ABH error codes


ABH Claims: 1-780-422-1600
ABH ULI/Prac ID: 1-780-422-1522

01 Not Registered  No record of personal health number.
01A Not Registered This person is not registered under Alberta Health Care Insurance. If patient is newborn submit new claim with person data segment and newborn code.
01B Non Resident Can`t confirm patient is resident of Alberta, contact patient to obtain correct billing information.
01C Previous Good Faith Claim A Good Faith Claim was previously paid for this patient who is not a resident of Alberta.
02 Registration number/PHN Conflict The registration number and the PHN are not for the same person.
03 Newborn The claim was refused Claim refused unable to contact the parents of this child to confirm registration.
04 Donor`s Registration Number Used Submit this claim using the PHN of the donor recipient.
04A Changed Personal Health Number This is the correct PHN for this patient. It should be used from now on.
05 Patient Personal Health Number - Not Effective This PHN is not effective for the dates of service.
05A Invalid Person Health Number The PHN is invalid or blank.
05AA Opted Out Residents The Patient has opted out of Alberta Health Care. Patient has assumed all financial liability for all health services. Contact patient regarding payment.
05B Unregistered WVB Claim The patient is not eligible for Alberta Health coverage for the dates of service. Submit claim to workers compensation board.
05BA Invalid/Blank Registration Number This claim has been refused the registration number is invalid/blank.
05BB Invalid Blank ULI This claim has been refused as the Unique Lifetime Identifier is blank, invalid, not a valid ULI for the service recipient.
05C Eligibility Extended Health Benefits Program The patient did not have coverage under the EHB on this date. Effective April 1,2002 to be eligible for EHB the patient must be a recipient of Widows Pension or other benefit. If the patient does not fit the description they will be refused if they need more information call (780) 427-1432.
05E EHB Coverage Payment was refused as the services were provided when the patient did not have coverage under EHB.
06 Retroactive Eligibility Change Your request to change the claim was refused due to the retroactive eligibility change the patient is not eligible for Alberta Health Care.
07 New Recipient for Alternative Payment Plan Contract Your claim for a new recipient was paid as a fee for service benefit.
08 New Recipient Previously Paid for APP Contract Payment was refused as a fee for service claim was previously paid for a new recipient.
09 Initial Roster Relationship Payment was refused as an Initial Roster relationship exists for this patient. A fee for service claim is not payable under a temporary Roster Relationship.
10 Ineligible Practitioner/ Incorrect Submission We have not received notification from the Governing body/ Licensing Association that the practitioner is accredited to preform this service.
10A Service Provider Restriction Our service records indicate that the Service Provider is restricted to a specific facility or restricted to preforming specific services.
10AA Ineligible Practitioner This claim has been refused as you are not entitled to payment for this type of service.
11 Locum Business Arrangement This claim has been refused as the Business Arrangement does not include a Business Arrangement Type of Locum.
20 Ineligible Services Payment was refused as the services are not covered int he Schedule of Benefits. The services are: Advice by phone,Ambulance service, Anesthetic Materials,Cosmetic Services,Drugs/Agents,Medical and Surgical Appliances and Supplies, Medical Testimony in Court, Oculo-visual/Optometric services for residents 19 to 64, Secretarial or Reporting Fee, Stand by time, Tinted Glass (EHB), Travel Time, Refer to the General rule 3 in the Schedule of Medical Benefits or General rule 5.1 in the Schedule of Oral and Maxillofacial Surgery Benefits.
20A Third Party Services Examinations or services required to provide reports or certificates requested by a third party are not an insured service, ex. Adoption, Employment, School entrance, passport or visa.
20AB Experimental/Research services Payment was refused as Alberta Health Care does not cover services that are experimental or in research stage.
20B R.C.M.P, Armed Forces and Federal Penitentiary Members of the RCMP, Armed services and inmates are not beneficiaries under the plan.
20C Practitioner Billing for Own Family Services provided to members of your family or yourself are not a benefit under the plan.
20D Dental Care-Oral Surgery This service is not an oral surgical procedure payable by the plan.
20E Benefit Guide This is an incorrect Health service code, refer to the plans appropriate fee schedule.
20F Excluded Item This service is not payable under the EHB program.
21 Workers` Compensation board Claim This claim is the responsibility of the WCB.
21A Payment Responsibility/Benefit Code The payment responsibility (WCb or AHC) and the Health service code do not agree. Verify the responsibility and re submit.
21AA Workers` Compensation Board-patient over 14 The patient must be over 14 to qualify.
21AB Workers` Compensation Board Claim Submissions Claims are to submitted directly to WCB.
21B Workers` Compensation Board(out of province) This claim is the responsibility of another provinces WCB, submit claim directly to the appropriate WCB.
22 Ineligible Patient Records indicate that this patient is the responsibility of another provinces medical plan.
23 Contract Services This service is payable only to practitioners who provide medical services under written agreement with the department of health.
23A Prior Approval Payment was refused as: this service requires prior approval from the patient`s provincial Medical Plan and/or prior approval was not received for this date of service.
24A Podiatry Services only Payable in Office Facility This service is only payable when preformed in an office.
25 Excluded Service-Reciprocal Programs Payment has been refused as this service is excluded according to the reciprocal agreement. The claim should be billed directly to the patient or there home provincial health plan.
