Denial code M54

Remark code MA61 indicates a claim issue due to a missing, incomplete, or invalid social security number.

Remark code MA62 indicates a telephone review decision affecting claim payment or denial for healthcare providers.

Remark code MA63 indicates a claim denial due to a missing, incomplete, or invalid principal diagnosis.

Remark code MA64 indicates a claim's processing is on hold until primary and secondary payer details are provided to determine third payer responsibility.

Remark code MA65 indicates a claim issue due to a missing, incomplete, or invalid admitting diagnosis, requiring correction.

Remark code MA66 indicates a claim rejection due to a missing or incorrect principal procedure code.

Remark code MA67 indicates an adjustment made to correct a previous claim submission in the healthcare billing process.

Remark code MA68 indicates a claim wasn't crossed over due to incomplete secondary insurance info; providers must ensure data accuracy for proper routing.

Remark code MA69 indicates a claim issue due to missing, incomplete, or invalid remarks that require correction for processing.

Remark code MA70 indicates a claim issue due to a missing, incomplete, or invalid provider representative signature.

Remark code MA71 indicates a claim issue due to a missing or invalid provider signature date, requiring correction for processing.

Remark code MA72 indicates a patient overpayment for services; a refund must be issued within 30 days for the excess amount paid.

Remark code MA73 indicates a Medicare demo remittance; no fee-for-service payment due to the patient's managed care election.

Remark code MA74 indicates a replacement payment for a claim due to the original being lost, damaged, or returned.

Remark code MA75 indicates a claim issue due to a missing or invalid patient or representative signature.

Remark code MA76 indicates a claim issue due to an absent or incorrect provider ID for home health or hospice in care plan oversight.

Remark code MA77 indicates a patient overpayment. Providers must refund the excess within 30 days, as detailed in the payment notice.

Remark code MA79 indicates a billing error where charges exceed the set interim rate for services provided.

Remark code MA80 indicates no separate payment for a claim as it's covered under a hospital's demonstration project payment.

Remark code MA81 indicates a claim issue due to a missing, incomplete, or invalid provider signature.

Remark code MA83 is a notice that claims processing is pending due to missing primary or secondary payer details.

Remark code MA84 indicates a discrepancy with patient participation in the National Emphysema Treatment Trial; verification required with Johns Hopkins University.

Remark code MA88 indicates a claim issue due to missing or incorrect insured's address/phone for the primary payer.

Remark code MA89 indicates an issue with the patient's relationship to the insured for the primary payer, requiring correction.

Remark code MA90 indicates an issue with the primary insured's employment status code, such as it being missing, incomplete, or invalid.

Remark code MA91 indicates the decision made on an appeal you filed regarding a healthcare claim.

Remark code MA92 indicates a claim was denied due to missing plan details for secondary or tertiary insurance coverage.

Remark code MA93 indicates a non-PIP claim, meaning it's not subject to Periodic Interim Payment adjustments.

Remark code MA94 indicates a claim was denied because it lacked a statement certifying the attending physician is not a hospice employee.

Remark code MA96 indicates a claim was denied because it was filed for Medicare Managed Care without valid patient enrollment.

Remark code MA97 indicates a claim issue due to a missing or invalid Medicare contract or clinical trial number.

Remark code MA99 indicates that a claim has been denied due to missing, incomplete, or invalid Medigap information.

Remark code N1 is a notice that you can appeal the payment decision within set time limits by following the instructions provided.

Remark code N10 indicates an adjustment due to a review organization's findings or professional consultation during claims processing.

Remark code N103 indicates a patient was in custody when services were rendered, and the payer does not cover these costs unless the individual is liable by law.

Remark code N104 indicates a claim isn't payable in the jurisdiction area. Find the right Medicare contractor via the CMS website.

Remark code N105 indicates a claim was sent incorrectly for an RRB beneficiary and should be submitted to Palmetto GBA via the provided address or call for EDI details.

Remark code N106 indicates payment for SNF inpatient services is made to the SNF only, and providers should bill the SNF, not the patient.

Remark code N107 indicates that services to SNF inpatients must be included on the inpatient claim, not billed as outpatient services.

Remark code N108 indicates a claim issue due to missing, incomplete, or invalid upgrade information, requiring action for resolution.

Remark code N109 indicates a claim/service was selected for detailed verification during a complex review process.

Remark code N11 indicates a denial has been overturned following a medical review, ensuring accurate claim processing.

Remark code N110 indicates a claim denial because the facility lacks certification for film mammography services.

Remark code N111 indicates no appeal rights, except for duplicate claims/services, as the service was previously billed and adjudicated.

Remark code N112 indicates a claim is not part of your electronic remittance advice, requiring alternative processing.

Remark code N113 indicates coverage is limited to one initial visit per physician, group practice, or provider.

Remark code N114 indicates payment is based on the lesser of a blended rate or submitted charge for ambulance services during fee schedule transition.

Remark code N115 indicates a claim decision based on Local Coverage Determination (LCD), guiding item/service coverage.

Remark code N116 indicates conditional payment for services in a patient's home, subject to recoupment if under concurrent HHA care.

