The Request Has Been Back datedto Date of Receipt. Billing Provider is not certified for the Dispense Date. Do Not Use Informational Code(s) When Submitting Billing Claim(s). Valid Numbers Are Important For DUR Purposes. This drug is not covered for Core Plan members. Etiology Diagnosis Code(s) (E-Codes) are invalid as the Admitting/Principal Diagnosis 1. This Member Has Completed Intensive AODA Treatment Within The Past 12 Months and Documentation Provided Is Not Adequate To Justify Intensive Treatment at this time. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fifth Diagnosis Code. Only One Federally Required Annual Therapy Evaluation Per Calendar Year, Per Member, Per Provider. 0001: Member's . Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. Prescriber ID and Prescriber ID Qualifier do not match. Please Furnish A UB92 Revenue Code And Corresponding Description. PNCC Risk Assessment Not Payable Without Assessment Score. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. Participant Is Enrolled In Medicare Part D. Beginning 09/01/06, Providers AreRequired To Bill Part D And Other Payers Prior To Seniorcare Or Seniorcare WillDeny The Claim. Denied due to Provider Is Not Certified To Bill WCDP Claims. The National Drug Code (NDC) is not payable for the Provider Type and/or Specialty. Claim Denied. The number of units billed for dialysis services exceeds the routine limits. Not A WCDP Benefit. Reason Code 160: Attachment referenced on the claim was not received. Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. Routine foot care Diagnoses must be billed with valid routine foot care Procedure Codes. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Dispense Date Of Service(DOS) is after Date of Receipt of claim. Member is not Medicare enrolled and/or provider is not Medicare certified. Effective 5/31/2019, we will introduce new Coding Integrity Reimbursement Guidelines. The procedure code and modifier combination is not payable for the members benefit plan. No Functional Regression Has Occurred To Warrant A Spell Of Illness; Submit AsA Prior Authorization Request. Please Resubmit. Third Other Surgical Code Date is invalid. The drug code has Family Planning restrictions. Service paid in accordance with program requirements. To access the training video's in the portal . This Individual Is Either Not On The Registry Or The SSN On The Request D oesnt Match The SSN Thats Been Inputted On The Registry. The likelihood of a central nervous system (CNS) cause of the event is extremely low, and patient outcomes are not improved with brain imaging studies. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. This claim was processed using a program assigned provider ID number, (e.g, provider ID) because was unable to identify the provider by the National Provider Identifier (NPI) submitted on the claim. Billed Amount On Detail Paid By WWWP. Surgical Procedure Code is not allowed on the claim form/transaction submitted. Denied due to Medicare Allowed, Deductible, Coinsurance And Paid Amounts Do Not Balance. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. The American College of Emergency Physicians (ACEP) also indicates that it is not appropriate to perform screening with advanced imaging for syncope patients, however be guided by the patients history and physical exam findings. The Member Appears To Be At A Maximum Level For Age, Diagnosis, And Living Arrangement. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. Schedule 3, 4 or 5 drugs are limited to the original dispensing plus 5 refillsor 6 months. Procedure Code is allowed once per member per lifetime. OA 14 The date of birth follows the date of service. Denied. No Action Required on your part. Emergency Services Indicator must be "Y" or Pregnancy Indicator must be "Y" for this aid code. Claims may be denied if an advanced imaging procedure is billed with a diagnosis of syncope and there is no history of a 12-lead EKG being performed/billed the same date or in the previous 90 days. (National Drug Code). This service is payable at a frequency of once per 12-month period, per provider, per hearing aid. Billing Provider is restricted from submitting electronic claims. Please Do Not Resubmit Your Claim. Header From Date Of Service(DOS) is after the header To Date Of Service(DOS). Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Back-up dialysis sessions are limited to three per lifetime. The Procedure Code has Diagnosis restrictions. One or more Occurrence Code Date(s) is invalid in positions nine through 24. Refer to the Onine Handbook. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Based on these reimbursement guidelines, claims may deny when the following revenue codes are billed without the appropriate HCPCS code: You Must Either Be The Designated Provider Or Have A Referral. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan. Pricing Adjustment/ Prescription reduction applied. Member ID has changed. According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Members Consent Form. Duplicate Item Of A Claim Being Processed. Services In Excess Of This Cap Are Not Reimbursable for this Member. The CNA Is Only Eligible For Testing Reimbursement. Refer To Dental HandbookOn Billing Emergency Procedures. NFs Eligibility For Reimbursement Has Expired. Member is enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Pricing Adjustment/ Medicare pricing cutbacks applied. Code. Pricing Adjustment/ Third party liability deducible amount applied. Only One Date For EachService Must Be Used. Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization. Submitclaim to the appropriate Medicare Part D plan. The Provider Type/specialty Is Not Recognized For These Date(s) Of Service. In general, the more complex the visit, the higher the E&M level of code you may bill within the appropriate category. Pricing Adjustment/ Long Term Care pricing applied. Revenue Code 0001 Can Only Be Indicated Once. Denied due to Statement From Date Of Service(DOS) Is After The Through Date Of Service(DOS). Claim Corrected. 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. Independent RHCs Must Bill Codes W6251, W6252, W6253, W6254 Or W6255. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider. Continuous home care and routine home care may not be billed for the same member on the same Date Of Service(DOS). Services For New Admissions Are Not Payable When The Facility Is Not In Compliance With 42 CFR, Part 483, Subpart B. The service is not reimbursable for the members benefit plan. Resubmit Complete And/or Second Page Of Medicares EOMB Showing All Total And Payments. NFs Eligibility For Reimbursement Has Expired. Only one initial visit of each discipline (Nursing) is allowedper day per member. Do Not Submit Claims With Zero Or Negative Net Billed. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). This National Drug Code (NDC) has diagnosis restrictions. Start: 01/01/2000 | Last Modified: 03/06/2012 Notes: (Modified 2/28/03, 3/6/2012) N5: Therefore itIs Not Necessary To Wait The Full 6 Weeks After Extractions Before Taking Denture Impressions. Header To Date Of Service(DOS) is after the ICN Date. This Payment Is A Refund For An Overpayment Of A Provider Assessment, Thank You For Your Assessment Payment By Check, In Accordance With Your Request, EDS Has Deducted Your Assessment From This Payment. 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. Previously Denied Claims Are To Be Resubmitted As New Day Claims. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Only Medicare Crossover claims are reimbursed for coinsurance, copayment, and deductible. Denied. Occupational therapy limited to 35 treatment days per lifetime without prior authorization. Please Clarify. The Service Performed Was Not The Same As That Authorized By . Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Claims may deny for audiology screening (CPT 92551, 92560, V5008) may be denied when a provider bills for auditory screening services at the same time as a preventive medicine visit (CPT 99381-99397) or wellness visit (CPT G0438-G0439), without appropriate modifier appended to the E&M service to identify a separately identifiable procedure. Documentation You Have Submitted Does Not Meet The Requirements Of HSS 107.09(4)(k). Fifth Other Surgical Code Date is required. The Lens Formula Does Not Justify Replacement. Services Beyond The Six Week Postpartum Period Are Not Covered, Per DHS. Purchase Only Allowed; Medical Need For Rental Has Not Been Documented. Services restricted to EPSDT clients valid only with a Full Scope, EPSDT-eligible Aid 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. Denied due to Provider Signature Is Missing. With Payspan's eEOB member-friendly functionality, members can log into the payer's secure portal and . Please Furnish A NDC Code And Corresponding Description. No Interim Billing Allowed On Or After 01-01-86. Preventive Medicine Code Billed Is Allowed For Health Check Agencies Only With The Appropriate Healthcheck Modifier. Non-preferred Drug Is Being Dispensed. Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update ; Note: This article was revised on April 11, 2018, to update Web addresses. Claim Reduced Due To Member/participant Deductible. According to the American College of Radiology and the American Academy of Neurology, a CT of the head or brain, CTA of the head, MRA of the head or MRI of the brain should not be performed routinely for patients with a migraine in the absence of related neurologic signs and symptoms. Requests For Training Reimbursement Denied Due To Late Billing. The detail From Date Of Service(DOS) is required. Wellcare uses cookies. The Members Demonstrated Response To Current Therapy Does Not Warrant The Intense Freqency Requested. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. Designated codes for conditions such as fractures, burns, ulcers and certain neoplasms require documentation of the side/region of the body where the condition occurs. Denied due to Claim Or Adjustment Received After The Late Billing Filing Limit. WI Can Not Issue A NAT Payment Without A Valid Hire Date. wellcare eob explanation codes. HIPAA EOB codes are returned on the 835 Remittance Advice file and are maintained by the Washington Publishing Company. The code next to this was 264, which was described on the back of Frank's EOB as "Over What Medicare Allows" Total Patient Cost: $15.00 - Frank's office visit copayment; Amount Paid to the Provider: $50.00 - the amount of money that Frank's Medicare Advantage Plan sent to Dr. David T. Denied. Panel And Individual Test Not Payable For Same Member/Provider/ Date Of Service(DOS). No Rendering Provider Status Found for the From and To Date Of Service(DOS). Services Requested Do Not Meet The Criteria for an Acute Episode. Claim Denied Due To Incorrect Accommodation. EOB Code: EOB Description: 0000: This claim/service is pending for program review. Find top links about Wellcare Cvs Caremark Login along with social links, FAQs, and more. Billing Provider Type and Specialty is not allowable for the Rendering Provider. 191. Unrelated Procedure/Service by the Same Physician During the Post-op Period, Modifier 79. Denied. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. Discharge Diagnosis 2 Is Not Applicable To Members Sex. We have redesigned our website to help you find the information you need more easily. No payment allowed for Incidental Surgical Procedure(s). The Member Has At Least 4 Posterior Teeth, Including Bicuspids On Each Side, which Can Be Used For Chewing. Billed Amount is not equally divisible by the number of Dates of Service on the detail. Denied due to Procedure Billed Not A Covered Service For Dates Indicated. At Least One Of The Compounded Drugs Must Be A Covered Drug. Resubmit Claim With Copyof A Temporary ID Card, EVS Printed Response Or Indicate The AVR Transaction Log Number. No Supporting Documentation. Pharmaceutical care indicates the prescription was not filled. Channel: Medicare covered Codes Explanation Viewing all 30 articles Browse latest View live Explanation of Benefit. All services should be coordinated with the primary provider. Service Denied. If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement. Edentulous Alveoloplasty Requires Prior Authotization. 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. Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. First modifier code is invalid for Date Of Service(DOS). Other payer patient responsibility grouping submitted incorrectly. HMO Payment Equals Or Exceeds Hospital Rate Per Discharge. The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable. PleaseReference Payment Report Mailed Separately. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date Of Service(DOS). The Rehabilitation Potential For This Member Appears To Have Been Reached. Valid group codes for use on Medicare remittance advice are:. Please Ask Prescriber To Update DEA Number On TheProvider File. Physical Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization. ambulatory surgical center, outpatient hospital) exists for the same member, same date of service and the same procedure or service. Denied. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent. Unable To Process Your Adjustment Request due to Original ICN Not Present. Member does not meet the age restriction for this Procedure Code. The Performing Provider Id, Member Id, And Date Of Service(DOS) Must Match The Completion Certificate Received From Ddes. Dispense as Written indicator is not accepted by . Service Billed Exceeds Restoration Policy Limitation. A Pharmaceutical Care Code (PCC) must include a valid diagnosis code. One or more Diagnosis Codes has a gender restriction. Please Verify That Physician Has No DEA Number. Exceeds The 35 Treatment Days Per Spell Of Illness. Initial Visit/Exam limited to once per lifetime per provider. If required information is not received within 60 days, the claim will be. Denied. Ability to proficiently use Microsoft Excel, Outlook and Word. Value codes 48 Homoglobin Reading and 49 Hematocrit Reading, must have a zero in the far right position. Denied. Please Correct And Resubmit. The Information Provided Is Not Consistent With The Intensity Of Services Requested. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. -OR- The claim contains value code 49but does not contain revenue code 0636 and HCPCS Q4054. The quantity billed of the NDC is not equally divisible by the NDC package size. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. 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. All services should be coordinated with the Hospice provider. wellcare eob explanation codes. The Dispense As Written (DAW) indicator is not allowed for the National Drug Code. The Billing Providers taxonomy code is missing. Rqst For An Acute Episode Is Denied. Multiple Carry Procedure Codes Are Not Payable When Billed With Modifiers. Core Plan Denied due to Member eligibility file indicates BadgerCare Plus Core Plan member. Denied. paul pion cantor net worth. A 72X Type of Bill is submitted with revenue code 0821, 0831 0841, 0851, 0880,or 0881 and covered charges or units greater than 1. Day Treatment exceeding 120 hours per month is not payable regardless of PriorAuthorzation. Medicare accepts any National Uniform Billing Committee (NUBC) approved revenue codes. Denied. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. Documentation Does Not Justify Fee For ServiceProcessing . Pharmaceutical care code must be billed with a valid Level of Effort. 2434. Please Correct Claim And Resubmit. Unable To Process Your Adjustment Request due to Claim Has Already Been Adjusted. RN And LPN Subsequent Care Visits Limited To 6 Hrs Per Day/per Member/per Provider. Other Coverage Code is missing or invalid. The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program. Prosthodontic Services Appear To Have Started After Member EligibilityLapsed. No Extractions Performed. Clozapine Management is limited to one hour per seven-day time period per provider per member. This Members Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment. If this is your first visit, be sure to check out the FAQ & read the forum rules.To view all forums, post or create a new thread, you must be an AAPC Member.If you are a member and have already registered for member area and forum access, you can log in by clicking here.If you've forgotten your username or password use our . Documentation Does Not Justify Medically Needy Override. Reduction To Maintenance Hours. Denied. The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential. 690 Canon Eb R-FRAME-EB OA 12 The diagnosis is inconsistent with the provider type. Drug Dispensed Under Another Prescription Number. The Second Other Provider ID is missing or invalid. Total billed amount is less than the sum of the detail billed amounts. Medical record number If a medical record number is used on the provider's claim, that number appears here. Incorrect Liability Start/end Dates Or Dollar Amounts Must Be Corrected Through County Social Services Agency Before Claim/Adjustment/Reconsideration RequestCan be Processed. Only Healthcheck Modifiers Can Be Billed With Healthcheck Services. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. Please submit claim to HIRSP or BadgerRX Gold. Secondary Diagnosis Code (dx) is not on file. Head imaging in the form of CT scans, MRI or MRA is allowed only when the service is medically reasonable and necessary. This ProviderMay Only Bill For Coinsurance And Deductible On A Medicare Crossover Claim. Invalid Procedure Code For Dx Indicated. Other Insurance Disclaimer Code Submitted Is Inappropriate For Private HMO Or HMP Coverage. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. Summarize Claim To A One Page Billing And Resubmit. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. A National Drug Code (NDC) is required for this HCPCS code. Denied. The Member Is Also Involved In A Structured Living And/or Working Arrangement.A Reduction In Day Treatment Hours Is Indicated. Pricing Adjustment/ Medicare crossover claim cutback applied. Claim Denied/Cutback. Escalations. A National Provider Identifier (NPI) is required for the Performing Provider listed in the header. Denied. Claims Cannot Exceed 28 Details. No Complete WWWP Participation Agreement Is On File For This Provider. No Action On Your Part Required. Correct And Resubmit. No Private HMO Or HMP On File. Lab Procedures Billed In Conjunction With Family Planning Pharmacy Visit Denied as not a Benefit. The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill. Denied. CRNAs, AAs, And Anesthesiologists Supervising CRNAs/AAs Must Bill AnesthesiA Services Using The Appropriate Modifier. Denied. Other Medicare Part A Response not received within 120 days for provider basedbill. Time Spent In AODA Day Treatment By Affected Family Members Is Not Covered. Duplicate/second Procedure Deemed Medically Necessary And Payable. Unable To Process This Request Due To Either Missing, Invalid OrMismatched National Provider Identifier # (NPI)/Provider Name/POP ID. The Surgical Procedure Code is not payable for the Date Of Service(DOS). The Change In The Lens Formula Does Not Warrant Multiple Replacements. Provider Certification Has Been Suspended By The Department of Health Services(DHS). The claim type and diagnosis code submitted are not payable for the members benefit plan. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. Timely Filing Deadline Exceeded. Explanation of Benefit Codes (EOBs) Mar 14, 2022 1 EOB EOB DESCRIPTION. Denied due to Prescription Number Is Missing Or Invalid. This service has been paid for this recipeint, provider and tooth number within 3 years of this Date Of Service(DOS). The Medical Need For This Service Is Not Supported By The Submitted Documentation. Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. Denied. Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. The maximum number of details is exceeded. POS codes are required under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. This National Drug Code (NDC) has Encounter Indicator restrictions. NDC was reimbursed at State Maximum Allowable Cost (SMAC) rate. Please Resubmit Corr. One or more Diagnosis Code(s) is invalid in positions 10 through 25. Header Rendering Provider number is not found. Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. The Number Of Weeks Has Been Reduced Consistent With Goals And Progress Documented. Requested Documentation Has Not Been Submitted. Second Surgical Opinion Guidelines Not Met. The Procedure Code/Modifier combination is not payable for the Date Of Service(DOS). Denied due to The Members Last Name Is Incorrect. Denied due to Some Charges Billed Are Non-covered. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. Routine Foot Care Procedures Must Be Billed With Valid Routine Foot Care Diagnosis. Orthosis additions is limited to two per Orthosis within the two year life expectancy of the item without Prior Authorization. All services should be coordinated with the Inpatient Hospital provider. 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. This notice gives you a summary of your prescription drug claims and costs. Valid Numbers Are Important For DUR Purposes. See Physicians Handbook For Details. The Existing Appliance Has Not Been Worn For Three Years. Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). These case coordination services exceed the limit. The Reimbursement Code Assigned To This CNA Does Not Authorize A NAT Payment. This Is An Adjustment of a Previous Claim. All Day Treatment Services For Members With Nursing Home Status Should Be Billed Under Procedure Code W8912(pre 10/1/03)/h2012(post 10/1/03) And Require PriorAuthorization. 10 Important Billing Tips for FQHC and RHC Providers. This member is eligible for Medication Therapy Management services. Explanation of Benefits (EOB) The four-digit explanation of benefits (EOB) codes and the corresponding narratives indicate that the submitted claim paid as billed or describe the reason the claim suspended, was denied, or did not pay in full. Voided Claim Has Been Credited To Your 1099 Liability. Service Denied/cutback. NDC- National Drug Code is not covered on a pharmacy claim. Find top links about Wellcare Cvs Caremark Login along with social links, FAQs, and more. Copyright 2023 Wellcare Health Plans, Inc. New Coding Integrity Reimbursement Guidelines. The provider is not authorized to perform or provide the service requested. Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. Denied. Principal Diagnosis 6 Not Applicable To Members Sex. Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. The Procedure(s) Requested Are Not Medical In Nature. Service Fails To Meet Program Requirements. Service(s) Denied/cutback. This is a duplicate claim. Nine Digit DEA Number Is Missing Or Incorrect. Request Denied Due To Late Billing. Pediatric Community Care is limited to 12 hours per DOS. Claim Must Indicate A New Spell Of Illness And Date Of Onset. The Requested Procedure Is Cosmetic In Nature, Therefore Not Covered By . Here are just a few of them: EOB CODE. This Member Has Prior Authorization For Therapy Services. Claim Explanation Codes. The Seventh Diagnosis Code (dx) is invalid. The Duration Of Treatment Sessions Exceed Current Guidelines. The Rendering Providers taxonomy code in the detail is not valid. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19. This National Drug Code (NDC) has been terminated by CMS for the Date Of Service(DOS). The Service Requested Is Not A Covered Benefit Of The Program. CPT is registered trademark of American Medical Association. 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. Request Denied. The revenue code has Family Planning restrictions. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. Services billed are included in the nursing home rate structure. Scope Aid Code and an EPSDT Aid Code. Discharge Date is before the Admission Date. 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. This Dental Service Limited To Once A Year. No Reimbursement Rates on file for the Date(s) of Service. Medical Billing and Coding Information Guide. Claims With Dollar Amounts Greater Than 9 Digits. Correct Claim Or Resubmit With X-ray. Anesthesia Modifying Services Must Be Billed Separately From The Charge For Anesthesia Base And Time Units. Verify billed amount and quantity billed. This procedure is limited to once per day. One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year. Denied. Denied/Cutback. Services Denied In Accordance With Hearing Aid Policies.

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