HIPAA/LA Medicaid Error Code Crosswalk
LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 1 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------- B5 B5 B5 B5 B5 B5 B5 B5 B5 B5 B5 B7 B7 B7 B7 B7 B9 B9 B13 B13 B13 B13 B14 B14 B14 19:11:23 NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED REQ NONCOVRD CHARGES ABORTION JUST MAX # CLM LINES EXC BATCHED INCORRECTLY PROCESSING ERROR PROBLEM CODE PD 2YRS CUTBACK-SERV 1 YEAR RXNO USE GR THAN LIM THERAPEUTIC DUP DENY PREGNANCY DENIAL NEW RX REQUIRES PA ONLY-1ST DIAG,VS PD PROV CERT DATE ERROR PROV RATE NOF PROVIDER NOT COVERED BILL PROV NOT ELIG PROVIDER NOT ELIG HOSPICE MUST BILL NON HOSPICE PROVIDER CANNOT ADJUST PREPAY ADJ. DENY HEMA.COMP/IND/BILLED FY COST SETTLED VISIT CODE PD/DOS 1 CONSLT/PHYS/HOSP CONCURRENT CARE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE NOT USED - AVAILABLE CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED CLAIMCHECK RESERVED NON-COVERED CHARGES REQUIRED OR USED FOR PAYMENT DOES NOT MEET PROGRAM CRITERIA FOR ABORTION MAX EXCEEDED FOR ADDED CLAIM LINES-RESUBMIT/CLAIMCHECK BATCHED INCORRECTLY/ RE-ENTER PROCESSING ERROR PROBLEM ORIENTED CODE PAID WITHIN 2 YEARS CUTBACK-REPAIR MUST YIELD DENTURE SERVICEABLE FOR 1 YR USAGE OF SAME RX NUMBER GREATER THAN SYSTEM LIMIT THERAPEUTIC DUPLICATION DENIAL-LIMITED TO SPECIFIC CLAS PREGNANCY PRECAUTION-DENIAL-FDA CATEGORY X NEW RX WILL REQUIRE PA KELOID TREATMENT-ONLY FIRST DIAGNOSTIC VISIT IS PAID PROVIDER CERTIFICATION EXPIRED AS OF DOS PROVIDER FILE DOES NOT CONTAIN VALID RATE FOR DOS PROVIDER NOT COVERED FOR SERVICES RENDERED BY MEDICAID BILLING PROVIDER INELIGIBLE ON DATE OF SERV PROVIDER NOT ELIGIBLE ON DATES OF SERVICE HOSPICE CLIENT -ONLY HOSPICE PROVIDER CAN BILL SUBMIT JUSTIFICATION FOR SERVICES CANNOT ADJUST ZERO-PAID CLAIM FROM PRE-PAY RVW PROCESS ADJUSTMENT DENIED/ORIG CLAIM PAID CORRECTLY HEMATOLOGY COMPONENT/INDICE/PROFILE BILLED INCORRECTLY FISCAL YEAR COST SETTLED VISIT CODE ALREADY PAID FOR THIS DATE OF SERVICE ONLY 1 INITIAL CONSULT-SAME PHYS.PER HOSPITALIZATION CONCURRENT CARE IS NOT COVERED BY THE PROGRAM 393 861 858 875 870 891 886 880 881 824 825 820 821 809 829 831 836 834 841 185 331 947 935 936 696 698 647 482 483 484 488 360 244 213 207 201 382 493 501 367 614 975 644 642 401 N570 N570 N570 N570 N570 M86 M86 M86 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 2 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------B15 B15 B16 B16 B16 B20 B23 B23 1 3 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 5 5 5 5 5 5 6 6 6 6 19:11:23 GLOBAL CODE PD COMPONENT CODE PD NEW PT/EST PT CD CON NEW/EST PT CONFLICT ONGOING CM PRIOR TO PAY ADMIN ONLY NOT PAY W/CLIA CERT CLIA NOT CERT DOS DEDUCT EXCEEDS MAX PAY REDUCED BY COPAY PRIOR PAYMNT REDUCED USE CODE W3340 USE 52 REDUCE SERVIC RESUB W/MOD-50 1UNIT VOID PD CLM-SUB W/50 MODIFIER NOT CORRECT ADJ PD LINE 51 MOD QW MODIFIER NEEDED USE 62/66 MOD,RESUB PA/CLM MOD NOT SAME ADJ SEC,51 AND 62/66 ADJ MAJOR WITH 62/66 ADJ-ADD-ON-WITH-51 CLAIM-NEEDS-80-MOD MOD NOT NEEDED-RESUB USE CORRECT MODIFIER INVLD/MISSNG MODIFR NO SURGERY MODIFIER MOD.NOT USED FOR CLM MOD 51 REQ'D-ADDED MOD 51 INVAL-REMOVED MOD 51 DOESN'T APPLY MOD -50 INVALID UNITS NOT=SITE MOD INVALID PROC/MOD PROC/CLAIM TYP CONFL PROF COMP INVLD POT P/F PLACE RESTRICT POT NOT ICF-I OR II OUTSIDE LAB NOT COVD INV POS/MOD COMBO EPSDT DENT AGE GR 21 ADULT DENTAL-UNDER21 RESTOR NOT ALLOW-AGE EPSDT AGE ERROR GLOBAL CODE PD THIS DOS THIS RECIP COMPONENT CODE PD THIS DOS RECIP NEW PATIENT/ESTABLISHED PATIENT CODE CONFLICT NEW/ESTABLISHED PATIENT CONFLICT ONGOING CM PRIOR TO INITIAL CM ~ ADMINISTRATION ONLY IS REIMBURSABLE NOT PAYABLE WITH CLIA CERT TYPE CLIA # DOES NOT COVER DATE OF SERVICE DEDUCTIBLE EXCEEDS MAXIMUM PAYMENT REDUCED BY COPAY PRIOR PAYMENT REDUCED REBILL USING CODE W3340 WITH APPROPRIATE MODIFER RESUBMIT WITH 52 MODIFIER FOR REDUCED SERVICES BILATERAL-RESUBMIT WITH MODIFIER-50-ONE UNIT BILATERAL-VOID PAID CLAIM-RESUBMIT WITH MOD-50 ONE UNIT INAPPROPRIATE PROCEDURE CODE MODIFIER-REBILL ADJUST PAID LINE WITH 51 MODIFIER THEN RESUBMIT MAJOR QW MODIFIER NEEDED FOR TYPE OF CLIA CERTIFICATE USE OF 62/66 MOD INDICATED BY REPORT;RESUB &/OR ADJUST PA MODIFIER DOES NOT MATCH CLAIM MODIFIER ADJUST SECONDARY PROC WITH 51 MOD AND WITH 62 OR 66 ADJ MAJOR WITH 62 OR 66 THEN SECONDARY (S) WILL BE PAID ADJ ADD-ON CODE WITH 51 MOD THEN REBILL PRIMARY PROC APPEARS TO BE ASSISTANT--REBILL WITH 80 MODIFIER MODIFIER NOT NEEDED-REMOVE AND RESUBMIT CRNA'S MUST BILL CORRECT MODIFIER INVALID OR MISSING MODIFIER CLAIM DESCRIPT INDICATES PROC CODE SHOULD HAVE MODIFIER MODIFIER NOT USED TO PROCESS CLAIM MODIFIER 51 REQUIRED. ADDED TO CLAIM-CLAIMCHECK MODIFIER 51 INVALID. REMOVED FROM CLAIM-CLAIMCHECK MODIFIER 51 DOES NOT APPLY TO THIS PROC CODE-CLAIMCHECK MODIFIER -50 INVALID/CLAIMCHECK UNITS DO NOT MATCH SITE-SPECIFIC MODIFIER/CLAIMCHECK INVALID PROCEDURE-MODIFIER COMBINATION/CLAIMCHECK PROCEDURE CLAIM TYPE CONFLICT INVALID PLACE OF TREATMENT FOR PROF COMP P/F PLACE RESTRICTION PLACE OF TREATMENT MUST BE ICF-I OR ICF-II OUTSIDE LABORATORY SERVICES NOT COVERED INVALID PLACE OF SERVICE/PROCEDURE MODIFIER COMBINATION EPSDT DENTAL CLAIM - RECIPIENT AGE GREATER THAN 21 ADULT DENTAL CLAIM FILED FOR RECIP UNDER 21 RESTORATION NOT ALLOWABLE DUE TO PATIENT AGE EPSDT AGE OVER 21 678 679 702 645 776 649 386 329 480 662 658 669 687 707 710 781 757 475 500 597 561 566 563 397 430 186 092 973 039 934 938 964 961 921 933 182 279 236 243 405 578 604 601 609 631 N20 N20 N517 N517 N517 N517 N517 N519 N517 N517 N517 N519 N517 N517 N517 N517 N517 N517 N519 N517 N519 N517 N519 N519 N519 N519 N519 M77 M77 M77 M77 M77 N129 N129 N129 N129 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 3 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------6 6 6 6 7 7 8 9 10 11 11 11 11 13 14 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 15 16 16 16 16 16 16 16 19:11:23 PROCEDURE-AGE-RESTRT P/F AGE RESTRICTION STERILIZATION < 21 PROC/DX AGE RESTRICT P/F SEX RESTRICTION PROC/SEX CONFLICT PROV PROC CONFLICT DIAG AGE RESTRICTION DIAG SEX RESTRICTION DIAG PROC RESTRICT DENY FOR DIAGNOSIS BILL VISITS--SEE CPT NO ABORTION DONE RECIP INELIG/DECEASE DOS LESS THAN DOB NEGATIVE TPL AMT NOT PA NO NOT ON FILE PROC REQUIRES PA NEED SPANNING DOS PA RECIP NQ CLM RECI PA PROV NQ CLM PROV PA PROC/NDC NE CLM NO PRECERT RESUB DOC CLM/PA DTE MUST MTCH PRECERT NOT ON FILE HOSP STAY REQ PRECRT SURG REQUIRES PRECRT NEED-AUTH-AND-REPORT NONEMER TRANS REQ PA NON-EMER MLS GR 400 DME REQUIRES PA NOT USED - AVAILABLE PA-EMERGENCY-OVERRID PA REQUIRED PA EXPIRED PA TOOTH/CAV NQ CLM ADULT DENTAL REQ PA AIR TRNSPT REQS P/A BILL AS ADJ/CNT STAY DEL HYST/STER CONFLI REBILL CORRECT UNITS PROC:EXTRCT NOT PAY NO ADJ HISTORY ORIG/ADJ PROV DIFF SEAL.NOT PAY.TOOTH PROCEDURE ALLOWED FOR RECIP 0-30 DAYS OLD P/F AGE RESTRICTION STERILIZATION IS NOT COVERED FOR RECIPIENT UNDER 21 PROC/DX NOT COVERED FOR RECIPIENT THIS AGE P/F SEX RESTRICTION PROCEDURE CODE/SEX CONFLICT-CLAIMCHECK PROVIDER NOT CERTIFIED FOR THIS PROCEDURE DIAGNOSIS AGE RESTRICTION DIAG SEX RESTRICTION DIAGNOSIS/PROCEDURE RESTRICTION PROCEDURE DENIED NOT JUSTIFIED BY DIAGNOSIS SEE CPT-MEDICAL TREATMENT OF ABORTION USE E AND M CODES ABORTION NOT DONE-FETUS NOT ALIVE AT TIME OF PROCEDURE RECIPIENT INELIGIBLE/DECEASED DATE OF SERVICE LESS THAN DATE OF BIRTH NEGATIVE TPL AMOUNT NOT ALLOWED PA NUMBER NOT ON FILE PROCEDURE REQUIRES PRIOR AUTHORIZATION MUST HAVE SPANNING DOS IF BILLING FOR TOTAL AUTH AMOUNT CLAIM RECIPIENT ID DOES NOT MATCH ID ON PRIOR AUTH FILE PA PROVIDER ID NOT SAME AS CLAIM PROVIDER ID PA PROCEDURE/NDC NOT EQ CLAIM PROCEDURE/NDC NO HOSP PRECERT ON FILE RESUB WITH DOCUMENTATION CLAIM DATES MUST MATCH PRIOR AUTHORIZATION DATES PRECERT NUMBER NOT ON FILE HOSP STAY REQUIRES PRECERTIFICATION SURGERY REQUIRES PRECERTIFICATION ATTACH BHSF AUTHORIZATION LETTER AND OPERATIVE REPORT NON-EMER TRANSPORTATION REQUIRES PRIOR AUTHORIZATION NON-EMER MILES EXCEED 400-STATE AUTHO REQUIRED DME REQUIRES PRIOR AUTHORIZATION NOT USED - AVAILABLE EMERGENCY OVERRIDE OF DRUG THAT REQUIRES PA MD MUST CALL ULM-PA OPERATIONS STAFF MD MUST CALL ULM-PA OPERATIONS STAFF PA TOOTH/ORAL CAVITY CODE NOT SAME AS CLAIM ADULT DENTAL CLAIM MUST BE PRIOR AUTHORIZED AIR TRANSPT CLAIMS REQUIRES STATE APPROVAL THIS SHOULD BE BILLED AS ADJUST.FOR CNT STAY DELIVERY BILLED AFTER HYSTERECTOMY/STERLIZ WAS DONE UNITS AVAILABLE FOR CODE--REBILL USING UNITS PROCEDURE ON EXTRACTED TOOTH NOT PAYABLE NO HISTORY RECORD ON FILE FOR THIS ADJUSTMENT ORIG/ADJ BILLING PROVIDER NUMBER DIFFERENT SEALANT NOT PAYABLE FOR THIS TOOTH 263 234 332 956 235 584 210 254 255 256 251 476 663 364 211 315 190 191 195 196 197 198 171 172 160 161 165 960 407 408 413 456 487 485 486 598 606 760 755 749 780 779 799 796 608 N129 N129 N129 N129 N517 N517 N95 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N517 N50 MA66 M53 N39 N152 N257 N39 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 4 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 19:11:23 INV TOOTH/CAVITY CDE NOT USED - AVAILABLE REBILL