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Audit Trail Edit Explanations
(Revised 07/21/10)
| Loop Descriptions | |
|---|---|
| 1000A | Submitter |
| 1000B | Receiver |
| 2010AA | Billing provider |
| 2010AB | Pay-to provider |
| 2010BA | Subscriber |
| 2010BB | Payer |
| 2310A | Claim level referring provider |
| 2310B | Claim level rendering provider |
| 2310C | Claim level purchased service provider |
| 2310D | Claim level service facility location |
| 2310E | Claim level supervising provider |
| 2330A | Other subscriber |
| 2330B | Other payer |
| 2420A | Line level rendering provider |
| 2420B | Line level purchased service provider |
| 2420C | Line level service facility location |
| 2420D | Line level supervising provider |
| 2420E | Line level ordering provider |
| 2420F | Line level referring provider |
ERF Message Detail
Edit level: S = Submitter, B = Beneficiary, P = Provider, L = Line
| Edit #/ Level | Edit Message and Description |
|---|---|
| 000 C | CLAIM ACCEPTED This claim was accepted. |
| 001 S | SUBMITTER ID NOT ON FILE The submitter code in the ISA06 is not valid. |
| 002 S | 1000A SUBMITTER ID DOES NOT MATCH ISA06 The submitter code in the 1000A loop does not match the submitter code in ISA06. |
| 003 S | GS02 SUBMITTER ID DOES NOT MATCH ISA06 The submitter code in GS02 does not match the submitter code in ISA06. |
| 004 S | INVALID T/P INDICATOR FOR XXXX ISA15 = 'P' and file was submitted as a test file, or ISA15 = 'T' and file was submitted as a production file. XXXX = ‘PROD’ or ‘TEST’ |
| 005 S | INVALID NUMBER : XXXXXXXXXXXXXXX IN LOOP XXXXXX/PER Contact phone number in the PER segment contains spaces, letters, or other invalid characters. |
| 006 S | STOP DATE FOUND XXXXXXXXXX YYYYYYYYY Submitter ID has not been used for at least six months and has been deactivated. Complete a new EDI Application to have this submitter code reactivated. |
| 007 S | INTERCHANGE DATE GREATER THAN CURRENT DATE The date of the file is greater than the current date. This usually indicates the date on the system that created the file is not correct. |
| 008 S | BHT DATE GREATER THAN CURRENT DATE The file creation date is greater than the current date. This usually indicates the date on the system that created the file is not correct. |
| 010 S | PER/EX (TELEPHONE EXTENSION) MUST BE PRECEDED
BY PER/TE (TELEPHONE) Submitter contact phone number contains an extension number in the PER segment without a preceding “TE” qualifier. |
| 011 S | INVALID RECEIVER ID – XXXXXXXX
IN LOOP 1000B The receiver ID in the NM109 was invalid. For Alabama the receiver ID is 10102, for Georgia it is 10202, for Mississippi it is 00512, and for Tennessee it is 10302. The invalid number used will appear in the edit text. |
| 012 S | FIRST NAME OR MIDDLE NAME OR SUFFIX NOT ALLOWED
BY MEDICARE IN LOOP XXXXXX WH If the value in the 1000A loop, NM102 = 2 (submitter is a non-person entity, such as a corporation), then the NM104, NM105, and NM107 must not be sent. |
| 102 P | EDI ENROLLMENT APPLICATION NOT ON FILE FOR
PROVIDER/SUBMITTER : XXXXXXXXXX/XXXXXXXXX – IN LOOP 2010AA The billing provider NPI is invalid or not set up for electronic claims filing under the submitter code used. May also indicate a group number is required for this practice but was not used. |
| 105 P | INV STATE CD FOR XXXXXXXX A state code in the billing or pay-to provider address is not valid. XXXXXXXX = 'BILLING or 'PAY TO'. |
| 106 P | INVALID TAXONOMY CODE IN LOOP XXXXXX The taxonomy code used for the billing or pay-to provider is not valid. Taxonomy codes are not required for Medicare but, if submitted, must be valid. For the most current list of taxonomy codes visit the Washington Publishing Company’s website at www.wpc-edi.com. |
| 107 P | INVALID LAST NAME FIELD IN LOOP XXXXXX The last name of the billing or pay-to provider in the indicated loop contains a prefix, such as 'DR', or a suffix, such as 'MD', or begins with a space. |
| 108 P | INVALID CITY NAME FIELD IN LOOP XXXXXX The city name in the billing or pay-to provider's address in the indicated loop is not valid or begins with a space. |
| 109 P | INVALID ZIP CODE FIELD IN LOOP XXXXXX The billing or pay-to provider's zip code in the indicated loop is invalid. The zip code field must be either five or nine numeric characters. All nines or zeros is not valid. Spaces or dashes should not be used. |
| 111 P | INVALID FIRST NAME FIELD IN LOOP XXXXXX The billing or pay-to provider's first name contains a prefix, such as 'DR', or a suffix, such as 'MD', or begins with a space, in the loop indicated. |
| 112 P | INVALID MIDDLE NAME FIELD IN LOOP XXXXX The billing or pay-to provider's middle name is invalid or begins with a space in the indicated loop. |
| 113 P | INVALID ADDRESS1 FIELD IN LOOP XXXXXX The billing provider's address1 is invalid or begins with a space in the loop indicated. |
| 114 P | INVALID ADDRESS2 FIELD IN LOOP XXXXXX The billing or pay-to provider's address2 is invalid or begins with a space in the loop indicated. |
| 115 P | INVALID NUMBER : XXXXXXXXXXXXXXX IN LOOP XXXXXX/PER Contact phone number contains spaces, letters, or other invalid characters in the indicated loop. |
