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The following table lists each claim edit and its corresponding ID, help text, the area in the application where the claim edit applies, and the claim field on the 837 electronic claim file that the claim edit affects. The table does not contain the following fields:
| ID | Claim Edit | Description | Applicable To | Claim Field |
|---|---|---|---|---|
| 1 | Submitter Profile is required | Add the Submitter Profile. | Submitter Master | NM103 |
| 2 | Provider’s Specialty is required | Add the Provider’s Specialty. | Billing Provider | PRV03 |
| 3 | Provider’s Phone number must contain an area code | Add the area code to the Provider’s phone number. | Billing Provider | PER04 |
| 4 | Payer requires the Insurance Type code, when it is not primary | Add a valid Insurance Type code. Valid codes are 12, 13, 14, 15, 16, 41, 42, 43, and 47. | Payer Master | SBR05 |
| 5 | Claim Filing Indicator is required prior to mandated use of Plan ID | Add a valid Claim Filing Indicator. | Payer Master | SBR09 |
| 6 | Current Payers' Insured’s Policy Number is required | Add the Insured’s Policy Number for the insurance listed on the particular encounter. | Insurance Maintenance | NM109 |
| 7 | Current Payers' Insured’s Birth Date is required | Add the Insured’s Birth Date. | Subscriber Demographics | DMG02 |
| 8 | Current Payers' Insured’s Sex is required | Add the Insured’s Sex. | Subscriber Demographics | DMG03 |
| 10 | Provider’s Address is required | Add the Provider’s Address. | Billing Provider | N301 |
| 11 | Provider’s City is required | Add the Provider’s City. | Billing Provider | N401 |
| 12 | Provider’s Zip Code is required | Add the Provider’s Zip Code. | Billing Provider | N403 |
| 13 | Current Payers' Insured’s Address is required | Add the Insured’s Address. | Subscriber Demographics | N301 |
| 14 | Current Payers' Insured’s City is required | Add the Insured’s City. | Subscriber Demographics | N401 |
| 15 | Current Payers' Insured’s State is required | Add the Insured’s State. | Subscriber Demographics | N402 |
| 16 | Current Payers' Insured’s Zip Code is required | Add the Insured’s Zip Code. | Subscriber Demographics | N403 |
| 17 | Provider’s Name is required | Add the Provider’s Name. | Billing Provider | N103 |
| 18 | Patient’s Last Name is required | Add the Patient’s Last Name. | Patient Demographics | NM103 |
| 19 | Patient’s First Name is required | Add the Patient’s First Name. | Patient Demographics | NM104 |
| 20 | Patient’s Address is required | Add the Patient’s Address. | Patient Demographics | N301 |
| 21 | Patient’s City is required | Add the Patient’s City. | Patient Demographics | N401 |
| 22 | Patient’s State is required | Add the Patient’s State. | Patient Demographics | N402 |
| 23 | Patient’s Zip is required | Add the Patient’s Zip. | Patient Demographics | N403 |
| 24 | Provider’s ID Number is required | Add the Provider’s ID Number. | Billing Provider | N109 |
| 25 | Accident Symptom Date is required | Add the Accident Symptom Date. | Encounter Maintenance | DTP01 |
| 26 | Accident Hour is required | Add the Accident Hour. | Encounter Maintenance | DTP03 |
| 30 | Referring Physician’s Last Name is required | Add the Referring Physician’s Last Name. | Referring Physician | NM103 |
| 31 | Referring Physician’s First Name is required | Add Referring Physician’s First name. | Referring Physician | NM104 |
| 32 | Admission Date 1 is required | Add the Admission Date 1. | Encounter Maintenance | DTP03 |
| 33 | Discharge Date 1 is required | Add the Discharge Date 1. | Encounter Maintenance | DTP03 |
| 35 | Laboratory or Facility Name is required | Add the Laboratory or Facility Name. | Facility Master | N201 |
| 36 | Laboratory or Facility Address is required | Add the Laboratory or Facility Address. | Facility Master | N301 |
| 37 | Laboratory or Facility City is required | Add the Laboratory or Facility City. | Facility Master | N301 |
| 38 | Laboratory or Facility State is required | Add the Laboratory or Facility State. | Facility Master | N402 |
| 39 | Laboratory or Facility Zip is required | Add the Laboratory or Facility Zip. | Facility Master | N403 |
| 41 | Supervising Physician’s Last Name is required | Add the Supervising Physician’s Last Name. | Supervising Physician | NM103 |
| 42 | Supervising Physician’s First Name is required | Add the Supervising Physician’s First Name. | Supervising Physician | NM104 |
| 43 | Provider’s Address 2 is not allowed when Address 1 is blank | Add the Provider’s Address 1 and Address 2, if applicable. | Billing Provider | N302 |
| 44 | Patient’s Middle Initial is required | Add the Patient’s Middle Initial. | Patient Demographics | NM105 |
| 45 | Referring Physician’s Middle Initial is required | Add the Referring Physician’s Middle Initial. | Referring Physician | NM105 |
| 46 | Current Payers' Insured’s Middle Initial is required | Add the Insured’s Middle Initial. | Subscriber Demographics | NM105 |
| 47 | Current Payers' Insured’s First Name is required | Add the Insured’s First Name. | Subscriber Demographics | NM104 |
| 48 | Patient’s Address 2 is not allowed when Address 1 is blank | Add the Patient’s Address 1and Address 2, if applicable. | Patient Demographics | NM302 |
| 49 | Laboratory or Facility’s Address 2 not allowed when Address 1 is blank | Add the Laboratory or Facility’s Address 1. | Facility Master | NM302 |
| 50 | Current Payers' Insured’s Address 2 is not allowed when Address 1 is blank | Add Insured’s Address 1 and Address 2, if applicable. | Subscriber Demographics | NM302 |
| 52 | Place of Service is required | Add the Place of Service. | Charge Entry | SV105 |
| 53 | Type of Service Code is required | Add the Type of Service Code. | CPT4 Code Master | SV106 |
| 54 | Extra Narrative Data is required for CPT4(s) <Unknown> | Activate this edit and then select the applicable CPT4 codes that require the extra narrative data. | Charge Entry | NTE02 |
| 55 | Referring Physician’s Payer Number is missing | Add the Referring Physician’s Payer Number. | Referring Physician | REF01 |
| 58 | A maximum of 0 charges are allowed per Electronic Claim | Remove the excess charges from your electronic claims. | Billing | CHG01 |
| 61 | CPT4(s) <Unknown> cannot be submitted electronically | Remove specified procedure code from your electronic claim. | Charge Entry | CHG01 |
| 62 | COB 1 Requires Payer Verification | Add Payer Verification on COB 1. | Patient Insurance Verification | COB01 |
| 63 | COB 2 Requires Payer Verification | Add Payer Verification on COB 2. | Patient Insurance Verification | COB02 |
