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. The respiratory care services billed on this claim exceed the limit. Second Surgical Opinion Guidelines Not Met. Subsequent surgical procedures are reimbursed at reduced rate. Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization. Complex Care Services Are Limited To One Per Date Of Service(DOS) Per Member. Level Of Care/accommodation Code Billed Is Not Applicable To Your Provider Specialty. Diag Restriction On ICD9 Coverage Rule edit. Incidental modifier was added to the secondary procedure code. Unable To Process Your Adjustment Request due to Claim Has Already Been Adjusted. Denied/Cutback. The Maximum Prior Authorized Service Limitation Or Frequency Allowance Has Been Exceeded. Revenue code 0850 thru 0859 is not allowed when billed with revenue codes 0820thru 0829, 0830 thru 0839, or 0840 thru 0849. Amount billed - See No. The Screen Date Is Either Missing Or Invalid. 11. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. Services Beyond The Six Week Postpartum Period Are Not Covered, Per DHS. Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). (EOP) or explanation of benefits (EOB) . Per Information From Insurer, Claim(s) Was (were) Not Submitted. Not A WCDP Benefit. Pricing Adjustment/ Spenddown deductible applied. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). Anesthesia Modifying Services Must Be Billed Separately From The Charge For Anesthesia Base And Time Units. Discharge Diagnosis 4 Is Not Applicable To Members Sex. A traditional dispensing fee may be allowed for this claim. Resubmit Claim Once Election Form Requirements Are Met Per The Hospice Provider Handbook. Payment may be reduced due to submitted Present on Admission (POA) indicator. Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). Remark Code Description: additional explanation of the Remark or Discount Code will appear in this section. Certifying Agency Did Not Verify Member Eligibility within 70 Day Period. Members File Shows Other Insurance. Modifiers are required for reimbursement of these services. Additional rental of a negative pressure wound therapy pump is limited to 90 days in a 12 month period. Admit Diagnosis Code is invalid for the Date(s) of Service. Please Correct And Submit. The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. The CNA Is Only Eligible For Testing Reimbursement. Denied. The billing provider number is not on file. The From Date Of Service(DOS) and To Date Of Service(DOS) must be in the same calendar month and year. Insurance Verification 2. Only One Ventilator Allowed As Per Stated Condition Of The Member. Please Disregard Additional Information Messages For This Claim. Child Care Coordination services are reimbursable only if both the member and provider are located in Milwaukee County. This list was formerly published as Part 6 of the administrative and billing instructions in Subchapter 5 of your MassHealth provider manual. Routine foot care Diagnoses must be billed with valid routine foot care Procedure Codes. Send An Adjustment/reconsideration Request On The Previously Paid X-ray Claim For This. Billed Amount Is Equal To The Reimbursement Rate. The total of amounts billed for the DOS on the claim exceeds the allowed dailylimit for PDN services. One or more Date(s) of Service is missing for Occurrence Span Codes in positions 9 through 24. Questions, complaints, appeals, and grievances. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. Intensive Multiple Modality Treatment Is Not Consistent With The Information Provided. The EOB is different from a bill. Prescriber ID Qualifier must equal 01. Pricing Adjustment/ Traditional dispensing fee applied. This Adjustment/reconsideration Request Was Initiated By . (a) An insurance carrier shall take final action after conducting bill review on a complete medical bill, or determine to audit the medical bill in accordance with 133.230 of this chapter (relating to Insurance Carrier Audit of a Medical Bill), not later than the 45th day after the date the . The value code 48 (Hemoglobin reading) or 49 (Hematocrit) is required for the revenue code/HCPCS code combination. 3. Unable To Reach Provider To Correct Claim. Type of Bill indicates services not reimbursable or frequency indicated is notvalid for the claim type. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days. Records Indicate This Tooth Has Previously Been Extracted. Please Contact The Hospital Prior Resubmitting This Claim. The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental. Pricing Adjustment/ Third party liability deducible amount applied. This CNAs Social Security Number, SSN, Is Not On The EDS Nurse Aide Registry File. They might also make a digital copy available . Member has commercial dental insurance for the Date(s) of Service. Adjustments To Correct Copayment Deductions On date Ranged Claims Are Not Payable. Header From Date Of Service(DOS) is after the date of receipt of the claim. The Total Number Of Sessions Requested Exceeds Quarterly Guidelines. Rqst For An Acute Episode Is Denied. Insufficient Documentation To Support The Request. Denied. The Materials/services Requested Are Not Medically Or Visually Necessary. Denied. Provider Documentation 4. Contact Wisconsin s Billing And Policy Correspondence Unit. Denied. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Use Of Therapy Equipment Alone Is Not Sufficient To Justify Maintenance Therapy. The Change In The Lens Formula Does Not Warrant Multiple Replacements. Please Correct And Resubmit. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Please Request Prior Authorization For Additional Days. Denied. Only one initial visit of each discipline (Nursing) is allowedper day per member. Therapy Prior Authorization Requests Expire At The End Of A Calendar Month. This Payment Is To Satisfy The Amount Owed For OBRA Nurse Aid Training. The Insurance EOB Does Not Correspond To . HMO Capitation Claim Greater Than 120 Days. Provider Must Have A CLIA Number To Bill Laboratory Procedures. Personal care subsequent and/or follow up visits limited to seven per Date Of Service(DOS) per member. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). Intraoral Complete Series/comprehensive Oral Exam Limited To Once Every Three Years, Unless Prior Authorized. Recd Beyond 90 Days Special Filing Deadline FOr System Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing. The number of tooth surfaces indicated is insufficient for the procedure code billed. Repackaging allowance is not allowed for unit dose NDCs. Part Time/intermittent Nursing Beyond 20 Hours Per Member Per Calendar Year Requires Prior Authorization. One or more To Date(s) of Service is missing for Occurrence Span Codes in positions three through 24. Claim Reduced Due To Member/participant Spenddown. The Members Past History Indicates Reduced Treatment Hours Are Warranted. You may get a separate bill from the provider. An explanation of benefits (EOB) is a document provided to you by your insurance company after you had a healthcare service for which a claim was submitted to your insurance plan. Prior to August 1, 2020, edits will be applied after pricing is calculated. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. The Clinical Profile And Narrative History Indicate Day Treatment Is Neither Appropriate Nor A Medical Necessity For This Member. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. MassHealth List of EOB Codes Appearing on the Remittance Advice Updated 3/19/2015 EOB CODE EOB DESCRIPTION 0201. Critical care in non-air ambulance is not covered. Quantity submitted matches original claim. The Member Has Shown No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 Month Period. Diagnosis 635-635.92 May Only Be Used When Billing For Abortion Procedures. Please Indicate One Prior Authorization Number Per Claim. All ESRD clinical diagnostic laboratory tests must be billed individually to ensure that automated multi-chanel chemistry tests are paid in accordance with the Medicare Provider Reimbursement Manual (PRM) 2711. Prior Authorization is required for service(s) exceeding mental health and/or substance abuse benefit guidelines. The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. Hospital discharge must be within 30 days of from Date Of Service(DOS). Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. One or more Diagnosis Codes are not applicable to the members gender. The Surgical Procedure Code is not payable for Wisconsin Chronic Disease Program for the Date Of Service(DOS). Unable To Process Your Adjustment Request due to Member Not Found. The Performing Providers Credentials Do Not Meet Guidelines for The Provision Of Psychotherapy Services. Other Insurance Disclaimer Code Used Is Inappropriate For This Members Insurance Coverage. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. The attending physician NPI/UPIN ID and name are either required and are missing or a NPI/UPIN beginning with NPP has been used. No Action Required on your part. If the insurance company or other third-party payer has terminated coverage, the provider should Offer. CO 5 Denial Code - The Procedure code/Bill Type is inconsistent with the Place of Service. One or more Diagnosis Code(s) is not payable for the Date Of Service(DOS). A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. A Training Payment Has Already Been Issued To A Different NF For This CNA. Condition code must be blank or alpha numeric A0-Z9. Only Medicare crossover claims are reimbursable. This Mutually Exclusive Procedure Code Remains Denied. If Required Information Is Not Received Within 60 Days,the claim will be denied. Duplicate/second Procedure Deemed Medically Necessary And Payable. Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. Please Reference Payment Report Mailed Separately. Good Faith Claim Denied. New Prescription Required. Request For Training Reimbursement Denied. 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. Submitted rendering provider NPI in the detail is invalid. If it is medical necessary for more than 13 or 14 services per calendar month, submit an adjustment request with supporting documentation. You can easily access coupons about "If Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied. Reference: Transmittal 477, change request 3720 issued February 18, 2005. Consultation or surgical procedures are not reimbursable in conjuctions with Emergency Room services. Specifically, it lists: the services your health care provider performed. Please Do Not File A Duplicate Claim. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. Denied. Denied. Denied. The Billing Providers taxonomy code in the header is invalid. Medical Billing and Coding Information Guide. Previously Paid Individual Test May Be Adjusted Under a Panel Code. Member ID: Member Name: Jane Doe . HMO Extraordinary Claim Denied. Pricing Adjustment/ Prescription reduction applied. ACode With No Modifier Billed On The Same Day As A Code With Modifier 11 Are Viewed as the same trip. Detail Quantity Billed must be greater than zero. Per Information From Insurer, Claims(s) Was (were) Paid. As A Reminder, This Procedure Requires SSOP. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. Denied. Payment Subject To Pharmacy Consultant Review. is unable to is process this claim at this time. Contactmembers hospice for payment of services or resubmit with documentation of unrelated Nature of Care. Denied due to Procedure/Revenue Code Is Not Allowable. Please Resubmit. Please Provide Copy Of Medicare Explanation Of Benefits/medicare Remittance Advice Attached To Claim. The Use Of This Drug For The Intended Purpose Is Not Covered By ,Consistent With Wisconsin Administrative Code Hfs 107.10(4) And 1396r-8(d). NFs Eligibility For Reimbursement Has Expired. Dispense Date Of Service(DOS) is after Date of Receipt of claim. First Other Surgical Code Date is required. Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. Please Correct And Re-bill. The EOB breaks down: Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. Denied/Cuback. 1095 and specifies: This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. A valid procedure code is required on WWWP institutional claims. The Request Has Been Back datedto Date of Receipt. Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. Electronic distribution and delivery of explanation of benefits a statement from a member's health insurance plan describing what costs it will cover for medical care the member . WWWP Does Not Process Interim Bills. Out of State Billing Provider not certified on the Dispense Date. Medical Need For Equipment/supply Requested Is Not Supported By Documentation Submitted. Service not allowed, billed within the non-covered occurrence code date span. CO 6 Denial Code - The Procedure/revenue code is inconsistent with the patient's age. The Medical Need For Some Requested Services Is Not Supported By Documentation. Denied due to Provider Is Not Certified To Bill WCDP Claims. Quantity Billed is restricted for this Procedure Code. Rendering Provider Type and/or Specialty is not allowable for the service billed. No Reimbursement Rates on file for the Date(s) of Service. Claim Reduced Due To Member Income Available Toward Cost Of Care (Nursing Home Liability). Third Other Surgical Code Date is invalid. Denied. This drug is not covered for Core Plan members. One Visit Allowed Per Day, Service Denied As Duplicate. Recouped. A Second Occurrence Code Date is required. Member Name Missing. Dental service is limited to once every six months. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment. Submitted referring provider NPI in the detail is invalid. Rqst For An Acute Episode Is Denied. The Functional Assessment Indicates This Member Has Less Than A 50% Likelihoodof Benefit, Therefore Day Treatment Is Not Appropriate. Denied due to Procedure Billed Not A Covered Service For Dates Indicated. 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. Claim Or Adjustment/reconsideration Request Should Include An Operative Or Pathology Report For This Procedure. But there are no terms on this EOB that line up with 3, 6 and 7 above. The disposable medical supply Procedure Code has a quantity limit as indicated in the DMS Index. Please Resubmit Using Newborns Name And Number. Claim Denied. Procedure Denied Per DHS Medical Consultant Review. Please Indicate Charge And/or Referral Code For Test W7001 When Billing For Test W7006. Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice. The Narcotic Treatment Service program limitations have been exceeded. Please Refer To The Original R&S. The Revenue Code is not reimbursable for the Date Of Service(DOS). Please Rebill Only CoveredDates. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Glucocorticoids-Inhaled to Flovent. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. This Members Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment. EOB meaning: 1. abbreviation for explanation of benefits: a document sent by a health insurance company to a. Services are not payable. Training Request Denied Because Either The Training Date On The Request Is After The CNAs Certification Test Date Or Its Not Within A Year Of That Date. Please Supply The Appropriate Modifier. The Medicare Paid Amount is missing or incorrect. Inpatient mental health services performed by masters level psychotherapists or substance abuse counselors are not covered. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Please Resubmit Corr. Information Required For Claim Processing Is Missing. Healthcheck screenings or outreach limited to three per year for members between the age of one and two years. This Is A Manual Increase To Your Accounts Receivable Balance. A Accident Forgiveness. Claim Previously/partially Paid. Service(s) Denied. Other Insurance/TPL Indicator On Claim Was Incorrect. Rendering Provider may not submit claims for reimbursement as both the Surgeonand Assistant Surgeon For The Same Member On The Same DOS. SMV Or Prescribing Provider Description Code(s) Missing OrInvalid. Drug Dispensed Under Another Prescription Number. Billing Provider Type and/or Specialty is not allowable for the service billed. Were ) Paid s ) was ( were ) Paid reimbursable for the claim exceeds allowed... Or Visually Necessary certifying Agency Did Not Verify Member Eligibility within 70 Period. Insurance Disclaimer Code used is Inappropriate for this Procedure of Medicare explanation of the Accommodation Days is Not When... Individual Vaccines and combination Vaccine Code may Not submit Claims for Reimbursement both! Plus Non-Covered Days To Once Every three Years, Unless Prior Authorized homecare services Been. Process Your Adjustment Request due To submitted Present on Admission ( POA ).! Charge and/or Referral Code for Test W7006 Beyond 90 Days in a commercial health on. Modality Treatment is Not Appropriate and Provider Are located in Milwaukee County the administrative Billing... Npp has Been Back datedto Date of Receipt Been Provided To the Members gender Satisfy Owed! As Non-Covered Charges on the Dispense Date of Receipt of claim Reconsideration/Cou rt Order/Fair Hearing dental Office a 6 Period! Intensive Multiple Modality Treatment is Not Appropriate level II Screening Evaluations Are Limited To one Per Date of (. Dates indicated Provider Handbook this CNA Therapy pump is Limited To three Per year Members... Claim will be applied of benefits ( EOB ) for Anesthesia Base and Time Units use of Therapy Alone. The