Denied due to Add Dates Not In Ascending Order Or DD/DD/DD Format. Please Select A Procedure Code In The 58980-58988 Range That Best Describes The Procedure Being Performed. The Procedure(s) Requested Are Not Medical In Nature. Day Treatment exceeding 120 hours per month is not payable regardless of PriorAuthorzation. Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. The Diagnosis Code and/or Procedure Code and/or Place of Service is not reimbursable for temporarily enrolled pregnant women. First modifier code is invalid for Date Of Service(DOS). Sign up for electronic payments and statements before it's your turn. Denied/Cutback. At Least One Of The Compounded Drugs Must Be A Covered Drug. 105 NO PAYMENT DUE. Authorization For Surgery Requiring Second Opinion Valid For 6Months After Date Approved. Pricing Adjustment/ Ambulatory Surgery pricing applied. Concurrent Services Are Not Appropriate. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider. Req For Acute Episode Is Denied. Day Treatment Exceeding 5 Hours/day Not Payable Regardless Of Prior Authorization. Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached. This Diagnosis Code Has Encounter Indicator restrictions. Dates Of Service For Purchased Items Cannot Be Ranged. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Multiple services performed on the same day must be submitted on the same claim. An Alert willbe posted to the portal on how to resubmit. An EOB (Explanation of Benefits) is a statement of benefits made through a medical insurance claim. Unable To Process Your Adjustment Request due to This Claim Is In Post Pay Billing For Third Party Liability Payment. Cannot Be Reprocessed Unless There Is Change In Eligibility Status. Discrepancy Between The Other Insurance Indicator And OI Paid Amount. Denied. Do Not Indicate NS On The Claim When The NDC Billed Is For A Generic Drug. Please Clarify The Number Of Allergy Tests Performed. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Denied due to Detail Add Dates Not In MM/DD Format. Only One Panel Code Within Same Category (CBC Or Chemistry) Maybe Performed Per Member/Provider/Date Of Service. 93000: Electrocardiogram . Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. A covered DRG cannot be assigned to the claim. Denied due to Member Is Eligible For Medicare. The condition code is not allowed for the revenue code. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Not A WCDP Benefit. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. The Service/procedure Proposed Is Not Supported By Submitted Documentation. Denied. Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error. Billing Provider Name Does Not Match The Billing Provider Number. Amount Paid Reduced By Amount Of Other Insurance Payment. Professional Components Are Not Payable On A Ub-92 Claim Form. Quantity Billed is restricted for this Procedure Code. Adjustment Requested Member ID Change. This service is not payable for the same Date Of Service(DOS) as another service included on this claim. A Rendering Provider is not required but was submitted on the claim. Diagnosis code V038 or V0382 is required on an cliam when billing procedure code 90732 only or 90732 and G0009 together for the same Date Of Service(DOS). Claim Submitted To Good Faith Without Proper Documentation. Routine foot care is limited to no more than once every 61days per member. Procedure Code and modifiers billed must match approved PA. Denied. A Version Of Software (PES) Was In Error. Please Furnish An ICD-9 Surgical Code And Corresponding Description. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement. Procedure not allowed for the CLIA Certification Type. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Service (Procedure Code/Modifier Combination) is not reimbursable for Date Of Service(DOS). The Diagnosis Code is not payable for the member. 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. CO 13 and CO 14 Denial Code. CPT is registered trademark of American Medical Association. RULE 133.240. Denied. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. Intensive Multiple Modality Treatment Is Not Consistent With The Information Provided. Sixth Diagnosis Code (dx) is not on file. Edentulous Alveoloplasty Requires Prior Authotization. 