Remark Code list or Remittance Advice Code list N1 Series

Remittance Advice Code N1 series

N1 Alert: You may appeal this decision in writing within the required time limits following receipt of this notice by following the instructions included in your contract, plan benefit documents or jurisdiction statutes. Refer to the URL provided in the ERA for the payer website to access the appeals process guidelines.
Start: 01/01/2000 | Last Modified: 07/01/2018
Notes: (Modified 2/28/03, 4/1/07, 7/15/13, 7/1/18)
N2 This allowance has been made in accordance with the most appropriate course of treatment provision of the plan.
Start: 01/01/2000
N3 Missing consent form.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03) Related to N228
N4 Missing/Incomplete/Invalid prior Insurance Carrier(s) EOB.
Start: 01/01/2000 | Last Modified: 03/06/2012
Notes: (Modified 2/28/03, 3/6/2012)
N5 EOB received from previous payer. Claim not on file.
Start: 01/01/2000
N6 Under FEHB law (U.S.C. 8904(b)), we cannot pay more for covered care than the amount Medicare would have allowed if the patient were enrolled in Medicare Part A and/or Medicare Part B.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N7 Alert: Processing of this claim/service has included consideration under Major Medical provisions.
Start: 01/01/2000 | Last Modified: 07/15/2013
Notes: (Modified 7/15/13)
N8 Crossover claim denied by previous payer and complete claim data not forwarded. Resubmit this claim to this payer to provide adequate data for adjudication.
Start: 01/01/2000
N9 Adjustment represents the estimated amount a previous payer may pay.
Start: 01/01/2000 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)
N10 Adjustment based on the findings of a review organization/professional consult/manual adjudication/medical advisor/dental advisor/peer review.
Start: 01/01/2000 | Last Modified: 03/01/2015
Notes: (Modified 10/31/02, 7/1/08, 7/15/13, 3/1/2015)
N11 Denial reversed because of medical review.
Start: 01/01/2000
N12 Policy provides coverage supplemental to Medicare. As the member does not appear to be enrolled in the applicable part of Medicare, the member is responsible for payment of the portion of the charge that would have been covered by Medicare.
Start: 01/01/2000 | Last Modified: 08/01/2007
Notes: (Modified 8/1/07)
N13 Payment based on professional/technical component modifier(s).
Start: 01/01/2000
N14 Payment based on a contractual amount or agreement, fee schedule, or maximum allowable amount.
Start: 01/01/2000 | Stop: 10/01/2007
Notes: Consider using Reason Code 45
N15 Services for a newborn must be billed separately.
Start: 01/01/2000
N16 Family/member Out-of-Pocket maximum has been met. Payment based on a higher percentage.
Start: 01/01/2000
N17 Per admission deductible.
Start: 01/01/2000 | Stop: 08/01/2004
Notes: Consider using Reason Code 1
N18 Payment based on the Medicare allowed amount.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using N14
N19 Procedure code incidental to primary procedure.
Start: 01/01/2000
N20 Service not payable with other service rendered on the same date.
Start: 01/01/2000
N21 Alert: Your line item has been separated into multiple lines to expedite handling.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 8/1/05, 4/1/07)
N22 Alert: This procedure code was added/changed because it more accurately describes the services rendered.
Start: 01/01/2000 | Last Modified: 07/01/2015
Notes: (Modified 10/31/02, 2/28/03, 7/1/15)
N23 Alert: Patient liability may be affected due to coordination of benefits with other carriers and/or maximum benefit provisions.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 8/13/01, 4/1/07)
N24 Missing/incomplete/invalid Electronic Funds Transfer (EFT) banking information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N25 This company has been contracted by your benefit plan to provide administrative claims payment services only. This company does not assume financial risk or obligation with respect to claims processed on behalf of your benefit plan.
Start: 01/01/2000
N26 Missing itemized bill/statement.
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 2/28/03, 7/1/2008) Related to N232
N27 Missing/incomplete/invalid treatment number.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N28 Consent form requirements not fulfilled.