VISIT CODE ONLY LO-LEVEL OFFICE BLK 82/83 SRGN NAME ADJUST PAID LINE SURFACE CODE CONF TOOTH/CAVITY CDE REQ MISS/INV DIAG CODE MISS/INVLD PA/MC COD INV PRESCRIB ID QUAL INVALID MSA CODE MFCTR NOT IN REBATE M/I SERV PRV ID QUAL O/R REQ-SEND TO PA KIDMED FORMAT REQUIR PROV/HOSPICE NO MTCH HCPCS REQ BILLED AMT MUST BE 0 USE INDIV PRESC NO CANNOT BE ADJUSTED LOC NOT ON RECI FILE DENY FOR FILE REVIEW NDC MAY BE OBSOLETE INVALID NDC NDC TERMINATED/CMS GIVE DATE FOR TRANSP QTY OF 1 = 1 VIAL ENC PLAN PMT DT ERR ENC INT PMT ERROR M/I PROF SERV CODE QTY > PACKAGE SIZE MISSING/INVALID DIAG BILL HR CD PRE 15MIN TOT/LOC DAYS CONFL LTC DAYS/DATES CONFL INVLD RATE FOR LOC PSRO DATES MISSING MUST SPLIT BILL INV ZERO BILLED DAYS OCCUR DATES CONFLICT SPAN DAYS CONFLICT LTC SNF/DTE ERR SPAN DATE INVALID INV LTC CERT DATE INVALID TOOTH CODE/ORAL CAVITY DESIGNATOR NOT USED - AVAILABLE CRITICAL CARE/CONSULT NOT DOCUMENTED-BILL CORRECT VISIT ONLY LOW LEVEL OFF VISIT ALLOWED NEED SURGEONS NAME IN BLOCK 82 OR 83 ON UB92 ONLY A PAID LINE/THE CORRECT PAID LINE CAN BE ADJUSTED CLAIM DOES NOT INDICATE CORRECT NUMBER OF SURFACES TOOTH CODE/ORAL CAVITY DESIGNATOR REQUIRED MISSING OR INVALID DIAGNOSIS CODE MISSING OR INVALID PA/MC CODE OR NUMBER FOR RX OVERRIDE INVALID PRESCRIBER ID QUALIFIER MUST BE 01 OR 05 MSA CODE IS INVALID MANUFACTURER HAS NOT ENTERED INTO HCFA REBATE AGREEMENT MISSING/INVALID SERVICE PROVIDER ID QUALIFIER OVERRIDE REQUIRED-SEND TO DENTAL PA UNIT CLAIM MUST BE SUBMITTED IN KIDMED FORMAT PROV ID NO ON CLAIM MUST MATCH PROV ID NO ON RECI FILE HCPCS REQUIRED VACCINES FROM VFC AT NO COST-BILLED AMT MUST BE 0 PRESCRIBING PRVI BILLED IS GROUP USE INDIVIDUAL PRES NO ADJUSTMENT IS INVALID, VOID AND REBILL LEVEL OF CARE NOT ON RECIPIENT FILE DENY FOR REVIEW / CALL POS HELP DESK NDC POSSIBLY OBSOLETE INVALID NDC - NOT AVAILABLE CMS NOTIFIED US THAT NDC IS TERMINATED TRANSPLANT DISCHARGE DATE OR OTHER DX NEEDED DRUG IS A VIAL. QUANTITY OF 1 = 1 VIAL PLAN PAYMENT DATE ON ENCOUNTER IS MISSING OR INVALID INTEREST PAYMENT ON PLAN ENCOUNTER IS INVALID MISSING/INVALID PROFESSIONAL SERVICE CODE QUANTITY EXCEEDS PACKAGE SIZE MISSING/INVALID DIAGNOSIS CODE BILL CM HOUR CODE BEFORE 15 MIN CODE TO-DAY / TOT-DAYS / STATUS CONFLICT LTC LOC DAYS CONFLICT WITH LTC LOC FROM AND THRU DATES NO VALID RATE WAS FOUND FOR LTC LEVEL OF CARE PSRO DATES MISSING - DATE PRIOR TO 070183 SPAN FROM & THRU DATES CONFLICT MUST SPLIT BILL DAYS ZERO, PATIENT STATUS NOT 9 OCCUR CODES/DATES CONFLICT SPAN DAYS/NON COVERED DAYS CONFLICT LTC SNF THRU DATE IN ERROR SPAN DATE NOT ALLOWED MUST BILL PER DAY LTC CERTIFICATION DATE INVALID 613 632 636 638 681 693 602 603 575 576 497 494 472 509 515 517 511 513 520 521 523 525 459 460 465 462 448 437 414 417 431 432 433 426 356 357 358 342 344 345 339 340 350 351 352 N37 MA30 N56 M51 N261 N152 N75 N37 MA63 M62 N31 M49 M119 N253 M76 N34 N521 M20 M79 N31 N152 N54 N65 M119 M119 M119 N341 N378 N480 M49 N56 N378 M76 M20 M53 M53 N65 N299 N300 M53 M46 MA33 M59 N63 N322 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 5 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 19:11:23 SRV DTE PRIOR CERTIF NOT USED - AVAILABLE REFER PHYSICIAN REQD CLIA # NOT ON FILE ADJ DAYS CONFL HIST NO MEDICARE PAID DTE INSUFFICIENT DATA PT STAT REQ HOSP LVE RESUB SURGEONS CODE PROC INAPPROPRIATE DENY TO BE REBILLED ANESTH TIME MISSING SPEND DOWN FORM BILL 3RD PARTY CARRI BILL ONE PROC.PER L EFF 11/5/10 NDC REQU UNITS NOT=SVC DAY INV ADMISSION DATE ADMIT DTE GT SERV FM REBILL CORRECT HCPC INVALID TOT DOC CHG INVAL/MISS PROC CODE INV ACCOMODATION DAY INV ACCOM/ANCILL CHG INV ANCILLARY CHARGE INVALID UB92 BILL CD INV ATTENDING PHYS INV NATURE OF ADMIT INV PATIENT STATUS INV PATIENT STAT DTE PAT STAT DTE GT THRU INVALID/MISS PROC INV/CONFLIC SURG DTE INVALID COVERED DAYS INVALID NET AMOUNT INVALID APPROVED DYS INVALID CLM TYP MOD INVALID PROVIDER NO INVAL SERV FROM DATE INVAL SERV THRU DATE SERV THRU LT SERV FM ORG CLM W ADJ/VD ICN INVALID ACCIDENT IND INVALID ACCID IND SERV THR GT ENTR DTE SERVICE DATE IS PRIOR TO LTC CERTIFICATION DATE NOT USED - AVAILABLE REFERRING/ATTENDING PHYSICIAN REQUIRED NO CLIA # ON OUR FILE ADJUSTMENT DAYS CONFLICT WITH HISTORY DAYS MEDICARE PAYMENT DATE IS MISSING OR INVALID UNABLE TO PROCESS/REBILL/ATTENTION P.MISNER PT STATUS CODE 1 REQUIRES HOSPITAL ABSENT DAYS RESUBMIT CLAIM USING CODE SURGEON BILLED INAPPROPRIATE PROCEDURE - SEE CPT FOR VALID CODE MEDICARE DENIED,IF COVERED BILL WITH PROVIDER EOB ANESTHESIA MINUTES INVALID OR MISSING SPEND DOWN FORM 110MNP INVALID/MISSING PLEASE BILL THIRD PARTY CARRIER FIRST BILL ONE PROCEDURE PER LINE FOR EACH DATE OF SERVICE EFF 11/5/10 PAS FOR THIS HCPC REQUIRES CORRECT NDC CODE UNITS DO NOT MATCH DATES OF SERVICE/CLAIMCHECK ADMISSION DATE MISSING OR INVALID ADMISSION DATE GREATER THAN SERVICE FROM DATE ASC,OP FAC/PHYS.BILLED DIFF CODE;REBILL CORRECT HCPC TOTAL DOCUMENT CHARGE MISSING OR NOT NUMERIC INVALID OR MISSING PROCEDURE CODE ACCOMODATION DAYS MISSING OR INVALID ACCOMODATION/ANCILLARY CHARGE MISSING OR INVALID ANCILLARY CHARGE INVALID INVALID UB92 TYPE BILL CODE ATTENDING PHYSICIAN NUMBER NOT NUMERIC NATURE OF ADMISSION MISSING OR INVALID PATIENT STATUS CODE INVALID OR MISSING PATIENT STATUS DATE MISSING OR INVALID PATIENT STATUS DATE GREATER THAN THRU DATE INVALID OR MISSING PROCEDURE CODE INVALID/CONFLICT SURGICAL DATE COVERED HOSPITAL DAYS NOT NUMERIC OR MISSING THE NET BILLED AMOUNT IS NOT NUMERIC THE APPROVED STAY DAYS IS NOT NUMERIC INVALID CLAIM TYPE MODIFIER PROVIDER NUMBER MISSING OR NOT NUMERIC SERVICE FROM DATE MISSING/INVALID INVALID OR MISSING THRU DATE SERVICE THRU DATE LESS THAN SERVICE FROM DATE ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID ICN ACCIDENT INDICATOR MUST BE Y,N,SPACE ACCIDENT INDICATOR NOT Y, N OR SPACE SERVICE THRU DATE GREATER THAN DATE OF ENTRY 353 398 400 387 376 378 374 375 959 954 940 949 943 932 930 924 914 040 041 035 026 028 053 055 056 042 043 044 045 046 047 048 049 060 064 062 001 002 005 006 007 013 015 016 009 M52 N56 N286 MA120 M53 MA04 MA130 M46 N56 N56 MA04 N203 N58 MA92 N63 M119 N345 MA40 MA40 M20 M54 M51 M53 M79 M79 MA30 N290 MA41 MA43 M59 M59 M51 N301 MA32 M54 MA32 N34 N77 M52 M59 MA31 MA30 N305 N305 MA31 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 6 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 19:11:23 INVALID TPL INDICATR ORG CLM W/ADJ/VD CDE INVALID PRIM DIAGNOS INVALID SECOND DIAG INVAL/MISS DIAG CODE INVALID FORMER REFNO INVALID BILLED CHRGS INV PARTIAL RECIP INV BILLING PROV NO INAPPROPRIATE CODE, PROC/SERV REND CONF DIA CODE/DESC CONF STAMPED SIGNATURE. INVALID ADJ REASON COMP A-MODE ECHOENCH SYS CALC NET TOTAL DENIED TO REBILL/ADJ CLM RECIP NO MATCH DOS NOT PRECERT COVD LTC PROV NOT MATCHED LON/LOC NOT MATCHED CLM PROV ID NO MATCH BILL PROV NPI NOF REBILL W/APPROP CODE SERV PROV NPI NOF REF/PCP PROV NPI NOF BILL PROV NPI NO MAT SER PROV NPI NO MATC REF/PCP NPI NO MATCH 9F REF AUTH MISSING MIXED ICD CODE SETS QTY EXCEEDS MAX SITE # INVALD OR NOF DOS NOT COVERED/PA PROV/ATTEND NOF BILL PROV NOT ON FIL SURGERY PROC NOF INVALID COVERED DAYS INVALID ADMIT DATE INVALID BLOOD DEDUCT CHARGES MISSING INVALID DEDUCTIBLE REVENUE CODE MISSING MISSING PINTS BLOOD FROM THRU NOT EQUAL TPL INDICATOR NOT Y, N, OR SPACE ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID REASON CODE PRIMARY DIAGNOSIS AS CODED NOT ON FILE SECONDARY DIAGNOSIS INVALID INVALID OR MISSING DIAGNOSIS CODE FORMER REFERENCE NUMBER MISSING OR INVALID BILLED CHARGES MISSING OR NOT NUMERIC RECIPIENT NAME IS MISSING BILLING PROVIDER NUMBER NOT NUMERIC INAPPROPRIATE CODE, BILL LAB OR SPECIFIC HANDLING. PROCEDURE CODE DOES NOT REFLECT SERVICES RENDERED DIAGNOSIS CODE/DESCRIPTION CONFLICT STAMPED SIGNATURE NOT ALLOWED. INVALID ADJUSTMENT REASON COMPLETE A-MODE ECHOENCHEPHALOGRAPHY-BILL HCPC Z9100 SYSTEM CALCULATED TOTAL - NET BILLED NOT IN BALANCE DENIED TO BE REBILLED ON ADJUSTMENT FORM. CLAIM RECIP ID DOES NOT MATCH ID ON PRECERT FILE CLAIM DOS NOT PRECERT COVERED LTC PROV NOT MATCHED LEVEL OF NEED / LEVEL OF CARE NOT MATCHED CLAIM PROVIDER ID DOES NOT MATCH ID ON PRECERT FILE BILLING PROVIDER NPI MISSING/NOT ON FILE ONE ADJUNCT CODE ALLOWED PER DDS: REBILL W/APPROP CODE SERVING PROVIDER NPI MISSING/NOT ON FILE REF OR PCP PROVIDER NPI MISSING/NOT ON FILE BILLING PROVIDER NPI MISMATCH SERVICING PROVIDER NPI MISMATCH REFERRING/PCP NPI MISMATCH 9F REFERENCE AUTHORIZATION MISSING IN LOOP 2300 CLAIM CONTAIN MIXED ICD CODE SETS QUANTITY EXCEEDS MAX MD FAX OVERRIDE FOR 866-797-2329 SITE NUMBER INVALID OR NOT ON FILE DATE ON CLAIM NOT COVERED BY PA PROVIDER/ATTENDING PROVIDER NOT ON FILE BILLING PROVIDER NOT ON FILE SURGICAL PROCEDURE NOT ON FILE THE COVERED DAYS WAS NOT A VALID NUMERIC AMOUNT THE ADMISSION DATE WAS NOT A VALID DATE THE BLOOD DEDUCTIBLE FIGURE MUST BE NUMERIC NO CHARGES/COINS/DEDUCT GIVEN THE DEDUCTIBLE FIGURE MUST BE NUMERIC REVENUE CODE MISSING/INVALID MISSING PINTS BLOOD CONDITION CODE 40 FROM THRU NOT EQUAL 011 012 018 019 020 021 022 023 024 970 968 974 976 980 997 983 987 166 163 159 173 167 142 139 