C4994 A3 0 Y C4994 CANNOT PROVIDE STATUS ELECTRONICALLY CONTACT PAYER 12302003 03052004

C5422 A3 1 Y C5422 REFUNDED CLAIM-ORIGINAL CLAIM ANALYST APPROVED 12292003 02182004

C5423 A3 1 Y C5423 REFUNDED CLAIM-ORIGINAL CLAIM SYSTEM APPROVED 12292003 02182004

C4497 A3 6 Y C4497 COPAY, DED, COINSURANCE ARE SUBSCRIBER'S RESPONSIBILITY 12192003 03052004

C2039 A3 7 Y C2039 ADDITIONAL INFORMATION REQUESTED BY PAYER 12192003 03052004

C1111 A3 9 Y C1111 PAYMENT DENIED CONTACT PAYER 12192003 03162004

C1864 A3 9 Y C1864 CLAIM PAYMENT DENIED CONTACT PAYER 12192003 03052004

C1875 A3 9 Y C1875 PMT DENIED SERVICE NOT COVERED CONTACT PAYER 12192003 02202004

C4780 A3 9 Y C4780 NO PAYMENT WILL BE MADE FOR THIS CLAIM CONTACT PAYER 12292003 02202004

C796 A3 9 Y C796 NO PAYMENT WILL BE MADE FOR THIS CLAIM CONTACT PAYER 08192003 03052004

C4971 A3 12 Y C4971 PAYMENT INCLUDED IN PRIMARY PROCEDURE 12292003 03052004

CBA004 A3 18 Y CBA004 INVALID BATCH NUMBER 12292003 02202004

C1110 A3 18 IN Y C1110 PAYER RECEIVED CLAIM RETURNED TO PROV NO ADDT'L INFO 12192003 03052004

C4316 A2 20 Y C4316 ACCEPTED FOR PROCESSING 12192003 02232004

C4429 A2 20 Y C4429 ACCEPTED FOR PROCESSING 12192003 02232004

CXX3DA A3 21 Y CXX3DA MISSING OR INVALID INFORMATION 11252003 02202004

C2974 A3 21 Y C2974 NUMERIC FIELD CONTAINS NON-NUMERIC DATA 12192003 03052004

C2976 A3 21 Y C2976 MANDATORY FIELD MISSING 10282003 02202004

C4106 A3 21 Y C4106 MISSING/INVALID INFORMATION OR REQ SEGMENT MISSING 12192003 03052004

P321 A3 21 IL Y P321 INVALID SUBSCRIBER PREGNANCY INDICATOR 02022004 03052004

P039 A3 21 QC Y P039 INVALID PATIENT PREGNANCY INDICATOR 02022004 03112004

CAA002 A3 24 Y CAA002 SUBMITTER ID NOT APPROVED AS AN ELECTRONIC SUBMITTER 12292003 02202004

D013 A3 24 Y D013 SUBMITTER PRODUCTION INDICATOR INVALID 02042003 03162004

D014 A3 24 Y D014 SUBMITTER TEST INDICATOR INVALID 02042003 03162004

D015 A3 24 Y D015 SUBMITTER NOT FOUND ON APPROVED EDI SUBMITTER FILE 02042003 03162004

F027 A3 24 Y F027 SUBMITTER ID IS INVALID MUST BE A 9 NUMERICS 09152002 03052004

C3817 A3 24 1P Y C3817 PROVIDER NOT APPROVED AS AN ELECTRONIC SUBMITTER 12192003 02202004

F001 A3 24 1P Y F001 PROVIDER CODE UNAUTHORIZED 08122003 02202004

A142 A3 24 85 Y A142 PROVIDER NOT AUTHORIZED TO SUBMIT PAY SUBSCRIBER CLAIMS 08122003 02242004

A787 A3 24 85 Y A787 PROVIDER IS NOT AUTHORIZED FOR ELECTRONIC BILLING 08122003 02242004

P001 A3 24 85 Y P001 BLUE SHIELD OR BCN BILLING PROV CODE UNAUTHORIZED 08122003 04142004

P002 A3 24 85 Y P002 MEDICARE B BILLING PROV CODE UNAUTHORIZED 08122003 02202004

P003 A3 24 85 Y P003 COMMERCIAL BILLING PROV CODE UNAUTHORIZED 08122003 02202004

P004 A3 24 85 Y P004 BLUE SHIELD BILLING PROV CODE UNAUTHORIZED 04012003 02202004

C6002 A3 25 Y C6002 DENIED NON-PAR PROVIDER NO AUTH ON FILE 06292004

A337 A3 25 FA Y A337 OPC FACILITY PROVIDER CODE INVALID OR PRIOR TO APPROVAL 08122003 02242004

C2402 A3 26 IL Y C2402 SUBSCRIBER NOT FOUND 12192003 02232004

B26QC A3 26 QC Y B26QC MEMBER NOT FOUND 06082004

51303 A3 26 QC 51303 MEMBER NOT FOUND 05172004 05192004

B261P A3 26 1P Y B261P PROVIDER NOT FOUND 06082004

C710 A3 26 1P Y C710 PROVIDER DATA MISSING OR INVALID CONTACT PAYER 12192003 02232004

P007 A3 26 1P Y P007 INVALID BCN BILLING PROVIDER CODE REPORTED. 08122003 06022004

51304 A3 26 1P 51304 PROVIDER NOT FOUND 05172004 05192004

C4376 A3 28 Y C4376 CLAIM SUBMITTED TO WRONG PAYER 12192003 02232004

C4496 A3 28 Y C4496 BILL MEDICARE FIRST 12192003 02232004

A212 A3 29 IL Y A212 SUBSCRIBER'S LAST NAME DOES NOT MATCH REPORTED CONTRACT NUM. 08122003 02242004

C3694 A3 29 IL Y C3694 SUBSCRIBER & POLICY NUMBER/CONTRACT NUMBER INVALID 12192003 02202004

A210 A3 32 IL Y A210 SUBSCRIBER'S CONTRACT NUMBER NOT FOUND IN BCBSM'S FILES 08122003 02242004

C2400 A3 32 IL Y C2400 NO COVERAGE FOR INSURED 12192003 02202004

C4566 A3 32 IL Y C4566 SUBSCRIBER NOT FOUND 12292003 02202004

C4568 A3 32 IL Y C4568 MISSING/INVALID SUBSCRIBER INFO 12292003 02202004

C715 A3 32 IL Y C715 INSURED NOT ON PAYER'S FILE 12192003 02202004

C803 A3 33 IL Y C803 SUBSCRIBER ID NOT FOUND ON PAYER FILE 12192003 02192004

51409 A3 35 51409 INVALID RECALL CLAIM 05172004 05192004

51417 A3 35 51417 INVALID RECALL CLAIM 05172004 05192004

A319 A3 41 Y A319 IC PROCEDURE REQUIRES ATTACHMENTS 08122003 02242004

A326 A3 41 Y A326 SECOND OPINION CONSULTATION REQUIRES MANUAL HANDLING 08122003 02242004

A355 A3 41 Y A355 ABORTION RELATED SERV REQ HARDCOPY CLM TO CONTROL PLAN 08122003 03052004

A362 A3 41 Y A362 STERILIZATION PROC REQ HARDCOPY CLAIM TO CONTROL PLAN 08122003 03052004

A454 A3 41 Y A454 Z-PLASTY SERVICES REQUIRE OPERATIVE NOTES 08122003 02242004

A455 A3 41 Y A455 CLM REQ STATEMENT BY PHYS THAT A PERSON OPERATED PUMP 08122003 03052004

A515 A3 41 Y A515 SERV REQ ATTACHMENTS I/P FOLLOW UP CONSULT SAME ADM/PROV 08122003 03052004

A539 A3 41 Y A539 CLAIM REQUIRES PROGRESS NOTES 08122003 02242004

A643 A3 41 Y A643 PREPAYMENT UTILIZATION REVIEW REQ FOR KERATOPLASTY SERV 08122003 03112004

A194 A3 48 Y A194 PRIOR AUTHORIZATION NUMBER MISSING 08122003 02242004

C1075 A3 54 Y C1075 DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE 12192003 02202004

C2019 A3 54 Y C2019 DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE 10282003 02202004

C3109 A3 54 Y C3109 DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE 12192003 03052004

C3660 A3 54 Y C3660 DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM/LINE 10282003 02202004

