arkansas statistical claim data: first quarter 2019 · 2019. 8. 30. · outpatient chiropractic...

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Indication Physician Specialty Code Range Description Reason For Denial Inpatient Family Practice Endocrine, nutritional and metabolic diseases Inpatient Unknown Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Inpatient Orthopedic Surgery Diseases of the musculoskeletal system and connective tissue Inpatient Psychiatry Mental, Behavioral and Neurodevelopmental disorders Inpatient Unknown Diseases of the circulatory system Inpatient Family Practice Diseases of the circulatory system Inpatient Unknown Injury, poisoning and certain other consequences of external causes Inpatient Unknown Diseases of the blood and blood‐forming organs and certain disorders involving the immune Inpatient Pediatric Medicine Diseases of the digestive system Inpatient Internal Medicine Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Inpatient Unknown Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified Arkansas Statistical Claim Data: First Quarter 2019

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  • Indication Physician Specialty Code Range Description Reason For DenialInpatient Family Practice Endocrine, nutritional and metabolic diseasesInpatient Unknown Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedInpatient Orthopedic Surgery Diseases of the musculoskeletal system and connective tissueInpatient Psychiatry Mental, Behavioral and Neurodevelopmental disordersInpatient Unknown Diseases of the circulatory systemInpatient Family Practice Diseases of the circulatory system

    Inpatient Unknown Injury, poisoning and certain other consequences of external causesInpatient Unknown Diseases of the blood and blood‐forming organs and certain disorders involving the immune Inpatient Pediatric Medicine Diseases of the digestive systemInpatient Internal Medicine Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedInpatient Unknown Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified

    Arkansas Statistical Claim Data:First Quarter 2019

  • Indication Physician Specialty Code Range Description Reason For DenialInpatient Internal Medicine Diseases of the respiratory systemInpatient Pediatric Medicine Endocrine, nutritional and metabolic diseasesInpatient Neurosurgery Diseases of the musculoskeletal system and connective tissueInpatient Emergency Medicine Diseases of the circulatory systemInpatient Internal Medicine Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedInpatient Orthopedic Surgery Diseases of the musculoskeletal system and connective tissue

    Inpatient General Surgery Endocrine, nutritional and metabolic diseasesInpatient Geriatric Medicine Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedInpatient Internal Medicine Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedOutpatient Unknown/Not Given Mental, Behavioral and Neurodevelopmental disordersOutpatient Otolaryngology Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classifiedOutpatient Hematology/Oncology Diseases of the digestive systemOutpatient Family Practice Diseases of the musculoskeletal system and connective tissue

    Arkansas Statistical Claim Data:Fourth Quarter 2018

  • Indication Physician  Code Range Description Reason For DenialInpatient Neurosurgery Diseases of the musculoskeletal system and connective tissueInpatient Orthopedic Surgery Diseases of the musculoskeletal system and connective tissueInpatient Pediatric Medicine Diseases of the skin and subcutaneous tissueInpatient Orthopedic Surgery Diseases of the musculoskeletal system and connective tissueInpatient General Surgery Endocrine, nutritional and metabolic diseasesOutpatient Unknown/not given Symptoms, signs & abnormal clinical and laboratory findings, not elsewhere 

    Outpatient Orthopedic Surgery Factors influencing health status and contact with health services

    Arkansas Statistical Claim Data:Third Quarter 2018

  • Indication Physician Specialty Code Range Description Reason For DenialInpatient Obstetrics/Gynecology Diseases of the blood/blood‐forming organs & certain disorders involving the 

    immune mechanism

    Inpatient Unknown/not given Diseases of the circulatory systemInpatient General Surgery Diseases of the digestive systemInpatient Neurosurgery Diseases of the musculoskeletal system and connective tissue

    Inpatient Unknown/not given Diseases of the circulatory systemInpatient General Surgery Diseases of the blood/blood‐forming organs & certain disorders involving the Inpatient General Practice Diseases of the circulatory system

    Arkansas Statistical Claim Data:Second Quarter 2018

  • Indication Physician Specialty Code Range Description Reason For DenialInpatient Unknown/not given Symptoms, signs and abnormal clinical and laboratory findings, not 

    elsewhere classified

    Inpatient Physical Medicine & Rehabilitation Injury, poisoning and certain other consequences of external causes Not Medically Necessary

    Inpatient General Surgery Diseases of the digestive systemInpatient Preventive Medicine Mental, Behavioral and Neurodevelopmental disorders

    Arkansas Statistical Claim Data:First Quarter 2018

  • Indication Physician Specialty Code Range Description Reason For DenialInpatient Unknown/not given Mental, Behavioral and Neurodevelopmental disordersInpatient Unknown/not given Mental, Behavioral and Neurodevelopmental disordersInpatient Obstetrics/Gynecology Pregnancy, childbirth and the puerperium

    Arkansas Statistical Claim Data:Fourth Quarter 2017

  • Indication Physician Specialty Code Range Description Reason For DenialOutpatient ORTHOPEDIC SURGERY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient HOSPITAL Pathology

    Outpatient HOSPITAL Pathology

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient FAMILY PRACTICE Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient ALLERGY/IMMUNOLOGY Medicine

