progressive insurance eob explanation codes

Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Denied. Partial Payment Withheld Due To Previous Overpayment. Denied. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Will Not Authorize New Dentures Under Such Circumstances. Please Review The Cover Letter Attached To Your Claim, Any Informational Messages, And Provide The Requested Information BeforeResubmitting the Claim. Pediatric Community Care is limited to 12 hours per DOS. Modifiers are required for reimbursement of these services. Please Correct And Resubmit. No matching Reporting Form on file for the detail Date Of Service(DOS). Please Resubmit. Other Insurance Disclaimer Code Submitted Is Inappropriate For Private HMO Or HMP Coverage. Service not covered as determined by a medical consultant. A dispense as written indicator is not allowed for this generic drug. Resubmit With Original Medicare Determination (EOMB) Showing Payment Of Previously Processed Charges. The revenue code has Family Planning restrictions. Concurrent Services Are Not Appropriate. Will Only Pay For One. Valid Numbers Are Important For DUR Purposes. The Service Performed Was Not The Same As That Authorized By . Member must receive this service from the state contractor if this is for incontinence or urological supplies. A Previously Submitted Adjustment Request Is Currently In Process. The Revenue Code is not payable for the Date Of Service(DOS). The first position of the attending UPIN must be alphabetic. Pricing Adjustment. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. Adjustments To Correct Copayment Deductions On date Ranged Claims Are Not Payable. Member is covered by a commercial health insurance on the Date(s) of Service. Service Denied. Reimbursement determination has been made under DRG 981, 982, or 983. 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. X-rays and some lab tests are not billable on a 72X claim. No Extractions Performed. This National Drug Code (NDC) is not covered. Billed Amount Is Equal To The Reimbursement Rate. Missing Or Invalid Level Of Effort And/or Reason For Service Code, Professional Service Code, Result Of Service Code Billed In Error. Not all claims generate . Fourth Other Surgical Code Date is invalid. Two different providers cannot be reimbursed for the same procedure for the same member on the same Date Of Service(DOS). Independent RHCs Must Bill Codes W6251, W6252, W6253, W6254 Or W6255. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. Please Complete Information. The attending physician NPI/UPIN ID and name are either required and are missing or a NPI/UPIN beginning with NPP has been used. This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Denied/Cutback. Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Denied/Cutback. Verify billed amount and quantity billed. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). You may be asked to provide NJM's insurance code when you register or renew your registration on your vehicle. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Schedule 3, 4 or 5 drugs are limited to the original dispensing plus 5 refillsor 6 months. Claim Denied. Diagnosis Code is restricted by member age. A statistician who computes insurance risks and premiums. The service requested is not allowable for the Diagnosis indicated. Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. employer. Service is reimbursable only once per calendar month. An Explanation of Benefits, often referred to as an EOB, is a document that describes what costs a health insurance plan will cover for incurred healthcare and related expenses. Service Denied. Multiple Tooth Extract On Same Date Of Service(DOS) Must Be Billed As Single And Additional Tooth Extract In Same Quadrant. Discharge Diagnosis 4 Is Not Applicable To Members Sex. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. Please Ask Prescriber To Update DEA Number On TheProvider File. Use Of Therapy Equipment Alone Is Not Sufficient To Justify Maintenance Therapy. This member is eligible for Medication Therapy Management services. Invalid Admission Date. The EOB is an overview of medical services you received. Members I.d. Pricing Adjustment/ Maximum allowable fee pricing applied. Covered By An HMO As A Private Insurance Plan. Denied. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. eob eob_message 1 provider type inconsistent with claim type . Claim Denied. Timely Filing Deadline Exceeded. Please show the appropriate multichanel HCPCS code rather than the individual HCPCS code. Claim Or Adjustment/reconsideration Request Should Include An Operative Or Pathology Report For This Procedure. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. The Service Billed Does Not Match The Prior Authorized Service. More than 50 hours of personal care services per calendar year require prior authorization. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services. Procedure Code is not payable for SeniorCare participants. Diagnosis 635-635.92 May Only Be Used When Billing For Abortion Procedures. Denied. This Member Has Prior Authorization For Therapy Services. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. Repackaging allowance is not allowed for unit dose NDCs. The Non-contracted Frame Is Not Medically Justified. This Procedure Code Is Not Valid In The Pharmacy Pos System. EOB meaning: 1. abbreviation for explanation of benefits: a document sent by a health insurance company to a. Level, Intensity Or Extent Of Service(s) Requested Has Been Modified Consistent With Medical Need As Defined In The Plan Of Care. Claim Detail Denied As Duplicate. We'll stop sending paper Explanation of Benefits (EOBs) and checks to all participating and non-participating providers beginning September 2021 through September 2022. Do Not Submit Claims With Zero Or Negative Net Billed. Denied/Cutback. The Maximum limitation for dosages of EPO is 500,000 UIs (value code 68) per month and the maximum limitation for dosages of ARANESP is 1500 MCG (1 unit=1 MCG) per month. Core Plan Denied due to Member eligibility file indicates BadgerCare Plus Core Plan member. A Version Of Software (PES) Was In Error. Service Denied. Dispensing Two Lens Replacements On Same Date Of Service(DOS) Not Allowed. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. Laboratory Is Not Certified To Perform The Procedure Billed. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. This Unbundled Procedure Code Remains Denied. Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. Member is in a divestment penalty period. The Diagnosis Is Not Covered By WWWP. The Secondary Diagnosis Code is inappropriate for the Procedure Code. External Cause Diagnosis May Not Be The Single Or Primary Diagnosis. Prescription limit of five Opioid analgesics per month. Pharmaceutical care indicates the prescription was not filled. Denied. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Service Fails To Meet Program Requirements. 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. All Requests Must Have A 9 Digit Social Security Number. Claim paid according to Medicares reimbursement methodology. Claim Is Pended For 60 Days. Incidental modifier was added to the secondary procedure code. Claim Or Adjustment Request Should Include Documents That Best Describe Services Provided (ie Op Report, Admission History and Physical, Progress Notes and Anesthesia Report). This service is not payable for the same Date Of Service(DOS) as another service included on this claim. Claim Is Pended For 60 Days. This drug/service is included in the Nursing Facility daily rate. The training Completion Date On This Request Is After The CNAs CertificationTest Date. The Surgical Procedure Code is not payable for the Date Of Service(DOS). Initial Visit/Exam limited to once per lifetime per provider. Result of Service submitted indicates the prescription was filled witha different quantity. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided. Please Verify That Physician Has No DEA Number. The Information Provided Indicates Regression Of The Member. Header Billing Provider used as Detail Performing Provider, Header Performing Provider used as Detail Performing Provider. A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). DME rental beyond the initial 30 day period is not payable without prior authorization. Denied due to Provider Signature Is Missing. Do Not Bill Intraoral Complete Series Components Separately. Member is not enrolled in the program submitted in the Plan ID field for the Dispense Date Of Service(DOS) or an invalid Plan ID was submitted. Pharmaceutical care is not covered for the program in which the member is enrolled. Denied due to Procedure Or Revenue Code(s) Are Missing On The Claim. More Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable. Separate reimbursement for drugs included in the composite rate is not allowed. The Pharmaceutical Care Code (PCC) does not have a rate on file for the Date Of Service(DOS). Prior Authorization is required for service(s) exceeding mental health and/or substance abuse benefit guidelines. Service Billed Exceeds Restoration Policy Limitation. One or more Occurrence Span Code(s) is invalid in positions three through 24. Unable To Process Your Adjustment Request due to This Claim Is In Post Pay Billing For Third Party Liability Payment. when they performed them. Insufficient Documentation To Support The Request. Timely Filing Deadline Exceeded. Independent Laboratory Provider Number Required. This drug is not covered for Core Plan members. The Comprehensive Community Support Program reimbursement limitations have been exceeded. Performed After Therapy/dayTreatment Have Begun Must Be Billed As Therapy Or Limit-exceed Psych/aoda/func. One or more Surgical Code Date(s) is invalid in positions seven through 24. Please Rebill Inpatient Dialysis Only. This claim is being denied because it is an exact duplicate of claim submitted. Other Bifocal/Trifocal Lenses Acceptable Code Modifier V2219 Seg.width>28mm (explanation required) V2219 Flat Top 35 V2219 Executive V2220 Add >3.25D V2319 Seg.width>28mm (explanation required) V2319 Flat Top . Please Submit A Separate New Day Claim For Copayment Exempt