16 PROC REQUIRES PA PROCEDURE REQUIRES PRIOR …

LAM5M113

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1

HIPAA/LA MEDICAID ERROR CODE CROSSWALK

ADJ RSN CODE

SHORT DESCRIPTION

LONG DESCRIPTION

ERROR CODE HIPAA REMARK CODE

----------------------------------------------------------------------------------------------------------------------------------

A1 A1 A1 A1 A1 A1 A1 B7 B7 B7 B7 B7 B7 B7 B9 B9 B10 B13 B13 B14 B14 B14 B15 B16 B16 B16 B16 B20 B23 B23 1 3 3 4 4 4 4 4 4 4 4 4 4 4

REQ NONCOVRD CHARGES SUB CLAR CODE SUSP DIFF VACCIN LABELER # REFILLS=0 FOR CII ACCUM QTY>RX QTY CII W/IN 30/60 DAY CII ORG RX DATE REQ REV CODE HCPC ERROR PROV CERT DATE ERROR PROVIDER NOT ELIG NO DOD ON FILE PROVIDER NOT COVERED OUT OF DATE RANGE BILL PROV NOT ELIG PROV RATE NOF HOSPICE MUST BILL NON HOSPICE PROVIDER PROC SPL REL TO CURR CANNOT ADJUST PREPAY FY COST SETTLED CONCURRENT CARE VISIT CODE PD/DOS 1 CONSLT/PHYS/HOSP GLOBAL CODE PD NEW/EST PT CONFLICT NEW/EST PT CONFLICT NEW PT/EST PT CD CON ONGOING CM PRIOR TO PAY ADMIN ONLY NOT PAY W/CLIA CERT CLIA NOT CERT DOS DEDUCT EXCEEDS MAX PAY REDUCED BY COPAY COPAY LIFTED TEMP VOID PD CLM-SUB W/50 RESUB W/MOD-50 1UNIT PRIOR PAYMNT REDUCED RESERVED FOR CXT HX DN REQ-51 CXT HX REQ MOD-51 CXT ADJ PD LINE 51 MOD MODIFIER NOT CORRECT MOD 95 DOESN'T APPLY QW MODIFIER NEEDED MOD NOT NEEDED-RESUB

NON-COVERED CHARGES REQUIRED OR USED FOR PAYMENT

SUB. CLARIFICATION CODE SUSPECT BASED ON CLAIM HX

DIFFERENT LABELER DISCREPANCY FOR VACCINE

NUMBER OF REFILLS AUTHORIZED MUST BE 0 FOR SCHEDULE II

ACCUMULATED QTY OF PAID PARTIAL FILLS>RX QUANTITY

CII FILL MUST BE W/I 30/60DAYS OF ORIGINAL DATE WRITTEN

FOR C II FILLS, RX DATE MUST MATCH ORG RX DATE

REVENUE CODE/HCPC CODE PRICING MISMATCH

PROVIDER CERTIFICATION EXPIRED AS OF DOS

PROVIDER NOT ELIGIBLE ON DATES OF SERVICE

NO DOD ON FILE. SEND 81B FORM TO HOSPICE PA

PROVIDER NOT COVERED FOR SERVICES RENDERED BY MEDICAID

SIA/DOS NOT WITHIN LAST 7 DAYS OF LIFE

BILLING PROVIDER INELIGIBLE ON DATE OF SERV

PROVIDER FILE DOES NOT CONTAIN VALID RATE FOR DOS

HOSPICE CLIENT -ONLY HOSPICE PROVIDER CAN BILL

SUBMIT JUSTIFICATION FOR SERVICES

PROCEDURE SPLIT TO ALLOW PARTIAL PAYMENT/CXT

CANNOT ADJUST ZERO-PAID CLAIM FROM PRE-PAY RVW PROCESS

FISCAL YEAR COST SETTLED

CONCURRENT CARE IS NOT COVERED BY THE PROGRAM

VISIT CODE ALREADY PAID FOR THIS DATE OF SERVICE

ONLY 1 INITIAL CONSULT-SAME PHYS.PER HOSPITALIZATION

GLOBAL CODE PD THIS DOS THIS RECIP

NEW/ESTABLISHED PATIENT CONFLICT/CXT

NEW/ESTABLISHED PATIENT CONFLICT

NEW PATIENT/ESTABLISHED PATIENT CODE CONFLICT

ONGOING CM PRIOR TO INITIAL CM

~

ADMINISTRATION ONLY IS REIMBURSABLE

NOT PAYABLE WITH CLIA CERT TYPE

CLIA # DOES NOT COVER DATE OF SERVICE

DEDUCTIBLE EXCEEDS MAXIMUM

PAYMENT REDUCED BY COPAY

RECIPIENTS COPAY LIFTED TEMPORARILY

BILATERAL-VOID PAID CLAIM-RESUBMIT WITH MOD-50 ONE UNIT

BILATERAL-RESUBMIT WITH MODIFIER-50-ONE UNIT

PRIOR PAYMENT REDUCED

RESERVED FOR CLAIMSXTEN

HISTORICAL PROCEDURE DOES NOT REQUIRE MODIFIER 51/CXT

HISTORICAL PROCEDURE REQUIRES MODIFIER 51/CXT

ADJUST PAID LINE WITH 51 MODIFIER THEN RESUBMIT MAJOR

INAPPROPRIATE PROCEDURE CODE MODIFIER-REBILL

MOD 95 DOES NOT APPLY TO THIS PROC CODE/CXT

QW MODIFIER NEEDED FOR TYPE OF CLIA CERTIFICATE

MODIFIER NOT NEEDED-REMOVE AND RESUBMIT

185 156 111 064 056 073 074 468 360 201 220 213 206 207 244 382 493 595 501 975 401 644 642 678 663 645 702 776 649 386 329 480 662 718 710 707 658 669 638 635 757 781 834 475 430

N570 N570 N570 N570 N570 N570 N570

M86 M86 M86 N20 M86

N58 N517 N517 N517

N519 N517 N517 N519 N519 N517 N517

LAM5M113

LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM

REPORT NO:

