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835 Remittance Mapping File

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835 Remittance Mapping File Powered By Docstoc
					                                 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                 B15

      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




      THIS CONTRACT DOES NOT HAVE MEDICARE
035   CROSSOVER BENEFITS.                  16


                                      Page 3
                                CARCs_Query2




      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
046   the 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

      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

      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


                                              Page 5
                                CARCs_Query2




      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




098   PENDING RECEIPT OF MEDICAL RECORDS       16




                                   Page 6
                                CARCs_Query2




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




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


       NOT AUTHORIZED IN ADVANCE BY PRIMARY
1002   CARE PHYSICIAN OR BLUECHOICE.        197


       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


       ROUTINE SERVICES ARE NOT COVERED BY
101    THIS CONTRACT                           49

102    DEPENDENT HAS HIS OWN COVERAGE          32




                                   Page 7
                                CARCs_Query2




       NEED EMPLOYMENT/MEDICARE
104    INFORMATION FROM THE SUBSCRIBER         16




106    THIS IS NOT A COVERED SERVICE           96
       ACNE SURGERY ALLOWED ONE PER DATE
108    OF SERVICE                              35




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




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




       THESE SERVICES WERE BILLED IN ERROR
1102   BY THE PROVIDER                         125




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




                                   Page 8
                                 CARCs_Query2


       PLAN HAS LIMITED ROUTINE BENEFITS FOR
1104   EMPLOYEES ONLY                           35


       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.       96




       THIS CONTRACT PROVIDES BENEFITS FOR
1110   DENTAL SERVICES ONLY                     96




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




       SEND DENIAL OR NONCOVERED
1112   DOCUMENTATION FROM PRIMARY CARRIER 16




                                    Page 9
                                  CARCs_Query2




       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

       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


                                       Page 10
                                  CARCs_Query2



       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                    150


       APPROVED UNDER RTU. REFILE W/
1128   OBSERVATION, NOT ROOM/BOARD               150

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




       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




                                     Page 11
                                   CARCs_Query2




114    HEARING TEST AND EXAM IS NOT COVERED 96




       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
       MAXIMUM BENEFITS PAID UNDER ANOTHER
1145   ANESTHESIA CLAIM                           35

       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

       CONTRACT DOES NOT ALLOW BENEFITS
115    FOR THIS PROVIDER                          170




1150   CLAIM MISFILED FOR FLAT FEE                16

       VISION BENEFITS ARE PROVIDED THROUGH
1151   LENSCRAFTERS                         169


       DENIED FOR NO PRECERT. PATIENT IS NOT
1153   LIABLE.                                    38
       ADULT PREVENTIVE SERVICE COVERS
1154   EMPLOYEE, BUT NOT SPOUSE.                  32



                                      Page 12
                                  CARCs_Query2




1155   CLAIM MISFILED FOR GLOBAL FEE             16


1156   CLAIM FILED BEFORE DELIVERY               112


       AUTHORIZATION NOT FOUND FOR
1157   MATERNITY CLAIM.                          197




       REFILE INDICATING THE PHASE OF CARDIAC
116    REHABILITATION                         16


       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


       THIS SERVICE WAS PAID IN FULL BY
118    MEDICARE                                  23

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




                                       Page 13
                                  CARCs_Query2



       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




       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




       APPLIED TO CHAMPUS OUTPATIENT
119    DEDUCTIBLE - NOT COVERED                  96

       BLUE SELECT MEMBER - INPATIENT
1190   DEDUCTIBLE WAIVED                         45

       BLUE SELECT MEMBER OWES INPATIENT
1191   DEDUCTIBLE                                38

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




                                     Page 14
                                CARCs_Query2




       THIS CONTRACT DOES NOT COVER
1194   ROUTINE 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




       NEED CLAIM FOR TECHNICAL COMPONENT
1198   BEFORE WE CAN PROCESS                   16


       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




       OTHER INSURANCE CARRIER MUST
124    PROCESS FIRST                           16




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




                                   Page 15
                                 CARCs_Query2




      MEDICARE COINSURANCE IS NOT COVERED
126   BY THIS CONTRACT                    96

      SERVICES NOT COVERED WHEN RENDERED
129   BY THIS PROVIDER                   170




      MEDICAL INFO NOT RECEIVED-
134   HISTORY/OPERATIVE 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




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

      TWELVE MONTH WAITING PERIOD NOT
155   COMPLETED                                 179




                                    Page 16
                                 CARCs_Query2




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




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



                                    Page 17
                                 CARCs_Query2



      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 18
                                CARCs_Query2




       NO BENEFITS FOR PROCEDURES
195    PERFORMED ON THIS TOOTH                 96




197    NO XRAYS HAVE BEEN RECEIVED             16

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




       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




                                     Page 19
                               CARCs_Query2




      ROUTINE VISION/HEARING SERVICES NOT
213   COVERED.                                49


      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




                                  Page 20
                                 CARCs_Query2




       PREOPERATIVE ANESTHESIA
221    CONSULTATION IS NOT COVERED              96


224    SERVICE NOT MEDICALLY NECESSARY          50

       BENEFITS INCLUDED IN HOSPITAL OR
226    FACILITY CHARGES                         97

       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

       REFILE CLAIM TO MCC BEHAVORIAL CARE,
2307   MN                                       109




                                     Page 21
                                    CARCs_Query2



       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

       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




                                       Page 22
                                  CARCs_Query2




       SERVICE NOT COVERED FOR DIAGNOSIS
232    REPORTED                                  96
       INCORRECT ALPHA PREFIX FILED. PLEASE
2321   RECHECK & RESUBMIT.                       31

       CLAIM SHOULD BE SENT TO THE DENTAL
233    CARRIER                                   109


       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                          B11




                                    Page 23
                                   CARCs_Query2




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


       PROCEDURE IS INVESTIGATIONAL AND
2642   THEREFORE NOT COVERED.                     55

       THIS TEST HAS NOT BEEN PROVEN
2643   MEDICALLY NECESSARY                        50

       SERVICE SHOULD BE INCLUDED IN
2644   CHARGES 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

       FILE ALLERGEN VIAL CHRGS TO DRUG
2655   CARRIER; NOT PAID IN HEALTH                109
       MAXIMUM BENEFITS HAVE ALREADY BEEN
2656   PAID FOR THIS SERVICE                      35




                                        Page 24
                                  CARCs_Query2




       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




       PATIENT IS NOT ELIGIBLE FOR THIS
2666   BENEFIT.                                  96




       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


                                       Page 25
                                 CARCs_Query2




       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

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




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




                                    Page 26
                                CARCs_Query2




       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                                  16


       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




       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




                                   Page 27
                                  CARCs_Query2




2688   PLEASE FILE CLAIM TO BC/BS OF FLORIDA     109




2689   PLEASE RESUBMIT WITH MEDICAL RECORDS 16




       TREATMENT OF WAR INJURY IS NOT
269    COVERED                                   96

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

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


2692   REFILE THIS CLAIM TO BC/BS OF ALABAMA     109

       REFILE THIS CLAIM TO BC/BS OF
2693   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 28
                                   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




       PLEASE RETURN WITH MISSING
2709   QUADRANTS OR TOOTH RANGE.                  16
       FILE THESE PROFESSIONAL FEES ON A
271    HCFA 1500 CLAIM FORM                       89


