Wednesday, September 24, 2014

New Physician Specialty Code for Interventional Cardiology


This MLN Matters® Article is intended for physicians, non-physician practitioners, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services to Medicare beneficiaries.

CR 8812, from which this article is taken, provides notice that the Centers for Medicare & Medicaid Services (CMS) is establishing a new physician specialty code for Interventional Cardiology. The CR is also changing the description of specialty code 62, and updating the names associated to specialty codes 88 and 95. Make sure your billing staffs are aware of these changes.

Physicians who enroll in the Medicare program self-designate their Medicare physician specialty on the Medicare enrollment application (CMS-855B) or via the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS). Non-physician practitioners who enroll with Medicare are assigned a Medicare specialty code. These Medicare physician/non-physician practitioner specialty codes describe the specific/unique types of medicine that physicians and non-physician practitioners (and certain other suppliers) practice. They become associated with the claims that physician or non-physician practitioners submit; and are used by CMS for programmatic and claims processing purposes.


CR 8812 establishes a new physician specialty code for Interventional Cardiology (C3). CR8812 is also removing the word “Clinical” from the description of specialty code 62 (Psychologist (Billing Independently)), and is changing the description of specialty code 88 to “Unknown Provider,” and of specialty code 95 to “Unknown Supplier”. The changes to the descriptions for codes 88 and 95 align their names with their intended usages.

Sunday, August 24, 2014

Date format in CMS 1500 forms

Required Data Element Requirements

1 - Paper Claims
The following instruction describes certain data element formatting requirements to be followed when reporting the calendar year date for the identified items on the F9+o203 rm CMS-1500:
/
• If birth dates are furnished in the items stipulated below, then these items must contain 8-digit birth dates (MMDDCCYY). This includes 2-digit months (MM) and days (DD), and 4-digit years (CCYY).
Form CMS-1500 Items Affected by These Reporting Requirements:

Item 3 - Patient’s Birth Date
Item 9b - Other Insured’s Date of Birth
Item 11a - Insured’s Date of Birth
Note that 8-digit birth dates, when provided, must be reported with a space between month, day, and year (i.e., MM_DD_CCYY). On the Form CMS-1500, the space between month, day, and year is delineated by a dotted, vertical line.

If a birth date is provided in items 3, 9b, or 11a, and is not in 8-digit format, carriers must return the claim as unprocessable. Use remark code N329 on the remittance advice. For formats other than the remittance, use code(s)/messages that are consistent with the above remark codes.

If carriers do not currently edit for birth date items because they obtain the information from other sources, they are not required to return these claims if a birth date is reported in items 3, 9b, or 11a. and the birth date is not in 8-digit format. However, if carriers use date of birth information on the incoming claim for processing, they must edit and return claims that contain birth date(s) in any of these items that are not in 8-digit format.

For certain other Form CMS-1500 conditional or required date items (items 11b, 14, 16, 18, 19, or 24A.), when dates are provided, either a 6-digit date or 8-digit date may be provided.

If 8-digit dates are furnished for any of items 11a., 14, 16, 18, 19, or 24A. (excluding items 12 and 31), carriers must note the following:
• All completed date items, except item 24A., must be reported with a space between month, day, and year (i.e., MM_DD_CCYY). On the Form CMS-1500, the space between month, day, and year is delineated by a dotted, vertical line;

• Item 24A. must be reported as one continuous number (i.e., MMDDCCYY), without any spaces between month, day, and year. By entering a continuous number, the date(s) in item 24A. will penetrate the dotted, vertical lines used to separate month, day, and year. Carrier claims processing systems will be able to process the claim if the date penetrates these vertical lines. However, all 8-digit dates reported must stay within the confines of item 24A;

• Do not compress or change the font of the “year” item in item 24A. to keep the date within the confines of item 24A. If a continuous number is furnished in item 24A. with no spaces between month, day, and year, you will not need to compress the “year” item to remain within the confines of item 24A.;

• The “from” date in item 24A. must not run into the “to” date item, and the “to” date must not run into item 24B.;

• Dates reported in item 24A. must not be reported with a slash between month, day, and year; and

• If the provider of service or supplier decides to enter 8-digit dates for any of items 11b, 14, 16, 18, 19, or 24A. (excluding items 12 and 31), an 8-digit date must be furnished for all completed items. For instance, you cannot enter 8-digit dates for items 11b, 14, 16, 18, 19 (excluding items 12 or 31), and a 6-digit date for item 24A. The same applies to those who wish to submit 6-digit dates for any of these items.

Wednesday, February 19, 2014

Sample new CMS 1500 CLAIM form

Now we can enter 12 DX in single claim.

See the below changes in the format of 21 BLOCK


Thursday, January 23, 2014

Box #21, ICD 10 entering on CMS 1500 new form

Item 21 - Enter the patient's diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), all physician and nonphysician specialties (i.e., PA, NP, CNS, CRNA) use diagnosis codes to the highest level of specificity for the date of service. Enter the diagnoses in priority order. All narrative diagnoses for nonphysician specialties shall be submitted on an attachment.

Reminder: Do not report ICD-10-CM codes for claims with dates of service prior to October 1, 2014, on either the old or revised version of the CMS-1500 claim form.

For form version 08/05, report a valid ICD-9-CM code. Enter up to four diagnosis codes.

For form version 02/12, it may be appropriate to report either ICD-9-CM or ICD-10-CM codes depending upon the dates of service (i.e., according to the effective dates of the given code set).

• The “ICD Indicator” identifies the ICD code set being reported. Enter the applicable ICD indicator according to the following:

 Indicator Code Set 
 9 ICD-9-CM diagnosis
0 ICD-10-CM diagnosis

Enter the indicator as a single digit between the vertical, dotted lines.

• Do not report both ICD-9-CM and ICD-10-CM codes on the same claim form. If there are services you wish to report that occurred on dates when ICD-9-CM codes were in effect, and others that occurred on dates when ICD-10-CM codes were in effect, then send separate claims such that you report only ICD-9-CM or only ICD-10-CM codes on the claim. (See special considerations for spans of dates below.)

• If you are submitting a claim with a span of dates for a service, use the “from” date to determine which ICD code set to use.

• Enter up to 12 diagnosis codes. Note that this information appears opposite lines with letters A-L. Relate lines A- L to the lines of service in 24E by the letter of the line. Use the highest level of specificity. Do not provide narrative description in this field.

