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BILLCBILLEBUNDREFUND DUE TO BILLING CORRECTION FROM PROVIDERPROVIDER BILLING ERRORBundled ServiceCHIROALL CHIRO CLAIMS NEED TO BE SUBMITTED THROUGH COLUMBINE CHIROPRACTICE SERVICESCM302Only one family planning visit allowed per date of service.COFINSUBMIT CLAIMS THROUGH COFINITY EDI PAYER #38335.CON510CONTRPer contract clinic visit billed with a revenue code 510 code is not payable. Member not liablePaid at contracted rateCRATECOFINITY NEGOTATED CASE RATE INCLUDES WELL BABY DISCHARGED 4D37D39D40D41D42D43D45D46SERVICE RESPONSIBILITY OF LAB CORP ONLYNew Member LetterRequires manual processing.Billed amount exceeds UCR.Co-Surgeon Not CoveredTeam Surgeon Not CoveredMedical review denial.Triage only - not life threatening.Requires authorized referral.Member not enrolled on DOS.Member was not enrolled with this Medical Group on DOS .Patient not enrolled with Plan.Service not a plan benefit.Included in other procedure.Limited service exceeded.Assistant surgeon not covered.Incorrect Plan ID code.Incorrect AHCCCS ID code.Unauthorized provider.Duplicate Claim (Provider/Member/DOS)Claim submit time exceeded.Procedure code not on file.Diagnosis code not on file.Member ID number invalid.Category of service invalid.Stat charges are not covered.Service a part of lab contract.Service a part of Rx contract.Included in capitation.Submitted to plan in error.Services exceed Psych benefit.Plan not notified in time.Member responsible for charges.W/O contractual agreement.Reduce to urgent care.No stat order.Adjust to authorized level of care.No response to COB inquiry.

8D79D80D81D82D83D84D85D86D87D88D89Requires H&P.Included in OB package.Split billing required.Authorization number invalid for DOS.Revenue code missing / invalid.DOS incorrect.Claim has been denied. At DOS, assigned to other PCP.The Provider is not a member of the UHC PPO Network.DME rental costs have exceeded purchase price.Patient not enrolled with plan.CPT code terminated.Denied: Workmens Compensation.N/C. Routine well baby.Non-emergent services. Medical review denial.Plan not advised in 72 hrs. Medical review denial.Claim Doesn't have any Service LinesElectronic Claim has COBDuplicate Line on Same ClaimPrior authorization is closed.Prior authorization services do not match claim.Prior authorization is denied.Prior authorization cost estimate exceeded.Prior authorization not for same member.Prior authorization is not for same provider.Provider's specialty does not match authorized specialtyProvider's group does not match authorized groupProvider's network does not match authorized networkProvider's participation status does not match authorizedProvider type does not match authorized provider typePlace of service does not match authorizedPrior authorization is pended.Prior authorization not found.Prior authorization has no units available.Prior authorization has insufficient units remainingCPT codes billed include bundled and unbundledInvalid ICD9 Procedure CodeInvalid ICD-9 Diagnosis CodeDiagnosis not valid for BenefitTeam Surgeon not coveredCo-Surgeon not CoveredClaim line exceeds available bed days on auth.Authorization line item denied.DELIVMEDICAID REQUIREMENTS IF MOM & BABY ARE DISCHARGED SAME DAY CHARGES MUST BE COMBINED.DELTADENYDH450DH541BILL TO DELTA DENTALNOT COVEREDEmergency services paid on new additional claim.TIMELY FILING

