Complete directory of Claim Adjustment Reason Codes mandated by HIPAA.
Deductible Amount
Coinsurance Amount
Co-payment Amount
Procedure code inconsistent with modifier
Procedure code / Procedure code modifier combination inconsistent
Procedure/revenue code inconsistent
Procedure code unacceptable with Place of Service
Comprehensive code billed when specific code required
Disposition pending further review
Diagnosis inconsistent with patient age
Diagnosis inconsistent with patient gender
Diagnosis inconsistent with procedure
Diagnosis inconsistent with provider type
Service inconsistent with documented condition
Date of death precedes date of service
Date of birth follows date of service
Payer deems information incorrect
Authorization number missing, invalid, or does not apply
Penalty for failure to obtain prior authorization
Claim lacks information for adjudication
Requested information not provided
Information from another provider required
Exact duplicate claim/service
Claim processed as duplicate
Processed as per plan provisions
Service not covered by plan
Non-covered service for this payer
Non-covered service
Service not covered per contract
Non-covered charges
Charges exceed contracted/legislated fee
Charge exceeds fee schedule/maximum allowable
Processed per contract provisions
May be covered by another payer per COB
Impact of prior payer adjudication
Charges covered under capital expense
Expenses incurred prior to coverage
Expenses incurred after coverage terminated
Service dates not within approved dates
Time limit for filing has expired
Patient cannot be identified as our insured
Our records indicate patient not an employee
Insured has no dependent coverage
Insured has no coverage for newborns
Lifetime benefit maximum has been reached
Benefit maximum reached for period
Service rendered to patient in different location
Service by immediate relative
Attending provider not eligible
Multiple performing physicians
Procedure not separately payable
Procedure already paid under another procedure
Procedure paid under another procedure
Service not paid separately
Benefit for service included in another service
Nutrition not paid separately
Treatment not deemed medically necessary
Diagnosis/condition does not warrant treatment
Service not meeting criteria for emergency
Paid at 50% per legislative authority
Payment adjusted - qualifier insufficient
Not covered unless prescribed by MD
Payment made to patient/insured/responsible party
Predetermination: anticipated payment
Tax withholding
Prior payment being recovered
Related service denied
Rent/purchase guideline not met
Service not provided in approved facility
Billing date predates service date
Service dates not within charges
Service not furnished directly to patient
Service not furnished directly by provider
Procedure/product not FDA approved
Procedure postponed/canceled
Patient only covered for specific events/diagnoses
Transportation outside approved range
ESRD patient not home dialysis
Indemnity insurance plan adjustment
Psychiatric reduction
Submission/billing error
Newborn weight less than plan requirement
Prior processing information appears incorrect
Claim submission error
Claim specific negotiated discount
Prearranged demonstration project adjustment
Purchased service adjustment
Failure to follow plan provisions
Regulatory surcharge adjustment
Appeal/reconsideration denied
Contracted funding arrangement
Patient/insured health identification number not valid
Monthly Medicaid patient liability amount
Incentive adjustment
Premium payment withholding
Provider contracted/enrolled with plan
Payment adjusted - medical review
Service not covered in group home