Horizon NJ Health Denial Code List
Remark and Denial Codes
| Remark | Denial | Description |
| CDD | DEFINITE DUPLICATE CLAIM | |
| CRS | CODE SUPERCEDED-AMA CPT GUIDELINES | |
| CRT | CODE SUPERCEDED-AMA CPT GUIDELINES-DENIED | |
| F47 | PAYMENT REFLECTS COB, IF $0, MAXIMUM LIABILITY WAS MET | |
| F50 | CLAIM ADJ – THIRD PARTY DENIED OR BENEFITS EXHAUSTED | |
| I02 | X02 | ILLEGIBLE RECORDS SUBMITTED; REFILE |
| I04 | X04 | CORRECT NDC CODE REQUIRED FOR CONSIDERATION |
| I05 | X05 | INVALID/DELETED CODE, MODIFIER OR DESCRIPTION |
| I06 | X06 | ITEMIZED BILL/DATES OF SERVICE/CHARGES/ INVOICE REQUIRED |
| I08 | X08 | DIAGNOSIS INVALID/MISSING/DELETED REQUIRED 4TH/5TH DIGIT |
| I10 | E-CODE CANNOT BE USED AS PRIMARY DIAGNOSIS | |
| I11 | X11 | EOB FROM PRIMARY CARRIER REQUIRED |
| I18 | PAID BILLED CHARGES | |
| I19 | X19 | CARRIER OF SERVICE-HORIZON HEALTHCARE DENTAL SERVICE |
| I22 | X22 | RESUBMIT WITH VISIT CODES & CHARGES |
| I24 | X24 | CARRIER OF SERVICE-DAVIS VISION |
| I26 | X26 | EXHAUSTION OF BENEFITS |
| I27 | X27 | SUBMIT MEDICAL RECORDS TO HORIZON NJ HEALTH APPEALS UNIT |
| I28 | REPROCESSED-CLAIM SUBJECT TO INTEREST | |
| I30 | X30 | SERVICE EXCEEDS LIFETIME LIMITATION |
| I37 | X37 | RESUBMIT WITH APPROPRIATE MODIFIER AND/OR TIME UNITS |
| I42 | X42 | ILLEGIBLE/INCOMPLETE/INAPPROPRIATE REFERRAL RECEIVED |
| I43 | X43 | BI-LATERAL PROCEDURE PREVIOUSLY PAID WITH MODIFIER “50” |
| I44 | X44 | RESUBMIT WITH ICD/9 PRINCIPLE PROCEDURE CODE |
| I47 | X47 | NON CONTRACTED LEVEL OF CARE |
| I48 | Z48 | RESUBMIT TO PRIMARY CARRIER FOR APPEALS PROCESS |
| I64 | X64 | CAPITATED TO ANOTHER PROVIDER |
| I65 | DUPLICATE CLAIM-PREVIOUSLY DENIED APPROPRIATELY | |
| I68 | INVALID PLACE OF SERVICE FOR PROCEDURE | |
| I83 | X83 | MOTHER’S BILL NOT RECEIVED – REFILE |
| I98 | TOTAL BILLED STILL UNDER CONSIDERATION | |
| N02 | REDUNDANT PROCEDURE DISALLOW | |
| N06 | ASSISTANT SURGEON DISALLOW | |
| Q17 | ADMINISTRATIVE OVERTURN | |
| R00 | X00 | PAYMENT INCLUDED IN OTHER BILLED SERVICES |
| R01 | X01 | NO PRECERT/AUTHORIZATION OR REFERRAL |
| R07 | X07 | RECEIVED AFTER TIMELY FILING TIME LIMIT |
| R09 | X09 | REQUESTED HOSPITAL DOCUMENTS NOT RECEIVED |
| R10 | X10 | NOT ENROLLED ON DATE OF SERVICE |
| R15 | SUBSET/INCIDENTAL PROCEDURE DISALLOW | |
| R18 | RESUBMIT WITH ICD PRINCIPAL PROCEDURE, HCPCS OR CPT CODE | |
| R37 | COMBINED PAYMENT-MOTHER & BABY | |
| R38 | CONTRACTED FEE | |
| R39 | X39 | DUPLICATE CLAIM PREVIOUSLY PAID AT CORRECT RATE OR CAPITATION |
| R40 | X40 | DUPLICATE CLAIM-ORIGINAL STILL UNDER CONSIDERATION |
| R42 | DRG PAYMENT | |
| R43 | INTERIM BILL PAYMENT | |
| R44 | MULTIPLE SURGICAL REDUCTION | |
