REFVAL HLDDSC EOPCOD TYPCOD

12 AUTHORIZATION OR REFERRAL REQ. 12 E

13 SERVICE NOT COVERED BY BENEFIT 13 E
02 CLAIM OUTSIDE MEMBER EFFECTIVE 02 E
I1 GROUPER BENEFIT NOT FOUND E
05 SEX INVALID FOR SERVICE 05 E
I5 SERVICE INVALID FOR PROVIDER I5 E
03 AGE INVALID FOR BENEFIT 03 E
I6 OTHER INS. WITH NO INS ON CLM I6 E
I9 OUTSIDE CLAIM RECEIPT PERIOD I9 E
IQ SERVICE INCLUDED IN PRICER E
I4 SERVICE AFTER PCP EXPIRATION E
23 CLAIM SERVICE REVERSAL 002 E
ZZ CLAIM OUTSIDE FUTURE PERIOD E
24 AGE INVALID FOR DIAGNOSIS 24 E
25 BENEFIT NOT COVERED E
48 INVALID SERVICE CODE 48 E
II USER CLAIM LIMIT EXCEEDED E
G4 CALC. SET NOT COMMITED E
G5 U&C PERCENTILE NOT FOUND E
G8 AUTHORIZED DAYS EXCEEDED E
19 NO ALLOWABLE CHARGE FOR SERVIC 19 E
20 SEX INVALID FOR DIAGNOSIS 20 E
21 SERVICE BEFORE/AFTER GR EFFECT 21 E
Z8 CALC SERVICE AMNT IS NEGATIV E
22 NO RVS RECORD FOUND FOR PROCED E
ID SERVICE AFTER TERMINATION DATE ID E
G1 NO CALC SET FOUND FOR SERVICE E
G2 COVERAGE LIMIT REACHED BY PREP E
G3 U&C AMOUNT NOT FOUND E
G7 AUTHORIZED DAYS REACHED E
G9 DAYS APPROVED OVER LIMIT E
01 EXCT DUP:& 01 E
AO RECOVERED TRANSFERS IN A NON-E AO E
A1 MEMBER INACTIVE E
MC COVERED BY MEDICARE PART-A MC E
B6 SERVICE BY CAPITATION E
B3 PROVIDER INACTIVE E
A3 SERVICE PAST WAITING PERIOD E
BD BENEFIT NOT COVERED FOR DEP. BD E
B2 BENEFIT NOT FOUND OR NOT DENTA E
#R APPROPRIATE HEALTH CARE PRACTI NA E
BI SVC FEE/COPAY SCHEDULE NOT FD E
A4 MEMBER VENDOR NOT VALID E
A7 DENTAL LOCATION TYPE INCORRECT E
A8 CHANGED PLACE OF SERVICE E
A9 NO PROVIDER CONTRACT FOR SVCDT E
B1 PROVIDER VENDOR NOT VALID E
77 SVC CNT EXCEED FOR MEM/LOC/PER E
78 SVC CNT EXCEED FOR MEM/TTH/PER E
90 SUPERFICIES ENVUELTAS(DENTAL) E
5* COSMETIC PROCEDURE 5* E
6* INCIDENTAL PROCEDURE 6* E
B* EXPERIMENTAL PROCEDURE B* E
C* MEDICAL VISIT PROCEDURE C* E
E* POST OPERATIVE PROCEDURE E* E
F* MUTUALLY EXCLUSIVE PROCEDURE F* E
J* PROC.MAY NOT REQUIRED ASSISTAN J* E
K* ASSISTANT SURGEON DENIED K* E
N* PROCEDURE INVALID FOR MALE N* E
Q* PROC.INDIC.FOR AGE 12-55 YEAR Q* E
NC OUTOFNETWORK SERVICES NOT COV. NP E
EX EXCLUSION & SERV. NOT COVERED EX E
IP SERV. INCLUDED IN CONTRACT FEE IP E
HT DEBE FACTURAR CON MOD. TC 07 E
Z2 PAGAR CON MODIF. 26 E
PN PRE-AUTHORIZATION NOT FOUND PN E
60 REFERED TO PROVIDER SERVICES E
49 NOT A 2006 OR/AND 2007 CPT/HCP 49 E
OS CHG PART OF OTHER CONT. SERV, OS E
AP ALTERNATE PROCED CODE INFORMED AP E
42 LOSS DUE TO JOB RELATED INJURY 42 E
M1 CASO SIN AUDITORIA MEDICA M1 E
U1 DOES NOT MEET HOSP.REQUIREMENT U1 E
07 SERVICE INVALID FOR PROVIDER 07 E
NA REVISADO/DECLINADO POR CLINICO NA E
GB PROCEDURE NOT IN FEE SCHEDULE GB E
50 INVALID PLACE OF SERVICE 50 E
93 INCORRECT SOCIAL SECURITY # 93 E
MR MANAGED CARE REVISION E
NS NO PROV.CONTRACT FOR SERV.DATE NS E
27 COVERED BY AUTO INSURANCE E
MH SUBMIT TO MENTAL HEALTH ADMINI MH E
R1 LINE COPIED TO NEW LINE E
I2 STEPDOWN BENEFIT NOT FOUND E
51 INVALID HCPSC PROCEDURE CODE 51 E
IC IPA INVALID, REFERID REQUIRED IC E
BP SERVICE CODE / POS INVALID BP E
36 DETALLE DE LOS SERVICIOS BRIND 36 E
F3 CASE DENIED AND / OR EXPIRED F3 E
MO USE MODIFIERS FOR PROD AND INT MO E
57 SOLICITUD DE DIAGNOSTICO 57 E
70 NOT A CONTRACTED SERVICE / PRO 70 E
Y5 LIMIT OF 45 DAYS FOR RESUBMISS Y5 E
R5 MEMBER WAS NOT REPORTED BB E
R7 SERVICE CODE WAS NOT REPORTED BB E
R8 DIAGNOSTIC COD WAS NOT REPORTE DB E
R9 PLACE OF SERVICE WAS NOT REPOR PB E
S0 PROVIDER WAS NOT REPORTED BB E
S1 INVALID DIAGNOSTIC CODE DI E
S2 INVALID MEMBER NUMBER XX E
S4 INVALID SERVICE CODE XX E
S6 INVALID PLACE OF SERVICE PA E
S8 LIMIT OF 45 DAYS FOR RESUMISSI S8 E
S9 INVALID PROVIDER NUMBER XX E
9Z SUBMIT REPORT OR INVOICE 61 E
LG INVALID MODIFIER CODE FOR PROC L* E
RW SERV.NOT PRESENTED FOR UTILIZA RW E
AI NO PRECERT / NO BENEFIT 12 E
MN MD.NECESS.HAS NOT BEEN ESTABLI MN E
WP WAITING PERIOD WN E
CG CONGENITAL CONDITIONS WN E
EL SURGERY WITHIN PERIOD WN E
LH INVALID MODIFIER COMBINATION LH E
IF OUT-OF-POCKET MAXIMUM EXCEEDED E
IE OUT-OF-POCKET MAXIMUM REACHED E
H9 NOT A CPT/HCPCS CODES FOR THE H9 E
@1 VISION NA E
@2 DENTAL SERVICES NA E
@3 RENTAL PAYMENTS MAXIMUM NA E
@4 NON MEDICARE APPROVED DRUGS OR NA E
@5 AMBULANCE NA E
@6 INPATIENT PSYCHIATRIC CARE NA E
@7 INPATIENT PSYCH NA E
@8 NO COVERAGE NA E
@9 NON-FORMULARY DRUGS NA E
@A SPECIALTY SERVICE NA E
#A DME - 02 NA E
#B DME SPECIAL FEATURES NA E
#C DME TENS UNIT NA E
#D HEARING AIDS NA E
#E HOME HEALTH DOES NOT MEET SKIL NA E
#F HOME HEALTH MEMBER NOT HOMEBOU NA E
#G HOME HEALTH DOES NOT MEET INTE NA E
#H HOME HEALTH EXTENDED TREATMENT NA E
#I HOME HEALTH AID SERVICES ARE P NA E
#J HOME HEALTH AID(NO COVERED SKI NA E
#K PERSONAL COMFORT ITEM NA E
#L PT EXTENDED TREATMENTS NA E
#M ROUTINE FOOT CARE NA E
#N SSO NA E
#O SERVICE OUT OF PLAN NA E
#P SHOE ORTHOTICS NA E
#Q APPROPRIATE SETTING NA E
#T ADMISSION DENIAL NA E
#U GENERAL NON-SKILLED CARE NA E
#W CHANGE IN LEVEL OF CARE NA E
#X DISCONTINUING DAILY REABILITAT NA E
#Y TEACHING AND TRAINING PROGRAM NA E
#Z EXHAUSTION OF 100 SNF DAYS NA E
#1 INSUFFICIENT MEDICAL INFORMATI NA E
#2 NO MEDICALLY NECESSITY NA E
#3 COSMETIC NA E
#4 INVESTIGATIONAL NA E
#5 MULTIPLE VISITS. PT OR HOME HE NA E
#6 AMBULANCE TRANSPORT TO DR OFFI NA E
#7 CHIROPRACTIC CARE DOES NOT MEE NA E
#8 DME DOES NOT MEET MEDICARE DEF NA E
#9 DME - NO MEDICAL USE NA E
RS PHARMACY COVERED RS E
T9 RECOVERY OF SERV PAID MULT TIM T9 E
SD SETTLEMENT - DENIAL SD E
A2 SERVICE CODE NOT EFF FOR DATE DS E
FE DIAG.CODE NOT EFF FOR DATE FE E
Q1 CRITERIA NOT MET/ADD-ON CODE Q1 E
Q2 ASSISTANT SURGEON DISALLOW Q2 E
Q3 MULTIPLE COMPONENT BILLING Q3 E
Q4 SERV/PROC INCLUDED IN SURGERY Q4 E
Q5 ONLY 1 E/M ALLOWABLE PER DATE Q5 E
Q6 REBUNDLED TO FIRST PROCEDURE Q6 E
Q7 DUPLICATE PROCEDURE Q7 E
Q8 NEW PT CODE FILED WITHIN 3 YRS Q8 E
U4 PROC.CODE INC.LABORATORY PANEL U4 E
U5 PROCEDURE CODE INCL.IN 0722 U5 E
U6 MA-10 DENEGADA U6 E
U7 REC.POR COORDINACION BENEFICIO U7 E
OE ONLY ONE E/M BE REPORTED PER D OE E
Q0 PROC.DESC.INV.FOR GENDER/AGE Q0 E
Y6 DENEGADO POR MANEJO DE CASO Y6 E
Y8 INCORRECT STERILIZATION CODE Y8 E
CK ASEGURADO CON MEDICARE PLATINO CJ E
LR COMPLI.PAQUETE CARDIOVASCULAR LR E
EH NO COVERAGE ESRD AFTER 90 DAYS EH E
SJ POST CARD.SURGERY COPLICATION SJ E
#0 PAGO CORRESPONDE A LA IPA E
Q9 DX CODE DOES NOT VALIDATE MEDI Q9 E
3Q CODE CLASSIFIED AS NOT PAYABLE 3Q E
6C SOMETER REP O DOCUMENTO APOYO 6C E
PY NPI REQUIRED PY E
PJ INDIVIDUAL RENDERING NPI REQUI PJ E
M9 MED NECESSITY DOCUMENT REQ M9 E
MY AMBULANCE MED NEC NOT MET MY E
OU OUT SIDE US CLAIM RECEIPT PERI OU E
B0 REFERRAL REQUIRED, NOT FOUND B0 E
97 CHRA INCOMPLETO 97 E
CY INCORRECT CODING CY E
XQ INV DX CODE REQ 4TH OR 5TH DIG XQ E
TE EXCEEDS TIMELY FILING PERIOD TE E
|F MEDICARE FEE NOT SPECIFIED E
|B BUNDLED SERVICE-NO ADDTL PYMT |B E
|X STATUTORY EXCLUSION (MEDICARE) |X E
$Z EXCLUDED UNDER NEW TECHNOLOGY $Z E
REFVAL HLDDSC EOPCOD TYPCOD
AA DENY/VERTICAL DIMENSION/AUTH LF E
AE REQUEST PERIODONTIC CHART (DN) LF E
AH DUPLICATE DENTAL CLAIM 01 E
AI NO PRE-CERT/NO BENEFIT 12 E
AM GROUPER BENEFIT NOT FOUND E
