Incomplete/Invalid documentation of face-to-face examination. Code 047 (TP 03, 14) - Program Transfer Use this code if the recipient receiving assistance is being transferred from a non-DHS assistance program to a DHS assistance program. CMS WILL NOT BE LIABLE FOR ANY CLAIMS ATTRIBUTABLE TO ANY ERRORS, OMISSIONS, OR OTHER INACCURACIES IN THE INFORMATION OR MATERIAL COVERED BY THIS LICENSE. Missing/incomplete/invalid service facility primary address. PDF Remittance and Status (R&S) Reports - Tmhp However, the medical information we have for this patient does not support the need for this item as billed. Remittance Advice Remark Codes | X12 The current review reason codes and statements can be found below: List of Review Reason Codes and Statements Please email PCG-ReviewStatements@cms.hhs.gov for suggesting a topic to be considered as our next set of standardized review result codes and statements. PDF Claim Adjustment Reason Codes Crosswalk - Superior HealthPlan ", Code 136 Failure to Provide Proof of U.S. Not supported by clinical records. Copyright 2016-2023. Long term care case mix or per diem rate cannot be determined because the patient ID number is missing, incomplete, or invalid on the assignment request. The state should report the pay/deny decision passed to it by the prime MCO. "You now meet the citizenship requirement." Do not use this code for deceased applications that are simultaneously opened and closed. To apply for an X12 membership, complete and submit an application form which will be reviewed and verified, then you will be notified of the next steps. Computer-printed reason to applicant or recipient: Missing/incomplete/invalid credentialing data. Computer-printed reason to applicant: Services not included in the appeal review.
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