What's Your Job Profile: Gina Fricke

Therapist Gina Fricke, of Peace and Power Counseling, was included in a "What's Your Job?" roundup feature in the Sunday, Sept. 5 edition of the Omaha World-Herald.

Therapist Survey: Subleased Office Space (Part 4)

This is the fourth post in a five-part series of articles based on a July 2010 survey of therapists regarding office space subleases. Previous articles examined fees and amenities offered, an analysis of factors related to deciding which practice to affiliate with, and how referrals and emergency coverage issues are handled.

The most useful part of the survey was the advice given by therapists about renting office space. Experience is the best teacher, and therapists participating in this survey have either rented space from another therapist, or are a "landlord" themselves, renting space to other therapists (or, in some cases, they have experience on both sides of the equation).

Therapists provided guidance for what questions to ask/issues to consider when subleasing space:

• What does my rental fee include? (Billing, scheduling, referrals, consultation group, marketing, inclusion on practice website?)
• Ask about additional fees up front: Are any fixtures to be added or modified, and who will be responsible for paying this fee?
• Ask for a full disclosure of costs for the space and for how much profit the therapist will make from the rent/fees you will be paying them.
• "Consider sharing space with other independent therapists over renting space from a therapist. The costs can be cheaper, there is more equality in decision-making, there are no hierarchies, and there is full disclosure about what you are paying for and what you are getting."
• Will I be getting referrals?

A couple of therapists provided their ideas of a "model" situation:

• "I would want 100% of my counseling fees and pay a monthly rental fee. I would pay per referral, if referrals were given to me. I would not sign a non-compete, because clients ethically should not just be handed over to someone else if I decide to leave. I would want a very explicit plan for how call-ins to the office were handled, and how I would know that my calls would be mine. Personally, I would want my counseling philosophy to 'gel' with others in the office."
• "Try to get office/secretarial support, telephone, and a couple referrals per month."

"It may be helpful to start out renting space from another therapist when learning the ropes of private practice, but it is important to know exactly what is entailed in the contract, how decisions will be made, and what actions will be taken to address concerns about the space or services," one therapist wrote.

Others gave advice on which issues to focus on when selecting a practice to affiliate with:

• "Check for compatibility of clientele and for confidentiality issues."
• Look at the general style of the office (culture, feel, fit)
• "I have done a percentage before, but I believe a flat fee is best, because you know how to plan."
• "Each therapist should share either similar values, or be compatible. They should know the reputation of the persons they are renting with or to/from. When sharing with several people, they all should get a say about who might also join the practice."

It's important to examine the whole financial picture, not just the rental fee.

• "Private practice has many hidden and unforeseen costs: legal, accounting, consultation, and practice building." Consider these when choosing a practice as well.
• "Compare costs and what that cost gets you in amenities."
• "A private practice is a business, and to assume that one gets referrals just for being there is naive. Business development is complex, time-consuming, and costs money."
• "Remember that going out on your own can be challenging too. If you share office space or a building, you can share office equipment, phones, and Internet. This can save you a lot of money. Not to mention electricity and office materials, such as paper towels, etc. In the office I am in, I do not have to clean the office either, as this comes along with the rent."

One therapist provided an innovative suggestion: "If you start with a percentage arrangement, make a cap and change to a flat monthly fee once the cap is consistently reached for six months to one year." This will help the renter decrease his or her overhead as he or she gets more successful.

Be sure to ask about how referrals are handled. 

One therapist noted, "I was fortunate to have a large referral base prior to coming to this office, and I had a lot of referrals that went directly to me. Sharing referrals can be challenging if you are just starting out, but as you continue to build your referral base, people will begin asking for you. In a shared office, this can be challenging, as everyone wants to have business."

One therapist recommends a careful self-analysis before seeking a practice affiliation. "Where are they in their profession? What is needed? How much time do they want to make available to do the support work, marketing, and business development?" Ensuring you select the practice that provides the services you need/expect will make the arrangement a beneficial one for both the subleasing therapist and the practice or "landlord therapist."

Another therapist cautions peers not to simply limit their focus on the financial aspects of the selection process. "By far and away it is most important that you know and trust the personal and professional ethics that the other therapists have in the office you are using. Everything else comes down to money, and that's not as critical."

Compatibility is key. "It is important to know the therapists, or at least talk to them in depth, to see if your personalities are a fit." Another therapist added, "Don't rent from a therapist who wants to tell you how to do therapy. I have never had that problem, but others have."

"Know the dynamics of the other partners with whom you share space. Seek quality, ethical concerns, and professional compatibility. Being picky is best."

Several therapists advised getting the contract terms in writing. "Read it carefully and compare it to either past contracts or standard ones," one noted. Another added, "Get everything in writing, and have each therapist sign it. This prevents misunderstandings and complications at a later time." Make sure the contract notes the specific rights and responsibilities of each party. "Read the contract! Know exactly what you are getting."

And get everything hammered out up front, if possible. "Negotiate before signing; doing so afterwards gets thorny."

Even finding the perfect office sublease situation, getting into private practice can be difficult, as one therapist reminds us. "You need to be fully licensed, in network with many insurance providers, and have a good base of clientele you might bring with you. Even with that, it is difficult for about a year to make any money."

One concluded, "I've been very fortunate, but it's important to have a contract with those in the same office so that all expectations are understood by all."

Therapist Survey: Subleased Office Space (Part 3)

This post reports additional results from a survey conducted in July 2010. Previous posts have examined the costs and amenities available when renting office space and the issues therapists consider when selecting a subleasing arrangement.

One issue for contracting therapists is access to referrals, especially in a large practice. Unless the therapist has his or her own clientload -- or can build one independently of calls into the practice, renting space can make it difficult to attract clients.

Forty-one percent of therapists renting space had access to referrals within the office as part of the rental fee. One-third of therapists surveyed did not have access to internal referrals. Another third received referrals on a case-by-case basis.

When asked about referrals, some responses included:

• "Referrals are not part of the rental fee. However, referrals are frequent."
• "They go to partners first and then to contractors."
• "Referrals (are) provided as appropriate for patients, not as part of fee."
• From a therapist who rented space to other therapists: "If referrals were specifically for me, I kept them or referred them; other referrals were divided up by therapist/renter."

Another key issue is emergency coverage. In nearly three-quarters of the situations, no on-call services are provided for any therapists -- each therapist provides his or her own emergency coverage. In 13% of the situations, renter serve as an on-call therapist for clients (all therapists in the office rotate providing emergency coverage). Ten percent of therapists had access to emergency services through special arrangement:

• "My rent is adjusted slightly to include on-call service for my clients."
• "No coverage for purely renting space, but it would be possible if interdependence desired."
• "Phone coverage includes message service to contact each therapist in case of emergency.

Therapist Survey: Subleased Office Space (Part 2)

This is part 2 of the results of a July 2010 survey of therapists regarding office space subleasing. This post examines issues of deciding which practice to affiliate with.

Therapists have a choice of where they want to rent space. Some factors cited in influencing their decision about where to rent space include:

• Location -- interstate access; the part of town the office is located in, etc. -- 15%
• Rental cost -- 15%
• The therapists you would be working with -- 14%
• The "general feel" of the arrangement/office -- 13%
• Site accessibility (i.e., handicapped accessible) -- 10%
• Layout of office -- 9%
• Security -- 6%
• Amenities available -- 5%
• Reception area -- 4%
• Marketing availability -- 3%
• Availability of administrative support -- 3%
• Availability of billing services/support -- 3%

Most therapists choose to affiliate with other mental health practitioners. However, in addition to renting from other mental health therapists, a few therapists rented space from other types of practitioners, including a psychiatrist and a doctor's group.

The next post in the series examines how referrals and emergency coverage is handled when subleasing space.

Therapist Survey: Subleased Office Space (Part 1)

Are you a therapist who is interested in renting office space -- or are you a therapist who has space available for rent? A July 2010 survey of therapists reveals pricing and amenity details, and participating therapists give advice on making an arrangement work for you.

The survey was completed by 39 therapists. Nineteen percent of respondents have rented space from a non-therapist landlord; 38 percent have rented space from another therapist. To provide a balanced perspective, 32 percent are therapists who rent (or have rented) space to other therapists (a "landlord's view). The majority of responses (75%) came from Omaha-area therapists.