143 144 145 146 147 148 151 153 154 193 200 206 183 181 180 178 175 176 093 094 095 MA92 MA30 MA63 M64 MA63 M47 M79 MA36 N257 N56 N56 MA63 MA70 MA69 M20 M54 N34 N54 N54 N257 M50 N54 N257 N56 N290 N286 N257 N290 N286 M62 N657 N378 M77 N54 N289 N257 M51 MA32 MA40 M49 M54 N480 M50 M53 M52 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 7 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 19:11:23 REVENUE CHG MISSING BILL-CODE-REQ-MC-CHG PROC CD MUST 5 DIGIT NDC PRICE MISSING INVALID STATUS DATE INVALID STATUS CODE INVALID SERVICE CODE INVALID TREAT PLACE INVALID UNITS/VISITS MISSINVAL COINS DAY INVALID ORIGIN CODE M/I INCENTIVE AMOUNT REF PROV NO. NOF ATTEND MUST=BILLING FOUND NO PSRO CODE INV DME PA AMOUNT STMT FRM LT SERV FRM STMT THRU GT SRV THR INV OCCUR DATE INV STMT COVERS FROM INV STMT COVER THRU INVLD SIGNATURE IND INVALID NON-COVERED INV POINT ORIGIN MISSING NDC INVALID MAC INDICATR PRESCRIB PROV NPI NO DENY PROV. 9999999 PRIMARY DX NOF SECONDARY DX NOF REBILL W/ALL DETAILS NO ELIG SERVICE PAID QTY INVALID/MISSING MISS OR INV PRESCRIB INVALID RX DATE INVALID DAYS SUPPLY PRESCRIP NO MISSING INVALID SURFACE INV TOOTH/CAVITY CDE INDICTR/CPT CONFLICT INV/MISSING HCPCS HCPC CD NOT ON FILE COV DAYS NE ACCOM STMT DTE/ACCOM CONFL PSRO FROM LT ST FROM REVENUE CHARGE MISSING OR INVALID BILL CLASS 2 REQUIRES MEDICARE ALLOWED AMOUNT IN LOC#54 PROCEDURE CODE MUST BE 5 NUMERIC CHARACTERS NDC PRICE MISSING, CALL MYERS&STAUFFER @ 1-800-591-1183 INVALID OR MISSING PATIENT STATUS DATE INVALID PATIENT STATUS CODE INVALID SERVICE CODE INVALID OR MISSING PLACE OF TREATMENT INVALID OR MISSING UNITS, VISITS, AND STUDIES MISSING OR INVALID COINSURANCE DAYS INVALID ORIGIN CODE MISSING/INVALID INCENTIVE AMOUNT REFERRING PROVIDER NUMBER NOT ON FILE ATTENDING PROV MUST EQUAL BILLING PSRO CODE MISSING OR INVALID PRIOR AUTHORIZATION AMOUNT NOT NUMERIC STATEMENT COVERS FROM DATE LESS THAN SERVICE FROM DATE STATEMENT COVERS THRU DATE IS GREATER THAN SERVICE THRU INVALID OCCURRENCE DATE STATEMENT COVERS FROM DATE INVALID STATEMENT COVERS THRU DATE INVALID THE SIGNATURE INDICATOR MUST BE Y, N, OR BLANK NON COVERED HOSP DAYS NOT NUMERIC OR MISSING INVALID POINT OF ORIGIN NDC CODE MISSING OR INCORRECT. THE MAC OVERRIDE INDICATOR MUST BE A 'C' PRESCRIBING PROV NPI MISSING/NOT ON FILE ALL PROVIDERS 9999999 TO BE DENY. PRIMARY DIAGNOSIS NOT ON FILE SECONDARY DIAGNOSIS NOT ON FILE ADJUNCT CD RPTD AS ONLY DETAIL LNE: REBILL W/ALL DETAIL NO ELIGIBLE SERVICE PAID - ENCOUNTER DENIED QUANTITY INVALID/MISSING A PRESCRIBING PHYSICIAN NPI OR MEDICAID ID REQUIRED RX DATE MISSING OR INVALID DAYS SUPPLY MISSING,NOT NUMERIC, OR ZERO PRESCRIPTION NUMBER MISSING INVALID TOOTH SURFACE CODE INVALID TOOTH CODE/ORAL CAVITY DESIGNATOR INDICATOR 3 INVALID WITH CPT CODES-PCP REFERRAL REQ INVALID OR MISSING HCPCS HCPC CODE NOT ON FILE COVERED DAYS DO NOT EQUAL ACCOMODATION DAYS STATEMENT DATES CONFLICT WITH ACCOMODATION DAYS PSRO FROM DATE LESS THAN STATEMENT FROM DATE 096 098 100 101 081 082 083 084 085 087 088 089 090 077 079 076 073 074 069 071 072 065 067 068 127 128 129 130 131 132 138 136 120 121 122 124 125 102 103 104 114 115 316 317 321 M79 MA04 M51 N65 M59 MA43 M51 M77 M53 M53 MA42 N190 N286 N77 M44 N54 M52 M59 M46 M52 M59 MA75 MA33 MA42 M119 M62 N257 N257 MA63 M64 N56 N657 M53 N31 N57 M53 N388 N75 N37 N56 M20 N65 MA32 M53 N300 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 8 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 16 18 18 18 18 18 18 18 18 18 18 19:11:23 SURG DATE MISSING SURG PROC MISSING SURG DTE LT SRV FROM EXCEEDS MAX DAILY TPL/PRIVATE PROC/DESC CONFLICT INV DENY FOR PROV NO SALES TAX NOT ON CLM MANUAL PRICE GR BILL PAYMENT GR BILLED CH TPL RESOURCE REQ EOB INV BABY/MTHR PROC HOSPICE DAYS > 5 ADMISN MUST BE EMER INVALID PROC CODE INVALID BIRTHDATE P/F DATE RESTRICTION INV PAC CALL HELP DK PRICE MISSING ON P/F PRICE MISSING ON U/C NDC NOT ON P/F FILE PROCEDURE CODE NOF DIAGNOSIS NOT ON FIL DIAG DATE RESTRICT INPUT SPENDDOWN AMT DELETED,BILL CURR CD INVAL PROC TOS TRANS INPUT M-CARE PD AMT. ANESTHESIA UNITS NOF PAS-LOS 90TH EQ ZERO SPAN DATES/QUANT DIF INVALID AMB SURG REV REQ-ICD9-SURGICAL-CD INVALID-TREATMENT-PL ANES.CPT N/C-M'AID NOT USED - AVAILABLE DUP DRUG THERAPY CANNOT REVERSE CLAIM EXACT DUPE 16 TO 02 EXACT DUPE 16 TO 16 EXACT DUPE 17 TO 01 SUSPCT DUPE 16 TO 02 SUSPCT DUPE 16 TO 16 DUPLICATE SERVICES NO MULTI - PROVIDERS DATE OF SURGERY MISSING SURGICAL PROCEDURE MISSING DATE OF SURGERY LESS THAN SERVICE FROM DATE EXCEEDS MAX DAILY DOSE MD FAX OVERRIDE FORM866-797-2329 3RD PARTY CARRIER CODE MISSING-REFER TO CARRIER CD.LIST PROCEDURE CODE/DESCRIPTION CONFLICT INVALID PROVIDER NUMBER WHEN DENY APPLIED SALES TAXES NOT PRESENT ON RX CLAIM WITH TPL MANUAL PRICE EXCEEDS BILLED CHARGES PAYMENT EXCEEDS BILLED CHARGES/REQUIRES REVIEW NO EOB ATTACHED FOR RECIP WITH OTHER RESOURCE INDICATED BABY AND MOTHER - SURGICAL PROCEDURE MUST BE DELIVERY INPATIENT RESPITE DAYS GREATER THAN FIVE EMERGENCY ACCESS HOSP - NATURE OF ADMISN MUST BE EMER INVALID PROCEDURE CODE FOR DATE-OF-SERVICE INVALID BIRTHDATE ON RECIPIENT FILE PROCEDURE/NDC NOT COVERED FOR SERVICE DATE GIVEN INVALD PAC VS DOS / CALL HELP DESK PRICE MISSING FOR DATE OF SERVICE ON P/F CALL HELP DESK U AND C FILE - NO VALID PRICE FOR DOS NDC CODE NOT ON FILE PROCEDURE/TYPE OF SERVICE NOT COVERED BY PROGRAM DIAGNOSIS NOT ON FILE DIAG DATE RESTRICTION 110-MNP REQUIRED FOR RECIP LIABILITY AMOUNT DELETED,BILL CURRENT CODE INVALID PROCEDURE TOS FOR TRANSPORTATION INSERT PROVIDER PAID AMOUNT BY MEDICARE ANESTHESIA BASE UNITS ARE NOT ON FILE DX CODE REQUIRES 5TH DIGIT TO CALCULATE PAS DAYS DIFFERENCE BETWEEN SERVICE DATES AND QUANT REV CODE INVALID FOR AMBULATORY SURG PROC. REVENUE CODE 490 REQUIRES VALID ICD9 SURGICAL PROCEDURE TREATMENT PLACE IS INCORRECT ANES.CPT NOT COVERED FOR MEDICAID ONLY-BILL SURG+MOD. NOT USED - AVAILABLE DUPLICATE DRUG THERAPY PHARMACY CLAIM CANNOT BE REVERSED EXACT DUP ERROR: ADULT DAY CARE AND LTC EXACT DUPE: IDENTICAL ADULT DAY CARE CLAIMS EXACT DUPE: HABILITATION AND HOSPITAL SUSPCT DUPE: ADULT DAY CARE AND LTC SUSPCT DUPE: IDENTICAL ADULT DAY CARE CLAIMS DUPLICATE UNILATERAL/BILATERAL SERVICE-CLAIMCHECK MULTIPLE PROVIDERS WILL NOT BE PAID FOR THIS PROCEDURE 309 307 310 325 273 288 289 283 284 285 290 305 303 301 298 224 233 238 239 240 231 232 252 253 242 248 245 261 260 257 258 266 267 268 269 926 445 516 502 503 504 552 553 554 550 MA31 M51 MA31 N378 MA92 M51 N77 M54 M49 M49 MA04 N56 MA31 MA41 N56 N329 N56 N65 N65 N65 M119 N56 MA63 M76 N58 M20 N56 MA92 M53 M76 M53 M50 M51 M77 N34 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 9 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 19:11:23 HOSP DISCHARGE PAID MHR SERV PD THIS DOS SAME SPEC/SUBSP PAID 2ND. VISIT SAME DAY INITIAL HOSP INPT PD PREV PD ANES-SAME RE DUP ADJ. RECORD INPT SER PD SAME ATT HIST ALREADY ADJSTED ON-LINE DUPE DENY EXACT DUPE 01 TO 01 SAME ATTD PD IP CONS FND DUP SERV SM DAY EXACT DUPE 11 TO 11 EXACT DUPE 12 TO 12 EXACT DUPE 13 TO 13 EXACT DUPE 04 TO 13 EXACT DUPE 14 TO 14 EXACT DUPE 15 TO 15 EXACT DUPE 12 TO 15 PD SAME ATTEN/DIF BL UNSPECIF SUSPCT DUPE SUSPCT DUPE 01 TO 01 SUSPCT DUPE 01 TO 14 SUSPCT DUPE 02 TO 02 SUSPCT DUPE 02 TO 14 SUSPCT DUPE 03 TO 03 EXACT DUPE 09 TO 09 EXACT DUPE 09 TO 13 EXACT DUPE 09 TO 15 EXACT DUPE 10 TO 10 EXACT DUPE 08 TO 13 EXACT DUPE 08 TO 08 EXACT DUPE 07 TO 15 EXACT DUPE 07 TO 09 EXACT DUPE 03 TO 09 EXACT DUPE 03 TO 13 EXACT DUPE 03 TO 15 EXACT DUPE 04 TO 04 EXACT DUPE 04 TO 15 EXACT DUPE 05 TO 05 EXACT DUPE 05 TO 06 EXACT DUPE 05 TO 07 EXACT DUPE 05 TO 08 EXACT DUPE 05 TO 09 ONE HOSPITAL DISCHARGE SERVICE PAID PER ADMISSION MHR SERVICES ALREADY PAID FOR THIS DATE OF SERVICE SAME SPECIALTY/SUBSPECIALTY PAID ON SAME DATE OF SERV FOUND DUPLICATE VISIT SAME DAY ONE INITIAL HOSPITAL INPATIENT SERVICE PAID PER ADMISS PREVIOUSLY PAID ANES.OR SUPERVISING ANES,SAME RECI/DOS DUPLICATE ADJUSTMENT RECORDS ENTERED INPT HOSP SERV PAID FOR SAME DOS TO SAME ATTENDING PROV HISTORY RECORD ALREADY ADJUSTED DUPLICATE OF PREVIOUSLY PAID CLAIM EXACT DUPLICATE ERROR: IDENTICAL HOSPITAL CLAIMS SAME ATTENDING PROV PAID INPT CONSULTATION SAME STAY FOUND DUPLICATE SERVICE SAME DAY EXACT DUPLICATE ERROR: IDENTICAL DENTAL-ADULT CLAIMS EXACT DUPLICATE ERROR: IDENTICAL PHARMACY CLAIMS EXACT DUPLICATE ERROR: IDENTICAL EPSDT CLAIMS EXACT DUPLICATE ERROR: PHYSICIAN AND EPSDT EXACT DUPLICATE ERROR: IDENTICAL TITLE18 INST CLAIMS EXACT DUPLICATE ERROR: IDENTICAL TITLE18 PROF CLAIMS EXACT DUPLICATE ERROR:IDENTICAL DRUG & PARTB MC CLAIMS ALREADY PAID SAME ATTENDING DIFFERENT BILLING PROVIDER SUSPECT DUPLICATE OF PREVIOUSLY PROCESSED CLAIM SUSPCT DUPLICATE ERROR: IDENTICAL HOSPITAL CLAIMS SUSPT DUPLICATE ERROR: HOSPITAL AND TITLE18 SUSPCT DUPLICATE ERROR: IDENTICAL LTC CLAIMS SUSPCT DUPLICATE ERROR LTC AND TITLE18-INSTITUTIONAL SUSPCT DUPLICATE ERROR: IDENTICAL OUTPATIENT CLAIMS EXACT DUPLICATE ERROR: IDENTICAL DURABLE-EQUIP CLAIMS EXACT DUPLICATE ERROR: DURABLE-EQUIPMENT AND EPSDT EXACT DUPLICATE ERROR: DURABLE-EQUIPMENT AND TITLE18 EXACT DUPLICATE