wellcare eob explanation codes wellcare eob explanation codes

Description & Use Of Day RX Procedure Codes Based On Members Status-not the place Of Service Where Day Rx Service Performed. Pricing Adjustment/ Patient Liability deduction applied. Questionable Long Term Prognosis Due To Gum And Bone Disease. The From Date Of Service(DOS) for the Second Occurrence Span Code is invalid. This Report Was Mailed To You Separately. Day Treatment exceeding 120 hours per month is not payable regardless of PriorAuthorzation. Earn Money by doing small online tasks and surveys, What is Denials Management in Medical Billing? Dental service limited to twice in a six month period. This Surgical Code Has Encounter Indicator restrictions. Denied due to The Member WCDP Id Number Is Incorrect Or Not On Our Current Eligibility File. Pricing Adjustment/ Resource Based Relative Value Scale (RBRVS) pricing applied. Has Processed This Claim With A Medicare Part D Attestation Form. Unable To Process Your Adjustment Request due to Member Not Found. Allowed Amount On Detail Paid By WWWP. Denied. The canister, dressings and related supplies are included as part of the reimbursement for the negative pressure wound therapy pump. The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved. Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided. Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP. Please Do Not Resubmit Your Claim, And Disregard Additional Informational Messages for this claim. Good Faith Claim Denied. Member is not enrolled for the detail Date(s) of Service. A Payment Has Already Been Issued To A Different Nf. Up Medicare Paid The Total Allowable For The Service. To allow for multiple biopsies for investigation and diagnosis of certain disease entities, WellCare applies max units editing for CPT code 88305 based on gastrointestinal (GI) and prostate-related diagnoses. For FQHCs, place of service is 50. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. The Service Billed Does Not Match The Prior Authorized Service. EDI TRANSACTION SET 837P X12 HEALTH CARE . Benefit code These codes are submitted by the provider to identify state programs. The Member Is Involved In group Physical Therapy Treatment. CO/204. Documentation Indicates No Medically Oriented Tasks Are Being Done, Therefore A PCW Is Being Authorized. Cannot Be Reprocessed Unless There Is Change In Eligibility Status. Denied due to Claim Or Adjustment Received After The Late Billing Filing Limit. August 14, 2013, 9:23 am . Services Beyond The Six Week Postpartum Period Are Not Covered, Per DHS. Claim paid at program allowed rate. Submit Claim To Insurance Carrier. It Corrects A Mispayment FoundDuring Claims Processing Or Resulting From Retroactive File Changes. Timely Filing Deadline Exceeded. Emergency Services Indicator must be "Y" or Pregnancy Indicator must be "Y" for this aid code. This Procedure Is Limited To Once Per Day. According to the American College of Radiology and the International Society for Clinical Densitometry, dual-energy X-ray absorptiometry (DXA) bone density screening (77080 or 77081) is not indicated for women under age 65 or men under age 70 without risk factors for osteoporosis. "Laterality" (side of the body affected) is a coding convention added to relevant ICD-10 codes to increase specificity. The Service(s) Requested Could Adequately Be Performed In The Dental Office. Pricing AdjustmentUB92 Hospice LTC Pricing. Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. Detail Quantity Billed must be greater than zero. It has now been removed from the provider manuals . Documentation Does Not Justify Medically Needy Override. Denied. Services Requiring Prior Authorization Cannot Be Submitted For Payment On A Claim In Conjunction With Non Prior Authorized Services. The Billing Providers taxonomy code is missing. HCPCS procedure codes G0008, G0009 or G0010 are allowed only with revenue code0771. Please Resubmit. Procedure code 00942 is allowed only when provided on the same date ofservice as procedure code 57520. Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. Review Has Determined No Adjustment Payment Allowed. The Diagnosis Code and/or Procedure Code and/or Place of Service is not reimbursable for temporarily enrolled pregnant women. Denied. Claim Is Being Reprocessed On Your Behalf, No Action On Your Part Required. Members Age 3 And Older Must Have An Oral Assessment And Blood Pressure Check.With Appropriate Referral Codes, For Payment Of A Screening. This Members Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment. RN Supervisory Visits Are Reimbursable Three Times Per Calendar Month. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. Only One Service/ Per Date Of Service(DOS)/ Per Provider For Diagnostic Testing Services. The quantity billed of the NDC is not equally divisible by the NDC package size. Other Therapies Currently Provide Sufficient Services To Meet The Members Needs. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Duplicate/second Procedure Deemed Medically Necessary And Payable. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. Please show the appropriate multichanel HCPCS code rather than the individual HCPCS code. BMN prior authorization may be submitted for Mental Health drugs for which a Core Plan transitioned member has been previously grandfathered. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. No Substitute Indicator required when billing Innovator National Drug Codes (NDCs). Reason Code 159: State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. The To Date Of Service(DOS) for the Second Occurrence Span Code is invalid. The Clinical Profile, Narrative History, And Treatment History Indicate The Recipient Is Only Eligible For Maintenance Hours. Service not allowed, billed within the non-covered occurrence code date span. NDC was reimbursed at generic WAC (Wholesale Acquisition Cost) rate. The Request Has Been Approved To The Maximum Allowable Level. If correct, special billing instructions apply. Admission Denied In Accordance With Pre-admission Review Criteria. We have redesigned our website to help you find the information you need more easily. (National Drug Code). This drug/service is included in the Nursing Facility daily rate. The Service Requested Is Considered To Be Professionally Unacceptable, Unproven and/or Experimental. Unrelated Procedure/Service by the Same Physician During the Post-op Period, Modifier 79. This claim is a duplicate of a claim currently in process. This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim. MLN Matters Number: MM6229 Related . Subsequent Aide Visits Limited To 7 Hrs Per Day/per Member/per Provider. An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. the patient (or parent or guardian) at the address noted on the claim, be sure your doctor has updated your records with your current address. Has Recouped Payment For Service(s) Per Providers Request. One or more Occurrence Code Date(s) is invalid in positions nine through 24. A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). Restorative Nursing Involvement Should Be Increased. In the above example the claim was denied with two codes, the Adjustment Reason Code of 16 and then the explanatory Remark Code of N329 (Missing/incomplete/invalid patient birth date). Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Department Of Justice Settlement. Denied. Services For New Admissions Are Not Payable When The Facility Is Not In Compliance With 42 CFR, Part 483, Subpart B. The relationship between the Billed and Allowed Amounts exceeds a variance threshold. Service is covered only during the first month of enrollment in the Home and Community Based Waiver. Procedure Code is restricted by member age. Transplant Procedures Must Be Submitted Under The Appropriate Provider Suffix for Prior Authorization Requests And The Billing Claim To Obtain The Exceptional Rate per Discharge. Denied. Header From Date Of Service(DOS) is required. Take care to review your EOB to ensure you understand recent charges and they all are accurate. This Dental Service Limited To Once Every Six Months, Unless Prior Authorized. Services Not Provided Under Primary Provider Program. Handwritten Changes/corrections On The Medicare EOMB Are Not Acceptable. Amount Recouped For Duplicate Payment on a Previous Claim. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a Training Payment. The National Drug Code (NDC) has an age restriction. Medical explanation of benefits. Please Disregard Additional Informational Messages For This Claim. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. that provide either supplemental explanation for a monetary adjustment or policy information are required in the remittance advice transaction. Total billed amount is less than the sum of the detail billed amounts. Rendering Provider is not certified for the Date(s) of Service. We thank you for your continued partnership in servicing the Wellcare By Fidelis Care membership. This Is A Manual Increase To Your Accounts Receivable Balance. Contact Wisconsin s Billing And Policy Correspondence Unit. Claims may deny for a CT head or brain, CTA head, MRA head, MRI brain or CT follow-up when the only diagnosis on the claim is a migraine. Claim/adjustment Received Beyond The 455 Day Resubmission Deadline. No Action On Your Part Required. Unable To Process Your Adjustment Request due to Claim ICN Not Found. Summarize Claim To A One Page Billing And Resubmit. Claims may deny when a nerve conduction study is billed without a needle EMG, or a needle EMG is billed without a Nerve conduction study, and the only diagnosis is radiculopathy (ICD-10 codes M50.1-M50.23, M51.1-M51.27, M51.9, M53.80, M54.10-M54.18, M54.30-M54.42, and M79.2). BY . A1 This claim was refused as the billing service provider submitted is: . Lenses Only Are Approved; Please Dispense A Contracted Frame. ACTION TYPE LEGEND: The Rendering Providers taxonomy code in the header is invalid. Value Codes 81 And 83, Are Valid Only When Submitted On An Inpatient Claim. Type of Bill indicates services not reimbursable or frequency indicated is notvalid for the claim type. To allow for multiple biopsies for investigation and diagnosis of certain disease entities, WellCare applies max units editing for CPT code 88305 based on gastrointestinal (GI) and prostate-related diagnoses. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Healthcheck Screening Limited To Two Per Year From Birth To Age 3 And One Per Year For Age3 Or Older. Dental X-rays Indicate A Dental Cleaning, Followed By Good Dental Care At Home, Would Be Sufficient To Maintain Healthy Gums. Claim Is Being Reprocessed Through The System. An amount in the Gross Amount Due field and/or Usual and Customary Charge field is required. Ninth Diagnosis Code (dx) is not on file. Procedure Code is not allowed on the claim form/transaction submitted. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Training Completion Date Must Be Prior To And Within A Year Of The CNAs Certification Date. This Is Not A Good Faith Claim. Denied due to Prescription Number Is Missing Or Invalid. Description. Claim Explanation Codes. Please Furnish A NDC Code And Corresponding Description. Review Billing Instructions. The To Date Of Service(DOS) for the First Occurrence Span Code is required. Use The New Prior Authorization Number When Submitting Billing Claim. At Least One Of The Compounded Drugs Must Be A Covered Drug. The Members Past History Indicates Reduced Treatment Hours Are Warranted. Fourth Other Surgical Code Date is invalid. Services billed are included in the nursing home rate structure. Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service. A NAT Reimbursement Request Must Be Submitted To WI Within A Year Of The CNAs Hire Date. Please File With Champus Carrier. Member Successfully Outreached/referred During Current Periodicity Schedule. For dates of service on or after 7/1/10 for TOB 72X an occurrence code 51 and value code D5 are required when the KT/V reading was performed. Claim Generated An Informational ProDUR Alert, Drug-Drug Interaction prospective DUR alert, Drug-Disease (reported) prospective DUR alert, Drug-Disease (inferred) prospective DUR alert, Therapeutic Duplication prospective DUR alert, Suboptimal Regiment prospective DUR alert, Insufficient Quantity prospective DUR alert. Services Billed On This Claim/adjustment Have Been Split to Facilitate Processing. Claim or Adjustment received beyond 730-day filing deadline. Condition code 80 is present without condition code 74. Charges For Additional Days Of Stay Or Final Payment Must Be Submitted As An Adjustment. (8 days ago) WebMassHealth List of EOB Codes Appearing on the Remittance Advice. Condition Code 73 for self care cannot exceed a quantity of 15. Wk. Alternatively, CPT XXXXX has been billed in the previous 10 days for a CPT code with a 10-day post-operative period, or in the previous 90 days for a code with a 90-day post-operative period by the same provider. Header From Date Of Service(DOS) is after the date of receipt of the claim. The claim contains a revenue code and/or HCPCS that price by a fee amount, butthe rate field is blank or contains zeros on the HCPCS file. Claim Denied The Combined Medicare And Private Insurance Payments Equal Or Exceed The Lesser Of The And Medicare Allowable Amounts. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. Research Has Determined That The Member Does Not Qualify For Retroactive Eligibility According To Hfs 106.03(3)(b) Of The Wisconsin Administrative Code. Only preferred drugs are covered for the member?s program, Only generic drugs are covered for the member?s program. HIPAA EOB codes are returned on the 835 Remittance Advice file and are maintained by the Washington Publishing Company. An xray or diagnostic urinalysis is reimbursable only when performed on the same Date Of Service(DOS) and billed on the same claim as the initial office visit. All three DUR fields must indicate a valid value for prospective DUR. The Travel component for this service must be billed on the same claim as the associated service. Referring Provider ID is invalid. Medicare Id Number Missing Or Incorrect. Member does not have commercial insurance for the Date(s) of Service. Will Not Authorize New Dentures Under Such Circumstances. Diagnosis Code is restricted by member age. Pricing Adjustment/ Traditional dispensing fee applied. To allow for Medicare Pricing correct detail denials and resubmit. One or more Diagnosis Code(s) is invalid in positions 10 through 25. Members age does not fall within the approved age range. Please Resubmit. When coding HCPCS for outpatient services, the provider enters the HCPCS code describing the procedure. Individual Audiology Procedures Included In Basic Comprehensive Audiometry. Rqst For An Exempt Denied. Member is enrolled in QMB-Only benefits. Member enrolled in QMB-Only Benefit plan. All services should be coordinated with the primary provider. This Member Appears To Continue To Abuse Alcohol And/or Other Drugs And Is Therefore Not Eligible For Day Treatment. The Procedure Code Indicated Is For Informational Purposes Only. Sixth Diagnosis Code (dx) is not on file. A Payment For The CNAs Competency Test Has Already Been Issued. Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. Pricing Adjustment/ SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts. This drug has been paid under an equivalent code within seven days of this Date Of Service(DOS). Repackaged National Drug Codes (NDCs) are not covered. Denied. Please Correct And Resubmit. Use the most current year's ICD-9-CM or ICD-10-CM codes, depending on the date(s) of service. Services Denied. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Final Rate Settlement. Explanation . No Action On Your Part Required. Diagnosis of malignancies and inflammatory conditions frequently requires numerous biopsies of a particular organ or suspicious site. Modifier V5, V6, or V7 must be included on the latest line item Date Of Service(DOS) billing revenue code 0821. Service not payable with other service rendered on the same date. Whenever claim denied with CO 197 denial code, we need to follow the steps to resolve and reimburse the claim from insurance company: First step is to verify the denial reason and get the denial date. Do Not Bill Intraoral Complete Series Components Separately. Here are just a few of them: EOB CODE. Payment may be reduced due to submitted Present on Admission (POA) indicator. Third modifier code is invalid for Date Of Service(DOS). Denied. Rendering Provider may not submit claims for reimbursement as both the Surgeonand Assistant Surgeon For The Same Member On The Same DOS. Critical care in non-air ambulance is not covered. Members File Shows Other Insurance. These Supplies/items Are Included In The Purchase Of The Dme Item Billed On The Same Date Of Service(DOS). Previously Denied Claims Are To Be Resubmitted As New-day Claims. Only One Panoramic Film Or Intraoral Radiograph Series, By The Same Provider, Per Year Allowed. Occurance code or occurance date is invalid. Please Correct And Resubmit. This National Drug Code (NDC) has been terminated by CMS for the Date Of Service(DOS). A Third Occurrence Code Date is required. New Prescription Required. Reference: Transmittal 477, change request 3720 issued February 18, 2005. Revenue code 0850 thru 0859 is not allowed when billed with revenue codes 0820thru 0829, 0830 thru 0839, or 0840 thru 0849. The diagnosis code is not reimbursable for the claim type submitted. Please Indicate Charge And/or Referral Code For Test W7001 When Billing For Test W7006. Procedue Code is allowed once per member per calendar year. MassHealth List of EOB Codes Appearing on the Remittance Advice. The Revenue Code is not payable for the Date(s) of Service. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity. Reimbursement For This Service Has Been Approved. Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item. Quantity submitted matches original claim. The Members Clinical Profile/diagnosis Is Not Within Diagnostic Limitations for Psychotherapy Services. Default Prescribing Physician Number XX5555555 Was Indicated. The Lens Formula Does Not Justify Replacement. No payment allowed for Incidental Surgical Procedure(s). Condition code 70-76 is required on an ESRD claim when Influenza/PPV/HEP B HCPCS codes are the only codes being billed with condition code A6. Claims may deny when reported and not meeting the ICD-10-CM Laterality policy for Diagnosis-to-Diagnosis comparison. Seventh Occurrence Code Date is required. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. Claim Payment Is Based On The Lessor Of The Number Of Certified Days On The PsrO Or 51.42 Board Stamp Or Admitting Calendar Month Days In Specialty Hospital. Claim Denied. This Procedure Code Is Not Valid In The Pharmacy Pos System. The Members Demonstrated Response To Current Therapy Does Not Warrant The Intense Freqency Requested. Per Information From Insurer, Claim(s) Was (were) Not Submitted. Therapy visits in excess of one per day per discipline per member are not reimbursable. The Information Provided Is Not Consistent With The Intensity Of Services Requested. Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. Denied due to NDC Is Not Allowable Or NDC Is Not On File. Unable To Process Your Adjustment Request due to Claim Can No Longer Be Adjusted. Dates Of Service Must Be Itemized. Members I.d. Frequency or number of injections exceed program policy guidelines. Denied. A National Provider Identifier (NPI) is required for the Performing Provider listed in the header. The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone. Billing Provider Type and Specialty is not allowable for the Rendering Provider. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. The Procedure Requested Is Not On s Files. Claim Is Pended For 60 Days. Personal Care Services Exceeding 30 Hours Per 12 Month Period Per Member Require Prior Authorization. Denied. Req For Acute Episode Is Denied. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider. Please Indicate Mileage Traveled. Claim or line denied. Second modifier code is invalid for Date Of Service(DOS) (DOS). Inpatient psychiatric services are not reimbursable for members age 21 65 (age 22 if receiving services prior to 21st birthday). A discrepancy exists between the Other Coverage Indicator and the Other Paid Amount. Denied. Prosthodontic Services Appear To Have Started After Member EligibilityLapsed. 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. Billed Procedure Not Covered By WWWP. This Service Is Not Payable Without A Modifier/referral Code. Second Rental Of Dme Requires Prior Authorization For Payment. This service is not payable for the same Date Of Service(DOS) as another service included on the same claim, according to the National Correct Coding Initiative. EOB Codes List|Explanation of Benefit Reason Codes (2023) February 7, 2022 by medicalbillingrcm. Documentation Does Not Justify Fee For ServiceProcessing . Backdating Allowed Only In Cases Of Retroactive Member/provider Eligibility. NDC was reimbursed at brand WAC (Wholesale Acquisition Cost) (Wholesale Acquisition Cost) rate. Denied. Denied due to Provider Signature Date Is Missing Or Invalid. Compound Drug Service Denied. The Information Provided Indicates Regression Of The Member. Secondary Diagnosis Code(s) in positions 2-9 cannot duplicate the Primary Discharge Diagnosis. Multiple Requests Received For This Ssn With The Same Screen Date. Example: Diagnosis code 285.21 is entered as 28521, without a period or space. No Action Required on your part. Always bill the correct place of service. They are used to provide information about the current status of . Denied. Rural Health Clinics May Only Bill Revenue Codes On Medicare Crossover Claims. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. Medical record number If a medical record number is used on the provider's claim, that number appears here. Please Resubmit As A Regular Claim If Payment Desired. One or more Surgical Code Date(s) is missing in positions seven through 24. CO/96/N216. Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). Day Treatment Exceeding 5 Hours/day Not Payable Regardless Of Prior Authorization. Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service(DOS). Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. Please Provide The Type Of Drug Or Method Used To Stop Labor. Training Completion Date Must Be Within A Year Of The CNAs Certification, Test, Date. The procedure code has Family Planning restrictions. Dispense as Written indicator is not accepted by . For example, F80.2 (Mixed receptive-expressive language disorder) cannot be billed on the same claim as F84.0 (Autism Disorder) since ICD-10's Coding Manual views them as mutually exclusive dx codes. The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. Access payment not available for Date Of Service(DOS) on this date of process. Claim Denied Due To Incorrect Billed Amount. View the Part C EOB materials in the Downloads section below. 