Start: 01/01/2000
N29 Missing documentation/orders/notes/summary/report/chart.
Start: 01/01/2000 | Stop: 03/01/2016 | Last Modified: 03/01/2014
Notes: (Modified 2/28/03, 8/1/05, 3/1/2014) Related to N225, Explicit RARCs have been approved, this non-specific RARC will be deactivated in March 2016.
N30 Patient ineligible for this service.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N31 Missing/incomplete/invalid prescribing provider identifier.
Start: 01/01/2000 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
N32 Claim must be submitted by the provider who rendered the service.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N33 No record of health check prior to initiation of treatment.
Start: 01/01/2000
N34 Incorrect claim form/format for this service.
Start: 01/01/2000 | Last Modified: 11/18/2005
Notes: (Modified 11/18/05)
N35 Program integrity/utilization review decision.
Start: 01/01/2000
N36 Claim must meet primary payer’s processing requirements before we can consider payment.
Start: 01/01/2000
N37 Missing/incomplete/invalid tooth number/letter.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N38 Missing/incomplete/invalid place of service.
Start: 01/01/2000 | Stop: 02/05/2005
Notes: Consider using M77
N39 Procedure code is not compatible with tooth number/letter.
Start: 01/01/2000
N40 Missing radiology film(s)/image(s).
Start: 01/01/2000 | Last Modified: 07/01/2008
Notes: (Modified 2/1/04, 7/1/08) Related to N242
N41 Authorization request denied.
Start: 01/01/2000 | Stop: 10/16/2003
Notes: Consider using Reason Code 39
N42 Missing mental health assessment.
Start: 01/01/2000 | Last Modified: 11/01/2014
N43 Bed hold or leave days exceeded.
Start: 01/01/2000
N44 Payer’s share of regulatory surcharges, assessments, allowances or health care-related taxes paid directly to the regulatory authority.
Start: 01/01/2000 | Stop: 10/16/2003
Notes: Consider using Reason Code 137
N45 Payment based on authorized amount.
Start: 01/01/2000
N46 Missing/incomplete/invalid admission hour.
Start: 01/01/2000
N47 Claim conflicts with another inpatient stay.
Start: 01/01/2000
N48 Claim information does not agree with information received from other insurance carrier.
Start: 01/01/2000
N49 Court ordered coverage information needs validation.
Start: 01/01/2000
N50 Missing/incomplete/invalid discharge information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N51 Electronic interchange agreement not on file for provider/submitter.
Start: 01/01/2000
N52 Patient not enrolled in the billing provider's managed care plan on the date of service.
Start: 01/01/2000
N53 Missing/incomplete/invalid point of pick-up address.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N54 Claim information is inconsistent with pre-certified/authorized services.
Start: 01/01/2000
N55 Procedures for billing with group/referring/performing providers were not followed.
Start: 01/01/2000
N56 Procedure code billed is not correct/valid for the services billed or the date of service billed.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N57 Missing/incomplete/invalid prescribing date.
Start: 01/01/2000 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N304
N58 Missing/incomplete/invalid patient liability amount.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N59 Alert: Please refer to your provider manual for additional program and provider information.
Start: 01/01/2000 | Last Modified: 11/01/2015
Notes: (Modified 4/1/07, 11/1/09, 11/1/2015)
N60 A valid NDC is required for payment of drug claims effective October 02.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using M119
N61 Rebill services on separate claims.
Start: 01/01/2000
N62 Dates of service span multiple rate periods. Resubmit separate claims.
Start: 01/01/2000 | Last Modified: 03/08/2011
Notes: (Modified 3/8/11)
N63 Rebill services on separate claim lines.
Start: 01/01/2000
N64 The “from” and “to” dates must be different.
Start: 01/01/2000
N65 Procedure code or procedure rate count cannot be determined, or was not on file, for the date of service/provider.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N66 Missing/incomplete/invalid documentation.
Start: 01/01/2000 | Stop: 02/05/2005
Notes: Consider using N29 or N225.
