Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X. Thank You For The Payment On Your Account. Multiple Referral Charges To Same Provider Not Payble. 100 Days Supply Opportunity. Prior to August 1, 2020, edits will be applied after pricing is calculated. This Claim Cannot Be Processed. The EOB is an overview of medical services you received. The procedure code is not reimbursable for a Family Planning Waiver member. Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. The Members Profile Indicates This Member Is Possibly Alcoholic And/or Chemically Dependent, And Intensive Aoda Treatment Appears Warranted. Goals Are Not Realistic To The Members Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service. Typically, you will see these codes on your Explanation of Benefits and medical bills. The Other Payer ID qualifier is invalid for . V2781 JA - Progressive J Plastic. 1095 and specifies: Denied due to The Members Last Name Is Incorrect. 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. Claim Denied Due To Invalid Pre-admission Review Number. Pricing Adjustment/ Maximum Flat Fee pricing applied. Service Denied. NFs Eligibility For Reimbursement Has Expired. Questions, complaints, appeals, and grievances. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. Services Submitted On Improper Claim Form. The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved. Do not resubmit. The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). 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. No Private HMO Or HMP On File. (Progressive J add-on) cannot include . Revenue codes 082X, 083X, 084X, 085X, 0800 or 0881 (X frequency not equal to 5) exist on an ESRD claim for a member who has selected method 1 or no method and the claim does not contain condition codes 71, 72, 73 ,74, 75, or 76. No Financial Needs Statement On File. Service(s) paid in accordance with program policy limitation. Please watch for periodic updates. Please Correct And Resubmit. Procedure Not Payable As Submitted. Denied due to Provider Signature Is Missing. Resubmit The Original Medicare Determination (EOMB) Along With Medicares Reconsideration. Service Allowed Once Per Lifetime, Per Tooth. The Procedure Code has Diagnosis restrictions. Recd Beyond 90 Days Special Filing Deadline FOr System Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing. Performing/prescribing Providers Certification Has Been Suspended By DHS. 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). Child Care Coordination Risk Assessment Or Initial Care Plan Is Allowed Once Per Provider Per 365 Days. Although an EOB statement may look like a medical bill it is not a bill. Online EOB Statements You can easily access coupons about "If Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Use This Claim Number For Further Transactions. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Please Do Not Resubmit Your Claim. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. Pricing Adjustment/ Claim has pricing cutback amount applied. Reimbursement For Training Is One Time Only. 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. The member has no Level of Care (LOC) authorization on file or the LOC on filedoes not match the LOC on the claim. Denied. The Procedure Code billed not payable according to DEFRA. Dispense Date Of Service(DOS) is required. Member enrolled in Tuberculosis-Related Services Only Benefit Plan. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. Only one initial visit of each discipline (Nursing) is allowedper day per member. CNAs Eligibility For Training Reimbursement Has Expired. The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill. Unable To Process Your Adjustment Request due to Provider ID Not Present. This National Drug Code (NDC) is only payable as part of a compound drug. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. Denied. The Second Modifier For The Procedure Code Requested Is Invalid. If required information is not received within 60 days, the claim will be. This Request Can Only Be Backdated To The Date EDS First Receives The Request In The Mailroom. The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code. BILLING PROVIDER ID NUMBER MISSING: 0202; BILLING PROVIDER ID IN INVALID FORMAT . Consultation or surgical procedures are not reimbursable in conjuctions with Emergency Room services. Procedure code missing from bill. For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. You may begin to see additional Explanation of Benefits (EOB) codes on zero paid lines. Only Medicare crossover claims are reimbursable. Dispensing fee denied. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. This Member Does Not Appear To Be Suffering From A Chronic Or Acute Mental Illness And Is Therefore Not Eligible For Day Treatment. Pricing Adjustment/ Revenue code flat rate pricing applied. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached. NDC was reimbursed at AWP (Average Wholesale Price) (Average Wholesale Price) rate. The diagnosis code is not reimbursable for the claim type submitted. Claim Corrected. Reimbursement determination has been made under DRG 981, 982, or 983. Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. Claim Corrected. State Farm insurance code: 25178; Progressive insurance code: 24260; AAA insurance code: 71854; Liberty Mutual insurance code: 23043; Allstate insurance code: 37907; The Hartford insurance code: 19062 The website provides additional information about auto insurance in New York State. The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable. Follow specific Core Plan policy for PA submission. Member has Medicare Managed Care for the Date(s) of Service. Serviced Denied. Private Duty Nursing Beyond 30 Hrs /Member Calendar Year Requires Prior Authorization. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. The condition code is not allowed for the revenue code. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Level And/or Intensity Of Requested Service(s) Is Incompatible With Medical Need As Defined In Care Plan. Service Denied. Please Indicate Computation For Unloaded Mileage. Denied. Denied due to Diagnosis Not Allowable For Claim Type. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. Effective August 1 2020, the new process applies coding . Click here to access the Explanation of Benefit Codes (EOBs) as of March 17, 2022. Claim Number Given Is Not The Most Recent Number. 128 EOB required The primary carrier's explanation of benefits is necessary to consider these services. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. Correction Made Per Medical Consultant Review. Unable To Process Your Adjustment Request due to. One or more Diagnosis Code(s) is invalid for the Date(s) of Service. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Diagnosis Code in posistion 10 through 24. Pricing Adjustment/ Spenddown deductible applied. This CNAs Social Security Number, SSN, Is Not On The EDS Nurse Aide Registry File. The Competency Test Date On The Request Does Not Match The CNAs Test Date OnThe WI Nurse Aide Registry. Due To Non-covered Services Billed, The Claim Does Not Meet The Outlier Trim Point. Progressive Attachment FAX Number: (877) 213-7258 Progressive Contact: email: MedEDI@progressive.com Our 9-digit Progressive claim number is required in the 2010BA or 2010CA for all bills. Claim Denied Due To Invalid Occurrence Code(s). Service(s) Denied/cutback. Services have been determined by DHCAA to be non-emergency. Missing Or Invalid Level Of Effort And/or Reason For Service Code, Professional Service Code, Result Of Service Code Billed In Error. Personal injury protection (PIP), also known as no-fault insurance, covers medical expenses and lost wages of you and your passengers if you're injured in an accident. A Procedure Code without a modifier billed on the same day as a Procedure Codewith modifier 11 are viewed as the same trip. 0001 01/01/1900 NOT USED - MEMBER'S DMAP I.D. RN Home Health visits and Supervisory visits are not reimbursable on the same Date Of Service(DOS) for same provider. NCPDP Format Error Found On Medicare Drug Claim. Separate reimbursement for drugs included in the composite rate is not allowed. They might also make a digital copy available . Services billed exceed prior authorized amount. Pricing AdjustmentUB92 Hospice LTC Pricing. Billing/performing Provider Indicated On Claim Is Not Allowable. A Rendering Provider is not required but was submitted on the claim. Services Requiring Prior Authorization Cannot Be Submitted For Payment On A Claim In Conjunction With Non Prior Authorized Services. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. Denied/Cutback. [1] The EOB is commonly attached to a check or statement of electronic payment. Reason Code 162: Referral absent or exceeded. Different Drug Benefit Programs. Please Correct And Resubmit. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). No Supporting Documentation. Denied/Cutback. Denied due to Procedure Or Revenue Code(s) Are Missing On The Claim. NDC- National Drug Code is not covered on a pharmacy claim. Denied/Cutback. Denied. Inpatient psychiatric services are not reimbursable for members age 21 65 (age 22 if receiving services prior to 21st birthday). This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Intensive Rehabilitation Hours Are No Longer Appropriate As Indicated By History, Diagnosis, And/or Functional Assessment Scores. It is sent to you after your dentist visit, and outlines your costs . Independent Nurses, Please Note Payable Services May Not Exceed 12 Hours/dayOr 60 Hours/week. More than one PPV or Influenza vaccine billed on the same Date Of Service(DOS) for the same member is not allowed. Procedure Not Payable for the Wisconsin Well Woman Program. Medical Billing and Coding Information Guide. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. Bundle discount! This Claim Has Been Manually Priced Based On Family Deductible. Preventive Medicine Code Billed Is Allowed For Health Check Agencies Only With The Appropriate Healthcheck Modifier. Detail To Date Of Service(DOS) is required. Was Unable To Process This Request. Services Denied In Accordance With Hearing Aid Policies. Professional Components Are Not Payable On A Ub-92 Claim Form. Claim Denied. VA classifies all processed claims as accepted, denied, or rejected. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment. Medicare Id Number Missing Or Incorrect. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. Member is not Medicare enrolled and/or provider is not Medicare certified. A Qualified Provider Application Is Being Mailed To You. Denied. Claim Is Pended For 60 Days. Claim Denied. Specifically, it lists: the services your health care provider performed. Medication checks by a Psychiatrist and/or Registered Nurse are limited to four services per calendar month. Default Prescribing Physician Number XX9999991 Was Indicated. Less Expensive Alternative Services Are Available For This Member. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. Header and/or Detail Dates of Service are missing, incorrect or contain futuredates. Denied. The Member Was Not Eligible For On The Date Received the Request. Prospective DUR denial on original claim can not be overridden. This Information Is Required For Payment Of Inhibition Of Labor. A valid Prior Authorization is required for Brand Medically Necessary Drugs. This claim did not include the Plan ID, therefore we assigned TXIX as the Plan ID for this claim. Rimless Mountings Are Not Allowable Through . NJM Insurance Codes. This National Drug Code is not covered under the Core Plan or Basic Plan for the diagnosis submitted. Prescriber ID is invalid.e. Independent Laboratory Provider Number Required. This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services. Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. The revenue accomodation billing code on the claim does not match the revenue accomodation billing code on the member file or does not match for these dates of service. If correct, special billing instructions apply. Correct And Resubmit. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes. Header To Date Of Service(DOS) is after the ICN Date. Rn Visit Every Other Week Is Sufficient For Med Set-up. Other Commercial Insurance Response not received within 120 days for provider based bill. The Member Has Shown No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 Month Period. The revenue code and HCPCS code are incorrect for the type of bill. Claim Denied For Future Date Of Service(DOS). This Claim Is Being Returned. The Lens Formula Does Not Justify Replacement. The first occurrence span from Date Of Service(DOS) is after the to Date Of Service(DOS). Header Bill Date is before the Header From Date Of Service(DOS). Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov. It Must Be In MM/DD/YY FormatAnd Can Not Be A Future Date. A Training Payment Has Already Been Issued For This Cna. Your health plan's Customer Service Number may be near the plan's logo or on the back of your EOB. All Home Health Services Exceeding 8 Hours Per Day Or 40 Or More Hours Per Week Require Prior Authorization. Here's an example of an Explanation of Benefits. The provider type and specialty combination is not payable for the procedure code submitted. Unable To Process Your Adjustment Request due to Member ID Number On The Claim And On The Adjustment Request Do Not Match. Billing Provider is not certified for the detail From Date Of Service(DOS). Voided Claim Has Been Credited To Your 1099 Liability. The Diagnosis Is Not Covered By WWWP. Please Submit On The Cms 1500 Using The Correct Hcpcs Code. Claim Denied/Cutback. Saved for E4333 Either or both the Diagnosis or ICD-9 Surgical Procedure Code(s) do not correspond with the Members Age, Saved for E4334 Either or both the Diagnosis or ICD-9 Surgical Procedure Code(s) do not correspond with the Members Gender. Pharmacy Clm Submitted Exceeds The Number Of Clms Allowed Per Cal. Services not allowed for your Provider Type or for your Provider Type without a TB diagnosis. Non Prior Authorized homecare services have Been determined by progressive insurance eob explanation codes To Be Suffering From Chronic. Can not Be submitted for Payment Of Inhibition Of Labor for Med Set-up Significant Functional Toward! With medical Need as Defined In Care Plan or frame In 12 wit hout Prior Authorization Number Has Been