When Did No Fault Insurance Start in Michigan

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					                                  CARCs_Query2


Remit                                            CARC
Code               Remit Verbiage                Code




        RESUBMIT WITH THE NUMBER OF TESTS
 001    PERFORMED                                 125
        $200 YEARLY MAX FOR WELL CHILD HAS
 002    BEEN MET                                  35

        FILE CHARGES TO THE STATE WHERE
 003    SERVICES WERE RENDERED                    109

        CONTRACT COVERS ONLY ONE MEDICARE
 004    DEDUCTIBLE PER YEAR                       35


        THE COMPLETE PROCEDURE INCLUDES
 005    ALLOWANCE FOR THIS SERVICE                97


        RADIATION THERAPY INCLUDES
 006    ALLOWANCE FOR THIS SERVICE                97
        DEPENDENT NOT ADDED WITHIN 31 DAYS
 008    FROM THE DATE OF BIRTH                    32




        NO FREE STANDING DRUG COVERAGE FOR
 010    THIS DATE OF SERVICE                      96




        COVERAGE NOT UPDATED, CONTACT
 011    PATIENT'S PERSONNEL OFFICE                96


        TOTAL AMOUNT ALLOWED HAS BEEN PAID
 012    BY MEDICARE                               23


        ALLOWANCE FOR PROCEDURE INCLUDES
 013    ALLOWANCE FOR SUPPLIES                    97


                                     Page 1
                                CARCs_Query2




      REFILE WITH CORRECT CODE OR
014   DESCRIPTION OF THERAPY                   16

      CONTRACT COVERS ONLY FIVE VISITS PER
015   MONTH                                    119




      NEED SITE OF MANIPULATION AND SPECIFIC
016   DIAGNOSIS                                16




      LEARNING/COMMUNICATION/BEHAVIORAL
017   PROBLEMS NOT COVERED.                    96



      NOT MEDICALLY NECESSARY PER MEDI-
018   CALL                                     50

      NUMBER OF VISITS EXCEED APPROVED
019   DAYS                                     198
      DEPENDENT NOT COVERED UNLESS FULL
020   TIME STUDENT                             33



021   CRITERIA NOT MET FOR THIS SERVICE        B5




      NEED CANCELLATION DATE OF MEMBER'S
022   OTHER INSURANCE COVERAGE                 16




                                    Page 2
                                 CARCs_Query2



      PLEASE RESUBMIT THIS CLAIM TO
023   CONNECTICUT GENERAL                       109

      TOTAL CHARGE INCREASED TO INCLUDE
024   SEPARATED PROCEDURE(S)                    B15




      SEPARATE PROCEDURE COMBINED INTO
025   SINGLE COMPLETE PROCEDURE                 16

      THIS PROCEDURE IS NOT COVERED WITH
027   OTHER REPORTED PROCEDURE                  97

      THIS CODE IS NOT CORRECT FOR THE
028   PATIENT'S AGE AND/OR SEX                   7
      MAX INPATIENT DAYS/OUTPATIENT VISITS
029   USED                                      35


030   PENDING REVIEW OF MEDICAL NECESSITY       133




      THIS PROCEDURE IS CONSIDERED
031   COSMETIC                                  96
      THIS IS A DUPLICATE OF A PREVIOUSLY
032   FILED PRESCRIPTION                        18




      THIS DRUG HAS NOT BEEN APPROVED FOR
033   THE CONDITION REPORTED.                   96




      NO BENEFITS FOR SERVICES FURNISHED BY
034   NURSING HOME.                             96




                                      Page 3
                                 CARCs_Query2




      THIS CONTRACT DOES NOT HAVE MEDICARE
035   CROSSOVER BENEFITS.                       16




      REPAIRS AND PARTS NOT COVERED ON
036   RENTAL EQUIPMENT                          96




      RESUBMIT WITH A DESCRIPTION OF
037   SERVICE RENDERED OR SUPPLY                16
      PATIENT HAS NOT BEEN ENROLLED BY
038   STATE PERSONNEL                           31
      $5000 LIFETIME MAX FOR PSYCHIATRIC
039   SERVICES USED                             35
      TWO DAYS OR $300 MAX BENEFITS
040   ALLOWED FOR NEWBORN NURSERY               35




      HEALTH PLAN DOES NOT COVER DENTAL
041   SERVICES                                  96

      PRECERTIFICATION MUST BE OBTAINED ON
044   INPATIENT PROCEDURES                      197




      WE HAVE REQUESTED THE PATIENT
      COMPLETE AN ACCIDENT
      QUESTIONNAIRE. THE CLAIM IS PENDING
045   THE RECEIPT OF THAT INFORMATION           16


                                    Page 4
                                          CARCs_Query2




      Our records indicate the billing provider is inactive
      for the dates of service submitted. If this
      information is inaccurate, please download forms
      from www.southcarolinablues.com,send an e-mail
      to provider.cert@bcbssc.com,or fax to 803-264-
      4795 to update the provider information. Once the
046   file is updated, then send a new claim.                 16

      2ND OPINION NOT OBTAINED. PAYMENT
060   REDUCED.                                                61




      THIS DENTAL POLICY DOES NOT PROVIDE
063   BENEFITS FOR SEALANTS                                   96

      THIS SERVICE IS INCLUDED IN THE
064   ADMINISTRATION OF ANESTHESIA                            97




      NO BENEFITS FOR ABUTMENTS TO TEETH
067   MISSING PRIOR TO COVERAGE                               96




      CLAIM SHOULD BE FILED AS AN
069   ADJUSTMENT.                                             16

      ONE ROUTINE MAMMOGRAM COVERED PER
070   YEAR, OVER AGE 50                                       119

      ONE ROUTINE MAMMOGRAM COVERED
071   EVERY OTHER YEAR, AGE 40-49                             119

      ONLY ONE ROUTINE MAMMOGRAM IS
072   COVERED BETWEEN AGE 35-39                               119




                                               Page 5
                                CARCs_Query2




      ROUTINE MAMMOGRAM - GLOBAL FEE PAID
073   TO NETWORK PROVIDER                      97

      ROUTINE MAMMOGRAM NOT COVERED
074   WHEN RENDERED BY THIS PROVIDER           38


      PATIENT NOT ELIGIBLE FOR ROUTINE
075   MAMMOGRAM                                49
      SERVICES NOT CONSISTENT WITH
077   DIAGNOSIS                                11




      SERVICES NOT APPROVED BY MEDICARE
079   ARE NOT COVERED                          96


      PATIENT NOT ELIGIBLE FOR ROUTINE PAP
082   SMEAR BENEFITS                           49

      CONCURRENT CARE IS NOT COVERED BY
083   THIS CONTRACT                            B14


      WRONG ID, WILL BE PROCESSED UNDER
084   CORRECT ID                               B11


      CHAMPUS PAID THE ALLOWABLE CHARGES
093   IN FULL.                                 23

      COSMETIC/RECONSTRUCTIVE SURGERY
094   NOT APPROVED IN ADVANCE                  197




      DENIED BY CHAMPUS. IF CHAMPUS HAS
096   RECONSIDERED, SEND PROOF.                16




                                    Page 6
                                CARCs_Query2




098   PENDING RECEIPT OF MEDICAL RECORDS       16




      ATTACH COPY OF CHAMPUS REMIT/EOB TO
100   THIS FORM AND RESUBMIT                   16


      ROUTINE SERVICES ARE NOT COVERED BY
101   THIS CONTRACT                            49

102   DEPENDENT HAS HIS OWN COVERAGE.          32




      NEED EMPLOYMENT/MEDICARE
104   INFORMATION FROM THE SUBSCRIBER.         16




      THIS BENEFIT PLAN DOES NOT COVER THIS
106   SERVICE.                                 96


      ACNE SURGERY ALLOWED ONE PER DATE
108   OF SERVICE.                              35




114   HEARING TEST AND EXAM IS NOT COVERED     96



                                   Page 7
                                 CARCs_Query2



      CONTRACT DOES NOT ALLOW BENEFITS
115   FOR THIS PROVIDER.                        170




      REFILE INDICATING THE PHASE OF CARDIAC
116   REHABILITATION                            16


      THIS SERVICE WAS PAID IN FULL BY
118   MEDICARE                                  23




      APPLIED TO CHAMPUS OUTPATIENT
119   DEDUCTIBLE - NOT COVERED                  96


      PATIENT MUST BE REFERRED BY A
120   PHYSICIAN                                 B5

      PAIN MANAGEMENT IS NOT COVERED AS A
121   SEPARATE SERVICE                          B15




      SERVICES WERE RENDERED AFTER THE
122   PATIENT'S CANCELLATION DATE               27




      MEDICAL INFORMATION NOT RECEIVED-
123   DISCHARGE SUMMARY.                        16




                                      Page 8
                                CARCs_Query2




      OTHER INSURANCE CARRIER MUST
124   PROCESS FIRST                            16




      THIS CONTRACT WAS NOT IN EFFECT AT
125   TIME OF ACCIDENT                         96




      MEDICARE COINSURANCE IS NOT COVERED
126   BY THIS CONTRACT                         96

      SERVICES NOT COVERED WHEN RENDERED
129   BY THIS PROVIDER                         170




      MEDICAL INFORMATION NOT RECEIVED-
131   HISTORY/PHYSICAL EXAM.                   16




      MEDICAL INFO NOT RECEIVED-DISCHARGE
133   SUMMARY/OPERATIVE REPORT.                16




                                   Page 9
                                   CARCs_Query2




      MEDICAL INFO NOT RECEIVED-
134   HISTORY/OPERATIVE REPORT                    16




      MEDICAL INFO NOT RECEIVED-PATHOLOGY
135   REPORT.                                     16




      MEDICAL INFO NOT RECEIVED-
      HISTORY/OPERATIVE/PATHOLOGY
136   REPORT.                                     16




      MEDICAL INFO NOT RECEIVED-
137   HISTORY/PATHOLOGY REPORT.                   16




      MEDICAL INFO NOT RECEIVED-PATHOLOGY
138   REPORT/DISCHARGE SUMMARY                    16




                                     Page 10
                                 CARCs_Query2




      MEDICAL INFO NOT RECEIVED-
139   HISTORY/DISCHARGE SUMMARY.                16




      MEDICAL INFO NOT RECEIVED-HOSPITAL UR
140   REPORT.                                   16

      INTEGRAL PART OF CARDIAC
144   CATHERIZATION                             97

      SERVICES ARE NOT COVERED FOR
146   TREATMENT OF FAMILY MEMBERS               53


      THIS IS A DUPLICATE OF A PREVIOUSLY
149   PROCESSED SERVICE                         18




      PENDING MEMBER'S RESPONSE TO
150   INJURY/ILLNESS QUESTIONNAIRE              16




151   THIS CLAIM MUST BE FILED TO BCBS OF SC.   109




                                    Page 11
                                 CARCs_Query2




      TISSUE BIOPSY NOT COVERED WHEN THE
154   SURGERY IS NOT ALLOWED                    96

      TWELVE MONTH WAITING PERIOD NOT
155   COMPLETED                                 179


159   OFFICE VISIT INCLUDES THIS SERVICE        97

      PLEASE FILE CLAIMS TO BCBS OF NC,
160   DURHAM                                    109


161   FILE CLAIM TO BC/BS OF TENNESSEE          109


162   THIS IS THE MAXIMUM DENTAL ALLOWANCE      45

      CLAIM HAS BEEN PROCESSED BY BCBS OF
163   WESTERN PENNSYLVANIA                      B13

      CONTRACT LIMITS THIS PROCEDURE TO
164   TWICE PER CALENDAR YEAR                   119




165   LAB HANDLING FEE IS NOT COVERED           96




      TOOTH SHOWS INSUFFICIENT CORONAL
166   DESTRUCTION                               16

      DIALYSIS CHARGE INCLUDES BENEFITS FOR
167   DIALYSIS TRAINING                         97

      THIS PROCEDURE IS ONLY COVERED ONCE
168   EVERY TWO YEARS                           119




                                    Page 12
                                 CARCs_Query2




      WE REQUESTED OTHER HEALTH INSURANCE
      INFORMATION FROM THE MEMBER. WE WILL
      REVIEW THE CLAIM FOR BENEFITS WHEN
169   WE RECEIVE THIS INFORMATION.              16

      CONTRACT DOES NOT COVER SERVICES
173   RENDERED BY THIS PROVIDER                 170

      BENEFITS INCLUDED IN MEDICAL/SURGICAL
177   CARE                                      97




179   PLEASE RESUBMIT ON A DRUG CLAIM FORM      125




181   SPLINTING IS NOT COVERED                  96




182   LIFE INSURANCE COVERAGE ONLY              96

      PROCEDURE COVERED ONLY ONCE PER
185   TOOTH                                     35




      SURGICAL TRAY NOT COVERED WHEN
186   SURGERY IS NOT ALLOWED                    96




      SEALANT NOT COVERED. OCCLUSAL
190   RESTORATIVE PROCEDURE ON FILE.            96




                                   Page 13
                                CARCs_Query2




      NO BENEFITS FOR PROCEDURES
195   PERFORMED ON THIS TOOTH                  96




197   NO XRAYS HAVE BEEN RECEIVED              16

      PLEASE FORWARD DOCUMENTATION FOR
198   REVIEW.                                  133




      IMPACTED TOOTH REMOVAL NOT COVERED
202   UNDER THIS HEALTH PLAN                   96
      BENEFITS ONLY ALLOW SEALANTS FOR
203   CHILDREN 6 - 15 YEARS OLD                35


      CAST SUPPLIES INCLUDED IN THE
207   ALLOWANCE FOR FRACTURE CARE              97

      RETURNED CLAIM TO BE FILED WITH
209   BCBS/KANSAS.                             109

      RETURNED CLAIM TO BE FILED WITH
210   BCBS/VIRGINIA                            109




      NEED A SEPARATE CHARGE FOR EACH
211   PROCEDURE                                16


      ROUTINE VISION/HEARING SERVICES NOT
213   COVERED.                                 49




                                    Page 14
                                CARCs_Query2




      METROPOLITAN PAID THEREFORE NO BC/BS
215   BENEFITS                                 23




      NEED SPECIFIC DATE FOR EACH SERVICE
216   RENDERED.                                125




      THIS CONTRACT DOES NOT COVER THE
217   MEDICARE DEDUCTIBLE                      96




      NECESSARY MEDICARE INFORMATION HAS
218   NOT BEEN RECEIVED                        17




      ROUTINE MATERNITY IS NOT COVERED
220   UNDER THIS CONTRACT                      96




      PREOPERATIVE ANESTHESIA
221   CONSULTATION IS NOT COVERED              96
      BASED ON OUR MEDICAL STAFF REVIEW,
      THESE SERVICES DO NOT MEET THE
      MEDICAL NECESSITY GUIDELINES WITH THE
224   DOCUMENTATION PROVIDED.                  50

      BENEFITS INCLUDED IN HOSPITAL OR
226   FACILITY CHARGES                         97




                                   Page 15
                                CARCs_Query2




      SERVICE NOT COVERED FOR DIAGNOSIS
232   REPORTED                                 96

      CLAIM SHOULD BE SENT TO THE DENTAL
233   CARRIER                                  109




      RESUBMIT WITH A SPECIFIC DIAGNOSIS
256   CODES OR MEDICAL RECORDS.                16



      TREATMENT OF WAR INJURY IS NOT
269   COVERED                                  96
      FILE THESE PROFESSIONAL FEES ON A
271   HCFA 1500 CLAIM FORM                     89




      SERVICES RELATED TO ARTIFICIAL HEART
272   NOT COVERED                              96

      NO WELL BABY CARE FOR CHILDREN OVER
274   FIVE YEARS                               119


276   PLEASE FILE CLAIM TO BCBS OF GEORGIA     109




277   SERVICE NOT COVERED FOR DEPENDENT        96




      CONTRACT DOES NOT COVER MEDICARE
278   PART B COINSURANCE                       96




                                   Page 16
                                CARCs_Query2


      PATIENT EXCEEDS MAX DEPENDENT AGE.
279   VERIFY IF INCAPACITATED.                 32




      NO BENEFITS FOR CLINICAL PATHOLOGY
281   CONSULT/INTERPRETATION                   96




      CLAIM PENDING EMPLOYMENT
285   INFORMATION FROM SUBSCRIBER              16




      THIS POLICY DOES NOT COVER THE
286   MEDICARE PART A DEDUCTIBLE               96




      SERVICES RELATED TO ORTHODONTIC
289   TREATMENT NOT COVERED.                   96



290   BENEFITS PAID TO ANOTHER PHYSICIAN       B20




      NO BENEFITS FOR COUNSELING OR
292   TRAINING                                 96
      NO BENEFITS FOR ASST. SURGEON UNLESS
293   MEDICALLY NECESSARY.                     54




      EXCEEDS NUMBER OF WELL CHILD VISITS
294   COVERED BY CONTRACT                      35




                                    Page 17
                                CARCs_Query2




      THIS PROCEDURE IS ONLY COVERED ONCE
300   EVERY YEAR                               119




305   INTERN OR RESIDENT IS NOT COVERED        B7




306   NO BENEFITS FOR SKILLED NURSING CARE     96




      NOT WITHIN 14 DAYS OF HOSPITAL
307   DISCHARGE                                96




309   THIS DENTAL SERVICE IS NOT COVERED       96


      THIS PROCEDURE IS ONLY COVERED ONCE
310   EVERY THREE YEARS                        119




312   WAITING PERIOD NOT MET. NOT COVERED      179




                                   Page 18
                               CARCs_Query2




      NEED ADDITIONAL INFORMATION TO
313   COMPLETE PROCESSING                     16




315   270 DAY WAITING PERIOD NOT COMPLETED    179




      INVESTIGATIONAL OR EXPERIMENTAL
319   PROCEDURES ARE NOT COVERED              55




      SUPERVISION OF MORE THAN 4
320   CONCURRENT ANESTHESIA PROCEDURES        96



      ONLY STATE NETWORK PROVIDERS
322   RECEIVE DIRECT PAYMENT.                 100


324   ONLY THE MAJOR PROCEDURE IS COVERED     97




328   CUSTODIAL CARE IS NOT COVERED           96

      THIS PROCEDURE IS ONLY COVERED ONCE
330   EVERY FIVE YEARS                        119




                                  Page 19
                                CARCs_Query2




      NECESSARY HOSPITAL/MEDICAL
331   INFORMATION HAS NOT BEEN RECEIVED        16


332   REFILE CLAIM TO THE CORRECT BCBS PLAN    109




      SERVICE NOT COVERED UNLESS RENDERED
333   AT ROPER HOSPTIAL                        96


      FULL BENEFITS PAID BY THE PRIMARY
334   CARRIER                                  23




      ADMISSION FOR PHYSICAL THERAPY IS NOT
335   COVERED                                  96

      CHARGES SHOULD BE INCLUDED IN THE
337   SURGICAL OR MEDICAL FEE                  97

      ONE CHOLESTEROL SCREENING/YEAR BY
338   NETWORK PROVIDERS ONLY                   38




      OUTPATIENT CONSULTATION IS NOT
339   COVERED                                  96




      ONLY COVERS SUPPLIES THAT ARE
340   UNAVAILABLE AT RITE AID                  96

      MAXIMUM BENEFITS PAID FOR DIAGNOSTIC
341   SERVICES.                                119




                                   Page 20
                                CARCs_Query2




343   MEDICAL EMERGENCY CRITERIA NOT MET       40
      THIS SERVICE IS NOT DOCUMENTED IN THE
344   MEDICAL RECORDS                          B12




345   COSMETIC SURGERY IS NOT COVERED          96
      MEDICAL RECORDS SHOW THIS SERVICE
347   WAS RENDERED BY ANOTHER MD               B12

      WE NEED CURRENT INFORMATION ABOUT
      ANY OTHER HEALTH/DENTAL INSURANCE
      YOU MAY HAVE. FOR YOUR CONVENIENCE,
      YOU MAY EITHERCOMPLETE AND RETURN
      THE OTHER HEALTH/DENTAL INSURANCE
      QUESTIONNAIRE OR CONTACT US AT THE
348   CUSTOMER SERVICE PHONE                   22


      NO REPLY FROM OTHER INSURANCE
349   COMPANY                                  22

      TYPE OF SERVICE IS NOT COMPATIBLE WITH
350   THE PLACE OF SERVICE                      5




      MORE THAN ONE MD INDICATED-PLEASE
351   SEND MORE SPECIFIC RECORDS               16




      THIS PROCEDURE IS PENDING APPROVAL
352   UNTIL TEETH ARE EXTRACTED                16




                                   Page 21
                                CARCs_Query2




      PLEASE RESUBMIT WITH A DETAILED
353   DESCRIPTION OF THIS SERVICE              16

      THIS SERVICE IS INTEGRAL OF MAJOR
355   PROCEDURE.                               97




357   ROUTINE NEWBORN CARE IS NOT COVERED      34




      PREVENTIVE CARE BENEFIT COVERS WELL
359   BABY EXAMS TO AGE TWO                    35




      PRIVATE ROOM CHARGES COVERED AT
360   TUOMEY HOSPITAL ONLY.                    B5




      THIS SERVICE IS NOT COVERED AS PART OF
361   THE ROUTINE PHYSICAL                     96

      SERVICES RENDERED BY THIS PROVIDER
362   MUST BE REFERRED BY MD                   38


      BENEFITS ARE NOT PROVIDED FOR
364   MISSED/CANCELLED APPOINTMENTS            115




                                   Page 22
                                CARCs_Query2




      MAJOR MEDICAL CLAIM RETURNED FOR
366   ADDITIONAL INFORMATION.                  16


367   AMOUNT EXCEEDS MAXIMUM ALLOWANCE         45


      MAXIMUM BENEFITS PROVIDED BY
368   MEDICARE                                 23

369   MAXIMUM BENEFITS PROVIDED BY BCBS        35




      MEDICARE DEDUCTIBLE/COINSURANCE IS
370   NOT COVERED                              96

      ONLY 1 ROUTINE PHYSICAL PER YEAR WITH
371   A MAX OF $200                            119

      ONLY 100 PHYSICAL/OCCUPATIONAL
372   THERAPY VISITS PER YEAR                  119




373   BCBS DEDUCTIBLE IS NOT COVERED           96




      MEDICARE/BCBS DEDUCTIBLE IS NOT
374   COVERED                                  96




      THIS CONTRACT DOES NOT COVER
375   COINSURANCE                              96
      CONTRACT CANCELLED,CONTACT MARLENE
376   PERSONNEL OFFICE FOR INFO                27


                                     Page 23
                                  CARCs_Query2




      HEARING AIDS AND RELATED SUPPLIES ARE
377   NOT COVERED                                96



378   PATIENT IS NOT ELIGIBLE FOR BENEFITS       32

      THIS IS A REVCO DRUG PLAN SINCE 7-21-92,
380   WE CAN'T PROCESS                           B1

      THIS POLICY DOES NOT COVER DRUGS
381   PRESCRIBED BY THIS DOCTOR                  170

      PLEASE FILE ALL HEALTH CLAIMS TO BCBS
382   OF NORTH CAROLINA                          109

      PLEASE FILE CLAIMS TO THE TRAVELERS IN
384   ATLANTA,GEORGIA                            109


385   PAYMENT LIMITED TO FIXED AMOUNT            45

      SECONDARY PROCEDURE IS ALLOWED AT
386   50%                                        59




      MAXIMUM BENEFITS HAVE BEEN PAID FOR
387   THIS BENEFIT PERIOD                        119
      MAXIMUM LIFETIME BENEFITS HAVE BEEN
388   PAID                                       35

      MAXIMUM BENEFITS HAVE BEEN PAID FOR
389   THIS TYPE SERVICE                          119

      PLEASE FILE CLAIM TO BCBS OF CALIFORNIA-
390   VAN NUYS OFFICE                            109

      BENEFITS WERE COORDINATED FOR THIS
391   CLAIM                                      45


392   PLEASE FILE CLAIMS TO BCBS OF ILLINOIS     109




                                     Page 24
                                CARCs_Query2




393   PLEASE FILE CLAIMS TO BCBS OF TEXAS      109




394   NO OUTPATIENT PSYCHIATRIC BENEFITS       96


      CLAIM HAS BEEN FORWARDED TO
395   APPROPRIATE PLAN FOR PROCESSING          B11
      POLICY CANCELLED. CONTACT CCX
396   PERSONNEL FOR FILING ADDRESS             27

      BENEFITS LIMITED TO 50% OF COVERED
397   CHARGES                                  45


398   MAXIMUM ALLOWANCE PER VISIT = $XXXX      119

      MAXIMUM ALLOWANCE PER CONTRACT =
399   $XXXX                                    119




400   FAMILY THERAPY IS NOT COVERED            96




401   PSYCHOLOGICAL TESTING IS NOT COVERED     96




      ROUTINE VACCINATIONS OR
402   INNOCULATIONS ARE NOT COVERED.           96


      SERVICES WERE RENDERED PRIOR TO THE
403   PATIENT'S COVERAGE EFFECTIVE DATE        26

      ONLY 1 DEDUCTIBLE COVERED FOR EACH 60
404   DAY ILLNESS.                             119


405   DEPENDENT OVER AGE OF ELIGIBILITY.       32



                                   Page 25
                               CARCs_Query2


      THE PATIENT HAD NO COVERAGE FOR THE
406   DATE OF SERVICE.                        31




      MAJOR MEDICAL BENEFITS ARE NOT
407   AVAILABLE FOR THIS SERVICE.             96
      THIS PATIENT COVERED UNDER ANOTHER
408   CONTRACT                                32




      BENEFITS ARE NOT PROVIDED FOR ROUTINE
409   OR PREVENTIVE CARE.                     49

      CLAIM BEING REVIEWED UNDER PRIMARY
410   CONTRACT.                               133




      PREVENTIVE CARE BENEFIT DOESN'T COVER
411   THESE ROUTINE SERVICES                  96




412   NON LOCAL AMBULANCE IS NOT COVERED      96




      DELUXE MODEL SUPPLY OR EQUIPMENT IS
413   NOT COVERED                             96




414   THIS EQUIPMENT IS NOT COVERED           96

      EQUIPMENT MUST BE PRESCRIBED BY A
415   PHYSICIAN                               174



      DOES NOT MEET CRITERIA FOR DME EVEN
416   WHEN MD ORDERS                          50




                                  Page 26
                                 CARCs_Query2



      CLAIM COVERED UNDER WORKERS
418   COMPENSATION                              19
      SUBSCRIBER NOT ELIGIBLE UNDER TERMS
419   OF GROUP CONTRACT                         31




      PLEASE REFILE WITH A COPY OF THE
420   MEDICARE SUMMARY NOTICE                   16

      FILE CLAIMS TO BCBS OF CALIFORNIA--
421   WOODLAND HILLS OFFICE                     109



422   THIS AMOUNT WAS PAID BY CHAMPUS.          23



423   CLAIM IS TO BE PAID BY CONTROL PLAN       B11




      PLEASE REFILE WITH THE EXPLANATION OF
424   BENEFITS FROM CHAMPUS.                    16




      THIS CONTRACT PROVIDES BENEFITS FOR
425   INPATIENT SERVICES ONLY.                  96




      THIS CONTRACT DOES NOT COVER THE
426   CHAMPUS DEDUCTIBLE.                       96

      MAXIMUM BENEFITS HAVE BEEN PAID BY
427   BLUE SHIELD.                              119



                                    Page 27
                                   CARCs_Query2




      MAXIMUM BENEFITS HAVE BEEN PAID BY
428   WORKERS COMPENSATION                        23




      THIS POLICY ONLY COVERS VISION AND
429   DENTAL SERVICES.                            96
      DENTAL CONTRACT DOES NOT COVER
430   PATIENTS 14 AND OLDER                       35




431   NONCOVERED SUPPLY                           96




432   THIS IS NOT A COVERED DRUG                  96




      SERVICES RELATED TO BIRTH CONTROL
433   ARE NOT COVERED                             96




      NEED COPY OF TRAFFIC ACCIDENT REPORT
434   TO PROCESS CLAIM.                           16




435   B12 IS NOT COVERED FOR THIS CONDITION       96

      BENEFITS INCLUDED IN ALLOWANCE FOR
436   LABORATORY TEST.                            97




                                     Page 28
                                CARCs_Query2




437   DIET PILLS ARE NOT COVERED               96
      DUPLICATE - PREVIOUSLY PROCESSED &
438   APPLIED TO DEDUCTIBLE                    18




      PRESCRIPTION VITAMINS FOR WELL BEING
439   ARE NOT COVERED                          96




      CLAIM FORWARDED TO THE DRUG
440   PROGRAM FOR REVIEW                       B11




441   ROUTINE VISION CARE IS NOT COVERED       96




442   CONTACT LENSES ARE NOT COVERED           96




443   GLASSES ARE NOT COVERED                  96




      REFILE WITH EXACT DENIAL REASON OF
444   NON-PAYMENT FROM MEDICARE                16




                                    Page 29
                               CARCs_Query2




      PROVIDER DOES NOT MEET THE DEFINITION
445   OF A PHYSICIAN                          B7




446   CUSTODIAL CARE IS NOT COVERED           96




447   CONVALESCENT CARE IS NOT COVERED        96




448   SANITARIUM CARE IS NOT COVERED          96




      BENEFITS NOT PROVIDED UNLESS THERE
449   ARE UNUSUAL CIRCUMSTANCES               96




450   IMMUNIZATIONS ARE NOT COVERED           96




451   WELL BABY CARE IS NOT COVERED           96


      ROUTINE HEARING EXAMS ARE NOT
452   COVERED                                 49

      FILE CLAIM TO MANAGED HEALTH NETWORK-
453   CALL 1-800-967-9276                     109




                                  Page 30
                                CARCs_Query2




      NO BENEFITS AVAILABLE FOR SELF
454   INFLICTED INJURIES                       96




455   RESUBMIT WITH A SPECIFIC DIAGNOSIS       125




456   REFILE WITH ITEMIZATION OF CHARGES       16




457   FILE A SEPARATE CLAIM FOR EACH PERSON    16




      REPLACEMENT PROCEDURE NOT COVERED
458   IF MEMBER COVERED < 1 YEAR               96




      SEE PERSONNEL OFFICE FOR FILING
459   PROCEDURES FOR THIS SERVICE              109




                                   Page 31
                               CARCs_Query2




      SERVICE IS NOT COVERED UNDER THE
460   BASIC PORTION OF THE POLICY             96


461   MAXIMUM BENEFITS HAVE BEEN PAID         119


462   WAITING PERIOD NOT COMPLETED            179


      CLAIM FORWARDED TO BCBS FOR
463   PROCESSING                              B11




      COMPLETE CLAIM AND RETURN FOR
464   PROCESSING                              16

      BASIC BENEFITS HAVE BEEN PROVIDED
465   (PAID BY BASIC)                         B13

      EXCEEDS MAXIMUM ALLOWABLE FOR THIS
466   SERVICE                                 45




      ONLY DRUG/NURSING SERVICES ARE
467   COVERED                                 96




      CHIROPRACTIC SERVICES ARE NOT
468   COVERED                                 96




      BASED ON MEDICAL STAFF REVIEW,
470   SERVICES DENIED                         96



                                    Page 32
                                  CARCs_Query2




      CLAIM FORWARDED TO ANOTHER PLAN FOR
471   PROCESSING                                 B11




472   PREMIUM HAS NOT BEEN PAID                  96

      EXPERIMENTAL PROCEDURES ARE NOT
473   COVERED                                    55

      CONTACT RICHLAND MEM AT 434-6698 FOR
474   FILING PROCEDURES                          109

475   DUPLICATE CHARGES WITHIN THIS CLAIM        18




      COURTESY DISCOUNTS OR ADJUSTMENTS
476   ARE NOT COVERED                            96


      LEVEL OF CARE DOES NOT REQUIRE A
477   REGISTERED NURSE                           150




      PRIVATE DUTY NURSING IN A HOSPITAL IS
478   NOT COVERED                                A1




      PRIVATE DUTY NURSING NOT COVERED
479   WHEN HOSPITAL HAS AN ICU                   A1




480   SITTERS ARE NOT COVERED                    A1
      PRIVATE DUTY NURSING LIMITED TO A $500
481   MAXIMUM                                    119




                                    Page 33
                               CARCs_Query2




      PLEASE REFILE CLAIM WITH THE
482   CORRECTED MEDICARE REMITTANCE           16




      RESUBMIT WITH PLACE SERVICE WAS
483   RENDERED                                125




      PLEASE RESUBMIT THE NAME OF THE
484   PRESCRIBING PHYSICIAN                   125




      TRAVEL EXPENSES FOR PRIVATE DUTY
485   NURSING ARE NOT COVERED                 A1
      MAXIMUM ORTHODONTIC ALLOWACE
486   EXCEEDED                                35




      TREATMENT BEGAN PRIOR TO THE
487   CONTRACT EFFECTIVE DATE                 96




      ORTHODONTIC SERVICES ARE NOT
488   COVERED                                 96



                                  Page 34
                               CARCs_Query2


      CHARGES OVER THE SEMI-PRIVATE ROOM
489   ALLOWANCE ARE NOT COVERED               78

      CONTRACT ALLOWANCE IS $5 PER DAY
490   TOWARD PRIVATE ROOM                     45




      ROOM/BOARD NOT COVERED FOR
491   DIAGNOSTIC ADMISSIONS                   96

      CONTRACT ALLOWANCE IS $10 PER DAY
492   TOWARD PRIVATE ROOM                     45

      CONTRACT ALLOWANCE IS $4 PER DAY
493   TOWARD PRIVATE ROOM                     45




494   LATE CHECK OUT IS NOT COVERED           96




495   BLUE CROSS DEDUCTIBLE IS NOT COVERED    96




496   THIS SURGERY IS NOT COVERED             96

      NO BENEFITS FOR ASSISTANT SURGEON
497   UNLESS MEDICALLY NECESSARY              54




      THREE PINT BLOOD DEDUCTIBLE HAS NOT
498   BEEN SATISFIED                          96




      NO BENEFITS FOR OVER THE COUNTER
499   ITEMS.                                  96



                                    Page 35
                                CARCs_Query2




      THIS DENTAL SERVICE IS NOT COVERED
500   UNDER MAJOR MEDICAL                      96


      MAXIMUM BENEFITS HAVE BEEN PAID TO
501   ANOTHER PHYSICIAN                        B20


      NO BENEFITS FOR SERVICES PERFORMED
502   AT THIS PLACE OF SERVICE                 58


      NO BENEFITS FOR ACCIDENT SERVICES AT
503   THIS PLACE OF SERVICE                    58


      NO BENEFITS FOR THESE SERVICES AT THE
504   DOCTOR'S OFFICE                          58




      DRUGS FOR ROUTINE MATERNITY ARE NOT
505   COVERED                                  96

      SURGICAL ALLOWANCE INCLUDES LOCAL
506   ANESTHESIA                               97




      ANESTHESIA IS NOT COVERED WHEN THE
507   SURGERY IS NOT COVERED                   96


      ANESTHESIA NOT COVERED WHEN
508   RENDERED BY THE SURGEON                  194

509   NO BENEFITS FOR HOME VISITS.             B1




      NO BENEFITS FOR ACCIDENT RELATED
510   DENTAL SERVICES.                         96




                                     Page 36
                                CARCs_Query2




      NO BENEFITS FOR OUTPATIENT DIAGNOSTIC
511   SERVICES.                                96




      OUTMODED PROCEDURE- SUBMIT MEDICAL
512   RECORDS FOR REVIEW                       16

      CONTRACT ALLOWS ONLY ONE MEDICAL
513   VISIT PER DAY                            B14




      FREQUENCY OF VISITS NOT MEDICALLY
514   SUBSTANTIATED                            A1


      FORWARD TO BCBS OF ALA. CLAIMS FILING
515   OR WRITTEN INQUIRIES                     B11
      NO BENEFITS FOR NON-EMERGENCY
516   AMBULANCE TRANSPORT.                     40




      HORMONE INJECTION IS NOT COVERED
517   UNLESS ORAL INTOLERANCE EST              96

      MEDICAL NECESSITY NOT SUBSTANTIATED
518   (OBESITY)                                50


      NO SEPARATE ALLOWANCE- CONSIDERED
519   PART OF AMBULANCE SERVICE.               B15




                                   Page 37
                                CARCs_Query2




      DENTAL SERVICES COVERED ONLY WHEN
520   THE RESULT OF AN ACCIDENT                96

      NO PAYMENT BEFORE SERVICES ACTUALLY
521   RENDERED                                 112

522   CONTRACT LIMITS PAYMENT TO $XXXX         35

      PAYMENT FOR THIS PROCEDURE BASED ON
524   LESS COSTLY ALTERNATIVE.                 B8

      ONLY NETWORK PARTICIPATING PROVIDERS
525   RECEIVE DIRECT PAYMENT                   100
      CHARGES FOR CONSULTING PHYSICIAN ARE
526   NOT COVERED                              54




      OUTPATIENT CONVULSIVE THERAPY IS NOT
527   COVERED                                  96

      ONLY PAR PROVIDERS RECEIVE DIRECT
528   PAYMENT                                  100



      MEDICAL NECESSITY NOT SUBSTANTIATED
529   (CONSIDERED COSMETIC)                    50


      HOSPITAL STAY EXCEEDED APPROVED
530   DAYS. CHARGES NOT COVERED..              198




      NO BENEFITS DUE. THIS CLAIM RESOLVED
531   BY SEPARATE AGREEMENT.                   96


      NO BENEFITS WITHOUT REFERRAL BY THE
532   GATEKEEPER PHYSICIAN                     38




                                   Page 38
                                CARCs_Query2




      ACTION EXCEPTION OVERRIDE TO A
533   NEGATIVE TPR RECORD                      133




      THIS POLICY DOES NOT COVER NON-
534   SKILLED NURSING HOMES                    96

      MAXIMUM HAS BEEN PAID FOR OUTPATIENT
535   DIAGNOSTIC SERVICES                      35

      PART OF THIS ADMISSION NOT APPROVED.
536   ADDTL INFO REQUESTED.                    197




      THIS CONTRACT DOES NOT COVER
537   PRESCRIPTION DRUGS                       96

      CHARGE IS INCLUDED IN THE FEE FOR
538   MEDICAL CARE                             97



539   REFILE THIS CLAIM TO THE HMO CARRIER     109

      ALLOWANCE FOR THIS SERVICE INCLUDED
540   IN BASE RATE                             97




541   MAXIMUM LIFETIME BENEFITS EXHAUSTED      35



      HEALTH CLAIMS TO BCBS-OHIO.MAIL ORDER
542   & DENTAL STAYS INHOUSE                   B11

      ALLOWANCE WAS INCLUDED IN ALLOWANCE
543   FOR OTHER SERVICES FILED                 97


      SERVICES RENDERED BY A RELATIVE OF
544   PATIENT NOT A BENEFIT                    53




                                   Page 39
                                 CARCs_Query2




545   PAID IN FULL BY OTHER INSURANCE           23


      CHIROPRACTIC SERVICES ARE NOT
546   COVERED FOR THIS DEPENDENT                33



      YOUR CONTRACT DOES NOT COVER
547   SERVICES AT THIS FACILITY                 58




      DRUGS FOR PSYCHIATRIC CONDITIONS ARE
548   NOT COVERED                               96

      THE PATIENT'S BENEFIT PLAN DOES NOT
      PROVIDE BENEFITS FOR JOB RELATED
549   INJURY OR ILLNESS                         19


      REQUIRED PREDETERMINATION HAS BEEN
550   DENIED                                    39

      PAST THE TIMELY FILING LIMITATION
551   SPECIFIED BY THE CONTRACT                 29


      THIS PROCEDURE IS NOT INDICATED FOR
552   THE SEX OF THIS PATIENT                   7




      PATIENT OVER ELIGIBLE AGE FOR THIS TYPE
553   SERVICE                                   96




                                     Page 40
                                 CARCs_Query2




      INVALID CPT CODE-SERVICE REFERRED TO
554   PAR PLAN FOR CORRECTION                   16



      NO BENEFITS FOR MEDICAL CARE BY MORE
555   THAN ONE DOCTOR PER DAY                   B14

      THIS PERSON IS NOT LISTED ON OUR
556   MEMBERSHIP FILES                          32


      OUT OF AREA NON-EMERGENCY
557   ACCIDENT/MEDICAL CARE                     40




558   NO RECORD OF GROUP MEMBERSHIP             31
      DME MAXIMUM BENEFITS HAVE BEEN PAID
559   FOR THIS EQUIPMENT                        35

      THIS IS A DRUG PLAN ONLY. HEALTH
560   BENEFITS ARE NOT COVERED.                 109
      SERVICES PROVIDED PRIOR TO DATE OF
561   BIRTH                                     14




562   ORIGINAL CLAIM PROCESSED INCORRECTLY      96
      DUPLICATE CLAIM PREVIOUSLY PROCESSED
563   THROUGH INTERPLAN BANK                    18

      THIS IS A MEDICARE CLAIM THAT NEEDS TO
564   BE FILED DIRECT                           109




                                    Page 41
                                 CARCs_Query2




      THIS SERVICE IS NOT COVERED FOR THE
565   REPORTED CONDITION                        96




      DOCUMENT NOT LEGIBLE. PLEASE
566   RESUBMIT CLEAR/LEGIBLE COPY.              16


      NO COVERAGE FOR PRIVATE PSYCHIATRIC
567   FACILITIES                                58




      NO BENEFITS FOR PRIVATE PSYCHIATRIC
568   CARE OUTSIDE OF SC                        96


      THIS CLAIM HAS BEEN PAID BY THE AT
569   FAULT INSURANCE COMPANY                   23


      ONLY GENERAL FACILITIES COVERED FOR
570   PSYCHIATRIC CARE                          58

      SEPARATE AMBULATORY SURGERY FACILITY
571   FEE NOT PAID THIS PROC.                   B15



      SERVICES IN AN ASC SETTING ARE NOT
573   MEDICALLY INDICATED                       58




574   MATERNITY SERVICES ARE NOT COVERED        96

      CHARGES SHOULD BE FILED BY RENDERING
575   PRACTITIONER                               8




                                     Page 42
                                 CARCs_Query2




      ONE CONSULTATION PER PHYSICIAN PER
576   CONFINEMENT                               35




577   NO BENEFITS PAID TO THE CONSULTANT        96


      PAYMENT LIMITED TO ONE MEDICAL VISIT
578   PER DAY                                   B14




      NEWBORN CARE IS NOT COVERED WHEN
579   THE DELIVERY IS NOT COVERED               96




580   NEED CORRECTED CLAIM FROM HOSPITAL        125

      THESE SERVICES INCLUDED IN GLOBAL
581   PRICING AGREEMENT                         97


582   ADVANCED APPROVAL WAS NOT RECIEVED        197

      ONLY ONE GYN EXAM AND ONE PAP SMEAR
583   PER PERSON PER YEAR                       119


      HOSPITALIZATION IN A NON-CERTIFIED
584   HOSPITAL IS NOT COVERED                   B7




      CLAIM IS BEING ADJUSTED. FURTHER
585   NOTICE IS FORTHCOMING.                    96

      CHARGE IN EXCESS NEGOTIATED PER DIEM.
586   PATIENT HELD HARMLESS.                    45



                                    Page 43
                                 CARCs_Query2




      BENEFITS ARE NOT PAYABLE FOR MILITARY
587   FACILITIES.                               58




      DRUG NAME(S) MISSING OR UNCLEAR. NEED
588   NAME OF PRESCRIBING DR                    16



589   CLAIM FORWARDED TO BLUE SHIELD            B11


590   CLAIM IS BEING REVIEWED BY BLUE SHIELD    133

      FILE WITH EMPIRE BLUE CROSS OF NEW
591   YORK FOR PROCESSING                       109




      NO BENEFITS. PHYSICAL ONLY FOR MEMBER
592   AND/OR SPOUSE OVER 40.                    96

      CLAIM IS BEING REVIEWED FOR CONTRACT
593   MEDICAL BENEFITS                          133




      PLEASE FOWARD A COPY OF THE ITEMIZED
595   BILL                                      16




596   NO COVERAGE FOR STATE HOSPITALS           171


      THIS CLAIM HAS BEEN SENT TO MICHIGAN
597   FOR PROCESSING                            B11



                                    Page 44
                                 CARCs_Query2




      NO BENEFITS FOR GLASSES, CONTACT
598   LENSES OR EYEWEAR SUPPLIES                 96




      WE REQUESTED INFORMATION FROM THE
      PROVIDER REGARDING THIS CLAIM, BUT IT
599   HAS NOT YET BEEN RECEIVED                  17


      INCORRECT ID NUMBER OR ALPHA PREFIX.
600   HOST PLAN TO REFILE.                       B11


      MOTHER/BABY CHARGES FILED ON SAME
601   CLAIM, FILE CLAIM DIRECT                   109




      RENTAL
      COMPONENTS/REPAIRS/REPLACEMENT
602   PARTS ARE NOT COVERED                      96

      MOTHER/BABY CLAIM. PLEASE FILE DIRECT
603   TO HOME PLAN.                              109




      WAITING ON ITEMIZED BILL/WEHN
604   RECD/YOU'LL BE NOTIFIED OF BAL             16




      FIRST 20 DAYS IN A SKILLED NURSING
605   FACILITY IS NOT COVERED.                   96




                                       Page 45
                                 CARCs_Query2




      WE ARE SENDING A LETTER FOR
606   ADDITIONAL MEDICAL INFO. NEEDED.          16
      THIS CLAIM HAS BEEN FORWARDED TO THE
      MEMBER'S HOME PLAN FOR PROCESSING.
      DIRECT FUTURE INQUIRIES FOR THIS CLAIM
607   TO THE HOME PLAN.                         B11




      SECOND SURGICAL OPINION IS NOT
608   COVERED                                   96




      NO BENEFITS ARE PROVIDED FOR TERMINAL
610   MATERNITY                                 96




611   NEED CORRECTED CLAIM FROM PROVIDER        125

612   ACTIVE SUBROGATION CASE                   20
      BENEFITS ONLY PROVIDED FOR PHASE ONE
613   & TWO OF CARDIAC REHAB                    35

      ALLOWANCE FOR THIS PROCEDURE
614   INCLUDED IN DELIVERY ALLOWANCE            97

      PLS FILE THIS CLAIM AND MEDICARE REMIT
616   TO MEMBER'S HOME PLAN                     109

      CHARGES COMBINED WITH OTHER
619   CHARGES                                   B15




                                    Page 46
                                 CARCs_Query2



      THIS CLAIM NEEDS TO BE FILED DIRECT TO
620   MEMBER'S HOME PLAN                        109

      HOSPITAL BASED PHYSICIAN CHARGES
621   INCLUDED IN CONTRACT RATE                 97


      REHABILITATION ADMISSION WITHIN 60
623   DAYS OF DISCHARGE                         B5

      EFF. 11/1/94 DRUG CLMS ARE MAILED TO
624   BCBS OF VERMONT                           109

      SERVICES MUST BE RENDERED BY A
625   PHYSICIAN                                 8




      ALCOHOL REHABILITATION IS NOT COVERED
626   BY THIS CONTRACT                          96


      NOT COVERED WHEN RENDERED IN THIS
627   PLACE OF SERVICE                          58

      NOT COVERED WHEN RENDERED BY THIS
628   PROVIDER'S SPECIALTY                      172




      BENEFITS ARE NOT PAYABLE FOR THIS
629   PRESCRIPTION DRUG                         96




      NOT A COVERED SERVICE UNDER THIS HMO
630   BLUE HEALTH PLAN                          96

      DENIED - PCP NOT USED AND HMO BLUE DID
631   NOT PRE-AUTHORIZE                         38




      THESE MEDICAL SUPPLIES ARE NOT A
632   BENEFIT                                   96




                                    Page 47
                                CARCs_Query2




      PATIENT OVER AGE MAXIMUM FOR ROUTINE
633   IMMUNIZATIONS                            96

      FORWARD DRUG CLAIMS FOR PROCESSING
634   TO BC/BS OF ALABAMA                      109

      PRE-NEGOTIATED RATE. PATIENT NOT
635   LIABLE FOR NON-ALLOWED AMT.              45




      BCBS REQURIES THAT MILEAGE BE BILLED
637   SEPARATELY ON AMBULANCE                  16




638   NOT PAYABLE SEPARTELY FOR AMBULANCE      B15

      MEDICAL CARE IS COVERED AFTER THE 3RD
639   DAY OF HOSPITALIZATION                   119

      OUTPATIENT AUTHORIZATION ONLY - DENY
640   ROOM AND BOARD                           197




      FORWARD COPY OF MEDICARE CARD
641   SHOWING EFFECTIVE DATES                  16


      SERVICES ARE ONLY COVERED IN A
642   GENERAL HOSPITAL                         58




      DRUGS NOT COVERED UNLESS PURCHASED
643   FROM RITE AID PHARMACY                   96


                                   Page 48
                                 CARCs_Query2



      ONLY 1 ROUTINE EXAM/YR IF >40. 1 ROUTINE
644   EXAM/2YRS IF <40.                          119
      NO MORE THAN EIGHT PROCEDURES ARE
645   COVERED                                    35




      EYEWEAR COVERED ONLY WHEN NEEDED
646   AFTER CATARACT SURGERY                     96


647   NOT AUTHORIZED BY BLUECHOICE.              197

      WAITING PERIOD FOR MATERNITY NOT
649   COMPLETED                                  179



      DATE OF SERVICE IS MORE THAN 1 YEAR
650   FROM ACCIDENT DATE                         B5




      INFO REQUESTED FROM EMPLOYER OR
651   MEMBER HAS NOT BEEN RECEIVED               17

653   DEPENDENT SPOUSE IS NOT COVERED            32




      SEND DOCUMENTATION THAT CARDIAC
654   REHAB PROGRAM IS CERTIFIED                 16



      THIS BENEFIT NOT AVAILABLE UNTIL AGE 50;
655   THEN EVERY 2 YEARS.                        B5




                                     Page 49
                                  CARCs_Query2




      BENEFITS ARE PAYABLE ONLY ONCE PER
671   CONTRACT OR CALENDER YEAR                  119

      BENEFITS ARE PAYABLE ONLY TWICE PER
672   CONTRACT/CALENDER YEAR                     119

      BENEFITS ARE PAYABLE ONLY ONCE EVERY
673   SIX MONTHS                                 119

      BENEFITS ARE PAYABLE ONLY ONCE EVERY
674   THREE YEARS                                119



      BENEFITS ARE PAYABLE ONLY ONCE EVERY
675   FIVE YEARS                                 119

      A SIX MONTH WAITING PERIOD IS REQUIRED
676   FOR THIS PROCEDURE.                        179


      SERVICE RELATED TO TEETH MISSING
677   PRIOR TO EFFECTIVE DATE                    B5




      LOST OR MISPLACED DENTURES ARE NOT
678   COVERED                                    96




      IMPLANTS AND OR BRIDGES INVOLVING
679   IMPLANTS ARE NOT COVERED                   96

      FILE TO: PREMIER, PO BOX 241108,
680   CHARLOTTE, NC 28224                        109




681   COSMETIC DENTISTRY IS NOT COVERED          96




682   MULTIPLE ABUTMENTS ARE NOT COVERED         96



                                     Page 50
                                CARCs_Query2



      OUR RECORDS DO NOT SHOW YOU AS A
683   LICENSED PRACTIONER                      B7

      NOT COVERED FOR THE DENTIST
684   PERFORMING THE OPERATIVE SRVCS           38
      NO BENEFITS ARE ALLOWED FOR PATIENTS
685   NINETEEN AND OLDER                       35




      THIS PROCEDURE IS NOT COVERED UNDER
686   THIS DENTAL CONTRACT                     96

      LIMITED TO FOUR TIMES PER CALENDAR
687   YEAR                                     119




      THIS PROCEDURE IS NOT COVERED FOR
688   DECIDUOUS TEETH                          96
      THIS WAS PERFORMED PRIOR TO THE
689   EFFECTIVE DATE OF COVERAGE               26

      THIS IS THE MAXIMUM ALLOWABLE FOR THIS
690   SERVICE                                  45

      YEARLY MAXIMUM BENEFITS HAVE BEEN
691   EXCEEDED                                 119
      LIFETIME MAXIMUM BENEFITS HAVE BEEN
692   EXCEEDED                                 35

      BENEFIT PERIOD MAXIMUMS HAVE BEEN
693   EXCEEDED                                 119
      ORTHODONTIC RETENTION VISITS
694   EXCEEDED                                 35

      BENEFITS ARE PAYABLE FOR ONLY ONE
695   ORTHODONTIC VISIT A MONTH                119

      ORTHODONTIC YEARLY MAXIMUM BENEFITS
696   HAVE BEEN EXCEEDED                       119
      ORTHODONTIC LIFETIME MAXIMUM
697   BENEFITS HAVE BEEN EXCEEDED              35


      PATIENT EXCEEDS MAXIMUM AGE ALLOWED
698   FOR ORTHODONTIC BENEFITS                 B5



                                   Page 51
                                CARCs_Query2




      THE REPAIR/REPLACEMENT OF APPLIANCES
699   IS NOT COVERED                           96




      ORTHODONTIC BENEFITS ARE EXCLUDED
700   FOR EMPLOYEE OR SPOUSE.                  96




      CASE CLOSED - - NO RESPONSE TO PLAN
701   INQUIRIES                                16




      TEMPOROMANDIBULAR JOINT SYNDROME IS
702   NOT COVERED                              96




      TOOTH HAS BEEN PREVIOUSLY EXTRACTED,
703   REPLACED, OR IS MISSING                  96
      SERVICE WAS PERFORMED MORE THAN 31
704   DAYS AFTER TERMINATION                   27

      INCLUDED IN THE ALLOWANCE FOR THE
705   EXISTING DENTURE/PARTIAL                 97




      APPLIANCES ARE NOT COVERED FOR THE
707   REPORTED CONDITION                       96




                                   Page 52
                                CARCs_Query2




      PLEASE FORWARD DOCUMENTATION OF
708   MEDICAL NECESSITY                        16

      PER AUDIT, SHOULD BE INCLUDED IN
710   CHARGES FOR MEDICAL CARE.                97




      THE SIX MONTH WAITING PERIOD HAS NOT
711   BEEN MET                                 179
      SERVICE RENDERED AFTER TERMINATION
712   OF FAMILY COVERAGE                       27

