BCBS Commercial Insurance Denial Codes (2024)

Blue Cross Blue Shield denial codes or BCBS Commercial insurance denials codes list is prepared for the help of executives who are working in denials and AR follow-up. Most of the time when people work on denials they face difficulties to find out the exact reason of denials, so this Blue Cross Blue Shield denial codes or Commercial insurance denials codes list will help you.

Blue Cross Blue Shield Denial Codes List

Denial CodesDescriptionCARCRARC
2 Charge exceeds the maximum allowable under  member’s coverage.45 
8 Service is limited by the member’s plan. Benefits were extended by our Utilization Management department.119 
18 Charge exceeds the maximum allowable under  member’s coverage45 
01DProcessing of  Claim was suspended awaiting information requested from  provider or subscriber.133 
02DBenefits for  service are limited to two times per contract year.273N435
03DBenefits for  service are limited to one time per three-month period.273N435
04DBenefits for  service are limited to one time per thirty-six month period.273N435
50 Charge exceeds the maximum allowable under  member’s coverage.59N644
54Services denied due to being delegated to another entity.109N418
57We are deducting  amount because of an overpayment on a previous FSA Claim.  
05DBenefits for  service have a twelve-month waiting period.179 
62These expenses are not eligible since there is no money left in your Flexible Spending Account.187 
66 Service is not a covered  under medical benefits. The service is eligible under the Health Reimbursement Account.96N30
68These expenses are not eligible since there is no money in your Flexible Spending Account.187 
69These expenses are not eligible since there is no money in your Flexible Spending Account.187 
06D Service was performed on a previously missing tooth.272 
71Your Dependent Care Flexible Spending Account funds have been exhausted. Payment may be made when additional funds are available.187 
73Benefits for  service are excluded under  member’s plan.96N216
77Long Term Care Hospital Override  
79Line Item Denial Override  
07DBenefits for  service are limited to two times per twelve-month period.273N412
08DServices for hospital charges, hospital visits, and drugs are not covered.96N216
09DServices for premedication and relative analgesia are not covered.96N126
0DA This is an adjustment to a previous dental Claim that paid to the provider but should have paid to the subscriber.96MA67
0s0Change Secondary Coinsurance Amount  
0s1Change Secondary Copay Amount  
104 Member’s coverage excludes benefits for the condition for which  service was rendered.96N216
10DBenefits for sealants and dietary instruction are not covered.96N216
11DThe Procedure code and tooth number filed do not correspond. An alternate Procedure code was used for pricing.169 
12DBenefits for  Procedure are limited to once per lifetime, per tooth and tooth surface.119N587
13DAppliances due to wear and services to improve bite or to correct congenital or developmental problems are non-covered.96N216
14DBenefits for implants, TMJ (Temporomandibular Joint) Dysfunction and periodontal splinting are not covered.96N216
15DBenefits for  service are limited to one time per three-month period.273N435
16DWe cannot process  Claim until we receive previously requested information concerning the member’s other insurance.22 
17DBenefits for services that are considered to be primarily cosmetic are not covered.96N383
17dA portion of these services is considered primarily cosmetic and will not be covered.96N383
18D Procedure is not covered, an allowance for a standard Procedure was paid.169 
19DBenefits for  service are limited to two times per calendar year.273N435
1DA Dental Claim is being adjusted due to a corrected billing submitted by the provider.96MA67
1DOTemporary Procedure has been deducted from the amount of the primary Procedure.169 
1s1Secondary Supplementation Amount  
201Interest is being recouped.85 
20DRelines cannot be billed separately if done within six months of the primary denture and or partial Procedure.273N435
217Paid Limit Accumulator Has Been Altered by Med Supp Sequestration Reduced from the Paid Amount  
21DBenefits for  service are limited to one time per sixty-month period.273N435
22DBenefits for  service have a twenty-four month waiting period.179 
23DThese benefits have been paid by the member’s medical policy.168 
24DBenefits for  service are limited to one time per six-month period.273N435
25D Category of dental benefits has a waiting period as specified in  member’s dental contract.179 
26DBenefits for  service are limited to one time per five-month period.273N435
27DBenefits for  dental service are not available, per  member’s contract.96N216
28DBenefits for  service are limited to one time per twelve-month period.273N435
29DBenefits for  dental service are not available, per  member’s contract.96N216
2s2Secondary Allow Amount  
30D Charge is a duplicate of a previously processed Claim for  member.18N702
30d Procedure is a duplicate of a previously filed Procedure.18N522
31D Service is denied based on information submitted. Participating dentist should charge only amount in ‘Patient Owes’.96N10
328 Claim was adjusted to provide corrected benefits.96MA67
32DBenefits for  service are limited to one time per four-month period.273N435
33DBenefits for  service are limited to one time per two-year period.273N435
341 Claim was paid to the wrong payee.96MA67
342 Claim was paid to the wrong payee.96MA67
343 Claim was paid to the wrong payee.96MA67
344 Member’s coverage under  plan was not in effect on the date  service was provided.27N30
345Benefits for  service are excluded under  member’s plan.96N30
346Duplicate of previous Claim. If corrected billing, please resubmit according to billing guidelines.18N702
347Benefits for  service are excluded under  member’s plan.96N30
348Benefits are excluded for an on the job injury or for services eligible for Worker’s Compensation benefits.19N418
349 Claim was adjusted to provide benefits secondary to Medicare.96MA67
34DBenefits for  service have a ninety-day waiting period.179 
350 It is a subrogation adjustment. It will not effect previously assigned patient liability.215 
351 Claim was adjusted to provide benefits secondary to  member’s other insurance coverage.96MA67
352 Claim was previously processed under another member’s name or ID number in error.96MA67
353 Claim was previously processed under another member’s name or ID number in error.96MA67
354 Claim was adjusted to provide corrected benefits.96MA67
355 Claim was adjusted to provide corrected benefits.96MA67
356 Claim was adjusted to provide corrected benefits.96MA67
35DBenefits for  service are limited to one time per twenty-four month period.273N435
365 Claim was adjusted to provide corrected benefits.96MA67
366 Claim was adjusted to provide corrected benefits.96MA67
367 Claim was adjusted due to a change in provider information.96MA67
368 Claim was adjusted due to a change in provider information.96MA67
369 Claim was adjusted to provide benefits secondary to Medicare.96MA67
36DThese benefits were previously paid under an incorrect provider status.170N95
370 Claim was adjusted to provide corrected benefits.96MA67
371 Claim was adjusted to provide corrected benefits.96MA67
379 It is a subrogation adjustment. It will not effect previously assigned patient liability.215 
37D Service needs to be resubmitted using current American Dental Association Procedure codes.181M20
37d Service needs to be resubmitted using current American Dental Association Procedure codes.181M20
380 Claim was adjusted to provide benefits secondary to Medicare.96MA67
381Please submit a copy of the Explanation of Benefits from  member’s other insurance carrier.22MA92
382 Claim was adjusted to provide benefits secondary to Medicare.96MA67
383 Claim was adjusted to provide corrected benefits.96MA67
384 Claim was adjusted to provide corrected benefits.96MA67
385 Claim was adjusted because we were notified that the provider billed for  service in error.96MA67
389 Claim was adjusted to provide corrected benefits .96MA67
38D Service has been denied due to contract limitations.273N435
390 Claim was adjusted to provide corrected benefits.96MA67
391 Service was previously denied as a duplicate in error.96MA67
392 Claim was adjusted to provide corrected benefits.96MA67
393 Claim was adjusted to provide corrected benefits.96MA67
394 Claim was adjusted to provide corrected benefits.96MA67
395 Claim was adjusted to provide corrected benefits.96MA67
397ITS Inclusive Grouping Number  
39DBenefits for  service are limited to one time per year.273N435
3s3Supplemental Calculation Method  
40D Date of service is after  member’s termination date.27N30
41D Service has been paid based on group’s request.  
42dMcKee Executive Dental payment reimbursement  
43DProcessing of  Claim is suspended awaiting information from the provider.163N686
44D Charge exceeds the maximum allowable under  member’s contract.45 
46DProcessing of  Procedure is suspended awaiting information from  member’s medical or other carrier’s policy.168 
47DBenefits for adult orthodontics are only payable for TMJ Diagnosis.96N569
48DBenefits for  service are limited to one time per forty-eight month period.273N435
4s4Change Secondary Service Rule  
500Submitting IPA is not related to member’s IPA  
501Capitated entity charge amount equal 0.00  
502Prudent Layperson Override  
503Delegated Claim Entity Override  
504Capitation Indicator  
505Capitation Fund  
506Risk Indicator  
507Delegated UM Entity Override  
508Capitation Deduct  
509Opt out override  
50DBenefits for  service are limited to three times per twelve-month period.273N435
510Service Area Override  
511Reimbursable allowable amount  
51DGrace period for plan limits.45 
54DBenefits for  service are limited to one time per calendar year.273N435
55DBenefits for  service are limited to once per lifetime.273N435
56DBenefits for  service are limited to four times per calendar year.273N435
57DBenefits for  service are limited to one time per three-year period.96N130
57dBenefits for  service are limited to one time per three calendar year period.273N435
58DPlease submit a copy of the Explanation of Benefits from  member’s other insurance carrier.22N4
59DBenefits for  service are limited to one time per five-year period.273N435
5s5Bypass Secondary Plan Limits  
60DThe combination of x-ray charges submitted on  Claim should not exceed the cost of a full mouth series.169 
61D Allowance is based on a less costly Procedure. The disallowed amount will be the patient’s responsibility.169 
61d Procedure is non covered. An alternate standard Procedure has been used to price the allowed.169 
62DThe combination of x-ray charges submitted on  Claim should not exceed the cost of a full mouth series.169 
63DBenefits for crowns are available only when the tooth cannot be restored by any other material.96M25
6s6Change Secondary Allow per Unit  
704 Service needs to be resubmitted using current American Dental Association Procedure codes.  
7s7Change Secondary Allowed Units  
82D Member or dependent is not eligible for dental benefits.  
83D Member is not eligible for dental benefits.96N216
84D Member is not eligible for dental benefits.96N216
85D Patient has met his or her annual or lifetime maximum benefits.119N587
89D Dental Claim was processed in error.  
8s8Change Secondary Disallow Amount  
90D Member’s contract does not allow for crown coverage. An allowance has been made for a stainless steel crown.169 
95DTemporary partials are only covered for the anterior front teeth.96N130
97D Charge is considered part of the total cost. Please do not bill separately.169 
98D Dental Claim was processed in error.B11N216
9s9Change Secondary Deductible Amount  
A01 Provider is not eligible under  member’s coverage.170N348
AB0Call 1-800-924-7141 for Claim detail if needed.  
AD3It is a subrogation adjustment. It will not affect previously assigned patient liability.215 
AD4It is the disallowed amount prior to subrogation adjustment.215MA67
ADP Amount was previously paid to the wrong payee. A corrected payment has been made.96MA67
ADTIt is an adjustment of a previously processed Claim due to a BCBST change to the provider assignment.96MA67
ADX Claim was adjusted due to a change in provider information.96MA67
AUTBenefits cannot be provided for  service because the required authorization is not on file.197 
AY1Outside Year Period Override  
AZP Medication is to be dispensed by CVS Specialty at 1-888-265-7990. A one time exception was allowed under your medical plan. N189
B01 Procedure is not covered per contract limitations. Alternate Procedure pricing was used.169 
B02Number of services exceeds contract limitations. An alternate Procedure was used.169 
B03Benefits for  service are limited to one time per seven year period.273N435
B08 Member’s coverage does not provide benefits for TMJ (Temporomandibular Joint) Dysfunction and occlusion.96N216
B09 Member’s coverage does not provide benefits for implants and periodontal splinting.96N216
B10 Member’s coverage does not provide benefits for basic restorative dentistry.96N216
B11 Member’s coverage does not provide benefits for crown and prosthetic dentistry.96N216
B12 Member’s coverage does not provide benefits for orthodontic dentistry.96N216
B13 Member’s coverage does not provide benefits for gold foil restorations.96N216
B14 Member’s coverage does not provide benefits for dental care that is elective or a special technique.96N216
B15 Member’s coverage does not provide benefits for replacement services due to loss or theft.96N216
B16 Member’s coverage does not provide benefits for desensitizing teeth.96N216
B17 service is primarily considered medical. Please file with  member’s medical policy.168 
B18 Member’s coverage does not provide benefits for adult orthodontics.96N216
B19 Member’s coverage does not provide benefits for prescribed drugs and other medications.96N216
B20 Member’s coverage does not provide benefits for congenital, cosmetic or aesthetic services.96N216
B21 Member’s coverage only allows for sealants on the occlusal biting surface of a tooth.96N216
B22 Service is primarily considered medical. Please file with  Member’s medical policy.168 
B23 Provider is not eligible under  Member’s coverage.185 
B24 Patient has met his or her annual or lifetime maximum benefits.119N587
B25Benefits for  service have a twelve-month waiting period.273N435
B26Benefits for  service have a twenty-four month waiting period.273N435
B27Benefits for  service have a ninety-day waiting period.179 
B28 Service is not covered when performed on the same day as a related Procedure.273N435
B29Benefits cannot be provided for a prosthetic device that replaces one or more teeth that were missing prior to the policy effective date.96N130
B30 Service is not covered unless specific Services are performed in conjunction with or prior to  Service.96N130
B31 Charge exceeds the maximum allowable under  Member’s coverage.45 
B32 Service is not covered when performed within 90 days of another active surgical or non-surgical Procedure.273N435
B33Benefits cannot be provided until we receive information about  Member’s eligibility.252N375
B34Benefits for  Service are limited to one time per ten year period.  
B35Benefits payable for  Member’s orthodontic treatment has been provided.96N130
B36 Patient has met his or her dental quarterly maximum benefits.119N640
B37Benefits for  Service are limited to four times per twelve-month period.273N435
B51 Service does not meet BlueCross BlueShield of Tennessee clinical criteria and will not be considered for payment.96N130
B52Recementing or repairs cannot be billed separately if done within twelve months of the initial placement Procedure.273N435
B53A deleted Procedure code was filed.  code was replaced with a current Procedure code.181M20
B54Recementing or repairs cannot be billed separately if done within six months of the initial placement Procedure.273N435
B59 Service is considered part of the primary Procedure. Please do not bill separately.97N19
B61The servicing provider has billed  Claim under the incorrect patient.96N10
B62 Claim must be filed by the provider who actually rendered the Service.96N32
B63 Claim was adjusted because it was previously processed under a different patient.B13 
B64 Charge was adjusted because we were notified that the provider billed for  Service in error.96N10
B65 Claim was paid to the wrong payee.96N10
CBM Member’s primary insurance carrier already paid  amount.23 
CCCThe payment for  Service is to reimburse the provider for patient care coordination.24M112
CDD Claim is a duplicate of a previously submitted Claim for  member.18N522
CG0 Service falls into a category that is not covered under  Member’s dental plan.96N216
CG1 Service falls into a category that is not covered under  Member’s dental plan.96N216
CG2 Service falls into a category that is not covered under  Member’s dental plan.96N216
CG3 Service falls into a category that is not covered under  Member’s dental plan.96N216
CG4 Service falls into a category that is not covered under  Member’s dental plan.96N216
CG5 Service falls into a category that is not covered under  Member’s dental plan.96N216
CM1 charge exceeds the previous carrier’s allowed amount. Provider has agreed not to bill the patient for  amount.45 
CM2The provider has agreed to accept the amount allowed under  Member’s contract for  Service.131 
CMSThe provider has agreed to accept the amount allowed under  Member’s contract for  Service.131 
CO1 payment was secondary to primary benefits provided by  Member’s other health insurance.23 
CO2 amount includes the benefits provided by  Member’s other insurance carrier.23 
COBBenefits cannot be provided until we receive previously requested information concerning  Member’s other insurance.252N686
COS Procedure is not eligible for benefits under  Member’s coverage because it was performed for cosmetic purposes.96N383
CPYThe original Copay amount has been reduced to a percentage of the allowable amount  
CR Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
CRTCREdit-ADJUSTMENT-OVERPAYMENT TO BE DEDUCTED FROM PAID AMOUNT. Message appears on RA when auto deduct of overpayment.  
CVXCoverage Exclusion96N30
D01The dental allowable amount was increased.45 
D02The dental allowable amount was decreased.45 
D11The dental allowable amount per unit was increased.45 
D12The dental allowable amount per unit was decreased.45 
D13The dental allowable units were increased.45 
D14The dental allowable units were decreased.45 
D15 It is  dental disallowed amount.96N130
D21Please submit the date orthodontic treatment started.  
D22Please submit accompanying x-rays for  dental Procedure.16M129
DA0 dental Claim is being adjusted since we have been notified that the provider billed for  Service in error.96MA67
DA1 Claim was previously paid to the wrong provider. A payment has been made to the correct provider.96MA67
DA2 Claim was previously processed correctly under another ID number or patient’s name. No additional payment is due.96MA67
DA3 Disallowed amount is the ortho extended treatment and has been moved to another Claim.172 
DA4 it is an adjustment to a previous dental Claim that paid to the subscriber but should have paid to the provider.96MA67
DA6A dental adjustment is in process for  Claim, which will be reprocessed on a future date.96MA67
DA7 It is an adjustment to a previously paid dental Claim. The payable amount is less than the amount originally paid.96MA67
DA8 It is money reimbursed due to another party’s payment. Refer to Patient Owes column for any liability charges.215 
DA9 Dental Claim was previously processed with an incorrect date of Service.96MA67
DACOther insurance information has been received and  Member’s records updated.  Claim has been adjusted.96MA67
DADFull or partial dental benefits were denied in error.96MA67
DALIt is a dental adjustment. The provider was corrected and or subscriber payment liability.96MA67
DAPThe originally submitted Procedure was replaced due to benefit plan restrictions.169 
DB0 Dental Claim has been adjusted due to an incorrect tooth and or surface.96MA67
DB1 Dental Claim was adjusted due to an incorrect Procedure code.96MA67
DB2 Claim was denied for an Explanation of Benefits.  
DB3 Claim paid secondary to another insurance carrier.  
DB4 Dental Claim was denied requesting additional information from the provider.  
