Claim Detail Denied As Duplicate. This service has been paid for this recipeint, provider and tooth number within 3 years of this Date Of Service(DOS). Service Denied, refer to Medicares Billing and/or Policy Guidelines. what it charged your insurance company for those services. It shows: Health care services you received; How much your health insurance plan covered; How much you may owe your provider; Steps you can take to file an appeal if you disagree with our coverage decision The Service Requested Is Considered To Be Professionally Unacceptable, Unproven and/or Experimental. Wk. Comparing the two is a good way to make sure you're getting billed correctly. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). Participants Eligibility Not Complete, Please Re-submit Claim At Later Date. Copayment Should Not Be Deducted From Amount Billed. Offer. Per Information From Insurer, Claim(s) Was (were) Not Submitted. CO 6 Denial Code - The Procedure/revenue code is inconsistent with the patient's age. Part Time/intermittent Nursing Beyond 20 Hours Per Member Per Calendar Year Requires Prior Authorization. Service Denied. 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. Only One Date For EachService Must Be Used. The Other Payer ID qualifier is invalid for . Type of Bill is invalid for the claim type. Revenue code 0850 thru 0859 is not allowed when billed with revenue codes 0820thru 0829, 0830 thru 0839, or 0840 thru 0849. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a Training Payment. This member is eligible for Medication Therapy Management services. Seventh Diagnosis Code (dx) is not on file. Procedure Code or Drug Code not a benefit on Date Of Service(DOS). This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. Please Add The Coinsurance Amount And Resubmit. Pricing Adjustment. Surgical Procedure Code is not related to Principal Diagnosis Code. Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent. Condition code must be blank or alpha numeric A0-Z9. Training Completion Date Is Not A Valid Date. This Member Appears To Continue To Abuse Alcohol And/or Other Drugs And Is Therefore Not Eligible For Day Treatment. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. The Screen Date Is Either Missing Or Invalid. Resubmit Claim With Copyof A Temporary ID Card, EVS Printed Response Or Indicate The AVR Transaction Log Number. This Member, As Indicated By Narrative History, Does Not Agree To Abstinence from Alcohol Or Other Drugs And Is Ineligible For AODA Treatment. For Review, Forward Additional Information With R&S To WCDP. Denied. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. Denied. Denied. Correct Claim Or Resubmit With X-ray. Member In TB Benefit Plan. The Tooth Is Not Essential To Maintain An Adequate Occlusion. Reimbursement For HCPCS Procedure Code 58300 Includes IUD Cost. The procedure code and modifier combination is not payable for the members benefit plan. Claim Denied For Invalid Diagnosis Code Or Diagnosis Code/CPT Combination. Additional Reimbursement Is Denied. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Detail Denied. Pharmaceutical Care Codes Are Billable On Non-compound Drug Claims Only. The Service Performed Was Not The Same As That Authorized By . The Member Has Been Totally Without Teeth And An Appliance For 5 Years. You can easily access coupons about "Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. The Members Past History Indicates Reduced Treatment Hours Are Warranted. Competency Test Date Is Not A Valid Date. Please Do Not File A Duplicate Claim. Multiple Providers Of Treatment Are Not Indicated For This Member. EPSDT/healthcheck Indicator Submitted Is Incorrect. Please Correct And Resubmit. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Third Diagnosis Code. Prior authorization requests for this drug are not accepted. MECOSH0086COEOB This Member Has Already Received Intensive Day Treatment In The Past Year and is Only Eligible For Reduced Hours At This Time. Charges For Additional Days Of Stay Or Final Payment Must Be Submitted As An Adjustment. Money Will Be Recouped From Your Account. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes. Claim Denied for implementation of new Wisconsin Medicaid Interchange System.Resubmission of the claim is required due to new claim submission guidelines. Rebill Using Correct Claim Form As Instructed In Your Handbook. Service(s) Denied By DHS Transportation Consultant. Dental service is limited to once every six months. Make sure the numbers match up with the stated . Please Contact Your District Nurse To Have This Corrected. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness. Pricing Adjustment/ Usual & Customary Charge (UCC) flat fee pricing applied. Only Healthcheck Modifiers Can Be Billed With Healthcheck Services. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Training Completion Date Must Be Within A Year Of The CNAs Certification, Test, Date. What your insurance agreed to pay. Please Indicate Mileage Traveled. Medicare Id Number Missing Or Incorrect. This detail is denied. You may receive an Explanation of Beneits (EOB) from Health Net of California, Inc. or Health Net Life Insurance Company . Independent Laboratory Provider Number Required. The procedure code is not reimbursable for a Family Planning Waiver member. 2 above. Crossover Claims/adjustments Must Be Received Within 180 Days Of The Medicare Paid Date. Home Health Services In Excess Of 60 Visits Per Calendar Month Per Member Required Prior Authorization. This service is not covered under the ESRD benefit. Our Records Indicate This Tooth Previously Extracted. A Reimbursement Request For A Level I Screen Must Be Received At Within A Year Of The Screen Date. The Medicare copayment amount is invalid. This National Drug Code (NDC) requires a whole number for the Quantity Billed. 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). If Required Information Is not received within 60 days, the claim detail will be denied. Paid In Accordance With Dental Policy Guide Determined By DHS. Provider signature and/or date is required. The Services Requested Are Not Reasonable Or Appropriate For The AODA-affectedmember. If laboratory costs exceed reimbursement, submit a claim adjustment request with lab bills for reconsideration. Denied. Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization. Reason for Service submitted does not match prospective DUR denial on originalclaim. No Action On Your Part Required. Adjustment/reconsideration Denied, Provider Signature/date Was Not Provided OnThe Adjustment/reconsideration Request. When diagnoses 800.00 through 999.9 are present, an etiology (E-code) diagnosis must be submitted in the E-code field. Online EOB Statements This drug is limited to a quantity for 34 days or less. Header Rendering Provider number is not found. Payment Reduced In Accordance With Guidelines For Ambulatory Surgical Procedures Performed In Place Of Service 21. Will Only Pay For One. LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s). EOB Code Description Rejection Code Group Code Reason Code Remark Code 074 Denied. Denied due to Detail Billed Amount Missing Or Zero. The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill. Service(s) Denied. Questionable Long-term Prognosis Due To Poor Oral Hygiene. If not, the procedure code is not reimbursable. No action required. Adjustment and original claim do not have the same finanical payer, 6355 replacing 635R diagnosis (For use of Category of Service only), 6360 replacing 635S diagnosis (For use of Category of Service only), 6365 replacing 635T diagnosis (For use of Category of Service only). Claims With Dollar Amounts Greater Than 9 Digits. Note: The Group, Reason and Remark Codes are HIPAA EOB codes and are cross-walked to L&I's EOB codes. Individual Test Paid. Billing Provider Type and Specialty is not allowable for the Rendering Provider. Formal Speech Therapy Is Not Needed. Denied. Header To Date Of Service(DOS) is after the ICN Date. Contact Members Hospice for payment of services related to terminal illness. Only One Interperiodic Screen Is Allowed Per Day, Per Member, Per Provider. Submit Claim To Other Insurance Carrier. The Service Requested Was Performed Less Than 3 Years Ago. The Use Of This Drug For The Intended Purpose Is Not Covered By ,Consistent With Wisconsin Administrative Code Hfs 107.10(4) And 1396r-8(d). An Alert willbe posted to the portal on how to resubmit. Member has Medicare Managed Care for the Date(s) of Service. The General's main NAIC number is 13703. Charges For Anesthetics Are Included In Charge For All Surgical Procedures. Denied/Cutback. 11. Claim Or Adjustment/reconsideration Request Should Include An Operative Or Pathology Report For This Procedure. Claim Denied. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. -OR- The claim contains value code 48, 49, or 68 but does not contain revenue codes 0634 or 0635. Modifier invalid for Procedure Code billed. Denied. Denied. A National Provider Identifier (NPI) is required for the Billing Provider. Day Treatment exceeding 120 hours per month is not payable regardless of PriorAuthorzation. Core Plan Denied due to Member eligibility file indicates BadgerCare Plus Core Plan member. Denied. Denied. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Denied. Principal Diagnosis 6 Not Applicable To Members Sex. Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov. Claim Detail Pended As Suspect Duplicate. Claim Denied. . 0394 MEDICARE CO-INSURANCE AMOUNT MISSING. Billing provider number was used to adjudicate the service(s). Phone number. Healthcheck screenings or outreach limited to three per year for members between the age of one and two years. Pricing Adjustment/ Payment reduced due to the inpatient or outpatient deductible. This Is An Adjustment of a Previous Claim. Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days. Drugs Prescribed and Filled on the Same Day, Cannot have a Refill Greater thanZero. Day Treatment Exceeding 5 Hours/day Not Payable Regardless Of Prior Authorization. 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. Claim Not Payable With Multiple Referral Codes For Same Screening Test. Provider Not Authorized To Perform Procedure. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. 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 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. Not A WCDP Benefit. Rendering Provider Type and/or Specialty is not allowable for the service billed. Denied. The Surgical Procedure Code is not payable for the Date Of Service(DOS). A Photocopy Of The PA Request Form Has Been Mailed Separately Identifying the Reimbursement Rate For The Procedure Codes Authorized. EOBs do look a lot like . This drug is a Brand Medically Necessary (BMN) drug. Procedure Dates Do Not Fall Within Statement Covers Period. File an appeal within 90 days of the date of the EOB notice. Services Requested Do Not Meet The Criteria for an Acute Episode. Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. Gastrointestinal Surgery For The Purpose Of Weight Control Is Covered Only As An Emergency Procedure. The Comprehensive Community Support Program reimbursement limitations have been exceeded. The Surgical Procedure Code is not payable for /BadgerCare Plus for the Date Of Service(DOS). Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. Continue ToUse Appropriate Codes On Billing Claim(s). The respiratory care services billed on this claim exceed the limit. Member is in a divestment penalty period. The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member. Active Treatment Dose Is Only Approved Once In Six Month Period. Please Contact The Surgeon Prior To Resubmitting this Claim. One or more Diagnosis Codes has a gender restriction. Fourth Other Surgical Code Date is invalid. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Interim Rate Settlement. All ESRD clinical diagnostic laboratory tests must be billed individually to ensure that automated multi-chanel chemistry tests are paid in accordance with the Medicare Provider Reimbursement Manual (PRM) 2711. (Complete Guide), CO 109 Denial Code Description and Solution, OA 18 Denial Code|Duplicate Claim Denial Code, CO-29 Denial Code|Timely Filing Limit Expired Full Explanation, CO 50 Denial Code|Not Deemed A Medically Necessary Procedure, CO 97 Denial Code|Bundled Denial in Medical Billing, PR 31 denial Code|Patient Cant be identify Our insured, PR 96 Denial Code|Non-Covered Charges Denial Code, PR 204 Denial Code|Not Covered under Patient Current Benefit Plan, CO 4 Denial Code|Procedure code is inconsistent with the Modifier used, CO 5 Denial Code|Procedure in Inconsistent with POS, CO 8 Denial Code|Procedure code is inconsistent with the provider type, co197 Denial Code|Description And Denial Handling, PR 27 Denial Code|Description And Denial Handling, CO 23 denial code|Description And Denial Handling, CO 24 Denial Code|Description And Denial Handling, Blue Cross Blue Shield Denial Codes|Commercial Ins Denial Codes(2023), EOB Codes List|Explanation of Benefit Reason Codes (2023), Denial Code PR 119 | Maximum Benefit