LTDHTWTDHVALDHVFCDHWINDIALDKTVDNADBADJUSTMENT FOR CONTRACT FEE SCHEDULE CORRECTIONERROR ADJUSTMENTCORRECTED CLAIM ADJUSTMENTThis is an adjustment to previous claim.INCORRECT PROVIDEROUT OF POCKET ADJUSTMENTThis claim is considered part of global contract agreement. No additional payment will be madeCHECK VOIDED INCORRECT PROVIDERNO FACTOR IN THE FEE SCHEDULE.CLAIM LINE OVERLAPS CONTRACT AFFILIATION TERM DATEPAID PER CMS CAH RATE LETTERCapped rental period reached. No further rental payments may be made.Medicaid cost-to-charge allowableINVALID CLAIM FORM TYPEPaid per % CHP Plus fee scheduleINVALID CONDITION CODE ON DOSADJUSTED PER PROVIDER REQUESTCLAIM LINE OVERLAPS CONTRACT TERM TERMINATION DATE.DIAGNOSIS POINTER REQUIRED ON SERVICE LINE FOR DIAGNOSIS CODESEAPG PRICING APPLIEDINPATIENT CLAIM / UM EXISTS FOR SAME DOS AS ER CLAIMIncluded in dialysis composite rate.CLAIM LINE OVERLAPS FEE TABLE VALUE TERMINATION DATE.Rebill with correct ICD-10 CodeREQUIRE ITEMIZED BILLMULTIPLE SURGERIES - CLAIM SUBMITTED MISSING MODIFIER 51INVALID MEDICARE COB AMOUNTINVALID MODIFIER CODE ON DOSInvalid/Missing NDC CodeInvalid NDC and J Code Combination.New born not covered under the Med Adv ProgramINVALID OCCURRENCE CODE ON DOSINVALID OCCURRENCE SPAN CODEINVALID POA INDICATOR ON DIAGNOSIS CODE.DIAGNOSIS CODE REQUIRES POA INDICATORINVALID PLACE OF SERVICE CODEClaim must be split with ICD-9 codes prior to 10/1/15 and ICD-10 codes for 10/1/15 and laterHT AND WT REQD TO CALC DIALYSIS PAYMENTINVALID VALUE CODE ON DOSVACCINE IS SUPPLIED THROUGH THE VFC PROGRAMCLAIM LINE SUBMISSION WINDOW OVERLAPOccurrence Code of Date of last Kt/V reading missingAUTH DENIED - BENEFIT EXCEEDEDHEMATOCRIT VALUE REQDDNMCADNPRIPRIMARY INSURANCE ALLOWED MEDICAID ALLOWABLE - IT IS A CONTRACTUAL ADJUSTMENT.PRIMARY PMT IS GREATER THAN ALLOWABLE CHARGE BALANCE IS A CONTRACTUAL ADJUSTMENT.DUPOCDuplicate of an original claim already in process

DUPPDDUPLICATE OF A PREVIOUSLY PAID CLAIMDV49VALUE CODE A8 OVER 500KG DIALYSISEQUIPEQUIPMENT INCLUDED WITH RENTAL/PURCHASEESRDPayment based on 2014 ESRD Pricer.EXCEDSERVICES EXCEEDED PLAN BENEFIT LIMITEXCLEXCOTRTHESE SERVICES ARE NOT COVERED UNDER THE PLANCoverage terminated for non-payment of PremiumEXCVISERVICES EXCEEDED PLAN VISIT LIMITEXHTEXMBEXMREXNCEXUVREQ MED RECS FOR DIALYSIS QTYTHESE SERVICES ARE NOT COVERED UNDER THE PLAN. MEMBER MAY BE LIABLE.DIALYSIS CLM OVER QTY FOR REV CODE 634THESE SERVICES ARE NOT COVERED UNDER THE PLAN FOR OUT OF NETWORK.VALUE CODE A9 OVER 300CM DIALYSISFM178COLORADO MEDICAL ASSISTANCE PROGRAM STERILIZATION CONSENT FORM MED 178 IS REQUIRED IN ORDER TO PROPERLY ADJUDICATETHE CLAIM.FWAGLOB1FRAUD WASTE AND ABUSEService included in payment for surgical procedure.GLOBLTHIS SERVICE IS COVERED UNDER GLOBAL PERIODGRACEH1H2GRACE DAYCredit applied for prior RAP paymentTherapy Threshold not metINGLOLIFETSERVICES INCLUDED WITH NEGOTIATED OR GLOBAL RATESERVICES EXCEEDED PLAN LIFETIME 037M0038M0039M0040M0041M0042Provider Not Active for Plan on DOSInvalid Approved Provider Service for ProviderReferral Required by ContractIncorrect age for Nursery chargesBenefit Requires Prior AuthorizationBenefit Visit Limit ExceededBenefit Dollar Limit ExceededBenefit Applies to PCP OnlyAdmit Date Required for Inpatient ClaimAttending Physician Required for Inpatient ClaimsInvalid Bill TypeInterim Claim with no Initial ClaimDuplicate Claim Line(Member/DOS/CPT(Rev))Invalid CPT ModifierInvalid CPT/HCPCSInvalid Revenue CodeModifier required for CPT/HCPCSRevenue Code Requires HCPCSPhysicians Assistant requires Modifier 80 or 27CRNA requires Modifier AAInvalid Line Date of ServiceInvalid Start DateInvalid End DateInvalid Discharge StatusInvalid Revenue Code for Bill Type