• Do not insert a period in the ICD-9-CM or ICD-10-CM code.

Monday, January 20, 2014

EDI claim status code - Full list

Here is the full list of EDI claim status code. It may be a denial, rejection and Acknowledgement.


0

Cannot provide further status electronically.
Start: 01/01/1995
1 For more detailed information, see remittance advice.
Start: 01/01/1995
2 More detailed information in letter.
Start: 01/01/1995
3 Claim has been adjudicated and is awaiting payment cycle.
Start: 01/01/1995
6 Balance due from the subscriber.
Start: 01/01/1995
12 One or more originally submitted procedure codes have been combined.
Start: 01/01/1995 | Last Modified: 06/30/2001
15 One or more originally submitted procedure code have been modified.
Start: 01/01/1995 | Last Modified: 06/30/2001
16 Claim/encounter has been forwarded to entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
17 Claim/encounter has been forwarded by third party entity to entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
18 Entity received claim/encounter, but returned invalid status. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
19 Entity acknowledges receipt of claim/encounter. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
20 Accepted for processing.
Start: 01/01/1995 | Last Modified: 06/30/2001
21 Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information.
Start: 01/01/1995 | Last Modified: 07/09/2007
23 Returned to Entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
24 Entity not approved as an electronic submitter. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
25 Entity not approved. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
26 Entity not found. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
27 Policy canceled.
Start: 01/01/1995 | Last Modified: 06/30/2001
29 Subscriber and policy number/contract number mismatched.
Start: 01/01/1995
30 Subscriber and subscriber id mismatched.
Start: 01/01/1995
31 Subscriber and policyholder name mismatched.
Start: 01/01/1995
32 Subscriber and policy number/contract number not found.
Start: 01/01/1995
33 Subscriber and subscriber id not found.
Start: 01/01/1995
34 Subscriber and policyholder name not found.
Start: 01/01/1995
35 Claim/encounter not found.
Start: 01/01/1995
37 Predetermination is on file, awaiting completion of services.
Start: 01/01/1995
38 Awaiting next periodic adjudication cycle.
Start: 01/01/1995
39 Charges for pregnancy deferred until delivery.
Start: 01/01/1995
40 Waiting for final approval.
Start: 01/01/1995
41 Special handling required at payer site.
Start: 01/01/1995
42 Awaiting related charges.
Start: 01/01/1995
44 Charges pending provider audit.
Start: 01/01/1995
45 Awaiting benefit determination.
Start: 01/01/1995
46 Internal review/audit.
Start: 01/01/1995
47 Internal review/audit - partial payment made.
Start: 01/01/1995
49 Pending provider accreditation review.
Start: 01/01/1995
50 Claim waiting for internal provider verification.
Start: 01/01/1995
51 Investigating occupational illness/accident.
Start: 01/01/1995
52 Investigating existence of other insurance coverage.
Start: 01/01/1995
53 Claim being researched for Insured ID/Group Policy Number error.
Start: 01/01/1995
54 Duplicate of a previously processed claim/line.
Start: 01/01/1995
55 Claim assigned to an approver/analyst.
Start: 01/01/1995
56 Awaiting eligibility determination.
Start: 01/01/1995
57 Pending COBRA information requested.
Start: 01/01/1995
59 Information was requested by a non-electronic method. Note: At least one other status code is required to identify the requested information.
Start: 01/01/1995 | Last Modified: 10/17/2010
60 Information was requested by an electronic method. Note: At least one other status code is required to identify the requested information.
Start: 01/01/1995 | Last Modified: 10/17/2010
61 Eligibility for extended benefits.
Start: 01/01/1995
64 Re-pricing information.
Start: 01/01/1995
65 Claim/line has been paid.
Start: 01/01/1995
66 Payment reflects usual and customary charges.
Start: 01/01/1995
72 Claim contains split payment.
Start: 01/01/1995
73 Payment made to entity, assignment of benefits not on file. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
78 Duplicate of an existing claim/line, awaiting processing.
Start: 01/01/1995
81 Contract/plan does not cover pre-existing conditions.
Start: 01/01/1995
83 No coverage for newborns.
Start: 01/01/1995
84 Service not authorized.
Start: 01/01/1995
85 Entity not primary. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
86 Diagnosis and patient gender mismatch.
Start: 01/01/1995 | Last Modified: 02/28/2000
88 Entity not eligible for benefits for submitted dates of service. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
89 Entity not eligible for dental benefits for submitted dates of service. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
90 Entity not eligible for medical benefits for submitted dates of service. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
91 Entity not eligible/not approved for dates of service. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
92 Entity does not meet dependent or student qualification. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
93 Entity is not selected primary care provider. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
94 Entity not referred by selected primary care provider. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
95 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.
96 No agreement with entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
97 Patient eligibility not found with entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
98 Charges applied to deductible.
Start: 01/01/1995
99 Pre-treatment review.
Start: 01/01/1995
100 Pre-certification penalty taken.
Start: 01/01/1995
101 Claim was processed as adjustment to previous claim.
Start: 01/01/1995
102 Newborn's charges processed on mother's claim.
Start: 01/01/1995
103 Claim combined with other claim(s).
Start: 01/01/1995
104 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
105 Claim/line is capitated.
Start: 01/01/1995
106 This amount is not entity's responsibility. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
107 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
109 Entity not eligible. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