C4E A3 54 Y C4E DUPLICATE OF PREVIOUS PROCESSED CLAIM/SERVICE 08192003 02202004

C4576 A3 54 Y C4576 DUPLICATE OF PREVIOUSLY PROCESSED CLAIM 12292003 02202004

C720 A3 54 Y C720 DUPLICATE OF PREVIOUS PROCESSED CLAIM/SERVICE 08192003 02202004

C810 A3 54 Y C810 DUPLICATE OF A PREVIOUSLY PROCESSED CLAIM 08192003 02202004

CP0000 F1 65 Y CP0000 CLAIM/LINE HAS BEEN PAID 12292003 02232004

C4391 A3 65 Y C4391 CLAIM PREVIOUSLY PAID 12192003 02232004

C5483 A3 72 Y C5483 CLAIM CONTAINS SPLIT PAYMENT 12292003 02232004

C2060 A3 81 Y C2060 CONTRACT/PLAN DOES NOT COVER PRE-EXISTING CONDITIONS 10282003 02102004

C4581 A3 84 Y C4581 SERVICE NOT A BENEFIT 12292003 02232004

P305 A3 85 Y P305 MULTIPLE PRIMARY OR SECONDARY PAYERS REPORTED 04022003 02232004

C4390 A3 85 IN Y C4390 SUBMIT TO PRIMARY PAYER 12192003 02232004

C4495 A3 85 IN Y C4495 BILL PRIMARY INSURANCE FIRST 10302003 02232004

F026 A3 85 IN Y F026 BCN IS NOT PRIMARY PAYER 09092002 02232004

P301 A3 85 IN Y P301 ONLY PRIMARY CLAIMS ACCEPTED FOR COMMERCIAL PAYERS 03152003 02262004

C1160 A3 86 Y C1160 DIAGNOSIS AND PATIENT GENDER MISMATCH 12192003 02202004

C1884 A3 86 Y C1884 DIAGNOSIS AND PATIENT GENDER MISMATCH 12192003 02202004

C1989 A3 86 Y C1989 DIAGNOSIS AND PATIENT GENDER MISMATCH 12192003 02202004

C1126 A3 86 QC Y C1126 DIAGNOSIS AND PATIENT GENDER MISMATCH 12192003 02202004

C1907 A3 86 QC Y C1907 DIAGNOSIS AND PATIENT GENDER MISMATCH 10282003 02202004

C3678 A3 87 QC Y C3678 PATIENT NOT FOUND 10282003 02232004

C3695 A3 87 QC Y C3695 NO COVERAGE FOR DEPENDENT 11212003 02232004

C4547 A3 87 QC Y C4547 PATIENT NOT FOUND WITH PAYER 12292003 02232004

C2081 A3 90 Y C2081 PATIENT NOT ELIGIBLE FOR MED BENEFITS FOR SUBMITTED DATES 12192003 03052004

C4377 A3 90 Y C4377 PATIENT NOT COVERED FOR DATES OF SERVICE 10282003 02102004

C711 A3 90 Y C711 NO ACTIVE COVERAGE EXISTS FOR INSURED 08192003 02182004

C877 A3 90 Y C877 PAT NOT ELIGIBLE FOR MED BENEFITS FOR DATES OF SERVICE 10282003 03162004

C1968 A3 90 G0 Y C1968 NO DEPENDENT COVERAGE 10282003 02102004

C3690 A3 90 G0 Y C3690 DATE OF SERVICE AFTER COVERAGE PERIOD 12192003 02102004

C1816 A3 90 IL Y C1816 COVERAGE CANCELLED FOR DATES OF SERVICE 12192003 02102004

CF2013 A3 90 QC Y CF2013 PATIENT NOT COVERED FOR DATES OF SERVICE 12292003 03052004

CF509 A3 90 QC Y CF509 PATIENT NOT COVERED FOR DATES OF SERVICE 12292003 02202004

C2493 A3 90 QC Y C2493 PATIENT NOT ELIGIBLE FOR MED BENEFITS FOR SUBMITTED DATES 12192003 03112004

C5529 A3 91 1P Y C5529 PROVIDER NOT ELIGIBLE/NOT APPROVED FOR DATES OF SERVICE 12292003 02202004

A081 A3 91 85 Y A081 DATE OF SERVICE PRIOR TO PROVIDER ELIGIBILITY DATE 08122003 02242004

A082 A3 91 85 Y A082 DATE OF SERVICE AFTER PROVIDER TERMINATION DATE 08122003 02242004

C4970 A3 93 Y C4970 OUT-OF-NETWORK SERVICE NOT A BENEFIT 12292003 02182004

C4388 A3 94 Y C4388 REFFERAL REQUIRED FOR SERVICE 12192003 02232004

A531 A3 96 85 Y A531 PARTICIPATION CODE IS MISSING OR INVALID 08122003 02242004

A542 A3 96 85 Y A542 PAY SUBSCRIBER CLAIM FROM TRUST PROVIDER 08122003 02242004

A733 A3 96 85 Y A733 PAY PROVIDER CLAIM FROM NON-PARTICIPATING PROVIDER 08122003 02242004

C1966 A3 97 Y C1966 SPOUSE/DEP NOT ON PAYER FILE 12192003 02202004

C718 A3 97 Y C718 PATIENT NOT COVERED 08192003 02182004

A260 A3 97 IN Y A260 NO MEMBER MATCH FOR THIS COVERAGE PERIOD 08122003 02242004

C4531 A3 97 QC Y C4531 PATIENT ELIGIBILITY NOT FOUND WITH PAYER 12192003 02202004

C4593 A3 97 QC Y C4593 PATIENT NOT ELIGIBLE FOR BENEFIT 12292003 02202004

C705 A3 97 QC Y C705 PATIENT NOT ON PAYER FILE OR BIRTH DATE INVALID 10282003 02202004

C5952 A3 105 Y C5952 CLAIM/LINE IS CAPITATED 12292003 02232004

C1077 A3 106 Y C1077 NO COVERAGE FOR CHARGES SUBMITTED 12192003 03052004

C4383 A3 106 Y C4383 HAP NOR PATIENT SHOULD BE BILLED FOR THESE SERVICES 12192003 02202004

CF502 A3 107 Y CF502 PROCESSED ACCORDING TO CONTRACT/PLAN PROVISIONS 12292003 02262004

C5004 A3 107 Y C5004 PAYMENT LIMITED BY PLAN PROVISIONS 12292003 02262004

C788 A3 108 Y C788 COVERAGE HAS BEEN CANCELLED BY THE POLICY HOLDER 08192003 02192004

C3251 A3 110 Y C3251 CLAIM REQUIRES PRICING INFORMATION 12192003 02232004

C5479 A3 111 Y C5479 INSURED REQ NO ELECTRONIC CLM SUBMISSION 10282003 03112004

A262 A3 116 Y A262 SUBMIT CLAIM TO MEDICARE PRIOR TO BCBSM 08122003 02242004

A691 A3 116 Y A691 BCN CLAIM-RESUBMIT WITH CORRECT PAYER INFORMATION 08122003 02242004

CAA017 A3 116 Y CAA017 INVALID RECEIVER ID 12292003 02202004

CF5023 A3 116 Y CF5023 CLAIMS SUBMITTED TO INCORRECT PAYER 12292003 02202004

C5575 A3 116 Y C5575 CLM SUBMITTED TO INCORRECT PAYER/CLM OFFICE SEND TO DME 12292003 03052004

C892 A3 116 Y C782 CLAIM SUBMITTED TO INCORRECT PAYER 10282003 03052004

C970 A3 116 Y C970 CLAIM SUBMITTED TO WRONG PAYER 12192003 02202004

F090 A3 116 Y F090 COMMERCIAL CLAIMS NOT ACCEPTED AS DESTINATION PAYER 01142004 02202004

A525 A3 121 Y A525 MAXIMUM OF SIX SERVICES ALLOWED PER CLAIM 08122003 02242004

CXX3AC A3 121 Y CXX3AC SERV LINE NUMBER > MAX ALLOWABLE FOR PAYER 11122003 03052004

F074 A3 121 Y F074 BCN SERVICE LINES EXCEED MAXIMUM OF 99 ALLOWED 08122003 02202004

F075 A3 121 Y F075 FEP SERVICE LINES EXCEED MAXIMUM ALLOWED 08122003 02202004

F076 A3 121 Y F076 MEDICAID SERVICE LINES EXCEED MAXIMUM OF 50 ALLOWED 08122003 02202004

F077 A3 121 Y F077 MEDICARE SERVICE LINES EXCEED MAXIMUM OF 449 ALLOWED 08122003 02202004

C3624 A3 122 Y C3624 MISSING/INVALID DATA PREVENTS PAYER FROM PROC CLAIM 10282003 03052004

C782 A3 122 Y C782 MISSING/INVALID DATA PREVENTS PAYER FROM PROCESSING CLAIM 12192003 02192004

C787 A3 122 Y C787 MISSING/INVALID DATA PREVENTS PAYER FROM PROCESSING CLAIM 08192003 02192004

C878 A3 122 Y C878 DENIED DUE TO PLAN PROVISIONS 10302003 02192004

C908 A3 122 Y C908 CLAIM RETURNED TO PROVIDER - NO ADD'L INFO 12192003 02202004

F015 A3 122 Y F015 THE PROCESSING DATE IS GREATER THAN TODAY'S DATE 08122003 02172004

P029 A3 122 Y P029 INVALID CREDIT/DEBIT CARD INFO PRESENT 03152003 02262004

P034 A3 122 Y P034 PATIENT BIRTH DATE IS GREATER THAN PROCESSING DATE 03152003 02092004

P215 A3 122 Y P215 ADMISSION DATE IS > CURRENT DATE 03152003 03052004

P216 A3 122 Y P216 SUBSCRIBER BIRTH DATE IS > CURRENT DATE 03152003 03052004

P217 A3 122 Y P217 SERVICE DATE IS > CURRENT DATE 03152003 03052004

P319 A3 122 Y P319 FILE CREATE DATE IS GREATER THAN CURRENT DATE 03152003 02092004

P320 A3 122 Y P320 SUBSCRIBER BIRTH DATE IS GREATER THAN CURRENT DATE 03152003 02092004

99999 A3 122 99999 SUBSCRIBER NOT PATIENT 05172004 05192004

C1061 A3 123 Y C1061 ADDITIONAL INFORMATION REQUESTED PROVIDE ITEMIZED CLAIM 12192003 02202004

C1990 A3 123 Y C1990 ADDITIONAL INFORMATION REQUESTED BY PAYER 12192003 03052004

C909 A3 123 Y C909 ADDITIONAL INFORMATION REQUESTED BY PAYER - NOT RECEIVED 12192003 02202004

C839 A3 123 DN Y C839 REFERRING PROVIDER NAME MISSING OR INVALID 08192003 02202004

C4637 A3 123 IL Y C4637 ADDITIONAL INFORMATION REQUESTED FROM INSURED 12292003 02202004

F113 A3 124 Y F113 CREDIT CARD HOLDER NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 02252004

F118 A3 124 DN Y F118 REFERRING PROV NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 03052004

F126 A3 124 DN Y F126 OTHER REF PHYSICIAN NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 02252004

CXXSBA A3 124 IL Y CXXSB SUBSCRIBER NAME, ADDRESS, PHONE AND ID NUMBER 12052003 02252004

C807 A3 124 IL Y C807 INSURED ID, NAME, ADDRESS DOESN'T MATCH PAYER FILE 12192003 02252004

F121 A3 124 P4 Y F121 OTHER PAYER NAME, ADDRESS, PHONE & ID NUMBER REQUIRED 12302003 02252004

F120 A3 124 QB Y F120 OTHER SUB NAME, ADDRESS, PHONE & ID NUMBER REQUIRED 12302003 02252004

F122 A3 124 QC Y F122 OTHER PAYER PATIENT NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 02252004

F127 A3 124 QC Y F127 ENTITY'S NAME, ADDRESS, PHONE AND ID NUMBER 12302003 03112004

F114 A3 124 QD Y F114 RESPONSIBLE PARTY NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 02252004

F119 A3 124 SJ Y F119 SERVICE FACILITY NAME, ADDRESS, PHONE & ID NUMBER REQUIRED 12302003 02252004

CBA112 A3 124 1P Y CBA112 INVALID BILLING PROVIDER PHONE NUMBER 11122003 02252004

F031 A3 124 1P Y F031 BILLING PROV NME IS MISSING OR QUALIFIER DOES NOT EQUAL 2 03152003 02252004

F115 A3 124 71 Y F115 ATTEND PHYSICIAN NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 02252004

F123 A3 124 71 Y F123 OTHER PHYSICIAN NAME, ADDRESS, PHONE & ID NUMBER REQUIRED 12302003 02252004

F116 A3 124 72 Y F116 OPER PHYSICIAN NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 02252004

F124 A3 124 72 Y F124 OTHER OPER PHYS NAME, ADDRESS, PHONE & ID NUMBER REQUIRED 12302003 02252004

F117 A3 124 73 Y F 117 OTHER PHYSICIAN NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 02252004

