M1 X-ray not taken within the past 12 months or near enough to the start of treatment.
M2 Not paid separately when the patient is an inpatient.
M3 Equipment is the same or similar to equipment already being used.
M4 This is the last monthly installment payment for this durable medical equipment.
M5 Monthly rental payments can continue until the earlier of the 15th month from the first
rental month, or the month when the equipment is no longer needed.
M6 You must furnish and service this item for as long as the patient continues to need it.
We can pay for maintenance and/or servicing for every 6-month period after the end of
the 15th paid rental month or the end of the warranty period.
M7 No rental payments after the item is purchased, or after the total of issued rental
payments equals the purchase price.
M8 We do not accept blood gas tests results when the test was conducted by a medical
supplier or taken while the patient is on oxygen.
M9 This is the tenth rental month. You must offer the patient the choice of changing the
rental to a purchase agreement.
M10 Equipment purchases are limited to the first or the tenth month of medical necessity.
M11 DME, orthotics and prosthetics must be billed to the DME carrier who services the
patient's zip code.
M12 Diagnostic tests performed by a physician must indicate whether purchased services
are included on the claim.
M13 No more than one initial visit may be covered per specialty per medical group. Visit
may be rebilled with an established visit code.
M14 No separate payment for an injection administered during an office visit, and no
payment for a full office visit if the patient only received an injection.
M15 Separately billed services/tests have been bundled as they are considered components
of the same procedure. Separate payment is not allowed.
M16 See the letter or bulletin of (date) for further information. [Note: Payer must supply
the date of the letter/bulletin.]
M17 Payment approved as you did not know, and could not reasonably have been expected
to know, that this would not normally have been covered for this patient. In the future,
you will be liable for charges for the same service(s) under the same or similar
conditions.
M18 Certain services may be approved for home use. Neither a hospital nor a SNF is
considered to be a patient's home.
M19 Oxygen certification/recertification (HCFA-484) is incomplete or is required.
M20 HCPCS needed.
M21 Claim for services/items provided in a home must indicate the place of residence.
M22 Claim lacks the number of miles traveled.
M23 Invoice needed for the cost of the material or contrast agent.
M24 Claim must indicate the number of doses per vial.
M25 Payment has been (denied for the/made only for a less extensive) service because the
information furnished does not substantiate the need for the (more extensive) service.
If you believe the service should have been fully covered as billed, or if you did not
know and could not reasonably have been expected to know that we would not pay for
this (more extensive) service, or if you notified the patient in writing in advance that
we would not pay for this (more extensive) service and he/she agreed in writing to pay,
ask us to review your claim within six months of receiving this notice. If you do not
request a review, we will, upon application from the patient, reimburse him/her for the
amount you have collected from him/her (for the/in excess of any deductible and
coinsurance amounts applicable to the less extensive) service. We will recover the
reimbursement from you as an overpayment.
M26 Payment has been (denied for the/made only for a less extensive) service because the
information furnished does not substantiate the need for the (more extensive) service.
If you have collected (any amount from the patient/any amount that exceeds the
limiting charge for the less extensive service), the law requires you to refund that
amount to the patient within 30 days of receiving this notice.
The law permits exceptions to the refund requirement in two cases:
1. If you did not know, and could not have reasonably been expected to know, that we
would not pay for this service: or
2. If you notified the patient in writing before providing the service that you believed
that we were likely to deny the service, and the patient signed a statement agreeing
to pay for the service.
If you come within either exception, or if you believe the carrier was wrong in its
determination that we do not pay for this service, you should request review of this
determination within 30 days of receiving this notice. Your request for review should
include any additional information necessary to support your position. If you request
review within the 30-day period, you may delay refunding the amount to the patient
until you receive the results of the review. If the review decisions favorable to you,
you do not need to make any refund. If, however, the review is unfavorable, the law
specifies that you must make the refund within 15 days of receiving the unfavorable
review decision.
The law also permits you to request review at any time within six months of receiving
this notice. A review requested after the 30-day period does not permit you to delay
making the refund. Regardless of when a review is requested, the patient will be
notified that you have requested one, and will receive a copy of the determination.
The patient has received a separate notice of this denial decision. The notice advises
that he/she may be entitled to a refund of any amounts paid, if you should have known
that we would not pay and did not tell him/her. It also instructs the patient to contact
your office if he/she does not hear anything about a refund within 30 days. The
requirements for refund are in §1842(l) of the Social Security Act and 42CFR411.408.
The section specifies that physicians who knowingly and willfully fail to make
appropriate refunds may be subject to civil monetary penalties and/or exclusion from
the program. Contact this office if you have any questions about this notice.