110 Claim requires pricing information.
Start: 01/01/1995
111 At the policyholder's request these claims cannot be submitted electronically.
Start: 01/01/1995
114 Claim/service should be processed by entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
116 Claim submitted to incorrect payer.
Start: 01/01/1995
117 Claim requires signature-on-file indicator.
Start: 01/01/1995
121 Service line number greater than maximum allowable for payer.
Start: 01/01/1995
123 Additional information requested from entity. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
124 Entity's name, address, phone and id number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
125 Entity's name. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
126 Entity's address. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
127 Entity's Communication Number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 06/06/2010
128 Entity's tax id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
129 Entity's Blue Cross provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
130 Entity's Blue Shield provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
131 Entity's Medicare provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
132 Entity's Medicaid provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
133 Entity's UPIN. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
134 Entity's CHAMPUS provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
135 Entity's commercial provider id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
136 Entity's health industry id number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
137 Entity's plan network id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
138 Entity's site id . Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
139 Entity's health maintenance provider id (HMO). Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
140 Entity's preferred provider organization id (PPO). Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
141 Entity's administrative services organization id (ASO). Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
142 Entity's license/certification number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
143 Entity's state license number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
144 Entity's specialty license number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
145 Entity's specialty/taxonomy code. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
146 Entity's anesthesia license number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
147 Entity's qualification degree/designation (e.g. RN,PhD,MD). Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
148 Entity's social security number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
149 Entity's employer id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
150 Entity's drug enforcement agency (DEA) number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
152 Pharmacy processor number.
Start: 01/01/1995
153 Entity's id number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
154 Relationship of surgeon & assistant surgeon.
Start: 01/01/1995
155 Entity's relationship to patient. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
156 Patient relationship to subscriber
Start: 01/01/1995
157 Entity's Gender. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
158 Entity's date of birth. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
159 Entity's date of death. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
160 Entity's marital status. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
161 Entity's employment status. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
162 Entity's health insurance claim number (HICN). Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
163 Entity's policy number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
164 Entity's contract/member number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
165 Entity's employer name, address and phone. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
166 Entity's employer name. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
167 Entity's employer address. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
168 Entity's employer phone number. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
170 Entity's employee id. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
171 Other insurance coverage information (health, liability, auto, etc.).
Start: 01/01/1995
172 Other employer name, address and telephone number.
Start: 01/01/1995
173 Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
174 Entity's student status. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
175 Entity's school name. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
176 Entity's school address. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
177 Transplant recipient's name, date of birth, gender, relationship to insured.
Start: 01/01/1995 | Last Modified: 02/28/2000
178 Submitted charges.
Start: 01/01/1995
179 Outside lab charges.
Start: 01/01/1995
180 Hospital s semi-private room rate.
Start: 01/01/1995
181 Hospital s room rate.
Start: 01/01/1995
182 Allowable/paid from other entities coverage NOTE: This code requires the use of an entity code.
Start: 01/01/1995 | Last Modified: 01/24/2010
183 Amount entity has paid. Note: This code requires use of an Entity Code.
Start: 01/01/1995 | Last Modified: 02/11/2010
184 Purchase price for the rented durable medical equipment.
Start: 01/01/1995
185 Rental price for durable medical equipment.
Start: 01/01/1995
186 Purchase and rental price of durable medical equipment.
Start: 01/01/1995
187 Date(s) of service.
Start: 01/01/1995
188 Statement from-through dates.
Start: 01/01/1995
189 Facility admission date
Start: 01/01/1995 | Last Modified: 10/31/2006
190 Facility discharge date
Start: 01/01/1995 | Last Modified: 10/31/2006
191 Date of Last Menstrual Period (LMP)
Start: 02/28/1997
192 Date of first service for current series/symptom/illness.
Start: 01/01/1995
193 First consultation/evaluation date.
Start: 02/28/1997
194 Confinement dates.
Start: 01/01/1995
195 Unable to work dates/Disability Dates.
Start: 01/01/1995 | Last Modified: 09/20/2009
196 Return to work dates.
Start: 01/01/1995
197 Effective coverage date(s).
