Remittance Advice Details (RAD) Electronic Correlation Table to National Codes: 001 - 099

Remittance Advice Details (RAD) Electronic Correlation Table to remit elect corr001 National Codes: 001 – 099 1

Providers electing to receive electronic remittance advice in the ASC X12N 835 standard format can download the remittance advice from the Internet Bulletin Board System (IBBS). The 835 transaction includes national Adjustment Reason Codes (ARC), Adjustment Group Codes (AGC) and Health Care Remarks Codes (HCRC) similar to Medi-Cal Remittance Advice Details (RAD) codes.

In some cases, the ARC sufficiently conveys the RAD message. If not, the HCRC state information that cannot be expressed within an ARC. Some RAD codes do not currently have a matching HCRC. In this case, a request will be made to the Centers for Medicare and Medicaid Services (CMS) for additional HCRC.

The 700 RAD code series, at the provider level (non claim-specific provider financial transactions), were not mapped to Health Insurance Portability and Accountability Act HCRC since HCRC are reported at the service or claim level and not the provider level.

The following table details the crosswalk from RAD codes to ARC and HCRC. To help providers correlate the HCRC on the 835 transaction to Medi-Cal RAD codes, a HCRC to RAD code correlation follows the RAD/ARC/HCRC correlation table.

1 – RAD to National Code Correlation: 001 – 099 March 2004 remit elect corr001 2

RAD to ARC to HCRC Correlation Table RAD RAD Code Description HIPA ARC Description HIPA AGC HIPA HCRC Cod A A Descripti A Description e ARC AGC on HCRC 001 Recipient eligibility could not be 31 Claim denied as patient cannot be CO Contractu N30 Patient ineligible verified. identified or is not eligible as our al for this service. insured. Obligation s N375 Missing/incompl ete/ invalid questionnaire/ information required to determine dependent eligibility. 002 The recipient is not eligible for 31 Claim denied as patient cannot be CO Contractu N30 Patient ineligible benefits under the Medi-Cal identified or is not eligible as our al for this service. program or other special insured. Obligation programs. s 004 The recipient information billed 15 Payment adjusted because the CO Contractu N54 Claim information on the claim does not submitted authorization number is al is inconsistent correspond to the TAR missing, invalid, or does not apply to Obligation with pre- (Treatment Authorization the billed services or provider. s certified/authorize Request). d services. 005 The service billed requires an 197 Payment denied/reduced for CO Contractu M62 Missing/incomplet approved TAR. absence of al e/ precertification/authorization. Obligation invalid treatment s authorization code. 006 The date(s) of service reported 15 Payment adjusted because the CO Contractu N351 Service date on the claim is not within the submitted authorization number is al outside of the TAR authorized period. missing, invalid, or does not apply to Obligation approved the billed services or provider. s treatment plan service dates. 007 The number of the refills billed 198 Payment denied/reduced for CO Contractu on the claim exceeds the exceeded al number approved on the TAR. precertification/authorization. Obligation s 008 The provider of service is not B7 This provider was not CO Contractu N95 This provider eligible for the type of services certified/eligible to be paid for this al type/provider billed. procedure/service on this date of Obligation specialty may not service. s bill this service. 009 This service or NDC (National 96 Non-covered charge(s). At least CO Contractu M119 Missing/incompl Drug Code) is not a covered one Remark Code must be al ete/ benefit of the program. provided (may be comprised of Obligation invalid National either the Remittance Advice s Drug Code Remark Code or NCPDP Reject (NDC). Reason Code). MA66 Missing/incompl ete/ invalid principal procedure code. 010 This service is a duplicate of a B13 Previously paid. Payment for this CO Contractu M86 Service denied previously paid claim. claim/service may have been al because payment provided in a previous payment. Obligation already made for s same/similar procedure within set time frame.

