Ineligible codes
106
Provider is OON services must be performed INN.
171
MCR
uAMFD
Max frequency for service
Corrected claim for a 2025 claim
appeal timeframe applies
Active Employee who has Medicare due to Age (i.e. 65 or older)
Over 100 lives
UMR
224
network reduction
546
PA- Care
Always check PA vendor
DLP
duplicate
Corrected claim for a 2026 claim
follow the UHN contracted timely filing requirements.
Retiree or Dependent of a Retiree who has Medicare due to Age
under 20 lives
Medicare
125
Correct claim denied , Please review the original denial reason(s) and submit a written request for review with medical records for reconsideration.
538
SIU
TTOBF
Type of bill inappropriate for the service billed
OI showing recoupment
Process per Plan
Birthday Rule
Mom DOB 05/01/1980
Dad 03/25/1983
Primary plan is the plan whose parent birthday is earlier in the year
946
Mod discount -Payment adjusted due to provider billed modifier. You should not be billed for this amount.
614
ACR
Mbi
Medicaid
Medicaid has 3 years from the date of service on the claim to subm
Active employee who receives medicaid
UMR
026
not an eligible dependent
914
Possible appeal / check for written request
MOd
Mod missing/ invalid / incorrect for procedure
Resubmission form or letter with statement that wrong insurance billed
Process per plan
Active Employee who has Medicare due to Disability (other than ESRD)
plan has 80 lives
Medicare