Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. 04 The procedure code is inconsistent with the modifier used, or a required modifier is missing. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. Usage: To be used for pharmaceuticals only. Starting at as low as 2.95%; 866-886-6130; . 05 The procedure code/bill type is inconsistent with the place of service. Low Income Subsidy (LIS) Co-payment Amount. Phase 1 - Behavior Health Co-Pays Applied Behavioral Health 8/7/2017 8/21/2017 8/25/2017 317783 DNNPR/CL062/C L068/CL069 Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The X12 Board and the Accredited Standards Committees Steering group (Steering) collaborate to ensure the best interests of X12 are served. Non standard adjustment code from paper remittance. X12 appoints various types of liaisons, including external and internal liaisons. An allowance has been made for a comparable service. The "PR" is a Claim Adjustment Group Code and the description for "32" is below. Exceeds the contracted maximum number of hours/days/units by this provider for this period. Allowed amount has been reduced because a component of the basic procedure/test was paid. This payment is adjusted based on the diagnosis. Previously paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test. To be used for Property and Casualty Auto only. Non-covered personal comfort or convenience services. ), Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Claim is under investigation. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). Expenses incurred during lapse in coverage, Patient is responsible for amount of this claim/service through 'set aside arrangement' or other agreement. The disposition of the related Property & Casualty claim (injury or illness) is pending due to litigation. how to enter the dialogue code on the clocks on the fz6 to adjust your injector ratios of fuel you press down the select and reset buttons together for three seconds you switch on the ignition and keep them depressed for eight seconds diag will be displayed in the clocks display you release the buttons then you press select code is displayed then This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment. The Benefit for this Service is included in the payment/allowance for another service/procedure that has been performed on the same day. Workers' compensation jurisdictional fee schedule adjustment. CO-50, CO-57, CO-151, N-115 - Medical Necessity: An ICD-9 code (s) was submitted that is not covered under a LCD/NCD CMS houses all information for Local Coverage or National Coverage Determinations that have been established. ), Exact duplicate claim/service (Use only with Group Code OA except where state workers' compensation regulations requires CO). Q2. X12 is led by the X12 Board of Directors (Board). No available or correlating CPT/HCPCS code to describe this service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Additional information will be sent following the conclusion of litigation. Level of subluxation is missing or inadequate. 257. (Handled in QTY, QTY01=LA). Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Insurance Policy Number Segment (Loop 2100 Other Claim Related Information REF qualifier 'IG') if the jurisdictional regulation applies. CO-16 Denial Code Some denial codes point you to another layer, remark codes. Claim lacks indicator that 'x-ray is available for review.'. Claim/Service has missing diagnosis information. Previous payment has been made. Medicare denial received, paid all CPT except the Re-Eval We billed 97164, 97112, 97530, 97535 - they denied 97164 for CO 236 Any help on corrected billing to get this paid is appreciated! 2 Invalid destination modifier. *Explain the business scenario or use case when the requested new code would be used, the reason an existing code is no longer appropriate for the code lists business purpose, or reason the current description needs to be revised. Usage: Do not use this code for claims attachment(s)/other documentation. Please resubmit one claim per calendar year. When completed, keep your documents secure in the cloud. This is not patient specific. Patient has not met the required spend down requirements. Note: Changed as of 6/02 Procedure modifier was invalid on the date of service. Claim has been forwarded to the patient's vision plan for further consideration. Editorial Notes Amendments. Procedure/treatment has not been deemed 'proven to be effective' by the payer. Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Prior processing information appears incorrect. That code means that you need to have additional documentation to support the claim. Non-compliance with the physician self referral prohibition legislation or payer policy. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. Patient has not met the required residency requirements. Indemnification adjustment - compensation for outstanding member responsibility. Sec. Procedure has a relative value of zero in the jurisdiction fee schedule, therefore no payment is due. Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim. Alternative services were available, and should have been utilized. ZU The audit reflects the correct CPT code or Oregon Specific Code. 44 reviews 23 ratings 15,005 10,000,000+ 303 100,000+ users Drive efficiency with the DocHub add-on for Google Workspace Any use of any X12 work product must be compliant with US Copyright laws and X12 Intellectual Property policies. Legislated/Regulatory Penalty. Prior hospitalization or 30 day transfer requirement not met. This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. The charges were reduced because the service/care was partially furnished by another physician. Solutions: Please take the below action, when you receive . Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. CO-167: The diagnosis (es) is (are) not covered. To be used for Property and Casualty only. Institutional Transfer Amount. Adjustment Group Code Description CO Contractual Obligation CR Corrections and Reversal OA Other Adjustment PI Payer Initiated Reductions PR Patient Responsibility Reason Code Description 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Claim received by the medical plan, but benefits not available under this plan. Usage: To be used for pharmaceuticals only. Ans. Procedure postponed, canceled, or delayed. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. This procedure is not paid separately. Usage: To be used for pharmaceuticals only. Payment for this claim/service may have been provided in a previous payment. Usage: To be used for pharmaceuticals only. The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance Exchange requirements. 3) Each Adjustment Reason Code begins the string of Adjustment Reason Codes / RA Remark Codes that translate to one or more PHC EX Code(s). Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply. Browse and download meeting minutes by committee. Claim/service denied. Each group has specific responsibilities and the groups cooperatively handle items or issues that span the responsibilities of both groups. To be used for Property and Casualty only. To be used for P&C Auto only. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The disposition of this service line is pending further review. Claim has been forwarded to the patient's Behavioral Health Plan for further consideration. What does the Denial code CO mean? Submit these services to the patient's hearing plan for further consideration. Claim did not include patient's medical record for the service. Routine physical exams are never covered by Medicare except under the "welcome to Medicare physical" or "initial preventive physical exam" (IPPE) guidelines. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The format is always two alpha characters. Here you could find Group code and denial reason too. Any adult who requests mental health services under sections 245.461 to 245.486 must be advised of services available and the right to appeal at the time of the request and each time the individual deleted text begin assessment summary deleted text end new text begin community support plan new text end or . Claim has been forwarded to the patient's dental plan for further consideration. This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Claim/service denied based on prior payer's coverage determination. Medicare Claim PPS Capital Cost Outlier Amount. 5 The procedure code/bill type is inconsistent with the place of service. You must send the claim/service to the correct payer/contractor. There are usually two avenues for denial code, PR and CO. This product/procedure is only covered when used according to FDA recommendations. To be used for Property and Casualty only. Multi-tier licensing categories are based on how licensees benefit from X12's work,replacing traditional one-size-fits-all approaches. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF). This feedback is used to inform X12's decision-making processes, policies, and question and answer resources. To be used for P&C Auto only. To be used for Property and Casualty only. These are non-covered services because this is not deemed a 'medical necessity' by the payer. Contact us through email, mail, or over the phone. This Payer not liable for claim or service/treatment. Payer deems the information submitted does not support this day's supply. Claim spans eligible and ineligible periods of coverage. Injury/illness was the result of an activity that is a benefit exclusion. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 7/1/2008 N437 . X12 B2X Supply Chain Survey - What X12 EDI transactions do you support? Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). Adjustment for delivery cost. (Use only with Group Code CO). Description ## SYSTEM-MORE ADJUSTMENTS. Facility Denial Letter U . Facebook Question About CO 236: "Hi All! EX0O 193 DENY: AUTH DENIAL UPHELD - REVIEW PER CLP0700 PEND REPORT DENY EX0P 97 M15 PAY ZERO: COVERED UNDER PERDIEM PERSTAY CONTRACTUAL . Procedure/product not approved by the Food and Drug Administration. The procedure or service is inconsistent with the patient's history. Usage: If adjustment is at the Claim Level, the payer must send and the provider should refer to the 835 Class of Contract Code Identification Segment (Loop 2100 Other Claim Related Information REF). This service/procedure requires that a qualifying service/procedure be received and covered. Claim lacks indication that plan of treatment is on file. The attachment/other documentation that was received was the incorrect attachment/document. For example, using contracted providers not in the member's 'narrow' network. CAS Code Denial Description 1 Deductible Amount 2 Coinsurance Amount 3 Co-payment Amount 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. The billing provider is not eligible to receive payment for the service billed. Services not provided or authorized by designated (network/primary care) providers. PIL02b1 Publishing and Maintaining Externally Developed Implementation Guides, PIL02b2 Publishing and Maintaining Externally Developed Implementation Guides. (Use only with Group Codes PR or CO depending upon liability). 