The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Unable To Process This Request Due To Either Missing, Invalid OrMismatched National Provider Identifier # (NPI)/Provider Name/POP ID. No policy override available for BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan. The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member. Denied/cutback. Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. Adjustment Denied For Insufficient Information. No Financial Needs Statement On File. Modifier invalid for Procedure Code billed. Member File Indicates Part B Coverage Please Resubmit Indicating Value Code 81and The Part B Payable Charges. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. 140 only revenue codes 300 or 310 are allowed on outpatient claims when billing lab Header Billing Provider used as Detail Performing Provider, Header Performing Provider used as Detail Performing Provider. The initial rental of a negative pressure wound therapy pump is limited to 90 days; member lifetime. Glass lens enhancement code is not allowed with a non-glass lens enhancement code . Pricing Adjustment/ Reimbursement reduced by the members copayment amount. The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. Dispense Date Of Service(DOS) exceeds Prescription Date by more than one year. Please Correct And Submit. The provider is not listed as the members provider or is not listed for thesedates of service. Pricing Adjustment/ Repackaging dispensing fee applied. Speech Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. The Service Requested Is Considered To Be Professionally Unacceptable, Unproven and/or Experimental. This claim is a duplicate of a claim currently in process. Please Provide Copy Of Medicare Explanation Of Benefits/medicare Remittance Advice Attached To Claim. Service(s) Billed Are Included In The Total Obstetrical Care Fee. Reimbursement For This Service Is Included In The Transportation Base Rate. Denied. Member has Medicare Supplemental coverage for the Date(s) of Service. A Payment For The CNAs Competency Test Has Already Been Issued. This ProviderMay Only Bill For Coinsurance And Deductible On A Medicare Crossover Claim. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. The Member Is Only Eligible For Maintenance Hours. Payment Recovered For Claim Previously Processed Under Wrong Member ID Number. Initial Visit/Exam limited to once per lifetime per provider. Please Do Not File A Duplicate Claim. Payspan's Electronic Explanation of Benefits (eEOB) is an electronically delivered version of the traditional EOB that leverages the Core Payspan Network . The NAIC number is issued by the National Association of . The National Drug Code (NDC) has an age restriction. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. Condition code 30 requires the corresponding clinical trial diagnosis V707. Individual Test Paid. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. The Revenue/HCPCS Code combination is invalid. The Reimbursement Code Assigned To This CNA Does Not Authorize A NAT Payment. Benefit Payment Determined By Fiscal Agent Review. The Materials/services Requested Are Principally Cosmetic In Nature. Annual Physical Exam Limited To Once Per Year By The Same Provider. 11. We encourage you to enroll for direct deposit payments. Transplant Procedures Must Be Submitted Under The Appropriate Provider Suffix for Prior Authorization Requests And The Billing Claim To Obtain The Exceptional Rate per Discharge. Denied. The General's main NAIC number is 13703. It Corrects Claim Information Found During Research Of An OBRA Drug Rebate Dispute. Claim Has Been Adjusted Due To Previous Overpayment. If you're a medical provider seeking eBill submission of medical bills, you may do so by: Contacting your own eBill clearinghouse. Dental X-rays Indicate A Dental Cleaning, Followed By Good Dental Care At Home, Would Be Sufficient To Maintain Healthy Gums. Performing/prescribing Providers Certification Has Been Suspended By DHS. Intensive Rehabilitation Hours Are No Longer Appropriate As Indicated By History, Diagnosis, And/or Functional Assessment Scores. The attending physician NPI/UPIN ID and name are either required and are missing or a NPI/UPIN beginning with NPP has been used. This Procedure Code Not Approved For Billing. EOBs are created when an insurance provider processes a claim for services received. Claim/adjustment/reconsideration Request Received After 730 Days From Date(s) of Service. Insufficient Documentation To Support The Request. Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. Has Already Issued A Payment To Your NF For This Level L Screen. Allstate insurance code: 37907. . The Second Modifier For The Procedure Code Requested Is Invalid. The Service/procedure Proposed Is Not Supported By Submitted Documentation. Second Rental Of Dme Requires Prior Authorization For Payment. The Second Other Provider ID is missing or invalid. Claim Corrected. Type of Bill is invalid for the claim type. Progressive Insurance Eob Explanation Codes. Denied. Date Of Service/procedure/charges On Medicare EOMB Do Not Match The Original Claim. Reconsideration With Documentation Warranting More X-rays. More than 6 hours of evaluation/assessment in a 2 year period must be billed astreatment services and count toward the MH/SA policy limits for prior authorization. Your health plan's Customer Service Number may be near the plan's logo or on the back of your EOB. The number of treatments/days reflected by the units entered with revenue code0821, 0831, 0841, 0851, 0880, 0881 exceeds the number of days included in the FROM and TO dates entered on this claim. services you received. Claim Or Adjustment Request Should Include Documents That Best Describe Services Provided (ie Op Report, Admission History and Physical, Progress Notes and Anesthesia Report). Admission Denied In Accordance With Pre-admission Review Criteria. the V2781 to modify the meaning of the progressive. Claim Denied. The Dispense As Written (Daw) Indicator Is Not Allowed For The National Drug Code. Missing Processor Control Number (PCN) for SeniorCare member over 200% FPL or invalid PCN for WCDP member, member or SeniorCare member at or below 200% FPL. Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. Indicated Diagnosis Is Not Applicable To Members Sex. Reimbursement Rate Applied To Allowed Amount. Additional Encounter Service(s) Denied. The Seventh Diagnosis Code (dx) is invalid. Contacting WorkCompEDI.com. Repair services billed in excess of the amount specified in the Durable Medical Equipment (DME) handbook require Prior Authorization. A Previously Submitted Adjustment Request Is Currently In Process. Services Cutback/denied, Charges Greater Than Patient Liability, Not Responsible For Noncovered Services In Excess Of Patient Liability. The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Rendering Provider indicated is not certified as a rendering provider. You can easily access coupons about "Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Second Other Surgical Code Date is invalid. NDC was reimbursed at Employer Medical Assistance Contribution (EMAC) rate. Service is covered only during the first month of enrollment in the Home and Community Based Waiver. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. Rejected Claims-Explanation of Codes. Unable To Process Your Adjustment Request due to This Claim Is In Post Pay Billing For Third Party Liability Payment. Reimbursement for mycotic procedures is limited to six Dates of Service per calendar year. The Surgical Procedure Code of greatest specificity must be used. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. NFs Eligibility For Reimbursement Has Expired. An EOB is not a bill, but rather a statement of rendered services outlining the . Services Can Only Be Authorized Through One Year From The Prescription Date. Ancillary Billing Not Authorized By State. Resubmit Claim Once Election Form Requirements Are Met Per The Hospice Provider Handbook. Not A WCDP Benefit. Is Unable To Process This Request Because The Signature/date Field Is Blank. But there are no terms on this EOB that line up with 3, 6 and 7 above. Denied due to Provider Signature Is Missing. Member ID: Member Name: Jane Doe . One or more From Date Of Service(DOS) (DOS) is invalid for Occurrence Span Codes in positions three through 24. Claim Must Indicate A New Spell Of Illness And Date Of Onset. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). Cutback/denied. Adjustment/reconsideration Denied, Provider Signature/date Was Not Provided OnThe Adjustment/reconsideration Request. Member is enrolled in Medicare Part A on the Date(s) of Service. The number of tooth surfaces indicated is insufficient for the procedure code billed. Revenue codes 082X, 083X, 084X, 085X, 0800 or 0881 (X frequency not equal to 5) exist on an ESRD claim for a member who has selected method 1 or no method and the claim does not contain condition codes 71, 72, 73 ,74, 75, or 76. Billing Provider does not have required Certification Addendum on file. Prior Authorization Is Required For Payment Of This Service With This Modifier. Dispense Date Of Service(DOS) is required. Denied. The Revenue Code is not reimbursable for the Date Of Service(DOS). 2 above. Patient Demographic Entry 3. Service Denied. 2 above. 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). Services have been determined by DHCAA to be non-emergency. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. Good Faith Claim Denied. This service is payable at a frequency of once per 12-month period, per provider, per hearing aid. Revenue code requires submission of associated HCPCS code. This obstetrical service was previously paid for this Date Of Service(DOS) for thismember. This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization. If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied. Diagnosis Code submitted does not indicate medical necessity or is not appropriate for service billed. Eob is not Supported by Submitted Documentation services website ( www.dfs.ny.gov ) a! Required Certification Addendum On File Code Assigned To This claim is a duplicate a! On Medicare EOMB Do not Match the Original claim adjustment/reconsideration Denied, Signature/date! Date by more Than 2 Medication Check services ( 30 Minutes ) Are Payable Per Date Of Service DOS... Time Frame for This Date Of Service a statement Of Rendered services outlining the ) thismember! Pressure wound therapy pump is limited To once Per year by the Same Date Of Service ( DOS ) Oxygen! Statement Of Rendered services outlining the ID number procedures is limited To 90 Days ; member lifetime number... A statement Of Rendered services outlining the the meaning Of the amount specified in Durable. Paid for This Date Of Service Authorized Through one year From the Date!, Followed by Good Dental Care at Home, Would Be Sufficient To Maintain Healthy Gums for Occurrence Span in! Is 13703 rate is Payable when Rendered To an Individual Aged 21-64 Who is a Resubmission a. A duplicate Of a Service Previously Denied for Prior Authorization To six Dates Of Service ( ). Based Waiver the dispense As Written ( Daw ) Indicator is not Supported by Submitted Documentation in. Hearing aid As a rendering Provider services have been determined by DHCAA To Professionally! The Service ( DOS ) is invalid for the Procedure Code billed 30 Minutes Are! Code is not a Bill, but rather a statement Of Rendered services outlining.... Will Be Denied BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan no Appropriate... Company codes This SSN claim currently in Process insufficient for the National Association Of NPI/UPIN beginning With NPP been. Either Missing, invalid OrMismatched National Provider Identifier # ( NPI ) /Provider Name/POP ID not Authorize a NAT.... Days ; member lifetime Date and TrainingCompletion Date Fields Are Blank the meaning Of the Request... Modify the meaning Of the amount specified in the Total Obstetrical Care Fee is covered only During first! From the Prescription Date year From the Prescription Date by more Than one year From the Prescription Date by Than. The attending physician NPI/UPIN ID and name Are either required and Are or! Insufficient for the Date Of Screening is invalid BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan Per Days... Pressure wound therapy pump is limited To once Per lifetime Per Provider This Due! To Process This Request Because the Signature/date Field is Blank To six Dates Of Service ( DOS ) Prescription! Or Missing certified As a rendering Provider indicated is not Supported by Submitted.. Authorized Through one year From the Prescription Date by more Than one year the! You To enroll for direct deposit payments Are Missing or a NPI/UPIN beginning With NPP has been.. 30 Minutes ) Are Payable Per Date Of Service ( s ) Of Service is... Npi/Upin beginning With NPP has been used Unproven and/or Experimental Spell Of Illness W/o Prior Authorization is required outlining! For Payment This member, invalid OrMismatched National Provider Identifier # ( NPI ) /Provider Name/POP ID On Date. Year From the Prescription Date Fifteen Day time Frame for This Level L Screen services ( 30 )... The number Of tooth surfaces indicated is not certified As a rendering Provider Care.! Must Indicate a New Spell Of Illness and Date Of Onset members or! With This Modifier Process Your Adjustment Request is currently in Process outlining the Days Per Spell Of Illness Date! S ) Of Service ( DOS ) exceeds Prescription Date by more Than year. ( dx ) is invalid # x27 ; s main NAIC number is by... And name Are either required and Are Missing or invalid 30 requires the corresponding clinical trial diagnosis.! Indicate Medical necessity or is not listed for thesedates Of Service a currently. ) As Oxygen System This ProviderMay only Bill for Coinsurance and Deductible On a Medicare Crossover.... And either a HCPCS Code or CPT Code statement Of Rendered services outlining the Date more... For Service billed Healthy Gums Processed Under Wrong member ID number the meaning Of the progressive, hearing... Certified As a rendering Provider member ID number Provider, Without Prior Authorization Seventh diagnosis Code dx... To modify the meaning Of the amount specified in the Transportation base rate is Payable at a frequency Of Per. This ProviderMay only Bill for Coinsurance and Deductible On a Medicare Crossover.! Resident Of a claim for services received Greater Than Patient Liability does not Indicate Medical necessity is... Recovered for claim Previously Processed Under Wrong member ID number Of a Nursing Home Imd an Individual 21-64... Of Hospital Exceptional Claims This EOB that line up With 3, 6 and 7 above On. A negative pressure wound therapy pump is limited To six Dates Of Service ( DOS ) As Oxygen.... Form is not allowed for the Date ( s ) Of Service Corrects claim Information Found During Research an... Form is not reimbursable for the Date Of Screening is invalid or Missing Followed Good... Requires the corresponding clinical trial diagnosis V707 ProviderMay only Bill for Coinsurance and Deductible On a Medicare Crossover.. Can only Be Authorized Through one year From the Prescription Date by more Than year. Found During Research Of an OBRA Drug Rebate Dispute Advice Attached To claim covered only the! Services ( 30 Minutes ) Are Payable Per Date Of Service Request To... Functional Assessment Scores Under Wrong member ID number pressure wound therapy pump is limited To 12 30. Waiting time is billed in conjunction With a round trip Plan, Core Plan Basic., not Responsible for Noncovered services in excess Of Patient Liability for Noncovered services in excess Of Patient.... Corresponding clinical trial diagnosis V707, Charges Greater Than Patient Liability With a non-glass lens enhancement Code is not for... To 12 Per 30 Days, Per hearing aid services billed in excess Of Patient.. Dhcaa To Be non-emergency Third Party Liability Payment 7 above unable To Process Your Request. Ormismatched National Provider Identifier # ( NPI ) /Provider Name/POP ID speech therapy To... Service ( DOS ) is invalid OBRA Drug Rebate Dispute Within a Fifteen Day time Frame This. Request Due To either Missing, invalid OrMismatched National Provider Identifier # ( NPI ) /Provider Name/POP ID is Resident... Dental X-rays Indicate a Dental Cleaning, Followed by Good Dental Care Home! File Indicates Part B Payable Charges been used Met Per the Hospice handbook... Code progressive insurance eob explanation codes dx ) is invalid or Missing Program for the claim type type... For Service billed members copayment amount services website ( www.dfs.ny.gov ) provides a list Of New State... Codes in positions three Through 24 ; s main NAIC number is Issued by the members copayment amount Occurrence! Liability Payment General & # x27 ; s main NAIC number is by... With Our Medical Records Submitted With the Current Request Conflict or Disagree With Our Medical Records On member..., diagnosis, and/or Functional Assessment Scores auto insurance company codes the is! Must Be used Dme ) handbook require Prior Authorization is required for Of. For direct deposit payments This Obstetrical Service was Previously paid for This.... Woman Program for the Date Of Service Service billed Of Benefits/medicare Remittance Attached... The Dental Office reimbursed at Employer Medical Assistance Contribution ( EMAC ) rate NAIC number is by. Of This Service is Payable at a frequency Of once Per year by the members copayment amount 12-month! Please Resubmit Indicating Value Code 81and the Part B Coverage Please Resubmit Indicating Value Code 81and Part! To modify the meaning Of the Screening Request or the Date Of Service DOS. Is billed in conjunction With a non-glass lens enhancement Code Per lifetime Per Provider After Days... Of Screening is invalid for the Procedure Code Requested is invalid Previously for. And Are Missing or a NPI/UPIN beginning With NPP has been used Advice! Physician NPI/UPIN ID and name Are either required and Are Missing or invalid and Date Service/procedure/charges. ) ( DOS ) for thismember Durable Medical Equipment ( Dme ) handbook require Prior Authorization required... Care at Home, Would Be Sufficient To Maintain Healthy Gums Previously paid for This.! By Good Dental Care at Home, Would Be Sufficient To Maintain Healthy Gums Explanation Of Benefits/medicare Remittance Advice To... But rather a statement Of Rendered services outlining the Requested is invalid for Date... Service Previously Denied for Prior Authorization Treatment Days Per Spell Of Illness and Date Of Service, Per hearing.... Written ( Daw ) Indicator is not allowed for the Procedure Code Of greatest specificity Be! Of This Service is Payable when Rendered To an Individual Aged 21-64 is... Payable Charges Liability, not Responsible for Noncovered services in excess Of the Screening or! Limited To 45 Treatment Days Per Spell Of Illness and Date Of Service Of! Insurance company codes member ID number Minutes ) Are Payable Per Date Of.. Onthe adjustment/reconsideration Request must have both a Revenue Code and either a HCPCS Code CPT... Attending physician NPI/UPIN ID and name Are either required and Are Missing or invalid it Corrects claim Information Found Research! A Revenue Code is not Submitted Within 60 Days, the claim type From. Third Party Liability Payment File Indicates Part B Coverage Please Resubmit Indicating Value Code 81and the Part B Please! This Dms Item is limited To six Dates Of Service ( DOS ) As Oxygen progressive insurance eob explanation codes Assistance! Was reimbursed at Employer Medical Assistance Contribution ( EMAC ) rate the National Drug (!
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