EOB ADJ RMRKS apr05 - kmap-state-ks.us MEDICAL ASSISTANCE PROGRAM EOB to HIPAA Adjustment and Remark Code Crosswalk Page 3 of 132 EOB Code EOB Description HIPAA Adj Code HIPAA Adj

KANSAS MEDICAL ASSISTANCE PROGRAM EOB to HIPAA Adjustment and Remark Code Crosswalk Page 1 of 132

EOB Code EOB Description

HIPAA Adj Code HIPAA Adj Description

HIPAA Remarks Code HIPAA Remarks Description

94 REDUCED BY COPAYMENT. 3 Co-payment Amount

9001REIMBURSEMENT REDUCED BY THE RECIPIENT'S CO-PAYMENT AMOUNT. 3 Co-payment Amount

1127

A MODIFIER HAS BEEN ADDED TO YOUR CPT-4 PROCEDURE CODE TO MORE ACCURATELY REFL ECT THE SERVICE PERFORMED. 4

The procedure code is inconsistent with the modifier used or a required modifier is missing. N22

This procedure code was added/changed because it more accurately describes the services rendered.

1132

DETAIL DENIED - INVALID PROCEDURE CODE MODIFIER COMBINATION. CORRECT CODING AN D RESUBMIT IF APPROPRIATE. 4

The procedure code is inconsistent with the modifier used or a required modifier is missing.

1407 DENIED. MODIFIER CODE INVALID. 4The procedure code is inconsistent with the modifier used or a required modifier is missing. M51 Missing/incomplete/invalid procedure code(s).

8

DETAIL DENIED. THIS SERVICE IS NOT ALLOWED BY THE KANSAS MEDICAL ASSISTANCE PRO GRAM WHEN PERFORMED IN THE PLACE OF SERVICE INDICATED. 5

The procedure code/bill type is inconsistent with the place of service. M77 Missing/incomplete/invalid place of service.

115Please verify that procedure code and minutes billed are correct. 5

The procedure code/bill type is inconsistent with the place of service. M51 Missing/incomplete/invalid procedure code(s).

182Detail denied. Lab services performed in a hospital setting must be billed by the hospital. 5

The procedure code/bill type is inconsistent with the place of service. N32

Claim must be submitted by the provider who rendered the service.

203

DENIED. SERVICES PERFORMED IN AN INDEPENDENT LAB CAN ONLY BE BILLED BY THE IND EPENDENT LAB. REFER TO BILLING INSTRUCTIONS (SECTION 7000) IN YOUR KANSAS MEDI CAL ASSISTANCE PROGRAM PROVIDER MANUAL. 5



439Detail denied. Influenza Vaccines are non-covered in place of service indicate d. 5

The procedure code/bill type is inconsistent with the place of service.

467

DETAIL DENIED. PLACE OF SERVICE "81" IS AN INDEPENDENT LAB FACILITY. ONLY THE INDEPENDENT LAB MAY BILL FOR SERVICES PERFORMED IN THIS SETTING. REFER TO BIL LING INSTRUCTIONS (SECTION 7000) IN YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROV IDER MANUAL. 5



525

DENIED. PODIATRY SURGICAL PROCEDURES ARE NONCOVERED WHEN PERFORMED AS AN INPAT IENT SERVICE. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 5

The procedure code/bill type is inconsistent with the place of service. M2 Not paid separately when the patient is an inpatient.

1032

DETAIL DENIED. THE PLACE OF SERVICE VALUE INDICATED IS NOT RECOGNIZED BY THE K ANSAS MEDICAL ASSISTANCE PROGRAM. EFFECTIVE WITH CLAIMS RECEIVED ON AND AFTER NOVEMBER 30, 1992, A TWO-DIGIT PLACE OF SERVICE VALUE MUST BE USED. REFER TO S ECTION 7000 IN YOU KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. PLEASE C ORRECT AND RESUBMIT. 5

The procedure code/bill type is inconsistent with the place of service. M77 Missing/incomplete/invalid place of service.




HIPAA Remarks Code HIPAA Remarks Decsription

1086

DENIED. FQHC SERVICES ARE NONCOVERED WHEN PERFORMED IN PLACE OF SERVICE 21 - I NPATIENT. REFER TO SECTION 8430 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROFE SSIONAL SERVICES PROVIDER MANUAL. 5

The procedure code/bill type is inconsistent with the place of service.

1305DUE TO SYSTEM LIMITATIONS, WE HAVE CORRECTED YOUR TYPE OF BILL. 5

The procedure code/bill type is inconsistent with the place of service. MA30 Missing/incomplete/invalid type of bill.

7

DETAIL DENIED, PROCEDURE/NDC/REVENUE CODE NOT CONSISTENT WITH BENEFICIARY'S AGE . 6

THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE.

88Please bill mother's services using mother's name and number. 6


401

CLAIM DENIED. ONE OR MORE OF THE SERVICES BILLED IS RESTRICTED TO A SPECIFIC A GE GROUP. (SEE DETAIL DENIAL MESSAGE 007.) ACCORDING TO THE SRS ELIGIBILITY F ILE, THIS BENEFICIARY'S DATE OF BIRTH FAILS TO COMPLY WITH THE AGE RESTRICTION FOR THIS PROCEDURE. PLEASE VERIFY THE BENEFICIARY'S ID NUMBER/BIRTHDATE OR CO RRECT THE PROCEDURE CODE(S) AND RESUBMIT. IF YOU BELIEVE THE BENEFICIARY'S AGE 6


460

DENIED. KAN BE HEALTHY SERVICES ARE NON-COVERED FOR BENEFICIARIES 21 YEARS AND OLDER. REFER TO SECTION 2020 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDE R MANUAL FOR MORE INFORMATION. 6

THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S AGE. N129

THIS AMOUNT REPRESENTS THE DOLLAR AMOUNT NOT ELIGIBLE DUE TO THE PATIENT'S AGE.

989

Denied. Exceeds program limitations. This procedure is not covered for recipi ents over three years of age for diagnosis indicated. 6


1274Denied. Procedure not consistent with beneficiary's age. 6


17 Procedure/NDC not consistent with beneficiary's sex. 7THE PROCEDURE/REVENUE CODE IS INCONSISTENT WITH THE PATIENT'S GENDER.

9Detail denied, procedure not consistent with provider type. 8

The procedure code is inconsistent with the provider type/specialty (taxonomy).

10Detail denied, procedure not consistent with provider specialty for all or a po rtion of the service dates billed. 8


342Detail denied. Procedure code is noncovered for this provider type and special ty. 8


448

Detail denied. Professional Component Lab for anatomical procedures is allowed only when provided by a pathologist or association of pathologists. 8






651Detail denied. Procedure not consistent with claim type. Please resubmit on a HCFA 1500 claim form. 8


1270

Services for the HCBS Program for Children with Severe Emotional Disturbances m ust be billed using the HCBS Provider number. 8


1301

Denied. This service is denied/reduced when performed/billed by this type of p rovider in this type of facility, or by a provider of this specialty. 8


12DENIED, DIAGNOSIS NOT CONSISTENT WITH BENEFICIARY'S AGE OR SEX. 9

THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S AGE. M76 Missing/incomplete/invalid diagnosis or condition.

1424DENIED. DIAGNOSIS NOT CONSISTENT WITH BENEFICIARY'S GENDER. 10

THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENT'S GENDER.

11Detail denied, procedure not consistent with diagnosis range. 11 The diagnosis is inconsistent with the procedure.

171Program limitations do not allow coverage of this procedure/NDC for the diagnos is given. 11 The diagnosis is inconsistent with the procedure.

224

HYSTERECTOMIES ARE NONCOVERED FOR THE DIAGNOSIS GIVEN. DOCUMENTATION DOES NOT SUBSTANTIATE THE MEDICAL NEED OF THIS PROCEDURE. 11 The diagnosis is inconsistent with the procedure.

228

Denied. SRS does not allow payment for an Emergency Oral Examination for the d iagnosis indicated. 11 The diagnosis is inconsistent with the procedure.

301

DENIED. STATE GUIDELINES ALLOW PAYMENT FOR PSYCHIATRIC ADMISSIONS TO MEDIKAN B ENEFICIARIES ONLY WHEN THE DIAGNOSIS INDICATES ACUTE PSYCHOTIC EPISODES. REFER TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 11 The diagnosis is inconsistent with the procedure.

502

DENIED. THESE SERVICES HAVE BEEN REVIEWED BY THE MEDICAL STAFF AND DETERMINED TO BE INAPPROPRIATE FOR THE DIAGNOSIS LISTED. IF SUPPORTING DOCUMENTATION IS A VAILABLE ADDRESSING THE MEDICAL NECESSITY OF THE SERVICE PROVIDED, PLEASE ATTAC H TO THE CLAIM AND RESUBMIT. TO APPEAL THIS DENIAL, REFER TO THE INSTRUCTIONS IN SECTION 5300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 11 The diagnosis is inconsistent with the procedure.





548

SERVICE DENIED. THIS CLAIM AND ALL ATTACHMENTS HAVE BEEN REVIEWED BY THE MEDIC AL STAFF AND THE MEDICAL NECESSITY OF THE SERVICE RENDERED IS NOT SUPPORTED BY THE DOCUMENTATION PROVIDED. REFER TO SECTION 8200 OF YOUR KANSAS MEDICAL ASSI STANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 11 The diagnosis is inconsistent with the procedure.

1199

Denied. Claim indicates sterilization, either by the diagnosis code submitted or condition code 80, but the claim contains no sterilization procedure code. 11 The diagnosis is inconsistent with the procedure.

1200Denied. Diagnosis not payable with procedure code billed. 11 The diagnosis is inconsistent with the procedure.

1300 The diagnosis is inconsistent with the procedure. 11 The diagnosis is inconsistent with the procedure.

157

Denied. The beneficiary name indicated on Medical Necessity/Prior Authorizatio n Form does not correspond with the name given on the claim form. Please attac h the correct Medical Necessity/Prior Authorization Form and resubmit. 15

Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. N54

Claim information is inconsistent with pre-certified/authorized services.

161

Denied. The NDC billed is not authorized, or the beneficiary or provider ID do es not match the PA record, and/or the date of service is not within the approv ed PA range. 15

Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.

162Denied, prior authorization required. Services were rendered prior to consulta nt's approval date. 15


163

Denied, incomplete for processing. Prior Authorization form is not signed by p rovider. Review entire Prior Authorization form for completeness. 15


164

Denied/reduced. Prior Authorization does not authorize the submitted service o r the number of days/units billed exceeds that approved. 15

Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. N54


273

Payment reduced on emergency room physician fee. Diagnosis and/or documentatio n does not support emergent status. 15


379Denied. Dental treatment plans in excess of $2000 per calendar year require pr ior authorization. 15


472Denied. Service dates billed are prior to or after the approval date period au thorized. 15


474

Denied. Provider number approved to perform the service does not correspond wi th the provider performing the service as indicated on the claim. 15






639

DENIED, PRIOR AUTHORIZATION REQUIRED. PLEASE RESUBMIT CLAIM WITH PA NUMBER IN APPROPRIATE CLAIM FIELD. IF DISPENSED IN AN EMERGENCY SITUATION AND PA WAS NOT OBTAINED, ATTACH A MEDICAL NECESSITY FORM TO THE CLAIM 15

Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. M62 Missing/incomplete/invalid treatment authorization code.

640

Denied, prior authorization required. If dispensed in an emergency situation a nd PA was not obtained, attach a medical necessity form to the claim form expla ining the need for the drug and why PA was not obtained. 15

Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider. M62 Missing/incomplete/invalid treatment authorization code.

1179

Claim denied. Prior Authorization required. Either the service submitted did not have prior authorization or the number of days/units billed exceeds that ap proved. 15


1234

Denied. The procedure code, provider number, and/or dates of service billed do not match the information on the plan of care (prior authorization). Contact the beneficiary's case manager for instructions before rebilling. 15


1250

Denied. The procedure codes billed have been prior authorized under separate ( PA) numbers. For correct processing, only procedure codes which are approved b y the same (PA) number may be billed on the same claim. 15


1251

Denied. The dates of service billed span two prior authorization approval peri ods. Please rebill separate claims with dates of service authorized by each pr ior authorization number. 15


1252

Denied. The procedure code billed cannot be processed with an informational mo difier. The procedure code billed must exactly match the procedure code that w as prior authorized. 15


1289

Denied. The prior authorization applicable to this line approves multiple item s. We are unable to determine the item(s) being billed. Please resubmit and s pecify the item(s) being billed. 15


1Your claim will be returned for correction or additional information. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M54 Missing/incomplete/invalid total charges.

22

DENIED. ABORTION CERTIFICATION STATEMENT AND MEDICAL RECORDS MUST BE SUBMITTED WITH A PAPER CLAIM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE P ROGRAM PROFESSIONAL SERVICES OR THE KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N28 Consent form requirements not fulfilled.





31

DENIED, BENEFICIARY ID NUMBER NOT PRESENT. PLEASE RESUBMIT WITH THE KANSAS MED ICAL ASSITANCE BENEFICIARY ID NUMBER IN THE APPROPRIATE CLAIM FIELD. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate MA27

Missing/incomplete/invalid entitlement number or name shown on the claim.

36 Metric quantity invalid or missing. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M123

Missing/incomplete/invalid name, strength, or dosage of the drug furnished.

47

Denied. NDC's and/or description is not indicated for all ingredients. Please resubmit with NDC and description for each ingredient of this compound drug in box 16 (remarks). 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate

53

DENIED. PLEASE PROVIDE SPECIFIC DESCRIPTION OF SERVICE, OPERATIVE REPORT, ITEM IZED CHARGES, OR NATIONAL DRUG CODE FOR INJECTIONS. 16


56Claim denied, attending and/or operating physician number is missing/invalid. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N77

Missing/incomplete/invalid designated provider number.

58CLAIM DENIED, INVALID OR MISSING INFORMATION. RESUBMIT WITH NEXT BILLING. 16


60Please bill baby's services using baby's name and number. 16


Missing/incomplete/invalid entitlement number or name shown on the claim.

61

DENIED, INCOMPLETE FOR PROCESSING. PLEASE RESUBMIT WITH A VALID MEDICARE PAID DATE. REVIEW ENTIRE CLAIM FOR COMPLETENESS. 16


Missing/incomplete/invalid prior insurance carrier EOB.

87UNABLE TO PROCESS VIA SUBMITTED FORMAT. PLEASE RESUBMIT ON A PAPER CLAIM. 16


90Abortion services denied. Documentation not in compliance with program guideli nes. 16


100

Denied. Items A-K must be checked completed. If abnormal is checked, one of the four treatments must be indicated. 16


101Denied. Each of the items P-U must have one of the four possibilities checked 16






108

Denied, beneficiary's signature and date of signature in the beneficiary's Sect ion of the consent form are in error and are noncorrectable fields. 16


121

DENIED, INVALID HYSTERECTOMY STATEMENT. REFER TO SECTION 8400 OF THE KANSAS ME DICAL ASSISTANCE PROGRAM PROFESSIONAL SERVICES OR THE KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUALS. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N3 Missing consent form.

122Denied, missing Hysterectomy Statement. Resubmit with the Hysterectomy Stateme nt attached to the claim. 16


123

Denied, Sterilization Consent form is completed improperly. Refer to the lette r attached to the returned claim for the specific reason for claim denial. 16


124

Denied, Sterilization Consent form is not present. Resubmit with the appropria te Sterilization Consent form attached to the claim. 16


125

DENIED, INCOMPLETE FOR PROCESSING. PROVIDER SIGNATURE IS MISSING OR UNACCEPTAB LE. REFER TO THE BILLING INSTRUCTIONS FOR THIS CLAIM FIELD IN PART II OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 16


Missing/incomplete/invalid provider representative signature.

130Denied, consent form is not in compliance with federal time frame requirements. 16


131

DENIED. NOT IN COMPLIANCE WITH FEDERAL AGE REQUIREMENTS. BENEFICIARY MUST BE AT LEAST 21 YEARS OF AGE ON THE DATE THE CONSENT FORM WAS SIGNED. 16


133

THE FEDERALLY MANDATED STERILIZATION CONSENT FORM IS THE ONLY FORM ACCEPTABLE. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROFESSIONAL SERVICES PR OVIDER MANUAL OR SECTION 8430 OF THE KANSAS MEDICAL ASSISTANCE HOSPITAL MANUAL. IF THE APPROPRIATE FORM WAS NOT ORIGINALLY SIGNED, STERILIZATION CHARGES ARE NON-COVERED. 16






168

SERVICE DENIED. WE CANNOT ACCEPT STERILIZATION CONSENT FORM SIGNED WHILE THE B ENEFICIARY WAS SEEKING TO OBTAIN OR OBTAINING AN ABORTION. PLEASE DESIGNATE ST ERILIZATION CHARGES AS NONCOVERED. REVIEW THE STERILIZATION SECTION IN PART II OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 16


173

Detail denied. Services rendered require an Operative Report in order to proce ss. Please resubmit with an Operative Report. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M29 Missing operative report.

174

Detail denied. Services rendered require complete itemization. Please resubmi t with a breakdown of charges for each specific service/material and all curren t attachments. 16


Separately billed services/tests have been bundled as they are considered components of the same procedure. Separate payment is not allowed.

196Please verify that procedure code and units billed are correct. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M51 Missing/incomplete/invalid procedure code(s).

234

Denied. The surgeon has not submitted the documentation or documentation does not match surgeon's claim (dates of service) required to process this claim/pro cedure. Please contact the surgeon and request that he submit the necessary in formation or verify information. Resubmit this claim/service after verificatio n or after surgeon has submitted the information. 16


Missing documentation/orders/ notes/ summary/ report/ invoice.

236

DENIED. NOT IN COMPLIANCE WITH FEDERAL AGE REQUIREMENTS. BENEFICIARY MUST BE AT LEAST 21 YEARS OF AGE ON THE DATE THE CONSENT FORM WAS SIGNED. 16


238

Denied. The surgeon's claim and documentation has been denied. Not in complia nce with federal requirements. Please contact surgeon. 16



257DENIED. NDC BILLED IS EITHER MISSING OR INVALID. PLEASE RESUBMIT USING A VALI D NDC. 16


A valid NDC is required for payment of drug claims effective October 02.

260

DENIED. PROCEDURE CODE REQUIRES A COMPLETE DESCRIPTION OF THE SERVICES PERFORM ED. 16


336Denied. The claim submitted has no detail information. Please enter this info rmation and resubmit. 16






347

Denied, incomplete for processing. Please resubmit indicating tooth number(s)/ letter(s), surface(s) for each procedure code. Please use separate lines with separate charges. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N37 Missing/incomplete/invalid tooth number/letter.

406

DETAIL DENIED. PROCEDURE CODE BILLED REQUIRES THAT SPECIFIC TOOTH SURFACE(S) B E SUBMITTED. REFER TO APPENDIX I OF THE KANSAS MEDICAL ASSISTANCE PROGRAM DENT AL PROVIDER MANUAL FOR A DESCRIPTION OF THE PROCEDURE BILLED TO DETERMINE THE A PPROPRIATE NUMBER OF SURFACES REQUIRED. 16


407

DETAIL DENIED. PROCEDURE CODE BILLED REQUIRES THAT A TOOTH NUMBER OR LETTER BE ENTERED ON THE CLAIM. PLEASE CORRECT AND RESUBMIT. 16


408

Detail denied. The procedure code billed is for deciduous teeth which requires a tooth letter for processing. Please correct your claim and resubmit. 16


Procedure code is not compatible with tooth number/letter.

422Denied, incomplete for processing. Please resubmit claim with an invoice. 16


427

EITHER ACCIDENT DATE IS PRESENT BUT THE ACCIDENT INDICATOR IS MISSING OR THE AC CIDENT INDICATOR IS PRESENT BUT THE ACCIDENT DATE IS MISSING 16


450

DENIED. WHEN BILLING FOR CODE 99070, PLEASE ENTER A DESCRIPTION OF THE DRESSIN G AND/OR SUPPLIES PROVIDED ON THE FACE OF THE CLAIM. 16


528

DENIED, INCOMPLETE FOR PROCESSING. PLEASE ATTACH COPIES OF THE NURSING ASSESSM ENT, CURRENT PLAN OF CARE, AND DOCUMENTATION OF VISITS PROVIDED DURING THE BILL ING PERIOD TO YOUR CLAIM AND RESUBMIT. REFER TO SECTION 8400 OF YOUR KANSAS ME DICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 16



536

Denied, incomplete for processing. Attach copies of physician's orders/progres s notes/nurse's notes from the Observation Room that include time patient was a dmitted to and discharged from the area. 16







538

DENIED, DOCUMENTATION MISSING OR INCOMPLETE FOR PROCESSING. PLEASE ATTACH ALL REQUIRED DOCUMENTATION FOR APNEA MONITOR USE INCLUDING A COPY OF THE VALID RX A ND RESUBMIT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISSTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 16



545

DENIED, INCOMPLETE FOR PROCESSING. WHEN UTILIZING THE DIAGNOSIS CODE LISTED, A COPY OF THE EMERGENCY ROOM RECORD IS REQUIRED TO BE ATTACHED. PLEASE ATTACH A COPY OF THE EMERGENCY ROOM RECORD AND RESUBMIT. REFER TO SECTION 8200 AND APP ENDIX III OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL. 16



595Procedure code changed to 00230/D0230 for additional intraoral film in excess o f first film. 16



602

You have omitted the quantity of one or more of the drugs used in this compound . Please correct and resubmit. 16



606

Service(s) must be billed on a HCFA 1500 claim form using your Durable Medical Equipment provider number. 16


616

Denied. The drug code and/or drug strength is not consistent with previous cla ims processed for this prescription number. Please verify the NDC and prescrip tion number fields. Resubmit your corrected claim for processing. 16



643

We are unable to process your claim because the copy of the emergency room reco rd is not legible. Please resubmit with a legible copy. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N205 Information provided was illegible

710

This claim is receiving special attention through provider services. The claim required corrections and/or additional information. We will contact you if ad ditional information is necessary, otherwise refer to a future Remittance Advic e for adjudication of this claim. 16


The claim information has also been forwarded to Medicaid for review.

776

Denied, incomplete for processing. Please resubmit indicating an occurrence co de for each date entered (form locators 32-36). 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M45 Missing/incomplete/invalid occurrence code(s).





781Denied. Please complete claim form locator 7 (covered days) and resubmit. 16


Missing/incomplete/invalid number of covered days during the billing period.

785

Claim denied. Form locator 46 of the UB-92 claim form (units) is a required fi eld for all accommodations, revenue codes 100-219. Please complete and resubmi t. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M53 Missing/incomplete/invalid days or units of service.

797

Denied, incomplete for processing. All or portions of the ancillary services b illed pertain to delivery. The date of delivery and the procedure code for del ivery must be indicated in form locators 80-81. Please indicate the delivery i nformation on the claim and resubmit for processing. 16


Missing/incomplete/invalid date of current illness, injury or pregnancy.

798

Denied, incomplete for processing. Some or all of the ancillary services bill ed pertain to surgery. The surgery(s) performed are not indicated on the claim form in form locators 80-81. Please indicate the surgery information on the c laim and resubmit for processing. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N341 Missing/incomplete/invalid surgery date.

799

Denied, incomplete for processing. From and Thru dates of service (form locato r 7) missing or invalid. Please correct and resubmit. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M52 Missing/incomplete/invalid “from” date(s) of service.

825

DENIED. WHEN BILLING FOR ORAL MEDICATIONS (X9006), FOR SWINGBED PATIENTS, A LI ST WHICH IDENTIFIES THE NDC, DRUG NAME, QUANTITY AND BILLED AMOUNTS MUST BE ATT ACHED TO THE SWINGBED CLAIM. PLEASE ATTACH THIS INFORMATION TO THE SWINGBED CL AIM AND RESUBMIT FOR PROCESSING. REFER TO SECTION 7020 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL. 16


Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.

854

Denied. Explanation of Medicare Benefits missing or incomplete. Please resubmi t with Explanation of Medicare Benefits. EOMB should be present as proof of ti mely filing and amount allowed by Medicare. 16


Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.

955

DENIED. UNABLE TO PROCESS CLAIM DUE TO MISSING/INVALID DRUG FILE INFORMATION. PLEASE CONTACT THE EDS PHARMACY HELP DESK OR THE MEDICAL ASSISTANCE CUSTOMER SE RVICE CENTER. 16


Missing/incomplete/invalid/ deactivated/withdrawn National Drug Code (NDC).

1029

Denied. Please indicate the date of cataract surgery and resubmit your claim. If submitting your claim electronically, the electronic attachment form should be utilized. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate MA66 Missing/incomplete/invalid principal procedure code.





1056

DENIED. WE ARE UNABLE TO PROCESS YOUR CLAIM AS THE REQUIRED DOCUMENTATION WAS NOT SUBMITTED. PLEASE ATTACH A COPY OF THE REQUIRED PRE-PAY DOCUMENTATION AND RESUBMIT YOUR CLAIM. 16



1068

This DRG is on review. If the hospital stay was for medical treatment secondar y to a psychiatric disorder, resubmit the claim on paper with the history/physi cal, discharge notes, and emergency room report. 16



1079

Denied. IV and inhalation admixtures must be billed on paper using NDC 9999999 9999. Indicate NDCs, dosage and strength in remarks column for all ingredients dispensed. 16



1100

Denied. Unable to verify Medicare Buy-in. Delay in processing was due to an at tempt to verify Medicare Buy-in. 16


1106

THIS GLOBAL CPT-4 PROCEDURE CODE HAS BEEN ADDED TO MORE ACCURATELY REFLECT THE SERVICE PERFORMED. THE BILLED AMOUNT FOR THIS PROCEDURE IS THE SUM OF THE TOT AL DENIED CHARGES. 16



1113

Denied, incomplete for processing. Please resubmit with valid "discharge" date and valid "from" and "thru" dates of service. Review entire claim for complet eness. 16


Missing/incomplete/invalid beginning and ending dates of the period billed.

1123

THIS GLOBAL CPT-4 PROCEDURE CODE HAS BEEN ADDED TO MORE ACCURATELY REFLECT THE SERVICE PERFORMED. THE BILLED AMOUNT FOR THIS PROCEDURE IS THE SUM OF THE TOT AL DENIED CHARGES. THE AMOUNT ALLOWED IS DETERMINED BY REDUCING THE CURRENT CL AIM ALLOWED AMOUNT BY THE AMOUNT PAID ON THE SERVICES WHICH WERE REBUNDLED IN H ISTORY. 16



1176

EDS IS UNABLE TO PROCESS THIS POS CLAIM DUE TO AN UNEXPECTED CONDITION. PLEASE RETRANSMIT YOUR SERVICES AT A LATER DATE. 16


The original claim was denied. Resubmit a new claim, not a replacement claim.

1177 Denied. Provider does not meet CLIA requirements. 16


Missing/Incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory.

1178

Denied. The Physician's signature and date of signature in the physician's Sec tion of the consent form are in error. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N30 Patient ineligible for this service.





1184

Denied. Please provide a more detailed billing for the services billed on this SNF Medicare related claim including number of days the billing covers. 16


1188

Denied, consent form is not in compliance with federal time frame requirements. Consent date is more than 2 days prior to the surgery date. 16


1193

Denied. Please indicate in block 94 of the claim form the date(s) in which the non-inpatient follow-up consultation was performed. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M67 Missing/incomplete/invalid other procedure code(s).

1195Denied. Please resubmit with the date of accident or injury. 16


Missing/incomplete/invalid date of current illness, injury or pregnancy.

1219

Denied. Compound drugs must be submitted on paper claim. Please resubmit usin g NDC 99999999999 with a description in the remarks Section of the claim form. 16


1225

The Adjustment Request form submitted for this Internal Control Number (ICN) is being returned to you for additional information. 16



1228

DENIED. PLEASE RESUBMIT THE ACTUAL TOTAL CHARGE (FIELD 15); THE SAME TOTAL AMO UNT BILLED TO OTHER INSURANCE. INDICATE THE AMOUNT OTHER INSURANCE PAID IN REM ARKS (FIELD 16). REFERENCE SECTION 7000 OF THE KANSAS MEDICAL ASSISTANCE PROGR AM PROVIDER MANUAL. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M54 Missing/incomplete/invalid total charges.

1261

Denied. No receipts for subsistence were attached to claim. Please resubmit cl aim with receipts for subsistence. 16


1262

Denied. Due to possible program limitations we are unable to process the servi ces as billed. Please resubmit with charges broken out per service date. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M67 Missing/incomplete/invalid other procedure code(s).

1271

Claim/Detail Denied. This beneficiary may have had a surgical procedure on thi s date of service. Please verify the procedure codes billed and correct if nee ded before resubmitting. If procedure codes are correct, resubmit with records supporting services billed. 16







1295Claim/service denied because requested information was not provided or was insu fficient/incomplete. 16


1304

DENIED. CLAIM/SERVICE LACKS INFORMATION WHICH IS NEEDED FOR ADJUDICATION. INC OMPLETE/INVALID PROVIDER NAME. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N289 Missing/incomplete/invalid rendering provider name.

1402 DENIED. INVALID REFILL INDICATOR. 16


Incomplete/invalid documentation/orders/ notes/ summary/ report/ invoice.

1404DENIED, INCOMPLETE FOR PROCESSING. INVALID SOURCE OF ADMISSION. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate MA42 Missing/incomplete/invalid admission source.

1408 DENIED. DATE BILLED IS MISSING OR INVALID. 16



1409DENIED, INCOMPLETE FOR PROCESSING. PLEASE RESUBMIT WITH A VALID ADMIT TYPE. 16


We do not pay for this as the patient has no legal obligation to pay for this.

1410DENIED, INCOMPLETE FOR PROCESSING. COVERED DAYS MISSING OR INVALID. 16


This is a conditional payment made pending a decision on this service by the patient's primary payer. This payment may be subject to refund upon your receipt of any additional payment for this service from another payer. You must contact this office immediately upon receipt of an additional payment for this service.

1419

DENIED. MEDICARE PAID AMOUNT GREATER THAN MEDICARE ALLOWED AMOUNT. PLEASE CORR ECT AND RESUBMIT. 16


1420

DENIED. EPSDT REFERRAL VALUES REQUIRES SUBMISSION OF AN EPSDT OR EPSDT/FP INDIC ATOR. PLEASE CORRECT AND RESUBMIT. 16


1425UNABLE TO DETERMINE FUND CODE-ENCOUNTER ONLY 16






1445

CLIENT OBLIGATION DISTRIBUTION DOES NOT BALANCE OR WAS NOT ENTERED ON THE PLAN OF CARE. THE CLAIM CANNOT BE PROCESSED FOR PAYMENT UNTIL THE PLAN OF CARE I S CORRECT. CONTACT THE BENEFICIARY'S CASE MANAGER FOR MORE INFORMATION. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M135 Missing/incomplete/invalid plan of treatment.

1456

DENIED. INCOMPLETE FOR PROCESSING. PLEASE RESUBMIT WITH A VALID MEDICARE ALLOWE D AMOUNT. 16



1478

DETAIL DENIED. BILLED HCPCS PROCEDURE CODE NOT FOUND IN PROCEDURE HCPCS GROUP. 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M20 Missing/incomplete/invalid HCPCS.

1479DETAIL DENIED. QUANTITY MISSING OR INVALID FOR NDC USED WITH HCPCS PROCEDURE CO DE. 16



1480DETAIL DENIED. UNIT PRICE MISSING OR INVALID FOR NDC USED WITH HCPCS PROCEDURE CODE. 16


1481

DETAIL DENIED. UNIT OF MEASURE MISSING OR INVALID FOR NDC USED WITH HCPCS PROCE DURE CODE. 16


1482

DETAIL DENIED. NDC(S) FIRST DATE OF SERVICE IS PRIOR TO THE OLDEST AVERAGE WHO LESALE PRICING BEGIN DATE. 16


Procedure code billed is not correct/valid for the services billed or the date of service billed.

1483DETAIL DENIED. NDC DOES NOT MATCH THE HCPCS PROCEDURE CODE BEING BILLED. 16



4339INVALID FAMILY INDICATOR ON THE CONDITION CODE 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate M44 Missing/incomplete/invalid condition code.

4340

FALSE FAMILY PLANNING INDICATOR. NONE OF THE PROCEDURES/DIAGNOSIS ARE OF A FAM ILY PLANNING NATURE. 16


7000 PRODUR ALERT - REFILL TOO SOON 16

Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate N304 Missing/incomplete/invalid dispensed date.





7001PRODUR ALERT - PREGNANCY PRECAUTION- SEVERITY LEVEL, MAJOR 16



7002 PRODUR ALERT - THEARPEUTIC DUPLICATION 16



7003 PRODUR ALERT - HIGH DOSE FOR AGE 16



7004PRODUR ALERT - DRUG/DRUG INTERACTION - SEVERITY LEVEL - MAJOR 16



7005PRODUR ALERT - DRUG/AGE - PRECAUTION - SEVERITY LEVEL, MAJOR 16



7006 THIS EDIT IS NOT USED. 16


Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.

7007PRODUR ALERT - DRUG/DISEASE CONTRAINDICATION - SEVERITY LEVEL, MAJOR 16



7008PRODUR ALERT - DRUG/AGE - PRECAUTION - SEVERITY LEVEL, MODERATE 16



7009 PRODUR ALERT - LOW DOSE FOR AGE 16



7010PRODUR ALERT - DRUG/DRUG INTERACTION - SEVERITY LEVEL, MODERATE 16



7011PRODUR ALERT - EXCESSIVE DURATION OF THERAPY 16



7012 THIS EDIT IS NOT USED. 16







7013PRODUR ALERT - PREGNANCY PRECAUTION - SEVERITY LEVEL, MODERATE 16



7014PRODUR ALERT - PREGNANCY PRECAUTION - SEVERITY LEVEL, MINOR 16



7015

PRODUR ALERT - DRUG/DISEASE CONTRAINDICATION - SEVERITY LEVEL, MODERATE 16



7016PRODUR ALERT - DRUG/AGE - PRECAUTION - SEVERITY LEVEL, MINOR 16



7017PRODUR ALERT - DRUG/DISEASE CONTRAINDICATION - SEVERITY LEVEL, MINOR 16



7503

MISSING/INVALID PRODUR REASON FOR SERVICE CODE. ALERT ON RESPONSE DOES NOT MAT CH AN ALERT SET ON THE CLAIM. PLEASE USE APPROPRIATE REASON FOR SERVICE CODE A ND RESUBMIT. 16



7504

MISSING/INVALID PRODUR PROFESSIONAL SERVICE CODE. PLEASE USE M0, P0, OR R0 AND RESUBMIT. 16



7505MISSING/INVALID PRODUR RESULT OF SERVICE CODE. PLEASE USE 1A-1G, 2A OR 2B. 16



7506RESPONSE CLAIM. ORIGINAL CLAIM POSTED A NON-OVERRIDEABLE ALERT. 16



7507

VALID RESULT OF SERVICE CODE OF 'NOT FILLED' RECEIVED. RESPONSE ACCEPTED, CLAI M REJECTED. 16



7899PRODUR ALERT - CLAIM WAS APPLIED TOWARDS THE BENEFICIARY SPENDDOWN 16







9013CLAIM TREATED AS AN ADJUSTMENT. HEADER KEY SECTION OF CLAIM IS MISSING. 16


9014CLAIM TREATED AS AN ADJUSTMENT. CLAIM LACKS ORIGINAL ICN. 16


9017CLAIM TREATED AS AN ADJUSTMENT. ORIGINAL ICN NOT FOUND ON T_HIST_DIRECTORY. 16


187

Detail denied. The service requiring Medical Necessity (MN) is not indicated o n the MN Form attached. Resubmit with a valid MN Form for the service provided . 17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. M60 Missing Certificate of Medical Necessity.

