Appendices
A and B
835
835 Health Care Claim Payment/Advice
The following appendices are also included in the 835 Companion Document. We are providing
the appendices separately for convenience purposes.
LISTED BY HIPAA ADJUSTMENT REASON CODE
Appendix A - Adjustment Reason Codes and Remark Codes for BC/BS
and BlueCare Family Plan (DOS after 7/1/06) on ACES system
Appendix B - Adjustment Group Codes and Reason Codes for BlueCare
Family Plan (DOS prior 7/1/06) on DIS system
©Anthem Blue Cross and Blue Shield - East Region
Page 1 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Appendix A - Adjustment Reason Codes and Remark Codes for BC/BS and BlueCare
Family Plan (DOS after 7/1/06) on ACES System
835 Health Care Claim Payment / Advice
HIPAA Adjustment Reason and Remark Codes
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
RC
4
4
4
4
5
5
5
5
5
5
5
6
MA30
DC
REMITTANCE MESSAGE
A BILATERAL MODIFIER (50) WAS SUBMITTED WITH A PROCEDURE THAT CANNOT BE PERFORMED BILATERALLY. PLEASE
BCBI
RESUBMIT WITHOUT THE 50 MODIFIER IF THE DATE OF SERVICE IS PRIOR TO OCTOBER 1, 2001.
BCMD
MODIFIER INVALID FOR PROCEDURE. PLEASE RESUBMIT WITH VALID PROCEDURE - MODIFIER COMBINATION.
BCPM
MODIFIER IS NOT VALID OR IS MISSING FOR THIS PROCEDURE CODE. PLEASE RESUBMIT WITH THE APPROPRIATE
BJ66
MODIFIER.
RECORDS INDICATE THIS SERVICE WAS PERFORMED IN OUTPATIENT SETTING. CLAIM BILLED AS INPATIENT. PLEASE
B724
RESUBMIT WITH CORRECT PLACE-OF-SERVICE CODE.
BCLH
BCSR
PROCEDURE SUBMITTED DOES NOT REFLECT THE APPROPRIATE LOCATION.
BCSV
BCUC
BCWM BASED ON THE PLACE OF SERVICE, PROCEDURES WITH THIS MODIFIER ARE NOT PAYABLE.
BM81
SERVICES RENDERED WERE OUTPATIENT SERVICES (FOR INSTANCE, NO ROOM AND BOARD CHARGES HAVE BEEN BILLED.)
PLEASE RESUBMIT AS AN OUTPATIENT TYPE OF BILL, OR BILL THE INPATIENT CLAIMS INCLUDING ROOM AND BOARD.
6
6
7
BCAG PROCEDURE CODE SUBMITTED FOR THIS SERVICE IS NOT APPROPRIATE FOR THE PATIENT'S AGE.
ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE IS NOT COVERED BECAUSE THE MAXIMUM AGE FOR THIS
BH19
PROCEDURE HAS BEEN REACHED.
BH27 ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE IS NOT COVERED DUE TO THE PATIENT'S AGE
BL02 ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE IS NOT COVERED. THE PATIENT'S AGE EXCEEDS THE MAXIMUM
BP02 AGE FOR THIS PROCEDURE.
DATE OF SERVICE IS WITHIN 31 DAYS OF THE SUBMITTED DATE OF BIRTH, BUT TYPE OF SERVICE IS NOT
BN12
NEWBORN/SICKBORN. PLEASE CORRECT AND RESUBMIT.
BN84
PATIENT EXCEEDS MAXIMUM AGE LIMIT FOR THIS SERVICE.
BR02
BCSX PROCEDURE CODE SUBMITTED IS NOT APPROPRIATE FOR THE PATIENT'S GENDER.
7
BR06 ACCORDING TO THE TERMS OF THE PLAN, THE PROCEDURE SUBMITTED IS NOT APPROPRIATE FOR THE PATIENT'S GENDER.
8
8
9
B697
SERVICES RENDERED BY THIS PROVIDER ARE NOT PAYABLE.
BR09
BL04 THE DIAGNOSIS IS INCONSISTENT WITH THE PATIENTS AGE
THE ICD9 DX AND CPT CODES DO NOT MATCH. PLEASE SUBMIT THE APPROPRIATE PREVENTATIVE CPT/ICD9 DX CODES SO
B903
WE MAY CONTINUE PROCESSING THIS CLAIM.
BCDX BASED ON THE DIAGNOSIS CODE SUBMITTED THIS PROCEDURE IS NOT EXPECTED.
BCL1
BCL2
BCL3
BCL4
THE INTENSITY OF THE MEDICAL EVALUATION SERVICE IS HIGHER THAN EXPECTED BASED ON THE DIAGNOSIS CODE
BCL5
SUBMITTED.
BCL6
BCL7
BCL8
BCL9
B588 NO PRIOR AUTHORIZATION FOR THIS PROVIDER.
6
6
6
6
6
11
11
11
11
11
11
11
11
11
11
11
15
©Anthem Blue Cross and Blue Shield - East Region
Page 2 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
RC
DC
B100
B101
B102
B103
B104
B105
B106
B107
B120
B121
B122
B123
B124
B125
B126
B127
B129
B130
B131
B132
REMITTANCE MESSAGE
FIELD IN ERROR FOR DATE RECEIVED
FIELD IN ERROR FOR SUSPENSE CODE
FIELD IN ERROR FOR CLAIM NUMBER
FIELD IN ERROR FOR CLAIM SEQUENCE
FIELD IN ERROR FOR PREP CODE
FIELD IN ERROR FOR ADDRESS OVERRIDE INDICATOR
FIELD IN ERROR FOR MANAGERS OVERRIDE INDICATOR
FIELD IN ERROR FOR ADJUSTMENT REASON CODE
FIELD IN ERROR FOR TOTAL SUBMITTED NON COVERED CHARGES
FIELD IN ERROR FOR DISCOUNTED AMOUNT PAID
FIELD IN ERROR FOR MICROFILM NUMBER
FIELD IN ERROR FOR MEDICARE'S INTERNAL CONTROL NUMBER (ICN#)
FIELD IN ERROR FOR GROUP NUMBER
FIELD IN ERROR FOR CONTRACT CLASS
FIELD IN ERROR FOR CONTRACT STATUS CODE
FIELD IN ERROR FOR MEMBER TYPE CODE
FIELD IN ERROR FOR INTERNAL (DERIVED) TYPE OF SERVICE
FIELD IN ERROR FOR CLAIM INDICATOR
FIELD IN ERROR FOR CARRIER FIELD
FIELD IN ERROR FOR ADDRESS OVERRIDE ADDRESSEE INFORMATION
ADDITIONAL INFORMATION IS REQUIRED TO PROCESS THIS CLAIM. PLEASE PROVIDE A COPY OF YOUR LAST EXPLANATION
OF BENEFITS FORM YOUR BASIC CARRIER REGARDING YOUR MAJOR MEDICAL DEDUCTIBLES MET PRIOR TO YOUR PLAN
EFFECTIVE DATE WITH US.
MEDICARE COVERAGE IS IN EFFECT. PLEASE SUBMIT TO MEDICARE FIRST FOR CONSIDERATION. ALLOW 4-6 WEEKS FOR US
TO RECEIVE THE INFORMATION DIRECTLY FROM MEDICARE.
NO EXPLANATION OF MEDICARE BENEFITS RECEIVED WITH CLAIM. BEFORE RESUBMITTING CLAIM, PLEASE ALLOW 4-6
WEEKS FOR US TO RECEIVE THE INFORMATION DIRECTLY FROM MEDICARE.
SUBMIT HARD-COPY CLAIM TO US.
SERVICE REJECTED. REQUESTED MEDICAL INFORMATION NOT RECEIVED. CLAIM WILL BE REVIEWED UPON RECEIPT OF
REQUESTED INFORMATION.
PROVIDER ID NUMBER SUBMITTED IS INCORRECT. PLEASE SUBMIT CLAIM WITH CORRECT PROVIDER ID NUMBER
MULTIDISCIPLINARY NOTIFICATION FORM WAS NOT RECEIVED
LATE CHARGES CANNOT BE PROCESSED WITHOUT THE CORRESPONDING ORIGINAL CLAIM. PLEASE RESUBMIT ALL
CHARGES ON A NEW CLAIM.
PLEASE RESUBMIT WITH DESCRIPTION OF IMMUNIZATION USED
INVALID PROCEDURE CODE FOR MULTI-DISCIPLINARY EXAM
ANTHEM RECOGNIZES TIME INTERVALS IN UNITS ONLY.
THIS CLAIM CANNOT BE PROCESSED UNTIL WE RECEIVE ADDITIONAL INFORMATION REGARDING PEER-REVIEWED MEDICAL
LITERATURE OR COMPENDIA SOURCE.
16
B469
16
B950
16
B997
16
BE32
16
BF12
16
16
BH32
BH38
16
BH52
16
16
16
16
16
16
16
BH54
BH80
BI97
BJ76
BJ77
BK13 THIS CLAIM WILL BE PROCESSED WHEN THE SUBSCRIBER RESPONDS TO OUR MEDICARE INFORMATION LETTER.
BK25 PLEASE REBILL ON A UB92 CLAIM FORM.
LINE ITEM 1 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
BL24
FROM DATE, UNITS OR CHARGES
LINE ITEM 2 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
BL25
FROM DATE, UNITS OR CHARGES
LINE ITEM 3 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
BL26
FROM DATE, UNITS OR CHARGES
LINE ITEM 4 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
BL27
FROM DATE, UNITS OR CHARGES
LINE ITEM 5 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
BL28
FROM DATE, UNITS OR CHARGES
LINE ITEM 6 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
BL29
FROM DATE, UNITS OR CHARGES
LINE ITEM 7 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
BL30
FROM DATE, UNITS OR CHARGES
16
16
16
16
16
16
16
©Anthem Blue Cross and Blue Shield - East Region
Page 3 of 23
Appendices A and B
SERVICE
SERVICE
SERVICE
SERVICE
SERVICE
SERVICE
SERVICE
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
RC
DC
16
BL31
16
BL32
16
BL33
16
BL34
16
BL35
16
BL36
16
BL37
16
BL38
16
BL39
16
BL40
16
BL41
16
BL42
16
BL43
16
BL44
16
BL45
16
BL46
16
BL47
16
BL48
16
BL49
16
BL50
16
BL51
16
BL52
16
BL53
16
BL54
16
BL55
16
BL56
16
BL57
16
BL58
16
BL59
16
BL60
REMITTANCE MESSAGE
LINE ITEM 8 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES, SERVICE
FROM DATE, UNITS OR CHARGES
LINE ITEM 9 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES, SERVICE
FROM DATE, UNITS OR CHARGES
LINE ITEM 10 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 11 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 12 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 13 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 14 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 15 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 16 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 17 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 18 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 19 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 20 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 21 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 22 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 23 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 24 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 25 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 26 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 27 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 28 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 29 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 30 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 31 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 32 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 33 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 34 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 35 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 36 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 37 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
©Anthem Blue Cross and Blue Shield - East Region
Page 4 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
RC
DC
16
BL61
16
BL62
16
BL63
16
BL64
16
BL65
16
BL66
16
BL67
16
BL68
16
BL69
16
BL70
16
BL71
16
BL72
16
BL73
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
BS01
BS03
BS06
BS16
BS23
BS38
BS50
BS51
BS53
BS54
BS55
BS58
BS61
BS62
BS65
BS66
BS77
BS99
REMITTANCE MESSAGE
LINE ITEM 38 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 39 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 40 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 41 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 42 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 43 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 44 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 45 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 46 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 47 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 48 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 49 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
LINE ITEM 50 - FIELD IN ERROR FOR ONE OR MORE OF THE FOLLOWING HAS OCCURRED: REV CODE, HCPCS/RATES,
SERVICE FROM DATE, UNITS OR CHARGES
FIELD IN ERROR FOR PROVIDER NAME AND ADDRESS
FIELD IN ERROR FOR PATIENT CONTROL NUMBER
FIELD IN ERROR FOR STATEMENT FROM/THRU DATE
FIELD IN ERROR FOR PATIENT MARITAL STATUS
FIELD IN ERROR FOR MEDICAL RECORD NUMBER
FIELD IN ERROR FOR RESPONSIBLE PARTY INFORMATION
FIELD IN ERROR FOR PAYER CODE/NAME
FIELD IN ERROR FOR PROVIDER ID
FIELD IN ERROR FOR ASSIGNMENT OF BENEFITS INDICATOR
FIELD IN ERROR FOR PRIOR PAYMENT
FIELD IN ERROR FOR ESTIMATED AMOUNT DUE
FIELD IN ERROR FOR INSURED NAME
FIELD IN ERROR FOR GROUP NAME
FIELD IN ERROR FOR TYPE OF SERVICE CODE/TYPE OF MEMBER CODE/PLAN CODE/BENEFIT CODE (BC65 ONLY)
FIELD IN ERROR FOR EMPLOYER NAME
FIELD IN ERROR FOR EMPLOYER LOCATION
FIELD IN ERROR FOR E CODE
FIELD IN ERROR ON A EDI REQUESTED ADJUSTMENT/VOID CLAIM
IN ORDER FOR US TO CONSIDER THIS CHARGE, WE REQUIRE THE SUPPLY COMPANY'S BILL. PLEASE RESUBMIT THE CLAIM
WITH THIS INFORMATION.
PLEASE RESUBMIT THESE CHARGES WITH THE OPERATIVE/PATHOLOGY REPORT ATTACHED.
PLEASE SUBMIT AN OPERATIVE REPORT FOR THIS SERVICE TO ENSURE PROMPT PROCESSING OF THIS CLAIM. PLEASE
INCLUDE THIS EXPLANATION OF BENEFITS WITH THE REPORT.
