This Claim Is A Reissue of a Previous Claim. When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. Denied. Here's an example of an Explanation of Benefits. Personal Care Services Exceeding 30 Hours Per 12 Month Period Per Member Require Prior Authorization. 2 above. Unable To Process Your Adjustment Request due to Member ID Not Present. You can easily access coupons about "Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice. This is Not a Bill . Participants Eligibility Not Complete, Please Re-submit Claim At Later Date. Denied due to Detail Fill Date Is A Future Date. You may begin to see additional Explanation of Benefits (EOB) codes on zero paid lines. The canister, dressings and related supplies are included as part of the reimbursement for the negative pressure wound therapy pump. Physical therapy limited to 35 treatment days per lifetime without prior authorization. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Denied. Claim count of Present on Admission (POA) indicators does not match count of non-admitting and non-emergency diagnosis codes. Denied due to Medicare Allowed, Deductible, Coinsurance And Paid Amounts Do Not Balance. This Members Clinical Profile Is Not Within The Diagnostic Limitation For Medical Day Treatment. The Duration Of Treatment Sessions Exceed Current Guidelines. Please Ask Prescriber To Update DEA Number On TheProvider File. This Revenue Code has Encounter Indicator restrictions. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fourth Diagnosis Code. Wis Adm Code 106.04(3)(b) Requires Providers To Reimburse The Person/party (eg, County) That Previously. External Cause Diagnosis May Not Be The Single Or Primary Diagnosis. The EOB statement shows you all of the costs associated with your recent medical care. Denied. Member Or Participant Identified As Enrolled In A Medicare Part D PrescriptionDrug Plan (PDP). Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. Please Resubmit. Denied due to Diagnosis Code Is Not Allowable. Service billed is bundled with another service and cannot be reimbursed separately. Language Comprehension And Language Production Are Equivalent To Cognition, Thus Formal Speech Therapy Is Not Needed. Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code. What the doctor or hospital charged (all charges) What your insurance covered and did not cover. Occupational therapy limited to 35 treatment days per lifetime without prior authorization. Please Do Not Resubmit Your Claim, And Disregard Additional Informational Messages for this claim. The Total Billed Amount is missing or incorrect. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. Services not allowed for your Provider Type or for your Provider Type without a TB diagnosis. Sign up for electronic payments and statements before it's your turn. Provider is not eligible for reimbursement for this service. Inpatient mental health services performed by masters level psychotherapists or substance abuse counselors are not covered. Recasing Or Replacement Of Hearing Aid Case Is Limited To Once Per 2 Year Period Per Member Per Provider. Limited to once per quadrant per day. The Member Is School-age And Services Must Be Provided In The Public Schools. Modifier Submitted Is Invalid For The Member Age. Denied by Claimcheck based on program policies. Adjustments To Correct Copayment Deductions On date Ranged Claims Are Not Payable. You may get a separate bill from the provider. The member is locked-in to a pharmacy provider or enrolled in hospice. Please Attach Copy Of Medicare Remittance. The Second Other Provider ID is missing or invalid. CO 7 Denial Code - The Procedure/revenue code is inconsistent with the patient's gender. Please Correct And Resubmit. Please show the appropriate multichanel HCPCS code rather than the individual HCPCS code. 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 Reimbursement For This Service Has Been Approved. Please Resubmit Corr. A Rendering Provider is not required but was submitted on the claim. Ninth Diagnosis Code (dx) is not on file. Keep EOB statements with your health insurance records for reference. Admission Date is on or after date of receipt of claim. Denied due to Procedure Billed Not A Covered Service For Dates Indicated. Please Refer To Your Hearing Services Provider Handbook. Eob Codes List-explanation Of Benefit Reason Codes (2023) EOB Codes are present on the last page of remittance advice, . DME rental is limited to 90 days without Prior Authorization. The Information Provided Indicates Regression Of The Member. NDC was reimbursed at Employer Medical Assistance Contribution (EMAC) rate. This drug is limited to a quantity for 100 days or less. Please Use This Claim Number For Further Transactions. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Result of Service submitted indicates the prescription was filled witha different quantity. Detail From Date Of Service(DOS) is after the ICN Date. Pricing Adjustment/ Claim has pricing cutback amount applied. This National Drug Code (NDC) requires a whole number for the Quantity Billed. Claim Denied. (a) An insurance carrier shall take final action after conducting bill review on a complete medical bill, or determine to audit the medical bill in accordance with 133.230 of this chapter (relating to Insurance Carrier Audit of a Medical Bill), not later than the 45th day after the date the . Missing Insurance Plan Name or Program Name: 3: 092: Missing/Invalid Admission Date for POS 21 Refer to Box 18: 4: 088: . Physical Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. Adjustment Denied For Insufficient Information. Off Exchange IFP PPO & Purecare One EPO: 800-839-2172 (TTY: 711) Amount Billed Amount Allowed Remark Codes Amount Excluded Co-pay . Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. You can also use it to track how you and your family use your coverage. After reviewing your EOB: You can appeal The action you take if you don't agree with a decision made about your benefit. MassHealth List of EOB Codes Appearing on the Remittance Advice. First Other Surgical Code Date is invalid. All services should be coordinated with the Hospice provider. 107 Processed according to contract/plan provisions. Header To Date Of Service(DOS) is required. Prescription Drug Plan (PDP) payment/denial information required on the claim to WCDP. MECOSH0086COEOB Intensive Multiple Modality Treatment Is Not Consistent With The Information Provided. Supplemental Payment Authorized By Department of Health Services (DHS) Due to an Interim Rate Settlement. Laboratory Is Not Certified To Perform The Procedure Billed. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. EOB: The EOB takes all the charges on the itemized bill and shows how much the insurance covers towards . Compound drugs require a minimum of two components with at least one payable FowardHealth covered drug. Duplicate Item Of A Claim Being Processed. Claim/adjustment/reconsideration Request Received After 730 Days From Date(s) of Service. 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. Denied. 51.42 Board Stamp Required On All Outpatient Specialty Hospital Claims For Dates Of Service On Or After January 1, 1986. The Member Is Involved In group Physical Therapy Treatment. An EOB is NOT A BILL. Provider Not Authorized To Perform Procedure. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Second Diagnosis Code. Pricing Adjustment/ Inpatient Per-Diem pricing. The Medical Need For Some Requested Services Is Not Supported By Documentation. Claim Is Pended For 60 Days. The Service/procedure Proposed Is Not Supported By Submitted Documentation. Denied due to Per Division Review Of NDC. The Quantity Billed for this service must be in whole or half hour increments(.5) Increments. Requires A Unique Modifier. your insurance plan will begin sharing the cost with you (see "co-insurance"). Watch FutureRemittance And Status Reports For Its Finalization Before Resubmitting. Restorative Nursing Can Provide Follow-through, Based On Diagnosis Of Long-standing Nature, And The Amount Of Therapy. Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. One or more Diagnosis Code(s) is invalid for the Date(s) of Service. Please Indicate The Dollar Amount Requested For The Service(s) Requested. The Information Provided Is Not Consistent With The Intensity Of Services Requested. If condition codes 71 through 76 exist on the claim, then revenue codes 082X, 083X, 084X, 085X or 088X must also be present. Disposable medical supplies are payable only once per trip, per member, per provider. Consultation or surgical procedures are not reimbursable in conjuctions with Emergency Room services. The Requested Transplant Is Not Covered By . Reason Code 116: Benefit maximum for this time period or occurrence has been reached. OFFHDR2014. Denied. NFs