MA Remittance Advice Code List
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 4/1/07)
MA02 Alert: If you do not agree with this determination, you have the right to appeal. You must file a written request for an appeal within 180 days of the date you receive this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 10/31/02, 6/30/03, 8/1/05, 12/29/05, 8/1/06, 4/1/07)
MA03 If you do not agree with the approved amounts and $100 or more is in dispute (less deductible and coinsurance), you may ask for a hearing within six months of the date of this notice. To meet the $100, you may combine amounts on other claims that have been denied, including reopened appeals if you received a revised decision. You must appeal each claim on time.
Start: 01/01/1997 | Stop: 10/01/2006 | Last Modified: 11/18/2005
Notes: Consider using MA02 (Modified 10/31/02, 6/30/03, 8/1/05, 11/18/05)
MA04 Secondary payment cannot be considered without the identity of or payment information from the primary payer. The information was either not reported or was illegible.
Start: 01/01/1997
MA05 Incorrect admission date patient status or type of bill entry on claim.
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA30, MA40 or MA43
MA06 Missing/incomplete/invalid beginning and/or ending date(s).
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA31
MA07 Alert: The claim information has also been forwarded to Medicaid for review.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA08 Alert: Claim information was not forwarded because the supplemental coverage is not with a Medigap plan, or you do not participate in Medicare.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA09 Alert: Claim submitted as unassigned but processed as assigned in accordance with our current assignment/participation agreement.
Start: 01/01/1997 | Last Modified: 11/01/2015
Notes: (Modified 11/1/2014, 11/1/2015)
MA10 Alert: The patient's payment was in excess of the amount owed. You must refund the overpayment to the patient.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA11 Payment is being issued on a conditional basis. If no-fault insurance, liability insurance, Workers' Compensation, Department of Veterans Affairs, or a group health plan for employees and dependents also covers this claim, a refund may be due us. Please contact us if the patient is covered by any of these sources.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M32
MA12 You have not established that you have the right under the law to bill for services furnished by the person(s) that furnished this (these) service(s).
Start: 01/01/1997
MA13 Alert: You may be subject to penalties if you bill the patient for amounts not reported with the PR (patient responsibility) group code.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA14 Alert: The patient is a member of an employer-sponsored prepaid health plan. Services from outside that health plan are not covered. However, as you were not previously notified of this, we are paying this time. In the future, we will not pay you for non-plan services.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/07, 8/1/07)
MA15 Alert: Your claim has been separated to expedite handling. You will receive a separate notice for the other services reported.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA16 The patient is covered by the Black Lung Program. Send this claim to the Department of Labor, Federal Black Lung Program, P.O. Box 828, Lanham-Seabrook MD 20703.
Start: 01/01/1997
MA17 We are the primary payer and have paid at the primary rate. You must contact the patient's other insurer to refund any excess it may have paid due to its erroneous primary payment.
Start: 01/01/1997
MA18 Alert: The claim information is also being forwarded to the patient's supplemental insurer. Send any questions regarding supplemental benefits to them.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA19 Alert: Information was not sent to the Medigap insurer due to incorrect/invalid information you submitted concerning that insurer. Please verify your information and submit your secondary claim directly to that insurer.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA20 Skilled Nursing Facility (SNF) stay not covered when care is primarily related to the use of an urethral catheter for convenience or the control of incontinence.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA21 SSA records indicate mismatch with name and sex.
Start: 01/01/1997
MA22 Payment of less than $1.00 suppressed.
Start: 01/01/1997
MA23 Demand bill approved as result of medical review.
Start: 01/01/1997
MA24 Christian Science Sanitarium/ Skilled Nursing Facility (SNF) bill in the same benefit period.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA25 A patient may not elect to change a hospice provider more than once in a benefit period.
Start: 01/01/1997
MA26 Alert: Our records indicate that you were previously informed of this rule.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA27 Missing/incomplete/invalid entitlement number or name shown on the claim.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA28 Alert: Receipt of this notice by a physician or supplier who did not accept assignment is for information only and does not make the physician or supplier a party to the determination. No additional rights to appeal this decision, above those rights already provided for by regulation/instruction, are conferred by receipt of this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA29 Missing/incomplete/invalid provider name, city, state, or zip code.
