Multiple Service Location Found For the Billing Provider NPI. Only Four Dates Of Service Are Allowed Per Line Item (detail) For Each Procedure. Explanation Examples; ADJINV0001. 606 Primary Carrier EOB Required or proof of termination of Primary carrier 835:CO*22 607 Not A Covered Benefit 835:CO*204 . The below mention list of EOB codes is as below, EOB codes list is updated as per the latest information gathered from authorized sources of information, if any discrepancy please let us know via the contact us page, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. The topic of Requirements for Compression Garments can be found in the Claims Section, Submission Chapter. The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Resubmit Professional Component On The Proper Claim Form With The EOMB Attached. A Training Payment Has Already Been Issued To A Different NF For This CNA. Copayment Should Not Be Deducted From Amount Billed. CNAs Eligibility For Nat Reimbursement Has Expired. Reading your EOB may help you better understand your short term health insurance or major medical insurance benefits. Procedure Not Payable As Submitted. Etiology Diagnosis Code(s) (E-Codes) are invalid as the Admitting/Principal Diagnosis 1. This service is not payable for the same Date Of Service(DOS) as another service included on this claim. The Rendering Providers taxonomy code in the header is not valid. Service Not Covered For Members Medical Status Code. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. See Physicians Handbook For Details. Excessive height and/or weight reported on claim. CO 5 Denial Code - The Procedure code/Bill Type is inconsistent with the Place of Service. NDC was reimbursed at State Maximum Allowable Cost (SMAC) rate. The Billing Providers taxonomy code in the header is invalid. Claim Denied. The Member Information Provided By Medicare Does Not Match The Information On Files. Consultation or surgical procedures are not reimbursable in conjuctions with Emergency Room services. Billing Provider ID is missing or unidentifiable. Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. Contact Members Hospice for payment of services related to terminal illness. Dispensing Two Lens Replacements On Same Date Of Service(DOS) Not Allowed. Referring Provider ID is not required for this service. Adjustment Requested Member ID Change. You Must Adjust The Nursing Home Coinsurance Claim. The billing provider number is not on file. Your 1099 Liability Has Been Credited. Only non-innovator drugs are covered for the members program. This National Drug Code Has Diagnosis Restrictions. Reimbursement Is Limited To The Average Monthly Nursing Home Cost And Services Above That Amount Are Considered Non-covered Services. Therapy Prior Authorization Requests Expire At The End Of A Calendar Month. Pricing Adjustment/ Maximum Allowable Fee pricing used. Denied/Cutback. You can easily access coupons about "Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. 24260 Progressive insurance code: 24260. Denied. Rebill On Pharmacy Claim Form. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). Prescriber must contact the Drug Authorization and Policy Override Center for policy override. The National Drug Code (NDC) was reimbursed at a generic rate. The Change In The Lens Formula Does Not Warrant Multiple Replacements. New and Current Explanation of Benefit (EOB) Codes - Effective August 1, 2020 EOB Code EOB Description Claim Adjustment . READING YOUR EXPLANATION OF BENEFITS (EOB) go.cms . Member is enrolled in Medicare Part B on the Date(s) of Service. Other Medicare Managed Care Response not received within 120 days for providerbased bill. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Denied. Members File Shows Other Insurance. Voided Claim Has Been Credited To Your 1099 Liability. This claim has been adjusted due to a change in the members enrollment. Revenue code requires submission of associated HCPCS code. What the doctor or hospital charged (all charges) What your insurance covered and did not cover. This claim is a duplicate of a claim currently in process. Procedure Code Modifier(s) Invalid For Date Of Service(DOS) Or For Prior Authorization Date Of Receipt. your insurance plan will begin sharing the cost with you (see "co-insurance"). Denied. Additional Psychotherapy Is Not Considered Appropriate Or Inline With More Effective, Available Services. Please submit future claims with the appropriate NPI, taxonomy and/or Zip +4 Code. The Member Has Shown No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 Month Period. Progress, Prognosis And/or Behavior Are Complicating Factors At This Time. AAA insurance code: 71854. Denied due to Provider Signature Is Missing. Fourth Diagnosis Code (dx) is not on file. Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization. Provider Certification Has Been Suspended By The Department of Health Services(DHS). Unable To Process Your Adjustment Request due to Financial Payer Not Indicated. So, what is an EOB? An ICD-9-CM Diagnosis Code of greater specificity must be used for the Third Diagnosis Code. This claim/service is pending for program review. Invalid Admission Date. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19. Medication checks by a Psychiatrist and/or Registered Nurse are limited to four services per calendar month. No Action Required on your part. Denied/Cutback. The Processor Control Number (PCN) for SeniorCare member over 200% FPL is missing, or the PCN is invalid for a WCDP member, member or SeniorCare member at or below 200% FPL. Reason Code 162: Referral absent or exceeded. Denied. Member has commercial dental insurance for the Date(s) of Service. Outpatient Services To Be Billed As Inpatient Ancillaries When Same Day Stay Occurs Please File An Adjustment/reconsideration Request To Correct Inpatiet Billing. Service Denied/cutback. What Is an Explanation of Benefits (EOB) statement? Files Indicate You Are A Medicare Provider And Medicare Benefits May Be Available On This Claim. Please Indicate Separately On Each Detail. The Revenue Code is not payable for the Date Of Service(DOS). Please Rebill Inpatient Dialysis Only. Claim paid according to Medicares reimbursement methodology. Invalid modifier removed from primary procedure code billed. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. The Quantity Allowed Was Reduced To A Multiple Of The Products Package Size. Name And Complete Address Of Destination. 0395 HEADER STATEMENT COVERS PERIOD "FROM" DATE MISSING. Denied/Cutback. Sixth Diagnosis Code (dx) is not on file. Denied/Cutback. Previously Paid Individual Test May Be Adjusted Under a Panel Code. We'll stop sending paper Explanation of Benefits (EOBs) and checks to all participating and non-participating providers beginning September 2021 through September 2022. Understanding Insurance Codes To Avoid Billing Errors - Verywell . Contact Wisconsin s Billing And Policy Correspondence Unit. (part JHandbook). Review Billing Instructions. This National Drug Code is not covered under the Core Plan or Basic Plan for the diagnosis submitted. Please Correct And Resubmit. Details Include Revenue/surgical/HCPCS/CPT Codes. Reason Code 116: Benefit maximum for this time period or occurrence has been reached. Multiple Tooth Extract On Same Date Of Service(DOS) Must Be Billed As Single And Additional Tooth Extract In Same Quadrant. The Screen Date Must Be In MM/DD/CCYY Format. Procedure Code is allowed once per member per lifetime. Service(s) paid in accordance with program policy limitation. Denied. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. A traditional dispensing fee may be allowed for this claim. This notice gives you a summary of your prescription drug claims and costs. Drugs Prescribed and Filled on the Same Day, Cannot have a Refill Greater thanZero. Inpatient mental health services performed by masters level psychotherapists or substance abuse counselors are not covered. Good Faith Claim Denied For Timely Filing. Claim Denied/Cutback. For additional information on HIPAA EOB codes, visit the Code List section of the WPC website at www.wpc-edi.com. Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date. The Value Code and/or value code amount is missing, invalid or incorrect. Prosthodontic Services Appear To Have Started After Member EligibilityLapsed. Denied. Your health plan's Explanation of Benefits, more commonly known as an EOB, may be confusing at first glance, but it doesn't have to be. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. Denied. Amount allowed - See No. Submitted referring provider NPI in the detail is invalid. The Service Requested Is Not A Covered Benefit Of The Program. Please include the Identification Code used in PWK06 and our 9-digit claim number on all correspondence. Pricing Adjustment/ Spenddown deductible applied. Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. Denied due to The Members Last Name Is Missing. One or more Surgical Code Date(s) is missing in positions seven through 24. Missing Or Invalid Level Of Effort And/or Reason For Service Code, Professional Service Code, Result Of Service Code Billed In Error. Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. Progressive will accept records via Fax. Out of State Billing Provider not certified on the Dispense Date. Comprehension And Language Production Are Age-appropriate. Service paid in accordance with program requirements. Rqst For An Exempt Denied. CPT is registered trademark of American Medical Association. One or more From Date Of Service(DOS) (DOS) is invalid for Occurrence Span Codes in positions three through 24. The Clinical Profile And Narrative History Indicate Day Treatment Is Neither Appropriate Nor A Medical Necessity For This Member. The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services. Reimbursement For This Certification, Test, Segment Has Been Issued To AnotherNF. The Reimbursement Code Assigned To This CNA Does Not Authorize A NAT Payment. The first occurrence span from Date Of Service(DOS) is after the to Date Of Service(DOS). The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. Combine Like Details And Resubmit. The Member Appears To Be At A Maximum Level For Age, Diagnosis, And Living Arrangement. Service Denied, refer to Medicares Billing and/or Policy Guidelines. Lenses Only Are Approved; Please Dispense A Contracted Frame. Claim Denied. Member Name Missing. Explanation of Benefits (EOB) An EOB is a statement from the health insurance company that describes what costs they will cover. The Member Does Not Appear To Be Able Or Willing To Abstain From Alcohol/drug Usage While in Treatment And Is Therefore Not Eligible For AODA Day Treatment. Billed Amount Is Equal To The Reimbursement Rate. Please verify billing. Reimb Is Limited To The Average Montly NH Cost And Services Above that Amount Are Considered non-Covered Services. BMN prior authorization may be submitted for Mental Health drugs for which a Core Plan transitioned member has been previously grandfathered. The Primary Diagnosis Code is inappropriate for the Procedure Code. The Procedure Code is not payable by Wisconsin Chronic Disease Program for theDate(s) of Service. Denied. Questionable Long-term Prognosis Due To Apparent Root Infection. Information inadequate to establish medical necessity of procedure performed.Please resubmit with additional supporting documentation. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). Unable To Process Your Adjustment Request due to The Claim Type Of The Adjustment Does Not Match The Claim Type Of The Original Claim. Access payment not available for Date Of Service(DOS) on this date of process. The Dispense As Written (DAW) indicator is not allowed for the National Drug Code. Amount Paid By Other Insurance Exceeds Amount Allowed By . Quantity indicated for this service exceeds the maximum quantity limit established by the National Correct Coding Initiative. Unable To Process Your Adjustment Request due to Claim Has Already Been Adjusted. The Submission Clarification Code is missing or invalid. Date Of Service Must Fall Between The Prior Authorization Grant Date And Expiration Date. NDC was reimbursed at generic WAC (Wholesale Acquisition Cost) rate. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). This service is not covered under the ESRD benefit. The Rehabilitation Potential For This Member Appears To Have Been Reached. Please Correct And Resubmit. Do not leave blank fields between the multiple occurance codes. Service (Procedure Code/Modifier Combination) is not reimbursable for Date Of Service(DOS). Billing Provider Type and/or Specialty is not allowable for the service billed. Title 32, Code of Federal Regulations, Part 220 - Implements 10 U.S.C. Reimbursement determination has been made under DRG 981, 982, or 983. Medically Needy Claim Denied. Service Denied. Level, Intensity Or Extent Of Service(s) Requested Has Been Modified Consistent With Medical Need As Defined In The Plan Of Care. This Procedure Is Denied Per Medical Consultant Review. Does not meet hearing aid performance check requirement of 45 post dispensing days. Diagnosis 635-635.92 May Only Be Used When Billing For Abortion Procedures. Reimbursement Is At The Unilateral Rate. This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. Please Contact Your District Nurse To Have This Corrected. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information. NULL CO 16, A1 MA66 044 Denied. The Timeframe Between Certification, Test, Date And Hire Date Exceeds A Year. Pricing Adjustment/ Level of effort dispensing fee applied. One or more Surgical Code Date(s) is invalid in positions seven through 24. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment. All ESRD clinical diagnostic laboratory tests must be billed individually to ensure that automated multi-chanel chemistry tests are paid in accordance with the Medicare Provider Reimbursement Manual (PRM) 2711. More than 50 hours of personal care services per calendar year require prior authorization. Denied/Cutback. How will I receive my remittance advice, explanation of benefits (EOB) and payment? Ulcerations Of The Skin Do Not Warrant A New Spell Of Illness. NFs Eligibility For Reimbursement Has Expired. Diagnosis Code is restricted by member age. The NAIC number is issued by the National Association of . Ninth Diagnosis Code (dx) is not on file. eob eob_message 1 provider type inconsistent with claim type . All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied. 0959: Denied . (800) 297-6909. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. Learn more. Check Your Current/previous Payment Reports forPayment. Prior authorization is required for Maxalt when Maxalt or sumatriptan productshave not been reimbursed within 365 days. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a Training Payment. Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). The sum of all Value Code amounts must be numeric and less than or equal to 999.999.999. A Training Payment Has Already Been Issued For This Cna. Initial Visit/Exam limited to once per lifetime per provider. Denied. After Progressive adjudicates the bill, AccidentEDI will send an 835 Multiple Unloaded Trips For Same Day/same Recip. Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. Please Resubmit using A Approved CPT Or HCPCS Procedure Code. Seventh Diagnosis Code (dx) is not on file. Claim Number Given Is Not The Most Recent Number. Please Indicate Mileage Traveled. ACCOM REV CODE QTY BILLED NOT EQUAL TO DTL DOS. Occupational Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization. Please Refer To Your Hearing Services Provider Handbook. If you're hurt in an accident that's covered by Progressive, you can choose a medical provider of your own. Per Information From Insurer, Requested Information Was Not Supplied By The Provider. Member ID has changed. HMO Payment Equals Or Exceeds Hospital Rate Per Discharge. ACode With No Modifier Billed On The Same Day As A Code With Modifier 11 Are Viewed as the same trip. Claim date(s) of service modified to adhere to Policy. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. The Ninth Diagnosis Code (dx) is invalid. Claim Denied. Dispensing fee denied. NDC- National Drug Code is invalid for the Dispense Date Of Service(DOS). Denied due to Medicare Allowed Amount Is Greater Than Total Billed Amount. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. The Medical Need For Some Requested Services Is Not Supported By Documentation. Service Denied. Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. Please File With Champus Carrier. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. Outside Lab,element 20 On CMS 1500 Claim Form Must Be Checked Yes When Handling Charges Are Billed. Per Information From Insurer, Claim(s) Was (were) Not Submitted. One RN HH/RN supervisory visit is allowed per Date Of Service(DOS) per provider permember. The Surgical Procedure Code is not payable for the Date Of Service(DOS). Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. This Adjustment Was Initiated By . Out of state travel expenses incurred prior to 7-1-91 . NDC was reimbursed at brand WAC (Wholesale Acquisition Cost) (Wholesale Acquisition Cost) rate. Service Denied. A valid Prior Authorization is required for Brand Medically Necessary Drugs. Member enrolled in QMB-Only Benefit plan. Prescribing Provider UPIN Or Provider Number Missing. For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. Electronic distribution and delivery of explanation of benefits a statement from a member's health insurance plan describing what costs it will cover for medical care the member . Member History Indicates Member Was In Another Facility During This Period. Once Therapy Is Prior Authorized, All Therapy Must Be Billed