CLAIM STATUS CODES
Introduction
Claim Status codes are used in the Health Care Claim Status Notification (277) transaction in the STC01-2, STC10-2 and STC11-2 composite elements. They indicate the detail about the general status communicated in the Claim Status Category Codes carried in STC01-1, STC10-1 and STC11-1.Claim status codes communicate information about the status of a claim, i.e., whether it's been received, pended, or paid. The Claim Status transaction is not used as a financial transaction.
Health Care Claim Status Codes
|
Code
|
Description
|
Note
|
0
|
Cannot provide further status electronically.
|
Start: 01/01/1995
|
|
For more detailed information, see remittance advice.
|
Start: 01/01/1995
|
|
|
More detailed information in letter.
|
Start: 01/01/1995
|
|
|
Claim has been adjudicated and is awaiting payment
cycle.
|
Start: 01/01/1995
|
|
|
This is a subsequent request for information from the
original request.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
This is a final request for information.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
Balance due from the subscriber.
|
Start: 01/01/1995
|
|
|
Claim may be reconsidered at a future date.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
No payment due to contract/plan provisions.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008. |
|
|
No payment will be made for this claim.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
All originally submitted procedure codes have been
combined.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Some originally submitted procedure codes have been
combined.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
One or more originally submitted procedure codes have
been combined.
|
Start: 01/01/1995
Last Modified: 06/30/2001 |
|
|
All originally submitted procedure codes have been
modified.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Some all originally submitted procedure codes have been
modified.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
One or more originally submitted procedure code have
been modified.
|
Start: 01/01/1995
Last Modified: 06/30/2001 |
|
|
Claim/encounter has been forwarded to entity. Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Claim/encounter has been forwarded by third party entity
to entity. Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity received claim/encounter, but returned invalid
status. Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity acknowledges receipt of claim/encounter. Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Accepted for processing.
|
Start: 01/01/1995
Last Modified: 06/30/2001 |
|
|
Missing or invalid information. Usage: At least one
other status code is required to identify the missing or invalid information.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
... before entering the adjudication system.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Returned to Entity. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity not approved as an electronic submitter. Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity not approved. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity not found. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Policy canceled.
|
Start: 01/01/1995
Last Modified: 06/30/2001 |
|
|
Claim submitted to wrong payer.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Subscriber and policy number/contract number mismatched.
|
Start: 01/01/1995
|
|
|
Subscriber and subscriber ID mismatched.
|
Start: 01/01/1995
|
|
|
Subscriber and policyholder name mismatched.
|
Start: 01/01/1995
|
|
|
Subscriber and policy number/contract number not found.
|
Start: 01/01/1995
|
|
|
Subscriber and subscriber ID not found.
|
Start: 01/01/1995
|
|
|
Subscriber and policyholder name not found.
|
Start: 01/01/1995
|
|
|
Claim/encounter not found.
|
Start: 01/01/1995
|
|
|
Predetermination is on file, awaiting completion of
services.
|
Start: 01/01/1995
|
|
|
Awaiting next periodic adjudication cycle.
|
Start: 01/01/1995
|
|
|
Charges for pregnancy deferred until delivery.
|
Start: 01/01/1995
|
|
|
Waiting for final approval.
|
Start: 01/01/1995
|
|
|
Special handling required at payer site.
|
Start: 01/01/1995
|
|
|
Awaiting related charges.
|
Start: 01/01/1995
|
|
|
Charges pending provider audit.
|
Start: 01/01/1995
|
|
|
Awaiting benefit determination.
|
Start: 01/01/1995
|
|
|
Internal review/audit.
|
Start: 01/01/1995
|
|
|
Internal review/audit - partial payment made.
|
Start: 01/01/1995
|
|
|
Referral/authorization.
|
Start: 01/01/1995
Last Modified: 02/28/2001 Stop: 01/01/2012 Notes: Refer to codes 252 and 761. |
|
|
Pending provider accreditation review.
|
Start: 01/01/1995
|
|
|
Claim waiting for internal provider verification.
|
Start: 01/01/1995
|
|
|
Investigating occupational illness/accident.
|
Start: 01/01/1995
|
|
|
Investigating existence of other insurance coverage.
|
Start: 01/01/1995
|
|
|
Claim being researched for Insured ID/Group Policy
Number error.
|
Start: 01/01/1995
|
|
|
Duplicate of a previously processed claim/line.
|
Start: 01/01/1995
|
|
|
Claim assigned to an approver/analyst.
|
Start: 01/01/1995
|
|
|
Awaiting eligibility determination.
|
Start: 01/01/1995
|
|
|
Pending COBRA information requested.
|
Start: 01/01/1995
|
|
|
Information was requested by a non-electronic method.
Usage: At least one other status code is required to identify the requested
information.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Information was requested by an electronic method.
Usage: At least one other status code is required to identify the requested
information.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Eligibility for extended benefits.
|
Start: 01/01/1995
|
|
|
Re-pricing information.
|
Start: 01/01/1995
|
|
|
Claim/line has been paid.
|
Start: 01/01/1995
|
|
|
Payment reflects usual and customary charges.
|
Start: 01/01/1995
|
|
|
Payment made in full.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
Partial payment made for this claim.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
Payment reflects plan provisions.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Payment reflects contract provisions.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Periodic installment released.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
Claim contains split payment.
|
Start: 01/01/1995
|
|
|
Payment made to entity, assignment of benefits not on
file. Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Duplicate of an existing claim/line, awaiting processing.
|
Start: 01/01/1995
|
|
|
Contract/plan does not cover pre-existing conditions.
|
Start: 01/01/1995
|
|
|
No coverage for newborns.
|
Start: 01/01/1995
|
|
|
Service not authorized.
|
Start: 01/01/1995
|
|
|
Entity not primary. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Diagnosis and patient gender mismatch.
|
Start: 01/01/1995
Last Modified: 02/28/2000 |
|
|
Denied: Entity not found. (Use code 26 with appropriate
Claim Status category Code)
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Entity not eligible for benefits for submitted dates of
service. Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity not eligible for dental benefits for submitted
dates of service. Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity not eligible for medical benefits for submitted
dates of service. Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity not eligible/not approved for dates of service.
Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity does not meet dependent or student qualification.
Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity is not selected primary care provider. Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity not referred by selected primary care provider.
Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Requested additional information not received.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Notes: If known, the payer must report a second claim status code identifying the requested information. |
|
|
No agreement with entity. Usage: This code requires use
of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Patient eligibility not found with entity. Usage: This
code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Charges applied to deductible.
|
Start: 01/01/1995
|
|
|
Pre-treatment review.
|
Start: 01/01/1995
|
|
|
Pre-certification penalty taken.
|
Start: 01/01/1995
|
|
|
Claim was processed as adjustment to previous claim.
|
Start: 01/01/1995
|
|
|
Newborn's charges processed on mother's claim.
|
Start: 01/01/1995
|
|
|
Claim combined with other claim(s).
|
Start: 01/01/1995
|
|
|
Processed according to plan provisions (Plan refers to
provisions that exist between the Health Plan and the Consumer or Patient).
|
Start: 01/01/1995
Last Modified: 06/01/2008 |
|
|
Claim/line is capitated.
|
Start: 01/01/1995
|
|
|
This amount is not entity's responsibility. Usage: This
code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Processed according to contract provisions (Contract
refers to provisions that exist between the Health Plan and a Provider of
Health Care Services).
|
Start: 01/01/1995
Last Modified: 06/01/2008 |
|
|
Coverage has been canceled for this entity. (Use code
27)
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Entity not eligible. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Claim requires pricing information.
|
Start: 01/01/1995
|
|
|
At the policyholder's request these claims cannot be
submitted electronically.
|
Start: 01/01/1995
|
|
|
Policyholder processes their own claims.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
Cannot process individual insurance policy claims.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
Claim/service should be processed by entity. Usage: This
code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Cannot process HMO claims.
|
Start: 01/01/1995
Last Modified: 01/27/2008 Stop: 07/01/2008 |
|
|
Claim submitted to incorrect payer.
|
Start: 01/01/1995
|
|
|
Claim requires signature-on-file indicator.
|
Start: 01/01/1995
|
|
|
TPO rejected claim/line because payer name is missing. (Use
status code 21 and status code 125 with entity code IN)
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
TPO rejected claim/line because certification
information is missing. (Use status code 21 and status code 252)
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
TPO rejected claim/line because claim does not contain
enough information. (Use status code 21)
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Service line number greater than maximum allowable for
payer.
|
Start: 01/01/1995
|
|
|
Missing/invalid data prevents payer from processing
claim. (Use CSC Code 21)
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Additional information requested from entity. Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's name, address, phone and id number. Usage: This
code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's name. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's address. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's Communication Number. Usage: This code requires
use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's tax id. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's Blue Cross provider id. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's Blue Shield provider id. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's Medicare provider id. Usage: This code requires
use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's Medicaid provider id. Usage: This code requires
use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's UPIN. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's CHAMPUS provider id. Usage: This code requires
use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's commercial provider id. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's health industry id number. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's plan network id. Usage: This code requires use
of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's site id . Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's health maintenance provider id (HMO). Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's preferred provider organization id (PPO).