304

Denied. Medical necessity required. Please utilize the electronic attachment form to indicate appropriate documentation when submitting this claim. 17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. M60 Missing Certificate of Medical Necessity.

509

SERVICE DENIED. THE INFORMATION SUBMITTED WITH THIS CLAIM DOES NOT SUPPORT MED ICAL NECESSITY OF THE SERVICE PROVIDED. IF ADDITIONAL DOCUMENTATION IS AVAILAB LE, PLEASE ATTACH TO THE CLAIM AND RESUBMIT. TO APPEAL THIS DENIAL, REFER TO I NSTRUCTIONS IN SECTION 5300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate.

1292

Denied. The attached Behavior Management/Mental Health Proof of Denial form co ntains missing, illegible, and/or conflicting information. 17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate.

1423 ADJUSTMENT HAS AUTO DENIAL 17

Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate. N102

This claim has been denied without reviewing the medical record because the requested records were not received or were not received timely.

15 Duplicate of claim paid. 18 Duplicate claim/service. M63We do not pay for more than one of these on the same day.

16 Duplicate of another claim in process. 18 Duplicate claim/service. M63We do not pay for more than one of these on the same day.

92 DETAIL DENIED AS DUPLICATE. 18 Duplicate claim/service.





337

Denied. Overlapping dates of service are involved. Please verify dates of ser vice and resubmit. Overlapping dates of service may involve a claim previously paid. 18 Duplicate claim/service.

440

DENIED. DUPLICATE OF A CLAIM PREVIOUSLY PAID OR A CLAIM CURRENTLY IN PROCESS. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROFESSIONAL SER VICES PROVIDER MANUAL FOR ADDITIONAL INFORMATION CONCERNING BILLING OF LABORATO RY SERVICES. 18 Duplicate claim/service.

442 DUPLICATE OF A BENEFICIARY BILLED CLAIM. 18 Duplicate claim/service.

802

Claim denied. Possible duplicate of a claim paid or in process. If this claim is not a duplicate, resubmit and attach a completed Medical Necessity Form doc umenting the hour admitted for each visit and the reason for more than one ER o r outpatient visit on this date of service. 18 Duplicate claim/service.

1009

Denied. Exceeds program limitations. Trimester care has already been paid in h istory. Please verify coding and charges. 18 Duplicate claim/service.

1103

Detail denied. This claim and all attachments have been reviewed by the medic al staff and the medical necessity of the assistant surgeon services is not sup ported by the documentation provided. 18 Duplicate claim/service. N10

Claim/service adjusted based on the findings of a review organization/professional consult/manual adjudication/medical or dental advisor.

1105 Detail denied. Duplicate services were billed. 18 Duplicate claim/service.

1249Denied. Duplication of Services between Physicians and Rural Health Clinics ar e not allowed. 18 Duplicate claim/service.

1280

DENIED. CLAIMS ARE NOT TO BE PAID TO BOTH EARLY CHILDHOOD INTERVENTION PROVIDE RS AND LOCAL EDUCATION AGENCY PROVIDERS FOR ANY BENEFICIARY FOR THE SAME OR OVE RLAPPING DATES OF SERVICE. REFER TO YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PRO VIDER MANUAL. 18 Duplicate claim/service.

1299 Duplicate claim/service. 18 Duplicate claim/service.

9018CLAIM TREATED AS AN ADJUSTMENT. CLAIM HAS ALREADY BEEN ADJUSTED. 18 Duplicate claim/service.

9019

CLAIM TREATED AS AN ADJUSTMENT. CLAIM IS SCHEDULED TO BE ADJUSTED BY ANOTHER P ROCESS. 18 Duplicate claim/service.

186Denied. Condition is work related. Bill Worker's Compensation. 19

CLAIM DENIED BECAUSE THIS IS A WORK-RELATED INJURY/ILLNESS AND THUS THE LIABILITY OF THE WORKER'S COMPENSATION CARRIER.





235

Denied. The surgeon's claim and documentation has been returned for correction /information. Please contact the surgeon and refile this service after the sur geon has resubmitted. 19

CLAIM DENIED BECAUSE THIS IS A WORK-RELATED INJURY/ILLNESS AND THUS THE LIABILITY OF THE WORKER'S COMPENSATION CARRIER. N29


366

Claim denied. Our records indicate that this claim resulted from an employment related accident. Please bill the Workers' Compensation carrier. 19


367

Denied. Our records indicate that this claim resulted from an employment relat ed accident. You must contact the beneficiary to obtain the name and address o f the Workers' Compensation carrier to be billed. 19


1198

Denied. Please verify if the claim is a result of an employment related accide nt. If so, please bill the worker's compensation carrier. 19


240

Claim denied. Our records indicate that this is an accident related claim for which a third party is liable. This claim is being returned to you with instru ctions for billing the third party. 20

Claim denied because this injury/illness is covered by the liability carrier. MA64

Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.

1051Denied. Condition is related to an automobile accident. Bill the appropriate insurance carrier. 20

Claim denied because this injury/illness is covered by the liability carrier. MA85

Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance plan/group/program name or identification number. Enter the PlanID when effective.

38

DENIED. POSSIBLE MEDICARE COVERAGE FOR CHRONIC RENAL DISEASE. PLEASE RESUBMIT WITH PROOF OF MEDICARE CRD ELIGIBILITY/DENIAL. ACCEPTABLE PROOF OF MEDICARE C RD ELIGIBILITY IS LISTED IN SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROG RAM PROVIDER MANUAL. 22

Payment adjusted because this care may be covered by another payer per coordination of benefits.

66

Denied. Beneficiary's Medicaid eligibility file indicates other insurance cove rage. Please contact beneficiary for carrier and billing information. 22


68 Denied, co-insurance and/or deductible paid by Plan 65. 22Payment adjusted because this care may be covered by another payer per coordination of benefits.

74

MEDICARE COVERAGE INDICATED FOR THIS BENEFICIARY. PLEASE SUBMIT CLAIM TO MEDIC ARE FIRST AND RESUBMIT TO KANSAS MEDICAL ASSISTANCE PROGRAM WITH A COPY OF THE EOB/MEDICARE REMITTANCE ADVICE OR "OFFICIAL MEDICARE NOTIFICATION" SHOWING PRO OF OF PAYMENT OR DENIAL ATTACHED TO EACH CLAIM. 22

Payment adjusted because this care may be covered by another payer per coordination of benefits. MA04






77

DENIED, OTHER INSURANCE COVERAGE INDICATED FOR THIS BENEFICIARY. WHEN BILLED E LECTRONICALLY, PLEASE INDICATE THE PAID AMOUNT OR DENIAL AND RETRANSMIT. WHEN B ILLED ON PAPER, PLEASE ATTACH PROOF OF OTHER INSURANCE PAYMENT OR DENIAL AND RE SUBMIT. 22

Payment adjusted because this care may be covered by another payer per coordination of benefits. N4


148

Denied. Other Insurance payment not documented on claim form. Please complete Other Insurance payment field and resubmit. 22



175

DENIED. INVALID TPL INDICATION. VALIDATE OTHER INSURANCE AMOUNTS AND RESUBMIT WITH DOCUMENTATION FROM OTHER INSURANCE OR MEDICARE. (IF THE AMOUNT ENTERED I S CONSUMER COPAY OR SPENDDOWN, REMOVE THIS AMOUNT FROM THE CLAIM AND CORRECT T HE BALANCE DUE.) 22


185

DENIED. BILL BENEFICIARY'S OTHER INSURANCE FIRST. CARRIER/GROUP/POLICY NUMBER S ARE PRINTED AFTER EACH DENIED CLAIM. FOR COMPANY NAME AND BILLING ADDRESS, M ATCH THE 4-DIGIT CARRIER NUMBER WITH THE OTHER INSURANCE CARRIER'S LIST ON THE LAST PAGE OF THIS REMITTANCE ADVICE. 22


188

DENIED. WE HAVE NOTED YOUR COMMENTS REGARDING OTHER INSURANCE COVERAGE; HOWEVE R, SRS FILES INDICATE COVERAGE BY THE CARRIERS PRINTED AFTER EACH DENIED CLAIM. FOR COMPANY NAME AND BILLING ADDRESS, MATCH THE 4-DIGIT CARRIER NUMBER WITH THE OTHER INSURANCE CARRIER'S LIST ON THE LAST PAGE OF THIS REMITTANCE ADVICE. REF ER TO SECTION 3100 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM MANUAL. 22



189

DENIED. THE COMMENT "NO RESPONSE FROM OTHER INSURANCE COMPANY" HAS BEEN NOTED ON THIS CLAIM OR ITS ATTACHMENTS, BUT A COPY OF THE CLAIM BILLED TO THAT CARRIE R IS NOT PRESENT. PLEASE ATTACH THAT CLAIM COPY AND RESUBMIT TO EDS FOR PROCES SING. REFER TO SECTION 3300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 22







194

DENIED. THE COMMENT REGARDING TERMINATION OF THIS BENEFICIARY'S OTHER INSURANC E COVERAGE HAS BEEN NOTED ON THIS CLAIM OR ITS ATTACHMENTS. PLEASE PROVIDE DOC UMENTATION FROM THAT CARRIER (FOR COMPANY NAME, BILLING ADDRESS, MATCH THE 4-DI GIT CARRIER NUMBER WITH THE OTHER INSURANCE CARRIER'S LIST ON THE LAST PAGE OF THIS REMITTANCE ADVICE) AND RESUBMIT THIS CLAIM FOR PROCESSING. 22

Payment adjusted because this care may be covered by another payer per coordination of benefits. MA92 Missing plan information for other insurance.

289

BENEFICIARY'S AGE INDICATES MEDICARE ELIGIBILITY. PLEASE RESUBMIT WITH PROOF O F PAYMENT OR DENIAL FROM MEDICARE. REFER TO SECTION 3200 OF YOUR KANSAS MEDICA L ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 22


338

Denied. The beneficiary name, dates of service, and/or charges on the other in surance/Medicare document do not correspond with the information on the claim f orm. The claim may have been denied if the other insurance/Medicare document i s illegible. Please verify and resubmit for processing. 22


Claim information does not agree with information received from other insurance carrier.

609

Denied. Other Insurance coverage has been indicated on the claim. Please resu bmit claim providing insurance carrier name and amount paid in field 16 (remark s). 22



850

Denied. The column header/provider payment on the Medicare/Other Insurance Remi ttance Advice/Explanation of Benefits is illegible or omitted. Please resubmit. 22



855

Denied, incomplete for processing. Please resubmit a claim form with the Expla nation of Medicare Benefits (EOMB). (Attach the EOMB to your claim.) 22


1046

Denied. SRS files indicate this beneficiary has more than one insurance policy . Please resubmit with proof of payment or denial from all insurance policies. Carrier/group/policy numbers are printed after each denied claim. For compan y name and billing address, match the 4-digit carrier number with the Other Ins urance Carrier's list on the last page of this Remittance Advice. 22







1069

OTHER INSURANCE PAYMENT IS INDICATED ON CLAIM, HOWEVER, THE BENEFICIARY ELIGIBI LITY FILE INDICATES NO THIRD PARTY LIABILITY. PLEASE NOTIFY EDS OF THE OTHER I NSURANCE INFORMATION. EDS MEDICAL SERVICES WILL CONTACT YOU IN WRITING FOR TH E INSURANCE COMPANY NAME, BILLING ADDRESS AND CARRIER INFORMATION. 22


Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.

1074

DENIED. CLAIM INDICATES "NO RESPONSE FROM OTHER INSURANCE." PER CONTACT WITH OTHER INSURANCE COMPANY, CLAIM WAS NOT RECEIVED. PLEASE RESUBMIT TO OTHER INSU RANCE COMPANY. 22


Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance plan/group/program name or identification number. Enter the PlanID when effective.

1094

DENIED. PRIMARY INSURANCE PAYMENT REQUIRED FOR PROCESSING MAIL ORDER PHARMACY CLAIMS. 22


1190

Denied. Other insurance coverage indicated for this beneficiary. When billed electronically, please indicate appropriate payment/denial indicators (no attac hment necessary). When billed on paper, Medicaid is unable to process claim(s) without a copy of the EOMB/Medicare Remittance Advice or "official Medicare no tification" showing proof of payment or denial attached to each claim. For comm 22



1192Denied. Please resubmit the claim when other insurance has made a final determi nation. 22



1220

DENIED. CLAIMS PROCESSED BY MEDICARE MUST BE SUBMITTED TO KANSAS MEDICAL ASSIS TANCE PROGRAM ON PAPER. 22


2508 TPL EDITS PAY AND CHASE BYPASS 22Payment adjusted because this care may be covered by another payer per coordination of benefits.

95

REDUCED TO MAX ALLOWABLE. REDUCED BY MEDICARE, OTHER INS , COPAYMENT OR SPENDD OWN. THE MEDICARE, OTHER INSURANCE, COPAYMENT OR PATIENT'S SPENDDOWN WAS APPLI ED TO THE MEDICAID ALLOWANCE. MAX ALLOWABLE REDUCED BY MEDICARE PYMNT, OTHER I NSURANCE PYMNT, OR SPENDDOWN. COPAYMENT MAY ALSO HAVE BEEN DEDUCTED. SEE SECTI ON 3000, 3200, 3300 AND/OR 3600 OF THE GENERAL THIRD PARTY PAYMENTS MANUAL. 23

Payment adjusted because charges have been paid by another payer.

96PAYMENT REDUCED BY NON-PATIENT OBLIGATION. 23






134Zero pay. Amount paid by other insurance carrier is greater than or equal to t he total charge submitted. 23


149Denied. Total charge submitted equals amount paid by beneficiary. 23


244

REDUCED TO MAXIMUM ALLOWABLE. REDUCED BY OTHER INSURANCE. THE OTHER INSURANCE AMOUNT WAS DEDUCTED FROM THE MEDICAID ALLOWANCE. REFER TO SECTION 3300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 23


245

REDUCED TO MAXIMUM ALLOWABLE. REDUCED BY MEDICARE PAYMENT. REFER TO SECTION 3 200 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 23

Payment adjusted because charges have been paid by another payer. N18 Payment based on the Medicare allowed amount.

246

REDUCED TO MAXIMUM ALLOWABLE. REDUCED BY COPAYMENT AND OTHER INSURANCE. THE C OPAYMENT AND OTHER INSURANCE AMOUNT WAS DEDUCED FROM THE MEDICAID ALLOWANCE. R EFER TO SECTIONS 3000 AND 3300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVID ER MANUAL. 23


247

REDUCED TO MAXIMUM ALLOWABLE. REDUCED BY COPAYMENT AND MEDICARE PAYMENT. REFE R TO SECTIONS 3000 AND 3200 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 23


248

REDUCED TO MAXIMUM ALLOWABLE. REDUCED BY OTHER INSURANCE AND MEDICARE PAYMENT. REFER TO SECTIONS 3200 AND 3300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVI DER MANUAL. 23


249

REDUCED TO MAXIMUM ALLOWABLE. REDUCED BY COPAYMENT, OTHER INSURANCE, AND MEDIC ARE PAYMENT. REFER TO SECTIONS 3000, 3200 AND 3300 OF YOUR KANSAS MEDICAL ASSI STANCE PROGRAM PROVIDER MANUAL. 23


417

Denied. This is a noncovered Medicare Related service; however, Medicare has m ade an allowance. Please verify your coding. 23


818

CLAIM DENIED. THE SUM OF OTHER INSURANCE, NONCOVERED CHARGES, AND/ OR OTHER PAR TY LIABILITY EXCEEDS THE TOTAL AMOUNT BILLED/ALLOWED. 23


1054Denied. The Medicare payment exceeds the claim's allowed amount and results in a zero paid claim. 23






9002PRICING ADJUSTMENT-MEDICARE RELATED PRICING APPLIED 23


9003NO PAYMENT MADE-TPL/SPENDDOWN IS MORE THAN THE ALLOWED AMOUNT. 23

Payment adjusted because charges have been paid by another payer. N131

Total payments under multiple contracts cannot exceed the allowance for this service.

9907 TPL AMOUNT APPLIED 23Payment adjusted because charges have been paid by another payer. N45 Payment based on authorized amount.

1096

DENIED. SERVICE BILLED IS A COVERED SERVICE IN THE HEALTHWAVE XIX AND HEALTHWAV E XXI PROGRAMS AND MUST BE BILLED BY THE BENEFICIARY'S HEALTH MAINTENANCE ORGAN IZATION (HMO) 24

Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.

1302 PACE Policy 24Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.

349

DETAIL DENIED. PROGRAM LIMITATIONS DO NOT ALLOW PAYMENT FOR DENTAL SERVICES UNT IL THE STOP LOSS THRESHOLD HAS BEEN EXCEEDED AND APPROVED BY DORAL DENTAL. 25

Payment denied. Your Stop loss deductible has not been met.

2

CLAIM FILED PAST THE 6 MONTH LIMITATION. REFER TO SECTION 5100 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 29 The time limit for filing has expired. M54 Missing/incomplete/invalid total charges.

183

DENIED. THIS CLAIM IS BEYOND 12 MONTHS FROM THE DATE OF SERVICE AND CANNOT BE PAID. REFER TO SECTION 5100 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 29 The time limit for filing has expired.

503

Service denied. The information requested has not been received within the all otted time. If the documentation is available, please attach to your claim and resubmit. 29 The time limit for filing has expired.

1075

DENIED. THIS CLAIM/DETAIL IS BEYOND 24 MONTHS FROM THE DATE OF SERVICE AND CAN NOT BE PROCESSED. YOU MAY APPEAL THIS DENIAL WITHIN 30 DAYS FROM THIS NOTIFICA TION. REFER TO SECTIONS 5100 AND 5300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRA M PROVIDER MANUAL FOR ADDITIONAL INFORMATION. 29 The time limit for filing has expired. N1

You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.

1205

DENIED. WHEN A SERVICE IS NOT COVERED BY A BENEFICIARY'S PRIMARY INSURANCE CAR RIER, CORRESPONDENCE MUST BE ON THE INSURANCE CARRIER'S LETTERHEAD AND DATED WI THIN 1 YEAR OF THE DATE OF SERVICE BILLED. REFER TO SECTION 3100 OF YOUR KANSA S MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 29 The time limit for filing has expired.





46

DENIED, BENEFICIARY IN SPENDDOWN. THIS SERVICE IS DENIED BECAUSE SRS RECORDS IN DICATE BENEFICIARY IN SPENDDOWN. EDS HAS RECEIVED NO INDICATION THAT THE BENEFI CIARY HAS SUPPLIED VERIFICATION OF MEDICAL EXPENSES TO MEET THE SPENDDOWN. PLEA SE CONTACT EDS IF THE BENEFICIARY HAS A VALID MEDICAL CARD FOR THE MONTH(S) OF SERVICE. 30

Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.

170

Denied. A paid amount in block 30 indicates spenddown. Refer to Dental billin g instructions for more information. (If the amount entered is beneficiary's c opay, remove this amount from the claim form and correct the balance due). 30


190

PAYMENT REDUCED OR DENIED, BENEFICIARY IN SPENDDOWN PERIOD. PAYMENT IS BENEFIC IARY'S RESPONSIBILITY AS DOCUMENTED BY SPENDDOWN LETTER, EITHER ATTACHED TO THE CLAIM OR IN EDS' FILES. REFER TO SECTION 3600 OF YOUR KANSAS MEDICAL ASSISTAN CE PROGRAM PROVIDER MANUAL. 30


243Denied, please split bill. Break out dates of service pertaining only to spend down. 30

Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. N61 Rebill services on separate claims.

409

DENIED. A PAID AMOUNT IN BLOCK 30 OF THE DENTAL CLAIM FORM INDICATES SPENDDOWN . OTHER INSURANCE AND/OR MEDICARE PAYMENT SHOULD BE ENTERED IN BLOCK 29. REFE R TO BILLING INSTRUCTIONS (SECTION 7000) IN YOUR KANSAS MEDICAL ASSISTANCE PROG RAM PROVIDER MANUAL. 30


9922 SPENDDOWN DEDUCTIBLE APPLIED 30


9923PAYMENT ADJUSTED. DUPLICATE DETAIL APPLIED TO SPENDDOWN. 30


9924 PAYMENT ADJUSTED. SPENDDOWN UNMET. 30


32

BENEFICIARY ID NUMBER INCORRECT OR MISSING. USE ID CARD TO CORRECT CLAIM FORM A ND RESUBMIT. 31

Claim denied as patient cannot be identified as our insured.

9011CLAIM TREATED AS AN ADJUSTMENT. NO MEDICAID ID ON THE CLAIM. 31


9015CLAIM TREATED AS AN ADJUSTMENT. BENEFICIARY NOT FOUND ON T_RE_BASE. 31






40

DENIED/REDUCED. ONLY TWO MONTHS RENTAL OF NEBULIZER WITH COMPRESSOR IS ALLOWED PER LIFETIME. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 35 Lifetime benefit maximum has been reached.

48

DENIED. ONLY ONE IMMUNIZATION, ACTIVE; MEASLES, MUMPS, AND RUBELLA VIRUS VACCI NE, LIVE IS ALLOWED PER LIFETIME, REGARDLESS OF PROVIDER, UNLESS THE CONSUMER I S A KAN BE HEALTHY PARTICIPANT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL A SSISTANCE PROGRAM PROVIDER MANUAL. 35 Lifetime benefit maximum has been reached.

398

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE INSTALLATION OF PERSONAL EMERGE NCY RESPONSE SERVICE IS ALLOWED PER LIFETIME. REFER TO SECTION 8000 OF THE KAN SAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDERLY PERSONAL EMERGENCY RESPONSE PROVIDER MANUAL. 35 Lifetime benefit maximum has been reached. N117

THIS SERVICE IS PAID ONLY ONCE IN A PATIENT'S LIFETIME.

1169Denied. This service is only allowed to be billed once per lifetime. 35 Lifetime benefit maximum has been reached.

1218

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE HOME MODIFICATION ALLOWE D. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS HEAD I NJURY HOME MODIFICATION PROVIDER MANUAL. 35 Lifetime benefit maximum has been reached.

30

CLAIM DENIED. BENEFICIARY LOCK-IN. REFER TO SECTION 2400 OF YOUR KANSAS MEDIC AL ASSISTANCE PROGRAM GENERAL PROVIDER MANUAL. 38

Services not provided or authorized by designated (network/primary care) providers.

102

DENIED. OTHER INSURANCE CARRIER DOES NOT REIMBURSE THE PROVIDER WHEN MEMBER LA CKS AUTHORIZATION FROM THE CARRIER'S CASE MANAGER OR THE BENEFICIARY HAS USED A PROVIDER OUT OF THE CARRIER'S NETWORK. KMAP CONSIDERS THESE NON-COVERED SERVI CES BILLABLE TO THE BENEFICIARY. 38


106

DENIED. SERVICE(S) BILLED WERE NOT PERFORMED OR REFERRED BY THE CONSUMER'S HEAL THCONNECT PHYSICIAN. (ALPHA ENTRIES ARE NOT ACCEPTABLE.) THE HEALTHCONNECT PHYS ICIAN'S MEDICAID PROVIDER NUMBER FOR THE PROVIDER SHOWN ON THE MEDICAID ID CARD MUST BE ENTERED IN THE APPROPRIATE FIELD. 38






150

DENIED. THE BENEFICIARY'S HEALTHCONNECT PHYSICIAN'S KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER NUMBER MUST BE INDICATED ON THE CLAIM FORM AS EITHER THE REFE RRING OR PERFORMING PHYSICIAN FOR THE DATES OF SERVICE GIVEN. PLEASE REFER TO B LOCK 17A OR 24K OF THE HCFA-1500 FORM AND FORM LOCATORS 82 OR 83 OF THE UB-92. 38

Services not provided or authorized by designated (network/primary care) providers. N55

Procedures for billing with group/referring/performing providers were not followed.

218

Denied. Lock-in beneficiary. The billing provider is not this beneficiary's l ock-in pharmacy. Refer to Section 2400 of your Kansas Medical Assistance Gener al Provider Manual. 38


219

Denied. Lock-in beneficiary. The prescribing physician is not this beneficiar y's lock-in physician. Refer to Section 2400 of your Kansas Medical Assistance General Provider Manual. 38


948

DENIED. BENEFICIARY ASSIGNED TO FOSTER CARE OR HOSPICE AND PROVIDER NOT ELIGIB LE TO BILL. 38


1237

DENIED. OUR RECORDS INDICATE THAT THIS BENEFICIARY IS ASSIGNED TO A CHILDREN A ND FAMILY SERVICES (CFS) CONTRACTOR. IF YOU FEEL THIS ASSIGNMENT INFORMATION I S INCORRECT, PLEASE CONTACT THE CFS CONTRACT SPECIALIST AT THE LOCAL SRS OFFICE FOR VERIFICATION OF ASSIGNMENT INFORMATION. REFER TO SECTION 2900 OF YOUR KANS AS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR DETAILED INFORMATION. 38


159Denied. Prior Authorization does not approve the procedure code billed. 39

Services denied at the time authorization/pre-certification was requested. N54


160Denied. The ICD-9-CM surgical procedure/DRG code billed is not authorized. 39

Services denied at the time authorization/pre-certification was requested. N54


165 Denied, Prior Authorization denied by State consultant. 39Services denied at the time authorization/pre-certification was requested.

543

THE EMERGENCY ROOM SERVICES HAVE BEEN DETERMINED TO BE OF A NON-EMERGENT NATURE .THE FEE SUBMITTED HAS BEEN REDUCED TO REFLECT THE NON-EMERGENT LEVEL. REFER T O SECTION 8420 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HOSPTIAL PROVIDER MANU AL OR SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROFESSIONAL PROVID ER MANUAL FOR MORE INFORMATION. 40

Charges do not meet qualifications for emergent/urgent care.





546

DETAIL DENIED. THIS CLAIM AND ATTACHMENTS HAVE BEEN REVIEWED BY THE MEDICAL S TAFF AND THE EMERGENCY STATUS OF THE SERVICES RENDERED IS NOT SUPPORTED BY THE DOCUMENTATION PROVIDED. REFER TO SECTIONS 7020, 8200, 8420 AND APPENDIX III OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL FOR MORE INFOR MATION. 40


547

Detail denied. The primary and/or secondary diagnosis listed has been reviewed and determined to be nonemergent. Refer to Sections 7020, 8200, 8400, 8420 an d Appendix III of your Kansas Medicaid/MediKan Hospital provider manual or Sect ion 8400 of your Kansas Medicaid/MediKan Professional provider manual for more information. 40


635

THIS CLAIM AND ATTACHMENTS HAVE BEEN REVIEWED BY THE MEDICAL STAFF AND THE EMER GENCY ROOM SERVICES HAVE BEEN DETERMINED TO BE OF A NON-EMERGENT LEVEL. REFER TO SECTION 8420 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MAN UAL FOR MORE INFORMATION. 40


950

Denied. Your Medical Necessity form and any other supporting documentation giv en has been reviewed and determined to be nonemergent. 40


1073

DENIED. NON-EMERGENT AMBULANCE SERVICES ARE NONCOVERED FOR RESIDENTS OF ADULT CARE HOMES. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PR OVIDER MANUAL. 40


18

PAID AT MAXIMUM DAYS ALLOWED. KANSAS HOSPITALS PAID AT MAXIMUM ALLOWED BY THAT HOSPITAL'S UTILIZATION REVIEW. OUT-OF-STATE HOSPITALS PAID AT MAXIMUM ALLOWED . 42

Charges exceed our fee schedule or maximum allowable amount.

23

Denied. Billed charges greatly exceed the assigned DRG cost outlier limit. Pl ease verify charges are correct and resubmit on paper. 42


41

CLAIM DENIED. BILLED AMOUNT EXCEEDS THE KANSAS MEDICAL ASSISTANCE PROGRAM REIM BURSEMENT RATE FOR THE NDC SUBMITTED. RESUBMIT WITH CORRECT NDC, QUANTITY AND BILLED AMOUNT. 42


73 Claim reviewed and reimbursed at maximum allowable. 42Charges exceed our fee schedule or maximum allowable amount. N14

Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount.





93 REDUCED TO MAXIMUM ALLOWABLE. 42Charges exceed our fee schedule or maximum allowable amount. N14


323

DAYS PAID AT MAXIMUM ALLOWED. FOR MORE INFORMATION REGARDING PAYMENT FOR ALIEN MEDICAL SERVICES, REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGR AM PROVIDER MANUAL. 42


386

Claim reimbursed at maximum allowable. Prorated payment due to a portion of th e dates of service on inpatient claim being prior to the DRG effective date. 42


396

Claim reimbursed at maximum allowable. Payment has been prorated due to a port ion of the dates of service on the inpatient claim being prior to SRS fiscal ye ar. 42


490Detail denied. Billed amount exceeds the maximum allowed per month for Residen tial Habilitation services. 42


492Detail denied. Billed amount exceeds the reimbursement rate set for your facil ity by SRS. 42


552

DENIED, ONLY THE CODES LISTED UNDER "SPECTACLE MATERIALS" IN APPENDIX I OF THE KANSAS MEDICAL ASSISTANCE PROGRAM VISION PROVIDER MANUAL CAN BE BILLED ON AN OP TICAL WORK ORDER (OWO). 42


607Manually priced by Pharmacy Consultant. Claim reimbursed at maximum allowable. 42

Charges exceed our fee schedule or maximum allowable amount. N10


852Denied. Medicare paid amount equals or is greater than the total charge. 42


9801

DENIED. THE CLAIM HAS BEEN PRICED. THE ALLOWED AMOUNT IS CUTBACK AND NO PAYME NT HAS BEEN MADE. 42

Charges exceed our fee schedule or maximum allowable amount. N45 Payment based on authorized amount.

9908PRICING ADJUSTMENT - PHARMACY PRICING APPLIED 42


9909PRICING ADJUSTMENT - 50% OF AMOUNT BILLED APPLIED 42


9911PRICING ADJUSTMENT - LONG TERM CARE PRICING APPLIED 42


9916PRICING ADJUSTMENT - UCC RATE PRICING APPLIED 42


9918PRICING ADJUSTMENT - MAX FEE PRICING APPLIED 42


9919PRICING ADJUSTMENT - PROVIDER LOC PRICING APPLIED 42


9921 PRICING ADJUSTMENT - PA PRICING APPLIED 42Charges exceed our fee schedule or maximum allowable amount.





9928PRICING ADJUSTMENT - ENCOUNTER RATE PRICING APPLIED 42


9929PRICING ADJUSTMENT - PER DIEM RATE PRICING APPLIED 42


9930PRICING ADJUSTMENT - PERCENT OF CHARGE PRICING APPLIED 42


9931PRICING ADJUSTMENT - ANESTHESIA PRICING APPLIED 42


9932 PRICING ADJUSTMENT - DRG PRICING APPLIED 42Charges exceed our fee schedule or maximum allowable amount.

82This reprocessed claim is a result of an Adjustment Request. 45

Charges exceed your contracted/ legislated fee arrangement.

83We have deducted the original payment as a result of an Adjustment Request. 45

Charges exceed your contracted/ legislated fee arrangement.

9917 ELECTRONIC ADJUSTMENT 45Charges exceed your contracted/ legislated fee arrangement.

54

DENIED. THE ICD-9-CM DIAGNOSIS CODE IS MISSING, INVALID, ILLEGIBLE, OR NOT ACC EPTABLE BY THE KANSAS MEDICAL ASSISTANCE PROGRAM . PLEASE RESUBMIT WITH APPROPR IATE SPECIFIC ICD-9 CM DIAGNOSIS CODE. 47

This (these) diagnosis(es) is (are) not covered, missing, or are invalid. M64 Missing/incomplete/invalid other diagnosis.

508

Denied. Medical necessity of the service provided cannot be determined by this nonspecific diagnosis code. Please resubmit with the specific diagnosis code reflecting the condition that brought the beneficiary in for treatment. 47

This (these) diagnosis(es) is (are) not covered, missing, or are invalid. M76 Missing/incomplete/invalid diagnosis or condition.

1194

Pharmacy claim was processed without consideration of the diagnosis information . Diagnosis code on the claim is invalid. 47

This (these) diagnosis(es) is (are) not covered, missing, or are invalid.

1203

DENIED. EITHER A DIAGNOSIS CODE WAS NOT SUBMITTED AND IS REQUIRED FOR THE NDC SUBMITTED OR THE DIAGNOSIS CODE SUBMITTED IS NOT COVERED FOR THIS NDC. 47

This (these) diagnosis(es) is (are) not covered, missing, or are invalid.

1411DENIED. ADMITTING DIAGNOSIS MISSING OR INVALID. 47

This (these) diagnosis(es) is (are) not covered, missing, or are invalid. M65

One interpreting physician charge can be submitted per claim when a purchased diagnostic test is indicated. Please submit a separate claim for each interpreting physician.

104Denied. An eye exam cannot be billed on the same day as a KAN Be Healthy Visio n screen. 49

These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. M63

We do not pay for more than one of these on the same day.

105Denied. A periodic/ER oral exam cannot be billed on the same day as a KAN Be H ealthy Dental screen. 49

These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. M63


39

Medical necessity required, form not present. Please resubmit on paper with me dical necessity form attached. 50

THESE ARE NON-COVERED SERVICES BECAUSE THIS IS NOT DEEMED A 'MEDICAL NECESSITY' BY THE PAYER.