DB5A dental adjustment has been completed and has resulted in a statistical change.96MA67
DB6 Claim was adjusted because the Member’s eligibility has been updated.96MA67
DCGOverride Dental Category  
DEN Dental Service is not eligible for benefits under  Member’s coverage.96N216
DG2The allowable is a discounted DRG amount.45 
DGEOverride Age Limitation  
Dis Charge exceeds the maximum allowable under  Member’s coverage.45 
DMD Oral surgery Service does not meet the requirements of  Member’s program for coverage.96N216
DOPWe are deducting  amount because of an overpayment on a previous Claim.172 
DP0 Patient’s age is not within the normal range established for  dental Procedure.96N130
DP1 Pental Procedure is not a covered Service for  tooth/teeth numbers.96N130
DP2The charge or number of occurrences  Procedure was performed has exceeded the contract limits.273N435
DP3The charge or number of occurrences  Procedure was performed has exceeded the contract limits.273N435
DP4The charge or number of occurrences  Procedure was performed has exceeded the contract limits.273N435
DP5The number of occurrences  Procedure was performed has exceeded the contract limits.273N435
DPXYour group’s contract requires a period of membership before benefits are available for  Service.51N607
DRCThe dental runout time limit has been exceeded.29 
DRE Claim is prior to effective date of the coverage.26N30
DRQ Date of Service (DOS) is after the termination of coverage.27N30
DRTTimely filing has been exceeded.29 
DSRYour Claim has been received and is currently under special review.216 
DUPDuplicate of previous Claim. If corrected billing, please resubmit according to billing guidelines.18N522
DWPOverride Dental Category Waiting Period  
ECTECT single or multiple is not a billable Service for  discipline level.185N684
EMR Amount was previously reimbursed and is not included in the Executive Medical Reimbursement.96M86
EMr Amount is for Executive Medical Reimbursement.96M86
EOBPlease submit a copy of the Explanation of Benefits from  Member’s other insurance carrier.22MA04
EXC Claim was paid as an exception. Future Claims without a referral from the Member’s PCP will be denied.45N189
FTPFamily therapy is a non-covered Service.96N30
FYIRECALCULATED PAYMENT – EXCLUDED FROM AMOUNT PAID. (Message appears on RA when auto deduct of overpayment.)  
G44 Check amount is the outstanding balance (minus deductible and coinsurance) that the provider may bill.96N30
GARExecution Of Garnishment  
GLB Claim is disallowed because it is included in the global case payment.97N525
GNSThe provider must file  Claim with Magellan, P.O. BOX 5190, Columbia, MD 21046.109N418
GRPThe Member’s group has already paid for  Claim. We are reimbursing the Member’s group by manual check.96N30
HLDThere is a hold on payment of  Claim.96N30
HM0Call 1-800-924-7141 for Claim detail if needed.  
HRA amount was paid from the Member’s Health Reimbursement Account.187 
INFMedical records have been requested from the provider.252M127
INH Charge exceeds the maximum allowable under  Member’s coverage.45 
INV Procedure is considered investigative and is not covered under  Member’s plan.55N623
IPMIndividual Psychotherapy with Medical Management is non-covered.96N30
IRSExecution of IRS Levy  
is1 It is the State surcharge amount which is payable to the provider.96N30
isS Service is not covered per the information submitted. The provider should verify coding and resubmit if incorrect.16MA39
ITABenefits cannot be provided for  Service because the required authorization is not on file.197 
ITDThe provider must file  Claim with his or her local BlueCross BlueShield plan for processing.109N418
LAB Lab charge was already paid to the lab that performed the Service. The patient should not be billed.24 
LB1 Lab charge was already paid to  Member’s physician. The patient should not be billed.24 
LETBenefits cannot be provided for  Service. We are sending the member additional correspondence to explain.96N179
LOV Charge exceeds the maximum allowed under  Member’s coverage.45 
M09The provider has not contracted to provide  Service.96N448
MAD Portion of your Medicare Part A deductible is not covered under your supplemental policy.96N30
MARCall 1-800-924-7141 for Claim detail if needed.  
MATA portion of  Claim is denied because  member was not eligible for benefits for the entire term of the pregnancy.179 
MBD Member’s plan does not cover the Medicare Part B deductible.96N30
MCCWe cannot pay benefits until  Member’s out-of-pocket amount has been satisfied.96N30
MCD Charge was denied by Medicare and is not covered on  plan. The provider can bill the patient.96N30
MDC Amount exceeds the reimbursement due to Medicaid.45 
MEDPlease submit a copy of the Medicare Explanation of Benefits (EOB) so we can determine benefits.22MA04
MLNThe provider must submit the primary Diagnosis.11N657
MPFMedicare paid  Service in full.23 
MPfMedicare paid  Service in full.23 
MR1Medicare denied  charge and the provider cannot bill you for it.45 
MR3The provider agreed to accept the amount allowed under  Member’s contract for  Service.131 
MSDThe allowable amount for  Service has been reduced according to multiple same day surgery guidelines.59N644
MSP Payment is secondary to benefits provided by Medicare.23 
MTN Service was prepaid by Middle Tennessee IPA.24 
MXCThe provider’s charge exceeds the amount allowed by Medicare. The member is not responsible for  amount.45 
Mds It is a non-participating facility. The Medicare Part A deductible/coinsurance is not covered under  Member’s plan.242M115
MrxThese benefits are reduced because a non-participating pharmacy was used.242 
N01 Procedure is considered subset or redundant to the primary Procedure and is limited by  Member’s plan.97M80
N02The Procedure is considered subset or redundant to the primary Procedure and is limited by  Member’s plan.97M80
N03 Procedure is secondary to the primary Procedure and is limited by  Member’s plan.97M80
N04 Service is a part of the original surgical Procedure and is limited by  Member’s plan.97M144
N05 Service is not covered when performed on the same day as a surgical Procedure.97N20
N06 Procedure does not normally require the Services of an assistant surgeon.54N646
N09 Procedure is not eligible for benefits under  Member’s coverage because it was performed for cosmetic purposes.96N383
N10 Procedure is considered investigative and is not a covered Service under  Member’s plan.55N623
N11 Procedure is no longer considered clinically effective and is not eligible for benefits.56N623
N13 It is a deleted/invalid code or modifier for  date of Service. The provider should submit the proper code.182N657
N14 Service is not covered for  member. The provider should submit the proper code or medical documentation.16MA39
N15 Service is not normally performed for members in  age range.6N129
N16 Service is not normally performed for members in  age range.6N129
N17 Service is not covered when performed in  setting.96N428
N19 Service is not covered when performed for the reported Diagnosis.11N657
N25The charge for  Service has been combined with the primary Procedure.234M15
N26 Service is a part of the original surgical Procedure and is limited by  Member’s plan.97M144
N29 Procedure is redundant to the primary Procedure and is limited by  Member’s plan.97M80
N30The maximum amount allowable for  equipment has been reached.45 
NBThese benefits are for an eligible newborn who has not been added to subscriber’s plan.96N30
NCC Member’s coverage excludes benefits for the condition for which  service was rendered.96N216
NCPBenefits for  Service are excluded under  Member’s plan.96N216
NECBenefits cannot be provided for Services that have been determined not to be medically necessary.50N130
NERBenefits cannot be provided for Services not considered a medical emergency.40 
NRT It is a non-contracted room type. The room type is disallowed.45 
O25The charge for  Service has been combined with the primary Procedure.169 
OAS Service is not normally covered for members in  age range.6N129
OJIThese Services are related to an on-the-job injury.19 
OOA Claim was filed by an out of area dental provider.  
OPCOverride PCA Disallow  
OTCDrugs that can be purchased without a prescription are not an eligible expense.96N30
OTcDrugs that can be purchased without a prescription are not an eligible expense.96N30
OUTThese benefits have been reduced because a non-participating provider was used.242N130
OVPWe are deducting  amount because of an overpayment on a previous Claim.96N10
P50Present On Admission indicator required but is not valid.  
P59There are one or more Edits present that cause the whole Claim to be rejected.96N56
P60There are one or more Edits present that cause the whole Claim to be returned to the provider.96N56
P61There are one or more Edits present that cause the whole Claim to be rejected.96N56
P62There are one or more Edits present that cause the whole Claim to be denied.96N56
PAA Charge exceeds the maximum allowable under  Member’s coverage.45 
PAC Charge exceeds the maximum allowable under  Member’s coverage.45 
PAHAPC Rate  
PAI Charge exceeds the maximum allowable under  Member’s coverage.45 
PAK Charge exceeds the maximum allowable under  Member’s coverage.45 
PAL Charge exceeds the maximum allowable under  Member’s coverage.45 
PAP Charge exceeds the maximum allowable under  Member’s coverage.45 
PAR Charge exceeds the maximum allowable under  Member’s coverage.45 
PCD Charge exceeds the maximum allowable under  Member’s coverage.45 
PCP member has not chosen a PCP or has selected a PCP who is not participating in the plan.242N130
PCS prescription requires prior authorization through your pharmacy.197 
PDA Charge has been reduced based on a discount arrangement with  provider.45 
PDC Charge has been reduced based on a discount arrangement with  provider.45 
PDD Charge has been reduced based on a discount arrangement with the provider of Service.45 
PDP Charge has been reduced based on a discount arrangement with  provider.45 
PE0 Charge exceeds the maximum allowable for  Service.45 
PEDRoutine nursery or pediatric care of a newborn is not eligible for benefits.96N30
PENBenefits for  Service have been reduced due to lack of compliance with plan requirements.197 
PEO Charge exceeds the maximum allowable under  Member’s coverage.45 
PEX Charge exceeds the maximum allowable under  Member’s coverage.45 
PFC Charge exceeds the maximum allowable under  Member’s coverage.45 
PFS Charge exceeds the maximum allowable under  Member’s coverage.45 
PFU Charge exceeds the maximum allowable under  Member’s coverage.45 
PFV Charge exceeds the maximum allowable under  Member’s coverage.45 
PFW Charge exceeds the maximum allowable under  Member’s coverage.45 
PGA Charge is not reimbursed according to your DRG contract. Please see the provider manual.45 
PGD Charge exceeds the maximum allowable under  Member’s coverage.45 
PGE Charge exceeds the DRG rate for  confinement.45 
PGO Charge exceeds the maximum allowable under  Member’s coverage.45 
PGP Charge exceeds the maximum allowable under  Member’s coverage.45 
PGR Charge exceeds the maximum allowable under  Member’s coverage.45 
PHAPharmacological Management is non-covered.96N30
PHHHold Harmless Payment Applied  
PHYPhysician fees should be filed separately from the hospital Claim. The provider should rebill on the proper form.89N200
PIPersonal items cannot be considered for benefits.96N30
PLCThe Medicare limiting Charge was applied.96N30
PLPPercent Threshold Stoploss Met119 
PPD Service is included in the ordering physician’s agreement. It should be billed to the ordering physician.24 
PROProfessional Pricer Reduction  
PS Charge exceeds the maximum allowable under  Member’s coverage.45 
PS0Benefits for  Service are excluded under  Member’s plan.96N30
PS1The maximum amount payable under  Member’s coverage for  Service has been provided.119N587
PS2The maximum number of Services payable under  Member’s coverage has been provided.119N362
PS3Drugs that can be purchased without a prescription or other non-covered drugs are excluded under  Member’s plan.96N30
PS4Maximum benefits payable under  Member’s coverage have been provided.119N587
PSB Charge exceeds the maximum allowable under  Member’s coverage.45 
PSC Charge exceeds the maximum allowable under  Member’s coverage.45 
PSM Charge exceeds the maximum allowable under  Member’s coverage.45 
PSNCharge Exceeds SNF amount for Services  
PSR Charge exceeds the maximum allowable under  Member’s coverage.45 
PSS Charge exceeds the maximum allowable under  Member’s coverage.45 
PSU Charge exceeds the maximum allowable under  Member’s coverage.45 
PSV Charge exceeds the maximum allowable under  Member’s coverage.45 
PSW Charge exceeds the maximum allowable under  Member’s coverage.45 
PT1Bypass Provider Termination Date Override  
PTRThe maximum number of units allowed for  Service under  Member’s coverage has been provided.119N362
PU4Milliliters  
PU5Units  
PXCharges for a pre-existing condition are not eligible for benefits.51 
PXNNetworX Std Fee Schedule45 
RBThese Charges exceed the maximum room and board allowance under  Member’s coverage.78 
RDP Procedure is considered subset or redundant to the primary Procedure and is limited by  Member’s plan.97M80
RECMONEY RECEIVED – NO DEDUCTION FROM AMOUNT PAID. (Message appears on RA when auto recovery bypassed).  
REFThese Services were provided after the time limit specified in the referral from the PCP or  Member’s plan.95N630
REJ Service is not covered under  Member’s plan.96N30
REXRoutine examinations are not eligible for benefits under  Member’s plan.49N429
RFDThe referral for these Services was denied and benefits cannot be provided under  Member’s plan.16N335
RFNBenefits cannot be provided for these Services because we have no record of a referral from  Member’s PCP.16N335
ROURoutine Services are not covered under  Member’s plan.49N429
RPCCharges cannot be considered if the referring provider’s National Provider Identifier is not present on the Claim.16N286
RWCRecoup due to Subrogation/Workers Comp Third Party Liability overpayment.  
RWDA risk withhold has been applied to  Service. The member is not responsible for  amount.104 
RXD Amount was applied to your prescription deductible.1 
RXISave $$ on drug cost. Show your BlueCross BlueShield ID card and use a member pharmacy when buying prescription drugs.96N30
RY1We have paid the annual maximum allowable for these Services for  member.119N362
RY2The maximum days allowed for these Services have been used for  member.119N362
S10 Member’s coverage ended before the date these Services were provided.27N30
S11 Member’s coverage was not in effect on the date  Service was provided.26N30
S12 Member’s coverage was not in effect on the date these Services were provided.26N30
S13 Member’s coverage was not in effect on the date  Service was provided.26N30
S14 Member’s coverage did not take effect until after the date  Service was provided.26N30
S16 Member’s coverage was not in effect on the date  Service was provided.26N30
S17 Member’s coverage was not in effect on the date  Service was provided.27N619
S1A Member’s coverage was not in effect on the date  Service was provided.26N30
S1B Member’s coverage was not in effect on the date  Service was provided.26N30
S1C Member’s coverage was not in effect on the date  Service was provided.27N30
S1D Member’s coverage was not in effect on the date  Service was provided.27N30
S1E Member’s coverage was not in effect on the date  Service was provided.27N30
S1F Member’s coverage was not in effect on the date  Service was provided.27N30
S2 Member’s coverage was not in effect on the date  Service was provided.14 
S20 Member’s coverage was not in effect on the date these Services were provided.26N30
S21 Member’s coverage was not in effect on the date these Services were provided.26N30
S22 Member’s coverage was not in effect on the date these Services were provided.26N30
S23 Member’s coverage was not in effect on the date these Services were provided.26N30
S24 Member’s coverage was not in effect on the date these Services were provided.26N30
S25We have placed a hold on all Claims administration for  subscriber and related members.26N30
S3 Member’s coverage was not in effect on the date  Service was provided.14 
S4 Member’s coverage was not in effect on the date  Service was provided.27N30
S5 Member’s eligibility does not include coverage for  type of Service.31 
S6 Member’s age is beyond the limiting age for the plan.32N129
S61 member is older than the plan’s age limit for coverage of  Service.32N129
S7 Member’s age is beyond the limiting age for the plan.27N30
S8 Member’s age is beyond the limiting age for the plan.27N30
S9 Member’s coverage was not in effect on the date  Service was provided.27N30
S? member was not eligible for coverage on the date  Service was provided.27N30
SB Patient is not a covered member under the plan.33 
SC Patient is not a covered member under the plan.33 
SD Patient is not a covered member under the plan.33 
SDP Service is not covered when performed on the same day as a surgical Procedure.97N20
SE Patient is not a covered member under the plan.33 
SF Patient is not a covered member under the plan.33 
SG Patient is not a covered member under the plan.33 
SH1 Charge is a duplicate of a previously processed Claim.18N522
SHD Charge is a duplicate of a previously submitted Charge for  member.18N522
SL Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
SL2 Charge was discounted under the provider agreement. You have saved  amount by using a participating provider.45 
SM Member’s coverage under  plan was not in effect on the date  Service was provided.13 
SN Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
SN1 Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
SNFThe level of care billed does not match the level authorized. The provider must submit a corrected billing.197 
SO Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
SO1 Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
SP Member’s coverage under  plan was not in effect on the date  Service was provided.27N619
SPDSupplemental Discount45 
SPL Patients stop-loss limit has been reached. Benefits are payable at 100%.119 
SPT Member’s coverage has terminated.27N30
SQ Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
SS Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
ST Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
STN Claim is pended due to non-payment of premiums. The member should contact his or her State Group Representative.27N30
STP Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
STUBenefits cannot be provided until we receive information about  Member’s eligibility.252N375
SW Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
SW2 It is a non-billable Service for the discipline level.185N684
TF0The Claim for these Services was received after the time limit specified in  Member’s benefit plan.29 
TF1The Claim for these Services was received after the time limit specified in the provider’s agreement.29 
TMFThe Claim for these Services was filed after the time limit for filing specified in  Member’s plan.29 
TPSPayments have been suspended at the direction of the Bureau of TennCare.B7 
TR0Benefits cannot be provided because there was no authorization and/or referral for  Service.197 
TR1 It is not a covered Service.96N30
TR2The maximum amount payable under  Member’s coverage for  Service has been provided.119N587
TR3The maximum amount payable under  Member’s coverage for  Service has been provided.119N587
TR4The maximum number of Services payable under  Member’s coverage has been provided.119N362
TR5The maximum number of Services payable under  Member’s coverage has been provided.119N362
TR6The payment is reduced by the amount paid by your primary insurance carrier.23 
Th Member’s coverage was not in effect on the date these Services were provided.26N30
TrxYour annual prescription drug maximum has been met.119N587
UAS Member was not covered under the plan on the date  Service was provided.26N30
UCR Charge exceeds the maximum allowed under  Member’s coverage.45 
UDThese Charges have been disallowed by Utilization Management.39 
UM0These Services were disallowed by Utilization Management.39 
UM1The number of Services provided exceeds the number approved in the Utilization Management authorization.198N351
UM2These Services were limited by a Utilization Management authorization.198N351
UM3Benefits cannot be provided because there was no authorization and/or referral for  Service.197 
VBBAn enhanced medical benefit has been applied to a Service on  Claim.  