2710   HANDLE DIRECT WITH VENDOR.                 109




                                      Page 29
                                  CARCs_Query2




       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

       40 VISIT MAXIMUM FOR HOME HEALTH CARE
2718   PER YEAR                              119




       NO PAYMENT FOR SERVICES EXCLUDED
2719   FROM COVERAGE                             96




                                      Page 30
                                 CARCs_Query2




       SERVICES RELATED TO ARTIFICIAL HEART
272    NOT COVERED                              96




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




       WILL ADJUST CLAIM UPON RECEIPT OF
2721   MEDCOST PRICING INFO                     16

       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




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




                                    Page 31
                                        CARCs_Query2




       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




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




                                            Page 32
                                CARCs_Query2




       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




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




                                    Page 33
                                  CARCs_Query2




       MEDICAL INFORMATION IS NEEDED FROM
2738   ANOTHER PROVIDER                          16

       NO WELL BABY CARE FOR CHILDREN OVER
274    FIVE YEARS                                119
       THE MAXIMUM BENEFIT FOR THIS SERVICE
2740   HAS BEEN PAID                             35


       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

       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




                                      Page 34
                                   CARCs_Query2



       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




       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



                                     Page 35
                                 CARCs_Query2




276    PLEASE FILE CLAIM TO BCBS OF GEORGIA     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




       NOT A COVERED SERVICE FOR MEMBERS
2767   OVER 15                                  96



                                    Page 36
                               CARCs_Query2




       NOT A COVERED SERVICE FOR MEMBERS
2768   OVER 16                                96




       NOT A COVERED SERVICE FOR MEMBERS
2769   OVER 17                                96




277    SERVICE NOT COVERED FOR DEPENDENT      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




                                  Page 37
                               CARCs_Query2




       NOT A COVERED SERVICE FOR MEMBERS
2774   OVER 25                                96




       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




       CONTRACT DOES NOT COVER MEDICARE
278    PART B COINSURANCE                     96




                                  Page 38
                                 CARCs_Query2




       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

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

       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



                                    Page 39
                                  CARCs_Query2



       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

       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


                                       Page 40
                                 CARCs_Query2




       NO BENEFITS FOR CLINICAL PATHOLOGY
281    CONSULT/INTERPRETATION                   96

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




       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 41
                                 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




                                    Page 42
                                 CARCs_Query2




       WILL REVIEW CLAIM UPON RECEIPT OF
2827   INPATIENT HOSPITAL BILL                  16




       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
2835                                            29




                                    Page 43
                                 CARCs_Query2




       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

       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

       REFILE TO THE STATE GROUP DRUG CARD
2844   PROGRAM                              109
       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




                                    Page 44
                                    CARCs_Query2



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




       CLAIM PENDING EMPLOYMENT
285    INFORMATION FROM SUBSCRIBER                  16


       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




                                          Page 45
                                 CARCs_Query2




       THIS CHARGE WILL BE PROCESSED ON A
2855   SEPARATE CLAIM                           96




       PLEASE RETURN ORTHODONTIC
2856   RECERTIFICATION LETTER                   16


       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




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




                                    Page 46
                                   CARCs_Query2


       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




       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




       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




                                      Page 47
                                  CARCs_Query2




       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


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             181




                                     Page 48
                                 CARCs_Query2




       SERVICES RELATED TO ORTHODONTIC
289    TREATMENT NOT COVERED.                   96



290    BENEFITS PAID TO ANOTHER PHYSICIAN   B20
       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
       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 WITH OVERLAPPING TIME
2908   INCREMENTS.                              16




                                    Page 49
                                 CARCs_Query2



       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
       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




                                    Page 50
                                 CARCs_Query2




       NO BENEFITS FOR COUNSELING OR
292    TRAINING                                 96

       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
       NO BENEFITS FOR ASST. SURGEON UNLESS
293    MEDICALLY NECESSARY.                     54
       SERVICES AND SUPPLIES ASSOCIATED WITH
2930   TMJ ARE NOT COVERED.                     167
       TREATMENT OF MORBID OBESITY IS NOT
2931   COVERED.                                 167




                                    Page 51
                                 CARCs_Query2




       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
       EXCEEDS NUMBER OF WELL CHILD VISITS
294    COVERED BY CONTRACT                   35

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


                                     Page 52
                                  CARCs_Query2


       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
       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
 296                                          1
       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




                                     Page 53
                                 CARCs_Query2



       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

       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




                                    Page 54
                                CARCs_Query2




       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

       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 BENEFITS UNDER DENTAL CAN BE
2987   PAID                                     109

       TREATMENT LIMITED TO TWO TIMES PER
2988   QUADRANT PER YEAR                        119
       THIS CLAIM HAS ALREADY BEEN
       PROCESSED FOR PAYMENT WITH
       BENEFITS BEING DIRECTED TO THE
2989   MEMBER                                   100


                                   Page 55
                                   CARCs_Query2


       REPLACEMENT/DUPLICATE PROSTHETIC
       DEVICES AND APPLIANCES ARE NOT
2990   COVERED IF LOST, MISSING OR STOLEN          18


       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
       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

       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




                                      Page 56
                               CARCs_Query2




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




      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 57
                                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




                                   Page 58
                                CARCs_Query2



341                                            35

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 59
                                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


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




                                   Page 60
                                 CARCs_Query2



      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




      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



                                    Page 61
                                  CARCs_Query2



       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                         35

       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


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       35
       MAXIMUM ALLOWANCE PER CONTRACT =
399    $XXXX                                     35




400    FAMILY THERAPY IS NOT COVERED       96
       THESE PREVENTATIVE SERVICES ARE NOT
       COVERED WHEN RENDERED BYAN OUT-OF-
4000   NETWORK PROVIDER.                   38



                                     Page 62
                                 CARCs_Query2



       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




       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




401    PSYCHOLOGICAL TESTING IS NOT COVERED 96




                                    Page 63
                                  CARCs_Query2



       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                        17
       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                                   31
       ALPHA PREFIX CANNOT BE FOUND. PLEASE
       REVIEW THE INSURANCE INFORMATION
4017   WITH PATIENT.                             140




       ROUTINE VACCINATIONS OR
402    INNOCULATIONS ARE NOT COVERED.            96




       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


                                     Page 64
                                 CARCs_Query2



       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

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

       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




                                    Page 65
                                  CARCs_Query2




       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
       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

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




       BENEFITS ARE NOT COVERED FOR THIS
4040   SERVICE.                                   96
       PAYMENT FOR THIS CLAIM WAS
       PREVIOUSLY SENT TO THE MEDICAID
       AGENCY UNDER A SEPARATE CLAIM
4042   NUMBER.                                    23




                                     Page 66
                                 CARCs_Query2


       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
4046   COVERAGE 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

405    DEPENDENT OVER AGE OF ELIGIBILITY.       32




       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.            38
       THE PATIENT HAD NO COVERAGE FOR THE
406    DATE OF SERVICE.                         31
       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.            23




                                    Page 67
                                 CARCs_Query2


       WE HAVE REQUESTED MEDICAL
       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




       MAJOR MEDICAL BENEFITS ARE NOT
407    AVAILABLE FOR THIS SERVICE.              96

       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
       THIS PATIENT COVERED UNDER ANOTHER
408    CONTRACT                                 32


       BENEFITS ARE NOT PROVIDED FOR
409    ROUTINE OR PREVENTIVE CARE.              49
       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 68
                                 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


