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The Other Payer Amount Paid qualifier is invalid for . This Is A Duplicate Request. Claim Corrected. Accommodation Days Missing/invalid. You can choose to receive only your EOBs online, eliminating the paper . Pricing Adjustment/ Long Term Care pricing applied. Claim/adjustment Received Beyond The 455 Day Resubmission Deadline. We have created a list of EOB reason codes for the help of people who are . PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. Fourth Other Surgical Code Date is invalid. Policy override must be granted by the Drug Authorizationand Policy Override Center to dispense early. Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP. Inicio Quines somos? Service(s) Must Be Submitted On Paper Claim Form Along With Preoperative History And Physical Report And Operation Report. Other Insurance Or Medicare Response Not Received Within 120 Days For ProviderBased Bill. Resubmit Your Services Using The Appropriate Modifier After YouReceive A Update Providing Additional Billing Information. The Skills Of A Therapist Are Not Required To Maintain The Member. Traditional dispensing fee may be allowed. Follow specific Core Plan policy for PA submission. Authorization For Surgery Requiring Second Opinion Valid For 6Months After Date Approved. Documentation Provided Indicates A Less Elaborate Procedure Should Be Considered. Denied. Denied/Cutback. Denied. This Procedure Is Limited To Once Per Day. These coding rules are published within the Medicare Claims Processing Manual, Current Procedural Terminology (CPT) by the American Medical Association (AMA) and ICD-10-CM guidelines governed by Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). Please Verify That Physician Has No DEA Number. Claim Denied In Order To Reprocess WithNew ID. Denied. Request Denied Due To Late Billing. Complete Refusal Detail Is Not Payable Without Referral/treatment Details. Service(s) exceeds four hour per day prolonged/critical care policy. Resubmit Complete And/or Second Page Of Medicares EOMB Showing All Total And Payments. Pricing Adjustment/ Level of effort dispensing fee applied. Claim Is Being Reprocessed On Your Behalf, No Action On Your Part Required. Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization. "Laterality" (side of the body affected) is a coding convention added to relevant ICD-10 codes to increase specificity. Psychotherapy Provided In The Members Home Is Not A Covered Benefit Of . A Training Payment Has Already Been Issued To Your NF For This CNA. Claim Denied. A Payment For The CNAs Competency Test Has Already Been Issued. Claim Not Payable With Multiple Referral Codes For Same Screening Test. Denied. The value code 48 (Hemoglobin reading) or 49 (Hematocrit) is required for the revenue code/HCPCS code combination. Customer Service Agents are available to answer questions at this toll-free number: Phone: 800-688-6696. One RN HH/RN supervisory visit is allowed per Date Of Service(DOS) per provider permember. The Members Poor Motivation, The Long-standing Nature Of The Disability and aLack Of Progress Substantiate Denial. . Denied. The Service Requested Is Inappropriate For The Members Diagnosis. Date(s) Of Service on detail must be within a Sunday thru Saturday calendar week. It is a duplicate of another detail on the same claim. BY . The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental. Submit Claim To Other Insurance Carrier. Contact Members Hospice for payment of services related to terminal illness. The relationship between the Billed and Allowed Amounts exceeds a variance threshold. Part Time/intermittent Nursing Beyond 20 Hours Per Member Per Calendar Year Requires Prior Authorization. The Medicare Paid Amount is missing or incorrect. This Surgical Code Has Encounter Indicator restrictions. A Separate Notification Letter Is Being Sent. This Incidental/integral Procedure Code Remains Denied. Please Select A Procedure Code In The 58980-58988 Range That Best Describes The Procedure Being Performed. The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19. Documentation You Have Submitted Does Not Meet The Requirements Of HSS 107.09(4)(k). This Is A Manual Increase To Your Accounts Receivable Balance. Claim contains duplicate segments for Present on Admission (POA) indicator. Pediatric Community Care is limited to 12 hours per DOS. The Requested Procedure Is Cosmetic In Nature, Therefore Not Covered By . Mississippi Medicaid Explanation of Benefits (EOB) Codes EOB Code Effective Date Description 0000 01/01/1900 THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW. Denied/Cutback. Remark Codes: N20. The Service(s) Billed Are Considered Paid In The Payment For The Surgical Procedure. Please Correct And Resubmit. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. 0001: Member's . If it is medical necessary for more than 13 or 14 services per calendar month, submit an adjustment request with supporting documentation. Use Of Therapy Equipment Alone Is Not Sufficient To Justify Maintenance Therapy. Please Rebill Only CoveredDates. The Medical Necessity For The Hours Requested Is Not Supported By The Information Submitted In The Personal Care Assessment Tool. A NAT Reimbursement Request Must Be Submitted To WI Within A Year Of The CNAs Hire Date. Normal delivery reimbursement includes anesthesia services. Reimbursement For This Detail Does Not Include Unit DoseDispensing Fee. The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). Resubmit charges for covered service(s) denied by Medicare on a claim. Claim Is For A Member With Retro Ma Eligibility. These Services Paid In Same Group on a Previous Claim. Our Records Indicate This Tooth Previously Extracted. Continuous home care and routine home care may not be billed for the same member on the same Date Of Service(DOS). To Date Of Service(DOS) Precedes From Date Of Service(DOS). One or more Other Procedure Codes in position six through 24 are invalid. Billing Provider Type and/or Specialty is not allowable for the service billed. Real time pharmacy claims require the use of the NCPDP Plan ID. Authorizations. Insufficient Documentation To Support The Request. Initial Visit/Exam limited to once per lifetime per provider. codes are provided per day by the same individual physician or other health care professional. The Information Provided Is Not Consistent With The Intensity Of Services Requested. Denied. Has Recouped Payment For Service(s) Per Providers Request. Refer To Your Pharmacy Handbook For Policy Limitations. . Indicator for Present on Admission (POA) is not a valid value. Questionable Long-term Prognosis Due To Apparent Root Infection. Medicare Part A Services Must Be Resubmitted. Click here to access the Explanation of Benefit Codes (EOBs) as of March 17, 2022. When a provider submits an E&M level of service that exceeds the maximum level of E&M service level based on the diagnosis submitted, the E&M code is recoded (and allowed to pay) to match the maximum level of E&M service allowed based on the severity of the medical diagnosis submitted. Bill The Single Appropriate Code That Describes The Total Quantity Of Tests Performed. Accident Related Service(s) Are Not Covered By WCDP. 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. Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. New Prescription Required. Designated codes for conditions such as fractures, burns, ulcers and certain neoplasms require documentation of the side/region of the body where the condition occurs. Phone: 800-723-4337. Psych Evaluation And/or Functional Assessment Ser. Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice. The drug code has Family Planning restrictions. Inpatient Respite Care Is Not Covered For Hospice Members Residing In Nursing Homes. No Substitution Indicator Invalid For Non-innovator Drugs Not On The Current Wisconsin MAC List. The National Drug Code (NDC) is not payable for the Provider Type and/or Specialty. Please Indicate Computation For Unloaded Mileage. This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. Pricing Adjustment/ Inpatient Per-Diem pricing. One or more Diagnosis Codes has a gender restriction. Duplicate/second Procedure Deemed Medically Necessary And Payable. To access the training video's in the portal . One or more Diagnosis Code(s) is not payable for the Date Of Service(DOS). The Sixth Diagnosis Code (dx) is invalid. Member first name does not match Member ID. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. This Member Has Prior Authorization For Therapy Services. Approved. The Documentation Submitted Does Not Substantiate Additional Care. Documentation Does Not Justify Reconsideration For Payment. Service(s) Approved By DHS Transportation Consultant. Only One Ventilator Allowed As Per Stated Condition Of The Member. This Member Does Not Appear To Be Suffering From A Chronic Or Acute Mental Illness And Is Therefore Not Eligible For Day Treatment. Denied. Please Furnish An ICD-9 Surgical Code And Corresponding Description. Denied due to Detail Dates Are Not Within Statement Covered Period. Unable To Process Your Adjustment Request due to Financial Payer Not Indicated. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). Principal Diagnosis 7 Not Applicable To Members Sex. Second Other Surgical Code Date is required. Member enrolled in QMB-Only Benefit plan. Based on these reimbursement guidelines, claims may deny when the following revenue codes are billed without the appropriate HCPCS code: The Lens Formula Does Not Justify Replacement. The content shared in this website is for education and training purpose only. Medical Necessity For Food Supplements Has Not Been Documented. Denied. The revenue code has Family Planning restrictions. Denied due to Services Billed On Wrong Claim Form. The Request Has Been Back datedto Date of Receipt. Surgical Procedure Code billed is not appropriate for members gender. It Must Be In MM/DD/YY FormatAnd Can Not Be A Future Date. Discrepancy Between The Other Insurance Indicator And OI Paid Amount. Please Resubmit Corr. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Please Contact Your District Nurse To Have This Corrected. Please Correct And Resubmit. Next step verify the application to see any authorization number available or not for the services rendered. Please Resubmit using A Approved CPT Or HCPCS Procedure Code. Therefore itIs Not Necessary To Wait The Full 6 Weeks After Extractions Before Taking Denture Impressions. This Is Not A Reimbursable Level I Screen. Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service(DOS). This Is A Manual Decrease To Your Accounts Receivable Balance. Denied due to From Date Of Service(DOS)/date Filled Is Missing/invalid. Details Include Revenue/surgical/HCPCS/CPT Codes. Effective 1/1: Electronic Prescribing of Controlled Substances Required. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Discharge Diagnosis 2 Is Not Applicable To Members Sex. MedicalBillingRCM.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. Invalid Admission Date. Please Refer To The Original R&S. Multiple Unloaded Trips For Same Day/same Recip. Please Reference Payment Report Mailed Separately. This Adjustment/reconsideration Request Was Initiated By . Denied. Less Expensive Alternative Services Are Available For This Member. Member is assigned to a Lock-in primary provider. This National Drug Code (NDC) requires a whole number for the Quantity Billed. Charges For Anesthetics Are Included In Charge For All Surgical Procedures. NCTracks AVRS. Claim Denied for implementation of new Wisconsin Medicaid Interchange System.Resubmission of the claim is required due to new claim submission guidelines. Dispense Date Of Service(DOS) is invalid. This claim was processed using a program assigned provider ID number, (e.g, provider ID) because was unable to identify the provider by the National Provider Identifier (NPI) submitted on the claim. The Dispense As Written (DAW) indicator is not allowed for the National Drug Code. Case Planning And/or On-going Monitoring For Both Targeted Case Managementand Child Care Coordination Are Not Allowed In The Same Month. No Complete Program Enrollment Form Is On File For This Client Or The Client Is Not Eligible For The Date Of Service(DOS) On The Clai im. Procedure Denied Per DHS Medical Consultant Review. Denied due to Discharge Diagnosis 1 Missing Or Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 1 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 2 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 3 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 4 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 5 Invalid, Denied due to Diagnosis Pointer(s) Are Invalid. Billing Provider is restricted from submitting electronic claims. The Procedure Requested Is Not Allowable For The Process Type Indicated On TheRequest. Third Diagnosis Code (dx) (dx) is not on file. Please Correct And Resubmit. The Medical Necessity For Psychotherapy Services Has Not Been Documented, ThusMaking This Member Ineligible For The Requested Service. Denied. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Interim Rate Settlement. Intermittent Peritoneal Dialysis hours must be entered for this revenue code. Recip Does Not Meet The Reqs For An Exempt. The maximum number of details is exceeded. Unable To Reach Provider To Correct Claim. Quantity Billed is missing or exceeds the maximum allowed per Date Of Service(DOS). The sum of all Value Code amounts must be numeric and less than or equal to 999.999.999. Claims Cannot Exceed 28 Details. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Secondary Diagnosis Code (dx) is not on file. DME rental beyond the initial 180 day period is not payable without prior authorization. In addition, duplex scan of extracranial arteries, computed tomographic angiography (CTA) of the neck and magnetic resonance angiography (MRA) of the neck are not medically necessary for evaluation of syncope in patients with no suggestion of seizure and no report of other neurologic symptoms or signs. This Service Is Covered Only In Emergency Situations. 100 Days Supply Opportunity. Pricing Adjustment/ Maximum Allowable Fee pricing used. Ancillary Codes Dates Of Service And/or Quantity Billed Do Not Match Level Of Care authorized Dates. Outside Lab Indicator Must Be Y For The Procedure Code Billed. Services Not Provided Under Primary Provider Program. WellCare Known Issues List EOP Denial Code or Rejection Reason Code Issue Description Impacted Provider Specialty . (8 days ago) WebMassHealth List of EOB Codes Appearing on the Remittance Advice. Please Refer To The Original R&S. CNAs Eligibility For Training Reimbursement Has Expired. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Please Resubmit As A Regular Claim If Payment Desired. Pharmaceutical Care Code must be billed with a payable drug detail or if a prescription was not filled, the quantity dispensed must be zero. Claim paid at the program allowed amount. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. The Total Number Of Sessions Requested Exceeds Quarterly Guidelines. Only Healthcheck Modifiers Can Be Billed With Healthcheck Services. The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. Please Resubmit. The Maximum Prior Authorized Service Limitation Or Frequency Allowance Has Been Exceeded. You Must Adjust The Nursing Home Coinsurance Claim. According to the American Association of Neuromuscular & Electro-Diagnostic Medicine and CMS Policy, nerve conduction studies and a needle electromyography (EMG) must both be performed in order to diagnose radiculopathy (pinched nerve in back or neck). Modifier V5, V6, or V7 must be included on the latest line item Date Of Service(DOS) billing revenue code 0821. Service(s) paid in accordance with program policy limitation. Request was not submitted Within A Year Of The CNAs Hire Date. Claim Denied. This Member is enrolled in Wisconsin or BadgerCare Plus for Date(s) of Service. The Diagnosis Does Not Indicate A Significant Change In the Members Condition. Did You check More Than One Box?If So, Correct And Resubmit. To access the training video's in the portal, please register for an account and request access to your contract or medical group. Serviced Denied. Multiple Requests Received For This Ssn With The Same Screen Date. Denied due to Medicare Allowed Amount Is Greater Than Total Billed Amount. Invalid Provider Type To Claim Type/Electronic Transaction. Payment Subject To Pharmacy Consultant Review. The Resident Or CNAs Name Is Missing. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. Critical care in non-air ambulance is not covered. Only One Panoramic Film Or Intraoral Radiograph Series, By The Same Provider, Per Year Allowed. Tooth surface is invalid or not indicated. Diagnosis Code is restricted by member age. Please Contact The Surgeon Prior To Resubmitting this Claim. Performed After Therapy/dayTreatment Have Begun Must Be Billed As Therapy Or Limit-exceed Psych/aoda/func. The Comprehensive Community Support Program reimbursement limitations have been exceeded. Critical care performed in air ambulance requires medical necessity documentation with the claim. OA 11 The diagnosis is inconsistent with the procedure. Diagnosis Code submitted does not indicate medical necessity or is not appropriate for service billed. The Request Does Not Meet Generally Accepted Conditions Requiring Fluoride Treatments. To allow for Medicare Pricing correct detail denials and resubmit. LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s). Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. Detail To Date Of Service(DOS) is required. Denied. Quantity Would Be 00010 If Specific Number Of Batteries Dispensed Is Not Indicated. Please Correct And Re-bill. No Complete WWWP Participation Agreement Is On File For This Provider. Denied due to NDC Is Not Allowable Or NDC Is Not On File. The Billing Providers taxonomy code 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. Please Clarify Services Rendered/provide A Complete Description Of Service. Contact Wisconsin s Billing And Policy Correspondence Unit. Other Payer Coverage Type is missing or invalid. 