PLEASE SUBMIT A LABORATORY OR PATHOLOGY REPORT FOR THIS SERVICE TO ENSURE PROMPT PROCESSING OF THIS
CLAIM. PLEASE INCLUDE THIS EXPLANATION OF BENEFITS WITH YOUR SUBMISSION.
16
M23
B467
16
M29
B560
16
M29
BD08
16
M30
BD06
16
16
16
16
16
16
16
M44
M44
M44
M44
M44
M44
M44
BS24
BS25
BS26
BS27 FIELD IN ERROR FOR CONDITION CODE
BS28
BS29
BS30
©Anthem Blue Cross and Blue Shield - East Region
Page 5 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
16
16
16
16
16
16
16
16
16
RC
M45
M45
M45
M45
M46
M47
M49
M49
M49
DC
BS32
BS33
BS34
BS35
BS36
BS11
BS39
BS40
BS41
16
M51
B659
16
16
16
16
16
M51
M53
M53
M53
M54
BS79
B118
BD43
BH35
B119
16
M57
B483
16
M58
BG51
16
16
16
16
M58
M58
M58
M58
BG53
BI30
BI32
BI33
16
M58
BI34
16
16
16
16
16
16
16
16
16
16
16
16
16
16
M62
M64
M64
M64
M64
M64
M64
M64
M64
M67
M67
M67
M67
M67
BS63
BS68
BS69
BS70
BS71
BS72
BS73
BS74
BS75
B480
B481
BCOP
BG52
BS81
16
M77
BQ09
16
16
16
16
16
M79
M79
M118
M118
M119
16
MA06
BD09
BH58
B666
BK38
BJ99 THE NDC NUMBER SUBMITTED IS INVALID. PLEASE RESUBMIT WITH THE CORRECT NUMBER.
MISSING DATE OF SERVICE ON THIS CLAIM. PLEASE SUBMIT DATE OF SERVICE. WHEN WE RECEIVE THIS INFORMATION,
BJ34
WE WILL CONTINUE TO PROCESS THIS CLAIM.
THE FACILITY CODE REQUIRED FOR PROCESSING THIS TYPE OF SERVICE WAS OMITTED. PLEASE PROVIDE US WITH THE
B657
NAME AND/OR FACILITY CODE
BM45 PLEASE CORRECT BILLING, TYPE OF BILL INCORRECT FOR PROVIDER.
BS04 FIELD IN ERROR FOR TYPE OF BILL
BD29 INCORRECT DATE OF SERVICE (VOID).
16
MA29
16
16
16
MA30
MA30
MA31
REMITTANCE MESSAGE
FIELD IN ERROR FOR OCCURRENCE CODES/DATES
FIELD IN ERROR FOR OCCURRENCE SPAN CODE/DATES
FIELD IN ERROR FOR ICN (MEDICARE CROSSOVER)
FIELD IN ERROR FOR VALUE CODE/AMOUNT
THE NARRATIVE/CLAIM NOTE FOR THIS PROCEDURE CODE WAS OMITTED. PLEASE COMPLETE THE REQUIRED
INFORMATION AND RESUBMIT THIS CLAIM AGAIN.
FIELD IN ERROR FOR PROCEDURE CODING METHOD
FIELD IN ERROR FOR TOTAL UNITS
UNITS ARE REQUIRED FOR PROCESSING.
RESUBMIT CLAIM WITH ONE HOUR INCREMENTS IN UNITS FIELD
FIELD IN ERROR FOR TOTAL CHARGES
CLAIM DENIED PENDING VERIFICATION OF PROVIDER STATUS/LICENSE/CERTIFICATION IN STATE OF PRACTICE. UPON
RECEIPT OF INFORMATION, YOUR CLAIM WILL BE PROCESSED IN ACCORDANCE WITH YOUR CONTRACT.
PLEASE RESUBMIT ORTHODONTIC CLAIM WITH THE BANDING DATE, PROPOSED LENGTH OF TREATMENT, AND TOTAL CASE
FEE.
PLEASE RESUBMIT ORTHODONTIC WORK-UP FEES WITH INDIVIDUAL ADA CODES AND INDIVIDUAL FEES.
PLEASE RESUBMIT CLAIM WITH PRE-OPERATIVE X-RAYS LABELED RIGHT AND LEFT.
THE X-RAY ENVELOPE WAS EMPTY. PLEASE RESUBMIT CLAIM WITH PRE-OPERATIVE X-RAY(S).
X-RAYS RETURNED. PLEASE LABEL X-RAYS RIGHT AND LEFT AND/OR SPECIFY DATE X-RAYS WERE TAKEN.
TOOTH NUMBER(S) SUBMITTED ON CLAIM FORM AND X-RAY(S) SUBMITTED DO NOT AGREE. PLEASE RESUBMIT CLAIM WITH
CORRECT PRE-OPERATIVE X-RAY OR TOOTH NUMBER.
FIELD IN ERROR FOR TREATMENT AUTHORIZATION CODE
FIELD IN ERROR FOR OTHER DIAGNOSIS CODE
INVALID OR UNACCEPTABLE PROCEDURE CODE. PLEASE SUBMIT A VALID OR ACCEPTABLE HCPCS OR CPT PROCEDURE
CODE. WHEN WE RECEIVE THIS INFORMATION, WE WILL CONTINUE TO PROCESS THIS CLAIM.
PLEASE RESUBMIT ORTHODONTIC CLAIM WITH A SINGLE ADA CODE THAT REPRESENTS ALL ITEMIZED SERVICES.
FIELD IN ERROR FOR OTHER PROCEDURE CODES/DATES
THE CLAIM CONTAINED AN INVALID OR MISSING PLACE OF SERVICE. PLEASE RESUBMIT WITH THE CORRECTED
INFORMATION. PARTICIPATING PROVIDERS SHOULD NOT BALANCE BILL MEMBERS FOR THIS SERVICE.
A ZERO CHARGE WAS SUBMITTED FOR THIS SERVICE.
IMMUNIZATIONS OBTAINED FROM THE VFC PROGRAM MUST BE 0.00 CHARGE
ADDITIONAL INFORMATION IS REQUIRED TO PROCESS THIS CLAIM. PLEASE CALL YOUR PROVIDER TELEPHONE UNIT FOR
DETAILS ON THE INFORMATION NEEDED.
©Anthem Blue Cross and Blue Shield - East Region
Page 6 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
16
16
16
16
16
RC
MA31
MA32
MA33
MA34
MA35
DC
BK02
BS07
BS08
BS09
BS10
REMITTANCE MESSAGE
THIS CLAIM CANNOT BE PROCESSED UNTIL WE ARE ADVISED OF THE ADMISSION AND DISCHARGE DATES
FIELD IN ERROR FOR COVERED DAY COUNT
FIELD IN ERROR FOR NON-COVERED DAY COUNT
FIELD IN ERROR FOR COINS DAYS
FIELD IN ERROR FOR LIFETIME RESERVE DAYS
16
MA36
BM99 FIRST NAME BEING SUBMITTED IS "BABY", OR "BABY A", OR "BABY B", ETC. PLEASE CORRECT NAME AND RESUBMIT.
16
16
16
16
16
16
16
16
16
16
16
16
16
16
16
MA36
MA37
MA39
MA40
MA41
MA42
MA50
MA58
MA60
MA61
MA63
MA65
MA66
MA69
MA90
BS12
BS13
BS15
BS17
BS19
BS20
B128
BS52
BS59
BS60
BS67
BS76
BS80
BS84
BS64
16
MA92
16
16
N3
N4
FIELD IN ERROR FOR PATIENT NAME
FIELD IN ERROR FOR PATIENT ADDRESS
FIELD IN ERROR FOR PATIENT SEX
FIELD IN ERROR FOR ADMISSION DATE
FIELD IN ERROR FOR ADMISSION TYPE CODE
FIELD IN ERROR FOR ADMISSION SOURCE CODE
FIELD IN ERROR FOR INVESTIGATIVE CLAIM INDICATOR
FIELD IN ERROR FOR RELEASE OF INFORMATION INDICATOR
FIELD IN ERROR FOR RELATION TO INSURED CODE
FIELD IN ERROR FOR CERT-SSN-HIC-ID NO.
FIELD IN ERROR FOR PRINCIPLE DIAGNOSIS CODE-DENY CLAIM B510
FIELD IN ERROR FOR ADMITTING DIAGNOSIS
FIELD IN ERROR FOR PRINCIPLE PROCEDURE CODE/DATE
FIELD IN ERROR FOR REMARKS
FIELD IN ERROR FOR EMPLOYMENT STATUS CODE
PLEASE RESUBMIT ORTHODONTIC CLAIM WITH A PRIMARY EXPLANATION OF BENEFITS THAT REPRESENTS TOTAL CASE
BG54
FEE.
BH37 PLEASE RESUBMIT CLAIM WITH ORIGINAL CONSENT FORM FOR STERILIZATION
BH34 NEED EXPLANATION OF DENIAL FROM PRIMARY INSURANCE
16
N26
B477 ACCORDING TO THE TERMS OF THE PLANS, THE DENTAL SERVICES IS NOT COVERED DUE TO INSUFFICIENT BREAKDOWN.
16
N29
B456
16
N29
B592
16
N29
B869
16
N29
B922
16
N29
B966
16
N29
BD02
16
N29
BD04
16
N29
BD05
16
N29
BF93
16
N29
BG59
16
N29
BG77
16
N29
BI17
16
N29
16
N29
BEFORE SERVICES CAN BE CONSIDERED, AN ITEMIZED BILL MUST BE SUBMITTED WITH A COMPLETED DESCRIPTION OF
SERVICES RENDERED.
SERVICES DENIED. OUTPATIENT TREATMENT REPORT NOT RECEIVED.
PLEASE SUBMIT THE MEDICAL RECORDS FOR THIS SERVICE TO ACCESS ONE SO THAT WE MAY CONTINUE TO PROCESS
THIS CLAIM.
PLEASE SUBMIT THE MEDICAL RECORDS FOR THIS SERVICE SO THAT WE MAY CONTINUE TO PROCESS THIS CLAIM. THE
RECORDS MUST INCLUDE THE DATE OF ADMISSION AND DISCHARGE AND THE FACILITY NAME. WHEN WE RECEIVE THIS
INFORMATION, WE WILL CONTINUE TO PROCESS YOUR CLAIM.
ADDITIONAL INFORMATION IS REQUIRED TO FURTHER PROCESS THIS CLAIM. WE HAVE REQUESTED THE INFORMATION
AND WILL CONTINUE PROCESSING YOUR CLAIM WHEN THIS INFORMATION IS RECEIVED
PLEASE PROVIDE US WITH THE NAME, STRENGTH AND DOSAGE OF THE RADIOPHARMACEUTICAL/CONTRAST AGENT WITH
THIS REMITTANCE SO WE MAY COMPLETE THE PROCESSING OF THIS CLAIM.
PLEASE SUBMIT A SLEEP STUDY REPORT WITH THIS REMITTANCE. WHEN WE RECEIVE THIS INFORMATION, WE WILL
CONTINUE TO PROCESS THIS CLAIM.
PLEASE SUBMIT YOUR OFFICE NOTES FOR THIS SERVICE TO ENSURE PROMPT PROCESSING OF THIS CLAIM. PLEASE
INCLUDE THIS EXPLANATION OF BENEFITS WITH YOUR SUBMISSION.
PLEASE SUBMIT COMPLETE ITEMIZED BILL TO US WITH REFERRING PROVIDER UPIN NUMBER IF APPLICABLE.
A COMPLETED OUTPATIENT TREATMENT REPORT (OTR) IS REQUIRED IN ORDER TO REVIEW YOUR CLAIM. AN OTR FORM IS
BEING SENT TO YOUR ATTENTION UNDER SEPARATE COVER. ONCE IT IS RETURNED IT WILL BE CLINICALLY REVIEWED AND
YOU WILL BE NOTIFIED OF THE DETERMINATION.
CLAIM REJECTED PENDING HOSPITAL RECORD REVIEW. HOSPITAL RECORDS HAVE BEEN REQUESTED. WHEN THIS REVIEW
IS COMPLETE, WE WILL CONTINUE TO PROCESS THIS CLAIM.
THIS CLAIM IS BEING DENIED UNTIL THE REQUESTED INFORMATION HAS BEEN RECEIVED FROM THE PLAN IN THE STATE
WHERE SERVICES WERE RENDERED. WHEN THE INFORMATION IS RECEIVED, THIS CLAIM WILL BE PROCESSED
PERIODONTAL CHARTING MUST BE DATED WITHIN 12 MONTHS OF THE DATE OF SERVICE. IF CURRENT CHARTING IS NOT
AVAILABLE, PLEASE SUBMIT A NARRATIVE OF POCKET DEPTH AND PRE-OPERATIVE X-RAYS.
A DETAILED DESCRIPTION OF THE SERVICES RENDERED IS REQUIRED TO PROCESS THIS CLAIM. WHEN THE INFORMATION
BJ79
IS RECEIVED THE CLAIM WILL BE RECONSIDERED FOR PAYMENT.
BI35
©Anthem Blue Cross and Blue Shield - East Region
Page 7 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
RC
DC
16
N29
BJ93
16
N29
BK17
16
N29
BM22
16
N29
B995
16
N37
BD14 TOOTH NUMBERS ARE REQUIRED FOR PERIAPICAL XRAYS. PLEASE RESUBMIT CLAIM WITH REQUIRED INFORMATION.
