Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent. Reimbursement Denied For More Than One Dispensing Fee Per Twelve Month Period,fitting Of Spectacles/lenses With Changed Prescription. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). Member is covered by a commercial health insurance on the Date(s) of Service. BMN prior authorization may be submitted for Mental Health drugs for which a Core Plan transitioned member has been previously grandfathered. The National Drug Code (NDC) has a quantity restriction. The Billing Providers taxonomy code is missing. A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. These materials include the HPMS memorandum titled, "Updates Regarding Final Part C EOB Model Templates and Implementation of the Part C EOB," the final templates and instructions, and Frequently Asked Questions regarding the Part C EOB requirements for Medicare Advantage . CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Denied. Denied due to Claim Or Adjustment Received After The Late Billing Filing Limit. Incorrect Or Invalid National Drug Code Billed. Dispense Date Of Service(DOS) is invalid. Performed After Therapy/dayTreatment Have Begun Must Be Billed As Therapy Or Limit-exceed Psych/aoda/func. wellcare eob explanation codes. Claims For Sterilization Procedures Must Reflect ICD-9 Diagnosis Code V25.2. The content shared in this website is for education and training purpose only. Medicare Paid The Total Allowable For The Service. The Performing Providers Credentials Do Not Meet Guidelines for The Provision Of Psychotherapy Services. The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount. This Is A Manual Increase To Your Accounts Receivable Balance. Do Not Use Informational Code(s) When Submitting Billing Claim(s). Pricing Adjustment/ Anesthesia pricing applied. A Payment For The CNAs Competency Test Has Already Been Issued. Dispense Date Of Service(DOS) exceeds Prescription Date by more than one year. Claim or Adjustment received beyond 365-day filing deadline. Correct Claim Or Submi Paper Claim Noting That Verification Has Occurred. Please Resubmit Using Newborns Name And Number. Dosings for Narcotic Treatment Service program are limited to six per Sunday thru Saturday calendar week. Ninth Diagnosis Code (dx) is not on file. Other Insurance Disclaimer Code Used Is Inappropriate For This Members Insurance Coverage. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. Correct And Resubmit. Billing or Rendering Provider certification is cancelled for the From Date Of Service(DOS). Please Correct And Resubmit. Secondary Diagnosis Code (dx) is not on file. Real time pharmacy claims require the use of the NCPDP Plan ID. Alternatively, the provider has billed a prior inpatient E&M visit, without an inpatient discharge service (CPT 99238-99239) in the interim. NDC- National Drug Code is not allowed for the member on the Date Of Service(DOS). Please Refer To The Original R&S. This change to be effective 4/1/2008: Submission/billing error(s). Wk. Member is assigned to a Hospice provider. Two Informational Modifiers Required When Billing This Procedure Code. Service Denied. NDC is obsolete for Date Of Service(DOS). 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. Supplemental Payment Authorized By Department of Health Services (DHS) Due to an Interim Rate Settlement. Billing Provider is not certified for the Dispense Date. All Requests Must Have A 9 Digit Social Security Number. Description & Use Of Day RX Procedure Codes Based On Members Status-not the place Of Service Where Day Rx Service Performed. Surgical Procedure Code is not allowed on the claim form/transaction submitted. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. HCPCS procedure codes G0008, G0009 or G0010 are allowed only with revenue code0771. We have redesigned our website to help you find the information you need more easily. The Treatment Request Is Not Consistent With The Members Diagnosis. Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed. Claims may deny when reported with incompatible ICD-10-CM Laterality policy for Diagnosis-to-Modifier comparison. Denied. Explanation of Benefits (EOB) The four-digit explanation of benefits (EOB) codes and the corresponding narratives indicate that the submitted claim paid as billed or describe the reason the claim suspended, was denied, or did not pay in full. Denied by Claimcheck based on program policies. Only Four Dates Of Service Are Allowed Per Line Item (detail) For Each Procedure. Billing Provider Name Does Not Match The Billing Provider Number. Denied. Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. Claim or line denied. This Surgical Code Has Encounter Indicator restrictions. No Functional Regression Has Occurred To Warrant A Spell Of Illness; Submit AsA Prior Authorization Request. Resubmit Claim With Copyof A Temporary ID Card, EVS Printed Response Or Indicate The AVR Transaction Log Number. Member has commercial dental insurance for the Date(s) of Service. Please Correct And Resubmit. PA required for payment of this service. Amount Indicated In Current Processed Line On R&S Report Is The Manual Check You Recently Received. Service Denied. Explanation of Benefit codes (EOBs) Explanation of Benefit (EOB) codes are reported on your remittance statement. Reimbursement For This Detail Does Not Include Unit DoseDispensing Fee. To access the training video's in the portal, please register for an account and request access to your contract or medical group. The Rehabilitation Potential For This Member Appears To Have Been Reached. Professional Service code is invalid. Inpatient psychiatric services are not reimbursable for members age 21 65 (age 22 if receiving services prior to 21st birthday). The Second Occurrence Code Date is invalid. Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization. Claim Denied. Disposable medical supplies are payable only once per trip, per member, per provider. If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied. The Other Payer ID qualifier is invalid for . The From Date Of Service(DOS) and To Date Of Service(DOS) must be in the same calendar month and year. Revenue Code 0001 Can Only Be Indicated Once. Providers should submit adequate medical record documentation that supports the claim (services) billed. Please correct and resubmit. Pricing Adjustment/ Prior Authorization pricing applied. Claim Denied. Was Unable To Process This Request Due To Illegible Information. 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). This detail is denied. One or more Surgical Code(s) is invalid in positions six through 23. Member enrolled in Tuberculosis-Related Services Only Benefit Plan. EOB. Rendering Provider is not certified for the Date(s) of Service. A Previously Submitted Adjustment Request Is Currently In Process. Denied/Cutback. This service is not covered under the ESRD benefit. This Member, As Indicated By Narrative History, Does Not Agree To Abstinence from Alcohol Or Other Drugs And Is Ineligible For AODA Treatment. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. The statement coverage FROM date on a hemodialysis ESRD claim (revenue code 0821, 0880, or 0881) was greater than the hemodialysis termination date in the provider file. Denied. Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. This Is A Duplicate Request. Contact Provider Services For Further Information. Service(s) Must Be Submitted On Paper Claim Form Along With Preoperative History And Physical Report And Operation Report. The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. Prior authorization is required for Maxalt when Maxalt or sumatriptan productshave not been reimbursed within 365 days. NCTracks AVRS. There are many different remittance adjustment reason codes (RARCs) established for Medicare and we understand their explanations may be "generic" and confusing, so we have provided a listing in the table below of the most commonly used denial messages and RARCs utilized by Medical Review Part B during medical record review. Provider Not Eligible For Outlier Payment. Personal care subsequent and/or follow up visits limited to seven per Date Of Service(DOS) per member. Please Clarify. This Unbundled Procedure Code Remains Denied. Claim Denied/cutback. This Claim Has Been Denied Due To A POS Reversal Transaction. Claim Has Been Adjusted Due To Previous Overpayment. This limitation may only exceeded for x-rays when an emergency is indicated. CNAs Eligibility For Training Reimbursement Has Expired. Member In TB Benefit Plan. Services Cutback/denied, Charges Greater Than Patient Liability, Not Responsible For Noncovered Services In Excess Of Patient Liability. Independent Laboratory Provider Number Required. Denied. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Periodontal Sealing And Root Planning. One or more Occurrence Code Date(s) is invalid in positions nine through 24. Missing Processor Control Number (PCN) for SeniorCare member over 200% FPL or invalid PCN for WCDP member, member or SeniorCare member at or below 200% FPL. Denied/recouped. Extended Care Is Limited To 20 Hrs Per Day. According To Our Records, The Hospital Has Not Received Prior Authorization For This Surgery. What steps can we take to avoid this denial? Out of State Billing Provider not certified on the Dispense Date. The Clinical Profile, Narrative History, And Treatment History Indicate The Recipient Is Only Eligible For Maintenance Hours. . NDC- National Drug Code billed is not appropriate for members gender. Please Indicate Separately On Each Detail. No Substitution Indicator Invalid For Non-innovator Drugs Not On The Current Wisconsin MAC List. Services are not payable. Charges Paid At Reduced Rate Based Upon Your Usual And Customary Pricing Profile. Invalid modifier removed from primary procedure code billed. To Date Of Service(DOS) Precedes From Date Of Service(DOS). Denied. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Second Diagnosis Code. A Primary Occurrence Code Date is required. Please Clarify. These Urinalysis Procedures Reimbursed Collectively At The Maximum For Routine Urinalysis With Microscopy. Please Submit On The Cms 1500 Using The Correct Hcpcs Code. 