25A Medical Reciprocal-Incorrect Claim Payment was refused as you have submitted a medical reciprocal claim for services provided to an Alberta patient.
28 Opted Out Practitioner This service was provided by a Practitioner who has opted out of the Alberta Health Care Insurance Plan and there is no indication that this was emergency service.
30 Address The claim was refused because the address on the persons Data Segment was invalid, incomplete, or blank.
30A Province Code The claim was refused because the Province code on the persons Data segment was invalid,incomplete or blank.
30AA City Name The claim was refused because the City name on the persons Data segment was invalid,incomplete or blank.
30AB Country Code The claim was refused because the County code on the persons Data segment was invalid,incomplete or blank.
30AC Postal Code The claim was refused because the Postal code on the persons Data segment was invalid.
30B Date of Birth The claim was refused because the Date of birth on the persons Data segment was invalid,incomplete,blank or after the date of service.
30BA Gender The claim was refused because the Gender on the persons data segment is invalid or blank.
30E Surname The claim was refused because the surname on the persons data segment is invalid or blank.
30EA First Name The claim was refused because the first name on the persons data segment was invalid or blank.
30EB Middle Name The claim was refused because the middle name on the persons data segment was invalid or blank.      
30F Person Type this claim was refused because the person type on the persons data segment was invalid or blank.
30G Guardian/Parent Personal Health Number This claim was refused because the Guardian/Parent Personal Health number on the persons data segment is invalid or blank.
30H Guardian/Parent Health Plan Number This claim was refused because the Guardian/Parent Health Plan Number is invalid or blank.
31 Incomplete Person Data This claim was refused because the Person Data segment is required, incomplete for the person type submitted, required as we have no record of the PHN which was submitted.
31A Person Data Segment Conflict The out of province registration number and the Person Data Segment do not match the service recipient information in our files. Confirm patients out of province health care card number, home province/recovery code and personal data information with the patient or the patients home provincial health plan. If Applicable submit new claim.
34AA Claim Current Year Segment The current year indicated with in the claim number is not numeric or not the current year.
34AB Claim Sequence Number The claim sequence number indicated with in the claim number is not numeric.
34AC Claim Check digit the check digit number within the claim number is invalid.
34AD Action Code the action code is inconsistent with other information segments within this transaction.
34B EMSAF Indicator the EMSAF indicator is invalid.
34C Claim Record Type The record type is invalid. To process the claim the record type must be: #2 in the (batch header) data field, #3 in the(claim detailed record)field, #4 int batch trailer) data field.
34DA Claim Transaction Type The transaction type is not CIPI.
34DB Claim Segment Type The segment type must be: CIBI-claim regular or, CPDI-person data segment or, CSTI-text segment or, CTXI-text cross reference segment or in the proper order.
34DC Segment Sequence Number the segment sequence number is not incremental.
34DD CST1 Segment Required At least on CST1 segment must be submitted with an "R" (Reassess Action Code) transaction.
34DE Maximum CST1 Segment The maximum number of CIT1 segments (500) was exceeded.
34DF CIB1 Segment Required Only provide a "CIB1" Base Claim Segment when submitting a "D" (Delete Action Code) transaction.
34DG CPD1 Segment Not Allowed A "CDP1" Person Data Segment cannot be provided when submitting an"R" (Reassess Action Code) transaction.
34DH Maximum CPD1 Segment A transaction cannot have more than one "CPD1" Person Data Segment for any one person data type.
34EA Claim Text Segment The text information you supplied is not in alpha numeric format.
34EB Claim Source code The claim source code is invalid.
34EC Supporting Text Cross Reference The supporting text cross reference segment claim(s) number has failed the claim check algorithm.
34ED CTX1 and CST1 Segment The transaction being cross referenced and referred by a "CXT1" test cross reference segment must have a "CST1" test segment.
34F Chart Number The chart number information was not in alpha numeric characters. Only ASCII print characters are valid for this field.
35 Action Code This transaction was refused because: the action code is invalid or, action code R is only allowed if test is submitted and the original health service code was reduced required reassessment or, action code D cannot be processed when the pay to code is not "BAPY" or, action code C cannot be processed on a refused claim.
35A Intercept The intercept code on the claim is invalid.
35B Recovery Code The recovery code on the claim is invalid or not allowed for this business arrangement.
35C Reassess Reason Code The reassess reason code on the claim is invalid or blank.
35D Claim Type The claim type on the claim is invalid or blank.
35E Confidential Indicator Code The confidential indicator code on the claim is invalid.
35F Claim Number the claim number on the claim is invalid or blank.
35FA Submission of a Claim Number The claim number was previously used on a refused claim or, claim which is being held or, a paid service event or claim applied at a zero amount.
35FB Unable To Process Updated Transaction the transaction to update a previously submitted claim cannot be processed as the original add transaction cannot be located or, the result of your original claim must be known or, the original claim was previously deleted.
35FC Unable to Process Add Transaction This claim number submitted was previously used and the add "A" transaction cannot be processed. If applicable, submit the original claim number with the appropriate action code of "R" , "C", or"D".
35G Good Faith Indicator The good faith indicator on the claim is invalid.
35H Supporting Documentation Indicator The Supporting Documentation Indicator on the claims invalid.
