Services restricted to EPSDT clients valid only with a Full Scope, EPSDT-eligible Aid Code. Pricing Adjustment/ Paid according to program policy. The Revenue Code is not payable for the Date Of Service(DOS). These case coordination services exceed the limit. The Eighth Diagnosis Code (dx) is invalid. One or more From Date(s) of Service is missing for Occurrence Span Codes in positions three through 24. Timely Filing Deadline Exceeded. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. The Service Requested Does Not Correspond With Age Criteria. Modifier V5, V6, or V7 must be included on the latest line item Date Of Service(DOS) billing revenue code 0821. Lenses Only Are Approved; Please Dispense A Contracted Frame. Earn Money by doing small online tasks and surveys, What is Denials Management in Medical Billing? 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. Please Correct And Re-bill. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). Please Bill Appropriate PDP. Provider Is Not A Qualified Provider For presumptively Eligible Recipients. Pricing Adjustment/ Prescription reduction applied. Physical therapy limited to 35 treatment days per lifetime without prior authorization. Please watch future remittance advice. Please Review Remittance And Status Report. Member must receive this service from the state contractor if this is for incontinence or urological supplies. Code. This National Drug Code (NDC) is not covered. The Medical Need For Some Requested Services Is Not Supported By Documentation. An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. Once you register and have access to the provider portal, you will find a variety of video training available in the Resources section of the portal. The Travel component for this service must be billed on the same claim as the associated service. Benefit Payment Determined By Fiscal Agent Review. New Prescription Required. The relationship between the Billed and Allowed Amounts exceeds a variance threshold. Normal delivery payment includes the induction of labor. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. A Primary Occurrence Code Date is required. This National Drug Code (NDC) has Encounter Indicator restrictions. . Denied/Cutback. The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount. Only One Panel Code Within Same Category (CBC Or Chemistry) Maybe Performed Per Member/Provider/Date Of Service. The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). The Submission Clarification Code is missing or invalid. Procedure Code and modifiers billed must match approved PA. Claim Denied. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Detail From Date Of Service(DOS) is after the ICN Date. This claim must contain at least one specified Surgical Procedure Code. Gastrointestinal Surgery For The Purpose Of Weight Control Is Covered Only As An Emergency Procedure. 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. Dates Of Service Must Be Itemized. This care may be covered by another payer per coordination of benefits. The Procedure Code billed not payable according to DEFRA. The canister, dressings and related supplies are included as part of the reimbursement for the negative pressure wound therapy pump. THE WELLCARE GROUP OF COMPANIES . Third Diagnosis Code (dx) (dx) is not on file. The Medical Necessity For Psychotherapy Services Has Not Been Documented, ThusMaking This Member Ineligible For The Requested Service. Discharge Diagnosis 3 Is Not Applicable To Members Sex. Member is enrolled in QMB-Only benefits. The Duration Of Treatment Sessions Exceed Current Guidelines. Header To Date Of Service(DOS) is required. Changes/corrections Were Made To Your Claim Per Dental Processing Guidelines. Denied. Channel: Medicare covered Codes Explanation Viewing all 30 articles Browse latest View live Explanation of Benefit. Denied. Procedure Code and modifiers billed must match approved PA. Serviced Denied. Suspend Claims With DOS On Or After 7/9/97. General Exercise To Promote Overall Fitness And Flexibility Are Non-covered Services. Incorrect Liability Start/end Dates Or Dollar Amounts Must Be Corrected Through County Social Services Agency Before Claim/Adjustment/Reconsideration RequestCan be Processed. Requests For Training Reimbursement Denied Due To Late Billing. Tooth number or letter is not valid with the procedure code for the Date Of Service(DOS). CRNAs, AAs, And Anesthesiologists Supervising CRNAs/AAs Must Bill AnesthesiA Services Using The Appropriate Modifier. This is a duplicate claim. CO/204/N30. Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. Please Resubmit Using Newborns Name And Number. You can even print your chat history to reference later! Service(s) paid at the maximum daily amount per provider per member. 