| 64 | COB 3 Requires Payer Verification | Add Payer Verification on COB 3. | Patient Insurance Verification | COB03 |
| 65 | COB 1 Requires Payer Notification | Add Payer Notification on COB 1. | Patient Insurance Verification | COB01 |
| 66 | COB 2 Requires Payer Notification | Add Payer Notification on COB 2 | Patient Insurance Verification | COB02 |
| 67 | COB 3 Requires Payer Notification | Add Payer Notification on COB 3 | Patient Insurance Verification | COB03 |
| 68 | COB 1 Requires Payer Authorization | Add Payer Authorization on COB 1 | Patient Insurance Verification | COB01 |
| 69 | COB 2 Requires Payer Authorization | Add Payer Authorization on COB 2 | Patient Insurance Verification | COB02 |
| 70 | COB 3 Requires Payer Authorization | Add Payer Authorization on COB 3 | Patient Insurance Verification | COB03 |
| 71 | Payer’s Medigap ID Number is required | Add Payer’s Medigap ID Number if Payer’s Insurance Type is Medigap. | Payer Master | NM109 |
| 72 | Current Payers' Insured’s Last Name is required | Add Insured’s Last Name. | Subscriber Demographics | NM103 |
| 73 | Payer’s Name is required | Add Payer’s Name. | Payer Master | NM103 |
| 74 | Payer’s Address 1 is required | Add Payer’s Address 1. | Payer Master | N301 |
| 75 | Payer’s City is required | Add Payer’s City. | Payer Master | N401 |
| 76 | Payer’s State is required | Add Payer’s State. | Payer Master | N402 |
| 77 | Payer’s Zip is required | Add Payer’s Zip. | Payer Master | N403 |
| 78 | Total Claim Charge Amount cannot be negative | Revise the Total Claim Charge Amount. Amount must be equal or greater than zero. | Charge Entry | CLM02 |
| 79 | Patient’s Paid Amount cannot be negative | Revise the Patient Paid Amount. Amount must be equal or greater than zero. | Payment Entry | AMT02 |
| 80 | Patient’s Weight cannot be negative | Revise the Patient’s Weight. | Encounter Maintenance | CR102 |
| 81 | Payer’s Paid Amount cannot be negative | Revise the Payer’s Paid Amount. Amount must be equal or greater than zero. | Payment Entry | AMT02 |
| 82 | Line Item Charge Amount cannot be negative | Revise the Line Item Charge Amount. Amount must be equal or greater than zero. | Charge Entry | SV102 |
| 83 | Unit Count cannot be negative | Revise the Unit Count. Amount must be equal or greater than one. | Charge Entry | SV104 |
| 84 | Purchased Service Charge Amount cannot be negative | Revise the Purchased Service Charge Amount. Amount must be equal or greater than zero. | Charge Entry | PS102 |
| 85 | Payer’s Address 2 is not allowed when Address 1 is blank | Add the Payer’s Address 1. | Payer Master | N302 |
| 86 | Provider’s State is required | Add Provider’s State. | Billing Provider | NM402 |
| 87 | Quadrant cannot have a value, since Tooth and Surface has a value | Do not enter a Quadrant value. | Charge Entry | CHG01 |
| 88 | Tooth and Surface cannot have a value, since Quadrant has a value | Do not enter Tooth or Surface values. | Charge Entry | CHG01 |
| 89 | Invalid Surface Value for the selected Tooth | Select a valid Surface associated with the Tooth. | Charge Entry | CHG01 |
| 90 | Supervising Physician’s Middle Initial is required | Add the Supervising Physician’s Middle Initial. | Supervising Physician | NM105 |
| 91 | Charge Primary Diagnosis is required | Assign a Primary Diagnosis to the charge. | Charge Entry | H1012 |
| 92 | Charge Service Date is before insurance effective date | Review insured’s insurance for valid effective date and verify Charge Service Date. | Insurance Maintenance | DTP02 |
| 93 | Charge Service Date is after insurance expiration date | Review insured’s insurance for valid expiration date and verify Charge Service Date. | Insurance Maintenance | DTP02 |
| 94 | Onset date is after Charge Service Date | Review and verify proper Charge Service Date and onset date. The onset date must be equal to or less than the charge date. | Encounter Maintenance | DTP02 |
| 95 | Line Item Charge is greater than $0.00 | Review and/or adjust charge amount for particular service item. | Charge Entry | SV102 |
| 96 | Line Item Charge is less than $0.00 | Review and/or adjust charge amount for particular service item. Amount must be equal to or greater than zero. | Charge Entry | SV102 |
| 97 | Line Item Charge is equal to $0.00 | Review and/or adjust charge amount for particular service item. | Charge Entry | SV102 |
| 98 | Group Number is missing | Add the Group Number to appropriate group attached to specific provider and payer. | Group List | REF02 |
| 99 | Patient’s Zip Code is 00000 | Verify and correct patient’s zip code. | Patient Demographics | N403 |
| 100 | Current Payers' Insured’s Zip Code is 00000 | Verify and correct insured’s zip code. | Subscriber Demographics | N403 |
| 101 | Current Payers' Insured’s Policy Number cannot equal Group Number | Correct the invalid Policy Number or Group Number. | Insurance Maintenance | NM109 |
| 102 | Referring Physician is required for CPT4(s) | Add the Referring Physician to the encounter. | Encounter Maintenance | REF01 |
| 103 | Rendering and Referring Physician cannot be identical for CPT4(s) <Unknown> | Remove or change the Referring Physician to the encounter. | Encounter Maintenance | REF01 |
| 104 | Provider’s Taxonomy Code is required | Add the Provider’s Taxonomy. | Billing Provider | PRV03 |
| 105 | Admission Date 1 is required for Occurrence Code(s) <Unknown> | Add the Admission Date 1. | Encounter Maintenance | DTP03 |
| 106 | Discharge Date 1 is required for Occurrence Code(s) <Unknown> | Add the Discharge Date 1. | Encounter Maintenance | DTP03 |
| 107 | Admission Date 1 is required for Place of Service <Inpatient Hospital> | Add the Admission Date 1. | Encounter Maintenance | DTP03 |
| 108 | Discharge Date 1 is required for Place of Service <Unknown> | Add the Discharge Date 1. | Encounter Maintenance | DTP03 |
| 109 | Supervising Physician’s ID Number is required | Add the Referring Physician’s Provider ID Number. | Supervising Physician | N109 |
| 110 | Supervising Physician’s Payer Number is required | Add the Referring Physician’s Payer Number. | Supervising Physician | REF01 |
| 111 | Component element separator from submitter profile found in application data for electronic claim | Change the component element separator character from data field and add the appropriate value. | Claim Data | ISA16 |
| 112 | Element separator from submitter profile found in application data for electronic claim | Change the element separator character from data field and add the appropriate value. | Claim Data | ISA |