16
N37
BD15
16
N40
THIS CLAIM HAS BEEN DENIED PENDING ADDITIONAL INFORMATION. PLEASE RESUBMIT CLAIM WITH TOOTH LOCATION
(I.E., TOOTH NUMBER, QUADRANT, OR ARCH) AND/OR SURFACE CODE(S).
B475 POST-OPERATIVE X-RAY REQUIRED. PLEASE RESUBMIT CLAIM WITH THE X-RAY.
16
N40
BD13 INCORRECT XRAYS SENT AND RETURNED. CLAIM SHOULD BE RESUBMITTED WITH CORRECT CORRESPONDING XRAYS.
16
16
16
16
16
N40
N40
N40
N40
N40
BD16
BG16
BG17
BI36
BI37
16
N40
BI38
16
16
16
N45
N46
N50
BI80
BS18
BS22
16
N56
BK24
16
N95
BH55
16
N149
BH39 ALL THREE COVERED SERVICES UNDER THE MULTIDISCIPLINARY EXAMINATION MUST BE BILLED AT THE SAME TIME
16
N205
BD03 THIS CLAIM WAS ILLEGIBLE. PLEASE RESUBMIT A CLAIM THAT IS READABLE SO WE MAY COMPLETE THE PROCESSING.
16
16
N206
N209
16
N237
16
N253
16
N257
16
16
16
17
17
17
18
18
18
18
18
18
18
N270
N317
N329
BH36 EOB INFORMATION DOES NOT MATCH HCFA, PLEASE SUBMIT CORRECT EOB
BS05 FIELD IN ERROR FOR FED TAX NUMBER
IN ORDER TO PROCESS YOUR INFANT FORMULA CLAIM, THE FOLLOWING INFORMATION IS NEEDED: A RECEIPT
BK05 CONTAINING THE COMPLETE FORMULA NAME, CHILD'S NAME AND MEDICAL HISTORY, INCLUDING THE DIAGNOSIS. PLEASE
RESUBMIT YOUR CLAIM WITH THIS INFORMATION.
BS82 FIELD IN ERROR FOR ATTENDING PHYSICIAN
THIS CLAIM WAS SUBMITTED WITH THE INCORRECT PROVIDER OFFICE LOCATION NUMBER. PLEASE RESUBMIT WITH THE
B820
ACTIVE OFFICE NUMBER.
BS83 FIELD IN ERROR FOR OTHER PHYSICIAN
BS21 FIELD IN ERROR FOR DISCHARGE HOUR
BS14 FIELD IN ERROR FOR PATIENT DATE OF BIRTH
B620 CLAIM CLOSED UNTIL REQUESTED INFORMATION IS RECEIVED.
BK01 THIS CLAIM REMAINS DENIED BECAUSE WE DID NOT RECEIVE SUFFICIENT ADDITIONAL INFORMATION TO OVERTURN OUR
BK06 ORIGINAL DENIAL.
19
B509
B881
BT28
B937
BL19
BL20
BM32
REMITTANCE MESSAGE
THE PROVIDER OF CARE IS BEING ASKED TO ADVISE US OF THE AMOUNT OF TIME SPENT DOING THIS PROCEDURE WHICH
WE NEED TO PROCESS THIS CLAIM.
BEFORE SERVICES CAN BE CONSIDERED, AN ITEMIZED BILL MUST BE SUBMITTED WITH A COMPLETED DESCRIPTION OF
SERVICES RENDERED.
ADDITIONAL INFORMATION IS REQUIRED TO FURTHER PROCESS THIS CLAIM. WE HAVE REQUESTED THE INFORMATION
AND WILL CONTINUE PROCESSING YOUR CLAIM WHEN THIS INFORMATION IS RECEIVED
ADDITIONAL INFORMATION IS REQUIRED TO FURTHER PROCESS THIS CLAIM. WE HAVE REQUESTED THE INFORMATION
AND WILL CONTINUE PROCESSING YOUR CLAIM WHEN THIS INFORMATION IS RECEIVED
XRAYS ARE REQUIRED. CLAIM SHOULD BE RESUBMITTED WITH XRAYS.
X-RAYS AND PERIODONTAL CHARTING ARE REQUIRED. CLAIM SHOULD BE RESUBMITTED WITH XRAYS AND PERIODONTAL
CHARTING.
POST-OPERATIVE X-RAY(S) RECEIVED. PLEASE RESUBMIT CLAIM WITH PRE-OPERATIVE X-RAYS.
PRE-ESTIMATES ARE ONLY VALID FOR ONE YEAR. PLEASE RESUBMIT WITH PRE-OPERATIVE X-RAYS.
X-RAYS RECEIVED ARE NOT OF DIAGNOSTIC QUALITY. PLEASE RESUBMIT CLAIM WITH DIAGNOSTIC PRE-OPERATIVE XRAYS.
VALUE CODE/OCCURRENCE CODE MISSING. NEED ADDITIONAL INFORMATION IN ORDER TO PROCESS THIS CLAIM.
FIELD IN ERROR FOR ADMISSION HOUR
FIELD IN ERROR FOR DISCHARGE STATUS CODE
THIS PROCEDURE/REVENUE CODE IS NOT COVERED UNDER YOUR SPECIAL CONTRACT. PLEASE REBILL WITH THE
APPROPRIATE CODE
INVALID PROVIDER NUMBER FOR MULTIDISCIPLINARY EXAM
THIS SERVICE IS A DUPLICATE TO ONE PRESENTLY BEING REVIEWED.
THIS PROCEDURE IS A DUPLICATE TO ONE ALREADY PROCESSED.
DUPLICATE PAYMENT (VOID).
THIS CLAIM/SERVICE IS A DUPLICATE OF A CLAIM THAT HAS BEEN PROCESSED AND PAID TO THE MEMBER DIRECTLY
CLAIM IS A DUPLICATE TO ONE ALREADY PROCESSED.
OUR RECORDS INDICATE THESE SERVICES ARE THE RESULTS OF A CONDITION ARISING FROM THE PATIENT'S
B955 EMPLOYMENT. OUR CONTRACT SPECIFIES "NO BENEFITS WILL BE PAID FOR SERVICES THAT SHOULD BE OBTAINED UNDER
WORKER'S COMPENSATION, OR WHICH BY LAW, WERE RENDERED WITHOUT EXPENSE TO THE MEMBER."
©Anthem Blue Cross and Blue Shield - East Region
Page 8 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
19
21
22
22
RC
DC
REMITTANCE MESSAGE
BWCR THESE SERVICES ARE NOT COVERED BECAUSE THEY ARE THE RESULT OF A WORK RELATED INJURY.
OUR RECORDS INDICATE THESE SERVICES WERE RELATED TO AN AUTOMOBILE ACCIDENT AND ARE BEING PAID BY YOUR
B954
MEDPAY POLICY.
THIS CHARGE HAS BEEN DENIED BY MEDICARE DUE TO LACK OF INFORMATION. THE PROVIDER MUST SUBMIT THE
B468
NECESSARY INFORMATION TO THEM BEFORE WE CAN CONSIDER BENEFITS.
ADDITIONAL INFORMATION IS REQUIRED TO PROCESS THIS CLAIM. PLEASE PROVIDE A COPY OF YOUR EXPLANATION OF
B548
MEDICARE BENEFITS.
OUR RECORDS INDICATE WE ARE THE PATIENT'S PRIMARY CARRIER. MEDICARE HAS ALREADY PAID ON THESE CHARGES.
PRIMARY LIABILITY IS BEING RESEARCHED. CLAIMS WILL BE REPROCESSED WHEN PRIMARY LIABILITY IS DETERMINED.
22
B668
22
22
22
B789 OUR RECORDS INDICATE THE PATIENT HAS OTHER INSURANCE. SUBMIT THESE CHARGES TO THE OTHER INSURANCE
B965 CARRIER AND SEND US THEIR ITEMIZED STATEMENT OF PAYMENT OF DENIAL ONLY. DO NOT RESUBMIT THE CLAIM. ONCE
B956 THIS INFORMATION HAS BEEN RECEIVED YOUR CLAIM WILL BE RECONSIDERED FOR PAYMENT.
MEDICARE COVERAGE IS IN EFFECT. WE ARE THE SECONDARY COVERAGE. PLEASE SUBMIT TO MEDICARE FIRST FOR
B839
CONSIDERATION, THEN FORWARD THE NOTICE OF PAYMENT OR DENIAL TO US.
OUR RECORDS INDICATE THE PATIENT IS COVERED BY MEDICARE. THE SERVICES SUBMITTED ARE NOT COVERED BY THE
B952
PATIENT'S CONTRACT.
B957 OUR RECORDS INDICATE THE PATIENT HAS OTHER INSURANCE. SUBMIT THESE SERVICES TO THE OTHER INSURANCE
BM31 CARRIER AND SEND US THEIR ITEMIZED STATEMENT OF PAYMENT OF DENIAL. PLEASE FORWARD THAT INFORMATION TO
BM23 OUR CLAIM RECOVERY DEPARTMENT.
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
22
OUR RECORDS INDICATE THE PATIENT HAS OTHER INSURANCE. THE OTHER INSURANCE HAS PROVIDED FULL COVERAGE
FOR THESE SERVICES, THEREFORE WE HAVE NO LIABILITY ON THIS CLAIM.
BE09 THIS CLAIM SHOULD BE SUBMITTED TO YOUR PRIOR CARRIER AS IT HAS BEEN DETERMINED THIS SERVICE IS RELATED TO
BE21 YOUR DISABILITY.
BE47 CHARGES MUST BE SUBMITTED SHOWING AMOUNT ALLOWED BY PRIMARY CARRIER.
BH28 THIS SERVICE/PROCEDURE IS NOT COVERED, PLEASE SUBMIT DIRECTLY TO THE PROPER VENDOR FOR PROCESSING
THIS CLAIM CANNOT BE PROCESSED UNTIL THE SUBSCRIBER RESPONDS TO OUR COORDINATION OF BENEFITS
BI46
QUESTIONNAIRE.
AT THIS TIME, WE CANNOT PROCESS THIS CLAIM RECEIVED FROM THE MEDICARE INTERMEDIARY. PLEASE SUBMIT THIS
BI74
CLAIM ON PAPER WITH THE CORRESPONDING MEDICARE EOMB.
THIS CLAIM CANNOT BE PROCESSED UNTIL THE SUBSCRIBER RESPONDS TO OUR COORDINATION OF BENEFITS
BJ23
QUESTIONNAIRE.
BM62 PLEASE CORRECT BILLING, MEDICARE IS PRIMARY. RESUBMIT WITH CORRECT MEDICARE TYPE OF SERVICE.
BMSC ADJUSTMENT TO A PREVIOUSLY PROCESSED SECONDARY MEDICARE PART D CLAIM
MEDICARE COVERAGE IS IN EFFECT. WE ARE THE SECONDARY COVERAGE. PLEASE SUBMIT TO MEDICARE PART D PLAN
BMSE
FIRST FOR CONSIDERATION, THEN FORWARD THE NOTICE OF PAYMENT OF DENIAL TO US
THIS PROCEDURE IS A BENEFIT OF MEDICARE PART D, PLEASE SUBMIT TO THE MEDICARE PART D CARRIER FOR
BMSG
PROCESSING
THIS CLAIM WAS PAID IN ERROR. MEDICARE IS PRIMARY AND ANTHEM IS SECONDARY. A MEDICARE EXPLANATION OF
BN99
BENEFITS IS NEEDED TO PROCESS THIS CLAIM AS SECONDARY.
B958
23
B951 MEDICARE HAS PROVIDED FULL COVERAGE FOR THIS PROCEDURE, THEREFORE WE HAVE NO LIABILITY FOR THIS SERVICE.
23
B968
23
23
23
26
26
27
27
27
THIS CLAIM HAS BEEN PARTIALLY CREDITED. OUR RECORDS INDICATE THAT THE PATIENT'S OTHER INSURANCE HAS MADE
PARTIAL PAYMENT FOR THESE SERVICES.
MEDICARE PAID THE TOTAL BENEFITS AVAILABLE UNDER THE SNET MEDICAL PLAN. THEREFORE, NO ADDITIONAL BENEFITS
B998 ARE AVAILABLE. HOWEVER, THE AMOUNTS SHOWN IN THE DEDUCTIBLE AND COINSURANCE FIELDS, IF APPLICABLE, HAVE
BEEN CREDITED TO YOUR ANNUAL DEDUCTIBLE AND OUT OF POCKET MAXIMUMS.
BD31 PAID BY ANOTHER CARRIER (VOID).
BK08 BENEFITS ARE NOT AVAILABLE FOR THAT PORTION THE CHARGES WHICH HAVE BEEN PAID BY MEDICARE.
B801 SERVICES OR ADMISSION RENDERED PRIOR TO THE CONTRACT EFFECTIVE DATE.
IDENTIFICATION NUMBER IS INCORRECT FOR DATES OF SERVICE PRIOR TO 07/01/06. PLEASE RESUBMIT CLAIM WITH THE
BH60
MEMBER'S ORIGINAL BLUE CARE FAMILY PLAN IDENTIFICATION NUMBER.
B805 SERVICES WERE RENDERED AFTER THE CANCELLATION DATE FOR THIS MEMBER.
B828
SERVICES WERE RENDERED AFTER THE GROUP'S CANCELLATION DATE.
B846
©Anthem Blue Cross and Blue Shield - East Region
Page 9 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
RC
DC
REMITTANCE MESSAGE
DELIVERY OCCURRED AFTER CANCELLATIONS DATE. PLEASE RESUBMIT ITEMIZED BILL USING EVALUATION AND
MANAGEMENT CODES, APPROPRIATE DELIVERY CODE AND DIAGNOSIS, FOR CONSIDERATION OF SERVICES RENDERED
DURING ACTIVE PERIOD OF THE CONTRACT.
