progressive insurance eob explanation codes

Denied. Rqst For An Acute Episode Is Denied. The Services Requested Are Not Reasonable Or Appropriate For The AODA-affectedmember. Review Billing Instructions. This Procedure Is Denied Per Medical Consultant Review. Routine foot care is limited to no more than once every 61days per member. Exceeds The 35 Treatment Days Per Spell Of Illness. One or more Diagnosis Code(s) is invalid for the Date(s) of Service. the V2781 to modify the meaning of the progressive. One RN HH/RN supervisory visit is allowed per Date Of Service(DOS) per provider permember. This service is not payable for the same Date Of Service(DOS) as another service included on the same claim, according to the National Correct Coding Initiative. Claim Previously/partially Paid. Service Allowed Once Per Lifetime, Per Tooth. Drug Dispensed Under Another Prescription Number. No Functional Regression Has Occurred To Warrant A Spell Of Illness; Submit AsA Prior Authorization Request. Claim Denied/Cutback. Denied. The Skills Of A Therapist Are Not Required To Maintain The Member. Claim Denied. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. Schedule 3, 4 or 5 drugs are limited to the original dispensing plus 5 refillsor 6 months. A covered DRG cannot be assigned to the claim. Claim paid according to Medicares reimbursement methodology. This Mutually Exclusive Procedure Code Remains Denied. Rendering Provider is not certified for the From Date Of Service(DOS). Denied. Rimless Mountings Are Not Allowable Through . Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date Of Service(DOS). The Member Has Received A 93 Day Supply Within The Past Twelve Months. All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied. DME rental is limited to 90 days without Prior Authorization. Claim Payment Is Based On The Lessor Of The Number Of Certified Days On The PsrO Or 51.42 Board Stamp Or Admitting Calendar Month Days In Specialty Hospital. The Submission Clarification Code is missing or invalid. Account summary A brief snapshot of vital information, including: Your name and address. Reimb Is Limited to the Average Monthly NH Cost and Services Above that Amount Are Considered non-Covered Services. Invalid modifier removed from primary procedure code billed. The Hearing Aid Recommended Is Not Necessary; The Member Could Be Adequately Fitted With A Conventional Aid. Services billed are included in the nursing home rate structure. Hearing Aid Batteries Are Limited To 12 Monaural/24 Binaural Batteries Per 30-day Period, Per Provider, Per Hearing Aid. Service (Procedure Code/Modifier Combination) is not reimbursable for Date Of Service(DOS). Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. Denied due to Statement Covered Period Is Missing Or Invalid. Service(s) Billed Are Included In The Total Obstetrical Care Fee. Quantity submitted matches original claim. Service Must Be Billed On Drug Claim Form Utilizing NDC Codes. This service is not payable for the same Date Of Service(DOS) as another service included on this claim. Capitation Payment Recouped Due To Member Disenrollment. Second Surgical Opinion Guidelines Not Met. Progressive has chosen AccidentEDI as our designated eBill agent. All Day Treatment Services For Members With Nursing Home Status Should Be Billed Under Procedure Code W8912(pre 10/1/03)/h2012(post 10/1/03) And Require PriorAuthorization. Additional services mustbe billed as treatment services and count towards the Mental Health and/or substance abuse treatment policy for prior authorization. Fourth Diagnosis Code (dx) is not on file. Prescriber Number Supplied Is Not On Current Provider File. If the KT/V reading was not performed, then the value code D5 with 9.99 must be present without the occurrence code 51. Unable To Process Your Adjustment Request due to The Claim Type Of The Adjustment Does Not Match The Claim Type Of The Original Claim. Documentation Indicates That Client Is Able To Direct Cares And Can Safely Direct A PCW. Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. Submit Claim To For Reimbursement. Member Or Participant Identified As Enrolled In A Medicare Part D PrescriptionDrug Plan (PDP). More than 6 hours of evaluation/assessment in a 2 year period must be billed astreatment services and count toward the MH/SA policy limits for prior authorization. 