Denial code and denial reason of CA Medical insurance

Jul 19, 2010 | Medical billing basics

Medical CA denial code and reason

RAD Code Message
2 Recipient is not eligible for benefits under the Medi-Cal program or other special programs.
6 The date(s) of service reported on the claim is not within the TAR (Treatment Authorization Request) authorized period.
8 The provider of service is not eligible for the type of services billed.
10 This service is a duplicate of a previously paid claim.
12 Medi-Cal benefits cannot be paid without proof of payment/description of the denial from Medicare. Recipient not eligible for Medi-Cal benefits until payment/denial information is given from other insurance carrier.
21 This claim was received after one-year maximum billing limitation.
22 This service is the patient’s liability (Share of Cost).
31 The provider was not eligible for the services billed on the date of service.
33 The recipient is not eligible for special program billed and/or restricted services billed.
36 RTD (Resubmission Turnaround Document) was either not returned or was returned uncorrected; therefore, your claim is formally denied.
37 Health Care Plan enrollee, capitated service not billable to Medi-Cal.
79 Service billed exceeds remaining occurrence approved on the TAR (Treatment Authorization Request).
93 Non-emergency services are not payable for limited service OBRA/IRCA recipients.
116 This procedure is payable only once per month (30 days).
157 Claims for recipients in fabricating optical laboratory counties are limited to frames and dispensing fees only.  Lenses are billed by the fabricating laboratory.
186 This service requires an original Medi label or a Medi-Service reservation for the place of service billed.
243 The TAR Control Number submitted on the claim is not found on the TAR Master File.
250 Quantity exceeds allowed for per-visit codes, or a claim with the same date of service and the same per-visit code was found in history. Medical justification is required.
314 Recipient is not eligible for the month of service billed.
341 Units of service billed exceed the TAR (Treatment Authorization Request) authorized days. Please resubmit with a new TAR Control Number.
351 Additional benefits are not warranted per Medi-Cal regulations.
362 Procedure number billed is not an authorized Medi-Cal procedure code.
691 The diagnosis code is invalid for the date of service.
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