F125 A3 124 73 Y F125 OTHER OPER PHYS NAME, ADDRESS, PHONE & ID NUMBER REQUIRED 12302003 02252004

F008 A3 124 85 Y F008 THE SAME QUALIFIER CANNOT BE REPEATED FOR BILLING PROVIDER 08122003 02252004

P008 A3 124 85 Y P008 ENTITY'S NAME/ADDRESS/PHONE & ID (MULTIPLE ID QUALIFIERS) 08122003 03052004

CBA118 A3 124 87 Y CBA118 INVALID PAY-TO-PROVIDER PHONE NUMBER 11122003 02252004

F112 A3 124 87 Y F112 PAY TO PROVIDER NAME, ADDRESS, PHONE & ID # REQUIRED 12302003 02252004

C1937 A3 125 Y C1937 PATIENT LAST NAME DOESN'T MATCH HAP NUMBER 12192003 02202004

F029 A3 125 Y F029 SUBMITTER NAME REQUIRED WHEN SUBMITTER TYPE IS A PERSON 03142003 02202004

P174 A3 125 Y P174 OTHER PAYER PRIOR AUTH 1ST NAME REPORTED - SERVICE 03152003 02202004

P306 A3 125 Y P306 SUBMITTER FIRST NAME MISSING/INVALID 03152003 03052004

P312 A3 125 Y P312 SUBMITTER FIRST NAME REPORTED WITH NON-PERSON QUALIFIER 03152003 02202004

P154 A3 125 DK Y P154 ORDERING PROV FIRST NAME IS MISSING OR INVALID - SERVICE 03152003 02242004

CEA022 A3 125 DN Y CEA022 INVALID REFERRING PROVIDER LAST NAME 11122003 02202004

CEA023 A3 125 DN Y CEA023 INVALID REFERRING PROVIDER FIRST NAME 12292003 02202004

CXXYEI A3 125 DN Y CXXYEI REFERRING PROVIDER'S FIRST NAME IS MISSING 03082004 03112004

C4074 A3 125 DN Y C4074 REFERRING PHY LAST NAME MISSING/INVALID 12192003 02202004

P147 A3 125 DN Y P147 REFERRING PROVIDER FIRST NAME IS MISSING OR INVALID - CLAIM 03152003 02242004

P155 A3 125 DN Y P155 REFERRING PROV FIRST NAME IS MISSING OR INVALID - SERVICE 03152003 02242004

P167 A3 125 DN Y P167 REFERRING PROV 1ST NAME REPORTED WITH NON-PERSON QUAL 03152003 03052004

P176 A3 125 DN Y P176 OTHER INSURANCE REFERRING PROV 1ST NAME REPORTED - CLAIM 03152003 02202004

P150 A3 125 DQ Y P150 SUPERVISING PHYSICIAN FIRST NAME IS MISSING OR INVALID-CLAIM 03152003 02242004

P153 A3 125 DQ Y P153 SUPERVISING PHYSICIAN FIRST NAME IS MISSING OR INVALID-SERV 03152003 02242004

P159 A3 125 DQ Y P159 SUPERVISING PROV PRIMARY ID INVALID - CLAIM 03152003 02202004

P180 A3 125 DQ Y P180 OTHER INS SUP PROV 1ST NAME REPORTED - CLAIM 03152003 02202004

P169 A3 125 FA Y P169 FACILITY PROV 1ST NAME REPORTED 03152003 02202004

P173 A3 125 FA Y P173 FACILITY PROV 1ST NAME REPORTED - SERVICE 03152003 02202004

P179 A3 125 FA Y P179 OTHER INS FACILITY 1ST NAME REPORTED - CLAIM 03152003 02202004

A051 A3 125 IL Y A051 PAY SUB CLAIM AND SUBSCRIBER'S LAST NAME IS MISSING 08122003 02242004

A521 A3 125 IL Y A521 SUBSCRIBER'S LAST NAME IS MISSING OR INVALID 08122003 02242004

CDA019 A3 125 IL Y CDA019 INVALID INSURED LAST NAME 12292003 02202004

CDA020 A3 125 IL Y CDA020 INVALID INSURED FIRST NAME 12292003 02202004

C682 A3 125 IL Y C682 INSURED'S LAST NAME MISSING OR INVALID 08192003 02182004

C771 A3 125 IL Y C771 INSURED'S FIRST NAME REQUIRED 08192003 02182004

F023 A3 125 IL Y F023 SUB LST NM MUST BE > 1 ALPHA NO SPACE OR SPECIAL CHAR 08122003 03052004

F024 A3 125 IL Y F024 SUB FIRST NAME MUST BE ONE ALPHA NO SPACES OR SPECIAL CHAR 08122003 02202004

F034 A3 125 IL Y F034 SUBSCRIBER LAST AND FIRST NAME REQUIRED 03152003 02202004

P021 A3 125 IL Y P021 SUBSCRIBER LAST NAME MISSING OR INVALID 08122003 02202004

P056 A3 125 IL Y P056 PRIMARY INSURED LAST OR FIRST NAME MISSING 08122003 02242004

P151 A3 125 IL Y P151 OTHER SUBSCRIBER FIRST NAME IS MISSING OR INVALID 03152003 02242004

P302 A3 125 IL Y P302 SUBSCRIBER NAME QUALIFIER DOES NOT EQUAL 1 03152003 02202004

P309 A3 125 IL Y P309 SUBSCRIBER FIRST NAME IS MISSING/INVALID 03152003 02202004

P315 A3 125 IL Y P315 SUBSCRIBER FIRST NAME REPORTED WITH NON-PERSON QUALIFIER 03152003 02202004

CDA009 A3 125 IN Y CDA009 INVALID COMMERCIAL PAYER NAME 12292003 02202004

F021 A3 125 IN Y F021 PAYER NAME IS INVALID 08122003 02202004

P170 A3 125 P2 Y P170 OTHER INSURANCE SUB 1ST NAME REPORT W/NON-PERSON QUAL 03152003 03052004

A159 A3 125 P4 Y A159 PRIMARY PAYER NAME OR ADDRESS IS MISSING 08122003 02242004

A160 A3 125 P4 Y A160 PRIMARY INSURED FIRST OR LAST NAME IS MISSING 08122003 02242004

A161 A3 125 P4 Y A161 PRIMARY PAYER APPROVED/PAID AMTS INCONSISTENT-SERVICE 08122003 02242004

F153 A3 125 P4 Y F153 OTHER PAYER'S NAME CANNOT CONTAIN SPECIAL CHARACTERS 02022004 02172004

P055 A3 125 P4 Y P055 PRIMARY PAYER NAME IS MISSING 08122003 02242004

P171 A3 125 P4 Y P171 OTHER INSURANCE PAYER 1ST NAME REPORTED 03152003 02202004

A052 A3 125 QC Y A052 PATIENT'S FIRST NAME IS MISSING OR INVALID 08122003 02242004

A522 A3 125 QC Y A522 PATIENT'S FIRST NAME IS MISSING OR INVALID 08122003 02242004

CCA004 A3 125 QC Y CCA004 INVALID PATIENT LAST NAME 12292003 02202004

CCA005 A3 125 QC Y CCA005 INVALID PATIENT FIRST NAME 12292003 02202004

CR221 A3 125 QC Y CR221 INVALID PATIENT NAME 12292003 02202004

CXXSP1 A3 125 QC Y CXXSP1 PATIENT LAST NAME IS INVALID 03032004 03092004

C2385 A3 125 QC Y C2385 PATIENT NAME/MEMBER ID NOT ON FILE 10282003 02202004

F017 A3 125 QC Y F017 PAT LST NM MUST BE > 1 ALPHA NO SPACE OR SPECIAL CHAR 08122003 03052004

F018 A3 125 QC Y F018 PAT FIRST NAME MUST BE ONE ALPHA NO SPACES OR SPECIAL CHAR 08122003 02202004

P032 A3 125 QC Y P032 PATIENT FIRST NAME IS MISSING/INVALID 03152003 02202004

P033 A3 125 QC Y P033 PAT 1ST NAME PRESENT BUT NON PERSON QUALIFIER REPORTED 03152003 03052004

P037 A3 125 QC Y P037 PATIENT NAME TYPE MUST EQUAL PERSON 03152003 02242004

P175 A3 125 QC Y P175 OTHER INSURANCE PATIENT 1ST NAME REPORTED - CLAIM 03152003 02202004

CCB004 A3 125 QD Y CCB004 INVALID LEGAL REP LAST NAME 12292003 02202004

CCB005 A3 125 QD Y CCB005 INVALID LEGAL REP FIRST NAME 12292003 02202004

P141 A3 125 SJ Y P141 PURCHASED SERVICE PROVIDER NAME CANNOT BE PRESENT 03152003 02242004

P149 A3 125 SJ Y P149 SERVICE PROV FIRST NAME IS MISSING OR INVALID - CLAIM 03152003 02242004

P178 A3 125 SJ Y P178 OTHER INS PRUCHASED SERVICE PROV 1ST NAME REPORTED-CLAIM 03152003 02202004

CBA018 A3 125 1P Y CBA018 INVALID BILLING GROUP PROVIDER/ORGANIZATION NAME 12292003 02202004

CBA019 A3 125 1P Y CBA019 INVALID BILLING PROVIDER LAST NAME (INDIVIDUAL) 12292003 02202004

CBA020 A3 125 1P Y CBA020 INVALID BILLING PROVIDER FIRST NAME 12292003 02202004

C2820 A3 125 1P Y C2820 INVALID PROVIDER FIRST NAME 12192003 02202004

C4459 A3 125 1P Y C4459 PROVIDER NAME IS MISSING OR INVALID 12192003 02202004

C671 A3 125 1P Y C671 INVALID PROVIDER LAST NAME 08192003 02182004

F100 A3 125 71 Y F100 ATTENDING PHYSICIAN FIRST AND LAST NAME IS REQUIRED 03152003 02202004

F128 A3 125 71 Y F128 ATTENDING PHYSICIAN INFORMATION MISSING/INVALID 12152003 03162004

F152 A3 125 71 Y F152 ATTEND PHYS FIRST NAME CANNOT CONTAIN SPECIAL CHARACTERS 02022004 02172004

F129 A3 125 72 Y F129 OPERATING PHYSICIAN INFORMATION MISSING/INVALID 12152003 03162004

CFB115 A3 125 82 Y CFB115 INVALID RENDERING PROVIDER FIRST NAME 10282003 02202004

C1123 A3 125 82 Y C1123 INVALID RENDERING PROVIDER FIRST NAME 12192003 02202004

C5370 A3 125 82 Y C5370 RENDERING PROVIDER REQUIRED WHEN BILLING GROUP 12292003 02202004

P148 A3 125 82 Y P148 RENDERING PROVIDER FIRST NAME IS MISSING OR INVALID - CLAIM 03152003 02242004

P152 A3 125 82 Y P152 RENDERING PROV FIRST NAME IS MISSING OR INVALID - SERVICE 03152003 02242004

P168 A3 125 82 Y P168 RENDERING PROV 1ST NAME REPORTED WITH NON-PERSON QUAL 03152003 03052004

P172 A3 125 82 Y P172 RENDERING PROV 1ST NAME REPORTED WITH NON-PERSON QUAL 03152003 03052004

P177 A3 125 82 Y P177 OTHER INSURANCE REND PROV 1ST NAME REPORTED - CLAIM 03152003 02202004

P307 A3 125 85 Y P307 BILLING PROV FIRST NAME IS MISSING/INVALID 03152003 03052004

P313 A3 125 85 Y P313 BILLING PROV FIRST NAME REPORTED WITH NON-PERSON QUALIFIER 03152003 02202004

P308 A3 125 87 Y P308 PAY-TO PROV FIRST NAME IS MISSING/INVALID 03152003 02202004

P314 A3 125 87 Y P314 PAY-TO PROV FIRST NAME REPORTED WITH NON-PERSON QUALIFIER 03152003 02202004

A057 A3 126 Y A057 PROVIDER OR SUBSCRIBER ADDRESS MISSING 08122003 03052004

A058 A3 126 Y A058 PROV/SUB CITY, STATE OR ZIP CODE MISSING OR INVALID 08122003 03052004

CAA010 A3 126 Y CAA010 SUBMITTER STATE INVALID 12292003 02202004

F154 A3 126 GB Y F154 OTHER SUBSCRIBER CITY CANNOT CONTAIN SPECIAL CHARACTERS 02022004 02172004

A053 A3 126 IL Y A053 PAY SUB CLAIM AND SUBSCRIBER'S ADDRESS IS MISSING 08122003 03052004

CDA204 A3 126 IL Y CDA204 INVALID INSURED'S ADDRESS 10282003 02202004

CDA206 A3 126 IL Y CDA206 INVALID INSURED'S CITY 12292003 02202004

CDA207 A3 126 IL Y CDA207 INVALID INSURED'S STATE 12292003 02202004

CDA208 A3 126 IL Y CDA208 INVALID INSURED'S ZIP CODE 10282003 02202004

CXXSS5 A3 126 IL Y CXXSS5 INVALID INSURED'S STATE 06292004

CXXSS6 A3 126 IL Y CXXSS6 INVALID INSURED'S ZIP CODE 06112004

CXXSS9 A3 126 IL Y CXXSS9 INVALID INSURED'S ZIP CODE 06112004

C3746 A3 126 IL Y C3746 PROVIDER PRACTICING ZIP CODE MISSING 12192003 02202004

C4133 A3 126 IL Y C4133 SUBSCRIBER STATE REQUIRED FOR PAYER 12192003 02202004

C5659 A3 126 IL Y C5659 INSURED ZIP CODE INVALID 12292003 02202004

C820 A3 126 IL Y C820 INSURED'S ZIP CODE INVALID 08192003 02192004

F138 A3 126 IL Y F138 SUBSCRIBER CITY MUST BE AT LEAST 2 CHARACTERS 01212004 02202004

P300 A3 126 IL Y P300 SUBSCRIBER ADDRESS IS MISSING 03152003 02202004

CDA104 A3 126 IN Y CDA104 ENTITY'S ADDRESS 10282003 03112004

CDA106 A3 126 IN Y CDA106 PAYER'S ADDRESS 12292003 03112004

CXX3BL A3 126 IN Y CXX3BL PAYER'S STATE DOES NOT MATCH ZIP 02022004 03112004

C814 A3 126 IN Y C814 INVALID PAYER ADDRESS 08192003 02192004

F139 A3 126 P4 Y F139 OTHER PAYER CITY MUST BE AT LEAST 2 CHARACTERS 01212004 02202004

CCA011 A3 126 QC Y CCA011 INVALID PATIENT ADDRESS 11122003 02202004

CCA013 A3 126 QC Y CCA013 INVALID PATIENT CITY 11122003 02202004

CCA014 A3 126 QC Y CCA014 INVALID PATIENT STATE 11122003 02202004

CCA015 A3 126 QC Y CCA015 INVALID PATIENT ZIP CODE 10282003 02202004

CXXSP3 A3 126 QC Y CXXSP3 PATIENT ADDRESS IS INVALID 03182004

CXXSP5 A3 126 QC Y CXXSP5 INVALID PATIENT STATE 06082004

CXXSP6 A3 126 QC Y CXXSP6 - INVALID PATIENT ZIP CODE 03172004

CXXSP9 A3 126 QC Y CXXSP9 INVALID PATIENT ZIP CODE 03232004

C1877 A3 126 QC Y C1877 INVALID PATIENT ZIP CODE 12192003 02202004

CCB007 A3 126 QD Y CCB007 INVALID LEGAL REP ADDRESS 12292003 02202004

CCB009 A3 126 QD Y CCB009 INVALID LEGAL REP CITY 12292003 02202004

C2970 A3 126 1N Y C2970 PAYER ADDRESS INVALID 12192003 02202004

CBA107 A3 126 1P Y CBA107 INVALID BILLING PROVIDER ADDRESS 11122003 02202004

CBA109 A3 126 1P Y CBA109 INVALID BILLING PROVIDER CITY 11122003 02202004

CBA110 A3 126 1P Y CBA110 INVALID BILLING PROVIDER STATE 11122003 02202004

CBA111 A3 126 1P Y CBA111 INVALID BILLING PROVIDER ZIP CODE 10282003 02202004

C108 A3 126 1P Y C108 PROVIDER ZIP - NOT VALID 08192003 02102004

C2021 A3 126 1P Y C2021 INVALID PROVIDER ZIP CODE 12192003 02202004

CDA213 A3 126 36 Y CDA213 INVALID INSURED'S EMPLOYER ADDRESS 12292003 02202004

CDA215 A3 126 36 Y CDA215 INVALID INSURED'S EMPLOYER CITY 12292003 02202004

CDA216 A3 126 36 Y CDA216 INVALID INSURED'S EMPLOYER STATE 12292003 02202004

CDA217 A3 126 36 Y CDA217 INVALID INSURED'S EMPLOYER ZIP CODE 12292003 02202004

C2470 A3 126 82 Y C2470 RENDERING PROV ZIP CODE INVALID 10282003 02202004

C2949 A3 126 82 Y C2949 ENTITY'S ADDRESS 12192003 03052004

C2950 A3 126 82 Y C2950 RENDERING PROV CITY MISSING 12192003 02202004

C2951 A3 126 82 Y C2951 RENDERING PROV STATE MISSING 12192003 02202004

C2952 A3 126 82 Y C2952 RENDERING PROV ZIP CODE MISSING 12192003 02202004

CBA113 A3 126 87 Y CBA113 INVALID PAY-TO-PROVIDER ADDRESS 11122003 02202004

