Error codes are reported to providers on Form DHFS 194-M-l, Remittance Advice. A three-character code appears in the farthest column to the right. An error message will appear on the same line directly under each service section(s), starting in the Category of Service Column. The error code is the key to identifying specific procedures for the resolution of errors. Providers must review error messages and take corrective action.

Current error codes and procedures follow. If an error code appears on a remittance advice that is not on this list, please contact the Medicaid Liaison for substance abuse services.

"C" SERIES - VALIDATION ERRORS

The "C" series errors indicate that HFS is unable to process the particular service due to incorrect or insufficient information. Review the billing instructions to determine proper field content and requirements.

ERROR MESSAGE PROCEDURE
C31 Procedure not on file for date Review procedure codes billed ensuring procedure codes listed are valid for the dates of service being billed. If valid code was originally used, contact your DHS representative.
C32 Procedure illogical for category of service Review procedure codes billed ensuring procedure codes listed are valid. If valid code was originally used, contact your DHS representative.

"D" SERIES - MISCELLANEOUS ERRORS

The "D" series of errors includes miscellaneous errors not otherwise listed. Review applicable billing instructions to determine proper field content and resubmittal requirements.

ERROR MESSAGE PROCEDURE
D01 Duplicate payment voucher An invoice was received which was a duplicate of one previously processed. If the claim was not previously paid, contact your DHS representative.
D05 Submitted later than one year after service DHS and/or DHFS will not consider for payment any claim received for charges more than 12 months from the date of service. If the service date is more than one year prior to HFS' receipt of claim, the claim will be rejected.
D22 NO claim found to be adjusted Review adjustment form that was submitted to ensure it was to adjust services that were previously paid. If dates are incorrect, submit new adjustment form. If adjustment originally submitted appears correct, contact your DHS representative.
D23 Duplicate adjustment found for this claim A previous adjustment was submitted on the same original claim.
D97 Denied adjustment Adjustment submitted is being denied. Contact your DHS representative.

"P" SERIES - PROVIDER ERRORS

The "P" series of errors identifies problems associated with provider eligibility. In order to receive payment under the Medical Assistance Program, a provider must be approved for participation and be enrolled to provide the specific category of service for which charges are made.

ERROR MESSAGE PROCEDURE
P03 Provider not enrolled for category of service; date of service

A charge was submitted for which the date of service either precedes the effective date of the provider's enrollment for the category of service or is subsequent to the termination of participation for the applicable category of service.

Review records to verify that dates of service were entered correctly. If incorrect dates were entered, submit corrected claim. If an error cannot be corrected, the provider is to review the Provider Information Sheet for the correctness of beginning and ending enrollment dates for the category of service provider. If the enrollment dates on the Provider Information Sheet appear incorrect, the provider should contact the DHS representative.
P05 Provider number not on file This number should be the exact number as it appears on your Provider Information Sheet from HFS. If incorrect number was submitted, resubmit corrected claim. If original number is correct, contact your DHS representative.
P06 Provider name does not match provider number Submit corrected claim with provider name as registered with HFS. Review claim to verify that provider name and number agree and are entered as shown on the Provider Information Sheet.

"R" SERIES - PROGRAM PARTICIPATION ERRORS

The "R" series of errors indicates that payment cannot be allowed on behalf of the patient for specific services provided on a specific date. By reviewing the exact rejection, the provider can determine what action should be taken. Review billing instructions to determine proper field content and resubmittal requirements.

ERROR MESSAGE PROCEDURE
R02 Recipient name does not match recipient number The patient name and number does not match. Submit a new claim with correct information. Recipient name and number must appear exactly as on MediPlan Card.
R03 Recipient not eligible on date of service An invoice was received for a date of service which does not fall within the range of the patient's medical eligibility period. Review the patient's MediPlan Card to ensure the correct recipient number was used for dates of service being billed. Contact the local DHS office for assistance. If the local DHS office confirms the patient was not eligible on the dates of service, the patient is liable for payment of services. If the provider can obtain proof of eligibility at the time of service, contact your DHS representative.
R06 Spend down not met Recipient not eligible on date of service due to an unmet spend down. Verify patient's eligibility by checking eligibility dates on patient's MediPlan card. If patient is not eligible on date of service, do not rebill.
R10 Services not covered for recipient's category Review recipient category as identified in the Case Number listed on the Medical Eligibility Document of the recipient. Submit a new invoice including correct information. If no billing error occurred, do not rebill.
R17 Service invalid for recipient age An invoice was received with a diagnosis, procedure, or revenue code denoting services which are not covered for patient's age.
R36 Recipient has part B Medicare Bill needs to be submitted to Medicare for payment.
R66 QMB recipient only-not eligible for Medicaid On the date of service, the patient is a QMB recipient and eligible for payment of Medicare co-insurance and deductible only. Provider should bill Medicare.