RAD RAD Code Description HIPA ARC Description HIPA AGC HIPA HCRC Cod A A Descripti A Description e ARC AGC on HCRC 011 The 184 The prescribing/ordering provider is CO Contractu attending/referring/prescribing not eligible to prescribe/order the al provider is not eligible to service billed. Obligation refer/prescribe/order the s service billed. 012 Medi-Cal benefits cannot be 109 Claim not covered by this CO Contractu MA04 Secondary paid without proof of payer/contractor. You must send the al payment cannot payment/description of the claim to the correct payer/contractor. Obligation be considered denial from Medicare. s without the Recipient not eligible for Medi- identity of or Cal benefits until payment payment/denial information is information from given from other insurance the primary carrier. payer. The information was either not reported or was illegible.

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 013 Medi-Cal benefits cannot be 16 Claim/service lacks information CO Contractu MA04 Secondary paid without proof of needed for adjudication. Additional al payment cannot payment/denial from CHAMPUS. information is supplied using Obligation be considered remittance advice remarks codes s without the whenever appropriate. At least one identity of or remark code must be provided (may payment be comprised of either the information from Remittance Advice Remark Code or the primary NCPDP Reject Reason Code). payer. The information was either not reported or was illegible. 014 Medi-Cal benefits cannot be 16 Claim/service lacks information CO Contractu MA04 Secondary paid without proof of needed for adjudication. Additional al payment cannot payment/denial from Ross Loos information is supplied using Obligation be considered (CIGNA). remittance advice remarks codes s without the whenever appropriate. At least one identity of or remark code must be provided (may payment be comprised of either the information from Remittance Advice Remark Code or the primary NCPDP Reject Reason Code). payer. The information was either not reported or was illegible. 015 Medi-Cal benefits cannot be 16 Claim/service lacks information CO Contractu MA04 Secondary paid without proof of needed for adjudication. Additional al payment cannot payment/denial from Kaiser. information is supplied using Obligation be considered remittance advice remarks codes s without the whenever appropriate. At least one identity of or remark code must be provided (may payment be comprised of either the information from Remittance Advice Remark Code or the primary NCPDP Reject Reason Code). payer. The information was either not reported or was illegible. 016 The drug or medical supply 96 Non-covered charge(s). At least one CO Contractu M119 Missing/incomplet billed is not listed on the list of Remark Code must be provided (may al e/ contract drugs for the date of be comprised of either the Obligation invalid National service. Remittance Advice Remark Code or s Drug Code (NDC). NCPDP Reject Reason Code). 017 The quantity or number 153 Payment adjusted because the CO Contractu N378 Missing/incomplet dispensed is not in accordance payer deems the information al e/ with the current submitted does not support this Obligation invalid Medi-Cal List of Contract Drugs. dosage. s prescription quantity. 018 An approved TAR (Treatment 15 Payment adjusted because the CO Contractu M62 Missing/incomplet Authorization Request) is submitted authorization number is al e/ required for the drug missing, invalid, or does not apply to Obligation invalid treatment combination billed. the billed services or provider. s authorization code. 019 The Code I restrictions for this 197 Payment denied/reduced for absence CO Contractu N29 Missing drug were not met. of precertification/authorization. al documentation/or Obligation ders/notes/summa s ry/report/ chart.

1 – RAD to National Code Correlation: 001 – 099 June 2007 remit elect corr001 3

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC N225 Incomplete/invalid documentation/ orders/notes/ summary/report/c hart.

