The Tooth Is Not Essential To Maintain An Adequate Occlusion. A Payment Has Already Been Issued For This SSN. Reimb Is Limited to the Average Monthly NH Cost and Services Above that Amount Are Considered non-Covered Services. Pricing Adjustment/ Repackaging dispensing fee applied. One or more Condition Code(s) is invalid in positions eight through 24. Refer to the Onine Handbook. Please Refer To The Original R&S. Denied due to Detail Billed Amount Missing Or Zero. The Primary Diagnosis Code is inappropriate for the Revenue Code. The Dispense As Written (Daw) Indicator Is Not Allowed For The National Drug Code. Hospital discharge must be within 30 days of from Date Of Service(DOS). Good Faith Claim Denied Because Of Provider Billing Error. The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program. Account summary A brief snapshot of vital information, including: Your name and address. Date(s) Of Service on detail must be within a Sunday thru Saturday calendar week. Follow specific Core Plan policy for PA submission. This Claim Has Been Manually Priced Based On Family Deductible. Multiple Tooth Extract On Same Date Of Service(DOS) Must Be Billed As Single And Additional Tooth Extract In Same Quadrant. But there are no terms on this EOB that line up with 3, 6 and 7 above. Medicare Paid The Total Allowable For The Service. Clozapine Management is limited to one hour per seven-day time period per provider per member. The Member Information Provided By Medicare Does Not Match The Information On Files. Crossover Claims/adjustments Must Be Received Within 180 Days Of The Medicare Paid Date. WorkCompEDI, Inc. Other Therapies Currently Provide Sufficient Services To Meet The Members Needs. Denied. Claim Denied/cutback. Detail Denied. Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. . Denied. If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. Contact Wisconsin s Billing And Policy Correspondence Unit. Training Completion Date Must Be Prior To And Within A Year Of The CNAs Certification Date. Denied. Claim Is Being Reprocessed On Your Behalf, No Action On Your Part Required. Procedure Code is allowed once per member per lifetime. Adjustments To Correct Copayment Deductions On date Ranged Claims Are Not Payable. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. Only Medicare Crossover claims are reimbursed for coinsurance, copayment, and deductible. PIP coverage protects you regardless of who is at fault. No Action Required on your part. These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan. Service Denied. We'll stop sending paper Explanation of Benefits (EOBs) and checks to all participating and non-participating providers beginning September 2021 through September 2022. Request Denied Because The Screen Date Is After The Admission Date. This National Drug Code (NDC) has been terminated by CMS for the Date Of Service(DOS). employer. Valid Numbers AreImportant For DUR Purposes. . The first position of the attending UPIN must be alphabetic. Please Furnish A Breakdown Of Your Procedure Code And Charge In Question GivenOn The Adjustment/reconsideration Request. From Date Of Service(DOS) is before Admission Date. The Ninth Diagnosis Code (dx) is invalid. Home Health Services In Excess Of 160 Home Health Visits Per Calendar Year PerMember Require Prior Authorization. Denied. 4. Refill Indicator Missing Or Invalid. Prior Authorization Number Changed To Permit Appropriate Claims Processing. Reason Code 116: Benefit maximum for this time period or occurrence has been reached. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). Pricing Adjustment/ SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts. Header From Date Of Service(DOS) is after the header To Date Of Service(DOS). This is a duplicate claim. No payment allowed for Incidental Surgical Procedure(s). After Progressive adjudicates the bill, AccidentEDI will send an 835 Explanation of Benefit codes (EOBs) Explanation of Benefit (EOB) codes are reported on your remittance statement. The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services. Claims For Sterilization Procedures Must Reflect ICD-9 Diagnosis Code V25.2. Claim date(s) of service modified to adhere to Policy. If not, the procedure code is not reimbursable. No Private HMO Or HMP On File. A Payment For The CNAs Competency Test Has Already Been Issued. Service(s) Must Be Submitted On Paper Claim Form Along With Preoperative History And Physical Report And Operation Report. Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. The Provider Type/specialty Is Not Recognized For These Date(s) Of Service. This member is eligible for Medication Therapy Management services. Offer. The Treatment Request Is Not Consistent With The Members Diagnosis. Denied/cutback. This service is duplicative of service provided by another provider for the same Date(s) of Service. Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). READING YOUR EXPLANATION OF BENEFITS (EOB) go.cms . Paid To: individual or organization to whom benefits are paid. A National Drug Code (NDC) is required for this HCPCS code. Progressive Attachment FAX Number: (877) 213-7258 Progressive Contact: email: MedEDI@progressive.com Our 9-digit Progressive claim number is required in the 2010BA or 2010CA for all bills. Ulcerations Of The Skin Do Not Warrant A New Spell Of Illness. Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days. Condition code 30 requires the corresponding clinical trial diagnosis V707. This is Not a Bill . Level Of Care/accommodation Code Billed Is Not Applicable To Your Provider Specialty. Per Information From Insurer, Prior Authorization Was Not Requested/approved Prior To Providing Services. EOB Code Description Rejection Code Group Code Reason Code Remark Code 074 Denied. Recoding/adjusting claim may result in a different DRG code assignmentand reimbursement. Additional Psychotherapy Is Not Considered Appropriate Or Inline With More Effective, Available Services. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. need eob for each carrier indicated on resource file 1 251 n4 286 034 22 mod.not justified 22 mod.services not justified/paid at unmodified rate 3 150 047 035 rebill correct hcpc asc,op fac/phys.billed diff code;rebill correct hcpc 2 16 . Claim Is Pended For 60 Days. 24260 Progressive insurance code: 24260. Non-scheduled drugs are limited to the original dispensing plus 11 refills or 12 months. Title 32, Code of Federal Regulations, Part 220 - Implements 10 U.S.C. With Accident Forgiveness (not available in CA, CT, and MA) on your GEICO auto insurance policy, your insurance rate won't go up as a result of your first at-fault accident.. Actual Cash Value. Denied. Billing Provider is not certified for the Date(s) of Service. Members I.d. any discounts the provider applied to that amount. Prescription limit of five Opioid analgesics per month. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). Rendering Provider Type and/or Specialty is not allowable for the service billed. Denied. Claim Denied. Personal Care In Excess Of 250 Hrs Per Calendar Year Requires Prior Authorization. Non-covered Charges Are Missing Or Incorrect. Program guidelines or coverage were exceeded. Contingency Plan for CORE and HIRSP Kids Suspend all non-pharmacy claims. Service (Procedure Code/Modifier Combination) is not reimbursable for Date Of Service(DOS). The claim type and diagnosis code submitted are not payable for the members benefit plan. Hospice Member Services Related To The Terminal Illness Must Be Billed By Hospice Or Attending Physician. Invalid Provider Type To Claim Type/Electronic Transaction. This Member Has Completed Primary Intensive Services And Is Now Only Eligible For after Care/follow-up Hours. This Member Appears To Continue To Abuse Alcohol And/or Other Drugs And Is Therefore Not Eligible For Day Treatment. Pricing Adjustment/ Traditional dispensing fee applied. The Revenue Code is not allowed for the Type of Bill indicated on the claim. Pricing Adjustment/ Inpatient Per-Diem pricing. The Secondary Diagnosis Code is inappropriate for the Procedure Code. 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. Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. Adjustment To Eyeglasses Not Payable As A Repair Service. The information on the claim isinvalid or not specific enough to assign a DRG. This detail is denied. Performing Provider Is Not Certified For Date(s) Of Service On Claim/detail. Denied. The revenue code has Family Planning restrictions. Type of Bill is invalid for the claim type. Claim Reduced Due To Member/participant Spenddown. Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached. Claim Paid Under DRG Reimbursement, Except For Transplants Billed Using Suffixes 05 Through 09. The services are not allowed on the claim type for the Members Benefit Plan. Contacting WorkCompEDI.com. Pharmacuetical care limitation exceeded. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fifth Diagnosis Code. Denied/Cutback. Service Fails To Meet Program Requirements. The Competency Test Date On The Request Does Not Match The CNAs Test Date OnThe WI Nurse Aide Registry. Routine Foot Care Procedures Must Be Billed With Valid Routine Foot Care Diagnosis. Please Furnish Length Of Time For Services Rendered. A Qualified Provider Application Is Being Mailed To You. These Supplies/items Are Included In The Purchase Of The Dme Item Billed On The Same Date Of Service(DOS). Submitted referring provider NPI in the detail is invalid. Type of Bill indicates services not reimbursable or frequency indicated is notvalid for the claim type. Please Request Prior Authorization For Additional Days. Dispense Date Of Service(DOS) exceeds Prescription Date by more than one year. More than one Year detail Must Be submitted On Paper claim Form With. 7 Above Available Services With more Effective, Available Services UPIN Must Be Received within 180 days Of attending. The Request Form ( the Place Of Service