When it comes to fees, it is difficult to compare apples to apples. However, from the information supplied, a few general conclusions can be drawn.

Part-time rentals generally are in the $150 to $750 per month range. Full-time rentals most often cost $1,000+ per month. The overall average (including both part-time and full-time) rentals was $726 per month.

Most space is rented for a flat fee, although a small percentage (25%) of respondents reported their rent is a percentage of the session fee billed or collected. These figures were more consistent -- the most-often cited figure was 35% of the amount collected. Other options were 30% of the amount billed, and 1/3 of the total office rent.

There was insufficient data on hourly rental rates to draw any conclusions.

In exchange for the rent, therapists generally receive:

• Exclusive use of a private office (12%) vs. shared office space (5%)
• Administrative support (6%)
• Billing services (7%)
• Access to conference room/meeting space (8%)
• Copier/Fax (11%)
• Consumables, like office supplies (8%)
• Participation in marketing/advertising (8%)
• Telephone (11%)
• Internet access (10%)
• Checking patient insurance benefits and/or securing insurance authorizations (9%)
• Access to emergency coverage (5%)

Therapists are generally required to carry their own liability insurance when renting space. However, in some circumstances, liability/property insurance was included.

Some rental agreements offered some flexibility in services offered. One therapist reported their agreement was based on the "percent of overhead used," what supportive services were included, and whether marketing was needed.

Next post: Selecting which practice to affiliate with.

Links to Billing Teleseminars

You can find information about Billing Questions Teleseminar #1 (June 9) here and Billing Questions Teleseminar #2 (July 14) here. Please note that the Billing Questions Teleseminar that was scheduled for Aug. 11 was cancelled due to an injury to the guest speaker.

Why Online Directories Are A Smart Investment

Why should you advertise your private therapy practice in an online directory?

This is a question that I'm often asked by therapists. "Shouldn't I develop my own website and get clients to find me online where I'm not surrounded by all the other therapists who do what I do, or work where I work?"

Absolutely you should have your own website. And an online profile in a directory can help drive clients to your website. It can also spur calls to your practice directly, from clients who like your profile and need help immediately.

The second concern is the idea that if a client is looking for a therapist online, he or she will not choose YOU; instead, he or she will choose another therapist. That is a very real possibility, obviously. However, if you use the personal branding concepts I've talked about before on this blog (and wrote about in my book, "Therapist's Guide to Branding Yourself Online"), you'll attract the kinds of clients you most want to work with.

People often choose directories because of the variety they offer. You know you're going to get access to a range of service providers -- but there is bound to be one that feels like a fit. The Yellow Pages work because there are a lot of companies in there. It wouldn't be used as much if there were only 2 plumbers listed, or 1 attorney.

Today's Billing Teleseminar is Cancelled

Today's billing teleseminar is cancelled. Our guest, Deb Winsor, was a victim of a physical assault and will be unable to make today's call. 

Billing Questions Teleseminar #2 (July 14, 2010)

The second Billing Questions Teleseminar was held on Wednesday, July 14, 2010.

Download the .mp3 audio file here.

(You can find information about Billing Questions Teleseminar #1 (June 9) here.

Our guest was Deb Winsor of W-Tech Solutions. Here is an abbreviated transcript of the call.

Bridget: Thanks so much for joining us today for “Billing Questions,” your chance to get your mental health billing questions answered.

My name is Bridget (Weide) Brooks, and I’ll be your host for today’s call, which is sponsored by w-Tech Solutions Inc. and TherapySites.com.

This is our second teleseminar call, and I’m thrilled to be able to offer therapists the chance to ask questions of our distinguished guest, Deb Winsor, of W-Tech Solutions. A little background on Deb: she has a bachelor’s degree in business administration from the University of Nebraska Lincoln worked in a hospital setting for more than five years before joining what we call an extremely well-known insurance company here in Omaha, where she has worked for the past 11 years. Deb has experience with Medicare, Medicaid, managed Medicaid, PPO insurance, Tricare, and numerous other insurance companies and she has a wealth of information to offer to therapists who have questions about billing or insurance. Her company, W-Tech Solutions, provides billing services to mental health therapists. Welcome, Deb!

Deb: Thank you.

Bridget: So, just like last time, first off, I wanted to let the therapists who are participating live on the call ask their questions, and then we’ll get to the questions that were submitted by therapists via e-mail. So if there is anyone on the call with a question, let’s go ahead and take it now.

Caller #1: My question is how much transferability is there between how Medicaid in Nebraska handles claims and requirements versus Medicaid in other states — particularly Kansas? My office partner and I are both located in the greater Kansas City area.

Deb: My first question is: Do you have any patients that have Nebraska Medicaid?

Caller #1: No.

Deb: So your patients have Kansas Medicaid? Correct?

Caller #1: Will have. Right.

Deb: Each state has their own program. It’s on a state-by-state basis. But I am trying to find on the web if there is any kind of provider line for you.

Caller #1: We’re both in the process of applying for (Kansas Medicaid). I was a (Medicaid) provider in Nebraska. I think we probably have the provider line (number).

Deb: So you are in the process of setting up your provider status with Kansas Medicaid, and you’ve contacted them. The paperwork is in the mail.

Caller #1: And (my office partner) has been a Kansas Medicaid provider in other situations (with other employers).

Deb: So they’re going to send you a packet of information and assign you a specific number. Once that is done, they will send you a letter of acceptance, stating that you are now eligible to see this type of patient. You should be able to file claims electronically to them. As far as that is concerned, the billing itself is just a different location, but it’s the same CPT codes. You fill out your HCFA 1500 form the same way, and you shouldn’t have any problems. I would just say make sure you cross your “t”s and dot your “I”s and you shouldn’t have a problem. But any questions with them, contact their office.

Bridget: To answer the caller’s question also, each state administers their own program, so while federal guidelines are the same, each state is allowed to contract with its own providers, for example, with Managed Medicaid, so that’s where you’re going to get a little bit of discretion for how things are authorized, paid, and that sort of thing. If Magellan is administering the Medicaid in Kansas, you might see that a lot of their policies and procedures are the same (as in Nebraska), because they don’t want to duplicate efforts across the different states, but if it is a different provider – Coventry, or some other one — that’s when you’re likely to see a little bit of difference between how they do things. I know Magellan and the state of Nebraska right now are working to clarify some of the service definitions in particular in Nebraska, and there has been a little bit of back and forth on that on how they’re clarifying certain things and how they want to handle medical necessity and those sorts of things. So probably the first step is to find out who is administering Medicaid and that might give you some sort of insight into how much will be transferable.

Caller #1: We’re in the process of applying for Tricare – I think it was Tricare -- and (my office partner was) told that they were holding off on accepting new applications, but that she could be a “pseudo-provider,” which was a new term.

Bridget: I’ve never heard of a “pseudo-provider” before. What kinds of rights and responsibilities does a pseudo-provider have?

Caller #1: Well, that’s what we didn’t know. We didn’t know if there was a “pseudo-provider application” – but I wondered if you were familiar with this term. She was told she could go ahead and bill as if she was a provider, but I wondered if you had heard of this.

Deb: What is her credentials?

Caller #1: She is a licensed, master’s-level psychologist, so “LMLP.”

Deb: I have never heard that term (“pseudo-provider”) before. Usually, with Tricare, you have your Tricare Prime... Be very careful with Tricare. They are very good about paying, but make sure you have your pre-authorizations before you submit for your services because if you don’t have your authorizations, they will either deny, or they will pay at a much lower benefit. Also, for the member (for out of network services), they have a much larger deductible rather than a certain dollar amount of a copay.

Bridget: That might be a good question to call the provider relations folks and ask them.

Deb: I would call their provider line and ask them about that. Because the first thing that came to my mind was maybe that it was like a PLMHP that was submitting under an auxiliary provider.

Caller #2: It didn’t seem to be about my licensure, it seemed to be about having me be part of a group that was already established. She (the provider relations rep) didn’t explain it well.

Bridget: So it seemed to be part of a network provider issue rather than a credentialing provider issue.

Caller #2: Right.

Bridget: I am Googling the words “Tricare” and “pseudo-provider” and they use the word “pseudo” a lot, so I think they like that word.