64 This service reviewed and denied by consultant. 50


67Hysterectomies performed for sterilization are noncovered. 50


169

Denied/reduced. Exceeds program limitations. Documentation of medical necessi ty on the Medical Necessity Form was determined insufficient for service(s) ren dered. 50


308

DETAIL DENIED. DOCUMENTATION INDICATING THE MEDICAL NEED FOR THIS NONCOVERED P ROCEDURE WAS NOT RECEIVED WITH YOUR CLAIM. SUBMIT REQUESTS FOR COVERAGE TO THE KANSAS MEDICAL ASSISTANCE PROGRAM. REFER TO SECTION 4200 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 50


321

Service denied/reduced. The information submitted with this claim does not sup port medical necessity of the service provided. If additional documentation is available, please attach to the claim and resubmit on paper. 50


549

SERVICE DENIED. THE DIAGNOSIS CODE(S) LISTED DOES NOT SUPPORT THE MEDICAL NECE SSITY OF THE SERVICE PROVIDED. PLEASE VERIFY THAT THE DIAGNOSIS CODE(S) ON YOU R CLAIM REFLECT THE CONDITION THAT NECESSITATED THE SERVICE PROVIDED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 50


1245

SERVICE DENIED. THIS CLAIM AND ANY ATTACHMENTS HAVE BEEN REVIEWED BY THE QUALI TY ASSURANCE/UM UNIT AND IT HAS BEEN DETERMINED THAT THE BENEFICIARY DOES NOT M EET THE KMAP CRITERIA FOR THE SERVICE BILLED. 50


1246

Service denied. This claim and any attachments have been reviewed by the Qualit y Assurance/UM unit and the medical necessity of the services rendered are not supported by the documentation provided. 50


26These services must be billed using the appropriate provider number for this cl aim type. 52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.





55PROVIDER IS INELIGIBLE PER PROGRAM GUIDELINES. 52


107

Denied, incomplete for processing. Referring physician number is invalid or mi ssing. Please correct and resubmit. 52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. N284 Missing/incomplete/invalid referring provider taxonomy.

192

Detail denied. Physicians not in a group practice must use the same performing provider number as the billing provider number or the performing provider is i neligible for dates of service billed. 52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. N32


303Denied. Incorrect provider number used when billing inpatient services. 52


Missing/incomplete/invalid service facility primary identifier.

343

PROVIDER INELIGIBLE TO RENDER SERVICES TO KANSAS MEDICAL ASSISTANCE PROGRAM BE NEFICIARIES. 52


423

Detail denied. Surgery and Assistant Surgery must be billed with different per forming provider numbers in block 24K if billing provider (block 33) is a group . If the billing provider is not a group, each provider must bill on a separat e claim form under his individual provider number. 52


Missing/incomplete/invalid prescribing provider identifier.

451

DETAIL DENIED. PHYSICIANS NOT IN A GROUP PRACTICE MUST USE THE SAME PERFORMING PROVIDER NUMBER AS THE BILLING PROVIDER. 52


466

KANSAS MEDICAL ASSISTANCE PROGRAM WILL NOT ALLOW PAYMENT TO THE PHYSICIAN FOR S ERVICES SENT TO A REFERENCE LABORATORY FOR PROCESSING. THE PROVIDER WHO PERFOR MED THE SERVICE MUST BILL. 52



527

SERVICE DENIED. SKILLED NURSING SERVICES ARE NOT COVERED WHEN PERFORMED BY AN LPN. TO APPEAL THIS DENIAL, REFER TO INSTRUCTIONS IN SECTION 5300 OF YOUR KANS AS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 52


530

SERVICE DENIED. THESE SERVICES HAVE BEEN DETERMINED TO BE SKILLED NURSING SERV ICES AND ARE NOT COVERED WHEN PERFORMED BY A HOME HEALTH AIDE. TO APPEAL THIS DENIAL, REFER TO INSTRUCTIONS IN SECTION 5300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 52


581Detail denied. Consultations allowed only when referring physician is indicate d on claim form. 52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. N285 Missing/incomplete/invalid referring provider name.





597

DENIED. PERFORMING PROVIDER NUMBER IS INELIGIBLE. TWO OR MORE ENROLLMENT UPDA TE REQUESTS HAVE PREVIOUSLY BEEN SENT AND EDS HAS RECEIVED NO RESPONSE. PLEASE SUBMIT WITH A COMPLETED ENROLLMENT UPDATE REQUEST. 52


599

DETAIL DENIED. DENTISTS NOT IN A GROUP PRACTICE MUST USE THE SAME PERFORMING P ROVIDER NUMBER AS THE BILLING PROVIDER NUMBER. 52


610

DENIED. THE PRESCRIBING PHYSICIAN'S KMAP NUMBER MUST BE PRESENT AND VALID IN F IELD 8 OF THE CLAIM FORM. IF THE KMAP NUMBER IS NOT AVAILABLE, INDICATE THE PH YSICIAN'S NAME IN BLOCK 16 (REMARKS) FOR EACH LINE AND RESUBMIT. REFER TO SECT ION 7000 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 52


Missing/incomplete/invalid prescribing provider identifier.

650

CLAIM DENIED. MEDICAID DOES NOT PAY FOR KAN BE HEALTHY SCREENS PROVIDED BY STAT E INSTITUTIONS OR MISCELLANEOUS PROVIDERS. THE DENIED SCREEN WILL BE APPLIED TO EDS' FILES FOR PROCESSING. 52


This provider type/provider specialty may not bill this service.

952Denied. Performing provider ineligible for dates of service billed. 52


1067

Denied. Lock-in beneficiary. The pharmacy and/or prescribing provider is not this beneficiary's lock-in provider. Alpha entries are not acceptable in field 8. Refer to Section 2400 of your Kansas Medical Assistance General Provider M anual. 52


1185

Denied. Our records indicate that the billing provider is a group and the perfo rming provider is not a member of that group. 52

The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. MA32


1189Detail denied. Our records do not indicate that the performing provider is a me mber of this group practice. 52



216

TRANSPORTATION SERVICES LEVEL 1 (T2003) AND TRANSPORTATION SERVICES LEVEL II CA N NOT BE BILLED ON THE SAME DAY FOR THE SAME BENEFICIARY. 151

Payment adjusted because the payer deems the information submitted does not support this many services.

220

DENIED. THE PROCEDURE BILLED IS FOR TRANSPORTATION LEVEL OF CARE SERVICES NOT MATCHING THE BENEFICIARY'S TRANSPORTATION LEVEL OF CARE 150

Payment adjusted because the payer deems the information submitted does not support this level of service.





181

DETAIL DENIED. PLACE OF SERVICE IS MISSING OR INVALID. REFER TO THE BILLING I NSTRUCTIONS FOR THIS CLAIM FIELD IN PART II OF YOUR KANSAS MEDICAL ASSISTANCE P ROGRAM PROVIDER MANUAL. 58

Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. M77 Missing/incomplete/invalid place of service.

195

DETAIL DENIED. PLACE OF SERVICE CODE INDICATED IS INVALID FOR NURSING HOME SER VICES. REFER TO HCFA-1500 BILLING INSTRUCTIONS IN PART II OF YOUR KANSAS MEDIC AL ASSISTANCE PROGRAM PROVIDER MANUAL FOR VALID PLACE OF SERVICE CODES. 58


213Detail denied. Professional component not allowed when performed in the place of service indicated. 58

Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.

214

Detail denied. Professional and technical components not allowed when performe d in the place of service indicated. 58


363Detail denied. Durable Medical Equipment is noncovered in place of service ind icated. 58


468

Detail denied. The place of service given does not correspond with your provid er type as an independent lab. Please correct and resubmit. 58


1126

Detail reimbursed at maximum allowed for multiple surgical procedures performed during the same operative session. 59

Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules.

5Prior authorization expiration date is prior to service date. 62

Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.

6 Claim denied. Prior authorization required. 62Payment denied/reduced for absence of, or exceeded, pre-certification/authorization.

20

CLAIM DENIED. ALCOHOL AND DRUG REHABILITATION SERVICES REQUIRE PRE-CERTIFICATI ON. PLEASE RESUBMIT THE CLAIM FOR ONLY THE DETOXIFICATION PORTION OF THE STAY IF PRE-CERTIFICATION WAS DENIED OR WAS NOT OBTAINED. REFER TO SECTION 8410 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL FOR MORE INFORM ATION. 62


52

DENIED. SERVICES PERFORMED BY OUT-OF-STATE PROVIDERS REQUIRE PRIOR AUTHORIZATI ON. IF SERVICES ARE A RESULT OF AN EMERGENCY, COMPLETE THE KANSAS MEDICAID MED ICAL NECESSITY (MN) FORM AND RESUBMIT CLAIM AND MN FORM TO EDS FOR PROCESSING. IF YOU HAVE ANY FURTHER QUESTIONS, CONTACT EDS PROVIDER ASSISTANCE UNIT. 62

Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. M62 Missing/incomplete/invalid treatment authorization code.





80

Denied. The from and thru dates billed do not match the certification data rec ord on file. Please resubmit with the from and thru dates and charges approved by Utilization Review. 62

Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. MA31


356

Detail denied. Procedure requires both prior authorization and KAN Be Healthy (EPSDT) participation. 62


471

Denied. The Prior Authorization identified by the PA number on the claim is vo id. If approval was obtained prior to performing the service, resubmit with th e valid PA number in the appropriate claim block. 62


584

DENIED. DENTAL TREATMENT PLANS IN EXCESS OF $500 PER CALENDAR YEAR REQUIRE PRI OR AUTHORIZATION. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PRO GRAM PROVIDER MANUAL FOR MORE INFORMATION. 62


625

CLAIM DENIED. INPATIENT ALCOHOL/DRUG REHABILITATION REQUIRES RECERTIFICATION. IF CERTIFICATION WAS OBTAINED PRIOR TO INPATIENT REHABILITATION, RESUBMIT CLAI M WITH CERTIFICATION NUMBER IN THE APPROPRIATE CLAIM FIELD. REFER TO SECTION 8 410 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL. 62


626Claim denied. Inpatient alcohol/drug recertification expiration date is prior to service date. 62


627

CLAIM DENIED. THE SURGICAL/DIAGNOSTIC PROCEDURE BILLED REQUIRES PRIOR AUTHORIZ ATION. IF PRIOR AUTHORIZATION WAS OBTAINED PRIOR TO THE PROCEDURE BEING PERFOR MED RESUBMIT CLAIM WITH PRIOR AUTHORIZATION NUMBER IN THE APPROPRIATE CLAIM FIE LD. 62


628Claim denied. The surgical/diagnostic prior authorization expiration date is p rior to service date. 62


629

Claim denied. Inpatient Alcohol/Drug Rehabilitation requires prior authorizati on. If prior authorization was not obtained, only bill for the medical portion of the stay. 62


633Claim denied. The surgical/diagnostic prior authorization effective date is af ter the date of service. 62






636

PROCEDURE DENIED. THIS OPERATIVE CHOLANGIOGRAM WAS PERFORMED DURING OR AFTER A CHOLECYSTECTOMY THAT WAS NOT PRIOR AUTHORIZED. PLEASE REFER TO SECTION 4300 O F THE KANSAS MEDICAL ASSISTANCE PROGRAM GENERAL SPECIAL REQUIREMENTS PROVIDER M ANUAL. 62


638

Our records indicate that prior authorization was obtained for this procedure. The prior authorization number was added or corrected as a courtesy to the cla im record in order to adjudicate this claim. When billing future claims enter the prior authorization number in the designated area of the claim. 62


642

Claim denied. The surgical/diagnostic procedure billed requires prior authoriz ation which was not obtained by the primary physician. It is the responsibilit y of the primary physician to obtain prior authorization. Ancillary providers cannot file for prior authorization reconsiderations. Please contact the prima ry physician to initiate this process. 62


763

SWING BED ADMISSION DENIED, APPROVAL FROM SRS TO PAY YOUR HOSPITAL FOR SWING BE D SERVICES HAS NOT BEEN RECEIVED. FOR MORE INFORMATION, CONTACT EDS PROVIDER E NROLLMENT UNIT. 62


1080

DENIED. THIS BENEFICIARY HAS NOT BEEN SCREENED AND/OR APPROVED FOR ADMISSION T O A HEAD INJURY REHABILITATION FACILITY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 62


1227

Denied. An HCBS plan of care (prior authorization) has not been generated for t he month in which services are being billed. 62


1232

DENIED. EXCEEDS THE MAXIMUM RECOMMENDED DOSE. PRIOR AUTHORIZATION IS REQUIRED . REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDERMANU AL. 62


1233

Denied. An HCBS plan of care (prior authorization) is not on the prior authori zation master file for the month in which services are being billed. Contact t he beneficiary's case manager for instructions before rebilling. 62






1235

Denied. The units or dollars billed on the claim exceed those authorized on th e HCBS plan of care (prior authorization). Contact the beneficiary's case mana ger for instructions before rebilling. 62


1244

DENIED. THE PROCEDURE BILLED REQUIRES PRIOR AUTHORIZATION. DENIAL FROM BENEFI CIARY'S PRIMARY INSURANCE WAS ATTACHED TO YOUR CLAIM. CONTACT THE PRIOR AUTHOR IZATION UNIT TO RETROACTIVELY AUTHORIZE THIS PROCEDURE. MEDICAL INFORMATION WI LL BE REQUIRED. REFER TO SECTION 4300 OF YOUR KANSAS MEDICAL ASSISTANCE PROVID ER MANUAL FOR ADDITIONAL INFORMATION ON THE PRIOR AUTHORIZATION PROCESS. 62


1253All or a portion of this claim has been recouped as prior authorization was not obtained for the services billed. 62


1266

Denied. Procedure requires prior authorization. If procedure was performed as an Emergency Service, attach Medical Necessity Documentation indicating the em ergent nature of the procedure. This should include Exam and X-Ray results. 62


1418DENIED. ATTACHMENT INDICATED ON CLAIM NOT RECEIVED. 62

Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. N102

This claim has been denied without reviewing the medical record because the requested records were not received or were not received timely.

378Paid at maximum allowed. Claim reimbursed using the day outlier methodology. 69 Day outlier amount.

377Paid at maximum allowed. Claim reimbursed using the cost outlier methodology. 70

Cost outlier - Adjustment to compensate for additonal costs.

913This dollar amount reflects your disproportionate share payment. 76 Disproportionate Share Adjustment.

51 Denied. Non-covered reserve days. 78 Non-Covered days/Room charge adjustment.700 Paid amount reduced; noncovered reserve days. 78 Non-Covered days/Room charge adjustment.

960

DENIED, THE BENEFICIARY IS A PARTICIPANT IN THE KANWORK TRANSITIONAL MEDICAL PR OGRAM AND THE BENEFICIARY IS NOT ELIGIBLE FOR HEALTH CARE BENEFITS COVERAGE ON THE DATES OF SERVICE BILLED DUE TO NO PAYMENT OF PREMIUM. 95 Benefits adjusted. Plan procedures not followed.

961

DENIED, THE BENEFICIARY IS A PARTICIPANT IN KANWORK TRANSITIONAL MEDICAL PROGRA M AND THE BENEFICIARY IS NOT ELIGIBLE DUE TO A PROGRAM REQUIREMENT. 95 Benefits adjusted. Plan procedures not followed.

962

DENIED, THE BENEFICIARY IS A PARTICIPANT IN KANWORK TRANSITIONAL MEDICAL PROGRA M AND THE BENEFICIARY IS NOT ELIGIBLE DUE TO A PROGRAM REQUIREMENT. 95 Benefits adjusted. Plan procedures not followed.





72

THIS PROCEDURE/REVENUE CODE HAS BEEN REVIEWED AND DETERMINED TO BE A NONCOVERED KANSAS MEDICAL ASSISTANCE PROGRAM SERVICE. 96 Non-covered charge(s).

91THIS SERVICE NOT COVERED BY KANSAS MEDICAL ASSISTANCE PROGRAM. 96 Non-covered charge(s).

143

DENIED. INTERMEDIATE OR DAY TREATMENT FOR ALCOHOL AND/OR DRUG ADDICTION IS NON COVERED FOR MEDIKAN BENEFICIARIES. REFER TO YOUR KANSAS MEDICAL ASSISTANCE PRO GRAM PROVIDER MANUAL. 96 Non-covered charge(s).

261

DENIED. NONEMERGENT AMBULANCE SERVICES ARE NONCOVERED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 96 Non-covered charge(s).

302

DENIED. MEDIKAN BENEFICIARIES ARE LIMITED TO RECEIVING MEDICATIONS WHICH FALL INTO SPECIFIC THERAPEUTIC CATEGORIES DEEMED COVERED BY SRS. REFER TO SECTION 8 300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMAT ION. 96 Non-covered charge(s).

309

DENIED. NONCOVERED SERVICE FOR MEDIKAN BENEFICIARIES. REFER TO SECTIONS 2010 AND 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 96 Non-covered charge(s).

369

DENIED. ALIEN MEDICAL SERVICES ARE ONLY ALLOWED FOR EMERGENCY SERVICES. REFER TO SECTION 2040 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 96 Non-covered charge(s). N30 Patient ineligible for this service.

1078Denied. The primary drug in the compound being billed is a noncovered drug. 96 Non-covered charge(s).

1097

DENIED. DENTAL SEALANTS ARE NONCOVERED WHEN PERFORMED ON DECIDUOUS TEETH. REF ER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 96 Non-covered charge(s).

1215

Detail denied. According to our records, this beneficiary is not eligible for HCBS Physical Disabilities Waiver services for all or a portion of the service dates billed. Please contact the beneficiary's case manager. 96 Non-covered charge(s).





1223

DENIED. THIS CLAIM HAS BEEN REVIEWED BY THE MEDICAL CONSULTANT. THE HOSPITAL ADMISSION HAS BEEN DETERMINED AS NONCOVERED FOR THIS MEDIKAN BENEFICIARY. REFE R TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 96 Non-covered charge(s). M85

Subjected to review of physician evaluation and management services.

1421DENIED. THE SERVICE IS NOT COVERED FOR THE KANSAS MEDICAL ASSISTANCE PROGRAM. 96 Non-covered charge(s). N30 Patient ineligible for this service.

8516AN ENCOUNTER VOID TRANSACTION DENIED THIS CLAIM. 96 Non-covered charge(s).

120

State guidelines consider supplies content of service of Advanced Life Support (ALS) all inclusive services, emergency transport one way, when billed on the s ame date of service by the same provider. 97

Payment is included in the allowance for another service/procedure. M63


140

STATE GUIDELINES CONSIDER SUPPLIES CONTENT OF SERVICE OF LABOR AND DELIVERY IN A MATERNITY CENTER SETTING WHEN BILLED ON THE SAME DATE OF SERVICE. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MOR E INFORMATION. 97

Payment is included in the allowance for another service/procedure.

179Incidental services are content of service of the initial encounter and are not reimbursed separately. 97



205

Denied, content of another service performed. A component part cannot be bille d on the same day as the complete test, which includes the component part. 97



217Detail denied. Arterial Puncture is content of service of the lab testing prov ided on this date of service. 97


223

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. HEARING AID REPAIRS ARE CONSIDERE D CONTENT OF SERVICE WITHIN SIX MONTHS OF THE HEARING AID PURCHASE. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM AUDIOLOGY PROVIDER MANU AL. 97


230

Denied. SRS considers Sutures content of service of Simple Tooth Extraction wh en billed on the same date of service. 97


231

DENIED. SRS CONSIDERS CERTAIN DENTAL X-RAYS CONTENT OF SERVICE OF THE ORTHODON TIC WORK UP. 97






373

DENIED. PRENATAL RISK REDUCTION VISITS ARE A COVERED SERVICE WHEN BILLED IN CO NJUNCTION WITH PRENATAL HEALTH PROMOTION AND/OR RISK REDUCTION SERVICES. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 97


410

Denied, exceeds program limitations. Pulpotomy procedures are considered conte nt of service when performed within 30 days prior to Root Canal Therapy or Extr action of the same tooth. 97


430

DETAIL DENIED. HEARING TEST(S) ARE CONSIDERED CONTENT OF SERVICE TO THE FITTIN G AND DISPENSING OF A HEARING AID. REFER TO SECTION 8400 OF YOUR KANSAS MEDICA L ASSISTANCE PROGRAM AUDIOLOGY PROVIDER MANUAL. 97


432

This lab service, and others provided on this date of service, are part of a Ch emistry Profile. Reimbursement has been made at the maximum allowed for the ap propriate profile. 97


441

PAYMENT REDUCED/DENIED. THE OFFICE OR HOSPITAL VISIT IS CONSIDERED CONTENT OF SERVICE OF THE CHEMOTHERAPY ADMINISTRATION AND CANNOT BE BILLED SEPARATELY. RE FER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 97


443

Denied. Normal newborn infant History and Examination is considered content of service when performed within 7 days before or after a KAN Be Healthy Screen b y the same provider. 97


455

DENIED. OFFICE VISITS ARE CONTENT OF SERVICE WHEN BILLED ON THE SAME DAY AS AN IN-0FFICE SURGERY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PRO GRAM PROVIDER MANUAL. 97


521

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. PODIATRY FOLLOW-UP OFFICE VISITS A RE CONSIDERED CONTENT OF SERVICE OF FRACTURE AND DISLOCATION SURGICAL PROCEDURE S. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MA NUAL. 97


522

Detail denied, exceeds program limitations. Physical Therapy is considered con tent of service of a Podiatry Office Visit. 97






523

Detail denied, exceeds program limitations. Nerve Blocks are considered conten t of service of a podiatry surgery. 97


580

DENIED. EXCEEDS PROGRAM LIMITATIONS. OFFICE/HOSPITAL VISITS ARE CONSIDERED C ONTENT OF SERVICE UP TO 21 DAYS AFTER MINOR SURGERY. REFER TO YOUR KANSAS MED ICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 97


594Detail denied. Root recovery and Alveoloplasty are considered content of serv ice of an Extraction. 97


630

IV sedation is content of service of the procedure code billed. If general ane sthesia was given, resubmit with medical necessity. 97


631

Detail denied/reduced. This procedure is content of the full procedure code bi lled. Please refer to the Introduction in the CPT-4 Format of Terminology when billing a procedure with multiple components. 97


815

Denied. Outpatient services billed fall within an inpatient stay. These servi ces are therefore considered content of service of the inpatient DRG reimbursem ent. 97


999

DENIED. EXCEEDS PROGRAM LIMITATIONS. ANTEPARTUM/POSTPARTUM CARE ARE CONSIDER ED CONTENT OF SERVICE WHEN BILLED WITHIN NINE MONTHS BEFORE AND/OR 45 DAYS AFT ER TOTAL OB DELIVERY OR CESAREAN SECTION PACKAGE. REFER TO YOUR KANSAS MEDICA L ASSISTANCE PROGRAM PROVIDER MANUAL. 97


1081

Denied. Outpatient services performed three days prior to or following an admi ssion to the same facility for the same or similar diagnosis are considered con tent of service of the inpatient services. 97


1102

Detail denied. Procedure billed was performed with a primary procedure. This procedure is considered content of service of the primary procedure and should not be reimbursed separately. 97


1107

DETAIL DENIED. OFFICE VISITS/HOSPITAL VISITS ARE CONTENT OF SERVICE WHEN BILLE D ONE DAY PRIOR TO A MAJOR SURGERY. 97






1108

DETAIL DENIED. OFFICE AND HOSPITAL VISITS ARE CONTENT OF SERVICE UP TO 21 DAYS AFTER A MINOR SURGERY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTAN CE PROGRAM PROVIDER MANUAL. 97


1109

DETAIL DENIED. OFFICE AND HOSPITAL VISITS ARE CONTENT OF SERVICE UP TO 42 DAYS AFTER A MAJOR SURGERY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTAN CE PROGRAM PROVIDER MANUAL. 97


1116

CLAIM/SERVICE HAS BEEN DENIED/REDUCED DUE TO AN OFFICE VISIT PROCEDURE CODE, WH ICH IS CONTENT OF SERVICE OF THE EYE EXAM, BEING REIMBURSED PREVIOUSLY. 97

Payment is included in the allowance for another service/procedure. N19 Procedure code incidental to primary procedure.

1117

Claim/service has been denied/reduced due to a manipulation procedure code, whi ch is content of service of the office visit, being reimbursed previously. 97


1120

ALLOWED AMOUNT FOR THIS PROCEDURE MAY HAVE BEEN PRORATED DUE TO PREVIOUS REIMBU RSEMENT OF AN OFFICE VISIT/INITIAL EMERGENCY TREATMENT PROCEDURE, WHICH IS CONT ENT OF SERVICE OF THE SURGERY. 97


1122

CLAIM/SERVICE HAS BEEN DENIED/REDUCED DUE TO A HOSPITAL/OFFICE VISIT PROCEDURE CODE, WHICH IS CONTENT OF SERVICE OF THE CHEMOTHERAPY ADMINISTRATION, BEING REI MBURSED PREVIOUSLY. 97


1128

Detail reduced. Procedure billed was reduced because another procedure, which was content to this procedure, was paid. 97


1129

DETAIL DENIED. PROCEDURE BILLED WAS PERFORMED WITH A PRIMARY PROCEDURE. ACCOR DING TO THE NATIONAL CORRECT CODING GUIDE THIS PROCEDURE IS CONSIDERED CONTENT OF SERVICE OF THE PRIMARY PROCEDURE AND SHOULD NOT BE REIMBURSED SEPARATELY. 97


1156

Claim/service has been denied/reduced due to the photochemotherapy (96910) proc edure code, which is content of service of the photochemotherapy (96912), bei ng reimbursed previously. 97

Payment is included in the allowance for another service/procedure. N20

Service not payable with other service rendered on the same date.

1180

Claim/service has been reduced due to the lesser code, which is content of this service, being reimbursed previously. 97






1231Denied. Incidental services are content of service of the initial encounter an d are not reimbursed separately. 97


1272

Denied. IV Sedation is Content Of Service of the procedure code billed. Medic al staff has reviewed the documentation with your claim and determined IV Sedat ion was administered. 97


1277

Allowed amount for this procedure may have been prorated due to previous reimbu rsement of another surgical procedure performed during the same operation sessi on. 97


954DENIED - PRESCRIPTION DATE IS AFTER BILLING DATE 110 Billing date predates service date. N57 Missing/incomplete/invalid prescribing date.

65 Provider did not accept Medicare assignment. 111 Not covered unless the provider accepts assignment. N82

Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.

1066 Denied. Non-FDA approved use. 114Procedure/product not approved by the Food and Drug Administration.

42

Denied/reduced. Only two office medical service, established patient; intermed iate service visits are allowed per calendar year, regardless of provider. 119

Benefit maximum for this time period or occurrence has been reached.

43

Denied/reduced. Only two subsequent care, skilled nursing, intermediate care o r long-term care facility; intermediate service visits are allowed per calendar year, regardless of provider. 119


49

DENIED. URINARY CATHETERS ARE LIMITED TO TWO PER MONTH, REGARDLESS OF PROVIDER . ALL OR A PORTION OF THE SERVICES BILLED EXCEED THIS LIMITATION. REFER TO SE CTION 8420 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMAP HOME HEA LTH AGENCY PROVIDER MANUAL. 119


50

DENIED. CATHETER INSERTION TRAYS ARE LIMITED TO TWO PER MONTH, REGARDLESS OF P ROVIDER. ALL OR A PORTION OF THE SERVICES BILLED EXCEED THE LIMITATION. REFER TO SECTION 8420 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMAP HO ME HEALTH AGENCY PROVIDER MANUAL. 119


57

DENIED. URINARY DRAINAGE BAGS ARE LIMITED TO TWO PER MONTH, REGARDLESS OF PROV IDER. ALL OR A PORTION OF THE SERVICES BILLED EXCEED THIS LIMITATION. REFER T O SECTION 8420 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMAP HOME HEALTH AGENCY PROVIDER MANUAL. 119






63

DENIED. NASOGASTRIC TUBES ARE LIMITED TO TWO PER MONTH, REGARDLESS OF PROVIDER . ALL OR A PORTION OF THE SERVICES BILLED EXCEED THIS LIMITATION. REFER TO SE CTION 8420 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMAP HOME HE ALTH AGENCY PROVIDER MANUAL. 119


69 Allowed amount reduced to reflect program limitation. 119Benefit maximum for this time period or occurrence has been reached.

71 This exceeds program limitations. 119Benefit maximum for this time period or occurrence has been reached.

76

DENIED. STOMACH/GASTROSTOMY TUBES ARE LIMITED TO SIX PER YEAR, REGARDLESS OF P ROVIDER. ALL OR A PORTION OF THE SERVICES BILLED EXCEED THIS LIMITATION. REFE R TO SECTION 8420 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMAP H OME HEALTH AGENCY PROVIDER MANUAL. 119


99

DENIED, EXCEEDS PROGRAM LIMITATIONS. BUTORPHANOL (STADOL) NASAL SPRAY IS LIMITE D TO 12.5 UNITS PER 30 DAYS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAID/MED IKAN PROVIDER MANUAL. 119

Benefit maximum for this time period or occurrence has been reached. M86

Service denied because payment already made for same/similar procedure within set time frame.

109

Denied. Individual and Group Psychotherapy is limited to 36 hours per calendar year for consumers in a KAN Be Healthy (EPSDT) program. 119


110Denied. State guidelines allow only 8 hours of Children's Partial Hospitalizat ion per day. 119


111Denied. State guidelines allow only 2080 hours of Children's Partial Hospitali zation per calendar year. 119


113

Denied. State guidelines allow payment for only one study, either a CAT scan o r MRI scan, per body region, or one total body scan, in a 90 day period. 119


114

Denied. State guidelines allow payment for the professional component of only one study, either a CAT scan or MRI scan, per body region, or one total body sc an, in a 90 day period. 119


117

Denied. State guidelines allow payment for the technical component of only one study, either a CAT scan or MRI scan, per body region, or one total body scan, in a 90 day period. 119


118

Denied. State guidelines allow payment for only three trimesters of Prenatal R isk Reduction per pregnancy. All or a portion of the services billed exceed th is limitation. 119






119

DENIED. ONLY ONE KAN BE HEALTHY DENTAL SCREEN IS ALLOWED PER CALENDAR YEAR, RE GARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


126

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. BENEFICIARIES ARE LIMITED TO 4 HO URS OF PSYCHOLOGICAL TESTING PER 2 CALENDAR YEARS. KAN BE HEALTHY PARTICIPANTS ARE ALLOWED 6 HOURS OF PSYCHOLOGICAL TESTING PER 2 CALENDAR YEARS. REFER TO S ECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 119


127

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. ME DIKAN BENEFICIARIES ARE LIMITED TO 4 HOURS OF PSYCHOLOGICAL TESTING PER 3 CALEN DAR YEARS. KAN BE HEALTHY PARTICIPANTS ARE ALLOWED 6 HOURS OF PSYCHOLOGICAL TE STING PER 3 CALENDAR YEARS. REFER TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSIS TANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 119


128Denied. Only one encounter per day is allowed for Federally Qualified Health C enters. 119



138Denied. Only one encounter per day is allowed for Indian Health Services. 119



146

DENIED. TARGETED CASE MANAGEMENT IS NOT ALLOWED WITHIN THE SAME CALENDAR MONTH AS BEHAVIOR MANAGEMENT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANC E PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 119


153

DENIED. EXCEEDS PROGRAM LIMITATIONS. HOME HEALTH TELE-MEDICINE VISIT FOR AN U NSTABLE PATIENT IS NOT ALLOWED WHEN BILLED ON THE SAME DAY AS A HOME HEALTH TEL E-MEDICINE VISIT FOR A STABLE PATIENT. REFER TO SECTION 8400 OF YOUR KANSAS ME DICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


158

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE HOME HEALTH TELE-MEDICINE VISIT IS ALLOWED PER DAY. REFER TO SECTION 8 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119







176Detail denied. Only one encounter per day is allowed for Rural Health Services . 119



180

Detail denied. Only one postnatal obstetrical visit is allowed per pregnancy. All or a portion of the services billed exceed this limitation. 119


200

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. ONLY 1 BIOMECHANICAL EVALUATION PE R 18 MONTHS ALLOWED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE P ROGRAM PODIATRY PROVIDER MANUAL FOR MORE INFORMATION. 119


202

Denied, exceeds program limitations. SRS does not allow payment for both Trime ster Care and Total Antepartum Care during the same pregnancy. 119


207

DENIED/REDUCED. ONLY ONE WHEELCHAIR PURCHASE IS ALLOWED EVERY FIVE YEARS, UNLE SS THE BENEFICIARY IS A KAN BE HEALTHY PARTICIPANT. REFER TO SECTION 8410 OF Y OUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


212Denied. A maximum of 21 days is allowed per crisis stabilization placement. 119


215Denied/reduced, exceeds program limitations. Only one dental consultation is allowed every 60 days. 119


225

Denied. SRS does not allow payment for an Office Visit or Family Planning Visi t when billed on same day as Insertion of Intra-Uterine Device (IUD). 119



227

Denied/reduced. SRS does not allow payment for more than one Oral Examination on the same date of service when performed by the same provider. 119



232

DENIED. SRS DOES NOT ALLOW PAYMENT FOR A HOSPITAL VISIT IF BILLED WITHIN FIVE DAYS AFTER NORMAL NEWBORN INFANT HISTORY AND EXAMINATION. 119


233

DENIED. SRS DOES NOT ALLOW PAYMENT FOR A COMPREHENSIVE OFFICE VISIT IF BILLED WITHIN ONE WEEK AFTER A NORMAL NEWBORN INFANT HISTORY AND EXAMINATION. 119


242

DENIED. REIMBURSEMENT LIMITED TO $43,200 PER CALENDAR YEAR FOR CASE MANAGEMENT FEE. 119






250

DETAIL DENIED/REDUCED. ONLY 30 UNITS OF RESPITE CARE ALLOWED PER CALENDAR YEA R. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS RESPIT E CARE MANUAL. 119


252

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. STOMA BAGS OR POUCHES ARE LIMITED TO 15 PER CALENDAR MONTH UNLESS BENEFICIARY IS A KAN BE HEALTHY PARTICIPANT. RE FER TO SECTION 8420 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMA P HOME HEALTH AGENCY PROVIDER MANUAL. 119


253

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. STOMA BAGS OR POUCHES ARE LIMITED TO 30 PER CALENDAR MONTH FOR KAN BE HEALTHY PARTICIPANTS. REFER TO SECTION 842 0 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMAP HOME HEALTH AGEN CY PROVIDER MANUAL. 119


254

DETAIL DENIED/REDUCED. INDIVIDUAL AND GROUP PSYCHOTHERAPY IS LIMITED TO 40 HOU RS PER CALENDAR YEAR FOR BENEFICIARIES IN THE KAN BE HEALTHY PROGRAM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119

Benefit maximum for this time period or occurrence has been reached. M90 Not covered more than once in a 12 month period.

