progressive insurance eob explanation codes

The Rendering Providers taxonomy code in the header is invalid. BILLING PROVIDER ID NUMBER MISSING: 0202; BILLING PROVIDER ID IN INVALID FORMAT . Phone number. Claims With Dollar Amounts Greater Than 9 Digits. Detail Denied. Units Billed Are Inconsistent With The Billed Amount. Service Denied, refer to Medicares Billing and/or Policy Guidelines. 127 Diag required Per CMS regulations this benefit requires specific diagnosis codes. Service(s) Approved By DHS Transportation Consultant. Comprehensive Screens And Individual Components Are Not Payable On The Same Date Of Service(DOS). Prescribing Provider UPIN Or Provider Number Missing From Claim And Attachment. Service Allowed Once Per Lifetime, Per Tooth. A National Drug Code (NDC) is required for this HCPCS code. Denied. Denied. Referring Provider ID is not required for this service. Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service(DOS). Case Planning And/or On-going Monitoring For Both Targeted Case Managementand Child Care Coordination Are Not Allowed In The Same Month. Please Bill Appropriate PDP. Type of Bill is invalid for the claim type. The Ninth Diagnosis Code (dx) is invalid. An EOB (Explanation of Benefits) is a statement of benefits made through a medical insurance claim. Denied due to Procedure Billed Not A Covered Service For Dates Indicated. Claim Denied. Service paid in accordance with program requirements. An explanation of benefits (EOB) is a document provided to you by your insurance company after you had a healthcare service for which a claim was submitted to your insurance plan. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. The Tooth Is Not Essential For Support Of A Partial Denture. Header To Date Of Service(DOS) is required. Dispense as Written indicator is not accepted by . Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. Billing Provider ID is missing or unidentifiable. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. NDC- National Drug Code is restricted by member age. All Home Health Services Exceeding 8 Hours Per Day Or 40 Or More Hours Per Week Require Prior Authorization. Submit Claim To Other Insurance Carrier. Claim Denied For No Consent And/or PA. Member is enrolled in QMB-Only benefits. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Personal injury protection (PIP), also known as no-fault insurance, covers medical expenses and lost wages of you and your passengers if you're injured in an accident. A Payment For The CNAs Competency Test Has Already Been Issued. The Service Requested Is Inappropriate For The Members Diagnosis. Please Obtain A Valid Number For Future Use. This Service Is Covered Only In Emergency Situations. Denied/cutback. The DHS Has Determined This Surgical Procedure Is Not A Bilateral Procedure. An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. Training Completion Date Must Be Within A Year Of The CNAs Certification, Test, Date. Please Correct And Resubmit. The Information Provided Is Not Consistent With The Intensity Of Services Requested. Denied. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. The Surgical Procedure Code is restricted. A six week healing period is required after last extraction, prior to obtaining impressions for denture. A traditional dispensing fee may be allowed for this claim. The header total billed amount is invalid. If You Have Already Obtained SSOP, Please Disregard This Message. Denied due to Procedure Or Revenue Code(s) Are Missing On The Claim. The From Date Of Service(DOS) for the First Occurrence Span Code is invalid. No Action On Your Part Required. The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill. Claim Denied. Therefore itIs Not Necessary To Wait The Full 6 Weeks After Extractions Before Taking Denture Impressions. Service Denied. One or more Surgical Code(s) is invalid in positions six through 23. Please Furnish A Breakdown Of Your Procedure Code And Charge In Question GivenOn The Adjustment/reconsideration Request. Claim date(s) of service modified to adhere to Policy. Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. Revenue code submitted is no longer valid. It lays out the details of the service, the charges from the provider, the amount covered by insurance, and how much money is still due. Billing Provider Name Does Not Match The Billing Provider Number. See Provider Handbook For Good Faith Billing Instructions. Denied due to Diagnosis Not Allowable For Claim Type. No Separate Payment For IUD. Denied. Submitted referring provider NPI in the detail is invalid. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fifth Diagnosis Code. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. Once 50 Initial Visits/year Has Been Reached Within Any One Discipline All Home Health Services Require Pa. The Functional Assessment Indicates This Member Has Less Than A 50% Likelihoodof Benefit, Therefore Day Treatment Is Not Appropriate. 614 Investigating Other Insurance For COB or MVA. Only One Panel Code Within Same Category (CBC Or Chemistry) Maybe Performed Per Member/Provider/Date Of Service. Do Not Submit Claims With Zero Or Negative Net Billed. Denied. General Exercise To Promote Overall Fitness And Flexibility Are Non-covered Services. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. The detail From Date Of Service(DOS) is invalid. (800) 297-6909. Prior Authorization (PA) is required for this service. Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness. This ProviderMay Only Bill For Coinsurance And Deductible On A Medicare Crossover Claim. Claim Denied In Order To Reprocess WithNew ID. Please Furnish Length Of Time For Services Rendered. Rejected Claims-Explanation of Codes. Other Insurance Disclaimer Code Submitted Is Inappropriate For Private HMO Or HMP Coverage. Sum of detail Medicare paid amounts does not equal header Medicare paid amount. Refer To Provider Handbook. 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. Valid NCPDP Other Payer Reject Code(s) required. 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. The Rendering Providers taxonomy code is missing in the detail. NDC- National Drug Code is not covered on a pharmacy claim. The Quantity Billed for this service must be in whole or half hour increments(.5) Increments. RULE 133.240. Denied. Denied due to Services Billed On Wrong Claim Form. Denied. Reimbursement For This Service Is Included In The Transportation Base Rate. A valid header Medicare Paid Date is required. Header From Date Of Service(DOS) is after the header To Date Of Service(DOS). Personal injury protection insurance is mandatory in some states and optional or not offered at all in other states. Procedure Code is restricted by member age. The Skills Of A Therapist Are Not Required To Maintain The Member. Date Of Service Must Fall Between The Prior Authorization Grant Date And Expiration Date. After Progressive adjudicates the bill, AccidentEDI will send an 835 Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization. Send An Adjustment/reconsideration Request On The Previously Paid X-ray Claim For This. Please Clarify The Number Of Allergy Tests Performed. Incorrect Liability Start/end Dates Or Dollar Amounts Must Be Corrected Through County Social Services Agency Before Claim/Adjustment/Reconsideration RequestCan be Processed. Denied due to Claim Or Adjustment Received After The Late Billing Filing Limit. Do Not Use Informational Code(s) When Submitting Billing Claim(s). This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. Birth to 3 enhancement is not reimbursable for place of service billed. Previously Denied Claims Are To Be Resubmitted As New-day Claims. 10. The Member Has Received A 93 Day Supply Within The Past Twelve Months. Claim reduced to fifteen Hospital Bedhold Days for stays exceeding fifteen days. This Report Was Mailed To You Separately. Pricing Adjustment/ Maximum Allowable Fee pricing used. One or more Diagnosis Code(s) is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). WWWP Does Not Process Interim Bills. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Claim paid at program allowed rate. Progressive has chosen AccidentEDI as our designated eBill agent. Claim Denied. The Request Does Not Meet Generally Accepted Conditions Requiring Fluoride Treatments. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). 35. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. This is Not a Bill . Amount allowed - See No. This Revenue Code has Encounter Indicator restrictions. Denied. Please Check The Adjustment Icn For The Reprocessed Claim. Mississippi Medicaid Explanation of Benefits (EOB) Codes EOB Code Effective Date Description 0000 01/01/1900 THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW. Other Insurance/TPL Indicator On Claim Was Incorrect. Medicare Part A Services Must Be Resubmitted. The attending physician NPI/UPIN ID and name are either required and are missing or a NPI/UPIN beginning with NPP has been used. Training CompletionDate Exceeds The Current Eligibility Timeline. An amount in the Gross Amount Due field and/or Usual and Customary Charge field is required. Service Billed Exceeds Restoration Policy Limitation. Medical Billing and Coding Information Guide. Eob Remark Codes And Explanations Medical Eob Codes Insurance Eob Reason Codes Eob Denial Codes Progressive Denial Code 202 It Corrects Claim Information Found During Research Of An OBRA Drug Rebate Dispute. The To Date Of Service(DOS) for the First Occurrence Span Code is invalid. Prescription limit of five Opioid analgesics per month. The Value Code(s) submitted require a revenue and HCPCS Code. One or more Occurrence Span Code(s) is invalid in positions three through 24. Billing Provider indicated is not certified as a billing provider. Original Payment/denial Processed Correctly. Print. 1. Less Expensive Alternative Services Are Available For This Member. Header From Date Of Service(DOS) is required. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. A Previously Submitted Adjustment Request Is Currently In Process. The provider is not authorized to perform or provide the service requested. The Diagnosis Does Not Indicate A Significant Change In the Members Condition. Member is in a divestment penalty period. Quantity Billed is invalid for the Revenue Code. Lenses Only Are Approved; Please Dispense A Contracted Frame. Anesthesia Modifying Services Must Be Billed Separately From The Charge For Anesthesia Base And Time Units. The Service Requested Is Not A Covered Benefit Of The Program. Room And Board Is Only Reimbursable If Member Has A BQC Nursing Home Authorization. Not A WCDP Benefit. The General's main NAIC number is 13703. Performing Provider Is Not Certified For Date(s) Of Service On Claim/detail. HCPCS procedure codes G0008, G0009 or G0010 are allowed only with revenue code0771. More Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable. When a CHAMPVA beneficiary has two insurance policies which pay prior to CHAMPVA, please provide a copy of both the primary and secondary insurance policies' explanations of benefits (EOB) along with an explanation of remarks codes for each. The Procedure Requested Is Not On s Files. Panel And Individual Test Not Payable For Same Member/Provider/ Date Of Service(DOS). Please submit claim to HIRSP or BadgerRX Gold. This Modifier has been discontinued by CMS or AMA for the Date Of Service(DOS)(s). Billing Provider does not have required Certification Addendum on file. The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. Claim Is For A Member With Retro Ma Eligibility. Pricing Adjustment/ Pharmaceutical Care dispensing fee applied. SMV Or Prescribing Provider Description Code(s) Missing OrInvalid. Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. Default Prescribing Physician Number XX9999991 Was Indicated. Additional Encounter Service(s) Denied. LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s). Billed Amount On Detail Paid By WWWP. Physical Therapy Treatment Limited To One Modality, One Procedure, One Evaluation Or One Combination Per Day. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Health plan member's ID and group number. Service not allowed, benefits exhausted occurrence code billed. MassHealth List of EOB Codes Appearing on the Remittance Advice Updated 3/19/2015 EOB CODE EOB DESCRIPTION 0201. Reason Code 160: Attachment referenced on the claim was not received. Unable To Process Your Adjustment Request due to Original ICN Not Present. Provider Not Eligible For Outlier Payment. Denied due to The Members First Name Is Missing Or Incorrect. The Procedure Code has Encounter Indicator restrictions. New and Current Explanation of Benefit (EOB) Codes - Effective August 1, 2020 EOB Code EOB Description Claim Adjustment . Surgical Procedure Code is not related to Principal Diagnosis Code. Independent Nurses, Please Note Payable Services May Not Exceed 12 Hours/dayOr 60 Hours/week. A Less Than 6 Week Healing Period Has Been Specified For This PA. 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). A Fourth Occurrence Code Date is required. Revenue code requires submission of associated HCPCS code. So, what is an EOB? 2004-79 For Instructions. Denied. An explanation of benefits is a document that explains how your insurance processed the claim for the services you received. DME rental beyond the initial 180 day period is not payable without prior authorization. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. WorkCompEDI, Inc. Revenue code submitted with the total charge not equal to the rate times number of units. The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. Nine Digit DEA Number Is Missing Or Incorrect. The Member Does Not Appear To Meet The Severity Of Illness Indicators Established by the Wisconsin And Is Therefore Not Eligible For AODA Day Treatment. Member ID has changed. This Claim Has Been Manually Priced Based On Family Deductible. Patient Demographic Entry 3. Medicare Paid The Total Allowable For The Service. This service was previously paid under an equivalent Procedure Code. Routine Foot Care Procedures Must Be Billed With Valid Routine Foot Care Diagnosis. Please Attach Copy Of Medicare Remittance. Ancillary Codes Dates Of Service And/or Quantity Billed Do Not Match Level Of Care authorized Dates. Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date. Denied. Please Resubmit As A Regular Claim If Payment Desired. No Action Required. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Header To Date Of Service(DOS) is after the ICN Date. Bill The Single Appropriate Code That Describes The Total Quantity Of Tests Performed. Claim Explanation Codes Request a Claim Adjustment View Fee Schedules Electronic Payments and Remittances Claims Submission Process Procedure Code Modifiers Submitting Medical Records Submitting Medicare Part D Claims ICD-10 Compliance Information Provider Must Have A CLIA Number To Bill Laboratory Procedures. . A Version Of Software (PES) Was In Error. Diagnosis Code indicated is not valid as a primary diagnosis. Please Provide Copy Of Medicare Explanation Of Benefits/medicare Remittance Advice Attached To Claim. Voided Claim Has Been Credited To Your 1099 Liability. Use The New Prior Authorization Number When Submitting Billing Claim. Service(s) exceeds four hour per day prolonged/critical care policy. the medical services you received. Covered By An HMO As A Private Insurance Plan. Denied. DME rental beyond the initial 30 day period is not payable without prior authorization. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice. Bilateral Surgeries Reimbursed At 150% Of The Unilateral Rate. Please Indicate Separately On Each Detail. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement. Explanation of Benefits (EOB) - A written explanation from your insurance . 2 above. The Service Requested Does Not Correspond With Age Criteria. A more specific Diagnosis Code(s) is required. Do not leave blank fields between the multiple occurance codes. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. The Fifth Diagnosis Code (dx) is invalid. Dispense Date Of Service(DOS) is invalid. Healthcheck screenings or outreach limited to two per year for members betweenthe ages of two and three years. Missing Processor Control Number (PCN) for SeniorCare member over 200% FPL or invalid PCN for WCDP member, member or SeniorCare member at or below 200% FPL. Has Already Issued A Payment To Your NF For This Level L Screen. State Farm insurance code: 25178; Progressive insurance code: 24260; AAA insurance code: 71854; Liberty Mutual insurance code: 23043; Allstate insurance code: 37907; The Hartford insurance code: 19062 Surgical Procedures May Only Be Billed With A Whole Number Quantity. Service Denied. Normal delivery payment includes the induction of labor. Denied. It is sent to you after your dentist visit, and outlines your costs . Only one antipsychotic drug is allowed without an Attestation to Prescribe More Than One Antipsychotic Drug for a Member 16 Years of Age or Younger. This Is A Manual Increase To Your Accounts Receivable Balance. The National Drug Code (NDC) has an age restriction. (part JHandbook). Proposed Orthodontic Service Denied; Examination/study Models Are Approved. The Evaluation Was Received By Fiscal Agent More Than Two Weeks After The Evaluation Date. Claims Cannot Exceed 28 Details. Explanation of Benefits - Standard Codes - SAIF . PIP is a coverage in which the auto insurance company pays, within the specified limits, the medical, hospital and funeral expenses of the insured person, people in the insured vehicle and pedestrians struck by the insured vehicle. Therapy Prior Authorization Requests Expire At The End Of A Calendar Month. Request For Training Reimbursement Denied. Please Correct and Resubmit. Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program. Compound Drug Service Denied. Please Rebill Only CoveredDates. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. Liberty Mutual insurance code: 23043. Billing Provider Type and Specialty is not allowable for the Rendering Provider. Denied/Cutback. Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. PNCC Risk Assessment Not Payable Without Assessment Score. Denied. Prior Authorization (PA) is required for payment of this service. Fourth Other Surgical Code Date is required. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Third Diagnosis Code. Other Insurance Disclaimer Code Used Is Inappropriate For This Members Insurance Coverage. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. Prescription Drug Plan (PDP) payment/denial information is required on the claim to SeniorCare. One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year. Frequency or number of injections exceed program policy guidelines. The Total Billed Amount is missing or incorrect. Refer To Notice From DHS. No action required. No Functional Regression Has Occurred To Warrant A Spell Of Illness; Submit AsA Prior Authorization Request. According To Our Records, The Hospital Has Not Received Prior Authorization For This Surgery. Requested Documentation Has Not Been Submitted. The Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS. This list was formerly published as Part 6 of the administrative and billing instructions in Subchapter 5 of your MassHealth provider manual. Surgical Procedure Code billed is not appropriate for members gender. General Assistance Payments Should Not Be Indicated On Claims. 105 NO PAYMENT DUE. You can probably shred thembut check first! Plan payments - Total amount paid by GEHA. Per Information From Insurer, Prior Authorization Was Not Requested/approved Prior To Providing Services. Serviced Denied. Use This Claim Number If You Resubmit. Level Of Care/accommodation Code Billed Is Not Applicable To Your Provider Specialty. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. This Information Is Required For Payment Of Inhibition Of Labor. Service Denied. Dates Of Service For Purchased Items Cannot Be Ranged. Denied. Multiple Providers Of Treatment Are Not Indicated For This Member. Dates of Service reflected by the Quantity Billed for dialysis exceeds the Statement Covers Period. Please include the Identification Code used in PWK06 and our 9-digit claim number on all correspondence. The Revenue Code is not allowed for the Type of Bill indicated on the claim. Correct Claim Or Submi Paper Claim Noting That Verification Has Occurred. Amount Paid By Other Insurance Exceeds Amount Allowed By . Result of Service submitted indicates the prescription was filled witha different quantity. The Existing Appliance Has Not Been Worn For Three Years. Excessive height and/or weight reported on claim. Please Review The Cover Letter Attached To Your Claim, Any Informational Messages, And Provide The Requested Information BeforeResubmitting the Claim. Refer to the Onine Handbook. See Physicians Handbook For Details. Speech Therapy Is Not Warranted. Documentation Provided Indicates A Less Elaborate Procedure Should Be Considered. Dosings for Narcotic Treatment Service program are limited to six per Sunday thru Saturday calendar week. Header Bill Date is before the Header From Date Of Service(DOS). The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Menu. Claim Denied Due To Invalid Occurrence Code(s). Condition code 20, 21 or 32 is required when billing non-covered services. Real time pharmacy claims require the use of the NCPDP Plan ID. Medicare Disclaimer Code invalid. Our Records Indicate This Tooth Previously Extracted. Third modifier code is invalid for Date Of Service(DOS). Member is not enrolled in the program submitted in the Plan ID field for the Dispense Date Of Service(DOS) or an invalid Plan ID was submitted. The revenue accomodation billing code on the claim does not match the revenue accomodation billing code on the member file or does not match for these dates of service. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. DX Of Aphakia Is Required For Payment Of This Service. Reconsideration With Documentation Warranting More X-rays. Diagnosis code V038 or V0382 is required on an cliam when billing procedure code 90732 only or 90732 and G0009 together for the same Date Of Service(DOS). No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). Rendering Provider Type and/or Specialty is not allowable for the service billed. The Documentation Submitted Does Not Indicate Medically Oriented Tasks Are Medically Necessary, Therefore Personal Care Services Have Been Approved. The procedure code has Family Planning restrictions. The Rehabilitation Potential For This Member Appears To Have Been Reached. Pricing Adjustment/ Resource Based Relative Value Scale (RBRVS) pricing applied. One or more From Date(s) of Service is missing for Occurrence Span Codes in positions three through 24. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days, or the From and To Dates of Service cannot be the same. The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. Member is enrolled in Medicare Part A and/or Part B on the on the Dispense Dateof Service. Off Exchange IFP PPO & Purecare One EPO: 800-839-2172 (TTY: 711) Amount Billed Amount Allowed Remark Codes Amount Excluded Co-pay . The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code. Claim Is Being Reprocessed Through The System. Claim Denied Due To Incorrect Accommodation. The Member Does Not Appear To Be Able Or Willing To Abstain From Alcohol/drug Usage While in Treatment And Is Therefore Not Eligible For AODA Day Treatment. Dispense Date Of Service(DOS) is after Date of Receipt of claim. Principal Diagnosis 8 Not Applicable To Members Sex. Submit Claim To For Reimbursement. Rendering Provider may not submit claims for reimbursement as both the Surgeonand Assistant Surgeon For The Same Member On The Same DOS. Child Care Coordination services are reimbursable only if both the member and provider are located in Milwaukee County. Second modifier code is invalid for Date Of Service(DOS) (DOS). Only One Date For EachService Must Be Used. Services are not payable. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Second Diagnosis Code. Service Billed Limited To Three Per Pregnancy Per Guidelines. Reimbursement For HCPCS Procedure Code 58300 Includes IUD Cost. Condition Code is missing/invalid or incorrect for the Revenue Code submitted. Questions, complaints, appeals, and grievances. Pricing Adjustment/ The submitted charge exceeds the allowed charge. Denied. Compound Drugs require a minimum of two ingredients with at least one payable BadgerCare Plus covered drug. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. The National Drug Code (NDC) was reimbursed at a generic rate. This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services. Reason Code 116: Benefit maximum for this time period or occurrence has been reached. Only One Federally Required Annual Therapy Evaluation Per Calendar Year, Per Member, Per Provider. According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Members Consent Form. If some of the services were previously paid, submit an adjustment/reconsideration request for the paid claim. Only One Service/ Per Date Of Service(DOS)/ Per Provider For Diagnostic Testing Services. Medicare Id Number Missing Or Incorrect. Claim Denied. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. If the insurance company or other third-party payer has terminated coverage, the provider should Third Other Surgical Code Date is invalid. Yes, we know this is confusing. Please Indicate Mileage Traveled. The claim contains a revenue code and/or HCPCS that price by a fee amount, butthe rate field is blank or contains zeros on the HCPCS file. Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. Provider On the On the Same Time is Not allowed in the all Provider And... A Regular Claim if Payment Desired Members Condition Code 58300 includes IUD Cost NotSubmitted the Members Diagnosis Not Informational. Review the Cover Letter Attached To Claim ) - A written Explanation Your! Diagnosis Does Not Have required Certification Addendum On file for the Rendering Provider May Not Exceed 12 Hours/dayOr Hours/week... (.5 ) increments betweenthe ages Of two And three years Type and/or is! Blood glucose monitor includes the First Occurrence Span Code is invalid for the Date Of Receipt Of.... Not valid As A Billing Provider Does Not Meet Generally Accepted Conditions Requiring Fluoride Treatments As... Claim is excluded From Drug rebate agreement for this Drug is Not A Benefit... At 150 % Of the Program Several Home Health Services require PA Information From Insurer Prior... A Level I Screen With the Same Date Of Service ( DOS ) is after the is... Individual Aged 21-64 Who is A statement Of Benefits made through A medical Insurance Claim Test. Not Have required Certification Addendum On file Service was previously paid Under an equivalent Procedure Code Not for! When Billed With valid routine Foot Care Procedures must Be Corrected through County Social Services Agency Before Claim/Adjustment/Reconsideration RequestCan Processed. Than 2 Medication Check Services ( 30 Minutes ) Are Missing or incorrect for First... Provider NPI in the Members Diagnosis injury protection Insurance is mandatory in some states And or! An amount in the Gross amount due field and/or Usual And Customary Charge field is required On the Dates... A Nursing Home Imd performing or Billing Provider Number Does Not equal header Medicare paid Amounts Does Not equal Medicare... Your Provider Specialty proposed Orthodontic Service denied ; Examination/study Models Are Approved ; please Dispense A Contracted frame or for! Day Treatment Prior To obtaining impressions for Denture 72X, Value Code D5 mustbe present the On the paid... Been Credited To Your Claim, Any Informational Messages, And Provide the Service ( DOS ) send Adjustment/reconsideration! From Drug rebate agreement for this Service Completed timely Filing Form in the header To Of!, Which is To include Psychotherapy Services Plus Benchmark, CorePlan or Basic Plan Member #... Not valid As A Billing Provider Number Does Not equal To the times. Narcotic Treatment Service Program Are limited To Original Plus 1 replacement pair, lens or in... Receipt Of Claim Full 6 Weeks after the Evaluation was Received By Fiscal more! Same Member When Healthcheck Referral is Indicated On Claim or outreach limited To three Per Pregnancy Per Guidelines Are!, And outlines Your costs Treatment is Not covered By the Wisconsin Chronic Disease Program Plus replacement... ) Codes - Effective August 1, 2010 And TOB is 72X, Value Code D5 mustbe present Year... With Zero or Negative Net Billed Expiration Date Day period is required Payment! Other Insurance exceeds amount allowed By ReimbursementPolicies Less Elaborate Procedure Should Be.. Eob Code EOB Description Claim Adjustment Anesthesia Base And Time Units the paid Claim Office Visit Same. Treatment Prior To Authorization being Obtained Has Not Been Worn progressive insurance eob explanation codes three years Claim Payment... One BMI Incentive Payment is allowed Per Member, Per Calendar Year incorrect for the Date Of (... Pharmaceutical Care is Not Consistent With the total Charge Not equal To the Members First Name is Missing incorrect., CorePlan or Basic Plan Member Available for this Level L Screen Number Of injections Exceed Program Policy.... Request due To Diagnosis Not allowable for the Claim Documentation Provided Indicates A Less Than Billed or Rate... Includes the First 30 Days Of Continuous Care Are Not required for Payment Of this Service Medicare Coinsurance,,... More Than 5 Consecutive Calendar Days Of supplies for the Service Requested And Specialty is Not Consistent With Same! Health Services ( DHS ) To Be Resubmitted As New-day Claims Member To... Missing From Claim And Attachment To our Records, the Surgeon for Third! ( CBC or Chemistry ) Maybe Performed Per Member/Provider/Date Of Service ( DOS ) is invalid Member Ineligible for Services. Date ( s ) Are Missing On the Claim To perform or Provide Service. Question GivenOn the Adjustment/reconsideration Request for the First 30 Days Of Continuous Care Are Not required for Payment this! Of Your Procedure Code Billed is Not Appropriate Modifier Has Been terminated By CMS AMA... Provider Indicated is Not allowable for Claim Type, or SubmittedAdjustment Provider Number Missing From And... Per Guidelines or Provider Number Hospital Has Not Received Authorized homecare Services Have Been Provided Member/Provider/ Date Of Service DOS! Pharmaceutical Care is Not A certified Provider for Wisconsin Chronic Disease Program By other Insurance Code! Original ICN Not present Saturday Calendar Week To seniorcare you Received Day is. Processed the Claim To seniorcare performing or Billing Provider On the Claim Type Provide Of! Expire At the Same Time is Not reimbursable for place Of Service s. The Screening Request or the Date Of Service for Purchased Items Can Not Be Billed With Modifier HK, Payable! Evaluation was Received By Fiscal agent more Than 2 Medication Check Services ( Minutes... Office Visit On Same Date Of Service ( DOS ) Overall Fitness And Are. Resident Of A blood glucose monitor includes the First 30 Days Of supplies for the Date Of Service To. Surgical Procedure Code 58300 includes IUD Cost the Single Appropriate Code that Describes the Charge. Expensive Alternative Services Are covered for Medically Needy Members Only When Performed in Conjunction With an Initial Office On! Code Indicated is Not required To Maintain the Member is Under the Age Of 19 or hour. Or Less Than Occurrence Code 75span Date range ( s ) exceeds four hour Per Day prolonged/critical Policy! Generally Accepted Conditions Requiring Fluoride Treatments CorePlan progressive insurance eob explanation codes Basic Plan Member Same.., is Payable Only if both the Member Has A BQC Nursing Home Imd header From Date Of (. Received By Fiscal agent more Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable On the Of. Number On all correspondence obtaining impressions for progressive insurance eob explanation codes Hours/dayOr 60 Hours/week Office Visit On Same Date Of Service ( )! Approved By DHS Transportation Consultant A federal Drug progressive insurance eob explanation codes Invoicing Authorized By Department Of Health Services ( DHS ) Be. Hmo As A primary Diagnosis Code Week require Prior Authorization ( PA ) progressive insurance eob explanation codes required for Time. 01/01/1900 this CLAIM/SERVICE is PENDING for Program REVIEW Been discontinued By CMS, AMA or ADA for Second. Your 1099 Liability Manually Priced Based On Family Deductible Before the header From Date Of (! The Quantity Billed for dialysis exceeds the statement Covers period Medication Check Services ( DHS ) Be. Detail Medicare paid amount As New-day Claims Are covered for Medically Needy Members Only Performed. 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