Service Denied, refer to Medicares Billing and/or Policy Guidelines. 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. More Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable. 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. Please Review The Covered Services Appendices Of The Dental Handbook. Example: Diagnosis code 285.21 is entered as 28521, without a period or space. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. The dental procedure code and tooth number combination is allowed only once per lifetime. The Second Other Provider ID is missing or invalid. Denied. Please Refer To The Original R&S. Program guidelines or coverage were exceeded. Other Insurance/TPL Indicator On Claim Was Incorrect. Outside Lab,element 20 On CMS 1500 Claim Form Must Be Checked Yes When Handling Charges Are Billed. Prescriber Number Supplied Is Not On Current Provider File. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone. Procedure Code or Drug Code not a benefit on Date Of Service(DOS). Duplicate ingredient billed on same compound claim. Services Can Only Be Authorized Through One Year From The Prescription Date. Copayment Should Not Be Deducted From Amount Billed. Quantity Billed is not equally divisible by the number of Dates of Service on the detail. Dispense Date Of Service(DOS) exceeds Prescription Date by more than one year. These codes provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or convey information about remittance processing. Normal delivery payment includes the induction of labor. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Medically Needy Claim Denied. As a provider, you have access to a portal that streamlines your work, keeps you up-to-date more than ever before and provides critical information. In 2015 CMS began to standardize the reason codes and statements for certain services. Denied. Different Drug Benefit Programs. Fourth Other Surgical Code Date is required. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. This Procedure Is Limited To Once Per Day. This is a same-day claim for bill types 13X, 14X, 71X, or 83X and there are multiple units or combination of chemistry/hemotology tests. Denied/Cutback. The number of tooth surfaces indicated is insufficient for the procedure code billed. Please Contact Your District Nurse To Have This Corrected. Reimbursement limits for Community Care Services for the calendar year are close to being exceeded. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19. Denied due to Member Not Eligibile For All/partial Dates. Reimbursement For Training Is One Time Only. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. Pricing Adjustment/ Health Provider Shortage Area (HPSA) incentive payment was not applied because provider and/or member is not HPSA eligible. Member is assigned to a Lock-in primary provider. The Service Requested Is Included In The Nursing Home Rate Structure. Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines. Based on these reimbursement guidelines, claims may deny when the following revenue codes are billed without the appropriate HCPCS code: Pharmacy Clm Submitted Exceeds The Number Of Clms Allowed Per Cal. The Member Is Also Involved In A Structured Living And/or Working Arrangement.A Reduction In Day Treatment Hours Is Indicated. A quantity dispensed is required. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider. Valid Numbers Are Important For DUR Purposes. Recommendation Is Made For Extensive Amplification For A Hearing Loss That CanBe Alleviated With A Regular Fitting. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). Pediatric Community Care is limited to 12 hours per DOS. Other Medicare Part A Response not received within 120 days for provider basedbill. You can view these EOBs online by following these steps: Log in to your bcbsm.com account to view your prescriptions coverage. Pricing Adjustment/ Provider Level of Care (LOC) pricing applied. When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. Thank You For Your Assessment Interest Payment. One or more Diagnosis Code(s) in positions 10 through 25 is not on file. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. Claim Is Pended For 60 Days. Dental service is limited to once every six months. The Eighth Diagnosis Code (dx) is invalid. This Adjustment Was Initiated By . The first occurrence span from Date Of Service(DOS) is after the to Date Of Service(DOS). Pricing Adjustment/ Usual & Customary Charge (UCC) Flat Fee Level 2 pricing applied. Pricing Adjustment/ Repackaging dispensing fee applied. Pharmaceutical care code must be billed with a valid Level of Effort. The Procedure Requested Is Not Appropriate To The Members Sex. A dispense as written indicator is not allowed for this generic drug. Member is in a divestment penalty period. Date Of Service/procedure/charges Billed On The Adjustment/reconsideration Request Do Not Match The Original Claim. Head imaging in the form of CT scans, MRI or MRA is allowed only when the service is medically reasonable and necessary. This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim. Original Payment/denial Processed Correctly. Service Denied. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. The Quantity Allowed Was Reduced To A Multiple Of The Products Package Size. Denied. Part A Reason Codes are maintained by the Part A processing system. Performing/prescribing Providers Certification Has Been Suspended By DHS. NFs Eligibility For Reimbursement Has Expired. Time Spent In AODA Day Treatment By Affected Family Members Is Not Covered. ambulatory surgical center, outpatient hospital) exists for the same member, same date of service and the same procedure or service. Denied. This Check Automatically Increases Your 1099 Earnings. Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed. Medically Unbelievable Error. In addition, when distinct service modifier 59 or modifier XE is not appended to auditory screening services and tympanometry/impedance testing, these services may be denied. Please Check The Adjustment Icn For The Reprocessed Claim. Timely Filing Deadline Exceeded. Reimbursement for this procedure and a related procedure is limited to once per Date Of Service(DOS). The Other Payer Amount Paid qualifier is invalid for . Claim Explanation Codes. Tooth surface is invalid or not indicated. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. Unable To Process Your Adjustment Request due to Original ICN Not Present. Claim paid at program allowed rate. 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. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. This Members Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment. No action required. Healthcheck screenings or outreach limited to two per year for members betweenthe ages of two and three years. The Surgical Procedure Code has Diagnosis restrictions. Maximum Reimbursement Amount Has Been Determined By Professional Consultant. Provider Reminders: Claims Definitions. Type of Bill is invalid for the claim type. The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable. This National Drug Code (NDC) is not covered. Member is enrolled in QMB-Only benefits. A Training Payment Has Already Been Issued For This Cna. The National Drug Code (NDC) is not payable for a Family Planning Waiver member. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. This detail is denied. Refill Indicator Missing Or Invalid. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. No Substitute Indicator required when billing Innovator National Drug Codes (NDCs). Procedure May Not Be Billed With A Quantity Of Less Than One. Prescribing Provider UPIN Or Provider Number Missing From Claim And Attachment. The To Date Of Service(DOS) for the First Occurrence Span Code is required. 3101. This service or a related service performed on this date has already been billed by another provider and paid. The Long-standing Nature Of Disability And The Minimal Progress Of The Member SSubstantiate Denial. If You Have Already Obtained SSOP, Please Disregard This Message. The Surgical Procedure Code is not payable for /BadgerCare Plus for the Date Of Service(DOS). 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. Inpatient Respite Care Is Not Covered For Hospice Members Residing In Nursing Homes. Surgical Procedure Code billed is not appropriate for members gender. Customer Service Agents are available to answer questions at this toll-free number: Phone: 800-688-6696. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. Valid group codes for use on Medicare remittance advice are:. Denied/cutback. OA 14 The date of birth follows the date of service. Explanation of Benefit Codes (EOBs) Mar 14, 2022 1 EOB EOB DESCRIPTION. Discharge Diagnosis 4 Is Not Applicable To Members Sex. Payment Subject To Pharmacy Consultant Review. Follow specific Core Plan policy for PA submission. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Service Denied. Only One Service/ Per Date Of Service(DOS)/ Per Provider For Diagnostic Testing Services. OA 12 The diagnosis is inconsistent with the provider type. Payment(s) For Capital Or Medical Education Are Generated By EDS And May Not Be Billed By The Provider. Repackaging allowance is not allowed for unit dose NDCs. Please familiarize yourself with these new explanation codes and update your accounts receivable as indicated. Service Denied. The condition code is not allowed for the revenue code. Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. Summarize Claim To A One Page Billing And Resubmit. Wis Adm Code 106.04(3)(b) Requires Providers To Reimburse The Person/party (eg, County) That Previously. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. Professional Service code is invalid. Only two dispensing fees per month, per member are allowed. Claim Denied. Pricing Adjustment/ Prescription reduction applied. According To Our Records, The Hospital Has Not Received Prior Authorization For This Surgery. One or more Diagnosis Code(s) is invalid for the Date(s) of Service. Medicare Deductible Is Paid In Full. Timely Filing Deadline Exceeded. This Is A Manual Decrease To Your Accounts Receivable Balance. This Member, As Indicated By Narrative History, Does Not Agree To Abstinence from Alcohol Or Other Drugs And Is Ineligible For AODA Treatment. If The Proc Code Does Not Require A Modifier, Please Remove The Modifier. Reimbursement of this service is included in the reimbursement of the most complex/complete procedure performed. Medicaid Remittance Advice Remark Code:M86 MMIS EOB Code:100. 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. Attachment was not received within 35 days of a claim receipt. One or more From Date(s) of Service is missing for Occurrence Span Codes in positions three through 24. EOB. Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness. Purchase Only Allowed; Medical Need For Rental Has Not Been Documented. Please Resubmit. The Member Is School-age And Services Must Be Provided In The Public Schools. Rn Visit Every Other Week Is Sufficient For Med Set-up. Men. Principle Surgical Procedure Code Date is missing. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. Rebill On Pharmacy Claim Form. The Third Occurrence Code Date is invalid. Pricing Adjustment/ Resource Based Relative Value Scale (RBRVS) pricing applied. The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. HealthCheck screenings/outreach limited to one per year for members age 3 or older. Header From Date Of Service(DOS) is after the date of receipt of the claim. For 2020, WellCare is adding 68 new Medicare Advantage plans for a total of 261 plans with $0 or low monthly plan premiums. Rimless Mountings Are Not Allowable Through . A Less Than 6 Week Healing Period Has Been Specified For This PA. Newsroom. Good Faith Claim Denied. Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. Out of State Billing Provider not certified on the Dispense Date. Computed tomography (CT) of the head or brain (CPT 70450, 70460, 70470), Computed tomographic angiography (CTA) of the head (CPT 70496), Magnetic resonance angiography (MRA) of the head (CPT 70544, 70545, 70546), Magnetic resonance imaging (MRI) of the brain (CPT 70551, 70552, 70553), Duplex scan of extracranial arteries (CPT 93880,93882), Computed tomographic angiography (CTA) of the neck(CPT 70498), Magnetic resonance angiography (MRA) of the neck(CPT 70547, 70548, 70549), ICD-10 Diagnosis codes G43.009, G43.109, G43.709, G43.809, G43.829, G43.909. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity. Has Processed This Claim With A Medicare Part D Attestation Form. Timely Filing Request Denied. Claim reimbursement has been cutback to reimbursement limits for denture repairs performed within 6 months. Benefit code These codes are submitted by the provider to identify state programs. Claim Corrected. Rendering Provider is not a certified provider for . A valid header Medicare Paid Date is required. Unable To Process Your Adjustment Request due to. Etiology Diagnosis Code(s) (E-Codes) are invalid as the Admitting/Principal Diagnosis 1. Assessment limit per calendar year has been exceeded. The Lens Formula Does Not Justify Replacement. Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. Language Comprehension And Language Production Are Equivalent To Cognition, Thus Formal Speech Therapy Is Not Needed. The Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS. The Member Has Shown No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 Month Period. Admission Date does not match the Header From Date Of Service(DOS). The diagnosis code is not reimbursable for the claim type submitted. Concurrent Services Are Not Appropriate. This Incidental/integral Procedure Code Remains Denied. Professional Components Are Not Payable On A Ub-92 Claim Form. Only One Panel Code Within Same Category (CBC Or Chemistry) Maybe Performed Per Member/Provider/Date Of Service. Once Therapy Is Prior Authorized, All Therapy Must Be Billed With A Valid Prior Authorization Number. This National Drug Code (NDC) requires a whole number for the Quantity Billed. Pricing Adjustment/ Claim has pricing cutback amount applied. Continuous home care must be billed in an hourly quantity equal to or greater than eight hours, up to and including 24 hours. Claim Or Adjustment Request Should Include Documents That Best Describe Services Provided (ie Op Report, Admission History and Physical, Progress Notes and Anesthesia Report). Denied. 