255

DETAIL DENIED/REDUCED. INDIVIDUAL AND GROUP PSYCHOTHERAPY IS LIMITED TO 32 HOU RS PER CALENDAR YEAR UNLESS THE BENEFICIARY IS IN THE KAN BE HEALTHY PROGRAM. R EFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


258

DENIED/REDUCED. MEDIKAN BENEFICIARIES ARE LIMITED TO 24 HOURS OF GROUP AND/OR FAMILY THERAPY PER CALENDAR YEAR. REFER TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


259

DENIED/REDUCED. MEDIKAN BENEFICIARIES ARE LIMITED TO 720 HOURS OF PARTIAL HOSP ITALIZATION ACTIVITY AND/OR MEDICATION GROUP PER CALENDAR YEAR. REFER TO SECTI ON 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






262

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. M EDIKAN BENEFICIARIES ARE LIMITED TO 320 UNITS (80 HOURS) OF TARGETED CASE MANAG EMENT PER CALENDAR YEAR. REFER TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSISTAN CE PROGRAM PROVIDER MANUAL. 119


263

DETAIL DENIED. MEDIKAN BENEFICIARIES ARE LIMITED TO 24 HOURS OF PSYCHOTHERAPY PER CALENDAR YEAR. REFER TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PR OGRAM PROVIDER MANUAL. 119


264

DENIED/REDUCED. MEDICAID BENEFICIARIES ARE LIMITED TO 40 HOURS OF GROUP AND/OR FAMILY THERAPY PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


265

DENIED. MEDICAID BENEFICIARIES ARE LIMITED TO 6 HOURS OF PSYCHOLOGICAL TESTIN G PER 2 CALENDAR YEARS WITH PRIOR AUTHORIZATION REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


266

DENIED. BENEFICIARIES ARE LIMITED TO 1560 HOURS OF PARTIAL HOSPITALIZATION ACT IVITY AND/OR MEDICATION GROUP PER CALENDAR YEAR. ALL OR A PORTION OF THE SERVI CES BILLED EXCEED THIS LIMITATION. REFER TO SECTION 8400 OF YOUR KANSAS MEDICA L ASSISTANCE PROGRAM PROVIDER MANUAL. 119


267

DENIED. MEDICAID CONSUMERS ARE LIMITED TO 100 HOURS OF TARGETED CASE MANAGEMEN T PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE P ROGRAM PROVIDER MANUAL. 119


269

DENIED. ONLY 5 HOURS OF ADMISSION EVALUATION ALLOWED PER CALENDAR YEAR. ALL O R A PORTION OF THE SERVICES BILLED EXCEED THIS LIMITATION. REFER TO SECTION 8 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


276

Detail denied/reduced. Exceeds program limitations. Only six units of hearing aid batteries allowed per calendar month. 119






277

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. C ASE CONFERENCE IS LIMITED TO 12 HOURS PER CALENDAR YEAR FOR BENEFICIARIES IN TH E KAN BE HEALTHY PROGRAM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTA NCE PROGRAM PROVIDER MANUAL. 119


278

DETAIL DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE HEARING AID REPL ACEMENT ALLOWED EVERY FOUR YEARS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM AUDIOLOGY PROVIDER MANUAL. 119


279

DETAIL DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE HEARING AID DISP ENSING ALLOWED EVERY FOUR YEARS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM AUDIOLOGY PROVIDER MANUAL. 119


280

DENIED/REDUCED. CASE CONFERENCE IS LIMITED TO 6 HOURS PER CALENDAR YEAR UNLESS THE BENEFICIARY IS A KAN BE HEALTHY PARTICIPANT. REFER TO SECTION 8400 OF YO UR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


281

DENIED. MEDICAID/MEDIKAN CONSUMERS ARE LIMITED TO 90 DAYS OF IN-HOME THERAPY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL . 119


282

DENIED/REDUCED. BENEFICIARIES ARE LIMITED TO ONE MEDICATION REVIEW PER DAY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL . 119



283

DENIED. KANSAS MEDICAL ASSISTANCE PROGRAM BENEFICIARIES ARE LIMITED TO ONE MED ICATION GROUP VISIT PER WEEK (SEVEN DAY PERIOD). ALL OR A PORTION OF THE SERVI CES BILLED EXCEED THIS LIMITATION. 119


284

DENIED. STATE GUIDELINES WILL NOT ALLOW PAYMENT OF AN INTERIM FAMILY PLANNING VISIT ON THE SAME DATE OF SERVICE AS AN ANNUAL FAMILY PLANNING VISIT. 119



286

DENIED/REDUCED. ONLY ONE INITIAL CONSULTATION IS ALLOWED EVERY 60 DAYS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






287

DENIED/REDUCED. ONLY ONE INPATIENT FOLLOW-UP CONSULTATION IS ALLOWED EVERY 10 DAYS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDE R MANUAL. 119


288

DENIED/REDUCED. ONLY ONE NON-INPATIENT FOLLOW-UP CONSULTATION IS ALLOWED EVERY 60 DAYS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PRO VIDER MANUAL. 119


291

DETAIL DENIED. MENTAL HEALTH ATTENDANT CARE IS LIMITED TO 40 HOURS PER CALENDA R YEAR UNLESS THE CONSUMER IS IN THE KAN BE HEALTHY PROGRAM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


293

DETAIL DENIED. ONLY ONE PERIODIC ORAL EXAM PER SIX MONTHS. REFER TO SECTION 8 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


296

Detail denied. Mental Health Attendant Care is limited to 325 hours per calend ar year for consumers in the KAN Be Healthy program. Refer to Section 8400 of your Kansas Medicaid/MediKan provider manual. 119


297

Detail denied. KAN Be Healthy consumers are limited to 24 Chiropractic Office Visits per calendar year. Refer to Section 8400 of your Kansas Medicaid/MediKa n provider manual. 119


298

DETAIL DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE CHIROPRACTIC HIST ORY AND PHYSICAL ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANS AS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


299

DENIED, EXCEEDS PROGRAM LIMITATIONS. OFFICE VISITS ARE LIMITED TO 12 PER CALEN DAR YEAR UNLESS BENEFICIARY IS A KAN BE HEALTHY (EPSDT) PARTICIPANT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


306

DETAIL DENIED. ONLY 60 HOURS OF TARGETED CASE MANAGEMENT ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






307

DETAIL DENIED/REDUCED. ONLY 120 HOURS OF TARGETED CASE MANAGEMENT ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


311

DENIED. KMAP MEDIKAN BENEFICIARIES ARE LIMITED TO 6 HOURS OF PSYCHOLOGICAL TES TING PER 3 CALENDAR YEARS WITH PRIOR AUTHORIZATION. REFER TO SECTION 8300 OF Y OUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


313

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. C HILD AND ADOLESCENT PARTIAL HOSPITALIZATION IS LIMITED TO 200 HOURS PER CALENDA R YEAR UNLESS THE BENEFICIARY IS A KAN BE HEALTHY PARTICIPANT. REFER TO SECTIO N 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


315

DENIED. OUTPT. PSYCHOTHERAPY AND PARTIAL HOSPITALIZATION ACTIVITY/TARGETED CAS E MGMENT ARE NOT ALLOWED BY SAME PROVIDER WITHIN THE SAME 90 DAY PERIOD UNLESS THE BENEFICIAR IS A KBH PARTICIPANT. IF MORE THAN 6 HRS OF INDIVIDUAL, GROUP O R FAMILY THERAPY ARE BILLED IN THE SAME 90 DAY PERIOD, MEDICAL NECESSITY IS REQ UIRED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM MANUAL. 119


316

DETAIL DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. MEDIKAN BENEFICIARIES ARE LIMITED TO 24 HOURS OF PSYCHOTHERAPY PER CALENDAR YEAR. REFER TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


318

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. KMAP MEDIKAN BENEFICIARIES ARE LIM ITED TO 6 HOURS OF PSYCHOLOGICAL TESTING EVERY 3 YEARS. REFER TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATIO N. 119






319

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. KMAP MEDIKAN BENEFICIARIES ARE LIM ITED TO 480 UNITS OF PSYCHOTHERAPY PER CALENDAR YEAR. REFER TO SECTION 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


320

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. KMAP MEDIKAN BENEFICIARIES ARE LIM ITED TO 120 UNITS OF PARTIAL HOSPITALIZATION PER CALENDAR MONTH. REFER TO SECT ION 8300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


322

DENIED. ONLY TWO CONSECUTIVE DAYS ARE ALLOWED FOR PSYCHIATRIC OBSERVATION BED STAYS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSSISTANCE PROGRAM PROVID ER MANUAL. 119


324

DENIED, EXCEEDS PROGRAM LIMITATIONS. KMAP MEDIKAN BENEFICIARIES ARE LIMITED TO 24 HOURS OF PSYCHOTHERAPY PER CALENDAR YEAR. REFER TO SECTION 8300 OF YOUR KA NSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


326

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. OUTPATIENT PSYCHOTHERAPY IS LIMITE D TO 200 UNITS PER CALENDAR QUARTER. REFER TO SECTION 8400 OF YOUR KANSAS MEDI CAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


327

DENIED. OBSERVATION ROOM IS NOT ALLOWED ON THE SAME DATE OF SERVICE AS A MINOR SURGERY. REFER TO SECTION 8200 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVI DER MANUAL. 119

Benefit maximum for this time period or occurrence has been reached. N20


328

DENIED. FETAL NON-STRESS TEST/FETAL OXYTOCIN STRESS TEST IS NOT ALLOWED ON THE SAME DATE OF SERVICE AS AN OBSERVATION ROOM. REFER TO SECTION 8200 OF YOUR KA NSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119







329

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. KMAP MEDICAID BENEFICIARIES ARE LI MITED TO 6 HOURS OF PSYCHOLOGICAL TESTING PER 2 CALENDAR YEARS WITH PRIOR AUTHO RIZATION.REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVID ER MANUAL. 119


330

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. ONLY FIVE HOURS (100 UNITS) OF ADM ISSION EVALUATION ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KAN SAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


331

DENIED. A MAXIMUM OF 21 DAYS IS ALLOWED PER CRISIS STABILIZATION PLACEMENT. R EFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


332

DENIED, EXCEEDS PROGRAM LIMITATIONS. PARTIAL HOSPITALIZATION IS LIMITED TO 208 0 HOURS PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIST ANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 119


334

Denied, exceeds program limitations. Short-term Partial Hospitalization is lim ited to 6 months per year without prior authorization. 119


340

DENIED/REDUCED. ONLY ONE PAIR OF TEMPLES IS ALLOWED EVERY FOUR YEARS. REFER T O SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM VISION PROVIDER MANUAL . 119


341

DENIED/REDUCED. ONLY ONE TINTING/PAIR IS ALLOWED EVERY FOUR YEARS. REFER TO S ECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM VISION PROVIDER MANUAL FO R MORE INFORMATION. 119


358

DENIED/REDUCED. TARGETED CASE MANAGEMENT IS LIMITED TO 800 UNITS PER CALENDAR YEAR. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAI L ELDERLY TARGETED CASE MANAGEMENTPROVIDER MANUAL. 119


359

DENIED/REDUCED. ONLY THREE UNITS OF ADULT DAY CARE ARE ALLOWED PER DAY. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDERLY A DULT DAY CARE PROVIDER MANUAL. 119






360Detail denied. The Blood Glucose Monitor can only be rented for one month. 119


361

DENIED/REDUCED. ONLY TWO UNITS OF ADULT DAY CARE ARE ALLOWED PER DAY. REFER T O SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDERLY ADUL T DAY CARE PROVIDER MANUAL. 119


362

DENIED/REDUCED. ONLY ONE SLEEP CYCLE SUPPORT IS ALLOWED PER DAY. REFER TO SE CTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDERLY SLEEP CY CLE SUPPORT PROVIDER MANUAL. 119



364Payment reduced/denied. A maximum of $15 is allowed per month for miscellaneou s ostomy supplies. 119


365

DETAIL DENIED. THE ENTERAL FEEDING SUPPLY KITS ARE LIMITED TO FIFTEEN PER MONT H. ALL OR A PORTION OF THE SERVICES BILLED EXCEED THIS LIMITATION. REFER TO SECTION 8420 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMAP HOM E HEALTH AGENCY PROVIDER MANUAL. 119


368

DETAIL DENIED. ONLY THREE NASOGASTRIC TUBES ALLOWED PER MONTH. REFER TO SECTI ON 8420 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM DME PROVIDER MANUAL OR SECTIO N 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HOME HEALTH AGENCY PROVIDER MAN UAL. 119


370

DENIED/REDUCED. ONLY ONE UNIT RENTAL OF PERSONAL EMERGENCY RESPONSE IS ALLOWED PER MONTH. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM H CBS FRAIL ELDERLY PERSONAL EMERGENC Y RESPONSE PROVIDER MANUAL. 119


This service is not paid if billed more than once every 28 days.

376

DENIED. INTERIM BILLING IS LIMITED TO EVERY 60 DAYS. REFER TO SECTION 7020 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


381Denied/reduced. Only one Incontinence Clamp is allowed per calendar month. 119


385

Denied. State guidelines will not allow payment of Routine Home Care on the sa me day as Continuous Home Care. 119







391

DENIED, EXCEEDS PROGRAM LIMITATIONS. PARTIAL DENTURE RELININGS ARE NOT ALLOWED WITHIN TWO YEARS OF PARTIAL DENTURE PURCHASE. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


394

Denied/reduced. State guidelines allow only one 07110/D7110 (simple extraction , single tooth) per quadrant per day. 119



395

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 5 REUSABLE OSTOMY POUCHES IN 6 MONTHS ARE ALLOWED. REFER TO SECTION 8420 O F YOUR KANSAS MEDICAL ASSISTANCE PROGRAM DME PROVIDER MANUAL OR SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HOME HEALTH AGENCY PROVIDER MANUAL. 119


397

DETAIL DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. TWO WHEELCHAIR BATTERIES ALLOWED EACH CALENDAR YEAR UNLESS PRIOR AUTHORIZED. REFER TO SECTION 8420 OF Y OUR KANSAS MEDICAL ASSISTANCE PROGRAM DME PROVIDER MANUAL OR SECTION 8400 OF TH E KANSAS MEDICAL ASSISTANCE PROGRAM HOME HEALTH AGENCY PROVIDER MANUAL. 119


399

DENIED. STATE GUIDELINES DO NOT ALLOW PAYMENT FOR WELLNESS MONITORING WITHIN 6 0 DAYS OF SKILLED NURSING SERVICES. REFER TO SECTION 8000 OF THE KANSAS MEDICA L ASSISTANCE PROGRAM HCBS FRAIL ELDERLY WELLNESS MONITORING PROVIDER MANUAL. 119


400

DENIED, EXCEEDS PROGRAM LIMITATIONS. COMPLETE UPPER DENTURE RELININGS ARE NOT ALLOWED WITHIN TWO YEARS OF COMPLETE UPPER DENTURE PURCHASE. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


402

DENIED/REDUCED. ONLY ONE WELLNESS MONITORING VISIT ALLOWED PER 60 DAYS. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDERLY WEL LNESS MONITORING PROVIDER MANUAL. 119






404

DENIED/REDUCED. ONLY 180 UNITS OF RESPITE CARE ARE ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDER LY RESPITE CARE PROVIDER MANUAL. 119


411

DENIED/REDUCED. ONLY ONE UNIT OF PERSONAL SERVICES IS ALLOWED PER MONTH. REFE R TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS PHYSICAL DISABI LITIES PERSONAL SERVICES PROVIDER MANUAL. 119


412

Detail denied. An Initial or Periodic Oral Exam is not allowed within 6 months following a KAN Be Healthy (EPSDT) Dental Screen. 119


413

DENIED/REDUCED. ONLY 12 HOURS OF HEALTH CARE ATTENDANT ARE ALLOWED PER DAY. R EFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDERL Y HEALTH CARE ATTENDANT PROVIDER MANUAL. 119


414

DENIED/REDUCED. ONLY 120 UNITS OF INDEPENDENT LIVING COUNSELING ALLOWED PER CA LENDAR YEAR. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HC BS PHYSICAL DISABILITIES INDEPENDENT LIVING COUNSELING PROVIDER MANUAL. 119


420ONLY ONE INITIAL OFFICE VISIT ALLOWED PER BENEFICIARY. 119


431

DETAIL DENIED. THIS KAN BE HEALTHY (EPSDT) SCREEN EXCEEDS THE LIMITATION SPECI FIED BY THE PERIODICITY SCHEDULE. REFER TO SECTION 2020 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


436

Payment reduced/denied, exceeds program limitations. Hospital visits not allow ed on the same day as Psychotherapy. 119



444

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. OFFICE VISITS ARE LIMITED TO 24 P ER CALENDAR YEAR FOR KAN BE HEALTHY PARTICIPANTS. REFER TO SECTION 8400 OF YO UR KANSAS MEDICAL ASSISTANCE PROGRAM PROFESSIONAL SERVICES PROVIDER MANUAL FOR MORE INFORMATION. 119






446

DETAIL DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. INDIVIDUAL AND GROUP PSYCH OTHERAPY IS LIMITED TO A MAXIMUM OF $284.00 PER CALENDAR MONTH WITH PRIOR AUTHO RIZATION FOR CHILDREN IN SPECIAL PSYCHIATRIC PROGRAMS. REFER TO SECTION 8400 O F YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


454

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. OFFICE VISITS ARE LIMITED TO 12 P ER CALENDAR YEAR UNLESS BENEFICIARY IS A KAN BE HEALTHY PARTICIPANT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROFESSIONAL SERVICES PR OVIDER MANUAL. 119


469Detail denied/reduced. Only one Dialysis Session allowed per day. 119



470Detail denied/reduced. Only one unit of Hemodialysis Supervision allowed per m onth. 119


476

Denied. All or a portion of the services billed exceed program limitations. O nly one Annual Family Planning Visit allowed per year. 119


477

Denied. All or a portion of the services billed exceed program limitations. O nly three Interim Family Planning Visits allowed per year. 119


478

Denied. State guidelines will not allow payment of an Annual Family Planning V isit on the same date of service as an Initial Family Planning Visit. 119



479

Denied. State guidelines will not allow payment of an Interim Family Planning Visit on the same date of service as an Initial Family Planning Visit. 119



482

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY 72 HOURS OF CASE MANAGEMENT ALLOWED PER YEAR. REFER TO SECTION 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/DD CASE MANAGEMENT PROVIDER MA NUAL. 119


483

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY 36 HOURS OF CASE MANAGEMENT ALLOWED THIS YEAR. REFER TO SECTION 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/DD CASE MANAGEMENT PROVIDER MANUAL. 119


486Detail denied. Billed amount exceeds the maximum allowed per month for Prevoca tional services. 119






487

DETAIL DENIED/REDUCED. ONLY 1 UNIT OF NIGHT SUPPORT ALLOWED PER NIGHT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS NIGHT SUPPORT PR OVIDER MANUAL. 119


488

DETAIL DENIED/REDUCED. ONLY 1 UNIT OF RESPITE CARE ALLOWED PER DAY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS RESPITE CARE MANUAL . 119


489Detail denied. Only 90 units of Respite Care allowed per calendar year. 119


494

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY 60 HOURS OF EMERGENCY RESPITE CARE ALLOWED THIS YEAR. REFER TO SECTION 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROG RAM HCBS MR/DD RESPITE CARE PROVIDER MANUAL. 119


495

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY 120 HOURS OF EMERGENCY RESPI TE CARE ALLOWED PER YEAR. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTAN CE PROGRAM HCBS MR/DD RESPITE CARE PROVIDER MANUAL. 119


496

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY 15 DAYS OF OVERNIGHT RESPITE CARE A LLOWED THIS YEAR. REFER TO SECTION 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGR AM HCBS MR/DD PROVIDER MANUAL. 119


497

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY 30 DAYS OF OVERNIGHT RESPITE CARE A LLOWED PER YEAR. REFER TO SECTION 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRA M HCBS MR/DD RESPITE CARE PROVIDER MANUAL. 119


498

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY 96 HOURS OF TEMPORARY RESPITE CARE ALLOWED THIS YEAR. REFER TO SECTION 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROG RAM HCBS MR/DD RESPITE CARE PROVIDER MANUAL. 119


499

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY 192 HOURS OF TEMPORARY RESPITE CARE ALLOWED PER YEAR. REFER TO SECTION 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGR AM HCBS MR/DD RESPITE CARE PROVIDER MANUAL. 119






500

DENIED/REDUCED. ONLY 8 HOURS OF ADULT DAY HEALTH/TREATMENT SERVICE ALLOWED PER DAY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS ADUL T DAY HEALTH PROVIDER MANUAL. 119


510

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. INDIVIDUAL AND GROUP PSYCHOTHERAPY IS LIMITED TO 24 HOURS PER CALENDAR YEAR UNLESS THE BENEFICIARY IS A KAN BE HE ALTHY (EPSDT) PARTICIPANT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASS ISTANCE PROGRAM PROVIDER MANUAL. 119


511

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. SIX HOURS OF PSYCHOLOGICAL TESTING ALLOWED EVERY 2 YEARS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 119


512

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 168 HOURS OF MEDICAL RESPITE CARE ARE ALLOWED PER CALENDAR YEAR. REFER TO THE KANSAS MEDICAL ASSISTANCE PROGRAM HOME HEALTH AGENCY PROVIDER MANUAL. 119


513

DENIED, EXCEEDS PROGRAM LIMITATIONS. KMAP MEDICAID BENEFICIARIES ARE LIMITED TO 3 HOURS OF PSYCHOLOGICAL TESTING PER 2 CALENDAR YEARS AND KMAP MEDIKAN BENEF ICIARIES ARE LIMITED TO 3 HOURS OF TESTING PER 3 CALENDAR YEARS UNLESS PRIOR AU THORIZED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROV IDER MANUAL FOR MORE INFORMATION. 119


514

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 12 HOURS OF SUPPORTIVE HOME CARE ALLOWED DURING A 24 HOUR PERIOD. REFER TO SECTION 8400 OF THE KANSAS MEDI CAL ASSISTANCE PROGRAM HCBS MR/DD SUPPORTIVE HOME CARE PROVIDER MANUAL. 119


515

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE HOME MODIFICATION ALLOWE D. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/DD HOME MODIFICATION PROVIDER MANUAL. 119






516

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE VAN LIFT IS ALLOWED. RE FER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/DD VAN LI FT PROVIDER MANUAL. 119


517

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY $300.00 ALLOWED PER YEAR FOR ANNUAL REPAIR OF HOME MODIFICATIONS. REFER TO SECTION 8400 OF YOUR KANSAS MEDI CAL ASSISTANCE PROGRAM HCBS MR/DD HOME MODIFICATION PROVIDER MANUAL. 119


518

DENIED. STATE GUIDELINES DO NOT ALLOW PAYMENT OF ANNUAL REPAIR OF HOME MODIFIC ATIONS WITHIN THE SAME YEAR AS HOME MODIFICATION. REFER TO SECTION 8400 OF YOU R KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/DD HOME MODIFICATION PROVIDER MANUA L. 119


519

DENIED, STATE GUIDELINES WILL NOT ALLOW PAYMENT FOR HOME MODIFICATION AND VAN L IFT DURING THE SAME YEAR. REFER TO SECTION 400 OF YOUR KANSAS MEDICAL ASSISTAN CE PROGRAM HCBS MR/DD HOME MODIFICATION OR VAN LIFT PROVIDER MANUAL. 119


520

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. PODIATRY OFFICE VISITS FOR KAN BE HEALTHY BENEFICIARIES ARE LIMITED TO 24 PER CALENDAR YEAR. REFER TO SECTION 84 00 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


524

DENIED, EXCEEDS PROGRAM LIMITATIONS. PODIATRY OFFICE VISITS ARE LIMITED TO 12 PER CALENDAR YEAR UNLESS BENEFICIARY IS A KAN BE HEALTHY (EPSDT) PARTICIPANT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL . 119


553Detail denied. Billed amount exceeds the maximum allowed per month for Habilit ation Services. 119



555

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE MAINTENANCE PAYMENT ON CPAP DEVICE ALLOWED EVERY SIX MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






556

DENIED. STATE GUIDELINES DO NOT ALLOW MAINTENANCE PAYMENT ON CPAP DEVICE WITHI N SIX MONTHS OF CPAP RENTAL. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSI STANCE PROGRAM PROVIDER MANUAL. 119


558

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY 120 HOURS OF MEDICAL CASE MA NAGEMENT ARE ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8410 OF THE KANSAS ME DICAL ASSISTANCE PROGRAM PROFESSIONAL SERVICES PROVIDER MANUAL. 119


559

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE EYE EXAM ALLOWED EVERY FOUR YEARS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PR OVIDER MANUAL. 119


561

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY TWO EYE EXAMS FOR MEDICAL C ONDITIONS ALLOWED PER MONTH. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSI STANCE PROGRAM VISION PROVIDER MANUAL FOR MORE INFORMATION. 119


562

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE SPECTACLE DISPENSING ALL OWED EVERY FOUR YEARS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM VISION PROVIDER MANUAL FOR MORE INFORMATION. 119


563

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE PAIR OF LENSES ALLOWED E VERY FOUR YEARS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGR AM VISION PROVIDER MANUAL FOR MORE INFORMATION. 119


564

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE COMPLETE FRAME ALLOWED E VERY FOUR YEARS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGR AM VISION PROVIDER MANUAL FOR MORE INFORMATION. 119


566

DENIED, EXCEEDS PROGRAM LIMITATIONS. COMPONENT PARTS OF AN EYE EXAM ARE NOT CO VERED WHEN PERFORMED MORE THAN TWICE PER MONTH. REFER TO SECTION 8400 OF YOU K ANSAS MEDICAL ASSISTANCE PROGRAM VISION PROVIDER MANUAL FOR MORE INFORMATION. 119






570

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE DENTAL SEALANT PER TOOTH IS ALLOWED PER 12 MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIST ANCE PROGRAM PROVIDER MANUAL. 119


572

DENIED. EXCEEDS PROGRAM LIMITATIONS. PAYMENT FOR TRIMESTER CARE IS NOT ALLOWE D WHEN BILLED WITHIN NINE MONTHS OF COMPLETE CARE. REFER TO SECTION 8400 OF YO UR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


573

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 15 IRRIGATION SETS ALLOWED PER MONTH WITHOUT MEDICAL NECESSITY. REFER TO SECTION 8420 OF YOUR KANSAS MED ICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


574

DENIED. EXCEEDS PROGRAM LIMITATIONS. PAYMENT IS NOT ALLOWED FOR ANALGESIA WHE N BILLED ON THE SAME DATE OF SERVICE AS A DIAGNOSTIC DENTAL SERVICE. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119



576

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 36 UNITS OF HEAT MOISTURE EXCHANGE IS ALLOWED PER MONTH. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


577

DENIED. EXCEEDS PROGRAM LIMITATIONS. NURSING HOME VISIT NOT ALLOWED ON THE SA ME DAY AS A COMPLETE HISTORY AND PHYSICAL. REFER TO SECTION 8400 OF YOUR KANS AS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119



579

DENIED. EXCEEDS PROGRAM LIMITATIONS. THIS SERVICE IS NOT ALLOWED IF THE INDIV IDUAL IS MENTALLY INCOMPETENT OR INSTITUTIONALIZED. SIGNATURE OF PARENT/LEGAL GUARDIAN IS NOT ACCEPTABLE. REFER TO SECTION 8410 OF YOUR KANSAS MEDICAL ASSIS TANCE PROGRAM PROVIDER MANUAL. 119






583

DENIED. EXCEEDS PROGRAM LIMITATIONS. PSYCHOTHERAPY IS NOT ALLOWED ON THE SAME DAY AS ELECTROSHOCK THERAPY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASS ISTANCE PROGRAM PROVIDER MANUAL. 119



586

DETAIL DENIED/REDUCED. ONLY ONE PANORAMIC X-RAY ALLOWED PER 18 MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


587

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE INITIAL ORTHODONTIC STUD Y ALLOWED PER 18 MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTA NCE PROGRAM PROVIDER MANUAL. 119


588

DETAIL DENIED/REDUCED. ONLY ONE PROPHYLAXIS TREATMENT ALLOWED PER SIX MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL . 119


589

DETAIL DENIED/REDUCED. ONLY ONE COMPLETE DENTURE RELINING (UPPER AND LOWER) AL LOWED PER TWO CALENDAR YEARS. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASS ISTANCE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION. 119


590

DETAIL DENIED/REDUCED. ONE PARTIAL DENTURE RELINING (UPPER AND LOWER) ALLOWED PER TWO CALENDAR YEARS. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTAN CE PROGRAM PROVIDER MANUAL FOR MORE INFORMATION . 119


593

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE FLUORIDE TREATMENT IS AL LOWED PER SIX MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


598

Denied. Additional films billed on the same day or within 90 days prior to the complete intraoral series (00210/D0210) are not allowed without medical necess ity. Panoramic film (00330/D0330) billed in conjunction with two bitewings (00 272/D0272) or panoramic film (00330/D0330) billed in conjunction with four bite wings (00274/D0274) is considered the equivalent of a complete intraoral series 119







613

Denied. According to State law and regulations, Schedule III and IV drugs cann ot be filled or refilled for a prescription over 6 months old or be refilled mo re than 5 times. Charges denied due to these limitations cannot be billed to t he beneficiary. 119


620

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY SIX ELECTROSHOCK THERAPY TR EATMENTS ALLOWED PER MONTH. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIS TANCE PROGRAM PROVIDER MANUAL. 119


621

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 12 ELECTROSHOCK THERAPY TRE ATMENTS ALLOWED PER MONTH. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIST ANCE PROGRAM PROVIDER MANUAL. 119


656

PROCEDURE BILLED INCORRECTLY ACCORDING TO BEHAVIOR MANAGEMENT PROGRAM GUIDELINE S 119


703

DENIED, EXCEEDS PROGRAM LIMITATIONS FOR HOSPITAL RESERVE DAYS. REFER TO SECTIO N 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM ACH PROVIDER MANUAL FOR MORE I NFORMATION. 119


714

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. HOME RESERVE DAYS ARE LIMITED TO 21 FOR ICF/MH RESIDENTS PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANS AS MEDICAL ASSISTANCE PROGRAM ACH PROVIDER MANUAL FOR MORE INFORMATION. 119


715

ALLOWED AMOUNT DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. HOME RESERVE DAYS ARE LIMITED TO 12 DAYS FOR ICF AND SNF RESIDENTS PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM ACH PROVIDER MANUAL FOR MORE INFORMATION. 119


721

DENIED/REDUCED. ONLY TWO CONSECUTIVE DAYS FOR PSYCHIATRIC OBSERVATION BED STAY S IS ALLOWED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL. 119






722

DENIED. INTERIM BILLING IS LIMITED TO EVERY 180 DAYS. REFER TO SECTION 7020 O F YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


748

Denied/Reduced, Only one Telephonic Transmission of Post-Symptom Electrocardiog ram Rhythm Strip(s) is allowed every 30 days. Refer to current procedural term inology Manual. 119


766Denied. Inpatient stay for psychiatric admissions is limited to a maximum of 1 4 days. 119


767

Denied. Length of Stay exceeds the maximum days allowed for uncomplicated norm al deliveries (48 hours/2 hospital days). 119


789Denied. Only one Therapeutic Pass Day is covered per hospitalization. 119


953Denied. Reimbursement allows for only one Minor Surgery procedure per day. 119



966

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. REPLACEMENT EAR MOLDS ARE NOT A LLOWED WITHIN THREE MONTHS AFTER A BINAURAL OR MONAURAL HEARING AID. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


967

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY TWO SONOGRAMS ALLOWED PER PREGNANCY WITHOUT PRIOR AUTHORIZATION. REFER TO SECTION 8200 OF YOUR KANSAS MEDICAL ASS ISTANCE PROGRAM PROVIDER MANUAL. 119


969

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY THREE OFFICE VISITS ARE ALLOWED PER MONTH WITHOUT MEDICAL NECESSITY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


970

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE ROUTINE ANNUAL HISTORY AND PHYSICAL ALLOWED PER YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


971

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE HOME HEALTH AIDE OR RESTORATIVE AIDE VISIT IS ALLOWED PER DAY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119







972Denied. Exceeds program limitations. Only four units of child day treatment a re allowed per day. 119


973

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE COMPREHENSIVE OFFICE VISIT IS ALLOWED PER CALENDAR YEAR. REFER TO SE CTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


975

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY THREE NIGHT DRAINAGE BAGS A LLOWED PER YEAR. REFER TO SECTION 8420 OF YOUR KANSAS MEDICAL ASSISTANCE PRO GRAM DME PROVIDER MANUAL OR SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PRO GRAM HHA PROVIDER MANUAL. 119


976Denied/reduced. Exceeds program limitations. Only one postpartum care is allo wed per nine months. 119


977

DENIED. EXCEEDS PROGRAM LIMITATIONS. ALLOW ONLY ONE FIRST TRIMESTER, ONE SECO ND TRIMESTER AND ONE THIRD TRIMESTER CARE PER NINE MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


978

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE IUD INSERTION ALLOWED W ITHIN A SEVEN DAY PERIOD. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIS TANCE PROGRAM PROVIDER MANUAL. 119


979

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE ANTEPARTUM CARE ALLOWED PER NIN E MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PR OVIDER MANUAL. 119


980

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 10 OSTOMY SKIN BARRIERS ARE ALLOWED PER MONTH WITHOUT MEDICAL NECESSITY. REFER TO SECTION 8420 OF YOUR KA NSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


981

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE OSTOMY LIQUID BARRIER I S ALLOWED PER MONTH WITHOUT MEDICAL NECESSITY. REFER TO SECTION 8420 OF YOUR K ANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






982

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE UNIT OF PARTIAL EYE EXA M IS ALLOWED EVERY 4 YEARS UNLESS PERFORMED FOR A MEDICAL CONDITION OR WITHIN O NE YEAR OF CATARACT SURGERY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSI STANCE PROGRAM PROVIDER MANUAL. 119


983Denied/reduced. Exceeds program limitations. Only 24 units of hourly intensiv e care allowed per day. 119


984

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 30 DISPOSABLE OSTOMY POUCHE S ARE ALLOWED PER MONTH WITHOUT MEDICAL NECESSITY. REFER TO SECTION 8420 OF YO UR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


988

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE PRENATAL HEALTH PROMOT ION AND RISK REDUCTION ALLOWED PER PREGNANCY. REFER TO SECTION 8420 OF YOUR K ANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


990Denied/reduced. Exceeds program limitations. Only one Cesarean Section is all owed every nine months. 119


993

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE EXTERNAL CATHETER IS AL LOWED PER DAY. REFER TO SECTION 8420 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119



994

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. A MAXIMUM OF NINE UNITS ARE ALLOWED PER DAY FOR PRE-ADMISSION SCREENING. REFE R TO YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