      THE TWELVE MONTH WAITING PERIOD HAS
713   NOT BEEN MET                             179




      CASE CLOSED - NO PREOPERATIVE XRAYS
714   WERE RECEIVED FOR REVIEW                 16




      DISTAL ABUTMENT NOT PRESENT-
716   CANTILEVER PONTIC NOT COVERED            96




      E.R. SERVICE IS NOT COVERED FOR NON-
718   EMERGENCY CARE                           58

      THIS CHARGE EXCEEDS THE AMOUNT
719   ALLOWED                                  45




                                   Page 53
                                CARCs_Query2




      BENEFITS WERE DENIED BY OUR DENTAL
720   CONSULTANT                               96

      PERIO PROCEDURES ARE ALLOWED ONLY
721   ONCE EVERY THREE MONTHS                  119

      SEALANT ALLOWANCE CAN ONLY BE GIVEN
722   ONCE PER LIFETIME                        35




      MULTIPLE ABUTMENTS ARE NOT COVERED
723   UNDER THIS DENTAL PLAN                   96




      SPACE MAINTAINER IS NOT COVERED FOR
724   THE REPORTED TEETH                       96

      RESTORATIVE SERVICES RENDERED MORE
725   THAN ONCE IN TWO YEARS                   119


      REPORTED TOOTH HAS BEEN PREVIOUSLY
727   CROWNED                                  B5


      REPORTED TOOTH SHOWS A PREVIOUS
728   ROOT CANAL                               B5

      AFTER AGE 65, PNEUMOVAX IS ALLOWED
729   ONCE, FLU VACCINE YEARLY                 119

      PRECERT FROM HEALTH FIRST NOT
730   OBTAINED. INQUIRIES: 242-8111            197




      PLEASE SEND ITEMIZED BILL TO COMPANION
732   BENEFIT ALTERNATIVES                     16




                                   Page 54
                                 CARCs_Query2




      30 INPATIENT/50 OUTPATIENT/$5000 MENTAL
733   HEALTH MAXIMUM MET                        35
      OUR RECORDS INDICATE A DENTURE IS
734   ALREADY PRESENT                           18

      THE THREE MONTH WAITING PERIOD HAS
735   NOT BEEN MET                              179
      30 INPATIENT/50 OUTPATIENT/$2000 MENTAL
736   HEALTH MAXIMUM MET                        35

      FILE TO: KANAWHA HEALTHCARE, 210 S
737   WHITE ST. LANCASTER, SC                   109

      PROCEDURE REIMBURSEMENT NOT PAID
738   SEPARATELY                                B15




      PLEASE PROVIDE EXPLANATION OF
      DIFFERENCE BETWEEN SUBMITTED CHARGE
739   AND THE ALLOWED AMOUNT.                   16




      THE PRIMARY CARRIER INFORMATION IS
      INCORRECT. PLEASE REFILE CLAIM TO
740   MEMBER'S CORRECT PRIMARY PLAN.            16




      FULL MOUTH X-RAYS & PERIODONTAL
742   CHARTING NEEDED FOR REVIEW                16
      THIS DEPENDENT IS NOT COVERED UNDER
743   THIS CONTRACT                             33




                                    Page 55
                                CARCs_Query2




      FULL MOUTH OR FULL ARCH X-RAYS
744   NEEDED FOR REVIEW                        16




      PATHOLOGY REPORT & X-RAYS NEEDED
745   FOR REVIEW                               16

      SERVICE MUST BE PROVIDED BY
746   WALMART'S VISION NETWORK                 38

747   COBRA BENEFITS HAVE EXPIRED              27




748   ZERO PAYMENT DUE TO HIS                  96




      THIS REVENUE CODE REQUIRES A HCPCS
749   CODE. PLEASE REFILE                      16
      ONLY THE INITIAL NEWBORN EXAM IS
750   COVERED                                  35




      BENEFITS NOT AVAILABLE SINCE MEMBER
751   ON LEAVE OF ABSENCE                      96




                                    Page 56
                                 CARCs_Query2




      DENIED SINCE PRIMARY CARE PHYSICIAN
752   NOT SELECTED                              96
      CANNOT BILL AS URGENT CARE. PROVIDER
753   IS THE PCP.                               40




      THIS PATIENT DOES NOT HAVE THE URGENT
754   CARE BENEFIT                              96
      PRE-EXISTING CONDITION. PLEASE FILE TO
755   PREVIOUS CARRIER.                         51



756   SENT TO DRUG UNIT FOR PROCESSING          B11




      STILL IN PROCESS. YOU WILL RECEIVE
757   SEPARATE DISPOSITION.                     96




      INFERTILITY TREATMENT IS NOT A COVERED
758   SERVICE                                   96




      ANESTHESIA MUST BE FILED ON A
759   PROFESSIONAL CLAIM FORM                   125


760   MAXIMUM BENEFITS HAVE BEEN ALLOWED        119




                                      Page 57
                                 CARCs_Query2




      MULTIPLE CARRIERS INDICATED. NEED
761   EACH ONE'S REMIT NOTICES                  16

      ROOM & BOARD REVENUE CODE NOT
762   APPROPRIATE FOR PATIENT'S AGE              6

      GLOBAL CARDIAC PROCEDURE REQUIRES A
763   '26' MODIFER                               4


      LAB CAPITATED TO UMA. PATIENT IS NOT
764   RESPONSIBLE.                              24

      THIS PROCEDURE IS AN INTEGRAL PART OF
765   ANOTHER SURGERY                           97




      SERVICES WERE APPROVED AS INPATIENT.
      NO REIMBURSEMENT DUE FOR
766   OUTPATIENT                                125


767   INPATIENT MEDICAL CARE IS NOT COVERED     170

      THIS PROCEDURE IS NOT IN THE
768   CONTRACTED AGREEMENT                      B15




769   THIS TYPE OF THERAPY IS NOT COVERED       96

      THIS CHARGE IS ONLY COVERED UNDER
770   MEDICAL PORTION OF POLICY                 109
      FILE TO MAGELLAN BEHAVIORAL
      HEALTHCARE, PO BOX 2123 MARYLAND
771   HEIGHTS, MO 63043                         109




                                     Page 58
                                CARCs_Query2



      PRACTICE NOT CERTIFIED BY BLUECHOICE
772   TO PERFORM THIS SERVICE.                 B7

      PENDING RECEIPT OF OFFICE VISIT
773   CHARGES                                  B15
      PLEASE REFILE WITH APPROPRIATE
774   ANESTHESIA CODE.                         115
      NOT ELIGIBLE FOR COVERAGE FOR THIS
775   DATE OF SERVICE                          31




      BENEFITS APPROVED AS OUTPATIENT.
777   ROOM AND BOARD NOT COVERED.              198

      PREAPPROVAL NOT OBTAINED - ROOM AND
778   BOARD NOT COVERED                        197

      ROOM AND BOARD EXCEEDED THE
779   APPROVED DAYS                            198

      REVIEWING TO DETERMINE IF HOSP STAY
783   WAS FOR PHY THERAPY                      133

      SURGERY NOT COVERED UNLESS SECOND
784   OPINION OBTAINED                         61

      PRECERTIFICATION NOT OBTAINED.
795   PENALTY APPLIED                          197

      OFFICE CHARGES PAYABLE TO PHYSICIAN
796   ONLY                                     38

      HOME HEALTH CARE IS NOT COVERED
797   WITHOUT PREAUTHORIZATION                 197



      HOSPICE CARE IS NOT COVERED WITHOUT
798   PREAUTHORIZATION                         197

      THE REVISIONS ON THIS CORRECTED CLAIM
      ARE BEING MADE TO THE ORIGINAL CLAIM.
800   YOU WILL RECEIVE SEPARATE DISPOSITION.   B13




                                   Page 59
                                CARCs_Query2




      NEED MEDICAL INFORMATION FROM
801   FAMILY/REFERRING PHYSICIAN               16

      MAXIMUM BENEFITS HAVE BEEN PAID FOR
802   PSYCHIATRIC CARE                         35




      THIS CARDIAC REHABILITATION LEVEL OF
804   CARE IS NOT COVERED                      96

      PRIVATE DUTY NURSING IS NOT COVERED
805   WITHOUT PREAUTHORIZATION                 197


      CHARGE SHOULD BE INCLUDED IN FEE FOR
806   MEDICAL CARE                             97




      TRAVEL, LODGING & MEALS ARE NOT
807   COVERED FOR THIS TRANSPLANT              96

      MUST BE RENDERED UNDER SUPERVISION
809   OF PHYSICIAN OR THERAPIST                185


      MEDICAL NECESSITY FOR REPEAT
810   ULTRASOUND IS NOT DOCUMENTED             50


811   ADVANCE APPROVAL WAS NOT OBTAINED        197

      DRUGS COVERED WHEN PURCHASED FROM
812   LICENSED PHARMACY ONLY.                  B7



815   NO ADDITIONAL BENEFITS ARE DUE           35




                                   Page 60
                                CARCs_Query2




      THIS CLAIM WAS FORWARDED TO THE
816   DENTAL UNIT FOR PROCESSING               B11




      THIS HEALTH PLAN DOES NOT COVER
817   DRUGS                                    96



818   ROUTINE DENTAL CARE IS NOT COVERED       49


      COVERED UNDER VISION PLAN.
819   FORWARDED TO VISION UNIT                 B11




      THIS SERVICE IS COVERED ONLY FOR
821   PSYCHOLOGICAL REASONS                    96




      PLEASE RESUBMIT WITH THE NAME OF THE
826   PROVIDER                                 125




      RESUBMIT WITH THE CORRECT DATE OF
827   SERVICE                                  125


      PENDING EMPLOYMENT AND/OR OTHER
828   INSURANCE INFO FROM MEMBER               22




                                   Page 61
                                CARCs_Query2




      CLAIM PENDING REGULATIONS INFO FROM
829   FEDERAL GOVERNMENT                       16




      PLEASE RESUBMIT WITH THE NAME OF THE
830   DRUG PURCHASED                           16

      CHARGE SHOULD BE INCLUDED IN THE FEE
832   FOR GLOBAL CARE                          97




      A SEPARATE CLAIM MUST BE FILED FOR
833   EACH FAMILY MEMBER                       16


      TOTAL BENEFITS WERE PAID BY BLUE
837   SHIELD OR THE OTHER CARRIER              23

      PSYCHIATRIC MAXIMUM EXHAUSTED FOR
839   THIS BENEFIT PERIOD                      119




      CHARGE FOR TELEPHONE CALLS BY THE
840   PHYSICIAN ARE NOT COVERED                96

      DENIED SINCE ADMISSION WAS DEEMED
843   MEDICALLY UNNECESSARY                    50




                                   Page 62
                                 CARCs_Query2




      SERVICE RENDERED DURING
844   HOSPITALIZATION THAT WASN'T APPROVED      197


      CLAIM HAS BEEN SENT TO MEMBER'S HOME
845   PLAN FOR PROCESSING.                      B11




      RESUBMIT WITH LICENSE NUMBER, SHIFT
846   AND PLACE OF SERVICE                      16




      OCCUPATIONAL OR RECREATIONAL
847   THERAPY IS NOT COVERED                    96

      SERVICE COVERED ONLY WHEN RENDERED
849   BY A PSYCHIATRIST                          8

      CLAIM IS STILL IN PROCESS. FURTHER
850   NOTICE IS FORTHCOMING.                    133




      MATERNITY IS NOT COVERED FOR
851   DEPENDENT CHILDREN                        96

      NO BENEFITS FOR MORE THAN ONE DR
853   UNLESS UNRELATED CONDITION                B14

      FILE DRUG CLMS WITH BCBS OF WESTERN
854   PENNSYLVANIA                              109
      THE PATIENT'S PRE-EXISTING WAITING
      PERIOD HAS NOT BEEN MET. WE NEED A
      CERTIFICATE OF CREDITABLE COVERAGE
      FROM THE PATIENT THAT SHOWS THERE
      HAS NOT BEEN MORE THAN A 63-DAY LAPSE
857   IN COVERAGE                               51




                                     Page 63
                                 CARCs_Query2




      SERVICE MUST BE PERFORMED BY
859   PHYSICIAN OR HIS/HER EMPLOYEE             185



      SERVICE NOT ALLOWED SEPARATELY WHEN
860   MAMMOGRAM IS COVERED                      B15




      NO COVERAGE FOR OBESITY, WEIGHT
861   REDUCTION OR WEIGHT CONTROL               96

      CONTRACT ALLOWS ONLY THREE
862   CHIROPRACTIC VISITS PER MONTH             119



      ROUTINE EYE CARE & FITTING OF
863   EYEGLASSES IS NOT COVERED                 49




      PLEASE RESUBMIT WITH A STATEMENT OF
864   MEDICAL NECESSITY                         16




865   MEDICAL RECORDS NEEDED FOR CLAIM          16

      IT IS INAPPROPRIATE FOR CRNAS TO USE AA
866   MODIFIER                                   4




                                      Page 64
                                 CARCs_Query2




      BILL PROSTHETIC EYE SUPP UNDER APPRO
867   "V" (HCPCS VISION) CDS                    125

      ALLOWANCE REDUCED BY AMOUNT
868   ALLOWED PREVIOUSLY FOR PULPOTOMY          59


      MISROUTED CLAIM - THIS IS A BLUECHOICE
869   MEMBER                                    B11

      CLAIM IS IN MEDICAL REVIEW. FURTHER
870   NOTICE IS FORTHCOMING.                    133




      NEED MEDICAL RECORDS WITH DETAILED
871   INFO ABOUT CODE 97530                     16




      RESUBMIT WITH SPECIFIC DATE OF
872   ACCIDENT                                  125




      SERVICE IS NOT COVERED UNLESS
873   SURGERY IS ALLOWED                        96




      NOT COVERED. SENDING YOU A LETTER OF
874   EXPLANATION.                              96


                                    Page 65
                                  CARCs_Query2



      CONTRACT ONLY ALLOWS TWO
875   TREATMENTS/SESSIONS PER MONTH               119

      DRUG CLAIMS SHOULD BE FILED TO BCBS
876   OF TEXAS                                    109

      SEND MENTAL/NERV./SUBST. ABUSE CLMS
877   TO MCC BEHAVIORAL CARE                      109




      RESUBMIT WITH THE ANESTHESIA TIME
878   (ACTUAL MINUTES)                            16




879   MAINTENANCE THERAPY IS NOT COVERED          96

      PROVIDER WAS NOT ELIGIBLE OR WAS
881   INACTIVE ON SERVICE DATE                    B7

      PLEASE REFILE CLAIMS TO MCC
882   BEHAVIORAL CARE, INC.                       109

      ONLY ONE VISIT PER DAY, PER PHYSICIAN, IS
884   COVERED                                     B14




885   DRUG DEDUCTIBLE IS NOT COVERED              96



      CONTRACT DOES NOT COVER
886   MEDICAL/SURGICAL CONCURRENT CARE            B14


      PAYMENT BEING APPLIED TO SATISFY A
887   PREVIOUS REFUND REQUEST                     125




      DRUGS DISPENSED FROM A HOSPITAL
889   PHARMACY ARE NOT COVERED                    96



                                     Page 66
                                CARCs_Query2




      DIAGNOSITC ADMISSIONS ARE NOT
890   COVERED                                  96


      CONCURRENT MEDICAL CARE WITH
891   SURGERY IS NOT COVERED                   B14




      ALCOHOL, DRUG, SUBSTANCE ABUSE
892   REHABILITATION IS NOT COVERED            96


      MAXIMUM BENEFITS HAVE BEEN PAID TO
893   ANOTHER CHIROPRACTOR                     B20




      SEND MED RECS & PATIENT'S AUTH TO USE
894   LIFETIME RESERVE DAYS                    16

      CONTRACT DOESN'T COVER BEYOND THE
895   FIRST 100 DAYS IN SNF                    35
      LIFETIME MAXIMUM OF TWO, 45 DAY
896   ADMISSIONS HAS BEEN EXCEEDED             35

      2 O/P TREATMENTS FOR LIFE/NO MORE
897   THAN 2 VISITS PER WEEK                   119




      SPEECH THERAPY IS NOT COVERED UNDER
899   THIS CONTRACT                            96




      SERVICES PROCESSED SEPARATELY - MAY
901   GET MORE THAN 1 NOTICE                   96




                                   Page 67
                                 CARCs_Query2


      NO RECORD OF COVERAGE UNDER THIS
902   IDENTIFICATION NUMBER                     31




      PSYCHIATRIC CARE IS NOT COVERED BY
904   THIS CONTRACT                             96




      SPEECH THERAPY IS ONLY COVERED UNDER
905   CERTAIN CONDITIONS                        96




      SINGLE MATERNITY IS NOT COVERED BY
909   THIS CONTRACT                             96




      PLEASE RESUBMIT WITH THE SPECIFIC SITE
910   OF MANIPULATION                           16
      THIS SERVICE MUST BE FILED WITHIN ONE
911   YEAR OF ACCIDENT DATE                     29

      ADMISSION NOT MEDICALLY NECESSARY.
912   ROOM & BOARD NOT COVERED.                 50




      RESUBMIT WITH THE DRUG NAME,
913   STRENGTH AND DOSAGE                       16




915   PLEASE REFILE WITH NAME OF PATIENT        31




                                     Page 68
                                CARCs_Query2




      CHARGES FOR COSMETIC SERVICES ARE
916   NOT COVERED                              96
      MAXIMUM BENEFITS HAVE BEEN PAID FOR
917   THIS TYPE OF SERVICE                     35




      PLEASE FORWARD REQUESTED
918   INFORMATION AND CORRECTED CLAIM          17


      MEDICARE SHOULD PAY 1ST FOR
919   TRANSPLANT DRUGS, THEN RESUBMIT.         22


      EQUIPMENT RENTAL EXCEEDS THE
920   PURCHASE PRICE                           45

      INCREMENTAL NURSING CHARGES ARE
921   INCLUDED WITH ROOM & BOARD.              97

      THIS PROCEDURE IS AN INTEGRAL PART OF
922   ANOTHER SERVICE                          97




      THIS WEEKEND ADMISSION IS NOT
923   COVERED                                  96
      THIS SERVICE WAS PROCESSED ON A
924   PREVIOUSLY FILED CLAIM                   18




      THESE CHARGES MUST BE SUBMITTED ON A
925   UB92 CLAIM FORM.                         125


                                   Page 69
                                CARCs_Query2




      EDUCATIONAL, NOT MEDICAL - THEREFORE
926   NOT COVERED                              96


      PAYABLE IF RENDERED FIVE YEARS AFTER
927   ORIGINAL PLACEMENT DATE                  B5

      PER DAVIS MECHANICAL-NOT COVERED
928   CALL 288-7430 W/IN 5 DAYS                31




      PLEASE REFILE WITH THE DATE OF SERVICE
929   AND/OR DRUG NAME                         16




930   ELECTIVE ABORTIONS ARE NOT COVERED       96
      THE MAXIMUM PAYMENT AMOUNT FOR THIS
931   VISIT HAS BEEN MET                       35

      EQUIPMENT RENTAL AND/OR PURCHASE
932   MUST BE PRE-APPROVED                     197

      MEDICAL CLAIMS FOR THIS SERVICE DATE
937   SHOULD BE FILED TO BLUECHOICE.           109

      THIS CLAIM NEEDS TO BE FILED WITH YOUR
938   NEW INSURANCE CARRIER                    109




      WE NEED THE EXACT # OF INJECTIONS
939   GIVEN. PLEASE REFILE.                    125




                                   Page 70
                                CARCs_Query2




      SUPPLIES/SOLUTIONS INCLUDED IN
940   ALLOWANCE FOR CHEMO ADMIN                97




      PRECERTIFICATION INFORMATION HAS NOT
941   YET BEEN RECEIVED                        16


      PRIVATE ROOM NOT COVERED UNLESS
942   MEDICALLY NECESSARY                      50




      THIS CHIROPRACTIC SERVICE IS NOT
943   COVERED                                  96

      EXCEEDS CONTRACT LIMIT OF ONE, 28 DAY,
944   ADMISSION                                119




      CONTRACT DOES NOT COVER INFANTS
945   UNTIL 15 DAYS OLD                        96




      PRIMARY CARE PHYSICIAN MISSING OR
946   INVALID                                  148




947   SERVICE OUT OF NETWORK                   38




      CONTRACT ALLOWS ONE VISIT PER WEEK,
948   UP TO 30 VISITS PER YEAR                 35



                                   Page 71
                                CARCs_Query2




      OUTPATIENT CT SCAN IS NOT COVERED FOR
949   THIS PROVIDER                            58


      NO BENEFITS WHEN USING AN OUT OF
950   NETWORK PROVIDER                         38



      PRE-NEGOTIATED RATE. PATIENT NOT
951   LIABLE FOR NON-ALLOWED AMT.              45
      CHARGES FOR HOME HEALTH AND SKILLED
      NURSING FACILITIES ARE N
      OT COVERED UNLESS SERVICES ARE
      RENDERED WITHIN 120 DAYS OF
952   DISCHARGE FROM THE HOSPITAL.             B5

      THIS CONTRACT LIMITS THIS PROCEDURE
953   TO ONCE EVERY SIX MONTHS                 119

      INPATIENT MENTAL HEALTH LIMITED TO
954   $12,000 PER LIFETIME                     35




      PRE-OPERATIVE X-RAYS REQUIRED TO
955   PROCESS THESE CHARGES                    16




      VOLUNTARY STERLIZATIONS ARE NOT
957   COVERED                                  96




      NEED STATEMENT INDICATING WHAT RX IS
958   BEING USED TO TREAT                      16




                                   Page 72
                                CARCs_Query2




      NO BENEFITS FOR THIS SERVICE.
959   PRECERTIFICATION NOT OBTAINED            197

      WE DID NOT RECEIVE ENOUGH
      INFORMATION TO PROCESS THIS CLAIM.
      PLEASE FILE A CORRECTED CLAIM THAT
      INCLUDES A DETAILED DESCRIPTION OF
      THE PROCEDURE, SERVICE, OR SUPPLY
960   AND INCLUDE OPERATIVE NOTES              16




      PLEASE FORWARD NAME OF FAMILY AND/OR
961   REFERRING PHYSICIAN                      16



      PAYMENT REDUCED SINCE PRECERT WAS
962   NOT OBTAINED                             197


      LIMITATIONS FOR PREAUTHORIZATION HAVE
963   BEEN EXCEEDED                            198



      CHIROPRACTIC MANIPULATIONS ARE
965   LIMITED TO ONE PER DAY                   35



      CONTRACT ALLOWS ONLY ONE ROUTINE
966   PHYSICAL PER YEAR                        119




      THIS SERVICE NOT INCLUDED IN MEMBER'S
967   CHIROPRACTIC BENEFIT                     96


      PRECERT NOT OBTAINED FOR EQUIPMENT.
968   NEED MEDICAL RECORDS.                    197




                                   Page 73
                                CARCs_Query2




969   CLAIM COORDINATED WITH MEDICARE          45



      WELL CHILD CARE COV'D ONLY WHEN
970   RENDERED BY STATE NTWK PVDR              38




      VACCINATIONS/INNOCULATIONS COVERED
971   FOR WELL CHILD CARE ONLY                 96

      SERVICE HAS BEEN FILED TO PRIMARY
972   CONTRACT                                 22



      PAYMENT REDUCED BECAUSE THIS WAS A
973   WEEKEND ADMISSION                        B5




      PAYMENT REDUCED-SERVICES COULD HAVE
974   BEEN OUTPATIENT SETTING                  58




      REQUESTED MEDICAL INFORMATION HAS
975   NOT BEEN RECEIVED                        17




      RESUBMIT WITH BREAKDOWN OF DAILY
977   CHARGES FOR NEWBORN CARE                 16



                                   Page 74
                                 CARCs_Query2




      APPEARS TO BE ROUTINE; IF NOT, SEND
978   ADDITIONAL DOCUMENTATION                  49



      CHARGE SHOULD BE INCLUDED IN THE
979   SURGICAL FEE                              97




      NOT COVERED UNDER MEMBER'S
980   CONTRACT                                  96




      RX FOR TREATMENT OF HAIR LOSS IS NOT
981   COVERED UNDER CONTRACT                    96




      PLEASE RESUBMIT WITH THE PHARMACIST'S
982   SIGNATURE OR STAMP                        125




      HOME HEALTH SERVICES ARE NOT
984   COVERED BY THIS CONTRACT                  96



      NON PARTICIPATING PROVIDERS ARE NOT
985   COVERED BY THIS CONTRACT                  38

      RAND CLAIM, PAYMENT WILL BE SENT TO
987   THE RAND CORP.                            100

      IN REVIEW TO DETERMINE IF ADMISSION
990   WAS FOR PHYSICAL THERAPY                  133




                                    Page 75
                                 CARCs_Query2




       BENEFITS ARE PROVIDED FOR INPATIENT
991    CHARGES ONLY.                            58




       REFILE WITH STATEMENT OF MEDICAL
992    NECESSITY                                16




       ROUTINE NURSERY CHARGES ARE NOT
993    COVERED                                  96




       MEDICAL NECESSITY NOT DOCUMENTED,
994    ROOM AND BOARD NOT COVERED               16


       EXCEEDS CONTRACT LIMIT OF TWO, 28 DAY,
995    ADMISSIONS                               119




       KIT DOES NOT REQUIRE PHYSICIANS'S RX
997    OR ORDER.                                96


       PAYABLE ONLY IF DEVICE ORDERED BY DR &
998    APPROVED BY BCBSSC                       38

       DME PRE-CERT NOT RECEIVED. PARTIAL
999    DENIAL.                                  197




       DEPENDENT MATERNITY COVERED IF
1001   CONCEIVED PRIOR TO 12/1/95               96




                                    Page 76
                                CARCs_Query2




       NOT AUTHORIZED IN ADVANCE BY PRIMARY
1002   CARE PHYSICIAN OR BLUECHOICE.           38



       DENIED-NOT AUTHORIZED IN ADVANCE BY
1003   PCP OR PRIME COMPANION                  38




       ROUTINE PREVENTIVE CARE NOT COVERED
1004   AFTER AGE 12                            96




       WELL CHILD CARE SVC NOT COVERED
1006   UNLESS W/ WELL OFFICE VISIT             96


       PROCEDURE CODE NOT COMPATIBLE
1007   W/DIAGNOSIS. REFILE CLAIM.              11


       POLICY HAS AUTOMATIC CROSSOVER FROM
       MEDICARE. PLEASE ALLOW
       TIME FOR RECEIPT OF CLAIM FROM
1008   MEDICARE.                               125


       PATIENT REACHED MAX. WELL CHILD CARE
1100   BENEFITS FOR AGE GROUP                  96




       CORRECTION: NON-COVERED SERVICE.
1101   PAYMENT IS DUE FROM PATIENT             96




                                   Page 77
                                  CARCs_Query2




       THESE SERVICES WERE BILLED IN ERROR
1102   BY THE PROVIDER                           125




       DENIED-CHARGES NOT RESPONSIBILITY OF
1103   HMO BLUE OR PATIENT                       96

       PLAN HAS LIMITED ROUTINE BENEFITS FOR
1104   EMPLOYEES ONLY                            119


       DENIED-NOT PREAPPROVED BY HMO BLUE
1105   OR PRIMARY CARE PHYSICIAN                 38

       DENIED-HOME HEALTH CARE AGENCY NOT
1106   CONTRACTED WITH BCBS                      38




       PLEASE FILE THIS CLAIM DIRECTLY TO
1107   COMPANION LIFE.                           109


       LICENSED PROFESSIONAL NOT REQUIRED;
1108   SERVICES NOT COVERED                      B1




1109   THIS POLICY DOES NOT COVER DENTAL.        109




       THIS CONTRACT PROVIDES BENEFITS FOR
1110   DENTAL SERVICES ONLY                      96




                                     Page 78
                                 CARCs_Query2




       NEED DATE PRIMARY COVERAGE
1111   CANCELLED. ALSO ANY NEW COVERAGE?         16




       SEND DENIAL OR NONCOVERED
1112   DOCUMENTATION FROM PRIMARY CARRIER        16




       THE EOB/REMIT DOESN'T MATCH CLAIM
1113   FILED. RECHECK & RESUBMIT.                16




       ORIGINAL EOB FROM PRIMARY CARRIER
1114   NEEDED                                    16




       NEED COPY OF PATIENT'S EOB OR
1115   PROVIDER'S REMITTANCE                     16




                                       Page 79
                                   CARCs_Query2



       FILE TO: AETNA, CS10036, TOLEDO, OHIO
1116   43699-0036                                 109


       SEND RX CLAIMS TO DIVERSIFIED
1117   PHARMACEUTICAL SERVICES                    109

       FILE TO VALUE BEHAVIORAL HEALTH, BOX
1118   1008 SKOKIE IL 60076                       109




       THIS POLICY COVERS ONLY 3 CYCLES OF
       GAMETE OR ZYGOTE INTRA- FALLOPIAN
1121   TRANSFER.                                  96

       THIS ACCIDENTAL DENTAL IS COVERED
       UNDER MEDICAL. REFILE TO MEMBER'S
1122   MEDICAL HEALTH PLAN                        109


       FILE MENTAL HEALTH CLAIMS: APS
       HEALTHCARE, PO BOX 1307, ROCKVILLE,
1123   MD, 20849 (PH: 1-800-221-8699)             109


       LAB MUST BE PERFORMED BY A
1125   CONTRACTING LABORATORY FACILITY            38


       PLAN ALLOWS ONLY TWO ROUTINE GYN
1126   VISITS PER MEMBER PER YEAR                 119




       23 HR OBSERVATION ONLY. REFILE FOR
1127   OBSERV, NOT ROOM/BOARD                     125




       APPROVED UNDER RTU. REFILE W/
1128   OBSERVATION, NOT ROOM/BOARD                125




       THIS CHARGE WAS FILED AND PROCESSED
1129   ON AN EARLIER CLAIM.                       B13




                                       Page 80
                                  CARCs_Query2




       DOCUMENTATION DOESN'T SUPPORT
1130   COVERAGE CRITERIA FOR DRUG                153



       HEARING SRV ONLY COVERED WHEN
1131   PROVIDED BY BELTONE NETW MEM              169

       HEARING BENEFIT: ONE SCREENING/YR;
1132   $400 FOR DEVICES/3 YRS                    119




       VISION BENEFIT: ONE SCREENING/YR; $120
1133   EYEWEAR/2 YRS                             119




       PLEASE REFILE ON HCFA-1500 W/CPT-4
1136   CODES & CHARGES SEPARATED                 16



       FILE CLAIMS TO BCBS OF WESTERN
1137   PENNSYLVANIA                              109


       DENTAL BENEFITS ARE PROCESSED
1139   THROUGH AETNA INSURANCE                   109




       CONVERTED CLAIM THAT WAS
1140   REJECTED/DENIED UNDER PAST SYSTEM         96


       SERVICES NOT APPROVED BY HMO BLUE.
1143   REIMBURSEMENT REDUCED.                    197
       DUPLICATE OF A PREVIOUSLY PROCESSED
1144   SERVICE                                   18



                                     Page 81
                                     CARCs_Query2




       MAXIMUM BENEFITS PAID UNDER ANOTHER
1145   ANESTHESIA CLAIM                             119


       CHARGES WERE COMBINED INTO ONE
1147   COMPLETE PROCEDURE                           B15



       PAYMENT REDUCED-CRNA CHARGES
1148   INDICATED SUPERVISION                        59

       ONLY INITIAL CHIROPRACTIC OFFICE VISIT IS
1149   COVERED                                      B1




1150   CLAIM MISFILED FOR FLAT FEE                  16

       VISION BENEFITS ARE PROVIDED THROUGH
1151   LENSCRAFTERS                                 38



       DENIED FOR NO PRECERT. PATIENT IS NOT
1153   LIABLE.                                      38

       ADULT PREVENTIVE SERVICE COVERS
1154   EMPLOYEE, BUT NOT SPOUSE.                    32




1155   CLAIM MISFILED FOR GLOBAL FEE                16


1156   CLAIM FILED BEFORE DELIVERY                  112


       AUTHORIZATION NOT FOUND FOR
1157   MATERNITY CLAIM.                             197




                                       Page 82
                                  CARCs_Query2



       NOT APPROVED IN ADVANCE BY HMO BLUE
1164   MEDICAL STAFF                             38



       COVERED AFTER 70 CONTINUOUS DAYS OF
1167   BASIC HOSPITAL BENEFITS                   B5




1173   SERVICE SHOULD BE FILED TO FPA            109




       PROVIDENT, STATION B, PO BOX 6185,
1174   GREENVILLE, SC 29606-6185                 109

       FILE CLAIM TO VALUE BEHAVIORAL HEALTH:
1176   1-800-820-3290                            109

       STAND BY & NOT FACE-TO-FACE CONTACT:
1180   NOT MEDICALLY NECESSARY                   50




       LAB TESTS MUST BE PERFORMED BY
1181   CONTRACTING LABORATORY                    38




       VERIFY TEETH WERE EXTRACTED WHILE
1182   UNDER WSRC DENTAL PLAN                    16




       CLAIM MAY BE ROUTINE. SUBMIT MEDICAL
1183   RECORDS FOR REVIEW.                       49




                                     Page 83
                                  CARCs_Query2




       BENEFITS NOT AVAILABLE UNTIL AGE 40,
1184   THEN ONCE YEARLY                          96




       THIS CLAIM MUST BE FILED TO YOUR LOCAL
1186   BCBS PLAN                                 109




       VBH, ONE TOWNE SQUARE STE 600,
1187   SOUTHFIELD, MI 48076                      109
       PLEASE FILE THIS CLAIM TO: VALUE
       OPTIONS ATTN: CLAIMS P.O. BOX 1347
1188   LATHAM, NY 12110-8847.                    109

       NON-NETWORK PROVIDER. WELL CHILD
1189   CARE NT COVERED AFTER AGE 1               38


       BLUE SELECT MEMBER - INPATIENT
1190   DEDUCTIBLE WAIVED                         45

       BLUE SELECT MEMBER OWES INPATIENT
1191   DEDUCTIBLE                                38

       CLAIMS:BCBSTN POB 18150-CLAIMS UNIT G11
1193   CHATTA.TN37401-7150                       109


       THIS CONTRACT DOES NOT COVER ROUTINE
1194   WELL CHILD CARE                           49




       ROUTINE MATERNITY BENEFITS 1ST 12
1195   MONTHS OF CONTRACT NOT COCVERED           179

       ROUTINE WELL CHILD CARE BY OUT-OF-
1196   NTWK PROVIDER NOT COVERED                 38




                                     Page 84
                                  CARCs_Query2




       NEED CLAIM FOR TECHNICAL COMPONENT
1198   BEFORE WE CAN PROCESS                     16

       SEND CLAIMS TO DEBRA CRITCHER, BCBSNC
2001   1-800-222-2783                            109

       REPEAT PROCEDURES NOT COVERED
2300   WITHOUT MEDICAL DOCUMENTATION             50

       REFILE TO LOCAL PLAN IN STATE WHERE
2301   SERVICE WAS RENDERED                      109




       REFILE W/SUPERVISING PHYSICIAN'S NAME
2302   AND SOCIAL SECURITY NO                    125


       SERVICE NOT AUTHORIZED BY THE PRIMARY
2303   CARE PHYSICIAN                            38




       NO BENEFITS FOR PROCEDURE
2304   PERFORMED ON THIS TOOTH                   96



       THERE ARE NO VISITS LEFT ON THIS
2305   AUTHORIZATION                             198




       PRESCRIPTIONS MUST BE FILED TO PCS
2306   HEALTH SYSTEMS, PHOENIX                   109




                                     Page 85
                                  CARCs_Query2




       REFILE CLAIM TO MCC BEHAVORIAL CARE,
2307   MN                                        109

       SUBMIT CLAIM TO CORAM RESOURCE
2308   NETWORK, HOUSTON TX                       109




       ADDITIONAL INFO ABOUT AUTO ACCIDENT IS
2309   NEEDED FROM MEMBER                        16

       CLM: VBH, ONE TOWNE SQUARE #600,
2310   SOUTHFIELD MI 48076                       109

       EXAMS NOT COVERED WHEN RENDERED BY
2311   NON-NETWORK PROVIDER                      38
       12 MONTH WAIT FOR PRE-EXISTING. IF NOT
2312   PRE-EX, SEND PROOF.                       51


       THIS CLAIM DOES NOT MEET EMERGENCY
2313   ROOM CRITERIA                             40


       DOES NOT MEET CRITERIA: HIGH RISK
2314   PATIENT AGE 13-18/ANNUALLY                B5

       BENEFITS FOR ONE ROUTINE MAMMOGRAM
2315   BETWEEN AGE 34-39                         119

       CLAIM SHOULD BE FILED DIRECTLY TO BCBS
2316   OF ARIZONA                                109




       THIS CLAIM NEEDS TO BE FILED ON A HCFA
2317   CLAIM FORM                                125




                                     Page 86
                                    CARCs_Query2



       FILE CLM: VBH, PO BOX 1008, SKOKIE, IL
2318   60076-8008                                  109

       CLMS: YORK HEALTH PLAN, 1803 MT ROSE
2319   AVE #B5, YORK PA 17403                      109

       INCORRECT ALPHA PREFIX FILED. PLEASE
2321   RECHECK & RESUBMIT.                         31

       NOT PRE-AUTHORIZED BY BLUECHOICE-
2330   MEMBER IS LIABLE                            197


2511   DENY, NOT AUTHORIZED.                       197

       NO BENEFITS WITHOUT PRE-
2522   AUTHORIZATION                               197




       ANY CLAIMS NOT RECEIVED/PROCESSED
2634   PRIOR TO 5/31/97: BCBS TN                   109




       WILL ADJUST UPON RECEIPT OF HEALTH
2635   CARE SAVINGS PRICING INFO                   16


2636   REFILE CLAIM TO MEDICAL MUTUAL OF OHIO      109

       NO PRIOR AUTHORIZATION FOR HOSP STAY-
2637   25% PENALTY ON CHRGS                        197
       EMERGENCY CRITERIA NOT MET. MAY
2638   APPEAL TO PRIME COMPANION                   40

       CLM SENT:MCC 11095 VIKING DR #350 EDEN
2639   PRAIRIE MN 55334                            109




       PER OBURG CNTY REQUEST WE WONT PAY
2641   CLAIMS PRIOR TO 8/1/96                      96




                                        Page 87
                                   CARCs_Query2




       PROCEDURE IS INVESTIGATIONAL AND
2642   THEREFORE NOT COVERED.                     55

       THIS TEST HAS NOT BEEN PROVEN
2643   MEDICALLY NECESSARY                        50




       SERVICE SHOULD BE INCLUDED IN CHARGES
2644   FOR SURGICAL CARE                          97

       PLEASE FORWARD YOUR CLAIMS TO BCBS
2645   OF PENNSYLVANIA.                           109




       THIS IS A DUPLICATE CLAIM PAID
2646   PREVIOUSLY BY SPECIAL CHECK                B13




       UNRELATED TO TRANSPLANT SERVICE.
2647   REFILE TO HEALTH PLAN                      109




       FILE CLAIM TO VALUEOPTIONS, LONG
2649   BEACH, CA 90802                            109




       FILE CLM: VALUE OPTIONS PO BOX 1830
2650   LATHAM, NY 12110                           109

       FILE: UHCC, ATTN CLAIMS, PO BOX 30755,
2651   SALT LAKE    CITY, UT 84130-0755           109

       FILE: ECS PLUS, PO BOX 30018, LAGUNA
2652   NIGEL CA 92607-0018                        109
       THIS CLAIM HAS BEEN FORWARDED TO THE
       HOME PLAN FOR DIRECT PROCESSING. THE
       HOME PLAN WILL BE PROVIDING COMPLETE
       SERVICEON THIS ACCOUNT TO INCLUDE
2654   YOUR REMIT                                 B11



                                        Page 88
                                   CARCs_Query2



       FILE ALLERGEN VIAL CHRGS TO DRUG
2655   CARRIER; NOT PAID IN HEALTH                 109

       MAXIMUM BENEFITS HAVE ALREADY BEEN
2656   PAID FOR THIS SERVICE                       119




       BENEFIT PLAN DOES NOT PROVIDE
2657   COVERAGE FOR BIRTH CONTROL                  96

       BENEFIT ALREADY PROVIDED FOR POLICY'S
2658   AGE OR FREQUENCY LIMIT                      119

       AGES 19-24 CVRD IF FULLTIME STUDENT.
2659   CERT FROM ACCRED INST                       32



       PROVIDER INELIGIBLE FOR WORKSITE
2660   PREVENTIVE SCREENING BNFTS                  171

       PRE-NEGOTIATED RATE. PATIENT NOT
2661   LIABLE FOR NON-ALLOWED AMT.                 45




       THESE SERVICES SHOULD BE FILED TO
2662   MEMBER'S BCBS DENTAL PLAN                   109




       CLAIM WILL BE FORWARDED TO MEMBER'S
2663   NEW INSURANCE CARRIER                       B11

       REFILE TO: CAREMARK PO BOX 686005 SAN
2664   ANTONIO TX 78268-6005                       109

       ONLY ONE PREVENTIVE SCREENING
2665   PROVIDED PER YEAR                           119




2666   PATIENT IS NOT ELIGIBLE FOR THIS BENEFIT.   96



                                      Page 89
                                 CARCs_Query2




       TX FOR INFERTILITY OR REVERSE
2667   STERILIZATION IS NOT COVERED              96

       ONE YEARLY ROUTINE MAMMOGRAM
2668   ALREADY RECEIVED BY PATIENT               119


       $50 ANNUAL MAX FOR ROUTINE SERVICES
2669   HAS ALREADY BEEN PAID                     35




       INVALID PROVIDER CODE. HOST PLAN WILL
2670   NOTIFY PROVIDER.                          16

       MENTAL, NERVOUS AND SUB ABUSE: C.
2671   SINGLETON 1-800-245-1150                  109




       ROUTINE SERVICE NOT COVERED WHEN
2672   RENDERED BY NONPAR PROVIDER               38



       PRE-CERT IS REQUIRED FOR PRIVATE DUTY
2673   NURSING.                                  197




       OUT-OF-NETWORK BENEFITS NOT
2674   PROVIDED UNDER THIS CONTRACT              38




       APPROVED AS OUPATIENT. REFILE CLAIM TO
2675   EXCLUDE ROOM/BOARD.                       16




                                       Page 90
                                 CARCs_Query2




       PRESCRPT 10/95 OR < PAID PRESCRIPTION
2676   POB 770 PARSIPPANY NJ                    109




       PAYMENT IS NOT WARRANTED DUE TO
2677   PRIOR CLAIMS ON HISTORY                  96


       AUTOMATIC BLUE ON BLUE PROCESSING
       DOES NOT APPLY TO THIS GROUP. IN
       ORDER TO REQUEST ADDITIONAL BENEFITS,
       A CLAIM MUSTBE FILED TO THE SECONDARY
2678   PLAN                                     22



       SERVICE REQUIRES ADVANCE APPROVAL BY
2679   GATES MEDICAL DIRECTOR                   197



       COMPANION SELECT MEMBER IS
2680   RESPONSIBLE FOR INPATIENT DED             1




       COMPANION SELECT MEMBER - INPATIENT
2681   DEDUCTIBLE WAIVED                        45


       THIS ITS HOME/CONTROL CLM HANDLED
2683   LOCALLY DUE TO COB PROBLEM               B11

       PLEASE CHECK SUBSCRIBER'S CURRENT ID
       CARD AND REFILE WITH CORRECT
       INSURANCE IDENTIFICATION NUMBER AND
2684   ALPHA PREFIX IF GIVEN                    31




                                    Page 91
                                  CARCs_Query2




       WILL ADJUST CLAIM UPON RECEIPT OF USA
2685   PPO PRICING INFO                          16




       NOT COVERED WHEN SAFETY EQUIPMENT
2686   NOT USED                                  96




       NOT COVERED WHEN UNDER INFLUENCE OF
2687   ALCOHOL/NARCOTICS                         96




2688   PLEASE FILE CLAIM TO BC/BS OF FLORIDA     109




2689   PLEASE RESUBMIT WITH MEDICAL RECORDS      16




       NOT ELIGIBLE FOR BLUECARD. FILE DIRECT
2690   TO COMPANION LIFE                         109




                                     Page 92
                                  CARCs_Query2




       NOT ELIGIBLE FOR BLUECARD. FILE TO BCBS
2691   OF SOUTH CAROLINA                          109




2692   REFILE THIS CLAIM TO BC/BS OF ALABAMA      109




2693   REFILE THIS CLAIM TO BC/BS OF CALIFORNIA   109



2694   REFILE THIS CLAIM TO BC/BS OF KENTUCKY     109




2695   REFILE THIS CLAIM TO BC/BS OF MICHIGAN     109
       THIS CLAIM CANNOT BE PROCESSED WITH
       THE MEMBER     ID INCLUDED ON THE
       CLAIM. PLEASE VERIFY THE MEMBER ID,
       INCLUDING THE ALPH-PREFIX, AND REFILE
2698   THE CLAIM.                                 31




       LIMITED TO PATIENTS AGE 14 & UNDER
2699   PAYABLE EVERY 6 MONTHS                     119




       REFILE CLAIM TO BLUE CROSS AND BLUE
2700   SHIELD OF OHIO                             109



       PATIENT IS NOT RESPONSIBLE FOR
2701   PAYMENT OF THIS CHARGE                     45


                                     Page 93
                                   CARCs_Query2




       REFILE CLAIM TO BLUE CROSS AND BLUE
2702   SHIELD OF INDIANA                          109




       CLAIM FILED WITH INCORRECT ALPHA
       PREFIX. THIS CLAIM IS BEING CORRECTED
2703   AND RESUBMITTED FOR PROCESSING.            140




2704   FILE VISION/DENTAL TO NEW CARRIER.         109


       PAYMENT WILL BE MADE THROUGH THE
2705   TRANSPLANT NETWORK                         97




       PLEASE RETURN WITH MISSING TOOTH
2706   NUMBER.                                    16




       PLEASE RETURN WITH MISSING TOOTH
2707   SURFACE(S).                                16



       CLAIM DENIED, CARE IS LIABILITY OF NO-
2708   FAULT CARRIER.                             21




                                       Page 94
                                  CARCs_Query2




       PLEASE RETURN WITH MISSING QUADRANTS
2709   OR TOOTH RANGE.                           16


2710   HANDLE DIRECT WITH VENDOR.                109




       NOT COVERED. DETAILED NARRATIVE
2711   REQUIRED TO CONSIDER                      16




       PLEASE RETURN WITH MISSING TOOTH
2712   NUMBER AND SURFACE(S)                     16


       NOT PAYABLE - THIS IS CONSIDERED PART
2713   OF OBSTESTRICAL PANEL                     97


       NOT COVERED SINCE HEARING AID
2714   PURCHASED WITHIN 36 MONTHS                B5


       NOT COVERED SINCE HEARING TEST
2715   RENDERED WITHIN PAST 36 MO.               B5

       REFILE THIS CLAIM TO BCBS OF
2716   CONNECTICUT                               109

       OXYGEN\OXYGEN SUPPLIES INCLUDED IN
2717   MONTHLY RENTAL                            97




                                      Page 95
                                 CARCs_Query2




       40 VISIT MAXIMUM FOR HOME HEALTH CARE
2718   PER YEAR                                 119




       NO PAYMENT FOR SERVICES EXCLUDED
2719   FROM COVERAGE                            96




       WILL ADJUST CLAIM UPON RECEIPT OF CAPP
2720   CARE PRICING INFO                        16




       WILL ADJUST CLAIM UPON RECEIPT OF
2721   MEDCOST PRICING INFO                     16

       WILL ADJUST CLAIM UPON RECEIPT OF
2722   MEDPLAN PRICING INFO.                    133

       SERVICES ARE NOT PAYABLE IF A REFERRAL
2723   IS NOT OBTAINED                          38

       POLICY COVERS PRE-EX CONDITIONS ONLY.
2724   FILE TO PRIM.CARRIER                     109

       THIS SERVICE SHOULD BE FILED TO
2725   MEMBER'S BCBS VISION PLAN                109


2726   FILE TO ANCILLARY CARE MANAGEMENT        109




                                    Page 96
                                 CARCs_Query2




       NEED THE NAME OR TYPE OF INJECTION TO
2728   PROCESS CLAIM                            16


       THESE CHARGES WILL BE PROCESSED BY
2729   THE MEDICARE CARRIER                     B11




       NEED COPIES OF MEDICARE AND OTHER
2730   HEALTH COVERAGE BENEFITS                 16




       OBSERVATION FILED WITH ER CHARGES.
2731   PLEASE FILE SEPARATELY.                  16




       REFILE WITH APPROPRIATE CPT4 CODE FOR
2732   THIS DATE OF SERVICE                     16




                                    Page 97
                                         CARCs_Query2




       Please send the additional information previously
       requested within 45 days from the receipt date of
2733   the request to have this claim reconsidered.        17




       PLEASE SEND THE ADDITIONAL
       INFORMATION PREVIOUSLY REQUESTED
       WITHIN 45 DAYS FROM THE RECEIPT DATE
       OF THE REQUEST TO HAVE THIS CLAIM
2733   RECONSIDERED.                                       17




       OPERATIVE REPORT NEEDED TO
2734   DETERMINE BENEFITS                                  16




       ADDITIONAL INFO REQUESTED FROM
2735   PROVIDER BUT NOT RECEIVED                           17

       NO BENEFITS BECAUSE NOT AUTHORIZED.
2736   PROVIDER LIABLE.                                    197




                                             Page 98
                                  CARCs_Query2




       CLAIM WILL BE ADJUSTED UPON RECEIPT OF
2737   PRICING FROM MEDPLAN                      16




       MEDICAL INFORMATION IS NEEDED FROM
2738   ANOTHER PROVIDER                          16

2739   PLEASE FORWARD MEDICAL RECORDS.           17

       THE MAXIMUM BENEFIT FOR THIS SERVICE
2740   HAS BEEN PAID                             119

       PRIOR AUTHORIZATION NOT OBTAINED.
2741   PATIENT ISN'T LIABLE                      197




       PLEASE REFILE CLAIM WITH APPROPRIATE
2742   CPT4 CODE                                 16




       REFILE THIS CLAIM TO BCBS OF
2743   WASHINGTON STATE                          109




       THIS SERVICE NOT COVERED BY
2744   COMPANION LIFE BASIC DENTAL               96




                                      Page 99
                                   CARCs_Query2



       ALLOWANCE REDUCED. INCIDENTAL TO
2745   PROCEDURE ALREADY ALLOWED.                 97




       THIS PROCEDURE IS INCIDENTAL TO A
2746   PROCEDURE ALREADY ALLOWED                  97

       PRE-OPERATIVE CARE IS CONSIDERED
2747   INCIDENTAL TO THE SURGERY                  97

       POST-OPERATIVE CARE IS CONSIDERED
2748   INCIDENTAL TO THE SURGERY                  97



       DENIED OR REDUCED. THIS COMPONENT
2749   HAS ALREADY BEEN ALLOWED.                  97




       THE MEDICARE DEDUCTIBLE AMOUNT IS
2750   NOT COVERED                                96




       SERVICES & SUPPLIES FOR SMOKING
2751   CESSATION ARE NOT COVERED.                 96




2752   NOT ELIGIBLE FOR BENEFITS                  96




       REFILE CLAIM WITH PROVIDER'S CORRECT
2753   NAME AND ADDRESS                           125




                                     Page 100
                                 CARCs_Query2




       REFILE WITH RENDERING PROVIDER'S TAX
2755   IDENTIFICATION NUMBER                    16

       PLEASE REFILE TO BLUE CROSS AND BLUE
2756   SHIELD OF MISSISSIPPI                    109

       PLEASE REFILE TO BLUE CROSS AND BLUE
2757   SHIELD OF WEST VIRGINIA                  109




       NEED RENDERING PROVIDER NAME. CALL
2761   BLUECHOICE:   1-800-868-2528.            125

       PROCEDURE PAYABLE ONLY 2 TIMES PER
2762   BENEFIT PERIOD.                          119




2763   NOT A CURRENT ADA CODE                   16

       PROCEDURE PAYABLE ONLY 1 TIME PER
2764   BENEFIT PERIOD                           119




       NOT A COVERED SERVICE FOR MEMBERS
2765   OVER 13                                  96




       NOT A COVERED SERVICE FOR MEMBERS
2766   OVER 14                                  96




                                   Page 101
                               CARCs_Query2




       NOT A COVERED SERVICE FOR MEMBERS
2767   OVER 15                                96




       NOT A COVERED SERVICE FOR MEMBERS
2768   OVER 16                                96




       NOT A COVERED SERVICE FOR MEMBERS
2769   OVER 17                                96




       NOT A COVERED SERVICE FOR MEMBERS
2770   OVER 18                                96




       NOT A COVERED SERVICE FOR MEMBERS
2771   OVER 19                                96




       NOT A COVERED SERVICE FOR MEMBERS
2772   OVER 20                                96




       NOT A COVERED SERVICE FOR MEMBERS
2773   OVER 21                                96




       NOT A COVERED SERVICE FOR MEMBERS
2774   OVER 25                                96




                                 Page 102
                                CARCs_Query2




       NOT A COVERED SERVICE FOR MEMBERS
2775   UNDER AGE 13                            96




       NOT A COVERED SERVICE FOR MEMBERS
2776   UNDER AGE 14                            96




       NOT A COVERED SERVICE FOR MEMBERS
2777   UNDER AGE 15                            96




       NOT A COVERED SERVICE FOR MEMBERS
2778   UNDER 16                                96


       NOT A COVERED SERVICE FOR MEMBERS
2779   UNDER 17                                96




       NOT A COVERED SERVICE FOR MEMBERS
2782   UNDER 20                                96




       NOT A COVERED SERVICE FOR MEMBERS
2783   UNDER 21                                96




       NOT A COVERED SERVICE FOR MEMBER
2784   UNDER 25                                96


2785   PAYABLE ONCE EVERY 5 YEARS              119




                                    Page 103
                                 CARCs_Query2



       NOT PAYABLE WHEN RENDERED ON SAME
2786   DATE OF SERVICE AS D4341                 97




       RETREATMENT NOT PAYBALE WITHIN YEAR
2787   OF ORIGINAL PROCEDURE                    B5

       ONLY 2 CLEANINGS ALLOWED PER BENEFIT
2788   PERIOD                                   119

       PAYABLE 1 TIME EVERY 6 MONTHS AFTER
2789   INITIAL PLACEMENT                        119




       SERVICE PAYABLE ONLY 2 TIMES PER
2791   LIFETIME                                 119

       SERVICE PAYABLE ONLY 3 TIMES PER
2792   LIFETIME                                 119


2793   PAYABLE 1 TIME EVERY 12 MONTHS           119




       SERVICE PAYABLE ONE TIME EVERY 36
2794   MONTHS                                   119




       SERVICE PAYABLE ONE TIME EVERY 24
2795   MONTHS                                   119

       SERVICE PAYABLE ONE TIME EVERY 12
2796   MONTHS                                   119

       PRE-OP OR POST-OP CARE IS CONSIDERED
2798   INCIDENTAL TO SURGERY                    97

       THIS PORTION OF ADMISSION WAS DEEMED
2799   NOT MEDICALLY NECESSARY                  50


                                   Page 104
                                   CARCs_Query2



       THIS CLAIM IS NOT ELIGIBLE FOR BENEFITS.
       THE MEMBER DID NOT USE A PHYSICIAN'S
2800   EYECARE NETWORK PROVIDER.                  109