N67 Professional provider services not paid separately. Included in facility payment under a demonstration project. Apply to that facility for payment, or resubmit your claim if: the facility notifies you the patient was excluded from this demonstration; or if you furnished these services in another location on the date of the patient’s admission or discharge from a demonstration hospital. If services were furnished in a facility not involved in the demonstration on the same date the patient was discharged from or admitted to a demonstration facility, you must report the provider ID number for the non-demonstration facility on the new claim.
Start: 01/01/2000
N68 Prior payment being cancelled as we were subsequently notified this patient was covered by a demonstration project in this site of service. Professional services were included in the payment made to the facility. You must contact the facility for your payment. Prior payment made to you by the patient or another insurer for this claim must be refunded to the payer within 30 days.
Start: 01/01/2000
N69 Alert: PPS (Prospective Payment System) code changed by claims processing system.
Start: 01/01/2000 | Last Modified: 11/01/2015
Notes: (Modified 6/30/03, 7/1/12, 11/1/2015)
N70 Consolidated billing and payment applies.
Start: 01/01/2000 | Last Modified: 11/05/2007
Notes: (Modified 2/28/02, 11/5/07)
N71 Your unassigned claim for a drug or biological, clinical diagnostic laboratory services or ambulance service was processed as an assigned claim. You are required by law to accept assignment for these types of claims.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 2/21/02, 6/30/03)
N72 PPS (Prospective Payment System) code changed by medical reviewers. Not supported by clinical records.
Start: 01/01/2000 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N73 A Skilled Nursing Facility is responsible for payment of outside providers who furnish these services/supplies under arrangement to its residents.
Start: 01/01/2000 | Stop: 01/31/2004
Notes: Consider using MA101 or N200
N74 Resubmit with multiple claims, each claim covering services provided in only one calendar month.
Start: 01/01/2000
N75 Missing/incomplete/invalid tooth surface information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N76 Missing/incomplete/invalid number of riders.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N77 Missing/incomplete/invalid designated provider number.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N78 The necessary components of the child and teen checkup (EPSDT) were not completed.
Start: 01/01/2000
N79 Service billed is not compatible with patient location information.
Start: 01/01/2000
N80 Missing/incomplete/invalid prenatal screening information.
Start: 01/01/2000 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N81 Procedure billed is not compatible with tooth surface code.
Start: 01/01/2000
N82 Provider must accept insurance payment as payment in full when a third party payer contract specifies full reimbursement.
Start: 01/01/2000
N83 No appeal rights. Adjudicative decision based on the provisions of a demonstration project.
Start: 01/01/2000
N84 Alert: Further installment payments are forthcoming.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07, 8/1/07)
N85 Alert: This is the final installment payment.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07, 8/1/07)
N86 A failed trial of pelvic muscle exercise training is required in order for biofeedback training for the treatment of urinary incontinence to be covered.
Start: 01/01/2000
N87 Home use of biofeedback therapy is not covered.
Start: 01/01/2000
N88 Alert: This payment is being made conditionally. An HHA episode of care notice has been filed for this patient. When a patient is treated under a HHA episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the HHA's payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under a HHA episode of care.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N89 Alert: Payment information for this claim has been forwarded to more than one other payer, but format limitations permit only one of the secondary payers to be identified in this remittance advice.
Start: 01/01/2000 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N90 Covered only when performed by the attending physician.
Start: 01/01/2000
N91 Services not included in the appeal review.
Start: 01/01/2000
N92 This facility is not certified for digital mammography.
Start: 01/01/2000
N93 A separate claim must be submitted for each place of service. Services furnished at multiple sites may not be billed in the same claim.
Start: 01/01/2000
N94 Claim/Service denied because a more specific taxonomy code is required for adjudication.
Start: 01/01/2000
N95 This provider type/provider specialty may not bill this service.
Start: 07/31/2001 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N96 Patient must be refractory to conventional therapy (documented behavioral, pharmacologic and/or surgical corrective therapy) and be an appropriate surgical candidate such that implantation with anesthesia can occur.
