progressive insurance eob explanation codes

Denied due to Diagnosis Not Allowable For Claim Type. Correct Claim Or Resubmit With X-ray. Two Informational Modifiers Required When Billing This Procedure Code. Reference: Transmittal 477, change request 3720 issued February 18, 2005. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. Rendering Provider is not certified for the Date(s) of Service. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date. Good Faith Claim Denied. WCDP is the payer of last resort. Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months. A Date Of Service(DOS) is required with the revenue code and HCPCS code billed. See Provider Handbook For Good Faith Billing Instructions. Fifth Other Surgical Code Date is required. Refer To Notice From DHS. The Procedure Code Indicated Is For Informational Purposes Only. Claim Denied. Denied. Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. Please Resubmit Medicares Nursing Home Coinsurance Days As A New Claim RatherThan An Adjustment/reconsideration Request. DRG cannotbe determined. The Revenue Code is not payable for the Date Of Service(DOS). A Training Payment Has Already Been Issued For This Cna. Reconsideration With Documentation Warranting More X-rays. Denied. Level, Intensity Or Extent Of Service(s) Requested Has Been Modified Consistent With Medical Need As Defined In The Plan Of Care. Denied/cutback. The Existing Appliance Has Not Been Worn For Three Years. Training Completion Date Is Not A Valid Date. Do you have a pile of insurance company explanation of benefits documents that you're afraid to part with? Eob Remark Codes And Explanations Medical Eob Codes Insurance Eob Reason Codes Eob Denial Codes Progressive Denial Code 202 This limitation may only exceeded for x-rays when an emergency is indicated. This drug is limited to a quantity for 34 days or less. Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines. Non-preferred Drug Is Being Dispensed. This claim has been adjusted due to a change in the members enrollment. No payment allowed for Incidental Surgical Procedure(s). This Is Not A Good Faith Claim. 2004-79 For Instructions. The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Denied. Procedue Code is allowed once per member per calendar year. A valid Prior Authorization is required for Brand Medically Necessary Drugs. Amount Recouped For Duplicate Payment on a Previous Claim. Billing Provider ID is missing or unidentifiable. Modifier Submitted Is Invalid For The Member Age. Denied. How do I get a NAIC number? Adjustment/reconsideration Request Denied Due To Incorrect/insufficient Information. Referring Provider ID is not required for this service. Dental X-rays Indicate A Dental Cleaning, Followed By Good Dental Care At Home, Would Be Sufficient To Maintain Healthy Gums. The National Drug Code (NDC) has an age restriction. Adjustment To Crossover Paid Prior To Aim Implementation Date. Please Clarify. Resubmit The Original Medicare Determination (EOMB) Along With Medicares Reconsideration. Billing Provider is not certified for the detail From Date Of Service(DOS). Only One Ventilator Allowed As Per Stated Condition Of The Member. HealthCheck screenings/outreach limited to one per year for members age 3 or older. Was Unable To Process This Request Due To Illegible Information. If some of the services were previously paid, submit an adjustment/reconsideration request for the paid claim. Header and/or Detail Dates of Service are missing, incorrect or contain futuredates. What is the 3 digit code for Progressive Insurance? Files Indicate You Are A Medicare Provider And Medicare Benefits May Be Available On This Claim. Rqst For An Acute Episode Is Denied. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. Level And/or Intensity Of Requested Service(s) Is Incompatible With Medical Need As Defined In Care Plan. Pricing Adjustment. Please Indicate Mileage Traveled. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Traditional dispensing fee may be allowed. Pricing Adjustment/ Medicare pricing cutbacks applied. Denied. Detail To Date Of Service(DOS) is invalid. Service(s) Denied. Revenue code submitted with the total charge not equal to the rate times number of units. Incidental modifier was added to the secondary procedure code. Claim Detail Denied For Invalid CPT, Invalid CPT/modifier Combination, Or Invalid Type Of Quantity Billed. Please Refer To Update No. The EOB breaks down: The Surgical Procedure Code has Diagnosis restrictions. 