Start: 01/01/1995
198 Medicare effective date.
Start: 01/01/1995
199 Date of conception and expected date of delivery.
Start: 01/01/1995
200 Date of equipment return.
Start: 01/01/1995
201 Date of dental appliance prior placement.
Start: 01/01/1995
202 Date of dental prior replacement/reason for replacement.
Start: 01/01/1995
203 Date of dental appliance placed.
Start: 01/01/1995
204 Date dental canal(s) opened and date service completed.
Start: 01/01/1995
205 Date(s) dental root canal therapy previously performed.
Start: 01/01/1995
206 Most recent date of curettage, root planing, or periodontal surgery.
Start: 01/01/1995
207 Dental impression and seating date.
Start: 01/01/1995
208 Most recent date pacemaker was implanted.
Start: 01/01/1995
209 Most recent pacemaker battery change date.
Start: 01/01/1995
210 Date of the last x-ray.
Start: 01/01/1995
211 Date(s) of dialysis training provided to patient.
Start: 01/01/1995
212 Date of last routine dialysis.
Start: 01/01/1995
213 Date of first routine dialysis.
Start: 01/01/1995
214 Original date of prescription/orders/referral.
Start: 02/28/1997
215 Date of tooth extraction/evolution.
Start: 01/01/1995
216 Drug information.
Start: 01/01/1995
217 Drug name, strength and dosage form.
Start: 01/01/1995
218 NDC number.
Start: 01/01/1995
219 Prescription number.
Start: 01/01/1995
222 Drug dispensing units and average wholesale price (AWP).
Start: 01/01/1995
223 Route of drug/myelogram administration.
Start: 01/01/1995
224 Anatomical location for joint injection.
Start: 01/01/1995
225 Anatomical location.
Start: 01/01/1995
226 Joint injection site.
Start: 01/01/1995
227 Hospital information.
Start: 01/01/1995
228 Type of bill for UB claim
Start: 01/01/1995 | Last Modified: 10/31/2006
229 Hospital admission source.
Start: 01/01/1995
230 Hospital admission hour.
Start: 01/01/1995
231 Hospital admission type.
Start: 01/01/1995
232 Admitting diagnosis.
Start: 01/01/1995
233 Hospital discharge hour.
Start: 01/01/1995
234 Patient discharge status.
Start: 01/01/1995
235 Units of blood furnished.
Start: 01/01/1995
236 Units of blood replaced.
Start: 01/01/1995
237 Units of deductible blood.
Start: 01/01/1995
238 Separate claim for mother/baby charges.
Start: 01/01/1995
239 Dental information.
Start: 01/01/1995
240 Tooth surface(s) involved.
Start: 01/01/1995
241 List of all missing teeth (upper and lower).
Start: 01/01/1995
242 Tooth numbers, surfaces, and/or quadrants involved.
Start: 01/01/1995
243 Months of dental treatment remaining.
Start: 01/01/1995
244 Tooth number or letter.
Start: 01/01/1995
245 Dental quadrant/arch.
Start: 01/01/1995
246 Total orthodontic service fee, initial appliance fee, monthly fee, length of service.
Start: 01/01/1995
247 Line information.
Start: 01/01/1995
249 Place of service.
Start: 01/01/1995
250 Type of service.
Start: 01/01/1995
251 Total anesthesia minutes.
Start: 01/01/1995
252 Entity's authorization/certification number. Note: This code requires the use of an Entity Code.
Start: 01/01/1995 | Last Modified: 01/30/2011
254 Principal diagnosis code.
Start: 01/01/1995 | Last Modified: 01/30/2011
255 Diagnosis code.
Start: 01/01/1995
256 DRG code(s).
Start: 01/01/1995
257 ADSM-III-R code for services rendered.
Start: 01/01/1995
258 Days/units for procedure/revenue code.
Start: 01/01/1995
259 Frequency of service.
Start: 01/01/1995
260 Length of medical necessity, including begin date.
Start: 02/28/1997
261 Obesity measurements.
Start: 01/01/1995
262 Type of surgery/service for which anesthesia was administered.
Start: 01/01/1995
263 Length of time for services rendered.
Start: 01/01/1995
264 Number of liters/minute & total hours/day for respiratory support.
Start: 01/01/1995
265 Number of lesions excised.
Start: 01/01/1995
266 Facility point of origin and destination - ambulance.
Start: 01/01/1995
267 Number of miles patient was transported.
Start: 01/01/1995
268 Location of durable medical equipment use.
Start: 01/01/1995
269 Length/size of laceration/tumor.
Start: 01/01/1995
270 Subluxation location.
Start: 01/01/1995
271 Number of spine segments.
Start: 01/01/1995
272 Oxygen contents for oxygen system rental.
Start: 01/01/1995
273 Weight.
Start: 01/01/1995
274 Height.
Start: 01/01/1995
275 Claim.
Start: 01/01/1995
276 UB04/HCFA-1450/1500 claim form
Start: 01/01/1995 | Last Modified: 10/31/2006
277 Paper claim.
Start: 01/01/1995
279 Claim/service must be itemized
Start: 01/01/1995 | Last Modified: 10/17/2010
281 Related confinement claim.
Start: 01/01/1995
282 Copy of prescription.
Start: 01/01/1995
283 Medicare entitlement information is required to determine primary coverage
Start: 01/01/1995 | Last Modified: 01/27/2008
284 Copy of Medicare ID card.
Start: 01/01/1995
286 Other payer's Explanation of Benefits/payment information.
Start: 01/01/1995
287 Medical necessity for service.
Start: 01/01/1995
288 Hospital late charges
Start: 01/01/1995 | Last Modified: 10/17/2010
290 Pre-existing information.
Start: 01/01/1995
291 Reason for termination of pregnancy.
Start: 01/01/1995
292 Purpose of family conference/therapy.
Start: 01/01/1995
293 Reason for physical therapy.
Start: 01/01/1995
294 Supporting documentation. Note: At least one other status code is required to identify the supporting documentation.
Start: 01/01/1995 | Last Modified: 10/17/2010
295 Attending physician report.
Start: 01/01/1995
296 Nurse's notes.
Start: 01/01/1995
297 Medical notes/report.
Start: 02/28/1997
298 Operative report.
Start: 01/01/1995
299 Emergency room notes/report.
Start: 01/01/1995
300 Lab/test report/notes/results.
Start: 02/28/1997
301 MRI report.
Start: 01/01/1995
305 Radiology/x-ray reports and/or interpretation
Start: 01/01/1995 | Last Modified: 01/30/2011
306 Detailed description of service.
Start: 01/01/1995
307 Narrative with pocket depth chart.
Start: 01/01/1995
308 Discharge summary.
Start: 01/01/1995
310 Progress notes for the six months prior to statement date.
Start: 01/01/1995
311 Pathology notes/report.
Start: 01/01/1995
312 Dental charting.
Start: 01/01/1995
313 Bridgework information.
Start: 01/01/1995
314 Dental records for this service.
Start: 01/01/1995
315 Past perio treatment history.
Start: 01/01/1995
316 Complete medical history.
Start: 01/01/1995
318 X-rays/radiology films
Start: 01/01/1995 | Last Modified: 10/17/2010
319 Pre/post-operative x-rays/photographs.