Caller #1: I hope they don’t send “pseudo-payment!”

Bridget: I agree with you! They talk about “pseudo sponsor IDs” and “pseudo social security numbers” — so specifically what they are referring to in terms of your responsibilities would be a great question for your provider relations representative. Ask them: What distinguishes me as a “pseudo” from a “real”? I wonder if maybe it’s that their network is pretty full, but they don’t want to turn you down flat, just in case they need you later.

Deb: They might have restrictions on how many providers they can actually have on the panel. I’ve seen that before, once in a while. Like a waiting list.

Bridget: So you can see them, but maybe it’s on a case-by-case basis. But I agree with Deb, you want to make sure you’re approved and pre-authorized for specific sessions and clients before you see them… because “pseudo” or not, you don’t want that “pseudo-payment.”

Deb: I am going to do some research on this, and I’ll send Bridget my findings. I would love to give you a definite answer. I pride myself on getting the right answer, and I want to find the right answer for you before I give out any information. Let me research it and I will give Bridget an e-mail and have her forward it on.

Bridget: Next up are questions we received via e-mail from therapists who weren’t able to make the call live, but wanted to get their questions in.

Question: Do the CPT codes for home visits have a certain time frame, and if so, are they 15-minute increments, like health and behavior interventions?

Deb: I have researched this, and I have personal experience with this too. The answer to that would be, the information I have is that you should just bill as if you were in the office. You can use your 90806s, 90801s as if you were in the office. You would bill the same as if you’re out of the office at a patient’s home. I can tell you from experience, when we moved to our current home, my son was little at the time and he was having a little harder time adjusting, so we had a very nice man come out, an LMHP, and he sat with my son and spoke with him for 50 minutes at a time, two or three times a month. I got to stay in the home; I didn’t have to drive anywhere. He just submitted the regular 90806 to the insurance company, and they paid. It was almost as if we were in the office, just a different location, and it got paid like a normal office claim.

Bridget: So, in general, they would be paid – but, if you had a particular claim, this would be a good question to ask the specific insurance company.

Deb: I would. It’s always good to call if you have any doubts, to ask questions. They are always willing to answer, and you won’t be the first one to ask, and you won’t be the last one to ask. To my (personal) experience — and to my billing experience — you can bill the same code that you would as if you were in the office.

Bridget: And with the same time length.

Deb: Right. If you’re seeing them for 25-30 minutes, you’d bill them 90804, but 45-50, 60-75, use the right code.

Bridget: And that’s face-to-face interaction; you can’t count your driving time.

Deb: Right.

Question: We received this question from a therapist after the first billing teleseminar call: I just listened to the recording of the initial billing teleseminar and am a little confused about using my tax id instead of my social security number on claims. I already have a federal tax id, but was told by my tax preparer that I should use only my social security number so I've billed with it for years. Since I already have the federal id, do I just contact each insurance company I participate with and have my information changed?

Deb: I was glad we got this question. It’s a very good question. My answer to that would be: With regards to privacy (and this is what I was trying to say last time), I am very proactive when it comes to HIPAA and personal privacy. I go above and beyond what is required.

With regard to privacy, any time you can keep you SSN for the purpose of personal tax identification, the better. If you choose to have an EIN (Federal Tax ID), that helps protect your personal social security number information from identity theft and other fraud activities. This is the reason why I was suggesting an EIN during the seminar; as I’m a big proponent for personal identity security, and I feel that an EIN gives you a layer of protection.

If you have an EIN, all the better. It would be great to use that. However, her tax preparer is correct. She can use her social security number but in regards to identity theft, if you don’t submit electronically (if you submit by paper), yes, the post office is safe, but anything can happen. It can just take one minor mistake and your social security number could be out in the open.

I’d like to go on to say: When you sign a contract with an insurance company, you are doing so under some type of identifying number: your SSN or an EIN. If you signed those contracts under your SSN, it can be difficult to switch to an EIN as, in many cases, the insurance company will want a new contract signed using the appropriate identification number (or they’ll want to update your current contract).

You can bill under either identification number; just make sure you are billing using the number used when you signed with the insurance companies. If a claim is submitted using your EIN, but you signed/registered with the insurance company using your social security number, payment of benefits may be extremely delayed or they could be denied.

My personal preference is to use an EIN as that allows you a level of personal security because your personal SSN is not distributed to so many people with whom you do not know. However, since you have been billing under your social security number for so long (this is a provider who had been in business for a number of years), switching to your EIN can be cumbersome. You can call the insurance companies that you are in network or PPO status with and ask to speak with the provider relations and let them know that you are currently using your social security number and ask what the process is in regards to updating that and using the EIN.

It just puts up red flags for me when people are using their social security number for billing. You can do it, but it just scares me to death to have that personal information going out. It’s my personal opinion to use an EIN so that you can be protected. Because it doesn’t mean anything to anyone else but you and the insurance company.

If you’re just starting out, take the extra steps and get the EIN. It’s your choice, but if I were you, and I were just starting out, I would use the EIN to set up my contracts with insurance companies.

Bridget: For therapists who might have started out using their social security number, what are some of the things that the insurance companies might balk at? You said they might want to update their existing contract or they might want to have you sign a new one. Would you maybe run into an issue where they might say, “You can’t do that, because you’d be considered a new provider, and we’re not taking new providers”?

Deb: Well, number one, it depends on the insurance company. As long as you’re an existing provider, they’re just updating information. If you started 10 years ago, using your social security number, the norm was to use your social security number, because we didn’t have the HIPAA laws like we did then. It’s possible they would want you to sign a new contract, because the old one was outdated, but that’s no big deal. It’s nothing to be afraid of. I just wanted you to be aware that they can do it.

Updating your contract can be a good thing too. Some providers are afraid of going electronic. Just making that change, you can get so much information. The insurance company can send you feedback, they’ll send you updates. They can catch things – “We notice you did ‘this’ a lot.” You’ll get newsletters with frequently asked questions. It can turn out to be a much better experience with that kind of information.

Bridget: So billing with your EIN makes it more secure for you to file your claims, both paper and electronic. And, of course, electronic billing opens you up to more recordkeeping and reporting information and resources from the insurance companies, because they want to reduce their costs, so they want to encourage folks to bill online, when possible.

Deb: I want to put out my little disclaimer here. Insurance companies are not always the bad guys. Employers will tell the insurance companies what kind of benefits they want, and there are contracts out there that have no mental illness benefits as part of the policy. That can be from the employer. I go to the pharmacy a lot to pick up my prescriptions and it just really gets my goat when people say, “My insurance company didn’t pay this. “I just want to say to them, “If you have a complaint, you really need to go back to your employer because your employer is choosing those benefits for you.” The same thing for mental illness. Just because you have an insurance company and they’re not paying, it could be that it’s not because of the insurance company – it could be because the employer wants to save some money, or they chose one benefit over another, because times are tough and money is tight. It’s not always the insurance company (at fault). Insurance companies have a lot of experience and they train their people to be ready for your questions and they’re more than willing to answer those questions.

If I get a representative who doesn’t answer my questions, or they’re rude to me, let the insurance company know. They need to know that information. They’re willing to answer your questions. Don’t be afraid of them.

Question: Are there separate billing codes used for transporting a patient from place to place?

Yes. What I found out, and what I’ve seen in the past, from billing, is that for Medicaid, currently the code is 99082. This is a CPT code for mileage. The reimbursement rate for Nebraska Medicaid managed care plan is $.45 per mile, but please note that many private insurance companies do not pay for this item. However, if your client is covered under Medicaid (remember, it’s a payer of last resort, so if the client has another insurance company, you’ll need to get a denial first), you may be able to get reimbursed.

I’d invite you to contact Deb at W-Tech Solutions at 557-8628 or e-mail w-tech_billing@cox.net if you have any billing questions or if you’re interested in working with her. W-Tech Solutions allows therapists to focus on the billing aspect of your business so you can focus on your clients.

Today’s call is also sponsored by TherapySites. You can build a successful online website for your private practice in just four easy steps. In addition to a website, you’ll also receive unlimited email accounts, online appointment request capability, credit card processing, and more – for just $59 per month. There’s no up-front costs, no long-term commitments, and you can get your FIRST MONTH FREE when you use the promotional code PromoIBC when you sign up. Visit www.TherapySites.com and try it for free before you sign up. And be sure to use the code PromoIBC to get your first month free.

