Remittance Advice Details (RAD) Electronic Correlation Table to remit elect corr9000 National Codes: 9000 – 9099 1

RAD to CARC to RARC Correlation Table RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 900 Information on the RAD 251 The attachment/other CO Contractu N206 The supporting 1 (Remittance Advice Details) documentation that was al documentation does not correspond to received was incomplete or Obligation does not match information on the submitted deficient. The necessary s the claim. claim. information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N464 Incomplete/invalid support data for claim. 900 The SSA (Social Security 16 Claim/service lacks information or CO Contractu MA70 Missing/incomplet 2 Administration) has submission/billing error(s) al e/ signature/stamp is missing from which is needed for adjudication. Do Obligation invalid provider the submitted documentation. not use this code for claims s representative attachment(s)/other signature. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim. 900 The Medicare denial indicates it 109 Claim not covered by this CO Contractu N130 Consult plan 3 was sent to a recipient’s HMO payer/contractor. You must send the al benefit (Health Maintenance claim to the correct Obligation documents/guid Organization). payer/contractor. s elines for information about restrictions for this service. 900 For multiple procedures per 251 The attachment/other CO Contractu N29 Missing 4 date of service, indicate documentation that was al documentation/ different time/sites. received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 2

900 For multiple births, indicate the 16 Claim/service lacks information or CO Contractu N329 Missing/incompl 5 delivery date for each twin, has submission/billing error(s) al ete/ triplet, etc. which is needed for adjudication. Do Obligation invalid patient not use this code for claims s birth date. attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim.

1 – RAD to National Code Correlation: 9000 – 9099 May 2006 Remittance Advice Details (RAD) Electronic Correlation Table to remit elect corr9000 National Codes: 9000 – 9099 3

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 900 This medical supply is not 252 An attachment/other CO Contractu N29 Missing 6 payable without a copy of the documentation is required to al documentation/ supplier’s invoice. adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/ provided (may be comprised of chart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). M23 Missing invoice. N463 Missing support data for claim. 900 Provide the supplier’s invoice or 252 An attachment/other CO Contractu M23 Missing invoice. 7 manufacturer’s name/item documentation is required to al number. adjudicate this claim/service. At Obligation least one Remark Code must be s provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. N463 Missing support data for claim. 900 Invoice must show the 251 The attachment/other CO Contractu N354 Incomplete/invalid 8 manufacturer’s name, date of documentation that was al invoice. service, catalog number and received was incomplete or Obligation price. deficient. The necessary s information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 900 This claim contains inadequate 251 The attachment/other CO Contractu N225 Incomplete/invalid 9 documentation. documentation that was al documentation/or received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N29 Missing documentation/ orders/notes/ summary/report/c hart. N464 Incomplete/invalid support data for claim.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 4

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 901 Medications or supplies being 16 Claim/service lacks information or CO Contractu M119 Missing/incomplet 0 billed are not specified. has submission/billing error(s) al e/ which is needed for adjudication. Do Obligation invalid National not use this code for claims s Drug Code (NDC). attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N29 Missing documentation/ orders/notes/ summary/report/c hart. N463 Missing support data for claim. 901 The modifier breakdown should 16 Claim/service lacks information or CO Contractu MA69 Missing/incomplet 1 be entered in the Remarks area has submission/billing error(s) al e/ of the claim. which is needed for adjudication. Do Obligation invalid remarks. not use this code for claims s attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim. 901 Please submit a complete 251 The attachment/other CO Contractu N29 Missing 2 report; the quantity is missing. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. N378 Missing/incomplet e/ invalid prescription quantity.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 5

901 Please submit the hematocrit or 251 The attachment/other CO Contractu N29 Missing 3 hemoglobin level and weight in documentation that was al documentation/ kilograms (kg) or pounds (lbs). received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. N463 Missing support data for claim.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 6