Start: 02/28/1997
320 Study models.
Start: 01/01/1995
322 Recent Full Mouth X-rays
Start: 01/01/1995 | Last Modified: 10/17/2010
323 Study models, x-rays, and/or narrative.
Start: 01/01/1995
324 Recent x-ray of treatment area and/or narrative.
Start: 01/01/1995
325 Recent fm x-rays and/or narrative.
Start: 01/01/1995
326 Copy of transplant acquisition invoice.
Start: 01/01/1995
327 Periodontal case type diagnosis and recent pocket depth chart with narrative.
Start: 01/01/1995
329 Exercise notes.
Start: 01/01/1995
330 Occupational notes.
Start: 01/01/1995
331 History and physical.
Start: 01/01/1995 | Last Modified: 08/01/2007
333 Patient release of information authorization.
Start: 01/01/1995
334 Oxygen certification.
Start: 01/01/1995
335 Durable medical equipment certification.
Start: 01/01/1995
336 Chiropractic certification.
Start: 01/01/1995
337 Ambulance certification/documentation.
Start: 01/01/1995
339 Enteral/parenteral certification.
Start: 01/01/1995
340 Pacemaker certification.
Start: 01/01/1995
341 Private duty nursing certification.
Start: 01/01/1995
342 Podiatric certification.
Start: 01/01/1995
343 Documentation that facility is state licensed and Medicare approved as a surgical facility.
Start: 01/01/1995
344 Documentation that provider of physical therapy is Medicare Part B approved.
Start: 01/01/1995
345 Treatment plan for service/diagnosis
Start: 01/01/1995
346 Proposed treatment plan for next 6 months.
Start: 01/01/1995
352 Duration of treatment plan.
Start: 01/01/1995
353 Orthodontics treatment plan.
Start: 01/01/1995
354 Treatment plan for replacement of remaining missing teeth.
Start: 01/01/1995
360 Benefits Assignment Certification Indicator
Start: 01/01/1995 | Last Modified: 10/17/2010
363 Possible Workers' Compensation
Start: 01/01/1995 | Last Modified: 10/17/2010
364 Is accident/illness/condition employment related?
Start: 01/01/1995
365 Is service the result of an accident?
Start: 01/01/1995
366 Is injury due to auto accident?
Start: 01/01/1995
374 Is prescribed lenses a result of cataract surgery?
Start: 01/01/1995
375 Was refraction performed?
Start: 01/01/1995
380 CRNA supervision/medical direction.
Start: 01/01/1995 | Last Modified: 10/17/2010
382 Did provider authorize generic or brand name dispensing?
Start: 01/01/1995
383 Nerve block use (surgery vs. pain management)
Start: 01/01/1995 | Last Modified: 10/17/2010
384 Is prosthesis/crown/inlay placement an initial placement or a replacement?
Start: 01/01/1995
385 Is appliance upper or lower arch & is appliance fixed or removable?
Start: 01/01/1995
386 Orthodontic Treatment/Purpose Indicator
Start: 01/01/1995 | Last Modified: 10/17/2010
387 Date patient last examined by entity. Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
388 Date post-operative care assumed
Start: 02/28/1997
389 Date post-operative care relinquished
Start: 02/28/1997
390 Date of most recent medical event necessitating service(s)
Start: 02/28/1997
391 Date(s) dialysis conducted
Start: 02/28/1997
394 Date(s) of most recent hospitalization related to service
Start: 02/28/1997
395 Date entity signed certification/recertification Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
396 Date home dialysis began
Start: 02/28/1997
397 Date of onset/exacerbation of illness/condition
Start: 02/28/1997
398 Visual field test results
Start: 02/28/1997
400 Claim is out of balance
Start: 02/28/1997
401 Source of payment is not valid
Start: 02/28/1997
402 Amount must be greater than zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 02/28/1997 | Last Modified: 09/20/2009
403 Entity referral notes/orders/prescription
Start: 02/28/1997
406 Brief medical history as related to service(s)
Start: 02/28/1997
407 Complications/mitigating circumstances
Start: 02/28/1997
408 Initial certification
Start: 02/28/1997
409 Medication logs/records (including medication therapy)
Start: 02/28/1997
414 Necessity for concurrent care (more than one physician treating the patient)
Start: 02/28/1997 | Last Modified: 10/17/2010
417 Prior testing, including result(s) and date(s) as related to service(s)
Start: 02/28/1997
419 Individual test(s) comprising the panel and the charges for each test
Start: 02/28/1997
420 Name, dosage and medical justification of contrast material used for radiology procedure
Start: 02/28/1997
428 Reason for transport by ambulance
Start: 02/28/1997
430 Nearest appropriate facility
Start: 02/28/1997
431 Patient's condition/functional status at time of service.
Start: 02/28/1997 | Last Modified: 10/17/2010
432 Date benefits exhausted
Start: 02/28/1997
433 Copy of patient revocation of hospice benefits
Start: 02/28/1997
434 Reasons for more than one transfer per entitlement period
Start: 02/28/1997
435 Notice of Admission
Start: 02/28/1997
441 Entity professional qualification for service(s)
Start: 02/28/1997
442 Modalities of service
Start: 02/28/1997
443 Initial evaluation report
Start: 02/28/1997
449 Projected date to discontinue service(s)
Start: 02/28/1997
450 Awaiting spend down determination
Start: 02/28/1997
451 Preoperative and post-operative diagnosis
Start: 02/28/1997
452 Total visits in total number of hours/day and total number of hours/week
Start: 02/28/1997
453 Procedure Code Modifier(s) for Service(s) Rendered
Start: 02/28/1997
454 Procedure code for services rendered.
Start: 02/28/1997
455 Revenue code for services rendered.
Start: 02/28/1997
456 Covered Day(s)
Start: 02/28/1997
457 Non-Covered Day(s)
Start: 02/28/1997
458 Coinsurance Day(s)
Start: 02/28/1997
459 Lifetime Reserve Day(s)
Start: 02/28/1997
460 NUBC Condition Code(s)
Start: 02/28/1997
464 Payer Assigned Claim Control Number
Start: 02/28/1997 | Last Modified: 10/31/2004
465 Principal Procedure Code for Service(s) Rendered
Start: 02/28/1997
466 Entity's Original Signature. Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 01/30/2011
467 Entity Signature Date. Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
468 Patient Signature Source
Start: 02/28/1997
469 Purchase Service Charge
Start: 02/28/1997
470 Was service purchased from another entity? Note: This code requires use of an Entity Code.
Start: 02/28/1997 | Last Modified: 02/11/2010
471 Were services related to an emergency?
Start: 02/28/1997
472 Ambulance Run Sheet
Start: 02/28/1997
473 Missing or invalid lab indicator
Start: 06/30/1998