0M11M12M14M16M2M3Invalid HCPCS for Revenue CodeClaim Tiers Do Not Match ReferralMissing Primary DiagnosisAdmit Type RequiredDischarge Status RequiredInvalid For MaleInvalid For FemaleNo EnrollmentDuplicate Claim (Member/DOS)Coverage Period Insufficient for Benefit CoverageMember has no active enrollment on DOSProvider is not part of Network required for BenefitService is capitated to PCP or IPANo Attending Physician ID (Outpatient)Provider is Not CredentialedClaim amount exceeds maximum allowed during Mass AdjudicationNegative charge on claim lineProvider has Alert/MemosProvider Watch flag has been set for reviewClaim amount exceeds Maximum allowedProvider does not match required typeProvider requires a specialty codeClaim denied manuallyElectronic claim has COBBenefit has age restrictionsProvider type does not match termPCP is solely responsible for servicesPrice UB by CPT billed yes/noInvalid Admit HourAnnual Benefit Amount ExceededInvalid Discharge HourClaim Doesn't have any Service LinesGenerate 1500 From EPSDT FormClaim payment amt exceeds max allowed for mass adjudicationClaim payment amount exceeds maximum allowedClaim payment amt exceeds max allowed for mass adjudicationEARLY INTERVENTION SERVICES (EIS) ARE DENIED, PROVIDERS MUST BILL FOR EIS THRU THE EIS TRUST FUNDMEMBER IS DECEASED PRIOR TO DATE OF SERVICE ON CLAIMProvider not revalidated per Colorado MedicaidThe hospital has by contract agreed to accept as payment inServices are not eligible with diagnosis provided by physiciService is not related to direct treatment of an illness orService appears to be experimental and is not covered by theIf you have any questions concerning this claim, please callThe payment amount has been reduced by the amount paid by thThe amount shown as eligible is the maximum amount allowableThis is a duplicate of a claim that has been previously proc

M345M389M4M5M6M7M8M9Out-of-Area Claim - Pay at 80%Non-Participating Differential Contract Pricing AppliedBenefits for the above charges are subject to a reduction bePayment has been made at 85% of the eligible amount. The amPayment has been made at 100% of the eligible amount. The aWell child care is not eligible under the plan.Annual/routine physicals, or routine lab or x-rays are not eRoutine eye exams are not eligible under the plan.MAX20 2000 MAXIMUM BENEFIT EXCEEDEDMBRINMEMBER INELIGIBLE ON DATE OF SERVICEMCMAXMEMBER HAS MET THEIR MEDICARE LIFETIME MAX BENEFITMCRHOSMP001MP005MP006MP007The member has elected Hospice. Please submit claims to Medicare for PaymentWhen multiple procedures are performed on the same day, payment is made based on the highest amount allowed.Payment for this procedure is included with the payment made for medical treatment rendered on the same day by a different provider.Payment for prenatal and postnatal care is included in the payment for the obstetrical procedure. No additional payment can be made.If prenatal care and OB procedure is on paid history within 270 days, same provider, related or unrelated diag, claim is rejected.If postnatal and an OB proc. are on same claim or paid history, and postnatal care is within 45 days of post ob proc., same prov, related or unrelated diag,claim is denied.Payment for this procedure is included with the payment made for the surgical procedure.Payment for this consultation is included in the payment for anesthesia. No separate payment can be made.A payment cannot be made for more than three physical therapy procedures.If major surgery is performed same day as major/minor surgery, same POS, already paid on history and prov are same or different. Claim is pendedIf assistant surgery is performed on the same day as another asst surgery, on the same claim or paid history, same POS and the prov are different. Pendclaim.If anesthesia is performed on the same day, same POS as anesthesia no the same claim and the prov are the same or different, pay 100% of time and baseunit allowance for greater procedure and 100% of time for each lesser procedure. Pend claim.Medical necessity not established for services rendered.MAX VISITS DIALYSIS PER MONTH EXCEEDEDMAX DIALYSIS VISITS PER WEEK EXCEEDEDThis service cannot be billed separately.Payment adjusted based on x-ray radiograph on XPWKN390N775NCACSNCARQNCBMCAUTHORIZATION CLOSEDAUTHORIZATION REQUIREDNCBMDNOT COVERED BY MEDICARENOT COVERED BY MEDICAIDNCCOBNCLTKEOB FROM PRIMARY CARRIER NEEDED TO ADJUDICATE CLAIMSUBMIT CLAIMS TO LIFE TRAC FOR RE-PRICINGNCOPTNCPCASUBMIT CLAIM TO OPTUM HEALTH CARENot covered per contracted agreementNCWRPNELIGNOAUTNOCLMNOFACWRAPAROUND BENEFIT - BILL MEDICAID FEE FOR SERVICEMEMBER NOT ELIGIBLE ON DATE OF SERVICESERVICES WERE NOT AUTHORIZEDDENVER HEALTH MEDICAL PLAN DOES NOT PROCESS CLAIMS FOR THIS LINE OF BUSINESS - CLAIM DENIEDNO FACTOR IN RBRVS CANNOT CALCULATE PRICEOCE001OCE002OCE003OCE005Invalid diagnosis code.Invalid diagnosis based on patient ageInvalid diagnosis based on patient sexE- Diagnosis code can not be used as principal.

