Denied due to The Members First Name Is Missing Or Incorrect. Whenever claim denied with CO 197 denial code, we need to follow the steps to resolve and reimburse the claim from insurance company: First step is to verify the denial reason and get the denial date. Please Correct And Resubmit. An approved PA was not found matching the provider, member, and service information on the claim. Inpatient Respite Care Is Not Covered For Hospice Members Residing In Nursing Homes. This claim must contain at least one specified Surgical Procedure Code. 1 PC Dispensing Fee Allowed Per Date Of Service(DOS). Please Contact The Hospital Prior Resubmitting This Claim. Claim Corrected. This Procedure Is Limited To Once Per Day. Insufficient Documentation To Support The Request. There are approximately 20 Medicaid Explanation Codes which map to Denial Code 16. Gastrointestinal Surgery For The Purpose Of Weight Control Is Covered Only As An Emergency Procedure. Modifiers are required for reimbursement of these services. Please Review All Provider Handbook For Allowable Exception. Please Correct And Resubmit. The Services Requested Do Not Meet Criteria For An Acute Episode. Denied. Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. Bilateral Surgeries Reimbursed At 150% Of The Unilateral Rate. Payspan's Core Payment Network comes with a feature that allows payers to send members an electronic version of their Explanation of Benefits (eEOB). Pricing Adjustment/ Usual & Customary Charge (UCC) flat fee pricing applied. Claim Is For A Member With Retro Ma Eligibility. 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. This dental service limited to once per five years.Prior Authorization is needed to exceed this limit. The Member Has At Least 4 Posterior Teeth, Including Bicuspids On Each Side, which Can Be Used For Chewing. General Exercise To Promote Overall Fitness And Flexibility Are Non-covered Services. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. Billed amount exceeds prior authorized amount. Claim Denied Due To Incorrect Accommodation. Service Must Be Billed On Drug Claim Form Utilizing NDC Codes. Medicare Coinsurance Amount Was Not Provided On Crossover Claim. Do not insert a period in the ICD-9-CM or ICD-10-CM codes. Claim Denied. This claim has been adjusted because a service on this claim is not payable inconjunction with a separate paid service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). Please Bill Appropriate PDP. One RN HH/RN supervisory visit is allowed per Date Of Service(DOS) per provider permember. Unable To Process Your Adjustment Request due to Member ID Number On The Claim And On The Adjustment Request Do Not Match. These coding rules are published within the Medicare Claims Processing Manual, Current Procedural Terminology (CPT) by the American Medical Association (AMA) and ICD-10-CM guidelines governed by Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS). Copayment Should Not Be Deducted From Amount Billed. Unable To Process Your Adjustment Request due to Provider Not Found. Seventh Diagnosis Code (dx) is not on file. Multiple Service Location Found For the Billing Provider NPI. The Requested Procedure Is Cosmetic In Nature, Therefore Not Covered By . Other Medicare Managed Care Response not received within 120 days for providerbased bill. The Sixth Diagnosis Code (dx) is invalid. See Physicians Handbook For Details. Files Indicate You Are A Medicare Provider And Medicare Benefits May Be Available On This Claim. You Must Adjust The Nursing Home Coinsurance Claim. Correct And Resubmit. Procedue Code is allowed once per member per calendar year. Occurrence Codes 50 And 51 Are Invalid When Billed Together. Occupational Therapy Limited To 35 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. According to the American College of Radiology and the International Society for Clinical Densitometry, dual-energy X-ray absorptiometry (DXA) bone density screening (77080 or 77081) is not indicated for women under age 65 or men under age 70 without risk factors for osteoporosis. Denied due to Service Is Not Covered For The Diagnosis Indicated. Service Denied. Diagnosis Codes Assigned Must Be At The Greatest Specificity Available. Please Resubmit. Reimbursement For IUD Insertion Includes The Office Visit. wellcare eob explanation codes. Denied. Please Review The Covered Services Appendices Of The Dental Handbook. Service Denied. Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X. 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. Pricing Adjustment/ Pharmacy dispensing fee applied. The Secondary Diagnosis Code is inappropriate for the Procedure Code. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fourth Diagnosis Code. DME rental is limited to 90 days without Prior Authorization. Please correct and resubmit. Claims may deny for audiology screening (CPT 92551, 92560, V5008) may be denied when a provider bills for auditory screening services at the same time as a preventive medicine visit (CPT 99381-99397) or wellness visit (CPT G0438-G0439), without appropriate modifier appended to the E&M service to identify a separately identifiable procedure. Procedure Code and modifiers billed must match approved PA. Only One Panoramic Film Or Intraoral Radiograph Series, By The Same Provider, Per Year Allowed. No Extractions Performed. The Ninth Diagnosis Code (dx) is invalid. Service is covered only during the first month of enrollment in the Home and Community Based Waiver. 