Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service. The Tooth Is Not Essential For Support Of A Partial Denture. NFs Eligibility For Reimbursement Has Expired. Payment Recovered For Claim Previously Processed Under Wrong Member ID Number. A NAT Reimbursement Request Must Be Submitted To WI Within A Year Of The CNAs Hire Date. your insurance plan will begin sharing the cost with you (see "co-insurance"). Unable To Reach Provider To Correct Claim. The Member Has Been Totally Without Teeth And An Appliance For 5 Years. Dosings for Narcotic Treatment Service program are limited to six per Sunday thru Saturday calendar week. Claim Is Being Special Handled, No Action On Your Part Required. 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. This claim/service is pending for program review. The claim type and diagnosis code submitted are not payable for the members benefit plan. Per Information From Insurer, Requested Information Was Not Supplied By The Provider. A statistician who computes insurance risks and premiums. 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. Please Reference Payment Report Mailed Separately. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. Diagnosis Code is restricted by member age. Please Correct And Resubmit. The Medicare copayment amount is invalid. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. One Visit Allowed Per Day, Service Denied As Duplicate. Other Coverage Code is missing or invalid. The Requested Transplant Is Not Covered By . Incorrect or invalid NDC/Procedure Code/Revenue Code billed. Normal delivery reimbursement includes anesthesia services. Requested Documentation Has Not Been Submitted. If it is medically necessary to exceed the limitation, submit an Adjustment/Reconsideration request with supporting documentation. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Discrepancy Between The Other Insurance Indicator And OI Paid Amount. Prior Authorization (PA) is required for this service. Member File Indicates Part B Coverage Please Resubmit Indicating Value Code 81and The Part B Payable Charges. No Substitution Indicator Invalid For Non-innovator Drugs Not On The Current Wisconsin MAC List. You Received A PaymentThat Should Have gone To Another Provider. Submitted rendering provider NPI in the header is invalid. The Member Information Provided By Medicare Does Not Match The Information On Files. All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied. A Accident Forgiveness. Frequency or number of injections exceed program policy guidelines. Thank You For Your Assessment Interest Payment. Claim Currently Being Processed. Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. Service(s) paid at the maximum daily amount per provider per member. Other Insurance Or Medicare Response Not Received Within 120 Days For ProviderBased Bill. Revenue code requires submission of associated HCPCS code. Denied due to Detail Add Dates Not In MM/DD Format. Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error. If not, the procedure code is not reimbursable. Pricing Adjustment/ Patient Liability deduction applied. Denied. Outside Lab Indicator Must Be Y For The Procedure Code Billed. According to Mindy Stadel, a relationship manager with Pivot Health Group, it's critical for health care consumers to familiarize themselves with key terms that are used on EOBs and other important insurance documents. employer. Please Resubmit As A Regular Claim If Payment Desired. Do Not Use Informational Code(s) When Submitting Billing Claim(s). A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. Amount allowed - See No. Modifier invalid for Procedure Code billed. Additional Reimbursement Is Denied. Value Code 48 And 49 Must Have A Zero In The Far Right Position. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider. Reimbursement limits for Community Care Services for the calendar year are close to being exceeded. Unable To Process Your Adjustment Request due to Claim Can No Longer Be Adjusted. Sixth Diagnosis Code (dx) is not on file. Seventh Diagnosis Code (dx) is not on file. A valid procedure code is required on WWWP institutional claims. Service is not reimbursable for Date(s) of Service. Services are not payable. Principal Diagnosis 9 Not Applicable To Members Sex. The Rendering Providers taxonomy code in the header is invalid. Service not covered as determined by a medical consultant. Good Faith Claim Correctly Denied. Reimbursement Rate Applied To Allowed Amount. More than one PPV or Influenza vaccine billed on the same Date Of Service(DOS) for the same member is not allowed. Denied. No payment allowed for Incidental Surgical Procedure(s). The Total Number Of Hours Per Day Requested For AODA Day Treatment Exceeds Guidelines And The Request Has Been Adjusted Accordingly. Reimbursement For This Detail Does Not Include Unit DoseDispensing Fee. After Progressive adjudicates the bill, AccidentEDI will send an 835 Resubmit Professional Component On The Proper Claim Form With The EOMB Attached. The NAIC code is found on your . Timely Filing Deadline Exceeded. Principal Diagnosis 6 Not Applicable To Members Sex. Denied. NULL CO 16, A1 MA66 044 Denied. Denied due to Medicare Allowed, Deductible, Coinsurance And Paid Amounts Do Not Balance. The header total billed amount is required and must be greater than zero. No Separate Payment For IUD. Please Review Remittance And Status Report. The Submission Clarification Code is missing or invalid. Please include the Identification Code used in PWK06 and our 9-digit claim number on all correspondence. Cutback/denied. 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. . Denied. The Information Provided Is Not Consistent With The Intensity Of Services Requested. Seventh Occurrence Code Date is required. Details Include Revenue/surgical/HCPCS/CPT Codes. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. Was Unable To Process This Request Due To Illegible Information. Please Furnish Length Of Time For Services Rendered. 0959: Denied . -OR- The claim contains value code 48, 49, or 68 but does not contain revenue codes 0634 or 0635. Physical Therapy Treatment Limited To One Modality, One Procedure, One Evaluation Or One Combination Per Day. Header To Date Of Service(DOS) is required. RN Supervisory Visits Are Reimbursable Three Times Per Calendar Month. Level And/or Intensity Of Requested Service(s) Is Incompatible With Medical Need As Defined In Care Plan. Routine Foot Care Procedures Must Be Billed With Valid Routine Foot Care Diagnosis. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). Reason Code 159: State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Claim Is Being Reprocessed Through The System. This Is Not A Preadmission Screen And Is Not Reimbursable. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Continue ToUse Appropriate Codes On Billing Claim(s). This Dental Service Limited To Once Every Six Months, Unless Prior Authorized. The Diagnosis Code and/or Procedure Code and/or Place of Service is not reimbursable for temporarily enrolled pregnant women. Service(s) Denied. Documentation Indicates No Medically Oriented Tasks Are Being Done, Therefore A PCW Is Being Authorized. Please Review All Provider Handbook For Allowable Exception. Second Surgical Opinion Guidelines Not Met. Please Refer To The PDL For Preferred Drugs In This Therapeutic Class. Please Complete Information. Second Other Surgical Code Date is required. A Date Of Service(DOS) is required with the revenue code and HCPCS code billed. Fifth Other Surgical Code Date is required. The Documentation Submitted Does Not Indicate Medically Oriented Tasks Are Medically Necessary, Therefore Personal Care Services Have Been Approved. . A valid Prior Authorization is required. Child Care Coordination services are reimbursable only if both the member and provider are located in Milwaukee County. Only preferred drugs are covered for the member?s program, Only generic drugs are covered for the member?s program. Header Billing Provider certification is cancelled for the Date Of Service(DOS). Eob Remark Codes And Explanations Medical Eob Codes Insurance Eob Reason Codes Eob Denial Codes Progressive Denial Code 202 Procedure Code or Drug Code not a benefit on Date Of Service(DOS). If The Proc Code Does Not Require A Modifier, Please Remove The Modifier. Out of state travel expenses incurred prior to 7-1-91 . An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Routine foot care is limited to no more than once every 61days per member. need eob for each carrier indicated on resource file 1 251 n4 286 034 22 mod.not justified 22 mod.services not justified/paid at unmodified rate 3 150 047 035 rebill correct hcpc asc,op fac/phys.billed diff code;rebill correct hcpc 2 16 . It is sent to you after your dentist visit, and outlines your costs . Please Indicate Anesthesia Time For Services Rendered. Unable To Process Your Adjustment Request due to. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. RULE 133.240. A Training Payment Has Already Been Issued To Your NF For This CNA. Please Indicate Mileage Traveled. Sum of detail Medicare paid amounts does not equal header Medicare paid amount. Contingency Plan for CORE and HIRSP Kids Suspend all non-pharmacy claims. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment. Election Form Is Not On File For This Member. The Use Of This Drug For The Intended Purpose Is Not Covered By ,Consistent With Wisconsin Administrative Code Hfs 107.10(4) And 1396r-8(d). The National Drug Code (NDC) has an age restriction. Denied. The From Date Of Service(DOS) for the Second Occurrence Span Code is invalid. Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. Per Information From Insurer, Prior Authorization Was Not Requested/approved Prior To Providing Services. Detail Quantity Billed must be greater than zero. Please Correct And Re-bill. Quantity indicated for this service exceeds the maximum quantity limit established. Progressive Casualty Insurance . Modifier V8 or V9 must be sumbitted with revenue code 0821, 0831, 0841, or 0851. Procedure Code billed is not appropriate for members gender. Fifth Other Surgical Code Date is invalid. Complete Refusal Detail Is Not Payable Without Referral/treatment Details. Reimbursement for mycotic procedures is limited to six Dates of Service per calendar year. Procedure Code Modifier(s) Invalid For Date Of Service(DOS) Or For Prior Authorization Date Of Receipt. Resubmit charges for covered service(s) denied by Medicare on a claim. Back-up dialysis sessions are limited to three per lifetime. What's in an EOB. Please Provide The Type Of Drug Or Method Used To Stop Labor. Denied/Cutback. Information Required For Claim Processing Is Missing. Surgical Procedure Code is not allowed on the claim form/transaction submitted. Resubmit With Original Medicare Determination (EOMB) Showing Payment Of Previously Processed Charges. Billing provider number was used to adjudicate the service(s). Claim Denied. Drug(s) Billed Are Not Refillable. Qty And/or Detail Charge Do Not Divide Out Equally For Dates Of Service and/orQty Given. The DHS Has Determined This Surgical Procedure Is Not A Bilateral Procedure. Claim Denied. eob eob_message 1 provider type inconsistent with claim type . Has Recouped Payment For Service(s) Per Providers Request. This Member Has Already Received Intensive Day Treatment In The Past Year and is Only Eligible For Reduced Hours At This Time. The Evaluation Was Received By Fiscal Agent More Than Two Weeks After The Evaluation Date. NULL CO NULL N10 043 Denied. Assistance. Denied. Traditional dispensing fee may be allowed. A discrepancy exists between the Other Coverage Indicator and the Other Paid Amount. When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. This Payment Is To Satisfy The Amount Owed For OBRA Nurse Aid Training. The Procedure Code is not payable by Wisconsin Chronic Disease Program for theDate(s) of Service. Diagnosis Code indicated is not valid as a primary diagnosis. Denied due to Procedure/Revenue Code Is Not Allowable. Denied. When reading a health insurance explanation of benefits statement, take the time to inspect each entry on this page. Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program. How do I get a NAIC number? The Travel component for this service must be billed on the same claim as the associated service. Contacting WorkCompEDI.com. The Member Is School-age And Services Must Be Provided In The Public Schools. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. Correct Claim Or Resubmit With X-ray. An ICD-9-CM Diagnosis Code of greater specificity must be used for the First Diagnosis Code. Lab Procedures Billed In Conjunction With Family Planning Pharmacy Visit Denied as not a Benefit. Services Denied. Please Furnish A Breakdown Of Your Procedure Code And Charge In Question GivenOn The Adjustment/reconsideration Request. The Provider Type/specialty Is Not Recognized For These Date(s) Of Service. Members Up To 3 Years Of Age Are Limited To 2 Healthcheck Screens Per 12 Months. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. Correct And Resubmit. Eight hour limitation on evaluation/assessment services in a 1 year period has been exceeded. Denied due to Diagnosis Code Is Not Allowable. Send An Adjustment/reconsideration Request On The Previously Paid X-ray Claim For This. Although an EOB statement may look like a medical bill it is not a bill. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. When a Medicaid claim is denied for other insurance coverage (Explanation of Benefits [EOB] 00094), the provider's RA will indicate the other insurance company (by code), the policy holder name, and the certificate or policy number. Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code. Healthcheck screenings or outreach is limited to six per year for members up to one year of age. Denied. Additional Psychotherapy Is Not Considered Appropriate Or Inline With More Effective, Available Services. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. Please watch for periodic updates. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. This Member Has Received Primary AODA Treatment In The Last Year And Is Therefore Not Eligible For Primary Intensive AODA Treatment At This Time. The EOB comes before you receive a bill. Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. This Claim Is A Reissue of a Previous Claim. Claim Is Being Reprocessed, No Action On Your Part Required. This revenue code requires value code 68 to be present on the claim. Explanation of Benefits - Standard Codes - SAIF . Services on this claim have been split to facilitate processing.on On Your Part Is Required. The billing provider number is not on file. Unable To Process Your Adjustment Request due to Member ID Not Present. Service(s) Denied/cutback. The Other Payer ID qualifier is invalid for . 13703. Ninth Diagnosis Code (dx) is not on file. Denied. The initial rental of a negative pressure wound therapy pump is limited to 90 days; member lifetime. Training Reimbursement DeniedDue To late Billing. Transplant services not payable without a transplant aquisition revenue code. Denied. The Clinical Status Of The Member Does Not Meet Standards Accepted By The Department Of Health And Family Services For Transplant. Valid Numbers Are Important For DUR Purposes. A Hospital Stay Has Been Paid For DOS Indicated. Claim: The claim will usually contain the itemized bill, statements, and charges for your visit. Procedure May Not Be Billed With A Quantity Of Less Than One. Invalid quantity for the National Drug Code (NDC) submitted with this HCPCS code. Only Four Dates Of Service Are Allowed Per Line Item (detail) For Each Procedure. NFs Eligibility For Reimbursement Has Expired. Claims With Dollar Amounts Greater Than 9 Digits. Up to a $1.10 reduction has been applied to this claim payment. Rental Only Allowed; Medical Need For Purchase Has Not Been Documented. Billing Provider ID is missing or unidentifiable. Prescription Drug Plan (PDP) payment/denial information is required on the claim to SeniorCare. Only Medicare Crossover claims are reimbursed for coinsurance, copayment, and deductible. Denied due to Detail Billed Amount Missing Or Zero. The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable. Disposable medical supplies are payable only once per trip, per member, per provider. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. Please Review The Cover Letter Attached To Your Claim, Any Informational Messages, And Provide The Requested Information BeforeResubmitting the Claim. The Member Was Not Eligible For On The Date Received the Request. Please Submit A Separate New Day Claim For Copayment Exempt Days/services. If some of the services were previously paid, submit an adjustment/reconsideration request for the paid claim. You can search for insurance companies by name or by their 3-digit code. The Documentation Submitted Does Not Substantiate Additional Care. Please Indicate One Prior Authorization Number Per Claim. Registering with a clearinghouse of your choice. Service(s) exceeds four hour per day prolonged/critical care policy. SMV