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Accident Related Service(s) Are Not Covered By WCDP. Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error. This service was previously paid under an equivalent Procedure Code. Use the most current year's ICD-9-CM or ICD-10-CM codes, depending on the date(s) of service. Please Correct Claim And Resubmit. 0001 01/01/1900 NOT USED - MEMBER'S DMAP I.D. Please Clarify The Number Of Allergy Tests Performed. They are used to provide information about the current status of . Service Billed Exceeds Restoration Policy Limitation. Normal delivery reimbursement includes anesthesia services. Avoiding denial reason code CO 22 FAQ Q: We received a denial with claim adjustment reason code (CARC) CO 22. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. The Maximum Allowable Was Previously Approved/authorized. Service(s) Denied. A valid Prior Authorization is required for Brand Medically Necessary Drugs. Pharmaceutical Care Code must be billed with a payable drug detail or if a prescription was not filled, the quantity dispensed must be zero. We thank you for your continued partnership in servicing the Wellcare By Fidelis Care membership. This Modifier has been discontinued by CMS or AMA for the Date Of Service(DOS)(s). trevor lawrence 225 bench press; new internal . Other Payer Date can not be after claim receipt date. Billing Tips - Wellcare NC Member In TB Benefit Plan. Election Form Is Not On File For This Member. No payment allowed for Incidental Surgical Procedure(s). 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). Pricing Adjustment/ Pharmacy pricing applied. Member Expired Prior To Date Of Service(DOS) On Claim. Diag Restriction On ICD9 Coverage Rule edit. This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. Value code 48 exceeds 13.0 or value code 49 exceeds 39.0 and HCPCS codes Q4081or J0882 are present but either modifer ED or EE are not present. Preventive Medicine Code Billed Is Allowed For Health Check Agencies Only With The Appropriate Healthcheck Modifier. Claim Indicates Other Insurance/TPL Payment Must Be Received Prior To Filing Claim. An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code. Effective With Claims Received On And After 10/01/03 , Occurrence Codes 50 And 51 Are Invalid. Service not payable with other service rendered on the same date. TPA Certification Required For Reimbursement For This Procedure. Value Codes 81 And 83, Are Valid Only When Submitted On An Inpatient Claim. Fourth Diagnosis Code (dx) is not on file. Reimbursement of this service is included in the reimbursement of the most complex/complete procedure performed. subsequent hospital care (CPT 99231-99233) or inpatient consultations (CPT 99251-99255) in the previous week. Revenue code billed with modifier GL must contain non-covered charges. Real time pharmacy claims require the use of the NCPDP Plan ID. Denied. Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided. EOB Codes List|Explanation of Benefit Reason Codes (2023) All Home Health Services Exceeding 8 Hours Per Day Or 40 Or More Hours Per Week Require Prior Authorization. OA 12 The diagnosis is inconsistent with the provider type. CO - Contractual Obligations: This group code is used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment.These adjustments are considered a write off for the provider and are not billed to . WellCare Expands Medicare Benefits for 2020 Annual - InsuranceNewsNet The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). Fifth Diagnosis Code (dx) is not on file. If correct, special billing instructions apply. Cutback/denied. Description. This claim did not include the Plan ID, therefore we assigned TXIX as the Plan ID for this claim. The National Drug Code (NDC) is not on file for the Dispense Date Of Service(DOS). Modification Of The Request Is Necessitated By The Members Minimal Progress. Training Completion Date Must Be Prior To And Within A Year Of The CNAs Certification Date. These Services Paid In Same Group on a Previous Claim. Denied. One or more Surgical Code Date(s) is missing in positions seven through 24. Pricing Adjustment/ Paid according to program policy. This level not only validates the code sets , but also ensures the usage is appropriate for any An approved PA was not found matching the provider, member, and service information on the claim. Denied due to Member Is Eligible For Medicare. Member is not Medicare enrolled and/or provider is not Medicare certified. Third Other Surgical Code Date is required. Modifier V8 or V9 must be sumbitted with revenue code 0821, 0831, 0841, or 0851. Denied. CO/204/N30. Additional Encounter Service(s) Denied. The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member. Basic knowledge of CPT and ICD-codes. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. For 2020, WellCare is adding 68 new Medicare Advantage plans for a total of 261 plans with $0 or low monthly plan premiums. Routine foot care is limited to no more than once every 61days per member. Service Denied/cutback. Denied. Denied. Please Review All Provider Handbook For Allowable Exception. Billing Provider Type and Specialty is not allowable for the Rendering Provider. Denied due to Add Dates Not In Ascending Order Or DD/DD/DD Format. Please Correct And Resubmit. Claim Payment Is Based On The Lessor Of The Number Of Certified Days On The PsrO Or 51.42 Board Stamp Or Admitting Calendar Month Days In Specialty Hospital. Training Completion Date Must Be Within A Year Of The CNAs Certification, Test, Date. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. The Second Modifier For The Procedure Code Requested Is Invalid. Denied. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. Only One Ventilator Allowed As Per Stated Condition Of The Member. The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. Denied. Denied due to Member Not Eligibile For All/partial Dates. Home Health Services In Excess Of 60 Visits Per Calendar Month Per Member Required Prior Authorization. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. 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). Please Do Not Resubmit Your Claim, And Disregard Additional Informational Messages for this claim. Denied due to Prescription Number Is Missing Or Invalid. The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code. Claims may deny when reported with mutually exclusive code combinations according to the ICD-10-CM Excludes 1 Notes guideline policy. Claim Has Been Adjusted Due To Previous Overpayment. A valid header Medicare Paid Date is required. The billing provider number is not on file. EOB for services that should be paid as primary by the Health Plan EPSDT: claims billed with EP modifier 3/28/2022 03/09/2022 2636 In Process DN018 . Services Not Provided Under Primary Provider Program. Condition code must be blank or alpha numeric A0-Z9. Learns to use professional . Quantity indicated for this service exceeds the maximum quantity limit established by the National Correct Coding Initiative. A Fourth Occurrence Code Date is required. Prior Authorization is required for service(s) exceeding mental health and/or substance abuse benefit guidelines. Dispense Date Of Service(DOS) is required. The Request Can Only Be Backdated Up To 5 Working Days Prior To The Date Eds Receives The Request In Eds Mailroom If Adequate Justification Is Provided. Assessment limit per calendar year has been exceeded. This service or a related service performed on this date has already been billed by another provider and paid. Prior Authorization Is Required For Payment Of This Service With This Modifier. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). Service Denied. A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). wellcare explanation of payment codes and comments. Assistant Surgery Must Be Billed Separately By The Assistant Surgeon With Modifier 80. Multiple Unloaded Trips for same day, same member, require unique Trip Modifiers. The amount in the Other Insurance field is invalid. For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. Procedimientos. The Service Requested Is Not A Covered Benefit As Determined By . Training Completion Date Is Not A Valid Date. This Procedure Is Denied Per Medical Consultant Review. When the nerve conduction study or the needle EMG is performed on its own, the results can be misleading and important diagnoses may be missed. A group code is a code identifying the general category of payment adjustment. Please Submit On The Cms 1500 Using The Correct Hcpcs Code. Result of Service submitted indicates the prescription was filled witha different quantity. Please watch future remittance advice. Member has Medicare Supplemental coverage for the Date(s) of Service. Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Procedure Code and modifiers billed must match approved PA. Member Successfully Outreached/referred During Current Periodicity Schedule. Claim Denied Due To Invalid Pre-admission Review Number. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. Please Correct And Resubmit. 2. Child Care Coordination Risk Assessment Or Initial Care Plan Is Allowed Once Per Provider Per 365 Days. The provider is not authorized to perform or provide the service requested. Please Correct And Resubmit. The Member Has Shown No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 Month Period. Rendering Provider Type and/or Specialty is not allowable for the service billed. Plan options will be available in 25 states, including plans in Missouri . Services on this claim were previously partially paid or paid in full. Pricing Adjustment/ Reimbursement reduced by the members copayment amount. Medical Billing and Coding Information Guide. The Quantity Billed for this service must be in whole or half hour increments(.5) Increments. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. MassHealth List of EOB Codes Appearing on the Remittance Advice. The National Drug Code (NDC) is not payable for the Provider Type and/or Specialty. Denied. Formal Speech Therapy Is Not Needed. The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved. Inpatient mental health services performed by masters level psychotherapists or substance abuse counselors are not covered. Principal Diagnosis 7 Not Applicable To Members Sex. Any single or combination of restorations on one surface of a tooth shall be considered as a one-surface restoration for reimbursement purposes. The Existing Appliance Has Not Been Worn For Three Years. Detail To Date Of Service(DOS) is required. Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. Third Other Surgical Code Date is invalid. Please adjust quantities on the previously submitted and paid claim. Level Of Care/accommodation Code Billed Is Not Applicable To Your Provider Specialty. Reason Code 234 | Remark Codes N20. Recd Beyond 90 Days Special Filing Deadline FOr System Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing. Split Decision Was Rendered On Expansion Of Units. Reduction To Maintenance Hours. Member enrolled in Tuberculosis-Related Services Only Benefit Plan. Speech Therapy Limited To 35 Treatment Days Per Spell Of Illness w/o Prior Authorization. The Primary Diagnosis Code is inappropriate for the Procedure Code. Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. If you haven't created an account yet, register now. Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service(DOS). Diagnosis Code indicated is not valid as a primary diagnosis. Please Supply NDC Code, Name, Strength & Metric Quantity. A number is required in the Covered Days field. 0; Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization. Discharge Diagnosis 3 Is Not Applicable To Members Sex. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. Insufficient Documentation To Support The Request. Do not insert a period in the ICD-9-CM or ICD-10-CM codes. Procedure not allowed for the CLIA Certification Type. This Is A Manual Decrease To Your Accounts Receivable Balance. Please familiarize yourself with these new explanation codes and update your accounts receivable as indicated. You can choose to receive only your EOBs online, eliminating the paper . The From Date Of Service(DOS) for the Second Occurrence Span Code is required. Strong knowledge of adjustment and denial reason codes from Electronic Remittance Advices (ERA/835 files) and from paper Explanation of benefits (EOB's) / Explanation of payments (EOP's), CPT . This Is Not A Good Faith Claim. Denied. Please Disregard Additional Information Messages For This Claim. The Procedure Code has Encounter Indicator restrictions. . Denied. Pricing Adjustment/ Claim has pricing cutback amount applied. Denied. Claim Denied. This Member Has A Current Approved Authorization For Intensive AODA OutpatientServices. Speech Therapy Is Not Warranted. Result of Service submitted indicates the prescription was not filled. Immunization Questions A And B Are Required For Federal Reporting. WCDP is the payer of last resort. This Claim Has Been Denied Due To A POS Reversal Transaction. One or more Date(s) of Service is missing for Occurrence Span Codes in positions 9 through 24. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fifth Diagnosis Code. Unrelated Procedure/Service by the Same Physician During the Post-op Period, Modifier 79. The Fourth Occurrence Code Date is invalid. General Assistance Payments Should Not Be Indicated On Claims. Payment Recouped. The Service Requested Is Not Medically Necessary. Name And Complete Address Of Destination. We update the Code List to conform to the most recent publications of CPT and HCPCS . Here are just a few of them: EOB CODE. Denied. 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. HCPCS procedure codes G0008, G0009 or G0010 are allowed only with revenue code0771. 1. Denied. Provider Must Have A CLIA Number To Bill Laboratory Procedures. Has Processed This Claim With A Medicare Part D Attestation Form. Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. Prior Authorization Number Changed To Permit Appropriate Claims Processing. Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. Quick Tip: In Microsoft Excel, use the " Ctrl + F " search function to look up specific denial codes. Has Recouped Payment For Service(s) Per Providers Request. Surgical Procedure Code is not related to Principal Diagnosis Code. If you are still unable to resolve the login problem, read the troubleshooting steps or report your issue. A Procedure Code without a modifier billed on the same day as a Procedure Codewith modifier 11 are viewed as the same trip. The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental. Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. Basic Knowledge of Explanation of Benefits (EOB) interpretation. ACode With No Modifier Billed On The Same Day As A Code With Modifier 11 Are Viewed as the same trip. Review Billing Instructions. The Members Poor Motivation, The Long-standing Nature Of The Disability and aLack Of Progress Substantiate Denial. Services Denied. Please Verify The Units And Dollars Billed. Please Indicate The Dollar Amount Requested For The Service(s) Requested. . Claim Explanation Codes View Fee Schedules Electronic Payments and Remittances Submit Behavioral Health Claim Durable Medical Equipment - Rental/Purchase Grid Claims Submission Process Procedure Code Modifiers Submitting Medical Records Submitting Medicare Part D Claims . Service Billed Limited To Three Per Pregnancy Per Guidelines. Please Resubmit Your Non-healthcheck Services Using The Appropriate Claim SortIndicator Or Electronic Format. -OR- The claim contains value code 49but does not contain revenue code 0636 and HCPCS Q4054. Unable To Process Your Adjustment Request due to Original Claim ICN Not Found. Drug Dispensed Under Another Prescription Number. Explanation of Benefit Codes (EOBs) Mar 14, 2022 4. Claim Generated An Informational ProDUR Alert, Drug-Drug Interaction prospective DUR alert, Drug-Disease (reported) prospective DUR alert, Drug-Disease (inferred) prospective DUR alert, Therapeutic Duplication prospective DUR alert, Suboptimal Regiment prospective DUR alert, Insufficient Quantity prospective DUR alert. Claim count of Present on Admission (POA) indicators does not match count of non-admitting and non-emergency diagnosis codes. 1 PC Dispensing Fee Allowed Per Date Of Service(DOS). Sum of detail Medicare paid amounts does not equal header Medicare paid amount. The second occurrence span from Date Of Service(DOS) is after to to Date Of Service(DOS). This Is Not A Preadmission Screen And Is Not Reimbursable. Eight hour limitation on evaluation/assessment services in a 1 year period has been exceeded. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. A Pharmaceutical Care Code (PCC) must include a valid diagnosis code. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. Procedure Code and modifiers billed must match approved PA. Medicare Part A Or B Charges Are Missing Or Incorrect. CO/204. This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services. The Member Is Involved In group Physical Therapy Treatment. Does not meet hearing aid performance check requirement of 45 post dispensing days. Intraoral Complete Series/comprehensive Oral Exam Limited To Once Every Three Years, Unless Prior Authorized. Medicare Deductible Is Paid In Full. The number of units billed for dialysis services exceeds the routine limits. One or more From Date Of Service(DOS) (DOS) is invalid for Occurrence Span Codes in positions three through 24. Authorization For Surgery Requiring Second Opinion Valid For 6Months After Date Approved. The Submission Clarification Code is missing or invalid. In addition, duplex scan of extracranial arteries, computed tomographic angiography (CTA) of the neck and magnetic resonance angiography (MRA) of the neck are not medically necessary for evaluation of syncope in patients with no suggestion of seizure and no report of other neurologic symptoms or signs. 100 Days Supply Opportunity. Claim contains duplicate segments for Present on Admission (POA) indicator. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. Prior Authorization (PA) required for payment of this service. LO DENIED - RCVD MORE THAN 60 DAYS AFTER DATE ON EOB FROM OTHER MA67 2D ADJUSTMENT - DENIAL UPHELD-TIMELINESS NOT JUSTIFIED: 31 N30 34: DENIED - NOT A PLAN MEMBER,PROVIDER MUST BILL E.D.S. Claim reimbursement has been cutback to reimbursement limits for denture repairs performed within 6 months. Medicare accepts any National Uniform Billing Committee (NUBC) approved revenue codes. This Is A Duplicate Request. Example: Diagnosis code 285.21 is entered as 28521, without a period or space. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. Timely Filing Deadline Exceeded. WellCare has established maximum frequency per day (MFD) values, which are the highest number of units eligible for reimbursement of services on a single date of service. All services should be coordinated with the Hospice provider. Complex care of 17-plus hours and complex care of less than 17 hours are not allowed on the same Date Of Service(DOS). 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. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Final Rate Settlement. Service Denied. These case coordination services exceed the limit. According to the American Association of Neuromuscular & Electro-Diagnostic Medicine and CMS Policy, nerve conduction studies and a needle electromyography (EMG) must both be performed in order to diagnose radiculopathy (pinched nerve in back or neck). Denied. Previously Paid Individual Test May Be Adjusted Under a Panel Code. Claims may deny when reported and not meeting the ICD-10-CM Laterality policy for Diagnosis-to-Diagnosis comparison. Denied due to Discharge Diagnosis 1 Missing Or Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 1 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 2 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 3 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 4 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 5 Invalid, Denied due to Diagnosis Pointer(s) Are Invalid. Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization. Pricing Adjustment/ Payment amount decreased based on Pay for Performance policies. The disposable medical supply Procedure Code has a quantity limit as indicated in the DMS Index. Please submit claim to HIRSP or BadgerRX Gold. Part B Frequently Used Denial Reasons - Novitas Solutions Unable To Process Your Adjustment Request due to Financial Payer Not Indicated. Please Contact The Hospital Prior Resubmitting This Claim. Discharge Diagnosis 4 Is Not Applicable To Members Sex. Please Request Prior Authorization For Additional Days. Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. This Revenue Code has Encounter Indicator restrictions. The sum of all Value Code amounts must be numeric and less than or equal to 999.999.999. Dispensing fee denied. Number On Claim Does Not Match Number On Prior Authorization Request. Unable To Process Your Adjustment Request due to Member Not Found. This drug is not covered for Core Plan members. The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services. Amount Recouped For Mother Baby Payment (newborn). Explanation of benefits. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Periodontal Sealing And Root Planning. 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 . Ancillary Codes Dates Of Service And/or Quantity Billed Do Not Match Level Of Care authorized Dates. Newborn Care Must Be Billed Under Newborn Name And Number; Occurrence Codes 50& 51 Cannotbe Present if Billing Under Newborn Name. Denied. Reimbursement for mycotic procedures is limited to six Dates of Service per calendar year. Code. X . Request Denied Because The Screen Date Is After The Admission Date. Printable . Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Certifying Agency Verified Member Was Not Eligible for Dates Of Services. Complex Care Services Are Limited To One Per Date Of Service(DOS) Per Member. Reason Code: 234. Denied. Denial Code Resolution - JE Part B - Noridian Admission Denied In Accordance With Pre-admission Review Criteria. ambulatory surgical center, outpatient hospital) exists for the same member, same date of service and the same procedure or service. Denied. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. Crossover Claims/adjustments Must Be Received Within 180 Days Of The Medicare Paid Date. Description & Use Of Day RX Procedure Codes Based On Members Status-not the place Of Service Where Day Rx Service Performed. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Diagnosis Code in posistion 10 through 24. If The Proc Code Does Not Require A Modifier, Please Remove The Modifier. Pregnancy Indicator must be "Y" for this aid code. Denied. Incorrect Or Invalid National Drug Code Billed. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Please Contact Your District Nurse To Have This Corrected. 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. Do Not Bill Intraoral Complete Series Components Separately. Please Bill Your Medicare Intermediary Prior To Submitting To . Please Use This Claim Number For Further Transactions. Please Rebill Inpatient Dialysis Only. Denied due to Procedure/Revenue Code Is Not Allowable. The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill. One or more Occurrence Code Date(s) is invalid in positions nine through 24. The procedure code and modifier combination is not payable for the members benefit plan. Submit Claim To Other Insurance Carrier. NDC was reimbursed at State Maximum Allowable Cost (SMAC) rate. The value code 48 (Hemoglobin reading) or 49 (Hematocrit) is required for the revenue code/HCPCS code combination. Billing Provider Type and/or Specialty is not allowable for the service billed. The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program. 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: Home Health services for CORE plan members are covered only following an inpatient hospital stay. This claim has been adjusted due to a change in the members enrollment. Refer To Notice From DHS. Detail Denied. A Version Of Software (PES) Was In Error. We have redesigned our website to help you find the information you need more easily. Tooth number or letter is not valid with the procedure code for the Date Of Service(DOS). Reimbursement also may be subject to the application of Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness. Denied/Cutback. Claim Denied Due To Incorrect Accommodation. Services not allowed for your Provider Type or for your Provider Type without a TB diagnosis. Edentulous Alveoloplasty Requires Prior Authotization. Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization. Denials with solutions in Medical Billing; Denials Management - Causes of denials and solution in medical billing; Medical Coding denials with solutions Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code. Out-of-State non-emergency services require Prior Authorization. Pricing Adjustment/ Payment reduced due to benefit plan limitations. Revenue code 0850 thru 0859 is not allowed when billed with revenue codes 0820thru 0829, 0830 thru 0839, or 0840 thru 0849. Please Correct And Resubmit. Adjustment and original claim do not have the same finanical payer, 6355 replacing 635R diagnosis (For use of Category of Service only), 6360 replacing 635S diagnosis (For use of Category of Service only), 6365 replacing 635T diagnosis (For use of Category of Service only).