{"aaData": [["01", "
PRICE AUTHORIZATION EXPIRED
\n", ""], ["0A", "
TESTING NOT INCLUDED
\n", ""], ["0B", "
REQUEST FORWARDED TO AND DECISION RESPONSE FORTHCOMING FROM AN EXTERNAL REVIEW ORGANIZATION
\n", ""], ["0C", "
AUTHORIZATION/ACCESS RESTRICTIONS
\n", ""], ["0D", "
REQUIRES PCP AUTHORIZATION
\n", ""], ["0E", "
PROVIDER IS NOT PRIMARY CARE PHYSICIAN
\n", ""], ["0F", "
NOT MEDICALLY NECESSARY
\n", ""], ["0G", "
LEVEL OF CARE NOT APPROPRIATE
\n", ""], ["0H", "
CERTIFICATION NOT REQUIRED FOR THIS SERVICE
\n", ""], ["0J", "
CERTIFICATION RESPONSIBILITY OF EXTERNAL REVIEW ORGANIZATION
\n", ""], ["0K", "
PRIMARY CARE SERVICE
\n", ""], ["02", "
PRICE AUTHORIZATION NO LONGER REQUIRED
\n", ""], ["0L", "
EXCEEDS PLAN MAXIMUMS
\n", ""], ["0M", "
NON-COVERED SERVICE
\n", ""], ["0N", "
NO PRIOR APPROVAL
\n", ""], ["0P", "
REQUESTED INFORMATION NOT RECEIVED
\n", ""], ["0Q", "
DUPLICATE REQUEST
\n", ""], ["0R", "
SERVICE INCONSISTENT WITH DIAGNOSIS
\n", ""], ["0S", "
PRE-EXISTING CONDITION
\n", ""], ["0T", "
EXPERIMENTAL SERVICE OR PROCEDURE
\n", ""], ["0U", "
ADDITIONAL PATIENT INFORMATION REQUIRED
\n", ""], ["0V", "
REQUIRES MEDICAL REVIEW
\n", ""], ["03", "
PRODUCT NOT ON THE PRICE AUTHORIZATION
\n", ""], ["0W", "
DISPOSITION PENDING REVIEW
\n", ""], ["0X", "
SERVICE INCONSISTENT WITH PROVIDER TYPE
\n", ""], ["0Y", "
SERVICE INCONSISTENT WITH PATIENT'S AGE
\n", ""], ["0Z", "
SERVICE INCONSISTENT WITH PATIENT'S GENDER
\n", ""], ["10", "
PRODUCT/SERVICE/PROCEDURE DELIVERY PATTERN (e.g., UNITS, DAYS, VISITS, WEEKS, HOURS, MONTHS)
\n", ""], ["11", "
PRICING
\n", ""], ["12", "
PATIENT IS RESTRICTED TO SPECIFIC PROVIDER
\n", ""], ["13", "
SERVICE AUTHORIZED FOR ANOTHER PROVIDER
\n", ""], ["14", "
PLAN/CONTRACTUAL GUIDELINES NOT FOLLOWED
\n", ""], ["15", "
PLAN/CONTRACTUAL GEOGRAPHIC RESTRICTION
\n", ""], ["04", "
AUTHORIZED QUANTITY EXCEEDED
\n", ""], ["16", "
INAPPROPRIATE FACILITY TYPE
\n", ""], ["17", "
TIME LIMITS NOT MET
\n", ""], ["18", "
NOTIFICATION RECEIVED
\n", ""], ["19", "
COSMETIC
\n", ""], ["20", "
ONCE IN A LIFETIME RESTRICTION APPLIES
\n", ""], ["21", "
TRANSPORT REQUEST DENIED
\n", ""], ["22", "
AMBULANCE CERTIFICATION SEGMENT INFORMATION DOESN'T CORRESPOND TO TRANSPORT ADDRESS SEGMENT
\n", ""], ["23", "
MILEAGE CANNOT BE COMPUTED BASED ON DATA SUBMITTED
\n", ""], ["24", "
COMPUTED MILEAGE IS INCONSISTENT WITH TRANSPORT INFORMATION OR SERVICE UNITS SUBMITTED
\n", ""], ["25", "
SERVICES WERE NOT CONSIDERED DUE TO OTHER ERRORS IN THE REQUEST
\n", ""], ["05", "
SPECIAL COST INCORRECT
\n", ""], ["26", "
MISSING PROVIDER ROLE
\n", ""], ["06", "
NO CREDIT ALLOWED
\n", ""], ["07", "
ADMINISTRATIVE CANCELLATION
\n", ""], ["08", "
UNIT RESALE HIGHER THAN AUTHORIZED
\n", ""], ["09", "
OUT OF NETWORK
\n", ""]]}