Caregiver Explanatory Codes 2018-04-18T08:44:38+00:00

Caregiver Explanatory Codes

Here are the most frequently used explanatory codes found on WCB cheques/EFT statements to caregivers.

AJ Adjust.
BA Duplicate: payment has been made for a similar service provided on the same day.
BG Billed less than listed payment: appropriate payment for the date of service has been approved.
BQ Service code and/or amount submitted incorrect: please review and re-submit.
BS The service code submitted is not correct for the condition described; or the service(s) provided.
BU Payment not approved. See MSB description of this code.
BW Billed more than listed payment: appropriate payment for the date of service has been approved.
CN Claim received more than twelve months after the date of service cannot be accepted for any reason.
CR Credit of previously paid service: now seeking recovery.
DA Not approved for payment. Only one visit type service is approved during a single patient contact.
DE Included in the payment for another service provided during the same Physician/Patient contact.
DI Disallowed.
EL Consultation converted to a partial/follow-up assessment. Re: Assessment Rules – “Consultations”, item f(ii).
FE The greater payment approved. (1) Procedure not approved in addition to another service. (2) Included in the payment for the procedure. Re: (1) Assessment Rules – “Multiple Services”, Rule 1. (2) Payment Schedule listing.
FP A “0” or “10” day procedure billed in addition to a visit/hospital care or consultation: approved at the greater of, the procedure alone or the visit plus the procedure at 75%.
HS Not WCB responsibility, please submit to Hospital Services.
IC Report incomplete: no report fee.
IJ Interjurisdictional Claim. This WCB claim is being handled in a Province outside of SK and will not be paid. Please resubmit to the accepting province for payment.
JO Paid in accordance with rules for two or more procedures performed on the same day by the same physician, another physician in same specialty and clinic or part of the surgical team. Re: Assessment Rules – “Multiple Services”, Rule 8.
KA An inclusion in the payment for the procedure when provided by the same physician, another physician in same specialty and clinic or part of the surgical team. See MSB description of this code.
KM Diagnostic procedure on the day of a 42 day procedure: diagnostic approved at 75%.
KP Visit (including hospital care) or consultation, same day, is included in the payment for a “42” Day procedure when provided by the same physician, another physician in same specialty and clinic or part of the team.
LD Approved only with specified services as listed in the schedule under payment item 897L, 899L or 300T, where provided in a physician’s office.
MS Billing would have to be submitted to MSP by the caregiver
NA Not Authorized, Not Approved for payment.
NM No Manufacturers invoice submitted. Please resubmit with the original invoice attached to your invoice for consideration of payment.
NR No report found on file for service date billed: invoice for report not paid.
NW More than one report received on a claim the same day: only one report fee payable.
TX No GST payable.
XT Cost transfer. Paid on incorrect claim number.

For a complete list of explanatory codes, please visit the Medical Services Branch (MSB) website.

Please direct inquiries to Medical Accounts at 306.787.4412 or toll-free 1.800.667.7590.