   |
| Adjustment | ||
| AD |
ADAPL |
Claim Adjusted Due To Provider Appeal |
| AD |
ADAUT |
Claim Adjusted Due To Change In Authorization |
| AD |
ADCOB |
Claim Adjusted For COB |
| AD |
ADCOR |
Claim Adjusted |
| AD |
ADERP |
Claim Adjusted Due To Provider Error |
| AD |
ADERR |
Claim Adjusted Due To Processor Error |
| AD |
ADMBR |
Claim Adjusted Due To Change In Member Eligibility |
| AD | ADWSA | AOD Women's Set-aside |
| AD |
LMBEN |
Maximum Benefit for this Service Reached |
| AD |
MCDBA |
Medicaid Billed Amount Correction |
| AD |
MCDCR |
Claim Adjusted Following MH Compliance Review |
| AD |
MCDDU |
Confirmed Medicaid Duplicate Claim (MH Only) |
| AD |
MCDIA |
Medicaid Claim Adjusted (Internal Audit) MH Only |
| AD |
MCDMO |
Medicaid Modifier Correction |
| AD |
MCDPR |
Medicaid Procedure Code Correction |
| AD | MCDPS | MCD Place of Service Correction |
| AD |
MCDSC |
Confirmed Not Covered Due to MH Service Content |
| AD |
MCDTP |
Medicaid Third Party Payment Correction |
| AD |
MCDUN |
Medicaid Units Of Service Correction |
| AD |
MCDWC |
Confirmed Incorrect UCI Billed |
| AD |
MCDWD |
Confirmed Incorrect Date of Service Billed |
| AD |
MCDYO |
Medicaid Claim More Than a Year Old When Received |
| AD |
NEGPA |
Negative Paid Amount |
| AD |
NONBA |
Non-Medicaid Billed Amount Correction |
| AD |
NONCR |
Claim Adjusted Following MH Compliance Review |
| AD |
NONDU |
Confirmed Non-Medicaid Duplicate Claim (MH Only) |
| AD |
NONIA |
Non-Medicaid Claim Adjusted (Internal Audit) |
| AD |
NONMO |
Non-Medicaid Modifier Correction |
| AD |
NONON |
Service Not Included in on-Medicaid Contract |
| AD |
NONPR |
Non-Medicaid Procedure Code Correction |
| AD | NONPS | Non-MCD Place of Service Correction |
| AD |
NONSC |
Confirmed Not Covered Due to Service Content |
| AD |
NONTP |
Non-Medicaid Third Party Payment Correction |
| AD |
NONUN |
Non-Medicaid Units Of Service Correction |
| AD |
NONWC |
Confirmed Incorrect UCI Billed |
| AD |
NONWD |
Confirmed Incorrect Date of Service Billed |
| AD |
NONYO |
Non-Medicaid Claim More than a Year Old When Received |
| AD |
NPR30 |
No Provider Response Within 30 Days |
| AD |
RWJCF |
RWJ Adjust CAP to FFS |
| AD |
RWJFC |
RWJ Adjust FFS to Cap |
| Allowed | ||
| AL |
DUPOP
|
Potential Dup O/P Claim |
| AL |
GRPIN |
System Generated - Group Ineligible |
| AL | HIPAA | HIPAA |
| AL |
INFOR |
Informational Line Item |
| AL |
IPCAR |
Inpatient Carve Out |
| AL |
MARP |
Cuyahoga County MARP Project |
| AL |
MBDEC |
Member Deceased |
| AL |
MBRIN |
System Generated - Member Ineligible |
| AL |
MCDBA |
Medicaid Billed Amount Correction |
| AL |
MCDUN |
Medicaid Units Of Service Correction |
| AL |
NOAUT |
No Authorization on File |
| AL |
NONBA |
Non-Medicaid Billed Amount Correction |
| AL |
NONUN |
Non-Medicaid Units Of Service Correction |
| AL |
PCCNV |
Amount Allowed Per Conversion Factor |