M27 The patient has been relieved of liability of payment of these items and services under
the limitation of liability provision of the law. You, the provider, are ultimately liable
for the patient's waived charges, including any charges for coinsurance, since the items
or services were not reasonable and necessary or constituted custodial care, and you
knew or could reasonably have been expected to know, that they were not covered.
You may appeal this determination provided that the patient does not exercise his/her
appeal rights. If the beneficiary appeals the initial determination, you are automatically
made a party to the appeals determination. If, however, the patient or his/her
representative has stated in writing that he/she does not intend to request a
reconsideration, or the patient's liability was entirely waived in the initial
determination, you may initiate an appeal.
You may ask for a reconsideration for hospital insurance (or a review for medical
insurance) regarding both the coverage determination and the issue of whether you
exercised due care. The request for reconsideration must be filed within 60 days (or 6
months for a medical insurance review) from the date of this notice. You may make
the request through any Social Security office or through this office.
M28 This does not qualify for payment under Part B when Part A coverage is exhausted or
not otherwise available.
M29 Claim lacks the operative report.
M30 Claim lacks the pathology report.
M31 Claim lacks the radiology report.
M32 This is a conditional payment made pending a decision on this service by the patient's
primary payer. This payment may be subject to refund upon your receipt of any
additional payment for this service from another payer. You must contact this office
immediately upon receipt of an additional payment for this service.
M33 Claim lacks the UPIN of the ordering/referring or performing physician or practitioner,
or the UPIN is invalid.
M34 Claim lacks the CLIA certification number.
M35 Claim lacks pre-operative photos or visual field results.
M36 This is the 11th rental month. We cannot pay for this until you indicate that the patient
has been given the option of changing the rental to a purchase.
M37 Service not covered when the patient is under age 35.
M38 The patient is liable for the charges for this service as you informed the patient in
writing before the service was furnished that we would not pay for it, and the patient
agreed to pay.
M39 The patient is not liable for payment for this service as the advance notice of
noncoverage you provided the patient did not comply with program requirements.
M40 Claim must be assigned and must be filed by the practitioner's employer.
M41 We do not pay for this as the patient has no legal obligation to pay for this.
M42 The medical necessity form must be personally signed by the attending physician.
M43 Payment for this service previously issued to you or another provider by another
carrier/intermediary.
M44 Incomplete/invalid condition code.
M45 Incomplete/invalid occurrence codes and dates.
M46 Incomplete/invalid occurrence span code and dates.
M47 Incomplete/invalid internal or document control number.
M48 Payment for services furnished to hospital inpatients (other than professional services
of physicians) can only be made to the hospital. You must request payment from the
hospital rather than the patient for this service.
M49 Incomplete/invalid value code(s) and/or amount(s).
M50 Incomplete/invalid revenue code(s).
M51 Incomplete/invalid, procedure code(s) and/or rates, including “not otherwise
classified” or “unlisted” procedure codes submitted without a narrative description or
the description is insufficient. (Add to message by Medicare carriers only: “Refer to
the HCPCS Directory. If an appropriate procedure code(s) does not exist, refer to Item
19 on the HCFA-1500 instructions.")
M52 Incomplete/invalid “from” date(s) of service.
M53 Did not complete or enter the appropriate number (one or more) of days or units(s) of
service.
M54 Did not complete or enter the correct total charges for services rendered.
M55 We do not pay for self-administered anti-emetic drugs that are not administered with a
covered oral anti-cancer drug.
M56 Incomplete/invalid payer identification.
M57 Incomplete/invalid provider number.
M58 Resubmit the claim with the missing/correct information so that it may be processed.
M59 Incomplete/invalid “to” date(s) of service.
M60 Rejected without appeal rights due to invalid CMN form or format. Resubmit with
completed, OMB-approved form or in an approved format.
M61 We cannot pay for this as the approval period for the FDA clinical trial has expired.
M62 Incomplete/invalid treatment authorization code.
M63 We do not pay for more than one of these on the same day.
M64 Incomplete/invalid other diagnosis code.
M65 One interpreting physician charge can be submitted per claim when a purchased
diagnostic test is indicated. Submit a separate claim for each interpreting physician.
M66 Our records indicate that you billed diagnostic tests subject to price limitations and the
procedure code submitted includes a professional component. Only the technical
component is subject to price limitations. Submit the technical and professional
components of this service as separate line items.
M67 Incomplete/invalid other procedure code(s) and/or date(s).
M68 Incomplete/invalid attending or referring physician identification.
M69 Paid at the regular rate as you did not submit documentation to justify modifier 22.
M70 NDC code submitted for this service was translated to a HCPCS code for processing,
but continue to submit the NDC on future claims for this item.