Usage: This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's administrative services organization id (ASO). Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's license/certification number. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's state license number. Usage: This code requires
use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's specialty license number. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's specialty/taxonomy code. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's anesthesia license number. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's qualification degree/designation (e.g. RN, PhD,
MD). Usage: This code requires use of an Entity Code.
|
Start: 02/28/1997
Last Modified: 07/01/2017 |
|
|
Entity's social security number. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's employer id. Usage: This code requires use of
an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's drug enforcement agency (DEA) number. Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Pharmacy processor number.
|
Start: 01/01/1995
|
|
|
Entity's id number. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Relationship of surgeon & assistant surgeon.
|
Start: 01/01/1995
|
|
|
Entity's relationship to patient. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Patient relationship to subscriber.
|
Start: 01/01/1995
|
|
|
Entity's Gender. Usage: This code requires use of an
Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's date of birth. Usage: This code requires use of
an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's date of death. Usage: This code requires use of
an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's marital status. Usage: This code requires use
of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's employment status. Usage: This code requires
use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's health insurance claim number (HICN). Usage:
This code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's policy/group number. Usage: This code requires
use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's contract/member number. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's employer name, address and phone. Usage: This
code requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's employer name. Usage: This code requires use of
an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's employer address. Usage: This code requires use
of an Entity Code.
|
Start: 0/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's employer phone number. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's employer ID.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Entity's employee id. Usage: This code requires use of
an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Other insurance coverage information (health, liability,
auto, etc.).
|
Start: 01/01/1995
|
|
|
Other employer name, address and telephone number.
|
Start: 01/01/1995
|
|
|
Entity's name, address, phone, gender, DOB, marital
status, employment status and relation to subscriber. Usage: This code
requires use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's student status. Usage: This code requires use
of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's school name. Usage: This code requires use of
an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Entity's school address. Usage: This code requires use
of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Transplant recipient's name, date of birth, gender,
relationship to insured.
|
Start: 01/01/1995
Last Modified: 02/28/2000 |
|
|
Submitted charges.
|
Start: 01/01/1995
|
|
|
Outside lab charges.
|
Start: 01/01/1995
|
|
|
Hospital s semi-private room rate.
|
Start: 01/01/1995
|
|
|
Hospital s room rate.
|
Start: 01/01/1995
|
|
|
Allowable/paid from other entities coverage Usage: This
code requires the use of an entity code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Amount entity has paid. Usage: This code requires use of
an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Purchase price for the rented durable medical equipment.
|
Start: 01/01/1995
|
|
|
Rental price for durable medical equipment.
|
Start: 01/01/1995
|
|
|
Purchase and rental price of durable medical equipment.
|
Start: 01/01/1995
|
|
|
Date(s) of service.
|
Start: 01/01/1995
|
|
|
Statement from-through dates.
|
Start: 01/01/1995
|
|
|
Facility admission date.
|
Start: 01/01/1995
Last Modified: 10/31/2006 |
|
|
Facility discharge date.
|
Start: 01/01/1995
Last Modified: 10/31/2006 |
|
|
Date of Last Menstrual Period (LMP).
|
Start: 02/28/1997
|
|
|
Date of first service for current series/symptom/illness.
|
Start: 01/01/1995
|
|
|
First consultation/evaluation date.
|
Start: 02/28/1997
|
|
|
Confinement dates.
|
Start: 01/01/1995
|
|
|
Unable to work dates/Disability Dates.
|
Start: 01/01/1995
Last Modified: 09/20/2009 |
|
|
Return to work dates.
|
Start: 01/01/1995
|
|
|
Effective coverage date(s).
|
Start: 01/01/1995
|
|
|
Medicare effective date.
|
Start: 01/01/1995
|
|
|
Date of conception and expected date of delivery.
|
Start: 01/01/1995
|
|
|
Date of equipment return.
|
Start: 01/01/1995
|
|
|
Date of dental appliance prior placement.
|
Start: 01/01/1995
|
|
|
Date of dental prior replacement/reason for replacement.
|
Start: 01/01/1995
|
|
|
Date of dental appliance placed.
|
Start: 01/01/1995
|
|
|
Date dental canal(s) opened and date service completed.
|
Start: 01/01/1995
|
|
|
Date(s) dental root canal therapy previously performed.
|
Start: 01/01/1995
|
|
|
Most recent date of curettage, root planing, or
periodontal surgery.
|
Start: 01/01/1995
|
|
|
Dental impression and seating date.
|
Start: 01/01/1995
|
|
|
Most recent date pacemaker was implanted.
|
Start: 01/01/1995
|
|
|
Most recent pacemaker battery change date.
|
Start: 01/01/1995
|
|
|
Date of the last x-ray.
|
Start: 01/01/1995
|
|
|
Date(s) of dialysis training provided to patient.
|
Start: 01/01/1995
|
|
|
Date of last routine dialysis.
|
Start: 01/01/1995
|
|
|
Date of first routine dialysis.
|
Start: 01/01/1995
|
|
|
Original date of prescription/orders/referral.
|
Start: 02/28/1997
|
|
|
Date of tooth extraction/evolution.
|
Start: 01/01/1995
|
|
|
Drug information.
|
Start: 01/01/1995
|
|
|
Drug name, strength and dosage form.
|
Start: 01/01/1995
|
|
|
NDC number.
|
Start: 01/01/1995
|
|
|
Prescription number.
|
Start: 01/01/1995
|
|
|
Drug product ID number. (Use code 218)
|
Start: 01/01/1995
Last Modified: 10/17/2010 Stop: 07/01/2011 |
|
|
Drug days supply and dosage.
|
Start: 01/01/1995
Last Modified: 01/24/2010 Stop: 01/01/2012 |
|
|
Drug dispensing units and average wholesale price (AWP).
|
Start: 01/01/1995
|
|
|
Route of drug/myelogram administration.
|
Start: 01/01/1995
|
|
|
Anatomical location for joint injection.
|
Start: 01/01/1995
|
|
|
Anatomical location.
|
Start: 01/01/1995
|
|
|
Joint injection site.
|
Start: 01/01/1995
|
|
|
Hospital information.
|
Start: 01/01/1995
|
|
|
Type of bill for UB claim.
|
Start: 01/01/1995
Last Modified: 10/31/2006 |
|
|
Hospital admission source.
|
Start: 01/01/1995
|
|
|
Hospital admission hour.
|
Start: 01/01/1995
|
|
|
Hospital admission type.
|
Start: 01/01/1995
|
|
|
Admitting diagnosis.
|
Start: 01/01/1995
|
|
|
Hospital discharge hour.
|
Start: 01/01/1995
|
|
|
Patient discharge status.
|
Start: 01/01/1995
|
|
|
Units of blood furnished.
|
Start: 01/01/1995
|
|
|
Units of blood replaced.
|
Start: 01/01/1995
|
|
|
Units of deductible blood.
|
Start: 01/01/1995
|
|
|
Separate claim for mother/baby charges.
|
Start: 01/01/1995
|
|
|
Dental information.
|
Start: 01/01/1995
|
|
|
Tooth surface(s) involved.
|
Start: 01/01/1995
|
|
|
List of all missing teeth (upper and lower).
|
Start: 01/01/1995
|
|
|
Tooth numbers, surfaces, and/or quadrants involved.
|
Start: 01/01/1995
|
|
|
Months of dental treatment remaining.
|
Start: 01/01/1995
|
|
|
Tooth number or letter.
|
Start: 01/01/1995
|
|
|
Dental quadrant/arch.
|
Start: 01/01/1995
|
|
|
Total orthodontic service fee, initial appliance fee,
monthly fee, length of service.
|
Start: 01/01/1995
|
|
|
Line information.
|
Start: 01/01/1995
|
|
|
Accident date, state, description and cause.
|
Start: 01/01/1995
Last Modified: 01/24/2010 Stop: 01/01/2012 |
|
|
Place of service.
|
Start: 01/01/1995
|
|
|
Type of service.
|
Start: 01/01/1995
|
|
|
Total anesthesia minutes.
|
Start: 01/01/1995
|
|
|
Entity's prior authorization/certification number.