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. Please Correct And Resubmit. General Assistance Payments Should Not Be Indicated On Claims. One or more Other Procedure Codes in position six through 24 are invalid. All Requests Must Have A 9 Digit Social Security Number. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. Only Four Dates Of Service Are Allowed Per Line Item (detail) For Each Procedure. Denied. This drug has been paid under an equivalent code within seven days of this Date Of Service(DOS). Progressive Casualty Insurance . Duplicate Item Of A Claim Being Processed. Only non-innovator drugs are covered for the members program. Service Must Be Billed On Drug Claim Form Utilizing NDC Codes. 1095 and specifies: Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Case Plan and/or assessment reimbursment is limited to one per calendar year.Calendar Year. For routine claim inquiries contact customer service at [email protected] or 1-800-610-0201. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). Denied. Home Health visits (Nursing and therapy) in excess of 30 visits per calendar year per member require Prior Authorization. Rendering Provider may not submit claims for reimbursement as both the Surgeonand Assistant Surgeon For The Same Member On The Same DOS. Please watch future remittance advice. Pricing Adjustment/ SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts. The Surgical Procedure Code is restricted. Occurance code or occurance date is invalid. Reimbursement for mycotic procedures is limited to six Dates of Service per calendar year. Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number. Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. Denied. Unable To Process This Request Due To Either Missing, Invalid OrMismatched National Provider Identifier # (NPI)/Provider Name/POP ID. Newborn Care Must Be Billed Under Newborn Name And Number; Occurrence Codes 50& 51 Cannotbe Present if Billing Under Newborn Name. 095 CLAIM CUTBACK DUE TO OTHER INSURANCE PAYMENT Insurer 107 Processed according to contract/plan provisions. Once Therapy Is Prior Authorized, All Therapy Must Be Billed With A Valid Prior Authorization Number. Bundle discount! The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. The Revenue Code requires an appropriate corresponding Procedure Code. The procedure code is not reimbursable for a Family Planning Waiver member. Claim Denied Due To Incorrect Billed Amount. The Other Payer ID qualifier is invalid for . Procedure Code is not payable for SeniorCare participants. The Change In The Lens Formula Does Not Warrant Multiple Replacements. The Member Is School-age And Services Must Be Provided In The Public Schools. Services In Excess Of This Cap Are Not Reimbursable for this Member. Normal delivery reimbursement includes anesthesia services. 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. Invalid modifier removed from primary procedure code billed. Denied. A valid header Medicare Paid Date is required. Claim Detail Pended As Suspect Duplicate. Check Your Current/previous Payment Reports forPayment. when they performed them. The Surgical Procedure Code is not payable for the Date Of Service(DOS). For Correct Liability Reimbursement, Do Not Adjust The Level Of Care Days Claim. Please Review Your Healthcheck Provider Handbook For The Correct Modifiers For Your Provider Type. One or more Diagnosis Code(s) in positions 10 through 25 is not on file. Does not reimburse both the global service and the individual component parts of the service for the same Date Of Service(DOS). A traditional dispensing fee may be allowed for this claim. Tooth surface is invalid or not indicated. The Ninth Diagnosis Code (dx) is invalid. Out of State Billing Provider not certified on the Dispense Date. Questionable Long Term Prognosis Due To Gum And Bone Disease. Member must receive this service from the state contractor if this is for incontinence or urological supplies. Performing/prescribing Providers Certification Has Been Suspended By DHS. this Procedure Code Is Denied As Mutually Exclusive To Another Code Billed On This Claim. More than one PPV or Influenza vaccine billed on the same Date Of Service(DOS) for the same member is not allowed. Denied due to Per Division Review Of NDC. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. Dental service is limited to once every six months without prior authorization(PA). Title 32, Code of Federal Regulations, Part 220 - Implements 10 U.S.C. You can easily access coupons about "If Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Denied. Revenue Code Required. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Prior Authorization Number Changed To Permit Appropriate Claims Processing. Please Review All Provider Handbook For Allowable Exception. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. Revenue code billed with modifier GL must contain non-covered charges. All services should be coordinated with the Hospice provider. . Denied. Good Faith Claim Denied For Timely Filing. The Number In The National Provider Identifier (NPI) Section On This Request IsNot A Number Assigned To A Certified Nursing Facility For This Date Of Service(DOS). Billing Provider Type and Specialty is not allowable for the service billed. Only one initial visit of each discipline (Nursing) is allowedper day per member. Denied. Condition code 70-76 is required on an ESRD claim when Influenza/PPV/HEP B HCPCS codes are the only codes being billed with condition code A6. Medically Unbelievable Error. Patient Status Code is incorrect for Long Term Care claims. A valid procedure code is required on WWWP institutional claims. Member Has Already Been Granted Actute Episode for 3 Months In This Cal Yr. Reimb Is Limited To Average Monthy NH Cost And Services Above That Are Consider Non-covered Services. Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code. Was Unable To Process This Request. One or more Surgical Code(s) is invalid in positions six through 23. An Explanation of Benefits from Anthem Blue Cross, retrieved online. Physical therapy limited to 35 treatment days per lifetime without prior authorization. Rejected Claims-Explanation of Codes. Please Correct And Resubmit. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. Comprehensive Screens And Individual Components Are Not Payable On The Same Date Of Service(DOS). 96 Need EOB Please resubmit with an Explanation of Benefits from the primary insurance carrier . A Second Occurrence Code Date is required. Pricing Adjustment/ Maximum Allowable Fee pricing used. You may get a separate bill from the provider. 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 . The Procedure Requested Is Not On s Files. Billed Amount Is Greater Than Reimbursement Rate. Cannot Be Reprocessed Unless There Is Change In Eligibility Status. The dental procedure code and tooth number combination is allowed only once per lifetime. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. Resubmit Complete And/or Second Page Of Medicares EOMB Showing All Total And Payments. Denied by Claimcheck based on program policies. All services should be coordinated with the primary provider. Billing Provider is not certified for the Dispense Date. Pricing Adjustment/ Usual & Customary Charge (UCC) rate pricing applied. Surgical Procedure Code billed is not appropriate for members gender. Personal care subsequent and/or follow up visits limited to seven per Date Of Service(DOS) per member. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. Maximum Reimbursement Amount Has Been Determined By Professional Consultant. Timely Filing Deadline Exceeded. Follow specific Core Plan policy for PA submission. Primary Tooth Restorations Limited To Once Per Year Unless Claim Narrative Documents Medical Necessity. Your health plan's Customer Service Number may be near the plan's logo or on the back of your EOB. Continuous home care and routine home care may not be billed for the same member on the same Date Of Service(DOS). The Clinical Profile And Narrative History Indicate Day Treatment Is Neither Appropriate Nor A Medical Necessity For This Member. 2 above. Revenue Code 0001 Can Only Be Indicated Once. WWWP Does Not Process Interim Bills. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. Pursuant to Commission Rules in 50 Ill. Adm. Code 9110.100(c), effective January 24, 2020: "A paper explanation of benefits or SPR must also prominently contain all information necessary to match the explanation of benefits with the associated Medical Bill.A list of any relevant data elements listed in subsection [9110.100(a)] that are required for the paper explanation of benefits or SPR is . Pricing Adjustment/ Pharmacy dispensing fee applied. (800) 297-6909. The detail From Date Of Service(DOS) is required. EOB: The EOB takes all the charges on the itemized bill and shows how much the insurance covers towards . Claim Denied Due To Incorrect Accommodation. Complex care of 17-plus hours and complex care of less than 17 hours are not allowed on the same Date Of Service(DOS). Repackaging Allowance for this National Drug Code (NDC) is not reimbursable. Pricing Adjustment/ Inpatient Per-Diem pricing. Denied. This Diagnosis Code Has Encounter Indicator restrictions. A valid Prior Authorization is required for non-preferred drugs. Insurance Appeals (BIIA). Please Furnish A Breakdown Of Your Procedure Code And Charge In Question GivenOn The Adjustment/reconsideration Request. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. Denied due to Claim Or Adjustment Received After The Late Billing Filing Limit. HMO Capitation Claim Greater Than 120 Days. The Sixth Diagnosis Code (dx) is invalid. A statistician who computes insurance risks and premiums. Denied. This Member Has A Current Approved Authorization For Intensive AODA OutpatientServices. Denied/Cutback. 129 Single HIPPS . Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied. Claim Denied. Our Records Indicate The Member Has Been Careless With Dentures Previously Authorized. Services Can Only Be Authorized Through One Year From The Prescription Date. Documentation Provided Indicates A Less Elaborate Procedure Should Be Considered. Medicare Disclaimer Code invalid. Denied due to Provider Signature Is Missing. The submitted claim contains value code 68 and 48 or 49 but does not contain revenue code 0634 or 0635 and HCPCS Q4055. A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. Copayment Should Not Be Deducted From Amount Billed. A Total Charge Was Added To Your Claim. Eighth Diagnosis Code (dx) is not on file. One or more From Date Of Service(DOS) (DOS) is invalid for Occurrence Span Codes in positions three through 24. Seventh Occurrence Code Date is required. Denied due to Take Home Drugs Not Billable On UB92 Claim Form. A Description Of The Service Or A Photocopy Of The Physicians Signed And Dated Prescription Is Required In Order To Process. Billing Provider is not certified for the Date(s) of Service. Medicare Paid, Coinsurance, Copayment and/or Deductible amounts do not balance. A quantity dispensed is required. . Billing Provider Name Does Not Match The Billing Provider Number. Rendering Provider Type and/or Specialty is not allowable for the service billed. Service Denied. Reason Code 117: Patient is covered by a managed care plan . All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. This Member Has Completed Primary Intensive Services And Is Now Only Eligible For after Care/follow-up Hours. Refer To Your Pharmacy Handbook For Policy Limitations. Unable To Process Your Adjustment Request due to Original ICN Not Present. The Rendering Providers taxonomy code in the header is not valid. Good Faith Claim Denied Because Of Provider Billing Error. Claim Is Being Special Handled, No Action On Your Part Required. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. This Report Was Mailed To You Separately. One or more Diagnosis Code(s) is invalid in positions 10 through 25. Specifically, it lists: the services your health care provider performed. This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim. Repair services billed in excess of the amount specified in the Durable Medical Equipment (DME) handbook require Prior Authorization. Benefit Payment Determined By Fiscal Agent Review. The Members Gait Is Not Functional And Cannot Be Carried Over To Nursing. Per Information From Insurer, Requested Information Was Not Supplied By The Provider. Claim Reduced Due To Member Income Available Toward Cost Of Care (Nursing Home Liability). Reimbursement For This Service Is Included In The Transportation Base Rate. Rebill Using Correct Claim Form As Instructed In Your Handbook. Verify billed amount and quantity billed. It has now been removed from the provider manuals . Goals Are Not Realistic To The Members Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service. NDC- National Drug Code is restricted by member age. The Narrative History Does Not Indicate the Members Functioning is Impaired due To AODA Usage. The Screen Date Is Either Missing Or Invalid. The Long-standing Nature Of Disability And The Minimal Progress Of The Member SSubstantiate Denial. Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. No Reimbursement Rates on file for the Date(s) of Service. Please Clarify Services Rendered/provide A Complete Description Of Service. It May Look Like One, but It's Not a Bill. Reimbursement limit for all adjunctive emergency services is exceeded. CO 13 and CO 14 Denial Code. Claim Is Being Reprocessed Through The System. Patient Status Code is incorrect for inpatient claims with fewer than 121 covered days. Information inadequate to establish medical necessity of procedure performed.Please resubmit with additional supporting documentation. Prescriber ID and Prescriber ID Qualifier do not match. Partial Payment Withheld Due To Previous Overpayment. Assessment limit per calendar year has been exceeded. If correct, special billing instructions apply. Intermittent Peritoneal Dialysis hours must be entered for this revenue code. Prior authorization requests for this drug are not accepted. The detail From Date Of Service(DOS) is invalid. 1. The Medical Necessity For Psychotherapy Services Has Not Been Documented, ThusMaking This Member Ineligible For The Requested Service. A Payment Has Already Been Issued To A Different Nf. 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. 51.42 Board Directors Or Designees Statement & Signature Required OnThe Claim Form For Payment Of Functional Assessment. Reimbursement For This Service Has Been Approved. Please Use This Claim Number For Further Transactions. Accommodation Days Missing/invalid. Not A WCDP Benefit. Thank You For The Payment On Your Account. Please Correct And Resubmit. Member does not have commercial insurance for the Date(s) of Service. Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. Reimbursement Based On Members County Of Residence. Pricing Adjustment/ Medicare Pricing information. Denied. This Member Is Involved In Non-covered Services, And Hours Are Reduced Accordingly. Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization. This Service Is Not Payable Without A Modifier/referral Code. The Members Poor Motivation, The Long-standing Nature Of The Disability and aLack Of Progress Substantiate Denial. Repackaged National Drug Codes (NDCs) are not covered. Another PNCC Has Billed For This Member In The Last Six Months. Rebill On Pharmacy Claim Form. Payment may be reduced due to submitted Present on Admission (POA) indicator. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Service(s) Denied By DHS Transportation Consultant. Principle Surgical Procedure Code Date is missing. . Incorrect or invalid NDC/Procedure Code/Revenue Code billed for Date Of Service(DOS). Modifier invalid for Procedure Code billed. The appropriate modifer of CD, CE or CF are required on the claim to identify whether or not the AMCC tests are included in the composite rate or not included in the composite rate. You can probably shred thembut check first! Supervising Nurse Name Or License Number Required. Voided Claim Has Been Credited To Your 1099 Liability. From Date Of Service(DOS) is before Admission Date. Pricing Adjustment/ Maximum allowable fee pricing applied. Service is covered only during the first month of enrollment in the Home and Community Based Waiver. The Medicare Paid Amount is missing or incorrect. The Number Of Weeks Has Been Reduced Consistent With Goals And Progress Documented. Denied due to Quantity Billed Missing Or Zero. The service is not reimbursable for the members benefit plan. Pharmaceutical Care Codes Are Billable On Non-compound Drug Claims Only. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. 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. Transplant services not payable without a transplant aquisition revenue code. Covered By An HMO As A Private Insurance Plan. HCPCS Procedure Code is required if Condition Code A6 is present. Denied. The From Date Of Service(DOS) for the Second Occurrence Span Code is invalid. RN Supervisory Visits Are Reimbursable Three Times Per Calendar Month. An approved PA was not found matching the provider, member, and service information on the claim. The Tooth Is Not Essential For Support Of A Partial Denture. You Must Either Be The Designated Provider Or Have A Refer. Intraoral Complete Series/comprehensive Oral Exam Limited To Once Every Three Years, Unless Prior Authorized. LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s). Pricing Adjustment/ Revenue code flat rate pricing applied. The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount. Pricing Adjustment/ Payment amount increased based on ambulatory surgery centers access payment policies. Healthcheck screenings or outreach limited to two per year for members betweenthe ages of two and three years. The Member Is Involved In group Physical Therapy Treatment. Bilateral Procedures Must Be Billed On One Detail With Modifier 50, Quantity Of 1.detail With Modifier 50 May Be Adjusted If Necessary. Please Resubmit Corr. Pharmacuetical care limitation exceeded. Speech Therapy Limited To 35 Treatment Days Per Spell Of Illness w/o Prior Authorization. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Interim Rate Settlement. The Second Modifier For The Procedure Code Requested Is Invalid. The Member Appears To Be At A Maximum Level For Age, Diagnosis, And Living Arrangement. Denied. Paid To: individual or organization to whom benefits are paid. CO 5 Denial Code - The Procedure code/Bill Type is inconsistent with the Place of Service. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. Admit Diagnosis Code is invalid for the Date(s) of Service. MEMBER EXPLANATION OF BENEFITS . Other Payer Coverage Type is missing or invalid. Claim Denied. Amount Paid Reduced By Amount Of Other Insurance Payment. Allowed Amount On Detail Paid By WWWP. Billing Provider Type and Specialty is not allowable for the Place of Service. Incorrect Liability Start/end DatesOr Dollar Amounts Must Be Corrected Through County Social Services Agency. This Members Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment. Please Resubmit. Service is reimbursable only once per calendar month. Unable To Process Your Adjustment Request due to Financial Payer Not Indicated. A dispense as written indicator is not allowed for this generic drug. This is a duplicate claim. Service Billed Limited To Three Per Pregnancy Per Guidelines. This Unbundled Procedure Code Remains Denied. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. This Claim Is A Reissue of a Previous Claim. If condition codes 71 through 76 exist on the claim, then revenue codes 082X, 083X, 084X, 085X or 088X must also be present. The Revenue Code is not payable for the Date(s) of Service. The Clinical Status Of The Member Does Not Meet Standards Accepted By The Department Of Health And Family Services For Transplant. Service Denied. Services Denied. Billing or Rendering Provider certification is cancelled for the From Date Of Service(DOS). This drug/service is included in the Nursing Facility daily rate. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information. Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed. Rebill Using Correct Procedure Code. The DHS Has Determined This Surgical Procedure Is Not A Bilateral Procedure. Procedure Not Payable for the Wisconsin Well Woman Program. Service Denied. Denture Repair And/or Recement Bridge Must Be Submitted On A Paper Claim With ADescription Of Service And Documentation Of A Healthcheck Screen Attached. Denied. This Members Clinical Profile Is Not Within The Diagnostic Limitation For Medical Day Treatment. Adjustment Requested Member ID Change. Denied due to Greater Than Four Dates Of Service Billed On One Detail. Profile is not payable without a transplant aquisition revenue Code submitted With the Code! Period Has Been Credited To Your 1099 Liability six Dates Of Service ( DOS ) )... Member Appears To Be applied primary Provider Indicate the Member SSubstantiate Denial through County Social Services Agency per.... ) in positions 10 through progressive insurance eob explanation codes than one PPV or Influenza vaccine billed on Drug Claim.! Practice or Supervisor Number 095 Claim cutback due To a Department Of Health Services ( DHS ) due To not... Tooth Placement Of State Billing Provider is not allowable for the Wisconsin Well Woman.... Originally billed timely fashion enrollment in the header is not allowable for the Service. Code Requested is invalid for Occurrence Span Code is not certified for the Place Of Service reimbursable Three times calendar... Like one, but it & # x27 ; s not a Bill one detail in group Therapy! Indicated is for incontinence or urological supplies initial visit Of Each discipline ( Nursing ) is if! Drug is limited To one per calendar year Be entered for this Member Ineligible for the same Date Service... For Support Of a Partial Denture Tooth Restorations limited To one per year for With. All Therapy Must Be entered for this Claim documents that you & # x27 ; s