M71 Total payment reduced due to overlap of tests billed.
M72 Did not enter full 8-digit date (MM/DD/CCYY).
M73 The HPSA bonus can only be paid on the professional component of this service.
Rebill as separate professional and technical components. Use the HPSA modifier on
the professional component only.
M74 This service does not qualify for a HPSA bonus payment.
M75 Allowed amount adjusted. Multiple automated multichannel tests performed on the
same day combined for payment.
M76 Incomplete/invalid patient's diagnosis(es) and condition(s).
M77 Incomplete/invalid place of service(s).
M78 Did not complete or enter accurately an appropriate HCPCS modifier(s).
M79 Did not complete or enter the appropriate charge for each listed service.
M80 We cannot pay for this when performed during the same session as a previously
processed service for the patient.
M81 Patient’s diagnosis code(s) is truncated, incorrect or missing; you are required to code
to the highest level of specificity.
M82 Service is not covered when patient is under age 50.
M83 Service is not covered unless the patient is classified as at high risk.
M84 Old and new HCPCS cannot be billed for the same date of service.
M85 Subjected to review of physician evaluation and management services.
M86 Service denied because payment already made for similar procedure within set time
frame.
M87 Claim/service(s) subjected to CFO-CAP prepayment review.
M88 We cannot pay for laboratory tests unless billed by the laboratory that did the work.
M89 Not covered more than once under age 40.
M90 Not covered more than once in a 12-month period.
M91 Lab procedures with different CLIA certification numbers must be billed on separate
claims.
M92 Services subjected to review under the Home Health Medical Review Initiative.
M93 Information supplied supports a break in therapy. A new capped rental period began
with delivery of this equipment.
M94 Information supplied does not support a break in therapy. A new capped rental period
will not begin.
M95 Services subjected to Home Health Initiative medical review/cost report audit.
M96 The technical component of a service furnished to an inpatient may only be billed by
that inpatient facility. You must contact the inpatient facility for technical component
reimbursement. If not already billed, you should bill us for the professional
component only.
M97 Not paid to practitioner when provided to patient in this place of service. Payment
included in the reimbursement issued the facility.
M98 Begin to report the Universal Product Number on claims for items of this type. We
will soon begin to deny payment for items of this type if billed without the correct
UPN.
M99 Incomplete/invalid/missing Universal Product Number.
M100 We do not pay for an oral anti-emetic drug that is not administered for use immediately
before, at, or within 48 hours of administration of a covered chemotherapy drug.
M101 Begin to report a G1-G5 modifier with this HCPCS. We will soon begin to deny
payment for this service if billed without a G1-G5 modifier.
M102 Service not performed on equipment approved by the FDA for this purpose.
M103 Information supplied supports a break in therapy. However, the medical information
we have for this patient does not support the need for this item as billed. We have
approved payment for this item at a reduced level, and a new capped rental period will
begin with the delivery of this equipment.
M104 Information supplied supports a break in therapy. A new capped rental period will
begin with delivery of the equipment. This is the maximum approved under the fee
schedule for this item or service.
M105 Information supplied does not support a break in therapy. The medical information we
have for this patient does not support the need for this item as billed. We have
approved payment for this item at a reduced level, and a new capped rental period will
not begin.
M106 Information supplied does not support a break in therapy. A new capped rental period
will not begin. This is the maximum approved under the fee schedule for this item or
service.
M107 Payment reduced as 90-day rolling average hematocrit for ESRD patient exceeded
36.5%.
M108 Must report the PIN of the physician who interpreted the diagnostic test.
M109 We have provided you with a bundled payment for a teleconsultation. You must send
25 percent of the teleconsultation payment to the referring practitioner.
M110 Missing/invalid provider number for the provider from whom you purchased
interpretation services.
M111 We do not pay for chiropractic manipulative treatment when the patient refuses to have
an x-ray taken.
M112 The approved amount is based on the maximum allowance for this item under the
DMEPOS Competitive Bidding Demonstration.
M113 Our records indicate that this patient began using this service(s) prior to the current
round of the DMEPOS Competitive Bidding Demonstration. Therefore, the approved
amount is based on the allowance in effect prior to this round of bidding for this item.
M114 This service was processed in accordance with rules and guidelines under the
Competitive Bidding Demonstration Project. If you would like more information
regarding this project, you may phone 1-888-289-0710.
M115 This item is denied when provided to this patient by a nondemonstration supplier.
M116 Even though this service is being paid in accordance with the rules and guidelines
under the Competitive Bidding Demonstration, future claims may be denied when this
item is provided this patient by a nondemonstration supplier. If you would like more
information regarding this project, you may phone 1-888-289-0710.
M117 Not covered unless supplier files an electronic media claim (EMC).