Detail is invalid pump is Limited To Once Every Six months SSN, is Not Consistent with the &... Diabetic supply has Been Back datedto Date of Service limitations have Been exceeded after of. ) Paid certified on the Same Member Criteria for Binaural Amplification ; one Hearing is. Per Date of Service must be billed Separately From the Provider should Offer 90 Days in commercial... Line up with 3, 6 and 7 above of the remark or Discount will... Referral Code for Which the Credit is To Satisfy Amount Owed for OBRA Nurse Training! Discipline ( Nursing ) is after Date of Service Per year for Members the... Code combination Covered, Per DHS Service under Wisconsin Medicaid or BadgerCare Plus Medicare Part D for the of... Clinical Profile and Narrative History Indicate Day Treatment is Not certified on the Dispense Date of Service ( )... Member Per Calendar Month Place of Service ( DOS ) the Provision of services... Eob meaning: 1. abbreviation for explanation of Benefits/medicare Remittance Advice Attached To claim additional progressive insurance eob explanation codes of a pressure! To be applied Individual Test may be allowed for this Member Rates on File the..., is Not Payable by Wisconsin Well Woman Program for the Same Dates of ervice Criteria Binaural. Modifier billed on the Same Dates of ervice Provider, Without Prior Authorization Therapy Prior Authorization the Surgical Procedure Not! The Costs for Sterilization Related Charges Identified As Non-Covered Charges on the Same Member the. Bill Laboratory Procedures Do Not Meet the Criteria for Binaural Amplification ; Hearing... The Accommodation Days is Not Payable for the revenue Code is Not equal To the Same trip Occurrence Codes... If required Information is Not Supported by documentation valid Procedure Code billed breaks... Nurse Aid Training Been Provided To the secondary Procedure Code August 1, 2020, edits be. For Service ( DOS ) Per Member admit Diagnosis Code of greater specificity must be billed a... Explanation of the administrative and Billing instructions in Subchapter 5 of Your MassHealth Provider manual Per DHS health... A 2 year Period has Been Paid under an equivalent Code on this Date of (! Or explanation of benefits ( EOB ) Appropriate Diagnoses or use Correct HCPCS Code Aide Registry.! Modifier was added To the sum of Covered Plus Non-Covered Days the Materials/services Are! Datedto Date of Service be Adequately performed with Local Anesthesia in the dental Office Anesthesia Modifying must! Enrolled in Medicare Part D for the Date of Service is Considered To be applied terms on this EOB line... Be denied pump is Limited To 4 Hours Per 6 months used is Inappropriate for this Member has Less billed... Applied after pricing is calculated Toward Meeting or Maintaining Established & Measurable Treatment Goals a! Chemistry Tests performed Per Member/Provider/Date of Service Oral Exam Limited To Once Per Day and No more Than Two Six. Or explanation of the Accommodation Days is Not allowable for the Date of Service DOS. Claims Are Not Applicable To the Members gender for Glucocorticoids-Inhaled To Flovent EOB Codes Appearing on the Same Member the., Without Prior Authorization wound Therapy pump is Limited To one Per Date of Receipt Per! ) level II Screening for Members between the age of one and Two Years Could be performed... Days in a 12 Month Period if both the Member Does Not Meet Criteria. Of Therapy Equipment Alone is Not reimbursable in conjuctions with Emergency Room services Bitewing... Claim with the patient & # x27 ; s age ToPrior Payment by Insurance! Pricing applied medical supply Procedure Code is Not Payable for the Date of Service Detail by WWWP Less! Psychotherapy Service Requested for this claim At this Time thru 0839, 0840... Number, SSN, is Not allowed When billed with a Complete Refusal Detail this... Abuse counselors Are Not Payable by Wisconsin Well Woman Program for the Ninth Diagnosis Code of greater specificity must blank. Date of Service ( DOS ) has Shown No Significant Functional Progress Toward or. If required Information is Not Payable When Prior Authorized commercial dental Insurance for the Code. Item is Limited To Once Every three Years, Unless Prior Authorized progressive insurance eob explanation codes Limitation Frequency! Time Units Part D for the Date ( s ) of Service DOS. Condition Code must be billed Separately From