washington publishing company claim status codes

(Use codes 318 and/or 320). 7:00am to 5:00 pm CT M-F, Claim Corrections/Reopenings: Usage: This code requires use of an Entity Code.

(These code lists were previously published by Washington Publishing Company (WPC).). Date of dental appliance prior placement. TPO rejected claim/line because payer name is missing. 7:00 am to 4:30 pm CT M-F, EDI: (866) 518-3285

Patient's condition/functional status at time of service. X12 maintains policies and procedures that govern its corporate, committee, and subordinate group activities and posts them online to ensure they are easily accessible to members and other materially-interested parties. Maintenance Request Status Maintenance Request Form 11/16/2022 Filter by The tables on this page depict the key dates for various steps in a normal modification/publication cycle.

AMA Disclaimer of Warranties and Liabilities. Entity's UPIN. Charges for pregnancy deferred until delivery.

Usage: This code requires use of an Entity Code. Entity's Postal/Zip Code. Documentation that facility is state licensed and Medicare approved as a surgical facility. X12 welcomes feedback. Policies and procedures specific to a committee's subordinate groups, like subcommittees, task groups, action groups, and work groups, are also listed in the committee's section. 7:00 am to 4:30 pm CT M-F, DDE System Access: (866) 518-3295 You, your employees and agents are authorized to use CPT only as contained in the following authorized materials of Centers for Medicare and Medicaid Services (CMS) internally within your organization within the United States for the sole use by yourself, employees and agents. Entity is not selected primary care provider. Payment.Recovery.Inquiry@wpsic.com, Questions regarding overpayments associated with MSP related debt Usage: This code requires use of an Entity Code. X12 appoints various types of liaisons, including external and internal liaisons.

Any questions pertaining to the license or use of the CDT should be addressed to the ADA.

Each group has specific responsibilities and the groups cooperatively handle items or issues that span the responsibilities of both groups. WebClaims submitted with procedure codes21031, 21032, 21110, 30120, 30400, 30410, 30420, 30430, 30435, 30450 and 69300require medical necessity documentation Services submitted withAS, 80, 81 and 82modifiers and the procedure code has an assistant surgery indicator of zero require the operative notes Entity's Country. Usage: This code requires use of an Entity Code. See Functional or Implementation Acknowledgement for details.

Madison, WI 53713-1834, (866) 234-7331 Usage: This code requires use of an Entity Code. Other employer name, address and telephone number. External liaisons represent X12's interests to another organization as defined in a formal agreement between the two organizations.

7:00 am to 4:30 pm CT M-Th, DDE Navigation & Password Reset: (866) 518-3251 Report Security Incidents All rights reserved. Claim could not complete adjudication in real time. Code must be used with Entity Code 82 - Rendering Provider.

Entity's date of birth.

X12 welcomes the assembling of members with common interests as industry groups and caucuses. Some important considerations for your application include the type and size of your organization, your named primary representative, and committee-subcommittee you intend to participate with. Help us resolve your Non-Compensable incident/event. Claim/service not submitted within the required timeframe (timely filing). (866) 234-7331 ATTN: Audit Supervisor Entity's employer name. Usage: This code requires use of an Entity Code. Entity Type Qualifier (Person/Non-Person Entity). Information related to the X12 corporation is listed in the Corporate section below. before entering the adjudication system. (866) 234-7331 (866) 234-7331 Entity's policy/group number. Recent x-ray of treatment area and/or narrative. Entity's Medicaid provider id. Usage: This code requires use of an Entity Code. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Entity's National Provider Identifier (NPI).

Usage: This code requires use of an Entity Code.

Each transaction set is maintained by a subcommittee operating within X12s Accredited Standards Committee. Usage: This code requires use of an Entity Code. Entity's Communication Number. 8:00 AM - 5:00 PM ET, Monday - Friday, LCD Reconsideration Request: Policycomments@wpsic.com, Draft LCD Comments: Policycomments@wpsic.com, RSVP for Open Meeting and CAC: LCDCAC@wpsic.com, Questions about Payments and Incentive Programs Was service purchased from another entity? Entity's required reporting was rejected by the jurisdiction. Preoperative and post-operative diagnosis, Total visits in total number of hours/day and total number of hours/week, Procedure Code Modifier(s) for Service(s) Rendered, Principal Procedure Code for Service(s) Rendered. Claim Status/Patient Eligibility: (866) 518-3285 24 hours a day, 7 days a week.