| R45 | X45 | COMPLETE MED RECORDS REQUIRED FOR CONSIDERATION; REFILE |
| R46 | X46 | OVER MAX PROCEDURE/BENEFIT LIMIT (All LOBs) |
| R47 | PAYMENT REFLECTS COORDINATION OF BENEFITS, IF $0, MAX LIABILITY MET | |
| R49 | X49 | PREVIOUS PYMTS EQUAL TO PURCHASE PRICE |
| R50 | X50 | SAME PROCEDURE PAID TO A DIFFERENT PROVIDER |
| R51 | X51 | SERVICE NOT COVERED |
| R53 | X53 | SERVICES WERE NOT PROVIDED |
| R55 | BILLED INFORMATION REFLECTS LOWER DEGREE ACUITY/TREATMENT | |
| R56 | ADMINISTRATIVE APPROVAL | |
| R59 | X59 | AUTHORIZATION/REFERRAL EXPIRED |
| R60 | X60 | DATES AND/OR SERVICES OUTSIDE REFERRAL/AUTHORIZATION |
| R61 | X61 | NO PCP REFERRAL |
| R65 | INTERIM BILL 2ND CYCLE PAYMENT | |
| R66 | Z34 | INTERIM BILL FINAL CYCLE PAYMENT |
| R67 | X67 | DISCREPANCY WITH LEVEL OF CARE-APPEAL REQUIRED |
| R70 | X70 | EPSDT SCREENING DID NOT COMPLY WITH PERIODICITY SCHEDULE |
| R71 | X71 | DUPLICATE OF PREVIOUSLY SUBMITTED EPSDT SCREENING |
| R72 | X72 | PROVIDER WAS NOT MEMBER’S PCP |
| R78 | R78 | MEMBER’S AGE NOT VALID FOR PROCEDURE CODE |
| R79 | X79 | SPECIAL PROJECT-ADJUSTMENT |
| R81 | X81 | CHARGES CONSIDERED INCLUDED IN INPATIENT ADMISSION |
| R84 | X84 | PLEASE OBTAIN INDIVIDUAL PROVIDER ID # |
| R86 | X85 | INVALID/MISSING REVENUE CODE ON CLAIM |
| R89 | AUTHORIZATION ON FILE FOR TECHNICAL COMPONENT | |
| R91 | X91 | INAPPROPRIATE CODING FOR CONTRACT AGREEMENT |
| R95 | X95 | CLAIM SUBMITTED WITHOUT PHYSICIAN NAME |
| R96 | X96 | EOB/ATTACHMENTS WERE INCOMPLETE/ILLEGIBLE |
| R97 | X97 | DATE OF SERVICE CANNOT BE GREATER THAN THE RECEIVED DATE |
| X12 | MOTOR VEHICLE ACCIDENT – AUTO CARRIER PRIMARY | |
| X13 | WORKERS COMPENSATION PRIMARY CARRIER | |
| X21 | BILL THROUGH PHARMACY PROGRAM | |
| X25 | INCLUDED IN SETTLEMENT PAYMENT | |
| X32 | APPEAL – DENIAL UPHELD | |
| X33 | APPEAL – ORIGINAL CLAIM PAYMENT UPHELD | |
| X35 | AUTHORIZATION DENIED FOR THIS DATE OF SERVICE | |
| X55 | MEMBER AGE NOT VALID FOR DIAGNOSIS CODE | |
| X56 | CLINIC CLAIM SUBMITTED WITHOUT PHYSICIAN NAME | |
| X57 | THIS “V” DIAGNOSIS CANNOT BE BILLED ALONE | |
| X62 | INVALID/MISSING DRG | |
| X68 | X68 | INVALID UNITS SUBMITTED |
| X77 | INCORRECT PROVIDER NAME/TIN IDENTIFICATION # SUBMITTED | |
| X94 | PROVIDER NUMBER SUBMITTED VIA EDI INCORRECT/TERMINATED | |
| X78 | X78 | COMBINED PAYMENT – MOTHER AND BABY |
| Z19 | Z19 | CARRIER FOR SERVICE-HORIZON BLUE |
| Z47 | Z47 | SUBMIT CHARGES TO MA FEE-FOR-SERVICE PROGRAM |
| Z50 | SUBMIT CHARGES TO MEDICAID FEE FOR SERVICE PROGRAM | |
| Z92 | INVALID OR MISSING PLACE OF SERVICE | |
| Z99 | Z99 | CODE NOT PAYABLE FOR PROVIDER SPECIALTY NO FEE ON FILE |
| Z55 | NOT AUTHORIZED UNDER CONTRACT TO PROVIDE THIS SERVICE |