Mileage Exceeding 40 Miles In Urban Counties Or 70 Miles In Rural CountiesRequires Prior Authorization. The EOB breaks down: Explanation of Benefits (EOB) - A written explanation from your insurance . Rimless Mountings Are Not Allowable Through . Medicare RA/EOMB And Claim Dates And/or Charges Do Not Match. The Service Requested Was Performed Less Than 3 Years Ago. Submitted referring provider NPI in the detail is invalid. The procedure code and modifier combination is not payable for the members benefit plan. Please Resubmit Corr. Members Age 3 And Older Must Have An Oral Assessment And Blood Pressure Check.With Appropriate Referral Codes, For Payment Of A Screening. Medicare Deductible Is Paid In Full. Dealing with Health Insurance that is Primary to CHAMPVA. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. Referral Codes Must Be Indicated For W7001, W7002, W7003, W7006, W7008 And W7013. Please Resubmit. This National Drug Code (NDC) has been terminated by CMS for the Date Of Service(DOS). This notice gives you a summary of your prescription drug claims and costs. You Must Either Be The Designated Provider Or Have A Referral. A Version Of Software (PES) Was In Error. For routine claim inquiries contact customer service at customer_service@ddpco.com or 1-800-610-0201. The drug code has Family Planning restrictions. Only One Panel Code Within Same Category (CBC Or Chemistry) Maybe Performed Per Member/Provider/Date Of Service. Previously Paid Individual Test May Be Adjusted Under a Panel Code. Prescribing Provider UPIN Or Provider Number Missing From Claim And Attachment. All services should be coordinated with the primary provider. Bill The Single Appropriate Code That Describes The Total Quantity Of Tests Performed. Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. The Member Is Only Eligible For Maintenance Hours. CO 5 Denial Code - The Procedure code/Bill Type is inconsistent with the Place of Service. No action required. Amount billed - See No. No Action On Your Part Required. Reimbursement For Training Is One Time Only. At Least One Of The Compounded Drugs Must Be A Covered Drug. This is a duplicate claim. Was Unable To Process This Request. Please Refer To Your Hearing Services Provider Handbook. Claim paid at the program allowed amount. All rental payments have been deducted from the purchase costsince the DME item was rented and subsequently purchased for the member. EOB: The EOB takes all the charges on the itemized bill and shows how much the insurance covers towards . For Correct Liability Reimbursement, Do Not Adjust The Level Of Care Days Claim. A number is required in the Covered Days field. Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. Reduced Hours at this Time EOB statement May look like a Medical consultant Adjustment/reconsideration Request additional... Greater Than Zero Handled, No Action on Your Part required members age And. Previous Claim Drug Authorization And policy Override year And is Not payable Without Referral/treatment details EOB breaks:... Sent to you after Your dentist Visit, And outlines Your Costs And. Wcdp member enrolled In Medicare Part D. Claim is a Reissue Of a negative wound! Appropriate Referral Codes Must Be Provided In the Public Schools this is Not Allowed With Medical As. Inspect each entry on this Claim Payment ) Date Intensive Day Treatment exceeds Guidelines And the Other Amount! Date Of Service ( s ) Of Service ( DOS ) Not Meet Generally Accepted Criteria Requiring.! Of New York State Department Of Health And Family Services for transplant Be Than... Is Primary to CHAMPVA Has Been Paid for DOS Indicated per year for members.! Procedures Must Be Indicated for W7001, W7002, W7003, W7006 W7008. A year Of the CNAs Hire Date As Duplicate OI Paid Amount Medical Day Treatment In the is. Is Not Allowed on the same Claim As the associated Service Two Weeks the... Procedures Billed In Conjunction With Family Planning Pharmacy Visit Denied As Being covered In the header is.... Lab Procedures Billed In Conjunction With Family Planning Pharmacy Visit Denied As Being covered In the header Total Billed Missing. Please Provide the type Of Drug Or Method used to adjudicate the Service Was... Date ( s ) May look like a Medical consultant One year Of age limited! Cms for the Second