| AL |
PCCRT |
Amount Allowed Per Case Rate |
| AL |
PCFSC |
Amount Allowed Per Fee Schedule |
| AL |
PCMNR |
Modifier Not Used For This Procedure |
| AL |
PCMNV |
Modifier Not Valid For Procedure Code |
| AL |
PCMOD |
A Modifier Is Required For This Procedure |
| AL |
PCPDM |
Amount Allowed Per Diem Rate |
| AL |
PCTBI |
System Generated - Percent Of Billed |
| AL |
PERD1 |
Per Diem Days 1 Through 3 |
| AL |
PERD4 |
Per Diem Days 4 Plus |
| AL | PRE04 | Pre FY04 |
| AL |
PRE2K |
Closed As Pre-FY-2000 Span |
| AL |
PRE99 |
Service Provider Pre SFY 1999 |
| AL |
PREGL |
Pre Go-Live Allowed Reason |
| AL |
PRVIN |
System Generated - Provider Ineligible |
| AL |
SPLUC |
Special Lucas County Contracting |
| Check | CK | ALIGN | Check Alignment |
| CK | CANCL | Check Cancel |
| CoPay | ||
|
CP |
00%SF |
0% Sliding Fee |
|
CP |
05%SF |
5% Sliding Fee Scale |
|
CP |
10%SF |
10% Sliding Fee Scale |
|
CP |
100%F |
100% Client Pay |
|
CP |
15%SF |
15% Sliding Fee Scale |
|
CP |
20%SF |
20% Sliding Fee Scale |
|
CP |
25%SF |
25% Sliding Fee Scale |
|
CP |
30%SF |
30% Sliding Fee Scale |
|
CP |
35%SF |
35% Sliding Fee Scale |
|
CP |
40%SF |
40% Sliding Fee Scale |
|
CP |
45%SF |
45% Sliding Fee Scale |
|
CP |
50%SF |
50% Sliding Fee Scale |
|
CP |
55%SF |
55% Sliding Fee Scale |
|
CP |
60%SF |
60% Sliding Fee Scale |
|
CP |
65%SF |
65% Sliding Fee Scale |
|
CP |
70%SF |
70% Sliding Fee Scale |
|
CP |
75%SF |
75% Sliding Fee Scale |
|
CP |
80%SF |
80% Sliding Fee Scale |
|
CP |
85%SF |
85% Sliding Fee Scale |
|
CP |
90%SF |
90% Sliding Fee Scale |
| CP | 90W | FFSE for ODADAS Women's Set-aside Programs |
|
CP |
95%SF |
95% Sliding Fee Scale |
|
CP |
CIOOP |
Member Coinsurance = 0 |
|
CP |
CISTP |
Deactivated, Duplicate With Coins |
|
CP |
COINS |
Member Coinsurance |
CP |
COPAY |
Client Co-Payment |
|
CP |
CPPCP |
Primary Care Co-payment |
|
CP |
FF10 |
$10/Month Flat Fee Scale |
|
CP |
FF100 |
$100/Month Flat Fee Scale |
|
CP |
FF125 |
$125/Month Flat Fee Scale |
|
CP |
FF15 |
$15/Month Flat Fee Scale |
|
CP |
FF150 |
Summit County Flat Fee Scale |
|
CP |
FF175 |
$175/Month Flat Fee Scale |
|
CP |
FF200 |
$200/Month Flat Fee Scale |
|
CP |
FF225 |
$225/Mo Flat Fee Scale |
|
CP |
FF25 |
$25/Month Flat Fee Scale |
|
CP |
FF250 |
$250/Month Flat Fee Scale |
|
CP |
FF5 |
$5/Month Flat Fee Scale |
|
CP |
FF50 |
$50/Month Flat Fee Scale |
|
CP |
FF75 |
$75/Mo Flat Fee Scale |
|
CP |
MAXED |
System Generated - Oop Limit Has Been Satisfied |
|
CP |
MCDDF |
No Copay Applied For Medicaid Member |
CP |
VERIF |
100% Co-Pay on Non-MCD/Non-Emer Until Income Verified |
| Deductible | ||
|
DD |
MAXED |
System Generated - Oop Limit Has Been Satisfied |
| Hold | ||
|
HD |
CLATH |
Claim Requires Approval |
|
HD |
CLBIL |
Please Submit An Itemized Bill From The Provider |
|
HD |
CLHLD |
Claim Placed On Hold Due To B-Rule |
|
HD |
CLMAN |