VEX Member’s coverage does not provide benefits for routine vision examinations.96N30
VGC Member’s coverage does not provide benefits for glasses or contact lens.96N30
Vis Charge exceeds the maximum allowed for vision Services.119N587
VNC Service is not an eligible vision expense under  Member’s coverage.96N30
W01The maximum amount allowable for  equipment has been reached.45 
W02 Charge is more than Medicare allows for  Service. The member is not responsible for  amount.45 
W03Benefits cannot be provided until a special review is completed.133 
W04The provider must submit the NDC, drug name, RX number, strength, day supply and quantity before benefits can be provided.16M123
W05The provider must submit a copy of the manufacturer’s invoice before benefits can be provided.252M23
W06The provider must submit the operative report or office notes before benefits can be provided.252M29
W07The provider must submit a Procedure code before benefits can be provided.16M51
W08The information on  Claim does not match the medical records submitted.250M127
W09The provider has not contracted to provide  Service.96N448
W0LThe Ambulatory Code Editor detected one or more errors for  Claim line.16M50
W10 Procedure is not eligible for benefits when performed in a hospital setting.96N428
W11A copy of the Anesthesia Flow sheet is needed to process  Claim. The provider should submit  information to us.252N439
W12The provider has not contracted to provide  Service.45 
W13 Service is not paid in addition to or separately from the primary Service.234N20
W14 Service should not be billed separately from the room and board.234M2
W15Revenue code is not valid for place of Service billed.16M50
W16 It is a non-covered Service.16M12
W17 Service requires a detailed revenue code. The provider should refer to billing guidelines locator form 44.16M12
W18 Requires Case Management approval prior to rendering Services.197 
W19The provider must submit a hard copy of  Claim with outpatient medical records.50M127
W1LThe Claim line contains revenue code 058x, 059x,0275,0276,0277,or 0278 with Charges greater than zero or it has revenue code 0624.16M50
W1TBenefits cannot be provided until the doctor submits additional information for the Abortion, Sterilization or Hysterectomy review.252M127
W21The provider must submit the appropriate CDT/CPT/HCPCS code for  Service.189M81
W22 It is not a valid revenue code for  provider. The provider should refer to billing guidelines.16M50
W23 It is an inactive revenue code. The provider should refile with a valid code.16M50
W24 Service requires a detailed revenue code. The provider should refer to billing guidelines locator form 42.16M50
W25 The revenue code is invalid for the place of Service billed. The provider should verify  code.16M50
W26The provider must refer to the billing guidelines for proper billing.16N657
W27The facility has a separate contract for lithotripsy. When billing, the provider must use revenue code 790.96N56
W29The facility did not contract for lithotripsy, revenue code 790. The provider must bill using revenue code 490 or 360.96N56
W2AThe provider must refer to the billing guidelines for proper billing.96N56
W2L Claim contains injectable osteoporosis drugs that are not payable because the Claim does not meet all of the required criteria.50N130
W30 It is a bundled Service. The payment is included in the Service to which item/Service is incident.97M80
W31Only the initial visit is eligible.96N113
W33These Charges were included in the reimbursement for the mother’s room and board.128 
W34It is a deleted/invalid code or modifier for  date of Service. The provider should submit the proper code.182N657
W35These DRG outlier days were denied by Utilization Management.69 
W36These DRG inlier days were approved by Utilization Management.69 
W37 per diem rate was approved for  DRG facility transfer.232 
W38 The amount was disallowed for  DRG facility transfer.232 
W39 DRG code is no longer valid.A8N657
W3L ESRD Claim was billed with another bill type than 72x.16MA30
W40A valid DRG code could not be assigned for the coding that was submitted. The provider must submit valid codes.A8N657
W41Medical Direction of four or more concurrent Procedures is not eligible for reimbursement.B15M80
W42For dates of Service prior to 1/1/01, please submit the Claim to Magellan.109N418
W43 Procedure is considered investigative and is not a covered Service.55N623
W44Benefits cannot be provided for Services that have been determined not to be medically necessary.96N30
W45The Claim for these Services was filed after the time limit for filing specified in  Member’s plan.29 
W46The organ acquisition cost is included in the kidney transplant case rate.97N525
W47 It is a non-covered chiropractic Service.185N684
W48Benefits for maintenance or servicing of durable medical equipment within six months of purchase date are not available.96N30
W49Benefits cannot be provided for  Service because the required authorization is not on file.197 
W4LESRD Claims must contain condition codes 59,71,72,73,74,76 or 80. Condition codes 73 and 74 cannot appear on the same Claim.16M44
W50Benefits cannot be provided for Services that have been determined not to be medically necessary.50N130
W51CPT code, modifier, or provider type is invalid. The provider should refer to billing guidelines.96N56
W52The provider must submit  patient’s complete medical history before benefits can be provided for  Service.252M127
W53 Facility number is used only for Signature members. The provider must refile under the correct provider number.16N77
W54The provider must submit  patient’s medical records. Please reference  Claim number and member id when you submit the records.252M127
W55Benefits are unavailable until we receive the information we requested in a recent letter to the provider’s office.252M143
W56The provider must submit a letter of medical necessity and plan of treatment for  patient.50M135
W57Information has been requested from another provider to completed a pre-existing review. Not action is required.252N204
W58Interim bills should only be submitted once every thirty days for the same hospital stay.16M53
W59 Claim was filed under the BlueCare provider number. Please resubmit using the Commercial provider number.16N77
W5LAn ESRD Claim must contain a Diagnosis of End Stage Renal Disease.16M64
W60Benefits cannot be provided until the provider submits a manufacturer name, product name, product number, and quantity.252M23
W61 Charge exceeds the maximum allowable under  Member’s coverage.45 
W62 Charge exceeds the maximum allowable under  Member’s coverage.45 
W63The provider has agreed to waive the Medicare Part A deductible and coinsurance.45N364
W64Measurement/Reporting Codes No Fee –  Charge is incidental to the primary Service.97M80
W65 Charge is more than Medicare allows for  Service. The member is not responsible for  amount.45 
W66 Charge exceeds the maximum allowable under  Member’s coverage.45 
W67 Service is not covered since it is supplied by the government.212N658
W6LAn ESRD Claim must contain a valid weight and height passed through value codes A8 and A9.16N207
W71 Charge exceeds the maximum allowable under  Member’s coverage.45 
W72The rendering provider is not eligible to perform the Service billed.185N570
W73 Claim was adjusted following a provider audit.96MA67
W74Medical information is needed to complete a pre-existing review. Correspondence to the provider will follow.252N204
W75 Charge exceeds the maximum allowable under the group practice agreement.45 
W76 Charge is included in the facility or physician fee that contracted for  Service.234M80
W77 Claim was processed under continuity of care guidelines.131 
W78Charges do not meet qualifications for emergent/urgent care.40 
W79The provider must file  Claim with CMS. The Medicare contractor to process  Claim can be identified through the CMS website.109N104
W7LAutomated Multi-Channel Chemistry HCPCS component codes must be billed separately.16M126
W80 Member’s benefits are based on Medicare’s allowed amount.23 
W8L ESRD Claim has an invalid modifier for pricing or is missing the required combination of modifier codes4N519
W9LThe incorrect number of units billed for revenue code 0634 or 0635 or a dialysis code was billed with units greater than 1.16M53
WA0 Charge was adjusted because we were notified that the provider billed for  Service in error.96N10
WA1We cannot provide benefits for Services that have been determined not to be a standard medical Procedure.56N623
WA2 Claim must be filed by the provider who actually rendered the Service.96N32
WA3 Procedure is not covered when rendered in  place of Service.96N428
WA4 Charge exceeds the maximum allowable under  Member’s coverage.45 
WA5Benefits for  Charge must be determined by filing through  Member’s appropriate pharmacy network.109N418
WA7For dates of Service prior to 1/1/01, please submit the Claim to Magellan.109N418
WA8The provider who rendered these Services is not eligible to assist during surgery.185N684
WB0A completed consent form is required from the provider before  Service can be considered for benefits.252N28
WB1Benefits cannot be provided until a Behavioral Health provider number and/or taxonomy code is submitted with a corrected Claim.96N30
WB2The provider must file  Claim with Tennessee Bureau of Medicaid PO Box 460, Nashville, TN 67202-0460. 1-800-852-2683109N418
WB3The provider must file  Claim with Magellan Health Services, PO Box 85042 Richmond, VA 23261. 1-866-434-5524109N418
WB4 Claim is paid according to the State Medicaid Rates due to the Deficit Reduction Act.45 
WB5Benefits are provided under the Vaccines for Children Program for the handling/administration of the vaccine only.45 
WB6Benefits can not be provided for out of network Services because the required authorization is not on file.243M115
WB7A completed consent form is required from the provider before  Service can be considered for benefits.252N28
WB8The number of administration Services for these injections must equal injections billed. The provider may need to file a corrected bill.45 
WB9The provider must submit a valid National Drug Code, unites and quantity qualifier before benefits can be provided.16M119
WCBenefits are excluded for an on the job injury or for Services eligible for Worker’s Compensation benefits.19N418
WC1Benefits are excluded for an on the job injury or for Services eligible for Worker’s Compensation benefits.19N418
WCSBenefits are excluded for an on the job injury or for Services eligible for Worker’s Compensation benefits.19N418
WD1 Service is not eligible since it was not filed according to the corrected billing guidelines. Please submit a corrected Claim.96N56
WD2We are adjusting  Claim because the Procedure was billed in error.96MA67
WD3The provider must refer to billing guidelines for BlueCare or TennCare Select.96N56
WD4 is not a valid revenue code for  type of provider. The provider should refer to billing guidelines.170N95
WD5The provider must file  Claim with OPTUM HEALTH ServiceS 1-855-437-3486 (1-855-Here4TN)109N418
WD6The provider must file  Claim with Beacon Health Options 1-888-474-0929109N418
WE0 Service is not a covered benefit under the Member’s plan.96N30
WE1 Claim was paid to the wrong payee.96N10
WE2The provider must submit Room and Board Charges correctly before benefits can be provided.16MA30
WE3The servicing provider has billed  Claim under the incorrect patient.16MA36
WE4 Charge was adjusted because we were notified that the provider billed for  Service in error.96N10
WE5 Claim must be filed by the provider who actually rendered the Service.96N32
WE6 Claim was paid to the wrong payee.129MA130
WE7 Charge has been forwarded to the Member’s appropriate pharmacy network to determine benefits.109N216
WE8Benefits have been provided at the PCP Enhancement Rate.45 
WE9The provider has agreed to accept the amount allowed under  Member’s contract for  Service.45 
WEL Member’s coverage does not provide benefits for physical examinations and related Services.49N429
WF0 Service is not eligible since it was not filed according to the corrected billing guidelines. Please submit a corrected Claim.96N56
WF1 Procedure or related Procedure code cannot be billed on the same or different Claim within ten months.119N435
WF2The provider must submit a valid National Provider Identifier before benefits can be provided.208 
WF4Payment of Claim is pending receipt of State of Medicaid number or Need Medicaid number and/or Disclosure Form.16MA112
WG0The Claim for these Services was received after the time limit specified in the provider’s agreement29 
WG1These Services were disallowed by Utilization Management.39MA67
WG2Medical Records are required before outlier days will be reviewed for medical appropriateness.252M127
WG3No approved authorization. Specialty Pharmacy Drug authorizations are handled through PBM Vendor. Please contact CVS/Caremark.243 
WG4No approved authorization. Specialty Pharmacy Drug authorizations are handled through PBM Vendor. Please contact CVS/Caremark.243 
WGBThese Services should be filed and paid by the behavioral health carrier at ComPsych Claims, PO Box 8379, Chicago, IL 60680-8379.109N418
WH0 Claim was adjusted because it was previously processed under a different patient.B13 
WH1Exceeds maximum units considered medically appropriate.119N435
WH2 Service was included in the Bundled Episode Payment.97N525
WH3The maximum amount payable under  Member’s coverage for  bundled episode.45 
WH4Benefits cannot be provided until the provider submits a brand name, manufacturer name, model and description.252M23
WH5The information on  Claim does not match the medical records submittedB12 
WH6The provider must submit an itemized or detailed billing before benefits can be provided for  Service.16N260
WH7The provider must submit the NDC, drug name, Rx number, strength, day supply and quantity before benefits can be provided.16M123
WH8Care Coordination fees are not payable.96N30
WH9Care Coordination fees are not payable.96N30
WK0 Lab Service is required to be performed by Quest Diagnostics or Solstas Lab Partners.185 
WK1The provider must file  Claim with his or her local BlueCross BlueShield plan for processing.109N418
WK2Corrected Bill was received after the time limit for submission.29 
WK3Corrected Bill was received after the time limit for submission.29 
WK4The provider must submit a correct Procedure code before benefits can be provided.16M51
WK5Statement begin and end dates can’t span calendar months TOB 89X and 66X.273N435
WK6The provider must submit a correct occurrence code before benefits can be provided.16M46
WK7The provider must submit a correct value code before benefits can be provided.16M49
WK8The provider must submit a correct condition code before benefits can provided.16M44
WK9Revenue codes not keyed in date of Service order.16M50
WL0 Home Health Claim has a UB04 bill type other than 0322, 0327, 0329, 0332, 0337, 0339, or 034x.16MA30
WL1 Home Health Claim has an invalid Service date, from -thru dates or admission date.16MA31
WL2The length of stay for  Home Health Claim is greater than 60 days16MA31
WL3The Home Health Claim has more than one Claim line with a HIPPS code and revenue code 0023.16N471
WL4The Home Health Claim indicates non-routine supplies were provided during the episode, without revenue code 027x or 0623.16M20
WL5 Home Health Claim is missing the Core Based Statistical Area in the UB-04 Value Amount with UB-04 Value Code 61.16M49
WL6 Claim must have at least on Home Health visit related revenue code16M50
WL7A weight/rate record cannot be found for  particular facility ID, payer ID, effective date and Home Health Resource Group.16N471
WL8Therapy Services billed with revenue codes 042x, 043x and 044x must be billed with the applicable modifier codes.182N657
WL9 Service is not found on the fee schedule because it may be covered under the HHA episode rate, so it is not separately payable.16N471
WM0The provider must submit a correct type of admission code before benefits can be provided.16MA41
WM1 Charge exceeds the maximum allowable under  Member’s coverage.45 
WM2 It is a subrogation adjustment. It will not affect previously assigned patient liability.215 
WM3The provider must submit a correct disCharge status before benefits can be provided.16N50
WM4The provider must submit a correct admission status before benefits can be provided.16MA43
WM5Statement from/thru dates must correspond Service line dates of Service before benefits can be provided.16MA31
WM6Duplicate data not allowed in 5010 formatted Claim.18N522
WM7Member has other insurance; please bill the primary carrier. Claim is paid due to the Services being under the pay and chase option.22N598
WM8 Modifier code or Procedure code is not valid for the date of Service on the Claim.4N519
WM9 Service is not covered when performed with an invalid Diagnosis code.11N657
WMNPayment of Claim is pending receipt of Medicaid registration.16MA112
WMT Claim is on hold based on current premium information. The member should contact his or her Human Resource office.27N30
WN1The provider has agreed to accept the amount allowed under  Member’s contract for  Service.45 
WN2The only appropriate bill types for SNF Claims are 18X, 21X, 22X, and 23X.16MA30
WN3 Claim contains Service dates that are invalid or out of range.16MA31
WN4Only one Resource Utilization Group can be billed per individual date of Service.16N471
WN5SNF Part B Claims are not allowed to cross the calendar year boundary.16M52
WN6Part B therapy Services billed with revenue codes 042x, 043x and 044x must be billed with the applicable modifier codes.182N657
WN7 Service is non-covered because authorization guidelines were not followed for  Service.197 
WN8 Claim was adjusted following an HDI provider Audit50N10
WN9The Claim was adjusted following an HDI provider Audit50N10
WODPayment of  Claim is pending the receipt of a ownership and disclosure form from the rendering provider or group billing entity.16MA112
WP0Call 1-800-924-7141 for Claim detail if needed.  