Usage: This code requires the use of an Entity Code.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Procedure/revenue code for service(s) rendered. Use
codes 454 or 455.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 02/28/1997 |
|
|
Principal diagnosis code.
|
Start: 01/01/1995
Last Modified: 01/30/2011 |
|
|
Diagnosis code.
|
Start: 01/01/1995
|
|
|
DRG code(s).
|
Start: 01/01/1995
|
|
|
ADSM-III-R code for services rendered.
|
Start: 01/01/1995
|
|
|
Days/units for procedure/revenue code.
|
Start: 01/01/1995
|
|
|
Frequency of service.
|
Start: 01/01/1995
|
|
|
Length of medical necessity, including begin date.
|
Start: 02/28/1997
|
|
|
Obesity measurements.
|
Start: 01/01/1995
|
|
|
Type of surgery/service for which anesthesia was
administered.
|
Start: 01/01/1995
|
|
|
Length of time for services rendered.
|
Start: 01/01/1995
|
|
|
Number of liters/minute & total hours/day for
respiratory support.
|
Start: 01/01/1995
|
|
|
Number of lesions excised.
|
Start: 01/01/1995
|
|
|
Facility point of origin and destination - ambulance.
|
Start: 01/01/1995
|
|
|
Number of miles patient was transported.
|
Start: 01/01/1995
|
|
|
Location of durable medical equipment use.
|
Start: 01/01/1995
|
|
|
Length/size of laceration/tumor.
|
Start: 01/01/1995
|
|
|
Subluxation location.
|
Start: 01/01/1995
|
|
|
Number of spine segments.
|
Start: 01/01/1995
|
|
|
Oxygen contents for oxygen system rental.
|
Start: 01/01/1995
|
|
|
Weight.
|
Start: 01/01/1995
|
|
|
Height.
|
Start: 01/01/1995
|
|
|
Claim.
|
Start: 01/01/1995
|
|
|
UB04/HCFA-1450/1500 claim form.
|
Start: 01/01/1995
Last Modified: 10/31/2006 |
|
|
Paper claim.
|
Start: 01/01/1995
|
|
|
Signed claim form.
|
Start: 01/01/1995
Stop: 11/01/2011 |
|
|
Claim/service must be itemized.
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Itemized claim by provider.
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 279 |
|
|
Related confinement claim.
|
Start: 01/01/1995
|
|
|
Copy of prescription.
|
Start: 01/01/1995
|
|
|
Medicare entitlement information is required to
determine primary coverage.
|
Start: 01/01/1995
Last Modified: 01/27/2008 |
|
|
Copy of Medicare ID card.
|
Start: 01/01/1995
|
|
|
Vouchers/explanation of benefits (EOB).
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 286 |
|
|
Other payer's Explanation of Benefits/payment
information.
|
Start: 01/01/1995
|
|
|
Medical necessity for service.
|
Start: 01/01/1995
|
|
|
Hospital late charges.
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Reason for late discharge.
|
Start: 01/01/1995
Stop: 11/01/2011 |
|
|
Pre-existing information.
|
Start: 01/01/1995
|
|
|
Reason for termination of pregnancy.
|
Start: 01/01/1995
|
|
|
Purpose of family conference/therapy.
|
Start: 01/01/1995
|
|
|
Reason for physical therapy.
|
Start: 01/01/1995
|
|
|
Supporting documentation. Usage: At least one other
status code is required to identify the supporting documentation.
|
Start: 01/01/1995
Last Modified: 07/01/2017 |
|
|
Attending physician report.
|
Start: 01/01/1995
|
|
|
Nurse's notes.
|
Start: 01/01/1995
|
|
|
Medical notes/report.
|
Start: 02/28/1997
|
|
|
Operative report.
|
Start: 01/01/1995
|
|
|
Emergency room notes/report.
|
Start: 01/01/1995
|
|
|
Lab/test report/notes/results.
|
Start: 02/28/1997
|
|
|
MRI report.
|
Start: 01/01/1995
|
|
|
Refer to codes 300 for lab notes and 311 for pathology
notes.
|
Start: 01/01/1995
Stop: 01/31/1997 |
|
|
Physical therapy notes. Use code 297:6O (6 'OH' - not
zero)
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 02/28/1997 |
|
|
Reports for service.
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to codes 297, 298, 299, 300 |
|
|
Radiology/x-ray reports and/or interpretation.
|
Start: 01/01/1995
Last Modified: 01/30/2011 |
|
|
Detailed description of service.
|
Start: 01/01/1995
|
|
|
Narrative with pocket depth chart.
|
Start: 01/01/1995
|
|
|
Discharge summary.
|
Start: 01/01/1995
|
|
|
Code was duplicate of code 299.
|
Start: 01/01/1995
Stop: 01/31/1997 |
|
|
Progress notes for the six months prior to statement
date.
|
Start: 01/01/1995
|
|
|
Pathology notes/report.
|
Start: 01/01/1995
|
|
|
Dental charting.
|
Start: 01/01/1995
|
|
|
Bridgework information.
|
Start: 01/01/1995
|
|
|
Dental records for this service.
|
Start: 01/01/1995
|
|
|
Past perio treatment history.
|
Start: 01/01/1995
|
|
|
Complete medical history.
|
Start: 01/01/1995
|
|
|
Patient's medical records.
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes |
|
|
X-rays/radiology films.
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Pre/post-operative x-rays/photographs.
|
Start: 02/28/1997
|
|
|
Study models.
|
Start: 01/01/1995
|
|
|
Radiographs or models. (Use codes 318 and/or 320)
|
Start: 01/01/1995
Last Modified: 10/17/2010 Stop: 07/01/2011 |
|
|
Recent Full Mouth X-rays.
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Study models, x-rays, and/or narrative.
|
Start: 01/01/1995
|
|
|
Recent x-ray of treatment area and/or narrative.
|
Start: 01/01/1995
|
|
|
Recent fm x-rays and/or narrative.
|
Start: 01/01/1995
|
|
|
Copy of transplant acquisition invoice.
|
Start: 01/01/1995
|
|
|
Periodontal case type diagnosis and recent pocket depth
chart with narrative.
|
Start: 01/01/1995
|
|
|
Speech therapy notes. Use code 297:6R.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 02/28/1997 |
|
|
Exercise notes.
|
Start: 01/01/1995
|
|
|
Occupational notes.
|
Start: 01/01/1995
|
|
|
History and physical.
|
Start: 01/01/1995
Last Modified: 08/01/2007 |
|
|
Authorization/certification (include period covered).
(Use code 252)
|
Start: 02/28/1997
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Patient release of information authorization.
|
Start: 01/01/1995
|
|
|
Oxygen certification.
|
Start: 01/01/1995
|
|
|
Durable medical equipment certification.
|
Start: 01/01/1995
|
|
|
Chiropractic certification.
|
Start: 01/01/1995
|
|
|
Ambulance certification/documentation.
|
Start: 01/01/1995
|
|
|
Home health certification. Use code 332:4Y.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 02/28/1997 |
|
|
Enteral/parenteral certification.
|
Start: 01/01/1995
|
|
|
Pacemaker certification.
|
Start: 01/01/1995
|
|
|
Private duty nursing certification.
|
Start: 01/01/1995
|
|
|
Podiatric certification.
|
Start: 01/01/1995
|
|
|
Documentation that facility is state licensed and
Medicare approved as a surgical facility.
|
Start: 01/01/1995
|
|
|
Documentation that provider of physical therapy is
Medicare Part B approved.
|
Start: 01/01/1995
|
|
|
Treatment plan for service/diagnosis.
|
Start: 01/01/1995
|
|
|
Proposed treatment plan for next 6 months.
|
Start: 01/01/1995
|
|
|
Refer to code 345 for treatment plan and code 282 for
prescription.
|
Start: 01/01/1995
Stop: 01/31/1997 |
|
|
Chiropractic treatment plan. (Use 345:QL)
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Psychiatric treatment plan. Use codes 345:5I, 5J, 5K,
5L, 5M, 5N, 5O (5 'OH' - not zero), 5P.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 02/28/1997 |
|
|
Speech pathology treatment plan. Use code 345:6R.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 02/28/1997 |
|
|
Physical/occupational therapy treatment plan. Use codes
345:6O (6 'OH' - not zero), 6N.
|
Start: 01/01/1995
Last Modified: 07/09/2007 Stop: 02/28/1997 |
|
|
Duration of treatment plan.
|
Start: 01/01/1995
|
|
|
Orthodontics treatment plan.
|
Start: 01/01/1995
|
|
|
Treatment plan for replacement of remaining missing
teeth.
|
Start: 01/01/1995
|
|
|
Has claim been paid?
|
Start: 01/01/1995
Stop: 11/01/2011 |
|
|
Was blood furnished?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 235 |
|
|
Has or will blood be replaced?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 236 |
|
|
Does provider accept assignment of benefits? (Use code
589)
|
Start: 01/01/1995
Last Modified: 10/17/2010 Stop: 07/01/2011 |
|
|
Is there a release of information signature on file?
