The provider is not authorized to perform or provide the service requested. WellCare 2022 schedule; NOFEE: Code is not a covered service on your fee schedule modifiers, Part 2 for CR, GT and blank modifiers IH033: Exceeds clinical guidelines; IH038: Please Itemize Services Including Date And Charges For Each Procedure Performed. Reimbursement limit for all adjunctive emergency services is exceeded. Please Resubmit using A Approved CPT Or HCPCS Procedure Code. You Received A PaymentThat Should Have gone To Another Provider. Rqst For An Acute Episode Is Denied. According to the American College of Radiology and the American Academy of Neurology, a CT of the head or brain, CTA of the head, MRA of the head or MRI of the brain should not be performed routinely for patients with a migraine in the absence of related neurologic signs and symptoms. Service Fails To Meet Program Requirements. This Incidental/integral Procedure Code Remains Denied. Review Has Determined No Adjustment Payment Allowed. Service Denied/cutback. Service Must Be Billed On Drug Claim Form Utilizing NDC Codes. 2004-79 For Instructions. Member has Medicare Managed Care for the Date(s) of Service. Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided. Dental service is limited to once every six months. The Fourth Occurrence Code Date is invalid. Billed Amount Is Equal To The Reimbursement Rate. Denied/Cutback. This Is An Adjustment of a Previous Claim. The Member Is Only Eligible For Maintenance Hours. HMO Capitation Claim Greater Than 120 Days. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fourth Diagnosis Code. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. The Submission Clarification Code is missing or invalid. Services Denied In Accordance With Hearing Aid Policies. NDC- National Drug Code is not covered on a pharmacy claim. Occupational therapy limited to 35 treatment days per lifetime without prior authorization. Please Verify That Physician Has No DEA Number. Correct Claim Or Resubmit With X-ray. Billed Procedure Not Covered By WWWP. Condition codes 71, 72, 73, 74, 75, and 76 cannot be present on the same ESRD claim at the same time. Denied. . Denied due to Detail Billed Amount Missing Or Zero. Denied due to Claim Exceeds Detail Limit. A Primary Occurrence Code Date is required. that provide either supplemental explanation for a monetary adjustment or policy information are required in the remittance advice transaction. 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. Service Denied. Discharge Diagnosis 3 Is Not Applicable To Members Sex. No Action On Your Part Required. An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code. Header To Date Of Service(DOS) is invalid. Please Correct And Submit. Therapy visits in excess of one per day per discipline per member are not reimbursable. This Information Is Required For Payment Of Inhibition Of Labor. Denied. Abortion Dx Code Inappropriate To This Procedure. The sum of all Value Code amounts must be numeric and less than or equal to 999.999.999. Per Information From Insurer, Claims(s) Was (were) Paid. One or more Occurrence Code Date(s) is invalid in positions nine through 24. WWWP Does Not Process Interim Bills. Discharge Diagnosis 2 Is Not Applicable To Members Sex. Services on this claim were previously partially paid or paid in full. Backdating Allowed Only In Cases Of Retroactive Member/provider Eligibility. An Alert willbe posted to the portal on how to resubmit. Claim Denied. Additional Reimbursement Is Denied. The Service Requested Is Inappropriate For The Members Diagnosis. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. Referral Codes Must Be Indicated For W7001, W7002, W7003, W7006, W7008 And W7013. Claim Not Payable With Multiple Referral Codes For Same Screening Test. Description. The Surgical Procedure Code is not payable for Wisconsin Chronic Disease Program for the Date Of Service(DOS). Member is not Medicare enrolled and/or provider is not Medicare certified. Rebill Using Correct Claim Form As Instructed In Your Handbook. If correct, special billing instructions apply. Supervising Nurse Name Or License Number Required. We have created a list of EOB reason codes for the help of people who are working on denials, AR-follow-up, medical coding, etc. Please Correct And Resubmit. Claim Denied Due To Invalid Occurrence Code(s). This Claim Has Been Denied Due To A POS Reversal Transaction. For dates of service on or after 7/1/10 for TOB 72X an occurrence code 51 and value code D5 are required when the KT/V reading was performed. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. Member enrolled in QMB-Only Benefit plan. The Other Payer ID qualifier is invalid for . Denied due to NDC Is Not Allowable Or NDC Is Not On File. Denied due to Services Billed On Wrong Claim Form. Training Completion Date Must Be Prior To And Within A Year Of The CNAs Certification Date. Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number. Procedure Not Payable for the Wisconsin Well Woman Program. Incidental modifier is required for secondary Procedure Code. Claim Denied for implementation of new Wisconsin Medicaid Interchange System.Resubmission of the claim is required due to new claim submission guidelines. Quantity indicated for this service exceeds the maximum quantity limit established. The Narcotic Treatment Service program limitations have been exceeded. The Member Appears To Be At A Maximum Level For Age, Diagnosis, And Living Arrangement. Submit Claim To Other Insurance Carrier. A discrepancy exists between the Other Coverage Indicator and the Other Paid Amount. Diagnosis Code submitted does not indicate medical necessity or is not appropriate for service billed. Procedure Code is restricted by member age. Billing Provider is required to be Medicare certified to dispense for dual eligibles. The Procedure Code Indicated Is For Informational Purposes Only. Reimbursement For This Service Is Included In The Transportation Base Rate. Denied. Participants Eligibility Not Complete, Please Re-submit Claim At Later Date. Reimbursement of this service is included in the reimbursement of the most complex/complete procedure performed. Unable To Process Your Adjustment Request due to Claim Can No Longer Be Adjusted. Oral exams or prophylaxis is limited to once per year unless prior authorized. Dates of Service reflected by the Quantity Billed for dialysis exceeds the Statement Covers Period. This care may be covered by another payer per coordination of benefits. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year. Nursing Home Visits Limited To One Per Calendar Month Per Provider. A SeniorCare drug rebate agreement is not on file for this drug for the Date Of Service(DOS). Remark Codes: N20. Medicare Copayment Out Of Balance. This drug has been paid under an equivalent code within seven days of this Date Of Service(DOS). The following are the most common reasons HCFA/CMS-1500 and UB/CMS-1450 paper claims for Veteran care are rejected: Requires the 17 alpha-numeric internal control number (ICN) [format: 10 digits + "V" + 6 digits] or 9-digit social security number (SSN) with no special characters. Procedure Not Payable As Submitted. is unable to is process this claim at this time. The respiratory care services billed on this claim exceed the limit. Denied. Services Beyond The Six Week Postpartum Period Are Not Covered, Per DHS. A valid Referring Provider ID is required. The Treatment Request Is Not Consistent With The Members Diagnosis. Denied. Header Rendering Provider number is not found. Second And Subsequent Cerebral Evoked Response Tests Paid At A Reduced Rate Per Guidelines. Member is enrolled in Medicare Part B on the Date(s) of Service. The Service Requested Is Not Medically Necessary. Based on reimbursement guidelines it is not appropriate for providers to bill inpatient Evaluation and Management (E/M) services while the patient is in an observation status. 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). Modifiers submitted are invalid for the Date Of Service(DOS) or are missing.. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Sixth Diagnosis Code. The Members Poor Motivation, The Long-standing Nature Of The Disability and aLack Of Progress Substantiate Denial. Questionable Long Term Prognosis Due To Gum And Bone Disease. Services Not Provided Under Primary Provider Program. Services Denied. The Rendering Providers taxonomy code in the header is not valid. Denied. Due To Non-covered Services Billed, The Claim Does Not Meet The Outlier Trim Point. Continuous home care and routine home care may not be billed for the same member on the same Date Of Service(DOS). The Revenue Code is not payable for the Date Of Service(DOS). The Rendering Providers taxonomy code in the detail is not valid. Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. Value code 48 exceeds 13.0 or value code 49 exceeds 39.0 and HCPCS codes Q4081or J0882 are present but either modifer ED or EE are not present. ICD-9-CM Diagnosis code in diagnosis code field(s) 1 through 9 is missing or incorrect. Req For Acute Episode Is Denied. OA 10 The diagnosis is inconsistent with the patient's gender. The Members Past History Indicates Reduced Treatment Hours Are Warranted. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. Claims may deny the chest X-ray billed when the only diagnoses is one of the following routine screening diagnoses: General medical exam (ICD-10 codes Z00.0-Z00.01, Z00.5, Z00.6, Z00.8), Pre-admission/administrative exam (ICD-10 codes Z02.0-Z02.6, Z02.8-Z02.89, Z04.6), Pre-operative exam (ICD-10 codes Z01.810-Z01.811, Z01.818), FL 42 Revenue Code Required. Wellcare uses cookies. Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling. Condition Code is missing/invalid or incorrect for the Revenue Code submitted. Diagnosis Treatment Indicator is invalid. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. Medicare Part A Or B Charges Are Missing Or Incorrect. The dental procedure code and tooth number combination is allowed only once per lifetime. Benefit code These codes are submitted by the provider to identify state programs. Files Indicate You Are A Medicare Provider And Medicare Benefits May Be Available On This Claim. Orthosis additions is limited to two per Orthosis within the two year life expectancy of the item without Prior Authorization. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. Pricing Adjustment/ Provider Level of Care (LOC) pricing applied. Independent Laboratory Provider Number Required. Policy override must be granted by the Drug Authorization and Policy Override Center to dispense less than a 100 day supply. Pricing Adjustment/ Maximum Allowable Fee pricing used. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. The From Date Of Service(DOS) and To Date Of Service(DOS) must be in the same calendar month and year. Please Verify The Units And Dollars Billed. Do Not Indicate NS On The Claim When The NDC Billed Is For A Generic Drug. Member is assigned to a Lock-in primary provider. Occurance code or occurance date is invalid. Procedure not allowed for the CLIA Certification Type. Default Prescribing Physician Number XX5555555 Was Indicated. Claim Is Pended For 60 Days. Denied. Birth to 3 enhancement is not reimbursable for place of service billed. NDC was reimbursed at brand WAC (Wholesale Acquisition Cost) (Wholesale Acquisition Cost) rate. Records Indicate This Tooth Has Previously Been Extracted. Amount Indicated In Current Processed Line On R&S Report Is The Manual Check You Recently Received. We encourage you to take advantage of this easy-to-use feature. Claim Is For A Member With Retro Ma Eligibility. This level not only validates the code sets , but also ensures the usage is appropriate for any Out Of State Billing Provider Not Enrolled For Entire Detail DOS Span. Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. Billing Provider is not certified for the detail From Date Of Service(DOS). There is no action required. Please Do Not Resubmit Your Claim, And Disregard Additional Informational Messages for this claim. Individual Audiology Procedures Included In Basic Comprehensive Audiometry. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment. Staywell is committed to continually improving its claims review and payment processes. ACTION DESCRIPTION: ACTION TYPE. Diag Restriction On ICD9 Coverage Rule edit. Transplants and transplant-related services are not covered under the Basic Plan. Please Obtain A Valid Number For Future Use. Do not insert a period in the ICD-9-CM or ICD-10-CM codes. Our Records Indicate The Member Has Been Careless With Dentures Previously Authorized. Please Furnish A NDC Code And Corresponding Description. Adjustment To Eyeglasses Not Payable As A Repair Service. Additional Encounter Service(s) Denied. Effective With Claims Received On And After 10/01/03 , Occurrence Codes 50 And 51 Are Invalid. To Date Of Service(DOS) Precedes From Date Of Service(DOS). The Medicare copayment amount is invalid. Good Faith Claim Denied For Timely Filing. Surgical Procedure Code is not related to Principal Diagnosis Code. Use Of Therapy Equipment Alone Is Not Sufficient To Justify Maintenance Therapy. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. Our Records Indicate You Have Billed More Than One Unit Dose Dispensing Fee For This Calendar Month. Laboratory Is Not Certified To Perform The Procedure Billed. Denied. This Claim Has Been Excluded From Home Care Cap To Allow For Acute Episode. 0001: Member's . Pricing Adjustment. Units Billed Are Inconsistent With The Billed Amount. CO/204/N30. Member is not enrolled for the detail Date(s) of Service. The Medical Need For This Service Is Not Supported By The Submitted Documentation. The CNA Is Only Eligible For Testing Reimbursement. Services on this claim have been split to facilitate processing.on On Your Part Is Required. You should receive it within 30 to 60 days of services provided, but it's not an official bill. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. Incorrect Or Invalid National Drug Code Billed. Rendering Provider may not submit claims for reimbursement as both the Surgeonand Assistant Surgeon For The Same Member On The Same DOS. Service Denied. NFs Eligibility For Reimbursement Has Expired. This Modifier has been discontinued by CMS or AMA for the Date Of Service(DOS)(s). What steps can we take to avoid this denial? Service Denied. Revenue Code 0001 Can Only Be Indicated Once. No Supporting Documentation. These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan. The Requested Procedure Is Cosmetic In Nature, Therefore Not Covered By . Occupational Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. . -OR- The claim contains value code 48, 49, or 68 but does not contain revenue codes 0634 or 0635. Please Use This Claim Number For Further Transactions. . Therefore, physician provider claim would deny. The Secondary Diagnosis Code is inappropriate for the Procedure Code. Please Bill Your Medicare Intermediary Prior To Submitting To . An ICD-9-CM Diagnosis Code of greater specificity must be used for the Diagnosis Code in posistion 10 through 24. Claim Currently Being Processed. X-rays and some