| 116 P | INVALID SSN/EIN IN LOOP XXXXXX Social Security Number or Employer Identification Number in the indicated loop is invalid. |
| 118 P | SSN NOT VALID IN LOOP XXXXXX A Social Security number was sent in a loop where it is an invalid value on a Medicare claim. See the beginning of this article for an explanation of loops. |
| 119 P | CURRENCY SEGMENT INVALID FOR MEDICARE A currency (CUR) segment was submitted on a Medicare claim. This segment should not be used for Medicare. |
| 122 P | EIN OR SSN REQUIRED WHEN NPI USED IN LOOP XXXXX When the National Provider Identifier (NPI) is used in the indicated loop the EIN or Tax ID number must also be submitted. See the beginning of this article for an explanation of loops. |
| 123 P | INVALID NPI IN LOOP XXXXX The National Provider Identifier (NPI) used is not valid in the indicated loop. See the beginning of this article for an explanation of loops. |
| 124 P | PER/EX (TELEPHONE EXTENSION) MUST BE PRECEDED
BY PER/TE (TELEPHONE) Provider contact phone number contains an extension number in the PER segment without a preceding “TE” qualifier. |
| 125 P | NPI REQUIRED IN LOOP : XXXXXX WHEN PROVIDER
IDENTIFIER IS SUBMITTED The loop indicated was submitted without an NPI where one was required. See the beginning of this article for an explanation of loops. |
| 127 P | INVALID NPI/EIN OR SSN COMBINATION IN LOOP
: XXXXXX NPI used is not associated with the Tax ID/Social Security Number used in the loop indicated. See the beginning of this article for an explanation of loops. |
| 128 P | CLAIM CONTAINS A MEDICARE LEGACY ID IN LOOP
: XXXXXX Claim contained a PTAN or UPIN in the indicated loop, or the indicated loop contained a REF segment with a 1C or 1G qualifier in REF01. See the beginning of this article for an explanation of loops. |
| 129 P | NPI : XXXXXXXXXXX NOT FOUND ON UPIN CROSSWALK
FILE IN LOOP : XXXXXX NPI submitted in the indicated loop was not found on the crosswalk. See the beginning of this article for an explanation of loops. |
| 131 P | FIRST NAME OR MIDDLE NAME OR SUFFIX NOT ALLOWED
BY MEDICARE IN LOOP XXXXXX WHEN An NM102 in the indicated loop contains the value 2 which indicates a non-person entity, such as a corporation, but a first and/or middle name and/or suffix were submitted. See the beginning of this article for an explanation of loops. |
| 200 B | INVALID NUMERIC VALUE IN FIELD XXXXXXXX The PAT08 (patient’s weight) contained non-numeric characters, such as a minus sign or spaces. |
| 202 B | RAILROAD Patient is a Railroad Retiree. The claim should be submitted to the Railroad Retiree carrier. |
| 203 B | INVALID HIC NUMBER (1ST 9 NOT NUMERIC) First portion of the patient's HIC (Medicare number) contained non-numeric characters, such as a space. |
| 207 B | INVALID HIC NUMBER SUFFIX HIC (Medicare number) suffix is not valid. To see an explanation of HIC number suffixes visit http://www.cahabagba.com/part_b/education_and_outreach/newsletters/2009/2009_01.pdf and go to page 9.. |
| 208 B | INVALID SEX FOR HIC SUFFIX Suffix on HIC is gender-specific, and does not match the gender of the beneficiary. For an explanation of HIC number suffixes visit http://www.cahabagba.com/part_b/education_and_outreach/newsletters/2009/2009_01.pdf and go to page 9. |
| 212 B | INVALID PATIENT BIRTH DATE Patient's date of birth is invalid. |
| 213 B | INVALID PAYER ID OR QUAL IN 2010BB Payer ID or qualifier for the payer ID is not valid. |
| 214 B | INVALID LAST NAME FIELD IN LOOP XXXXXX Payer last name field is invalid in the loop indicated. See the beginning of this article for an explanation of loops. |
| 215 B | INVALID CITY NAME FIELD IN LOOP XXXXXX City name for payer is invalid in the loop indicated. See the beginning of this article for an explanation of loops. |
| 216 B | INVALID ZIP CODE FIELD IN LOOP XXXXXX Zip code for payer is not valid in the loop indicated. See the beginning of this article for an explanation of loops. |
| 217 B | INVALID FIRST NAME FIELD IN LOOP XXXXXX Beneficiary's first name is invalid in the indicated loop. See the beginning of this article for an explanation of loops. |
| 218 B | INVALID MIDDLE NAME FIELD IN LOOP XXXXXX Beneficiary's middle name is invalid in the loop indicated. See the beginning of this article for an explanation of loops. |
| 219 B | INVALID ADDRESS1 FIELD IN LOOP XXXXXX Beneficiary's address is invalid or equals spaces in the loop indicated. See the beginning of this article for an explanation of loops. |
| 220 B | INVALID ADDRESS2 FIELD IN LOOP XXXXXX Beneficiary's address is invalid or equals spaces in the indicated loop. Be sure the first character in the beneficiary’s address is not a space. See the beginning of this article for an explanation of loops. |
| 221 B | INVALID STATE FIELD IN LOOP XXXXXX Beneficiary's state abbreviation is not valid in the loop indicated. See the beginning of this article for an explanation of loops. |
| 222 B | INVALID COUNTRY FIELD IN LOOP XXXXXX Country field was used and contains invalid data in the indicated loop. See the beginning of this article for an explanation of loops. The country field is not required for Medicare. |
