Dispensing fee denied. Please submit future claims with the appropriate NPI, taxonomy and/or Zip +4 Code. Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached. that provide either supplemental explanation for a monetary adjustment or policy information are required in the remittance advice transaction. Another PNCC Has Billed For This Member In The Last Six Months. Rendering Provider Type and/or Specialty is not allowable for the service billed. Purchase Only Allowed; Medical Need For Rental Has Not Been Documented. Only one antipsychotic drug is allowed without an Attestation to Prescribe More Than One Antipsychotic Drug for a Member 16 Years of Age or Younger. Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization. Please Refer To The Original R&S. 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. Member is in a divestment penalty period. This claim did not include the Plan ID, therefore we assigned TXIX as the Plan ID for this claim. Claims may deny the chest X-ray billed when the only diagnoses is one of the following routine screening diagnoses: General medical exam (ICD-10 codes Z00.0-Z00.01, Z00.5, Z00.6, Z00.8), Pre-admission/administrative exam (ICD-10 codes Z02.0-Z02.6, Z02.8-Z02.89, Z04.6), Pre-operative exam (ICD-10 codes Z01.810-Z01.811, Z01.818), FL 42 Revenue Code Required. A valid Referring Provider ID is required. Pricing Adjustment/ Repackaging dispensing fee applied. The Hearing Aid Recommended Is Not Necessary; The Member Could Be Adequately Fitted With A Conventional Aid. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. Use Of Therapy Equipment Alone Is Not Sufficient To Justify Maintenance Therapy. NFs Eligibility For Reimbursement Has Expired. Only Medicare crossover claims are reimbursable. Once Therapy Is Prior Authorized, All Therapy Must Be Billed With A Valid Prior Authorization Number. Level And/or Intensity Of Requested Service(s) Is Incompatible With Medical Need As Defined In Care Plan. Do Not Submit Claims With Zero Or Negative Net Billed. WellCare 2022 schedule; NOFEE: Code is not a covered service on your fee schedule modifiers, Part 2 for CR, GT and blank modifiers IH033: Exceeds clinical guidelines; IH038: Please Itemize Services Including Date And Charges For Each Procedure Performed. 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. Real time pharmacy claims require the use of the NCPDP Plan ID. Incorrect Liability Start/end Dates Or Dollar Amounts Must Be Corrected Through County Social Services Agency Before Claim/Adjustment/Reconsideration RequestCan be Processed. Fourth Other Surgical Code Date is invalid. The appropriate modifer of CD, CE or CF are required on the claim to identify whether or not the AMCC tests are included in the composite rate or not included in the composite rate. Denied due to Member Is Eligible For Medicare. Compound drugs require a minimum of two components with at least one payable FowardHealth covered drug. Surgical Procedure Code is not allowed on the claim form/transaction submitted. Next step verify the application to see any authorization number available or not for the services rendered. POS codes are required under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This Procedure Is Limited To Once Per Day. Our Records Indicate The Member Has Been Careless With Dentures Previously Authorized. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). Denial Codes - RCM Revenue Cycle Management - Healthcare Guide 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. To bill any code, the services furnished must meet the definition of the code. Service billed is bundled with another service and cannot be reimbursed separately. The Third Occurrence Code Date is invalid. Senior Reimbursement Specialist - Medical Claims Rural Health Clinics May Only Bill Revenue Codes On Medicare Crossover Claims. First Other Surgical Code Date is required. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Independent RHCs Must Bill Codes W6251, W6252, W6253, W6254 Or W6255. This Is Not A Reimbursable Level I Screen. Payment(s) For Capital Or Medical Education Are Generated By EDS And May Not Be Billed By The Provider. Medication checks by a Psychiatrist and/or Registered Nurse are limited to four services per calendar month. Billing Provider Name Does Not Match The Billing Provider Number. Please Resubmit Your Non-healthcheck Services Using The Appropriate Claim SortIndicator Or Electronic Format. This Service Is Included In The Hospital Ancillary Reimbursement. Cannot Be Reprocessed Unless There Is Change In Eligibility Status. The Non-contracted Frame Is Not Medically Justified. Service not payable with other service rendered on the same date. Benefit Payment Determined By DHS Medical Consultant Review. Claims adjustments. Payment Recovered For Claim Previously Processed Under Wrong Member ID Number. Continue ToUse Appropriate Codes On Billing Claim(s). Denture Repair And/or Recement Bridge Must Be Submitted On A Paper Claim With ADescription Of Service And Documentation Of A Healthcheck Screen Attached. The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable. A Previously Submitted Adjustment Request Is Currently In Process. Providers May Only Bill For Assessments And Care Plans Twice Per Calendar Year. Reimbursement For Training Is One Time Only. Invalid modifier removed from primary procedure code billed. Members I.d. 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. The Primary Occurrence Code Date is invalid. Serviced Denied. Services Denied In Accordance With Hearing Aid Policies. Claim Denied Due To Incorrect Billed Amount. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). The Revenue/HCPCS Code combination is invalid. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Prescription Date is after Dispense Date Of Service(DOS). The diagnosis code is not reimbursable for the claim type submitted. A covered DRG cannot be assigned to the claim. Unable To Process Your Adjustment Request due to A Different Adjustment Is Pending For This Claim. All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied. Revenue codes 082X, 083X, 084X, 085X, 0800 or 0881 (X frequency not equal to 5) exist on an ESRD claim for a member who has selected method 1 or no method and the claim does not contain condition codes 71, 72, 73 ,74, 75, or 76. Reason Code 160: Attachment referenced on the claim was not received. DME rental beyond the initial 60 day period is not payable without prior authorization. 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. Pricing Adjustment/ Pharmacy pricing applied. EOB Code: EOB Description: 0000: This claim/service is pending for program review. Contactmembers hospice for payment of services or resubmit with documentation of unrelated Nature of Care. Active Treatment Dose Is Only Approved Once In Six Month Period. Medically Needy Claim Denied. The Procedure Code has Diagnosis restrictions. Recd Beyond 90 Days Special Filing Deadline FOr System Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing. The first position of the attending UPIN must be alphabetic. 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. The Number Of Weeks Has Been Reduced Consistent With Goals And Progress Documented. EOB EOB DESCRIPTION. Please Disregard Additional Messages For This Claim. Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. Will Not Authorize New Dentures Under Such Circumstances. If you are still unable to resolve the login problem, read the troubleshooting steps or report your issue. Service Denied. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling. 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. Multiple Tooth Extract On Same Date Of Service(DOS) Must Be Billed As Single And Additional Tooth Extract In Same Quadrant. Complex Care Services Are Limited To One Per Date Of Service(DOS) Per Member. We have created a list of EOB reason codes for the help of people who are . Indiana Medicaid: Providers: Explanation of Benefits (EOB) Please Disregard Additional Information Messages For This Claim. Reimb Is Limited To The Average Montly NH Cost And Services Above that Amount Are Considered non-Covered Services. Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines. If you are having difficulties registering please . Assessment limit per calendar year has been exceeded. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. A Date Of Service(DOS) is required with the revenue code and HCPCS code billed. Oral exams or prophylaxis is limited to once per year unless prior authorized. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Glucocorticoids-Inhaled to Flovent. To Date Of Service(DOS) Precedes From Date Of Service(DOS). Please Rebill Only CoveredDates. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. Principle Surgical Procedure Code Date is missing. Claim date(s) of service modified to adhere to Policy. The Diagnosis Code is not payable for the member. Effective 1/1: Electronic Prescribing of Controlled Substances Required. Fourth Other Surgical Code Date is required.