|
*A |
Our records indicate patient deceased. Please contact MSP. |
|
*B |
Patient's eligibility with MSP is in question. Please have patient contact MSP. |
|
*C |
MSP is unable to locate patient. Please have patient contact MSP. |
|
*D |
MSP has been unable to contact patient. Please have patient contact MSP. |
|
*E |
Our records indicate patient has permanently moved outside of B.C. Please have patient re-apply for coverage if applicable. |
|
*F |
Patient has opted out of MSP. Patient should be billed directly. |
|
*G |
Our records indicate MSP is not the primary insurer for this patient. |
|
*H |
Our records indicate the patient requested coverage to be cancelled. |
|
*I |
Date of service is prior to coverage effective date. |
|
AA |
PHN is missing or invalid. |
|
AB |
PHN is not on our records. |
|
AC |
This is not a valid PHN for MSP. |
|
AD |
This is an incorrect PHN for this patient. |
|
AE |
This claim is the responsibility of the interim Federal Health Program. |
|
AF |
This patient does not have coverage for the DOS. |
|
AG |
This service billed as "A Donor" coverage. |
|
AH |
Dependent number is missing or invalid. |
|
AI |
Dependent is not registered. |
|
AJ |
This is an incorrect dependent number. |
|
AK |
Coverage for this dependent has been cancelled. |
|
AL |
This dependent is not eligible for coverage with MSP. |
|
AM |
Dependent number and/or initial(s) do not match our records. |
|
AO |
First name or initial(s) does not match our records. |
|
AP |
Initials and/or surname are missing or invalid. |
|
AQ |
Surname does not match our records. |
|
AR |
Birthdate missing or invalid. |
|
AS |
Baby not registered. |
|
AU |
A claim for this service has been paid on the mother's PHN, under dependent 66. |
|
AV |
Technical difficulties with coverage check. Contact Teleplan support. |
|
AW |
Claim must be submitted with PHN. |
|
AX |
Province contacted, name and health number not matching. |
|
AY |
Provincial/insurer or institution code missing or invalid or fee item not valid. |
|
A1 |
Patient signature required on pay patient account. |
|
A2 |
Patient address required on pay patient account. |
|
A5 |
Referred to or by doctor number is not valid for DOS. |
|
A6 |
Child is over-age for dependent 66. |
|
A7 |
Dependent 66 - PHN submitted is registered to male. Please resubmit using mother's PHN and dependent 66. |
|
A9 |
PHN not approved for ICBC claim number. Please contact ICBC. |
|
BA |
Initials and/or surname changed to match CareCard. Please confirm correct initials and surname with patient. |
|
BB |
PHN changed to match CareCard. |
|
BC |
Surname/initials and PHN changed to match CareCard. |
|
BD |
Child not registered. Processed under dependent 66. |
|
BE |
PHN changed to newborn's PHN. |
|
BF |
Claim is held for future processing. |
|
BG |
Amount adjusted to the rate effective for this DOS. |
|
BH |
This claim will be processed on a future remittance statement. Please do not rebill. |
|
BI |
Fee item and diagnosis do not correspond. |
|
BJ |
Fee item and amount billed do not correspond. |
|
BK |
Your claim submission is being held pending WorkSafeBC notice of approval. |
|
BL |
Massage therapy discounted. |
|
BN |
The maximum number of additional areas has been paid for this date of service. |
|
BP |
Birthdate submitted does not match our records. |
|
BR |
Please clarify the date of service. |
|
BU |
Claim was received prior to date of service. |
|
BV |
Service date exceeds allowable claim submission period. |
|
BW |
Hospital visits must be submitted with each month on a separate line. |
|
BX |
Claim is being held pending ICBC notice of approval. |
|
BZ |
MSP has consolidated two PHNs held by this person. Please update your records to the PHN indicated. |
|
B2 |
Previous PHN has been replaced with PHN indicated. Please update your records. |
|
B3 |
In future, please bill multiple services of the same fee item on one line (eg. 13621 x 3; 09921 x 3) |
|
B4 |
Patient now has B.C. coverage. Please contact patient and rebill under the correct PHN. |
|
B5 |
Child is over-age for billing under mother's identity number under the reciprocal agreement. |
|
CA |
Fee item and time stated do not correspond. |
|
CB |
Number of services and time stated do not correspond. |
|
CC |
Please state time anesthetic commenced. |
|
CD |
Date of service and fee item billed do not correspond. |
|
CE |
DOS was not a Saturday, Sunday or statutory holiday. |
|
CF |
Time called or time service was rendered is missing or invalid. |
|
CG |
Each service must be on a separate line. |
|
CH |
Please clarify billing; writing is illegible. |
|
CI |
Number of services and amount billed do not correspond. |
|
CJ |
Date of service and amount billed do not correspond. |
|
CK |
Practitioner number is invalid for this payment number and date of service. |
|
CL |
Payment number is invalid for this date of service. |
|
CM |
Specialty is invalid for this date of service. |
|
CN |
Practitioner is not registered with the College of Physicians and Surgeons or not active with MSP for this date of service. |
|
CP |
Practitioner status invalid for date of service and type of submission. |
|
CQ |
Practitioner is not licensed to bill for this service. |
|
CR |
(531) WorkSafeBC incentive applied for proof submission. Please refer to the contract for more information. |
|
CS |
WorkSafeBC adjusted payment. Form received outside time limit. If clarification required, contact WorkSafeBC Health Care Services. |
|
CT |
WorkSafeBC adjusted payment. ECCR did not meet standards. Contact WorkSafeBC claims adjudicator. |
|
CU |
We are unable to process this account as this is an invalid referral. |
|
CV |
Claim submission changed to the appropriate MSP consultation rate plus the amount for fee item 19908. If clarification required, contact WorkSafeBC Health Care Services. |
|
CW |
Telephone advice fees may not be charged when another service was provided on the same day. |
|
CX |
WorkSafeBC adjusted payment. Fee not paid with tray. Contact WorkSafeBC Health Care Services. |
|
CY |
WorkSafeBC adjusted payment to fee schedule. If clarification required, contact WorkSafeBC Health Care Services. |
|
CZ |
(562) WorkSafeBC amount adjusted to $0.00 refer to fee schedule or contract. |
|
C1 |
Contract with invalid. |
|
C2 |
Special program name invalid. |
|
C3 |
Assessment diagnostic invalid. |
|
C4 |
Treatment plan prescription missing or invalid - please specify. |
|
C5 |
Primary disposition missing or invalid. |
|
C6 |
(524) WorkSafeBC daily maximum for good/service has already been reached. |
|
C7 |
(525) WorkSafeBC invoiced units reduced to approved units for good/service. |
|
C8 |
(528) WorkSafeBC invoice amount was adjusted to the Fee Schedule. |
|
C9 |
(532) WorkSafeBC penalty applied for proof submission. Please refer to the contract for more information. |
|
DJ |
This claim is the responsibility of ICBC. |
|
DP |
Your claim has been debited as our records show that the patient was out of province for the date of service. |
|
DR |
Debit adjustment. See secondary explanatory code(s). |
|
DS |
Account debited to agree with fee item paid to surgeon. Please rebill for payment. |
|
DV |
Item 00012 is not payable with laboratory blood work or visit fee charges to the same or an associated physician on the same date. |
|
DW |
Debit adjustment of MSP claim as WorkSafeBC hospital emergency per diem rate billed for same date of service. |
|
D0 |