WP1 Charge is being discounted in accordance with NPPN agreement. The member is not responsible for  amount.45 
WP2 Charge is being discounted in accordance with URN agreement. The member is not responsible for  amount.45 
WP3 Charge is discounted in accordance with MultiPlan Inc. agreement. The member is not responsible for  amount.45 
WP4Benefits cannot be provided until the provider submits complete medical records for  inpatient admission.252N451
WPXCharges for a pre-existing condition are not eligible for benefits.51N607
WQ0The number of units on  line is considered Medically Unlikely.96N362
WQ1Automated Multi Channel Chemistry HCPCS component codes must have only one occurrence of a CD, CE or CF modifier on each line.16M53
WQ2Automated Multi-Channel Chemistry Service is not paid because less than 50% of these Services are separately payable.234M15
WQ3Telehealth originating site fee, HCPCS code Q3014, is billed incorrectly.16M20
WQ4 Service has been paid at a user-defined percent of Charges.169 
WQ5Claim lines for EPO and Aranesp must be billed with the proper revenue codes.16M50
WQ6The HCT or HGB exceeds monitoring threshold without the appropriate modifier code.4N519
WQ7Part A SNF Claims must contain at least one Resource Utilization Group Codes.16N471
WQ8Part B ambulance Services must have the zip code of the location of pick-up present on the Claim.16N53
WQ9 Revenue code is not covered for type of bill 22x.16M50
WR0 Service is not covered when performed for the reported Diagnosis.11N657
WR1 Procedure is redundant to the primary Procedure and is limited by  Member’s plan.234M15
WR2 Service is not eligible since it was not filed according to the corrected billing guidelines. Please submit a corrected Claim.18N522
WR3Services performed in a school setting requires an Individualized Educational Plan.252M135
WR4Medial Branch Block Injection Certification form invalid or incomplete252N473
WR5The provider must file  Claim to the non-emergency transportation broker for processing.96N61
WR6The provide must submit a corrected EOB from the primary insurance before benefits can be provided.16N4
WR7 Claim was pended due to non-payment of premium and will be denied if the premium is not pad by the end of the grace period.200N619
WR8The provider must submit a corrected EOB from the primary insurance before benefits can be provided.16N4
WR9 is a subrogation adjustment. It will not affect previously assigned patient liability.215 
WS0 revenue code is not valid with the Diagnosis on the Claim. The provider should refer to billing guidelines.96N95
WS1Submit dental Claims to DentaQuest, 11100 W Liberty Drive, Milwaukee, WI 53224.109N418
WS2 Claim needs to be submitted to Magellan Rx109N418
WS3 Claim should be submitted to Department of Medical Assistance Services.109N418
WS4Consumer Directed Services are not payable for the submitted Claim. Please contact Public Partnerships, LLC, at 1-866-3009.109N418
WS5These Services will need to be billed to Vision Services Plan. Please contact the vendor at 1-800-877-7195.109N418
WS6 Service will need to be billed to the Member’s non emergent transportation provider.109N418
WS8Medical review on these DRG outlier days has been completed. The outlier days have been denied.69 
WS9Medical records are required before outlier days will be reviewed for medical appropriateness.252M127
WSH is an excluded benefit under the member’s coverage.96N30
WSP specialist does not participate in your network. Please contact your PCP for a new referral.242N130
WT0Benefits for abortion, sterilization or hysterectomy Services are excluded due to not meeting State or Federal requirements.272N584
WT1Benefits for abortion, sterilization or hysterectomy Services are excluded due to not meeting State or Federal requirements.272N584
WT2 ancillary Service is not eligible for reimbursement when billed with a triage visit.97M86
WT3Benefits can not be provided since the dates of Service must equal the number of units billed. The provider may file a corrected bill.16M53
WT4The provider must submit a valid National Provider Identifier before benefits can be provided.208 
WT5 Emergency room Service is included in the reimbursement for the observation room.45 
WT6Payment has already been made by another TennCare coverage for these Services. No additional reimbursement will be provided.129MA36
WT7 Service must be billed with a Category II code before benefits can be provided. The provider needs to file a corrected bill.16M51
WT8 It is not a covered Service since the primary carrier payment policies were not followed for  member.136N23
WTA It is not a covered Service since the primary carrier payment policies were not followed for  member.136N23
WU0Provider timely filing has been exceeded.29 
WU1Provider timely filing has been exceeded.29 
WU2Contracted funding agreement – Subscriber is employed by the provider of Services.139 
WU3Contracted funding agreement – Subscriber is employed by the provider of Services.139 
WU4Charges are eligible for Crossover or Do not match EOMB.250N479
WU6The date of death precedes the date of Service.13 
WU7The date of death precedes the date of Service.13 
WU8Charges are eligible for processing via existing crossover arrangements.B11 
WU9Charges are eligible for processing via existing crossover arrangements.B11 
WV0 It is a subrogation adjustment. It will not affect previously assigned patient liability.215 
WV1Provider changed data from original Claim related to COB.96MA67
WV2Line item units cannot contain a decimal.16M53
WV3The provider must submit a correct occurrence code before benefits can provided.16M46
WV4 Claim is considered a duplicate due to a previous settlement for Medicaid Provider.B13 
WV5 Claim was adjusted following a provider audit.50N10
WV6The provider must submit  patient’s medical records. Please reference  Claim number and member id when you submit the records.252M127
WV7Surgical ICD Dates can’t be more than three day prior to the Statement From Date or should not be greater than the Statement To Date.16N301
WV8The provider must submit appropriate Attending Physician information before benefits can be provided.206N253
WV9Medical Records need to be submitted to HDI in Las Vegas for reconsideration.50M127
WVAThe provider must file  Claim with VA Health Administration Ctr. CHAMPVA, PO Box 65024 Denver, CO 80206-9024.109N36
WW0Medical Records need to be submitted to HDI in Las Vegas for reconsideration.50N10
WW1 Lab Service is required to be performed by Quest Diagnostics.242N95
WW2The servicing provider has billed  Claim under the incorrect patient.96N10
WW3These Services are only covered when performed by the primary care provider or designee after the network discounts.242N450
WW4The provider has agreed to accept the amount allowed under  Member’s contract for  Service.131 
WW5Benefits for  Service cannot be reimbursed until the correct provider indicator number is billed.16MA134
WW6Provider must submit medical records to better support Claim. Please reference Claim number and member id when you submit the records.252M127
WW7Provider must submit medical records to better support Claim. Please reference Claim number and member id when you submit the records.252M127
WW8 Claim contains one or more duplicate line items to the current Claim. Please resubmit according to billing guidelines.18N111
WW9 Claim contains one or more duplicate line items to the current Claim. Please resubmit according to billing guidelines.18N111
WX0Member incarcerated medical necessity review required.16M60
WX1Line item units cannot contain a decimal.16M53
WX2Claim rejected due to Member’s Medicare eligibility status; unable to apply surCharge.137N733
WX3The ICD code version submitted by the provider is not compliant with Federal Regulation for  Service/disCharge date.16M76
WX4Benefits for  Service cannot be reimbursed until the correct provider indicator number is billed.16MA134
WX5 Service is not paid in addition to or separately from the denied Service.234N20
WX6The provider has not contracted to provide  Service.45 
WX7 Charge exceeds the maximum allowable under  Member’s coverage.45 
WX8The provider must submit a valid pick up location zip code before benefits can be provided.16N53
WX9 Claim was pended due to non-payment of premium and will be denied if the premium is not paid by the end of the grace period.200N619
WY0A corrected bill has been received. Any previous payment from  is being recouped.96MA67
WY1The units of Service billed for the Procedure code exceeds the allowed number of units.50N362
WY2Benefits cannot be provided until a special review is completed.133M127
WY3 Edit occurred because a submitted Procedure code is not valid for the Service dates on the Claim.181M20
WY4Benefits cannot be provided until a special review is completed.133M127
WY5The provider has agreed to accept the amount allowed under  Member’s contract for  Service.131 
WY6The patient is not liable for these Charges.133 
WY7Provider is required to enroll in the Medicaid Program where the member resides.B7N570
WY8Provider is required to enroll in the Medicaid Program where the member resides.B7N570
WY9Medicaid Data Elements are Missing.252M127
WZ0 Provider has been termed per special review completed by BlueCross BlueShield of Tennessee.170 
WZ1Payment of Claim is pending receipt of Disclosure Form from the rendering provider or group billing entity.16MA112
WZ2Claim did not meet the Tennessee Perinatal Care System for Guidelines for Regionalization, Hospital Care Levels, Staffing and Facilities.272N584
WZ3Exceeds maximum units considered medically appropriate.119N435
WZ4Medicare Advantage requires a completed CMS-2728-U3 form to be on file prior to adjudicating  Claim.252M127
WZ5Medicare Advantage requires a completed CMS-2728-U3 form to be on file prior to adjudicating  Claim.252M127
WZ6Statement from/thru dates must correspond Service line date of Service before benefits can be provided.16MA31
WZ7A maximum of one Patient Assessment Form is payable each calendar year under  Member’s coverage.119N362
WZ8Delivery Charges for mother and baby must be billed separately.16MA36
WZ9 revenue code is not valid with the Diagnosis on the Claim. The provider should refer to billing guidelines.96N95
WZABelow minimum units considered medically appropriate16N430
WZBClaim is being reviewed to determine if a third party payer, subrogation has liability on  Claim. Questionnaire to follow.252N686
WZDImproper or inappropriate use of the modifier billed with  Procedure.236 
WZERoutine vision Services should be filed to Eyemed for payment. Contact Eyemed for filing instructions at 1-844-261-9034.109N418
WZFCMHRS Services are only billable through Magellan BH of VA. Re-submit to PO Box 1099; Maryland Heights, MO 63043.109N418
WZGThe Member’s Individualized Family Service Plan (IFSP) is not found or does not include  Service.15M62
WZHThe Member’s Individualized Family Service Plan (IFSP) is not found or does not include  Service.15MA62
WZI Service can only be billed with a professional modifier code and will not be reimbursed at the global or technical rate.234M15
WZJCMHRS Services are only billable through Magellan BH of VA through 12/31/17. Re-submit to PO Box 1099; Maryland Heights, MO 63043109N418
WZK Charge exceeds the maximum allowable under  Member’s coverage.45 
WZL Service was billed on the incorrect Claim form type.16N34
WZM Service was billed on the incorrect Claim form type.16N34
X01The actual date of Service is needed for  Charge.16M52
X02 Charge should be filed at the time of delivery.96N56
X04 Charge has been applied to the maximum for routine Services.96N30
X05The provider must submit an itemized or detailed billing before benefits can be provided for  Service.252N26
X06The provider must submit the anesthesia time before benefits can be provided for  Service.16N203
X07The provider must submit the name and title of the individual who rendered  Service before benefits can be provided.16N289
X08The provider must submit a description of Services rendered before benefits can be provided.252N350
X09 principal Diagnosis code is invalid. The provider must submit a valid code.16MA63
X10DRG is not paid under the Acute Care Hospital Agreement.45 
X11 Charge exceeds the maximum allowable under  Member’s coverage.59N644
X12The provider has not contracted to provide  Service.185N684
X13 Service is not paid in addition to or separately from the primary Service.234N20
X14 Service is not covered for  member. The provider should submit the proper code or medical documentation.16MA39
X15A valid DRG code could not be assigned for the coding that was submitted. The provider must submit valid codes.236N657
X16The reimbursement for re-admission is included in the DRG allowance on a previous Claim.97N525
X17The provider must submit a correct Procedure and revenue code combination before benefits can be provided.199N657
X18 Service is not normally performed for members in  age range.6N129
X19Benefits have been reduced since the required authorization for  Service was not obtained.197 
X20Benefits have been reduced since the required authorization for  Service was not obtained.197 
X29 modifier is not compatible with  Procedure code. The provider should submit the proper code.4N519
X30Benefits cannot be determined until the provider submits the first date of dialysis.16MA122
X31A split billing is needed for  confinement. The hospital must rebill according to the letter being sent to them.96N61
X32The provider should refer to billing guidelines on filing days or units for Durable Medical Equipment Claims.108N130
X33The Diagnosis code or Procedure code is not valid for the date of Service on the Claim.146M76
X34The provider must submit the x-ray report before benefits can be provided for  Service.252M31
X35The provider must file  Claim with Magellan Health Services, PO Box 2154, Maryland Heights, MO 63043 (1-800-308-4934).109N418
X36The provider must refer to the billing guidelines for proper billing of patient Services.96N56
X37Medical information is needed to complete a pre-existing review. Correspondence to the provider will follow.252N204
X38Information has been requested from another provider to complete a pre-existing review. No action is required.252N204
X39Pricing is based on a prior year agreement. The member is not liable for the amount that exceeds  pricing.45 
X40 The amount represents your Medicare savings.23 
X49Medical records have been requested for a provider audit reconsideration.252M127
X50 The amount was paid by your dental policy.23 
X51Vanderbilt employee PPO Claims must be filed with Signature Health Alliance.109N418
X53Benefits cannot be provided for Services that have been determined not to be medically necessary.50N130
X54 Service in non-covered because authorization guidelines were not followed for  Service.197 
X55The provider must file the Claim with CareCentrix, PO Box 277947 Atlanta, GA 30384.109N418
X56Medical records have been requested for a provider audit reconsideration.252M127
X57The provider has agreed to accept the amount allowed under  Member’s contract for  Service.131 
X58Medicaid Data Elements are Missing.252M127
X60Benefits for Services related to obesity, including surgical Procedures, are not covered under  Member’s plan.96N30
X76Medical records have been requested from the provider.252M127
X77The provider must submit the NDC, drug name, RX number, strength, day supply and quantity before benefits can be provided.16M123
X78The provider must refer to the billing guidelines for Home Infusion Therapy. A separate line must be billed for each date of Service.16N61
X79The provider must submit the appropriate CDT/CPT/HCPCS code for  Service.189M81
X80 Procedure requires an Origin and Destination modifier be billed. The provider should submit the proper code and modifier.4N519
X83The provider must submit the proper code. No medication currently manufactured matching the code billed.16M119
X84The date of birth follows the date of Service.14 
X85The date of birth follows the date of Service.14 
X86The provider must submit a correct Procedure and revenue code combination before benefits can be provided.199N657
X87The provider must submit a correct Type of Bill and revenue code combination before benefits can be provided.16MA30
X88The provider must submit a correct Procedure and place of Service combination before benefits can be provided.5M77
X89The submitted Procedure is disallowed because an add on code was billed without the presence of the related primary Service/Procedure.97N122
X90 modifier code or Procedure code is not valid for the date of Service on the Claim.4N519
X91Each per diem must be filed with any medication/injection.16M123
X92Date span is not within HHA benefit week. HHA benefit week.199N657
X93Date span is not within HHA benefit week. benefit week.96N56
X94Each per diem must be filed with any medication/injection.50M51
XA1 Member’s maternity benefits include a twelve-month waiting period before benefits can be provided.179 
XA2Completed questionnaire is needed from the member before the Claim can be processed.133 
XA3 dental Service is not eligible for benefits under  Member’s coverage.96N130
XA4 Service is not eligible because it was not rendered by  Member’s PCP.185N684
XA5 Procedure is considered investigative and is not covered under  Member’s plan.55N623
XA6These Charges will be considered if a referral is submitted.16N335
XA7Routine examinations are not eligible for benefits under  Member’s plan.49N567
XA8 Member’s coverage was not in effect on the date these Services were provided.27N30
XA9Charges for a pre-existing condition are not eligible for benefits.51N10
XACInformation concerning other insurance has been received and your records updated.  Claim has been adjusted.96MA67
XADThe accident date or onset date is needed from the provider before benefits can be provided for these Services.16N305
XATProvider Audit Rec. – Call 423-755-5891  
XAXSelf-administered drugs not covered Services under your plan.96N426
XB0 newborns date of birth and effective date are different, please contact the Department of Human Services.26N30
XB1 Member’s plan does not cover a portion of the Medicare Part B deductible.96N30
XB2Benefits for  Service are excluded under  Member’s plan.96N30
XB3Services for prenatal and postnatal care are not covered by  plan. Please re-file the labor and delivery Charges only.96N188
XB4We are deducting  amount because of an overpayment on a previous Claim.96N10
XB5Please submit a copy of the Medicare Explanation of Benefits so we can determine benefits.252MA04
XB6Please submit a copy of the Explanation of Benefits from  Member’s other insurance carrier.252MA04
XB7Benefits are excluded for an on the job injury or for Services eligible for Worker’s Compensation benefits.19N418
XB8Your plan does not provide benefits for Services by an out of network provider.242M115
XB9Benefits cannot be provided for Services not considered a medical emergency.40 
XBGThe blood gases report is needed from the provider before benefits can be provided for these Services.252N749
XC1Benefits for compound drugs purchased from a non-participating pharmacy are not covered under  Member’s plan.96N30
XC2The provider must file  Claim with the members home BlueCross BlueShield plan for processing.109N418
XC3Please refile  Claim with the correct Explanation of Benefits from the other insurance carrier.16N4
XC4Your plan does not provide benefits for Services by an out of network provider.242M115
XC5 The amount includes the benefits provided by  Member’s other insurance carrier.23 
XCBPlease refile  Claim with the correct Explanation of Benefits from the other insurance carrier.16N4
XCCBenefits for Services related to custodial care are not provided under  Member’s plan.96N30
XCDBenefits cannot be provided until we receive previously requested information concerning  Member’s other insurance.252N686
XCKReimbursement amount applying is due to the Service not meeting medical emergency guidelines.45 
XCMBenefits cannot be provided until the provider submits a Certificate of Medical Necessity.252N170
XCOBenefits cannot be provided until we receive previously requested information concerning  Member’s other insurance.252N4
XCPBenefits for a compound prescription cannot be provided until the pharmacy supplies additional information.16M123
XCUCOU-Charges were reduced due to a coupon or discount applied at point of sale.246 
XD1 Charge is a duplicate of a previously submitted Charge for  member.18N702
XD2We are deducting  amount because of an overpayment on a previous Claim.96N10
XD3The provider must file  Claim with the members home BlueCross BlueShield plan for processing.109N418
XD4Maximum benefits payable under  Member’s coverage have been provided.119N640
XD5The maximum amount allowable for  equipment has been reached.119N640
XD6We have paid the annual maximum allowable for these Services for  member.119N640
XD7 provider is not eligible under  Member’s coverage.170 
XDC Dental Service is not eligible for benefits under  Member’s coverage.96N30
XDD Member is not eligible to receive pharmacy benefits since they have Medicare Part D.96N30
XDEThe provider must file  Claim with DentaQuest. 12121 N. Corporate Pkwy; Mequon, WI 53092 – 1-855-418-1623.109N418
XDF Expense is a duplicate of a previously submitted expense for  member.18N522
XDNNewborn Charges have been denied under the subscriber’s name.  newborn is not eligible for benefits.34 
XDPPlease submit the original Medicare Explanation of Benefits showing the amount Medicare paid on  Charge.252MA04
XDRA copy of all diagnostic reports for the patient is needed before the Claim can be considered.252N457
XDUDuplicate of previous Claim. If corrected billing, please resubmit according to billing guidelines.18N522
XE1The Charges for the 2004 dates of Service were forwarded to another BlueCross BlueShield plan for processing.B11 
XEDPlease submit a copy of the Explanation of Benefits from  Member’s other insurance carrier.252MA04
XEGA copy of the EEG report with analysis is needed before the Claim can be considered.252M31
XEP Service must be approved by your EAP.197 
XF0 Service is non-covered when billed by a practitioner with  specialty.170N95
XF1The Claim was adjusted due to Maternity Incentive requirements were not met.50N10
XF2Multiple transitional care management codes have been filed within a specific time period.96M86
XF3The required modifier is missing or the modifier is invalid for the Procedure code.16N519
XF4 Procedure is considered a part of the global package previously paid on another Claim.97N525
XF5The units billed on  Claim fall outside the range of units that are considered medically appropriate.151N362
XF6The Claim was adjusted to reflect your payment to the Division of TennCare.131 
XF7A Charge in history relating to  Procedure has been paid. Please re-file corrected bill with all necessary Charges on one Claim.97M15
XF8The ambulance report is needed from the provider before benefits can be provided for these Services.252N745
XFB Service is not covered because benefits for the related condition are limited by a rider to  Member’s contract.51N607
XFD Contract does not provide benefits for Services intended to create a pregnancy.96N30
XFOService ordered by provider sanctioned by HHS. Federal law mandates no payment when insured by federally funded program.185 
XFSProvider sanctioned by HHS. Patient insured by federally funded healthcare plan. Federal law mandates no payment.185 
XFT contract does not cover infertility treatment, Services to create a pregnancy, or any resulting complications.96N30
XFW It is a subrogation adjustment. It will not affect previously assigned patient liability.215 
XG0Maximum benefits payable under  Member’s coverage have been provided.119N587
XH0An intermediary handles  Service. The Claim should be filed to the intermediary.16N8
XH1Charges for outpatient Services with  proximity to inpatient Services are not covered.60N676
XH2 It is not a covered Service unless the provider accepts assignment.111 
XH3 It is not a covered Service since appeal Procedures were not followed or time limits were not met.138N584
XH4 It is not a covered Service since the patient It is enrolled in Hospice.B9 
XH5 It is not a covered Service since new patient qualifications were not met.B16 
XH6 It is not a covered Service since the DiagnosIt is It is inconsIt istent with the provider type.12N657
XH7Information has been requested from the member.95 
XH8 It is not a covered Service since there was a lapse in coverage.200N650
XH9 It is not a covered Service since prior hospitalization or thirty day transfer requirement was not met.A6 
XHA Claim has been paid up to the Member’s local plan’s allowance.45 
XHB is a Medicare Advantage Type Claim. Medicare Charge limitations may apply.  
XHCThe payment on  Claim includes a Personal Savings Account or Health Reimbursement Account payment.187 
XHDThe Payment Direction has been changed on  Claim.  
XHE Claim is being paid in full up to the Charged amount.  
