EOBList
EOBList
177 Denied. Fifth ICD diagnosis code is not sufficiently specific. NULL CO 16, A1 M81
178 Denied. First diagnosis code denotes a non-industrial NULL CO 16, A1 M81
condition or is not sufficiently specific
179 Admit type is invalid. Valid admit types are 1,2,3, and 4. NULL CO 16 MA41
180 Denied. Principal procedure date is more than 2 days prior to NULL CO 26, A1 MA66
the bill's first covered date.
181 Denied. Principal diagnosis denotes a non-industrial condition NULL CO 16, A1 MA63
or is not sufficiently specific.
182 Incorrect revenue code billed for this service. NULL CO 16, A1 M50
183 The units of service are missing or invalid. NULL CO 16, A1 M53
184 Charge is missing or $0.00; invalid (rate X days not equal to DU CO 16, A1 M79
charge); or CPT category 2 code.
185 The admission date is missing. NULL CO 16, A1 MA40
186 Denied. The provider has already been paid for this service NULL CO 18 M86
under his individual L&I provider number.
187 Denied. The clinic has already been paid for this service under NULL CO 18 M86
the clinic's L&I provider number.
188 Denied. Second diagnosis denotes a non-industrial condition NULL CO 16, A1 M81
or is not sufficiently specific.
189 Denied. Third diagnosis denotes a non-industrial condition or NULL CO 16, A1 M81
is not sufficiently specific.
450 Denied. The admittance date is not within the date span for the NULL CO 15 MA40, N54
billed notification (PA) number
451 Denied. The 10 digit prior authorization (PA) number is for an NULL CO A1 M62
admission denied by L&I Claim Manager.
452 Denied. The prior authorization (PA) number on the bill is not NULL CO 15, A1 N54
a valid number for this claim.
453 Denied. L&I has not received the required documentation for NULL CO 16, A1 N29
this admission.
454 For admit dates of July 18, 1988 and after include the prior NULL NULL NULL NULL
authorization number in field 91.
455 Outpatient service within 24 hrs of an admit must be billed as NULL CO 60 M2
inpatient on the inpatient bill.
456 This readmission/transfer has been denied as a result of a NULL CO A1 N35
medical review.
457 Denied. CPT coding was on the bill. Pain clinic service must NULL CO A1, 16 M50
be billed by revenue code.
458 We have changed the units billed to 1 and paid the procedure NULL CO 226 M53
at the rate for 1 unit of service.
459 Excessive units of service were billed. Enter 1 unit for each NULL CO P12 M53
time the procedure was performed.
460 Denied. A telephone call to your office verified that errors NULL CO A1, 16 MA62
were made in the charges billed.
461 Denied. Immunization procedures include the cost of NULL CO 97 M14
materials.
462 Denied. Procedure 97261 is payable only when an additional NULL CO A1, 96 NULL
area of the body is manipulated.
463 Denied. Payment for room accommodation charge for the date NULL CO 96, A1 N153
of discharge is not payable.
498 An adjustment to this bill is in process and will appear on a 87 CR P12 NULL
future remittance advice.
562 Avoid possible bill rejection. Please contact your nearest NULL NULL NULL NULL
service location for current bill forms.
566 Manually priced due to other surgery bills with same date. NULL CO 59, 45 N10
Modifiers are ranked within bill only.
580 Denied. Service payable at intervals of no less than 6 months. NULL CO A1, P12 N640
See WA RBRVS payment policies.
582 NULL NULL NULL NULL
583 Denied. This is not a managed care pilot claim. Rebill using NULL CO 16 N290
your non-managed care provider #.
589 Codes not payable in combination. Rebill exam with codes in NULL CO A1 N20
range of 90671-90695 or Z0001-Z0045
598 Action is being taken. Do not send rebill, adjustment or NULL CO 133 NULL
appeal until you receive notice of payment decision. After 60
days call L&I 800-848-0811.
599 Action is being taken. Do not send rebill, adjustment or NULL CO 133 NULL
appeal until you receive notice of payment decision. After 60
days call L&I 800-848-0811.
