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CAS Code:1 Deductible Amount

CAS Code:2 Coinsurance Amount

CAS Code:3 Co-payment Amount

CAS Code:4 The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:5 The procedure code/bill type is inconsistent with the place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:6 The procedure/revenue code is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:7 The procedure/revenue code is inconsistent with the patient's gender. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:8 The procedure code is inconsistent with the provider type/specialty (taxonomy). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:9 The diagnosis is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:10 The diagnosis is inconsistent with the patient's gender. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:11 The diagnosis is inconsistent with the procedure. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:12 The diagnosis is inconsistent with the provider type. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:13 The date of death precedes the date of service.

CAS Code:14 The date of birth follows the date of service.

CAS Code:15 The authorization number is missing, invalid, or does not apply to the billed services or provider.

CAS Code:16 Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:18 Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO)

CAS Code:19 This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.

CAS Code:20 This injury/illness is covered by the liability carrier.

CAS Code:21 This injury/illness is the liability of the no-fault carrier.

CAS Code:22 This care may be covered by another payer per coordination of benefits.

CAS Code:23 The impact of prior payer(s) adjudication including payments and/or adjustments. (Use only with Group Code OA)

CAS Code:24 Charges are covered under a capitation agreement/managed care plan.

CAS Code:26 Expenses incurred prior to coverage.

CAS Code:27 Expenses incurred after coverage terminated.

CAS Code:29 The time limit for filing has expired.

CAS Code:31 Patient cannot be identified as our insured.

CAS Code:32 Our records indicate that this dependent is not an eligible dependent as defined.

CAS Code:33 Insured has no dependent coverage.

CAS Code:34 Insured has no coverage for newborns.

CAS Code:35 Lifetime benefit maximum has been reached.

CAS Code:39 Services denied at the time authorization/pre-certification was requested.

CAS Code:40 Charges do not meet qualifications for emergent/urgent care. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:44 Prompt-pay discount.

CAS Code:45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. Note: This adjustment amount cannot equal the total service or claim charge amount; and must not duplicate provider adjustment amounts (payments and contractual reductions) that have resulted from prior payer(s) adjudication. (Use only with Group Codes PR or CO depending upon liability)

CAS Code:49 This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:51 These are non-covered services because this is a pre-existing condition. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:53 Services by an immediate relative or a member of the same household are not covered.

CAS Code:54 Multiple physicians/assistants are not covered in this case. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:55 Procedure/treatment/drug is deemed experimental/investigational by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:56 Procedure/treatment has not been deemed 'proven to be effective' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:59 Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services.

CAS Code:61 Penalty for failure to obtain second surgical opinion. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. This change effective 1/1/2017: Adjusted for failure to obtain second surgical opinion

CAS Code:66 Blood Deductible.

CAS Code:69 Day outlier amount.

CAS Code:70 Cost outlier - Adjustment to compensate for additional costs.

CAS Code:74 Indirect Medical Education Adjustment.

CAS Code:75 Direct Medical Education Adjustment.

CAS Code:76 Disproportionate Share Adjustment.

CAS Code:78 Non-Covered days/Room charge adjustment.

CAS Code:85 Patient Interest Adjustment (Use Only Group code PR)

CAS Code:89 Professional fees removed from charges.

CAS Code:90 Ingredient cost adjustment. Note: To be used for pharmaceuticals only.

CAS Code:91 Dispensing fee adjustment.

CAS Code:94 Processed in Excess of charges.

CAS Code:95 Plan procedures not followed.

CAS Code:96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:100 Payment made to patient/insured/responsible party/employer.

CAS Code:101 Predetermination: anticipated payment upon completion of services or claim adjudication.

CAS Code:102 Major Medical Adjustment.

CAS Code:103 Provider promotional discount (e.g., Senior citizen discount).

CAS Code:104 Managed care withholding.

CAS Code:105 Tax withholding.

CAS Code:106 Patient payment option/election not in effect.

CAS Code:107 The related or qualifying claim/service was not identified on this claim. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:108 Rent/purchase guidelines were not met. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:109 Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.

CAS Code:110 Billing date predates service date.

CAS Code:111 Not covered unless the provider accepts assignment.

CAS Code:112 Service not furnished directly to the patient and/or not documented.

CAS Code:114 Procedure/product not approved by the Food and Drug Administration.

CAS Code:115 Procedure postponed, canceled, or delayed.