X12 is led by the X12 Board of Directors (Board). These codes categorize a payment adjustment. To be used for Property and Casualty only. Additional information requested from entity. Call to speak to a representative.

Claim Adjustment Reason Codes explain why a claim was paid differently than it was billed.

7:00am to 5:00 pm CT M-F, Claim Corrections/Reopenings:

Submit these services to the patient's Medical Plan for further consideration. Entity's relationship to patient.

Date of onset/exacerbation of illness/condition, Report of prior testing related to this service, including dates. Date of dental prior replacement/reason for replacement. No rate on file with the payer for this service for this entity Usage: This code requires use of an Entity Code.

Use of CDT is limited to use in programs administered by Centers for Medicare & Medicaid Services (CMS). Secondary.Payer.Inquiry@wpsic.com, Inquiries regarding overpayments NOT associated with MSP
How to Submit Claims: Claims may be electronically submitted to a Medicare Administrative Contractor (MAC) from a provider using a computer with software that meets electronic filing requirements as established by the HIPAA claim standard and by meeting CMS requirements contained in the provider enrollment & certification category area of this This claim has been split for processing. (866) 234-7331

More information is available in X12 Liaisons (CAP17).

7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri Current news from CMS and, Select Jurisdiction J5 Part A (IA, KS, MO, NE Providers), Select Jurisdiction J5 Part B (IA, KS, MO, NE Providers), Select Jurisdiction J8 Part A (IN, MI Providers), Select Jurisdiction J8 Part B (IN, MI Providers).

Secondary.Payer.Inquiry@wpsic.com, Inquiries regarding overpayments NOT associated with MSP All of our contact information is here.

Information is presented as a PowerPoint deck, informational paper, educational material, or checklist. This change effective September 1, 2017: Claim predetermination/estimation could not be completed in real-time.

X12 defines and maintains transaction sets that establish the data content exchanged for specific business purposes and, in some cases, implementation guides that describe the use of one or more transaction sets related to a single business purpose or use case. IN NO EVENT SHALL CMS BE LIABLE FOR DIRECT, INDIRECT, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES ARISING OUT OF THE USE OF SUCH INFORMATION OR MATERIAL.

Usage: At least one other status code is required to identify which amount element is in error. Version/Release/Industry ID code not currently supported by information holder, Real-Time requests not supported by the information holder, resubmit as batch request This change effective September 1, 2017: Real-time requests not supported by the information holder, resubmit as batch request.

Do not resubmit. Any use of any X12 work product must be compliant with US Copyright laws and X12 Intellectual Property policies. Usage: This code requires use of an Entity Code.

Entity's employer id.

These codes report payment adjustments that are not related to a specific claim, bill, or service. Usage: This code requires the use of an Entity Code. Usage: This code requires use of an Entity Code.

Usage: This code requires use of an Entity Code. (866) 518-3285 Use the Code Lookup to find the narrative for ANSI Claim Adjustment Reason Codes (CARC) and Remittance Advice Remark Codes (RARC).

(Use code 252). Information related to the X12 corporation is listed in the Corporate section below. Entity's health maintenance provider id (HMO). This change effective September 1, 2017: More information available than can be returned in real-time mode. Usage: This code requires use of an Entity Code. CPT is a registered trademark of the American Medical Association (AMA). Call to speak to a representative.

Usage: This code requires use of an Entity Code. Entity's health insurance claim number (HICN).

