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7.2 item level hicaps response codes
code Receipt print Out Description
00 Approved (8) Transaction Approved
0 Item No Benefit (5) Nil benefit payable on this item
0 Restricted Item (5) Nil benefit – restricted item
0 Restricted Item (5) Reduced benefit – restricted item
04 Previously Paid (5) Nil benefit – benefit previously paid
05 Limit Reached Nil benefit – limit reached
06 Limit Reached Reduced benefit – limit reached
07 Waiting Period Nil benefit – qualifying period applies
08 PreReq Ser Reqd Nil benefit – pre-requisite service required
09 Pre Existing Nil benefit – pre existing ailment
0 Item Nbr Invalid Item number invalid
Item Nbr Ceased Item number ceased
Item Not Valid Item not valid for provider
Item Not Apprvd Item not approved – not payable by HICAPS
4 Max Nbr Ser Exc Service exceeds number of times permitted
5 Cost Missing Cost must be entered
6 DOS Not Valid Date of service must be before today
7 DOS too Old Date of service too old
8 Clinicl Code Rqd Clinical Code required
9 Pat Not Covered Patient not covered
0 Depd Status End Dependent status ceased
Invald Pat Code Invalid patient code
Mship Not Cover Membership not covered
Mship Ended DOS Membership ceased/suspended
at date of service
4 Mship Unfin DOS Membership unfinancial at date of service
5 No Ancill Cover No ancillary cover
6 Item Not Coverd Not covered for this service
7 Duplicate Serv Duplicate service already processed
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