       THIS PORTION OF THE ADMISSION WAS NOT
2801   APPROVED                                   38




       BENEFITS NOT ALLOWABLE BASED ON
2802   NARRATIVE                                  96




       NOT PAYABLE FOR 6 MONTHS OF
2803   INSTALLATION                               96

       TWO ROUTINE EXAMS OR TWO
2804   PROPHYLAXIS ALLOWED/YEAR                   119

       CODE SHOULD NOT BE FILED SEPARATELY
2805   FROM OTHER CODE LISTED                     B15

       SERVICE INCLUDED IN RADIATION
2806   TREATMENT                                  97


2807   THIS SERVICE WAS NOT AUTHORIZED            197




       NEED DOCUMENTATION AS TO WHETHER
2808   PATIENT IS LEGAL DEPENDENT                 32

       MENTAL HEALTH SERVICES HANDLED BY
2809   CAMERON AND ASSOCIATES                     109

       TRANSPLANT RELATED. FILE:LINCOLN
2810   NATIONAL/UNITED RESOURCES                  109




                                       Page 105
                                 CARCs_Query2




       PLEASE FORWARD CLINICAL INFOR SO
2811   CLAIM CAN BE REVIEWED                    16




       NON-COVERED AMOUNT IS DIFFERENCE
2812   BETWEEN GENERIC AND BRAND                45




       SELF FUNDED ERISA PLAN HAS CEASED
2813   FUNDING CLAIM PAYMENT                    96




       THIS PROVIDER DOES NOT PARTICIPATE
2814   WITH THE SUNSTAR NETWORK                 38




       INPATIENT REHABILIATION IS NOT COVERED
2815   FOR THIS SERVICE                         58


2816   FILE TO DELTA DENTAL OF ARKANSAS         109




       NEED COPY OF REMITTANCE OR EOB FROM
2817   DELTA DENTAL                             16




                                    Page 106
                                  CARCs_Query2



       HUMAN ORGAN TRANSPLANT PERFORMED
2818   OUT OF NETWORK NOT COVERED                38

       FILE TO WALMART, 922 W WALNUT, STE A,
2819   ROGERS, AR 72756                          109




       THIS TMJ RELATED SERVICE IS NOT
2820   COVERED                                   96


       SERVICE DIDN'T BEGIN WITHIN CONTRACT'S
2821   SPECIFIED TIME FRAME                      B5
       INPATIENT REHAB SERVICES FOR THIS
2822   CONDITION HAVE EXHAUSTED                  35




       VITAMIN INJECTIONS ARE NOT COVERED
2823   FOR THIS CONDITION                        96




       DURABLE MEDICAL EQUIPMENT REPAIR IS
2824   NOT COVERED                               96




       SERVICES RELATED TO PULMONARY REHAB
2825   ARE NOT COVERED                           96




       INSULIN INFUSION PUMPS ARE NOT
2826   COVERED FOR THIS CONDITION                96




       WILL REVIEW CLAIM UPON RECEIPT OF
2827   INPATIENT HOSPITAL BILL                   16




                                    Page 107
                                 CARCs_Query2




       NOT COVERED UNTIL MEMBER HAS BEEN ON
2829   PLAN OVER 1 YEAR                         96

       20 UNITS OF SCRATCH OR ALLERGY
2830   TESTING REQUIRES PREAUTH                 38
       BENEFITS FOR THIS SERVICE HAVE BEEN
2831   EXHAUSTED                                35
       EXCEEDS MAXIMUM NUMBER OF VISITS
2832   ALLOWED                                  35




       REFILE WITH OPTIMUM TAX IDENTIFICATION
2833   NUMBER                                   125




       FOR BENEFIT CONSIDERATION, PLEASE
2834   SUBMIT THE TRIP RECORD.                  16




       GE CLAIM-PLEASE PROVIDE OTHER HEALTH
2836   INSURANCE ASAP.                          16

       NOT COVERED WHEN TECH COMP DONE BY
2837   NON-NETWORK PROVIDER                     38

       PRE-AUTHORIZ. NECESSARY PROCEDURE
2838   BY NON-PARTICIP. PROVIDER                38




                                    Page 108
                                    CARCs_Query2



       CLAIM PAYMENT WITHHELD DUE TO
2839   SUBRO/WORKER'S COMP LIEN                      19

       DENIED PRE-AUTHORIZATION REQUIRED
2840   FOR 20 UNITS OR MORE                          197

       PRIOR AUTHORIZATION SHOULD BE GIVEN
2841   FOR THIS PROCEDURE                            197

       PLEASE REFILE THIS CLAIM TO THE
2842   CONTROL PLAN                                  109




       CLAIM SENT TO BCBS OF INDIANA FOR
2843   PRICING. ADJUST ON RETURN                     16
       ALL PRESCRIPTIONS ARE PAID UNDER THE
       STATE GROUP DRUG CAR PROGRAM WHEN
       PURCHASED FROM A LICENSED RETAIL
2844   PHARMACY.                                     109




       THESE CLAIMS SHOULD BE FILED TO UNITED
2845   HEALTH CARE                                   109




       FILE TO: GE VISION, PO BOX 2243,
2846   SCHNECTADY, NY 12301                          109




       REFILE WITH HCPCS FOR DIAGNOSTIC
2847   TESTS                                         16

       FILE DOS AFTER 1-31-00 TO ASI POB 83900
2848   MIAMI FL 33283-900                            109




                                          Page 109
                                  CARCs_Query2



       DENIED DUE TO PERSON INJURY
2849   PROTECT/MED-PAY/NO-FAULT CVRG.            21




       CAPITATED TO LABCORP. PATIENT NOT
2850   RESPONSIBLE                               24

       FILE PHARMACY CLAIM TO PO BOX 8128,
2851   GRAND RAPIDS, MI 49518                    109




       ACCIDENTAL DENTAL IS COVERED UNDER
2852   MEMBER'S BLUECHOICE.                      109

       PAYMENT IS INCLUDED IN GLOBAL
2853   REIMBURSEMENT TO THE FACILITY             97




       PENDING ADDITIONAL INFORMATION FROM
2854   PRIMARY CARRIER                           16




       THIS CHARGE WILL BE PROCESSED ON A
2855   SEPARATE CLAIM                            96




       PLEASE RETURN ORTHODONTIC
2856   RECERTIFICATION LETTER                    16




                                    Page 110
                                 CARCs_Query2




       PENDING RECEIPT OF ADDITIONAL
2857   INSURANCE INFO FROM MEMBER               22

       CHARGES ARE MEDICARE ELIGIBLE. PLEASE
2858   FILE TO MEDICARE.                        109
       CHIRO OFFICE VISIT NOT COVERED WITH
2859   OTHER CHIRO SERVICES                     B1

       MAXIMUM NUMBER OF DAYS HAVE BEEN
2860   ALLOWED                                  35

       PRICING AGREEMENT WITH COALITION
2861   AMERICA, GALAXY HEALTH NTWK              45




       PLEASE SUBMIT ITEMIZATION OF TIME
2862   INCREMENTS RENDERED                      16




       PRICING AGREEMENT WITH COALITION
2863   AMERICA, MULTIPLAN NETWORK               45




       PRICING AGREEMENT WITH COALITION
2864   AMERICA, PREFERRED HLTH NET              45




       THIS MENTAL HEALTH ADMISSION WAS
2865   WITHIN 60 DAYS OF LAST ONE               96



       MUST FILE AMB SURGERY CTR CLAIMS ON
2866   HCFA WITH MODIFIER SG                    4




                                    Page 111
                                   CARCs_Query2




       2867 NEED TAX ID INFO (W9). SEND TO
2867   FLORIDA COMBINED LIFE                      16

       PRICING AGREEMENT WITH COALITION
2868   AMERICA, HEALTH PAYORS ORG                 45




       CONTRACT ALLOWS FOR SURGICAL
2869   PATHOLOGY ONLY                             96



       PAYMENT REDUCED PENDING RECEIPT OF
2870   STUDENT CERTIFICATION                      32

       EDUCATION/TRAINING NOT COVERED
2871   UNLESS DIABETIC EDUCATION                  96


       MUSC OR LABCORP MUST PERFORM LAB.
2872   PATIENT IS NOT LIABLE.                     24

       FILE CLAIM TO S&S HEALTHCARE
2873   STRATEGIES, CINCINNATI, OHIO               109




       UNLISTED CPT-4 OR HCPCS CODE. PLEASE
2874   RECHECK AND REFILE.                        16




       CLAIM WAS RECONSIDERED, BUT ORIGINAL
2875   STATUS REMAINS                             96

       NOT COVERED UNTIL MEMBER HAS BEEN ON
2876   PLAN FOR 5 YEARS                           179

       FILE MENTAL HEALTH CLAIMS TO CIGNA
2877   HEALTHCARE                                 109


                                      Page 112
                                  CARCs_Query2




2878   FILE TO: COMPSYCH CORP, CHICAGO, IL       109


2879   FILE TO: VALUEOPTIONS, MERRIFIELD, VA     109

       PRICING AGREEMENT WITH COALITION
2880   AMERICA                                   45


       COALITION AMERICA PRICING AGREEMENT:
2881   HMN, AMN & RAN NETWORK                    45

       COALITION AMERICA PRICING AGREEMENT:
2882   FOCUS NETWORK                             45

       COALITION AMERICA PRICING AGREEMENT:
2883   NOVA NETWORK                              45


       MEDICAL NECESSITY FOR THIS SERVICE
2886   WAS NOT DOCUMENTED                        50



2888   NUTRITIONISTS ARE NOT COVERED             170
       TWO HCPCS CODES IDENTIFYING SIMILAR
       PROCEDURES WERE INAPPROPRIATELY
       FILED. IDENTIFY THE CODE THAT MORE
       CLOSELY IDENTIFIES THE PROCEDURE AND
       RESUBMIT THE CLAIM WITH ONLY THAT
2901   CODE.                                     18


       THIS PROCEDURE CODE WAS FILED WITH
2903   TOO MANY UNITS.                           151




       THE SUBMITTED REVENUE CODE REQUIRES
2904   A HCPCS CODE.                             16




                                     Page 113
                                  CARCs_Query2


       THE PROCEDURE INDICATED IS NOT
       APPROPRIATE FOR THE GENDER OF THE
2905   PATIENT.                                   7
       PARTIAL HOSPITIALIZATION SERVICES MUST
       BE FILED WITH A MENTAL HEALTH
2906   DIAGNOSIS.                                B22
       INCIDENTAL SERVICES FILED WITHOUT AN
       ACCOMPANYING PRIMARY SERVICE ARE
2907   NOT PAYABLE.                              B15




       MULTIPLE OBSERVATIONS CANNOT BE FILED
2908   WITH OVERLAPPING TIME INCREMENTS.         16

       A MODIFIER 50 MUST BE USED WHEN FILING
2909   FOR MULTIPLE BILATERAL PROCEDURES.         4

       THE MODIFIER FILED IS NOT USED FOR THE
2911   PROCEDURE FILED.                           4
       THE DIAGNOSIS INDICATED IS NOT
       APPROPRIATE FOR THE GENDER OFTHE
2913   PATIENT.                                   7



       EITHER THE STATEMENT DATES ("FROM"
       AND "THROUGH" DATES) OR THE LINE ITEM
       DATE OF SERVICE ARE INVALID. VERIFY THE
       DATES ENTERED ARE IN THE MMDDCCYY
       FORMAT AND THAT IT IS A REAL DATE (FOR
       EXAMPLE, THERE IS NO 02/30/2005 DATE).
2915   ALSO VERIFY                               125
       THIS PROCEDURE WAS EITHER FILED
       WITHOUT THE REQUIRED MODIFIER, OR
       INCLUDED A MODIFIER THAT IS NOT
2916   APPROPRIATE FOR THE PROCEDURE.             4




       THE IMPLANTATION PROCEDURE FILED
       DOES NOT MATCH THE DEVICE BEING
2917   IMPLANTED.                                125


                                     Page 114
                                  CARCs_Query2


       MULTIPLE MEDICAL VISITS ON SAME DAY
       WITH SAME REVENUE CODE W/O CONDITION
2918   CODE G0                                   18




       OBSERVATION REVENUE CODES CANNOT BE
       FILED ON A LINE WITH A NON-OBSERVATION
2919   HCPCS CODE.                               16

       FOR BILATERAL PROCEDURES, MODIFIER 73
       SHOULD ONLY BE SUBMITTED IF THE
       PROCEDURE WAS TERMINATED AFTER THE
       PATIENT WAS PREPARED FOR SURGERY
       AND TAKEN TO THE ROOM WHERE THE
       PROCEDURE IS TO BE PERFORMED. DO NOT
2920   FILE PROCEDURES WHEN                      4
       THIS COMPONENT OF A COMPREHENSIVE
       PROCEDURE IS NOT ALLOWED BY NCCI,
2921   EVEN WHEN FILED WITH A MODIFIER.          97

       THIS COMPONENT OF A COMPREHENSIVE
       PROCEDURE MAY BE ALLOWED BY NCCI IF
2922   FILED WITH THE APPROPRIATE MODIFIER.      4

       THIS IS A MUTUALLY EXCLUSIVE
       PROCEDURE THAT IS NOT ALLOWED BY
2923   NCCI, EVEN WHEN FILED WITH A MODIFIER.    181
       THIS MUTUALLY EXCLUSIVE PROCEDURE
       CAN BE PAID ONLY WHEN FILED WITH THE
2924   APPROPRIATE MODIFIER.                     4




       ALLERGY TESTING IS NOT COVERED BY THIS
2928   CONTRACT.                                 96




       HEARING EXAMS ARE NOT COVERED UNDER
2929   THIS PLAN                                 96

       SERVICES AND SUPPLIES ASSOCIATED WITH
2930   TMJ ARE NOT COVERED.                      167




                                    Page 115
                                 CARCs_Query2




       TREATMENT OF MORBID OBESITY IS NOT
2931   COVERED.                                 167




       TRAVEL & LODGING FOR HUMAN ORGAN
2932   TRANSPLANTS IS NOT COVERED.              96

       YOUR CONTRACT DOES NOT COVER
2933   LICENSED PROFESSIONAL                    170



       DIABETIC SUPPLIES ARE COVERED UNDER
       YOUR PRESCRIPTION DRUG BENEFIT.
       PLEASE REFILE TO ADVANCE PCS FOR
2934   PROCESSING.                              109



       THE RENDERING DOCTOR NUMBER
       PROVIDED HAS NOT BEEN ADDED TO THE
       BCBSSC PROVIDER FILE. PLEASE
       DOWNLOAD FORMS FROM
       WWW.SOUTHCAROLINABLUES.COM SEND
       AN EMAIL TO      PROVIDER.CERT.COM,OR
2935   FAX TO 803-264-4795 TO UPDATE THE        16


       SUBMIT A NEW CLAIM WITH THE LEVEL OF
2936   CARE FOR ACCURATE PROCESSING             150

       THIS ANESTHESIA SERVICE IS COVERED IF
       ANESTHESIA IS PERSONALLY PERFORMED
       BY THE ANESTHESIOLOGIST.NO
       PAYMENT IS MADE FOR THIS ANESTHESIA
       SERVICE TO   CRNA'S OR TO SUPERVISING
2937   ANESTHESIOLOGIST                         185




       THIS CONTRACT DOES NOT COVER MENTAL
2939   HEALTH OR SUBTANCE ABUSE SERVICES.       96




                                    Page 116
                                  CARCs_Query2




       PLEASE REFILE WITH THE APPROPRIATE
2941   MODIFIER.                                  4
       TMJ IS NOT COVERED UNDER YOUR BENEFIT
2942   PLAN.                                     167

2944   THIS CONTRACT IS CANCELLED.               27

2945   CLAIM HAS PROCESSED                       94

       THIS CHARGE IS BEING CONSIDERED UNDER
       A PROFESSIONAL CLAIM NUMBER. YOU
       WILL RECEIVE A SEPARATE
2950   EOB/REMITTANCE FOR THIS SERVICE.          89
       WHEN MEDICARE A IS EXHAUSTED, STATE
       HEALTH PLAN NEEDS THE MEDICARE A &
       MEDICARE B REMITTANCES BEFORE THIS
       CLAIM CAN BE PROCESSED. THIS CLAIM
       CANNOT BE PROCESSED UNTIL THIS
2951   INFORMATION IS RECEIVED.                  148

       THERAPEUTIC SERVICES, RADIATION,
       CHEMOTHERAPY, RESPIRATORY,SHORT
       TERM SERVICES FOR SPEECH OR
       OCCUPATIONAL THERAPY ARE NOT
2952   ELIGIBILE FOR EXTENSION OF LIABILITY.     96
       NOT COVERED BY THE STATE MEDICAL
       PLAN. SERVICES COVERED UNDER
       ROUTINE DENTAL SHOULD BE FILED TO:
       STATE DENTAL PLAN PO BOX 100300
2953   COLUMBIA ,SC 29202                        109
       NOT A BENEFIT UNDER THIS LINE OF
       BUSINESS. REIMBURSEMENT TO THE
       SUBSCRIBER WILL BE CONSIDERED
2955   UNDER ANOTHER LINE OF BUSINESS.           B11
       CLAIM SUBMITTED UNDER BLUECARD
       TRADITIONAL      PROCESSING; CLAIM
       SHOULD BE SUBMITTED UNDER        THE
2956   BLUECARD POINT OF SERVICE PROGRAM         109
       THE WAITING PERIOD FOR THIS
       PROCEDURE         UNDER YOUR DENTAL
2957   CONTRACT HAS NOT BEEN MET.                179




                                     Page 117
                                  CARCs_Query2




       PROVIDER DID NOT FILE CLAIM WITHIN TIME
2958   LIMIT.                                    29

       REVIEW OF CLINICAL LABORATORY
       RESULTS IS NOT A SEPARATELY COVERED
       SERVICE UNLESS IT MEETS CRITERIA FOR A
2959   CLINICAL PATHOLOGY CONSULTATION.          B15
       THE PUBLIX GROUP HEALTH BENEFIT PLAN
       DOES NOT ALLOW PAYMENT FOR THESE
       SERVICES WHEN RENDERED BY       A
2960   SOCIAL WORKER.                            170




       ZERO CLAIM CHARGES RECEIVED FOR
2961   CLAIM LINE                                16

       SUBMIT HARDCOPY CLAIM WITH EOB
       INFORMATION TO BLUE CROSS BLUE
2963   SHIELD.                                   22




       ONE OR MORE OF THE SUBMITTED LINES
       CONTAINS ERRORS. PLEASE REVIEW THE
2964   CLAIM LINES, CORRECT AND RESUBMIT.        16


2965   SERVICE IS NOT SEPARATELY PAYABLE         B15

       SERVICES INCLUDED IN THE PER DIEM NOT
2967   COVERED UNDER IV THERAPY CONTRACT         B15

       THESE DRUGS ARE NOT COVERED UNDER
       YOUR MEDICAL PLAN. PLEASE RESUBMIT
2969   CLAIM TO YOUR DRUG VENDOR.                109




                                     Page 118
                                 CARCs_Query2



       BENEFITS ARE NOT PAYABLE FOR SERVICES
       AND SUPPLIES RELATED TO OBESITY,
2970   WEIGHT LOSS, OR WEIGHT CONTROL           167
       ONE OR MORE LINES ON THIS CLAIM WERE
       FILED WITH AN INAPPROPRIATE NUMBER
       OF UNITS. PLEASE REVIEW THE CLAIM
2971   LINES, CORRECT AND RESUBMIT.             151
       PREAUTHORIZATION IS REQUIRED FOR
       HOME HEALTH CARE SERVICES. BENEFITS
       ARE NOT PAYABLE WHEN
2972   PREAUTHORIZATION IS NOT OBTAINED         197




       REFER TO YOUR STATE BASE PLAN REMIT
2973   FOR DENIAL INFORMATION                   96
       CARE OR TREATMENT FOR INJURY OR
       ILLNESSES RESULTING FROM THE
       VOLUNTARY TAKING OF, OR WHILE UNDER
       THE INFLUENCE OF ANY CONTROLLED
       SUBSTANCE, DRUG, HALLUCINOGEN, OR
       NARCOTIC NOT ADMINISTERED ON THE
2974   ADVICE OF A PHYSICIAN IS NOT             160


       MEDICAL RECORDS DO NOT SUPPORT THIS
2975   LEVEL OF CARE                            150

       PAYMENT HAS BEEN REDUCED BY THE
       AMOUNT MEDICARE WOULD HAVE PAID HAD
2977   THE MEMBER ELECTED PART B COVERAGE       23

2979   MUST REFILE ON A HCFA1500 FORM           89
       BLUE RX BENEFITS ARE NOT AVAILABLE FOR
       THESE SERVICES WHEN RENDERED BY
       PROVIDERS WHO ARE NOT IN OUR
2980   NETWORK                                  38
       YOUR CLAIM HAS FORWARDED TO THE
       THIRD PARTY ADMINISTRATOR FOR
       PROCESSING. PLEASE CALL THE TPA FOR
       UPDATED CLAIMS STATUS. REFER TO THE
       PATIENT'S ID CARD FOR TPA CONTACT
2981   INFORMATION.                             B11

       SERVICES FOR THIS CONDITION MUST BE
       SUBMITTED TO DUKE OCCUPATIONAL
       HEALTH. FOR ASSISTANCE, PLEASE CALL
2983   1-800-336-3853                           109




                                   Page 119
                                   CARCs_Query2



       THESE MEDICATIONS ARE NOT COVERED
2984   UNDER YOUR MEDICAL PLAN                     109

       THE PLAN PROVIDES NO WEIGHT LOSS
       SERVICES FOR     SUPPLIES, PROCEDURES
       OF TREATMENTS. THIS EXCLUSION ALSO
       APPLIES TO CONDITIONS OR
       COMPLICATIONS RESULTING FROM OR
2985   RELATED TO SUCH CARE OR TREATMENT           96

       THESE SERVICES ARE NOT COVERED
       UNDER YOUR MEDICAL PLAN. HOWEVER:
       THE SERVICES MAYBE COVERED UNDER
       YOUR PHARMACY BENEFITS.PLEASE
       CONTACT CAREMARK CUSTOMER SERVICE
2986   FOR INFORMATION AND ASSISTANCE.             109

       THIS CLAIM NEEDS TO PROCESS UNDER THE
       HEALTH PORTION OF YOURPOLICY BEFORE
2987   BENEFITS UNDER DENTAL CAN BE PAID           109

       TREATMENT LIMITED TO TWO TIMES PER
2988   QUADRANT PER YEAR                           119

       THIS CLAIM HAS ALREADY BEEN
       PROCESSED FOR PAYMENT WITH
2989   BENEFITS BEING DIRECTED TO THE MEMBER       100
       REPLACEMENT/DUPLICATE PROSTHETIC
       DEVICES AND APPLIANCES ARE NOT
2990   COVERED IF LOST, MISSING OR STOLEN          18




       THIS CLAIM CANNOT BE REPROCESSED
       UNTIL THE MEDICAL RECORDS A
2991   RE RECEIVED AND REVIEWED                    16


       BENEFITS NOT AVAILABLE UNTIL MEDICARE
2992   COMPLETES ADJUDICATIONOF CLAIM              22


       SEND CLAIMS TO: CHROMCRAFT FURNITURE
       #1 QUALITY LANE (P.O. BOX 126) SENATOBIA,
2995   MS 38668                                    109




                                      Page 120
                                   CARCs_Query2


       SEND CLAIMS TO: COCHRANE FURNITURE
       ATTN: SHARON WILLIAMS 190COCHRANE
       ROAD (PO BOX 220 / ZIP 28093-0220)
2996   LINCOLNTON, NC 28092                       109
       SEND CLAIMS TO: SUMTER CABINET
       COMPANY ATTN: RON PRICE 187 S.
       LAFAYETTE STREET (PO BOX 100)SUMTER
2997   SC 29151                                   109



       SEND CLAIMS TO: PAI P O BOX 6927
2998   COLUMBIA, SC 29260                         109


       NO ROUTINE BENEFITS ARE ALLOWED FOR
2999   THIS SERVICE                               49




3006   ACUPUNCTURE IS NOT COVERED.                96
       THESE PREVENTATIVE SERVICES ARE NOT
       COVERED WHEN RENDERED BYAN OUT-OF-
4000   NETWORK PROVIDER.                          38

       CLAIMS ARE CURRENTLY UNDER REVIEW BY
       OUR AUDIT STAFF. CLAIMS WILL BE
4002   PROCESSED ONCE REVIEW IS COMPLETE.         133




       SUBMIT A NEW CLAIM WITH THE REQUIRED
       SOURCE CODE FIELD FOR UB92 CLAIM.
4004   SOURCE CODE MUST EQUAL 1-9 OR A-Z          16

       SUBMIT A NEW CLAIM WITH ACCURATE BILL
4005   TYPE FOR REVENUE CODES FILED ON UB92       5
       CPT-IV CODE PROVIDED IS NOT VALID FOR
       PATIENT SEX AND AGE. VERIFY CODING AND
       SUBMIT NEW CLAIM WITH ACCURATE
4006   CODE(S)                                    7




                                     Page 121
                                   CARCs_Query2




       THE RENDERING DOCTOR NUMBER IS A
       REQUIRED FIELD. PLEASE PROVIDE THE
       ACCURATE PROVIDER INDENTIFICATION
4007   NUMBER                                      16




       DATE OF SERVICE(S) MUST BE WITHIN THE
       SAME YEAR. SUBMIT A CLAIM FOR DATE OF
4008   SERVICE(S) WITHIN THE SAME YEAR             125

       WE DO NOT PROVIDER BENEFITS FOR
       TREATMENT OR SERVICES RECEIVED THAT
       ARE RESULTING FROM THE COVERED
       PERSON BEING INTOXICATED OR UNDER
       THE INFLUENCE OF ANY NARCOTIC UNLESS
4010   TAKEN ON THE ADVISE OF A PHYSICIAN          160




       WE SENT A QUESTIONAIRE EARLIER TO
       DETERMINE IF A CLAIM WAS FOR
       TREATMENT OF AN ACCIDENTAL INJURY OR
       ILLNESS. WE NEED YOUR RESPONSE TO
       THAT QUESTIONAIRE BEFORE WE CAN
4011   PROCESS THIS CLAIM                          16
       THIS GROUP COVERS ROUTINE VISION
       SERVICES ONLY. THERE ARE NOMEDICAL
       BENEFITS FOR THIS GROUP. IF THIS CLAIM IS
       FOR MEDICAL SERVICES, PLEASE
       RESUBMIT WITH THE CORRECT ID
4012   NUMBER.                                     31
       ALPHA PREFIX IS NOT VALID FOR THIS DATE
       OF SERVICE. PLEASE REVIEW THE
       INSURANCE INFORMATION WITH THE
4016   PATIENT                                     140
       ALPHA PREFIX CANNOT BE FOUND. PLEASE
       REVIEW THE INSURANCE INFORMATION
4017   WITH PATIENT.                               140




                                     Page 122
                                 CARCs_Query2




       INVALID ZIP CODE PLUS FOUR. PLEASE
       REFILE WITH THE CORRECT ZIP CODE PLUS
4020   FOUR.                                    16




       SEXUAL DYSFUNCTION TREATMENT IS NOT
       COVERED FOR    PSYCHOLOGICAL,
4022   EMOTIONAL OR MENTAL ORIGINS              167

       BENEFITS ARE NOT PAYABLE FOR SERVICES
       AND SUPPLIES RELATED TO OBESITY,
4024   WEIGHT LOSS, OR WEIGHT CONTROL           167

       STATE HEALTH PLAN DOES NOT PAY FOR
4025   NON-EMERGENT TRANSPORTS                  40




       HOST CLAIM INFORMATION IS MISSING, OR
       INVALID AS FILED. REVIEW LINE MESSAGE
       CODES FOR SPECIFIC MISSING OR INVALID
4026   INFORMATION                              125




4027   ABORTIONS ARE NOT COVERED                96




4028   YOUR CONTRACT DOES NOT COVER THESE       96
       THIS SERVICE IS FOR MEDICARE
       RECIPIENTS ONLY. SINCE THE PATIENT IS
       NOT A MEDICARE OR MEDICARE
       BENEFICIARY, BENEFITS CANNOT BE
       PROVIDED. YOU ARE RESPONSIBLE FOR
4029   THESE CHARGES.                           96




                                    Page 123
                                  CARCs_Query2


       THIS SERVICE IS FOR MEDICARE
       RECIPIENTS ONLY. SINCE THE PATIENT IS
       NOT A MEDICARE RECIPIENT OR MEDICARE
       BENEFICIARY BENEFITS CANNOT BE
       PROVIDED. YOU ARE NOT RESPONSIBLE
4030   FOR THESE CHARGES.                         96




       THIS CLAIM WAS FILED WITH
       INACCURATE/INACTIVE EIN AND/OR
       INACCURATE/INACTIVE RENDERING
       PROVIDER INFORMATION. PLEASE FILE A
       CORRECTED CLAIM IF YOU HAVE NOT YET
4031   DONE SO.                                   125

       BENEFITS ARE NOT PROVIDED UNDER THE
       STATE HEALTH PLAN FOR A PHYSICIAN
       ASSISTANT'S SERVICES WHEN RENDERED
4032   AS AN ASSISTANT AT SURGERY.                54
       YOUR MEDICARE ADVANTAGE POLICY WILL
       NOT PAY BENEFITS FOR SERVICES
       RENDERED BY PROVIDERS WHO HAVE
4033   OPTED OUT OF THE ORIGNIAL MEDICARE.        38
       MONITORED ANESTHESIA CARE IS ONLY
       COVERED IF ANESTHESIA IS PERSONALLY
       BEING MONITORED BY THE
       ANESTHESIOLOGIST. NO PAYMENT IS MADE
       FOR SUPERVISION OF CRNA'S PERFORMING
4034   MONITORED ANESTHESIA.                      185


       THIS CONTRACTS DOES NOT COVER
       MORBID OBESITY WHEN SERVICES ARE
       RENDERED BY AN OUT-OF-NETWORK
4035   PROVIDER.                                  96
       WE CANNOT ALLOW BENEFITS FOR
       SERVICES THAT HAVE NOT BEEN
4037   PERFORMED.                                 115
       MENTAL HEALTH AND SUBSTANCE ABUSE
       SHOULD BE FILED TO: CAMERON &
       ASSOCIATES, INC. 6100 LAKE FOREST DRIVE,
       SUITE 550 ATLANTA, GEORGIA 30328 TOLL
4038   FREE NUMBER: 1-800-387-9919.               109




       BENEFITS ARE NOT COVERED FOR THIS
4040   SERVICE.                                   96




                                     Page 124
                                CARCs_Query2



       PAYMENT FOR THIS CLAIM WAS PREVIOUSLY
       SENT TO THE MEDICAID AGENCY UNDER A
4042   SEPARATE CLAIM NUMBER.                  23
       ADMISSION DATE FILED ON THIS CLAIM
       DOES NOT FALL WITHIN THE EFFECTIVE
       DATE OF COVERAGE FOR THIS ALPHA
       PREFIX. PLEASE CONTACT SUBSCRIBER
       FOR THE ACCURATE INSURANCE COVERAGE
4046   FOR THIS ADMISSION.                     31



       MEDICARE ADVANTAGE DEDUCTIBLES, CO-
       PAYS AND COINSURANCES ARENOT
4047   COVERED BY A MEDICARE SUPPLEMENT.       96

       YOUR BENEFIT PLAN DOES NOT COVER
       SERVICES THAT MEDICARE DENIED.IF
       MEDICARE ALLOWED BENEFITS FOR THIS
       SERVICE, PLEASE SEND US THE MEDICARE
4048   SUMMARY NOTICE.                         96




       HIPAA SEX AND RELATIONSHIP CODE IS
       INVALID OR UNKNOWN. REFILE CLAIM WITH
       SPECIFIC HIPAA COMPLIANT SEX AND
4050   RELATIONSHIP CODE.                      125




       PREVENTIVE SERVICES ARE NOT COVERED
4054   WHEN RENDERED OUT OF NETWORK.           96




4058   AGE CRITERIA NOT MET.                   A1




                                   Page 125
                                 CARCs_Query2




       MEDICARE'S PAYMENT WAS CONSIDERED IN
       THE PROCESSING OF THIS
       CLAIM. HOWEVER WE HAVE DETERMINED
       THAT NO BENEFIT IS DUE UN
       DER THE STATE HEALTH PLAN BECAUSE OF
       THE CARVE OUT PAYMENT
       METHOD OUTLINED IN THE STATE
4063   INSURANCE BENEFITS GUIDE.
       WE HAVE REQUESTED MEDICAL                23
       INFORMATION FROM ANOTHER PROVIDER,
       WHICH WILL ASSIST IN THE FINAL
       DETERMINATION OF BENEFITS FOR
       THIS CLAIM. WE WILL PROCESS THIS STATE
       HEALTH PLAN CLAIM WHE
       N WE RECEIVE THE INFORMATION
4069   REQUESTED.                               16
       WE HAVE SENT A REQUEST FOR MEDICAL
       INFORMATION TO YOU. A DET
       ERMINATION OF STATE HEALTH PLAN
       BENEFITS WILL BE MADE FOR TH
       IS CLAIM UPON RECEIPT OF THE
4070   REQUESTED INFORMATION.                   16

       WE ALLOW BENEFITS FOR THE
       REPLACEMENT OF FILLINGS ONCE IN A
4076   12-MONTH PERIOD.                         119


       THESE VISION SERVICES ARE NOT COVERED
4089   BY THIS CONTRACT.                        204
       THIS HEALTH PLAN DOES ALLOW BENEFITS
       FOR SELF-INJECTABLE
       DRUGS. PLEASE SUBMIT THIS CLAIM TO THE
       PRESCRIPTION DRUG
4090   VENDOR.                                  109




       THE ALLOWANCE FOR THIS PROCEDURE IS
       INCLUDED IN THE
4091   ALLOWANCE FOR MEDICAL CARE.              97
       THIS HEALTH PLAN DOES ALLOW BENEFITS
       FOR SELF-INJECTABLE
       DRUGS. PLEASE SUBMIT THIS CLAIM TO THE
       PRESCRIPTION DRUG
4092   VENDOR.                                  109




                                    Page 126
                                  CARCs_Query2


       BASED ON THE MEMBER'S CONTRACT, WE
       CANNOT ALLOW BENEFITS FOR
       SERVICES UNTIL THEY ARE PERFORMED OR
       COMPLETED. PLEASE
       REFILE THIS CLAIM WITH THE DATE THE
       PROSTHODONTIC WAS SEATED
4093   OR DELIVERED.                             16
       THIS HEALTH PLAN COVERS THIS SERVICE
       AND WILL ALLOW
       BENEFITS FOR IT BEFORE THE DENTAL
       PLAN. THEREFORE, WE
       CANNOT PROVIDE YOU WITH A DENTAL PRE-
4096   ESTIMATE.                                 101


       THE PAYMENT ON THIS CLAIM INCLUDES A
       PSA (PERSONAL SAVINGS ACCOUNT)
       AMOUNT THAT IS BEING MADE ON BEHALF
       OF THE MEMBER. THIS AMOUNT MAY
       INCLUDE FUNDS TO COVER A PORTION OF
       THE MEMBER'S DEDUCTIBLE, COINSURANCE
       OR CO-PAYMENT. IT MAY ALSO INCLUDE
       AMOUNTS FOR ITEMS THAT ARE NORMALLY
       NON-COVERED UNDER THE MEMBER'S
4098   HEALTHCARE BENEFITS.                      94




       BACKBENCH PROCEDURES ARE INCLUDED
4103   IN THE TRANSPLANT ALLOWANCE.              97




       WE ARE ADDING THESE CHARGES TO THE
       ORIGINAL CLAIM. YOU WILL
       RECEIVE A CORRECTED EXPLANATION OF
4107   BENEFITS SOON.                            97




4109   THIS CHARGE INCLUDED IN A PAID SERVICE.   97




                                    Page 127
                                 CARCs_Query2




4118   NON-COVERED PROCEDURE.                   96

       SEPARATE PAYMENT FOR SERVICES IS NOT
4120   PROVIDED BY MEDICARE.                    109



       MULTIPLE BILATERAL PROCEDURES
4121   WITHOUT MODIFIER 50.                     4




4122   INPATIENT PROCEDURE (E)                  16


       MULTIPLE EXCLUSIVE PROCEDURE THAT IS
       NOT ALLOWED BY NCCI
       EVEN IF APPROPRIATE MODIFIER IS
4123   PRESENT.                                 A1

       CODE2 OF A CODE PAIR THAT IS NOT
       ALLOWED BY NCCI EVEN IF
4124   APPROPRIATE MODIFIER IS PERSENT.         A1

       THE ALLOWANCE FOR THIS PROCEDURE IS
       INCLUDED IN THE ALLOWANCES FOR OTHER
       PROCEDURES THAT WERE FILED ON THIS
4125   CLAIM.                                   4




4126   ONLY INCIDENTAL SERVICES REPORTED (F)    16



       CODE NOT RECOGNIZED BY MEDICARE;
       ALTERNATIVE CODE FOR SAME
4127   SERVICE MAY BE AVAILABLE.                B8
       MUTUALLY EXCLUSIVE PROCEDURE THAT
       WOULD BE ALLOWED BY NCCI IF
4128   APPROPRIATE MODIFIER WERE PRESENT.       4




                                   Page 128
                                 CARCs_Query2


       CODE 2 OF A CODE PAIR THAT WOULD BE
       ALLOWED BY NCCI IF APPROPRIATE
4129   MODIFER WERE PRESENT.                    4




       INVALID USE OF OBSERVATION REVENUE
4130   CODE.                                    125




       INPATIENT SEPARATE PROCEDURES NOT
4131   PAID                                     A1



4132   SERVICE NOT SEPARATELY PAYABLE.          18




       NON-COVERED BASED ON STATUTORY
4134   EXCLUSION (G)                            160



       SERVICE CAN ONLY BE BILLED TO THE
4135   DMERC (J)                                109




       CODE NOT RECOGNIZED BY OPPS;
       ALTERNATE CODE FOR SAME SERVICE
4136   MAY BE AVAILABLE (J)                     B8




       REVENUE CODE NOT RECOGNIZED BY
4137   MEDICARE (K).                            A1




                                    Page 129
                                  CARCs_Query2




       SERVICE PROVIDED OUTSIDE APPROVAL
4138   PERIOD (L).                               152



       SERVICE NOT BILLABLE TO THE FISCAL
4139   INTERMEDIARY (M).                         96




       THIS CLAIM/SERVICE IS A DUPLICATE OF
       ANOTHER CLAIM/SERVICE THAT HAS
       ALREADY BEEN PROCESSED AND PAID TO
4143   THE PROVIDER DIRECTLY.                    97
       WE CANNOT ALLOW BENEFITS FOR THIS
       SERVICE AS THIS PATIENT DO
       ES NOT MEET THE AGE CRITERIA UNDER
       THIS BENEFIT PLAN FOR ROU
4147   TINE MAMMOGRAPHY BENEFITS.                6




4160   CASE CLOSED.                              16




       THIS DENTAL PLAN DOES NOT COVER
       DENTAL PROCEDURES COVERED
4161   UNDER THE MEDICAL PLAN.                   96


       ANESTHESIA RELATED TO NON-COVERED
       DENTAL SERVICES IS NOT
4162   COVERED.                                  96



       PERIODONTAL CHARTING IS REQUESTED IN
       ORDER TO COMPLETE
4163   PROCESSING OF THIS CLAIM.                 16




                                    Page 130
                                 CARCs_Query2



       BEFORE WE CAN PROCESS THIS CLAIM,WE
       NEED CURRENT INFORMATION
       REGARDING ANY OTHER DENTAL
       INSURANCE COVERAGE THE MEMBER MAY
       HAVE.WE'VE RECENTLY MAILED A OTHER
       DENTAL COVERAGE QUESTIONNAIRE TO
       THE MEMBER.FAILURE OF THE MEMBER TO
       PROVIDE THIS UPDATE MAY RESULT IN THE
4164   DENIAL OF FUTURE CLAIMS.                 16


       VACCINATIONS AND IMMUNIZATIONS ARE
       COVERED UNDER WELL CHILD BENEFITS
4165   ONLY                                     96



       THESE SERVICES ARE NOT COVERED FOR A
4166   DEPENDENT CHILD.                         96



       THIS PROCEDURE IS COVERED FOR
4167   ELIGIBLE FEMALE DEPENDENTS ONLY.         96


       ROUTINE PAP SMEARS ARE COVERED FOR
4171   FEMALE DEPENDANTS ONLY.                  7



       PATIENT DOES NOT MEET THE AGE
4172   CRITERIA FOR ROUTINE PAP TEST.           96




       ORTHOPEDIC SHOES AND DEVICES ARE NOT
4177   COVERED.                                 96

       SPEECH THERAPY FOR A COMMUNICATION
       DELAY OR DEVELOPMENTAL DELAY IS A
       CONTRACT EXCLUSION UNDER THE STATE
4180   HEALTH PLAN.                             96




       THIS BENEFIT PLAN DOES NOT COVER
       SERVICES PERFORMED BY AN OUT-OF-
4182   NETWORK PROVIDER.                        96



                                   Page 131
                                 CARCs_Query2



       THE PRIMARY CONTRACTUAL OBLIGATION
       DOES NOT BALANCE WITH THE
       CHARGE AND ALLOWANCE. PLEASE REVIEW
       AND RESUBMIT ELECTRONIC
4185   ALLY.                                    16



       THIS POLICY DOES NOT COVER THE
4186   MEDICARE DEDUCTIBLE AMOUNTS              96



       THIS POLICY DOES NOT COVER THE
4187   MEDICARE COINSURANCE AMOUNTS.            96




       THE PRIMARY PAYMENT INFORMATION
       SUBMITTED INCLUDES LINES DENIED BY
       MEDICARE. WE NEED THE DENIAL REASON
4188   IN ORDER TO CONSIDER FOR PAYMENT.        16

       THE PRIMARY PAYMENT INFORMATION HAS
       CONFLICTING CODES FOR
       CONTRACTED OBLIGATION AND PATIENT
       RESPONSIBILITY. PLEASE
       REVIEW AND RESUBMIT ELECTRONICALLY.
4189                                            16


       THE PRIMARY PAYMENT INFORMATION
       SUBMITTED DOES NOT BALANCE.
       PLEASE REVIEW AND RESUBMIT
4190   ELECTRONICALLY                           23

       RENDERING MUST BE FILED FOR
       PROFESSIONAL/DENTAL CLAIMS. PLEA
       SE REFILE ELECTRONICALLY WITH THE
       RENDERING PROVIDER'S NUMBE
4193   R.                                       16



       CLAIM RETURNED TO PROVIDER FOR
       ADMITTING DIAGNOSIS/PATIENT REASON
4194   FOR VISIT CODE.                          16




                                   Page 132
                                 CARCs_Query2




       RUG CODE FOR REVENUE CODE IS MISSING.
4195   PLEASE REFILE CLAIM.                      16

       WE HAVE RECEIVED YOUR CLAIM FOR
       ROUTINE VISION SERVICES. WE WILL
4197   HANDLE THIS AS A LOCAL BCBSSC CLAIM.      B11

       INCORRECT OCL VALUE CODE. PLEASE
       RESUBMIT WITH CORRECT OCL VALUE
4200   CODE.                                     129




       CERTIFICATE OF LETTER OF MEDICAL
       NECESSITY NEEDED BEFORE A FINAL
4202   BENEFIT DETERMINATION CAN BE MADE.        16


       THIS IS A MEDICARE ADVANTAGE TYPE
       CLAIM. MEDICARE CHARGE LIM
4203   ITATIONS MAY APPLY.                       131




       HOSPITAL BASED TESTS ARE NOT
4206   REIMBURSABLE.                             96




       CPT-4 CODE IS NOT CORRECT FOR THIS
4207   PATIENT'S AGE.                             6
       INCORRECT MODIFIER FILED WITH CRNA
       CHARGES. PLEASE RESUBMIT WITH
4208   CORRECTED MODIFIER.                        4




                                      Page 133
                                   CARCs_Query2


       YOUR CLAIM CONTAINS INCOMPLETE
       AND/OR INVALID INFORMATION.
       AND NO APPEAL RIGHTS ARE AFFORDED
       BECAUSE THE CLAIM IS NOT
       ABLE TO BE PROCESSED AS SUBMITTED.
       PLEASE SUBMIT A NEW
       CLAIM WITH THE CORRECT NINE-DIGIT ZIP
       CODE FOR THE LOCATION
4210   WHERE THE SERVICES WERE RENDERED.          16

       PRE-CERTIFICATION FOR ALL SCHEDULED
       OUTPATIENT PET, CT SCANS, MRI(S) AND
       MRA(S) IS REQUIRED. FOR FUTURE CLAIMS
       FOR THESE SERVICES CALL 1-866-500-7664
4215   OR LOG IN AT WWW.RADMD.COM.                197



       THE DENTAL BENEFITS DO NOT COVER
       ORTHODONTIC TREATMENT FOR
4233   EMPLOYEES OR COVERED SPOUSE                96
       ALCOHOL AND OR SUBSTANCE ABUSE
       ASSESSMENT AND INTERVENTION
       SERVICES PROVIDED AS A SCREENING
       SERVICE. SERVICE IS ONLY
       PAYABLE WHEN PERFORMED IN THE
       CONTEXT OF A DIAGNOSIS FOR
4241   TREATMENT OF ILLNESS OR INJURY.            181




       AMBULATORY SURGERY PACKAGED ITEM.
       NO SEPARATE PAYMENT FOR THESE
4242   SERVICES.                                  97


       PROCEDURE IS EXCLUDED FROM THE LIST
       OF COVERED AMBULATORY SURGICAL
       PROCEDURES OR COVERED ANCILLARY
4243   SERVICES.                                  96
       PROCEDURE IS A DELETED OR
4244   DISCONTINUED CODE.                         181


       A DESCRIPTION OF THE SERVICES
       RENDERED OR AN ITEMIZED
4245   LISTING OF CHARGES IS NEEDED.              16




                                     Page 134
                                  CARCs_Query2




       A COPY OF THE AMBULANCE REPORT IS
4246   NEEDED.                                   16


       THE PHYSICIAN'S OFFICE RECORDS,THE
       PATIENT'S HISTORY AND/OR PLAN OF
4247   TREATMENT IS NEEDED.                      16




       INFORMATION ABOUT THE ORDERING OR
4248   REFERRING PHYSICIAN IS NEEDED.            16


       THE NAME, DOSAGE, QUANTITY, AND
       RELATED NDC NUMBER OF THE DRUG IS
4249   NEEDED.                                   16

       PURSUANT TO THE SOUTH CAROLINA
       HEALTH INSURANCE POOL POLICY
       (SCHIP) THIS SUBSCRIBER CAN NOT HAVE A
       SCHIP MAJOR MEDICAL
       POLICY AND MEDICARE. ELIGIBILITY FOR
       MEDICARE COVERAGE AUTOM
       ATICALLY TERMINATES SCHIP MAJOR
       MEDICAL COVERAGE. THIS SUBS
       CRIBER IS ELIGIBLE TO APPLY FOR A SCHIP
4253   MEDIGAP POLICY.                           96

       PROCEDURE CODES ARE ONLY
       REIMBURSABLE FOR PROVIDERS WITH AUT
4257   IISM NETWORK AFFILIATION.                 B7



       OUT OF NETWORK PROVIDER APPROVED BY
4259   PMCS.                                     45




4260   1ST REQUEST FOR MEDICAL RECORDS.          16




                                     Page 135
                                 CARCs_Query2




4261   SECOND REQUEST FOR MEDICAL RECORDS.        17

       THIS DENTAL CONTRACT LIMITS THE
       ALLOWANCE ON XRAYS TAKEN ON
       THE SAME DATE OF SERVICE TO THAT OF A
       FULL MOUTH SERIES.
4263   THE MAXIMUM ALLOWANCE WAS MET.             119



       THESE CHARGES CANNOT BE PROCESSED
       UNTIL WE RECEIVE MEDICAL HISTORY
       INFORMATION REQUESTED FROM ANOTHER
       PROVIDER. THIS INFORMATION IS NEEDED
       TO DETERMINE BENEFITS PER THE
       MEMEBER'S BENEFIT PLAN OR POLICY.
       THERE CHARGES WILL BE CONSIDERED
4266   WHEN THIS INFORMATION IS RECEIVED.         16
       THESE CHARGES CANNOT BE PROCESSED
       UNTIL WE RECEIVE HEALTH HISTORY
       INFORMATION. THIS INFORMATION IS
       NEEDED TO DETERMINE BENEFITS PER THE
       MEMBER'S BENEFIT PLAN OR POLICY. THESE
       CHARGES WILL BE CONSIDERED WHEN THIS
4267   INFORMATION IS RECEIVED.                   16


       $50 COPAYMENT FOR THIS AMBULANCE
       SERVICE WAIVED BASED ON HOSPITAL
4272   ADMISSION.                                 97


       $50 COPAYMENT FOR THIS EMERGENCY
       SERVICE WAIVED BASED ON HOSPITAL
4273   ADMISSION.                                 97




4274   SUBSCRIBER LAST NAME INVALID.              16




4275   SUBSCRIBER FIRST NAME INVALID.             16



                                       Page 136
                                   CARCs_Query2




4276   SUBSCRIBER ADDRESS INVALID.                16




4277   SUBSCRIBER CITY INVALID.                   16




4278   SUBSCRIBER STATE INVALID.                  16




4279   SUBSCRIBER ZIP CODE NOT NUMERIC.           16




       BCBS PROVIDER NUMBER INVALID OR DOES
4280   NOT MATCH SCSF.                            16




4281   PROVIDER NAME INVALID.                     16




4282   PROVIDER ADDRESS INVALID.                  16




4283   PROVIDER CITY INVALID.                     16




4284   PROVIDER STATE INVALID.                    16




       TYPE OF FEDERAL TAX ID INVALID OR DOES
4285   NOT MATCH SCSF.                            16




                                     Page 137
                                    CARCs_Query2




       CLASSIFICATION OF PROVIDER INVALID
4286   VALUE.                                      16




       PATIENT STATUS CODE INVALID VALUE OR
4287   DOES NOT MATCH SCSF.                        16




       MEDICARE PROVIDER NUMBER IS MISSING
4288   OR DOES NOT MATCH SCSF.                     16

       THESE SERVICES WERE INCURRED AFTER
       THE TERMINATION DATE OF Y
       OUR BENEFIT PLAN. IF YOU HAVE BEEN
       CONTINUOUSLY DISABLE SINC
       E YOUR PRIOR CANCELLATION DATE,
       PLEASE SUBMIT DOCUMENTATION
4289   FOR A REVIEW OF YOUR CLAIM.                 96




4292   PROVIDER ZIP CODE NOT NUMERIC.              16




4293   PATIENT NAME IS MISSING.                    16




4294   PATIENT BIRTHDATE INVALID FORMAT.           16




4295   PATIENT SEX INVALID VALUE.                  16




                                      Page 138
                                 CARCs_Query2




       ADMISSION/SERVICE DATE INVALID FORMAT
4296   OR DOES NOT MATCH SCSF                   125




       STATEMENT COVERS FROM DATE INVALID
4297   FORMAT.                                  125




       STATEMENT COVERS TO DATE INVALID
4298   FORMAT.                                  125




       TOTAL DAYS APPROVED FOR PAYMENT NOT
4299   NUMERIC.                                 16




       TOTAL BENEFITS MANAGEMENT PENALTY
4300   AMOUNT NOT NUMERIC                       16




       TOTAL BENEFITS MANAGEMENT REDUCTION
4301   AMOUNT NOT NUMERIC                       16




       TOTAL AMOUNT PAID Y OTHER CARRIER
4302   NOT NUMERIC                              16




                                   Page 139
                                  CARCs_Query2




       TOTAL AMOUNT EXCEEDING MAX NOT
4303   NUMERIC.                                  16




       TOTAL COVERED ANCILLARY CHARGES NOT
4304   NUMERIC.                                  16




4305   TOTAL COVERED SERVICES NOT NUMERIC.       16




       TOTAL COVERED ACCOMMODATION
4306   CHARGES NOT NUMERIC.                      16




       TOTAL NON-COVERED CHARGES NOT
4307   NUMERIC.                                  16




4308   DATE OF SERVICE (START) INVALID FORMAT.   125




4309   DATE OF SERVICE (END) INVALID FORMAT.     125




                                    Page 140
                                   CARCs_Query2




4310   INCORRECT DIAGNOSIS CODE.                  146




4311   INCORRECT MODIFIER FILED.                  182




4312   INCORRECT DATES OF SERVICE.                125




4313   INCORRECT DAYS, UNITS, TIMES(DUT'S)        125




       NO SERVICE RENDERED ON THIS DATE OF
4314   SERVICE.                                   A1




4315   INCORRECT SEX AND RELATIONSHIP CODE        16




4316   DISCHARGE DATE INVALID FORMAT              16




4317   INCURRED DATE NOT VALID.                   16




                                     Page 141
                                 CARCs_Query2




4318   DISCHARGE DATE INVALID.                  16

       INSTITUTIONAL CLAIMS WITHIN PERIOD OF
       HOSPITALIZATION ON PREVIOUSLY
4319   REPORTED.                                97


4320   INSUFFICIENT MATERNITY WAITING PERIOD.   179




4321   S&R CODE INVALID FOR PROCEDURE CODE.     16




       TYPE/PLACE OF SERVICE NOT COVERED BY
4322   CONTRACT.                                96


       PER PCMS, NO PRE-EXISTING ESRD
4323   DETERMINED.                              101




       REQUESTED RECORDS NOT RECEIVED.
       RECOMMEND DENIAL FOR LACK OF MEDICAL
4324   RECORDS.                                 16

       THIS IS A CONVERTED CLAIM THAT WAS
       PAID UNDER THE PREVIOUS
4325   SYSTEM.                                  B13




       PAYMENT IS REDUCED. AN E&M SERVICE
       WAS PAID DURING THE SURGERY 90 DAY
4326   GLOBAL PERIOD.                           97




