Intellect™
CLAIM STATUS CODES 09
0 Cannot provide further status electronically.
Start: 1/1/1995
1 For more detailed information, see remittance advice.
Start: 1/1/1995
2 More detailed information in letter.
Start: 1/1/1995
3 Claim has been adjudicated and is awaiting payment cycle.
Start: 1/1/1995
4 This is a subsequent request for information from the original request.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
5 This is a final request for information.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
6 Balance due from the subscriber.
Start: 1/1/1995
7 Claim may be reconsidered at a future date.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
8 No payment due to contract/plan provisions.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
9 No payment will be made for this claim.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
10 All originally submitted procedure codes have been combined.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
11 Some originally submitted procedure codes have been combined.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
12 One or more originally submitted procedure codes have been combined.
Start: 1/1/1995 | Last Modified: 6/30/2001
13 All originally submitted procedure codes have been modified.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
14 Some all originally submitted procedure codes have been modified.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
15 One or more originally submitted procedure code have been modified.
Start: 1/1/1995 | Last Modified: 6/30/2001
16 Claim/encounter has been forwarded to entity.
Start: 1/1/1995
17 Claim/encounter has been forwarded by third party entity to entity.
Start: 1/1/1995
18 Entity received claim/encounter, but returned invalid status.
Start: 1/1/1995
19 Entity acknowledges receipt of claim/encounter.
Start: 1/1/1995 | Last Modified: 6/30/2001
20 Accepted for processing.
Start: 1/1/1995 | Last Modified: 6/30/2001
21 Missing or invalid information. Note: At least one other status code is required to identify the missing or invalid information.
Start: 1/1/1995 | Last Modified: 7/9/2007
22 ... before entering the adjudication system.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