       CLAIM BEING REVIEWED UNDER PRIMARY
410    CONTRACT.                                133




       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




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


                                    Page 69
                                 CARCs_Query2




412    NON LOCAL AMBULANCE IS NOT COVERED       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




                                   Page 70
                                CARCs_Query2




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




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




       DELUXE MODEL SUPPLY OR EQUIPMENT IS
413    NOT COVERED                             96




       INVALID USE OF OBSERVATION REVENUE
4130   CODE.                                   125




       INPATIENT SEPARATE PROCEDURES NOT
4131   PAID                                    A1


                                   Page 71
                                 CARCs_Query2




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




       SERVICE PROVIDED OUTSIDE APPROVAL
4138   PERIOD (L).                              152




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




                                    Page 72
                                 CARCs_Query2




414    THIS EQUIPMENT IS NOT COVERED            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

       EQUIPMENT MUST BE PRESCRIBED BY A
415    PHYSICIAN                                174

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




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 73
                                        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
4164   Reject Reason Code.)                              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

       CLAIM COVERED UNDER WORKERS
418    COMPENSATION                                      19


       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

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



                                           Page 74
                                CARCs_Query2




       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

       SUBSCRIBER NOT ELIGIBLE UNDER TERMS
419    OF GROUP CONTRACT                       31


       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 75
                                 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




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


       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



                                      Page 76
                                  CARCs_Query2



       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

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



422    THIS AMOUNT WAS PAID BY CHAMPUS.          23



423    CLAIM IS TO BE PAID BY CONTROL PLAN       B11




       THE DENTAL BENEFITS DO NOT COVER
       ORTHODONTIC TREATMENT FOR
4233   EMPLOYEES OR COVERED SPOUSE               96




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




       THIS CONTRACT PROVIDES BENEFITS FOR
425    INPATIENT SERVICES ONLY.                  96



                                     Page 77
                                CARCs_Query2




      THIS CONTRACT DOES NOT COVER THE
426   CHAMPUS DEDUCTIBLE.                      96
      MAXIMUM BENEFITS HAVE BEEN PAID BY
427   BLUE SHIELD.                             35


      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




                                   Page 78
                                CARCs_Query2




      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




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




                                   Page 79
                                CARCs_Query2




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


      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




                                  Page 80
                                CARCs_Query2




      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




      NO BENEFITS AVAILABLE FOR SELF
454   INFLICTED INJURIES                       96




455   RESUBMIT WITH A SPECIFIC DIAGNOSIS       125




                                   Page 81
                               CARCs_Query2




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




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

461   MAXIMUM BENEFITS HAVE BEEN PAID         35


462   WAITING PERIOD NOT COMPLETED            179


      CLAIM FORWARDED TO BCBS FOR
463   PROCESSING                              B11




                                  Page 82
                                  CARCs_Query2




      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


      CLAIM FORWARDED TO ANOTHER PLAN FOR
471   PROCESSING                          B11




472   PREMIUM HAS NOT BEEN PAID                  96


      EXPERIMENTAL PROCEDURES ARE NOT
473   COVERED                                    55



                                    Page 83
                                CARCs_Query2



      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                                  35




      PLEASE REFILE CLAIM WITH THE
482   CORRECTED MEDICARE REMITTANCE            16




                                    Page 84
                               CARCs_Query2




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

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




                                 Page 85
                               CARCs_Query2




      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 86
                                CARCs_Query2




       THIS DENTAL SERVICE IS NOT COVERED
500    UNDER MAJOR MEDICAL                     96


       NONCOVERED SERVICES OR SUPPLIES.
       MEDICARE'S NATIONAL COVERAGE
       DECISION GUIDELINES AND OUR COVERAGE
       GUIDELINES WERE CONSI
5007   DERED TO MAKE THIS DETERMINATION.    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




                                   Page 87
                                CARCs_Query2




      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




      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




                                     Page 88
                                  CARCs_Query2




       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




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




       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.       185




       INVALID OTHER INSURANCE PAYMENT
5204   AMOUNT                                    23




                                     Page 89
                                  CARCs_Query2




5205   PROVIDER SIGNATURE NEEDED ON CLAIM        16




       THIS PATIENT IS NOT ENROLLED IN HIS
5206   MEDICARE ADVANTAGE PROGRAM.               31




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

       NO PAYMENT BEFORE SERVICES ACTUALLY
521    RENDERED                            112
       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




                                     Page 90
                                 CARCs_Query2




       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




5218   MISSING OR INVALID OCCURRENCE CODE       16




       ADMISSION DATE IS AFTER BEGIN DATE OF
5219   SERVICE                                  16


522    CONTRACT LIMITS PAYMENT TO $XXXX         35




       MISSING OR INVALID DATE OF SERVICE,
5220   ADMIT DATE                               16




                                     Page 91
                                   CARCs_Query2




       PATIENT STATUS OR BILL TYPE INVALID OR
5221   INCONSISTENT.                              4




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




       PROCEDURE CODE IS INCOMPATIBLE WITH
5226   THE PATIENT AGE OR SEX                     16




5227   PROCEDURE CODE IS INVALID                  16

       PAYMENT FOR THIS PROCEDURE BASED ON
524    LESS COSTLY ALTERNATIVE.             B8
       ONLY NETWORK PARTICIPATING
525    PROVIDERS RECEIVE DIRECT PAYMENT     100
       CHARGES FOR CONSULTING PHYSICIAN ARE
526    NOT COVERED                          54




                                     Page 92
                                CARCs_Query2




      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




      ACTION EXCEPTION OVERRIDE TO A
533   NEGATIVE TPR RECORD                      133



      THIS POLICY DOES NOT COVER NON-
534   SKILLED NURSING HOMES                58
      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




                                   Page 93
                                CARCs_Query2



      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



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




                                   Page 94
                                CARCs_Query2




      PATIENT OVER ELIGIBLE AGE FOR THIS
553   TYPE SERVICE                             96




      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




      THIS SERVICE IS NOT COVERED FOR THE
565   REPORTED CONDITION                       96


                                   Page 95
                                 CARCs_Query2




      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
571   FACILITY 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
      ONE CONSULTATION PER PHYSICIAN PER
576   CONFINEMENT                          35




                                    Page 96
                                CARCs_Query2




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 97
                                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




                                   Page 98
                                CARCs_Query2




      THIS CLAIM HAS BEEN SENT TO MICHIGAN
597   FOR PROCESSING                           B11




      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




                                   Page 99
                                 CARCs_Query2




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




      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




                                    Page 100
                                 CARCs_Query2



      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

      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




                                   Page 101
                                CARCs_Query2




      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




      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




                                  Page 102
                                 CARCs_Query2




      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

      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




                                    Page 103
                                 CARCs_Query2




      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

      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




                                   Page 104
                                  CARCs_Query2




      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


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

      NOT COVERED FOR THE DENTIST
684   PERFORMING THE OPERATIVE SRVCS       45
      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




                                     Page 105
                                CARCs_Query2




      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




      THE REPAIR/REPLACEMENT OF APPLIANCES
699   IS NOT COVERED                       96




      ORTHODONTIC BENEFITS ARE EXCLUDED
700   FOR EMPLOYEE OR SPOUSE.                  96




                                  Page 106
                                CARCs_Query2




      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




      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


                                   Page 107
                                CARCs_Query2


      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




      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




                                  Page 108
                                CARCs_Query2




      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
732   COMPANION BENEFIT ALTERNATIVES          16
      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




                                   Page 109
                               CARCs_Query2




      PLEASE PROVIDE EXPLANATION OF
      DIFFERENCE BETWEEN SUBMITTED
739   CHARGE 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