                                    Page 142
                                 CARCs_Query2




       PAYMENT REDUCED. AN E&M SERVICE WAS
       PAID DURING THE SURGERY 10 DAY GLOBAL
4327   PERIOD.                                  97




       PAYMENT REDUCED. AN E&M SERVICE WAS
4328   PAID FOR SAME DATE AS SURGERY.           97



       PAYMENT FOR THE BASE ENDOSCOPY
4329   PROCEDURE IS INCLUDED IN THE PRICE.      97


       SEMI-PRIVATE ROOM BENEFITS WERE PAID,
       AS MEDICAL NEED NOT DOCUMENTED FOR
4330   PRIVATE ROOM.                            45


       THE AMOUNT ALLOWED WAS THE LESSER
       OF BILLED CHARGES, CONTRACTED RATE
       OR THE MEDICARE MAXIMUM ALLOWABLE
4331   CHARGE FOR THIS CONTRACT.                59



       CHARGE IS MORE THAN ALLOWABLE
       AMOUNT. PAYMENT BASED ON GUIDELINES
4332   ESTABLISHED FOR MULTIPLE SURGERY.        59


       CHARGES ARE MORE THAN ALLOWABLE
       AMOUNT. ALLOWED AMOUNT BASE UNIT
4333   PER CPT4 GUIDELINES.                     97
       THE THIRD AND ALL FOLLOWING LESION
       PROCEDURES PERFORMED BY THE SAME
       PROVIDER ON THE SAME DAY ARE ALLOWED
       AT 25% OF THE NORMAL ALLOWANCE THEN
       PAID ACCORDING TO REGULAR CONTRACT
4334   BENEFITS.                                59



       UNDER TERMS OF YOUR CONTRACT,
       PAYMENT IS THE MAXIMUM AMOUNT
4335   ALLOWED.                                 45



                                    Page 143
                                   CARCs_Query2




       THIS AMOUNT EXCEED THE MAXIMUM
       ALLOWABLE CHARGE FOR THE SERV
4336   ICE PROVIDED AT A NON-PPC FACLITY.         45




       THIS NON COVERED SERVICE HAS BEEN
4337   PAID FROM PSA FUNDS.                       96

       TOTAL COVERED CHARGES WERE PAID BY
       MEDICARE. THERE ARE NO A
       BENEFITS PAYABLE UNDER THIS
4338   COMPANION LIFE COVERAGE.                   23


       THIS IS THE MAXIMUM ALLOWANCE
       PROVIDED BY THIS CONTRACT FOR THE
4339   DRUGS PURCHASED.                           45


       CLAIM PAID AND COB QUESTIONNAIRE
4340   MAILED.                                    22
       ON A CLAIM WITH MULTIPLE R+B LINES, LINE
       CLAIM DAYS ARE GREATER THAN PRECERT
       APPROVED DAYS. PENALTIES ARE APPLIED
4341   TO THE EXCESS DAYS.                        198

       BECAUSE PRE-ADMISSION REVIEW WAS
       OBTAINED, THIS BENEFIT PLAN
       HAS WAVIED ALL OR A PORTION OF THE PER
       ADMISSION CO-PAYMENT
4342   IN ACCORDANCE WITH THIS CONTRACT.          45
       BECAUSE PRE-ADMISSION REVIEW WAS NOT
       OBTAINED, THE ENTIRE
       PER-ADMISSION CO-PAYMENT HAS BEEN
       TAKEN IN ACCORDANCE WITH THIS
4343   CONTRACT.                                  210

       BECAUSE PRE-ADMISSION REVIEW WAS NOT
       OBTAINED, THIS BENEFIT PLAN HAS APPLIED
       A REDUCTION IN BENEFITS IN
4344   ACCORORDANCE WITH THIS CONTRACT.           197



       PRECERTIFICATION IS REQUIRED ON ALL
4345   DME PURCHASES OR RENTALS                   197




                                     Page 144
                                  CARCs_Query2




       DME PRE-CERT NOT RECEIVED PARTIAL
4346   DENIAL.                                   197

       PRECERTIFICATION IS REQUIRED FOR
       PROFESSIONAL PSYCHIATRIC SERVICES.
       SINCE PRECERTIFICATION WAS NOT
       OBTAINED, WE HAVE PARTIALLY DENIED
4347   THIS CLAIM.                               197
       PRECERTIFICATION IS REQUIRED FOR
       OUTPATIENT PSYCHIATRIC SERV
       IVES. SINCE PRECERTIFICATION WAS NOT
       OBTAINED, WE HAVE PARTIALLY DENIED
4348   THIS CLAIM.                               197

       PRECERTIFICATION IS REQUIRED FOR
       THESE SERVICES. SINCE
       PRECERTIFICATION WAS NOT OBTAINED,
4349   WE HAVE PARTIALLY DENIED THIS CLAIM.      197



       THIS CONTRACT DOES NOT COVER THE
4350   MEDICARE PART A DEDUCTIBLE.               96
       TOTAL COVERED CHARGES WERE PAID IN
       FULL BY MEDICARE. THERE
       ARE NO ADDITIONAL BENEFITS PAYABLE
       UNDER THIS BLUE CROSS
4351   BLUE SHIELD POLICY.                       23
       TOTAL COVERED CHARGES WERE PAID IN
       FULL BY MEDICARE. THERE
       ADDITIONAL BENEFITS PAYABLE UNDER
4352   THIS COMPANION LIFE POLICY                23




4353   HOME PLAN PAID THE PROVIDER.              23



       BENEFITS REDUCED BECAUSE A NATIONAL
       SPECIALTY CENTER PROVIDE UTILIZED FOR
4354   THE PROCEDURE PERFORMED.                  38
       THE PRE-ADMISSION REVIEW APPROVED
       FEWER DAYS THAN THE TOTAL NUMBER OF
       DAYS THE PATIENT REMAINED IN THE
       HOSPITAL, THEREFORE, THE ADDITIONAL
4355   DAYS WERE NOT COVERED.                    198




                                      Page 145
                                   CARCs_Query2



       BENEFITS WERE APPROVED FOR
       OUTPATIENT SERVICES ONLY, THEREFORE A
       PORTION OF THE ROOM AND BOARD
4356   CHARGES WAS NOT COVERED.                   198


       BENEFITS NOT AVAILABLE BECAUSE A
       NATIONAL SPECIALTY CENTER PROVIDER
       WAS NOT UTILIZED FOR THE PROCEDURE
4357   PERFORMED.                                 38

       THE CLAIM HAS BEEN PAID UP TO THE
       CONTROL/HOME LICENSEE'S ALLOWANCE
       BECAUSE IT IS LESS THAN THE PAR/HOST
4358   LICENSEE ALLOWANCE.                        94

       BENEFITS WERE APPROVED FOR
       OUTPATIENT SERVICES ONLY, THERE
       FORE, THE ROOM AND BOARD CHARGES
4359   WERE NOT COVERED.                          198

       THIS CONTRACT REQUIRES PRE-APPROVAL
       ON HOSPITAL ADMISSIONS W
       HICH WAS NOT OBTAINED. THEREFORE, THE
       ROOM AND BOARD
       CHARGES WERE NOT COVERED OR
       REDUCED AS PROVIDED IN THIS
4360   CONTRACT.                                  197


       THE PRE-ADMISSION REVIEW APPROVED
       FEWER DAYS THAN THE TOTAL NUMBER OF
       DAYS THE PATIENT REMAINED IN THE
       HOSPITAL,
       THEREFORE, THE ADDITIONAL DAYS WERE
4361   NOT COVERED.                               198


       THE PRE-ADMISSION REVIEW APPROVED
       LESS DAYS/VISITS/SHIFTS
       THAN FILED, THEREFORE, THIS IS A PARTIAL
       PAYMENT FOR COVERED
4362   SERVICES.                                  198

       THIS DENTAL CONTRACT LIMITS THE
       ALLOWANCE ON XRAYS TAKEN ON
       THE SAME DATE OF SERVICE TO THAT OF A
       FULL MOUTH SERIES. THE MAXIMUM
4363   ALLOWANCE WAS MET.                         119




                                     Page 146
                                  CARCs_Query2




       THIS CLAIM HAS BEEN PROCESSED BASED
       ON THE HOME PLANS
4364   CONTRACT BENEFITS.                        23


       SUBSCRIBER USED AN OUT OF NETWORK
       PROVIDER, THE CLAIM HAS
       BEEN PROCESSED BASED ON THE HOME
4365   PLANS CONTRACT BENEFITS.                  38




       THE ALLOWABLE AMOUNT IS BASED ON
4366   MEDICARE LIMITING CHARGE.                 45



       CHARGE REDUCED TO ESTABLISHED VISIT
       BASED ON PREVIOUSLY PAID
4367   NEW PATIENT OFFICE VISIT.                 45




4368   CHARGE REDUCED BASED ON REVIEW.           216

       PAYMENT REDUCED DUE TO OTHER HEALTH
4369   INSURANCE PAYMENT.                        23


       PAYMENT COORDINATED WITH MEDICAID
4370   AGENCY.                                   23


       THIS AMOUNT PLUS THE AMOUNT ALLOWED
       ON PREVIOUS CLAIM(S)
       FOR A PART OF THIS SERVICE PERFORMED
       AT THE SAME TIME IS THE MAXIMUM
       ALLOWANCE AMOUNT FOR THIS SERVICE. IF
       THIS CLAIM WAS FILED ON A PARTICIPATING
       BASIS, THE BENEFICIARY IS NOT
       RESPONSIBLE FOR PAYMENT OF THE
4371   DISALLOWED AMOUNT.                        B10


       BENEFIT YEAR OR ENROLLMENT PERIOD
       CATASTROPHIC CAP REACHED. COST
4372   SHARES AND COPAYS NO LONGER APPLY.        45




                                    Page 147
                                CARCs_Query2




       THIS AMOUNT EXCEEDS THE ORTHODONTIC
       MAXIMUM ALLOWABLE BENEFIT FOR THIS
4373   SERVICE.                                B5


       CHARGES PREVIOUSLY APPLIED TO THE
       DISAPPEARING DEDUCTIBLE ARE BEING
4374   REIMBURSED.                             94




       CHARGES PREVIOUSLY APPLIED TO THE
4375   DEDUCTIBLE ARE BEING REIMBURSED.        94




       AMOUNT TAKEN TO SATISFY A PREVIOUS
4376   OVERPAYMENT.                            45
       THE ORTHODONTIC LIFETIME BENEFITS
4377   HAVE BEEN MET.                          35



       THIS BENEFIT PLAN DOES NOT COVER
       EMERGENCY ROOM SERVICES FOR
       CONDITIONS OR ILLNESSES THAT ARE NOT
4378   LIFE THREATENING OR TRUE EMERGENCIES.   204




       THESE PREVENTIVE SERVICES ARE NOT
       COVERED WHEN RENDERED BY A
4379   OUT-OF-NETWORK PROVIDER.                204



       FLU SHOTS ARE COVERED IF RENDERED BY
       A PCP. SPECIALISTS ARE
4380   NOT COVERED.                            38




       THIS BENEFIT PLAN ONLY COVERS HEARING
4381   AIDS FOR DEPENDENT CHIDREN.             96




                                   Page 148
                                  CARCs_Query2




       THESE PREVENTIVE SERVICES ARE NOT
       COVERED WHEN RENDERED BY A
4382   SPECIALIST.                               38
       THESE CHARGES ARE NOT COVERED. ONLY
       APPROVED PROCEDURES PERFORMED BY
       PROVIDER WITH AUTISM NETWORK
       AFFILIATION ARE
4383   REIMBURSABLE.                             38
       THIS BENEFIT PLAN COVERS SERVICES
       PROVIDED BY A PREFERRED PROVIDER
       ONLY. BECAUSE A PREFERRED PROVIDER
       DID NOT PERFORM THESE SERVICES, THE
       PATIENT IS REPONSIBLE FOR THESE
4384   CHARGES.                                  38


4385   VISION CLAIMS SHOULD BE FILED TO BCSBS.   109
       THIS BENEFIT PLAN DOES NOT COVER
       SERVICES PERFORMED BY
4386   NON-NETWORK PROVIDERS.                    38
       THIS BENEFIT PLAN DOES NOT COVER
4387   BLOOD OR BLOOD PLASMA.                    204

       NEED OFFICE NOTES, H&P, AND LAB
       RESULTS FROM THE REFERRING/
       ORDERING PHYSICIAN TO DETERMINE
4388   MEDICAL NECESSITY.                        16

       THIS BENEFIT PLAN COVERS PHYSICIAN
4390   CHARGES ONLY.                             38
       HOME HEALTH CARE AND HOSPICE CARE
       ARE NOT COVERED SERVICES UNDER THIS
4391   BENEFIT PLAN.                             204
       BITEWINGS PAYABLE 1 TIME PER BENEFIT
4392   PERIOD.                                   119
       THE CALENDAR YEAR FREQUENCY
       LIMITATION FOR THIS SERVICE HAS
4393   BEEN EXCEEDED.                            119


       THIS SERVICE IS ONLY COVERED TWO
4394   TIMES PER CALENDAR YEAR.                  45
       THIS PROCEDURE IS ALLOWED TWO TIMES
       PER CALENDAR YEAR BUT NO
       MORE THAN ONE TIME IN A FIVE MONTH
4395   PERIOD.                                   45
       THIS PROCEDURE IS ALLOWED TWO TIMES
       PER CALENDAR YEAR BUT NO
       MORE THAN ONE TIME IN A FIVE MONTH
4396   PERIOD.                                   119



                                    Page 149
                                CARCs_Query2




4398   NON-COVERED LAB.                        96

       OUT OF NETWORK CHIROPRACTIC
4399   SERVICES ARE NOT COVERED.               38
       SERVICES RENDERED AFTER
4400   CANCELLATION DATE.                      27

       THE ALLOWANCE FOR THIS SERVICE WAS
       INCLUDED IN THE PAYMENT F
       OR HOSPITAL SERVICES. FOR
       RECONSIDERATION SUBMIT WITH
       DOCUMENTATION OF DIRECT PHYSICAIN
       PARTICIPATION AND
4402   PERFORMANCE OF TEST.                    97
       THESE CHARGES SHOULD BE FILED TO THE
       FOLLOWING ADDRESS FOR
       PROCESSING:
       GREEN SPRINGS OF WESTERN PA
       P O BOX 2750
4403   PITTSBURG PA 15230-2750                 109
       CHARGES FOR THESE SERVICES ARE NON
       COVERED UNDER THIS DENTAL
       PLAN. PLEASE SUBMIT THESE CHARGES TO
       THE MEDICAL BENEFIT
4404   PLAN FOR CONSIDERATION.                 109




       THIS PROCEDURE IS ONLY COVERED FOR
4405   PATIENTS AGE 14 AND OVER.               96



       YOUR BENEFIT PLAN DOES NOT COVER THIS
4406   SERVICE FOR MEMBERS OVER AGE 3.         96


       THIS PROCEDURE IS ONLY COVERED ON
       PERMANENT AND SECOND MOLARS FOR
4407   DEPENDENTS THROUGH THE AGE OF 10.       96




                                   Page 150
                                  CARCs_Query2


       YOUR BENEFIT PLAN DOES NOT COVER THIS
       SERVICE FOR MEMBERS OVER AGE 12.
       PLEASE REFER TO THE SCHEDULE OF
       BENEFITS OR EXCLUSIONS SECTION OF
       YOUR BENEFIT BOOKLET FOR MORE
4408   DETAILS.                                  96
       PRESCRIPTION:
       PAID PRESCRIPTIONS, INC
       P. O. BOX 770
4409   PARSIPPANY, NJ 07054-0770                 109




4410   THE MINIMUM AGE FOR THIS BENEFIT IS 14.   96
       THIS PROCEDURE IS ONLY ALLOWED ONCE
4411   IN A SEVEN YEAR PERIOD.                   B5




       THIS PROCEDURE IS ONLY COVERED ONE
       TIME IN A FIVE YEAR
4412   PERIOD.                                   B5




       THIS PROCEDURE IS ONLY ALLOWED ONCE
       IN A SEVEN YEAR PERIOD AND ONLY IF THE
       TREATMENT IS FOR DECAY PURPOSES.
4413                                             B5




       YOUR COMPANION LIFE DENTAL PLAN DOES
4414   NOT COVER THIS.                           204




       THIS HEALTH PLAN DOES NOT COVER
       INSULIN OR DIABETIC
4415   SUPPLIES.                                 96




                                     Page 151
                                 CARCs_Query2




       YOUR DENTAL PLAN DOES NOT COVER THIS
       SERVICE FOR PATIENTS OVER THE AGE OF
       13. PLEASE REFER TO THE EXCLUSIONS OR
       SCHEDULE OF BENEFITS
       SECTION OF YOUR BENEFIT BOOKLET FOR
4416   SPECIFIC DETAILS.                        96




4417   NON-COVERED BY DME/NCD GUIDELINES        96




       NO BENEFITS ARE PROVIDED FOR OUT OF
4418   HOSPITAL PRESCRIPTION DRUGS.             96



       THIS PROCEDURE IS ONLY COVERED FOR
       DEPENDENT CHILDREN UNDER THE AGE OF
       14 AND IS COVERED ONLY FOR MOLAR
4419   TEETH ONCE PER TOOTH PER LIFETIME.       96




       THIS PROCEDURE IS COVERED ONCE PER
       LIFETIME ON PERMANENT FIRST AND
       SECOND MOLARS ONLY FOR DEPENDENT
4420   CHILDREN THROUGH THE AGE OF 14.          B5



       THIS PROCEDURE IS ONLY COVERED ONCE
       EVERY THREE YEARS ON FIRST AND
       SECOND PERMANENT MOLARS FOR
4421   DEPENDENTS THROUGH THE AGE OF 16.        B5




       THIS PROCEDURE IS ONLY COVERED
4422   THROUGH AGE 17.                          96


                                   Page 152
                                 CARCs_Query2




       THIS IS NOT A COVERED SERVICE FOR
4423   MEMBERS UNDER THE AGE OF12.              96



       THIS BENEFIT PLAN DOES NOT COVER THIS
4424   SERVICE FOR MEMBERS UNDER AGE 18.        96


       THIS PROCEDURE IS NOT COVERED BY
       MEDICARE ADVANTAGE WHEN FILED WITH
4425   THE DIAGNOSIS CODE.                      96



       NOT A COVERED SERVICE FOR MEMBERS
4426   UNDER 19.                                96



       NOT A COVERED SERVICE FOR MEMEBERS
4427   UNDER 25.                                96
       THE PROCEDURE CODE IS PAYABLE ONE
       TIME PER LIFETIME AND PAYABLE FOR
4428   CHILDREN AGES 8 TO 19 ONLY.              35



       THIS BENEFIT PLAN DOES NOT COVER THIS
4429   SERVICE FOR MEMBERS OVER AGE 15.         96
       PRIVATE ROOM ALLOWED DUE T0
4431   CONTAGION.                               94

       REJECTION ON PARTIAL PAYMENT OF LAB
       AND X-RAY ON ADMISSION FOR IMPACTED
4432   TEETH.                                   45

4433   NO PRE-ADMISSION REVIEW WAS OBTAINED.    197



4434   THE WROND PROVIDER WAS PAID.             A1


4435   DUPLICATE PAYMENT.                       B13


4436   WAITING PERIOD NOT SERVED.               179




                                    Page 153
                                  CARCs_Query2




4437   CONTRACT CANCELLED.                        27


       BLOOD PRODUCTS, BIOLOGICAL SERA AND
       IMMUNIZATION AGENTS ARE NOT PAYABLE
4438   ON AN OUTPATIENT BASIS.                    96




4439   COCHLEAR IMPLANTS ARE NOT COVERED.         96

       PRESCRIPTION DRUG CLAIMS ARE HANDLED
       BY BLUE CROSS BLUE
       SHIELD OF VIRGINIA. PLEASE SEND CLAIMS
       TO THE FOLLOWING
       ADDRESS:
       BLUE CROSS BLUE SHIELD
       P O BOX 27401
       RICHMOND VIRGINIA 25279
       CUSTOMER SERVICE INQUIRIES ON
       PRESCRIPTION DRUG CLAIMS
       CONTACT
       1-800-322-1834.
4440                                              109


       CLAIMS FILING OR WRITTEN INQUIRIES
       SHOULD BE FORWARDED TO :
       BLUE CROSS BLUE SHIELD OF GEORGIA
       P.O. BOX 9907
4441   COLUMBUS, GEORGIA 31908-9907               109




4442   REFILE WITH A VALID E&M CODE.              16

       THIS PLAN COVERS ONLY THE EMPLOYEE.
       SERVICES FOR DEPENDENTS ARE NOT
4443   COVERED.                                   32




       BENEFITS ARE NOT PAYABLE FOR SERVICES
       THAT WERE DENIED BY MEDICARE UNDER
4444   THIS SUPPLEMENTARY CONTRACT.               96



                                       Page 154
                                 CARCs_Query2




       MENTAL HEALTH, CHEMICAL DEPENDENCY,
       & SUBSTANCE ABUSE ARE NOT COVERED
       SERVICES IF PROVIDED AS PART OF AN
4445   EMERGENCY ROOM VISIT.                    96




4446   NON-COVERED SERVICES.                    96

       NO BENEFITS ARE ALLOWED ON THE
       SAVINGS PLAN OPTION FOR DRUGS
       PROVIDED BY A NON-PARTICIPATING
4447   PROVIDER.                                170



       THIS BENEFIT PLAN ONLY COVERS THIS
       SERVICE TWO TIMES EVERY 48
4448   CONSECUTIVE MONTHS.                      119



       THIS CONTRACT DOES NOT COVER
       SERVICES RELATED TO CHEMICAL
4449   DEPENDENCY OR SUBSTANCE ABUSE.           96




       THIS BENEFIT PLAN DOES NOT COVER FLU
4450   SHOTS.                                   96




       THIS BENEFIT PLAN DOES NOT COVER
4451   ROUTINE FOOT CARE.                       96


       THIS BENEFIT PLAN DOES NOT COVER ARCH
       SUPPORTS, ORTHOPEDIC SHOES, SHOE
       INSERTS OR SIMILAR TYPE ITEMS,
4452   REGARDLESS OF THE INTENDED USE.          96




       THIS SERVICE IS PAYABLE UNDER HEALTH
4453   ONLY.                                    96




                                    Page 155
                                 CARCs_Query2




       PRE-OP XRAYS REQUIRED FOR IMPACTED
4454   TEETH.                                   16

       FLORIDA COMBINED LIFE /INDEMNITY DOES
       NOT COVER NON
4455   PARTICIPATING PROVIDERS.                 170



       THIS IS A DRUG POLICY ONLY. MEDICAL
       BENEFITS ARE NOT PAYABLE UNDER THIS
4456   CONTRACT.                                96



       THIS BENEFIT PLAN DOES NOT COVER THIS
       SERVICE WHEN IT IS PERFORMED FOR THIS
4457   CONDITION OR ILLNESS.                    96




       THIS BENEFIT PLAN DOES NOT COVER
       SERVICES RELATED TO NON-EMERGENCY
4458   AMBULANCE TRANSPORTS.                    96




       THIS SERVICE IS DENIED AS THERE IS NO
       VISION COVERAGE FOR THIS GROUP AS OS
4460   8/1/96.                                  96
       THIS DENTAL PLAN COVERS THIS
       PROCEDURE ONLY ONCE EVERY FIVE
4461   MONTHS.                                  119




       THIS BENEFIT PLAN ALLOWS FOR VISION
4462   AND DENTAL BENEFITS ONLY.                96




4463   NON-COVERED CHIRO SERVICES.              96




                                     Page 156
                                  CARCs_Query2




       MEMBER DOES NOT HAVE MEDICAL
       COVERAGE THROUGH A STAND ALONE
4464   PFFS PLAN.                                96



4465   PARTIAL HOSPITALIZATION DENIED.           45
       SERVICES FOR THIS PROVIDER ARE NOT
4466   COVERED BY THIS BENEFIT PLAN.             170

       HUMAN ORGAN AND TISSUE TRANSPLANTS
4467   ARE NOT COVERED OUT-OF-NETWORK.           38



       ROUTINE NURSERY BENEFITS ARE NOT
4469   COVERED.                                  96



       IMMUNIZATIONS ARE NOT COVERED UNDER
4470   THIS CONTRACT.                            96




       THIS SERVICE IS NOT A COVERED
4471   INFERTILITY BENEFIT UNDER THIS POLICY.    96



       INPATIENT SPEECH THERAPY IS NOT
4472   COVERED UNDER THIS BENEFIT PLAN.          96



       CHEMICAL DEPENDENCY AND SUBSTANCE
4473   ABUSE ARE EXCLUDED.                       96




       COVERAGE FOR CONTRACEPTIVE
       MANAGEMENT IS NOT COVERED UNDER
4474   THIS CONTRACT.                            96




                                     Page 157
                                 CARCs_Query2




       BENEFITS ARE NOT PAYABLE FOR
       MAMMOGRAMS PERFORMED BY
       PROVIDERS WHO ARE NOT A PART OF THE
       MAMMOGRAPHY NETWORK OR
4475   THE PARTICIPATING PROVIDER NETWORK.      38




       THIS BENEFIT PLAN DOES NOT ALLOW
       BENEFITS FOR SERVICES OTHER THAN THIS
4476   ROUTINE EXECUTIVE PHYSICAL.              96
       INPATIENT MENTAL HEALTH, CHEMICAL
       DEPENDENCY, AND SUBSTANCE ABUSE ARE
       NOT COVERED WHEN PERFORMED BY A
4477   NON-PARTICIPATING PROVIDER.              170




4478   MENTAL HEALTH SERVICES ARE EXCLUDED.     96
       THIS VISION CONTRACT WAS CANCELLED AT
       THE TIME THESE SERVICES WERE
4479   RENDERED.                                27




       CHARGES MUST BE BILLED BY THE
       RENDERING PHYSICIAN. PATIENT CANNOT
4480   BE BILLED.                               170




4481   TMJ IS NOT COVERED.                      96
       THIS BENEFIT PLAN COVERS THIS SERVICE
4482   ONLY ONCE PER LIFETIME.                  35




       DOUBLE KIDNEY, DOUBLE LUNG, OR DOUBLE
       LUNG WITH HEART TRANSPLANTS ARE NOT
4483   COVERED.                                 96




       NON-COVERED BY LABORATORY/NCD
4484   GUIDELINES.                              96


                                    Page 158
                                     CARCs_Query2




       CLAIMS FILING OR WRITTEN INQUIRIES
       SHOULD BE FORWARDED TO:
       BLUE CROSS/BLUE SHIELD OF FLORIDA
       POST OFFICE BOX 1798
       JACKSONVILLE, FLA 32231
       FOR PHONE INQUIRIES:
       (904) 354 - 3331 IF IN JACKSONVILLE FLA
       (800) 879 - 6285 IF OUTSIDE OF
4485   JACKSONVILLE FLA                             109



       PAYMENT FOR LAB SERVICES SHOULD
4486   COME FROM RCG.                               94




       THIS BENEFIT PLAN ONLY COVERS THIS
       SERVICE FOR AGES 18 AND
4487   OVER.                                        96

       THIS BENEFIT PLAN DOES NOT PROVIDE
       BENEFITS FOR THIS SERVICE UNLESS THE
       SERVICE IS RENDERED BY A MCLEOD
       NETWORK FACILITY (FLORENCE,
4493   DARLINGTON, OR DILLON.)                      38




       THIS BENEFIT PLAN DOES NOT COVER
4494   MARRIAGE AND FAMILY COUNSELING.              96


       THESE SERVICES ARE COVERED BY
       MAGELLAN. PLEASE CALL 800-891-4317 FOR
4495   BENEFIT INFORMATION.                         109


       THIS BENEFIT PLAN DOES NOT COVER
       SERVICES PERFORMED BY AN OUT OF
4496   NETWORK PROVIDER.                            38




       CHIROPRACTIC SERVICES FILED WITHOUT
       THE CORRECT DIAGNOSIS CODES ARE NOT
4497   COVERED.                                     96




                                        Page 159
                                  CARCs_Query2




       NO BENEFITS ARE PAYABLE FOR THIS TYPE
4499   PROVIDER.                                 170


       THIS INPATIENT PIGGYBACK CLAIM HAS
       BEEN DENIED. THE CLAIM W ILL NEED TO BE
       SPLIT INTO MULTIPLE CLAIMS FOR
       PROCESSING BECAUSE IT INFORMATION ON
       IT FOR LIFE TIME RESERVE DAYS,
       COINSURANCE DAYS OR MEDICARE
4500   BENEFITS EXHAUSTED.                       96




       THIS BENEFIT PLAN DOES NOT COVER
       SERVICES RELATED TO THIS CODITION OR
4501   ILLNESS.                                  96


       THIS VISION COVERAGE IS HANDLED BY
       EYEMED. PLEASE REFILE THIS VISION CLAIM
4502   TO EYEMED.                                109


       PLEASE SEND US THE MEDICARE
       EXPLANATION OF BENEFITS THAT GIVES
       THE REASON WHY MEDICARE DENIED THESE
4503   CHARGE.                                   16




       THIS BENEFIT PLAN DOES NOT COVER
4504   GLUCOMETERS AND RELATED SUPLIES.          96

       THIS BENEFIT PLAN DOES NOT COVER
       MENTAL HEALTH OR SUBSTANC
       ABUSE ASERVICES. BENEFITS ARE
       PROVIDED BY:
       COMPPSYCH CORPORATION
       NBC TOWER-13TH FLOOR
       455 N. CITY FRONT PLAZA DRIVE
       CHICAGO, IL 60611
4505   1-877-616-0511                            109




                                    Page 160
                                 CARCs_Query2




       HEARING AIDS AND/OR THE FITTING OR
       REPAIR OF HEARING AIDS ARE NOT
4506   COVERED UNDER THIS BENEFIT PLAN.         96



       THIS BENEFIT PLAN DOES COVER DURABLE
4509   MEDICAL EQUIPMENT.                       96
       THIS CONTRACT EXCLUDES DRUGS
       RELATED TO MENTAL, NERVOUS AND
4510   SUBSTANCE ABUSE SERVICES.                204
       THESE SERVICES ARE ONLY AVAILABLE AT
4511   AN HMA FACILITY.                         170
       SERVICES FOR MENTAL/NERVOUS BENEFITS
       ARE NOT COVERED UNDER
       THIS CONTRACT WHEN RENDERED BY AN
4512   OUT-OF-NETWORK PROVIDER.                 170

       THIS CONTRACT DOES NOT COVER HUMAN
       ORGAN TRANSPLANTS OR THE TRAVEL,
       MEALS AND LODGING ASSOCIATED WITH
4513   THEM.                                    96



       THIS GROUP DOES NOT COVER HEALTH
4514   BENEFITS.                                96
       THIS BENEFIT PLAN ONLY COVERS
4515   PRESCRIPTION DRUG SERVICES.              204




       CONTRACEPTIVE DEVICES OR IMPLANTS
4516   ARE NOT COVERED.                         96




       ORTHOTICS ARE NOT COVERED UNDER THIS
4517   CONTRACT.                                96
       BENEFITS FOR TEMPOROMANDIBULAR
       JOINT DISORDER (TMJ) ARE NOT COVERED
       WHEN SERVICES ARE RENDERED BY AN OUT-
4518   OF-NETWORK PROVIDER.                     170

       VISION BENEFITS ARE NOW BEING HANDLED
4519   BY ANOTHER CARRIER.                      109




                                    Page 161
                                 CARCs_Query2




       THIS BENEFIT PLAN DOES NOT COVER
4520   THESE OUTPATIENT SERVICES.               96

       THIS BENEFIT PLAN DOES NOT COVER
       PRESCRIPTION DRUGS WHEN PURCHASED
4521   AT A NON-PARTICIPATING PHARMACY.         204
       OPTOMETRISTS ARE NOT COVERED BY THIS
4522   BENEFIT PLAN.                            170
       ORTHOGNATHIC SURGERIES ARE NOT
4523   COVERED UNDER THIS PLAN.                 204

       HOME SLEEP STUDIES ARE NOT COVERED.
       SERVICES MUST BE RENDERED IN A CLINIC,
       EITHER FREE-STANDING OR HOSPITAL
4524   AFFILIATED.                              96
       THIS SERVICE IS A NON-COVERED SERVICE
       THAT THE MEMBER IS NOT LIABLE TO PAY
       AS IT SHOULD BE INCLUDED IN THE OFFICE
4525   VISIT CHARGE.                            97
       THIS BENEFIT PLAN DOES NOT COVER
       THESE SUPPLIES AS THEY ARE INCLUDED IN
4526   THE DIALYSIS KIT.                        204

       THIS PROCEDURE IS ONLY PAYABLE IN AN
4527   OUTPATIENT SETTING.                      58



       WE DID NOT RECEIVE ENOUGH
       INFORMATION TO PROCESS THIS CLAIM.
       FILE A CORRECTED CLAIM THAT INCLUDES A
       DESCRIPTION OF THE SERVICE,
4528   PROCEDURE OR SUPPLY.                     16
       THIS SERVICE IS NOT COVERED WHEN
4529   PERFORMED BY THIS PROVIDER.              170



       THIS COMPANION LIFE CHAMPUS
       SUPPLEMENT DOES NOT COVER POINT
4530   OF SERVICE COST UNDER TRICARE PRIME.     96
       NO COVERAGE FOR PROSTHODONTIC
       BENEFITS FOR SERVICES RELATED TO
       MISSING TEETH UNTIL THE MEMBER HAS
4531   BEEN COVERED FOR 12 MONTH.               177

       CONSCIOUS SEDATION IS NOT COVERED
       SEPARATELY FROM THE SURGICAL/MEDICAL
4532   PROCEDURE PERFORMED.                     204




                                    Page 162
                                 CARCs_Query2



       REVIEW OF X-RAYS AND DIAGNOSTIC TEST
       PERFORMED ELSEWHERE ARE
4533   INCLUDED IN OTHER MEDICAL CARE.           59
       DATE OF SERVICE PRIOR TO 07-01-99.
       PLEASE REFILE TO:
       SUNSTAR; ATTN: SUSAN GULLETT; PO BOX
       951539; LAKE MARY,FL 32
4534   795-1539.                                 109


       THIS GROUP DOES NOT COVER TRAVEL &
       LODGING EXPENSES FOR RECIPIENT'S
4535   FAMILY.                                   96


       THIS MEMBER HAS VISION COVERAGE ONLY.
       NO HEALTH BENEFITS ARE
4536   AVAILABLE.                                96
       THIS BENEFIT PLAN DOES NOT COVER
       DENTAL OR VISION SERVICES.
       FILE DENTAL CLAIMS TO:
       ASSURANT EMPLOYEE BENEFITS
       P.O. BOX 2940
       CLINTON,IA 52733 OR CALL 1-800-442-7742
       FILE VISION CLAIMS TO:
       VISION SERVICE PLAN (VSP)
       3333 QUALITY DRIVE
       RANCHO CORDOVA, CA 95670 OR CALL 1-800-
4537   877-7195                                  109




       THIS PLAN DOES NOT COVER VOLUNTARY
4538   STERILIZATION.                            96
       SEALANTS COVERED THROUGH AGE 19, NO
       MORE THAN ONE APPLICATION PER TOOTH
4539   EVERY TWO YEARS.                          119




       SERVICES AND SUPPLIES RELATED TO
4540   PENILE PROSTHESES ARE NOT COVERED.        96




       THIS BENEFIT PLAN ONLY COVERS THIS
4541   SERVICE FOR MEMBERS AGE 12 AND OVER.      96




                                    Page 163
                                  CARCs_Query2


       THIS CLAIM IS BEING MAILED TO BLUE
       CROSS BLUE SHIELD OF ILLINOIS FOR
       PROCESSING. NO ACTION ON YOUR PART IS
4542   REQUIRED.                                 B11
       SERVICES OTHER THAN SMOKING
4543   CESSATION ARE NOT COVERED.                204
       CLAIMS FILED BY A PHARMACY ARE NOT
4544   COVERED.                                  170
       THIS CLAIM IS NOT ALLOWED BASED ON A
       REVIEW OF MEDICARE
       ADVANTAGE AND MEDICARE NATIONAL
       COVERAGE DECISIONS. YOU MAY
       SUBMIT ADDITIONAL CLINICAL INFORMATION
       IF YOU BELIEVE OUR
4545   DECISION IS WRONG.                        50



       DME IS NOT COVERED WHEN RENDERED IN
4546   THE HOME.                                 58


       PHARMACY IS A NON-COVERED PLACE OF
4547   SERVICE.                                  58


       THIS HEALTH PLAN DOES NOT COVER
       BENEFITS FOR SELF-INJECTABLE
4548   DRUGS.                                    109

       THE ALLOWANCE FOR THIS PROFESSIONAL
       SERVICE IS INCLUDED IN THE ALLOWANCE
       FOR THE FACILITY SERVICES ON THE SAME
       DAY. BASED OUR MEDICAL GUIDELINES, WE
4549   CANNOT ALLOW ADDITIONAL BENEFITS.         97

       THIS IS A MEDICARE CLAIM THAT NEEDS TO
4550   BE FILED DIRECT                           109
       THIS PLAN DOES NOT PROVIDE BENEFITS
       FOR OUTPATIENT INSTITUTIONAL
4551   OCCUPATIONAL THERAPY.                     204
       SERVICE PERFORMED BEFRE EFFECTIVE
4552   DATE.                                     26




       THIS PATIENT IS NOT COVERED UNDER THIS
4553   BENEFIT PLAN.                             96
       SERVICE PERFORMED AFTER 31 DAY
       EXTENSION OF COVERAGE FROM
4554   EFFECTIVE DATE OF TERMINATION.            27




                                    Page 164
                                  CARCs_Query2




4555   PLEASE HANDLE DIRECTLY WITH OUR PLAN.      109
       PREADMISSION CERTIFICATION APPLIES. NO
4556   RECORD OF AUTHORIZATION ON FILE.           197
       SERVICE NOT COVERED UNDER INPATIENT
4557   PROVISION OF CONTRACT.                     204




       INVALID DIAGNOSIS. FOURTH OR FIFTH DIGIT
4558   REQUIRED. SEE ICD9 MANUAL.                 16
       THE PROCEDURE CODE IS INCONSISTENT
4559   WITH THE PATIENT'S AGE.                    6
       THIS DENTAL PLAN COVERS THIS
4560   PROCEDURE ONCE PER CALENDAR YEAR.          119
       THIS PROCEDURE IS ONLY COVERED ONCE
4561   EVERY THREE MONTHS.                        119




       PLEASE REFILE THIS CLAIM WITH THE
4562   CORRECT DATES OF SERVICE.                  16



       PLEASE REFILE THIS CLAIM WITH THE
       CORRECT PROCEDURE CODE AND
4563   MODIFIER.                                  16


       THIS BENEFIT PLAN ONLY COVERS
       SERVICES THAT ARE CONSISTENT WITH THE
4564   PATIENT'S GENDER.                          96
       CHARGES FOR OUT-PATIENT SERVICES
       WITH THIS PROXIMITY TO INPATIENT
4565   SERVICES ARE NOT COVERED.                  60
       PAYMENT DENIED BECAUSE
       SERVICE/PROCEDURE WAS PROVIDED
       OUTSIDE THE UNITED STATES OR AS A
4566   RESULT OF WAR.                             58
       CLAIM/SERVICE DENIED. APPEAL
       PROCEDURES NOT FOLLOWED OR TIME
4567   LIMITS NOT MET.                            138




                                     Page 165
                                  CARCs_Query2




       WE CANNOT ALLOW BENEFITS ON THIS
       CLAIM BECAUSE THE PATIENT WAS NOT
4568   HOSPITALIZED WITHIN THE LAST 30 DAYS.     96
       CLAIM/SERVICE NOT COVERED/REDUCED
       BECAUSE ALTERNATIVE SERVICES WERE
       AVAILABLE, AND SHOULD HAVE BEEN
4569   UTILIZED.                                 150




       SERVICES NOT COVERED BECAUSE THE
4570   PATIENT IS ENROLLED IN A HOSPICE.         96
       SERVICES NOT DOCUMENTED IN PATIENT'S
4571   MEDICAL RECORDS.                          B12


       WE CANNOT ALLOW BENEFITS BECAUSE
       ATHE PATIENT DID NOT MEET THE CRITERIA
4572   FOR A NEW PATIENT.                        96

       SERVICES ARE PART OF A GLOBAL FEE.
       PLEASE SUBMIT WITH GLOBAL FEE
4573   MESSAGE CODE AND PRICING.                 45
       CLAIM INCORRECTLY SUBMITTED AS BEING
       PART OF A GLOBAL FEE. PLEASE RESEND
4574   WITH NORMAL PRICING.                      109

       THESE SERVICES ARE COVERED BY AN
4575   INTERMEDIARY.                             109




       EMERGENCY SERVICES RECORDS NEEDED
4576   BEFORE A CLAIM CAN BE PROCESSED.          16




       ACCIDENT DATE AND/OR ONSET DATE
4577   NEEDED BEFORE CLAIM CAN BE PROESSED.      16




                                    Page 166
                                CARCs_Query2




       PROGRESS NOTES/REPORT NEEDED
4578   BEFORE CLAIM CAN BE PROCESSED.          16




       OPERATIVE/SURGICAL REPORT NEEDED
4579   BEFORE CLAIM CAN BE PROCESSED.          16




       TREATMENT PLAN NEEDED BEFORE CLAIM
4580   CAN BE PROCESSED.                       16
       BENEFITS FOR THESE SERVICES CANNOT BE
       DETERMINED AT THIS TIME WHEN RECORDS
       FOR THIS GROUP HAVE BEEN PROPERLY
       RECONCILED, THESE SERVICES WILL BE
       RECONSIDERED FOR PAYMENT
4581   DETERMINATIONS.                         16


       THIS DENTAL CONTRACT DOES NOT COVER
       CHARGES FOR TREATMENT, SERVICES OR
       SUPPLIES THAT DO NOT MEET OUR
       CRITERIA FOR MEDICAL NECESSITY ARE
       NOT NORMALLY PROVIDED FOR THE
4582   TREATMENT OF THIS CONDITION.            96
       THESE CHARGES ARE NOT COVERED. AS A
       RESULT OF ARBITRATION, T
       HESE SERVICES ARE THE RESPONSIBILITY
       OF THE MEMBER'S
4583   AUTOMOBILE INSURANCE CARRIER.           96

       THESE CHARGES CANNOT BE PROCESSED
       UNTIL WE RECIEVE THE HOSPI
       TAL CHARGES THAT RELATE TO THE
       PROFESSIONAL FEE SUBMITTED.
       PER THE MEMBER'S BENEFIT PLAN OR
       POLICY. THESE CHARGES WILL
       BE CONSIDERED WHEN THE REQUESTED
4584   INFORMATION IS RECEIVED.                16




                                  Page 167
                                CARCs_Query2




       THE NAME AND ADDRESS OF THE ORDERING
       OR REFERRING PHYSICIAN
       IS NEEDED BEFORE THE CLAIM CAN BE
4585   CONSIDERED.                             16
       THESE CHARGES ARE NOT COVERED. THE
       PRIMARY CARE PROVIDER DID NOT
       AUTHORIZE THE SERVICES AND THE
       CONDITION TREATED DID NOT MEET THE
4586   URGENT CARE GUIDELINES.                 197


       THESE CHARGES ARE NOT COVERED. THE
       PATIENT'S PRIMARY PHYSICIAN HAS NOT
4587   APPROVED THIS OUT-OF-AREA CARE.         96
       THESE CHARGES ARE NOT COVERED
       BECAUSE THE PATIENT'S CONTRACT
       DOES NOT ALLOW A SECOND SURGICAL
       OPINION FROM THIS TYPE OF
4588   PROVIDER.                               61
       THIS SERVICE COULD NOT BE COVERED.
       THE MAXIMUM AMOUNT ALLOWED FOR THE
       FACILITY FEE FOR THIS SURGICAL
       PROCEDURE WAS PAID ON A PREVIOUS
4589   CLAIM.                                  119




       THE CHARGES SHOWN ON THIS CLAIM DO
       NOT MATCH THOSE ON THE EOMB. PLEASE
       RESUBMIT THE CLAIM WITH CORRECTED
4590   CHARGES OR RETURN THE CORRECT EOMB.     148

       THE SERVICES SUBMITTED EXCEED THE
4591   NUMBER OF VISITS PREVIOUSLY APPROVED.   119




       THIS TYPE OF DENTAL SERVICE IS
       EXCLUDED UNDER THE PATIENT'S
4592   BENEFIT PLAN OR POLICY.                 96
       WE HAVE RECEIVED AN EOMB FROM
       MEDICARE. HOWEVER, WE ALSO REQUIRE
       AND EOB FROM THE PATIENT'S OTHER
4593   INSUANCE CARRIER.                       23




                                   Page 168
                                 CARCs_Query2




       A COPY OF THE ANESTHESIA REPORT IS
       NEEDED BEFORE THE CLAIM CLAIM CAN BE
4594   CONSIDERED.                                16


       A COPY OF THE PSYCHIATRIC EVALUATION,
       ALONG WITH THE LENGTH OF SESSION, IS
       NEEDED BEFORE CLAIM CAN BE
4595   CONSIDERED.                                16


       THIS BENEFIT PLAN DOES NOT COVER
       CONTRACEPTIVE SERVICES FOR
4596   DEPENDENT CHILDREN.                        204




       PLEASE PROVIDE A VALID NAME AND DATE
4597   OF BIRTH FOR THIS NEWBORN.                 16


       A COPY OF THE MANUFACTURER'S
       DESCRIPTION OF THIS SUPPLY/EQUIQMENT
       IS NEEDED BEFORE THE CLAIM CAN BE
4598   CONSIDERED.                                16




       A COPY OF THE SLEEP STUDY REPORT IS
       NEEDED BEFORE THE CLAIM CAN BE
4599   CONSIDERED.                                16




       COVERAGE OF THIS ITEM IS ONLY
       CONSIDERED WHEN THE ITEM IS
4600   PURCHASED.                                 96




       THIS SERVICE IS PRIMARILY EDUCATIONAL
       AND THEREFORE EXCLUDED UNDER THE
4601   PATIENT'S BENEFIT PLAN OR POLICY.          96




                                       Page 169
                                  CARCs_Query2



       COVERAGE UNDER THE PATIENT'S BENEFIT
       PLAN OR POLICY IS LIMIT TO ONE MEDICAL
4602   VISIT PER DAY FOR THE SAME CONDITION.     119

       THESE CHARGES ARE NOT COVERED
       BECAUSE THE DATES ON THE TREAT
       MENT PLAN DO NOT MATCH THE DATE(S) OF
       SERVICE ON THIS CLAIM. THESE CHARGES
4603   ARE THE MEMBER'S RESPONSIBILITY.          96




       WE NEED THE FIRST CONSULTATION DATE
4604   ABOUT THIS CONDITION.                     16
       DIAGNOSIS OR SURGICAL PROCEDURE
       CODE IS NOT IN EFFECT OR IS
       INCOMPLETE FOR THE DATE OF SERVICE.
       PLEASE RESUBMIT WITH A
       VALID HIPPA COMPLIANT CODE FOR THE
4605   DATE OF SERVICE.                          146
       PER GROUP BENEFITS, AS SECONDARY
       INSURER, OUR LIABILITY UNDER THIS
4606   CONTRACT IS ZERO.                         23
       WE ARE THE MEMBER'S TERTIARY
       INSURANCE CARRIER. PLEASE SUBMI
       T CLAIM TO MEMBER'S PRIMARY AND
       SECONDARY COVERAGE
       CARRIERS. ONCE CLAIMS ARE PROCESSED
       BY THE OTHER CARRIERS
       PLEASE SUBMIT CLAIM WITH BOTH PRIMARY
       AND SECONDARY EOB'S
4607   TO YOUR LOCAL PLAN.                       23

       THIS DENTAL PLAN COVERS THIS
4608   PROCEDURE ONLY TWICE PER CALENDAR.        119
       PAYABLE 1 TIME EVERY 36 MONTHS-6
       MONTHS AFTER INITIAL INSTALLATION OF
4610   DENTURE.                                  119
       MONITORED ANESTHESIA CARE IS ONLY
       COVERED IF ANESTHESIA IS PERSONALLY
       BEING MONITORED BY THE
       ANESTHESIOLOGIST. NO PAYMENT IS MADE
       FOR SUPERVISION OF CRNA'S PERFORMING
4611   MONITORED ANESTHESIA.                     194




                                    Page 170
                                 CARCs_Query2




       QUALIFYING CIRCUMSTANCES ARE
       COVERED IF ANESTHESIA IS PERSON
       ALLY PERFORMED BY THE
       ANESTHESIOLOGIST. NO PAYMENT IS MADE
       FOR QUALIFYING CIRCUMSTANCES TO
       CRNA'S OR TO SUPERVISING
4612   ANESTHESIOLOGIST.                        194
       CLAIM EITHER LACKS INFORMATION OR WAS
       REJECTED BY MEDICARE. PLEASE REFER TO
       THE MEDICARE CLAIM ADJUSTMENT
4613   REASON CODE.                             23




       PLACE OF SERVICE LOCATION ZIP CODE
4614   NOT PROVIDED.                            16




       THIS BENEFIT PLAN ONLY COVERS
4615   PRESCRIPTION DRUG SERVICES.              16

       ROUTINE COLONOSCOPIES ARE COVERED
       FOR STATE HEALTH PLAN MEMBERS 50 AND
       OLDER. OUR RECORDS INDICATE THAT THE
4616   PATIENT DID NOT MEET THE AGE CRITERIA.   177
       MAXIMUM BENEFITS HAVE BEEN PAID TO
4617   THE EMPLOYEE FOR THIS SERVICE.           119
       MAXIMUM BENEFITS HAVE BEEN PAID TO
4618   THE PHYSICIAN FOR THIS SERVICE.          119
       DRUG CLAIMS FOR STATE MEMBERS WITH
       SAVINGS PLAN OPTION SHOULD BE FIELD
4619   DIRECTLY TO MEDCO.                       109
       DUPLICATE CLAIM PROCESSED PRIOR TO
       "ITS" SYSTEM. VERIFY YOUR PREVIOUS
       INTER PLAN BANK RECORDS FOR
4620   RECONCILIATION OF THIS CLAIM.            18



       ROUTINE MAMMOGRAM COVERAGE ONLY
4621   ALLOWS BENEFITS FOR FEMALE PATIENTS.     96
       SINCE MEDICARE IS THE PRIMARY
       INSURANCE, THIS BENEFIT PLAN DOES NOT
4622   COVER THESE SERVICES.                    204

       ASSISTANT SURGEON SERVICES IS NOT
4623   ALLOWED FOR THIS SURGICAL PROCEDURE.     170



                                    Page 171
                                 CARCs_Query2



       SURGICAL PROCEDURE DOES NOT QUALIFY
4624   FOR CO-SURGEON SERVICES.                 38



       THIS PROLONGED SERVICE WAS NOT BILLED
4625   WITH THE NECESSARY COMPANION CODES.      125

       SURGERY WAS PERFORMED DURING THE 10
       DAY GLOBAL PERIOD OF A PREVIOUS
       SURGERY.PAYMENT IS INCLUDED IN THE
4626   GLOBAL PRICE OF THE PREVIOUS SURGERY.    97

       SURGERY WAS PERFORMED DURING THE 90
       DAY GLOBAL PERIOD OF A PREVIOUS
       SURGERY. PAYMENT IS INCLUDED IN THE
4627   GLOBAL PRICE OF THE PREVIOUS SURGERY.    97

       PAYMENT FOR PHYSICAL THERAPY SERVICE
       BY AN INDEPENDENTLY PRACTICING
       PHYSICAL OR OCCUPATIONAL THERAPIST
       CANNOT BE MADE WHILE THE PATIENT IS IN
4628   A FACILITY SETTING.                      171


       PAYMENT IS INCLUDED IN ANOTHER
4629   SERVICE YOU HAVE RECEIVED.               97
       TEAM SURGEON NOT ALLOWED FOR THIS
4631   PROCEDURE.                               54

       PAYMENT FOR THIS SERVICE CAN NOT BE
       MADE WHEN THE PATIENT IS IN AN
4632   INPATIENT SETTING.                       A1



       THIS SERVICE DOES NOT QUALIFY AS A
4633   PROLONGED SERVICE.                       96

       PAYMENT FOR THIS E&M SERVICE IS
       INCLUDED IN THE MINOR SURGERY PAID
4634   FOR THE SAME DATE OF SERVICE.            97
       THIS PREOPERATIVE PROCEDURE HAS
4635   ALREADY BEEN PAID.                       18
       THIS COVERAGE DOES NOT INCLUDE A
       DRUG CARD PROGRAM. WE ARE
       FORWARDING THESE CHARGES TO BE
       PROCESSED UNDER THE BENEFIT PLAN.
       PLEASE ALLOW AMPLE TIME FOR
4636   PROCESSING.                              204



                                    Page 172
                                  CARCs_Query2




       PLEASE TO REFILE THIS CLAIM WITH THE
       GENDER OF THE PATIENT'S SPOUSE
4637   INCLUDED.                                  16




       DEPENDENTS S/R REQUIRED FOR
4638   CONTRACT WITH DENTAL COVERAGE.             16
       BENEFITS ARE PROVIDED FOR OVER-AGE
       DEPENDENTS WHEN THEY ARE
       FINANCIALLY DEPENDENT UPON
       SUBSCRIBER AND EITHER LIVING AT HOME
       OR ATTENDING SCHOOL ON A PART-TIME OR
       FULL-TIME BASIS. OUR RECORDS INDICATE
       THIS DEPENDENT DOES NOT MEET THE
       ELIGIBILITY REQUIREMENTS THEREFORE,
       BENEFITS ARE NOT PAYABLE
4639   FOR THIS CLAIM.                            32
       BENEFITS ARE AVAILABLE FOR THE
       TREATMENT OF THIS CONDITION ONLY
       WHEN PRE-AUTHORIZATED BY BLUE CROSS
4640   BLUE SHIELD.                               15




4641   THIS PATIENT IS RIDERED OUT.               96


       PRESCRIPTION DRUG BENEFIT IS THRU
       MERCK-MEDCO MANAGED C
       PLEASE MAIL TO: PAID PRESCRIPTIONS, INC.
               P.O. BOX 770
4642           PARSIPPANY, N.J. 07054-0770        109




