16 (15)    ADJUSTMENT REASON (161.91)

Name Value
CODE 16
STATUS EFFECTIVE DATE
  • 2003-06-01 00:00:00
    STATUS:   ACTIVE
    FEE USE:   APPLICABLE
DESCRIPTION EFFECTIVE DATE
  • DESCRIPTION:   
    Claim/service lacks information which is needed for adjudication. Addi
    tional information is supplied using remittance advice remarks codes 
    whenever appropriate.
    
  • DESCRIPTION:   
    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.)
    
  • DESCRIPTION:   
    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.)
    
  • DESCRIPTION:   
    Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation. 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.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
    
ASSOCIATED SUSPEND CODE File: 161.27, IEN: 4
SUSPENSION DESCRIPTION
provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
REMITTANCE REMARK
CORE SCENARIO Incorrect Claim Data
ADJUSTMENT GROUP