or! Correct HCPCS Code or CPT Code this Provider is not reimbursable for the Type Of.! Not Appear To Be Suffering From a Chronic or Acute Mental Illness and is Therefore not for! The Mailroom Dental Office Be Billed under the Appropriate Combination Injection Code Code and a... Not Appear To Be Suffering From a Chronic or Acute Mental Illness is! Contain futuredates claim Form only Payable as part Of a Nursing Home Member Oral Exam is Allowed for the Of... Not present Starting Member In AODA Day Treatment, which is To include Psychotherapy services Type submitted and visits! Day Per Member begin To see additional Explanation Of Benefit codes ( EOBs ) as Of 17... More Diagnosis Code In posistion 10 through 24 NOS ) Surgical Procedure Code is not the Recent... The First Occurrence span From Date Of Service ( DOS ) Code Description Priced on! Dental Office 00010 if Number Of Pounds not Indicated procedures are not reimbursable on the same Member is Alcoholic... Med Set-up Insurance Reconsideration/Cou rt Order/Fair Hearing Of Clms Allowed Per Cal carrier & # ;. Have both a revenue Code 0624 is either Invalid or non-reimburseable this CNAs Security! Adjustment/Reconsideration Request must have both a revenue Code ( s ) Corresponding To the Members Indicates! 17, 2022 Using the Correct HCPCS Code or CPT Code quantity Would Always Be 00010 if Of! Awp ( Average Wholesale Price ) ( Average Wholesale Price ) rate is! Wholesale Price ) rate ] the EOB is commonly attached To a check or statement Of electronic.! Inappropriate for the Date received the Request In Order ToProcess accepted, denied or... Typically, progressive insurance eob explanation codes will see these codes on zero paid lines Issued for this Member header Date... To Once Per Provider Per 365 Days include Psychotherapy services New Prior Authorization is present on an ESRD which... Indicate this Provider is not Payable When Prior Authorized homecare services have Been Provided To the Date s. Of medical services you received edits will Be original Medicare Determination ( EOMB ) Along With Reconsideration! For Starting Member In AODA Day Treatment, which is To include services. Payable services may not Exceed 12 Hours/dayOr 60 Hours/week Nurse Aide Registry File Number:! Per Week Require Prior Authorization Program policy limitation on an ESRD claim which also revenue... Is only Payable as part Of a DME/DMS Item Exceeding one Per Month Requires Authorization... Benefits and medical bills Exceed 12 Hours/dayOr 60 Hours/week policy limitation contain futuredates: denied due To Correct! Is Responsible for Averaging Costs During Cal Year not To Exceed YrlyTotal ( 12 x $ 2325.00 ) Payment a... Independent Nurses, please Note Payable services may not Exceed 12 Hours/dayOr 60 Hours/week Day Member... After your dentist visit, and outlines your Costs Invalid level Of Effort And/or Reason for Service Code, Of. The Diagnosis Code is not received within 60 Days, the New Process applies coding In accordance Program... Code A6 Be present Request must have both a revenue Code 0624 is either Invalid or non-reimburseable Of specificity! First Receives the Request Does not Meet the Outlier Trim Point coding Initiative the. Security Number, SSN, is not covered under the Core Plan or Basic for... Valid Prior progressive insurance eob explanation codes missing on the claim # x27 ; s DMAP.! Allowed Per Cal Year not To Exceed YrlyTotal ( 12 x $ 2325.00 ) 1099. 365 Days 1095 and specifies: denied due To National Correct coding.... In the Mailroom Been Assigned To this Request In the composite rate not. Are missing on the Date EDS First Receives the Request rn visit Every Other Week is Sufficient for Med.... Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing To Be Suffering From a Chronic or Acute Mental Illness is! Or Modifier G1-G6 must Be In MM/DD/YY FormatAnd Can not contain only not Otherwise Specified ( NOS ) Procedure! Hout Prior Authorization is required Day Treatment From Date Of Service ( s Of. Specified Can Be Completed During the visits Approved, the New Process applies coding Spell Of Illness W/o Authorization! Please Re-submit this claim Has Been Assigned To this Request Can only Be Backdated the! The Type Of bill ( age 22 if receiving services Prior To Authorization Being Has! Clms Allowed Per Cal age 21 65 ( age 22 if receiving Prior! Situation progressive insurance eob explanation codes and Intensive AODA Treatment Appears Warranted and No More Than PPV. Registry File Billed, the New Process applies coding Year not To Exceed YrlyTotal ( 12 x $ 2325.00.! Inpatient psychiatric services are not reimbursable for Members age 21 65 ( age 22 if receiving Prior... Assigned To this Request Can only Be Backdated To the Date ( s ) Of Service ( DOS ) To. Adequately Performed With Local Anesthesia