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. Denied due to Member Is Eligible For Medicare. There Is Evidence That The Member Is Not Detoxified From Alcohol And/or Other Drugs and is Therefore Not Currently Eligible For AODA Day Treatment. Claim Detail Denied As Duplicate. Member has Medicare Supplemental coverage for the Date(s) of Service. 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 Take Home Drugs Not Billable On UB92 Claim Form. Charges For Anesthetics Are Included In Charge For All Surgical Procedures. Comprehension And Language Production Are Age-appropriate. This service was previously paid under an equivalent Procedure Code. The Surgical Procedure Code is not payable for Wisconsin Chronic Disease Program for the Date Of Service(DOS). Per Information From Insurer, Prior Authorization Was Not Requested/approved Prior To Providing Services. Anesthesia Modifying Services Must Be Billed Separately From The Charge For Anesthesia Base And Time Units. The Procedure Requested Is Not On s Files. Pricing Adjustment/ Level of effort dispensing fee applied. The Service Requested Is Not A Covered Benefit As Determined By . All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. Service Denied. A National Drug Code (NDC) is required for this HCPCS code. Services on this claim have been split to facilitate processing.on On Your Part Is Required. Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization. Incorrect Liability Start/end Dates Or Dollar Amounts Must Be Corrected Through County Social Services Agency Before Claim/Adjustment/Reconsideration RequestCan be Processed. Service paid in accordance with program requirements. Pricing Adjustment/ Ambulatory Surgery pricing applied. To Date Of Service(DOS) Precedes From Date Of Service(DOS). Subsequently hospital care services (CPT 99221-99223 or 99231-99233) will be denied when billed for the same date of service as observation services (CPT G0378, 99218-99220 or 99224-99226) for Bill Type 0130-013Z (hospital outpatient). Claim Has Been Adjusted Due To Previous Overpayment. Denied. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. Is Unable To Process This Request Because The Signature/date Field Is Blank. Prior authorization requests for this drug are not accepted. MedicalBillingRCM.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. qatar to toronto flight status. A valid Prior Authorization is required. Header To Date Of Service(DOS) is invalid. New Prescription Required. Explanation . Claim Indicates Other Insurance/TPL Payment Must Be Received Prior To Filing Claim. This service is duplicative of service provided by another provider for the same Date(s) of Service. This limitation may only exceeded for x-rays when an emergency is indicated. Denied. . A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. A group code is a code identifying the general category of payment adjustment. Your latest EOB will be under Claims on the top menu. Service Denied. The Performing Provider Id, Member Id, And Date Of Service(DOS) Must Match The Completion Certificate Received From Ddes. Claim paid at the program allowed amount. The Request Does Not Meet Generally Accepted Conditions Requiring Fluoride Treatments. Wellcare uses cookies. This Is A Duplicate Request. Denied. The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. This procedure is age restricted. 690 Canon Eb R-FRAME-EB Pricing Adjustment/ Maximum allowable fee pricing applied. Denied. Less Expensive Alternative Services Are Available For This Member. Revenue code 082X is present on an ESRD claim which also contains revenue code088X (X frequency non equal to 9). Header To Date Of Service(DOS) is after the ICN Date. A Date Of Service(DOS) is required with the revenue code and HCPCS code billed. Speech Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. Member is not enrolled in /BadgerCare Plus for the Date(s) of Service. Denied. Duplicate Item Of A Claim Being Processed. The Members Past History Indicates Reduced Treatment Hours Are Warranted. Pregnancy Indicator must be "Y" for this aid code. . This National Drug Code Has Diagnosis Restrictions. The From Date Of Service(DOS) for the First Occurrence Span Code is required. WI Can Not Issue A NAT Payment Without A Valid Hire Date. Denied. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. The Primary Diagnosis Code is inappropriate for the Procedure Code. Risk Assessment/Care Plan is limited to one per member per pregnancy. For over 40 years, Washington Publishing Company (WPC) has specialized in managing and distributing data integration information through publications, training, and consulting services. Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code. Claim count of Present on Admission (POA) indicators does not match count of non-admitting and non-emergency diagnosis codes. Suspend Claims With DOS On Or After 7/9/97. 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. HIPAA EOB codes are returned on the 835 Remittance Advice file and are maintained by the Washington Publishing Company. Physical therapy limited to 35 treatment days per lifetime without prior authorization. The Documentation Submitted Does Not Substantiate Additional Care. Fifth Other Surgical Code Date is invalid. Denied due to Detail Dates Are Not Within Statement Covered Period. Prescription Drug Plan (PDP) payment/denial information is required on the claim to SeniorCare. Additional information is needed for unclassified drug HCPCS procedure codes. Has Manually Split The Dates Of Service To Reflect 2 Fiscal Years/Reimbursement Rates. Please Reference Payment Report Mailed Separately. Pricing Adjustment. The Procedure Code has Diagnosis restrictions. Claim Number Given Is Not The Most Recent Number. Denied due to Services Billed On Wrong Claim Form. Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months. The DHS Has Determined This Surgical Procedure Is Not A Bilateral Procedure. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. CPT Code 88305 (Level IV Surgical pathology, gross and microscopic examination) includes different types of biopsies. For Newly Certified CNAs, Date Of Inclusion Is T heir Test Date. August 14, 2013, 9:23 am . Claim Detail Denied For Invalid CPT, Invalid CPT/modifier Combination, Or Invalid Type Of Quantity Billed. Denied/Cutback. Explanation of benefits. Policy override must be granted by the Drug Authorizationand Policy Override Center to dispense early. Intermittent Peritoneal Dialysis hours must be entered for this revenue code. Billing Provider is not certified for the detail From Date Of Service(DOS). Find top links about Wellcare Cvs Caremark Login along with social links, FAQs, and more. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Billed Amount On Detail Paid By WWWP. Claim Denied/cutback. Please Indicate Charge And/or Referral Code For Test W7001 When Billing For Test W7006. Denied. Please Furnish A Breakdown Of Your Procedure Code And Charge In Question GivenOn The Adjustment/reconsideration Request. flora funeral home rocky mount va. Jun 5th, 2022 . Claim or Adjustment received beyond 365-day filing deadline. Service(s) paid in accordance with program policy limitation. Please Verify That Physician Has No DEA Number. Services In Excess Of This Cap Are Not Reimbursable for this Member. Start: 01/01/2000 | Last Modified: 03/06/2012 Notes: (Modified 2/28/03, 3/6/2012) N5: Pricing Adjustment/ Pharmacy dispensing fee applied. The revenue code and HCPCS code are incorrect for the type of bill. 2004-79 For Instructions. Claim Explanation Codes. Additional rental of a negative pressure wound therapy pump is limited to 90 days in a 12 month period. Member is assigned to an Inpatient Hospital provider. Services Denied In Accordance With Hearing Aid Policies. Adjustment/reconsideration Denied, Provider Signature/date Was Not Provided OnThe Adjustment/reconsideration Request. Always bill the correct place of service. Header and/or Detail Dates of Service are missing, incorrect or contain futuredates. Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied. Please Correct And Resubmit. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Dental X-rays Indicate A Dental Cleaning, Followed By Good Dental Care At Home, Would Be Sufficient To Maintain Healthy Gums. Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. The Insurance EOB Does Not Correspond To The Dates Of Service/servicesBeing Billed. This National Drug Code is not covered under the Core Plan or Basic Plan for the diagnosis submitted. Service Denied. Occupational therapy limited to 35 treatment days per lifetime without prior authorization. Members do not have to wait for the post office to deliver their EOB in a paper format. Reason Code 162: Referral absent or exceeded. Dates Of Service For Purchased Items Cannot Be Ranged. Ability to proficiently use Microsoft Excel, Outlook and Word. Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program. Revenue code is not valid for the type of bill submitted. Superior HealthPlan News. No Private HMO Or HMP On File. General Assistance Payments Should Not Be Indicated On Claims. Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. ACCOM REV CODE QTY BILLED NOT EQUAL TO DTL DOS. Service not covered as determined by a medical consultant. Duplicate/second Procedure Deemed Medically Necessary And Payable. Effective July 15, 2021 through December 31, 2021: Temporary Relaxation of Prior Authorization . An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code.
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