| 113 | Segment terminator from submitter profile found in application data for electronic claim | Change the segment terminator character from data field and add the appropriate value. | Claim Data | ISA |
| 114 | Charge dates of service must be in the same month | Review and/or adjust charge dates of service. | Charge Entry | DTP02 |
| 115 | Duplicate charges: CPT4, Mod 1, Mod 2, service dates are identical | Review and/or remove duplicate charge. | Charge Entry | SV101 |
| 116 | Modifier(s) <Unknown> require review on charge | Review the modifier(s) on charge to determine if valid. | Charge Entry | SV1 |
| 117 | CPT4(s) requires specific Diagnosis Code(s) | Review and/or change the diagnosis code(s) for the specific CPT4(s) code. | Charge Entry | SV1 |
| 118 | CPT4(s) require review when using specific Modifier(s) | Review the modifier on specific CPT4(s) code to determine if valid. | Charge Entry | SV1 |
| 119 | Supervising provider required at the encounter level | Add supervising provider to encounter | Encounter Maintenance | NM1 |
| 120 | CPT4(s) required for provider and CPT4 | Add the required CPT4(s) | Charge Entry | SV1 |
| 121 | CPT4(s) required for CPT4 | Add the required CPT4(s) | Charge Entry | SV1 |
| 123 | Group name is required when group number field is populated | Add the group name | Insurance Maintenance | SBR04 |
| 124 | CPT4(s) not allowed for patient gender | Review and/or correct the CPT4 code | Charge Entry | SV1 |
| 125 | ICD(s) not allowed for patient gender | Review and/or correct the ICD code | Charge Entry | HI01-2 |
| 126 | CPT4(s) not allowed for patient age | Review and/or correct the CPT4 code | Charge Entry | SV1 |
| 127 | ICD(s) not allowed for patient age | Correct the ICD code | Charge Entry | HI01-2 |
| 128 | CPT4(s) <unknown> is used and quantity does not equal dates of service | Review and/or correct the dates of service or quantity | Charge Entry | SV1 |
| 129 | Charge quantity greater than 0 must be submitted on paper | Review and/or correct the quantity or change media to paper | Charge Entry | SV1 |
| 130 | CPT4(s) cannot be on the same encounter for same date of service | Review and/or correct the CPT4 codes | Charge Entry | SV1 |
| 131 | Insurance type(s) <Unknown> cannot be primary for an encounter that has more than one payer | Review and/or correct the insurance order | Patient Insurance | Generic |
| 132 | Charge service date after patient expiration date | Review and/or correct the charge date of service | Charge Entry | SV1 |
| 133 | Check for prior invalid taxonomy code | Review and/or correct the provider's taxonomy code | Provider Maintenance | PRV03 |
| 134 | Referring physician not equal to rendering physician | Correct the physician(s) | Encounter Maintenance | NM1 |
| 135 | Referring physician not equal to supervising physician | Correct the physician(s) | Encounter Maintenance | NM1 |
| 136 | Referring physician not equal to rendering physician for CPT4(s) <Unknown> | Correct the physician(s) | Encounter Maintenance | NM1 |
| 137 | Patient's Birth Date is required | Add the Patient's Birth Date | Patient Demographics | DMG02 |
| 138 | Patient's Gender value(s) of <Unknown> are not allowed | Review and/or correct the Patient's Gender | Patient Demographics | DMG03 |
| 139 | Delay Reason Code is required for claims greater than 0 days | Add a Delay Reason Code | Encounter Maintenance | CLM20 |
| 140 | Clinic Rate claim indicator code <Unknown> has been suppressed | Claim not created due to Clinic Rate business rule or an existing secondary clinic rate claim already exists | Claim data | SV2 |
| 141 | Provider's Tax ID is required | Add the Physician's Tax ID | Billing Provider | NM109 |
| 142 | Patient's Sex is required | Add the Patient's Sex | Patient Demographics | DMG03 |
| 143 | Surface Value cannot exceed maximum length of 0 | Revise the Surface Value to be less than or equal to the maximum length specified | Charge Entry | CHG01 |
| 144 | Surface Value can contain only <Unknown> | Correct the Surface Value to contain only those code letters specified | Charge Entry | CHG01 |
| 145 | Electronic transmitter ID missing | Add an Electronic transmitter ID to the Payer | Payer Master | NM109 |
| 146 | Other Payers' Insured's Birth Date is required | Add the Other Payers' Insured's Birth Date. | Relationship Maintenance | DMG02 |
| 147 | Other Payers' Insured's Address is required | Add the Other Payers' Insured's Address. | Relationship Maintenance | N3-N4 |
| 148 | Other Payers' Insured's First Name is required | Add the Other Payers' Insured's First Name. | Subscriber Demographics | NM104 |
| 149 | Other Payers' Insured's Last Name is required | Add the Other Payers' Insured's Last Name. | Subscriber Demographics | NM103 |
| 150 | Other Payers' Insured's Middle Initial is required | Add the Other Payers' Insured's Middle Initial. | Subscriber Demographics | NM105 |
| 151 | Other Payers' Insured's Policy Number cannot equal Group Number | Review and/or correct the invalid Policy Number or Group Number. | Insurance Maintenance | SBR03 |
| 152 | Other Payers' Insured's Policy Number is required | Add the Other Payers' Insured's Policy Number. | Insurance Maintenance | SBR03 |
| 153 | Other Payers' Insured's Sex is required | Add the Other Payers' Insured's Sex. | Subscriber Demographics | DMG03 |
| 154 | Other Payers' Insured's Zip Code is 00000. | Verify and correct the Other Payers' Insured's Zip Code. | Subscriber Demographics | N4 |
| 155 | Narrative cannot be longer than 80 characters | Reduce length of narrative text. | Charge Entry | NTE02 |
| 156 | Other Payers' Insured's Sex value(s) of <> are not allowed | Correct the Other Payers' Insured's Sex. | Subscriber Demographics | DMG03 |
| 157 | If Referring Physician is present on encounter, UPIN is required | Add a UPIN for the Referring Physician | Provider Maintenance | REF02 |
| 158 | Invalid Character(s) present in claim data | Activate this edit to check the claim for invalid characters. Enter a list of special characters and symbols that you do not want to include on your claims. | Claim Data | Generic |
| 159 | Revenue code is required. | Add the revenue code. | Service Item Maintenance | Generic |
| 160 | Multiple encounters are not allowed on the same date of service for this patient. | Check the encounter service date. | Encounter Maintenance | Generic |
| 161 | Multiple SIM Departments value(s) of <unknown> are not allowed for the same date of service for this patient. | Check encounter department. | Encounter Maintenance | Generic |
| 163 | Occurrence Date missing | Add Occurrence Date | Encounter Maintenance | H1 |
| 164 | Line item charge greater than $0.00 must be dropped to paper | Adjust charge amount or adjust media to paper | Charge Entry | SV1 |