M118 Letter to follow containing further information.
M119 National Drug Code (NDC) needed.
M120 Lacks UPIN of the substituting physician who furnished the service(s) under a
reciprocal billing or locum tenens arrangement.
M121 We pay for this service only when performed with a covered cryosurgical ablation.
M122 Level of subluxation is missing or inadequate.
M123 Failed to submit the name, strength, or dosage of the drug furnished.
M124 Information to indicate if the patient owns the equipment that requires the part or
supply was missing.
M125 Information about the period of time for which this will be needed was missing.
M126 The individual lab codes included in the test were not submitted.
M127 The patient’s medical record for this service was not submitted with the claim as
required.
M128 The date of the patient’s most recent physician visit must be submitted.
M129 Indicator lacking that “X-ray is available for review.”
M130 Invoice or statement certifying the actual cost of the lens, less discounts, or the type of
intraocular lens used was missing.
M131 Completed physician financial relationship form not on file.
M132 Completed pacemaker registration form required.
M133 Claim did not identify who performed the purchased diagnostic test or the amount you
were charged for the test.
M134 Performed by a facility/supplier in which the ordering/referring physician has a
financial interest.
M135 Claim lacked indication that the plan of treatment is on file.
M136 Claim lacked indication that the service was supervised or evaluated by a physician.
M137 Part B coinsurance under a demonstration project.
M138 Patient identified as a demonstration participant but the patient was not enrolled in the
demonstration at the time services were rendered. Coverage is limited to
demonstration participants.
M139 Denied services exceed the coverage limit for the demonstration.
M140 Service not covered until after the patient’s 50th birthday, i.e., no coverage prior to the
day after the 50th birthday.
M141 Missing/incomplete/invalid physician certified plan of care.
M142 Missing/incomplete/invalid American Diabetes Association Certificate of Recognition
to establish qualification.
M143 We have no record that you are licensed to dispense drugs in the State where located.
M144 Pre-/post-operative care payment is included in the allowance for the
surgery/procedure.
MA01 If you do not agree with what we approved for these services, you may appeal our
decision. To make sure that we are fair to you, we require another individual that did
not process your initial claim to conduct the review. However, in order to be eligible
for a review, you must write to us within 6 months of the date of this notice, unless you
have a good reason for being late.
MA02 If you do not agree with this determination, you have the right to appeal. You must
file a written request for a reconsideration within 60 days of receipt of this notification.
Decisions made by a PRO must be appealed to that PRO.
MA03 If you do not agree with the approved amounts and $100 or more is in dispute (less
deductible and coinsurance), you may ask for a hearing. You must request a hearing
within 6 months of the date of this notice. To meet the $100, you may combine
amounts on other claims that have been denied. This includes reopened reviews if you
received a revised decision. You must appeal each claim on time. At the hearing, you
may present any new evidence which could affect our decision.
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.
MA05 Incorrect admission date, patient status or type of bill entry on claim.
MA06 Incorrect/incomplete/missing beginning and/or ending date(s) on claim.
MA07 The claim information has also been forwarded to Medicaid for review.
MA08 You should also submit this claim to the patient's other insurer for potential payment of
supplemental benefits. We did not forward the claim information as the supplemental
coverage is not with a Medigap plan, or you do not participate in Medicare.
MA09 Claim submitted as unassigned but processed as assigned. You agreed to accept
assignment for all claims.
MA10 The patient's payment was in excess of the amount owed. You must refund the
overpayment to the patient.
MA11 Payment is being issued on a conditional basis. If no-fault insurance, liability
insurance, workers' compensation, Department of Veterans Affairs, or a group health
plan for employees and dependents also covers this claim, a refund may be due us.
Contact us if the patient is covered by any of these sources.
MA12 You have not established that you have the right under the law to bill for services
furnished by the person(s) that furnished this (these) service(s).
MA13 You may be subject to penalties if you bill the patient for amounts not reported with
the PR (patient responsibility) group code.
MA14 Patient is a member of an employer-sponsored prepaid health plan. Services from
outside that health plan are not covered. However, as you were not previously notified
of this, we are paying this time. In the future, we will not pay you for non-plan
services.
MA15 Your claim has been separated to expedite handling. You will receive a separate notice
for the other services reported.
MA16 The patient is covered by the Black Lung Program. Send this claim to the Department
of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.
MA17 We are the primary payer and have paid at the primary rate. You must contact the
patient's other insurer to refund any excess it may have paid due to its erroneous
primary payment.
MA18 The claim information is also being forwarded to the patient's supplemental insurer.
Send any questions regarding supplemental benefits to them.