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 901 This requires a valid report – 251 The attachment/other CO Contractu N225 Incomplete/invalid 4 submit with the original claim. documentation that was al documentation/or received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N394 Incomplete/invalid progress notes/report. N464 Incomplete/invalid support data for claim. 901 This report does not justify 150 Payer deems the information CO Contractu N640 Exceeds 5 what is being billed. submitted does not support this level al number/frequen of service. Obligation cy s approved/allowe d within time period. N445 Missing document for actual cost or paid amount. N495 Missing Supplemental Medical Report. 901 This report requires a start and 16 Claim/service lacks information or CO Contractu N443 Missing/incomplet 6 finish time. has submission/billing error(s) al e/invalid total which is needed for adjudication. Do Obligation time or begin/end not use this code for claims s time. attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N394 Incomplete/invalid progress notes/report. 901 Provider billing error – claim 251 The attachment/other CO Contractu N399 Incomplete/inva 7 and consent form do not match. documentation that was al lid elective received was incomplete or Obligation consent form. deficient. The necessary s information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N28 Consent form requirements not fulfilled.

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N206 The supporting documentation does not match the claim

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 8

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 901 The patient’s name does not 16 Claim/service lacks information CO Contractu MA36 Missing/incomplet 8 match the line that is being or has submission/billing error(s) al e/ billed. which is needed for adjudication. Obligation invalid patient Do not use this code for claims s name. attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N379 Claim level information does not match line level information. N382 Missing/incomplet e/ invalid patient identifier. 901 Information on the claim does 125 Submission/billing error(s). At least CO Contractu MA67 Correction to a 9 not match what is being billed. one remark code must be provided al prior claim. (may be comprised of either the Obligation NCPDP reject reason code or s Remittance Advice Remark Code that is not an alert). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. 902 This requires original claims 251 The attachment/other CO Contractu N29 Missing 0 with all relevant documentation that was al documentation/or documentation. received was incomplete or Obligation ders/notes/summa deficient. The necessary s ry/ information is still needed to report/chart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for data. 902 Submit copies of RADs 252 An attachment/other CO Contractu N4 Missing/incompl 1 (Remittance Advice Details) documentation is required to al ete/ that reflect payment or denial. adjudicate this claim/service. At Obligation invalid prior least one Remark Code must be s insurance provided (may be comprised of carrier EOB. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for data.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 9

902 Please list all tests 251 The attachment/other CO Contractu N29 Missing 2 administered. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. N463 Missing support data for data.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 10

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 902 Please submit all justification 252 An attachment/other CO Contractu N29 Missing 3 and documentation. documentation is required to al documentation/ adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. N463 Missing support data for data. 902 This denial message does not 251 The attachment/other CO Contractu N225 Incomplete/invalid 4 fit the message for sterilization. documentation that was al documentation/or received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N464 Incomplete/invalid support data for claim. 902 The NDC (National Drug Code) P7 The applicable fee schedule/fee CO Contractu M119 Missing/incomplet 5 number entered on the claim is database does not contain the al e/ incorrect for billing compound billed code. Please resubmit a Obligation invalid National drugs. bill with the appropriate fee s Drug Code (NDC). schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. To be used for Property and Casualty only. 902 The compounding 251 The attachment/other CO Contractu N206 The supporting 6 sheet/quantity does not match documentation that was al documentation the quantity on the claim. received was incomplete or Obligation does not match deficient. The necessary s the claim. information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). 902 The claim cannot be read. 251 The attachment/other CO Contractu N205 Information 7 documentation that was al provided was received was incomplete or Obligation illegible. deficient. The necessary s information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). 1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 11

