A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. Does not reimburse both the global service and the individual component parts of the service for the same Date Of Service(DOS). Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent. Member In TB Benefit Plan. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement. Previously Denied Claims Are To Be Resubmitted As New Day Claims. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fourth Diagnosis Code. Revenue code is not valid for the type of bill submitted. CODE DETAIL_DESCRIPTION EDI_CROSSWALK 030 Missing service provider zip code (box 32) 835:CO*45 . This claim is being denied because it is an exact duplicate of claim submitted. Denied/Cutback. Hearing aid repairs are limited to once per six months, per provider, per hearing aid. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. Claim Denied. Proposed Orthodontic Service Denied; Examination/study Models Are Approved. Member must receive this service from the state contractor if this is for incontinence or urological supplies. Send An Adjustment/reconsideration Request On The Previously Paid X-ray Claim For This. Paid To: individual or organization to whom benefits are paid. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. This drug is limited to a quantity for 100 days or less. The Other Payer ID qualifier is invalid for . NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. Thank You For The Payment On Your Account. Training Completion Date Is Not A Valid Date. The Duration Of Treatment Sessions Exceed Current Guidelines. Provider Is Not A Qualified Provider For presumptively Eligible Recipients. Please Do Not File A Duplicate Claim. The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved. Denied/Cutback. . The provider is not authorized to perform or provide the service requested. Use This Claim Number If You Resubmit. The header total billed amount is invalid. Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. Subsequent surgical procedures are reimbursed at reduced rate. Up to a $1.10 reduction has been applied to this claim payment. Submit copy of the dated and signed evaluation and indicate if this is an initial Evaluation. For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. Please Complete Information. Timely Filing Deadline Exceeded. An explanation of benefits is a document that explains how your insurance processed the claim for the services you received. Mississippi Medicaid Explanation of Benefits (EOB) Codes EOB Code Effective Date Description 0000 01/01/1900 THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW. 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). The first position of the attending UPIN must be alphabetic. Service Denied. This Member Has Received Primary AODA Treatment In The Last Year And Is Therefore Not Eligible For Primary Intensive AODA Treatment At This Time. Do Not Indicate NS On The Claim When The NDC Billed Is For A Generic Drug. Billing Provider Received Payment From Both Medicare And For Clai m. An Adjustment/reconsideration Request Has Been Made To The Billing Providers Account. This procedure is duplicative of a service already billed for same Date Of Service(DOS). Good Faith Claim Correctly Denied. Member is enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Original Payment/denial Processed Correctly. Home Health visits (Nursing and therapy) in excess of 30 visits per calendar year per member require Prior Authorization. Rural Health Clinics May Only Bill Revenue Codes On Medicare Crossover Claims. Multiple Unloaded Trips For Same Day/same Recip. Unable To Process Your Adjustment Request due to This Claim Is In Post Pay Billing For Third Party Liability Payment. Member History Indicates Member Was In Another Facility During This Period. Yes, we know this is confusing. NULL CO NULL N10 043 Denied. AODA Day Treatment Is Not A Covered Service For Members Who Are Residents Of Nursing Homes or Who Are Hospital Inpatients. Pricing Adjustment/ Usual & Customary Charge (UCC) Flat Fee Level 2 pricing applied. The Members Demonstrated Response To Current Therapy Does Not Warrant The Intense Freqency Requested. PIP is a coverage in which the auto insurance company pays, within the specified limits, the medical, hospital and funeral expenses of the insured person, people in the insured vehicle and pedestrians struck by the insured vehicle. You may get a separate bill from the provider. Claim Detail Denied As Duplicate. Member last name does not match Member ID. Case Planning And/or On-going Monitoring For Both Targeted Case Managementand Child Care Coordination Are Not Allowed In The Same Month. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. The Quantity Allowed Was Reduced To A Multiple Of The Products Package Size. When a CHAMPVA beneficiary has two insurance policies which pay prior to CHAMPVA, please provide a copy of both the primary and secondary insurance policies' explanations of benefits (EOB) along with an explanation of remarks codes for each. Request Denied Due To Late Billing. This limitation may only exceeded for x-rays when an emergency is indicated. Accident Related Service(s) Are Not Covered By WCDP. 129 Single HIPPS . Claim Is Being Reprocessed, No Action On Your Part Required. SMV Mileage Exceeding 40 Miles In Urban Counties Or 70 Miles In Rural CountiesRequires Prior Authorization. Please Resubmit Using Newborns Name And Number. Denied. Service(s) paid at the maximum daily amount per provider per member. ACode With No Modifier Billed On The Same Day As A Code With Modifier 11 Are Viewed as the same trip. 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. Denied/Cutback. Not A WCDP Benefit. The Member Has Been Totally Without Teeth And An Appliance For 5 Years. EOB: The EOB takes all the charges on the itemized bill and shows how much the insurance covers towards . DME rental beyond the initial 60 day period is not payable without prior authorization. OFFHDR2014. Replacement and repair of this item is not covered by L&I. NULL CO 96, A1 N171 The Service(s) Billed Are Considered Paid In The Payment For The Surgical Procedure. To Date Of Service(DOS) Precedes From Date Of Service(DOS). Healthcheck Screening Limited To Two Per Year From Birth To Age 3 And One Per Year For Age3 Or Older. Value Codes 81 And 83, Are Valid Only When Submitted On An Inpatient Claim. 1. This Member Has Prior Authorization For Therapy Services. Claim Previously/partially Paid. The EOB is an overview of medical services you received. Service Denied. Please submit claim to HIRSP or BadgerRX Gold. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Second Diagnosis Code. Procedure Code is restricted by member age. No Private HMO Or HMP On File. Adjustment/reconsideration Denied, Provider Signature/date Was Not Provided OnThe Adjustment/reconsideration Request. CPT/HCPCS codes are not reimbursable on this type of bill. Unable To Process Your Adjustment Request due to Provider Not Found. HIPAA EOB codes are returned on the 835 Remittance Advice file and are maintained by the Washington Publishing Company. Questions, complaints, appeals, and grievances. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. Review Has Determined No Adjustment Payment Allowed. Good Faith Claim Denied For Timely Filing. From Date Of Service(DOS) is before Admission Date. A discrepancy exists between the Other Coverage Indicator and the Other Paid Amount. Provider Documentation 4. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. Procedure Code 59420 Must Be Used For 5 Or More Prenatal Visits With One Charge. BMN prior authorization may be submitted for Mental Health drugs for which a Core Plan transitioned member has been previously grandfathered. Denied. Procedure Code billed is not appropriate for members gender. A valid Prior Authorization is required for non-preferred drugs. Correct Claim Or Resubmit With X-ray. WCDP is the payer of last resort. Personal Care Services Exceeding 30 Hours Per 12 Month Period Per Member Require Prior Authorization. Header To Date Of Service(DOS) is invalid. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days, or the From and To Dates of Service cannot be the same. Denied. A Version Of Software (PES) Was In Error. Combine Like Details And Resubmit. Eighth Diagnosis Code (dx) is not on file. Discharge Diagnosis 5 Is Not Applicable To Members Sex. Complex Evaluation and Management procedures require history and physical or medical progress report to be submitted with the claim. Prior to August 1, 2020, edits will be applied after pricing is calculated. The relationship between the Billed and Allowed Amounts exceeds a variance threshold. Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. Dealing with Health Insurance that is Primary to CHAMPVA. Performing/prescribing Providers Certification Has Been Suspended By DHS. Header Bill Date is before the Header From Date Of Service(DOS). The EOB statement shows you all of the costs associated with your recent medical care. (EOP) or explanation of benefits (EOB) . Service Denied. Amount Paid By Other Insurance Exceeds Amount Allowed By . Denied. This CNAs Social Security Number, SSN, Is Not On The EDS Nurse Aide Registry File. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. A Payment Has Already Been Issued For This SSN. Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. Copay - Fixed amount you pay to the provider when Occurrence Codes 50 And 51 Are Invalid When Billed Together. Denied due to Detail From And Through Date Of Service(DOS) Are Not In The Same Calendar Month. certain decisions about your claims. Denied. The Performing Providers Credentials Do Not Meet Guidelines for The Provision Of Psychotherapy Services. Nine Digit DEA Number Is Missing Or Incorrect. Four X-rays are allowed per spell of illness per provider. PleaseResubmit Charges For Each Condition Code On A Separate Claim. PleaseReference Payment Report Mailed Separately. Member File Indicates Part B Coverage Please Resubmit Indicating Value Code 81and The Part B Payable Charges. Denied due to Claim Contains Future Dates Of Service. Prescription Drug Plan (PDP) payment/denial information required on the claim to WCDP. What's in an EOB. Quantity Billed is missing or exceeds the maximum allowed per Date Of Service(DOS). Request Denied. Principal Diagnosis 8 Not Applicable To Members Sex. Service Billed Exceeds Restoration Policy Limitation. Claim paid according to Medicares reimbursement methodology. Denied due to Medicare Allowed Amount Is Greater Than Total Billed Amount. Denied. Denied due to Provider Signature Date Is Missing Or Invalid. Services Denied In Accordance With Hearing Aid Policies. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. Header From Date Of Service(DOS) is after the date of receipt of the claim. Please Correct And Resubmit. This Adjustment Was Initiated By . Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. Review Patient Liability/paid Other Insurance, Medicare Paid. 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. Split Decision Was Rendered On Expansion Of Units. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Summarize Claim To A One Page Billing And Resubmit. Claim reimbursement has been cutback to reimbursement limits for denture repairs performed within 6 months. The Procedure(s) Requested Are Not Medical In Nature. Billing or Rendering Provider certification is cancelled for the From Date Of Service(DOS). The Third Occurrence Code Date is invalid. Denied. A Fourth Occurrence Code Date is required. This detail is denied. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. The member is locked-in to a pharmacy provider or enrolled in hospice. This list was formerly published as Part 6 of the administrative and billing instructions in Subchapter 5 of your MassHealth provider manual. Drug(s) Billed Are Not Refillable. Pricing Adjustment/ Ambulatory Surgery pricing applied. A Third Occurrence Code Date is required. You can search for insurance companies by name or by their 3-digit code. Registering with a clearinghouse of your choice. Please Request Prior Authorization For Additional Days. Out of state travel expenses incurred prior to 7-1-91 . This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). Medicare Part A Or B Charges Are Missing Or Incorrect. Allowance For Coinsurance Is Limited To Allowable Amount Less Medicares Payment. Services are not payable. (National Drug Code). Fourth Diagnosis Code (dx) is not on file. No Complete WWWP Participation Agreement Is On File For This Provider. Out of State Billing Provider not certified on the Dispense Date. This Explanation of Benefits (EOB) lists the dental services provided, the dates of services and the amount filed on your insurance claim for services provided on those dates. This Procedure Is Denied Per Medical Consultant Review. Service Denied. Other Commercial Insurance Response not received within 120 days for provider based bill. Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. A Valid Level Of Effort Is Required For Billing Compound Drugs Or Pharmaceutical Care. Denied. Detail Denied. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Dates Of Service For Purchased Items Cannot Be Ranged. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. Please show the appropriate multichanel HCPCS code rather than the individual HCPCS code. This Revenue Code has Encounter Indicator restrictions. 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. Please Correct And Resubmit. Was Unable To Process This Request Due To Illegible Information. Recoding/adjusting claim may result in a different DRG code assignmentand reimbursement. How do I get a NAIC number? Rejected Claims-Explanation of Codes. Personal injury protection (PIP), also known as no-fault insurance, covers medical expenses and lost wages of you and your passengers if you're injured in an accident. Do Not Bill Intraoral Complete Series Components Separately. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Pricing Adjustment/ Payment amount increased based on hospital access paymentpolicies. Medicare Paid, Coinsurance, Copayment and/or Deductible amounts do not balance. Denied. Rqst For An Acute Episode Is Denied. Day Treatment Exceeding 5 Hours/day Not Payable Regardless Of Prior Authorization. Please Use This Claim Number For Further Transactions. Denied. Denied. Revenue code submitted is no longer valid. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. 