| 223 B | PATIENT MUST BE SUBSCRIBER The claim indicated the patient is not the Medicare beneficiary. For a Medicare claim the patient is always the beneficiary. SBR02 was not equal to 18. |
| 224 B | INVALID QUAL (SY) IN 2010BA/REF 2010BA loop, REF01 (Subscriber name), contains the SY qualifier (Social Security Number). SY may not be used for Medicare in the 2010BA loop. |
| 226 B | INVALID SSN/EIN IN LOOP XXXXXX Social Security Number or Employer Identification number entered is invalid in the indicated loop. See the beginning of this article for an explanation of loops. |
| 227 B | SUBSCRIBER MUST BE A PERSON Claim indicates that subscriber is a non-person entity. The subscriber is always a person for Medicare. (2010BA loop, NM102 contains a 2.) |
| 228 B | 2000C LOOP INVALID FOR MEDICARE 2000C loop was used for a Medicare claim. 2000C is used when the patient is not the subscriber and the patient is always the subscriber for Medicare. |
| 229 B | INVALID QUALIFIER IN 2010BA/NM108 Qualifier in Subscriber Name segment is not equal to MI. |
| 230 B | INVALID DATE FIELD IN XXXX/PAT/XXX/XXX-CCYYMMDD Date submitted in the indicated loop was invalid or not in the correct format. See the beginning of this article for an explanation of loops. |
| 231 B | INVALID NPI IN LOOP XXXXX National Provider Identifier (NPI) submitted was not valid in the referenced loop. See the beginning of this article for an explanation of loops. |
| 300 C | INVALID NUMERIC VALUE IN FIELD XXXXXXXX A numeric field contained non-numeric data or spaces in the indicated field. |
| 301 C | INVALID TOTAL CLAIM CHARGES Total claim charges were invalid or missing or contained non-numeric characters, such as spaces or a minus sign. |
| 302 C | INVALID BILLING (NO CHARGES BILLED) Claim did not contain any charges. |
| 303 C | CLAIM CHARGE NOT = TOTAL OF LINE CHARGES Total billed amount on the claim is not equal to the total of the line charges. |
| 304 C | CLAIM XXXXXXXXXXX PROVIDER ID REQUIRED Referring/ordering physician's UPIN was required and is missing. |
| 307 C | DIAG CODE (XXXXX) INVALID OR INACTIVE The date of service on the claim was before the effective date or after the end date of the ICD-9 code used. |
| 308 C | MULTIPLE MEDICARE CONTRACTS NOT VALID Primary and secondary insurance information were both submitted as Medicare. Qualifier ‘MB’ is present in 2000B loop, SBR09, and the 2320 loop, SBR05 or SBR09. |
| 309 C | INVALID INSURANCE TYPE CODE FOR MSP An invalid insurance type code was used for primary or secondary insurance. This is the code that identifies the type of insurance policy within a specific insurance program (Working Aged, No-Fault Auto, Worker’s Compensation, etc.). |
| 310 C | INVALID CLAIM FREQUENCY Claim frequency code in the CLM05 – 3 must be a 1 (original claim). |
| 311 C | NOT A MEDICARE PART B CLAIM This was not a Medicare Part B claim. Claim filing indicator code in the SBR segment for neither the primary nor the secondary payer was = MB. |
| 313 C | AUTO ACCIDENT STATE CODE INVALID State abbreviation for the location of the accident (2300 loop, CLM11 – 4) was invalid. |
| 314 C | ACCIDENT DATE MISSING OR INVALID The date of the accident was required and was omitted or not valid. |
| 315 C | ACCIDENT TIME INVALID The time of the accident was not valid. |
| 316 C | INVALID PATIENT PAID AMOUNT Patient paid amount was invalid. One possibility is the patient paid amount contained a negative amount. |
| 317 C | INVALID TAXONOMY CODE IN LOOP XXXXXX An invalid taxonomy code was used in the loop indicated. For a list of current taxonomy codes visit the Washington Publishing Company’s website at www.wpc-edi.com. See the beginning of this article for an explanation of loops. Taxonomy codes are not required for Medicare but, if used, must be valid. |
| 318 C | HOMEBOUND INDICATOR REQUIRED A homebound indicator in the CRC03 segment, loop 2300, was required and was missing from the claim. |
| 319 C | INVALID LAST NAME FIELD IN LOOP XXXXXX A provider's last name field on the claim is invalid. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 320 C | INVALID CITY NAME FIELD IN LOOP XXXXXX A city name is invalid or equals spaces. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 321 C | INVALID ZIP CODE FIELD IN LOOP XXXXXX A zip code on the claim was invalid. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 322 C | INVALID CLAIM LEVEL CLIA NUMBER The CLIA number in the 2300 loop was invalid. |
| 323 C | INVALID FIRST NAME FIELD IN LOOP XXXXXX A first name field on the claim is invalid. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 324 C | INVALID MIDDLE NAME FIELD IN LOOP XXXXXX A middle name was invalid or equal to spaces. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 325 C | INVALID ADDRESS1 FIELD IN LOOP XXXXXX An address was invalid or equal to spaces. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 326 C | INVALID ADDRESS2 FIELD IN LOOP XXXXXX An address was invalid or equal to spaces. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 327 C | INVALID STATE FIELD IN LOOP XXXXXX A state abbreviation on the claim is invalid. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 328 C | INVALID COUNTRY FIELD IN LOOP XXXXXX Country field was used on the claim and contains an invalid value. The country field is not required for Medicare. See the beginning of this article for an explanation of loops. |