       THIS SERVICE CANNOT BE PAID WHEN
4643   PROVIDED IN THIS LOCATION OR FACILITY.     96

        PAYMENT FOR THE BASE ENDOSCOPY
       PROCEDURE IS INCLUDED IN THE
4644    ENDOSCOPY PRICE.                          97
       INPATIENT IMMUNIZATION SERVICES
       COVERED ONLY WHEN SUBMITTED ON BILL
       TYPE 12X AND THE APPROPRIATE REVENUE
4645   AND HCPCS CODES.                           5



                                      Page 173
                                 CARCs_Query2




4646   THE AMBULANCE SERVICE IS NOT COVERED.     96


       AMBULATORY SURGERY CLAIMS MUST BE
       SUBMITTED ON A CMS 1500 FOOR DATES OF
4647   SERVICE ON OR AFTER JANUARY 1, 2008.      125
       DUPLICATE CLAIM WHERE EVERYTHING
       MATCHES EXCEPT EITHER THE PLACE OF
4648   SERVICE OR THE TYPE OF SERVICE.           18
       SERVICE PROVIDED PRIOR TO FDA
4649   APPROVAL.                                 197




       NON COVERED BASED ON STATUTORY
4650   EXCLUSION.                                96
       OBSERVATION DOES NOT MEET MINIMUM
       HOURS, QUALIFYING DIAGNOSE AND/OR T
4651   PROCEDURE CONDITIONS                      107




       INPATIENT SEPARATE PROCEDURES NOT
4652   PAID                                      96

       THE INFORMATION PROVIDED DOES NOT
       SUPPORT THE NEED FOR THIS SERVICE OR
4653   ITEM.                                     150
       PROCEDURE CODE IS INCONSISTENT WITH
       THE MODIFIER USED OR REQUIRED
4654   MODIFIER IS MISSING.                      182



       THIS SERVICE IS RELATED TO A PRIOR
       SERVICE WHICH HAS BEEN DENIED, AND
4655   THEREFORE IS NOT PAYABLE.                 96




       THIS ITEM OR SERVICE CANNOT BE PAID AS
4656   BILLED.                                   96




4657   ROUTINE CARE IS NOT COVERED.              96


                                      Page 174
                                   CARCs_Query2



       THE CLAIM HAS BEEN PAID UP TO THE
       CONTROL/HOME LICENSEE'S
       ALLOWANCE BECAUSE IT IS LESS THAN THE
4658   PAR/HOST LICENSEE ALLOWANCE.                45
       LEVEL OF CARE BILLED NOT
       SUBSTANTIATED. ALLOWABLE REFLECTS
       LOWER INTENSITY OF SERVICE CONSISTENT
4659   WITH DIAGNOSIS.                             186


4660   PAYABLE ONLY 1 TIME EVERY 12 MONTHS.        119

       THIS BENEFIT IS LIMITED TO ONCE PER
4661   YEAR.                                       119
       THIS BENEFIT IS LIMITED TO 1 TIME EVERY 2
4662   YEARS.                                      119
       THIS BENEFIT IS LIMITED TO 1 TIME EVERY
4663   36 MONTHS.                                  119
       THIS BENEFIT IS LIMTIED TO 1 TIME EVERY 4
4664   YEARS.                                      119
       THIS BENEFIT IS LIMITED TO 1 TIME EVERY
4665   60 MONTHS.                                  119
       THIS BENEFIT IS LIMITED TO 1 TIME EVERY 3
4666   CALENDAR YEARS.                             119
       THIS BENEFIT IS LIMITED TO 1 TIME EVERY 4
4667   CALENDAR YEARS.                             119
       THIS BENEFIT IS LIMITED TO 1 TIME PER
4668   LIFETIME.                                   119
       THIS PROCEDURE IS ONLY ALLOWED ONE
4669   TIME IN A 24 MONTH PERIOD.                  119


       ONLY ONE MEDICARE PART A DEDUCTIBLE
       PER CALENDER YEAR IS PAYABLE UNDER
4670   THIS CONTRACT.                              96


       FLUORIDE TREATMENT FOR COVERED
       PERSONS AGE 18 AND OLDER WILL BE
4671   DENIED.                                     96
       THIS DENTAL PLAN COVERS SEALANTS
4672   TWICE PER TOOTH.                            96
       NO BENEFITS ARE PROVIDED IF THE
       PATIENT IS ELIGIBLE FOR WORKMAN'S
4673   COMPENSATION.                               19
       MAXIMUM BENEFITS FOR THIS PROCEDURE
       HAVE BEEN PROVIDED BY BLUE SHIELD
4674   COVERAGE.                                   119
       THE PRIMARY INSURANCE PAID THE
4675   MAXIMUM BENEFITS FOR THIS SERVICE.          23




                                      Page 175
                                 CARCs_Query2



       THESE PROCEDURES SHOULD BE FILED TO
4677   THE PRIMARY CARRIER.                     109
       THIS DENTAL CONTRACT WAS CANCELLED
       AT THE TIME THIS SERVICE
4678   WAS PERFORMED.                           27


       OUR RECORDS INDICATE THERE IS NO
       DENTAL COVERAGE UNDER THIS
4679   IDENTIFICATION NUMBER.                   96
       THIS DEPENDENT IS NOT ELIGIBLE UNDER
4680   THIS DENTAL CONTRACT.                    32
       THIS PATIENT EXCEEDS THE MAXIMUM
       DEPENDENT AGE UNDER THIS CONTRACT.
       IF THIS IS A COLLEGE DEPENDENT PLEASE
       SEND VERIFICATION OF CURRENT SCHOOL
4681   ENROLLMENT.                              32
       UNDER THIS DENTAL CONTRACT,
       DEPENDENT CHILDREN ARE COVERED UP
4682   TO AGE 23.                               32

       UNDER THIS DENTAL CONTRACT,
       DEPENDENT CHILDREN ARE COVERED UP
4683   TO AGE 22.                               32

       UNDER THIS DENTAL CONTRACT,
       DEPENDENT CHILDREN ARE COVERED UP
4684   TO AGE 25.                               32

       DEDUCTIBLE AND/OR CO-INSURANCE
       AMOUNTS REMAINING FROM THIS CLAIM
       ARE NOT COVERED UNDER THIS DENTAL
4685   CONTRACT.                                96




       CASE CLOSE--NO RESPONSE TO PLAN
4686   INQUIRES.                                16

       TEMPOROMANDIBULAR JOINT SYNDROME IS
       NOT COVERED UNDER THIS DENTAL
4687   CONTRACT.                                204
       THIS SERVICE IS COVERED BY THE BLUE
       SHIELD AND/OR MAJOR MEDICAL
       CONTRACT. WE ARE FORWARDING TO THE
       APPROPRIATE DEPARTMENT FOR
4688   PROCESSING.                              109




                                    Page 176
                                CARCs_Query2




       THIS PATIENT DOES NOT HAVE BLUE CROSS
4689   COVERAGE.                               96



       THIS PATIENT IS NOT INCLUDED IN THIS
4690   PLAN.                                   96
       THIS PATIENT WAS OVER THE MAXIMUM AGE
4691   FOR A DEPENDENT CHILDREN.               32




       SERVICES REPORTED ARE AFTER THE DATE
4692   OF DEATH OF THE PATIENT.                96
       APPLIANCES PLACED FOR THE TREATMENT
       OF THE CONDITION REPORTED ARE NOT
4693   COVERED.                                204

       WHEN PERFORMED MORE OFTEN THAN
       EVERY THREE MONTHS, DOCUMENTATION
       OF MEDICAL NECESSITY IS REQUIRED.
4694   PLEASE FORWARD FOR ECONSIDERATION.      119
       THIS DENTAL CONTRACT LIMITS THE
       NUMBER OF TIMES THIS PROCEDURE MAY
4695   BE PERFORMED TO TWICE A YEAR.           119



       WE ARE UNABLE TO PROCESS THIS CLAIM
       BECAUSE REQUIRED INFORMA
       TION CONCERNING OTHER INSURANCE WAS
4696   NOT RECEIVED.                           16




       CASE CLOSED--NO RESPONSE TO REQUEST
       TO FOR XRAYS. PLEASE RE-
4697   SUBMIT WITH APPROPRIATE XRAYS.          16


       BENEFITS ARE DENIED BASED ON REVIEW
       RESULTS OBTAINED FORM OUR DENTAL
4698   CONSULTANT.                             96




                                   Page 177
                                  CARCs_Query2




       THIS DENTAL PLAN DOES NOT COVER THIS
4699   SERVICE FOR PATIENTS OVER AGE 14.         96




       THIS PROCEDURE IS NOT COVERED DUE TO
       SPECIAL LIMITATIONS UNDER THIS DENTAL
4700   CONTRACT.                                 96

       BENEFITS ARE NOT PROVIDED FOR
       SEALANTS WHICH ARE REAPPLIED TO A
       MOLAR WITHIN 3 MONTHS FROM THE DATE
4701   OF PREVIOUS SEALANT APPLICATION.          96
       THIS DENTAL CONTRACT DOES NOT COVER
       SPACE MAINTAINERS UPON
4703   BECOMING AGE 16.                          204



       SEALANTS ARE COVERED FOR CHILDREN
4704   AGES 6 THROUGH 19.                        96




       THE DENTAL PLAN ONLY COVERS SEALANTS
4705   FOR PATIENTS UNDER AGE 25.                96
       THIS DENTAL CONTRACT ONLY ALLOWS
       THIS PROCEDURE CODE ONCE PER
4706   OCCURRENCE/VISIT.                         119

       BENEFITS FOR INPATIENT SUBSTANCE
       ABUSE TREATMENT RENDERED IN
       A NON-PREFERRED FACILITY ARE LIMITED
       TO ONE TREATMENT PROGRAM LIFETIME
       (MAXIMUM OF 28 DAYS). BECAUSE THE
       MAXIMUM BENEFITS ALREADY BEEN
       PROVIDED, NO ADDITIONAL BENEFITS ARE
       AVAILABLE. THE PATIENT IS RESPONSIBLE
4707   FOR THESE CHARGES.                        119




       SPACE MAINTAINERS ARE ONLY PAYABLE
4708   WHEN REPLACING PRIMARY TEETH.             96




                                    Page 178
                                 CARCs_Query2




       PLEASE FORWARD ALL CLAIMS TO:
          ELLA MARX
          BENEFIT SOURCE
          4740 GRAND
4709      KANSAS CITY, MO 64141                 109


       THIS PROCEDURE IS ONLY COVERED ONCE
       EVERY FIVE YEARS AND ONLY FOR
4710   PATIENTS AGE 15 AND OVER.                96


       PROCEDURE IS ONLY COVERED FOR
       MEMBERS TO AGE 16, ONCE EVERY THREE
4711   YEARS.                                   96



       ANESTHESIA RELATED TO NON-COVERED
4712   DENTAL SERVICES IS NOT COVERED.          96
       THIS PROCEDURE IS ONLY PAYABLE ONCE
4713   PER TOOTH PER LIFETIME.                  119
       THIS CONTRACT HAS A 6 MONTH WAITING
4714   PERIOD FOR MAJOR SERVICE.                179
       THIS VISIT FOR WELL BABY CARE EXCEEDS
       THE NUMBER OF VISITS ALLOWED BY THIS
4715   CONTRACT.                                119
       BENEFITS ARE PAYABLE FOR UP TO 240
       HOURS OF PRIVATE DUTY NURSING
       SERVICES BY A REGISTERED NURSE OR
       LICENSED PRACTICAL NURSE EACH
       CALENDAR YEAR. MAXIMUM BENEFITS HAVE
       ALREADY BEEN PAID FOR THIS CALENDAR
4716   YEAR.                                    119

       RECEMENTATION OF SPACE MAINTAINERS IS
       PAYABLE ONCE IN A SIX MONTH PERIOD BUT
       NOT WITHIN SIX MONTHS OF INSERTION BY
4717   THE SAME DENTIST.                        96
       THIS PROCEDURE IS ONLY COVERED TWICE
       PER BENEFIT PERIOD AT LEAST 6 MONTHS
4718   AFTER THE INITAL PLACEMENT.              119
       THIS CLAIM HAS ALREADY BEEN
       PROCESSED BY THE BLUE CROSS BLUE
4719   SHIELD PLAN OF MARYLAND.                 23
       THIS PROVIDER NOT ALLOWED TO SUBMIT
4720   AN INTERIM BILL.                         170
       INCURRED PRIOR TO EFFECTIVE DATE, FILE
4721   TO PREVIOUS CARRIER.                     26




                                   Page 179
                                 CARCs_Query2




       TRANSACTION MORE THAN ONE YEAR FROM
4722   GROUP'S TERMINATION DATE.                96



       NO COVERAGE FOR THIS INTEGRAL
4723   COMPONENT FILED SEPARATELY.              96

       THE BENEFIT FOR THIS PROCEDURE IS
       INCLUDED IN THE RECOMMENDED
4724   ALTERNATE BENEFIT.                       97

       RECEMENTATION OF SPACE MAINTAINERS IS
       ONLY COVERED ONE TIME PER PLAN YEAR
       AND MUST BE AT LEAST SIX MONTHS FROM
       DATE OF SERVICE OF ORIGNINAL
4725   PLACEMENT.                               96



       NO BENEFITS FOR MATERNITY UNLESS
       ENROLLED IN THE GREAT
       EXPECTATIONS PROGRAM WITHIN THE
4726   FIRST TRIMESTER OF PREGNANCY.            96
       BITEWINGS ARE ONLY PAYABLE ONCE PER
4727   BENEFIT PERIOD.                          119
       THIS PROCEDURE IS ONLY COVERED ONE
4728   TIME PER CALENDAR YEAR.                  119
       MAXIMUM FREQUENCY FOR THIS
       PROCEDURE HAS BEEN MET FOR THIS
4729   BENEFIT PERIOD.                          119


       FREQUENCY MAXIMUM FOR THIS
       PROCEDURE HAS BEEN MET FOR THIS
4730   BENEFIT PERIOD.                          119

       THIS CONTRACT PROVIDES BENEFITS FOR
       ONLY ONE PATHOLOGY BIOPSY PER DAY.
4731   MAXIMUM BENEFITS HAVE BEEN ALLOWED.      119
       THIS CONTRACT ALLOWS BENEFITS FOR
       ONLY ONE VISIT PER DAY BY THE
       ATTENDING PHYSICIAN. MAXIMUM BENEFITS
4732   HAVE BEEN PROVIDED.                      119




                                   Page 180
                                  CARCs_Query2




       PERIODONTAL CHARTING IS REQUESTED IN
       ORDER TO COMPLETE PROCESSING OF THIS
4733   CLAIM.                                    16
       PREAUTHORIZATION IS REQUIRED FOR
       PRIVATE DUTY NURSING SERVICE. BENEFITS
       ARE NOT PAYABLE FOR THESE SERVICES
       WHEN PREAUTHORIZATION IS NOT
4734   OBTAINED.                                 197
       MAXIMUM BENEFITS FOR CHEMICAL
4735   DEPENDENCY HAVE BEEN PAID.                119

       A CLINICAL PATHOLOGIST DID NOT
       PERSONALLY PERFORM THESE
       LABORATORY SERVICES. THEREFORE,
       BASED ON OUR CORPORATE
4736   GUIDELINES, WE CANNOT ALLOW BENEFITS.     38



       AN ALLOWANCE FOR CONTACTS IS NOT
4737   AVAILABLE IF FRAMES ARE PURCHASED.        96
       PLEASE MAIL CLAIMS TO THE FOLLOWING
       ADDRESS:
       COMPSYCH
       NBC TOWER
       24TH FLOOR
4738   CHICAGO, IL 60611 5506                    109




       IN ORDER TO PROCESS THIS CLAIM IT WAS
       NECESSARY TO REQUEST ADDITIONAL
       INFORMATION. THE CLAIM WILL BE
       PROCESSED UPON RECEIPT OF THIS
4739   INFORMATION.                              226


       THIS PLAN DOES NOT ALLOW BENEFITS FOR
       SERVICES OR SUPPLIES THAT ARE
4740   COSMETIC IN NATURE.                       96


4741   THIS MUST BE FILED TO CAREMARK.           109
       THIS BENEFIT PLAN DOES NOT COVER
       SKILLED NURSING OR SKILLED FACILITY
4742   CARE SERVICES.                            204




                                    Page 181
                                  CARCs_Query2


       THIS PROCEDURE IS ONLY COVERED ONCE
4743   EVERY THREE YEARS.                        119

       CHARGES FOR THESE SERVICES ARE NON
       COVERED UNDER THIS DENTAL. PLEASE
       SUBMIT THESE CHARGES TO THE MEDICAL
4744   BENEFIT PLAN FOR CONSIDERATION.           109
       THIS PROCEDURE IS COVERED ONCE PER
       TOOTH PER LIFETIME FOR PRIMARY TEETH
4745   ONLY/                                     119
       THERE IS A 6 MONTH WAITING PERIOD FROM
       THE EFFECTIVE DATE OF THIS COVERAGE
4746   FOR THIS SERVICE.                         179
       THIS PROCEDURE IS ONLY PAYABLE TWO
       TIMES PER BENEFIT PERIOD AT LEAST 6
4747   MONTHS AFTER THE DATE OF INSERTION.       119

       UPS ONLY PAYS FOR HEARING AIDS FOR
       EACH EAR EVERY 3 YEARS FOR CHILDREN
       UP TO AGE 19. THIS CLAIM DOES NOT MEET
4748   THAT CRITERIA.                            96




       THIS SERVICE IS NOT AVAILABLE FOR THIS
4749   PATIENT.                                  96
       THE MAXIMUM ALLOWANCE FOR THIS
       SKILLED NURSING CLAIM HAS ALREADY
       BEEN MET FOR THIS DATE OF SERVICE.
       STATE HEALTH PLAN MEMBERS ARE NOT
4750   RESPONSIBLE FOR THIS CHARGE.              119




4751   NON-COVERED BY DME/NCD GUIDELINES.        96




       PLEASE SEND US THIS PATIENT'S
       PERIODONTAL CHARTING SO WE CAN
4752   PROCESS THIS CLAIM.                       16
       INJURIES RECEIVED AS A RESULT OF DRUG
       OR ALCOHOL RELATED MOTOR VEHICLE
       ACCIDENTS ARE NOT PAYABLE UNDER THIS
       CONTRACT IF CONVICTED. IF NOT
       CONVICTED PLEASE PROVIDE
       DOCUMENTATION OVERTURNING
       CONVICTION TO ENABLE US TO
4753   RECONSIDER THIS CLAIM.                    96




                                     Page 182
                                 CARCs_Query2




       NO BENEFITS ARE PROVIDED FOR OUT OF
4754   HOSPITAL PRESCRIPTION DRUGS.             96



       THIS BENEFIT PLAN DOES NOT COVER THIS
4755   SERVICE FOR MEMBERS UNDER AGE 19.        96
       NOT A COVERED SERVICE FOR MEMBERS
4756   UNDER 18.                                32


       THIS IS A COPAY BENEFIT AT THE
       PHARMACY. NOT REIMBURSABLE UNDER
4757   MEDICAL.                                 96



       THIS DENTAL PLAN DOES NOT COVER THIS
4758   PROCEDURE FOR THIS TOOTH.                96
       THIS DENTAL CONTRACT LIMITS THE
       NUMBER OF TIMES THIS PROCEDURE MAY
       BE PERFORMED TO ONE TIME EVERY TWO
4759   YEARS.                                   119
       THIS PROCEDURE IS ONLY COVERED ONE
4760   TIME EVERY TWO CALENDAR YEARS.           119
       THIS PROCEDURE IS ONLY COVERED TWO
4761   TIMES IN TWELVE CONSECUTIVE MONTHS.      119
       THIS DENTAL PLAN ONLY COVERS THIS
4762   PROCEDURE ONCE EVERY 5 YEARS.            119
       DENTURE ADJUSTMENTS ARE PAYABLE
4763   ONCE EVERY 6 MONTHS/                     119

       DIAGNOSTIC CASTS ARE ONLY PAYABLE
       ONCE EVERY 6 MONTHS AND NOT IN
       CONJUNCTION WITH ANY
4764   PROSTHODONTICS.                          119
       DIETARY FORMULA IS NOT PAYABLE UNDER
4765   THIS PLAN.                               119
       REPAIRS TO PROSTHODONTICS ONLY
4766   ALLOWED ONCE IN 12 MONTHS.               119
       RECEMENTING OF PROSTHODONTICS IS
4767   ONLY ALLOWED ONCE IN 12 MONTHS.          119
       TISSUE CONDITIONING IS ONLY PAYABLE
4768   ONCE EVERY 12 MONTHS.                    119


       BENEFITS ARE NOT PROVIDED FOR
       EDUCATIONAL AND OTHER COUNSELING OR
4769   TRAINING SERVICES.                       96



                                   Page 183
                                 CARCs_Query2



       EMERGENCY ROOM SUTURE REMOVAL IS
       INCLUDED IN THE ORIGINAL EMERGENCY
4770   ROOM SERVICE.                            97
       SERVICES FOR MISSING TEETH ARE NOT
4771   PAYABLE FOR NEW EMPLOYEES.               204


       OUR RECORDS INDICATE THAT COVERAGE
       FOR THESE SERVICES BY THE PRIMARY
       CARRIER HAS BEEN EITHER EXHAUSTED OR
4772   DENIED.                                  16
       THIS BENEFIT PLAN LIMITS THIS
4773   PROCEDURE TO ONCE PER QUADRANT.          119
       BENEFITS FOR MARITAL AND FAMILY
       COUNSELING SERVICES ARE ONLY
       PROVIDED WHEN PERFORMED BY A
       PREFERRED BLUE PROVIDER. BECAUSE
       THESE SERVICES WERE PERFORMED B A
       NON-PREFERRED PROVIDER, THE PATIENT
4774   IS RESPONSIBLE FOR THESE CHARGES.        38
       D4910 IS PAYABLE ONLY 2 TIMES PER
4775   BENEFIT PERIOD.                          119
       D4910 ALLOWED 1 TIME PER THREE
4776   CONSECUTIVE MONTHS.                      119
       SINCE THE PRIMARY PLAN'S PAYMENT
       EXCEEDS THIS PLAN'S ALLOWANCE, WE
4778   CANNOT MAKE AN ADDITONAL PAYMENT.        23
       PROCEDURE CODE D6080 IS ONLY PAYABLE
       EVERY 90 DAYS, LIMITED TO 3 TIMES PER
4779   YEAR.                                    119
       PROCEDJRE D4910 IS LIMITED TO TWO PER
4780   BENEFIT YEAR.                            119



       DIAGNOSTIC CASTS ARE PAYABLE FOR
4781   ORTHODONTIC SERVICES ONLY.               96
       THIS STATE WELL CHILD PROCEDURE IS
4782   ALLOWED 3 TIMES IN A CALENDAR YEAR.      119
       THIS STATE WELL CHILD PROCEDURE IS
4783   ALLOWED 4 TIMES IN A CALENDAR YEAR.      119
       THIS STATE WELL CHILD PROCEDURE IS
4784   ALLOWED 5 TIMES IN A CALANDER YEAR.      119
       THIS STATE WELL CHILD PROCEDURE IS
4785   ALLOWED 6 TIMES IN A CALENDAR YEAR.      119
       THIS STATE WELL CHILD PROCEDURE IS
4786   ALLOWED 7 TIMES IN A CALENDAR YEAR.      119
       THIS STATE WELL CHILD PROCEDURE IS
4787   ALLOWED 8 TIMES IN A CALENDAR YEAR.      119




                                    Page 184
                                  CARCs_Query2


       THIS STATE WELL CHILD PROCEDURE IS
4788   ALLOWED 9 TIMES IN A CALENDAR YEAR.       119

       THIS PLAN DOES NOT COVER MATERNITY
       SERVICES WHEN CONCEPTION OCCURS
       WITHIN 30 DAYS OF OR PRIOR TO THE
4789   MATERNITY COVERAGE EFFECTIVE DATE.        96




       PRE-OP XRAYS REQUIRED FOR IMPACTED
4790   TEETH.                                    16
       ABORTION PROCEDURES AND
       COMPLICATIONS RESULTING FROM
       ABORTION PROCEDURES ARE NOT
       COVERED UNLESS THE LIFE OF THE
       MOTHER IS CONSIDERED TO BE
       ENDANGERED IF SHE WOULD CARRY THE
       FETUS TO TERM, OR UNLESS THE FETUS
       WAS DIAGNOSED WITH A FETAL
       CHROMOSOMAL DISORDER OR
       ABNORMALITY PRIOR TO THE ABORTION
4791   BEING COMPLETED.                          96

       HEARING AIDS ARE ONLY COVERED IF THE
       HEARING LOSS IS A RESULT OF SURGERY
       PERFORMED WHILE THE MEMBER WAS
4792   COVERED UNDER THIS PLAN.                  96
       THIS CONTRACT IS LIMITED TO ONLY ONE
       ROUTINE PROSTRATE EXAMINATION PER
       YEAR FOR IN NET-WORK PROVIDER. THIS
       SERVICE IS NOT COVERED FOR OUT OF
4793   NETWORK PROVIDERS.                        109

       REFILE WITH CORRECT CODE FOR
       ENDOLUMINAL RADIOFREQUENCY ABLATION
4794   OF REFLUXING SAPHENOUS VEIN.              A1


       THIS BENEFIT PLAN DOES NOT COVER
       SERVICES THAT PATIENT HAS NOT YET
4795   RECEIVED.                                 96

       PLEAE REFILE THIS CLAIM WITH THE ACTUAL
       DATE OF SERVICE. WE CANNOT PROCESS A
4796   CLAIM WITH A FUTURE DATE OF SERVICE.      A1
       WE HAVE PAID THE MAXIMUM AMOUNT
       ALLOWED FOR THIS SERVICE UNDER YOUR
       BENEFIT PLAN DUE TO DOLLAR OR VISIT
4797   LIMITATIONS.                              B5




                                    Page 185
                                  CARCs_Query2


       SPECIALTY DRUGS ARE ONLY COVERED
4798   WHEN PURCHASED AT A CAREMARK.             170
       THIS CONTRACT DOES NOT PROVIDE
       BENEFITS FOR THESE SERVICES IF
       PERFORMED BY A PROVIDER OUTSIDE OF
4799   NETWORK.                                  170
       ALTHOUGH THESE SERVICES WERE
       AVAILABLE AT AN HMA FACILITY, SERVICES
       WERE RENDERED AT A NON-HMA FACILITY.
4800   BENEFITS DENIED.                          170


       THIS BENEFIT PLAN DOES NOT COVER
       PARTIAL HOSPITALIZATIONS FOR THIS
4801   CONDITION.                                96
       DAILY CONTRACT LIMITATIONS HAVE BEEN
4802   MET FOR THE SERVICE.                      119
       THIS CONTRACT PROVIDES NO COVERAGE
       FOR SERVICE RENDERED BY
       COUNSELORS, SOCIAL WORKERS, AND
4803   PSYCHOLOGISTS.                            170

       APPROVAL WAS FOR INPATIENT. PLEASE
4804   REFILE AS INPATIENT.                      15

       THIS CONTRACT ALLOWS 31 INPATIENT
       DAYS PER CALENDAR YEAR AND 60 DAYS
       PER LIFETIME FOR MENTAL AND NERVOUS
       CARE. THIS CLAIM HAS BEEN DENIED
4805   BECAUSE BENEFITS HAVE BEEN EXCEEDED.      149

       SERVICES NOT RELATED TO AN
       EMERGENCY OR ACCIDENT ARE NOT
       COVERED WHEN RENDERED OUTSIDE OF
4806   THE UNITED STATES.                        40
       THIS BENEFIT PLAN COVERS SERVICES
4807   ONLY TO DIAGNOSE INFERTILITY.             204
       THIS HEALTH PLAN DOES NOT COVER
       INJECTIONS THAT CAN BE SELF-
       ADMINISTERED. PLEASE SUBMIT THIS CLAIM
       TO CAREMARK FOR PROCESSING UNDER
4808   THE PRESCRIPTION DRUG PLAN.               170

       PAYMENT HAS BEEN MADE ON PREVIOUS
4809   INTERIM BILLINGS.                         97

       THIS BENEFIT PLAN DOES NOT COVER
4810   PRESCRIPTION DRUGS.                       109
       THIS PROCEDURE IS ONLY COVERED ONCE
4811   VERY THREE YEARS.                         119
       THIS PROCEDURE IS ONLY COVERED EVERY
4812   SIX MONTHS.                               119



                                    Page 186
                                 CARCs_Query2


       SERVICE PAYABLE ONLY 1 TIME PER
4813   LIFETIME.                                35



       NON-COVERED BY LABORATORY/NCD
4814   GUIDELINES                               96


       THIS DENTAL PLAN DOES NOT COVER THIS
       SERVICE WHEN IT IS PERFOMRED WITH A
4815   PROCEDURE AT THE SAME VISIT.             96

       THIS CONTRACT ONLY COVERS THIS
       SERVICE ONCE PER CALENDAR YEAR FOR
       ADULTS AGE 19 AND OVER AND TWICE PER
       CALENDAR YEAR FOR CHILD 18 AND
4816   YOUNGER.                                 96
       MAXIMUM BENEFITS WERE PAID ON THIS OR
4817   A PREVIOUS CLAIM.                        119
       THIS PROCEDURE IS ONLY PAYABLE ONE
       TIME PER BENEFIT PERIOD AT LEAST SIX
4818   MONTHS AFTER THE DATE OF INSERTION.      119
       BENEFITS ARE NOT PAYABLE UNDER THIS
       CONTRACT FOR SERVICES THAT WERE
4819   DENIED MY MEDICARE.                      23

       NO COVERAGE FOR PROSTHODONTIC
       BENEFITS FOR SERVICES RELATED
       TO MISSING TEETH UNTIL THE MEMBER HAS
4820   BEEN COVERED FOR 12 MONTHS.              96




       SUPPLIES FOR AMBULANCE PROVIDERS NOT
4821   COVERED.                                 96
       BASED ON SUBMITTED RECORDS MEDICAL
       NECESSITY IS NOT EVIDENT SO THE
4822   PROCEDURE IS DENIED.                     50
       THIS DRUG IS NOT COVERED UNDER THIS
4823   MEDICARE ADVANTAGE PLAN.                 204
       THE PRIMARY PLAN DENIED THIS SERVICE
4824   AS A DUPLICATE CHARGE/ SERVICE.          18



       APPLIANCE MUST BE 12 MONTHS OLD FOR
4825   THIS SERVICE TO BE COVERED.              96




                                    Page 187
                                 CARCs_Query2




       INELIGIBLE FOR COBRA AFTER MEDICARE'S
4826   EFFECTIVE DATE.                          A1



       WE CANNOT PROCESS THIS CLAIM UNTIL WE
       GET CLARIFICATION FROM MEDICARE
4827   REGARDING PAYMENT ON THESE CHARGES.      16
       WE CANNOT PROVIDE BENEFITS ON THIS
       CLAIM. BENEFITS ARE NOT PAID FOR
       TREATMENT WHICH THE LOCAL BLUE
       CROSS BLUE SHIELD PLAN DETERMINES
       DOES NOT PROVIDE THE LEVEL OF CARE
       REQUIRED FOR THIS CONDITION OR IS NOT
       MEDICALLY NECESSARY. BECAUSE
       YOU ARE A PREFERRED PROVIDER, THE
       PATIENT IS NOT RESPONSIBLE FOR THESE
4828   CHARGES.                                 50

       THE EXPENSES INCURRED WERE APPLIED
       TOWARD THE MEDICARE OUTPATIENT
       DEDUCTIBLE, WHICH IS NOT A COVERED
4829   BENEFIT.                                 96




4830   PLEASE SUBMIT CLAIM TO DME CARRIER.      109
       THIS BENEFIT PLAN ALLOWS ONLY THREE
4831   ADULT CLEANINGS PER BENEFIT PERIOD.      119



       NURSERY CHARGES SHOULD BE FILED ON
       THE MOTHER'S BILL. PLEASE RESUBMIT AS
4832   ONE CLAIM.                               A1
       PLEASE REFILE THIS CLAIM WITH THE
       APPROPRIATE ANESTHESIA MODIFIER. WE
       CANNOT DETERMINE BENEFITS UNTIL WE
4833   RECEIVE THIS INFORMATION.                4


       ALL PAYMENT IS INCLUSIVE UNDER MOM'S
4834   CHARGES.                                 97




                                    Page 188
                                 CARCs_Query2




       AMBULANCE CHARGES ARE NOT COVERED
       WHEN THE PATIENT WAS NOT
4835   TRANSPORTED.                             96


       THIS DENTAL PLAN DOES NOT COVER THIS
       SERVICE WHEN IT IS PERFORMED ON THIS
4836   TOOTH.                                   96

       NO COVERAGE FOR PROSTHODONTIC
       BENEFITS FOR SERVICES RELATED TO
       MISSING TEETH UNTIL THE MEMBER HAS
4837   BEEN COVERED FOR 6 MONTHS.               96


       THIS CODE IS MUTUALLY EXCLUSIVE TO
4838   OTHER SERVICES FILED.                    97

       THE PATIENT CANNOT BE COVERED BY
       MEDICARE AND MEDICAID WHILE
       ENROLLED IN THE MEDICAID BENCHMARK
4840   PROGRAM.                                 96
       THIS PROCEDURE IS ONLY ALLOWED FOUR
4841   TIMES PER BENEFIT PERIOD.                119




       PLEASE REFILE THIS CLAIIM WITH THE
       CORRECT PROCEDURE CODE, NDC
       NUMBER, DESCRIPTION OF THE SERVICE OR
4842   OPERATIVE NOTES.                         16


       SERVICES RENDERED AS A RESULT OF A
       COMPLICATION TO A NON-COVERED
4843   SERVICE ARE NOT PAYABLE.                 96


       OUR ELIGIBITY RECORDS SHOW NO STATE
       DENTAL PLAN COVERAGE FOR THIS
4844   MEMBER FOR THIS DATE OF SERVICE.         96
       THE STATE HEALTH PLAN DOES NOT COVER
       NON-EMERGENCY
       TRANSPORTATION OR TRANSPORTATION TO
       A PLACE OF TREATMENT OTHER THAN A
4845   HOSPITAL.                                204
       CONTRACT CANCELLED. SERVICES ARE NOT
       A PART OF THE EXTENSION OF LIABILITY
4846   COVERAGE.                                27


                                   Page 189
                                 CARCs_Query2


       BCHP COVERS INJECTABLE INFLUENZA
       VACCINE BUT DOES NOT COVER THE NASAL
4847   METHOD OF ADMINISTRATION.                204


       OUR ELIGIBILITY RECORDS SHOW NO STATE
       HEALTH PLAN MEDICAL
       COVERAGE FOR THIS MEMBER FOR THIS
4848   DATE OF SERVICE.                         96



       PROCEDURE NOT ALLOWED FOR MEMBERS
4849   UNDERS 60 YEARS OF AGE.                  96
       CLAIMS FILING OR WRITTEN INQUIRES
       SHOULD BE FORWARDED TO:
       BLUE CROSS AND BLUE SHIELD OF NORTH
       CAROLINA
       POST OFFICE BOX 35
4850   DURHAM, NC 27702                         109
       PROCEDURE D4910 IS LIMITED TO THREE
4851   TIMES PER BENEFIT YEAR.                  119



       NO REIMBURSEMENT ALLOWED FOR NON-
4852   COVERED SERVICE BILL TYPES.              96
       THIS CLAIM WAS NOT FILED WITHIN THE
       TIME LIMIT SPECIFIED IN THIS PLANS
4853   COVERAGE.                                29


       THIS PROCEDURE IS NOT COVERED DURING
       THE FIRST 6 MONTHS AFTER THE INITIAL
4854   PLACEMENT.                               96

       PLEASE FORWARD DENTAL CLAIMS FOR
       PROCESSING TO THE FOLLOWING
       ADDRESS:
       TDA
       ATTN: DENTAL CLAIMS DEPARTMENT
       P.O.BOX 44035
4855   PHOENIX, AZ 85064                        109


       THIS BENEFIT PLAN DOES NOT COVER
       PHYSICIAN SERVICES PERFORMED AN
4856   OUTPATIENT SETTING OR IN THE HOME.       96




                                   Page 190
                                 CARCs_Query2



       THIS POLICY DOES NOT COVER PHYSICAL
       THERAPY SERVICES WHEN CARE IS
       RENDERED IN AN OFFICE, OUTPATIENT
4857   HOSPITAL OR HOME SETTING.                96
       ORGAN PROCUREMENT IS NOT A COVERED
4858   BENEFIT UNDER THIS PLAN.                 204



       SERVICE WERE NOT RENDERED AT A BLUE
4859   QUALITY CENTER OF EXCELLENCE.            96




       PROCEDURE NOT ALLOWED FOR MEMBERS
4860   26 YEARS OF AGE AND OLDER.               96

       THIS CLAIM HAS BEEN SENT TO OWEN
4861   STEEL'S NEW INSURANCE CARRIER.           109
       WE CANNOT PROVIDE BENEFITS ON THIS
       CLAIM BECAUSE THESE PARTIAL
       HOSPITALIZATION OR INTENSIVE
       OUTPATIENT TREATMENT SERVICES WERE
       RECEIVED WITHOUT PRIOR APPROVAL, AS IS
4862   REQUIRED.                                197

       THIS BENEFIT PLAN DOES NOT COVER THIS
       SERVICE SEPARATELY. AN A LLOWANCE
       FOR IT IS INCLUDED IN THE BENEFITS FOR
4863   THE COMPLETE PROCEDURE.                  97
       THIS CONTRACT COVERS UP TO 120 DAYS
       FOR EACH ADMISSION. THIS BENEFIT
       RENEWS WHEN THE PATIENT HAS BEEN OUT
       OF THE HOSPITAL FOR 180 DAYS. MAXIMUM
       BENEFITS HAVE ALREADY BEEN
4864   PROVIDED.                                119
       A SEPARATE BENEFIT IS NOT ALLOWED FOR
       PERIODONTAL EXAM WHEN
       RENDERED ON THE SAME DATE OF SERVICE
4865   AS ANY OTHER ORAL EXAM.                  97



       THIS SERVICE IS COVERED ONLY WHEN
4866   PERFORMED BY A MEDICAL DOCTOR. (M.D.)    170



       THESE SERVICES ARE NOT ALLOWED BY
4867   MEDICARE.                                96



                                   Page 191
                                 CARCs_Query2




       THIS BENEFIT PLAN COVERS THIS SERVICE
       ONLY WHEN IT MEETS CERTAIN CRITERIA,
4868   WHICH HAS NOT BEEN MET.                  96

       OUR PAYMENT OF THIS CLAIM HAS BEEN
       PRO-RATED BECAUSE THE OTHER HEALTH
       INSURANCE COVERGE HAS ALSO MADE
       PAYMENT ON THIS CLAIM. THIS AMOUNT
       REFLECTS THE OTHER CARRIER'S
4870    PAYMENT.                                119

       NO BENEFITS WERE PROVIDED ON THIS
       CLAIM BECAUSE OUR RECORDS DO NOT
       SHOW THAT THIS DEPENDENT HAS BEEN
4871   ADDED TO THIS POLICY.                    96
       SERVICES RELATED TO TEETH MISSING
       PRIOR TO THE EFFECTIVE DATE OF
       COVERAGE ARE NOT ELIGIBLE FOR
4872   PAYMENT FOR A PERIOD OF 24 MONTHS.       179

       WE ARE UNABLE TO ALLOW BENEFITS FOR
       THESE SERVICES BECAUSE THIS POLICY
       HAS A WAITING PERIOD FOR PRE-EXISTING
4873   CONDITIONS.                              179
       OUR RECORDS INDICATE THIS SERVICE HAS
4874   ALREADY BEEN PERFORMED.                  18
       THIS BENEFIT PLAN DOES NOT COVER
       SERVICES PERFORMED BY THIS TYPE OF
4875   PROVIDER.                                170
       TMJ BENEFITS ARE BEING PROCESSED
4876   UNDER A SEPARATE CLAIM NUMBER.           94
       THIS PROCEDURE IS ONLY COVERED ONCE
       PER PATIENT PER PROVIDER IN A 12 MONTH
4877   PERIOD.                                  119
       THIS SERVICE MUST BE AUTHORIZED IN
4878   ORDER TO BE PAID.                        197

       OUR MEDICAL STAFF REVIEWED THIS CLAIM
       FOR MEDICAL NECESSITY. BASED ON
       AVAILABLE DOCUMENTATION THE MEDICAL
       STAFF FOUND THAT THESE SERVICES DID
       NOT MEET MEDICAL NECESSITY
       GUIDELINES. BENEFITS ARE NOT PAYABLE
       FOR SERVICES THAT ARE NOT MEDICALLY
4879   NECESSARY.                               50

       BASED ON MEDICAL RECORDS, MEDICAL
4880   NECESSITY WAS NOT SUBSTANTIATED.         50




                                    Page 192
                                  CARCs_Query2


       OUR MEDICAL STAFF HAS REVIEWED THE
       INFORMATION ABOUT THE CLAIM ABOVE.
       THE STAFF CONSIDERED THE SERVICES
       INDIVIDUALLY, AND UPHELD THE ORIGINAL
       DECISION. THERE WILL BE NO ADDITIONAL
4881   REIMBURSEMENT.                            216

       PLEASE REFILE THESE CHARGES WITH THE
       SPECIFIC PROCEDURE CODE FOR THE
       SERVICE RENDERED. WE CANNOT
       DETERMINE BENEFITS WITHOUT THIS
4882   INFORMATION.                              16



       THIS SHOULD BE FILED AS REHABILITATION
4883   SERVICES.                                 125


       THIS CLAIM IS THE RESULT OF AN ACCIDENT
       AND SHOULD BE FILED TO THE
4884   APPROPRIATE LIABILITY CARRIER\PARTY.      20


       THE ALLOWANCE FOR THESE SUPPLIES IS
       INCLUDED IN THE ALLOWANCE FOR THE
4885   MAJOR PROCEDURE.                          97
       THESE SERVICES ARE NOT COVERED
       UNDER THIS DENTAL PLAN. PLEASE SUBMIT
       TO THE MEDICAL PLAN FOR
4886   CONSIDERATION.                            204
       SERVICE DENIED. PREVENTIVE FREQUENCY
4887   HAS BEEN EXCEEDED.                        119




       REVENUE CODE 0022 AND 0023 REQUIRE
       RUG CODE OR HCPCS CODE. REFILE CLAIMS
4888   ACCORDINGLY.                              16


       BASED ON THE ADA GUIDELINES, THIS
       PROCEDURE IS NOT COVERED WHEN THE
       SAME DENTIST WHO ORIGINALLY PLACED
       THE APPLIANCE PERFORMS IF. THEREFORE,
4889   WE CANNOT ALLOW ENEFITS.                  96




                                    Page 193
                                  CARCs_Query2




       PLEASE FILE CLAIMS TO:
       BLUE CROSS BLUE SHIELD OF TENNESSEE
       P.O.BOX 18150-CLAIMS UNIT G11
4890   CHATANOOGA, TENESSEE 37401-7150           109




4891   PLEASE REFILE WITH SPECIFIC CPT4 CODE.    16




       THIS BENEFIT PLAN ONLY ALLOWS TWO
4894   EXAMS PER BENEFIT PERIOD.                 50




       PROCEDURES NOT ALLOWED FOR
4898   MEMBERS UNDER 60 YEARS OF AGE.            96
       THE IMMUNIZATION IS NOT COVERED BY
4901   THIS CONTRACT.                            204


       THE BENEFIT PLAN DOES NOT COVER
       FRAMES FOR EYEGLASSES WHEN THE
4903   PATIENT PURCHASES CONTACT LENSES.         96

       ONLY ONE VISION EXAM PER BENEFIT
4905   PERIOD.                                   222

       HUMAN ORGAN TRANSPLANTS PERFORMED
       AT AN OUT OF NETWORK FACILITY FOR
4910   DONOR SERVICES ARE NOT COVERED.           170
       THIS CONTRACT COVER UP TO 30 DAYS FOR
       EACH ADMISSION. CHARGE FOR DAYS IN
       EXCESS OF THE 30-DAY MAXIMUM ARE NOT
4911   COVERED.                                  222



       VITAMINS ARE NOT COVERED FOR THIS
4912   CONDITION.                                96




                                    Page 194
                                  CARCs_Query2


       THIS SERVICE IS ONLY PAYABLE ONE TIME
       WITHIN 12 MONTHS OF THE ORIGINAL
       PROCEDURE AND ONE TIME EVERY 24
4913   MONTHS THERE AFTER.                       222
       THIS PROCEDURE IS ONLY PAYABLE ONCE
       EVERY SIX MONTHS FOR DEPENDENT
       CHILDREN THROUGH THE AGE OF 17 AND
       ONCE EVERY TWELVE MONTHS AGE 19 AND
4914   OLDER.                                    222
       PLEASE RESUBMIT CLAIM WITH
       APPROPRIATE MODIFIER FOR END STAGE
4915   RENAL DISEASE.                            4
       THIS BENEFIT PLAN DOES NOT COVER
4916   PRESCRIPTION DRUGS.                       204
       THIS CLAIM HAS BEEN FILED WITH A
       LOCATION THAT IS CURRENTLY NOT IN OUR
       SYSTEM, PLEASE UPDATE LOCATION
       INFORMATION OR REFILE CORRECTED
4917   CLAIM.                                    B7
       THIS CLAIM IS NOT ALLOWED BASED ON A
       CLINICAL REVIEW OF MEDICARE
       ADVANTAGE AND MEDICARE NATIONAL
       DECISIONS. YOU MAY SUBMIT ADDITIONAL
       CLINICAL INFORMATION IF YOU BELIEVE OUT
4918   DECISION IS WRONG.                        96



       PLEASE RESUBMIT CLAIM WITH
       HEMATOCRIT AND/OR HEMOGLOBIN
4919   LEVELS.                                   16
       HUMAN ORGAN TRANSPLANTS MUST BE
       PREAPPROVED AND PERFORMED BY
       A MCS APPROVED PROVIDER. IF THESE
       SERVICES ARE NOT PREAPPROVED AND/OR
       PERFORMED BY A PROVIDER DESIGNATED
       BY BLUE CROSS BLUE SHIELD, NO BENEFITS
4920   ARE PAYABLE.                              197

       THE ALLOWANCE FOR THIS PROFESSIONAL
       SERVICE IS INCLUDED IN THE ALLOWANCE
       FOR THE FACILITY SERVICES ON THE SAME
       DAY. BASED ON MEDICAL GUIDELINES, WE
4921   CANNOT ALLOW ADDITIONAL BENEFITS.         97

       PLEASE REFILE THIS CLAIM WITH THE
       INITIAL HOSPITAL CHARGES AND INCLUDE
       THESE INTERIM CHARGES. WE CANNOT
       DETERMINE BENEFITS WITHOUT THIS
4923   INFORMATION.                              16




                                    Page 195
                                 CARCs_Query2




       PLEASE REFILE A CORRECTED CLAIM WITH
4924   A MORE SPECIFIC DIAGNOSIS CODE.          16




       PLEASE REFILE A CORRECTED CLAIM WITH
4925   A VALID PRINCIPLE DIAGNOSIS CODE.        16
       PROCEDURE CODE AND TYPE OF SERVICE
       OR PLACE OF TREATMENT ARE
       INCOMPATIABLE. PLEASE REFILE A
4926   CORRECTED CLAIM.                          5
       A CLAIM FOR THESE SERVICES HAS
       ALREADY BEEN PROCESSED FOR AN
4927   OTHER PROVIDER.                          B20

       THIS BENEFIT PLAN COVERS SERVICES FOR
       SPEECH THERAPY ONLY WHEN CERTAIN
       CRITERIA IS MET AND THE INFORMATION WE
4929   HAVE INDICATE CRITERIA WAS NOT MET.      A1




       A LETTER OF MEDICAL NECESSITY MUST BE
       FILED WITH THIS SERVICE FOR
4930   CONSIDERATION OF PAYMENT.                16


       THESE SERVICES ARE NOT RELATED TO AN
       ACCIDENT OR EMERGENCY. THIS CONTRACT
       DOES NOT ALLOW BENEFITS FOR THESE
       SERVICES WHEN PERFORMED BY
4931   PROVIDERS WHO ARE NOT IN NETWORK.        170
       THIS BENEFIT PLAN DOES NOT COVER THIS
4932   DRUG.                                    204



       PLEASE REFILE THIS CLAIM INDICATING
       WHICH PHASE OF CARDIAC
       REHABILITATION THIS PATIENT IS
4933   RECEIVING.                               16
       PLEASE REFILE THIS CLAIM TO BLUECROSS
       BLUECROSS BLUESHIELD
4934   OF LOUISIANA.                            109




                                   Page 196
                                  CARCs_Query2



       PLEASE REFILE THIS CLAIM TO BLUE CROSS
4935   AND BLUE SHIELD OF MARYLAND.               109
       MENTAL HEALTH AND SUBSTANCE ABUSE
       CLAIMS SHOULD BE FILED TO:
       COMPSYCH
       P.O. BOX 8379
4936   CHICAGO, IL 60680                          109




       THIS CLAIM IS DENIED UNTIL THE HOST PLAN
       RECEIVES INFORMATION PREVIOUSLY
4939   REQUESTED. NO ACTION NEEDED.               16

       CHARGES FOR THESE SERVICES WERE
       INCLUDED UNDER THE PRIMARY ITS GLOBAL
4940   FEE CLAIM.                                 97

       MEMBER DOES NOT HAVE MEDICAL
       COVERAGE THROUGH A STAND ALONE
4941   PFFS PLAN.                                 96
       THE MAXIMUM LIFETIME BENEFIT FOR
       PSYCHIATRIC CARE IS $50,000. THESE
       CHARGES ARE NOT COVERED BECAUSE
       MAXIMUM LIFETIME BENEFITS HAS ALREADY
4942   BEEN PAID.                                 35

       BENEFITS ARE PAYABLE FOR UP TO 60 DAYS
       OF PSYCHIATRIC CARE. THESE CHARGES
       ARE NOT COVERED BECAUSE MAXIMUM
4943   BENEFITS HAVE ALREADY BEEN PROVIDED.       45
       THIS CONTRACT ALLOWS 120 DAYS EACH
       CALENDAR YEAR FOR THIS TYPE OF
       SERVICE. MAXIMUM BENEFITS HAVE
       ALREADY BEEN PAID FOR THIS CALENDAR
4944   YEAR.                                      45


       THIS PROCEDURE IS ONLY COVERED ONE
4945   TIME IN 12 CONSECUTIVE MONTHS.             45



       BENEFITS ARE NOT PAYABLE FOR MORE
4946   THAN ONE CHIROPRACTIC VISIT EACH DAY.      96
       THIS SERVICE IS ONLY PAYBLE 1 TIME
       WITHIN 12 MONTHS OF THE ORIGINAL
       PROCEDURE AND 1 TIME EVERY 12 MONTHS
4947   THERE AFTER.                               45




                                     Page 197
                                 CARCs_Query2



       THIS PROCEDURE IS ONLY COVERED ONCE
       EVERY 12 MONTHS PER PATIENT PER
4948   PROVIDER.                                45




       PLEASE TO REFILE THIS CLAIM WITH THE
4949   CORRECT DATES OF SERVICE.                16
       THE DIAGNOSIS IS INCONSISTENT WITH THE
4950   PATIENT'S AGE.                            9
       THE DIAGNOSIS IS INCONSISTENT WITH THE
4951   PATIENT'S GENDER.                        10




       CHARGES FOR OUT-PATIENT SERVICES
       WITH THIS PROXIMITY TO INPATIENT
4952   SERVICES ARE NOT COVERED.                60
       PAYMENT DENIED BECAUSE
       SERVICE/PROCEDURE WAS PROVIDED
       OUTSIDE THE UNITED STATES OR AS A
4953   RESULT OF WAR.                           158

       CLAIM/SERVICE DENIED. APPEAL
       PROCEDURES NOT FOLLOWED OR TIME
4954   LIMITS NOT MET.                          A1
       CLAIM/SERVICE NOT COVERED/REDUCED
       BECAUSE ALTERNATIVE SERVICE WERE
       AVAILABLE, AND SHOULD HAVE BEEN
4956   UTILIZED.                                A1


       SERVICES NOT COVERED BECAUSE THE
4957   PATIENT IS ENROLLED IN A HOSPICE.        A1
       SERVICES NOT DOCUMENTED IN PATIENT'S
4958   MEDICAL REOCRDS.                         B12




       ONSET DATE NEEDED BEFORE CLAIM CAN
4960   BE PROCESSED.                            16


       BENEFITS ARE NOT PAYBLE BECAUSE THE
       MAXIMUM FREQUENCY FOR THIS
4961   PROCEDURE HAS BEEN MET.                  96




                                    Page 198
                                  CARCs_Query2


       THERE IS A 12 MONTH WAITING PERIOD FOR
       THESE SERVICES FOR NEWLY ENROLLED
4962   DEPENDENTS.                               179
       THE CALENDAR YEAR MAXIMUM FOR THIS
4963   TYPE OF SERVICE HAS BEEN MET.             119

       THIS PROCEDURE IS ONLY PAYABLE TWICE
4964   EVERY 12 CONSECUTIVE MONTHS.              222


       THIS PROCEDURE IS ONLY COVERED TWICE
       PER TOOTH PER LIFETIME FOR POSTERIOR
4965   TEETH ONLY.                               96


       THIS BENEFIT PLAN ONLY ALLOWS THIS
       PROCEDURE THREE TIMES PER YEAR AT
4966   LEAST THREE MONTHS APART.                 96



       RETREATMENT NOT PAYBALE WITHIN 3
4967   YEARS OF ORIGINAL PROCEDURE.              96


       YOUR MEDICARE LICENSE NUMBER IS
       NEEDED IN ORDER TO PROCESS THIS CLAIM.
       PLEASE CONTACT OUR PROVIDER
       CERTIFICATION AREA AND PROVIDE THE
4968   NEEDED INFORMATION.                       16
       THIS BENEFIT PLAN COVERS WELL CHILD
       CARE ONLY IF THE MOTHER IS ENROLLED IN
       THE MATERNITY MANAGEMENT PROGRAM,
       AND OUR RECORD INDICATE THAT SHE WAS
4969   NOT.                                      96
       PLEASE REFILE THIS CLAIM TO:
       APS HEALTHCARE CLAIMS
       STATE OF SC
       P.O. BOX 1307
       ROCKVILLE, MD 20849
4970   1-800-221-8699                            109