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. No Functional Regression Has Occurred To Warrant A Spell Of Illness; Submit AsA Prior Authorization Request. 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. The From Date Of Service(DOS) and To Date Of Service(DOS) must be in the same calendar month and year. Ulcerations Of The Skin Do Not Warrant A New Spell Of Illness. The Pharmaceutical Care Code (PCC) does not have a rate on file for the Date Of Service(DOS). Please Resubmit. MassHealth List of EOB Codes Appearing on the Remittance Advice. Dosings for Narcotic Treatment Service program are limited to six per Sunday thru Saturday calendar week. Reimbursement For This Certification, Test, Segment Has Been Issued To AnotherNF. Second modifier code is invalid for Date Of Service(DOS) (DOS). A: This denial is received when Medicare records indicate that Medicare is the beneficiary's secondary payer. Claim Previously/partially Paid. Comprehension And Language Production Are Age-appropriate. 1. Service Denied. Assessment Is Not A Covered Service Unless All Four Components Of Skilled Nursing Are Present: Assessment, Planning, Intervention And Evaluation. Reimb Is Limited to the Average Monthly NH Cost and Services Above that Amount Are Considered non-Covered Services. A Photocopy Of The PA Request Form Has Been Mailed Separately Identifying the Reimbursement Rate For The Procedure Codes Authorized. This Check Automatically Increases Your 1099 Earnings. The Service Requested Is Not Medically Necessary. Cutback/denied. The Medicare copayment amount is invalid. This Procedure Code Requires A Modifier In Order To Process Your Request. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. To better assist you, please first select your state. Review Patient Liability/paid Other Insurance, Medicare Paid. Watch FutureRemittance And Status Reports For Its Finalization Before Resubmitting. Adjustment To Eyeglasses Not Payable As A Repair Service. A Second Occurrence Code Date is required. Member is assigned to an Inpatient Hospital provider. Please Select A Procedure Code In The 58980-58988 Range That Best Describes The Procedure Being Performed. Use The ICN which Is In An Allowed Or Paid Status When Filing An Adjustment/ReconsiderationRequest. The National Drug Code (NDC) was reimbursed at a generic rate. Claim Denied. Claims With Dollar Amounts Greater Than 9 Digits. When coding HCPCS for outpatient services, the provider enters the HCPCS code describing the procedure. Denied. Healthcheck screenings or outreach limited to two per year for members betweenthe ages of two and three years. Service Denied. This drug/service is included in the Nursing Facility daily rate. This procedure is not paid separately. Billing Provider is not certified for the Dispense Date. Please Attach Copy Of Medicare Remittance. Member has Medicare Managed Care for the Date(s) of Service. The Treatment Request Is Not Consistent With The Members Diagnosis. Documentation Does Not Justify Medically Needy Override. This member is eligible for Medication Therapy Management services. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement. Contact Provider Services For Further Information. Pricing Adjustment/ Prior Authorization pricing applied. One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. The value code 48 (Hemoglobin reading) or 49 (Hematocrit) is required for the revenue code/HCPCS code combination. Non-scheduled drugs are limited to the original dispensing plus 11 refills or 12 months. Denied due to Member Is Eligible For Medicare. Name And Complete Address Of Destination. Incidental modifier is required for secondary Procedure Code. DX Of Aphakia Is Required For Payment Of This Service. A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. Please Furnish A NDC Code And Corresponding Description. Schedule 3, 4 or 5 drugs are limited to the original dispensing plus 5 refillsor 6 months. Other Medicare Part B Response not received within 120 days for provider basedbill. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Incorrect Liability Start/end Dates Or Dollar Amounts Must Be Corrected Through County Social Services Agency Before Claim/Adjustment/Reconsideration RequestCan be Processed. Denied due to Per Division Review Of NDC. Please Correct and Resubmit. A Reimbursement Request For A Level I Screen Must Be Received At Within A Year Of The Screen Date. that provide either supplemental explanation for a monetary adjustment or policy information are required in the remittance advice transaction. Denied due to The Members Last Name Is Missing. A Primary Occurrence Code Date is required. The Screen Date Is Either Missing Or Invalid. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days. Revenue Code Required. The Service/procedure Proposed Is Not Supported By Submitted Documentation. The From Date Of Service(DOS) for the Second Occurrence Span Code is invalid. Nine Digit DEA Number Is Missing Or Incorrect. X . If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied. Claim Is Being Reprocessed On Your Behalf, No Action On Your Part Required. Procedure Dates Do Not Fall Within Statement Covers Period. Denied. PleaseReference Payment Report Mailed Separately. Services Requiring Prior Authorization Cannot Be Submitted For Payment On A Claim In Conjunction With Non Prior Authorized Services. Prior authorization is required for Maxalt when Maxalt or sumatriptan productshave not been reimbursed within 365 days. This service is not covered under the ESRD benefit. This Surgical Code Has Encounter Indicator restrictions. Supplemental Payment Authorized By Department of Health Services (DHS) Due to an Interim Rate Settlement. Service Denied/cutback. The content shared in this website is for education and training purpose only. 2. Goals Are Not Realistic To The Members Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service. The quantity billed of the NDC is not equally divisible by the NDC package size. 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. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Service(s) Denied/cutback. ACTION DESCRIPTION: ACTION TYPE. Service billed is bundled with another service and cannot be reimbursed separately. Service not covered as determined by a medical consultant. When a provider submits an E&M level of service that exceeds the maximum level of E&M service level based on the diagnosis submitted, the E&M code is recoded (and allowed to pay) to match the maximum level of E&M service allowed based on the severity of the medical diagnosis submitted. Claims may deny when tympanometry/impedance testing (CPT 92567) is billed with a preventive medicine service (CPT 99381-99397) or wellness visit (CPT G0438-G0439) without appropriate modifier appended to the E&M service to identify a separately identifiable procedure; tympanometry/impedance testing will be considered part of the office visit. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. HTTP Status Code Connect Time (ms) Result; 2023-03-01 04:10:52: 200: 255: Page Active: Procedure Code or Drug Code not a benefit on Date Of Service(DOS). Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. Claim Detail Denied As Duplicate. Unable To Process Your Adjustment Request due to Claim ICN Not Found. Header From Date Of Service(DOS) is after the date of receipt of the claim. Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. This service was previously paid under an equivalent Procedure Code. Member Is Enrolled In A Family Care CMO. Denied. This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. Other Payer Date can not be after claim receipt date. Denied. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Billed Amount Is Greater Than Reimbursement Rate. Explanation of Benefit Codes (EOBs) Mar 14, 2022 4. Escalations. SMV Mileage Exceeding 40 Miles In Urban Counties Or 70 Miles In Rural CountiesRequires Prior Authorization. Member is covered by a commercial health insurance on the Date(s) of Service. Previously Denied Claims Are To Be Resubmitted As New Day Claims. Medicaid id number does not match patient name. Denied due to Services Billed On Wrong Claim Form. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Denied/Cutback. Prior Authorization (PA) is required for this service. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim. this Procedure Code Is Denied As Mutually Exclusive To Another Code Billed On This Claim. Member does not meet the age restriction for this Procedure Code. Billing Provider does not have required Certification Addendum on file. Complete Refusal Detail Is Not Payable Without Referral/treatment Details. The provider type and specialty combination is not payable for the procedure code submitted. Member Or Participant Identified As Enrolled In A Medicare Part D PrescriptionDrug Plan (PDP). Claims may deny when a nerve conduction study is billed without a needle EMG, or a needle EMG is billed without a Nerve conduction study, and the only diagnosis is radiculopathy (ICD-10 codes M50.1-M50.23, M51.1-M51.27, M51.9, M53.80, M54.10-M54.18, M54.30-M54.42, and M79.2). WellCare 2016 NA_11_16 NA6PROGDE80121E_1116 . Services restricted to EPSDT clients valid only with a Full Scope, EPSDT-eligible Aid Code. The maximum number of details is exceeded. Billing or Rendering Provider certification is cancelled for the From Date Of Service(DOS). This limitation may only exceeded for x-rays when an emergency is indicated. Out Of State Billing Provider Not Enrolled For Entire Detail DOS Span. Claim or Adjustment received beyond 730-day filing deadline. Please Resubmit. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. Information Required For Claim Processing Is Missing. Drug Dispensed Under Another Prescription Number. Review Of Adjustment/reconsideration Request Shows Original Claim Payment Was Max Allowed For Medical Service/Item/NDC. This Payment Is To Satisfy The Amount Owed For OBRA Level 1. The changes in the brain that happen during a migraine cannot be seen by the imaging studies since a migraine is caused by a complicated interaction between the brain and the blood vessels in the face and head. trevor lawrence 225 bench press; new internal . Please Indicate Mileage Traveled. 