995

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE STOMA FACE PLATE IS ALL OWED PER MONTH. REFER TO SECTION 8420 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRA M PROVIDER MANUAL. 119






996

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 30 STOMA CAPS ARE ALLOWED P ER MONTH. REFER TO SECTION 8420 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM DME MANUAL OR SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HHA PROVIDER MANUAL. 119


998

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY TWO E CYLINDERS ARE ALLOWED PER MONTH. REFER TO SECTION 8400 OF YOUR KANSA S MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1000

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE HOME VISIT IS ALLOWED P ER CALENDAR MONTH. REFER TO YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER M ANUAL. 119


1001

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE HOSPITAL VISIT IS ALLOW ED PER DAY WITHOUT MEDICAL NECESSITY. REFER TO SECTION 8400 OF YOUR KANSAS ME DICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119



1002Denied/reduced. Exceeds program limitations. Only one obstetrical delivery is allowed every nine months. 119


1003

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 30 COLOSTOMY BAGS ARE ALLOW ED PER CALENDAR MONTH. REFER TO YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVID ER MANUAL. 119


1004

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE NURSING HOME VISIT ALLO WED PER CALENDAR MONTH. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANC E PROGRAM PROVIDER MANUAL. 119


1005

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 30 ILEOSTOMY, UROSTOMY AND/ OR LOOP OSTOMY POUCHES ARE ALLOWED PER CALENDAR MONTH. REFER TO SECTION 8420 O F YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






1006

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 11 FOLLOW-UP DIETITIAN VISITS ALLOWED PER YEAR. REFER TO SECTION 8400 OF Y OUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1013Only one evaluation and management service for a new patient is allowed every t hree calendar years. 119


1019

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE ADJUSTABLE POSTURAL SEATING SYSTEM IS ALLOWED EVERY FOUR YEARS FOR KAN BE HEALTHY PARTICIPANTS, REGARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1020

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE CUSTOM-DESIGNED SEATING UNIT IS ALLOWED EVERY FOUR YEARS FOR KAN BE HEA LTHY PARTICIPANTS, REGARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSA S MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1021

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE BATH CHAIR IS ALLOWED EVERY FOUR YEARS FOR KAN BE HEALTHY PARTICIPANTS, REGARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANC E PROGRAM PROVIDER MANUAL. 119


1022

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE CHEST HARNESS IS ALLOWED EVERY THREE YEARS FOR KAN BE HEALTHY PARTICIPA NTS, REGARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSI STANCE PROGRAM PROVIDER MANUAL. 119


1023

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY TWO PAIR OF SUPPORT PADS ARE ALLOWED EVERY THREE YEARS FOR KAN BE HEALTHY P ARTICIPANTS, REGARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSAS MEDI CAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






1024

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE ABDUCTOR IS ALLOWED EVERY THREE YEARS FOR KAN BE HEALTHY PARTICIPANTS, REGARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANC E PROGRAM PROVIDER MANUAL. 119


1025

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE HEAD REST IS ALLOWED EVERY FOUR YEARS FOR KAN BE HEALTHY PARTICIPANTS, REGARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANC E PROGRAM PROVIDER MANUAL. 119


1027

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 60 DAYS OF OVERNIGHT RESPITE CARE IS ALLOWED PER CALENDAR YEAR. REFER TO S ECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/DD RESPITE CARE P ROVIDER MANUAL. 119


1028

DENIED/REDUCED. ONLY 260 HOURS OF TEMPORARY RESPITE CARE IS ALLOWED PER CALEND AR YEAR. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/DD RESPITE CARE PROVIDER MANUAL. 119


1033

DETAIL DENIED. ONLY ONE PERIODIC ORAL EXAM IS ALLOWED PER CALENDAR YEAR FOR AD ULTS. REFER TO SECTION 8600 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1034

DETAIL DENIED. ONLY ONE INTRAORAL PERIAPICAL-FIRST FILM IS ALLOWED PER CALENDA R YEAR FOR ADULTS. REFER TO SECTION 8600 OF YOUR KANSAS MEDICAL ASSISTANCE PRO GRAM PROVIDER MANUAL. 119


1035

DETAIL DENIED. ONLY ONE BITEWING- 2 FILMS IS ALLOWED PER CALENDAR YEAR FOR ADU LTS. REFER TO SECTION 8600 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1036

DETAIL DENIED. MENTAL HEALTH ATTENDANT CARE AND/OR BEHAVIOR MANAGEMENT ATTENDA NT CARE IS LIMITED TO 500 HOURS PER CALENDAR YEAR FOR BENEFICIARIES IN THE KAN BE HEALTHY PROGRAM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PR OGRAM PROVIDER MANUAL. 119






1037

DETAIL DENIED. MENTAL HEALTH ATTENDANT CARE AND/OR BEHAVIOR MANAGEMENT ATTENDA NT CARE IS LIMITED TO 80 HOURS PER CALENDAR YEAR UNLESS THE BENEFICIARY IS IN T HE KAN BE HEALTHY PROGRAM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSI STANCE PROGRAM PROVIDER MANUAL. 119


1038

DETAIL DENIED. TARGETED CASE MANAGEMENT IS LIMITED TO 250 HOURS PER CALENDAR Y EAR UNLESS THE BENEFICIARY IS IN THE KAN BE HEALTHY PROGRAM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1039

DETAIL DENIED. TARGETED CASE MANAGEMENT IS LIMITED TO 300 HOURS PER CALENDAR Y EAR FOR BENEFICIARIES IN THE KAN BE HEALTHY PROGRAM. REFER TO SECTION 8400 O F YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1040

DENIED. CHILD AND ADOLESCENT PSYCHOSOCIAL TREATMENT GROUP IS LIMITED TO 1040 H OURS PER CALENDAR YEAR FOR BENEFICIARIES KAN BE HEALTHY PROGRAM. REFER TO SECT ION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1041

DETAIL DENIED. ADULT PSYCHOSOCIAL TREATMENT GROUP IS LIMITED TO 520 HOURS PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1042

DETAIL DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATI ONS. PREGNANCY RELATED SOCIAL WORK SERVICES ARE LIMITED TO 10 HOURS PER CALEND AR YEAR. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVID ER MANUAL. 119


1044

DENIED/REDUCED. ONLY ONE INTRAORAL COMPLETE SERIES (00210/D0210) IS ALLOWED EV ERY 36 MONTHS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






1045

DENIED/REDUCED. A PANORAMIC FILM (00330/D0330) BILLED IN CONJUNCTION WITH TWO BITEWINGS (00272/D0272) OR A PANORAMIC FILM (00330/D0330) BILLED IN CONJUNCTION WITH FOUR BITEWINGS (00274/D0274) IS CONSIDERED THE EQUIVALENT OF AN INTRAORAL COMPLETE SERIES (00210/D0210). INTRAORAL COMPLETE SERIES (OR THE EQUIVALENT) I S LIMITED TO ONE EVERY 36 MONTHS. REFER TO SECTION 8400 OF YOUR KMAP MANUAL. 119



1047

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY ONE ADDUCTOR IS ALLOWED EVERY THREE YEARS FOR KAN BE HEALTHY BENEFICIARIES, REGARDLESS OF PROVIDER. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTAN CEPROGRAM PROVIDER MANUAL. 119


1048

DETAIL DENIED. CHILD AND ADOLESCENT PSYCHOSOCIAL TREATMENT GROUP IS LIMITED TO 520 HOURS PER CALENDAR YEAR UNLESS THE BENEFICIARY IS IN THE KAN BE HEALTHY PR OGRAM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROFESS IONAL PROVIDER MANUAL. 119


1049

DENIED/REDUCED. ONLY EIGHT CONSECUTIVE DAYS OF BEHAVIOR MANAGEMENT OBSERVATION BED STAYS ARE ALLOWED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1050

DENIED/REDUCED. ONLY TWO CONSECUTIVE DAYS OF BEHAVIOR MANAGEMENT OBSERVATION B ED STAYS ARE ALLOWED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1053

DENIED/REDUCED. ONLY FOUR HOURS OF TRANSITIONAL LIVING SKILLS ARE ALLOWED PER DAY. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS/HI TRANSITIONAL LIVING SKILLS TRAINING PROVIDER MANUAL. 119


1057

DENIED/REDUCED. STATE GUIDELINES WILL ALLOW PAYMENT FOR ONLY ONE INSTALLATION FEE FOR THE MEDICAL ALERT DEVICE FOR HEAD INJURY WAIVER BENEFICIARY, REGARDLESS OF PROVIDER. 119






1059Denied/reduced. Only 30 consecutive days for Comprehensive Evaluation are allo wed. 119


1060Denied/reduced. Only 60 consecutive days for Treatment Services are allowed. 119


1065

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE ANTEPARTUM CARE PROCED URE ALLOWED PER PREGNANCY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIST ANCE PROGRAM PROVIDER MANUAL 119


1072

DENIED/REDUCED. BUTTON G-TUBES ARE LIMITED TO TWO EVERY 12 MONTHS, REGARDLESS OF PROVIDER. REFER TO SECTION 8420 OF THE KMAP DME PROVIDER MANUAL OR SECTION 8400 OF THE KMAP HOME HEALTH AGENCY PROVIDER MANUAL. 119


1076Denied/reduced. Supplies and materials (procedure code 99070) are limited to o ne unit per day. 119



1084

DENIED, EXCEEDS PROGRAM LIMITATIONS. BUTORPHANOL (STADOL) NASAL SPRAY IS LIMIT ED TO 15 UNITS PER CALENDAR MONTH. REFER TO SECTION 8400 OF YOUR KANSAS MEDICA L ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1085

DENIED. A PORTION OF THE UNITS DISPENSED EXCEED PROGRAM LIMITATIONS. BUTORPHA NOL (STADOL) NASAL SPRAY IS LIMITED TO 125 MG ACTIVE INGREDIENT (15 UNITS) PER CALENDAR MONTH. PLEASE CORRECT THE UNITS DISPENSED TO REFLECT ONLY THOSE UNITS WHICH DO NOT EXCEED THE LIMITATION AND RESUBMIT. REFER TO SECTION 7010 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1088

DENIED/REDUCED. ONLY 780 UNITS OF TRANSITIONAL LIVING SKILLS TRAINING ARE ALLO WED PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANC E PROGRAM HCBS/HI TRANSITIONAL LIVING SKILLS TRAINING PROVIDER MANUAL. 119


1089

DENIED/REDUCED. ONLY 156 UNITS OF OCCUPATIONAL THERAPY ARE ALLOWED PER CALENDA R YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS/H I OCCUPATIONAL THERAPY PROVIDER MANUAL. 119






1090

DENIED/REDUCED. ONLY 156 UNITS OF PHYSICAL THERAPY ARE ALLOWED PER CALENDAR YE AR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS/HI PH YSICAL THERAPY PROVIDER MANUAL. 119


1091

DENIED/REDUCED. ONLY 156 UNITS OF SPEECH-LANGUAGE THERAPY ARE ALLOWED PER CALE NDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCB S/HI SPEECH/LANGUAGE THERAPY PROVIDER MANUAL. 119


1092

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 2 UNITS OF OSTOMY SKIN BARR IER (LIQUID, POWDER OR PASTE) PER MONTH (1 UNIT = 1OZ.) WITHOUT MEDICAL NECESSI TY. REFER TO SECTION 8420 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER M ANUAL. 119


1098

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY THREE UNITS OF DISPOSABLE UNDERPADS ARE ALLOWED PER MONTH. REFER TO SECTIO N 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROFESSIONAL SERVICES PROVIDER MANUAL. 119


1181

DENIED. ONLY 140 DAYS OF BEHAVIOR MANAGEMENT RESIDENTIAL GROUP TREATMENT ARE A LLOWED PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTA NCE PROGRAM PROVIDER MANUAL. 119


1182

DENIED. ONLY 180 DAYS OF BEHAVIOR MANAGEMENT FAMILY TREATMENT ARE ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1186

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 10 UNITS OF PORTABLE OXYGEN (E0443) ALLOWED PER MONTH. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSIST ANCE PROGRAM PROVIDER MANUAL. 119



1201

DENIED, EXCEEDS PROGRAM LIMITATIONS. COMPLETE LOWER DENTURE RELININGS ARE NOT ALLOWED WITHIN TWO YEARS OF COMPLETE LOWER DENTURE PURCHASE. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119






1230

DENIED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE DISABILITY CODE (ONE UNIT) IS A LLOWED PER MONTH. REFER TO SECTION 7010 AND 8400 OF YOUR KANSAS MEDICAL ASSIST ANCE PROGRAM PROFESSIONAL SERVICES PROVIDER MANUAL. 119



1242

DETAIL DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. SED RESPITE CARE IS LIMITE D TO 300 HOURS PER CALENDAR YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM SED PROVIDER MANUAL. 119


1248

DENIED. EXCEEDS PROGRAM LIMITATIONS. ALCOHOL AND DRUG TREATMENT SERVICES PER HOUR ARE NOT ALLOWED WHEN BILLED ON THE SAME DAY AS ALCOHOL AND DRUG TREAMENT SERVICES PER DAY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PRO GRAM PROVIDER MANUAL FOR MORE INFORMATION. 119



1257

DENIED/REDUCED. ONE UNIT PERSONAL SERVICES ARE ALLOWED PER MONTH, PER PROVIDER . REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS/HI PERSO NAL SERVICES PROVIDER MANUAL. 119



1258

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 3744 UNITS FOR REHABILITATION THERAPIES ARE ALLOWED PER CALENDAR YEAR, REGA RDLESS OF PROVIDER. PLEASE REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTA NCE PROGRAM HCBS PROVIDER MANUAL. 119


1259

DENIED. ALL OR A PORTION OF THE UNITS BILLED EXCEEDS PROGRAM LIMITATIONS. ONL Y TEN TABLETS OF VIAGRA ALLOWED PER MONTH WITH PRIOR AUTHORIZATION. REFER TO S ECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1263

DETAIL DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY TWO HEARING AID DISP ENSING ALLOWED EVERY FOUR YEARS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM AUDIOLOGY PROVIDER MANUAL. 119






1265

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. R EINTEGRATION COUNSELING IS LIMITED TO THREE (3) HOURS PER WEEK (7 DAYS) PER BEN EFICIARY, REGARDLESS OF PROVIDER. REFERENCE SECTION 8400 OF YOUR KANSAS MEDICA L ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1267

DENIED. ALL OR A PORTION OF THE UNITS BILLED EXCEEDS PROGRAM LIMITATIONS. ONL Y TWO TWELVE WEEK COURSES OF THERAPY ARE ALLOWED PER YEAR. REFER TO SECTION 84 00 OF YOUR MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1268

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY FOUR (4) HIV TESTS WILL BE ALLOWED PER CALENDAR YEAR, REGARDLESS OF PROVIDE R. REFER TO SECTION 8400 OF THE KMAP PROFESSIONAL SERVICES PROVIDER MANUAL OR SECTION 8420 OF THE KMAP HOSPITAL PROVIDER MANUAL. 119


1269

DENIED. ACCORDING TO STATE LAW AND REGULATIONS, PRESCRIPTIONS FOR SCHEDULE II DRUGS MAY ONLY BE FILLED FOR UP TO 60 DAYS UP TO THE MAX NUMBER THE PRESCRIPTI ON IS WRITTEN FOR. 119


1281

DENIED. ALL OR PORTION OF THE UNITS BILLED EXCEEDS PROGRAM LIMITATIONS. ONLY ONE TWELVE WEEK COURSE OF THERAPY IS ALLOWED PER YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1282

DENIED. STATE GUIDELINES DO NOT ALLOW PAYMENT FOR WELLNESS MONITORING WITHIN 5 5 DAYS OF SKILLED NURSING SERVICES. REFER TO SECTION 8000 OF THE KANSAS MEDICA L ASSISTANCE PROGRAM HCBS FRAIL ELDERLY WELLNESS MONITORING PROVIDER MANUAL. 119


1283

DENIED/REDUCED. ONLY ONE WELLNESS MONITORING VISIT ALLOWED PER 55 DAYS. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDERLY WE LLNESS MONITORING PROVIDER MANUAL. 119






1284

DENIED. ALL OR A PORTION OF THE UNITS BILLED EXCEEDS PROGRAM LIMITATIONS. ONL Y FOUR (4) IMPOTENCE PILLS ALLOWED PER CALENDER MONTH. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1285

DENIED. PRESCRIPTION DRUGS ARE LIMITED TO A 34 DAY SUPPLY. REFER TO SECTION 8 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 119


1286

DENIED. PRESCRIPTION DRUGS CANNOT BE REFILLED IF LESS THAN 80 PERCENT OF THE P REVIOUS FILL HAS BEEN UTILIZED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL A SSISTANCE PROGRAM PROVIDER MANUAL. 119


1308

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY FOUR UNITS OF NON-EMERGENCY TRANSPORTATION ALLOWED PER DAY - OR - COMMERCIAL NEMT FORM NOT RECEIVED. 119


1429

DENIED/REDUCED. ONLY 120 UNITS OF RESPITE CARE ARE ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDER LY RESPITE CARE PROVIDER MANUAL. 119


1430

DENIED/REDUCED. ONLY 48 UNITS OF HEALTH CARE ATTENDANT ARE ALLOWED PER DAY. R EFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM FRAIL ELDERLY HEA LTH CARE ATTENDANT PROVIDER MANUAL. 119


1431

DENIED/REDUCED. ONLY TWO UNITS OF ADULT DAY CARE ARE ALLOWED PER DAY. REFER T O SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS FRAIL ELDERLY ADUL T DAY CARE PROVIDER MANUAL. 119


1432

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 480 UNITS OF EMERGENCY RESP ITE CARE ALLOWED PER YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIST ANCE PROGRAM HCBS MR/DD RESPITE CARE PROVIDER MANUAL. 119


1433

DENIED/REDUCED. ONLY 1040 UNITS OF TEMPORARY RESPITE CARE IS ALLOWED PER CALEN DAR YEAR. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/DD RESPITE CARE PROVIDER MANUAL. 119






1434

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 672 UNITS OF MEDICAL RESPIT E CARE ARE ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8410 OF YOUR KANSAS MED ICAL ASSISTANCE PROGRAM PROFESSIONAL SERVICES PROVIDER MANUAL. 119


1435

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 480 UNITS OF MEDICAL CASE M ANAGEMENT ARE ALLOWED PER CALENDAR YEAR. REFER TO SECTION 8410 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROFESSIONAL SERVICES PROVIDER MANUAL. 119


1436

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY 48 UNITS OF SUPPORTIVE HOME CARE ALLOWED DURING A 24 HOUR PERIOD. REFER TO SECTION 8400 OF YOUR KANSAS MED ICAL ASSISTANCE PROGRAM HCBS MR/DD SUPPORTIVE HOME CARE PROVIDER MANUAL. 119


1437

DENIED/REDUCED. ONLY 3120 UNITS OF TRANSITIONAL LIVING SKILLS ARE ALLOWED PER YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HCBS/HI TRANSITIONAL LIVING SKILLS TRAINING PROVIDER MANUAL. 119


1438

DENIED/REDUCED. ONLY 16 UNITS OF TRANSITIONAL LIVING SKILLS TRAINING ARE ALLOW ED PER DAY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HC BS/HI TRANSITIONAL LIVING SKILLS TRAINING PROVIDER MANUAL. 119


1439

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 3744 UNITS FOR REHABILITATION THERAPIES ARE ALLOWED PER CALENDAR YEAR, REGA RDLESS OF PROVIDER. PLEASE REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTA NCE PROGRAM HCBS PROVIDER MANUAL. 119


1440

DETAIL DENIED/REDUCED. ONLY 480 UNITS OF TARGETED CASE MANAGEMENT ALLOWED PER CALENDAR YEAR. 119






1441

DENIED/REDUCED. ONLY 480 UNITS OF INDEPENDENT LIVING COUNSELING ALLOWED PER CA LENDAR YEAR. REFER TO SECTION 8000 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HC BS PHYSICAL DISABILITIES INDEPENDENT LIVING COUNSELING PROVIDER MANUAL. 119


1442

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 672 UNITS OF MEDICAL RESPITE CARE ARE ALLOWED PER CALENDAR YEAR. REFER TO APPENDIX III OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOME HEALTH AGENCY PROVI DER MANUAL. 119


1443

DENIED/REDUCED. KMAP BENEFICIARIES ARE LIMITED TO TWO MEDICATION REVIEWS PER D AY. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MA NUAL. 119


1444

DETAIL DENIED/REDUCED. SED RESPITE HAS EXCEEDED THE 1200 UNITS ALLOWED PER CALE NDAR YEAR, OR DETAILS THAT ARE DATE RANGE NEED TO BE BROKEN OUT PER SERVICE. 119


1457

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY 1 FULL MOUTH DEBRIDEMENT ALLO WED EVERY 12 MONTHS. 119


1458

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY 4 PERIODONTAL SCALING AND PLA NING ALLOWED EVERY 12 MONTHS. 119


21A mathematical error was found in your billing and was corrected. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M54 Missing/incomplete/invalid total charges.

25 This line was deleted by the pharmacy. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate.

34

DATE DISPENSED IS MISSING, INVALID, OR AFTER CLAIM SUBMISSION DATE. PLEASE COR RECT AND RESUBMIT. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. N304 Missing/incomplete/invalid dispensed date.

35

Denied. NDC is not present on the claim. If billing a Compound Drug, please i nclude NDC's used in Box 16 (Remarks). Please resubmit with correct NDC and/or Clarification of the Description in Box 16. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M119






37Billed amount/net charge missing or invalid. Please correct and resubmit. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M49 Missing/incomplete/invalid value code(s) or amount(s).

44

Denied. NDC of one ingredient not correct. Please resubmit with NDC and descr iption for each ingredient of this compound drug in box 16 (remarks). 125



45

Denied. NDC does not match the description given. Please resubmit with correc t NDC and description in box 16 (remarks). 125



62

WE HAVE CORRECTED THE BENEFICIARY NAME, NUMBER AND/OR BIRTHDATE FOR YOU. PLEAS E UPDATE YOUR FILES. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. MA36 Missing/incomplete/invalid patient name.

135

DENIED, INCOMPLETE FOR PROCESSING. SURGERY DATE IS MISSING OR INVALID. PLEASE RESUBMIT WITH A VALID DATE. REVIEW ENTIRE CLAIM FOR COMPLETENESS. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. N341 Missing/incomplete/invalid surgery date.

136

DENIED, INCOMPLETE FOR PROCESSING. THE SURGERY PROCEDURE CODE(S) IS EITHER MIS SING OR INVALID. PLEASE RESUBMIT WITH A VALID ICD-9-CM SURGICAL PROCEDURE CODE( S). 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. MA51

Missing/Incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory.

137

DENIED. INCOMPLETE FOR PROCESSING. PLEASE RESUBMIT WITH A VALID "ADMIT" DATE AN D / OR VALID "FROM" AND "TO" DATES OF SERVICE. REVIEW ENTIRE CLAIM FOR COMPLETE NESS. 125



139

Denied, incomplete for processing. "Thru" date of service is earlier than "Fro m" date of service. Please resubmit with correct dates. Review entire claim f or completeness. 125



144

CLAIM DENIED. 1) THE ADMIT DATE AND THE FROM DATE MUST REFLECT THE SAME DATE UN LESS THE CLAIM IS PART OF AN INTERIM BILLING. INTERIM BILLINGS ARE RESTRICTED T O INPATIENT STAYS LASTING LONGER THAN 180 DAYS. 2) WHEN THE BENEFICIARY IS INEL IGIBLE FOR PART OF THE STAY, PLEASE BILL THE ENTIRE STAY AND EDS WILL PRORATE T HE CLAIM BASED UPON THE DAYS THE BENEFICIARY IS ELIGIBLE 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. MA40 Missing/incomplete/invalid admission date.

167

Denied, incomplete for processing. Signature of provider is missing. Review e ntire Medical Necessity Form for completeness and resubmit appropriately. 125


The medical necessity form must be personally signed by the attending physician.





310Denied. The total charge does not equal the sum of the details. Please correc t and resubmit. 125


317

Denied. Dates of service on Adult Care Home claims span multiple months. Plea se resubmit the claim as multiple claims separating the calendar months. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. N61 Rebill services on separate claims.

333

DENIED. PSYCHIATRIC OR BEHAVIOR MANAGEMENT PREADMISSION ASSESSMENTS MUST BE SU BMITTED ON A SEPARATE CLAIM FORM FROM ALL OTHER COMMUNITY MENTAL HEALTH CENTER SERVICES. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROV IDER MANUAL. 125


344

CLAIM DENIED. THE ADJUSTMENT FORM YOU SUBMITTED FOR THIS ICN INDICATED THAT TH E CLAIM WAS BILLED IN ERROR OR NON-COVERED SERVICES WERE BILLED. 125


346

Denied, incomplete or invalid tooth surface code(s) used. Please resubmit with code(s) indicating correct surfaces: O, I, D, L, M, F. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. N75 Missing or invalid tooth surface information

380

Denied. Utilization Review has reviewed your claim and determined a billing er ror has occurred. Refer to your letter from Utilization Review for detailed in formation. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. N10


382

DENIED. MOTHER AND BABY'S CHARGES CANNOT BE BILLED ON THE SAME CLAIM FORM. PL EASE REBILL ON SEPARATE CLAIMS. REFER TO SECTION 7020 OF YOUR KANSAS MEDICAL A SSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL. 125


383

Denied. Medicare Related claims received with anesthesia and other services bi lled on the same claim are not acceptable. Please split bill. 125


428U&C AND GAD AMOUNTS ARE MISSING. PLEASE RESUBMIT WITH THE U&C AND GAD AMOUNT. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M49 Missing/incomplete/invalid value code(s) or amount(s).

459

CLAIM DENIED. ONE OR MORE OF THE CLAIM DETAILS HAVE INVALID, ILLEGIBLE, OR MIS SING SERVICE DATES. A VALID DATE OF SERVICE IN MM/DD/CCYY FORMAT MUST BE PRESE NT FOR EACH DETAIL. 125







604Quantity billed does not equal the sum of ingredients reported. Please correct and resubmit. 125


605

An NDC has been assigned to this particular compound Rx. Please use this NDC i nstead of 99999-9999-99 when billing. 125


611Denied. NDC is invalid. Please resubmit with correct NDC and description in B ox 16 (Remarks). 125



707

Denied. From and Thru dates of service do not equal total days billed. (Patie nt status code is equal to 9). Please correct and resubmit. 125



708

DENIED. PATIENT STATUS CODE INDICATES PATIENT DISCHARGED. DO NOT INCLUDE DATE OF DISCHARGE IN TOTAL DAYS BILLED. PLEASE CORRECT AND RESUBMIT. 125


Missing/incomplete/invalid discharge or end of care date.

753

Denied, incomplete for processing. Please enter a valid patient status code an d resubmit. Review entire claim for completeness. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. MA43 Missing/incomplete/invalid patient status.

762

CLAIM DENIED. ANCILLARY SERVICES CANNOT BE BILLED ON THE SWINGBED CLAIM FORM. REFER TO SECTION 7020 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVID ER MANUAL FOR MORE INFORMATION. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. N43 Bed hold or leave days exceeded.

765

Denied. All inpatient stays must report accommodations and ancillary charges u sing the appropriate revenue codes. If no ancillary services were provided, at tach supporting documentation or so note in remarks field and resubmit the clai m. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M50 Missing/incomplete/invalid revenue code(s).

770DENIED. TYPE OF BILL GIVEN IS INVALID, MISSING, OR UNACCEPTABLE. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. MA30 Missing/incomplete/invalid type of bill.

771

Denied. The sum of the detail charges given in form locators 47 and 48 does no t equal the total charges given for revenue code 001. 125


772

Denied. The sum of the detail non-covered charges in form locator 48 does not equal the claim's total non-covered charges given for revenue code 001. 125






773DENIED. CONDITION CODE(S) GIVEN IS INVALID/UNACCEPTABLE FOR MEDICAID BILLING. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M44 Missing/incomplete/invalid condition code.

774

DENIED. THE OCCURRENCE CODE(S) BILLED IS INVALID/UNACCEPTABLE FOR KANSAS MEDIC AL ASSISTANCE PROGRAM. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M45 Missing/incomplete/invalid occurrence code(s).

775

Denied. A valid date (MM/DD/YY) is required in form locators 32-36 when an occ urrence code is given. The accident date cannot be after the date of service. Also note that an occurrence code must be present for each date entered. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M45 Missing/incomplete/invalid occurrence code(s).

779

DETAIL DENIED. THE REVENUE CODE GIVEN IS EITHER INVALID, UNACCEPTABLE, OR NONCO VERED. 125


782

DENIED. THE NUMBER OF DAYS ARE REQUIRED FIELDS AND SHOULD EQUAL THE DATE SPAN, EXCLUDING THE DATE OF DISCHARGE WHEN PATIENT STATUS IS OTHER THAN 30 (STILL A PATIENT). 125



783

DENIED. PRO/UR INDICATES STAY PARTIALLY APPROVED. THE NUMBER OF COVERED DAYS (FORM LOCATOR 7) SHOULD EQUAL THE DATE SPAN APPROVED. 125



784

CLAIM DENIED. THE SUM OF ALL ACCOMODATION REVENUE CODES 101-219 (FORM LOCATOR 4 6) IS NOT EQUAL TO THE NUMBER OF COVERED DAYS (FORM LOCATOR 7). PLEASE CORRECT AND RESUBMIT. 125


Missing/incomplete/invalid release of information indicator.

787

Denied. The type of bill code given indicates an inpatient billing; however, n o accommodation revenue codes were billed or the accommodation revenue code bil led is inactive for the dates of service billed. Please correct and resubmit. 125


804

Denied. The type of bill code given indicates an outpatient billing; however, an accommodation code(s) was billed. Please correct and resubmit. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. MA30 Missing/incomplete/invalid type of bill.

911Your 1099 amount has been decreased by the amount specified on this transaction . 125






1011

DENIED. BILLED AMT IS SIGNIFICANTLY LESS THAN ALLOWED AMT FOR THE NDC AND/OR T HE UNIT/QUANTITY SUBMITTED. IF BILLING FOR AN INJECTABLE DRUG, VERIFY UNITS AR E BILLED CORRECTLY (ML VS VIAL/AMP). FOR INJECTABLES, USING "MG" AS THE UNIT I S NOT APPROPRIATE. VERIFY THE QUANTITY IS CORRECT IN RELATION TO THE UNITS DIS PENSED AND PACKAGE SIZE. RESUBMIT CLAIM WITH CORRECTED INFORMATION. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M53 Missing/incomplete/invalid days or units of service.

1061Denied. Billing provider is only acceptable as a performing provider. 125



1064

Denied. Detail date of service does not fall within the "Statement Covers Peri od From and Through" dates indicated on the claim. Please correct and resubmit . 125



1224Denied. The level of care submitted is missing or invalid. 125


The approved level of care does not match the procedure code submitted.

1255

Detail denied. Physician and Technical Components of a procedure should not be reported separately when performed by the same provider. Please rebill using the appropriate Total Component Procedure Code. 125


1260

Denied. Our records indicate the billing provider number does not match the pr ovider number on the Long Term Care File for dates of service on the claim. 125


Missing/incomplete/invalid provider number of the facility where the patient resides.

1294Claim/service denied/reduced due to a submission/billing error(s). 125


1403DENIED. THIRD PARTY PAYMENT AMOUNT INVALID. 125


You should also submit this claim to the patient's other insurer for potential payment of supplemental benefits. We did not forward the claim information as the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.

1405DENIED, INCOMPLETE FOR PROCESSING. UNITS OF SERVICE MISSING OR INVALID. 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M53 Missing/incomplete/invalid days or units of service.





1406DENIED. MAXIMUM NUMBER OF DETAILS EXCEEDED. 125


Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.

1449 CLAIM DENIED. CLAIM TYPE BILLED IS INVALID. 125


8053PROVIDER REQUESTED ADJUSTMENT DUE TO INCORRECT CODE BILLED 125

Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate. M20 Missing/incomplete/invalid HCPCS.

9800 CUTBACK DUE TO HMO PAYMENT/COVERAGE. 125


193Denied. One or more of the fields on the detail were illegible. Please correc t and resubmit. 129

Payment denied - Prior processing information appears incorrect.

1416DENIED, INCOMPLETE FOR PROCESSING. INVALID ATTACHMENT TYPE. 129

Payment denied - Prior processing information appears incorrect. N206

The supporting documentation does not match the claim

75Claim has been split to assist in processing. Allow 60 days for total processi ng. 133

The disposition of this claim/service is pending further review.

145

Detail denied. This claim and all attachments have been forwarded to SRS for r eview. You will be notified by prior authorization letter of approval or denia l. If your claim is approved, it will be reprocessed. 133


393

DENIED. CLAIM PENDING UTILIZATION REVIEW. AFTER YOUR CLAIM HAS BEEN REVIEWED, EDS WILL SUBMIT FOR PROCESSING. 133

The disposition of this claim/service is pending further review. N10


956

Claim denied. Your claim has been referred to Provider Relation Services for a ssistance in resolving processing discrepancies. Disposition of claim will be received by you at a later date. 133


1083

Your claim has been identified as potentially being a medical manifestation of a psychiatric disorder. Your claim has been referred to KFMC for review. They will be in contact with you. 133

The disposition of this claim/service is pending further review. MA07

The claim information has also been forwarded to Medicaid for review.

1165Paid claim. Delay in processing due to Newborn Identification Number verificat ion. 133


1168Received but not finalized. Pending Spenddown file verification. 133


1174Denied. An adjustment or credit is currently in progress for the services on t his claim. 133


1187

CLAIM RECEIVED BUT NOT FINALIZED. CLAIM PENDING DUE TO NEWBORN IDENTIFICATION NUMBER VERIFICATION. 133






1196This claim was suspended pending individual consideration of the NDC billed. 133


1197This claim was suspended pending third party liability verification. 133


1243This claim was suspended pending individual consideration of services for this Beneficiary. 133


1306

CLAIM DENIED FOR AN INTERNAL ERROR AND WILL BE REPROCESSED ON A FUTURE REMITTA NCE ADVICE. 133


28THE BENEFICIARY NAME OR NUMBER IS MISSING OR DISAGREE. 140

Patient/Insured health identification number and name do not match. N179

Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.

600Claim denied. Beneficiary name is incomplete, missing or not legible on the cl aim form. Please clarify. 140

Patient/Insured health identification number and name do not match. MA36 Missing/incomplete/invalid patient name.

615This claim is being denied due to a "pending" or "timely filing" notation in th e beneficiary ID number field. 140

Patient/Insured health identification number and name do not match.

