Defect Code Defect Description Defect Type Effect

01D DISCREPANCIES ON SERVICES PERFORMED MANUAL D

04P NOT IN 4P MASTERLIST MANUAL D
0AF DENIED BASED ON CIRC 14 S2008, CIRC 28 S2012 MANUAL D
0BD BENEFIT DISALLOWED (NOT QUALIFIED AS NON-PAYING MEMBER) MANUAL D
0BE BENEFIT ALREADY EXHAUSTED MANUAL D
0CD CLAIMING FOR PROFESSINAL FEE ONLY, BUT DOCTOR NOT ACCREDITED MANUAL D
0CE CASE NOT EMERGENCY MANUAL D
0CP CLAIM/PROCEDURE ALREADY PAID MANUAL D
0DL NO D.O.H. LICENSE MANUAL D
0DP PENSIONER WITH LESS THAN 120 CONTRIBUTION MANUAL D
0F2 DENIED, USING OLD PHILHEALTH FORM 2 MANUAL D
0IC CASE NOT COMPENSABLE MANUAL D
0ID INCONSISTENT DATA MANUAL D
0II INVALID IDENTIFICATION NUMBER MANUAL D
0IM INCOMPLETE NEWBORN CARE SERVICES RENDERED MANUAL D
0LP LATE PAYMENT/NO RETROACTIVE PAYMENT MANUAL D
0LR LATE REFILING MANUAL D
0MD DOCTOR NOT MENTIONED IN O.R. REPORT MANUAL D
0NC DENIED DUE TO NON-COMPLIANCE MANUAL D
0ND PATIENT NOT A QUALIFIED DEPENDENT MANUAL D
0NQ LACK OF/NO QUALIFYING CONTRIBUTION MANUAL D
OFFICIAL RECEIPTS ATTACHED NOT COMPENSABLE/OUTSIDE CONFINEMENT PERIOD MANUAL D
0OC
0OF DENIED, USING OLD PHILHEALTH FORM 1 MANUAL D
DENIED PER PRO LEGAL UNITS RECOMMENDATION BASED ON CIRC. 14,S.2008,CIRC.
MANUAL D
0PL 28,S.2012
0PN PHILHEALTH NUMBER USED BY THE CLAIMANT BELONGS TO ANOTHER MEMBER MANUAL D
0QP NOT QUALIFIED PENSIONER (GSIS SURVIVOR) MANUAL D
0RA SURVIVORSHIP/DISABILITY PENSIONER AFTER RA 7875 MANUAL D
0SD FORGED SIGNATURE OF DOCTOR IN FORM #2 MANUAL D
1DC DIFFERENT DOCTOR REFLECTED IN FORM3/ CLINICAL CHART MANUAL D
1PT NO TIN AND/OR ACCREDITATION NUMBER IN FORM 2 MANUAL D
1SD NO NAME OF DOCTOR REFLECTED IN FORM 2 MANUAL D
1TB DOTS CLAIM IS A RELAPSE/RAD/FAILURE CASE MANUAL D
2SB DOCTOR SIGNED "IN BEHALF OF" NOT ALLOWED MANUAL D
3AM MATERNITY PACKAGE NO PAYMENT FOR ANESTHESIOLOGIST FEE MANUAL D
PENSIONER BELOW RETIREMENT AGE NOT QUALIFIED AS AN NHIP NON-PAYING MEMBER MANUAL D
3PN
A75 CASE RATE CLAIM ATTENDED BY NOT ACCREDITED DOCTOR MANUAL D
B04 IOL NOT FDA APPROVED MANUAL D
B55 OPTHALMIC CASES NOT ALLOWED IN THIS HCI MANUAL D
B92 NON-COMPLIANCE TO STANDARD OF CARE (MANUAL) MANUAL D
D01 CASE NOT COMPENSABLE AS PER CIRCULAR #____________SERIES________- MANUAL D
D02 ILL-DEFINED DIAGNOSIS FOR FIRST CASE RATE CLAIM NOT COMPENSABLE MANUAL D
D03 ILL-DEFINED DIAGNOSIS FOR SECOND CASE RATE CLAIM NOT COMPENSABLE MANUAL D
D09 NON-COMPLIANCE TO DEFICIENCIES MANUAL D