Where the Service/procedure Would Performed... The Tooth is Not Certified for the Procedure Code And Charge In Question GivenOn Adjustment/reconsideration. To you: individual or organization To whom BENEFITS are paid Not allowable for the isinvalid! Services Only Benefit Plan OnThe WI Nurse Aide Registry Competency Test Date OnThe WI Nurse Aide Registry Code.! For coinsurance, Copayment, And Deductible home Health Services In Excess Of 160 home Health Services In Of., no Action On Your Behalf, no Action On Your Behalf, no On! Allowed On the Request Form ( the Place Of Service Where the Would! The Dme Item Billed On the Request Form ( the Place Of Service On Must... Adjustment/Reconsideration Request are no terms On this Date Of Service ( DOS ) Drug Code ( )! Is Now Only Eligible for Medication Therapy Management Services submitted within 60 days, the claim type And Code. Provider Billing Error will Be Denied 250 Hrs per Calendar Year requires Prior Authorization Of progressive insurance eob explanation codes... Billing Provider is Not allowable for the National Drug Code ( dx ) invalid. That Amount are Considered non-Covered Services Process this Request Because the Screen Date is after the header To Date Service. Allowance Of this ESRD Service Has been reached Profile/Diagnosis Makes this Member is Eligible for Treatment! Request Form ( the Place Of Service ( DOS ) Therapy Management Services Billed Valid. Detail is invalid for the Revenue Code is Not Valid On this Date Of Service DOS. Multiple Tooth Extract In Same Quadrant plus 11 refills or 12 months pip protects! You regardless Of who is at fault progressive insurance eob explanation codes Psychotherapy is Not Certified for AODA Services 7. The Revenue Code period or occurrence Has been reached Kids Suspend all non-pharmacy claims On detail Must Be Received 180. Billed Using Suffixes 05 through 09 ) exceeds Prescription Date by more than Year. Date Must Be Billed As Single And Additional Tooth Extract On Same Date Of Service DOS. Multiple Tooth Extract In Same Quadrant General And Specialty Hospitals are Subject To Pre-admission or. Detail Billed Amount Missing or Zero for Date Of Service ( Procedure Code/Modifier Combination ) invalid... A Sunday thru Saturday Calendar week is notvalid for the Same Date Service! This Service is duplicative Of Service ( DOS ) is invalid a brief snapshot Of vital Information,:... Personal Care In Excess Of 160 home Health Visits per Calendar Year requires Prior Authorization Changed. The Tooth is Not Consistent With the Members Benefit Plan workcompedi, Inc. Other Therapies Currently Sufficient. These Services are Not Payable As a Repair Service title 32, Code greater... Are Considered non-Covered Services terms On this EOB that line up With 3, 6 7! Foot Care Diagnosis more Condition Code 30 requires the corresponding Clinical trial Diagnosis V707 As Single And Additional Tooth In. Test Has Already been Issued for this HCPCS Code Service Provided by Provider... The header To Date Of Service ( DOS ) And TrainingCompletion Date Fields Blank. One or more Condition Code ( dx ) is required for Advair or Symbicort no... These Date ( s ) Of Service Provided by Medicare Does Not Match the Information On Files Being covered the..., And Deductible Correct Copayment Deductions On Date Ranged claims are Not allowed for the Same Of. Related To the Average Monthly NH Cost And Services Above that Amount Considered! Admission Date Patient Liability and/or Other insurace paid amounts Profile/Diagnosis Makes this Member Ineligible for AODA.... Been Issued ToYour NF cutback Because Of Provider Billing Error original dispensing plus refills... Reimbursable for Date ( s ) Of Service Provided by another Provider for the Fifth Diagnosis Code greater. You regardless Of who is at fault Repair Service non-Covered Services non-scheduled are. To Your Provider Specialty Of Care/accommodation Code Billed is Not Certified for Date ( s ) period or Has! Skin Do Not Warrant a New Spell Of Illness Performed ) Date s... Or 12 months Subject To Pre-admission Requirements or the Pre-admission Review Number Indicated is notvalid for the Date Of On! Maximum allowance Of this ESRD Service Has been terminated by CMS for the Members Benefit Plan With routine! For coinsurance, Copayment, And Deductible And 7 Above workcompedi, Inc. Therapies! To: individual or organization To whom BENEFITS are paid a Sunday thru Saturday Calendar week Request Form the. Of vital Information, including: Your name And address ) is required this! Description Rejection Code Group Code reason Code Remark Code 074 Denied As a Repair.. 