The next Billing Questions Teleseminar will be Wednesday, August 11 from 3 to 3:45 p.m.

No More "A Counseling Center, P.C."

Kevin Fitzmaurice has closed his practice, A Counseling Center, P.C. and is moving out of state. The practice was formerly located at 3323 North 109th Plaza in Omaha, Nebraska.

Using LinkedIn to Cultivate Referral Sources

Using social networking to fill your private practice is a complex subject. It's filled with ethical issues and lots of decisions (should I have a presence on Twitter? My own Ning group?).

One social networking strategy I do recommend for therapists, however, is LinkedIn.

LinkedIn bills itself as "the world's largest professional network," with more than 70 million members worldwide. It connects you to business contacts and allows you to exchange knowledge, ideas, and referrals. Private practice therapists can use it to grow their business and get practice management advice.


Once you're on LinkedIn, however, the question is: "What do I do now?" I have the perfect book for you. It's called, appropriately, "I'm on LinkedIn. Now What?" by Jason Alba.

The first step, however, is signing up for an account.

Office Space Openings in Omaha, Nebraska

If you are looking to join an existing private mental health practice, simply rent office space, or switch group practices, there's no better time than now! Several groups are actively seeking new members (or renters), and I've compiled a short list of these here. I also know of a couple of others that are quietly seeking members, so contact me directly at (402) 393-4600 if you'd like to be put in touch with those folks. (I'll give them your contact information.)

Steve Abraham - (402) 398-9055
New office space available at 7602 Pacific, Suite 205. Space includes a bathroom & shower, kitchen, plus ample storage. Price is reasonable.

Steve Brownrigg - (402) 510-1754

Spacious, quiet, well-appointed 270-foot deluxe office space for adult/adolescent therapist. In the John Wear Building at 76th & Pacific. New Berber carpet, ample natural light, new waiting room furnishings, oak trim throughout. New soundproofing (walls and ceilings). Refurbished utility room with fridge & sink. Also offering hourly rental of new office on Friday/Saturday only. $20/session.

Aspire Counseling Services -- Deanna Hanquist -- (402) 502-5030

Two offices available in office space at Terrace Plaza, 11414 West Center Road, Suite 233. Plenty of parking. Interstate access (right off of 680 & West Center Road).

Gina Fricke -- (402) 515-7412

Office available for rent (by the hour or by the day) at 6901 Dodge Street, Suite 101. The cost is $15 per hour or $60 per day. Includes Internet access, desk, and waiting room. No fax, no phone, no computer. Office is handicapped accessible and has a window.

Kairos Psychological -- Bob Kraft -- (402) 330-0800

Opportunity for new independent contractor to join the practice.

Jeff Stormberg -- (402) 393-0642
Office at the Historic Paxton building (14th & Farnam, Suite 215). Includes waiting room, reception area, telephone system, Yellow Pages listing, fax, and public bathrooms (on the same floor as the office). One heated parking stall is included. Ample public (metered) parking available outside building.

Reasons to Join the Association of Private Practice Therapists (APPT)

The Association of Private Practice Therapists (APPT) invites practicing mental health therapists -- even if they are not yet in private practice -- to join the organization. There are two levels of membership -- Traditional membership is for therapists who are currently in private practice for more than 10 hours per week. Associate Membership is for those who are interested in private practice as a future career (and this category is also applicable for students, retired therapists, professors, and vendors).

As an APPT member, you will receive the following member benefits:

• Education and Training: Your APPT membership provides you with access to hours of high quality, low-cost professional seminars and workshops.

• Discounted Registration Fees: APPT members can register for our annual conferences, mini-series workshops, and other events at a significant discount. APPT members also may be eligible for discounts offered by other organizations.

• Newsletter: A quarterly newsletter promoting upcoming APPT events, industry news, and member accomplishments.

• Training Resources: APPT members own a variety of video and audio training programs. Network with your colleagues to borrow these resources.

• Professional Support and Networking with Your Peers: Attending APPT meetings provides valuable opportunities to meet with and learn from others in your profession.

• Business Referrals: At APPT meetings, you'll meet other private practice therapists who are in the position to refer clients your way.

• Reputation Building: APPT actively works with numerous organizations in the public and private sectors to raise awareness of the interpreting and translating profession.

• Advocacy for the Profession: APPT representatives work with legislators at all levels of government to help preserve your interests and those of your clients.

• Client Confidence in You: Membership in APPT is an indication of your professionalism and commitment to your career.

• Leadership Opportunities: APPT offers many opportunities to achieve professional growth via voluntary involvement on our Board of Directors and project committees.

• Scholarships: APPT provides opportunities for financial support to attend continuing education programs designed to improve your clinical and practice management skills.

To join APPT, complete and return the application form.

The Psychological Impact of Infertility Treatment and the Mind-Body Connection

The experience of infertility can often result in anxiety, depression, guilt, and stress. The medical treatments can be physically, emotionally, and socially taxing on your clients. Clinical research has shown that both mind/body programs and couples groups improve a person s ability to cope with their experiences and reduce negative symptoms throughout their treatment. Learn some of these strategies you can use with your clients - - as well as other resources available.


This podcast, recorded in June 2008, can be purchased for $10 (includes 1-hour .mp3 file and 22-page handouts).


Key excerpts:

• Infertility affects 7 million people (1 in 8 couples). About 25% has to do with the female; 25% with the male; 35% both, and 10% "we don't know."
• The average cost of IVF is $12,000.
• The psychological impact of infertility: Many women will experience anxiety and depression levels similar to those experiencing a life-threatening illness, with anxiety increasing throughout the course of the infertility treatment.
• Men typically suffer from grief, identity challenges, and interpersonal struggles as a result of infertility treatment.
• "Psychological distress" is one of the main reasons cited for discontinuing medical treatment of infertility.
• Infertility treatment -- or pregnancy -- may significantly worsen an active psychiatric illness.
• Avoid terms that evoke shame and a sense of failure -- i.e., "We are infertile" or "failed cycle" or "unsuccessful fertility treatment."
• "Unlike most couples, who are never confronted with infertility, those who encounter infertility are likely to think carefully and deliberately about why they want to be parents, and what children mean to them."
• FertileHope is an organization that advocates for cancer patients whose medical treatments present the risk of infertility.

Julie Luzarraga, LCSW, DCSW, has been practicing in the mental health field for over 10 years. She is the founder of The Center for Counseling and Psychotherapy and Emerging Mindfulness. Her primary focuses are supporting people through infertility and working with families participating in Collaborative Divorce.

Julie can be reached at (402) 502-1024 x 290
http://www.midtownmind.com (Omaha, Nebraska)

Need More Clients?

Want to grow -- or simply maintain -- your private practice? You need clients!

One easy, inexpensive way to get prospective clients to call or e-mail you is through a profile on Psychology Today's Therapy Directory.

But you can only get prospective clients to click on your profile -- or call or e-mail you -- if you have an effective profile. Want to build an effective profile quickly and easily?

Download my exclusive Therapy Directory Sign-Up Kit. It will walk you through all the information you need to sign up for a free 90-day trial with The Therapy Directory. (You will need the special code in the back of the Sign-Up Kit to access the free 3-month trial!)

Once you've signed up for your free trial on The Therapy Directory, I'm offering you a SECOND FREE BONUS -- a free copy of my book, "Therapist's Guide to Branding Yourself Online." It's a $19 value and covers these topics:

• Identifying what makes you unique as a therapist -- and how you can turn that into a client-attracting personal brand.
• How to find out if you are "digitally distinct" online.
• What your profile needs to be in order to become a "client-winning online presence."
• Strategies to attract your "ideal client" through your online profile.
• Specific tips for writing an online profile.
• What a vanity URL is -- and why you need one.

Here's how to GET your free copy of the book. Once you've signed up for your free 90-day trial of The Therapy Directory, send an e-mail to me at info@therapistprofile.com with the subject line "Free Book." I'll e-mail you back with your link to download your free copy. I'll also provide you with a free analysis of your Therapy Directory profile once your listing is "live."