(Use code 333)
|
Start: 01/01/1995
Last Modified: 10/17/2010 Stop: 07/01/2011 |
|
|
Benefits Assignment Certification Indicator.
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Is there other insurance?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to codes 171 and 550 |
|
|
Is the dental patient covered by medical insurance?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 171 |
|
|
Possible Workers' Compensation.
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Is accident/illness/condition employment related?
|
Start: 01/01/1995
|
|
|
Is service the result of an accident?
|
Start: 01/01/1995
|
|
|
Is injury due to auto accident?
|
Start: 01/01/1995
|
|
|
Is service performed for a recurring condition or new
condition?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 397 |
|
|
Is medical doctor (MD) or doctor of osteopath (DO) on
staff of this facility?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 676 |
|
|
Does patient condition preclude use of ordinary bed?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to codes 287, 335 |
|
|
Can patient operate controls of bed?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to codes 287, 335 |
|
|
Is patient confined to room?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527 |
|
|
Is patient confined to bed?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to codes 287, 335, 527 |
|
|
Is patient an insulin diabetic?
|
Start: 01/01/1995
Stop: 11/01/2011 |
|
|
Is prescribed lenses a result of cataract surgery?
|
Start: 01/01/1995
|
|
|
Was refraction performed?
|
Start: 01/01/1995
|
|
|
Was charge for ambulance for a round-trip?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 453 |
|
|
Was durable medical equipment purchased new or used?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to codes 184, 185, 186, 335 |
|
|
Is pacemaker temporary or permanent?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 340 |
|
|
Were services performed supervised by a physician?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to codes 453, 454, 666 & procedure code |
|
|
CRNA supervision/medical direction.
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Is drug generic?
|
Start: 01/01/1995
Stop: 11/01/2011 Notes: Refer to code 216 |
|
|
Did provider authorize generic or brand name dispensing?
|
Start: 01/01/1995
|
|
|
Nerve block use (surgery vs. pain management).
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Is prosthesis/crown/inlay placement an initial placement
or a replacement?
|
Start: 01/01/1995
|
|
|
Is appliance upper or lower arch & is appliance fixed
or removable?
|
Start: 01/01/1995
|
|
|
Orthodontic Treatment/Purpose Indicator.
|
Start: 01/01/1995
Last Modified: 10/17/2010 |
|
|
Date patient last examined by entity. Usage: This code
requires use of an Entity Code.
|
Start: 02/28/1997
Last Modified: 07/01/2017 |
|
|
Date post-operative care assumed.
|
Start: 02/28/1997
|
|
|
Date post-operative care relinquished.
|
Start: 02/28/1997
|
|
|
Date of most recent medical event necessitating
service(s).
|
Start: 02/28/1997
|
|
|
Date(s) dialysis conducted.
|
Start: 02/28/1997
|
|
|
Date(s) of blood transfusion(s).
|
Start: 02/28/1997
Stop: 11/01/2011 |
|
|
Date of previous pacemaker check.
|
Start: 02/28/1997
Stop: 11/01/2011 |
|
|
Date(s) of most recent hospitalization related to
service.
|
Start: 02/28/1997
|
|
|
Date entity signed certification/recertification Usage:
This code requires use of an Entity Code.
|
Start: 02/28/1997
Last Modified: 07/01/2017 |
|
|
Date home dialysis began.
|
Start: 02/28/1997
|
|
|
Date of onset/exacerbation of illness/condition.
|
Start: 02/28/1997
|
|
|
Visual field test results.
|
Start: 02/28/1997
|
|
|
Report of prior testing related to this service,
including dates.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 417 |
|
|
Claim is out of balance.
|
Start: 02/28/1997
|
|
|
Source of payment is not valid.
|
Start: 02/28/1997
|
|
|
Amount must be greater than zero. Usage: At least one
other status code is required to identify which amount element is in error.
|
Start: 02/28/1997
Last Modified: 07/01/2017 |
|
|
Entity referral notes/orders/prescription. Effective 05/01/2018:
Entity referral notes/orders/prescription. Usage: this code requires use of
an entity code.
|
Start: 02/28/1997
Last Modified: 11/01/2017 |
|
|
Specific findings, complaints, or symptoms necessitating
service.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to codes 287, 488 |
|
|
Summary of services.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 306 |
|
|
Brief medical history as related to service(s).
|
Start: 02/28/1997
|
|
|
Complications/mitigating circumstances.
|
Start: 02/28/1997
|
|
|
Initial certification.
|
Start: 02/28/1997
|
|
|
Medication logs/records (including medication therapy).
|
Start: 02/28/1997
|
|
|
Explain differences between treatment plan and patient's
condition.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes |
|
|
Medical necessity for non-routine service(s).
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 287 |
|
|
Medical records to substantiate decision of non-coverage.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes |
|
|
Explain/justify differences between treatment plan and
services rendered.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes |
|
|
Necessity for concurrent care (more than one physician
treating the patient).
|
Start: 02/28/1997
Last Modified: 10/17/2010 |
|
|
Justify services outside composite rate.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 287 |
|
|
Verification of patient's ability to retain and use information.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes |
|
|
Prior testing, including result(s) and date(s) as
related to service(s).
|
Start: 02/28/1997
|
|
|
Indicating why medications cannot be taken orally.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes |
|
|
Individual test(s) comprising the panel and the charges
for each test.
|
Start: 02/28/1997
|
|
|
Name, dosage and medical justification of contrast
material used for radiology procedure.
|
Start: 02/28/1997
|
|
|
Medical review attachment/information for service(s).
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes |
|
|
Homebound status.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 575 |
|
|
Prognosis.
|
Start: 02/28/1997
Last Modified: 07/09/2007 Stop: 01/01/2008 |
|
|
Statement of non-coverage including itemized bill.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 279 & 286 |
|
|
Itemize non-covered services.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 279 & 286 |
|
|
All current diagnoses.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 255, 232 & 488 |
|
|
Emergency care provided during transport.
|
Start: 02/28/1997
Stop: 11/01/2011 |
|
|
Reason for transport by ambulance.
|
Start: 02/28/1997
|
|
|
Loaded miles and charges for transport to nearest
facility with appropriate services.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to codes 267, 178, 430 |
|
|
Nearest appropriate facility.
|
Start: 02/28/1997
|
|
|
Patient's condition/functional status at time of
service.
|
Start: 02/28/1997
Last Modified: 10/17/2010 |
|
|
Date benefits exhausted.
|
Start: 02/28/1997
|
|
|
Copy of patient revocation of hospice benefits.
|
Start: 02/28/1997
|
|
|
Reasons for more than one transfer per entitlement
period.
|
Start: 02/28/1997
|
|
|
Notice of Admission.
|
Start: 02/28/1997
|
|
|
Short term goals.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 345 |
|
|
Long term goals.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 345 |
|
|
Number of patients attending session.
|
Start: 02/28/1997
Stop: 11/01/2011 |
|
|
Size, depth, amount, and type of drainage wounds.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 297 or other specific report type codes |
|
|
why non-skilled caregiver has not been taught procedure.
|
Start: 02/28/1997
Stop: 11/01/2011 |
|
|
Entity professional qualification for service(s).
|
Start: 02/28/1997
|
|
|
Modalities of service.
|
Start: 02/28/1997
|
|
|
Initial evaluation report.
|
Start: 02/28/1997
|
|
|
Method used to obtain test sample.
|
Start: 02/28/1997
Stop: 11/01/2011 |
|
|
Explain why hearing loss not correctable by hearing aid.