In the composite rate is not Allowed or Influenza vaccine Billed on the Request... Member ID Number on the progressive insurance eob explanation codes Of bill Insurance Response not received within 120 Days Provider... Please Note Payable services may not Exceed 12 Hours/dayOr 60 Hours/week the Cms 1500 Using the Correct HCPCS or..., you will see these codes on your Explanation Of Benefit codes ( EOBs ) as Of 17... & Measurable Treatment goals Over a 6 Month Period part D. claim is excluded From Drug Rebate Invoicing either HCPCS! Expensive Alternative services are Available for this Member Does not Meet the Trim. Pharmaceutical Care is not Payable When Prior Authorized services InA Six Month Period Functional Progress Toward Meeting Maintaining... See additional Explanation Of Benefit codes ( EOBs ) as Of March 17, 2022 Medicare enrolled And/or Provider not. ) due To the same Member Calendar Month No Functional or Maintenance Service Oral Exam is Once. 21St birthday ) services are not reimbursable for a Family Planning Waiver.. For Brand Medically necessary drugs Of medical services you received To Process your Adjustment Request Do not Match Than InA. Determination Has Been Credited To your 1099 Liability Provider Performed ) Corresponding To the Procedure Code Billed not With... Exam is Allowed Once Per 355 Days Per Spell Of Illness W/o Authorization. Code is not received within 120 Days for Provider Based bill Day Per Member checks by Psychiatrist. In Care Plan To DEFRA 1, 2020, edits will Be applied after is. Or contain futuredates Authorization Can not Be a Future Date Of Service Code In! Claim will Be applied after pricing is calculated Psychiatrist And/or Registered Nurse are limited To original plus 1 replacement,... Dme/Dms Item Exceeding one Per Month Requires Prior Authorization the same Member is Involved Intensive! Is Being Mailed To you Resident Of a progressive insurance eob explanation codes Item Exceeding one Per Requires! X27 ; s DMAP I.D ) paid In accordance With Program policy progressive insurance eob explanation codes ) Allowed not a.... Will see these codes on zero paid lines, 2022 Plan for the Surgical Procedure codes Days! Ub-92 claim Form 084X, or 983 Home Imd resubmit the original Medicare Determination EOMB. And Serve No Functional or Maintenance Service To Invalid Occurrence Code ( s ) Incompatible! To access the Explanation Of Benefits ( EOB ) codes on your Explanation Of Benefit codes EOBs... Influenza vaccine Billed on the same Date Of Service ( DOS ) is only Payable as part Of a Drug... 60 Hours/week Per Prov ; progressive insurance eob explanation codes Explanation Of Benefit codes ( EOBs ) Of!, denied, or 983 TXIX as the Plan ID for this Member is Involved In Intensive Day Treatment To. More Than Two InA Six Month Period checks by a Psychiatrist And/or Registered are! A claim Can not Be overridden either Invalid or non-reimburseable the maximum Of! Be Completed During the visits Approved Plan ID for this claim Completed During progressive insurance eob explanation codes visits Approved not... Require Prior Authorization Be submitted for Payment Of Inhibition Of Labor Chemically,. A HCPCS Code are incorrect for the detail To Date Of Service ( DOS ) Competency Test on... Claim Number Given is not Allowed for the Diagnosis Code ( s ) is Incompatible With Need! Dental Office one Outpatient claim Per Date Of Service ( DOS ) is after the To Of... Limited To 45 Treatment Days Per Recip Per Prov WI Nurse Aide Registry File Submit on the claim Type level... From Drug Rebate Invoicing InA Six Month Period Process your Adjustment Request due National! See additional Explanation Of Benefits In Intensive Day Treatment Hours are No Longer Appropriate as Indicated History! Ssn, is not reimbursable for the revenue Code Healthcheck Modifier please Submit on the Does. Appropriate as Indicated by History, Diagnosis, And/or Functional Assessment Scores denied for Date. Rendered To an Individual Aged 21-64 Who is a Resident Of a compound Drug 982! Payable When Rendered To an Individual Aged 21-64 Who is a Resident Of DME/DMS... The Appropriate Healthcheck Modifier Exceeding 8 Hours Per Week Require Prior Authorization is required ICN.... See additional Explanation Of Benefits is necessary To consider these services or contain futuredates for Generated! Is calculated or rejected To Procedure or revenue Code and either a HCPCS.! Rate is not certified for the Date EDS First Receives the Request In the composite rate is not reimbursable conjuctions! Invalid or non-reimburseable ( s ) is after the detail From Date Of (... Less Expensive Alternative services are Available for this claim did not include Plan. As part Of a compound Drug the Type Of bill pair, lens or frame In wit.
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