35J Text Indicator The test indicator on the claim is invalid.
35K Pay to Code The pay to CADE on the claim is invalid or cannot be changed.
35KA Pay to Code/Pay to ULI Conflict There is a conflict between the info shown in the pay to code and the pay to ULI field. When the pay to code is "OTHR" the pay to ULI cannot be the service provider or, BA payee or, Patient or, AH registration contract holder responsible for the patient.
35L Pay to ULI The pay to ULI on the claim is invalid or blank.
35M Newborn Code The newborn code is invalid or not required when the patients personal health number is already provided on the claim.
36 Locum Business Arrangement The locum business arrangement number on the claim is invalid or not required.
36A Locum/Business Arrangement Numbers The locum business arrangement and the business arrangement fields were not completed properly. Refer to the "physicians resource guide" and submit new claim.
37 Business Arrangement The business arrangement number on the claim: is invalid or blank, is restricted to performing specific services or, is restricted to performing services at a specific facility or, is not registered with the submitter of the transaction or, does not have a relationship with the service provider PHN submitted, is restricted to patients from a specific area.
37A Provider ULI The service provider ULI field is blank, invalid, or not effective for the date of service submitted.
37B Skill Code The skill code on the claim is invalid or blank.
39 Date of Service The date of service for the claim is invalid or blank or, more than 1 year from date of birth (newborn) or, in conflict with the explicit modifier indicated.
39A Date of Service Conflict The date of service for the claim and the supporting documentation do not agree.
39B Health Service Code Payment has been refused as the health service code on the claim is: blank or invalid or, not listed in the applicable AH schedule of benefits.
39BA Gender Restriction The health service code and /or diagnosis submitted does not agree with the gender of the patient.
39BB Age Restriction The patient does not qualify for this service due to the age restriction.
39BC Health Service Code Does Not Appropriate For Diagnosis The type of service provided does not agree with the diagnosis.
39BD Date of Service/Health Service Code Conflict The health service code is not effective on this date of service.
39BE Conceptual Age Payment for the additional benefit has been refused as the patients conceptual age is greater than 26 weeks.
39C Number of Calls This claim was refused as the number of calls is invalid or blank or, the number of calls on the claim is more than the number allowed for this service.
39D Location of Service The location of service on the claim is not appropriate for the health service code indicated.
39DA Facility Number The facility number on the claim is invalid or blank.
39DB Functional Center Code The functional center code on the claim: is blank or invalid or, does not exist for the facility submitted, or is restricted from preforming the service submitted.
39DC Originating Facility Number The collection facility number on the claim is invalid or blank.
39DD Originating Location The originating location on the claim is invalid or blank or not required when the originating facility number is completed.
39DE Originating Facility Number/Location for Pathology Services The originating facility number or the originating location field is required for pathology services (E codes)
39EB Diagnostic Code The Diagnostic Code on the claim is invalid or blank.
39EC Health Services Code and Diagnostic Code Conflict The claim was refused as the health service code and the diagnostic code on the claim are in conflict.
39F Use Claimed Amount Indicator The "use claim amount indicator" on the claim is invalid.
39FA Amount Claimed/Use Claimed Amount Indicator Your claim was refused as: the amount claimed is blank. Claims for unlisted procedures(health service codes in the 99.09 series) require a claimed amount and a "Y" in the claimed amount indicator field or, the amount claimed is blank or invalid and the claimed amount indicator is "Y" or, the amount claimed is completed, but the claimed amount indicator is blank or invalid.
39G Modifier Code The modifier code field is required with service submitted, is invalid, can only have one modifier of the same type, can not have this combination of modifiers.
39H Telehealth Services The claim was refused as the health service code and the modifier code are in conflict for the following reasons: "STFO"(store and forward modifier) applies only to teledermatology or "TELES"(telehealth modifier) applies only to consultations and non-referred visits 03.01C,03.03A, and 03.04A.
41 Documentation Incomplete/Not Received The supporting documentation for this claim was incomplete or not received.
41B Time/Sites -E.H.B Submit new claim indicating the number of units, quadrants or sextants.
42 Hospital Admission/Originating Encounter Date The hospital admission/origin date on the claim is invalid or blank.
43 Out of Province Health Plan Number The Out of province health plan number on the claim is invalid or blank.
45 Invalid Referring practitioner Number The referring practitioners personal health number on the claim is invalid or blank or, not an intraspecialty or from a practitioner without appropriate discipline or skill.
45A Out of Province Referral Indicator The out of province referral indicator is invalid.
45AA Referral ULI Invalid Unable to Resolve Your claim has been refused as the referral ULI is invalid. Contact the referring practitioner for the correct ULI number.
45B Encounter Number The encounter number on the claim is invalid.
47 Service Recipient Personal Health Number (PHN) This claim was refused as the service recipients PHN cannot be changed. Delete the original claim and submit a new claim with correct service recipient PHN.
48 Provider Personal Health Number This claim was refused as the Provider PHN cannot be changed. Delete the original claim and submit a new claim with the correct provider PHN.
49 Business Arrangement/Locum Business Arrangement Number This claim was refused as the business arrangement and/or locum business arrangement number cannot be changed. Delete the original claim and submit a new claim with the correct business arrangement or locum business arrangement number.