474 Procedure code and patient gender mismatch
Start: 06/30/1998 | Last Modified: 02/29/2000
475 Procedure code not valid for patient age
Start: 06/30/1998 | Last Modified: 02/29/2000
476 Missing or invalid units of service
Start: 06/30/1998
477 Diagnosis code pointer is missing or invalid
Start: 06/30/1998
478 Claim submitter's identifier
Start: 06/30/1998 | Last Modified: 01/24/2010
479 Other Carrier payer ID is missing or invalid
Start: 06/30/1998
480 Entity's claim filing indicator. Note: This code requires use of an Entity Code.
Start: 06/30/1998 | Last Modified: 06/06/2010
481 Claim/submission format is invalid.
Start: 10/31/1998
483 Maximum coverage amount met or exceeded for benefit period.
Start: 06/30/1999
484 Business Application Currently Not Available
Start: 02/29/2000
485 More information available than can be returned in real time mode. Narrow your current search criteria.
Start: 02/28/2001
486 Principal Procedure Date
Start: 10/31/2001 | Last Modified: 07/01/2009
487 Claim not found, claim should have been submitted to/through 'entity'. Note: This code requires use of an Entity Code.
Start: 02/28/2002 | Last Modified: 02/11/2010
488 Diagnosis code(s) for the services rendered.
Start: 06/30/2002
489 Attachment Control Number
Start: 10/31/2002
490 Other Procedure Code for Service(s) Rendered
Start: 02/28/2003
491 Entity not eligible for encounter submission. Note: This code requires use of an Entity Code.
Start: 02/28/2003 | Last Modified: 02/11/2010
492 Other Procedure Date
Start: 02/28/2003
493 Version/Release/Industry ID code not currently supported by information holder
Start: 02/28/2003
494 Real-Time requests not supported by the information holder, resubmit as batch request
Start: 02/28/2003
495 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
496 Submitter not approved for electronic claim submissions on behalf of this entity. Note: This code requires use of an Entity Code.
Start: 02/29/2004 | Last Modified: 02/11/2010
497 Sales tax not paid
Start: 06/30/2004
498 Maximum leave days exhausted
Start: 06/30/2004
499 No rate on file with the payer for this service for this entity Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
500 Entity's Postal/Zip Code. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
501 Entity's State/Province. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
502 Entity's City. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
503 Entity's Street Address. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
504 Entity's Last Name. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
505 Entity's First Name. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
506 Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse. Note: This code requires use of an Entity Code.
Start: 06/30/2004 | Last Modified: 02/11/2010
507 HCPCS
Start: 10/31/2004
508 ICD9 NOTE: At least one other status code is required to identify the related procedure code or diagnosis code.
Start: 10/31/2004 | Last Modified: 07/01/2009
509 External Cause of Injury Code (E-code).
Start: 10/31/2004 | Last Modified: 01/30/2011
510 Future date. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
511 Invalid character. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
512 Length invalid for receiver's application system. Note: At least one other status code is required to identify the data element in error.
Start: 10/31/2004 | Last Modified: 09/20/2009
513 HIPPS Rate Code for services Rendered
Start: 10/31/2004
514 Entity's Middle Name Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 01/30/2011
515 Managed Care review
Start: 10/31/2004
516 Other Entity's Adjudication or Payment/Remittance Date. Note: An Entity code is required to identify the Other Payer Entity, i.e. primary, secondary.
Start: 10/31/2004 | Last Modified: 11/29/2009
517 Adjusted Repriced Claim Reference Number
Start: 10/31/2004
518 Adjusted Repriced Line item Reference Number
Start: 10/31/2004
519 Adjustment Amount
Start: 10/31/2004
520 Adjustment Quantity
Start: 10/31/2004
521 Adjustment Reason Code
Start: 10/31/2004
522 Anesthesia Modifying Units
Start: 10/31/2004
523 Anesthesia Unit Count
Start: 10/31/2004
524 Arterial Blood Gas Quantity
Start: 10/31/2004
525 Begin Therapy Date
Start: 10/31/2004
526 Bundled or Unbundled Line Number
Start: 10/31/2004
527 Certification Condition Indicator
Start: 10/31/2004
528 Certification Period Projected Visit Count
Start: 10/31/2004
529 Certification Revision Date
Start: 10/31/2004
530 Claim Adjustment Indicator
Start: 10/31/2004
531 Claim Disproportinate Share Amount
Start: 10/31/2004
532 Claim DRG Amount
Start: 10/31/2004
533 Claim DRG Outlier Amount
Start: 10/31/2004
534 Claim ESRD Payment Amount
Start: 10/31/2004
535 Claim Frequency Code
Start: 10/31/2004
536 Claim Indirect Teaching Amount
Start: 10/31/2004
537 Claim MSP Pass-through Amount
Start: 10/31/2004
538 Claim or Encounter Identifier
Start: 10/31/2004
539 Claim PPS Capital Amount
Start: 10/31/2004
540 Claim PPS Capital Outlier Amount
Start: 10/31/2004
541 Claim Submission Reason Code
Start: 10/31/2004
542 Claim Total Denied Charge Amount
Start: 10/31/2004
543 Clearinghouse or Value Added Network Trace
Start: 10/31/2004
544 Clinical Laboratory Improvement Amendment
Start: 10/31/2004
545 Contract Amount
Start: 10/31/2004
546 Contract Code
Start: 10/31/2004
547 Contract Percentage
Start: 10/31/2004
548 Contract Type Code
Start: 10/31/2004
549 Contract Version Identifier
Start: 10/31/2004
550 Coordination of Benefits Code
Start: 10/31/2004
551 Coordination of Benefits Total Submitted Charge
Start: 10/31/2004
552 Cost Report Day Count
Start: 10/31/2004
553 Covered Amount
Start: 10/31/2004
554 Date Claim Paid
Start: 10/31/2004
555 Delay Reason Code
Start: 10/31/2004
556 Demonstration Project Identifier
Start: 10/31/2004
557 Diagnosis Date
Start: 10/31/2004
558 Discount Amount
Start: 10/31/2004
559 Document Control Identifier
Start: 10/31/2004
560 Entity's Additional/Secondary Identifier. Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
561 Entity's Contact Name. Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
562 Entity's National Provider Identifier (NPI). Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
563 Entity's Tax Amount. Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
564 EPSDT Indicator
Start: 10/31/2004