| 329 C | INVALID DATE FIELD IN XXXX/DTP/XXX/XXX-XXX/XXX-CCYYMMDD A date on the claim was in an invalid format. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 330 C | INVALID CLAIM FILING INDICATOR An invalid claim filing indicator was used in the 2000B loop, SBR09. |
| 331 C | INVALID PATIENT PAID AMOUNT Patient amount paid on the claim was invalid. One possibility is this amount was submitted as a negative number. |
| 332 C | INVALID INS TYPE CD (SBR05) FOR PRIMARY MB An invalid insurance type code was used for a Medicare primary claim. |
| 333 C | INVALID PROVIDER NUMBER IN LOOP XXXXXX The NPI used in the indicated loop is not valid. See the beginning of this article for an explanation of loops. |
| 334 C | DIAGNOSIS CODE REQUIRED No ICD-9 (diagnosis) code was submitted on the claim. |
| 336 C | INVALID INS TYPE CD (2320/SBR05) Insurance type code used in the SBR05 segment, 2320 loop, is not valid. |
| 337 C | SERVICE FACILITY LOOP INVALID FOR POS=12 Place-of-service code used is 12 (patient's home) but facility information was given on the claim. Facility information should not be given for place-of-service 12. |
| 339 C | INVALID USAGE OF PRV SEGMENT IN LOOP XXXXX PRV segment exists in both billing and rendering provider loops. If a rendering provider NPI is being submitted (2310B loop) then the PRV segment should be submitted in the rendering provider loop instead of the billing or pay-to provider loops. See the beginning of this article for an explanation of loops. |
| 340 C | INS TYPE CD (2320/SBR05 = XX) INVALID AS PRIMARY SBR01 in 2320 loop = P and SBR05 = CP, MB, MC, MI, or MP. |
| 341 C | PAYER PAID AMT IS MISSING FOR 2320/SBR01 =
P SBR01 in 2320 loop = P and 2320/AMT is missing. Claim indicates Medicare is secondary and the primary amount paid was missing. Zero is an acceptable value. |
| 342 C | CLM11 REQUIRED WHEN ACCIDENT DATE PRESENT Related causes element must be used when an accident date (2300 loop, DTP segment with a 439 qualifier) is included on the claim. |
| 343 C | 2320/SBR01 MUST = P WHEN 2000B/SBR01 = S No primary payer was identified on the claim. |
| 344 C | AMT02 > 99,999.99 Dollar value for the claim exceeded $99,999.99 |
| 345 C | MORE THAN 1 2320/SBR01 = S SUBMITTED More than one payer was identified as secondary. |
| 346 C | INVALID NUMBER : XXXXXXXXXXXXXXX IN LOOP XXXXXX/PER Contact phone number is invalid or contains spaces or invalid characters. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 347 C | CR1 SEGMENT REQUIRED FOR AMBULANCE CLAIMS The CR1 segment, containing ambulance transport information, is required for ambulance claims. |
| 348 C | ADMISSION DATE REQUIRED Admission date is required for place of service codes 21, 51, 61, 41 (for hospital-to-hospital transports), and 42 (for hospital-to-hospital transports). |
| 349 C | INVALID SSN/EIN IN LOOP XXXXXX Social Security Number or Employer Identification Number in referenced loop was invalid. See the beginning of this article for an explanation of loops. |
| 351 C | RENDERING PROV LOOP REQUIRED FOR GROUP PRACTICE A provider's group NPI was used but the rendering provider NPI was not given. (Warning message only.) |
| 352 C | SSN NOT VALID IN LOOP XXXXXX A Social Security Number was used but is an invalid value for this loop. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 353 C | INVALID COUNTRY CODE IN CLM SEGMENT Country code used was invalid. The country code is not required for Medicare. |
| 354 C | INVALID CLAIM LEVEL PLACE OF SERVICE Place of service code used for the claim is invalid. |
| 355 C | INVALID DOB - 2320 DMG Subscriber's date of birth on secondary insurance information is invalid. |
| 356 C | DIAGNOSIS CODES NOT IN ORDER A diagnosis code was preceded by an empty diagnosis code field. For example, primary and tertiary diagnosis codes were given, but no secondary (2300 loop, HI01 and HI03 contain ICD-9 codes but HI02 does not.) |
| 358 C | NM109 MISSING IN LOOP XXXXXX There is an NM108 present without a corresponding NM109 in the identified loop. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 359 C | REF02 MISSING IN LOOP XXXXXX There is a REF01 segment present without a corresponding REF02. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 360 C | STATE CODE REQUIRED WITH AUTO ACCIDENT Claim indicates services were the result of an accident but the two character state abbreviation where the accident occurred was not given. |
| 361 C | INVALID AMT IN 2320/CAS Claim-level adjustment amount was invalid. |
| 362 C | BILLING & RENDERING PROVIDER MUST BE
IN SAME GROUP Rendering provider NPI used is not associated with provider group NPI used. (Warning message only.) |
| 363 C | LOOP 2310B INVALID WHEN 2000A/PRV SEGMENT
