Code J2778 and J0585 Added to MIHMS, CR 32105

April 17, 2013

Code J2778 and J0585 have been added to MIHMS, effective 1/1/2013. If you received a denial for claims with these codes and the edit reasons below, please rebill your claims.

Edit 163 - Benefit requires documentation.

CARC 16 - Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.)

RARC N29 - Missing documentation/orders/notes/summary/report/chart.

Edit 149 - Benefit does not meet date criteria of the claim.

CARC 204 - This service/equipment/drug is not covered under the patient's current benefit plan. No RARC listed.

Edit 152 - Provider type does not match type required by benefit.

CARC 170 - Payment is denied when performed/billed by this type of provider. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

RARC N95 - This provider type/provider specialty may not bill this service.

The CARC and RARC document is found on the Health PAS Online Portal, under Billing Instructions in the Supplemental Billing Info folder.