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 020 This billing limit exception 16 Claim/service lacks information CO Contractu N29 Missing requires supporting needed for adjudication. Additional al documentation/ documentation; please information is supplied using Obligation orders/notes/ resubmit with required remittance advice remarks codes s summary/report/c attachment(s). whenever appropriate. At least one hart. remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). N225 Incomplete/invalid documentation/ orders/notes/ summary/report/ chart. 021 This claim was received after 29 The time limit for filing has expired. CO Contractu MA11 Provider level the al 9 adjustment for one-year maximum billing Obligation late claim filing limitation. s applies to claim. 022 This service is the patient’s 177 Payment denied because patient has CO Contractu liability (Share of Cost). not met the eligibility requirements. al Obligation s 023 The strength or principal labeler 96 Non-covered charge(s). At least one CO Contractu M119 Missing/incomplet billed is not a benefit of the Remark Code must be provided (may al e/ Medi-Cal program. be comprised of either the Obligation invalid National Remittance Advice Remark Code or s Drug Code (NDC). NCPDP Reject Reason Code). 024 This patient is not eligible for 177 Payment denied because patient has CO Contractu N30 Patient ineligible the drug or medical supply not met the eligibility requirements. al for this service. billed. Obligation s 025 The quantity billed exceeds the 35 Benefit maximum has been reached. CO Contractu N362 The number of maximum allowed al days or units of amount/usual practice. Please Obligation service exceeds check to see if the quantity was s the acceptable billed using the correct units maximum. (each/vials). N378 Missing/incomplet e/ invalid prescription quantity. 026 Date of service was prior to a B5 Payment adjusted because CO Contractu fiscal year for which GHPP coverage/program guidelines were al (Genetically Handicapped not met or were exceeded. Obligation Persons Program) funds are s available. Contact GHPP Regional Office. 027 Services denied by Medicare 136 Claim adjusted based on failure to CO Contractu N36 Claim must meet (included in surgical fee, follow prior payer’s coverage rules. al primary payer's incidental, or not separately Obligation processing payable) are not payable by s requirements Medi-Cal. before we can consider payment. 028 This drug is billable only for B5 Payment adjusted because CO Contractu multiple patients in a Nursing coverage/program guidelines were al Facility Level A (NF-A) and not met or were exceeded. Obligation Nursing Facility Level B (NF-B). s

1 – RAD to National Code Correlation: 001 – 099 May 15, 2007 remit elect corr001 4

029 This procedure allowable only 119 Benefit maximum for this time CO Contractu M86 Service denied once per date of service. period or occurrence has been al because payment reached. Obligation already made for s same/similar procedure within set time frame. N362 The number of days or units of service exceeds the acceptable maximum.

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 030 Date of death prior to date of 13 The date of death precedes the date CO Contractu service. of service. al Obligation s 031 The rendering provider was not 185 The rendering provider is not eligible CO Contractu eligible for the services billed to perform the service billed. al on the date of service. Obligation s 032 The prescribing provider was 184 The prescribing/ordering provider is CO Contractu not eligible for this service on not eligible to prescribe/order the al the date of service billed. service billed. Obligation s 033 The recipient is not eligible for 177 Payment denied because the patient CO Contractu N30 Patient ineligible the special program billed has not met the eligibility al for this service. and/or restricted services billed. requirements. Obligation s 034 Services provided for this B22 This claim/service is adjusted based CO Contractu N30 Patient ineligible diagnosis are not payable for a on the diagnosis. al for this service. GHPP (Genetically Handicapped Obligation Persons Program) claim. s 035 This claim does not correspond 15 Payment adjusted because the CO Contractu N54 Claim information to the approved submitted TAR submitted authorization number is al is inconsistent (Treatment Authorization missing, invalid or does not apply to Obligation with pre- Request). the billed services or provider. s certified/authorize d services. N351 Service date outside of the approved treatment plan service dates. 036 RTD (Resubmission Turnaround 17 Payment adjusted because CO Contractu N225 Incomplete/invalid Document) was either not requested information was not al documentation/ returned or was returned provided or was Obligation orders/notes/ uncorrected; therefore, your insufficient/incomplete. Additional s summary/report/ claim is formally denied. information is supplied using the chart. remittance advice remarks codes whenever appropriate. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). N29 Missing documentation/ orders/notes/ summary/report/ chart. 037 Health Care Plan/Mental Health 24 Payment for charges adjusted. CO Contractu Care enrollee, capitated service Charges are covered under a al not billable to Medi-Cal. capitation agreement/ managed care Obligation plan. s 038 This service is not a Medi-Cal 150 Payment adjusted because the CO Contractu benefit without an explanation payer deems the information al that usage is for specified submitted does not support this Obligation conditions. level of service. s

039 Claims with “ZZ” manufacturer 16 Claim/service lacks information CO Contractu N29 Missing code cannot be processed needed for adjudication. Additional al documentation/or without a catalog or price information is supplied using Obligation ders/notes/summa reference book page listing the remittance advice remarks codes s ry/report/ item billed. whenever appropriate. At least one chart. remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). N225 Incomplete/invalid documentation/ orders/notes/ summary/report/c hart.