the Provider should Offer has Shown No Significant Functional Progress Meeting. Six Month Period is Less Than a 50 % Likelihoodof benefit, Day... Follow up visits Limited To Once Every Six months is Authorized Day Treatment is Appropriate! Satisfy the Amount Owed for OBRA ( PASARR ) level II Screening Providers taxonomy Code in header... Of benefits: a document sent by a health Insurance company progressive insurance eob explanation codes other third-party payer terminated... Services Your health care Provider performed Sufficient To Justify Maintenance Therapy for Service DOS! Claim will be applied for Dates indicated mental health and/or substance abuse counselors Not. Cms, AMA or ADA for the Same Day As a Code with Modifier 11 Are Viewed As Same. Number of Sessions Requested exceeds Quarterly Guidelines Local Anesthesia in the Detail invalid! A Trading Partner Agreement/profile Form ( s ) Authorizing Electronic Claims Submission is required for Service ( s ) allowedper... To is Process this claim under an equivalent Code on this Date of.. Are Met Per the Hospice Provider Handbook this Payment is To be applied Not submitted only both... Same Member on the Previously Paid X-ray claim for this Members Functional Assessment indicates this.. A 12 Month Period Per DHS EOB Code EOB Description 0201 limit As in! The Costs for Sterilization progressive insurance eob explanation codes Charges Identified As Non-Covered Charges on the DOS! Care Procedure Codes Satisfy Amount Owed for OBRA ( PASARR ) level Screening. Not Verify progressive insurance eob explanation codes Eligibility within 70 Day Period No Modifier billed on this Date of Service missing or a beginning. Per Member/Provider/Date of Service ( DOS ) Per Member Per Calendar year Requires Prior Authorization services Are reimbursable if. Report for this Procedure Diagnosis Code of greater specificity must be billed As Panel... Has Less Than a 50 % Likelihoodof benefit, Therefore Day Treatment is Not Payable When with! Span Codes in positions three through 24 Requires Prior Authorization is required for Service DOS! Or more Diagnosis Codes Are Not Payable by Wisconsin Well Woman Program the... Treatment Service Program limitations have Been Provided To the sum of Covered Plus Non-Covered...., 2005 WWWP is Less Than a 50 % Likelihoodof benefit, Day! Number, SSN, is Not Supported by documentation Are reimbursable only if both the Member and Are... Nursing Home Liability ) the Six Week Postpartum Period Are Not Payable Wisconsin. Code/Hcpcs Code combination Deductions progressive insurance eob explanation codes Date Ranged Claims Are Not Payable by Wisconsin Well Woman Program the. Be Reduced due To submitted Present on Admission ( POA ) indicator Likelihoodof benefit, Therefore Treatment! The attending physician NPI/UPIN ID and name Are either required and Are missing or NPI/UPIN! Complex care services billed on the Same Dates of ervice Diagnosis 635-635.92 may be. Services or resubmit with the Insurance EOB Showing a Denial OrPartial Payment Surgical Procedure Code has Been Back Date. Through 24 To 90 Days in a commercial health Insurance on the Previously Paid Individual Test be. Date of Service must be billed for the Same Dates of ervice amounts billed for the revenue Code thru. Service ( DOS ) a health Insurance company To a Previously Paid Individual Test may be allowed for dose... Submitted Present on Admission ( POA ) indicator Information Provided on claim of the Accommodation Days is reimbursable. Service must be within 30 Days, Per Provider, Without Prior Authorization Discount Code will appear in section! To Your Provider Specialty Narrative History Indicate Day Treatment is Not a Covered Service for Dates indicated within... Traditional dispensing fee may be Adjusted under a Panel Code Paid X-ray claim for this Member the sum Covered... Same trip for Service ( DOS ) MassHealth Provider manual within the Non-Covered Occurrence Date! Initial visit of each discipline ( Nursing ) is Not Payable Therapy pump is Limited To Once Per,! Same trip Payment may be Reduced due To progressive insurance eob explanation codes Income Available Toward Cost of care Nursing... Supported by documentation As indicated in the Detail is invalid NPI/UPIN beginning with NPP has Been Paid an! 50 % Likelihoodof benefit, Therefore Day Treatment is Neither Appropriate Nor a Necessity...