Match found for debit request record. |
|
D1 |
Debit request record did not meet Pre-Edit or Edit requirements. |
|
D2 |
No match found for debit request record. |
|
D3 |
Payment withdrawn per debit request record. |
|
D4 |
Unable to perform debit request at this time. Claim is currently in process. Please review account with processed. |
|
D8 |
Debit adjustment of account paid at GP rates. |
|
D9 |
Original claim is at WorkSafeBC and your debit request has been forwarded to WorkSafeBC. |
|
EA |
Fee items 00101, 12101, 12201, 13201, 15201, 15301, 16101, 16201, 17101, 17201, 18101 or 18201 are not payable to emergency room physicians. |
|
EB |
Standby time is not payable by the Plan. |
|
EC |
Services provided by the Canadian Blood Service are not a benefit of the Plan. |
|
ED |
There is insufficient medical necessity to process this claim. |
|
EE |
This service is not an insured benefit of the Plan. |
|
EF |
Not a benefit under the Reciprocal Agreement. |
|
EH |
Mileage is not a benefit except for unusual emergencies. |
|
EI |
Service not listed in the Payment Scheduke. Please contact your Association. |
|
EJ |
Services at the request of a third party are not an insured benefit of the Plan. |
|
EP |
(512) WorkSafeBC service is not allowed with another service already paid on this date of service. Please refer to the contract. |
|
ER |
(520) WorkSafeBC pre-requisite item not received or rejected. Please check contract for pre-requisite required and your previous billing information. |
|
ET |
(516) WorkSafeBC invoiced units reduced to remaining approved units. |
|
EX |
This claim has been paid as a WorkSafeBC account. |
|
EZ |
These fees are not a benefit when used for overtime compensation. |
|
E1 |
This service appears to be performed during your APP contracteed hours - therefore it is not billable to MSP. |
|
E2 |
(521) WorkSafeBC limit 1 form 8 per cliam, rate adjusted to Form 11 fee. |
|
FA |
Previous claim incorrectly refused/adjusted by the Plan. |
|
FB |
This is a duplicate claim. An identical claim is being processed. |
|
FC |
This account has been paid or refused in accordance with previous correspondence, phone call or note record. |
|
FE |
Payment adjusted per information received. |
|
FF |
Payment for the full fee has been paid to another physician; we do not split the fees. |
|
FG |
Age of patient does not correspond with the fee item billed. |
|
FH |
Service by definition is bilateral or multiple. |
|
FI |
Services rendered to a physician's own family member are not payable. |
|
FJ |
00112, 01200-01202 only applies to the first patient treated. |
|
FK |
This account was billed under the wrong PHN or dependent number. |
|
FL |
Professional/technical fee paid to another facility. Total fee not payable. |
|
FM |
Repeat graded exercise tests require an explanation of the medical necessity. |
|
FN |
Previously paid service(s) considered to be included, have been deducted. |
|
FO |
The sex of the patient does not correspond with the fee item/diagnostic code. |
|
FP |
This patient's care is restricted to another physician. Please refer to the MSP bulletin. |
|
FQ |
Adjustment made because of additional information received. |
|
FR |
See explanatory letter. |
|
FS |
Service is refused or adjusted. Information requested has not been received. |
|
FT |
Additional information was not received. |
|
FW |
Rebilling submitted to change insurer responsibility. |
|
FX |
This is a reciprocal claim. |
|
FY |
This claim normally requires manual processing. It has been computer paid and is subject to review at a later date. |
|
FZ |
This claim normally requires manual processing but has been computer adjusted or refused. If you disagree please resubmit with details in the claim comment/note field. |
|
F1 |
Included in WorkSafeBC hospital emergency per diem rate. |
|
F2 |
Time/date does not correspond with related claims. |
|
F3 |
Your rebilling is being processed. |
|
F4 |
Operative/procedural report does not substantiate the fee item billed. |
|
F5 |
Group therapy is not paid for more than one member of a family per session. |
|
F6 |
Please check patient identification. This card has been reported lost or stolen. |
|
F7 |
Payment records show that this patient is seeing multiple general practitioners. |
|
F8 |
An adjustment is in process for the remainder of this claim. |
|
F9 |
Payment/refusal of the original claim cannot be reviewed until receipt of a rebilling plus additional details and/or operative/pathology report, if applicable. |
|
GA |
A new consultation is not allowed when a group of physicians routinely working together provide a call for each other. Your claim was refused or reduced. |
|
GB |
A referral had not been received at the time of processing. |
|
GC |
A major consultation is not payable if the patient has been seen within 6 months for the same condition. |
|
GE |
Claim has been refused or adjusted as the service is included in the dialysis fee. |
|
GF |
As there is no indication of medical necessity for a new consultation, your account has been adjusted to the appropriate visit fee. |
|
GG |
This fee is included in the consultation or visit fee. |
|
GH |
Consultation/visit is included in the fee for the procedure. |
|
GJ |
Our records indicate this is a referred case. |
|
GK |
Referral now received. |
|
GL |
A consultation is not payable to the family physician. |
|
GM |
Specialist discharge care plan for complex patients has already been paid to you or another specialist. |
|
GN |
Specialist discharge care plan for complex patients is only payable on inpatients. |
|
GN |
Specialist advance care planning discussion is not paid while patients are receiving critical or intensive care in the hospital. |
|
GQ |
Referral now received. Computer generated code. |
|
GR |
Directive care is payable at 2 visits per week. |
|
GS |
Directive care is payable after surgery unless the patient is seen for a different condition. |
|
GT |
WorkSafeBC refused - Electronic report submission. Incomplete form transmission. |
|
GU |
(608) WorkSafeBC - payee is not authorized for date of service. For more information contact Corporate and Health Care Purchasing. |
|
GV |
(514) WorkSafeBC service is not approved or outside allowable entitlement period. |
|
GW |
(501) WorkSafeBC information missing. Please resubmit with missing information. |
|
G1 |
WorkSafeBC refused - Electronic report submission included an invalid date format. |
|
G2 |
WorkSafeBC refused - Electronic report submission incomplete. Required information missing, employer's name. |
|
G3 |
(563) WorkSafeBC GST amount exceeds maximum allowable amount. |
|
G4 |
(209) WorkSafeBC refused - electronic report submission incomplete, required information missing, employee's address. |
|
G5 |
(227) WorkSafeBC refused electronic report submission incomplete required information missing, estimated time off work. |
|
G6 |
WorkSafeBC refused - electronic report submission incomplete. Required information, work restrictions. |
|
G7 |
(564) WorkSafeBC total amount must be greater than Federal tax amount. |
|
G8 |
(565) WorkSafeBC total amount must be greater than Provincial tax amount. |
|
G9 |
(566) WorkSafeBC PST amount exceeds maximum allowable amount. |
|
HA |
This claim has been paid to you. |
|
HB |
This claim has been paid to you. Please note the change in name/PHN. |
|
HC |
This claim has been paid under the indicated fee item. |
|
HD |