1455THE BENEFICIARY BIRTH DATE IS MISSING, INVALID OR DISAGREE. 140

Patient/Insured health identification number and name do not match. N179

Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.

3

BENEFICIARY INELIGIBLE FOR ALL OR A PORTION OF THE SERVICE DATE(S) BILLED. IF NECESSARY, PLEASE RESUBMIT AND BREAK OUT SERVICES FOR WHICH THE BENEFICIARY IS ELIGIBLE FROM SERVICES FOR WHICH THE BENEFICIARY IS INELIGIBLE. REFER TO SEC TIONS 1210 AND 2000 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 141

Claim adjustment because the claim spans eligible and ineligible periods of coverage. N30 Patient ineligible for this service.

59Covered days reduced. Patient ineligible for a portion of claim. 141

Claim adjustment because the claim spans eligible and ineligible periods of coverage.

79

BENEFICIARY INELIGIBLE. IF THIS CLAIM WAS SUBMITTED ON PAPER, THE CLAIM HAS BE EN ROUTED TO SRS, AND CLAIM WILL BE RESUBMITTED FOR PROCESSING AFTER ELIGIBILIT Y HAS BEEN CORRECTED. 141

Claim adjustment because the claim spans eligible and ineligible periods of coverage. N30 Patient ineligible for this service.

129

Please break out services for which the beneficiary is eligible from services f or which the beneficiary is ineligible. 141


390

Claim reimbursed at maximum allowable. Prorated payment due to beneficiary bei ng ineligible for a portion of the inpatient stay. 141


481

Detail denied. According to our records, this beneficiary is not eligible to r eceive Home and Community Based Services. Please contact your SRS case manager . 141






484

Detail denied. According to our records, this beneficiary is not eligible for HCBS services for a portion of the service dates billed. Please contact your S RS case worker. 141


1099

Beneficiary ineligible for date(s) of service. Please break out charges as non covered for services provided on ineligible days and resubmit. 141


1208

Detail denied. According to our records, this beneficiary is not eligible for HCBS Head Injury Waiver services. Please contact the beneficiary's case manage r. 141


1209

Detail denied. According to our records, this beneficiary is not eligible for HCBS Head Injury Waiver services for all or a portion of the service dates bill ed. Please contact the beneficiary's case manager. 141


1210

Detail denied. According to our records, this beneficiary is not eligible for HCBS Mentally Retarded/Developmental Disabilities Waiver services for all or a portion of the service dates billed. Please contact the beneficiary's case man ager. 141


1211

Detail denied. According to our records, this beneficiary is not eligible for HCBS Mentally Retarded/Developmental Disablilites Waiver services for all or a portion of the service dates billed. Please contact the beneficiary's case man ager. 141


1212

Detail denied. According to our records, this beneficiary is not eligible for HCBS Frail Elderly Waiver services. Please contact the beneficiary's case mana ger. 141


1213

Detail denied. According to our records, this beneficiary is not eligible for HCBS Frail Elderly Waiver services for all or a portion of the service dates bi lled. Please contact the beneficiary's case manager. 141


1214

Detail denied. According to our records, this beneficiary is not eligible for HCBS Physical Disabilities Waiver services. Please contact the beneficiary's ca se manager. 141


1216

Detail denied. According to our records, this beneficiary is not eligible for HCBS Technology-Assisted Children Waiver services. Please contact the benefici ary's case manager. 141






1217

DETAIL DENIED. ACCORDING TO OUR RECORDS, THIS BENEFICIARY IS NOT ELIGIBLE FOR HCBS TECHNOLOGY-ASSISTED CHILDREN WAIVER SERVICES FOR ALL OR A PORTION OF THE S ERVICE DATES BILLED. PLEASE CONTACT THE BENEFICIARY'S CASE MANAGER. 141


1241

Denied. According to our records, this Beneficiary is not eligible for the HCB S Program for Children with Severe Emotional Disturbances for all or a portion of the service dates billed. Please contact the Beneficiary's case manager. 141


1287

Denied. Beneficiary is not eligible for all or a portion of the dates billed f or Family Service Coordination. Please resubmit your claim breaking out those service dates not covered by the HCBS program or CFS contract. 141


97 REDUCED BY PATIENT LIABILITY. 142Claim adjusted by the monthly Medicaid patient liability amount.

151

The patient liability plus the other insurance payment amount exceeds the claim 's allowed amount and results in a zero paid claim. 142

Claim adjusted by the monthly Medicaid patient liability amount.

1010

Denied. The patient liability amount exceeds the claim's allowed amount and re sults in a zero paid claim. 142


9004PATIENT LIABILITY DEDUCTED FROM THE PAID AMOUNT 142


9005PAYMENT REDUCED BY NON-PATIENT OBLIGATION. SYSTEM PLUGGED 142


184

THE PRIMARY DIAGNOSIS INDICATED IS NOT AN ACCEPTABLE DIAGNOSIS FOR THE KANSAS M EDICAL ASSISTANCE PROGRAM. PLEASE RESUBMIT WITH VALID CODE. 146

Payment denied because the diagnosis was invalid for the date(s) of service reported. MA63 Missing/incomplete/invalid principal diagnosis.

1400

THE PRIMARY DIAGNOSIS CODE INDICATED ON THE CLAIM IS NOT COVERED FOR THE KANSAS MEDICAL ASSISTANCE PROGRAM. 146

Payment denied because the diagnosis was invalid for the date(s) of service reported. MA63 Missing/incomplete/invalid principal diagnosis.

155Reimbursement has been made utilizing the FFP percentage methodology. 147

Provider contracted/negotiated rate expired or not on file.

704

Denied. Our records do not indicate a rate for the "Level of Care" submitted. Please file an Adjustment Request indicating the correct "Level of Care". 147


1031REIMBURSEMENT HAS BEEN MADE UTILIZING THE ENCOUNTER RATE PRICING METHODOLOGY. 147


1426NO PRICING SEGMENT ON FILE FOR THIS PROCEDURE-ENCOUNTER ONLY 147


1427ENCOUNTER RATE NOT ON FILE FOR DATE OF SERVICE-ENCOUNTER ONLY 147






1428

DENIED. VERIFY THE DATE OF SERVICE BILLED AND/OR CONTACT THE ELIGIBILITY WORKER REGARDING THE BENEFICIARY LEVEL OF CARE. 147


1450

DENIED. OUR RECORDS INDICATE THE BENEFICIARY HAS SWINGBED ELIGIBILITY. YOUR F ACILITY DOES NOT HAVE A SWINGBED PER DIEM RATE ON FILE. IF YOU BELIEVE THIS BE NEFICIARY'S ELIGIBILITY IS INCORRECT, PLEASE CONTACT THE SRS CASEWORKER ASSIGNE D TO THIS BENEFICIARY TO REQUEST A CORRECTION OF THEIR ELIGIBILITY. 147


222

DENIED. LOCK-IN BENEFICIARY. CLAIMS SUBMITTED FOR SERVICES PERFORMED ON REFER RAL FROM A BENEFICIARY'S LOCK-IN PHYSICIAN MUST REFLECT THE KANSAS MEDICAL ASS ISTANCE PROGRAM ID NUMBER OF THE LOCKED IN PHYSICIAN IN FIELD 17A OF THE HCFA-1 500 CLAIM FORM. 148

Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete.

241

DENIED. INFORMATION REQUIRED TO PROCESS THIS CLAIM IS NOT INDICATED/DOES NOT C ORRESPOND WITH SURGEON'S CLAIM. PLEASE CONTACT SURGEON AND VERIFY PERFORMING P ROVIDER NUMBER (FORM LOCATOR 83 ON UB92 OR FIELD 24K ON THE HCFA 1500 FORM). C ORRECT AND RESUBMIT. 148

Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete.

623Denied/reduced. Exceeds program limitations. Only one appendectomy is allowed per lifetime. 148

Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete. N117


1413

DENIED. PROVIDER NUMBER SUBMITTED IN FIRST OTHER PROVIDER FIELD IS NOT A VALID KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER IDENTIFICATION NUMBER. PLEASE CORRE CT AND RESUBMIT. 148


Missing/incomplete/invalid other provider primary identifier.

1414

DENIED. PROVIDER NUMBER SUBMITTED IN SECOND OTHER PROVIDER FIELD IS NOT A VALID KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER IDENTIFICATION NUMBER. PLEASE CORRE CT AND RESUBMIT. 148


Missing/incomplete/invalid other provider secondary identifier.

112

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. KANSAS MEDICAL ASSISTANCE BENEFICI ARIES ARE LIMITED TO 800 UNITS OF SUBSTANCE ABUSE TREATMENT PER LIFETIME. 149

Lifetime benefit maximum has been reached for this service/benefit category.

229

Denied/reduced. SRS only allows payment once for the same tooth extraction per lifetime regardless of provider. 149

Lifetime benefit maximum has been reached for this service/benefit category. N117






251

DENIED, EXCEEDS PROGRAM LIMITATIONS. ALCOHOL AND DRUG TREATMENT ADMISSIONS ARE LIMITED TO 3 PER LIFETIME. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIST ANCE PROGRAM HOSPITAL PROVIDER MANUAL. 149


268

DENIED/REDUCED. MEDICAID/MEDIKAN BENEFICIARIES ARE LIMITED TO 200 UNITS OF ALC OHOL/DRUG TREATMENT PER LIFETIME. ALL OR A PORTION OF THE SERVICES BILLED EXCE ED THIS LIMITATION. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PR OGRAM PROVIDER MANUAL. 149



285

Denied. All or a portion of the services billed exceed program limitations. O nly one Initial Family Planning Visit allowed per beneficiary. 149



403

DETAIL DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY THREE ORTHODONTIC ST UDIES PER LIFETIME. 149


418

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. BILLED AMOUNT EXCEEDS THE MAXIMU M ALLOWED PER LIFETIME FOR ASSISTIVE SERVICES. REFER TO SECTION 8000 OF THE KA NSAS MEDICAL ASSISTANCE PROGRAM HCBS PHYSICAL DISABILITIES ASSISTIVE SERVICES P ROVIDER MANUAL. 149


465

DENIED/REDUCED. ONLY ONE NEWBORN HOME VISIT IS ALLOWED PER LIFETIME. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 149



554

DENIED. ALL OR A PORTION OF THE SERVICES BILLED EXCEED PROGRAM LIMITATIONS. O NLY 10 MONTHS RENTAL OF THE CPAP DEVICE IS ALLOWED PER LIFETIME. REFER TO SECT ION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 149

Lifetime benefit maximum has been reached for this service/benefit category. M28

This does not qualify for payment under Part B when Part A coverage is exhausted or not otherwise available.

585

DETAIL DENIED/REDUCED. ONLY ONE INITIAL ORAL EXAM ALLOWED PER LIFETIME. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 149



619Denied/reduced. Exceeds program limitations. Only one peritoneal dialysis tra ining is allowed per lifetime. 149



622Denied/reduced. Exceeds program limitations. Only one hysterectomy is allowed per lifetime. 149



624Denied/reduced. Exceeds program limitations. Only one sterilization is allowe d per lifetime. 149







964

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY ONE SPLENECTOMY IS ALLOWED PER LIFETIME. 149



965Denied/reduced. Exceeds program limitations. Only one cholecystectomy is allo wed per lifetime. 149



974Denied/reduced. Exceeds program limitations. Only one In-hospital well baby c are is allowed per lifetime. 149



985

Denied. Exceeds program limitations. Only one neurometrics exam and one neurom etrics psychiatric screening are allowed per lifetime. 149


986

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY TWO REMOVABLE APPLIANCES AL LOWED PER LIFETIME. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PR OGRAM PROVIDER MANUAL. 149


987

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. ONLY TWO FIXED APPLIANCES ALLOWE D PER LIFETIME. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRA M PROVIDER MANUAL. 149


991

DENIED. EXCEEDS PROGRAM LIMITATIONS. A MAXIMUM OF $1,728.00 IS ALLOWED FOR O RTHODONTIC WORK. REFER TO SECTION 8500 OF YOUR KANSAS MEDICAL ASSISTANCE PROGR AM PROVIDER MANUAL. 149


1256

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATION. BILLED AMOUNT EXCEEDS THE MAXIMUM ALLOWED OF $7,500.00 PER LIFETIME FOR ASSISTIVE SERVICES. PLEASE REFER TO SEC TION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS/HI ASSISTIVE SERVICES P ROVIDER MANUAL. 149


1291Denied. Only one Nursing Evaluation visit per provider per beneficiary is allo wed per lifetime. 149



1293

DENIED/REDUCED. EXCEEDS PROGRAM LIMITATIONS. BILLED AMOUNT EXCEEDS THE MAXIMU M ALLOWED OF $7500.00 PER LIFETIME FOR ASSISTIVE TECHNOLOGY SERVICES. PLEASE R EFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS-FE ASSISTIVE SERVICES PROVIDER MANUAL. 149


201

Procedure code changed to Standard Office Visit. Initial Office Visit allowed only once to a podiatrist for each new patient. 150






272Denied. Emergency Room noncovered due to nonemergency diagnosis. Please bill the beneficiary. 150


345

Payment for Consultation reduced to allowance for an Oral Exam because field #2 0 (referred by) was not complete. 150


473Denied. Services billed for this beneficiary were not prior authorized. 150

Payment adjusted because the payer deems the information submitted does not support this level of service. N29


475

Payment reduced/denied. Submitted documentation does not support the procedure code/level of service billed. 150


537

Services denied. Observation Room service are non-covered if the patient was n ot seen by a physician within two (2) hours prior to admission to the Observati on Room. 150


541

Service denied. The diagnosis code has been determined to require additional d ocumentation to support the medical necessity of the procedure code being bille d. Specify the symptoms and/or circumstances which prompted the physician to o rder this procedure. 150

Payment adjusted because the payer deems the information submitted does not support this level of service. M60 Missing Certificate of Medical Necessity.

591

DENIED. EXCEEDS PROGRAM LIMITATIONS. OFFICE AND HOSPITAL VISITS ARE CONTENT OF SERVICE UP TO 42 DAYS AFTER A MAJOR SURGERY. REFER TO SECTION 8400 OF YOUR K ANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 150


992

DENIED. EXCEEDS PROGRAM LIMITATIONS. PAYMENT IS NOT ALLOWED FOR AN OFFICE VISI T WHEN PERFORMED ON THE SAME DAY AS AN ENDOSCOPIC PROCEDURE. REFER TO YOUR K ANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 150



997

Denied. Exceeds program limitations. Reimbursement to psychiatric free standi ng facilities is not allowed for beneficiaries between the ages of 21 through 6 4. 150


1055

THIS CLAIM AND ATTACHMENTS HAVE BEEN REVIEWED BY THE MEDICAL STAFF AND IT WAS D ETERMINED THAT LAND AMBULANCE WOULD HAVE SUFFICED. REIMBURSEMENT HAS BEEN REDU CED TO THAT ALLOWED FOR LAND AMBULANCE SERVICES. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. 150






1119

Denied. State guidelines will not allow payment for an office visit/initial em ergency treatment on the same date of service as a surgery. 150



1121

Denied. State guidelines will not allow payment for a hospital/office visit on the same date of service as a chemotherapy administration. 150



1124

DENIED. SOME OR ALL OF THE LABORATORY SERVICES BILLED ON THIS CLAIM OR IN HIST ORY ARE PART OF A CHEMISTRY PROFILE. PLEASE REBILL WITH THE APPROPRIATE PROCED URE CODE. 150

Payment adjusted because the payer deems the information submitted does not support this level of service. M126

Missing/incomplete/invalid individual lab codes included in the test.

1130

Denied. Some or all of the laboratory services billed on this claim or in hist ory are part of a laboratory panel procedure code. Please rebill with the appr opriate laboratory panel procedure code. 150

Payment adjusted because the payer deems the information submitted does not support this level of service. N19 Procedure code incidental to primary procedure.

1139

Please rebill with the appropriate CBC procedure code. Denied. State guidelin es will not allow payment for a biophysical profile on the same date of service as a complete obstetrical sonogram. 150



1146

Denied. State guidelines will not allow payment for a hospital visit on the sa me date of service as a consultation. 150



1147Denied. State guidelines will not allow payment for an office visit on the sam e date of service as an injection. 150



1150

Denied. State guidelines will not allow payment for an office visit on the sam e date of service as a preventative medicine evaluation. 150



1151

Denied. State guidelines will not allow payment for observation care on the sa me date of service as a surgery. 150



1154

Denied. State guidelines will not allow payment for a hospital inpatient servi ce on the same date of service as an emergency department visit. 150



1298

CLAIM/SERVICE DENIED/REDUCED BECAUSE THE PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS LEVEL OF SERVICE, THIS MANY SERVICES, THIS LENGTH OF SER VICE, OR THIS DOSAGE. 150


Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed

14

DETAIL DENIED/REDUCED. ADDITIONAL SERVICES ARE ALLOWED ONLY WHEN A KAN BE HEALT HY SCREEN CAN BE VERIFIED BY THE FISCAL AGENT. 151

Payment adjusted because the payer deems the information submitted does not support this many services. N78

The necessary components of the child and teen checkup (EPSDT) were not completed.





152

DENIED/REDUCED, EXCEEDS PROGRAM LIMITATIONS. ONLY 5 URINARY POUCHES WITH FACEP LATE ARE ALLOWED WITHIN 6 MONTHS. REFER TO SECTION 8420 OF THE KMAP DME PROVI DER MANUAL OR SECTION 8400 OF THE KMAP HOME HEALTH AGENCY PROVIDER MANUAL. 151


172PLEASE VERIFY FROM AND TO DATES OF SERVICE VERSUS QUANTITY BEING BILLED. 151

Payment adjusted because the payer deems the information submitted does not support this many services. M53 Missing/incomplete/invalid days or units of service.

632

Denied/reduced. The claim and/or documentation does not support the necessity o f billing multiple units. If documentation is available to support the billing of more than 1 unit, please file an adjustment form with supporting documentat ion attached. 151


1167Denied. Please verify the number of units billed. Units billed must not excee d 31 days. 151


1183

DENIED. ONLY THREE CONSECUTIVE DAYS OF BEHAVIOR MANAGEMENT OBSERVATION BED STA YS ARE ALLOWED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRA M PROVIDER MANUAL. 151


1236Denied. You have billed for more than one month's service on the same claim. 151


1417 DENIED. UNITS DO NOT EQUAL TEETH BILLED. 151


1114Denied, incomplete for processing. The units of service should equal the servi ce date span. 152

Payment adjusted because the payer deems the information submitted does not support this length of services.

1206

Denied. We are unable to determine the specific dates of service to match the n umber of units billed. Please resubmit with the actual service dates and the co rresponding units. 152

Payment adjusted because the payer deems the information submitted does not support this length of services. MA31


1077

Denied. Dosages of ingredients noted in compound do not appear to be appropria te. Please provide a copy of the original RX. Reminder: Only vials needing to be reconstituted should be billed in whole vials. Only the amounts actually d ispensed should be billed for all other vials that do not require reconstitutio n. 153

Payment adjusted because the payer deems the information submitted does not support this dosage. M123


1170Denied. The quantity billed is below the minimum daily dose allowed for the Be neficiary's age. 153

Payment adjusted because the payer deems the information submitted does not support this dosage.





1171Denied. The quantity billed exceeds the maximum daily dose allowed for the Ben eficiary's age. 153


1172Denied. The quantity billed is below the minimum daily dose for this drug. 153


1173Denied. The quantity billed is above the maximum daily dose allowed for this d rug. 153


29 Quantity/NDC changed to match description of service. 154

PAYMENT ADJUSTED BECAUSE THE PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS DAY'S SUPPLY. M119


256

NDC and/or package size has been corrected. Please make the corrections in you r records for future billings. Future claims billed with incorrect NDC or pack age size will be denied. 154

PAYMENT ADJUSTED BECAUSE THE PAYER DEEMS THE INFORMATION SUBMITTED DOES NOT SUPPORT THIS DAY'S SUPPLY.

1446

DENIED. MEDICAID BENEFICIARIES ARE LIMITED TO 6240 UNITS OF PARTIAL HOSPITALIZ ATION ACTIVITY AND/OR MEDICATION GROUP PER CALENDAR YEAR. ALL OR A PORTION OF THE SERVICES BILLED EXCEED THIS LIMITATION. REFER TO SECTION 8400 OF YOUR KAN SAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. A1 Claim denied charges.

1447

DENIED/REDUCED. MEDIKAN BENEFICIARIES ARE LIMITED TO 2880 UNITS OF PARTIAL HOS PITALIZATION ACTIVITY AND/OR MEDICATION GROUP PER CALENDAR YEAR. REFER TO SECT ION 8300 OF YOUR KANSAS MEDICAL ASSISTANE PROGRAM PROVIDER MANUAL. A1 Claim denied charges.

1448

CPT A0425 SUBMITTED NOT CONSISTANT WITH PROGRAM GUIDELINES. PLEASE REFER TO SEC TION 7000 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM COMMERCIAL NEMT PROVIDER MA NUAL FOR SPECIFIC BILLING INSTRUCTIONS. A1 Claim denied charges. M20 Missing/incomplete/invalid HCPCS.

1452

"DENIED. ADJUSTMENTS/VOIDS CANNOT BE SUBMITTED FOR A CLAIM THAT HAS BEEN DENIE D OR IS IN SUSPENDED OR RESUBMITTED STATUS. PLEASE RESUBMIT ORIGINAL CLAIM FOR PROCESSING." A1 Claim denied charges.

1459DENIED. CONTACT THE SRS TITLE XXI PROGRAM MANAGER AT (785) 296-3981. A1 Claim denied charges.

8000PROVIDER REQUESTED ADJUSTMENT DUE TO BILLING ERROR. A7 Presumptive Payment Adjustment

8001PROVIDER REQUESTED ADJUSTMENT DUE TO OTHER INSURANCE. A7 Presumptive Payment Adjustment





8002PROVIDER REQUESTED ADJUSTMENT DUE TO MEDICARE. A7 Presumptive Payment Adjustment

8003PROVIDER REQUESTED UNDERPAYMENT ADJUSTMENT DUE TO KEYING ERROR. A7 Presumptive Payment Adjustment

8004PROVIDER REQUESTED ADJUSTMENT DUE TO PATIENT LIABILITY. A7 Presumptive Payment Adjustment

8005KMAP REQUESTED ADJUSTMENT DUE TO SPENDDOWN. A7 Presumptive Payment Adjustment

8006PROVIDER REQUESTED ADJUSTMENT DUE TO MISCELLANEOUS ERROR. A7 Presumptive Payment Adjustment

8007PROVIDER REQUESTED ADJUSTMENT DUE TO RESERVE DAYS A7 Presumptive Payment Adjustment N9

Adjustment represents the estimated amount the primary payer may have paid.

8019PROVIDER REQUESTED A FULL RECOUP DUE TO A MISCELLANEOUS ERROR. A7 Presumptive Payment Adjustment

8020FADS INITIATED A FULL RECOUP DUE TO A DUPLICATE PAYMENT. A7 Presumptive Payment Adjustment

8021FADS INITIATED A FULL RECOUP DUE TO WRONG PROVIDER. A7 Presumptive Payment Adjustment

8022FADS INITIATED A FULL RECOUP DUE TO WRONG BENEFICIARY NUMBER. A7 Presumptive Payment Adjustment

8023FADS INITIATED A FULL RECOUP DUE TO WRONG NDC/PROCEDURE CODE/MODIFIER CODE A7 Presumptive Payment Adjustment

8024FADS INITIATED A FULL RECOUP DUE TO WRONG UNITS OF SERVICE. A7 Presumptive Payment Adjustment

8025FADS INITIATED A FULL RECOUP DUE TO WRONG PATIENT LIABILITY AMOUNT. A7 Presumptive Payment Adjustment

8026FADS INITIATED A FULL RECOUP DUE TO PAYMENT IN FULL FROM ANOTHER INSURANCE. A7 Presumptive Payment Adjustment

8027FADS INITIATED A FULL RECOUP DUE TO PAYMENT IN FULL FROM MEDICARE. A7 Presumptive Payment Adjustment

8028FADS INITIATED A FULL RECOUP DUE TO WRONG DATE(S) OF SERVICE. A7 Presumptive Payment Adjustment

8030PROVIDER REQUESTED OVERPAYMENT ADJUSTMENT DUE TO BILLING ERROR. A7 Presumptive Payment Adjustment

8031PROVIDER REQUESTED OVERPAYMENT ADJUSTMENT DUE TO OTHER INSURANCE. A7 Presumptive Payment Adjustment

8032PROVIDER REQUESTED OVERPAYMENT ADJUSTMENT DUE TO MEDICARE. A7 Presumptive Payment Adjustment

8033PROVIDER REQUESTED OVERPAYMENT ADJUSTMENT DUE TO PATIENT LIABILITY. A7 Presumptive Payment Adjustment

8034KMAP REQUESTED OVERPAYMENT ADJUSTMENT DUE TO SPENDDOWN. A7 Presumptive Payment Adjustment

8035PROVIDER REQUESTED ADJUSTMENT DUE TO AUTO LIABILITY. A7 Presumptive Payment Adjustment

8036PROVIDER REQUESTED ADJUSTMENT DUE TO WORKERS COMP. A7 Presumptive Payment Adjustment

8037PROVIDER REQUESTED FULL RECOUP DUE TO BILLING ERROR. A7 Presumptive Payment Adjustment





8038PROVIDER REQUESTED OVERPAYMENT ADJUSTMENT DUE TO MISCELLANEOUS ERROR. A7 Presumptive Payment Adjustment

8039PROVIDER REQUESTED OVERPAYMENT ADJUSTMENT DUE TO RESERVE DAYS A7 Presumptive Payment Adjustment N9

Adjustment represents the estimated amount the primary payer may have paid.

8040 KFMC REQUESTED ADMISSION DENIAL A7 Presumptive Payment Adjustment8041 KFMC REQUESTED BILLING ERROR A7 Presumptive Payment Adjustment8042 KFMC REQUESTED DRG REVISION A7 Presumptive Payment Adjustment

8043KFMC REQUESTED CHARGES AND/OR DAYS DENIED A7 Presumptive Payment Adjustment

8044KFMC REQUESTED DRG REVISION WITH CHARGES AND/OR DAYS DENIED A7 Presumptive Payment Adjustment

8045 KFMC REQUESTED ADJUSTMENT. A7 Presumptive Payment Adjustment N10


8046 KFMC REQUESTED OTHER ADJUSTMENT. A7 Presumptive Payment Adjustment8047 KFMC REQUESTED FULL RECOUPMENT. A7 Presumptive Payment Adjustment8048 KFMC REQUESTED TECHNICAL DENIAL A7 Presumptive Payment Adjustment

8050PROVIDER REQUESTED ADJUSTMENT OF DATE OF SERVICE A7 Presumptive Payment Adjustment N14


8059PROVIDER SENT A FULL REFUND DUE TO MISCELLANEOUS OR UNSPECIFIED ERROR. A7 Presumptive Payment Adjustment

8060PROVIDER SENT REFUND DUE TO BILLING ERROR. A7 Presumptive Payment Adjustment

8061PROVIDER SENT REFUND DUE TO CLAIMS PROCESSING ERROR. A7 Presumptive Payment Adjustment

8062PROVIDER SENT REFUND DUE TO DUPLICATE PAYMENT. A7 Presumptive Payment Adjustment

8063PROVIDER SENT REFUND DUE TO EFT DEPOSIT ERROR. A7 Presumptive Payment Adjustment

8064 PROVIDER SENT REFUND DUE TO MEDICARE. A7 Presumptive Payment Adjustment8065 PROVIDER SENT REFUND DUE TO KFMC REVIEW. A7 Presumptive Payment Adjustment

8066PROVIDER SENT REFUND DUE TO OTHER INSURANCE. A7 Presumptive Payment Adjustment

8067 PROVIDER SENT REFUND DUE TO FADS REVIEW. A7 Presumptive Payment Adjustment

8068PROVIDER SENT REFUND PAYMENT DUE TO FADS REVIEW. A7 Presumptive Payment Adjustment

8069PROVIDER SENT REFUND DUE TO LEGAL SETTLEMENT. A7 Presumptive Payment Adjustment

8070PROVIDER SENT REFUND DUE TO MEDICAID FRAUD. A7 Presumptive Payment Adjustment

8071PROVIDER SENT REFUND PAYMENT DUE TO MEDICAID FRAUD. A7 Presumptive Payment Adjustment

8072 PROVIDER SENT REFUND DUE TO AUTO LIABILITY. A7 Presumptive Payment Adjustment

8073PROVIDER SENT REFUND DUE TO WORKERS COMP. A7 Presumptive Payment Adjustment





8074PROVIDER SENT REFUND FOR CLAIM NOT IN HISTORY. A7 Presumptive Payment Adjustment

8075PROVIDER SENT REFUND DUE TO MISCELLANEOUS OR UNSPECIFIED ERROR. A7 Presumptive Payment Adjustment

8082NON-CLAIM SPECIFIC REFUND DUE TO BILLING ERROR. A7 Presumptive Payment Adjustment

8083NON-CLAIM SPECIFIC REFUND DUE TO OTHER INSURANCE. A7 Presumptive Payment Adjustment

8084 NON-CLAIM SPECIFIC REFUND DUE TO FADS. A7 Presumptive Payment Adjustment

8085NON-CLAIM SPECIFIC REFUND DUE TO MISC OR UNSPECIFIED ERROR. A7 Presumptive Payment Adjustment

8090KMAP REQUESTED FULL RECOUP DUE TO ACCOUNTS RECEIVABLE. A7 Presumptive Payment Adjustment

8091KMAP REQUESTED FULL RECOUP DUE TO AUDIT DIVISION REVIEW. A7 Presumptive Payment Adjustment

8092KMAP REQUESTED FULL RECOUP DUE TO BILLING ERROR. A7 Presumptive Payment Adjustment

8093KMAP REQUESTED FULL RECOUP DUE TO CLAIMS PROCESSING ERROR. A7 Presumptive Payment Adjustment

8094KMAP REQUESTED FULL RECOUP DUE TO WRONG PROVIDER PAID/EFT ERROR. A7 Presumptive Payment Adjustment

8095KMAP REQUESTED FULL RECOUP DUE TO MEDICARE. A7 Presumptive Payment Adjustment

8096 KMAP REQUESTED FULL RECOUP DUE TO KFMC A7 Presumptive Payment Adjustment

8097KMAP REQUESTED FULL RECOUP DUE TO OTHER INSURANCE. A7 Presumptive Payment Adjustment

8098KMAP REQUESTED FULL RECOUP DUE TO FADS REVIEW. A7 Presumptive Payment Adjustment

8099KMAP REQUESTED FULL RECOUP DUE TO LEGAL SETTLEMENT. A7 Presumptive Payment Adjustment

8100KMAP REQUESTED FULL RECOUP DUE TO MEDICAID FRAUD. A7 Presumptive Payment Adjustment

8101KMAP REQUESTED FULL RECOUP DUE TO MANAGED CARE. A7 Presumptive Payment Adjustment

8110KMAP INITIATED ADJUSTMENT DUE TO AUDIT DIVISION REVIEW A7 Presumptive Payment Adjustment

8111KMAP INITIATED ADJUSTMENT DUE TO CALL CENTER A7 Presumptive Payment Adjustment

8112KMAP INITIATED ADJUSTMENT DUE TO CLAIMS RESOLUTION A7 Presumptive Payment Adjustment

8113KMAP INITIATED ADJUSTMENT DUE TO COST SETTLEMENT ADJUSTMENT A7 Presumptive Payment Adjustment

8116 KMAP INITIATED ADJUSTMENT DUE TO SRS. A7 Presumptive Payment Adjustment8118 KMAP INITIATED ADJUSTMENT DUE TO KDOA A7 Presumptive Payment Adjustment

8119KMAP INITIATED ADJUSTMENT DUE TO DISPROPORTIONATE SHARE ADJUSMENT A7 Presumptive Payment Adjustment

8123KMAP INITIATED ADJUSTMENT DUE TO JUVENILE JUSTICE AUTHORITY. A7 Presumptive Payment Adjustment





8124KMAP INITIATED ADJUSTMENT DUE TO KEYING ERROR A7 Presumptive Payment Adjustment

8125KMAP INITIATED ADJUSTMENT DUE TO LEGAL SETTLEMENT. A7 Presumptive Payment Adjustment

8128 KMAP INITIATED ADJUSTMENT DUE TO MEDICARE A7 Presumptive Payment Adjustment

8129KMAP INITIATED ADJUSTMENT DUE TO KFMC REVIEW. A7 Presumptive Payment Adjustment

8130KMAP INITIATED ADJUSTMENT DUE TO PHARMACY REVIEW A7 Presumptive Payment Adjustment

8131KMAP INITIATED ADJUSTMENT DUE TO PROCESSING ERROR A7 Presumptive Payment Adjustment

8132KMAP INITIATED ADJUSTMENT DUE TO SURS REVIEW. A7 Presumptive Payment Adjustment

8133KMAP INITIATED ADJUSTMENT DUE TO WRONG PROVIDER PAID A7 Presumptive Payment Adjustment

8134KMAP INITIATED ADJUSTMENT DUE TO MISCELLANEOUS ERROR A7 Presumptive Payment Adjustment

8135KMAP INITIATED ADJUSTMENT DUE TO RATE CHANGE. A7 Presumptive Payment Adjustment

8136KMAP INITIATED ADJUSTMENT DUE TO OTHER INSURANCE A7 Presumptive Payment Adjustment

8139KMAP INITIATED ADJUSTMENT DUE TO MANAGED CARE. A7 Presumptive Payment Adjustment

8150KMAP INITIATED ADDITIONAL PAYMENT DUE TO CALL CENTER A7 Presumptive Payment Adjustment

8151KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO CLAIMS RESOLUTION A7 Presumptive Payment Adjustment

8152KMAP INITIATED UNDERPAYMENT PAYMENT DUE TO SRS/CFP A7 Presumptive Payment Adjustment

8153KMAP INITIATED ADDITIONAL PAYMENT DUE TO DHS/SRS. A7 Presumptive Payment Adjustment

8154KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO DISPROPORTIONATE SHARE A7 Presumptive Payment Adjustment

8155KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO AUDIT DIVISION REVIEW. A7 Presumptive Payment Adjustment

8156KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO JUVENILE JUSTICE AUTHORITY. A7 Presumptive Payment Adjustment

8157KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO KEYING ERROR A7 Presumptive Payment Adjustment

8158KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO FADS REVIEW. A7 Presumptive Payment Adjustment

8159KMAP INITIATED ADJUSTMENT DUE TO PRIOR AUTHORIZATION. A7 Presumptive Payment Adjustment

8160KMAP INITIATED ADDITIONAL PAYMENT DUE TO MEDICARE A7 Presumptive Payment Adjustment