CBA115 A3 126 87 Y CBA115 INVALID PAY-TO-PROVIDER CITY 11122003 02202004

CBA116 A3 126 87 Y CBA116 INVALID PAY-TO-PROVIDER STATE 11122003 02202004

CBA117 A3 126 87 Y CBA117 INVALID PAY-TO-PROVIDER ZIP CODE 11122003 02202004

P164 A3 128 DK Y P164 ORDERING PROV PRIMARY ID INVALID - SERVICE 03152003 02202004

P156 A3 128 DN Y P156 REFERRING PROVIDER PRIMARY ID IS INVALID - CLAIM 03152003 02242004

P165 A3 128 DN Y P165 REFERRING PROV PRIMARY ID INVALID - SERVICE 03152003 02202004

P163 A3 128 DQ Y P163 SUPERVISING PROV PRIMARY ID INVALID - SERVICE 03152003 02202004

P162 A3 128 FA Y P162 FACILITY PROV PRIMARY ID INVALID - SERVICE 03152003 02202004

P158 A3 128 SJ Y P158 PURCHASED SERVICE PROV PRIMARY ID INVALID - CLAIM 03152003 02202004

P161 A3 128 SJ Y P161 PURCHASED SERVICE PROV PRIMARY ID INVALID - SERVICE 03152003 02202004

CBA006 A3 128 1P Y CBA006 BILLING PROVIDER TAX ID IS INVALID 10302003 02202004

CBA008 A3 128 1P Y CBA008 BILLING PROVIDER TAX ID TYPE INVALID 12292003 02202004

C1118 A3 128 1P Y C1118 PROVIDER TAX ID NOT ON FILE WITH PAYER 10282003 02202004

C1165 A3 128 1P Y C1165 PROVIDER TAX ID DOESN'T MATCH PROV NAME 12192003 02202004

F016 A3 128 1P Y F016 BILLING PROVIDER FEDERAL TAX ID AND/OR QUALIFIER IS INVALID 08122003 02202004

P157 A3 128 82 Y P157 RENDERING PROV PRIMARY ID INVALID - CLAIM 03152003 02202004

P160 A3 128 82 Y P160 RENDERING PRO PRIMARY ID INVALID - SERVICE 03152003 02202004

A753 A3 128 85 Y A753 PROVIDER'S TAX ID IS NOT ON FILE 08122003 02242004

C2291 A3 128 85 Y C2291 - PROVIDER'S BILLING TAX ID NOT AUTHORIZED FOR HAP 04262004 04262004

P018 A3 128 85 Y P018 PPOM BILLING PROV TAX ID IS MISSING/INVALID 08122003 02262004

P020 A3 128 85 Y P020 ULTIMED BILLING PROV ID IS MISSING/INVALID 08122003 02262004

P086 A3 128 85 Y P086 BILLING PROVIDER TAX ID INVALID ON CROSSOVER CLAIM 09092002 02242004

P310 A3 128 85 Y P310 BILLING PROV PRIMARY ID DOES NOT EQUAL 9 NUMERICS 03152003 03052004

P311 A3 128 87 Y P311 PAY-TO PROV PRIMARY ID DOES NOT EQUAL 9 NUMERICS 03152003 03052004

F013 A3 130 IP Y F013 BC/BCN PROVIDER NUMBER IS INVALID FOR BILLING PROVIDER 08122003 02192004

A022 A3 130 85 Y A022 BLUE SHIELD BILLING PROVIDER CODE IS MISSING OR INVALID 08122003 02242004

A023 A3 130 85 Y A023 BLUE SHIELD BILLING PROVIDER CODE IS MISSING OR INVALID 08122003 02242004

A024 A3 130 85 Y A024 BLUE SHIELD BILLING PROVIDER CODE IS MISSING OR INVALID 08122003 02242004

A025 A3 130 85 Y A025 BLUE SHIELD BILLING PROVIDER CODE IS MISSING OR INVALID 08122003 02242004

A026 A3 130 85 Y A026 OPC FACILITY PROVIDER CODE IS INVALID 08122003 02242004

A080 A3 130 85 Y A080 BLUE SHIELD BILLING PROVIDER CODE IS INVALID 08122003 02242004

D001 A3 130 85 Y D001 BCBSM BILLING PROVIDER/QUALIFIER DO NOT MATCH OR MISSING 08192003 03052004

D002 A3 130 85 Y D002 FEP BILLING PROVIDER/QUALIFIER DO NOT MATCH OR MISSING 08192003 03052004

F009 A3 130 85 Y F009 BILLING PROVIDER ID AND/OR QUALIFIER IS INVALID OR MISSING 08122003 02192004

P009 A3 130 85 Y P009 BLUE SHIELD OR BCN BILLING PROV CODE IS MISSING 08122003 04142004

F002 A3 131 Y F002 PROVIDER CODE MISSING ON PROVIDER ID TABLE 08122003 02262004

F003 A3 131 Y F003 PROVIDER CODE MISSING ON SUBMITTER ID TABLE 08122003 02262004

F004 A3 131 Y F004 PROVIDER CODE MISSING ON PROVIDER AUTHORIZATION TABLE 08122003 02262004

F005 A3 131 Y F005 PROVIDER CODE MISSING ON PROVIDER TABLE 08122003 03112004

F006 A3 131 Y F006 PROVIDER CODE MISSING ON SOP TABLE 08122003 02262004

F007 A3 131 Y F007 SUBMITTER ID MISSING 09172002 02262004

F010 A3 131 Y F010 PROVIDER TYPE IS MISSING 08122003 02262004

P078 A3 131 Y P078 BILLING PROVIDER NUMBER IS INVALID 08122003 02262004

P197 A3 131 DK Y P197 MEDICARE ORDERING PROV ID IS GREATER THAN ONE - SERVICE 03152003 02262004

P181 A3 131 DN Y P181 MEDICARE REFER PROV ID IS GREATER THAN ONE - CLAIM 03152003 02262004

P198 A3 131 DN Y P198 MEDICARE RENDER PROV ID IS GREATER THAN ONE - SERVICE 03152003 02262004

P200 A3 131 DN Y P200 OTHER INS MEDICARE REFER PROV ID IS > ONE - CLAIM 03152003 03052004

P185 A3 131 DQ Y P185 MEDICARE SUPERVISING PROV ID IS > ONE - CLAIM 03152003 03052004

P196 A3 131 DQ Y P196 MEDICARE SUPERVISING PROV ID IS GREATER THAN ONE - SERVICE 03152003 02262004

P204 A3 131 DQ Y P204 OTHER INS MEDICARE SUP PROV ID IS > ONE - CLAIM 03152003 03052004

P184 A3 131 FA Y P184 MEDICARE FACILITY PROV ID IS > ONE - CLAIM 03152003 03052004

P195 A3 131 FA Y P195 MEDICARE FACILITY PROV ID IS GREATER THAN ONE - SERVICE 03152003 02262004

P203 A3 131 FA Y P203 OTHER INS MEDICARE FAC PROV ID IS > ONE - CLAIM 03152003 03052004

P183 A3 131 SJ Y P183 MEDICARE PURCHASE SERV PROV ID IS GREATER THAN ONE - CLAIM 03152003 02262004

P194 A3 131 SJ Y P194 MEDICARE PURCHASED SERV PROV ID IS > ONE - SERVICE 03152003 03052004

P202 A3 131 SJ Y P202 OTHER INS MEDICARE PUR SERV PROV ID IS < ONE - CLAIM 03152003 03052004

P182 A3 131 82 Y P182 MEDICARE RENDER PROV ID IS GREATER THAN ONE - CLAIM 03152003 02262004

P193 A3 131 82 Y P193 MEDICARE RENDERING PROV ID IS > ONE - SERVICE 03152003 03052004

P201 A3 131 82 Y P201 OTHER INS MEDICARE RENDER PROV ID IS > ONE - CLAIM 03152003 03052004

P206 A3 131 82 Y P206 RENDERING STATE LICENSE NUMBER IS INVALID - CLAIM 03152003 02262004

F043 A3 131 85 Y F043 MEDICARE SOP BILLING PROV/QUAL DO NOT MATCH 08192003 02262004

P015 A3 131 85 Y P015 BILLING PROV ID IS INVALID - CROSSOVER 08122003 02262004

P038 A3 131 85 Y P038 MEDICARE PROVIDER CODE IS MISSING 07302003 02262004

P316 A3 131 85 Y P316 MULTIPLE MEDICARE BILLING PROV ID REPORTED 03152003 02262004

P317 A3 131 87 Y P317 MULTIPLE MEDICARE PAY-TO PROV ID REPORTED 03152003 02262004

P125 A3 132 DK Y P125 MEDICAID ORDERING PROVIDER CODE INALID SERVICE 01112003 03112004

P105 A3 132 DN Y P105 MEDICAID REFERRING PROVIDER CODE INVALID CLAIM 11142002 03112004

P127 A3 132 DN Y P127 MEDICAID REFERRING PROVIDER CODE INVALID SERVICE 01112003 03112004

P188 A3 132 DN Y P188 REFERRING PROV SECONDARY ID MISSING 03152003 02262004

P213 A3 132 DN Y P213 MEDICAID REFER PROV SECONDARY ID IS MISSING - CLAIM 03152003 02262004

P116 A3 132 DQ Y P116 MEDICAID SUPERVISING PROVIDER CODE INVALID CLAIM 01112003 03112004

P123 A3 132 DQ Y P123 MEDICAID SUPERVISING PROVIDER CODE INVALID SERVICE 01112003 03112004

P192 A3 132 DQ Y P192 SUPERVISING PROV SECONDARY ID MISSING 03152003 02262004

P115 A3 132 FA Y P115 MEDICAID FACILITY PROVIDER CODE INVALID CLAIM 01112003 03112004

P121 A3 132 FA Y P121 MEDICAID FACILITY PROVIDER CODE INVALID SERVICE 01112003 03112004

P191 A3 132 FA Y P191 FACILITY PROV SECONDARY ID MISSING 03152003 02262004

P113 A3 132 SJ Y P113 MEDICAID PURCHASED SERVICE PROVIDER CODE INVALID CLAIM 01112003 03112004

P119 A3 132 SJ Y P119 MEDICAID PURCHASED SERVICE PROVIDER CODE INVALID SERVICE 01112003 03112004

P190 A3 132 SJ Y P190 PURCHASED SERVICE PROV SECONDARY ID MISSING 03152003 02262004

F025 A3 132 1P Y F025 MEDICAID PROV # INVALID 08122003 03052004

F037 A3 132 71 Y F037 ATTENDING PHYSICIAN MEDICAID PROVIDER NUMBER IS INVALID 03152003 02262004

F046 A3 132 71 Y F046 MEDICAID ATTENDING PROVIDER TYPE IS MISSING OR INVALID 09242003 02262004

F038 A3 132 72 Y F038 OPERATING PHYSICIAN MEDICAID PROVIDER NUMBER IS INVALID 03152003 02262004

F047 A3 132 72 Y F047 MEDICAID OPERATING PROVIDER TYPE IS MISSING OR INVALID 09242003 02262004

F039 A3 132 73 Y F039 OTHER PHYSICIAN MEDICAID PROVIDER NUMBER IS INVALID 03152003 02262004

F048 A3 132 73 Y F048 MEDICAID OTHER PROVIDER TYPE IS MISSING OR INVALID 09242003 02262004

P107 A3 132 82 Y P107 MEDICAID RENDERING PROVIDER CODE INVALID CLAIM 11142002 03112004

P117 A3 132 82 Y P117 MEDICAID RENDERING PROVIDER CODE INVALID SERVICE 01112003 03112004

P189 A3 132 82 Y P189 RENDERING PROV SECONDARY ID MISSING 03152003 02262004

P214 A3 132 82 Y P214 MEDICAID RENDER PROV SECONDARY ID IS MISSING - CLAIM 03152003 02262004

F042 A3 132 85 Y F042 MEDICAID SOP BILLING PROV/QUAL DO NOT MATCH OR MISSING 08192003 02262004

F045 A3 132 85 Y F045 MEDICAID BILLING PROVIDER TYPE IS MISSING OR INVALID 09242003 02262004

P101 A3 132 85 Y P101 MEDICAID BILLING PROVIDER CODE INVALID 11142002 02262004

P109 A3 132 85 Y P109 MEDICAID BILLING PROVIDER MISSING 07072003 02262004

P103 A3 132 87 Y P103 MEDICAID PAY-TO PROVIDER CODE INVALID 11142002 02262004

CFA023 A3 135 Y CFA023 INVALID RENDERING PROVIDER COMMERCIAL ID 10282003 02232004

C2425 A3 135 Y C2425 COMMERCIAL PROVIDER ID IS MISSING OR INVALID 03262004

P079 A3 135 Y P079 MCARE PROVIDER NUMBER IS INVALID 08122003 02242004

P220 A3 135 Y P220 WELLNESS PLAN BILLING OR PAY-TO PROV ID IS MISSING 04232003 02232004

P223 A3 135 Y P223 PRIORITY HEALTH GILLING OR PAY-TO PROV ID IS MISSING 04232003 02232004

P226 A3 135 Y P226 MCARE BILLING OR PAY-TO PROV ID IS MISSING 04232003 02232004

CEA020 A3 135 DN Y CEA020 INVALID REFERRING PROVIDER COMMERCIAL ID 12292003 02232004

CFA024 A3 135 DN Y CFA024 INVALID REFERRING PROVIDER COMMERCIAL ID 12292003 02232004

CFB113 A3 135 DN Y CFB113 INVALID REFERRING PROVIDER UPIN 12292003 02232004

CXXYEP A3 135 DN Y CXXYEP REFERRING PROVIDER ID QUALIFIER INVALID 05192004 05192004

CBA015 A3 135 1P Y CBA015 INVALID BILLING PROVIDER PAYER SPECIFIC ID 12292003 03052004

C3116 A3 135 1P Y C3116 PAYER SPECIFIC PROVIDER ID REQUIRED 12192003 02232004

C33 A3 135 1P Y C33 PAYER SPECIFIC PROVIDER ID REQUIRED 08182003 02102004

C5259 A3 135 1P Y C5259 PROVIDER'S PAYER SPECIFIC ID REQUIRED 12292003 03112004

C5819 A3 135 82 Y C5819 RENDERING PROVIDER ID MUST BE NUMERIC 12292003 02232004

C680 A3 135 82 Y C680 PROVIDER PAYER SPECIFIC ID REQUIRED 12192003 02232004

P080 A3 135 82 Y P080 WELLNESS PLAN RENDERING PROVIDER NUMBER IS INVALID 08122003 02242004

P082 A3 135 82 Y P082 PRIORITY HEALTH RENDERING PROVIDER NUMBER IS INVALID 08122003 02242004

P089 A3 135 82 Y P089 WELLNESS PLAN RENDERING PROV TAX ID INVALID - CLAIM 01312003 02242004

P090 A3 135 82 Y P090 WELLNESS PLAN RENDERING PROV TAX ID INVALID - SERVICE 01312003 02242004

P091 A3 135 82 Y P091 PRIORITY HEALTH RENDERING PROVIDER ID INVALID - CLAIM 01312003 02232004

P092 A3 135 82 Y P092 PRIORITY HEALTH RENDERING PROVIDER ID INVALID - SERVICE 01312003 02232004

P218 A3 135 82 Y P218 WELLNESS PLAN RENDERING PROV ID INVALID - CLAIM 04232003 02232004

P219 A3 135 82 Y P219 WELLNESS PLAN RENDERING PROV ID INVALID - SERVICE 04232003 02232004

P221 A3 135 82 Y P221 PRIORITY HEALTH RENDER PROV ID INVALID - CLAIM 04232003 02232004

P222 A3 135 82 Y P222 PRIORITY HEALTH RENDER PROV ID INVALID - SERVICE 04232003 02232004

P224 A3 135 82 Y P224 MCARE RENDERING PROV ID IS INVALID - CLAIM 04232003 02232004

P225 A3 135 82 Y P225 MCARE RENDERING PROV ID IS INVALID - SERVICE 04232003 02232004

CBA002 A3 135 85 Y CBA002 BILLING PROVIDER COMMERCIAL ID INVALID 12292003 02232004

P019 A3 135 85 Y P019 HAP BILLING PROV ID IS MISSING/INVALID 08122003 02262004

P322 A3 135 85 Y P322 WELLNESS PLAN BILLING PROV ID INVALID 04232003 02232004

P324 A3 135 85 Y P324 PRIORITY HEALTH BILLING PROV ID INVALID 04232003 02232004

P326 A3 135 85 Y P326 MCARE BILLING PROV ID INVALID 04232003 02232004

CR1811 A3 135 87 Y CR1811 PAY-TO-PROVIDER COMMERCIAL ID REQUIRED 12292003 02232004

P323 A3 135 87 Y P323 WELLNESS PLAN PAY-TO PROV ID INVALID 04232003 02232004

P325 A3 135 87 Y P325 PRIORITY HEALTH PAY-TO PROV ID INVALID 04232003 02232004

P327 A3 135 87 Y P327 MCARE PAY-TO PROV ID INVALID 04232003 02232004