565 Estimated Claim Due Amount
Start: 10/31/2004
566 Exception Code
Start: 10/31/2004
567 Facility Code Qualifier
Start: 10/31/2004
568 Family Planning Indicator
Start: 10/31/2004
569 Fixed Format Information
Start: 10/31/2004
571 Frequency Count
Start: 10/31/2004
572 Frequency Period
Start: 10/31/2004
573 Functional Limitation Code
Start: 10/31/2004
574 HCPCS Payable Amount Home Health
Start: 10/31/2004
575 Homebound Indicator
Start: 10/31/2004
576 Immunization Batch Number
Start: 10/31/2004
577 Industry Code
Start: 10/31/2004
578 Insurance Type Code
Start: 10/31/2004
579 Investigational Device Exemption Identifier
Start: 10/31/2004
580 Last Certification Date
Start: 10/31/2004
581 Last Worked Date
Start: 10/31/2004
582 Lifetime Psychiatric Days Count
Start: 10/31/2004
583 Line Item Charge Amount
Start: 10/31/2004
584 Line Item Control Number
Start: 10/31/2004
585 Denied Charge or Non-covered Charge
Start: 10/31/2004 | Last Modified: 07/09/2007
586 Line Note Text
Start: 10/31/2004
587 Measurement Reference Identification Code
Start: 10/31/2004
588 Medical Record Number
Start: 10/31/2004
589 Provider Accept Assignment Code
Start: 10/31/2004 | Last Modified: 10/17/2010
590 Medicare Coverage Indicator
Start: 10/31/2004
591 Medicare Paid at 100% Amount
Start: 10/31/2004
592 Medicare Paid at 80% Amount
Start: 10/31/2004
593 Medicare Section 4081 Indicator
Start: 10/31/2004
594 Mental Status Code
Start: 10/31/2004
595 Monthly Treatment Count
Start: 10/31/2004
596 Non-covered Charge Amount
Start: 10/31/2004
597 Non-payable Professional Component Amount
Start: 10/31/2004
598 Non-payable Professional Component Billed Amount
Start: 10/31/2004
599 Note Reference Code
Start: 10/31/2004
600 Oxygen Saturation Qty
Start: 10/31/2004
601 Oxygen Test Condition Code
Start: 10/31/2004
602 Oxygen Test Date
Start: 10/31/2004
603 Old Capital Amount
Start: 10/31/2004
604 Originator Application Transaction Identifier
Start: 10/31/2004
605 Orthodontic Treatment Months Count
Start: 10/31/2004
606 Paid From Part A Medicare Trust Fund Amount
Start: 10/31/2004
607 Paid From Part B Medicare Trust Fund Amount
Start: 10/31/2004
608 Paid Service Unit Count
Start: 10/31/2004
609 Participation Agreement
Start: 10/31/2004
610 Patient Discharge Facility Type Code
Start: 10/31/2004
611 Peer Review Authorization Number
Start: 10/31/2004
612 Per Day Limit Amount
Start: 10/31/2004
613 Physician Contact Date
Start: 10/31/2004
614 Physician Order Date
Start: 10/31/2004
615 Policy Compliance Code
Start: 10/31/2004
616 Policy Name
Start: 10/31/2004
617 Postage Claimed Amount
Start: 10/31/2004
618 PPS-Capital DSH DRG Amount
Start: 10/31/2004
619 PPS-Capital Exception Amount
Start: 10/31/2004
620 PPS-Capital FSP DRG Amount
Start: 10/31/2004
621 PPS-Capital HSP DRG Amount
Start: 10/31/2004
622 PPS-Capital IME Amount
Start: 10/31/2004
623 PPS-Operating Federal Specific DRG Amount
Start: 10/31/2004
624 PPS-Operating Hospital Specific DRG Amount
Start: 10/31/2004
625 Predetermination of Benefits Identifier
Start: 10/31/2004
626 Pregnancy Indicator
Start: 10/31/2004
627 Pre-Tax Claim Amount
Start: 10/31/2004
628 Pricing Methodology
Start: 10/31/2004
629 Property Casualty Claim Number
Start: 10/31/2004
630 Referring CLIA Number
Start: 10/31/2004
631 Reimbursement Rate
Start: 10/31/2004
632 Reject Reason Code
Start: 10/31/2004
633 Related Causes Code (Accident, auto accident, employment)
Start: 10/31/2004 | Last Modified: 10/17/2010
634 Remark Code
Start: 10/31/2004
635 Repriced Ambulatory Patient Group Code
Start: 10/31/2004
636 Repriced Line Item Reference Number
Start: 10/31/2004
637 Repriced Saving Amount
Start: 10/31/2004
638 Repricing Per Diem or Flat Rate Amount
Start: 10/31/2004
639 Responsibility Amount
Start: 10/31/2004
640 Sales Tax Amount
Start: 10/31/2004
642 Service Authorization Exception Code
Start: 10/31/2004
643 Service Line Paid Amount
Start: 10/31/2004
644 Service Line Rate
Start: 10/31/2004
645 Service Tax Amount
Start: 10/31/2004
646 Ship, Delivery or Calendar Pattern Code
Start: 10/31/2004
647 Shipped Date
Start: 10/31/2004
648 Similar Illness or Symptom Date
Start: 10/31/2004
649 Skilled Nursing Facility Indicator
Start: 10/31/2004
650 Special Program Indicator
Start: 10/31/2004
651 State Industrial Accident Provider Number
Start: 10/31/2004
652 Terms Discount Percentage
Start: 10/31/2004
653 Test Performed Date
Start: 10/31/2004
654 Total Denied Charge Amount
Start: 10/31/2004
655 Total Medicare Paid Amount
Start: 10/31/2004
656 Total Visits Projected This Certification Count
Start: 10/31/2004
657 Total Visits Rendered Count
Start: 10/31/2004
658 Treatment Code
Start: 10/31/2004
659 Unit or Basis for Measurement Code
Start: 10/31/2004
660 Universal Product Number
Start: 10/31/2004
661 Visits Prior to Recertification Date Count CR702
Start: 10/31/2004
662 X-ray Availability Indicator
Start: 10/31/2004
663 Entity's Group Name. Note: This code requires use of an Entity Code.
Start: 10/31/2004 | Last Modified: 02/11/2010
664 Orthodontic Banding Date
Start: 10/31/2004
665 Surgery Date
Start: 10/31/2004
666 Surgical Procedure Code
Start: 10/31/2004
667 Real-Time requests not supported by the information holder, do not resubmit
Start: 02/28/2005
668 Missing Endodontics treatment history and prognosis
Start: 06/30/2005
669 Dental service narrative needed.
Start: 10/31/2005
670 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
671 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
672 Other Payer's payment information is out of balance
Start: 10/31/2006
673 Patient Reason for Visit
Start: 10/31/2006
674 Authorization exceeded
Start: 10/31/2006
675 Facility admission through discharge dates
Start: 10/31/2006
676 Entity possibly compensated by facility. Note: This code requires use of an Entity Code.
Start: 10/31/2006 | Last Modified: 02/11/2010
677 Entity not affiliated. Note: This code requires use of an Entity Code.
Start: 10/31/2006 | Last Modified: 02/11/2010
678 Revenue code and patient gender mismatch
Start: 10/31/2006
679 Submit newborn services on mother's claim
Start: 10/31/2006
680 Entity's Country. Note: This code requires use of an Entity Code.
Start: 10/31/2006 | Last Modified: 02/11/2010
681 Claim currency not supported
Start: 10/31/2006
682 Cosmetic procedure
Start: 02/28/2007
683 Awaiting Associated Hospital Claims
Start: 02/28/2007