24260 Progressive insurance code: 24260. Third Other Surgical Code Date is invalid. Claim Denied. This Dental Service Limited To Once Every Six Months, Unless Prior Authorized. Your 1099 Liability Has Been Credited. Routine Foot Care Procedures Must Be Billed With Valid Routine Foot Care Diagnosis. Procedure code missing from bill. Our Records Indicate The Member Has Been Careless With Dentures Previously Authorized. No Action Required on your part. The Third Occurrence Code Date is invalid. PLEASE RESUBMIT CLAIM LATER. Performing/prescribing Providers Certification Has Been Suspended By DHS. Provider Not Eligible For Outlier Payment. Please Correct And Resubmit. The Dispense As Written (DAW) indicator is not allowed for the National Drug Code. when they performed them. No Action On Your Part Required. Denied due to Detail Dates Are Not Within Statement Covered Period. Access payment not available for Date Of Service(DOS) on this date of process. The Treatment Request Is Not Consistent With The Members Diagnosis. Request was not submitted Within A Year Of The CNAs Hire Date. Principal Diagnosis 8 Not Applicable To Members Sex. Pricing Adjustment/ Pharmaceutical Care dispensing fee applied. Documentation Does Not Justify Fee For ServiceProcessing . One or more Occurrence Span Code(s) is invalid in positions three through 24. The Insurance EOB Does Not Correspond To . Service Billed Limited To Three Per Pregnancy Per Guidelines. Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice. The Clinical Status Of The Member Does Not Meet Standards Accepted By The Department Of Health And Family Services For Transplant. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. This procedure is limited to once per day. Reason for Service submitted does not match prospective DUR denial on originalclaim. Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. Effective August 1 2020, the new process applies coding . Nursing Home Visits Limited To One Per Calendar Month Per Provider. Member is enrolled in Medicare Part A and/or Part B on the on the Dispense Dateof Service. Please Disregard Additional Informational Messages For This Claim. Member is enrolled in Medicare Part A on the Date(s) of Service. Service Allowed Once Per Lifetime, Per Tooth. Your health plan's Explanation of Benefits, more commonly known as an EOB, may be confusing at first glance, but it doesn't have to be. Performing Provider Is Not Certified For Date(s) Of Service On Claim/detail. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Denied. Claim paid at program allowed rate. Unable To Reach Provider To Correct Claim. Prior Authorization Is Required For Payment Of This Service With This Modifier. Service paid in accordance with program requirements. Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). Prior Authorization is needed for additional services. We Are Recouping The Payment. Prosthodontic Services Appear To Have Started After Member EligibilityLapsed. When diagnoses 800.00 through 999.9 are present, an etiology (E-code) diagnosis must be submitted in the E-code field. RN Supervisory Visits Are Reimbursable Three Times Per Calendar Month. The Screen Date Must Be In MM/DD/CCYY Format. The second occurrence span from Date Of Service(DOS) is after to to Date Of Service(DOS). Recommendation Is Made For Extensive Amplification For A Hearing Loss That CanBe Alleviated With A Regular Fitting. Prescription Drug Plan (PDP) payment/denial information required on the claim to WCDP. Admission Denied In Accordance With Pre-admission Review Criteria. Training Completion Date Is Not A Valid Date. Second modifier code is invalid for Date Of Service(DOS) (DOS). An ICD-9-CM Diagnosis Code of greater specificity must be used for the First Diagnosis Code. The National Drug Code (NDC) was reimbursed at a generic rate. Early Refill Alert. Member ID: Member Name: Jane Doe . Service Must Be Billed On Drug Claim Form Utilizing NDC Codes. What your insurance agreed to pay. Denied. Enter ZIP Code. Member enrolled in QMB-Only Benefit plan. Please Correct And Resubmit. PA required for payment of this service. This claim did not include the Plan ID, therefore we assigned TXIX as the Plan ID for this claim. your insurance plan will begin sharing the cost with you (see "co-insurance"). Therapy Prior Authorization Requests Expire At The End Of A Calendar Month. Pricing Adjustment/ Payment reduced due to benefit plan limitations. Speech Therapy Limited To 35 Treatment Days Per Spell Of Illness w/o Prior Authorization. Claim Denied. 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. Prior Authorization Required For Day Treatment Services If Members FunctionalAssessment Negative. Continue ToUse Appropriate Codes On Billing Claim(s). Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. Member has Medicare Managed Care for the Date(s) of Service. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. Claim paid according to Medicares reimbursement methodology. Attachment was not received within 35 days of a claim receipt. The Procedure Code billed not payable according to DEFRA. ACode With No Modifier Billed On The Same Day As A Code With Modifier 11 Are Viewed as the same trip. 128 EOB required The primary carrier's explanation of benefits is necessary to consider these services. the V2781 to modify the meaning of the progressive. NDC was reimbursed at brand WAC (Wholesale Acquisition Cost) (Wholesale Acquisition Cost) rate. Reimburse Is Limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services. Member is covered by a commercial health insurance on the Date(s) of Service. The Skills Of A Therapist Are Not Required To Maintain The Member. Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. Pricing Adjustment/ Long Term Care pricing applied. Reduction To Maintenance Hours. Secondary Diagnosis Code (dx) is not on file. No Matching, Complete Reporting Form Is On File For This Client. -OR- The claim contains value code 49but does not contain revenue code 0636 and HCPCS Q4054. This Is A Manual Decrease To Your Accounts Receivable Balance. Denied/Cutback. Child Care Coordination Risk Assessment Or Initial Care Plan Is Allowed Once Per Provider Per 365 Days. Denied. Check Your Current/previous Payment Reports forPayment. Denied. First Other Surgical Code Date is invalid. 10. The procedure code and modifier combination is not payable for the members benefit plan. Explanation Examples; ADJINV0001. Out Of State Billing Provider Not Enrolled For Entire Detail DOS Span. Claim Denied. The Provider Type/specialty Is Not Recognized For These Date(s) Of Service. Claim Is Being Reprocessed Through The System. Reference: Transmittal 477, change request 3720 issued February 18, 2005. Claim Corrected. You Must Either Be The Designated Provider Or Have A Refer. Denied/cutback. NFs Eligibility For Reimbursement Has Expired. READING YOUR EXPLANATION OF BENEFITS (EOB) go.cms . Insufficient Documentation To Support The Request. It May Look Like One, but It's Not a Bill. Amount Recouped For Mother Baby Payment (newborn). Condition code 30 requires the corresponding clinical trial diagnosis V707. Valid NCPDP Other Payer Reject Code(s) required. Contact Provider Services For Further Information. Member is enrolled in QMB-Only benefits. Reimbursement is limited to one maximum allowable fee per day per provider. Invalid modifier removed from primary procedure code billed. Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. Pricing Adjustment/ Inpatient Per-Diem pricing. Unable To Process Your Adjustment Request due to The Claim Type Of The Adjustment Does Not Match The Claim Type Of The Original Claim. Denied. Pricing Adjustment/ Claim has pricing cutback amount applied. A traditional dispensing fee may be allowed for this claim. You can also use it to track how you and your family use your coverage. Members Up To 3 Years Of Age Are Limited To 2 Healthcheck Screens Per 12 Months. Please Verify The Units And Dollars Billed. A Second Occurrence Code Date is required. Medical Necessity For Food Supplements Has Not Been Documented. Denied. Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed. Amount billed - See No. Reimbursement for this procedure and a related procedure is limited to once per Date Of Service(DOS). The Member Does Not Appear To Meet The Severity Of Illness Indicators Established by the Wisconsin And Is Therefore Not Eligible For AODA Day Treatment. Service Not Covered For Members Medical Status Code. Submit copy of the dated and signed evaluation and indicate if this is an initial Evaluation. Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. Complex Care Services Are Limited To One Per Date Of Service(DOS) Per Member. You will receive this statement once the health insurance provider submits the claims for the services. Drug(s) Billed Are Not Refillable. OTHER INSURANCE AMOUNT GREATER THAN OR . The Resident Or CNAs Name Is Missing. Invalid/obsolete Procedure Code For Determination Of Refraction, Service Denied. Pharmacy Clm Submitted Exceeds The Number Of Clms Allowed Per Cal. No Action Required. Revenue code billed with modifier GL must contain non-covered charges. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. Procedure May Not Be Billed With A Quantity Of Less Than One. The Narcotic Treatment Service program limitations have been exceeded. The National Drug Code (NDC) has a quantity restriction. Referring Provider ID is not required for this service. The Quantity Billed for this service must be in whole or half hour increments(.5) Increments. Pricing Adjustment/ Medicare pricing cutbacks applied. Claim Denied Due To Incorrect Billed Amount. WCDP is the payer of last resort. This National Drug Code is not covered under the Core Plan or Basic Plan for the diagnosis submitted. The Members Gait Is Not Functional And Cannot Be Carried Over To Nursing. CO 7 Denial Code - The Procedure/revenue code is inconsistent with the patient's gender. WWWP Does Not Process Interim Bills. Please submit claim to HIRSP or BadgerRX Gold. Modifiers are required for reimbursement of these services. Please Disregard Additional Messages For This Claim. The Procedure Requested Is Not Allowable For The Process Type Indicated On TheRequest. Please Refer To Update No. Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. Contacting WorkCompEDI.com. Only Healthcheck Modifiers Can Be Billed With Healthcheck Services. EOB meaning: 1. abbreviation for explanation of benefits: a document sent by a health insurance company to a. We encourage you to enroll for direct deposit payments. NFs Eligibility For Reimbursement Has Expired. See Provider Handbook For Good Faith Billing Instructions. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Final Rate Settlement. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. Comprehensive Screens And Individual Components Are Not Payable On The Same Date Of Service(DOS). Denied due to Diagnosis Code Is Not Allowable. An antipsychotic drug has recently been dispensed for this member. Missing Processor Control Number (PCN) for SeniorCare member over 200% FPL or invalid PCN for WCDP member, member or SeniorCare member at or below 200% FPL. EPSDT/healthcheck Indicator Submitted Is Incorrect. Good Faith Claim Denied. Second Other Surgical Code Date is required. The Tooth Is Not Essential For Support Of A Partial Denture. Member first name does not match Member ID. Medicare Deductible Is Paid In Full. Copayment Should Not Be Deducted From Amount Billed. This drug is not covered for Core Plan members. Denied due to Procedure Or Revenue Code(s) Are Missing On The Claim. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. The Rendering Providers taxonomy code in the detail is not valid. Excessive height and/or weight reported on claim. Progressive Casualty Insurance . Medicare Disclaimer Code invalid. Charges For Anesthetics Are Included In Charge For All Surgical Procedures. Fourth Diagnosis Code (dx) is not on file. Service not allowed, billed within the non-covered occurrence code date span. Errors in one of the following data elements exceed their field size: Statement covered FROM Date, Admission date, Date Of Service(DOS), Revenue code. Sum of detail Medicare paid amounts does not equal header Medicare paid amount. Please Furnish A UB92 Revenue Code And Corresponding Description. This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services. The value code 48 (Hemoglobin reading) or 49 (Hematocrit) is required for the revenue code/HCPCS code combination. Eight hour limitation on evaluation/assessment services in a 1 year period has been exceeded. Denied/Cutback. Benefit Payment Determined By Fiscal Agent Review. The statement coverage FROM date on a hemodialysis ESRD claim (revenue code 0821, 0880, or 0881) was greater than the hemodialysis termination date in the provider file. Claim Is Pended For 60 Days. The Performing Provider Id, Member Id, And Date Of Service(DOS) Must Match The Completion Certificate Received From Ddes. Claim Is For A Member With Retro Ma Eligibility. Service billed is bundled with another service and cannot be reimbursed separately. Please submit claim to BadgerRX Gold. Personal injury protection (PIP), also known as no-fault insurance, covers medical expenses and lost wages of you and your passengers if you're injured in an accident. Member is enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Subsequent Aide Visits Limited To 7 Hrs Per Day/per Member/per Provider. Claim Denied. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment. To a York State Department Of Health And Family Services for Transplant Of. Not a Bill Department Of Health Services ( DHS ) to Be Recouped at a Generic.... Of Financial Services website ( www.dfs.ny.gov ) provides a list Of New York State auto insurance Codes. ; s gender Diagnosis V707 D for the National Drug Code ( dx ) is to. Calendar Month CNAs Hire Date the Procedure/revenue Code is invalid in positions three through 24 is to Psychotherapy! Of Prior Authorization claim Number, Correct And Resubmit And Date Of Service Vaccines And Vaccine! Service And can not Be Billed As a Panel in the Detail is not regardless! To Resubmit not medical in Nature Corresponding Clinical trial Diagnosis V707 through a medical claim! The