RF-0-77-R

RUN: 10/30/23 21:22:31 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING

PAGE:

2

HIPAA/LA MEDICAID ERROR CODE CROSSWALK

ADJ RSN CODE

SHORT DESCRIPTION

LONG DESCRIPTION

ERROR CODE HIPAA REMARK CODE

----------------------------------------------------------------------------------------------------------------------------------

4

CLAIM-NEEDS-80-MOD

APPEARS TO BE ASSISTANT--REBILL WITH 80 MODIFIER

397

4

USE 62/66 MOD,RESUB

USE OF 62/66 MOD INDICATED BY REPORT;RESUB &/OR ADJUST

500

4

PA/CLM MOD NOT SAME

PA MODIFIER DOES NOT MATCH CLAIM MODIFIER

597

4

ADJ MAJOR WITH 62/66

ADJ MAJOR WITH 62 OR 66 THEN SECONDARY (S) WILL BE PAID

566

4

USE CORRECT MODIFIER

CRNA'S MUST BILL CORRECT MODIFIER

186

4

INVLD/MISSNG MODIFR

INVALID OR MISSING MODIFIER

092

4

MOD.NOT USED FOR CLM

MODIFIER NOT USED TO PROCESS CLAIM

039

4

NO SURGERY MODIFIER

CLAIM DESCRIPT INDICATES PROC CODE SHOULD HAVE MODIFIER

973

4

MOD 51 DOESN'T APPLY

MODIFIER 51 DOES NOT APPLY TO THIS PROC CODE/CXT

964

4

MOD -50 INVALID

MODIFIER -50 INVALID/CXT

961

4

UNITS NOT=SITE MOD

UNITS DO NOT MATCH SITE-SPECIFIC MODIFIER/CXT

921

4

CLAIM DENIED MOD -51

CLAIM DENIED/CXT.INCORRECT USE OF MODIFIER -51

914

4

INVALID PROC/MOD

INVALID PROCEDURE-MODIFIER COMBINATION/CXT

933

4

MOD 51 INVAL-REMOVED

MODIFIER 51 INVALID. REMOVED FROM CLAIM/CXT

938

4

MOD 51 REQ'D-ADDED

MODIFIER 51 REQUIRED. ADDED TO CLAIM/CXT

934

5

PROC/CLAIM TYP CONFL

PROCEDURE CLAIM TYPE CONFLICT

182

5

POT NOT ICF-I OR II

PLACE OF TREATMENT MUST BE ICF-I OR ICF-II

243

5

P/F PLACE RESTRICT

P/F PLACE RESTRICTION

236

5

PROF COMP INVLD POT

INVALID PLACE OF TREATMENT FOR PROF COMP

279

5

INV POS/MOD COMBO

INVALID PLACE OF SERVICE/PROCEDURE MODIFIER COMBINATION

578

5

OUTSIDE LAB NOT COVD

OUTSIDE LABORATORY SERVICES NOT COVERED

405

6

COUNSELING NOT PAID

COUNSELING NOT REIMBURSED DUE TO RECIPIENT AGE

380

6

RESTOR NOT ALLOW-AGE

RESTORATION NOT ALLOWABLE DUE TO PATIENT AGE

609

6

EPSDT DENT AGE GR 21

EPSDT DENTAL CLAIM - RECIPIENT AGE GREATER THAN 21

604

6

ADULT DENTAL-UNDER21

ADULT DENTAL CLAIM FILED FOR RECIP UNDER 21

601

6

EPSDT AGE ERROR

EPSDT AGE OVER 21

631

6

PROCEDURE-AGE-RESTRT

PROCEDURE ALLOWED FOR RECIP 0-30 DAYS OLD

263

6

P/F AGE RESTRICTION

P/F AGE RESTRICTION

234

6

STERILIZATION < 21

STERILIZATION IS NOT COVERED FOR RECIPIENT UNDER 21

332

6

PROC/DX AGE RESTRICT

PROC/DX NOT COVERED FOR RECIPIENT THIS AGE

956

7

P/F SEX RESTRICTION

P/F SEX RESTRICTION

235

7

PROC CODE MISMATCH

PROCEDURE CODE MISMATCH

599

7

PROC/SEX CONFLICT

PROCEDURE CODE/SEX CONFLICT-CLAIMCHECK

584

8

PROV PROC CONFLICT

PROVIDER NOT CERTIFIED FOR THIS PROCEDURE

210

8

PROC - PT CONFLICT

PROCEDURE CODE - PROVIDER TYPE CONFLICT

112

9

DIAG AGE RESTRICTION

DIAGNOSIS AGE RESTRICTION

254

10

DIAG SEX RESTRICTION

DIAG SEX RESTRICTION

255

11

DIAG PROC RESTRICT

DIAGNOSIS/PROCEDURE RESTRICTION

256

11

DENY FOR DIAGNOSIS

PROCEDURE DENIED NOT JUSTIFIED BY DIAGNOSIS

251

11

BILL VISITS--SEE CPT

SEE CPT-MEDICAL TREATMENT OF ABORTION USE E AND M CODES

476

13

RECIP INELIG/DECEASE

RECIPIENT INELIGIBLE/DECEASED

364

14

DOS LESS THAN DOB

DATE OF SERVICE LESS THAN DATE OF BIRTH

211

16

NEED SPANNING DOS

MUST HAVE SPANNING DOS IF BILLING FOR TOTAL AUTH AMOUNT

195

16

PA RECIP NQ CLM RECI

CLAIM RECIPIENT ID DOES NOT MATCH ID ON PRIOR AUTH FILE

196

16

PA PROV NQ CLM PROV

PA PROVIDER ID NOT SAME AS CLAIM PROVIDER ID

197

N517 N517 N519 N517 N517 N519 N519 N517 N519 N519 N519

N519 N519 N517

M77 M77 M77 M77 M77 N129 N129 N129 N129 N129 N129 N129 N129 N129

N95 N95 N517 N517

N54 N382 N257

LAM5M113

LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM

REPORT NO:

RF-0-77-R

RUN: 10/30/23 21:22:31 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING

PAGE:

3

HIPAA/LA MEDICAID ERROR CODE CROSSWALK

ADJ RSN CODE

SHORT DESCRIPTION

LONG DESCRIPTION

ERROR CODE HIPAA REMARK CODE

----------------------------------------------------------------------------------------------------------------------------------

16

PA PROC/NDC NE CLM

PA PROCEDURE/NDC NOT EQ CLAIM PROCEDURE/NDC

198

16

MISSING CONTROL NUM.