| 165 | Require Valid Relationship | Change Relationship Code | Patient Demographics | PAT01 |
| 166 | Rendering provider not set up for UB Billing on Payer UB tab | Edit Rendering Provider or Payer UB information. | Insurance Maintenance | NM101 |
| 167 | Date Last Seen required | Add Date Last Seen | Encounter Maintenance | DTP |
| 168 | Invalid Type of Bill | Verify Type of Bill on the Encounter | Encounter Maintenance | CLM05 |
| 169 | Charge(s) currently within After Care Days period not having modifier(s) <Unknown> | Verify the charge(s) | Charge Entry | CHG01 |
| 170 | CPT4 Code sets require specific Modifier(s) | Correct the Modifier on at least one of the CPT4 Codes. | Charge Entry | SV1 |
| 171 | CPT4(s) requires valid Facility | Add a valid Facility to the Encounter | Encounter Maintenance | SV1 |
| 172 | Charge(s) location must match the encounter location | Verify and correct the charge or encounter location. | Charge Entry | SV1 |
| 173 | Charge(s) rendering provider must match the encounter rendering provider | Verify and correct the charge or encounter rendering provider | Charge Entry | SV1 |
| 174 | Service Item Department(s) require(s) modifier(s) | Add required modifiers. | Charge Entry | SV1 |
| 175 | Service Item Department(s) <Unknown> requires referring provider | Add referring provider. | Encounter Maintenance | NM1 |
| 176 | Service Item Department(s) <Unknown> requires extra narrative | Add required extra narrative. | Charge Entry | SV1 |
| 177 | CPT4(s) <Unknown> not billable to this payer | Correct CPT4 codes. | Charge Entry | SV1 |
| 178 | Any required CPT4(s) must be present for the CPT4 | Add any required CPT4 codes. | Charge Entry | SV1 |
| 179 | Invalid ICD(s) | Remove invalid diagnosis code. | Charge Entry | H1 |
| 180 | CPT4 Code Hierarchy | Verify order of charge line items. | Charge Entry | SV1 |
| 181 | CPT4(s) <Unknown> requires tooth and surface | Activate this edit to require tooth and surface information for a specific CPT4 code. Enter the CPT4 code that requires tooth and surface information. | Charge Entry | SV1 |
| 182 | CPT4(s) <Unknown> requires review | Activate this edit to flag the claim for review for specific CPT4 codes. Enter the CPT4 codes that require a review of the claim. | Charge Entry | SV1 |
| 183 | Places of service <Unknown> required | Activate this edit to require a specific place of service for a charge. You can enter multiple places of service, but only one from the list is required for the charge. | Charge Entry | DTP03 |
| 184 | ICD(s) <Unknown> requires last menstrual period | Add last menstrual period information. | Encounter Maintenance | HI |
| 185 | Missing COB information for non-primary electronic claim | Change claim media type to paper. | Claim Maintenance | Generic |
| 186 | If Supervising Provider is present on an encounter, Referring Provider is required | Add the referring provider. | Encounter Maintenance | NM1 |
| 187 | Charge(s) referring provider must match the encounter referring provider | Verify and correct the charge or encounter referring provider. | Charge Entry | NM1 |
| 188 | ICD requires at least one selected ICD(s) | Add additional required ICD. | Charge Entry | HI01-2 |
| 189 | Service Item Departments(s) not allowed for Provider Specialty | Confirm provider setup correctly for charge item. | Charge Entry | SV1 |
| 190 | CPT4 Range not allowed | Activate this edit to disallow a specific range of CPT4 codes on the same day. | Charge Entry | SV1 |
| 191 | Requires Condition Related To Employment Indicator | Activate this edit to require a check in the Condition Related to Employment check box on the Encounter Maintenance window. If it is not checked, the edit displays during the billing process. | Encounter Maintenance | Generic |
| 192 | Requires valid occurrence code(s) <Unknown> | Activate this edit to require a valid occurrence code. This code is pulled from the Encounter Maintenance window. Select the occurrence codes for the edit from the Parameter 1 list. | Encounter Maintenance | Generic |
| 193 | Claim Type <Unknown> requires Accident Date | Activate this edit to require the accident date for a claim type of Auto-Accident or Work Comp. Enter the accident from the encounter. | Encounter Maintenance | DTP |
| 194 | Quantity cannot be in excess of 0 | Activate this edit to require a review of the charge if the quantity is greater than the specified amount. Check the number of units on the line item charge. Enter the number of units that trigger this edit when the quantity on the claim exceeds this amount. | Charge Entry | SV1 |
| 195 | CPT4(s) require initial and subsequent CPT(4) | Activate this edit to require an administrative code (CPT4) for a vaccine and a different administrative code for each subsequent vaccine. Example: Three vaccines are administered, 90701, 90702, and 90703. At charge entry, 90701 is entered first. The first vaccine requires the entry of a corresponding administrative code of 90471. When 90702 and 90703 are entered, a subsequent administrative code of 90472 must be entered after each charge is entered. So, 90471 is entered once and 90472 is entered twice. Each vaccine charge is paired with an administrative charge. To configure this edit, enter all of the CPT4 codes for the vaccines that require an administrative code in the first column on the left. Enter the administrative code in the second column from the left for the initial vaccine. Enter the subsequent administrative code for the subsequent vaccines in the column on the right. | Charge Entry | SV1 |
| 196 | CPT4(s) require CPT4(s) from set B or set C | Activate this edit to require a set of CPT4 codes on the claim when a specific CPT4 code is found on the claim. The additional codes can be from set B (second parameter) or set C (third parameter), but not from both. To configure this edit, you must enter three parameters. The first parameter is the CPT4 code(s) that cannot be billed alone and requires a set of CPT4 codes on the same claim. The second parameter represents set B, which is one set of additional CPT4 codes that can be billed with the CPT4 code(s) in the first parameter. The third parameter represents set C, which is the other set of additional CPT4 codes that can be billed with the CPT4 code(s) in the first parameter. | Charge Entry | SV1 |
| 197 | CPT4(s) <Unknown> only allowed | Activate this edit to allow only specific CPT4 codes when billing a certain payer. Only enter the CPT4 codes that are allowed for the payer. | Charge Entry | SV1 |