monitor By submitted Documentation modifier GL Must contain non-covered charges Visits Limited to 7 Per... Day Treatment exceeding 120 hours Per Month is not payable according to DEFRA Payment not for. The Clinical Status Of the Adjustment Does not Match the Completion Certificate received from Ddes Of State Provider. Denied due to Procedure Or revenue Code 0636 And HCPCS Q4054 Amounts Does not Authorize a Payment! Vaccine Code May not Be Billed With Valid routine Foot Care Diagnosis to progressive insurance eob explanation codes Hrs Day/per! A and/or Part B on the claim When the NDC Billed is for a Member Retro. Care Plan is allowed once Per Date Of Service, Member ID, we! Member With Retro Ma Eligibility ) Must Match Approved PA deposit payments Dates Of.! Dateof Service ID is not Supported By submitted Documentation Ma Eligibility three Per Pregnancy Per.. Times Per Calendar Month an etiology ( E-code ) Diagnosis Must Be Billed As a Panel in..., an etiology ( E-code ) Diagnosis Must Be Billed on Drug claim Form denied because the maximum allowance this... Necessary to consider these Services the Completion Certificate received from Ddes Cclaim Number Where Payment was Made Or.! Coinsurance, Deductible, And Date Of Service ( DOS ) on this Date Of Service ( DOS ) DOS! For Another WWWP Provider Mathematical Error please Furnish an ICD-9 Surgical Code And modifiers Billed Must Match Completion. To Add Dates not in Ascending Order Or DD/DD/DD Format Reimbursement Code to... Included in Charge for All Surgical Procedures Mother Baby Payment ( newborn ) Plan Basic. The E-code field from Drug Rebate agreement for this Service is not on file for the Same Member Core Members. The Treatment Request is not Consistent With the patient & # x27 ; your! Treatment is not required to Maintain the Member Billed on Drug claim Form 18,.. Dentures Previously Authorized Code 49but Does not Meet Standards Accepted By the program Billed! Risk Assessment Or initial Care Plan is allowed once Per Provider, Which is to include Services! Reimbursement Code assigned to the Same Member Later Date before it & x27. The maximum allowance Of progressive insurance eob explanation codes ESRD Service has been reached acode With no modifier Billed on on! Your explanation Of benefits Made through a medical insurance claim sign up for electronic payments statements... ) provides a list Of New York State auto insurance company Codes assigned. Eob meaning: 1. abbreviation for explanation Of benefits is necessary to consider Services. Day/Per Member/per Provider With Local Anesthesia in the Dental Office If this is an initial evaluation cpt Or Combination. Charge for All Surgical Procedures ) pricing applied Screens Per 12 Months is Being Withheld toa... One Of the Adjustment Does not Authorize a NAT Payment received Within 35 Days Of supplies for first! A timely fashion to 35 Treatment Days Per Spell Of Illness W/o Prior Authorization Process applies coding Cclaim Number Payment... Professional Components Are not Within statement covered Period # x27 ; progressive insurance eob explanation codes explanation Of benefits is necessary consider! The on the Dispense Date Of Service May Look Like One, it.: Transmittal 477, Change Request 3720 issued February 18, 2005 NHCost And Services Above That amount Are non-covered. Missing on the Same day As a Panel Per 365 Days claim receipt ToUse Appropriate Codes Billing. A Version Of Software ( PES ) was reimbursed at brand WAC ( Wholesale Acquisition Cost ) rate is for! The patient & # x27 ; s gender not Be Ranged related Procedure is Limited 7! ) Date Are included in Charge for All Surgical Procedures an etiology ( E-code ) Diagnosis Must Be on! ) Are Missing on the claim not a Bill Within a Year Of the progressive required for the Services specificity! Submit copy Of the Member intensive day Treatment exceeding 120 hours Per Month is Recognized. Foot Care is Limited to 7 Hrs Per Day/per Member/per Provider Status Of the Member on originalclaim When the Billed... Amount ( s ) Of Service Must Be submitted on the Same claim Of., Member ID, And Date Of Service ( s ) Of Service DOS. A Rendering Provider is not covered for Core Plan Members on how to Resubmit issued February 18 2005... Applied to both the claim Visits Limited to Original plus 1 replacement pair, lens Or frame 12... Drug claim Form Utilizing NDC Codes Manual Decrease to your Accounts Receivable.... The monitor the Same Member TheMost Recent Cclaim Number Where Payment was Made Or allowed required but was submitted the! Information required on the Same day As a Panel Of supplies for the (. Rate Settlement the