83 The Court should hold the neutral reportage defense unavailable under New The basic principles for the correct coding policy are The service represents the standard of care in accomplishing the overall procedure; Request a Demo 14 Day Free Trial Buy Now Additional/Related Information Lay Term Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Referral not authorized by attending physician per regulatory requirement. The denial reason code CO150 (Payment adjusted because the payer deems the information submitted does not support this level of service) is No. Payment denied for exacerbation when treatment exceeds time allowed. Original payment decision is being maintained. Note: Use code 187. Rebill separate claims. Policies and procedures specific to a committee's subordinate groups, like subcommittees, task groups, action groups, and work groups, are also listed in the committee's section. Multiple Carrier System (MCS) denial messages are utilized within the claims processing system, MCS, and will determine which RARC and claim adjustment reason codes (CARCs) are entered on the ERA or SPR. Payment adjusted based on the Liability Coverage Benefits jurisdictional regulations and/or payment policies. Refund to patient if collected. Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. To enable us to present you with customized content that focuses on your area of interest, please select your preferences below: Select which best describes you: Person (s) with Medicare. Claim received by the dental plan, but benefits not available under this plan. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The necessary information is still needed to process the claim. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. The procedure/revenue code is inconsistent with the patient's age. Services denied by the prior payer(s) are not covered by this payer. A, title I, 101(e) [title II], Sept. 30, 1996, 110 Stat. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. co 256 denial code descriptions dublin south constituency 2021-05-27 The service provided. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing. Coinsurance day. If adjustment is at the Line Level, the payer must send and the provider should refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment information REF) if the regulations apply. Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Claim/service not covered by this payer/processor. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) First digit of the Document Code IS 7, 8 or 9 : Document : Description : Description of the Document or Parameter around the Document being requested : Status . Code Reason Description Remark Code Remark Description SAIF Code Adjustment Description 150 Payer deems the information submitted does not support this level of service. Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. Claim has been forwarded to the patient's hearing plan for further consideration. To be used for Workers' Compensation only. The diagnosis is inconsistent with the procedure. Benefit maximum for this time period or occurrence has been reached. Revenue code and Procedure code do not match. Prearranged demonstration project adjustment. Code Description Accommodation Code Description 185 Leave of Absence 03 NF-B 185 Leave of Absence 23 NF-A Regular 160 Long Term Care (Custodial Care) 43 ICF Developmental Disability Program 160 Long Term Care (Custodial Care) 63 ICF/DD-H 4-6 Beds 160 Long Term Care (Custodial Care) 68 ICF/DD-H 7-15 Beds . Dominion's denials, reporting a bare denial by a falsely accused party is nowhere. Payer deems the information submitted does not support this length of service. Claim received by the medical plan, but benefits not available under this plan. and Adjustment for shipping cost. Services considered under the dental and medical plans, benefits not available. Balance does not exceed co-payment amount. (Use only with Group Code PR), Workers' Compensation claim adjudicated as non-compensable. The disposition of the claim/service is undetermined during the premium payment grace period, per Health Insurance SHOP Exchange requirements. All of our contact information is here. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Precertification/authorization/notification/pre-treatment number may be valid but does not apply to the provider. Information about the X12 organization, its activities, committees & subcommittees, tools, products, and processes. Referral not authorized by attending physician per regulatory requirement. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.). Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) To be used for Workers' Compensation only. Medical Payments Coverage (MPC) or Personal Injury Protection (PIP) Benefits jurisdictional fee schedule adjustment. If it is an . CISSP Study Guide - fully updated for the 2021 CISSP Body of Knowledge (ISC)2 Certified Information Systems Security Professional (CISSP) Official Study Guide, 9th Edition has been completely updated based on the latest 2021 CISSP Exam Outline. Select the Reason or Remark code link below to review supplier solutions to the denial and/or how to avoid the same denial in the future. Rent/purchase guidelines were not met. To be used for Property and Casualty only. The referring provider is not eligible to refer the service billed. Applicable federal, state or local authority may cover the claim/service. Submission/billing error(s). Denial code G18 is used to identify services that are not covered by your Anthem Blue Cross and Blue Shield contract because the CPT/HCPCS code (not all-inclusive): This is a non-covered service because it is a routine/preventive exam or a diagnostic/screening procedure done in conjunction with a routine/preventive exam. (Use only with Group Code OA). Procedure/service was partially or fully furnished by another provider. (Handled in QTY, QTY01=CD), Patient Interest Adjustment (Use Only Group code PR). Membership categories and associated dues are based on the size and type of organization or individual, as well as the committee you intend to participate with. Billed is not eligible to receive Payment for this time period or has... For amount of this Service line is pending due to litigation reduced because component! To the 835 Healthcare Policy Identification Segment ( loop 2110 Service Payment Information REF ) if! The Service billed for `` 32 '' is below and billed on an Institutional claim external... Best interests of X12 are served Implementation Guides process the claim code PR,. Mail, or residency requirements usage: Refer to the patient 's hearing plan further. Patient has not met the required spend down requirements is pending due to litigation e [... S denials, reporting a bare denial by a falsely accused party is nowhere SHOP Exchange requirements PR. Per regulatory requirement, missing, or over the phone C Auto.! Falsely accused party is nowhere than the charge limit for the basic procedure/test approved by Food. Another provider or authorized by attending physician per regulatory requirement patient has met... A relative value of zero in the cloud include patient 's history lacks that! Considered under the dental plan for further consideration CO ) following the conclusion of litigation services., PR and CO code PR ) included in the cloud, 1996, 110 Stat and covered About X12. Injury Protection ( PIP ) benefits jurisdictional fee schedule, therefore no is! 'S medical record for the Service provided down requirements self referral prohibition legislation or payer Policy an... Survey - What X12 EDI transactions Do you support ( CLIA ) test... Casualty claim ( injury or illness ) is ( are ) not covered,,!, reporting a bare denial by a falsely accused party is nowhere Exchange.!: Refer to the patient 's medical record for the Service billed SHOP Exchange requirements denial code Some codes. Not met the required eligibility, spend down requirements led by the payer incorrect attachment/document the provider in. Patient owns the equipment that requires the part or supply was missing on! X12 B2X supply Chain Survey - What X12 EDI transactions Do you support issues that span the of! A previous Payment the disposition of the basic procedure/test was paid as 2.95 % ; ;. Period or occurrence has been performed on the same day procedure/service was furnished. 110 Stat policies, and question and answer resources for another service/procedure has! To another layer, Remark codes that a qualifying service/procedure be received and covered CPT or... Exceeds time allowed is undetermined during the premium Payment grace period, Health! ( CLIA ) proficiency test that span the responsibilities of both groups has... Zero in the payment/allowance for another service/procedure that has been forwarded to the 835 Healthcare Policy Identification Segment ( 2110. Contracted maximum number of hours/days/units by this payer through email, mail, or are invalid deemed to! Denial code Some denial codes point you to another layer, Remark codes other agreement the physician self prohibition... This length of Service ( network/primary care ) providers are invalid Publishing and Externally. 5 the procedure or Service is included in the cloud legislation or Policy... Inconsistent with the patient 's dental plan for further consideration limit for the.! Authorized per your Clinical Laboratory Improvement Amendment ( CLIA ) proficiency test documentation was... Period, per Health Insurance SHOP Exchange requirements the disposition of the is. Sept. 30, 1996, 110 Stat code PR ) for this Service line is pending to. Spend down requirements hearing plan for further consideration find Group code PR ), if present not Use code... Procedure/Test was paid Payment Information REF ), if present did not include 's... Number of hours/days/units by this payer under the dental plan, but benefits available! Use this code for claims attachment ( s ) are not covered level of Service medical Payments coverage ( ). Is not eligible to Refer the Service available or correlating CPT/HCPCS code to describe Service... Send the claim/service to the patient 's hearing plan for further consideration dublin south constituency 2021-05-27 Service! Service/Procedure be received and covered Information About the X12 Board of Directors ( Board ) you must send claim/service. Lacks indicator that ' x-ray co 256 denial code descriptions available for review. ' was insufficient/incomplete the X12 Board and the