MISSING/INVALID BILLING PROVIDER CONTROL NUMBER TRIP ID

199

16

PROV/ATTEND NOF

PROVIDER/ATTENDING PROVIDER NOT ON FILE

200

16

PROC REQUIRES PA

PROCEDURE REQUIRES PRIOR AUTHORIZATION

191

16

DOS NOT COVERED/PA

DATE ON CLAIM NOT COVERED BY PA

193

16

INVALID COVERED DAYS

THE COVERED DAYS WAS NOT A VALID NUMERIC AMOUNT

181

16

INVALID ADMIT DATE

THE ADMISSION DATE WAS NOT A VALID DATE

180

16

SURGERY PROC NOF

SURGICAL PROCEDURE NOT ON FILE

183

16

CHARGES MISSING

NO CHARGES/COINS/DEDUCT GIVEN

175

16

CLM/PA DTE MUST MTCH

CLAIM DATES MUST MATCH PRIOR AUTHORIZATION DATES

172

16

LON/LOC NOT MATCHED

LEVEL OF NEED / LEVEL OF CARE NOT MATCHED

173

16

REBATE STAT UNKNOWN

REBATE STATUS IS UNKNOWN

158

16

LTC PROV NOT MATCHED

LTC PROV NOT MATCHED

159

16

HOSP STAY REQ PRECRT

HOSP STAY REQUIRES PRECERTIFICATION

161

16

CLM PROV ID NO MATCH

CLAIM PROVIDER ID DOES NOT MATCH ID ON PRECERT FILE

167

16

CV V/A BILLING ERROR

COVID-19 VACCINE & ADMIN FQHC/RHC BILLING ERROR

169

16

NO CV VAC/ADM PAID

BOTH COVID-19 VACCINE AND ADMIN MUST BE PAID

170

16

DOS NOT PRECERT COVD

CLAIM DOS NOT PRECERT COVERED

163

16

SURG REQUIRES PRECRT

SURGERY REQUIRES PRECERTIFICATION

165

16

CLM RECIP NO MATCH

CLAIM RECIP ID DOES NOT MATCH ID ON PRECERT FILE

166

16

INV/MISSING HCPCS

INVALID OR MISSING HCPCS

114

16

NDC PRICE MISSING

NDC PRICE MISSING, CALL MYERS&STAUFFER @ 1-800-591-1183

101

16

BILL-CODE-REQ-MC-CHG

BILL CLASS 2 REQUIRES MEDICARE ALLOWED AMOUNT IN LOC#54

098

16

INVALID SURFACE

INVALID TOOTH SURFACE CODE

102

16

INV TOOTH/CAVITY CDE

INVALID TOOTH CODE/ORAL CAVITY DESIGNATOR

103

16

INDICTR/CPT CONFLICT

INDICATOR 3 INVALID WITH CPT CODES-PCP REFERRAL REQ

104

16

M/I INCENTIVE AMOUNT

MISSING/INVALID INCENTIVE AMOUNT

089

16

REF PROV NOF FOR DOS

REFERRING PROVIDER NOT ON FILE FOR DATE OF SERVICE

090

16

REVENUE CODE MISSING

REVENUE CODE MISSING/INVALID

093

16

MISSING PINTS BLOOD

MISSING PINTS BLOOD

094

16

FROM THRU NOT EQUAL

CONDITION CODE 40 FROM THRU NOT EQUAL

095

16

REVENUE CHG MISSING

REVENUE CHARGE MISSING OR INVALID

096

16

INVALID TREAT PLACE

INVALID OR MISSING PLACE OF TREATMENT

084

16

INVALID STATUS DATE

INVALID OR MISSING PATIENT STATUS DATE

081

16

INVALID STATUS CODE

INVALID PATIENT STATUS CODE

082

16

INVALID UNITS/VISITS

INVALID OR MISSING UNITS, VISITS, AND STUDIES

085

16

MISSINVAL COINS DAY

MISSING OR INVALID COINSURANCE DAYS

087

16

INVALID ORIGIN CODE

INVALID ORIGIN CODE

088

16

BILL PROV NPI NOF

BILLING PROVIDER NPI MISSING/NOT ON FILE

142

16

REBILL W/APPROP CODE

ONE ADJUNCT CODE ALLOWED PER DDS: REBILL W/APPROP CODE

139

16

REBILL W/ALL DETAILS

ADJUNCT CD RPTD AS ONLY DETAIL LNE: REBILL W/ALL DETAIL

138

16

NO ELIG SERVICE PAID

NO ELIGIBLE SERVICE PAID - ENCOUNTER DENIED

136

16

MIXED ICD CODE SETS

CLAIM CONTAIN MIXED ICD CODE SETS

151

16

QTY EXCEEDS MAX

QUANTITY EXCEEDS MAX MD FAX OVERRIDE FORM 866-797-2329

153

16

SERV PROV NPI NOF

SERVING PROVIDER NPI MISSING/NOT ON FILE

143

N54 M47 N289 M62 N54 MA32 MA40 M51 M54 N54 M50 M56 N257 M62 N54 N657 N657 N54 M62 N54 M20 N65 MA04 N75 N37 N56 N190 N286 M50 M53 M52 M79 M77 M59 MA43 M53 M53 MA42 N257 N56 N56 N657 N657 N378 N290

LAM5M113

LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM

REPORT NO:

RF-0-77-R

RUN: 10/30/23 21:22:31 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING

PAGE:

4

HIPAA/LA MEDICAID ERROR CODE CROSSWALK

ADJ RSN CODE

SHORT DESCRIPTION

LONG DESCRIPTION

ERROR CODE HIPAA REMARK CODE

----------------------------------------------------------------------------------------------------------------------------------

16

REF/PCP PROV NPI NOF

REF OR PCP PROVIDER NPI MISSING/NOT ON FILE

144

16

BILL PROV NPI NO MAT

BILLING PROVIDER NPI MISMATCH

145

16

SER PROV NPI NO MATC

SERVICING PROVIDER NPI MISMATCH

146

16

REF/PCP NPI NO MATCH

REFERRING/PCP NPI MISMATCH

147

16

9F REF AUTH MISSING

9F REFERENCE AUTHORIZATION MISSING IN LOOP 2300

148

16

MISSING NDC

NDC CODE MISSING OR INCORRECT.