902 Supplies are billed in the 251 The attachment/other CO Contractu N225 Incomplete/invalid 8 ingredient section. documentation that was al documentation/or received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N29 Missing documentation/or ders/ notes/summary/re port/ chart.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 902 Ingredients are billed in the 252 An attachment/other CO Contractu N225 Incomplete/invalid 9 supply section. documentation is required to al documentation/or adjudicate this claim/service. At Obligation ders/ least one Remark Code must be s notes/summary/re provided (may be comprised of port/ either the NCPDP Reject Reason chart. Code, or Remittance Advice Remark Code that is not an ALERT). N29 Missing documentation/or ders/ notes/summary/re port/ chart. 903 An XX modifier is being used to 4 The procedure code is inconsistent CO Contractu N517 Resubmit a new 0 bill for supplies/simple drugs. with the modifier used or a required al claim with the modifier is missing. Note: Refer to Obligation requested the 835 Healthcare Policy s information. Identification Segment (loop 2110 Service Payment Information REF), if present. 903 Supply/simple drug modifier is 4 The procedure code is inconsistent CO Contractu N517 Resubmit a new 1 being used to bill for a with the modifier used or a required al claim with the compound drug. modifier is missing. Note: Refer to Obligation requested the 835 Healthcare Policy s information. Identification Segment (loop 2110 Service Payment Information REF), if present. N657 This should be billed with the appropriate code for these services. 903 Please bill 96 Non-covered charge(s). At least CO Contractu N61 Rebill services on 2 coinsurance/deductible charges one Remark Code must be provided al separate claims. on a separate claim. (may be comprised of either the Obligation NCPDP Reject Reason [sic] Code, or s Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. 903 Only one modifier can be used 4 The procedure code is inconsistent CO Contractu N517 Resubmit a new 3 to bill this procedure. with the modifier used or a required al claim with the modifier is missing. Note: Refer to Obligation requested the 835 Healthcare Policy s information. Identification Segment (loop 2110 Service Payment Information REF), if present.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 13

903 The claim is missing SSA (Social 16 Claim/service lacks information or CO Contractu MA04 Secondary 4 Security Administration) has submission/billing error(s) al payment cannot documentation stating that the which is needed for adjudication. Do Obligation be considered recipient is not entitled to not use this code for claims s without the Medicare. attachment(s)/other identity of or documentation. At least one payment Remark Code must be provided (may information from be comprised of either the NCPDP the primary Reject Reason Code, or Remittance payer. The Advice Remark Code that is not an information was ALERT). Note: Refer to the 835 either not Healthcare Policy Identification reported or was Segment (loop 2110 Service illegible. Payment Information REF), if present. N463 Missing support data for data. 903 The recipient on the claim does 16 Claim/service lacks information CO Contractu N4 Missing/incomplet 5 not appear on the attached or has submission/billing error(s) al e/ Explanation of Medicare which is needed for adjudication. Obligation invalid prior Benefits (EOMB)/Medicare Do not use this code for claims s insurance carrier Remittance Notice (MRN). attachment(s)/other EOB. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 14

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 903 Billed amount/claim line 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 6 charges do not match the has submission/billing error(s) al e attached Explanation of which is needed for adjudication. Do Obligation invalid prior Medicare Benefits not use this code for claims s insurance carrier (EOMB)/Medicare Remittance attachment(s)/other EOB. Notice (MRN) charges. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N206 The supporting documentation does not match the claim. N379 Claim level information does not match line level information. 903 Explanation or description of 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 7 Explanation of Medicare has submission/billing error(s) al e/ Benefits (EOMB)/Medicare which is needed for adjudication. Do Obligation invalid prior Remittance Notice (MRN) denial not use this code for claims s insurance carrier codes is required. attachment(s)/other EOB. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. MA04 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. N479 Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 15

903 Resubmit with Medicare 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 8 explanation codes stating the has submission/billing error(s) al e/ reason for the denial. which is needed for adjudication. Do Obligation invalid prior not use this code for claims s insurance carrier attachment(s)/other EOB. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 16

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 903 Send Explanation of Medicare 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 9 Benefits (EOMB)/Medicare has submission/billing error(s) al e/ Remittance Notice (MRN) which is needed for adjudication. Do Obligation invalid prior page(s) showing the not use this code for claims s insurance carrier reason/explanation for attachment(s)/other EOB. non-payment/denial. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim. N479 Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer). 904 The HMO (Health Maintenance 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 0 Organization) denial is has submission/billing error(s) al e/ insufficient. Rebill for which is needed for adjudication. Do Obligation invalid prior denial/non-coverage statement. not use this code for claims s insurance carrier attachment(s)/other EOB. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N464 Incomplete/invalid support data for claim. 904 The denied claim was sent to 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 1 the HMO (Health Maintenance has submission/billing error(s) al e/ Organization) – provide proof of which is needed for adjudication. Do Obligation invalid prior payment or denial. not use this code for claims s insurance carrier attachment(s)/other EOB. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim.