ERROR: IDENTICAL DENTAL-EPSDT CLAIMS EXACT DUPLICATE ERRORS: NON-AMBULANCE AND EPSDT EXACT DUPLICATE ERROR: IDENTICAL NON-AMBULANCE CLAIMS EXACT DUPLICATE ERROR: AMBULANCE AND TITLE18 EXACT DUPLICATE ERROR: AMBULANCE AND DURABLE-EQUIP EXACT DUPLICATE ERROR: OUTPATIENT AND DURABLE-EQUIPMENT EXACT DUPLICATE ERROR: OUTPATIENT AND EPSDT EXACT DUPLICATE ERROR: OUTPATIENT AND TITLE18 EXACT DUPLICATE ERROR: IDENTICAL PHYSICIAN CLAIMS EXACT DUPLICATE ERROR: PHYSICIAN AND TITLE18 EXACT DUPLICATE ERROR: IDENTICAL REHAB-SERVICES CLAIMS EXACT DUPLICATE ERROR: REHAB-SERVICES AND HOME HEALTH EXACT DUPLICATE ERROR: REHAB-SERVICES AND AMBULANCE EXACT DUPLICATE ERROR: REHAB-SERVICES AND NON-AMBULANCE EXACT DUPLICATE ERROR: REHAB-SERVICES AND DURABLE EQUIP 695 689 711 715 712 735 797 794 798 800 801 746 758 842 843 844 845 846 847 848 849 850 851 852 853 854 855 837 838 839 840 835 833 832 830 810 811 812 813 814 815 816 817 818 819 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 10 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 18 22 22 22 22 22 22 22 22 22 22 22 22 22 19:11:23 EXACT DUPE 01 TO 14 EXACT DUPE 02 TO 02 EXACT DUPE 02 TO 14 EXACT DUPE 03 TO 03 EXACT DUPE 03 TO 05 EXACT DUPE 03 TO 06 EXACT DUPE 03 TO 07 EXACT DUPE 06 TO 06 EXACT DUPE 06 TO 07 EXACT DUPE 06 TO 13 EXACT DUPE 06-14 EXACT DUPE 07 TO 07 SUSPCT DUPE 07 TO 15 SUSPCT DUPE 08 TO 08 SUSPCT DUPE 11 TO 11 SUSPCT DUPE 12 TO 12 SUSPCT DUPE 13 TO 13 SUSPCT DUPE 13 TO 15 SUSPCT DUPE 14 TO 14 SUSPCT DUPE 15 TO 15 EXACT DUPE SAME ICN SUSPCT DUPE 09 TO 09 SUSPCT DUPE 09 TO 15 SUSPCT DUPE 10 TO 10 SUSPECT DUPE 05-14 SUSPCT DUPE 06 TO 06 SUSPECT DUPE 06-14 SUSPCT DUPE 07 TO 07 SUSPCT DUPE 03 TO 15 SUSPCT DUPE 04 TO 04 SUSPCT DUPE 04 TO 15 SUSPCT DUPE 05 TO 05 MEDICARE-COVERAGE BILL MEDICARE PART D BILL MEDICARE PART B RECI IS MEDCARETCHOI LACHIP AFFORDABLE EDITED FOR MEDICARE EDITED FOR INSURANCE BILL MEDICARE FIRST COV MDCARE IF INSULI BILL MEDCARE NEB MED DENY TO BE REBILLED COVERED BY MEDICARE BANKRUPT.FILE W/CARR EXACT DUPLICATE ERROR: HOSPITAL AND TITLE18-INSTITUTION EXACT DUPLICATE ERROR: IDENTICAL LTC CLAIMS EXACT DUPLICATE ERROR: LTC AND TITLE18-INSTITUTIONAL EXACT DUPLICATE ERROR: IDENTICAL OUTPATIENT CLAIMS EXACT DUPLICATE ERROR: OUTPATIENT AND REHAB SERVICES EXACT DUPLICATE ERROR: OUTPATIENT AND HOME HEALTH EXACT DUPLICATE ERROR: OUTPATIENT AND AMBULANCE EXACT DUPLICATE ERROR: IDENTICAL HOME HEALTH CLAIMS EXACT DUPLICATE ERROR: HOME HEALTH AND AMBULANCE EXACT DUPLICATE ERROR: HOME HEALTH AND EPSDT EXACT DUPE ERROR-HOME HEALTH & TITLE 18 EXACT DUPLICATE ERROR: IDENTICAL AMBULANCE CLAIMS SUSPECT DUPLICATE ERROR: AMBULANCE AND TITLE18 SUSPECT DUPLICATE ERROR: IDENTICAL NON-AMBULANCE CLAIMS SUSPECT DUPLICATE ERROR: IDENTICAL DENTAL-ADULT CLAIMS SUSPECT DUPLICATE ERROR: IDENTICAL PHARMACY CLAIMS SUSPECT DUPLICATE ERROR: IDENTICAL EPSDT CLAIMS SUSPECT DUPLICATE ERROR: EPSDT AND TITLE18 CLAIMS SUSPECT DUPLICATE ERROR: IDENTICAL TITLE18-INST CLAIMS SUSPECT DUPLICATE ERROR: IDENTICAL TITLE18-PROF CLAIMS EXACT DUPE SAME ICN - DROPPED SUSPECT DUPLICATE ERROR: IDENTICAL DURABLE-EQUIP CLAIMS SUSPECT DUPLICATE ERROR: DME AND TITLE18 CLAIMS SUSPECT DUPLICATE ERROR: IDENTICAL DENTAL-EPSDT CLAIMS SUSPECT DUPE ERROR-REHAB SERVICES & TITLE 18 SUSPCT DUPLICATE ERROR: IDENTICAL HOME HEALTH CLAIMS SUSPECT DUPE ERROR-HOME HEALTH & TILE 18 SUSPCT DUPLICATE ERROR: IDENTICAL AMBULANCE CLAIMS SUSPCT DUPLICATE ERROR: OUTPATIENT AND TITLE18-PROF SUSPCT DUPLICATE ERROR:IDENTICAL PHYSICIAN CLAIMS SUSPCT DUPLICATE ERROR: PHYSICIAN AND TITLE18-PROF SUSPEC DUPLICATE ERROR: IDENTICAL REHAB-SERVICES CLAIMS CLM VOID/ADJ BY STATE**RECIPIENT HAS MEDICARE COVERAGE BILL MEDICARE PART D BILL MEDICARE PART B RECIPIENT IS MEDICARETCHOICE LACHIP AFFORDABLE SUBMIT CLAIM TO BCBS EDITED FOR MEDICARE -SERV. PAYABLE EDITED FOR INSURANCE SERV. PAYABLE BILL MEDICARE FIRST BASED ON DISCHARG DATE ITEM COVERED BY MEDICARE IF REC IS INSULIN TREATED BILL MEDICARE NEBULIZER MED DENY TO BE REBILLED TO MEDICARE ITEM COVERED BY MEDICARE DECLARED BANKRUPTCY.FILE W/CARRIER FOR POSSIBLE PMTS. 802 803 804 805 806 807 808 822 823 826 827 828 882 883 892 893 894 895 896 897 898 887 889 890 871 872 877 878 862 863 864 865 661 535 536 590 528 473 474 449 467 434 341 988 297 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 11 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------22 22 22 23 23 23 23 23 23 23 23 23 24 24 24 24 24 24 24 24 26 27 27 27 29 29 29 29 29 29 29 29 29 29 29 29 31 31 31 31 31 31 31 35 35 19:11:23 POSSIBLE TPL RECIP MEDICARE ELIG RECIP ELIG MEDICARE MEDICARE PAID 100% PD PATIENT RESP AMT MCAID PD ALLOWABLE DENIED PER TPL EOB REDUCED BY TPL NOT PAID BY MEDICARE MC-CROSSOVER-ADJVOID OBRA 90 EXCLUDED DRU MC-XOVER-NON-FINANCE CLAIM FROM BYU UHC CLAIM FROM BYU CHS SUBMIT CLAIM TO SMO UTILIZE HMO ELIG FOR PACE ONLY SUBMIT TO PREPAID PL NOT USED - AVAILABLE BH XOVER SENT TO SMO NOT HCBS LOCKED IN RECIP RECYC 3 TIMES. RECYC RECI INELG DOS RECIPIENT NOT ELIG CLAIM OVER 90 DAYS SER HOSPICE RELATED CLAIM OVER 1 YEAR CLAIM OVER 180 DAYS MEDICARE CLAIM > 6MO SERV MORE THAN 12 MO SERV THRU DT TOO OLD KIDMED TIMELY FILLIN TIMELY FILING REVIEW NOT USED - AVAILABLE NEW PRESC OVER 10 DA REFILL OVER 6 MONTHS NOT CCM ELIGIBLE RECIPIENT # INVALID QMB NOT MED. ELIG. RECYC RECIP NOF RECYC RECIP N/O FILE RECIPIENT NOT ON FIL RECIP NOT XREF OVER LIFETIME LIMIT EXCEEDS MAX DURATION POSSIBLE THIRD PARTY LIABILITY RECIPIENT IS MEDICARE ELIGIBLE RECIPIENT POSSIBLY ELIGIBLE FOR MEDICARE ALLOWABLE AMOUNT PAID IN FULL BY MEDICARE PAID PATIENT RESPONSIBILITY AMT PER THE EOB PRIMARY INS NON-COVERED SERVICE - MCAID ALLOWABLE PAID DENIED PER THE TPL EOB INFORMATION MEDICAID ALLOWABLE AMOUNT REDUCED BY OTHER INSURANCE NOT PAID BY MEDICARE MEDICARE CROSSOVER ADJUSTMENT OR VOID OBRA 90 EXCUDED DRUG PAID BY MEDICAID MEDICARE CROSSOVER ADJUSTMENT MON-FINANCIAL CLAIM SUBMITTED TO MOLINA BY BYU UHC (UNITED) CLAIM SUBMITTED TO MOLINA BY BYU CHS (COMMUNITY) SUBMIT CLAIM TO LBHP SMO MUST UTILIZE HMO SERVICES CAPITATED-SERVICE MUST BE AUTHORIZE/PAID BY PACE PROVDR SUBMIT TO RECIPIENTS PREPAID PLAN NOT USED - AVAILABLE BEHAVIORAL HEALTH CROSSOVER SENT TO SMO(MAGELLAN) NOT HCBS LOCKED IN RECIPIENT INELIGIBLE RECYCLED THREE TIMES RECYCLED RECIPIENT INELIG ON DOS RECIPIENT NOT ELIGIBLE ON DATE OF SERVICE CLAIM EXCEEDS 90 DAY FILING LIMIT (PHARMACY) HOSPICE RELATED/SUB BILL TO HOSPICE 30 DAYS TO APPEAL CLAIM EXCEEDS 1 YEAR FILING LIMIT CLAIMS EXCEEDS 180 DAY FILING LIMIT CLAIM EXCEEDS FILLING LIMIT COIN/DEDUCT. SERVICE MORE THAN 12 MONTHS OLD SERV THRU DATE MORE THAN TWO YEARS OLD KM CLAIMS SHOULD BE SUBMITTED WITHIN 60 DAYS OF SERVICE ATTACHMENT REQUIRES REVIEW/FILING DEADLINE NOT USED - AVAILABLE NEW PRESCRIPTION MUST BE FILLED WITHIN 10 DAYS REFILL MUST BE FILLED WITHIN 6 MONTHS RECIPIENT NOT ELIG FOR THIS SERVICE-ON DATE OF SERVICE RECIPIENT NUMBER INVALID OR LESS THAN 13 DIGITS QMB NOT MEDICAID ELIGIBLE RECIPIENT NOT ON FILE RECYCLED 3 TIMES RECYCLED RECIPIENT NOT 0N FILE RECIPIENT NOT ON FILE NO MEDICAID ID FOUND FOR MEDICARE ID LIFETIME LIMITS FOR THIS SERVICE HAVE BEEN EXCEEDED EXCEEDS MAX DURATION MD FAX OVERRIDE FORM 866-797-2329 274 275 278 972 928 929 931 918 944 937 537 639 666 667 555 490 524 507 425 133 109 295 293 216 270 271 272 322 971 029 030 435 371 653 654 655 738 003 330 294 223 215 174 917 697 N52 N30 N30 N30 N30 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 12 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------35 39 39 49 50 50 50 50 50 50 50 50 50 54 54 55 55 59 59 59 59 59 59 59 59 59 59 59 59 59 59 59 59 59 60 95 95 95 96 96 96 96 96 96 96 19:11:23 MAX SERVICE LIFETIME PRECERT NOT APPROVED PA NOT APPROVED PAN & IND CODE/ PANE MED NEC INSUFFICIENT SEND EPSDT REFERRAL SEND MED NECESSITY NEED EPSDT & MED NEC SONOS NOT JUSTIFIED DG USE NOT WARRENTED PSRO/UR CLAIM DENIED DME COVERAGE ONLY PROC/DIAG NO MED NEC ASSIST SURG INVALID SUR ASST NOT NEEDED NOT USED - AVAILABLE INVEST,EXPER,OR NOT DENY SPANDATE/UVS >1 SUB VOID,REBILL ANES PP CARE INCL IN DEL INVALID W/O PRIMARY CLAIMCHECK RESERVED PP PREVIOUSLY PAID CCI:HIST VOIDED-INC INVALID W/O PRIMARY CCI:INCIDENTAL-CURR CCI:INCIDENTAL-HIST ALL BUT MAJ. NEED 51 HST PROC VOIDED-REB LINE ADDED-REB INCIDENTAL PROC/HIST HIST PROC VOIDED-INC INCIDENTAL PROC/CURR MULTIPLE SURGERY EXACT DUPE 01 TO 03 SEE MED SERV MANUAL DUR DATA UNNECESSARY NOT EMC ELIGIBLE REBILL-BABYS INFO 2 PROC SAME TOTH/DAY DENY, NOT TO REBILL DENIED PER SURS CUTBACK PER SURS DISCH DATE NOT COV NOT COVERED BE HH MAXIMUM SERVICES EXCEEDED-LIFETIME/CLAIMCHECK PRECERT HAS NOT BEEN APPROVED PA HAS NOT BEEN APPROVED BILLED PANEL AND INDIVIDUAL CODE WITHIN PANEL DOCUMENTATION OF MEDICAL NECESSITY INSUFFICIENT SEND EPSDT REFERRAL AND PROOF OF MEDICAL NECESSITY SEND PROOF OF MEDICAL NECESSITY AND EPSDT REFERRAL NEED EPSDT REFERRAL AND PROOF OF MEDICAL NECESSITY DOCUMENTATION DOES NOT JUSTIFY ADDITIONAL SONOGRAMS DRUG USE NOT WARRENTED PSRO/ UR CLAIM DENIED ITEM COVERED UNDER DURABLE MED EQUIP. PROG ONLY PROCEDURE/DIAGNOSIS NOT MEDICALLY NECESSARY ASSISTANT SURGEON INVALID FOR