| 198 | Same day CPT4 range requires modifier | Activate this edit to require a modifier when an E&M and procedure are billed on the same day. | Charge Entry | SV1 |
| 199 | CPT4(s) require additional CPT4(s) on Encounter | Review requirements and add CPT4(s) as necessary. | Charge Entry | SV1 |
| 200 | CPT4(s) require a particular number of units | Correct number of units. | Charge Entry | SV1 |
| 201 | Referring provider not allowed for SIM Department(s) <Unknown> | Remove referring provider. | Charge Entry | SV1 |
| 202 | Referring provider must equal PCP for SIM Department(s) <Unknown> | Correct referring provider. | Charge Entry | SV1 |
| 203 | CPT(s) with particular number of units requires diagnoses | Review requirements and modify CPT4(s), units, or ICD(s) as necessary. | Charge Entry | SV1 |
| 204 | Modifier(s) require(s) encounter modifier(s) | Add or correct modifier. | Charge Entry | SV1 |
| 205 | SIM Department(s) require service location(s) | Activate this edit to require a service location when the charge is associated with a SIM Department. To configure this edit, you must enter two parameters. The first parameter is the SIM Department(s) associated with a charge that requires a service location. The second parameter is the service location(s) required for the SIM Department. | Charge Entry | SV1 |
| 206 | CPT4(s) <Unknown> requires a Supervising Physician | Activate this edit to require a supervising physician for specific CPT4 codes. Enter the CPT4 codes that require a supervising physician. | Charge Entry | SV1 |
| 207 | CPT4(s) requires Condition Code | Activate this edit to require a condition code for a specific CPT4 code. Enter the codes in the applicable columns. | Encounter Maintenance | HI |
| 208 | UPIN OTH000 is invalid | Activate this edit to check the claim for the generic UPIN of OTH000. | Provider Maintenance | REF02 |
| 210 | Value codes out of sequence | Activate this edit to generate a Claim Production Status message if the value codes on an encounter are out of sequence. | Encounter Maintenance | Generic |
| 211 | Subscriber policy number has invalid format | Correct the indicated subscriber policy number.
| Insurance Maintenance | NM1 |
| 212 | Group Provider NPI required. | Add the Group Provider's NPI. | Group Master | NM1 |
| 213 | Rendering Provider NPI required. | Add the Rendering Provider's NPI. | Provider Master | NM1 |
| 214 | Referring Provider NPI required. | Add the Referring Provider's NPI. | Provider Master | NM1 |
| 215 | Service Location NPI required for place of service <Unknown>. | Add the Service Location's NPI.
| Location Master | NM1 |
| 216 | Supervising Provider NPI required. | Add the Supervising Provider's NPI. | Provider Master | NM1 |
| 217 | Claim payer requires case management. | Attach case to encounter. | Encounter Maintenance | Generic |
| 218 | Current Payer's Insured's Group Number Required | Add the Insured's Group Number.
| Insurance Maintenance | NM109 |
| 220 | PQRI Edit -220 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 221 | PQRI Edit -221 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 222 | PQRI Edit -222 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 223 | PQRI Edit -223 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 224 | PQRI Edit -224 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 225 | PQRI Edit -225 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 226 | PQRI Edit -226 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 227 | PQRI Edit -227 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 228 | PQRI Edit -228 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 229 | PQRI Edit -229 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 230 | PQRI Edit -230 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 231 | PQRI Edit -231 | Add required PQRI procedure code. | Charge Entry | SV1 |
| 235 | NG Real Time Edits - ICD Edits | NG Real Time Edits Engine - ICD. | Charge Entry | SV1 |
| 236 | NG Real Time Edits - CCI Edits | NG Real Time Edits Engine - CCI. | Charge Entry | SV1 |
| 237 | NG Real Time Edits - Modifier Edits | NG Real Time Edits Engine - Modifier. | Charge Entry | SV1 |
| 238 | NG Real Time Edits - LCD/NCD Edits | NG Real Time Edits Engine - LCD/NCD. | Charge Entry | SV1 |
| 239 | NG Real Time Edits - CPT/HCPCS Edits | NG Real Time Edits Engine - CPT/HCPCS. | Charge Entry | SV1 |
| 240 | CPT4(s) <Unknown> requires tooth or surface | Activate this edit to require tooth or surface information for a specific CPT4 code. To set up the edit, add the CPT4 codes that require tooth or surface information. To correct this error, add the required tooth or surface information. | Charge Entry | SV1 |
| 241 | Charge Service Date is between admit and discharge date | Activate this edit to verify that the date of service on the charge is between the admit and discharge dates on the encounter. | Charge Entry | SV1 |
| 242 | CPT4 Code sets require specific Modifier(s) for Encounter | Activate this edit to prevent a claim from having 2 specified CPT4 codes without a modifier. It checks the whole encounter, even if you are just billing for one of the line items on the encounter. To set up the edit, enter the following: In column 1, enter one or a range of CPT4 codes In column 2, enter another one or a range of CPT4 codes In column 3, add one or more of the corresponding modifiers To correct the error, add the modifier for the specified CPT4 codes. | Charge Entry | SV1 |
| 243 | Revenue Code(s) require valid Facility | Activate this edit to check for a valid facility. To set up the edit, enter the revenue code in column 1 and the facility in column 2. To correct the error, add a valid facility to the encounter. | Encounter Maintenance | Generic |
| 244 | CPT4(s) not allowed to be billed with CPT4(s) | Activate this edit to check for allowable billing of CPT4 codes. To set up the edit, enter the following: In column 1, enter one or a range of CPT4 codes In column 2, enter one or a range of CPT4 codes that cannot be billed with those from column 1 To correct the error, replace the CPT4 codes with allowable CPT4 codes. | Charge Entry | SV1 |
| 245 | Current Payers' Insured's Employer is required | Activate this edit to require the Insured's Employer's name and address for the payer. To correct the error, add the Insured's Employer information. | Subscriber Employer | Generic |
| 246 | Same day duplicate charges: CPT4, Mod 1, Mod 2, service dates are identical | Activate this edit to check for duplicate charges within the claim. The edit checks the service dates, CPT4 codes, modifier 1 and modifier 2. To correct the error, remove duplicate charges. | Charge Entry | SV1 |
