| Name | Value |
|---|---|
| CODE | 12 |
| STATUS EFFECTIVE DATE |
|
| DESCRIPTION EFFECTIVE DATE |
|
| ASSOCIATED SUSPEND CODE | File: 161.27, IEN: 4 |
| SUSPENSION DESCRIPTION | The diagnosis is inconsistent with the provider type. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. |
| REMITTANCE REMARK |
|
| CORE SCENARIO | Billed Service Not Covered |
| ADJUSTMENT GROUP |
|