Interested? Then download your copy of the sign-up kit right now and get started!

Ethics Program July 16 or August 27

Take Flight Farms will be offering a workshop for mental health therapists on "Strengthening Ethical Decision-Making Skills: A Horse Powered Tutorial in Ethics" on July 16 and again on August 27. The program offers 6 Ethics CEUs and is taught by Quinn Lawton, MS, LMHP.

For more information, e-mail contact@takeflightfarms.org or call (402) 930-3037.

BlueCross BlueShield Claim Adjustment Reason Codes

A while back, we had a number of therapists looking for the BCBS Claim Adjustment Reason Code listing. Claim adjustment reason codes communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code.

You can also download this document here.

1 Deductible Amount Start: 01/01/1995 2 Coinsurance Amount Start: 01/01/1995 3 Co-payment Amount Start: 01/01/1995 4 The procedure code is inconsistent with the modifier used or a required modifier is missing. This change to be effective 7/1/2010: The procedure code is inconsistent with the modifier used or a required modifier is missing. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 5 The procedure code/bill type is inconsistent with the place of service. This change to be effective 7/1/2010: The procedure code/bill type is inconsistent with the place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 6 The procedure/revenue code is inconsistent with the patient's age.This change to be effective 7/1/2010: The procedure/revenue code is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 7 The procedure/revenue code is inconsistent with the patient's gender. This change to be effective 7/1/2010: The procedure/revenue code is inconsistent with the patient's gender. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 8 The procedure code is inconsistent with the provider type/specialty (taxonomy). This change to be effective 7/1/2010: The procedure code is inconsistent with the provider type/specialty (taxonomy). Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 9 The diagnosis is inconsistent with the patient's age. This change to be effective 7/1/2010: The diagnosis is inconsistent with the patient's age. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 10 The diagnosis is inconsistent with the patient's gender. This change to be effective 7/1/2010: The diagnosis is inconsistent with the patient's gender. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 11 The diagnosis is inconsistent with the procedure. This change to be effective 7/1/2010: The diagnosis is inconsistent with the procedure. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 12 The diagnosis is inconsistent with the provider type. This change to be effective 7/1/2010: The diagnosis is inconsistent with the provider type. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 13 The date of death precedes the date of service. Start: 01/01/1995 14 The date of birth follows the date of service. Start: 01/01/1995 15 The authorization number is missing, invalid, or does not apply to the billed services or provider. Start: 01/01/1995 | Last Modified: 09/30/2007 16 Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Claim/service lacks information which is needed for adjudication. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 01/01/1995 | Last Modified: 09/20/2009 17 Requested information was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) Start: 01/01/1995 | Last Modified: 09/21/2008 | Stop: 07/01/2009 18 Duplicate claim/service. Start: 01/01/1995 19 This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 20 This injury/illness is covered by the liability carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 21 This injury/illness is the liability of the no-fault carrier. Start: 01/01/1995 | Last Modified: 09/30/2007 22 This care may be covered by another payer per coordination of benefits. Start: 01/01/1995 | Last Modified: 09/30/2007 23 The impact of prior payer(s) adjudication including payments and/or adjustments. Start: 01/01/1995 | Last Modified: 09/30/2007 24 Charges are covered under a capitation agreement/managed care plan. Start: 01/01/1995 | Last Modified: 09/30/2007 25 Payment denied. Your Stop loss deductible has not been met. Start: 01/01/1995 | Stop: 04/01/2008 26 Expenses incurred prior to coverage. Start: 01/01/1995 27 Expenses incurred after coverage terminated. Start: 01/01/1995 28 Coverage not in effect at the time the service was provided. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Redundant to codes 26&27. 29 The time limit for filing has expired. Start: 01/01/1995 30 Payment adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements. Start: 01/01/1995 | Stop: 02/01/2006 31 Patient cannot be identified as our insured. Start: 01/01/1995 | Last Modified: 09/30/2007 32 Our records indicate that this dependent is not an eligible dependent as defined. Start: 01/01/1995 33 Insured has no dependent coverage. Start: 01/01/1995 | Last Modified: 09/30/2007 34 Insured has no coverage for newborns. Start: 01/01/1995 | Last Modified: 09/30/2007 35 Lifetime benefit maximum has been reached. Start: 01/01/1995 | Last Modified: 10/31/2002 36 Balance does not exceed co-payment amount. Start: 01/01/1995 | Stop: 10/16/2003 37 Balance does not exceed deductible. Start: 01/01/1995 | Stop: 10/16/2003 38 Services not provided or authorized by designated (network/primary care) providers. Start: 01/01/1995 | Last Modified: 06/30/2003 39 Services denied at the time authorization/pre-certification was requested. Start: 01/01/1995 40 Charges do not meet qualifications for emergent/urgent care. This change to be effective 04/01/2010: Charges do not meet qualifications for emergent/urgent care. Note: Refer to the 835 Healthcare Policy Identification Segment, if present. This change to be effective 07/01/2010: Charges do not meet qualifications for emergent/urgent care. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 41 Discount agreed to in Preferred Provider contract. Start: 01/01/1995 | Stop: 10/16/2003 42 Charges exceed our fee schedule or maximum allowable amount. (Use CARC 45) Start: 01/01/1995 | Last Modified: 10/31/2006 | Stop: 06/01/2007 43 Gramm-Rudman reduction. Start: 01/01/1995 | Stop: 07/01/2006 44 Prompt-pay discount. Start: 01/01/1995 45 Charge exceeds fee schedule/maximum allowable or contracted/legislated fee arrangement. (Use Group Codes PR or CO depending upon liability). Start: 01/01/1995 | Last Modified: 10/31/2006 46 This (these) service(s) is (are) not covered. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 96. 47 This (these) diagnosis(es) is (are) not covered, missing, or are invalid. Start: 01/01/1995 | Stop: 02/01/2006 48 This (these) procedure(s) is (are) not covered. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 96. 49 These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. This change to be effective 7/1/2010: These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 50 These are non-covered services because this is not deemed a 'medical necessity' by the payer. This change to be effective 07/01/2010: These are non-covered services because this is not deemed a 'medical necessity' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 51 These are non-covered services because this is a pre-existing condition. This change to be effective 7/1/2010: These are non-covered services because this is a pre-existing condition. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 52 The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed. Start: 01/01/1995 | Stop: 02/01/2006 53 Services by an immediate relative or a member of the same household are not covered. Start: 01/01/1995 54 Multiple physicians/assistants are not covered in this case. This change to be effective 07/01/2010: Multiple physicians/assistants are not covered in this case. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 55 Procedure/treatment is deemed experimental/investigational by the payer. This change to be effective 07/01/2010: Procedure/treatment is deemed experimental/investigational by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 56 Procedure/treatment has not been deemed 'proven to be effective' by the payer. This change to be effective 7/1/2010: Procedure/treatment has not been deemed 'proven to be effective' by the payer. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 57 Payment denied/reduced because the payer deems the information submitted does not support this level of service, this many services, this length of service, this dosage, or this day's supply. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Split into codes 150, 151, 152, 153 and 154. 58 Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. This change to be effective 07/01/2010: Treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 59 Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) This change to be effective 07/01/2010: Processed based on multiple or concurrent procedure rules. (For example multiple surgery or diagnostic imaging, concurrent anesthesia.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 60 Charges for outpatient services are not covered when performed within a period of time prior to or after inpatient services. Start: 01/01/1995 | Last Modified: 06/01/2008 61 Penalty for failure to obtain second surgical opinion. This change to be effective 7/1/2010: Penalty for failure to obtain second surgical opinion. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 62 Payment denied/reduced for absence of, or exceeded, pre-certification/authorization. Start: 01/01/1995 | Last Modified: 10/31/2006 | Stop: 04/01/2007 63 Correction to a prior claim. Start: 01/01/1995 | Stop: 10/16/2003 64 Denial reversed per Medical Review. Start: 01/01/1995 | Stop: 10/16/2003 65 Procedure code was incorrect. This payment reflects the correct code. Start: 01/01/1995 | Stop: 10/16/2003 66 Blood Deductible. Start: 01/01/1995 67 Lifetime reserve days. (Handled in QTY, QTY01=LA) Start: 01/01/1995 | Stop: 10/16/2003 68 DRG weight. (Handled in CLP12) Start: 01/01/1995 | Stop: 10/16/2003 69 Day outlier amount. Start: 01/01/1995 70 Cost outlier - Adjustment to compensate for additional costs. Start: 01/01/1995 | Last Modified: 06/30/2001 71 Primary Payer amount. Start: 01/01/1995 | Stop: 06/30/2000 Notes: Use code 23. 72 Coinsurance day. (Handled in QTY, QTY01=CD) Start: 01/01/1995 | Stop: 10/16/2003 73 Administrative days. Start: 01/01/1995 | Stop: 10/16/2003 74 Indirect Medical Education Adjustment. Start: 01/01/1995 75 Direct Medical Education Adjustment. Start: 01/01/1995 76 Disproportionate Share Adjustment. Start: 01/01/1995 77 Covered days. (Handled in QTY, QTY01=CA) Start: 01/01/1995 | Stop: 10/16/2003 78 Non-Covered days/Room charge adjustment. Start: 01/01/1995 79 Cost Report days. (Handled in MIA15) Start: 01/01/1995 | Stop: 10/16/2003 80 Outlier days. (Handled in QTY, QTY01=OU) Start: 01/01/1995 | Stop: 10/16/2003 81 Discharges. Start: 01/01/1995 | Stop: 10/16/2003 82 PIP days. Start: 01/01/1995 | Stop: 10/16/2003 83 Total visits. Start: 01/01/1995 | Stop: 10/16/2003 84 Capital Adjustment. (Handled in MIA) Start: 01/01/1995 | Stop: 10/16/2003 85 Patient Interest Adjustment (Use Only Group code PR) Start: 01/01/1995 | Last Modified: 07/09/2007 Notes: Only use when the payment of interest is the responsibility of the patient. 86 Statutory Adjustment. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Duplicative of code 45. 87 Transfer amount. Start: 01/01/1995 | Last Modified: 09/20/2009 | Stop: 01/01/2012 88 Adjustment amount represents collection against receivable created in prior overpayment. Start: 01/01/1995 | Stop: 06/30/2007 89 Professional fees removed from charges. Start: 01/01/1995 90 Ingredient cost adjustment. This change to be effective 04/01/2010: Ingredient cost adjustment. Note: To be used for pharmaceuticals only. Start: 01/01/1995 | Last Modified: 07/01/2009 91 Dispensing fee adjustment. Start: 01/01/1995 92 Claim Paid in full. Start: 01/01/1995 | Stop: 10/16/2003 93 No Claim level Adjustments. Start: 01/01/1995 | Stop: 10/16/2003 Notes: As of 004010, CAS at the claim level is optional. 94 Processed in Excess of charges. Start: 01/01/1995 95 Plan procedures not followed. Start: 01/01/1995 | Last Modified: 09/30/2007 96 Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 97 The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. This change to be effective 7/1/2010: The benefit for this service is included in the payment/allowance for another service/procedure that has already been adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 98 The hospital must file the Medicare claim for this inpatient non-physician service. Start: 01/01/1995 | Stop: 10/16/2003 99 Medicare Secondary Payer Adjustment Amount. Start: 01/01/1995 | Stop: 10/16/2003 100 Payment made to patient/insured/responsible party/employer. Start: 01/01/1995 | Last Modified: 01/27/2008 101 Predetermination: anticipated payment upon completion of services or claim adjudication. Start: 01/01/1995 | Last Modified: 02/28/1999 102 Major Medical Adjustment. Start: 01/01/1995 103 Provider promotional discount (e.g., Senior citizen discount). Start: 01/01/1995 | Last Modified: 06/30/2001 104 Managed care withholding. Start: 01/01/1995 105 Tax withholding. Start: 01/01/1995 106 Patient payment option/election not in effect. Start: 01/01/1995 107 The related or qualifying claim/service was not identified on this claim. This change to be effective 7/1/2010: The related or qualifying claim/service was not identified on this claim. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 108 Rent/purchase guidelines were not met. This change to be effective 7/1/2010: Rent/purchase guidelines were not met. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 109 Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor. Start: 01/01/1995 110 Billing date predates service date. Start: 01/01/1995 111 Not covered unless the provider accepts assignment. Start: 01/01/1995 112 Service not furnished directly to the patient and/or not documented. Start: 01/01/1995 | Last Modified: 09/30/2007 113 Payment denied because service/procedure was provided outside the United States or as a result of war. Start: 01/01/1995 | Last Modified: 02/28/2001 | Stop: 06/30/2007 Notes: Use Codes 157, 158 or 159. 114 Procedure/product not approved by the Food and Drug Administration. Start: 01/01/1995 115 Procedure postponed, canceled, or delayed. Start: 01/01/1995 | Last Modified: 09/30/2007 116 The advance indemnification notice signed by the patient did not comply with requirements. Start: 01/01/1995 | Last Modified: 09/30/2007 117 Transportation is only covered to the closest facility that can provide the necessary care. Start: 01/01/1995 | Last Modified: 09/30/2007 118 ESRD network support adjustment. Start: 01/01/1995 | Last Modified: 09/30/2007 119 Benefit maximum for this time period or occurrence has been reached. Start: 01/01/1995 | Last Modified: 02/29/2004 120 Patient is covered by a managed care plan. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 24. 121 Indemnification adjustment - compensation for outstanding member responsibility. Start: 01/01/1995 | Last Modified: 09/30/2007 122 Psychiatric reduction. Start: 01/01/1995 123 Payer refund due to overpayment. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Refer to implementation guide for proper handling of reversals. 124 Payer refund amount - not our patient. Start: 01/01/1995 | Last Modified: 06/30/1999 | Stop: 06/30/2007 Notes: Refer to implementation guide for proper handling of reversals. 125 Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Submission/billing error(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 01/01/1995 | Last Modified: 09/20/2009 126 Deductible -- Major Medical Start: 02/28/1997 | Last Modified: 09/30/2007 | Stop: 04/01/2008 Notes: Use Group Code PR and code 1. 127 Coinsurance -- Major Medical Start: 02/28/1997 | Last Modified: 09/30/2007 | Stop: 04/01/2008 Notes: Use Group Code PR and code 2. 128 Newborn's services are covered in the mother's Allowance. Start: 02/28/1997 129 Prior processing information appears incorrect. Start: 02/28/1997 | Last Modified: 09/30/2007 130 Claim submission fee. Start: 02/28/1997 | Last Modified: 06/30/2001 131 Claim specific negotiated discount. Start: 02/28/1997 132 Prearranged demonstration project adjustment. Start: 02/28/1997 133 The disposition of this claim/service is pending further review. Start: 02/28/1997 | Last Modified: 10/31/1999 134 Technical fees removed from charges. Start: 10/31/1998 135 Interim bills cannot be processed. Start: 10/31/1998 | Last Modified: 09/30/2007 136 Failure to follow prior payer's coverage rules. (Use Group Code OA). Start: 10/31/1998 | Last Modified: 09/30/2007 137 Regulatory Surcharges, Assessments, Allowances or Health Related Taxes. Start: 02/28/1999 | Last Modified: 09/30/2007 138 Appeal procedures not followed or time limits not met. Start: 06/30/1999 | Last Modified: 09/30/2007 139 Contracted funding agreement - Subscriber is employed by the provider of services. Start: 06/30/1999 140 Patient/Insured health identification number and name do not match. Start: 06/30/1999 141 Claim spans eligible and ineligible periods of coverage. Start: 06/30/1999 | Last Modified: 09/30/2007 142 Monthly Medicaid patient liability amount. Start: 06/30/2000 | Last Modified: 09/30/2007 143 Portion of payment deferred. Start: 02/28/2001 144 Incentive adjustment, e.g. preferred product/service. Start: 06/30/2001 145 Premium payment withholding Start: 06/30/2002 | Last Modified: 09/30/2007 | Stop: 04/01/2008 Notes: Use Group Code CO and code 45. 