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#CODE OF VA 55 243 CODE#
Use code 96.Ĥ7 This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Insured has no coverage for newborns.ģ5 Lifetime benefit maximum has been reached.ģ6 Balance does not exceed co-payment amount.ģ8 Services not provided or authorized by designated (network/primary care) providers.ģ9 Services denied at the time authorization/pre-certification was requested.Ĥ0 Charges do not meet qualifications for emergent/urgent care.Ĥ1 Discount agreed to in Preferred Provider contract.Ĥ2 Charges exceed our fee schedule or maximum allowable amount.Ĥ5 Charges exceed your contracted/ legislated fee arrangement.Ĥ6 This (these) service(s) is (are) not covered.
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Insured has no dependent coverage.ģ4 Claim denied. ģ1 Claim denied as patient cannot be identified as our insured.ģ2 Our records indicate that this dependent is not an eligible dependent as defined.ģ3 Claim denied. Redundant to codes 26&27.Ģ9 The time limit for filing has expired.ģ0 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.
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Your Stop loss deductible has not been met.Ģ7 Expenses incurred after coverage terminated.Ģ8 Coverage not in effect at the time the service was provided. Charges are covered under a capitation agreement/managed care plan.Ģ5 Payment denied. Additional information is supplied using the remittance advice remarks codes whenever appropriate.ġ9 Claim denied because this is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.Ģ0 Claim denied because this injury/illness is covered by the liability carrier.Ģ1 Claim denied because this injury/illness is the liability of the no-fault carrier.Ģ2 Payment adjusted because this care may be covered by another payer per coordination of benefits.Ģ3 Payment adjusted due to the impact of prior payer(s) adjudication including paymentsĢ4 Payment for charges adjusted. Additional information is supplied using remittance advice remarks codes whenever appropriate Note: Changed as of 2/02ġ7 Payment adjusted because requested information was not provided or was insufficient/incomplete. 4 The procedure code is inconsistent with the modifier used or a required modifier is missing.ĥ The procedure code/bill type is inconsistent with the place of service.Ħ The procedure/revenue code is inconsistent with the patient's age.ħ The procedure/revenue code is inconsistent with the patient's gender.Ĩ The procedure code is inconsistent with the provider type/specialty (taxonomy).ĩ The diagnosis is inconsistent with the patient's age.ġ0 The diagnosis is inconsistent with the patient's gender.ġ1 The diagnosis is inconsistent with the procedure.ġ2 The diagnosis is inconsistent with the provider type.ġ3 The date of death precedes the date of service.ġ4 The date of birth follows the date of service.ġ5 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.ġ6 Claim/service lacks information which is needed for adjudication.