THIS PROCEDURE/CLAIMCHECK PROCEDURE DOES NOT WARRANT SURGICAL ASSIST NOT USED - AVAILABLE NOT COVERED-IS INVESTIG.,EXPERI.OR NOT MED.NECESSARY SPANDATE OR UVS>1 WILL DENY-BILL LA ST TX DATE AND UVS= SUBMIT VOID THEN REBILL ANESTHESIA PP CARE INCLUDED IN REIMBURSEMENT FOR DELIVERY/CLAIMCHK PROCEDURE INVALID W/O PRIMARY PD/CLAIMCHECK CLAIMCHECK RESERVED POSTPARTUM CARE PREVIOUSLY PAID-EXCEEDS MAX/CLAIMCHECK CCI:HISTORY PROCEDURE INCIDENTAL TO CURRENT-HIST VOIDED ADD-ON PROCEDURE INVALID WITHOUT PRIMARY/CLAIMCHECK CCI:PROCEDURE INCIDENTAL TO ANOTHER CURRENT PROCEDURE CCI:PROCEDURE INCIDENTAL TO PROCEDURE IN HISTORY CANNOT PAY MAJOR UNTIL SECONDARY IS PAID AT 50% HISTORY PROC VOIDED DUE TO REBUNDLING/CLAIMCHECK CLAIM LINE ADDED AS A RESULT OF CLAIMCHECK REBUNDLING PROCEDURE INCIDENTAL TO PROC IN HISTORY-CLAIMCHECK HISTORY PROC VOIDED-INCIDENTAL TO CURRENT/CLAIMCHECK PROCEDURE INCIDENTAL TO PROC ON CURR CLAIM-CLAIMCHECK MULTIPLE SURGERY - PENDED FOR MANUAL PRICING OUTPATIENT AND INPATIENT HOSPITAL SERVICES ON SAME DAY MATERNITY ANES. SEE PG. 10-5 OF MEDICAL SERVICES MANUAL DUR DATA UNNECESSARY FOR CONFLICT,INTERVENTION,OUTCOME PROVIDER NOT APPROVED FOR EMC BY STATE OFS REBILL-BABYS MID & MOTHERS D/C DATE AS BABYS ADMIT DATE EMERGENCY/DEFINITIVE NOT PAYABLE ON SAME TOOTH/SAME DAY DENIED BY MEDICARE, NOT COVERED BY MEDICAID DENIED PER SURS GUIDELINES CUTBACK PER SURS GUIDELINES DATE OF DISCHARGE NOT COVERED SERVICE NOT COVERED BY HOME HEALTH PROGRAM 564 162 192 619 625 626 627 628 599 531 070 099 957 558 721 998 119 168 036 969 967 981 977 982 945 731 759 560 549 546 573 574 567 403 622 637 479 031 986 990 942 941 939 951 965 M86 N225 N225 N225 N225 N225 N180 N10 N180 N163 N15 N20 N425 N35 N35 N174 N174 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 13 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 19:11:23 ICF-MR LIMIT OVER 45 LTC MED-LOA OVER 15 LTC HOME LV OVER MAX LTC HOME LVD OVER 9 DESI-NOT PAYABLE LTC CERT DTE BAD GRP NOT ON INDIV REC NOT IN GROUP ON DOS POST-OP XRAY REQUIRE PATIENT NOT COVERED PRV TYPE AGE RESTRIC CHANGING AGAIN PROC NOT COV BY FP PROV MUST BE INDIV PRESCRIB PROV ONLY GRP MST BILL FOR PRV SVC OVERLAPS REC ELI GEN ASST - NOT COVRD EPSDT REFER OVER 21 P.E. - NOT COVERED P/F PROV SPEC RESTRT PROC/DRUG NOTCOVERED HIGH VARIANCE ERROR NH/ICF NOT COVERED SUBMIT TO FI DRUG-DRUG INTERACTIO NOT HOSPICE ELIGIBLE PA APRVD PROC DELETD MOTH/NEWBRN BILL SEP NON WAIVER PAY IP NOT LTC ELIGIBLE HOSP LEAVE DAY ADJ. ADJ. REL BUDGET CUTS NH OFFSET ER TRANSPORT OFFSET CT NOT COV FP IP SERV NOT COV FP PRE-PAY REVIEW 0-PAY HOME LEAVE DAYS > 15 ICF-MR LV OVER MAX REHAB CTR SRV NOT CO HOSP LEAVE DAYS > 7 LTC LV DAYS OVER MAX RECIP NOT COVER,DRUG HOME LEAVE DAY REDUC ICF-MR HOME LEAVE EXCEEDS ANNUAL MAXIMUM ALLOWED (45) LTC LEAVE DAYS EXCEED LIMIT - 15 PER HOSPITAL STAY LTC LEAVE DAYS EXCEED LIMIT LTC HOME LEAVE EXCEEDS ANNUAL MAXIMUM ALLOWED (9) DESI INEFFECTIVE-NOT PAYABLE LTC CERTIFICATION DATE INVALID OR MISSING BILLING PROV NOT ON ATTENDING PROV RECORD ON DOS ATTENDING PROV NOT IN GROUP ON DATE OF SERV POST-OP XRAY REPORT REQUIRED SEND TO DENTAL PA UNIT PATIENT NOT COVERED FOR PHARMACY SERVICE PROV TYPE SERVICES NOT COVERED FOR RECIPIENT THIS AGE THIS IS A CHANGED ERROR PROCEDURE IS NOT COVERED BY THE FAMILY PLANNING PROGRAM ATTENDING PROVIDER MUST BE INDIVIDUAL PRESCRIBER ONLY-CALL 1-800-473-2783 FOR INFO GROUP MUST BILL FOR PROVIDER RECIPIENT INELIGIBLE ON ONE OR MORE SERVICE DATE(S) STATE ONLY ASSISTANCE - SERVICE NOT COVERED EPSDT REFERRAL FOR RECIPIENT OVER 21 CLAIM NOT COVERED FOR PRESUM ELIG RECIP P/F PROVIDER SPECIALTY RESTRICTION PROC/DRUG NOT COVERED BY MEDICAID HIGH VARIANCE ERROR NOT COVERED FOR RECIPIENT IN NH/ICF SUBMIT CLAIM TO FISCAL INTERMEDIARY,NOT BYU OR LBHP PLN DRUG TO DRUG INTERACTION-DENY NOT HOSPICE ELIGIBLE PRIOR AUTHORIZATION APPROVED PRIOR TO DELETION OF CODE MOTHER/NEWBORN MUST BE BILLED SEPARATE WAIVER SVC NOT PAYABLE WHILE IP NOT LTC ELIGIBLE HOSP LEAVE DAY ADJ. REL TO MEDICAID SPENDING RED PLAN ADJUSTMENT RELATED TO MEDICAID SPENDING REDUCTION PLAN NH OFFSET ADJ. REL TO M'CAID SPEND REDUCT PLAN $1.11 ER TRANSPORT OFFSET REL TO M'CAID SPEND RED PLAN CLAIM TYPE/FORMAT NOT COVERED BY THE FP PROGRAM INPATIENT SERVICES ARE NOT COVERED BY THE FP PROGRAM ZERO PAID DUE TO PRE-PAYMENT REVIEW HOME LEAVE DAYS EXCEED 15 ICF-MR HOME LEAVE IN EXCESS OF MAXIMUM 22/30 BUDGET CUT REHAB CENTER SERVICES NOT COVERED-NURSING HOME RESIDENT HOSPITAL LEAVE DAYS EXCEED 7 LTC HOSP LEAVE DAYS IN EXCESS OF MAXIMUM-5-BUDGET CUT RECIPIENT NOT COVERED FOR THIS DRUG HOME LEAVE DAYS REDUCED TO ONE/HALF PER DIEM 910 905 902 909 149 150 204 205 177 135 108 111 091 212 208 209 222 221 219 225 237 299 276 328 313 471 495 534 522 508 568 569 570 571 572 544 541 551 396 392 394 395 391 388 379 N43 N43 N43 N43 N448 N351 N55 N55 N435 N30 N30 N10 N30 N55 N95 N55 N30 N30 N30 N30 N95 N643 N372 M97 N52 M80 N30 N448 N15 M2 N30 MA67 MA67 MA67 MA67 N30 N30 N10 N43 N43 N174 N43 N43 N30 N59 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 14 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 96 19:11:23 PAYABLE QMB RECIP NOT COVERED NH RESID NOT COVERED NH RESID LTC-MED-LOA-OVER-10 OFS 24 NOT ON FILE S/C EXCDS 80% C-CARE INVALID TYPE CASE NOT PAY FOR MED NEED PSYCH SERV NOT COVER NOT USED - AVAILABLE REFILLS NOT PAYABLE SCH2 NARC OVER 5 DAY SCH2 NARC NO REFILL NDC OBSOLETE/MFTR MFT SAYS FOOD SUPPLM THIS SERV NOT PAYABL PYMNT INCDL DELV FEE URINALYSIS NOT BILLE NOT USED - AVAILABLE PULPOTOMY NO PAY-PER PIN NOT PAY THIS TOO PAY RED TO STATE MAX HOSP CUTBACK APPLIED RED TO MULTI-SRC MAX REBIL W/ONE PRIM CDE 1 INP HSP VST PER DA TO BE BILLED BY PROV BILL EMERG OV/XRAY EXCEEDS DAILY MAX EXCEEDS MAX DOLLAR EXCEEDS DAILY MAX EMERG COMB XRAY ONLY ER VISIT/INP HOS SER AID/RN/PT NO SAME DY REPR DENIED 1 YEAR REFERRED TO P.A. 1-INTRAOCULAR-LEN-AL REBILL-DELIVERY 3 HOSP VISIT SERV PD PAY CUT SAME TOOTH SUSPCT DUPE 05 TO 06 SUSPCT DUPE 05 TO 07 SUSPCT DUPE 05 TO 08 SUSPCT DUPE 05 TO 09 SUSPCT DUPE 03 TO 08 PAYABLE ONLY FOR QMB RECIP NOT COVERED FOR NURSING HOME RESIDENT DIABETIC SUPPLIES NOT COVERED FOR LTC RECIPIENT LTC LEAVE DAYS EXCEED LIMIT - 10 PER HOSPITAL STAY OFS 24 NOT ON FILE SERVICE CHARGE EXCEEDS 80% OF COMPARABLE CARE RECIPIENT NOT COVERED FOR THIS SERVICE NOT PAYABLE FOR MED NEEDY PROGRAM PSYCHIATRIC SERVICES NOT COVERED UNDER HOME HEALTH NOT USED - AVAILABLE REFILLS NOT PAYABLE SCHEDULE 2 NARCOTIC NOT FILLED WITHIN 5 DAYS SCHEDULE 2 NARCOTIC CANNOT BE REFILLED MANUFACTURER NOTIFIED US THAT NDC IS OBSOLETE MANUFACTURER HAS IDENTIFIED PRODUCT AS FOOD SUPPLEMENT THIS CHIROPRACTIC SERVICE NO LONGER PAYABLE PAYMENT INCLUDED IN DELIVERY FEE URINEALYSIS BILLED INCORRECTLY NOT USED - AVAILABLE PULPOTOMY NOT PAYABLE FOR PERMANENT TOOTH PIN NOT PAYABLE FOR THIS TOOTH PAYMENT MADE AT STATE MAXIMUM HOSPITAL CUTBACK APPLIED PAYMENT REDUCED TO MULTI-SOURCE MAXIMUM REBILL.ONLY ONE PRIMARY VACCINE ADMIN CODE ALLOWED/DAY ONE INP HOSP INITIAL/SUBSEQ CARE VISIT ALLOWED PER DAY MUST BE BILLED BY PROVIDER OF SERVICE EMERGENCY CANNOT BE COMBINED WITH CODES OTHER THAN XRAY EXCEEDS DAILY SERVICE MAXIMUM EXCEEDS MAXIMUM DOLLAR AMOUNT PER TOOTH EXCEEDS DAILY SERVICE MAXIUM EMERGENCY CAN BE COMBINED WITH X-RAY ONLY ER VISIT ON DATE OF INP HOS SERVICES AIDE/RN/PT VISIT SAME DAY NOT ALLOWED/H.HEALTH REPAIR DENIED FOR 1 YR POST INSERTION TO BE REVIEWED BY PRIOR AUTHORIZATION;DO NOT RESUBMIT ONLY ONE PROCEDURE V2630,V2631,V2632 ALLOWED PER RECIP REBILL DELIVERY (DELIVERY-SURGERY) CODE & OFFICE VISIT 3 HOSPITAL INPATIENT SERV PAID FOR SAME DATE OF SERVICE PAYMENT CUTBACK SAME TOOTH SUSPCT DUPLICATE ERROR: REHAB-SERVICES AND HOME HEALTH SUSPCT DUPLICATE ERROR: REHAB-SERVICES AND AMBULANCE SUSPCT DUPLICATE ERROR: REHAB-SERVICES AND NON-AMBULANC SUSPCT DUPLICATE ERROR: REHAB-SERVICES AND DME SUSPCT DUPLICATE ERROR: OUTPATIENT AND NON-AMBULANCE 377 384 385 381 363 348 349 429 427 421 461 453 452 438 439 624 617 618 610 611 612 650 651 660 659 730 720 722 727 724 714 719 704 705 699 769 740 753 790 775 866 867 868 869 859 N30 N174 N174 N43 N194 N372 N30 N30 N174 N54 N410 N410 N410 N448 N59 N30 N20 M86 N174 N174 N174 N381 N381 N381 N362 N20 N32 M80 N20 N59 N20 M80 N20 N20 M86 N10 M86 N61 N20 N59 N20 N20 N20 N20 N20 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 15 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------96 96 96 96 96 96 96 96 96 96 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 97 19:11:23 SUSPCT DUPE 06 TO 13 SUSPCT DUPE 06 TO 07 SUSPCT DUPE 06 TO 08 SUSPCT DUPE 09 TO 13 SUSPCT DUPE 12 TO 15 SUSPCT DUPE 08 TO 09 SUSPCT DUPE 08 TO 13 SUSPCT DUPE 07 TO 08 ONLY EXM&XRAY ON DOS SUSPCT DUPE 01 TO 06 INC IN RELATED SERV IN TRANSPLANT FEE CLM BYPASS CC EDITS CLM BYPASS PAM EDITS FEE IN SCREEN. FEE SEPARATE CHGS EPIS. INCLD TOTAL OB CARE FOLLOW UP VS CHG ICFMR RESPONSIBILITY PAYMENT IN SURG FEE REBILL SURGERY SERVICE IN PD 77427 EVAL & MGT PD DOS SEPARATE NB CARE CHG SEP.CHG.FETAL MONIT CODE INC FRAMES/LENS PROC INCLUDED IN OV MULTI-CHANN TEST SEP D&C/BIOP-CERVIX CRG BLOOD COMP + PANEL URINE COMP + PANEL