| PR-1 | Deductible Amount
(also CO-1, OA-1)
| → |
| PR-2 | Coinsurance Amount
(also CO-2)
| → |
| PR-3 | Co-payment Amount
(also CO-3)
| → |
| CO-24 | Charges Covered Under Capitation or Managed Care | → |
| CO-26 | Expenses Incurred Prior to Coverage
(also PR-26)
| → |
| CO-27 | Expenses Incurred After Coverage Terminated
(also PR-27)
| → |
| CO-51 | Pre-Existing Condition Exclusion | → |
| CO-91 | Dispensing Fee Adjustment | → |
| CO-94 | Processed in Excess of Charges | → |
| OA-100 | Payment Made to Patient/Insured | → |
| CO-101 | Predetermination: Anticipated Payment | → |
| CO-102 | Major Medical Adjustment
(also PR-102, OA-102)
| → |
| CO-103 | Provider Promotional Discount | → |
| CO-104 | Managed Care Withhold | → |
| OA-105 | Tax Withholding Amount | → |
| CO-118 | ESRD Network Support Adjustment | → |
| CO-119 | Benefit Maximum Reached | → |
| OA-121 | Indemnification Adjustment | → |
| CO-122 | Psychiatric Services Reduction | → |
| CO-128 | Newborn Services in Mother's Allowance | → |
| CO-130 | Claim Submission Fee | → |
| CO-131 | Claim-Specific Negotiated Discount | → |
| OA-133 | Service Line Pending Further Review | → |
| OA-136 | Failure to Follow Prior Payer's Coverage Rules | → |
| OA-137 | Regulatory Surcharges, Assessments, or Health-Related Taxes | → |
| CO-139 | Contracted Funding Agreement — Subscriber Employed by Provider | → |
| PR-142 | Monthly Medicaid Patient Liability Amount | → |
| OA-143 | Portion of Payment Deferred | → |
| CO-144 | Incentive Adjustment for Preferred Product/Service | → |
| CO-147 | Provider Contracted/Negotiated Rate Expired or Not on File | → |
| CO-160 | Benefit Exclusion — Activity-Related Injury/Illness
(also PR-160, OA-160)
| → |
| CO-161 | Provider Performance Bonus | → |
| CO-166 | Payer's Plan Responsibility Ended | → |
| CO-167 | Diagnosis Not Covered
(also PR-167, OA-167)
| → |
| CO-169 | Alternate Benefit Provided
(also PR-169, OA-169)
| → |
| CO-177 | Patient Eligibility Requirements Not Met
(also PR-177, OA-177)
| → |
| CO-178 | Spend Down Requirements Not Met
(also PR-178, OA-178)
| → |
| CO-179 | Waiting Requirements Not Met
(also PR-179)
| → |
| CO-180 | Residency Requirements Not Met
(also PR-180)
| → |
| PR-187 | Consumer Spending Account Payment Not Approved | → |
| OA-192 | Non-Standard COB Adjustment Code | → |
| CO-197 | Precertification/Authorization/Notification Absent | → |
| CO-198 | Precertification/Authorization Limits Exceeded | → |
| CO-202 | Non-Covered Personal Comfort or Convenience Services | → |
| PR-204 | Service/Equipment/Drug Not Covered Under Benefit Plan
(also CO-204)
| → |
| CO-205 | Pharmacy Discount Card Processing Fee | → |
| OA-209 | Regulatory Non-Collectible Amount | → |
| CO-211 | NDC Not Eligible for Rebate / Not Covered | → |
| CO-212 | Administrative Surcharges Not Covered | → |
| CO-213 | Physician Self-Referral Prohibition Violation | → |
| CO-235 | Sales Tax Not Reimbursable
(also PR-235)
| → |
| PR-238 | Ineligible Coverage Period Reduction | → |
| PR-241 | Low Income Subsidy Co-payment Adjustment
(also CO-241)
| → |
| CO-303 | QMB Patient Responsibility Not Covered
(also OA-303)
| → |
| CO-304 | Benefits Not Available — Submit to Hearing Plan
(also OA-304)
| → |
| CO-305 | Claim Forwarded to Hearing Plan
(also OA-305)
| → |
| CO-A0 | Patient Refund Amount
(also OA-A0)
| → |
| CO-B1 | Non-Covered Visits
(also PR-B1, OA-B1)
| → |
| CO-B10 | Allowed Amount Reduced — Component Already Paid
(also OA-B10)
| → |
| CO-B11 | Claim Transferred to Proper Payer
(also OA-B11, PR-B11)
| → |
| CO-B15 | Qualifying Service/Procedure Not Received
(also OA-B15)
| → |
| CO-P1 | State Mandated Requirement — Property and Casualty
(also OA-P1)
| → |