This claim has been paid to an associated doctor or alternate payment number. |
|
HE |
A retro adjustment has been applied to this paid claim. |
|
HF |
This account has been paid to the physician providing LOCUM services. |
|
HG |
Your account has been refused or debited as the patient was out of province on this/these dates. |
|
HH |
Payment reversed at the request of WorkSafeBC |
|
HI |
Referral has now been received. Payment will remain at specialist rates. |
|
HJ |
This fee has been paid to another physician or facility. |
|
HK |
Credit Adjustment - See secondary code for explanation. |
|
HL |
This claim has been paid for a different date of service. |
|
HM |
This claim does not meet the over-aged submission requirements. |
|
HN |
The information provided does not correspond with our records on file. |
|
HO |
This claim was paid as an ICBC account. |
|
HP |
Your note comment/correspondence has been considered, however, we are unable to alter our previous decision. |
|
HQ |
Computer generated credit. |
|
HR |
This procedure is normally performed once in a lifetime. Please resubmit with an explanation for the repeat procedure. |
|
HS |
A credit adjustment has been processed for this claim. |
|
HT |
This account has been overpaid in error. |
|
HU |
Previously paid amounts for individually billed services exceed per diem rate. |
|
HV |
A claim for this service has previously been processed. |
|
HW |
(507) WorkSafeBC duplicate service. A service was already paid for this date of service. Please do not rebill. |
|
HX |
This claim has been paid to you. Computer refusal. |
|
HY |
Balance payment. Amount previously paid for individually billed services deducted from per diem rate. |
|
HZ |
Payment for this account was previously withdrawn per your debit request record. If requesting payment, please resubmit with an explanation in your note record. |
|
H1 |
Daily volume limit exceeded. Payment discounted by 100% |
|
H2 |
Referral not received. |
|
H4 |
Referral not received. |
|
H5 |
Daily volume limit exceeded. Payment adjusted. |
|
H6 |
Referral not received. |
|
H7 |
Referral not received. |
|
IA |
"B" prefixed or asterisk items are included in visit/procedure fee. |
|
IB |
00012/90000 is not payable when performed with other blood work. |
|
IC |
Multiple injections are paid to a maximum of three per sitting. |
|
ID |
Claims for 00081 must be supported with details of bedside/resuscitative services. Please provide break down on a per 1/2 hour basis. |
|
IE |
The Tariff Committee has not recommended approval for this tray service. Patient may be charged for costs. |
|
IF |
A visit fee is not payable with subsequent injections. |
|
IG |
Fee is not applicable unless the physician is called from another site to render the emergency service. Resubmit with details of where you were called from. |
|
IH |
The consult or visit constituted the first half hour of care. |
|
II |
Misc fees must be supported with details of the service provided. |
|
IJ |
00083 cannot be billed alone. Your claim has been adjusted to the appropriate visit fee. |
|
IK |
Duration of visit is required for this service. |
|
IL |
00081 includes any minor procedures performed at the same time. |
|
IM |
This service charge is not applicable for the time/date and/or the item billed. |
|
IN |
01210 - 01212 are not payable with diagnostic procedures. |
|
IO |
Paid according to the time and/or duration stated. |
|
IP |
00039 is the only fee payable for any visit associated with methadone maintenance. |
|
IQ |
Refractory period is 30 minutes for non-operative continuing care surcharges unless for CCFPP care. |
|
IR |
Minor tray fee not applicable. |
|
IS |
Major tray fee not applicable. |
|
IT |
Tray fee not applicalbe with fee item billed/paid. |
|
IU |
Tray fee not applicable when service performed in a Ministry funded facility. |
|
IV |
Tray fee not payable to hospitals or extended care facilities, etc. |
|
IW |
The Tariff Committee has recommended approval for the addition of this tray service. |
|
IX |
The Tariff Committee has not recommended approval for the addition of this tray service. Included in overhead. |
|
IY |
Tray fee to be billed by physician performing procedure. |
|
IZ |
Mini tray fee not applicable. |
|
I0 |
ICBC has refused responsibility for this claim, therefore, MSP has accepted responsibility. The insurer code has been changed. |
|
I1 |
Please resubmit with details of the emergency call-out. |
|
I2 |
01210 - 01212 are not billable with non-emergency procedures. |
|
I3 |
01200 - 01202 an d01205 - 01207 and 01215 - 01217 only apply when the physician is specially called to render emergency or non-elective services. |
|
I4 |
Please resubmit the remainder of this claim under the applicable fee for continuing care, according to the time indicated. |
|
I5 |
Emergency visits/surcharges are not paid for routine call backs. Please resubmit with details of the medical necessity for additional emergency services. |
|
I6 |
Claims for 00082 must be supported by details of the care provided to critically ill patient. Please provide breakdown on a per 1/2 hour basis. |
|
I7 |
Only one tray fee is applicable when multiple procedures are performed. |
|
I8 |
Our records indicate that another physician is responsible for care under the methadone maintenance program during the same time period. Rebill with additional information if necessary. |
|
I9 |
ICBC has refused responsibility of this claim. |
|
JA |
Multiple diagnostic procedures are paid at 100% or the larger fee and 50% for the lesser. |
|
JB |
If a diagnostic procedure takes place on a subsequent visit within 30 days, only the diagnostic procedure is paid. |
|
JC |
The annual limit has been reached. |
|
JD |
Fee items 00931 - 00936, 00942, 00943 are paid at 100 percent when billed together. |
|
JE |
Payment has been made at the appropraite per diem rate based on date(s) and sequence of associated claims. |
|
JF |
When the patient acuity level changes up or down, the appropriate second day rate applied (01521 01522 or 01523). |
|
JG |
Services for pain control/acute pain control are included in Critical Care fees for ventilatory support and/or comprehensive care. |
|
JH |
This service is included in the payment for critical care. |
|
JI |
There is insufficient medical necessity to process this claim. Resubmit explaining the need for services outside the critical care team, if applicable. |
|
JJ |
Written support for medical necessity is required to pay critical care fees within the post-op period. Resubmit with additional information if applicable. |
|
JK |
Information provided does not meet the criteria for the critical care fee item billed. Please resubmit with additional information, if applicable. |
|
JL |
Subsequent non-inclusive surgical procedures rendered by a member of the critical care team are paid at 75%. |
|
JM |
The fee for the first day of critical care has already been paid to you or another physician. |
|
JN |
Critical Care schedule fee items are not payable within the duration of a general anesthetic. |
|
JO |
To be considered for payment claims for fee items 00081/00082 in lieu of critical care fees must be accompanied by a written explanation of medical necessity. |
|
JP |
Critical Care ventilatory support (01412 - 01442) has been paid to another physician. Your claim has been paid/refused according to the Section Preamble. |
|
JQ |
