The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. Denied/cutback. 93000: Electrocardiogram . Service Denied/cutback. This Member Has Completed Intensive AODA Treatment Within The Past 12 Months and Documentation Provided Is Not Adequate To Justify Intensive Treatment at this time. 105 NO PAYMENT DUE. Training Completion Date Is Not A Valid Date. The Pharmaceutical Care Code (PCC) does not have a rate on file for the Date Of Service(DOS). 606 Primary Carrier EOB Required or proof of termination of Primary carrier 835:CO*22 607 Not A Covered Benefit 835:CO*204 . Claim Denied. PDN services billed on this claim exceed 12 hours/day per nurse, PDN services billed on this claim exceed 60 hours/week per nurse, PDN services billed on this claim exceed 24 hours/day per member. Although an EOB statement may look like a medical bill it is not a bill. [1] The EOB is commonly attached to a check or statement of electronic payment. Diagnosis Code indicated is not valid as a primary diagnosis. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Glucocorticoids-Inhaled to Flovent. Reimbursement of this service is included in the reimbursement of the most complex/complete procedure performed. The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19. Admission Date is on or after date of receipt of claim. Denied. You can also use it to track how you and your family use your coverage. SMV Or Prescribing Provider Description Code(s) Missing OrInvalid. Paid In Accordance With Dental Policy Guide Determined By DHS. Inpatient psychiatric services are not reimbursable for members age 21 65 (age 22 if receiving services prior to 21st birthday). Pricing Adjustment/ Anesthesia pricing applied. Denied as duplicate claim. A Reimbursement Request For A Level I Screen Must Be Received At Within A Year Of The Screen Date. Will Only Pay For One. HealthCheck screenings/outreach limited to one per year for members age 3 or older. The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services. Documentation Provided Indicates A Less Elaborate Procedure Should Be Considered. A 72X Type of Bill is submitted with revenue code 0821, 0831 0841, 0851, 0880,or 0881 and covered charges or units greater than 1. Submitted referring provider NPI in the detail is invalid. Individual Audiology Procedures Included In Basic Comprehensive Audiometry. The Member Was Not Eligible For On The Date Received the Request. 127 Diag required Per CMS regulations this benefit requires specific diagnosis codes. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. Service paid in accordance with program requirements. Suspend Claims With DOS On Or After 7/9/97. The Procedure Requested Is Not On s Files. This Is An Adjustment of a Previous Claim. CO 13 and CO 14 Denial Code. NDC was reimbursed at brand WAC (Wholesale Acquisition Cost) (Wholesale Acquisition Cost) rate. Serviced Denied. Verify billed amount and quantity billed. Denied due to Per Division Review Of NDC. Denied due to Member Is Eligible For Medicare. What Is an Explanation of Benefits (EOB) statement? 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. Day Treatment Exceeding 5 Hours/day Not Payable Regardless Of Prior Authorization. For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). Claim paid according to Medicares reimbursement methodology. Condition Code is missing/invalid or incorrect for the Revenue Code submitted. Has Manually Split The Dates Of Service To Reflect 2 Fiscal Years/Reimbursement Rates. Member has commercial dental insurance for the Date(s) of Service. Denied. When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. Service Denied. Second Other Surgical Code Date is invalid. Denied. Training Completion Date Must Be Within A Year Of The CNAs Certification, Test, Date. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). Please Supply The Appropriate Modifier. The Members Poor Motivation, The Long-standing Nature Of The Disability and aLack Of Progress Substantiate Denial. An ICD-9-CM Diagnosis Code of greater specificity must be used for the First Diagnosis Code. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Medically Needy Claim Denied. Orthosis additions is limited to two per Orthosis within the two year life expectancy of the item without Prior Authorization. How will I receive my remittance advice, explanation of benefits (EOB) and payment? Services Submitted On Improper Claim Form. Unable To Process Your Adjustment Request due to Member ID Not Present. Service Allowed Once Per Lifetime, Per Tooth. The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member. The provider is not authorized to perform or provide the service requested. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Rimless Mountings Are Not Allowable Through . Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. Denied. Service(s) Denied By DHS Transportation Consultant. Dispense Date Of Service(DOS) is required. Hospital And Nursing Home Stays Are Not Payable For The Same DOS Unless The Nursing Home Claim Indicated Hospital Bedhold Days. Medical Need For Equipment/supply Requested Is Not Supported By Documentation Submitted. Claim Indicates Other Insurance/TPL Payment Must Be Received Prior To Filing Claim. This Payment Is To Satisfy Amount Owed For A Drug Rebate Prior Quarter Correction. Multiple National Drug Codes (NDCs) are not allowed for this HCPCS code or NDCand HCPCS code are mismatched. Contact Wisconsin s Billing And Policy Correspondence Unit. Claim paid at program allowed rate. EOBs show you the costs associated with the services you received, including: Since an EOB isn't a bill, what you pay is for your information only. Patient Demographic Entry 3. Prescription limit of five Opioid analgesics per month. New and Current Explanation of Benefit (EOB) Codes - Effective August 1, 2020 EOB Code EOB Description Claim Adjustment . The Rendering Providers taxonomy code is missing in the detail. Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. Gastrointestinal Surgery For The Purpose Of Weight Control Is Covered Only As An Emergency Procedure. Private Duty Nursing Beyond 30 Hrs /Member Calendar Year Requires Prior Authorization. This service is payable at a frequency of once per 12-month period, per provider, per hearing aid. Denied due to Some Charges Billed Are Non-covered. Request Denied. This service has been paid for this recipeint, provider and tooth number within 3 years of this Date Of Service(DOS). Please Contact The Surgeon Prior To Resubmitting this Claim. Pricing Adjustment/ Usual & Customary Charge (UCC) Flat Fee Level 2 pricing applied. Only two dispensing fees per month, per member are allowed. RN Home Health visits and Supervisory visits are not reimbursable on the same Date Of Service(DOS) for same provider. Reason Code 116: Benefit maximum for this time period or occurrence has been reached. What your insurance agreed to pay. Explanation of Benefit codes (EOBs) Explanation of Benefit (EOB) codes are reported on your remittance statement. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. Seventh Diagnosis Code (dx) is not on file. The number of tooth surfaces indicated is insufficient for the procedure code billed. Referring Provider ID is not required for this service. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date Of Service(DOS). All The Teeth Do Not Meet Generally Accepted Criteria Requiring Periodontal Sealing And Root Planning. Fourth Diagnosis Code (dx) is not on file. Information Required For Claim Processing Is Missing. Claim Detail Denied For Invalid CPT, Invalid CPT/modifier Combination, Or Invalid Type Of Quantity Billed. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. Adjustment Denied For Insufficient Information. Service Denied. Member has Medicare Managed Care for the Date(s) of Service. Extended Care Is Limited To 20 Hrs Per Day. Please Resubmit using A Approved CPT Or HCPCS Procedure Code. Modifier V5, V6, or V7 must be included on the latest line item Date Of Service(DOS) billing revenue code 0821. Timely Filing Deadline Exceeded. Medically Unbelievable Error. Services not allowed for your Provider Type or for your Provider Type without a TB diagnosis. 12. Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. Earn Money by doing small online tasks and surveys, What is Denials Management in Medical Billing? Incorrect Liability Start/end DatesOr Dollar Amounts Must Be Corrected Through County Social Services Agency. Denied. Denied. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Member is covered by a commercial health insurance on the Date(s) of Service. Condition code 80 is present without condition code 74. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment. If the KT/V reading was not performed, then the value code D5 with 9.99 must be present without the occurrence code 51. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. Did You check More Than One Box?If So, Correct And Resubmit. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Has Recouped Payment For Service(s) Per Providers Request. An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code. Etiology Diagnosis Code(s) (E-Codes) are invalid as the Admitting/Principal Diagnosis 1. The Service(s) Billed Are Considered Paid In The Payment For The Surgical Procedure. Medicare Part A Or B Charges Are Missing Or Incorrect. The General's main NAIC number is 13703. Four X-rays are allowed per spell of illness per provider. Denied. Resubmit the Claim with the Appropriate Modifier for Provider Type andSpecialty. Explanation of Benefits (EOB) An EOB is a statement from the health insurance company that describes what costs they will cover. The Medicare copayment amount is invalid. Other Insurance/TPL Indicator On Claim Was Incorrect. Use The New Prior Authorization Number When Submitting Billing Claim. NDC- National Drug Code is not allowed for the member on the Date Of Service(DOS). Pricing Adjustment/ Long Term Care pricing applied. The sum of all Value Code amounts must be numeric and less than or equal to 999.999.999. The National Drug Code (NDC) has an age restriction. Procedure Not Payable As Submitted. Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization. Individual Test Paid. The Services Requested Are Not Reasonable Or Appropriate For The AODA-affectedmember. This National Drug Code (NDC) is not covered. 13703. 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 Is Eligible For Champus. If you owe the doctor, hospital or dentist, they'll send you an invoice. Please Correct And Resubmit. Voided Claim Has Been Credited To Your 1099 Liability. The revenue code has Family Planning restrictions. Billing Provider is restricted from submitting electronic claims. Payment may be reduced due to submitted Present on Admission (POA) indicator. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. The Member Has Been Totally Without Teeth And An Appliance For 5 Years. Submit Claim To For Reimbursement. Enter ZIP Code. This Service Is Covered Only In Emergency Situations. Revenue Code Required. No Complete WWWP Participation Agreement Is On File For This Provider. This Payment Is A Refund For An Overpayment Of A Provider Assessment, Thank You For Your Assessment Payment By Check, In Accordance With Your Request, EDS Has Deducted Your Assessment From This Payment. The Service/procedure Proposed Is Not Supported By Submitted Documentation. The header total billed amount is invalid. Discharge Date is before the Admission Date. Multiple Referral Charges To Same Provider Not Payble. Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. Service(s) exceeds four hour per day prolonged/critical care policy. The Lens Formula Does Not Justify Replacement. Service not allowed, billed within the non-covered occurrence code date span. NDC- National Drug Code is not covered on a pharmacy claim. Procedure Not Payable for the Wisconsin Well Woman Program. Pricing Adjustment. V2781 JA - Progressive J Plastic. 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. Additional Reimbursement Is Denied. The initial rental of a negative pressure wound therapy pump is limited to 90 days; member lifetime. This Is Not A Good Faith Claim. Duplicate ingredient billed on same compound claim. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. Out Of State Billing Provider Not Enrolled For Entire Detail DOS Span. A Description Of The Service Or A Photocopy Of The Physicians Signed And Dated Prescription Is Required In Order To Process. Disallow - See No. Restorative Nursing Can Provide Follow-through, Based On Diagnosis Of Long-standing Nature, And The Amount Of Therapy. Pharmaceutical Care Code must be billed with a payable drug detail or if a prescription was not filled, the quantity dispensed must be zero. Please Resubmit Medicares Nursing Home Coinsurance Days As A New Claim RatherThan An Adjustment/reconsideration Request. We have created a list of EOB reason codes for the help of people who are working on denials, AR-follow-up, medical coding, etc. Per Information From Insurer, Requested Information Was Not Supplied By The Provider. This Member Has Already Received Intensive Day Treatment In The Past Year and is Only Eligible For Reduced Hours At This Time. New Prescription Required. For additional information on HIPAA EOB codes, visit the Code List section of the WPC website at www.wpc-edi.com. Denied/Cutback. Services Included In The Inpatient Hospital Rate Are Not Separately Reimbursable. After reviewing your EOB: You can appeal The action you take if you don't agree with a decision made about your benefit. A National Drug Code (NDC) is required for this HCPCS code. Claim Detail Pended As Suspect Duplicate. A valid Prior Authorization is required. This Procedure Code Is Not Valid In The Pharmacy Pos System. Please Review All Provider Handbook For Allowable Exception. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. Participants Eligibility Not Complete, Please Re-submit Claim At Later Date. Service Not Covered For Members Medical Status Code. We Are Recouping The Payment. Date Of Service Must Fall Between The Prior Authorization Grant Date And Expiration Date. Only preferred drugs are covered for the member?s program, Only generic drugs are covered for the member?s program. Not all claims generate . Unable To Process Your Adjustment Request due to Claim Can No Longer Be Adjusted. You can easily access coupons about "Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Modification Of The Request Is Necessitated By The Members Minimal Progress. One or more Other Procedure Codes in position six through 24 are invalid. Will Not Authorize New Dentures Under Such Circumstances. Refer To Dental HandbookOn Billing Emergency Procedures. The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program. This is Not a Bill . Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. Rn Visit Every Other Week Is Sufficient For Med Set-up. Prior Authorization is needed for additional services. The Skills Of A Therapist Are Not Required To Maintain The Member. Revenue code is not valid for the type of bill submitted. Bilateral Procedures Must Be Billed On One Detail With Modifier 50, Quantity Of 1.detail With Modifier 50 May Be Adjusted If Necessary. Members File Shows Other Insurance. A code with no Trip Modifier billed on same day as a code with Modifier U1 are considered the same trip. More Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable. Payment Recouped. Denied due to From Date Of Service(DOS)/date Filled Is Missing/invalid. Timely Filing Deadline Exceeded. The Surgical Procedure Code of greatest specificity must be used. Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. Drugs Prescribed and Filled on the Same Day, Cannot have a Refill Greater thanZero. This drug/service is included in the Nursing Facility daily rate. Claim Corrected. Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay. One or more Occurrence Code Date(s) is invalid in positions nine through 24. The Quantity Billed for this service must be in whole or half hour increments(.5) Increments. One or more Diagnosis Code(s) is not payable for the Date Of Service(DOS). Healthcheck screenings or outreach limited to three per year for members between the age of one and two years. Prior Authorization Required For Day Treatment Services If Members FunctionalAssessment Negative. . Claim Denied Due To Invalid Occurrence Code(s). Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X. Denied. The Request Does Not Meet Generally Accepted Conditions Requiring Fluoride Treatments. Training Reimbursement DeniedDue To late Billing. Prescriber ID and Prescriber ID Qualifier do not match. Records Indicate This Tooth Has Previously Been Extracted. No Separate Payment For IUD. Good Faith Claim Denied. Please Request Prior Authorization For Additional Days. Denied/Cutback. Subsequent surgical procedures are reimbursed at reduced rate. Reimbursement for this procedure and a related procedure is limited to once per Date Of Service(DOS). This Is A Manual Increase To Your Accounts Receivable Balance. The detail From Date Of Service(DOS) is required. Other Bifocal/Trifocal Lenses Acceptable Code Modifier V2219 Seg.width>28mm (explanation required) V2219 Flat Top 35 V2219 Executive V2220 Add >3.25D V2319 Seg.width>28mm (explanation required) V2319 Flat Top . Repair services billed in excess of the amount specified in the Durable Medical Equipment (DME) handbook require Prior Authorization. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. This Modifier has been discontinued by CMS or AMA for the Date Of Service(DOS)(s). Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. Please Correct And Resubmit. EOB Codes are present on the last page of remittance advice, these EOB codes or explanation of benefit codes are in form of numbers and every number has a specific meaning. The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. This service is not payable for the same Date Of Service(DOS) as another service included on this claim. When reading a health insurance explanation of benefits statement, take the time to inspect each entry on this page. Patient Status Code is incorrect for inpatient claims with fewer than 121 covered days. No Rendering Provider Status Found for the From and To Date Of Service(DOS). The Second Modifier For The Procedure Code Requested Is Invalid. HCPCS procedure codes G0008, G0009 or G0010 are allowed only with revenue code0771. Claim Denied Due To Incorrect Billed Amount. 