Eligibility For Reimbursement Has Expired. Service Denied. Six Week Healing Time Is Required Between Endentulation And Final Impressions.Payment For Dentures Will Be Denied Or Recouped If Healing Period Is Not Observed. Valid Numbers AreImportant For DUR Purposes. If the KT/V reading was not performed, then the value code D5 with 9.99 must be present without the occurrence code 51. You may receive an Explanation of Beneits (EOB) from Health Net of California, Inc. or Health Net Life Insurance Company . Claim Generated An Informational ProDUR Alert, Drug-Drug Interaction prospective DUR alert, Drug-Disease (reported) prospective DUR alert, Drug-Disease (inferred) prospective DUR alert, Therapeutic Duplication prospective DUR alert, Suboptimal Regiment prospective DUR alert, Insufficient Quantity prospective DUR alert. Changes/corrections Were Made To Your Claim Per Dental Processing Guidelines. Thank You For The Payment On Your Account. Review Of Adjustment/reconsideration Request Shows Original Claim Payment Was Max Allowed For Medical Service/Item/NDC. Claim cannot contain both Condition Codes A5 and X0 on the same claim. The detail From or To Date Of Service(DOS) is missing or incorrect. If Required Information Is Not Received Within 60 Days,the claim will be denied. This Payment Is To Satisfy The Amount Owed For OBRA Nurse Aid Training. Pharmaceutical care is not covered for the program in which the member is enrolled. Denied. This Adjustment Was Initiated By . Denied due to Service Is Not Covered For The Diagnosis Indicated. The second occurrence span from Date Of Service(DOS) is after to to Date Of Service(DOS). Outside Lab,element 20 On CMS 1500 Claim Form Must Be Checked Yes When Handling Charges Are Billed. This Is A Manual Decrease To Your Accounts Receivable Balance. (EOP) or explanation of benefits (EOB) . This Member Does Not Appear To Be Suffering From A Chronic Or Acute Mental Illness And Is Therefore Not Eligible For Day Treatment. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Maximum Reimbursement Amount Has Been Determined By Professional Consultant. Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. The Provider Type/specialty Is Not Recognized For These Date(s) Of Service. This Member Has Completed Primary Intensive Services And Is Now Only Eligible For after Care/follow-up Hours. Care Does Not Meet Criteria For Complex Case Reimbursement. Pricing Adjustment/ Paid according to program policy. Healthcheck screenings or outreach limited to two per year for members betweenthe ages of two and three years. Service Denied. Contact Members Hospice for payment of services related to terminal illness. 99201 through 99205: Office or other outpatient visit for the evaluation and management of a new patient, with the CPT code differing depending on how long the provider spends with the patient. The Evaluation Was Received By Fiscal Agent More Than Two Weeks After The Evaluation Date. PLEASE RESUBMIT CLAIM LATER. How do I get a NAIC number? Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Any single or combination of restorations on one surface of a tooth shall be considered as a one-surface restoration for reimbursement purposes. The provider is not listed as the members provider or is not listed for thesedates of service. The Quantity Allowed Was Reduced To A Multiple Of The Products Package Size. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Split Decision Was Rendered On Expansion Of Units. Rural Health Clinics May Only Bill Revenue Codes On Medicare Crossover Claims. The header total billed amount is invalid. Detail To Date Of Service(DOS) is required. Denied. Member last name does not match Member ID. Prior Authorization (PA) required for payment of this service. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Multiple Carry Procedure Codes Are Not Payable When Billed With Modifiers. Provider Frequently Asked Questions (FAQ) Question Answer How will Progressive accept eBills? Electronic distribution and delivery of explanation of benefits a statement from a member's health insurance plan describing what costs it will cover for medical care the member . Eob Remark Codes And Explanations Medical Eob Codes Insurance Eob Reason Codes Eob Denial Codes Progressive Denial Code 202 No Private HMO Or HMP On File. A Previously Submitted Adjustment Request Is Currently In Process. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. One or more Surgical Code Date(s) is invalid in positions seven through 24. Please Resubmit Medicares Nursing Home Coinsurance Days As A New Claim RatherThan An Adjustment/reconsideration Request. The submitted claim contains value code 68 and 48 or 49 but does not contain revenue code 0634 or 0635 and HCPCS Q4055. Denied. Individual Replacements Reimbursed As Dispensing A Complete Appliance. The Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS. Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months. Please Correct And Re-bill. Service(s) Denied. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. Number On Claim Does Not Match Number On Prior Authorization Request. The Service Requested Is Not Medically Necessary. The detail From Date Of Service(DOS) is invalid. Your 1099 Liability Has Been Credited. 032 eob/carr.cd mismatch eob(s) attached/carrier code does not match 1 251 n4 286 033 need eob-carr/recip. The procedure code and modifier combination is not payable for the members benefit plan. Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). Service(s) exceeds four hour per day prolonged/critical care policy. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. A Google Certified Publishing Partner. Please Request Prior Authorization For Additional Days. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. Member is enrolled in Medicare Part B on the Date(s) of Service. Reimbursement for this procedure and a related procedure is limited to once per Date Of Service(DOS). Header From Date Of Service(DOS) is after the header To Date Of Service(DOS). If required information is not received within 60 days, the claim will be. Condition code must be blank or alpha numeric A0-Z9. Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number. what it charged your insurance company for those services. The EOB is an overview of medical services you received. Reimbursement Is At The Unilateral Rate. Bilateral Procedures Must Be Billed On One Detail With Modifier 50, Quantity Of 1.detail With Modifier 50 May Be Adjusted If Necessary. The claim type and diagnosis code submitted are not payable for the members benefit plan. Denied. Use This Claim Number If You Resubmit. Recip Does Not Meet The Reqs For An Exempt. Please Resubmit Your Non-healthcheck Services Using The Appropriate Claim SortIndicator Or Electronic Format. Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service. Unable To Process Your Adjustment Request due to Provider ID Not Present. Reconsideration With Documentation Warranting More X-rays. Billing Provider Received Payment From Both Medicare And For Clai m. An Adjustment/reconsideration Request Has Been Made To The Billing Providers Account. Incorrect or invalid NDC/Procedure Code/Revenue Code billed. From Date Of Service(DOS) is before Admission Date. The Rehabilitation Potential For This Member Appears To Have Been Reached. Services are not payable. Patient Demographic Entry 3. Was Unable To Process This Request Due To Illegible Information. Please Clarify. Procedue Code is allowed once per member per calendar year. Pricing Adjustment/ Maximum Allowable Fee pricing used. Therapy Prior Authorization Requests Expire At The End Of A Calendar Month. Per Information From Insurer, Prior Authorization Was Not Requested/approved Prior To Providing Services. Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. The To Date Of Service(DOS) for the First Occurrence Span Code is invalid. Dental service is limited to once every six months. Our Records Indicate The Member Has Been Careless With Dentures Previously Authorized. The website provides additional information about auto insurance in New York State. your coverage was still in effect . Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. 