HIPAA AND INSURANCE CODE SEARCHES

CLAIM STATUS CATEGORY CODES >>

 

Claim Status Category codes indicate the general category of the status (accepted, rejected, additional information requested, etc.) which is then further detailed in the Claim Status Codes.

HEALTH CARE PROVIDER CHARACTERISTICS >>

 

This code list is for use with health care provider information for enrollment and credentialing transactions and their corresponding responses. It is intended to provide codified responses to questions presented to a health care provider applying to or registering with an entity and to report the outcome of such application or registration. It may also be used for responses to inquiries regarding provider participation or registration in a program or plan.

HEALTH CARE SERVICE TYPES >>

 

Health Care Service Type Codes are used to identify the classification of service or benefits. This external code list is for use in ASC X12 Transaction Sets 270, 271 and 278, versions 006010 and higher.

HEALTH CARE SERVICES DECISION REASON >>

 

Health Care Services Decision Reason Codes are used to indicate the primary reason for the certification action code assigned as part of a health care services review.

HEALTH CARE ADJUSTMENT REASON >>

 

Claim adjustment reason codes communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code.

HIPAA CLAIM DENIAL >>

 

HIPAA claims denial list

INSURANCE BUSINESS PROCESS APPLICATION ERROR >>

 

REMITTANCE ADVICE REMARK CODES >>

 

Remittance Advice Remark Codes are used to convey information about remittance processing or to provide a supplemental explanation for an adjustment already described by a Claim Adjustment Reason Code. Each Remittance Advice Remark Code identifies a specific message as shown in the Remittance Advice Remark Code List.

CLAIM STATUS CATEGORY CODES >>

 

Claim Status Category codes indicate the general category of the status (accepted, rejected, additional information requested, etc.) which is then further detailed in the Claim Status Codes.

REASON CODES >>

 

Reason codes appear on an explanation of benefits (EOB) to communicate why a claim has been adjusted. If there is no adjustment to a claim/line, then there is no adjustment reason code.

INSURANCE MODIFIERS >>

 

Modifiers often provide justification as to why additional procedures should be paid. Using modifiers can prevent bundling of procedures, however, they should only be used if the chart note justifies it.

PLACE OF SERVICE CODES >>

 

Place of Service Codes is a required element in box 24b on your CMS Form 1500. These codes identify where the service took place.