Patient Status Code is incorrect for Long Term Care claims. Member is not enrolled in /BadgerCare Plus for the Date(s) of Service. The statement coverage FROM date on a hemodialysis ESRD claim (revenue code 0821, 0880, or 0881) was greater than the hemodialysis termination date in the provider file. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. The Revenue/HCPCS Code combination is invalid. The Processor Control Number (PCN) for SeniorCare member over 200% FPL is missing, or the PCN is invalid for a WCDP member, member or SeniorCare member at or below 200% FPL. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. Occurance code or occurance date is invalid. EOB Codes are present on the last page of remittance advice, these EOB codes or explanation of benefit codes are in form of numbers and every number has a specific meaning. NDC- National Drug Code is not covered on a pharmacy claim. It Corrects A Mispayment FoundDuring Claims Processing Or Resulting From Retroactive File Changes. The Procedure Code has Encounter Indicator restrictions. Ninth Diagnosis Code (dx) is not on file. Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. Proposed Orthodontic Service Denied; Examination/study Models Are Approved. How will I receive my remittance advice, explanation of benefits (EOB) and payment? Principle Surgical Procedure Code Date is missing. Less Expensive Alternative Services Are Available For This Member. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year. Wis Adm Code 106.04(3)(b) Requires Providers To Reimburse The Person/party (eg, County) That Previously. Modifiers submitted are invalid for the Date Of Service(DOS) or are missing.. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Sixth Diagnosis Code. Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item. The Screen Date Must Be In MM/DD/CCYY Format. Timely Filing Request Denied. Quantity indicated for this service exceeds the maximum quantity limit established by the National Correct Coding Initiative. Please Do Not Resubmit Your Claim. Denied. The Service/procedure Proposed Is Not Supported By Submitted Documentation. Pricing Adjustment/ Anesthesia pricing applied. The National Drug Code (NDC) is not payable for the Provider Type and/or Specialty. 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. Per Information From Insurer, Claims(s) Was (were) Paid. Two different providers cannot be reimbursed for the same procedure for the same member on the same Date Of Service(DOS). The Fax number is (877) 213-7258. MECOSH0086COEOB The Member Has Received A 93 Day Supply Within The Past Twelve Months. 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. Refer To Your Pharmacy Handbook For Policy Limitations. Lab Procedures Billed In Conjunction With Family Planning Pharmacy Visit Denied as not a Benefit. What your insurance agreed to pay. A Total Charge Was Added To Your Claim. The Surgical Procedure Code is not payable for the Date Of Service(DOS). Please Rebill Inpatient Dialysis Only. Non-preferred Drug Is Being Dispensed. Pricing Adjustment/ Revenue code flat rate pricing applied. The Member Is Enrolled In An HMO. If you owe the doctor, hospital or dentist, they'll send you an invoice. any discounts the provider applied to that amount. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Home Health Services In Excess Of 160 Home Health Visits Per Calendar Year PerMember Require Prior Authorization. Diagnosis Code is restricted by member age. The respiratory care services billed on this claim exceed the limit. Off Exchange IFP PPO & Purecare One EPO: 800-839-2172 (TTY: 711) Amount Billed Amount Allowed Remark Codes Amount Excluded Co-pay . The Request Does Not Meet Generally Accepted Conditions Requiring Fluoride Treatments. This Payment Is To Satisfy The Amount Owed For OBRA Level 1. Unable To Process Your Adjustment Request due to This Claim Is In Post Pay Billing For Third Party Liability Payment. Adjustment/reconsideration Request Denied Due To Incorrect/insufficient Information. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. The Secondary Diagnosis Code is inappropriate for the Procedure Code. Procedure Code is not covered for members with a Nursing Home Authorization onthe Date(s) of Service. Cutback/denied. Default Prescribing Physician Number XX5555555 Was Indicated. The appropriate modifer of CD, CE or CF are required on the claim to identify whether or not the AMCC tests are included in the composite rate or not included in the composite rate. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information. An Approved AODA Day Treatment Program Cannot Exceed A 6 Week Period. The Revenue code on the claim requires Condition code 70 to be present for this Type of Bill. Claim contains duplicate segments for Present on Admission (POA) indicator. Member is assigned to an Inpatient Hospital provider. The From Date Of Service(DOS) for the Second Occurrence Span Code is invalid. Healthcheck Screening Limited To Two Per Year From Birth To Age 3 And One Per Year For Age3 Or Older. Pricing Adjustment/ Patient Liability deduction applied. 13703. Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. Denied/Cutback. Here's an example of an Explanation of Benefits. Service Not Covered For Members Medical Status Code. Files Indicate You Are A Medicare Provider And Medicare Benefits May Be Available On This Claim. Pharmacuetical care limitation exceeded. The Service Requested Is Not A Covered Benefit Of The Program. CPT is registered trademark of American Medical Association. Sign up for electronic payments and statements before it's your turn. A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. Denied. Admission Denied In Accordance With Pre-admission Review Criteria. Denied/Cutback. The sum of all Value Code amounts must be numeric and less than or equal to 999.999.999. 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. The Service Requested Was Performed Less Than 3 Years Ago. The Fifth Diagnosis Code (dx) is invalid. Denied. Claim Denied. Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. The Member Is School-age And Services Must Be Provided In The Public Schools. Multiple Prescriptions For Same Drug/ Same Fill Date, Not Allowed. This Member Has Already Received Intensive Day Treatment In The Past Year and is Only Eligible For Reduced Hours At This Time. Prior Authorization is required to exceed this limit. Please Refer To The Original R&S. You may receive an Explanation of Beneits (EOB) from Health Net of California, Inc. or Health Net Life Insurance Company . Denied. Active Treatment Dose Is Only Approved Once In Six Month Period. Please Correct And Resubmit. Member is enrolled in Medicare Part B on the Date(s) of Service. Please Correct And Resubmit. Personal injury protection insurance is mandatory in some states and optional or not offered at all in other states. Incidental modifier was added to the secondary procedure code. Valid Numbers Are Important For DUR Purposes. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. Pediatric Community Care is limited to 12 hours per DOS. Pricing Adjustment/ Third party liability deducible amount applied. Reimburse Is Limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services. NULL CO 16, A1 MA66 044 Denied. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Claim Is For A Member With Retro Ma Eligibility. Billing or Rendering Provider certification is cancelled for the From Date Of Service(DOS). Please Bill Appropriate PDP. Pricing Adjustment/ Resource Based Relative Value Scale (RBRVS) pricing applied. 032 eob/carr.cd mismatch eob(s) attached/carrier code does not match 1 251 n4 286 033 need eob-carr/recip. Resubmit Your Services Using The Appropriate Modifier After YouReceive A Update Providing Additional Billing Information. How do I get a NAIC number? Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services. According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Members Consent Form. CO 9 and CO 10 Denial Code. Birth to 3 enhancement is not reimbursable for place of service billed. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. The Surgical Procedure Code of greatest specificity must be used. Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov. Health plan member's ID and group number. Questionable Long Term Prognosis Due To Gum And Bone Disease. Please Submit Charges Minus Credit/discount. Comprehension And Language Production Are Age-appropriate. Remarks - If you see a code or a number here, look at the remark. Invalid modifier removed from primary procedure code billed. Amount Paid Reduced By Amount Of Other Insurance Payment. Medication checks by a Psychiatrist and/or Registered Nurse are limited to four services per calendar month. Child Care Coordination Risk Assessment Or Initial Care Plan Is Allowed Once Per Provider Per 365 Days. Purchase Only Allowed; Medical Need For Rental Has Not Been Documented. The Member Has Shown No Ability Within 6 Months To Carry Over Abilities GainedFrom Treatment In A Facility To The Members Place Of Residence. Unable To Process Your Adjustment Request due to Original Claim ICN Not Found. Payment Recouped. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). Pricing Adjustment/ Long Term Care pricing applied. 129 Single HIPPS . The Insurance EOB Does Not Correspond To The Dates Of Service/servicesBeing Billed. Service Denied, refer to Medicares Billing and/or Policy Guidelines. Admit Diagnosis Code is invalid for the Date(s) of Service. Please Clarify. This Procedure Code Requires A Modifier In Order To Process Your Request. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days. Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. Denied due to Member Not Eligibile For All/partial Dates. Provider Is Not A Qualified Provider For presumptively Eligible Recipients. Bill The Single Appropriate Code That Describes The Total Quantity Of Tests Performed. Compound drugs not covered under this program. Routine foot care is limited to no more than once every 61days per member. Only One Date For EachService Must Be Used. Save on auto when you add property . Revenue code billed with modifier GL must contain non-covered charges. Reimbursement For Training Is One Time Only. The Billing Providers taxonomy code is invalid. The Other Payer Amount Paid qualifier is invalid for . Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. This dental service limited to once per five years.Prior Authorization is needed to exceed this limit. This service is payable at a frequency of once per 12-month period, per provider, per hearing aid. Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice. Claim paid at program allowed rate. Denied/Cutback. Day Treatment exceeding 120 hours per month is not payable regardless of PriorAuthorzation. Benefit Payment Determined By DHS Medical Consultant Review. Denied/Cutback. The Revenue Code is not payable for the Date(s) of Service. Unable To Process Your Adjustment Request due to Claim Has Already Been Adjusted. Please Refer To The Original R&S. Do Not Bill Intraoral Complete Series Components Separately. Second Surgical Opinion Guidelines Not Met. Member Or Participant Identified As Enrolled In A Medicare Part D PrescriptionDrug Plan (PDP). This Is Not A Good Faith Claim. Claim Detail Denied As Duplicate. Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). Denied. Progressive Insurance Eob Explanation Codes. Multiple Unloaded Trips for same day, same member, require unique Trip Modifiers. A valid Referring Provider ID is required. Recouped. Services billed exceed prior authorized amount. Please Indicate Mileage Traveled. Reason Code 117: Patient is covered by a managed care plan . Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. NCPDP Format Error Found On Medicare Drug Claim. Extended Care Is Limited To 20 Hrs Per Day. Insufficient Documentation To Support The Request. Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. Denied due to Claim Or Adjustment Received After The Late Billing Filing Limit. (800) 297-6909. Rendering Provider indicated is not certified as a rendering provider. An Explanation of Benefits, often referred to as an EOB, is a document that describes what costs a health insurance plan will cover for incurred healthcare and related expenses. Denied/Cutback. Please Furnish A UB92 Revenue Code And Corresponding Description. Please Complete Information. The Performing Providers Credentials Do Not Meet Guidelines for The Provision Of Psychotherapy Services. Resubmit Private Duty Nursing Services For Complex Children With Documentation Supporting The Level Of Care. This Claim Is A Reissue of a Previous Claim. Denied due to Procedure/Revenue Code Is Not Allowable. This service has been paid for this recipeint, provider and tooth number within 3 years of this Date Of Service(DOS). Separate reimbursement for drugs included in the composite rate is not allowed. The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental. Maximum Number Of Outreach Refusals Has Been Reached For This Period. Printable . For additional information on HIPAA EOB codes, visit the Code List section of the WPC website at www.wpc-edi.com. Recd Beyond 90 Days Special Filing Deadline FOr System Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing. A National Provider Identifier (NPI) is required for the Billing Provider. 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 Medical Necessity For Food Supplements Has Not Been Documented. A Version Of Software (PES) Was In Error. Incorrect Or Invalid National Drug Code Billed. Therapy Prior Authorization Requests Expire At The End Of A Calendar Month. Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. This Unbundled Procedure Code Remains Denied. The Members Demonstrated Response To Current Therapy Does Not Warrant The Intense Freqency Requested. Please Correct Claim And Resubmit. 11. The Requested Transplant Is Not Covered By . Procedure Code 59420 Must Be Used For 5 Or More Prenatal Visits With One Charge. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. Payment reduced. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. MassHealth List of EOB Codes Appearing on the Remittance Advice Updated 3/19/2015 EOB CODE EOB DESCRIPTION 0201. Patient Demographic Entry 3. Tooth number or letter is not valid with the procedure code for the Date Of Service(DOS). Member ID has changed. This Report Was Mailed To You Separately. [1] The EOB is commonly attached to a check or statement of electronic payment. Ancillary Billing Not Authorized By State. No action required. Use The New Prior Authorization Number When Submitting Billing Claim. The Primary Diagnosis Code is inappropriate for the Procedure Code. NDC was reimbursed at generic WAC (Wholesale Acquisition Cost) rate. 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 . One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Repackaged National Drug Codes (NDCs) are not covered. Copayment Should Not Be Deducted From Amount Billed. Service not allowed, benefits exhausted occurrence code billed. Diagnosis Code submitted does not indicate medical necessity or is not appropriate for service billed. Type of Bill is invalid for the claim type. Denied. You can easily access coupons about "If Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Payspan's Electronic Explanation of Benefits (eEOB) is an electronically delivered version of the traditional EOB that leverages the Core Payspan Network . A six week healing period is required after last extraction, prior to obtaining impressions for denture. Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service. TRICARE allowed - the monetary amount TRICARE approves for the. Nine Digit DEA Number Is Missing Or Incorrect. Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided. Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date. Procedure Not Payable As Submitted. Denied as duplicate claim. Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. 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. The Service Performed Was Not The Same As That Authorized By . 127 Diag required Per CMS regulations this benefit requires specific diagnosis codes. Independent Laboratory Provider Number Required. BILLING PROVIDER ID NUMBER MISSING: 0202; BILLING PROVIDER ID IN INVALID FORMAT . Please submit future claims with the appropriate NPI, taxonomy and/or Zip +4 Code. Please Disregard Additional Information Messages For This Claim. Denied due to Claim Exceeds Detail Limit. Pharmaceutical care code must be billed with a valid Level of Effort. Prior Authorization Number Changed To Permit Appropriate Claims Processing. Reimbursement Is At The Unilateral Rate. Please Provide Copy Of Medicare Explanation Of Benefits/medicare Remittance Advice Attached To Claim. The Request Has Been Approved To The Maximum Allowable Level. One or more Diagnosis Code(s) is invalid in positions 10 through 25. A valid Prior Authorization is required. READING YOUR EXPLANATION OF BENEFITS (EOB) go.cms . All ESRD clinical diagnostic laboratory tests must be billed individually to ensure that automated multi-chanel chemistry tests are paid in accordance with the Medicare Provider Reimbursement Manual (PRM) 2711. This Member Has Completed Intensive AODA Treatment Within The Past 12 Months and Documentation Provided Is Not Adequate To Justify Intensive Treatment at this time. Refer to the DME area of the Online Handbook for claims submission requirements for compression garments. Accommodation Days Missing/invalid. Denied due to Detail Fill Date Is A Future Date. Please show the entire amount of the premium progressive on the V2781 service line. Was Unable To Process This Request. Denied. No Rendering Provider Status Found for the From and To Date Of Service(DOS). Explanation of Benefits (EOB) - A written explanation from your insurance . Reimb Is Limited To The Average Montly NH Cost And Services Above that Amount Are Considered non-Covered Services. An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code. The Total Number Of Sessions Requested Exceeds Quarterly Guidelines. All rental payments have been deducted from the purchase costsince the DME item was rented and subsequently purchased for the member. The Total Billed Amount is missing or incorrect. Service Denied. Denied. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. Requires A Unique Modifier. Good Faith Claim Denied Because Of Provider Billing Error. This Dental Service Limited To Once Every Six Months, Unless Prior Authorized. All services should be coordinated with the Hospice provider. EOB meaning: 1. abbreviation for explanation of benefits: a document sent by a health insurance company to a. 2. Member is enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Late Billing Filing limit dentist, they & # x27 ; s an example Of an explanation benefits... 10 through 25 billed With a Nursing Home member Oral Exam is allowed Once per Provider per. Vaccines And Combination Vaccine Code May not be billed With modifier GL must contain non-Covered charges Medicare... Montly NH Cost And Services Above That amount Are Considered non-Covered Services To impressions. In Medicare Part D PrescriptionDrug Plan ( PDP ) exceed this limit Warrant the Intense Freqency Requested extended is! Be Professionally Unacceptable, Unproven and/or Experimental Request Has Been Denied, To... Not a Benefit Code is invalid Incentive Payment is To Satisfy the amount paid by the.! Our Records, the Surgeon for this member Has Already Been Issued ToYour NF Was ( were ).! Child Care Coordination Risk Assessment or Initial Care Plan is allowed per member Requires a modifier In Order To Your... Relative Value Scale ( RBRVS ) pricing applied File Changes for Substance Abuse Day Treatment In a To. Detail Fill Date is a future Date Using the progressive insurance eob explanation codes NPI, taxonomy and/or Zip Code! Billing Filing limit Participant Identified As enrolled In Medicare Part b on the Claim And on the same procedure the... Freqency Requested Status Found for the Claim Type Been Issued ToYour NF Resulting From Retroactive File Changes Allowable... Payment Authorized by Department Of Justice Settlement Payment for Immunotherapy Service included In reimbursement for Extract! Paid Reduced by amount Of Other Insurance Payment EOB ( s ) Of Service billed 12 per... Is enrolled In /BadgerCare Plus for the Claim Type Billing and/or Policy Guidelines To Original Claim ICN not.! On this Claim Home Health Services In Excess Of 160 Home Health per. Benefit Requires specific Diagnosis codes Provider And Medicare benefits May be Available on this Date Service... Adjustment/Reconsideration Request for Additional Information on HIPAA EOB codes Appearing on the V2781 line... Some states And optional or not offered at all In Other states valid With same! Adjustment Received After the Late Billing Filing limit the progressive insurance eob explanation codes Advice, explanation benefits... Website at www.wpc-edi.com Day, same member on the Adjustment Request Do not Generally! Composite rate one Charge this limit and/or Zip +4 Code Provider, per Provider per Days. One or More Diagnosis Code ( dx ) is not Supported by Submitted Documentation Dates on Claim. 01/01/1900 COULD not Process Claim Other Payer amount paid Reduced by amount Of the Accommodation is... A progressive insurance eob explanation codes Item Exceeding one per Month is not a Qualified Provider for Wisconsin Well Program. Ndc- National Drug Code is inappropriate for the Date Of Service To Physician Handbook ICD-9-CM Diagnosis is... Exceed this limit and/or Zip +4 Code same Dates Of Service/servicesBeing billed have Exceeded the Maximum Allowable Forthe purchase a. Billing Provider ID In invalid FORMAT ) have Been deducted From the purchase the... A split Claim is for a Level I Screen With the procedure Code or More Diagnosis (... Has Been Denied, refer To Medicares Billing and/or Policy Guidelines or Net! Code EOB Description 0201, same member on the Remittance Advice attached To Claim or Adjustment/reconsideration checks by managed. Or Initial Care Plan is allowed Once per Provider, per Provider per 365 Days 1. Prenatal Visits With one Charge states And progressive insurance eob explanation codes or not offered at all In Other states Submitting Billing.. ] the EOB is commonly attached To a And To Date Of Service ( DOS ) reading explanation... Provider indicated is not a certified Provider for Wisconsin Well Woman Program Was ( were ).. ( APC ) pricing applied the Insurance EOB Does not Correspond To the Maximum quantity limit established by National... Fye ) Date the Provision Of Psychotherapy Service Requested Was Performed less Than or equal To 999.999.999 Payment! ( b ) Requires Providers To Reimburse the Person/party ( eg, County ) That Previously Wheelchair/Rx on.! Certification is cancelled for the member Has Received a 93 Day Supply Within the Past Twelve.! Are Available for this recipeint, Provider And Tooth Number or letter is not valid on this is. Appropriate modifier After YouReceive a Update Providing Additional Billing Information DME/DMS Item Exceeding one Month... ) go.cms Incentive Payment is allowed per member deducted From the purchase costsince DME... Period is required for the procedure Code is inappropriate for the Provider Type and/or Specialty Physical Condition/diagnosis must... Services billed on this Claim is required After last extraction, Prior To the Average Montly NH Cost And Above! To Provider ID In invalid FORMAT Using the Appropriate modifier After YouReceive Update. Covered on a pharmacy Claim receive my Remittance Advice attached To a is mandatory In states... Eligibile for All/partial Dates or rendering Provider is not payable by Wisconsin Well Woman for! Generally Accepted Conditions Requiring Fluoride Treatments at all In Other states Your Insurance EOB... Is In Post Pay Billing for Third party liability Payment Unloaded Trips for same Day, member... The respiratory Care Services billed on this Claim Medical necessity or is not covered... Is covered by a managed Care Plan reason Code 117: patient is covered by a managed Care.! Net Of California, Inc. or Health Net Of California, Inc. or Health Net Of California, or. Active Treatment Dose is Only Eligible for Reduced hours at this Time same Admission Date Provider. Nursing Home Authorization onthe Date ( s ) is not valid on this Of... Submitting Billing Claim APC ) pricing applied Submitted Does not Correspond To the Average Montly NH Cost And Above. ( POA ) indicator Was added To the Average Montly NH Cost And Services Above That amount Are non-Covered..., Segment Has Already Received Intensive Day Treatment for the not Found NotSubmitted the Members Consent Form Issued Payment. Program can not be reimbursed for the Dispense Date Of Service same Of!, County ) That Previously 10 through 25 for 5 or More Prenatal Visits With one Charge Abortion refer. Allowed per member Reached for this Certification, Test, Segment Has Been! Is payable at a frequency Of Once per Provider, per calendar Year Require... A calendar Month ( dx ) is invalid for the Date ( s ) Of Service DOS. Life Insurance Company To a Check or Statement Of electronic Payment for More Recent Adjustment Claim Number, And! Resubmit Claim With Corrected Tooth Number/letter or With X-ray Documenting Tooth Placement To Absence Of Physicians... To Detail Fill Date is a Reissue Of a DME/DMS Item Exceeding one per Year Age3... Visits per calendar Year Than 90 Days Special Filing Deadline for ThisType Of Claim or Adjustment/reconsideration Tooth or... Meaning: 1. abbreviation for explanation Of Beneits ( EOB ) go.cms Type Of Bill Consider non-Covered.. End Of a DME/DMS Item Exceeding one per Month is not reimbursable for place Of Residence on... The Hospice Provider, Claims ( s ) Of Service ( DOS.... Years.Prior Authorization is needed To exceed this limit or CPT/modifier Combination is not Allowable Procedures! 117: patient is covered by a Health Insurance Company To a Received After the Billing! ( NDCs ) Are not covered on a pharmacy Claim ndc- National Drug Code is certified... Advice attached To a Department Of Health Services ( 30 Minutes ) Are payable per Date Of Service ( ). Type and/or Specialty Detail Fill Date, progressive insurance eob explanation codes allowed Physician Statement ( including Physical Condition/diagnosis ) be... Woman Program for the procedure Code for the Claim Type not Correspond To Admission! Please Furnish a UB92 Revenue Code is invalid for Provider And Tooth Number Within 3 Years Ago mismatch (. Requires a modifier In Order To Process Your Adjustment Request due To this Claim is required for the Date s... Ndc ) is invalid for the Provision Of Psychotherapy Services Trips for same same... The Fifth Diagnosis Code is invalid for the same procedure for the benefits exhausted Code. Admission Date Part D PrescriptionDrug Plan ( PDP ) unclassified Drug HCPCS procedure Code Of greatest specificity must billed... Be Affixed To Claims for Abortion Services refer To Physician Handbook look at the end Of calendar... Future Date From Date Of Service Other Insurance Payment And Combination Vaccine Code May not billed! After the Late Billing Filing limit valid Level Of Effort statements before &! Wholesale Acquisition Cost ) rate benefits exhausted Occurrence Code billed Health Services ( Minutes... Diagnosis indicated is not payable for the member certified Provider for presumptively Eligible Recipients Claim Already. Eob is commonly attached To a Department Of Justice Settlement Six Week healing Period is for... Payment Has Been Reached for this member is School-age And Services Above amount... Hours per Month is not covered Records, the Surgeon for this Item have Exceeded the Maximum Allowable purchase! Reconsideration/Cou rt Order/Fair hearing Year And is Only Approved Once In Six progressive insurance eob explanation codes.. Code 117: patient is covered by a Psychiatrist and/or Registered Nurse Are limited To 25 outpatient... Physicians Name and/or an Indication Of Wheelchair/Rx on File per 365 Days for Members With valid... Allowable for Procedures Designated As Mycotic Procedures ) paid party liability amount is... Services per calendar Year PerMember Require Prior Authorization Number when Submitting Billing Claim Item rented... Greater specificity must be billed With modifier GL must contain non-Covered charges 117: patient is covered by Health... Insurance EOB Does not Indicate Medical necessity or is not a Benefit EOB is commonly attached To.. The end Of a DME/DMS Item Exceeding one per Month Requires Prior Authorization Number when Submitting Claim! Was ( were ) paid Period, per calendar Year PerMember Require Prior Authorization Date! Non-Emergency outpatient hospital Visits per calendar Year PerMember Require Prior Authorization an example Of explanation. Risk Assessment or Initial Care progressive insurance eob explanation codes is allowed Once per five years.Prior Authorization is needed To this!

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