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 Quantity Billed for this service must be in whole or half hour increments(.5) Increments. Detail Denied. Claims may deny for procedures billed with modifier 79 when the same or different 0-, 10- or 90-day procedure code has not been billed on the same date of service. Pricing Adjustment/ Claim has pricing cutback amount applied. Total billed amount is less than the sum of the detail billed amounts. Previously Denied Claims Are To Be Resubmitted As New Day Claims. Procedure Code Modifier(s) Invalid For Date Of Service(DOS) Or For Prior Authorization Date Of Receipt. Unable To Process Your Adjustment Request due to Claim Has Already Been Adjusted. Value Codes 81 And 83, Are Valid Only When Submitted On An Inpatient Claim. 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). It has now been removed from the provider manuals . Req For Acute Episode Is Denied. Pricing Adjustment/ Level of effort dispensing fee applied. Crosswalk - Adjustment Reason Codes and Remittance Advice (RA) Remark Codes to PHC Explanation (EX) Codes Revised 11/16/2020 Page 1 Key: If RA has . Submitted referring provider NPI in the header is invalid. An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. The Medical Need For This Service Is Not Supported By The Submitted Documentation. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). The Service Requested Was Performed Less Than 5 Years Ago. The Value Code and/or value code amount is missing, invalid or incorrect. Principal Diagnosis 7 Not Applicable To Members Sex. 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. Resubmit Using Valid Rn/lpn Procedure Codes And A Valid PA Number. Charges For Anesthetics Are Included In Charge For All Surgical Procedures. Claim paid according to Medicares reimbursement methodology. Occurrence Codes 50 And 51 Are Invalid When Billed Together. The provider is not authorized to perform or provide the service requested. Denied. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Member is enrolled in QMB-Only benefits. Pharmaceutical Care Codes Are Billable On Non-compound Drug Claims Only. The detail From or To Date Of Service(DOS) is missing or incorrect. ACTION TYPE LEGEND: Billed Amount is not equally divisible by the number of Dates of Service on the detail. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Discrepancy Between The Other Insurance Indicator And OI Paid Amount. Verify billed amount and quantity billed. The diagnosis codes must be coded to the highest level of specificity. Pricing Adjustment/ Medicare benefits are exhausted. The Service Performed Was Not The Same As That Authorized By . This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Part C Explanation of Benefits (EOB) Materials. If this is your first visit, be sure to check out the FAQ & read the forum rules.To view all forums, post or create a new thread, you must be an AAPC Member.If you are a member and have already registered for member area and forum access, you can log in by clicking here.If you've forgotten your username or password use our . "Laterality" (side of the body affected) is a coding convention added to relevant ICD-10 codes to increase specificity. Please Bill Your Medicare Intermediary Prior To Submitting To . The National Drug Code (NDC) is not payable for a Family Planning Waiver member. Payment may be reduced due to submitted Present on Admission (POA) indicator. Reduction To Maintenance Hours. The Members Gait Is Not Functional And Cannot Be Carried Over To Nursing. 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. Claim Paid Under DRG Reimbursement, Except For Transplants Billed Using Suffixes 05 Through 09. Services Can Only Be Authorized Through One Year From The Prescription Date. Date Of Service/procedure/charges On Medicare EOMB Do Not Match The Original Claim. This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization. The Rendering Providers taxonomy code in the detail is not valid. this Procedure Code Is Denied As Mutually Exclusive To Another Code Billed On This Claim. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Denied/Cutback. NDC was reimbursed at generic WAC (Wholesale Acquisition Cost) rate. Claim Denied For Future Date Of Service(DOS). OA 13 The date of death precedes the date of service. Member is not Medicare enrolled and/or provider is not Medicare certified. qatar to toronto flight status. OA 14 The date of birth follows the date of service. FACIAL. Amount Recouped For Duplicate Payment on a Previous Claim. A Pharmaceutical Care Code (PCC) must include a valid diagnosis code. Eighth Diagnosis Code (dx) is not on file. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. Only non-innovator drugs are covered for the members program. Drugs Prescribed and Filled on the Same Day, Cannot have a Refill Greater thanZero. Prescriber Number Supplied Is Not On Current Provider File. The Tooth Is Not Essential To Maintain An Adequate Occlusion. Invalid Procedure Code For Dx Indicated. The Diagnosis Code is not payable for the member. For Newly Certified CNAs, Date Of Inclusion Is T heir Test Date. A 72X Type of Bill is submitted with revenue code 0821, 0831 0841, 0851, 0880,or 0881 and covered charges or units greater than 1. Per Information From Insurer, Prior Authorization Was Not Requested/approved Prior To Providing Services. External Cause Diagnosis May Not Be The Single Or Primary Diagnosis. Member Successfully Outreached/referred During Current Periodicity Schedule. Procedure Not Payable for the Wisconsin Well Woman Program. 