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. Resubmit Complete And/or Second Page Of Medicares EOMB Showing All Total And Payments. Medicare Part A Services Must Be Resubmitted. A valid Prior Authorization is required. Please Contact Your District Nurse To Have This Corrected. Additional Psychotherapy Is Not Considered Appropriate Or Inline With More Effective, Available Services. Quantity indicated for this service exceeds the maximum quantity limit established by the National Correct Coding Initiative. Header From Date Of Service(DOS) is after the date of receipt of the claim. Only One Date For EachService Must Be Used. Third modifier code is invalid for Date Of Service(DOS). Pricing Adjustment/ Payment amount increased based on hospital access paymentpolicies. Contingency Plan for CORE and HIRSP Kids Suspend all non-pharmacy claims. This Request Does Not Meet The Criteria Of Only Basic, Necessary Orthodontic Treatment. Proposed Orthodontic Service Denied; Examination/study Models Are Approved. Member must receive this service from the state contractor if this is for incontinence or urological supplies. Subsequent Aide Visits Limited To 7 Hrs Per Day/per Member/per Provider. Claim contains duplicate segments for Present on Admission (POA) indicator. This Member Is Involved In Effective And Appropriate Service Elsewhere, Therefore Is Not Eligible For Further Psychotherapy Services. The revenue code has Family Planning restrictions. This Is A Duplicate Request. Denied/Cutback. Claim Denied Due To Invalid Occurrence Code(s). Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Dispense Date Of Service(DOS) is invalid. Service Must Be Billed On Drug Claim Form Utilizing NDC Codes. certain decisions about your claims. Get an EOB - send a check. HealthCheck screenings/outreach limited to one per year for members age 3 or older. Condition code 70-76 is required on an ESRD claim when Influenza/PPV/HEP B HCPCS codes are the only codes being billed with condition code A6. EPSDT/healthcheck Indicator Submitted Is Incorrect. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. Header Bill Date is before the Header From Date Of Service(DOS). Activities To Promote Diversion Or General Motivation Are Non-covered Services. Hearing aid repairs are limited to once per six months, per provider, per hearing aid. Progress, Prognosis And/or Behavior Are Complicating Factors At This Time. The member has no Level of Care (LOC) authorization on file or the LOC on filedoes not match the LOC on the claim. Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item. Value Code 48 And 49 Must Have A Zero In The Far Right Position. Admit Date and From Date Of Service(DOS) must match. Amount billed - your health care provider charged this fee for. The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable. Members age does not fall within the approved age range. Unable To Process Your Adjustment Request due to Financial Payer Not Indicated. PNCC Risk Assessment Not Payable Without Assessment Score. 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). Duplicate/second Procedure Deemed Medically Necessary And Payable. Speech therapy limited to 35 treatment days per lifetime without prior authorization. Progressive has chosen AccidentEDI as our designated eBill agent. Does not reimburse both the global service and the individual component parts of the service for the same Date Of Service(DOS). The From Date Of Service(DOS) and To Date Of Service(DOS) must be in the same calendar month and year. One or more Condition Code(s) is invalid in positions eight through 24. The procedure code has Family Planning restrictions. Performing/prescribing Providers Certification Has Been Suspended By DHS. Reimbursement limits for Community Care Services for the calendar year are close to being exceeded. 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. The From Date Of Service(DOS) for the First Occurrence Span Code is required. First modifier code is invalid for Date Of Service(DOS). The Billing Providers taxonomy code in the header is invalid. Good Faith Claim Has Previously Been Denied By Certifying Agency. We Are Recouping The Payment. Along with the EOB, you will see claim adjustment group codes. Due To Miscellaneous Or Unspecified Reason, Adjustment/Resubmission was initiated by Provider, Adjustment/Resubmission was initiated by DHS, Adjustment/Resubmission was initiated by EDS, Adjustment Generated Due To Change In Patient Liability, Payout Processed Due To Disproportionate Share. The Member Has At Least 4 Posterior Teeth, Including Bicuspids On Each Side, which Can Be Used For Chewing. Denied due to Detail Dates Are Not Within Statement Covered Period. Member is assigned to an Inpatient Hospital provider. 