Day 2 rates for Critical Care apply when patient is re-admitted for the same condition. |
|
JR |
Critical care (01411 - 01441) has been paid to another physician. Your claim has been paid/refused according to the Section Preamble. |
|
JS |
Day 2 rates for critical care apply when the service is preceded by a consultation. |
|
JT |
Claims for precutaneous transluminal coronary angioplastry/additional vessel (00840 - 00842) are payable at 75% when billed by a team member. |
|
JU |
Comprehensive care (01413 - 01443) has been paid to another physician. Therefore, we are unable to process your claim for payment. |
|
JV |
When a patient is admitted to NICU after 48 hours, second day rates will apply again (01521, 01522, 01523). |
|
JW |
01200 - 01202 and 01205 - 01207 and 01215 - 01217 are not payable in addition to adult and pediatric critical care fees (01411 - 01441, 01412 - 01442 and 01413 - 01443). |
|
JX |
When a patient is readmitted to NICU within 48 hours, billing continues at the same rate as if there were no break, unless there is a change in acuity level. |
|
JY |
When a patient is readmitted to ICU within 48 hours with the same or similar problem, billing continues at the same rate as if there were break. |
|
JZ |
When a patient is readmitted to ICU after 48 hours with the same or similar problem, day 2 rates apply. |
|
J0 |
(519) WorkSafeBC payee is not authorized to provide goods/services for more information contact corporate and health care purchasing. |
|
J1 |
(283) WorkSafeBC refused - report submission incomplete, required information missing, work location missing. |
|
J2 |
(568) WorkSafeBC HST not applicable for item. |
|
J3 |
(287) WorkSafeBC refused - report submission invalid, specific reference number invalid or missing. |
|
J4 |
WorkSafeBC refused - report submission incomplete, required information missing, clinical information missing. |
|
J5 |
(281) WorkSafeBC refused - report submission incomplete, required information missing, worker's city and/or work location missing. |
|
J6 |
WorkSafeBC refused - report submission incomplete, required information missing, injury description missing. |
|
J7 |
WorkSafeBC refused - report submission incomplete, required information missing, patient duration missing. |
|
J8 |
WorkSafeBC refused - report subsmission incomplete, required information missing, disabled from work flag missing. |
|
J9 |
WorkSafeBC refused - report submission incomplete, required information missing, rehab program not indicated. |
|
KA |
There is no indication that two separate visits were made. If two visits were perforemd, please provide times of each visit. |
|
KB |
Visits and minor procedures, same diagnosis - larger fee only is paid. Different diagnosis - lesser fee paid at 50%. |
|
KC |
Repeat complete physicals within 6 months require an explanation of medical necessity. |
|
KD |
This service does not meet the criteria for fee item billed. |
|
KE |
This fee is applicable between 8 am and 6 pm |
|
KF |
Patient's annual limit for counselling has been reached. |
|
KG |
Counselling for two or more members of a family must indicate that they were seen individually. |
|
KH |
One 00114 is paid every two weeks for care provided in a long-term care institution (eg. nursing home, intermediate care facility) unless supported by an explanation. |
|
KI |
Another physician has been paid for daily hospital care. |
|
KJ |
The total number of services exceeds the number of hospital days. |
|
KK |
This service is not a benefit of the Plan when performed in a hospital. |
|
KL |
Daily care is payable up to 30 days only unless supported by additional information of the medical necessity. |
|
KM |
Supportive care visits are limited to one visit for the first 10 days of hospitalization then one visit per 7 days per MSC Payment Schedule Preamble D.4.7. |
|
KN |
Out-of-hospital care was provided during this time. Please verify hospitalization dates. |
|
KO |
In-hospital care was provided during this time. Please verify the dates. |
|
KP |
Lab, x-ray and/or interpretation fees are not a benefit under the Plan for a registered bed patient. |
|
KR |
Hospital visits are not payable in addition to the routine care of a newborn. |
|
KS |
Hospital visits have been paid during the period you have billed nursing home care. Please verify location of patient. |
|
KT |
Nursing home visits have been paid during the time you have billed hospital care. Please verify location of patient. |
|
KU |
Please resubmit the remainder of this claim, if applicalbe, under supportive or directive care. |
|
KV |
Emergency Medicine fees and minor procedures - the lesser fee is paid at 50%. |
|
KW |
Fee item billed does not meet the criteria for group counselling. The appropriate visit fee has been paid. |
|
KX |
Fee item billed is only applicable when service is provided in hospital emergency room. The appropriate visit fee has been paid. |
|
KY |
Visit fee includes examination/assessment of multiple diagnoses. |
|
KZ |
Fee item and diagnostic code/note comment do not correspond. |
|
K0 |
92515/92516 not payable with 92510, 92520-92544 or 92546. |
|
K1 |
Processed according to the Preamble to the Medical Services Commission Payment Schedule. |
|
K2 |
Processed according to the Section Preamble to the Medical Services Commission Payment Schedule. |
|
K3 |
Processed according to the description of the fee item, or the note relating to the fee item, in the Payment Schedule. |
|
K4 |
Please refer to the protocol for this fee item. |
|
K5 |
Your rebilling has been processed. In future, please ensure that the necessary information (eg. "CCFFP") appears in the first line of your note record. |
|
K6 |
Primary base fee is not applicable. Your account has been paid under the appropriate split base fee. |
|
K7 |
Patient not registered. Payment for third and subsequent services will be reduced to 50% (Primary Care). |
|
K8 |
Patient not registered - payment reduced to 50% (Primary Care). |
|
K9 |
Our records indicate that fee item 00114/00115 is not applicable. Please verify the patient's location. |
|
LA |
Volume discount mechanism applied as per 2007 renewed lab agreement. |
|
LB |
This item is not a benefit of the plan unless performed in an MSC approved facility or as an outpatient service. |
|
LC |
Your claim for fee item 13075 was refused as MSP has not received an associated claim from you or an ICBC visit (Must be for an unrelated condition). |
|
LD |
Nerve blocks/IV procedures are not paid with time units or procedures. |
|
LE |
Continuous care by a second anaesthetist is paid under time fees only. |
|
LF |
Anesthetic Procedural Fee Modifiers are not payable in addition to diagnostic or therapeutic anesthesia fees. |
|
LG |
Your claim for fee item 13070 was refused as the WSBC visit was claimed for the same or a related condition. |
|
LH |
Anesthetic procedural modifies are only applicable to general, regional and monitored anesthesia. |
|
LI |
Your claim for fee item 13075 was refused as the ICBC visit was claimed for the same or a related condition. |
|
LJ |
Intensity/complexity fees are not applicalbe to the surgical/diagnostic procedure(s) billed. |
|
LK |
Your claim for fee item 13070/13075 was refused as a procedure was billed for the same or a related condition. |
|
LL |
13052 is not applicable for a pre-operative examination. |
|
LM |
Insufficient medical necessity for two anaesthetists has been received. |
|
LN |