VOID REBILL VISIT PAID. DO NOT REBILL VOID COMPON,REBILL VOID REBILL HIGH COD HIGH CODE TRIAD PAID SERV. IN MED SCREEN. PROC REB REL TO CURR PROC REB REL TO HIST ADJ INTO PAID LINE HIST PROC VOIDED-PST E&M NOT PAYABLE/CURR E&M NOT PAYABLE/HIST HIST PROC VOIDED/VIS PROC SPL REL TO CURR SUSPCT DUPLICATE ERROR: HOME HEALTH AND EPSDT SUSPCT DUPLICATE ERROR: HOME HEALTH AND AMBULANCE SUSPCT DUPLICATE ERROR: HOME HEALTH AND NON-AMBULANCE SUSPECT DUPLICATE ERROR: DURABLE-EQUIPMENT AND EPSDT SUSPECT DUPLICATE ERROR:DRUG & PARTB MC CLAIMS SUSPECT DUPLICATE ERROR: NON-AMBULANCE AND DME CLAIMS SUSPECT DUPLICATE ERROR: NON-AMBULANCE AND EPSDT CLAIMS SUSPCT DUPLICATE ERROR: AMBULANCE AND NON-AMBULANCE ONLY EXAM&XRAY MAY BE ON SAME DOS AS FULL MOUTH DEBRIDE SUSPCT DUPLICATE ERROR: OUTPATIENT AND HOME-HEALTH INCLUDED IN RELATED SERVICE INCLUDED IN GLOBAL FEE FOR TRANSPLANT CLAIM BYPASSED THE CLAIMCHECK EDITS CLAIM BYPASSED THE PAM EDITS/CLAIMCHECK FEE INCLUDED IN SCREENING FEE EPISIOTOMY INCLUDED IN DELIVERY CHARGE INCLUDED IN FEE FOR TOTAL OB CARE. CONSULT FOLLOW-UP VISITS NOT ALLOWED. ICFMR FACILITY IS REQUIRED TO PROVIDE THIS SERVICE PAYMENT INCLUDED IN SURGERY FEE VISIT PAID IN GSP.VOID VISIT;REBILL SURGERY SERVICE INCLUDED IN PAID 77427 EVAL AND MGT CODE PAID FOR THIS DOS FOLLOWUP NB CARE BILLED SEPARATELY FETAL MONITORING INCLUDED IN DELIVERY FEE CD 00089 INCL FRAME&LENS-HIST INDIC COMP PMT PROCEDURE INCLUDED IN THE PHYSICIAN VISIT PANEL AUTOMATED MULTICHANNEL TEST SEE CPT-CODE 57520 INCLUDES D&C/DO NOT BILL CODE 58120 BLOOD COMPONENT BILLED ALONG WITH PANEL CODE URINE COMPONENT BILLED ALONG WITH PANEL CODE VOID PAID URINALYSIS REBILL VISIT INCLUDED IN PAID PRE/POSTNATAL CAREVISIT. DO NOT REBILL VOID COMPONENTS, REBILL PANEL CODE VOID PAID CODE; REBILL HIGHER CODE IN TRIAD HIGHER CODE IN TRIAD ALREADY PAID SERVICE INCLUDED IN MED SCREENING PROCEDURE REBUNDLED DUE TO CURRENT CLAIM/CLAIMCHECK PROCEDURE REBUNDLED DUE TO HISTORY CLAIM/CLAIMCHECK COMBINE CHARGES AND ADJUST THIS LINE INTO THE PAID LINE HISTORY PROC VOIDED-POST-OP PERIOD OF CURR/CLAIMCHECK E&M CODE NOT PAYABLE SAME DAY-CURR/CLAIMCHECK E&M CODE NOT PAYABLE SAME DAY-HIST/CLAIMCHECK HISTORY PROC VOIDED-E&M NOT PAYABLE/CLAIMCHECK PROCEDURE SPLIT TO ALLOW PARTIAL PAYMENT/CLAIMCHECK 876 873 874 888 899 884 885 879 856 857 774 773 792 795 737 703 700 701 688 690 691 672 673 706 708 718 716 713 725 728 729 670 671 633 634 635 383 547 548 580 591 592 593 594 595 N20 N20 N20 N20 N20 N20 N20 N20 M80 N20 M80 M144 N130 N130 N20 N19 M144 M86 M97 M144 M80 M80 M80 M86 M144 N20 N122 N20 N122 N122 N122 N20 M80 M15 M15 N20 N390 M15 M144 N20 N20 N20 N123 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 16 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------97 97 97 97 97 97 97 97 97 97 97 106 107 107 107 107 107 109 110 115 115 115 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 19:11:23 LINE ADDED-SPL PRE-OP PROC/CURR PRE-OP PROC/HIST HIST PROC VOIDED-PRE POST-OP PROC/CURR POST-OP PROC/HIST VISIT INC. SURG CHGS PRE-OP INC IN SURG. INC IN OV/RELAT PROC INC IN MAJ SUR PROC PROCEDURE IN PANEL CLAIMCHECK RESERVED CLAIM REQ DETAIL REBIL W/APP PRIM CDE VACCINE/ADM CONFLICT PRIMARY CODE DENIED RESTORATIVE/SURG REQ ENC DENIED BY PLAN SERV FRM GT ENTR DTE TRIP CANC BY DISPTCH TRIP CANCELED NONPAY 2A,2B-RX NOT FILLED ONE H.HLTH AIDE/DAY EXCEEDS 3 TREATMENTS SERV, MAX 1 PER MO NO SERV EXCEEDS MAX EXCEEDS MAX-23 DAYS RECIP EXCD HM/LV DYS FP VISIT OVER MAX UNITS > DAILY MAX UNITS 33-47 HOME LEAVE DAYS ADJ MAX SERVICE SAME DAY OVERRIDE OF RX LIMIT ALLOW 1 PER 7 YEARS CLM RECD NO CC EDITS KATRINA EVACUE/CAT11 EXCEEDS MAX ER REVS KATRINA EVACU/PARISH SERVICE ALREADY PAID NO OF RX GR THAN LIM EYEWEAR DENIED JUSTIFY OVER 1/A/YR ABORT PD MOTHER LIFE EXCEEDS-MAX-UNITS-AL CLAIM LINE ADDED AS A RESULT OF CLAIMCHECK SPLIT PROCEDURE DENIED IN PRE-OP PERIOD-CURR/CLAIMCHECK PROCEDURE DENIED IN PRE-OP PERIOD-HIST/CLAIMCHECK HISTORY PROC VOIDED-PRE-OP PERIOD OF CURR/CLAIMCHECK PROCEDURE DENIED IN POST-OP PERIOD-CURR/CLAIMCHECK PROCEDURE DENIED IN POST-OP PERIOD-HIST/CLAIMCHECK OFFICE VISIT CONS. BILLED SEP. FROM SURG FEE PRE-OP INCLUDED IN TOTAL SURGICAL FEE INCLUDED IN OFFICE VISIT/RELATED PROCEDURE INCLUDED IN MAJOR SURGICAL PROCEDURE PROCEDURE INCLUDED IN PANEL RESERVED FOR CLAIMCHECK CLAIM REQUIRES DETAILED BILLING MUST BE BILLED WITH APPROPRITATE PRIMARY CODE VACC & ADM MUST PAY/AGREE;IF ONLY ONE PAYS TOTAL DENIES PAYABLE ONLY IF PRIMARY CODE IS PAID RESTORATIVE AND/OR SURGICAL SERVICE REQ ON SAME DOS DENIED ENCOUNTER SUBMITTED BY PLAN SERVICE FROM DATE LATER THAN DATE PROCESSED TRIP CANCELED BY DISPATCH (CLAIM VOIDED) TRIP CANCELED NON PAYABLE OUTCOME 2A OR 2B -RX NOT FILLED -TRANSACTION REPORTING ONLY ONE HOME HEALTH AIDE VISIT ALLOWED PER DAY EXCEEDS THREE CHIRO TREATMENTS SAME DAY SERVICE EXCEEDS MAXIMUM ALLOWABLE OF 1 PER MONTH NUMBER OF SERVICES EXCEEDS STATE MAX/ CUTBACK APPLIED EXCEEDS MAXIMUM MONTHLY DAYS RECIPIENT HAS USED THE MAXIMUM HOME LEAVE DAYS OF 25 FP VISIT EXCEEDS ANNUAL MAXIMUM ALL OWED UNITS EXCEED MAXIMUM DAILY ALLOWED LIMIT UNITS PAID BETWEEN 33 AND 47 HOME LEAVE DAYS AT 75% MAXIMUM SERVICES EXCEEDED SAME DAY/CLAIMCHECK OVERRIDE OF MONTHLY PRESCRIPTION LIMIT ONLY 1 OF THESE PROCS IN 7 YEARS PER RECIP/PROVIDER CLAIM DID NOT RECEIVE CLAIMCHECK EDITS HURRICAN KATRINA EVACUEE/AID CAT 11 EXCEEDS MAXIMUM ER REVENUE CODES PER VISIT HURRICANE KATRINA EVACUEE/PARISH RECIPIENT WAS REIMBURSED FOR THIS SERVICE NUMBER OF PRESCRIPTIONS GREATER THAN LIMIT LIMITATION MET - SUBMIT JUSTIFICATION FOR ADD'L EYEWEAR SEND DOC TO JUSTIFY OVER ONE PROCEDURE PER YEAR ABORTION PAID MOTHERS LIFE ENDANGERED RECIPIENT HAS EXCEEDED MAXIMUM ALLOWED SERVICES PER 6MO 596 585 586 587 588 589 281 282 952 948 991 995 539 615 675 676 677 134 008 188 199 441 423 406 390 402 347 361 540 542 543 559 565 577 510 505 526 533 527 530 498 469 477 680 734 N123 M144 M144 M144 M144 M144 N390 M144 M80 N19 N122 N36 M86 M86 M86 N362 N362 N362 M86 N362 N45 N45 N362 N45 M86 N45 N45 N362 N45 N111 N362 N435 N435 N45 M86 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 17 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 119 19:11:23 95165-90 DAYS PROV RESPONSIBLE/SVC FOUND TWO PANEL CODE ONE PANEL/PREGNANCY PAN & IND CODE/ PANE OVER LMT PER PREG ALLOW 1 PER 8 YEARS 1 PAYABLE/180 DAYS OVER MAX DURATION EXCEEDS DAY MAX VISI EXCEEDS DAY MAX VISI EXCEEDS MAX,PHYS,YRS EXCEEDS MAX/HOSPITAL EXCEEDS-MAX-UNITS-AL ONLY 1 PER YEAR/RECI ALLOW 1 PER 5 YEARS PREG EXCEEDED 1 DEL.ALLOW. 6MTH.SP PCA SERV LIMIT EXCEE CODE CONFLICT ABORTION INCEST-PAID ABORTION RAPE-PAID SEND DATED NOTES EXCEEDS MO LIMIT LIFETIME LIMITS-ONE UNITS WERE CUTBACK EXCEEDS LIMIT OF 8 AUTH.PORT X-RAY ONE ER CDE PER VISIT DEFRA REDUCTION MAX:2DAYS TRSFR MHIS PROV ALLOW 1 PROC/CM O.P.AUTH. EXT. NEED MC-PAYMENT-REDUCED PAID ACC TO MED REV MAX SERVICE SAME DAY HH VISITS OVER 50 EXCEEDS MAX ALLOWED PHY/CLINIC OVER MAX NEEDS MANUAL CUTBACK SVC BEYOND TIME LIM HOSP DAYS OVER MAX PENICL INJ OVER 12 PHY/HOSP VIS OVER MX EMERG OP OVER 3 95165-90 DAYS PROVIDER RESPONSIBLE FOR THIS SERVICE MAX ALLOW ONE PANEL A DAY/BILLING PROVIDER ONLY ONE PRENATAL LAB PANEL PER PREGNANCY ONE URINALYSIS,PER PREGNANCY PAYABLE EXCEEDS LIMIT PER PREGNANCY ONLY 1 OF THESE PROCES IN 8 YEARS PER RECIP/PROVIDER ONLY ONE (1) PAYABLE PER 180 DAYS EXCEEDS MAXIMUM DURATION OF THERAPY EXCEEDS DAILY MAXIMUM VISITS PER PROVIDER/SPECIALTY EXCEEDS DAILY MAXIMUM ALLOWED VISITS EXCEEDS MAXIMUM ALLOWED BY SAME PHYSICIAN W/I 3 YEARS EXCEEDS MAXIMUM ALLOWED PER HOSPITALIZATION RECIPIENT HAS EXCEEDED MAXIMUM ALLOWED SERVICES PER YR ONLY 1 D0120/D0272/D1110/D1120/D1203/D1204 PER YR/RECI ONLY 1 OF THESE PROCS ALLOWED IN 5 YEARS PER RECIP/PROV MAX PER PREGNANCY EXCEEDED ONLY 1 DELIVERY ALLOWED IN 6 MONTH SPAN PCA SERVICE LIMIT EXCEEDED BILLED CODE CONFLICTS WITH CODE ALREADY PAID ABORTION DUE TO INCEST PAID ABORTION DUE TO RAPE PAID EXCEEDS SONOGRAMS/PREGNANCY IN 270 DAYS EXCEEDS MONTHLY LIMIT ONLY 1 NEWBORN HOSPITAL CARE PER RECIPIENT ALLOWED SERVICE LIMITS EXCEEDED - PARTIAL/FULL CUTBACK APPLIED EXCEEDS LIMIT OF 8 CO-INS DAYS NO DOCUMENT/EDIT OVERRIEDE PORT. X-RAY ONLY ONE ER REVENUE (450/459) CODE PER VISIT PAYMENT REDUCED TO MEDICARE MAXIMUM MAXIMUM OF 2 DAYS ALLOWED TO TRANSFER MHISA PATIENTS PROVIDER ALLOWED 1 SERVICE PER RECIPIENT PER DAY FOUND NO DOC/EDIT OVERRIDE CODE OUTPATIENT EXTENSION DEDUCTIBLE & OR CO-INSURANCE REDUCED TO MAX ALLOWABLE PAID ACCORDING TO MEDICAL REVIEW MAXIMUM SERVICES EXCEEDED SAME DAY/CLAIMCHECK HOME HEALTH VISITS EXCEEDS ANNUAL MAXIMUM ALLOWED (50) EXCEEDS MAMIMUM ALLOWED PHYSICIAN/CLINIC VISITS EXCEEDS ANNUAL MAXIMUM DAILY LIMITS EXCEEDED - MANUALLY APPLY PARTIAL PAYMENT SERVICE PERFORMED BEYOND REQUIRED TIME SPECIFICATIONS HOSPITAL DAYS EXCEED ANNUAL MAXIMUM ALLOWED PENICILLIN/BICILLIN INJCTNS EXCEED ANNUAL ALLOWED (12) PHYSICIAN HOSPITAL VISITS EXCEED ANNUAL MAXIMUM EMERGENCY OUTPATIENT VISITS EXCEED ANNUAL MAXIMUM (3) 733 723 717 616 620 605 629 664 656 646 643 640 641 739 741 742 743 748 793 791 789 777 782 784 900 901 157 112 113 116 117 