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Providers > Repricing Reason Codes >

If a claim cannot be repriced an error message will appear at the top or bottom of the repricing statement that explains the reason the claim was not repriced. The following is a list of these reason codes:

Code:

Description:

18

Admission Date OR Date Of Service Is Invalid - Return To Provider

12

Cannot Determine Employer - Please Send Copy Of Member ID Card To HFN, Inc.

3

Client Does Not Have Access To This Provider

2

Client Not Effective For This Date Of Service - Forward To Provider

35

Clients Differential Does Not Qualify For A Discount

51

Discount Applied In Accordance With The Illinois Workers Compensation Act

19

DRG Repricing Produced An Amount Greater Than Billed Charges - No Discount Taken

15

Duplicate Claim

58

Member Not Effective For This Date Of Service - Forward To Provider

60

Principal Diagnosis Code Is Missing

56

Provider Information Incomplete - Please Re-Enter Claim With Complete Provider Data

50

Provider Not Accessible Under Health Plan

6

Provider Not In The Database

72

Provider Not In The Database - Forward To HSPC

38

Provider Not Under Contract At This Location For This Date of Service For GH

17

The DRG Code Does Not Exist In The Database Or Is Termed - Forward To Provider

68

The Revenue Code Is Missing Or Invalid

1

Validation Error

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