added gacl config files to upgrade instructions

[openemr.git] / interface / billing / adjustment_reason_codes.php

<?php

// See http://www.wpc-edi.com/codes
//
$adjustment_reasons = array(
 '1' => xl('Deductible Amount'),
 '2' => xl('Coinsurance Amount'),
 '3' => xl('Co-payment Amount'),
 '4' => xl('The procedure code is inconsistent with the modifier used or a required modifier is missing'),
 '5' => xl('The procedure code/bill type is inconsistent with the place of service'),
 '6' => xl('The procedure/revenue code is inconsistent with the patients age'),
 '7' => xl('The procedure/revenue code is inconsistent with the patients gender'),
 '8' => xl('The procedure code is inconsistent with the provider type/specialty (taxonomy)'),
 '9' => xl('The diagnosis is inconsistent with the patients age'),
 '10' => xl('The diagnosis is inconsistent with the patients gender'),
 '11' => xl('The diagnosis is inconsistent with the procedure'),
 '12' => xl('The diagnosis is inconsistent with the provider type'),
 '13' => xl('The date of death precedes the date of service'),
 '14' => xl('The date of birth follows the date of service'),
 '15' => xl('Payment adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider'),
 '16' => xl('Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remarks codes whenever appropriate'),
 '17' => xl('Payment adjusted because requested information was not provided or was insufficient/incomplete. Additional information is supplied using the remittance advice remarks codes whenever appropriate'),
 '18' => xl('Duplicate claim/service'),
 '19' => xl('Claim denied because this is a work-related injury/illness and thus the liability of the Workers Compensation Carrier'),
 '20' => xl('Claim denied because this injury/illness is covered by the liability carrier'),
 '21' => xl('Claim denied because this injury/illness is the liability of the no-fault carrier'),
 '22' => xl('Payment adjusted because this care may be covered by another payer per coordination of benefits'),
 '23' => xl('Payment adjusted due to the impact of prior payer(s) adjudication including payments and/or adjustments'),
 '24' => xl('Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan'),
 '25' => xl('Payment denied. Your Stop loss deductible has not been met'),
 '26' => xl('Expenses incurred prior to coverage'),
 '27' => xl('Expenses incurred after coverage terminated'),
 '29' => xl('The time limit for filing has expired'),
 '31' => xl('Claim denied as patient cannot be identified as our insured'),
 '32' => xl('Our records indicate that this dependent is not an eligible dependent as defined'),
 '33' => xl('Claim denied. Insured has no dependent coverage'),
 '34' => xl('Claim denied. Insured has no coverage for newborns'),
 '35' => xl('Lifetime benefit maximum has been reached'),
 '38' => xl('Services not provided or authorized by designated (network/primary care) providers'),
 '39' => xl('Services denied at the time authorization/pre-certification was requested'),
 '40' => xl('Charges do not meet qualifications for emergent/urgent care'),
 '42' => xl('Charges exceed our fee schedule or maximum allowable amount'),
 '43' => xl('Gramm-Rudman reduction'),
 '44' => xl('Prompt-pay discount'),
 '45' => xl('Charges exceed your contracted/ legislated fee arrangement'),
 '49' => xl('These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam'),
 '50' => xl('These are non-covered services because this is not deemed a "medical necessity" by the payer'),
 '51' => xl('These are non-covered services because this is a pre-existing condition'),
 '53' => xl('Services by an immediate relative or a member of the same household are not covered'),
 '54' => xl('Multiple physicians/assistants are not covered in this case '),
 '55' => xl('Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer'),
 '56' => xl('Claim/service denied because procedure/treatment has not been deemed "proven to be effective" by the payer'),
 '57' => xl('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 days supply'),
 '58' => xl('Payment adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service'),
 '59' => xl('Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules'),
 '60' => xl('Charges for outpatient services with this proximity to inpatient services are not covered'),
 '61' => xl('Charges adjusted as penalty for failure to obtain second surgical opinion'),
 '62' => xl('Payment denied/reduced for absence of, or exceeded, pre-certification/authorization'),
 '66' => xl('Blood Deductible'),
 '69' => xl('Day outlier amount'),
 '70' => xl('Cost outlier - Adjustment to compensate for additional costs'),
 '74' => xl('Indirect Medical Education Adjustment'),
 '75' => xl('Direct Medical Education Adjustment'),
 '76' => xl('Disproportionate Share Adjustment'),
 '78' => xl('Non-Covered days/Room charge adjustment'),
 '85' => xl('Interest amount'),
 '87' => xl('Transfer amount'),
 '88' => xl('Adjustment amount represents collection against receivable created in prior overpayment'),
 '89' => xl('Professional fees removed from charges'),
 '90' => xl('Ingredient cost adjustment'),
 '91' => xl('Dispensing fee adjustment'),
 '94' => xl('Processed in Excess of charges'),
 '95' => xl('Benefits adjusted. Plan procedures not followed'),
 '96' => xl('Non-covered charge(s)'),
 '97' => xl('Payment is included in the allowance for another service/procedure'),