C1124 A3 137 82 Y C1124 INVALID RENDERING NETWORK ID FOR PAYER 10282003 02202004

CDA013 A3 140 Y CDA013 INVALID PPO/HMO ID 12302003 02202004

P208 A3 143 DK Y P208 ORDERING STATE LICENSE NUMBER IS INVALID - SERVICE 03152003 02202004

A761 A3 143 DN Y A761 REFERRING PROVIDER'S STATE LICENSE NUMBER MISSING/INVALID 08122003 03052004

P205 A3 143 DN Y P205 REFERRING STATE LICENSE NUMBER IS INVALID - CLAIM 03152003 02202004

P209 A3 143 DN Y P209 REFERRING STATE LICENSE NUMBER IS INVALID - SERVICE 03152003 02202004

A271 A3 143 82 Y A271 REND PROV STATE LICENSE NUMBER MISSING/INVALID 08122003 03052004

P207 A3 143 82 Y P207 RENDERING STATE LICENSE NUMBER IS INVALID - SERVICE 03152003 02202004

P318 A3 143 85 Y P318 BILLING PROV STATE LICENSE NUMBER IS INVALID 03152003 02202004

C2147 A3 145 Y C2147 PROVIDER SPECIALTY CODE INVALID 12192003 02232004

P010 A3 145 Y P010 PROVIDER TYPE IS MISSING 08122003 03052004

P210 A3 145 Y P210 MEDICAID FACILITY TYPE CODE IS INVALID - CLAIM 03102003 02232004

P211 A3 145 Y P211 MEDICAID FACILITY TYPE CODE IS INVALID - SERVICE 03102003 02232004

P126 A3 145 DK Y P126 MEDICAID ORDERING PROVIDER TYPE INVALID SERVICE 01112003 03112004

CXXYBB A3 145 DN Y CXXYBB REFERRING PROVIDER TAXONOMY CODE 02162004 03052004

P106 A3 145 DN Y P106 MEDICAID REFERRING PROVIDER TYPE INVALID CLAIM 11142002 03112004

P128 A3 145 DN Y P128 MEDICAID REFERRING PROVIDER TYPE INVALID SERVICE 01112003 03112004

P122 A3 145 DQ Y P122 MEDICAID SUPERVISING PROVIDER TYPE INVALID CLAIM 01112003 03112004

P124 A3 145 DQ Y P124 MEDICAID SUPERVISING PROVIDER TYPE INVALID SERVICE 01112003 03112004

P114 A3 145 SJ Y P114 MEDICAID PURCHASED SERVICE PROVIDER TYPE INVALID CLAIM 01112003 03112004

P120 A3 145 SJ Y P120 MEDICAID PURCHASED SERVICE PROVIDER TYPE INVALID SERVICE 01112003 03112004

CBA022 A3 145 1P Y CBA022 INVALID BILLING PROVIDER SPECIALITY CODE 12292003 02232004

P108 A3 145 82 Y P108 MEDICAID RENDERING PROVIDER TYPE INVALID CLAIM 11142002 03112004

P118 A3 145 82 Y P118 MEDICAID RENDERING PROVIDER TYPE INVALID SERVICE 01112003 03112004

P102 A3 145 85 Y P102 MEDICAID BILLING PROVIDER TYPE INVALID 11142002 02232004

P104 A3 145 87 Y P104 MEDICAID PAY-TO PROVIDER TYPE INVALID 11142002 02232004

C804 A3 148 Y C804 INSURED SSN/EMP NUMBER NOT FOUND ON PAYER FILE 12192003 03052004

C709 A3 148 IL Y C709 SSN/EMPLOYEE NUMBER NOT FOUND 12192003 03052004

F035 A3 148 IL Y F035 BLUE CROSS INSURED CONTRACT NUMBER IS INVALID (ITS CLAIM) 09242003 02232004

F014 A3 153 Y F014 RECEIVER ID IS INVALID 08122003 02232004

F044 A3 153 Y F044 GROUP NAME AND/OR NUMBER ARE PRESENT ON MEDICARE CLAIM 09242003 03052004

P027 A3 153 Y P027 RECEIVER ID IS INVALID 03152003 02262004

P028 A3 153 Y P028 SUBMITTER ID IS INVALID 03152003 02262004

C880 A3 153 DN Y C880 REFERRING PROVIDER ID INVALID 12192003 02232004

F133 A3 153 DN Y F133 OTHER PAYER REFERRING PROVIDER QUALIFIER IS INVALID 12152003 02232004

CDA010 A3 153 IL Y CDA010 INVALID PAYER ASSIGNED GROUP NUMBER-MUST BE NUMERIC 10282003 02232004

C1141 A3 153 IL Y C1141 REQUIRED INSURED GROUP POLICY NUMBER 12192003 03052004

C4503 A3 153 IL Y C4503 GROUP NUMBER INVALID FOR PAYER 12192003 02232004

C723 A3 153 IL Y C723 INVALID GROUP NUMBER FOR PAYER 12192003 02232004

C756 A3 153 IL Y C756 INSURED'S GROUP POLICY NUMBER REQUIRED BY PAYER 10282003 02232004

C757 A3 153 IL Y C757 INSURED'S GROUP NUMBER INVALID FOR PAYER 12192003 02232004

D018 A3 153 IL Y D018 SUBSCRIBER CONTRACT QUALIFIER INVALID MUST EQUAL 'MI' 02042003 03162004

F022 A3 153 IL Y F022 SUBSCRIBER BC/BCN GROUP NUMBER IS MISSING/INVALID 08122003 03052004

CDA007 A3 153 IN Y CDA007 INVALID COMMERCIAL PAYER ID 10282003 02232004

F020 A3 153 IN Y F020 PAYER ID IS INVALID 08122003 02232004

P017 A3 153 IN Y P017 COMMERCIAL PAYER ID AND OR CLAIM OFFICE NUMBER IS INVALID 08122003 02232004

P022 A3 153 IN Y P022 PAYER ID IS INVALID FOR SOURCE OF PAYMENT 01112003 02262004

F134 A3 153 SJ Y F134 OTHER PAYER SERVICE FACILITY PROVIDER QUALIFIER IS INVALID 12152003 02232004

F030 A3 153 1P Y F030 BILLING PROV ID MUST BE 9 NUMBERS 03142003 02232004

F092 A3 153 71 Y F092 ATTENDING PHYSICIAN IS INVALID 08122003 02232004

F130 A3 153 71 Y F130 OTHER PAYER ATTENDING PROVIDER IS INVALID 12152003 02232004

F135 A3 153 71 Y F135 ATTENDING PHYSICIAN QUALIFIER OF XX IS INVALID 12152003 02232004

F093 A3 153 72 Y F093 OPERATING PHYSICIAN IS INVALID 08122003 02232004

F131 A3 153 72 Y F131 OTHER PAYER OPERATING PROVIDER IS INVALID 12152003 02232004

F136 A3 153 72 Y F136 OPERATING PHYSICIAN QUALIFIER OF XX IS INVALID 12152003 02232004

F094 A3 153 73 Y F094 OTHER PHYSICIAN PROVIDER NUMBER IS INVALID 08122003 02232004

F132 A3 153 73 Y F132 OTHER PAYER OTHER PROVIDER QUALIFIER IS INVALID 12152003 02232004

F137 A3 153 73 Y F137 OTHER PHYSICIAN QUALIFIER OF XX IS INVALID 12152003 02232004

A524 A3 156 Y A524 PATIENT'S RELATIONSHIP TO SUBSCRIBER IS MISSING OR INVALID 08122003 02242004

P023 A3 156 Y P023 SUBSCRIBER RELATIONSHIP IS INVALID 03152003 02202004

P025 A3 156 Y P025 SUBSCRIBER INFO MISSING 03152003 02262004

P031 A3 156 Y P031 PATIENT INFORMATION REPORTED ON MED B OR MEDICAID CLAIM 03152003 03052004

F104 A3 156 IL Y F104 PATIENT RELATIONSHIP TO INSURED MUST BE 18 03152003 02202004

P129 A3 156 P2 Y P129 SUBSCRIBER REL CODE IS INVALID FOR OTHER INSURANCE 03152003 03112004

CDA017 A3 156 QC Y CDA017 PATIENT RELATIONSHIP TO SUBSCRIBER 12292003 02202004

F040 A3 156 QC Y F040 PATIENT RELATIONSHIP CODE TO INSURED IS INVALID 03152003 03222004

F110 A3 156 QC Y F110 2320 PATIENT RELATIONSHIP CODE TO INSURED IS INVALID 10202003 02202004

P035 A3 156 QC Y P035 PATIENT RELATIONSHIP TO INSURED CODE IS INVALID 03152003 02202004

P199 A3 157 GB Y P199 OTHER INSURED SEX CODE MISSING/INVALID 03152003 02202004

CDA023 A3 157 IL Y CDA023 INSURED GENDER 12292003 02202004

F011 A3 157 IL Y F011 SUBSCRIBER SEX CODE IS INVALID 08122003 02202004

P014 A3 157 IL Y P014 PATIENT SEX CODE NOT EQUAL TO M OR F 08122003 02202004

A523 A3 157 QC Y A523 PATIENT'S GENDER CODE IS MISSING OR INVALID 08122003 02242004

CCA009 A3 157 QC Y CCA009 INVALID PATIENT GENDER 10282003 02202004

CXXSPS A3 157 QC Y CXXSPS PATIENT'S SEX CODE INVALID 05192004 05192004

F019 A3 157 QC Y F019 PATIENT SEX CODE IS INVALID 08122003 02202004

P030 A3 157 QC Y P030 PATIENT SEX CODE IS INVALID 08122003 02202004

C3108 A3 158 Y C3108 INVALID DATE OF BIRTH 12192003 03162004

P094 A3 158 GB Y P094 SUBSCRIBER'S DATE OF BIRTH MISSING 03152003 02202004

CDA024 A3 158 IL Y CDA024 INVALID INSURED DATE OF BIRTH 10282003 02202004

C2044 A3 158 IL Y C2044 INVALID DATE OF BIRTH FOR SUBSCRIBER 12192003 02202004

A063 A3 158 QC Y A063 PATIENT'S BIRTH YEAR IS MISSING OR ILLOGICAL 08122003 02242004

CCA008 A3 158 QC Y CCA008 INVALID PATIENT BIRTH DATE 12292003 02202004

CR225 A3 158 QC Y CR225 PATIENT'S DATE OF BIRTH INVALID 12292003 02202004

F032 A3 158 QC Y F032 PATIENT BIRTHDATE IS INVALID 03152003 02202004

CXXSPW A3 159 QC Y CXXSPW PATIENT DATE OF DEATH PRIOR TO DATE OF SERVICE 05192004 05192004

CCA019 A3 161 QC Y CCA019 INVALID PATIENT EMPLOYMENT STATUS CODE 12292003 02252004

P088 A3 162 Y P088 HIC NUMBER INVALID 09162002 02262004

P052 A3 162 P2 Y P052 BCBSM SUPPLEMENTAL CLAIM AND HIC NUMBER IS MISSING 08122003 02262004

C5B A3 164 Y C5B SUBSCRIBER CONTRACT/MEMBER NUMBER INVALID 08192003 02192004

D016 A3 164 Y D016 BCBSM SUBSCRIBER CONTRACT INVALID MUST BE 9 NUMBERS 02042003 02192004

D017 A3 164 Y D017 FEP SUBSCRIBER CONTRACT INVALID 'R' FOLLOWED BY 8 NUMBERS 02042003 03052004

P013 A3 164 Y P013 BCBSM OR BCN CONTRACT NUMBER IS INVALID 08122003 04072004

P016 A3 164 Y P016 PATIENT ID NUMBER IS INVALID CROSSOVER 08122003 03112004

P100 A3 164 Y P100 MEDICAID RECEIPIENT ID NUMBER INVALID 09172002 02192004

A002 A3 164 IL Y A002 SUBSCRIBER'S CONTRACT NUMBER IS INVALID 08122003 02242004

A005 A3 164 IL Y A005 SUBSCRIBER'S CONTRACT NUMBER IS MISSING 08122003 02242004

A006 A3 164 IL Y A006 SUBSCRIBER'S CONTRACT NUMBER IS INVALID 08122003 02242004

A050 A3 164 IL Y A050 SUBSCRIBER'S CONTRACT NUMBER IS MISSING OR INVALID 08122003 02242004

A520 A3 164 IL Y A520 SUBSCRIBER'S CONTRACT NUMBER IS MISSING OR INVALID 08122003 02242004

CDA018 A3 164 IL Y CDA018 INVALID INSURED ID NUMBER 10282003 02202004

CF5013 A3 164 IL Y CF5013 INSURED ID INVALID FOR PAYER 12292003 02202004

CR2212 A3 164 IL Y CR2212 INSURED CONTRACT NUMBER REQUIRED 12292003 02202004

C4019 A3 164 IL Y C4019 SUBSCRIBER ID NOT ON FILE 10282003 02192004

C4231 A3 164 IL Y C4231 MEMBER NUMBER NOT ON FILE 12192003 02192004

C689 A3 164 IL Y C689 INVALID INSURED ID FOR PAYER 12192003 02192004

C700 A3 164 IL Y C700 INVALID INSURED ID FOR PAYER 12192003 02192004

C748 A3 164 IL Y C748 INSURED ID INVALID 08192003 02192004

C897 A3 164 IL Y C897 INVALID INSURED ID - CANNOT = PAYER ID 12192003 02202004

C900 A3 164 IL Y C900 INSURED'S ID INVALID FOR PAYER 12192003 02202004

F028 A3 164 IL Y F028 MEDICAID RECIPIENT ID INVLD MUST PASS CHECK DIGIT 01092003 03052004

F036 A3 164 IL Y F036 SUB'S CONTRACT # INVALID MUST BE AT LEAST TWO CHAR 02252004 03052004

F159 A3 164 IL Y F159 SUB'S FEP CONT NUM MUST BEGIN WITH 'R' FOLLOWED BY 8 NOS 02252004 03052004

P024 A3 164 IL Y P024 ID MUST BE IN SUBSCRIBER'S INFORMATION 03152003 03052004

P400 A3 164 IL Y P400 INVALID FEP CONTRCT NUMBER 02272004

A156 A3 164 P2 Y A156 MEDICARE HIC NUMBER MISSING 08122003 02242004

A164 A3 164 P2 Y A164 PRIMARY INSURED'S ID NUMBER IS MISSING 08122003 02242004

P036 A3 164 QC Y P036 COMMERCIAL CLAIM AND SUB OR PATIENT PRIMARY ID IS MISSING 04142003 02192004

CDA212 A3 166 IL Y CDA212 INVALID INSURED'S EMPLOYER NAME 12292003 02252004

CDA012 A3 171 Y CDA012 INVALID PPO/HMO INDICATOR 12292003 02252004

P026 A3 171 Y P026 INSURANCE TYPE CODE IS MISSING/INVALID 03152003 02262004

P095 A3 171 Y P095 MDCH CLAIM WITH INVALID OTHER INSURANCE IND REPORTED 03152003 03052004

P142 A3 171 Y P142 OTHER PAYER ID NUMBER IS INVALID 03152003 02252004

P186 A3 171 Y P186 OTHER INSURANCE TYPE CODE IS INVALID 07112003 02252004

CDA209 A3 173 IL Y CDA209 INVALID INSURED'S PHONE NUMBER 12292003 02202004

F041 A3 173 IL Y F041 PATIENT RELATIONSHIP '18' REQUIRES SUBSCRIBER INFO 03212003 03222004

CCA018 A3 174 QC Y CCA018 INVALID PATIENT STUDENT STATUS 11122003 02252004

A015 A3 178 Y A015 PAY SUB CLAIM AND SERVICE CHARGE IS MISSING OR INVALID 08122003 02242004

A016 A3 178 Y A016 SERVICE CHARGE IS MISSING OR INVALID 08122003 02242004

A530 A3 178 Y A530 CHARGE IS MISSING OR INVALID-SERVICE 08122003 02242004

CFA013 A3 178 Y CFA013 INVALID LINE CHARGES 12292003 02202004

C4077 A3 178 Y C4077 TOTAL CLAIM CHARGE MISSING/INVALID 12192003 02192004

C44 A3 178 Y C44 LINE CHARGE INVALID 12192003 02192004

F072 A3 178 Y F072 ACCOMMODATION TOTAL CHARGES IS INVALID 08122003 02192004

F073 A3 178 Y F073 ACCOM N/C CHARGES CANNOT BE GREATER THAN TOTAL CHARGE 08122003 02192004

F106 A3 178 Y F106 CLAIM TOTAL CHARGES MUST EQUAL SERVICE LINES 03152003 02192004

P062 A3 178 Y P062 TOTAL CHARGES < OR = ZERO ON CROSSOVER CLAIM 08122003 03052004

P076 A3 178 Y P076 SERVICE CHARGE IS INVALID 08122003 02242004

P097 A3 178 Y P097 CLAIM CHARGE EQUALS A NEGATIVE AMOUNT 03152003 02192004

P098 A3 178 Y P098 SERVICE LINE CHARGE EQUALS A NEGATIVE AMOUNT 03152003 02192004

F071 A3 181 Y F071 ACCOMMODATION RATE IS INVALID 08122003 02262004

F091 A3 181 Y F091 ANCILLARY RATE MUST BE GREATER THAN ZERO 07232003 02262004

P058 A3 182 Y P058 PRIMARY PAYER PAID=0 APPROVED/ALLOWED > ZERO NO DED AMT 08122003 03112004