50 2 Physicians-Unrelated Abdominal Surgical Procedures Payment was reduced 75% of the fee as the full benefit for the major procedure was paid to the physician most responsible for the patients care.
50A Procedures Included in the Major Procedural Benefit Payment was refused as this service is included in the fee aid for the major procedure.
50AA Diagnostic Procedures Relating to Surgery Payment was refused as the diagnostic procedure is included in the benefit paid for the surgical procedure when preformed under the same anesthetic.
50B Repeat Closed Reduction-Same Practitioner Payment was refused as a repeat closed reduction performed by the same practitioner is not payable.
50BA Repeat Closed Reduction-Different Practitioner Payment was reduced to 50% as a different practitioner has performed a repeat closed reduction for the fracture or dislocation.
50BB Closed-Open Reduction-Different Practitioner Payment was reduced to 50% as a different practitioner has performed a repeat open reduction for the fracture or dislocation.
50BC Closed-Open Reduction-Same Practitioner Payment was refused as a closed reduction is not payable when the same practitioner performs an open reduction for the same fracture under the same anesthetic.
51 Pre-And/Or Post-Operative Care-2 Practitioners Payment was reduced or refused as another practitioner was paid for pre- and/or post-operative care.
51A Unilateral-Bilateral Procedures Payment was reduced as the fee does not increase when a bilateral procedure is preformed.
51G Surgical Assists Payment was refused according to General 13, for one of the following reasons: a surgical assist fee is not payable for the procedure performed or, a surgical procedure was not claimed for this date of service or,documentation was not submitted to support a claim involving unusual circumstances.
52 Procedures Re-submissions Payment was refused as this service cannot be paid when as associated procedure was claimed within 90 days. See the note in the Schedule of Medical Benefits following the health service code claimed.
52A Lacerations Payment was made according to the explanation following health services code 98.22B.
52B Same physician-2 Functions Payment was refused as only one benefit can be paid when both surgical and anesthetic services are preformed by the same physician.
53 Obstetrics and Gynecology Payment was refused as conservative surgery for endometriosis (item 81.29C) must be claimed in addition to item 66.83.
53A Chronic Villus Sampling Payment was refused as benefits for Chronic Villus Sampling are only payable when the service is provided in a hospital.
54 Included Services Payment was refused as the service(s) is included in the benefit paid for the delivery.
54A Post-Natal Maximum Payment was refused as only one routine post-natal visit, per physician, is payable.
54B Prenatal Care Payment was refused as; only one 03.04B may be claimed per pregnancy per physician, Health Service code 03.04B may not be charged with in 91 days of a major visit item, 03.04B benefit may only be claimed for the prenatal visits and may not be claimed for date of service following a delivery.
56 Procedure-Visit Payment was refused as: only the greater of a minor procedure or office visits payable when the service and diagnosis are related or, only the greater of a consultation and minor procedure are payable on the same date of service, or, only the greater of a procedure and hospital visit are payable on the same date of service or, multiple surgical procedures have been preformed; refer to governing rules 6.9.1,6.9.2,6.9.3,6.9.5,and 6.9.7
56A Multiple Minor Surgical Procedures Payment was reduced 75% as only the greater benefit is payable in full when multiple minor surgical procedures are preformed.
56B Varicose Veins Injections Payment was refused as the maximum for the benefit year(July 1 to June 30) was paid. the schedule of medical benefits allows one initial 51.92B, six repeat 51.92A's and up to eighteen 51.92B services for each patient per benefit year.
56C Tray Services Payment was reduced or refused according to governing rules 14.1,14.2 and 14.3 in the schedule of medical benefits.
56D Fibreglass Cast Payment was reduced to the equivalent rate of an application of a cast health service code (7.53B or 7.53D) as the service was performed in a nursing home, general or auxiliary hospital or a facility which has a contract with a regional health authority; Payment was reduced by a rate equivalent to health service code 7.53B ir 7.53D as the benefit for the application of a cast is included in the fracture reduction health service code; Payment was reduced by a rate equivalent to a major tray service benefit which was paid for health service code 7.53B or 7.53D as cast supplies are included in the benefits for 7.53H and 7.53J.
58 2 Procedures-2 Surgeons Payment was reduced as the greater anesthetic benefit is paid at 100% and the lesser at 75% when 2 procedures are preformed consecutively by 2 surgeons under the same anesthetic.
58A Inclusive Anesthetic Benefit Payment was refused as only the greater is payable when both the local anesthetic and the procedure are claimed by the same practitioner.
58BA Simultaneous Surgery Payment was refused as only the greater anesthetic benefit is payable when 2 practitioners operate simultaneously.
58C Multiple Benign Skin Lesions Payment was reduced or refused as only a single anesthetic benefit is payable when surgical treatment of multiple benign lesions are performed under 45min of anesthetic.
58D Resuscitation Payment was refused as health service code 13.88E can only be paid when the physician is specially called for resuscitation. Submit a new claim using the appropriate Health Service Code 13.99J or 13.99F.
58E Related Anesthetic Code Payment was made according to the information submitted on the Surgeons claim.
58F additional Age Benefit Payment was reduced to general rule 12.7 or 12.8. Only one additional anesthetic benefit per patient encounter is payable regardless of the number of services provided.