With A Valid Prior Authorization Number. Proposed Orthodontic Service Denied; Examination/study Models Are Approved. A Reimbursement Request For A Level I Screen Must Be Received At Within A Year Of The Screen Date. A Payment Has Already Been Issued For This SSN. Traditional dispensing fee may be allowed. The Procedure Requested Is Not Appropriate To The Members Sex. No Rendering Provider Status Found for the From and To Date Of Service(DOS). Please Itemize Services Including Date And Charges For Each Procedure Performed. Denied due to Claim Exceeds Detail Limit. Healthcheck screenings or outreach limited to two per year for members betweenthe ages of two and three years. Subsequent Aide Visits Limited To 7 Hrs Per Day/per Member/per Provider. Was Unable To Process This Request Due To Illegible Information. Reimbursement For This Service Is Included In The Transportation Base Rate. You Must Either Be The Designated Provider Or Have A Referral. Payment Is Limited To One Unit Dose Service Per Calendar Month, Per Legend Drug, Per Member. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Condition Code 73 for self care cannot exceed a quantity of 15. Please Clarify. Detail Quantity Billed must be greater than zero. The Duration Of Treatment Sessions Exceed Current Guidelines. The dental procedure code and tooth number combination is allowed only once per lifetime. Payment(s) For Capital Or Medical Education Are Generated By EDS And May Not Be Billed By The Provider. PIP coverage is typically available in no-fault automobile insurance . For Correct Liability Reimbursement, Do Not Adjust The Level Of Care Days Claim. Follow specific Core Plan policy for PA submission. No policy override available for BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan. Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization. Please Indicate Computation For Unloaded Mileage. The Quantity Billed for this service must be in whole or half hour increments(.5) Increments. Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. All Day Treatment Services For Members With Nursing Home Status Should Be Billed Under Procedure Code W8912(pre 10/1/03)/h2012(post 10/1/03) And Require PriorAuthorization. No Separate Payment For IUD. Payment Subject To Pharmacy Consultant Review. Services Submitted On Improper Claim Form. Account summary A brief snapshot of vital information, including: Your name and address. Services Billed On This Claim/adjustment Have Been Split to Facilitate Processing. Denture Repair And/or Recement Bridge Must Be Submitted On A Paper Claim With ADescription Of Service And Documentation Of A Healthcheck Screen Attached. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. Second And Subsequent Cerebral Evoked Response Tests Paid At A Reduced Rate Per Guidelines. With Accident Forgiveness (not available in CA, CT, and MA) on your GEICO auto insurance policy, your insurance rate won't go up as a result of your first at-fault accident.. Actual Cash Value. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. The Maximum Prior Authorized Service Limitation Or Frequency Allowance Has Been Exceeded. Pursuant to Commission Rules in 50 Ill. Adm. Code 9110.100(c), effective January 24, 2020: "A paper explanation of benefits or SPR must also prominently contain all information necessary to match the explanation of benefits with the associated Medical Bill.A list of any relevant data elements listed in subsection [9110.100(a)] that are required for the paper explanation of benefits or SPR is . SMV Or Prescribing Provider Description Code(s) Missing OrInvalid. Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. The Documentation Submitted Does Not Substantiate Additional Care. Insurance Appeals (BIIA). Abortion Dx Code Inappropriate To This Procedure. Each time they provide services to you, doctors, dentists, and other medical professionals will submit claims to your insurance. New Prescription Required. Surgical Procedure Code is not allowed on the claim form/transaction submitted. Third Diagnosis Code (dx) (dx) is not on file. Insufficient Documentation To Support The Request. Provider Not Eligible For Outlier Payment. Two different providers cannot be reimbursed for the same procedure for the same member on the same Date Of Service(DOS). The Service Billed Does Not Match The Prior Authorized Service. The Eighth Diagnosis Code (dx) is invalid. Home Health services for CORE plan members are covered only following an inpatient hospital stay. Dates of Service reflected by the Quantity Billed for dialysis exceeds the Statement Covers Period. 