Strong knowledge of adjustment and denial reason codes from Electronic Remittance Advices (ERA/835 files) and from paper Explanation of benefits (EOB's) / Explanation of payments (EOP's), CPT and ICD10 codes; Excellent interpersonal and communication skills with professional demeanor and positive attitude Room And Board Is Only Reimbursable If Member Has A BQC Nursing Home Authorization. The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable. Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. Denied/Cutback. This Is An Adjustment of a Previous Claim. The header total billed amount is required and must be greater than zero. The Number In The National Provider Identifier (NPI) Section On This Request IsNot A Number Assigned To A Certified Nursing Facility For This Date Of Service(DOS). There are many different remittance adjustment reason codes (RARCs) established for Medicare and we understand their explanations may be "generic" and confusing, so we have provided a listing in the table below of the most commonly used denial messages and RARCs utilized by Medical Review Part B during medical record review. Requests For Training Reimbursement Denied Due To Late Billing. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment. Other Medicare Managed Care Response not received within 120 days for providerbased bill. Revenue Code 0001 Can Only Be Indicated Once. Transplant services not payable without a transplant aquisition revenue code. Pricing Adjustment/ Maximum Allowable Fee pricing used. The Procedure Requested Is Not On s Files. 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. Service Denied. Denied due to Detail Fill Date Is A Future Date. Our Records Indicate This Tooth Previously Extracted. Insufficient Documentation To Support The Request. Service Not Covered For Members Medical Status Code. Billing provider number was used to adjudicate the service(s). Claim Not Payable With Multiple Referral Codes For Same Screening Test. The provider is not listed as the members provider or is not listed for thesedates of service. HCPCS Procedure Code is required if Condition Code A6 is present. The Functional Assessment Indicates This Member Has Less Than A 50% Likelihoodof Benefit, Therefore Day Treatment Is Not Appropriate. Please Resubmit. Denied due to Provider Is Not Certified To Bill WCDP Claims. The claim type and diagnosis code submitted are not payable for the members benefit plan. If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied. Please Do Not Resubmit Your Claim. Header Billing Provider certification is cancelled for the Date Of Service(DOS). Denied. A Total Charge Was Added To Your Claim. 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: No Action On Your Part Required. Prior authorization requests for this drug are not accepted. Claims may deny when a procedure defined as requiring an anatomical modifier is billed without an associated anatomical modifier. Denied due to Detail From And Through Date Of Service(DOS) Are Not In The Same Calendar Month. Complex care of 17-plus hours and complex care of less than 17 hours are not allowed on the same Date Of Service(DOS). Basic Knowledge of Explanation of Benefits (EOB) interpretation. Claim Is Pended For 60 Days. Revenue code 0850 thru 0859 is not allowed when billed with revenue codes 0820thru 0829, 0830 thru 0839, or 0840 thru 0849. Modification Of The Request Is Necessitated By The Members Minimal Progress. Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached. Denied/cutback. Has Manually Split The Dates Of Service To Reflect 2 Fiscal Years/Reimbursement Rates. This Member is enrolled in Wisconsin or BadgerCare Plus for Date(s) of Service. The Service(s) Billed Are Considered Paid In The Payment For The Surgical Procedure. Denied due to The Members First Name Is Missing Or Incorrect. Documentation Does Not Justify Medically Needy Override. The Member Is Involved In group Physical Therapy Treatment. This Member Has Already Received Intensive Day Treatment In The Past Year and is Only Eligible For Reduced Hours At This Time. Has Already Issued A Payment To Your NF For This Level L Screen. A valid procedure code is required on WWWP institutional claims. Only two dispensing fees per month, per member are allowed. A standard 12-lead electrocardiogram should be obtained first for patients with a diagnosis of syncope and collapse before performing advanced imaging procedures. Time Spent In AODA Day Treatment By Affected Family Members Is Not Covered. Service is reimbursable only once per calendar month. Reimbursement For HCPCS Procedure Code 58300 Includes IUD Cost. Please Reference Payment Report Mailed Separately. The number of tooth surfaces indicated is insufficient for the procedure code billed. Escalations. The training Completion Date On This Request Is After The CNAs CertificationTest Date. Header From Date Of Service(DOS) is after the date of receipt of the claim. CO/96/N216. This National Drug Code (NDC) is not covered. Strong knowledge of adjustment and denial reason codes from Electronic Remittance Advices (ERA/835 files) and from paper Explanation of benefits (EOB's) / Explanation of payments (EOP's), CPT . PleaseResubmit Charges For Each Condition Code On A Separate Claim. The member has no Level of Care (LOC) authorization on file or the LOC on filedoes not match the LOC on the claim. Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. Denied due to Detail Add Dates Not In MM/DD Format. This Service Is Included In The Hospital Ancillary Reimbursement. 0001: Member's . The Seventh Diagnosis Code (dx) is invalid. Multiple Tooth Extract On Same Date Of Service(DOS) Must Be Billed As Single And Additional Tooth Extract In Same Quadrant. Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness. The Other Payer Amount Paid qualifier is invalid for . Payment Recovered For Claim Previously Processed Under Wrong Member ID Number. Claim Explanation Codes. Once medical records are received, medical review professionals will review the documentation to determine whether the claim is supported as submitted and pay or deny accordingly. For FQHCs, place of service is 50. Please Indicate Anesthesia Time For Services Rendered. Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. Billed Amount Is Equal To The Reimbursement Rate. Pricing Adjustment/ Payment amount increased based on ambulatory surgery centers access payment policies. No Action Required. These Urinalysis Procedures Reimbursed Collectively At The Maximum For Routine Urinalysis With Microscopy. The revenue code has Family Planning restrictions. Claim reimbursement has been cutback to reimbursement limits for denture repairs performed within 6 months. Two Informational Modifiers Required When Billing This Procedure Code. One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Reason Code Remark Code(s) Denial Denial Description; 16: M51 | N56: Service is not reimbursable for Date(s) of Service. Denied due to From Date Of Service(DOS)/date Filled Is Missing/invalid. PATIENT PAID PORTION USED TOWARDS DEDUCTIBLE. Amount Paid Reduced By Amount Of Other Insurance Payment. See Provider Handbook For Good Faith Billing Instructions. Authorization For Surgery Requiring Second Opinion Valid For 6Months After Date Approved. Unable To Process Your Adjustment Request due to A Different Adjustment Is Pending For This Claim. OA 12 The diagnosis is inconsistent with the provider type. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Third Diagnosis Code. Denied/Cutback. The Materials/services Requested Are Principally Cosmetic In Nature. The number of treatments/days reflected by the units entered with revenue code0821, 0831, 0841, 0851, 0880, 0881 exceeds the number of days included in the FROM and TO dates entered on this claim. Early Refill Alert. Denied. Mississippi Medicaid Explanation of Benefits (EOB) Codes EOB Code Effective Date Description 0000 01/01/1900 THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW. Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. Please Disregard Additional Information Messages For This Claim. Denied. This National Drug Code (NDC) requires a whole number for the Quantity Billed. Diagnosis Treatment Indicator is invalid. Detail Quantity Billed must be greater than zero. Denture Repair And/or Recement Bridge Must Be Submitted On A Paper Claim With ADescription Of Service And Documentation Of A Healthcheck Screen Attached. Modifier invalid for Procedure Code billed. The Member Has Received A 93 Day Supply Within The Past Twelve Months. Will Not Authorize New Dentures Under Such Circumstances. Information Required For Claim Processing Is Missing. Please Correct And Resubmit. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. If laboratory costs exceed reimbursement, submit a claim adjustment request with lab bills for reconsideration. Please Submit A Separate New Day Claim For Copayment Exempt Days/services. Good Faith Claim Denied. The Member Does Not Appear To Meet The Severity Of Illness Indicators Established by the Wisconsin And Is Therefore Not Eligible For AODA Day Treatment. Up to a $1.10 reduction has been applied to this claim payment. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. This obstetrical service was previously paid for this Date Of Service(DOS) for thismember. Incorrect Liability Start/end DatesOr Dollar Amounts Must Be Corrected Through County Social Services Agency. Quantity Billed is restricted for this Procedure Code. Prior Authorization (PA) required for payment of this service. Active Treatment Dose Is Only Approved Once In Six Month Period. NDC was reimbursed at brand WAC (Wholesale Acquisition Cost) (Wholesale Acquisition Cost) rate. Timely Filing Deadline Exceeded. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Discharge Diagnosis 5 Is Not Applicable To Members Sex. Claims For Sterilization Procedures Must Reflect ICD-9 Diagnosis Code V25.2. Consent Form Is Missing, Incomplete, Or Contains Invalid Information. Claims may deny when DXA bone density studies (CPT 77080 or 77081) are billed and the only diagnosis on the claim is osteoporosis screening (ICD-10 code Z13.820) for a woman who is under age 65 or for a man who is under age 70. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. Fourth Diagnosis Code (dx) is not on file. Revenue code requires submission of associated HCPCS code. Providers should submit adequate medical record documentation that supports the claim (services) billed. If authorization number available . Missing or invalid level of effort submitted and/or reason for service, professional service, or result of service code billed in error. Reason Code 160: Attachment referenced on the claim was not received. that provide either supplemental explanation for a monetary adjustment or policy information are required in the remittance advice transaction. Six Week Healing Time Is Required Between Endentulation And Final Impressions.Payment For Dentures Will Be Denied Or Recouped If Healing Period Is Not Observed. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. CO/204/N182 . Date Of Service Must Fall Between The Prior Authorization Grant Date And Expiration Date. Discrepancy Between The Other Insurance Indicator And OI Paid Amount. Second modifier code is invalid for Date Of Service(DOS) (DOS). Frequency or number of injections exceed program policy guidelines. The Information Provided Indicates This Member Is Not Willing Or Able To Participate Inaftercare/continuing Care Services And Is Therefore Not Eligible For AODA Day Treatment. Member In TB Benefit Plan. The To Date Of Service(DOS) for the First Occurrence Span Code is required. The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved. A Less Than 6 Week Healing Period Has Been Specified For This PA. Formal Speech Therapy Is Not Needed. Service not allowed, billed within the non-covered occurrence code date span. CRNAs, AAs, And Anesthesiologists Supervising CRNAs/AAs Must Bill AnesthesiA Services Using The Appropriate Modifier. A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. Claim Denied Due To Invalid Occurrence Code(s). Good Faith Claim Correctly Denied. If you are still unable to resolve the login problem, read the troubleshooting steps or report your issue. This drug is a Brand Medically Necessary (BMN) drug. Prior Authorization (PA) is required for payment of this service. NDC was reimbursed at AWP (Average Wholesale Price) (Average Wholesale Price) rate. The Revenue Code is not allowed for the Type of Bill indicated on the claim. Condition code 70-76 is required on an ESRD claim when Influenza/PPV/HEP B HCPCS codes are the only codes being billed with condition code A6. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. This Dental Service Limited To Once A Year. Claim Reduced Due To Member Income Available Toward Cost Of Care (Nursing Home Liability). Denied. Denied. The Surgical Procedure Code of greatest specificity must be used. The Surgical Procedure Code is not payable for Wisconsin Chronic Disease Program for the Date Of Service(DOS). This drug is not covered for Core Plan members. The Second Occurrence Code Date is invalid. 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. Benefit Payment Determined By DHS Medical Consultant Review. This Adjustment Was Initiated By . Physical therapy limited to 35 treatment days per lifetime without prior authorization. Services For Members With Medical Status Code TR, SH, SJ, TS Or ST NotAllowed For Your Provider Type, Or For Your Provider Type without a TB Diagnosis. Medical Billing and Coding Information Guide. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Hypoglycemics-Insulin to Humalog and Lantus. Billing Provider indicated is not certified as a billing provider. Do Not Indicate NS On The Claim When The NDC Billed Is For A Generic Drug. One or more To Date(s) of Service is missing for Occurrence Span Codes in positions three through 24. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Department Of Justice Settlement. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Pricing Adjustment/ Usual & Customary Charge (UCC) flat fee pricing applied. It Corrects A Mispayment FoundDuring Claims Processing Or Resulting From Retroactive File Changes. The Service Requested Is Included In The Nursing Home Rate Structure. The To Date Of Service(DOS) for the First Occurrence Span Code is invalid. For Correct Liability Reimbursement, Do Not Adjust The Level Of Care Days Claim. Claim paid at the program allowed amount. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. 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 . 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. RN And LPN Subsequent Care Visits Limited To 6 Hrs Per Day/per Member/per Provider. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. For additional information on HIPAA EOB codes, visit the Code List section of the WPC website at www.wpc-edi.com. Denied. The Procedure(s) Requested Are Not Medical In Nature. Duplicate/second Procedure Deemed Medically Necessary And Payable. The National Drug Code (NDC) is not on file for the Dispense Date Of Service(DOS). Service(s) paid at the maximum daily amount per provider per member. Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. 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. Authorizations. Medically Needy Claim Denied. The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program. Critical care in non-air ambulance is not covered. A HCPCS code is required when condition code A6 is included on the claim. Denied. ACTION DESCRIPTION: ACTION TYPE. Anesthesia and Moderate Sedation Services CPTs 00300, 00400, 00600, 01935-01936, 01991-01992, 99152-99153, 99156-99157, Pain Management Services CPTs 20552, 20553, 27096, 62273, 62320-62323, 64405, 64479, 64480, 64483, 64484, 64490-64495, 0228T, 0229T, 0230T, 0231T, G0260, Nerve Conduction Studies CPT 95907-95913, Needle electromyography (EMG)-CPT 95885, 95886. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Rendering Provider Type and/or Specialty is not allowable for the service billed. Claim Or Adjustment/reconsideration Request Should Include An Operative Or Pathology Report For This Procedure. Find top links about Wellcare Cvs Caremark Login along with social links, FAQs, and more. This Member Has Received Primary AODA Treatment In The Last Year And Is Therefore Not Eligible For Primary Intensive AODA Treatment At This Time. Other Insurance Disclaimer Code Invalid. Requested Documentation Has Not Been Submitted. Revenue Code Required. Pricing Adjustment/ Repackaging dispensing fee applied. Physical Therapy Treatment Limited To One Modality, One Procedure, One Evaluation Or One Combination Per Day. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. NCTracks Contact Center. Service Denied. Medicaid Remittance Advice Remark Code:M86 MMIS EOB Code:100. Claim Detail Pended As Suspect Duplicate. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Amount Recouped For Mother Baby Payment (newborn). Use This Claim Number If You Resubmit. Please Indicate Computation For Unloaded Mileage. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). Type of Bill indicates services not reimbursable or frequency indicated is notvalid for the claim type. Member is not enrolled in /BadgerCare Plus for the Date(s) of Service. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment. Unrelated Procedure/Service by the Same Physician During the Post-op Period, Modifier 79. Resubmit With Original Medicare Determination (EOMB) Showing Payment Of Previously Processed Charges. A Payment For The CNAs Competency Test Has Already Been Issued. Procedure May Not Be Billed With A Quantity Of Less Than One. Well-baby visits are limited to 12 visits in the first year of life. Services not allowed for your Provider Type or for your Provider Type without a TB diagnosis. Program guidelines or coverage were exceeded. Service Denied. Denied. Submitted rendering provider NPI in the detail is invalid. Description. Inpatient psychiatric services are not reimbursable for members age 21 65 (age 22 if receiving services prior to 21st birthday). This drug is limited to a quantity for 34 days or less. Header From Date Of Service(DOS) is required. Claim or Adjustment received beyond 365-day filing deadline. The Tooth Is Not Essential To Maintain An Adequate Occlusion. Previously Paid Individual Test May Be Adjusted Under a Panel Code. The National Drug Code (NDC) is not payable for the Provider Type and/or Specialty. No matching Reporting Form on file for the detail Date Of Service(DOS). Prosthodontic Services Appear To Have Started After Member EligibilityLapsed. Claim Denied. Unable To Process Your Adjustment Request due to Member ID Number On The Claim And On The Adjustment Request Do Not Match. If some of the services were previously paid, submit an adjustment/reconsideration request for the paid claim. Claim Detail Denied For Invalid CPT, Invalid CPT/modifier Combination, Or Invalid Type Of Quantity Billed. Service Denied. 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. Timely Filing Request Denied. A Valid Level Of Effort Is Required For Billing Compound Drugs Or Pharmaceutical Care. The Tooth Is Not Essential For Support Of A Partial Denture. Services Not Allowed For Your Provider T. The Procedure Code has Place of Service restrictions. This HMO Capitation Payment Is Being Recouped It Was Inappropriately Paid During The Inital February HMO Capitation Cycle. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. Always bill the correct place of service. Occurrence Code is required when an Occurrence Date is present. Denied. Denied due to Take Home Drugs Not Billable On UB92 Claim Form. Resubmit the Claim with the Appropriate Modifier for Provider Type andSpecialty. Please Furnish A Breakdown Of Your Procedure Code And Charge In Question GivenOn The Adjustment/reconsideration Request. All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. No Interim Billing Allowed On Or After 01-01-86. The From Date Of Service(DOS) for the First Occurrence Span Code is required. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. Recouped. Reimbursement rate is not on file for members level of care. A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. No Functional Regression Has Occurred To Warrant A Spell Of Illness; Submit AsA Prior Authorization Request. Prescribing Provider UPIN Or Provider Number Missing From Claim And Attachment. At Least One Of The Compounded Drugs Must Be A Covered Drug. Total billed amount is less than the sum of the detail billed amounts. A valid Prior Authorization is required for non-preferred drugs. 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. Dental service limited to twice in a six month period. The Procedure Code billed not payable according to DEFRA. Fourth Other Surgical Code Date is invalid. Other Insurance Disclaimer Code Used Is Inappropriate For This Members Insurance Coverage. Non-covered Charges Are Missing Or Incorrect. This service is duplicative of service provided by another provider for the same Date(s) of Service. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Provider Must Have A CLIA Number To Bill Laboratory Procedures. Denied. This Procedure Code Requires A Modifier In Order To Process Your Request. Fourth Other Surgical Code Date is required. Pharmaceutical care code must be billed with a valid Level of Effort. Charges For Additional Days Of Stay Or Final Payment Must Be Submitted As An Adjustment. This Procedure Is Limited To Once Per Day. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. Services Not Provided Under Primary Provider Program. A NAT Reimbursement Request Must Be Submitted To WI Within A Year Of The CNAs Hire Date. The Members Profile Indicates This Member Is Possibly Alcoholic And/or Chemically Dependent, And Intensive Aoda Treatment Appears Warranted. Risk Assessment/Care Plan is limited to one per member per pregnancy. The maximum number of details is exceeded. the patient (or parent or guardian) at the address noted on the claim, be sure your doctor has updated your records with your current address. Medical Necessity For Food Supplements Has Not Been Documented. Additional Psychotherapy Is Not Considered Appropriate Or Inline With More Effective, Available Services. Case Plan and/or assessment reimbursment is limited to one per calendar year.Calendar Year. Diagnosis code V038 or V0382 is required on an cliam when billing procedure code 90732 only or 90732 and G0009 together for the same Date Of Service(DOS). Service Denied. Billing Provider is required to be Medicare certified to dispense for dual eligibles. Adjustment To Crossover Paid Prior To Aim Implementation Date. Dates Of Service Must Be Itemized. Member Is Eligible For Champus. Revenue code submitted with the total charge not equal to the rate times number of units. Less Expensive Alternative Services Are Available For This Member. Denied due to Member Is Eligible For Medicare. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. The Member Is Only Eligible For Maintenance Hours. Compound Drug Service Denied. View the Part C EOB materials in the Downloads section below. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider. Independent Laboratory Provider Number Required. Reimb Is Limited to the Average Monthly NH Cost and Services Above that Amount Are Considered non-Covered Services. Another PNCC Has Billed For This Member In The Last Six Months. DN017 Medicare EOB Denials BH N/A 10/15/2017 9/26/2017 6815, 321095 CE034 99213 99214 in Place of Service 52 Claim reduced to fifteen Hospital Bedhold Days for stays exceeding fifteen days. Services Cutback/denied, Charges Greater Than Patient Liability, Not Responsible For Noncovered Services In Excess Of Patient Liability. Established in 1975 and incorporated in 1987, WPC is widely recognized as a leading expert in supporting the development, publishing, and licensing of complex . A Training Payment Has Already Been Issued For This Cna. Request Denied. All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied. Records Indicate This Tooth Has Previously Been Extracted. Payment Subject To Pharmacy Consultant Review. Providers May Only Bill For Assessments And Care Plans Twice Per Calendar Year. Part A Reason Codes are maintained by the Part A processing system. HIPAA EOB codes are returned on the 835 Remittance Advice file and are maintained by the Washington Publishing Company. Diagnosis 635-635.92 May Only Be Used When Billing For Abortion Procedures. Level Of Care/accommodation Code Billed Is Not Applicable To Your Provider Specialty. Part C Explanation of Benefits (EOB) Materials. The Medical Need For This Service Is Not Supported By The Submitted Documentation. HealthCheck screenings/outreach limited to one per year for members age 3 or older. Claim Detail Is Pended For 60 Days. Default Prescribing Physician Number XX5555555 Was Indicated. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Diagnosis Code in posistion 10 through 24. This Members Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment.
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