60 Initial Visit-Major Payment was refused as an initial visit provided by the same practitioner may not be claimed more than once every 180 days.
60A Consultation-Inclusive Benefit Payment was refused ad a consultation benefit is included in the payment for the procedure.
60AA Consultation Payment was reduced to the rate payable for a non-referred visit item as: the service does not meet the requirements of a consultation or, the referral was not from a physician or, the referral was from a family member.
60B Dental Consultation Payment was refused as a dental consultation is only payable when it is requested by the patients physician, Dental surgeon, or Oral and Maxillofacial Surgeon and it concerns a procedure under the schedule of oral and maxillofacial surgery benefits.
60C Hospital Admission Payment was refused as an admission is not payable when the patient was seen by the same practitioner on the same day for the same or related diagnosis.
60E Hospital Visit-Emergency and Outpatient Departments Payment was refused as: another physician had claimed for the same service. Submit a new claim with a DSCH modifier according to governing rule 5.1 or, 03.05F cannot be claimed by the same physician who provided the initial assessment prior to determining the disposition status of the patient.
60EA Critical Care-Emergency Visit Payment was refused as the information/diagnostic code provided does not support payment under this health service code. Submit a new claim with the appropriate emergency department visit.
60EB Services Unscheduled Payment was refused as the maximum benefit for unscheduled services was reached.
60EC Special Callback to Hospital Emergency Out-Patient Department Payment was refused according to general rule 5.2 in the scheduled medical benefits or general rule 17 in the schedule of oral and maxillofacial surgery benefits.
61 Dressing Changes-Burns Your claim for 07.75 and 07.57A has been changed to an office visit as the service is not for a burn. The corresponding tray service has been deducted where applicable.
61A Generalized Diagnostic Codes Payment was refused as this service is included in the benefit paid for the related surgical procedure.
61B Removal of Sutures Payment was refused as the fee for removal of sutures is included in the surgical benefit according to general rule 6.3 in the schedule of medical benefits or general rule 6.1 in the schedule of oral and maxillofacial surgery benefits.
61C Nursing Home and Senior Citizens Home Payment was refused as the service was not provided in a "home" location as specified in governing rule 1.6.
61CA Auxiliary Hospital Visits Payment was reduced to a lesser benefit as the service provided was a routine visit for custodial care.
61CB Auxiliary Hospital/Nursing Home Visit/Management of Dialysis Patients. Payment was refused as visit for a prior date of service during the same calendar week was paid.
61E Concurrent Care Payment was reduced or refused as services for concurrent care require supporting information according to general rule 4.8 in the schedule of medical benefits or general rule 13 in the schedule of oral or maxillofacial surgery benefits.
61EA Continuing Care Payment was reduced or refused according to the general rule 4.10 in the schedule of medical benefits or general rule 14 in the schedule of oral or maxillofacial surgery benefits.
61F Conflicting Hospital Dates Payment was reduced or refused as a benefit for some or all of the hospital dates of service was previously paid.
61G Post-Partum Office Visits Payment was refused as the service is not payable when provided to healthy newborn during the postpartum period.
61H Inclusive-Surgical Benefit-Pre/Post-Operative Care Payment was refused as the service(s) for pre- / post- operative care is included in the surgical benefit.
62 Professional Interview/Case Conference Payment was refused as health service code 03.05YM may only be claimed when health service code 03.05Y has been previously submitted and paid. Refer to the notes in the schedule of Medical Benefits under health services codes 03.05Y and 03.05YM.
63 Claim In Process Your claim is being held as: it requires manual assessment or, the supporting information must be received. Do not submit a new claim.
63A Schedule of Benefits Payment was reduced or refused according to the governing rules and /or the health service code notes in the schedule of benefits.
63AA Unscheduled Services and Designated Holidays Payment was reduced or refused according to general rule 1.2 and 15 in the schedule of medical benefits or general rules 1.10 in the schedule of oral or maxillofacial surgery benefits.
63B Maximum Number of Calls Payment was reduced as the maximum number of calls for the health services code was reached.
63C Inclusive Health Service Code Payment was refused as there is an inclusive health service code in the schedule of benefits for these services.
64 Supporting information Payment was refused as text information, an operative or pathology report or an invoice is required to support assessment of the claim.
64AA Unanswered Correspondence/Telephone Response Payment was refused as our requests for additional information were not answered.
64AB Relationship Payment was refused as the relationship of the relative being interviewed was not provided.
64C information Provided The information provided has been reviewed and payment was: reduced or refused,unchanged, or altered and the future claims of this nature should be submitted under the applicable health service code. Unlisted procedures are to be claimed only for new procedures not listed in the schedule.
64D Anesthetic and Surgery Discrepancy Payment was refused as there is a discrepancy between the health service code shown on the anesthetic surgery claim.
64E Date Conflict Payment was refused as the date of service does not agree with the anesthetists, surgical assistants or surgeons claim.
65 Hospital Services/Non-Invasive Diagnostic Procedure/Interpretations Payment was refused as this laboratory/x-ray/non-invasive diagnostic service was provided for a hospital patient. Benefits for this service are the responsibility of the hospital.
65A Blood Specimen This claim was refused as payment cannot be made: for both obtaining the blood specimen and a lab test requiring blood or for services performed by non-laboratory facilities.
