Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Supplemental tests billed on the same Date Of Service(DOS) as vision examination are not payable. 129 Single HIPPS . Good Faith Claim Denied Because Of Provider Billing Error. New Prescription Required. Health plan member's ID and group number. Liberty Mutual insurance code: 23043. Billed Procedure Not Covered By WWWP. Only non-innovator drugs are covered for the members program. Discharge Diagnosis 2 Is Not Applicable To Members Sex. Detail To Date Of Service(DOS) is invalid. At Least One Of The Compounded Drugs Must Be A Covered Drug. Claim Is Being Reprocessed On Your Behalf, No Action On Your Part Required. Service code is invalid . Pricing Adjustment/ Medicare Pricing information. Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). Was Unable To Process This Request. Contingency Plan for CORE and HIRSP Kids Suspend all non-pharmacy claims. MEMBER EXPLANATION OF BENEFITS . The Request Has Been Approved To The Maximum Allowable Level. The diagnosis code is not reimbursable for the claim type submitted. Pricing Adjustment/ Ambulatory Surgery pricing applied. This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. Other Bifocal/Trifocal Lenses Acceptable Code Modifier V2219 Seg.width>28mm (explanation required) V2219 Flat Top 35 V2219 Executive V2220 Add >3.25D V2319 Seg.width>28mm (explanation required) V2319 Flat Top . Please Provide The Type Of Drug Or Method Used To Stop Labor. Denied/Cutback. your insurance plan will begin sharing the cost with you (see "co-insurance"). This procedure is age restricted. Denied. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. Reason Code 117: Patient is covered by a managed care plan . Procedure Not Payable for the Wisconsin Well Woman Program. This National Drug Code (NDC) is not covered. Reimbursement for this procedure and a related procedure is limited to once per Date Of Service(DOS). This Incidental/integral Procedure Code Remains Denied. Denied. WCDP is the payer of last resort. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. Benefit Payment Determined By Fiscal Agent Review. Although an EOB statement may look like a medical bill it is not a bill. Copayment Should Not Be Deducted From Amount Billed. Missing or invalid level of effort submitted and/or reason for service, professional service, or result of service code billed in error. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fourth Diagnosis Code. Supervisory visits for Unskilled Cases allowed once per 60-day period. 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 . The Revenue Code is not payable for the Date Of Service(DOS). 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. Date of services - the date you received the care. Please Furnish Length Of Time For Services Rendered. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. Claims Cannot Exceed 28 Details. Please Correct And Resubmit. Pricing Adjustment. Denied. . Detail Denied. Service is reimbursable only once per calendar month. Denied. What is the 3 digit code for Progressive Insurance? This National Drug Code (NDC) has diagnosis restrictions. The Surgical Procedure Code is not payable for Wisconsin Chronic Disease Program for the Date Of Service(DOS). Please Disregard Additional Information Messages For This Claim. Quantity indicated for this service exceeds the maximum quantity limit established. Payment Recovered For Claim Previously Processed Under Wrong Member ID Number. Compound Ingredient Quantity must be greater than zero. Third Diagnosis Code (dx) (dx) is not on file. An Explanation of Benefits (EOB) . Documentation Does Not Justify Reconsideration For Payment. Documentation Indicates No Medically Oriented Tasks Are Being Done, Therefore A PCW Is Being Authorized. Offer. Claim Is Being Special Handled, No Action On Your Part Required. Please Resubmit. Please Contact The Hospital Prior Resubmitting This Claim. You Must Adjust The Nursing Home Coinsurance Claim. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. Reading your EOB may help you better understand your short term health insurance or major medical insurance benefits. Summarize Claim To A One Page Billing And Resubmit. Denied due to The Members Last Name Is Incorrect. Routine foot care Diagnoses must be billed with valid routine foot care Procedure Codes. A Qualified Provider Application Is Being Mailed To You. Pharmaceutical care indicates the prescription was not filled. Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error. Here is what you'll typically find on your EOB: 1. Timeframe Between The CNAs Training Date And Test Date Exceeds 365 Days. 51.42 Board Directors Or Designees Statement & Signature Required OnThe Claim Form For Payment Of Functional Assessment. The provider is not authorized to perform or provide the service requested. Recasing Or Replacement Of Hearing Aid Case Is Limited To Once Per 2 Year Period Per Member Per Provider. Physical Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. Service Billed Limited To Three Per Pregnancy Per Guidelines. This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim. Please Refer To Your Hearing Services Provider Handbook. Reimbursement For This Service Is Included In The Transportation Base Rate. This Surgical Code Has Encounter Indicator restrictions. Medicare Allowed Amount Was Incorrect Or Not Provided On Crossover Claim. The member is locked-in to a pharmacy provider or enrolled in hospice. Provider signature and/or date is required. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Denied. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Duplicate ingredient billed on same compound claim. Claim or Adjustment received beyond 365-day filing deadline. Indicator for Present on Admission (POA) is not a valid value. This National Drug Code (NDC) is only payable as part of a compound drug. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. Good Faith Claim Has Previously Been Denied By Certifying Agency. Invalid Provider Type To Claim Type/Electronic Transaction. The EOB breaks down: Procedure May Not Be Billed With A Quantity Of Less Than One. Correct Claim Or Resubmit With X-ray. Independent RHCs Must Bill Codes W6251, W6252, W6253, W6254 Or W6255. Not all claims generate . Disposable medical supplies are payable only once per trip, per member, per provider. AAA insurance code: 71854. Admit Date and From Date Of Service(DOS) must match. Submitted referring provider NPI in the detail is invalid. Not A WCDP Benefit. Incidental modifier is required for secondary Procedure Code. Refer to the DME area of the Online Handbook for claims submission requirements for compression garments. Print. Service Fails To Meet Program Requirements. Denied due to Greater Than Four Dates Of Service Billed On One Detail. Please Correct And Resubmit. Anesthesia Modifying Services Must Be Billed Separately From The Charge For Anesthesia Base And Time Units. The Diagnosis Code Is Not Valid On This Date Of Service(DOS). Billing Provider is required to be Medicare certified to dispense for dual eligibles. this Procedure Code Is Denied As Mutually Exclusive To Another Code Billed On This Claim. Valid Numbers Are Important For DUR Purposes. Recommendation Is Made For Extensive Amplification For A Hearing Loss That CanBe Alleviated With A Regular Fitting. Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. According to Mindy Stadel, a relationship manager with Pivot Health Group, it's critical for health care consumers to familiarize themselves with key terms that are used on EOBs and other important insurance documents. 0959: Denied . Denied. To Date Of Service(DOS) Precedes From Date Of Service(DOS). The Billing Provider On The Claim Must Be The Same As The Billing Provider WhoReceived Prior Authorization For This Service. Procedue Code is allowed once per member per calendar year. Claim Detail Denied. Claim date(s) of service modified to adhere to Policy. Member first name does not match Member ID. Prior Authorization Is Required For Payment Of This Service With This Modifier. Dates Of Service Must Be Itemized. Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. NJM Insurance Codes. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. Please File With Champus Carrier. Denied. Rqst For An Exempt Denied. This Revenue Code has Encounter Indicator restrictions. A valid Prior Authorization is required. This claim is a duplicate of a claim currently in process. Procedure Code is not allowed on the claim form/transaction submitted. A valid Referring Provider ID is required. Please submit future claims with the appropriate NPI, taxonomy and/or Zip +4 Code. Medical Payments and Denials. EOB Code Description Rejection Code Group Code Reason Code Remark Code 074 Denied. 10. [1] The EOB is commonly attached to a check or statement of electronic payment. Please Correct And Submit. Qty And/or Detail Charge Do Not Divide Out Equally For Dates Of Service and/orQty Given. The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. This list was formerly published as Part 6 of the administrative and billing instructions in Subchapter 5 of your MassHealth provider manual. Denied due to Prescription Number Is Missing Or Invalid. 2004-79 For Instructions. Member is not enrolled in /BadgerCare Plus for the Date(s) of Service. Endurance Activities Do Not Require The Skills Of A Therapist. Please Select A Procedure Code In The 58980-58988 Range That Best Describes The Procedure Being Performed. Medicare Deductible Is Paid In Full. Claim Denied. Denied. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Services on this claim were previously partially paid or paid in full. Payment Reduced Due To Patient Liability. Services Not Provided Under Primary Provider Program. No Complete WWWP Participation Agreement Is On File For This Provider. Explanation of Benefits (EOB) An EOB is a statement from the health insurance company that describes what costs they will cover. Amount Paid By Other Insurance Exceeds Amount Allowed By . We encourage you to enroll for direct deposit payments. Insufficient Documentation To Support The Request. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). The Members Profile Indicates This Member Is Possibly Alcoholic And/or Chemically Dependent, And Intensive Aoda Treatment Appears Warranted. ESRD claims are not allowed when submitted with value code of A8 (weight) and a weight of more than 500 kilograms and/or the value code of A9 (height) and the height of more than 900 centimeters. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19.