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. Description. One or more Condition Code(s) is invalid in positions eight through 24. Denied. Pricing Adjustment/ Medicare crossover claim cutback applied. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Eighth Diagnosis Code. Take care to review your EOB to ensure you understand recent charges and they all are accurate. Claim paid at program allowed rate. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. Header To Date Of Service(DOS) is after the ICN Date. Correct Claim Or Resubmit With X-ray. The Procedure(s) Requested Are Not Medical In Nature. Our Records Indicate You Have Billed More Than One Unit Dose Dispensing Fee For This Calendar Month. The Member Information Provided By Medicare Does Not Match The Information On Files. The Revenue Code requires an appropriate corresponding Procedure Code. The Member Has Shown No Ability Within 6 Months To Carry Over Abilities GainedFrom Treatment In A Facility To The Members Place Of Residence. Claim Is Pended For 60 Days. ESRD claims are not allowed when submitted with value code of A8 (weight) and a weight of more than 500 kilograms and/or the value code of A9 (height) and the height of more than 900 centimeters. Please Itemize Services Including Date And Charges For Each Procedure Performed. Assessment limit per calendar year has been exceeded. Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). Denied. Submit Claim To Other Insurance Carrier. A Payment Has Already Been Issued For This SSN. Provider signature and/or date is required. 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. 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. This Modifier has been discontinued by CMS or AMA for the Date Of Service(DOS)(s). Services Denied. A dispense as written indicator is not allowed for this generic drug. Note: This PA Request Has Been Backdated A Maximum Of 3 Weeks Prior To Its First Receipt By EDS, Based Upon Difficulty In Obtaining The Physicians Written Prescription. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. With Payspan's eEOB member-friendly functionality, members can log into the payer's secure portal and . Modifiers submitted are invalid for the Date Of Service(DOS) or are missing.. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Sixth Diagnosis Code. Independent Laboratory Provider Number Required. Total billed amount is less than the sum of the detail billed amounts. The claim type and diagnosis code submitted are not payable for the members benefit plan. Denied due to Diagnosis Not Allowable For Claim Type. Please note that the submission of medical records is not a guarantee of payment. It Corrects Claim Information Found During Research Of An OBRA Drug Rebate Dispute. Please Ask Prescriber To Update DEA Number On TheProvider File. Please Refer To The All Provider Handbook For Instructions. The revenue code has Family Planning restrictions. This Claim Is Being Returned. Billing Provider is restricted from submitting electronic claims. Medical explanation of benefits. Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service. Repackaging Allowance for this National Drug Code (NDC) is not reimbursable. Procedure Code is not covered for members with a Nursing Home Authorization onthe Date(s) of Service. An ICD-9-CM Diagnosis Code of greater specificity must be used for the First Diagnosis Code. Pricing Adjustment/ Spenddown deductible applied. Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay. Please Indicate One Prior Authorization Number Per Claim. Claim Denied/Cutback. Header From Date Of Service(DOS) is after the header To Date Of Service(DOS). Medicaid Remittance Advice Remark Code:M86 MMIS EOB Code:100. An Alert willbe posted to the portal on how to resubmit. Principle Surgical Procedure Code Date is missing. Because a claim can have edits and audits at both the header and detail levels, EOB codes are listed . Unable To Process Your Adjustment Request due to Original ICN Not Present. Denied due to Procedure Is Not Allowable For Diagnosis Indicated. The Member Is Only Eligible For Maintenance Hours. 0; The procedure code is not reimbursable for a Family Planning Waiver member. Avoiding denial reason code CO 22 FAQ Q: We received a denial with claim adjustment reason code (CARC) CO 22. Contact The Nursing Home. Detail To Date Of Service(DOS) is required. Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number. Use This Claim Number For Further Transactions. Second Other Surgical Code Date is required. The Members Gait Is Not Functional And Cannot Be Carried Over To Nursing. Diagnosis Code indicated is not valid as a primary diagnosis. OA 12 The diagnosis is inconsistent with the provider type. Duplicate ingredient billed on same compound claim. If laboratory costs exceed reimbursement, submit a claim adjustment request with lab bills for reconsideration. Denied. The Second Modifier For The Procedure Code Requested Is Invalid. Determinations as to whether services are reasonable and necessary for an individual patient should be made on the same basis as all other such determinations: with reference to accepted standards of medical practice and the medical circumstances of the individual case. 51.42 Board Directors Or Designees Statement & Signature Required OnThe Claim Form For Payment Of Functional Assessment. Payment Recouped. Claim Is Being Reprocessed, No Action On Your Part Required. Edentulous Alveoloplasty Requires Prior Authotization. Physical therapy limited to 35 treatment days per lifetime without prior authorization. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. The Rendering Providers taxonomy code is missing in the header. The Documentation Submitted Does Not Substantiate Additional Care. Denied due to Provider Number Missing Or Invalid. Earn Money by doing small online tasks and surveys, What is Denials Management in Medical Billing? Denied. The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved. These are EOB codes, revised for NewMMIS, that may appear on your PDF remittance advice. Contingency Plan for CORE and HIRSP Kids Suspend all non-pharmacy claims. The Procedure Requested Is Not Appropriate To The Members Sex. Services Included In The Inpatient Hospital Rate Are Not Separately Reimbursable. Claim Denied. Rebill On Pharmacy Claim Form. Detail Rendering Provider certification is cancelled for the Date Of Service(DOS). WWWP Does Not Process Interim Bills. Medically Unbelievable Error. Emergency Services Indicator must be "Y" or Pregnancy Indicator must be "Y" for this aid code. Claim Detail Denied Due To Required Information Missing On The Claim. Claim Denied. Oral exams or prophylaxis is limited to once per year unless prior authorized. Documentation Provided Indicates A Less Elaborate Procedure Should Be Considered. Amount Recouped For Mother Baby Payment (newborn). Medical Need For Equipment/supply Requested Is Not Supported By Documentation Submitted. Prescription limit of five Opioid analgesics per month. This drug is limited to a quantity for 34 days or less. Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied. The Primary Occurrence Code Date is invalid. Medically Needy Claim Denied. A National Provider Identifier (NPI) is required for the Performing Provider listed in the header. We have created a list of EOB reason codes for the help of people who are . Please Furnish A UB92 Revenue Code And Corresponding Description. Denied. Not A WCDP Benefit. Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov. Reason Code 162: Referral absent or exceeded. One or more Diagnosis Code(s) is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code. This service is payable at a frequency of once per 12-month period, per provider, per hearing aid. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. The Skills Of A Therapist Are Not Required To Maintain The Member. Inpatient psychiatric services are not reimbursable for members age 21 65 (age 22 if receiving services prior to 21st birthday). Only One Panel Code Within Same Category (CBC Or Chemistry) Maybe Performed Per Member/Provider/Date Of Service. Example: Diagnosis code 285.21 is entered as 28521, without a period or space. Rendering Provider Type and/or Specialty is not allowable for the service billed. Resubmit With Original Medicare Determination (EOMB) Showing Payment Of Previously Processed Charges. Surgical Procedure Code billed is not appropriate for members gender. The Request Has Been Approved To The Maximum Allowable Level. Member enrolled in Tuberculosis-Related Services Only Benefit Plan. The Eighth Diagnosis Code (dx) is invalid. Header Bill Date is before the Header From Date Of Service(DOS). Claims adjustments. Denied. The taxonomy code for the attending provider is missing or invalid. Member is assigned to a Hospice provider. Pricing Adjustment/ Payment reduced due to benefit plan limitations. Remark Codes: N20. Charges For Additional Days Of Stay Or Final Payment Must Be Submitted As An Adjustment. Good Faith Claim Denied Because Of Provider Billing Error. The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). Claim Is Pended For 60 Days. Please Contact Your District Nurse To Have This Corrected. Pricing Adjustment/ Revenue code flat rate pricing applied. All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same 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: Service(s) paid in accordance with program policy limitation. 51.42 Board Stamp Required On All Outpatient Specialty Hospital Claims For Dates Of Service On Or After January 1, 1986. One or more Occurrence Code Date(s) is invalid in positions nine through 24. No payment allowed for Incidental Surgical Procedure(s). The detail From Date Of Service(DOS) is invalid. General Assistance Payments Should Not Be Indicated On Claims. The Revenue Code is not payable for the Date(s) of Service. Adjustment Denied For Insufficient Information. The Rendering Providers taxonomy code in the header is not valid. Denied. Reimbursement For Panel Test Only- Individual Tests In Addition To Panel Test Disallowed. Professional Components Are Not Payable On A Ub-92 Claim Form. Abortion Dx Code Inappropriate To This Procedure. Members Age 3 And Older Must Have An Oral Assessment And Blood Pressure Check.With Appropriate Referral Codes, For Payment Of A Screening. is unable to is process this claim at this time. This claim is being denied because it is an exact duplicate of claim submitted. EOB Code: EOB Description: 0000: This claim/service is pending for program review. Activities To Promote Diversion Or General Motivation Are Non-covered Services.