       OUTPATIENT OBSERVATION STAY SERVICES
4971   ARE NOT MEDICALLY NECESSARY.              96




4972   ASC CLAIM MUST BE FILED ON A UB04 FORM.   17


                                    Page 199
                                 CARCs_Query2


       THIS BENEFIT PLAN COVERS OVER-AGE
       DEPENDENTS WHEN THEY MEET
       CERTAIN CRITERIA, WHICH HAS NOT BEEN
4973   MET.                                     177
       THESE SERVICES WERE INCURRED PRIOR
       TO THE EFFECTIVE DATE OF THIS BENEFIT
4974   PLAN.                                    26




       NON-COVERED ASC ANCILLARY
4975   PROCEDURES.                              96
       TAKE HOME DRUGS FROM THE HOSPITAL
4976   ARE NOT COVERED.                         204




4977   THE AMBULANCE SERVICE IS NOT COVERED.    96

       AMBULATORY SURGERY PACKAGED ITEM.
       NO SEPARATE PAYMENT FOR THESE
4978   SERVICES.                                97
       THIS SERVICE ISN'T PAYABLE BECAUSE THE
       PATIENT HAS ALREADY MET THE CALENDAR
       YEAR MAXIMUM FOR THE NUMBER OF
       SERVICES THE CONTRACT ALLOWS FOR
4979   THIS TYPE OF SERVICE.                    222
       THIS SERVICE IS NOT PAYABLE TO THE
4980   PROVIDER SPECIALTY REPORTED.             170
       THIS PROCEDURE IS ONLY COVERED ONCE
4981   PER TOOTH EVERY 12 MONTHS.               119


       BENEFITS ARE PROVIDED FOR ONE ROUTINE
       MAMMOGRAM OCCURING
4982   BETWEEN THE AGES OF 34 AND 39.           96


       THIS BENEFIT PLAN ONLY COVERS ONE
       ROUTINE MAMMOGRAM EACH YEAR FOR
4983   PATIENTS AGES 40 AND ABOVE.              96

       THESE CHARGES REPRESENT THE PORTION
       OF THE PATIENT'S ADMISSION THAT WAS
4984   DEEMED NOT MEDICALLY NECESSARY.          50




                                    Page 200
                                  CARCs_Query2


       THIS DENTAL CONTRACT LIMITS THE
       NUMBER OF TIMES THIS PROCEDURE MAY
       BE PERFORMED TO TWICE PER BENEFIT
4985   PERIOD.                                    119



       THE MEDICAL RECORDS RECEIVED ARE NOT
       IN ENGLISH. PLEASE FILE THE
4986   APPROPRIATE RECORDS IN ENGLISH.            16

       THIS PROCEDURE IS NOT COVERED
       SEPARATELY WHEN PERFORMED WITH THE
       OTHER SERVICES THAT THE PATIENT
4987   RECEIVED.                                  96



       PAYMENT IS INCLUDED IN ANOTHER PAID
4988   SERVICE RECEIVED ON THE SAME DAY.          97
       THIS IS A DUPLICATE OF A CHARGE
4989   ALREADY SUBMITTED.                         18
       THIS PROCEDURE IS NOT COVERED WHEN
4990   BILLED BY THIS PROVIDER.                   170

       THERE IS A 12 MONTH WAITING PERIOD ON
4991   MAJOR SERVICES FOR LATE ENROLLEES.         179
       THIS CLAIM WAS PROCESSED BASED ON
       YOU BEING A NON-NETWORK PROVIDER
       WITH THE MEMBER'S RESPONSIBILITY
       LIMITED TO THE
4992   IN-NETWORK COST SHARE.                     38

       THE NON-COVERED AMOUNT IS THE PRICE
       DIFFERENCE BETWEEN THE GENERIC AND
4993   BRAND DRUG.                                45

       THIS AMOUNT EXCEEDED THE DAY SUPPLY
4994   LIMITATION FOR PRESCRIPTION DRUGS.         B5
       FOR CLAIMS WHERE SUBSCRIBER IS NOT
       HELD HARMLESS, SUBSCRIBER CANNOT BE
       HELD HARMLESS FOR PROVIDER
       DISCOUNTS. SUBSCRIBER MAY BE BALANCE
4995   BILLED.                                    45

       SERVICE IS INCIDENT TO A PHYSICIAN'S
       SERVICE AND IS NOT PAYABLE IN A FACILITY
4996   SETTING.                                   97
       PROCEDURES CODES D7230, D7240, D7241,
       D9220, D9221, D9241 AND D9242 ARE NOT
4997   COVERED BY THIS GROUP.                     204




                                     Page 201
                                  CARCs_Query2


       REPLACEMENT OF PARTIALS/DENTURES
4998   LESS THAN 5 YEARS NOT COVER                119

       SERVICES FOR THE CLAIM ARE COVERED BY
4999   AN INTERMEDIARY.                           109



       THIS SERVICE IS NOT COVERED WHEN
       PERFORMED FOR THE REPORTED
5003   DIAGNOSIS.                                 96


       NONCOVERED SERVICES OR SUPPLIES.
       MEDICARE'S NATIONAL COVERAGE
       DECISION GUIDELINES AND OUR COVERAGE
       GUIDELINES WERE CONSIDERED TO MAKE
5005   THIS DETERMINIATION.                       96

       NONCOVERED SERVICES OR SUPPLIES.
       MEDICARE'S NATIONAL COVERAGE
       DECISION GUIDELINES AND OUR COVERAGE
       GUIDELINES WERE CONSI
5007   DERED TO MAKE THIS DETERMINATION.          96




       MISSING OR INVALID HCPCS CODE. PLEASE
5011   RESUBMIT CORRECTED CLAIM.                  16

       PLEASE SEND US AN EXPLANATION OF
       BENEFITS FROM EACH OF YOUR POLICIES.
       EITHER THE CLAIM OR OUR RECORDS SHOW
       OTHER HEALTH INSURANCE (OHI)
5014   COVERAGE FROM TWO OR MORE POLICIES         22
       PROVIDER NOT AUTHORIZED FOR THIS
       SERVICE AS AN INTERIM OR RESIDENT OF A
5016   HOSPITAL.                                  170
       OUR RECORDS INDICATE THE RENDERING
       PROVIDER IS INACTIVE FOR THE DATES OF
       SERVICE SUBMITTED.IF THIS INFORMATION
       IS INACCURATE, PLEASE DOWNLOAD FORMS
       FROM
       WWW.SOUTHCAROLINABLUES.COM,SEND
       AN E-MAIL TO PROVIDER.
       CERT@BCBCSC.COM OR FAX TO
       803.264.4795 TO UPDATE THE
       PROVIDER INFORMATION. ONCE FILE IS
5018   UPDATED THEN SEND A NEW CLAIM.             170

5020   PATIENT NOT ELIGIBILE AT TIME OF SERVICE   26



                                     Page 202
                                CARCs_Query2



       THE MEMBER'S COVERAGE WAS NOT IN
       EFFECT ON THE DATE THE SERVICE WAS
5022   PROVIDED.                               26

       THESE SERVICES WERE INCURRED AFTER
       THE TERMINATION DATE OF YOUR BENEFIT
5023   PLAN                                    27
       OBSOLETE PROCEDURE CODE(S)
       SUBMITTED-SERVICE(S) DENIED;
       PROVIDER MUST PROVIDE CORRECT FIVE
       DIGIT ANESTHESIA PROCEDURE CODE(S)
5029   (00100-01999)                           181



5067   CHIROPRATCIC SERVICES NOT COVERED.      204
       DUPLICATE OF SERVICE PREVIOUSLY
5079   CLAIMED.                                18




       NON-COVERED DIAGNOSIS FOR
5087   ULTRASOUND.                             96


       SERVICE INCLUDED IN SURGICAL
5091   ALLOWANCE.                              97
       SERVICES RENDERED OR SUPPLIES
       PROVIDED ARE NOT MEDICALLY
       NECESSARY, FOR EMERGENCY ROOM LEVEL
5094   OF CARE                                 50

       OTHER HEALTH INSURANCE INFORMATION
       NOT PROVIDED. NEED OTHER
5116   CARRIER'S EXPLANATION OF BENEFITS       22
       CHARGES MUST BE SUBMITTED TO AND
       PROCESSED BY BENEFICIARY'S
       PRIMARY INSURANCE CARRIER PRIOR TO
5117   MEDICARE PAYMENT CONSIDERATION          23


5118   PRIMARY CARRIER INFORMATION REQUIRED    22


5121   PRIMARY CARRIER INFORMATION REQUIRED    22


5122   PRIMARY CARRIER INFORMATION REQUIRED    22




                                   Page 203
                                  CARCs_Query2




5123   PRIMARY CARRIER INFORMATION REQUIRED      22

5128   COB INFORMATION NOT RECEIVED              22



       WE HAVE NOT RECEIVED ENOUGH
       INFORMATION TO PROCESS THIS
5143   SERVICE OR SUPPLY                         16

       NON-COVERED SERVICES. INCIDENTAL
       PROCEDURE TO ANOTHER PROCEDURE
       CODE ACCORDING TO OUR MEDICARE
5171   ADVANTAGE PROGRAM                         96
       THIS SERVICE IS NOT COVERED WHEN
5196   REPORTED FOR THIS DIAGNOSIS.              167



       THIS CLAIM WAS FILED WITH AN INVALID
       PRINCIPLE DIAGNOSIS FOR MEDICARE
5201   ADVANTAGE                                 16



       THIS CLAIM WAS FILED WITH AN INVALID
       OTHER DIAGNOSIS FOR MEDICARE
5202   ADVANTAGE                                 16


5203   PROVIDER NOT ON FILE OR NOT ACTIVE.       B7

       INVALID OTHER INSURANCE PAYMENT
5204   AMOUNT                                    23




5205   PROVIDER SIGNATURE NEEDED ON CLAIM        16


       THIS PATIENT IS NOT ENROLLED IN HIS
5206   MEDICARE ADVANTAGE PROGRAM.               31




                                     Page 204
                                CARCs_Query2




5207   PROCEDURES REQUIRE A BILLED CHARGE      16

       OTHER PAYER'S APPROVED AMOUNT IS
5208   REQUIRED                                23




       NEED RENDERING PROVIDER'S MEDICARE
5209   PIN AND/OR NPI NUMBER.                  16
       RESUBMIT WITH CORRECT PLACE OF
5210   SERVICE                                 5
       INCONSISTANT PROCEDURE CODE/TYPE OF
       SERVICE OR PROCEDURE
5211   CODE/PLACE OF SERVICE.                  5
       INCONSISTENT PROCEDURE AND PATIENT
5212   AGE OR GENDER                           6



5213   PROCEDURE CODE MISSING OR INVALID       181




       DAYS/UNITS OR ANESTHESIA MINUTES ARE
5214   REQUIRED                                16




5215   DAYS/UNITS ARE INVALID FOR PROCEDURE    16




5216   DAYS/UNITS REQUIRED FOR PROCEDURE       16




5217   MISSING OR INVALID SURGERY CODE         16




                                   Page 205
                                  CARCs_Query2




5218   MISSING OR INVALID OCCURRENCE CODE        16




       ADMISSION DATE IS AFTER BEGIN DATE OF
5219   SERVICE                                   16




       MISSING OR INVALID DATE OF SERVICE,
5220   ADMIT DATE                                16




       PATIENT STATUS OR BILL TYPE INVALID OR
5221   INCONSISTENT.                             16




5222   REVENUE CODE INVALID OR INCONSISTENT.     16




5223   INVALID OR MISSING CONDITION CODE.        16




5224   FULL ICD9 DIAGNOSIS IS REQUIRED           16




       DIAGNOSIS CODE IS INVALID OR
       INCOMPATIBLE WITH SURGICAL
5225   PROCEDURE CODE OR TYPE OF SERVICE.        16




                                    Page 206
                                  CARCs_Query2




       PROCEDURE CODE IS INCOMPATIBLE WITH
5226   THE PATIENT AGE OR SEX                    16




5227   PROCEDURE CODE IS INVALID                 16
       THIS CLAIM IS RELATED TO A POSSIBLE
       WORKERS' COMPENSATION/ACCIDENT
5232   CASE.                                     19
       THIS IS A PAY AND CHASE CLAIM IN
       REFERENCE TO WORKMAN
5233   COMP/SUBROGATION.                         45



       THIS BENEFIT PLAN DOES NOT COVER
5236   PRIVATE ROOM DIFFERENCE.                  96


       SECONDARY PROCEDURE IS ALLOWED AT
5288   50%                                       45
       SECOND AND THIRD PROCEDURES
       PERFORMED BY THE SAME PROVIDER
       ON THE SAME DAY ARE ALLOWED AT 50% OF
       AMOUNT USUALLY ALLOWED
       FOR THESE PROCEDURES, THEN PAID
       ACCORDING TO REGULAR
5289   CONTRACT BENEFITS.                        45
       FOURTH THROUGH THE EIGHTH LESION
       PROCEDURES PERFORMED BY SAME
       PROVIDER ON THE SAME DAY ARE
       ALLOWED AT 25% OF THE NORMAL
       ALLOWANCE AND PAID ACCORDING TO
       REGULAR DAY ARE ALLOWED AT 25% OF
       THE NORMAL ALLOWANCE AND PAID
       ACCORDING TO REGULAR CONTRACT
5290   BENEFITS.                                 45
       NINTH AND ALL OTHER LESION
       PROCEDURES PERFORMED BY SAME
       PROVIDER ON SAME DAY ARE ALLOWED AT
       10% OF NORMAL ALLOWANCE AND PAID
       ACCORDING TO REGULAR CONTRACT
5291   BENEFITS.                                 45




                                     Page 207
                                  CARCs_Query2




       MEDICAL VISIT FILED WITHOUT MODIFIER 25
       ON THE SAME DAY AS A TYPE 'T' OR 'S'
5301   PROCEDURE.                                96


5303   INCORRECT BILLING OF MODIFIER FB.         4

       COVERAGE OF THIS PROCEDURE IS
       RESTRICTED TO UNUSUAL
       CIRCUMSTANCES. THIS IS A NON COVERED
5306   SERVICES.                                 96



       PROCEDURE NOT ALLOWED FOR MEMBERS
7000   UNDER 9 YEARS OF AGE.                     96
       PA'S ALLOWED A MAXIMUM OF 12 FILMS PER
7001   BENEFIT YEAR.                             119
       THE PROCEDURE CODE IS INCONSISTENT
       WITH THE MODIFIER USED OR A REQUIRED
7003   MODIFIER IS MISSING.                      4




       ATTENDING MUST BE FILED FOR
7005   INSTITUTIONAL CLAIMS.                     16
       THIS PROCEDURE CODE IS COVERED ONLY
       FOR PERIODONTAL SPECIALIST.
       PROCEDURE ALLOWED ONLY ONE TIME PER
7007   24 MONTHS.                                170
       D0180 IS NOT ALLOWED FOR PROVIDERS
       OTHER THAN PERIODONTISTS AND ITS
       ALLOWED ONLY ONE TIME EVERY THREE
7008   CONSECUTIVE MONTHS.                       170

       THE HEALTH FIRST MEDICAL STAFF
       REVIEWED THIS CLAIM TO VERIFY THAT
       THESE SERVICES WERE MEDICALLY
       NECESSARY. BASED ON AVAILABLE
       DOCUMENTATION, THE MEDICAL STAFF
       FOUND THE SERVICE DID NOT MEET
       MEDICAL NECESSITY GUIDELINES. BENEFITS
       ARE NOT PAYABLE FOR SERVICES THAT ARE
       NOT MEDICALLY
       NECESSARY. PLEASE DIRECT ALL INQUIRIES
       RELATED TO THIS DENIAL OF BENEFIT TO
7009   HEALTH FIRST AT 212-8111.                 50




                                     Page 208
                                  CARCs_Query2


       ESAB DOES NOT COVER PREVENTIVE
       SERVICES WHEN RENDERED BY A
7011   SPECIALIST PROVIDER.                      170

       NO BENEFITS ARE AVAILABLE FOR THE
       TREATMENT OF OBESITY OR MORBID
       OBESITY WHEN RENDERED OUT OF
7012   NETWORK.                                  96




       PLEASE SEND A MORE DETAILED NARRATIVE
       TO COMPLETE THE PROCES
7014   SSING OF THIS CLAIM.                      16


       DIAGNOSIS AND/OR TREATMENT OF SEXUAL
       DYSFUNCTION IS NOT COVERED UNDER
7015   THIS BENEFIT PLAN.                        96

       THIS PLAN IS NOT ELIGIBLE FOR THE
7016   BLUECARD PROGRAM.                         109
       THIS LINE OF BUSINESS IS PROCESSED BY A
       VENDOR. HANDLE DIRECT WITH THE HOME
7017   PLAN.                                     109

       CLAIMS SUBMITTED AS BLUE CARD POS, BUT
       MEMBER IS NOT ENROLLED IN THE PAR
7018   PLAN NETWORK.                             A1
       ANCILLARY AMBULATORY SURGERY
       PROCEDURES SUBMITTED WITHOUT AN
       AMBULATORY SURGICAL PROCEDURE ON
7019   THE SAME DAY.                             59



       SEPARATE PAYMENT FOR SERVICES NOT
7022   PROVIDED BY MEDICARE.                     96



       TRANSFUSION OR BLOOD PRODUCT
       EXCHANGE WITHOUT SPECIFICATION OF
7023   BLOOD PRODUCT.                            16
       THIS OT CODE ONLY BILLED ON PARTIAL
7024   HOSPITALIZATION CLAIMS.                   5
       AT SERVICE NOT PAYABLE OUTSIDE PARTIAL
7025   HOSPITALIZATION PROGRAGM.                 5
       SERVICE ON SAME DAY AS INPATIENT
7026   PROCEDURE.                                18




                                    Page 209
                                  CARCs_Query2




7027   NON REPORTABLE FOR SITE OF SERVICE.       96



       ADMISSION TYPE IS INCONSISTENT WITH
       THE DIAGNOSIS AND OR REVENUE CODE OR
7029   THE TYPE OF ADMISSION IS INVALID.         16
       NOT COVERD UNLESS THE PROVIDER
7030   ACCEPTS ASSIGNMENT.                       111




7031   INTERIM BILLING IS NOT ALLOWED.           96


       THIS PROCEDURE IS NONCOVERED BY
       MEDICARE BASED ON THE DIAGNOSIS
7032   SUBMITTED.                                96



       EXTENSIVE MENTAL HEALTH SERVICES
       PROVIDED ON DAY OF ECT OR
7034   SIGNIFICANT PROCEDURE.                    16
       AS OF APRIL 1, 2009, THIS HEALTH PLAN
       REQUIRES PRE-CERTIFICATION FOR ALL
       SCHEDULED OUTPATIENT PET AND CT
       SCANS, MRI(S) AND MRA(S). WE HAVE PAID
       THIS CLAIM, BUT IN THE FUTURE YOU
       MUST CALL 1-800-500-7664 OR LOG IN AT
       WWW.RADMD.COM TO REQUEST
7036   AUTHORIZATION OF SERVICES.                197

       BECAUSE THIS PROVIDER IS A
       PARTICIPATING PROVIDER WITH US, WE
       WILL PROCESS THIS CLAIM THROUGH OUR
7039   PLAN.                                     94
       ONLY ONE INITIAL VISIT PER PATIENT PER
7040   DENTIST IS ALLOWED.                       119

       PCP LAB SERVICE PERFORMED BY AN
7041   INELIGIBLE PROVIDER.                      38

       PRE-CERTIFICATION WAS DENIED FOR THIS
7043   SERVICE.                                  39




                                     Page 210
                                  CARCs_Query2




       WE ARE ADJUSTING ANOTHER CLAIM THAT
       WE PROCESSED THESE SERVICES ON. YOU
       WILL RECEIVE A CORRECTED EXPLANATION
7046   OF BENEFITS FOR THAT CLAIM.               18

       RE-FILE THIS PROCEDURE WITH THE
7049   APPROPRIATE MODIFIER.                     4




       NON COVERED DUE TO CONTRACT
Z1     LIMITATIONS.                              96


       PLEASE REFILE THIS CLAIM TO VALUE
       BEHAVIORAL HEALTH (VBH), ONE TOWN
Z10    SQUARE, SUITE 600, SOUTHFIELD, MI 48076   109
       PLEASE REFILE THIS CLAIM TO VALUE
       BEHAVIORAL HEALTH (VBH), PO BOX 1008,
Z11    SKOKIE, IL 60076                          109
       PLEASE REFILE THIS CLAIM TO: AETNA,
       OWENS CORNING BENEFITS PAYMENT
Z12    OFFICE, CS10036, TOLEDO, OH 43699-0036    109
       THIS ADJUSTMENT IS FOR AN
       OVERPAYMENT. THIS AMOUNT HAS BEEN
Z13    SUBTRACTED FROM THE TOTAL.                125

       AS A RESULT OF THIS ADJUSTMENT, THE
       HOSPITAL MAY NEED TO REFUND THE
       PATIENT ANY AMOUNT PAID PERSONALLY BY
Z14    THE PATIENT.                              45
       THE PAYMENT ON THIS CLAIM HAS BEEN
       PROVIDED AS STIPULATED IN FEHB LAW (5
       U.S.C. 8904 (B)). THIS LEGISLATION
       REQUIRES THAT THE PLAN WILL PAY NO
       MORE FOR COVERED CARE THAN AN
       AMOUNT EQUIVALENT TO THE AMOUNT
Z15    MEDICARE WOULD HAVE ALLOWED IF            45
       MAJOR MEDICAL BENEFITS APPLIED TO THE
Z2     DEDUCTIBLE.                               126

       REQUIRED PRECERTIFICATION WAS NOT
       OBTAINED FOR THIS HOSPITALIZATION;
       THEREFORE, ROOM AND BOARD CHARGES
       HAVE BEEN DENIED OR REDUCED AS
Z6     STIPULATED IN YOUR CONTRACT.              197

       CHOICES POINT OF SERVICE CLAIM PAID ON
Z7     BEHALF OF BCBSSC.                         45


                                     Page 211
                              CARCs_Query2




     NON-COVERED AMOUNTS ARE DUE TO
     EITHER CONTRACTUAL LIMITATIONS,
     DEDUCTIBLES, COINSURANCE OR MISSING
Z9   INFORMATION.                            96




                                Page 212
                                                  CARCs_Query2


                                                  Remarks
             CARC Verbiage                         Code



Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M53
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435

Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Our records indicate that this dependent is not
an eligible dependent as defined.                   N375
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N23

Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15


                                                    Page 213
                                                   CARCs_Query2




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M51
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N362


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M127
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N174

These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                               N174
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N54
Claim denied. Insured has no dependent
coverage.                                            N129

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                              N2

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N197




                                                     Page 214
                                                   CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   M15

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M15
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              N20
The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as of
6/02                                                 MA66
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N362

The disposition of this claim/service is pending
further review. Note: Changed as of 10/99            N10

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Duplicate claim/service.                             N389

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30




                                                     Page 215
                                                   CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N63
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N350
Claim denied as patient cannot be identified as
our insured.                                         N30
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N362
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N179


                                                     Page 216
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06..( The rendering provider
is not eligible to perform the service billed
Note: New as of 06/05                               N257
Charges adjusted as penalty for failure to
obtain second surgical opinion. Note: Changed
as of 6/00                                          N130
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N380
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362




                                                    Page 217
                                                   CARCs_Query2



Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95

These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                  N429
The diagnosis is inconsistent with the
procedure.                                           M76
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                  N429
Payment denied because only one visit or
consultation per physician per day is covered.
Note: Changed as of 2/01                             N174
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                     N382
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                             N23
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N179




                                                     Page 218
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N29

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04

These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                 N429
Our records indicate that this dependent is not
an eligible dependent as defined.                   N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N179
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N174


Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30



                                                    Page 219
                                                  CARCs_Query2



Payment is denied when performed/billed by
this type of provider. Note: New as of 6/05         N95


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M135
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N23
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                            N55
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                  M15




Expenses incurred after coverage terminated.        N174

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N459




                                                    Page 220
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment is denied when performed/billed by
this type of provider. Note: New as of 6/05         N95

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N366

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N459




                                                    Page 221
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N102

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M30
Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed            M29

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N459




                                                    Page 222
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N459

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N366
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Services by an immediate relative or a
member of the same household are not
covered.                                            N30



Duplicate claim/service.                            N111

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N179




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 223
                                                  CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                      N30
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Previously paid. Payment for this claim/service
may have been provided in a previous
payment.                                            M86
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N75
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362




                                                    Page 224
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N155

Payment is denied when performed/billed by
this type of provider. Note: New as of 6/05         N95
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed            N34
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




                                                    Page 225
                                                   CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N40
The disposition of this claim/service is pending
further review.
                                                     M127
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N435

Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M79

These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                  N429




                                                     Page 226
                                                  CARCs_Query2


Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N23

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N301
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment adjusted because requested
information was not provided or was
insufficient/incomplete. Additional information
is supplied using the remittance advice
remarks codes whenever appropriate. This
change to be effective 4/1/2007: At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.) Note: Changed as of 2/02 and 6/06            MA92
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                              N174
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15




                                                    Page 227
                                                  CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M76
Payment denied because service/procedure
was provided outside the United States or as a
result of war. Note: Changed as of 2/01;
Inactive for version 004060. Use Codes 157,
158 or 159.                                         N30

Professional fees removed from charges.             N200
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N30
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




                                                    Page 228
                                                  CARCs_Query2


Our records indicate that this dependent is not
an eligible dependent as defined.                   N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N179
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment adjusted because procedure/service
was partially or fully furnished by another
provider. Note: Changed as of 2/01                  N472
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Multiple physicians/assistants are not covered
in this case .                                      N95




Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362




                                                    Page 229
                                                  CARCs_Query2




Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          M90



This provider was not certified/eligible to be
paid for this procedure/service on this date of
service. Note: Changed as of 10/98                  N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362



Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                      N30




                                                    Page 230
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N225




Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                      N30




Claim/service denied because
procedure/treatment is deemed
experimental/investigational by the payer.          N30




Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30



Payment made to patient/insured/responsible
party.                                               N7
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             N20
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362




                                                    Page 231
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N102
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N23
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             N20
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached.
                                                    N435




                                                    Page 232
                                                  CARCs_Query2




Charges do not meet qualifications for
emergent/urgent care.                               N180
Services not documented in patients' medical
records.                                            N237
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Services not documented in patients' medical
records.                                            N32




Payment adjusted because this care may be
covered by another payer per coordination of
benefits. Note: Changed as of 2/01                  MA04

Payment adjusted because this care may be
covered by another payer per coordination of
benefits. Note: Changed as of 2/01                  MA04

The procedure code/bill type is inconsistent
with the place of service.                          N56

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
Claim/service 6/06
as of 2/02 andlacks information which is            N237
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed            M62




                                                    Page 233
                                                  CARCs_Query2

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed            N29
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             N19




Claim denied. Insured has no coverage for
newborns.                                           N30




Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N129




Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                            N514
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N489


Payment adjusted as procedure postponed or
canceled. Note: Changed as of 2/01                  M51




                                                    Page 234
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N366
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N23
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Expenses incurred after coverage terminated.        N174


                                                    Page 235
                                                  CARCs_Query2




Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30


Our records indicate that this dependent is not
an eligible dependent as defined.                   N174



Non-covered visits.                                 N174

Payment is denied when performed/billed by
this type of provider. Note: New as of 6/05         N95
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Charges are adjusted based on multiple
surgery rules or concurrent anesthesia rules.
Note: Changed as of 6/00                             N7




Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N23
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 236
                                                  CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N418

Expenses incurred after coverage terminated.        N174
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Benefit maximum for this time period or
occurrence has been reached.
                                                     N2
Benefit maximum for this time period or
occurrence has been reached.
                                                     N2
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30



Expenses incurred prior to coverage.                N174
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N2
Our records indicate that this dependent is not
an eligible dependent as defined.                   N30



                                                    Page 237
                                                   CARCs_Query2


Claim denied as patient cannot be identified as
our insured.                                         N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Our records indicate that this dependent is not
an eligible dependent as defined.                    N30



These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                  N429

The disposition of this claim/service is pending
further review. Note: Changed as of 10/99            N23
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Payment denied because this service was not
prescribed prior to delivery Note: New as of
6/05                                                 N31


These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                               N180




                                                     Page 238
                                                  CARCs_Query2


Claim denied because this is a work-related
injury/illness and thus the liability of the
Worker's Compensation Carrier.                      N23
Claim denied as patient cannot be identified as
our insured.                                        N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N23
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached.
                                                    N362



                                                    Page 239
                                                  CARCs_Query2


Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N23
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N29
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15




                                                    Page 240
                                                  CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Duplicate claim/service.                            M86
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30


The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N418

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04




                                                    Page 241
                                                  CARCs_Query2



This provider was not certified/eligible to be
paid for this procedure/service on this date of
service. Note: Changed as of 10/98                  N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                 N174
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 242
                                                  CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M76

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N26

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N61
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 243
                                                  CARCs_Query2




Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached.
                                                    N362
Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                      N30
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                MA130
Previously paid. Payment for this claim/service
may have been provided in a previous
payment.                                            M86
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30



                                                    Page 244
                                                    CARCs_Query2


The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                      N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                            N30
Claim/service denied because
procedure/treatment is deemed
experimental/investigational by the payer.            N30
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                     N418

Duplicate claim/service.                              M86
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                            N30

Payment adjusted because the payer deems
the information submitted does not support
this level of service. Note: New as of 10/02          M79

Payment denied/reduced because the payer
deems the information submitted does not
support this level of service, this many
services, this length of service, this dosage, or
this day's supply. Note: Inactive for 004050.
Split into codes 150, 151, 152, 153 and 154.          N174

Payment denied/reduced because the payer
deems the information submitted does not
support this level of service, this many
services, this length of service, this dosage, or
this day's supply. Note: Inactive for 004050.
Split into codes 150, 151, 152, 153 and 154.          N174

Payment denied/reduced because the payer
deems the information submitted does not
support this level of service, this many
services, this length of service, this dosage, or
this day's supply. Note: Inactive for 004050.
Split into codes 150, 151, 152, 153 and 154.          N174
Benefit maximum for this time period or
occurrence has been reached.                          N435




                                                      Page 245
                                                    CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                   MA04

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                   M77

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  MA102

Payment denied/reduced because the payer
deems the information submitted does not
support this level of service, this many
services, this length of service, this dosage, or
this day's supply. Note: Inactive for 004050.
Split into codes 150, 151, 152, 153 and 154.          N174
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                              N2
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                            N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                            N30



                                                      Page 246
                                                 CARCs_Query2




Non-Covered days/Room charge adjustment.           N174
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                       N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                       N45
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                       N45

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30

Multiple physicians/assistants are not covered
in this case .                                     N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30



                                                   Page 247
                                                CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30

Payment adjusted because procedure/service
was partially or fully furnished by another
provider. Note: Changed as of 2/01                N472
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                          N428
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                          N428
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                          N428
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                           M15
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30
Payment adjusted when anesthesia is
performed by the operating physician, the
assistant surgeon or the attending physician
Note: New as of 2/06                              N174

Non-covered visits.                               N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30




                                                  Page 248
                                                    CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                            N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                   MA66
Payment denied because only one visit or
consultation per physician per day is covered.
Note: Changed as of 2/01                              N435


Payment denied/reduced because the payer
deems the information submitted does not
support this level of service, this many
services, this length of service, this dosage, or
this day's supply. Note: Inactive for 004050.
Split into codes 150, 151, 152, 153 and 154.          N174
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                      N418
Charges do not meet qualifications for
emergent/urgent care.                                 N174
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                            N30
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                                N30
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                    M15




                                                      Page 249
                                                   CARCs_Query2



Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Payment adjusted as not furnished directly to
the patient and/or not documented. Note:
Changed as of 2/01                                   N182
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N45
Claim/service not covered/reduced because
alternative services were available, and should
have been utilized.                                  N442

Payment made to patient/insured/responsible
party.                                               N182
Multiple physicians/assistants are not covered
in this case .                                       N174

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Payment made to patient/insured/responsible
party.                                               N182


These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                               N383
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N435
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N475




                                                     Page 250
                                                   CARCs_Query2




The disposition of this claim/service is pending
further review. Note: Changed as of 10/99            MA11
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N45
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15



Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N45

The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                     N418
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15

Services by an immediate relative or a
member of the same household are not
covered.                                             N30




                                                     Page 251
                                                 CARCs_Query2




Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                           N23


Claim denied. Insured has no dependent
coverage.                                          N30
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                           N428

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30

Claim denied because this is a work-related
injury/illness and thus the liability of the
Worker's Compensation Carrier.                     N30


Services denied at the time authorization/pre-
certification was requested.                       N30


The time limit for filing has expired.             N182

The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as of
6/02                                               M51

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30




                                                   Page 252
                                                  CARCs_Query2




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M51

Payment denied because only one visit or
consultation per physician per day is covered.
Note: Changed as of 2/01                            N435

Our records indicate that this dependent is not
an eligible dependent as defined.                   N30


Charges do not meet qualifications for
emergent/urgent care.                               N180




Claim denied as patient cannot be identified as
our insured.                                        N375
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N45
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

The date of birth follows the date of service.      N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          MA67

Duplicate claim/service.                            M86
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 253
                                                  CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N63
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                            N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N82
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                            N95
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                  N390
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                            N428
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
The procedure code is inconsistent with the
provider type/specialty (taxonomy). Note:
Changed as of 6/02                                  N32




                                                    Page 254
                                                   CARCs_Query2




Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N435

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N95
Payment denied because only one visit or
consultation per physician per day is covered.
Note: Changed as of 2/01                             N435
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N380
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N362
This provider was not certified/eligible to be
paid for this procedure/service on this date of
service. Note: Changed as of 10/98                   N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           MA67
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                         N45



                                                     Page 255
                                                        CARCs_Query2


Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                                  N428

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                       M123
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                          N418

The disposition of this claim/service is pending
further review. Note: Changed as of 10/99                 N381
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                         N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                                N30

The disposition of this claim/service is pending
further review. Note: Changed as of 10/99                 M127

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                       N26


Payment is denied when performed/billed by
this type of provider in this type of facility. Note:
New as of 6/05                                            N428
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                          N418



                                                          Page 256
                                                  CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30


Payment adjusted because requested
information was not provided or was
insufficient/incomplete. Additional information
is supplied using the remittance advice
remarks codes whenever appropriate. This
change to be effective 4/1/2007: At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.) Note: Changed as of 2/02 and 6/06            N358
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N382

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N26
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




                                                    Page 257
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N225
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N380
Claim denied because this injury/illness is
covered by the liability carrier.                   N409
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N174
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                  M15




                                                    Page 258
                                                CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                 N418
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                           M15

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                          N435
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                 N418
The procedure code is inconsistent with the
provider type/specialty (taxonomy). Note:
Changed as of 6/02                                N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                          N428
Payment is adjusted when performed/billed by
a provider of this specialty Note: New as of
6/05                                              N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                          N95
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30




                                                  Page 259
                                                   CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                         N45

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N61

Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   M15
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N362
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  MA04
Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                             N428
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30


                                                     Page 260
                                                   CARCs_Query2


Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N362
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N435
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                       N30


Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                             N362

Payment adjusted because requested
information was not provided or was
insufficient/incomplete. Additional information
is supplied using the remittance advice
remarks codes whenever appropriate. This
change to be effective 4/1/2007: At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.) Note: Changed as of 2/02 and 6/06             N366
Our records indicate that this dependent is not
an eligible dependent as defined.                    N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N223

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                             M140




                                                     Page 261
                                               CARCs_Query2




Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                       M90
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                       N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                       N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                       N362

Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                       N362
Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                   N30

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                         N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30



                                                 Page 262
                                                  CARCs_Query2


This provider was not certified/eligible to be
paid for this procedure/service on this date of
service. Note: Changed as of 10/98                  N95

Services not provided or authorized by
designated (network/primary care) providers.        N95
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Expenses incurred prior to coverage.                N30
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N435
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N435
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                            N362



                                                    Page 263
                                                  CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N358
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30


Expenses incurred after coverage terminated.        N30
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




                                                    Page 264
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M60
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15


Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                      N30

Expenses incurred after coverage terminated.        N30
Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                      N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N40
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                            N428
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45




                                                    Page 265
                                                   CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N435

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N435
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N435

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                             N362

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                             N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N435
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N26




                                                     Page 266
                                                  CARCs_Query2




Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362

Duplicate claim/service.                            M86
Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                      N30
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                  M86

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N4

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N40
Claim denied. Insured has no dependent
coverage.                                           N30




                                                    Page 267
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N40

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N29
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95

Expenses incurred after coverage terminated.        N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M20
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




                                                    Page 268
                                                CARCs_Query2



Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30
Charges do not meet qualifications for
emergent/urgent care.                             N180
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30
These are non-covered services because this
is a pre-existing condition                       N30
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                  N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        MA15
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                               N34
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                        N435




                                                  Page 269
                                                   CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                   N4
The procedure/revenue code is inconsistent
with the patient's age. Note: Changed as of
6/02                                                 M50

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51
Payment for charges adjusted. Charges are
covered under a capitation
agreement/managed care plan. Note:
Changed as of 6/00                                   N45
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N381

Payment is denied when performed/billed by
this type of provider. Note: New as of 6/05          N95
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N182
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




                                                     Page 270
                                                   CARCs_Query2


This provider was not certified/eligible to be
paid for this procedure/service on this date of
service. Note: Changed as of 10/98                   N95
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   N390
Payment adjusted as procedure postponed or
canceled. Note: Changed as of 2/01                   M51
Claim denied as patient cannot be identified as
our insured.                                         N30

Payment Adjusted for exceeding
precertification/ authorization. This change to
be effective 4/1/2008:
Precertification/authorization exceeded.             N54
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N362

The disposition of this claim/service is pending
further review. Note: Changed as of 10/99
Charges adjusted as penalty for failure to
obtain second surgical opinion. Note: Changed
as of 6/00                                           N130
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Previously paid. Payment for this claim/service
may have been provided in a previous
payment.                                             MA67




                                                     Page 271
                                                   CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N181

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
The rendering provider is not eligible to
perform the service billed. Note: New as of
6/05                                                 N95

These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                               N180
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
This provider was not certified/eligible to be
paid for this procedure/service on this date of
service. Note: Changed as of 10/98                   M143

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N435




                                                     Page 272
                                                CARCs_Query2



The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                  N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30

These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.               N429
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                  N418

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                               N256

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                               MA31

Payment adjusted because this care may be
covered by another payer per coordination of
benefits. Note: Changed as of 2/01                MA04




                                                  Page 273
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N181

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M123
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N61
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N23
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N435
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                              N180




                                                    Page 274
                                                   CARCs_Query2




Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                     N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N26

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
The procedure code is inconsistent with the
provider type/specialty (taxonomy). Note:
Changed as of 6/02                                   N95

The disposition of this claim/service is pending
further review. Note: Changed as of 10/99            N202
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Payment denied because only one visit or
consultation per physician per day is covered.
Note: Changed as of 2/01                              N2
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




These are non-covered services because this
is a pre-existing condition                          N30




                                                     Page 275
                                                   CARCs_Query2




The rendering provider is not eligible to
perform the service billed. Note: New as of
6/05                                                 N95

Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   M15

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N362


These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                  N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N102

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N102

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51




                                                     Page 276
                                                   CARCs_Query2



Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N56
Charges are adjusted based on multiple
surgery rules or concurrent anesthesia rules.
Note: Changed as of 6/00                              N2
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                     N418

The disposition of this claim/service is pending
further review. Note: Changed as of 10/99            N202

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M127

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA100
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30


                                                     Page 277
                                                  CARCs_Query2


Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or         N203
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
This provider was not certified/eligible to be
paid for this procedure/service on this date of
service. Note: Changed as of 10/98                  N95
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Payment denied because only one visit or
consultation per physician per day is covered.
Note: Changed as of 2/01                            N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30


Payment denied because only one visit or
consultation per physician per day is covered.
Note: Changed as of 2/01                            N174

Adjustment amount represents collection
against receivable created in prior
overpayment. Note: Inactive for 004050.             N25
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30



                                                    Page 278
                                                  CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Payment denied because only one visit or
consultation per physician per day is covered.
Note: Changed as of 2/01                            N174
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment adjusted because procedure/service
was partially or fully furnished by another
provider. Note: Changed as of 2/01                  N472

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M127

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          MA15




                                                    Page 279
                                                  CARCs_Query2


Claim denied as patient cannot be identified as
our insured.                                        N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N29


The time limit for filing has expired.              N409
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.
Claim/service lacks information which is            N180
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed            M123



Claim denied as patient cannot be identified as
our insured.                                        MA36




                                                    Page 280
                                                  CARCs_Query2



Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435

Payment adjusted because requested
information was not provided or was
insufficient/incomplete. Additional information
is supplied using the remittance advice
remarks codes whenever appropriate. This
change to be effective 4/1/2007: At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.) Note: Changed as of 2/02 and 6/06            N380

Payment adjusted because this care may be
covered by another payer per coordination of
benefits. Note: Changed as of 2/01                  MA04
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                           M7
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Duplicate claim/service.                            M86

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N34


                                                    Page 281
                                                   CARCs_Query2



Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                              N2

Claim denied as patient cannot be identified as
our insured.                                         N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M123

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N362
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M53




                                                     Page 282
                                                  CARCs_Query2



Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N54

These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                              N174
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Information from another provider was not
provided or was insufficient/incomplete. This
change effective 7/1/2009: Information from
another provider was not provided or was
insufficient/incomplete. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N181


Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95




Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N435



                                                    Page 283
                                                  CARCs_Query2


Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                            N95
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45



Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                            N174
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N2

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N40

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06
Claim/service lacks information which is            N30
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed            M125




                                                    Page 284
                                                   CARCs_Query2




Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01 information which is
Claim/service lacks                                  M62
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
Claim/service lacks information which is             N237
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed             N285


Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N362



Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            M63


Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           M90

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M127




                                                     Page 285
                                                  CARCs_Query2



Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N45

Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

This care may be covered by another payer
per coordination of benefits.                       MA04


Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                             N2

Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                            N45

Payment adjusted because requested
information was not provided or was
insufficient/incomplete. Additional information
is supplied using the remittance advice
remarks codes whenever appropriate. This
change to be effective 4/1/2007: At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.) Note: Changed as of 2/02 and 6/06            M127


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N26



                                                    Page 286
                                                   CARCs_Query2




These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                  N429

Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  MA81
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30


Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95

Payment made to patient/insured/responsible
party.                                               N381

The disposition of this claim/service is pending
further review. Note: Changed as of 10/99            N381




                                                     Page 287
                                                   CARCs_Query2



Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                              N2
Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may change to be of
Non-covered charge(s). This be comprised             M60
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N54

Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N182
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30




                                                     Page 288
                                                   CARCs_Query2




Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N182

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N182

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30


The diagnosis is inconsistent with the
procedure.                                           M51
Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)
                                                     N36
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or                 N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30




                                                     Page 289
                                                   CARCs_Query2




Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N56
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Benefit maximum for this time period or
occurrence has been reached.                         N45

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N182
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418



Non-covered visits.                                  N174
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30




                                                     Page 290
                                                  CARCs_Query2




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA92

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N48

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04




                                                    Page 291
                                                  CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95

Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362

Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                              M79

Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                              M79



Previously paid. Payment for this claim/service
may have been provided in a previous
payment.                                            M86




                                                    Page 292
                                                    CARCs_Query2




Payment denied/reduced because the payer
deems the information submitted does not
support this level of service, this many
services, this length of service, this dosage, or
this day's supply. Note: Inactive for 004050.
Split into codes 150, 151, 152, 153 and 154.          N464


Payment adjusted because an alternate
benefit has been provided Note: New as of
6/05                                                  N95
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                            N362



Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                            N362

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                   N63


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                     N418

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                     N418

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                            MA67
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                    M62


Duplicate claim/service.                              N19



                                                      Page 293
                                                   CARCs_Query2




Benefit maximum for this time period or
occurrence has been reached.                         M86
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   M15

Charges are adjusted based on multiple
surgery rules or concurrent anesthesia rules.
Note: Changed as of 6/00                              N2


Non-covered visits.                                  N174

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N63

Services not provided or authorized by
designated (network/primary care) providers.         N95

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Our records indicate that this dependent is not
an eligible dependent as defined.                    N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N63
Payment adjusted as not furnished directly to
the patient and/or not documented. Note:
Changed as of 2/01                                   N182

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62




                                                     Page 294
                                                   CARCs_Query2


Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62


Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                             N182


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                               N174




Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N224




These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                  M127




                                                     Page 295
                                                CARCs_Query2



Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                        N30




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                 N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                 N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                 N418
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                          N30

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                      N45
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                          N45
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                 N418

These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.               N174




Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                    N30
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                          N95




                                                  Page 296
                                                   CARCs_Query2


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or          N195
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                               N174
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA102

Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             M62
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N435




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




                                                     Page 297
                                                  CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or         N179
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95
These are non-covered services because this
is a pre-existing condition                         N30


Charges do not meet qualifications for
emergent/urgent care.                               M127

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                            N180
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N435
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N34




                                                    Page 298
                                                   CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Claim denied as patient cannot be identified as
our insured.                                        MA130
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or          M51
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Charges do not meet qualifications for
emergent/urgent care.                                N180
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30




                                                     Page 299
                                                  CARCs_Query2



Claim/service denied because
procedure/treatment is deemed
experimental/investigational by the payer.          N174
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                              N174


Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418



Previously paid. Payment for this claim/service
may have been provided in a previous
payment.                                            M86




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N418



                                                    Page 300
                                                        CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                         N418
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                                N435
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                                N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                                N435

Our records indicate that this dependent is not
an eligible dependent as defined.                         N375


Payment is denied when performed/billed by
this type of provider in this type of facility. Note:
New as of 6/05                                            N428
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                              N45




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                         N418




The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                          N174
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                         N418
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                                M90
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                                N30



                                                          Page 301
                                                   CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           M90


Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                             N2

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N290
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95


Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62




Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95
Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or          N63




                                                     Page 302
                                                   CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30




This care may be covered by another payer
per coordination of benefits.
                                                     MA04


Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62




Deductible Amount                                     N2




Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                         N45
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                     N418




Claim denied as patient cannot be identified as
our insured.                                        MA130




                                                     Page 303
                                                  CARCs_Query2




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N358

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N29




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 304
                                                  CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Claim denied as patient cannot be identified as
our insured.                                       MA130




Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N435


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45


                                                    Page 305
                                                  CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Patient/Insured health identification number
and name do not match. Note: New as of 6/99         N382




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              N2

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N37

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N37



Claim denied because this injury/illness is the
liability of the no-fault carrier.                  N30




                                                    Page 306
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N37
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N37

Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                            N174

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                            N174
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15




                                                    Page 307
                                                   CARCs_Query2




Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N358

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N358
The disposition of this claim/service is pending
further review.
                                                     N366
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N182
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




                                                     Page 308
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M123
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N418


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N61

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M51




                                                    Page 309
                                                   CARCs_Query2



Payment adjusted because requested
information was not provided or was
insufficient/incomplete. Additional information
is supplied using the remittance advice
remarks codes whenever appropriate. This
change to be effective 4/1/2007: At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.) Note: Changed as of 2/02 and 6/06             N102

Payment adjusted because requested
information was not provided or was
insufficient/incomplete. Additional information
is supplied using the remittance advice
remarks codes whenever appropriate. This
change to be effective 4/1/2007: At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.) Note: Changed as of 2/02 and 6/06             N102


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M29

Payment adjusted because requested
information was not provided or was
insufficient/incomplete. Additional information
is supplied using the remittance advice
remarks codes whenever appropriate. This
change to be effective 4/1/2007: At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.) Note: Changed as of 2/02 and 6/06             N358
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62




                                                     Page 310
                                                   CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N358

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N181
Requested information was not provided or
was insufficient/incomplete.                         M127
Benefit maximum for this time period or
occurrence has been reached.
                                                     N362
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M51




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30




                                                     Page 311
                                               CARCs_Query2


Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                          M15




Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                          M15
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                          M144
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                          M144


Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                          N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                              N256




                                                 Page 312
                                                  CARCs_Query2


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or         N277
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or                N289
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N435

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M51
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          M90
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




                                                    Page 313
                                               CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30




                                                 Page 314
                                               CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06
Non-covered charge(s). This change to be         N30
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed         N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                       N435




                                                 Page 315
                                              CARCs_Query2


Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                         N20




Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                        N174
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                      N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                      N435




Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                      N435
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                      N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                      M90




Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                      N362




Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                      N362
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                      M90
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                         M144
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                          N180


                                                Page 316
                                                   CARCs_Query2



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N95
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N54
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                           N362
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   N390
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62




Our records indicate that this dependent is not
an eligible dependent as defined.                    N375
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N193




                                                     Page 317
                                                  CARCs_Query2




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M127




Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95



Payment adjusted because treatment was
deemed by the payer to have been rendered in
an inappropriate or invalid place of service.
Note: Changed as of 2/01                            N180
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04




                                                    Page 318
                                                  CARCs_Query2


Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                            N95
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Payment adjusted because coverage/program
guidelines were not met or were exceeded.
Note: Changed as of 2/01                            N130
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                           N362
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or         N182




                                                    Page 319
                                                   CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N362
Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N435

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M57

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M22

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  MA04
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62




                                                     Page 320
                                                   CARCs_Query2


Claim denied because this is a work-related
injury/illness and thus the liability of the
Worker's Compensation Carrier.                       N23
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   M62
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor. information which is
Claim/service lacks                                  N418
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed             N181

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M20
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




                                                     Page 321
                                                  CARCs_Query2



Claim denied because this injury/illness is the
liability of the no-fault carrier.                  N30




Payment for charges adjusted. Charges are
covered under a capitation
agreement/managed care plan. Note:
Changed as of 6/00                                   N2
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                             M15

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA04
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          MA15

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 N313




                                                    Page 322
                                                   CARCs_Query2



Payment adjusted because this care may be
covered by another payer per coordination of
benefits. Note: Changed as of 2/01                   MA92
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Non-covered visits.                                  N30

Lifetime benefit maximum has been reached.
Note: Changed as of 10/02                            N435
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                         N45

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N26




Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                         N45


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                         N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30



The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51




                                                     Page 323
                                                  CARCs_Query2


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or         N209
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Our records indicate that this dependent is not
an eligible dependent as defined.
                                                    N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either        N30
Payment for charges adjusted. Charges are
covered under a capitation
agreement/managed care plan. Note:
Changed as of 6/00                                  N381
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M51
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          MA67
Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                      N30
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


                                                    Page 324
                                                  CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                        N45

These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                              N180


Payment is denied when performed/billed by
this type of provider.                              N95




Duplicate claim/service.                            N56

Payment adjusted because the payer deems
the information submitted does not support
this many services. Note: New as of 10/02           N362

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M20




                                                    Page 325
                                                   CARCs_Query2


The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as of
6/02                                                 M51

This payment is adjusted based on the
diagnosis. Note: Changed as of 2/01                  M76
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   N19

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M53

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51
The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as of
6/02                                                 M76

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  MA31


The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M51


                                                     Page 326
                                                   CARCs_Query2




Duplicate claim/service.                             M44

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M50




The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51
Payment is included in the allowance for
another service/procedure. Note: Changed as
of 2/99                                              M15


The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51

Payment adjusted because this procedure
code was invalid on the date of service Note:
New as of 6/05                                       M51

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30

This (these) diagnosis(es) is (are) not covered.
Note: New as of 6/05                                 N174




                                                     Page 327
                                                   CARCs_Query2




This (these) diagnosis(es) is (are) not covered.
Note: New as of 6/05                                 N174

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N157

Payment is denied when performed/billed by
this type of provider. Note: New as of 6/05          N95




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N290

Payment adjusted because the payer deems
the information submitted does not support
this level of service. Note: New as of 10/02         N142




The rendering provider is not eligible to
perform the service billed. Note: New as of
6/05                                                 N95




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174




                                                     Page 328
                                                   CARCs_Query2




The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51
This (these) diagnosis(es) is (are) not covered.
Note: New as of 6/05                                 N174

Expenses incurred after coverage terminated.         N30

Processed in Excess of charges.                       N2




Professional fees removed from charges.              N202


Claim/service rejected at this time because
information from another provider was not
provided or was insufficient/incomplete. Note:
New as of 6/02                                       N374
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                     N418

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Payment adjusted because the patient has not
met the required waiting requirements Note:
New as of 6/05                                       N30




                                                     Page 329
                                                  CARCs_Query2




The time limit for filing has expired.              N182


Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                  M15


Payment is denied when performed/billed by
this type of provider. Note: New as of 6/05         N95

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M54

Payment adjusted because this care may be
covered by another payer per coordination of
benefits. Note: Changed as of 2/01                  MA04

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                MA130
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                   N2
Payment adjusted because this
procedure/service is not paid separately. Note:
Changed as of 2/01                                  M15

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 330
                                                       CARCs_Query2




This (these) diagnosis(es) is (are) not covered.
Note: New as of 6/05                                     N174

Payment adjusted because the payer deems
the information submitted does not support
this many services. Note: New as of 10/02                M53

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                       M62
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                               N30




Payment denied/reduced because
injury/illness was the result of an activity that is
a benefit exclusion. Note: New as of 9/03                N174

Payment adjusted because the payer deems
the information submitted does not support
this level of service. Note: New as of 10/02             N163
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                                 N12

Professional fees removed from charges.                  N200

Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                                 N95


The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                         N418


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                        N418




                                                         Page 331
                                                  CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418
Benefit maximum for this time period or
occurrence has been reached. Note: Changed
as of 2/04                                          N362


Payment made to patient/insured/responsible
party.                                              N381


Duplicate claim/service.                            N111

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 M127

Payment adjusted because this care may be
covered by another payer per coordination of
benefits. Note: Changed as of 2/01                  MA04


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 332
                                                   CARCs_Query2



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

These are non-covered services because this
is a routine exam or screening procedure done
in conjunction with a routine exam.                  N429


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174
Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                             N95


The disposition of this claim/service is pending
further review. Note: Changed as of 10/99            N175

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  MA42

The procedure code/bill type is inconsistent
with the place of service.                           N56

The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as of
6/02                                                 M51




                                                     Page 333
                                                       CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                      N290

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                      M59




Payment denied/reduced because
injury/illness was the result of an activity that is
a benefit exclusion. Note: New as of 9/03                N174




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                         N179




Claim denied as patient cannot be identified as
our insured.                                             N30

Patient/Insured health identification number
and name do not match.
                                                         N382


Patient/Insured health identification number
and name do not match. Note: New as of 6/99              N382




                                                         Page 334
                                                   CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  N258




This (these) diagnosis(es) is (are) not covered.
Note: New as of 6/05                                 N30


This (these) diagnosis(es) is (are) not covered.
Note: New as of 6/05                                 N30

Charges do not meet qualifications for
emergent/urgent care. to a submission/billing
Payment adjusted due                                 N180
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed            MA130
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30




                                                     Page 335
                                                 CARCs_Query2


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                N257



Multiple physicians/assistants are not covered
in this case .                                     N95