Start: 08/24/2001
N97 Patients with stress incontinence, urinary obstruction, and specific neurologic diseases (e.g., diabetes with peripheral nerve involvement) which are associated with secondary manifestations of the above three indications are excluded.
Start: 08/24/2001
N98 Patient must have had a successful test stimulation in order to support subsequent implantation. Before a patient is eligible for permanent implantation, he/she must demonstrate a 50 percent or greater improvement through test stimulation. Improvement is measured through voiding diaries.
Start: 08/24/2001
N99 Patient must be able to demonstrate adequate ability to record voiding diary data such that clinical results of the implant procedure can be properly evaluated.
Start: 08/24/2001
N100 PPS (Prospect Payment System) code corrected during adjudication.
Start: 09/14/2001 | Stop: 11/01/2016 | Last Modified: 11/01/2015
Notes: (Modified 6/30/03, 11/1/2015)
N101 Additional information is needed in order to process this claim. Please resubmit the claim with the identification number of the provider where this service took place. The Medicare number of the site of service provider should be preceded with the letters 'HSP' and entered into item #32 on the claim form. You may bill only one site of service provider number per claim.
Start: 10/31/2001 | Stop: 01/31/2004 | Last Modified: 03/14/2014
Notes: Consider using MA105 (Modified 3/14/2014)
N102 This claim has been denied without reviewing the medical/dental record because the requested records were not received or were not received timely.
Start: 10/31/2001 | Stop: 07/01/2016 | Last Modified: 11/01/2013
N103 Records indicate this patient was a prisoner or in custody of a Federal, State, or local authority when the service was rendered. This payer does not cover items and services furnished to an individual while he or she is in custody under a penal statute or rule, unless under State or local law, the individual is personally liable for the cost of his or her health care while in custody and the State or local government pursues the collection of such debt in the same way and with the same vigor as the collection of its other debts. The provider can collect from the Federal/State/ Local Authority as appropriate.
Start: 10/31/2001 | Last Modified: 11/01/2013
Notes: (Modified 6/30/03, 7/1/12, 11/1/13)
N104 This claim/service is not payable under our claims jurisdiction area. You can identify the correct Medicare contractor to process this claim/service through the CMS website at www.cms.gov.
Start: 01/29/2002 | Last Modified: 07/01/2010
Notes: (Modified 10/31/02, 7/1/10)
N105 This is a misdirected claim/service for an RRB beneficiary. Submit paper claims to the RRB carrier: Palmetto GBA, P.O. Box 10066, Augusta, GA 30999. Call 888-355-9165 for RRB EDI information for electronic claims processing.
Start: 01/29/2002 | Last Modified: 07/01/2017
Notes: (Modified 7/1/2017)
N106 Payment for services furnished to Skilled Nursing Facility (SNF) inpatients (except for excluded services) can only be made to the SNF. You must request payment from the SNF rather than the patient for this service.
Start: 01/31/2002
N107 Services furnished to Skilled Nursing Facility (SNF) inpatients must be billed on the inpatient claim. They cannot be billed separately as outpatient services.
Start: 01/31/2002
N108 Missing/incomplete/invalid upgrade information.
Start: 01/31/2002 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
N109 Alert: This claim/service was chosen for complex review.
Start: 02/28/2002 | Last Modified: 07/01/2015
Notes: (Modified 3/1/2009, 7/1/15)
N110 This facility is not certified for film mammography.
Start: 02/28/2002
N111 No appeal right except duplicate claim/service issue. This service was included in a claim that has been previously billed and adjudicated.
Start: 02/28/2002
N112 This claim is excluded from your electronic remittance advice.
Start: 02/28/2002
N113 Only one initial visit is covered per physician, group practice or provider.
Start: 04/16/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N114 During the transition to the Ambulance Fee Schedule, payment is based on the lesser of a blended amount calculated using a percentage of the reasonable charge/cost and fee schedule amounts, or the submitted charge for the service. You will be notified yearly what the percentages for the blended payment calculation will be.