IS PRESENT Taxonomy code was given for billing/pay-to provider and a 2310B loop for a rendering provider was sent. For practices billing with a group NPI the PRV should only be submitted in the 2310B loop. See the beginning of this article for an explanation of loops. |
| 364 C | LMP DATE REQUIRED WHEN PREGNANT Date of last menstrual period is required when beneficiary is pregnant. |
| 366 C | INVALID MSP AMT IN LOOP 2320 Amount the primary payer paid, allowed, adjusted, etc., was not valid. Either a required amount was missing or was negative or contained non-numeric characters. |
| 367 C | CRC SEGMENT MISSING FOR EPSDT CLAIM Claim indicates EPSDT involvement (SV111 = “Y”) and there is no corresponding CRC segment. |
| 368 C | CLAIM PAYER PAID AMOUNT DOES NOT EQUAL SUM OF LINE
PAYER PAID AMOUNTS The amount submitted as the primary payer paid for the claim does not equal the total of the amounts submitted as the primary payer paid total for the line charges. |
| 369 C | CLAIM PAYER ALLOWED AMOUNT DOES NOT EQUAL SUM OF
LINE PAYER ALLOWED AMOUNTS The amount submitted as the primary payer allowed for the claim does not equal the amount submitted as the total of the primary allowed amounts for the line charges. |
| 370 C | CLAIM OTAF AMOUNT DOES NOT EQUAL SUM OF LINE OTAF
AMOUNTS The claim level Obligate to Accept in Full (OTAF) amount is not equal to the total of the OTAF amounts for the line charges. |
| 371 C | PRIMARY MAMMOGRAPHY CODE MUST BE BILLED ON SAME CLAIM A secondary mammography code was billed without the primary mammography code. Primary and secondary mammography codes must be billed on the same claim and the appropriate secondary code must be billed for the primary code. |
| 372 C | MULTIPLE PRIMARY INSURANCES BILLED At least two payers were indicated on the claim and the value in the SBR01 segments for each = P. |
| 373 C | INVALID NPI IN LOOP XXXXXX National Provider Identifier (NPI) is not valid in the referenced loop. See the beginning of this article for an explanation of loops. |
| 374 C | PRIMARY AND SECONDARY MUST BE BILLED WITH TERTIARY |
| 375 C | PAID AMOUNT CANNOT BE GREATER THAN ALLOWED AMOUNT
OR ONE OF THESE IS MISSING |
| 376 C | INVALID ADJUSTMENT REASON CODE (XX) IN LOOP XXXXThe adjustment reason code indicated in the loop indicated is not valid. See the beginning of this article for an explanation of loops. For a list of valid adjustment reason codes visit the Washington Publishing Company’s website at www.wpc-edi.com. |
| 377 C | PAID & ADJUSTMENT AMOUNTS DO NOT EQUAL
CLAIM CHARGE AMOUNT Claim paid and adjustment amounts do not equal the total charged amount for the claim. For more information on submitting Medicare Secondary Payer (MSP) claims go to www.cahabagba.com/part_b/msp/Providers_Electronic_Billing_Instructions.htm. |
| 378 C | WHEN MEDICARE IS PRIMARY ADJUSTMENTS ARE NOT ALLOWEDMedicare was billed as the primary payer but adjustments or primary payments were submitted on the claim. For more information on submitting Medicare Secondary Payer (MSP) claims go to www.cahabagba.com/part_b/msp/Providers_Electronic_Billing_Instructions.htm. |
| 379 C | WHEN MEDICARE IS PRIMARY OTAF AMOUNT IS NOT ALLOWEDMedicare was billed as primary but an obligated to accept in full (OTAF) amount was submitted. This will appear in a CN1 segment. For more information on submitting Medicare Secondary Payer claims go to www.cahabagba.com/part_b/msp/Providers_Electronic_Billing_Instructions.htm. |
| 381 C | PER/EX (TELEPHONE EXTENSION) MUST BE PRECEDED
BY PER/TE (TELEPHONE) Claim level PER segment (contact information) contains a telephone extension number that is not preceded by the qualifier ‘EX’. |
| 382 C | NPI REQUIRED IN LOOP : XXXXXX WHEN PROVIDER
IDENTIFIER IS SUBMITTED The claim was submitted without an NPI in the indicated loop when one was required. See the beginning of this article for an explanation of loops. |
| 384 C | INVALID NPI/EIN OR SSN COMBINATION IN LOOP
: XXXXXX NPI submitted is not associated with the EIN or SSN submitted in the indicated loop. See the beginning of this article for an explanation of loops. |
| 385 C | CLAIM CONTAINS A MEDICARE LEGACY ID IN LOOP
: XXXXXX A legacy (PTAN) provider number was submitted in the indicated loop, or a REF02 = 1C or 1G. See the beginning of this article for an explanation of loops. |
| 386 C | 2300/CN102 > $99,999.99 OTAF (obligated to accept in full) amount for the claim was greater than $99,999.99. |
| 387 C | NPI : XXXXXXXXXX NOT FOUND ON UPIN CROSSWALK
FILE IN LOOP : XXXXXX NPI submitted in indicated loop was not found on the crosswalk. See the beginning of this article for an explanation of loops. |
| 388 C | INVALID DEMONSTRATION PROJECT IDENTIFIER An invalid demonstration project identifier was submitted in the 2300 loop, REF segment, with a P4 qualifier. |
| 389 C | EIN OR SSN REQUIRED WHEN NPI USED IN LOOP
XXXXXX An EIN or SSN required in the indicated loop when the NPI is used. See the beginning of this article for an explanation of loops. The EIN or SSN should be submitted in a REF segment with the appropriate qualifier. |
| 390 C | 2310C LOOP AND 2300/AMT/NE REQUIRED FOR PURCHASED