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 17

904 Send a copy of the Medicare 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 2 CMS-1500 and a copy of the has submission/billing error(s) al e/ Explanation of Medicare which is needed for adjudication. Do Obligation invalid prior Benefits (EOMB)/Medicare not use this code for claims s insurance carrier Remittance Notice (MRN) to the attachment(s)/other EOB. Crossover Unit. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N479 Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary Payer).

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 18

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 904 Bill the Crossover Unit to 16 Claim/service lacks information CO Contractu MA04 Secondary 3 receive the Medi-Cal allowable or has submission/billing error(s) al payment cannot amount on the Medicare which is needed for adjudication. Obligation be considered deductible. Do not use this code for claims s without the attachment(s)/other identity of or documentation. At least one payment Remark Code must be provided information from (may be comprised of either the the primary NCPDP Reject Reason Code, or payer. The Remittance Advice Remark Code information was that is not an ALERT). Note: Refer either not to the 835 Healthcare Policy reported or was Identification Segment (loop illegible. 2110 Service Payment Information REF), if present. 904 Attach RADs (Remittance 252 An attachment/other CO Contractu N4 Missing/incompl 4 Advice Details) to the Medi-Cal documentation is required to al ete/ invalid claim when billing the Medicare adjudicate this claim/service. At Obligation prior insurance coinsurance/deductible. least one Remark Code must be s carrier EOB. provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 904 Claim information indicates that 16 Claim/service lacks information CO Contractu N34 Incorrect claim 5 the claim type is other than or has submission/billing error(s) al form/format for what is specified. which is needed for adjudication. Obligation this service. Do not use this code for claims s attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N29 Missing documentation/or ders/ notes/summary/re port/ chart. 904 This is an incorrect format for 16 Claim/service lacks information CO Contractu N34 Incorrect claim 6 billing inpatient Medicare Part B or has submission/billing error(s) al form/format for services. which is needed for adjudication. Obligation this service. Do not use this code for claims s attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

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904 Coinsurance/deductible charges 251 The attachment/other CO Contractu N29 Missing 7 can only be combined as take- documentation that was al documentation/or home drugs. received was incomplete or Obligation ders/notes/summa deficient. The necessary s ry/report/chart. information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

1 – RAD to National Code Correlation: 9000 – 9099 September 2015 remit elect corr9000 20

RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 904 Adding/deleting inpatient lines 96 Non-covered charge(s). At least CO Contractu N61 Rebill services 8 is not allowed for adjustments. one Remark Code must be provided al on separate (may be comprised of either the Obligation claims. NCPDP Reject Reason [sic] Code, or s Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. 904 OHC (Other Health Coverage) 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 9 documentation is not has submission/billing error(s) al e/ acceptable – information is which is needed for adjudication. Do Obligation invalid prior missing or invalid. not use this code for claims s insurance carrier attachment(s)/other EOB. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim. N464 Incomplete/invalid support data for claim. 905 OHC (Other Health Coverage) 16 Claim/service lacks information or CO Contractu N4 Missing/incomplet 0 documentation is not has submission/billing error(s) al e/ acceptable – invalid information which is needed for adjudication. Do Obligation invalid prior was given to the SSA (Social not use this code for claims s insurance carrier Security Administration). attachment(s)/other EOB. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N245 Incomplete/invalid plan information for other insurance. MA04 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. 1 – RAD to National Code Correlation: 9000 – 9099 October 2008 remit elect corr9000 21

905 Indicate the quantity per box 251 The attachment/other CO Contractu N354 Incomplete/invalid 1 and/or case on the invoice. documentation that was al invoice. received was incomplete or Obligation deficient. The necessary s information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N378 Missing/incomplet e/ invalid prescription quantity. N463 Missing support data for claim.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 905 Indicate the actual time spent 16 Claim/service lacks information or CO Contractu N29 Missing 2 with the patient. has submission/billing error(s) al documentation/ which is needed for adjudication. Do Obligation orders/notes/ not use this code for claims s summary/report/c attachment(s)/other hart. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N443 Missing/incomplet e/ invalid total time or begin/end time. 905 Indicate the start and stop 16 Claim/service lacks information or CO Contractu N29 Missing 3 times for the procedure billed. has submission/billing error(s) al documentation/ which is needed for adjudication. Do Obligation orders/notes/ not use this code for claims s summary/report/c attachment(s)/other hart. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N443 Missing/incomplet e/ invalid total time or begin/end time. 905 Indicate the patient’s weight, 252 An attachment/other CO Contractu N29 Missing 4 hematocrit, dosage and history. documentation is required to al documentation/ adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. N463 Missing support data for claim.