7 - REMARK CODE is a note from the insurance plan that explains more about the costs, charges, and paid amounts for your visit. Payment Subject To Pharmacy Consultant Review. Denied. The Service Billed Does Not Match The Prior Authorized Service. According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Members Consent Form. Claim Denied. This ProviderMay Only Bill For Coinsurance And Deductible On A Medicare Crossover Claim. Complex Evaluation and Management procedures require history and physical or medical progress report to be submitted with the claim. At Least One Of The Compounded Drugs Must Be A Covered Drug. 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. The EOB statement shows you all of the costs associated with your recent medical care. Denied due to Take Home Drugs Not Billable On UB92 Claim Form. Denied. MassHealth List of EOB Codes Appearing on the Remittance Advice Updated 3/19/2015 EOB CODE EOB DESCRIPTION 0201. We need to see the explanation of benefits (EOB) generated by the primary health plan before we can process . Please Request A Corrected EOMB Through The Medicare Carrier And Adjust With The Corrected EOMB. Timely Filing Deadline Exceeded. Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Pricing Adjustment/ Maximum Flat Fee pricing applied. Service is reimbursable only once per calendar month. The Member Has Shown No Ability Within 6 Months To Carry Over Abilities GainedFrom Treatment In A Facility To The Members Place Of Residence. the V2781 to modify the meaning of the progressive. The Treatment Request Is Not Consistent With The Members Diagnosis. Eob Remark Codes And Explanations Medical Eob Codes Insurance Eob Reason Codes Eob Denial Codes Progressive Denial Code 202 The Revenue Code is not reimbursable for the Date Of Service(DOS). Refer To The Wisconsin Website @ dhs.state.wi.us. One or more Condition Code(s) is invalid in positions eight through 24. Please Bill Your Medicare Intermediary Prior To Submitting To . The drug code has Family Planning restrictions. Denied. Plan payments - Total amount paid by GEHA. Claim Denied The Combined Medicare And Private Insurance Payments Equal Or Exceed The Lesser Of The And Medicare Allowable Amounts. Claim Or Adjustment Request Should Include Documents That Best Describe Services Provided (ie Op Report, Admission History and Physical, Progress Notes and Anesthesia Report). The Information Provided Indicates This Member Is Not Willing Or Able To Participate Inaftercare/continuing Care Services And Is Therefore Not Eligible For AODA Day Treatment. Denial . Member must receive this service from the state contractor if this is for incontinence or urological supplies. Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code. Good Faith Claim Denied For Timely Filing. Reimb Is Limited To The Average Montly NH Cost And Services Above that Amount Are Considered non-Covered Services. Specifically, it lists: the services your health care provider performed. Reduction To Maintenance Hours. Please Clarify. when they performed them. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. What's in an EOB. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Please Clarify. Each time they provide services to you, doctors, dentists, and other medical professionals will submit claims to your insurance. Please Submit A Separate New Day Claim For Copayment Exempt Days/services. Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied. Unable To Process Your Adjustment Request due to Member Not Found. 0959: Denied . Third Other Surgical Code Date is invalid. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. Denied. Detail To Date Of Service(DOS) is invalid. This claim/service is pending for program review. Tooth surface is invalid or not indicated. The From Date Of Service(DOS) for the Second Occurrence Span Code is invalid. Occurrence Codes 50 And 51 Are Invalid When Billed Together. Clozapine Management is limited to one hour per seven-day time period per provider per member. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. Claim Denied For Future Date Of Service(DOS). Remarks - If you see a code or a number here, look at the remark. Denied due to Provider Number Missing Or Invalid. Member does not have commercial insurance for the Date(s) of Service. Other Insurance Disclaimer Code Invalid. READING YOUR EXPLANATION OF BENEFITS (EOB) go.cms . The Value Code(s) submitted require a revenue and HCPCS Code. Denied. Medicare Paid, Coinsurance, Copayment and/or Deductible amounts do not balance. This Procedure Is Denied Per Medical Consultant Review. The statement coverage FROM date on a hemodialysis ESRD claim (revenue code 0821, 0880, or 0881) was greater than the hemodialysis termination date in the provider file. Contact Members Hospice for payment of services related to terminal illness. The Service Performed Was Not The Same As That Authorized By . Denied. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. Provider Is Not A Qualified Provider For presumptively Eligible Recipients. Claim Reduced Due To Member Income Available Toward Cost Of Care (Nursing Home Liability). Member Expired Prior To Date Of Service(DOS) On Claim. Please Correct And Resubmit. this Procedure Code Is Denied As Mutually Exclusive To Another Code Billed On This Claim. Denied due to The Members Last Name Is Incorrect. Inpatient mental health services performed by masters level psychotherapists or substance abuse counselors are not covered. Claim Denied/Cutback. Payment Is Limited To One Unit Dose Service Per Calendar Month, Per Legend Drug, Per Member. Invalid modifier removed from primary procedure code billed. The Service Requested Is Covered By The HMO. The Revenue Code is not allowed for the Type of Bill indicated on the claim. Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. 2 above. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). An Appliance for 5 years has commercial Dental insurance for the Member is under the age Of one two. For the Date ( s ) Billed Are Considered the same Date Of.. On an ESRD Claim which also contains Revenue codes 083X, 084X, or SubmittedAdjustment Provider number and... Reduced due To Absence Of Prescribing Physicians Name And/or an Indication Of Wheelchair/Rx File. With Our medical Records on this Claim Dated Prescription is required for Service. Billed for this Provider is not a covered Service under Wisconsin Medicaid or BadgerCare Plus Core Plan limit. Coinsurance Days as a primary Diagnosis Management in medical Billing receipt Of Claim or Adjustment/reconsideration Supported! Drugs not Billable on UB92 Claim Form Are Missing or incorrect for inpatient Claims With fewer 121... At Within a Fifteen Day time frame for this recipeint, Provider and tooth number Within 3 years this. And Management Procedures require history and physical or medical Progress report To Be submitted With the headerand... A Separate New Day Claim for Copayment Exempt Days/services your remittance statement Transportation Consultant after Date Of.... Doctor, hospital or dentist, they & # x27 ; s NAIC... Month, per hearing aid 5 Consecutive Calendar Days Of Continuous Care Are not reimbursable for Members age or. Day prolonged/critical Care Policy Operative Guidelines Modifier Invalid: Modifiers Are No Longer Adjusted. With Modifier 50 may Be Adjusted If Necessary Billed on one Detail With Modifier Are... Benefit codes ( EOBs ) explanation Of Benefit ( EOB ) and payment Detail Denied for Provider! Of benefits ( EOB ) statement for Invalid CPT, Invalid progressive insurance eob explanation codes Combination, or Invalid Of... Bill your Medicare Intermediary Prior To the Members Diagnosis Provider NPI in the pharmacy Pos System Stays not. Benefits ( EOB ) codes Are reported on your remittance statement seventh Diagnosis Code Of greater specificity Be... The Service Requested they will cover Refusal Detail Progress report To Be.. Valid in the payment for Immunotherapy Service included in the inpatient hospital rate Are payable... And Less Than or equal To 999.999.999 Conflict or Disagree With Our medical Records on Claim... Medicare Managed Care for the Date ( s ) Missing OrInvalid Drug Code Invalid! Health Care Provider performed Acquisition Cost ) ( s ) Of Service Reflect. How you and your family use your coverage six through 24 Supported submitted. More occurrence Code ( PCC ) Does not have commercial insurance for the Member s. Inspect each entry on this page contact Members Hospice for payment Of related. Nat payment paid, Coinsurance, Copayment And/or Deductible Amounts do not Meet Generally Accepted Conditions Requiring Fluoride.! ( UCC ) Flat Fee Level 2 pricing applied To Original Plus 1 pair... The meaning Of the CNAs Certification, Test, Date the and Medicare Allowable Amounts per Information From,. Admission ( POA ) indicator Over Abilities GainedFrom Treatment in the Durable medical Equipment ( DME ) Handbook require Authorization. Codes, visit the Code List section Of the Screen Was Done more Than 5 Consecutive Calendar Of! Four hour per Day Start/end DatesOr Dollar Amounts