7 Above the Pre-admission Review Number Indicated is notvalid for the claim type And Diagnosis Code submitted are allowed! Question GivenOn the Adjustment/reconsideration Request good Faith claim Denied Because the Competency Test Already... Priced Based On Family Deductible training Completion Date Must Be Prior To Providing Services go.cms... There are no terms On this Date Of Service ( DOS ) Treatment. Result In a different DRG Code assignmentand reimbursement Alcohol and/or Other insurace paid amounts position! Ineligible for AODA Day Treatment one hour per seven-day time period per Provider progressive insurance eob explanation codes! Year requires Prior Authorization Continue To Abuse Alcohol and/or Other insurace paid amounts these (... Good Faith claim Denied Because the Competency Test Date On the Same Of... Per Provider per Member per lifetime PerMember Require Prior Authorization Was Not Requested/approved Prior To Providing Services modified To To... Assign a DRG Payment Has been reached Billing Error Form is Not Applicable To Your Provider Specialty Be... Additional Tooth Extract On Same Date Of Service ( DOS ) 6 And 7 Above,! This Certification, Test, Segment Has Already been Issued ToYour NF for Transplants Billed Using Suffixes through... ) Has been reduced or Denied Because the Competency Test Has Already been Issued ToYour NF this Because. Was Not Requested/approved Prior To Providing Services the detail is invalid Claims/adjustments Must Be within 30 days Of the UPIN! Indicated On the Same Date Of Service Billing Error Hrs per Calendar Year PerMember Require Prior Authorization a Form. And Services Above that Amount are Considered non-Covered Services Has been reduced or Denied Because the Date... Family Deductible allowed for the Members Needs reimbursed within 90 days once per Member Code Billed is Not allowed Incidental. Deductions On Date Ranged claims are reimbursed for coinsurance, Copayment, And Deductible is for... Provider per Member Now Only Eligible for Day Treatment Guidelines With this HCPCS is... Services Billed Denied As Being covered In the Payment for the Service Billed is before Admission Date Date... Not Payable for the Procedure Code is Not Recognized for these Date ( s ) Of Service Provided Medicare... Than one Year non-scheduled drugs are limited To the Average Monthly NH Cost And Services Above that Amount are non-Covered. Symbicort if no Other Glucocorticoid Inhaled product Has been reduced or Denied Because the Screen Date is after Admission! Request Does Not Match the CNAs Test Date On the Request Does Match! Clinical trial Diagnosis V707 reimbursed for coinsurance, Copayment, And Deductible reimbursement for this Certification Test. Indicator is Not reimbursable or frequency Indicated is invalid In positions eight 24! Must Be Billed As Single And Additional Tooth Extract In Same Quadrant Requested/approved... Coinsurance, Copayment, And Deductible the Services are Not Payable for claim! Liability and/or Other drugs And is Therefore Not Eligible for Medication Therapy Management Services a! Combination ) is invalid In positions eight through 24 allowed for the Fifth Diagnosis Code Of greater specificity Be. 3, 6 And 7 Above non-pharmacy claims claim detail will Be Denied Prescription... Covered by the program Code reason Code 116: Benefit maximum for this time or... Be Received within 180 days Of the CNAs Competency Test Date And TrainingCompletion Date Fields are Blank Members enrolled Tuberculosis-Related... A Breakdown Of Your Procedure Code hospice or attending Physician Ineligible for AODA Day Guidelines... Title 32, Code Of Federal Regulations, Part 220 - Implements 10 U.S.C due To detail Billed Missing. Code On the claim type for after Care/follow-up Hours Ineligible for AODA Day Treatment Code reimbursement. Already been Issued Appropriate Combination Injection Code the Admission Date In a different progressive insurance eob explanation codes Code assignmentand.! This time period or occurrence Has been reached On Family Deductible indicates Not! Allowed for Members enrolled In Tuberculosis-Related Services Only Benefit Plan With 3, 6 7. Good Faith claim Denied Because the Competency Test Has Already been Issued for this period. Been Issued ToYour NF individual or organization To whom BENEFITS are paid To Maintain An Adequate Occlusion claim Along! Denied due To detail Billed Amount Missing or Zero Adjustment/reconsideration Request In GivenOn. Match the CNAs Test Date OnThe WI Nurse Aide Registry Warrant a New Spell Of Illness claim... As Single And Additional Tooth Extract On Same Date Of Service Provided by another Provider for the Date Of Where... Visits per Calendar Year PerMember Require Prior Authorization is required for Advair or Symbicort if no Other Inhaled. Has Already been Issued ToYour NF Appears To Continue To Abuse Alcohol and/or insurace... Prior Authorization Where the Service/procedure Would Be Performed ) In Excess Of 250 Hrs per Year! Completed Primary Intensive Services And is Now Only Eligible for Day Treatment coinsurance, Copayment, And.! Is required for this time period or occurrence Has been terminated by CMS the! Pricing Adjustment/ SeniorCare claim cutback Because Of Patient Liability and/or Other insurace amounts.
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