SERVICE COMPONENTS Claim indicates that some services were purchased but the provider information for the purchased service provider, or the net billed amount, were not submitted. |
| 392 C | FIRST NAME OR MIDDLE NAME OR SUFFIX NOT ALLOWED
BY MEDICARE IN LOOP XXXXXX WHEN An NM102 in the indicated loop contains the value 2 which indicates a non-person entity, such as a corporation, but a first and/or middle name and/or suffix were submitted. See the beginning of this article for an explanation of loops. |
| 393 C | CLAIM OR LINE REFERRING PROVIDER REQUIRED
WHEN PRIOR AUTH OR REFERAL NUMBER PRES Claim was submitted with a Prior Authorization Number or a Referral Number but without the NPI of the referring physician. |
| 394 C | INVALID REF SEGMENT IN LOOP : XXXXXX A REF segment was submitted in the indicated loop with an invalid or inappropriate qualifier in REF01. See the beginning of this article for an explanation of loops. |
| 399 C | CLAIM CONTAINED LINE ERRORS (NO DISPLAY) A line-level error was found on the claim. The next PBL segment will give a description of the error. |
| 401 L | INVALID LINE ITEM CHARGES Line item amount charged field was non-numeric or contained spaces or was negative. |
| 402 L | INVALID LINE ITEM AMOUNT : NNNNNNNNN Line level charges were greater than $10,000 or negative.. |
| 403 L | FROM SERVICE DATE > DATE CLAIM RECEIVE The "from" date of service on the line is greater than the date the claim was received. |
| 404 L | THRU SERVICE DATE > DATE CLAIM RECEIVE The "thru" date of service on the line is greater than the date the claim was received. |
| 405 L | AP PRV REQ MOD90 AND LAB CHGS Claim indicates purchased services were performed but the NPI of the provider who performed the services was invalid or missing. |
| 406 L | INVALID MODIFIER COMBINATION More than one modifier was submitted on this line and the modifiers form an invalid or conflicting combination. |
| 407 L | SERVICES MAY NOT SPAN YEARS From and To dates of service for this line item span years. |
| 408 L | INVALID PROCEDURE CODE Procedure code submitted was invalid. |
| 409 L | INVALID PLACE OF SERVICE FOR PROCEDURE Procedure code billed is not valid for the place-of-service code used. |
| 410 L | USE A MORE SPECIFIC PROCEDURE CODE A miscellaneous code was billed without a NTE segment in the 2400 loop for the item. |
| 411 L | MISSING OR INVALID FROM SERVICE DATE The "From" service date on the line item was missing or invalid. |
| 412 L | MISSING OR INVALID TO SERVICE DATE The "To" service date on the line item was missing or invalid. |
| 413 L | FROM SERVICE DATE > THRU SERVICE DATE The 'From" date of service is later than the 'Through' date of service on the line item. |
| 414 L | CTP03 UNIT PRICE MUST BE > 0 Unit price submitted for the drug was equal to or less than zero. |
| 415 L | FACILITY ZIP REQ FOR AMBULANCE Facility Zip is required on the line charge but was not submitted. |
| 416 L | MORE SPECIFIC DIAG CODE NEEDED=(XXXXX) There is a more specific ICD-9 code available. The ICD code in error will appear in the place of the Xs in the edit. |
| 417 L | MOD LC, LD OR RC REQ FOR CORONARY PROC A code for a coronary procedure was billed with a required modifier missing. |
| 418 L | EIN FORMAT IN THE 2420X/REF SEGMENT Tax ID number submitted in the indicated segment was in an invalid format. |
| 419 L | VALUE MUST BE PRESENT IN EITHER SV504 OR SV505
- BUT NOT BOTH A DME rental price and a DME purchased price were both submitted . |
| 420 L | INVALID AND/OR MISSING DATE LAST SEEN Procedure code requires the date last seen by primary care physician and this is missing or invalid. |
| 421 L | DIAG CODE (XXXXX) INVALID FOR DATE SVC The ICD-9 code used was not valid on the date of service billed. The invalid diagnosis code will appear in the edit in the place of the Xs. |
| 422 L | INVALID ID FOR MAMMOGRAM PROCEDURE Mammography certification number billed is not valid. |
| 423 L | AMBULANCE MODIFIER MISSING OR INVALID An ambulance code that requires a modifier was billed without one. |
| 424 L | INVALID MODIFIER =(XX XX XX XX) One of the modifiers on the item billed was not valid. The invalid modifier will be shown inside the parentheses. |
| 425 L | USE MODIFIER LT OR RT TO IDENTIFY EYE Cataract surgery was billed without the left (LT) or right (RT) to indicate on which eye the surgery was performed. |
| 426 L | CONFLICTING EMPLOYEE/CONCUR SVCS INFO Charge for anesthesia contained conflicting modifiers. |
| 427 L | INVALID REF SEGMENT IN LOOP : XXXXXX A REF segment was submitted in the indicated loop with an invalid or inappropriate qualifier in REF01. See the beginning of this article for an explanation of loops. |
| 428 L | MOD QX OR QZ REQ FOR CRNA/ANES ASSIST CRNA services billed without QX or QZ modifier. |
| 431 L | SUPPLIER OF PURCHASE SVCS NEEDED Claim indicates services were purchased but the supplier of the purchased service information is missing. (A PS1 segment in 2400 loop was sent without a corresponding 2310C or 2420B loop. The amount in PS102 must be greater than zero.) |
| 432 L | INVALID PAYER ID OR QUAL IN 2420G