|
Start: 02/28/1997
Stop: 11/01/2011 Notes: Refer to code 287 |
|
|
Documentation from prior claim(s) related to service(s).
|
Start: 02/28/1997
Stop: 11/01/2011 |
|
|
Plan of teaching.
|
Start: 02/28/1997
Stop: 11/01/2011 |
|
|
Invalid billing combination. See STC12 for details. This
code should only be used to indicate an inconsistency between two or more
data elements on the claim. A detailed explanation is required in STC12 when
this code is used.
|
Start: 02/28/1997
Last Modified: 01/24/2010 Stop: 01/01/2012 |
|
|
Projected date to discontinue service(s).
|
Start: 02/28/1997
|
|
|
Awaiting spend down determination.
|
Start: 02/28/1997
|
|
|
Preoperative and post-operative diagnosis.
|
Start: 02/28/1997
|
|
|
Total visits in total number of hours/day and total
number of hours/week.
|
Start: 02/28/1997
|
|
|
Procedure Code Modifier(s) for Service(s) Rendered.
|
Start: 02/28/1997
|
|
|
Procedure code for services rendered.
|
Start: 02/28/1997
|
|
|
Revenue code for services rendered.
|
Start: 02/28/1997
|
|
|
Covered Day(s).
|
Start: 02/28/1997
|
|
|
Non-Covered Day(s).
|
Start: 02/28/1997
|
|
|
Coinsurance Day(s).
|
Start: 02/28/1997
|
|
|
Lifetime Reserve Day(s).
|
Start: 02/28/1997
|
|
|
NUBC Condition Code(s).
|
Start: 02/28/1997
|
|
|
NUBC Occurrence Code(s) and Date(s).
|
Start: 02/28/1997
Last Modified: 01/24/2010 Stop: 01/01/2012 |
|
|
NUBC Occurrence Span Code(s) and Date(s).
|
Start: 02/28/1997
Last Modified: 01/24/2010 Stop: 01/01/2012 |
|
|
NUBC Value Code(s) and/or Amount(s).
|
Start: 02/28/1997
Last Modified: 01/24/2010 Stop: 01/01/2012 |
|
|
Payer Assigned Claim Control Number.
|
Start: 02/28/1997
Last Modified: 10/31/2004 |
|
|
Principal Procedure Code for Service(s) Rendered.
|
Start: 02/28/1997
|
|
|
Entity's Original Signature. Usage: This code requires
use of an Entity Code.
|
Start: 02/28/1997
Last Modified: 07/01/2017 |
|
|
Entity Signature Date. Usage: This code requires use of
an Entity Code.
|
Start: 02/28/1997
Last Modified: 07/01/2017 |
|
|
Patient Signature Source.
|
Start: 02/28/1997
|
|
|
Purchase Service Charge.
|
Start: 02/28/1997
|
|
|
Was service purchased from another entity? Usage: This
code requires use of an Entity Code.
|
Start: 02/28/1997
Last Modified: 07/01/2017 |
|
|
Were services related to an emergency?
|
Start: 02/28/1997
|
|
|
Ambulance Run Sheet.
|
Start: 02/28/1997
|
|
|
Missing or invalid lab indicator.
|
Start: 06/30/1998
|
|
|
Procedure code and patient gender mismatch.
|
Start: 06/30/1998
Last Modified: 02/29/2000 |
|
|
Procedure code not valid for patient age.
|
Start: 06/30/1998
Last Modified: 02/29/2000 |
|
|
Missing or invalid units of service.
|
Start: 06/30/1998
|
|
|
Diagnosis code pointer is missing or invalid.
|
Start: 06/30/1998
|
|
|
Claim submitter's identifier.
|
Start: 06/30/1998
Last Modified: 01/24/2010 |
|
|
Other Carrier payer ID is missing or invalid.
|
Start: 06/30/1998
|
|
|
Entity's claim filing indicator. Usage: This code
requires use of an Entity Code.
|
Start: 06/30/1998
Last Modified: 07/01/2017 |
|
|
Claim/submission format is invalid.
|
Start: 10/31/1998
|
|
|
Date Error, Century Missing.
|
Start: 02/28/1999
Last Modified: 09/20/2009 Stop: 10/01/2010 |
|
|
Maximum coverage amount met or exceeded for benefit
period.
|
Start: 06/30/1999
|
|
|
Business Application Currently Not Available.
|
Start: 02/29/2000
|
|
|
More information available than can be returned in real
time mode. Narrow your current search criteria. This change effective
September 1, 2017: More information available than can be returned in
real-time mode. Narrow your current search criteria.
|
Start: 02/28/2001
Last Modified: 03/01/2017 |
|
|
Principal Procedure Date.
|
Start: 10/31/2001
Last Modified: 07/01/2009 |
|
|
Claim not found, claim should have been submitted
to/through 'entity'. Usage: This code requires use of an Entity Code.
|
Start: 02/28/2002
Last Modified: 07/01/2017 |
|
|
Diagnosis code(s) for the services rendered.
|
Start: 06/30/2002
|
|
|
Attachment Control Number.
|
Start: 10/31/2002
|
|
|
Other Procedure Code for Service(s) Rendered.
|
Start: 02/28/2003
|
|
|
Entity not eligible for encounter submission. Usage:
This code requires use of an Entity Code.
|
Start: 02/28/2003
Last Modified: 07/01/2017 |
|
|
Other Procedure Date.
|
Start: 02/28/2003
|
|
|
Version/Release/Industry ID code not currently supported
by information holder.
|
Start: 02/28/2003
|
|
|
Real-Time requests not supported by the information
holder, resubmit as batch request This change effective September 1, 2017:
Real-time requests not supported by the information holder, resubmit as batch
request.
|
Start: 02/28/2003
Last Modified: 03/01/2017 |
|
|
Requests for re-adjudication must reference the newly
assigned payer claim control number for this previously adjusted claim.
Correct the payer claim control number and re-submit.
|
Start: 10/31/2003
|
|
|
Submitter not approved for electronic claim submissions
on behalf of this entity. Usage: This code requires use of an Entity Code.
|
Start: 02/29/2004
Last Modified: 07/01/2017 |
|
|
Sales tax not paid.
|
Start: 06/30/2004
|
|
|
Maximum leave days exhausted.
|
Start: 06/30/2004
|
|
|
No rate on file with the payer for this service for this
entity Usage: This code requires use of an Entity Code.
|
Start: 06/30/2004
Last Modified: 07/01/2017 |
|
|
Entity's Postal/Zip Code. Usage: This code requires use
of an Entity Code.
|
Start: 06/30/2004
Last Modified: 07/01/2017 |
|
|
Entity's State/Province. Usage: This code requires use
of an Entity Code.
|
Start: 06/30/2004
Last Modified: 07/01/2017 |
|
|
Entity's City. Usage: This code requires use of an
Entity Code.
|
Start: 06/30/2004
Last Modified: 07/01/2017 |
|
|
Entity's Street Address. Usage: This code requires use
of an Entity Code.
|
Start: 06/30/2004
Last Modified: 07/01/2017 |
|
|
Entity's Last Name. Usage: This code requires use of an
Entity Code.
|
Start: 06/30/2004
Last Modified: 07/01/2017 |
|
|
Entity's First Name. Usage: This code requires use of an
Entity Code.
|
Start: 06/30/2004
Last Modified: 07/01/2017 |
|
|
Entity is changing processor/clearinghouse. This claim
must be submitted to the new processor/clearinghouse. Usage: This code
requires use of an Entity Code.
|
Start: 06/30/2004
Last Modified: 07/01/2017 |
|
|
HCPCS.
|
Start: 10/31/2004
|
|
|
ICD9 Usage: At least one other status code is required
to identify the related procedure code or diagnosis code.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
External Cause of Injury Code.
|
Start: 10/31/2004
Last Modified: 03/01/2016 |
|
|
Future date. Usage: At least one other status code is
required to identify the data element in error.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
Invalid character. Usage: At least one other status code
is required to identify the data element in error.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
Length invalid for receiver's application system. Usage:
At least one other status code is required to identify the data element in
error.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
HIPPS Rate Code for services Rendered.
|
Start: 10/31/2004
|
|
|
Entity's Middle Name Usage: This code requires use of an
Entity Code.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
Managed Care review.
|
Start: 10/31/2004
|
|
|
Other Entity's Adjudication or Payment/Remittance Date.