THIS PAYMENT WAS MADE IN ERROR. THE POLICY/MEMBER WAS NOT ACTIVE ON THE DATE OF SERVICE.
PLEASE DIRECT YOUR CLAIMS TO BLUE CROSS AND BLUE SHIELD OF DELAWARE, PO BOX 8799, WILMINGTON, DE 19899,
ATTN: MARY EVA PAERCE ROUTE CODE 3-1-48
ACCORDING TO THE TERMS OF THE PLAN, THERE IS NO REIMBURSEMENT AVAILABLE FOR THIS SERVICE AS THE CLAIM
WAS NOT SUBMITTED WITHIN THE CONTRACTUALLY ESTABLISHED TIME LIMIT.
27
B895
27
BD49
27
BG94
29
29
29
B829
BD07
BJ98 REQUEST FOR ADJUSTMENT EXCEEDS FILING TIME LIMIT.
SINCE YOU WERE UNABLE TO OBTAIN INSURANCE INFORMATION FROM THE MEMBER SO THAT THIS CLAIM COULD BE
BK16
FILED ON A TIMELY BASIS, THIS AMOUNT IS MEMBER RESPONSIBILITY.
ADDITIONAL INFORMATION IS REQUIRED REGARDING POSSIBLE PRE-EXISTING CONDITION. WE HAVE REQUESTED THE
B732 INFORMATION FROM YOU UNDER SEPARATE COVER. WHEN THIS INFORMATION IS RECEIVED, YOU CLAIM WILL BE
RECONSIDERED.
B438 CLAIM VOIDED. CONTRACT CANCELLED.
THE ALPHA PREFIX WITH WHICH YOU HAVE SUBMITTED THIS CLAIM IS INVALID. PLEASE VERIFY THE PREFIX ON THE
B580
MEMBER'S CARD AND RESUBMIT.
B803 PATIENT NOT ON CONTRACT AT THE TIME OF SERVICE.
CLAIM SUBMITTED WITH AN INVALID IDENTIFICATION NUMBER. PLEASE SUBMIT WITH THE CORRECT IDENTIFICATION
B809
NUMBER.
THE PATIENT'S LAST NAME DOES NOT MATCH OUR MEMBERSHIP RECORDS. PLEASE HAVE THE MEMBER CONTACT US.
B814
ADDITIONAL INFORMATION IS NEEDED BEFORE CLAIMS CAN BE PROCESSED.
B821 PATIENT NOT ON CONTRACT AT THE TIME OF SERVICE.
PATIENT IS NOT LISTED AS AN ELIGIBLE MEMBER. PLEASE CHECK NAME, AGE, GENDER AND ANTHEM ID CARD NUMBER. IF
B822
NO ERRORS ARE FOUND PLEASE CONTACT US BY PHONE.
B823
PATIENT IS NOT LISTED AS AN ELIGIBLE MEMBER.
B862
B825 PATIENT IS NOT LISTED AS AN ELIGIBLE ADULT MEMBER.
THE WRONG 3 DIGIT PREFIX WAS SUBMITTED FOR THIS DATE OF SERVICE. PLEASE RESUBMIT WITH THE CORRECT PREFIX
BD22
FOR THIS DATE OF SERVICE.
PATIENT NOT FOUND ON MEMBERSHIP NUMBER SUBMITTED, OR THE SOCIAL SECURITY NUMBER SUBMITTED DOES NOT
BE07 MATCH PATIENT'S NAME, DATE OF BIRTH AND SEX. CLAIM SHOULD BE SUBMITTED WITH THE IDENTIFICATION NUMBER ON
YOUR IDENTIFICATION CARD.
29
30
31
31
31
31
31
31
31
31
31
31
31
31
31
31
32
32
32
35
38
38
38
38
39
39
39
39
40
40
42
42
M118
BI02
THE THREE POSITION ALPHA CHARACTERS PRECEDING THE MEMBERSHIP NUMBER ARE NOT VALID FOR ONE OR ALL OF
THESE DATES OF SERVICE. PLEASE DETERMINE CORRECT PREFIX FOR EACH DATE OF SERVICE AND RESUBMIT CLAIM.
YOUR CLAIM HAS BEEN DENIED BECAUSE IT WAS SUBMITTED WITH A THREE LETTER ALPHA PREFIX IN FRONT OF YOUR
BN60 IDENTIFICATION NUMBER. PLEASE CONTACT YOUR CUSTOMER ACTION TEAM AND REQUEST THIS DENIED CLAIM BE
PROCESSED USING ONLY THE CORRECT TEN DIGIT IDENTIFICATION NUMBER.
B563 CLAIM IS REJECTED PENDING VERIFICATION OF STUDENT STATUS.
B813 PATIENT'S AGE EXCEEDS THE MAXIMUM AGE LIMIT.
B826 PATIENT IS NOT LISTED AS AN ELIGIBLE CHILD DEPENDENT.
BH20 ACCORDING TO THE TERMS OF THE PLAN, THE CONTRACT LIFETIME MAXIMUM FOR THIS SERVICE HAS BEEN MET.
B649 NON-NETWORK FACILITY UTILIZED.
BE27 PROVIDER NOT APPROVED FOR MATERNITY DISCHARGE PROGRAM
BJ15 ACCORDING TO THE TERMS OF YOUR PLAN, COVERAGE IS NOT AVAILABLE OUT OF NETWORK.
BJ70 THIS PROVIDER OF CARE IS NOT COVERED FOR THE SERVICES RENDERED.
BF14
BF38 REQUEST FOR PRIOR AUTHORIZATION OF THESE SERVICES DENIED.
BF39
BG13 PRIOR APPROVAL FOR THESE SERVICES DENIED. SERVICES AVAILABLE IN NETWORK.
B470 SERVICES NOT OF AN EMERGENCY NATURE ARE NOT COVERED.
BH41 CLAIM FOR THIS PROVIDER TYPE NOT COVERED WITH DIAGNOSIS SUBMITTED
BILLED TIME UNITS ARE IN EXCESS OF ANESTHESIA TIME DOCUMENTED ON CLAIM AND ARE NOT ELIGIBLE FOR
B420
ADDITIONAL REIMBURSEMENT; PARTICIPATING PROVIDERS MAY NOT BALANCE BILL MEMBERS
BJ95 ALLOWABLE BENEFITS FOR THIS SERVICE HAVE ALREADY BEEN PAID TO ANOTHER PROVIDER OF CARE.
©Anthem Blue Cross and Blue Shield - East Region
Page 10 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
45
RC
45
47
47
47
47
47
47
47
BCPI
BCSI
BCUI
47
M77
50
51
52
52
54
54
54
54
54
55
58
58
58
59
60
60
62
62
62
62
62
62
ADDITIONAL INFORMATION IS REQUIRED TO PROCESS THIS CLAIM. PLEASE RESUBMIT A NEW CLAIM WITH THE VALID ICD9 DIAGNOSIS CODE.
DIAGNOSIS CODE REQUIRED FOR THIS PROCEDURE WAS OMITTED. PLEASE COMPLETE THE REQUIRED INFORMATION AND
B557
RESUBMIT THIS CLAIM AGAIN.
BM26
DIAGNOSIS NOT COVERED.
BM30
BCWI BASED ON THE PLACE OF SERVICE, THIS DIAGNOSIS IS NOT PAYABLE.
B500
B543
THE CHARGE HAS BEEN DENIED BECAUSE IT HAS BEEN DETERMINED THAT IT IS NOT MEDICALLY NECESSARY.
BG82
BJ86
THESE SERVICES ARE NOT COVERED BECAUSE WE HAVE DETERMINED THAT THE LEVEL OF CARE PROVIDED DOES NOT
BJ87 MEET OUR MEDICAL NECESSITY GUIDELINES. THIS DETERMINATION WAS MADE AS A RESULT OF A REVIEW BY OUR
MEDICAL STAFF AND/OR AN INDEPENDENT HEALTH CARE PROFESSIONAL.
SERVICES RELATED TO A PRE-EXISTING CONDITION ARE NOT PAYABLE DURING THE PRE-EXISTING EXCLUSION PERIOD AS
B838 DEFINED IN YOUR CONTRACT. CALL CUSTOMER SERVICE IF YOU HAD PRIOR HEALTH INSURANCE TO DETERMINE IF CREDIT
CAN BE GRANTED TOWARDS THE PRE-EXISTING EXCLUSION PERIOD.
BI43 BENEFITS ARE NOT AVAILABLE FOR ROUTINE SERVICES UNLESS PERFORMED BY THE PRIMARY CARE PHYSICIAN.
BM44 REVENUE CODE NOT APPROVED FOR THIS PROVIDER.
B555
BCAD SURGICAL ASSISTANT SERVICES ARE NOT APPROVED FOR THIS PROCEDURE.
B510
47
47
47
47
50
50
50
50
DC
REMITTANCE MESSAGE
BH30 ADDITIONAL CHARGES ON URGENT CARE CLAIM NOT COVERED
PLEASE CORRECT BILLING OR SUBMIT NEW DATE. REVENUE CODE RATE EXCEEDS THE MAXIMUM PUBLISHED CHARGE FOR
BM14
THIS DATE OF SERVICE.
B444
B467
B479
BCDI ACCORDING TO THE TERMS OF YOUR PLAN AND BASED ON THE DIAGNOSIS, THIS SERVICE IS NOT PAYABLE.
M50
BCAQ
B556
BI39
BCEX
B682
B683
BM70
B863
BG97
BL05
B405
B436
B484
B485
B487
B488
62
B521
62
B524
62
B541
62
B542
62
62
B582
B589
SURGICAL ASSISTANT SERVICES NOT PAYABLE AT THIS FACILITY.
CO-SURGERY SERVICES ARE NOT APPROVED FOR THIS PROCEDURE.
ACCORDING TO THE TERMS OF YOUR PLAN, SERVICES CONSIDERED INVESTIGATIONAL ARE NOT COVERED.
INPATIENT SETTING FOR SERVICES DENIED BY MANAGED BENEFITS.
THE MAXIMUM NUMBER OF SURGERIES ALLOWED PER DATE OF SERVICE HAS BEEN PROCESSED.
CHARGES FOR OUTPATIENT SERVICES DURING INPATIENT SERVICES ARE NOT COVERED
CHARGES FOR OUTPATIENT SERVICES WITH THIS PROXIMITY TO INPATIENT SERVICES ARE NOT COVERED
A PORTION OF THIS TREATMENT WAS NOT CERTIFIED.
PRIOR AUTHORIZATION IS REQUIRED FOR THIS SERVICE.
NO AUTHORIZATION FOR THIS PROCEDURE CODE FOR SERVICES RENDERED BY THIS PROVIDER
VISITS EXCEED AUTHORIZATION.
NO PREAUTHORIZATION FOR INFUSION THERAPY SERVICES, PENALTY APPLIED.
NO PRIOR AUTHORIZATION
A PRIOR AUTHORIZATION NON COMPLIANCE PENALTY WOULD HAVE BEEN ASSESSED HAD YOU NOT BEEN IN A MANAGED
BENEFITS EDUCATION PERIOD.
A PRIOR AUTHORIZATION AND SECOND SURGICAL OPINION NONCOMPLIANCE PENALTY WOULD HAVE BEEN ASSESSED HAD
YOU NOT BEEN IN A MANAGED BENEFITS EDUCATION PERIOD.
THESE SERVICES ARE NOT PAYABLE AS THE PROVIDER IS NOT LISTED ON THE TREATMENT PLAN.
THE CHARGE HAS BEEN DENIED SINCE WE HAVE NOT RECEIVED THE TREATMENT PLAN FROM THE PROVIDER. SHOULD THE
INFORMATION BE RECEIVED AT A LATER DATE THE CHARGE WILL BE REVIEWED.
SERVICES ARE BEYOND THE NUMBER OF APPROVED VISITS.
MAXIMUM PRIOR AUTHORIZED VISITS/DAYS/HOURS FOR THIS TREATMENT PERIOD HAVE BEEN REACHED.
©Anthem Blue Cross and Blue Shield - East Region
Page 11 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
62
62
62
62
62
RC
DC
B684
B700
B698
B706
BD48
62
BE62
62
BF17
62
62
62
BF29
BG26
BG83
REMITTANCE MESSAGE
CHARGES OUTSIDE THE APPROVED LENGTH OF STAY ARE NOT COVERED.
CLAIM HAS BEEN REJECTED. PRIOR AUTHORIZATION MUST BE OBTAINED FOR THIS TREATMENT.
THIS CLAIM HAS BEEN REJECTED BASED ON UTILIZATION REVIEW; BENEFITS HAVE BEEN EXHAUSTED.
REQUIRED PRIOR AUTHORIZATION WAS NOT OBTAINED FOR THIS SERVICE.
REQUIRED PRIOR AUTHORIZATION/TREATMENT PLAN WAS NOT OBTAINED. SUBSEQUENT CLAIMS WILL CONTINUE TO DENY
UNTIL THIS INFORMATION IS RECEIVED. WHEN THIS INFORMATION IS RECEIVED, CLAIMS WILL BE RECONSIDERED FOR
PAYMENT.
THE VISIT(S) ARE REJECTED SINCE THE APPROVED NUMBER OF VISITS FOR THIS PRIOR AUTHORIZATION/TREATMENT PLAN
HAVE BEEN EXCEEDED.
HOLD PATIENT HARMLESS FOR CHARGES APPLICABLE TO SERVICES EXCEEDING THE APPROVED LENGTH-OF-STAY.
