012

Invalid Procedure Code. (ETS Note: The operator did not complete the data entry of field and used the mouse to get off the field. You must fix the data in the cc_fund screen for the consumer an edit and rebill the records through Correct Rejected Items.)

019

The referring provider number is not a seven-digit number. (ETS Note: The operator completed the data entry on this field and used the mouse to get off the field. You must fix the data on the medcc screen in Funding for this consumer, and rebill the records through Correct Rejected Items.)

038

Invalid Place of Service. (ETS Note: If the submission file is in HIPAA format, it must contain a HIPAA place of service. The place of service code in the contract file must be changed and the rejected records must be edited and rebilled through Correct Rejected Items.)

100

Suspected Duplicate of previously paid claim.

103

Duplicate Claim has previously been paid.

156

Place of service location conflicts with the procedure code. (ETS Note: The place of service in the contract file must be changed. The rejected records must be edited and rebilled through Correct Rejected Items.)

159

The provider number is not listed on the Prior Authorization File.

178

Procedure code is not covered for the provider type.

180

Provider-specific rate is not on file on the Date of Service.

202

PA number does not match a number on the PA file.

203

RID number not on Medicaid Recipient File.

205

The referring provider number is not on the Medicaid Provider File.

246

The recipient was not eligible on that Day of Service.

278

The Procedure Code was not covered on the date of service. (ETS Note: The procedure code used to bill this claim was no longer being used for this procedure or a new procedure code was used before it’s effective date. The rejected records must be edited and rebilled through Correct Rejected Items.)

281

The calculated payment amount requires manual review.

291

The calculated payment amount requires manual review.

296

The claim exceeds the billing deadline because it was received later than 90 days from the Date of Service.

405

The ICD-9-CM Diagnosis Code requires medical review by the Department.

513

This resubmittal claim contains a TCN of a claim that was denied because the deadline of 90 days was exceeded.

525

The recipient has other insurance on the Date of Service.

526

The Third Party Liability indicator conflicts with the Third-Party liability information.

535

This is a claim for a service to a recipient participating in the Mass Managed Care Program. The recipient is enrolled with a Primary Care Clinician (PCC).

537

Invalid Referral for managed care service. The referral number does not belong to the recipient’s PCC or the number is invalid.

591

Max Procedure Limit Exceeded. The procedure has been provided in excess of the limit allowed.

594/595

Procedure in conflict with previously paid services provided on same day.

770

The days or units exceed the maximum allowed for this procedure.

777

The service was provided after the expiration date of the prior authorization.

862/220

HIPAA Replacement Claim without Void. HIPAA replacement code 7 used with no 8 void claim.

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