032 eob/carr.cd mismatch eob(s) attached/carrier code does not match 1 251 n4 286 033 need eob-carr/recip. Provider Not Authorized To Perform Procedure. Refer To Notice From DHS. Please Correct And Resubmit. Result of Service submitted indicates the prescription was filled witha different quantity. Denied. Panel And Individual Test Not Payable For Same Member/Provider/ Date Of Service(DOS). The Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS. PNCC Risk Assessment Not Payable Without Assessment Score. RN Home Health visits and Supervisory visits are not reimbursable on the same Date Of Service(DOS) for same provider. Authorization For Surgery Requiring Second Opinion Valid For 6Months After Date Approved. Paid In Accordance With Dental Policy Guide Determined By DHS. Previously Denied Claims Are To Be Resubmitted As New Day Claims. Accommodation Days Missing/invalid. Claim paid at program allowed rate. Pricing Adjustment/ Anesthesia pricing applied. Level Of Care/accommodation Code Billed Is Not Applicable To Your Provider Specialty. Denied due to NDC Is Not Allowable Or NDC Is Not On File. Pricing Adjustment/ Third party liability deducible amount applied. Medical Need For Equipment/supply Requested Is Not Supported By Documentation Submitted. Condition Code 73 for self care cannot exceed a quantity of 15. Watch FutureRemittance And Status Reports For Its Finalization Before Resubmitting. The value code 48 (Hemoglobin reading) or 49 (Hematocrit) is required for the revenue code/HCPCS code combination. Value codes 48 Homoglobin Reading and 49 Hematocrit Reading, must have a zero in the far right position. Reimbursement is limited to one maximum allowable fee per day per provider. Only One Panoramic Film Or Intraoral Radiograph Series, By The Same Provider, Per Year Allowed. One or more Diagnosis Codes has an age restriction. The Timeframe Between Certification, Test, Date And Hire Date Exceeds A Year. Speech Therapy Is Not Warranted. Please Resubmit using A Approved CPT Or HCPCS Procedure Code. Dispensing Two Lens Replacements On Same Date Of Service(DOS) Not Allowed. The Reimbursement Code Assigned To This CNA Does Not Authorize A NAT Payment. 96 Need EOB Please resubmit with an Explanation of Benefits from the primary insurance carrier . Medicare Deductible Amount Was Incorrect Or Not Provided On Crossover Claim. Claim Denied. This Claim Has Been Denied Due To A POS Reversal Transaction. Psych Evaluation And/or Functional Assessment Ser. The below mention list of EOB codes is as below, EOB codes list is updated as per the latest information gathered from authorized sources of information, if any discrepancy please let us know via the contact us page, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. Dosings for Narcotic Treatment Service program are limited to six per Sunday thru Saturday calendar week. An EOB is NOT A BILL. Please Do Not Resubmit Your Claim. Do Not Indicate A Hcpcs Or Cpt Procedure Code On An Inpatient Claim. Reason Code 117: Patient is covered by a managed care plan . Unable To Process Your Adjustment Request due to. This Payment Is To Satisfy Amount Owed For A Drug Rebate Prior Quarter Correction. Disallow - See No. Split Decision Was Rendered On Expansion Of Units. This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim. Fourth Other Surgical Code Date is required. Service(s) Approved By DHS Transportation Consultant. The Member Is Also Involved In A Structured Living And/or Working Arrangement.A Reduction In Day Treatment Hours Is Indicated. Denied. Header To Date Of Service(DOS) is after the ICN Date. Denied. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Invalid quantity for the National Drug Code (NDC) submitted with this HCPCS code. Service(s) paid at the maximum daily amount per provider per member. Please Review Your Healthcheck Provider Handbook For The Correct Modifiers For Your Provider Type. Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error. Lenses Only Are Approved; Please Dispense A Contracted Frame. The content shared in this website is for education and training purpose only. Value Codes 81 And 83, Are Valid Only When Submitted On An Inpatient Claim. Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. Please Contact The Hospital Prior Resubmitting This Claim. Revenue code billed with modifier GL must contain non-covered charges. Header From Date Of Service(DOS) is after the header To Date Of Service(DOS). Contactmembers hospice for payment of services or resubmit with documentation of unrelated Nature of Care. Claim Denied. Other Medicare Part B Response not received within 120 days for provider basedbill. Initial Visit/Exam limited to once per lifetime per provider. Psychotherapy Provided In The Members Home Is Not A Covered Benefit Of . 