65AA Miscellaneous Laboratory Procedures Payment was refused according to the following: claims submitted for E1 and/or combination of E2,E3,E4,E5, and E& for the same date of service are not payable in excess of the listed benefit for E1 or, the greater benefit is paid when claims are submitted for health service code E1 and E41 or E400 for the same date of service or, the greater benefit is paid when claims are submitted for E234 and E235 for the same date of service or, a maximum of either one E553 and one E554 or two E553`s or two E554`s are paid within a 14 day period.
65C Diagnostic Ultrasound Payment was refused as when claims are submitted for the same date of service for combination of: X222 - X233 inclusive, x234 - X244 inclusive only the greater benefit is paid, X258 is not payable in addition to X234, X235, X239A, X240, x241, X242, X243.            
65D Allergy Investigation Payment was reduced or refused as the maximum benefit payable for the 365 day period was reached.
65E Detention Time Payment was refused as supporting information must provide a breakdown of the procedures performed during the time of continuous attendance spent with the patient and the time of attendance during the ambulance trip, if applicable.
66 Detention Time Payment was reduced or refused as: when a consultation is claimed in association with 03.05A 05 13.99J during the same encounter, the consultation is considered to occupy the first 30 min. of the time spent with the patient or, the greater benefit is paid when health services codes 03.05A or 13.99J are claimed for the same patient encounter.
66A Ventilatory Support Payment was reduced or refused for one of the following reasons; ventilatory support may be claimed only once per 24 hour period regardless of the number of physicians providing care, ventilatory support is not paid for the same date of service by the same physician who has provided either an anesthetic or surgical procedure, ventilatory support is not paid unless provided in approval level 2 and 3 intensive care units, a surcharge is not payable with benefit code 13.62A but after hour callback or surcharge is payable under benefit code 03.05P,03.05R, 03.05Q or 03.05N, in accordance with governing rule 5.4.
67 Multiple Charges/Same Encounter Payment was refused as claims for multiple services provided in the same encounter require supporting information.
67A Previous Payment Payment for this service was refused as the claim was previously paid or the claim was applied at "0" on a previous statement of assessment. Requests for a reassessment of applied at "0" claims must be submitted with the original claim number and the appropriate action code of "C", "D" or "R". Exception: Hospital Reciprocal claims must be resubmitted as described in the Alberta Health and wellness hospital reciprocal submission guide.
67AA Payment To Contract Holder/Patient Payment was refused as the benefit for this service was paid to the patient/contract holder.
67AB Previous Payment-different Health Service Code Payment was refused as a benefit was paid under a different health service code.
67AC Previous Payment Payment was refused as this benefit was paid to another practitioner.
67AD Duplicate-Different Service Date Payment was refused as this claim appears to be a duplicate of a paid benefit, although the dates of service do not agree. If this is not a duplicate, submit a new claim with supporting information.
67B Location Of Service Conflict Payment was refused as claims were paid for services that the patient received on this date at different location/hospital. Verify the dates of service and resubmit applicable claims with additional details.
67D Medical Staff-Assessment This claim has been assessed according to the advice received from our medical staff. A review of this assessment by the assessment advisory committee can be requested by submitting a new claim with relevant information.
67DA Related Assessment Accounts of a similar nature have been reviewed by the assessment Advisory committee and this claim has been assessed according to there recommendations.
67DB Final Assessment This claim has been paid, reduced or refused as recommended by the assessment advisory committee.
68 Reduced Benefits For Listed Procedures This claim was reduced to the listed benefit as the service listed in General rule 6.8.4 in the schedule of medical benefits or general rule 16.3.5 in the schedule of oral and maxillofacial surgery benefits, was not provided in a hospital or approved non-hospital surgical facility.
69 Alternative Payment Plan Additonal Fee For Service Payments An additional fee for service payments was paid due to additional supporting documentation for special circumstances.
70 Pre/Post-Operative Care This claim was assessed in accordance with general rule 16.1 in the schedule of oral and maxillofacial surgery benefits or general rule 6.2 in the schedule of dental extended health benefits.
70A 2 Dental Procedures-2 Incisions Payment was reduced 75% of the listed benefit as the major surgical procedure was paid at the full rate.
70AA 2 Dental Procedures-1 Incision Services for lesser value procedures are reduced 75% of the listed benefit, as the major surgical procedure was paid at the full rate.
70D Ineligible Dental Services Payment has been refused as tissue conditioning is only payable in conjunction with a denture or reline with 5 years. There is no reline or denture claimed for this period, or tissue conditioning is not payable within 3 months of partial or complete denture insertion as this is included with the benefit for the denture, or only 2 tissue conditioning benefits are payable for a denture or reline with in 5 years, you have reached the maximum allowed for a tissue conditioning benefit.
70E Tooth Identification Payment has been refused as identification of tooth numbers and surfaces are required as applicable or, the tooth surface field for this procedure should be blank or, the tooth surface(s) indicated is/are not valid for the tooth code submitted or, the tooth number indicated is not valid for this procedure.
70EA Dental Extraction Payment was refused as our records show this tooth was previously extracted.
70EB Tooth Surface/Tooth Code Payment was refused as the tooth surface or tooth code is invalid.
70F Dentures/Rebase/Reset Payment was refused for one of the following reasons: a benefit was paid for a complete denture with in the last 5 years or, a benefit was paid for a partial denture with in the last 5 years.