AP ALTERNATE PROCED CODE INFORMED AP E
AQ CONTROL TOTS DO NOT MATCH CLM E
AU AUTHORIZED AMOUNT EXCEEDED 06 E
AV SERVICE AFTER PCP EXPIRATION E
A1 MEMBER INACTIVE E
A2 SERVICE CODE NOT EFF FOR DATE DS E
A3 SERVICE PAST WAITING PERIOD E
A4 MEMBER VENDOR NOT VALID E
A5 PROVIDER SPEC INVALID FOR SERV E
A7 DENTAL LOCATION TYPE INCORRECT E
A8 CHANGED PLACE OF SERVICE E
A9 NO PROVIDER CONTRACT FOR SVCDT E
B* EXPERIMENTAL PROCEDURE B* E
BA DENY/CORRECTION OCCLUSION/AUTH LF E
BH CALC. SERVICE AMNT IS NEGATIVE E
BI SVC FEE/COPAY SCHEDULE NOT FD E
BK SERVICE AFTER TERMINATION DATE E
B1 PROVIDER VENDOR NOT VALID E
B2 BENEFIT NOT FOUND OR NOT DENTA E
B3 PROVIDER INACTIVE E
B5 FACTURAS O RECIBOS ORIGINALES LF E
B6 SERVICE BY CAPITATION E
C* MEDICAL VISIT PROCEDURE C* E
CA DENY/DENTAL COSMETIC/AUTH LF E
CB DENY/DENTAL COSMETIC/CLAIM LF E
CC PENDING COB CALCULATION E
CD CONSIDERED UNDER DENTAL COVERA CD E
CE PRE-DETERMINACION DENTAL 1J E
CF SOLICITUD AUTORIZACION DE PAGO LF E
CP COPAY/DEDUCTIBLE NOT COVERED CP E
CS COSME.SURG.NOT COVERED(MEMBER) 52 E
C4 SOL.#DE PIEZA/SUPERFICIE (DN) LF E
C5 COPIA DEL RECORD DEL PAC.(DN) LF E
C8 SOL.RADIOG.AREA SUPE/INFER(DN) LF E
DA DENY/ TMJ /AUTH LF E
DL SOLC.PROTESIS INICIAL REEMPLAZ E
DO DENTAL COVERAGE ONLY DO E
DP NO MATERNITY COVERAGE DEP.(MEM LF E
DT DETENTION COVERED ONLY ICU/CCU DT E
DZ NO DENTAL COVERAGE LF E
D2 SOL. RADIOG.AREA AFECTADA(DN) LF E
D3 DENTAL REPORT (DENTAL) LF E
E* POST OPERATIVE PROCEDURE E* E
EA DENY/ ADDITIONAL DENTURES/AUTH LF E
ED E.R. INCLUDED IN PER DIEM ED E
ET REFERIDO ELECTRONIC CLAIM E
F* MUTUALLY EXCLUSIVE PROCEDURE F* E
FA DENY/SERV STRT PRIOR EFF DT/AU LF E
FM SERV RENDERED BY FAM MEMB N/C FM E
FR REFERIDO ****FELIX RIVERA***** E
F9 COPAYMENT IS MORE THAN CHARGE F9 E
GA PROCEDURE REFERRED TO MED CONS E
GB PROCEDURE NOT IN MCS FEE SCHD GB E
GC PROCEDURE REFERRD TO COMMITTEE E
HA DENY/REPLACE TH LOST <FF DT/AU LF E
HB DENY/REPLACE TH LOST <FF DT/CL LF E
HS ADM. DECLINED INSUFF. INFORM. HS E
ID SERVICE AFTER TERMINATION DATE E
IE OUT-OF-POCKET MAXIMUM REACHED E
IF OUT-OF-POCKET MAXIMUM EXCEEDED E
II USER CLAIM LIMIT EXCEEDED E
IJ NO PAID-THU DATE AN ACCOUNT E
IP THIS SRVC PART OF PER DIEM IP E
IQ SERVICE INCLUDED IN PRICER E
I1 GROUPER BENEFIT NOT FOUND E
I2 STEPDOWN BENEFIT NOT FOUND E
I3 CONTROL TOTALS DO NOT MATCH E
I4 SERVICE AFTER PCP EXPIRATION E
I5 SERVICE INVALID FOR PRV/VENDOR 07 E
I6 OTHER INS. WITH NO INS ON CLM I6 E
I7 EXCESSIVE CHARGE AMOUNT E
I9 OUTSIDE CLAIM RECEIPT PERIOD I9 E
J* PROC.MAY NOT REQUIRED ASSISTAN J* E
JA DENY/SUBST LOST PROST./AUTH LF E
JB DENY/REPLACE LOST PROST/CLM LF E
JC DENY/PANORAMIC X-RAY/CLM LF E
JO SOL.FECHA DE EXTRACION (DN) LF E
J1 CARGOS POR SERV. BRINDADOS LF E
K* ASSISTANT SURGEON DENIED K* E
KA DUPLICATE OR OVERLAPPING AUTH. E
KB INVALID REFERRING PHYSICIAN E
KC AGE INVALID FOR SERVICE E
KD SEX INVALID FOR SERVICE E
KE AGE INVALID FOR DIAGNOSIS E
KF SEX INVALID FOR DIAGNOSIS E
KG "TO" PROVIDER INVALID CONTRACT E
KH "FROM"PROVIDER INVALID CONTRCT E
LM LIMITED TO ONE PER MONTH LM E
MA NO MAJOR MEDICAL BENEFIT FOUND MA E
MC NO MEDICAL COVERAGE LF E
MN MD.NECESS.HAS NOT BEEN ESTABLI MN E
MO USE MODIFIERS FOR PROD AND INT MO E
MR MANAGED CARE REVISION E
M1 CASO SIN AUDITORIA MEDICA M1 E
NC NO COORDINATION APPLIES E
NE NOT ELIGIBLE/NOT REGISTERED E
NH MESES DE TRATAMIENTO(ORTODON) LF E
NI SOL.FACTURAS ORIGINALES DENTAL LF E
NL NOMB.FECHA NAC.PACIENTE(DENTAL LF E
NN EMPLOYEE EXCEEDS AGE LIMIT E
NR FOTOS PRE-OPER.Y/O RADIOGR(DNT LF E
NZ RECIB.OFC.(NOMB.DIR.Y ESP)(DN) LF E
N2 SOL.DETALLE ACCIDENTE (DENTAL) LF E
N3 SOL.MODELOS DE ESTUDIO(DENTAL) LF E
N4 SOL.EXP.PLAN PRIMARIO(DENTAL) LF E
N6 SOL.DESGLOSE SEVICIOS (DEN) LF E
N7 PLACA PANORAMICA (DENTAL) LF E
N8 TIPO MALOCLUCION (ORTODONCIA) LF E
N9 PAGO INICIAL (ORTODONCIA) LF E
OC ORTHO FOR DEPENDENT CHILD ONLY E
OD SOLICITUD ORDEN MEDICA LF E
OJ ONLY FOR J&J PHARMACEUTHICAL E
OL ORTHO.LIFETIME MAX EXCEEDED E
OM ORTHODONTIA MAXIMUM EXCEEDED OM E
OS CHG PART OF OTHER CONT. SERV, OS E
OT NO ORTHO COVERAGE OT E
PD PANORAMIC NOT COVERED PD E
PE PEND. ELEGIBILIDAD U.P.R. E
PI INCIDENTAL PROCEDURE NOT COVER E
PL ONE PARIAPICAL/YEAR COVERED PL E
PR PRIVATE ROOM IS NOT COVERED PR E
P2 NON PARTICIPATING PROVIDER P2 E
Q* PROC.INDIC.FOR AGE 12-55 YEAR Q* E
RA REF FROM EAP MANAGER REQUIRED E
RH REFER TO HEALTH SOUTH DRS.HOSP RH E
RN REFERRAL FROM PCP REQUIRED RN E
RQ REFERRAL SOLUTIONS/EAP MAN.REQ RQ E
RR REQUEST FR REPORT & X-RAYS E
RT LIMITED TO A MAX. OF 2 RESP.TE RT E
R1 SOL.RECIBOS OFICIALES LF E
SH HOSPITAL BENEFITS ONLY E
SM SERV.IN MOVILE UNITS NOT COVER SM E
SN ASSISTANT SURGEON NOT COVERED E
SU SLF INFLICTED INJURIES NOT COV E
S3 ONLY COVERAGE UNDER EAP PROG. PS E
U1 DOES NOT MEET HOSP.REQUIREMENT U1 E
U3 DOES NOT MEET DENTAL REQUIREME U3 E
VC USE OTHER DIAGNOSTIC CODE E
X5 SOLICITUD REPORTE DE CONSULTA CR E
YF GROUP NOT COVERED FOR SVC DATE E
YN TOOTH NUMBER REQUIRED (DN) LF E
Y2 COVERED BY OTHER INSURANCE 15 E
Y3 SURFACE CODE INVALID FOR SERVI E
ZZ CLAIM OUTSIDE FUTURE PERIOD E
Z1 NO DEPENDENT DENTAL COVERAGE 54A E
Z2 PAGAR CON MOD.26 (X-RAY) E
Z8 CALC. SERVICE AMNT IS NEGATIVE E
01 EXCT DUP:& 01 E
02 CLAIM OUTSIDE MEMBER EFFECTIVE 02 E
03 AGE INVALID FOR BENEFIT 03 E
05 SEX INVALID FOR SERVICE 05 E
07 SERVICE INVALID FOR PROVIDER 07 E
09 SEX INVALID FOR BENEFIT 09 E
1D FORMA DEBIDAMENTE CUMPL.(DENTA LF E
1J PRE-DETERMINACION DENTAL 1J E
1N ERROR REFRACCION 1N E
1P ORTODONTIC DETERMINATION E
1Q ORTODONTIC DETERMINATION E
12 AUTHORIZATION OR REFERRAL REQ. 12 E
13 SERVICE NOT COVERED BY BENEFIT 13 E
2E C-GENERICA DEN-ORTODONCIA E
2G DEN-NO CUB-TRAT-ORTODONCIA LF E
2K NO CUB-REEMP.O PERDIDA PROTESI LF E
20 SEX INVALID FOR DIAGNOSIS 20 E
21 SERVICE BEFORE/AFTER GR EFFECT 21 E
22 NO RVS RECORD FOUND FOR PROCED E
23 CLAIM SERVICE REVERSAL 002 E
24 AGE INVALID FOR DIAGNOSIS 24 E
25 BENEFIT NOT COVERED E
27 COVERED BY AUTO INSURANCE 27 E
29 ROUTINE NOT COVERED 29 E
3R DECLINED FOR INSUFF.INFORMATIO 3R E
30 NO SERVICE CHARGE FOUND(DENTAL 30 E
33 PERSONAL ITEMS NOT COVERED 33 E
35 NON-PRESCRIPTION DRUGS NOT COV 35 E
36 DETALLE DE LOS SERVICIOS BRIND 36 E
38 TESTS & OR PROCED UNRELATED NO 38 E
4B NO CUBIERTA FARMACIA (REMBOLSO LF E
4C NO CUB-VISION (MEM-REMBOLSO) LF E
4D NO CUBIERTA ACC. TRAB-REMBOLSO LF E
4E NO CUB-CIRUG-COSMETICA REMBOL LF E
4F NO CUBIERTA DE MATERNIDAD DEP LF E
4H NO CUBIERTA MEDICA (REMBOLSO) LF E
40 PRE-EXISTING CONDITION NOT-COV 40 E
41 IN EXCESS OF PRE-EXISTING LIMI 41 E
42 LOSS DUE TO JOB RELATED INJURY 42 E
43 REQ.PATHOLOGY REPORT E
45 PRESCRIPTION# REQUIRED/& NAME 45 E
46 DEPENDENT NOT A FULL TIME STUD 46 E
47 NOT AN ELIGIBLE DEPENDENT 47 E
48 NO FEE SCHEDULE FOUND E
49 NOT A 2006 OR/AND 2007 CPT/HCP 49 E
5* COSMETIC PROCEDURE 5* E
52 COSMETIC SURGERY NOT COVERED 52 E
53 NO VISION COVERAGE 53 E
54 NO DENTAL COVERAGE 54 E
55 NO PHARMACY COVERAGE 55 E
57 SOLICITUD DIAGNOSTICO 57 E
6* INCIDENTAL PROCEDURE 6* E
6E OUTSIDE MEMBER PERIOD E
6I INFORMATION RESQ.FROM PROVIDER E
6S INVALID SOCIAL SECURITY NUMBER E
