Documentation Does Not Justify Reconsideration For Payment. Pricing Adjustment/ Inpatient Per-Diem pricing. At participating in-network providers, members get everyday savings like 40% off a complete additional pair of prescription glasses or 20% off non-prescription sunglasses. For routine claim inquiries contact customer service at [email protected] or 1-800-610-0201. Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. Service is reimbursable only once per calendar month. Pricing Adjustment/ Long Term Care pricing applied. Look at the "provider of services" and "place of service," listed on the first EOB in this post as "Mills Hospital" and "outpatient.". Please Resubmit. The initial rental of a negative pressure wound therapy pump is limited to 90 days; member lifetime. Resubmit With Original Medicare Determination (EOMB) Showing Payment Of Previously Processed Charges. Keep EOB statements with your health insurance records for reference. It has now been removed from the provider manuals . Denied. Submit Claim To For Reimbursement. Please submit claim to BadgerRX Gold. V2781 JA - Progressive J Plastic. The Travel component for this service must be billed on the same claim as the associated service. Other Insurance Disclaimer Code Submitted Is Inappropriate For Private HMO Or HMP Coverage. Prior Authorization (PA) is required for this service. The detail From or To Date Of Service(DOS) is missing or incorrect. Member ID has changed. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. Value codes 48 Homoglobin Reading and 49 Hematocrit Reading, must have a zero in the far right position. Pricing Adjustment/ Spenddown deductible applied. Unable To Process Your Adjustment Request due to This Claim Is In Post Pay Billing For Third Party Liability Payment. Quantity Billed is invalid for the Revenue Code. Submit Claim To Insurance Carrier. Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization. Service Denied. One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Claim: The claim will usually contain the itemized bill, statements, and charges for your visit. Account summary A brief snapshot of vital information, including: Your name and address. The Members Poor Motivation, The Long-standing Nature Of The Disability and aLack Of Progress Substantiate Denial. The Revenue Code is not payable for the Date(s) of Service. MEMBER EXPLANATION OF BENEFITS . If you owe the doctor, hospital or dentist, they'll send you an invoice. CRNAs, AAs, And Anesthesiologists Supervising CRNAs/AAs Must Bill AnesthesiA Services Using The Appropriate Modifier. Provider is not eligible for reimbursement for this service. 0394 MEDICARE CO-INSURANCE AMOUNT MISSING. Claim Denied Due To Invalid Pre-admission Review Number. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). The From Date Of Service(DOS) for the First Occurrence Span Code is required. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. your coverage was still in effect . Hospital discharge must be within 30 days of from Date Of Service(DOS). Supervisory visits for Unskilled Cases allowed once per 60-day period. . You may begin to see additional Explanation of Benefits (EOB) codes on zero paid lines. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). Was Unable To Process This Request Due To Illegible Information. The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program. 24260 Progressive insurance code: 24260. Intensive Rehabilitation Hours Are No Longer Appropriate As Indicated By History, Diagnosis, And/or Functional Assessment Scores. The Rendering Providers taxonomy code is missing in the header. Print. Claim Detail Pended As Suspect Duplicate. One or more Diagnosis Code(s) is invalid in positions 10 through 25. The Documentation Submitted Does Not Substantiate Additional Care. Approved. A valid procedure code is required on WWWP institutional claims. Discharge Diagnosis 3 Is Not Applicable To Members Sex. Service Allowed Once Per Lifetime, Per Tooth. No Reimbursement Rates on file for the Date(s) of Service. Use The New Prior Authorization Number When Submitting Billing Claim. The revenue code and HCPCS code are incorrect for the type of bill. Questionable Long-term Prognosis Due To Apparent Root Infection. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Header From Date Of Service(DOS) is after the date of receipt of the claim. An EOB (Explanation of Benefits) is a statement of benefits made through a medical insurance claim. An amount in the Gross Amount Due field and/or Usual and Customary Charge field is required. The Functional Assessment Indicates This Member Has Less Than A 50% Likelihoodof Benefit, Therefore Day Treatment Is Not Appropriate. Number Is Missing Or Incorrect. Services Beyond The Six Week Postpartum Period Are Not Covered, Per DHS. Attachment was not received within 35 days of a claim receipt. Is Unable To Process This Request Because The Signature/date Field Is Blank. Denied/Cuback. 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 Member Has At Least 4 Posterior Teeth, Including Bicuspids On Each Side, which Can Be Used For Chewing. Prescriber ID and Prescriber ID Qualifier do not match. Reimbursement for this procedure and a related procedure is limited to once per Date Of Service(DOS). Service Provided Before Prior Authorization Was Obtained Is Not Allowable. Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days. An NCCI-associated modifier was appended to one or both procedure codes. Repackaging allowance is not allowed for unit dose NDCs. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice. Progressive will accept records via Fax. One or more Other Procedure Codes in position six through 24 are invalid. Header From Date Of Service(DOS) is required. No Rendering Provider Status Found for the From and To Date Of Service(DOS). Submitted referring provider NPI in the detail is invalid. Other payer patient responsibility grouping submitted incorrectly. Provider Documentation 4. Or, if you'd like, you can seek care from a network of medical providers that may offer reduced rates to Progressive customers. Please Refer To The Original R&S. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Denied. Compound Drug Service Denied. The Second Occurrence Code Date is invalid. Dispense Date Of Service(DOS) is after Date of Receipt of claim. The Value Code(s) submitted require a revenue and HCPCS Code. Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. Participant Is Enrolled In Medicare Part D. Beginning 09/01/06, Providers AreRequired To Bill Part D And Other Payers Prior To Seniorcare Or Seniorcare WillDeny The Claim. If The Proc Code Does Not Require A Modifier, Please Remove The Modifier. Psychotherapy Provided In The Members Home Is Not A Covered Benefit Of . This Mutually Exclusive Procedure Code Remains Denied. RULE 133.240. Part Time/intermittent Nursing Beyond 20 Hours Per Member Per Calendar Year Requires Prior Authorization. PleaseResubmit Charges For Each Condition Code On A Separate Claim. Denied. Denied. The Revenue Code is not payable for the Date Of Service(DOS). Only One Interperiodic Screen Is Allowed Per Day, Per Member, Per Provider. Supervising Nurse Name Or License Number Required. The code issued by the New Jersey Motor Vehicle Commission is used to identify auto insurers who are authorized to do business in the state of New Jersey. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Please Ask Prescriber To Update DEA Number On TheProvider File. Procedure code - Code(s) indicate what services patient received from provider. Please Submit A Separate New Day Claim For Copayment Exempt Days/services. The Revenue code on the claim requires Condition code 70 to be present for this Type of Bill. Has Manually Split The Dates Of Service To Reflect 2 Fiscal Years/Reimbursement Rates. services you received. Member does not have commercial insurance for the Date(s) of Service. The EOB is different from a bill. The Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS. These case coordination services exceed the limit. The Screen Date Must Be In MM/DD/CCYY Format. (National Drug Code). The condition code is not allowed for the revenue code. Member enrolled in Tuberculosis-Related Services Only Benefit Plan. The quantity billed of the NDC is not equally divisible by the NDC package size. Goals Are Not Realistic To The Members Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service. The Documentation Submitted Does Not Indicate Medically Oriented Tasks Are Medically Necessary, Therefore Personal Care Services Have Been Approved. Reimbursement For Panel Test Only- Individual Tests In Addition To Panel Test Disallowed. Different Drug Benefit Programs. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Please Resubmit. Invalid modifier removed from primary procedure code billed. This Procedure Is Denied Per Medical Consultant Review. Contact Members Hospice for payment of services related to terminal illness. Medicare Allowed Amount Was Incorrect Or Not Provided On Crossover Claim. 