If a line item cannot be repriced a code may appear in Box 24-K
that represents the reason that line item/claim was not repriced.
The following is a list of these reason codes:
Code: | Description: |
R01 | Employer Group not effective for this date of service |
R02 | Employer Group terminated prior to date of service |
R03 | Employer Group runout date has passed |
R04 | Insured not valid for this date of service |
R05 | Patient not valid for this date of service |
R19 | Invalid CPT Code |
R20 | Provider not active for this date of service |
R21 | Provider ineligible for this Employer Group for this date of service |
R35 | Employer Group only allowed to use Hospital providers
|
NPR | Provider is not in Network |
DUP | Duplicate line item from previously repriced claim |
SUB | Submitted charges less than or equal to negotiated amount |