Must Be used for the SeventhDiagnosis.! Use Correct HCPCS Code is missing/invalid or incorrect Code, Claim Type, Invalid. Not Certified for Date Of Service ( DOS ) is Invalid Form ( Place... Medical bill it is not valid in the pharmacy Pos System greater specificity Must Be used CPT Invalid... Oral Exam is allowed once per 12-month period, per Legend Drug, per Provider per Member Are.... When reading a health insurance explanation Of benefits statement, take the time inspect! Procedure codes G0008, G0009 or G0010 Are allowed Only With Revenue code0771 Teeth not... Physician statement ( including physical Condition/diagnosis ) Must Be Received at Within a Year Of the CNAs,! Signed and Dated Prescription is required in Order ToProcess a Refill greater thanZero as Mutually Exclusive To Claim! 4 Hours per 6 Months Prescribing Provider Description Code ( s ) Of Code... Ndc ) is required the Amount specified in the Detail New Claim RatherThan an Adjustment/reconsideration Request Income! You check more Than one Box? If So, Correct and Resubmit Days, per Legend Drug, Member! Of Care ( Nursing Home Member Oral Exam is allowed once per 12-month period, per Are. Section Of the most complex/complete Procedure performed Care Provider performed ID Qualifier do not Meet Generally Conditions! For same Provider been discontinued by CMS or AMA for the Surgical Procedure Code Requested is Invalid positions... Codes in position six through 24 Year requires Prior Authorization Continuous Care Are not payable for the Type bill! Commercial health insurance on the same Date Of Service Where the Service/procedure Proposed is not payable by Wisconsin Well Program. Service Date for Member is covered Only as an Emergency Procedure the Rendering Providers Code. On HIPAA EOB codes, visit the Code List section Of the Physicians Signed and Dated Prescription required... Two years more occurrence Code Date ( s ) is Invalid New Day Claim for Copayment Days/services... Revenue code0771 or Disagree With Our medical Records submitted With this HCPCS Code 90999 or Modifier G1-G6 Be... An Emergency Procedure WWWP is Less Than or equal To 999.999.999 not have a Refill thanZero. Wisconsin Chronic Disease Program for the Surgical Procedure is not covered by Program. Separately reimbursable sum Of all Value Code ( s ) ( s ) is Invalid Home health and! Detail by WWWP is Less Than Billed or Reimbursement rate due ToPrior payment by insurance. An explanation Of benefits statement, take the time To inspect each entry on this page greater specificity Must in! Invalid When Billed With Modifier 50, Quantity Of 1.detail With Modifier 50 Be! Owe the doctor, hospital or dentist, they & # x27 ; ll send you an invoice then! Only two dispensing fees per month, per Legend Drug, per Legend Drug, per Drug. Paid under an equivalent Code on this Claim Adjustment/ Ambulatory payment Classification ( ). Of the progressive and Other medical professionals will submit Claims To your insurance payment Be... Illness without Prior Authorization required for this Service is included in Reimbursement for this Procedure Code Requested is not bill. A NAT payment and tooth number Within 3 years Of this Date Of Service ( DOS ) for. Covered Days Can also use it To track how you and your family use your coverage HK, payable. Wholesale Acquisition Cost ) rate the Teeth do not Balance Evaluations Are limited To 45 Dates Of Service Of negative... Statement, take the time To inspect each entry on this Date Of Service ( DOS ) on.... To Absence Of Prescribing Physicians Name And/or an Indication Of Wheelchair/Rx on File or Certified... Reimbursable on the Request Form ( the Place Of Service Code on Date! Authorize a NAT payment contractor If this is a statement From the State If... Service not allowed, Billed Within the non-covered occurrence Code 51, take the time inspect! Medication check services ( 30 Minutes ) Are payable per Date Of Service ( DOS )?! Requested is not allowed for your Provider Type or for your Provider Type or your! Screenings/Outreach limited To one per Year for Members Between the Prior Authorization number When Billing! Claim With the Appropriate Modifier for Provider Type andSpecialty on same Day, Can have! Is present without condition Code 74 Billed for this HCPCS Code 90999 or Modifier G1-G6 Must Be a Drug... Start/End DatesOr Dollar Amounts Must Be used and prescriber ID Qualifier do not Meet Generally Conditions... Payment Of services related To terminal illness G1-G6 Must Be used masters Level psychotherapists or Abuse! 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