    Outpatient PAIN MANAGEMENT Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient PSYCHIATRY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OPTOMETRISTS Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Integumentary System

    Outpatient FAMILY PRACTICE Medicine

    Outpatient GASTROENTEROLOGY Medicine

    Outpatient PSYCHIATRY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including Ambulance

    Arkansas Statistical Claim Data: Third Quarter 2017

    Page 1 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient FAMILY PRACTICE Auditory System

    Outpatient FAMILY PRACTICE Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient FAMILY PRACTICE Radiology

    Outpatient FAMILY PRACTICE Pathology

    Outpatient OTOLARYNGOLOGY Medicine

    Outpatient INTERNAL MEDICINE Medicine

    Outpatient FAMILY PRACTICE Mediastinum

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    Method

    Outpatient BEHAVIORAL HEALTH Medicine

    Outpatient ONCOLOGY Medicine

    Outpatient ANESTHESIOLOGY Anesthesia

    Outpatient RADIOLOGY Radiology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR SURGERY

    Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    Method

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient UROLOGY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient GENERAL SURGERY Medicine

    Outpatient INTERNAL MEDICINE Medicine

    Outpatient HEALTH DEPARTMENT Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Page 2 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient GENERAL SURGERY Radiology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient ANESTHESIOLOGY Anesthesia

    Outpatient GENERAL SURGERY Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient GENERAL SURGERY Drugs Administered Other Than Oral Method

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient RADIATION ONCOLOGY Radiology

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    MethodOutpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Medicine

    Outpatient ALLERGY/IMMUNOLOGY Medicine

    Outpatient HOSPITAL Medicine

    Page 3 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR

    SURGERY

    Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including

    AmbulanceOutpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient NEPHROLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    MethodOutpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient GENERAL SURGERY Digestive System

    Outpatient HOSPITAL Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient UROLOGY Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR SURGERY

    Medicine

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    Method

    Page 4 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient OPTOMETRISTS Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient RADIOLOGY Radiology

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient LABORATORY Pathology

    Outpatient HOSPITAL Radiology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient RHEUMATOLOGY Medicine

    Outpatient BEHAVIORAL HEALTH Medicine

    Outpatient GENERAL SURGERY Digestive System

    Outpatient FAMILY PRACTICE Medicine

    Outpatient ANESTHESIOLOGY Radiology

    Outpatient OTOLARYNGOLOGY Medicine

    Outpatient OTOLARYNGOLOGY Digestive System

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient INTERNAL MEDICINE Medicine

    Outpatient PSYCHIATRY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PEDIATRICS Medicine

    Outpatient PEDIATRICS Medicine

    Outpatient GASTROENTEROLOGY Digestive System

    Outpatient GASTROENTEROLOGY Pathology

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including Ambulance

    Outpatient ANESTHESIOLOGY Medicine

    Outpatient HOSPITAL Drugs Administered Other Than Oral Method

    Outpatient FAMILY PRACTICE Medicine

    Page 5 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient NEUROLOGY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PEDIATRICS Medicine

    Outpatient GASTROENTEROLOGY Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient HOSPITAL Procedures/Professional Services

    Outpatient RADIOLOGY Radiology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient HEALTH DEPARTMENT Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient RADIATION ONCOLOGY Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OPTOMETRISTS Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient AMBULATORY SURGICAL CTR/ENDOSCOPY CTR Digestive System

    Outpatient HOSPITAL Drugs Administered Other Than Oral Method

    Outpatient HOSPITAL Pathology

    Outpatient HOSPITAL Pathology

    Outpatient FAMILY PRACTICE Pathology

    Outpatient RADIATION ONCOLOGY Drugs Administered Other Than Oral Method

    Outpatient PATHOLOGY Pathology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Page 6 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral Method

    Outpatient FAMILY PRACTICE Medicine

    Outpatient ANESTHESIOLOGY Anesthesia

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient PATHOLOGY Pathology

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR SURGERY

    Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient AMBULATORY SURGICAL CTR/ENDOSCOPY CTR Digestive System

    Outpatient HOSPITAL Medicine

    Outpatient ORTHOPEDIC SURGERY Integumentary System

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PAIN MANAGEMENT Nervous System

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    Method

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient ANESTHESIOLOGY Anesthesia

    Outpatient PSYCHIATRY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient BEHAVIORAL HEALTH Medicine

    Page 7 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient ENDOCRINOLOGY Medicine

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including

    AmbulanceOutpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including

    Ambulance

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Temporary Codes: Equipment, Replacement, Repair, Rental

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR

    SURGERY

    Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DERMATOLOGY Medicine

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    MethodOutpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    MethodOutpatient RADIATION ONCOLOGY Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Pathology

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient HOSPITAL Drugs Administered Other Than Oral

    MethodOutpatient HOSPITAL Drugs Administered Other Than Oral

    MethodOutpatient HOSPITAL Drugs Administered Other Than Oral

    MethodOutpatient HOSPITAL Radiology

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral Method

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral Method

    Page 8 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    MethodOutpatient FAMILY PRACTICE Medicine