70G Reline or Rebase Payment was refused as benefits were paid for a reline in the past 2 years.
70J Inclusion Within The Composite Benefit Payment was refused as the service is included in the benefit for the major procedure.
70K Ineligble Dental Mechanics Services Payment was reduced or refused for the following reasons: Only one oral examination per day is payable when a corresponding new denture or reline benefit is provided on or after Jan 1/01 and paid by the Alberta Health and wellness extended health benefits program or, only on oral examination is payable for each new denture or reline service provided or, an oral examination occurred with 90 days of the denture/reline service. The examination is included in the benefit for the denture/reline or, an oral examination is not payable if performed more than 365 days after a denture or reline benefit was provided.
70L Dental Procedures Payment was refused as when multiple services are claimed for the same date of service, the following rules apply: only the greater benefit of a minor procedure, consultation or any visit is payable when the services and diagnosis are related or, only the greater benefit of a minor (M- or M+) procedure or a hospital visit is payable regardless of the diagnosis or, only the greater benefit of a minor(M-) procedure or a visit is payable when preformed in a location other than an Oral and Maxillofacial Surgeons or dentists office, or surgical suite, regardless of the diagnosis or, an office visit benefit is not payable with a minor procedure and a consultation, regardless of whether the services are performed at different encounters.
72 AHC And WCB Claim For The Same Visit Payment was refused as a benefit was paid for a workers` compensation board claim.
72C Workers` Compensation Board Responsibility Payment was refused as the WCB will not accept responsibility for this service.
72D Workers` Compensation Board The WCB has accepted responsibility for this claim.
73 EMSAF Refused Payment was refused as non-residents, allied health providers or subscriber claims do not qualify for EMSAF benefits.
73A EMSAF Assessment This claim was paid, reduced or refused as recommended by the EMSAF committee.
73BA Incorrect EMSAF Claim Submission Payment was refused as the claim for EMSAF was submitted incorrectly, refer to the physicians resource guide and resubmit appropriately.
73BB No Payment By Alberta Health Care Payment of the EMSAF portion of the claim was refused as there is no record of an Alberta health care payment for this service.
73BC Request For EMSAF Payment was refused as supporting documentation is required for the EMSAF claim.
73BD Non-insured Service Payment was refused as this service is not insured by Alberta health care.
73BE Change Of Payment Responsibility This EMSAF claim was paid as an Alberta health benefit.
73D By-Assessment Health Service Codes For EMSAF Payment was refused ass By-assessment health services do not qualify for EMSAF benefits.
80 Residency/Good Faith Payment was refused as good faith claims must be submitted within 30 days of the date of service.
80B Eye Examinations Payment was refused as this is the second claim for this type of eye exam provided to this patient with in the benefit period.
80BA Optometric Services Payment was refused as either a complete vision examination, a partial visual examination or a single Diagnostic Procedure was paid for the same date of service or the maximum benefit allowed was reached.
80BB Optometric Services Default Price Adjustments This is a repayment of benefits that were reduced by implementation of the default price adjustment mechanism in fiscal year 2002/2003.
80C Podiatric/Chiropractic/Dental Limits This claim has been reduces or refused as: the yearly limit for podiatric benefits has been reached however payment may be reviewed at a later date if we receive changed to other related claims for this patient or, the yearly limit for chiropractic benefits has been reached or, the calendar year limit for the following dental services has been reached: benefit for only 2 examinations of any type may be paid in a calendar year, benefit for only two films may be paid in a calendar year, benefit for panoramic x-rays may be paid once every 5 calendar years, benefit for no more than two units of time(30 min) for subgingival scaling/root planing may be paid in a calendar year.
80CA Limit On Daily Visit This claim has been reduced or refused as this patient has reached the limit allowed for this date of service.
80D Eyeglass/Lenses/Frame Payment has been reduced ar refused as this patient has received: eyeglasses with in the last 3 years or lenses/lens within the last 3 years.
80E Second Chiropractic X-ray Payment was refused as this is the second x-ray for this benefit year.
80F 12 Month Limit Payment has been reduced or refused as the patient has received this benefit with in 12 months.
80G Outdated Claims Payment was refused as the time limit for submission has expired.
80H Contract Limits Payment was reduced or refused as the Contract Limit was reached.
80J Practitioner/Business Arrangement Limits Payment was reduces or refused as the limit was reached for the service provider of the business arrangement.
80K Recipient Limit Has Been Reached For APP Contract Payment was refused or reduced as the recipient has reached capitation rate.
80L Alternative Payment Plan Fee For Service Payment was reduced as the capitation maximum was paid for the month of service.
90 Payment Reduction This is an adjustment of a previously assessed item.
90A Previous Correspondence-Mutual information This claim has been assessed in accordance with correspondence or telephone call.
90D Adjustment, Recipient No Longer Eligible For Coverage This is an adjustment to update your records only, Payment has not been deducted from your account.
95 Newborn Payment was refused as the diagnostic submitted does not agree with the ward rate claim.
95A Inpatient/Outpatient Services Payment was refused as an inpatient and an outpatient service provided at the same hospital on the same day to an individual patient is not payable.
95B Day of Discharge Payment has been reduced as standard ward rate is not payable for the day of discharge.