12/06/2022 . Denied due to Detail Billed Amount Missing Or Zero. This service is not payable for the same Date Of Service(DOS) as another service included on this claim. Pricing Adjustment/ Payment amount decreased based on Pay for Performance policies. Submit copy of the dated and signed evaluation and indicate if this is an initial Evaluation. Pricing Adjustment/ SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts. This Claim Has Been Denied Due To A POS Reversal Transaction. The Service Billed Does Not Match The Prior Authorized Service. Header From Date Of Service(DOS) is required. The condition code is not allowed for the revenue code. Denied. Admission Date is on or after date of receipt of claim. Third modifier code is invalid for Date Of Service(DOS). 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. Member is in a divestment penalty period. This Member, As Indicated By Narrative History, Does Not Agree To Abstinence from Alcohol Or Other Drugs And Is Ineligible For AODA Treatment. The Clinical Status Of The Member Does Not Meet Standards Accepted By The Department Of Health And Family Services For Transplant. When billing multiple diagnosis codes, the recoding is based on the highest level of service associated to one or more of the diagnosis codes billed. No Reimbursement Rates on file for the Date(s) of Service. Denied. The Dispense As Written (Daw) Indicator Is Not Allowed For The National Drug Code. Reason Code 234 | Remark Codes N20. Compound drugs not covered under this program. An approved PA was not found matching the provider, member, and service information on the claim. Timely Filing Request Denied. The Requested Transplant Is Not Covered By . CPT Code 88305 (Level IV Surgical pathology, gross and microscopic examination) includes different types of biopsies. ACTION DESCRIPTION: ACTION TYPE. No Action Required. Please Use This Claim Number For Further Transactions. Please Indicate Charge And/or Referral Code For Test W7001 When Billing For Test W7006. Please Refer To The All Provider Handbook For Instructions. CO/204. Resubmit Claim Once Election Form Requirements Are Met Per The Hospice Provider Handbook. Procedure May Not Be Billed With A Quantity Of Less Than One. Denied due to Detail Fill Date Is A Future Date. The National Drug Code (NDC) was reimbursed at a generic rate. Restorative Nursing Involvement Should Be Increased. Adjustment Denied For Insufficient Information. Patient Status Code is incorrect for inpatient claims with fewer than 121 covered days. The Surgical Procedure Code is not payable for Wisconsin Chronic Disease Program for the Date Of Service(DOS). According to the AMA CPT Manual and our policy, an initial inpatient admission (CPT 99221-99223) is allowed once every seven days. Please Submit A Separate New Day Claim For Copayment Exempt Days/services. Room And Board Is Only Reimbursable If Member Has A BQC Nursing Home Authorization. An Individual CBC Or Chemistry Test With A CBC Or Chemistry Panel, Performed Per Member/Provider/Date Of Service Must Be Billed w/ Appropriate Panel Code. NCTracks Contact Center. We thank you for your continued partnership in servicing the Wellcare By Fidelis Care membership. Service Not Covered For Members Medical Status Code. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. Claim Denied. The Eighth Diagnosis Code (dx) is invalid. In 2015 CMS began to standardize the reason codes and statements for certain services. A Pharmaceutical Care Code (PCC) must include a valid diagnosis code. Claims may deny when a nerve conduction study is billed without a needle EMG, or a needle EMG is billed without a Nerve conduction study, and the only diagnosis is radiculopathy (ICD-10 codes M50.1-M50.23, M51.1-M51.27, M51.9, M53.80, M54.10-M54.18, M54.30-M54.42, and M79.2). The second occurrence span from Date Of Service(DOS) is after to to Date Of Service(DOS). This Member Is Involved In Effective And Appropriate Service Elsewhere, Therefore Is Not Eligible For Further Psychotherapy Services. Pricing Adjustment/ Prescription reduction applied. The Fourth Occurrence Code Date is invalid. Claims may deny when reported and not meeting the ICD-10-CM Laterality policy for Diagnosis-to-Diagnosis comparison. Please Verify The Units And Dollars Billed. Qty And/or Detail Charge Do Not Divide Out Equally For Dates Of Service and/orQty Given. Rendering Provider may not submit claims for reimbursement as both the Surgeonand Assistant Surgeon