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. A number is required in the Covered Days field. Questionable Long-term Prognosis Due To Decay History. Refer To Dental HandbookOn Billing Emergency Procedures. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. According to the American Society of Anesthesiologists and the International Spine Intervention Society, minor pain procedures such as epidural steroid injections, epidural blood patch, trigger point injections, sacroiliac joint injection, bursal injections, occipital nerve block and facet injections under most routine circumstances, require only local anesthesia. Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. Claim Number Given Is Not The Most Recent Number. Avoiding denial reason code CO 22 FAQ Q: We received a denial with claim adjustment reason code (CARC) CO 22. No action required. Payment Reduced Due To Patient Liability. The Submission Clarification Code is missing or invalid. Was Unable To Process This Request. The training Completion Date On This Request Is After The CNAs CertificationTest Date. Denied. Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. Area of the Oral Cavity is required for Procedure Code. . No matching Reporting Form on file for the detail Date Of Service(DOS). Please Supply NDC Code, Name, Strength & Metric Quantity. Denied. Less Expensive Alternative Services Are Available For This Member. This Member Has Completed Intensive AODA Treatment Within The Past 12 Months and Documentation Provided Is Not Adequate To Justify Intensive Treatment at this time. Service Billed Exceeds Restoration Policy Limitation. A1 This claim was refused as the billing service provider submitted is: . Medically Unbelievable Error. Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. The Service Requested Is Covered By The HMO. These are EOB codes, revised for NewMMIS, that may appear on your PDF remittance advice. For 2020, WellCare is adding 68 new Medicare Advantage plans for a total of 261 plans with $0 or low monthly plan premiums. Claim Denied. The Materials/services Requested Are Principally Cosmetic In Nature. Resubmit Claim Through Regular Claims Processing. Independent RHCs Must Bill Codes W6251, W6252, W6253, W6254 Or W6255. Please Rebill Only CoveredDates. Contactmembers hospice for payment of services or resubmit with documentation of unrelated Nature of Care. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. This Dental Service Limited To Once A Year. Reimbursement For This Service Has Been Approved. Second Rental Of Dme Requires Prior Authorization For Payment. Please Review All Provider Handbook For Allowable Exception. Backdating Allowed Only In Cases Of Retroactive Member/provider Eligibility. Complete Refusal Detail Is Not Payable Without Referral/treatment Details. Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling. Admission Denied In Accordance With Pre-admission Review Criteria. Please Correct And Resubmit. Provider Not Authorized To Perform Procedure. Fifth Other Surgical Code Date is invalid. Please Bill Medicare First. This drug/service is included in the Nursing Facility daily rate. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). Service paid in accordance with program requirements. The Revenue Code is not payable for the Date(s) of Service. Please Furnish A Breakdown Of Your Procedure Code And Charge In Question GivenOn The Adjustment/reconsideration Request. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Code. Value codes 48 Homoglobin Reading and 49 Hematocrit Reading, must have a zero in the far right position. The Medicare Claims Processing Manual and the UB-04 Data Specifications Manual outlines requirements for billing outpatient claims including that (HCPCS) codes are required on outpatient claims (UB-04) with related revenue codes. Here are just a few of them: EOB CODE. Immunization Questions A And B Are Required For Federal Reporting. Service (Procedure Code/Modifier Combination) is not reimbursable for Date Of Service(DOS). Due To Non-covered Services Billed, The Claim Does Not Meet The Outlier Trim Point. The Rendering Providers taxonomy code in the header is invalid. The Maximum limitation for dosages of EPO is 500,000 UIs (value code 68) per month and the maximum limitation for dosages of ARANESP is 1500 MCG (1 unit=1 MCG) per month. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Unable To Process Your Adjustment Request due to This Claim Is In Post Pay Billing For Third Party Liability Payment. Denied due to Add Dates Not In Ascending Order Or DD/DD/DD Format. RN And LPN Subsequent Care Visits Limited To 6 Hrs Per Day/per Member/per Provider. Rendering Provider is not certified for the From Date Of Service(DOS). Please Use This Claim Number For Further Transactions. One or more Occurrence Span Code(s) is invalid in positions three through 24. Rinoplastia; Blefaroplastia Speech Therapy Is Not Warranted. Split Decision Was Rendered On Expansion Of Units. Multiple Referral Charges To Same Provider Not Payble. paul pion cantor net worth. Surgical Procedures May Only Be Billed With A Whole Number Quantity. Printable . Pediatric Community Care is limited to 12 hours per DOS. Tooth number or letter is not valid with the procedure code for the Date Of Service(DOS). Valid Numbers Are Important For DUR Purposes. Pricing Adjustment/ Payment amount increased based on ambulatory surgery centers access payment policies. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice. Header Billing Provider used as Detail Performing Provider, Header Performing Provider used as Detail Performing Provider. Note: The Group, Reason and Remark Codes are HIPAA EOB codes and are cross-walked to L&I's EOB codes. Has Processed This Claim With A Medicare Part D Attestation Form. Dispensing fee denied. The Total Number Of Sessions Requested Exceeds Quarterly Guidelines. Unable To Process This Request Due To Either Missing, Invalid OrMismatched National Provider Identifier # (NPI)/Provider Name/POP ID. Authorization For Surgery Requiring Second Opinion Valid For 6Months After Date Approved. Unable To Process Your Adjustment Request due to. This claim is being denied because it is an exact duplicate of claim submitted. Modification Of The Request Is Necessitated By The Members Minimal Progress. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. A National Drug Code (NDC) is required for this HCPCS code. By continuing to use our site, you agree to our Privacy Policy and Terms of Use. This Members Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment. A valid Prior Authorization is required for Brand Medically Necessary Drugs. Please show the appropriate multichanel HCPCS code rather than the individual HCPCS code. The Member Has At Least 4 Posterior Teeth, Including Bicuspids On Each Side, which Can Be Used For Chewing. Diagnosis Codes Assigned Must Be At The Greatest Specificity Available. Only Healthcheck Modifiers Can Be Billed With Healthcheck Services. The Timeframe Between Certification, Test, Date And Hire Date Exceeds A Year. A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number. Rqst For An Exempt Denied. Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided. Service(s) paid in accordance with program policy limitation. DME rental beyond the initial 30 day period is not payable without prior authorization. Denied. Claims may deny when a procedure defined as requiring an anatomical modifier is billed without an associated anatomical modifier. Procedure Not Payable As Submitted. Additional Encounter Service(s) Denied. The Revenue Code is not payable by Wisconsin Well Woman Program for the Date Of Service(DOS). Only One Interperiodic Screen Is Allowed Per Day, Per Member, Per Provider. Denied/Cutback. Header and/or Detail Dates of Service are missing, incorrect or contain futuredates. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment. Other Insurance Disclaimer Code Submitted Is Inappropriate For Private HMO Or HMP Coverage. Condition code 20, 21 or 32 is required when billing non-covered services. Member does not meet the age restriction for this Procedure Code. This Claim Has Been Excluded From Home Care Cap To Allow For Acute Episode. Please Correct And Resubmit. Services billed are included in the nursing home rate structure. Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. These Services Paid In Same Group on a Previous Claim. Money Will Be Recouped From Your Account. One or more Diagnosis Codes has an age restriction. Rebill Using Correct Claim Form As Instructed In Your Handbook. Denied. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days, or the From and To Dates of Service cannot be the same. The Revenue Code is not reimbursable for the Date Of Service(DOS). This Procedure Code Is Not Valid In The Pharmacy Pos System. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. The Travel component for this service must be billed on the same claim as the associated service. Physical Therapy Treatment Limited To One Modality, One Procedure, One Evaluation Or One Combination Per Day. Denied. The quantity billed of the NDC is not equally divisible by the NDC package size. Amount Paid Reduced By Amount Of Other Insurance Payment. Formal Speech Therapy Is Not Needed. No policy override available for BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan. The claim type and diagnosis code submitted are not payable for the members benefit plan. Reading your EOB. Do Not Bill Intraoral Complete Series Components Separately. Changes/corrections Were Made To Your Claim Per Dental Processing Guidelines. Claim Denied. A Total Charge Was Added To Your Claim. You Received A PaymentThat Should Have gone To Another Provider. Other Amount Submitted Not Reimburseable. Medical explanation of benefits. Complex care of 17-plus hours and complex care of less than 17 hours are not allowed on the same Date Of Service(DOS). Revenue Code Required. NDC- National Drug Code is not covered on a pharmacy claim. This National Drug Code (NDC) is only payable as part of a compound drug. Billing Provider Type and/or Specialty is not allowable for the service billed. Find top links about Wellcare Cvs Caremark Login along with social links, FAQs, and more. Please Resubmit. The Information Provided Indicates Regression Of The Member. Service(s) Denied By DHS Transportation Consultant. Claim Detail Denied As Duplicate. Voided Claim Has Been Credited To Your 1099 Liability. 100 Days Supply Opportunity. Wellcare uses cookies. LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s). Recd Beyond 90 Days Special Filing Deadline FOr System Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office.