Please provide duration of continuous time spent with the patient during second and/or third stages of labour only. |
|
LO |
Your claim for fee item 13070 was refused as MSP has received a non WSBC visit claim from you. |
|
LP |
Fee items 01151 and 13052 are not applicable when performed in conjunction with other anesthetic services. |
|
LQ |
Visit fees are not payable at the time anesthetic services are rendered. |
|
LR |
This service is included in the annual complex care block fee. |
|
LS |
Age related annual complex care block fee items must be provided on the same date of service as complex care planning fee item 14033. |
|
LT |
This service is not payable on inpatients who reside in a care facility. |
|
LU |
Your claim has been refused due to an inadequate medical record. The MSC Payment Schedule Preamble C.10 describes the requirements of an adequate medical record. |
|
LV |
This service is limited to once per calendar year per patient and has been paid to another practitioner. |
|
LW |
This service is only payable if the patient is seen and a visit billed on the same date. Please resubmit for both services, if applicable. |
|
LX |
Fee item 33583 is for administering single parenteral chemotherapeutic agents and not for the injection if 1 hrh. Please resubmit using fee item 00100 if applicable. |
|
LY |
Claim for Fee Item 32308/32318 has been paid as Fee Item 00308 as care has exceeded the first 10 days of hospitalization. |
|
L1 |
(510) WorkSafeBC practitioner not authorized for date of service. For more information contact corporate and health care. |
|
L2 |
WorkSafeBC refused - duplicate form detected. |
|
L3 |
(517) WorkSafeBC invoiced units reduced to daily maximum for good/service. |
|
L4 |
(533) WorkSafeBC incentive applied for proof timeliness. Please refer to the contract for more information. |
|
L5 |
(539) WorkSafeBC interest applied. |
|
L9 |
(509) WorkSafeBC practitioner number is missing or not recognized. Please add or correct the information on the invoice and resubmit. |
|
MA |
Multiple exams performed on the same visit, the lesser exams are paid at 50%. |
|
MB |
A repeat refraction within a 6 month period requires medical necessity. |
|
MC |
Items 02010, 02015 and 02012 include certain individual eye exams. |
|
MD |
Exam and a minor procedure billed on the same day, the lesser fee is paid at 50%. |
|
ME |
Eye exams are not paid with office/hospital visits. |
|
MF |
Referring doctor provided is invalid for payment of consultation billed. |
|
MG |
These exams are paid to a maximum of three per day. |
|
MH |
02012 is not payable within three days of emergency surgery. |
|
MI |
The appropriate fees for removal of foreign bodies from the surface of the eye are 13610, 13611 or 06063 |
|
MJ |
A fee item has been established for this service. Please resubmit under the approved code. |
|
MK |
Fee item 13005 is not payable when the patient is a registered bed patient in an acute care hospital. |
|
ML |
Fee item 13005 may only be billed once per day per physician per patient. |
|
MN |
Fee item 13005 is not payable in addition to services provided on the same day/same physician/same patient. |
|
MP |
Fee item 00109 is not applicable when a patient is referred for continuing care by a certified specialist. The appropriate visit fee has been paid. |
|
MQ |
Fee item 00109 is not applicable when a patient is referred for continuing care by a certified specialist. The appropriate visit fee has been paid. |
|
MR |
Fee item 00109 is not applicable when preceded by a complete physical exam within 7 days by the same physician. The appropriate visit fee has been paid. |
|
MS |
Does not meet the criteria for billed services for hospitalized patients. |
|
MT |
Sub acute care has been paid during the period you have billed for acute/supportive care. Please verify the location of the patient. |
|
MV |
Acute/supportive care has been paid during the period you have billed for sub acute care. Please verify the location of the patient. |
|
MW |
This OSMV form fee is not payable on the same date of service as another OSMV form fee that you have billed. |
|
MX |
Driver's licence number is not numeric, is missing or is not located in the first seven spaces of the note or comment field. |
|
MY |
A repeat OSMV form fee is not payable to any practitioner within 3 months. |
|
MZ |
Insurer is invalid for this service. |
|
M1 |
WorkSafeBC refused - report submission incomplete, required info, regular practitioner indicator missing or invalid. |
|
M2 |
WorkSafeBC refused – report submission incomplete, required info, return to full duties indicator missing or invalid. |
|
M3 |
GPSC conference fee items 14015, 14016 or 14017 have been paid to you on the same date of service. Therefore, this GPSC attachment Fee Item is not applicable. |
|
M4 |
GPSC conference fee items 14015, 14016 or 14017 have been paid to a different GP on the same date of service so this GPSC attachment fee is not applicable. |
|
M5 |
GPSC attachment fee items have been paid to you on the same or prior date of service so GPSC fee items 14015, 14016, 14017 and 14033 are not applicable. |
|
M6 |
GPSC attachment fee items have been paid to another GP on the same or prior date of service so GPSC fee items 14015, 14016, 14017 and 14033 are not applicable. |
|
NA |
Payable at 50% when billed with delivery fees. |
|
NB |
Fee item 14094 is payable once within 6 weeks following a C-section or vaginal delivery but not to the physician who performed the C-section. |
|
NC |
04116 is only applicable in the immediate post-partum phase. |
|
ND |
Pre-natal visit fees are not payable within the post-natal period. |
|
NE |
Included in the fee for delivery, caesarean section or post-natal care. |
|
NG |
Additional prenatal visits must be supported by medical necessity. |
|
NH |
Included in fee items 04025, 04050, 04052, 14108 and 14109. |
|
NI |
Only one prenatal complete examination (00101/14090) is payable per physician per pregnancy. |
|
NJ |
Multiple call backs are not normally paid with delivery. Provide details of serious complication(s) requiring additional emergency care. |
|
NK |
Timing for fee item 14199 begins after two hours of continuous care during second stage of labour. |
|
NL |
This claim has been paid to the obstetrician. |
|
NM |
The incentive for full service GP obstetrical bonus is only applicable when fee item 14104, 14108 or 14109 is paid to the same physician/same day. |
|
NO |
Item 14000 is only payable when the physician attends one delivery on the date billed. |
|
NP |
Fee item 14000 is payable for the first delivery the GP attends on the date billed, to a maximum of 25 bonuses per calendar year. |
|
NQ |
The incentive for full service GP obstetrical delivery bonus is payable for the first delivery the GP attends on the date billed. |
|
NR |
The incentive for full service GP obstetrical delivery bonus is payable to a maximum of 25 bonuses per calendar year. |
|
NS |
You have reached or exceeded the practitioner calendar year limit for this service. |
|
NV |
This fee item is only payable to the physician who has provided the majority of the longitudinal general practice care to the patient over the preceding year. |
|
NW |
This fee item is not payable for services provided by physician who are working under a salaried, sessional or service contract arrangement. |
|
N1 |
WorkSafeBC refused – long term care not paid when an acute care per diem or an emergency visit has been paid. |