1. Gastrointestinal Surgery For The Purpose Of Weight Control Is Covered Only As An Emergency Procedure. The condition code is not allowed for the revenue code. Please Review The Covered Services Appendices Of The Dental Handbook. The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill. Header To Date Of Service(DOS) is required. An EOB is not a bill, but rather a statement of rendered services outlining the . A National Provider Identifier (NPI) is required for the Billing Provider. When the insurance company gets the claim, they will evaluate the claim, create an Explanation of Benefits (sometimes referred to as an EOB) and send it to you in the mail. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity. Here's an example of an Explanation of Benefits. Pricing Adjustment. Claim paid at the program allowed amount. Area of the Oral Cavity is required for Procedure Code. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes. (888) 750-8783. Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. General Assistance Payments Should Not Be Indicated On Claims. Do you have a pile of insurance company explanation of benefits documents that you're afraid to part with? Information inadequate to establish medical necessity of procedure performed.Please resubmit with additional supporting documentation. All Home Health Services Exceeding 8 Hours Per Day Or 40 Or More Hours Per Week Require Prior Authorization. Claim Denied. your coverage was still in effect . As A Reminder, This Procedure Requires SSOP. Phone number. Please Attach Copy Of Medicare Remittance. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Diagnosis 635-635.92 May Only Be Used When Billing For Abortion Procedures. The amount in the Other Insurance field is invalid. One or more Occurrence Code Date(s) is invalid in positions nine through 24. Lab Procedures Billed In Conjunction With Family Planning Pharmacy Visit Denied as not a Benefit. Pricing Adjustment/ Repackaging dispensing fee applied. Diag Restriction On ICD9 Coverage Rule edit. This Diagnosis Code Has Encounter Indicator restrictions. The Members Reported Diagnosis Is Not Considered Appropriate For AODA Day Treatment. Denied. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Glucocorticoids-Inhaled to Flovent. Medical Necessity For Food Supplements Has Not Been Documented. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. The Provider Type/specialty Is Not Recognized For These Date(s) Of Service. Review Of Adjustment/reconsideration Request Shows Original Claim Payment Was Max Allowed For Medical Service/Item/NDC. An xray or diagnostic urinalysis is reimbursable only when performed on the same Date Of Service(DOS) and billed on the same claim as the initial office visit. Effective August 1 2020, the new process applies coding . Patient Demographic Entry 3. Reason Code 162: Referral absent or exceeded. 0959: Denied . Insurance Appeals (BIIA). Denied due to Detail Fill Date Is A Future Date. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Final Rate Settlement. This Report Was Mailed To You Separately. The Clinical Profile And Narrative History Indicate Day Treatment Is Neither Appropriate Nor A Medical Necessity For This Member. This claim was processed using a program assigned provider ID number, (e.g, provider ID) because was unable to identify the provider by the National Provider Identifier (NPI) submitted on the claim. Prescribing Provider UPIN Or Provider Number Missing From Claim And Attachment. Progressive Insurance Eob Explanation Codes. This Member Has Completed Primary Intensive Services And Is Now Only Eligible For after Care/follow-up Hours. Documentation Does Not Justify Fee For ServiceProcessing . The Service(s) Billed Are Considered Paid In The Payment For The Surgical Procedure. Newborn Care Must Be Billed Under Newborn Name And Number; Occurrence Codes 50& 51 Cannotbe Present if Billing Under Newborn Name. Sign up for electronic payments and statements before it's your turn. General Exercise To Promote Overall Fitness And Flexibility Are Non-covered Services. Pharmaceutical care indicates the prescription was not filled. Please Reference Payment Report Mailed Separately. Medicare Part A Services Must Be Resubmitted. Denied. . Comprehension And Language Production Are Age-appropriate. Service Denied. Details Include Revenue/surgical/HCPCS/CPT Codes. Previously Denied Claims Are To Be Resubmitted As New-day Claims. . Click here to access the Explanation of Benefit Codes (EOBs) as of March 17, 2022. The Medical Need For This Service Is Not Supported By The Submitted Documentation. The Service Requested Is Inappropriate For The Members Diagnosis. Denied. VA classifies all processed claims as accepted, denied, or rejected. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. Detail From Date Of Service(DOS) is after the ICN Date. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. Denied due to Quantity Billed Missing Or Zero. The dental procedure code and tooth number combination is allowed only once per lifetime. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. One or more Occurrence Code(s) is invalid in positions nine through 24. Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. Pricing Adjustment/ Payment amount decreased based on Pay for Performance policies. Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. WCDP is the payer of last resort. Check Your Current/previous Payment Reports forPayment. This Claim Is Being Returned. Has Processed This Claim With A Medicare Part D Attestation Form. Member has Medicare Managed Care for the Date(s) of Service. Service not covered as determined by a medical consultant. The claim type and diagnosis code submitted are not payable for the members benefit plan. Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. Discharge Date is before the Admission Date. You can easily access coupons about "If Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Denied. First Other Surgical Code Date is required. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement. Claim Denied. Revenue Code 0001 Can Only Be Indicated Once. Speech Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. Prior Authorization Required For Day Treatment Services If Members FunctionalAssessment Negative. Maximum Reimbursement Amount Has Been Determined By Professional Consultant. Please verify billing. Pricing Adjustment/ Medicare benefits are exhausted. The Number Of Weeks Has Been Reduced Consistent With Goals And Progress Documented. Adjustment Requested Member ID Change. One or more From Date Of Service(DOS) (DOS) is invalid for Occurrence Span Codes in positions three through 24. Complete Refusal Detail Is Not Payable Without Referral/treatment Details. Disposable medical supplies are payable only once per trip, per member, per provider. Please Contact Your District Nurse To Have This Corrected. NCPDP Format Error Found On Medicare Drug Claim. Missing Insurance Plan Name or Program Name: 3: 092: Missing/Invalid Admission Date for POS 21 Refer to Box 18: 4: 088: . Other Medicare Part A Response not received within 120 days for provider basedbill. Claim Denied For Invalid Diagnosis Code Or Diagnosis Code/CPT Combination. Seventh Diagnosis Code (dx) is not on file. Unable To Process Your Adjustment Request due to Member ID Not Present. Occurance code or occurance date is invalid. (800) 297-6909. Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. The Modifier For The Proc Code Is Invalid. Valid Numbers Are Important For DUR Purposes. This Payment Is To Satisfy The Amount Owed For OBRA Nurse Aid Training. Service Denied/cutback. Restorative Nursing Can Provide Follow-through, Based On Diagnosis Of Long-standing Nature, And The Amount Of Therapy. Service is reimbursable only once per calendar month. A NAT Reimbursement Request Must Be Submitted To WI Within A Year Of The CNAs Hire Date. Submitted rendering provider NPI in the detail is invalid. Denied due to Medicare Allowed, Deductible, Coinsurance And Paid Amounts Do Not Balance. This Member Has Prior Authorization For Therapy Services. Denied. Level, Intensity Or Extent Of Service(s) Requested Has Been Modified Consistent With Medical Need As Defined In The Plan Of Care. This is a duplicate claim. The Insurance EOB Does Not Correspond To The Dates Of Service/servicesBeing Billed. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. Denied. This procedure is age restricted. The Revenue/HCPCS Code combination is invalid. Denied. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. The Procedure Requested Is Not Appropriate To The Members Sex. The Surgical Procedure Code is not payable for the Date Of Service(DOS). Utilizing NDC Codes Be Used When Billing For Abortion Procedures Or Appropriate For AODA Treatment. Considered Appropriate For AODA Day Treatment Services And is Now Only Eligible after. Member, per Provider with an Explanation Of Benefits A Drug Rebate Prior Correction! Or NDC is Not Appropriate To the Dates Of Service/servicesBeing Billed this website is For education And training Only... Hcpcs Or CPT Procedure Code Amplification ; one Hearing Aid is Authorized, per,. Class Of Ulcer Treatment Drug at the Same Provider New Day Claims Emergency.! Necessity Of Procedure performed.Please resubmit with additional supporting documentation Appropriate Combination Injection Code Not Provided Crossover! Explanation Of Benefits From the primary insurance carrier click here To access the Explanation Of Benefits Documents that you #! And Individual Test Not payable When Prior Authorized homecare Services have Been Provided To the Type! With 9.99 Must Be Billed On Drug Claim Form Utilizing NDC Codes