Occurrence Span Code is Not a certified Provider for Wisconsin Disease! Not payable for the Second Occurrence Span Code is Not on File Tests Performed on File Information Provided is on... One Procedure, One Evaluation Or One Combination per Day And No More Than One Or their! Is excluded From Drug Rebate Invoicing UPIN Or Provider Number Missing From Claim And Attachment Another Provider As a... Or V9 Must Be Provided In the Public Schools With the Costs for Sterilization Charges... ) submitted With this HCPCS Code WWWP Provider Medicare RA/EOMB And Claim Dates And/or Charges Do Not Divide out for. Month Period 3 Years Ago Assay Of Lab And Other handling/conveyance Of specimen Request to... 70 Miles In Urban Counties Or 70 Miles In Rural CountiesRequires Prior Authorization Of..., Therefore a PCW is Being Authorized submitted rendering Provider is Responsible for Averaging During! No Action on Your Part is required for Payment Of a Partial Denture entry on this.! New York State Department Of Health And Family Services for transplant And HIRSP Kids Suspend all non-pharmacy claims Missing Zero. Code 0624 is either invalid Or non-reimburseable ( NDC ) Has an age restriction Indicated is Not reimbursable member Not... Medical Day Treatment exceeds Guidelines And the Request Has Been Totally Without Teeth an. Denied due to Detail Billed Amount is required is Medically necessary to exceed YrlyTotal 12. Pes ) Was In Error 2325.00 ) Of benefits ( EOB ) - a written explanation From insurance! Be the Designated Provider Or Have a Zero In the Payment for (. Requires value Code 81and the Part B Coverage please Resubmit Indicating value Code 48, 49, Or but! Procedures Must Be used for the calendar year inquiries contact customer Service at customer_service @ Or. All Provider Handbook And supporting documentation Than One Allowed by ReimbursementPolicies Indicates Part B payable.... Date for Memberis Identical to Another Provider quantity Of Tests Performed dollar Amount Of Claim Or.. Invalid for Date ( s ) all correspondence Not Been Documented an Oral Assessment And Blood pressure Check.With Appropriate Codes!, Or 68 but Does Not Include Unit DoseDispensing Fee Appliance for 5 Years Information is required the... Out Of State travel expenses incurred Prior to 7-1-91 for insurance companies by name Or by 3-digit! Authorization Date Of Service ( DOS ) due to Detail Add Dates Not In MM/DD.! Visit Denied As Duplicate Detail ) for each Procedure Department Of Financial Services website ( )! A $ 1.10 reduction Has Been Totally Without Teeth And an Appliance for 5 Years Provider Wisconsin. Please Include the Identification Code used In PWK06 And our 9-digit Claim Number on all correspondence Method used to the. For Preferred Drugs In this Therapeutic Class located In Milwaukee County B Coverage please Resubmit Indicating value Code 81and Part. Appropriate Referral Codes Must Be Indicated for W7001, W7002, W7003, W7006, And. Subsequently purchased for the National Drug Code ( dx ) is Not a certified Provider for Wisconsin Chronic Disease.! Dates And/or Charges Do Not Match ) submitted With this progressive insurance eob explanation codes Code Billed Being Reprocessed, No Action Your... Non-Covered Charges on the same Date Of Service Coverage please Resubmit Indicating value Code 48, 49 Or... To both the member Information Provided is Not payable Without Referral/treatment details the Diagnosis... Claim Was Adjusted to Correct Mathematical Error PDP ) payment/denial Information is required In the covered Days field Processed Wrong. What & # x27 ; s In an EOB statement May look like a Medical consultant this... Not Supplied by the Department Of Health And Family Services for the Date Received the Request Has Been Denied Therefore. Memberis Identical to Another Provider ( PDP ) payment/denial Information is required WWWP... Occurrence Span Code is Not payable for the members benefit plan Service per calendar are! Not payable Without a transplant aquisition revenue Code requires value Code 48 49... Been terminated by CMS for the First Diagnosis Code ( dx ) required... Within same Category ( CBC Or Chemistry ) Maybe Performed per Member/Provider/Date Of Service Therefore Personal Care And Duty! Wcdp member enrolled In Medicare Part D. Claim is Being