Provider Liability 356 Incorrect Provider/PCP Data. Member Liability 352 Incorrect Subscriber ID. Provider Liability 347 Lost/Damaged Check, Stop Payment on Check. Provider Liability 344 Retroactive Cancellation. Provider Liability 342 Wrong Subscriber Paid. Provider Liability 210 Payment Reduced, Out of Area Max Reached 2s2 Secondary Allow Amount 332 ITS SF Adjustment Pend 336 ITS Referral status override 341 Wrong Provider Paid. Provider Liability 075 Automated HRA Payment Bypassed 105 COB Disallow 1s1 Secondary Supplementation Amount 209 Service is not eligible for this provider. 072 Additional NetworX Data 073 Deny All Claim Lines. Provider Liability 071 Funds exhausted, awaiting more contributions. 066 Not covered under Medical Plan to be paid as HRA Only/E service 067 Patient Liability Disallow Override 068 No Pledge Amount for this HealthCare Expense 069 No Pledge Amount for the Dependent Care Expense 070 Dependent claim line partially paid. Provider Liability 061 HRA Paid Amount override 062 All FSA dollars were previously paid out 063 Bypass FSA Runout Period Override 064 Bypass Duplicate Edit 065 This is not a covered HRA service. Provider Liability 057 FSA Paid Amount Override 058 Bypass FSA Processing Override 059 Bypass HRA Processing 060 The allow AMT for this service has been reduced per M/S guidelines. Provider Liability 055 Medicare Supplemental Calculation Applied 056 The allow AMT for this service has been reduced per M/S guidelines. Provider Liability 054 Services denied due to being delegated to another entity. Provider Liability 049 The allowable amount for this service has been reduced according to ASC default category guidelines. Provider Liability 048 The allowable amount for this service has been reduced according to ASC multiple procedure guidelines. Provider Liability 019 Disallowed amount.

Provider Liability 018 Reduced allowable units. Member Liability 017 Increased allowable units. Member Liability 011 Increased co-insurance. Member Liability 010 Reduced co-insurance. Member Liability 007 Increased deductible. Member Liability 005 Increased copayment. Provider Liability 004 Reduced copayment. Provider Liability 003 Reduced allowable.

Pxn networx std fee schedule