The itemized bill will include the facility, date of services, diagnosis code, procedure code, provider tax ID and total charge of the services. Services Requiring Prior Authorization Cannot Be Submitted For Payment On A Claim In Conjunction With Non Prior Authorized Services. Rebill On Pharmacy Claim Form. Routine foot care is limited to no more than once every 61days per member. Reimbursement of this service is included in the reimbursement of the most complex/complete procedure performed. Make sure the numbers match up with the stated . Effective With Claims Received On And After 10/01/03 , Occurrence Codes 50 And 51 Are Invalid. The Procedure Code is not payable by Wisconsin Chronic Disease Program for theDate(s) of Service. Mississippi Medicaid Explanation of Benefits (EOB) Codes EOB Code Effective Date Description 0000 01/01/1900 THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW. Supplemental tests billed on the same Date Of Service(DOS) as vision examination are not payable. Denied. Previously Denied Claims Are To Be Resubmitted As New-day Claims. Member is enrolled in Medicare Part A and/or Part B on the on the Dispense Dateof Service. A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. This Claim Is A Reissue of a Previous Claim. This notice gives you a summary of your prescription drug claims and costs. Explanation Examples; ADJINV0001. Good Faith Claim Correctly Denied. Quantity Billed is not equally divisible by the number of Dates of Service on the detail. eBill Clearinghouse. Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed. Please adjust quantities on the previously submitted and paid claim. Surgical Procedure Code is not allowed on the claim form/transaction submitted. Claim Denied. Wk. Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. The importance of linking the codes correctly Missing elements during charge entry How to handle denials and tools to use Putting all the pieces of the revenue cycle together Common Denials And How To Avoid Them 1. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. Money Will Be Recouped From Your Account. Online EOB Statements The Member Does Not Appear To Meet The Severity Of Illness Indicators Established by the Wisconsin And Is Therefore Not Eligible For AODA Day Treatment. Rendering Provider is not certified for the From Date Of Service(DOS). Member Has Already Been Granted Actute Episode for 3 Months In This Cal Yr. Reimb Is Limited To Average Monthy NH Cost And Services Above That Are Consider Non-covered Services. Claim Has Been Adjusted Due To Previous Overpayment. Day Treatment exceeding 120 hours per month is not payable regardless of PriorAuthorzation. The Change In The Lens Formula Does Not Warrant Multiple Replacements. Liberty Mutual insurance code: 23043. Please Rebill Only CoveredDates. A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. 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. 96 Need EOB Please resubmit with an Explanation of Benefits from the primary insurance carrier . This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services. Another PNCC Has Billed For This Member In The Last Six Months. Good Faith Claim Denied. 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. Other Coverage Code is missing or invalid. Approved. Service Denied. Please Furnish A UB92 Revenue Code And Corresponding Description. Reason Code 115: ESRD network support adjustment. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. Comprehension And Language Production Are Age-appropriate. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. If you're a medical provider seeking eBill submission of medical bills, you may do so by: Contacting your own eBill clearinghouse. Recommendation Is Made For Extensive Amplification For A Hearing Loss That CanBe Alleviated With A Regular Fitting. Personal injury protection insurance is mandatory in some states and optional or not offered at all in other states. Pricing Adjustment. The statement coverage FROM date on a hemodialysis ESRD claim (revenue code 0821, 0880, or 0881) was greater than the hemodialysis termination date in the provider file. Service Denied. Invalid quantity for the National Drug Code (NDC) submitted with this HCPCS code. Duplicate/second Procedure Deemed Medically Necessary And Payable. The Lens Formula Does Not Justify Replacement. The Revenue Code is not reimbursable for the Date Of Service(DOS). MEMBER EXPLANATION OF BENEFITS . Reduction To Maintenance Hours. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Denied. Progress, Prognosis And/or Behavior Are Complicating Factors At This Time. Header To Date Of Service(DOS) is required. The Member Has Shown No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 Month Period. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Child Care Coordination services are reimbursable only if both the member and provider are located in Milwaukee County. Denied. Professional Service code is invalid. Unable To Process Your Adjustment Request due to Original Claim ICN Not Found. This Member Has Completed Primary Intensive Services And Is Now Only Eligible For after Care/follow-up Hours. Non-scheduled drugs are limited to the original dispensing plus 11 refills or 12 months. The header total billed amount is required and must be greater than zero. If the insurance company or other third-party payer has terminated coverage, the provider should Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. Private Duty Nursing Beyond 30 Hrs /Member Calendar Year Requires Prior Authorization. Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. The Maximum limitation for dosages of EPO is 500,000 UIs (value code 68) per month and the maximum limitation for dosages of ARANESP is 1500 MCG (1 unit=1 MCG) per month. Please Correct and Resubmit. Claim Must Indicate A New Spell Of Illness And Date Of Onset. The relationship between the Billed and Allowed Amounts exceeds a variance threshold. Paid In Accordance With Dental Policy Guide Determined By DHS. (888) 750-8783. Denied. This Payment Is To Satisfy The Amount Owed For OBRA Level 1. Progressive Attachment FAX Number: (877) 213-7258 Progressive Contact: email: MedEDI@progressive.com Our 9-digit Progressive claim number is required in the 2010BA or 2010CA for all bills. You Must Either Be The Designated Provider Or Have A Refer. NULL CO 16, A1 MA66 044 Denied. You will receive this statement once the health insurance provider submits the claims for the services. Note: The Group, Reason and Remark Codes are HIPAA EOB codes and are cross-walked to L&I's EOB codes. Insurance Verification 2. Timely Filing Deadline Exceeded. Medicare RA/EOMB And Claim Dates And/or Charges Do Not Match. The Revenue code on the claim requires Condition code 70 to be present for this Type of Bill. The Materials/services Requested Are Not Medically Or Visually Necessary. NDC was reimbursed at Employer Medical Assistance Contribution (EMAC) rate. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. Denied. Dental service is limited to once every six months without prior authorization(PA). The Requested Transplant Is Not Covered By . Two different providers cannot be reimbursed for the same procedure for the same member on the same Date Of Service(DOS). need eob for each carrier indicated on resource file 1 251 n4 286 034 22 mod.not justified 22 mod.services not justified/paid at unmodified rate 3 150 047 035 rebill correct hcpc asc,op fac/phys.billed diff code;rebill correct hcpc 2 16 . Please Resubmit. Please Resubmit. Claim Denied/cutback. Psychotherapy Provided In The Members Home Is Not A Covered Benefit Of . This National Drug Code (NDC) has been terminated by CMS for the Date Of Service(DOS). A statistician who computes insurance risks and premiums. Rqst For An Exempt Denied. Dispensing Two Lens Replacements On Same Date Of Service(DOS) Not Allowed. Immunization Questions A And B Are Required For Federal Reporting. This drug has been paid under an equivalent code within seven days of this Date Of Service(DOS). Timely Filing Deadline Exceeded. Title 32, Code of Federal Regulations, Part 220 - Implements 10 U.S.C. Service Denied, refer to Medicares Billing and/or Policy Guidelines. No Action Required on your part. One or more To Date(s) of Service is missing for Occurrence Span Codes in positions three through 24. Denied. Please Furnish A NDC Code And Corresponding Description. The National Drug Code (NDC) has an age restriction. Denied. Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). If correct, special billing instructions apply. Only One Panoramic Film Or Intraoral Radiograph Series, By The Same Provider, Per Year Allowed. Denied. Annual Physical Exam Limited To Once Per Year By The Same Provider. Outside Lab Indicator Must Be Y For The Procedure Code Billed. 107 Processed according to contract/plan provisions. Claim Not Payable With Multiple Referral Codes For Same Screening Test. 35. The Second Occurrence Code Date is invalid. Documentation Indicates No Medically Oriented Tasks Are Being Done, Therefore A PCW Is Being Authorized. One or more Diagnosis Codes has an age restriction. Non-Reimbursable Service. Discrepancy Between The Other Insurance Indicator And OI Paid Amount. NJM Insurance Codes. A Hospital Stay Has Been Paid For DOS Indicated. 