    Outpatient HOSPITAL Digestive System

    Outpatient NEPHROLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    MethodOutpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Radiology

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral Method

    Outpatient GENERAL SURGERY Drugs Administered Other Than Oral Method

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR SURGERY

    Medicine

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR

    SURGERY

    Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient AMBULATORY SURGICAL CTR/ENDOSCOPY CTR Integumentary System

    Outpatient HOSPITAL Pathology

    Outpatient HOSPITAL Anesthesia

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Page 9 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient SLEEP MEDICINE Medicine

    Outpatient PULMONARY MEDICINE Medicine

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral Method

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient HOSPITAL Medicine

    Outpatient ALLERGY/IMMUNOLOGY Medicine

    Outpatient RADIATION ONCOLOGY Radiology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OPHTHALMOLOGY Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR

    SURGERY

    Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including

    Ambulance

    Outpatient PODIATRY Medicine

    Outpatient HOSPITAL Pathology

    Outpatient HOSPITAL Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient PSYCHIATRY Medicine

    Outpatient AMBULANCE Transportation Services Including Ambulance

    Page 10 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient RADIOLOGY Radiology

    Outpatient PATHOLOGY Pathology

    Outpatient PEDIATRICS Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient FAMILY PRACTICE Procedures/Professional Services

    Outpatient FAMILY PRACTICE Pathology

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR SURGERY

    Medicine

    Outpatient HOSPITAL Drugs Administered Other Than Oral

    MethodOutpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient ENDOCRINOLOGY Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OPTOMETRISTS Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Orthotic/Prosthetic Devices and Procedures

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient NEPHROLOGY Drugs Administered Other Than Oral Method

    Page 11 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    MethodOutpatient INTERNAL MEDICINE Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient ORTHOPEDIC SURGERY Medicine

    Outpatient ORTHOPEDIC SURGERY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including

    AmbulanceOutpatient HOSPITAL Medicine

    Outpatient HOSPITAL Pathology

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Procedures/Professional Services

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Pathology

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral Method

    Outpatient FAMILY PRACTICE Pathology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient ENDOCRINOLOGY Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient RADIOLOGY Radiology

    Outpatient ENDOCRINOLOGY Medicine

    Outpatient GENERAL SURGERY Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient PSYCHIATRY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Page 12 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including Ambulance

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including Ambulance

    Outpatient HOSPITAL Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Mediastinum

    Outpatient FAMILY PRACTICE Pathology

    Outpatient FAMILY PRACTICE Pathology

    Outpatient HOSPITAL Pathology

    Outpatient HOSPITAL Radiology

    Outpatient PSYCHIATRY Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient RADIATION ONCOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PULMONARY MEDICINE Medicine

    Outpatient PULMONARY MEDICINE Procedures/Professional Services

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient BEHAVIORAL HEALTH Medicine

    Page 13 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient OPTOMETRISTS Medicine

    Outpatient OPHTHALMOLOGY Eye and Ocular Adnexa

    Outpatient OPHTHALMOLOGY Auditory System

    Outpatient RADIATION ONCOLOGY Radiology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient NURSE PRACTITIONER Medicine

    Outpatient INTERNAL MEDICINE Medicine

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    MethodOutpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    MethodOutpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    Method

    Outpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    MethodOutpatient NURSE PRACTITIONER Drugs Administered Other Than Oral

    Method

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral Method

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient INTERNAL MEDICINE Medicine

    Page 14 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient RADIOLOGY Medicine

    Outpatient INTERNAL MEDICINE Medicine

    Outpatient HOSPITAL Pathology

    Outpatient FAMILY PRACTICE Pathology

    Outpatient FAMILY PRACTICE Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient HOSPITAL Drugs Administered Other Than Oral

    MethodOutpatient EMERGENCY MEDICINE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient PATHOLOGY Pathology

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient RADIOLOGY Radiology

    Outpatient SLEEP MEDICINE Medicine

    Outpatient SLEEP MEDICINE Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient LABORATORY Pathology

    Outpatient HOSPITAL Procedures/Professional Services

    Outpatient EMERGENCY MEDICINE Radiology

    Page 15 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient HOSPITAL Drugs Administered Other Than Oral

    MethodOutpatient HOSPITAL Radiology

    Outpatient HOSPITAL Pathology

    Outpatient HOSPITAL Medicine

    Outpatient INTERNAL MEDICINE Medicine

    Outpatient PHYSICAL THERAPY Medicine

    Outpatient INTERNAL MEDICINE Medicine

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Procedures/Professional Services

    Outpatient HOSPITAL Drugs Administered Other Than Oral

    Method

    Outpatient PATHOLOGY Pathology

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral Method

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Medicine

    Outpatient ALLERGY/IMMUNOLOGY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient RADIOLOGY Radiology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Medicine

    Outpatient PLASTIC & RECONSTRUCTIVE SURGERY Medicine

    Outpatient PLASTIC & RECONSTRUCTIVE SURGERY Medicine

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient OPHTHALMOLOGY Medicine

    Page 16 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient BEHAVIORAL HEALTH Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient NEPHROLOGY Medicine