Claim Manually Placed On Hold |
|
HD |
DUPDA |
Dup Res/Day Services |
|
HD |
DUPLM |
Potential Duplicate Claim |
|
HD |
FRHLD |
Franklin Claims Hold |
|
HD |
FRMOD |
Franklin County Modifiers - Hospital/Penal Sys |
|
HD |
GRHLD |
Group On Hold |
HD |
LMARP |
Limit of One Per Elapsed Year |
HD |
LMBEN |
Benefit Limit Reached |
|
HD |
LMDAY |
Day Servs Limit 1 Per Day |
|
HD |
LMOUT |
O/P Limit 24 Hrs/Day |
| HD | LMPHA | MH Par Hosp Limit 1/Day Adults |
|
HD |
LMPHC |
Par Hosp Limit Two/Day For Children |
HD |
LMRWJ |
MH RWJ Cuyahoga Waiver |
|
HD |
MBRIN |
System Generated - Member Is Ineligible |
|
HD |
MCDBA |
Potential Medicaid Billed Amount Correction |
|
HD |
MCDCR |
Held Due To Medicaid Compliance Review Results |
|
HD |
MCDDU |
Medicaid Potential Duplicate Service |
|
HD |
MCDMO |
Potential Medicaid Modifier Correction |
|
HD |
MCDPR |
Potential Medicaid Procedure Code Correction |
|
HD |
MCDTP |
Potential Medicaid Third Party Payment Correction |
|
HD |
MCDUN |
Potential Medicaid Units Of Service Correction |
|
HD |
MCDWC |
Incorrect UCI Billed |
|
HD |
MCDWD |
Incorrect Date Of Service Billed |
|
HD |
MEDEF |
Held For Invalid MEDEF |
|
HD |
NEGPA |
Negative Paid Amount |
|
HD |
NOGLR |
System Generated - Comp Or G/L Ref Code Is Missing |
|
HD |
NOMCD |
Service Not Included In Mcd Contract |
|
HD |
NONBA |
Potential Non-Medicaid Billed Amount Correction |
|
HD |
NONCR |
Held Due To Non-Medicaid Compliance Review Results |
|
HD |
NONDU |
Potential Non-Medicaid Duplicate Service |
|
HD |
NONMO |
Potential Non-Medicaid Modifier Correction |
|
HD |
NONON |
Service Not Included In Non-Medicaid Contract |
|
HD |
NONPR |
Potential Non-Medicaid Procedure Code Correction |
|
HD |
NONTP |
Potential Non-Medicaid Third Party Pmt. Correction |
|
HD |
NONUN |
Potential Non-Medicaid Units Of Service Correction |
|
HD |
NONWC |
Incorrect UCI Billed |
|
HD |
NONWD |
Incorrect Date Of Service Billed |
| HD | NOQTY | No Units of Service Billed |
|
HD |
OOCTY |
Out Of County |
|
HD |
PCINV |
Procedure Code Inactive |
|
HD |
PCREV |
Procedure Code/Modifier Review |
|
HD |
PRCLD |
Non-Medicaid Provider Contract On Hold |
|
HD |
PRHLD |
System Generated - Provider On Hold |
|
HD |
PRINF |
Additional Information Required From Provider |
|
HD |
VEHLD |
Vendor On Hold |
| Not Covered | ||
| NC |
AUTHC |
System Generated - Authorization Is Closed |
| NC |
AUTHD |
System Generated - Authorization Has Been Denied |
| NC |
DUPLY |
Duplicate Claim |
| NC |
DXMIS |
Not Covered Because Diagnosis Is Missing |
| NC |
GRANT |
Grant Based Non-MCD Funding (100% Withhold) |
| NC |
INVPC |
Invalid Procedure Code/Modifier Combination |
| NC |
LMARP |
Limit Of One Per Elapsed Year |
| NC |
LMBEN |
Maximum Benefit For This Service Reached |
| NC |
LMDAY |
Day Servs Limit 1 Per Day |
| NC | LMDIP | AOD DIP Services Limit of One Per Day |
| NC | LMEAT | Meals Service Limited to 3 Meals Per Day |