Usage: An Entity code is required to identify the Other Payer Entity, i.e.
primary, secondary.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
Adjusted Repriced Claim Reference Number.
|
Start: 10/31/2004
|
|
|
Adjusted Repriced Line item Reference Number.
|
Start: 10/31/2004
|
|
|
Adjustment Amount.
|
Start: 10/31/2004
|
|
|
Adjustment Quantity.
|
Start: 10/31/2004
|
|
|
Adjustment Reason Code.
|
Start: 10/31/2004
|
|
|
Anesthesia Modifying Units.
|
Start: 10/31/2004
|
|
|
Anesthesia Unit Count.
|
Start: 10/31/2004
|
|
|
Arterial Blood Gas Quantity.
|
Start: 10/31/2004
|
|
|
Begin Therapy Date.
|
Start: 10/31/2004
|
|
|
Bundled or Unbundled Line Number.
|
Start: 10/31/2004
|
|
|
Certification Condition Indicator.
|
Start: 10/31/2004
|
|
|
Certification Period Projected Visit Count.
|
Start: 10/31/2004
|
|
|
Certification Revision Date.
|
Start: 10/31/2004
|
|
|
Claim Adjustment Indicator.
|
Start: 10/31/2004
|
|
|
Claim Disproportionate Share Amount.
|
Start: 10/31/2004
|
|
|
Claim DRG Amount.
|
Start: 10/31/2004
|
|
|
Claim DRG Outlier Amount.
|
Start: 10/31/2004
|
|
|
Claim ESRD Payment Amount.
|
Start: 10/31/2004
|
|
|
Claim Frequency Code.
|
Start: 10/31/2004
|
|
|
Claim Indirect Teaching Amount.
|
Start: 10/31/2004
|
|
|
Claim MSP Pass-through Amount.
|
Start: 10/31/2004
|
|
|
Claim or Encounter Identifier.
|
Start: 10/31/2004
|
|
|
Claim PPS Capital Amount.
|
Start: 10/31/2004
|
|
|
Claim PPS Capital Outlier Amount.
|
Start: 10/31/2004
|
|
|
Claim Submission Reason Code.
|
Start: 10/31/2004
|
|
|
Claim Total Denied Charge Amount.
|
Start: 10/31/2004
|
|
|
Clearinghouse or Value Added Network Trace.
|
Start: 10/31/2004
|
|
|
Clinical Laboratory Improvement Amendment (CLIA) Number
|
Start: 10/31/2004
Last Modified: 03/01/2018 |
|
|
Contract Amount.
|
Start: 10/31/2004
|
|
|
Contract Code.
|
Start: 10/31/2004
|
|
|
Contract Percentage.
|
Start: 10/31/2004
|
|
|
Contract Type Code.
|
Start: 10/31/2004
|
|
|
Contract Version Identifier.
|
Start: 10/31/2004
|
|
|
Coordination of Benefits Code.
|
Start: 10/31/2004
|
|
|
Coordination of Benefits Total Submitted Charge.
|
Start: 10/31/2004
|
|
|
Cost Report Day Count.
|
Start: 10/31/2004
|
|
|
Covered Amount.
|
Start: 10/31/2004
|
|
|
Date Claim Paid.
|
Start: 10/31/2004
|
|
|
Delay Reason Code.
|
Start: 10/31/2004
|
|
|
Demonstration Project Identifier.
|
Start: 10/31/2004
|
|
|
Diagnosis Date.
|
Start: 10/31/2004
|
|
|
Discount Amount.
|
Start: 10/31/2004
|
|
|
Document Control Identifier.
|
Start: 10/31/2004
|
|
|
Entity's Additional/Secondary Identifier. Usage: This
code requires use of an Entity Code.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
Entity's Contact Name. Usage: This code requires use of
an Entity Code.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
Entity's National Provider Identifier (NPI). Usage: This
code requires use of an Entity Code.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
Entity's Tax Amount. Usage: This code requires use of an
Entity Code.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
EPSDT Indicator.
|
Start: 10/31/2004
|
|
|
Estimated Claim Due Amount.
|
Start: 10/31/2004
|
|
|
Exception Code.
|
Start: 10/31/2004
|
|
|
Facility Code Qualifier.
|
Start: 10/31/2004
|
|
|
Family Planning Indicator.
|
Start: 10/31/2004
|
|
|
Fixed Format Information.
|
Start: 10/31/2004
|
|
|
Free Form Message Text.
|
Start: 10/31/2004
Stop: 01/01/2013 |
|
|
Frequency Count.
|
Start: 10/31/2004
|
|
|
Frequency Period.
|
Start: 10/31/2004
|
|
|
Functional Limitation Code.
|
Start: 10/31/2004
|
|
|
HCPCS Payable Amount Home Health.
|
Start: 10/31/2004
|
|
|
Homebound Indicator.
|
Start: 10/31/2004
|
|
|
Immunization Batch Number.
|
Start: 10/31/2004
|
|
|
Industry Code.
|
Start: 10/31/2004
|
|
|
Insurance Type Code.
|
Start: 10/31/2004
|
|
|
Investigational Device Exemption Identifier.
|
Start: 10/31/2004
|
|
|
Last Certification Date.
|
Start: 10/31/2004
|
|
|
Last Worked Date.
|
Start: 10/31/2004
|
|
|
Lifetime Psychiatric Days Count.
|
Start: 10/31/2004
|
|
|
Line Item Charge Amount.
|
Start: 10/31/2004
|
|
|
Line Item Control Number.
|
Start: 10/31/2004
|
|
|
Denied Charge or Non-covered Charge.
|
Start: 10/31/2004
Last Modified: 07/09/2007 |
|
|
Line Note Text.
|
Start: 10/31/2004
|
|
|
Measurement Reference Identification Code.
|
Start: 10/31/2004
|
|
|
Medical Record Number.
|
Start: 10/31/2004
|
|
|
Provider Accept Assignment Code.
|
Start: 10/31/2004
Last Modified: 10/17/2010 |
|
|
Medicare Coverage Indicator.
|
Start: 10/31/2004
|
|
|
Medicare Paid at 100% Amount.
|
Start: 10/31/2004
|
|
|
Medicare Paid at 80% Amount.
|
Start: 10/31/2004
|
|
|
Medicare Section 4081 Indicator.
|
Start: 10/31/2004
|
|
|
Mental Status Code.
|
Start: 10/31/2004
|
|
|
Monthly Treatment Count.
|
Start: 10/31/2004
|
|
|
Non-covered Charge Amount.
|
Start: 10/31/2004
|
|
|
Non-payable Professional Component Amount.
|
Start: 10/31/2004
|
|
|
Non-payable Professional Component Billed Amount.
|
Start: 10/31/2004
|
|
|
Note Reference Code.
|
Start: 10/31/2004
|
|
|
Oxygen Saturation Qty.
|
Start: 10/31/2004
|
|
|
Oxygen Test Condition Code.
|
Start: 10/31/2004
|
|
|
Oxygen Test Date.
|
Start: 10/31/2004
|
|
|
Old Capital Amount.
|
Start: 10/31/2004
|
|
|
Originator Application Transaction Identifier.
|
Start: 10/31/2004
|
|
|
Orthodontic Treatment Months Count.
|
Start: 10/31/2004
|
|
|
Paid From Part A Medicare Trust Fund Amount.
|
Start: 10/31/2004
|
|
|
Paid From Part B Medicare Trust Fund Amount.
|
Start: 10/31/2004
|
|
|
Paid Service Unit Count.
|
Start: 10/31/2004
|
|
|
Participation Agreement.
|
Start: 10/31/2004
|
|
|
Patient Discharge Facility Type Code.
|
Start: 10/31/2004
|
|
|
Peer Review Authorization Number.
|
Start: 10/31/2004
|
|
|
Per Day Limit Amount.
|
Start: 10/31/2004
|
|
|
Physician Contact Date.
|
Start: 10/31/2004
|
|
|
Physician Order Date.
|
Start: 10/31/2004
|
|
|
Policy Compliance Code.
|
Start: 10/31/2004
|
|
|
Policy Name.
|
Start: 10/31/2004
|
|
|
Postage Claimed Amount.
|
Start: 10/31/2004
|
|
|
PPS-Capital DSH DRG Amount.
|
Start: 10/31/2004
|
|
|
PPS-Capital Exception Amount.
|
Start: 10/31/2004
|
|
|
PPS-Capital FSP DRG Amount.
|
Start: 10/31/2004
|
|
|
PPS-Capital HSP DRG Amount.