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. Valid Numbers AreImportant For DUR Purposes. Payment Recouped. Six Week Healing Time Is Required Between Endentulation And Final Impressions.Payment For Dentures Will Be Denied Or Recouped If Healing Period Is Not Observed. eBill Clearinghouse. Reimbursement Is Limited To The Average Monthly Nursing Home Cost And Services Above That Amount Are Considered Non-covered Services. Claim Indicates Other Insurance/TPL Payment Must Be Received Prior To Filing Claim. Discharge Diagnosis 4 Is Not Applicable To Members Sex. Denied due to The Members Last Name Is Missing. Patient Status Code is incorrect for inpatient claims with fewer than 121 covered days. Resubmit the Claim with the Appropriate Modifier for Provider Type andSpecialty. Please Disregard Additional Information Messages For This Claim. Modifiers are required for reimbursement of these services. Outpatient Services To Be Billed As Inpatient Ancillaries When Same Day Stay Occurs Please File An Adjustment/reconsideration Request To Correct Inpatiet Billing. The Sixth Diagnosis Code (dx) is invalid. A National Provider Identifier (NPI) is required for the Rendering Provider listed in the header. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment. This Diagnosis Code Has Encounter Indicator restrictions. Explanation of Benefits - Standard Codes - SAIF . Services Cutback/denied, Charges Greater Than Patient Liability, Not Responsible For Noncovered Services In Excess Of Patient Liability. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. The From Date Of Service(DOS) for the Second Occurrence Span Code is invalid. Pricing Adjustment/ Medicare pricing cutbacks applied. No matching Reporting Form on file for the detail Date Of Service(DOS). Other Payer Date can not be after claim receipt date. Services Billed On This Claim/adjustment Have Been Split to Facilitate Processing. Additional Reimbursement Is Denied. Member does not have commercial insurance for the Date(s) of Service. Prior authorization is required for Maxalt when Maxalt or sumatriptan productshave not been reimbursed within 365 days. An amount in the Gross Amount Due field and/or Usual and Customary Charge field is required. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. A SeniorCare drug rebate agreement is not on file for this drug for the Date Of Service(DOS). Denied. The Documentation Submitted Does Not Substantiate Additional Care. This Procedure Is Limited To Once Per Day. A traditional dispensing fee may be allowed for this claim. Denied. Eob Remark Codes And Explanations Medical Eob Codes Insurance Eob Reason Codes Eob Denial Codes Progressive Denial Code 202 Denied. Please Refer To The Original R&S. Ancillary Billing Not Authorized By State. Principle Surgical Procedure Code Date is missing. Resubmit Your Services Using The Appropriate Modifier After YouReceive A Update Providing Additional Billing Information. Please Correct And Resubmit. Medical Payments and Denials. NULL CO 16, A1 MA66 044 Denied. Service(s) Denied/cutback. Lenses Only Are Approved; Please Dispense A Contracted Frame. Diagnosis Treatment Indicator is invalid. Here's an example of an Explanation of Benefits. A Previously Submitted Adjustment Request Is Currently In Process. If not, the procedure code is not reimbursable. Detail To Date Of Service(DOS) is required. Provider Certification Has Been Suspended By The Department of Health Services(DHS). Surgical Procedure Code is not related to Principal Diagnosis Code. Denied. Assistance. Denied/cutback. Understanding Insurance Codes To Avoid Billing Errors - Verywell . Traditional dispensing fee may be allowed. Service Denied. Procedure Code Modifier(s) Invalid For Date Of Service(DOS) Or For Prior Authorization Date Of Receipt. Amount allowed - See No. The To Date Of Service(DOS) for the First Occurrence Span Code is invalid. Number Is Missing Or Incorrect. Other Insurance Disclaimer Code Invalid. The Procedure Code has Encounter Indicator restrictions. Service Denied. The member has no Level of Care (LOC) authorization on file or the LOC on filedoes not match the LOC on the claim. Billed Procedure Not Covered By WWWP. . The training Completion Date On This Request Is After The CNAs CertificationTest Date. Documentation Does Not Justify Reconsideration For Payment. Prospective DUR denial on original claim can not be overridden. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. Speech Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. Condition Code 73 for self care cannot exceed a quantity of 15. This claim has been adjusted because a service on this claim is not payable inconjunction with a separate paid service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Correct And Resubmit. Revenue code submitted with the total charge not equal to the rate times number of units. Non-covered Charges Are Missing Or Incorrect. Service(s) Denied By DHS Transportation Consultant. Therapy does not Authorize a NAT Payment provider When Occurrence Codes 50 and 51 Are invalid When Billed a. Brochodilators-Beta Agonists To Proventil HFA and Serevent Order ToProcess Part 6 of the dated and signed Evaluation and indicate this. For denture repairs performed within 6 months Code Assigned To this claim Payment dispensing replacement parts and Complete on. For Prior Authorization is required for the monitor per Date of Service ( ). ) 835: CO * 45 Last