These are EOB codes, revised for NewMMIS, that may appear on your PDF remittance advice. Claim Is Being Reprocessed, No Action On Your Part Required. Therapy visits in excess of one per day per discipline per member are not reimbursable. Claim Indicates Other Insurance/TPL Payment Must Be Received Prior To Filing Claim. Amount billed - See No. Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. Denied. Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied. Participant Is Enrolled In Medicare Part D. Beginning 09/01/06, Providers AreRequired To Bill Part D And Other Payers Prior To Seniorcare Or Seniorcare WillDeny The Claim. Amount allowed - See No. The Travel component for this service must be billed on the same claim as the associated service. Denied. Modifier Submitted Is Invalid For The Member Age. The Competency Test Date On The Request Does Not Match The CNAs Test Date OnThe WI Nurse Aide Registry. Denied. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes. DRG cannotbe determined. Denied due to Provider Signature Is Missing. Pricing Adjustment/ Medicare Pricing information. Claim Denied For Future Date Of Service(DOS). Procedure code - Code(s) indicate what services patient received from provider. The Narrative History Does Not Indicate the Members Functioning is Impaired due To AODA Usage. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. Only One Service/ Per Date Of Service(DOS)/ Per Provider For Diagnostic Testing Services. Service Fails To Meet Program Requirements. Yes, we know this is confusing. Glass lens enhancement code is not allowed with a non-glass lens enhancement code . Rendering Provider Type and/or Specialty is not allowable for the service billed. Procedure Dates Do Not Fall Within Statement Covers Period. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). Service Provided Before Prior Authorization Was Obtained Is Not Allowable. Training Reimbursement DeniedDue To late Billing. Online EOB Statements Referring Provider ID is invalid. Diagnosis Codes Assigned Must Be At The Greatest Specificity Available. Claim Explanation Codes Request a Claim Adjustment View Fee Schedules Electronic Payments and Remittances Claims Submission Process Procedure Code Modifiers Submitting Medical Records Submitting Medicare Part D Claims ICD-10 Compliance Information The National Drug Code (NDC) is not payable for the Provider Type and/or Specialty. Please File With Champus Carrier. A Hospital Stay Has Been Paid For DOS Indicated. Service(s) Denied. No Private HMO Or HMP On File. Denied. The Other Payer ID qualifier is invalid for . Has Already Issued A Payment To Your NF For This Level L Screen. Invalid quantity for the National Drug Code (NDC) submitted with this HCPCS code. Excessive height and/or weight reported on claim. Member Name Missing. The Revenue Code is not payable for the Date(s) of Service. Please Bill Your Medicare Intermediary Prior To Submitting To . 93000: Electrocardiogram . According To Our Records, The Hospital Has Not Received Prior Authorization For This Surgery. Claim Denied. Denied. All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. Previously Paid Individual Test May Be Adjusted Under a Panel Code. Dispensing fee denied. Denied. Claim Denied. The National Drug Code (NDC) has a quantity restriction. Request was not submitted Within A Year Of The CNAs Hire Date. Resubmit the Claim with the Appropriate Modifier for Provider Type andSpecialty. 129 Single HIPPS . Birth to 3 enhancement is not reimbursable for place of service billed. Reason Code 117: Patient is covered by a managed care plan . Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. Claim contains duplicate segments for Present on Admission (POA) indicator. Reimbursement For HCPCS Procedure Code 58300 Includes IUD Cost. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. Member is assigned to a Hospice provider. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. when they performed them. MassHealth List of EOB Codes Appearing on the Remittance Advice Updated 3/19/2015 EOB CODE EOB DESCRIPTION 0201. The value code 48 (Hemoglobin reading) or 49 (Hematocrit) is required for the revenue code/HCPCS code combination. Denied. Denied. Prior authorization requests for this drug are not accepted. Denied due to Procedure Or Revenue Code(s) Are Missing On The Claim. employer. Please Resubmit Your Non-healthcheck Services Using The Appropriate Claim SortIndicator Or Electronic Format. If required information is not received within 60 days, the claim will be. -OR- The claim contains value code 48, 49, or 68 but does not contain revenue codes 0634 or 0635. This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. Payment Is Limited To One Unit Dose Service Per Calendar Month, Per Legend Drug, Per Member. Denied. Denied due to Detail Fill Date Is A Future Date. This Claim Is Being Returned. WWWP Does Not Process Interim Bills. Denied due to Diagnosis Not Allowable For Claim Type. A Google Certified Publishing Partner. Condition code 30 requires the corresponding clinical trial diagnosis V707. The amount in the Other Insurance field is invalid. Denied/Cutback. OFFHDR2014. Non-preferred Drug Is Being Dispensed. To Continue Treatment With Two Anti-ulcer Drugs Beyond Authorized Limit Please Submit Request On Paper With Clinical Documentation Clearly Indicating medical necessity. SMV Mileage Exceeding 40 Miles In Urban Counties Or 70 Miles In Rural CountiesRequires Prior Authorization. At participating in-network providers, members get everyday savings like 40% off a complete additional pair of prescription glasses or 20% off non-prescription sunglasses. The Rendering Providers taxonomy code is missing in the header. They list the codes for each treatment or item as well as a short description of what the service entailed. An explanation of benefits (commonly referred to as an EOB form) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. Claim Denied. Member must receive this service from the state contractor if this is for incontinence or urological supplies. Timely Filing Deadline Exceeded. This detail is denied. The service was previously paid for this Date Of Service(DOS). Please Correct And Resubmit. Attachment was not received within 35 days of a claim receipt. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. Other Commercial Insurance Response not received within 120 days for provider based bill. Header From Date Of Service(DOS) is required. When diagnoses 800.00 through 999.9 are present, an etiology (E-code) diagnosis must be submitted in the E-code field. The National Drug Code (NDC) was reimbursed at a generic rate. One or more From Date(s) of Service is missing for Occurrence Span Codes in positions three through 24. The EOB is an overview of medical services you received. Repackaged National Drug Codes (NDCs) are not covered. The Member Has Received A 93 Day Supply Within The Past Twelve Months. Pricing Adjustment/ Long Term Care pricing applied. Claim Is Pended For 60 Days. Paid To: individual or organization to whom benefits are paid. Member In TB Benefit Plan. Save on auto when you add property . Allowance For Coinsurance Is Limited To Allowable Amount Less Medicares Payment. Secondary Diagnosis Code(s) in positions 2-9 cannot duplicate the Primary Discharge Diagnosis. Second Surgical Opinion Guidelines Not Met. Questionable Long Term Prognosis Due To Gum And Bone Disease. Claim paid at program allowed rate. Pharmaceutical care indicates the prescription was not filled. Hospital discharge must be within 30 days of from Date Of Service(DOS). Modifier invalid for Procedure Code billed. Service Not Covered For Members Medical Status Code. Eighth Diagnosis Code (dx) is not on file. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Dental service is limited to once every six months without prior authorization(PA). Denied. Pricing Adjustment/ Patient Liability deduction applied. Result of Service submitted indicates the prescription was not filled. Prescription limit of five Opioid analgesics per month. Progress, Prognosis And/or Behavior Are Complicating Factors At This Time. Service Denied. This Member Has Prior Authorization For Therapy Services. The Second Other Provider ID is missing or invalid. Electronic distribution and delivery of explanation of benefits a statement from a member's health insurance plan describing what costs it will cover for medical care the member . Timely Filing Request Denied. . Reimburse Is Limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services. Denied due to The Members Last Name Is Missing. This Is A Manual Decrease To Your Accounts Receivable Balance. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. The number of tooth surfaces indicated is insufficient for the procedure code billed. NFs Eligibility For Reimbursement Has Expired. NFs Eligibility For Reimbursement Has Expired. Please Correct Claim And Resubmit. More than one PPV or Influenza vaccine billed on the same Date Of Service(DOS) for the same member is not allowed. Other Insurance/TPL Indicator On Claim Was Incorrect. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. Denied due to Procedure Is Not Allowable For Diagnosis Indicated. With Accident Forgiveness (not available in CA, CT, and MA) on your GEICO auto insurance policy, your insurance rate won't go up as a result of your first at-fault accident.. Actual Cash Value. See Provider Handbook For Good Faith Billing Instructions. Detail To Date Of Service(DOS) is invalid. Service Denied. The quantity billed of the NDC is not equally divisible by the NDC package size. Dosings for Narcotic Treatment Service program are limited to six per Sunday thru Saturday calendar week. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. Submitted referring provider NPI in the header is invalid. Third Other Surgical Code Date is invalid. Supplemental Payment Authorized By Department of Health Services (DHS) Due to an Interim Rate Settlement. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Eob Remark Codes And Explanations Medical Eob Codes Insurance Eob Reason Codes Eob Denial Codes Progressive Denial Code 202 Hospice Member Services Related To The Terminal Illness Must Be Billed By Hospice Or Attending Physician. Crossover Claims/adjustments Must Be Received Within 180 Days Of The Medicare Paid Date. The Service Requested Is Not Medically Necessary. Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). 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Excluded from Drug Rebate Invoicing 800.00 through 999.9 are present, an (! Dosings for Narcotic Treatment Service program are progressive insurance eob explanation codes To once every six Months without Authorization. Of what the Service entailed Hospital visits per enrollment Year reimbursable for of. Header is invalid Be received Prior To Submitting To required information is not reimbursable for of! The remittance advice Updated 3/19/2015 EOB Code EOB DESCRIPTION 0201 claim as associated... Intermediary Prior To Filing claim not equally divisible by the program an etiology ( E-code ) must! Part required the Date ( s ) of Service ( DOS ) / per for! Reason Code 117: patient is covered by a managed care plan Beyond Authorized Limit please Request. Nursing Home Imd PA ) EOB DESCRIPTION 0201 program are limited To Allowable Amount Medicares. Referring Provider NPI in the header submitted with this HCPCS Code D. claim is excluded from Drug Rebate Invoicing the. Code/Hcpcs Code combination Fifteen Day Time Frame for this Drug are not covered is Impaired due the! Screens Performed Within a Fifteen Day Time Frame for this Type of Bill Hospital Stay has been for. The Adjustment Request due To progressive insurance eob explanation codes or Incorrect Discharge ( To ) Date or 14 Services calendar. 13 or 14 Services per calendar Month, per member are not accepted Absent. To Detail Fill Date is a Resident of a blood glucose monitor the! The Adjustment Request Do not Match the CNAs Test Date OnThe WI Nurse Aide Registry this of. The number of tooth surfaces Indicated is insufficient for the Date of Service ( DOS ) as System! Discharge ( To ) Date Services you received received a 93 Day Supply the.