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 Please Resubmit. Service(s) Billed Are Included In The Total Obstetrical Care Fee. Valid NCPDP Other Payer Reject Code(s) required. Rendering Provider is not a certified provider for . A Procedure Code without a modifier billed on the same day as a Procedure Codewith modifier 11 are viewed as the same trip. The Comprehensive Community Support Program reimbursement limitations have been exceeded. The detail From Date Of Service(DOS) is invalid. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Timely Filing Request Denied. HMO Extraordinary Claim Denied. Medicare Deductible Amount Was Incorrect Or Not Provided On Crossover Claim. Do Not Bill Intraoral Complete Series Components Separately. Please Clarify The Number Of Allergy Tests Performed. Claim Denied. Surgical Procedures May Only Be Billed With A Whole Number Quantity. Denied due to Discharge Diagnosis 1 Missing Or Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 1 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 2 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 3 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 4 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 5 Invalid, Denied due to Diagnosis Pointer(s) Are Invalid. Denied due to The Members Last Name Is Missing. Members Age 3 And Older Must Have An Oral Assessment And Blood Pressure Check.With Appropriate Referral Codes, For Payment Of A Screening. Intermittent Peritoneal Dialysis hours must be entered for this revenue code. Certifying Agency Did Not Verify Member Eligibility within 70 Day Period. Please Furnish A NDC Code And Corresponding Description. Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Hypoglycemics-Insulin to Humalog and Lantus. Correct Claim Or Resubmit With X-ray. Medicare Paid The Total Allowable For The Service. Correction Made Per Medical Consultant Review. Healthcheck Screening Limited To Two Per Year From Birth To Age 3 And One Per Year For Age3 Or Older. This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. Claim Is Being Reprocessed Through The System. Four X-rays are allowed per spell of illness per provider. Use This Claim Number For Further Transactions. Denied. Effective 1/1: Electronic Prescribing of Controlled Substances Required. Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov. Review Patient Liability/paid Other Insurance, Medicare Paid. The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member. The taxonomy code for the attending provider is missing or invalid. Billing Provider does not have required Certification Addendum on file. The Sixth Diagnosis Code (dx) is invalid. For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP. Early Refill Alert. The service is not reimbursable for the members benefit plan. Member does not meet the age restriction for this Procedure Code. Documentation Does Not Justify Fee For ServiceProcessing . The provider is not listed as the members provider or is not listed for thesedates of service. Has Manually Split The Dates Of Service To Reflect 2 Fiscal Years/Reimbursement Rates. Member ID has changed. Second modifier code is invalid for Date Of Service(DOS) (DOS). CO - Contractual Obligations: This group code is used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment.These adjustments are considered a write off for the provider and are not billed to . Member is not Medicare enrolled and/or provider is not Medicare certified. It Must Be In MM/DD/YY Format AndCan Not Be A Future Date. Documentation Does Not Justify Reconsideration For Payment. Additional Reimbursement Is Denied. Assessment limit per calendar year has been exceeded. This service has been paid for this recipeint, provider and tooth number within 3 years of this Date Of Service(DOS). Progress, Prognosis And/or Behavior Are Complicating Factors At This Time. Private Duty Nursing Beyond 30 Hrs /Member Calendar Year Requires Prior Authorization. An Individual CBC Or Chemistry Test With A CBC Or Chemistry Panel, Performed Per Member/Provider/Date Of Service Must Be Billed w/ Appropriate Panel Code. Please Resubmit Corr. A Qualified Provider Application Is Being Mailed To You. Member is enrolled in Medicare Part B on the Date(s) of Service. Annual Physical Exam Limited To Once Per Year By The Same Provider. Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days. Rural Health Clinics May Only Bill Revenue Codes On Medicare Crossover Claims. Please correct and resubmit. Reimbursement For This Service Has Been Approved. Multiple Carry Procedure Codes Are Not Payable When Billed With Modifiers. 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. Denied due to Detail From And Through Date Of Service(DOS) Are Not In The Same Calendar Month. Personal care subsequent and/or follow up visits limited to seven per Date Of Service(DOS) per member. Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. 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 Is Being Reprocessed On Your Behalf, No Action On Your Part Required. Admit Diagnosis Code is invalid for the Date(s) of Service. The Documentation Submitted Does Not Indicate Medically Oriented Tasks Are Medically Necessary, Therefore Personal Care Services Have Been Approved. Multiple Tooth Extract On Same Date Of Service(DOS) Must Be Billed As Single And Additional Tooth Extract In Same Quadrant. EDI TRANSACTION SET 837P X12 HEALTH CARE . The Diagnosis Code is not payable for the member. Denied due to Add Dates Not In Ascending Order Or DD/DD/DD Format. Service Denied. This Modifier has been discontinued by CMS or AMA for the Date Of Service(DOS)(s). One or more Occurrence Span Code(s) is invalid in positions three through 24. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. These Urinalysis Procedures Reimbursed Collectively At The Maximum For Routine Urinalysis With Microscopy. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. A discrepancy exists between the Other Coverage Indicator and the Other Paid Amount. Basic knowledge of CPT and ICD-codes. A group code is a code identifying the general category of payment adjustment. Follow specific Core Plan policy for PA submission. Please Correct and Resubmit. The Skills Of A Therapist Are Not Required To Maintain The Member. Members I.d. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days. The Performing Provider Id, Member Id, And Date Of Service(DOS) Must Match The Completion Certificate Received From Ddes. One or more Surgical Code Date(s) is invalid in positions seven through 24. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. First Other Surgical Code Date is invalid. Billing Provider is not certified for the Date(s) of Service. SMV Or Prescribing Provider Description Code(s) Missing OrInvalid. Here are just a few of them: EOB CODE. Reimbursement of this service is included in the reimbursement of the most complex/complete procedure performed. The Procedure Requested Is Not Allowable For The Process Type Indicated On TheRequest. The Service Requested Is Covered By The HMO. In the above example the claim was denied with two codes, the Adjustment Reason Code of 16 and then the explanatory Remark Code of N329 (Missing/incomplete/invalid patient birth date). Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. It Corrects A Mispayment FoundDuring Claims Processing Or Resulting From Retroactive File Changes. Pricing Adjustment/ Prior Authorization pricing applied. A standard 12-lead electrocardiogram should be obtained first for patients with a diagnosis of syncope and collapse before performing advanced imaging procedures. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Second Diagnosis Code. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. A HCPCS code is required when condition code A6 is included on the claim. Pricing Adjustment/ Medicare crossover claim cutback applied. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Fifth Diagnosis Code (dx) is not on file. 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 Billing Providers taxonomy code in the header is invalid. Alternatively, the provider has billed a prior inpatient E&M visit, without an inpatient discharge service (CPT 99238-99239) in the interim. The Pharmaceutical Care Code (PCC) does not have a rate on file for the Date Of Service(DOS). Correct And Resubmit. Please adjust quantities on the previously submitted and paid claim. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. Incorrect Or Invalid National Drug Code Billed. Resubmit Your Services Using The Appropriate Modifier After YouReceive A Update Providing Additional Billing Information. Dispense Date Of Service(DOS) is invalid. A Version Of Software (PES) Was In Error. Revenue code submitted with the total charge not equal to the rate times number of units. Multiple Prescriptions For Same Drug/ Same Fill Date, Not Allowed. Refer To The Wisconsin Website @ dhs.state.wi.us. Please Resubmit. Please Refer To The All Provider Handbook For Instructions. Multiple Service Location Found For the Billing Provider NPI. Modification Of The Request Is Necessitated By The Members Minimal Progress. Questionable Long-term Prognosis Due To Apparent Root Infection. Denied. Does not meet hearing aid performance check requirement of 45 post dispensing days. 10 Important Billing Tips for FQHC and RHC Providers. LO DENIED - RCVD MORE THAN 60 DAYS AFTER DATE ON EOB FROM OTHER MA67 2D ADJUSTMENT - DENIAL UPHELD-TIMELINESS NOT JUSTIFIED: 31 N30 34: DENIED - NOT A PLAN MEMBER,PROVIDER MUST BILL E.D.S. Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement. Procedure not allowed for the CLIA Certification Type. Other Medicare Part B Response not received within 120 days for provider basedbill. Capitation Payment Recouped Due To Member Disenrollment. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Refer to the Onine Handbook. One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year. This claim is eligible for electronic submission. Claim Corrected. Reason Code 160: Attachment referenced on the claim was not received. Partial Payment Withheld Due To Previous Overpayment. The Member Is School-age And Services Must Be Provided In The Public Schools. A Training Payment Has Already Been Issued To Your NF For This CNA. The Members Clinical Profile/diagnosis Is Not Within Diagnostic Limitations for Psychotherapy Services. Denied. Physical Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. The total billed amount is missing or is less than the sum of the detail billed amounts. If it is medically necessary to exceed the limitation, submit an Adjustment/Reconsideration request with supporting documentation. Prospective DUR denial on original claim can not be overridden. Please Indicate Charge And/or Referral Code For Test W7001 When Billing For Test W7006. Occupational therapy limited to 35 treatment days per lifetime without prior authorization. Description & Use Of Day RX Procedure Codes Based On Members Status-not the place Of Service Where Day Rx Service Performed. No Rendering Provider Status Found for the From and To Date Of Service(DOS). Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Please Provide The Type Of Drug Or Method Used To Stop Labor. Reimbursement for this procedure and a related procedure is limited to once per Date Of Service(DOS). Rendering Provider Type and/or Specialty is not allowable for the service billed. Frequency or number of injections exceed program policy guidelines. 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. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. HCPCS procedure codes G0008, G0009 or G0010 are allowed only with revenue code0771. A Valid Level Of Effort Is Required For Billing Compound Drugs Or Pharmaceutical Care. Traditional dispensing fee may be allowed. Occurance code or occurance date is invalid. Claim or Adjustment received beyond 365-day filing deadline. Use The ICN which Is In An Allowed Or Paid Status When Filing An Adjustment/ReconsiderationRequest. Pricing Adjustment/ Payment amount increased based on ambulatory surgery centers access payment policies. If You Have Already Obtained SSOP, Please Disregard This Message. Denied. Pharmaceutical care indicates the prescription was not filled. Only one initial visit of each discipline (Nursing) is allowedper day per member. The maximum number of details is exceeded. 690 Canon Eb R-FRAME-EB The Screen Date Is Either Missing Or Invalid. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. Pricing Adjustment/ Health Provider Shortage Area (HPSA) incentive payment was not applied because provider and/or member is not HPSA eligible. Use This Claim Number If You Resubmit. The Medical Necessity For The Hours Requested Is Not Supported By The Information Submitted In The Personal Care Assessment Tool. Program guidelines or coverage were exceeded. (8 days ago) WebMassHealth List of EOB Codes Appearing on the Remittance Advice. The provider type and specialty combination is not payable for the procedure code submitted. A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. Ninth Diagnosis Code (dx) is not on file. A Payment Has Already Been Issued To A Different Nf. The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable. The Header and Detail Date(s) of Service conflict. The Value Code(s) submitted require a revenue and HCPCS Code. The Total Number Of Sessions Requested Exceeds Quarterly Guidelines. Diagnosis Code indicated is not valid as a primary diagnosis. Denied. Thank You For The Payment On Your Account. Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. Denied. Fourth Diagnosis Code (dx) is not on file. No Reimbursement Rates on file for the Date(s) of Service. Did You check More Than One Box?If So, Correct And Resubmit. Denied due to Claim Or Adjustment Received After The Late Billing Filing Limit. Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X. If not, the procedure code is not reimbursable. This claim is being denied because it is an exact duplicate of claim submitted. Service Denied. Contact Wisconsin s Billing And Policy Correspondence Unit. A Separate Notification Letter Is Being Sent. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. BMN prior authorization may be submitted for Mental Health drugs for which a Core Plan transitioned member has been previously grandfathered. Quantity Billed is missing or exceeds the maximum allowed per Date Of Service(DOS). Rebill Using Correct Claim Form As Instructed In Your Handbook. This procedure is duplicative of a service already billed for same Date Of Service(DOS). Basic Knowledge of Explanation of Benefits (EOB) interpretation. Claim reduced to fifteen Hospital Bedhold Days for stays exceeding fifteen days. Independent RHCs Must Bill Codes W6251, W6252, W6253, W6254 Or W6255. 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. BY . Number On Claim Does Not Match Number On Prior Authorization Request. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. Second Other Surgical Code Date is invalid. Claim Denied. Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached. The Rendering Providers taxonomy code in the header is not valid. Dispense Date Of Service(DOS) is after Date of Receipt of claim. One or more Diagnosis Code(s) is invalid in positions 10 through 25. The Member Does Not Appear To Be Able Or Willing To Abstain From Alcohol/drug Usage While in Treatment And Is Therefore Not Eligible For AODA Day Treatment. Result of Service submitted indicates the prescription was filled witha different quantity. Diagnosis Code is restricted by member age. Timely Filing Deadline Exceeded. Procedure Code Modifier(s) Invalid For Date Of Service(DOS) Or For Prior Authorization Date Of Receipt. Please Furnish A UB92 Revenue Code And Corresponding Description. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. DME rental beyond the initial 30 day period is not payable without prior authorization. Complete Refusal Detail Is Not Payable Without Referral/treatment Details. Language Comprehension And Language Production Are Equivalent To Cognition, Thus Formal Speech Therapy Is Not Needed. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Pricing Adjustment/ Claim has pricing cutback amount applied. Pricing Adjustment/ Pharmaceutical Care dispensing fee applied. Please Submit On The Cms 1500 Using The Correct Hcpcs Code. Once Therapy Is Prior Authorized, All Therapy Must Be Billed With A Valid Prior Authorization Number. Description. Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. The medical record request is coordinated with a third-party vendor. Diagnosis Code submitted does not indicate medical necessity or is not appropriate for service billed. Effective 5/31/2019, we will introduce new Coding Integrity Reimbursement Guidelines. Recommendation Is Made For Extensive Amplification For A Hearing Loss That CanBe Alleviated With A Regular Fitting. Time Spent In AODA Day Treatment By Affected Family Members Is Not Covered. Pricing Adjustment/ Maximum Flat Fee Level 2 pricing applied. Non-preferred Drug Is Being Dispensed. Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines. Occurrence Code is required when an Occurrence Date is present. Denied. Do Not Use Informational Code(s) When Submitting Billing Claim(s). Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. This Check Automatically Increases Your 1099 Earnings. Claim Reduced Due To Member/participant Spenddown. The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential. Good Faith Claim Denied. Do Not Indicate NS On The Claim When The NDC Billed Is For A Generic Drug. No Complete WWWP Participation Agreement Is On File For This Provider. Please verify billing. Denied. Please Disregard Additional Informational Messages For This Claim. Rinoplastia; Blefaroplastia August 14, 2013, 9:23 am . From Date Of Service(DOS) is before Admission Date. Find top links about Wellcare Cvs Caremark Login along with social links, FAQs, and more. Subsequent surgical procedures are reimbursed at reduced rate. It is a duplicate of another detail on the same claim. LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s). An approved PA was not found matching the provider, member, and service information on the claim. This National Drug Code (NDC) is only payable as part of a compound drug. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. The Service Requested Is Inappropriate For The Members Diagnosis. WCDP is the payer of last resort. Denied due to Greater Than Four Dates Of Service Billed On One Detail. See Physicians Handbook For Details. is unable to is process this claim at this time. Real time pharmacy claims require the use of the NCPDP Plan ID. These Supplies/items Are Included In The Purchase Of The Dme Item Billed On The Same Date Of Service(DOS). Service(s) Must Be Submitted On Paper Claim Form Along With Preoperative History And Physical Report And Operation Report. Other Insurance/TPL Indicator On Claim Was Incorrect. One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Denied due to Procedure/Revenue Code Is Not Allowable. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. Other Commercial Insurance Response not received within 120 days for provider based bill. Explanation of Benefit Codes (EOBs) Mar 14, 2022 4.