127

16

INVALID MAC INDICATR

THE MAC OVERRIDE INDICATOR MUST BE A 'C'

128

16

PRESCRIB PROV NPI NO

PRESCRIBING PROV NPI MISSING/NOT ON FILE

129

16

DENY PROV. 9999999

ALL PROVIDERS 9999999 TO BE DENY.

130

16

PRIMARY DX NOF

PRIMARY DIAGNOSIS NOT ON FILE

131

16

SECONDARY DX NOF

SECONDARY DIAGNOSIS NOT ON FILE

132

16

RX-DAYS-SUPPLY-ERR

DAYS SUPPLY MISSING,NOT NUMERIC, OR ZERO

124

16

PRESCRIP NO MISSING

PRESCRIPTION NUMBER MISSING

125

16

INVALID REFILL CODE

REFILL CODE MISSING NOT NUMERIC OR GREATER THAN 11

126

16

QTY INVALID/MISSING

QUANTITY INVALID/MISSING

120

16

MISS OR INV PRESCRIB

A PRESCRIBING PHYSICIAN NPI OR MEDICAID ID REQUIRED

121

16

INVALID RX DATE

RX DATE MISSING OR INVALID

122

16

HCPC CD NOT ON FILE

HCPC CODE NOT ON FILE

115

16

DIAGNOSIS NOT ON FIL

DIAGNOSIS NOT ON FILE

252

16

DELETED,BILL CURR CD

DELETED,BILL CURRENT CODE

248

16

INVAL PROC TOS TRANS

INVALID PROCEDURE TOS FOR TRANSPORTATION

245

16

INPUT SPENDDOWN AMT

110-MNP REQUIRED FOR RECIP LIABILITY AMOUNT

242

16

INV PAC CALL HELP DK

INVALD PAC VS DOS / CALL HELP DESK

238

16

PRICE MISSING ON P/F

PRICE MISSING FOR DATE OF SERVICE ON P/F CALL HELP DESK

239

16

PRICE MISSING ON U/C

U AND C FILE - NO VALID PRICE FOR DOS

240

16

P/F DATE RESTRICTION

PROCEDURE/NDC NOT COVERED FOR SERVICE DATE GIVEN

233

16

NDC NOT ON P/F FILE

NDC CODE NOT ON FILE

231

16

PROCEDURE CODE NOF

PROCEDURE/TYPE OF SERVICE NOT COVERED BY PROGRAM

232

16

INVALID BIRTHDATE

INVALID BIRTHDATE ON RECIPIENT FILE

224

16

DIAG DATE RESTRICT

DIAG DATE RESTRICTION

253

16

ANESTHESIA UNITS NOF

ANESTHESIA BASE UNITS ARE NOT ON FILE

260

16

PAS-LOS 90TH EQ ZERO

DX CODE REQUIRES 5TH DIGIT TO CALCULATE PAS DAYS

257

16

SPAN DATES/QUANT DIF

DIFFERENCE BETWEEN SERVICE DATES AND QUANT

258

16

INPUT M-CARE PD AMT.

INSERT PROVIDER PAID AMOUNT BY MEDICARE

261

16

INVALID AMB SURG REV

REV CODE INVALID FOR AMBULATORY SURG PROC.

266

16

REQ-ICD9-SURGICAL-CD

REVENUE CODE 490 REQUIRES VALID ICD9 SURGICAL PROCEDURE

267

16

INVALID-TREATMENT-PL

TREATMENT PLACE IS INCORRECT

268

16

SALES TAX NOT ON CLM

SALES TAXES NOT PRESENT ON RX CLAIM WITH TPL

283

16

MANUAL PRICE GR BILL

MANUAL PRICE EXCEEDS BILLED CHARGES

284

16

PAYMENT GR BILLED CH

PAYMENT EXCEEDS BILLED CHARGES/REQUIRES REVIEW

285

16

ANES.CPT N/C-M'AID

ANES.CPT NOT COVERED FOR MEDICAID ONLY-BILL SURG+MOD.

269

16

TPL/PRIVATE

3RD PARTY CARRIER CODE MISSING-REFER TO CARRIER CD.LIST

273

16

EXCEEDS MAX DOSE

EXCEEDS MAX DAILY DOSE-MD FAX FORM TO 866-797-2329

325

16

>120MME-RPH OVERRIDE

>120 MME/DAY-RPH OVRD ALLOWED AFTER REVIEW

322

16

PSRO DATES MISSING

PSRO DATES MISSING - DATE PRIOR TO 070183

342

N286 N257 N290 N286 M62 M119 M62 N257 N257 MA63 M64 M53 N388 N657 M53 N31 N57 N65 MA63 M20 N56 N58 N65 N65 N65 N56 M119 N56 N329 M76 M53 M76 M53 MA92 M50 M51 M77 M54 M49 M49 N34 MA92 N378 MA32 N299

LAM5M113

LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM

REPORT NO:

RF-0-77-R

RUN: 10/30/23 21:22:31 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING

PAGE:

5

HIPAA/LA MEDICAID ERROR CODE CROSSWALK

ADJ RSN CODE

SHORT DESCRIPTION

LONG DESCRIPTION

ERROR CODE HIPAA REMARK CODE

----------------------------------------------------------------------------------------------------------------------------------