8161KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO OTHER INSURANCE A7 Presumptive Payment Adjustment





8162KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO PATIENT LIABILITY. A7 Presumptive Payment Adjustment

8163KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO PROCESSING ERROR A7 Presumptive Payment Adjustment

8164KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO RATE CHANGE A7 Presumptive Payment Adjustment

8165KMAP INITIATED UNDERPAYMENT ADJUSTMENT DUE TO MISCELLANEOUS ERROR A7 Presumptive Payment Adjustment

8166KMA INITIATED UNDERPAYMENT ADJUSTMENT DUE TO MANAGED CARE. A7 Presumptive Payment Adjustment

8167KMAP INITIATED ADJUSTMENT DUE TO MEDICAID FRAUD. A7 Presumptive Payment Adjustment

8179 SAVE FOR FUTURE USE A7 Presumptive Payment Adjustment

8181KMAP INITIATED ADJUSTMENT DUE TO DRUG REBATE. A7 Presumptive Payment Adjustment

8185MASS ADJUSTMENT - RETROACTIVE RATE CHANGE. A7 Presumptive Payment Adjustment

8187 MISC. OTHER MASS ADJUSTMENT. A7 Presumptive Payment Adjustment8188 VOID TRANSACTIONS - MASS ADJUSTMENT A7 Presumptive Payment Adjustment

8189MASS ADJUSTMENT - VOID TRANSACTIONS - REFUND RECEIVED. A7 Presumptive Payment Adjustment

8190MASS ADJUSTMENT - VOID TRANSACTIONS - WARRANT CANCELLED A7 Presumptive Payment Adjustment

8191MASS ADJUSTMENT - VOID TRANSACTIONS OTHER REQUEST A7 Presumptive Payment Adjustment

8199 SAVE FOR FUTURE USE. A7 Presumptive Payment Adjustment8200 TPL PRIVATE HEALTH INSURANCE - CARRIER A7 Presumptive Payment Adjustment

8241ADJUSTMENT GENERATED DUE TO CHANGE IN PATIENT LIABILITY A7 Presumptive Payment Adjustment

8246 POINT OF SALE REVERSAL A7 Presumptive Payment Adjustment

8300

A PAYOUT HAS BEEN ESTABLISHED FOR THE PROVIDER. THE REIMBURSEMENT IS INCLUDED IN THE CHECKWRITE A7 Presumptive Payment Adjustment

8301

A PAYOUT HAS BEEN ESTABLISHED FOR THE PROVIDER. THE REIMBURSEMENT HAS BEEN EXC LUDED FROM THE CHECKWRITE. A7 Presumptive Payment Adjustment

8302

A PAYOUT IS DUE TO THE PROVIDER AS A RESULT OF OVER REFUND. THE REIMBURSEMENT IS INCLUDED IN THE CHECKWRITE. A7 Presumptive Payment Adjustment

8303

A PAYOUT IS DUE TO THE PROVIDER AS A RESULT OF OVER PAYMENT. THE REIMBURSEMENT HAS BEEN INCLUDED IN THE CHECKWRITE. A7 Presumptive Payment Adjustment

8306

CHECK RECEIVED BY EDS FOR CLAIM ADJUSTMENT ON A PREVIOUSLY ADJUSTED CLAIM. AMO UNT OF REFUND BEING RETURNED TO PROVIDER. A7 Presumptive Payment Adjustment





8308PAYOUT DUE TO HOSPITAL SUPPLEMENTAL GME ADJUSTMENT A7 Presumptive Payment Adjustment

8426

AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO DISPROPORTIONATE SHARE ADJUS TMENT. A7 Presumptive Payment Adjustment

8427AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO DRUG REBATE.. A7 Presumptive Payment Adjustment

8428

AS THE RESULT OF A FINANCIAL MANAGEMENT REVIEW, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. A7 Presumptive Payment Adjustment

8429

AS THE RESULT OF A LEGAL SETTLEMENT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHE D. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. A7 Presumptive Payment Adjustment

8430

AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO LONG TERM CARE FACILITY CLAI M PROCESSING ERROR. A7 Presumptive Payment Adjustment

8431

AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO MANAGED CARE ADJUSTMENTS. A7 Presumptive Payment Adjustment

8432AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO MEDICAID FRAUD. A7 Presumptive Payment Adjustment

8433

AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO SRS MEDICAL DIVISION REVIEW A7 Presumptive Payment Adjustment

8434

AS THE RESULT OF AN KFMC REVIEW, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. T HE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. A7 Presumptive Payment Adjustment

8435AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO PATIENT LIABILITY ERROR. A7 Presumptive Payment Adjustment

8436

AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO PATIENT SPENDDOWN ERROR. A7 Presumptive Payment Adjustment

8437

AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO SRS PHARMACY DIVISION REVIEW . A7 Presumptive Payment Adjustment

8438

AS THE RESULT OF A FADS AUDIT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. A7 Presumptive Payment Adjustment

8439AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO THIRD PARTY LIABILITY. A7 Presumptive Payment Adjustment

8450

DUE TO A TRANSFER OF ACCOUNT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. A7 Presumptive Payment Adjustment





8451

DUE TO AN ADJUSTMENT SUBMITTED BY PROVIDER FOR A CLAIM TOO OLD TO PROCESS, AN A CCOUNT RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR P AYMENTS. A7 Presumptive Payment Adjustment

8452

AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO MISCELLANEOUS OR UNSPECIFIED ERROR. A7 Presumptive Payment Adjustment

8453

THIS ACCOUNTS RECEIVABLE WAS ESTABLISHED FOR THE WRONG AMOUNT. WE HAVE MADE COR RECTION AND INCREASED THIS ACCOUNTS RECEIVABLE. A7 Presumptive Payment Adjustment

8454

THIS ACCOUNTS RECEIVABLE WAS ESTABLISHED FOR THE WRONG AMOUNT. WE HAVE MADE COR RECTION AND DECREASED THIS ACCOUNTS RECEIVABLE. A7 Presumptive Payment Adjustment

8455

THIS ACCOUNTS RECEIVABLE WAS ESTABLISHED FOR THE WRONG PROVIDER. WE HAVE CORREC TED THE ACTION AND DECREASED THIS ACCOUNTS RECEIVABLE. A7 Presumptive Payment Adjustment

8456A CASH RECEIPT WAS APPLIED TO AND DECREASED THIS ACCOUNTS RECEIVABLE. A7 Presumptive Payment Adjustment

8457AN OVER REFUND HAS BEEN APPLIED AND DECREASED THIS ACCOUNTS RECEIVABLE A7 Presumptive Payment Adjustment

8458A STOP PAYMENT CHECK WAS APPLIED AND DECREASED THIS ACCOUNTS RECEIVABLE. A7 Presumptive Payment Adjustment

8459THIS ACCOUNTS RECEIVABLE HAS BEEN INCREASED DUE TO FINANCIAL DIVISION REVIEW. A7 Presumptive Payment Adjustment

8460THIS ACCOUNTS RECEIVABLE HAS BEEN DECREASED DUE TO FINANCIAL DIVISION REVIEW A7 Presumptive Payment Adjustment

8461THIS ACCOUNTS RECEIVABLE HAS BEEN INCREASED DUE TO AUDIT DIVISION REVIEW. A7 Presumptive Payment Adjustment

8462THIS ACCOUNTS RECEIVABLE HAS BEEN DECREASED DUE TO AUDIT DIVISION REVIEW. A7 Presumptive Payment Adjustment

8463THIS ACCOUNTS RECEIVABLE HAS BEEN INCREASED DUE TO FADS REVIEW. A7 Presumptive Payment Adjustment

8464THIS ACCOUNTS RECEIVABLE HAS BEEN DECREASED DUE TO FADS REVIEW. A7 Presumptive Payment Adjustment

8465THIS ACCOUNTS RECEIVABLE HAS BEEN INCREASED DUE TO INTEREST BEING APPLIED. A7 Presumptive Payment Adjustment

8466THIS ACCOUNTS RECEIVABLE HAS BEEN DECREASED BY A MISCELLANEOUS ACTION A7 Presumptive Payment Adjustment

8467THIS ACCOUNTS RECEIVABLE HAS BEEN INCREASED BY A MISCELLANEOUS ACTION. A7 Presumptive Payment Adjustment

8468THIS ACCOUNTS RECEIVABLE HAS BEEN WRITTEN OFF. A7 Presumptive Payment Adjustment





8469THIS ACCOUNTS RECEIVABLE WAS DECREASED BY A CLAIM OFFSET. A7 Presumptive Payment Adjustment

312

Denied. Please verify primary diagnosis coding. A more specific primary diagn osis must be utilized for accurate DRG assignment. A8 Claim denied; ungroupable DRG

374

Denied. The DRG code assigned to the diagnosis code you have indicated on your claim form is not a covered DRG code. A8 Claim denied; ungroupable DRG

375

Denied. DRG code 999 is a non-assigned DRG code which indicates incorrect or i ncomplete information. Please check your claim and coding information and resu bmit the claim. A8 Claim denied; ungroupable DRG

1422PROVIDER DOES NOT HAVE A VALID DRG RATE FOR THE DATES OF SERVICE. A8 Claim denied; ungroupable DRG N144 The rate changed during the dates of service billed.

1007

Denied. Exceeds program limitations. Antepartum care has already been paid in history. Please verify coding and charges. B13

Previously paid. Payment for this claim/service may have been provided in a previous payment.

1008

Denied. Exceeds program limitations. Postpartum care has already been paid in history. Please verify coding and charges. B13


1175Denied. An adjustment/credit has previously been applied to this claim. B13


458

Denied. All or a portion of the services billed exceed program limitations. O nly one Consultation is allowed per day. B14

Payment denied because only one visit or consultation per physician per day is covered. M63


608

DENIED. PROGRAM LIMITATIONS DO NOT ALLOW PAYMENT TO TWO DIFFERENT PSYCHOLOGIST S ON THE SAME DATE OF SERVICE FOR THE SAME CONSUMER. PLEASE VERIFY YOUR DATES OF SERVICE. REFER TO YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B14

Payment denied because only one visit or consultation per physician per day is covered. M20 Missing/incomplete/invalid HCPCS.

24Claim denied, services are included in your per diem rate. B15

Payment adjusted because this procedure/service is not paid separately.

70This service is part of another procedure and not paid separately. B15


103Denied. A component part cannot be billed on the same day as a KAN Be Healthy Hearing screen. B15


204

Denied, content of another service performed. This service is included in the Total Spectacle Dispensing fee. B15


210Denied. This service is part of another procedure and not paid separately. B15


1131

DENIED. THE COMPLETE BLOOD COUNT (CBC) COMPONENT PART(S) BILLED ON THIS CLAIM OR IN HISTORY ARE PART OF ANOTHER CBC PROCEDURE CODE. B15






1148

CLAIM/SERVICE HAS BEEN DENIED/REDUCED DUE TO AN OFFICE VISIT PROCEDURE CODE, WH ICH IS CONTENT OF SERVICE OF THE INJECTION, BEING REIMBURSED PREVIOUSLY. B15

Payment adjusted because this procedure/service is not paid separately. M14

No separate payment for an injection administered during an office visit, and no payment for a full office visit if the patient only received an injection.

1149

Claim/service has been denied/reduced due to an office visit procedure code, wh ich is content of service of the preventative medicine evaluation, being reimbu rsed previously. B15

Payment adjusted because this procedure/service is not paid separately. N20


1153

Claim/service has been denied/reduced due to a hospital inpatient service proce dure code, which is content of service of the emergency department visit, being reimbursed previously. B15

Payment adjusted because this procedure/service is not paid separately. N20


33 Prescription number invalid/missing. B17

Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current.

614

DENIED. ACCORDING TO STATE LAW AND REGULATIONS, PRESCRIPTIONS FOR SCHEDULE II DRUGS CANNOT BE REFILLED. CHARGES DENIED FOR THIS REASON CANNOT BE BILLED TO THE BENEFICIARY. B17

Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current.

116

Denied. The description and/or documentation does not match the procedure code on your claim. Please verify the service provided and correct the procedure c ode and/or description to reflect the service accurately. Resubmit the claim w ith all attachments and corrections. Refer to the CPT manual and/or your provi der manual to determine the correct code. B18

Payment denied because this procedure code/modifier was invalid on the date of service or claim submission. N56


154

ONLY PROCEDURE/REVENUE CODES SPECIFIED IN YOUR KANSAS MEDICAL ASSISTANCE PROGRA M PROVIDER MANUAL ARE REIMBURSABLE. B18

Payment denied because this procedure code/modifier was invalid on the date of service or claim submission.

156

DENIED. DIAGNOSIS CODE IS MISSING, INVALID, ILLEGIBLE, OR NOT ACCEPTED BY THE KANSAS MEDICAL ASSISTANCE PROGRAM. PLEASE RESUBMIT WITH THE APPROPRIATE DIAG NOSIS CODE. B18

Payment denied because this procedure code/modifier was invalid on the date of service or claim submission. M76 Missing/incomplete/invalid diagnosis or condition.

405

DENIED. PROCEDURE CODE MISSING OR INVALID. REFER TO APPENDIX I OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL FOR THE LIST OF PROCEDURE CODES THA T MUST BE UTILIZED FOR ALL DENTAL BILLINGS. PLEASE CORRECT YOUR CODING AND RES UBMIT. B18

Payment denied because this procedure code/modifier was invalid on the date of service or claim submission. M51 Missing/incomplete/invalid procedure code(s).





461

DENIED. PROCEDURE CODE MISSING OR INVALID. CPT AND HCPCS MUST BE UTILIZED. COR RECT YOUR CODING AND RESUBMIT IF APPROPRIATE. CPT CODES BILLED BY AN ORAL SURGE ON MUST BE BILLED ON THE HCFA 1500 CLAIM FORM. B18

Payment denied because this procedure code/modifier was invalid on the date of service or claim submission.

463

DETAIL DENIED. THE MODIFIER YOU HAVE UTILIZED IS NOT ACCEPTABLE FOR PROCESSING BY THE KANSAS MEDICAL ASSISTANCE PROGRAM. B18

Payment denied because this procedure code/modifier was invalid on the date of service or claim submission. M78 Missing/incomplete/invalid HCPCS modifier.

1412 DENIED. E-CODE IS INVALID. B18Payment denied because this procedure code/modifier was invalid on the date of service or claim submission. M51 Missing/incomplete/invalid procedure code(s).

1415DENIED, INCOMPLETE FOR PROCESSING. PROCEDURE TYPE MISSING OR INVALID. B18

Payment denied because this procedure code/modifier was invalid on the date of service or claim submission. M20 Missing/incomplete/invalid HCPCS.

13

Denied. ACCL-LPN care, ACCL-Skilled Nursing Service and/or ACCL-Attendant Care are not allowed on the same date of service as ACCL-Daily Rate. B20

Payment adjusted because procedure/service was partially or fully furnished by another provider. M63


617

DENIED. PROGRAM LIMITATIONS DO NOT ALLOW PAYMENT TO TWO DIFFERENT PSYCHIATRIST S ON THE SAME DATE OF SERVICE FOR THE SAME BENEFICIARY. PLEASE VERIFY YOUR DAT ES OF SERVICE. REFER TO YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL . B20

Payment adjusted because procedure/service was partially or fully furnished by another provider. M63


712Denied. Payment has been made to another adult care home for the date(s) of se rvice billed. B20

Payment adjusted because procedure/service was partially or fully furnished by another provider.

1014

Denied. Our records indicate one or more of the dates of service on your claim have been paid to another hospital. Please verify dates of service and resubm it with admission records and discharge summary. B20

Payment adjusted because procedure/service was partially or fully furnished by another provider. N47 Claim conflicts with another inpatient stay.

1226

Denied. Payment has been made to another Adult Care Home for a portion of the date(s) of service billed. Please verify date(s) of service and resubmit with the date(s) of service the beneficiary was in your facility. B20

Payment adjusted because procedure/service was partially or fully furnished by another provider.

197DENIED. SERVICES BILLED FOR THE DIAGNOSIS INDICATED ARE NONCOVERED. B22 This payment is adjused based on the diagnosis.

198DENIED. SERVICES BILLED FOR DEVELOPMENTAL DELAY DIAGNOSIS ARE NONCOVERED. B22 This payment is adjused based on the diagnosis.

596Denied. Services billed for Infertility diagnosis codes are noncovered. B22 This payment is adjused based on the diagnosis.





19

ONLY ONE EMERGENCY RENAL DIALYSIS SESSION (REVENUE CODE 809) IS ALLOWED PER 18 MONTHS. REFER TO BILLING INSTRUCTIONS IN SECTION 7020 OF YOUR KANSAS MEDICAL A SSISTANCE PROGRAM PROVIDER MANUAL. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. M86

Service denied because payment already made for same/similar procedure within set time frame.

27

THIS CLAIM INDICATES A PREGNANCY RELATED DIAGNOSIS AND WAS ROUTED TO SRS TO UPD ATE THE ELIGIBILITY FILES FROM KANSAS MEDICAL ASSISTANCE PROGRAM FOR THE DATE S PAN IN WHICH THE BENEFICIARY WAS PREGNANT. YOUR CLAIM WILL BE REPROCESSED ONCE THE ELIGIBILITY FILES HAVE BEEN UPDATED. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded.

78Adjustment resulted in reduced payment. Accounts receivable set up for residua l. B5


81Processing of returned state warrant completed. 1099's adjusted accordingly. B5


84We have adjusted this claim to reconcile an overpayment made to you. B5


85Thank you for your refund. Your 1099's have been adjusted accordingly. B5


86Advance payment, will be deducted from subsequent payment. B5


89Detail denied. Independent Lab provider not certified by Medicare for the proc edure billed. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. MA120 Missing/incomplete/invalid CLIA certification number.

98

This amount has been applied to an outstanding accounts receivable. (This amou nt is a negative dollar amount and is being deducted from other claims paid on this Remittance Advice.) B5


132Denied, please break out anesthesia charges and minutes for sterilization proce dure and resubmit. B5


141

Denied, incomplete for processing. Accident date is after "Thru" date of servi ce or is invalid. Please resubmit with correct dates. Review entire claim for completeness. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N305 Missing/incomplete/invalid accident date.

142 Denied. Non-covered service for QMB only consumers. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

147

THE PROVIDER NUMBER INDICATED IN FORM LOCATORS 82 AND/OR 83 OF THE UB92 HOSPITA L CLAIM FORM OR FIELDS 'PHY PRVDR NO' AND/OR 'OTHR PVDR NO' ON ELECTRONIC CLAIM S IS A GROUP # RATHER THAN AN INDIVIDUAL'S PROVIDER #. THE INDIVIDUAL PROVIDER # IS REQUIRED IN THESE FIELDS. IN THE FUTURE YOUR CLAIMS MAY BE DENIED. REFE R TO YOUR JANUARY 1991 HOSPITAL BULLETIN, VOLUME 9101 FOR MORE INFORMATION. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N32






166

DETAIL DENIED. REFERENCE SECTION 7010 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRA M PROVIDER MANUAL REGARDING ANESTHESIA. B5


177

NON-EMERGENT MEDICAL TRANSPORTATION PROCEDURES ARE NOT COVERED FOR RESIDENTS OF ADULT CARE HOMES. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N157 Transportation to/from this destination is not covered.

178

CLAIM REIMBURSED AT A SPECIAL RATE FOR PEDIATRIC PATIENTS UNDER AGE 18 ON THE D ATE OF SERVICE. B5


191

CLAIM DENIED. PRE-NATAL VITAMINS ARE COVERED ONLY WHEN PRESCRIBED FOR PREGNANC Y RELATED CONDITIONS. REFER TO SECTION 7000 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PHARMACY PROVIDER MANUAL. B5


211Denied. This service has been reviewed and determined to be non-covered. B5


221Program limitations do not allow coverage for incidental appendectomies. B5


237

DENIED. FAMILY/INDIVIDUAL SUPPORTS (W1385) MAY NOT BE BILLED WITH SUPPORTIVE H OME CARE (Y9524), OVERNIGHT RESPITE (Y9530), TEMPORARY RESPITE (Y9531), EMERGEN CY RESPITE (Y9532), OR NIGHT SUPPORT (Y9561). REFER TO SECTION 8400 OF YOUR KM AP MR/DD FAMILY/INDIVIDUAL SUPPORTS PROVIDER MANUAL. B5



239

DENIED. THE MS-2001 IS MISSING OR INCOMPLETE. PLEASE RESUBMIT A COMPLETED MS-20 01 WITH NEXT MONTH'S BILLING. B5


270Hearing Aid Medical Necessity Document required, form not present. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. M60 Missing Certificate of Medical Necessity.

271

Denied, incomplete for processing. Signature of provider is missing on the Hea ring Aid Medical Necessity Document. Review entire Hearing Aid Medical Necessi ty Document for completeness and resubmit appropriately. B5


290

Denied. State guidelines will not allow payment of Manipulations on the same d ate of service as an Office Visit. B5







292

DENIED. OUTPATIENT PSYCHOTHERAPY AND PARTIAL HOSPITALIZATION ACTIVITY AND/OR T ARGETED CASE MANAGEMENT ARE NOT ALLOWED ON THE SAME DATE OF SERVICE UNLESS A PR IOR AUTHORIZATION FORM IS PRESENT AND/OR THE BENEFICIARY IS IN THE KAN BE HEALT HY (EPSDT) PROGRAM. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PR OGRAM PROVIDER MANUAL. B5



294

THIS CLAIM IS AN UNDERPAYMENT ADJUSTMENT OF A PREVIOUSLY BILLED CLAIM FOR THE B ENEFICIARY AND DATE OF SERVICE LISTED. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. MA67 Correction to a prior claim.

295

DETAIL DENIED. ONLY ONE MODALITY ALLOWED PER VISIT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5



305

DENIED. WHEN MORE THAN ONE DATE OF SERVICE IS BILLED FOR AN OUTPATIENT CLAIM, THE SPECIFIC DATES OF SERVICE MUST BE INDICATED IN THE REMARKS FIELD OF THE CLA IM. REFER TO SECTION 7000 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER M ANUAL. B5


314

The sum of the detail's total charges (covered/noncovered) and claim's total ch arges (covered/noncovered) do not equal. Please correct charges and resubmit e lectronically. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. M54 Missing/incomplete/invalid total charges.

339

DENIED. ACIL-DAILY RATE AND HCBS MEDICAL ATTENDANT ARE NOT ALLOWED WHEN BILLED ON THE SAME DATE OF SERVICE. B5



348

DENIED. INCOMPLETE FOR PROCESSING. PLEASE RESUBMIT USING TOOTH NUMBERS OR LETT ERS AS THEY APPEAR ON THE KANSAS MEDICAL ASSISTANCE PROGRAM CLAIM FORM. REVIEW ENTIRE CLAIM FOR COMPLETENESS. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N37 Missing/incomplete/invalid tooth number/letter.

350

DENIED, EXCEEDS PROGRAM LIMITATIONS. ONLY 1 CONSULTATION ALLOWED PER DAY BY TH E SAME DENTAL PROVIDER TO THE SAME BENEFICIARY. B5



352

Denied, incomplete for processing. Please resubmit dental claim with the corre ct number of surfaces. Please indicate surfaces. Review entire claim for comp leteness. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N75 Missing or invalid tooth surface information

353 Dental services denied. Please resubmit with X-rays. B5Payment adjusted because coverage/program guidelines were not met or were exceeded. M129

Missing/incomplete/invalid indicator of x-ray availability for review.





357

DETAIL DENIED. THIS DRUG/PROCEDURE REQUIRES THE BENEFICIARY TO BE A PARTICIPAN T IN THE KAN BE HEALTHY PROGRAM. ADDITIONAL SERVICES ARE ALLOWED ONLY WHEN A K AN BE HEALTHY SCREEN CAN BE VERIFIED BY EDS FOR BENEFICIARIES WHOSE AGE IS 20 Y EARS OR LESS. DRUGS/PROCEDURES THAT REQUIRE KAN BE HEALTHY PARTICIPATION ARE N OT COVERED FOR BENEFICIARIES AGE 21 YEARS AND OLDER. B5


The necessary components of the child and teen checkup (EPSDT) were not completed.

371

A claim Correction form was previously sent for the following claim. No correc tions have been received. Claim processed with the original data submitted. B5


372

DENIED. SERVICES REIMBURSED AT THE FEDERAL FINANCIAL PARTICIPATION (FFP) ONLY RATE MUST BE SUBMITTED ON A SEPARATE CLAIM FORM FROM ALL OTHER LOCAL HEALTH DE PARTMENT SERVICES. REFER TO SECTION 8420 OF THE KANSAS MEDICAL ASSISTANCE PROG RAM PROVIDER MANUAL. B5


384Detail denied. Therapeutic pulpotomy (excluding final restoration) is covered for deciduous teeth only. B5


387

Claim not allowed. This claim is part of an interim has been made on previous claim and no outlier limitations have been exceeded on current claim. B5


388

Denied. Utilization Review has reviewed and determined no payment will be made on this claim. Refer to your letter from Utilization Review. B5



389

Claim reimbursed at maximum allowable. This is the discharge claim of an inter im billing. Reimbursement of this claim reflects any corrections or denied ser vices identified by Utilization Review during the review of the entire interim billing. Refer to your letter from Utilization Review for specific information . B5



392

We have reviewed your adjustment request and corrected your claim accordingly, however, these corrections will not affect the original payment made on this cl aim. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. MA67 Correction to a prior claim.

415

DENIED. CAPPED RENTAL SERVICES MUST BE ALLOWED BY MEDICARE IN ORDER FOR THE KA NSAS MEDICAL ASSISTANCE PROGRAM TO MAKE PAYMENT. B5






416

DENIED. SERVICE MUST BE ALLOWED BY MEDICARE IN ORDER FOR THE KANSAS MEDICAL AS SISTANCE PROGRAM TO MAKE PAYMENT. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N18 Payment based on the Medicare allowed amount.

419

Payment reduced/denied, exceeds program limitations. Psychotherapy not allowed on the same date of service by both a psychiatrist and a psychologist. B5



424

Denied, incomplete for processing. A date has been indicated in the Accident D ate field, 14. If this service is related to an accident, please resubmit and indicate type of accident in the Condition Related To field, 10. If no acciden t was involved, leave both fields blank. Review entire claim for completeness. B5


425

Denied, incomplete for processing. When the Condition Related To field, 10, in dicates a type of accident, the Accident Date field, 14, on the HCFA 1500 claim form must be completed in MM/DD/YY format. Date of accident must be indicated on dental claims when yes is indicated in fields 9 or 10. If the services bil led do not relate to an accident, leave both fields blank. Review entire claim B5


426

DETAIL DENIED, EXCEEDS PROGRAM LIMITATIONS. ONLY ONE ALLERGY EVALUATION ALLOWE D PER YEAR. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PR OVIDER MANUAL. B5


434

Procedure code changed to Standard Admission. State guidelines will not allow payment of a Comprehensive Admission on the same day as an Office Visit. B5



435

PROCEDURE CODE CHANGED TO STANDARD ADMISSION. STATE GUIDELINES WILL NOT ALLOW PAYMENT OF AN INPATIENT COMPREHENSIVE EXAMINATION WITHIN ONE WEEK OF A COMPRE HENSIVE OFFICE VISIT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5



449Denied. Office Visits are not reimbursable when billed on the same day as an O ffice Visit with Manipulation. B5







456

PROCEDURE CODE CHANGED TO STANDARD ADMISSION. STATE GUIDELINES WILL NOT ALLOW PAYMENT OF AN INPATIENT COMPREHENSIVE EXAMINATION ON THE SAME DAY AS AN INTER MEDIATE OR EXTENDED OFFICE VISIT. REFER TO SECTION 8400 OF YOUR KANSAS MEDICA L ASSISTANCE PROGRAM PROVIDER MANUAL. B5



457

DENIED. INITIAL EMERGENCY TREATMENTS AND PRIMARY SURGERY PROCEDURES ARE NOT ALL OWED ON THE SAME DATE OF SERVICE. REIMBURSEMENT IS MADE ACCORDING TO THE HIGHE ST ALLOWED AMOUNT. B5



462Detail denied. Please indicate specific length of each laceration repair. B5


464

NOC (NOT OTHERWISE CLASSIFIED) CODES ARE NON-COVERED. IF AN APPROPRIATE PROCED URE CODE IS NOT AVAILABLE FOR SERVICE PERFORMED, SUBMIT A PRE-DETERMINATION REQ UEST TO EDS. THIS PROCESS IS OUTLINED IN SECTION 4200 OF THE KANSAS MEDICAL AS SISTANCE PROGRAM PROVIDER MANUAL. B5


485

DENIED. STATE GUIDELINES WILL NOT ALLOW PAYMENT OF SUPPORTIVE HOME CARE AND AL SO RESIDENTIAL HABILITATION. REFER TO SECTION 8400 OF THE KANSAS MEDICAL ASSIS TANCE PROGRAM HCBS MR/DD RESIDENTIAL HABILITATION OR THE KANSAS MEDICAL ASSIST ANCE PROGRAM SUPPORTIVE HOME CARE PROVIDER MANUAL. B5


493

DETAIL DENIED. CLAIM IDENTIFIES THESE DAYS AS DAYS THIS BENEFICIARY WAS NOT UN DER YOUR CARE. B5


501

Detail denied. Components of a procedure cannot be split and billed separately . Please refer to the CPT-4 coding manual for a description of the complete pr ocedure. Re-bill the claim with a single charge for the complete procedure. B5


504

DENIED. BENEFICIARY HAS UTILIZED AN APNEA MONITOR LONGER THAN SIX MONTHS. WHE N BILLING FOR A BENEFICIARY'S SEVENTH MONTH OF APNEA MONITOR RENTAL AND BEYOND, ATTACHMENTS DOCUMENTING THE MEDICAL NECESSITY OF CONTINUED MONITORING ARE REQU IRED. REFER TO SECTION 8410 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDE R MANUAL FOR MORE INFORMATION. B5






507

Denied, documentation missing or incomplete for processing. Please attach all required documentation for oxygen therapy including a copy of the valid RX and resubmit. Refer to DME Bulletin 87-1, March 1987 for information required. B5



526

DENIED. RX AND/OR OXYGEN BLOOD LEVELS SUBMITTED WITH THIS CLAIM ARE AFTER THE DATES OF SERVICE OR ARE REPORTED TO BE NOT AVAILABLE. AN RX IS REQUIRED PRIOR TO THE INITIATION OF HOME OXYGEN THERAPY. "NON-ACUTE" OXYGEN BLOOD LEVELS ARE REQUIRED PRIOR TO INITIATION OF HOME OXYGEN THERAPY AND ON AN ANNUAL BASIS THER EAFTER. REFER TO SECTION 8200 OF YOUR KMAP PROVIDER MANUAL B5



529

SERVICES DENIED. SERVICES RENDERED ARE NOT A HOME HEALTH/SKILLED NURSING SERVI CE. TO APPEAL THIS DENIAL, REFER TO INSTRUCTIONS IN SECTION 5300 OF YOUR KANSA S MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


531

THIS CLAIM/SERVICE HAS BEEN REVIEWED BY THE PHYSICIAN MEDICAL NECESSITY ISSUES COMMITTEE AND HAS BEEN DENIED. THE PHYSICIANS DETERMINED THAT THE MEDICAL NECE SSITY IS NOT SUPPORTED BY THE DOCUMENTATION PROVIDED. TO APPEAL THIS DENIAL, R EFER TO INSTRUCTIONS IN SECTION 5300 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5



532

SERVICE DENIED. SERVICES PROVIDED BY A PHYSICAL THERAPY/RESTORATIVE AIDE ARE N OT COVERED. TO APPEAL THIS DENIAL REFER TO INSTRUCTIONS IN SECTION 5300 OF YOU R KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


This provider type/provider specialty may not bill this service.

533

This service has been reviewed and has been determined to be a Skilled Nursing service. Please correct the procedure code to reflect this service and resubmi t. B5


534

Not all services billed on this detail are reimbursable. Please split this lin e and bill by separate dates of service with breakdown of charges and units. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N61 Rebill services on separate claims.





539

Services denied. The Home Apnea Monitoring Equipment has been in use beyond th e projected time length stated on the medical necessity/informational form you submitted earlier. If additional documentation supporting continued monitoring is available, please attach to the claim and resubmit. B5



540

The RX submitted with this claim is not dated or is after the dates of service. An RX is required prior to the initiation of the Home Apnea Monitor. B5


542

DETAIL DENIED. DOCUMENTATION DOES NOT INDICATE DIRECT PHYSICAL ATTENDANCE BY A PHYSICIAN OR PHYSICIAN EXTENDER IN THE EMERGENCY ROOM AND/OR EXAMINATION BY A P HYSICIAN OR PHYSICIAN EXTENDER WITHIN TWO HOURS PRIOR TO ADMISSION TO THE OBSER VATION ROOM. REFER TO SECTIONS 8200 AND 8420 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL FOR MORE INFORMATION. B5



544

This claim and attachments have been reviewed by the medical staff and the leve l of Emergency Room service being billed has been determined to be inappropriat e. The procedure code has been changed to reflect the appropriate level of car e provided. Refer to the Hospital Bulletin, 88-5, October, 1988 for further in formation. B5


550Optical Work Order approved and forwarded to optical manufacturer. B5


551

Denied, the optical materials supplier is either not indicated in block 18 on t he Optical Work Order or the supplier indicated is not an SRS authorized optica l materials supplier. Please correct and resubmit. B5


557

Optical Work Order denied and not forwarded to optical manufacturer because one or more of the OWO details has been denied. Refer to OWO details for specific denial reasons. B5


560Denied. This service is noncovered for Technology Assisted Children's Waiver p articipants. B5


565

DENIED. THIS PROCEDURE IS NOT COVERED WHEN PERFORMED ON THE SAME DAY AS AN EYE EXAMINATION. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM P ROVIDER MANUAL. B5







567

DENIED, EXCEEDS PROGRAM LIMITATIONS. COORDINATION TESTING IS NOT COVERED WHEN PERFORMED ON THE SAME DAY AS AN EYE EXAMINATION. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM VISION PROVIDER MANUAL FOR FURTHER DISCUSSIO N. B5



568

CLAIM REQUIRES ONE OF THE SPECIAL CATEGORIES: 366.50-366.53 OR KAN BE HEALTHY. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM VISION PROVIDER MANUAL FOR MORE INFORMATION. B5


This item or service does not meet the criteria for the category under which it was billed.