CHARGES FOR SERVICES BEYOND THE APPROVED LENGTH OF STAY NOT COVERED.
62
ACCORDING TO THE TERMS OF YOUR PLAN, THESE SERVICES ARE NOT COVERED WITHOUT A PRIOR AUTHORIZATION. THIS
BG84 CLAIM WAS SUBMITTED WITHOUT A PRIOR AUTHORIZATION, THEREFORE NO BENEFITS ARE AVAILABLE.
62
62
62
62
62
62
62
62
62
62
62
62
BG99
BK32
BK44
BK49
BK60
BM63
BM71
BM75
BM76
BM77
BM91
BM79
62
BM80
62
BMBL
62
BN79
62
62
62
78
85
85
85
95
95
95
BT52
INPATIENT ELECTIVE ADMISSION WAS NOT PRIOR AUTHORIZED BY UTILIZATION MANAGEMENT
MEMBER DID NOT CONTACT UTILIZATION MANAGEMENT WITHIN 48 HOURS TO REPORT EMERGENCY HOSPITALIZATION OR
TREATMENT.
ACCORDING TO THE TERMS OF THE PATIENT'S PLAN THIS SERVICE IS NOT COVERED BECAUSE THE REQUIRED PRIOR
AUTHORIZATION WAS NOT OBTAINED. THIS CHARGE IS THE MEMBER'S LIABILITY.
NO RECORD FOR OUTPATIENT PRIOR AUTHORIZATION.
THE VISIT(S) ARE REJECTED SINCE THE APPROVED NUMBER OF VISITS FOR THIS PRIOR AUTHORIZATION/TREATMENT PLAN
HAVE BEEN EXCEEDED.
SERVICES PROVIDED DIFFER FROM WHAT WAS CERTIFIED.
NO AUTHORIZATION FOR THIS PROCEDURE CODE FOR THIS DATE OF SERVICE.
BENEFIT REDUCED FOR UNAPPROVED MEDICALLY UNNECESSARY DAYS
THE PHYSICIAN IS OUT OF NETWORK AND/OR A REFERRAL WAS NOT OBTAINED. SERVICES ARE NOT COVERED.
SERVICES RENDERED OUT OF NETWORK ARE NOT COVERED.
SERVICES NOT ALLOWED OUT OF NETWORK.
CLAIM REJECTED. PRIMARY CARE PHYSICIAN WAS NOT SELECTED AT TIME OF ENROLLMENT.
95
95
95
95
B587
B486
BK66
B440
BE88
BE89
B907
BF04
CLAIM REJECTED DUE TO LACK OF REFERRAL.
BF11
ACCORDING TO THE TERMS OF YOUR PLAN, THIS SERVICE IS NOT COVERED BECAUSE THE REQUIRED PRIOR
BF16
AUTHORIZATION WAS NOT OBTAINED.
BF30 NO PRIOR AUTHORIZATION OBTAINED. CLAIM REJECTED.
BG09 REFERRAL FOR THIS SERVICE NOT OBTAINED.
BH33 SERVICE NOT AUTHORIZED BY OTHER INSURANCE CARRIER
BN42 SELF-REFERRAL OPTION NOT AVAILABLE FOR THIS SERVICE.
95
BN86 THIS PATIENT'S PLAN DOES NOT COVER THIS TYPE OF SERVICE WHEN RENDERED BY AN OUT-OF-NETWORK PROVIDER.
95
BN87 THIS PATIENT'S PLAN DOES NOT COVER SERVICES RENDERED BY AN OUT-OF-NETWORK PROVIDER.
95
N54
N256
LEVEL OF CARE BILLED DIFFERS FROM APPROVED. PLEASE RESUBMIT WITH APPROVED LEVEL OF CARE
CLAIM IS DENIED BECAUSE DATES OF SERVICE ARE BEYOND THE APPROVED DATE RANGE.
SERVICES WERE NOT AUTHORIZED.
YOUR AUTHORIZATION DOES NOT INCLUDE THIS DATE OF SERVICE
CLAIM SUBMITTED WITH NO REFERRAL INFORMATION. HOST PLAN WILL RESUBMIT CORRECTED CLAIM.
INPATIENT OR OUTPATIENT ADMISSION WAS NOT PRIOR AUTHORIZED BY UTILIZATION MANAGEMENT.
SUBMITTED COVERED DAYS EXCEEDS APPROVED LENGTH OF STAY. ADDITIONAL DAYS DENIED.
SNET/NO PRIOR AUTHORIZATION, THEREFORE BENEFITS ARE DENIED.
INPATIENT ADMISSION EXCEEDS APPROVED LENGTH OF STAY. BILLING CORRECTION REQUESTED FROM PROVIDER.
CLAIM DENIED; NO PRIOR AUTHORIZATION OBTAINED. PLEASE CONTACT HMA BEHAVIORAL HEALTH, INC. AT P.O. BOX 706,
WORCESTER, MA OR AT 1-800-248-9908
©Anthem Blue Cross and Blue Shield - East Region
Page 12 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
95
95
95
95
95
95
95
96
96
96
96
96
96
96
96
96
RC
M68
M68
DC
BT33
BT51
BT53
BT54
BT55
BG06
BG07
B415
B449
B471
B478
B515
B564
B569
B654
B603
96
B661
96
96
B667
B669
96
B753
96
B757
96
B758
96
B759
96
B760
96
B761
96
96
96
96
96
96
96
96
96
96
96
96
96
96
96
96
96
B794
BCCS
BCSP
B800
B802
B830
B836
BH21
B896
B899
B944
BC02
BCDP
BP06
BP07
BR11
BCWP
96
BD01
96
96
96
96
96
BD30
BD46
BD65
BF59
BG12
REMITTANCE MESSAGE
ACCORDING TO THE TERMS OF YOUR PLAN, THIS SERVICE IS NOT COVERED BECAUSE THE REQUIRED PRIOR
AUTHORIZATION WAS NOT OBTAINED.
REFERRAL FOR THIS SERVICE NOT OBTAINED.
ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE IS NOT COVERED.
THIS PATIENT IS NOT ELIGIBLE TO RECEIVE BENEFITS FOR THE SERVICES SUBMITTED.
EMERGENCY MEDICAL SERVICES NOT RENDERED WITHIN A 60 DAY PERIOD OF LIABILITY ARE NOT COVERED.
BENEFITS DENIED FOR NONCOMPLIANCE WITH MANAGED CARE PROVISIONS.
ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE IS NOT COVERED.
BENEFITS DENIED FOR NONCOMPLIANCE WITH MANAGED CARE PROVISIONS.
SERVICES NOT COVERED IN ACCORDANCE WITH CONTRACT POLICY.
THIS SERVICE IS NOT PAYABLE WHEN PERFORMED BY A NON-PARTICIPATING PROVIDER.
THIS SERVICE WAS NOT APPROVED BY MEDICARE AND THEREFORE, CANNOT BE APPROVED BY THE MEMBERS ANTHEM
SUPPLEMENTAL POLICY. THE PATIENT BALANCE IS DEPENDENT ON MEDICARE'S PAYMENT/DENIAL INFORMATION, PLEASE
REFER TO YOUR EXPLANATION OF MEDICARE BENEFITS
THIS PLAN DOES NOT COVER CHARGES WHICH HAVE BEEN APPLIED TO YOUR MEDICARE DEDUCTIBLE.
OUR RECORDS INDICATE THAT THERE IS NO COVERAGE UNDER THIS IDENTIFICATION NUMBER.
BENEFITS FOR THIS PROCEDURE ARE NOT PAYABLE BASED ON THE CONDITIONS AND LIMITATIONS OF THE PATIENT'S
POLICY.
ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE IS NOT COVERED.
ACCORDING TO THE TERMS OF THE PLAN, HOME AND OFFICE MEDICAL CARE IS NOT COVERED BY THE PATIENT'S
CONTRACT.
ACCORDING TO THE TERMS OF THE PLAN, LABORATORY TEST ARE NOT COVERED BY THE PATIENT'S CONTRACT.
ACCORDING TO THE TERMS OF THE PLAN, PHYSICAL EXAMINATIONS AND/OR ROUTINE IMMUNIZATIONS ARE NOT
COVERED.
ACCORDING TO THE TERMS OF THE PLAN, ROUTINE GYNECOLOGICAL EXAMINATIONS ARE NOT COVERED BY THE PATIENT'S
CONTRACT.
COSMETIC SURGERY IS NOT COVERED.
UNDER THIS CONTRACT NUMBER, THERE IS NO COVERAGE FOR THIS SERVICE.
ACCORDING TO THE TERMS OF THE PLAN, SERVICES ARE NOT PAYABLE FOR THIS MEMBER.
ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE/REVENUE CODE IS NOT COVERED
ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE IS NOT COVERED.
PATIENT'S AGE EXCEEDS THE MAXIMUM AGE LIMIT FOR THIS PROCEDURE.
ACCORDING TO THE TERMS OF THE PLAN, THIS PROCEDURE IS NOT COVERED.
SERVICES NOT COVERED IN ACCORDANCE WITH CONTRACT POLICY.
BENEFITS ARE NOT PAYABLE FOR SERVICES PERFORMED DUE TO OCCLUSAL WEAR, EROSION, ABRASION AND/OR SURFACE
DEFECTS.
SERVICE NOT COVERED (VOID).
SERVICES ARE NOT COVERED UNDER THE PATIENT'S CONTRACT.
NO SUPPLEMENTAL BENEFIT COVERAGE FOR THIS TYPE OF SERVICE.
CHIROPRACTIC SERVICES NOT COVERED WITH THIS PATIENT'S COVERAGE.
SERVICES RENDERED NOT COVERED
©Anthem Blue Cross and Blue Shield - East Region
Page 13 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
96
96
96
RC
96
96
96
96
96
96
96
96
96
96
96
96
96
96
96
96
M7
96
M42
96
M67
96
M67
96
96
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
M97
M97
DC
REMITTANCE MESSAGE
BG12 SERVICES RENDERED NOT COVERED
BJ14 THIS CODE IS NOT COVERED IN YOUR PROVIDER CONTRACT.
BJ88 BENEFITS ARE NOT AVAILABLE FOR EXPERIMENTAL OR INVESTIGATIVE SERVICES.
MAJOR MEDICAL BENEFITS ARE NOT AVAILABLE FOR COINSURANCE/COPAYMENT AMOUNTS NOT COVERED UNDER YOUR
BJ94
PRESCRIPTION DRUG PROGRAM.
BJ96 PATIENT DISCOUNTS ARE NOT AVAILABLE FOR BENEFITS.
THIS PROCEDURE IS NOT COVERED WHEN RENDERED IN THIS PLACE OF SERVICE. PLEASE VERIFY THE INFORMATION AND
BK41
RESUBMIT IF INCORRECT.
BK56 BENEFIT NOT PROVIDED FOR SERVICES DENIED BY MEDICARE, MEMBER NOT LIABLE.
BK57 CONTRACT DOES NOT COVER CHARGES NOT COVERED BY MEDICARE - PATIENT LIABLE.
BK86 THIS CLAIM WILL BE PROCESSED UNDER THE MAJOR MEDICAL PORTION OF YOUR CONTRACT SHORTLY.
BM25
PROCEDURE NOT COVERED.
BM29
BN08 THIS PULMONARY FUNCTION TEST IS NOT COVERED.
BN16 SERVICES DO NOT MEET SUDDEN AND SERIOUS CRITERIA.
DIAGNOSIS CODE DOES NOT MEET SUDDEN AND SERIOUS GUIDELINES. INFORMATION SUBMITTED ON THE CLAIM
BN18 INDICATES THAT URGENT CARE GUIDELINES HAVE BEEN MET. PLEASE EITHER APPEAL WITH ADDITIONAL INFORMATION AS
APPROPRIATE OR RESUBMIT AS AN URGENT CARE CLAIM.
THIS SERVICE IS NOT COVERED IF BILLED MORE THAN ONCE BY THE SAME PROVIDER. PARTICIPATING PROVIDERS CAN
BQ07
NOT BILL THE PATIENT
BR07 THIS PROCEDURE IS NOT COVERED WHEN RENDERED IN THIS PLACE OF SERVICE. PLEASE VERIFY THE INFORMATION AND
BT26 RESUBMIT IF INCORRECT.
PROVIDER ID NUMBER SUBMITTED IS INCORRECT FOR TYPE OF SERVICE OR PRIMARY DIAGNOSIS SUBMITTED ON CLAIM.
BT01
PLEASE RESUBMIT CLAIM WITH CORRECT PROVIDER ID NUMBER.
B482 THE RENTAL FEES FOR THIS ITEM HAVE EXCEEDED THE PURCHASE PRICE. NO ADDITIONAL PAYMENT MAY BE MADE.
PLEASE SUBMIT A LETTER OF MEDICAL NECESSITY, WHICH INCLUDES THIS MEMBERS CONDITION. WE WILL FURTHER
B472
CONSIDER THIS CLAIM WHEN WE RECEIVE THE LETTER
INVALID PROCEDURE CODE. PLEASE CONTACT OUR REIMBURSEMENT DEPARTMENT TO ADD THIS PROCEDURE TO YOUR
B735
PRICING PROFILE.
SECOND OPINION SERVICES NOT PAYABLE WITH THIS PROCEDURE CODE. PLEASE RESUBMIT THE CLAIM WITH AN OFFICE
B756
VISIT CODE.
B655 SURGICAL ASSISTANT SERVICES ARE NOT PAYABLE AT THIS FACILITY.
B658 THE SERVICES RENDERED ARE NOT COVERED AT THIS LOCATION.