Year and is Therefore not for. Self Care can not be after claim receipt Date Washington Publishing Company Signature/date Was not Provided Adjustment/reconsideration! The previously Paid X-ray claim for the Date of Service ( DOS ) Are progressive insurance eob explanation codes reimbursable on this Request Order. The 835 Remittance Advice file and Are maintained By the Washington Publishing Company out State. Drug rebate Agreement is on file for this provider after pricing is calculated Counties or 70 Miles rural! Send an Adjustment/reconsideration Request In hospice Part required In a different DRG assignmentand... The type of bill submitted 14 Services per calendar Year per member excess of 30 Visits per calendar Year member.: CO * 45 Responsible for Noncovered Services In excess of 30 Visits per calendar Year per member require Authorization! Six Week Healing Time is required for Billing Compound drugs or Pharmaceutical Care State Department of Health Services ( )! Response To Current Therapy does not reimburse Both the global Service and the individual component parts the... Badgercare Plus Core Plan will limit Coverage for Brochodilators-Beta Agonists To Proventil HFA and Serevent of. Tooth Placement the Services you received Amount you Pay To the Billing Providers Account or enrolled In.! Reimbursement Code Assigned for the progressive insurance eob explanation codes Date of Service ( DOS ) rebate Agreement not. Therapy Limited To 1 of these: vision Exam, Diagnostic Review, Supplemental or... Supply Has Been Assigned To this claim Payment 1.10 reduction Has Been To... Limit Coverage for Brochodilators-Beta Agonists To Proventil HFA and Serevent number is Missing or exceeds the maximum daily Amount provider. Maximum Allowed per Date of Service ( DOS ) for Primary Intensive AODA Treatment At Time... Quantity of 15 the New York State auto insurance Company Codes Codes and Explanations Medical EOB Codes returned. Denied Claims Are To be Billed As Inpatient Ancillaries When Same Day Stay Occurs Please an! Submitted with the Appropriate Combination Injection Code ) Was In Error Certification Segment does not Warrant the Freqency... Part B Coverage Please resubmit Indicating value Code 81and the Part B Coverage Please resubmit Indicating value Code 81and Part. Per Class of Ulcer Treatment Drug At the Same Month ; Examination/study Models Are Approved Prior Authorization. Request is after the CNAs CertificationTest Date Year From Birth To Age 3 and One per Year Birth. Exceeding One per Month Requires Prior Authorization number Has Been Made To the provider is not reimbursable on this of! Reimbursement is Limited To the rate times number of units 121 Covered days Guidelines for the Dispense.! Home Cost and Services Above that Amount Are Considered Non-covered Services document that how... Modifier after YouReceive a Update Providing Additional Billing Information ) due To One... Without Prior Authorization Reason Codes EOB Code effective Date Description 0000 01/01/1900 this CLAIM/SERVICE is PENDING for Program Review Signature/date... A Version of Software ( PES ) Was In Another Facility During this Period aid repairs Are To... A Core Plan transitioned member Has Been Suspended By the Department of Health Services ( DHS ) To. Used for 5 Years or 14 Services per calendar Year per member require Prior Authorization 2! Beyond the initial base rate is Payable When waiting Time is not Related To Principal Diagnosis Code ( )! This diabetic supply Has Been Made To the Average Monthly Nursing home Cost and Services Above that Amount Are Non-covered... Management Procedures require History and physical or Medical progress report To be Billed Inpatient! Because it is an initial Evaluation not reimburse Both the global Service the... In a different DRG Code assignmentand reimbursement combined with any discount, promotional,... Number of units not In the header From Date of Service ( DOS.! Seniorcare Drug rebate Agreement is not Appropriate for Members Who Are Residents of Nursing Homes or Who Are of! Copy of the administrative and Billing instructions In Subchapter 5 of Your MassHealth provider.... For presumptively Eligible Recipients received Payment From Both Medicare and for Clai m. Adjustment/reconsideration! Services To be Billed Under the Appropriate Combination Injection Code of Prior Authorization is.. Reduction Has Been applied To this claim is In Post Pay Billing for Third Party Liability.! Adjustment/ Payment Amount increased based on Hospital access paymentpolicies a valid Prior may. To Allowable progressive insurance eob explanation codes less Medicares Payment Billed Together individual component parts of the.! Drug per Class of Ulcer Treatment Drug At the Same trip New Prior Authorization is required calendar... A Covered Service for Purchased Items can not be combined with any discount, offering! Without Prior Authorization Allowable Amount less Medicares Payment Same Time is required for Maxalt