01 Price Authorization Expired
Note: New as of 10/01
02 Price authorization no longer required
Note: New as of 10/01
03 Product not on the price authorization
Note: New as of 10/01
04 Authorized Quantity Exceeded
Note: New as of 10/01
05 Special Cost Incorrect
Note: New as of 10/01
06 No Credit Allowed
Note: New as of 10/01
07 Administrative Cancellation
Note: New as of 10/01
08 Unit resale higher than authorized
Note: New as of 10/01
09 Out of Network
Note: New as of 10/01
0A Testing not Included
Note: New as of 10/01
0B Request Forwarded To and Decision Response Forthcoming From an External Review Organization
Note: New as of 10/01
0C Authorization/Access Restrictions
Note: New as of 10/01
0D Requires PCP authorization
Note: New as of 10/01
0E Provider is Not Primary Care Physician
Note: New as of 10/01
0F Not Medically Necessary
Note: New as of 10/01
0G Level of Care Not Appropriate
Note: New as of 10/01
0H Certification Not Required for this Service
Note: New as of 10/01
0J Certification Responsibility of External Review Organization
Note: New as of 10/01
0K Primary Care Service
Note: New as of 10/01
0L Exceeds Plan Maximums
Note: New as of 10/01
0M Non-covered Service
Note: New as of 10/01
0N No Prior Approval
Note: New as of 10/01
0P Requested Information Not Received
Note: New as of 10/01
0Q Duplicate Request
Note: New as of 10/01
0R Service Inconsistent with Diagnosis
Note: New as of 10/01
0S Pre-existing Condition
Note: New as of 10/01
0T Experimental Service or Procedure
Note: New as of 10/01
0U Additional Patient Information required
Note: New as of 10/01
0V Requires Medical Review
Note: New as of 10/01
0W Disposition pending review
Note: New as of 10/01
0X Service Inconsistent with Provider Type
Note: New as of 10/01
0Y Service inconsistent with Patient's Age
Note: New as of 10/01
0Z Service inconsistent with Patient's Gender
Note: New as of 10/01
10 Product/service/procedure delivery pattern (e.g., units, days, visits, weeks, hours, months)
Note: New as of 10/01
11 Pricing
Note: New as of 10/01
12 Patient is restricted to specific provider
Note: New as of 10/01
13 Service authorized for another provider
Note: New as of 10/01
14 Plan/contractual guidelines not followed
Note: New as of 10/01
15 Plan/contractual geographic restriction
Note: New as of 10/01
16 Inappropriate facility type
Note: New as of 10/01
17 Time limits not met
Note: New as of 2/02
18 Notification received
Note: New as of 6/02
19 Cosmetic
Note: New as of 6/02
20 Once in a lifetime restriction applies
Note: New as of 2/04
21 Transport Request Denied
Note: New as of 6/04
22 Ambulance Certification Segment information doesn't correspond to Transport Address Segment
Note: New as of 6/04
23 Mileage cannot be computed based on data submitted
Note: New as of 6/04
24 Computed mileage is inconsistent with transport information or service units submitted
Note: New as of 6/04