26
Claim Adjustment Reason Codes-Texas
Code
Description Denial Language
3 SERVICE NOT AUTHORIZED
There is no authorization on file for these services.
7
SKILLED NURSING DAYS BENEFIT
EXHAUSTED
This claim exceeds the maximum of 100 days per benefit period in a Medicare certified skilled nursing
facility.
8 PREDATES ELIGIBILITY WITH PLAN
This service was rendered prior to the Member's effective date with Bravo Health.
9 POSTDATES ELIGIBILITY W/PLAN
This service was rendered after the Member's Bravo Health coverage ended.
14 PATIENT ENROLLED IN HOSPICE
Please submit this claim to Medicare. The patient is enrolled in Hospice.
15 DME RENTAL FOR 15 MOS. ONLY
Rental for durable medical equipment is capped at 15 months. No additional benefits are available for
this equipment.
16 MEDICAL RECORDS REQUIRED
Please resubmit this claim with medical records.
17 INVALID PROCEDURE CODE
The procedure code billed is not valid. Please resubmit this claim with a valid code.
18 INVALID DIAGNOSIS CODE
Please resubmit this claim with a valid ICD9 diagnosis code.
19 INVALID PLACE OF SERVICE
Please resubmit this claim with a valid place of service e code.
21 CORRECTION TO PRIOR CLAIM
This claim represents a correction to a prior claim.
22 FILING TIME LIMIT EXPIRED
All claims for participating Providers must be submitted within 180 days of the date of service. This
claim was submitted after the filing deadline.
25 AUTH EXPIRED
This service was rendered after the expiration date of the authorization.
32 SUBMITTED W/O NDC NUMBERS
Please resubmit this claim with National Drug Code number(s).
33 SUBMITTED W/O DETAIL
Please resubmit this claim with a detailed bill showing the charges and specific services for each date
of service.
35 SUBMITTED W/O CPT CODES
Please resubmit with a valid CPT4 code.
36 INCLUDED IN PER DIEM
Reimbursement for this service is included in the per diem payment.
37 INCLUDED IN BASE RATE
Reimbursement for this service is included in the base rate.
38 SUBMITTED W/O HCPCS CODE
Please resubmit this claim with HCPCS codes.
39 MISSING DATE OF SERVICE
Please resubmit with dates of service.
60 ANESTHESIA TIME UNITS
This line item represents the payment of the anesthesia time units.
61 MISSING ANESTHESIA TIME UNITS
The claim was submitted without anesthesia time or anesthesia time units. Please resubmit the claim
to indicate the length of time the patient was anesthetized.
63 DISCONTINUED PROCEDURE CODE
The procedure code billed has been discontinued. Please resubmit with a current procedure code.
72 SKILLED AT DIFFERENT LEVEL
The skill level billed is different than the skill level that was authorized. This claim has been
processed according to the level authorized.
76 MISSING NUMBER OF UNITS
Please resubmit with the number of units specified.
82 INCORRECT PLACE OF SERVICE
Please resubmit with the correct place of service.
91 MISSING DIAGNOSIS
Please resubmit with appropriate diagnosis codes.
102 BILL WITH CPT ANESTHESIA CODES
Anesthesia claims must be submitted with ASA codes. Please resubmit this claim with ASA codes.
103 PREDATES AUTHORIZATION DATES
This service was rendered before the effective date of the authorization.