INDICATION ON VAGINAL DELIVERY (RVS 59409) NOT IN LIST OF ACCEPTED INDICATIONS MANUAL D
D14
RE-FILED CLAIM THAT STILL HAS DEFICIENCIES/ERRORS STARTING APRIL 1, 2014
MANUAL D
D15 ADMISSIONS:DENIED
CLAIM FOR REFERRAL PACKAGE NOT COMPENSABLE ( MEDICAL CONDITIONS NOT
MANUAL D
D21 INCLUDED IN THE LIST
D22 ADMISSION DUE TO PATIENT CHOICE NOT COMPENSABLE MANUAL D
D23 VIOLATION OF SINGLE PERIOD OF CONFINEMENT (SPC) RULE MANUAL D
0CX CLAIM FORM SUBMITTED SHOULD BE ORIGINAL. PHOTOCOPY NOT ALLOWED MANUAL P
0DD DISCREPANCIES MANUAL P
Defect Code Defect Description Defect Type Effect
0FS FILE AS SEPARATE CLAIM MANUAL P
0PD PREVIOUSLY DENIED CLAIM MANUAL P
1AD INCONSISTENT NAME OF DOCTOR IN FORM 2 AND ACCREDITATION DATABASE MANUAL P
1AR NO ANESTHESIA RECORD MANUAL P
1CC NO ATTACHED CHEMOTHERAPY CHART MANUAL P
1CF REQUIRED CLAIM FORM(S) MANUAL P
1CN NO CP CLEARANCE NOTE MANUAL P
1DI DISCREPANCIES ON DOCTOR'S REQUIREMENTS MANUAL P
1DS NO SIGNATURE OF DOCTOR IN FORM 2 MANUAL P
1FA ORIGINAL PHILHEALTH CLAIM FORM 1 NOT PROPERLY ACCOMPLISHED MANUAL P
1FB ORIGINAL PHILHEALTH CLAIM FORM 2 NOT PROPERLY ACCOMPLISHED MANUAL P
1FC ORIGINAL PHILHEALTH CLAIM FORM 3 NOT PROPERLY ACCOMPLISHED MANUAL P
1FD ORIGINAL PHILHEALTH CLAIM FORM 4 NOT PROPERLY ACCOMPLISHED MANUAL P
1FE ORIGINAL PHILHEALTH CLAIM FORM 5 NOT PROPERLY ACCOMPLISHED MANUAL P
1FF CLAIM SHOULD BE FILED AS FEE FOR SERVICE MANUAL P
1FM CLAIM SHOULD BE FILED UNDER MEMBERSHIP OF PATIENT MANUAL P
1FO DOUBLE FILING - FILE AS ONE CLAIM AS PER FFAID DECISION MANUAL P
1LB REQUIRED LABORATORY RESULT MANUAL P
1MD REQUIRED MEDICAL DOCUMENT(S) MANUAL P
1MP CASE NOT INCLUDED IN MATERNITY PACKAGE MANUAL P
1NO CLAIMANT IS NOT AN OWP MEMBER MANUAL P
1NT NOT PROPERLY ACCOMPLISHED NTP CARD MANUAL P
1OR NO OPERATIVE RECORD ATTACHED MANUAL P
1OT OTHER DOCUMENTS REQUIRED MANUAL P
1OW LACKS DOCUMENT TO ESTABLISHED OFW IS ACTIVE MANUAL P
1PC NO PROOF OF CONTRIBUTION MANUAL P
1PD NO PROOF OF DEPENDENCY MANUAL P
1PF NO PROOF OF PROFESSIONAL FEE BILLING/PAYMENT MANUAL P
1PH NO PROOF OF HOSPITAL BILLING/PAYMENT MANUAL P
1RL CLAIM IS REFERRED TO LEGAL MANUAL P
1RP CLAIM IS REFERRED TO PEER REVIEW/QARPDG MANUAL P
1SF NEWBORN SCREENING CERTIFICATE MANUAL P
1SO DIFFERENT DOCTOR REFLECTED IN OPERATIVE RECORD MANUAL P
1SP SERVICES PERFORMED NOT ACCOMPLISHED IN FORM 2 MANUAL P
1TD ACCREDITATION #/TIN BELONGS TO ANOTHER DOCTOR MANUAL P
1WS NO SIGNATURE OF REPRESENTATIVE IN WAIVER MANUAL P