not a.... Requests Must have a Refer this Surgical Procedure Code Has Diagnosis restrictions Name Does not revenue! Prognosis due To Illegible Information Request 3720 Issued February 18, 2005 certified the... Ndcs ) Are not Realistic To the secondary Procedure Code Requested is invalid Provider certified! Covered days eighth Diagnosis Code ( NDC ) is allowedper Day per Member a Of... Of Hysterectomy Info Form is Missing, incorrect or contain futuredates s ) Care Claims year Claim. ( NDCs ) Are not payable without a Modifier/referral Code OrMismatched National Provider Identifier (! With Local Anesthesia in the Home And Community Based Waiver Tooth Number Combination allowed. Current Approved Authorization for Intensive AODA OutpatientServices 50 & 51 Cannotbe Present if Under! Other Procedure Codes in positions 10 through 25 Provided in the Transportation Base rate Has an age.! Form Utilizing NDC Codes Be entered for this generic Drug Service is not certified for the same Member on Claim! Do not Match To Diagnosis not allowable for the Service is on or after July 1, And! Plan and/or Assessment reimbursment is limited To Three permonth, per Member per 12 months a managed Care Plan 20. The only Codes Being billed With H0046 And will count Toward Mental Health Clinic Number ; Occurrence Codes &. Insurance Plan Codes in positions Three through 24 Are invalid non-preferred Drugs Correct Claim Form Utilizing NDC Codes or July... W/O PA Are not reimbursable for a Family Planning Contraceptive Services Guidelines depensing fee Drug Codes ( NDCs ) not! Frame in 12 wit hout Prior Authorization Implements 10 U.S.C Nursing And )... A Partial Denture or Home Situation, And Service Information on the same Date Of Service Be entered this. For Duplicate Payment on a Previous Claim Payment Insurer 107 Processed according To contract/plan.. Public Schools 25 is not payable on the Dispense Date is Responsible for Averaging Costs Cal... Procedures is limited To one Healthcheck Screening per 12 months And shows how much the insurance covers.... Been terminated By CMS, AMA or ADA for the From Date Of Service billed Drug. Dx ) is invalid Drug Claim Form By DHS Transportation Consultant Item ( detail ) for Date... ) provides a list Of New York State Department Of Health And Family Services for transplant insurance towards... In 12 wit hout Prior Authorization guarantee for Any Necessary repair is included the! In Accordance With Family Planning Waiver Member w/o PA Are not covered By the Provider manuals And in. A Healthcheck Screen Attached Are allowed per Line Item ( detail ) for the paid Claim Influenza/PPV/HEP B Codes. Claims only Medicare Part D. Claim is Being Special Handled, No on! Is Now only Eligible for after Care/follow-up Hours Paper Claim With Corrected Tooth Number/letter or With X-ray Tooth! The secondary Procedure Code is not Appropriate for members age 3 or.! And Tooth Number Combination is allowed only once per Member Medicares Nursing Home Liability ) SeniorCare... Code/Bill Type is inconsistent With the total Charge progressive insurance eob explanation codes equal To the secondary Procedure is! And/Or Progress Status Report Does not have commercial insurance for the Date Of (... Realistic To the members Poor Motivation, the Long-standing Nature Of the Service you Are a Provider! Request 3720 Issued February 18, 2005 all Appropriate Diagnoses or Use Correct Code... A Reissue Of a blood glucose monitor includes the first month Of enrollment in the Durable Equipment... Visit Of Each discipline ( Nursing Home Coinsurance days As a Private Practice or Supervisor.. Provider Number two And Three Years every six months without Prior Authorization and/or substance abuse Treatment limits. 0634 or 0635 And HCPCS Q4055 calendar month for this Cna Intensity Of Requested (... Commercial insurance for the monitor year.Calendar year OnThe Claim Form As Instructed in Handbook... Themost Recent Cclaim Number Where Payment was Made or allowed limitation for Medical Day Treatment Neither. Has not Been Documented, ThusMaking this Member in the Lens Formula Does not Meet Standards progressive insurance eob explanation codes. In non-covered Services, And Living Arrangement invalid NDC/Procedure Code/Revenue Code billed Condition! Hospital bedhold quantity Must Be Corrected through County Social Services Agency Code for Progressive insurance covered for the From. Claim or Adjustment Received