ATTENDING/SERVICING PROVIDER IS NOT LINKED TO PIHP ( 556 PIHP ) Added procedure has been denied as a duplicate procedure because the 565 maximum allowed daily occurrences of this procedure was exceeded due to current codes. Current procedure is flagged because the indicated procedure is 584 inappropriate for sex. patient’s Current multi-unit line contains units, which have been denied for more 595 than one reason. (Split-Decision) 596 Code added due to SPL claim OUTPATIENT AND INPATIENT HOSPITAL SERVICES ON SAME 622 DAY 715 FOUND DUPLICATE VISIT SAME DAY 727 EXCEEDS DAILY SERVICE MAXIMUM 791 BILLED CODE CONFLICTS WITH CODE ALREADY PAID 813 EXACT DUPLICATE ERROR: IDENTICAL PHYSICIAN CLAIMS 851 SUSPCT DUPLICATE ERROR: IDENTICAL HOSPITAL CLAIMS 855 SUSPCT DUPLICATE ERROR: IDENTICAL OUTPATIENT CLAIMS 863 SUSPCT DUPLICATE ERROR:IDENTICAL PHYSICIAN CLAIMS MEDICAID ALLOWABLE AMOUNT REDUCED BY RECIPIENT 919 SPENDOWN 964 Integration Wizard Defined AUDIT-RESULT 967 Integration Wizard Defined AUDIT-RESULT 978 CALCULATED PRICING IS ZERO/CALL HELP DESK EDIT DISPOSITION - NON REPAIRABLE DENIALS EDIT CODE EDIT DESCRIPTION MAXIMUM OF 2 DAYS ALLOWED TO TRANSFER MHISA 117 PATIENTS 141 REFILL NOT FILLED WITHIN 12 MONTHS 149 DESI INEFFECTIVE-NOT PAYABLE______ 210 PROVIDER NOT CERTIFIED FOR THIS PROCEDURE 219 EPSDT REFERRAL FOR RECIPIENT OVER 21 years old 222 RECIPIENT INELIGIBLE ON ONE OR MORE SERVICE DATE(S) 231 NDC IS NOT ON THE PROCUDURE FORMULARY FILE 233 PROCEDURE/NDC NOT COVERED FOR SERVICE DATE GIVEN 234 PROCEDURE/NDC NOT COVERED FOR AGE GIVEN PROCEDURE/NDC NOT COVERED FOR PROVIDER SPECIALTY 237 GIVEN 255 DIAG SEX RESTRICTION 293 RECYCLED RECIPIENT INELIGIBLE ON DOS 299 PROCEDURE/DRUG NOT COVERED BY MEDICAID 349 RECIPIENT NOT COVERED FOR THIS SERVICE 367 ADJUSTMENT DENIED/ORIG CLAIM PAID CORRECTLY 508 WAIVER SVC NOT PAYABLE WHILE IP LACHIP AFFORDABLE PLAN - SUBMIT CLAIM TO LOUISIANA 528 OFFICE OF GROUP BENEFITS
556 ATTENDING/SERVICING PROVIDER IS NOT LINKED TO PIHP ( PIHP ) 565 Added procedure has been denied as a duplicate procedure because the maximum allowed daily occurrences of this procedure was exceeded due to current codes. 584 Current procedure is flagged because the indicated procedure is inappropriate for patient’s sex. 595 Current multi-unit line contains units, which have been denied for more than one reason. (Split-Decision) 596 Code added due to SPL claim 622 OUTPATIENT AND INPATIENT HOSPITAL SERVICES ON SAME DAY 715 FOUND DUPLICATE VISIT SAME DAY 727 EXCEEDS DAILY SERVICE MAXIMUM 791 BILLED CODE CONFLICTS WITH CODE ALREADY PAID 813 EXACT DUPLICATE ERROR: IDENTICAL PHYSICIAN CLAIMS 851 SUSPCT DUPLICATE ERROR: IDENTICAL HOSPITAL CLAIMS 855 SUSPCT DUPLICATE ERROR: IDENTICAL OUTPATIENT CLAIMS 863 SUSPCT DUPLICATE ERROR:IDENTICAL PHYSICIAN CLAIMS 919 MEDICAID ALLOWABLE AMOUNT REDUCED BY RECIPIENT SPENDOWN 964 Integration Wizard Defined AUDIT-RESULT 967 Integration Wizard Defined AUDIT-RESULT 978 CALCULATED PRICING IS ZERO/CALL HELP DESK EDIT CODE EDIT DISPOSITION - NON REPAIRABLE DENIALS EDIT DESCRIPTION 117 MAXIMUM OF 2 DAYS ALLOWED TO TRANSFER MHISA PATIENTS 141 REFILL NOT FILLED WITHIN 12 MONTHS 149 DESI INEFFECTIVE-NOT PAYABLE______ 210 PROVIDER NOT CERTIFIED FOR THIS PROCEDURE 219 EPSDT REFERRAL FOR RECIPIENT OVER 21 years old 222 RECIPIENT INELIGIBLE ON ONE OR MORE SERVICE DATE(S) 231 NDC IS NOT ON THE PROCUDURE FORMULARY FILE 233 PROCEDURE/NDC NOT COVERED FOR SERVICE DATE GIVEN 234 PROCEDURE/NDC NOT COVERED FOR AGE GIVEN 237 PROCEDURE/NDC NOT COVERED FOR PROVIDER SPECIALTY GIVEN 255 DIAG SEX RESTRICTION 293 RECYCLED RECIPIENT INELIGIBLE ON DOS 299 PROCEDURE/DRUG NOT COVERED BY MEDICAID 349 RECIPIENT NOT COVERED FOR THIS SERVICE 367 ADJUSTMENT DENIED/ORIG CLAIM PAID CORRECTLY 508 WAIVER SVC NOT PAYABLE WHILE IP 528 LACHIP AFFORDABLE PLAN - SUBMIT CLAIM TO LOUISIANA OFFICE OF GROUP BENEFITS