K
|
01K
|
AUTHORIZATION/PREAUTHORIZATION
NEEDED
|
K
|
02K
|
BENEFIT DETERMINATION UNSUPPORTED
|
K
|
03K
|
BILLED AMOUNT INCORRECT
|
K
|
04K
|
COST-SHARE/DEDUCTIBLE ERROR
|
K
|
05K
|
DEVELOPMENT CLAIM DENIED PREMATURELY
|
K
|
06K
|
DEVELOPMENT REQUIRED
|
K
|
07K
|
DUPLICATE SERVICES PAID
|
K
|
08K
|
ELIGIBILITY DETERMINATION -
PATIENT
|
K
|
09K
|
ELIGIBILITY DETERMINATION -
PROVIDER
|
K
|
10K
|
MEDICAL EMERGENCY NOT SUBSTANTIATED
|
K
|
11K
|
MEDICAL NECESSITY NOT EVIDENT
|
K
|
13K
|
OHI - GOVERNMENT PAY MISCALCULATED
|
K
|
14K
|
OHI PAYMENT OMITTED
|
K
|
15K
|
PAYEE WRONG - SPONSOR/PATIENT
|
K
|
16K
|
PAYEE WRONG - PROVIDER
|
K
|
17K
|
PARTICIPATING/NONPARTICIPATING
ERROR
|
K
|
18K
|
PRICING INCORRECT - OTHER
|
K
|
19K
|
PROCEDURE CODE INCORRECT
|
K
|
20K
|
SIGNATURE ERROR
|
K
|
21K
|
TIMELY FILING ERROR
|
K
|
22K
|
DRG REIMBURSEMENT ERROR
|
K
|
23K
|
CONTRACT JURISDICTION ERROR
|
K
|
24K
|
BENEFIT DETERMINATION WRONG
|
K
|
25K
|
CLAIM NOT PROVIDED
|
K
|
26K
|
CLAIM NOT AUDITABLE
|
K
|
28K
|
POINT OF SERVICE MISCALCULATED/OMITTED
|
K
|
50K
|
PRICING INCORRECT - CPT/HCPCS/CMAC/Fee
Schedule Allowed Amount Miscalculated
|
K
|
51K
|
PRICING INCORRECT - OPPS Reimbursement
Rate Miscalculation
|
K
|
52K
|
PRICING INCORRECT - HHS Reimbursement
Rate Miscalculation
|
K
|
53K
|
PRICING INCORRECT - Critical
Access Hospital Reimbursement Rate Miscalculated
|
K
|
54K
|
PRICING INCORRECT - Residential
Treatment Center (RTC) Per-Diem Rate Miscalculated
|
K
|
55K
|
PRICING INCORRECT - Long Term
Care Facility Per-Diem Rate Miscalculated
|
K
|
56K
|
PRICING INCORRECT - Substance
Abuse Treatment Facility Per-Diem Rate Miscalculated
|
K
|
57K
|
PRICING INCORRECT - Skilled
Nursing Facility (SNF) Per-Diem Rate Miscalculated
|
K
|
58K
|
PRICING INCORRECT - Hospice
Per-Diem Rate (Inpatient) Miscalculated
|
K
|
59K
|
PRICING INCORRECT - Hospice
Per-Diem Rate (Outpatient) Miscalculated
|
K
|
60K
|
PRICING INCORRECT - Professional/Technical
Component Rate Miscalculated
|
K
|
61K
|
PRICING INCORRECT - Provider
Discount Rate Miscalculated/Not Applied
|
K
|
62K
|
PRICING INCORRECT - Blended
Rate Allowed Amount Miscalculated/Not Applied
|
K
|
63K
|
PRICING INCORRECT - Locality
Based Waiver Miscalculated/Not Applied
|
K
|
64K
|
PRICING INCORRECT - Claim Incorrectly
Paid as Billed (PAB)
|
K
|
65K
|
PRICING INCORRECT - DMEPOS
Fee Schedule - Incorrect rate/information used
|
K
|
66K
|
PRICING INCORRECT - Number/Units
of Service Miscalculated
|
K
|
67K
|
PRICING INCORRECT - Multiple
Procedure/Surgery Discount Miscalculated/Not Applied
|
K
|
68K
|
PRICING INCORRECT - Inpatient
Psych Hospital Per-Diem Rate Miscalculated/Not Applied
|
K
|
69K
|
PRICING INCORRECT - Reimbursement
Rate for SCH Miscalculated/Not Applied
|
K
|
70K
|
PRICING INCORRECT - AMBi Surg
Miscalculated
|
K
|
71K
|
PRICING INCORRECT - Overseas
Exchange Rate Miscalculated/Not Applied
|
K
|
72K
|
PRICING INCORRECT - Lesser
Of Reimbursement Logic Miscalculated/Not Applied
|
K
|
73K
|
PRICING INCORRECT - Outpatient
Hospital Claim Incorrectly Processed
|
K
|
74K
|
PRICING INCORRECT - Ambulance
Service (Air/Ground) - Reimbursement Rate Miscalculated
|
K
|
75K
|
PRICING INCORRECT - Anesthesia
Pricing Miscalculated
|
K
|
76K
|
PRICING INCORRECT - Pharmacy
Pricing Methodology (i.e., AWP, U&C, billed discount) Incorrectly
Applied and/or Miscalculated
|
K
|
77K
|
PRICING INCORRECT - Pharmacy
Compound Drug Pricing Miscalculation
|
K
|
78K
|
PRICING INCORRECT - Pharmacy
Specialty Drug Rate Miscalculated
|
K
|
79K
|
PRICING INCORRECT - Pharmacy
Discount Miscalculated/Not Applied
|
K
|
80K
|
PRICING INCORRECT - Pharmacy
Dispensing Fee Miscalculated/Not Applied
|
K
|
99K
|
OTHER - SEE REMARKS
|