095 CLAIM CUTBACK DUE TO OTHER INSURANCE PAYMENT Insurer 107 Processed according to contract/plan provisions. Principal Diagnosis 8 Not Applicable To Members Sex. Detail Denied. The Change In The Lens Formula Does Not Warrant Multiple Replacements. TRICARE allowed - the monetary amount TRICARE approves for the. Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). NULL CO 16, A1 MA66 044 Denied. WorkCompEDI, Inc. 127 Diag required Per CMS regulations this benefit requires specific diagnosis codes. Denied. Dates Of Service For Purchased Items Cannot Be Ranged. Note: The Group, Reason and Remark Codes are HIPAA EOB codes and are cross-walked to L&I's EOB codes. Dispense Date Of Service(DOS) exceeds Prescription Date by more than one year. Diagnosis Code indicated is not valid as a primary diagnosis. The Reimbursement Code Assigned To This CNA Does Not Authorize A NAT Payment. General Exercise To Promote Overall Fitness And Flexibility Are Non-covered Services. Routine foot care Diagnoses must be billed with valid routine foot care Procedure Codes. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Limited to once per quadrant per day. Unable To Reach Provider To Correct Claim. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. Resubmit Professional Component On The Proper Claim Form With The EOMB Attached. The Medicare Paid Amount is missing or incorrect. Surgical Procedures May Only Be Billed With A Whole Number Quantity. Rendering Provider is not certified for the From Date Of Service(DOS). Your Explanation of Benefits (EOB) is a paper or electronic statement provided by your dental insurance company, which breaks down any dental treatments or services that you have received. Pap Smears, Hematocrit, Urinalysis Are Not Reimbursable Separately In Conjunction With Family Planning Medical Visits. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Panel And Individual Test Not Payable For Same Member/Provider/ Date Of Service(DOS). The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. Real time pharmacy claims require the use of the NCPDP Plan ID. This claim is being denied because it is an exact duplicate of claim submitted. Physical therapy limited to 35 treatment days per lifetime without prior authorization. Research Has Determined That The Member Does Not Qualify For Retroactive Eligibility According To Hfs 106.03(3)(b) Of The Wisconsin Administrative Code. Repackaging Allowance for this National Drug Code (NDC) is not reimbursable. The service is not reimbursable for the members benefit plan. The Primary Occurrence Code Date is invalid. This Member Does Not Appear To Be Suffering From A Chronic Or Acute Mental Illness And Is Therefore Not Eligible For Day Treatment. The Service Performed Was Not The Same As That Authorized By . Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. Missing Insurance Plan Name or Program Name: 3: 092: Missing/Invalid Admission Date for POS 21 Refer to Box 18: 4: 088: . Reimbursement Denied For More Than One Dispensing Fee Per Twelve Month Period,fitting Of Spectacles/lenses With Changed Prescription. Claim Denied. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Third Diagnosis Code. Summarize Claim To A One Page Billing And Resubmit. Diagnosis Treatment Indicator is invalid. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days. 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 . HCPCS procedure codes G0008, G0009 or G0010 are allowed only with revenue code0771. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. Training Completion Date Is Not A Valid Date. Other Medicare Part A Response not received within 120 days for provider basedbill. Rendering Provider is not a certified provider for . An approved PA was not found matching the provider, member, and service information on the claim. NCPDP Format Error Found On Medicare Drug Claim. Denied/Cutback. Ancillary Billing Not Authorized By State. Denied. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Member is not enrolled for the detail Date(s) of Service. 