2MP MATERNITY CARE PACKAGE SHOULD BE FILED AS ONE CLAIM MANUAL P
2OW NO ATTACHED OFFICIAL RECEIPT OR WAIVER MANUAL P
INDICATE RELATIONSHIP OF THE REPRESENTATIVE TO THE MEMBER/PATIENT IN CF2, PART
MANUAL P
B28 III ITEM B
INDICATE THE REASON FOR SIGNING IN BEHALF OF THE MEMBER/PATIENT IN CF2, PART III
MANUAL P
B29 ITEM B
RIGHT THUMBMARK OF MEMBER/PATIENT OR HIS/HER AUTHORIZED REPRESENTATIVE IS
MANUAL P
B30 REQUIRED, IF UNABLE TO WRITE IN CF2, PART III ITEM B
REQUIRED DOCUMENT IS UNAVAILABLE/INCOMPLETE/INCONSISTENT/UNREADABLE MANUAL P
B35
B89 CF4 NOT PROPERLY ACCOMPLISHED MANUAL P
B90 ADDITIONAL REQUIREMENTS TO CF4 NOT ATTACHED TO THE CLAIM (MANUAL) MANUAL P
B91 NO ELECTRONIC CF4 DATA ATTACHED TO THE CLAIM (MANUAL) MANUAL P
WITH ERRORS ENCOUNTERED IN CF4 XML FOR REFERRAL TO SERVICE PROVIDER TO FIX
MANUAL P
B95 AND RE-FILE
P01 NO ATTACHED PROPERLY ACCOMPLISHED REFFERAL FORM MANUAL P
P02 NO ATTACHED PROPERLY ACCOMPLISHED PHILHEALTH CLAIM FORM 1 MANUAL P
P03 NO ATTACHED PROPERLY ACCOMPLISHED PHILHEALTH CLAIM FORM 2 MANUAL P
P04 NO ATTACHED PROPERLY ACCOMPLISHED PHILHEALTH CLAIM FORM 3 MANUAL P
P05 NO ATTACHED JUSTIFICATION LETTER FOR NON-AVAILABILITY OF ROOM MANUAL P
Defect Code Defect Description Defect Type Effect
P06 NO ATTACHED PROPERLY ACCOMPLISHED PMRF MANUAL P
P07 PLEASE SUBMIT PROOF OF MEMBERSHIP MANUAL P
P08 PLEASE SUBMIT PROOF OF QUALIFYING CONTRIBUTION MANUAL P
P09 PLEASE SUBMIT ENHANCED PHILHEALTH CLAIM FORMS MANUAL P
P10 REQUIREMENTS FOR CONFINEMENT ABROAD MANUAL P
P11 NO ATTACHED SURGICAL OR OPERATIVE TECHNIQUE MANUAL P
P12 NO ATTACHED ANESTHESIA RECORD MANUAL P
P13 ALTERNATIVE REQUIREMENTS FOR SPECIFIC PROCEDURES MANUAL P
P15 LATERALITY NOT INDICATED FOR PROCEDURE THAT REQUIRES LATERALITY MANUAL P
004 CONFINEMENT NOT WITHIN CLAIM ELIGIBILITY PERIOD SYSTEM D
013 FILED BEYOND 180 DAYS STATUTORY PERIOD SYSTEM D
014 EXHAUSTED 45 COMPENSABLE DAYS SYSTEM D
015 FILED BEYOND 120 DAYS STATUTORY PERIOD SYSTEM D
016 FILED BEYOND 60 DAYS STATUTORY PERIOD SYSTEM D
017 FILED BEYOND 90 DAYS STATUTORY PERIOD SYSTEM D
019 DOUBLE FILING/SAME DAY CONFINEMENT SYSTEM D
020 PARENT'S AGE SHOULD BE 60 OR ABOVE SYSTEM D
021 CHILD'S AGE SHOULD BE BELOW 21 YEARS OLD SYSTEM D
024 LESS THAN 24 HOURS CONFINEMENT. CASE NOT EMERGENCY SYSTEM D
025 OPD CASE NOT COMPENSABLE SYSTEM D
050 HCP ACCREDITATION IS SUSPENDED SYSTEM D
059 SURGEON NOT PAID, OUTSIDE COVERAGE SYSTEM D