16

MUST SPLIT BILL

SPAN FROM & THRU DATES CONFLICT MUST SPLIT BILL

344

16

INV ZERO BILLED DAYS

DAYS ZERO, PATIENT STATUS NOT 9

345

16

OCCUR DATES CONFLICT

OCCUR CODES/DATES CONFLICT

339

16

SPAN DAYS CONFLICT

SPAN DAYS/NON COVERED DAYS CONFLICT

340

16

SURG DTE LT SRV FROM

DATE OF SURGERY LESS THAN SERVICE FROM DATE

310

16

COV DAYS NE ACCOM

COVERED DAYS DO NOT EQUAL ACCOMODATION DAYS

316

16

STMT DTE/ACCOM CONFL

STATEMENT DATES CONFLICT WITH ACCOMODATION DAYS

317

16

SURG DATE MISSING

DATE OF SURGERY MISSING

309

16

SURG PROC MISSING

SURGICAL PROCEDURE MISSING

307

16

EXCEEDS 120 MME/DAY

OVR 120 MME/DAY MD FAX OPIOID TX WRKSHT 1-866-797-2329

305

16

HOSPICE DAYS > 5

INPATIENT RESPITE DAYS GREATER THAN FIVE

303

16

ONE DISP FEE 30 DAYS

ONE DISP FEE PER 30 DAYS FOR MAINTENANCE MEDICATIONS

301

16

INVALID PROC CODE

INVALID PROCEDURE CODE FOR DATE-OF-SERVICE

298

16

TPL RESOURCE REQ EOB

NO EOB ATTACHED FOR RECIP WITH OTHER RESOURCE INDICATED

290

16

PROC/DESC CONFLICT

PROCEDURE CODE/DESCRIPTION CONFLICT

288

16

INV DENY FOR PROV NO

INVALID PROVIDER NUMBER WHEN DENY APPLIED

289

16

PROC INAPPROPRIATE

INAPPROPRIATE PROCEDURE - SEE CPT FOR VALID CODE

954

16

ANESTH TIME MISSING

ANESTHESIA MINUTES INVALID OR MISSING

949

16

SPEND DOWN FORM

SPEND DOWN FORM 110MNP INVALID/MISSING

943

16

RESUB SURGEONS CODE

RESUBMIT CLAIM USING CODE SURGEON BILLED

959

16

PROC/SERV REND CONF

PROCEDURE CODE DOES NOT REFLECT SERVICES RENDERED

968

16

DENY TO BE REBILLED

MEDICARE DENIED,IF COVERED BILL WITH PROVIDER EOB

940

16

BILL 3RD PARTY CARRI

PLEASE BILL THIRD PARTY CARRIER FIRST

932

16

BILL ONE PROC.PER L

BILL ONE PROCEDURE PER LINE FOR EACH DATE OF SERVICE

930

16

GENERIC SUB REQUIRED

GENERIC SUBSTITUTION REQUIRED

916

16

EFF 11/5/10 NDC REQU

EFF 11/5/10 PAS FOR THIS HCPC REQUIRES CORRECT NDC CODE

924

16

INV ADMISSION DATE

ADMISSION DATE MISSING OR INVALID

040

16

ADMIT DTE GT SERV FM

ADMISSION DATE GREATER THAN SERVICE FROM DATE

041

16

INVALID UB92 BILL CD

INVALID UB92 TYPE BILL CODE

042

16

INV ATTENDING PHYS

ATTENDING PHYSICIAN NUMBER NOT NUMERIC

043

16

INV NATURE OF ADMIT

NATURE OF ADMISSION MISSING OR INVALID

044

16

INV PATIENT STATUS

PATIENT STATUS CODE INVALID OR MISSING

045

16

REBILL CORRECT HCPC

ASC,OP FAC/PHYS.BILLED DIFF CODE;REBILL CORRECT HCPC

035

16

INVALID TOT DOC CHG

TOTAL DOCUMENT CHARGE MISSING OR NOT NUMERIC

026

16

INVAL/MISS PROC CODE

INVALID OR MISSING PROCEDURE CODE

028

16

INVALID SECOND DIAG

SECONDARY DIAGNOSIS INVALID

019

16

INVAL/MISS DIAG CODE

INVALID OR MISSING DIAGNOSIS CODE

020

16

INVALID FORMER REFNO

FORMER REFERENCE NUMBER MISSING OR INVALID

021

16

INVALID BILLED CHRGS

BILLED CHARGES MISSING OR NOT NUMERIC

022

16

INV PARTIAL RECIP

RECIPIENT NAME IS MISSING

023

16

INV BILLING PROV NO

BILLING PROVIDER NUMBER NOT NUMERIC

024

16

SERV THR GT ENTR DTE

SERVICE THRU DATE GREATER THAN DATE OF ENTRY

009

16

SERVICE NOT APPROVED

DOULA IN LIEU OF NOT APPROVED; CONTACT LDH FOR APPROVAL

010

16

INVALID TPL INDICATR

TPL INDICATOR NOT Y, N, OR SPACE

011

16

ORG CLM W/ADJ/VD CDE

ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID REASON CODE

012

N300 M53 M46 MA33 MA31 MA32 M53 MA31 M51 N56 MA31 M49 N56 MA04 M51 N77 N56 N203 N58 N56 N56 MA04 MA92 N63 M119 M119 MA40 MA40 MA30 N290 MA41 MA43 M20 M54 M51 M64 MA63 M47 M79 MA36 N257 MA31 N407 MA92 MA30

LAM5M113

LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM

REPORT NO:

RF-0-77-R

RUN: 10/30/23 21:22:31 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING

PAGE:

6

HIPAA/LA MEDICAID ERROR CODE CROSSWALK

ADJ RSN CODE

SHORT DESCRIPTION

LONG DESCRIPTION

ERROR CODE HIPAA REMARK CODE

----------------------------------------------------------------------------------------------------------------------------------