569Denied. This service is noncovered for Head Injury Waiver participants. B5


571Denied. This procedure is non-covered when billed by an oral surgeon. B5


578

DETAIL DENIED. CLAIMS SUBMITTED BY CLINICS, ASSOCIATIONS, OR GROUP PRACTICES R EQUIRE THE PERFORMING PROVIDER'S VALID MEDICAID NUMBER TO BE INDICATED IN FIELD 24K OF THE DETAIL ON THE HCFA-1500 CLAIM FORM AND FIELD 12 OF THE DENTAL CLAIM FORM. B5



582

PAYMENT REDUCED. REIMBURSEMENT LIMITED TO THE CHARGE FOR ADMINISTRATION OF IMM UNIZATIONS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PR OVIDER MANUAL. B5


601Drug claim denied. Service rendered after the approved "Thru" date on the Prio r Authorization form. B5


603

Do not report quantities of drugs in fractions, percentages, drops or apothecar y units. Please correct and resubmit using metric quantities (gm's or cc's). B5


612

DENIED. THE NDC BILLED IS EITHER A NON-COVERED SERVICE AND THEREFORE NOT CARRI ED ON THE KMAP DRUG FILE OR IT WAS PREVIOUSLY CARRIED ON THE DRUG FILE BUT HAS BEEN REPLACED WITH A NEW NDC ASSIGNED BY THE MANUFACTURER. IF THE NDC HAS CHA NGED, PLEASE RESUBMIT USING THE MANUFACTURER'S CURRENT NDC. B5



618DENIED. CLAIM ROUTED TO ADULT SERVICES FOR PAYMENT CONSIDERATION. B5






634

The claim and documentation does not support the number of units billed for eme rgency room. When billing for emergency room, 1 unit equals 1 hour direct (con stant) physical attendance by a physician or physician extender. Based on your documentation, the number of units has been reduced to the appropriate number. If further documentation is available to support more than the units allowed, B5



637

CLAIM DENIED. PRIOR AUTHORIZATION FOR THIS PROCEDURE WAS NOT OBTAINED WITHIN T WO WORKING DAYS FROM DATE OF SERVICE. REFER TO SECTION 4300 OF THE GENERAL SPE CIAL REQUIREMENTS PROVIDER MANUAL. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. M62 Missing/incomplete/invalid treatment authorization code.

641

THE MAINTENANCE DRUG BILLED WAS NOT DISPENSED IN THE APPROPRIATE MINIMUM QUANTI TY OF 90 DOSAGE UNITS OR A 30 DAY SUPPLY (WHICHEVER WAS GREATER). AS A RESULT, THE PROFESSIONAL DISPENSING FEE HAS BEEN REDUCED TO $0.00. REFER TO SECTION 8 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PHARMACY PROVIDER MANUAL FOR MORE INFORMATION. B5


644

Only the acute detox part of this inpatient stay is reimbursable. Alcohol and drug rehab is a non-covered inpatient service for Medicaid as of July 1, 1991. Please resubmit claim billing for detox part of stay only. B5


645

Denied. The base code includes the technical and professional components. Ple ase resubmit using the appropriate CPT base code if both technical and professi onal were performed. B5


Rebill technical and professional components separately.

646

DENIED. ONLY TWO SONOGRAM'S ALLOWED PER PREGNANCY WITHOUT PRIOR AUTHORIZATION (PA). IF YOU WERE UNABLE TO OBTAIN PA BECAUSE OF AN EMERGENCY, A COPY OF ALL D OCUMENTATION SUPPORTING THAT EMERGENCY IS REQUIRED TO PROCESS YOUR CLAIM. PLEA SE RESUBMIT YOUR CLAIM WITH THIS DOCUMENTATION. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


647Denied. Your documentation does not reflect that the care provided followed th e plan of care submitted. B5







648

Denied. Multiple home health services are not coordinated to provide the appro priate care for this patient, based on the submitted documentation. B5



649

Denied. Your plan of care and/or nursing documentation does not address change s in the patient's condition, or response to nursing interventions. B5


652

DENIED. THE EMERGENCY ROOM PHYSICIAN FEE IS CONTENT OF THE OBSERVATION ROOM FE E. PLEASE REFER TO SECTION 8200 OF THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVI DER MANUAL. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N19 Procedure code incidental to primary procedure.

701Denied. MS-2150 Form must be present to process Hospital Leave Days. B5


702Denied. Payment for Hospital Leave Days has been denied by SRS on the MS-2150 Form. B5


705

DENIED. OUR RECORDS INDICATE THAT THE PATIENT WAS IN THE HOSPITAL ON ALL OF TH E DATE(S) OR A PORTION OF THE DATE(S) OF SERVICE BILLED. REFER TO SECTION 7030 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM ACH PROVIDER MANUAL. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. MA133

Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.

706

DENIED. YOUR ADULT CARE HOME, ACCORDING TO SRS INFORMATION, IS NOT CERTIFIED TO PROVIDE THE LEVEL OF CARE SHOWN ON YOUR CLAIM FOR THIS RESIDENT. B5


709

Denied. Review reserve days to verify that they fall within the from and thru dates of service and all dates are within the same calendar month. Please corr ect and resubmit. B5


716

State Institution claim denied for one of the following reasons: I. Medical e ligibility code on first date of service is 01= General Assistance adults; 02= Refugees; 04= under 21, no FFP, 06 = 21 thru 64, no FFP; or 09 = General Assist ance emancipated minor. II. Medical eligibility code on first date of service is 03 = under FFP; 05 = 21 thru 64, no FFP; 07 = 65 or over, FFP; or 08 = 65 or B5



720

Detail denied. Emergency Room record or documentation is required to be attach ed when billing this procedure code. This service is not allowed with a Level I emergency code. B5






725

The diagnosis code on your claim has been changed to adjudicate payment. Diagn osis codes Y97.00 and Y98.00 are not acceptable. Refer to General Optical Lab Bulletin 90-2, June 1990, General Physician Bulletin 90-6, June or General Visi on Bulletin 90-4, June 1990. B5


757

Denied, incomplete for processing. Please resubmit with a valid surgery date t hat is prior to the "Thru" date of service and on or after the date of admissio n. B5


760

Denied, Length of Stay is equal to or exceeds the 75th percentile as establishe d by the Professional Activity Study (PAS). A completed Medical Necessity form must be attached if the Length of Stay is equal to or exceeds the 75th percent ile. B5


761

CLAIM DENIED. TYPE OF BILL INDICATES SWINGBED BILLING, BUT THE ACTUAL SERVICES BILLED ARE NOT SWINGBED SERVICES. REFER TO SECTION 7020 OF YOUR KANSAS MEDICA L ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL FOR CORRECT BILLING INSTRUCTIONS. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. MA30 Missing/incomplete/invalid type of bill.

764

Denied. All inpatient stays beginning prior to July 1, 1989 and extending beyo nd June 30, 1989 must be interim billed. B5


768Denied. Total non-covered charge submitted is greater than or equal to the tot al charge submitted. B5


769DENIED. PRO/UR APPROVAL INDICATOR GIVEN IS INVALID/UNACCEPTABLE/NOT PRESENT. B5


777

Denied, incomplete for processing. Please resubmit with valid PRO/UR approval from and thru dates when PRO/UR indicator is a 3 (partial approval). B5


780 Denied. Admission was denied by UR committees. B5Payment adjusted because coverage/program guidelines were not met or were exceeded. N10


788

Denied. All inpatient stays beginning prior to July 1, 1988 and extending beyo nd June 30, 1988 must be interim billed. B5


790

CLAIM DENIED. BABY'S STAY EXCEEDS OR IS NOT EQUAL TO MOTHER'S HOSPITALIZATION. PLEASE REMOVE BABY'S CHARGES FROM THIS CLAIM FORM AND RESUBMIT FOR PROCESSING OF MOTHER'S CHARGES. COMPLETE A SEPARATE CLAIM FORM UTILIZING THE NEWBORN'S B ENEFICIARY ID NUMBER FOR BILLING OF BABY'S SERVICES. B5






794

CLAIM DENIED. THE ADMISSION DATE DOES NOT MATCH THE CERTIFICATION DATA RECORD ON FILE. PLEASE CONTACT YOUR UR CONTRACTOR FOR CORRECTION/VERIFICATION. B5


801

Denied, incomplete for processing. Please resubmit with a valid surgery date t hat is prior to the "Thru"date (form locator 7) of service and after the "From" date. B5


805

Denied. Detail noncovered charge is greater than the detail covered charge. P lease correct all affected claim charge fields and resubmit. B5


806

Denied. Total noncovered charge is greater than the total covered charge. Ple ase correct all affected claim charge fields and resubmit. B5


808

DENIED. OUTPATIENT SERVICES PERFORMED WITHIN 48 HOURS OF ADMISSION TO THE SAME FACILITY FOR THE SAME DIAGNOSIS ARE CONSIDERED CONTENT OF SERVICE OF THE INPAT IENT SERVICES. B5


814

DETAIL DENIED. NOC (NOT OTHERWISE CLASSIFIED) CODES ARE NON-COVERED. REFER TO APPENDIX I OF THE KANSAS MEDICAL ASSISTANCE PROGRAM HOSPITAL PROVIDER MANUAL A ND SECTION 4200. IF THERE IS NO SPECIFIC CODE FOR THE PROCEDURE (S) PERFORMED, FOLLOW THE PRE-DETERMINATION GUIDELINES GIVEN. B5


820

Denied. Outpatient lab charges submitted for processing on and after January 1 , 1986 must be billed on the UB-92 claim form. B5


822

DENIED. SURGICAL PROCEDURE CODE NOT ALLOWED WHEN BILLED BY OUTPATIENT HOSPITAL . PLEASE VERIFY YOUR CODING AND RESUBMIT. (UTILIZE MINOR SURGERY MODIFIER "WC " IF APPLICABLE.) B5


823Denied. Professional component not allowed when billed on a UB-92 claim form. B5


824

DENIED. NON-EMERGENCY SERVICES BILLED OVER A SPAN OF DAYS. TO ENSURE COPAYMEN T IS DEDUCTED CORRECTLY, PLEASE PROVIDE US WITH THE SPECIFIC DATES OF SERVICE O N WHICH PROCEDURES X9003WPOO AND/OR X9004WPOO WERE BILLED IN THE REMARKS SECTIO N (BLOCK 94) OF YOUR CLAIM AND RESUBMIT. B5


900Thank you for your refund. This is as a result of an audit (refer to letter se nt by SRS to the administrator). B5






901Interim/final SRS audit settlement (refer to letter sent by SRS to the administ rator). B5


902Interim/final SRS audit recoupment (refer to letter from SRS for detailed infor mation). B5


903Non-claim specific payment (refer to letter from SRS for detailed information). B5


904 Recoupment of advanced payment. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

905

NON-CLAIM SPECIFIC RECOUPMENT (REFER TO LETTER FROM EDS OR KFMC FOR DETAILED IN FORMATION). B5


906

Thank you for your refund. Since this adjustment could not be processed routin ely, your 1099 information was not adjusted. B5


907NON-CLAIM RECOUPMENT (REFER TO LETTER FROM EDS/SRS FOR DETAILED INFORMATION). B5


908

Previously denied services, submitted as an adjustment by you, have been reproc essed and if appropriate, paid. B5


910YOUR 1099 AMOUNT HAS BEEN INCREASED BY THE AMOUNT SPECIFIED ON THIS TRANSACTION . B5


912

THIS ADJUSTMENT HAS BEEN INITIATED TO RECONCILE AN UNDERPAYMENT MADE TO YOU IN YOUR DECEMBER CASE MANAGEMENT FEES. B5


914

This non-claim specific adjustment is to correct a processing error in rate cha nges that occurred for D.O.S. 10/01/89 through 11/10/89. B5


915Payment is a result of correcting ECS daily rate information previously reporte d on your RA. B5


916 Reserved for non-claim specific payouts. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.




920Recoupment is a result of correcting ECS daily rate information previously repo rted on your RA. B5


921

Payment for this claim has been recouped due to Utilization Review determining a billing error. Refer to your letter from Utilization Review for detailed inf ormation and resubmit your corrected claim. B5


922

Payment for this detail has been recouped due to a technical denial issued by U tilization Review. Refer to your letter from Utilization Review for detailed i nformation. B5






923

THIS DETAIL HAS BEEN ADJUSTED DUE TO UTILIZATION REVIEW REVISING THE EMERGENCY ROOM PHYSICIAN/EMERGENCY ROOM LEVEL OF CARE. B5


924

THIS DETAIL HAS BEEN ADJUSTED DUE TO UTILIZATION REVIEW REVISING THE DIAGNOSIS AND EMERGENCY ROOM PHYSICIAN/EMERGENCY ROOM LEVEL OF CARE. B5


925

THIS DETAIL HAS BEEN ADJUSTED DUE TO UTILIZATION REVIEW REVISING THE UNITS FOR THE EMERGENCY ROOM PHYSICIAN/EMERGENCY ROOM . B5


926

THIS DETAIL HAS BEEN ADJUSTED DUE TO UTILIZATION REVIEW REVISING THE DIAGNOSIS AND THE UNITS FOR THE EMERGENCY ROOM PHYSICIAN/EMERGENCY ROOM. B5


927 Reserved for non-claim specific recoups. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.








951

UNABLE TO PROCESS VIA TAPE FORMAT. PLEASE RESUBMIT ON A PAPER CLAIM UTILIZING THE HCPCS PROCEDURE CODES LISTED IN THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVI DER MANUAL, APPROPRIATE FOR YOUR PROVIDER TYPE. B5


958

CLAIM DENIED. EDS SHOWS NO CERTIFICATION DATA RECORD ON FILE FOR THIS BENEFICIA RIES ID AND ADMISSION PERIOD. B5


959Claim denied. UR data on file does not encompass all the dates of stay billed. B5



963 DENIED. NDC IS TERMINATED/OBSOLETE. B5Payment adjusted because coverage/program guidelines were not met or were exceeded. M119






1012

DENIED. REFILL INDICATOR MISSING/INVALID. REFER TO SECTION 7000 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


1016Denied. The date of service billed does not fall within the coverage date of t he NDC billed. B5


1017 NOT USED B5Payment adjusted because coverage/program guidelines were not met or were exceeded. N45 Payment based on authorized amount.

1026

DENIED. STATE GUIDELINES WILL NOT ALLOW PAYMENT OF NIGHT SUPPORT AND ALSO RESI DENTIAL HABILITATION. REFER TO THE KANSAS MEDICAL ASSISTANCE PROGRAM HCBS MR/ DD RESIDENTIAL HABILITATION OR NIGHT SUPPORT PROVIDER MANUAL. B5


1030

DENIED. INTERIM BILLING IS LIMITED TO ONCE EVERY 30 DAYS FOR SPECIALTY HOSPITA LS. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


1052

DETAIL DENIED. STATE GUIDELINES DO NOT ALLOW PAYMENT OF PSYCHOSOCIAL TREATMEN T GROUP ON THE SAME DAY AS PARTIAL HOSPITALIZATION. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5



1058

Denied. The optical work order turn around document must be returned within si x months in order to be processed. Since the TAD was not returned, the claim w ill have to be resubmitted for processing in order to receive payment. B5


1071

CLAIM DENIED. NONE OF THE INGREDIENTS LISTED ARE LEGEND DRUGS. AT LEAST ONE I NGREDIENT MUST BE A LEGEND DRUG IN ORDER TO BE REIMBURSED BY THE KANSAS MEDICAL ASSISSTANCE PROGRAM. B5



1082

DENIED. THE BENEFICIARY'S COVERAGE INDICATOR CODE INDICATES THIS BENEFICIARY I S NOT ELIGIBLE TO HAVE THEIR ACH BILLS PAID BY KANSAS MEDICAL ASSISTANCE PROGRA M. PLEASE REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROV IDER MANUAL FOR MORE INFORMATION. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N30 Patient ineligible for this service.

1087

Denied. Services for TB only beneficiaries are limited to inpatient services w hen related to a tuberculosis diagnosis. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. N30 Patient ineligible for this service.

1093

Denied. One or more of the compound drug ingredients listed has been discontin ued. Please correct and resubmit for processing. B5







1101

DETAIL DENIED. UNLISTED OR NOT OTHERWISE CLASSIFIED CODES ARE NONCOVERED. REF ER TO SECTION 4200 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


1104

DETAIL DENIED. COSMETIC SURGERY IS NONCOVERED. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


1110

DETAIL DENIED. THIS SERVICE WAS BILLED WITH ANOTHER SERVICE THAT BY CLINICAL P RACTICE STANDARDS AND/OR CPT-4 GUIDELINES SHOULD NOT CO-EXIST ON THE SAME DAY. B5


1111Received but not finalized. Claim pending due to Medicare Buy-in file verifica tion. B5


1112

DETAIL DENIED. THE PROCEDURE BILLED HAS BEEN REBUNDLED TO A GLOBAL CPT-4 CODE THAT MORE ACCURATELY REFLECTS THE COMPREHENSIVE NATURE OF THE SERVICE THAT WAS PERFORMED. B5


1115Claim received but not finalized. Claim pending due to newborn identification number verification. B5


1118

Denied. State guidelines will not allow payment for manipulations on the same date of service as an office visit. B5



1125Denied. According to State guidelines, this surgery procedure code does not re quire an assistant surgeon. B5



1140

Claim/service has been denied/reduced due to a biophysical profile procedure co de, which is content of service of the complete obstetrical sonogram, being rei mbursed previously. B5



1145

Claim/service has been denied/reduced due to a hospital visit procedure code, w hich is content of service of the consultation, being previously reimbursed. B5



1152

Allowed amount for this procedure may have been prorated due to previous reimbu rsement of the observation care procedure code, which is content of service of the surgery. B5


1155

Denied. State guidelines will not allow payment for procedure code (96910) on the same date of service as procedure code (96912). (96910 and 96912 - Photoche motherapy) B5



1157

Allowed amount for this procedure may have been prorated due to previous reimbu rsement of pre/post operative care, which is content of service of the surgery . B5






1158 reserved for CLIA B5Payment adjusted because coverage/program guidelines were not met or were exceeded.







1166Denied. This beneficiary was not enrolled with this primary care physician at the time of service. B5


PATIENT NOT ENROLLED IN THE BILLING PROVIDER'S MANAGED CARE PLAN ON THE DATE OF SERVICE.

1191Denied. The date of service billed does not fall within the coverage date of th is DRG. B5


1202

Detail reduced. The allowed amount for this procedure has been based on a more appropriate code for the service provided. B5



1204

POS claims greater than 30 days old will be captured and processed in a batch e nvironment. Claim will appear in your next remittance advice. B5


1207This claim has been selected for a post-pay review of prior authorized services . B5


1222Returned to provider. Signature missing or invalid. Please sign claim and ret urn for processing. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. MA70

Missing/incomplete/invalid provider representative signature.

1229Denied. Please bill the same procedure code as billed to Medicare. Correct cl aim and resubmit. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. M51 Missing/incomplete/invalid procedure code(s).

1238

DENIED. SKILLED NURSING FACILITY SERVICES NOT COVERED BY MEDICARE MUST BE BILL ED ON THE INSTITUTIONAL CLAIM FORM USING THE APPROPRIATE TYPE OF BILL. REFEREN CE SECTION 7020 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM ADULT CARE HOME PROVI DER MANUAL FOR MORE INFORMATION. B5


1239

Denied. According to our records, this beneficiary does not reside in a nursin g facility for the dates of service billed. Please contact the beneficiary's c ase manager. B5


The patient was not residing in a long-term care facility during all or part of the service dates billed.

1240Denied. Services can only be provided as described in your Children and Family Services (CFS) Contract. B5






1247

Service(s) denied. Beneficiaries in a Home and Community Based Service Program do not reside in a nursing facility. Please review the service(s) billed. B5



1254

Denied. Our records indicate the beneficiary is not in a Long Term Care Living arrangement or all of the claim dates of service do not fall within a Single L ong Term Care segment approved for Nursing Home Payment. B5



1279

DENIED. BILLED QUANTITY EXCEEDS ALLOWED AMOUNT, RESUBMIT WITH CORRECT AMOUNT. PLEASE REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. M53 Missing/incomplete/invalid days or units of service.

1296

Claim/Service Denied/Reduced because coverage/program guidelines were not met o r were exceeded. B5


1303

DATA CORRECTED. THE FISCAL AGENT WAS UNABLE TO INTERPRET THE PERFORMING PROVID ER NUMBER SUBMITTED. THE BILLING PROVIDER NUMBER WAS COPIED INTO THE PERFORMIN G PROVIDER FIELD. B5

Payment adjusted because coverage/program guidelines were not met or were exceeded. MA30 Missing/incomplete/invalid type of bill.

1453

DENIED/REDUCED. INDIVIDUAL PYSCHOTHERAPY IS LIMITED TO 40 HOURS PER CALENDAR YE AR FOR MEDICAID BENEFICIARIES IN THE KAN BE HEALTHY PROGRAM. REFER TO SECTION 8 400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


1454

DENIED/REDUCED. INDIVIDUAL PYSCHOTHERAPY IS LIMITED TO 32 HOURS PER CALENDAR YE AR FOR NON-KAN BE HEALTHY MEDICAID BENEFICIARIES. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER MANUAL. B5


2000 NOT USED B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

4011 THIS EDIT IS NOT USED. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.





8201 TPL PRIVATE HEALTH INSURANCE - PROVIDER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.





8202 TPL PRIVATE HEALTH INSURANCE - RECIPIENT B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8203 AUTO LIABILITY - CARRIER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8204 AUTO LIABILITY - PROVIDER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8205 AUTO LIABILITY - RECIPIENT B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8206 NON-AUTO LIABILITY - CARRIER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8207 NON-AUTO LIABILITY - PROVIDER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8208 NON-AUTO LIABILITY - RECIPIENT B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8209 WORKER'S COMP - CARRIER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8210 WORKER'S COMP - PROVIDER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8211 WORKER'S COMP - BENEFICIARY B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8212 PROBATE'S ESTATE B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8213 INCOME PENSION TRUST RECOVERIES B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8214 VICTIM'S RESTITUTION B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8215 ABSENT PARENTS/CSE B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8216 TPL ERROR B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8244PAYOUT PROCESSED DUE TO DISPROPORTIONATE SHARE B5


8245 POINT OF SALE B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8304PAYOUT DUE TO ADVANCE. PAYMENT INCLUDED IN CHECKWRITE. B5


8305PAYOUT DUE TO ADVANCE. PAYMENT EXCLUDED FROM CHECKWRITE. B5


8307 PAYOUT EXCLUDED FROM CHECKWRITE. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8309PAYOUT DUE TO MANAGED CARE - RESIDENT PCP PAYMENT B5


8310PAYOUT DUE TO MANAGED CARE - RESIDENT DELIVERY PAYMENT B5


8311PAYOUT DUE TO MANAGED CARE - ABD RISK BASED PAYMENT. B5


8312PAYOUT DUE TO MANAGED CARE - SP/ABD QUARTERLY PAYMENT B5






8313PAYOUT DUE TO MANAGED CARE - EPSDT BONUS PAYMENT B5


8314PAYOUT DUE TO MANAGED CARE - CUSTODY INDICATOR ERROR B5


8315PAYOUT DUE TO MANAGED CARE - ENROLLMENT ERROR B5


8316 PAYOUT DUE TO MANAGED CARE - OTHER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8317PAYOUT DUE TO MEDICAL AUTHORIZATION UNIT REVIEW -CCU B5


8318PAYOUT DUE TO LONG TERM CARE FACILITY CERTIFICATION DATE ERROR B5


8319PAYOUT DUE TO LONG TERM CARE FACILITY CLAIM PROCESSING ERROR B5


8320 PAYOUT DUE TO PATIENT LIABILITY ERROR B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8321 PAYOUT DUE TO PATIENT SPENDDOWN ERROR B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8322PAYOUT DUE TO ENHANCED RATE-OUT OF STATE RTC SERVICES B5


8323PAYOUT DUE TO NON-EMERGENCY TRANSPORTATION B5


8326PAYOUT DUE TO CORRECTION TO ACCOUNTS RECEIVABLE PROCESSED. B5


8327PAYOUT DUE TO SRS SUPPORTED LIVING PROGRAM AUDIT. B5


8328 PAYOUT DUE TO SRS AUDIT. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8329 PAYOUT PROCESSED FROM STATE ONLY FUNDS B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8330 PAYOUT DUE TO ELIGIBILITY NOT ON FILE. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8331 PAYOUT DUE TO CLAIM TOO OLD TO PROCESS B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8332PAYOUT DUE TO MISCELLANEOUS OR UNSPECIFIED REASON. B5


8336 RETROACTIVE INTEREST PAYMENT B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8399THIS ACTION IS THE RESULT OF A STOP PAYMENT. A MANUAL CHECK HAS BEEN ISSUED. B5


8400

ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED . THE AMOUNT WILL BE DEDUCTED FROM YO UR FUTURE PAYMENTS. B5


8401

DUE TO A CHECK ADVANCE, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR FUTURE PAYMENTS. B5






8402

DUE TO AN IRS LIEN, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WIL L BE DEDUCTED FROM YOUR PAYMENTS. B5


8403

DUE TO A GARNISHMENT, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. B5


8404

DUE TO A LIABILITY AND CASUALTY LIEN, AN ACCTS RCVBLE HAS BEEN ESTABLISHED . THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. B5


8405

DUE TO A LIEN, AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. B5


8406

DUE TO TAX ASSESSMENT (31%), AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED. THE A MOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. B5


8407 RELEASE OF LIEN RECEIVED BY LIEN HOLDER B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8408 DECREASE TO ORIGINAL LIEN AMOUNT. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8409 INCREASE TO ORIGINAL LIEN AMOUNT B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8420

AS THE RESULT OF AN AUDIT DIVISION REVIEW, AN ACCOUNTS RECEIVABLE HAS BEEN ESTA BLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. B5


8421

AS THE RESULT OF CLAIMS PROCESSING ERROR, AN ACCOUNTS RECEIVABLE HAS BEEN ESTAB LISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. B5


8422

AS THE RESULT OF A COST SETTLEMENT REVIEW, AN ACCOUNTS RECEIVABLE HAS BEEN ESTA BLISHED. THE AMOUNT WILL BE DEDUCTED FROM YOUR PAYMENTS. B5


8423AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO SRS AUDIT. B5


8424AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO SRS/CFP. B5


8425AN ACCOUNTS RECEIVABLE HAS BEEN ESTABLISHED DUE TO JUVENILE JUSTICE. B5


8500PAYMENT WITHHELD DUE TO A LIEN THAT WAS ESTABLISHED FROM A COURT ORDER. B5


8501PAYMENT WITHHELD DUE TO AN IRS LEVY ESTABLISHED. B5






8502PAYMENT WITHHELD DUE TO A LIEN THAT WAS ESTABLISHED FROM OTHER LEGAL ENTITY. B5


8510 CYCLE ACTIVITY B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8511DECREASE TO ORIGINAL LIEN AMOUNT RECEIVED BY LIEN HOLDER. B5


8512DECREASE TO ORIGINAL LIEN AMOUNT DUE TO PAYMENT RECEIVED. B5


8513INCREASE TO ORIGINAL LIEN AMOUNT RECEIVED BY LIEN HOLDER. B5


8514 RELEASE OF LIEN RECEIVED BY LIEN HOLDER. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8515THIS CLAIM HAS BEEN DENIED DUE TO A POS REVERSAL TRANSACTION. B5


8998 CLAIM SUSPENDED FOR ADDITIONAL REVIEW B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

8999SUSPENDED FOR REVIEW-DISPOSITIONING ERROR B5


9000

THE SUBMITTED CHARGE EXCEEDS THE ALLOWED CHARGE. CLAIM PAID AT THE KANSAS MEDI CAL ASSISTANCE PROGRAM ALLOWED AMOUNT. B5


9006CLAIM ADJUSTMENT DUE TO TRANSACTION BALANCING ISSUE. B5


9009

SERVICE DENIED. REIMBURSEMENT FOR INPATIENT HOSPITAL CARE LIMITED TO ONCE PER DAY. B5



9621 LTC INDICATOR INVALID B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

9904

SERVICE DENIED. REIMBURSEMENT LIMITED TO ONE SET OF LENSES EVERY TWO YEARS FOR RECIPIENTS 19 YEARS OR OLDER UNLESS REPAIR OR REPLACEMENT IS DUE TO EXTENUATIN G CIRCUMSTANCES BEYOND THE RECIPIENT'S CONTROL. DOCUMENTATION RECEIVED DOES NOT INDICATE EXTENUATING CIRCUMSTANCES B5


9910 PHARMACY DISPENSING FEE APPLIED B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

9912PRICING ADJUSTMENT - AMBULATORY SURGERY PRICING APPLIED B5


9914PRICING ADJUSTMENT - REV CODE FLAT RATE PRICING APPLIED B5


9920 PRICING ADJUSTMENT - RBRVS PRICING APPLIED B5Payment adjusted because coverage/program guidelines were not met or were exceeded.





9926 CLAIM HAS CUTBACK AMOUNT B5Payment adjusted because coverage/program guidelines were not met or were exceeded.


9990DEFAULT EOB USED FOR CONVERSION PURPOSES ONLY-ERROR STATUS CODE B5


9991DEFAULT EOB USED FOR CONVERSION PURPOSES ONLY - ADJUSTMENT REASON CODE B5


9995 ADJUSTMENT MANUALLY DENIED B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

9997

PERSONAL RESOURCES DEDUCTED FROM THE CLAIM ARE A RESULT OF PREVIOUS RESOURCES C OLLECTED FOR THE RECIPIENT IN THE SAME MONTH. B5


9998

CLAIM WAS PRICED IN ACCORDANCE WITH CURRENT KANSAS HEALTH COVERAGE PROGRAM POLI CIES. B5


9999

CLAIM PROCESSED IN ACCORDANCE WITH KANSAS MEDICAL ASSISTANCE PROGRAM POLICIES. B5


10@5 1111 B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

12H4 THIS EOB IS NOT USED. B5Payment adjusted because coverage/program guidelines were not met or were exceeded.

4

Provider ineligible for all or a portion of the services on this claim. Please resubmit only those services for which the provider is eligible. B7

This provider was not certified/eligible to be paid for this procedure/service on this date of service.

199

This claim has been returned to you prior to this Remittance Advice under separ ate cover. Performing provider is not an active Kansas Medicaid provider on th e date(s) of service billed. In order to be paid for this service(s), an enrol lment update form must be completed and attached to the claim for the service(s ) in question. B7


335

DENIED. THE DATE OF SERVICE BILLED IS PRIOR TO THE EFFECTIVE DATE OF THE RATE ESTABLISHED FOR YOUR PROVISION OF THIS SERVICE OR YOU ARE NOT APPROVED FOR THI S SERVICE. PLEASE VERIFY DATE AND PROCEDURE CODE BILLED. B7


535

Denied. Documentation provided indicates services rendered are reflective of H ome Care Worker responsibilities and are not a covered home health aide service . B7






575

DENIED. BILLING PROVIDER IS NOT AN ACTIVE KANSAS MEDICAL ASSISTANCE PROGRAM PR OVIDER ON THE DATE OF SERVICE BILLED. PLEASE RESUBMIT ON A PAPER CLAIM. THE E NROLLMENT UPDATE FORM YOU RECEIVED UNDER SEPARATE COVER MUST BE COMPLETED AND A TTACHED TO THE CLAIM IN ORDER TO RECEIVE PAYMENT FOR THIS SERVICE. B7


592

REMITTANCE ADVICE UNDER SEPARATE COVER. BILLING PROVIDER IS NOT AN ACTIVE KANS AS MEDICAL ASSISTANCE PROGRAM PROVIDER ON THE DATE(S) OF SERVICE BILLED. IN OR DER TO BE PAID FOR THIS SERVICE(S) AN ENROLLMENT UPDATE FORM MUST BE COMPLETED AND ATTACHED TO TH E CLAIM FOR THE SERVICE(S) IN QUESTION. B7


856

DENIED. YOUR CLAIM CANNOT BE PROCESSED BECAUSE THE BILLING AND/OR PERFORMING PR OVIDER ID NUMBER OR SERVICE LOCATION CODE IS MISSING, INVALID, NOT ON THE PROVI DER DATABASE FILE OR YOUR MEDICARE ID CANNOT BE MATCHED TO AN ACTIVE KANSAS MED ICAL ASSISTANCE PROGRAM PROVIDER ID. PLEASE CORRECT CLAIM AND RESUBMIT USING TH E KMAP PROVIDER IDENTIFICATION NUMBER WHICH WAS EFFECTIVE 10/15/2003. B7


1018

DENIED. PLEASE BILL PARTIAL HOSPITALIZATION SERVICES USING YOUR PARTIAL HOSPIT ALIZATION PROVIDER NUMBER. REFER TO SECTION 8400 OF YOUR KANSAS MEDICAL ASSIST ANCE PROGRAM CMHC PROVIDER MANUAL. B7


1221Returned to provider. Please resubmit with a valid provider number. B7


1297Denied. This provider was not certified/eligible to be paid for this procedure /service on this date of service. B7


1401

CLAIM RECEIVED AND PROCESSED USING AN OBSOLETE PROVIDER IDENTIFICATION NUMBER. PLEASE SUBMIT ALL CLAIMS USING THE KANSAS MEDICAL ASSISTANCE PROGRAM PROVIDER I DENTIFICATION NUMBER. B7


9012

CLAIM TREATED AS AN ADJUSTMENT. CROSSOVER CLAIM WITH NO MEDICARE PROVIDER NUMB ER. B7


9016CLAIM TREATED AS AN ADJUSTMENT. BILLING PROVIDER NOT FOUND ON T_PR_PROV. B7






206

DENIED. THIS BENEFICIARY HAS ELECTED HOSPICE CARE. PAYMENT FOR SERVICES RELAT ED TO THE TERMINAL ILLNESS OR RELATED CONDITIONS ARE THE RESPONSIBILITY OF THE HOSPICE. B9

Services not covered because the patient is enrolled in a Hospice.

968

DENIED. HOSPICE ELECTION STATEMENT REQUIRED. PLEASE FORWARD A COPY OF THE HOS PICE ELECTION STATEMENT TO EDS. ONCE EDS HAS RECEIVED THIS STATEMENT, PLEASE R ESUBMIT YOUR CLAIM FOR PROCESSING. B9


1275

This beneficiary has elected Hospice care. Payment for services related to the terminal illness or related conditions are the responsibility of the Hospice. If this inpatient stay was not related to the terminal illness, resubmit claim with a copy of the admission and discharge summary. The claim and documentati on will be reviewed to determine if Medicaid can reimburse for this stay or if B9


1276

Documentation has been reviewed and this stay has been determined to be related to the beneficiary's terminal illness and payment is the responsibility of the Hospice provider. B9


Documents

EOB ADJ RMRKS apr05 - kmap-state-ks.us MEDICAL ASSISTANCE PROGRAM EOB to HIPAA Adjustment and Remark Code Crosswalk Page 3 of 132 EOB Code EOB Description HIPAA Adj Code HIPAA Adj