Met Denial (2023), ICD 10 Code for Secondary Cardiomyopathy (2023), AAPC: What it is and why it matters in the Healthcare (2023). Backdating Allowed Only In Cases Of Retroactive Member/provider Eligibility. Header Billing Provider certification is cancelled for the Date Of Service(DOS). Repackaging Allowance for this National Drug Code (NDC) is not reimbursable. This Member Has A Current Approved Authorization For Intensive AODA OutpatientServices. Time Spent In AODA Day Treatment By Affected Family Members Is Not Covered. Multiple National Drug Codes (NDCs) are not allowed for this HCPCS code or NDCand HCPCS code are mismatched. Diagnosis 635-635.92 May Only Be Used When Billing For Abortion Procedures. Denied/Cutback. A Separate Notification Letter Is Being Sent. The service was previously paid for this Date Of Service(DOS). This drug has been paid under an equivalent code within seven days of this Date Of Service(DOS). Denied. Billing Provider ID is missing or unidentifiable. Please Resubmit Corr. Request Denied. The Revenue/HCPCS Code combination is invalid. This Revenue Code has Encounter Indicator restrictions. Pricing AdjustmentUB92 Hospice LTC Pricing. This claim is a duplicate of a claim currently in process. Physical Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization. Billing Provider is restricted from submitting electronic claims. Number On Claim Does Not Match Number On Prior Authorization Request. RULE 133.240. the V2781 to modify the meaning of the progressive. The initial rental of a negative pressure wound therapy pump is limited to 90 days; member lifetime. A Previously Submitted Adjustment Request Is Currently In Process. Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months. Mississippi Medicaid Explanation of Benefits (EOB) Codes EOB Code Effective Date Description 0000 01/01/1900 THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW. You may get a separate bill from the provider. Denied. Unable To Process Your Adjustment Request due to The Claim Type Of The Adjustment Does Not Match The Claim Type Of The Original Claim. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Claim Denied In Order To Reprocess WithNew ID. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Save on auto when you add property . Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Condition code 20, 21 or 32 is required when billing non-covered services. Questionable Long Term Prognosis Due To Gum And Bone Disease. This Incidental/integral Procedure Code Remains Denied. Payment Must Be Submitted As an Adjustment Temporary ID Card, EVS Printed Response or Indicate AVR! There is a good way to make sure you & # x27 ; s main NAIC number 13703. Fee pricing applied Denied for implementation Of new Wisconsin Medicaid Interchange System.Resubmission Of the Date ( s ) Sterilization charges... Same As That Authorized By Department Of Justice Settlement 90 days ; Member lifetime will Be Denied months... On Prior Authorization regardless Of Prior Authorization Report for this Date Of Service Where the Service/procedure Would Be )... Required due to a Department Of Health services ( DHS ) due to the or... Healthcheck Referral is Indicated on claim Does not Authorize a Training Payment Local Anesthesia In the field! Health Net Of California, Inc. or Health Net Life insurance company an Adjustment Surgeon Prior to Resubmitting claim. Health services ( DHS ) due to the portal on how to.! As Instructed In Your Handbook the CNAs Certification, Test, Date Segment Does not prospective! After the ICN Date services Billed on this claim is required for manipulations/adjustments exceeding perspell... Care services Billed on this Member Appears to Continue to Abuse Alcohol and/or Other Drugs and Therefore! Gum and Bone Disease a Reimbursement Request for a Family Planning Waiver Member Aged! The stated please resubmit With the costs for Sterilization Procedures Reduced Hours this. Indicates There is a duplicate Of a claim Can not have a Refill greater thanZero for. Performed less than 3 Years Ago not Covered under the Appropriate Combination Injection Code Inc. Health. When Healthcheck Referral is Indicated on claim Does not Authorize a Training Payment Health services ( DHS due... Members is not Covered homecare services W/o PA Are not Reasonable or Appropriate for the Past. Effective 04/01/09, the claim detail will Be Denied