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 040 This service is not payable 16 Claim/service lacks information CO Contractu N29 Missing without a catalog or price needed for adjudication. Additional al documentation/ reference book page listing the information is supplied using Obligation orders/notes/ item billed. remittance advice remarks codes s summary/report/c whenever appropriate. At least one hart. remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). N225 Incomplete/invalid documentation/ orders/notes/ summary/report/c hart. 041 Medi-Cal benefits cannot be 16 Claim/service lacks information CO Contractu MA04 Secondary paid without proof of needed for adjudication. Additional al payment cannot payment/denial from other information is supplied using Obligation be considered coverage. remittance advice remarks codes s without the whenever appropriate. At least one identity of or remark code must be provided (may payment be comprised of either the information from Remittance Advice Remark Code or the primary NCPDP Reject Reason Code). payer. The information was either not reported or was illegible. 042 Date of service is missing or 16 Claim/service lacks information CO Contractu MA31 Missing/incomplet invalid. needed for adjudication. Additional al e/ information is supplied using Obligation invalid beginning remittance advice remarks codes s and ending dates whenever appropriate. At least one for the period remark code must be provided (may billed. be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). 043 Patient status code is not 125 Payment adjusted due to a CO Contractu MA43 Missing/incomplet appropriate for accommodation submission/billing error(s). al e/ code listed. Additional information is supplied Obligation invalid patient using the remittance advice remarks s status. codes whenever appropriate. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). 044 Accommodation code is not 125 Payment adjusted due to a CO Contractu M50 Missing/incomplet appropriate for patient status submission/billing error(s). al e/ code listed. Additional information is supplied Obligation invalid revenue using the remittance advice remarks s code(s). codes whenever appropriate. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). 045 Service period is in excess of B5 Payment adjusted because CO Contractu MA32 Missing/incomplet period allowed for patient coverage/program guidelines were al e/ status or “from-thru” period. not met or were exceeded. Obligation invalid number of s covered days during the billing period. 1 – RAD to National Code Correlation: 001 – 099 March 2007 remit elect corr001 6

046 SSN (Social Security Number) is 16 Claim/service lacks information CO Contractu N225 Incomplete/invalid not permitted for billing Medi- needed for adjudication. Additional al documentation/ Cal. information is supplied using Obligation orders/notes/ remittance advice remarks codes s summary/report/c whenever appropriate. At least one hart. remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 047 TAR (Treatment Authorization 15 Payment adjusted because the CO Contractu N351 Service date Request) is invalid for services submitted authorization number is al outside of the and/or period billed. missing, invalid or does not apply to Obligation approved the billed services or provider. s treatment plan service dates. 048 Patient discharged within 24 B5 Payment adjusted because CO Contractu hours of LOA (Leave of coverage/program guidelines were al Absence) return. not met or were exceeded. Obligation s 049 Provider billing error. Claim line 125 Payment adjusted due to a CO Contractu N225 Incomplete/invalid is invalid. Verify line charge, submission/billing error(s). al documentation/ procedure code and other line Additional information is Obligation orders/notes/ information. supplied using the remittance s summary/ advice remarks codes whenever report/chart. appropriate. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). N379 Claim level information does not match line level information. 050 Denied as a result of internal 63 Correction to a prior claim. (X12 CR Correction processing error. Claim is now request to and being reprocessed. re-activate.) Reversals 051 Signature is missing or is not an 125 Payment adjusted due to a CO Contractu MA70 Missing/incomplet original. submission/billing error(s). al e/ Additional information is Obligation invalid provider supplied using the remittance s representative advice remarks codes whenever signature. appropriate. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). Contractu MA81 Missing/incomplet al e/ Obligation invalid s provider/supplier signature. 052 RTD (Resubmission Turnaround 17 Payment adjusted because CO Contractu N225 Incomplete/invalid Document) returned unsigned requested information was not al documentation/ or without requested provided or was Obligation orders/notes/ information. insufficient/incomplete. Additional s summary/report/ information is supplied using the chart. remittance advice remarks codes whenever appropriate. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).