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




      PATHOLOGY REPORT & X-RAYS NEEDED
745   FOR REVIEW                              16


                                  Page 110
                                CARCs_Query2



      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




      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




                                    Page 111
                                CARCs_Query2




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




      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


                                   Page 112
                                CARCs_Query2



      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


      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




                                     Page 113
                                CARCs_Query2




      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




      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


                                   Page 114
                               CARCs_Query2




      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


      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




                                   Page 115
                               CARCs_Query2




      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




      CLAIM PENDING REGULATIONS INFO FROM
829   FEDERAL GOVERNMENT                      16




                                  Page 116
                                CARCs_Query2




      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


      SERVICE RENDERED DURING
844   HOSPITALIZATION THAT WASN'T APPROVED 197


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




                                  Page 117
                                 CARCs_Query2




      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

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

      SERVICE NOT ALLOWED SEPARATELY WHEN
860   MAMMOGRAM IS COVERED                B15




                                   Page 118
                                CARCs_Query2




      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
866   AA MODIFIER                              4




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

      ALLOWANCE REDUCED BY AMOUNT
868   ALLOWED PREVIOUSLY FOR PULPOTOMY         59




                                  Page 119
                                CARCs_Query2




      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

      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



                                   Page 120
                                 CARCs_Query2




      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,
884   IS 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 121
                               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 122
                                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
905   UNDER 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 123
                               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




                                  Page 124
                                CARCs_Query2




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




      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




                                  Page 125
                                CARCs_Query2



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




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

      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                                  B5




                                  Page 126
                                CARCs_Query2




947   SERVICE OUT OF NETWORK                   38
      CONTRACT ALLOWS ONE VISIT PER WEEK,
948   UP TO 30 VISITS PER YEAR                 35



      OUTPATIENT CT SCAN IS NOT COVERED
949   FOR 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


      NOT WITHIN 120 DAYS OF HOSPITAL
952   DISCHARGE                                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 127
                                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



969   CLAIM COORDINATED WITH MEDICARE          45


                                  Page 128
                                CARCs_Query2



      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                                 B11


      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


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

      CHARGE SHOULD BE INCLUDED IN THE
979   SURGICAL FEE                             97


                                   Page 129
                                CARCs_Query2




      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



      BENEFITS ARE PROVIDED FOR INPATIENT
991   CHARGES ONLY.                            58




                                  Page 130
                                CARCs_Query2




      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




      NON COVERED DUE TO CONTRACT
Z1    LIMITATIONS.                             96


                                  Page 131
                                 CARCs_Query2



      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
Z14   BY 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



      NON-COVERED AMOUNTS ARE DUE TO
      EITHER CONTRACTUAL LIMITATIONS,
      DEDUCTIBLES, COINSURANCE OR MISSING
Z9    INFORMATION.                              96




                                    Page 132
                                               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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Our records indicate that this dependent is
not an eligible dependent as defined.
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99




                                                 Page 133
                                              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
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
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Claim denied. Insured has no dependent
coverage.
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
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                    N197


                                                Page 134
                                              CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01                        M15
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01
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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
The disposition of this claim/service is
pending further review. Note: Changed as
of 10/99

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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                     N63


                                                Page 135
                                               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                     N350
Claim denied as patient cannot be identified
as our insured.
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
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 136
                                                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
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
The diagnosis is inconsistent with the
procedure.


                                                  Page 137
                                              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
These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
Payment denied because only one visit or
consultation per physician per day is
covered. Note: Changed as of 2/01
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.
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

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
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/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




                                                Page 138
                                              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

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
Our records indicate that this dependent is
not an eligible dependent as defined.




                                                Page 139
                                               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                     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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 140
                                              CARCs_Query2


Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered visits.
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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                    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




                                                Page 141
                                              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                     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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.


                                                Page 142
                                               CARCs_Query2


Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Previously paid. Payment for this
claim/service may have been provided in a
previous payment.
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.
Payment adjusted because an alternate
benefit has been provided Note: New as of
6/05
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
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.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                 Page 143
                                              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                       MA67

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Duplicate claim/service.
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
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

Non-covered visits.
Payment is denied when performed/billed
by this type of provider. Note: New as of
6/05
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 an alternate
benefit has been provided Note: New as of
6/05

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Our records indicate that this dependent is
not an eligible dependent as defined.



                                                Page 144
                                              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
Payment adjusted as not furnished directly
to the patient and/or not documented. Note:
Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
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 denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.




                                                Page 145
                                              CARCs_Query2


Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
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.
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                Page 146
                                            CARCs_Query2


These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
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                  N195
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01
Expenses incurred after coverage
terminated.
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




                                              Page 147
                                              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 is denied when performed/billed
by this type of provider. Note: New as of
6/05
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
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Services by an immediate relative or a
member of the same household are not
covered.

Duplicate claim/service.
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.
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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




                                                Page 148
                                              CARCs_Query2


Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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.
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
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



                                                Page 149
                                               CARCs_Query2


Payment is denied when performed/billed
by this type of provider. Note: New as of
6/05
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99

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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 150
                                              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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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




                                                Page 151
                                               CARCs_Query2


These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
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

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




                                                 Page 152
                                               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
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                 Page 153
                                               CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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.
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
These are non-covered services because
this is a pre-existing condition
Charges do not meet qualifications for
emergent/urgent care.
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                 Page 154
                                               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 denied as patient cannot be identified
as our insured.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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.

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Charges do not meet qualifications for
emergent/urgent care.
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.




                                                 Page 155
                                              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 denied because
procedure/treatment is deemed
experimental/investigational by the payer.
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Previously paid. Payment for this
claim/service may have been provided in a
previous payment.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02




                                                Page 156
                                                     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
Our records indicate that this dependent is
not an eligible dependent as defined.

Payment is denied when performed/billed
by this type of provider in this type of facility.
Note: New as of 6/05
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.
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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
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


                                                       Page 157
                                              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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 158
                                               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 denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Deductible Amount
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.


Claim denied as patient cannot be identified
as our insured.
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




                                                 Page 159
                                               CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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

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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.



Claim denied as patient cannot be identified
as our insured.
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.




                                                 Page 160
                                               CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Patient/Insured health identification number
and name do not match. Note: New as of
6/99
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
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.
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

Professional fees removed from charges.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                 Page 161
                                              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                     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
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 162
                                              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                    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
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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




                                                Page 163
                                               CARCs_Query2


The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.
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

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




                                                 Page 164
                                               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
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
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




                                                 Page 165
                                              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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
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




                                                Page 166
                                               CARCs_Query2


Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
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                     N277
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.



                                                 Page 167
                                               CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 168
                                           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




                                             Page 169
                                           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




                                             Page 170
                                              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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Our records indicate that this dependent is
not an eligible dependent as defined.
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
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



                                                Page 171
                                              CARCs_Query2


Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
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.

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Our records indicate that this dependent is
not an eligible dependent as defined.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.


                                                Page 172
                                                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.
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

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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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 173
                                              CARCs_Query2


Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 174
                                               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                     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

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

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
The time limit for filing has expired.




                                                 Page 175
                                               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
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Claim denied because this is a work-related
injury/illness and thus the liability of the
Worker's Compensation Carrier.