| NC |
LMMTH |
Limits Billing To One Per Elapsed Month (28 Days) |
| NC |
LMOUT |
O/P Limit 24 Hrs/Day |
| NC |
LMPHA |
Par Hosp Limit One/Day For Adults |
| NC |
LMPHC |
Par Hosp Limit Two/Day For Children |
| NC |
LMRWJ |
MH RWJ Cuyahoga Waiver |
| NC | LMTRS | Limits Transportation to One Per Elapsed Month |
| NC |
MAXED |
System Generated - Oop Limit Has Been Satisfied |
| NC |
MBDEC |
Member Deceased |
| NC |
MCDBA |
Confirmed Medicaid Billed Amount Correction |
| NC |
MCDCR |
Claim Not Covered Following MH Compliance Review |
| NC |
MCDDU |
Confirmed Medicaid Duplicate Service |
| NC |
MCDEL |
Member Not Medicaid Eligible At Time Of Service |
| NC |
MCDIA |
Medicaid Claim Adjusted (Internal Audit) MH Only |
| NC |
MCDMO |
Confirmed Medicaid Modifier Correction |
| NC |
MCDPR |
Confirmed Medicaid Procedure Code Correction |
| NC |
MCDSC |
Confirmed Not Covered Due To Service Content |
| NC |
MCDTP |
Confirmed Medicaid Third Party Payment Correction |
| NC |
MCDUN |
Confirmed Medicaid Units Of Service Correction |
| NC |
MCDWC |
Confirmed Incorrect UCI Billed |
| NC |
MCDWD |
Confirmed Incorrect Date Of Service Billed |
| NC |
MCDYO |
Medicaid Claim Over 365 Days Old When Received |
| NC |
MEDEF |
Denied For Invalid MEDEF |
| NC |
MODFM |
Missing Or Invalid Modifier Code |
| NC |
NCSVC |
Service/Supply Not Covered |
| NC |
NEGPA |
Negative Paid Amount |
| NC |
NOAUT |
No Authorization on File |
| NC |
NONBA |
Confirmed Non-Medicaid Billed Amount Correction |
| NC |
NONCR |
N-M Adjustment Following MH Compliance Review |
| NC |
NONDU |
Confirmed Non-Medicaid Duplicate Service |
| NC |
NONIA |
Non-Medicaid Claim Adjusted (Internal Audit) |
| NC |
NONMO |
Confirmed Non-Medicaid Modifier Correction |
| NC |
NONON |
Service Not Included in Non-Medicaid Contract |
| NC |
NONPR |
Confirmed Non-Medicaid Procedure Code Correction |
| NC |
NONSC |
Confirmed Not Covered Due To Service Content |
| NC |
NONTP |
Confirmed Non-Medicaid Third Party Pmt. Correction |
| NC |
NONUN |
Confirmed Non-Medicaid Units Of Service Correction |
| NC |
NONWC |
Confirmed Incorrect UCI Billed |
| NC |
NONWD |
Confirmed Incorrect Date Of Service Billed |
| NC |
NONYO |
Non-Medicaid Claim Is Over 365 Days Old When Rcvd. |
| NC |
NOQTY |
No Units of Service Billed |
| NC |
NPR30 |
No Provider Response Within 30 Days |
| NC |
OOCTY |
Out Of County Not Covered |
| NC |
PCINV |
Procedure Code Invalid Or Nonspecific |
| Other Carrier | ||
| OC |
2 |
Blue Cross/Blue Shield |
| OC |
3 |
Other Priv Ins |
| OC |
4 |
Employer/Union |
| OC |
5 |
Public Agency |
| OC |
6 |
Other Carrier |
| OC |
9 |
Harbor Other Carrier |
| OC |
E |
Benefits Exhausted |
| OC |
F |
No Coverage For Any Family Member |
| OC |
L |
Disputed |
| OC |
P |
No Coverage For This Member |
| OC |
R |
No Response From Ins Co |
| OC |
S |
Not Covered Service |
| OC |
X |