95C High Cost Procedure/Zero Ward Rate Payment has been refused as when a high cost procedure and an inpatient standard ward rate are being claimed, 2 separate claims must be submitted: one claim showing the admission and discharge date and an inpatient standard ward rate, with the claimed amount of "0" and the other claim for the high cost procedure.
95D Multiple Transplants Same Hospital Stay Payment has been refused as multiple same organ transplants within the same hospital stay are not payable.
95E Reduced Benefits Payment has been reduced as the number of days between the admit date and the discharge date to not agree with the claim.
95F Outpatient Services Payment has been refused as an outpatient hospital service has been previously paid for this patient for this date of service.
95G Maximum Number Of Services Payment has been refused as the maximum number of services was paid.
95K Claim in Process Hold for documentation.
95L Out Of Province Registration Expiry Date Payment has been refused as the out of province registration expiry date on the claim must be blank if the out of province registration number is blank.
95M Unable To Process Updated Transaction The transaction to update a previously submitted claim cannot be processed as: The original add transaction cannot be located or, the result of your original claim is unknown or, the original claim was previously deleted. Review your records and resubmit if applicable.
95T Invalid ICD10CA Code Payment was refused as the diagnostic code on the claim is invalid. Effective April 1/02 date of service, only the international statistical classification of diseases and related health problems, 10th Canadian revision, diagnostic codes (ICD10CA) are acceptable for hospital reciprocal inpatient billing.
96A Mother/Newborn Registration Number This is an adjustment of a previously processed claim. Payment was deducted as the mothers out of province registration number may not be used for a baby over the age of 3 months. Please obtain the baby`s correct out of province number and resubmit the claim.
96B Declaration Form Incomplete/Incorrect This is an adjustment of a previously processed claim. Payment was deducted as the declaration form requested by the patients home province was: not provided, incomplete or, not signed by the patient or parent/guardian.
96C Out Of Province Patient information/Claim information Discrepancy This is an adjustment of a previously processed claim. Payment was deducted as there is a discrepancy between the home province`s patient registration information information and the patients personal information indicated on the claim.
96D Out Of Province Patient Coverage Not Effective This is an adjustment of a previously processed claim. Payment was deducted as the patients home province has verified that the patients health card was not valid on the: date of service or, admission date or, discharge date.
96E Incorrect Claim-Alberta Responsibility This is an adjustment of a previously processed claim. Payment was deducted as our records indicate that the patient was an Alberta resident on the date of service.
96F Workers Compensation Board Responsibility This is an adjustment of a previously processed claim. Payment was deducted as we have received information advising this service is the responsibility of WCB. This claim should be submitted directly to the WCB.
96G Incorrect Service/Date Of Service/Rate Claimed This is an adjustment of a previously processed claim. Payment was deducted at the request of the patients home province as an incorrect: service or, date of service, or rate was claimed. Submit new claim using the correct information, if applicable.
96H Second Outpatient Visit This is an adjustment of a previously processed claim. Payment was deducted as multiple out-patient visits on the same day for the same patient are not payable.
97A Incorrect Service/Date Of Service/Rate Claimed This is an adjustment of previously processed claim. Payment was deducted at the request of the Alberta RHA/hospital as an incorrect service, date of service, or rate was claimed. submit new claim using the correct information, if applicable.
98 Capitation Paid Payment was refused as capitation(payment in lieu of fee for services payment) was paid for this patient for this date of service. therefore, a fee for service claim is not payable.
98A Invalid Health Service Code Payment was refused as this health service code may not be claimed by the business arrangement number indicated on the claim.
98AA FFS/APP Reassessed Claims Thank you for your payment. Your fee for service (FFS) claim transactions have been reassessed and have been applied as Alternate Payment Plan (APP billing.
98B Non-Patient Specific ULI- Other Interventions This transaction was refused as the non-patient specific unique lifetime identifier must be used for services defined as other interventions, refer to APP information in your physicians resource guide.
98C Locum Business Arrangement-Fee For Service This transaction was refused as a practitioner with a locum business arrangement may not be paid fee-for-service under alternate payment plan practice.
98D Other Interventions-Non-Enrolled Patients This transaction was refused as services defined as other interventions may not be submitted for non-enrolled patients. For definition of other interventions, refer to the APP information in your physicians resource guide.
98DA Other Interventions Not Eligible Under Good Faith This transaction was refused as services defined as other interventions may not be claimed under the good faith program. For definition of other interventions, refer to the APP info in your physicians resource guide.
98DB Ineligible Other Interventions This transaction was refused as this other intervention service may not be claimed under the alternate payment program.
98DC Date Of Service/Alternate Payment Plan Effective Date This transaction was refused as the alternate payment program is not active for this date of service.
98E Invalid Pay-To Code This transaction was refused as the pay-to code must be "BAPY" for all alternate payment plan services.
98EA Invalid Health service Code Non-Patient Specific ULI This transaction was refused as only health service codes that are defined as non-patient may be submitted under non-patient specific ULI.
98EB Invalid Business Arrangement Number This transaction was refused as the APP business arrangement number must be used for all services listed as other interventions.
98F Recipient Annual Capitation Limit This service was reduced or applied at "0" as the patient has reached the annual capitation maximum amount payable under this APP.

 

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