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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 not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                 Page 176
                                              CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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.
Claim denied because this injury/illness is
the liability of the no-fault carrier.
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
Payment for charges adjusted. Charges are
covered under a capitation
agreement/managed care plan. Note:
Changed as of 6/00
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
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 177
                                              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                       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
Payment adjusted because this care may
be covered by another payer per
coordination of benefits. Note: Changed as
of 2/01
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered visits.
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
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




                                                Page 178
                                              CARCs_Query2



                                                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.
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                    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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 for charges adjusted. Charges are
covered under a capitation
agreement/managed care plan. Note:
Changed as of 6/00
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                Page 179
                                              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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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.
Payment adjusted because this procedure
code was invalid on the date of service
Note: New as of 6/05




                                                Page 180
                                              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




Duplicate claim/service.
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
The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as
of 6/02

This payment is adjusted based on the
diagnosis. Note: Changed as of 2/01
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




                                                Page 181
                                               CARCs_Query2


The procedure code is inconsistent with the
modifier used or a required modifier is
missing.
The procedure code is inconsistent with the
modifier used or a required modifier is
missing.
The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as
of 6/02

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.

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


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




                                                 Page 182
                                              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




The procedure code is inconsistent with the
modifier used or a required modifier is
missing.
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.

Payment adjusted because this procedure
code was invalid on the date of service
Note: New as of 6/05
The procedure code is inconsistent with the
modifier used or a required modifier is
missing.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 .
This (these) diagnosis(es) is (are) not
covered. Note: New as of 6/05
This (these) diagnosis(es) is (are) not
covered. Note: New as of 6/05




                                                Page 183
                                              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                       N157
Payment is denied when performed/billed
by this type of provider. Note: New as of
6/05

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
The procedure code is inconsistent with the
modifier used or a required modifier is
missing.
This (these) diagnosis(es) is (are) not
covered. Note: New as of 6/05
Expenses incurred after coverage
terminated.


Processed in Excess of charges.




Professional fees removed from charges.        N202


                                                Page 184
                                              CARCs_Query2




Claim/service rejected at this time because
information from another provider was not
provided or was insufficient/incomplete.
Note: New as of 6/02
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05

The time limit for filing has expired.


Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01
Deductible Amount

Payment is denied when performed/billed
by this type of provider. Note: New as of
6/05
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




                                                Page 185
                                               CARCs_Query2


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
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.


This (these) diagnosis(es) is (are) not
covered. Note: New as of 6/05
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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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




                                                 Page 186
                                              CARCs_Query2


Payment adjusted because the payer
deems the information submitted does not
support this level of service. Note: New as
of 10/02
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


The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04


Payment made to
patient/insured/responsible party.


                                                Page 187
                                                 CARCs_Query2




Duplicate claim/service.                          N111
Payment adjusted because this care may
be covered by another payer per
coordination of benefits. Note: Changed as
of 2/01
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 188
                                             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
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05
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

Claim/service denied because
procedure/treatment is deemed
experimental/investigational by the payer.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
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



                                               Page 189
                                              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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 190
                                               CARCs_Query2


Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Charges do not meet qualifications for
emergent/urgent care.
Services not documented in patients'
medical records.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.




Payment adjusted because this care may
be covered by another payer per
coordination of benefits. Note: Changed as
of 2/01
Payment adjusted because this care may
be covered by another payer per
coordination of benefits. Note: Changed as
of 2/01
The procedure code/bill type is inconsistent
with the place of service.
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                     N237
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                      M62




                                                 Page 191
                                              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
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.
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Payment adjusted as procedure postponed
or canceled. Note: Changed as of 2/01
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.
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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 192
                                              CARCs_Query2


Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.

Non-covered visits.
Payment is denied when performed/billed
by this type of provider. Note: New as of
6/05
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                    N45



                                                Page 193
                                              CARCs_Query2


Charges are adjusted based on multiple
surgery rules or concurrent anesthesia
rules. Note: Changed as of 6/00
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Expenses incurred after coverage
terminated.
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.                                    N45
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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



                                                Page 194
                                               CARCs_Query2



The disposition of this claim/service is
pending further review. Note: Changed as
of 10/99
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.

The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as
of 6/02
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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 195
                                               CARCs_Query2




Payment denied/reduced because
injury/illness was the result of an activity
that is a benefit exclusion. Note: New as of
9/03

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                     N179




Claim denied as patient cannot be identified
as our insured.


Claim denied as patient cannot be identified
as our insured.
Patient/Insured health identification number
and name do not match. Note: New as of
6/99

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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                     N258

This (these) diagnosis(es) is (are) not
covered. Note: New as of 6/05


                                                 Page 196
                                               CARCs_Query2




This (these) diagnosis(es) is (are) not
covered. Note: New as of 6/05
Charges do not meet qualifications for
emergent/urgent care.

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                     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


Expenses incurred prior to coverage.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 197
                                               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                     N257



Multiple physicians/assistants are not
covered in this case .

Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03



The rendering provider is not eligible to
perform the service billed. Note: New as of
6/05                                             N95

Payment adjusted as procedure postponed
or canceled. Note: Changed as of 2/01


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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                                  N192




                                                 Page 198
                                               CARCs_Query2




Claim denied as patient cannot be identified
as our insured.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Our records indicate that this dependent is
not an eligible dependent as defined.

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
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Claim denied as patient cannot be identified
as our insured.



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




                                                 Page 199
                                              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.)                                         N102
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.)                                         N102
Our records indicate that this dependent is
not an eligible dependent as defined.
These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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.



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                Page 200
                                             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.
The disposition of this claim/service is
pending further review. Note: Changed as
of 10/99

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.                             N202
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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 201
                                              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.




The procedure code is inconsistent with the
modifier used or a required modifier is
missing.

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.




                                                Page 202
                                              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 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




The procedure code is inconsistent with the
modifier used or a required modifier is
missing.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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). 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              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


                                                Page 203
                                                CARCs_Query2




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.




Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

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

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




                                                  Page 204
                                              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 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.




The procedure/revenue code is inconsistent
with the patient's age.                        N180
Payment denied because this service was
not prescribed prior to delivery Note: New
as of 6/05
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.
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 205
                                               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
Claim denied because this is a work-related
injury/illness and thus the liability of the
Worker's Compensation Carrier.

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
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



                                                 Page 206
                                               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
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.)                                          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

Claim denied as patient cannot be identified
as our insured.
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.
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 207
                                             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.
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 denied - Prior processing
information appears incorrect. This change
to be effective 4/1/2008: Prior processing
information appears incorrect.
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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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



                                               Page 208
                                              CARCs_Query2



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.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




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
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
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.


Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 209
                                              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
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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 210
                                             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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 211
                                                 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                       MA04

This provider was not certified/eligible to be
paid for this procedure/service on this date
of service. Note: Changed as of 10/98

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 212
                                               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
These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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




                                                 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                     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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.




                                                Page 214
                                             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                   MA130
Previously paid. Payment for this
claim/service may have been provided in a
previous payment.
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.



                                               Page 215
                                               CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Duplicate claim/service.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
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 216
                                               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                      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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 days/Room charge
adjustment.
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.




                                                 Page 217
                                           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 exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.
Charges exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 .

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 218
                                                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
Payment adjusted because
procedure/service was partially or fully
furnished by another provider. Note:
Changed as of 2/01

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

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

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
Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 adjusted when anesthesia is
performed by the operating physician, the
assistant surgeon or the attending physician
Note: New as of 2/06

Non-covered visits.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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                     MA66
Payment denied because only one visit or
consultation per physician per day is
covered. Note: Changed as of 2/01
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.
Charges do not meet qualifications for
emergent/urgent care.




                                                 Page 220
                                              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
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.)                                         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




The rendering provider is not eligible to
perform the service billed.                    N181

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




                                                Page 221
                                               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.)                                          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.