23 Returned to Entity.
Start: 1/1/1995 | Last Modified: 6/30/2001
24 Entity not approved as an electronic submitter.
Start: 1/1/1995 | Last Modified: 6/30/2001
25 Entity not approved.
Start: 1/1/1995 | Last Modified: 6/30/2001
26 Entity not found.
Start: 1/1/1995 | Last Modified: 6/30/2001
27 Policy canceled.
Start: 1/1/1995 | Last Modified: 6/30/2001
28 Claim submitted to wrong payer.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
29 Subscriber and policy number/contract number mismatched.
Start: 1/1/1995
30 Subscriber and subscriber id mismatched.
Start: 1/1/1995
31 Subscriber and policyholder name mismatched.
Start: 1/1/1995
32 Subscriber and policy number/contract number not found.
Start: 1/1/1995
33 Subscriber and subscriber id not found.
Start: 1/1/1995
34 Subscriber and policyholder name not found.
Start: 1/1/1995
35 Claim/encounter not found.
Start: 1/1/1995
37 Predetermination is on file, awaiting completion of services.
Start: 1/1/1995
38 Awaiting next periodic adjudication cycle.
Start: 1/1/1995
39 Charges for pregnancy deferred until delivery.
Start: 1/1/1995
40 Waiting for final approval.
Start: 1/1/1995
41 Special handling required at payer site.
Start: 1/1/1995
42 Awaiting related charges.
Start: 1/1/1995
44 Charges pending provider audit.
Start: 1/1/1995
45 Awaiting benefit determination.
Start: 1/1/1995
46 Internal review/audit.
Start: 1/1/1995
47 Internal review/audit - partial payment made.
Start: 1/1/1995
48 Referral/authorization.
Start: 1/1/1995 | Last Modified: 2/28/2001
49 Pending provider accreditation review.
Start: 1/1/1995
50 Claim waiting for internal provider verification.
Start: 1/1/1995
51 Investigating occupational illness/accident.
Start: 1/1/1995
52 Investigating existence of other insurance coverage.
Start: 1/1/1995
53 Claim being researched for Insured ID/Group Policy Number error.
Start: 1/1/1995
54 Duplicate of a previously processed claim/line.
Start: 1/1/1995
55 Claim assigned to an approver/analyst.
Start: 1/1/1995
56 Awaiting eligibility determination.
Start: 1/1/1995
57 Pending COBRA information requested.
Start: 1/1/1995
59 Non-electronic request for information.
Start: 1/1/1995
60 Electronic request for information.
Start: 1/1/1995
61 Eligibility for extended benefits.
Start: 1/1/1995
64 Re-pricing information.
Start: 1/1/1995
65 Claim/line has been paid.
Start: 1/1/1995
66 Payment reflects usual and customary charges.
Start: 1/1/1995
67 Payment made in full.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
68 Partial payment made for this claim.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
69 Payment reflects plan provisions.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
70 Payment reflects contract provisions.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
71 Periodic installment released.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
72 Claim contains split payment.
Start: 1/1/1995
73 Payment made to entity, assignment of benefits not on file.
Start: 1/1/1995
78 Duplicate of an existing claim/line, awaiting processing.
Start: 1/1/1995
81 Contract/plan does not cover pre-existing conditions.
Start: 1/1/1995
83 No coverage for newborns.
Start: 1/1/1995
84 Service not authorized.
Start: 1/1/1995
85 Entity not primary.
Start: 1/1/1995
86 Diagnosis and patient gender mismatch.
Start: 1/1/1995 | Last Modified: 2/28/2000
87 Denied: Entity not found. (Use code 26 with appropriate Claim Status category Code)
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
88 Entity not eligible for benefits for submitted dates of service.
Start: 1/1/1995
89 Entity not eligible for dental benefits for submitted dates of service.
Start: 1/1/1995
90 Entity not eligible for medical benefits for submitted dates of service.
Start: 1/1/1995
91 Entity not eligible/not approved for dates of service.
Start: 1/1/1995
92 Entity does not meet dependent or student qualification.
Start: 1/1/1995
93 Entity is not selected primary care provider.
Start: 1/1/1995
94 Entity not referred by selected primary care provider.
Start: 1/1/1995
95 Requested additional information not received.
Start: 1/1/1995 | Last Modified: 7/9/2007
Note: If known, the payer must report a second claim status code identifying the requested information.
96 No agreement with entity.
Start: 1/1/1995
97 Patient eligibility not found with entity.
Start: 1/1/1995
98 Charges applied to deductible.
Start: 1/1/1995
99 Pre-treatment review.
Start: 1/1/1995
100 Pre-certification penalty taken.
Start: 1/1/1995
101 Claim was processed as adjustment to previous claim.
Start: 1/1/1995
102 Newborn's charges processed on mother's claim.
Start: 1/1/1995
103 Claim combined with other claim(s).
Start: 1/1/1995
104 Processed according to plan provisions. This change to be effective 1/1/2009: Processed according to plan provisions (Plan refers to provisions that exist between the Health Plan and the Consumer or Patient)
Start: 1/1/1995 | Last Modified: 6/1/2008
105 Claim/line is capitated.
Start: 1/1/1995
106 This amount is not entity's responsibility.
Start: 1/1/1995
107 Processed according to contract/plan provisions. This change to be effective 1/1/2009: Processed according to contract provisions (Contract refers to provisions that exist between the Health Plan and a Provider of Health Care Services)
