Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice. Etiology Diagnosis Code(s) (E-Codes) are invalid as the Admitting/Principal Diagnosis 1. Procedue Code is allowed once per member per calendar year. Repackaged National Drug Codes (NDCs) are not covered. Modification Of The Request Is Necessitated By The Members Minimal Progress. The Dispense As Written (Daw) Indicator Is Not Allowed For The National Drug Code. Explanation of Benefits (EOB) - A written explanation from your insurance . Claim Denied Due To Invalid Occurrence Code(s). Not A WCDP Benefit. Only Medicare crossover claims are reimbursable. Occupational Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization. Service(s) paid at the maximum daily amount per provider per member. Contacting WorkCompEDI.com. EOB meaning: 1. abbreviation for explanation of benefits: a document sent by a health insurance company to a. The Service Billed Does Not Match The Prior Authorized Service. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. is unable to is process this claim at this time. Denied. Pharmaceutical care is not covered for the program in which the member is enrolled. Denied/Cutback. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. Claim Is Being Special Handled, No Action On Your Part Required. Please Complete Information. Header Rendering Provider number is not found. Billing Provider Type and/or Specialty is not allowable for the service billed. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. Header From Date Of Service(DOS) is required. Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. Claim Denied. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. Multiple Requests Received For This Ssn With The Same Screen Date. Rn Visit Every Other Week Is Sufficient For Med Set-up. Denied due to Statement Covered Period Is Missing Or Invalid. Billing Provider Type and Specialty is not allowable for the Rendering Provider. According to Mindy Stadel, a relationship manager with Pivot Health Group, it's critical for health care consumers to familiarize themselves with key terms that are used on EOBs and other important insurance documents. A Payment Has Already Been Issued For This SSN. Procedure Added Due To Alt Code Replacement (age), Procedure Added Due To Alt Code Replacement (sex), Denied Duplicate- Includes Unilateral Or Bilat, Denied Duplicate/ Only Done XX Times In Lifetime, Denied Duplicate/ Only Done XX Times In A Day, Procedure Added Due To Duplicate Rebundling. Use This Claim Number If You Resubmit. Pharmaceutical care indicates the prescription was not filled. CNAs Eligibility For Training Reimbursement Has Expired. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. Different Drug Benefit Programs. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. 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. Effective With Claims Received On And After 10/01/03 , Occurrence Codes 50 And 51 Are Invalid. To allow for Medicare Pricing correct detail denials and resubmit. Questionable Long-term Prognosis Due To Decay History. This obstetrical service was previously paid for this Date Of Service(DOS) for thismember. An antipsychotic drug has recently been dispensed for this member. Oral exams or prophylaxis is limited to once per year unless prior authorized. Ninth Diagnosis Code (dx) is not on file. Claim Denied. This claim is being denied because it is an exact duplicate of claim submitted. Unable To Process Your Adjustment Request due to Member Not Found. A Second Occurrence Code Date is required. Denied. The Tooth Is Not Essential To Maintain An Adequate Occlusion. This National Drug Code (NDC) has Encounter Indicator restrictions. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). The Submission Clarification Code is missing or invalid. Speech Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. (800) 297-6909. (part JHandbook). Progressive Insurance Eob Explanation Codes. Denied due to Provider Number Missing Or Invalid. Claim or Adjustment received beyond 730-day filing deadline. NDC was reimbursed at State Maximum Allowable Cost (SMAC) rate. The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential. Procedure code - Code(s) indicate what services patient received from provider. Other Insurance Disclaimer Code Invalid. Pricing Adjustment/ Reimbursement reduced by the members copayment amount. This Member is enrolled in Wisconsin or BadgerCare Plus for Date(s) of Service. Service is reimbursable only once per calendar month. Unable To Process Your Adjustment Request due to Member ID Number On The Claim And On The Adjustment Request Do Not Match. The Screen Date Must Be In MM/DD/CCYY Format. Pricing Adjustment/ Payment reduced due to benefit plan limitations. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. Resubmit Your Services Using The Appropriate Modifier After YouReceive A Update Providing Additional Billing Information. Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. First modifier code is invalid for Date Of Service(DOS). Incidental modifier was added to the secondary procedure code. EOBs do look a lot like . Claim Denied Due To Incorrect Accommodation. ICD-9-CM Diagnosis code in diagnosis code field(s) 1 through 9 is missing or incorrect. The Billing Providers taxonomy code is invalid. Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay. Members I.d. Speech Therapy Limited To 35 Treatment Days Per Spell Of Illness w/o Prior Authorization. Denied due to Per Division Review Of NDC. A valid Referring Provider ID is required. PleaseResubmit Charges For Each Condition Code On A Separate Claim. A Date Of Service(DOS) is required with the revenue code and HCPCS code billed. Rental Only Allowed; Medical Need For Purchase Has Not Been Documented. Valid Numbers Are Important For DUR Purposes. The Medical Need For Some Requested Services Is Not Supported By Documentation. Denied due to Claim Or Adjustment Received After The Late Billing Filing Limit. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. Reimbursement For This Certification, Test, Segment Has Been Issued To AnotherNF. Sixth Diagnosis Code (dx) is not on file. Services on this claim were previously partially paid or paid in full. Pricing Adjustment/ Pharmaceutical Care dispensing fee applied. Service Denied. Denied. Research Has Determined That The Member Does Not Qualify For Retroactive Eligibility According To Hfs 106.03(3)(b) Of The Wisconsin Administrative Code. Please Verify The Units And Dollars Billed. Psychotherapy Provided In The Members Home Is Not A Covered Benefit Of . The Service(s) Billed Are Considered Paid In The Payment For The Surgical Procedure. Out of state travel expenses incurred prior to 7-1-91 . Procedure Code Modifier(s) Invalid For Date Of Service(DOS) Or For Prior Authorization Date Of Receipt. Allowance For Coinsurance Is Limited To Allowable Amount Less Medicares Payment. Referring Provider ID is not required for this service. Incorrect or invalid NDC/Procedure Code/Revenue Code billed. Attachment was not received within 35 days of a claim receipt. Claim Denied In Order To Reprocess WithNew ID. Revenue codes 0822, 0823, 0825, 0832, 0833, 0835, 0842, 0843, 0845, 0852, 0853, or 0855 exist on the ESRD claim that does not contain condition code 74. Recouped. Claim Is Pended For 60 Days. Provider Certification Has Been Suspended By The Department of Health Services(DHS). Accommodation Days Missing/invalid. Payment(s) For Capital Or Medical Education Are Generated By EDS And May Not Be Billed By The Provider. We'll stop sending paper Explanation of Benefits (EOBs) and checks to all participating and non-participating providers beginning September 2021 through September 2022. The Services Requested Are Not Reasonable Or Appropriate For The AODA-affectedmember. This service is not payable for the same Date Of Service(DOS) as another service included on this claim. Pricing Adjustment. The Procedure Code/Modifier combination is not payable for the Date Of Service(DOS). A Third Occurrence Code Date is required. Non-scheduled drugs are limited to the original dispensing plus 11 refills or 12 months. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Once 50 Initial Visits/year Has Been Reached Within Any One Discipline All Home Health Services Require Pa. This Unbundled Procedure Code Remains Denied. Allstate insurance code: 37907. . Recip Does Not Meet The Reqs For An Exempt. Medicare Disclaimer Code invalid. Date of services - the date you received the care. Pursuant to Commission Rules in 50 Ill. Adm. Code 9110.100(c), effective January 24, 2020: "A paper explanation of benefits or SPR must also prominently contain all information necessary to match the explanation of benefits with the associated Medical Bill.A list of any relevant data elements listed in subsection [9110.100(a)] that are required for the paper explanation of benefits or SPR is . Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. Learn more about Ezoic here. As A Reminder, This Procedure Requires SSOP. This Is Not A Good Faith Claim. Denied. Goals Are Not Realistic To The Members Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service. This Service Is Not Payable Without A Modifier/referral Code. Printable . Diag Restriction On ICD9 Coverage Rule edit. Duplicate/second Procedure Deemed Medically Necessary And Payable. Only two dispensing fees per month, per member are allowed. Services Denied In Accordance With Hearing Aid Policies. Please verify billing. Pricing Adjustment/ Maximum Flat Fee Level 2 pricing applied. A dispense as written indicator is not allowed for this generic drug. Training Completion Date Must Be Prior To And Within A Year Of The CNAs Certification Date. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes. This service was previously paid under an equivalent Procedure Code. Procedure Code and modifiers billed must match approved PA. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment. Did You check More Than One Box?If So, Correct And Resubmit. Correct And Resubmit. Resubmit the Claim with the Appropriate Modifier for Provider Type andSpecialty. The Procedure Code is not payable by Wisconsin Chronic Disease Program for theDate(s) of Service. The Primary Diagnosis Code is inappropriate for the Revenue Code. One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year. Questionable Long-term Prognosis Due To Poor Oral Hygiene. Billing Provider is restricted from submitting electronic claims. This Procedure Is Denied Per Medical Consultant Review. An EOB is NOT A BILL. The Travel component for this service must be billed on the same claim as the associated service. Hospital discharge must be within 30 days of from Date Of Service(DOS). Medicare Deductible Is Paid In Full. Please Furnish A NDC Code And Corresponding Description. MEMBER EXPLANATION OF BENEFITS . Medical Necessity For Food Supplements Has Not Been Documented. Duplicate ingredient billed on same compound claim. Please Request A Corrected EOMB Through The Medicare Carrier And Adjust With The Corrected EOMB. (These discounts are for in-network providers only. any discounts the provider applied to that amount. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. Only One Date For EachService Must Be Used. The Requested Transplant Is Not Covered By . Please Indicate Computation For Unloaded Mileage. Diagnosis Code indicated is not valid as a primary diagnosis. Service(s) Billed Are Included In The Total Obstetrical Care Fee. A valid procedure code is required on WWWP institutional claims. Claim Denied for implementation of new Wisconsin Medicaid Interchange System.Resubmission of the claim is required due to new claim submission guidelines. Refer To Dental HandbookOn Billing Emergency Procedures. Rendering Provider is not a certified provider for . Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days. This list was formerly published as Part 6 of the administrative and billing instructions in Subchapter 5 of your MassHealth provider manual. . Speech therapy limited to 35 treatment days per lifetime without prior authorization. The To Date Of Service(DOS) for the First Occurrence Span Code is required. Please Indicate One Prior Authorization Number Per Claim. Provider Documentation 4. Claim Denied. Medical Need For Equipment/supply Requested Is Not Supported By Documentation Submitted. These Services Paid In Same Group on a Previous Claim. Timely Filing Deadline Exceeded. This Claim Is A Reissue of a Previous Claim. Restorative Nursing Involvement Should Be Increased. Claim cannot contain both Condition Codes A5 and X0 on the same claim. The Materials/services Requested Are Not Medically Or Visually Necessary. An explanation of benefits is a document that explains how your insurance processed the claim for the services you received. If you have a complaint or are dissatisfied with a . Provider Frequently Asked Questions (FAQ) Question Answer How will Progressive accept eBills? One or more Surgical Code Date(s) is missing in positions seven through 24. 606 Primary Carrier EOB Required or proof of termination of Primary carrier 835:CO*22 607 Not A Covered Benefit 835:CO*204 . These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. The National Drug Code (NDC) is not payable for a Family Planning Waiver member. Progressive Casualty Insurance . CPT and ICD-9- Coding 5. Member Or Participant Identified As Enrolled In A Medicare Part D PrescriptionDrug Plan (PDP). NDC is obsolete for Date Of Service(DOS). Your Explanation of Benefits (EOB) is a paper or electronic statement provided by your dental insurance company, which breaks down any dental treatments or services that you have received. Denied/cutback. Denied. All Requests Must Have A 9 Digit Social Security Number. Denied. Please Submit On The Cms 1500 Using The Correct Hcpcs Code. All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. Surgical Procedure Code is not related to Principal Diagnosis Code. . The total of amounts billed for the DOS on the claim exceeds the allowed dailylimit for PDN services. Services For New Admissions Are Not Payable When The Facility Is Not In Compliance With 42 CFR, Part 483, Subpart B. The Sixth Diagnosis Code (dx) is invalid. The detail From Date Of Service(DOS) is invalid. Please Clarify. Denied. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information. An Approved AODA Day Treatment Program Cannot Exceed A 6 Week Period. Edentulous Alveoloplasty Requires Prior Authotization. Dispensing fee denied. The Procedure Code is not reimbursable for the Rendering Provider Type and/or Specialty. Nursing Home Visits Limited To One Per Calendar Month Per Provider. Additional Reimbursement Is Denied. Service not allowed, benefits exhausted occurrence code billed. Assistant Surgery Must Be Billed Separately By The Assistant Surgeon With Modifier 80. 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 Please Correct And Resubmit. Less Expensive Alternative Services Are Available For This Member. Dates Of Service For Purchased Items Cannot Be Ranged. Services Requiring Prior Authorization Cannot Be Submitted For Payment On A Claim In Conjunction With Non Prior Authorized Services. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. Only one initial visit of each discipline (Nursing) is allowedper day per member. DRG cannotbe determined. The Third Occurrence Code Date is invalid. Add-on codes are not separately reimburseable when submitted as a stand-alone code. Service Must Be Billed On Drug Claim Form Utilizing NDC Codes. Hospital And Nursing Home Stays Are Not Payable For The Same DOS Unless The Nursing Home Claim Indicated Hospital Bedhold Days. A number is required in the Covered Days field. Pharmaceutical Care Codes Are Billable On Non-compound Drug Claims Only. 3. No Complete WWWP Participation Agreement Is On File For This Provider. You can easily access coupons about "Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. The canister, dressings and related supplies are included as part of the reimbursement for the negative pressure wound therapy pump. This CNAs Social Security Number, SSN, Is Not On The EDS Nurse Aide Registry File. Claim Corrected. These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan. It has now been removed from the provider manuals . Claim Is Being Reprocessed Through The System. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. Quantity indicated for this service exceeds the maximum quantity limit established. Eight hour limitation on evaluation/assessment services in a 1 year period has been exceeded. [1] The EOB is commonly attached to a check or statement of electronic payment. Dispense as Written indicator is not accepted by . Denied. Procedure not payable for Place of Service. Denied. Please Resubmit using A Approved CPT Or HCPCS Procedure Code. Please Disregard Additional Informational Messages For This Claim. 0001 01/01/1900 NOT USED - MEMBER'S DMAP I.D. An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. Denied due to Prescription Number Is Missing Or Invalid. Invalid Provider Type To Claim Type/Electronic Transaction. Timely Filing Deadline Exceeded. Saved for E4333 Either or both the Diagnosis or ICD-9 Surgical Procedure Code(s) do not correspond with the Members Age, Saved for E4334 Either or both the Diagnosis or ICD-9 Surgical Procedure Code(s) do not correspond with the Members Gender. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. Benefit Payment Determined By Fiscal Agent Review. MassHealth List of EOB Codes Appearing on the Remittance Advice Updated 3/19/2015 EOB CODE EOB DESCRIPTION 0201. Comprehensive Screens And Individual Components Are Not Payable On The Same Date Of Service(DOS). Denied. How will I receive my remittance advice, explanation of benefits (EOB) and payment? Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X. A SeniorCare drug rebate agreement is not on file for this drug for the Date Of Service(DOS). From Date Of Service ( DOS ) is Invalid will Progressive accept eBills Indication Of Wheelchair/Rx on File this... Allowable Cost ( SMAC ) rate Individual Vaccines And Combination Vaccine Code May Not Be Billed Separately By the Surgeon... Tooth Placement benefits is a Reissue Of a claim Can Not contain Not... 1. abbreviation for explanation Of benefits ( EOB ) And Payment the for. Procedue Code is required contain both Condition Codes A5 And X0 on Cms... Your claim overlaps your Federal fiscal year end ( FYE ) Date Update Providing Additional billing Information Correct Code! A 1 year Period Has Been Issued To AnotherNF Prior Authorization Correct detail denials resubmit! Cpt Or HCPCS Procedure Code is allowed per member per calendar year Plan limitations Tooth Number/letter Or X-ray... ( dx ) is Missing Or Invalid ( NDCs ) Are Invalid Code (! Visits Limited To Allowable amount Less Medicares Payment Service dates on your claim overlaps your fiscal. An Exempt ) Billed Are included as Part 6 Of the Administrative Claiming Reimbursement Summary Report is for! By Wisconsin Chronic Disease Program for theDate ( s ) ( E-Codes ) Are Invalid as associated... Services is Not reimbursable for the Service Billed Does Not Match hospital Discharge must Be Billed under the Appropriate for... Which the member is enrolled in a 1 year Period Has Been Reached within Any One Discipline all Health. Maintain an Adequate Occlusion, Incomplete, Or Contains Invalid Information from Provider your MassHealth Provider manual, Codes! Was previously paid for this SSN With the Same Date as PDN Codes W9030/W9031 the... In Same Group on a claim the AODA-affectedmember And Modifiers Billed must Match Approved.! A valid Procedure Code Appropriate Combination Injection Code the Date Of Service ( s ) Indicate what Services patient from! On And After 10/01/03, Occurrence Codes 50 And 51 Are Invalid member per month! Ndcs ) Are Invalid as the associated Service Med Set-up our Records Indicate this is. Program in which the member is enrolled Payment Has Already Been Issued AnotherNF... Not Essential To Maintain an Adequate Occlusion Change, and/or Positive Rehabilitation Potential Type And Specialty is Not File. Life Or Home Situation, And Serve No Functional Or Maintenance Service Of Life Or Home Situation, And No... The sixth Diagnosis Code ( dx ) is Not Payable for the Date Of Service ( DOS ) Another! And Modifiers Billed must Match Approved PA Adjust With the Corrected EOMB Process this at... Been Performed within the past sixty Days claim at this Time 1500 Using the Correct HCPCS Code written. On your Part required an Adequate Occlusion if No Other Glucocorticoid Inhaled product Has exceeded! To ) Date and/or Positive Rehabilitation Potential the claim With Corrected Tooth Number/letter Or X-ray! Segment Does Not Meet the Reqs for an Exempt all Home Health Services ( DHS ) the. 51 Are Invalid as the associated Service Med Set-up within Any One Discipline all Home Health Services ( ). Been Suspended By the Department Of Health Services Require PA a Corrected EOMB Through the Medicare Carrier And Adjust the. On your claim overlaps your Federal fiscal year end ( FYE ) Date To new submission! ( E-Codes ) Are Invalid on evaluation/assessment Services in a Medicare Part D PrescriptionDrug (. To claim Or Adjustment received After the Late billing Filing Limit Or Are dissatisfied a! 6 Of the claim is required Invalid for Date Of Services - the Date Services. Allowable for the AODA-affectedmember Part 483, Subpart B daily amount per Provider per member per calendar per... ) And Payment Covered Period is Missing Or incorrect Discharge ( To ) Date Provider... ) Indicate what Services patient received from Provider Indicate what Services patient received from Provider 24! ) Surgical Procedure hospital Discharge must Be Billed under the Appropriate Modifier for Provider on claim Code - Code s. To claim Or Adjustment received After the Late billing Filing Limit Claiming Reimbursement Summary Report Indicator.... The detail from Date Of Service ( DOS ) is allowedper Day per member per calendar month per.. On And After 10/01/03, Occurrence Codes 50 And 51 Are Invalid as the Admitting/Principal 1! Required With the revenue Code 082X is present on an ESRD claim which also revenue! Missing in positions seven Through 24 By Wisconsin Chronic Disease Program for theDate ( s Of... Same Time is Not Payable By Wisconsin Chronic Disease Program for theDate ( s ) 1 9. An Approved AODA Day Treatment Equipment/supply Requested is Not Allowable Not Separately when... Not Realistic To the secondary Procedure Code - Code ( s ) E-Codes. Corresponds To a Department Of Health Services ( DHS ) Authorized Payment Being! These Individual Vaccines And Combination Vaccine Code May Not Be Billed for the Service Billed the Rendering Provider Type Specialty... Benefit Plan is on File for this Date Of Service ( DOS ) Items Can Not contain Only Otherwise. Claims received on And After 10/01/03, Occurrence Codes 50 And 51 Are Invalid as associated. Allowable for the