Qualifier or payer ID used in 2420G loop (Other payer prior authorization or referral number) is invalid. |
| 433 L | LINE ITEM PROC QUAL MUST BE HC SV01 segment does not contain the value ‘HC’. |
| 434 L | PROC CODE REQUIRES REFERRING NPI Line item procedure code requires the NPI of the referring or ordering physician, which was omitted. |
| 435 L | LINE ITEM XXXXXXXXXXX PROVIDER ID REQUIRED A provider ID for the procedure code is required but was omitted. |
| 436 L | INVALID LINE LEVEL CLIA NUMBER CLIA number in the 2400 loop for this line item is not valid. |
| 437 L | MODIFIER AQ MISSING FACILITY INFO Facility name and address was missing when modifier AQ was used. |
| 438 L | INVALID UNITS IN SV104 Units or quantity is invalid or non-numeric. |
| 439 L | INVALID DIAG CODE POINTER FIELD IN LOOP XXXXXX There was a diagnosis code pointer in the indicated loop that was invalid. See the beginning of this article for an explanation of loops. |
| 440 L | INVALID PROCEDURE CODE FIELD IN LOOP XXXXXX There was an invalid procedure code billed in the loop indicated. See the beginning of this article for an explanation of loops. |
| 441 L | INVALID DATE FIELD IN XXXX/DTP/XXX/XXX-CCYYMMDD A date field was in an invalid format in the indicated loop. See the beginning of this article for an explanation of loops. |
| 442 L | INVALID TAXONOMY CODE IN LOOP XXXXXX A line level taxonomy code was invalid in the indicated loop. See the beginning of this article for an explanation of loops. |
| 443 L | INVALID PROVIDER NUMBER IN LOOP XXXXXX A line level NPI is not valid in the indicated loop. See the beginning of this article for an explanation of loops. |
| 444 L | SERVICE FACILITY LOOP INVALID FOR POS=12 Facility name/address information was given for place-of-service code 12 (patient's home). |
| 446 L | INVALID PROCEDURE/MODIFIER COMBINATION Modifier used is not valid with the procedure code. |
| 447 L | AMT02 > 99,999.99 Line level billed amount exceeded $99,999.99. |
| 449 L | MEA SEGMENT AND UNITS REQUIRED FOR HEMATOCRIT Hematocrit code was billed but the results were not given. |
| 450 L | INVALID NUMBER : XXXXXXXXXXXXXXX IN LOOP XXXXXX/PER An invalid phone number was given for performing physician. The loop involved will be indicated in the message. See the beginning of this article for an explanation of loops. |
| 451 L | SV102 > 99,999.99 Line item charged amount greater than $99,999.99 |
| 453 L | PAYER PAID DATE REQUIRED The date of the payment from the primary payer was not submitted on a Medicare Secondary Payer (MSP) claim. |
| 454 L | ADMISSION DATE REQUIRED The admission date is required but was not submitted. |
| 455 L | CRC SEGMENT MISSING FOR EPSDT CLAIM EPSDT screening referral information is required but was not submitted. |
| 456 L | INVALID LINE LEVEL PLACE OF SERVICE The place-of-service code used for the line-level service is invalid. |
| 457 L | INITIAL TREAT DATE REQUIRED FOR SPINAL MANIP Initial treatment date is required for spinal manipulation but was not submitted. |
| 458 L | LINE ITEM CHARGE MUST BE > 0 Line item charged was equal to or less than zero. |
| 459 L | CLIA REQUIRED W/MODIFIER 90 The CLIA of the performing lab is required for modifier 90 but was not submitted. |
| 460 L | CLAIM & LINE CLIA CANNOT MATCH CLIA was submitted at claim and line level and was identical. The CLIA should only be submitted at line-level if it is different from the CLIA submitted at claim level. |
| 461 L | CLAIM CLIA REQUIRED WHEN LINE CLIA USED Claim level CLIA (2300 loop) was not submitted when line level CLIA (2400 loop) was used. A line level CLIA should only be used when it is different from the claim level CLIA. |
| 462 L | MODIFIER 90 REQUIRED W/LINE CLIA Line level CLIA (2400 loop) was used on a line item where the procedure code was billed without the modifier 90. |
| 463 L | MODIFIERS NOT IN ORDER An empty modifier field was submitted before an occupied modifier field. For example, the first modifier field (SV101 – 3) is empty, the second (SV101 – 4) contains modifier 25. |
| 464 L | REF02 MISSING IN LOOP XXXXXX REF01 is present without a corresponding REF02 in the identified loop. See the beginning of this article for an explanation of loops. |
| 465 L | UNITS REQUIRED FOR NON ANESTHESIA SERVICES Units required (SV103 = UN) for non anesthesia procedure codes. |
| 466 L | INVALID DATE LAST SEEN: CCYYMMDD Date patient was last seen by primary care physician was invalid or submitted in an invalid format. |
| 467 L | INVALID VALUE IN MEA03 Test results must be greater than zero. |
| 468 L | INVALID AMT IN 2430/CAS Line level adjustment amount was not valid. |
| 469 L | INVALID AMT IN 2430/SVD05 Service line adjudication amount was invalid. |
| 470 L | DIAG CODE POINTER NOT IN ORDER IN LOOP XXXXXX An empty diagnosis pointer field precedes diagnosis code pointer. For example, the first diagnosis pointer (SV107 – 1) is empty, and the second (SV107 – 2) contains the value 1. See the beginning of this article for an explanation of loops. |
| 471 L | 2400/PWK SEGMENT INVALID FOR MEDICARE The line-level paperwork segment (PWK) was submitted and is invalid for Medicare. |