060 ANEST NOT PAID, SURGERY OUTSIDE COVERAGE SYSTEM D
0AB ABT CLAIM NOT COMPENSABLE SYSTEM D
0AC DENIED ASTHMA CASE AS PER CIRC 20 S2011 SYSTEM D
0AD SURGEON ADMINISTERS ANESTHESIA SYSTEM D
0AN ADMISSION DATE NOT WITH-IN MATERNITY CLAIM CONFINEMENT SYSTEM D
0AR FACILITY NOT LISTED AS AN ABT PROVIDER SYSTEM D
0BC DATE OF OPERATION NOT WITHIN THE CONFINEMENT PERIOD SYSTEM D
0BN PATIENT BIRTHDATE NOT WITH-IN MATERNITY CLAIM DATES SYSTEM D
0CC CASE NOT COMPENSABLE ANYMORE (CASE RATE OR FFS) SYSTEM D
0CM SHOULD BE PAYABLE TO HOSPITAL, UNLESS WITH SUPPORTED OFFICIAL RECEIPT SYSTEM D
0CU CASE RATE CLAIM ATTENDED BY NOT ACCREDITED DOCTOR SYSTEM D
0DA DOCTOR NOT ACCREDITED SYSTEM D
0DC SERVICE NOT ALLOWED IN A FREE STANDING DIALYSIS CLINIC SYSTEM D
0DE CONFINEMENT NOT WITHIN DOCTOR'S ACCREDITATION PERIOD SYSTEM D
0DM DATE OF OPERATION OUTSIDE MEMBERSHIP COVERAGE SYSTEM D
0DS DAY SURGERY, CLAIMING RVU GREATER THAN 200 SYSTEM D
0HA HOSPITAL/FACILITY NOT ACCREDITED SYSTEM D
0HE CONFINEMENT NOT WITHIN HOSPITAL ACCREDITATION PERIOD SYSTEM D
0MB BENEFITS/ACTUAL CHARGES NOT ACCOMPLISHED SYSTEM D
0NA AGE NOT ALLOWED TO CLAIM MATERNITY PACKAGE UNDER MATERNITY CLINIC SYSTEM D
0NB NO MATERNITY CLAIM FILED (ONLY NEWBORN CARE PACKAGE CLAIM FILED) SYSTEM D
0NH SERVICE NOT ALLOWED IN A NON-HOSPITAL FACILITY SYSTEM D
0NM SUPPLIED MATERNITY CLAIM IS NOT UNDER MATERNITY PACKAGE SYSTEM D
0OA DATE OF OPERATION NOT WITHIN ACCREDITATION PERIOD SYSTEM D
0OR O.R. FEE NOT PAID, NO SURGEON SYSTEM D
0PE PRIMARY HOSPITAL CLAIMING RUV GREATER THAN LIMIT, CASE NOT EMERGENCY SYSTEM D
0PP DENIED PNEUMONIA CASE AS PER CIRC 20 S2011 SYSTEM D
0PS PATHOLOGY SERVICES LIMITED TO PROFESSIONALS WITH ACCRE CODE 1206 SYSTEM D
0PT SERVICE NOT ALLOWED IN A PRIMARY HOSPITAL SYSTEM D
0PZ PREAUTH DATE BEYOND EFFECTIVITY OF ZBENEFIT SYSTEM D
0Q2 QIDS CERTIFICATION OF HOSPITAL IS OUTSIDE COVERAGE SYSTEM D
0RS RADIOLOGY SERVICES LIMITED TO PROFESSIONALS WITH ACCRE CODE 1207 SYSTEM D
0SC IN-PATIENT CASE NOT ALLOWED IN AMBULATORY SURGICAL CLINIC SYSTEM D
0SH SERVICE NOT ALLOWED IN A HOSPITAL FACILITY SYSTEM D
Defect Code Defect Description Defect Type Effect
0SP HCI ACCREDITATION IS SUSPENDED SYSTEM D
0SS SERVICE NOT ALLOWED IN A SECONDARY HOSPITAL SYSTEM D
0ST SERVICE NOT ALLOWED IN A TB DOTS FACILITY SYSTEM D
0TB NO INTENSIVE DOTS TREATMENT, CLAIMING MAINTENANCE SYSTEM D
0TI PATIENT ALREADY HAS AN INTENSIVE DOTS TREATMENT SYSTEM D