Start: 01/01/1997 | Stop: 06/02/2005
MA30 Missing/incomplete/invalid type of bill.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA31 Missing/incomplete/invalid beginning and ending dates of the period billed.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA32 Missing/incomplete/invalid number of covered days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA33 Missing/incomplete/invalid noncovered days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA34 Missing/incomplete/invalid number of coinsurance days during the billing period.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA35 Missing/incomplete/invalid number of lifetime reserve days.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA36 Missing/incomplete/invalid patient name.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA37 Missing/incomplete/invalid patient's address.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA38 Missing/incomplete/invalid birth date.
Start: 01/01/1997 | Stop: 06/02/2005
MA39 Missing/incomplete/invalid gender.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA40 Missing/incomplete/invalid admission date.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA41 Missing/incomplete/invalid admission type.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA42 Missing/incomplete/invalid admission source.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA43 Missing/incomplete/invalid patient status.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA44 Alert: No appeal rights. Adjudicative decision based on law.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA45 Alert: As previously advised, a portion or all of your payment is being held in a special account.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA46 Alert: The new information was considered but additional payment will not be issued.
Start: 01/01/1997 | Last Modified: 11/01/2015
Notes: (Modified 3/1/2009, 11/1/2015)
MA47 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment.
Start: 01/01/1997
MA48 Missing/incomplete/invalid name or address of responsible party or primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA49 Missing/incomplete/invalid six-digit provider identifier for home health agency or hospice for physician(s) performing care plan oversight services.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA76
MA50 Missing/incomplete/invalid Investigational Device Exemption number or Clinical Trial number.
Start: 01/01/1997 | Last Modified: 03/01/2014
Notes: (Modified 2/28/03, 3/1/2014)
MA51 Missing/incomplete/invalid CLIA certification number for laboratory services billed by physician office laboratory.
Start: 01/01/1997 | Stop: 02/05/2005
Notes: Consider using MA120
MA52 Missing/incomplete/invalid date.
Start: 01/01/1997 | Stop: 06/02/2005
MA53 Missing/incomplete/invalid Competitive Bidding Demonstration Project identification.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04)
MA54 Physician certification or election consent for hospice care not received timely.
Start: 01/01/1997
MA55 Not covered as patient received medical health care services, automatically revoking his/her election to receive religious non-medical health care services.
Start: 01/01/1997
MA56 Our records show you have opted out of Medicare, agreeing with the patient not to bill Medicare for services/tests/supplies furnished. As result, we cannot pay this claim. The patient is responsible for payment, but under Federal law, you cannot charge the patient more than the limiting charge amount.
Start: 01/01/1997
MA57 Patient submitted written request to revoke his/her election for religious non-medical health care services.
Start: 01/01/1997
MA58 Missing/incomplete/invalid release of information indicator.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA59 Alert: The patient overpaid you for these services. You must issue the patient a refund within 30 days for the difference between his/her payment and the total amount shown as patient responsibility on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA60 Missing/incomplete/invalid patient relationship to insured.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA61 Missing/incomplete/invalid social security number.
Start: 01/01/1997 | Last Modified: 03/01/2018
Notes: (Modified 2/28/03, 3/1/2018)
MA62 Alert: This is a telephone review decision.
Start: 01/01/1997 | Last Modified: 08/01/2007
Notes: (Modified 4/1/07, 8/1/07)
MA63 Missing/incomplete/invalid principal diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA64 Our records indicate that we should be the third payer for this claim. We cannot process this claim until we have received payment information from the primary and secondary payers.
Start: 01/01/1997
MA65 Missing/incomplete/invalid admitting diagnosis.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA66 Missing/incomplete/invalid principal procedure code.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04) Related to N303
MA67 Alert: Correction to a prior claim.
Start: 01/01/1997 | Last Modified: 11/01/2015
Notes: (Modified 11/1/2015)
MA68 Alert: We did not crossover this claim because the secondary insurance information on the claim was incomplete. Please supply complete information or use the PLANID of the insurer to assure correct and timely routing of the claim.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA69 Missing/incomplete/invalid remarks.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA70 Missing/incomplete/invalid provider representative signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA71 Missing/incomplete/invalid provider representative signature date.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA72 Alert: The patient overpaid you for these assigned services. You must issue the patient a refund within 30 days for the difference between his/her payment to you and the total of the amount shown as patient responsibility and as paid to the patient on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA73 Informational remittance associated with a Medicare demonstration. No payment issued under fee-for-service Medicare as patient has elected managed care.