| 247 | CPT4(s) require CLIA number | Activate this edit to verify that the CLIA number is in the Location master file for the specified CPT4 codes. To set up the edit, enter the range of CPT4 codes that require CLIA numbers. To correct the error, add the CLIA number for the service location. | Location Mstr | REF02 |
| 248 | Eligibility submission required at the encounter level | Activate this edit to check whether an eligibility verification has been submitted for a patient for an encounter. To correct the error, submit an eligibility verification for the encounter. This applies to NextGen® Eligibility Verification only. | Eligibility Verification | Generic |
| 249 | CPT4(s) <Unknown> requires special program EPSDT or CHAP | Activate this edit to check for an entry of EPSDT or CHAP in the Special Program field on the Claims tab of the Encounter Maintenance window for a specified CPT4 codes. To set up the edit, enter the CPT4 codes that require EPSDT or CHAP. To correct the error, set the Special Program field to EPSDT or CHAP. | Encounter Maintenance | CLM12 |
| 250 | ICD(s) <Unknown> require Extra Narrative | Add extra narrative information. | Charge Entry | HI01-2 |
| 252 | CPT4 used too many times in specified period | Activate this edit to check for the frequency of CPT4 codes. Enter the following: In column 1, enter a range of CPT4 codes In column 2, enter the Duration in Months In column 3, enter the units The edit triggers if more than the frequency allowed for the CPT4 units of service occur in the specified number of months. | Charge Entry | SV1 |
| 253 | ICD code(s) has expired or does not exist in the ICD Master File | Activate this edit when an encounter is being billed that has an expired ICD code. To correct the error, remove the invalid ICD code from the encounter and, if appropriate, attach another one. | Charge Entry | SV1 |
| 254 | COB edit: Paid amount and patient responsibility amounts do not equal allowed amount | Balance the paid amount, patient responsibility adjustment, and allowed amount sums. This edit applies only to secondary electronic claims. | COB Info Entry | SVD02 |
| 255 | COB edit: All payments and adjustments do not equal billed amount. | Balance the paid, adjustment, and billed amount sums. This edit applies only to secondary electronic claims. | COB Info Entry | SVD02 |
| 256 | Value code 39a of <Unknown> required for secondary institutional claim | Activate this edit to check for a value code in the 39a field on the UB tab of the Encounter Maintenance window when billing secondary institutional claims. To correct the error, add a valid 39a code to the encounter. | Encounter Maintenance | HI01 |
| 257 | COB 1 Requires Payer Referral | Activate this edit to require the payer to have a referral attached to the encounter for COB 1. To correct this error, add the payer referral to COB 1. | Patient Insurance Verification | COB1 |
| 258 | COB 2 Requires Payer Referral | Activate this edit to require the payer to have a referral attached to the encounter for COB 2. To correct this error, add the payer referral to COB 2. | Patient Insurance Verification | COB2 |
| 259 | COB 3 Requires Payer Referral | Activate this edit to require the payer to have a referral attached to the encounter for COB 3. To correct this error, add the payer referral to COB 3. | Patient Insurance Verification | COB3 |
| 260 | Service Location(s) require(s) specific Rendering Provider | Activate this edit to check for a specific provider at a specific location. To set up the edit, enter the rendering provider in column 1 and a specific service location for billing the provider in column 2. To correct the edit, correct the charge rendering provider or the service location for the provider. | Charge Entry | SV1 |
| 261 | Electronic COB claim requires adjudication date | Add adjudication date to transaction in COB Payer to Encounter. | COB Info Entry | DTP |
| 262 | Payer missing subsequent COB wrap payer | Review or Add COB Payer to Encounter. | Patient Insurance | Generic |
| 263 | Admission Type Code is required | Add Type of Admission to the encounters. | Encounter Maintenance | CL101 |
| 264 | Payer's Group Name (SBR04) and Group Number (SBR03) are both present on claim | Remove either Group Name or Group Number from subscriber policy information. | Insurance Maintenance | SBR04 |
| 265 | CPT4 requires CMN information for this payer when present | Add CMN information for the payer. | CMN Information | PWK |
| 266 | Patient weight required if CMN is present | Add the patient's weight. | CMN Information | PAT |
| 267 | Patient height required if CMN is present | Add the patient's height. | CMN Information | MEA |
| 268 | Non-Rental SIMs for Rental Encounter | Enable rental indicator on this SIM code or use another SIM code. | Charge Entry | RSIM01 |
| 269 | Rental SIMs are present without Rental Information | Add rental information for this encounter. | Rental Information | RSIM01 |
| 270 | CPT4(s) requires NDC Code | Correct the CPT4 codes. | Charge Entry | SV1 |
| 272 | Requires Property and Casualty Claim Number | Patients Property/Casualty Claim number to Insurance Verification. | Encounter Maintenance | REF01 |
| 273 | CPT4(s) only valid if <DX> is primary | Review requirements and modify CPT4s or units as necessary. | Charge Entry | SV1 |
| 274 | CPT4(s) cannot be greater than <X> units. | Review requirements and modify CPT4s or units as necessary. | Charge Entry | SV1 |
| 275 | COB 1 - Date Appliance Placed required because dental procedure is in specified Orthodontic range | Add Date Appliance Placed on COB1. | Patient Insurance Verification | COB01 |
| 276 | COB 2 - Date Appliance Placed required because dental procedure is in specified Orthodontic range | Add Date Appliance Placed on COB2. | Patient Insurance Verification | COB02 |
| 277 | COB 3 - Date Appliance Placed required because dental procedure is in specified Orthodontic range | Add Date Appliance Placed on COB3. | Patient Insurance Verification | COB03 |
| 278 | This payer only accepts ICD-9 codes | Please set-up an alternative diagnosis code. | Charge Entry | HI01-1 |
| 279 | This payer only accepts ICD-10 codes | Please correct and re-bill. | Charge Entry | HI01-1 |
| 280 | NG Real time edits - Other | NG Real time edits engine - Other. | Charge Entry | SV1 |
| 281 | CPT4(s) <Unknown> Requires Line Item Authorization | Add line item Authorization for a Primary, Secondary, or Tertiary payer Code Ranges
| Patient Insurance Verification | REFG1 |
| 282 | CPT4(s) <Unknown> Requires Line Item Referral | Add line item Referral for a Primary, Secondary, or Tertiary payer Code Ranges.