6T COVERED AFTER 6 THERAPIES ONLY 6T E
60 REFERED TO PROVIDER SERVICES E
62 REVIEW INFO FOR CORRECT # S1 E
63 DEPENDENT NOF/REFERRED TO REC. E
67 REQ.SURGICAL REPORT E
68 REQ.SURG.,PATOL.,ANEST.REPORT E
69 REQ.PROGRESSIVE NOTES E
7G BEN.EN PROCESO DE REVISION E
7J REF.EJECUT.DE CUENTAS E
70 NOT A CONTRACTED SERVICE / PRO 70 E
73 CUADRANTE Y/O DIENTE ENVUELTO LF E
77 SVC CNT EXCEED FOR MEM/LOC/PER E
78 SVC CNT EXCEED FOR MEM/TTH/PER E
79 SVC INVALID AFTER PREVIOUS SVC E
82 SERVICE COVERED BY OTHER PROC E
90 SUPERFICIES ENVUELTAS(DENTAL) LF E
G1 NO CALC.SET FOUND FOR SEVICE E
G2 COVERAGE LIMIT REACHED BY PREP E
G3 U&C AMOUND NOT FOUND E
G4 CALC. SET NOT COMMITED E
G5 U&C PERCENTILE NOT FOUND E
MS STUDENT CERTIFICATION E
SO REFERRAL SOLUTIONS PROGRAM SO E
BX REEMP.PROTESIS MENOS DE 5 ANOS E
HT DEBE FACTURAR CON MOD. TC 07 E
OE ONLY ONE E/M BE REPORTED PER D OE E
NM OUT OF REGION/NO MATERNITY BEN NM E
TR SERVICES RELATED TO TRANSPLANT TR E
PF PROC. PEND. PAYMENT TO FOLLOW PF E
G7 AUTHORIZED DAYS REACHED E
G8 AUTHORIZED DAYS EXCEEDED E
G9 DAYS APPROVED OVER LIMIT E
NA REVISADO/DECLINADO POR CLINICO NA E
V9 BENEFIT LIMITED BY RELATIONSHI E
W2 RETROACTIVE ENROLLMENT CHANGE E
SV SERV.INCLUDED IN OFFICE VISIT SV E
EN EXCLUSION & SERV. NOT COVERED E
BP BEN.AND/OR PS SERVICE INVALIDO BP E
F3 CASE DENIED AND / OR EXPIRED F3 E
Y5 LIMIT OF 45 DAYS FOR RESUBMISS Y5 E
R5 MEMBER WAS NOT REPORTED BB E
R7 SERVICE CODE WAS NOT REPORTED BB E
R8 DIAGNOSTIC COD WAS NOT REPORTE DB E
R9 PLACE OF SERVICE WAS NOT REPOR PB E
S0 PROVIDER WAS NOT REPORTED BB E
S1 INVALID DIAGNOSTIC CODE DI E
S2 INVALID MEMBER NUMBER XX E
S4 INVALID SERVICE CODE XX E
S6 INVALID PLACE OF SERVICE PA E
S8 LIMIT OF 45 DAYS FOR RESUMISSI S8 E
S9 INVALID PROVIDER NUMBER XX E
9Z SUBMIT REPORT OR INVOICE 61 E
LG INVALID MODIFIER CODE FOR PROC L* E
RW SERV.NOT PRESENTED FOR UTILIZA RW E
LH INVALID MODIFIER COMBINATION LH E
H9 NOT A CPT/HCPCS CODES FOR THE H9 E
#1 INSUFFICIENT MEDICAL INFORMATI NA E
#2 NO MEDICALLY NECESSITY NA E
#3 COSMETIC NA E
#4 INVESTIGATIONAL NA E
#5 MULTIPLE VISITS. PT OR HOME HE NA E
#6 AMBULANCE TRANSPORT TO DR OFFI NA E
#7 CHIROPRACTIC CARE DOES NOT MEE NA E
#8 DME DOES NOT MEET MEDICARE DEF NA E
#9 DME - NO MEDICAL USE NA E
#A DME - 02 NA E
#B DME SPECIAL FEATURES NA E
#C DME TENS UNIT NA E
#D HEARING AIDS NA E
#E HOME HEALTH DOES NOT MEET SKIL NA E
#F HOME HEALTH MEMBER NOT HOMEBOU NA E
#G HOME HEALTH DOES NOT MEET INTE NA E
#H HOME HEALTH EXTENDED TREATMENT NA E
#I HOME HEALTH AID SERVICES ARE P NA E
#J HOME HEALTH AID(NO COVERED SKI NA E
#K PERSONAL COMFORT ITEM NA E
#L PT EXTENDED TREATMENTS NA E
#M ROUTINE FOOT CARE NA E
#N SSO NA E
#O SERVICE OUT OF PLAN NA E
#P SHOE ORTHOTICS NA E
#Q APPROPRIATE SETTING NA E
#R APPROPRIATE HEALTH CARE PRACTI NA E
#T ADMISSION DENIAL NA E
#U GENERAL NON-SKILLED CARE NA E
#W CHANGE IN LEVEL OF CARE NA E
#X DISCONTINUING DAILY REABILITAT NA E
#Y TEACHING AND TRAINING PROGRAM NA E
#Z EXHAUSTION OF 100 SNF DAYS NA E
@1 VISION NA E
@2 DENTAL SERVICES NA E
@3 RENTAL PAYMENTS MAXIMUM NA E
@4 NON MEDICARE APPROVED DRUGS OR NA E
@5 AMBULANCE NA E
@6 INPATIENT PSYCHIATRIC CARE NA E
@7 INPATIENT PSYCH NA E
@8 NO COVERAGE NA E
@9 NON-FORMULARY DRUGS NA E
@A SPECIALTY SERVICE NA E
T9 RECOVERY OF SERV PAID MULT TIM T9 E
SD SETTLEMENT - DENIAL SD E
FE DIAG.CODE NOT EFF FOR DATE FE E
MV USE MODIFIERS FOR BILLING MV E
Q1 CRITERIA NOT MET/ADD-ON CODE Q1 E
Q2 ASSISTANT SURGEON DISALLOW Q2 E
Q3 MULTIPLE COMPONENT BILLING Q3 E
Q4 SERV/PROC INCLUDED IN SURGERY Q4 E
Q5 ONLY 1 E/M ALLOWABLE PER DATE Q5 E
Q6 REBUNDLED TO FIRST PROCEDURE Q6 E
Q7 DUPLICATE PROCEDURE Q7 E
Q8 NEW PT CODE FILED WITHIN 3 YRS Q8 E
U4 PROC.CODE INC.LABORATORY PANEL U4 E
U5 PROCEDURE CODE INCL.IN 0722 U5 E
U6 MA-10 DENEGADA U6 E
U7 REC.POR COORDINACION BENEFICIO U7 E
Q0 PROC.DESC.INV.FOR GENDER/AGE Q0 E
Y6 DENEGADO POR MANEJO DE CASO Y6 E
Y8 INCORRECT STERILIZATION CODE Y8 E
LR COMPLI.PAQUETE CARDIOVASCULAR LR E
EH NO COVERAGE ESRD AFTER 90 DAYS EH E
SJ POST CARD.SURGERY COMPLICATION SJ E
Q9 DX CODE DOES NOT VALIDATE MEDI Q9 E
3Q CODE CLASSIFIED AS NOT PAYABLE 3Q E
6C SOMETER REP O DOCUMENTO APOYO 6C E
PY NPI REQUIRED PY E
$N SERVICE NOT COVERED E
PJ INDIVIDUAL RENDERING NPI REQUI PJ E
M9 MED NECESSITY DOCUMENT REQ M9 E
MY AMBULANCE MED NEC NOT MET MY E
OU OUT SIDE US CLAIM RECEIPT PERI OU E
B0 REFERRAL REQUIRED, NOT FOUND B0 E
97 CHRA INCOMPLETO 97 E
CY INCORRECT CODING CY E
XQ INV DX CODE REQ 4TH OR 5TH DIG XQ E
TE EXCEEDS TIMELY FILING PERIOD TE E
$Z EXCLUDED UNDER NEW TECHNOLOGY $Z E
REFVAL HLDDSC EOPCOD TYPCOD
LF FEE INCLUDE LENS & FRAMES W
BP SERVICE CODE / POS INVALID BP E
*C CANCER-REGISTRY W
A* UNDEFINED PROCEDURE A* W
AA DENY/VERTICAL DIMENSION/AUTH AA E
AB ***DENY/VERTICAL DIMENSION/CL W
AC ADJUSTMENT CLAIM AC W
AD SOL.DETALLE ACCIDENTE AD W
AE REQUEST PERIODONTIC CHART (DN) AE E
AF THE PERDIEM IN EFFECT AT TIME AF W
AG VER SIBEL PARA INFO. BENEFICIO W
AI NO PRECERT / NO BENEFIT 12 E
AL DRG & ALCH NOT COV EFF 6/1/93 E
AM COVERED UP TO $15,000 PER CASE W
AO RECOVERED TRANSFERS IN A NON-E AO W
AP ALTERNATE PROCED CODE INFORMED AP E
AR CLAIM AUDITED W
AS PROVIDER AUDIT SURGERIES ONLY W
AT OTHER INSURANCE W
A0 ALLOWED EXCEEDS USER MAXIMUM W
A1 MEMBER INACTIVE E
A2 SERVICE CODE NOT EFF FOR DATE DS E
A3 SERVICE PAST WAITING PERIOD E
A4 MEMBER VENDOR NOT VALID E
A5 PROVIDER SPEC INVALID FOR SERV A5 E
A6 DENTAL LOCATION IS NOT PCP W
A7 DENTAL LOCATION TYPE INCORRECT E
A8 CHANGED PLACE OF SERVICE E
A9 NO PROVIDER CONTRACT FOR SVCDT E
B* EXPERIMENTAL PROCEDURE B* E
BA DENY/CORRECTION OCCLUSION/AUTH BA E
BB ***DENY/CORRECTION OCCLUSION/C W
BC BENEFIT UNIT COUNT EXCEEDED W
BD BENEFIT NOT COVERED FOR DEP. BD E
BH ****************************** W
BJ SERVICE DURING PROBATION PERIO W
BK ****************************** W
BL SOLO SE CONSIDERA PRODUCCION W
BM SUBJ AVAILABLE BENS SERVS REND W
B1 PROVIDER VENDOR NOT VALID E
B2 BENEFIT NOT FOUND OR NOT DENTA E
B3 PROVIDER INACTIVE E
B4 BENEFIT AMOUNT EXCEEDED B4 W
B5 FACTURAS O RECIBOS ORIGINALES B5 E
B6 SERVICE BY CAPITATION E
C* MEDICAL VISIT PROCEDURE C* E
CA DENY/DENTAL COSMETIC/AUTH CA E
CC PENDING COB CALCULATION E
CD CONSIDERED UNDER DENTAL COVERA CD E
CE PRE-DETERMINACION DENTAL 1J E
CF SOLICITUD AUTORIZACION DE PAGO CF E
CH CONTRACT IN PROCESS W
CI ANALYST CALCULATION W
CM CANCELACION LÍNEA EN AUTO CCMS W
CO DUPLICATION OF COVERAGE/ COB CO W
CP COPAY/DEDUCTIBLE NOT COVERED CP E
CR SOLICITUD REPORTE DE CONSULTA W
CS COSME.SURG.NOT COVERED(MEMBER) CS E
C1 VERIFICAR SI ES 1RA VISITA W
C2 ++++++++++CASO VERIFICADO POR: W
C3 PATIENT PRE-CERTIFIED NO COPAY C3 W
C4 SOL.#DE PIEZA/SUPERFICIE (DN) LF E
C5 COPIA DEL RECORD DEL PAC.(DN) C5 E
C6 CARTAS PREVENTIVAS W
C7 REV BY DEJESUS/ADJUSTMENT REQ W
C8 SOL.RADIOG.AREA SUPE/INFER(DN) C8 E
C9 *****90 DAY PD.FOR REV. &/OR W
D* PRE OPERATIVE PROCEDURE D* W
DA DENY/ TMJ /AUTH DA E
DB ***DENY/ TMJ /CLAIM W
DC DENTAL CLAIM REFERRED TO CONS. W
DD CHARGES APPLIED TO ANUAL DED DD W
