Medicaid Claim Adjustment Reason Code:22

Medicaid Remittance Advice Remark Code:MA04

MMIS EOB Code:25

This claim has been denied for one or both of the following reasons: 1) the number of units appears to be excessive, or 2) the pricing and/or quantity indicates that an incorrect NDC may have been used. If you feel this is incorrect, contact Betty Devaney at 444-3457.

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