053 Unable to process claim due to 17 Payment adjusted because CO Contractu N225 Incomplete/invalid illegibility, incorrect format or requested information was not al documentation/ attachment. provided or was Obligation orders/notes/ insufficient/incomplete. Additional s summary/report/ information is supplied using the chart. remittance advice remarks codes whenever appropriate. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). 054 Our records do not show that 125 Payment adjusted due to a CO Contractu N225 Incomplete/inva this manufacturer makes the submission/billing error(s). al lid product(s) billed. Additional information is Obligation documentation/ supplied using the remittance s orders/notes/ advice remarks codes whenever summary/report appropriate. At least one / Remark Code must be provided chart. (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 055 The primary/secondary 167 This (these) diagnosis(es) is CO Contractu M76 Missing/incomplet diagnosis codes have no match (are) not covered. al e/ on the diagnosis file. The Obligation invalid diagnosis primary diagnosis code must be s or condition. the condition resulting in incontinence; the secondary diagnosis code must be the type of incontinence when billing for incontinence supplies. 056 Billing error: Refer to use of 4 The procedure code is inconsistent CO Contractu modifier with the modifier used or a required al ZM, ZN, or 99 for correct billing modifier is missing. Obligation of supplies. s 057 The modifier/qualifier billed 16 Claim/service lacks information CO Contractu MA69 Missing/incomplet requires a statement of medical needed for adjudication. Additional al e/ necessity in the Remarks information is supplied using Obligation invalid remarks. area/Reserved for Local Use remittance advice remarks codes s field (Box 19) of the claim or on whenever appropriate. At least an attachment. one remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). 058 The procedure code is 11 The diagnosis is inconsistent with the CO Contractu inconsistent with the primary procedure. al diagnosis code. Obligation s 059 The combination of procedure 8 The procedure code is inconsistent CO Contractu code and type has no match on with the provider type. al the procedure file. Obligation s 060 Invalid Record – internal denial Not CO Contractu (does not appear on Provider match al RAD) ed Obligation s 061 The procedure code and type 96 Non-covered charge(s). At least CO Contractu MA66 Missing/incompl are not a covered benefit on the one Remark Code must be al ete/ date of service. provided (may be comprised of Obligation invalid principal either the Remittance Advice s procedure code. Remark Code or NCPDP Reject Reason Code). MA31 Missing/incompl ete invalid beginning and ending dates for the period billed. 062 The Place of Service is not 58 Payment adjusted because CO Contractu M77 Missing/incomplet acceptable for this procedure. treatment was deemed by the payer al e/ to have been rendered in an Obligation invalid place of inappropriate or invalid place of s service. service. 063 The procedure is not consistent 6 The procedure code is inconsistent CO Contractu with the recipient’s age. with the patient's age. al Obligation s 064 The procedure is not consistent 7 The procedure code is inconsistent CO Contractu with the recipient’s sex. with the patient's sex. al Obligation s

065 The provider type is not allowed B7 This provider was not CO Contractu N95 This provider to perform this procedure. certified/eligible to be paid for this al type/provider procedure/service on this date of Obligation specialty may not service. s bill this service. 066 The reimbursement information 16 Claim/service lacks information CO Contractu N354 Incomplete/invalid on this claim does not equal the needed for adjudication. Additional al Medicare coinsurance and information is supplied using Obligation invoice. deductible amounts indicated remittance advice remarks codes s on the invoice. whenever appropriate. At least one remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). 067 The primary/secondary surgical 96 Non-covered charge(s). At least CO Contractu MA66 Missing/incomplet procedure code has no match one Remark Code must be al e/ on the procedure file. provided (may be comprised of Obligation invalid principal either the Remittance Advice s procedure code. Remark Code or NCPDP Reject Reason Code). N303 Missing/incomplet e/ invalid principal procedure date.