CAS Code:116 The advance indemnification notice signed by the patient did not comply with requirements.

CAS Code:117 Transportation is only covered to the closest facility that can provide the necessary care.

CAS Code:118 ESRD network support adjustment.

CAS Code:119 Benefit maximum for this time period or occurrence has been reached.

CAS Code:121 Indemnification adjustment - compensation for outstanding member responsibility.

CAS Code:122 Psychiatric reduction.

CAS Code:128 Newborn's services are covered in the mother's Allowance.

CAS Code:129 Prior processing information appears incorrect. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:130 Claim submission fee.

CAS Code:131 Claim specific negotiated discount.

CAS Code:132 Prearranged demonstration project adjustment.

CAS Code:133 The disposition of this service line is pending further review. (Use only with Group Code OA). Note: Use of this code requires a reversal and correction when the service line is finalized (use only in Loop 2110 CAS segment of the 835 or Loop 2430 of the 837).

CAS Code:134 Technical fees removed from charges.

CAS Code:135 Interim bills cannot be processed.

CAS Code:136 Failure to follow prior payer's coverage rules. (Use only with Group Code OA)

CAS Code:137 Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.

CAS Code:138 Appeal procedures not followed or time limits not met.

CAS Code:139 Contracted funding agreement - Subscriber is employed by the provider of services.

CAS Code:140 Patient/Insured health identification number and name do not match.

CAS Code:142 Monthly Medicaid patient liability amount.

CAS Code:143 Portion of payment deferred.

CAS Code:144 Incentive adjustment, e.g. preferred product/service.

CAS Code:146 Diagnosis was invalid for the date(s) of service reported.

CAS Code:147 Provider contracted/negotiated rate expired or not on file.

CAS Code:148 Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:149 Lifetime benefit maximum has been reached for this service/benefit category.

CAS Code:150 Payer deems the information submitted does not support this level of service.

CAS Code:151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services.

CAS Code:152 Payer deems the information submitted does not support this length of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:153 Payer deems the information submitted does not support this dosage.

CAS Code:154 Payer deems the information submitted does not support this day's supply.

CAS Code:155 Patient refused the service/procedure.

CAS Code:157 Service/procedure was provided as a result of an act of war.

CAS Code:158 Service/procedure was provided outside of the United States.

CAS Code:159 Service/procedure was provided as a result of terrorism.

CAS Code:160 Injury/illness was the result of an activity that is a benefit exclusion.

CAS Code:161 Provider performance bonus

CAS Code:163 Attachment/other documentation referenced on the claim was not received.

CAS Code:164 Attachment/other documentation referenced on the claim was not received in a timely fashion.

CAS Code:165 Referral absent or exceeded.

CAS Code:166 These services were submitted after this payers responsibility for processing claims under this plan ended.

CAS Code:167 This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:168 Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan.

CAS Code:169 Alternate benefit has been provided.

CAS Code:170 Payment is denied when performed/billed by this type of provider. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:171 Payment is denied when performed/billed by this type of provider in this type of facility. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:172 Payment is adjusted when performed/billed by a provider of this specialty. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:173 Service/equipment was not prescribed by a physician.

CAS Code:174 Service was not prescribed prior to delivery.

CAS Code:175 Prescription is incomplete.

CAS Code:176 Prescription is not current.

CAS Code:177 Patient has not met the required eligibility requirements.

CAS Code:178 Patient has not met the required spend down requirements.

CAS Code:179 Patient has not met the required waiting requirements. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:180 Patient has not met the required residency requirements.

CAS Code:181 Procedure code was invalid on the date of service.

CAS Code:182 Procedure modifier was invalid on the date of service.

CAS Code:183 The referring provider is not eligible to refer the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:184 The prescribing/ordering provider is not eligible to prescribe/order the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:185 The rendering provider is not eligible to perform the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:186 Level of care change adjustment.

CAS Code:187 Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.)

CAS Code:188 This product/procedure is only covered when used according to FDA recommendations.

CAS Code:189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service

CAS Code:190 Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay.

CAS Code:192 Non standard adjustment code from paper remittance. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment.

CAS Code:193 Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly.

CAS Code:194 Anesthesia performed by the operating physician, the assistant surgeon or the attending physician.

CAS Code:195 Refund issued to an erroneous priority payer for this claim/service.

CAS Code:197 Precertification/authorization/notification absent.

CAS Code:198 Precertification/authorization exceeded.

