Code assigned by issuer to identify reason for rejection
Type
ID
Length
Max 2 / Min 2
Codes
<> 01
Price Authorization Invalid
<> 02
Price Authorization Expired
<> 03
Product not on the price authorization
<> 04
Authorized Quantity Exceeded
<> 05
Zero Balance
<> 06
Special Cost Incorrect
<> 07
Catalog Cost Incorrect
<> 08
Invalid Ship Location
<> 09
No Credit Allowed
<> 10
Administrative Cancellation
<> 11
Invalid Debit Number
<> 12
Duplicate Sequence Number
<> 13
Not Valid for Price Protection
<> 14
Invalid part number
<> 15
Required application data missing
<> 16
Unit resale higher than authorized
<> 17
Negotiated price was not less than book price
<> 18
Ship date must not be after current date
<> 19
Ship date cannot be prior to price authorization issue date
<> 20
Ship date should not be before price authorization date (for rebills)
<> 21
Price authorization is a rebill type
<> 23
Price authorization has been deleted
<> 24
Price authorization used on a sales order
<> 25
Disposition pending vendor review.
<> 26
Invalid Customer Number
<> 27
Invalid Ship Date
<> 28
Duplicate Invoice Number
<> 29
Claim Submitted Past Excerise Period
<> 30
Invalid Meet Competition Cost
<> 31
Invalid Book Cost
<> 32
Input Incomplete
<> 33
Input Errors
<> 34
No Coverage
<> 35
Out of Network
<> 36
Testing not Included
<> 37
Request Forwarded To and Decision Response Forthcoming From an External Review Organization
<> 41
Authorization/Access Restrictions
<> 42
Unable to Respond at Current Time
<> 43
Invalid/Missing Provider Identification
<> 44
Invalid/Missing Provider Name
<> 45
Invalid/Missing Provider Specialty
<> 46
Invalid/Missing Provider Phone Number
<> 47
Invalid/Missing Provider State
<> 48
Invalid/Missing Referring Provider Identification Number
<> 49
Provider is Not Primary Care Physician
<> 50
Provider Ineligible for Inquiries
<> 51
Provider Not on File
<> 52
Service Dates Not Within Provider Plan Enrollment
<> 53
Inquired Benefit Inconsistent with Provider Type
<> 54
Inappropriate Product/Service ID Qualifier
<> 55
Inappropriate Product/Service ID
<> 56
Inappropriate Date
<> 57
Invalid/Missing Date(s) of Service
<> 58
Invalid/Missing Date-of-Birth
<> 59
Invalid/Missing Date-of-Death
<> 60
Date of Birth Follows Date(s) of Service
<> 61
Date of Death Precedes Date(s) of Service
<> 62
Date of Service Not Within Allowable Inquiry Period
<> 63
Date of Service in Future
<> 64
Invalid/Missing Patient ID
<> 65
Invalid/Missing Patient Name
<> 66
Invalid/Missing Patient Gender Code
<> 67
Patient Not Found
<> 68
Duplicate Patient ID Number
<> 69
Inconsistent with Patient's Age
<> 70
Inconsistent with Patient's Gender
<> 71
Patient Birth Date Does Not Match That for the Patient on the Database
<> 72
Invalid/Missing Subscriber/Insured ID
<> 73
Invalid/Missing Subscriber/Insured Name
<> 74
Invalid/Missing Subscriber/Insured Gender Code
<> 75
Subscriber/Insured Not Found
<> 76
Duplicate Subscriber/Insured ID Number
<> 77
Subscriber Found, Patient Not Found
<> 78
Subscriber/Insured Not in Group/Plan Identified
<> 79
Invalid Participant Identification
<> 80
No Response received - Transaction Terminated
<> 81
Invalid or Missing Case Number
<> 82
Not Medically Necessary
<> 83
Level of Care Not Appropriate
<> 84
Certification Not Required for this Service
<> 85
Certification Responsibility of External Review Organization
<> 86
Primary Care Service
<> 87
Exceeds Plan Maximums
<> 88
Non-covered Service
<> 89
No Prior Approval
<> 90
Requested Information Not Received
<> 91
Duplicate Request
<> 92
Service Inconsistent with Diagnosis
<> 95
Patient Not Eligible
<> 96
Pre-existing Condition
<> 97
Invalid or Missing Provider Address
<> 98
Experimental Service or Procedure
<> E1
Requested Record Will Not Be Sent; Cannot Identify the Record
<> E2
Requested Record Will Not Be Sent; Need Student or Parent Permission
<> E3
Requested Record Will Not Be Sent
<> E4
Requested Record Will Not Be Sent; Never Enrolled
<> E5
Requested Record Will Not Be Sent; No Degree Awarded
<> E6
Requested Record Will Not Be Sent; No Grades Posted
<> E7
Requested Record Cannot Be Sent Electronically; Record Resides in Paper Format only which Will Be Sent by Mail
<> E8
Requires Medical Review
<> T1
Cannot Identify Provider as TPO (Third Party Organization) Participant
<> T2
Cannot Identify Payer as TPO (Third Party Organization) Participant
<> T3
Cannot Identify Insured as TPO (Third Party Organization) Participant
<> T4
Payer Name or Identifier Missing
<> T5
Certification Information Missing
<> T6
Claim does not contain enough information for re-pricing
<> ZZ
Mutually Defined