MA19 Information was not sent to the Medigap insurer due to incorrect/invalid information
you submitted concerning that insurer. Verify your information and submit your
secondary claim directly to that insurer.
MA20 SNF stay not covered when care is primarily related to the use of an urethral catheter
for convenience or the control of incontinence.
MA21 SSA records indicate mismatch with name and sex.
MA22 Payment of less than $1.00 suppressed.
MA23 Demand bill approved as result of medical review.
MA24 Christian Science Sanitorium/SNF bill in the same benefit period.
MA25 A patient may not elect to change a hospice provider more than once in a benefit
period.
MA26 Our records indicate that you were previously informed of this rule.
MA27 Incorrect entitlement number or name shown on the claim. Use the entitlement
number or name shown on this notice for future claims for this patient.
MA28 Receipt of this notice by a physician or supplier who did not accept assignment is for
information only and does not make the physician or supplier a party to the
determination. No additional rights to appeal this decision, above those rights already
provided for by regulation/instruction, are conferred by receipt of this notice.
MA29 Incomplete/invalid provider name, city, State, and zip code.
MA30 Incomplete/invalid type of bill.
MA31 Incomplete/invalid beginning and ending dates of the period billed.
MA32 Incomplete/invalid number of covered days during the billing period.
MA33 Incomplete/invalid number of noncovered days during the billing period.
MA34 Incomplete/invalid number of coinsurance days during the billing period.
MA35 Incomplete/invalid number of lifetime reserve days.
MA36 Incomplete/invalid patient's name.
MA37 Incomplete/invalid patient's address.
MA38 Incomplete/invalid patient's birthdate.
MA39 Incomplete/invalid patient's sex.
MA40 Incomplete/invalid admission date.
MA41 Incomplete/invalid type of admission.
MA42 Incomplete/invalid source of admission.
MA43 Incomplete/invalid patient status.
MA44 No appeal rights. Adjudicative decision based on law.
MA45 As previously advised, a portion or all of your payment is being held in a special
account.
MA46 The new information was considered, however, additional payment cannot be issued.
Review the information listed for the explanation.
MA47 Our records show you have opted out of Medicare, agreeing with the patient not to bill
Medicare for services/tests/supplies furnished. As result, we cannot pay this claim.
The patient is responsible for payment
MA48 Incomplete/invalid name and/or address of responsible party or primary payer.
MA49 Incomplete/invalid six-digit provider number of home health agency or hospice for
physician(s) performing care plan oversight services.
MA50 Incomplete/invalid investigational device exemption number for FDA-approved
clinical trial services.
MA51 Incomplete/invalid CLIA certification number for laboratory services billed by
physician office laboratory.
MA52 Did not enter full 8-digit date (MM/DD/CCYY for paper form or CCYY/MM/DD for
electronic format).
MA53 Inconsistent demonstration project information. Correct and resubmit with information
on no more than one demonstration project.
MA54 Physician certification or election consent for hospice care not received timely.
MA55 Not covered as patient received medical health care services, automatically revoking
his/her election to receive religious non-medical health care services.
MA56 Our records show you have opted out of Medicare, agreeing with the patient not to bill
Medicare for services/tests/supplies furnished. As result, we cannot pay this claim.
The patient is responsible for payment, but under Federal law, you cannot charge the
patient more than the limiting charge amount.
MA57 Patient submitted written request to revoke his/her election for religious nonmedical
health care services.
MA58 Incomplete release of information indicator.
MA59 The patient overpaid you for these services. You must issue the patient a refund within
30 days for the difference between his/her payment and the total amount shown as
patient responsibility on this notice.
MA60 Incomplete/invalid patient's relationship to insured.
MA61 Did not complete or enter correctly the patient's social security number or health
insurance claim number.
MA62 Telephone review decision
MA63 Incomplete/invalid principal diagnosis code.
MA64 Our records indicate that we should be the third payer for this claim. We cannot
process this claim until we have received payment information from the primary and
secondary payers.
MA65 Incomplete/invalid admitting diagnosis.
MA66 Incomplete/invalid principal procedure code and/or date.
MA67 Correction to a prior claim.
MA68 We did not crossover this claim because the secondary insurance information on the
claim was incomplete. Supply complete information or use the PLANID of the insurer
to assure correct and timely routing of the claim.
MA69 Incomplete/invalid remarks.
MA70 Incomplete provider representative signature.
MA71 Incomplete/invalid provider representative signature date.
MA72 The patient overpaid you for these assigned services. You must issue the patient a
refund within 30 days for the difference between his/her payment to you and the total
of the amount shown as patient responsibility and as paid to the patient on this notice.
MA73 Informational remittance associated with a Medicare demonstration. No payment
issued under fee-for-service Medicare as patient has elected managed care.