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 068 Billing error: Refer to the CPT-4 4 The procedure code is inconsistent CO Contractu MA66 Missing/incomplet book or provider manual for the with the modifier used or a required al e/ proper procedure code and modifier is missing. Obligation invalid principal modifier. s procedure code. 069 This is a duplicate of a previous 18 Duplicate claim/service. CO Contractu adjustment. al Obligation s 070 Denied by VCCR (Vision Care A1 Claim/service denied. At least one CO Contractu N10 Claim/service Claims Review) – not Remark Code must be provided (may al adjusted based on reconsidered per provider. be comprised of either the Obligation the findings of a Remittance Advice Remark Code or s review NCPDP Reject Reason Code). organization/ professional consult/manual adjudication/medi cal or dental advisor. 071 The maximum allowance for 119 Benefit maximum for this time CO Contractu N362 The number of this service/procedure has been period or occurrence has been al days or units of paid. reached. Obligation service exceeds s the acceptable maximum. 072 This service is included in 97 Payment adjusted because the CO Contractu another procedure code billed benefit for this service is included in al on the same date of service. the payment/ Obligation allowance for another s service/procedure that has already been adjudicated. 073 Billing error: Z7610, 99070, 125 Payment adjusted due to a CO Contractu N225 Incomplete/invalid inappropriate for billing this submission/billing error(s). al documentation/ type of item (for example, Additional information is supplied Obligation orders/notes/ drugs, hearing aid batteries). using the remittance advice remarks s summary/report/ codes whenever appropriate. At chart. least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). N29 Missing documentation/ orders/notes/ summary/report/ chart. N232 Incomplete/invalid itemized bill. 074 This service is included in the 97 Payment adjusted because the CO Contractu surgical fee. benefit for this service is included in al the payment/ Obligation allowance for another s service/procedure that has already been adjudicated. 075 The necessary documentation 16 Claim/service lacks information CO Contractu N29 Missing was not received. needed for adjudication. Additional al documentation/ information is supplied using Obligation orders/notes/ remittance advice remarks codes s summary/report/c whenever appropriate. At least one hart. remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).

076 The submitted documentation 16 Claim/service lacks information CO Contractu N225 Incomplete/invalid was not adequate. needed for adjudication. Additional al documentation/ information is supplied using Obligation orders/notes/ remittance advice remarks codes s summary/report/c whenever appropriate. At least one hart. remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code).

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 077 This transportation must be 150 Payment adjusted because the CO Contractu N29 Missing ordered by a physician for payer deems the information al documentation/or reasons of medical necessity. submitted does not support this Obligation ders/notes/summa level of service. s ry/report/ chart. N225 Incomplete/invalid documentation/ orders/notes/ summary/report/c hart. 079 Service billed exceeds 198 Payment denied/reduced for CO Contractu N351 Service date remaining occurrences exceeded al outside of the approved on the TAR precertification/authorization. Obligation approved (Treatment Authorization s treatment plan Request). service dates. 080 Procedure code is invalid for 125 Payment adjusted due to a CO Contractu MA66 Missing/incomplet admission type. submission/billing error(s). al e/ Additional information is supplied Obligation invalid principal using the remittance advice remarks s procedure code. codes whenever appropriate. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). N303 Missing/incomplet e/ invalid principal procedure date. MA41 Missing/incomplet e/ invalid admission type. 081 The specific item billed is not a 96 Non-covered charge(s). At least one CO Contractu N225 Incomplete/invalid Medi-Cal benefit. Remark Code must be provided (may al documentation/ be comprised of either the Obligation orders/notes/ Remittance Advice Remark Code or s summary/report/ NCPDP Reject Reason Code). chart. 082 Service exceeds maximum 35 Benefit maximum has been reached. CO Contractu N362 The number of allowed by Medi-Cal policy. al days or units of Obligation service exceeds s the acceptable maximum. 083 Provider is not Medicare- B7 This provider was not CO Contractu certified for laboratory certified/eligible to be paid for this al procedure on date of service. procedure/service on this date of Obligation service. s 084 Accommodation cost center is 6 The procedure code is inconsistent CO Contractu M50 Missing/incomplet inappropriate for age of with the patient's age. al e/ recipient. Obligation invalid revenue s code(s). N329 Missing/incomplet e/ invalid patient birth date. 085 Ancillary code has no match on 96 Non-covered charge(s). At least one CO Contractu MA66 Missing/incomplet procedure file. Remark Code must be provided (may al e/ be comprised of either the Obligation invalid principal Remittance Advice Remark Code or s procedure code. NCPDP Reject Reason Code).

