oa – b5 coverage/program guidelines were not met or were exceeded.

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oa – b5 coverage/program guidelines were not met or were exceeded.

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R470CP.pdf – CMS

Feb 4, 2005 … and reason code combinations (attachment) were the product of an FI, FI Shared
System. (FISS) maintainer, and CMS work ….. Payment denied/reduced for
absence of, or exceeded,. X …. B5. Payment adjusted because coverage/
program guidelines were not met or. CO/PR/OA. PR/OA. CO/PR/OA were …

Adjustment Reason Code – Explanation of Benefits – eohhs

OA. B7. THIS PROVIDER WAS NOT CERTIFIED/ELIGIBLE TO BE PAID FOR
THIS … PAYMENT ADJUSTED BECAUSE THE PATIENT HAS NOT MET THE ….
COVERAGE/PROGRAM GUIDELINES WERE NOT MET OR WERE EXCEEDED.
….. RESUBMIT ON PAPER/ATTACH EOMB USING RI MA GUIDELINES. CO. B5.

Common Adjustment Reasons and Remark Codes – Maine.gov

169-Claim and contract term modifiers do NOT match. DENY. 245-Multiple ….. B5
. Coverage/program guidelines were not met or were exceeded. Ungroupable …

ADJUSTMENT REASON CODES REASON CODE DESCRIPTION 1 …

Payment adjusted because the patient has not met the required eligibility, spend
down, ….. code OA) This change effective 7/1/2013: Per regulatory or other
agreement. ….. B5. Coverage/program guidelines were not met or were
exceeded. B6.

Claim Adjustment Reason Codes – LACDMH

Use when CLP02=22, Reversal of Previous Payment. OA. Other adjustments. PI
… 42 Charges exceed our fee schedule or maximum allowable amount … B5
Payment adjusted because coverage/program guidelines were not met or were …

EOB Reason and Remark crosswalk – Montana Medicaid provider …

Claim/line denied: revenue code is not valid for recipient's age. 6 …… denied/
reduced because coverage/program guidelines were not met or were exceeded.
B5.

Group Code Code Description Start Modified End – Mass.Gov

Jan 1, 1995 … OA. 6. The procedure/revenue code is inconsistent with the patient's age. ….
Charges exceed your contracted/ legislated fee arrangement. …. Payment
adjusted because rent/purchase guidelines were not met. ….. B5. Payment
adjusted because coverage/program guidelines were not met or were exceeded.

Transparency Denial Standard – Utah Insurance Department

Jun 1, 2008 … Transparency – CARC code guidelines for denial reporting. I Include the CARC in
… Exact duplicate claim/service (Use only with Group Code OA except ….. I B5.
Coverage/program guidelines were not met or were exceeded.





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