0TM PATIENT ALREADY HAS A MAINTENANCE DOTS TREATMENT SYSTEM D
0VA VISIT NOT WITHIN ACCREDITATION PERIOD SYSTEM D
0VD PATIENT IS NOT A VALID DEPENDENT SYSTEM D
0ZA AGE OF PATIENT DOES NOT QUALIFY FOR Z-BENEFIT SYSTEM D
0ZC CASE Z APPLICABLE TO Z-BENEFIT CODES ONLY SYSTEM D
0ZD Z-BENEFIT NOT PRE-AUTHORIZED SYSTEM D
0ZG SEX OF PATIENT DOES NOT QUALIFY FOR Z-BENEFIT SYSTEM D
0ZH HCI IS NOT CONTRACTED WITH THE Z BENEFIT PACKAGE SYSTEM D
0ZJ Z-BENEFIT CLAIM BEFORE JUNE-21-2012 SYSTEM D
0ZL WITH PREVIOUS Z-BENEFIT CLAIM, AVAILMENT ALLOWED ONLY ONCE SYSTEM D
0ZM ILLNESS AND PROCEDURE DOES NOT MATCH WITH Z-BENEFIT CODE SELECTED SYSTEM D
0ZP WITH PREVIOUS Z-BENEFIT Z004 CLAIM SYSTEM D
0ZT NO INITIAL TRANCHE, 2ND TRANCHE NOT ALLOWED SYSTEM D
0ZU PREVIOUS TRANCHES NOT YET PAID SYSTEM D
102 DATE RECEIVED IS EARLIER THAN DATE DISCHARGED SYSTEM D
113 UNRECOGNIZED MEMBERSHIP NUMBER SYSTEM D
1ST SERVICE ALLOWED ONLY FOR TB DOTS FACILITY SYSTEM D
201 DATE ADMISSION EARLIER THAN DATE OF BIRTH SYSTEM D
2BE BENEFIT EXHAUSTED SYSTEM D
352 HOSPITAL IS UNCATEGORIZED SYSTEM D
A01 ICD CODE NOT MATCH FOR THIS CASERATE SYSTEM D
A02 RVS CODE NOT MATCH FOR THIS CASERATE SYSTEM D
A03 MISSING ICD/RVS CODE, UNABLE TO MATCH AGAINST CASERATE SYSTEM D
A04 NOT ALLOWED AS SECONDARY CASERATE SYSTEM D
A05 NOT ALLOWED FOR PRIMARY CARE FACILITY SYSTEM D
A06 NOT ALLOWED FOR LEVEL 1 FACILITY SYSTEM D
A07 NOT ALLOWED FOR LEVEL 2 FACILITY SYSTEM D
A08 NOT ALLOWED FOR LEVEL 3 FACILITY SYSTEM D
A09 NOT ALLOWED FOR AMBULATORY SURGICAL CLINIC SYSTEM D
A10 NOT ALLOWED FOR PRIMARY CARE FACILITY SYSTEM D
A11 NOT ALLOWED FOR MATERNAL CARE CLINIC SYSTEM D
A12 NOT ALLOWED FOR FREE-STANDING DIALYSIS CENTERS SYSTEM D
A13 PROVIDER CATEGORY NOT ALLOWED FOR CASE RATE SYSTEM D
A14 CASE RATE RULE REQUIRES LATERALITY SYSTEM D
A15 CASE RATE RULE ON PATIENT SEX SYSTEM D
A16 CASE RATE RULE ON PATIENT AGE SYSTEM D
ALLOWABLE NUMBER OF CLAIMS FOR THIS ILLNESS/PROCEDURE HAS BEEN REACHED SYSTEM D
A17
INPATIENT BLOOD TRANSFUSION CLAIMED AS A SECOND CASE RATE NOT FOR PAYMENT SYSTEM D
A18
A19 MEDICAL CASE RATE ADMITTED LESS THAN 24 HOURS SYSTEM D
A20 CASE RATE NOT FOUND FOR THIS ICD 10 / RVS CODE SYSTEM D
A21 ICD AND RVS CODES SHOULD NOT BE USED AT THE SAME TIME FOR A CASE RATE SYSTEM D
A22 OVERLAPPING OR MATCHING LATERALITY FOUND WITHIN THIS CLAIM SYSTEM D
ICD OF SECOND CASE RATE BELONGS TO THE SAME ACR GROUP OF FIRST CASE RATE.