For The Same Member On The Same DOS. The Existing Appliance Has Not Been Worn For Three Years. -OR- The claim contains value code 49but does not contain revenue code 0636 and HCPCS Q4054. Please Furnish A NDC Code And Corresponding Description. Reason Code 162: Referral absent or exceeded. Denied. Always bill the correct place of service. In the above example the claim was denied with two codes, the Adjustment Reason Code of 16 and then the explanatory Remark Code of N329 (Missing/incomplete/invalid patient birth date). The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Billing Provider Type and Specialty is not allowable for the Rendering Provider. Rqst For An Acute Episode Is Denied. Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. Prescriber Number Supplied Is Not On Current Provider File. PA required for payment of this service. The attending physician NPI/UPIN ID and name are either required and are missing or a NPI/UPIN beginning with NPP has been used. Admit Date and From Date Of Service(DOS) must match. Member Expired Prior To Date Of Service(DOS) On Claim. Pricing Adjustment/ Usual & Customary Charge (UCC) rate pricing applied. One Visit Allowed Per Day, Service Denied As Duplicate. Default Prescribing Physician Number XX9999991 Was Indicated. A SeniorCare drug rebate agreement is not on file for this drug for the Date Of Service(DOS). The changes in the brain that happen during a migraine cannot be seen by the imaging studies since a migraine is caused by a complicated interaction between the brain and the blood vessels in the face and head. Please Request Prior Authorization For Additional Days. Allowed Amount On Detail Paid By WWWP. Copyright 2023 Wellcare Health Plans, Inc. New Coding Integrity Reimbursement Guidelines. The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program. A Rendering Provider is not required but was submitted on the claim. 1. Claim Detail Denied Due To Required Information Missing On The Claim. This Member Has Already Received Intensive Day Treatment In The Past Year and is Only Eligible For Reduced Hours At This Time. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. NFs Eligibility For Reimbursement Has Expired. Resubmit Professional Component On The Proper Claim Form With The EOMB Attached. 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. Denied. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Complex Care Services Are Limited To One Per Date Of Service(DOS) Per Member. Personal Care In Excess Of 250 Hrs Per Calendar Year Requires Prior Authorization. Missing or invalid level of effort submitted and/or reason for service, professional service, or result of service code billed in error. The Rendering Providers taxonomy code is missing in the header. Language Comprehension And Language Production Are Equivalent To Cognition, Thus Formal Speech Therapy Is Not Needed. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity. Contact Provider Services For Further Information. qatar to toronto flight status. A Qualified Provider Application Is Being Mailed To You. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. Program guidelines or coverage were exceeded. Member has commercial dental insurance for the Date(s) of Service. Watch FutureRemittance And Status Reports For Its Finalization Before Resubmitting. Hospital And Nursing Home Stays Are Not Payable For The Same DOS Unless The Nursing Home Claim Indicated Hospital Bedhold Days. Do Not Submit Claims With Zero Or Negative Net Billed. 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. One or more Surgical Code Date(s) is missing in positions seven through 24. Fourth Diagnosis Code (dx) is not on file. This Payment Is To Satisfy Amount Owed For A Drug Rebate Prior Quarter Correction. The Procedure Code/Modifier combination is not payable for the Date Of Service(DOS). The Primary Diagnosis Code is inappropriate for the Procedure Code. Modification Of The Request Is Necessitated By The Members Minimal Progress. Subsequently hospital care services (CPT 99221-99223 or 99231-99233) will be denied when billed for the same date of service as observation services (CPT G0378, 99218-99220 or 99224-99226) for Bill Type 0130-013Z (hospital outpatient). This Request Can Only Be Backdated To The Date EDS First Receives The Request In The Mailroom. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. Services restricted to EPSDT clients valid only with a Full Scope, EPSDT-eligible Aid Code. PLEASE RESUBMIT CLAIM LATER. Rimless Mountings Are Not Allowable Through .