P063 A3 182 Y P063 APPROVED ALLOWED/PAID AMTS NOT < ZERO ON CROSSOVER CLAIM 08122003 02242004

P068 A3 182 Y P068 PRIMARY PAYER APPROVED AMOUNT GREATER THAN SUBMITTED CHARGE 09102002 02242004

P072 A3 182 Y P072 CLAIM APPROVED/ALLOWED AMT NOT EQUAL TO SUM OF SERV AMTS 08122003 03052004

P073 A3 182 Y P073 CLAIM PAID AMT NOT EQUAL TO SUM OF SERVICE AMTS 08122003 03052004

P074 A3 182 Y P074 PAID AMTS MINUS ADJUSTMENTS MUST EQUAL SERVICE CHARGE 08122003 02242004

P077 A3 182 Y P077 MEDICARE PRIOR PAID AMT IS INVALID 08122003 02242004

P081 A3 182 Y P081 MEDICARE PRIOR APPROVED AMT IS INVALID 08122003 02242004

P084 A3 182 Y P084 PRIMARY PAYER PAID=0 APPROVED AMT>0 NO DEDUCTIBLE AMT 09092002 02242004

P096 A3 182 Y P096 SUPPLEMENTAL/COB CLAIM W/CLAIM PAID AMOUNT MISSING/INVALID 03152003 02202004

P143 A3 182 Y P143 PAID AMT>0 APPROVED AMT MISSING OR EQUAL TO 0 - SERVICE 03152003 03162004

A031 A3 182 P4 Y A031 MEDICARE PAID AMOUNT FOR SERVICE IS INVALID 08122003 02242004

A032 A3 182 P4 Y A032 MEDICARE ALLOWED AMOUNT FOR SERVICE IS INVALID 08122003 02242004

A039 A3 182 P4 Y A039 MEDICARE ALLOWABLE FOR SERVICE EXCEEDS CHARGE 08122003 02242004

A157 A3 182 P4 Y A157 MED B ALLOWED AMT MISSING OR > CHARGE - SERVICE 08122003 03112004

A168 A3 182 P4 Y A168 PRIMARY PAYER ALLOWED AMOUNT GREATER THAN CHARGE 08122003 02242004

A240 A3 183 Y A240 AMOUNT PAID BY PAYER/PATIENT IS INVALID 08122003 02242004

CXA019 A3 183 QC Y CXA019 INVALID AMOUNT PATIENT HAS PAID 10282003 02202004

A036 A3 187 Y A036 DATE(S) OF SERVICE MISSING OR INVALID 08122003 02242004

A059 A3 187 Y A059 DATE(S) OF SERVICE MISSING OR INVALID 08122003 02242004

A214 A3 187 Y A214 DATE(S) OF SERVICE INVALID 08122003 02242004

A346 A3 187 Y A346 MEDICAL CARE VISIT DOES NOT INCLUDE TO DATE OF SERVICE 08122003 02242004

A526 A3 187 Y A526 DATE OF SERVICE IS MISSING OR INVALID 08122003 02242004

CFA005 A3 187 Y CFA005 INVALID DATES OF SERVICE 10282003 02202004

CFA006 A3 187 Y CFA006 INVALID DATES OF SERVICE 11142003 02202004

CXX3DC A3 187 Y CXX3D DATE(S) OF SERVICE INVALID (YEAR) 12222003 02202004

D019 A3 187 Y D019 DATE OF SERVICE IS MISSING AT CLAIM/SERVICE LEVEL 06052003 03052004

D020 A3 187 Y D020 DATE OF SERVICE QUALIFIER MUST EQUAL '08'-SERVICE 06052003 03052004

F084 A3 187 Y F084 DATE OF SERVICE INVALID 08122003 02202004

F085 A3 187 Y F085 DATE OF SERVICE MISSING 08122003 02202004

P065 A3 187 Y P065 DATE(S) OF SERVICE MISSING OR ILLOGICAL 08122003 02242004

P070 A3 187 Y P070 UNITS>1 ON HIT PER DIEM AND SVC TO DATE MISSING 08122003 02242004

P137 A3 187 Y P137 DATE OF SERVICE GREATER THAN TWO YEARS OLD 03152003 02242004

P138 A3 187 Y P138 SERVICE FROM DATE CANNOT BE GREATER THAN TO DATE 03152003 02242004

C2178 A3 188 Y C2178 SERVICE FROM - THROUGH DATES INVALID 12192003 02232004

C3218 A3 188 Y C3218 SERVICE FROM - THROUGH DATES INVALID 12192003 02232004

F052 A3 188 Y F052 STATEMENT FROM DATE IS INVALID 08122003 02232004

F054 A3 188 Y F054 STATEMENT THRU DATE IS INVALID 08122003 02232004

M003 A3 188 M003 INTERNAL PROGRAM ERROR - NOT A PROVIDER DATA ISSUE 05222003 03052004

M004 A3 188 M004 INTERNAL PROGRAM ERROR - NOT A PROVIDER DATA ISSUE 05222003 03052004

A415 A3 189 Y A415 ADMISSION DATE MISSING OR INVALID FOR FACILITY SERVICE 08122003 02242004

CEA026 A3 189 Y CEA026 INVALID REFERRING PROVIDER MIDDLE INITIAL 11122003 02202004

CEA028 A3 189 Y CE1028 HOSPITAL ADMISSION DATE INVALID 12292003 03052004

P132 A3 189 Y P132 ADMISSION DATE REQUIRED - CLAIM 03152003 02202004

P134 A3 189 Y P134 ADMISSION DATE REQUIRED - SERVICE 03152003 02202004

A433 A3 190 Y A433 DISCHARGE DATE MISSING OR INVALID FOR FACILITY SERVICE 08122003 02242004

A437 A3 190 Y A437 DISCHARGE DATE IS MISSING OR INVALID 08122003 02242004

CEA027 A3 190 Y CEA027 INVALID REFERRING PROVIDER STATE 12292003 02202004

CEA029 A3 190 Y CEA029 HOSPITAL DISCHARGE DATE INVALID 12292003 02202004

A328 A3 191 Y A328 PRE/POST NATAL SERVICE AND LMP IS MISSING OR INVALID 08122003 02242004

A400 A3 191 Y A400 LMP MISSING OB RELATED SERV & CONTINUOUS COV < 270 DAYS 08122003 03112004

A403 A3 191 Y A403 LMP MISSING/INVALID FOR VOLUNTARY ABORTION ANESTH SERV 08122003 03112004

A513 A3 191 Y A513 LMP DATE IS MISSING OR INVALID 08122003 02242004

CEA113 A3 193 Y CEA113 INVALID DATE OF FIRST CONSULTATION 12292003 02262004

CEA018 A3 195 Y CEA018 INVALID PATIENT DISABLED FROM DATE 12292003 02262004

CEA019 A3 196 Y CEA019 INVALID PATIENT DISABLED TO DATE 12292003 02262004

C3700 A3 197 QC Y C3700 PATIENT NOT COVERED FOR DATES OF SERVICE 12172003 02232004

A147 A3 221 Y A147 MAXIMUM DRUG DOSAGE MET FOR REPORTED PROCEDURE CODE 08122003 02242004

F059 A3 228 Y F059 CLAIM TYPE INVALID OR MISSING 08122003 02262004

F103 A3 228 Y F103 CLAIM TYPE FREQUENCY IS INVALID 03152003 02262004

P051 A3 228 Y P051 CLAIM FREQUENCY TYPE CODE IS INVALID 08122003 02262004

F051 A3 229 Y F051 SOURCE OF ADMISSION IS INVALID 08122003 02262004

F033 A3 230 Y F033 ADMISSION HOUR IS INVALID 03152003 02262004

F050 A3 231 Y F050 TYPE OF ADMISSION IS INVALID 08122003 02262004

F111 A3 232 Y F111 ADMITTING DIAGNOSIS IS MISSING ON INPATIENT CLAIM 10242003 02262004

MF16 A3 232 Y MF16 INVALID ICD9 ADMITTING DIAGNOSIS CLAIM 05222003 03112004

F056 A3 233 Y F056 DISCHARGE HOUR IS INVALID 08122003 02262004

F055 A3 234 Y F055 PATIENT STATUS IS INVALID 08122003 02262004

247 A3 247 YYY 247 - LINE RETURNED. REFER TO CLAIM OR OTHER SERVICE LINE EDITS 03122004

A145 A3 248 Y A145 AUTO ACCIDENT RELATED AND ACCIDENT DATE IS MISSING 08122003 02242004

CEA004 A3 248 Y CEA004 INVALID EMPLOYMENT RELATED INDICATOR 10282003 02202004

CEA005 A3 248 Y CEA005 INVALID ACCIDENT INDICATOR 10282003 02202004

CEA007 A3 248 Y CE1007 INVALID ACCIDENT/SYMPTOM DATE 10282003 03162004

CEA010 A3 248 Y CEA010 INVALID ACCIDENT STATE 12292003 02202004

CEA011 A3 248 Y CEA011 INVALID ACCIDENT HOUR 10282003 02202004

P130 A3 248 Y P130 ACCIDENT STATE IS MISSING/INVALID 03152003 02202004

P303 A3 248 Y P303 ACCIDENT IND IS PRESENT BUT ACCIDENT DATE NOT REPORTED 03152003 03052004

A078 A3 249 Y A078 PLACE OF SERVICE IS INVALID 08122003 02242004

A395 A3 249 Y A395 PLACE OF SERVICE MISSING OR INVALID FOR FACILITY SERVICE 08122003 02242004

A527 A3 249 Y A527 PLACE OF SERVICE IS MISSING OR INVALID 08122003 02242004

A631 A3 249 Y A631 PLACE OF SERVICE IS MISSING OR INVALID 08122003 02242004

CFA007 A3 249 Y CFA007 PLACE OF SERVICE INVALID 12012003 02202004

C1853 A3 249 Y C1853 INVALID PLACE OF SERVICE 12192003 02202004

C1871 A3 249 Y C1871 INVALID PLACE OF SERVICE 12192003 02202004

C2975 A3 249 Y C2975 INVALID PLACE OF SERVICE 12192003 03162004

C4363 A3 249 Y C4363 INVALID PLACE OF SERVICE 12192003 02202004

C4741 A3 249 Y C4741 PLACE OF SERVICE INVALID 12292003 02202004

C4742 A3 249 Y C4742 PLACE OF SERVICE INVALID 12292003 02202004

C4743 A3 249 Y C4743 PLACE OF SERVICE INVALID 12292003 02202004

C4746 A3 249 Y C4746 PLACE OF SERVICEINVALID 12292003 02202004

C4749 A3 249 Y C4749 PLACE OF SERVICE INVALID 12292003 02202004

C5569 A3 249 Y C5569 SERVICE NOT PAYABLE IN PCP/OB-GYN OFFICE 12292003 02202004

P050 A3 249 Y P050 PLACE OF SERVICE IS INVALID - CLAIM 08122003 02242004

P075 A3 249 Y P075 PLACE OF SERVICE INVALID - SERVICE 08122003 02242004

A079 A3 250 Y A079 TYPE OF SERVICE IS INVALID 08122003 02242004

A399 A3 250 Y A399 TYPE OF SERVICE IS INVALID 08122003 03162004

A528 A3 250 Y A528 TYPE OF SERVICE IS MISSING OR INVALID 08122003 02242004

CFA008 A3 250 Y CFA008 TYPE OF SERVICE INVALID 10282003 02202004

C1917 A3 250 Y C1917 TYPE OF SERVICE INVALID 12192003 02202004

CXX51C A3 251 Y CXX51 TOTAL ANESTHESIA MINUTES INVALID 11122003 03052004

CDA014 A3 252 Y CDA014 INVALID PRIOR AUTHORIZATION NUMBER 12292003 02252004

F060 A3 252 Y F060 TREATMENT AUTHORIZATION NUMBER INVALID 08122003 02252004

P110 A3 252 Y P110 INVALID CLAIM PRIOR AUTHORIZATION NUMBER REPORTED 09192002 02252004

P111 A3 252 Y P111 INVALID SERVICE PRIOR AUTHORIZATION NUMBER REPORTED 09192002 02252004

C1916 A3 254 Y C1916 PRIMARY DIAGNOSIS CODE INVALID 11122003 02262004

C899 A3 254 Y C899 PRIMARY DIAG CODE INVALID 12192003 02262004

MF04 A3 254 Y MF04 INVALID ICD9 PRINCIPAL DIAGNOSIS CLAIM 05222003 03112004

MP01 A3 254 Y MP01 INVALID ICD9 PRINCIPAL DIAGNOSIS CLAIM 05222003 03112004

A305 A3 255 Y A305 DIAGNOSIS MISSING FOR MEDICAL EMERGENCY SERVICE 08122003 02242004

A309 A3 255 Y A309 DIAGNOSIS MISSING FOR FIRST AID SERVICE 08122003 02242004

A334 A3 255 Y A334 DIAGNOSIS CODE MISSING FOR OPC SERVICE 08122003 02242004

A353 A3 255 Y A353 DIAG CODE MISSING/NOT TRAUMATIC ACCIDENTAL DENTAL SERVICE 08122003 03112004

A367 A3 255 Y A367 DIAGNOSIS CODE MISSING OR INVALID FOR OPTICAL SERVICE 08122003 02242004

A389 A3 255 Y A389 DIAGNOSIS CODE MISSING FOR STERILIZATION ANESTHESIA SERVICE 08122003 02242004

A402 A3 255 Y A402 DIAGNOSIS CODE IS MISSING OR INVALID 08122003 02242004

A414 A3 255 Y A414 DIAGNOSIS CODE IS MISSING ON SURGERY PROCEDURE 08122003 02242004

A420 A3 255 Y A420 DIAGNOSIS CODE IS MISSING FOR TSA SERVICE 08122003 02242004

A716 A3 255 Y A716 DIAGNOSIS CODE IS MISSING 08122003 02242004

CEA030 A3 255 Y CEA030 DIAGNOSIS CODE - 1 INVALID 10282003 02202004

CEA031 A3 255 Y CEA031 DIAGNOSIS CODE - 2 INVALID 10282003 02202004

CEA032 A3 255 Y CEA032 DIAGNOSIS CODE - 3 INVALID 10282003 02202004

CEA033 A3 255 Y CEA033 DIAGNOSIS CODE - 4 INVALID 10282003 02202004

C2029 A3 255 Y C2029 INVALID TERTIARY DIAGNOSIS CODE 10282003 02202004

C2065 A3 255 Y C2065 INVALID DIAGNOSIS POINTER 10282003 02242004

C2483 A3 255 Y C2483 INVALID OTHER DIAG CODE 11122003 02202004

C4143 A3 255 Y C4143 INVALID SECONDARY DIAGNOSIS 12192003 02202004

C4335 A3 255 Y C4335 INVALID SECONDARY DIAGNOSIS 12192003 02202004

C4404 A3 255 Y C4404 INVALID SECONDARY DIAGNOSIS 12192003 02202004

C4582 A3 255 Y C4582 DIAGNOSIS CODE DOES NOT MEET ER CRITERIA 12292003 02202004

C5135 A3 255 Y C5135 DIAGNOSIS CODE DOES NOT MEET EMERGENCY CRITERIA 12292003 02202004

C847 A3 255 Y C847 DIAGNOSIS CODE INVALID 08192003 02192004

C849 A3 255 Y C849 DIAGNOSIS CODE INVALID 08192003 02192004

C872 A3 255 Y C872 DIAGNOSIS CODE INVALID 08192003 02192004

C887 A3 255 Y C887 INVALID SECONDARY DIAGNOSIS CODE 12192003 03052004

F087 A3 255 Y F087 OTHER DIAGNOSIS CODE INVALID OR SAME AS PRINCIPLE DIAG CODE 08122003 02202004

MF05 A3 255 Y MF05 INVALID ICD9 OTHER DIAGNOSIS CODE CLAIM 05222003 03112004

MF17 A3 255 Y MF17 INVALID ICD9 EXTENDED INJURY DIAGNOSIS CLAIM 05222003 03112004

MP02 A3 255 Y MP02 INV ICD9 ADD'L DIAGNOSIS CLAIM 05222003 03112004

M002 A3 255 M002 INTERNAL PROGRAM ERROR - NOT A PROVIDER DATA ISSUE 05222003 03052004

P144 A3 255 Y P144 AT LEAST ONE DIAGNOSIS CODE MUST BE PRESENT 03152003 02242004

P145 A3 255 Y P145 DIAGNOSIS POINTER NUMBER > DIAGNOSIS CODES PRESENT 03152003 02242004

P146 A3 255 Y P146 DIAGNOSIS CODE CONTAINS DECIMALS OR NOT SPECIFIC ENOUGH 03152003 02242004

CDA114 A3 256 P4 Y CDA114 INVALID PAYER PAID AMOUNT 11122003 02252004

F098 A3 258 Y F098 ACCOMMODATION DAYS IS INVALID 03152003 02262004

F099 A3 258 Y F099 ANCILLARY UNITS INVALID 03152003 02262004

P131 A3 258 Y P131 REPORTED QUANTITY MUST BE GREATHER THAN ZERO 03152003 02262004

C34 A3 259 Y C34 FREQUENCY OF SERVICE 12192003 02232004

275 A3 275 YYY 275 - CLAIM RETURNED. REFER TO SERVICE LEVEL EDITS 03122004

C2054 A3 283 Y C2054 MEDICARE WORKSHEET REQUIRED 12192003 02232004

C719 A3 283 Y C719 MEDICARE WORKSHEET REQUIRED BY PAYER 08192003 02182004