 '100' => xl('Payment made to patient/insured/responsible party'),
 '101' => xl('Predetermination: anticipated payment upon completion of services or claim adjudication'),
 '102' => xl('Major Medical Adjustment'),
 '103' => xl('Provider promotional discount (e.g., Senior citizen discount)'),
 '104' => xl('Managed care withholding'),
 '105' => xl('Tax withholding'),
 '106' => xl('Patient payment option/election not in effect'),
 '107' => xl('Claim/service denied because the related or qualifying claim/service was not previously paid or identified on this claim'),
 '108' => xl('Payment adjusted because rent/purchase guidelines were not met'),
 '109' => xl('Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor'),
 '110' => xl('Billing date predates service date'),
 '111' => xl('Not covered unless the provider accepts assignment'),
 '112' => xl('Payment adjusted as not furnished directly to the patient and/or not documented'),
 '113' => xl('Payment denied because service/procedure was provided outside the United States or as a result of war'),
 '114' => xl('Procedure/product not approved by the Food and Drug Administration'),
 '115' => xl('Payment adjusted as procedure postponed or canceled'),
 '116' => xl('Payment denied. The advance indemnification notice signed by the patient did not comply with requirements'),
 '117' => xl('Payment adjusted because transportation is only covered to the closest facility that can provide the necessary care'),
 '118' => xl('Charges reduced for ESRD network support'),
 '119' => xl('Benefit maximum for this time period or occurrence has been reached'),
 '120' => xl('Patient is covered by a managed care plan'),
 '121' => xl('Indemnification adjustment'),
 '122' => xl('Psychiatric reduction'),
 '123' => xl('Payer refund due to overpayment'),
 '124' => xl('Payer refund amount - not our patient'),
 '125' => xl('Payment adjusted due to a submission/billing error(s). Additional information is supplied using the remittance advice remarks codes whenever appropriate'),
 '126' => xl('Deductible -- Major Medical'),
 '127' => xl('Coinsurance -- Major Medical'),
 '128' => xl('Newborns services are covered in the mothers Allowance'),
 '129' => xl('Payment denied - Prior processing information appears incorrect'),
 '130' => xl('Claim submission fee'),
 '131' => xl('Claim specific negotiated discount'),
 '132' => xl('Prearranged demonstration project adjustment'),
 '133' => xl('The disposition of this claim/service is pending further review'),
 '134' => xl('Technical fees removed from charges'),
 '135' => xl('Claim denied. Interim bills cannot be processed'),
 '136' => xl('Claim Adjusted. Plan procedures of a prior payer were not followed'),
 '137' => xl('Payment/Reduction for Regulatory Surcharges, Assessments, Allowances or Health Related Taxes'),
 '138' => xl('Claim/service denied. Appeal procedures not followed or time limits not met'),
 '139' => xl('Contracted funding agreement - Subscriber is employed by the provider of services'),
 '140' => xl('Patient/Insured health identification number and name do not match'),
 '141' => xl('Claim adjustment because the claim spans eligible and ineligible periods of coverage'),
 '142' => xl('Claim adjusted by the monthly Medicaid patient liability amount'),
 '143' => xl('Portion of payment deferred'),
 '144' => xl('Incentive adjustment, e.g. preferred product/service'),
 '145' => xl('Premium payment withholding'),
 '146' => xl('Payment denied because the diagnosis was invalid for the date(s) of service reported'),
 '147' => xl('Provider contracted/negotiated rate expired or not on file'),
 '148' => xl('Claim/service rejected at this time because information from another provider was not provided or was insufficient/incomplete'),
 '149' => xl('Lifetime benefit maximum has been reached for this service/benefit category'),
 '150' => xl('Payment adjusted because the payer deems the information submitted does not support this level of service'),
 '151' => xl('Payment adjusted because the payer deems the information submitted does not support this many services'),
 '152' => xl('Payment adjusted because the payer deems the information submitted does not support this length of service'),
 '153' => xl('Payment adjusted because the payer deems the information submitted does not support this dosage'),
 '154' => xl('Payment adjusted because the payer deems the information submitted does not support this days supply'),
 '155' => xl('This claim is denied because the patient refused the service/procedure'),
 '156' => xl('Flexible spending account payments'),
 '157' => xl('Payment denied/reduced because service/procedure was provided as a result of an act of war'),
 '158' => xl('Payment denied/reduced because the service/procedure was provided outside of the United States'),
 '159' => xl('Payment denied/reduced because the service/procedure was provided as a result of terrorism'),
 '160' => xl('Payment denied/reduced because injury/illness was the result of an activity that is a benefit exclusion'),
 '161' => xl('Provider performance bonus'),
 '162' => xl('State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation'),
 '163' => xl('Claim/Service adjusted because the attachment referenced on the claim was not received'),
 '164' => xl('Claim/Service adjusted because the attachment referenced on the claim was not received in a timely fashion'),