DE DIFF EXCEEDS U&C. NOT COVERED W
DF DEDUCTIBLE CHARGED AFFECTS PMT W
DG LONG TERM DISABILITY W
DL SOLC.PROTESIS INICIAL REEMPLAZ DL E
DO DENTAL COVERAGE ONLY DO E
DP NO MATERNITY COVERAGE DEP.(MEM DP E
DS INACTIVE SERVICE CODE W
DT DETENTION COVERED ONLY ICU/CCU DT E
DX X RAY AREA SUPERIOR/INFERIOR W
DZ NO DENTAL COVERAGE DZ E
D1 #PROC.SEGUN ESCALA MCS (DN) W
D2 SOL. RADIOG.AREA AFECTADA(DN) D2 E
D3 DENTAL REPORT (DENTAL) D3 E
D4 ALTERNATE SERVICE PROVISION AP D4 W
D5 4 PARIAPCLS +2 BITWNGS=FULL MT D5 W
D6 DENTAL AUTHORIZATION W
D8 DENTAL PROSTHESIS INFO REQ. W
E* POST OPERATIVE PROCEDURE E* E
EA DENY/ ADDITIONAL DENTURES/AUTH EA E
EB ***DENY/ ADDITIONAL DENTURES/ W
ED E.R. INCLUDED IN PER DIEM ED E
EE ***PRTE DE 93307 DENEGAR 93300 W
EP 93300/93307SAME DAY PAY 93307 W
ER HISTORY EXCLUDED,RBN LIMIT EXC W
ES $75 MAX.PAYMT.PER VISIT (SICK) W
ET REFERIDO ELECTRONIC CLAIM E
EU USE TYPE "NP" IF NO EAP PSYCHI W
EX INJURY POSSIBLE/THIRD PARTY W
E1 U.S. OUT OF POCKET MAXIMUM E1 W
E2 P.R. OUT OF POCKET MAXIMUM E2 W
E3 DEDUCTIBLE ADJUSTMENT E3 W
E4 PARTIAL PAYMENT AWAITING E4 W
E5 BENEFITS WERE NOT ASSIGNED E5 W
E6 $15,000.00 AUTH.LIMIT EXCEEDED W
E7 AUTHORIZATION RECEIVED E7 W
F* MUTUALLY EXCLUSIVE PROCEDURE F* E
FA DENY/SERV STRT PRIOR EFF DT/AU FA E
FB ***DENY/SERV STRT PRIOR EFF DT W
FD YEAR FAMILY DEDUCTIBLE WAS MET W
FF OVER 65 Y/O CHANGE B.P. E
FM SERV RENDERED BY FAM MEMB N/C FM E
FR PRIVATE ROOM IS NOT COVERED FR W
FS PAGAR "FETAL NON STRESS TEST" W
F6 HOLD CODE EXEPTIONS (RF1301) W
F7 MINIMUN $1.00 W
F8 XX W
F9 COPAYMENT IS MORE THAN CHARGE F9 E
G* PROF.RVU N-AVAILA.REVIEW CODE G* W
GA ***PROCEDURE REFERRED TO MED C W
GB PROCEDURE NOT IN MCS FEE SCHD GB E
GC ***PROCEDURE REFERRD TO COMMIT W
H* MEDICAL VISIT MODIFIER WARNING H* W
HA DENY/REPLACE TH LOST <FF DT/AU LF E
HB DENY/REPLACE TH LOST <FF DT/CL LF E
HO ESTE MEDICO ES GENERALISTA W
HP $250 MAX.PAYMENT PER DAY W
HR ASEGURADO COMPLETO HRA W
HS ADM. DECLINED INSUFF. INFORM. HS E
H1 AUTH/BEN.DEFINITION CONFLICT W
H2 MEMBER WITH UNASSIGNED PCP W
I* POST OPERATIVE MODIFIER WARNIN I* W
IA ***DENY/SUBST OF REM DENTURE/A W
IB ***DENY/SUBST OF REMOV DENT/CL W
ID SERVICE AFTER TERMINATION DATE ID E
IE OUT-OF-POCKET MAXIMUM REACHED E
IF OUT-OF-POCKET MAXIMUM EXCEEDED E
IG MEMBER CO-INSURANCE LIMIT REAC CI W
IH MEMBER CO-INSURANCE LIMIT EXCE CG W
II USER CLAIM LIMIT EXCEEDED E
IJ NO PAID-THU DATE AN ACCOUNT W
IK DEPENDENT OVER AGE W
IL STUDENT OVERAGE W
IM UNAPPLIED UTIL. UPDATE RECORD W
IN INCAPACITY W
IO ADMIT/DISCHARGE DT NOT ON AUTH W
IP SERV. INCLUDED IN CONTRACT FEE IP E
IQ SERVICE INCLUDED IN PRICER E
IR POSIBLE SURGICAL FOLLOW-UP W
IS PRIMARY SURGICAL CLAIM MISSING W
IT SUBROGATION W
I1 GROUPER BENEFIT NOT FOUND E
I2 STEPDOWN BENEFIT NOT FOUND E
I3 CONTROL TOTALS DO NOT MATCH E
I4 SERVICE AFTER PCP EXPIRATION E
I5 SERVICE INVALID FOR PRV/VENDOR 07 E
I6 COB CLAIM W/NO PRIMARY PAYOR A I6 E
I7 EXCESSIVE CHARGE AMOUNT E
I8 OTHER INSURANCE IS PRIMARY W
I9 OUTSIDE CLAIM RECEIPT PERIOD I9 E
J* PROC.MAY NOT REQUIRED ASSISTAN J* E
JA DENY/SUBST LOST PROST./AUTH JA E
JB DENY/REPLACE LOST PROST/CLM JB E
JC DENY/PANORAMIC X-RAY/CLM JC E
JJ CHANGE IN DATE OF SERVICE JJ W
JO SOL.FECHA DE EXTRACION (DN) JO E
J1 CARGOS POR SERV. BRINDADOS J1 E
K* ASSISTANT SURGEON DENIED K* E
KA DUPLICATE OR OVERLAPPING AUTH. E
KB INVALID REFERRING PHYSICIAN KB E
KC AGE INVALID FOR SERVICE 04 E
KD SEX INVALID FOR SERVICE 05 E
KE AGE INVALID FOR DIAGNOSIS 24 E
KF SEX INVALID FOR DIAGNOSIS 20 E
KG "TO" PROVIDER INVALID CONTRACT E
KH "FROM"PROVIDER INVALID CONTRCT E
KI AUTH EXP OUTSIDE MEMBER EFFECT W
KJ SERVICE NOT COVERED BY BENEFIT W
KK BENEFIT NOT COVERED W
KL AUTH SPANS BILLING RECORDS W
K1 PROC.REPLACED DUE INVALID SEX K1 W
K2 PROC.REPLACED BY REBUNDLING K2 W
K3 PROC.ADDED DUE TO REBUNDLING K3 W
K4 ADDED DUE TO ALT.REPL.(AGE) K4 W
K5 ADDED DUE TO ALT.REPL.(SEX) K5 W
K8 CLAIM HAS BEEN REPROCESSED W
L* INVALID MODIFIER CODE FOR PROC L* E
LA XXXXXX W
LD LIMIT 3 DOSIS W
LI LIMIT 1 PER YEAR W
LM LIMITED TO ONE PER MONTH LM E
LT REVIEW / HISTORY W
LY LIMIT 1 PER POLICY YEAR W
M* PROCEDURE INVALID FOR FEMALE M* W
MA NO MAJOR MEDICAL BENEFIT 13 E
MC NO MEDICAL COVERAGE MC E
MD ***NO MEDICAL COVERAGE W
ME VER ME1083 W
MG NECESITA LIC. PARA PAGAR SERV. W
ML TIENE AUT MAMOGRAFIAS W
MM MESSAGES UNDER ME# CL1083 W
MN MD.NECESS.HAS NOT BEEN ESTABLI MN E
MO USE MODIFIERS FOR PROD AND INT MO E
MP BENEFICIO MERP W
MR MANAGED CARE REVISION E
MT CASO REFERIDO A MULTIPLAN W
MU PD W/MULTIPLAN DISCOUNT AGREEM MU W
M1 CASO SIN AUDITORIA MEDICA M1 E
N* PROCEDURE INVALID FOR MALE N* E
NE NOT ELIGIBLE/NOT REGISTERED NE E
NH MESES DE TRATAMIENTO(ORTODON) NH E
NI SOL.FACTURAS ORIGINALES DENTAL B5 E
NL NOMB.FECHA NAC.PACIENTE(DENTAL NL E
NN EMPLOYEE EXCEEDS AGE LIMIT NN E
NO ******SERV. DONE NOT IN DR'S W
NP ****NO PAYMENT W
NR FOTOS PRE-OPER.Y/O RADIOGR(DNT NR E
NS SICOLOGOS NO ESTAN CUBIERTOS NS W
NT REQ.REF MED & PRE-AUT(REH.PED) NT W
NX ***SOL.FECHA DE SERV.RECL.DEN W
NZ RECIB.OFC.(NOMB.DIR.Y ESP)(DN) NZ E
N1 ***AUTORIZAR PAGO DE BENEFICIO W
N2 SOL.DETALLE ACCIDENTE (DENTAL) AD E
N3 SOL.MODELOS DE ESTUDIO(DENTAL) N3 E
N4 SOL.EXP.PLAN PRIMARIO(DENTAL) N4 E
N5 ***SOL.AUT.INFORM.REQUERIDA(D W
N6 SOL.DESGLOSE SEVICIOS (DEN) N6 E
N7 PLACA PANORAMICA (DENTAL) N7 E
N8 TIPO MALOCLUCION (ORTODONCIA) N8 E
N9 PAGO INICIAL (ORTODONCIA) N9 E
O* PROC.INDICATED FOR AGE< 1 YEAR O* W
OB REF. COB MAJOR MEDICAL ONLY W
OC ORTHO FOR DEPENDENT CHILD ONLY E
OD SOLICITUD ORDEN MEDICA OD E
OJ ONLY FOR J&J PHARMACEUTHICAL E
OL ORTHO.LIFETIME MAX EXCEEDED E
OM ORTHODONTIA MAXIMUM EXCEEDED OM E
OR ***ORTHO NOT COVERED BY CONTRA W
OS CHG PART OF OTHER CONT. SERV, OS E
OT NO ORTHO COVERAGE OT E
O1 NEC CERT SALUD FISICA Y MENTAL W
O2 NECESITA REGISTRO EDUC. CONTIN W
O3 NEC.CERT./"MALPRACTICE INS." W
O4 NEC. LIC. NARCOTICOS INSULAR W
O5 NEC. LIC. NARCOTICOS FED-"DEA" W
O6 LIC. DEL DEPT DE SALUD W
O7 NECESITA CERTIF Y # DE C.L.I.A W
O8 CERT.FDA/MAMMOGRAPHY FACILITY W
P* PROC.INDIC.FOR AGE 1-17 YEAR P* W
PA PROVIDER AUDIT W
PB USE 'NP' UNDER CLAIM TYPE W
PC FACT.PEND.RECL.HOSP & FACILIDA W
PD PANORAMIC NOT COVERED PD E
PE PEND. ELEGIBILIDAD U.P.R./INT E
PH PAYMENT BASED ON PRE-CERT DAYS PH W
PI INCIDENTAL PROCEDURE NOT COVER PI E
PL ONE PARIAPICAL/YEAR COVERED PL E
PM BAL.PYMT.AWAITING INT.RV STA. W
PN ***PRENATALS PENDED TILL DEL W
PP POSSIBLE PRE-EXIST CONDITION W
PQ PD EN PROPORCION SERVICIO W
PS AJUSTE DISPENSING FEE FARMACIA FF W
PT SUBJECT TO POL TERMS & COND W
PU PAID AS NEGOTIATED W
PV EXCESS OF NEGOTIATED FEE W
P1 NON EPO PROVIDER ZX E
P2 NON PARTICIPATING PROVIDER P2 E
P3 ***NON E.A.P PROVIDER W
Q* PROC.INDIC.FOR AGE 12-55 YEAR Q* E
RA REF FROM EAP MANAGER REQUIRED W
RB CHARGE R&B IN EXCESS OF ACTUAL W
RC RECOBRO POR FALTA DE PRE-AUTO RC W
RD ***E.R. DETENTIONS ARE NOT COV W
RE PROVEEDOR EN PROCESO DE REVISI W
RF REFUND CK- W
RH REFER TO HEALTH SOUTH DRS.HOSP RH E
RM RE MICRO W
RN REFERRAL FROM PCP REQUIRED RN E
RO REIMBURSEMENT OUT OF NETWORK W
RP PAY PPO IF NO EAP MGR REFERRAL W