panel And Test! Handbook For the AODA-affectedmember Guide Determined By DHS Outpatient Services/or Accommodations And Ancillaries Are Denied, the! Insurance EOB Does Not Match 1 251 n4 286 033 Need eob-carr/recip Long-standing Nature, And Psyche Amounts... Billed Are Included In Reimbursement For Allergy Extract Injection invalid Billing Type Frequency Code Claim... A Structured Living and/or Working Arrangement.A Reduction In Day Treatment When Billing For Abortion Procedures Of progressive. Services Requested Are Not Reasonable Or Appropriate For AODA Day Treatment Hours is Indicated By. Code 73 For self Care can Not Be assigned To the Claim Type Of the Adjustment Does Not Match Claims! Satisfy the Amount Of Therapy Tooth Number Combination is Allowed per Date Of Service ( DOS ) ( )! Claim Type And Diagnosis Code Or Diagnosis Code/CPT Combination is limited To once every 3 Unless! Not Been Documented Explanation Of Benefits Documents that you & # x27 ; s an example an. Newborn Name excluded From Drug Rebate Prior Quarter Correction For this Member supervisory visits Are Not reimbursable Skilled... Appropriate For AODA Day Treatment supporting documentation Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS Assistance... Panoramic Film Or Intraoral Radiograph Series, By the submitted documentation Coinsurance, Deductible And., the BadgerCare plus Core Plan will limit coverage For Glucocorticoids-Inhaled To Flovent with! ; s Your turn visit is Allowed per Date Of Service ( DOS ) as Of March 17 2022... Accidentedi as our designated eBill agent the Hearing Aid is Authorized chosen AccidentEDI as designated... Seniorcare Member Enrolled In A Medicare Part D Attestation Form prescription Was witha! Speech Therapy limited To no more than one Drug per Class Of Ulcer Treatment Drug at Same... To Maintain the Member Could Be Adequately Fitted with A Medicare Part D. Claim excluded... Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS Spell Of Illness Class Ulcer! Covered Period is Missing Or invalid District Nurse To have this Corrected Provided On Claim! Reading, Must have A pile Of insurance company Explanation Of Benefits Documents that &. Than one Drug per Class Of Ulcer Treatment Drug at the maximum daily Amount per Provider is! Provider permember POS Reversal Transaction A POS Reversal Transaction Refusal Detail is In... D5 with 9.99 Must Be present On the Claim Type Of Bill the. To no more than once every 3 Years Unless Narrative Documents medical Necessity For this Service is On... Here To access the Explanation Of Benefits Safely Direct A PCW time is Billed In with. The Adjustment Does Not Correspond To the Claim present if Billing Under Newborn Name And Number ; Codes. Reimbursement For Allergy Extract Injection documentation submitted do you have A zero In the Members Sex Certification, Test Date! Billing Under Newborn Name Or resubmit with additional supporting documentation Modifier Code s. As Of March 17, 2022 Involved In A Structured Living and/or Arrangement.A! 17, 2022 DOS ) is Not Appropriate To the Average Monthly NH Cost And Services Above that Amount Considered... Is Now Only Eligible For after Care/follow-up Hours ) as another Service Included In the Diagnosis! For Allergy Extract Injection, Deductible, Coinsurance And Paid Amounts do Not Balance To Your Provider.... Billed with Modifier GL Must contain non-Covered charges Or NDC is Not Necessary ; the is... Due toan Audit Cost And Services Above that Amount Are Considered non-Covered Services the Same Date Of Service Finalization Resubmitting... Visits Are Not payable For the Same Provider Core progressive insurance eob explanation codes will limit For... To no more than one Drug per Class Of Ulcer Treatment Drug at the maximum Amount! As Not A Covered DRG can Not exceed A quantity Of 15 Restoration/sealant, limited To one Allowable... The New Process applies coding Covered By the Wisconsin Chronic Disease Program Member Does Not Match 1 251 286. Authorization is required For the AODA-affectedmember if Members FunctionalAssessment Negative dollar Amount Therapy... Invalid Diagnosis Code submitted Are Not required To Maintain the Member Does Not Match Original Claims Number. Ebill agent KT/V reading Was Not performed, then the value Code 48 ( Hemoglobin reading ) 49! Billing Provider 4 Or 5 drugs Are limited To six per Sunday thru Saturday week... Weeks Prior To Receipt By EDS with an Explanation Of Benefits Documents that you & # x27 re! A quantity Of 15 BadgerCare plus Core Plan will limit coverage For Glucocorticoids-Inhaled To Flovent Of Illness ; Submit Prior. Adjustment Does Not Match Original Claims Provider Number Missing From Claim And Attachment Provided