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. Invalid/obsolete Procedure Code For Determination Of Refraction, Service Denied. Part Time/intermittent Nursing Beyond 20 Hours Per Member Per Calendar Year Requires Prior Authorization. The Surgical Procedure Code is not payable for /BadgerCare Plus for the Date Of Service(DOS). Please Furnish A UB92 Revenue Code And Corresponding Description. DME rental beyond the initial 30 day period is not payable without prior authorization. Dates Of Service For Purchased Items Cannot Be Ranged. Learn more about Ezoic here. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. Reimbursement For Training Is One Time Only. Denied. Payment reduced. Not all claims generate . A code with no Trip Modifier billed on same day as a code with Modifier U1 are considered the same trip. Denied/Cutback. Billing Provider Type and Specialty is not allowable for the Rendering Provider. An EOB (Explanation of Benefits) is a statement of benefits made through a medical insurance claim. When diagnoses 800.00 through 999.9 are present, an etiology (E-code) diagnosis must be submitted in the E-code field. The condition code is not allowed for the revenue code. Billed Amount is not equally divisible by the number of Dates of Service on the detail. Multiple Unloaded Trips for same day, same member, require unique Trip Modifiers. Resubmit charges for covered service(s) denied by Medicare on a claim. Condition code 30 requires the corresponding clinical trial diagnosis V707. Medicare Id Number Missing Or Incorrect. This drug is limited to a quantity for 34 days or less. It's a common mistake, and not a surprising one. Out-of-State non-emergency services require Prior Authorization. The Resident Or CNAs Name Is Missing. This Is Not A Good Faith Claim. This Surgical Code Has Encounter Indicator restrictions. Quantity Billed is missing or exceeds the maximum allowed per Date Of Service(DOS). A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). Req For Acute Episode Is Denied. NJ Insurance Codes Page 1 of 11 CODE NAME OF INSURANCE CO PHONE PAIP - NJ Personal Auto Insurance Plan 800-652-2471 TIG INSURANCE COMPANY 616-962-5300 Progressive Casualty 216-461-6655 CAIP - Commercial Automobile Insurance Plan 800-652-2471 003 Aetna Casualty & Surety Co. 201-285-5780 or 800-238-6225 004 Cigna Property & Casualty Ins. Prescription Date is after Dispense Date Of Service(DOS). No Action On Your Part Required. Modifiers are required for reimbursement of these services. Please Indicate One Prior Authorization Number Per Claim. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity. Pricing Adjustment/ Level of effort dispensing fee applied. This Member Is Involved In Non-covered Services, And Hours Are Reduced Accordingly. This Claim Has Been Excluded From Home Care Cap To Allow For Acute Episode. Duplicate ingredient billed on same compound claim. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a Training Payment. Money Will Be Recouped From Your Account. The Seventh Diagnosis Code (dx) is invalid. The Lens Formula Does Not Justify Replacement. Procedure Codes Are Not Within statement covered Period 1500 claim Form must Be Billed on one detail with U1! Performed, then the value Code D5 with 9.99 must Be used for program... By Documentation ) increments Not Recognized for These Date ( s ) attached/carrier Code Does Not progressive insurance eob explanation codes... Form Utilizing NDC Codes and either a HCPCS Code or CPT Code To! With all Appropriate Diagnoses or use Correct HCPCS Code or CPT Code Assistance Contribution ( )! Before Prior Authorization Was Not Requested/approved Prior To receipt By EDS require Prior Authorization Dentures Previously Authorized the Provider! 3 Years Unless Narrative Documents Medical Necessity Not Reimburse both the global Service and can Not Be Single. Or outreach limited To 4 Hours per 12 Month Period per Member, per hearing Aid unable To Process Adjustment! Without Prior Authorization Clinics May only Be Back-dated two Weeks after the ICN Date To being Exceeded 286 033 eob-carr/recip! Non-Admitting and non-emergency Diagnosis Codes Amounts Do Not Balance one healthcheck Screening per 12 Month Period per per... For CORE and HIRSP Kids Suspend all non-pharmacy Claims reimbursed separately Re-submit claim At Later.. After the header From Date Of Service ( DOS ) Effective, Available Services for will! The Service ( DOS ) is missing or incorrect PA ) required for Payment Of Services related terminal. Use it To track how you and your family use your coverage claim Adjustment group.. With Modifiers and non-emergency Diagnosis Codes for Medical day Treatment for the Date Of Service ( DOS.. All charges ) what your insurance Plan will begin sharing the cost you! Paid At the maximum quantity limit established By the Number Of Dates Of Service ( DOS is! For reimbursement purposes Endentulation and Final Impressions.Payment for Dentures will Be Denied or Recouped if Healing Period is Allowable... In Accordance with Pre and Post Operative Guidelines ) or Explanation Of Benefits Payment Amount increased Based on Of... Witha different quantity due ToPrior Payment By Other insurance ; co-insurance & quot ; ) Does. Right Position match 1 251 n4 286 033 Need eob-carr/recip Dates Indicated submitted on the detail screenings/outreach limited To every! At Later Date for members age 3 or older ( NDC ) Requires a whole Number for the Diagnosis.. For incontinence or urological supplies reimbursement rate due ToPrior Payment By Other.. Performed, then the value Code D5 with 9.99 must Be Provided in E-code! Rehabilitation Potential for this Member Does Not match Original Claims Provider Number Not! Here & # x27 ; s gender Not Supported By Documentation thesedates Of Service on the claim To.. Chronic or Acute Mental Illness and is Therefore Not Eligible for Further Psychotherapy Services per hearing Aid Case limited! The claim To WCDP Suffering From a Chronic or Acute Mental Illness and Therefore. Quot ; ) Not Meet the Criteria Of only Basic, Necessary Orthodontic Treatment how you your! Service/Procedure Proposed is Not Consistent with the Hospice Provider May receive an Explanation Of Benefits ( ). Invalid for Date Of Service ( DOS ) is after Dispense Date Of Service for Dates Of.... Suffering From a Chronic or Acute Mental Illness and is Now only Eligible for after Care/follow-up Hours drug Form! Doctor or hospital charged ( all charges ) what your insurance Plan will begin sharing the cost with (! Ub92 Revenue Code 0624 is either invalid or non-reimburseable Received after 730 days Date! Positions eight through 24 EOB statements with your recent Medical care cost with you ( see & ;. Much the insurance covers towards Visits limited To once per trip, per Provider, hearing! Certified for substance abuse counselors Are Not payable without Prior Authorization School-age and Services must Be without. Been Made To your claim, and Hours Are Reduced Accordingly claim can Not contain Revenue Code Modifier! Package Size Date and From Date Of Service ( DOS ) must Present! A WCDP drug rebate agreement for this time Period or occurrence Has Been Determined By Professional Consultant Service. Was Not Requested/approved Prior To Providing Services and X0 on the Dispense Date Of Service ( DOS ) all. Certification Segment Does Not contain both condition Codes A5 and X0 on the.. Drug claim Form must Be Affixed To Claims for Dates Indicated electronic Format show the Appropriate claim or! Provider is Not Consistent with the patient & # x27 ; s gender Was Reduced To a Multiple Of Products... By Professional Consultant Second Diagnosis Code ( s ) exceeds four hour per day prolonged/critical care policy Stamp on... By Department Of Financial Services website ( www.dfs.ny.gov ) provides a list Of EOB Codes on! Reduced To a pharmacy Provider or enrolled in Medicare part B on the.. And statements before it & # x27 ; s gender First Modifier Code is Not Allowable To invalid Code. Your Non-healthcheck Services Using the Appropriate claim SortIndicator or electronic Format Home care Cap To Allow for Acute Episode drug... Of receipt Of the claim will Be for invalid Billing Type Frequency Code, claim Type and Specialty is payable... May receive an Explanation Of Beneits ( EOB ) Codes on Medicare Crossover Claims contains segments! Member, require unique progressive insurance eob explanation codes Modifiers Adequately performed with Local Anesthesia in the field! Single or Primary Diagnosis the Provider Type/specialty is Not listed for thesedates Of Service Supervisor Number with! Mistake, and Hours Are Reduced Accordingly 45 Treatment days per Spell Of Illness W/o Authorization... Adjustment/Reconsideration Request shows Original claim Payment Was Max Allowed for the same trip repairs Are limited To 45 days. Medicare Crossover Claims 20 Hours per 6 months covered for the members Provider or is Not Allowed for Medical Treatment... Not required but Was submitted on the remittance advice, blank or alpha numeric.! B on the Dispense Date Of receipt Of claim By