Non-Cooperative Member With Insurance |
| Place of Service | ||
| PL | 03 | School |
| PL | 04 | Homeless Shelter |
| PL | 05 | Indian Health SVC Free-Standing Facility |
| PL | 06 | Indian Health SVC Provider-Based Facility |
| PL | 07 | Tribal 638 Free-Standing Facility |
| PL | 08 | Tribal 638 Provider-Based Facility |
|
PL |
11 |
Office |
|
PL |
12 |
Home |
|
PL |
13 |
Assisted Living Facility |
|
PL |
14 |
|
|
PL |
15 |
Mobile Unit |
| PL | 20 | Urgent Care Facility |
|
PL |
21 |
Hospital -- Med/Surg Inpatient |
|
PL |
22 |
Hospital -- Outpatient |
|
PL |
23 |
Hospital -- ER |
|
PL |
24 |
Ambulatory Surgical Center |
|
PL |
25 |
Birthing Center |
|
PL |
26 |
Military Treatment Center/VA Hospital |
|
PL |
31 |
Skilled Nursing Facility |
|
PL |
32 |
Nursing Facility |
|
PL |
33 |
Custodial Care Facility |
|
PL |
34 |
Hospice |
|
PL |
41 |
Ambulance -- Land |
|
PL |
42 |
Ambulance -- Air |
|
PL |
49 |
Independent Clinic |
|
PL |
50 |
Federally Qualified Health Center |
|
PL |
51 |
Inpatient Psychiatric Facility (IMD) |
|
PL |
52 |
Psychiatric Facility Partial Hospitalization |
|
PL |
53 |
Community Behavioral Health Center |
|
PL |
54 |
Intermediate Care Facility/MR |
|
PL |
55 |
Residential Substance Abuse Treatment Facility |
|
PL |
56 |
Psychiatric Residential Treatment Center |
|
PL |
57 |
Non-Residential Substance Abuse Treatment Facility |
|
PL |
60 |
Mass Immunization Center |
|
PL |
61 |
Comprehensive Inpatient Rehabilitation Facility |
|
PL |
62 |
Comprehensive Outpatient Rehabilitation Facility |
|
PL |
65 |
End Stage Renal Disease Treatment Center |
|
PL |
71 |
Public Health Clinic |
|
PL |
72 |
Rural Health Clinic |
|
PL |
81 |
Independent Laboratory |
|
PL |
99 |
Other |
| Term | ||
| TM |
CLSED |
Provider Closed |
| TM |
EDUP1 |
Electronic Duplicate Same SSN/D.O.B. |
| TM |
EDUP2 |
Electronic Duplicate - Invalid D.O.B |
| TM |
EDUP3 |
Electronic Duplicate - Invalid SSN |
| TM |
ERR01 |
Invalid Required Field |
| TM |
ETERM |
Member Terminated Electronically |
| TM | HIPAA | HIPAA |
| TM |
IPUCI |
Invalid Pseudo UCI Code |
| TM |
LBCLR |
Local Board Contract Limits Reached |
| TM |
MBDEC |
Member Deceased |
| TM |
MBINL |
Member Ineligible |
| TM |
MBMOS |
Member Moved Out of State |
| TM |
MBMOV |
Member Left Service Area/Moved |
| TM |
MBPLC |
Plan Changed Manually By Board |
| TM |
MERGR |
Provider Merged |
| TM |
PRAEX |
Providers AoD Certification Has Expired |
| TM |
PRDEX |
Both AoD And MH Certifications Have Expired |
| TM |
PRE2K |
PROVC Term Reason Of Pre SFY 2000 |
| TM |
PREGL |
Pre Go-Live Contract Terminated |
| TM |
PRMEX |
Providers MH Certification Has Expired |
| TM |
PRVOL |
Provider Contract Terminated (Voluntary) |
| TM |
PSCHG |
Primary And/Or Alternate Price Schedule Changed |
| TM |
RIDER |
Rider Change |
| TM |
VNDCH |
Vendor Changed |
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