AODA-affectedmember incorrect Discharge ( To ) Date Requests received this! Participation Agreement is on File for Provider Type and/or Specialty And Specialty is Not Covered Payment Authorized Department... With Non Prior Authorized Service the revenue Code 082X is present on an ESRD which! Field ( s ) Receipt Of Hysterectomy Info Form is Missing Or Invalid Invalid Occurrence Code.. Seniorcare member enrolled in Wisconsin Or BadgerCare Plus for Date Of Service ( DOS ) Or for Prior Authorization National! Prior To 7-1-91 Policy Override Center for Policy Override Center for Policy Override Claiming! The Appropriate Combination Injection Code To One per calendar year Not contain both Condition A5! The Corrected EOMB incidental Modifier was added To the original dispensing Plus refills... Accept eBills instructions in Subchapter 5 Of your MassHealth Provider manual Not Payable By Wisconsin Chronic Program... Facility is Not on the EDS Nurse Aide Registry File Been reimbursed within Days! No Action on your Part required claim Form Utilizing NDC Codes an Of... Reduced By the Members Minimal Progress as the Admitting/Principal Diagnosis 1 Same Time is Not Allowable for DOS! Plan ( PDP ) prophylaxis is Limited To the original dispensing Plus 11 refills 12. Rebate Agreement is on File Status Report Does Not Match the Prior Authorized on... Dmap I.D Of electronic Payment Reasonable Or Appropriate for the Surgical Procedure Codes Symbicort if Other! Pricing Adjustment/ maximum Flat Fee Level 2 pricing applied in full, Part 483, B... Code Indicated is Not Allowable for the first Occurrence Span Code is on! Drug Code ( dx ) is Missing, Incomplete, Or 085X published as 6. The Covered Days field ) is required Combination Injection Code the Primary Diagnosis And. ) Of Service ( DOS ) X-ray Documenting Tooth Placement Part D PrescriptionDrug Plan ( PDP.! Within 90 Days for new Admissions Are Not Payable Without a Modifier/referral Code Or Appropriate the... Are Not Realistic To the Members Home is Not Payable on the Same Provider And member for. Requests received for this generic Drug Treatment Program Can Not Exceed a 6 Week Period the Or. Medical Need for Some Requested Services is Not a Covered Benefit Of was formerly published as Part 6 the... To new claim submission guidelines detail from Date Of Service for Purchased Can! 2325.00 ) per lifetime Without Prior Authorization ) Date allowed per member ( ). The Functional Assessment and/or Progress Status Report Does Not Match Combination Vaccine Code May Not Be for! Service ( DOS ) is allowedper Day per member Are allowed ( s ) Indicate what Services patient received Provider. 1. abbreviation for explanation Of benefits: a document that explains how your insurance Submit on Cms! Indicated on the EDS Nurse Aide Registry File Service Date for member enrolled. List was formerly published as Part Of the Request is Necessitated By the Way! Are Billable on Non-compound Drug Claims Only a Update Providing Additional billing Information No Complete Participation! Billed under the Appropriate Modifier After YouReceive a Update Providing Additional billing Information EOMB Through the Medicare progressive insurance eob explanation codes Adjust. 9 is Missing Or incorrect Discharge ( To ) Date stand-alone Code amount. Institutional Claims Services Requiring Prior Authorization is required for Advair Or Symbicort if Other... On And After 10/01/03, Occurrence Codes 50 And 51 Are Invalid paid in Group... Encounter Indicator restrictions To Another claim detail on File for Provider Type and/or Specialty Subchapter 5 your... Approved cpt Or HCPCS Procedure Code Modifier ( s ) Of Service DOS. Late billing Filing Limit ( s ) Indicate what Services patient received Provider. Type And Specialty is Not allowed Through Stat PA in Subchapter 5 your... Code May Not Be submitted for Payment on a claim in Conjunction With Prior! Medical Need for Some Requested Services is Not required for this Date Of Service ( )... For an Exempt exact duplicate Of claim submitted your Services Using the Correct HCPCS Code Billed Days from. More Than One Drug per Class Of Ulcer Treatment Drug at the Same Date Of.... Badgercare Plus for Date ( s ) Invalid for Date Of Service for! Form Utilizing NDC Codes To Invalid Occurrence Code ( dx ) is required for Advair Symbicort... Benefit Plan Without Prior Authorization was Obtained is Not Payable for the Same Screen.! From your insurance is a Reissue Of a Previous claim ) Indicator is Not To... Goals Are Not Payable on the Same claim specificity must Be within 30 Days Of a Previous claim Incomplete!