XHHThe maximum home health Services under  Member’s coverage has been provided.119N362
XHIThe provider must submit  patient’s progress notes or progress report before benefits can be provided for  Service.252N393
XHJThe provider must submit a photo or copy of  patient’s X-rays before benefits can be provided for  Service.252N40
XHKThe provider must submit the plan of treatment for  patient before benefits can be provided for  Service.50M132
XHLThe provider must submit the psychiatric testing results before benefits can be provided for  Service.252N467
XHM Claim is a duplicate to a Medicare cross over Claim which was processed directly by the Member’s plan.18N522
XHNThe provider must submit the tooth number before benefits can be provided for  Service.16N37
XHOYour plan does not provide benefits for Services by an out of network provider.242M115
XHP Claim was closed without processing by the Member’s Plan.227 
XHRYour plan does not provide benefits for Services by an out of network provider.242M115
XHS Claim is a duplicate to a Medicare cross over Claim which was processed directly by the Member’s plan.18N522
XHTA copy of the PET/MRI/CT Scan reports for the patient is needed before the Claim can be considered.252M31
XID The contract does not cover infertility treatment, Services to create a pregnancy, or any resulting complications.96N30
XIF The contract does not provide benefits for Services intended to create a pregnancy.96N30
XJ0Claim needs to be filed to the Plan in whose Service area the DME equipment was shipped to or purchased at a retail store.96N30
XJ1Claim needs to be filed to the Plan in whose Service area the specimen was drawn.109N557
XJ2Specialty Pharmacy Claim needs to be filed to the Plan in whose Service area the ordering physician is located.96N30
XJ3Claim needs to be filed to the Plan in whose Service area the DME equipment was shipped to or purchased at a retail store.96N30
XJ4Claim needs to be filed to the Plan in whose Service area the specimen was drawn.109N557
XJ5Specialty Pharmacy Claim needs to be filed to the Plan in whose Service area the ordering physician is located.96N30
XK0 is an inactive revenue code. The provider should refile with a valid code.16M50
XK1The provider must submit a correct Procedure and revenue code combination before benefits can be provided.199N657
XK2Medicare considered  amount as a contractual write-off and the provider cannot bill you for it.96M41
XK3 Charge exceeds the maximum allowable under  Member’s coverage.45 
XK4The provider has agreed to accept the amount allowed under  Member’s contract for  Service.131 
XK5The provider has not contracted to provide  Service.96N448
XK6 Service is not paid in addition to or separately from the primary Service.234N20
XK7A maximum of one DME maintenance Service is payable every 6 months.119N362
XK8The provider has agreed to accept the amount allowed under  Member’s contract for  Service.131 
XK9Claim contains DOS that span  patient’s hospice benefit election date. Please reference applicable billing guidelines.96N143
XKA Charge exceeds the maximum allowable under  Member’s coverage.45 
XL1The maximum annual benefits payable under  Member’s coverage have been provided.119N587
XL2The maximum number of Services payable under  Member’s coverage has either been met or exceeded on  Claim.119N362
XL3The maximum annual benefits payable under  Member’s coverage have been provided.119N587
XLTThe maximum lifetime benefits payable under  Member’s coverage have been provided.119N587
XM1A new Claim is being requested that meets Medicare payment guidelines. No action is required by the member.96N386
XM2 Member’s coverage allows hearing aids for the subscriber and dependent children only.96N30
XM3Services are eligible for processing under the Medicare crossover arrangement.22N479
XM4 Charge is more than Medicare allows for  Service. The member is liable for  amount.45 
XMAThese Services are not covered for a dependent child under your plan.96N30
XMBPlease refile  Claim with the correct Medicare Explanation of Benefits.252MA04
XMCMedicare coinsurance is not covered by  policy.96N30
XMDPlease submit a copy of the Medicare Explanation of Benefits so we can determine benefits.252MA04
XMF Provider is not eligible under  Member’s coverage.170 
XMH Policy does not provide secondary benefits when Medicare is an HMO or Choice Plan.96N30
XMIBenefits cannot be provided until the provider submits additional information to complete a pre-existing review.252N204
XMK Date of Service (DOS)  is prior to the effective date. The provider must file with the prior carrier.26N30
XMP Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
XMS Member’s coverage was not in effect at the time of  Service.27N30
XMTThe timely filing limit as outlined in the Member’s contract/benefit has expired.29 
XN1The member failed to comply with the Mandatory Case Management requirement.272N584
XNCThe difference between the Medicare allowance and benefit maximum is not eligible under your contract.122 
XNE Service is being reimbursed based on the non emergency fee schedule.45 
XNFInformation is needed from the Member to complete a pre-existing review. Correspondence to the member will follow.96N204
XNMNon maternity Service not covered. Maternity Only Policy. For a list of eligible maternity codes see BCBST.com96N30
XNNBenefits for  Service are excluded under  Member’s plan.96N30
XNP Charge exceeds the maximum allowable under  Member’s contract for a non-participating provider.45 
XNRBenefits cannot be provided until we receive previously requested information concerning another party’s liability.20 
XOBYour contract provides benefits for maternity Services only at  facility.242N130
XONYour plan does not provide benefits for Services by an out of network provider.242M115
XOVPlease submit dates of Service beginning 7/1/2015 to TRH/Farm Bureau Health Plans.27N30
XP1 Service is denied as a pre-existing condition because symptoms existed prior to  Member’s effective date.51N607
XP2 Service is denied as a pre-existing condition because treatment was recommended prior to  Member’s enrollment date.51N607
XP3 Service is denied as a pre-existing condition because treatment as received prior to  Member’s enrollment date.51N607
XP4 Service is denied as pre-existing because treatment was recommended prior to  Member’s effective date.51N607
XP5 Service is denied as pre-existing because treatment was received prior to  Member’s effective date.51N607
XP6 Member’s coverage does not include benefits for congenital malformations that do not meet medical policy criteria.96N30
XP7 Service is not covered because benefits for the related condition are limited by a rider to  Member’s contract.51N607
XPA Provider is not eligible under  Member’s coverage.185N684
XPB Service is denied as a pre-existing condition because treatment prior to  Member’s enrollment date.26N30
XPC Service is not eligible because it was not rendered by  Member’s PCP.242M115
XPD Member’s age is beyond the limiting age for these benefits.96N129
XPHPhysician Services must be billed separately from the hospital Claim.89N200
XPIBenefits are not provided for personal convenience items.96N30
XPRA non-participating provider has been used.242M115
XPWBenefits for  Service have a ninety-day waiting period.179 
XPXYour coverage has a one-year waiting period before benefits are available for  Service.179 
XR0Benefits cannot be provided since an authorization was not obtained for  Service.197 
XR1 Provider is ineligible to provide  pharmacy Service.185N684
XR2Diabetic Testing Supplies should be provided through Pharmacy.109N418
XR3 Medication is not covered under the Member’s medical plan. Please contact CVS Specialty at 1-888-265-7790 for pharmacy benefits.185N684
XRUBlueCross BlueShield of Tennessee no longer administers Claims for  group. Please contact employer for information.27N30
XRX Member’s coverage does not provide benefits for prescribed drugs and other medications.96N30
XS1Secondary benefits will be paid until day one hundred of confinement. Benefits will then be based on medical necessity.96N30
XSA is money reimbursed due to another party’s payment. Refer to Patient Owes column for any liability changes.215 
XSB The amount exceeds the Member’s liability per Health Care Financing Administration guidelines.45 
XSDWe are providing secondary benefits to your prescription drug card.23 
XSF coverage does not provide benefits for the treatment of self inflicted injuries.96N30
XSH The amount was applied to the member’s monthly patient pay.  
XSI Coverage does not provide benefits for the treatment of self inflicted injuries.96N30
XSMFor Services after 1/1/2000,  Claim is administered by United Behavioral Health 1-877-237-8574.27N30
XSNNon-skilled nursing home visits are not a covered benefit under  plan.B1N30
XSRBenefits have been reduced because a non-participating provider was used.45 
XSSYour supplemental BlueCross BlueShield coverage does not provide benefits for these Charges.96N30
XSmThese Services are handled by your Behavioral Health Provider. Please have your provider refile  Claim with the appropriate carrier.96N30
XT1 Member’s contract does not provide benefits for contraceptives.96N30
XT2 Member’s contract does not provide benefits for routine maternity Services.96N30
XT3 Member’s coverage does not provide benefits for Temporomandibular Joint Dysfunction – TMJ.96N30
XTBWe have provided extended benefits for a condition that was diagnosed and treated before  Member’s policy expired.96N30
XTFThe timely filing limit as outlined in the Member’s contract/benefit has expired.29 
XTHServices not eligible for Telehealth.96N776
XTP Service has been reimbursed by a third party liability carrier.20 
XUC Charge exceeds the maximum allowable under  Member’s coverage.45 
XUN Claim was for date of Service July 1, 2015, or after, please submit to new Claims Administrator.27N30
XV1Benefits for  Service are limited to one time per twelve-month period.119M90
XV2Benefits for  Service are limited to one time per twenty-four month period.119N435
XVSThe vein study report is needed from the provider before benefits can be provided for these Services.252N739
XW1Benefits for  Service have a six-month waiting period.179 
XW2Benefits for  Service have a six-month waiting period.179 
XW3Benefits for  Service have a sixty-day waiting period.179 
XWP Member’s maternity rider includes a ten-month waiting period before benefits can be provided.179 
XZAPaid according to the USA MCO/USA Senior Care Network contractual agreement.1N364
YAB Claim was adjusted because the Service is eligible for benefits under the Member’s coverage.96MA67
YAI Claim was adjusted because additional information was received.96MA67
YBC Claim was adjusted because the provider submitted a corrected billing.96MA67
YBE Claim was adjusted because we were notified that the provider billed for  Service in error.96MA67
YBI Claim was adjusted to include the additional billing from the provider.96MA67
YCACost Share – Corrected – DO NOT ADJUST.  
YCBClaim not handled as a corrected bill due to original Claim was denied96MA67
YCC Claim was adjusted to correct the deductible, copay or coinsurance.96MA67
YCM Claim was adjusted to provide benefits secondary to Medicare.96MA67
YCOCost Share – Corrected – Additional Payment Made.  
YCP Claim was adjusted because the Member’s BlueCross BlueShield coverage is primary.96MA67
YCS Claim was adjusted to provide benefits secondary to  Member’s other insurance coverage.96MA67
YDD Claim was adjusted because  Service was processed on a previous Claim.96MA67
YDP Service was previously denied as a duplicate in error.96MA67
YEU Claim was adjusted because the Member’s eligibility has been updated.96MA67
YGO Claim was adjusted to provide corrected benefits.96MA67
YHCMember has been enrolled in Contraceptive coverage. Please note new contraceptive Only identification number.  
YM1Your Claim for  date of Service is being adjusted due to an increase in Medicare’s allowed amount.96MA67
YM2 Claim was adjusted because  Member’s coverage has been terminated.96MA67
YMP Claim was adjusted to provide corrected benefits.96MA67
YMR Claim was adjusted because  Member’s coverage has been terminated.96MA67
YNI Claim was adjusted to provide corrected benefits.96MA67
YPD Claim was adjusted because  Service is related to a pre-existing condition.96MA67
YPP Claim was adjusted because it was determined that  Service is not related to a pre-existing condition.96MA67
YRB Claim was adjusted because the Service is not eligible for benefits under the Member’s coverage.96MA67
YRD Claim was adjusted because  Service is related to a condition limited by a rider to  Member’s contract.96MA67
YSC Claim was adjusted to provide corrected benefits under  Member’s coverage.96MA67
YSD Claim was adjusted because  Service is not eligible for benefits under the Member’s coverage.96MA67
YSP Claim was adjusted because  Service is eligible for benefits under  Member’s coverage.96MA67
YTHAlthough  Member’s benefit limit has been met,  Claim has been reconsidered and adjusted pursuant to your separate mailing.96MA67
YUM Claim was adjusted because the authorization for  Service has been updated.96MA67
YWI Claim was previously processed under another Member’s name or ID number in error.  
Z02Agreement Discount Off Charges45 
Z05CoverKids – Claim to apply Network S rates.  
Z19Call 1-800-276-1978 for Claim detail if needed. MR
Z21Call 1-800-468-9736 for Claim detail if needed. MR
Z2B Claim is being processed under your secondary coverage.B11N418
Z44Call 1-800-468-9736 for Claim detail if needed.  
Z55Call 1-800-468-9736 for Claim detail if needed. MR
Z57We are investigation to determine if  condition is pre-existing. If found to be pre-existing we may seek a refund.  
Z66Call 1-800-468-9736 for Claim detail if needed. MR
Z8AHIPAA 835 Runbook setting CapitatedPayment24 
Z8CHIPAA 835 Runbook setting RishWhAmt104 
Z8DHIPAA 835 Runbook setting DentalPreDeterminationAmt101 
Z8EHIPAA 835 Runbook setting CalculatedCdcbAdjAmt22N598
Z8FHIPAA 835 Runbook setting OffsetCdcbAdjAmt22N598
Z8GHIPAA 835 Runbook setting SbPymAmt100 
Z8HHIPAA 835 Runbook setting CdcbCobAmt23 
Z8IHIPAA 835 Runbook setting ConsiderChg94 
Z8JHIPAA 835 Runbook setting CoinsAmt2 
Z8KHIPAA 835 Runbook setting CopayAmt3 
Z8LHIPAA 835 Runbook Setting DedAmt1 
Z8MHIPAA 835 Runbook setting InclusiveA1 
Z8NHIPAA 835 Runbook setting BundleOrigSubmChg97M15
Z8OHIPAA 835 Runbook setting BundleChgsAdjustedUp94 
Z8PHIPAA 835 Runbook setting Hra187 
ZA4Call 1-800-468-9736 for Claim detail if needed. MR
ZA5Call 1-800-468-9736 for Claim detail if needed. MR
ZA6Call 1-800-468-9736 for Claim if needed. MR
ZA7Call 1-800-276-1978 for Claim detail if needed. MR
ZA8Call 1-800-468-9736 for Claim detail if needed. MR
ZASA reduction was applied to provider Claim paid amount due to CMS Sequestration.  
ZB1Call 1-800-705-0391 if you need assistance or Claim detail.  
ZCBIT is TIME TO UPDATE INFORMATION REGARDING OTHER INSURANCE. PLEASE CALL 1-800-200-3704.252N686
ZCDIT is TIME TO UPDATE INFORMATION REGARDING OTHER INSURANCE. PLEASE CALL 1-800-200-3704.252N686
ZCN Payment was recommended by NCN Data isight. For questions contact www.dataisight.com or 1-800-499-9708 and select option 2.96N30
ZD1These Services were not approved by your EAP.  
ZD2These Services were approved by your EAP.  
ZD3Benefits are being provided for  Claim; however, future Claims for  Diagnosis should be submitted to your EAP.  
ZD5Benefits were provided for  Claim since a free cleaning coupon was redeemed.  Service did not apply toward any annual maximum.  
ZDAYour contract provides alternate courses of treatment that must meet accepted dental standards. Benefits are reduced.  
ZDK Claim has been approved based on information provided by Duke EAP. Call 800-336-DUKE (3853) if you have any questions.  
ZDNCall 1-800-924-7141 for Claim detail if needed.  
ZE1 Member’s Claim has been separated for processing. No action is required.B11MA15
ZF5Manual Recovery – Call 1-800-572-1003 for details MR
ZHF Member’s coverage under  plan was not in effect on the date  Service was provided.27N30
ZMBYou may not be liable for the amount indicated in the Amount You Owe Provider field. Please verify with your provider or primary carrier.96N30
ZMGCall 1-800-924-7141 for Claim detail if needed.  
ZMPThe Maintenance of Benefits provision in  Member’s contract may affect liability. Please see primary carrier’s remittance for details.96N30
ZMRCall 1-800-924-7141 for Claim detail if needed.  
ZMS payment is secondary to benefits provided by Medicare. In network benefits have been applied.  
ZNNIn-Network benefits have been applied to  Out-of-Network Provider. You may be subject to balance billing.  
ZONIn-Network benefits have been applied to  Out-of-Network Provider. You may be subject to balance billing.  
ZOOIn-Network benefits have been applied to  Out-of-Network Provider. You may be subject to balance billing.  
ZP1Failure to obtain a prior authorization for  Service will result in a $250.00 copay.96N30
ZP2Our records indicate that you have overpaid at the pharmacy for  date of Service.  
ZP3Benefits are not payable when Medicare’s primary benefit exceeds  plan’s maximum payment. The amount owed is shown as patient liability.96N30
ZPAProvider Advance Recovery  
ZPSPart D medications that are otherwise covered under the ESRD PPS bundled payment are not eligible for a separate Part D benefit payment96MA67
ZPXCharges not shown on the Explanation of Benefits are in pre-existing review. No action is required.B11MA15
ZR1 Claim was adjusted because additional information was received.96MA67
ZRA Claim was combined with a related Claim and considered as one confinement.96MA67
ZRB Medical chart was not submitted for review within the required time frame.96MA67
ZRCApproved orders for  inpatient stay were not included in the medical records.96MA67
ZRD Charge was combined with an inpatient Claim of an affiliated hospital.96MA67
ZREA provider audit determined that  CPT code is not appropriate for the Service rendered.96MA67
ZRF CPT code was added due to appropriateness.96MA67
ZRGA provider audit determined that  code is a component of a more comprehensive code filed on a different Claim.96MA67
ZRHPre-admission and post-disCharge Services were combined with the inpatient Claim.96MA67
ZRIA provider audit determined that  Service is considered to be part of  Member’s inpatient confinement.96MA67
ZRJPayment for pre-admission testing is included in the ambulatory surgery global fee.96MA67
ZRKThe medical chart indicates that a twenty-three hour observation stay was rendered instead of an inpatient stay.96MA67
ZRLA provider audit determined that  code is a component of a more comprehensive code filed on the same Claim.96MA67
ZRMA provider audit determined that  Service is a duplicate of another CPT code filed on the same Claim.96MA67
ZRNA provider audit determined that  Service should be included in the global case payment.96MA67
ZS0Call 1-800-558-6213 for Claim detail if required. MR
ZS1Call 1-800-558-6213 for Claim detail if required. MR
ZS2Call 1-800-558-6213 for Claim detail if required. MR
ZS3Call 1-800-558-6213 for Claim detail if required. MR
ZS4Call 1-800-558-6213 for Claim detail if required. MR
ZS5Call 1-800-558-6213 if Claim detail is required. MR
ZS6Call 1-800-558-6213 for Claim detail if required. MR
ZS7Call 1-800-558-6213 for Claim detail if required. MR
ZS8Call 1-800-558-6213 for Claim detail if required. MR
ZS9Call 1-800-558-6213 for Claim detail if required. MR
ZSBCall 1-800-924-7141 for Claim detail if required. MR
ZSCCall 1-800-468-9736 for Claim detail if required. MR
ZSPCall 1-800-924-7141 for Claim detail if required. MR
ZSTCall 1-800-276-1978 for Claim detail if required. MR
ZTBThe Claim was adjusted to reflect your payment to the Bureau of TennCare.  
ZTCDue to TennCare RAC Recovery your payment has been applied to the Claim.  
ZTDThe Claim was adjusted to reflect your payment to the Bureau of TennCare.  
ZTHTHCII – Review Episode of Care Report in BlueAccess.  
