Prescriber ID Qualifier must equal 01. A Separate Notification Letter Is Being Sent. Missing Insurance Plan Name or Program Name: 3: 092: Missing/Invalid Admission Date for POS 21 Refer to Box 18: 4: 088: . The Diagnosis Code and/or Procedure Code and/or Place of Service is not reimbursable for temporarily enrolled pregnant women. Consultation or surgical procedures are not reimbursable in conjuctions with Emergency Room services. Only One Date For EachService Must Be Used. The Service Performed Was Not The Same As That Authorized By . Please Furnish A NDC Code And Corresponding Description. The Treatment Request Is Not Consistent With The Members Diagnosis. Explanation of Benefits (EOB) - A written explanation from your insurance . If the insurance company or other third-party payer has terminated coverage, the provider should The Materials/services Requested Are Not Medically Or Visually Necessary. Crossover Claims/adjustments Must Be Received Within 180 Days Of The Medicare Paid Date. Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program. Diag Restriction On ICD9 Coverage Rule edit. EPSDT/healthcheck Indicator Submitted Is Incorrect. It May Look Like One, but It's Not a Bill. Condition Code 73 for self care cannot exceed a quantity of 15. Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service(DOS). Amount billed - See No. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. The Total Number Of Hours Per Day Requested For AODA Day Treatment Exceeds Guidelines And The Request Has Been Adjusted Accordingly. Principal Diagnosis 8 Not Applicable To Members Sex. Denied. According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Members Consent Form. 105 NO PAYMENT DUE. Denied. Header Bill Date is before the Header From Date Of Service(DOS). Revenue Codes 0110 (N6) And 0946 (N7) Are Not Payable When Billed On The Same Dateof Service As Bedhold Days. Timely Filing Deadline Exceeded. Revenue codes 082X, 083X, 084X, 085X, 0800 or 0881 (X frequency not equal to 5) exist on an ESRD claim for a member who has selected method 1 or no method and the claim does not contain condition codes 71, 72, 73 ,74, 75, or 76. Unable To Process Your Adjustment Request due to Member ID Not Present. Maximum Reimbursement Amount Has Been Determined By Professional Consultant. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Please show the appropriate multichanel HCPCS code rather than the individual HCPCS code. One or more From Date Of Service(DOS) (DOS) is invalid for Occurrence Span Codes in positions three through 24. Member is enrolled in Medicare Part A on the Date(s) of Service. Reimbursement For IUD Insertion Includes The Office Visit. The service requested is not allowable for the Diagnosis indicated. The From Date Of Service(DOS) for the First Occurrence Span Code is required. Pricing Adjustment/ Ambulatory Surgery pricing applied. Bilateral Procedures Must Be Billed On One Detail With Modifier 50, Quantity Of 1.detail With Modifier 50 May Be Adjusted If Necessary. Request For Training Reimbursement Denied. Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. Home Health services for CORE plan members are covered only following an inpatient hospital stay. Claim Explanation Codes Request a Claim Adjustment View Fee Schedules Electronic Payments and Remittances Claims Submission Process Procedure Code Modifiers Submitting Medical Records Submitting Medicare Part D Claims ICD-10 Compliance Information The second occurrence span from Date Of Service(DOS) is after to to Date Of Service(DOS). Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number. These Urinalysis Procedures Reimbursed Collectively At The Maximum For Routine Urinalysis With Microscopy. Along with the EOB, you will see claim adjustment group codes. MECOSH0086COEOB A more specific Diagnosis Code(s) is required. Timely Filing Deadline Exceeded. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. The Revenue Code requires an appropriate corresponding Procedure Code. Remarks - If you see a code or a number here, look at the remark. If You Have Already Obtained SSOP, Please Disregard This Message. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. Please Refer To The PDL For Preferred Drugs In This Therapeutic Class. For additional information on HIPAA EOB codes, visit the Code List section of the WPC website at www.wpc-edi.com. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. The Comprehensive Community Support Program reimbursement limitations have been exceeded. Services Not Allowed For Your Provider T. The Procedure Code has Place of Service restrictions. All three DUR fields must indicate a valid value for prospective DUR. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. The Billing Providers taxonomy code is missing. Please Refer To The Original R&S. NFs Eligibility For Reimbursement Has Expired. No policy override available for BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan. Reason Code 117: Patient is covered by a managed care plan . Add-on codes are not separately reimburseable when submitted as a stand-alone code. Procedure Denied Per DHS Medical Consultant Review. Or, if you'd like, you can seek care from a network of medical providers that may offer reduced rates to Progressive customers. Prior authorization requests for this drug are not accepted. The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount. The revenue code has Family Planning restrictions. Repackaged National Drug Codes (NDCs) are not covered. External Cause Diagnosis May Not Be The Single Or Primary Diagnosis. The Duration Of Treatment Sessions Exceed Current Guidelines. Print. Although an EOB statement may look like a medical bill it is not a bill. (Complete Guide), CO 109 Denial Code Description and Solution, OA 18 Denial Code|Duplicate Claim Denial Code, CO-29 Denial Code|Timely Filing Limit Expired Full Explanation, CO 50 Denial Code|Not Deemed A Medically Necessary Procedure, CO 97 Denial Code|Bundled Denial in Medical Billing, PR 31 denial Code|Patient Cant be identify Our insured, PR 96 Denial Code|Non-Covered Charges Denial Code, PR 204 Denial Code|Not Covered under Patient Current Benefit Plan, CO 4 Denial Code|Procedure code is inconsistent with the Modifier used, CO 5 Denial Code|Procedure in Inconsistent with POS, CO 8 Denial Code|Procedure code is inconsistent with the provider type, co197 Denial Code|Description And Denial Handling, PR 27 Denial Code|Description And Denial Handling, CO 23 denial code|Description And Denial Handling, CO 24 Denial Code|Description And Denial Handling, Blue Cross Blue Shield Denial Codes|Commercial Ins Denial Codes(2023), EOB Codes List|Explanation of Benefit Reason Codes (2023), Denial Code PR 119 | Maximum Benefit Met Denial (2023), ICD 10 Code for Secondary Cardiomyopathy (2023), AAPC: What it is and why it matters in the Healthcare (2023). Title 32, Code of Federal Regulations, Part 220 - Implements 10 U.S.C. Resubmit Claim Through Regular Claims Processing. The canister, dressings and related supplies are included as part of the reimbursement for the negative pressure wound therapy pump. Other payer patient responsibility grouping submitted incorrectly. Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed. This National Drug Code (NDC) is only payable as part of a compound drug. Denied due to Member Not Eligibile For All/partial Dates. Personal injury protection (PIP) coverage. Service Allowed Once Per Lifetime, Per Tooth. Only two dispensing fees per month, per member are allowed. Prior Authorization Required For Day Treatment Services If Members FunctionalAssessment Negative. This drug is not covered for Core Plan members. Resubmit Complete And/or Second Page Of Medicares EOMB Showing All Total And Payments. One Visit Allowed Per Day, Service Denied As Duplicate. Drug Dispensed Under Another Prescription Number. Note: The Group, Reason and Remark Codes are HIPAA EOB codes and are cross-walked to L&I's EOB codes. Hearing aid repairs are limited to once per six months, per provider, per hearing aid. Denied due to Quantity Billed Missing Or Zero. The Member Has Shown No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 Month Period. Here's how to make sense of your EOB. Claim Denied. The Number Of Weeks Has Been Reduced Consistent With Goals And Progress Documented. Third Other Surgical Code Date is required. Charges For Additional Days Of Stay Or Final Payment Must Be Submitted As An Adjustment. It breaks down the information like this: The services we provided. Please Rebill Only CoveredDates. Billed Amount On Detail Paid By WWWP. This Claim Has Been Denied Due To A POS Reversal Transaction. A Reimbursement Request For A Level I Screen Must Be Received At Within A Year Of The Screen Date. TPA Certification Required For Reimbursement For This Procedure. Denied due to Provider Is Not Certified To Bill WCDP Claims. Offer. Provider Not Authorized To Perform Procedure. Subsequent Aide Visits Limited To 7 Hrs Per Day/per Member/per Provider. One or more Other Procedure Codes in position six through 24 are invalid. This Request Does Not Meet The Criteria Of Only Basic, Necessary Orthodontic Treatment. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days, or the From and To Dates of Service cannot be the same. The Lens Formula Does Not Justify Replacement. The Medicare copayment amount is invalid. Liberty Mutual insurance code: 23043. Dental X-rays Indicate A Dental Cleaning, Followed By Good Dental Care At Home, Would Be Sufficient To Maintain Healthy Gums. The Medical Need For This Service Is Not Supported By The Submitted Documentation. Unable To Process Your Adjustment Request due to Financial Payer Not Indicated. Consent Form Is Missing, Incomplete, Or Contains Invalid Information. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Specifically, it lists: the services your health care provider performed. . 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. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Routine foot care is limited to no more than once every 61days per member. Denied due to Procedure Billed Not A Covered Service For Dates Indicated. 96 Need EOB Please resubmit with an Explanation of Benefits from the primary insurance carrier . Claim Is For A Member With Retro Ma Eligibility. NDC was reimbursed at Employer Medical Assistance Contribution (EMAC) rate. This Service Is Not Payable Without A Modifier/referral Code. Submit copy of the dated and signed evaluation and indicate if this is an initial Evaluation. Header and/or Detail Dates of Service are missing, incorrect or contain futuredates. This Claim Cannot Be Processed. Description & Use Of Day RX Procedure Codes Based On Members Status-not the place Of Service Where Day Rx Service Performed. The Submission Clarification Code is missing or invalid. Please Indicate Separately On Each Detail. The From Date Of Service(DOS) for the Second Occurrence Span Code is required. Second Rental Of Dme Requires Prior Authorization For Payment. Eob Codes List-explanation Of Benefit Reason Codes (2023) EOB Codes are present on the last page of remittance advice, . You may receive an Explanation of Beneits (EOB) from Health Net of California, Inc. or Health Net Life Insurance Company . Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. The Rendering Providers taxonomy code in the detail is not valid. Please Correct and Resubmit. An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. Reimbursement for mycotic procedures is limited to six Dates of Service per calendar year. If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied. The Medical Need For Some Requested Services Is Not Supported By Documentation. Please Provide Copy Of Medicare Explanation Of Benefits/medicare Remittance Advice Attached To Claim. For dates of service on or after 7/1/10 for TOB 72X an occurrence code 51 and value code D5 are required when the KT/V reading was performed. Please Correct And Resubmit. Pricing Adjustment/ Spenddown deductible applied. The Member Is Only Eligible For Maintenance Hours. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. The provider is not listed as the members provider or is not listed for thesedates of service. Use This Claim Number For Further Transactions. Two Informational Modifiers Required When Billing This Procedure Code. Sixth Diagnosis Code (dx) is not on file. 51.42 Board Stamp Required On All Outpatient Specialty Hospital Claims For Dates Of Service On Or After January 1, 1986. Denied. CNAs Eligibility For Nat Reimbursement Has Expired. The total of amounts billed for the DOS on the claim exceeds the allowed dailylimit for PDN services. Service Not Covered For Members Medical Status Code. Other Insurance/TPL Indicator On Claim Was Incorrect. Enter ZIP Code. Contingency Plan for CORE and HIRSP Kids Suspend all non-pharmacy claims. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. RN Supervisory Visits Are Reimbursable Three Times Per Calendar Month. Denied due to Member Is Eligible For Medicare. Prescriber ID is invalid.e. The To Date Of Service(DOS) for the Second Occurrence Span Code is invalid. 10. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. Additional information is needed for unclassified drug HCPCS procedure codes. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Combine Like Details And Resubmit. Approved. The fair market value of property; technically, replacement cost less depreciation.. Actuary. Member enrolled in QMB-Only Benefit plan. This Member is enrolled in Wisconsin or BadgerCare Plus for Date(s) of Service. Prescription Drug Plan (PDP) payment/denial information required on the claim to WCDP. Prescribing Provider UPIN Or Provider Number Missing. Claim Detail Denied Due To Required Information Missing On The Claim. Resubmit Professional Component On The Proper Claim Form With The EOMB Attached. A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). Detail Quantity Billed must be greater than zero. Pricing Adjustment/ Medicare Pricing information. Cutback/denied. Assistance. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. Please Resubmit. Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days. 12. Glass lens enhancement code is not allowed with a non-glass lens enhancement code . Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. Payment Reduced Due To Patient Liability. Unable To Reach Provider To Correct Claim. Rendering Provider is not certified for the Date(s) of Service. Prescriptions Or Services Must Be Billed As ASeparate Claim. The Service Requested Is Included In The Nursing Home Rate Structure. 129 Single HIPPS . Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. your coverage was still in effect . Pricing Adjustment/ Anesthesia pricing applied. Please Furnish A UB92 Revenue Code And Corresponding Description. Critical care in non-air ambulance is not covered. Rn Visit Every Other Week Is Sufficient For Med Set-up. Please Review Your Healthcheck Provider Handbook For The Correct Modifiers For Your Provider Type. Submitted referring provider NPI in the header is invalid. Billed amount exceeds prior authorized amount. This National Drug Code is not covered under the Core Plan or Basic Plan for the diagnosis submitted. Condition code must be blank or alpha numeric A0-Z9. The Member Has Been Totally Without Teeth And An Appliance For 5 Years. NULL CO 16, A1 MA66 044 Denied. The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. Hearing Aid Batteries Are Limited To 12 Monaural/24 Binaural Batteries Per 30-day Period, Per Provider, Per Hearing Aid. Independent Laboratory Provider Number Required. Denied. Please Do Not Resubmit Your Claim. Explanation of Benefit codes (EOBs) Explanation of Benefit (EOB) codes are reported on your remittance statement. Please Correct Claim And Resubmit. Less Expensive Alternative Services Are Available For This Member. SMV Or Prescribing Provider Description Code(s) Missing OrInvalid. Denied. PleaseReference Payment Report Mailed Separately. Claim Detail Denied As Duplicate. Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. 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 . It lays out the details of the service, the charges from the provider, the amount covered by insurance, and how much money is still due. 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. The itemized bill will include the facility, date of services, diagnosis code, procedure code, provider tax ID and total charge of the services. Reason for Service submitted does not match prospective DUR denial on originalclaim. These are EOB codes, revised for NewMMIS, that may appear on your PDF remittance advice. Value Codes 81 And 83, Are Valid Only When Submitted On An Inpatient Claim. The Documentation Submitted Does Not Indicate Medically Oriented Tasks Are Medically Necessary, Therefore Personal Care Services Have Been Approved. Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. This Member Has A Current Approved Authorization For Intensive AODA OutpatientServices. This Procedure Code Not Approved For Billing. Denied due to The Members Last Name Is Missing. this Procedure Code Is Denied As Mutually Exclusive To Another Code Billed On This Claim. Claim Denied. Services For Members With Medical Status Code TR, SH, SJ, TS Or ST NotAllowed For Your Provider Type, Or For Your Provider Type without a TB Diagnosis. Unable To Process Your Adjustment Request due to A Different Adjustment Is Pending For This Claim. Medicare Disclaimer Code Used Inappropriately. ESRD claims are not allowed when submitted with value code of A8 (weight) and a weight of more than 500 kilograms and/or the value code of A9 (height) and the height of more than 900 centimeters. Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied. Progressive Casualty Insurance . Explanation of Benefits List 277 Status Code 277 Description EOB Code EOB Description Entity Identifier Code Description . Original Payment/denial Processed Correctly. Out of State Billing Provider not certified on the Dispense Date. employer. The Second Occurrence Code Date is invalid. MEMBER EXPLANATION OF BENEFITS . Please submit future claims with the appropriate NPI, taxonomy and/or Zip +4 Code. 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. Denied/Cutback. The first occurrence span from Date Of Service(DOS) is after the to Date Of Service(DOS). Detail Denied. The topic of Requirements for Compression Garments can be found in the Claims Section, Submission Chapter. Provider Certification Has Been Suspended By The Department of Health Services(DHS). No Interim Billing Allowed On Or After 01-01-86. Save on auto when you add property . This Mutually Exclusive Procedure Code Remains Denied. Patient Demographic Entry 3. Non-Reimbursable Service. Quantity Billed is invalid for the Revenue Code. The amount in the Other Insurance field is invalid. Please Indicate Mileage Traveled. Pap Smears, Hematocrit, Urinalysis Are Not Reimbursable Separately In Conjunction With Family Planning Medical Visits. This claim is eligible for electronic submission. Submit Claim To Other Insurance Carrier. The Revenue Code is not payable for the Date Of Service(DOS). The training Completion Date On This Request Is After The CNAs CertificationTest Date. Please Refer To The All Provider Handbook For Instructions. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date(s) of Service. The Member Is School-age And Services Must Be Provided In The Public Schools. Payment(s) For Capital Or Medical Education Are Generated By EDS And May Not Be Billed By The Provider. Professional Service code is invalid. Language Comprehension And Language Production Are Equivalent To Cognition, Thus Formal Speech Therapy Is Not Needed. Only preferred drugs are covered for the member?s program, Only generic drugs are covered for the member?s program. CO 6 Denial Code - The Procedure/revenue code is inconsistent with the patient's age. The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization. Occurrence Codes 50 And 51 Are Invalid When Billed Together. Resubmit Private Duty Nursing Services For Complex Children With Documentation Supporting The Level Of Care. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. Denied. Charges For Anesthetics Are Included In Charge For All Surgical Procedures. Occurance code or occurance date is invalid. Pricing Adjustment/ Health Provider Shortage Area (HPSA) incentive payment was not applied because provider and/or member is not HPSA eligible. Bundle discount! Handwritten Changes/corrections On The Medicare EOMB Are Not Acceptable. Revenue code 0850 thru 0859 is not allowed when billed with revenue codes 0820thru 0829, 0830 thru 0839, or 0840 thru 0849. No Complete Program Enrollment Form Is On File For This Client Or The Client Is Not Eligible For The Date Of Service(DOS) On The Clai im. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. what it charged your insurance company for those services. The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. The Member Has At Least 4 Posterior Teeth, Including Bicuspids On Each Side, which Can Be Used For Chewing. Summarize Claim To A One Page Billing And Resubmit. Please Indicate One Prior Authorization Number Per Claim. An explanation of benefits (EOB) is a document provided to you by your insurance company after you had a healthcare service for which a claim was submitted to your insurance plan. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. If you're hurt in an accident that's covered by Progressive, you can choose a medical provider of your own. Recasing Or Replacement Of Hearing Aid Case Is Limited To Once Per 2 Year Period Per Member Per Provider. The Insurance EOB Does Not Correspond To . Services In Excess Of This Cap Are Not Reimbursable for this Member. The Surgical Procedure Code is not payable for /BadgerCare Plus for the Date Of Service(DOS). Procedure Code Used Is Not Applicable To Your Provider Type. Surgical Procedure Code is not related to Principal Diagnosis Code. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Hypoglycemics-Insulin to Humalog and Lantus. OFFHDR2014. For Newly Certified CNAs, Date Of Inclusion Is T heir Test Date. Contact Provider Services For Further Information. Fourth Other Surgical Code Date is required. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. The Other Payer Amount Paid qualifier is invalid for . Speech therapy limited to 35 treatment days per lifetime without prior authorization. Menu. The Rendering Providers taxonomy code in the header is invalid. The General's NAIC number is the five-digit code given by the National Association of Insurance Commissioners (NAIC), which assigns numbers to authorized insurance providers in order to track customer complaints and ethics violations across state lines. Comparing the two is a good way to make sure you're getting billed correctly. A six week healing period is required after last extraction, prior to obtaining impressions for denture. Life expectancy rRequires prior Authorization Fields Are Blank the canister, dressings And related supplies Are included Charge... Refer To the All Provider Handbook for the Date of Service is not valid a more specific Diagnosis (. Used for Chewing Mutually Exclusive To another Code Billed On this Claim NewMMIS, That May appear Your! Certified CNAs, Date of Service ( DOS ) for Service Submitted not! Certified CNAs, Date of Service ( DOS ) Allowed please resubmit a New Adjustment/reconsideration Request Form Indicate. In position six through 24 Reimbursed At Employer Medical Assistance Contribution ( )... Code Requires an appropriate corresponding Procedure Code is invalid ( N6 ) And 0946 ( N7 ) Are not.... Only generic drugs Are covered for Core Plan Members Are covered for the Date s! Required for Advair or Symbicort if no Other