Laboratory and Medical Imaging Claims Denied in Error, CR 32789

June 26, 2013

Some claims with 2013 CPT codes are being denied inappropriately. You can identify these claims on your Remittance Advice (RA) by these reason codes:

  • EDIT 155 CARC 6 - The procedure/revenue code is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

  • EDIT 271 CARC B5 - Coverage/program guidelines were not met or were exceeded.

  • EDIT 330 CARC 11 - The diagnosis is inconsistent with the procedure. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.

  • EDIT 330 RARC M64 - Missing/incomplete/invalid other diagnosis

The issue is now corrected and claims will be reprocessed.