ZTMPrevious payment. MR
ZY1 Procedure is not covered under the Member’s current benefit plan.204 
ZYPThe required modifier is missing or the modifier is invalid for the Procedure code.4N519
ZYQ Charge was denied by Medicare and is not covered on  plan. The provider can bill the patient.96N30
ZYR Service is not covered when performed in  setting.96N428
ZYS Procedure code is not a billable Service under  plan.96N431
ZYTThe benefit for  Service is included in the allowance for another Service that has already been adjudicated.97 
ZYUThe date of Service is past timely filing guidelines.29 
ZYV Procedure was denied because it was billed by a provider with an invalid or inactive NPI number.16N433
ZYWCosurgeons need to be of a different subspecialty.54N646
ZYXEach provider is reimbursed according to the portion of surgical care they provided during Procedure(s).B20M86
ZYYProcedure denied due to multiple submissions for the technical or professional component of the same Procedure.B13M86
ZYZContracted amount for Procedure is greater than submitted Charge. Payment reduced to the submitted Charge.16M54
ZZ1 CPT code has been denied because a more appropriate CPT code that better describes the Services rendered should be billed.96N56
ZZ2 Charge is a duplicate of a previously submitted Charge for  member.18N522
ZZ3 Procedure is considered subset or redundant to the primary Procedure and is limited by  Member’s plan.97M80
ZZ4 principle Diagnosis code is invalid. The provider must submit a valid code.16MA63
ZZ5 Service is not normally performed for members in  age range.6N129
ZZ6 Service is considered part of the primary Procedure. Please do not bill separately.97N19
ZZ7 Service is not covered when performed on the same day as a related Procedure.273N435
ZZ8 Edit occurred because a submitted Procedure code is not valid for the Service dates on the Claim.181M20
ZZ9A history Procedure code is within the global period of the Procedure code on  line.96M86
ZZA is a bundled Service. The payment is included in the Service to which item/Service is incident.97M80
ZZDThere is one or more Edits present that cause the whole Claim to be denied.96N56
ZZEThe billed Service has been denied since the maximum units of Service allowed has been exceeded.119N362
ZZF is a bundled Service. The payment is included in the Service to which item or Service is incident.234M15
ZZGPrice adjusted due to additional line item modifiers.  
ZZHSubmitted Procedure is disallowed, mutually exclusive to other Procedure.96N20
ZZI Service is a part of the original surgical Procedure and is limited by  Member’s plan.97M144
ZZJA potential overpayment has been identified on  Claim.45 
ZZLOnly postoperative portion of global payment is allowed.45 
ZZMThe single/unilateral code disallowed – billed more than once on a single date of Service. Replaced with Bilateral code.  
ZZNNon-physician assistant at surgery Services are included in the physician/facility payment.54N646
ZZOThe submitted Procedure is disallowed because it does not typically require a co-surgeon according to CMS Medicare guidelines.54N646
ZZPThe submitted Procedure is disallowed because it does not typically require a team of surgeons according to CMS Medicare guidelines.54N646
ZZQProcedure qualifies for multiple endoscopy reduction and payment should be reduced. RVU value for  line should be reduced.  
ZZUMultiple Procedures billed for the same Service date in which a reduction is applicable, per CMS guidelines.45 
ZZVThe Procedure code describes a physician interpretation for Service and is not appropriate in place of Service.96M97
ZZW Claim line is being disallowed because and E and M code is within the global period with a same Diagnosis category by same provider.97N525
ZZX Service is not paid in addition to or separately from the primary Service.234N20
ZZY The health Service code was denied as it is not a covered Service when billed with the submitted Diagnosis code.11N657
E01The submitted line is disallowed because it  was previously billed.  
E02The submitted line was submitted after the filing deadline.  
E03The submitted code is disallowed because of an invalid Procedure code.  
E04The submitted line item is disallowed because it was received after the code deletion date.  
E05The submitted code is disallowed because the Procedure is not covered.  
E06The line item is disallowed because the payment modifier and Procedure code combination is invalid.  
E07The submitted Procedure code and nonpayment modifier are disallowed because the payment modifier and Procedure code combination is invalid  
E08The submitted code is disallowed because the Procedure code is unlisted.  
E09The submitted office consultation is disallowed because it was submitted by a provider who is classified as a primary care provider.  
E10The submitted Procedure is disallowed because it does not typically require an assistant surgeon.  
E11The submitted non-anesthesia Procedure is disallowed because is not eligible to be crosswalked to an anesthesia Procedure.  
E12The submitted Procedure is disallowed because is inconsistent with the patient’s age.  
E13The submitted Procedure is disallowed because is inconsistent with the patient’s gender.  
E14The submitted Procedure is disallowed because an add on code was billed without the presence of the related primary Service/Procedure.  
E15The submitted line item is disallowed because the Diagnoses are inconsistent with the male gender.  
E16The submitted line item is being disallowed because the Diagnoses are inconsistent with the female gender.  
E17The submitted line item is being disallowed because of incomplete Diagnosis codes.  
E18The submitted line item is disallowed because of invalid Diagnosis code(s).  
E19A surgical code is billed rather anesthesia code Service disallowed. Replaced anesthesia code.  
E20A surgical code is billed rather anesthesia code Service disallowed. Replaced anesthesia code.  
E21Submitted quantity corrected to reflect submitted date range. The submitted quantity exceeded the date rage with previous Claims.  
E22The submitted Procedure is disallowed because is inconsistent with the patient’s gender.  
E23The submitted Procedure is disallowed because is inconsistent with the patient’s age.  
E24Submitted Procedure is disallowed since the total Procedure was previously billed. Cannot submit the professional or tech component.  
E25Submitted Procedure is disallowed, total Procedure was previously billed by another provider. Cannot submit the prof or tech component.  
E26The submitted Procedure is disallowed because CMS indicates that  Procedure is always bundled when billed with any other Procedure.  
E27Submitted Procedure is disallowed, incidental to other Procedures.  
E28Submitted Procedure is disallowed, mutually exclusive to other Procedures.  
E29Submitted Procedure is disallowed, component to other Procedures.  
E30The visis disallowed because it was billed by the same provider on the same date of Service as a code within the global period.  
E31The submitted line is disallowed because code pairs found to be unbundled according to CMS National Correct Coding Initiative.  
E32The submitted line is disallowed because the supply was submitted for the same date as a surgical Procedure.  
E33The submitted line is disallowed because code pairs found to be unbundled according to CMS Outpatient Code Editor.  
E34The submitted line is disallowed because the visit was billed by the same provider within the Procedure’s preoperative period.  
E35The submitted line is disallowed because the visit was billed by the same provider within the Procedure’s postoperative period.  
E36The submitted line is disallowed, primary Service billed with a quantity greater than one, rather than appropriate addon code.  
E37The submitted Procedure is disallowed because it was submitted more than once per date of Service.  
E38The submitted Procedure is disallowed because it was submitted more than once per date of Service.  
E39The submitted quantity is replaced since it exceeded the maximum number of times allowed on a single date of Service.  
E40The submitted Procedure is disallowed because the Procedure has already been billed with a modifier 50 for the same date of Service.  
E41The submitted Procedure is disallowed because the Procedure is not payable without immunization code billed on the same date of Service.  
E42The payment for  Procedure was reduced based on CMS multiple radiology Procedure cutback guidelines.  
E43The submitted Procedure is disallowed; a single more comprehensive code that more accurately represents the Service performed was added.  
E44The single/unilateral code disallowed – billed more than once on a single date of Service. Replaced with Bilateral code.  
E45The visit/outpatient consultation code is disallowed – billed at an inappropriate level. Replaced with Unlisted E and M.  
E46The inpatient consultation code is disallowed – billed at an inappropriate level. Replaced with Unlisted E and M.  
E47The submitted new patient Procedure is disallowed for an established patient.. Replaced with Established code  
E48Multiple surgical Procedures identified. Modifier 51 added.  
E49The submitted line modified to include modifier 26, denoting professional component performed at noted place of Service.  
E50Pay percent cutback applied  
E51The submitted Procedure is disallowed based on CMS Status Code Payment guidelines.  
E52The submitted Procedure is disallowed based on CMS Medicare Status Code Guidelines  
E53The submitted Procedure is disallowed because it does not typically require an assistant surgeon according to CMS.  
E54The submitted Procedure is disallowed because it does not typically require an co-surgeon according to CMS Medicare guidelines.  
E55The submitted Procedure is disallowed because it does not typically require a team of surgeons according to CMS Medicare guidelines.  
E56The DME Service is disallowed because it classified as Frequently Serviced in the DMEPOS fee.  
E57The DME replacement is disallowed because it classified as Frequently Serviced in the DMEPOS fee.  
E58The item is classified as rented and the Service is included in the rental fee.  
E59The DME Service disallowed. Special CMS coverage instructions apply.  
E60The submitted modifier is not a valid CPT or HCPCS modifier.  
E61The line item is disallowed because the modifier and Procedure code combination is invalid according to CMS.  
E62The submitted Procedure is disallowed because it is not recommended for payment based on CMS National Coverage Lab Policy.  
E63The submitted Procedure is disallowed because it is not recommended for payment based on CMS National Coverage Lab Policy.  
E64The Claim line is disallowed because the Diagnosis is inconsistent with the patient’s age.  
E65Procedure is disallowed because other payable Services under the physician fee schedule are billed on same date by same provider  
E66The DME item is disallowed because it was submitted for maintenance and servicing and is currently rented or beneficiary owned  
E67The DME item is disallowed because it was submitted for maintenance  
E68The DME item is disallowed because it was submitted for maintenance and servicing and is currently rented or beneficiary owned  
E69The DME item is disallowed because the item was purchased new and is beneficiary owned. Rental payments should not be submitted.  
E70The DME item disallowed because the item was purchased new and is beneficiary owned. Payments should not be submitted for owned DME item  
E71The DME item is disallowed because the maximum payment for the DME item was exceeded  
E72Allowed Procedure represents remaining MUE amount that can be paid. The submitted Procedure disallowed.Quantity billed was over MUE limit  
E73Allowed Procedure represents remaining MUE amount that can be paid. Multiple Procedures disallowed. Quantity billed was over MUE limit  
E74The submitted facility code is disallowed because the Procedure is not covered.  
E75The submitted revenue code is an invalid revenue code.  
E76Represents more appropriate code for the patient’s age than submitted Procedure code. Submitted code denied.  
E77Procedure is disallowed because component was previously billed.  
E78Submitted payment modifier and Procedure code combination is invalid. Line disallowed.  
E79Submitted non-payment modifier and Procedure code combination is invalid.Line disallowed.  
E80The DME item is disallowed because the maximum payment amount for the item has been exceeded in history or on the current Claim.  
E81The submitted Procedure is disallowed because it was submitted more than once per date of Service.  
E82The submitted quantity is replaced since it exceeded the maximum number of times allowed on a single date of Service.  
E83The single/unilateral code disallowed – billed more that once on a single date of Service.  
E84Revenue code is disallowed because a required HCPCS code was not submitted.  
E85Observation revenue code is disallowed because a required HCPCS code was not submitted.  
E86Procedure is disallowed because a E code was submitted as the primary Diagnosis.  
E87Submitted quantity greater than 1 on bilateral Procedure with history with history Claims. Replaced with quantity of one  
E88Submitted quantity exceeds MUE limit. Remaining allowed MUE quantity shown.  
E89Remaining MUE allowed amount. One or more submitted Claim lines were disallowed because the quantity billed was over the MUE limit.  
E90Submitted Procedure is disallowed because it was submitted without modifier -27.  
E91Submitted facility Procedure is disallowed because it is incidental to another submitted.  
E92Submitted Procedure is disallowed because it was submitted without modifier CA or exceeds quantities allowed.  
E93Submitted Procedure is disallowed because it was submitted submitted without modifier 91  
E94Submitted quantity corrected to reflect submitted date range. The submitted quantity exceeded the date range.  
E95Submitted quantity corrected to reflect submitted date range. The submitted quantity exceeded the date range.  
E96Submitted Procedure is disallowed because it is considered to be non-covered based on health plan medical and /or payment policy.  
E97Submitted Procedure is disallowed because related Services were previously also disallowed.  
E98Submitted Procedure is disallowed because it is not listed on the CMS NCD covered list for the submitted Diagnosis.  
E99Submitted Procedure is disallowed because it is listed on the CMS NCD not-covered list for the submitted Diagnosis.  
P01A required Procedure code or modifier is missing or invalid on the current line or an associated Claim line16M67
P02The patient’s age or gender conflicts with the Procedure and/or Diagnosis code.16M51
P03A Diagnosis code which meets medical necessity for  Procedure code is missing or invalid16M76
P04Documentation or authorization is required to be submitted and/or reviewed.197 
P05 is a possible duplicate Claim line of another Claim line in history18N111
P06 E/M Procedure code is inappropriately reported for an established or new patient.16N657
P07The units have exceeded the allowable maximum frequency per time span119N640
P08The required modifier is missing or the modifier is invalid for the Procedure code4 
P09 is a non-covered, restricted, reporting only or bundled Procedure code or Service96N130
P10The place of Service code is missing or invalid for the Procedure code16M77
P11The provider specialty is missing or invalid for the place of Service or Procedure code8 
P12A Procedure reduction should be applied to  Claim line based on the Procedure code or modifier submitted59 
P13The type of bill, Procedure code, or revenue code are conflicting16N657
P14The Procedure code has an unbundle relationship with another Procedure on  Claim or on a Claim in history97M15
P15 Claim or Claim line is missing information which is needed for Editing16M84
P16There is a conflict with the occurrence, value or condition code and the Procedure, revenue code or TOB on the Claim16N657
P17A potential overpayment has been identified on  Claim97 
S01The patient status is not valid.16MA43
S02The patient status code is missing.16MA43
S03Procedure code is limited coverage code.16N657
S04Procedure code is limited coverage since there is an associated limited Diagnosis code on the Claim.16N657
S05Procedure codes 02RK0JZ and 02RL0JZ are limited coverage when Z006 Diagnosis code is present.16N657
S06The Other Diagnosis code indicates that a wrong Procedure was performed.11MA63
S07The Principal Diagnosis code indicates that a wrong Procedure was performed.11MA63
S08Procedure code 9672 should not be reported when the patient’s length of stay is less than four days16N657
S09Non-exempt facility submitted admission Diagnosis with Hospital Acquired Condition233 
S10Non-exempt facility submitted principle Diagnosis code with Hospital Acquired Condition233 
S11Non-exempt facility submitted Non-exempt Diagnosis w/POA of 1 or X16N434
S12The Principal Diagnosis code requires a non-exempt POA indicator of 1 or X16N434
S13The Other Diagnosis code requires a non-exempt POA indicator of 1 or X16N434
S14Non-exempt facility submitted other Diagnosis code with Hospital Acquired Condition233 
T01 Edit occurred because the Procedure code requires a specific modifier when billed at  place of Service.  
T02The required Procedure code is missing according to a Local Coverage Determination.16M51
T03The provider specialty does not meet criteria for the Procedure code according to a Local Coverage Determination.8MA130
T04Add-on Procedure code billed with primary Procedure on Claim-Id Line.16MA66
T05History Procedure Code has incidental relationship with  Procedure code.97M80
T06LCD/NCD – Policy requirements are not met for Procedure code.  
T07The Diagnosis on the line is inconsistent with the Procedure according to a Local Coverage Determination.11N657
T08 Edit occurred because the Procedure has a profile relationship according to the Local or National Coverage Determination.96N386
T09 Procedure requires documentation according to a Local Coverage Determination.252M127
T10 Add-on Procedure is not eligible when the primary Procedure is not eligible.B15N674
T11Bilateral Procedure reduction.59N670
T12Procedure code and history Procedure code indicate multiple imaging Services. A 25% reduction of the technical component applies.59 
T13Procedure code and history Procedure code indicate multiple imaging. 25% reduction of the technical component applies.59 
T14 Procedure is missing an appropriate modifier when related to an evaluation and management visit in patient history.4N519
T15 Procedure is missing an appropriate modifier when billed with an evaluation and management code.4N519
T16Procedure qualifies for multiple endoscopy reduction and payment should be reduced. RVU value for  line should be reduced.  
T17For Procedure code and history code a multiple endoscopy reduction applies to the history Claim and payment should have been reduced.  
T18The maximum frequency for  Procedure code has been exceeded.119N362
T19A multiple Procedure reduction of 50 percent of the allowed amount should be applied to  Claim line.59N670
T20An operative report must be reviewed when more than 5 Procedures have been performed on the same date of Service.252M29
T21A multiple Procedure reduction of 50% of the allowed amount should be applied to History Claim.59 
T22An add on Procedure code has been submitted without the appropriate primary Procedure.B15N122
T23Procedure code is a non-covered Service per the Non-covered Service list.  
T24Add-on Procedure code has been submitted without an appropriate primacy Procedure code.B15N122
T25Procedure Code has an incidental relationship with another Procedure code.97M80
T26Only intraoperative portion of global payment is allowed.59 
T27Only postoperative portion of global payment is allowed.59 
T28Only preoperative portion of global payment is allowed.59 
T29Only intraoperative portion of global payment is allowed.59 
T30Per Medically Unlikely Edits, the units of Service billed for  Procedure code exceeds the allowed units.96N362
T31The presence of an anesthesia modifier indicates a reduction in payment.59 
T32Anesthesia code on  line requires an appropriate modifier.4N519
T33 Edit occurred because a professional component modifier is needed for  place of Service for  diagnostic Procedure code.4N519
T34The Procedure code describes the physician Service. Use of modifier ZY is not appropriate.4N519
T35 Procedure code describes only the technical portion of a Service or diagnostic test. Modifier ZY is not appropriate.4N519
T36The Procedure code describes the global code of a Service or diagnostic test. Modifier ZY is not appropriate.4N519
T37The Procedure code describes a physician interpretation for Service and is not appropriate in place of Service.96M97
T38The Procedure code is a Service covered incident to a physician’s Service and modifier XY is not appropriate.4N519
T39The Procedure code is a Service covered incident to a physician’s Service and modifier YZ is not appropriate.4N519
T40The use of a modifier is not typical for the billed Procedure.4N519
T41 Procedure was performed on the same day of a history Procedure by the same provider. The Diagnosis indicates same condition.96M86
T42Items that do not have a physician order or prescription are not covered.173N667
T43The ESRD Supply HCPCS code billed is not Payable to DME Suppliers.96N95
T44The maximum frequency for the DME Procedure code has been exceeded96N435
T45The Procedure was performed on the same day of a history Procedure by the same provider. The Diagnosis indicates condition96M86
T46A Diagnosis code or codes which meets medical necessity for the Procedure code is missing or invalid.146M76
T47A history Procedure code by the same provider is in the global period of the Procedure code for the same condition96M86
T48A Diagnosis code, which meets medical necessity for the Procedure code is missing or invalid.146M76
T49All Claim lines on the same Claim must contain the modifier EY.4N519
T50Modifier GK cannot be submitted alone, another line with GA or GZ must be present on the same Claim.4N519
T51Item or Service statutorily excluded or does not meet the definition of any Medicare benefit.4N519
T52The Procedure code is a non covered code or the modifier is a non covered modifier.16N657
T53These are non-covered Services because  is not deemed a medical necessity by the payer.50 
T54A Diagnosis code, which meets medical necessity for the Procedure code is missing or invalid.146M76
T55In the absence of injury or direct exposure, preventive immunization and its administration is not covered.50N130
T56A history Procedure code is within the global period of the Procedure code on  line96M86
T57The date of Service is past timely filing guidelines.29 
T58The units of Service billed for the Procedure code exceed the allowed number of units.50N362
T59Per NCCI Edits, the a history Procedure has an unbundle relationship with the Procedure code97M80
T60Per NCCI Edits, the Procedure code has an unbundle relationship with a code in history97M80
T61And ICD-9 Diagnosis code in history was compared to an ICD-10 Diagnosis code on the current Claim.  
