Immediate subscriber updating
PI 23 Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments CO 24 Payment for charges adjusted. CO 50 These are non-covered services because this is not deemed a `medical necessity' by the payer. PI 112 Payment adjusted as not furnished directly to the patient and/or not documented.
Charges are covered under a capitation agreement/managed care plan. CO 51 These are non-covered services because this is a pre-existing condition OA 53 Services by an immediate relative or a member of the same household are not covered. CO 114 Procedure/product not approved by the Food and Drug Administration.
OA 13 The date of death precedes the date of service.
OA 14 The date of birth follows the date of service.
PI 153 Payment adjusted because the payer deems the information submitted does not support this dosage.
At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) PI 17 Payment adjusted because requested information was not provided or was insufficient/incomplete. CO 38 Services not provided or authorized by designated (network/primary care) providers.
At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) OA 18 Duplicate claim/service. CO 39 Services denied at the time authorization/pre-certification was requested.
Medicare contractors are permitted to use the following group codes: CO Contractual Obligation (provider is financially liable); CR Correction and Reversal (no financial liability); OA Other Adjustment (no financial liability); and PR Patient Responsibility (patient is financially liable).
PR 1 Deductible Amount PR 2 Coinsurance Amount PR 3 Co-payment Amount OA 4 The procedure code is inconsistent with the modifier used or a required modifier is missing.CO 15 Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.