 '165' => xl('Payment denied /reduced for absence of, or exceeded referral'),
 '166' => xl('These services were submitted after this payers responsibility for processing claims under this plan ended'),
 '167' => xl('This (these) diagnosis(es) is (are) not covered'),
 '168' => xl('Payment denied as Service(s) have been considered under the patients medical plan. Benefits are not available under this dental plan'),
 '169' => xl('Payment adjusted because an alternate benefit has been provided'),
 '170' => xl('Payment is denied when performed/billed by this type of provider'),
 '171' => xl('Payment is denied when performed/billed by this type of provider in this type of facility'),
 '172' => xl('Payment is adjusted when performed/billed by a provider of this specialty'),
 '173' => xl('Payment adjusted because this service was not prescribed by a physician'),
 '174' => xl('Payment denied because this service was not prescribed prior to delivery'),
 '175' => xl('Payment denied because the prescription is incomplete'),
 '176' => xl('Payment denied because the prescription is not current'),
 '177' => xl('Payment denied because the patient has not met the required eligibility requirements'),
 '178' => xl('Payment adjusted because the patient has not met the required spend down requirements'),
 '179' => xl('Payment adjusted because the patient has not met the required waiting requirements'),
 '180' => xl('Payment adjusted because the patient has not met the required residency requirements'),
 '181' => xl('Payment adjusted because this procedure code was invalid on the date of service'),
 '182' => xl('Payment adjusted because the procedure modifier was invalid on the date of service'),
 '183' => xl('The referring provider is not eligible to refer the service billed'),
 '184' => xl('The prescribing/ordering provider is not eligible to prescribe/order the service billed'),
 '185' => xl('The rendering provider is not eligible to perform the service billed'),
 '186' => xl('Payment adjusted since the level of care changed'),
 '187' => xl('Health Savings account payments'),
 '188' => xl('This product/procedure is only covered when used according to FDA recommendations'),
 '189' => xl('"Not otherwise classified" or "unlisted" procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service'),
 '190' => xl('Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay'),
 '191' => xl('Claim denied because this is not a work related injury/illness and thus not the liability of the workers’ compensation carrier'),
 '192' => xl('Non standard adjustment code from paper remittance advice'),
 '193' => xl('Original payment decision is being maintained. This claim was processed properly the first time'),
 '194' => xl('Payment adjusted when anesthesia is performed by the operating physician, the assistant surgeon or the attending physician'),
 '195' => xl('Payment denied/reduced due to a refund issued to an erroneous priority payer for this claim/service'),
 'A0' => xl('Patient refund amount'),
 'A1' => xl('Claim denied charges'),
 'A2' => xl('Contractual adjustment'),
 'A4' => xl('Medicare Claim PPS Capital Day Outlier Amount'),
 'A5' => xl('Medicare Claim PPS Capital Cost Outlier Amount'),
 'A6' => xl('Prior hospitalization or 30 day transfer requirement not met'),
 'A7' => xl('Presumptive Payment Adjustment'),
 'A8' => xl('Claim denied; ungroupable DRG'),
 'B1' => xl('Non-covered visits'),
 'B4' => xl('Late filing penalty'),
 'B5' => xl('Payment adjusted because coverage/program guidelines were not met or were exceeded'),
 'B7' => xl('This provider was not certified/eligible to be paid for this procedure/service on this date of service'),
 'B8' => xl('Claim/service not covered/reduced because alternative services were available, and should have been utilized'),
 'B9' => xl('Services not covered because the patient is enrolled in a Hospice'),
 'B10' => xl('Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test'),
 'B11' => xl('The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor'),
 'B12' => xl('Services not documented in patients medical records'),
 'B13' => xl('Previously paid. Payment for this claim/service may have been provided in a previous payment'),
 'B14' => xl('Payment denied because only one visit or consultation per physician per day is covered'),
 'B15' => xl('Payment adjusted because this procedure/service is not paid separately'),
 'B16' => xl('Payment adjusted because "New Patient" qualifications were not met'),
 'B18' => xl('Payment adjusted because this procedure code and modifier were invalid on the date of service'),
 'B20' => xl('Payment adjusted because procedure/service was partially or fully furnished by another provider'),
 'B22' => xl('This payment is adjusted based on the diagnosis'),
 'B23' => xl('Payment denied because this provider has failed an aspect of a proficiency testing program'),
 'D16' => xl('Claim lacks prior payer payment information'),
 'D17' => xl('Claim/Service has invalid non-covered days'),
 'D18' => xl('Claim/Service has missing diagnosis information'),
 'D19' => xl('Claim/Service lacks Physician/Operative or other supporting documentation'),
 'D20' => xl('Claim/Service missing service/product information'),
 'D21' => xl('This (these) diagnosis(es) is (are) missing or are invalid'),
 'W1' => xl('Workers Compensation State Fee Schedule Adjustment')
);
?>