600 Return letter for inpatient hospital bills containing multiple NULL NULL NULL NULL
charges for unrelated conditions.
609 Return letter for invalid inpatient hospital ICD codes. NULL NULL NULL NULL
610 Return letter for problem with principal (first) diagnosis on NULL NULL NULL NULL
hospital bill.
611 Return letter for hospital bill with invalid data. NULL NULL NULL NULL
612 Return letter for inpatient hospital bill with invalid age or sex- NULL NULL NULL NULL
code data.
613 Return letter for skilled nursing facility charge submitted on a NULL NULL NULL NULL
UB92.
614 Return letter for inpatient hospital bills that have invalid data NULL NULL NULL NULL
and DRG cannot be assigned.
617 Return letter for possible duplicate bill. NULL NULL NULL NULL
621 Return letter for late charges that must be requested by NULL NULL NULL NULL
adjustment to previously paid bill.
622 Return letter for inpatient bill with invalid units of service for NULL NULL NULL NULL
room charges.
623 Return letter for IP bill submitted without prior notification NULL NULL NULL NULL
and selected for audit.
635 Return letter for bill using "old" and "new" IME codes. NULL NULL NULL NULL
Provider instructed to resubmit bill using only one type of
procedure code.
636 Return letter for IP bill regarding admit & discharge dates NULL NULL NULL NULL
being equal.
637 Return letter for IP bill for incorrect information on bill. NULL NULL NULL NULL
640 Return letter for IME bill. Another bill for this date of service NULL NULL NULL NULL
was previously paid under different procedure codes.
641 Return letter for bill using out-of-date procedure code for a NULL NULL NULL NULL
disability rating or an IME. Provider instructed to refer to
current IME handbook.
645 Return letter for compound drugs billed incorrectly. NULL NULL NULL NULL
811 Portable/mobile x-rays not payable to hospital based NULL CO 5, A1, 171 N95, M97
providers.
812 Bill physician assistant with PA name, supervising physician NULL CO 16 N296, N297
name and physician provider number.
813 Denied. Rental fees cannot exceed purchase price. NULL CO A1, 108 M7
814 Denied. Lab work is not payable when billed with complex NULL CO A1 N20
assessment.
815 Denied. Provider is not a L&I approved Independent Medical NULL CO A1, 185 N31
Examiner.
816 Denied. Please bill Kaiser / Attn: Kathleen Sharp / 2701 NW NULL OA 109 NULL
Vaughn #700 / Portland, OR 97210
817 Free Standing surgical center not payable for this surgical NULL CO 5, A1, 171 N95
procedure.
818 Denied. Bill the primary occupational medicine managed care NULL OA 109 NULL
provider.
819 Denied. Worker's MCPP participation period has ended. Rebill NULL NULL NULL NULL
using fee for svc provider #.
820 Denied. Service included in Pain Clinic fees and not payable NULL CO B13, A1 N390
separately.
860 Invalid data removed from prior authorization (PA) field. NULL CO 16 M62
Leave blank if not required. Invalid data causes delay.
861 Denied. There is no employer/employee relationship. NULL PR A1, 31 MA89
862 Denied. Travel not authorized on pension claims with or NULL NULL NULL NULL
without a treatment order.
863 Denied. Bill submitted without prior authorization. Call NULL PI 15, A1 M62
utilization review (UR) vendor 800-541-2894. Rebill when
authorized.
864 Allowed amt. Is $0.00. Immunobiologic is distributed at no NULL CO P13 NULL
cost by Centers for Disease Control.
865 Denied. Chart notes required for service billed. No chart notes NULL CO A1 N29
received.
866 Denied. Call utilization review (UR) vendor 800-541-2894 to NULL PI 15, A1 M62
be reviewed. Rebill when authorized.
867 Decision made by L&I Office of the Medical Director to pay NULL PI 137 N11
for noncovered services.
908 Denied. Service is included in flat fee. NULL CO A1, B13 M15
909 Service balance was previously paid in this claim or a related NULL CO B13 NULL
claim for this injured worker.