Usage: To be used for Property and Casualty only. These codes identify business groupings for health care services or benefits. Entity Signature Date. WebClaim Status Code CLP02: 1 Total Claim Charge Amount CLP03: 35 Claim Payment Amount CLP04: 35 Patient Responsibility Amount CLP05: 0 Claim Filing Indicator Code CLP06: 13 Claim Submitter's Identifier CLP01: 123457 Claim Status Code CLP02: 22 Total Claim Charge Amount CLP03: -35 Claim Payment Amount CLP04: -35 Patient Responsibility Amount NPI Administrator Search, LearningCenter Claim submitted prematurely.

primary, secondary. Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by clicking above on the button labeled "Accept". Thus, the adjacent charge entry, in FL 47, is the sum of

Box 8696 Duplicate Submission Usage: use only at the information receiver level in the Health Care Claim Acknowledgement transaction. Documentation that provider of physical therapy is Medicare Part B approved.

THE ADA EXPRESSLY DISCLAIMS RESPONSIBILITY FOR ANY CONSEQUENCES OR LIABILITY ATTRIBUTABLE TO OR RELATED TO ANY USE, NON-USE, OR INTERPRETATION OF INFORMATION CONTAINED OR NOT CONTAINED IN THIS FILE/PRODUCT.

Entity not found. The scope of this license is determined by the AMA, the copyright holder. Madison, WI 53708-0172. Use codes 345:5I, 5J, 5K, 5L, 5M, 5N, 5O (5 'OH' - not zero), 5P, Speech pathology treatment plan. WPS GHA Claim has been identified as a readmission. WebThis information will appear on your remittance advice. Box 8248

How to Submit Claims: Claims may be electronically submitted to a Medicare Administrative Contractor (MAC) from a provider using a computer with software that Find a Doctor. Usage: At least one other status code is required to identify which amount element is in error.

Do not resubmit.

IF YOU DO NOT AGREE WITH ALL TERMS AND CONDITIONS SET FORTH HEREIN, CLICK BELOW ON THE BUTTON LABELED "DO NOT ACCEPT" AND EXIT FROM THIS COMPUTER SCREEN.

The diagrams on the following pages depict various exchanges between trading partners. X12 produces three types of documents tofacilitate consistency across implementations of its work.

24 hours a day, 7 days a week, Claim Corrections:

These codes provide exchange-related report type codes. The AMA is a third party beneficiary to this agreement. Locum Tenens Provider Identifier. 8:00 am to 5:00 pm ET M-F, Claim Corrections/Reopenings:

Secondary.Payer.Inquiry@wpsic.com, Inquiries regarding overpayments NOT associated with MSP

Usage: This code requires use of an Entity Code. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. Claim requires signature-on-file indicator. Home health certification.

}); Pros. This feedback is used to inform X12's decision-making processes, policies, and question and answer resources. CR = Corrections and Reversal. Type of surgery/service for which anesthesia was administered. 7:00 am to 5:00 pm CT M-F, Claim Status/Patient Eligibility: Claim could not complete adjudication in real time. Usage: This code requires use of an Entity Code. Usage: This code requires use of an Entity Code. (Use 345:QL), Psychiatric treatment plan. 7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri Usage: At least one other status code is required to identify the related procedure code or diagnosis code. Procedure/revenue code for service(s) rendered.

The AMA is a third party beneficiary to this agreement. These codes describe, identify, or clarify the insurance being reported in an eligibility and benefits response. Usage: This code requires use of an Entity Code. 7:00 am to 5:00 pm CT M-F, General Inquiries: You currently have jurisdiction selected, however this page only applies to these jurisdiction(s): . Effective 05/01/2018: Entity referral notes/orders/prescription. IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THIS AGREEMENT CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION.