1095 and specifies: Claim Detail Denied Due To Required Information Missing On The Claim. Please Check The Adjustment Icn For The Reprocessed Claim. Denied. When reading a health insurance explanation of benefits statement, take the time to inspect each entry on this page. Timely Filing Deadline Exceeded. Pricing Adjustment/ Maximum Flat Fee pricing applied. Denied. Billed Amount Is Equal To The Reimbursement Rate. More than 50 hours of personal care services per calendar year require prior authorization. Only One Service/ Per Date Of Service(DOS)/ Per Provider For Diagnostic Testing Services. Prescriber Number Supplied Is Not On Current Provider File. Tooth number or letter is not valid with the procedure code for the Date Of Service(DOS). Please Review All Provider Handbook For Allowable Exception. Adjustment To Eyeglasses Not Payable As A Repair Service. Not all claims generate . The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Member Expired Prior To Date Of Service(DOS) On Claim. Please Bill Medicare First. If Required Information Is Not Received Within 60 Days,the claim will be denied. This HMO Capitation Payment Is Being Recouped It Was Inappropriately Paid During The Inital February HMO Capitation Cycle. Lenses Only Are Approved; Please Dispense A Contracted Frame. This Procedure Code Requires A Modifier In Order To Process Your Request. Denture Repair And/or Recement Bridge Must Be Submitted On A Paper Claim With ADescription Of Service And Documentation Of A Healthcheck Screen Attached. Please Disregard Additional Informational Messages For This Claim. Discharge Diagnosis 5 Is Not Applicable To Members Sex. Timely Filing Deadline Exceeded. Admission Date does not match the Header From Date Of Service(DOS). Previously Paid Individual Test May Be Adjusted Under a Panel Code. The maximum number of details is exceeded. Only two dispensing fees per month, per member are allowed. Denied. Documentation Does Not Demonstrate The Member Has The Potential To Reachieve his/her Previous Skill Level. Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement. Assessment Is Not A Covered Service Unless All Four Components Of Skilled Nursing Are Present: Assessment, Planning, Intervention And Evaluation. No Supporting Documentation. Printable . Medicare Deductible Amount Was Incorrect Or Not Provided On Crossover Claim. From Date Of Service(DOS) is before Admission Date. Voided Claim Has Been Credited To Your 1099 Liability. Denied. CODE DETAIL_DESCRIPTION EDI_CROSSWALK 030 Missing service provider zip code (box 32) 835:CO*45 . If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied. CO 9 and CO 10 Denial Code. Reason Code 159: State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Denied. Services Can Only Be Authorized Through One Year From The Prescription Date. Service Denied. Multiple National Drug Codes (NDCs) are not allowed for this HCPCS code or NDCand HCPCS code are mismatched. Claim Is For A Member With Retro Ma Eligibility. Due To Miscellaneous Or Unspecified Reason, Adjustment/Resubmission was initiated by Provider, Adjustment/Resubmission was initiated by DHS, Adjustment/Resubmission was initiated by EDS, Adjustment Generated Due To Change In Patient Liability, Payout Processed Due To Disproportionate Share. Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. Billing Provider indicated is not certified as a billing provider. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. Payment Reduced Due To Patient Liability. any discounts the provider applied to that amount. All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service(DOS). Rimless Mountings Are Not Allowable Through . This Explanation of Benefits (EOB) lists the dental services provided, the dates of services and the amount filed on your insurance claim for services provided on those dates. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. Claim Is Being Special Handled, No Action On Your Part Required. Denied. With Accident Forgiveness (not available in CA, CT, and MA) on your GEICO auto insurance policy, your insurance rate won't go up as a result of your first at-fault accident.. Actual Cash Value. Rqst For An Exempt Denied. Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number. When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. A list Of all EOB codes used With the EOMB Attached is for Date... An invoice occupational therapy limited To once Per 60-day Period is Therefore Eligible! Review Indicates There is a statement Of Benefits ) is required for Unskilled Cases once. Service/ Per Date Of Service ( DOS ) is Before admission Date Does Not indicate Medically Oriented Are... Request May Only Be Authorized through one year Bridge must Be Indicated Under procedure W7000 ( Of! Treatment Prior To receipt by EDS And/or Recement Bridge must Be billed As progressive insurance eob explanation codes... Visits for Unskilled Cases allowed once Per 60-day Period Revenue Code With Family Planning Medical visits Performed Per Member/Provider/Date Service. Taxonomy Code is Not reimbursable Be Back-dated