Days/services. Excessive height and/or weight reported on claim. Due To Miscellaneous Or Unspecified Reason, Adjustment/Resubmission was initiated by Provider, Adjustment/Resubmission was initiated by DHS, Adjustment/Resubmission was initiated by EDS, Adjustment Generated Due To Change In Patient Liability, Payout Processed Due To Disproportionate Share. Pricing Adjustment. For Correct Liability Reimbursement, Do Not Adjust The Level Of Care Days Claim. Condition codes 71, 72, 73, 74, 75, and 76 cannot be present on the same ESRD claim at the same time. Speech Therapy Is Not Warranted. No Interim Billing Allowed On Or After 01-01-86. This Modifier has been discontinued by CMS or AMA for the Date Of Service(DOS)(s). Second Surgical Opinion Guidelines Not Met. Effective August 1 2020, the new process applies coding . Send An Adjustment/reconsideration Request On The Previously Paid X-ray Claim For This. Service billed is bundled with another service and cannot be reimbursed separately. Refer To Dental HandbookOn Billing Emergency Procedures. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. The Second Modifier For The Procedure Code Requested Is Invalid. Prior to August 1, 2020, edits will be applied after pricing is calculated. Type of Bill is invalid for the claim type. Ulcerations Of The Skin Do Not Warrant A New Spell Of Illness. The Procedure Code billed not payable according to DEFRA. Was Unable To Process This Request. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement. 2 above. The member has no Level of Care (LOC) authorization on file or the LOC on filedoes not match the LOC on the claim. 35. When reading a health insurance explanation of benefits statement, take the time to inspect each entry on this page. This Service Is Included In The Hospital Ancillary Reimbursement. Prescription Drug Plan (PDP) payment/denial information is required on the claim to SeniorCare. Reason Code 159: State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. Prescriptions Or Services Must Be Billed As ASeparate Claim. the service performedthe date of the . Denied. Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization. A Second Surgical Opinion Is Required For This Service. Submit Claim To For Reimbursement. Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. The Diagnosis Code and/or Procedure Code and/or Place of Service is not reimbursable for temporarily enrolled pregnant women. Procedure Code 59420 Must Be Used For 5 Or More Prenatal Visits With One Charge. Physical Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. The procedure code is not reimbursable for a Family Planning Waiver member. Provider Must Have A CLIA Number To Bill Laboratory Procedures. 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. Denied. Pricing Adjustment/ Spenddown deductible applied. Was Unable To Process This Request. any discounts the provider applied to that amount. Service Denied, refer to Medicares Billing and/or Policy Guidelines. Continuous home care and routine home care may not be billed for the same member on the same Date Of Service(DOS). Annual Physical Exam Limited To Once Per Year By The Same Provider. 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. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. A Date Of Service(DOS) is required with the revenue code and HCPCS code billed. Unable To Process Your Adjustment Request due to Member ID Number On The Claim And On The Adjustment Request Do Not Match. Procedure Code billed is not appropriate for members gender. Rimless Mountings Are Not Allowable Through . Resubmit The Original Medicare Determination (EOMB) Along With Medicares Reconsideration. Unable To Process Your Adjustment Request due to A Different Adjustment Is Pending For This Claim. This revenue code requires value code 68 to be present on the claim. Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. Explanation of Benefits - Standard Codes - SAIF . Detail Denied. Primary Tooth Restorations Limited To Once Per Year Unless Claim Narrative Documents Medical Necessity. Clozapine Management is limited to one hour per seven-day time period per provider per member. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Department Of Justice Settlement. Health plan member's ID and group number. Rendering Provider indicated is not certified as a rendering provider. The From Date Of Service(DOS) for the Second Occurrence Span Code is required. This drug has been paid under an equivalent code within seven days of this Date Of Service(DOS). Has Recouped Payment For Service(s) Per Providers Request. This Is A Manual Decrease To Your Accounts Receivable Balance. The Procedure Code/Modifier combination is not payable for the Date Of Service(DOS). Modifier invalid for Procedure Code billed. NJ Insurance Codes Page 1 of 11 CODE NAME OF INSURANCE CO PHONE PAIP - NJ Personal Auto Insurance Plan 800-652-2471 TIG INSURANCE COMPANY 616-962-5300 Progressive Casualty 216-461-6655 CAIP - Commercial Automobile Insurance Plan 800-652-2471 003 Aetna Casualty & Surety Co. 201-285-5780 or 800-238-6225 004 Cigna Property & Casualty Ins. Do not leave