T62The Diagnosis code and modifier combination are inappropriate  
T63The Procedure code has an unbundle relationship with a history Procedure code.97M80
T64A history Procedure code has an unbundle relationship with the code on the current line97M80
T65The frequency of the Procedure code has exceeded the allowable maximum frequency for  code119N435
T66Procedure is identified as an ambulance code and requires an ambulance modifier4 
T67The presence of modifier GZ indicates  is not eligible for payment.96N30
T68Procedure indicate multiple imaging Services were performed. Per CMS, a 25% reduction of the professional component applies.59 
T69Procedure indicate that multiple imaging Services were performed. Per CMS, a 25% reduction of the professional component applies to history.59 
T70A multiple Procedure reduction should be applied to  Claim line59 
T71Based on  Claim line, a multiple Procedure reduction should be applied to history59 
U99 Claim requires configuration review.133 
W01Invalid Diagnosis code unnecessary 4th/5th digit for patient’s admission on/disCharge date.146M76
W02Invalid Diagnosis code missing 4th/5th digit for patient’s admission/ disCharge date.146M76
W03Invalid Procedure code. Not found on table of valid ICD-CM codes.16M51
W04Invalid Procedure code. Unnecessary 4th digit.16M51
W05Invalid Procedure code. Missing 4th digit.16M51
W06Invalid Procedure code. Found on ICD-CM table but not valid for patient’s admission/disCharge date.16M51
W07Invalid Procedure code. Unnecessary 4th digit for patient’s admission/ disCharge date.16M51
W08Invalid Procedure code. Missing 4th digit for patient’s admission/ disCharge date.16M51
W09 Claim lacks required HCPCS Level II code for radiopharmaceutical drug.16M20
W10Revenue codes 381 and 382 can only be used when billing for packed red blood cells and whole blood.  
W11Non-approved partial hospitalization mental health Services cannot be submitted with a bill type of 13X and condition code 41.  
W12Approved partial hospitalization mental health Services submitted with TOB 12X, 13X or 14X must have condition code 41 on the Claim.  
W13The Charged amount for HCPCS code C9898 cannot exceed $1.01.  
W14 Service was provided after the end date of the approved coverage in the national coverage determination.  
W15Only whole blood revenue codes can be used when billing for whole blood.16M50
W16 HCPCS code is not approved for a partial hospitalization Claim.16M51
W17 HCPCS code can only be billed on a partial hospitalization Claim.16M51
W18The Charge on  line exceeds the token Charge $1.01.16M54
W19 Service was provided after the end date of coverage for the National Coverage Determination Policy.96N386
W20 Service is denied per Medically Unlikely Edits, the units billed exceed the allowable units for  code.96N362
W21Per LCD or NCD, the patient’s age does not meet policy requirements for the Procedure code and/or Diagnosis code.6N115
W22Per LCD or NCD guidelines, at CTP/HCPCS code is needed to meet policy requirements.96N115
W23Per LCD or NCD guidelines, Procedure code has a denied relationship.96N115
W24Per LCD or NCD, the frequency does not meet policy requirements for the Procedure code.96N115
W25Per LCD or NCD, the patient’s gender does not meet policy requirements for the Procedure code and/or a Diagnosis code.7N115
W26Per LCD or NCD guidelines, a Diagnosis code(s), which meets medical necessity for the Procedure code is missing or invalid.96N115
W27Per LCD or NCD guidelines, a modifier, which meets medical necessity for the Procedure code is missing or invalid.96N115
W28Per LCD or NCD, the condition code is missing or does not meet policy requirements for the Procedure code.96N115
W29Per LCD or NCD guidelines, a primary Diagnosis code, which meets medical necessity for the Procedure code is missing or invalid.96N115
W30Per LCD or NCD guidelines, Procedure code has a profiled relationship. Please review the policy.96N115
W31Per LCD or NCD guidelines, documentation should be requested or reviewed for the Procedure code96N115
W32Per LCD or NCD guidelines, a secondary Diagnosis code, to meet medical necessity for the Procedure code, is missing or invalid.96N115
W33Per LCD or NCD guidelines, a tertiary Diagnosis code, to meet medical necessity for the Procedure code is missing or invalid.96N115
W34Per LCD or NCD, the revenue code does not meet policy requirements for the Procedure code.96N115
W35Per LCD or NCD, the type of bill does not meet policy requirements for the Procedure code.96N115
W36Per LDC or NCD, the value code is missing or does not meet policy requirements for the Procedure code.96N115
W37Per Medically Unlikely Edits, the units of Service billed for the Procedure code exceed the allowed units50N362
W38Per NCCI Edits, a history Procedure has an unbundle relationship with the Procedure code on  line97M80
W39Per NCCI Edits, the Procedure code has an unbundle relationship with one in history97M80
W40The Statement Covers Period Through Date of Service is past the facility timely filing limit.29 
W41An ICD-9 Diagnosis code in history was compared to an ICD-10 Diagnosis code on the current Claim.96N569
W42The HCPCS add-on code 33225 is lacking a required primary code on the Claim.234N122
W43Procedure code must be submitted with required device or Procedure code on the same date of Service.16M20
W44Review the conditional or independent bilateral Procedure code for possible payment adjustment59N644
W45Procedure code is retained from the transfer relationshipP14 
W46History Procedure code is retained from the transfer relationshipP14 
W47The units have exceeded the allowable maximum frequency per time span119N640
W48The units including history have exceeded the allowable maximum frequency per time span.119N640
W49The units have exceeded the allowable maximum frequency per time span119N640
W50The units have exceeded the allowable maximum frequency per time span119N640
W51Multiple Procedures billed for the same Service Date in which a reduction is applicable, per CMS guidelines.59N644
W52Procedure Code should be denied due to a rebundle into another code97M80
W53History Procedure should be denied due to a rebundle into another code97M80
W54The surgical Procedure code contains a termination modifier, and all other Services on  Claim should be denied based on CMS guidelines.97M80
W55The surgical Procedure code contain a terminated modifier and should be reviewed for a 50% reduction.59 
W56Bundled codes transfer into new Procedure to be added to  Claim59 
W57Age and gender conflict; the Admission Diagnosis code is not permissible for the patient’s age and gender16MA65
W58Age and gender conflict; the Other Diagnosis code is not permissible for the patient’s age and gender.16M64
W59Age and gender conflict; the Principal Diagnosis code is not permissible for the patient’s age and gender.16MA63
W60The Admission Diagnosis code is invalid because it has an incomplete number of digits.16MA65
W61The Admission Diagnosis code is invalid16MA65
W62The Admission Diagnosis code is missing16MA65
W63The Other Procedure code is invalid based on the Admission date16M67
W64The Other Diagnosis code is invalid because it has an incomplete number of digits.16M64
W65The Other Procedure code must contain a fourth or fifth digit in order to be valid.16M64
W66The Other Diagnosis code must be valid and is effective based on the through date on the Claim.16M64
W67The Other Procedure code must be in the ICD-PSC code Table.16M67
W68The Other Procedure code contains an unnecessary digit.16M67
W69The Principal Procedure code must be valid and is effective based on the admission date on the Claim.16MA66
W70The Principal Diagnosis code does not contain a complete number of digits.16MA63
W71The Principal Procedure code must be complete in order to be valid.16MA66
W72The Principal Diagnosis code is not valid based on the through date on the Claim.16MA63
W73The Principal Procedure code must be in the ICD-PSC code Table.16MA66
W74The Principal Diagnosis code is missing on the Claim16MA63
W75The Principal Procedure code contains an unnecessary digit.16MA66
W76The Other Diagnosis code is a duplicate of the Principal Diagnosis code16MA64
W77The Other Diagnosis code is a duplicate of another Other Diagnosis code on the Claim.16M64
W78Age conflict; the Admission Diagnosis is not permissible for the patient’s age.9 
W79Age conflict; the Other diagnoses is not permissible for the patient’s age.9 
W80Age conflict; the Principal Diagnosis is not permissible for the patient’s age.9 
W81Gender conflict; the patient’s gender and Admission Diagnosis code, on the Claim are not permissible.10N657
W82Gender conflict; the patient’s gender and other Diagnosis code, on the Claim are not permissible.10N657
W83Gender conflict; the patient’s gender and Other Procedure code on the Claim are not permissible.7 
W84Gender conflict; the patient’s gender and Principal Diagnosis code, on the Claim are not permissible.10N657
W85Gender conflict; the patient’s gender and Principal Procedure code, on the Claim are not permissible.7 
W86Manifestation codes cannot be used as the Admission Diagnosis.16MA65
W87Manifestation codes cannot be used as the Principal Diagnosis.16MA63
W88Principal Diagnosis code indicates a questionable admission.16MA63
W89Diagnosis code is unacceptable as a principal Diagnosis unless a required secondary Diagnosis is included on the Claim.16MA63
W90Diagnosis code is unacceptable as a principal Diagnosis.16MA63
W91An E-code cannot be used as the Admission Diagnosis code.16MA65
W92An E-code cannot be used as the Principal Diagnosis code.16MA63
W93A non-covered over age 65 ICD Procedure code is on the Claim and the patient is older than 60 years of age.6N129
W94Procedure code is non-covered when a designated Diagnosis code is present.11 
W95Procedure code is non-covered unless the exemption ICD Procedure code or exemption ICD Diagnosis code is present.96N30
W96Claim contains Procedure codes that may be bilateral Procedures: The documentation for Procedures, should be reviewed.16N657
W97Age invalid. Must be in range 0-124 years.16N329
W98The patient gender is missing.16MA39
W99The Patient Gender is invalid. Gender must be M, F, or U.16MA39
X01Information only – linked OCE Edit 6  
X02Information only – linked to OCE Edit 6.  
X03Information only – linked to OCE Edits 16 and 17.  
X04Information only – linked to OCE Edits 16 and 17.  
X05Information only – linked to OCE Edits 16 and 17.  
X06Information only – linked to OCE Edits 16 and 17.  
X07 Edit indicates that Services essential to a Procedure should not be separately coded.234M15
X08 Edit indicates that Services essential to a Procedure should not be separately coded.234M80
X09 Procedure is considered part of a more comprehensive Procedure. The provider should submit the proper code.234M15
X10 Procedure is considered part of a more comprehensive Procedure. The provider should submit the proper code.234M80
X11 Procedure is considered part of a more comprehensive Procedure for  site. The provider should submit the proper code.B15M51
X12 Procedure is considered part of a more comprehensive Procedure for  site. The provider should submit the proper code.B15M80
X13 Edit indicates that with and without codes should not be used together.50M51
X14 Edit indicates that with and without codes should not be used together.B15M80
X15 Edit indicates that anesthesia should not be reported separately when administered by the operating physician.194M80
X16 Edit indicates that anesthesia should not be reported separately when administered by the operating physician.194 
X17 Edit indicates that individual lab tests should not be reported separately when a lab panel exists.97M15
X18 Edit indicates that individual lab tests should not be reported separately when a lab panel exists.97M15
X19 Edit indicates that only the code for the more invasive Service should be reported.50M51
X20 Edit indicates that only the code for the more invasive Service should be reported.50M51
X21Preparation or monitor Services that are integral to performance of the Procedure should not be coded in addition to the Procedure.234N390
X22Preparation or monitor Services that are integral to performance of the Procedure should not be coded in addition to the Procedure.234M15
X23These codes should not be reported together per Current Procedural Terminology coding guidelines.16M81
X24These codes should not be reported together per Current Procedural Terminology coding guidelines.16M81
X25These codes should not be reported together per Current Procedural Terminology coding guidelines.16M81
X26These codes should not be reported together per Current Procedural Terminology coding guidelines.16M81
X27Certain Services are not typically performed together.234N20
X28Certain Services are not typically performed together.234N20
X29These codes indicate Mutually Exclusive Services considered reasonably impossible or improbable to perform on same patient at same time.231 
X30Codes indicate Mutually Exclusive Services considered reasonably impossible or improbable to perform on same patient at the same time.231 
X31Two codes with opposing sex designations cannot be reported for the same patient visit.7 
X32Two codes with opposing sex designations cannot be reported for the same patient visit.108N370
X33Supporting information for OCE/Mutually exclusive Procedure Edits 019MEP.  
X34Supporting information for OCE/Mutually exclusive Procedure Edits 020CCP.  
X35Information only – An appropriate modifier on code 1 or code 2 may affect Edit.  
X36 Claim contains a statutory denied Diagnosis and will be denied by Medicare.96N425
X37 Procedure code is not valid or not valid for the Service date on the Claim line.181 
X38 Procedure code is not valid or not valid for the Service date on the Claim line.181 
X39 Procedure code not currently covered.96N425
X40 Procedure code is not covered based on a statutory requirement.96N425
X41 Service does not have a supporting Diagnosis Code under applicable medical necessity policy requirements.50M26
X42 Code violates age requirements of an applicable Local or National Coverage Determination Policy.96N115
X43 Code violates age requirements of an applicable Local or National Coverage Determination Policy.6N115
X44 Code violates gender requirements of an applicable Local or National Coverage Determination Policy.7N115
X45Code violates sex contrains of applicable medical necessity policy LCD or NCD, or the patient sex on Claim is missing or invalid.  
X46 Service lacks the required accompanying Procedure according to a Local or National Coverage Determination Policy.96N115
X47 Service lacks the required accompanying Procedure according to a Local or National Coverage Determination Policy.96N115
X48Age invalid; not in range 0-124 years.50N129
X49 Edit occurred because the sex is invalid. It is not 1 or 2, M or F.16MA39
X50Invalid disCharge disposition/patient status.16N50
X52An emergency code cannot be used as a principal Diagnosis.146MA63
X53A manifestation code cannot be used as principal Diagnosis.146MA63
X55The principal Diagnosis is invalid. The principal Diagnosis indicates questionable admission.146 
X56The principal Diagnosis is invalid. It is an unacceptable principal Diagnosis.146MA63
X57The principal Diagnosis is invalid because it is without the required secondary Diagnosis.146MA63
X58Principal Diagnosis suggests surgery but there are no O R Procedure codes on  Claim.  
X59 Edit occurred because all operating room Procedure codes on  Claim are non-specific.  
X60Two or more different bilateral joint Procedures are present on the Claim.  
X61Admit DX code not found on table of valid ICD-CM codes or missing/ unnecessary 4th/5th digit.  
X62The patient age and Diagnosis are inconsistent.10N657
X63The patient gender and Diagnosis are inconsistent.10N657
X64The patient age and sex are inconsistent with the patient Diagnosis.10N657
X65Insurer may be secondary payer to Auto Insurance, Worker’s Comp, etc.  
X66An emergency Diagnosis code cannot be used as an admitting Diagnosis.146MA65
X67A manifestation code cannot be submitted as admitting Diagnosis.146MA65
X68Dx not found on the table of valid ICD-CM codes or missing/unnecessary 4th/5th digit.  
X69 Diagnosis code is a duplicate of the principle Diagnosis.146MA63
X70The patient age and Diagnosis are inconsistent.10N657
X71The patient age and sex are inconsistent with the patient Diagnosis.10N657
X72The patient age and sex are inconsistent with the patient Diagnosis.10N657
X73Diagnosis code suggests that insurer may be secondary payer to Auto Insurance, Workers’ Comp, No Fault, etc.  
X74 Diagnosis code is a duplicate of another secondary Diagnosis code on  Claim.146M64
X75Proc not found on table of valid ICD-CM codes or missing/unnecessary 4th/5th digit.  
X76The patient gender and Procedure are inconsistent.7N115
X77 Procedure is not covered.96N30
X78 Edit occurred because an open biopsy code was used when a closed biopsy code may be more appropriate.  
X79 Procedure is covered in limited circumstances only.59 
X80Identifies bilateral Procedures.  
X81DOS to Units Discrepancy for Facility.  
X82The units are greater than one for a bilateral Procedure with modifier 50.16M53
X83Modifier FB submitted for a Service which is not assigned to payment status S or T or V or X.4N519
X84Revenue code 068X and Procedure code 99291 not submitted on the same date of Service as G0390.199N657
X85The Claim lacks allowed accompanying Procedure code for device.16M51
X86 Edit occurred because  Claim is a possible duplicate of another Claim.18N522
X87 Occurred because the Principal ICD Procedure Code is invalid, has a missing date, or has an invalid date.  
X88ICD-CM Diagnosis that is denied based on statutory exclusion.  
X89Proposed alternate closed biopsy code.59 
X90 Edit occurred because the admitting Diagnosis code is invalid.16MA65
X91 Edit occurred because the admitting Diagnosis code is invalid It contains an unnecessary 4th or 5th digit.16MA65
X92 Edit occurred because the admitting Diagnosis code is invalid. It has a missing 4th or 5th digit.16MA65
X93Invalid patient admission date DX the patient admission date.146MA65
X94Invalid DOA DX, 4th/5th digit date of admission. It contains an unnecessary 4th or 5th digit.146MA65
X95Invalid DOA DX missing digit 4,5 date of admission. It has a missing 4th or 5th digit.146MA65
X96 Edit occurred because an invalid Diagnosis code cannot be found on table of valid ICD-10-CM codes.16M76
X97 Edit occurred because the Diagnosis code is invalid. It has an unnecessary 4th or 5th digit.16M76
X98 Edit occurred because the Diagnosis code is invalid. It has a missing 4th or 5th digit.16M76
X99 Edit occurred because an invalid Diagnosis code was found on ICD-CM table but is not valid for patient admit or disCharge date.146M76
Y01The account ID field is missing or invalid.16N382
Y02The BDSf Edit validates the Service Date at the line level.  
Y03The FTD Edit validates the Admission and DisCharge Dates at the Claim Level.16M52
Y04The CCA Edit verifies that the condition codes on the Claim are valid.16M44
Y05The PSC Edit identifies Claims that are missing or contains an invalid Patient DisCharge Status Code.16MA43
Y06The REV Edit identifies line items that contain missing or invalid Revenue Codes.  