Services not provided or authorized by
designated (network/primary care) providers.
Note: Changed as of 6/03                           N95



The rendering provider is not eligible to
perform the service billed. Note: New as of
6/05                                               N95


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174


Payment adjusted as procedure postponed or
canceled. Note: Changed as of 2/01                 M79


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                  N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                         N30




                                                   Page 336
                                                  CARCs_Query2


Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. Note: Changed as of 2/01,
and 6/05                                            N192




Claim denied as patient cannot be identified as
our insured.                                        N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N23

Payment adjusted due to a submission/billing
error(s). Additional information is supplied
using the remittance advice remarks codes
whenever appropriate. This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                 MA60


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N429




Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129




                                                    Page 337
                                                   CARCs_Query2




Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. This change to be
effective 4/1/2008: The impact of prior payer(s)
adjudication including payments and/or
adjustments.                                         N23


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N102

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N102


Benefit maximum for this time period or
occurrence has been reached.                         N362


This service/equipment/drug is not covered
under the patient’s current benefit plan.            N174


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418

Payment adjusted because the benefit for this
service is included in the payment/allowance
for another service/procedure that has already
been adjudicated. This change to be effective
4/1/2008: The benefit for this service is
included in the payment/allowance for another
service/procedure that has already been
adjudicated.                                         M15


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418




                                                     Page 338
                                                 CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N308




Predetermination: anticipated payment upon
completion of services or claim adjudication.       N2




Processed in Excess of charges.                     N2

Payment adjusted because the benefit for this
service is included in the payment/allowance
for another service/procedure that has already
been adjudicated. This change to be effective
4/1/2008: The benefit for this service is
included in the payment/allowance for another
service/procedure that has already been
adjudicated.                                       N19

Payment adjusted because the benefit for this
service is included in the payment/allowance
for another service/procedure that has already
been adjudicated. This change to be effective
4/1/2008: The benefit for this service is
included in the payment/allowance for another
service/procedure that has already been
adjudicated.
Payment adjusted because the benefit for this      N202
service is included in the payment/allowance
for another service/procedure that has already
been adjudicated. This change to be effective
4/1/2008: The benefit for this service is
included in the payment/allowance for another
service/procedure that has already been
adjudicated.                                       M15




                                                   Page 339
                                                   CARCs_Query2




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418



The procedure code is inconsistent with the
modifier used or a required modifier is missing.     N56

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M51


Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N56



The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M15


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M51

Claim/service not covered/reduced because
alternative services were available, and should
have been utilized. This change to be effective
4/1/2008: Alternative services were available,
and should have been utilized.                       M51

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     N301




                                                     Page 340
                                                       CARCs_Query2



The procedure code is inconsistent with the
modifier used or a required modifier is missing.         M51

Payment adjusted due to a submission/billing
error(s). At least one Remark Code must be
provided (may be comprised of either the
Remittance Advice Remark Code or NCPDP
Reject Reason Code.) This change to be
effective 4/1/2008: Submission/billing error(s).
At least one Remark Code must be provided
(may be comprised of either the Remittance
Advice Remark Code or NCPDP Reject
Reason Code.)                                            M50



Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                               N302



Duplicate claim/service.                                 N19

Payment denied/reduced because
injury/illness was the result of an activity that is
a benefit exclusion. This change to be
effective 4/1/2008: Injury/illness was the result
of an activity that is a benefit exclusion.              N174


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                        N418


Claim/service not covered/reduced because
alternative services were available, and should
have been utilized. This change to be effective
4/1/2008: Alternative services were available,
and should have been utilized.                           M67




Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                               M50




                                                         Page 341
                                                 CARCs_Query2


Payment adjusted because the payer deems
the information submitted does not support
this length of service. This change to be
effective 4/1/2008: Payer deems the
information submitted does not support this
length of service.                                 N351

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N56

Payment adjusted because the benefit for this
service is included in the payment/allowance
for another service/procedure that has already
been adjudicated. This change to be effective
4/1/2008: The benefit for this service is
included in the payment/allowance for another
service/procedure that has already been
adjudicated.                                       M86



The procedure/revenue code is inconsistent
with the patient's age.                            N180

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N358



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N180

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N180

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N29




                                                   Page 342
                                               CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N197

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30


The procedure/revenue code is inconsistent
with the patient's gender.                       N30

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30



                                                 Page 343
                                                   CARCs_Query2



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N30

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N181


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N48
Payment adjusted due to the impact of prior
payer(s) adjudication including payments
and/or adjustments. This change to be
effective 4/1/2008: The impact of prior payer(s)
adjudication including payments and/or
adjustments.                                         MA04

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N289

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M76




                                                     Page 344
                                                   CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M70
The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                     N418
Payment denied - Prior processing information
appears incorrect. This change to be effective
4/1/2008: Prior processing information
appears incorrect.                                   M49

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate. This change to
be effective 4/1/2007: At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 2/02 and 6/06                                  M60




Claim specific negotiated discount.                  N45
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N365




The procedure/revenue code is inconsistent
with the patient's age.                              M51

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51




                                                     Page 345
                                                  CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         MA114




Precertification/authorization/notification
absent.                                             M62
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30



Payment adjusted because this procedure
code was invalid on the date of service. This
change to be effective 4/1/2008: Procedure
code was invalid on the date of service.            N390

Payment adjusted because the benefit for this
service is included in the payment/allowance
for another service/procedure that has already
been adjudicated. This change to be effective
4/1/2008: The benefit for this service is
included in the payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                    N431
Procedure code was invalid on the date of
service.                                            M51

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N26




                                                    Page 346
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N29

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M127



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N268

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M129




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                    N30

This provider was not certified/eligible to be
paid for this procedure/service on this date of
service.                                            N95
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N45


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate                          M127




                                                    Page 347
                                                  CARCs_Query2


Requested information was not provided or
was insufficient/incomplete. At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)
                                                    N102




Benefit maximum for this period or occurrence
has been reached.                                    N2




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M127




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M127

The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         M2

The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         M2

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         MA36

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         MA36



                                                    Page 348
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         MA37

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         MA37

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         MA37

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         MA37

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N77

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N256

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N258

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N258

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N258

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N209




                                                    Page 349
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M56

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M49

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M56


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                          N30

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N258


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         MA36



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N329




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advise remarks
codes whenever appropriate.                         MA39




                                                    Page 350
                                               CARCs_Query2




Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)
                                                 MA40
Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)
                                                 M52
Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)
                                                 M59

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                 M53

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                 M54

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                 M54

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                 M54




                                                 Page 351
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                    M54


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M54



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M54




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M54



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M54

Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                              M52




Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                              M59




                                                    Page 352
                                                   CARCs_Query2




Diagnosis was invalid for the date(s) of service
reported.                                            M76




Procedure modifier was invalid on the date of
service.                                             M51

Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                               M53


Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                               M53



Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M79



Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                          MA39


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                          N318


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                          N299




                                                     Page 353
                                                  CARCs_Query2




Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         N318
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         N2

Patient has not met the required waiting
requirements.                                       N30


Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         MA39



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174


Predetermination: anticipated payment upon
completion of services or claim adjudication.        N7



Claim/service lacks information which is
needed for adjudication. Additional informatin
is supplied using remittance advice remarks
codes whenever appropriate.                         M127

Previously paid. Payment for this claim/service
may have been provided in a previous
payment.                                            M86



The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         N7




                                                    Page 354
                                                  CARCs_Query2




The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         N7



The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         N7

The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         N7

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N45



Processed based on multiple or concurrent
procedure rules. (For example multiple surgery
or diagnostic imaging, concurrent anesthesia.)       N2



Processed based on multiple or concurrent
procedure rules. (For example multiple surgery
or diagnostic imaging, concurrent anesthesia.)       N2

The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         N2




Processed based on multiple or concurrent
procedure rules. (For example multiple surgery
or diagnostic imaging, concurrent anesthesia.)       N2


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N45



                                                    Page 355
                                                CARCs_Query2




Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                        N45


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N174




The impact of prior payer(s) adjudication
including payments and/or adjustments.            N23

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                        N45


This care may be covered by another payer
per coordination of benefits.                     N23




Precertification/authorization exceeded.          N45


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                        N45



Payment adjusted because pre-
certification/authorization not received in a
timely fashion.                                   M62




Precertification/authorization/notification
absent.                                           M62



Precertification/authorization/notification
absent.                                           M62




                                                  Page 356
                                               CARCs_Query2




Precertification/authorization/notification
absent.                                          M62




Precertification/authorization/notification
absent.                                          M62




Precertification/authorization/notification
absent.                                          M62



Precertification/authorization/notification
absent.                                          M62

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174



The impact of prior payer(s) adjudication
including payments and/or adjustments.           N23


The impact of prior payer(s) adjudication
including payments and/or adjustments.           N23




The impact of prior payer(s) adjudication
including payments and/or adjustments.           N23




Services not provided or authorized by
designated (network/primary care) providers.      N2




Precertification/authorization exceeded.         N45




                                                 Page 357
                                               CARCs_Query2




Precertification/authorization exceeded.         N45




Services not provided or authorized by
designated (network/primary care) providers.     N95




Processed in Excess of charges.                  N45




Precertification/authorization exceeded.         N45




Precertification/authorization/notification
absent.                                          N45




Precertification/authorization exceeded.         N45




Precertification/authorization exceeded.         N45



Benefit maximum for this time period or
occurrence has been reached.
                                                  N2




                                                 Page 358
                                                    CARCs_Query2




The impact of prior payer(s) adjudication
including payments and/or adjustments.
                                                      N23




Services not provided or authorized by
designated (network/primary care) providers.          N23


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                            N219


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                             N2




Based on the findings of a review organization.       N10

The impact of prior payer(s) adjudication
including payments and/or adjustments.                N219


The impact of prior payer(s) adjudication
including payments and/or adjustments.                N23




Allowed amount has been reduced because a
component of the basic procedure/test was
paid. The beneficiary is not liable for more than
the charge limit for the basic procedure/test.         N2

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                            N45




                                                      Page 359
                                               CARCs_Query2




Coverage/program guidelines were not met or
were exceeded.                                   N362




Processed in Excess of charges.                   N2




Processed in Excess of charges.                   N2

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                       N45

Lifetime benefit maximum has been reached.       N362




This service/equipment/drug is not covered
under the patient’s current benefit plan.        N174




This service/equipment/drug is not covered
under the patient’s current benefit plan.        N95




Services not provided or authorized by
designated (network/primary care) providers.     N30




Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30




                                                 Page 360
                                                  CARCs_Query2




Services not provided or authorized by
designated (network/primary care) providers.        N30



Services not provided or authorized by
designated (network/primary care) providers.        N174




Services not provided or authorized by
designated (network/primary care) providers.        N95
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

Services not provided or authorized by
designated (network/primary care) providers.        N30
This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174

Claim/service lacks information which is
needed for adjudication. Additional information
is supplied using remittance advice remarks
codes whenever appropriate.                         M127

Services not provided or authorized by
designated (network/primary care) providers.        N95

This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174
Benefit maximum for this time period or
occurrence has been reached.                        M90

Benefit maximum for this time period or
occurrence has been reached.                        N435
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N435
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N345


Benefit maximum for this time period or
occurrence has been reached.                        N418



                                                    Page 361
                                                  CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174

Services not provided or authorized by
designated (network/primary care) providers.        N95

Expenses incurred after coverage terminated.        N30




The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         N2



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30




                                                    Page 362
                                                 CARCs_Query2




Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N30

Claim not covered by tis payer/contractor. You
must send the claim to the correct
payer/contractor.                                  N418

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N30
Coverage/program guidelines were not met or
were exceeded.                                     N435




Coverage/program guidelines were not met or
were exceeded.
                                                   N435




Coverage/program guidelines were not met or
were exceeded.
                                                   N435




This service/equipment/drug is not covered
under the patient’s current benefit plan
                                                   N174




Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                   N30




                                                   Page 363
                                               CARCs_Query2




Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                 N30



Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174




Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30



Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30




Coverage/program guidelines were not met or
were exceeded.
                                                 N362




Coverage/program guidelines were not met or
were exceeded.
                                                 N362


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)
                                                 N129


                                                 Page 364
                                                  CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129


Lifetime benefit maximum has been reached.          N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129

Processed in Excess of charges.                      N2
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N45
Precertification/authorization/notification
absent.                                             N45
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N472
Previously paid. Payment for this claim/service
may have been provided in a previous
payment.                                            M86

Patient has not met the required waiting
requirements.                                       N30




                                                    Page 365
                                                  CARCs_Query2




Expenses incurred after coverage terminated.        N30

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M51


Our records indicate that this dependent is not
an eligible dependent as defined.                   N30



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174



                                                    Page 366
                                              CARCs_Query2




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N30



Payment is denied when performed/billed by
this type of provider.                          N95




Benefit maximum for this time period or
occurrence has been reached.                    N362


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N429


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174




                                                Page 367
                                               CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M129


Payment is denied when performed/billed by
this type of provider.                           N95


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30

Benefit maximum for this time period or
occurrence has been reached.                     N362


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174




                                                 Page 368
                                               CARCs_Query2




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                       N45
Payment is denied when performed/billed by
this type of provider.                           N95

Services not provided or authorized by
designated (network/primary care) providers.     N95

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N429

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174




                                                 Page 369
                                               CARCs_Query2




Services not provided or authorized by
designated (network/primary care) providers.     N95


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Payment is denied when performed/billed by
this type of provider.                           N95


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Expenses incurred after coverage terminated.     N30




Payment is denied when performed/billed by
this type of provider.                           N95


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Lifetime benefit maximum has been reached.       N117


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


                                                 Page 370
                                               CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418




Processed in Excess of charges.                   N2


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30




Services not provided or authorized by
designated (network/primary care) providers.     N95


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418



Services not provided or authorized by
designated (network/primary care) providers.     N95


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174




                                                 Page 371
                                               CARCs_Query2




Payment is denied when performed/billed by
this type of provider.                           N95




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N130


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       MA04


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418




                                                 Page 372
                                              CARCs_Query2




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174

This service/equipment/drug is not covered
under the patient’s current benefit plan.       N174
Payment is denied when performed/billed by
this type of provider.                          N95


Payment is denied when performed/billed by
this type of provider.                          N95

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N30
This service/equipment/drug is not covered
under the patient’s current benefit plan.       N30


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174


Payment is denied when performed/billed by
this type of provider.                          N95
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                               N418




                                                Page 373
                                                  CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174


This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174
Payment is denied when performed/billed by
this type of provider.                              N95
This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15

This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174
Treatment was deemed by the payer to have
been rendered in an inappropriate or invalid
place of service.                                   N428



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M51
Payment is denied when performed/billed by
this type of provider.                              N95

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174


Patient has not met the required eligibility
requirements.                                       N30


This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174




                                                    Page 374
                                                 CARCs_Query2



Processed based on multiple or concurrent
procedure rules. (For example multiple surgery
or diagnostic imaging, concurrent anesthesia.)      N2



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                  N418

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N30




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                  N418

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174

Benefit maximum for this time period or
occurrence has been reached.                       N362


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N30




                                                   Page 375
                                                  CARCs_Query2


The claim/service has been transferred to the
proper payer/processor for processing.
Claim/service not covered by this
payer/processor.                                    N418
This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174
Payment is denied when performed/billed by
this type of provider.                              N95




These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                              N358


Treatment was deemed by the payer to have
been rendered in an inappropriate or invalid
place of service.                                   N429

Treatment was deemed by the payer to have
been rendered in an inappropriate or invalid
place of service.                                   N428


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418



The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418

This service/equipment/drug is not covered
under the patient’s current benefit plan.           N428

Expenses incurred prior to coverage.                N30

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30


Expenses incurred after coverage terminated.        N30




                                                    Page 376
                                                CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                 N418
Precertification/authorization/notification
absent.                                           M62
This service/equipment/drug is not covered
under the patient’s current benefit plan.         N174


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        M76
The procedure/revenue code is inconsistent
with the patient's age.                           M51
Benefit maximum for this time period or
occurrence has been reached.                      N362
Benefit maximum for this time period or
occurrence has been reached.                      N362

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        M53

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        M51

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N30
Charges for outpatient services are not
covered when performed within a period of
time prior to or after inpatient services.        N390

Treatment was deemed by the payer to have
been rendered in an inappropriate or invalid
place of service.                                 N428
Appeal procedures not followed or time limits
not met.
                                                  N130




                                                  Page 377
                                               CARCs_Query2




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30



                                                 N174




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30
Services not documented in patients' medical
records.                                         N237

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N180
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                       N45
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M127

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N305




                                                 Page 378
                                               CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M127

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M127

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M135

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M127




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M79




                                                 Page 379
                                                CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N285



Precertification/authorization/notification
absent.                                           M62

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        M62



Penalty for failure to obtain second surgical
opinion.                                          N174



Benefit maximum for this time period or
occurrence has been reached.                      N362



Information from another provider was not
provided or was insufficient/incomplete. This
change effective 7/1/2009: Information from
another provider was not provided or was
insufficient/incomplete. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N4

Benefit maximum for this time period or
occurrence has been reached.                      N362


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N174


The impact of prior payer(s) adjudication
including payments and/or adjustments.             N4




                                                  Page 380
                                               CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N203

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M127




This service/equipment/drug is not covered
under the patient’s current benefit plan.        N30

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       MA36

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N350

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M127


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174




                                                 Page 381
                                                   CARCs_Query2




Benefit maximum for this time period or
occurrence has been reached.                         M86


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M127




Diagnosis was invalid for the date(s) of service
reported.                                            M44

The impact of prior payer(s) adjudication
including payments and/or adjustments.                N2




The impact of prior payer(s) adjudication
including payments and/or adjustments.               MA64

Benefit maximum for this time period or
occurrence has been reached.                         N362

Benefit maximum for this time period or
occurrence has been reached.                         N362




Anesthesia performed by the operating
physician, the assistant surgeon or the
attending physician.                                 N450




                                                     Page 382
                                               CARCs_Query2




Anesthesia performed by the operating
physician, the assistant surgeon or the
attending physician.                             N450


The impact of prior payer(s) adjudication
including payments and/or adjustments.           N23

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M77

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N182



Patient has not met the required eligibility
requirements.                                    M82
Benefit maximum for this time period or
occurrence has been reached.                     N362
Benefit maximum for this time period or
occurrence has been reached.                     N362
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418



Duplicate claim/service.                         N111

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30

This service/equipment/drug is not covered
under the patient’s current benefit plan.        N174

Payment is denied when performed/billed by
this type of provider.                           N95



                                                 Page 383
                                                  CARCs_Query2



Services not provided or authorized by
designated (network/primary care) providers.        N95
Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                               N2

The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15

The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15




Payment is denied when performed/billed by
this type of provider in this type of facility.      M2
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15
Multiple physicians/assistants are not covered
in this case .                                      N95
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M2

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N180
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15

Duplicate claim/service.                             N2




This service/equipment/drug is not covered
under the patient’s current benefit plan            N30



                                                    Page 384
                                                  CARCs_Query2



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          MA39

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          MA39




Our records indicate that this dependent is not
an eligible dependent as defined.                   N30

The authorization number is missing, invalid,
or does not apply to the billed services or
provider.                                           M62

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M77
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15


The procedure code/bill type is inconsistent
with the place of service.                          N56



                                                    Page 385
                                                  CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174
Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                              N34


Duplicate claim/service.                            M86
Precertification/authorization/notification
absent.                                             N182


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30

The related or qualifying claim/service was not
identified on this claim.                           N180

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N182


Payer deems the information submitted does
not support this level of service.                  N180

Procedure modifier was invalid on the date of
service.                                            M51

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N356


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N182


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N429


                                                    Page 386
                                                 CARCs_Query2



Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                         N45



Level of care change adjustment.                    N2

Benefit maximum for this time period or
occurrence has been reached.                       N362

Benefit maximum for this time period or
occurrence has been reached.                       N362
Benefit maximum for this time period or
occurrence has been reached.                       N362
Benefit maximum for this time period or
occurrence has been reached.                       N362
Benefit maximum for this time period or
occurrence has been reached.                       N362
Benefit maximum for this time period or
occurrence has been reached.                       N362
Benefit maximum for this time period or
occurrence has been reached.                       N362
Benefit maximum for this time period or
occurrence has been reached.                       N362
Benefit maximum for this time period or
occurrence has been reached.                       N362
Benefit maximum for this time period or
occurrence has been reached.                       N362

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N362

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N129
Coverage/program guidelines were not met or
were exceeded.                                     N30
This is a work-related injury/illness and thus
the liability of the Worker's Compensation
Carrier.                                           N23

Benefit maximum for this time period or
occurrence has been reached.                       N362
The impact of prior payer(s) adjudication
including payments and/or adjustments.             N23




                                                   Page 387
                                                  CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N362


Expenses incurred after coverage terminated.        N30

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30
Our records indicate that this dependent is not
an eligible dependent as defined.                   N30



Our records indicate that this dependent is not
an eligible dependent as defined.                   N30

Our records indicate that this dependent is not
an eligible dependent as defined.                   N30


Our records indicate that this dependent is not
an eligible dependent as defined.                   N30


Our records indicate that this dependent is not
an eligible dependent as defined.                   N30

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N2

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N358


This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




                                                    Page 388
                                                  CARCs_Query2




Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30
Our records indicate that this dependent is not
an eligible dependent as defined.                   N30

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30

This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174




Benefit maximum for this time period or
occurrence has been reached.                        N362

Benefit maximum for this time period or
occurrence has been reached.                        N362


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          MA92



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N40

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N109




                                                    Page 389
                                               CARCs_Query2



Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30



Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N362

This service/equipment/drug is not covered
under the patient's current benefit plan.        N174

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N129



Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N129

Benefit maximum for this time period or
occurrence has been reached.                     N362




Benefit maximum for this time period or
occurrence has been reached.                     N362


Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N130




                                                 Page 390
                                               CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N129

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N129

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174
Benefit maximum for this time period or
occurrence has been reached.                     N362
Patient has not met the required waiting
requirements.                                    N30

Benefit maximum for this time period or
occurrence has been reached.                     N362




Benefit maximum for this time period or
occurrence has been reached.                     N362

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Benefit maximum for this time period or
occurrence has been reached.                     N362

The impact of prior payer(s) adjudication
including payments and/or adjustments.           N23
Payment is denied when performed/billed by
this type of provider.                           N95

Expenses incurred prior to coverage.             N30




                                                 Page 391
                                                  CARCs_Query2



Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30

Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N130
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15



Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174



Non-covered charges (s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N130
Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362

Benefit maximum for this time period or
occurrence has been reached.                        N362



Benefit maximum for this time period or
occurrence has been reached.                        N435


Benefit maximum for this time period or
occurrence has been reached.                        N362


Benefit maximum for this time period or
occurrence has been reached.                        N362




                                                    Page 392
                                                 CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N483



Precertification/authorization/notification
absent.                                            M62
Benefit maximum for this time period or
occurrence has been reached.                       N362




Services not provided or authorized by
designated (network/primary care) providers.       N95

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                  N418

Information requested from the
Billing/Rendering Provider was not provided or
was insufficient/incomplete. At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                             N102

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N383
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                  N418

This service/equipment/drug is not covered
under the patient’s current benefit plan.          N30




                                                   Page 393
                                               CARCs_Query2


Benefit maximum for this time period or
occurrence has been reached.                     N362


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418

Benefit maximum for this time period or
occurrence has been reached.                     N362

Patient has not met the required waiting
requirements.                                    N30

Benefit maximum for this time period or
occurrence has been reached.                     N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N180

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30



Benefit maximum for this time period or
occurrence has been reached.                     N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N130

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N483




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N130




                                                 Page 394
                                                  CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M77

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129
Our records indicate that this dependent is not
an eligible dependent as defined.                   N129

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N182

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174


Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362



Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174



                                                    Page 395
                                                  CARCs_Query2


The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15
This service/equipment/drug is not covered
under the patient’s current benefit plan.           N30

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M135
Benefit maximum for this time period or
occurrence has been reached.                        N362




Services not provided or authorized by
designated (network/primary care) providers.        N182
Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362

The impact of prior payer(s) adjudication
including payments and/or adjustments.              N23

Benefit maximum for this time period or
occurrence has been reached.                        N362
Benefit maximum for this time period or
occurrence has been reached.                        N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N130
Benefit maximum for this time period or
occurrence has been reached.                        N435
Benefit maximum for this time period or
occurrence has been reached.                        N435
Benefit maximum for this time period or
occurrence has been reached.                        N435
Benefit maximum for this time period or
occurrence has been reached.                        N435
Benefit maximum for this time period or
occurrence has been reached.                        N35
Benefit maximum for this time period or
occurrence has been reached.                        N435




                                                    Page 396
                                               CARCs_Query2


Benefit maximum for this time period or
occurrence has been reached.                     N435

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N30

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M31




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N95
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N56

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N182
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       MA31


Coverage/program guidelines were not met or
were exceeded.                                   N362




                                                 Page 397
                                                CARCs_Query2


Payment is denied when performed/billed by
this type of provider.                            N95


Payment is denied when performed/billed by
this type of provider.                            N95


Payment is denied when performed/billed by
this type of provider.                            N95

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N174
Benefit maximum for this time period or
occurrence has been reached.                      N362


Payment is denied when performed/billed by
this type of provider.                            N95
The authorization number is missing, invalid,
or does not apply to the billed services or
provider.                                         N54




Lifetime benefit maximum has been reached
for this service/benefit category.                N362



Charges do not meet qualifications for
emergent/urgent care.                             N180
This service/equipment/drug is not covered
under the patient’s current benefit plan.         N174



Payment is denied when performed/billed by
this type of provider.                            N95
Service denied because payment already
made for same/similar procedure within set
time frame.                                       M86
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                 N418
Benefit maximum for this time period or
occurrence has been reached.                      N362
Benefit maximum for this time period or
occurrence has been reached.                      N362



                                                  Page 398
                                              CARCs_Query2



Lifetime benefit maximum has been reached.      N117

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      M80


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N129
Benefit maximum for this time period or
occurrence has been reached.                    N362

Benefit maximum for this time period or
occurrence has been reached.                    N362

The impact of prior payer(s) adjudication
including payments and/or adjustments.          N23

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                          N180
This service/equipment/drug is not covered
under the patient’s current benefit plan.       N174

Duplicate claim/service.                        M86

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N174




                                                Page 399
                                                   CARCs_Query2




Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N30

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N479




These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                               N180

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N408



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Benefit maximum for this time period or
occurrence has been reached.                         N362


Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N130


The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         M15




                                                     Page 400
                                                  CARCs_Query2




Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N130

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30
The number of Days or Units of Service
exceeds our acceptable maximum.                     N362



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M127

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N356

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N30



This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174


Expenses incurred after coverage terminated.        N30


                                                    Page 401
                                              CARCs_Query2



This service/equipment/drug is not covered
under the patient’s current benefit plan.       N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N30

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N129




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                               N418
Benefit maximum for this time period or
occurrence has been reached.                    N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      MA30


The time limit for filing has expired.          N182

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N357




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                               N418

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N30




                                                Page 402
                                                  CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N428
This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N428


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418




Precertification/authorization/notification
absent.                                             M62

The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15




Benefit maximum for this time period or
occurrence has been reached.                        N362
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        N20



Payment is denied when performed/billed by
this type of provider.                              N95

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174



                                                    Page 403
                                              CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N180




Benefit maximum for this time period or
occurrence has been reached.                    N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                      N30


Patient has not met the required waiting
requirements.                                   N30



Patient has not met the required waiting
requirements.                                   N30

Duplicate claim/service.                        N111

Payment is denied when performed/billed by
this type of provider.                          N95

Processed in Excess of charges.                  N2

Benefit maximum for this time period or
occurrence has been reached.                    N362
Precertification/authorization/notification
absent.                                         M62




These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                          N180
These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                          N180




                                                Page 404
                                                  CARCs_Query2




Based on the findings of a review organization.     N180

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M20
Submission/billing error(s). At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                              M77



This injury/illness is covered by the liability
carrier.                                            N418

The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         N2


This service/equipment/drug is not covered
under the patient’s current benefit plan.           N30
Benefit maximum for this time period or
occurrence has been reached.                        N435


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M50



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N182




                                                    Page 405
                                               CARCs_Query2




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M20




These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                           N362



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174
This service/equipment/drug is not covered
under the patient’s current benefit plan.        N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174
Exceeds the contracted maximum number of
hours/days/units by this provider for this
period. This is not patient specific.            N435


Payment is denied when performed/billed by
this type of provider.                           N95

Exceeds the contracted maximum number of
hours/days/units by this provider for this
period. This is not patient specific.            N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174




                                                 Page 406
                                                   CARCs_Query2



Exceeds the contracted maximum number of
hours/days/units by this provider for this
period. This is not patient specific.                N362


Exceeds the contracted maximum number of
hours/days/units by this provider for this
period. This is not patient specific.                N362

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51
This service/equipment/drug is not covered
under the patient’s current benefit plan.            N174


This provider was not certified/eligible to be
paid for this procedure/service on this date of
service.                                             M143


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M76




Precertification/authorization/notification
absent.                                              M62


The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                         M15

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M54




                                                     Page 407
                                               CARCs_Query2




Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M44


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M64


The procedure code/bill type is inconsistent
with the place of service.                       N56

Procedure/service was partially or fully
furnished by another provider.                   N472

Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N180


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M60




Payment is denied when performed/billed by
this type of provider.                           N95
This service/equipment/drug is not covered
under the patient’s current benefit plan.        N161


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M135
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418




                                                 Page 408
                                                  CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                   N418


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N366
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15
Non-covered(s). At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCDDP Reject Reason Code.)                          N30




Lifetime benefit maximum has been reached.          N435

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N362

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N362
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N362
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N362




                                                    Page 409
                                                   CARCs_Query2


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                           N362


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M52
The diagnosis is inconsistent with the patient's
age.                                                 M64
The diagnosis is inconsistent with the patient's
gender.                                              M64

Charges for outpatient services with this
proximity to inpatient services are not covered.
This change to be effective 1/1/2009: Charges
for outpatient services are not covered when
performed within a period of time prior to or
after inpatient services.                            N428


Service/procedure was provided outside of the
United States.                                       N174
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174
Services not documented in patients' medical
records.                                             N29

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N305

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N362




                                                     Page 410
                                               CARCs_Query2



Patient has not met the required waiting
requirements.                                    N30
Benefit maximum for this time period or
occurrence has been reached.                     M139
Exceeds the contracted maximum number of
hours/days/units by this provider for this
period. This is not patient specific.            N362

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be providded (may be comprised
of either the Remittance Advice Remark Code
or NCPDP Reject Reason Code.)                    M143

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N174
Requested information was not provided or
was insufficient/incomplete. At least one
Remark Code must be provided (may be
comprised of either the Remittance Advice
Remark Code or NCPDP Reject Reason
Code.)                                           N182


                                                 Page 411
                                                  CARCs_Query2




Patient has not met the required eligibility
requirements.                                       N129


Expenses incurred prior to coverage.                N30



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174
This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174


Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15


Exceeds the contracted maximum number of
hours/days/units by this provider for this
period. This is not patient specific.               N362
Payment is denied when performed/billed by
this type of provider.                              N95
Benefit maximum for this time period or
occurrence has been reached.                        N435

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N129

These are non-covered services because this
is not deemed a `medical necessity' by the
payer                                               N180




                                                    Page 412
                                                  CARCs_Query2



Benefit maximum for this time period or
occurrence has been reached.
                                                    N435

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M127

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N20

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          M15

Duplicate claim/service.                            N111
Payment is denied when performed/billed by
this type of provider.                              N95

Patient has not met the required waiting
requirements.                                       N30



Services not provided or authorized by
designated (network/primary care) providers.         N2
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                          N45

Coverage/program guidelines were not met or
were exceeded.                                      N362

Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                           N2
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        N38

This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174




                                                    Page 413
                                               CARCs_Query2


Benefit maximum for this time period or
occurrence has been reached.                     N362
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                N418
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       M76

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N174
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M20




This care may be covered by another payer
per coordination of benefits.                    MA92

Payment is denied when performed/billed by
this type of provider.                           N95




Payment is denied when performed/billed by
this type of provider.                           N95

Expenses incurred prior to coverage.             N30



                                                 Page 414
                                                  CARCs_Query2




Expenses incurred prior to coverage.                N30



Expenses incurred after coverage terminated.        N174




Procedure code was invalid on the date of
service.                                            M51


This service/equipment/drug is not covered
under the patient’s current benefit plan.           N174

Duplicate claim/service.                            M86


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                          N174
The benefit for this service is included in the
payment/allowance for another
service/procedure that has already been
adjudicated.                                        M15

These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                              N180


This care may be covered by another payer
per coordination of benefits.                       MA04

The impact of prior payer(s) adjudication
including payments and/or adjustments.
                                                    MA04

This care may be covered by another payer
per coordination of benefits.                       MA04

This care may be covered by another payer
per coordination of benefits.                       MA04

This care may be covered by another payer
per coordination of benefits.                       MA04




                                                    Page 415
                                                   CARCs_Query2



This care may be covered by another payer
per coordination of benefits.                        MA04
This care may be covered by another payer
per coordination of benefits.                        MA92

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M51

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M15

This (these) diagnosis(es) is (are) not covered.     N174

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           MA63

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M64
This provider was not certified/eligible to be
paid for this procedure/service on this date of
service.                                             N95

The impact of prior payer(s) adjudication
including payments and/or adjustments.               MA04


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           MA81
Claim denied as patient cannot be identified as
our insured. This change to be effective
4/1/2008: Patient cannot be identified as our
insured.                                             N382




                                                     Page 416
                                                CARCs_Query2



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N181

The impact of prior payer(s) adjudication
including payments and/or adjustments.            MA04

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N77
The procedure code/bill type is inconsistent
with the place of service.                        M77

The procedure code/bill type is inconsistent
with the place of service.                        N56
The procedure/revenue code is inconsistent
with the patient's age.                           N56
Payment adjusted because this procedure
code was invalid on the date of service. This
change to be effective 4/1/2008: Procedure
code was invalid on the date of service.          N56

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N203

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        M53


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N301

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                        N181




                                                  Page 417
                                               CARCs_Query2



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N181

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N181

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N181

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       MA43

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N181

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       M44

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N181


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                       N181




                                                 Page 418
                                                 CARCs_Query2



Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         M51

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         M51
This is a work-related injury/illness and thus
the liability of the Worker's Compensation
Carrier.                                           N23
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO             N45

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                         N45




Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                       N45




Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                       N45



Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                       N45




                                                   Page 419
                                                   CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           M51

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N174

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N129
Benefit maximum for this time period or
occurrence has been reached.                         N362

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M78

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                           N252


Payment is denied when performed/billed by
this type of provider.                               N95


Payment is denied when performed/billed by
this type of provider.                               N95




These are non-covered services because this
is not deemed a `medical necessity' by the
payer.                                               N180




                                                     Page 420
                                                 CARCs_Query2



Payment is denied when performed/billed by
this type of provider.                             N95

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174


Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N29

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                  N130
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                  N418
Claim/Service denied. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N182

Processed based on multiple or concurrent
procedure rules. (For example multiple surgery
or diagnostic imaging, concurrent anesthesia.)     M51

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N23

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         M53
The procedure code/bill type is inconsistent
with the place of service.                         N130
The procedure code/bill type is inconsistent
with the place of service.                         N130

Duplicate claim/service.                           N20




                                                   Page 421
                                                 CARCs_Query2



Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N174

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         MA41
Not covered unless the provider accepts
assignment.                                        N182

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N390

Non-covered charge(s). At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         M76

Claim/service lacks information which is
needed for adjudication. At least one Remark
Code must be provided (may be comprised of
either the Remittance Advice Remark Code or
NCPDP Reject Reason Code.)                         N182




Precertification/authorization/notification
absent.                                            N363




Processed in Excess of charges.                     N2
Benefit maximum for this time period or
occurrence has been reached.                       N362

Services not provided or authorized by
designated (network/primary care) providers.       N95

Services denied at the time authorization/pre-
certification was requested.                       N182




                                                   Page 422
                                                   CARCs_Query2




Duplicate claim/service.                             N111

The procedure code is inconsistent with the
modifier used or a required modifier is missing.     M51

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                           N30


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.                                    N418
Adjustment amount represents collection
against receivable created in prior
overpayment. Note: Inactive for 004050.              N45


Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                         MA67




Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                          N6
Deductible -- Major Medical Note: New as of
2/97                                                  N7



Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization. Note:
Changed as of 2/01                                   N45
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                         N45


                                                     Page 423
                                               CARCs_Query2



Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark Code
must be provided (may be comprised of either
the Remittance Advice Remark Code or
NCPDP Reject Reason Code.) Note: Changed
as of 6/06                                       N30




                                                 Page 424
                                                   CARCs_Query2




                               Remarks Verbiage




Missing/incomplete/invalid days or units of service. Note: (Modified 2/28/03)
Exceeds number/frequency approved /allowed within time period without support
documentation.


Misrouted claim. See the payer's claim submission instructions.

Exceeds number/frequency approved /allowed within time period without support
documentation.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.
Missing/incomplete/invalid questionnaire/information required to determine
dependent eligibility.




'Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


                                                       Page 425
                                                   CARCs_Query2




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301



The number of Days or Units of Service exceeds our acceptable maximum.




Missing patient medical record for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Claim information is inconsistent with pre-certified/authorized services.

Not eligible due to the patient's age.


This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




The subscriber must update insurance information directly with payer.




                                                     Page 426
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Service not payable with other service rendered on the same date.


Missing/incomplete/invalid principal procedure code.

The number of Days or Units of Service exceeds our acceptable maximum.

Payment based on the findings of a review organization/professional
consult/manual adjudication/medical or dental advisor.




Patient ineligible for this service. Note: (Modified 6/30/03)

Duplicate prescription number submitted.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 427
                                                   CARCs_Query2




Rebill services on separate claim lines.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid description of service for a Not Otherwise Classified
(NOC) code or an Unlisted procedure.


Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)


Missing/incomplete/invalid treatment authorization code.




Additional information has been requested from the member. The charges will be
reconsidered upon receipt of that information.


                                                      Page 428
                                                   CARCs_Query2




Missing/incomplete/invalid billing provider/supplier primary identifier. Note: (New
Code 12/2/04)

Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.




Patient ineligible for this service. Note: (Modified 6/30/03)

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service. Note: (Modified 6/30/03)




The original claim has been processed, submit a corrected claim.


The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.




                                                      Page 429
                                                   CARCs_Query2




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



This provider type/provider specialty may not bill this service.



This is not covered since it is considered routine.

Missing/incomplete/invalid diagnosis or condition.




Patient ineligible for this service. Note: (Modified 6/30/03)



This is not covered since it is considered routine.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Missing/incomplete/invalid patient identifier.


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.


Missing/incomplete/invalid treatment authorization code.




Additional information has been requested from the member. The charges will be
reconsidered upon receipt of that information.




                                                      Page 430
                                                   CARCs_Query2




Missing documentation/orders/notes/summary/report/chart. Note: (Modified
2/28/03, 8/1/05) Related to N225




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.



This is not covered since it is considered routine.

Patient ineligible for this service. Note: (Modified 6/30/03)




Additional information has been requested from the member. The charges will be
reconsidered upon receipt of that information.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 431
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.




Missing/incomplete/invalid plan of treatment.


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Patient ineligible for this service. Note: (Modified 6/30/03)



Procedures for billing with group/referring/performing providers were not followed.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing Discharge Summary.




                                                      Page 432
                                                   CARCs_Query2




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


This provider type/provider specialty may not bill this service.




Requested information not provided. The claim will be reopened if the information
previously requested is submitted within one year after the date of this denial
notice.




Missing Discharge Summary.




                                                      Page 433
                                              CARCs_Query2




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.




Missing pathology report.




Missing operative note/report.




Missing pathology report.




Missing Discharge Summary.




                                                  Page 434
                                                CARCs_Query2




Missing Discharge Summary.




Requested information not provided. The claim will be reopened if the information
previously requested is submitted within one year after the date of this denial
notice.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Patient ineligible for this service.


No appeal right except duplicate claim/service issue. This service was included in
a claim that has been previously billed and adjudicated.




Additional information has been requested from the member. The charges will be
reconsidered upon receipt of that information.




Misrouted claim. See the payer's claim submission instructions.




                                                    Page 435
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


Patient ineligible for this service. Note: (Modified 06/30/03)

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.


Payment based on authorized amount.

Service denied because payment already made for same/similar procedure within
set time frame.


The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




Additional information has been requested from the member. The charges will be
reconsidered upon receipt of that information.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


The number of Days or Units of Service exceeds our acceptable maximum.




                                                       Page 436
                                                   CARCs_Query2




Alert: Our records do not indicate that other insurance is on file. Please submit
other insurance information for our records.


This provider type/provider specialty may not bill this service.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Incorrect claim form/format for this service. Note: (Modified 11/18/05)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)

Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 437
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing x-ray. Note: (Modified 2/1/04) Related to N242


Missing patient medical record for this service.




Patient ineligible for this service. Note: (Modified 6/30/03)
Exceeds number/frequency approved /allowed within time period without support
documentation.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid charge.



This is not covered since it is considered routine.




                                                      Page 438
                                                   CARCs_Query2




Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Missing/incomplete/invalid procedure date(s). Note: (New Code 12/2/04)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing plan information for other insurance.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




                                                      Page 439
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid diagnosis or condition.




Patient ineligible for this service. Note: (Modified 6/30/03)

The professional component must be billed separately.




Patient ineligible for this service. Note: (Modified 6/30/03)


Patient ineligible for this service. Note: (Modified 6/30/03)


Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 440
                                                   CARCs_Query2



Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Additional information has been requested from the member. The charges will be
reconsidered upon receipt of that information.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)



Payment for this service has been issued to another provider.




Patient ineligible for this service. Note: (Modified 6/30/03)

This provider type/provider specialty may not bill this service.




The number of Days or Units of Service exceeds our acceptable maximum.




                                                      Page 441
                                                   CARCs_Query2




Not covered more than once in a 12 month period.




This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)



The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 442
                                                   CARCs_Query2




Incomplete/invalid documentation/orders/notes/summary/report/chart.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)



Processing of this claim/service has included consideration under Major Medical
provisions.


Service not payable with other service rendered on the same date.




Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.




                                                      Page 443
                                                   CARCs_Query2




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.


Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Patient ineligible for this service. Note: (Modified 6/30/03)


Service not payable with other service rendered on the same date.


This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)

Exceeds number/frequency approved /allowed within time period without support
documentation.




                                                      Page 444
                                                   CARCs_Query2




This item or service does not meet the criteria for the category under which it was
billed.


Incomplete/invalid patient medical record for this service.




Patient ineligible for this service. Note: (Modified 6/30/03)

Claim must be submitted by the provider who rendered the service.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.

Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.

Procedure code billed is not correct/valid for the services billed or the date of
service billed.




Incomplete/invalid patient medical record for this service.




Missing/incomplete/invalid treatment authorization code.




                                                      Page 445
                                                   CARCs_Query2




Missing documentation/orders/notes/summary/report/chart.


Procedure code incidental to primary procedure.




Patient ineligible for this service. Note: (Modified 6/30/03)




Not eligible due to the patient's age.




Consult plan benefit documents/guidelines for information about restrictions for
this service.




Patient ineligible for this service. Note: (Modified 6/30/03)


Missing referral form.



Missing/incomplete/invalid procedure code(s).




                                                      Page 446
                                                   CARCs_Query2




Requested information not provided. The claim will be reopened if the information
previously requested is submitted within one year after the date of this denial
notice.


Payment based on authorized amount.


Patient liability may be affected due to coordination of benefits with other carriers
and/or maximum benefit provisions. Note: (Modified 8/13/01)

The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


                                                      Page 447
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This provider type/provider specialty may not bill this service.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.


 Payment based on authorized amount.

Processing of this claim/service has included consideration under Major Medical
provisions.




The number of Days or Units of Service exceeds our acceptable maximum.
Exceeds number/frequency approved /allowed within time period without support
documentation.


The number of Days or Units of Service exceeds our acceptable maximum.


Misrouted claim. See the payer's claim submission instructions.

Patient liability may be affected due to coordination of benefits with other carriers
and/or maximum benefit provisions. Note: (Modified 8/13/01)


Misrouted claim. See the payer's claim submission instructions.




                                                      Page 448
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service.



Misrouted claim. See the payer's claim submission instructions.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


 Payment based on authorized amount.

This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.

This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.


Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 449
                                                   CARCs_Query2



Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)

Patient ineligible for this service. Note: (Modified 6/30/03)




This is not covered since it is considered routine.

Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


Missing/incomplete/invalid prescribing provider identifier.



This item or service does not meet the criteria for the category under which it was
billed.




                                                      Page 450
                                                   CARCs_Query2



Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.


Patient ineligible for this service. Note: (Modified 6/30/03)




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.


Misrouted claim. See the payer's claim submission instructions.


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.



Misrouted claim. See the payer's claim submission instructions.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.



                                                      Page 451
                                                   CARCs_Query2




Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Patient ineligible for this service. Note: (Modified 6/30/03)


Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing documentation/orders/notes/summary/report/chart.




Patient ineligible for this service. Note: (Modified 6/30/03)

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




                                                      Page 452
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)
Service denied because payment already made for same/similar procedure within
set time frame.




Patient ineligible for this service. Note: (Modified 6/30/03)




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




                                                      Page 453
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Misrouted claim. See the payer's claim submission instructions.




                                                      Page 454
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid diagnosis or condition. Note: (Modified 2/28/03)




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




Rebill services on separate claims.




Patient ineligible for this service. Note: (Modified 6/30/03)




Misrouted claim. See the payer's claim submission instructions.




                                                      Page 455
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.


Patient ineligible for this service. Note: (Modified 6/30/03)



Misrouted claim. See the payer's claim submission instructions.




Your claim contains incomplete and/or invalid information, and no appeal rights are
afforded because the claim is unprocessable. Please submit a new claim with the
complete/correct information.

Service denied because payment already made for same/similar procedure within
set time frame.


Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 456
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)


Patient ineligible for this service. Note: (Modified 6/30/03)


Misrouted claim. See the payer's claim submission instructions.
Service denied because payment already made for same/similar procedure within
set time frame.




Patient ineligible for this service. Note: (Modified 6/30/03)



Missing/incomplete/invalid charge.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.
Exceeds number/frequency approved /allowed within time period without support
documentation.




                                                      Page 457
                                                   CARCs_Query2




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Missing/incomplete/invalid place of service. Note: (Modified 2/28/03)




 Missing/incomplete/invalid name or provider identifier for the rendering/referring/
ordering/ supervising provider.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.
This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 458
                                                   CARCs_Query2


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)


Payment based on authorized amount.


Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 459
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)



Payment for this service has been issued to another provider.



Service/procedure not covered when performed in this place of service.



Service/procedure not covered when performed in this place of service.



Service/procedure not covered when performed in this place of service.




Patient ineligible for this service. Note: (Modified 6/30/03)

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service. Note: (Modified 6/30/03)


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 460
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid principal procedure code.

Exceeds number/frequency approved /allowed within time period without support
documentation.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Misrouted claim. See the payer's claim submission instructions.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service. Note: (Modified 6/30/03)


Patient ineligible for this service. Note: (Modified 6/30/03)


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




                                                      Page 461
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


This claim/service must be billed according to the schedule for this plan.

Payment based on authorized amount.


Payment based on an alternate fee schedule.


This claim/service must be billed according to the schedule for this plan.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service. Note: (Modified 6/30/03)


This claim/service must be billed according to the schedule for this plan.




Services deemed cosmetic are not covered


Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)



Missing completed referral form.




                                                      Page 462
                                                   CARCs_Query2



Payment is being issued on a conditional basis. If no-fault insurance, liability
insurance, Workers' Compensation, Department of Veterans Affairs, or a group
health plan for employees and dependents also covers this claim, a refund may be
due us. Please contact us if the patient is covered by any of these sources.




Patient ineligible for this service. Note: (Modified 6/30/03)


Payment based on authorized amount.


Missing/incomplete/invalid treatment authorization code.




Patient ineligible for this service. Note: (Modified 6/30/03)

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



Misrouted claim. See the payer's claim submission instructions.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Payment based on authorized amount.




Misrouted claim. See the payer's claim submission instructions.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



Patient ineligible for this service.




                                                      Page 463
                                                   CARCs_Query2




Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.



Patient ineligible for this service.




Service/procedure not covered when performed in this place of service.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service.


This claim/service must be billed according to the schedule for this plan.



Missing/incomplete/invalid procedure code(s).




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 464
                                                   CARCs_Query2




Missing/incomplete/invalid procedure code(s).



Exceeds number/frequency approved /allowed within time period without support
documentation.


Patient ineligible for this service. Note: (Modified 6/30/03)


This item or service does not meet the criteria for the category under which it was
billed.




Missing/incomplete/invalid questionnaire/information required to determine
dependent eligibility.


Payment based on authorized amount.


Misrouted claim. See the payer's claim submission instructions.

Patient ineligible for this service.




Correction to a prior claim.
 Service denied because payment already made for same/similar procedure within
set time frame.


Misrouted claim. See the payer's claim submission instructions.




                                                      Page 465
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Rebill services on separate claim lines.



This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)


Provider must accept insurance payment as payment in full when a third party
payer contract specifies full reimbursement.



This provider type/provider specialty may not bill this service.



This service/report cannot be billed separately.




Service/procedure not covered when performed in this place of service.




Patient ineligible for this service. Note: (Modified 6/30/03)


Claim must be submitted by the provider who rendered the service.




                                                      Page 466
                                                   CARCs_Query2




Exceeds number/frequency approved /allowed within time period without support
documentation.




This provider type/provider specialty may not bill this service.


Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)




The original claim has been processed, submit a corrected claim.

 Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Missing/incomplete/invalid treatment authorization code.


The number of Days or Units of Service exceeds our acceptable maximum.



This provider type/provider specialty may not bill this service.




Correction to a prior claim.


Payment based on authorized amount.



                                                      Page 467
                                                   CARCs_Query2




Service/procedure not covered when performed in this place of service.




Missing/incomplete/invalid name, strength, or dosage of the drug furnished.



Misrouted claim. See the payer's claim submission instructions.

Consult our contractual agreement for restrictions/billing/payment information
related to these charges.


Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)


Missing patient medical record for this service.




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




Service/procedure not covered when performed in this place of service.



Misrouted claim. See the payer's claim submission instructions.



                                                      Page 468
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.




Missing/incomplete/invalid patient identifier.



Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)


Misrouted claim. See the payer's claim submission instructions.




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 469
                                                   CARCs_Query2




Incomplete/invalid documentation/orders/notes/summary/report/chart.



Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




The original claim has been processed, submit a corrected claim.
 This service is related to an accidental injury and is not covered unless provided
within a specific time frame from the date of the accident.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Misrouted claim. See the payer's claim submission instructions.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




                                                      Page 470
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Exceeds number/frequency approved /allowed within time period without support
documentation.


Misrouted claim. See the payer's claim submission instructions.


This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)



Service/procedure not covered when performed in this place of service.


This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 471
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


Misrouted claim. See the payer's claim submission instructions.


Payment based on authorized amount.




Rebill services on separate claims.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


The number of Days or Units of Service exceeds our acceptable maximum.


Missing/incomplete/invalid treatment authorization code.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.



Service/procedure not covered when performed in this place of service.




Patient ineligible for this service. Note: (Modified 6/30/03)


                                                      Page 472
                                                   CARCs_Query2




The number of Days or Units of Service exceeds our acceptable maximum.
Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)


Missing/incomplete/invalid treatment authorization code.


Patient ineligible for this service. Note: (Modified 6/30/03)




The number of Days or Units of Service exceeds our acceptable maximum.




Requested information not provided. The claim will be reopened if the information
previously requested is submitted within one year after the date of this denial
notice.

Patient ineligible for this service. Note: (Modified 6/30/03)




Missing documentation of benefit to the patient during initial treatment period



Service not covered until after the patient’s 50th birthday, i.e., no coverage prior to
the day after the 50th birthday




                                                       Page 473
                                                   CARCs_Query2




Not covered more than once in a 12 month period.


The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.


Patient ineligible for this service.



Patient ineligible for this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 474
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.


This provider type/provider specialty may not bill this service.
Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)

Patient ineligible for this service. Note: (Modified 6/30/03)


Payment based on authorized amount.

Exceeds number/frequency approved /allowed within time period without support
documentation.

The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

Exceeds number/frequency approved /allowed within time period without support
documentation.


The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.



The number of Days or Units of Service exceeds our acceptable maximum.



                                                      Page 475
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


Patient ineligible for this service. Note: (Modified 6/30/03)

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 476
                                                   CARCs_Query2




Missing Certificate of Medical Necessity.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service. Note: (Modified 6/30/03)

Patient ineligible for this service. Note: (Modified 6/30/03)


Patient ineligible for this service. Note: (Modified 6/30/03)




Missing x-ray. Note: (Modified 2/1/04) Related to N242




Patient ineligible for this service. Note: (Modified 6/30/03)




Service/procedure not covered when performed in this place of service.



Payment based on authorized amount.




                                                      Page 477
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)

Exceeds number/frequency approved /allowed within time period without support
documentation.

Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)

Exceeds number/frequency approved /allowed within time period without support
documentation.



The number of Days or Units of Service exceeds our acceptable maximum.



The number of Days or Units of Service exceeds our acceptable maximum.

Exceeds number/frequency approved /allowed within time period without support
documentation.


Missing/incomplete/invalid treatment authorization code.




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




                                                      Page 478
                                                   CARCs_Query2




The number of Days or Units of Service exceeds our acceptable maximum.
Service denied because payment already made for same/similar procedure within
set time frame.


Patient ineligible for this service. Note: (Modified 6/30/03)

The number of Days or Units of Service exceeds our acceptable maximum.


Misrouted claim. See the payer's claim submission instructions.

Service denied because payment already made for same/similar procedure within
set time frame.




Missing/incomplete/invalid prior insurance carrier EOB. Note: (Modified 2/28/03)




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Missing x-ray. Note: (Modified 2/1/04) Related to N242

Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 479
                                                   CARCs_Query2




Missing x-ray. Note: (Modified 2/1/04) Related to N242




Missing documentation/orders/notes/summary/report/chart.


This provider type/provider specialty may not bill this service.

Patient ineligible for this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid HCPCS. Note: (Modified 2/28/03)
Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 480
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)
This item or service does not meet the criteria for the category under which it was
billed.




Patient ineligible for this service. Note: (Modified 6/30/03)

Patient ineligible for this service. Note: (Modified 6/30/03)



Misrouted claim. See the payer's claim submission instructions.




Your claim has been separated to expedite handling. You will receive a separate
notice for the other services reported.