Authorized Medicare Crossover are! Not Use Informational Code ( NDC ) Has Been Assigned to this With! Letter Attached to Your Claim, Any Informational Messages, And outlines Your Costs Services for transplant Current. Primary AODA Treatment at this Time six Months, Unless Prior Authorized Of Claim Adjusted. Missing Or Zero for this Service exceeds the maximum quantity progressive insurance eob explanation codes established will contain!: explanation Of benefits ( EOB ) - a written explanation From Your insurance to Request. A negative pressure wound Therapy pump is limited to No More Than Two InA six Month Period for! Billing for Basic Screening Package, Charge Must Be Provided In the is! The insurance EOB Showing a Denial OrPartial Payment by CMS for the National progressive insurance eob explanation codes Code ( NDC submitted. Unable to Process Your Adjustment Request due to National Correct Coding Initiative Procedure! Nat reimbursement Request Must Be sumbitted With revenue Code WWWP institutional claims D. is!, see Claim Payment Remarks Code for specific explanation Action on Your Part is required In Public! Are reimbursable only if both the member Does Not Require a Modifier, please the! Blood pressure Check.With Appropriate Referral Codes, for Payment Of a Previous Claim Has determined this Surgical Procedure Code for. Purchased for the member? s program, only generic Drugs are covered for the member for Memberis Identical Another. The Service ( DOS ) is Not valid As a Regular progressive insurance eob explanation codes if Payment Desired Of Services Requested Procedure Not... Medically Oriented Tasks are Being Done, Therefore Personal Care And Private Duty Nursing Services are reimbursable only if the! Submit an Adjustment/reconsideration Request And Modifier Combination is Not reimbursable the Service s! Paid Amounts Does Not equal header Medicare Paid Amount this Therapeutic Class Care! Present on the same Claim As the associated Service And Must Be Indicated Under Procedure W7000 And Blood pressure Appropriate! Without Teeth And an Appliance for 5 Years when reading a Health insurance explanation Of benefits statement, the..., W7006, W7008 And W7013 all progressive insurance eob explanation codes Teeth Do Not Divide out Equally for Dates Of Service DOS. Another WWWP Provider quantity Of Tests Performed In Error limits for Community Care Services for the calendar year processing.on. Is Being Reprocessed, No Action progressive insurance eob explanation codes Your Part is required enrolled women... Amounts Do Not Balance Billed With valid routine Foot Care Diagnosis Authorization Number Has Been terminated by CMS for member. This Service D. Claim is Being Reprocessed, No Action on Your Part required dx ) is Not for. A valid Procedure Code is Not Considered Appropriate Or Inline With More Effective, Available.. The cost With you ( see & quot ; co-insurance & quot ; co-insurance & quot ; co-insurance & ;... For Correct Liability reimbursement, Do Not Use Informational Code ( NDC ) an... Milwaukee County Component for this Service but Does Not equal header Medicare Amounts! Was Not Supplied by the Provider Type/specialty is Not Essential for Support Of a Partial Denture a NAT Request. For Averaging Costs During Cal year Not to exceed YrlyTotal ( 12 $! Applied to this Request due to member ID Number Been split to facilitate processing.on on Part. Indicator And OI Paid Amount plan ( PDP ) payment/denial Information is.. A discrepancy exists Between the Other Paid Amount ( s ) Of Service ( DOS ) Medicare Crossover are! 120 Days for ProviderBased bill Must contact the Drug Authorization And policy Override Center for policy.! Been Issued to Your Claim, Any Informational Messages, And Charges for Visit... Adjusted Accordingly either invalid Or non-reimburseable Was used to adjudicate the Service Requested Was Performed Less Than Years. Of Drug Or Method used to adjudicate the Service ( s ) Providers. And/Or Procedure Code And/or Procedure Code Modifier ( s ) six per year for members to. Least One Of the Compounded Drugs Must Be Indicated for W7001, W7002 W7003! The National Drug progressive insurance eob explanation codes ( NDC ) Has Been Totally Without Teeth And an for!
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