Remark code N117 indicates a service is reimbursable only once per patient's lifetime, impacting claim payments.

Remark code N118 indicates a service isn't covered if billed more than once every 28 days, alerting providers to billing frequency limits.

Remark code N119 indicates a service isn't covered if billed within 28 days of a patient's 5+ day stay in an inpatient or SNF.

Remark code N12 indicates coverage is supplemental to Medicare, and as the member isn't enrolled in Medicare, they must pay the portion Medicare would have covered.

Remark code N120 indicates a payment adjustment under the home health prospective payment system due to patient transfer or readmission.

Remark code N121 indicates Medicare Part B won't cover services by certain practitioners during a Medicare Part A SNF stay.

Remark code N122 indicates an add-on procedure code was billed without the primary service, which is required for valid billing.

Remark code N123 indicates a split service, signifying only part of the units from the original submission are billed.

Remark code N124 indicates a denial of payment for a service/item deemed not necessary based on provided information, with patient liability established by prior written consent.

Remark code N125 indicates a denial or reduced payment for a service/item due to insufficient information to justify the necessity. Refunds to patients are required within 30 days.

Remark code N126 indicates coverage denial for services to individuals deported, as per Social Security Records and payer policy.

Remark code N127 indicates a claim was incorrectly sent for a UMWA beneficiary and should be resubmitted to the correct payer.

Remark code N128 indicates the amount is from the pre-coverage allowance, not payable by the insurer.

Remark code N129 indicates a claim denial because the patient's age does not meet the eligibility requirements for coverage.

Remark code N13 indicates a payment adjustment based on the use of professional/technical component modifiers in billing.

Remark code N130 indicates a need to review plan documents or guidelines for service restrictions.

Remark code N131 indicates that payments from various contracts cannot surpass the allowed amount for the provided service.

Remark code N132 indicates that payments will stop after a 30-day grace period for services by a debarred or excluded provider.

Remark code N133 indicates separate processing for services needing predetermination and those requesting payment.

Remark code N134 alerts providers that payment is scheduled for a service. If treatment stopped, contact Customer Service for guidance.

Remark code N135 indicates that record fees fall under patient responsibility, up to the co-payment amount set by their insurance plan.

Remark code N136 indicates the need to contact Arizona's Consumer Assistance Office for appeal process information.

Remark code N137 indicates providers can appeal to the payer or file a complaint for urgent care coverage decisions without an initial appeal.

Remark code N138 indicates a dental advisor's opinion can be contested by submitting additional information and radiographs for a second review.

Remark code N139 indicates a non-participating provider cannot appeal unless appointed by the beneficiary in writing.

Remark code N140 alerts providers they're not authorized OCONUS providers and outlines appeal steps if appointed by a beneficiary.

Remark code N141 indicates that the claim was denied because the patient wasn't in long-term care for some or all service dates.

Remark code N142 indicates that the initial claim was denied. Providers should resubmit as a new claim, not as a correction or replacement.

Remark code N143 indicates that the claim was denied because the patient wasn't enrolled in hospice care for some or all service dates.

Remark code N144 indicates a change in billing rates within the service dates, affecting claim reimbursement.

Remark code N146 indicates a claim denial due to the absence of required screening documentation.

Remark code N147 indicates a long-term care payment issue due to a missing or incorrect patient ID on the assignment request.

Remark code N148 indicates a claim issue due to a missing or incorrect date of the last menstrual period.

Remark code N149 indicates that providers should consolidate and resubmit all relevant services together on one claim form.

Remark code N15 indicates that billing for newborn services should be done independently from other charges.

Remark code N150 indicates a claim denial due to a missing, incomplete, or invalid model number on the submitted documentation.

Remark code N151 indicates payment for telephone services is pending until face-to-face contact requirements are fulfilled.

Remark code N152 indicates a claim was denied due to missing, incomplete, or invalid information for a replacement claim.

Remark code N153 indicates an issue with the claim due to missing, incomplete, or invalid room and board rate details.

Remark code N154 indicates a delay in payment due to the need for correcting the provider's mailing address.

Remark code N155 alerts providers that records lack other insurance info, prompting submission for accurate billing.

Remark code N156 indicates the patient owes the balance between the insurance-approved amount and the elective treatment cost.

Remark code N157 indicates that transportation to or from the specified destination is not covered by the insurance plan.

Remark code N158 indicates that transportation by non-ambulance vehicles is not covered by the insurance plan.

Remark code N159 indicates payment denial or reduction due to non-covered mileage when the patient isn't in the ambulance.

Remark code N16 indicates the patient's out-of-pocket maximum is met, leading to a higher payment percentage for covered services.

Remark code N160 indicates that a patient's selection is required before payment for a specific healthcare service or supply can be processed.

Remark code N161 indicates coverage for a drug/service/supply is provided only if the related service is also covered.

Remark code N162 indicates a paid claim for a test not covered under current lab certification, warning of future denials if not corrected.

Remark code N163 indicates that the medical record lacks documentation to justify the billing code used, as per code definitions.

Remark code N167 indicates that the billed charges surpass the limit allowed for post-transplant care coverage.