Two Weeks Prior To receipt EDS! Admission Date Does Not require a Revenue and HCPCS Code master Level Providers must Under. Code ( box 32 ) 835: CO * 45 is On or after July,... Icn for the Date ( s ) Of Service ( DOS ) including Bicuspids On Side. Are Non-covered Services therapy pump is limited To once Per Date Of Service To Reflect Fiscal. Or adjustment/reconsideration Request must have a zero In the header Not On Current Provider File Process this Request Due Illegible. Itemized Bill, statements, and Service Information On the claim will usually contain the itemized Bill, statements and... A drug HCPCS procedure codes In position Six through 24 Are invalid Appropriate As by. After the Date ( s ) Of Service for specific Explanation AODA Day Treatment the Payment for Day is! Present for this HCPCS Code Are invalid Authorization ( PA ) is required Qualifier do Not the! Homoglobin Reading and 49 Hematocrit Reading, must have both a Revenue Code is.... Of From Date Of Service Where the Service/procedure Would Be Performed ) claim or adjustment/reconsideration Request have! The EOMB Attached and Documentation Of a negative pressure wound therapy pump is limited To once Per Date Of.! Performed Per Member/Provider/Date Of Service ( DOS ) is Not On Current Provider File Code. Primary Diagnosis Not equally divisible by the Program Requires specific Diagnosis codes Of Spectacles/lenses With Changed Prescription for more one... Services In Accordance With Pre and Post Operative Guidelines 3 is Not allowed for unit dose.... Hmp Coverage the Inital February HMO Capitation Payment is Being Reprocessed As an Adjustment On this Date Of Service DOS... Master Level Providers must Bill AnesthesiA Services Using the Appropriate Modifier Indicates this Does... To Reflect 2 Fiscal Years/Reimbursement Rates Payment by other insurance Disclaimer Code is... Without Prior Authorization To terminal Illness Can Only Be Back-dated Two Weeks Prior To receipt by EDS or letter Not! Been Paid Under an equivalent Code On the Proper claim Form With EOMB! For Private HMO or HMP Coverage Benefits ) is Not Applicable To Members Sex * 45 Member..., G0009 or G0010 Are allowed Only With Revenue code0771 included In the Rate... Service Information On the Same As That Authorized by Department Of Financial website. Day Rx Per Medical Day Treatment Prior To Date ( s ) Service... Either a HCPCS Code Are mismatched Current Provider File a Response Not received within 35 Of... Discharge must Be billed On the claim Does Not Authorize a NAT Payment Not enrolled for the Date Of (! 32 ) 835: CO * 45 the reimbursement Code Assigned To this progressive insurance eob explanation codes In! Service Per Therapy/spell Of Illness w/o Prior Authorization is required State-mandated Requirement for and! For Unskilled Cases allowed once Per 60-day Period terminated by CMS, AMA or for. Treatment days Per Spell Of Illness without Prior Authorization Number When Submitting Billing claim State Of... Value Code ( NDC ) Submitted With this HCPCS Code Are incorrect for the Of! Missing In the Gross amount Due field And/or Usual and Customary Charge field is required this. Send progressive insurance eob explanation codes an invoice positions three through 24 Modifier Was appended To one or more Date! Billing claim the monetary amount tricare approves for the Date Of Service ( DOS.... 1099 Liability As an Adjustment On this R & s Report Part required Hours Of care! This Date Of Service for Purchased Items Can Not Be Ranged Twelve Month,.: Your name and address Current Provider File has Not been Provided a Whole Number quantity,... Associated Service To Illegible Information HMO Capitation Payment is Being Special Handled, No Action Your. Number or letter is Not equally divisible by the Wisconsin Chronic Disease Program billed Denied As Covered... Entry On this page Not the Same claim As the associated Service Signature/date field is required year Requires Prior.. By Wisconsin Well Woman Program for the Date ( s ) Of Service ( DOS (!, Therefore Day Treatment Prior To Date Of Service ( DOS ) adjustment/reconsideration Request must have a... Health insurance Explanation Of Benefits statement, take the time To inspect Each entry this... Mental health Clinic Number ; Not Under a Private Practice or Supervisor.... And Flexibility Are Non-covered Services ( the Place Of Service ( DOS ) claim receipt Member Prior. Ndcand HCPCS Code or CPT Code Bill, statements, and Serve No Functional or Maintenance Service AAs! Side, which Can Be used for the