RQ REFERRAL FROM EAP MANAGER REQ RQ E
RR REQUEST FR REPORT & X-RAYS RR E
RT LIMITED TO A MAX. OF 2 RESP.TE RT E
RX COPY OF DRS PRESCRIPTION W
R1 SOL.RECIBOS OFICIALES 8K E
R2 ****************************** W
R4 ***REC.DESP.90 DIAS CANC.POLIZ W
SC ***SERDIEM ISNOTCONTRACTEDSERV W
SE SI ENVIA REPORTE SE PAGA CONS SE W
SH ***HOSPITAL BENEFITS ONLY W
SI ***SERVICE INCLUDED IN SURGICA W
SL SERVICE LIMITS APPLY W
SM SERV.IN MOVILE UNITS NOT COVER SM E
SN ASSISTANT SURGEON NOT COVERED K* E
SR SUBMIT RECEIPT OF CO-PAYMENT SR W
SU SLF INFLICTED INJURIES NOT COV SU E
S3 ONLY COVERAGE UNDER EAP PROG. PS E
TC O/P USE 99070V FOR TRAY W
TD ***TRAY IS NOT COVERED W
TF TERAPIA FISICA PREVENTIVA TFP W
TP TERAPIAS FISICAS AUTORIZADAS W
TX ***SOL.REPORTE PAP-SMEAR W
UA O/P USE CLAIM TYPE "AT" (75%) W
UC COVER USUAL & CUSTOMARY CHARGE W
UP ATLETA UPR W
US NO PRE-CERT US/PPO BENEFIT US W
UT USE CLAIM TYPE-TP/TO PAY 75% W
UV UNIDENTIFIED VISIT PD AS SUBS W
U1 DOES NOT MEET HOSP.REQUIREMENT U1 E
U2 BASED ON UTILIZATION REVIEW U2 W
U3 DOES NOT MEET DENTAL REQUIREME U3 E
VB ***VISITS SHOULD BESUBMITTEDON W
VC USE OTHER DIAGNOSTIC CODE E
VI *** W
VM VER PR1011 / PR1063 W
VV ***CHGS BEF/AFT ADM/DISCH DATE W
WA NO CPT NUMBER W
WB NO PROVIDER TAX ID WB W
WC NO EMPLOYEE NUMBER WC W
WE SERVICIO DESDE 3/1/94 VA A PHS W
WF SERVICIO DESDE 7/1/94 VA A PHS W
WW TIENE LIC DE SONOGRAMA W
X* PROC.INDIC.FOR AGE > 14 YEAR X* W
XM USAR COD.VIS.INIC.ORTOP.99203 W
XN USAR COD.VIS.INIC.NEUROL.99204 W
XO USAR COD.VIS.INIC.HEMAT.99205 W
XX UNDER SYSTEM AUDIT/REFER CLM W
XY DUPLICATE OR OVERLAPPING AUTH W
XZ MEMBER NOT COVERD ON SVC DATE W
X0 EXCESSIVE CHARGE AMOUNT W
X1 SERVICE NOT COVERED BY BENEFIT W
X2 GROUPER BENEFIT NOT FOUND W
X3 STEPDOWN BENEFIT NOT FOUND W
X4 SERVICE INVALID FOR MEMBER AGE W
X5 ***SOLICITUD REPORTE DE CONSUL CR E
X6 SERVICE INVALID FOR PRV/VENDOR W
X7 MEMBER DEDUCTIBLE REACHED W
X8 BENEFIT AMOUNT EXCEEDED W
X9 AGE INVALID FOR BENEFIT W
Y* PROC.REPL.DUE TO INVALID AGE Y* W
YA SERVICE PAST WAITING PERIOD W
YB BENEFIT UNIT COUNT EXCEEDED W
YC MEMBER CO-PAY LIMIT REACHED W
YD NO ALLOWABLE CHARGE FOR SERVIC W
YE BENEFIT NOT FOUND OR NOT DENTA W
YF GROUP NOT COVERED FOR SVC DATE E
YG SVC FEE/COPAY SCHEDULE NOT FD W
YH SERVICE DURING PROBATION PERIO W
YI SERVICE AFTER TERMINATION DATE W
YJ PROVIDER SPEC INVALID FOR SVC W
YK PROVIDER NOT MEMBERS PCP W
YL CHANGES PLACE OF SERVICE W
YM TOOTH INVALID FOR SERVICE W
YN TOOTH NUMBER REQUIRED (DN) 73 E
YO PRIMARY TOOTH AGE LIMIT EXCEED W
YP PERM TOOTH AGE LIMIT EXCEEDED W
YQ SERVICE COUNT EXCEEDED W
YR SRV CNT EXCEEDD 4 MEM/LOC/PER W
YS SVC CNT EXCEEDD 4 MEM/TTH/PER W
YT SVC INVALID AFTER PREVIOUS SVC W
YU PREREQUISITES MISSING C PERIOD W
YV SERVICE ALLOWANCE PRORATED W
YW SERVICE COVERED BY OTHER PROC W
YX COPAY INVALID FOR THE AGE W
YY ABP MAY APPLY W
YZ EXCLUSIONS APPLY W
Y1 *** DETALLE ACCIDENTE(ADULTO) W
Y2 COVERED BY OTHER INSURANCE 15 E
Y3 SURFACE CODE INVALID FOR SERVI E
ZX ****************************** W
ZZ CLAIM OUTSIDE FUTURE PERIOD E
Z0 INCORRECT BENEFIT PROCESS W
Z1 NO DEPENDENT DENTAL COVERAGE 54A E
Z2 PAGAR CON MODIFICADOR 26 E
Z3 MEMBER CO-PAY LIMIT REACHED W
Z4 MEMBER DEDUCTIBLE LIMIT EXCEED Z4 W
Z5 ALLOWABLE CHARGES EXCEEDED W
Z6 MEMBER UNITS LIMIT EXCEEDED LE W
Z7 MEMBER CO-PAY LIMIT EXCEED W
Z8 CALC. SERVICE AMNT IS NEGATIVE E
Z9 SERV.M.M./SEE PRE-EXIST CLAUSE W
01 EXCT DUP:& 01 E
02 CLAIM OUTSIDE MEMBER EFFECTIVE 02 E
03 AGE INVALID FOR BENEFIT 03 E
04 AGE INVALID FOR SERVICE 04 E
05 SEX INVALID FOR SERVICE 05 E
06 AUTHORIZED AMOUNT EXCEEDED 06 W
07 SERVICE INVALID FOR PROVIDER 07 E
08 MAXIMUM ALLOWABLE CHARGE REACH 08 W
09 SEX INVALID FOR BENEFIT 09 E
1* PRIMARY PROCEDURE 1* W
1A REPORTE DE PATOLOGIA W
1B REPORTE DE CIRUG. Y PATOLOGIA W
1C REP CIRUG. Y PATOL-ANESTESIA W
1D FORMA DEBIDAMENTE CUMPL.(DENTA 1D E
1F REPORTE DE CIRUGIA W
1G NOTAS DE PROGRESO W
1H REPORTE DE SAL DE EMERGENCIA W
1I COPIA DEL RECORD MEDICO W
1J PRE-DETERMINACION DENTAL 1J E
1K PENDING EVALUATION CLASSICARE W
1L REFERIDOS AL CONSULTOR MEDICO W
1M PRE.DETER.ORTODONCIA DPR W
1N REFRACTION DIAG. NOT COVERED 1N E
1O DETER.ORTODONCIA ESPAÑOL W
1P ORTODONTIC DETERMINATION 1P E
1Q ***ORTODONTIC DETERMINATION W
1V ***ONLY 1 VIST.IS CONS.PER DAY W
1W ***DENY/PANORAMICX-RAY/CL(MEM) W
1X ***ORTHO NOT COVERED (MEMBER) W
1Y ***NO DENTAL COVERAGE (MEMBER) W
1Z ***DENY/REPLACE LOST PROST(ME W
10 EXCT OPN:& W
11 AUTHORIZED UNITS EXCEEDED 11 W
12 AUTHORIZATION OR REFERRAL REQ. 12 E
13 SERVICE NOT COVERED BY BENEFIT 13 E
14 MEMBER UNITS LIMIT REACHED 14 W
15 COVERED BY OTHER INSURANCE 15 W
16 ***PROCESSED IN DENTAL W
17 MEMBER DEDUCTIBLE REACHED 17 W
18 ***SOLICITUD FECHA DE SERVICIO W
19 NO ALLOWABLE CHARGE FOR SERVIC 19 W
2* SECONDARY PROCEDURE 2* W
2A *** CARTA GENERICA DENTAL W
2D REFERIDO AL CONSULTOR DENTAL W
2E *** C-GENERICA DEN-ORTODONCIA W
2F ***DEN-NO CUB-PLACA PANORAMICA W
2G DEN-NO CUB-TRAT-ORTODONCIA OT E
2H ***NO CUBIERTA DENTAL DEPENDIE W
2I *** NO CUBIERTA DENTAL W
2J *** NO CUB-REEMPLAZO PROTESIS W
2Z ***DENY/SUBS.OF REMOV DENT/MEM W
20 SEX INVALID FOR DIAGNOSIS 20 E
21 SERVICE BEFORE/AFTER GR EFFECT 21 E
22 NO RVS RECORD FOUND FOR PROCED E
23 CLAIM SERVICE REVERSAL 002 E
24 AGE INVALID FOR DIAGNOSIS 24 E
25 BENEFIT NOT COVERED E
26 AGE LIMIT EXCEPTION W
27 COVERED BY AUTO INSURANCE 27 E
28 CLM.REF.TO CLINICAL CONSULTANT W
29 ROUTINE NOT COVERED 29 E
3* TERTIARY PROCEDURE 3* W
3A ***PROVEEDOR NOPARTICIPANTEMCS W
3B ***NO CUBIERTA DE FARMACIA W
3D ***NO CUBIERTA ACC. TRAB W
3G ***NO CUBIERTADE MATERNIDADDEP W
3I ***DENEGACION NOCUBIERTAMEDICA W
3R DECLINED FOR INSUFF.INFORMATIO 3R E
30 NO SERVICE CHARGE FOUND(DENTAL 30 E
31 ***WELLBABY-CARE EXCEEDS1ST YR W
32 ***NUTRITIONAL SUPPLEMENT NOT W
33 PERSONAL COMFORT ITEMS NOT COV 33 E
34 COVERAGE ONLY FOR ACC/ILLNESS W
35 NON-PRESCRIPTION DRUGS NOT COV 35 E
36 DETALLE DE LOS SERVICIOS BRIND 36 E
37 ***NURSERY, NEWBORN WELL-BABY W
38 TESTS & OR PROCED UNRELATED NO 38 E
39 SURGICAL / PATHOLOGY REPORT W
4* OTHER PROCEDURE 4* W
4A ***NO SEV.DESP.TERM.POLIZA(REM W
4B NO CUBIERTA FARMACIA (REMBOLSO 55 E
4C NO CUB-VISION (MEM-REMBOLSO) 53 E
4D NO CUBIERTA ACC. TRAB-REMBOLSO 4D E
4E NO CUB-CIRUG-COSMETICA REMBOL CS E
4F NO CUBIERTA DE MATERNIDAD DEP DP E
4H NO CUBIERTA MEDICA (REEMBOLSO) MC E
4I ***NO CUB-PLACA PANORAMICA REM W
4J ***NO CUB-TRAT-ORTODONCIA-REMB W
4N ***NO CUB-REEM-SUSTIT-PROT-REM W
40 PRE-EXISTING CONDITION NOT-COV 40 E
41 IN EXCESS OF PRE-EXISTING LIMI 41 E
42 SERV.DUE TO JOB RELATED INJURY 42 E
43 REQ.PATHOLOGY REPORT 43 E
44 ***PROOF OF LOSSNOTSUBMITTEDON W
45 PRESCRIPTION# REQUIRED/& NAME 45 E
46 DEPENDENT NOT A FULL TIME STUD 46 E
47 NOT AN ELIGIBLE DEPENDENT 47 E
48 NO FEE SCHEDULE FOUND E
49 NOT A 2006 OR/AND 2007 CPT/HCP 49 E
5* COSMETIC PROCEDURE 5* E
50 ***REQUEST FOR COMPLETED CLAIM W
51 ***SOL.NOMBRE & FECHA DE NACIM W
52 COSMETIC SURGERY OR TREATMENT 52 E
53 NO VISION COVERAGE 53 E
54 NO DENTAL COVERAGE 54 E
55 NO PHARMACY COVERAGE 55 E
56 STUDENT LETTER W