Start: 1/1/1995 | Last Modified: 6/1/2008
108 Coverage has been canceled for this entity. (Use code 27)
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
109 Entity not eligible.
Start: 1/1/1995
110 Claim requires pricing information.
Start: 1/1/1995
111 At the policyholder's request these claims cannot be submitted electronically.
Start: 1/1/1995
112 Policyholder processes their own claims.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
113 Cannot process individual insurance policy claims.
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
114 Claim/service should be processed by entity.
Start: 1/1/1995 | Last Modified: 1/27/2008
115 Cannot process HMO claims
Start: 1/1/1995 | Stop: 7/1/2008 | Last Modified: 1/27/2008
116 Claim submitted to incorrect payer.
Start: 1/1/1995
117 Claim requires signature-on-file indicator.
Start: 1/1/1995
118 TPO rejected claim/line because payer name is missing. (Use status code 21 and status code 125 with entity code IN)
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
119 TPO rejected claim/line because certification information is missing. (Use status code 21 and status code 252)
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
120 TPO rejected claim/line because claim does not contain enough information. (Use status code 21)
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
121 Service line number greater than maximum allowable for payer.
Start: 1/1/1995
122 Missing/invalid data prevents payer from processing claim. (Use CSC Code 21)
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
123 Additional information requested from entity.
Start: 1/1/1995
124 Entity's name, address, phone and id number.
Start: 1/1/1995
125 Entity's name.
Start: 1/1/1995
126 Entity's address.
Start: 1/1/1995
127 Entity's phone number.
Start: 1/1/1995
128 Entity's tax id.
Start: 1/1/1995
129 Entity's Blue Cross provider id
Start: 1/1/1995
130 Entity's Blue Shield provider id
Start: 1/1/1995
131 Entity's Medicare provider id.
Start: 1/1/1995
132 Entity's Medicaid provider id.
Start: 1/1/1995
133 Entity's UPIN
Start: 1/1/1995
134 Entity's CHAMPUS provider id.
Start: 1/1/1995
135 Entity's commercial provider id.
Start: 1/1/1995
136 Entity's health industry id number.
Start: 1/1/1995
137 Entity's plan network id.
Start: 1/1/1995
138 Entity's site id .
Start: 1/1/1995
139 Entity's health maintenance provider id (HMO).
Start: 1/1/1995
140 Entity's preferred provider organization id (PPO).
Start: 1/1/1995 | Last Modified: 6/30/2001
141 Entity's administrative services organization id (ASO).
Start: 1/1/1995
142 Entity's license/certification number.
Start: 1/1/1995
143 Entity's state license number.
Start: 1/1/1995
144 Entity's specialty license number.
Start: 1/1/1995
145 Entity's specialty/taxonomy code.
Start: 1/1/1995 | Last Modified: 9/30/2007
146 Entity's anesthesia license number.
Start: 1/1/1995
147 Entity's qualification degree/designation (e.g. RN,PhD,MD)
Start: 2/28/1997
148 Entity's social security number.
Start: 1/1/1995
149 Entity's employer id.
Start: 1/1/1995
150 Entity's drug enforcement agency (DEA) number.
Start: 1/1/1995
152 Pharmacy processor number.
Start: 1/1/1995
153 Entity's id number.
Start: 1/1/1995
154 Relationship of surgeon & assistant surgeon.
Start: 1/1/1995
155 Entity's relationship to patient
Start: 1/1/1995
156 Patient relationship to subscriber
Start: 1/1/1995
157 Entity's Gender
Start: 1/1/1995
158 Entity's date of birth
Start: 1/1/1995
159 Entity's date of death
Start: 1/1/1995
160 Entity's marital status
Start: 1/1/1995
161 Entity's employment status
Start: 1/1/1995
162 Entity's health insurance claim number (HICN).
Start: 1/1/1995
163 Entity's policy number.
Start: 1/1/1995
164 Entity's contract/member number.
Start: 1/1/1995
165 Entity's employer name, address and phone.
Start: 1/1/1995
166 Entity's employer name.
Start: 1/1/1995
167 Entity's employer address.
Start: 1/1/1995
168 Entity's employer phone number.
Start: 1/1/1995
169 Entity's employer id.
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
170 Entity's employee id.
Start: 1/1/1995
171 Other insurance coverage information (health, liability, auto, etc.).
Start: 1/1/1995
172 Other employer name, address and telephone number.