B455
B514
B596
PAYMENT FOR THESE SERVICES IS INCLUDED IN THE ALLOWANCE FOR THE PRIMARY PROCEDURE. NO ADDITIONAL
B611
BENEFITS ARE AVAILABLE. PARTICIPATING PROVIDERS SHOULD NOT BILL SEPARATELY FOR THESE SERVICES.
BCA1
BCA2
BCA3
B473 SEPARATE PAYMENT CANNOT BE MADE FOR THIS RELATED SERVICE.
BCA4
BCA5
BCA6
BCA7
BCA8
BCA9
MEDICAL CARE WITHIN THE AFTERCARE PERIOD IS INCLUDED IN THE SURGICAL ALLOWANCE. NO ADDITIONAL BENEFITS
BCAA
MAY BE MADE. PARTICIPATING OR PREFERRED PROVIDER SHOULD NOT BILL SEPARATELY FOR THESE SERVICES.
BCAB
BCAC
BCAF
BCAH
BCAR
BCB1
©Anthem Blue Cross and Blue Shield - East Region
Page 14 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
RC
DC
BCE1
BCE2
BCE3
BCE4
BCE5
BCE6
BCE7
BCE8
BCE9
BCEA
BCEB
BCEC
BCEF
BCEG
BCEH
BCER
BCI2
BCI3
BCI4
BCI5
BCI6
BCI7
BCI8
BCI9
BCIA
BCIB
BCIC
BCIG
REMITTANCE MESSAGE
PROCEDURE NOT PAYABLE WHEN PERFORMED WITH OTHER RELATED PROCEDURE(S) ON THE SAME DATE OF SERVICE.
PROCEDURE NOT PAYABLE WHEN PERFORMED WITH OTHER RELATED PROCEDURE(S) ON THE SAME DATE OF SERVICE. THE
RELATED PROCEDURE(S) WERE SUBMITTED ON A PREVIOUSLY PROCESSED CLAIM.
PROCEDURE NOT PAYABLE WHEN PERFORMED AT THE SAME TIME AS A LARGER, MORE COMPLEX PRIMARY PROCEDURE.
PROCEDURE NOT PAYABLE WHEN PERFORMED AT THE SAME TIME AS A LARGER, MORE COMPLEX PRIMARY PROCEDURE.
THE PRIMARY PROCEDURE WAS SUBMITTED ON A PREVIOUS CLAIM.
97
BCIR
97
97
97
97
97
97
97
97
97
97
97
97
97
BCM1
BCM2
BCM3
BCM4
BCM5
BCM6
BCM7 PROCEDURE NOT PAYABLE WHEN PERFORMED WITH OTHER RELATED PROCEDURE(S) ON THE SAME DATE OF SERVICE.
BCM8
BCM9
BCMA
BCMB
BCME
BCMG
PROCEDURE CODE HAS BEEN COMBINED INTO THE APPROPRIATE, ALL-INCLUSIVE PROCEDURE CODE. SEPARATE
BCMC
REIMBURSEMENT FOR EACH PROCEDURE IS NOT APPROPRIATE.
THIS PROCEDURE HAS BEEN COMBINED INTO THE APPROPRIATE ALL-INCLUSIVE PROCEDURE CODE SUBMITTED ON A
BCMF
SEPARATE CLAIM.
BCMH PROCEDURE CODE HAS BEEN COMBINED INTO THE APPROPRIATE, ALL-INCLUSIVE PROCEDURE CODE WHICH WAS
BCMR SUBMITTED ON A PREVIOUS CLAIM.
97
97
97
97
©Anthem Blue Cross and Blue Shield - East Region
Page 15 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
RC
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
DC
REMITTANCE MESSAGE
BCO1
BCO2
BCO3
BCO4
BCO5
BCO6
BCO7
PAYMENT FOR THIS MEDICAL VISIT IS INCLUDED IN PAYMENT FOR THE SURGICAL PROCEDURE PERFORMED ON THIS DATE
BCO8
OF SERVICE. IT IS NOT ELIGIBLE FOR SEPARATE PAYMENT. PARTICIPATING PROVIDERS CANNOT BALANCE BILL MEMBERS.
BCO9
BCOA
BCOB
BCOC
BCOF
BCOH
BCOV
PROCEDURE NOT PAYABLE WHEN PERFORMED WITH OTHER RELATED PROCEDURE(S) ON THE SAME DATE OF SERVICE.
BCPF
RELATED PROCEDURE(S) SUBMITTED ON A SEPARATE CLAIM.
PROCEDURE NOT PAYABLE WHEN PERFORMED WITH OTHER RELATED PROCEDURE(S) ON THE SAME DATE OF SERVICE. THE
BCPH
RELATED PROCEDURE(S) WERE SUBMITTED ON A PREVIOUSLY PROCESSED CLAIM.
BCPP
PROCEDURE NOT PAYABLE WHEN PERFORMED WITH OTHER RELATED PROCEDURE(S) ON THE SAME DATE OF SERVICE.
BCUP
BCR2
BCR3
BCR4
BCR5
BCR6
BCR7
PROCEDURE CODE HAS BEEN COMBINED INTO THE APPROPRIATE, ALL-INCLUSIVE PROCEDURE CODE. SEPARATE
BCR8
REIMBURSEMENT FOR EACH PROCEDURE IS NOT APPROPRIATE.
BCR9
BCRA
BCRB
BCRC
BCRG
BCRX
BCRH PROCEDURE CODE HAS BEEN COMBINED INTO THE APPROPRIATE, ALL-INCLUSIVE PROCEDURE CODE WHICH WAS
BCRR SUBMITTED ON A PREVIOUS CLAIM.
97
BCVR
97
BD21 ALL INCLUSIVE PAYMENT WAS NEGOTIATED WITH THE PROVIDER/FACILITY, AS SUCH, THERE IS NO PATIENT BALANCE.
97
97
97
97
97
97
97
97
97
97
97
97
97
97
97
M15
M15
M15
M15
M15
M15
M15
M15
M15
M15
M15
M15
PAYMENT FOR THIS MEDICAL VISIT IS INCLUDED IN PAYMENT FOR THE SURGICAL PROCEDURE PERFORMED ON THIS DATE
OF SERVICE. IT IS NOT ELIGIBLE FOR SEPARATE PAYMENT. PARTICIPATING PROVIDERS CANNOT BALANCE BILL MEMBERS.
BINC PAYMENT IS INCLUDED IN THE ALLOWANCE FOR ANOTHER SERVICE/PROCEDURE
BCH1
BCH2
BCH3
BCH4
BCH5
BCH6 THIS PREVIOUSLY ADJUDICATED PROCEDURE CODE WAS ADDED TO THE CLAIM AND DENIED AS INCLUSIVE TO
BCH7 PROCEDURE(S) ON CURRENT CLAIM SUBMISSION.
BCH8
BCH9
BCHA
BCHB
BCHC
©Anthem Blue Cross and Blue Shield - East Region
Page 16 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
RC
DC
97
M15
BT07
97
M144
B910
97
97
N19
N19
BF71
BG96
REMITTANCE MESSAGE
THIS PROCEDURE HAS BEEN COMBINED INTO THE APPROPRIATE ALL-INCLUSIVE PROCEDURE CODE SUBMITTED ON A
SEPARATE CLAIM.
PRE OPERATIVE CARE IS INCLUDED IN THE SURGICAL ALLOWANCE. NO ADDITIONAL BENEFITS MAY BE MADE.
PARTICIPATING OR PREFERRED PROVIDER SHOULD NOT BILL SEPARATELY FOR THESE SERVICES.
PAYMENT FOR THIS SERVICE IS INCLUDED IN THE GLOBAL REIMBURSEMENT WHICH HAS BEEN PREVIOUSLY PAID.
PARTICIPATING PROVIDERS SHOULD NOT BALANCE BILL.
107
BE33 HOME HEALTH CARE BENEFITS DENIED. SKILLED SERVICES ARE REQUIRED WHEN BILLING HOME HEALTH AIDE BENEFITS.
107
109
109
BM88 BLOOD ADMINISTRATION NOT COVERED WHEN BILLED ALONE.
B562 PLEASE SUBMIT TO YOUR NEW INSURANCE CARRIER.
B779 THIS SERVICE IS PROCESSED BY A VENDOR. HANDLE DIRECT WITH THE HOME PLAN.
PLEASE RESUBMIT THIS CLAIM TO VALUE BEHAVIORAL HEALTH AT P.O. BOX 599, TROY, NEW YORK. 12181-0599. PLEASE
BD44
CALL 1-800-441-6613 WITH ANY QUESTIONS.
PLEASE FORWARD THE CLAIM FOR THESE SERVICES FOR PROCESSING TO VALUE BEHAVIORAL HEALTH AT P.O. BOX 599,
BD45
TROY, NEW YORK 12181-0599. PLEASE CALL 1-800-441-6613 WITH ANY QUESTIONS.
109
109
109
BE87 COVERAGE FOR HOSPICE RELATED CLAIMS NOT COVERED. SUBMIT CLAIMS DIRECTLY TO MEDICARE FOR CONSIDERATION.
109
BFWD
109
ON YOUR BEHALF, WE HAVE FORWARDED THIS CLAIM TO ANTHEM VISION. PLEASE BE SURE TO PROPERLY SUBMIT FUTURE
CLAIMS DIRECTLY TO ANTHEM VISION.
BI10 THIS IS A HANDLE DIRECT CLAIM. PLEASE SUBMIT TO MEMBERS HOME PLAN.
109
BJ07
109
BJ78 PLEASE SUBMIT THIS EXPENSE TO YOUR PRESCRIPTION DRUG PROGRAM
THIS CLAIM WAS SENT TO BLUE CROSS AND BLUE SHIELD IN ERROR. THE PROVIDER OF CARE HAS BEEN ASKED TO REBILL
BJ92
THROUGH OUR COMPANION PLAN SYSTEM.
IF YOU ARE A PARTICIPATING PROVIDER WITH ANTHEM VISION, YOU MUST SUBMIT THE CLAIM ACCORDING TO THE
BK90 NETWORK'S FILING GUIDELINES. IF YOU ARE A NONPARTICIPATING PROVIDER, THE MEMBER HAS BEEN INSTRUCTED HOW
TO PROPERLY SUBMIT THIS CLAIM.
BL21 INTERMEDIARY ARRANGEMENT IN PLACE. FILE CLAIM WITH INTERMEDIARY
BM08 PLEASE CORRECT BILLING, WRONG MEMBER TYPE USED. THIS IS A NATIONAL ACCOUNT CLAIM.
BM28 CLAIM IS NOT A BLUE CROSS LIABILITY, MUST BE PROCESSED BY YALE HEALTH PLAN.
THIS DATE OF SERVICE IS PRIOR TO 9/1/04. SERVICES PRIOR TO 9/1/04 HAVE BEEN FORWARDED FOR PROCESSING TO
BT00
ANTHEM BEHAVIORAL HEALTH.
CLAIMS FOR ROUTINE VISION SERVICES MUST BE RESUBMITTED DIRECTLY TO VISION SERVICE PLAN (VSP). TO REQUEST A
BVSP
CLAIM FORM, PLEASE CALL 1-800-877-7195.
BL06 NOT COVERED UNLESS THE PROVIDER ACCEPTS ASSIGNMENT
B476 PROCEDURE NOT COMPLETED, NO BENEFITS PROVIDED.
BM82 MEDICAL RECORDS DEPARTMENT INDICATES PATIENT NEVER ADMITTED.
PAYMENT ADJUSTED BECAUSE TRANSPORTATION IS ONLY COVERED TO THE CLOSEST FACILITY THAT CAN PROVIDE THE
BL08
NECESSARY CARE
B435 AN EVALUATION WAS PREVIOUSLY PAID TO THIS PROVIDER FOR THIS MEMBER.
B506
ACCORDING TO THE TERMS OF THE PLAN, THE CONTRACTUAL LIMIT FOR THIS SERVICE HAS PREVIOUSLY BEEN PAID.
B507
B623 EXCEEDS ONE PER CALENDAR YEAR CONTRACT ALLOWANCE.
B837 PROCEDURE IS NOT COVERED SINCE THE MAXIMUM BENEFIT FOR RELATED SERVICES HAS PREVIOUSLY BEEN PAID.
B856 MAXIMUM POLICY BENEFIT HAS PREVIOUSLY BEEN PAID.
B877 THE MAXIMUM CONTRACT BENEFIT FOR THIS TYPE OF SERVICE HAS PREVIOUSLY BEEN PAID.
B878
ACCORDING TO THE TERMS OF THE PLAN, THE CONTRACTUAL LIMIT FOR THIS SERVICE HAS PREVIOUSLY BEEN PAID.
B880
BD24 SERVICES RENDERED EXCEED ALLOWABLE LIMIT.
BD57 MEDICARE AND YOUR HEALTH PLAN'S BENEFITS WERE EXHAUSTED AT THE TIME SERVICES WERE RENDERED.
109
109
109
109
109
109
109
111
113
115
117
119
119
119
119
119
119
119
119
119
119
119
MA122
THIS CLAIM HAS BEEN FORWARDED FOR PROCESSING TO ANTHEM BEHAVIORAL HEALTH. PLEASE SUBMIT FUTURE CLAIMS
FOR THIS MEMBER DIRECTLY TO: ANTHEM BEHAVIORAL HEALTH, PO BOX 22899, DENVER, CO 80222-0899.
©Anthem Blue Cross and Blue Shield - East Region
Page 17 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
119
119
119
119
119
119
119
119
119
119
RC
119
DC
BD93
BD94
BD95
BD96
BD97
BD98
BE30
BE31
BE51
BH10
BI68
119
BI69
119
119
119
BJ61
BJ74
BJ75
REMITTANCE MESSAGE
PROCEDURE IS NOT COVERED SINCE THE MAXIMUM BENEFIT FOR RELATED SERVICES HAS PREVIOUSLY BEEN PAID.