N303 Missing/incomplet e/ invalid principal procedure date. 086 OBRA/IRCA/100%/133%/185%/2 95 Benefits adjusted. Plan procedures CO Contractu N30 Patient ineligible 00% recipients are not eligible not followed. al for this service. for long term care or vision care Obligation services. s 087 This procedure has been 119 Benefit maximum for this time CO Contractu N117 This service is performed previously for this period or occurrence has been al paid only once in recipient. It is payable only once reached. Obligation a patient’s in a lifetime. s lifetime.

RAD RAD Code Description HIPAA ARC Description HIPA AGC HIPA HCRC Cod ARC A Descripti A Description e AGC on HCRC 088 The secondary diagnosis code 9 The diagnosis is inconsistent with the CO Contractu is invalid for the age of the patient’s age. al recipient. Obligation s 089 The secondary diagnosis code 10 The diagnosis is inconsistent with the CO Contractu M64 Missing/incomplet is invalid for the sex of the patient's sex. al e/ recipient. Obligation invalid/other s diagnosis. 090 The combination of service 4 The procedure code is inconsistent CO Contractu code and modifier is not valid. with the modifier used or a required al modifier is missing. Obligation s 091 Our records do not show 16 Claim/service lacks information CO Contractu MA69 Missing/incomplet documentation for the modifier needed for adjudication. Additional al e/ billed. information is supplied using Obligation invalid remarks. remittance advice remarks codes s whenever appropriate. At least one remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). N29 Missing documentation/ orders/notes/ summary/report/c hart. N225 Incomplete/invalid documentation/ orders/notes/ summary/report/c hart. 092 This Short-Doyle mental health 109 Claim not covered by this CO Contractu service is not reimbursable by payer/contractor. You must send the al Medi-Cal; submit to the State’s claim to the correct Obligation program office. payer/contractor. s 093 Non-emergency services are 40 Charges do not meet qualifications CO Contractu N30 Patient ineligible not payable for limited service for emergent/urgent care. al for this service. OBRA/IRCA recipients. Obligation s 094 The rendering provider is not 184 The prescribing/ordering provider is CO Contractu N252 Missing/incomplet eligible for this group type. not eligible to prescribe/order the al e/ Please resubmit claim using service billed. Obligation invalid attending individual provider number or s provider name. under appropriate group type. N290 Missing/incomplet e/ invalid rendering provider primary identifier. 095 This service is not payable due B13 Previously paid. Payment for this CO Contractu to a procedure, or procedure claim/service may have been al and modifier, previously provided in a previous payment. Obligation reimbursed. s 096 This service requires an original 197 Payment denied/reduced for CO Contractu M62 Missing/incomplet MEDI label, Medi-Service absence of al e/ reservation or an approved TAR precertification/authorization. Obligation invalid treatment (Treatment Authorization s authorization Request). code.

097 Billed service is not payable A2 Contractual adjustment. CO Contractu due to al no-fee billing agreement. Obligation s 098 Hospital contract exception. 16 Claim/service lacks information CO Contractu N29 Missing Requires provider certification. needed for adjudication. Additional al documentation/ information is supplied using Obligation orders/notes/ remittance advice remarks codes s summary/report/c whenever appropriate. At least hart. one remark code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code). 099 Well-child services provided by 109 Claim not covered by this CO Contractu Child Health and Disability payer/contractor. You must send the al Prevention (CHDP) program claim to the correct Obligation providers must be billed to payer/contractor. s CHDP.

1 – RAD to National Code Correlation: 001 – 099 March 2007