2 above. . The Procedure Requested Is Not On s Files. Do Not Use Informational Code(s) When Submitting Billing Claim(s). Multiple National Drug Codes (NDCs) are not allowed for this HCPCS code or NDCand HCPCS code are mismatched. Offer. You can probably shred thembut check first! The Performing Provider Id, Member Id, And Date Of Service(DOS) Must Match The Completion Certificate Received From Ddes. Claim Is Being Reprocessed, No Action On Your Part Required. Member is enrolled in Medicare Part A on the Date(s) of Service. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date(s) of Service. Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines. 96 Need EOB Please resubmit with an Explanation of Benefits from the primary insurance carrier . Documentation Does Not Demonstrate The Member Has The Potential To Reachieve his/her Previous Skill Level. Denied. Please Correct And Resubmit. Procedure Code is not payable for SeniorCare participants. Please Correct And Resubmit. The Fax number is (877) 213-7258. NJ Insurance Codes Page 1 of 11 CODE NAME OF INSURANCE CO PHONE PAIP - NJ Personal Auto Insurance Plan 800-652-2471 TIG INSURANCE COMPANY 616-962-5300 Progressive Casualty 216-461-6655 CAIP - Commercial Automobile Insurance Plan 800-652-2471 003 Aetna Casualty & Surety Co. 201-285-5780 or 800-238-6225 004 Cigna Property & Casualty Ins. Default Prescribing Physician Number XX9999991 Was Indicated. TRICARE allowed - the monetary amount TRICARE approves for the. Correct Claim Or Submi Paper Claim Noting That Verification Has Occurred. Denied due to From Date Of Service(DOS)/date Filled Is Missing/invalid. Claim Denied. 100 Days Supply Opportunity. Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. Member is not enrolled for the detail Date(s) of Service. CODE DETAIL_DESCRIPTION EDI_CROSSWALK 030 Missing service provider zip code (box 32) 835:CO*45 . Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Preventive Medicine Code Billed Is Allowed For Health Check Agencies Only With The Appropriate Healthcheck Modifier. Medicare Coinsurance Amount Was Not Provided On Crossover Claim. Pricing Adjustment/ Patient Liability deduction applied. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. Services billed are included in the nursing home rate structure. Contact Provider Services For Further Information. Quantity submitted matches original claim. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. The Total Number Of Hours Per Day Requested For AODA Day Treatment Exceeds Guidelines And The Request Has Been Adjusted Accordingly. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Questionable Long-term Prognosis Due To Decay History. These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan. The Procedure Code has Encounter Indicator restrictions. The Service Requested Is Not A Covered Benefit As Determined By . Please Rebill Only CoveredDates. The Non-contracted Frame Is Not Medically Justified. Denied due to Provider Signature Date Is Missing Or Invalid. Service Denied. Timely Filing Deadline Exceeded. Member is enrolled in Medicare Part D for the Dispense Date Of Service(DOS). WWWP Does Not Process Interim Bills. 0001 01/01/1900 NOT USED - MEMBER'S DMAP I.D. Certifying Agency Did Not Verify Member Eligibility within 70 Day Period. The Procedure(s) Requested Are Not Medical In Nature. Pricing Adjustment/ Pharmaceutical Care dispensing fee applied. Procedure code 00942 is allowed only when provided on the same date ofservice as procedure code 57520. Denied due to Member Not Eligibile For All/partial Dates. What your insurance agreed to pay. CPT and ICD-9- Coding 5. Member is enrolled in QMB-Only benefits. Out Of State Billing Provider Not Enrolled For Entire Detail DOS Span. Billing Provider Received Payment From Both Medicare And For Clai m. An Adjustment/reconsideration Request Has Been Made To The Billing Providers Account. The relationship between the Billed and Allowed Amounts exceeds a variance threshold. If you're a medical provider seeking eBill submission of medical bills, you may do so by: Contacting your own eBill clearinghouse. Claim Denied for implementation of new Wisconsin Medicaid Interchange System.Resubmission of the claim is required due to new claim submission guidelines.
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