| Code | Display |
| ELIG-001 | Patient is not a covered member |
| ELIG-005 | Services performed after the last date of coverage |
| ELIG-006 | Services performed prior to the effective date of coverage |
| ELIG-007 | Services performed by a non-network provider |
| AUTH-001 | Prior approval is required and was not obtained |
| AUTH-003 | PriorAuthorizationNumber is invalid |
| AUTH-004 | Service(s) is (are) performed outside authorization validity date |
| AUTH-005 | Claim information is inconsistent with pre-certified/authorized services |
| AUTH-006 | Alert drug - drug interaction or drug is contra-indicated |
| AUTH-007 | Drug duplicate therapy |
| AUTH-008 | Inappropriate drug dose |
| AUTH-009 | Prescription out of date |
| AUTH-010 | Authorization request overlaps or is within the period of another paid claim or approved authorization |
| AUTH-011 | Waiting period on pre-existing / specific conditions |
| AUTH-012 | Request for information |
| BENX-002 | Benefit maximum for this time period or occurrence has been reached |
| BENX-005 | Annual limit/sublimit amount exceeded |
| CLAI-007 | Claim is a work-related injury/illness and thus the liability of the employer |
| CLAI-008 | Claim overlaps inpatient stay. Resubmit only those services rendered outside the inpatient stay |
| CLAI-009 | Date of birth follows the date of service |
| CLAI-010 | Date of death precedes the date of service |
| CLAI-011 | Inpatient admission spans multiple rate periods. Resubmit separate claims |
| CLAI-012 | Submission not compliant with contractual agreement between provider & payer |
| CLAI-014 | Claim not compliant with Resubmission type (used only for resubmissions) |
| CLAI-017 | Services not available on direct billing |
| CLAI-018 | Claims Recalled By Provider |
| CODE-010 | Activity/diagnosis inconsistent with clinician specialty |
| CODE-012 | Encounter type inconsistent with service(s) / diagnosis |
| CODE-013 | Invalid principal diagnosis |
| CODE-014 | Activity/diagnosis is inconsistent with the patient's age/gender |
| CODE-015 | Activity/diagnosis is inconsistent with the provider type |
| DUPL-001 | Claim is a duplicate based on service codes and dates |
| DUPL-002 | Payment already made for same/similar service within set time frame |
| MNEC-003 | Service is not clinically indicated based on good clinical practice |
| MNEC-004 | Service is not clinically indicated based on good clinical practice, without additional supporting diagnoses/activities |
| MNEC-005 | Service/supply may be appropriate, but too frequent |
| MNEC-006 | Alternative service should have been utilized |
| NCOV-001 | Diagnosis(es) is (are) not covered |
| NCOV-002 | Pre-existing conditions are not covered |
| NCOV-003 | Service(s) is (are) not covered |
| NCOV-025 | Service(s) is (are) not performed (used after audit) |
| PRCE-001 | Calculation discrepancy |
| PRCE-002 | Payment is included in the allowance for another service |
| PRCE-003 | Recovery of Payment |
| PRCE-006 | Consultation within free follow up period |
| PRCE-007 | Service has no contract price |
| PRCE-008 | Multiple procedure payment rules incorrectly applied |
| PRCE-009 | Charges inconsistent with clinician specialty |
| PRCE-010 | Use bundled code |
| PRCE-011 | Discount discrepancy |
| TIME-001 | Time limit for submission has expired |
| TIME-002 | Requested additional information was not received or was not received within time limit |
| TIME-003 | Appeal procedures not followed or time limits not met |
| COPY-001 | Deductible/co-pay not collected from member |
| SURC-001 | Severe drug - drug interaction |
| SURC-002 | Severe drug - age contraindication |
| SURC-003 | Severe drug - gender contraindication |
| SURC-004 | Severe drug - diaganosis contraindication |
| SURC-005 | Severe procedure\service - diagnosis contraindication |
| SURC-006 | Severe procedure\service - drug contraindication |
| SURC-007 | Severe procedure\service - procedure contraindication |
| SURC-008 | Serious safety issue with drug dose |
| WRNG-001 | Wrong submission, receiver is not responsible for the payer within this transaction submission. |
| CLAI-019 | Wrong IR-DRG code |
| CLAI-020 | Missing IR-DRG code |
