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The following Evaluation Codes may be located on your Notice of Determination. They are provided to help you better understand how your claim was evaluated.

 

Evaluation Code Evaluation Description

1

THE AMOUNT CLAIMED IS NOT A COVERED EXPENSE ITEM

2

YOUR CLAIM WAS PAID IN FULL BY THE INSURANCE COMPANY PRIOR TO LIQUIDATION

5

THE INSURANCE COMPANY POLICY CONTRACT DID NOT PROVIDE COVERAGE FOR THIS LOSS

6

THE INSURANCE POLICY WAS EITHER VOIDED, CANCELLED OR EXPIRED BEFORE LOSS

9

YOUR CLAIM WAS PAID IN FULL BY A GUARANTY ASSOCIATION

10

DENIED DUE TO INSUFFICIENT DOCUMENTATION

12

YOUR CLAIM WAS DENIED BECAUSE THE RECEIVER COULD NOT VERIFY COVERAGE CONFIRMATION

14

DUPLICATE CLAIM PREVIOUSLY SUBMITTED

21

YOUR CLAIM IS DENIED DUE TO PROCEDURAL ERROR

24

THE POLICY WAS UNDERWRITTEN BY ANOTHER COMPANY

41

AMOUNT ALLOWED TO PROVIDER UNDER A DIFFERENT CLAIM ID#   

52

YOUR CLAIM WAS PREVIOUSLY PAID BY THE FLORIDA RECEIVER

53

AMOUNT CLAIMED IS RECOMMENDED

54

DUPLICATE CLAIM

55

AMOUNT RECOMMENDED OTHER THAN AMOUNT CLAIMED

58

CLAIM ALREADY PAID

60

YOUR CLAIM WAS DENIED BY INSURANCE COMPANY PRIOR TO LIQUIDATION

64

STATUTE OF LIMITATION EXPIRED

66

TPA ADJUDICATED - MEDICARE

67

TPA ADJUDICATED - MEDICAID