CAS Code:199 Revenue code and Procedure code do not match.

CAS Code:200 Expenses incurred during lapse in coverage

CAS Code:201 Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. (Use only with Group Code PR) At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:202 Non-covered personal comfort or convenience services.

CAS Code:203 Discontinued or reduced service.

CAS Code:204 This service/equipment/drug is not covered under the patient’s current benefit plan

CAS Code:205 Pharmacy discount card processing fee

CAS Code:206 National Provider Identifier - missing.

CAS Code:207 National Provider identifier - Invalid format

CAS Code:208 National Provider Identifier - Not matched.

CAS Code:209 Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use only with Group code OA)

CAS Code:210 Payment adjusted because pre-certification/authorization not received in a timely fashion

CAS Code:211 National Drug Codes (NDC) not eligible for rebate, are not covered.

CAS Code:212 Administrative surcharges are not covered

CAS Code:213 Non-compliance with the physician self referral prohibition legislation or payer policy.

CAS Code:215 Based on subrogation of a third party settlement

CAS Code:216 Based on the findings of a review organization

CAS Code:219 Based on extent of injury. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF).

CAS Code:222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:223 Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created.

CAS Code:224 Patient identification compromised by identity theft. Identity verification required for processing this and future claims.

CAS Code:225 Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837)

CAS Code:226 Information requested from the Billing/Rendering Provider was not provided or not provided timely or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:228 Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication

CAS Code:229 Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. (Use only with Group Code PR)

CAS Code:231 Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:232 Institutional Transfer Amount. Note - Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions.

CAS Code:233 Services/charges related to the treatment of a hospital-acquired condition or preventable medical error.

CAS Code:234 This procedure is not paid separately. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:235 Sales Tax

CAS Code:236 This procedure or procedure/modifier combination is not compatible with another procedure or procedure/modifier combination provided on the same day according to the National Correct Coding Initiative or workers compensation state regulations/ fee schedule requirements.

CAS Code:237 Legislated/Regulatory Penalty. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:238 Claim spans eligible and ineligible periods of coverage, this is the reduction for the ineligible period. (Use only with Group Code PR)

CAS Code:239 Claim spans eligible and ineligible periods of coverage. Rebill separate claims.

CAS Code:240 The diagnosis is inconsistent with the patient's birth weight. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:241 Low Income Subsidy (LIS) Co-payment Amount

CAS Code:242 Services not provided by network/primary care providers.

CAS Code:243 Services not authorized by network/primary care providers.

CAS Code:245 Provider performance program withhold.

CAS Code:246 This non-payable code is for required reporting only.

CAS Code:247 Deductible for Professional service rendered in an Institutional setting and billed on an Institutional claim.

CAS Code:248 Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim.

CAS Code:249 This claim has been identified as a readmission. (Use only with Group Code CO)

CAS Code:250 The attachment/other documentation that was received was the incorrect attachment/document. The expected attachment/document is still missing. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

CAS Code:251 The attachment/other documentation that was received was incomplete or deficient. The necessary information is still needed to process the claim. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

CAS Code:252 An attachment/other documentation is required to adjudicate this claim/service. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT).

CAS Code:253 Sequestration - reduction in federal payment

CAS Code:254 Claim received by the dental plan, but benefits not available under this plan. Submit these services to the patient's medical plan for further consideration.

CAS Code:256 Service not payable per managed care contract.

CAS Code:257 The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)

CAS Code:258 Claim/service not covered when patient is in custody/incarcerated. Applicable federal, state or local authority may cover the claim/service.

CAS Code:259 Additional payment for Dental/Vision service utilization.

CAS Code:260 Processed under Medicaid ACA Enhanced Fee Schedule

CAS Code:261 The procedure or service is inconsistent with the patient's history.

CAS Code:262 Adjustment for delivery cost. Note: To be used for pharmaceuticals only.

CAS Code:263 Adjustment for shipping cost. Note: To be used for pharmaceuticals only.

CAS Code:264 Adjustment for postage cost. Note: To be used for pharmaceuticals only.

CAS Code:265 Adjustment for administrative cost. Note: To be used for pharmaceuticals only.

CAS Code:266 Adjustment for compound preparation cost. Note: To be used for pharmaceuticals only.

CAS Code:267 Claim/service spans multiple months. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:268 The Claim spans two calendar years. Please resubmit one claim per calendar year.

