Subscriber Contract by fha15947


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Rev 06252008

ANSII Code     ANSI Code Definition                                                                JVHL CD JVHL Error Code Definition
26             Entity not found. JVHL Note: Check for valid contract number and rebill claim.      012     Member Contract Not On File
28             Claim submitted to wrong payer.                                                     052     Medicare Supplemental - Not A JVHL Covered Member. Bill Health Plan Directly.
32             Subscriber and policy number/contract number not found.                             001     Contract Number Missing Or Invalid (Subscriber/Patient Member ID)
54             Duplicate of a previously processed claim/line.                                     508     Duplicate Charge On DOS
84             Service not authorized.                                                             055     Physician Office Is Outside Your Authorized Service Area.
86             Diagnosis and Patient gender mismatch                                               083     Diagnosis and Patient gender mismatch
88             Entity not eligible for benefits for submitted dates of service.                    013     Member Not Eligible For Coverage On Date Of Service
91             Entity not eligible/not approved for dates of service.                              015     Dos Is Outside of Your JVHL Participation for This Payer x2
105            Claim/line is capitated.                                                            039     Not On File As Hap Fee For Service - Rebill As HAP Capitated
105            Claim/line is capitated.                                                            048     Not On File As DMC Care Ffs - Rebill As DMC Care Capitated
109            Entity not eligible.                                                                514     DOS Is Outside Of Your JVHL Participation For This Payer
116            Claim submitted to incorrect payer.                                                 040     JVHL Does Not Hold This Contract On Dos Billed x2
122            Missing/invalid data prevents payer from processing claim.                          051     JVHL Contract Code Missing
122            Missing/invalid data prevents payer from processing claim.                          599     No Service Lines Sent With Claim
128            Entity's tax id.                                                                    076     Lab location FederalL ID submitted not on file as being associated with submitted lab code.
157            Entity's Gender.                                                                    006     Patient Sex Code Missing Or Invalid
157            Entity's Gender.                                                                    080     PATIENT GENDER SENT ON CLAIM DOES NOT MATCH GENDER ON PAYER ELIGIBILITY.
158            Entity's date of birth.                                                             075     Date Of Service Cannot Be Before Patients Date Of Birth.
158            Entity's date of birth.                                                             079     PATIENT DATE OF BIRTH SENT ON CLAIM DOES NOT MATCH DATE OF BIRTH ON PAYER ELIGIBILITY
158            Entity's date of birth.                                                             084     Age / Diagnosis mismatch
               Entity's name, address, phone, gender, DOB, marital status, employment status and           PATIENT SENT AS THE SUBSCRIBER BUT WAS IDENTIFIED AS A NON-SUBSCRIBER BASED ON ELIGIBILITY. THE FIRST
173            relation to subscriber.                                                             081     NAME OF THE PATIENT ALSO DOES NOT MATCH THE NAME ON THE PAYERS ELIGIBILITY FILE.
178            Submitted charges.                                                                  071     Charges And Credits Cannot Be Submitted On Same Claim. Resubmit Charges On One Claim And Credits On Another.
178            Submitted charges.                                                                  524     Claim Submitted As 'Credit' But No Charges Were Previously Approved For Payment. Credit Not Applied.
179            Outside lab charges.                                                                525     CPTs Submitted With Esrd/Renal Failure Diagnosis Are Not JVHL Covered Services. Bill Health Plan Directly.
187            Date(s) of service.                                                                 078     DATE OF SERVICE END DATE CANNOT BE PRIOR TO DATE OF SERVICE BEGIN DATE
187            Date(s) of service.                                                                 500     Date Of Service Invalid
249            Place of service.                                                                   501     Place Of Service Missing
249            Place of service.                                                                   512     Place Of Service Code Submitted Is Not Covered By JVHL
255            Diagnosis code.                                                                     511     Diagnosis Code Not On File
255            Diagnosis code.                                                                     518     Diagnosis Code Requires Further Specification
255            Diagnosis code.                                                                     522     Diagnosis Code Is Inactive On DOS
258            Days/units for procedure/revenue code.                                              077     Quantity measurement basis must be set to 'UN'.
259            Frequency of service.                                                               503     Quantity Not Numeric Or Greater Than 99
275            Claim                                                                               041     Date Billed Is Beyond Payer'S Filing Limit
275            Claim                                                                               510     Date Of Service Is Beyond Filing Limit
400            Claim is out of balance                                                             070     Total Of Service Line Charges Do Not Equal Claim Charge Amount.
453            Procedure Code Modifier(s) for Service(s) Rendered                                  506     CPT/Modifier Not On File As A Laboratory Covered Service. Bill Valid CPT/Modifiers For Non-Lab Services To Health Plan
453            Procedure Code Modifier(s) for Service(s) Rendered                                  507     CPT/Modifier Not Billable On DOS
454            Procedure code for services rendered.                                               530     CPT/Modifier Not On File As A Covered Service.
476            Missing or invalid units of service                                                 517     Quantity Is < 1 Or > 99
481            Claim/submission format is invalid.                                                 074     Patient Loop Not Valid On Medicaid Contracts.
488            Diagnosis code(s) for the services rendered.                                        504     Diagnosis Required
550            Coordination of Benefits Code                                                       050     Claim Must Be Resubmitted With Complete COB Information
562            Entity's National Provider Identifier (NPI)                                         011     Ordering Physician Not On File. Resubmit Claim With Valid Npi. X3
562            Entity's National Provider Identifier (NPI)                                         072     Organizational NPI Sent For Referring Physician. Resubmit With The Physicians Individual NPI.
562            Entity's National Provider Identifier (NPI)                                         073     Lab Location Npi Submitted Not On File As Being Associated With The Submitted JVHL Lab Code.
562            Entity's National Provider Identifier (NPI)                                         082     REFERRING PHYSICIAN MISSING NPI NUMBER.
644            Service Line Rate                                                                   531     Service Line Charge Amount Cannot Be Zero.

Confidential                                                                                                   8/16/2011                                                                                                     Page 1

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