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

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.)                                           N77
Payment adjusted as not furnished directly
to the patient and/or not documented. Note:
Changed as of 2/01
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




                                                 Page 222
                                            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.)                                        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

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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

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 223
                                              CARCs_Query2



The procedure code is inconsistent with the
modifier used or a required modifier is
missing.
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
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
Claim/service not covered/reduced because
alternative services were available, and
should have been utilized.
Payment made to
patient/insured/responsible party.
Multiple physicians/assistants are not
covered in this case .




                                                Page 224
                                                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 made to
patient/insured/responsible party.
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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



The disposition of this claim/service is
pending further review. Note: Changed as
of 10/99                                         MA11

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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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


Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Services by an immediate relative or a
member of the same household are not
covered.
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
Claim denied. Insured has no dependent
coverage.

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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Services denied at the time
authorization/pre-certification was
requested.

The time limit for filing has expired.
The procedure/revenue code is inconsistent
with the patient's gender. Note: Changed as
of 6/02




                                                  Page 226
                                                 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                        M51
Payment denied because only one visit or
consultation per physician per day is
covered. Note: Changed as of 2/01
Our records indicate that this dependent is
not an eligible dependent as defined.
Charges do not meet qualifications for
emergent/urgent care.
Claim denied as patient cannot be identified
as our insured.
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

The date of birth follows the date of service.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 227
                                                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

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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

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
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01

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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02




                                                  Page 228
                                                 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                           N95
Payment denied because only one visit or
consultation per physician per day is
covered. Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

This provider was not certified/eligible to be
paid for this procedure/service on this date
of service. Note: Changed as of 10/98

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 229
                                                     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
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.
The disposition of this claim/service is
pending further review. Note: Changed as
of 10/99
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
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




                                                       Page 230
                                               CARCs_Query2


The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
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 231
                                               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                     N225
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02




                                                 Page 232
                                                CARCs_Query2


Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
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.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
The procedure code is inconsistent with the
provider type/specialty (taxonomy). Note:
Changed as of 6/02

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Payment is adjusted when performed/billed
by a provider of this specialty Note: New as
of 6/05

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 233
                                              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
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01




                                                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                      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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01




                                                  Page 235
                                               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                     N366
Our records indicate that this dependent is
not an eligible dependent as defined.
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
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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01




                                                 Page 236
                                                 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 not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 provider was not certified/eligible to be
paid for this procedure/service on this date
of service. Note: Changed as of 10/98
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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




                                                   Page 237
                                           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

Expenses incurred prior to coverage.
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 238
                                            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
Expenses incurred after coverage
terminated.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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                   M60
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05


                                              Page 239
                                                CARCs_Query2


Expenses incurred after coverage
terminated.
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05
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
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

Duplicate claim/service.
Payment adjusted because the patient has
not met the required waiting requirements
Note: New as of 6/05
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01




                                                Page 241
                                           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
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.
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


                                             Page 242
                                           CARCs_Query2


Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Expenses incurred after coverage
terminated.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Charges do not meet qualifications for
emergent/urgent care.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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




                                             Page 243
                                               CARCs_Query2


The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
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
The procedure code is inconsistent with the
modifier used or a required modifier is
missing.
Payment for charges adjusted. Charges are
covered under a capitation
agreement/managed care plan. Note:
Changed as of 6/00


                                                 Page 244
                                                 CARCs_Query2


Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99

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
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

This provider was not certified/eligible to be
paid for this procedure/service on this date
of service. Note: Changed as of 10/98
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01

Payment adjusted as procedure postponed
or canceled. Note: Changed as of 2/01              M51
Claim denied as patient cannot be identified
as our insured.
Payment Adjusted for exceeding
precertification/ authorization. This change
to be effective 4/1/2008:
Precertification/authorization exceeded.




                                                   Page 245
                                             CARCs_Query2



Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
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

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Previously paid. Payment for this
claim/service may have been provided in a
previous payment.                             MA67
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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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



Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

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
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.




                                                   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 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
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




                                                 Page 248
                                              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
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.




                                                Page 249
                                              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                     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
The disposition of this claim/service is
pending further review. Note: Changed as
of 10/99

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




These are non-covered services because
this is a pre-existing condition
The rendering provider is not eligible to
perform the service billed. Note: New as of
6/05
Payment adjusted because this
procedure/service is not paid separately.
Note: Changed as of 2/01




                                                Page 250
                                               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
These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
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.

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




                                                 Page 251
                                               CARCs_Query2


The claim/service has been transferred to
the proper payer/processor for processing.
Claim/service not covered by this
payer/processor.
The disposition of this claim/service is
pending further review. Note: Changed as
of 10/99
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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.



                                                 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                       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
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Payment denied because only one visit or
consultation per physician per day is
covered. Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

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 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
Payment denied because only one visit or
consultation per physician per day is
covered. Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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
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
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 254
                                               CARCs_Query2


Claim denied as patient cannot be identified
as our insured.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
These are non-covered services because
this is not deemed a `medical necessity' by
the payer.
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
Claim denied as patient cannot be identified
as our insured.




                                                 Page 255
                                               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

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
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
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.




                                                 Page 256
                                               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                      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
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01
Claim denied as patient cannot be identified
as our insured.
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

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.




                                                 Page 257
                                               CARCs_Query2


Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

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
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99
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.

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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




                                                 Page 258
                                                CARCs_Query2


Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02

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
Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03
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
Benefit maximum for this time period or
occurrence has been reached. Note:
Changed as of 2/04
Lifetime benefit maximum has been
reached. Note: Changed as of 10/02
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
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                      M125


                                                  Page 259
                                             CARCs_Query2



Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
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                   N237
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                   N269

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
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
Charge exceeds fee schedule/maximum
allowable or contracted/legislated fee
arrangement. (Use Group Codes PR or CO
depending upon liability).                     N45


                                               Page 260
                                                CARCs_Query2


Services not provided or authorized by
designated (network/primary care)
providers. Note: Changed as of 6/03

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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.
Payment adjusted because
coverage/program guidelines were not met
or were exceeded. Note: Changed as of
2/01

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

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
These are non-covered services because
this is a routine exam or screening
procedure done in conjunction with a
routine exam.
Payment is included in the allowance for
another service/procedure. Note: Changed
as of 2/99


                                                  Page 261
                                                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

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
Payment made to
patient/insured/responsible party.
The disposition of this claim/service is
pending further review. Note: Changed as
of 10/99

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




                                                  Page 262
                                             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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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

Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01

Non-covered charge(s). This change to be
effective 4/1/2007: At least one Remark
Code 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 263
                                              CARCs_Query2



Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.
Claim not covered by this payer/contractor.
You must send the claim to the correct
payer/contractor.

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



Payment denied/reduced for absence of, or
exceeded, pre-certification/authorization.
Note: Changed as of 2/01
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




                                                Page 264
                                                   CARCs_Query2




                          Remarks Verbiage




Missing/incomplete/invalid days or units of service. Note: (Modified
2/28/03)




'Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                       Page 265
                                                   CARCs_Query2




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04)
Related to N301




Patient ineligible for this service. Note: (Modified 6/30/03)




The subscriber must update insurance information directly with payer.


                                                      Page 266
                                                   CARCs_Query2




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.




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)




Rebill services on separate claim lines.


                                                      Page 267
                                                   CARCs_Query2




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)




Additional information has been requested from the member. The
charges will be reconsidered upon receipt of that information.




                                                      Page 268
                                                   CARCs_Query2




Missing/incomplete/invalid billing provider/supplier primary identifier.
Note: (New Code 12/2/04)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 269
                                                   CARCs_Query2




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.