Y07The TOB Edit identifies Claims that are missing or contains an invalid Type of Bill.16MA30
Y08The VAL Edit confirms that the Value Codes on the Claim are valid.16M49
Y09The ICMf Edit validates that the Claim contains the required primary Diagnosis prior to HSS processing.16MA63
Y10The Claim has a missing Patient ID. Analysis cannot be performed without a Patient ID.16N382
Y11The DOBf Edit identifies a Claim that has a missing or invalid DOB. Certain Edits cannot be performed without the patient DOB.16N329
Y12The PSXf Edit identifies a Claim with a missing or invalid patient gender. Certain Edits cannot be performed without the patient gender.  
Y13 Edit identifies a Claim missing a Provider ID. Analysis cannot be performed without a Provider ID.207N257
Y14The IPA Edit validates that the ICD Procedure codes on the Claim are valid.  
Y15The OCC Edit validates that the occurrence codes on the Claim are valid.  
Y16The OSC Edit validates that the occurrence span codes on the Claim are valid.  
Y17The SOA Edit identifies Claims that contain an invalid Source of Admission code.16MA42
Y18The TOA Edit identifies Claims that contain an invalid Type of Admission code.16MA41
Y19 Edit identifies line items that are potentially duplicates when two lines entered on one or more Claims are identical.18N522
Y20Identifies an entire outpatient Claim that is a potential duplicate of a previously submitted outpatient Claim.  
Y21 Edit identifies an entire inpatient Claim that is a potential duplicate of a previously submitted inpatient Claim.18N522
Y22Identifies an entire inpatient Claim that is a potential duplicate of a previously submitted inpatient Claim.  
Y23 Edit occurred because the first listed Diagnosis field is blank or any Diagnosis code is not valid for Service dates on the Claim.146M76
Y24 Edit occurred because the Diagnosis code includes an age range and the patient age is outside of that range.9N657
Y25 Edit occurred because the Diagnosis code includes gender designation and the patient gender does not match.16MA39
Y26 Edit occurred because the Diagnosis code has an MSP alert warning indicator.  
Y27 Edit occurred because the first letter of the first listed Diagnosis code is an E.146M76
Y28 Edit occurred because the submitted Procedure code is not valid for the Service dates on the Claim.181M20
Y29 Edit occurred because the Procedure code includes an age range and the patient age is outside of that range.  
Y30 Edit occurred because the Procedure code includes gender designation and the patient gender does not match.16MA39
Y31 Edit occurred because the Procedure code has a noncovered Service indicator meaning it is not covered.96N115
Y32 Edit occurred because Condition Code 21 indicates the provider is requesting verification of denial.96N30
Y33 Edit occurred because the Claim was submitted with Condition Code 20.16M44
Y34 Edit occurred because the Procedure code has a questionable covered Service indicator.16N657
Y35 Edit occurred because a Procedure code indicates a Service N/C by Medicare based on the type of bill and condition codes on Claim.  
Y36 Edit occurred because the Procedure code does not have an OPPS indicator, but may be payable in other settings.  
Y37 Edit occurred because the sum of units or all lines with the same proc except lab with mod 91, exceeds the max allowed for proc.  
Y38 Edit occurred because multiple exclusive bilateral proc codes are present, 2 or more times on the same svc date, without a mod 50.  
Y39 Edit occurred where multiple exclusive bilateral Procedure codes are present on same Service date with or without modifier 50.4N519
Y40 Edit occurred because Medicare designated Procedure as pay status C meaning Procedure is not covered when performed as outpatient.5M77
Y41 Edit occurred because two mutually exclusive Procedures were billed with same Service date.234M80
Y42 Procedure is one of a pair of mutually exclusive Procedures and both codes exist on a Claim with the same Service date.234M15
Y43 Edit occurred because the Procedure is identified as a component of another Procedure also on the Claim for the same Service date.97M15
Y44 Edit occurred because the Procedure is identified as a component of another Procedure also on the Claim for the same Service date.97M15
Y45 Edit occurred because one or more type T or S Procedures are on same day as an Evaluation Management code without modifier 25.182N657
Y46 Edit occurred because the modifier is not in the list of valid Outpatient Prospective Payment System modifiers.182N657
Y47Only Edits for valid modifiers not specific to outpatient facility Claims.182N657
Y48 Edit occurred because the From, Thru, or Service date is invalid or Service dt falls outside range of the From and Thru dates.  
Y49 Edit occurred because the age is non-numeric or outside the range of 0-124 years.50N129
Y50 Service is not covered for  member. The provider should submit the proper code or medical documentation.16MA39
Y51 Edit occurred because only incidental Services were reported.97N20
Y52 Edit occurred because Procedure code indicator is Not Recognized.16N657
Y53 Edit occurred because the principal Diagnosis is not related to mental health on a partial hospitalization Claim.16MA63
Y54 Edit occurred because Ambulatory Payment Class 323 or 324 or 325 is present and three or more qualifying criteria are not present.16N657
Y55 Edit occurred because electroconvulsive therapy or a significant Procedure occurs on the same day as partial hospitalization.  
Y56 Edit occurred because a partial hospitalization Claim is suspended for medical review and does not span more than three days.16N657
Y57 Edit occurred because Claims suspended for medical review and spans more than three days and mental health Services not 57 percent.16N657
Y58 Edit occurred because Claims suspended for medical review and spans more than three days and mental health Services not 57 percent.16N657
Y59 Edit occurred because a mental health Service assigned to Ambulatory Payment Class 323 or 324 or 325 does not exist.16N657
Y60 Edit occurred because electroconvulsive therapy or a non-mental health proc is present on same day as extensive mental hlth svcs.  
Y61Modifier 73 is present with an independent or conditional bilateral Procedure with modifier 50 or a Procedure with more than 1 unit.4N519
Y62 Edit occurred because the Claim contains an implanted device with no surgical or other Service to implant the device.16M67
Y63 Edit occurred because one of a pair of mutually exclusive Procedures with same Service date and no qualifying NCCI modifier.4N519
Y64 Edit occurred because one of a pair of mutually exclusive Procedures with same Service date and no qualifying NCCI modifier.4N519
Y65 Procedure is a component of another code on the Claim without a qualifying NCCI modifier on the same day.4N519
Y66 Procedure is a component of another code on the Claim without a qualifying NCCI modifier on the same day in history.4N519
Y67The Edit occurred because  is not a valid revenue code.16M50
Y68 Edit occurred because multiple medical visits are present on the same day with the same Revenue Code without Condition Code G0.16M44
Y69HCPCS code 36430 requires a HCPCS code for the blood product to billed for the same date of Service.16M51
Y70 Edit occurred because Observation Revenue code 762 is used with a Procedure code that does not represent an Observation Service.199N657
Y71 Edit occurred because Services with Service indicator C are present on a separate Procedure list.96M2
Y72 Edit occurred because Type of Bill 12X or 14X is present with Condition Code 41.16MA30
Y73 Edit occurred because Claim consists entirely of a combination of lines that are denied or rejected or are considered packaged.97N390
Y74 Edit occurred because Claim line contains a revenue code that requires a Procedure code.16M20
Y75 Edit is assigned to all other Claim lines when one or more line contains a Procedure code with a status indicator of C.96M2
Y76 Edit occurred because a Claim line contains a Procedure code which is noncovered by statute.96N425
Y77 Edit occurred because multiple observations on Claim are paid separately if the required criteria are met for each one.  
Y78 Edit occurred because Claim shows billable observation but dx is not in list of dx codes that qualify for separate observation py  
Y79 Edit occurred because observation codes G0243 or G0244 are billed on a Claim with Type of Bill not equal to 13X.16MA30
Y80 Edit occurred because blood components that are not allowed to be coded together are reported on the same Date of Service.96N56
Y81 Edit occurred because Procedure code starting with letter C is used without Bill Type 12X or 13X or 14X.16MA30
Y82 Edit occurred because no E/M visit the day of or the day before the observation and the date of observation is not 12/31 or 1/1.  
Y83 Edit occurred because no Evaluation Management visit the day of or day before the observation and date is December 31 or January 1.96N56
Y84 Edit occurred because code G0379 is present w/o code G0378 for same Claim with bill type 13x96N56
Y85 Edit occurred because code G0292 or G0293 or G0294 are on the Claim and Diagnosis V707 is not present as admit or second Diagnosis.16MA65
Y86 Edit occurred because modifier CA is on 1 or more lines with Indicator C and same Service date or modifier CA with multiple units.96N56
Y87 Edit occurred because proc code reported has a status indicator of Y indicating item can only be billed to DME Regional Carrier.16M51
Y88 Edit occurred because Procedure is not reportable on an Outpatient Prospective Payment System Claim.96N56
Y89 Edit occurred because Procedure G0129 Occupational Therapy is furnished as a component of partial hospitalization treatment program.96N56
Y90 Edit occurred because Procedure G0176 Activity Therapy furnished as a component of partial hospitalization treatment program daily.96N56
Y91 Edit occurred because the line item contains a revenue code that is not recognized.16M50
Y92 Edit occurred because C9399 was billed which is a drug that received Federal Drug Administration approval but is an unlisted code.16N350
Y93 Edit occurred because the Service was performed prior to the date of Federal Drug Administration approval.188N386
Y94 Edit occurred because the Service was performed prior to the effective date as specified in the National Coverage Determination.96N386
Y95 Edit occurred because the Service was performed outside an approved clinical trial period.96M61
Y96 Edit occurred because modifier CA has been reported and 20 is not patient status code in form locator 22.182N657
Y97 Edit occurred because a Procedure was not reported with 1 or more associated device codes.96N56
Y98 Edit occurred because a Procedure code has a status indicator of M and it cannot be reported to the fiscal intermediary.16M51
Y99 Edit occurred because blood products are billed with Revenue code 39X and modifier BL without a line billed with Revenue Code 38X.16M50
Z01The Account ID is missing.16N382
Z02The Procedure code was crosswalked to an appropriate anesthesia code.59 
Z03 Claim line is being disallowed because the anesthesia Procedure code was performed by a non-anesthesia provider.96N95
Z04 Claim line is not reimbursed because more than one anesthesia Procedure code was billed on the same date of Service.59N633
Z05 Service is not paid in addition to another anesthesia Service on the same day.59N633
Z06 Claim line is being disallowed because there is a missing or invalid beginning or ending date of Service (DOS).16MA31
Z07 line is eligible for a Bilateral Procedure Reduction.59N644
Z08The place of Service code is missing or invalid.16M77
Z09The surgical Procedure cannot be crosswalked to an anesthesia code without report.252M29
Z10 Service is not normally performed for members in  age range.6N129
Z11It  is a deleted or invalid code or modifier for  date of Service . The provider should submit the proper code.181M20
Z12 It is a deleted or invalid code or modifier for  date of Service . The provider should submit the proper code.181M20
Z13 Service is not covered for  member. The provider should submit the proper code or medical documentation.7N115
Z14Documentation is required when a modifier 59 is billed with the Procedure code.252M127
Z15 It is a duplicate of previous Claim. If corrected billing please resubmit according to billing guidelines.18N522
Z16 Claim line is being disallowed because the patients date of birth is missing, invalid, or after the date of Service.16N329
Z17Claim line is being disallowed because number of units doesn’t match the date span between the beginning and ending dates of Service.16N345
Z18 It is a duplicate of a previous Claim. If corrected billing please resubmit according to billing guidelines.18N522
Z19The System was unable to obtain results for  Claim line.  
Z20 Claim line is being disallowed because an E and M code is within the global period with a same Diagnosis category by same provider.97N525
Z21The Procedure code on  Claim line is retained from a transfer relationship.97M15
Z22Claim line is disallowed because a surgical code was submitted w/in the period w/a Dx from same category by the same provider.97N525
Z23A history Claim line is disallowed because its Procedure code is unbundled and is considered exclusive.97M80
Z24A history Claim line is disallowed because its Procedure code is unbundled and is considered unbundled.97M80
Z25A history Claim line is disallowed because its Procedure code is disallowed as part of a rebundle relationship.97M80
Z26A Procedure code on a history Claim line was part of a transfer relationship, but the Procedure code was retained.  
Z27 condition is not normal for  patient age.9N657
Z28 Service is not covered when performed for the reported Diagnosis.50M64
Z29 Service is not covered when performed for the reported Diagnosis.50M64
Z30 Claim line is being disallowed because there is no primary Diagnosis code.16MA63
Z31The Procedure can be crosswalked to two or more anesthesia codes and review is required to determine the appropriate code.252M29
Z32 Claim line is being disallowed because Diagnosis code requires a fourth and/or fifth digit to provide appropriate specificity.16M64
Z33The Claim line contains an inappropriate modifier combination.4N519
Z34 It is an invalid modifier for  date of Service. The provider should submit the proper code.4N519
Z35 condition is not normal for  patient gender.16N657
Z36 Procedure requires modifier 26 be billed.4N517
Z37Reimbursement for surgical assistant is not allowed on  Procedure code.54N646
Z38 Edit occurred because the Bilateral adjustment does not apply to  Procedure code.  
Z39 It is a bundled Service. The payment is included in the Service to which item or Service is incident.234M15
Z40 It is a bundled Service. The payment is included in the Service to which item or Service is incident.234M15
Z41The provider who rendered these Services is not eligible to assist during surgery.96N95
Z42 Edit occurred because the Procedure requires supporting documentation for an assistant surgeon.252M29
Z43 Edit occurred because the Procedure requires supporting documentation for a co-surgeon.252M29
Z44 Edit occurred because the Procedure requires supporting documentation for team surgery.252M29
Z45 Procedure is redundant to the primary Procedure and is limited by  member plan.234M15
Z46 Service is a part of the original surgical Procedure and is limited by  member plan.234M15
Z47 modifier is not compatible with  Procedure code. The provider should submit the proper code.4N519
Z48 is a bundled Service. The payment is included in the Service to which item or Service is incident.234M15
Z49 code or modifier or provider type is invalid.4N517
Z50 Edit occurred because a non-covered Service was submitted. The member is not liable for these Charges.96N30
Z51 It is a deleted or invalid code or modifier for  date of Service The provider should submit the proper code.4N519
Z52 modifier is not compatible with  Procedure code. The provider should submit the proper code.4N517
Z53 line is eligible for a multiple Procedure reduction.59 
Z54Physical therapy is not covered in  place of Service. The member is not liable for these Charges.96N428
Z55 Service is a part of the original surgical Procedure and is limited by  member plan.97M15
Z56 It is a deleted/invalid code or modifier for  date of Service. The provider should submit the proper code.182N657
Z57A Claim line in history is disallowed because its Procedure code is unbundled to a line on  Claim.234M15
Z58 Procedure is considered part of the primary Procedure and is limited by  member plan.234M15
Z60 Service is not covered when performed for the reported Diagnosis.16M64
Z61 Procedure should not be billed since the member is an established patient.B16 
Z62 Claim line is being disallowed because the patient ID is missing or invalid.16N382
Z63 is a deleted or invalid code or modifier for  date of Service . The provider should submit the proper code.4N519
Z64The place of Service is not typical for the Procedure code.5M77
Z65 line is eligible for a Assistant/Co/Team Surgery modifier reduction.  
Z66 Procedure is considered part of the primary Procedure and is limited by  member plan.97M15
Z67 Service is a part of the original surgical Procedure and is limited by  Member’s plan.97M144
Z68 Claim line is being disallowed because the provider ID is missing or invalid.207N257
Z69The patient gender is missing or invalid.16MA39
Z70 Claim line is being disallowed because the Procedure code is disallowed as part of a rebundle relationship.97M80
Z71 Procedure does not normally require the Services of an assistant surgeon.54N646
Z72 Claim line is being disallowed because the Procedure code does not typically allow an assistant surgeon modifier.54N646
Z74 Edit occurred because a Diagnosis code on the line is a possible third party liability.20 
Z75A transfer to an appropriate Procedure occurred.  Claim lines Procedure was part of the transfer group.97M15
Z76 Claim line is being disallowed because the Procedure code is unbundled and is considered exclusive.97M80
Z77 Claim line is being disallowed because the Procedure code is unbundled and is considered unbundle.97M80
Z78 Edit occurred because the Procedure code is unlisted.16M51
Z79 Procedure is considered cosmetic and is not a covered Service under  Member’s plan.96N383
Z80 Procedure is considered investigative and is not a covered Service under  Member’s plan.55N623
Z81Unbundled Proc – Incidental  
Z82Unbundled Hx Proc – Incidental.  
Z83Bilateral Procedure Reduction59N644
Z84Multiple Procedure Reduction59 
Z85CA modifier requires patient status code 20.  
Z86Missing or Invalid Additional Procedure.  
Z87Missing or Invalid Diagnosis for Code to Code.  
Z88 Service is not covered when performed for the reported Diagnosis.16M64
Z89 modifier is not compatible with  Procedure code. The provider should submit the proper code.96N115
Z90 Service is not covered when performed for the reported Diagnosis.50M64
Z91 Edit occurred because a primary Diagnosis code is missing or invalid due to a Local or National Coverage Determination.16MA63
Z92 Edit occurred because a secondary Diagnosis code is missing or in valid due to a Local or National Coverage Determination.16M76
Z93 Service is not covered when performed for the reported Diagnosis.16M64
Z95The frequency and/or Diagnosis does not meet policy requirements for Procedure due to a Local or National Coverage Determination.11N386
Z96LCD Part B Frequency with Diagnosis Override.  
Z97The place of Service does not meet policy requirements for Procedure code due to a Local or National Coverage Determination.16M77
Z98The patient’s gender does not meet policy requirements due to a Local or National Coverage Determination.16MA39
Z99The age does not meet policy requirements for Procedure or Diagnosis due to a Local or National Coverage Determination.50N129
Blue Cross Blue shield Denial Codes Denial Codes List

The following explanation codes or Blue Cross Blue Shield denial codes for remittance and descriptions are based on those that appear in paper (paper) Commercial remittance advice. The identical codes and descriptions are also applicable to commercial remittance advice online that is available on BlueAccess the secure portion on www.bcbst.com. Although the information/action column of the provider isn’t in the remittance guidance however, we have added the information on this page to aid you.

Electronic remittance guidance that is HIPAA compliant (ANSI-835) does not employ the explanation code. Electronic remittance guidance (ANSI-835) utilizes HIPAA-compliant remark as well as adjustment reasons codes. 

What is Denials Management in Medical Billing? (Complete Guide)

BCBS Provider Phone Number and Claim Address

Harvard Pilgrim Insurance Phone Number and Claim Address

Insurance Claim Address and Phone Number (A to Z)

Molina Healthcare Phone Number| Molina Claim Address

Kaiser Permanente Phone Number and Claim Addresses