HOME HEALTH AIDE VISITS EXHAUSTED FOR CALENDAR YEAR.
HOME HEALTH CARE BENEFITS EXHAUSTED FOR CALENDAR YEAR.
ONLY 2 SKILLED NURSING VISITS ALLOWED ON EARLY MATERNITY DISCHARGE HOME HEALTH CARE CLAIM.
THE MAXIMUM CONTRACT BENEFIT FOR THIS TYPE OF SERVICE HAS PREVIOUSLY BEEN PAID.
ACCORDING TO THE TERMS OF YOUR PLAN, THE MAXIMUM COMBINED PSYCHIATRIC AND SUBSTANCE ABUSE BENEFIT DAYS
HAVE BEEN PREVIOUSLY REACHED.
ACCORDING TO THE TERMS OF YOUR PLAN, THESE SERVICES EXCEED THE COMBINED PSYCHIATRIC AND SUBSTANCE
ABUSE BENEFIT DAY MAXIMUM.
MAXIMUM # OF VISITS MET FOR THIS PROGRAM.
THE MAXIMUM CONTRACT BENEFIT FOR THIS TYPE OF INSTITUTIONAL SERVICE HAS PREVIOUSLY BEEN PAID.
THE MAXIMUM CONTRACT BENEFIT FOR THIS TYPE HAS PREVIOUSLY BEEN PAID.
SUPPLIES ARE NOT COVERED AFTER THE PURCHASE PRICE OF THE RELATED DURABLE MEDICAL EQUIPMENT HAS BEEN
PAID
AUTHORIZED NUMBER OF SERVICES HAS BEEN MET
119
BJ81
119
119
119
119
119
BK47
BM72
BM73
BENEFIT DAYS FOR THIS SERVICE EXHAUSTED WITH THIS CLAIM. RESUBMIT WITH COVERED/NONCOVERED DAYS.
BM74
BM92
BENEFIT DAYS FOR DIALYSIS TREATMENT EXHAUSTER WITH THIS CLAIM. MEDICARE IS NOW PRIMARY. SUBMIT TO
BN14
MEDICARE AND REBILL US AS SECONDARY.
BN72
CLAIM DENIED. BENEFIT DAYS EXHAUSTED WITH A PREVIOUS CLAIM.
BN73
BP03
BP04 ACCORDING TO THE TERMS OF THE PLAN, THE CONTRACT MAXIMUM FOR THIS SERVICE HAS PREVIOUSLY BEEN PAID.
119
119
119
119
119
119
119
119
119
119
BP05
BP10 THE MAXIMUM CONTRACT BENEFIT FOR THIS TYPE OF INSTITUTIONAL SERVICE HAS PREVIOUSLY BEEN PAID.
BR03 ACCORDING TO THE TERMS OF THE PLAN, THE MAXIMUM LIABILITY FOR THIS SERVICE HAS PREVIOUSLY BEEN PAID.
BR05
THE MAXIMUM CONTRACT BENEFIT FOR THIS TYPE OF INSTITUTIONAL SERVICE HAS PREVIOUSLY BEEN PAID.
BR10
PLEASE SUBMIT TWO SEPARATE BILLS, ONE FOR EMERGENCY ROOM SERVICES AND ANOTHER FOR THE INPATIENT
B769
ADMISSION.
BD64 HOSPITAL CLAIM RECEIVED ON MEDICARE CROSSOVER FILE. PROVIDER MUST RESUBMIT AS A CARVE-OUT CLAIM.
BJ85 THIS DRUG WAS NOT FOR CHEMOTHERAPY. PLEASE RESUBMIT WITH THE CORRECT DRUG CODE.
BM11
BT04 PLEASE CORRECT BILLING , UNABLE TO VERIFY TYPE OF SERVICE SUBMITTED BASED ON THE DIAGNOSIS, PRIMARY
BT18 PROCEDURE AND/OR REVENUE CODES SUBMITTED.
125
125
125
125
125
125
125
125
125
125
125
125
N34
N34
M38
M38
125
M45
BN77 PLEASE CORRECT BILLING. ACCIDENT TYPE OF SERVICE BUT NO OCCURRENCE CODE AND/OR DATE OF ACCIDENT ON BILL.
125
M53
125
N75
BM18 PLEASE CORRECT BILLING, CENTURY PREFERRED REIMBURSEMENT APPLIED AND LINE ITEM UNITS MISSING.
THIS CLAIM HAS BEEN DENIED BECAUSE DESCRIPTION OF SERVICE OR TOOTH LOCATION OR SURFACE CODE(S) DO NOT
BF60
MATCH THE PROCEDURE CODE SUBMITTED. PLEASE RESUBMIT WITH CORRECTED INFORMATION.
BT24
BM16
B601
BE68
BF32
BF34
PLEASE CORRECT THE BILLING BY INCLUDING THE HCPC CODE FOR THIS LINE ITEM.
SUBMISSION OF DATA CORRECTIONS/ADJUSTMENTS ARE NOT ACCEPTED ON A HCFA1500.
HOME HEALTH AGENCY MUST USE UNIFORM BILLING (UB92). PLEASE BILL ON UB92 AND RESUBMIT.
REFERRING PHYSICIAN UPIN NUMBER IS INVALID. CONTACT REFERRING PHYSICIAN FOR CORRECT NUMBER AND RESUBMIT
THE CLAIM.
©Anthem Blue Cross and Blue Shield - East Region
Page 18 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
125
RC
N234
129
129
129
129
129
129
129
DC
REMITTANCE MESSAGE
B882 SERVICES SHOULD BE BILLED ON A UB92
ACCORDING TO THE TERMS OF YOUR PLAN, THESE SERVICES ARE NOT COVERED WITHOUT A REFERRAL FROM YOUR
BF03 PRIMARY CARE PHYSICIAN (PCP). THIS CLAIM WAS SUBMITTED WITHOUT A REFERRAL THEREFORE NO BENEFITS ARE
AVAILABLE.
BQ10 CLAIM REJECTED. PRIMARY CARE PHYSICIAN WAS NOT SELECTED AT TIME OF ENROLLMENT.
REFERRING PHYSICIAN UPIN NUMBER IS INVALID. CONTACT REFERRING PHYSICIAN FOR CORRECT NUMBER AND RESUBMIT
BF02
THE CLAIM.
B938 INCORRECT PROVIDER PAID (VOID).
B940 INCORRECT CONTRACT/PATIENT PAID (VOID).
BD26 THIS REPRESENTS AN ADMINISTRATIVE ADJUSTMENT (VOID).
BD32 INCORRECT PAYMENT AMOUNT (VOID).
BD33 INCORRECT COB CALCULATION (VOID).
BD34 INCORRECT PROVIDER OFFICE PAID (VOID).
BK07 THE CHARGES FROM THE MEDICARE EOMB DO NO MATCH THE CHARGES BILLED ON THE CLAIM.
125
N256
125
N256
125
N286
129
BMSB CHARGES FROM THE MEDICARE EXPLANATION OF DRUG BENEFITS DO NOT MATCH THE CHARGES BILLED ON THE CLAIM
133
133
B600 YOUR HOSPITAL CLAIM HAS BEEN RECEIVED AND IS BEING PROCESSED. YOU WILL BE NOTIFIED SHORTLY OF THE FINAL
B662 DISPOSITION.
YOUR CLAIM IS BEING HELD PENDING A REVIEW OF MEDICAL RECORDS. AS SOON AS A DECISION IS MADE WE WILL
B728
CONTINUE PROCESSING YOUR CLAIM.
BL09 CLAIM ADJUSTED. PLAN PROCEDURES OF A PRIOR PAYOR WERE NOT FOLLOWED
BL10 CLAIM/SERVICE DENIED. APPEAL PROCEDURES NOT FOLLOWED OR TIME LIMITS NOT MET
BL11 CONTRACTED FUNDING AGREEMENT-SUBSCRIBER IS EMPLOYED BY THE PROVIDER OF SERVICES
THIS CLAIM CANNOT BE PROCESSED UNTIL WE ARE ADVISED OF THE FULL NAME AND ADDRESS OF THE REFERRING
BJ83
PHYSICIAN
BJ84 THIS CLAIM CANNOT BE PROCESSED UNTIL WE KNOW THE INDIVIDUAL PROVIDER OF CARE'S NAME AND ADDRESS.
APPROVAL FOR THIS SERVICE IS DENIED. AN INPATIENT STAY, OR APPROVED EMERGENCY VISIT HAS NOT BEEN
BN95
SUBMITTED, WHICH IS NECESSARY FOR THIS SERVICE TO BE PAYABLE.
THIS CHARGE IS NOT COVERED BECAUSE THERE IS NO DOCUMENTATION IN THE MEDICAL RECORDS TO INDICATE THE
BK03
SERVICE WAS PERFORMED.
BM97 ACCORDING TO THE TERMS OF THE PLAN, THE NUMBER OF DAYS EXCEEDS THE LIMIT FOR WELL NEWBORNS.
PAYMENT DENIED BECAUSE SERVICE/PROCEDURE WAS PROVIDED OUTSIDE OF THE UNITED STATES OR AS A RESULT OF
BL07
WAR
NO PAYMENT IS AVAILABLE AT THIS TIME. THE POLICY HOLDER SHOULD CONTACT THEIR EMPLOYER FOR FURTHER
B664
INFORMATION.
B691 THE SERVICES YOU SUBMITTED CANNOT BE APPROVED FOR PAYMENT. ANY QUESTIONS SHOULD BE DIRECTED TO OUR
B733 SPECIAL INVESTIGATIONS UNIT.
133
136
138
139
148
148
148
150
152
157
A1
A1
A1
A1
A1
B900 THE HEALTH MAINTENANCE ORGANIZATION HAS DENIED BENEFITS FOR THIS SERVICE.
BD52 NO WORLD WIDE BENEFIT COVERAGE FOR SERVICES RENDERED IN A FOREIGN COUNTRY.
MONTHLY ORTHODONTIC BILLS ARE NOT A COVERED SERVICE. INITIAL ORTHODONTIC CLAIM ALREADY RECEIVED AND IS
BG55
IN PROCESS.
THIS CLAIM MERELY REPRESENTS ADDITIONAL INFORMATION RECEIVED FROM MEDICARE FOR A PREVIOUSLY PROCESSED
BH04 CLAIM THROUGH BLUECARD. PLEASE SUBMIT ADDITIONAL CLAIM INFORMATION TO THE LOCAL BLUE CROSS/BLUE SHIELD
PLAN WHERE SERVICES WERE RENDERED.
SERVICES WITH RESPECT TO CONGENITAL MALFORMATION(S) ARE NOT COVERED. BENEFITS FOR THIS PROCEDURE ARE
BI31
NOT PAYABLE BASED ON THE CONDITIONS AND LIMITATIONS OF THE POLICY.
BL16 CLAIM INCORRECTLY SUBMITTED AS BEING PART OF A GLOBAL FEE. PLEASE RESEND WITH NORMAL PRICING
MEDICARE CROSSOVER IS IN EFFECT. CLAIM SUBMITTED THROUGH BLUECARD IN ERROR. ALLOW 4-6 WEEKS FOR US TO
BQ06
RECEIVE THE INFORMATION DIRECTLY FROM MEDICARE VIA CROSSOVER ARRANGEMENTS.
BT08
BT09 THIS CODE IS NOT COVERED UNDER YOUR PROVIDER AGREEMENT
A1
A1
A1
A1
A1
A1
A1
A1
A1
BT10
M67
BD17
THIS CLAIM HAS BEEN DENIED PENDING ADDITIONAL INFORMATION. PLEASE RESUBMIT WITH VALID ADA PROCEDURE
CODE(S).
©Anthem Blue Cross and Blue Shield - East Region
Page 19 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
RC
DC
A1
N5
B953
A1
N20
B909
A1
N61
BM64
REMITTANCE MESSAGE
ADDITIONAL INFORMATION IS NEEDED TO PROCESS THIS CLAIM. OUR RECORDS INDICATE THAT WE ARE THE PATIENT'S
PRIMARY HEALTH INSURANCE CARRIER. PLEASE SUBMIT A COMPLETED HEALTH INSURANCE CLAIM FORM. THE CLAIM WILL
BE RECONSIDERED WHEN THE INFORMATION IS RECEIVED
ATTENDING MEDICAL CARE AND INTENSIVE CARE ARE NOT PAYABLE ON THE SAME DAY. PARTICIPATING/PREFERRED
PROVIDERS SHOULD NOT BALANCE BILL.
PLEASE CORRECT BILLING, CLAIM SPANS YEAR END, SPLIT BILL.
THIS AMOUNT REPRESENTS COINSURANCE, DEDUCTIBLE AND EXCESS CHARGES PAYABLE UNDER YOUR PLAN. NO PATIENT
BALANCE
VACCINE PROVIDED AT NO CHARGE BY STATE OR OTHER OUTSIDE SOURCE
CLAIM HAS BEEN REFERRED FOR REVIEW UNDER THE MEMBER'S MEDICAL PLAN BENEFITS ANY BALANCE WILL BE
CONSIDERED UNDER THE DENTAL PLAN BENEFITS.
OUTPATIENT TREATMENT REPORT HAS NOW BEEN RECEIVED FROM PROVIDER. MEMBER IS RESPONSIBLE FOR COST-SHARE
ONLY.
CHARGES HAVE BEEN PAID IN FULL UNDER THE HOSPITAL PORTION OF YOUR COVERAGE.