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905 Indicate the reason doxorubicin 251 The attachment/other CO Contractu N29 Missing 5 was not used. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 905 Indicate poor control, if 251 The attachment/other CO Contractu N29 Missing 6 trainable, and if for home use. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 905 Indicate the type of portable 251 The attachment/other CO Contractu N29 Missing 7 oxygen system that was used. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 905 Indicate a possible need for 251 The attachment/other CO Contractu N29 Missing 8 referral. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 905 A copy of the plotted fields 252 An attachment/other CO Contractu N29 Missing 9 must be attached. documentation is required to al documentation/ adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. N463 Missing support data for claim. 906 Indicate medical necessity for 251 The attachment/other CO Contractu N29 Missing 0 minus lenticular lenses. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 906 The procedure code is invalid 5 The procedure code/bill type is CO Contractu M77 Missing/incompl 1 for the Place of Service. inconsistent with the Place of al ete/ invalid Service. Note: Refer to the 835 Obligation place of service. Healthcare Policy Identification s Segment (loop 2110 Service Payment Information REF), if present. 1 – RAD to National Code Correlation: 9000 – 9099 ____ 2008 remit elect corr9000 25

906 Indicate the drug dosage, name 16 Claim/service lacks information or CO Contractu M123 Missing/incomplet 2 and/or invoice. has submission/billing error(s) al e/ which is needed for adjudication. Do Obligation invalid name, not use this code for claims s strength, or attachment(s)/other dosage of the documentation. At least one drug furnished. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 906 This modifier requires a “By 252 An attachment/other CO Contractu N29 Missing 3 Report” to be submitted. documentation is required to al documentation/ adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. 906 CCS/GHPP is unable to process 251 The attachment/other CO Contractu N225 Incomplete/invalid 4 the claim for payment because documentation that was al documentation/or of incorrect information. received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N29 Missing documentation/ orders/notes/ summary/report/c hart. N463 Missing support data for claim. 906 The “payer” field (Box 50) is 251 The attachment/other CO Contractu N206 The supporting 5 inconsistent with the documentation that was al documentation information on this claim. received was incomplete or Obligation does not match deficient. The necessary s the claim. information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N373 It has been determined that another payer paid the services as primary when they were not the primary payer. Therefore, we are refunding to the payer that paid as primary on your behalf.

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906 Documentation does not 16 Claim/service lacks information or CO Contractu M136 Missing/incomplet 6 indicate that a physician was has submission/billing error(s) al e/ present. which is needed for adjudication. Do Obligation invalid indication not use this code for claims s that the service attachment(s)/other was supervised or documentation. At least one evaluated by a Remark Code must be provided physician. (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 906 One or more documents of the 252 An attachment/other CO Contractu N29 Missing 7 report are missing. documentation is required to al documentation/ adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N393 Missing progress notes/report. N463 Missing support data for claim. 906 Submit documentation 252 An attachment/other CO Contractu N29 Missing 8 indicating the procedure documentation is required to al documentation/ performed was unilateral or adjudicate this claim/service. At Obligation orders/notes/ bilateral. least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 906 The signature and/or date is 16 Claim/service lacks information or CO Contractu MA70 Missing/incomplet 9 missing or invalid on the has submission/billing error(s) al e/ documentation. which is needed for adjudication. Do Obligation invalid provider not use this code for claims s representative attachment(s)/other signature. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. MA71 Missing/incomplet e/ invalid provider representative signature date. MA75 Missing/incomplet e/ invalid patient or authorized representative signature. 907 Visual field study or treatment 252 An attachment/other CO Contractu M135 Missing/incompl 0 plan is not present. documentation is required to al ete/ invalid plan adjudicate this claim/service. At Obligation of treatment. least one Remark Code must be s provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N29 Missing documentation/ orders/notes/ summary/report/c hart.