Start: 05/30/2002
N115 This decision was based on a Local Coverage Determination (LCD). An LCD provides a guide to assist in determining whether a particular item or service is covered. A copy of this policy is available at www.cms.gov/mcd, or if you do not have web access, you may contact the contractor to request a copy of the LCD.
Start: 05/30/2002 | Last Modified: 07/01/2010
Notes: (Modified 4/1/04, 7/1/10)
N116 Alert: This payment is being made conditionally because the service was provided in the home, and it is possible that the patient is under a home health episode of care. When a patient is treated under a home health episode of care, consolidated billing requires that certain therapy services and supplies, such as this, be included in the home health agency’s (HHA’s) payment. This payment will need to be recouped from you if we establish that the patient is concurrently receiving treatment under an HHA episode of care.
Start: 06/30/2002 | Last Modified: 11/01/2016
Notes: (Modified 11/1/2016)
N117 This service is paid only once in a patient’s lifetime.
Start: 07/30/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N118 This service is not paid if billed more than once every 28 days.
Start: 07/30/2002
N119 This service is not paid if billed once every 28 days, and the patient has spent 5 or more consecutive days in any inpatient or Skilled /nursing Facility (SNF) within those 28 days.
Start: 07/30/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N120 Payment is subject to home health prospective payment system partial episode payment adjustment. Patient was transferred/discharged/readmitted during payment episode.
Start: 08/09/2002 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
N121 Medicare Part B does not pay for items or services provided by this type of practitioner for beneficiaries in a Medicare Part A covered Skilled Nursing Facility (SNF) stay.
Start: 09/09/2002 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04, 6/30/03)
N122 Add-on code cannot be billed by itself.
Start: 09/12/2002 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
N123 Alert: This is a split service and represents a portion of the units from the originally submitted service.
Start: 09/24/2002 | Last Modified: 03/01/2016
Notes: (Modified 3/1/2016)
N124 Payment has been denied for the/made only for a less extensive service/item because the information furnished does not substantiate the need for the (more extensive) service/item. The patient is liable for the charges for this service/item as you informed the patient in writing before the service/item was furnished that we would not pay for it, and the patient agreed to pay.
Start: 09/26/2002
N125 Payment has been (denied for the/made only for a less extensive) service/item because the information furnished does not substantiate the need for the (more extensive) service/item. If you have collected any amount from the patient, you must refund that amount to the patient within 30 days of receiving this notice.
The requirements for a refund are in §1834(a)(18) of the Social Security Act (and in §§1834(j)(4) and 1879(h) by cross-reference to §1834(a)(18)). Section 1834(a)(18)(B) specifies that suppliers which knowingly and willfully fail to make appropriate refunds may be subject to civil money penalties and/or exclusion from the Medicare program. If you have any questions about this notice, please contact this office.
Start: 09/26/2002 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05. Also refer to N356)
N126 Social Security Records indicate that this individual has been deported. This payer does not cover items and services furnished to individuals who have been deported.
Start: 10/17/2002
N127 This is a misdirected claim/service for a United Mine Workers of America (UMWA) beneficiary. Please submit claims to them.
Start: 10/31/2007 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04
N128 This amount represents the prior to coverage portion of the allowance.
Start: 10/31/2002
N129 Not eligible due to the patient's age.
Start: 10/31/2002 | Last Modified: 08/01/2007
Notes: (Modified 8/1/07)
N130 Consult plan benefit documents/guidelines for information about restrictions for this service.
Start: 10/31/2002 | Last Modified: 11/01/2009
Notes: (Modified 4/1/07, 7/1/08, 11/1/09)
N131 Total payments under multiple contracts cannot exceed the allowance for this service.
Start: 10/31/2002
N132 Alert: Payments will cease for services rendered by this US Government debarred or excluded provider after the 30 day grace period as previously notified.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N133 Alert: Services for predetermination and services requesting payment are being processed separately.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N134 Alert: This represents your scheduled payment for this service. If treatment has been discontinued, please contact Customer Service.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N135 Record fees are the patient's responsibility and limited to the specified co-payment.