THIS CLAIM HAS BEEN CREDITED DUE TO THE ORIGINAL CLAIM BEING SUBMITTED IN ERROR.
UNITS OF SERVICE ROUNDED TO NEAREST WHOLE NUMBER
ALL OR A PORTION OF THE AMOUNT NOT COVERED IS THE DIFFERENCE BETWEEN THE MEDICARE ALLOWED AMOUNT AND
THE CHARGE. SINCE YOU HAVE ACCEPTED ASSIGNMENT WITH FEDERAL MEDICARE, THIS BALANCE IS YOUR
RESPONSIBILITY.
DONOR BENEFITS ONLY AVAILABLE UNDER THE RECIPIENTS COVERAGE
EXPENSES FOR CONVALESCENT/SKILLED NURSING FACILITIES CONSIDERED ONLY FOR ADMISSIONS WITHIN 30 DAYS
FOLLOWING HOSPITALIZATION OF AT LEAST 3 DAYS.
CLAIM DENIED. AN INPATIENT STAY OF 3 OR MORE DAYS IS REQUIRED IN ORDER FOR YOUR HEALTH PLAN TO CONSIDER
THESE CHARGES.
PRIOR HOSPITALIZATION OR 30 DAY TRANSFER REQUIREMENT NOT MET
A2
B424
A2
B586
A2
B602
A2
B650
A2
A2
A2
B708
B738
BE36
A2
BK09
A2
BK46
A6
B268
A6
BE58
A6
B1
B1
B1
B1
B1
B1
B1
B1
B1
B1
BL12
BCN1
BCN2
BCN3
BCN4
BCN5 E&M VISIT PREVIOUSLY SUBMITTED WITHIN THE PAST THREE YEARS. REFER TO CPT EVALUATION AND MANAGEMENT
BCN6 SERVICES GUIDELINES.
BCN7
BCN8
BCN9
BCNV
CHIROPRACTIC COVERAGE IS LIMITED TO SPINAL MANIPULATIONS WITH A DIAGNOSIS OF SUBLUXATION AND/OR
BE96
EVALUATION.
BJ06 THESE SERVICES ARE NOT COVERED WHEN RENDERED BY A NON-PARTICIPATING PROVIDER.
BK48 THIS TYPE OF SERVICE HAS NOT BEEN AUTHORIZED
BK50 HOME HEALTH SERVICE DENIED BECAUSE THE MEMBER IS NOT HOMEBOUND.
BM27 NO REFERRAL FOR SERVICE OUTSIDE OF NETWORK.
BM85 THESE SERVICES ARE NOT COVERED UNDER YOUR BENEFIT WHEN PERFORMED AT THIS FACILITY.
BM38 PROVIDER NOT APPROVED.
BM39 PROVIDER NOT ACTIVE ON DATE OF SERVICE.
BCLE THE ORIGINAL SERVICE IS NOT ALLOWABLE IN FULL AS THERE IS A LESS COSTLY ALTERNATIVE SERVICE.
CLAIM/SERVICE NOT COVERED/REDUCED BECAUSE ALTERNATIVE SERVICE WERE AVAILABLE AND SHOULD HAVE BEEN
BL13
UTILIZED
BL14 SERVICES NOT COVERED BECAUSE THE PATIENT IS ENROLLED IN HOSPICE
B460 CHARGES HAVE BEEN REFERRED TO THE NON-PARTICIPATING PROVIDER NETWORK FOR PROCESSING
B577 THE CLAIM HAS BEEN FORWARDED TO THE HOME PLAN WHO WILL PAY THE SUBSCRIBER DIRECTLY.
B709
B812 YOUR CLAIM HAS BEEN RECEIVED AND WAS FORWARDED TO THE PROPER DEPARTMENT FOR TIMELY PROCESSING.
B5
B5
B5
B5
B5
B6
B7
B7
B8
B8
B9
B11
B11
B11
B11
B11
B11
M77
B851
BECR CLAIM HAS BEEN FORWARDED TO HOME PLAN FOR DIRECT PROCESSING.
©Anthem Blue Cross and Blue Shield - East Region
Page 20 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Note: The following list of 835 HIPAA and Remittance Proprietary Codes was prepared as of 05/15/06. Anthem reserves the right to
change this information in the list and is under no obligation to notify the recipient of any such changes. This information is
confidential and proprietary to Anthem and the recipient agrees not to disclose or make use of unless specifically authorized in
advance by Anthem.
ADJUSTMENT REASON CODE (ARC) REMARK CODE (RC) PROPRIETARY DISPOSITION CODE (DC)
ARC
RC
DC
B11
BI01
B11
BI03
B11
BI18
B11
BI21
B11
BI44
B11
BJ71
REMITTANCE MESSAGE
CLAIM HAS BEEN FORWARDED TO THE HOME PLAN FOR PROCESSING. PAYMENT WILL BE MADE BY THE HOME PLAN TO
THEIR MEMBER.
THIS CLAIM IS BEING FORWARDED TO THE BLUE CROSS/BLUE SHIELD PLAN WHERE THE SERVICES WERE RENDERED. THIS
WILL ALLOW THE CLAIM TO PROCESS AT THE "IN NETWORK" COST SHARE LEVELS IF THE PROVIDER IS PARTICIPATING
WITH THAT PLAN.
THIS CLAIM HAS BEEN SUBMITTED TO THE WRONG LOCATION FOR PROCESSING. WE WILL FORWARD TO THE PROPER
LOCATION FOR ADJUDICATION. FUTURE CLAIMS FOR THIS MEMBER SHOULD BE SUBMITTED DIRECTLY TO: BLUE CROSS
AND BLUE SHIELD OF CONNECTICUT, 321 RESEARCH PARKWAY, ME
THE CLAIM HAS BEEN FORWARDED TO THE HOME PLAN FOR PROCESSING. PLEASE DEAL DIRECT WITH HOME PLAN.
YOUR CLAIM HAS BEEN SENT TO BEECH STREET FOR REPRICING. ONCE THE CLAIM IS RETURNED, IT WILL BE SENT FOR
PROCESSING.
YOUR CLAIM HAS BEEN RECEIVED AT ABCBS AND IS BEING FORWARDED TO YOUR MEDICAL MANAGEMENT ADMINISTRATOR
FOR VERIZON V3/4 MEMBERS, VALUE OPTIONS, FOR REVIEW.
YOUR CLAIM HAS BEEN RECEIVED AT ABCBS AND IS BEING FORWARDED TO YOUR MEDICAL MANAGEMENT ADMINISTRATOR
FOR FLEET MEMBERS, USBH, FOR REVIEW.
SERVICE NEVER PERFORMED (VOID).
A PROFESSIONAL SERVICE HAS PREVIOUSLY BEEN PAID FOR THIS DAY.
THESE CHARGES ON THIS CLAIM ARE A DUPLICATE TO ANOTHER CLAIM FROM MEDICARE. WE ARE PROCESSING THAT
CLAIM FOR ADDITIONAL PAYMENT.
DATE IF SERVICE WAS PREVIOUSLY PAID BY SPECIAL CHECK EXCEPTION PROCESS
B11
BJ72
B12
B13
B939
B591
B13
BK81
B13
BL17
B15
BJ97 BENEFITS ARE NOT AVAILABLE FOR THIS CHARGE BILLED SEPARATELY. PLEASE BILL A GLOBAL FEE FOR THESE SERVICES.
B16
B18
BL15 PAYMENT ADJUSTED BECAUSE 'NEW PATIENT' QUALIFICATIONS WERE NOT MET
B612 INVALID PROCEDURE CODE SUBMITTED. PLEASE RESUBMIT WITH THE PROPER CPT PROCEDURE CODE.
B18
THIS CLAIM WAS SUBMITTED WITH AN INVALID OR UNACCEPTABLE PROCEDURE CODE FOR THIS DATE OF SERVICE. PLEASE
B651 SUBMIT A VALID OR ACCEPTABLE HCPCS OR CPT PROCEDURE CODE. WHEN WE RECEIVE THIS INFORMATION, WE WILL
CONTINUE TO PROCESS THIS CLAIM. PARTICIPATING PROVIDERS SHOULD NOT BILL THE MEMBER.
B20
B22
B22
BJ82 THIS CHARGE MUST BE BILLED BY THE LAB THAT PERFORMED THE SERVICE
B553 EMERGENCY ROOM SERVICES NOT PAYABLE FOR THIS DIAGNOSIS.
OUR RECORDS INDICATE THAT THE PATIENT HAS MAJOR MEDICAL COVERAGE WHICH SHOULD REIMBURSE FOR THESE
B963 SERVICES PRIOR TO YOUR SECONDARY COVERAGE. PLEASE SUBMIT THESE SERVICES TO YOUR MAJOR MEDICAL CARRIER
AND FORWARD YOUR ITEMIZED STATEMENT TO US FOR FURTHER PROCESSING.
©Anthem Blue Cross and Blue Shield - East Region
Page 21 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
Appendix B - Adjustment Reason Codes and Remark Codes for BlueCare Family Plan
(DOS prior to 7/1/06) on DIS system
835 Health Care Claim Payment / Advice
HIPAA Adjustment Reason Codes for BlueCare Family Plan
Note: The following list of 835 HIPAA and Remittance Proprietary Codes for BlueCare Family Plan was prepared as of
03/01/05. Anthem reserves the right to change this information in the list and is under no obligation to notify the
recipient of any such changes. This information is confidential and proprietary to Anthem and the recipient agrees not to
disclose or make use of unless specifically authorized in advance by Anthem.
ADJUSTMENT
GROUP CODE
ADJUSTMENT
REASON CODE
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
6
7
8
9
10
10
11
18
20
24
27
27
27
27
27
29
30
30
32
35
35
35
35
38
40
47
47
47
52
57
61
62
62
62
78
95
96
96
96
97
97
97
97
REMITTANCE MESSAGE
Services not covered due to patient age
Services not covered due to patient sex
Provider specialty not covered for this service
Member's age not compatible with this diagnosis
Services not covered due to sex restrictions
Patient's sex no allowed for this diagnosis
Procedure not covered with this diagnosis
Duplicate of a service previously submitted
Claim denied due to third party liability
Capitated line item
Patient has been terminated
Plan terminated or not in effect on date of service
Group terminated or not in effect on date of service
Subscriber or patient terminated or not in effect
Date of service not within effective dated range
Claim was not received within the filing limit
Patient waiting period has not expired
Diagnosis waiting period has not expired
Dependent children over age or not students are not covered
Member met or exceeded maximum dollar amount allowed
Maximum benefits paid for this diagnosis
Major Medical Lifetime Maximum met
Major Medical Lifetime Maximum met
Primary Care Physician did not approve these services
Out-of-plan services not covered for emergencies
Services not covered with this diagnosis
Diagnosis not allowed
Special processing claim
Disallowed out of plan referrals are not covered
Non-payment is a result of utilization review decision
Proper second opinion was not obtained
Limit on number of units/visits on authorization exceeded
Dollar limit on authorization is exceeded
Penalty applied - No precertification
Inpatient services are denied for this stay
Penalty applied to line
Service is not covered
Not a covered benefit for this member
Not a covered benefit for this type of employee
Procedure is incident to
Procedure part of lab panel
No fee schedule for this line item
Line XXX denied due to starred procedure rule
©Anthem Blue Cross and Blue Shield - East Region
Page 22 of 23
Appendices A and B
Anthem East EDI User Guide
Appendix 3 - 835 Health Care Claim Payment/Advice Companion Document
835 Health Care Claim Payment / Advice
HIPAA Adjustment Reason Codes for BlueCare Family Plan
ADJUSTMENT
GROUP CODE
ADJUSTMENT
REASON CODE
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
CO
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
OA
PI
PI
PR
97
97
97
97
97
119
141
141
A1
A1
A1
A2
A2
A2
A2
B1
B5
B5
B15
B18
B18
B22
5
6
6
7
11
11
19
22
30
51
52
54
54
125
125
A2
B18
B18
B18
50
55
A2
REMITTANCE MESSAGE
Procedure is mutually exclusive to
Procedure is being rebundled to
Procedure is included in
Denied service rendered within pre-op days
Denied service rendered within post-op days
Member met or exceeded maximum number of services allowed
Services occurs between two period counts
Some or all services did not meet eligibility requirement
Not covered by BlueCare Family Plan
Claim not eligible for payment
Denied - multiple component billing
Procedure covered only in the case of an accident
Procedure covered only in emergency (urgent) case
Second surgical opinion paid at reduced rate
Denied - Smart suspense
Service(s) covered only under an accident rider
BlueCare Family Plan guidelines not followed
Charges applied toward penalty
Follow-up visits included in the global surgery fee
Procedure has been terminated on the plan
Invalid procedure code - please submit with the correct code
Diagnosis must be severe for this service to be covered
Place of service not valid for this procedure
Procedure inappropriate for age replace with
Denied - age conflict
Procedure inappropriate for sex replace with
One or more line items denied due to ambulatory review
Denied - procedure not expected with diagnosis
Employment-related claims are not covered
Episode and or plan co-pay or deductible limit reached
Waiting period for this type of service has expired
Pre-existing waiting period not expired for diagnosis
Provider not authorized to render second surgical opinion
Assistant surgeons are not covered for this surgery
Denied procedure does not allow assistant surgeon
E & M higher than exprected to diagnosis, replaced with
New E & M already used, replaced with
Patient stop loss limit has been reach
Denied - Unlisted procedure
Denied - Procedure undefined
Denied - Obsolete procedure
Denied - Cosmetic procedure
Denied - experimental procedure
Benefits applied towards episode, copay, deductible limit
©Anthem Blue Cross and Blue Shield - East Region
Page 23 of 23
Appendices A and B