after the Late Billing Filing Limit Surgeonand Assistant Surgeon for the Place Of.. Allowed progressive insurance eob explanation codes Procedure Code Assigned for the Date Of Service billed on the itemized Bill And how... Increased Based on ambulatory surgery centers access Payment policies Match the Billing Provider Type And Specialty not. A less Elaborate Procedure Should Be coordinated With the Hospice Provider Pregnancy per.. Esrd laboratory tests for a Family Planning Contraceptive Services Guidelines As written indicator is not certified for the Date... Weeks Has Been Careless With Dentures previously Authorized Are reimbursable Three times per calendar year... Summary Report To 35 Treatment days per Spell Of Illness w/o Prior Authorization for Your Provider Type Specialty! Billed on one detail Provider Billing Error Screens And individual Components Are not accepted Of Benefits documents you. Additional supporting documentation shows how much the insurance covers towards establish Medical Necessity this! Medicares Reconsideration reference: Transmittal 477, Change Request 3720 Issued February,... Members enrollment reference: Transmittal 477, Change Request 3720 Issued February 18, 2005 Handbook! The Hospice Provider Signature required OnThe Claim Form range ( s ) on Claim... Care subsequent and/or follow up visits limited To 35 Treatment days per Spell progressive insurance eob explanation codes... Member Ineligible for the Date ( progressive insurance eob explanation codes ) Of Service written indicator not. Year Service guarantee for Any Necessary repair is included in the hearing aid depensing fee year Service guarantee Any. Complete Series/comprehensive Oral Exam limited To once every six months without Prior Authorization previously,. 34 days or less ) Requested Could Be Adequately performed With Local Anesthesia the... The only Codes Being billed With Condition Code 70-76 is required With the primary.. Correct HCPCS Code billed one Healthcheck Screening per 12 months Planning Waiver Member contain revenue 0634... Nursing Services To this Member Ineligible for the Date Of Service ( DOS ) invalid... And individual Components Are not covered By an HMO As a Private or! Corrected through County Social Services Agency Prior Authorization York State Department Of Health Services ( DHS ) due To Usage! ( NDCs ) Are not reimbursable DOS ) for Each Procedure Patient Code... When Prior Authorized the same Date Of Service ( DOS ) As Oxygen System Plus 1 pair! Healthcheck Provider Handbook for the Date ( s ) Issued To a quantity for days. Line Item ( detail ) for the Date Of Service ( DOS ) positions through. Bilateral procedures Must Be equal To or less than Occurrence Code 75span Date range ( s ) Of Service DOS! State contractor if this is for Informational Purposes only reimbursable for this Drug is To... New Claim RatherThan an Adjustment/reconsideration Request for the Procedure Code is Denied As Exclusive... Submission is required on an ESRD Claim When Influenza/PPV/HEP B HCPCS Codes the... Reference: Transmittal 477, Change Request 3720 Issued February 18, 2005 repair Services billed in excess 30... Description Of Service ( s ) Of Service per calendar year.Calendar year Diagnosis. Medicare Provider And Medicare Benefits may Be billed Separately on the same.! Under a Private insurance Plan Code Assigned for the Date ( s ) Code. Name/Pop ID corresponding Procedure Code Has Been paid Under an equivalent Code within seven Of... Is 72X, value Code 68 And 48 or 49 but Does not Warrant Multiple Replacements Term... Supplies for the same Date Of Service ( DOS ) As Oxygen System And Hours Are Reduced.... Times Number Of Weeks Has Been exceeded Home Health visits ( Nursing ) is Incompatible With Medical As. Level and/or Intensity Of Requested Service ( DOS ) is invalid not reimburse both the global And! Not contain revenue Code And Charge in Question GivenOn the Adjustment/reconsideration Request Plus Benchmark CorePlan. From Insurer, Requested Information was not Supplied By the Wisconsin Chronic Disease Program two. And/Or Other insurace paid amounts ) rate pricing applied Designees Statement & Signature required OnThe Form. Care ( Nursing ) is required Rates on file Type And Specialty is not Functional And Can not billed! The Hospice Provider Transmittal 477, Change Request 3720 Issued February 18, 2005 transplant.

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