A028 A3 286 P4 Y A028 MEDICARE DEDUCTIBLE AMOUNT FOR SERVICE IS INVALID 08122003 02242004

A029 A3 286 P4 Y A029 MEDICARE COINSURANCE AMOUNT FOR SERVICE IS INVALID 08122003 02242004

A030 A3 286 P4 Y A030 MEDICARE PSYCHIATRIC AMOUNT FOR SERVICE IS INVALID 08122003 02242004

A158 A3 286 P4 Y A158 MED B DEDUCTIBLE AMT NOT NUMERIC > ALLOWED AMT- SERVICE 08122003 03162004

A163 A3 286 P4 Y A163 PRIMARY PAYER'S ADJUDICATION AMTS DO NOT BALANCE-SERVICE 08122003 03052004

A165 A3 286 P4 Y A165 INCONSISTENCY IN PRIMARY PAYERS 08122003 02242004

A170 A3 286 P4 Y A170 BCBSM STATUS INQUIRY CLAIM AND NP CODE IS MISSING 08122003 02242004

A499 A3 286 P4 Y A499 MEDICARE DEDUCTIBLE AMOUNT EXCEEDS ANNUAL AMOUNT 08122003 02242004

A543 A3 286 P4 Y A543 MEDICARE DENIED AND DENIAL CODE IS MISSING 08122003 02242004

A762 A3 286 P4 Y A762 OTHER INSURANCE INDICATOR INCONSISTENT WITH CLAIM INFO 08122003 02242004

A934 A3 286 P4 Y A934 MED B DID NOT MAKE PAYMENT BUT APPROVED AMT IS PRESENT 08122003 03052004

D021 A3 286 P4 Y D021 CLAIM ADJUSTMENT REASON CODE 1 IS INVALID 02022004 03052004

D022 A3 286 P4 Y D022 CLAIM ADJUSTMENT REASON CODE 2 IS INVALID 02022004 03052004

D023 A3 286 P4 Y D023 CLAIM ADJUSTMENT REASON CODE 3 IS INVALID 02022004 03052004

D024 A3 286 P4 Y D024 CLAIM ADJUSTMENT REASON CODE 4 IS INVALID 02022004 03052004

D025 A3 286 P4 Y D025 CLAIM ADJUSTMENT REASON CODE 5 IS INVALID 02022004 03052004

D026 A3 286 P4 Y D026 CLAIM ADJUSTMENT REASON CODE 6 IS INVALID 02022004 03052004

D027 A3 286 P4 Y D027 SERVICE LINE ADJUSTMENT REASON CODE 1 IS INVALID 02022004 03052004

D028 A3 286 P4 Y D028 SERVICE LINE ADJUSTMENT REASON CODE 2 IS INVALID 02022004 03052004

D029 A3 286 P4 Y D029 SERVICE LINE ADJUSTMENT REASON CODE 3 IS INVALID 02022004 03052004

D030 A3 286 P4 Y D030 SERVICE LINE ADJUSTMENT REASON CODE 4 IS INVALID 02022004 03052004

D031 A3 286 P4 Y D031 SERVICE LINE ADJUSTMENT REASON CODE 5 IS INVALID 02022004 03052004

D032 A3 286 P4 Y D032 SERVICE LINE ADJUSTMENT REASON CODE 6 IS INVALID 02022004 03052004

F140 A3 286 P4 Y F140 CLAIM ADJUSTMENT REASON CODE 1 IS INVALID 02022004 02192004

F141 A3 286 P4 Y F141 CLAIM ADJUSTMENT REASON CODE 2 IS INVALID 02022004 02192004

F142 A3 286 P4 Y F142 CLAIM ADJUSTMENT REASON CODE 3 IS INVALID 02022004 02192004

F143 A3 286 P4 Y F143 CLAIM ADJUSTMENT REASON CODE 4 IS INVALID 02022004 02192004

F144 A3 286 P4 Y F144 CLAIM ADJUSTMENT REASON CODE 5 IS INVALID 02022004 02192004

F145 A3 286 P4 Y F145 CLAIM ADJUSTMENT REASON CODE 6 IS INVALID 02022004 02192004

F146 A3 286 P4 Y F146 SERVICE LINE ADJUSTMENT REASON CODE 1 IS INVALID 02022004 02192004

F147 A3 286 P4 Y F147 SERVICE LINE ADJUSTMENT REASON CODE 2 IS INVALID 02022004 02192004

F148 A3 286 P4 Y F148 SERVICE LINE ADJUSTMENT REASON CODE 3 IS INVALID 02022004 02192004

F149 A3 286 P4 Y F149 SERVICE LINE ADJUSTMENT REASON CODE 4 IS INVALID 02022004 02192004

F150 A3 286 P4 Y F150 SERVICE LINE ADJUSTMENT REASON CODE 5 IS INVALID 02022004 02192004

F151 A3 286 P4 Y F151 SERVICE LINE ADJUSTMENT REASON CODE 6 IS INVALID 02022004 02192004

P054 A3 286 P4 Y P054 BCBSM SUPPLEMENTAL CLAIM AND DEDUCTIBLE AMT > APPROVED 08122003 03112004

P064 A3 286 P4 Y P064 INVALID REMARK CODE ON CROSSOVER CLAIM 08122003 02242004

P085 A3 286 P4 Y P085 DEDUCTIBLE AMT>APPROVED AMT-SERVICE 09092002 02242004

P166 A3 286 P4 Y P166 OTHER PAYER DATE CLAIM PAID MISSING 03152003 02192004

P328 A3 286 P4 Y P328 CLAIM ADJUSTMENT REASON CODE 1 IS INVALID 02022004 03052004

P329 A3 286 P4 Y P329 CLAIM ADJUSTMENT REASON CODE 2 IS INVALID 02022004 03052004

P330 A3 286 P4 Y P330 CLAIM ADJUSTMENT REASON CODE 3 IS INVALID 02022004 03052004

P331 A3 286 P4 Y P331 CLAIM ADJUSTMENT REASON CODE 4 IS INVALID 02022004 03052004

P332 A3 286 P4 Y P332 CLAIM ADJUSTMENT REASON CODE 5 IS INVALID 02022004 03052004

P333 A3 286 P4 Y P333 CLAIM ADJUSTMENT REASON CODE 6 IS INVALID 02022004 03052004

P334 A3 286 P4 Y P334 SERVICE LINE ADJUSTMENT REASON CODE 1 IS INVALID 02022004 03052004

P335 A3 286 P4 Y P335 SERVICE LINE ADJUSTMENT REASON CODE 2 IS INVALID 02022004 03052004

P336 A3 286 P4 Y P336 SERVICE LINE ADJUSTMENT REASON CODE 3 IS INVALID 02022004 03052004

P337 A3 286 P4 Y P337 SERVICE LINE ADJUSTMENT REASON CODE 4 IS INVALID 02022004 03052004

P338 A3 286 P4 Y P338 SERVICE LINE ADJUSTMENT REASON CODE 5 IS INVALID 02022004 03052004

P339 A3 286 P4 Y P339 SERVICE LINE ADJUSTMENT REASON CODE 6 IS INVALID 02022004 03052004

C2042 A3 287 Y C2042 MEDICAL NECESSITY FOR SERVICES REQUIRED BY PAYER 12192003 02202004

C2168 A3 287 Y C2168 PROVIDE CERTIFICATE OF MEDICAL NECESSITY FOR SERVICE 12192003 02202004

C4063 A3 287 Y C4063 PAYER REQUIRES PHYS PRESCRIPTION FOR PT 12192003 02202004

CEA038 A3 294 Y CEA038 INVALID DOCUMENTATION INDICATOR 12292003 02232004

C4398 A3 294 Y C4398 MISSING DOCUMENTATION INDICATOR 12192003 02232004

F097 A3 294 Y F097 CLAIM NOTE SEGMENT REQUIRED 09252002 02232004

A067 A3 306 Y A067 NOC PROCEDURE REPORTED WITHOUT DESCRIPTION OF SERVICE 08122003 02242004

C2967 A3 317 QC Y C2967 MEDICAL RECORDS REQUIRED BY PAYER 12192003 02232004

C1121 A3 332 Y C1121 PRIOR AUTHORIZATION/CERTIFICATION REQUIRED BY PAYER 11042003 02202004

C1122 A3 332 Y C1122 INVALID PRIOR AUTHORIZATION FOR PAYER 11042003 02202004

C6004 A3 332 Y C6004 HOME HEALTH CARE PLAN IS MISSING OR INVALID 04072004

CEA013 A3 333 Y CEA013 INVALID RELEASE OF INFORMATION INDICATOR 12292003 02262004

CXXY81 A3 337 Y CXXY81 AMBULANCE CR1 MISSING 05192004

C6005 A3 337 Y C6005 AMBLULANCE CR1 MISSING 05282004

C5464 A3 348 Y C5464 CHIROPRACTIC TREATMENT PLAN REQUIRED BY PAYER 12292003 02232004

C840 A3 358 Y C840 PAYMENT ASSIGNMENT INDICATOR INVALID 12302003 02252004

A973 A3 366 Y A973 AUTO ACCIDENT INDICATOR IS INVALID 08122003 02242004

CEA046 A3 387 Y CEA046 INVALID DATE LAST SEEN 12292003 02262004

A776 A3 390 Y A776 RELATED DATE IS MISSING OR ILLOGICAL 08122003 02242004

CEA006 A3 390 Y CEA006 INVALID SYMPTON INDICATOR 11122003 02202004

CEA016 A3 390 Y CEA016 INVALID SAME/SIMILAR SYMPTOM DATE 12292003 03162004

A713 A3 397 Y A713 ILLNESS/INJURY DATE IS MISSING OR INVALID 08122003 02242004

A179 A3 400 Y A179 SUM OF PRIMARY PAYER SERVICE PAID AMTS DO NOT = CLAIM PAID 08122003 02242004

A532 A3 400 Y A532 CHARGE IS MISSING OR INVALID-CLAIM 08122003 02242004

C5607 A3 400 Y C5607 CLAIM IS OUT OF BALANCE 12292003 02202004

F068 A3 400 Y F068 ESTIMATED RESPONSIBILITY IS MISSING 08122003 02202004

F078 A3 400 Y F078 LEAVE OF ABSENCE TOTAL CHARGES NOT EQUAL TO NON COV CHG 08122003 03052004

F080 A3 400 Y F080 ANCILLARY TOTAL CHARGE IS INVALID 08122003 02202004

F081 A3 400 Y F081 ANCILLARY NON COVERED CHARGE IS INVALID 08122003 02202004

F082 A3 400 Y F082 ANCILLARY TOTAL CHARGE IS INVALID 08122003 02202004

F083 A3 400 Y F083 ANCILLARY NON COVERED CHARGE IS INVALID 08122003 02202004

P071 A3 400 Y P071 CLAIM CHARGE NOT EQUAL TO SUM OF SERVICE CHARGES 08122003 02242004

P069 A3 400 P4 Y P069 SUM OF SVC PRIOR PAYER PAID AMT NOT EQUAL TO CLAIM PAID AMT 08122003 02242004

CAA018 A3 401 Y CAA018 SOURCE OF PAYMENT IS NOT VALID 12292003 02252004

CDA005 A3 401 Y CDA005 SOURCE OF PAYMENT IS INVALID 12292003 02252004

D012 A3 401 Y D012 SUBSCRIBER SOURCE OF PAY INVALID 'BL' OR 'FI' ONLY 02042003 03112004

F012 A3 401 Y F012 SOURCE OF PAYMENT IS INVALID FOR SUBSCRIBER 08122003 02252004

F057 A3 401 Y F057 OTHER SUBSCRIBER CLAIM SOURCE OF PAYMENT IS INVALID 08122003 02252004

F108 A3 401 Y F108 PAYER RESPONSIBILITY IS INVALID 03152003 02252004

P012 A3 401 Y P012 SOURCE OF PAYMENT CODE IS INVALID 08122003 02252004

A155 A3 448 Y A155 CLAIM TYPE CANNOT BE DETERMINED CLAIM TYPE CANNOT BE DETERMINED 08122003 03162004

A162 A3 448 Y A162 OTHER CARRIER PAID AMT = TO PROVIDER'S CHARGE-SERVICE OTHER CARRIER PAID AMOUNT IS EQUAL TO PROVIDER'S CHARGE 08122003 03052004

A167 A3 448 Y A167 COB CLAIM & EMPLOYMENT OR AUTO RELATED IND IS PRESENT COB CLAIM AND EMPLOYMENT OR AUTO RELATED INDICATOR IS PRESENT 08122003 03112004

A416 A3 448 Y A416 DATE OF SERVICE IS PRIOR TO THE ADMISSION DATE DATE OF SERVICE IS PRIOR TO THE ADMISSION DATE 08122003 02242004

A438 A3 448 Y A438 LAST DATE OF SERVICE IS GREATER THAN THE DISCHARGE DATE LAST DATE OF SERVICE IS GREATER THAN THE DISCHARGE DATE 08122003 02242004

A488 A3 448 Y A488 INJURY DATE MISSING OR INVALID & DIAGNOSIS INDICATES TRAUMA INJURY DATE MISSING OR INVALID AND DIAGNOSIS INDICATES TRAUMA 08122003 02242004

A564 A3 448 Y A564 STATUS INQUIRY CLAIM TYPE IS MISSING OR INVALID STATUS INQUIRY CLAIM TYPE IS MISSING OR INVALID. 08122003 03162004

A779 A3 448 Y A779 SVC TO DATE MISS/INV; OR HIT PER DIEM SVC UNITS >1 & NO DATE SVC TO DATE MISS/INV; OR HIT PER DIEM SVC UNITS > 1, & NO DATE. 08122003 02242004

A933 A3 448 Y A933 STATUS INQUIRY CLAIM ORIGINAL FORM IND MISSING/INVALID STATUS INQUIRY CLAIM ORIGINAL FORM IND MISSING/INVALID 08122003 03162004

CAA015 A3 448 Y CAA015 INVALID CREATION DATE 12292003 02202004

CCA024 A3 448 Y CCA024 INVALID TYPE OF CLAIM INDICATOR INVALID TYPE OF CLAIM INDICATOR 12302003 03052004

CEA015 A3 448 Y CEA015 INVALID SAME/SIMILAR SYMPTOM INDICATOR INVALID SAME/SIMILAR SYMPTOM INDICATOR 12292003 03162004

CXXY1P A3 448 Y CXXY1 PLACE OF SERVICE REQUIRES ADM DATE PLACE OF SERVICE REQUIRES ADM DATE 01212004 02202004

C1113 A3 448 Y C1113 INVALID SERVICE FROM DATE CANNOT BE < BIRTHDATE INVALID SERVICE FROM DATE. CANNOT BE < BIRTHDATE 12192003 03162004

C2439 A3 448 Y C2439 FOR COMMERCIAL PAYER DATE IS BEYOND FILING LIMITATION FOR COMMERCIAL PAYER DATE IS BEYOND FILING LIMITATION 04262004 04262004

C3849 A3 448 Y C3849 VERIFY BIRTHDATE/SEX/RELATIONSHIP CODE VERIFY BIRTHDATE/SEX/RELATIONSHIP CODE 12192003 02202004

C4299 A3 448 Y C4299 INVALID DATE, PLACE, UNITS OR CHARGE INVALID DATE, PLACE, UNITS OR CHARGE 12192003 03162004

C4300 A3 448 Y C4300 INVALID PROV NUMBER/TAX ID COMBINATION INVALID PROV NUMBER/TAX ID COMBINATION 12192003 02202004

C4394 A3 448 Y C4394 CLAIM AMT APPROVED < OR = ENROLLEE'S OBLIGATION CLM AMT APP < OR = ENROLLEE OBLIGATIONS 12192003 03052004

C4499 A3 448 Y C4499 NON-COMP ER PRE AUTH CONTRACTED HOSPITAL NON-COMP ER PRE-AUTH CONTRACTED HOSPITAL 12192003 03112004

C5007 A3 448 Y C5007 NO 48 HOUR TELEPHONE CALL IN ON ADMISSION NO 48 HOUR TELEPHONE CALL IN ON ADMISSION 12292003 03162004

C5536 A3 448 Y C5536 DIAGNOSIS CODE NOT VALID FOR AGE DIAGNOSIS CODE NOT VALID FOR AGE 12292003 03162004

C6000 A3 448 Y C6000 CLAIM LEVEL REFERENCE ID MISSING/INVALID CLAIM LEVEL REFERENCE ID MISSING OR INVALID 03262004

C777 A3 448 Y C777 DATE OF SERVICE BEFORE DATE OF BIRTH 12192003 02202004

D997 A3 448 Y D997 FILE REJECTION-CONTAINS INVALID SPECIAL CHARACTERS FILE REJECTION - CONTAINS INVALID SPECIAL CHARACTERS 12052003 02202004

D998 A3 448 Y D998 MISSING CLAIM LOOP CLAIM IS MISSING 2300 LOOP 12052003 03052004

D999 A3 448 Y D999 MISSING SERVICE LOOP CLAIM IS MISSING 2400 LOOP 12052003 03112004

F049 A3 448 Y F049 REVENUE CODE 0912 REQUIRES INPATIENT BILL TYPE REVENUE CODE 0912 REQUIRES INPATIENT BILL TYPE 10012003 02202004

F053 A3 448 Y F053 FROM & THRU DAYS NOT EQUAL TO COVERED & NON COVERED DAYS FROM & THRU DAYS NOT EQUAL TO COVERED & NON COVERED DAYS 08122003 02202004

F101 A3 448 Y F101 ADM DATE CANNOT BE GREATER THAN STATEMENT FROM DATE ADMIT FROM DATE & STATEMENT FROM DATE CONFLICT 03152003 03052004

F107 A3 448 Y F107 COVERED/NON-COVERED VS ACCOMMODATION DAYS CONFLICT CONFLICT WITH COVERED/NON-COVERED DAYS VS ACCOMODATION DAYS 03152003 02202004