Start: 01/01/1997
MA74 Alert: This payment replaces an earlier payment for this claim that was either lost, damaged or returned.
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 7/1/15)
MA75 Missing/incomplete/invalid patient or authorized representative signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA76 Missing/incomplete/invalid provider identifier for home health agency or hospice when physician is performing care plan oversight services.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03, 2/1/04)
MA77 Alert: The patient overpaid you. You must issue the patient a refund within 30 days for the difference between the patient’s payment less the total of our and other payer payments and the amount shown as patient responsibility on this notice.
Start: 01/01/1997 | Last Modified: 04/01/2007
Notes: (Modified 4/1/07)
MA78 The patient overpaid you. You must issue the patient a refund within 30 days for the difference between our allowed amount total and the amount paid by the patient.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using MA59
MA79 Billed in excess of interim rate.
Start: 01/01/1997
MA80 Informational notice. No payment issued for this claim with this notice. Payment issued to the hospital by its intermediary for all services for this encounter under a demonstration project.
Start: 01/01/1997
MA81 Missing/incomplete/invalid provider/supplier signature.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA82 Missing/incomplete/invalid provider/supplier billing number/identifier or billing name, address, city, state, zip code, or phone number.
Start: 01/01/1997 | Stop: 06/02/2005
MA83 Did not indicate whether we are the primary or secondary payer.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Modified 8/1/05)
MA84 Patient identified as participating in the National Emphysema Treatment Trial but our records indicate that this patient is either not a participant, or has not yet been approved for this phase of the study. Contact Johns Hopkins University, the study coordinator, to resolve if there was a discrepancy.
Start: 01/01/1997
MA85 Our records indicate that a primary payer exists (other than ourselves); however, you did not complete or enter accurately the insurance plan/group/program name or identification number. Enter the PlanID when effective.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA86 Missing/incomplete/invalid group or policy number of the insured for the primary coverage.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA87 Missing/incomplete/invalid insured's name for the primary payer.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using MA92
MA88 Missing/incomplete/invalid insured's address and/or telephone number for the primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA89 Missing/incomplete/invalid patient's relationship to the insured for the primary payer.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA90 Missing/incomplete/invalid employment status code for the primary insured.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03).
MA91 Alert: This determination is the result of the appeal you filed.
Start: 01/01/1997 | Last Modified: 07/01/2015
Notes: (Modified 7/1/15)
MA92 Missing plan information for other insurance.
Start: 01/01/1997 | Last Modified: 02/01/2004
Notes: (Modified 2/1/04) Related to N245
MA93 Non-PIP (Periodic Interim Payment) claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA94 Did not enter the statement “Attending physician not hospice employee” on the claim form to certify that the rendering physician is not an employee of the hospice.
Start: 01/01/1997 | Last Modified: 08/01/2005
Notes: (Reactivated 4/1/04, Modified 8/1/05)
MA95 A not otherwise classified or unlisted procedure code(s) was billed but a narrative description of the procedure was not entered on the claim. Refer to item 19 on the HCFA-1500.
Start: 01/01/1997 | Stop: 01/01/2004 | Last Modified: 02/28/2003
Notes: (Deactivated 2/28/2003) (Erroneous description corrected 9/2/2008) Consider using M51
MA96 Claim rejected. Coded as a Medicare Managed Care Demonstration but patient is not enrolled in a Medicare managed care plan.
Start: 01/01/1997
MA97 Missing/incomplete/invalid Medicare Managed Care Demonstration contract number or clinical trial registry number.
Start: 01/01/1997 | Last Modified: 02/29/2008
Notes: (Modified 2/29/08)
MA98 Claim Rejected. Does not contain the correct Medicare Managed Care Demonstration contract number for this beneficiary.
Start: 01/01/1997 | Stop: 10/16/2003
Notes: Consider using MA97
MA99 Missing/incomplete/invalid Medigap information.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA100 Missing/incomplete/invalid date of current illness or symptoms.
Start: 01/01/1997 | Last Modified: 03/14/2014
Notes: (Modified 2/28/03, 3/30/05, 3/14/2014)
MA101 A Skilled Nursing Facility (SNF) is responsible for payment of outside providers who furnish these services/supplies to residents.
Start: 01/01/1997 | Stop: 01/01/2011 | Last Modified: 06/30/2003
Notes: Consider using N538
MA102 Missing/incomplete/invalid name or provider identifier for the rendering/referring/ ordering/ supervising provider.
