Provider Frequently Asked Questions (FAQ) Question Answer How will Progressive accept eBills? Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. Personal injury protection (PIP) coverage. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. You Received A PaymentThat Should Have gone To Another Provider. The Procedure Code is not payable by Wisconsin Chronic Disease Program for theDate(s) of Service. Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement. Case Plan and/or assessment reimbursment is limited to one per calendar year.Calendar Year. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. Denied. Claim Denied. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. The NAIC code is found on your . Please Clarify The Number Of Allergy Tests Performed. Procedure Code or Drug Code not a benefit on Date Of Service(DOS). Newborn Care Must Be Billed Under Newborn Name And Number; Occurrence Codes 50& 51 Cannotbe Present if Billing Under Newborn Name. Member is assigned to a Lock-in primary provider. Prescriber ID is invalid.e. Payment Reduced Due To Patient Liability. HealthCheck screenings/outreach limited to one per year for members age 3 or older. We have created a list of EOB reason codes for the help of people who are working on denials, AR-follow-up, medical coding, etc. Timeframe Between The CNAs Training Date And Test Date Exceeds 365 Days. Please File With Champus Carrier. Timely Filing Deadline Exceeded. First Other Surgical Code Date is invalid. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Note: This PA Request Has Been Backdated A Maximum Of 3 Weeks Prior To Its First Receipt By EDS, Based Upon Difficulty In Obtaining The Physicians Written Prescription. This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. A Google Certified Publishing Partner. This Claim Is Being Returned. Modification Of The Request Is Necessitated By The Members Minimal Progress. Effective August 1 2020, the new process applies coding . A more specific Diagnosis Code(s) is required. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. Rebill On Pharmacy Claim Form. HMO Capitation Claim Greater Than 120 Days. The Quantity Allowed Was Reduced To A Multiple Of The Products Package Size. The billing provider number is not on file. Billed Procedure Not Covered By WWWP. Pricing Adjustment/ Anesthesia pricing applied. The condition code is not allowed for the revenue code. Occupational therapy limited to 35 treatment days per lifetime without prior authorization. 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. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Please Review Remittance And Status Report. Please Select A Procedure Code In The 58980-58988 Range That Best Describes The Procedure Being Performed. Please Use This Claim Number For Further Transactions. Limited to once per quadrant per day. The member has no Level of Care (LOC) authorization on file or the LOC on filedoes not match the LOC on the claim. Revenue code is not valid for the type of bill submitted. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Use The ICN which Is In An Allowed Or Paid Status When Filing An Adjustment/ReconsiderationRequest. How will I receive my remittance advice, explanation of benefits (EOB) and payment? The revenue accomodation billing code on the claim does not match the revenue accomodation billing code on the member file or does not match for these dates of service. Admission Date is on or after date of receipt of claim. Surgical Procedure Code is not related to Principal Diagnosis Code. Pursuant to Commission Rules in 50 Ill. Adm. Code 9110.100(c), effective January 24, 2020: "A paper explanation of benefits or SPR must also prominently contain all information necessary to match the explanation of benefits with the associated Medical Bill.A list of any relevant data elements listed in subsection [9110.100(a)] that are required for the paper explanation of benefits or SPR is . Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. All services should be coordinated with the Inpatient Hospital provider. Resubmit Private Duty Nursing Services For Complex Children With Documentation Supporting The Level Of Care. Denied. The Rendering Providers taxonomy code in the header is invalid. The Clinical Profile, Narrative History, And Treatment History Indicate The Recipient Is Only Eligible For Maintenance Hours. The header total billed amount is required and must be greater than zero. Out of State Billing Provider not certified on the Dispense Date. Claim Denied. This Is Not A Reimbursable Level I Screen. Pharmaceutical care indicates the prescription was not filled. Services on this claim have been split to facilitate processing.on On Your Part Is Required. Print. Paid In Accordance With Dental Policy Guide Determined By DHS. This procedure is duplicative of a service already billed for same Date Of Service(DOS). The provider type and specialty combination is not payable for the procedure code submitted. Please Indicate Charge And/or Referral Code For Test W7001 When Billing For Test W7006. Claim Is Pended For 60 Days. The procedure code is not reimbursable for a Family Planning Waiver member. Condition code 80 is present without condition code 74. Medicare Copayment Out Of Balance. Denied. Four X-rays are allowed per spell of illness per provider. These Services Paid In Same Group on a Previous Claim. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Initial Visit/Exam limited to once per lifetime per provider. Benefit Payment Determined By DHS Medical Consultant Review. Intraoral Complete Series/comprehensive Oral Exam Limited To Once Every Three Years, Unless Prior Authorized. Claim Denied. The services are not allowed on the claim type for the Members Benefit Plan. No Reimbursement Rates on file for the Date(s) of Service. PDN services billed on this claim exceed 12 hours/day per nurse, PDN services billed on this claim exceed 60 hours/week per nurse, PDN services billed on this claim exceed 24 hours/day per member. An antipsychotic drug has recently been dispensed for this member. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fourth Diagnosis Code. Admit Diagnosis Code is invalid for the Date(s) of Service. 0001 01/01/1900 NOT USED - MEMBER'S DMAP I.D. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. The Pharmaceutical Care Code (PCC) does not have a rate on file for the Date Of Service(DOS). The Services Requested Are Not Reasonable Or Appropriate For The AODA-affectedmember. The From Date Of Service(DOS) for the Second Occurrence Span Code is required. Performed After Therapy/dayTreatment Have Begun Must Be Billed As Therapy Or Limit-exceed Psych/aoda/func. Phone number. Detail Quantity Billed must be greater than zero. A Primary Occurrence Code Date is required. The header total billed amount is invalid. Procedure Dates Do Not Fall Within Statement Covers Period. Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. Quantity indicated for this service exceeds the maximum quantity limit established by the National Correct Coding Initiative. This Check Automatically Increases Your 1099 Earnings. VA classifies all processed claims as accepted, denied, or rejected. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. If Required Information Is Not Received Within 60 Days,the claim will be denied. Please Correct And Resubmit. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. Denied due to Take Home Drugs Not Billable On UB92 Claim Form. Procedure Denied Per DHS Medical Consultant Review. Denied. Number Is Missing Or Incorrect. Refill Indicator Missing Or Invalid. NDC was reimbursed at brand WAC (Wholesale Acquisition Cost) (Wholesale Acquisition Cost) rate. Claim Denied Due To Invalid Occurrence Code(s). 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. Value code 48 exceeds 13.0 or value code 49 exceeds 39.0 and HCPCS codes Q4081or J0882 are present but either modifer ED or EE are not present. Procedure not allowed for the CLIA Certification Type. One or more Surgical Code Date(s) is invalid in positions seven through 24. Watch FutureRemittance And Status Reports For Its Finalization Before Resubmitting. You can search for insurance companies by name or by their 3-digit code. 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. Routine foot care Diagnoses must be billed with valid routine foot care Procedure Codes. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). Rendering Provider Type and/or Specialty is not allowable for the service billed. Service(s) Approved By DHS Transportation Consultant. Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached. Different Drug Benefit Programs. The From Date Of Service(DOS) for the First Occurrence Span Code is required. This Procedure Code Not Approved For Billing. Claim Corrected. This Incidental/integral Procedure Code Remains Denied. No policy override available for BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan. The Evaluation Was Received By Fiscal Agent More Than Two Weeks After The Evaluation Date. Thank You For Your Assessment Interest Payment. Revenue Code Required. Claim Number Given Is Not The Most Recent Number. Member is not Medicare enrolled and/or provider is not Medicare certified. any discounts the provider applied to that amount. Not A WCDP Benefit. Pricing Adjustment/ Third party liability deducible amount applied. Denied. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. Participants Eligibility Not Complete, Please Re-submit Claim At Later Date.
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