684 Rejected. Syntax error noted for this claim/service/inquiry. See Functional or Implementation Acknowledgement for details. (Note: 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
685 Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit.
Start: 01/27/2008
686 The claim/ encounter has completed the adjudication cycle and the entire claim has been voided
Start: 01/27/2008
687 Claim estimation can not be completed in real time. Do not resubmit.
Start: 01/27/2008
688 Present on Admission Indicator for reported diagnosis code(s).
Start: 01/27/2008
689 Entity was unable to respond within the expected time frame. Note: This code requires use of an Entity Code.
Start: 06/01/2008 | Last Modified: 02/11/2010
690 Multiple claims or estimate requests cannot be processed in real time.
Start: 06/01/2008
691 Multiple claim status requests cannot be processed in real time.
Start: 06/01/2008
692 Contracted funding agreement-Subscriber is employed by the provider of services
Start: 09/21/2008
693 Amount must be greater than or equal to zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 01/25/2009
694 Amount must not be equal to zero. Note: At least one other status code is required to identify which amount element is in error.
Start: 01/25/2009
695 Entity's Country Subdivision Code. Note: This code requires use of an Entity Code.
Start: 01/25/2009 | Last Modified: 02/11/2010
696 Claim Adjustment Group Code.
Start: 01/25/2009
697 Invalid Decimal Precision. Note: At least one other status code is required to identify the data element in error.
Start: 07/01/2009
698 Form Type Identification
Start: 07/01/2009
699 Question/Response from Supporting Documentation Form
Start: 07/01/2009
700 ICD10. Note: At least one other status code is required to identify the related procedure code or diagnosis code.
Start: 07/01/2009
701 Initial Treatment Date
Start: 07/01/2009
702 Repriced Claim Reference Number
Start: 11/01/2009
703 Advanced Billing Concepts (ABC) code
Start: 01/24/2010
704 Claim Note Text
Start: 01/24/2010
705 Repriced Allowed Amount
Start: 01/24/2010
706 Repriced Approved Amount
Start: 01/24/2010
707 Repriced Approved Ambulatory Patient Group Amount
Start: 01/24/2010
708 Repriced Approved Revenue Code
Start: 01/24/2010
709 Repriced Approved Service Unit Count
Start: 01/24/2010
710 Line Adjudication Information. Note: At least one other status code is required to identify the data element in error.
Start: 01/24/2010
711 Stretcher purpose
Start: 01/24/2010
712 Obstetric Additional Units
Start: 01/24/2010
713 Patient Condition Description
Start: 01/24/2010
714 Care Plan Oversight Number
Start: 01/24/2010
715 Acute Manifestation Date
Start: 01/24/2010
716 Repriced Approved DRG Code
Start: 01/24/2010
717 This claim has been split for processing.
Start: 01/24/2010
718 Claim/service not submitted within the required timeframe (timely filing).
Start: 01/24/2010
719 NUBC Occurrence Code(s)
Start: 01/24/2010
720 NUBC Occurrence Code Date(s)
Start: 01/24/2010
721 NUBC Occurrence Span Code(s)
Start: 01/24/2010
722 NUBC Occurrence Span Code Date(s)
Start: 01/24/2010
723 Drug days supply
Start: 01/24/2010
724 Drug dosage
Start: 01/24/2010
725 NUBC Value Code(s)
Start: 01/24/2010
726 NUBC Value Code Amount(s)
Start: 01/24/2010
727 Accident date
Start: 01/24/2010
728 Accident state
Start: 01/24/2010
729 Accident description
Start: 01/24/2010
730 Accident cause
Start: 01/24/2010
731 Measurement value/test result
Start: 01/24/2010
732 Information submitted inconsistent with billing guidelines. Note: At least one other status code is required to identify the inconsistent information.
Start: 01/24/2010
733 Prefix for entity's contract/member number.
Start: 01/24/2010
734 Verifying premium payment
Start: 06/06/2010
735 This service/claim is included in the allowance for another service or claim.
Start: 06/06/2010
736 A related or qualifying service/claim has not been received/adjudicated.
Start: 06/06/2010
737 Current Dental Terminology (CDT) Code
Start: 06/06/2010
738 Home Infusion EDI Coalition (HEIC) Product/Service Code
Start: 06/06/2010
739 Jurisdiction Specific Procedure or Supply Code
Start: 06/06/2010
740 Drop-Off Location
Start: 06/06/2010
741 Entity must be a person. Note: This code requires use of an Entity Code.
Start: 06/06/2010
742 Payer Responsibility Sequence Number Code
Start: 06/06/2010
743 Entity’s credential/enrollment information. Note: This code requires use of an Entity Code.
Start: 10/17/2010
744 Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.
Start: 10/17/2010
745 Identifier Qualifier Note: At least one other status code is required to identify the specific identifier qualifier in error.
Start: 10/17/2010
746 Duplicate Submission Note: use only at the information receiver level in the Health Care Claim Acknowledgement transaction.
Start: 10/17/2010
747 Hospice Employee Indicator
Start: 10/17/2010
748 Corrected Data Note: Requires a second status code to identify the corrected data.
Start: 10/17/2010
749 Date of Injury/Illness
Start: 10/17/2010
750 Auto Accident State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
751 Ambulance Pick-up State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
752 Ambulance Drop-off State or Province Code
Start: 10/17/2010 | Last Modified: 01/30/2011
753 Co-pay status code.
Start: 01/30/2011
754 Entity Name Suffix. Note: This code requires the use of an Entity Code.
Start: 01/30/2011
755 Entity's primary identifier. Note: This code requires the use of an Entity Code.
Start: 01/30/2011
756 Entity's Received Date. Note: This code requires the use of an Entity Code.
Start: 01/30/2011
757 Last seen date.
Start: 01/30/2011
758 Repriced approved HCPCS code.
Start: 01/30/2011
759 Round trip purpose description.
Start: 01/30/2011
760 Tooth status code.
Start: 01/30/2011
761 Entity's referral number. Note: This code requires the use of an Entity Code.
Start: 01/30/2011
762 Locum Tenens Provider Identifier. Code must be used with Entity Code 82 - Rendering Provider
Start: 01/20/2013
763 Ambulance Pickup ZipCode
Start: 01/20/2013
764 Professional charges are non covered.
Start: 06/02/2013
765 Institutional charges are non covered.
Start: 06/02/2013
766 Services were performed during a Health Insurance Exchange (HIX) premium payment grace period.
Start: 11/01/2013
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