|
N2 |
WorkSafeBC refused – cast clinic booked outpatient visit is not paid with acute care per diem unless it is the day of admission |
|
N3 |
WorkSafeBC refused – medical misc take away items must be billed on the same date as an emergency visit or day care surgery. |
|
N4 |
WorkSafeBC refused – billing submitted more than 90 days after service rendered. |
|
N5 |
WorkSafeBC refused – hospital service not payable with already paid services. |
|
N6 |
WorkSafeBC refused – dressing change booked outpatient visit is not paid with acute care per diem unless it is the day of admission. |
|
N7 |
WorkSafeBC refused – sterile environment booked out patient visit is not paid with acute care per diem unless it is the day of admission. |
|
N8 |
WorkSafeBC refused – ward rate – differential must be billed for same date of service as acute care per diem. |
|
N9 |
WorkSafeBC refused – call out charges not payable for service(s) billed. |
|
OA |
Primary and secondary wound management fees are only applicable with fees from the Orthopaedic Section. |
|
OB |
Consult/visit is included in the paid claim on the same date of service by the same practitioner or payee for OSMV fee item 96226 or 96227. |
|
OC |
Eye exam is included in the paid claim on the same date of service by the same practitioner or payee for OSMV fee item 96226 or 96227. |
|
OD |
Visual field test 02041, 02042, 02043 is included in the paid claim on the same date of service by the same practitioner or payee for fee item 96226, 96228. |
|
OH |
Adjusted to the appropriate fee/amount for an open reduction and/or compound fracture. |
|
OI |
External fixation is not payable with an open reduction fee. |
|
OJ |
Remanipulation is not payable to the same physician within five days of the initial procedure. |
|
OL |
Primary wound care management fees are not stand alone items. Please rebill with the appropriate fracture fee if applicable. |
|
OM |
51037/51038 is only paid with applicable orthopaedic section items. |
|
PA |
00622 has been paid for another dependent. This fee includes parental assessment. |
|
PB |
Consultations for two family members or more require individual referrals and must be seen separately. |
|
PC |
Psychotherapy sessions extending beyond one hour per day must be supported by an explanation of need. |
|
PD |
Family therapy is only payable on one member's PHN. |
|
PE |
Invalid service clarification code for psychiatry fee item. |
|
PF |
Invalid service clarification code for Rural Retention Premium. |
|
PG |
Specialty invalid for Rural Retention Premium. |
|
PH |
PCO Registration submitted for a PHN that is currently registered to an associated primary care organization. |
|
PI |
Adjustment due to PHN registration change. |
|
PJ |
PHN not registered on service date. Claim for a non physician and/or billed fee item does not meet conversion to fee for service criteria. |
|
PK |
Adjustment due to PHC registration change E-debit only, no matching credit created. |
|
PL |
Rural retention is not applicable to the geographic location where the service was provided. |
|
PO |
Beneficiary reimbursement for services. |
|
PW |
Resubmit as extended services code (960xx) or MSP fee code with an explanatory note. |
|
PZ |
Please resubmit with child’s PHN. Consider registering PHN with the primary care organization. |
|
P0 |
Claim for a non-physician and/or billed fee item does not meet conversion to fee for service criteria. |
|
P1 |
Related claims have been paid by ICBC. Please check your records and rebill using MVA indicator “Y”, if necessary |
|
P2 |
Partial payment from ICBC for one service. |
|
P3 |
Related claims have been paid by WorkSafeBC. Please check your records and rebill using insurer code “WC”, if necessary. |
|
P5 |
Not approved for service. |
|
P6 |
PHN not registered to primary care organization. |
|
QA |
An Operative Report is required to assess this claim. |
|
QB |
An Operative Report and the medical necessity is required to assess this claim. |
|
QC |
The medical necessity is required to assess this claim. |
|
QD |
Written support for two assistants is required from the surgeon. |
|
QE |
Service is within the pre or post-operative period. |
|
QF |
Pre and/or post-operative services have been deducted from this claim. |
|
QG |
Service is included in the composite surgical/procedural fee. |
|
QH |
Independent procedures are not payable with other services. |
|
QI |
13612 is per laceration. If resubmitting, bill each laceration separately, and state length of any over 5 cm. |
|
QJ |
Adjusted to agree with the surgical/assist fee item paid for this date of service. |
|
QK |
Assistance at surgery/diagnostic procedures usually performed by one physician is not payable. |
|
QL |
Assists and visits are not paid together unless distinct unrelated times are provided. |
|
QM |
Multiple procedures at the same time, the lesser fee(s) paid at 50%. |
|
QN |
Fee item requires pre-authorization. Please resubmit with the operative/procedural report and provide details regarding the medical necessity. |
|
QO |
A claim for surgical fee item G04705, G04707 or G04709 has not been received. Therefore, this gynaecological certified assist fee item is not applicable. |
|
QP |
Repeat/staged procedures are not paid within designated time limit. |
|
|
77043 is not applicable according to the information provided. |
|
QR |
A surgical surcharge is not applicable as the procedure billed is not considered a surgical item. |
|
QS |
07019/70019/70020 requires confirmation of medical necessity from surgeon. |
|
QT |
Payment at 75% is not applicable. |
|
QU |
Unassociated multiple procedures at the same time, the lesser fee is paid at 75%. |
|
QW |
Pre-approval is required for this fee item. Please resubmit upon approval. |
|
QX |
A new authorization is required after two years per Preamble D.9.1.1. Please rebill after a new authorization is received, if applicable. |
|
QY |
ICBC refusal. No refusal reason code. |
|
QZ |
77043 is only paid with applicable vascular surgery items. |
|
Q1 |
Long-term care institution visits have been paid during the time you are billing for home visits. Please verify location of service. |
|
Q2 |
Home visits have been paid during the time you are billing for long-term care institution visits. Please verify location of service. |
|
RA |
Claim has been paid under the composite fee 08547 which includes 08530, 08537, 08544 and 08545. |
|
RB |
X-rays billed by non-certified radiologists are paid at 75%. |
|
RC |
Your rebilling has been refused. A retroactive adjustment will be made on a future remittance statement. |
|
RD |
Payment has been reduced as this fee item is paid on a “per case basis”. |
|
RE |
Encounter received. |
|
RF |
Encounter required – patient registered to primary care organization. |
|
RG |
Encounter record converted to fee for service. |
|
RH |
Amount greater than $0 billed on an encounter record. |
|
RI |
RGP fee for service. Claims are not valid for dates of service greater than June 30, 1995. |
|
RJ |
Registration must be submitted by a medical doctor. |
|
RK |
Fee for service record converted to an encounter record. |
|
RL |
Payable only for approved procedures. |
|
RM |
The miscellaneous fee item billed has been changed to this established fee item. |
|
RN |
Dental/oral surgery with extractions – the higher gross fee item(s) are paid at 100% and extractions in the same quadrant paid as “each additional tooth”. |