Missing documentation/orders/notes/summary/report/chart. Note:
(Modified 2/28/03, 8/1/05) Related to N225




                                                      Page 270
                                                   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)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 271
                                                   CARCs_Query2




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)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 272
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




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.




                                                      Page 273
                                                   CARCs_Query2




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.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 274
                                           CARCs_Query2




Rebill services on separate claim lines.




                                             Page 275
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Correction to a prior claim.




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 claim lines.




                                                      Page 276
                                                CARCs_Query2




Rebill services on separate claim lines.




Missing/incomplete/invalid plan of treatment.




                                                  Page 277
                                                   CARCs_Query2




Incomplete/invalid documentation of benefit to the patient during initial
treatment period.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 278
                                                   CARCs_Query2




The technical component must be billed separately.




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)




                                                      Page 279
                                                   CARCs_Query2




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)




                                                      Page 280
                                                   CARCs_Query2




Payment based on authorized amount.




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.




Alert: Our records do not indicate that other insurance is on file. Please
submit other insurance information for our records.



                                                      Page 281
                                                   CARCs_Query2




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)




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 282
                                                   CARCs_Query2




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)




Missing/incomplete/invalid charge.




                                                      Page 283
                                                   CARCs_Query2




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)




                                                      Page 284
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid name or provider identifier for the
rendering/referring/ ordering/ supervising provider.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 285
                                                 CARCs_Query2




Additional information has been requested from the member. The
charges will be reconsidered upon receipt of that information.




Incorrect claim form/format for this service. Note: (Modified 11/18/05)




                                                    Page 286
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid procedure code(s).




                                                      Page 287
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 288
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Payment based on authorized amount.




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)


Not covered more than once in a 12 month period.




                                                      Page 289
                                                   CARCs_Query2




Missing/incomplete/invalid rendering provider primary identifier.




Rebill services on separate claim lines.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 290
                                                   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.




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)




                                                      Page 291
                                                   CARCs_Query2




Missing documentation/orders/notes/summary/report/chart. Note:
(Modified 2/28/03, 8/1/05) Related to N225




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 292
                                                CARCs_Query2




Missing/incomplete/invalid tooth number/letter. Note: (Modified 2/28/03)




Missing/incomplete/invalid tooth number/letter. Note: (Modified 2/28/03)




Missing/incomplete/invalid tooth number/letter. Note: (Modified 2/28/03)




                                                   Page 293
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid tooth number/letter. Note: (Modified 2/28/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 294
                                                   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.




Alert: This decision may be reviewed if additional documentation as
described in the contract or plan benefit documents is submitted.




Missing/incomplete/invalid name, strength, or dosage of the drug
furnished.




                                                      Page 295
                                               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.




Rebill services on separate claims.




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04)
Related to N301




This claim has been denied without reviewing the medical record
because the requested records were not received or were not received
timely.




                                                  Page 296
                                                CARCs_Query2




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.




 Alert: This decision may be reviewed if additional documentation as
described in the contract or plan benefit documents is submitted.




                                                   Page 297
                                                   CARCs_Query2




Additional information is required from another provider involved in this
service.




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04)
Related to N301




Patient ineligible for this service. Note: (Modified 6/30/03)




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.




                                                      Page 298
                                                   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)




Missing/incomplete/invalid other payer rendering provider identifier.




                                                      Page 299
                                                   CARCs_Query2




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)




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 300
                                                   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)




                                                      Page 301
                                                   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)




                                                      Page 302
                                                   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)




Service not payable with other service rendered on the same date.




Not covered more than once in a 12 month period.




                                                      Page 303
                                                   CARCs_Query2




Not covered more than once in a 12 month period.

Pre-/post-operative care payment is included in the allowance for the
surgery/procedure.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 304
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing patient medical record for this service.


Payment based on authorized amount.




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 305
                                                   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)




                                                      Page 306
                                                   CARCs_Query2




This claim/service must be billed according to the schedule for this plan.




Patient ineligible for this service. Note: (Modified 6/30/03)




 Missing/incomplete/invalid provider identifier.




Missing/incomplete/invalid number of miles traveled.




                                                      Page 307
                                                  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.




Additional information is required from another provider involved in this
service.




                                                     Page 308
                                               CARCs_Query2




Missing/incomplete/invalid HCPCS. Note: (Modified 2/28/03)




Additional information has been requested from the member. The
charges will be reconsidered upon receipt of that information.




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 309
                                                   CARCs_Query2




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.




Patient ineligible for this service. Note: (Modified 6/30/03)




Payment based on authorized amount.




Missing itemized bill. Note: (Modified 2/28/03) Related to N232


Payment based on authorized amount.




                                                      Page 310
                                                   CARCs_Query2



Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)




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)




                                                      Page 311
                                               CARCs_Query2




Missing/incomplete/invalid procedure code(s). Note: (Modified 12/2/04)
Related to N301




Correction to a prior claim.




Payment based on authorized amount.


Payment based on authorized amount.


Payment based on authorized amount.


Payment based on authorized amount.




                                                  Page 312
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




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)




Procedure code incidental to primary procedure.




Missing/incomplete/invalid days or units of service. Note: (Modified
2/28/03)




                                                      Page 313
                                                CARCs_Query2




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 condition code.




Missing/incomplete/invalid revenue code(s). Note: (Modified 2/28/03)




                                                   Page 314
                                                   CARCs_Query2




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)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 315
                                                 CARCs_Query2




Transportation to/from this destination is not covered. Note: (New Code
2/28/03, Modified 2/1/04)




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)




Additional information/explanation will be sent separately Note: (New
Code 6/30/03)


                                                     Page 316
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid total charges. Note: (Modified 2/28/03)




                                                      Page 317
                                                 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.




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 days or units of service. Note: (Modified
2/28/03)




Patient ineligible for this service.




                                                    Page 318
                                                   CARCs_Query2




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)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 319
                                                   CARCs_Query2


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)




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 320
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Incomplete/invalid documentation/orders/notes/summary/report/chart.




Patient ineligible for this service. Note: (Modified 6/30/03)




Service not payable with other service rendered on the same date.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 321
                                                   CARCs_Query2




This claim has been denied without reviewing the medical record
because the requested records were not received or were not received
timely.




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 322
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Incomplete/invalid patient medical record for this service.




Missing/incomplete/invalid treatment authorization code.




                                                      Page 323
                                                   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)




Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions. Note: (Modified 8/13/01)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 324
                                                   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)




 Payment based on authorized amount.



                                                      Page 325
                                                   CARCs_Query2




Patient liability may be affected due to coordination of benefits with other
carriers and/or maximum benefit provisions. Note: (Modified 8/13/01)




Patient ineligible for this service.




 Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 326
                                                   CARCs_Query2




Missing/incomplete/invalid admission source. Note: (Modified 2/28/03)




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)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 327
                                                   CARCs_Query2




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. Note: (Modified 6/30/03)




Missing/incomplete/invalid billing provider/supplier address.




                                                      Page 328
                                                CARCs_Query2




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.




Patient ineligible for this service.




                                                   Page 329
                                                   CARCs_Query2




Missing/incomplete/invalid billing provider/supplier primary identifier.
Note: (New Code 12/2/04)




This provider type/provider specialty may not bill this service. Note: (New
code 7/31/01, Modified 2/28/03)




Patient ineligible for this service.


Patient is a Medicaid/Qualified Medicare Beneficiary. Note: (New Code
2/28/03)




                                                      Page 330
                                                   CARCs_Query2




Patient ineligible for this service.




Patient ineligible for this service.




Missing/incomplete/invalid patient relationship to insured.