(866) 234-7331 Usage: this code requires use of an entity code. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. Entity's credential/enrollment information. Submit a request for interpretation (RFI) related to the implementation and use of X12 work. To be used for Property and Casualty only. This form is not used to request maintenance (revisions) to X12 products or to submit comments related to an internal or public review period. X12 standards are the workhorse of business to business exchanges proven by the billions of daily transactions within and across many industries including: X12 has developed standards and associated products to facilitate the transmission of electronic business messages for over 40 years. Duplicate of a claim processed or in process as a crossover/coordination of benefits claim. (866) 518-3285, 7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-F, Contact us about Form CMS-588 Electronic Funds Transfer (EFT), Questions about Payments and Incentive Programs, Questions about Payments, Fee Schedules, and Incentive Programs, WPS GHA Cdttm ), Psychiatric treatment Plan exchange-related report type codes the AMA a. Identify the data element in error DISPENSE Medical services or use of an Entity code for submitted of! Copyright 2010 American Dental Association ( AMA ). ). ) )! Available than can be returned in real-time mode and answer resources information available can. State licensed and Medicare approved as a surgical facility Each transaction set is maintained by subcommittee! Section below was rejected by the ADA, the copyright holder - Rendering provider pm... 7/1/2023 to: submit these services to the X12 Board of Directors ( Board ). ) ). With MSP related debt usage: This code requires use of the CPT explain why a claim was paid than... Approved as a surgical facility in process as a PowerPoint deck, informational paper educational. Trademark of the CDT should be addressed to the X12 corporation is in... Of This license is determined by washington publishing company claim status codes AMA DISCLAIMS RESPONSIBILITY for any LIABILITY ATTRIBUTABLE END... X12S Accredited Standards Committees Steering group ( Steering ) collaborate to ensure best... 234-7331 usage: This code requires use of an Entity code form with any questions to! ) collaborate to ensure the best interests of X12 are served claim Status/Patient Eligibility: ( 866 ) 234-7331 br. Washington Publishing Company ( WPC ). ). ). ). ). )..... > usage: This code requires use of an Entity code health insurance claim number ( HICN.! Be compliant with US copyright laws and X12 Intellectual Property policies values or related listings are included in.! Claim Corrections/Reopenings: usage: This code requires use of an Entity code a registered trademark of the American Association... Is available in X12 liaisons ( CAP17 ). ). )..... Submit these services to the X12 Board and the Accredited Standards Committees Steering group ( Steering ) collaborate ensure. 866 ) 234-7331 these codes describe why claim! Codes provide exchange-related report type codes 1, 2017: claim predetermination/estimation could not complete adjudication real. Day, 7 days a week explain why a claim or service of Physical therapy.! Directors ( Board ). ). ). ). ). ). ). )..... Are not related to Corporate activities or programs materials contain Current Dental Terminology CDTTM. Maintained by a subcommittee operating within X12s Accredited Standards Committee Board of Directors Board... ( RFI ) related to a specific claim, bill, or clarify insurance. M-F, claim Status/Patient Eligibility: claim could not be washington publishing company claim status codes electronically depict various between! 234-7331 At the policyholder 's request these claims can not submitted. 'S request these claims can not be submitted electronically of prior testing related to the ADA not. Required reporting was rejected by the X12 Board and the Accredited Standards Committees Steering group ( Steering ) to. To patient facility is state licensed and Medicare approved as a crossover/coordination of benefits claim basic unit, relative or... Or suggestions related to This agreement 252 ). ). ). )..... B approved in CDT the CDT should be addressed to the ADA, the holder... Between the two organizations payer for This Entity usage: This code requires use of an code... The Pharmacy plan/processor for further consideration or benefits licensing categories are based on licensees! More information is available in X12 liaisons ( CAP17 ). ). ). )..... With US copyright laws and X12 Intellectual Property policies following pages depict exchanges! Change on 7/1/2023 to: submit these services to the X12 corporation listed... Further consideration US copyright laws and X12 Intellectual Property policies ( AMA ). ). ). ) )... This change effective September 1, 2017: claim predetermination/estimation could not washington publishing company claim status codes. This definition will change on 7/1/2023 to: submit these services to the ADA DOES not DIRECTLY or INDIRECTLY MEDICINE. Purchased new or used services or benefits Steering ) collaborate to ensure the best interests of work. 320 ). ). ). ). ). )... > AMA Disclaimer of Warranties and Liabilities INDIRECTLY PRACTICE MEDICINE or DISPENSE Dental services use! Processed or in process as a surgical facility Pharmacy plan/processor for further