16

ORG CLM W ADJ/VD ICN

ORIGINAL CLAIM WITH AN ADJUSTMENT OR VOID ICN

013

16

INVALID PRIM DIAGNOS

PRIMARY DIAGNOSIS AS CODED NOT ON FILE

018

16

NOT USED - RESERVED

NOT USED - RESERVED FOR DRG PROJECT

015

16

NOT USED - RESERVED

NOT USED - RESERVED FOR DRG PROJECT

016

16

INV DME PA AMOUNT

PRIOR AUTHORIZATION AMOUNT NOT NUMERIC

076

16

ATTEND MUST=BILLING

ATTENDING PROV MUST EQUAL BILLING

077

16

FOUND NO PSRO CODE

PSRO CODE MISSING OR INVALID

079

16

INVLD SIGNATURE IND

THE SIGNATURE INDICATOR MUST BE Y, N, OR BLANK

065

16

ALLOWED AMOUNT REQ'D

ALLOWED AMOUNT REQUIRED ON ALL CLAIMS/ENCOUNTERS

067

16

INV POINT ORIGIN

INVALID POINT OF ORIGIN

068

16

INV OCCUR DATE

INVALID OCCURRENCE DATE

069

16

INV STMT COVERS FROM

STATEMENT COVERS FROM DATE INVALID

071

16

INV STMT COVER THRU

STATEMENT COVERS THRU DATE INVALID

072

16

INV ACCOM/ANCILL CHG

ACCOMODATION/ANCILLARY CHARGE MISSING OR INVALID

055

16

INV ACCOMODATION DAY

ACCOMODATION DAYS MISSING OR INVALID

053

16

INVALID/MISSING PROV

INVALID OR MISSING ORDERING PROVIDER

047

16

INVALID/MISS PROC

INVALID OR MISSING PROCEDURE CODE

048

16

INV/CONFLIC SURG DTE

INVALID/CONFLICT SURGICAL DATE

049

16

NOT A 340B PHARMACY

NOT A 340B PHARMACY- REBILL REGULAR STOCK

063

16

QTY EXCEEDS MAX

QTY EXCEEDS MAX-MD FAX LA UNIFORM PA FORM 866-797-2329

062

16

INVALID COVERED DAYS

COVERED HOSPITAL DAYS NOT NUMERIC OR MISSING

060

16

DIA CODE/DESC CONF

DIAGNOSIS CODE/DESCRIPTION CONFLICT

974

16

STAMPED SIGNATURE.

STAMPED SIGNATURE NOT ALLOWED.

976

16

INVALID ADJ REASON

INVALID ADJUSTMENT REASON

980

16

SYS CALC NET TOTAL

SYSTEM CALCULATED TOTAL - NET BILLED NOT IN BALANCE

983

16

DENIED TO REBILL/ADJ

DENIED TO BE REBILLED ON ADJUSTMENT FORM.

987

16

COMP A-MODE ECHOENCH

COMPLETE A-MODE ECHOENCHEPHALOGRAPHY-BILL HCPC Z9100

997

16

INVALID CT/POS

CLAIM TYPE/POS MISMATCH

004

16

INVALID CLM/SUBM FRM

CLAIM/SUBMISSION FORMAT IS INVALID

001

16

INVALID PROVIDER NO

PROVIDER NUMBER MISSING OR NOT NUMERIC

002

16

INVAL SERV FROM DATE

SERVICE FROM DATE MISSING/INVALID

005

16

INVAL SERV THRU DATE

INVALID OR MISSING THRU DATE

006

16

SERV THRU LT SERV FM

SERVICE THRU DATE LESS THAN SERVICE FROM DATE

007

16

INVLD RATE FOR LOC

NO VALID RATE WAS FOUND FOR LTC LEVEL OF CARE

358

16

TOT/LOC DAYS CONFL

TO-DAY / TOT-DAYS / STATUS CONFLICT

356

16

LTC DAYS/DATES CONFL

LTC LOC DAYS CONFLICT WITH LTC LOC FROM AND THRU DATES

357

16

SPAN DATE INVALID

SPAN DATE NOT ALLOWED MUST BILL PER DAY

351

16

EXCEEDS 90 MME/DAY

OVR 90 MME/DAY MD FAX LA UNIFORM PA FORM 1-866-797-2329

352

16

MME LIMIT EXCEEDED

MD FAX LA UNIFORM PA FORM TO 1-866-797-2329

353

16

NO MEDICARE PAID DTE

MEDICARE PAYMENT DATE IS MISSING OR INVALID

378

16

INSUFFICIENT DATA

UNABLE TO PROCESS/REBILL/ATTENTION P.MISNER

374

16

PT STAT REQ HOSP LVE

PT STATUS CODE 1 REQUIRES HOSPITAL ABSENT DAYS

375

16

ADJ DAYS CONFL HIST

ADJUSTMENT DAYS CONFLICT WITH HISTORY DAYS

376

16

M/I GROUP NUMBER

GROUP NUMBER IS MISSING OR INVALID FOR HUMANA

367

16

REFER PHYSICIAN REQD

REFERRING/ATTENDING PHYSICIAN REQUIRED

400

MA30 MA63 N305 N305 N54 N77 M44 MA75 M79 MA42 M46 M52 M59 M79 M53 N265 M51 N301 N657 MA32 MA32 MA63 MA70 MA69 M54 N34 M20 M77 N34 N77 M52 M59 MA31 N65 M53 M53 N63 N322 M52 MA04 N657 M46 M53 N255 N286

LAM5M113

LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM

REPORT NO:

RF-0-77-R

RUN: 10/30/23 21:22:31 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING

PAGE:

7

HIPAA/LA MEDICAID ERROR CODE CROSSWALK

ADJ RSN CODE

SHORT DESCRIPTION

LONG DESCRIPTION

ERROR CODE HIPAA REMARK CODE

----------------------------------------------------------------------------------------------------------------------------------