Alert: Patient liability may be affected due to coordination of benefits with
other carriers and/or maximum benefit provisions.




                                                      Page 331
                                                   CARCs_Query2




This claim has been denied without reviewing the medical record
because the requested records were not received or were not received
timely.




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.




                                                      Page 332
                                                   CARCs_Query2




Missing/incomplete/invalid appliance placement date.




Procedure code incidental to primary procedure.




Alert: Additional information/explanation will be sent separately




Patient ineligible for this service. Note: (Modified 6/30/03)


                                                      Page 333
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




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.




                                                      Page 334
                                                   CARCs_Query2




Missing/incomplete/invalid procedure code(s).




Missing/incomplete/invalid procedure code(s).




 Missing/incomplete/invalid procedure date(s).




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid revenue code(s).




Missing/incomplete/invalid other procedure date(s).


                                                      Page 335
                                                   CARCs_Query2




Procedure code incidental to primary procedure.




Missing/incomplete/invalid other procedure code(s).




Missing/incomplete/invalid revenue code(s).




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.




                                                      Page 336
                                                   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.




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 337
                                               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.




Patient ineligible for this service.




Patient ineligible for this service.




Patient ineligible for this service.



                                                   Page 338
                                                  CARCs_Query2




Patient ineligible for this service.




Patient ineligible for this service.




Additional information is required from another provider involved in this
service.




Claim information does not agree with information received from other
insurance carrier.




Missing/incomplete/invalid rendering provider name.




Missing/incomplete/invalid diagnosis or condition.




                                                     Page 339
                                                  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.




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 Certificate of Medical Necessity.




This procedure code is not payable. It is for reporting/information
purposes only.



                                                     Page 340
                                                   CARCs_Query2




Missing/incomplete/invalid procedure code(s).




Missing/incomplete/invalid information on where the services were
furnished.




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.




Patient ineligible for this service. Note: (Modified 6/30/03)



                                                      Page 341
                                                   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)




                                                      Page 342
                                                   CARCs_Query2




Missing 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)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 343
                                                   CARCs_Query2




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.




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 344
                                                   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/incomplete/invalid diagnosis or condition. Note: (Modified
2/28/03)




                                                      Page 345
                                                   CARCs_Query2




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)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 346
                                                   CARCs_Query2




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. 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 347
                                                   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 is not a covered service/procedure/ equipment/bed, however patient
liability is limited to amounts shown in the adjustments under group 'PR'.




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 348
                                                   CARCs_Query2




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'.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 349
                                                   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)




                                                      Page 350
                                                   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)




                                                      Page 351
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid principal procedure code.




This is not a covered service/procedure/ equipment/bed, however patient
liability is limited to amounts shown in the adjustments under group 'PR'.




                                                      Page 352
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid principal diagnosis.




Missing/incomplete/invalid other diagnosis.




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.




                                                      Page 353
                                                   CARCs_Query2




Missing/incomplete/invalid provider/supplier signature.




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.




                                                      Page 354
                                                  CARCs_Query2




 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.




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.




                                                       Page 355
                                                  CARCs_Query2




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.




Missing/incomplete/invalid procedure code(s).




Missing/incomplete/invalid procedure code(s).




                                                     Page 356
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




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)




                                                      Page 357
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 358
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid procedure code(s).




Correction to a prior claim.




Patient ineligible for this service. Note: (Modified 6/30/03)


                                                      Page 359
                                                   CARCs_Query2




Rebill services on separate claim lines.




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 360
                                                   CARCs_Query2




This provider type/provider specialty may not bill this service.




Patient ineligible for this service. Note: (Modified 6/30/03)




The original claim has been processed, submit a corrected claim.




Correction to a prior claim.


Payment based on authorized amount.


                                                      Page 361
                                                   CARCs_Query2




Missing/incomplete/invalid name, strength, or dosage of the drug
furnished.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




                                                      Page 362
                                                   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.




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




                                                      Page 363
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




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)




The original claim has been processed, submit a corrected claim.




                                                      Page 364
                                                   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. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 365
                                                   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)




Payment based on authorized amount.




Rebill services on separate claims.




                                                      Page 366
                                                   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)




                                                      Page 367
                                                    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.




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


Not covered more than once in a 12 month period.




                                                       Page 368
                                                   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)




                                                      Page 369
                                                   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)




                                                      Page 370
                                                   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)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing Certificate of Medical Necessity.




                                                      Page 371
                                                   CARCs_Query2




Missing x-ray. Note: (Modified 2/1/04) Related to N242




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 372
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




                                                      Page 373
                                                CARCs_Query2




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




Missing x-ray. Note: (Modified 2/1/04) Related to N242




Missing documentation/orders/notes/summary/report/chart.


                                                   Page 374
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing/incomplete/invalid HCPCS. Note: (Modified 2/28/03)




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 375
                                                   CARCs_Query2




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)




Missing/incomplete/invalid prior insurance carrier EOB.




                                                      Page 376
                                                   CARCs_Query2




Consult our contractual agreement for restrictions/billing/payment
information related to these charges.




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 377
                                                   CARCs_Query2




Correction to a prior claim.




Additional information is required from another provider involved in this
service.




Patient ineligible for this service. Note: (Modified 6/30/03)


                                                      Page 378
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




We have no record that you are licensed to dispensed drugs in the State
where located.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 379
                                                   CARCs_Query2




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)




Additional information is required from another provider involved in this
service.




                                                      Page 380
                                                   CARCs_Query2




Missing/incomplete/invalid name, strength, or dosage of the drug
furnished.




Rebill services on separate claims.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 381
                                                   CARCs_Query2




Missing itemized bill. Note: (Modified 2/28/03) Related to N232




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 382
                                                   CARCs_Query2




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.




Procedure code billed is not correct/valid for the services billed or the
date of service billed. Note: (Modified 2/28/03)




                                                      Page 383
                                                   CARCs_Query2




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 384
                                                   CARCs_Query2




Missing/incomplete/invalid anesthesia time/units




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




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 385
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




Patient ineligible for this service. Note: (Modified 6/30/03)




Missing patient medical record for this service.




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 386
                                                   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)




Missing documentation/orders/notes/summary/report/chart.




Missing/incomplete/invalid name, strength, or dosage of the drug
furnished.




                                                      Page 387
                                                   CARCs_Query2




Patient ineligible for this service. Note: (Modified 6/30/03)




The original claim has been processed, submit a corrected claim.




No rental payments after the item is purchased, or after the total of issued
rental payments equals the purchase price.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 388
                                                   CARCs_Query2




Incorrect claim form/format for this service. Note: (Modified 11/18/05)




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)




                                                      Page 389
                                                   CARCs_Query2




Missing/incomplete/invalid days or units of service. Note: (Modified
2/28/03)




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)




                                                      Page 390
                                                   CARCs_Query2




Payment based on authorized amount.




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 391
                                                   CARCs_Query2




Incomplete/invalid patient medical record for this service.




Missing/incomplete/invalid other provider name.




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)




Payment based on authorized amount.


                                                      Page 392
                                                   CARCs_Query2




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




                                                      Page 393
                                                   CARCs_Query2




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)




                                                      Page 394
                                                   CARCs_Query2




Missing Certificate of Medical Necessity.




Patient ineligible for this service. Note: (Modified 6/30/03)




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)


                                                      Page 395
                                                   CARCs_Query2




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)




Payment based on authorized amount.




Patient ineligible for this service. Note: (Modified 6/30/03)




                                                      Page 396

				
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