|
RO |
Multiple dental/oral surgeries are paid as the larger fee at 100%; the lesser fee at 50% unless otherwise stated in the MSP Dental Schedule. |
|
RQ |
This fee item is payable once per jaw. |
|
RS |
A claim for this service has been paid within the previous 12 months. |
|
RT |
A claim for this service has been paid within the previous 12 months to another practitioner. |
|
RW |
This item is not applicable unless continuous time is spent with the patient. |
|
RX |
Critical care fees are not applicable when the service starts after 2200 hours. |
|
RY |
The maximum rate paid for these multiple laparoscopic operations is the rate payable for fee item 04229. This service exceeds the maximum. |
|
RZ |
A visit is not payable in addition to an OSMV or MHR form fee when the patient is seen for the same diagnosis. |
|
R1 |
(567) WorkSafeBC payment amount reduced to BC rates. |
|
R3 |
(536) WorkSafeBC penalty applied for service timeliness. Please refer to contract for more information. |
|
SB |
WorkSafeBC refused your claim submission - concurrent treatment not authorized. If clarification required contact WSBC. |
|
SD |
(522) WorkSafeBC claim decision is pending. Please resubmit when claim status is accepted. |
|
SE |
(523) WorkSafeBC service is not allowed with another service already entitled on this claim. Please refer to contract for contract terms. |
|
SF |
(526) WorkSafeBC invoice date is greater than 90 days from date of service. |
|
SJ |
(518) WorkSafeBC proof was not received or not accepted. Please check contract for proof requirements. |
|
SM |
Your claim has been refused. Please resubmit with WorkSafeBC fee item for WorkSafeBC services. |
|
SN |
This service is the responsibility of WorkSafeBC. Please resubmit with WC insurer code. |
|
SR |
Invalid fee item for WorkSafeBC claim. Please resubmit using the appropriate MSP/WorkSafeBC fee item. |
|
SX |
(551) WorkSafeBC payee not contracted to provide service. |
|
SZ |
WorkSafeBC refused claim. Invalid body part code. Please resubmit with amended information. |
|
S1 |
WorkSafeBC refused claim. Invalid nature of injury code. Please resubmit with amended information. |
|
S2 |
WorkSafeBC refused claim. Invalid side of body code. Please resubmit with amended information. |
|
S3 |
(542) WorkSafeBC payee could not be matched. |
|
S4 |
WorkSafeBC refused your claim submission. Transmitted record had an invalid body part/anatomical position combination. |
|
S7 |
WorkSafeBC refused you claim submission. Transmitted record had a date of injury prior to the date of birth. |
|
TA |
Patient's annual limit for this benefit has been reached. |
|
TB |
This fee is paid only once per patient, per year. |
|
TC |
Balance owing on previously paid account. |
|
TD |
Less than 3 months have elapsed since the last visit for this condition. |
|
TE |
Less than 21 days have elapsed since the last visit for this condition. |
|
TF |
Less than 3 months have elapsed since the last paid treatment. |
|
TG |
As no authorization has been received, your account has been refused. |
|
TH |
Fee item 02897 is included in fee items 02888, 02889, 02898 and 02899. |
|
TI |
Two PVCs have been deducted as two services were rendered. |
|
TJ |
00159 is the only fee applicable for institutionalized patients. |
|
TK |
This item is not applicable until the MSP age appropriate counselling fee item (00120, etc) calendar year limit (4) has been utilized. |
|
TL |
ICBC approved claim with referring doctor number 99990. |
|
TM |
ICBC approved claim with referring doctor number 99995. |
|
TN |
PVC has been deducted. |
|
TO |
This claim is the responsibility of ICBC. |
|
TP |
Previous visit within 6 months for same condition. |
|
TR |
ICBC claim is outside of approved treatment dates. |
|
TS |
Payment has been made in accordance with the information provided by the referring physician. |
|
TU |
Details required for frequency of servicing. Please resubmit with explanation in note record. |
|
TV |
Service included in initial examination. |
|
TW |
Payment has recently been made to other optometrist for this service. |
|
TX |
ICD9 code does not match published list. |
|
TZ |
Retroactive adjustment. |
|
T0 |
Fee item 02888, 02889, 02898 and 02899 are included in fee items 02894 and 02895. |
|
T1 |
Extractions in conjunction with osteotomies/fractures – bill extractions as “each additional tooth per quadrant” regardless of the number of quadrants involved. |
|
T2 |
Please resubmit with location of extraction, lesion, etc. |
|
T3 |
A1234565 is not an acceptable ICBC claim number |
|
T4 |
ICBC refused. This may be a WorkSafeBC claim. Please contact ICBC. |
|
T5 |
Services exceed ICBC coverage limit. Please contact ICBC. |
|
T6 |
ICBC refused responsibility. Please contact adjuster |
|
T7 |
Therapy treatment discontinued by medical practitioner. Please contact ICBC. |
|
T8 |
Claimant has private plan for therapy. Please contact ICBC. |
|
T9 |
ICBC customer unknown - please contact ICBC. |
|
UA |
This claim was assessed by the Plan's Medical and Surgical Advisors. |
|
UB |
Claim has been paid/refused pending review by our Medical Advisors. You will be notified of any changes. |
|
UC |
If you disagree with the payment made, please refer to the appropriate committee of the DOCTORSOFBC(BCMA). |
|
UD |
Paid according to Reference Committee recommendations. |
|
UE |
Computer processed in accordance with Medical Services Commission Payment Schedule. |
|
UF |
Invalid MVA - no injury claim. |
|
UG |
Breach of ICBC coverage. |
|
UH |
MVA prior to April 1, 1994. |
|
UI |
Duplicate KOL 35 - contact ICBC if necessary. |
|
UJ |
No ICBC claim for PHN - use ICBC number. |
|
UL |
(515) WorkSafeBC the maximum service units entitled have already been invoiced. Contact claim owner for more information. |
|
UM |
(513) WorkSafeBC service is not entitled on claim. |
|
UP |
Claim refused as ICBC responsibility. Please rebill ICBC directly or if patient qualifies for MSP therapy benefits, please bill MSP. ICBC claim # not required. |
|
UQ |
This claim has been paid on an independent consideration and without precedent basis after review by MSP’s Medical and Surgical Advisors. |
|
U1 |
Patient benefit limit reached - refractions are only payable once every 24 months for patients between the ages of 16 and 64. |
|
U2 |
A refraction has been previously paid to a different specialty - refractions are only payable once every 24 months for patients between the ages of 16 and 64. |
|
U3 |
Insufficient information has been provided to authorize a repeat refraction within 24 months. |
|
U4 |
Routine eye examinations are not a benefit of MSP. |
|
U5 |
Insufficient medical necessity provided for a repeat eye examination for the diagnosis indicated. |
|
VA |
Payment number is missing or invalid. |
|
VB |
Invalid payment number for tape or diskette submission. |
|
VC |
Payment number not valid for this batch. |
|
VE |
Amount billed is missing or invalid. |
|
VF |
Number of services is missing or invalid. |
|
VG |
Fee item is missing or invalid. |
|
VH |
Date of service is missing or invalid. |
|
VI |
Practitioner number is missing or invalid. |
|
VJ |
Invalid diagnostic code for referral by oral/dental surgeon or orthodontist. Diagnosis must relate to problems with mouth or mastication. |
|
VK |
Claim number is missing or invalid. |
|
VL |
Claim number is out of sequence. |
|
VM |
Referring practitioner number is missing or invalid. |
