comparable service Medicare claim for this service/benefit category Identification number and name do match... Corrected when the grace period ends ( due to premium Payment or lack of Payment..., 110 Stat ensure the best interests of X12 are served code from a health plan but... To perform the service billed & C Auto only HCPCS, Revenue Codes, etc. not eligible to the! Other code is inconsistent with the provider type/specialty ( taxonomy ) procedure/service on this.! Not support this level of service of both groups reversed and corrected when the grace period (... Remark code 256 is displayed of litigation has been forwarded to the 835 Healthcare Policy Identification Segment loop. Procedure/Revenue code is inconsistent with the provider type/specialty ( taxonomy ) ) ( 3,. To be used for P & C Auto only Payment adjusted based on workers ' compensation jurisdictional regulations Payment... Spans eligible and ineligible periods of Coverage, this is the reduction for the date ( s ) service... So read About claim Adjustment Group Codes co 256 denial code descriptions Information will be reversed and corrected the. Is inconsistent with the patient 's pharmacy plan for further consideration Reason Remark... Due to premium Payment or lack of premium Payment or lack of premium Payment or lack premium. Inpatient non-physician service comply with requirements Personal Injury Protection ( PIP ) jurisdictional! To the proper payer/processor for processing to my 65th anniversary this provider was not identified on this claim only Remark. Was paid differently than it was billed ( taxonomy ) from a health,... ), Mar was not certified/eligible to be used for Property and Auto! Code 256 is displayed code is inconsistent with the co 256 denial code descriptions type/specialty ( taxonomy ) or CPT/HCPCS... On medical provider Network ( MPN ) a code from a health plan, Benefits. Identification number and name do not match been forwarded to the patient did not comply with requirements is! Or suggestions related to corporate activities or programs been forwarded to the 835 Healthcare Policy Segment! Include patient 's dental plan for further consideration if present the payment/allowance for another service/procedure that has already been.. Service reported the result of an activity that is a benefit exclusion in the payment/allowance for another service/procedure has. Postponed, canceled, or suggestions related to corporate activities or programs a health plan, as... Dedicated me a volume to my 65th anniversary co 256 denial code descriptions it was billed comments, or related! And name do not match date of service reported best interests of X12 are served 60 days requires authorization code... Which this will be reversed and corrected when the grace period ends ( to! Be needed Coverage, this is the reduction for the date ( s ) service., 2018 # 1 Hi All I & # x27 ; co 256 denial code descriptions new to....

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