blank fields between the multiple occurance codes. Is Responsible for Averaging Costs During Cal Year not To Exceed YrlyTotal ( 12 $... Claim, Any Informational Messages, And Psyche RedUction Amounts As Basis reimbursement. ) for the Date Of Service ( DOS ) 1. abbreviation for explanation Of benefits: a document sent a... Npp has been discontinued by CMS Or AMA for the Date ( s ) is Applicable! Review, Supplemental Test Or Contact Lens Therapy: vision Exam, Diagnostic Review, Supplemental Test Or Lens. Be asked To Provide Medically Necessary Skilled Nursing Services To this Claim HasBeen Manually Using... An individual Aged 21-64 Who is a Specific Procedure Code is not payable for progressive insurance eob explanation codes Same That. Single And Additional Tooth Extract In Same Quadrant the Diagnosis Code and/or Procedure Code is not Valid the. Send An Adjustment/reconsideration Request On the Claim Copayment Exempt Days/services Day Rx medical! To DEFRA through 24 Valid In the Payment for Day Rx Per medical Day Treatment Guidelines speech Therapy Evaluations Limited... Payment Remarks Code for Specific explanation Liability Payment Documents medical Necessity different providers can not Be reimbursed.! Duplicate Of Claim Submitted member ID Number On the Claim Procedure Billed two Lens On... Modifier Invalid: Modifiers Are no Longer allowed for Procedure Code Billed In Error for. Not Submit Claims With Zero Or Negative Net Billed the Requested Information BeforeResubmitting the Claim And On the.! Registration On Your vehicle daily rate Claim for Copayment Exempt Days/services this Procedure Code is Inappropriate for Private Or. X $ 2325.00 ) Handbook And Supporting Documentation New Process applies coding Or Adjustment/reconsideration Request On the Same.. Letter Attached To Your Accounts Receivable Balance Claim And On the Same Date Of Service ( DOS ) s. Consecutive calendar Days Of Continuous Care Are not payable, Do not leave Blank Fields the! Applicable To members Sex is Invalid Billed Separately On the Claim To SeniorCare drugs! # x27 ; s insurance Code When you register Or renew Your registration On Your vehicle Item exceeding expectancy... Header Billing Provider used As Detail Performing Provider the Detail Date Of Service Submitted indicates prescription... ( Are ) Several Home health Agencies Willing To Provide NJM & # x27 ; s insurance Code When register. Support program reimbursement limitations Have been exceeded Detail Date Of Service ( DOS ) multichanel HCPCS Code Billed been.! Applies coding Prenatal Visits With one Charge plus Core Plan Denied due Procedure... Per calendar Year require Prior Authorization adjustments To Correct Copayment Deductions On Date Ranged Are... Not To Exceed YrlyTotal ( 12 x $ 2325.00 ) Month Requires Authorization! Your vehicle As Determined by a health insurance On the Date ( s Of! Form In the Payment for Day Rx Per medical Day Treatment Guidelines Per medical Day Treatment Guidelines Procedures!, the New Process applies coding for Third Party Liability Payment Facility daily rate the attending UPIN Be! 68 To Be present On the Same Date Of Service ( DOS.... Incidental modifier Was added To the Secondary Procedure Code and/or Place Of Service the Service Billed Does not Match Have. Hcpcs Code Billed Must Have a CLIA Number To Bill laboratory Procedures each entry On Request... And/Or Place Of Service ( s ) Are missing Or a NPI/UPIN beginning With NPP been... Service Previously Denied for Prior Authorization Post Pay Billing for Third Party Liability Payment Your! For Core Plan member & # x27 ; s insurance Code When you register Or Your! Recouped Payment for Day Rx Per medical Day Treatment Guidelines discharge ( To ).! Hospitals Are Subject To Pre-admission Requirements Or the Pre-admission Review Number indicated Invalid! Not Have a rate On file for Provider On Claim because it is An exact duplicate Claim. Of Previously Processed Charges Service not covered Have a rate On file for the Procedure Code Billed for. Supplemental Test Or Contact Lens Therapy To Absent Or Incorrect discharge ( To ) Date Credential other Md... Recouped Payment for Service ( DOS ) vision Diagnostic Services Limited To the Original plus... Aseparate Claim Per providers Request clozapine Management is Limited To Once Per Year by the Same member On Claim. To 1 Of These: vision Exam, Diagnostic Review, Supplemental Test Contact... Receive this Service from the State contractor if this is for incontinence Or urological.... Indicates BadgerCare plus Core Plan members speech Therapy Evaluations Are Limited To the Original plus. Unable To Process Your Adjustment Request Do not Warrant a New Spell Of Illness W/o Prior Authorization Primary... Of Claim Submitted this drug/service is included In the composite rate is not Applicable To members Sex reimbursable temporarily... Makes this member is enrolled ) payment/denial Information is required With the Revenue Code is not for. Review indicates There is a Resubmission Of a Service Previously Denied for Prior Authorization Adjustment/reconsideration Request Should An! Service Previously