    Outpatient HOSPITAL Pathology

    Outpatient HOSPITAL Drugs Administered Other Than Oral

    Method

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR

    SURGERY

    Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient HOSPITAL Medicine

    Outpatient NURSE PRACTITIONER Medicine

    Outpatient NURSE PRACTITIONER Medicine

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Medicine

    Outpatient PHYSICIAN ASSISTANT CERTIFIED Medicine

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    Method

    Outpatient FAMILY PRACTICE Pathology

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Radiology

    Outpatient PHYSICIAN ASSISTANT CERTIFIED Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient RADIOLOGY Radiology

    Page 17 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient RADIOLOGY Medicine

    Outpatient PSYCHIATRY Medicine

    Outpatient FAMILY PRACTICE Temporary Codes

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Outpatient INTERNAL MEDICINE Medicine

    Outpatient PSYCHIATRY Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient PSYCHIATRY Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient PLASTIC & RECONSTRUCTIVE SURGERY Integumentary System

    Outpatient FAMILY PRACTICE Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient RADIATION ONCOLOGY Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient PEDIATRICS Medicine

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    MethodOutpatient ORTHOPEDIC SURGERY Drugs Administered Other Than Oral

    MethodOutpatient HOSPITAL Pathology

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Page 18 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient CERTIFIED REGISTERED NURSE ANESTHETIST Anesthesia

    Outpatient SPECIALIST Pathology

    Outpatient SPECIALIST Pathology

    Outpatient SPECIALIST Pathology

    Outpatient SPECIALIST Pathology

    Outpatient ANESTHESIOLOGY Anesthesia

    Outpatient NEUROLOGY Radiology

    Outpatient NEUROLOGY Medicine

    Outpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    MethodOutpatient FAMILY PRACTICE Drugs Administered Other Than Oral

    Method

    Outpatient FAMILY PRACTICE Medicine

    Outpatient ORTHOPEDIC SURGERY Medicine

    Outpatient SPECIALIST Medicine

    Outpatient ORTHOPEDIC SURGERY Musculoskeletal System

    Outpatient HOSPITAL Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Medicine

    Outpatient ANESTHESIOLOGY Medicine

    Outpatient HOSPITAL Pathology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient FAMILY PRACTICE Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Page 19 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient CHIROPRACTIC MEDICINE Medicine

    Outpatient ANESTHESIOLOGY Anesthesia

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PEDIATRICS Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient RADIATION ONCOLOGY Radiology

    Outpatient RADIATION ONCOLOGY Pathology

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient GENERAL SURGERY Digestive System

    Outpatient AMBULATORY SURGICAL CTR/ENDOSCOPY CTR Nervous System

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Procedures/Professional Services

    Outpatient HOSPITAL Drugs Administered Other Than Oral Method

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Medicine

    Outpatient RADIATION ONCOLOGY Procedures/Professional Services

    Outpatient FAMILY PRACTICE Medicine

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient AMBULATORY SURGICAL CTR/ENDOSCOPY CTR Eye and Ocular Adnexa

    Outpatient HOSPITAL Radiology

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Medicine

    Outpatient HOSPITAL Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Durable Medical Equipment

    Page 20 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient ANESTHESIOLOGY Anesthesia

    Outpatient HOSPITAL Medicine

    Outpatient OBSTETRICS/GYNECOLOGY Medicine

    Outpatient FAMILY PRACTICE Pathology

    Outpatient GASTROENTEROLOGY Medicine

    Outpatient DURABLE MEDICAL EQUIPMENT & MEDICAL SUPPLIES Transportation Services Including

    AmbulanceOutpatient FAMILY PRACTICE Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient FAMILY PRACTICE Medicine

    Outpatient PODIATRY Medicine

    Outpatient FAMILY PRACTICE Medicine

    Outpatient NEUROLOGY Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient PATHOLOGY Pathology

    Outpatient HOSPITAL Medicine

    Outpatient RADIOLOGY Medicine

    Outpatient PATHOLOGY Pathology

    Outpatient HOSPITAL Temporary Codes

    Outpatient EMERGENCY MEDICINE Medicine

    Outpatient EMERGENCY MEDICINE Radiology

    Outpatient HOSPITAL Pathology AGE INVALID FOR DIAGNOSIS

    Outpatient FAMILY PRACTICE Medicine BENEFIT NOT AVAILABLE

    Outpatient FAMILY PRACTICE Medicine BENEFIT NOT AVAILABLE

    Outpatient EMERGENCY MEDICINE Medicine CODES SHOULD NOT CO-EXIST WITH EACH OTHER/SAME DAY

    Page 21 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient EMERGENCY MEDICINE Medicine CODES SHOULD NOT CO-