| Patient Insurance Verification | REF9F |
| 283 | Remaining Units on Payer Authorization are less than the billed quantity | Add additional units to authorization for CPT. | Patient Insurance Verification | Generic |
| 284 | Remaining Units on Payer Referral are less than the billed quantity | Add additional units to referral for CPT. | Patient Insurance Verification | Generic |
| 286 | Test results are required for the cpt | Add test results to CPT code. | Charge Entry | 2400MEA |
| 287 | Test date is required for the cpt | Add test date to CPT code. | Charge Entry | 2400MEA |
| 288 | Prior Payer ICN/Resubmission Nbr required when Prior Payers <Unknown> | Enter ICN / Resubmission Number for Prior Payer. | Claim Data | REF02 |
| 289 | ICD and/or Modifiers require a Demonstration Project ID | ICD and/or Modifiers require a Demonstration Project ID. | Encounter Maintenance | REF-P4 |
| 290 | NDC associated with CPT4(s) requires valid Drug Unit Count | Drug Unit Count cannot be blank. | Charge Entry | SV1 |
| 291 | NDC associated with CPT4(s) requires valid Basis of Measure | Basis of Measure cannot be blank. | Charge Entry | SV1 |
| 292 | Claim Charges must all be for the same date of service | Set all encounter charges to the same date of service. | Claim Data | SV1 |
| 293 | Value Code <Value Code> is required when <Payer > is attached to encounter insurance. | Enter Value Code on tab. | Encounter Maintenance | HI*BE |
| 294 | Multiple office visit charges exist across encounters <list other encounters>. CPT4(s) <list CPT4s> requires modifier <list of modifiers> | Add modifier to one of the duplicate charge lines. | Charge Entry | SV1 |
| 295 | Payer row expired in CSC Library or CSC Library is not attached in Practice Preferences | Create a valid payer row in the CSC Library attached in Practice Preferences. | Billing | Generic |
| 296 | Date of Service for (CPT) does not match encounter date | Change encounter date or charge line date of service. | Billing | DTP |
| 297 | The payer requires a line item authorization for all CPT4 codes | Add a line item authorization to the encounter. | Patient Insurance Verification | REFG1 |
| 298 | The payer requires a line item referral for all CPT4 codes | Add a line item referral to the encounter. | Patient Insurance Verification | REF9F |
| 299 | Admission time is required | Add the Admit time. | Encounter Maintenance | DTP03 |
| 300 | Discharge time is required | Add the Discharge time. | Encounter Maintenance | DTP03 |
| 301 | Admission Time is required for Patient Type(s) <Unknown> | Add the Admit time. | Encounter Maintenance | DTP03 |
| 302 | Discharge Time is required for Patient Type(s) <Unknown> | Add the Discharge time. | Encounter Maintenance | DTP03 |
| Claim Attachment Edits (303- 307) Edits activate, when the first two fields of the PWK segment, Attachment Report Type and Report Transmission Code, are populated and other data meets edit configurable options. | ||||
| 303 | <Payer> requires attachments | Add attachment information on Right-click to select one or more payers. | Encounter Maintenance | PWK |
| 304 | <Financial Class> Requires Attachments | Add attachment information on
| Encounter Maintenance | PWK |
| 305 | <CPT4> Requires Attachments | Add attachment information on
| Encounter Maintenance | PWK |
| 306 | <Diagnosis Code> requires attachments | Add Attachment information on
| Encounter Maintenance | PWK |
| 307 | <Claim Type> requires attachments | Add attachment information on
| Encounter Maintenance | PWK |
| 308 | Place of Service <Unknown> requires an Admitting Diagnosis Code | Add the Admitting Diagnosis. | Encounter Diagnosis | HI |
| 309 | For Specified Type of Bill(s) Admitting Diagnosis Code is Required | Add the Admitting Diagnosis. | Encounter Diagnosis | HI |
| 310 | POS Location details are required when Place of Service equals 99 | Add the details in POS Location window for charges with a Place of Service of 99. | Charge Entry | NM1 |
| 311 | Valid payer(s) for financial class and service location(s) | Activate this edit to allow the application to validate whether the correct payer is attached to the billed encounters during the claim validation process. If the correct payer is not attached with the selected service locations and financial class, the Claim Production Status window displays an error message about an invalid payer. This claim edit enables you to set up a unique combination of service location and financial class for the applicable payers. | Encounter Insurance | NM1 |
| 312 | Document(s)<Unknown> requires sign-off | Activate this edit to allow the application while generating the claim to validate whether the attached PAQ documents are signed-off by the provider. If the PAQ documents are not signed-off, the Claim Production Status window displays an error message about the unsigned PAQ documents.
| Patient Documents | Generic |
| 313 | Documents(s)<Unknown> requiring sign-off is missing | Activate this edit to allow the application while generating the claim to validate whether the signed-off PAQ documents generated from the encounter are attached. If the signed-off PAQ documents are not attached, the Claim Production Status window displays an error message about the missing signed PAQ documents.