Start: 1/1/1995
173 Entity's name, address, phone, gender, DOB, marital status, employment status and relation to subscriber.
Start: 1/1/1995 | Last Modified: 2/28/2000
174 Entity's student status.
Start: 1/1/1995
175 Entity's school name.
Start: 1/1/1995
176 Entity's school address.
Start: 1/1/1995
177 Transplant recipient's name, date of birth, gender, relationship to insured.
Start: 1/1/1995 | Last Modified: 2/28/2000
178 Submitted charges.
Start: 1/1/1995
179 Outside lab charges.
Start: 1/1/1995
180 Hospital s semi-private room rate.
Start: 1/1/1995
181 Hospital s room rate.
Start: 1/1/1995
182 Allowable/paid from primary coverage.
Start: 1/1/1995
183 Amount entity has paid.
Start: 1/1/1995
184 Purchase price for the rented durable medical equipment.
Start: 1/1/1995
185 Rental price for durable medical equipment.
Start: 1/1/1995
186 Purchase and rental price of durable medical equipment.
Start: 1/1/1995
187 Date(s) of service.
Start: 1/1/1995
188 Statement from-through dates.
Start: 1/1/1995
189 Facility admission date
Start: 1/1/1995 | Last Modified: 10/31/2006
190 Facility discharge date
Start: 1/1/1995 | Last Modified: 10/31/2006
191 Date of Last Menstrual Period (LMP)
Start: 2/28/1997
192 Date of first service for current series/symptom/illness.
Start: 1/1/1995
193 First consultation/evaluation date.
Start: 2/28/1997
194 Confinement dates.
Start: 1/1/1995
195 Unable to work dates.
Start: 1/1/1995
196 Return to work dates.
Start: 1/1/1995
197 Effective coverage date(s).
Start: 1/1/1995
198 Medicare effective date.
Start: 1/1/1995
199 Date of conception and expected date of delivery.
Start: 1/1/1995
200 Date of equipment return.
Start: 1/1/1995
201 Date of dental appliance prior placement.
Start: 1/1/1995
202 Date of dental prior replacement/reason for replacement.
Start: 1/1/1995
203 Date of dental appliance placed.
Start: 1/1/1995
204 Date dental canal(s) opened and date service completed.
Start: 1/1/1995
205 Date(s) dental root canal therapy previously performed.
Start: 1/1/1995
206 Most recent date of curettage, root planing, or periodontal surgery.
Start: 1/1/1995
207 Dental impression and seating date.
Start: 1/1/1995
208 Most recent date pacemaker was implanted.
Start: 1/1/1995
209 Most recent pacemaker battery change date.
Start: 1/1/1995
210 Date of the last x-ray.
Start: 1/1/1995
211 Date(s) of dialysis training provided to patient.
Start: 1/1/1995
212 Date of last routine dialysis.
Start: 1/1/1995
213 Date of first routine dialysis.
Start: 1/1/1995
214 Original date of prescription/orders/referral.
Start: 2/28/1997
215 Date of tooth extraction/evolution.
Start: 1/1/1995
216 Drug information.
Start: 1/1/1995
217 Drug name, strength and dosage form.
Start: 1/1/1995
218 NDC number.
Start: 1/1/1995
219 Prescription number.
Start: 1/1/1995
220 Drug product id number.
Start: 1/1/1995
221 Drug days supply and dosage.
Start: 1/1/1995
222 Drug dispensing units and average wholesale price (AWP).
Start: 1/1/1995
223 Route of drug/myelogram administration.
Start: 1/1/1995
224 Anatomical location for joint injection.
Start: 1/1/1995
225 Anatomical location.
Start: 1/1/1995
226 Joint injection site.
Start: 1/1/1995
227 Hospital information.
Start: 1/1/1995
228 Type of bill for UB claim
Start: 1/1/1995 | Last Modified: 10/31/2006
229 Hospital admission source.
Start: 1/1/1995
230 Hospital admission hour.
Start: 1/1/1995
231 Hospital admission type.
Start: 1/1/1995
232 Admitting diagnosis.
Start: 1/1/1995
233 Hospital discharge hour.
Start: 1/1/1995
234 Patient discharge status.
Start: 1/1/1995
235 Units of blood furnished.
Start: 1/1/1995
236 Units of blood replaced.
Start: 1/1/1995
237 Units of deductible blood.
Start: 1/1/1995
238 Separate claim for mother/baby charges.
Start: 1/1/1995
239 Dental information.
Start: 1/1/1995
240 Tooth surface(s) involved.
Start: 1/1/1995
241 List of all missing teeth (upper and lower).
Start: 1/1/1995
242 Tooth numbers, surfaces, and/or quadrants involved.
Start: 1/1/1995
243 Months of dental treatment remaining.
Start: 1/1/1995
244 Tooth number or letter.
Start: 1/1/1995
245 Dental quadrant/arch.
Start: 1/1/1995
246 Total orthodontic service fee, initial appliance fee, monthly fee, length of service.
Start: 1/1/1995