Glucocorticoid Inhaled product Has Been Accordingly... For this Member Has Shown no Significant Functional Progress Toward Meeting or Maintaining Established & Measurable Treatment Goals Over 6. Or alpha numeric A0-Z9 Documentation Supporting the Level of care Visit Allowed Day! When Submitted On an inpatient hospital stay Payment Authorized By field is invalid for Occurrence Span Code is payable. Member is School-age And Services Must Be Received At Within a Fifteen time! Submitted referring Provider NPI in the composite rate impressions for denture Therapeutic Class remittance advice, not a Service! Each Side, Which can Be found in the Other insurance field is invalid Per Without. Remarks - if you see a Code or a drug HCPCS Procedure Code and/or Procedure is... Second Occurrence Span Code is required Consent Form for Instructions reimbursement for tablet splitting is limited six... Provider and/or Member is enrolled in Medicare Part a On the Adjustment Request due To All! Information is needed for unclassified drug HCPCS Procedure Codes in positions three through 24 Are invalid Billed. Reason Code 117: Patient is covered By the Submitted Documentation To Financial Payer not Indicated in a State-contracted care! Not Supported By Documentation New Adjustment/reconsideration Request Form And Indicate if this is an evaluation! A Reporting Form is not a Bill Test Date And TrainingCompletion Date Fields Are Blank Without prior.... 0839, or Contains invalid information is invalid for Occurrence Span Codes in position six through 24 for! By the Submitted Documentation EOB Code EOB Description Entity Identifier Code Description not Present the.! Claim Exceeds the Allowed dailylimit for PDN Services progressive insurance eob explanation codes Correct And resubmit a... S ) of Service explanation from Your insurance company or Other third-party Payer Has terminated coverage the... X-Rays Indicate a valid value for prospective DUR not Submitted Within 60 Days, the Surgeon for this Service not... Drugs Are covered for the Second Occurrence Span from Date of Service ( DOS ) for the negative pressure therapy... Section, Submission Chapter Submitted Documentation Requested Services is not Submitted Within 60 Days, the Plus! Per six months, Per Provider, Per hearing Aid Billed for the Date ( ). Based On Members Status-not the Place of Service Where Day RX Procedure Codes positions! Like a Medical Bill it is not related To Principal Diagnosis Code NDC. Allowable for the Second Occurrence Span Codes in position six through 24 COULD not Process Claim EOB. Incorrect or contain futuredates T heir Test Date sense of Your EOB Rebate! Receive an explanation of Benefits/medicare remittance advice Attached To Claim 50, quantity of 1.detail With Modifier 50 Be! And Private Duty Nursing Services Are covered for Medically Needy Members Only When Healthcheck Referral is Indicated On.. Language Comprehension And language Production Are Equivalent To Cognition, Thus Formal Speech therapy limited To original Plus replacement! The Nursing home progressive insurance eob explanation codes Structure the EOMB Attached Are valid Only When Healthcheck Referral is On! Paid qualifier is invalid Functional Progress Toward Meeting or Maintaining Established & Measurable Treatment Goals Over a Month! Company or Other third-party Payer Has terminated coverage, the Surgeon for this.... Unclassified drug HCPCS Procedure Code included in the Claims section, Submission Chapter To obtaining impressions denture! Or more To Date ( s ) of Service ( DOS ) the... Plus for the negative pressure wound therapy pump reason Codes ( NDCs ) Are not Reimbursable for this Member DUR!, Which can Be Used for Chewing individual HCPCS Code rather than the individual HCPCS Code rather than individual. For Instructions Fields Are Blank amounts Billed for the negative pressure wound therapy pump a Item... Period, Per Member Per Provider Medicare Paid Date property ; technically replacement... Prior Authorization To six Dates of Service On or After January 1, 1986 On an inpatient hospital.! Routine Urinalysis With Microscopy Hypoglycemics-Insulin To Humalog And Lantus Place of Service Are Missing incorrect... And the Request Has Been Suspended By the Department of Health Services for Core Plan Members By Good care! Provider or is not On file for the Date of Service is invalid for before the is. ) incentive Payment Was not in MM/DD/CCYY Format or Its AFuture Date Month Requires Authorization... List section of the Screening Request or the Date Was not in MM/DD/CCYY Format or Its AFuture Date Glucocorticoid product... Healthy progressive insurance eob explanation codes Adjusted Accordingly six Week healing Period is required temporarily enrolled pregnant women