MA74 This payment replaces an earlier payment for this claim that was either lost, damaged
or returned.
MA75 Our records indicate neither a patient's or authorized representative's signature was
submitted on the claim. Since this information is not on file, resubmit.
MA76 Incomplete/invalid provider number of HHA or hospice when physician is performing
care plan oversight services.
MA77 The patient overpaid you. You must issue the patient a refund within 30 days for the
difference between the patient’s payment less the total of our and other payer payments
and the amount shown as patient responsibility on this notice.
MA78 The patient overpaid you. You must issue the patient a refund within 30 days for the
difference between our allowed amount total and the amount paid by the patient.
MA79 Billed in excess of interim rate.
MA80 Informational notice. No payment issued for this claim with this notice. Payment
issued to the hospital by its intermediary for all services for this encounter under a
demonstration project.
MA81 Our records indicate neither a physician or supplier signature is on the claim or on file.
MA82 Did not complete or enter the correct physician/supplier's billing number and/or billing
name, address, city, State, zip code, and phone number.
MA83 Did not indicate whether we are the primary or secondary payer. Refer to Item 11 in
the HCFA-1500 instructions for assistance.
MA84 Patient identified as participating in the National Emphysema Treatment Trial but our
records indicate that this patient is either not a participant, or has not yet been approved
for this phase of the study. Contact Johns Hopkins University, the study coordinator,
to resolve if there was a discrepancy.
MA85 Our records indicate that a primary payer exists (other than Medicare); however, you
did not complete or enter accurately the insurance plan/group/program name or
identification number. Enter the Plan ID when effective.
MA86 Our records indicate that there is insurance primary to ours; however, you either did
not complete or enter accurately the group or policy number of the insured.
MA87 Our records indicate that a primary payer exists (other than Medicare); however, you
did not complete or enter accurately the correct insured's name.
MA88 Our records indicate that a primary payer exists (other than Medicare); however, you
did not complete or enter accurately the insured's address and/or telephone number.
MA89 Our records indicate that a primary payer exists (other than Medicare); however, you
did not complete or enter the appropriate patient's relationship to the insured.
MA90 Our records indicate that there is insurance primary to ours; however, you either did
not complete or enter accurately the employment status code of the primary insured.
MA91 This determination is the result of the appeal you filed.
MA92 Our records indicate that there is insurance primary to ours; however, you did not
complete or enter accurately the required information. Refer to the HCFA-1500
instructions on how to complete MSP information.
MA93 Non-PIP claim.
MA94 Did not enter the statement “Attending physician not hospice employee” on the claim
to certify that the rendering physician is not an employee of the hospice. Refer to item
19 on the HCFA-1500.
MA95 A “not otherwise classified” or “unlisted” procedure code(s) was billed, but a narrative
description of the procedure was not entered on the claim. Refer to item 19 on the
HCFA-1500.
MA96 Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not
enrolled in a Medicare managed care plan.
MA97 Claim rejected. Does not contain the Medicare Managed Care Demonstration contract
number, however, the beneficiary is enrolled in a Medicare managed care plan.
MA98 Claim rejected. Does not contain the correct Medicare Managed Care Demonstration
contract number for this beneficiary.
MA99 Our records indicate that a Medigap policy exists; however, you did not complete or
enter accurately any of the required information. Refer to the HCFA-1500 instructions
on how to complete a mandated Medigap transfer.
MA100 Did not complete or enter accurately the date of current illness, injury or pregnancy.
MA101 A SNF is responsible for payment of outside providers who furnish these
services/supplies to residents.
MA102 Did not complete or enter accurately the referring/ordering/supervising
physician's/physician’s assistant’s, nurse practitioner’s, or clinical nurse specialist’s
name and/or UPIN.
MA103 Hemophilia add on
MA104 Did not complete or enter accurately the date the patient was last seen and/or the UPIN
of the attending physician.
MA105 Missing/invalid provider number for this place of service. Place of service code shown
as 21, 22, or 23 (hospital).
MA106 PIP claim
MA107 Paper claim contains more than three separate data items in field 19.
MA108 Paper claim contains more than one data item in field 23.
MA109 Claim processed in accordance with ambulatory surgical guidelines.
MA110 Our records indicate that you billed diagnostic test(s) subject to price limitations;
however, you did not indicate whether the test(s) were performed by an outside entity
or if no purchased tests are included on the claim.
MA111 Our records indicate that you billed diagnostic test(s) subject to price limitations and
indicated that the test(s) were performed by an outside entity; however, you did not
indicate the purchase price of the test(s) and/or the performing laboratory's name and
address.