247 Line information.
Start: 1/1/1995
248 Accident date, state, description and cause.
Start: 1/1/1995
249 Place of service.
Start: 1/1/1995
250 Type of service.
Start: 1/1/1995
251 Total anesthesia minutes.
Start: 1/1/1995
252 Authorization/certification number.
Start: 1/1/1995
253 Procedure/revenue code for service(s) rendered. Use codes 454 or 455.
Start: 1/1/1995 | Stop: 2/28/1997 | Last Modified: 7/9/2007
254 Primary diagnosis code.
Start: 1/1/1995
255 Diagnosis code.
Start: 1/1/1995
256 DRG code(s).
Start: 1/1/1995
257 ADSM-III-R code for services rendered.
Start: 1/1/1995
258 Days/units for procedure/revenue code.
Start: 1/1/1995
259 Frequency of service.
Start: 1/1/1995
260 Length of medical necessity, including begin date.
Start: 2/28/1997
261 Obesity measurements.
Start: 1/1/1995
262 Type of surgery/service for which anesthesia was administered.
Start: 1/1/1995
263 Length of time for services rendered.
Start: 1/1/1995
264 Number of liters/minute & total hours/day for respiratory support.
Start: 1/1/1995
265 Number of lesions excised.
Start: 1/1/1995
266 Facility point of origin and destination - ambulance.
Start: 1/1/1995
267 Number of miles patient was transported.
Start: 1/1/1995
268 Location of durable medical equipment use.
Start: 1/1/1995
269 Length/size of laceration/tumor.
Start: 1/1/1995
270 Subluxation location.
Start: 1/1/1995
271 Number of spine segments.
Start: 1/1/1995
272 Oxygen contents for oxygen system rental.
Start: 1/1/1995
273 Weight.
Start: 1/1/1995
274 Height.
Start: 1/1/1995
275 Claim.
Start: 1/1/1995
276 UB04/HCFA-1450/1500 claim form
Start: 1/1/1995 | Last Modified: 10/31/2006
277 Paper claim.
Start: 1/1/1995
278 Signed claim form.
Start: 1/1/1995
279 Itemized claim.
Start: 1/1/1995
280 Itemized claim by provider.
Start: 1/1/1995
281 Related confinement claim.
Start: 1/1/1995
282 Copy of prescription.
Start: 1/1/1995
283 Medicare entitlement information is required to determine primary coverage
Start: 1/1/1995 | Last Modified: 1/27/2008
284 Copy of Medicare ID card.
Start: 1/1/1995
285 Vouchers/explanation of benefits (EOB).
Start: 1/1/1995
286 Other payer's Explanation of Benefits/payment information.
Start: 1/1/1995
287 Medical necessity for service.
Start: 1/1/1995
288 Reason for late hospital charges.
Start: 1/1/1995
289 Reason for late discharge.
Start: 1/1/1995
290 Pre-existing information.
Start: 1/1/1995
291 Reason for termination of pregnancy.
Start: 1/1/1995
292 Purpose of family conference/therapy.
Start: 1/1/1995
293 Reason for physical therapy.
Start: 1/1/1995
294 Supporting documentation.
Start: 1/1/1995
295 Attending physician report.
Start: 1/1/1995
296 Nurse's notes.
Start: 1/1/1995
297 Medical notes/report.
Start: 2/28/1997
298 Operative report.
Start: 1/1/1995
299 Emergency room notes/report.
Start: 1/1/1995
300 Lab/test report/notes/results.
Start: 2/28/1997
301 MRI report.
Start: 1/1/1995
302 Refer to codes 300 for lab notes and 311 for pathology notes
Start: 1/1/1995 | Stop: 1/31/1997
303 Physical therapy notes. Use code 297:6O (6 'OH' - not zero)
Start: 1/1/1995 | Stop: 2/28/1997 | Last Modified: 7/9/2007
304 Reports for service.
Start: 1/1/1995
305 X-ray reports/interpretation.
Start: 1/1/1995
306 Detailed description of service.
Start: 1/1/1995
307 Narrative with pocket depth chart.
Start: 1/1/1995
308 Discharge summary.
Start: 1/1/1995
309 Code was duplicate of code 299
Start: 1/1/1995 | Stop: 1/31/1997
310 Progress notes for the six months prior to statement date.
Start: 1/1/1995
311 Pathology notes/report.
Start: 1/1/1995
312 Dental charting.
Start: 1/1/1995
313 Bridgework information.
Start: 1/1/1995
314 Dental records for this service.
Start: 1/1/1995
315 Past perio treatment history.
Start: 1/1/1995
316 Complete medical history.
Start: 1/1/1995
317 Patient's medical records.
Start: 1/1/1995
318 X-rays.
Start: 1/1/1995
319 Pre/post-operative x-rays/photographs.
Start: 2/28/1997
320 Study models.
Start: 1/1/1995
321 Radiographs or models.
Start: 1/1/1995
322 Recent fm x-rays.
Start: 1/1/1995
323 Study models, x-rays, and/or narrative.
Start: 1/1/1995
324 Recent x-ray of treatment area and/or narrative.
Start: 1/1/1995
325 Recent fm x-rays and/or narrative.
Start: 1/1/1995
326 Copy of transplant acquisition invoice.