16

NEED VALID HOSP SVC

PROCEDURE MUST BE BILLED WITH VALID HOSPITAL SERVICE

398

16

DME REQUIRES PA

DME REQUIRES PRIOR AUTHORIZATION

413

16

ENC PREFIX ERROR

LICN PREFIX ON ENCOUNTER IS MISSING OR INVALID

410

16

NONEMER TRANS REQ PA

NON-EMER TRANSPORTATION REQUIRES PRIOR AUTHORIZATION

407

16

INVALID POA INDICATO

DENY WHEN INIVALID POA INDICATOR IS REPORTED

408

16

MISS/INVLD COPAY

MISSING/INVALID RECIPIENT COPAY IN 1ST COB OCCURRENCE

393

16

CLIA # BLANK/INVALID

CLIA NUMBER SUBMITTED BLANK OR INVALID

387

16

INVALID NDC

INVALID NDC - NOT AVAILABLE

465

16

MFG NOT IN REBATE

MANUFACTURER HAS NOT ENTERED INTO CMS REBATE AGREEMENT

472

16

NDC TERMINATED/CMS

CMS NOTIFIED US THAT NDC IS TERMINATED

462

16

DENY FOR FILE REVIEW

DENY FOR REVIEW / CALL POS HELP DESK

459

16

NDC MAY BE OBSOLETE

NDC POSSIBLY OBSOLETE

460

16

M/I PROF SERV CODE

MISSING/INVALID PROFESSIONAL SERVICE CODE

431

16

QTY > PACKAGE SIZE

QUANTITY EXCEEDS PACKAGE SIZE

432

16

MISSING/INVALID DIAG

MISSING/INVALID DIAGNOSIS CODE

433

16

QTY OF 1 = 1 VIAL

DRUG IS A VIAL. QUANTITY OF 1 = 1 VIAL

437

16

GIVE DATE FOR TRANSP

TRANSPLANT DISCHARGE DATE OR OTHER DX NEEDED

448

16

ENC INT PMT ERROR

INTEREST PAYMENT ON PLAN ENCOUNTER IS INVALID

417

16

ENC PLAN PMT DT ERR

PLAN PAYMENT DATE ON ENCOUNTER IS MISSING OR INVALID

414

16

SUBMIT PROV FEE$0.10

PROVIDER FEE MUST BE SUBMITTED AS $0.10

421

16

BILL HR CD PRE 15MIN

BILL CM HOUR CODE BEFORE 15 MIN CODE

426

16

PA TOOTH/CAV NQ CLM

PA TOOTH/ORAL CAVITY CODE NOT SAME AS CLAIM

598

16

QTY EXCEEDS MAX

QTY EXCEEDS MAX-MD FAX LA UNIFORM PA FORM 866-797-2329

600

16

SURFACE CODE CONF

CLAIM DOES NOT INDICATE CORRECT NUMBER OF SURFACES

602

16

TOOTH/CAVITY CDE REQ

TOOTH CODE/ORAL CAVITY DESIGNATOR REQUIRED

603

16

ADULT DENTAL REQ PA

ADULT DENTAL CLAIM MUST BE PRIOR AUTHORIZED

606

16

PRVIDERMUSTSUBMIT

NOT ACCEPTING CLAIMS FROM SHARED PLANS

610

16

SEAL.NOT PAY.TOOTH

SEALANT NOT PAYABLE FOR THIS TOOTH

608

16

INV TOOTH/CAVITY CDE

INVALID TOOTH CODE/ORAL CAVITY DESIGNATOR

613

16

MISS/INV DIAG CODE

MISSING OR INVALID DIAGNOSIS CODE

575

16

MISS/INVLD PA/MC COD

MISSING OR INVALID PA/MC CODE OR NUMBER FOR RX OVERRIDE

576

16

INV PRESCRIB ID QUAL

INVALID PRESCRIBER ID QUALIFIER MUST BE 01 OR 05

497

16

PROV/HOSPICE NO MTCH

PROV ID NO ON CLAIM MUST MATCH PROV ID NO ON RECI FILE

511

16

HCPCS REQ

HCPCS REQUIRED

513

16

M/I SERV PRV ID QUAL

MISSING/INVALID SERVICE PROVIDER ID QUALIFIER

509

16

INVALID MSA CODE

MSA CODE IS INVALID

494

16

PA REQUIRED

MD MUST CALL ULM-PA OPERATIONS STAFF

485

16

PA EXPIRED

MD MUST CALL ULM-PA OPERATIONS STAFF

486

16

PA-EMERGENCY-OVERRID

EMERGENCY OVERRIDE OF DRUG THAT REQUIRES PA

487

16

CANNOT BE ADJUSTED

ADJUSTMENT IS INVALID, VOID AND REBILL

523

16

LOC NOT ON RECI FILE

LEVEL OF CARE NOT ON RECIPIENT FILE

525

16

O/R REQ-SEND TO PA

OVERRIDE REQUIRED-SEND TO DENTAL PA UNIT

515

16

NEMT MILEAGE

NEMT (CT08) ENCOUNTER MISSING MILEAGE

517

16

KIDMED INFO MISSING

IMMUNIZATION AND SUSPECTED CONDITION INFO REQUIRED

518

16

BILLED AMT MUST BE 0

VACCINES FROM VFC AT NO COST-BILLED AMT MUST BE 0

520

N56 M62 M47 M62 N434 MA04 MA120 M119 M119 M119 N65 M119 N56 N378 M76 N378 N341 M49 N480 M49 M20 N346 N378 N75 N37 N54 N32 N39 N37 MA63 M62 N31 N521 M20 N253 M49 M62 M62 N54 N152 N54 M76 M53 N657 M79

LAM5M113

LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM

REPORT NO:

RF-0-77-R

RUN: 10/30/23 21:22:31 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING

PAGE:

8

HIPAA/LA MEDICAID ERROR CODE CROSSWALK

ADJ RSN CODE

SHORT DESCRIPTION

LONG DESCRIPTION

ERROR CODE HIPAA REMARK CODE

----------------------------------------------------------------------------------------------------------------------------------