214 247 996 955 962 908 906 907 903 904 911 912 913 915 M86 N362 M86 M86 M86 M86 M86 M86 N362 N362 M86 M86 M86 M90 M90 M86 M86 M86 M86 M86 N45 N45 M86 M86 M80 N45 N362 N435 N362 N45 N362 N362 N435 N45 N45 N362 M86 M86 M86 N362 N362 M86 M86 M86 M86 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 18 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------119 119 119 128 128 129 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 19:11:23 NON-EMER OP OVER 12 OVER 5 REFILLS CHIROP E&M VISIT MAX REBILL-MOTHERS INFO NEWBORN ZERO PD ADMIN CORRECTION INVALID OPERATOR CDE IMM NOT COMP RSN MIS INVALID EPSDT IND INV PRIOR AUTH DATE IMM COMPL MISS/INVLD INVALID TOTAL CHARGE INVALID PSRO DATE SUSP COND MISSNG/REQ WERE SUSP COND -MISS SUSP COND DISCRPANCY INV BLOOD NOT REPL INV BLOOD/PINT CHG CAL.PRICE IS ZERO CLAIM IN PROCESS STAND BY NEC. CLAIM IN PROCESS SURG REQ MED REV DIAG/PROC REQ REVIEW ANESTH REQ REVIEW ADJ-REQUIRES-REVIEW PA-01 REQUIRES REVIE POSSIBLE 707 PEND POSSIBLE 713 PEND POSSIBLE 714 PEND PROC REVIEW MANUAL PRICE REQ LOW VARIANCE ERROR CLAIM SPANS FISCL YR CAR-CODE REQ REVIEW FOUND MULT RESOURCES FOUND NO TPL AMOUNT INV BABY ADMISSION SERVICE LIMIT REVIEW AB REQUIRES REVIEW CONSENT FORM REVIEW INVALID REFILL CODE PEND FOR RECYCLE NON-COVCHG > BILLCHG INVALID TYPE SERVICE NON-EMERGENCY OUTPATIENT VISITS EXCEED MAXIMUM (12) MORE THAN 5 REFILLS PER PRESCRIPTION NOT REIMBURSABLE CHIROPRACTIC E & M VISIT MAX REACHED REBILL UNDER MOTHERS NAME & MID NUMBER NEWBORN CLAIM ZERO PAID ADMINISTRATIVE CORRECTION OPERATOR CODE MISSING IMMUN NOT COMPLETE AND CURRENT REASON CODE MISSING EPSDT INDICATOR NOT Y, N, OR SPACE PRIOR AUTHORIZATION DATE NOT NUMERIC IMMUN COMPLETE AND CURRENT FOR THIS AGE PATIENT MISSING THE TOTAL HOSPITAL CHARGE IS NOT NUMERIC A PSRO DATE IS NOT A VALID DATE SUSPECTED CONDITIONS ARE MISSING AND REQUIRED WERE THERE SUSPECTED CONDITIONS-MISSING WERE THERE SUSPECTED CONDITIONS IS NO BUT COND EXISTS BLOOD NOT REPLACED AMOUNT INVALID BLOOD CHARGE PER PINT INVALID CALCULATED PRICING IS ZERO/CALL HELP DESK CLAIM IN PROCESS PROLONGED ATTENDANCE BILLED;PENDED FOR REVIEW CLAIM HELD FOR PRE-PAYMENT REVIEW SURGERY REQUIRES REVIEW FOR ATTACHMENTS DIAGNOSIS/PROCEDURE REQUIRES REVIEW ANESTHESIA UNITS/MINUTES REQUIRE MED REVIEW PROVIDER'S ADJUSTMENTS ON REVIEW PA-01 FORM REQUIRES REVIEW FOR VALIDITY CLAIM IN PROCESS CLAIM IN PROCESS CLAIM IN PROCESS PROC REQUIRES REVIEW MANUAL PRICING REQUIRED/HARD COPY BILL LOW VARIANCE ERROR CLAIM SPANS FISCAL YEAR CARRIER CODE REQUIRES REVIEW/POSS NO MATCH CLAIM REQUIRES REVIEW FOR MULTIPLE TPL RESOURCES NO TPL AMOUNT INDICATED ON CLAIM/REQUIRES REVIEW BABY ONLY / PENDING FOR REVIEW. ATTACHMENT REVIEW SERVICE LIMITS ABORTION REQUIRES REVIEW STERILIZATION OFS FORM 96 REQUIRES REVIEW REFILL CODE MISSING, NOT NUMERIC, OR GREATER THAN 5 CLAIM PENDED FOR FUTURE RECYCLE NON-COVERED CHARGES EXCEED BILLED CHARGES TYPE SERVICE FOR AMBULANCE MUST BE 3 OR 9 916 920 923 985 519 999 004 025 017 010 014 063 061 059 057 058 050 051 978 979 246 241 249 250 259 262 264 227 228 229 230 280 277 300 296 291 292 306 335 336 337 126 086 097 075 M86 M86 M86 MA67 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 19 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 133 140 140 146 148 150 150 150 150 153 153 153 153 153 153 154 154 154 154 154 165 165 165 165 165 165 165 19:11:23 INVALID LAB INDICATR PRECERT REVIEW PROVIDER ON REVIEW HMO REVIEW TEMP PEND/NEW PROG REV MED NECESSITY UNABLE TO CALCU COS HYSTER REQ REVIEW INVALID LEAVE CODE INVALID LEAVE DATE OFS REV PA DT GT DOS PA AMOUNT GR LEVEL3 ADMIN.PEND PRESC DENTAL AGE ERR MAC/FUL COST IS ZERO MAC OVERRIDE NOT NEE SERV REV/CHIRO CNSLT RVW READMIT/DSCHG DX MULTIPLE SURGERY RECIP NAME MISMATCH MID CORRECTED. INV ICD CODE ON DOS SHARED PLAN DOC MISS PROC NEEDS DOCUMENT. 22 MOD.NOT JUSTIFIED 99297-52 NICU REDUCE DENY BY MED REVIEW NO HIST.INSULIN REQ. DRUG IS KIT/VERF.QTY PREGNANCY PRECAUTION DRUG/DRUG INTERACT THERAPEUTIC OVERLAY EXCEEDS MAX DOSE MON.EARLY/LATE REFIL QTY OVER PROGRAM MAX DAYS SUPPLY OVER MAX QTY OVER PROGRAM MAX SCH2 NARC NO REFILL REF NAME MIS/REQ-RF2 REF NAME MIS/REQ-RF1 REF REAS MIS/REQ-RF2 APP DATE MIS/REQ RF2 REF REAS MIS/REQ-RF1 APP DATE MIS/REQ-RF3 REF MISS/REQ-NUTRITN LABORATORY INDICATOR MUST BE Y, N, OR BLANK PRECERT REVIEW PROVIDER ON REVIEW HMO EOB REQUIRES REVIEW TEMPORARY PEND FOR NEW PROGRAM REV DIAGNOSIS AND/OR ATTACHMENT FOR MEDICAL NECESSITY CLAIM IN PROCESS ACKNOWLEDGEMENT REQUIRES REVIEW ABSENT DAY TYPE MUST BE AN A OR B ABSENT DAY AND/OR TOTAL DAYS CONFLICT OFS TO REVIEW-PA DATE GREATER THAN SERVICE DATE PRIOR AUTHORIZED AMOUNT GREATER THAN LEVEL 3 CHARGE ADMINISTRATIVE PEND DENTAL PRESCRIBER, RECIPIENT 21 OR OVER MAC/FUL COST IS ZERO/CALL HELP DESK DRUG DOES NOT NEED MAC OVERRIDE SERVICE LIMIT REVIEW BY CHIROPRACTIC CONSULTANT PEND FOR REVIEW OF READMIT/DISCHARGE DIAGNOSIS MULTIPLE SURGERY-PENDED FOR REVIEW NAME AND/OR NUMBER ON CLAIM DOES NOT MATCH FILE RECORD MID HAS BEEN CORRECTED/PLEASE UPDATE YOUR FILES. INVALID ICD CODE SET FOR CLAIM DATES OF SERVICE BYU SHARED PLAN DID NOT SUBMIT DOCUMENTATION TO MOLINA PROCEDURE CODE NOT SUBSTANTIATED BY DOCUMENT 22 MOD.SERVICES NOT JUSTIFIED/PAID AT UNMODIFIED RATE 99297-52 NICU PAID AT REDUCED RATE DENIED ACCORDING TO MED REVIEW GUIDELINES NO PATIENT HISTORY OF INSULIN REQUIREMENTS DRUG UNIT OF MEASUREMENT IS A KIT.PLEASE VERIFY QUANTIT PREGNANCY PRECAUTION DRUG/DRUG INTERACTION THERAPEUTIC OVERLAY EXCEEDS MAXIMUM DAILY DOSE COMPLIANCE MONITORING/EARLY OR LATE REFILL QUANTITY AND/OR DAYS SUPPLY EXCEEDS PROGRAM MAXIMUM DAYS SUPPLY >100 EXCEEDS PROGRAM MAXIMUM QUANTITY EXCEEDS PROGRAM MAXIMUM SCHEDULE 2 NARCOTIC CANNOT BE REFILLED REFERRED TO NAME MISSING AND REQUIRED FOR REFERRAL #2 REFERRED TO NAME IS MISSING AND REQUIRED FOR REFERRAL 1 REASON FOR REFERRAL MISSING AND REQUIRED FOR REFERRAL 2 APPOINTMENT DATE MISSING AND REQUIRED FOR REFERRAL #2 REASON FOR REFERRAL MISSING AND REQUIRED FOR REFERRAL 1 APPOINTMENT DATE MISSING AND REQUIRED FOR REFERRAL #3 REFERRAL MISSING AND REQUIRED FOR NUTRITIONAL 080 170 203 492 600 538 370 338 372 373 419 415 428 451 458 463 785 754 726 217 993 152 189 027 034 038 958 668 464 446 442 443 529 447 457 436 657 652 412 411 399 343 368 359 184 M76 N706 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 20 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------165 165 165 165 165 165 165 165 165 165 165 165 165 165 165 166 166 170 170 170 171 171 171 174 176 176 176 176 176 177 178 178 183 184 184 184 184 184 185 185 185 197 197 198 198 19:11:23 REF MISS/REQ-DENTAL REF MISS/REQ-HEARING REF MISS/REQ-MEDICAL REF MISS/REQ-VISION APP DATE MIS/REQ-RF1 REF ASST MIS/REQ-RF2 REF ASST MIS/REQ-RF3 REF MISS/REQ-PSY/SOC REF MISS/REQ-SPEECH REF ASST MIS/REQ-RF1 SUSP CON MIS/REQ-RF2 SUSP CON MIS/REQ-RF3 SUSP CON MIS/REQ-RF1 REF MISS/REQ-AB/NEGL REF MISS/REQ-DEVELOP SUBMIT TO DBPM SUB PROV NON PAR BYU SPECIALTY RESTRICTED PROV CLAIM TYP CONFL HOSP LIMITED TO EMER PARTIAL HOSP NOT PAY INV SURGERY MODIFIER SITE N/ALLW BILL/DOS RX > SERVICE DATE REFILL OVR 12 MONTHS C-II EXPIRED 90 DAYS NEW PRESC OVER 6 MOS REFILL OVER 6 MONTHS NEW PRESC OVER 12 MO SPD DOWN NOT MED NDY PAT LIAB EXCEEDS CHG REDUCED BY SPENDDOWN REF MUST BE MGR LOCK IN RECIPIENT PRESCRIBER NOT ON FI NO PRESCRIPTIVE AUTH INVALID PRESCRIBERNO PRESCRIBER IS GROUP ATND PRV NOT LNK BYU NOT PROV OF RECORD LOCK-IN RECIPIENT OOS SRVC REQ APPRVL CLIN PRE-AUTH REQ'D DAYS CUT TO PRECERT CLAIM > PRECERT LOS REFERRAL MISSING AND REQUIRED FOR DENTAL REFERRAL MISSING AND REQUIRED FOR HEARING REFERRAL MISSING AND REQUIRED FOR MEDICAL REFERRAL MISSING AND REQUIRED FOR VISION APPOINTMENT DATE MISSING AND REQUIRED FOR REFERRAL #1 REFERRAL ASSISTANCE MISSING AND REQUIRED FOR REFERRAL 2 REFERRAL ASSISTANCE MISSING AND REQUIRED FOR REFERRAL 3 REFERRAL MISSING AND REQUIRED FOR PSYCHOLOGICAL/SOCIAL REFERRAL MISSING AND REQUIRED FOR SPEECH/LANGUAGE REFERRAL ASSISTANCE MISSING AND REQUIRED FOR REFERRAL 1 SUSPECTED CONDITION MISSING AND REQUIRED FOR REFERRAL 2 SUSPECTED CONDITION MISSING REQUIRED FOR REFERRAL 3 SUSPECTED CONDITION MISSING AND REQUIRED FOR REFERRAL 1 REFERRAL MISSING AND REQUIRED FOR ABUSE/NEGLECT REFERRAL MISSING AND REQUIRED FOR DEVELOPMENTAL SUBMIT TO DENTAL BENEFITS PLAN SUBMIT TO RECIPIENTS SHARED PLAN PROVIDER IS RESTRICTED TO DESIGNATED PROCEDURES PER OFS PROVIDER CANNOT SUBMIT THIS TYPE CLAIM HOSP LIMITED TO EMERG CARE & TRANSFER OF MHISA PATIENTS PARTIAL HOSP NOT PAYABLE FOR MEDICAID ONLY COMPONENTS OF SURGERY PAID ONLY TO TEACHING FACILITIES PROV SITE NOT ALLWD TO BILL SCR TYPE ON DATE OF SERVICE RX DATE WAS AFTER DATE FILLED REFILL NOT FILLED WITHIN 12 MONTHS C-II EXPIRED-GREATER THAN 90 DAYS NEW PRESCRIPTION NOT FILLED WITHIN 6 MOS. OF DATE PRESC REFILL NOT FILLED WITHIN 6 MONTHS NEW PRESCRIPTION NOT FILLED WITHIN 12 MO OF DATE PRESC SPEND DOWN AMOUNT NOT MED NEEDY PATIENT LIABILITY EXCEEDS BILLED CHARGES MEDICAID ALLOWABLE AMOUNT REDUCED BY RECIPIENT SPENDOWN REFERRING MUST BE CASE MANAGER RECIPIENT IS MD, PHARM RESTRICTED-MD INVALID PRESCRIBING