Start: 1/1/1995
327 Periodontal case type diagnosis and recent pocket depth chart with narrative.
Start: 1/1/1995
328 Speech therapy notes. Use code 297:6R
Start: 1/1/1995 | Stop: 2/28/1997 | Last Modified: 7/9/2007
329 Exercise notes.
Start: 1/1/1995
330 Occupational notes.
Start: 1/1/1995
331 History and physical.
Start: 1/1/1995 | Last Modified: 8/1/2007
332 Authorization/certification (include period covered). (Use code 252)
Start: 2/28/1997 | Stop: 1/1/2008 | Last Modified: 7/9/2007
333 Patient release of information authorization.
Start: 1/1/1995
334 Oxygen certification.
Start: 1/1/1995
335 Durable medical equipment certification.
Start: 1/1/1995
336 Chiropractic certification.
Start: 1/1/1995
337 Ambulance certification/documentation.
Start: 1/1/1995
338 Home health certification. Use code 332:4Y
Start: 1/1/1995 | Stop: 2/28/1997 | Last Modified: 7/9/2007
339 Enteral/parenteral certification.
Start: 1/1/1995
340 Pacemaker certification.
Start: 1/1/1995
341 Private duty nursing certification.
Start: 1/1/1995
342 Podiatric certification.
Start: 1/1/1995
343 Documentation that facility is state licensed and Medicare approved as a surgical facility.
Start: 1/1/1995
344 Documentation that provider of physical therapy is Medicare Part B approved.
Start: 1/1/1995
345 Treatment plan for service/diagnosis
Start: 1/1/1995
346 Proposed treatment plan for next 6 months.
Start: 1/1/1995
347 Refer to code 345 for treatment plan and code 282 for prescription
Start: 1/1/1995 | Stop: 1/31/1997
348 Chiropractic treatment plan. (Use 345:QL)
Start: 1/1/1995 | Stop: 1/1/2008 | Last Modified: 7/9/2007
349 Psychiatric treatment plan. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P
Start: 1/1/1995 | Stop: 2/28/1997 | Last Modified: 7/9/2007
350 Speech pathology treatment plan. Use code 345:6R
Start: 1/1/1995 | Stop: 2/28/1997 | Last Modified: 7/9/2007
351 Physical/occupational therapy treatment plan. Use codes 345:6O (6 'OH' - not zero), 6N
Start: 1/1/1995 | Stop: 2/28/1997 | Last Modified: 7/9/2007
352 Duration of treatment plan.
Start: 1/1/1995
353 Orthodontics treatment plan.
Start: 1/1/1995
354 Treatment plan for replacement of remaining missing teeth.
Start: 1/1/1995
355 Has claim been paid?
Start: 1/1/1995
356 Was blood furnished?
Start: 1/1/1995
357 Has or will blood be replaced?
Start: 1/1/1995
358 Does provider accept assignment of benefits?
Start: 1/1/1995
359 Is there a release of information signature on file?
Start: 1/1/1995
360 Is there an assignment of benefits signature on file?
Start: 1/1/1995
361 Is there other insurance?
Start: 1/1/1995
362 Is the dental patient covered by medical insurance?
Start: 1/1/1995
363 Will worker's compensation cover submitted charges?
Start: 1/1/1995
364 Is accident/illness/condition employment related?
Start: 1/1/1995
365 Is service the result of an accident?
Start: 1/1/1995
366 Is injury due to auto accident?
Start: 1/1/1995
367 Is service performed for a recurring condition or new condition?
Start: 1/1/1995
368 Is medical doctor (MD) or doctor of osteopath (DO) on staff of this facility?
Start: 1/1/1995
369 Does patient condition preclude use of ordinary bed?
Start: 1/1/1995
370 Can patient operate controls of bed?
Start: 1/1/1995
371 Is patient confined to room?
Start: 1/1/1995
372 Is patient confined to bed?
Start: 1/1/1995
373 Is patient an insulin diabetic?
Start: 1/1/1995
374 Is prescribed lenses a result of cataract surgery?
Start: 1/1/1995
375 Was refraction performed?
Start: 1/1/1995
376 Was charge for ambulance for a round-trip?
Start: 1/1/1995
377 Was durable medical equipment purchased new or used?
Start: 1/1/1995
378 Is pacemaker temporary or permanent?
Start: 1/1/1995
379 Were services performed supervised by a physician?
Start: 1/1/1995
380 Were services performed by a CRNA under appropriate medical direction?
Start: 1/1/1995 | Last Modified: 10/31/1999
381 Is drug generic?
Start: 1/1/1995
382 Did provider authorize generic or brand name dispensing?
Start: 1/1/1995
383 Was nerve block used for surgical procedure or pain management?
Start: 1/1/1995
384 Is prosthesis/crown/inlay placement an initial placement or a replacement?
Start: 1/1/1995
385 Is appliance upper or lower arch & is appliance fixed or removable?