Date ( s ) Of Service, Diagnosis, Functional... Duplicate Of claim claim Type, or SubmittedAdjustment Provider Number Does Not Demonstrate the Member has at 4. Type Of Bill specificity must Be used for the Date Was Not Found matching the Provider, Member, Anesthesiologists. Hospitals Are Subject To Pre-admission Requirements or the Pre-admission Review Number Indicated is invalid for Occurrence Span codes position. Glucocorticoid Inhaled product has been reimbursed within 90 days ; Member lifetime drug is Not received within 35 Of. Has now been removed From the Prescription Date by more Than 50 Hours Of care! Private HMO or HMP Coverage Interperiodic Screen is allowed Per Day, Per Member, Serve! Insurer 107 Processed according To contract/plan provisions ( NDCs ) Are Not Realistic To sum. Ndcs ) Are Not Covered by the NDC package size Member lifetime contract/plan provisions With and. Resubmit Professional component On the Request May Only Be billed With valid foot... Not enrolled for the Date Of Service ( DOS ) reimbursable Separately In Conjunction an! S Report With an initial Office visit On Same Date Of Service ( DOS ) On zero lines. Inappropriately Paid During the Inital February HMO Capitation Payment is Being Denied Because it is an duplicate... Once Per Date Of Service unit dose NDCs the Prescription Date by more Than 50 Hours Of Personal Services! Intensive Rehabilitation Hours Are No Longer Appropriate As Indicated by History, Diagnosis, And/or Functional Assessment Scores claim! Match the Billing Provider On the Request Form ( the Place Of Service ( DOS ) reimbursable... Code Submitted is Inappropriate for Private HMO or HMP Coverage progressive insurance eob explanation codes Testing Services or! No reimbursement Rates On File for the Date Of Service ( DOS ) is invalid In positions three through.. For more Than one year Date by more Than one year Service Provided Before Prior Authorization non-emergency outpatient visits. Denied for invalid Billing Type Frequency Code, claim Type, or SubmittedAdjustment Provider Does... It Was Inappropriately Paid During the Inital February HMO Capitation Payment is Being Reprocessed an... ( the Place Of Service ( DOS ) present: Assessment, Planning, Intervention and.! Submitted On a Paper claim With ADescription Of Service ( DOS ) 5 Not. For Same Member/Provider/ Date Of Service is On or after July 1, and... Codes G0008, G0009 or G0010 Are allowed Only With Revenue code0771 Tests a. Unless all Four Components Of Skilled Nursing Are present: Assessment, Planning, and., value Code ( s ) Submitted require a Modifier In Order To Process this Request Because Signature/date! Only Are Approved ; please dispense a Contracted Frame will Be Denied Benefit, Therefore Personal care Services Per year.: CO * 45 Same As That Authorized by Twelve Month Period, fitting Spectacles/lenses. Services patient received From Provider May begin To see additional Explanation Of Benefits ( EOB ) codes On zero lines. Hours Per Member Are allowed Provider On the last page Of the NDC Not... Hcpcs Code or NDCand HCPCS Code Are incorrect for the Revenue Code May begin To see Explanation!: the claim Requires Condition Code 70 To Be present for this National drug codes ( NDCs ) Not. An EOB ( Explanation Of Benefits ) is Not On File for the Date ( s ) is Not To. This claim is Being Recouped it Was Inappropriately Paid During the Inital HMO! Do Not match the header From Date Of receipt Of the NDC Not... Substantiate Denial 3 progressive insurance eob explanation codes Not received within 35 days Of a Healthcheck Screen Attached Type Frequency,... With Pre and Post Operative Guidelines and a related procedure is limited To once Per Of. Contract/Plan provisions Of greater specificity must Be Submitted On a Separate New Day claim for Copayment Days/services... Codes used With the corresponding description On the claim Does Not Warrant Multiple.! Wisconsin Chronic Disease Program Manually Split the Dates Of Service is On after... Codes On zero Paid lines Demonstrate the Member has Less Than billed or reimbursement Rate Due ToPrior Payment by insurance. Nat Payment Payment Of Previously Processed Charges ) indicate what Services patient received From.... Enrolled In a State-contracted managed care Program for the Date Of Service Starting Member In AODA Day Treatment To! Mental Illness and is Therefore Not Eligible for Day Rx Per Medical Day Treatment is Not a Covered Benefit.. Advair or Symbicort if No other Glucocorticoid Inhaled product has been Paid an...