    EXIST WITH EACH OTHER/SAME DAY

    Outpatient EMERGENCY MEDICINE Medicine CODES SHOULD NOT CO-

    EXIST WITH EACH

    OTHER/SAME DAYOutpatient NEPHROLOGY Medicine GROUPED TO GLOBAL CPT

    CODEOutpatient INTERNAL MEDICINE Medicine GROUPED TO GLOBAL CPT

    CODEOutpatient UROLOGY Medicine GROUPED TO GLOBAL CPT

    CODEOutpatient FAMILY PRACTICE Medicine GROUPED TO GLOBAL CPT

    CODEOutpatient CARDIOLOGY,CARDIOTHORACIC & CARDIOVASCULAR

    SURGERYMedicine GROUPED TO GLOBAL CPT

    CODE

    Outpatient FAMILY PRACTICE Medicine GROUPED TO GLOBAL CPT CODE

    Outpatient FAMILY PRACTICE Medicine GROUPED TO GLOBAL CPT CODE

    Outpatient FAMILY PRACTICE Medicine GROUPED TO GLOBAL CPT CODE

    Outpatient FAMILY PRACTICE Medicine INELIGIBLE MEMBER-PATIENT RESP FOR BILLED

    CHARGESOutpatient HOSPITAL Procedures/Professional Services INELIGIBLE MEMBER-

    PATIENT RESP FOR BILLED CHARGES

    Outpatient EMERGENCY MEDICINE Medicine INELIGIBLE MEMBER-PATIENT RESP FOR BILLED

    CHARGES

    Page 22 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient AMBULANCE Transportation Services Including

    Ambulance

    INELIGIBLE MEMBER-

    PATIENT RESP FOR BILLED CHARGES

    Outpatient ORTHOPEDIC SURGERY Medicine INELIGIBLE MEMBER-

    PATIENT RESP FOR BILLED

    CHARGESOutpatient RADIOLOGY Radiology INELIGIBLE MEMBER-

    PATIENT RESP FOR BILLED CHARGES

    Outpatient RADIOLOGY Radiology INELIGIBLE MEMBER-PATIENT RESP FOR BILLED

    CHARGESOutpatient EMERGENCY MEDICINE Medicine INELIGIBLE MEMBER-

    PATIENT RESP FOR BILLED

    CHARGESOutpatient EMERGENCY MEDICINE Medicine INELIGIBLE MEMBER-

    PATIENT RESP FOR BILLED

    CHARGESOutpatient PATHOLOGY Pathology INELIGIBLE MEMBER-

    PATIENT RESP FOR BILLED

    CHARGESOutpatient CHIROPRACTIC MEDICINE Medicine MEMBER UNITS REACHED

    Outpatient CHIROPRACTIC MEDICINE Medicine MEMBER UNITS REACHED

    Outpatient PHYSICAL THERAPY Medicine MEMBER UNITS REACHED

    Outpatient PHYSICAL THERAPY Medicine MEMBER UNITS REACHED

    Outpatient HOSPITAL Pathology MEMBER UNITS REACHED

    Page 23 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient CHIROPRACTIC MEDICINE Medicine MEMBER UNITS REACHED

    Outpatient GENERAL SURGERY Medicine NO LEGAL OBLIGATION TO

    PAY -EXPENSES ARE NOT COVER

    Outpatient GENERAL SURGERY Medicine NO LEGAL OBLIGATION TO

    PAY -EXPENSES ARE NOT COVER

    Outpatient GENERAL SURGERY Medicine NO LEGAL OBLIGATION TO

    PAY -EXPENSES ARE NOT COVER

    Outpatient HEALTH DEPARTMENT Medicine NON-NETWORK SERVICES

    ARE NOT COVERED BY THIS

    PLANOutpatient RADIATION ONCOLOGY Medicine PRIOR CLAIM-SERVICES

    GROUPED TO

    COMPREHENSIVE CODEOutpatient OPTOMETRISTS Medicine ROUTINE VISION &

    GLASSES/CONTACTS

    EXCLUDEDOutpatient HOSPITAL Procedures/Professional Services SERV/DIAG CONSID

    EXPERIMENT-PATIENT RESP BILLED

    Outpatient RADIOLOGY Procedures/Professional Services SERV/DIAG CONSID EXPERIMENT-PATIENT

    RESP BILLEDOutpatient RADIOLOGY Radiology SERV/DIAG CONSID

    EXPERIMENT-PATIENT

    RESP BILLEDOutpatient HOSPITAL Procedures/Professional Services SERV/DIAG CONSID

    EXPERIMENT-PATIENT RESP BILLED

    Page 24 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Outpatient RADIOLOGY Radiology SERV/DIAG CONSID

    EXPERIMENT-PATIENT RESP BILLED

    Outpatient PEDIATRICS Medicine SERVICE/DIAG EXCLUDED

    BY PLAN-PATIENT RESP

    BILLEDOutpatient OPTOMETRISTS Medicine SERVICE/DIAG EXCLUDED

    BY PLAN-PATIENT RESP BILLED

    Outpatient ANESTHESIOLOGY Anesthesia SERVICE/DIAG EXCLUDED BY PLAN-PATIENT RESP

    BILLEDOutpatient PSYCHIATRY Medicine SERVICE/DIAG EXCLUDED

    BY PLAN-PATIENT RESP

    BILLEDOutpatient HOSPITAL Drugs Administered Other Than Oral

    MethodSERVICE/DIAG EXCLUDED

    BY PLAN-PATIENT RESP

    BILLEDOutpatient PATHOLOGY Pathology SERVICE/DIAG EXCLUDED

    BY PLAN-PATIENT RESP

    BILLEDOutpatient HOSPITAL Durable Medical Equipment SERVICE/DIAG EXCLUDED

    BY PLAN-PATIENT RESP BILLED

    Outpatient PATHOLOGY Pathology SERVICE/DIAG EXCLUDED BY PLAN-PATIENT RESP

    BILLEDOutpatient FAMILY PRACTICE Procedures/Professional Services SERVICE/DIAG EXCLUDED