Start: 10/31/2002
N136 Alert: To obtain information on the process to file an appeal in Arizona, call the Department's Consumer Assistance Office at (602) 912-8444 or (800) 325-2548.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N137 Alert: The provider acting on the Member's behalf, may file an appeal with the Payer. The provider, acting on the Member's behalf, may file a complaint with the State Insurance Regulatory Authority without first filing an appeal, if the coverage decision involves an urgent condition for which care has not been rendered. The address may be obtained from the State Insurance Regulatory Authority.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 8/1/04, 2/28/03, 4/1/07)
N138 Alert: In the event you disagree with the Dental Advisor's opinion and have additional information relative to the case, you may submit radiographs to the Dental Advisor Unit at the subscriber's dental insurance carrier for a second Independent Dental Advisor Review.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N139 Alert: Under 32 CFR 199.13, a non-participating provider is not an appropriate appealing party. Therefore, if you disagree with the Dental Advisor's opinion, you may appeal the determination if appointed in writing, by the beneficiary, to act as his/her representative. Should you be appointed as a representative, submit a copy of this letter, a signed statement explaining the matter in which you disagree, and any radiographs and relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.
Start: 10/31/2002 | Last Modified: 03/01/2017
Notes: (Modified 4/1/07, 3/1/2017)
N140 Alert: You have not been designated as an authorized OCONUS provider therefore are not considered an appropriate appealing party. If the beneficiary has appointed you, in writing, to act as his/her representative and you disagree with the Dental Advisor's opinion, you may appeal by submitting a copy of this letter, a signed statement explaining the matter in which you disagree, and any relevant information to the subscriber's Dental insurance carrier within 90 days from the date of this letter.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N141 The patient was not residing in a long-term care facility during all or part of the service dates billed.
Start: 10/31/2002
N142 The original claim was denied. Resubmit a new claim, not a replacement claim.
Start: 10/31/2002
N143 The patient was not in a hospice program during all or part of the service dates billed.
Start: 10/31/2002
N144 The rate changed during the dates of service billed.
Start: 10/31/2002
N145 Missing/incomplete/invalid provider identifier for this place of service.
Start: 10/31/2002 | Stop: 06/02/2005
N146 Missing screening document.
Start: 10/31/2002 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04) Related to N243
N147 Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request.
Start: 10/31/2002
N148 Missing/incomplete/invalid date of last menstrual period.
Start: 10/31/2002
N149 Rebill all applicable services on a single claim.
Start: 10/31/2002
N150 Missing/incomplete/invalid model number.
Start: 10/31/2002
N151 Telephone contact services will not be paid until the face-to-face contact requirement has been met.
Start: 10/31/2002
N152 Missing/incomplete/invalid replacement claim information.
Start: 10/31/2002
N153 Missing/incomplete/invalid room and board rate.
Start: 10/31/2002
N154 Alert: This payment was delayed for correction of provider's mailing address.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N155 Alert: Our records do not indicate that other insurance is on file. Please submit other insurance information for our records.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N156 Alert: The patient is responsible for the difference between the approved treatment and the elective treatment.
Start: 10/31/2002 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N157 Transportation to/from this destination is not covered.
Start: 02/28/2003 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
N158 Transportation in a vehicle other than an ambulance is not covered.
Start: 02/28/2003
N159 Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
Start: 02/28/2003
N160 The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
Start: 02/28/2003 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
N161 This drug/service/supply is covered only when the associated service is covered.
Start: 02/28/2003
N162 Alert: Although your claim was paid, you have billed for a test/specialty not included in your Laboratory Certification. Your failure to correct the laboratory certification information will result in a denial of payment in the near future.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N163 Medical record does not support code billed per the code definition.