MA112 Our records indicate that the performing physician/supplier/practitioner is a member of
a group practice; however, you did not complete or enter accurately their carrier
assigned individual and group PINs.
MA113 Incomplete/invalid taxpayer identification number (TIN) submitted by you per the
Internal Revenue Service. Your claims cannot be processed without your correct TIN,
and you may not bill the patient pending correction of your TIN. There are no appeal
rights for unprocessable claims, but you may resubmit this claim after you have
notified this office of your correct TIN.
MA114 Did not complete or enter accurately the name and address, the carrier assigned PIN, or
the regional office assigned OSCAR number of the entity where services were
furnished.
MA115 Our records indicate that you billed one or more services in a Health professional
shortage area (HPSA); however, you did not enter the physical location (name and
address, or PIN) where the service(s) were rendered.
MA116 Did not complete the statement "Homebound" on the claim to validate whether
laboratory services were performed at home or in an institution.
MA117 This claim has been assessed a $1 user fee.
MA118 Coinsurance and/or deductible amounts apply to a claim for services or supplies
furnished to a Medicare-eligible veteran through a facility of the Department of
Veterans Affairs. No Medicare payment issued.
MA119 Provider level adjustment for late claim filing applies to this claim.
MA120 Did not complete or enter accurately the CLIA number.
MA121 Did not complete or enter accurately the date the x-ray was performed.
MA122 Did not complete or enter accurately the initial date "actual" treatment occurred.
MA123 Your center was not selected to participate in this study, therefore, we cannot pay for
these services.
MA124 Processed for IME only.
MA125 Per legislation governing this program, payment constitutes payment in full.
MA126
MA127 Reserved for future use.
MA128 Did not complete or enter accurately the six-digit FDA approved, identification
number.
MA129 This provider was not certified for this procedure on this date of service. Effective
1/1/98, we will begin to deny payment for such procedures. Contact to correct or
obtain CLIA certification. The name and telephone number of the State agency to be
contacted in your state follows:
Wisconsin Department Of Health & Family Services — 608-266-5753
Illinois Department of Public Health — 217-782-6747
Michigan Department of Consumer & Industry Services — 517-241-2648
Minnesota Department Of Health Licensing & Certification Section — 651-215-8704
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are
afforded because the claim is unprocessable. Submit a new claim with the
complete/correct information.
MA131 Physician already paid for services in conjunction with this demonstration claim. You
must have the physician withdraw that claim and refund the payment before we can
process your claim.
MA132 Adjustment to the pre-demonstration rate.
MA133 Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient
stay.
MA134 Missing/incomplete/invalid provider number of the facility where the patient resides.
N1 You may appeal this decision in writing within the required time limits following
receipt of this notice.
N2 This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.
N3 Required/consent form incomplete, incorrect, or not on file.
N4 Prior insurance carrier EOB received was insufficient.
N5 EOB received from previous payer. Claim not on file.
N6 Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the
amount Medicare would have allowed if the patient were enrolled in Medicare Part A.
N7 Processing of this claim/service has included consideration under major medical
provisions.
N8 Crossover claim denied by previous payer and complete claim data not forwarded.
Resubmit this claim to this payer to provide adequate data for adjudication.
N9 Adjustment represents the estimated amount the primary payer may have paid.
N10 Claim/service adjusted because of the finding of a review organization/professional
consult/manual adjudication.
N11 Denial reversed because of medical review.
N12 Policy provides coverage supplemental to Medicare. As member does not appear to be
enrolled in Medicare Part B, the member is responsible for payment of the portion of
the charge that would have been covered by Medicare.
N13 Payment based on professional/technical component modifier(s).
N14 Payment based on a contractual amount or agreement, fee schedule, or maximum
allowable amount.
N15 Services for a newborn must be billed separately.
N16 Family/member out-of-pocket maximum has been met. Payment based on a higher
percentage.
N17 Per admission deductible.
N18 Payment based on the Medicare allowed amount.
N19 Procedure code incidental to primary procedure.
N20 Service not payable with other service rendered on the same date.
N21 Range of dates separated onto single lines.
N22 This procedure was added because it more accurately describes the services rendered.
N23 Patient liability may be affected due to coordination of benefits with primary carrier
and/or maximum benefit provisions.
N24 Electronic funds transfer (EFT) banking information incomplete/invalid.
N25 This company has been contracted by your benefit plan to provide administrative
claims payment services only. This company does not assume financial risk or
obligation with respect to claims processed on behalf of your benefit plan.
N26 Itemized bill required for claim adjudication.
N27 Treatment number not indicated on claim.
N28 Consent form requirements not fulfilled.
N29 Required documentation/orders/notes/summary/report/invoice needed to adjudicate.
N30 Recipient ineligible for this service.
