Usage: Do not use this code for claims attachment(s)/other documentation. The authorization number is missing, invalid, or does not apply to the billed services or provider.Ĭlaim/service lacks information or has submission/billing error(s). The date of birth follows the date of service.
The date of death precedes the date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The diagnosis is inconsistent with the provider type.
The diagnosis is inconsistent with the procedure. The diagnosis is inconsistent with the patient's gender. The diagnosis is inconsistent with the patient's age. The procedure code is inconsistent with the provider type/specialty (taxonomy). The procedure/revenue code is inconsistent with the patient's age. The procedure code/type of bill is inconsistent with the place of service. The procedure code is inconsistent with the modifier used. The payer does not always use the mandated additional RARC code, which I am dealing with the Simplification Act Mandate per payer to fix. The procedure/revenue code is inconsistent with the patient's sex. Should be changed to be accurate which would be: The procedure/revenue code is inconsistent with the patient's gender. Due to Federal/State Mandate Continuity of Care (CoC), this claim has been processed at the In-Network level of benefit
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