|
VN |
Diagnostic code missing or invalid. |
|
VO |
Anatomical position invalid. |
|
VP |
Service to-date missing or invalid. |
|
VQ |
The number of services exceeds the maximum allowed. |
|
VR |
Critical care must be submitted on a claim card with a covering letter providing the details. |
|
VS |
The to/by indicator for the referring doctor is invalid. |
|
VT |
Claim has been paid/refused pending review. You will be notified of any changes. |
|
VU |
Nature of injury missing or invalid. |
|
VW |
WorkSafeBC claim number invalid. |
|
VX |
Medical practitioner referral required by ICBC. Please contact ICBC. |
|
VY |
Area of injury missing or invalid. |
|
VZ |
ICBC claim number invalid for WORKSAFEBC claim. |
|
V2 |
Reserved for ICBC misc. adjustments where two bills are sent for one service. |
|
V3 |
Field(s) designated for future use contain(s) invalid data - refer to current Teleplan specs. |
|
V4 |
(553) WorkSafeBC invoiced amount paid. |
|
V8 |
Paid according to your MSP orthodontia contract. |
|
V9 |
This patient is not user fee exempt for this date of service. |
|
W$ |
Work Safe BC claim submitted to Work Safe BC on paper. |
|
WA |
Service not approved for this payment number or date of service prior to approval date |
|
WB |
(541) WorkSafeBC claim could not be matched. |
|
WC |
Fee item not listed with Medical Services Plan. |
|
WD |
(511) WorkSafeBC claim rejected or disallowed. Do not rebill. |
|
WE |
Hospital payee claim submission refused. Bill WorkSafeBC directly. |
|
WF |
Fee item billed and doctor's specialty/practitioner number do not correspond. |
|
WG |
Fee items with letter prefix 'A' are not benefits of the Plan. |
|
WH |
We are unable to process a single claim for two different patients. |
|
WI |
Billing is incomplete. Please resubmit with all required information. |
|
WK |
Please rebill with initial fee for the first service and the additional fee for each additional service performed. |
|
WN |
Pre-authorization number valid. |
|
WP |
Pre-authorization permits payment of this inactive coverage. |
|
WQ |
WorkSafeBC refused your claim submission – approval outstanding, pending time exceeded. Please resubmit using code “W”. |
|
WR |
Pre-authorized number invalid. |
|
WS |
(561) WorkSafeBC service prior to injury. |
|
WT |
Tray fee not applicable to procedure billed. Refer to the list of procedures eligible for a tray fee in the General Services Section of MSC Payment Schedule. |
|
WU |
Unknown reason for refusal or change to fee item and/or amount. Please contact WorkSafeBC. |
|
W0 |
Work Safe BC refused your claim submission - report incomplete. If clarification required contact WorkSafeBC Payment Services. |
|
W1 |
Postal code missing or format invalid. |
|
W2 |
Data centre and payee number combination not on file. |
|
W3 |
Payee not active. |
|
W4 |
Use claims comment or note record. Please do not use both. |
|
W5 |
Note data type not equal to "A". |
|
W6 |
Note data line blank (no data). |
|
W7 |
Provincial institution not applicable for batch eligibility. |
|
W8 |
Dependent 66 not applicable for batch eligibility. |
|
W9 |
Greater than three errors for this claim. |
|
XA |
RCP claims - birthdate and sex code missing or invalid. |
|
XB |
Eligibility Request - invalid patient status request code used. |
|
XC |
Eligibility Request - invalid sex code. |
|
XD |
Invalid/insufficient information provided. (In note or claim comment field/description area.) |
|
XE |
PHN not 9128673459 for fee items 00158/00164. |
|
XF |
Fee items 00158/00164 - patient name not P. Session. |
|
XG |
Note comment does not correspond with submission code. |
|
XH |
This claim has been returned to you per your submission code E request record. |
|
XJ |
Please resubmit on the appropriate claim card/online form. |
|
XK |
RCP/Registration Number is not numeric or is equal to zero. |
|
XL |
WorkSafeBC claim number has been added/updated. Please contact WorkSafeBC for correct claim number. |
|
XM |
PCO – ICBC has refused responsibility for this claim. |
|
XN |
PCO – encounter record created to replace fee for service claim refused by ICBC. |
|
XP |
ICBC refused – claim processed by MSP. |
|
XQ |
WorkSafeBC claim - date of service prior to May 8, 1996 |
|
X0 |
Fac – Prac or Payee fac not connected |
|
X1 |
Original MSP file number invalid. |
|
X2 |
Facility number is missing or invalid. |
|
X3 |
Sub-facility number is missing or invalid. |
|
X4 |
RCP/Institution number missing, invalid, or not in correct format. |
|
X5 |
RCP/Institution birthdate missing or invalid. |
|
X6 |
RCP/Institution first name missing or invalid. |
|
X7 |
RCP/Institution second initial invalid. |
|
X8 |
RCP/Institution - patient sex code missing or invalid. |
|
X9 |
RCP address missing or not showing in line one. |
|
YA |
Note record missing or invalid for submission code C, E or X. |
|
YB |
This Teleplan record code is not operational. Please contact Teleplan Support. |
|
YC |
Claim number refused by ICBC. Please contact ICBC. |
|
YD |
Insurer code does not match fee item billed. This fee item is only applicable for ICBC billings. |
|
YF |
Fee item valid for WorkSafeBC claim only |
|
YH |
No payment owing. Insurer code adjusted. |
|
YI |
Provincial institution not valid for WorkSafeBC claim. |
|
YK |
Claim reprocessed at the request of WorkSafeBC. |
|
YN |
Newborns invalid for WorkSafeBC claim - Dep 66. |
|
YP |
WorkSafeBC claim must be submitted by PHN. |
|
YR |
Claim reprocessed/adjusted at the request of ICBC to change insurer responsibility. |
|
YS |
Specialty invalid for WorkSafeBC claim. |
|
YT |
WorkSafeBC claim must be Teleplan for opted in practitioner. |
|
YU |
ICBC refusal reason unknown - Please contact ICBC. |
|
YV |
Data Centre change. Record submitted by previous data centre being returned to new data centre. |
|
YW |
Insurer responsibility switched at the request of ICBC. |
|
YX |
Claim reprocessed at the request of ICBC. |
|
YY |
Pre-Edit System refusal. See second explanatory code(s). |
|
YZ |
Facilities edit refusal. |
|
Y1 |
Billed fee prefix invalid. |
|
Y2 |
Payment mode is invalid. |
|
Y3 |
Submission code invalid. |
|
Y4 |
Service location code missing or invalid. |
|
Y5 |
Referring practitioner code 1 missing or invalid. |
|
Y6 |
Referring practitioner code 2 missing or invalid. |
|
Y7 |
Correspondence code invalid. |
|
Y8 |
MVA claim code invalid. |
|
Y9 |
ICBC claim number invalid. |
|
ZI |
Note record is not preceded by correspondence code equal to “N” or “B” or practitioner number does not match C01/C02 record. |
|
ZJ |
PHN equals zero and province code equals zero or blanks. |
|
ZK |
A note record did not accompany correspondence code "N" or "B" or payee number does not match C02 record. |
|
ZL |
RCP province code is present and PHN not equal to zero. |
|
ZM |
Coverage good - batch eligibility. This code is used in Teleplan II. |
|
ZN |
No coverage - batch eligibility. This code is used in Teleplan II. |
|
ZS |
The referring doctor number has been changed to correspond with our records. |
|
1B |
This fee item not valid for services provided in BC. Please resubmit with appropriate fee item. |
|
1W |
WorkSafeBC claim submitted to WorkSafeBC on paper – Work Safe BC adjusted – keying fee deducted. |
|
2A |
Chiropractic, Naturopathic, Optometric, Physiotherapy, Massage Therapy, Podiatry and Acupuncture services are not insured benefits outside of BC. |
|
2W |
WorkSafeBC Claim – Invalid PHN |