HIPAA Revised Adjustment Reason Codes
We have completed a review of our mapping to HIPAA Adjustment Reason Codes and Remit/Remark Codes. Below is a Microsoft Excel spreadsheet that reflects the most recent revisions we have made that became effective on May 19, 2014.
HIPAA Adjustment Reason Codes (Revised May 19, 2014)
Note: CMS has approved new Remittance Advice Remarks Codes effective October 1, 2003. Oklahoma Health Care Authority will implement the CMS approved codes October 1, 2003. You can find the CMS approved codes for October 1, 2003 posted on the Washington Publishing Company site.
Error Codes/Edit Disposition Codes
To help you understand the meaning of the more common error codes, we have developed a list of top reasons why provider claims deny and offered some solutions to correct each problem.
||procedure code vs. program indicator
||CPT or HCPCS code billed is not covered by this client's eligibility Program
||Give the appropriate procedure code for the service provided. If you are unsure whether a service is covered, review the fee schedule or utilize the pricing reference file on the secure internet site, or call
(800) 522-0114, option 1 or (405) 522-6205, option 1 in Oklahoma City metro.
||recipient number not on file
||invalid client id number
||Verify that the correct client id number is on your claim.
||dates of service not on PA database
||there is not a prior authorization on file for the service rendered
||Use the secure internet site, EVS, or call (800) 522-0114, option 1 or (405) 522-6205, option 1 in Oklahoma City metro to verify that there is a prior authorization on file.