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907 Documentation of treatment or 252 An attachment/other CO Contractu N29 Missing 1 referral is required. documentation is required to al documentation/ adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 907 The copy of the claim is 251 The attachment/other CO Contractu N205 Information 2 illegible. Please resubmit. documentation that was al provided was received was incomplete or Obligation illegible. deficient. The necessary s information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N464 Incomplete/invalid support data for claim. 907 The attached documentation is 251 The attachment/other CO Contractu N205 Information 3 illegible. Please resubmit. documentation that was al provided was received was incomplete or Obligation illegible. deficient. The necessary s information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N464 Incomplete/invalid support data for claim. 907 Verify the recipient 16 Claim/service lacks information CO Contractu MA61 Missing/incomplet 4 ID/procedure(s) with the CDP: or has submission/billing al e/ EWC (Cancer Detection error(s) which is needed for Obligation invalid social Program: Every Woman Counts) adjudication. Do not use this s security number service and billing code for claims or health requirements. attachment(s)/other insurance claim documentation. At least one number. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. MA66 Missing/incomplet e/ invalid principal procedure code. N303 Missing/incomplet e/ invalid principal procedure date.

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907 Indicate if the physician 16 Claim/service lacks information or CO Contractu M136 Missing/incomplet 5 administered or supervised the has submission/billing error(s) al e/ procedure. which is needed for adjudication. Do Obligation invalid indication not use this code for claims s that the service attachment(s)/other was supervised or documentation. At least one evaluated by a Remark Code must be provided physician. (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim. 907 Indicate the actual time spent 251 The attachment/other CO Contractu N29 Missing 6 with the patient. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N443 Missing/incomplet e/ invalid total time or begin/end time.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 907 Indicate the start and stop 251 The attachment/other CO Contractu N29 Missing 7 times for the procedure billed. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N303 Missing/incomplet e/ invalid principal procedure date. N443 Missing/incomplet e/ invalid total time or begin/end time. 907 Indicate the provider who 16 Claim/service lacks information or CO Contractu N253 Missing/incomplet 8 performed or interpreted the has submission/billing error(s) al e/ test. which is needed for adjudication. Do Obligation invalid attending not use this code for claims s provider primary attachment(s)/other identifier. documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim. N467 Missing Report of Tests and Analysis Report. 907 The diagnosis or report does 50 These are non-covered services CO Contractu N661 Documentation 9 not substantiate the procedure. because this is not deemed a al does not 'medical necessity' by the payer. Obligation support that the Note: Refer to the 835 s services Healthcare Policy Identification rendered were Segment (loop 2110 Service medically Payment Information REF), if necessary. present. 908 Submit a history and/or a 252 An attachment/other CO Contractu N29 Missing 0 physical report. documentation is required to al documentation/ adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart.

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N393 Missing progress notes/report. 908 Justify the use of the single- 252 An attachment/other CO Contractu N29 Missing 1 antigen vaccine. documentation is required to al documentation/ adjudicate this claim/service. At Obligation orders/notes/ least one Remark Code must be s summary/report/c provided (may be comprised of hart. either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

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RAD RAD Code Description HIPAA CARC Description HIPAA CAGC HIPA RARC Cod CARC CAGC Descripti A Description e on RARC 908 Submit an explanation of high 251 The attachment/other CO Contractu N29 Missing 2 refractive correction. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 908 Indicate the necessity for 251 The attachment/other CO Contractu N29 Missing 3 plastic, rather than glass, documentation that was al documentation/ lenses. received was incomplete or Obligation orders/notes/sum deficient. The necessary s mary/ information is still needed to report/chart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 908 Indicate the reason for the 251 The attachment/other CO Contractu N29 Missing 4 follow-up visit. documentation that was al documentation/ received was incomplete or Obligation orders/notes/sum deficient. The necessary s mary/ information is still needed to report/chart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim. 908 The procedure must be justified 251 The attachment/other CO Contractu N29 Missing 5 by significant signs or documentation that was al documentation/ symptoms. received was incomplete or Obligation orders/notes/sum deficient. The necessary s mary/ information is still needed to report/chart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N463 Missing support data for claim.