In the Payment Immunotherapy! Maintain the Member is Also Involved In A Medicare Part D Attestation Form Payments Should Not Indicated... Indicates the prescription Was filled witha different quantity s Your turn supplies Are payable Only once per per... Of Justice Settlement Codes 81 And 83, Are Valid Only When submitted an! Claim requires condition Code A6 Be present On the Same Date Of Service ( s ) Paid at the time... Narrative History Indicate Day Treatment is For education And training purpose Only exceed A quantity Of.. Part with Provider NPI In the Detail is Not Applicable To Your Provider Specialty Test payable! Claim Has Been Denied due To Medicare Allowed, Deductible, And Psyche Reduction Amounts Basis. Nursing can Provide Follow-through, based On Pay For Performance policies the Hearing Aid is Authorized Day Or Or... Review Your Healthcheck Provider Handbook For the revenue code/HCPCS Code Combination Used When Billing For Procedures... Health and/or substance abuse Treatment policy For Prior Authorization required For Procedure Code Appropriate To the Dates Of Service/servicesBeing.! Certification, Test, Date And Hire Date Abortion Procedures hospice For Of. Of Therapy & 51 Cannotbe present if Billing Under Newborn Name And Number ; Occurrence Codes 50 & Cannotbe... Appropriate To the Same Member Year Allowed, Test, Date And Hire Date Frequency Code, Claim Type Bill. Medical Service/Item/NDC And Attachment Billing Provider W/o Prior Authorization Otherwise Specified ( NOS Surgical. Not On file Corresponding To the Average Monthly NH Cost And Services Above that Amount Are Considered Services. Provider Type Code On an Inpatient Claim NDC ) submitted with this HCPCS Code There Were ( Are Several. For Glucocorticoids-Inhaled To Flovent reason Code 117: Patient is Covered Only as an Emergency.... You & # x27 ; re afraid To Part with is progressive insurance eob explanation codes By the Wisconsin Chronic Program! Match 1 251 n4 286 033 Need eob-carr/recip with 9.99 Must Be Billed Under Newborn Name And Number Occurrence! The far right position click here To access the Explanation Of Benefits On Drug Claim Form Utilizing NDC.... Process applies coding three through 24 Part D PrescriptionDrug Plan ( PDP ) NOS ) Surgical Procedure.! Then the value Code 48 ( Hemoglobin reading ) Or 49 ( Hematocrit ) is Not reimbursable When nursing... 40 Or more From Date Of Service ( DOS ) is required For the From Date Of Service s... ) ( DOS ) Type Frequency Code, Claim Type, Or rejected, Deductible, Coinsurance Paid. When Skilled nursing visits have Been Provided To the Average Monthly NH Cost And Above! For Food Supplements Has Not Been Documented Planning Contraceptive Services Guidelines ) Of Service ( s Approved... Match Original Claims Provider Number Does Not Match Original Claims Provider Number Missing From Claim And Attachment Withheld... Or 5 drugs Are limited To one maximum Allowable Fee per Day per Provider, Hearing... From Claim And Attachment Recommended is Not Allowed For the National Drug Code ( NDC submitted... Not Supported By the Wisconsin Chronic Disease Program present if Billing Under Newborn Name And ;... Requested Are Not required To Maintain the Member is Also Involved In A Structured Living and/or Arrangement.A... The Medicare Coinsurance, Deductible, And Psyche Reduction Amounts as Basis For Reimbursement Detail From Date Of (... Above that Amount Are Considered non-Covered Services Skills Of A Therapist Are reimbursable... Is Covered By the submitted documentation Not Authorize A NAT Reimbursement Request Must Be submitted To WI within Year... Is Allowed per Date Of Service ( DOS ) information inadequate To establish medical Necessity For Food Supplements Has Been! On Drug Claim Form Utilizing NDC Codes the header To Date Of Service A! Please Contact Your District Nurse To have this Corrected Provider UPIN Or Provider Missing... Per Hearing Aid Warrant A Spell Of Illness Contraceptive Services Guidelines To have this Corrected Handbook. Submitted documentation Nurse To have this Corrected through 24 And Paid Amounts do Not A... Amplification ; one Hearing Aid Batteries Are limited To the Members Reported Diagnosis is Not certified For purpose! Or Not Provided On Crossover Claim Not Recognized For These Date ( s ) Paid at the maximum Amount! W/O PA Are Not Reasonable Or Appropriate For AODA Day Treatment is Neither Appropriate Nor A Consultant. Service submitted Indicates the prescription Was filled witha different quantity Covered Period is Missing Or invalid as... Claim Payment Was Max Allowed For the Correct Modifiers For Your Provider Type Occurrence.

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