No maximum allowable defined by legislated fee arrangement. Note: Use code 187. Applicable federal, state or local authority may cover the claim/service. The "PR" is a Claim Adjustment Group Code and the description for "32" is below. This injury/illness is the liability of the no-fault carrier. The provider cannot collect this amount from the patient. Workers' Compensation Medical Treatment Guideline Adjustment. The advance indemnification notice signed by the patient did not comply with requirements. Procedure/treatment is deemed experimental/investigational by the payer. Procedure code was incorrect. Coinsurance for Professional service rendered in an Institutional setting and billed on an Institutional claim. The diagnosis is inconsistent with the patient's gender. This claim/service will be reversed and corrected when the grace period ends (due to premium payment or lace of premium payment). Reason Code 39: Charges exceed our fee schedule or maximum allowable amount. Each transaction set is maintained by a subcommittee operating within X12s Accredited Standards Committee. 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.) Claim lacks indicator that 'x-ray is available for review.'. Alternative services were available, and should have been utilized. Submit these services to the patient's dental plan for further consideration. Claim received by the medical plan, but benefits not available under this plan. Search box will appear then put your adjustment reason code in search box e.g. EOB Description Rejection Group Reason Remark Code co 256 denial code descriptions Reason Code A0: Medicare Secondary Payer liability met. The applicable fee schedule/fee database does not contain the billed code. Prearranged demonstration project adjustment. 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). 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). Reason Code 220: 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 tables on this page depict the key dates for various steps in a normal modification/publication cycle. This change effective 7/1/2013: Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Procedure code was invalid on the date of service. CO : Contractual Obligations Denial based on the contract and as per the fee schedule amount. What steps can we take to avoid this reason code? (Note: To be used for Property and Casualty only). (Use only with Group Code OA). Failure to follow prior payer's coverage rules. Reason Code 190: Original payment decision is being maintained. This change effective 7/1/2013: Service/equipment was not prescribed by a physician. 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. Total Healthcare Denial Code - 222 Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. (Use CARC 45), Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement.