Unable To Process Your Adjustment Request due to Provider Not Found. Denied. Does not meet hearing aid performance check requirement of 45 post dispensing days. Result of Service code is invalid. 0001 01/01/1900 NOT USED - MEMBER'S DMAP I.D. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Certifying Agency Did Not Verify Member Eligibility within 70 Day Period. DN017 Medicare EOB Denials BH N/A 10/15/2017 9/26/2017 6815, 321095 CE034 99213 99214 in Place of Service 52 The detail From Date Of Service(DOS) is invalid. Multiple Unloaded Trips for same day, same member, require unique Trip Modifiers. Submitted referring provider NPI in the detail is invalid. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. Invalid Provider Type To Claim Type/Electronic Transaction. HealthDrive Corporation Senior Reimbursement Specialist - Medical For over 40 years, Washington Publishing Company (WPC) has specialized in managing and distributing data integration information through publications, training, and consulting services. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). The Service Requested Is Not A Covered Benefit Of The Program. Denied. Denied due to Medicare Allowed Amount Required. Approved. Please File With Champus Carrier. No Action Required. Multiple Service Location Found For the Billing Provider NPI. . Sixth Diagnosis Code (dx) is not on file. See Physicians Handbook For Details. Men. X . Procedure Not Payable for the Wisconsin Well Woman Program. Denied. Procedure Code is not covered for members with a Nursing Home Authorization onthe Date(s) of Service. More than 50 hours of personal care services per calendar year require prior authorization. The Rendering Providers taxonomy code is missing in the header. The quantity billed of the NDC is not equally divisible by the NDC package size. To allow for multiple biopsies for investigation and diagnosis of certain disease entities, WellCare applies max units editing for CPT code 88305 based on gastrointestinal (GI) and prostate-related diagnoses. Date Of Service/procedure/charges On Medicare EOMB Do Not Match The Original Claim. First Other Surgical Code Date is required. Claim Denied. Resubmit Your Services Using The Appropriate Modifier After YouReceive A Update Providing Additional Billing Information. Correction Made Per Medical Consultant Review. Please Reference Payment Report Mailed Separately. Quick Tip: In Microsoft Excel, use the " Ctrl + F " search function to look up specific denial codes. Please Submit On The Cms 1500 Using The Correct Hcpcs Code. Condition code 20, 21 or 32 is required when billing non-covered services. Member is enrolled in Medicare Part A on the Date(s) of Service. Additional services mustbe billed as treatment services and count towards the Mental Health and/or substance abuse treatment policy for prior authorization. Services Denied In Accordance With Hearing Aid Policies. Referral Codes Must Be Indicated For W7001, W7002, W7003, W7006, W7008 And W7013. RN Home Health visits and Supervisory visits are not reimbursable on the same Date Of Service(DOS) for same provider. Was Unable To Process This Request. Denied. Service(s) Denied. Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling. A National Drug Code (NDC) is required for this HCPCS code. Incorrect Or Invalid National Drug Code Billed. Claim paid at the program allowed amount. Your latest EOB will be under Claims on the top menu. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Competency Test Date Is Not A Valid Date. A NAT Reimbursement Request Must Be Submitted To WI Within A Year Of The CNAs Hire Date. This Program Does Not Appear To Meet The Minimum Requirement For AODA Day Treatment Programming (10hrs) And Does Not Qualify For Aoda Day Treatment. Definitions and text of all the Claim Adjustment Reason Codes and the Remittance Advice Remark Codes used on the claim will be printed on the last page of the RA. Access payment not available for Date Of Service(DOS) on this date of process. The Travel component for this service must be billed on the same claim as the associated service. EDI TRANSACTION SET 837P X12 HEALTH CARE . The From Date Of Service(DOS) for the First Occurrence Span Code is required. Claim reduced to fifteen Hospital Bedhold Days for stays exceeding fifteen days. Header To Date Of Service(DOS) is invalid. A Reimbursement Request For A Level I Screen Must Be Received At Within A Year Of The Screen Date. Services billed are included in the nursing home rate structure. The Screen Date Must Be In MM/DD/CCYY Format. Prior Authorization (PA) is required for this service. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice. Claims may deny when reported with mutually exclusive code combinations according to the ICD-10-CM Excludes 1 Notes guideline policy. Also, to ensure claims process and pay accurately, Staywell may deny a claim and ask for pertinent medical documentation from the provider or supplier who submitted the claim. OA 11 The diagnosis is inconsistent with the procedure. Denied. Refill Indicator Missing Or Invalid. Good Faith Claim Denied. Please Correct And Resubmit. Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days. Diagnosis Code indicated is not valid as a primary diagnosis. This Payment Is A Refund For An Overpayment Of A Provider Assessment, Thank You For Your Assessment Payment By Check, In Accordance With Your Request, EDS Has Deducted Your Assessment From This Payment. Billing Provider Type and Specialty is not allowable for the service billed. Reimbursement rate is not on file for members level of care. Claim Denied. Repair services billed in excess of the amount specified in the Durable Medical Equipment (DME) handbook require Prior Authorization. Services Included In The Inpatient Hospital Rate Are Not Separately Reimbursable. The American College of Emergency Physicians (ACEP) also indicates that it is not appropriate to perform screening with advanced imaging for syncope patients, however be guided by the patients history and physical exam findings. These codes provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or convey information about remittance processing. Transplant services not payable without a transplant aquisition revenue code. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. Mississippi Medicaid Explanation of Benefits (EOB) Codes EOB Code Effective Date Description 0000 01/01/1900 THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW. Please Add The Coinsurance Amount And Resubmit. The Fifth Diagnosis Code (dx) is invalid. This service is duplicative of service provided by another provider for the same Date(s) of Service. Up A Pharmaceutical Care Code (PCC) must include a valid diagnosis code. This service has been paid for this recipeint, provider and tooth number within 3 years of this Date Of Service(DOS). Timeframe Between The CNAs Training Date And Test Date Exceeds 365 Days. Reimbursement For This Service Has Been Approved. (part JHandbook). Customer Service Agents are available to answer questions at this toll-free number: Phone: 800-688-6696. Header From Date Of Service(DOS) is after the header To Date Of Service(DOS). A HCPCS code is required when condition code A6 is included on the claim. Early Refill Alert. Normal delivery reimbursement includes anesthesia services. Denied. Provider Not Authorized To Perform Procedure. Anesthesia and Moderate Sedation Services CPTs 00300, 00400, 00600, 01935-01936, 01991-01992, 99152-99153, 99156-99157, Pain Management Services CPTs 20552, 20553, 27096, 62273, 62320-62323, 64405, 64479, 64480, 64483, 64484, 64490-64495, 0228T, 0229T, 0230T, 0231T, G0260, Nerve Conduction Studies CPT 95907-95913, Needle electromyography (EMG)-CPT 95885, 95886. Nursing Home Visits Limited To One Per Calendar Month Per Provider. Please submit claim to HIRSP or BadgerRX Gold. The Information Provided Indicates This Member Is Not Willing Or Able To Participate Inaftercare/continuing Care Services And Is Therefore Not Eligible For AODA Day Treatment. Discharge Diagnosis 2 Is Not Applicable To Members Sex. Claim Denied For No Consent And/or PA. Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service. You Received A PaymentThat Should Have gone To Another Provider. This Procedure Code Is Not Valid In The Pharmacy Pos System. Reference: Transmittal 477, change request 3720 issued February 18, 2005. Secondary Diagnosis Code (dx) is not on file. You can view these EOBs online by following these steps: Log in to your bcbsm.com account to view your prescriptions coverage. Please Clarify The Number Of Allergy Tests Performed. wellcare eob explanation codes ACTION TYPE LEGEND: Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. A National Provider Identifier (NPI) is required for the Billing Provider. Service(s) Denied/cutback. Provider Reminders: Claims Definitions. Medicare Copayment Out Of Balance. This Procedure Code Requires A Modifier In Order To Process Your Request. Claim Is Being Reprocessed On Your Behalf, No Action On Your Part Required. Please Correct And Resubmit. wellcare eob explanation codes. A Second Surgical Opinion Is Required For This Service. Home | WPC Units Billed Are Inconsistent With The Billed Amount. Denied. The Information Provided Is Not Consistent With The Intensity Of Services Requested. You can choose to receive only your EOBs online, eliminating the paper . Invalid modifier removed from primary procedure code billed. PDF Crosswalk - Adjustment Reason Codes and Remittance Advice (RA) Remark Discrepancy Between The Other Insurance Indicator And OI Paid Amount.

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