Start: 02/28/2003
N164 Transportation to/from this destination is not covered.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N157
N165 Transportation in a vehicle other than an ambulance is not covered.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N158)
N166 Payment denied/reduced because mileage is not covered when the patient is not in the ambulance.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N159
N167 Charges exceed the post-transplant coverage limit.
Start: 02/28/2003
N168 The patient must choose an option before a payment can be made for this procedure/ equipment/ supply/ service.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N160
N169 This drug/service/supply is covered only when the associated service is covered.
Start: 02/28/2003 | Stop: 01/31/2004
Notes: Consider using N161
N170 A new/revised/renewed certificate of medical necessity is needed.
Start: 02/28/2003
N171 Payment for repair or replacement is not covered or has exceeded the purchase price.
Start: 02/28/2003
N172 The patient is not liable for the denied/adjusted charge(s) for receiving any updated service/item.
Start: 02/28/2003
N173 No qualifying hospital stay dates were provided for this episode of care.
Start: 02/28/2003
N174 This is not a covered service/procedure/ equipment/bed, however patient liability is limited to amounts shown in the adjustments under group 'PR'.
Start: 02/28/2003
N175 Missing review organization approval.
Start: 02/28/2003 | Last Modified: 02/29/2008
Notes: (Modified 8/1/04, 2/29/08) Related to N241
N176 Services provided aboard a ship are covered only when the ship is of United States registry and is in United States waters. In addition, a doctor licensed to practice in the United States must provide the service.
Start: 02/28/2003
N177 Alert: We did not send this claim to patient’s other insurer. They have indicated no additional payment can be made.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 6/30/03, 4/1/07)
N178 Missing pre-operative images/visual field results.
Start: 02/28/2003 | Last Modified: 11/01/2013
Notes: (Modified 8/1/04, 11/1/13) Related to N244
N179 Additional information has been requested from the member. The charges will be reconsidered upon receipt of that information.
Start: 02/28/2003
N180 This item or service does not meet the criteria for the category under which it was billed.
Start: 02/28/2003
N181 Additional information is required from another provider involved in this service.
Start: 02/28/2003 | Last Modified: 12/01/2006
Notes: (Modified 12/1/06)
N182 This claim/service must be billed according to the schedule for this plan.
Start: 02/28/2003
N183 Alert: This is a predetermination advisory message, when this service is submitted for payment additional documentation as specified in plan documents will be required to process benefits.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N184 Rebill technical and professional components separately.
Start: 02/28/2003
N185 Alert: Do not resubmit this claim/service.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N186 Non-Availability Statement (NAS) required for this service. Contact the nearest Military Treatment Facility (MTF) for assistance.
Start: 02/28/2003
N187 Alert: You may request a review in writing within the required time limits following receipt of this notice by following the instructions included in your contract or plan benefit documents.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N188 The approved level of care does not match the procedure code submitted.
Start: 02/28/2003
N189 Alert: This service has been paid as a one-time exception to the plan's benefit restrictions.
Start: 02/28/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N190 Missing contract indicator.
Start: 02/28/2003 | Last Modified: 08/01/2004
Notes: (Modified 8/1/04) Related to N229
N191 The provider must update insurance information directly with payer.
Start: 02/28/2003
N192 Patient is a Medicaid/Qualified Medicare Beneficiary.
Start: 02/28/2003
N193 Alert: Specific federal/state/local program may cover this service through another payer.
Start: 02/28/2003 | Last Modified: 11/01/2015
Notes: (Modified 11/1/2015)
N194 Technical component not paid if provider does not own the equipment used.
Start: 02/25/2003
N195 The technical component must be billed separately.
Start: 02/25/2003
N196 Alert: Patient eligible to apply for other coverage which may be primary.
Start: 02/25/2003 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
N197 The subscriber must update insurance information directly with payer.
Start: 02/25/2003
N198 Rendering provider must be affiliated with the pay-to provider.
Start: 02/25/2003
N199 Additional payment/recoupment approved based on payer-initiated review/audit.
Start: 02/25/2003 | Last Modified: 08/01/2006
Notes: (Modified 8/1/06)