    BY PLAN-PATIENT RESP

    BILLED

    Page 25 of 26

  • Indication Physician Specialty Code Range Description Reason For Denial

    Arkansas Statistical Claim Data: Third Quarter 2017

    Inpatient Family Practice Symptoms, signs and abnormal clinical

    and laboratory findings, not elsewhere classified

    Inpatient Family Practice Neoplasms

    Inpatient Family Practice Symptoms, signs and abnormal clinical

    and laboratory findings, not elsewhere

    classifiedInpatient General Surgery Endocrine, nutritional and metabolic

    diseases

    Inpatient Orthopedic Surgery Diseases of the musculoskeletal system and connective tissue

    Inpatient Cardiology Diseases of the circulatory system

    Inpatient General Surgery Symptoms, signs and abnormal clinical

    and laboratory findings, not elsewhere classified

    Inpatient Orthopedic Surgery Injury, poisoning and certain other

    consequences of external causesInpatient Thoracic Surgery Diseases of the circulatory system

    Page 26 of 26

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenialOutpatient PEDIATRICS Medicine NotApplicable

    Outpatient FAMILYPRACTICE Orthotic/ProstheticDevicesandProcedures NotApplicable

    Outpatient PEDIATRICS Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicableOutpatient RADIOLOGY Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Procedures/ProfessionalServices NotApplicable

    Outpatient GENERALSURGERY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient HOSPITAL Pathology NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Procedures/ProfessionalServices NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient RHEUMATOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicable

    ArkansasStatisticalClaimData:SecondQuarter2017

    Page1of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient PATHOLOGY Pathology NotApplicableOutpatient SOCIALWORK Medicine NotApplicableOutpatient PSYCHIATRY Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient ORTHOPEDICSURGERY Mediastinum NotApplicableOutpatient NURSEPRACTITIONER Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient HOSPITAL Pathology NotApplicableOutpatient OPHTHALMOLOGY Medicine NotApplicableOutpatient ALLERGY/IMMUNOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient AMBULANCE TransportationServicesIncludingAmbulance NotApplicable

    Outpatient NEPHROLOGY Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicable

    Page2of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient RADIOLOGY Radiology NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicable

    Outpatient AMBULATORYSURGICALCENTER DigestiveSystem NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicableOutpatient PATHOLOGY Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicable

    Outpatient NURSEPRACTITIONER DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient URGENTCARE TemporaryNationalCodes(Non‐Medicare) NotApplicable

    Outpatient NURSEPRACTITIONER DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient SLEEPMEDICINE Medicine NotApplicableOutpatient SLEEPMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Page3of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIES DurableMedicalEquipment NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient HANDSURGERY TemporaryCodes NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient NEUROLOGY Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicableOutpatient PSYCHIATRY Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient EARS,NOSE&THROAT Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIES DurableMedicalEquipment NotApplicable

    Outpatient ORTHOPEDICSURGERY Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicable

    Page4of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient PODIATRY IntegumentarySystem NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicable

    Outpatient OPHTHALMOLOGY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PSYCHIATRY Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Procedures/ProfessionalServices NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY MaternityCare/Delivery NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicable

    Outpatient ORTHOPEDICSURGERY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIESTransportationServicesIncluding

    Ambulance NotApplicable

    Outpatient CHIROPRACTICCARE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient GENERALSURGERY Medicine NotApplicable

    Page5of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient EARS,NOSE&THROAT Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient EARS,NOSE&THROAT Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient GASTROENTEROLOGY DigestiveSystem NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient CHIROPRACTICCARE Medicine NotApplicableOutpatient HOSPITAL Pathology NotApplicableOutpatient OPHTHALMOLOGY Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient LICENSEDPROFCOUNSELOR Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient GENERALSURGERY Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient MULTIPLESPECIALTIES Medicine NotApplicableOutpatient ANESTHESIOLOGY Anesthesia NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient NURSEPRACTITIONER Medicine NotApplicableOutpatient NURSEPRACTITIONER Medicine NotApplicable

    Page6of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient PEDIATRICS Medicine NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIES DurableMedicalEquipment NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient OTOLARYNGOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient HEALTHDEPARTMENT Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient ALLERGY/IMMUNOLOGY Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicable

    Page7of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Pathology NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicable

    Outpatient GENERALSURGERY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient LICENSEDPROFCOUNSELOR Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient GENERALSURGERY DigestiveSystem NotApplicableOutpatient HOSPITAL Pathology NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient HOSPITAL Radiology NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL Radiology NotApplicable