|
Start: 10/31/2004
|
|
|
PPS-Capital IME Amount.
|
Start: 10/31/2004
|
|
|
PPS-Operating Federal Specific DRG Amount.
|
Start: 10/31/2004
|
|
|
PPS-Operating Hospital Specific DRG Amount.
|
Start: 10/31/2004
|
|
|
Predetermination of Benefits Identifier.
|
Start: 10/31/2004
|
|
|
Pregnancy Indicator.
|
Start: 10/31/2004
|
|
|
Pre-Tax Claim Amount.
|
Start: 10/31/2004
|
|
|
Pricing Methodology.
|
Start: 10/31/2004
|
|
|
Property Casualty Claim Number.
|
Start: 10/31/2004
|
|
|
Referring CLIA Number.
|
Start: 10/31/2004
|
|
|
Reimbursement Rate.
|
Start: 10/31/2004
|
|
|
Reject Reason Code.
|
Start: 10/31/2004
|
|
|
Related Causes Code (Accident, auto accident,
employment)
|
Start: 10/31/2004
Last Modified: 10/17/2010 |
|
|
Remark Code.
|
Start: 10/31/2004
|
|
|
Repriced Ambulatory Patient Group Code.
|
Start: 10/31/2004
|
|
|
Repriced Line Item Reference Number.
|
Start: 10/31/2004
|
|
|
Repriced Saving Amount.
|
Start: 10/31/2004
|
|
|
Repricing Per Diem or Flat Rate Amount.
|
Start: 10/31/2004
|
|
|
Responsibility Amount.
|
Start: 10/31/2004
|
|
|
Sales Tax Amount.
|
Start: 10/31/2004
|
|
|
Service Adjudication or Payment Date. Note: Use code
516.
|
Start: 10/31/2004
Last Modified: 09/20/2009 Stop: 10/01/2010 |
|
|
Service Authorization Exception Code.
|
Start: 10/31/2004
|
|
|
Service Line Paid Amount.
|
Start: 10/31/2004
|
|
|
Service Line Rate.
|
Start: 10/31/2004
|
|
|
Service Tax Amount.
|
Start: 10/31/2004
|
|
|
Ship, Delivery or Calendar Pattern Code.
|
Start: 10/31/2004
|
|
|
Shipped Date.
|
Start: 10/31/2004
|
|
|
Similar Illness or Symptom Date.
|
Start: 10/31/2004
|
|
|
Skilled Nursing Facility Indicator.
|
Start: 10/31/2004
|
|
|
Special Program Indicator.
|
Start: 10/31/2004
|
|
|
State Industrial Accident Provider Number.
|
Start: 10/31/2004
|
|
|
Terms Discount Percentage.
|
Start: 10/31/2004
|
|
|
Test Performed Date.
|
Start: 10/31/2004
|
|
|
Total Denied Charge Amount.
|
Start: 10/31/2004
|
|
|
Total Medicare Paid Amount.
|
Start: 10/31/2004
|
|
|
Total Visits Projected This Certification Count.
|
Start: 10/31/2004
|
|
|
Total Visits Rendered Count.
|
Start: 10/31/2004
|
|
|
Treatment Code.
|
Start: 10/31/2004
|
|
|
Unit or Basis for Measurement Code.
|
Start: 10/31/2004
|
|
|
Universal Product Number.
|
Start: 10/31/2004
|
|
|
Visits Prior to Recertification Date Count CR702.
|
Start: 10/31/2004
|
|
|
X-ray Availability Indicator.
|
Start: 10/31/2004
|
|
|
Entity's Group Name. Usage: This code requires use of an
Entity Code.
|
Start: 10/31/2004
Last Modified: 07/01/2017 |
|
|
Orthodontic Banding Date.
|
Start: 10/31/2004
|
|
|
Surgery Date.
|
Start: 10/31/2004
|
|
|
Surgical Procedure Code.
|
Start: 10/31/2004
|
|
|
Real-Time requests not supported by the information
holder, do not resubmit This change effective September 1, 2017: Real-time
requests not supported by the information holder, do not resubmit.
|
Start: 02/28/2005
Last Modified: 03/01/2017 |
|
|
Missing Endodontics treatment history and prognosis.
|
Start: 06/30/2005
|
|
|
Dental service narrative needed.
|
Start: 10/31/2005
|
|
|
Funds applied from a consumer spending account such as
consumer directed/driven health plan (CDHP), Health savings account (H S A)
and or other similar accounts.
|
Start: 06/30/2006
Last Modified: 02/28/2007 |
|
|
Funds may be available from a consumer spending account
such as consumer directed/driven health plan (CDHP), Health savings account
(H S A) and or other similar accounts.
|
Start: 06/30/2006
Last Modified: 02/28/2007 |
|
|
Other Payer's payment information is out of balance.
|
Start: 10/31/2006
|
|
|
Patient Reason for Visit.
|
Start: 10/31/2006
|
|
|
Authorization exceeded.
|
Start: 10/31/2006
|
|
|
Facility admission through discharge dates.
|
Start: 10/31/2006
|
|
|
Entity possibly compensated by facility. Usage: This
code requires use of an Entity Code.
|
Start: 10/31/2006
Last Modified: 07/01/2017 |
|
|
Entity not affiliated. Usage: This code requires use of
an Entity Code.
|
Start: 10/31/2006
Last Modified: 07/01/2017 |
|
|
Revenue code and patient gender mismatch.
|
Start: 10/31/2006
|
|
|
Submit newborn services on mother's claim.
|
Start: 10/31/2006
|
|
|
Entity's Country. Usage: This code requires use of an
Entity Code.
|
Start: 10/31/2006
Last Modified: 07/01/2017 |
|
|
Claim currency not supported.
|
Start: 10/31/2006
|
|
|
Cosmetic procedure.
|
Start: 02/28/2007
|
|
|
Awaiting Associated Hospital Claims.
|
Start: 02/28/2007
|
|
|
Rejected. Syntax error noted for this
claim/service/inquiry. See Functional or Implementation Acknowledgement for
details. (Usage: Only for use to reject claims or status requests in
transactions that were 'accepted with errors' on a 997 or 999 Acknowledgement.)
|
Start: 11/05/2007
Last Modified: 07/01/2017 |
|
|
Claim could not complete adjudication in real time.
Claim will continue processing in a batch mode. Do not resubmit. This change
effective September 1, 2017: Claim could not complete adjudication in
real-time. Claim will continue processing in a batch mode. Do not resubmit.
|
Start: 01/27/2008
Last Modified: 03/01/2017 |
|
|
The claim/ encounter has completed the adjudication
cycle and the entire claim has been voided.
|
Start: 01/27/2008
|
|
|
Claim estimation can not be completed in real time. Do
not resubmit. This change effective September 1, 2017: Claim
predetermination/estimation could not be completed in real-time. Do not
resubmit.
|
Start: 01/27/2008
Last Modified: 03/01/2017 |
|
|
Present on Admission Indicator for reported diagnosis
code(s).
|
Start: 01/27/2008
|
|
|
Entity was unable to respond within the expected time
frame. Usage: This code requires use of an Entity Code.
|
Start: 06/01/2008
Last Modified: 07/01/2017 |
|
|
Multiple claims or estimate requests cannot be processed
in real time. This change effective September 1, 2017: Multiple claims or
estimate requests cannot be processed in real-time.
|
Start: 06/01/2008
Last Modified: 03/01/2017 |
|
|
Multiple claim status requests cannot be processed in
real time. This change effective September 1, 2017: Multiple claim status
requests cannot be processed in real-time.
|
Start: 06/01/2008
Last Modified: 03/01/2017 |
|
|
Contracted funding agreement-Subscriber is employed by
the provider of services.
|
Start: 09/21/2008
|
|
|
Amount must be greater than or equal to zero. Usage: At
least one other status code is required to identify which amount element is
in error.
|
Start: 01/25/2009
Last Modified: 07/01/2017 |
|
|
Amount must not be equal to zero. Usage: At least one
other status code is required to identify which amount element is in error.
|
Start: 01/25/2009
Last Modified: 07/01/2017 |
|
|
Entity's Country Subdivision Code. Usage: This code
requires use of an Entity Code.
|
Start: 01/25/2009
Last Modified: 07/01/2017 |
|
|
Claim Adjustment Group Code.
|
Start: 01/25/2009
|
|
|
Invalid Decimal Precision. Usage: At least one other
status code is required to identify the data element in error.
|
Start: 07/01/2009
Last Modified: 07/01/2017 |
|
|
Form Type Identification.