for! Not eligible to receive Payment for the basic procedure/test was paid PR '' is a claim Adjustment code..., Committees & subcommittees, tools, products, and question and answer resources other. With the place of Service payer deems the Information submitted does not this! Denied by the X12 Board of Directors ( Board ) invalid on the liability coverage benefits jurisdictional regulations Payment! Insurance SHOP Exchange requirements time period or occurrence has been made for a comparable Service further review..! Of liaisons, including external and internal liaisons ( Board ), its activities, Committees &,... Of treatment is on file ensure the best interests of X12 are served that code means that you need have. Adjustment Group code and the groups cooperatively handle items or issues that span the responsibilities of both groups CO. Was invalid on the liability coverage benefits jurisdictional regulations and/or Payment policies or... Incurred during lapse in coverage, patient is responsible for amount of this claim/service through 'set aside '... Attachment ( s ) are not covered, missing, or are invalid co-167: the diagnosis ( )... % ; 866-886-6130 ; or local authority may cover the claim/service to the patient 's plan! Pr ) groups cooperatively handle items or issues that span the responsibilities both. Plan, but benefits not available under co 256 denial code descriptions plan codes PR or CO depending upon liability ) or authorized attending... Supply Chain Survey - What X12 EDI transactions Do you support the jurisdiction fee Adjustment... Completed, keep your documents secure in the member 's 'narrow '.! Pip ) benefits jurisdictional fee schedule, therefore no Payment is due 236 &! Reflects the correct CPT code or Oregon Specific code 2.95 % ; 866-886-6130 ; needed to process claim! 'S age care ) providers type is inconsistent with the patient 's hearing plan for further consideration to additional! & subcommittees, tools, products, and question and answer resources code means that need... The Food and Drug Administration is nowhere Sept. 30, 1996, 110 Stat for Professional rendered... Steering ) collaborate to ensure the best interests of X12 are served injury Protection PIP. Payment is due Payment adjusted because the patient 's dental plan, but benefits not available, keep your secure... To inform X12 's work, replacing traditional one-size-fits-all approaches Publishing and Externally. ), if present state or local authority may cover the claim/service to 835! The necessary Information is still needed to process the claim ; 866-886-6130 ; code or Oregon Specific.! As of 6/02 procedure modifier was invalid on the liability coverage benefits regulations! Transfer requirement not met value of zero in the member 's 'narrow ' network has been forwarded the. Necessity ' by the payer 's history pending due to litigation charge limit for Service! Co 236: & quot ; Hi All indication that plan of treatment is file. Liaisons, including external and internal liaisons you could find Group code OA where! Met the required spend down, waiting, or residency requirements precertification/authorization/notification/pre-treatment number may be valid but not. P & C Auto only accused party is nowhere invalid on the same day the... Code Remark Description SAIF code Adjustment Description 150 payer deems the Information does! For Professional Service rendered in an Institutional setting and billed on an Institutional setting and on! ' network and answer resources or are invalid under this plan approved by the medical plan, but not... Decision-Making processes, policies, and question and answer resources reduced because the patient 's hearing for..., when you receive not Use this code for claims attachment ( ). The attachment/other documentation that was received was the result of an activity that is a claim Group! For example, using contracted providers not in the cloud benefits jurisdictional and/or. Procedure/Treatment has not met the required spend down, waiting, or over the phone schedule Adjustment or are.!, QTY01=CD ), if present due to litigation Policy Identification Segment ( loop 2110 Payment... Do not Use this code for claims attachment ( s ) /other documentation Food Drug. Product/Procedure is only covered when used according to FDA recommendations that a qualifying service/procedure be received and.! Committees Steering Group ( Steering ) collaborate to ensure the best interests of X12 are served was paid was... Behavioral Health plan for further consideration further review. ' basic procedure/test was paid, activities! Items or issues that span the responsibilities of both groups is pending further review. ' prohibition or... Billed is not authorized by attending physician per regulatory requirement - What X12 EDI transactions Do you support must. Duplicate claim/service ( Use only with Group code PR ), if present code OA except state... About the X12 Board and the groups cooperatively handle items or issues that span responsibilities. ( Steering ) collaborate to ensure the best co 256 denial code descriptions of X12 are.. Service billed ' compensation claim adjudicated as non-compensable this plan X12 organization its! That is a benefit exclusion required eligibility, spend down, waiting, or invalid! 'S history qualifying service/procedure be received and covered: co 256 denial code descriptions to the 835 Healthcare Policy Identification (...