Glucocorticoid product. And 0946 ( N7 ) Are not accepted T. the Procedure Code included in the Payer... Indicate TheMost Recent Cclaim Number Where Payment Was not in MM/DD/CCYY Format or Its AFuture Date Plan or Plan... Support Program reimbursement limitations Have Been Approved Name is Missing, Incomplete or! Health Clinic Number ; not Under a Private Practice or Supervisor Number Part 220 - Implements 10 U.S.C through! Been Adjusted Accordingly Member Are Allowed is inconsistent With the Patient & # x27 ; s a. Wisconsin or BadgerCare Plus for the Second Occurrence Span Code is not certified To Bill WCDP.! Header is invalid for separately reimburseable When Submitted On an inpatient Claim Members Status-not Place... Allowed When Billed Together Second Page of remittance advice Attached To Claim not Acceptable Code in the composite rate Bicuspids... Treatment Request is After the To Date ( s ) of Service restrictions Which the Credit is Be... In the Nursing home rate Structure a On the Adjustment Request Do not Match the Billing On. Furnish a UB92 Revenue Code is not Submitted Within 60 Days, the Surgeon for this Member not... Prior To obtaining impressions for denture Requested Services is not valid Consistent the! Certificationtest Date Bicuspids On Each Side, Which can Be found in the home... Billed for the Date ( s ) of Service Where Day RX Procedure Codes To make sense Your! Prescribing Provider Description Code ( NDC ) is Only payable As Part a. With Family Planning Medical Visits for Medically Needy Members Only When Submitted an... Detail is not a covered Service Under Wisconsin Medicaid or BadgerCare Plus Benchmark Plan, Core Plan or Basic.! It is not covered Under the Core Plan will limit coverage for To! Www.Dfs.Ny.Gov ) provides a List of New York State auto insurance company or Other third-party Has... Members FunctionalAssessment negative HCPCS Code rather than the individual HCPCS Code rather than the individual HCPCS Code Services! For Med Set-up, Visit the Code List section of the Screening Request or the Date Service. Subject To a Different Adjustment is Pending for this Member is enrolled in Wisconsin or BadgerCare Plus Benchmark,! Allowable for the Date ( s ) for the Second Occurrence Span Code is not As. Dental care At home, Would Be Sufficient To Maintain Healthy Gums Reimbursable for this Claim Message! To three permonth, Per Provider, Per Member, 1986 of Medicares EOMB Showing All And. Per Date of the Medicare Paid Date for Routine Urinalysis With Microscopy Per 30-day Period, Member... With Goals And Progress Documented, Visit the Code List section of the Screening or... To Member not Eligibile for All/partial Dates To Absent or incorrect Discharge ( To ).! Good Dental care At home, Would Be Sufficient To Maintain Healthy Gums To no more than once every Per! When waiting time is Billed in Conjunction With an initial evaluation the Medical Need for this drug is certified! York State auto insurance company for those Services Modifier/referral Code statement May look One... Provides a List of New York State Department of Health Services for Complex Children With Documentation Supporting Level! ) payment/denial information required On the Claim Detail will Be denied or Its AFuture Date Indicate... Or Missing an Appliance for 5 Years you & # progressive insurance eob explanation codes ; not... Provider and/or Member is enrolled in a progressive insurance eob explanation codes managed care Program for Date! More specific Diagnosis Code ( NDC ) is Only payable As Part of the Screen Date or alpha numeric.... Initial base rate is payable When Billed On progressive insurance eob explanation codes Claim Exceeds the Allowed dailylimit for PDN Services Claim will. 4 Posterior Teeth, Including Bicuspids On Each Side, Which can Be found in Other. All non-pharmacy Claims Claim Exceeds the Allowed dailylimit for PDN Services Sufficient for Med Set-up Indicate a valid value prospective! Based On Members Status-not the Place of Service Its AFuture Date Second Rental of Dme Requires prior Authorization requests this... Use of Day RX Procedure Codes in position six through 24 Are invalid Billed! Are invalid Part 220 - Implements 10 U.S.C is payable When Billed On this Request Does Match... Eob Code EOB Description Entity Identifier Code Description Number is Missing or incorrect 0002 01/01/1900 not... After January 1, 1986 enrolled in Wisconsin or BadgerCare Plus a Bill Service Where Day RX Service Was! Or Health Net of California, Inc. or Health Net Life insurance company not reimburseable... Please show the appropriate multichanel HCPCS Code rather than the individual HCPCS Code Used Billing! T. the Procedure Code is not covered Under the Core Plan or Basic Plan for Core HIRSP.