| Patient Documents | Generic |
| 1001 | CCI Bundling: CPT4 Codes 00100-09999 | Anesthesia Services. | Charge Entry | SV1 |
| 1002 | CCI Bundling: CPT4 Codes 10000-19999 | Surgery: Integumentary System. | Charge Entry | SV1 |
| 1003 | CCI Bundling: CPT4 Codes 20000-29999 | Surgery: Musculoskeletal System. | Charge Entry | SV1 |
| 1004 | CCI Bundling: CPT4 Codes 30000-39999 | Surgery: Respiratory, Cardiovascular, Hemic, and Lymphatic Systems. | Charge Entry | SV1 |
| 1005 | CCI Bundling: CPT4 Codes 40000-49999 | Surgery: Digestive System. | Charge Entry | SV1 |
| 1006 | CCI Bundling: CPT4 Codes 50000-59999 | Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems. | Charge Entry | SV1 |
| 1007 | CCI Bundling: CPT4 Codes 60000-69999 | Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, Auditory Systems. | Charge Entry | SV1 |
| 1008 | CCI Bundling: CPT4 Codes 70000-79999 | Radiology Services. | Charge Entry | SV1 |
| 1009 | CCI Bundling: CPT4 Codes 80000-89999 | Pathology and Laboratory Services. | Charge Entry | SV1 |
| 1010 | CCI Bundling: CPT4 Codes 90000-99999 | Medicine Evaluation and Management Services. | Charge Entry | SV1 |
| 1011 | CCI Bundling: CPT4 Codes 0001T-0099T | Category III Codes. | Charge Entry | SV1 |
| 1012 | CCI Bundling: CPT4 Codes A0000-V9999 | Supplemental Services. | Charge Entry | SV1 |
| 1013 | CCI Mutually Exclusive: CPT4 Codes 00100-09999 | Anesthesia Services. | Charge Entry | SV1 |
| 1014 | CCI Mutually Exclusive: CPT4 Codes 10000-19999 | Surgery: Integumentary. | Charge Entry | SV1 |
| 1015 | CCI Mutually Exclusive: CPT4 Codes 20000-29999 | Surgery: Musculoskeletal System. | Charge Entry | SV1 |
| 1016 | CCI Mutually Exclusive: CPT4 Codes 30000-39999 | Surgery: Respiratory, Cardiovascular, Hemic, and Lymphatic Systems. | Charge Entry | SV1 |
| 1017 | CCI Mutually Exclusive: CPT4 Codes 40000-49999 | Surgery: Digestive System. | Charge Entry | SV1 |
| 1018 | CCI Mutually Exclusive: CPT4 Codes 50000-59999 | Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems. | Charge Entry | SV1 |
| 1019 | CCI Mutually Exclusive: CPT4 Codes 60000-69999 | Surgery: Endocrine, Nervous, Eye and Ocular Adnexa, Auditory Systems. | Charge Entry | SV1 |
| 1020 | CCI Mutually Exclusive: CPT4 Codes 70000-79999 | Radiology Services. | Charge Entry | SV1 |
| 1021 | CCI Mutually Exclusive: CPT4 Codes 80000-89999 | Pathology and Laboratory Services. | Charge Entry | SV1 |
| 1022 | CCI Mutually Exclusive: CPT4 Codes 90000-99999 | Medicine Evaluation and Management Services. | Charge Entry | SV1 |
| 1023 | CCI Mutually Exclusive: CPT4 Codes 0001T-0099T | Category III Codes. | Charge Entry | SV1 |
| 1024 | CCI Mutually Exclusive: CPT4 Codes A0000-V9999 | Supplemental Services. | Charge Entry | SV1 |
| 1025 | CCI ICD More specific diagnosis code required | Correct or review ICD code. | Charge Entry | HI01-2 |
| 1026 | CCI ICD Diagnosis not allowed for Patient Sex | Correct or review ICD code. | Charge Entry | HI01-2 |
| 1038 | Generalized LMRP: CPT4 Code 00100-09999 | Anesthesia Services: Please review charge diagnoses. | Charge Entry | SV1 |
| 1039 | Generalized LMRP: CPT4 Code 00100-09999 | Surgery: Integumentary System: Please review charge diagnoses. | Charge Entry | SV1 |
| 1040 | Generalized LMRP: CPT4 Code 00100-09999 | Surgery: Musculoskeletal System: Please review charge diagnoses. | Charge Entry | SV1 |
| 1041 | Generalized LMRP: CPT4 Code 00100-09999 | Surgery: Respiratory, Cardiovascular, Hemic, and Lymphatic Systems: Please review charge diagnoses. | Charge Entry | SV1 |
| 1042 | Generalized LMRP: CPT4 Code 00100-09999 | Surgery: Digestive System: Please review charge diagnoses. | Charge Entry | SV1 |
| 1043 | Generalized LMRP: CPT4 Code 00100-09999 | Surgery: Urinary, Male Genital, Female Genital, Maternity Care and Delivery Systems: Please review charge diagnoses. | Charge Entry | SV1 |
| 1044 | Generalized LMRP: CPT4 Code 00100-09999 | Surgery: Endocrine, Nervous, Eye, and Ocular Adnexa, Auditory Systems: Please review charge diagnoses. | Charge Entry | SV1 |
| 1045 | Generalized LMRP: CPT4 Code 00100-09999 | Radiology Services: Please review charge diagnoses. | Charge Entry | SV1 |
| 1046 | Generalized LMRP: CPT4 Code 00100-09999 | Pathology and Laboratory Services: Please review charge diagnoses. | Charge Entry | SV1 |
| 1047 | Generalized LMRP: CPT4 Code 00100-09999 | Medicine Evaluation and management Services: Please review charge diagnoses. | Charge Entry | SV1 |
| 1048 | Generalized LMRP: CPT4 Code 00100-09999 | Category III Codes: Please review charge diagnoses. | Charge Entry | SV1 |
| 1049 | Generalized LMRP: CPT4 Code 00100-09999 | Supplemental Services: Please review charge diagnoses. | Charge Entry | SV1 |
| 1050 | CCI ICD Diagnosis not allowed for Patient Age | Correct or review ICD code. | Charge Entry | HI01-2 |
| 1060 | CCI OCE Gender-specific CPT4 code | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1061 | CCI OCE Non-Covered Service based on Other Than Statute | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1062 | CCI OCE Questionable Procedures | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1063 | CCI OCE No Additional Payment | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1064 | CCI OCE Site of Service | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1065 | CCI OCE Inpatient Procedures | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1066 | CCI OCE Not Recognized | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1067 | CCI OCE ASC Procedure | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1068 | CCI OCE Unlisted Procedures | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1069 | CCI OCE Non-Covered Service Based on Statute | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1070 | CCI OCE Not Recognized by OPPS | Review and/or correct CPT4 code. | Charge Entry | SV1 |
| 1071 | CCI OCE DME Procedure | Review and/or correct CPT4 code. | Charge Entry | SV1 |