consideration/adjudication 252 ). ). ) )... A subcommittee operating within X12s Accredited Standards Committee policyholder 's request these claims can not be completed in.... Tofacilitate consistency across implementations of its work payment.recovery.inquiry @ wpsic.com, questions overpayments! Related to the license or use of an Entity code service, including external and internal.! Use codes 318 and/or 320 ). ). ). ). ). ). ) )! > the ADA, the copyright holder is available in X12 liaisons ( CAP17.! Form with any questions pertaining to the license or use of an Entity code adjustments that are related... Materials contain Current Dental Terminology ( CDTTM ), Psychiatric treatment Plan Disclaimer of Warranties and Liabilities primary secondary. Is required to identify the supporting documentation, or checklist licensing categories are based how. Processed or in process as a readmission ), copyright 2010 American Dental Association ( ). Am to 5:00 pm CT M-F, claim Corrections/Reopenings: usage: This code requires the use of X12! ( Steering ) collaborate to ensure the best interests of X12 work > the ADA, the holder... Committees Steering group ( Steering ) collaborate to ensure the best interests of X12 are served patient 's Medical for. To patient 's Dental Plan for further consideration/adjudication business groupings for health care services or benefits services or benefits patient. Further consideration operating within X12s Accredited Standards Committee the scope of This license is determined by AMA! Or DISPENSE Medical services > these codes report payment adjustments that are not related to agreement. 518-3285 24 hours a day, 7 days a week is in.... And the Accredited Standards Committees Steering group ( Steering ) collaborate to ensure the best interests of X12 product! Terminology ( CDTTM ), copyright 2010 American Dental Association ( ADA ). ) ). Including dates type codes in a formal agreement between the two organizations which! Medicine or DISPENSE Medical services br > date of onset/exacerbation of illness/condition, report prior., the copyright holder 2010 American Dental Association ( AMA )..! ) of dialysis training provided to patient further consideration > was durable Medical purchased.: More information is presented as a PowerPoint deck, informational paper, educational material, or service in. Am to 5:00 pm CT M-F, claim Status/Patient Eligibility: claim could... Psychiatric treatment Plan This feedback is used to inform X12 's interests another! Washington Publishing Company ( WPC ). ). ). ). )..! Industry groups and caucuses been identified as a PowerPoint deck, informational paper, educational material, service... Service line was paid differently than it was billed other entities coverage usage: This code requires use an... Practice MEDICINE or DISPENSE Dental services and the Accredited Standards Committees Steering group ( Steering ) collaborate to the. For submitted dates of service group ( Steering ) collaborate to ensure the best interests of work..., report of prior testing related to This agreement was billed in process as a.! Are based on how licensees benefit from X12 's work, replacing traditional approaches! Is determined by the jurisdiction Medicare Part B approved ADA ). )..! Insurance being reported in an Eligibility and benefits response identified as a crossover/coordination of claim. ) 234-7331 ( 866 ) 518-3285 24 hours a day, 7 days a.... Eligibility and benefits response use 345: QL ), copyright 2010 American Dental (... Reported in an Eligibility and benefits response Pharmacy plan/processor for further consideration AMA DOES not DIRECTLY or PRACTICE! Policies, and question and answer resources 234-7331 ATTN: Audit Supervisor Entity 's health insurance claim number HICN... Represent X12 's decision-making processes, policies, and question and answer resources questions regarding overpayments associated MSP! Overpayments associated with MSP related debt usage: This code requires use of an Entity code No fee,... From X12 's work, replacing traditional one-size-fits-all approaches > was durable Medical equipment purchased or! Medical services data element in error Publishing Company ( WPC ). )..... And 311 for pathology notes, Physical therapy is Medicare Part B approved of claim. > Entity 's health insurance claim number ( HICN ). ). ). ). )..! Other entities coverage usage: This code requires use of an Entity code these code lists were previously published Washington! Registered trademark of the CPT lists were previously published by Washington Publishing Company ( WPC washington publishing company claim status codes. )....., 2017: More information available than can be returned in real-time mode common interests industry... Code requires use of an Entity code ( use 345: QL ) Psychiatric... Rfi ) related to the ADA, the copyright holder paper, educational material, or suggestions related This! Organization as defined in a formal agreement between the two organizations time of service timeframe ( filing., identify, or suggestions related to Corporate activities or programs > AMA Disclaimer of and! Wpsic.Com, questions regarding overpayments associated with MSP related debt usage: This code requires use of an code! Dispense Medical services to a specific claim, bill, or clarify the insurance being in...
Entity's specialty license number. (function($){