N31 Prescribing/referring/attending practitioner license number is
absent/incorrect/incomplete.
N32 Provider performing service must submit claim.
N33 No record of health check prior to initiation of treatment.
N34 Incorrect claim form for this service.
N35 Program integrity/utilization review decision.
N36 Claim must meet primary payer’s processing requirements before we can consider
payment.
N37 Tooth number/letter required.
N38 Place of service missing.
N39 Procedure code is not compatible with tooth number/letter.
N40 Procedure requires x-ray.
N41 Authorization request denied.
N42 No record of mental health assessment.
N43 Bed hold or leave days exceeded.
N44 Payor’s share of regulatory surcharges, assessments, allowances or health care-related
taxes paid directly to the regulatory authority.
N45 Payment based on authorized amount.
N46 Missing/incomplete/invalid admission hour.
N47 Claim conflicts with another inpatient stay.
N48 Claim information does not agree with information received from other insurance
carrier.
N49 Court ordered coverage information needs validation.
N50 Discharge information missing/incomplete/incorrect/invalid.
N51 Electronic interchange agreement not on file for provider/submitter.
N52 Patient not enrolled in the billing provider's managed care plan on the date of service.
N53 Incomplete/invalid street, city, state and/or zip code for the point of pickup.
N54 Claim information is inconsistent with pre-certified/authorized services.
N55 Procedures for billing with group/referring/performing providers were not followed.
N56 Procedure code billed is not correct for the service billed.
N57 Missing/incomplete/invalid prescribing/dispensed date.
N58 Patient liability amount missing, invalid, or not on file.
N59 Refer to your provider manual for additional program and provider information.
N60 A valid NDC is required for payment of drug claims effective October 2002.
N61 Rebill services on separate claims.
N62 Inpatient admission spans multiple rate periods. Resubmit separate claims.
N63 Rebill services on separate claim lines.
N64 The “from” and “to” dates must be different.
N65 Procedure code or procedure rate count cannot be determined, or was not on file, for
the date of service/provider. Contact the Health Plan prior to refiling the claim.
N66 Claim lacks necessary documentation.
N67 Professional provider services not paid separately. Included in facility payment under
a demonstration project. Apply to that facility for payment, or resubmit your claim if:
the facility notifies you the patient was excluded from this demonstration; or if you
furnished these services in another location on the date of the patient’s admission or
discharge from a demonstration hospital. If services were furnished in a facility not
involved in the demonstration on the same date the patient was discharged from or
admitted to a demonstration facility, you must report the provider ID number for the
non-demonstration facility on the new claim.
N68 Prior payment being cancelled as we were subsequently notified this patient was
covered by a demonstration project in this site of service. Professional services were
included in the payment made to the facility. You must contact the facility for your
payment. Prior payment made to you by the patient or another insurer for this claim
must be refunded to the payer within 30 days.
N69 PPS code changed by claims processing system. Insufficient visits or therapies.
N70 Home health consolidated billing and payment applies. Ancillary providers/suppliers
must contact the HHA for reimbursement.
N71 Your unassigned claim for a drug or biological was processed as an assigned claim.
The law requires you must take assignments on all claims for drugs and biologicals.
N72 PPS code changed by medical reviewers. Not supported by clinical records.
N73 A SNF is responsible for payment of outside providers who furnish these
services/supplies to residents.
N74 Resubmit with multiple claims, each claim covering services provided in only one
calendar month
N75 Missing or invalid tooth surface information
N76 Missing or invalid number of riders (for ambulance services)
N77 Missing or invalid designated provider number
N78 The necessary components of the child and teen checkup (EPSDT) were not
completed.
N79 Service billed is not compatible with patient location information
N80 Missing or invalid prenatal screening information
N81 Procedure billed is not compatible with tooth surface code
N82 Provider must accept insurance payment as payment in full when a third party payer
contract specifies full reimbursement.
N83 No appeal rights. Adjudicative decision based on the provisions of a demonstration
project.
N84 Further installment payments forthcoming.
N85 Final installment payment.
N86 A failed trial of pelvic muscle exercise training is required in order for biofeedback
training for the treatment of urinary incontinence to be covered.
N87 Home use of biofeedback therapy is not covered.
N88 This payment is being made conditionally. An HHA episode of care notice has been
filed for this patient. When a patient is treated under a HHA episode of care,
consolidated billing requires that certain therapy services and supplies, such as this, be
included in the HHA’s payment. This payment will need to be recouped from you if
we establish that the patient is concurrently receiving treatment under a HHA episode
of care.
N89 Payment information for this claim has been forwarded to more than one other payer,
but format limitations permit only one of the secondary payers to be identified in this
remittance advice.