Patient ineligible for this service. Note: (Modified 6/30/03)




Incorrect claim form/format for this service. Note: (Modified 11/18/05)

Exceeds number/frequency approved /allowed within time period without support
documentation.




                                                      Page 481
                                                   CARCs_Query2




Missing/incomplete/invalid prior insurance carrier EOB.


Missing/incomplete/invalid revenue code(s).


Missing/incomplete/invalid procedure code(s).



Payment based on authorized amount.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Consult our contractual agreement for restrictions/billing/payment information
related to these charges.


This provider type/provider specialty may not bill this service.


Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)


This claim/service must be billed according to the schedule for this plan.


Misrouted claim. See the payer's claim submission instructions.




                                                      Page 482
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.


This service/report cannot be billed separately.
Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301

Patient ineligible for this service. Note: (Modified 6/30/03)




Claim information is inconsistent with pre-certified/authorized services.



Missing/incomplete/invalid treatment authorization code.



The number of Days or Units of Service exceeds our acceptable maximum.




Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.


Missing/incomplete/invalid treatment authorization code.


This provider type/provider specialty may not bill this service.


Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid treatment authorization code.



Correction to a prior claim.




                                                      Page 483
                                                   CARCs_Query2




Additional information is required from another provider involved in this service.


Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)


Missing/incomplete/invalid treatment authorization code.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service. Note: (Modified 6/30/03)


This provider type/provider specialty may not bill this service.


This item or service does not meet the criteria for the category under which it was
billed.


Missing/incomplete/invalid treatment authorization code.

We have no record that you are licensed to dispensed drugs in the State where
located.

Exceeds number/frequency approved /allowed within time period without support
documentation.




                                                      Page 484
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)



This is not covered since it is considered routine.



Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid billing provider/supplier name.




Missing/incomplete/invalid beginning and ending dates of the period billed. Note:
(Modified 2/28/03)

Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




                                                      Page 485
                                                   CARCs_Query2




Additional information is required from another provider involved in this service.




Missing/incomplete/invalid name, strength, or dosage of the drug furnished.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Rebill services on separate claims.


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.

Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)

This item or service does not meet the criteria for the category under which it was
billed.




                                                      Page 486
                                                   CARCs_Query2




Missing/incomplete/invalid treatment authorization code.



Misrouted claim. See the payer's claim submission instructions.




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




Patient ineligible for this service. Note: (Modified 6/30/03)


This provider type/provider specialty may not bill this service.


Alert: Additional information/explanation will be sent separately




Patient ineligible for this service. Note: (Modified 6/30/03)

This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.


Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 487
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.



 Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.


Missing/incomplete/invalid procedure code(s).




                                                      Page 488
                                                   CARCs_Query2




Procedure code billed is not correct/valid for the services billed or the date of
service billed. Note: (Modified 2/28/03)

This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.



Misrouted claim. See the payer's claim submission instructions.


Alert: Additional information/explanation will be sent separately




Missing patient medical record for this service.




Missing/incomplete/invalid date of current illness or symptoms Note: (Modified
2/28/03, 3/30/05)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


                                                      Page 489
                                                   CARCs_Query2




The number of Days or Units of Service exceeds our acceptable maximum.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid anesthesia time/units




Patient ineligible for this service. Note: (Modified 6/30/03)


This provider type/provider specialty may not bill this service.


Misrouted claim. See the payer's claim submission instructions.


The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This company has been contracted by your benefit plan to provide administrative
claims payment services only. This company does not assume financial risk or
obligation with respect to claims processed on behalf of your benefit plan.




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 490
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service. Note: (Modified 6/30/03)



Payment for this service has been issued to another provider.




Missing patient medical record for this service.

Exceeds number/frequency approved /allowed within time period without support
documentation.
Exceeds number/frequency approved /allowed within time period without support
documentation.


The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




Your claim has been separated to expedite handling. You will receive a separate
notice for the other services reported.




                                                      Page 491
                                                   CARCs_Query2




'Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing documentation/orders/notes/summary/report/chart.
This service is related to an accidental injury and is not covered unless provided
within a specific time frame from the date of the accident.

This item or service does not meet the criteria for the category under which it was
billed.




Missing/incomplete/invalid name, strength, or dosage of the drug furnished.




Missing/incomplete/invalid patient name.




                                                       Page 492
                                                  CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)
 Exceeds number/frequency approved /allowed within time period without support
documentation.




The original claim has been processed, submit a corrected claim.

Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.


No rental payments after the item is purchased, or after the total of issued rental
payments equals the purchase price.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service. Note: (Modified 6/30/03)
Service denied because payment already made for same/similar procedure within
set time frame.




Incorrect claim form/format for this service. Note: (Modified 11/18/05)


                                                     Page 493
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.


Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid name, strength, or dosage of the drug furnished.




Patient ineligible for this service. Note: (Modified 6/30/03)

The number of Days or Units of Service exceeds our acceptable maximum.


Missing/incomplete/invalid treatment authorization code.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid days or units of service. Note: (Modified 2/28/03)




                                                      Page 494
                                                   CARCs_Query2




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Claim information is inconsistent with pre-certified/authorized services


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




Additional information is required from another provider involved in this service.




This provider type/provider specialty may not bill this service.




Exceeds number/frequency approved /allowed within time period without support
documentation.



                                                      Page 495
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.



This provider type/provider specialty may not bill this service.




Payment based on authorized amount.




This is not covered since it is considered routine.


The number of Days or Units of Service exceeds our acceptable maximum.

This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Missing x-ray. Note: (Modified 2/1/04) Related to N242




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid information on the period of time for which the
service/supply/equipment will be needed.




                                                      Page 496
                                                   CARCs_Query2




Missing/incomplete/invalid treatment authorization code.




Incomplete/invalid patient medical record for this service.




Missing/incomplete/invalid referring provider name.




Missing/incomplete/invalid treatment authorization code.




The number of Days or Units of Service exceeds our acceptable maximum.




We do not pay for more than one of these on the same day.




Not covered more than once in a 12 month period.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing patient medical record for this service.




                                                      Page 497
                                                   CARCs_Query2




Payment based on authorized amount.




This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)
Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Payment based on authorized amount.




Missing patient medical record for this service.




Missing itemized bill. Note: (Modified 2/28/03) Related to N232



                                                      Page 498
                                                   CARCs_Query2




This is not covered since it is considered routine.



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid provider/supplier signature. Note: (Modified 2/28/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




This provider type/provider specialty may not bill this service.

Consult our contractual agreement for restrictions/billing/payment information
related to these charges.

Consult our contractual agreement for restrictions/billing/payment information
related to these charges.




                                                      Page 499
                                                   CARCs_Query2




 This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Missing Certificate of Medical Necessity.




Patient ineligible for this service. Note: (Modified 6/30/03)




Claim information is inconsistent with pre-certified/authorized services.



The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




This claim/service must be billed according to the schedule for this plan.


Missing/incomplete/invalid treatment authorization code.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 500
                                                   CARCs_Query2




This claim/service must be billed according to the schedule for this plan.




This claim/service must be billed according to the schedule for this plan.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)



Missing/incomplete/invalid procedure code(s).




Claim must meet primary payer’s processing requirements before we can consider
payment.



Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 501
                                                   CARCs_Query2




Procedure code billed is not correct/valid for the services billed or the date of
service billed.




Patient ineligible for this service. Note: (Modified 6/30/03)


Payment based on authorized amount.



This claim/service must be billed according to the schedule for this plan.



This provider type/provider specialty may not bill this service.




Misrouted claim. See the payer's claim submission instructions.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 502
                                                CARCs_Query2




Missing plan information for other insurance.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Claim information does not agree with information received from other insurance
carrier.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




                                                   Page 503
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.



Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.



This provider type/provider specialty may not bill this service.



The number of Days or Units of Service exceeds our acceptable maximum.




Missing/incomplete/invalid charge.




Missing/incomplete/invalid charge.




Service denied because payment already made for same/similar procedure within
set time frame.




                                                      Page 504
                                                   CARCs_Query2




Incomplete/invalid support data for claim.




This provider type/provider specialty may not bill this service.


The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.




Rebill services on separate claim lines.




Misrouted claim. See the payer's claim submission instructions.



Misrouted claim. See the payer's claim submission instructions.




Correction to a prior claim.



Missing/incomplete/invalid treatment authorization code.


Procedure code incidental to primary procedure.



                                                      Page 505
                                                   CARCs_Query2




Service denied because payment already made for same/similar procedure within
set time frame.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Rebill services on separate claim lines.


This provider type/provider specialty may not bill this service.




Missing/incomplete/invalid treatment authorization code.


Patient ineligible for this service.




Rebill services on separate claim lines.


This claim/service must be billed according to the schedule for this plan.




Missing/incomplete/invalid treatment authorization code.




                                                      Page 506
                                                   CARCs_Query2




Missing/incomplete/invalid treatment authorization code.




This claim/service must be billed according to the schedule for this plan.




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This provider type/provider specialty may not bill this service.




Incomplete/invalid documentation of benefit to the patient during initial treatment
period.




Missing patient medical record for this service.




                                                      Page 507
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.


Patient ineligible for this service.



Payment based on authorized amount.


Payment based on authorized amount.


Misrouted claim. See the payer's claim submission instructions.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.


This provider type/provider specialty may not bill this service.




                                                      Page 508
                                                   CARCs_Query2




The technical component must be billed separately.


Misrouted claim. See the payer's claim submission instructions.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid name or provider identifier for the rendering/referring/
ordering/ supervising provider.



Missing/incomplete/invalid treatment authorization code.




Patient ineligible for this service. Note: (Modified 6/30/03)



Exceeds number/frequency approved /allowed within time period without support
documentation.




Misrouted claim. See the payer's claim submission instructions.




                                                      Page 509
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.




Additional information has been requested from the member. The charges will be
reconsidered upon receipt of that information.


Misrouted claim. See the payer's claim submission instructions.


This provider type/provider specialty may not bill this service.


Patient ineligible for this service.




Missing patient medical record for this service.


This item or service does not meet the criteria for the category under which it was
billed.

Exceeds number/frequency approved /allowed within time period without support
documentation.


Misrouted claim. See the payer's claim submission instructions.




Incorrect claim form/format for this service. Note: (Modified 11/18/05)




                                                      Page 510
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.
Your claim contains incomplete and/or invalid information, and no appeal rights are
afforded because the claim is unprocessable. Please submit a new claim with the
complete/correct information.


Missing/incomplete/invalid treatment authorization code.


Missing/incomplete/invalid treatment authorization code.


Missing/incomplete/invalid treatment authorization code.




Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid procedure code(s).


Misrouted claim. See the payer's claim submission instructions.


Missing/incomplete/invalid treatment authorization code.
This item or service does not meet the criteria for the category under which it was
billed.


Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 511
                                                 CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Misrouted claim. See the payer's claim submission instructions.




Service denied because payment already made for same/similar procedure within
set time frame.




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.



                                                    Page 512
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.

Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service. Note: (Modified 6/30/03)

Exceeds number/frequency approved /allowed within time period without support
documentation.

Missing/incomplete/invalid questionnaire/information required to determine
dependent eligibility.




Service/procedure not covered when performed in this place of service.



Payment based on authorized amount.




Misrouted claim. See the payer's claim submission instructions.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Misrouted claim. See the payer's claim submission instructions.


Not covered more than once in a 12 month period.




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 513
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


Not covered more than once in a 12 month period.


This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Missing/incomplete/invalid rendering provider primary identifier.


Misrouted claim. See the payer's claim submission instructions.




This provider type/provider specialty may not bill this service.




Missing/incomplete/invalid treatment authorization code.




This provider type/provider specialty may not bill this service.




Rebill services on separate claim lines.




                                                      Page 514
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Missing/incomplete/invalid treatment authorization code.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Payment based on authorized amount.



Misrouted claim. See the payer's claim submission instructions.



Your claim contains incomplete and/or invalid information, and no appeal rights are
afforded because the claim is unprocessable. Please submit a new claim with the
complete/correct information.




                                                      Page 515
                                                   CARCs_Query2




Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Misrouted claim. See the payer's claim submission instructions.




Missing documentation/orders/notes/summary/report/chart. Note: (Modified
2/28/03, 8/1/05) Related to N225




Misrouted claim. See the payer's claim submission instructions.




                                                      Page 516
                                                CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.



Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.



Your claim contains incomplete and/or invalid information, and no appeal rights are
afforded because the claim is unprocessable. Please submit a new claim with the
complete/correct information.




Exceeds number/frequency approved /allowed within time period without support
documentation.




Misrouted claim. See the payer's claim submission instructions.




Payment based on authorized amount.


                                                   Page 517
                                                 CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid patient identifier.




Misrouted claim. See the payer's claim submission instructions.


This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Missing/incomplete/invalid tooth number/letter. Note: (Modified 2/28/03)




Missing/incomplete/invalid tooth number/letter. Note: (Modified 2/28/03)




Patient ineligible for this service.




                                                   Page 518
                                                   CARCs_Query2




Missing/incomplete/invalid tooth number/letter. Note: (Modified 2/28/03)


Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid tooth number/letter. Note: (Modified 2/28/03)


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Misrouted claim. See the payer's claim submission instructions.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




                                                      Page 519
                                                   CARCs_Query2




The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.




Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.
Requested information not provided. The claim will be reopened if the information
previously requested is submitted within one year after the date of this denial
notice.


This claim/service must be billed according to the schedule for this plan.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.




                                                      Page 520
                                                CARCs_Query2




Missing/incomplete/invalid name, strength, or dosage of the drug furnished.



Misrouted claim. See the payer's claim submission instructions.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Rebill services on separate claims.




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301




                                                   Page 521
                                                CARCs_Query2




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.




Missing operative report. Note: (Modified 2/28/03) Related to N233




 Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.


Missing/incomplete/invalid treatment authorization code.




                                                   Page 522
                                                   CARCs_Query2




 Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.




Additional information is required from another provider involved in this service.

Missing patient medical record for this service.


The number of Days or Units of Service exceeds our acceptable maximum.


Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 523
                                                   CARCs_Query2



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.

Pre-/post-operative care payment is included in the allowance for the
surgery/procedure.

Pre-/post-operative care payment is included in the allowance for the
surgery/procedure.




Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid billing provider/supplier name.




                                                      Page 524
                                                   CARCs_Query2




Missing/incomplete/invalid other payer rendering provider identifier.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid rendering provider name.

Exceeds number/frequency approved /allowed within time period without support
documentation.




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301


Not covered more than once in a 12 month period.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 525
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 526
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)

Exceeds number/frequency approved /allowed within time period without support
documentation.




                                                      Page 527
                                                 CARCs_Query2




Service not payable with other service rendered on the same date.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



The number of Days or Units of Service exceeds our acceptable maximum.

Exceeds number/frequency approved /allowed within time period without support
documentation.




Exceeds number/frequency approved /allowed within time period without support
documentation.


The number of Days or Units of Service exceeds our acceptable maximum.


Not covered more than once in a 12 month period.




The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.


Not covered more than once in a 12 month period.

Pre-/post-operative care payment is included in the allowance for the
surgery/procedure.

This item or service does not meet the criteria for the category under which it was
billed.


                                                    Page 528
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.


Claim information is inconsistent with pre-certified/authorized services.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


The number of Days or Units of Service exceeds our acceptable maximum.


This service/report cannot be billed separately.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid questionnaire/information required to determine
dependent eligibility.


Misrouted claim. See the payer's claim submission instructions.


Specific federal/state/local program may cover this service through another payer.




                                                      Page 529
                                                   CARCs_Query2




Missing patient medical record for this service.




Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)




This provider type/provider specialty may not bill this service.




This item or service does not meet the criteria for the category under which it was
billed.


Misrouted claim. See the payer's claim submission instructions.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




                                                      Page 530
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.


Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)


Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.

The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




This claim/service must be billed according to the schedule for this plan.




                                                      Page 531
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)


Missing/incomplete/invalid treatment authorization code.

The number of Days or Units of Service exceeds our acceptable maximum.
Exceeds number/frequency approved /allowed within time period without support
documentation.




 Missing/incomplete/invalid provider identifier.




Missing/incomplete/invalid number of miles traveled.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.


This provider type/provider specialty may not bill this service.


Missing/incomplete/invalid treatment authorization code.




                                                      Page 532
                                                   CARCs_Query2



Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.


Missing/incomplete/invalid treatment authorization code.


Missing/incomplete/invalid treatment authorization code.


Misrouted claim. See the payer's claim submission instructions.




Additional information is required from another provider involved in this service.



Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid HCPCS. Note: (Modified 2/28/03)


Misrouted claim. See the payer's claim submission instructions.




                                                      Page 533
                                                   CARCs_Query2




Patient ineligible for this service.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.


Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Your claim has been separated to expedite handling. You will receive a separate
notice for the other services reported.




Missing/incomplete/invalid certification revision date.




                                                      Page 534
                                                   CARCs_Query2




Missing plan information for other insurance.


Misrouted claim. See the payer's claim submission instructions.

Patient ineligible for this service.

Exceeds number/frequency approved /allowed within time period without support
documentation.


Payment based on authorized amount.




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




Payment based on authorized amount.




Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)



Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301




                                                      Page 535
                                                   CARCs_Query2




Missing/invalid/incomplete taxpayer identification number (TIN)


Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)


Patient ineligible for this service. Note: (Modified 6/30/03)


Consult our contractual agreement for restrictions/billing/payment information
related to these charges.


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301




Correction to a prior claim.


Patient ineligible for this service.


Misrouted claim. See the payer's claim submission instructions.


                                                      Page 536
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.


Payment based on authorized amount.



Payment based on authorized amount.


Payment based on authorized amount.


Payment based on authorized amount.


This item or service does not meet the criteria for the category under which it was
billed.



This provider type/provider specialty may not bill this service.




Procedure code billed is not correct/valid for the services billed or the date of
service billed.


The number of Days or Units of Service exceeds our acceptable maximum. Note:
(New Code 11/18/05)




Missing/incomplete/invalid HCPCS. Note: (Modified 2/28/03)




                                                      Page 537
                                                  CARCs_Query2




Missing/incomplete/invalid procedure code(s).


Missing/incomplete/invalid diagnosis or condition.


Procedure code incidental to primary procedure.




Missing/incomplete/invalid days or units of service.


Missing/incomplete/invalid procedure code(s).


Missing/incomplete/invalid procedure code(s).


Missing/incomplete/invalid diagnosis or condition.




Missing/incomplete/invalid beginning and ending dates of the period billed. Note:
(Modified 2/28/03)


Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04) Related to
N301


                                                       Page 538
                                                   CARCs_Query2




 Missing/incomplete/invalid condition code.




Missing/incomplete/invalid revenue code(s). Note: (Modified 2/28/03)




Missing/incomplete/invalid procedure code(s).

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



Missing/incomplete/invalid procedure code(s).



Missing/incomplete/invalid procedure code(s).


Missing/incomplete/invalid procedure code(s).




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 539
                                                   CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Transportation to/from this destination is not covered. Note: (New Code 2/28/03,
Modified 2/1/04)


This provider type/provider specialty may not bill this service.




Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid rendering provider primary identifier. Note: (New Code
12/2/04)


The original claim was denied. Resubmit a new claim, not a replacement claim.
Note: (New Code 10/31/02)




This provider type/provider specialty may not bill this service. Note: (New code
7/31/01, Modified 2/28/03)




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 540
                                                   CARCs_Query2




Missing/incomplete/invalid procedure code(s).
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

Patient ineligible for this service.
This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.



Additional information/explanation will be sent separately Note: (New Code
6/30/03)




Primary Medicare Part A insurance has been exhausted and a Part B Remittance
Advice is required.




Patient ineligible for this service. Note: (Modified 6/30/03)




Misrouted claim. See the payer's claim submission instructions.



Misrouted claim. See the payer's claim submission instructions.



Misrouted claim. See the payer's claim submission instructions.


Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 541
                                                   CARCs_Query2




This claim/service must be billed according to the schedule for this plan.



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



This provider type/provider specialty may not bill this service.




Missing/incomplete/invalid total charges. Note: (Modified 2/28/03)

Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Your claim contains incomplete and/or invalid information, and no appeal rights are
afforded because the claim is unprocessable. Please submit a new claim with the
complete/correct information.

This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.

Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



Misrouted claim. See the payer's claim submission instructions.




                                                      Page 542
                                                   CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Missing/incomplete/invalid days or units of service. Note: (Modified 2/28/03)



Missing/incomplete/invalid treatment authorization code.




Patient ineligible for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



rmsv

Policy provides coverage supplemental to Medicare. As member does not appear
to be enrolled in Medicare Part B, the member is responsible for payment of the
portion of the charge that would have been covered by Medicare.

The professional component must be billed separately. Note: (New Code 2/28/03)



This provider type/provider specialty may not bill this service.




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.




                                                      Page 543
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service. Note: (Modified 6/30/03)




Misrouted claim. See the payer's claim submission instructions.



Misrouted claim. See the payer's claim submission instructions.


The number of Days or Units of Service exceeds our acceptable maximum.


Consult our contractual agreement for restrictions/billing/payment information
related to these charges.

No appeal right except duplicate claim/service issue. This service was included in
a claim that has been previously billed and adjudicated. Note: (New Code 2/28/02)




Missing patient medical record for this service.

Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Misrouted claim. See the payer's claim submission instructions.




                                                      Page 544
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.



Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.



This is not covered since it is considered routine.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This provider type/provider specialty may not bill this service.



Missing review organization approval.




Missing/incomplete/invalid admission source. Note: (Modified 2/28/03)

Procedure code billed is not correct/valid for the services billed or the date of
service billed.



Missing/incomplete/invalid procedure code(s).




                                                      Page 545
                                                 CARCs_Query2




Missing/incomplete/invalid rendering provider primary identifier. Note: (New Code
12/2/04)




Missing/incomplete/invalid “to” date(s) of service. Note: (Modified 2/28/03)




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Additional information has been requested from the member. The charges will be
reconsidered upon receipt of that information. Note: (New Code 2/28/03)




Patient ineligible for this service.



Missing/incomplete/invalid patient identifier.



Missing/incomplete/invalid patient identifier.




                                                    Page 546
                                                  CARCs_Query2




Missing/incomplete/invalid billing provider/supplier address.




Patient ineligible for this service.



Patient ineligible for this service.

This item or service does not meet the criteria for the category under which it was
billed.




Your claim contains incomplete and/or invalid information, and no appeal rights are
afforded because the claim is unprocessable. Please submit a new claim with the
complete/correct information.




Patient ineligible for this service.




Patient ineligible for this service.




Patient ineligible for this service.




                                                     Page 547
                                                   CARCs_Query2




Patient ineligible for this service.




Missing/incomplete/invalid billing provider/supplier primary identifier. Note: (New
Code 12/2/04)




This provider type/provider specialty may not bill this service.



This provider type/provider specialty may not bill this service.




This provider type/provider specialty may not bill this service. Note: (New code
7/31/01, Modified 2/28/03)




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Missing/incomplete/invalid charge.




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service.




                                                      Page 548
                                                   CARCs_Query2




Patient is a Medicaid/Qualified Medicare Beneficiary. Note: (New Code 2/28/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service.




Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Missing/incomplete/invalid patient relationship to insured.




This is not covered since it is considered routine.




Not eligible due to the patient's age.




                                                      Page 549
                                                   CARCs_Query2




Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.




The number of Days or Units of Service exceeds our acceptable maximum.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Misrouted claim. See the payer's claim submission instructions.




                                                      Page 550
                                                  CARCs_Query2




Missing/incomplete/invalid appliance placement date.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Procedure code incidental to primary procedure.




Alert: Additional information/explanation will be sent separately




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




                                                     Page 551
                                                   CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Misrouted claim. See the payer's claim submission instructions.



Procedure code billed is not correct/valid for the services billed or the date of
service billed.




Missing/incomplete/invalid procedure code(s).




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


 Procedure code billed is not correct/valid for the services billed or the date of
service billed.



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Missing/incomplete/invalid procedure code(s).




Missing/incomplete/invalid procedure code(s).


 Missing/incomplete/invalid procedure date(s).




                                                      Page 552
                                                  CARCs_Query2




Missing/incomplete/invalid procedure code(s).




Missing/incomplete/invalid revenue code(s).




Missing/incomplete/invalid other procedure date(s).



Procedure code incidental to primary procedure.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid other procedure code(s).




Missing/incomplete/invalid revenue code(s).




                                                      Page 553
                                                   CARCs_Query2




Service date outside of the approved treatment plan service dates.
Start: 8/1/2005



Procedure code billed is not correct/valid for the services billed or the date of
service billed.




Service denied because payment already made for same/similar procedure within
set time frame.



This item or service does not meet the criteria for the category under which it was
billed.




Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.




This item or service does not meet the criteria for the category under which it was
billed.



This item or service does not meet the criteria for the category under which it was
billed.




Missing documentation/orders/notes/summary/report/chart.




                                                      Page 554
                                                 CARCs_Query2




The subscriber must update insurance information directly with payer.Start:
2/25/2003




Patient ineligible for this service.




Patient ineligible for this service.




Patient ineligible for this service.




Patient ineligible for this service.




Patient ineligible for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.




Patient ineligible for this service.



                                                    Page 555
                                                  CARCs_Query2




Patient ineligible for this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Additional information is required from another provider involved in this service.




Claim information does not agree with information received from other insurance
carrier.



Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Missing/incomplete/invalid rendering provider name.




Missing/incomplete/invalid diagnosis or condition.




                                                     Page 556
                                                 CARCs_Query2




Alert: The NDC code submitted for this service was translated to a HCPCS code
for processing, but please continue to submit the NDC on future claims for this
item.



Misrouted claim. See the payer's claim submission instructions.



Missing/incomplete/invalid value code(s) or amount(s).




Missing Certificate of Medical Necessity.




Payment based on authorized amount.




This procedure code is not payable. It is for reporting/information purposes only.




Missing/incomplete/invalid procedure code(s).


Missing/incomplete/invalid procedure code(s).




                                                     Page 557
                                                   CARCs_Query2




Missing/incomplete/invalid information on where the services were furnished.




Missing/incomplete/invalid treatment authorization code.




Patient ineligible for this service. Note: (Modified 6/30/03)




This service cannot be billed separately.




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




 Service is not covered with this procedure.


Missing/incomplete/invalid procedure code(s).




Missing itemized bill.




                                                      Page 558
                                                   CARCs_Query2




Missing documentation/orders/notes/summary/report/chart.




Missing patient medical record for this service.




Missing/incomplete/invalid ordering provider contact information.




Missing/incomplete/invalid indicator of x-ray availability for review.




Patient ineligible for this service. Note: (Modified 6/30/03)




This provider type/provider specialty may not bill this service.




Payment based on authorized amount.




Missing patient medical record for this service.




                                                       Page 559
                                                   CARCs_Query2




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Missing patient medical record for this service.




Missing patient medical record for this service.




Not paid separately when the patient is an inpatient.




Not paid separately when the patient is an inpatient.




Missing/incomplete/invalid patient name.




Missing/incomplete/invalid patient name.



                                                        Page 560
                                                  CARCs_Query2




Missing/incomplete/invalid patient's address.




Missing/incomplete/invalid patient's address.




Missing/incomplete/invalid patient's address.




Missing/incomplete/invalid patient's address.




Missing/incomplete/invalid designated provider number.




Missing/incomplete/invalid billing provider/supplier name.




Missing/incomplete/invalid billing provider/supplier address.




Missing/incomplete/invalid billing provider/supplier address.




Missing/incomplete/invalid billing provider/supplier address.




Missing/incomplete/invalid taxpayer identification number (TIN).




                                                     Page 561
                                                   CARCs_Query2




Missing/incomplete/invalid payer identifier.




Missing/incomplete/invalid value code(s) or amount(s).




M56 Missing/incomplete/invalid payer identifier.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid billing provider/supplier address.




Missing/incomplete/invalid patient name.




Missing/incomplete/invalid patient birth date.




Missing/incomplete/invalid gender.




                                                      Page 562
                                                  CARCs_Query2




Missing/incomplete/invalid admission date.




Missing/incomplete/invalid “from” date(s) of service.




Missing/incomplete/invalid “to” date(s) of service.




Missing/incomplete/invalid days or units of service.




Missing/incomplete/invalid total charges.




Missing/incomplete/invalid total charges.




Missing/incomplete/invalid total charges.




                                                        Page 563
                                                  CARCs_Query2




Missing/incomplete/invalid total charges.




Missing/incomplete/invalid total charges.




Missing/incomplete/invalid total charges.




Missing/incomplete/invalid total charges.




Missing/incomplete/invalid total charges.




Missing/incomplete/invalid “from” date(s) of service.




Missing/incomplete/invalid “to” date(s) of service.




                                                        Page 564
                                                 CARCs_Query2




Missing/incomplete/invalid diagnosis or condition.




Missing/incomplete/invalid procedure code(s).




Missing/incomplete/invalid days or units of service.




Missing/incomplete/invalid days or units of service.




Missing/incomplete/invalid charge.




Missing/incomplete/invalid gender.




Missing/incomplete/invalid discharge or end of care date.




Missing/incomplete/invalid occurrence date(s).




                                                       Page 565
                                                   CARCs_Query2




Missing/incomplete/invalid discharge or end of care date.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.


Patient ineligible for this service.




Missing/incomplete/invalid gender.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Processing of this claim/service has included consideration under Major Medical
provisions.




Missing patient medical record for this service.



Service denied because payment already made for same/similar procedure within
set time frame.




Processing of this claim/service has included consideration under Major Medical
provisions.




                                                     Page 566
                                               CARCs_Query2




Processing of this claim/service has included consideration under Major Medical
provisions.




Processing of this claim/service has included consideration under Major Medical
provisions.



Processing of this claim/service has included consideration under Major Medical
provisions.




Payment based on authorized amount.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Payment based on authorized amount.



                                                   Page 567
                                                   CARCs_Query2




Payment based on authorized amount.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Payment based on authorized amount.


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Payment based on authorized amount.




Payment based on authorized amount.




Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid treatment authorization code.




                                                      Page 568
                                                   CARCs_Query2




Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid treatment authorization code.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Payment based on authorized amount.




                                                      Page 569
                                                   CARCs_Query2




Payment based on authorized amount.




This provider type/provider specialty may not bill this service.




Payment based on authorized amount.




Payment based on authorized amount.




Payment based on authorized amount.




Payment based on authorized amount.




Payment based on authorized amount.




his allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




                                                      Page 570
                                                   CARCs_Query2




 Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




 Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Payment based on previous payer's allowed amount.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.


Payment based on the findings of a review organization/professional
consult/manual adjudication/medical or dental advisor.



Payment based on previous payer's allowed amount.


 Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Payment based on authorized amount.




                                                       Page 571
                                                   CARCs_Query2




The number of Days or Units of Service exceeds our acceptable maximum.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Payment based on authorized amount.

The number of Days or Units of Service exceeds our acceptable maximum.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This provider type/provider specialty may not bill this service.




Patient ineligible for this service.




Patient ineligible for this service.




                                                      Page 572
                                                   CARCs_Query2




Patient ineligible for this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This provider type/provider specialty may not bill this service.


Misrouted claim. See the payer's claim submission instructions.


Patient ineligible for this service.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing patient medical record for this service.


This provider type/provider specialty may not bill this service.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

Not covered more than once in a 12 month period.

Exceeds number/frequency approved /allowed within time period without support
documentation.


Exceeds number/frequency approved /allowed within time period without support
documentation.


Exceeds number/frequency approved /allowed within time period without support
documentation.



Misrouted claim. See the payer's claim submission instructions.



                                                      Page 573
                                                   CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This provider type/provider specialty may not bill this service.

Patient ineligible for this service.




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service.




Patient ineligible for this service.




Patient ineligible for this service.




                                                      Page 574
                                                 CARCs_Query2




Patient ineligible for this service.



Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service.
Exceeds number/frequency approved /allowed within time period without support
documentation.




Exceeds number/frequency approved /allowed within time period without support
documentation.




Exceeds number/frequency approved /allowed within time period without support
documentation.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.




                                                    Page 575
                                                 CARCs_Query2




Patient ineligible for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.




Patient ineligible for this service.




The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.




Not eligible due to the patient's age.


                                                    Page 576
                                                CARCs_Query2




Not eligible due to the patient's age.




Not eligible due to the patient's age.




Not eligible due to the patient's age.




Not eligible due to the patient's age.




Not eligible due to the patient's age.


The number of Days or Units of Service exceeds our acceptable maximum.




Not eligible due to the patient's age.
This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.



Payment based on authorized amount.

Payment based on authorized amount.



Payment for this service has been issued to another provider.

Service denied because payment already made for same/similar procedure within
set time frame.


Patient ineligible for this service.




                                                   Page 577
                                                 CARCs_Query2




Patient ineligible for this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid procedure code(s).



Patient ineligible for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



                                                    Page 578
                                                   CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.




This provider type/provider specialty may not bill this service.




The number of Days or Units of Service exceeds our acceptable maximum.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not covered since it is considered routine.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 579
                                                   CARCs_Query2




Missing/incomplete/invalid indicator of x-ray availability for review.



This provider type/provider specialty may not bill this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.


The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                       Page 580
                                                   CARCs_Query2




Patient ineligible for this service.



Payment based on authorized amount.

This provider type/provider specialty may not bill this service.


This provider type/provider specialty may not bill this service.




This is not covered since it is considered routine.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 581
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This provider type/provider specialty may not bill this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Patient ineligible for this service.




This provider type/provider specialty may not bill this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

The number of Days or Units of Service exceeds our acceptable maximum.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


                                                      Page 582
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Patient ineligible for this service.




This provider type/provider specialty may not bill this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.




This provider type/provider specialty may not bill this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 583
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.




Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.



Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.




                                                      Page 584
                                                   CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This provider type/provider specialty may not bill this service.



This provider type/provider specialty may not bill this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.

Patient ineligible for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This provider type/provider specialty may not bill this service.


Misrouted claim. See the payer's claim submission instructions.




                                                      Page 585
                                                   CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This provider type/provider specialty may not bill this service.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Service/procedure not covered when performed in this place of service.




Missing/incomplete/invalid procedure code(s).

This provider type/provider specialty may not bill this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Patient ineligible for this service.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 586
                                                 CARCs_Query2




This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Misrouted claim. See the payer's claim submission instructions.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.




Misrouted claim. See the payer's claim submission instructions.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


The number of Days or Units of Service exceeds our acceptable maximum.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.




                                                    Page 587
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This provider type/provider specialty may not bill this service.




Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.




This is not covered since it is considered routine.



Service/procedure not covered when performed in this place of service.




Misrouted claim. See the payer's claim submission instructions.




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Misrouted claim. See the payer's claim submission instructions.


Service/procedure not covered when performed in this place of service.

Patient ineligible for this service.




Patient ineligible for this service.


Patient ineligible for this service.




                                                      Page 588
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.

Missing/incomplete/invalid treatment authorization code.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing/incomplete/invalid diagnosis or condition.

Missing/incomplete/invalid procedure code(s).

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.




Missing/incomplete/invalid days or units of service.




Missing/incomplete/invalid procedure code(s).




Patient ineligible for this service.


This service/report cannot be billed separately.



Service/procedure not covered when performed in this place of service.

Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.




                                                       Page 589
                                                   CARCs_Query2




Patient ineligible for this service.




Patient ineligible for this service.

Incomplete/invalid patient medical record for this service.



This item or service does not meet the criteria for the category under which it was
billed.



Payment based on authorized amount.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.




Missing patient medical record for this service.




Missing/incomplete/invalid accident date.




                                                     Page 590
                                                   CARCs_Query2




Missing patient medical record for this service.




Missing patient medical record for this service.




Missing/incomplete/invalid plan of treatment.




Missing patient medical record for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing/incomplete/invalid charge.




                                                     Page 591
                                                 CARCs_Query2




Missing/incomplete/invalid referring provider name.




Missing/incomplete/invalid treatment authorization code.




Missing/incomplete/invalid treatment authorization code.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




The number of Days or Units of Service exceeds our acceptable maximum.




Missing/incomplete/invalid prior insurance carrier EOB.


The number of Days or Units of Service exceeds our acceptable maximum.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Missing/incomplete/invalid prior insurance carrier EOB.




                                                      Page 592
                                                   CARCs_Query2




Missing/incomplete/invalid anesthesia time/units




Missing patient medical record for this service.




Patient ineligible for this service.




Missing/incomplete/invalid patient name.




Missing/incomplete/invalid description of service for a Not Otherwise Classified
(NOC) code or for an Unlisted/By Report procedure.




Missing patient medical record for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                     Page 593
                                                   CARCs_Query2




Service denied because payment already made for same/similar procedure within
set time frame.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing patient medical record for this service.




Missing/incomplete/invalid condition code.

This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Our records indicate that we should be the third payer for this claim. We cannot
process this claim until we have received payment information from the primary
and secondary payers.


The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.




Covered only when performed by the primary treating physician or the designee.




                                                     Page 594
                                                   CARCs_Query2




Covered only when performed by the primary treating physician or the designee.


Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Missing/incomplete/invalid place of service.




This claim/service must be billed according to the schedule for this plan.




Service is not covered when patient is under age 50.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.


Misrouted claim. See the payer's claim submission instructions.


No appeal right except duplicate claim/service issue. This service was included in
a claim that has been previously billed and adjudicated.




Patient ineligible for this service.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This provider type/provider specialty may not bill this service.



                                                      Page 595
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




ot paid separately when the patient is an inpatient.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.

This provider type/provider specialty may not bill this service.



Not paid separately when the patient is an inpatient.



This item or service does not meet the criteria for the category under which it was
billed.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.
This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Patient ineligible for this service.



                                                        Page 596
                                                   CARCs_Query2




Missing/incomplete/invalid gender.




Missing/incomplete/invalid gender.




Patient ineligible for this service.



Missing/incomplete/invalid treatment authorization code.




Patient ineligible for this service.




Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid place of service.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


Procedure code billed is not correct/valid for the services billed or the date of
service billed.



                                                      Page 597
                                                  CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Incorrect claim form/format for this service.

Service denied because payment already made for same/similar procedure within
set time frame.

This claim/service must be billed according to the schedule for this plan.




Patient ineligible for this service.

This item or service does not meet the criteria for the category under which it was
billed.




This claim/service must be billed according to the schedule for this plan.


This item or service does not meet the criteria for the category under which it was
billed.


Missing/incomplete/invalid procedure code(s).




This service is not covered when performed with, or subsequent to, a non-covered
service.




This claim/service must be billed according to the schedule for this plan.




This is not covered since it is considered routine.


                                                      Page 598
                                                   CARCs_Query2




Payment based on authorized amount.


This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.                                               The
                                                                               number of
                                                                               Days or
The number of Days or Units of Service exceeds our acceptable maximum.         Units of


The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.




Not eligible due to the patient's age.

Patient ineligible for this service.

Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.


The number of Days or Units of Service exceeds our acceptable maximum.
Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




                                                      Page 599
                                                 CARCs_Query2




The number of Days or Units of Service exceeds our acceptable maximum.


Patient ineligible for this service.




Patient ineligible for this service.

Patient ineligible for this service.




Patient ineligible for this service.


Patient ineligible for this service.



Patient ineligible for this service.



Patient ineligible for this service.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.




Alert: This decision may be reviewed if additional documentation as described in
the contract or plan benefit documents is submitted.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.




                                                    Page 600
                                                 CARCs_Query2




Patient ineligible for this service.




Patient ineligible for this service.

Patient ineligible for this service.




Patient ineligible for this service.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.




Missing plan information for other insurance.




Missing radiology film(s)/image(s).



This claim was chosen for complex review and was denied after reviewing the
medical records.




                                                    Page 601
                                                 CARCs_Query2




Patient ineligible for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




The number of Days or Units of Service exceeds our acceptable maximum.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Not eligible due to the patient's age.




Not eligible due to the patient's age.


The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.




Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.




                                                    Page 602
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Not eligible due to the patient's age.




Not eligible due to the patient's age.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

The number of Days or Units of Service exceeds our acceptable maximum.

Patient ineligible for this service.


The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


The number of Days or Units of Service exceeds our acceptable maximum.

Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.

This provider type/provider specialty may not bill this service.

Patient ineligible for this service.




                                                      Page 603
                                                 CARCs_Query2




Patient ineligible for this service.



Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.



Exceeds number/frequency approved /allowed within time period without support
documentation.



The number of Days or Units of Service exceeds our acceptable maximum.



The number of Days or Units of Service exceeds our acceptable maximum.




                                                    Page 604
                                                   CARCs_Query2




Missing Periodontal Charts.




Missing/incomplete/invalid treatment authorization code.

The number of Days or Units of Service exceeds our acceptable maximum.




This provider type/provider specialty may not bill this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.




This claim has been denied without reviewing the medical record because the
requested records were not received or were not received timely.




Services deemed cosmetic are not covered


Misrouted claim. See the payer's claim submission instructions.


Patient ineligible for this service.




                                                      Page 605
                                                 CARCs_Query2



The number of Days or Units of Service exceeds our acceptable maximum.




Misrouted claim. See the payer's claim submission instructions.


The number of Days or Units of Service exceeds our acceptable maximum.


Patient ineligible for this service.


The number of Days or Units of Service exceeds our acceptable maximum.



This item or service does not meet the criteria for the category under which it was
billed.




Patient ineligible for this service.




The number of Days or Units of Service exceeds our acceptable maximum.



Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.




Missing Periodontal Charts.




Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.




                                                    Page 606
                                                 CARCs_Query2




Missing/incomplete/invalid place of service.




Not eligible due to the patient's age.

Not eligible due to the patient's age.




This claim/service must be billed according to the schedule for this plan.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



                                                     Page 607
                                                   CARCs_Query2




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.

Patient ineligible for this service.




Missing/incomplete/invalid plan of treatment.

The number of Days or Units of Service exceeds our acceptable maximum.




This claim/service must be billed according to the schedule for this plan.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.

Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.


The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.



Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.
Exceeds number/frequency approved /allowed within time period without support
documentation.
Exceeds number/frequency approved /allowed within time period without support
documentation.
Exceeds number/frequency approved /allowed within time period without support
documentation.
Exceeds number/frequency approved /allowed within time period without support
documentation.
Exceeds number/frequency approved /allowed within time period without support
documentation.
Exceeds number/frequency approved /allowed within time period without support
documentation.




                                                      Page 608
                                                   CARCs_Query2


Exceeds number/frequency approved /allowed within time period without support
documentation.




Patient ineligible for this service.




Missing radiology report.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This provider type/provider specialty may not bill this service.


Procedure code billed is not correct/valid for the services billed or the date of
service billed.




This claim/service must be billed according to the schedule for this plan.



Missing/incomplete/invalid beginning and ending dates of the period billed.



The number of Days or Units of Service exceeds our acceptable maximum.




                                                      Page 609
                                                   CARCs_Query2



This provider type/provider specialty may not bill this service.



This provider type/provider specialty may not bill this service.



This provider type/provider specialty may not bill this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

The number of Days or Units of Service exceeds our acceptable maximum.



This provider type/provider specialty may not bill this service.


Claim information is inconsistent with pre-certified/authorized services.




The number of Days or Units of Service exceeds our acceptable maximum.



This item or service does not meet the criteria for the category under which it was
billed.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This provider type/provider specialty may not bill this service.

Service denied because payment already made for same/similar procedure within
set time frame.


Misrouted claim. See the payer's claim submission instructions.

The number of Days or Units of Service exceeds our acceptable maximum.

The number of Days or Units of Service exceeds our acceptable maximum.



                                                      Page 610
                                                    CARCs_Query2



his service is paid only once in a patient’s lifetime.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Not covered when performed during the same session/date as a previously
processed service for the patient.




Not eligible due to the patient's age.

The number of Days or Units of Service exceeds our acceptable maximum.


The number of Days or Units of Service exceeds our acceptable maximum.

Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

This item or service does not meet the criteria for the category under which it was
billed.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.
Service denied because payment already made for same/similar procedure within
set time frame.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                         Page 611
                                                 CARCs_Query2




Patient ineligible for this service.




Missing Explanation of Benefits (Coordination of Benefits or Medicare Secondary
Payer).




This item or service does not meet the criteria for the category under which it was
billed.




This payer does not cover deductibles assessed by a previous payer.




Misrouted claim. See the payer's claim submission instructions.

The number of Days or Units of Service exceeds our acceptable maximum.




Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.



Missing/incomplete/invalid procedure code(s).


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




                                                    Page 612
                                                   CARCs_Query2




Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Patient ineligible for this service.

The number of Days or Units of Service exceeds our acceptable maximum.




Missing patient medical record for this service.



This service is not covered when performed with, or subsequent to, a non-covered
service.




Patient ineligible for this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Patient ineligible for this service.


                                                     Page 613
                                                 CARCs_Query2



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service.




Not eligible due to the patient's age.




Misrouted claim. See the payer's claim submission instructions.

The number of Days or Units of Service exceeds our acceptable maximum.




Missing/incomplete/invalid type of bill.


This claim/service must be billed according to the schedule for this plan.



Time frame requirements between this service/procedure/supply and a related
service/procedure/supply have not been met.




Misrouted claim. See the payer's claim submission instructions.




Patient ineligible for this service.




                                                     Page 614
                                                   CARCs_Query2




Service/procedure not covered when performed in this place of service.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Service/procedure not covered when performed in this place of service.




Not eligible due to the patient's age.


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid treatment authorization code.



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




The number of Days or Units of Service exceeds our acceptable maximum.



Service not payable with other service rendered on the same date.




This provider type/provider specialty may not bill this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



                                                      Page 615
                                                 CARCs_Query2




This item or service does not meet the criteria for the category under which it was
billed.




The number of Days or Units of Service exceeds our acceptable maximum.




Patient ineligible for this service.



Patient ineligible for this service.




Patient ineligible for this service.
No appeal right except duplicate claim/service issue. This service was included in
a claim that has been previously billed and adjudicated.


This provider type/provider specialty may not bill this service.
This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.


The number of Days or Units of Service exceeds our acceptable maximum.

Missing/incomplete/invalid treatment authorization code.




This item or service does not meet the criteria for the category under which it was
billed.

This item or service does not meet the criteria for the category under which it was
billed.




                                                    Page 616
                                                 CARCs_Query2




This item or service does not meet the criteria for the category under which it was
billed.




Missing/incomplete/invalid HCPCS.




Missing/incomplete/invalid place of service.




Misrouted claim. See the payer's claim submission instructions.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.



Patient ineligible for this service.
Exceeds number/frequency approved /allowed within time period without support
documentation.




Missing/incomplete/invalid revenue code(s).




This claim/service must be billed according to the schedule for this plan.




                                                     Page 617
                                                   CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid HCPCS.




The number of Days or Units of Service exceeds our acceptable maximum.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

Exceeds number/frequency approved /allowed within time period without support
documentation.



This provider type/provider specialty may not bill this service.



The number of Days or Units of Service exceeds our acceptable maximum.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 618
                                                 CARCs_Query2




The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.


Missing/incomplete/invalid procedure code(s).
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




he provider must update license information with the payer.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing/incomplete/invalid diagnosis or condition.




Missing/incomplete/invalid treatment authorization code.




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




Missing/incomplete/invalid total charges.




                                                     Page 619
                                                   CARCs_Query2




Missing/incomplete/invalid condition code.




Missing/incomplete/invalid other diagnosis.


Procedure code billed is not correct/valid for the services billed or the date of
service billed.


Payment for this service has been issued to another provider.



This item or service does not meet the criteria for the category under which it was
billed.




Missing Certificate of Medical Necessity.




This provider type/provider specialty may not bill this service.

This drug/service/supply is covered only when the associated service is covered.




Missing/incomplete/invalid plan of treatment.


Misrouted claim. See the payer's claim submission instructions.




                                                      Page 620
                                                CARCs_Query2




Misrouted claim. See the payer's claim submission instructions.




Misrouted claim. See the payer's claim submission instructions.




Requested information not provided. The claim will be reopened if the information
previously requested is submitted within one year after the date of this denial
notice.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.



Patient ineligible for this service.



Exceeds number/frequency approved /allowed within time period without support
documentation.




The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.



The number of Days or Units of Service exceeds our acceptable maximum.




The number of Days or Units of Service exceeds our acceptable maximum.



The number of Days or Units of Service exceeds our acceptable maximum.




                                                   Page 621
                                                 CARCs_Query2




The number of Days or Units of Service exceeds our acceptable maximum.




Missing/incomplete/invalid “from” date(s) of service.

Missing/incomplete/invalid other diagnosis.

Missing/incomplete/invalid other diagnosis.




Service/procedure not covered when performed in this place of service.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

Missing documentation/orders/notes/summary/report/chart.




Missing/incomplete/invalid accident date.




The number of Days or Units of Service exceeds our acceptable maximum.




                                                        Page 622
                                                 CARCs_Query2




Patient ineligible for this service.

Denied services exceed the coverage limit for the demonstration.


The number of Days or Units of Service exceeds our acceptable maximum.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




The provider must update license information with the payer.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Misrouted claim. See the payer's claim submission instructions.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This claim/service must be billed according to the schedule for this plan.


                                                     Page 623
                                                 CARCs_Query2




Not eligible due to the patient's age.


Patient ineligible for this service.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.




The number of Days or Units of Service exceeds our acceptable maximum.

This provider type/provider specialty may not bill this service.
Exceeds number/frequency approved /allowed within time period without support
documentation.




Not eligible due to the patient's age.




Not eligible due to the patient's age.


This item or service does not meet the criteria for the category under which it was
billed.




                                                    Page 624
                                                   CARCs_Query2




Exceeds number/frequency approved /allowed within time period without support
documentation.




Missing patient medical record for this service.




Service not payable with other service rendered on the same date.



Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.
No appeal right except duplicate claim/service issue. This service was included in
a claim that has been previously billed and adjudicated.

This provider type/provider specialty may not bill this service.


Patient ineligible for this service.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.



Payment based on authorized amount.


The number of Days or Units of Service exceeds our acceptable maximum.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.



Missing/incomplete/invalid place of service.

This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 625
                                                   CARCs_Query2



The number of Days or Units of Service exceeds our acceptable maximum.


Misrouted claim. See the payer's claim submission instructions.




Missing/incomplete/invalid diagnosis or condition.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid HCPCS.




Missing plan information for other insurance.


This provider type/provider specialty may not bill this service.




This provider type/provider specialty may not bill this service.

Patient ineligible for this service.



                                                      Page 626
                                                 CARCs_Query2




Patient ineligible for this service.


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing/incomplete/invalid procedure code(s).


This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.
Service denied because payment already made for same/similar procedure within
set time frame.




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.


Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.


This item or service does not meet the criteria for the category under which it was
billed.

Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.

Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.
Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.
Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.
Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




                                                    Page 627
                                                  CARCs_Query2


Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.

Missing plan information for other insurance.




Missing/incomplete/invalid procedure code(s).




Separately billed services/tests have been bundled as they are considered
components of the same procedure. Separate payment is not allowed.
This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing/incomplete/invalid principal diagnosis.




Missing/incomplete/invalid other diagnosis.


This provider type/provider specialty may not bill this service.
Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Missing/incomplete/invalid provider/supplier signature.



Missing/incomplete/invalid patient identifier.




                                                    Page 628
                                                   CARCs_Query2




Additional information is required from another provider involved in this service.
Secondary payment cannot be considered without the identity of or payment
information from the primary payer. The information was either not reported or was
illegible.




Missing/incomplete/invalid designated provider number.

Missing/incomplete/invalid place of service.

Procedure code billed is not correct/valid for the services billed or the date of
service billed.
Procedure code billed is not correct/valid for the services billed or the date of
service billed.


Procedure code billed is not correct/valid for the services billed or the date of
service billed.




 Missing/incomplete/invalid anesthesia time/units




Missing/incomplete/invalid days or units of service.




Missing/incomplete/invalid procedure date(s).




Additional information is required from another provider involved in this service.




                                                       Page 629
                                                  CARCs_Query2




Additional information is required from another provider involved in this service.




Additional information is required from another provider involved in this service.




Additional information is required from another provider involved in this service.




Missing/incomplete/invalid patient status.




Additional information is required from another provider involved in this service.




Missing/incomplete/invalid condition code.




Additional information is required from another provider involved in this service.




Additional information is required from another provider involved in this service.




                                                     Page 630
                                                   CARCs_Query2




Missing/incomplete/invalid procedure code(s).




Missing/incomplete/invalid procedure code(s).

Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.


Payment based on authorized amount.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.



Payment based on authorized amount.




Payment based on authorized amount.




Payment based on authorized amount.




Payment based on authorized amount.




                                                      Page 631
                                                   CARCs_Query2




Missing/incomplete/invalid procedure code(s).


Missing/incomplete/invalid procedure code(s).



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Not eligible due to the patient's age.

The number of Days or Units of Service exceeds our acceptable maximum.


Missing/incomplete/invalid HCPCS modifier.




Missing/incomplete/invalid attending provider name.



This provider type/provider specialty may not bill this service.



This provider type/provider specialty may not bill this service.




This item or service does not meet the criteria for the category under which it was
billed.




                                                      Page 632
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing documentation/orders/notes/summary/report/chart.



This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.

Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.


Misrouted claim. See the payer's claim submission instructions.



This claim/service must be billed according to the schedule for this plan.



Missing/incomplete/invalid procedure code(s).



Alert: Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions.




Missing/incomplete/invalid days or units of service.
Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.
Alert: Consult plan benefit documents/guidelines for information about restrictions
for this service.

Service not payable with other service rendered on the same date.




                                                      Page 633
                                                   CARCs_Query2




This is not a covered service/procedure/ equipment/bed, however patient liability is
limited to amounts shown in the adjustments under group 'PR'.




Missing/incomplete/invalid admission type.

This claim/service must be billed according to the schedule for this plan.




This service/report cannot be billed separately.




Missing/incomplete/invalid diagnosis or condition.




This claim/service must be billed according to the schedule for this plan.




Alert: in the near future we are implementing new policies/procedures that would
affect this determination.



This allowance has been made in accordance with the most appropriate course of
treatment provision of the plan.

The number of Days or Units of Service exceeds our acceptable maximum.


This provider type/provider specialty may not bill this service.



This claim/service must be billed according to the schedule for this plan.




                                                      Page 634
                                                   CARCs_Query2




No appeal right except duplicate claim/service issue. This service was included in
a claim that has been previously billed and adjudicated.



Missing/incomplete/invalid procedure code(s).




Patient ineligible for this service. Note: (Modified 6/30/03)




Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.


Misrouted claim. See the payer's claim submission instructions.


Payment based on authorized amount.




Correction to a prior claim.




Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the
amount Medicare would have allowed if the patient were enrolled in Medicare Part
A and/or Medicare Part B. Note: (Modified 2/28/03)
Processing of this claim/service has included consideration under Major Medical
provisions.




Payment based on authorized amount.


Payment based on authorized amount.


                                                      Page 635
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 636

				
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