Industry Specific Remark Codes

Maintence Request Status 1/1/2019 LAST UPDATED

These codes convey information about remittance processing or further explain an adjustment already described by a Claim Adjustment Reason Code (CARC) published in ECL 139.

The list below shows the status of change requests which are in process. The list is updated on the first of each month.

Each request will be in one of the following statuses:

  1. Received
    The request has been submitted but is not yet under review.
  2. Triaged
    Staff has looked at the request to ensure it's a legitimate request (not spam), that it is assigned to the correct CMG, and that all required information is present.
  3. In Process
    The CMG has initiated their decision process.
  4. On Hold
    The CMG has initiated their decision process but cannot complete it at this time.
  5. CMG Approved
    The CMG has considered and approved the request, this does not mean it was approved exactly as submitted, it means maintenance related to the request was approved. Requests in this status will be applied to the next version.
  6. CMG Disapproved
    The CMG has considered and disapproved the request, no maintenance action will occur. Requests in this status are complete/final.
Num. Date Requested Description Type Code Status
4 10/16/2018 Coverage under this policy is excess to other insurance New code In Process
5 10/16/2018 Reimbursement has been based on the number of body areas rated New code In Process
6 10/16/2018 These services were included in a settlement agreement and/or judgment and are the patient's responsibility. New code In Process
7 10/16/2018 Adjusted because the treating hospital is a lien hospital and their billing takes precedence. New code In Process
8 10/16/2018 Bill was not received within 120 days from the date of service. New code In Process
9 10/16/2018 May be billed once per Workers’ Compensation claim regardless of the number of limbs tested New code In Process
10 10/16/2018 FRAUD STATEMENT NOT PROVIDED PURSUANT TO SECTION 440.105(7), F.S. New code In Process
11 10/16/2018 REQUIRED FORM DFS-F5-DWC-25 NOT SUBMITTED WITHIN THREE BUSINESS DAYS OF THE FIRST TREATMENT PURSUANT TO SECTION 440.13(4)(A), F.S. New code In Process