    Page8of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient PATHOLOGY Pathology NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient PATHOLOGY Medicine NotApplicableOutpatient ONCOLOGY Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIATIONTHERAPY ChemotherapyDrugs NotApplicable

    Outpatient RADIATIONTHERAPY TransportationServicesIncludingAmbulance NotApplicable

    Outpatient PATHOLOGY Pathology NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicable

    Outpatient RADIATIONTHERAPY TransportationServicesIncludingAmbulance NotApplicable

    Outpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient CHIROPRACTICCARE Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Page9of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient GENERALSURGERY Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE IntegumentarySystem NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Mediastinum NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient ANESTHESIOLOGY Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Radiology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicable

    Outpatient OBSTETRICS/GYNECOLOGY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICCARE Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient GENERALSURGERY Medicine NotApplicableOutpatient GENERALSURGERY DigestiveSystem NotApplicableOutpatient RADIATIONTHERAPY Medicine NotApplicable

    Page10of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient ALLERGY/IMMUNOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE TemporaryCodes NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIESTransportationServicesIncluding

    Ambulance NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient NURSEPRACTITIONER Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicable

    Outpatient GENERALSURGERY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient RADIATIONTHERAPY Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PSYCHIATRY Medicine NotApplicable

    Page11of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient RADIOLOGY Radiology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient UROLOGY MaleGenitalSystem NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIES DurableMedicalEquipment NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient GASTROENTEROLOGY Medicine NotApplicableOutpatient PULMONARYMEDICINE Medicine NotApplicableOutpatient HOSPITAL Pathology NotApplicableOutpatient HOSPITAL Procedures/ProfessionalServices NotApplicableOutpatient HOSPITAL TemporaryCodes NotApplicableOutpatient PSYCHIATRY Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient NEUROSURGERY NervousSystem NotApplicableOutpatient NEUROLOGY Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient FAMILYPRACTICE Radiology NotApplicable

    Page12of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PEDCLINICALPHARMACOLOGY Medicine NotApplicableOutpatient PULMONARYDISEASE Medicine NotApplicableOutpatient ALLERGY/IMMUNOLOGY Medicine NotApplicable

    Outpatient NURSEPRACTITIONER DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient CHIROPRACTICCARE Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Pathology NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient HOSPITAL Medicine NotApplicable

    Outpatient PHYSICALTHERAPY/ORTHOPEDIC Medicine NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient ORTHOPEDICS DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient OBSTETRICS/GYNECOLOGY FemaleGenitalSystem NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient UROLOGY Medicine NotApplicable

    Page13of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient HOSPITAL TemporaryNationalCodes(Non‐Medicare) NotApplicable

    Outpatient HOSPITAL Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient PULMONARYMEDICINE RespiratorySystem NotApplicableOutpatient PATHOLOGY Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICCARE Medicine NotApplicableOutpatient FAMILYPRACTICE TemporaryCodes NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient ENDOCRINOLOGY/DIABETES Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Radiology NotApplicableOutpatient ALLERGY/IMMUNOLOGY Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient ALLERGY/IMMUNOLOGY Medicine NotApplicableOutpatient ALLERGY/IMMUNOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient ORTHOPEDICSURGERY MusculoskeletalSystem NotApplicable

    Page14of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient GASTROENTEROLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient ORTHOPEDICS Radiology NotApplicableOutpatient ORTHOPEDICSURGERY MusculoskeletalSystem NotApplicable

    Outpatient ORTHOPEDICSURGERY Orthotic/ProstheticDevicesandProcedures NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PODIATRY Medicine NotApplicableOutpatient PODIATRY Radiology NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient ANESTHESIOLOGY Anesthesia NotApplicableOutpatient INTERNALMEDICINE Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient CHIROPRACTICCARE Medicine NotApplicable

    Page15of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient ORTHOPEDICS Radiology NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIESTransportationServicesIncluding

    Ambulance NotApplicable

    Outpatient OPHTHALMOLOGY Medicine NotApplicableOutpatient CHIROPRACTICCARE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient PSYCHOLOGY Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Procedures/ProfessionalServices NotApplicableOutpatient HOSPITAL Pathology NotApplicableOutpatient HOSPITAL Medicine NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Page16of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIES DurableMedicalEquipment NotApplicable

    Outpatient LICENSEDPROFCOUNSELOR Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient PATHOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient GENERALSURGERY Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicable

    Outpatient GENERALSURGERY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient NURSEPRACTITIONER DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient RADIATIONTHERAPY Medicine NotApplicableOutpatient RADIATIONTHERAPY Pathology NotApplicableOutpatient RADIATIONTHERAPY Pathology NotApplicable

    Outpatient RADIATIONTHERAPY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient LABORATORY Pathology NotApplicableOutpatient NEUROLOGY Medicine NotApplicableOutpatient NEUROLOGY Medicine NotApplicableOutpatient SLEEPMEDICINE Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIATIONTHERAPY Pathology NotApplicableOutpatient PULMONARYMEDICINE Medicine NotApplicable