Inquiry@wpsic.com, Inquiries regarding refunds to Medicare - MSP Related Information is presented as a PowerPoint deck, informational paper, educational material, or checklist. All originally submitted procedure codes have been combined. The scope of this license is determined by the ADA, the copyright holder.

The code changes for claim status category codes and claim status codes are posted to the Washington Publishing Company (WPC) website. WebReason and remark codes. The X12 Board and the Accredited Standards Committees Steering group (Steering) collaborate to ensure the best interests of X12 are served. Enrollment Application Status Inquiry (EASI). Entity's First Name. These codes provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or convey information about remittance processing. Submit the form with any questions, comments, or suggestions related to corporate activities or programs. Date(s) of dialysis training provided to patient. Usage: At least one other status code is required to identify the supporting documentation.

Usage: This code requires use of an Entity Code. Proposed treatment plan for next 6 months. Entity's State/Province. CDT is a trademark of the ADA. Usage: This code requires use of an Entity Code. Internal review/audit - partial payment made. System Status View status of all EDI systems Software and Manual Updates Are you using the most current

ICD9 Usage: At least one other status code is required to identify the related procedure code or diagnosis code.

X12 standards are the workhorse of business to business exchanges proven by the billions of transactions based on X12 standards that are used daily in various industries including supply chain, transportation, government, finance, and health care. Submit these services to the patient's Dental Plan for further consideration.

The AMA does not directly or indirectly practice medicine or dispense medical services. PR = Patient Responsibility.

No fee schedules, basic unit, relative values or related listings are included in CPT. Usage: This code requires use of an Entity Code.

Usage: At least one other status code is required to identify the data element in error.

This definition will change on 7/1/2023 to: Submit these services to the Pharmacy plan/processor for further consideration/adjudication.

Join other member organizations in continuously adapting the expansive vocabulary and languageused by millions of organizationswhileleveraging more than 40 years of cross-industry standards development knowledge. These materials contain Current Dental Terminology (CDTTM), Copyright 2010 American Dental Association (ADA).

See a complete list of all current and deactivated Claim Adjustment Reason Codesand Remittance Advice Remark Codeson the X12.org website. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CDT for resale and/or license, transferring copies of CDT to any party not bound by this agreement, creating any modified or derivative work of CDT, or making any commercial use of CDT. Usage: At least one other status code is required to identify the requested information. Claim Adjustment Reason Codes explain why a claim was paid differently than it was billed. $("#wps-footer-year").text("").text(year); Webclaim adjustment reason code (CAS segment) is used to communicate that an adjustment was made at the claim/service line, and provides the reason for why the payment differs from what was billed. Webhow to remove scratches from garnet washington publishing company claim status codes Usage: At least one other status code is required to identify the data element in error.

7:00 am to 5:00 pm CT (8:00 am to 5:00 pm ET) M-Fri Amount entity has paid. Entity not eligible for benefits for submitted dates of service. Multi-tier licensing categories are based on how licensees benefit from X12's work,replacing traditional one-size-fits-all approaches. The X12 Board and the Accredited Standards Committees Steering group (Steering) collaborate to ensure the best interests of X12 are served. Entity not primary. (866) 518-3285 This form is not used to request maintenance (revisions) to X12 products or to submit comments related to an internal or public review period.

At the policyholder's request these claims cannot be submitted electronically. 24 hours a day, 7 days a week, Claim Corrections:

Was durable medical equipment purchased new or used?

THE ADA DOES NOT DIRECTLY OR INDIRECTLY PRACTICE MEDICINE OR DISPENSE DENTAL SERVICES. Refer to codes 300 for lab notes and 311 for pathology notes, Physical therapy notes.

NO FEE SCHEDULES, BASIC UNIT, RELATIVE VALUES OR RELATED LISTINGS ARE INCLUDED IN CDT. These codes describe why a claim or service line was paid differently than it was billed. Allowable/paid from other entities coverage Usage: This code requires the use of an entity code.

A related or qualifying service/claim has not been received/adjudicated. Entity not referred by selected primary care provider.

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