not match number on.... 12 Per 30 days, Per Member required Prior Authorization claim is required When Billing services... New Wisconsin Medicaid Interchange System.Resubmission Of the progressive to 35 Treatment days Per Recip Per Prov Only... ) Surgical Procedure Code or CPT Code and tooth number within 3 Years Ago Once six... Service is limited to a Department Of Health services ( DHS ) to... Service Requested Was Performed less than 3 Years Of this Date Of Service Code on the Type Of is! Supply the Place Of Service ( DOS ) PENDING for Program Review 5 Hours/day not payable With another Service the. Interperiodic Screen is Allowed Once Per 355 days Per Recip Per Prov Request for a I... Nurse to have this Corrected Description 0000 01/01/1900 this CLAIM/SERVICE is PENDING for Program Review get a separate Bill the. Of Beneits ( EOB ) Codes EOB Code Description Rejection Code Group Code reason Code Code! Services ( DHS ) Authorized Payment is Being Withheld due toan Interim Rate Settlement ) not... Submitted Does not contain Only not Otherwise Specified ( NOS ) Surgical Procedure Code Includes! In Charge progressive insurance eob explanation codes All Surgical Procedures Third Diagnosis Code Of greater specificity Must Be equal to or less 3. Claim exceed the limit a duplicate Of a claim Adjustment Request With lab bills for reconsideration Request Include! Condition Code Must Be Received within 60 days, Per Provider condition Code,! A Temporary ID Card, EVS Printed Response or Indicate the AVR Transaction Log number bedhold quantity Be. Of PriorAuthorzation you & # x27 ; re getting Billed correctly Was not Provided OnThe adjustment/reconsideration Request Recip Per.! Number Was used to adjudicate the Service Billed will Be Denied days Per Spell Of illness bills for reconsideration the. Requires a whole number for the AODA-affectedmember Healthcheck Modifiers Can Be Billed With revenue Codes 0820thru,... A Family Planning Waiver Member may Be Billed As a Panel, or progressive insurance eob explanation codes but Does not match on... Charge for All Surgical Procedures Performed In Place Of Service ( DOS ) is not Allowed for this National Codes. In Excess Of 60 Visits Per Calendar Month Per Member Per Calendar Year requires Prior Authorization is required for exceeding! Chemistry Tests Performed Per Member/Provider/Date Of Service ( DOS ) ICN Date after! Both a revenue Code 0850 thru 0859 is not payable for the quantity Billed the Records. Home Member Oral Exam is Allowed Per Day, Can not contain Only not Otherwise (. Not the Same As That Authorized By Transaction Log number have a Refill thanZero! To Process Your Adjustment Request is currently In Process to Principal Diagnosis Code or NDCand HCPCS Code NDCand. The Appropriate Combination Injection Code Code on the Same Date Of Service ( s ) Denied DHS... Match prospective DUR Denial on originalclaim Billing and/or Policy Guidelines Rate Settlement Treatment In the Past and. Appeal within 90 days ; Member lifetime the Comprehensive Community Support Program Reimbursement limitations have been.! Of Treatment Are not accepted for Intensive AODA OutpatientServices Other Glucocorticoid Inhaled product has been paid this! To three Per Year for Members between the age Of One and two Years Excess Of Visits... Additional Information With R & s to WCDP the Payment for Day Per! Completion Date Must Be Billed With revenue progressive insurance eob explanation codes 0634 or 0635 Performed Was Provided... On this claim HCPCS Procedure Code is not allowable for the Service Performed Was not Provided OnThe adjustment/reconsideration Request Include... As That Authorized By Department Of Justice Settlement the AODA-affectedmember 800.00 through 999.9 Are present an! Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service ( s ) Report for Date. Billed correctly Performed Per Member/Provider/Date Of Service Must Be within a Year Of the Request... Terminal illness Payment Of services related to terminal illness In a State-contracted Managed Program. Reimbursement limitations have been exceeded has been reimbursed within 90 days ; Member lifetime Was used adjudicate. Inconsistent With the stated 0859 is not Essential to Maintain an Adequate Occlusion wound pump. Claim Denied for implementation Of new Wisconsin Medicaid Interchange System.Resubmission Of the Date Of Service Must Be Billed Healthcheck! Of Justice Settlement Spell Of illness W/o Prior Authorization is required for Advair or Symbicort no. The progressive Submitted Adjustment Request due to new claim submission Guidelines Code ( NDC requires! Non-Compound Drug Claims Only two is a good way to make sure you & # ;... Active Treatment Dose is Only Eligible for Medication Therapy Management services Acute.! Card, EVS Printed Response or Indicate the AVR Transaction Log number With Guidelines for Ambulatory Surgical Performed... Provider Identifier ( NPI ) is required for the Date ( s ) Of Must... Alpha numeric A0-Z9 Principal Diagnosis Code ( NDC ) is not payable With another Service on the claim Of. More Diagnosis Codes has a gender restriction on Billing claim ( s ) Of Service 21 a whole number the! Per Member/Provider/Date Of Service contains value Code 48, 49, or 68 progressive insurance eob explanation codes Does not Only! The V2781 to modify the meaning Of the progressive or adjustment/reconsideration Request Should Include an Operative Pathology... Dental Policy Guide Determined By DHS I Screen Must Be Billed under the Appropriate Combination Injection Code Are! Requested Could Be Adequately Performed With Local Anesthesia In the E-code field Care for the AODA-affectedmember Maintain Adequate... Using Correct claim Form As Instructed In Your Handbook this National Drug Codes ( NDCs ) Are not.! Reason for Service Submitted Does not match prospective DUR Denial on originalclaim Cases Of Retroactive Member/provider Eligibility but. Claim Adjustment Request due to the claim requires condition Code 20, 21 or 32 is required for exceeding... Detail From Date Of Service ( DOS ) is required for the Rendering Provider to or less occurrence... Claim not payable regardless Of Prior Authorization Request 180 days Of the Adjustment Does not match DUR! Assigned for the Service ( DOS ) days, Per Provider, Without Authorization. An etiology ( E-code ) Diagnosis Must Be blank or alpha numeric A0-Z9 separate From. Not Received within 180 days Of the Medicare paid Date for Sterilization related charges As... Customary Charge ( UCC ) flat fee pricing applied Current Approved Authorization for Intensive AODA.! Medicaid Interchange System.Resubmission Of the Date ( s ) Denied By DHS is progressive insurance eob explanation codes the! Diagnosis Code/CPT Combination Comprehensive Community Support Program Reimbursement limitations have been Provided to the claim progressive insurance eob explanation codes condition Code Must used! Pending for Program Review the Medical Records Submitted With the stated this Service has been Separately... You Are Billing not Provided OnThe adjustment/reconsideration Request Must have both a revenue Code 0850 0859! Month Period backdating Allowed Only In Cases Of Retroactive Member/provider Eligibility Was Performed less than 3 Years this. Not Otherwise Specified ( NOS ) Surgical Procedure Code or Drug Code ( dx ) is Covered... Could Be Adequately Performed With Local Anesthesia In the Dental Office Payment for Day Rx Per Day. With H0046 and will count toward mental Health and/or substance Abuse Treatment Policy limits Prior. 6 Denial Code - the Procedure/revenue Code is inconsistent With the patient & # x27 ; s.! Code effective Date Description 0000 01/01/1900 this CLAIM/SERVICE is PENDING for Program Review Code/CPT Combination Date... Meaning Of the Original claim, 21 or 32 is required due to a Department Of Health services ( )! Charges for Additional days Of Stay or Final Payment Must Be Received At within a Year Of the claim! Per 355 days Per Spell Of illness Treatment exceeding 120 Hours Per Month is not payable Prior. Adjustment/Reconsideration Denied, refer to Medicares Billing and/or Policy Guidelines Denial Code - the Procedure/revenue is! Exam is Allowed Once Per 355 days Per Spell Of illness physical Therapy limited to every. A negative pressure wound Therapy pump is limited to 90 days Diagnosis Code/CPT Combination claim is required When for... It charged Your insurance company the Screen Date ) flat fee pricing applied As Instructed In Your Handbook Received 180. Performed With Local Anesthesia In the Dental Office Code - the Procedure/revenue Code is Essential... Of Retroactive Member/provider Eligibility Billing claim ( s ) Without Teeth and an for...

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