PROVIDER NOT ON FILE PRESCRIBING PROVIDER DOES NOT HAVE PRESCRIPTIVE AUTHORI PROVIDER TYPE NOT AUTHORIZED TO PRESCRIBE PRESCRIBER NUMBER NOT FOR INDIVIDUAL PRESCRIBER ATTENDING/SERVICING PROVIDER NOT LINKED TO BYU PLAN BILLING PROVIDER IS NOT THE DESIGNTED PROV. OF RECORD RECIP IS MD,PHARM RESTRICTED-PHARMACY INVALID OUT OF STATE SERVICES REQUIRE DHH APPROVAL LETTER CLINICAL PRE-AUTH REQUIRED MD FAX FORM TO 866-797-2329 DAYS CUTBACK TO PRECERT APPROVED DAYS CLAIM EXCEEDS PRECERT AUTHORIZED DAYS 179 158 155 156 326 323 324 308 312 320 318 319 314 302 286 369 506 420 202 118 107 226 440 123 141 311 454 455 422 220 287 919 105 218 450 514 489 491 556 424 389 532 066 169 164 N95 N95 N95 N428 N428 N428 N592 N592 N592 N54 N54 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 21 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------198 198 198 198 199 200 206 216 216 231 231 231 231 231 231 233 242 243 243 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 251 19:11:23 CLAIM OVER PA LIMITS ADJ > ORIG COV'D DYS >12 MONTH QTY LIMIT PA DATE GR SERV DATE REV CODE INVALID NDC SPLIT BILL FOR PART. M/I SERVICE PROVIDER PRE-PAY REV OVERRIDE STERILIZATION INDIC MUTUALLY EXCLU-CURR HIST PROC VOIDED-ME MUTUALLY EXCLU-HIST CCI:HX VOIDED-MUT EX CCI:MUT EXCLUS-CURR CCI:MUT EXCLUS-HIST CONDITION NOT PAYABL BILL PRV NOT PCP RECIP NOT ENROLL BYU RECIP NOT IN DBP CONSENT 30/180 DAYS THERAPEUTIC DUP-MD EOB/CARR.CD MISMATCH NEED EOB-CARR/RECIP. DOCUMENT NOT LEGIBLE EOMB MUST ATTACH OFS FORMS MISSING JUSTIFY EYEGLASSES ENC PREFIX ERROR ENC RCV DT ERROR HYST REQ ACK TL NEEDS OFS 96 DOC/READMIT SAME DAY CORRECT OFS 96 SEC 4 OFS96 NONCORRECTABLE CORRECT OFS 96 SEC 1 CORRECT OFS 96 SEC 2 CORRECT OFS 96 SEC 3 CIRCLE UNLISTED DESC INVALID COB ID DOC/FAILED RESTORATI STERIL CONSENT 96A INCOMPLETE/INCOR 96A DATED AFTER HYST NEED EDC ON FORM 96 DOCUMENT NAME CHANGE CLAIM EXCEEDS PRIOR AUTHORIZED LIMITS ADJUSTED COVERED DAYS > ORIGINAL COVERED DAYS > 12 MONTH QTY LIMIT MD FAX OVERRIDE FORM 866-797-2329 PA DATE GREATER THAN SERVICE DATE REVENUE CODE INVALID FOR REPORTING NDC INFO SPLIT BILL FOR PARTIAL ELIGIBILITY. MISSING/INVALID SERVICE PROVIDER ALLOW ADJUST/VOID FOR PREPAY ZERO-PAID CLAIM FOUND PROC. 2 X INDICATES STERILIZATION PROC MUTUALLY EXCLUSIVE TO ANOTHER CURR PROC/CLAIMCHECK HIST PROC VOIDED-MUTUALLY EXCLUSIVE TO CURR/CLAIMCHECK PROCEDURE MUTUALLY EXCLUSIVE TO PAID PROC/CLAIMCHECK CCI:HISTORY PROC MUTUALLY EXCLUSIVE TO CURR-HIST VOIDED CCI:PROCEDURE MUTUALLY EXCLUSIVE TO ANOTHER CURRENT PRO CCI:PROCEDURE MUTUALLY EXCLUSIVE TO PROCEDURE IN HISTOR PROVIDER PREVENTABLE CONDITION NOT PAYABLE BILLING PROVIDER NOT PCP OR SERVICE NOT AUTHOR BY PCP RECIPIENT NOT ENROLLED WITH BYU HEALTH PLAN RECIPIENT EXCLUDED FROM DBP CONSENT MUST BE AT LEAST 30 BUT NO MORE THAN 180 DAYS THERAPEUTIC DUPLICATION-DIFFERENT PRESCRIBER EOB(S) ATTACHED/CARRIER CODE DOES NOT MATCH NEED EOB FOR EACH CARRIER INDICATED ON RESOURCE FILE DOCUMENTS NOT LEGIBLE, PLEASE RESUBMIT MEDICARE EOMB INVALID/OR MISSING. OFS FORMS 158B & ACKNOWLEDGEMENT REQUIRED SEND DOCUMENTATION FOR MORE THAN 3 EYEGLASSES PER YEAR LICN PREFIX ON ENCOUNTER IS MISSING OR INVALID PLAN RECEIVE DATE ON ENCOUNTER IS MISSING OR INVALID HYST REQ ACKNOWLEDGEMENT OR PROOF PREVIOUSLY STERILE STERILIZATION REQUIRES OFS FORM 96. RESUBMIT WITH DOCUMENTATION OF DISC/READMIT SAME DATE OFS 96 CORRECTABLE ERROR IN SECTION 4 OFS 96 ERROR IN 7 8 10 11 14 15-DO NOT RESUBMIT OFS 96 CORRECTABLE ERROR IN SECTION 1 OFS 96 CORRECTABLE ERROR IN SECTION 2 OFS 96 CORRECTABLE ERROR IN SECTION 3 CIRCLE UNLISTED CODE DESCRIPTION IN-OPERATIVE REPORT INVALID COB-1 ID COB-1 PAYER ID MUST BE PLAN ID RESUBMIT WITH DOCUMENTATION OF PREV FAILED RESTORATION STERILIZATION CONSENT F0RM INCORRECT/ILLEGIBLE 96A INCOMPLETE OR INCORRECT 96A DATED AFTER HYST-RESUB WITH EMERGENCY DOCUMENTATION NEED EDC ON 96-SIGNATURE LESS THAN 30 DAYS FROM TUBAL 96/96A--DOC.NAME CHANGE-PG28 PROF SERV 2000 TRAIN PACK 194 327 052 607 545 946 444 557 750 579 583 582 992 984 989 054 106 187 304 334 140 032 033 994 922 927 468 410 416 751 752 756 766 767 763 764 765 778 860 630 709 682 683 684 674 N54 N54 N351 N351 MA67 N450 N130 N130 N28 MA81 N4 N4 N205 N4 N28 N464 N464 N446 N28 N28 N222 N28 N28 N28 N28 N28 N233 N464 N464 N28 N28 N28 N28 N28 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 22 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 252 19:11:23 NEED SPECIFIC REPORT ADMIT HIST,PHY,DISCH SEND TEST AND RESULT DID NOT SUB REQ DOC ATTACH DETAIL.DESCR. NEED OP/PATH/HISTORY EXCEEDS ONE PER YEAR DOC REQ CONCUR CARE RESUB HRDCPY ADJ/VOI EXCEEDS SONOS/270DAY JUSTIFY/#UNITS PERTINENT HIST/REQ SEND L & D RECORDS DAILY NOTES NEEDED UNKNOWN ABBREVATION SEND ALL DOCUMENTS SEND DATED NOTES RESUB/CORRECT MOD SEND DATED OP REPORT PROVIDE SPEC RADIONU 13/PREG-158A NEEDED 1/PREG-158A NEEDED ATTACH DET.DESCR DX HRD COPY REQ-FERTILI AMBULANCE-REQ-ATTACH ANESTH REP REQ SEND OP&PATH REPORT SND PLAN PROOF STERL NOT USED - AVAILABLE NOT USED - AVAILABLE NO 51 NH HURRICANE-REL WO ATT EDC ON 96 AND NOTES VNS REPROGRAMMING KIDMED INFO MISSING JUSTIFY PATH CONSULT LEERS DATA CONFLICT SONOGRAM-AND REPORTS JUSTIFY LAB TEST ANES AND MED DOC REQ SEND RECORDS FOR DOS PROC./DIAG. DESP.REQ JUSTIFY 22 MOD OPER & HIST REPT REQ CLAIM HARD COPY NEED RESUBMIT WITH SPECIFIC RELATED REPORT RESUBMIT WITH ADMIT HISTORY,PHYSICAL,DISCHARGE SUMMARY VISUAL FIELD TEST AND RESULTS NEEDED FOR REVIEW REQUESTED DOCUMENTS WERE NOT SUBMITTED ATTACH DETAILED DESCRIPTION OF PROCEDURE RESUBMIT WITH OPERATIVE AND PATH REPORTS AND HISTORY SEND DOCUMENTAION TO JUSTIFY MORE THAN ONE PER YEAR RESUBMIT W/DOCUMENTATION SUBSTANTIATING CONCURRENT CARE MEDICARE ADJ/VOID;RESUBMIT HARDCOPY ADJ OR VOID CLAIM JUSTIFY ADDITIONAL SONOGRAMS W PERTINENT DATED NOTES SEND NOTES JUSTIFYING # OF UNITS BILLED RESUBMIT WITH PERTINENT HISTORY RESUBMIT WITH LABOR AND DELIVERY RECORDS DAILY NOTES(TREATMENT,PROGRESS)NEEDED RESUBMIT WITH ABBREVATION LEGEND INADEQUATE DOCUMENTATION-SEE FEB 94 & AUG 93 UPDATES SEND SPECIFIC DATED NOTES FOR EACH DATE BILLED NO DOCUMENTATION FOR 62/66;CORRECT/RESUBMIT SEND DATED OPERATIVE REPORT FOR DATE BILLED RESUB W/SPECIFIC NUCLIDE/AMT USED PER PT/AMT PD/INVOICE 13 ALLOWED PER PREGNANCY; 158-A NEEDED FOR EXTENSION ONE ALLOWED/PREG.;158-A NEEDED FOR UNUSUAL SITUATIONS ATTACH DETAILED DESCRIPTION OF DIAGNOSIS HARD COPY REQUIRED-FERTILITY PREPARATION CLAIM REQUIRES MD CERTIFICATION ATTACHED AFTER 2/14/87 ANESTHESIOLOGY REPORT REQUESTED SEND BOTH OPERATIVE AND PATHOLOGY REPORT HYSTERECTOMY REQUIRES PROOF OF PRIOR STERILE TO PLAN NOT USED - AVAILABLE NOT USED - AVAILABLE NO 51 NH ATTACHED OR ADMIT CODE MUST BE A '6' HURRICANE RELATED CLAIMS ALLOWED TO PROCESS W/O ATTACHM LESS THAN 30 DAYS NEED EDC ON 96 AND RECORDS TO SUPPORT SUBMIT MEDICAL DOCUMENTATION TO JUSTIFY REPROGRAMMING IMMUNIZATION AND SUSPECTED CONDITION INFO REQUIRED SEND DOCUMENT TO JUSTIFY PATH CONSULT CONFLICT W LEERS DATA. VERIFY INFORMATION ON BIRTH REC SEND WRITTEN SONOGRAM RESULTS WITH OP,PATH AND HISTORY SEND DOCUMENTS TO JUSTIFY SPECIFIC LAB TEST ATTACH ANESTHESIA RECORD AND DOCUMENT MEDICAL NECESSITY SEND OFFICE RECORDS FOR DATE OF SERVICE PROCEDURE/DIAGNOSIS DESCRIPTION REQUIRED. RESUBMIT WITH JUSTIFICATION FOR USE OF 22 MODIFIER ATTACH BOTH OPERATIVE AND HISTORY REPORT SUBMIT HARD COPY OF CLAIM 685 686 692 694 732 621 623 648 665 783 772 770 771 788 786 787 762 768 761 747 744 745 736 466 380 365 366 362 346 354 355 581 562 512 518 499 496 478 481 470 925 963 953 950 966 N29 N221 M29 N29 N29 M29 N29 N29 N29 N29 N29 N29 N29 N29 N29 N29 N29 N29 M29 N225 M42 N170 N29 N29 M60 N29 M29 M29 M29 M29 N473 N29 N29 N29 N29 M29 N29 M29 N29 N439 N29 N29 N29 M29 N29 LAM5M113 RUN: 01/28/15 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM REPORT NO: RF-0-77-R DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 23 HIPAA/LA MEDICAID ERROR CODE CROSSWALK ADJ RSN CODE SHORT DESCRIPTION LONG DESCRIPTION ERROR CODE HIPAA REMARK CODE ---------------------------------------------------------------------------------------------------------------------------------252 252 252 252 252 252 256 256 256 19:11:23 MEDICARE ADJUSTMENT REBILL OB/ABORT D&C MEDICARE REPLACEMENT RESUB W/ DOCUMENTS AUTH MINOR UNM MO SURG REQUIRES PA-0 PMPM RECOUP - DOC PMPM RECOUP - LAHIPP PMPM RECOUP FOR DOD MEDICARE ADJUSTMENT/VOID,ADJUST OR ADJUST MEDICARE CLAI REBILL OB OR ABORTION D & C CPT CODE WITH REPORTS MEDICARE REPLACEMENT; SUBMIT HARDCOPY ADJ OR VOID CLAIM RESUB W/ DOCUMNTS CALL 800-473-2783 FOUND NO DOCUMENT/OVERRIDE CODE MINOR UNM MOTHER/UNBORN SURGERY DONE AS IP REQUIRES VALID PA-01 FORM PMPM RECOVERY FOR INCARCERATED MEMBERS PMPM RECOVERY FOR LAHIPP ELIGIBLES PMPM RECOVERY FOR DECEASED MEMBERS BASED ON DATEOFDEATH 037 110 137 078 333 265 418 409 404 N4 N29 N4 N29 N29 N29 LAM5M113 RUN: 01/28/15 19:11:23 ERRTXT CODES READ LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING SUMMARY REPORT OF ERRTXT CODES HIPAA/LA MEDICAID ERROR CODE CROSSWALK 999 REPORT NO: RF-0-77-R PAGE: 24
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