57 SOLICITUD DIAGNOSTICO 57 E
58 BENEFIT REDUCED DUE TO COB 58 W
59 CHECK AMT PD IF <$100 OVERRIDE W
6* INCIDENTAL PROCEDURE 6* E
6D REFERIDO ELEGIBILIDAD W
6E OUTSIDE MEMBER PERIOD E
6F ***AUTORIZAR PAGO DE BENEFICIO W
6I INFORMATION RESQ.FROM PROVIDER E
6S INVALID SOCIAL SECURITY NUMBER E
6T COVERED AFTER 6 THERAPIES ONLY 6T E
60 REFERED TO PROVIDER SERVICES E
61 BY REPORT/REQUEST REPORT W
62 REVIEW INFO FOR CORRECT # S1 W
63 DEPENDENT NOF/REFERRED TO REC. E
64 PROCEDURE CODE REFERRAL W
65 CHECK S/P ROOM RATE W
66 REVIEW INFO.(RF1031) W
67 REQ.SURGICAL REPORT 67 E
68 REQ.SURG.,PATOL.,ANEST.REPORT 68 E
69 REQ.PROGRESSIVE NOTES 69 E
7* REVIEW POSSI DUPL.PROCEDURE 7* W
7A REFERED TO OCAP (W.RIVAS) W
7B ALL INCLUSIVE PROCEDURE (DEN) W
7F COMPLETED CODE REVIEW W
7G BEN.EN PROCESO DE REVISION E
7I REVISADO EN "OPTIMED" W
7J REF.EJECUT.DE CUENTAS E
7M REF.TO MANAGED CARE (CLINICO) W
7N BENE.LIMITADO 2 TERAP.DIARIAS W
7R REFERER TO OCAP (O.LOPEZ) W
7S C/REVIEW BY COVERAGE COORDINAT W
70 NOT A CONTRACTED SERVICE / PRO 70 E
71 COPY OF MEDICAL RECORD 71 E
72 TOOTH INVALID FOR SERVICE W
73 CUADRANTE Y/O DIENTE ENVUELTO CDE E
74 PRIMARY TOOTH AGE LIMIT EXCEED W
75 PERM TOOTH AGE LIMIT EXCEEDED W
76 SERVICE COUNT EXCEEDED 76 W
77 SVC CNT EXCEED FOR MEM/LOC/PER E
78 SVC CNT EXCEED FOR MEM/TTH/PER E
79 SVC INVALID AFTER PREVIOUS SVC W
8* OBSOLETE PROCEDURE REVIEW CODE 8* W
80 PREREQUISITES MISSING W/IN PER W
81 SERVICE ALLOWANCE PRORATED W
82 ***SERVICE COVERED BYOTHERPROC E
83 SERVICE REQUIRES AUTHORIZATION W
84 SVC CNT W/IN PER REQUIRES AUTH W
85 SVC FEE SCHEDULE NOT EFFETIVE W
86 COPAY INVALID FOR AGE LIMIT W
87 ABP MAY APPLY W
88 COPAY OVERRIDN TO WRONG AMOUNT W
89 EXCLUSIONS APPLY 89 W
9* UNLISTED PROCEDURE REVIEW CODE 9* W
90 SUPERFICIES ENVUELTAS(DENTAL) 90 E
91 SURFACE CODE INVALID FOR SERVI W
92 ZERO CLM AMT ALLOWED USED W
95 CHECK AMT PD IF >$100 OVERRIDE W
98 EXCESS COPAY FOR GENERIC DRUGS 98 W
99 EXCESS COPAY CHARGED 99 W
G1 NO CALC.SET FOUND FOR SEVICE E
G2 COVERAGE LIMIT REACHED BY PREP E
G3 U&C AMOUND NOT FOUND E
G4 CALC. SET NOT COMMITED E
G5 U&C PERCENTILE NOT FOUND E
CQ 15 PER CALENDAR YEAR LIMIT W
HJ ADVISE MERNIE (ASTHMA PROGRAM) W
BR MIN. CO-PAY $5.00 W
F1 USE TYPE-C1 FOR EXT BENF.$1000 W
F2 USE TYPE-C2 FOR EXT BENF.50% W
RZ SEE PROCEDURES REQ. PRE-CERT W
L8 SEE BEN.88151,88150,86316 (GR# W
L7 SEE BEN. FOR 76091/76090 (GR#) W
LB GR#FOR 76091/90,88150/51,86316 W
BX REEMP.PROTESIS MENOS DE 5 ANOS BX E
EZ USE TYPE NP IF NO PAE REFERRAL W
MS STUDENT CERTIFICATION 56 E
SO PROCEDURES REQ. AUTHORIZATION W
O9 EVIDENCIA DE COLEGIACION VIGEN W
CN USAR COD.CONS.NEUROL.PED.99244 W
P4 PRE-CERT/CASE MANAG.PROGRAM W
FI AD&D PND FURTHER INVESTIGATION W
SS BEN.SONOGRAMA VER CL1083 GR # W
CT LIMITATIONS PER ANATOMIC REG. W
ST AMOUNT REPRESENTS 40% OF TOTAL ST W
TS 60% PENDING INTERNAL REVENUE W
EC PAGAR ECOCARDIOGRAMA W
TT PAGAR ECO Y STRESS TEST W
NV PAGAR NERVE CONDUCTION VELOC. W
J2 CONTRATO DESPERDICIOS BIOMEDIC W
J3 NECESITA LICENCIA SANITARIA W
J4 # GENERADOR DESPER. BIOMEDICOS W
J5 CERT SALUD RADIOLOGICA W
HT DEBE FACTURAR CON MOD. TC 07 E
B7 MIN. CO-PAY $7.00 W
TH PAGAR SIN MODIFICADOR W
W1 NO TIENE LIC DE SONOGRAMA W
4O NOT EAP COVERAGE E
G6 BENEFIT AGE BREAKDOWN NOT-FOUN W
G7 AUTHORIZED DAYS REACHED G7 E
G8 AUTHORIZED DAYS EXCEEDED E
G9 DAYS APPROVED OVER LIMIT E
FH ***SERVICE WILL BEBILLEDBYHOSP W
OF SOLO APLICA CO.80 UPR W
TI USE CODIGO DE INTERPRETACION W
TG USE CODDIGO DE INT. & PROD. W
TJ USE CODIGO DE PRODUCCION W
BI SVC FEE/COPAY SCHEDULE NOT FD E
AH DUPLICATE DENTAL CLAIM 01 E
IV ***INVALID CPT CODE W
TR SERV.INCLUDED IN TRANSPLANT FE TR E
LE MAX. 3 X YEAR WITH PRE-AUT W
T1 REFERIRSE MANUAL LABORATORIOS W
PF PAQ.CARDIOVASCULAR PENDIENTE W
P8 NO CO-PAY FIRST 8 VISIT-PSYCHO W
DH EFF.080199 DED.$25 NON EMERG A W
SQ USE TYPE "PQ" EAP PSYQUIATRIST W
L1 ***CODES INCL IN 2 PANELS BUND W
L2 CODES NOT INCL IN 2 PANEL CONS L2 W
UN PRE-CERT US / PPO RATES USED E
2L REFERRED TO SUPERVISOR W
2M REFERRED TO CARMEN MANDES W
2N REFERRED TO DIVISION MANAGER W
2O REFERRED TO TEAM LEADER W
2P REFERRED TO RAMONITA PLACIDO W
2Q REFERRED TO JOSE DURAN W
NB PAID ACCORDING NEG. CASE MANAG NB W
*1 PHASE I *1 W
*2 PHASE II *2 W
*3 PHASE III *3 W
*4 PHASE IV *4 W
*5 PHASE V *5 W
2Y REFERRED TO IVONNE NAVEDO W
NK ***POLICYCANCELLED/NONPAYMENT W
TL GROUP WITH TELEMEDIK BENEFIT W
CU CONSIDERED UNDER PHASE-I CU E
9B VERIFY HISTORY FIRST VISIT W
9C VERIFY CALENDAR YEAR LIMIT W
9D VERIFY EAP W
2C REFERRED TO CARMEN DOMINGUEZ W
NA REVISADO/DECLINADO POR CLINICO NA E
CL PACIENTE NO PREAUTORIZO W
B8 MIN. CO-PAY $8.00 W
MB MINIMUM $3.00 BIOEQUIVALENT W
EN EXCLUSION & SERV. NOT COVERED EN E
AN ANESTHESIA CLAIM W
BS REQ.DOCTOR'S ORDER,RESUL.,BILL W
TB INCORRECT THIRD PARTY TOPAY W
TK PRECERT REQUIRED, NOT FOUND W
TM ALLOWED EXCEEDS CHARGED W
TN CANNOT PROCESS W/OPEN SERVICE W
TO MULT PRIMARY/SEC PROCEDURE W
TQ MISSING SUBMITTED DRG W
TY INTERIM BILL DRG CLAIM W
T0 SURGICAL PERCENTAGES NOT FOUND W
T2 RENTAL PURCHASE PRICE EXCEEDED W
T3 THIRD-PARTY CLAIM EDITS MISSIN W
T4 ROOM & BOARD/DATE MISMATCH W
T5 REFERRAL REQUIRED, NOT FOUND W
T6 ALLOWED EXCEEDS THESHOLD W
T7 COPAY FOUND FOR VENDOR/SPEC/DA W
T8 SURGICAL RANKING NOT FOUND W
V0 UPIN MISSIN ON DRG CLAIM W
V4 CLAIM PAYMENT LIMIT EXCEEDED W
V5 RENTAL PURCHASE PRICE MET W
V6 SUB.DME RENTAL CLAIM FOUND W
V7 AUTHORIZATION FOR RENTAL ONLY W
V8 INVALYD FACILITY CODE W
V9 BENEFIT LIMITED BY RELATIONSHI W
W2 RETROACTIVE ENROLLMENT CHANGE W
RV PRE-AUTH EN PROCESO REVISION W
WP WAITING PERIOD WN E
MW MATERNITY WAITING PERIOD W
EL SURGERY WITHIN PERIOD WN E
WN WAITING PERIOD NOT COVERED WN E
SV SERV.INCLUDED IN OFFICE VISIT SV E
ON OUT OF NETWORK/NON EPO PROV. ZX E
CG CONGENITAL CONDITION WN E
MI MIN. CO-PAY $10.00 W
LP LIMIT ONE LIFETIME W
6A INCOMPLETE I.D.NUMBER SUFFIX 6A W
LC LIMIT ONE DURING PREGNANCY W
HF REQ.AUTORIZATION FHC PROGRAM W
LV LIMIT 2 DOSIS W
HC MAX.FEE REIMBURSABLE $75.00 W
CJ CERTIFICACION DENSITOMETRIA W
NJ ***NO CERTIFICACION DENSITOMET W
H VALID UNTIL 103101*SEE PR1011 W
5R PHARMACY COVER BY PCS PLAN 55 E
5D DENTAL COVERAGE BY DELTA PLAN 54 E
PO ONLY SERV.PERF.BY ORTH.ARE COV PO E
LL FOR ANEST.USE CODE + LETTER A W
LN FOR CAST USE K(LONG) J(SHORT) W
EV MEMBER/OR ESTUDENT IN U.S W
JL HOLD PROV E
F3 CASE DENIED AND / OR EXPIRED F3 E
DJ DENY DUE TO NON-COMPLIANCE COB DJ E
RJ COB LETTER/NO REPLY W
CZ USE CONTRACTED SCHEDULE AMOUNT W
D7 SOMETER FACTURAS A CARENET W
7O REFERED SETTING PR1013/PR1032 W
S5 REVIEW POSSIBLE ERROR (S9130) W
UR RESIDENT IN USA W
GP REVISAR #GRUPO DENTAL OPCIONAL W
Y5 LIMIT OF 45 DAYS FOR RESUBMISS Y5 E
Y4 CLAIM WAS OBJECTED W
R5 MEMBER WAS NOT REPORTED BB E
R7 SERVICE CODE WAS NOT REPORTED BB E
R8 DIAGNOSTIC COD WAS NOT REPORTE DB E
R9 PLACE OF SERVICE WAS NOT REPOR PB E
S0 PROVIDER WAS NOT REPORTED BB E
S1 INVALID DIAGNOSTIC CODE DI E
S2 INVALID MEMBER NUMBER XX E
S4 INVALID SERVICE CODE XX E
S6 INVALID PLACE OF SERVICE PA E
S8 LIMIT OF 45 DAYS FOR RESUMISSI S8 E
S9 INVALID PROVIDER NUMBER I XX E
