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Appeal Denial Crosswalk Appeal Denial Crosswalk

Updated: 03.20.18

REMITTANCE ADJUSTMENT REASON CODE (RARC) DISPLAYED ON THE REMITTANCE ADVICE (RA)

DESCRIPTION

CLAIM ADJUSTMENT REASON CODE (CARC) DISPLAYED ON REMITTANCE ADVICE (RA)

GENERIC DENIAL CODE

GENERIC REASON STATEMENT

N522

THIS IS A DUPLICATE CLAIM BILLED BY THE SAME PROVIDER

18

GBA01

THIS IS A DUPLICATE SERVICE PREVIOUSLY SUBMITTED BY THE SAME PROVIDER. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 SECTION 120-120.3

N522

THIS IS A DUPLICATE CLAIM BILLED BY DIFFERENT PROVIDER

18

GBA02

THIS IS A DUPLICATE SERVICE PREVIOUSLY SUBMITTED BY A DIFFERENT PROVIDER. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1 SECTION 120-120.3

N706

NO RECORDS WERE SUBMITTED

250

GBB01

THE REQUESTED RECORDS WERE NOT RECEIVED. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8

N705

INCOMPLETE/ INSUFFICIENT DOCUMENTATION

251

GBB02

THE DOCUMENTATION SUBMITTED WAS INCOMPLETE AND/OR INSUFFICIENT. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8, B/C

N163

THE DOCUMENTATION DOES NOT SUPPORT THE SERVICE

150

GBB03

THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT SERVICES WERE RENDERED AS BILLED. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5, A

N455

DOES NOT CONTAIN  PROVIDER ORDER

251

GBB04

THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A PHYSICIAN ORDER. REFER TO IOM, PUB 100-08, CHAPTER 3, SECTION 3.6.2.2

N382

MISSING PATIENT IDENTIFIERS

16

GBB05

THE DOCUMENTATION SUBMITTED WAS MISSING PATIENT IDENTIFIERS. REFER TO STANDARDS FOR ADEQUACY OF MEDICAL RECORDS; SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT

M53

INCORRECT DATE OF SERVICE

110

GBB06

THE DOCUMENTATION SUBMITTED WAS FOR THE INCORRECT DATE OF SERVICE. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.2

N519

INCORRECT MODIFIER 

4

GBB07

THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE MODIFIERS BILLED. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, IOM PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1

N563

ABN DENIAL

116

GBB08

THE ABN IS INVALID, INCOMPLETE OR MISSING. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 30, SECTION 40.3.6

MA36

THE BENEFICIARY NAME ON THE DOCUMENTATION DOES NOT MATCH WHAT IS ON THE CLAIM

16

  GBB09

THE DOCUMENTATION SUBMITTED WAS FOR THE INCORRECT BENEFICIARY. REFER TO IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.2.3.8

N205

ILLEGIBLE DOCUMENTATION

50

GBB10

THE DOCUMENTATION SUBMITTED IS NOT LEGIBLE. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3 SECTION 3.3.2.1

M53

THE DOCUMENTATION DOES NOT SUPPORT THE NUMBER OF UNITS BILLED

222

GBB11

THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE NUMBER OF UNITS BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23

N661

DOES NOT MEET MEDICAL NECESSITY

50

GBC01

THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICAL NECESSITY AS LISTED IN COVERAGE REQUIREMENT. REFER TO SSA 1862, IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.2

N661

DOES NOT MEET MEDICAL
NECESSITY

50

GBC02

THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT MEDICAL NECESSITY. REFER TO SSA 1862, IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.1, 3.6.2.2

N643

NON COVERED SERVICE

96

GBC03

THE SERVICE BILLED IS NOT A COVERED MEDICARE BENEFIT OR IS AN EXCLUDED SERVICE. REFER TO 42 CFR 411.15. MEDICARE BENEFIT POLICY MANUAL CHAPTER 16; CFR TITLE 42, CHAPTER IV, SUBCHAPTER B, PART 411

N435

DOES NOT SUPPORT NUMBER OF SERVICES FOR TIMEFRAME

151

GBC04

THE DOCUMENTATION PROVIDED DOES NOT SUPPORT THE MEDICAL NECESSITY FOR THIS NUMBER OF SERVICES OR ITEMS WITHIN THIS TIMEFRAME. REFER TO SSA 1862, IOM, 100-08, MPIM CHAPTER 3, SECTION 3.6.2.2

N362

THE MAX BENEFIT AS BEEN REACHED FOR THIS SERVICE

114

GBC05

THE MAXIMUM BENEFIT HAS BEEN REACHED FOR THIS SERVICE. REFER TO IOM, PUB 100-02, MEDICARE BENEFIT POLICY MANUAL CHAPTER 5 AND IOM, PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5 A

N429

SERVICE WAS PERFORMED FOR ROUTINE/SCREENING BUT IS NOT A COVERED MEDICARE SCREENING BENEFIT

96

GBC06

THE DOCUMENTATION INDICATES THAT THE SERVICE WAS PERFORMED FOR ROUTINE/SCREENING PURPOSES BUT IS NOT COVERED UNDER MEDICARE’S SCREENING BENEFIT. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 18

N705

BILLING ERROR

16

GBD01

BILLING ERROR. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4; 100-04 MEDICARE CLAIMS PROCESSING MANUAL, CHAPTER 23.