910 Bill adjusted. There was an error in your computation. NULL CR 129 MA67
911 This service was paid on a diagnostic basis only. NULL CO P12 M17
912 Adjusted charge. Unlisted fee set by L&I allowed. NULL CR P12 NULL
913 Consultation fee paid; treatment fees paid only to the attending NULL CO B10, P12 NULL
physician.
914 Reopening exam and application paid; claim remains closed. M5 CO P12 NULL
915 Rebill physician professional fees on CMS-1500 with CPT-4 NULL CO 16 N34, M51
service codes.
916 Denied. Multiple procedures/diagnoses/dates in a line item NULL CO A1 N63
cannot be processed. Rebill services
917 Denied. Wrong diagnosis or procedure code used for the NULL CO 11, A1 N56
described condition or service billed.
918 Report/documentation submitted does not justify the code NULL CO A1 M69
and/or fee billed.
954 Denied. There are no funds approved for this procedure code. NULL NULL NULL NULL
Contact vocational counselor.
955 These services were paid by a hand warrant. NULL CO B13 NULL
956 Reopening examination and application paid. Claim reopening NULL CO 133 NULL
is under consideration.
957 This is a deduction from the interim payment. NULL CR P12 NULL
958 Adjusted. Mileage allowed based on number of miles by NULL NULL NULL NULL
shortest direct route only.
959 Denied or adjusted. The per diem rate allowed includes NULL NULL NULL NULL
lodging and meals for the day.
960 Denied. Side of body treated disagrees with the side of body NULL CO 96, A1 N578
accepted as injured in this claim.
961 Denied. This is not a Washington state industrial injury. NULL CO A1, 109 N643
962 Adjusted. Remaining balance from this procedure fund paid. NULL NULL NULL NULL
Notify the vocational counselor.
963 This deduction is taken for payment(s) made in error. NULL CR P12 NULL
964 This payment is made for a deduction which was taken in NULL CR P12 NULL
error.
965 Denied. Injured worker expired prior to date of this service. M5 CO 13 NULL
966 This is a rebill, check for prior payment. If none received, NULL CO B13 NULL
resubmit.
967 No payment made because there were no charges listed on DU CO 16 M79
your billing.
968 Denied. The listed value for this service includes the NULL CO A1, 45 M15
professional component.
969 Denied. Provider tape billing fee is limited to one charge per NULL NULL NULL NULL
claim in any 30 day period.
970 Reopening denied. NULL CO A1 N578
A16 Denied. Noncovered service per code editor. NULL CO 96, A1 N578
A17 Denied. Condition code 21 (verification of denial) billed. NULL CO A1 M44
A18 Denied. Condition code 20 (submitted for review) billed. NULL CO A1 M44
A19 Denied. Defined as "questionable covered service" by code NULL CO 50 NULL
editor.
A20 Denied. Per code editor. Code indicates site of service not in NULL CO 5 NULL
Outpatient Prospective Payment System (OPPS).
A21 Denied. Service units outside of range allowed for procedure. NULL CO A1 M53
For units consideration, submit adjustment with justification
for additional units.
A22 Denied. Per code editor, multiple bilateral procedures were NULL CO 4 NULL
billed without modifier -50.
A23 Denied. Per code editor, specification of bilateral procedure is NULL CO 4 NULL
inappropriate.
A24 Denied. Even with modifier, code editor won't allow this NULL CO A1 NULL
mutually exclusive or component procedure.
A25 Denied. Per code editor, medical visit without modifier -25 not NULL CO 4 NULL
allowed with type "T" or "S" procedure.
A27 Denied. Per code editor, terminated bilateral procedure can't NULL CO A1 M53
have more than 1 unit.
A36 Denied. Per code editor, revenue code is invalid. NULL CO A1 M50
A37 Denied. Inpatient bill submitted without patient prior NULL CO 129 N473
authorization (PA#) number. Correct/obtain prior
authorization number and resubmit.
A38 Denied. Per code editor partial hospitalization requirements NULL CO A1 N719
are not met.