54OCE055OCE056OCE057OCE058OCE059Invalid procedure code.Invalid procedure based on patient age.Invalid procedure based on patient sexNon-covered for reason other than statuteServices submitted for FI review condition code 21Separate payment for service is not provided by the plan.Code indicates a site of services not included in OPPSInvalid/incomplete/incorrect unitsMultiple bilateral procedures without modifier 50Inappropriate specification of bilateral procedureInpatient procedure.Mutually exclusive procedure that is not allowed by NCCI even if appropriate modifier is present.Code 2 of a code pair that is not allowed by NCCI even if appropriate modifier is present.Medical visit on same day as type T or S procedure without modifier 25.Invalid modifierInvalid dateDate out of OCE rangeInvalid ageInvalid sexOnly incidental services reported.Code not recognized by Medicare; Alternate code for same service may be available.Partial hospitalization services for non-mental health diagnosis.Insufficient services on day of partial hospitalizationOnly Mental Health education and training services providedTerminated bilateral procedure or terminated procedure with units greater than one.Inconsistency between implanted device or administered substance and implantation or associated procedure.Mutually exclusive procedure that would be allowed by NCCI if appropriate modifier were present.Code 2 of a code pair that would be allowed by NCCI if appropriate modifier were present.Invalid Revenue CodeMultiple medical visits on same day with same revenue code without condition code G0Transfusion or blood product exchange without specification of blood product.Observation revenue code on line item with non-observation HCPCS codeInpatient separate procedures not paid.Partial hospitalization condition code 41 not approved for type of bill.Service is not separately payable.Revenue center requires HCPCSService on same day as inpatient procedure.Non-covered based on statutory exclusion.Multiple observations overlap in time.Observation does not meet minimum hours, qualifying diagnoses, and or T procedure conditionsCodes G0378 and G0379 only allowed with Bill Type 13xMultiple codes for the same services.Non-reportable for site of servicesEM condition not met and line item date for OBS code G0244 is not 12-31 or 01-01.EM Condition not met for separately payable observation and line item date for code G0378 is 01-01G0379 only allowed with G0378Clinical trial requires diagnosis code V707 as other than primary diagnosis.

CE87OCE88OCE89OCE90OCE91OCE92Use of modifier CA with more than one procedure not allowedCode not recognized by OPPS; alternate code for same service may be availableThis code only billed on partial hospitalization claimsAT service not payable outside the partial hospitalization.Revenue code not recognized by MedicareService provided prior to FDA approvalService provided prior to date of National Coverage Determination (NCD) approvalService provided outside approval periodCA modifier requires patient status code 20Claim lacks required device or procedure codeService not billable to Fiscal IntermediaryIncorrect billing of blood productsUnits greater than one for bilateral procedure billed with modifier 50Trauma response critical care code without revenue code 068x and CPT 99291Claim lacks allowed procedure codeClaim lacks required radiolabeled productIncorrect billing of revenue code with HCPCS codeMental health code not approved for partial hospitalization programMental health service not payable outside the partial hospitalization programCharge exceeds token charge ( 1.01Service provided on or after effective date of NCD non-coverageClaim lacks required primary codeClaim lacks required device or procedure codeOne or more lines on the claim has returned an OCE error with a Return to Provider dispositionModifier PN is reported for an item or service that is considered to be non-excepted for an off-campus provider-based hospital outpatient departmentunder Section 603Manifestation code not allowed as principal diagnosisSkin substitute application procedure without appropriate skin substitute product codeFQHC payment code not reported for FQHC claimFQHC claim lacks required qualifying visit codeIncorrect revenue code reported for FQHC payment codeItem or service not covered under FQHC PPSDevice-dependent procedure reported without device codeOFFICOOAOFFICE VISIT IS NOT PAYABLE SAME DAY A

D080 Co-Surgeon Not Covered D081 Team Surgeon Not Covered D10 Medical review denial. D11 Triage only - not life threatening. D12 Requires authorized referral. D15 Member not enrolled on DOS. D15A Member was not enrolled with this Medical Group on DOS . D16 Patient not enrolled with Plan. D17 Service not a plan benefit. D18 Included in other .