M15

BUNDLED  OR INCLUDED IN ANOTHER CODE BILLED

97

GBD03

BUNDLED OR INCLUDED IN ANOTHER CODE BILLED (NCCI). REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 20.3; NATIONAL CORRECT CODING INITIATIVE CODING POLICY MANUAL FOR MEDICARE SERVICES; MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.2.1

N163

DOES NOT SUPPORT SERVICE BILLED

50

GBD04

THE DOCUMENTATION DOES NOT SUPPORT THE SERVICE WAS PERFORMED AS BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23

M64

DOES NOT SUPPORT DIAGNOSIS

11

GBD05

THE DOCUMENTATION DOES NOT SUPPORT THE DIAGNOSIS CODE BILLED. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.2.1

N525

GLOBAL SURGERY PERIOD

97

GBD06

PAYMENT FOR THIS SERVICE IS COMPENSATED IN THE GLOBAL SURGICAL PERIOD. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12 SECTION 30.6.6

M15

BUNDLED IN ANOTHER SERVICE ON THE SAME DOS

 

97

GBD07

PAYMENT IS INCLUDED IN ANOTHER SERVICE RECEIVED ON THE SAME DATE (BUNDLED). REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 30 & 40

MA50

INVESTIGATIONAL

55

GBD08

THIS SERVICE OR PROCEDURE IS CONSIDERED INVESTIGATIONAL AND, THEREFORE, NOT COVERED BY MEDICARE. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.2

N163

DOES NOT SUPPORT ORDERED SERVICE

50

GBD09

THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE ORDERED SERVICE. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.5, A

N519

DOES NOT SUPPORT CPT MODIFIER 25

236

GBD10

THE DOCUMENTATION DOES NOT SUPPORT THAT A SEPARATELY IDENTIFIABLE SERVICE WAS PERFORMED. REFER TO IOM MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 12, SECTION 30.6; SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT

N19

APPROPRIATE PRIMARY CODE HAS NOT BEEN BILLED OR PAID

96

GBD11

THE APPROPRIATE PRIMARY CODE HAS NOT BEEN BILLED OR PAID. REFER TO IOM-PUB 100-08, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.6.2.4

N383

COSMETIC PURPOSES

96

GBD12

THE DOCUMENTATION SUBMITTED INDICATES THE SERVICE WAS PERFORMED FOR COSMETIC PURPOSES. REFER TO MEDICARE BENEFIT POLICY MANUAL CHAPTER 16, SECTION 120

N163

CLONED DOCUMENTATION

50

GBD13

THE DOCUMENTATION SUBMITTED CONTAINS CLONED OR ALTERED INFORMATION. REFER TO PUB 100-8, MEDICARE PROGRAM INTEGRITY MANUAL, CHAPTER 3, SECTION 3.3.2.5; CHAPTER 4.3

N705

BILLING ERROR

250

GBD14

THE PROVIDER INDICATED SERVICES WERE BILLED IN ERROR. REFER TO SECTION 1833 (E), TITLE XVIII, OF THE SOCIAL SECURITY ACT

N206

DOCUMENT CONTAINS CONFLICTING INFORMATION

50

GBD15

THE DOCUMENTATION CONTAINS CONFLICTING INFORMATION. REFER TO MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 4.3

M102

NOT FDA APPROVED

55

GBD16

THE SERVICE OR DEVICE WAS NOT FDA APPROVED. REFER TO SSA 1862; MEDICARE BENEFIT POLICY MANUAL CHAPTER 14

N425

STATUTORILY EXCLUDED

96

GBD17

THE SERVICE BILLED IS STATUTORILY EXCLUDED. REFER TO MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 30, SECTION 20.1.1, SOCIAL SECURITY ACT 1862 (A), 12 CFR 411.15, MEDICARE BENEFIT POLICY MANUAL CHAPTER 16

N55

PERFORMING PROVIDER IS NOT BILLING PROVIDER

B20/16

GBD18

THE DOCUMENTATION SUBMITTED SUPPORTS THE PERFORMING AND BILLING PROVIDERS ARE DIFFERENT

M25

DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED

150

GBE01

THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE MEDICAL NECESSITY OF THE LEVEL OF SERVICE BILLED. REFER TO IOM, 100-08, MEDICARE PROGRAM INTEGRITY MANUAL CHAPTER 3, SECTION 3.6.2.4 AND SECTION 3.6.2.5, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 23

M25

DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED

150

GBE02

THE DOCUMENTATION SUBMITTED DOES NOT SUPPORT THE LEVEL OF SERVICE BILLED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.6.2.4

MA81

INVALID SIGNATURE OR CREDENTIALS

50

GBF01

THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A VALID SIGNATURE AND/OR CREDENTIALS. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 AND CFR PART 482.24

MA81

NO RESPONSE TO ATTESTATION OR SIGNATURE LOG

16

GBF02

THE DOCUMENTATION SUBMITTED DID NOT INCLUDE A VALID SIGNATURE AND A RESPONSE TO ATTESTATION OR SIGNATURE LOG REQUEST WAS NOT RECEIVED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4 AND CFR PART 482.24

MA81

STAMPED SIGNATURE

50

GBF03

STAMPED SIGNATURES ARE NOT ACCEPTED. REFER TO IOM, MEDICARE PROGRAM INTEGRITY MANUAL, PUB 100-08, CHAPTER 3, SECTION 3.3.2.4

N170

DID NOT INCLUDE REQUIRED CERTIFICATIONS

50

GBG01

THE DOCUMENTATION SUBMITTED DID NOT INCLUDE THE REQUIRED CERTIFICATIONS OR RECERTIFICATIONS. REFER TO MEDICARE BENEFIT POLICY MANUAL, CHAPTER 15, 220.1.3

MA81

NOT A VALID NPI

207

GBH01

THE CLAIM DID NOT INCLUDE A VALID NPI. REFER TO IOM, PUB 100-04, MEDICARE CLAIMS PROCESSING MANUAL CHAPTER 1, SECTION 80.3.1

N705

DID NOT CONTAIN REQUIRED INFORMATION

50

GBH02

THE CLAIM SUBMITTED DID NOT CONTAIN REQUIRED INFORMATION

 

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