lab tests are not billable on a 72X claim. Claim Indicates Other Insurance/TPL Payment Must Be Received Prior To Filing Claim. Inpatient Respite Care Is Not Covered For Hospice Members Residing In Nursing Homes. Policy override must be granted by the Drug Authorizationand Policy Override Center to dispense early. Contact. For example, a claim from a physician provider with place of service 11 (Office) would be considered incorrectly coded when a claim from an outpatient facility (e.g. These same rules are used by most healthcare claims payers and enforced by the Centers for Medicare and Medicaid Services. One or more Diagnosis Code(s) is invalid for the Date(s) of Service. Activities To Promote Diversion Or General Motivation Are Non-covered Services. This Procedure Code Is Not Valid In The Pharmacy Pos System. The Screen Date Is Either Missing Or Invalid. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement. Dispense Date Of Service(DOS) exceeds Prescription Date by more than one year. This Adjustment/reconsideration Request Was Initiated By . An ICD-9-CM Diagnosis Code of greater specificity must be used for the First Diagnosis Code. The service requested is not allowable for the Diagnosis indicated. Prior Authorization Is Required For Payment Of This Service With This Modifier. Intermittent Peritoneal Dialysis hours must be entered for this revenue code. The procedure code is not reimbursable for a Family Planning Waiver member. Surgical Procedure Code billed is not appropriate for members gender. Please Attach Copy Of Medicare Remittance. You Must Adjust The Nursing Home Coinsurance Claim. The Service Requested Is Considered To Be Professionally Unacceptable, Unproven and/or Experimental. A Payment Has Already Been Issued To A Different Nf. As a provider, you have access to a portal that streamlines your work, keeps you up-to-date more than ever before and provides critical information. Rn Visit Every Other Week Is Sufficient For Med Set-up. Pricing Adjustment/ Long Term Care pricing applied. Denied/Cutback. Goals Are Not Realistic To The Members Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service. Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. This change to be effective 4/1/2008: Submission/billing error(s). One Visit Allowed Per Day, Service Denied As Duplicate. To access the training video's in the portal, please register for an account and request access to your contract or medical group. You Must Either Be The Designated Provider Or Have A Referral. Denied due to Medicare Allowed Amount Is Greater Than Total Billed Amount. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. MedicalBillingRCM.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. Claim Paid Under DRG Reimbursement, Except For Transplants Billed Using Suffixes 05 Through 09. Members do not have to wait for the post office to deliver their EOB in a paper format. Explanation of benefits. Plan options will be available in 25 states, including plans in Missouri . 100 Days Supply Opportunity. Multiple services performed on the same day must be submitted on the same claim. Note: The Group, Reason and Remark Codes are HIPAA EOB codes and are cross-walked to L&I's EOB codes. PA required for payment of this service. Healthcheck Screening Limited To Two Per Year From Birth To Age 3 And One Per Year For Age3 Or Older. Strong knowledge of adjustment and denial reason codes from Electronic Remittance Advices (ERA/835 files) and from paper Explanation of benefits (EOB's) / Explanation of payments (EOP's), CPT . Please Disregard Additional Informational Messages For This Claim. Routine Foot Care Procedures Must Be Billed With Valid Routine Foot Care Diagnosis. New Prescription Required. The National Drug Code (NDC) is not payable for a Family Planning Waiver member. Request Denied Because The Screen Date Is After The Admission Date. CO/204/N182 . One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Reimbursement For This Service Has Been Approved. Unable To Process Your Adjustment Request due to Member Not Found. The Service Performed Was Not The Same As That Authorized By . Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. Denied. Claims Cannot Exceed 28 Details. Seventh Diagnosis Code (dx) is not on file. Third modifier code is invalid for Date Of Service(DOS). Cannot Be Reprocessed Unless There Is Change In Eligibility Status. Medicare Claim Copy And EOMB Have Been Submitte d For Processing Of Coinsurance And Deductible. Reconsideration With Documentation Warranting More X-rays. All Requests Must Have A 9 Digit Social Security Number. Medical Necessity For Food Supplements Has Not Been Documented. The Members Clinical Profile/diagnosis Is Not Within Diagnostic Limitations for Psychotherapy Services. Claim Denied. Paid In Accordance With Dental Policy Guide Determined By DHS. Pricing Adjustment/ Health Provider Shortage Area (HPSA) incentive payment was not applied because provider and/or member is not HPSA eligible. The From Date Of Service(DOS) for the First Occurrence Span Code is invalid. Explanation of Benefit codes (EOBs) Explanation of Benefit (EOB) codes are reported on your remittance statement. All rental payments have been deducted from the purchase costsince the DME item was rented and subsequently purchased for the member. Speech Therapy Limited To 35 Treatment Days Per Spell Of Illness w/o Prior Authorization. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay. Procedure Code is not covered for members with a Nursing Home Authorization onthe Date(s) of Service. Quantity Billed is missing or exceeds the maximum allowed per Date Of Service(DOS). The total billed amount is missing or is less than the sum of the detail billed amounts. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. Invalid Provider Type To Claim Type/Electronic Transaction. Payment Reduced Due To Patient Liability. The From Date Of Service(DOS) for the Second Occurrence Span Code is required. This Claim Has Been Manually Priced Based On Family Deductible. Requested Documentation Has Not Been Submitted. A valid Prior Authorization is required for non-preferred drugs. Alternatively, CPT XXXXX has been billed in the previous 10 days for a CPT code with a 10-day post-operative period, or in the previous 90 days for a code with a 90-day post-operative period by the same provider. The Clinical Profile And Narrative History Indicate Day Treatment Is Neither Appropriate Nor A Medical Necessity For This Member. Claims For Sterilization Procedures Must Reflect ICD-9 Diagnosis Code V25.2. Denied. This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. 690 Canon Eb R-FRAME-EB Billing Provider Name Does Not Match The Billing Provider Number. No Functional Regression Has Occurred To Warrant A Spell Of Illness; Submit AsA Prior Authorization Request. Please Provide The Type Of Drug Or Method Used To Stop Labor. Third Other Surgical Code Date is required. Services Not Allowed For Your Provider T. The Procedure Code has Place of Service restrictions. Earn Money by doing small online tasks and surveys, What is Denials Management in Medical Billing? Claim Denied. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. PleaseResubmit Charges For Each Condition Code On A Separate Claim. Procedure Code billed is not appropriate for members gender. The Medical Necessity For The Hours Requested Is Not Supported By The Information Submitted In The Personal Care Assessment Tool. EOB for services that should be paid as primary by the Health Plan EPSDT: claims billed with EP modifier 3/28/2022 03/09/2022 2636 In Process DN018 . This procedure is age restricted. Please Resubmit As A Regular Claim If Payment Desired. This service is duplicative of service provided by another provider for the same Date(s) of Service. EOB Any EOB code that applies to the entire claim (header level) prints here. This is a duplicate claim. The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. Claim Or Adjustment/reconsideration Request Should Include An Operative Or Pathology Report For This Procedure. Critical care performed in air ambulance requires medical necessity documentation with the claim. Claim Denied In Order To Reprocess WithNew ID. The Clinical Status Of The Member Does Not Meet Standards Accepted By The Department Of Health And Family Services For Transplant. Reimburse Is Limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services. Review Patient Liability/paid Other Insurance, Medicare Paid. Money Will Be Recouped From Your Account. The National Drug Code (NDC) is not on file for the Dispense Date Of Service(DOS). Claim Denied. Claim Number Given Is Not The Most Recent Number. Denied. Purchase Only Allowed; Medical Need For Rental Has Not Been Documented. This drug is limited to a quantity for 100 days or less. No matching Reporting Form on file for the detail Date Of Service(DOS). Contact Wisconsin s Billing And Policy Correspondence Unit. Please Correct And Re-bill. Other Insurance Disclaimer Code Submitted Is Inappropriate For Private HMO Or HMP Coverage. Amount Paid By Other Insurance Exceeds Amount Allowed By . A National Provider Identifier (NPI) is required for the Billing Provider. Speech Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. An explanation of benefits is a document from your insurance company outlining the services you received and how much they cost. Claim Denied. Rendering Provider is not certified for the From Date Of Service(DOS). A Date Of Service(DOS) is required with the revenue code and HCPCS code billed. Compound Ingredient Quantity must be greater than zero. 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. Reading your EOB. Second Other Surgical Code Date is invalid. Services For Members With Medical Status Code TR, SH, SJ, TS Or ST NotAllowed For Your Provider Type, Or For Your Provider Type without a TB Diagnosis. Service is not reimbursable for Date(s) of Service. No Interim Billing Allowed On Or After 01-01-86. Please Submit On The Cms 1500 Using The Correct Hcpcs Code. An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim.
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