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908 The letter requires an 16 Claim/service lacks information or CO Contractu MA75 Missing/incomplet 6 administrator, guardian or has submission/billing error(s) al e/ patient signature. which is needed for adjudication. Obligation invalid patient or Do not use this code for claims s authorized attachment(s)/other representative documentation. At least one signature. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 908 An additional diagnosis is 16 Claim/service lacks information or CO Contractu M64 Missing/incomplet 7 required. has submission/billing error(s) al e/ which is needed for adjudication. Do Obligation invalid/other not use this code for claims s diagnosis. attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N463 Missing support data for claim. 908 Documentation must show the 50 These are non-covered services CO Contractu N661 Documentation 8 need for prolonged service. because this is not deemed a al does not 'medical necessity' by the payer. Obligation support that the Note: Refer to the 835 s services Healthcare Policy Identification rendered were Segment (loop 2110 Service medically Payment Information REF), if necessary. present. 908 The tests indicated do not equal 251 The attachment/other CO Contractu N225 Incomplete/invalid 9 the total hours billed on the documentation that was al documentation/or claim. received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). 909 The prescription change is not . 153 Payer deems the information CO Contractu 0 50 diopters or more. submitted does not support this al dosage. Obligation s 909 The date of service does not 50 These are non-covered services CO Contractu N206 The supporting 1 match the submitted date of because this is not deemed a al documentation report. 'medical necessity' by the payer. Obligation does not match Note: Refer to the 835 s the claim. Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N394 Incomplete/invalid progress notes or report. 909 This is an invalid report for this 251 The attachment/other CO Contractu N225 Incomplete/invalid 2 date of service. documentation that was al documentation/or received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). 1 – RAD to National Code Correlation: 9000 – 9099 ___ 2015 remit elect corr9000 37

N394 Incomplete/invalid progress notes/report. N464 Incomplete/invalid support data for claim. 909 The name on the report does 50 These are non-covered services CO Contractu N206 The supporting 3 not match the name on the because this is not deemed a al documentation claim. 'medical necessity' by the payer. Obligation does not match Note: Refer to the 835 s the claim. Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N394 Incomplete/invalid progress notes/report.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 909 The attached report is 251 The attachment/other CO Contractu N225 Incomplete/invalid 4 incomplete – pages are missing. documentation that was al documentation/or received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N394 Incomplete/invalid progress notes/report. N464 Incomplete/invalid support data for claim. 909 The attached report is illegible. 251 The attachment/other CO Contractu N225 Incomplete/invalid 5 Please resubmit. documentation that was al documentation/or received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N205 Information provided was illegible. N394 Incomplete/invalid progress notes/report. 909 The attached report is invalid. 251 The attachment/other CO Contractu N225 Incomplete/invalid 6 “By Report” is required. documentation that was al documentation/or received was incomplete or Obligation ders/ deficient. The necessary s notes/summary/re information is still needed to port/ process the claim. At least one chart. Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N394 Incomplete/invalid progress notes/report. N464 Incomplete/invalid support data for claim.

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909 The recipient’s name and/or 16 Claim/service lacks information or CO Contractu MA36 Missing/incomplet 7 date on the report is missing. has submission/billing error(s) al e/ invalid patient which is needed for adjudication. Do Obligation name. not use this code for claims s attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. N299 Missing/incomplet e/ invalid occurrence date(s). N463 Missing support data for claim. 909 The attached documentation is 252 An attachment/other CO Contractu N225 Incomplete/invalid 8 invalid. documentation is required to al documentation/or adjudicate this claim/service. At Obligation ders/ least one Remark Code must be s notes/summary/re provided (may be comprised of port/ either the NCPDP Reject Reason chart. Code, or Remittance Advice Remark Code that is not an ALERT). N464 Incomplete/invalid support data for claim.

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RAD RAD Code Description HIPAA CARC Description HIPA CAGC HIPA RARC Cod CARC A Descripti A Description e CAGC on RARC 909 The manufacturer’s name is 251 The attachment/other CO Contractu N29 Missing 9 required. documentation that was al documentation/ received was incomplete or Obligation orders/notes/ deficient. The necessary s summary/report/c information is still needed to hart. process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT). N225 Incomplete/invalid documentation/or ders/ notes/summary/re port/ chart. N463 Missing support data for claim.

1 – RAD to National Code Correlation: 9000 – 9099 ____ 2008