F109 A3 448 Y F109 SUB/OTHER PAYER RESPONSE CODE CANNOT BE SAME 2000B SDR01=P/S & 2320 SBR01=P/S:ONLY 1 PRIM/SEC ALLOWED 10152003 02202004

F997 A3 448 Y F997 FILE REJECTION CONTAINS INVALID SPECIAL CHARACTERS FILE REJECTION - CONTAINS INVALID SPECIAL CHARACTERS 12052003 02202004

F998 A3 448 Y F998 MISSING CLAIM LOOP CLAIM IS MISSING 2300 LOOP 12052003 03052004

F999 A3 448 Y F999 MISSING SERVICE LOOP CLAIM IS MISSING 2400 LOOP 12052003 03052004

P057 A3 448 Y P057 EMPLOYMENT OR AUTO ACCIDENT INDICATOR INVALID CLAIM EMPLOYMENT OR AUTO INVALID 08122003 02242004

P067 A3 448 Y P067 PRIMARY PAYER PAID EQUALS SUBMITTED CHARGE OTHER CARRIER PAID AMOUNT AND ADJ INVALID 08122003 02242004

P135 A3 448 Y P135 ADMISSION DATE MUST BE LESS THAN SERVICE DATE ADMISSION DATE MUST BE LESS THAN SERVICE DATE 03152003 02242004

P440 A3 448 Y P440 MEDICARE PRIMARY CLAIM CONTAINS OTHER PAYER PAID AMOUNTS MEDICARE PRIMARY CLAIM CONTAINS OTHER PAYER PAID AMOUNTS 04132004 04132004

P997 A3 448 Y P997 INVALID SPECIAL CHARACTERS REPORTED FILE REJECTION - CONTAINS INVALID SPECIAL CHARACTERS 12052003 02202004

P998 A3 448 Y P998 NO CLAIM INFORMATION REPORTED CLAIM IS MISSING 2300 LOOP 12052003 02202004

P999 A3 448 Y P999 NO SERVICE LINE INFORMATION REPORTED CLAIM IS MISSING 2400 LOOP 12052003 02202004

P136 A3 448 P4 Y P136 APPROVED AMOUNT IS LESS THAN PRIOR INSUR CARRIER PAID AMT APPROVED AMOUNT IS LESS THAN PRIOR INSURANCE CARRIER PAID AMOUNT 03152003 03052004

C1173 A3 448 QC Y C1173 PATIENT PAID MORE THAN BILL CHRG-AMT PAID PATIENT PAID MORE THAN BILL CHRG - AMT PAID 12192003 02202004

A368 A3 453 Y A368 MODIFIER MISSING OR INVALID FOR OPTICAL SERVICE 08122003 02242004

A377 A3 453 Y A377 MODIFIER MISSING OR INELIGIBLE FOR P&O SERVICE 08122003 03052004

A425 A3 453 Y A425 REQUIRED MODIFIER IS MISSING 08122003 02242004

A511 A3 453 Y A511 TWO REQUIRED MODIFIERS NOT PRESENT FOR AMBULANCE SERVICE 08122003 02242004

CFA010 A3 453 Y CFA010 PROCEDURE CODE MODIFIER(S) INVALID 12292003 02202004

CFA011 A3 453 Y CFA011 PROCEDURE CODE MODIFIER(S) INVALID 12292003 02202004

CFA012 A3 453 Y CFA012 PROCEDURE CODE MODIFIER(S) INVALID 12292003 02202004

C858 A3 453 Y C858 MODIFIER INVALID 08192003 02202004

F155 A3 453 Y F155 - INVALID PROCEDURE MODIFIER 1 - MUST BE 2 CHARS 02122004 02202004

F156 A3 453 Y F156 - INVALID PROCEDURE MODIFIER 2 - MUST BE 2 CHARS 02122004 02202004

F157 A3 453 Y F157 - INVALID PROCEDURE MODIFIER 3 - MUST BE 2 CHARS 02122004 02202004

F158 A3 453 Y F158 - INVALID PROCEDURE MODIFIER 4 - MUST BE 2 CHARS 02122004 02202004

MF10 A3 453 Y MF10 INVALID MODIFIER SERVICE 05222003 03112004

MF14 A3 453 Y MF14 INVALID MODIFIER SERVICE 05222003 03112004

MP04 A3 453 Y MP04 INVALID MODIFIER SERVICE 05222003 03112004

MP08 A3 453 Y MP08 INVALID MODIFIER SERVICE 05222003 03112004

P140 A3 453 Y P140 MODIFIER SEQUENCE MUST BE IN ORDER 03152003 02242004

A012 A3 454 Y A012 PROCEDURE CODE IS MISSING OR INVALID 08122003 02242004

A013 A3 454 Y A013 PROCEDURE CODE IS INVALID 08122003 03052004

A027 A3 454 Y A027 PROCEDURE CODE IS INVALID 08122003 03052004

A060 A3 454 Y A060 PROCEDURE CODE IS MISSING OR INVALID 08122003 02242004

A150 A3 454 Y A150 PROCEDURE CODE IS INVALID 08122003 02242004

A529 A3 454 Y A529 PROCEDURE CODE IS MISSING OR INVALID 08122003 02242004

CFA009 A3 454 Y CFA009 PROCEDURE CODE INVALID 10282003 02242004

CXX563 A3 454 Y CXX563 PROCEDURE CODE INVALID 11122003 02242004

C15 A3 454 Y C15 INVALID PROCEDURE CODE 08182003 02242004

C2082 A3 454 Y C2082 INVALID PROCEDURE CODE 12192003 02242004

C2423 A3 454 Y C2423 INVALID PROCEDURE CODE 12192003 02242004

C3051 A3 454 Y C3051 INVALID PROCEDURE CODE 12192003 02242004

C4382 A3 454 Y C4382 INVALID PROCEDURE CODE 12192003 02242004

C701 A3 454 Y C701 PROCEDURE CODE MISSING OR INVALID 08192003 02242004

C780 A3 454 Y C780 PROCEDURE CODE BE VALID CPT CODE 12192003 02242004

F086 A3 454 Y F086 HCPCS CODES ARE REQUIRED 08122003 02242004

F102 A3 454 Y F102 PRINCIPAL PROCEDURE DATE IS INVALID 03202003 02242004

MD01 A3 454 Y MD01 INVALID CDT4 PROCEDURE CODE SERVICE 05222003 03112004

MD02 A3 454 Y MD02 INVALID CDT4 PROCEDURE CODE OTHER PAYER - SERVICE 05222003 03052004

MF01 A3 454 Y MF01 INVALID HCPCS CODE-CLAIM (HOME HEALTH/REPRICING) 05222003 03052004

MF02 A3 454 Y MF02 INVALID ICD9 PROCEDURE CODE CLAIM (HOME HEALTH) 05222003 03112004

MF06 A3 454 Y MF06 INVALID HCPCS PROCEDURE CODE CLAIM 05222003 03112004

MF07 A3 454 Y MF07 INVALID ICD9 PROCEDURE CODE CLAIM 05222003 03112004

MF09 A3 454 Y MF09 INVALID HCPCS PROCEDURE CODE SERVICE 05222003 03112004

MF12 A3 454 Y MF12 INVALID HCPCS PROCEDURE CODE SERVICE (REPRICING) 05222003 03112004

MF13 A3 454 Y MF13 INVALID HCPCS PROCEDURE CODE OTHER PAYER SERVICE 05222003 03112004

MP03 A3 454 Y MP03 INVALID HCPCS PROCEDURE CODE SERVICE 05222003 03112004

MP05 A3 454 Y MP05 INVALID HCPCS PROCEDURE CODE SERVICE 05222003 03112004

MP06 A3 454 Y MP06 INVALID HCPCS PROCEDURE CODE SERVICE 05222003 03112004

MP07 A3 454 Y MP07 INVALID HCPCS PROCEDURE CODE OTHER PAYER SERVICE 05222003 03112004

P083 A3 454 Y P083 PROCEDURE CODE IS MISSING-SERVICE 08122003 02242004

P087 A3 454 Y P087 PROCEDURE CODE MISSING ON CROSSOVER CLAIM 09092002 02242004

P099 A3 454 Y P099 PROCEDURE CODE/NDC CODE MISSING/INVALID 03152003 02242004

F079 A3 455 Y F079 ANCILLARY REVENUE CODE IS INVALID 08122003 02262004

MF03 A3 455 Y MF03 INVALID REVENUE CODE CLAIM (REPRICING) 05222003 03112004

MF08 A3 455 Y MF08 INVALID REVENUE CODE SERVICE 05222003 03112004

MF11 A3 455 Y MF11 INVALID REVENUE CODE SERVICE (REPRICING) 05222003 03112004

MF15 A3 455 Y MF15 INVALID REVENUE CODE OTHER PAYER SERVICE 05222003 03112004

F095 A3 456 Y F095 COVERED DAYS MUST BE GREATER THAN ZERO 08122003 02262004

F096 A3 456 Y F096 COVER DAYS MUST BE EQUAL TO ZERO 08122003 05282004

F058 A3 459 Y F058 LIFETIME RESERVE DAYS INVALID 08122003 02262004

F065 A3 460 Y F065 CONDITION CODE IS INVALID 08122003 02262004

F089 A3 460 Y F089 MEDICAID CLAIM CONDITION CODE MISSING 05232003 02262004

F061 A3 461 Y F061 OCCURRENCE CODE IS INVALID 08122003 02262004

F062 A3 461 Y F062 OCCURRENCE DATE IS INVALID 08122003 02262004

F063 A3 462 Y F063 OCCURRENCE SPAN CODE IS INVALID 08122003 02262004

F064 A3 462 Y F064 OCCURRENCE SPAN DATE IS INVALID 08122003 02262004

F066 A3 463 Y F066 VALUE CODE IS INVALID 08122003 02262004

F067 A3 463 Y F067 VALUE AMOUNT IS INVALID 08122003 02262004

F069 A3 463 Y F069 VALUE CODE 08/10 IS REQUIRED 08122003 02262004

F070 A3 463 Y F070 VALUE CODE 01 IS REQUIRED 08122003 02262004

A636 A3 464 Y A636 STATUS INQUIRY CLM AND ORIGINAL DOCUMENT NUMBER IS MISSING 08122003 03052004

P059 A3 464 Y P059 BCBSM STATUS INQUIRY CLM & ORIGINAL CLM DOC NUMBER MISSING 08122003 02242004

P093 A3 464 Y P093 ORIGINAL CLAIM REFERENCE NUMBER MISSING ON REPLACEMENT CLAIM 03152003 02202004

P060 A3 464 P4 Y P060 PRIMARY PAYER CONTROL NUMBER MISSING ON CROSSOVER CLAIM 08122003 02242004

F088 A3 465 Y F088 PRINCIPAL PROCEDURE CODE IS REQUIRED 08122003 02182004

CDA016 A3 468 Y CDA016 INVALID PATIENT SIGNATURE SOURCE CODE 11042003 02252004

CXXYDB A3 468 QC Y CXXYDB INVALID / MISSING PATIENT SIGNATURE SOURCE 06292004

CXXYDI A3 468 QC Y CXXYDI INVALID PATIENT SIGNATURE SOURCE 06112004

A290 A3 474 Y A290 PROCEDURE LIMITED TO MALE SUBSCRIBER 08122003 02242004

A291 A3 474 Y A291 PROCEDURE LIMITED TO FEMALE SUBSCRIBER 08122003 02242004

A148 A3 476 Y A148 UNITS OF SERVICE INVALID OR ILLOGICAL FOR SERVICE REPORTED 08122003 02242004

A363 A3 476 Y A363 UNITS OF SERVICE (QUANTITY) MISSING FOR FACILITY SERVICE 08122003 02242004

A432 A3 476 Y A432 UNITS OF SERVICE (QUANTITY) MISSING FOR DME SERVICE 08122003 02242004

A533 A3 476 Y A533 UNITS OF SERVICE (QUANTITY) IS NOT NUMERIC 08122003 02242004

CFA018 A3 476 Y CFA018 MISSING OR INVALID UNITS OF SERVICE 10282003 02202004

CFA019 A3 476 Y CFA019 MISSING OR INVALID UNITS OF SERVICE (ANES/OXYGEN MIN) 12292003 03052004

C1000 A3 476 Y C1000 MISSING OR INVALID ANESTH MINUTES 12192003 03052004

C1885 A3 476 Y C1885 MISSING OR INVALID UNITS OF SERVICE MUST BE > 0 12192003 02202004

C1915 A3 476 Y C1915 MISSING OR INVALID UNITS OF SERVICE MUST BE > 0 12192003 02202004

C1918 A3 476 Y C1918 MISSING OR INVALID UNITS OF SERVICE MUST BE > 0 12192003 02202004

C989 A3 476 Y C989 INVALID PROCEDURE CODE 12192003 02202004

P066 A3 476 Y P066 QUANTITY INVALID FOR PROCEDURE CODE REPORTED 08122003 02242004

CFA014 A3 477 Y CFA014 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 11122003 02232004

CFA015 A3 477 Y CFA015 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 11122003 02232004

CFA016 A3 477 Y CFA016 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 11122003 02232004

C2180 A3 477 Y C2180 DIAG CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4145 A3 477 Y C4145 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4151 A3 477 Y C4151 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4155 A3 477 Y C4155 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4211 A3 477 Y C4211 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4212 A3 477 Y C4212 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4217 A3 477 Y C4217 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4218 A3 477 Y C4218 INVALID SECONDARY DIAGNOSIS 12192003 02232004

C4219 A3 477 Y C4219 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4221 A3 477 Y C4221 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4241 A3 477 Y C4241 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4265 A3 477 Y C4265 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4268 A3 477 Y C4268 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4271 A3 477 Y C4271 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4278 A3 477 Y C4278 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4330 A3 477 Y C4330 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4331 A3 477 Y C4331DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4333 A3 477 Y C4333 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

C4334 A3 477 Y C4334 DIAGNOSIS CODE POINTER IS MISSING OR INVALID 12192003 02232004

P212 A3 479 P4 Y P212 OTHER INS PAYER ID AT SVC LEVEL DOES NOT EQUAL CLM PAYER ID 03152003 02102004

P061 A3 480 P4 Y P061 MEDICARE 4081 IND MISSING OR INVALID ON CROSSOVER CLAIM 08122003 03052004

C3245 A3 481 Y C3245 AARP CLAIMS NOT ACCEPTED ELECTRONICALLY 12192003 03182004

C3993 A3 481 Y C3993 INVALID FORMAT 12192003 02232004

P011 A3 481 Y P011 TERTIARY CROSSOVER CLAIMS ARE NOT ACCEPTED. 08122003 03182004

C4819 A3 483 Y C4819 MAX COVERAGE AMT MET OR EXCEEDED FOR BENEFIT PERIOD 12292003 03052004

M001 A3 484 M001 INTERNAL PROGRAM ERROR - NOT A PROVIDER DATA ISSUE 05222003 03162004

M005 A3 484 M005 INTERNAL PROGRAM ERROR - NOT A PROVIDER DATA ISSUE 05222003 03162004

M006 A3 484 M006 INTERNAL PROGRAM ERROR - NOT A PROVIDER DATA ISSUE 05222003 03162004

C2396 A3 488 Y C2396 DATE OF SERVICE PRIOR TO DATE OF BIRTH 12192003 02232004

C2397 A3 488 Y C2397 DATE OF SERVICE PRIOR TO DATE OF BIRTH 12192003 02232004