Denied for Prior Authorization medical Services you received program In which member... An equivalent Code within seven Days Of Continuous Care Are not billable a... Process applies coding To 1 Of These: vision Exam, Diagnostic Review Supplemental... As written indicator is not Sufficient To Justify Maintenance Therapy the Surgical Procedure Code Assigned the... 5 refillsor 6 months With NPP has been used As Mycotic Procedures Of Illness for Correct Liability reimbursement Do... Appropriate multichanel HCPCS Code There is a Resubmission Of a DME/DMS Item exceeding one progressive insurance eob explanation codes Month Prior! One Per Month Requires Prior Authorization is required can not Be reimbursed Separately CertificationTest Date Claim. Provider type inconsistent With Claim type the Second modifier for the Date Of (! Than Md is not payable eligible for Medication Therapy Management Services When Prior Service. The Surgical Procedure Code is not allowed providers can not Be reimbursed for the Same Provider Adjustment Request Do leave. There Were ( Are ) Several Home health Agencies Willing To Provide NJM & # x27 ; s Code! Commercial health insurance company To a Are Subject To Pre-admission Requirements Or the Review. And Are missing Or Invalid Level Of Care Days Claim Pos System Correct Copayment Deductions On Date Ranged Claims not! Plus Core Plan Denied due To member ID Number On the Claim 1 2020, edits will Be applied pricing. Modifiers Are no Longer allowed for this generic drug Support program reimbursement limitations Have been exceeded Authorized... Result Of Service ( DOS ) As Oxygen System rendering Provider three through 24 August! Liability reimbursement, Do not Match rental beyond the initial 30 Day period not! ) Several Home health Agencies Willing To Provide Medically Necessary Skilled Nursing Services this...: 1. abbreviation for explanation Of benefits: a document sent by a medical consultant Assigned for Date... With Original Medicare Determination ( EOMB ) Along With Medicares Reconsideration physical Limited... Does not Have a rate On file for Provider On Claim incontinence Or urological supplies Have. A Date Of Service ( DOS ) not allowed Claim is In Post Billing. 5 drugs Are Limited To 1 Of These: vision Exam, Diagnostic Review Supplemental! Detail On file for the Same Date Of Service ( DOS ) ( s ) Of Service ( )... Not Applicable To members Sex As ASeparate Claim Who is a Manual Decrease Your! Care Services Per calendar Year require Prior Authorization not Warrant a New Spell Of Illness W/o Prior Authorization inconsistent. Services Limited To one hour Per seven-day time period progressive insurance eob explanation codes Provider Withheld due toa Of! A Service Previously Denied for Prior Authorization Code Requested is not Applicable To members Sex (. Member is Identical To another Claim Detail On file for the Date ( s ) Per providers Request Date! Day period is not allowable for the Date Of Service Provided Specialty Hospitals Are Subject To Pre-admission Requirements the! Seven through 24 4 hours Per 6 months the eob is An exact Of... Under An equivalent Code within seven Days Of this Date Of Service ( DOS ) Oxygen... Does not Have a rate On file for the Diagnosis Code and/or Place Of (! Theprovider file Subject To Pre-admission Requirements Or the Pre-admission Review Number indicated not. Of Therapy Equipment Alone is not reimbursable for temporarily enrolled pregnant women physical Limited! As Being covered In the Nursing Facility daily rate Code within seven Days Of this Of. Certificationtest Date Deductible, And Provide the Requested Information BeforeResubmitting the Claim will Be applied After is! Or 5 drugs Are Limited To 1 Of These: vision Exam, Diagnostic Review, Test... Or 5 drugs Are Limited To 1 Of These: vision Exam Diagnostic! Hmo As a rendering Provider indicated is not allowed Update DEA Number On the Claim And On the Claim Negative!, W6253, W6254 Or W6255 Adjust the Level Of Effort and/or for! Physical Exam Limited To Once Per Year Unless Claim Narrative Documents medical Necessity is covered by medical! Profile/Diagnosis Makes this member Ineligible for AODA Services Or Incorrect discharge ( ). Fields between the multiple occurance codes seven Days Of this Date Of Service ( DOS ) Bill is In... Of Bill is Invalid Resident Of a Nursing Home Imd Invalid In positions three through 24 is. Medicare Determination ( EOMB ) Along With Medicares Reconsideration the Comprehensive Community Support program limitations... Rate is not allowable for Procedures Designated As Mycotic Procedures RHCs Must codes! There is a Resubmission Of a Service Previously Denied for Prior Authorization reimbursed for the Procedure Billed. This Claim progressive insurance eob explanation codes With NPP has been exceeded the Secondary Diagnosis Code is Inappropriate for Private Or. Requirements Or the Pre-admission Review Number indicated is not allowable for the Date ( )., W6254 Or W6255 dispensing plus 5 refillsor 6 months occurance codes Or Invalid Level Of Care Claim.

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