    Page17of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient PATHOLOGY Pathology NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient DERMATOLOGY Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient ANESTHESIOLOGY Anesthesia NotApplicableOutpatient GENERALSURGERY Medicine NotApplicableOutpatient NEUROLOGY Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Pathology NotApplicable

    Outpatient URGENTCARE TemporaryNationalCodes(Non‐Medicare) NotApplicable

    Outpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient GASTROENTEROLOGY Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Radiology NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicable

    Outpatient OBSTETRICS/GYNECOLOGY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient RADIATIONTHERAPY Pathology NotApplicableOutpatient RADIATIONTHERAPY Pathology NotApplicableOutpatient RADIATIONTHERAPY Pathology NotApplicableOutpatient RADIATIONTHERAPY Pathology NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicable

    Page18of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient INTERNALMEDICINE Medicine NotApplicableOutpatient RADIATIONTHERAPY Medicine NotApplicableOutpatient SOCIALWORK Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient RADIATIONTHERAPY Pathology NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIES DurableMedicalEquipment NotApplicable

    Outpatient RADIOLOGY Radiology NotApplicableOutpatient PULMONARYMEDICINE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient HOSPITAL Pathology NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient FAMILYPRACTICE IntegumentarySystem NotApplicableOutpatient LICENSEDPROFCOUNSELOR Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicable

    Page19of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Radiology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient PODIATRY DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient HOSPITAL Pathology NotApplicableOutpatient HOSPITAL Procedures/ProfessionalServices NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient PATHOLOGY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Mediastinum NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient PATHOLOGY Pathology NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIES DurableMedicalEquipment NotApplicable

    Outpatient GENERALSURGERY Medicine NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Page20of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient DERMATOLOGY Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient PEDIATRICS Medicine NotApplicableOutpatient RADIATIONTHERAPY Pathology NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient PHYSICALTHERAPY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicable

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIESTransportationServicesIncluding

    Ambulance NotApplicable

    Outpatient PEDIATRICS Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient HOSPITAL Medicine NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient NURSEPRACTITIONER Medicine NotApplicableOutpatient NURSEPRACTITIONER Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient PODIATRY TransportationServicesIncludingAmbulance NotApplicable

    Outpatient CARDIOLOGY Medicine NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Radiology NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicable

    Page21of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE Pathology NotApplicableOutpatient PSYCHOLOGY Medicine NotApplicableOutpatient HOSPITAL Radiology NotApplicableOutpatient HOSPITAL Medicine NotApplicableOutpatient HOSPITAL Procedures/ProfessionalServices NotApplicableOutpatient HOSPITAL Pathology NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient HOSPITAL Pathology NotApplicableOutpatient PSYCHIATRY Medicine NotApplicableOutpatient PEDIATRICS Radiology NotApplicableOutpatient PEDIATRICS Radiology NotApplicableOutpatient GENERALSURGERY Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient PEDIATRICS Medicine NotApplicableOutpatient RHEUMATOLOGY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient CARDIOVASCULARDISEASE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient GENERALSURGERY Radiology NotApplicableOutpatient PULMONARYMEDICINE Medicine NotApplicableOutpatient ANESTHESIOLOGY Anesthesia NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Page22of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient CARDIOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient RADIOLOGY Radiology NotApplicableOutpatient ORTHOPEDICS Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient OBSTETRICS/GYNECOLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient LABORATORY Pathology NotApplicableOutpatient PSYCHIATRY Medicine NotApplicableOutpatient EMERGENCYMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient PATHOLOGY Pathology NotApplicableOutpatient OPTOMETRISTS Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient CARDIOLOGY Medicine NotApplicable

    Page23of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIESOrthotic/ProstheticDevicesand

    Procedures NotApplicable

    Outpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE Pathology NotApplicableOutpatient PSYCHIATRY Medicine NotApplicableOutpatient EARS,NOSE&THROAT Medicine NotApplicableOutpatient FAMILYPRACTICE Pathology NotApplicableOutpatient FAMILYPRACTICE Procedures/ProfessionalServices NotApplicableOutpatient ORTHOPEDICSURGERY Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient CHIROPRACTICCARE Medicine NotApplicableOutpatient CHIROPRACTICMEDICINE Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicableOutpatient NEUROLOGY Medicine NotApplicable

    Outpatient FAMILYPRACTICE DrugsAdministeredOtherThanOralMethod NotApplicable

    Outpatient ORTHOPEDICSURGERY Radiology NotApplicableOutpatient ORTHOPEDICSURGERY Radiology NotApplicableOutpatient GASTROENTEROLOGY Medicine NotApplicableOutpatient FAMILYPRACTICE Medicine NotApplicable

    Page24of76

  • Indication PhysicianSpecialty CodeRangeDescription ReasonForDenial

    ArkansasStatisticalClaimData:SecondQuarter2017

    Outpatient DURABLEMEDICALEQUIPMENT&MEDICALSUPPLIESTransportationServicesIncluding

    Ambulance NotApplicable

    Outpatient SLEEPMEDICINE Medicine NotApplicableOutpatient FAMIL