A41 Denied. Per code editor, service has not met the criteria for NULL CO A1 N180
separate observation payment.
A42 Denied. Per code editor, observation service cannot be billed NULL CO A1 M50
unless type of bill is 13X.
A43 Proc code not authd. For assistance contact L&I Medical NULL CO 15, P13 NULL
Director's Office at 360-902-5036 or contact 360-902-6818 for
IME related procedure codes.
A44 Bill denied. Per code editor, CA modifier requires patient NULL CO A1 N34
status code 20.
M08 Denied. Claim not allowed. Please rebill this service if claim NULL NULL NULL NULL
is allowed.
P01 Go to <http://www.lni.wa.gov/forms/pdf/248011a0.pdf> to NULL NULL NULL NULL
print & complete a provider application.
P02 Paid. One-time only provider number authorized. NULL CO 45 NULL
P09 Line adjusted due to refund. Other lines may adjust due to NULL CO P12 NULL
payment policies.
P10 Refund applies to related bill adjustment(s) which may affect NULL CO P12 NULL
multiple claim numbers.
P11 This transaction reflects a refund that clears a credit balance NULL CO P12 NULL
and corrects year to date info.
P12 Processed per direction of the Provider Review and Education NULL CO 12 N10
Section.
P13 The performing and/or payee provider account number was NULL CO 16 N77
terminated at your request. For assistance call 360-902-5140.
P14 Denied. Use of this procedure code is invalid for this provider NULL CO A1 N56
type on this date of service
P15 Denied. 1101M cannot be billed without 1100M. Please NULL CO A1 N182, N380
correct and rebill using appropriate procedure code.
P16 Denied. Our records indicate the injured worker did not take NULL CO A1 N675, N441
the flight.
P17 Service was paid on a more recent invoice sent to L&I. NULL CO B13 NULL
P18 Our records indicate your internship dates have ended. NULL CO P13 NULL
Contact Provider Credentialing at 360-902-5140.
P20 This transaction transfers your debt to L&I Collections. NULL OA 12 NULL
P25 This procedure code is not payable on the same day as the NULL CO A1 N20
IME.
P26 Add on procedures must be billed with primary code. NULL CO P12 NULL
P27 PT (97001-97799) not payable to chiropractors. Refer to WA NULL CO P13 NULL
State Fee Schedule to determine if service meets requirements
to be billed under 1040M.
P28 Denied. Rental is monthly. One month or less = 1 unit of NULL CO A1 MA32, M53
service. # of units = # of rental months calculated from 1st to
last date of service.
P29 Denied. 1 day is = to 1 unit of svc. The # of units must equal NULL CO A1 M53, MA32
the # of rental days calculated from the 1st date of svc to the
last date of svc.
P30 Denied. Modifier -7N may only be used with X-ray, lab NULL CO P13 M78
services, and other allowed diagnostic tests performed in
conjunction with an IME.
P31 Denied. Provider does not have valid credentials for date of NULL CO B7, A1 N612
service billed.
P32 Denied. Procedure undergoing review. NULL CO 133 NULL
P33 Denied. This procedure is only payable when billed with an NULL CO P13 NULL
IME exam code.
q06 Per review by L&I therapy consultant. NULL CO W1 N10
P34 Payment processed per Operations/MIPS Manager's NULL CO P12 N10
authorization.
P60 Denied. Date of service is after provider's date of death. NULL CO P13 NULL
P61 Denied. Radiology consultation service can only be performed NULL CO A1 N95
by a provider with a specialty for radiology diagnostic.
Provider specialty type 30.
P62 Denied. Individual name of provider must be listed under NULL CO A1 N225
appointment information on Interpreter Services Appointment
Record (ISAR).
P63 Denied. Same day charges for same claim number must be on NULL CO P13 NULL
the same bill. Please submit adjustment to the paid bill.
P64 Denied. Signed Interpreter Services Appointment Record NULL CO A1 N225
(ISAR) has not been received for date of service.
P65 Lines were added to your bill to split your charges to match NULL CO P12 NULL
multiple referral dates.