SYSTEM D
A23 DENIED
A27 ADMISSION/CONFINEMENT PERIOD SHOULD BE WITHIN 24 HOURS SYSTEM D
A28 CONFINEMENT NOT ALLOWED FOR DIRECT FILING: DENIED SYSTEM D
A31 Below 19-year old delivered in PCF/Dispensaries/MCP/Lying-ins not allowed SYSTEM D
A36 Incomplete Postpartum Service SYSTEM D
A37 Incomplete essential newborn care SYSTEM D
Defect Code Defect Description Defect Type Effect
A38 Operaton/Service not allowed in this HCI SYSTEM D
A40 Services already paid SYSTEM D
A46 Confinement/Admission is less than 24 hours SYSTEM D
A49 No DOH License to conduct hemodialysis services SYSTEM D
A50 No DOH License to conduct IUD insertion services SYSTEM D
A55 MEMBER/PATIENT ALREADY DECEASED AS PER RECORD SYSTEM D
A59 HCI ACCREDITATION HAS BEEN REVOKED SYSTEM D
A62 PRE-AUTHORIZATION NUMBER IS INVALID SYSTEM D
A63 PRE-AUTHORIZATION IS NOT APPROVED SYSTEM D
A64 NO ATTACHED OR HAS PROBLEM WITH Z SATISFACTION SURVEY SYSTEM D
A65 HAS PROBLEM WITH TRANCHE CHECKLIST SYSTEM D
A66 WITH UNEXPECTED NUMBER OF SESSIONS SYSTEM D
A67 EXPECTED RVS/ICD CODE NOT FOUND IN DIAGNOSIS SYSTEM D
A70 PROCEDURE DATE NOT WITHIN THE VALIDITY OF PRE-AUTHORIZATION REQUEST SYSTEM D
NO ATTACHED OR HAS PROBLEM WITH CHECKLIST OF MANDATORY AND OTHER
SYSTEM D
A71 OBLIGATED SERVICES
A77 NOT ALLOWED FOR NON-PCB/TSEKAP PROVIDER SYSTEM D
A79 NO APPLICABLE ENTRY FOUND IN THE BENEFITS LIBRARY SYSTEM D
A81 NO APPROVED PRE-AUTHORIZATION REQUEST SYSTEM D
A82 NO REQUIRED COPY OF OPERATIVE TECHNIQUE SYSTEM D
A83 LENGTH OF STAY (LOS) REQUIREMENT NOT MET SYSTEM D
A84 PRE-AUTHORIZATION NUMBER IS ALREADY USED SYSTEM D
A85 AUTHORIZED CATARACT PROCEDURE LIMIT OF 10 PER DAY REACHED SYSTEM D
A86 HCP NOT ALLOWED TO PERFORM OPTHALMIC PROCEDURES SYSTEM D
A87 PROCEDURE IS LESS THAN 180 DAYS FROM CATARACT PROCEDURE SYSTEM D
A88 EXPECTED ICD10 CODES NOT FOUND IN DISCHARGED DIAGNOSIS SYSTEM D
A89 NO CPSA ATTACHED SYSTEM D
A90 INVALID CPSA NUMBER SYSTEM D
A91 NO IOL STICKER SYSTEM D
A92 IOL EXPIRED PRIOR TO THE PROCEDURE SYSTEM D
A93 HCP NOT ALLOWED TO PERFORM THIS PROCEDURE SYSTEM D
A94 UNDER THE SAME GROUP OF EYE REMOVAL PROCEDURES SYSTEM D
A95 IOL SERIAL NUMBER ALREADY USED SYSTEM D
HAS REACHED MAXIMUM NUMBER OF SESSIONS/CLAIMS PER SPECIFIED ICD CODE IN
SYSTEM D
A96 DIAGNOSIS
REQUIRED MINIMUM DAYS INTERVAL FROM PREVIOUS CLAIM OF THE SAME PROCEDURE
SYSTEM D
A97 NOT MET
A98 INCONSISTENT LATERALITY OF CATARACT PROCEDURE SYSTEM D
B03 PATIENT EXPIRED LESS THAN 24 HOURS CLAIMING CAP SYSTEM D
B05 AUTHORIZED CATARACT PROCEDURE LIMIT OF 50 PER MONTH REACHED SYSTEM D
B06 HCI HAS NO TRAINING CERTIFICATE FOR THIS PROCEDURE SYSTEM D
ALLOWABLE NUMBER OF CLAIMS FOR THIS ILLNES/PROCEDURE FOR A SPECIFIED PERIOD
SYSTEM D