CAS Code:269 Anesthesia not covered for this service/procedure. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:270 Claim received by the medical plan, but benefits not available under this plan. Submit these services to the patient’s dental plan for further consideration.

CAS Code:271 Prior contractual reductions related to a current periodic payment as part of a contractual payment schedule when deferred amounts have been previously reported. (Use only with group code OA)

CAS Code:272 Coverage/program guidelines were not met.

CAS Code:273 Coverage/program guidelines were exceeded.

CAS Code:274 Fee/Service not payable per patient Care Coordination arrangement.

CAS Code:275 Prior payer's (or payers') patient responsibility (deductible, coinsurance, co-payment) not covered. (Use only with Group Code PR)

CAS Code:276 Services denied by the prior payer(s) are not covered by this payer.

CAS Code:277 The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lack of premium payment). (Use only with Group Code OA)

CAS Code:278 Performance program proficiency requirements not met. (Use only with Group Codes CO or PI) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:279 Services not provided by Preferred network providers.

CAS Code:A0 Patient refund amount.

CAS Code:A1 Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

CAS Code:A5 Medicare Claim PPS Capital Cost Outlier Amount.

CAS Code:A6 Prior hospitalization or 30 day transfer requirement not met.

CAS Code:A8 Ungroupable DRG.

CAS Code:B1 Non-covered visits.

CAS Code:B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.

CAS Code:B11 The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.

CAS Code:B12 Services not documented in patients' medical records.

CAS Code:B13 Previously paid. Payment for this claim/service may have been provided in a previous payment.

CAS Code:B14 Only one visit or consultation per physician per day is covered.

CAS Code:B15 This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:B16 'New Patient' qualifications were not met.

CAS Code:B20 Procedure/service was partially or fully furnished by another provider.

CAS Code:B22 This payment is adjusted based on the diagnosis.

CAS Code:B23 Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test.

CAS Code:B4 Late filing penalty.

CAS Code:B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:B8 Alternative services were available, and should have been utilized. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

CAS Code:B9 Patient is enrolled in a Hospice.

CAS Code:P1 State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. To be used for Property and Casualty only.

CAS Code:P10 Payment reduced to zero due to litigation. Additional information will be sent following the conclusion of litigation. To be used for Property and Casualty only.

CAS Code:P11 The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. To be used for Property and Casualty only. (Use only with Group Code OA)

CAS Code:P12 Workers' compensation jurisdictional fee schedule adjustment. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Workers' Compensation only.

CAS Code:P13 Payment reduced or denied based on workers' compensation jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Workers' Compensation only.

CAS Code:P14 The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To be used for Property and Casualty only.

CAS Code:P15 Workers' Compensation Medical Treatment Guideline Adjustment. To be used for Workers' Compensation only.

CAS Code:P16 Medical provider not authorized/certified to provide treatment to injured workers in this jurisdiction. To be used for Workers' Compensation only. (Use with Group Code CO or OA)

CAS Code:P17 Referral not authorized by attending physician per regulatory requirement. To be used for Property and Casualty only.

CAS Code:P18 Procedure is not listed in the jurisdiction fee schedule. An allowance has been made for a comparable service. To be used for Property and Casualty only.

CAS Code:P19 Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. To be used for Property and Casualty only.

CAS Code:P2 Not a work related injury/illness and thus not the liability of the workers' compensation carrier Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only.

CAS Code:P20 Service not paid under jurisdiction allowed outpatient facility fee schedule. To be used for Property and Casualty only.

CAS Code:P21 Payment denied based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.

CAS Code:P22 Payment adjusted based on Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional regulations or payment policies, use only if no other code is applicable. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.

CAS Code:P23 Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. To be used for Property and Casualty Auto only.

CAS Code:P3 Workers' Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. To be used for Workers' Compensation only. (Use only with Group Code PR)

CAS Code:P4 Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Workers' Compensation only

CAS Code:P5 Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. To be used for Property and Casualty only.

CAS Code:P6 Based on entitlement to benefits. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Property and Casualty only.

CAS Code:P7 The applicable fee schedule/fee database does not contain the billed code. Please resubmit a bill with the appropriate fee schedule/fee database code(s) that best describe the service(s) provided and supporting documentation if required. To be used for Property and Casualty only.

CAS Code:P8 Claim is under investigation. Note: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') for the jurisdictional regulation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). To be used for Property and Casualty only.

CAS Code:P9 No available or correlating CPT/HCPCS code to describe this service. To be used for Property and Casualty only.

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