S7 CLAIM WAS OBJECTED W
P5 MAX. REEMBOLSO $15.00 POR PAR W
QQ E.R.ADJUSTMENT CLAIM AC W
9Z SUBMIT REPORT OR INVOICE 61 E
P6 MAX.REEMBOLSO $35.00 POR VISIT W
LG INVALID MODIFIER CODE FOR PROC L* E
HD MAXIMUM FEE $125.00 W
RW SERV.NOT PRESENTED FOR UTILIZA RW E
QP QUERELLAS DE PROVEEDORES W
DK DENTAL CLAIMS CONVERSION W
HG MAX.FEE REIMBURSABLE $100.00 W
LH INVALID MODIFIER COMBINATION LH E
EM APPROVED MATERNITY W
** CHANGE CY TO AU W
*A AIDS & AIDS DX-REGISTRY W
*B AMBULANCE-REGISTRY W
*D SPECIAL DRUGS-REGISTRY W
*E ESRD-REGISTRY W
*G CONGENITAL / METAB W
*H HIV DX-REGISTRY W
*I INCENTIVES FOR IMMUNI-REGISTRY W
*L LITHOTRIPSY-REGISTRY W
*M MENTAL-REGISTRY W
*N NEONATAL ICU-REGISTRY W
*O OBSTETRICS-REGISTRY W
*P PROSTHETICS-REGISTRY W
*R SPECIAL REGISTRY W
*S SCREENING MAMMOGRAPHY-REGISTRY W
*T TRANSPLANTATION PATIENTS-REGIS W
*V CARDIOVASCULAR-REGISTRY W
*Y PRE-RENAL REGISTRY W
NU NEUROSURGERY-REGISTRY W
IC PAGAR CON "OVERRIDE"FEE $30.00 W
MX MEDICARE - REF.A LUZ RODRIGUEZ W
H9 NOT A CPT/HCPCS CODES FOR THE H9 E
HE MAX.FEE REIMBURSABLE $80.00 W
@1 VISION NA E
@5 AMBULANCE NA E
#6 AMBULANCE TRANSPORT TO DR OFFI NA E
#7 CHIROPRACTIC CARE DOES NOT MEE NA E
#3 COSMETIC NA E
@2 DENTAL SERVICES NA E
#8 DME DOES NOT MEET MEDICARE DEF NA E
#9 DME - NO MEDICAL USE NA E
#A DME - 02 NA E
#B DME SPECIAL FEATURES NA E
#C DME TENS UNIT NA E
@3 RENTAL PAYMENTS MAXIMUM NA E
@9 NON-FORMULARY DRUGS NA E
#E HOME HEALTH DOES NOT MEET SKIL NA E
#F HOME HEALTH MEMBER NOT HOMEBOU NA E
#G HOME HEALTH DOES NOT MEET INTE NA E
#H HOME HEALTH EXTENDED TREATMENT NA E
#I HOME HEALTH AID SERVICES ARE P NA E
#J HOME HEALTH AID(NO COVERED SKI NA E
#1 INSUFFICIENT MEDICAL INFORMATI NA E
#4 INVESTIGATIONAL NA E
#5 MULTIPLE VISITS. PT OR HOME HE NA E
#2 NO MEDICALLY NECESSITY NA E
@4 NON MEDICARE APPROVED DRUGS OR NA E
#K PERSONAL COMFORT ITEM NA E
#L PT EXTENDED TREATMENTS NA E
#M ROUTINE FOOT CARE NA E
#N SSO NA E
#O SERVICE OUT OF PLAN NA E
#P SHOE ORTHOTICS NA E
#Q APPROPRIATE SETTING NA E
#R APPROPRIATE HEALTH CARE PRACTI NA E
@6 INPATIENT PSYCHIATRIC CARE NA E
@7 INPATIENT PSYCH NA E
#T ADMISSION DENIAL NA E
#U GENERAL NON-SKILLED CARE NA E
#W CHANGE IN LEVEL OF CARE NA E
#X DISCONTINUING DAILY REABILITAT NA E
#Y TEACHING AND TRAINING PROGRAM NA E
#Z EXHAUSTION OF 100 SNF DAYS NA E
@8 NO COVERAGE NA E
#D HEARING AIDS NA E
@A SPECIALTY SERVICE NA E
V1 MAX.FEE REIMBURSABLE $67.00 W
EO EVALUAR REPORTE OPERATORIO W
T9 RECOVERY OF SERV PAID MULT TIM T9 E
SD SETTLEMENT - DENIAL SD E
RL REBUNDLING LINE LIMIT EXEEDED W
UM MULTIPLE UNITS, DOS RANGE W
LS CLAIM LINE SPLIT DOS RANGE W
FE DIAG.CODE NOT EFF FOR DATE FE E
MV USE MODIFIERS FOR BILLING MV E
MF MULT.AUTORIZATION FOR CLAIM W
Q1 CRITERIA NOT MET/ADD-ON CODE Q1 E
Q2 ASSISTANT SURGEON DISALLOW Q2 E
Q3 MULTIPLE COMPONENT BILLING Q3 E
Q4 SERV/PROC INCLUDED IN SURGERY Q4 E
Q5 ONLY 1 E/M ALLOWABLE PER DATE Q5 E
Q6 REBUNDLED TO FIRST PROCEDURE Q6 E
Q7 DUPLICATE PROCEDURE Q7 E
Q8 NEW PT CODE FILED WITHIN 3 YRS Q8 E
U4 PROC.CODE INC.LABORATORY PANEL U4 E
U5 PROCEDURE CODE INCL.IN 0722 U5 E
U6 MA-10 DENEGADA U6 E
U7 REC.POR COODINACION BENEFICIO U7 E
OE ONLY ONE E/M BE REPORTED PER D OE E
HI PAY WITH OVERRIDE FEE $600.00 W
OA DEPENDENT OVER AGE W
OQ STUDENT OVER AGE W
PX BLOODHOUND W
VS VER NUMERO DE GRUPO MEDICO W
M0 APROBADO COMITE EXCEPCIONES W
M2 APROBADO COMITE EXCEPCION ELA W
M3 APROBADO COMITE EXCEPCION RCM W
L4 PAGADA SOBRE 40 DIAS W
Q0 PROC.DESC.INV.FOR GENDER/AGE Q0 E
R3 REVERSAL-CONTRACT CHANGES R3 W
M4 APROBADO POR MANEJO DE CASOS W
MK COVERED BY MEDICARE MK E
R6 RECOVERED BY PROVIDER CHECK W
*K TRANSPLANTS-REGISTRY W
8A DISEASE MNGMT - BRONCHIAL ASTH W
8B MBR ENROLLED - DM BRONC ASTHMA W
8C DISEASE MNGMT - DIABETES W
8D MBR ENROLLED - DM DIABETES W
8F MBR ENROLLED - DM CHF W
8E DISEASE MNGMT - CHF W
8G DISEASE MNGMT - HBP W
8H MBR ENROLLED - DM HBP W
8J CASE MNGMT-RENAL DISEASE(ERSD) W
8K MBR ENROLLED - CASE MNGMT ERSD W
8L CASE MNGMT-CANCEL DISEASE W
8M MBR ENROLLED CASE MNGMT CANCEL W
8N CASE MNGMT-NEONATAL INTEN CARE W
8O MBR ENROLL.CASE MNGMT NEONATAL W
8P CASE MNGMT-PEDIATRIC INT.CARE W
8Q MBR ENROL.C.MNGMT PED.INT CARE W
8R CASE MNGMT- HIV / AIDS W
8S MBR ENROLL.CASE MNGMT HIV/AIDS W
8T CASE MNGMT- OBSTETRICAL CARE W
8U MBR ENROLL.CASE MNGMT OB CARE W
0A PROCESAR CON 2 UNIDADES W
RG RESPONSIBLE PARTY NOT FOUND W
IZ REFERIDO IMCS (RE ASEGURO) W
CV INC.IMUNIZATION VACCINE S.CODE CV W
Y7 AUDITORIA COB RENAL W
Y6 DENEGADO POR MANEJO DE CASO Y6 E
Y8 INCORRECT STERILIZATION CODE Y8 E
W3 SOM.CL.HOUSE SIN EVIDENCIA MHS W
W4 EXC.APROBADA DEP.SERV.PROVEEDO W
GR PAID WITH IMCS DISCOUNT AGREEM GR W
HW COMPANY INACTIVE IN MCS HW E
JW AJUSTES J WALK W
SP RECOVERY SERVICES PROVIDED ON SP W
P7 MAX.REEMBOLSO $30.00 PER VISIT W
CK PHARMACY ONLY COVERAGE 13 E
HM MAX.$100.00 DAILY UP TO $5,000 W
Z* HISTORICAL CLAIM CHECK Z* W
W* CODE DESCRIPTION OF SYSTEM USE W
LR COMPLI.PAQUETE CARDIOVASCULAR LR E
E8 EVALUANDO POSIBLE RECOBRO W
E9 RECLAMACION ORIGINAL EVALUADA W
XC ADJUSTMENT REQUIRED ON HISTORI W
SF RECOVERY OF BLOOD UNITS NOT PR SF W
SG RECOVERY OF SERVICES THAT WAS SG W
H3 FOR PART-A DED.MAX 2 ADMISSION W
D9 FOR PART-B MEDIC.UP FRONT $124 W
MJ COB A TRAVES DE REEMBOLSO MJ E
R0 RECOVERED BY CHECK - SIU W
P9 MAX.REEMBOLSO $25.00 DIARIOS W
HK MAX.REEMBOLSO $200.00 DIARIOS W
FP RECOBRO POR FALTA DE #PRE-CERT FP W
$O APC REVENUE CODE W
$D HIPPS DRG CODE PAYMENT $G W
M5 REF.IMCS PARA DESCUENTO W
$N NON CONTRACTED SERVICE/NO PAY NC E
|I INVALID CODE-USE INDUSTRY STD |I W
|B BUNDLED SERVICE-NO ADDTL PYMT |B E
|D DELETED/DISCONTINUED CODE |D E
|E EXCLUDED BY REGULATION FOR PHY |E E
|N NON-COVERED SERVICE (MEDICARE) $N E
|X STATUTORY EXCLUSION (MEDICARE) |X E
|P SRV INCL IN PER DIEM/CASE RATE IP E
|F MEDICARE FEE NOT SPECIFIED E
|T ANESTH CLM-ENTER TIME UNITS W
$0 ZERO PAYMENT PER CMS |A E
$A APC PAYMENT AMOUNT $A W
|H HCPCS/CPT REQ-NOT FOUND |H W
$H USE PRICER-ADD ALW & |J HLD W
$P USE PRICER & ENTER ALLOWED AMT W
M8 SUBMIT HOSPICE CLM MEDICARE FI E
$S SNF PER DIEM PAYMENT P$ W
ND SERV NOT AUTHORIZED TO NP PROV P2 W
$M MED/SURG PER DIEM PAYMENT P$ W
$I MD/SG ICU PER DIEM PAYMENT P$ W
$T MD/SG TELEMETRY PER DIEM PYMNT P$ W
$R MD/SG ISOLATION PER DIEM PYMNT P$ W
$E EMERGENCY SVCS CONTRACT RATE P$ W
|A NOT PAID UNDER CMS APC FEE SCH |A E
$B BY REPORT PROC/REVIEW REQUIRED W
|C CARRIER PRICED CODE W
|M INVALID/DELETED MODIFIER (CMS) |M E
|S CMS SPECIAL COVERAGE CODE W
D$ MEDICARE DMEPOS SERVICE D$ W
EH NO COVERAGE ESRD AFTER 90 DAYS EH E
SJ POST CARD.SURGERY COMPLICATION SJ E
$Y PSY PER DIEM PAYMENT P$ W
$C CORONARY CARE CASE RATE P$ W
+0 OPEN HISTORICAL: & W
|O NOT PAID UNDER OPPS FEE SCH |O E
A$ INCLUDED IN PART A PAYMENT E
B$ PAID UNDER PART B ONLY E
|2 2ND MODIFIER ONLY-CORRECT CODE |2 W
WR WAIVE AUTH REQUIREMENT W
RI RECOBRO POR SOBREPAGO DE COB RI W
UB US SERVICES MEDICARE ADVANTAGE W
P$ PAID CURRENT CONTRACTED AMOUNT P$ W
$G AMBULATORY SURGERY CASE RATE P$ W
|G PAID PER CMS REHAB PPS |G W
QE REVIEW PHYSICAL EXAM PAYMENT W