B07 HAS BEEN REACHED
B09 NOT ALLOWED FOR GOVERNMENT HCI SYSTEM D
B10 LABORATORY NUMBER DOES NOT MATCH WITH THE PREVIOUS CLAIM(S) SYSTEM D
B11 LABORATORY NUMBER ALREADY USED SYSTEM D
B14 PBEF NUMBER NOT FOUND SYSTEM D
B15 NOT ALLOWED FOR A PCB PROVIDER SYSTEM D
B17 NOT ALLOWED FOR AN RHU SYSTEM D
B33 DEHYDRATION STATUS NOT PROVIDED OR NOT COMPENSABLE SYSTEM D
B34 PATIENT NOT REGISTERED IN PHILHEALTH DIALYSIS DATABASE SYSTEM D
B37 NO ATTACHED OR HAS PROBLEM WITH MEMBER EMPOWERMENT (ME) FORM SYSTEM D
B38 HAS PROBLEM WITH LIST OF MANDATORY REQUIREMENTS FOR ZBENEFIT SYSTEM D
B40 INITIAL TRANCHE NOT YET PAID SYSTEM D
B44 NO REFERRAL FROM GOVERNMENT HCI SYSTEM D
B49 INACTIVE MEMBER SYSTEM D
Defect Code Defect Description Defect Type Effect
B50 NON-COMPLIANT TO THE REQUIRED NUMBER OF MONTHLY CONTRIBUTIONS SYSTEM D
B51 EXPIRED VALIDITY SYSTEM D
B53 NO PRIOR CATARACT OPERATION WITH THE SAME LATERALITY SYSTEM D
EXPECTED REPETITIVE PROCEDURE NOT SELECTED IN SECTION 8: SPECIAL
SYSTEM D
B56 CONSIDERATIONS OF CF2
B58 PROCEDURE IS LESS THAN 90 DAYS FROM CATARACT PROCEDURE SYSTEM D
PROCEDURE DONE NOT WITHIN THE VALID PERIOD FROM THE DATE OF INDUCTION SYSTEM D
B71
B73 SAME PROCEDURE AND DATE WITH THE 1ST CASE RATE NOT ALLOWED SYSTEM D
B77 NBS FILTER CARD NUMBER ALREADY USED SYSTEM D
B88 NON-COMPLIANCE TO STANDARD OF CARE (SYSTEM) SYSTEM D
B96 NO ESSENTIAL NEWBORN CARE SYSTEM D
B97 NO NEWBORN SCREENING TEST SYSTEM D
B98 NO ATTACH FILTER CARD STICKER SYSTEM D
C01 NO FILTER CARD NUMBER PROVIDED SYSTEM D
C03 FILTER CARD NUMBER NOT FOUND IN THE REGISTRY SYSTEM D
C12 CLAIM SHOULD NOT BE PROCESSED IN NCLAIMS N-TIER CLIENT SYSTEM D
D12 VIOLATION OF SINGLE PERIOD POLICY SYSTEM D
D16 DIRECTLY FILED CLAIM IN AN ACCREDITED HCI: DENIED SYSTEM D
G02 FEMALE PATIENT CLAIMING PROCEDURE NOT APPLICABLE TO GENDER SYSTEM D
Z01 BENEFIT CLAIM NOT ALLOWED SYSTEM D
Z02 BENEFIT CLAIM NOT ALLOWED IF PAYABLE TO MEMBER SYSTEM D
Z06 DATE OF PRE-NATAL CHECK-UP IS NOT WITHIN 16 WEEKS AFTER LMP SYSTEM D
Z07 DATE OF ADMISSION SHOULD BE AFTER DELIVERY DATE SYSTEM D
Z08 MALE PATIENT CLAIMING FOR MATERNITY PACKAGE SYSTEM D
Z13 FOUR PRENATAL CARE DATES REQUIRED SYSTEM D
Z14 NOT ALL ENC SERVICES HAS BEEN PROVIDED SYSTEM D
Z15 INVALID OR NO NBS FILTER CARD NUMBER SYSTEM D
0LT LATERALITY FOR THE PROCEDURE REQUIRED SYSTEM P
101 DATE DISCHARGED IS EARLIER THAN DATE ADMITTED SYSTEM P
103 DATE RECEIVED IS EARLIER THAN DATE ADMITTED SYSTEM P
106 SYSTEM DATE IS EARLIER THAN DATE RECEIVED SYSTEM P
107 SYSTEM DATE IS EARLIER THAN DATE RE-FILED SYSTEM P
10A NO PATIENT'S AGE REPORTED SYSTEM P
111 DATE RE-FILED IS EARLIER THAN DATE DISCHARGED SYSTEM P
112 DATE RE-FILED IS EARLIER THAN DATE RECEIVED SYSTEM P