1. Quantity Billed is not equally divisible by the number of Dates of Service on the detail. Member Is Eligible For Champus. Child Care Coordination services are reimbursable only if both the member and provider are located in Milwaukee County. Fifth Diagnosis Code (dx) is not on file. Denied due to Claim Exceeds Detail Limit. DME rental beyond the initial 180 day period is not payable without prior authorization. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Assessment limit per calendar year has been exceeded. Qty And/or Detail Charge Do Not Divide Out Equally For Dates Of Service and/orQty Given. Hospital discharge must be within 30 days of from Date Of Service(DOS). Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. Training Completion Date Is Not A Valid Date. The following table outlines the new coding guidelines. Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. The Request Does Not Meet Generally Accepted Conditions Requiring Fluoride Treatments. Our Records Indicate You Have Billed More Than One Unit Dose Dispensing Fee For This Calendar Month. Additional information is needed for unclassified drug HCPCS procedure codes. Claims may be denied if the only reported diagnosis is syncope and collapse when any of the listed diagnostic head, brain, carotid artery or neck imaging procedures are billed. The Other Payer ID qualifier is invalid for . Member last name does not match Member ID. CPT/HCPCS codes are not reimbursable on this type of bill. The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. DN017 Medicare EOB Denials BH N/A 10/15/2017 9/26/2017 6815, 321095 CE034 99213 99214 in Place of Service 52 Head imaging in the form of CT scans, MRI or MRA is allowed only when the service is medically reasonable and necessary. Please Clarify The Number Of Allergy Tests Performed. Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. 1. Member ID has changed. Request For Training Reimbursement Denied. Medicare RA/EOMB And Claim Dates And/or Charges Do Not Match. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. The Tooth Is Not Essential For Support Of A Partial Denture. Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. Procedure Code billed is not appropriate for members gender. Details Include Revenue/surgical/HCPCS/CPT Codes. Denied. Certifying Agency Did Not Verify Member Eligibility within 70 Day Period. Denied due to Detail Fill Date Is A Future Date. One or more Date(s) of Service is missing for Occurrence Span Codes in positions 9 through 24. Member is enrolled in Medicare Part B on the Date(s) of Service. Newsroom. Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. Exceeds The 35 Treatment Days Per Spell Of Illness. The Clinical Status Of The Member Does Not Meet Standards Accepted By The Department Of Health And Family Services For Transplant. Number Is Missing Or Incorrect. According to the AMA CPT Manual and our policy, an initial inpatient admission (CPT 99221-99223) is allowed once every seven days. Please Ask Prescriber To Update DEA Number On TheProvider File. Recouped. Healthcheck screenings or outreach is limited to six per year for members up to one year of age. Review Patient Liability/paid Other Insurance, Medicare Paid. Claim Denied. Resubmit Complete And/or Second Page Of Medicares EOMB Showing All Total And Payments. Paid In Accordance With Dental Policy Guide Determined By DHS. Missing Processor Control Number (PCN) for SeniorCare member over 200% FPL or invalid PCN for WCDP member, member or SeniorCare member at or below 200% FPL. Reimbursement For This Detail Does Not Include Unit DoseDispensing Fee. NDC- National Drug Code billed is not appropriate for members gender. General Exercise To Promote Overall Fitness And Flexibility Are Non-covered Services. A quantity dispensed is required. Please Submit A Separate New Day Claim For Copayment Exempt Days/services. Competency Test Date Is Not A Valid Date. Our Records Indicate This Tooth Previously Extracted. Please Rebill Only CoveredDates. . Unable To Process Your Adjustment Request due to. Member must receive this service from the state contractor if this is for incontinence or urological supplies. Nine Digit DEA Number Is Missing Or Incorrect. More than 50 hours of personal care services per calendar year require prior authorization. Maximum Number Of Outreach Refusals Has Been Reached For This Period. Attachment was not received within 35 days of a claim receipt. Please Use This Claim Number For Further Transactions.