Start: 01/01/1997 | Stop: 08/01/2004
Notes: Consider using M68
MA103 Hemophilia Add On.
Start: 01/01/1997
MA104 Missing/incomplete/invalid date the patient was last seen or the provider identifier of the attending physician.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using M128 or M57
MA105 Missing/incomplete/invalid provider number for this place of service.
Start: 01/01/1997 | Stop: 06/02/2005
MA106 PIP (Periodic Interim Payment) claim.
Start: 01/01/1997 | Last Modified: 06/30/2003
Notes: (Modified 6/30/03)
MA107 Paper claim contains more than three separate data items in field 19.
Start: 01/01/1997
MA108 Paper claim contains more than one data item in field 23.
Start: 01/01/1997
MA109 Claim processed in accordance with ambulatory surgical guidelines.
Start: 01/01/1997
MA110 Missing/incomplete/invalid information on whether the diagnostic test(s) were performed by an outside entity or if no purchased tests are included on the claim.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA111 Missing/incomplete/invalid purchase price of the test(s) and/or the performing laboratory's name and address.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA112 Missing/incomplete/invalid group practice information.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA113 Incomplete/invalid taxpayer identification number (TIN) submitted by you per the Internal Revenue Service. Your claims cannot be processed without your correct TIN, and you may not bill the patient pending correction of your TIN. There are no appeal rights for unprocessable claims, but you may resubmit this claim after you have notified this office of your correct TIN.
Start: 01/01/1997
MA114 Missing/incomplete/invalid information on where the services were furnished.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA115 Missing/incomplete/invalid physical location (name and address, or PIN) where the service(s) were rendered in a Health Professional Shortage Area (HPSA).
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA116 Did not complete the statement 'Homebound' on the claim to validate whether laboratory services were performed at home or in an institution.
Start: 01/01/1997
Notes: (Reactivated 4/1/04)
MA117 This claim has been assessed a $1.00 user fee.
Start: 01/01/1997
MA118 Alert: No Medicare payment issued for this claim for services or supplies furnished to a Medicare-eligible veteran through a facility of the Department of Veterans Affairs. Coinsurance and/or deductible are applicable.
Start: 01/01/1997 | Last Modified: 11/01/2014
MA119 Provider level adjustment for late claim filing applies to this claim.
Start: 01/01/1997 | Stop: 05/01/2008 | Last Modified: 11/05/2007
Notes: Consider using Reason Code B4
MA120 Missing/incomplete/invalid CLIA certification number.
Start: 01/01/1997 | Last Modified: 02/28/2003
Notes: (Modified 2/28/03)
MA121 Missing/incomplete/invalid x-ray date.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
MA122 Missing/incomplete/invalid initial treatment date.
Start: 01/01/1997 | Last Modified: 12/02/2004
Notes: (Modified 12/2/04)
MA123 Your center was not selected to participate in this study, therefore, we cannot pay for these services.
Start: 01/01/1997
MA124 Processed for IME only.
Start: 01/01/1997 | Stop: 01/31/2004
Notes: Consider using Reason Code 74
MA125 Per legislation governing this program, payment constitutes payment in full.
Start: 01/01/1997
MA126 Pancreas transplant not covered unless kidney transplant performed.
Start: 10/12/2001
MA127 Reserved for future use.
Start: 10/12/2001 | Stop: 06/02/2005
MA128 Missing/incomplete/invalid FDA approval number.
Start: 10/12/2001 | Last Modified: 03/30/2005
Notes: (Modified 2/28/03, 3/30/05)
MA129 This provider was not certified for this procedure on this date of service.
Start: 10/12/2001 | Stop: 01/31/2004 | Last Modified: 01/31/2004
Notes: Consider using MA120 and Reason Code B7
MA130 Your claim contains incomplete and/or invalid information, and no appeal rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
Start: 10/12/2001
MA131 Physician already paid for services in conjunction with this demonstration claim. You must have the physician withdraw that claim and refund the payment before we can process your claim.
Start: 10/12/2001
MA132 Adjustment to the pre-demonstration rate.
Start: 10/12/2001
MA133 Claim overlaps inpatient stay. Rebill only those services rendered outside the inpatient stay.
Start: 10/12/2001
MA134 Missing/incomplete/invalid provider number of the facility where the patient resides.
Start: 10/12/2001
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