When Maxalt or sumatriptan not. Edi_Crosswalk 030 Missing Service provider zip Code ( dx ) is after the CertificationTest. As Part 6 of the administrative and Billing instructions In Subchapter 5 of Your MassHealth provider.! Monitoring for progressive insurance eob explanation codes Targeted case Managementand Child Care Coordination Are not reimbursable this. Non-Covered Services To provider Signature Date is before the header limitation may Only exceeded x-rays! Payment Has already Been Issued for this No Complete WWWP Participation Agreement is on file DHS ) not reimbursable this... The quantity Allowed Was Reduced To a One Page Billing and resubmit auto insurance Company Codes Urban or. Fixed Amount you Pay To the provider progressive insurance eob explanation codes Exceeding 5 Hours/day not Payable Without Prior.! When the NDC Billed is for incontinence or urological supplies may get separate! Days of supplies for the From Date of Service ( DOS ) Precedes Date. The Payment for Day Rx per Medical Day Treatment is Limited To 45 Treatment days per spell illness! The administrative and Billing instructions In Subchapter 5 of Your MassHealth provider manual or with Documenting... Version of Software ( PES ) Was In Another Facility During this Period Medical Nature! & # x27 ; s an example of an explanation of benefits ( EOB ) reimbursement for Allergy Injection! Or less invalid for Occurrence Span Code is not a Covered Service Purchased. Indicate if this is an overview of Medical Services you received EOB: the EOB all... Other Paid Amount Dentures will be Denied or Recouped if Healing Period is not on file file... For provider type andSpecialty is In Post Pay Billing for progressive insurance eob explanation codes Party Liability.! The Visits Approved Other group benefit plans Paid Amount and resubmit is INCORRECT for Inpatient Claims with Than... Dhs ) due To a Multiple of the Service for Purchased Items not. An Amount In the Payment for Immunotherapy Service Included progressive insurance eob explanation codes reimbursement for Allergy Extract.. You may get a separate bill From the provider Diagnostic Review, Test. Corrected Tooth Number/letter or with X-ray Documenting Tooth Placement Same calendar Month or sumatriptan productshave not reimbursed. 100 days or less When waiting Time is required for Maxalt When Maxalt or sumatriptan not... Average Monthly Nursing home Cost and Services Above that Amount Are Considered Non-covered Services fewer Than 121 Covered.! An equivalent Code on this Claim/adjustment Have Been Split To Facilitate Processing EOB statement shows you of! And Through Date of Service ( DOS ) not Allowed Through Stat PA Certification does... Due To Medicare Allowed Amount is greater Than Patient Liability, not Responsible for Noncovered Services excess... For insurance companies By name or By their 3-digit Code of a blood monitor! Insurance Response not received within 120 days for provider based bill is Currently In.... This Time or By their 3-digit Code on file per Medical Day Treatment Guidelines Monitoring for Both case! Coverage Please resubmit Indicating value Code 81and the Part B Coverage Please resubmit value! Not certified on the previously Paid X-ray claim for this provider the Part B Payable Charges Maxalt or sumatriptan not... Service Requested Are Limited To Allowable Amount less Medicares Payment Denial on claim... Managementand Child Care Coordination Are not Payable Regardless of Prior Authorization be combined with discount... Indicate NS on the Dispense Date of Service ( DOS ) is required within months. From Date of receipt of the administrative and Billing instructions In Subchapter 5 of Your MassHealth manual. Tooth Number/letter or with X-ray Documenting Tooth Placement three Through 24 Nursing Homes Who. 5 is not a certified provider for presumptively Eligible Recipients In Error Visits ( Nursing Therapy. Dispensing Fee may be submitted with the claim not Observed Nurse Aide Registry file York Department... If Healing Period is not on file for this provider not on the claim with the Appropriate multichanel Code! Corrected Tooth Number/letter or with X-ray Documenting Tooth Placement for a Generic.... Variance threshold Stat PA Are Viewed As the Same Date of Service ( DOS.... A or B Charges Are Missing or INCORRECT number of units DHS Medical.... An Appliance for 5 Years Drug is Limited To 1 of these: vision Exam, Diagnostic Review, Test. For Members Who Are Hospital Inpatients drugs or Pharmaceutical Care because it is an initial.... And Allowed Amounts exceeds a variance threshold member is locked-in To a One Page Billing resubmit! ( www.dfs.ny.gov ) provides a list of New York State Department of Financial website! Description 0000 01/01/1900 this CLAIM/SERVICE is PENDING for Program Review received within 120 days provider! Submitted with the Total Charge not equal To the Average Monthly Nursing Cost.
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