| 472 L | 2310C OR 2420B PURCH SVC LOOP REQUIRED W/PS1
SEGMENT When claim indicates purchased services are being billed the NPI, CLIA, etc., of the performing entity must be submitted. |
| 473 L | LINE PAID AMT REQUIRED W/LINE APPROVED AMT Line item approved amount was given without the line item paid amount for a Medicare Secondary Payer (MSP) claim. Zero is an acceptable value for the line item paid amount. |
| 474 L | CLAIM OR LINE LEVEL PAYMENT REQUIRED W/LINE
OTAF No line or claim level payment amount given with line obligated to accept in full amount for a Medicare Secondary Payer (MSP) claim. |
| 475 L | CLAIM OR LINE LEVEL PAYMENT REQUIRED W/CLAIM
OTAF No claim or line level payment amount given with claim obligated to accept in full amount for a Medicare Secondary Payer (MSP) claim. |
| 476 L | LINE APP AND PD AMT REQ'D IF MSP APP AND PD
AMT SUBMITTED If Medicare Secondary Payer approved and paid amount are given at the claim level they must also be given at the line level. |
| 477 L | MULTIPLE 2430 LOOPS NOT ALLOWED BY MEDICARE Multiple 2430 loops (line level claim adjudication information) for line item. |
| 478 L | LN FAC ST CD MUST MATCH BILLING/PAY TO PROV
ST CD State code of facility where services were rendered at the line level must match billing/pay-to provider state code. |
| 479 L | MODIFIER KZ ONLY VALID FOR CARDIO-DEFIB PROCEDURES A procedure other than a cardio-defibrillation was billed with modifier KZ. |
| 480 L | LINE PAID AMOUNT CANNOT BE GREATER THAN ALLOWED AMOUNTPrimary paid amount submitted is greater than the primary allowed amount submitted for this line charge. |
| 481 L | LINE PAYMENT INFORMATION MISSING Line payment information was not submitted. For Medicare Secondary Payer claims primary payer information should be sent at the claim level and also at the line level. |
| 482 L | INVALID ADJUSTMENT REASON CODE (XX) IN LOOP XXXXThe indicated line-level adjustment reason code was invalid in the indicated loop. For the most recent list of adjustment reason codes visit the Washington Publishing Company’s website at http://www.wpc-edi.com/custom_html/claimadjustment.htm. |
| 483 L | NDC NUMBER REQUIRED WITH PRESCRIPTION NUMBERA prescription number was given without the NDC number. |
| 484 L | PRESCRIPTION NUMBER REQUIRED WITH MODIFIER
J1 A procedure code was billed with the modifier J1 but the prescription number was not given. |
| 485 L | PS1 SEGMENT REQUIRED W/2310C OR 2420B PURCH
SVC LOOP A 2310C loop or 2420B loop was sent without a PS1 segment. |
| 486 L | PER/EX (TELEPHONE EXTENSION) MUST BE PRECEDED
BY PER/TE (TELEPHONE) Provider contact information for the line-level contained a telephone extension that was not preceded by a TE qualifier. |
| 487 L | NPI REQUIRED IN LOOP : XXXXXX WHEN PROVIDER
IDENTIFIER IS SUBMITTED The charge was submitted without an NPI in the indicated loop when one was required. See the beginning of this article for an explanation of loops. |
| 489 L | INVALID NPI/EIN OR SSN COMBINATION IN LOOP
: XXXXXX NPI submitted is not associated with the EIN or SSN submitted in the indicated loop. See the beginning of this article for an explanation of loops. |
| 490 L | CLAIM CONTAINS A MEDICARE LEGACY ID IN LOOP
: XXXXXX The indicated loop contains a legacy provider number or a REF02 = 1C or 1G. See the beginning of this article for an explanation of loops. |
| 491 L | CERTIFICATION DATE (DTP/607) NOT VALID FOR
MEDICARE Certification date should not be submitted to Medicare. |
| 492 L | 2400/CN102 > $99,999.99 OTAF (obligated to accept in full) amount for the line charge is greater than $99,999.99. |
| 493 L | INVALID MODIFIER FOR E & M CODES An evaluation and management code was billed with an inappropriate modifier. |
| 494 L | NPI : XXXXXXXXXXX NOT FOUND ON UPIN CROSSWALK
FILE IN LOOP : XXXXXX Line-level NPI submitted was not found on the UPIN crosswalk file for the indicated loop. See the beginning of this article for an explanation of loops. |
| 495 L | INVALID MODIFIER IN 2430/SVD SEGMENT On a Medicare Secondary Payer (MSP) claim an invalid modifier was submitted in the line adjudicated information |
| 496 L | INVALID MEASUREMENT CODE VALUE IN 2410/CTP
SEGMENT A measurement code value was submitted in the drug pricing information that is not valid for Medicare Part B. |
| 497 L | DMERC CRC SEGMENT INVALID FOR MEDICARE A DMERC Condition Indicator was submitted, which is not valid for Medicare Part B. |
| 498 L | EIN/SSN REQUIRED WHEN NPI USED IN LOOP XXXXXX A tax ID or Social Security Number was required and not submitted when the NPI was used in the indicated loop. |
| 888 L | INSTREAM REJECTIONA level one or level two rejection occurred. See text of edit for the reason for the rejection. |
| 998 S | BATCH REJECTED - DUPLICATE BATCH This is a duplicate of a previously transmitted batch. Original submission date, total billed amount, and control number of file will be given. |
| 999 S | BATCH ACCEPTED - NO DUPLICATE FOUND This was not found to be a duplicate of a previously transmitted batch. |
Page last updated: July 23, 2010