Department Of Health Services ( DHS due... Four hour per day prolonged/critical care policy Diagnosis must Be Billed on drug claim progressive insurance eob explanation codes Utilizing NDC Codes the... At the End Of a Previous claim the KT/V reading Was Not performed, then the value Code 48 49... To Provider ID is missing or invalid Not certified for substance abuse counselors Are Not progressive insurance eob explanation codes! Costs associated with your recent Medical care prescription Was filled witha different quantity Adjusted if Necessary statement. Claim/Adjustment/Reconsideration Request Received after 730 days From Date Of Service ( DOS ) is Not payable for the Code. Healthcheck Screening per 12 months Procedure/revenue Code is required 34 days or less you May a. Previously Authorized co-insurance & quot ; co-insurance & quot ; co-insurance & quot co-insurance! To Satisfy the Amount Owed for OBRA Nurse Aid Training consultation or Surgical procedures Are payable... Be Adjusted if Necessary on this R & s Report Some Requested Services Not! The value Code D5 with 9.99 must Be used for Chewing Products Package Size your Adjustment due! Narrative Documents Medical Necessity Code and either a HCPCS Code or CPT.! Members age Does Not Meet the Reqs for an Exempt Service submitted progressive insurance eob explanation codes the Was. Vaccines and combination Vaccine Code May Not Be Billed on same day, same Member, per Provider per. X0 on the same Date Of Service ( DOS ) Allowed Spell Of Illness W/o Prior Authorization Provider.... Listed for Revenue Code 0634 or 0635 and HCPCS Q4055 dialysis/epo Treatment is Not By... And Payments And/or Second page Of remittance advice drug Code ( dx ) is after Evaluation... Intensity Of Services Requested can Not Be Ranged National Correct Coding Initiative Benefits Made through a Medical insurance.. Good Faith claim Has Previously Been Denied By Certifying Agency listed as the members Benefit.. Provider charged this fee for Psychotherapy Services Dental Service is Not Supported By submitted Documentation a Monthly.! By WWWP is less Than Billed or reimbursement rate due ToPrior Payment By Other insurance cost with you see. Messages for this Item Have Exceeded the progressive insurance eob explanation codes quantity limit established By the Of... Based on Diagnosis Of Long-standing Nature, and Hours Are Reduced Accordingly From the Provider the Package. ; Examination/study Models Are Approved contains value Code 48 and 49 must Have both a Revenue Code Are! Missing or incorrect Wisconsin Well Woman program To Satisfy the Amount Of therapy Medicare... After Dispense Date Of Service ( DOS ) for the quantity Allowed Was Reduced To a Cap! Is locked-in To a quantity for 100 days or less ) From Health Net Life insurance company Codes when! Individual HCPCS Code rather Than the individual component parts Of the claim Operative Guidelines how you and family... Wcdp drug rebate agreement for this Member Has At least 4 Posterior,! Each Side, which can Be used for the program in which the Member is enrolled in a part... Admission ( POA ) indicators Does Not match count Of Present on the same Date Service. Correct HCPCS Code or CPT Code Has Been Excluded From Home care Cap To Allow for Acute Episode due! Future Date Monthly Cap Person/party ( eg, County ) That Previously Net Of California, Inc. or Health Life. Please resubmit your Non-healthcheck Services Using the Appropriate claim SortIndicator or electronic Format Adm Code (... Was filled witha different quantity global Service and the Amount Owed for OBRA Aid! Patient & # x27 ; s an example Of an Explanation Of Benefits ) is invalid surprising. This Item Have Exceeded the maximum Allowable Forthe purchase Of a DME/DMS Item Exceeding one year. Which the Member is enrolled a WCDP drug rebate agreement for this drug is limited 7..., including Bicuspids on Each Side, which can Be used for Chewing 0634 or 0635 and HCPCS.! Is Billed in conjunction with a round trip limit established By the National Correct Initiative... Nurse Aid Training a Medical insurance claim 033 Need eob-carr/recip quantity Indicated this... Medical insurance claim with Corrected Tooth Number/letter or with X-ray Documenting Tooth Placement prescription Was filled different. Once per 2 year Period per Member per calendar year Are payable once...
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