Start: 1/1/1995
386 Is service for orthodontic purposes?
Start: 1/1/1995
387 Date patient last examined by entity
Start: 2/28/1997
388 Date post-operative care assumed
Start: 2/28/1997
389 Date post-operative care relinquished
Start: 2/28/1997
390 Date of most recent medical event necessitating service(s)
Start: 2/28/1997
391 Date(s) dialysis conducted
Start: 2/28/1997
392 Date(s) of blood transfusion(s)
Start: 2/28/1997
393 Date of previous pacemaker check
Start: 2/28/1997
394 Date(s) of most recent hospitalization related to service
Start: 2/28/1997
395 Date entity signed certification/recertification
Start: 2/28/1997
396 Date home dialysis began
Start: 2/28/1997
397 Date of onset/exacerbation of illness/condition
Start: 2/28/1997
398 Visual field test results
Start: 2/28/1997
399 Report of prior testing related to this service, including dates
Start: 2/28/1997
400 Claim is out of balance
Start: 2/28/1997
401 Source of payment is not valid
Start: 2/28/1997
402 Amount must be greater than zero
Start: 2/28/1997
403 Entity referral notes/orders/prescription
Start: 2/28/1997
404 Specific findings, complaints, or symptoms necessitating service
Start: 2/28/1997
405 Summary of services
Start: 2/28/1997
406 Brief medical history as related to service(s)
Start: 2/28/1997
407 Complications/mitigating circumstances
Start: 2/28/1997
408 Initial certification
Start: 2/28/1997
409 Medication logs/records (including medication therapy)
Start: 2/28/1997
410 Explain differences between treatment plan and patient's condition
Start: 2/28/1997
411 Medical necessity for non-routine service(s)
Start: 2/28/1997
412 Medical records to substantiate decision of non-coverage
Start: 2/28/1997
413 Explain/justify differences between treatment plan and services rendered.
Start: 2/28/1997
414 Need for more than one physician to treat patient
Start: 2/28/1997
415 Justify services outside composite rate
Start: 2/28/1997
416 Verification of patient's ability to retain and use information
Start: 2/28/1997
417 Prior testing, including result(s) and date(s) as related to service(s)
Start: 2/28/1997
418 Indicating why medications cannot be taken orally
Start: 2/28/1997
419 Individual test(s) comprising the panel and the charges for each test
Start: 2/28/1997
420 Name, dosage and medical justification of contrast material used for radiology procedure
Start: 2/28/1997
421 Medical review attachment/information for service(s)
Start: 2/28/1997
422 Homebound status
Start: 2/28/1997
423 Prognosis
Start: 2/28/1997 | Stop: 1/1/2008 | Last Modified: 7/9/2007
424 Statement of non-coverage including itemized bill
Start: 2/28/1997
425 Itemize non-covered services
Start: 2/28/1997
426 All current diagnoses
Start: 2/28/1997
427 Emergency care provided during transport
Start: 2/28/1997
428 Reason for transport by ambulance
Start: 2/28/1997
429 Loaded miles and charges for transport to nearest facility with appropriate services
Start: 2/28/1997
430 Nearest appropriate facility
Start: 2/28/1997
431 Provide condition/functional status at time of service
Start: 2/28/1997
432 Date benefits exhausted
Start: 2/28/1997
433 Copy of patient revocation of hospice benefits
Start: 2/28/1997
434 Reasons for more than one transfer per entitlement period
Start: 2/28/1997
435 Notice of Admission
Start: 2/28/1997
436 Short term goals
Start: 2/28/1997
437 Long term goals
Start: 2/28/1997
438 Number of patients attending session
Start: 2/28/1997
439 Size, depth, amount, and type of drainage wounds
Start: 2/28/1997
440 why non-skilled caregiver has not been taught procedure
Start: 2/28/1997
441 Entity professional qualification for service(s)
Start: 2/28/1997
442 Modalities of service
Start: 2/28/1997
443 Initial evaluation report
Start: 2/28/1997
444 Method used to obtain test sample
Start: 2/28/1997
445 Explain why hearing loss not correctable by hearing aid
Start: 2/28/1997
446 Documentation from prior claim(s) related to service(s)
Start: 2/28/1997
447 Plan of teaching
Start: 2/28/1997
448 Invalid billing combination. See STC12 for details. This code should only be used to indicate an inconsistency between two or more data elements on the claim. A detailed explanation is required in STC12 when this code is used.