146 Diagnosis was invalid for the date(s) of service reported. Start: 06/30/2002 | Last Modified: 09/30/2007 147 Provider contracted/negotiated rate expired or not on file. Start: 06/30/2002 148 Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Information from another provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 06/30/2002 | Last Modified: 09/20/2009 149 Lifetime benefit maximum has been reached for this service/benefit category. Start: 10/31/2002 150 Payer deems the information submitted does not support this level of service. Start: 10/31/2002 | Last Modified: 09/30/2007 151 Payment adjusted because the payer deems the information submitted does not support this many/frequency of services. Start: 10/31/2002 | Last Modified: 01/27/2008 152 Payer deems the information submitted does not support this length of service. This change to be effective 7/1/2010: Payer deems the information submitted does not support this length of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 10/31/2002 | Last Modified: 09/20/2009 153 Payer deems the information submitted does not support this dosage. Start: 10/31/2002 | Last Modified: 09/30/2007 154 Payer deems the information submitted does not support this day's supply. Start: 10/31/2002 | Last Modified: 09/30/2007 155 Patient refused the service/procedure. Start: 06/30/2003 | Last Modified: 09/30/2007 156 Flexible spending account payments. Note: Use code 187. Start: 09/30/2003 | Last Modified: 01/25/2009 | Stop: 10/01/2009 157 Service/procedure was provided as a result of an act of war. Start: 09/30/2003 | Last Modified: 09/30/2007 158 Service/procedure was provided outside of the United States. Start: 09/30/2003 | Last Modified: 09/30/2007 159 Service/procedure was provided as a result of terrorism. Start: 09/30/2003 | Last Modified: 09/30/2007 160 Injury/illness was the result of an activity that is a benefit exclusion. Start: 09/30/2003 | Last Modified: 09/30/2007 161 Provider performance bonus Start: 02/29/2004 162 State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Start: 02/29/2004 163 Attachment referenced on the claim was not received. Start: 06/30/2004 | Last Modified: 09/30/2007 164 Attachment referenced on the claim was not received in a timely fashion. Start: 06/30/2004 | Last Modified: 09/30/2007 165 Referral absent or exceeded. Start: 10/31/2004 | Last Modified: 09/30/2007 166 These services were submitted after this payers responsibility for processing claims under this plan ended. Start: 02/28/2005 167 This (these) diagnosis(es) is (are) not covered. This change to be effective 7/1/2010: This (these) diagnosis(es) is (are) not covered. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 168 Service(s) have been considered under the patient's medical plan. Benefits are not available under this dental plan. Start: 06/30/2005 | Last Modified: 09/30/2007 169 Alternate benefit has been provided. Start: 06/30/2005 | Last Modified: 09/30/2007 170 Payment is denied when performed/billed by this type of provider. This change to be effective 7/1/2010: Payment is denied when performed/billed by this type of provider. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 171 Payment is denied when performed/billed by this type of provider in this type of facility. This change to be effective 7/1/2010: Payment is denied when performed/billed by this type of provider in this type of facility. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 172 Payment is adjusted when performed/billed by a provider of this specialty. This change to be effective 7/1/2010: Payment is adjusted when performed/billed by a provider of this specialty. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 173 Service was not prescribed by a physician. Start: 06/30/2005 | Last Modified: 09/30/2007 174 Service was not prescribed prior to delivery. Start: 06/30/2005 | Last Modified: 09/30/2007 175 Prescription is incomplete. Start: 06/30/2005 | Last Modified: 09/30/2007 176 Prescription is not current. Start: 06/30/2005 | Last Modified: 09/30/2007 177 Patient has not met the required eligibility requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 178 Patient has not met the required spend down requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 179 Patient has not met the required waiting requirements. This change to be effective 7/1/2010: Patient has not met the required waiting requirements. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 180 Patient has not met the required residency requirements. Start: 06/30/2005 | Last Modified: 09/30/2007 181 Procedure code was invalid on the date of service. Start: 06/30/2005 | Last Modified: 09/30/2007 182 Procedure modifier was invalid on the date of service. Start: 06/30/2005 | Last Modified: 09/30/2007 183 The referring provider is not eligible to refer the service billed. This change to be effective 7/1/2010: The referring provider is not eligible to refer the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 184 The prescribing/ordering provider is not eligible to prescribe/order the service billed. This change to be effective 7/1/2010: The prescribing/ordering provider is not eligible to prescribe/order the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 185 The rendering provider is not eligible to perform the service billed. This change to be effective 7/1/2010: The rendering provider is not eligible to perform the service billed. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/30/2005 | Last Modified: 09/20/2009 186 Level of care change adjustment. Start: 06/30/2005 | Last Modified: 09/30/2007 187 Consumer Spending Account payments (includes but is not limited to Flexible Spending Account, Health Savings Account, Health Reimbursement Account, etc.) Start: 06/30/2005 | Last Modified: 01/25/2009 188 This product/procedure is only covered when used according to FDA recommendations. Start: 06/30/2005 189 'Not otherwise classified' or 'unlisted' procedure code (CPT/HCPCS) was billed when there is a specific procedure code for this procedure/service Start: 06/30/2005 190 Payment is included in the allowance for a Skilled Nursing Facility (SNF) qualified stay. Start: 10/31/2005 191 Not a work related injury/illness and thus not the liability of the workers' compensation carrier. Start: 10/31/2005 | Last Modified: 09/30/2007 192 Non standard adjustment code from paper remittance. Note: This code is to be used by providers/payers providing Coordination of Benefits information to another payer in the 837 transaction only. This code is only used when the non-standard code cannot be reasonably mapped to an existing Claims Adjustment Reason Code, specifically Deductible, Coinsurance and Co-payment. Start: 10/31/2005 | Last Modified: 09/30/2007 193 Original payment decision is being maintained. Upon review, it was determined that this claim was processed properly. Start: 02/28/2006 | Last Modified: 01/27/2008 194 Anesthesia performed by the operating physician, the assistant surgeon or the attending physician. Start: 02/28/2006 | Last Modified: 09/30/2007 195 Refund issued to an erroneous priority payer for this claim/service. Start: 02/28/2006 | Last Modified: 09/30/2007 196 Claim/service denied based on prior payer's coverage determination. Start: 06/30/2006 | Stop: 02/01/2007 Notes: Use code 136. 197 Precertification/authorization/notification absent. Start: 10/31/2006 | Last Modified: 09/30/2007 198 Precertification/authorization exceeded. Start: 10/31/2006 | Last Modified: 09/30/2007 199 Revenue code and Procedure code do not match. Start: 10/31/2006 200 Expenses incurred during lapse in coverage Start: 10/31/2006 201 Workers Compensation case settled. Patient is responsible for amount of this claim/service through WC 'Medicare set aside arrangement' or other agreement. (Use group code PR). Start: 10/31/2006 202 Non-covered personal comfort or convenience services. Start: 02/28/2007 | Last Modified: 09/30/2007 203 Discontinued or reduced service. Start: 02/28/2007 | Last Modified: 09/30/2007 204 This service/equipment/drug is not covered under the patient's current benefit plan Start: 02/28/2007 205 Pharmacy discount card processing fee Start: 07/09/2007 206 National Provider Identifier - missing. Start: 07/09/2007 | Last Modified: 09/30/2007 207 National Provider identifier - Invalid format Start: 07/09/2007 | Last Modified: 06/01/2008 208 National Provider Identifier - Not matched. Start: 07/09/2007 | Last Modified: 09/30/2007 209 Per regulatory or other agreement. The provider cannot collect this amount from the patient. However, this amount may be billed to subsequent payer. Refund to patient if collected. (Use Group code OA) Start: 07/09/2007 210 Payment adjusted because pre-certification/authorization not received in a timely fashion Start: 07/09/2007 211 National Drug Codes (NDC) not eligible for rebate, are not covered. Start: 07/09/2007 212 Administrative surcharges are not covered Start: 11/05/2007 213 Non-compliance with the physician self referral prohibition legislation or payer policy. Start: 01/27/2008 214 Workers' Compensation claim adjudicated as non-compensable. This Payer not liable for claim or service/treatment. (Note: To be used for Workers' Compensation only) Start: 01/27/2008 215 Based on subrogation of a third party settlement Start: 01/27/2008 216 Based on the findings of a review organization Start: 01/27/2008 217 Based on payer reasonable and customary fees. No maximum allowable defined by legislated fee arrangement. (Note: To be used for Workers' Compensation only) Start: 01/27/2008 218 Based on entitlement to benefits (Note: To be used for Workers' Compensation only) Start: 01/27/2008 219 Based on extent of injury (Note: To be used for Workers' Compensation only) Start: 01/27/2008 220 The applicable fee schedule does not contain the billed code. Please resubmit a bill with the appropriate fee schedule code(s) that best describe the service(s) provided and supporting documentation if required. (Note: To be used for Workers' Compensation only) Start: 01/27/2008 221 Workers' Compensation claim is under investigation. (Note: To be used for Workers' Compensation only. Claim pending final resolution) Start: 01/27/2008 222 Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. This change to be effective 7/1/2010: Exceeds the contracted maximum number of hours/days/units by this provider for this period. This is not patient specific. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 06/01/2008 | Last Modified: 09/20/2009 223 Adjustment code for mandated federal, state or local law/regulation that is not already covered by another code and is mandated before a new code can be created. Start: 06/01/2008 224 Patient identification compromised by identity theft. Identity verification required for processing this and future claims. Start: 06/01/2008 225 Penalty or Interest Payment by Payer (Only used for plan to plan encounter reporting within the 837) Start: 06/01/2008 226 Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Information requested from the Billing/Rendering Provider was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 09/21/2008 | Last Modified: 09/20/2009 227 Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Information requested from the patient/insured/responsible party was not provided or was insufficient/incomplete. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 09/21/2008 | Last Modified: 09/20/2009 228 Denied for failure of this provider, another provider or the subscriber to supply requested information to a previous payer for their adjudication Start: 09/21/2008 229 Partial charge amount not considered by Medicare due to the initial claim Type of Bill being 12X. Note: This code can only be used in the 837 transaction to convey Coordination of Benefits information when the secondary payer's cost avoidance policy allows providers to bypass claim submission to a prior payer. Use Group Code PR. Start: 01/25/2009 230 No available or correlating CPT/HCPCS code to describe this service. Note: Used only by Property and Casualty. Start: 01/25/2009 231 Mutually exclusive procedures cannot be done in the same day/setting. This change to be effective 7/1/2010: Mutually exclusive procedures cannot be done in the same day/setting. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 07/01/2009 | Last Modified: 09/20/2009 232 Institutional Transfer Amount. Note - Applies to institutional claims only and explains the DRG amount difference when the patient care crosses multiple institutions. Start: 11/01/2009 A0 Patient refund amount. Start: 01/01/1995 A1 Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) This change to be effective 7/1/2010: Claim/Service denied. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 01/01/1995 | Last Modified: 09/20/2009 A2 Contractual adjustment. Start: 01/01/1995 | Last Modified: 02/28/2007 | Stop: 01/01/2008 Notes: Use Code 45 with Group Code 'CO' or use another appropriate specific adjustment code. A3 Medicare Secondary Payer liability met. Start: 01/01/1995 | Stop: 10/16/2003 A4 Medicare Claim PPS Capital Day Outlier Amount. Start: 01/01/1995 | Last Modified: 09/30/2007 | Stop: 04/01/2008 A5 Medicare Claim PPS Capital Cost Outlier Amount. Start: 01/01/1995 A6 Prior hospitalization or 30 day transfer requirement not met. Start: 01/01/1995 A7 Presumptive Payment Adjustment Start: 01/01/1995 A8 Ungroupable DRG. Start: 01/01/1995 | Last Modified: 09/30/2007 B1 Non-covered visits. Start: 01/01/1995 B2 Covered visits. Start: 01/01/1995 | Stop: 10/16/2003 B3 Covered charges. Start: 01/01/1995 | Stop: 10/16/2003 B4 Late filing penalty. Start: 01/01/1995 B5 Coverage/program guidelines were not met or were exceeded. Start: 01/01/1995 | Last Modified: 09/30/2007 B6 This payment is adjusted when performed/billed by this type of provider, by this type of provider in this type of facility, or by a provider of this specialty. Start: 01/01/1995 | Stop: 02/01/2006 B7 This provider was not certified/eligible to be paid for this procedure/service on this date of service. This change to be effective 7/1/2010: This provider was not certified/eligible to be paid for this procedure/service on this date of service. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 B8 Alternative services were available, and should have been utilized. This change to be effective 7/1/2010: Alternative services were available, and should have been utilized. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 B9 Patient is enrolled in a Hospice. Start: 01/01/1995 | Last Modified: 09/30/2007 B10 Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test. Start: 01/01/1995 B11 The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor. Start: 01/01/1995 B12 Services not documented in patients' medical records. Start: 01/01/1995 B13 Previously paid. Payment for this claim/service may have been provided in a previous payment. Start: 01/01/1995 B14 Only one visit or consultation per physician per day is covered. Start: 01/01/1995 | Last Modified: 09/30/2007 B15 This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. This change to be effective 7/1/2010: This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. Start: 01/01/1995 | Last Modified: 09/20/2009 B16 'New Patient' qualifications were not met. Start: 01/01/1995 | Last Modified: 09/30/2007 B17 Payment adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current. Start: 01/01/1995 | Stop: 02/01/2006 B18 This procedure code and modifier were invalid on the date of service. Start: 01/01/1995 | Last Modified: 09/21/2008 | Stop: 03/01/2009 B19 Claim/service adjusted because of the finding of a Review Organization. Start: 01/01/1995 | Stop: 10/16/2003 B20 Procedure/service was partially or fully furnished by another provider. Start: 01/01/1995 | Last Modified: 09/30/2007 B21 The charges were reduced because the service/care was partially furnished by another physician. Start: 01/01/1995 | Stop: 10/16/2003 B22 This payment is adjusted based on the diagnosis. Start: 01/01/1995 | Last Modified: 02/28/2001 B23 Procedure billed is not authorized per your Clinical Laboratory Improvement Amendment (CLIA) proficiency test. Start: 01/01/1995 | Last Modified: 09/30/2007 D1 Claim/service denied. Level of subluxation is missing or inadequate. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D2 Claim lacks the name, strength, or dosage of the drug furnished. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D3 Claim/service denied because information to indicate if the patient owns the equipment that requires the part or supply was missing. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D4 Claim/service does not indicate the period of time for which this will be needed. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D5 Claim/service denied. Claim lacks individual lab codes included in the test. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D6 Claim/service denied. Claim did not include patient's medical record for the service. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D7 Claim/service denied. Claim lacks date of patient's most recent physician visit. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D8 Claim/service denied. Claim lacks indicator that 'x-ray is available for review.' Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D9 Claim/service denied. Claim lacks invoice or statement certifying the actual cost of the lens, less discounts or the type of intraocular lens used. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 16 and remark codes if necessary. D10 Claim/service denied. Completed physician financial relationship form not on file. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D11 Claim lacks completed pacemaker registration form. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D12 Claim/service denied. Claim does not identify who performed the purchased diagnostic test or the amount you were charged for the test. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D13 Claim/service denied. Performed by a facility/supplier in which the ordering/referring physician has a financial interest. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D14 Claim lacks indication that plan of treatment is on file. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D15 Claim lacks indication that service was supervised or evaluated by a physician. Start: 01/01/1995 | Stop: 10/16/2003 Notes: Use code 17. D16 Claim lacks prior payer payment information. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code [N4]. D17 Claim/Service has invalid non-covered days. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. D18 Claim/Service has missing diagnosis information. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. D19 Claim/Service lacks Physician/Operative or other supporting documentation Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. D20 Claim/Service missing service/product information. Start: 01/01/1995 | Stop: 06/30/2007 Notes: Use code 16 with appropriate claim payment remark code. D21 This (these) diagnosis(es) is (are) missing or are invalid Start: 01/01/1995 | Stop: 06/30/2007 D22 Reimbursement was adjusted for the reasons to be provided in separate correspondence. (Note: To be used for Workers' Compensation only) - Temporary code to be added for timeframe only until 01/01/2009. Another code to be established and/or for 06/2008 meeting for a revised code to replace or strategy to use another existing code Start: 01/27/2008 | Stop: 01/01/2009 D23 This dual eligible patient is covered by Medicare Part D per Medicare Retro-Eligibility. At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Start: 11/01/2009 | Stop: 01/01/2012 W1 Workers Compensation State Fee Schedule Adjustment Start: 02/29/2000

Courtesy of BlueCross BlueShield of Nebraska.