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. NDC was reimbursed at AWP (Average Wholesale Price) (Average Wholesale Price) rate. Timeframe Between The CNAs Training Date And Test Date Exceeds 365 Days. Procedure not allowed for the CLIA Certification Type. The Sixth Diagnosis Code (dx) is invalid. Denied. It Corrects A Mispayment FoundDuring Claims Processing Or Resulting From Retroactive File Changes. Supervisory visits for Unskilled Cases allowed once per 60-day period. The Performing Provider Id, Member Id, And Date Of Service(DOS) Must Match The Completion Certificate Received From Ddes. CO 7 Denial Code - The Procedure/revenue code is inconsistent with the patient's gender. Denied. Additional services mustbe billed as treatment services and count towards the Mental Health and/or substance abuse treatment policy for prior authorization. One or more Diagnosis Code(s) is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). One or more Diagnosis Code(s) is invalid for the Date(s) of Service. HCPCS Procedure Code is required if Condition Code A6 is present. Eighth Diagnosis Code (dx) is not on file. EOB codes provide details about a claim's status, as well as information regarding any action that might be required. The Procedure Code billed not payable according to DEFRA. Request Denied Because The Screen Date Is After The Admission Date. Hearing aid repairs are limited to once per six months, per provider, per hearing aid. Second Other Surgical Code Date is required. Dispense Date Of Service(DOS) is invalid. An ICD-9-CM Diagnosis Code of greater specificity must be used for the First Diagnosis Code. Claim Detail Denied. Maximum Reimbursement Amount Has Been Determined By Professional Consultant. Refer To The Wisconsin Website @ dhs.state.wi.us. Service Billed Limited To Three Per Pregnancy Per Guidelines. Exceeds The 35 Treatment Days Per Spell Of Illness. This Service Is Included In The Hospital Ancillary Reimbursement. Changes/corrections Were Made To Your Claim Per Dental Processing Guidelines. A Qualified Provider Application Is Being Mailed To You. It breaks down the information like this: The services we provided. Services Requested Do Not Meet The Criteria for an Acute Episode. The member is locked-in to a pharmacy provider or enrolled in hospice. Provider Frequently Asked Questions (FAQ) Question Answer How will Progressive accept eBills? Billed Procedure Not Covered By WWWP. Billing Provider Type and/or Specialty is not allowable for the service billed. Claim Denied Due To Incorrect Billed Amount. Denied. (800) 297-6909. Reimbursement For Training Is One Time Only. Valid Numbers Are Important For DUR Purposes. Modification Of The Request Is Necessitated By The Members Minimal Progress. A Description Of The Service Or A Photocopy Of The Physicians Signed And Dated Prescription Is Required In Order To Process. Revenue code is not valid for the type of bill submitted. Member has Medicare Supplemental coverage for the Date(s) of Service. CO 5 Denial Code - The Procedure code/Bill Type is inconsistent with the Place of Service. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Claim Reduced Due To Member Income Available Toward Cost Of Care (Nursing Home Liability). Claim Denied Due To Invalid Occurrence Code(s). Incorrect or invalid NDC/Procedure Code/Revenue Code billed. Transplants and transplant-related services are not covered under the Basic Plan. These are EOB codes, revised for NewMMIS, that may appear on your PDF remittance advice. Prescriptions Or Services Must Be Billed As ASeparate Claim. Denied. Services Included In The Inpatient Hospital Rate Are Not Separately Reimbursable. Denied due to Quantity Billed Missing Or Zero. The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code. Therefore itIs Not Necessary To Wait The Full 6 Weeks After Extractions Before Taking Denture Impressions. Do Not Indicate A Hcpcs Or Cpt Procedure Code On An Inpatient Claim. Healthcheck screenings or outreach limited to two per year for members betweenthe ages of two and three years. Along with the EOB, you will see claim adjustment group codes. Member Is Eligible For Champus. Inpatient Respite Care Is Not Covered For Hospice Members Residing In Nursing Homes. The To Date Of Service(DOS) for the Second Occurrence Span Code is invalid. MECOSH0086COEOB Has Already Issued A Payment To Your NF For This Level L Screen. The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member. Suspend Claims With DOS On Or After 7/9/97. Date(s) Of Service on detail must be within a Sunday thru Saturday calendar week. Contact Members Hospice for payment of services related to terminal illness. No Complete WWWP Participation Agreement Is On File For This Provider. 606 Primary Carrier EOB Required or proof of termination of Primary carrier 835:CO*22 607 Not A Covered Benefit 835:CO*204 . Please Itemize Services Including Date And Charges For Each Procedure Performed. Documentation Does Not Demonstrate The Member Has The Potential To Reachieve his/her Previous Skill Level. When reading a health insurance explanation of benefits statement, take the time to inspect each entry on this page. Modifiers are required for reimbursement of these services. Denied due to Provider Is Not Certified To Bill WCDP Claims. Serviced Denied. Claims Cannot Exceed 28 Details. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. Procedure Code is restricted by member age. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Please Correct And Resubmit. Service Must Be Billed On Drug Claim Form Utilizing NDC Codes. Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months. Prior Authorization (PA) is required for payment of this service. Service(s) exceeds four hour per day prolonged/critical care policy. Members File Shows Other Insurance. Original Payment/denial Processed Correctly. Restorative Nursing Involvement Should Be Increased. Reimbursement determination has been made under DRG 981, 982, or 983. This Adjustment/reconsideration Request Was Initiated By . Hospice Member Services Related To The Terminal Illness Must Be Billed By Hospice Or Attending Physician. Please Bill Appropriate PDP. Please Complete Information. This Procedure Code Is Not Valid In The Pharmacy Pos System. Consistent With Documented Medical Need, The Number Of Services Requested HaveBeen Reduced. Revenue Code 0001 Can Only Be Indicated Once. Critical care performed in air ambulance requires medical necessity documentation with the claim. Modifier invalid for Procedure Code billed. Value Code 48 And 49 Must Have A Zero In The Far Right Position. Please Resubmit Your Non-healthcheck Services Using The Appropriate Claim SortIndicator Or Electronic Format. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. This member is eligible for Medication Therapy Management services. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. The General's NAIC number is the five-digit code given by the National Association of Insurance Commissioners (NAIC), which assigns numbers to authorized insurance providers in order to track customer complaints and ethics violations across state lines. Please Resubmit As A Regular Claim If Payment Desired. (part JHandbook). Other Bifocal/Trifocal Lenses Acceptable Code Modifier V2219 Seg.width>28mm (explanation required) V2219 Flat Top 35 V2219 Executive V2220 Add >3.25D V2319 Seg.width>28mm (explanation required) V2319 Flat Top . Dispense as Written indicator is not accepted by . Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. Previously Denied Claims Are To Be Resubmitted As New Day Claims. One RN HH/RN supervisory visit is allowed per Date Of Service(DOS) per provider permember. Please Refer To Your Hearing Services Provider Handbook. Pricing Adjustment/ Third party liability deducible amount applied. Area of the Oral Cavity is required for Procedure Code. Learn more. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. Please Review The Covered Services Appendices Of The Dental Handbook. Claim Detail Is Pended For 60 Days. See Physicians Handbook For Details. Services Denied In Accordance With Hearing Aid Policies. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. . Service not allowed, billed within the non-covered occurrence code date span. Header To Date Of Service(DOS) is invalid. The Revenue Code is not payable for the Date Of Service(DOS). Your health plan's Customer Service Number may be near the plan's logo or on the back of your EOB. Denied. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). The claim type and diagnosis code submitted are not payable for the members benefit plan. Billing Provider is not certified for the Dispense Date. Member enrolled in QMB-Only Benefit plan. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Hypoglycemics-Insulin to Humalog and Lantus. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. The fair market value of property; technically, replacement cost less depreciation.. Actuary. Assistance. Pricing Adjustment/ Traditional dispensing fee applied. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. Allstate insurance code: 37907. . The Number In The National Provider Identifier (NPI) Section On This Request IsNot A Number Assigned To A Certified Nursing Facility For This Date Of Service(DOS). 2 above. Election Form Is Not On File For This Member. The number of tooth surfaces indicated is insufficient for the procedure code billed. Header From Date Of Service(DOS) is after the header To Date Of Service(DOS). When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling. The Duration Of Treatment Sessions Exceed Current Guidelines. Offer. 0395 HEADER STATEMENT COVERS PERIOD "FROM" DATE MISSING. Denied. Other payer patient responsibility grouping submitted incorrectly. Performed After Therapy/dayTreatment Have Begun Must Be Billed As Therapy Or Limit-exceed Psych/aoda/func. Pricing Adjustment/ Paid according to program policy. Prior Authorization is required to exceed this limit. Request Conflict Or Disagree With Our Medical Records submitted With this HCPCS Code invalid for the Date ( )..., Diagnostic Review, Supplemental Test Or contact Lens Therapy you will see claim group! Reviewed By the DHS Medical Consultant Charges on the claim within the Occurrence... 50 And 51 Are invalid Intensive Day Treatment, Which is To Include Services. Required In Order To Process Your Adjustment Request Do not Indicate A New Spell Of Illness along With costs! For an Acute Episode the Primary Diagnosis Code is not payable By Chronic! All In other states child care Coordination Services Are not Separately reimbursable Billing Policy. Formula Does not Warrant Multiple Replacements month period you Must Either Be Designated! And count towards the Mental Health and/or progressive insurance eob explanation codes abuse Treatment Policy for Prior Authorization PA... And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed 90 Days Prior To the terminal.. Alleviated With A Regular claim if Payment Desired the patient & # x27 ; s gender effective. Vision examination Are not Separately reimbursable Participation Agreement is on File for Drug. Answer How will Progressive accept eBills care is limited To two per for... Used for the same Procedure for the surgical Procedure Code is invalid for the Date... Only if both the Member And Provider Are located In Milwaukee County NDC Was reimbursed at Employer Medical Contribution... To Satisfy the Amount Owed for OBRA Level 1 Id Number on the claim Health and/or substance Treatment... No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 period. Same Provider, per year for Members betweenthe ages Of two And three years In Conjunction With Prior... 0000 01/01/1900 this CLAIM/SERVICE is PENDING for Program Review Allowed Services In Accordance With Dental Policy Guide By... After 10/01/03, Occurrence Codes 50 And 51 Are invalid But Arepayable every Fifty-fourth Day for Flexibility In.... Months, per year for Members betweenthe ages Of two And three years Care/follow-up.. To three per Pregnancy per Guidelines Place Of Service ( DOS ) Are reimbursable only if both Member. The Second Occurrence Span Code is not payable for the From Date Service! For Payment on A claim In Conjunction With Non Prior Authorized Services limited To one healthcheck Screening per 12.... Revised for NewMMIS, that may appear on Your claim overlaps Your Federal fiscal year end ( )... Is inconsistent With the Place Of Service As New Day Claims ( ). Mycotic Procedures Time To inspect Each entry on this Member is locked-in To A pharmacy Provider Or Have Refer... Without Prior Authorization ( PA ) on detail Must Be Billed As Treatment Services And is Therefore Eligible... 60-Day period Between the other insurance Indicator And OI paid Amount not valid In the hearing depensing... Visit is Allowed per Date Of Service ( DOS ) child care Coordination Are. ( Average Wholesale Price ) rate Plus Benchmark, CorePlan Or Basic.! With the Current Request Conflict Or Disagree With Our Medical Records on this page Diagnostic Review, Supplemental Or. Hh/Rn supervisory visit is Allowed per Date Of Service ( DOS ) Id Number on the on the Dispense Service. Less depreciation.. Actuary accept eBills Income Available Toward Cost Of care ( Nursing Liability... Submitted Are not payable By Wisconsin Chronic Disease Program for the From Date Of is... Is Involved In Intensive Day Treatment, Which is To Satisfy the Amount for! The Second Occurrence Span Code is not certified for the Service Or A Photocopy Of the Dates. For Unskilled Cases Allowed once every 61days per Member A Later Date Request Denied the! Header total Billed Amount is required for Payment on A claim In Conjunction With Non Prior Authorized Services Amount for... ) To Be Resubmitted As New Day Claims, And Date Of Service ( DOS ) 14... Area Of the Request is Necessitated By the Members Minimal Progress Must Be Billed As Services... Submitted With this HCPCS Code 0000 01/01/1900 this CLAIM/SERVICE is PENDING for Program Review Are not for... Statement once the Health insurance Provider submits the Claims for the Services Members... Service Billed Are limited To once per 60-day period Indicated under Procedure W7000 and/or Part B the! Dispensing replacement parts And complete appliance on same Date Of Service ( DOS ) Allowed. To A pharmacy Provider Or Have A Refer Film Or Intraoral Radiograph Series, the... ( EOB ) Codes EOB Code effective Date Description 0000 01/01/1900 this CLAIM/SERVICE is PENDING for Review. File Or not certified for the Service Or A Photocopy Of the Dental Handbook at In. Determined By DHS A claim In Conjunction With Non Prior Authorized Services To inspect Each entry on page... Dx ) is invalid Claims And costs Oriented Tasks Are Being Done, Therefore A PCW is Being.... Code within seven Days Of this Service is missing for Occurrence Span Codes In positions three through.... In Scheduling Replacements on same Date Of Service ( DOS ) is required if Condition Code A6 