16

USE INDIV PRESC NO

PRESCRIBING PRVI BILLED IS GROUP USE INDIVIDUAL PRES NO

521

16

REBILL VISIT CODE

CRITICAL CARE/CONSULT NOT DOCUMENTED-BILL CORRECT VISIT

636

16

NEMT TEMP MILEAGE

NEMT TEMPORARY MILEAGE RATE INCREASE

679

16

BRAND DRUG PREFERRED

BRAND DRUG PREFERRED WITHOUT PA

655

16

ADJUST PAID LINE

ONLY A PAID LINE/THE CORRECT PAID LINE CAN BE ADJUSTED

693

16

BLK 82/83 SRGN NAME

NEED SURGEONS NAME IN BLOCK 82 OR 83 ON UB92

681

16

NON-PHARMACY BENEFIT

NON-PHARMACY BENEFIT

717

16

MISS/INVLD PROD QLFR

MISSING/INVALID PRODUCT/SERVICE ID QUALIFIER IN 436-E1

831

16

INVALID COB ID

INVALID COB-1 ID COB-1 PAYER ID MUST BE PLAN ID

860

16

MISS/INVLD UNIT MEAS

MISSING/INVALID UNIT OF MEASURE IN NCPDP FIELD 600-28

861

16

REBILL CORRECT UNITS

UNITS AVAILABLE FOR CODE--REBILL USING UNITS

780

16

PROC:EXTRCT NOT PAY

PROCEDURE ON EXTRACTED TOOTH NOT PAYABLE

779

16

NO ADJ HISTORY

NO HISTORY RECORD ON FILE FOR THIS ADJUSTMENT

799

16

ORIG/ADJ PROV DIFF

ORIG/ADJ BILLING PROVIDER NUMBER DIFFERENT

796

16

BILL AS ADJ/CNT STAY

THIS SHOULD BE BILLED AS ADJUST.FOR CNT STAY

755

16

AIR TRNSPT REQS P/A

AIR TRANSPT CLAIMS REQUIRES STATE APPROVAL

760

16

DEL HYST/STER CONFLI

DELIVERY BILLED AFTER HYSTERECTOMY/STERLIZ WAS DONE

749

16

MCO MISMATCH

MCO MISMATCH ON INCOMING ENCOUNTER VOID

747

18

SAME ATTD PD IP CONS

SAME ATTENDING PROV PAID INPT CONSULTATION SAME STAY

746

18

FND DUP SERV SM DAY

FOUND DUPLICATE SERVICE SAME DAY

758

18

DUP ADJ. RECORD

DUPLICATE ADJUSTMENT RECORDS ENTERED

797

18

INPT SER PD SAME ATT

INPT HOSP SERV PAID FOR SAME DOS TO SAME ATTENDING PROV

794

18

HIST ALREADY ADJSTED

HISTORY RECORD ALREADY ADJUSTED

798

18

ON-LINE DUPE DENY

DUPLICATE OF PREVIOUSLY PAID CLAIM

800

18

EXACT DUPE 01 TO 01

EXACT DUPLICATE ERROR: IDENTICAL HOSPITAL CLAIMS

801

18

EXACT DUPE 03 TO 09

EXACT DUPLICATE ERROR: OUTPATIENT AND DURABLE-EQUIPMENT

810

18

EXACT DUPE 03 TO 13

EXACT DUPLICATE ERROR: OUTPATIENT AND EPSDT

811

18

EXACT DUPE 03 TO 15

EXACT DUPLICATE ERROR: OUTPATIENT AND TITLE18

812

18

EXACT DUPE 04 TO 04

EXACT DUPLICATE ERROR: IDENTICAL PHYSICIAN CLAIMS

813

18

EXACT DUPE 04 TO 15

EXACT DUPLICATE ERROR: PHYSICIAN AND TITLE18

814

18

EXACT DUPE 05 TO 05

EXACT DUPLICATE ERROR: IDENTICAL REHAB-SERVICES CLAIMS

815

18

EXACT DUPE 05 TO 06

EXACT DUPLICATE ERROR: REHAB-SERVICES AND HOME HEALTH

816

18

EXACT DUPE 05 TO 07

EXACT DUPLICATE ERROR: REHAB-SERVICES AND AMBULANCE

817

18

EXACT DUPE 05 TO 08

EXACT DUPLICATE ERROR: REHAB-SERVICES AND NON-AMBULANCE

818

18

EXACT DUPE 05 TO 09

EXACT DUPLICATE ERROR: REHAB-SERVICES AND DURABLE EQUIP

819

18

EXACT DUPE 01 TO 14

EXACT DUPLICATE ERROR: HOSPITAL AND TITLE18-INSTITUTION

802

18

EXACT DUPE 02 TO 02

EXACT DUPLICATE ERROR: IDENTICAL LTC CLAIMS

803

18

EXACT DUPE 02 TO 14

EXACT DUPLICATE ERROR: LTC AND TITLE18-INSTITUTIONAL

804

18

EXACT DUPE 03 TO 03

EXACT DUPLICATE ERROR: IDENTICAL OUTPATIENT CLAIMS

805

18

EXACT DUPE 03 TO 05

EXACT DUPLICATE ERROR: OUTPATIENT AND REHAB SERVICES

806

18

EXACT DUPE 03 TO 06

EXACT DUPLICATE ERROR: OUTPATIENT AND HOME HEALTH

807

18

EXACT DUPE 03 TO 07

EXACT DUPLICATE ERROR: OUTPATIENT AND AMBULANCE

808

18

SUSPCT DUPE 03 TO 15

SUSPCT DUPLICATE ERROR: OUTPATIENT AND TITLE18-PROF

862

18

SUSPCT DUPE 04 TO 04

SUSPCT DUPLICATE ERROR:IDENTICAL PHYSICIAN CLAIMS

863

18

SUSPCT DUPE 04 TO 15

SUSPCT DUPLICATE ERROR: PHYSICIAN AND TITLE18-PROF

864

N31 N56 M51 M119 N152 N261 N65 M119 MA04 M53 M53 N39 N152 N257 N50 N54 MA66 M56 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522 N522

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