|
Start: 07/01/2009
|
|
|
Question/Response from Supporting Documentation Form.
|
Start: 07/01/2009
|
|
|
ICD10. Usage: At least one other status code is required
to identify the related procedure code or diagnosis code.
|
Start: 07/01/2009
Last Modified: 07/01/2017 |
|
|
Initial Treatment Date.
|
Start: 07/01/2009
|
|
|
Repriced Claim Reference Number.
|
Start: 11/01/2009
|
|
|
Advanced Billing Concepts (ABC) code.
|
Start: 01/24/2010
|
|
|
Claim Note Text.
|
Start: 01/24/2010
|
|
|
Repriced Allowed Amount.
|
Start: 01/24/2010
|
|
|
Repriced Approved Amount.
|
Start: 01/24/2010
|
|
|
Repriced Approved Ambulatory Patient Group Amount.
|
Start: 01/24/2010
|
|
|
Repriced Approved Revenue Code.
|
Start: 01/24/2010
|
|
|
Repriced Approved Service Unit Count.
|
Start: 01/24/2010
|
|
|
Line Adjudication Information. Usage: At least one other
status code is required to identify the data element in error.
|
Start: 01/24/2010
Last Modified: 07/01/2017 |
|
|
Stretcher purpose.
|
Start: 01/24/2010
|
|
|
Obstetric Additional Units.
|
Start: 01/24/2010
|
|
|
Patient Condition Description.
|
Start: 01/24/2010
|
|
|
Care Plan Oversight Number.
|
Start: 01/24/2010
|
|
|
Acute Manifestation Date.
|
Start: 01/24/2010
|
|
|
Repriced Approved DRG Code.
|
Start: 01/24/2010
|
|
|
This claim has been split for processing.
|
Start: 01/24/2010
|
|
|
Claim/service not submitted within the required
timeframe (timely filing).
|
Start: 01/24/2010
|
|
|
NUBC Occurrence Code(s).
|
Start: 01/24/2010
|
|
|
NUBC Occurrence Code Date(s).
|
Start: 01/24/2010
|
|
|
NUBC Occurrence Span Code(s).
|
Start: 01/24/2010
|
|
|
NUBC Occurrence Span Code Date(s).
|
Start: 01/24/2010
|
|
|
Drug days supply.
|
Start: 01/24/2010
|
|
|
Drug dosage. This change effective 5/01/2017: Drug
Quantity
|
Start: 01/24/2010
Last Modified: 11/01/2016 |
|
|
NUBC Value Code(s).
|
Start: 01/24/2010
|
|
|
NUBC Value Code Amount(s).
|
Start: 01/24/2010
|
|
|
Accident date.
|
Start: 01/24/2010
|
|
|
Accident state.
|
Start: 01/24/2010
|
|
|
Accident description.
|
Start: 01/24/2010
|
|
|
Accident cause.
|
Start: 01/24/2010
|
|
|
Measurement value/test result.
|
Start: 01/24/2010
|
|
|
Information submitted inconsistent with billing
guidelines. Usage: At least one other status code is required to identify the
inconsistent information.
|
Start: 01/24/2010
Last Modified: 07/01/2017 |
|
|
Prefix for entity's contract/member number.
|
Start: 01/24/2010
|
|
|
Verifying premium payment.
|
Start: 06/06/2010
|
|
|
This service/claim is included in the allowance for
another service or claim.
|
Start: 06/06/2010
|
|
|
A related or qualifying service/claim has not been
received/adjudicated.
|
Start: 06/06/2010
|
|
|
Current Dental Terminology (CDT) Code.
|
Start: 06/06/2010
|
|
|
Home Infusion EDI Coalition (HEIC) Product/Service Code.
|
Start: 06/06/2010
|
|
|
Jurisdiction Specific Procedure or Supply Code.
|
Start: 06/06/2010
|
|
|
Drop-Off Location.
|
Start: 06/06/2010
|
|
|
Entity must be a person. Usage: This code requires use
of an Entity Code.
|
Start: 06/06/2010
Last Modified: 07/01/2017 |
|
|
Payer Responsibility Sequence Number Code.
|
Start: 06/06/2010
|
|
|
Entity's credential/enrollment information. Usage: This
code requires use of an Entity Code.
|
Start: 10/17/2010
Last Modified: 07/01/2017 |
|
|
Services/charges related to the treatment of a
hospital-acquired condition or preventable medical error.
|
Start: 10/17/2010
|
|
|
Identifier Qualifier Usage: At least one other status
code is required to identify the specific identifier qualifier in error.
|
Start: 10/17/2010
Last Modified: 07/01/2017 |
|
|
Duplicate Submission Usage: use only at the information
receiver level in the Health Care Claim Acknowledgement transaction.
|
Start: 10/17/2010
Last Modified: 07/01/2017 |
|
|
Hospice Employee Indicator.
|
Start: 10/17/2010
|
|
|
Corrected Data Usage: Requires a second status code to
identify the corrected data.
|
Start: 10/17/2010
Last Modified: 07/01/2017 |
|
|
Date of Injury/Illness.
|
Start: 10/17/2010
|
|
|
Auto Accident State or Province Code.
|
Start: 10/17/2010
Last Modified: 01/30/2011 |
|
|
Ambulance Pick-up State or Province Code.
|
Start: 10/17/2010
Last Modified: 01/30/2011 |
|
|
Ambulance Drop-off State or Province Code.
|
Start: 10/17/2010
Last Modified: 01/30/2011 |
|
|
Co-pay status code.
|
Start: 01/30/2011
|
|
|
Entity Name Suffix. Usage: This code requires the use of
an Entity Code.
|
Start: 01/30/2011
Last Modified: 07/01/2017 |
|
|
Entity's primary identifier. Usage: This code requires
the use of an Entity Code.
|
Start: 01/30/2011
Last Modified: 07/01/2017 |
|
|
Entity's Received Date. Usage: This code requires the
use of an Entity Code.
|
Start: 01/30/2011
Last Modified: 07/01/2017 |
|
|
Last seen date.
|
Start: 01/30/2011
|
|
|
Repriced approved HCPCS code.
|
Start: 01/30/2011
|
|
|
Round trip purpose description.
|
Start: 01/30/2011
|
|
|
Tooth status code.
|
Start: 01/30/2011
|
|
|
Entity's referral number. Usage: This code requires the
use of an Entity Code.
|
Start: 01/30/2011
Last Modified: 07/01/2017 |
|
|
Locum Tenens Provider Identifier. Code must be used with
Entity Code 82 - Rendering Provider.
|
Start: 01/20/2013
|
|
|
Ambulance Pickup Zip Code.
|
Start: 01/20/2013
|
|
|
Professional charges are non covered.
|
Start: 06/02/2013
|
|
|
Institutional charges are non covered.
|
Start: 06/02/2013
|
|
|
Services were performed during a Health Insurance
Exchange (HIX) premium payment grace period.
|
Start: 11/01/2013
|
|
|
Qualifications for emergent/urgent care
|
Start: 01/26/2014
|
|
|
Service date outside the accidental injury coverage
period.
|
Start: 01/26/2014
|
|
|
DME Repair or Maintenance
|
Start: 06/01/2014
|
|
|
Duplicate of a claim processed or in process as a
crossover/coordination of benefits claim.
|
Start: 09/28/2014
|
|
|
Claim submitted prematurely. Please resubmit after
crossover/payer to payer COB allotted waiting period.
|
Start: 09/28/2014
|
|
|
The greatest level of diagnosis code specificity is
required.
|
Start 03/01/2016
|
|
|
One calendar year per claim.
|
Start 11/01/2016
|
|
|
Experimental/Investigational
|
Start 11/01/2016
|
|
|
Entity Type Qualifier (Person/Non-Person Entity). Usage:
this code requires use of an entity code.
|
Start 07/01/2017
|
|
|
Pre/Post-operative care
|
Start 07/01/2017
|
|
|
Processed based on multiple or concurrent procedure
rules.
|
Start 07/01/2017
|
|
|
Non-Compensable incident/event. Usage: To be used for
Property and Casualty only.
|
Start 07/01/2017
|
|
|
Service submitted for the same/similar service within a
set timeframe.
|
Start 11/01/2017
|
|
|
Lifetime benefit maximum
|
Start 11/01/2017
|
|
|
Claim has been identified as a readmission
|
Start 11/01/2017
|
|
|
Second surgical opinion
|
Start 03/01/2018
|
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