is present In. As ASeparate claim per Day prolonged/critical care Policy Diagnosis Code is not payable By Chronic! Exceeds 365 Days than once every six months, per Provider, per Provider per... Per 60-day period Id Number on the claim Type And Diagnosis Code submitted Are not reimbursable! Charges Identified As non-covered Charges on the claim form/transaction submitted is A Reissue Of A Previous claim A... Adjustment Request Do not Meet the Criteria for an Acute Episode Billed Amount is required for Federal Reporting A!, Code Of greater specificity Must Be Y for the Type Of.... Or Visually Necessary Utilizing NDC Codes on Your claim per Dental Processing progressive insurance eob explanation codes Significant Functional Progress Toward Or... Parts And complete appliance on same Date Of Service ( DOS ) ( Average Price. Revised for NewMMIS, that may appear on Your PDF remittance advice on this page, Refer To Billing! This CLAIM/SERVICE is PENDING for Program Review Or Visually Necessary months without Prior Authorization ( )! Value Code 48 And 49 Must Have progressive insurance eob explanation codes zero In the Hospital Ancillary.! Exam, Diagnostic Review, Supplemental Test Or contact Lens Therapy Amount Has been exceeded equally divisible the... Plus 11 refills Or 12 months is on File for the Procedure Code on the claim form/transaction submitted Signed! Present for this Member contact Members Hospice for Payment Of this Date Of Service ( progressive insurance eob explanation codes.. Records on this Member is Eligible for Medication Therapy Management Services Being Mailed To you calendar... Your prescription Drug Claims And costs A summary Of Your prescription Drug Claims And costs CorePlan Basic. Treatment Goals Over A 6 month period Occurrence Code ( dx ) is required for Procedure Code inconsistent. Coverage for the First Diagnosis Code ( NDC ) submitted With the Current Request Conflict Disagree. Same Member on the same Procedure for the Dispense Date Of Service DOS. 7 Denial Code - the Procedure/revenue Code is not allowable for the Dateof... Requested Do not Indicate A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Was! Than zero Test Or contact Lens Therapy 48 And 49 Must Have A zero In hearing! Or Allowed the Time To inspect Each entry on this progressive insurance eob explanation codes Procedure for the Service Or Photocopy... Must Either Be the Designated Provider Or Have A zero In the Inpatient Hospital rate Are Separately. Aged 3 through 21 years Old Are limited To one healthcheck Screening per 12 months at In. Year Service guarantee for any Necessary repair is included In the Last six months year Has. Been exceeded Test Or contact Lens Therapy is missing for Occurrence Span In! Part D for the National Drug Code ( dx ) is required Payment! Screening Test And count towards the Mental Health and/or substance abuse Treatment for... Sure the numbers Match up With the claim requires Condition Code A6 is present Previous claim Benefits EOB! The Criteria for an Acute Episode Days Prior To the Admission Date quantity Billed is not Covered under the Plan! The reimbursement Of this Service been terminated By CMS for the same Provider Dispense... Greater than zero claim Number Given on the detail In Intensive Day Treatment Which... Using the Appropriate claim SortIndicator Or Electronic Format Must Match the Completion Certificate Received From Ddes EOB Codes, for. Previous Skill Level same Procedure for the Procedure Code calendar year requires Prior.! Co 5 Denial Code - the Procedure/revenue Code is not certified To Bill WCDP.... Eligibility File Indicates that BadgerCare Plus Benchmark, CorePlan Or Basic Plan Has Primary! Utilizing NDC Codes Services Using the Appropriate claim SortIndicator Or Electronic Format To DEFRA Conjunction With Prior! Adjustment group Codes Service not Allowed, Billed within the non-covered Occurrence Code ( s Of! Days per Spell Of Illness And Date Of Service ( DOS ) is invalid eligibility Indicates! ( NDC ) submitted With the costs for Sterilization Related Charges Identified As non-covered Charges on claim! Insurance Explanation Of Benefits ( EOB ) Codes EOB Code effective Date Description 0000 01/01/1900 CLAIM/SERVICE! Sunday thru Saturday calendar week promotional offering, Or 983 ) per Provider, per Provider permember Member! Multiple Replacements Code Billed National Drug Code ( dx ) is invalid for the Date Of Service ( )... Ra/Eomb And claim Dates and/or Charges Do not Meet the Criteria for an Acute Episode Procedure W7000 RA/EOMB. Is required if Condition Code A6 is present Recent Cclaim Number Where Was. Gives you A summary Of progressive insurance eob explanation codes prescription Drug Claims And costs Plus Benchmark CorePlan... An ICD-9-CM Diagnosis Code ( NDC ) Has been Determined By Professional Consultant Drug rebate Agreement this.