Start: 2/28/1997
449 Projected date to discontinue service(s)
Start: 2/28/1997
450 Awaiting spend down determination
Start: 2/28/1997
451 Preoperative and post-operative diagnosis
Start: 2/28/1997
452 Total visits in total number of hours/day and total number of hours/week
Start: 2/28/1997
453 Procedure Code Modifier(s) for Service(s) Rendered
Start: 2/28/1997
454 Procedure code for services rendered.
Start: 2/28/1997
455 Revenue code for services rendered.
Start: 2/28/1997
456 Covered Day(s)
Start: 2/28/1997
457 Non-Covered Day(s)
Start: 2/28/1997
458 Coinsurance Day(s)
Start: 2/28/1997
459 Lifetime Reserve Day(s)
Start: 2/28/1997
460 NUBC Condition Code(s)
Start: 2/28/1997
461 NUBC Occurrence Code(s) and Date(s)
Start: 2/28/1997
462 NUBC Occurrence Span Code(s) and Date(s)
Start: 2/28/1997
463 NUBC Value Code(s) and/or Amount(s)
Start: 2/28/1997
464 Payer Assigned Claim Control Number
Start: 2/28/1997 | Last Modified: 10/31/2004
465 Principal Procedure Code for Service(s) Rendered
Start: 2/28/1997
466 Entities Original Signature
Start: 2/28/1997
467 Entity Signature Date
Start: 2/28/1997
468 Patient Signature Source
Start: 2/28/1997
469 Purchase Service Charge
Start: 2/28/1997
470 Was service purchased from another entity?
Start: 2/28/1997
471 Were services related to an emergency?
Start: 2/28/1997
472 Ambulance Run Sheet
Start: 2/28/1997
473 Missing or invalid lab indicator
Start: 6/30/1998
474 Procedure code and patient gender mismatch
Start: 6/30/1998 | Last Modified: 2/29/2000
475 Procedure code not valid for patient age
Start: 6/30/1998 | Last Modified: 2/29/2000
476 Missing or invalid units of service
Start: 6/30/1998
477 Diagnosis code pointer is missing or invalid
Start: 6/30/1998
478 Claim submitter's identifier (patient account number) is missing
Start: 6/30/1998
479 Other Carrier payer ID is missing or invalid
Start: 6/30/1998
480 Other Carrier Claim filing indicator is missing or invalid
Start: 6/30/1998
481 Claim/submission format is invalid.
Start: 10/31/1998
482 Date Error, Century Missing
Start: 2/28/1999
483 Maximum coverage amount met or exceeded for benefit period.
Start: 6/30/1999
484 Business Application Currently Not Available
Start: 2/29/2000
485 More information available than can be returned in real time mode. Narrow your current search criteria.
Start: 2/28/2001
486 Principle Procedure Date
Start: 10/31/2001
487 Claim not found, claim should have been submitted to/through 'entity'
Start: 2/28/2002
488 Diagnosis code(s) for the services rendered.
Start: 6/30/2002
489 Attachment Control Number
Start: 10/31/2002
490 Other Procedure Code for Service(s) Rendered
Start: 2/28/2003
491 Entity not eligible for encounter submission
Start: 2/28/2003
492 Other Procedure Date
Start: 2/28/2003
493 Version/Release/Industry ID code not currently supported by information holder
Start: 2/28/2003
494 Real-Time requests not supported by the information holder, resubmit as batch request
Start: 2/28/2003
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
Start: 2/29/2004
497 Sales tax not paid
Start: 6/30/2004
498 Maximum leave days exhausted
Start: 6/30/2004
499 No rate on file with the payer for this service for this entity
Start: 6/30/2004
500 Entity's Postal/Zip Code
Start: 6/30/2004
501 Entity's State/Province
Start: 6/30/2004
502 Entity's City
Start: 6/30/2004
503 Entity's Street Address
Start: 6/30/2004
504 Entity's Last Name
Start: 6/30/2004
505 Entity's First Name
Start: 6/30/2004
506 Entity is changing processor/clearinghouse. This claim must be submitted to the new processor/clearinghouse
Start: 6/30/2004
507 HCPCS
Start: 10/31/2004
508 ICD9
Start: 10/31/2004
509 E-Code
Start: 10/31/2004
510 Future date
Start: 10/31/2004
511 Invalid character
Start: 10/31/2004
512 Length invalid for receiver's application system
Start: 10/31/2004
513 HIPPS Rate Code for services Rendered
Start: 10/31/2004
514 Entities Middle Name
Start: 10/31/2004
515 Managed Care review
Start: 10/31/2004
516 Adjudication or Payment Date
Start: 10/31/2004
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
Start: 10/31/2004
561 Entity's Contact Name
Start: 10/31/2004
562 Entity's National Provider Identifier (NPI)
Start: 10/31/2004
563 Entity's Tax Amount
Start: 10/31/2004
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
570 Free Form Message Text
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: 7/9/2007
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 Medicare Assignment Code
Start: 10/31/2004
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
Start: 10/31/2004
634 Remark Code
Start: 10/31/2004
635 Repriced Approved Ambulatory Patient Group
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
641 Service Adjudication or Payment Date
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
Start: 10/31/2004
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: 2/28/2005
668 Missing Endodontics treatment history and prognosis
Start: 6/30/2005
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: 6/30/2006 | Last Modified: 2/28/2007
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: 6/30/2006 | Last Modified: 2/28/2007
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
Start: 10/31/2006
677 Entity not affiliated
Start: 10/31/2006
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
Start: 10/31/2006
681 Claim currency not supported
Start: 10/31/2006
682 Cosmetic procedure
Start: 2/28/2007
683 Awaiting Associated Hospital Claims
Start: 2/28/2007
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: 11/5/2007
685 Claim could not complete adjudication in real time. Claim will continue processing in a batch mode. Do not resubmit.
Start: 1/27/2008
686 The claim/ encounter has completed the adjudication cycle and the entire claim has been voided
Start: 1/27/2008
687 Claim estimation can not be completed in real time. Do not resubmit.
Start: 1/27/2008
688 Present on Admission Indicator for reported diagnosis code(s).
Start: 1/27/2008
689 Entity was unable to respond within the expected time frame.
Start: 6/1/2008
690 Multiple claims or estimate requests cannot be processed in real time.
Start: 6/1/2008
691 Multiple claim status requests cannot be processed in real time.
Start: 6/1/2008
692 Contracted funding agreement-Subscriber is employed by the provider of services
Start: 9/21/2008