|J REIMB BY HOME HEALTH HIPPS |J W
+A PRICE ACCORDING TO CONTRACT W
RS USE CLAIM TYPE CB FOR COB W
|$ HIGH COST DRUG-REVIEW REQUIRED W
$K CURRENT PER MONTHLY RATE $K W
|U URR G MODIFIER REQ BY CMS |U E
(A DRG:INVALID PRINCIPLE DX E
(B DRG:DX CANNOT BE PRINCIPLE E
(C DRG:UNABLE TO GROUP E
(D DRG:INVALID AGE E
(E DRG:INVALID SEX E
(F DRG:INVALID DISCHARGE STATUS E
(G DRG:INVALID AGE-MEDICARE DX E
(H DRG:INVALIDMEDICARE PRIMARY DX E
(I DRG:INVALID MEDICARE PROCEDURE E
(J DRG:MEDICARE AS SECONDARY PAY E
(K DRG:INVALID OTHER DX E
(L DRG:SEX INVALID FOR DIAGNOSIS E
(M DRG:INVALID PROCEDURE |I E
(N DRG:SEX INVALID FOR PROCEDURE E
(O DRG:INVALID LENGTH OF STAY E
(P DRG:MISSING PRINCIPLE DX E
(Q DRG:NONSPECIFIC PRINCIPLE DX E
(R DRG:BIRTHDATE > DISCHARGE DATE E
(S DRG:DUPLICATE DX CODE E
(T DRG:PRINC. DX IS MANIFESTATION E
(U DRG:NONSPECIFIC PRINCIPLE DX E
(V DRG:QUESTIONABLE ADMISSION E
(W DRG:UNACCEPTABLE PRINCIPLE DX E
(X DRG:UNACCEPTABLE DX W/O 2ND DX E
(Y DRG:NONSPECIFIC OR PROCEDURE E
(Z DRG:NONCOVERED PROCEDURE $N E
)A DRG:INVALID PAYER NUMBER E
)B DRG:PAYER REIMB NOT INSTALLED E
)C DRG:TRNS TYP/DISCH STAT CONFL E
)D DRG:ERROR IN DATE ROUTINE E
)E DRG:PROVIDER NOT EFFECTIVE E
)F DRG:INVALID DX FOR DISCH DATE E
)G DRG:MORE SPECIFIC DX REQUIRED E
)H DRG:INVALID PROC FOR DISCH DAT E
)I DRG:MORE SPECIFIC PROC REQUIRE E
)J DRG:INVALID AGE IN DAYS E
)K DRG:BRTHWGHT MUST BE 200-9000G $N E
)L DRG:INVALID CPT PROCEDURE |I E
)M DRG:CPT4 REQUIRED FOR OUTPAT |H E
)N DRG:INVALID CPT FOR SERV DATE |I E
)O DRG:INVALID SEX FOR CPT PROC E
)P DRG:SERV DATE OUTSIDE ADMIT E
)Q DRG:VALIDATE OPEN BIOPSY PERFO W
)R DRG:CPT DATE < ADMIT/ >SERVICE E
)S DRG:HOSP UPIN NOT ON FILE E
)T DRG:BILATERAL PROCEDURE W
)U DRG ERROR $DGE$ E
)V DRG:SIGNIFICANT PROCEDURE W
)W DRG:ANCILLARY CONVENIENCE ITEM $N E
)X DRG:INCIDENTAL PROCEDURE $N E
)Y DRG:ALPHA HCPCS W/APG ASSIGNED E
)Z DRG:GROUPABLE BUT NOT APPLICAB E
(1 DRG:INPATIENT PROCEDURE I W
(2 DRG:INVALID ADMITTING DX CODE |I E
(3 DRG: RESERVED E
(4 DRG: RESERVED E
(5 DRG: RESERVED E
(6 DRG: RESERVED E
(7 DRG: RESERVED E
(8 DRG: RESERVED E
(9 DRG: RESERVED E
?D SUPPORTING DOC REQUIRED ?D E
H$ REHAB HIPPS PAYMENT |G W
XA RECL.AUDITADA NO PROCEDE AJUST XA W
E0 EOB ESTA INCOMPLETO/ILEGIBLE. E0 W
H| HCPCS/CPT CODE REQUIRED-DENY |H E
|Z ZERO FEE| ROUTE TO MED. MGMT. E
$X RED CROSS RATE PAID $X W
+P OVER PER DIEM APC PAYMENT AMT. $A W
>D DENTAL SERVICES >D E
$Q INV REQ.-NEED ACQUISITION COST W
+M OVER PER DIEM MCS PAYMENT AMT. P$ W
|V ALIVIA SERVICE P$ W
HH ENTER HH, HF, HL OR HR CLM TYP W
S& RECL SEG VIDA PND INFORMACION W
R& RELEVO PRIMA REF. CLINICO W
P& PAGO ACELERADO REF.CLINICO W
|Q SRV INCL IN PRICER |Q E
DR VERIFY ESRD DIAG REPORTED W
|0 ZERO ALW AMT IN CMS FEE SCH NC E
¬A DENY-REBILL W/ANESTHESIA CPTS ?A E
EW EYEWARE COVERAGE LIMITATION W
Q9 DX CODE DOES NOT VALIDATE MEDI Q9 E
|Y SERVICE MODIFIER COMBO INVALID |Y E
3Q CODE CLASSIFIED AS NOT PAYABLE 3Q E
6C SOMETER REP O DOCUMENTO APOYO 6C E
7E CASO US REFERIDO W
K7 PROC.ADDED DUE TO REBUNDLING K3 W
K9 PROC.ADDED DUE TO REBUNDLING K3 W
I INPATIENT ONLY SERVICE I E
O OUTPATIENT ONLY SERVICE O E
PG POS INVALID FOR SERVICE CODE BP E
+E OVER PER DIEM ER SERVICES P$ W
ZC MAXIMUN ALLOWABLE CHARGES EXCE ZC E
2K PENDING DRG MANUAL PRICING W
3K CLASSICARE REVIEW W
QB MULTIPLE COMPONENT BILLING Q3 E
QC SERV/PROC INCLUDED IN SURGERY Q4 E
QA DX CODE DOES NOT VALIDATE MEDI Q9 E
-N NON PAR NON CLEAN CLAIM W
@R CMS CURRENT AMB RATE PAID @R W
QD CRITERIA NOT MET/ADD-ON CODE Q1 E
QF ONLY 1 E/M ALLOWABLE PER DATE Q5 E
QH PROC.DESC.INV.FOR GENDER/AGE Q0 E
QG NEW PT CODE FILED WITHIN 3 YRS Q8 E
|K SEE CMS PRICING INSTRUCTIONS W
NC SERV NOT AUTHORIZED TO NP PROV P2 E
$L DIALYSIS PER DIEM PAYMENT P$ W
4K PENDING REEMBOLSO CLASSICARE W
!P INVALID W
FO HELD FOR FONDO COB PRICING W
$F USE SNF PRICER-ADD ALW |F W
QI DUPLICATE CLAIM (CLASSICARE) Q7 E
P+ PAR NON CLEAN CLAIM W
TZ TMG CLAIMS W
PR APC PRICER CLAIM W
FC ORIGINAL CLAIM PAID ON FACETS W
XE INJURY POSSIBLE/THIRD PARTY XE E
PY NPI REQUIRED PY E
8Y DISEASE MNGMT - ASMA/COPD W
8Z DISEASE MNGMT - CARDIOVASCULAR W
*Q MORBID OBESITY - REGISTRY W
C$ CANCELACION DE PERSONAL W
WX ERROR EN PAGO (MCS) W
TA TRANSITION DME W
CB CONTESTÓ INFORMACIÓN DE COB W
CX ASEGURADO CLASSICARE W
U8 RECOBRO POR COB RENAL W
PJ INDIVIDUAL RENDERING NPI REQUI PJ E
QJ ASSISTANT SURGEON DISALLOW W
7C REFERIDO PRE-CERTIFICACIONES W
7D REFERIDO REVISION DE HOSPITALE W
7H REFERIDO POLITICAS MEDICAS W
9A REFERIDO FARMACIA W
P0 MAX.REEMBOLSO $50.00 X PROCED W
7L REFERIDO CONSULTOR MÉDICO W
7K REFERIDO A LA UNIDAD DE COB W
WD REF.-FHC FUNCIONES DELEGADAS W
XP PLAN TO PLAN RECOVERY XP W
AX BR MED POLICY EVALUATION W
AZ CLM REPLACEMENT MANUAL REVIEW W
QK ASISTANT SURGEON DISALLOW QK E
*U LUPUS DX-REGISTRY W
M9 MED NECESSITY DOCUMENT REQ M9 E
M6 AMB MED NECESSITY INCLUDED W
M7 AMBULANCE MED NECESSITY EVAL W
XB P2P - PAYMENT W
NF NPI NO FIGURA EN SISTEMA W
OP PROCEDURE CODE CHANGE CC W
BE BAD VENDOR TMG CHK W
MY AMBULANCE MED NEC NOT MET MY E
OU OUT SIDE US CLAIM RECEIPT PERI OU E
*J HEART TRANSPLANTATION REGISTRY W
UD LEPRA-REGISTRY W
UE HEMOFILIA-REGISTRY W
UF FIBROSIS CISTICA-REGISTRY W
UG ESCLEROSIS MULTIPLE-REGISTRY W
UH ESCLERODERMA-REGISTRY W
UI VENTILADOR MECÁNICO REGISTRY W
B0 REFERRAL REQUIRED, NOT FOUND B0 E
-M AMBULANCE MED NEC NOT MET MY E
97 CHRA INCOMPLETO 97 E
CY INCORRECT CODING CY E
BN ONE BEACON (RE ASEGURO) W
QN BLOODHOUND FIRING NOT ACCEPTED W
UO DENEGACION LUPUS W
U9 SOLICITUD INFORMACION LUPUS W
XQ INV DX CODE REQ 4TH OR 5TH DIG XQ E
4M SOL.INF.ESCLEROSIS MULTIPLE W
4S SOL.INF.ESCLERODERMA W
4L SOL.INFORMACION LEPRA W
4V SOL.INF.VENTILADOR MECANICO W
4T SOLICITUD INF.TRANPLANTE W
4P SOL.INFORMACION HEMOFILIA W
4Q SOL.INF.FIBROSIS QUISTICA W
5Q DENEGACION FIBROSIS QUISTICA W
5P DENEGACION HEMOFILIA W
5T DENEGACION TRANPLANTE W
5E DENEGACION RENAL ESRD W
5V DENEGACION VENTILADOR MECANICO W
5H DENEGACION SIDA/HIV W
5C DENEGACION CANCER W
5L DENEGACION LEPRA W
5S DENEGACION ESCLERODERMA W
5M DENEGACION ESCLEROSIS MULTIPLE W
3C SOL.INFORMACION CANCER W
3H SOL.INFORMACION SIDA/HIV W
3E SOL.INFORMACION RENAL ESRD W
3F SOL.INF.CONDICIONES CONGENITAS W
5F DENEGACION CONDICIONES CONGENI W
IX GLOBAL MEDICAL MANAGEMENT W
DN DEN POR FALTA DE INFORMACION W
DI DEN POR FALTA DE DIAGNOSTICO W
DM DEN POR FALTA DE CRITERIOS W
-P MISSING/INVALID POA INDICATOR POA W
SA SPECIAL ARRANGEMENT W
SB SPECIAL AGREETMENT W
HL MAX.PAY $200 OVERRIDE PER SERV W
TE EXCEEDS TIMELY FELING PERIOD TE E
RU USE CT RU FOR RURAL SERVICES W
R# RURAL SERVICE W
BF MISSING/INVALID PATIENT STATUS BF E
AW MISSING/INVALID SOURCE ADM COD AW E
AV MISSING/INVALID TREAT AUTH COD AV E
AJ MISSING/INVALID HIPPS CODE AJ E
AK RE-CORDING/CL ADJUST PAYMENT AK W
AQ LUPA PAYMENT AQ W
$Z EXCLUDED UNDER NEW TECHNOLOGY $Z E
*6 REFERIDO GMM PARA DESCUENTO W
*7 PD W/GMM DISCOUNT AGREEMENT *7 W
*8 REF. ONE BEACON PARA DESCUENTO W
*9 PD W/ONE BEACON DISC AGREEMENT *9 W
BG INFORMATIVE MEASUREMENT CODE W
SX REC ADJ CLAMS DEPT W