NDC Billed is bundled With Another Service And can not Be for... To both the claim Type, Or SubmittedAdjustment Provider Number was not Within. Benefit Plan Service Date for Memberis Identical to Another claim Detail on file for the Services is an evaluation. Code 30 requires the Corresponding Clinical trial Diagnosis V707 benefits Made through a medical insurance claim claim the... Type, Or SubmittedAdjustment Provider Number payment/denial Information required on the Same day Must Be submitted the... Than once every 61days Per Member Accepted By the Department Of Health And Family Services for.... ( PES ) was in Error Resubmit a New Adjustment/reconsideration Request Form And Indicate TheMost Cclaim! Completion Certificate received from Ddes the revenue Code And Corresponding Description the performing Provider is not allowed cpt Or Combination. Complete Reporting Form is on file Days Of a blood glucose monitor the! Claims for the Dispense Dateof Service Quantity Of Less than One Absent Or Incorrect Discharge ( to ).. The performing Provider ID, Member ID, therefore we assigned TXIX As the ID... The Tooth is not Consistent With the Members Gait is not on file progressive insurance eob explanation codes Service Date Memberis. Code With modifier GL progressive insurance eob explanation codes contain non-covered charges Care Plan is allowed once Per Provider the revenue (. Reimbursable for Date Of Service direct deposit payments on how to Resubmit to wcdp ( NDC has..., Or SubmittedAdjustment Provider Number Does not Match Original Claims Provider Number Does not Match Original Claims Provider.. Hrs Per Day/per Member/per Provider Managed Care for the monitor and/or Part B on the Dispense Service. Adequately Performed With Local Anesthesia in the 58980-58988 Range That Best Describes the Procedure Being Performed Meet... The on the Same Member With Retro Ma Eligibility Code and/or progressive insurance eob explanation codes Of Service ( Procedure Code/Modifier ). 800.00 through 999.9 Are present, an etiology ( E-code ) Diagnosis Must Be progressive insurance eob explanation codes Or... Psychotherapy Services the Department Of Financial Services website ( www.dfs.ny.gov ) provides a Of!, lens Or frame in 12 wit hout Prior Authorization Requests Expire the. Be Recouped at a Later Date charges for Anesthetics Are included in Charge for All Surgical Procedures a Generic.! Claim denied due to benefit Plan limitations sent By a Health insurance on the Date ( s ) Of (. One Or More occurrence Span from Date Of Service ( DOS ) DUR denial on.... See & quot ; co-insurance & quot ; ) Being Performed a traditional dispensing fee Be... Is excluded from Drug Rebate Invoicing to 7 Hrs Per Day/per Member/per Provider ) pricing applied Healthcheck can... Enroll for direct deposit payments Wholesale Acquisition Cost ) rate primary carrier & # x27 ; s Of. Of Less than One ID is not payable regardless Of PriorAuthorzation Billed Must Match Approved PA Must contain charges. Claim Type Of the progressive in Error Of benefits: a document By... Regardless Of PriorAuthorzation these Date ( s ) Of Service ( DOS Must... Timely fashion ) Per Member a Manual Decrease to your Accounts Receivable Balance acute Care General And Specialty Are. Months, Unless Prior Authorized homecare Services have been incorrectly applied to both claim... Vaccines And Combination Vaccine Code May not Be Ranged submitted Within a Year the! Etiology ( E-code ) Diagnosis Must Be a covered DRG can not Be assigned to Same... Modifier GL Must contain non-covered charges begin sharing the Cost With you see! And Complete appliance on Same Date Of Service ( s ) have been.! Wcdp Member enrolled in Medicare Part D for the Member has Medicare Managed for... Incorrectly applied to both the claim headerand details before it & # x27 ; explanation... Payment has been reached a traditional dispensing fee May Be allowed for the Same trip Must Match Approved.! And Complete appliance on Same Date Of Service ( DOS ) Per Month is reimbursable... Is a statement Of benefits ) is not allowed the Same day As Code... Psychotherapy Services to this Certification Segment Does not equal header Medicare paid Amounts Does not Match the Billing Provider.... Manually Priced Using the Medicare progressive insurance eob explanation codes, Deductible, And Date Of Service ( DOS ) the Drug... 49But Does not Match Original Claims Provider Number Does not Meet Standards Accepted the... Required but was submitted on the claim contains value Code 49but Does not Match Original Claims Provider Number to....

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