1EM NO EMPLOYER SUPPLIED SYSTEM P
1LT INVALID LATERALITY FOR THE PROCEDURE SYSTEM P
1MC MEMBERSHIP INFO MISSING - PIN WAS CLEANED UP SYSTEM P
1NM MEMBER IS NOT YET A NON-PAYING MEMBER AS PER MEMBERSHIP RECORD SYSTEM P
1NP NO PHILHEALTH IDENTIFICATION NUMBER SYSTEM P
1OC NO PHYSICAL CLAIM YET SUBMITTED SYSTEM P
1OD OPERATION DATE NOT SPECIFIED SYSTEM P
1RV INVALID RVS CODE LENGTH SHOULD BE 5 OR 6 SYSTEM P
1UD UNPOSTED DEPENDENT IN MEMBERSHIP DATABASE SYSTEM P
1VD VISIT DATE NOT SPECIFIED SYSTEM P
212 OVERLAPPING CONFINEMENT SYSTEM P
351 MEDICAL CASE NOT DEFINED SYSTEM P
3VD PLEASE UPDATE THE DEPENDENTS PROFILE IF DOCUMENTS ARE AVAILABLE SYSTEM P
A24 TIME OF ADMISSION AND/OR DISCHARGE NOT SPECIFIED SYSTEM P
A26 ALLOWED ONLY FOR EXPIRED PATIENT SYSTEM P
RVS 59401 no longer applicable after November 15, 2014. Reflect the new code applicable
SYSTEM P
A30 to the claim.
RVS/ICD code is not applicable for this claim. Reflect the applicable RVS/ICD code. SYSTEM P
A34
Defect Code Defect Description Defect Type Effect
RVS 59400 no longer applicable after November 15, 2014. Reflect the new code applicable
SYSTEM P
A35 to the claim.
A41 No last menstrual period provided SYSTEM P
A42 No date of procedure provided SYSTEM P
A43 RVS/ICD code not found in discharge diagnoses SYSTEM P
A44 Date of procedure not between admission and discharge dates SYSTEM P
A45 Invalid prenatal consultation date(s) SYSTEM P
A68 OVERLAPPING TRANCHES SYSTEM P
A72 PROCEDURE NOT DONE WITHIN THE TARGET YEAR SYSTEM P
B08 MISSING/INVALID LABORATORY NUMBER SYSTEM P
SUBMIT PROPERLY ACCOMPLISHED STATEMENT OF ACCOUNT IN ACCORDANCE TO PC 2016-
SYSTEM P
B18 0005
SIGNATURE OF MEMBER/PATIENT/AUTHORIZED REPRESENTATIVE IS REQUIRED IN THE
SYSTEM P
B31 CONSENT TO ACCESS PATIENT RECORD
B36 SUBMIT PROPERLY ACCOMPLISHED VALID CLAIM SIGNATURE FORM SYSTEM P
B42 FAILED THE MEMBERSHIP DATA VALIDATION CHECK SYSTEM P
B43 FAILED THE DEPENDENT DATA VALIDATION CHECK SYSTEM P
B80 NO ATTACHED CHECKLIST OF MANDATORY AND OTHER SERVICES SYSTEM P
B81 NO ATTACHED DETOXIFICATION TREATMENT PLAN SYSTEM P
NO ATTACHED PHOTOCOPY OF COMPLETELY ACCOMPLISHED SATISFACTION
SYSTEM P
B82 QUESTIONNAIRE
B83 NO ATTACHED CHECKLIST OF REQUIREMENT FOR REIMBURSEMENT SYSTEM P
B93 ADDITIONAL REQUIREMENTS TO CF4 NOT ATTACHED TO THE CLAIM (SYSTEM) SYSTEM P
B94 NO ELECTRONIC CF4 DATA ATTACHED TO THE CLAIM (SYSTEM) SYSTEM P
B99 INCONSISTENT FILTER CARD NUMBER INCORRECT FILTER CARD SYSTEM P
C13 SYSTEM ENHANCEMENT ON-GOING SYSTEM P
R02 SESSION DATES HAVE NOT BEEN PROVIDED SYSTEM P
Z03 INITIAL PRENATAL CONSULTATION DATE IS REQUIRED SYSTEM P
Z04 LAST MENSTRUAL PERIOD (LMP) IS REQUIRED SYSTEM P
Z05 DELIVERY DATE IS REQUIRED SYSTEM P