progressive insurance eob explanation codes

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progressive insurance eob explanation codes

Please Clarify. Drugs Prescribed and Filled on the Same Day, Cannot have a Refill Greater thanZero. Unable To Process Your Adjustment Request due to Provider Not Found. Good Faith Claim Denied. A Previously Submitted Adjustment Request Is Currently In Process. Please Correct And Resubmit. All ESRD clinical diagnostic laboratory tests must be billed individually to ensure that automated multi-chanel chemistry tests are paid in accordance with the Medicare Provider Reimbursement Manual (PRM) 2711. New and Current Explanation of Benefit (EOB) Codes - Effective August 1, 2020 EOB Code EOB Description Claim Adjustment . Orthosis additions is limited to two per Orthosis within the two year life expectancy of the item without Prior Authorization. Discharge Date is before the Admission Date. Please Indicate Anesthesia Time For Services Rendered. Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. All three DUR fields must indicate a valid value for prospective DUR. Billing Provider is not certified for the detail From Date Of Service(DOS). Denied. Performing Provider Is Not Certified For Date(s) Of Service On Claim/detail. Please submit future claims with the appropriate NPI, taxonomy and/or Zip +4 Code. Other Medicare Part B Response not received within 120 days for provider basedbill. Provider Frequently Asked Questions (FAQ) Question Answer How will Progressive accept eBills? Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code. Co. 609 . Critical care in non-air ambulance is not covered. Denied due to Detail Add Dates Not In MM/DD Format. We have created a list of EOB reason codes for the help of people who are working on denials, AR-follow-up, medical coding, etc. Services Included In The Inpatient Hospital Rate Are Not Separately Reimbursable. Reduction To Maintenance Hours. NDC is obsolete for Date Of Service(DOS). Contact Members Hospice for payment of services related to terminal illness. One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Please Correct And Resubmit. Claim Submitted To Good Faith Without Proper Documentation. Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed. Refer To Provider Handbook. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Interim Rate Settlement. Claim Denied. Multiple Carry Procedure Codes Are Not Payable When Billed With Modifiers. Thank You For The Payment On Your Account. Incorrect Or Invalid National Drug Code Billed. Missing or invalid level of effort submitted and/or reason for service, professional service, or result of service code billed in error. Pricing Adjustment/ Repackaging dispensing fee applied. Our Records Indicate You Have Billed More Than One Unit Dose Dispensing Fee For This Calendar Month. What is the 3 digit code for Progressive Insurance? One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. You Received A PaymentThat Should Have gone To Another Provider. Denied. Denied. One or more Occurrence Code(s) is invalid in positions nine through 24. Procedure Code Used Is Not Applicable To Your Provider Type. NDC was reimbursed at AWP (Average Wholesale Price) (Average Wholesale Price) rate. One or more Occurrence Span Code(s) is invalid in positions three through 24. Phone number. Denied due to Quantity Billed Missing Or Zero. Routine foot care is limited to no more than once every 61days per member. The Narrative History Does Not Indicate the Members Functioning is Impaired due To AODA Usage. You can probably shred thembut check first! Services Billed On This Claim/adjustment Have Been Split to Facilitate Processing. HCPCS Procedure Code is required if Condition Code A6 is present. Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization. Denied due to Provider Is Not Certified To Bill WCDP Claims. Denied. This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization. This Member Has Already Received Intensive Day Treatment In The Past Year and is Only Eligible For Reduced Hours At This Time. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. The Second Modifier For The Procedure Code Requested Is Invalid. The Quantity Billed for this service must be in whole or half hour increments(.5) Increments. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. The Fifth Diagnosis Code (dx) is invalid. Along with the EOB, you will see claim adjustment group codes. Please Correct And Resubmit. Denied. All services should be coordinated with the Hospice provider. Review it for accuracy. Procedure Not Payable As Submitted. Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied. Other Insurance/TPL Indicator On Claim Was Incorrect. Header To Date Of Service(DOS) is after the ICN Date. Claim Previously/partially Paid. Detail Rendering Provider certification is cancelled for the Date Of Service(DOS). The Lens Formula Does Not Justify Replacement. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Please Verify That Physician Has No DEA Number. Denied. Subsequent surgical procedures are reimbursed at reduced rate. Denied. From Date Of Service(DOS) is before Admission Date. Physical therapy limited to 35 treatment days per lifetime without prior authorization. NFs Eligibility For Reimbursement Has Expired. This Is An Adjustment of a Previous Claim. A traditional dispensing fee may be allowed for this claim. New Prescription Required. Only one initial visit of each discipline (Nursing) is allowedper day per member. Quantity submitted matches original claim. The Information Provided Is Not Consistent With The Intensity Of Services Requested. This Is Not A Good Faith Claim. Fourth Other Surgical Code Date is required. Service(s) Must Be Submitted On Paper Claim Form Along With Preoperative History And Physical Report And Operation Report. All Day Treatment Services For Members With Nursing Home Status Should Be Billed Under Procedure Code W8912(pre 10/1/03)/h2012(post 10/1/03) And Require PriorAuthorization. MECOSH0086COEOB This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. Good Faith Claim Denied. Prescribing Provider UPIN Or Provider Number Missing From Claim And Attachment. The code issued by the New Jersey Motor Vehicle Commission is used to identify auto insurers who are authorized to do business in the state of New Jersey. Frequency or number of injections exceed program policy guidelines. Documentation You Have Submitted Does Not Meet The Requirements Of HSS 107.09(4)(k). A Photocopy Of The PA Request Form Has Been Mailed Separately Identifying the Reimbursement Rate For The Procedure Codes Authorized. CO 9 and CO 10 Denial Code. Hospice Member Services Related To The Terminal Illness Must Be Billed By Hospice Or Attending Physician. No Financial Needs Statement On File. All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Second Diagnosis Code. Reimbursement For This Detail Does Not Include Unit DoseDispensing Fee. If not, the procedure code is not reimbursable. The From Date Of Service(DOS) and To Date Of Service(DOS) must be in the same calendar month and year. Pharmaceutical care indicates the prescription was not filled. 3. The disposable medical supply Procedure Code has a quantity limit as indicated in the DMS Index. Quantity indicated for this service exceeds the maximum quantity limit established. Please Clarify The Number Of Allergy Tests Performed. This drug is limited to a quantity for 34 days or less. Referring Provider ID is invalid. Reimbursement For Training Is One Time Only. Pricing Adjustment/ Prescription reduction applied. Speech Therapy Is Not Warranted. The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount. Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. Please Check The Adjustment Icn For The Reprocessed Claim. The Service Requested Was Performed Less Than 5 Years Ago. Please Supply The Appropriate Modifier. Compound Ingredient Quantity must be greater than zero. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. The claim contains a revenue code and/or HCPCS that price by a fee amount, butthe rate field is blank or contains zeros on the HCPCS file. Pricing Adjustment/ Medicare crossover claim cutback applied. Claim Detail Pended As Suspect Duplicate. Denied. Do Not Indicate NS On The Claim When The NDC Billed Is For A Generic Drug. A more specific Diagnosis Code(s) is required. Dates of Service reflected by the Quantity Billed for dialysis exceeds the Statement Covers Period. If laboratory costs exceed reimbursement, submit a claim adjustment request with lab bills for reconsideration. Reimbursement limit for all adjunctive emergency services is exceeded. Correction Made Per Medical Consultant Review. You can also use it to track how you and your family use your coverage. Assistant Surgery Must Be Billed Separately By The Assistant Surgeon With Modifier 80. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Periodontal Sealing And Root Planning. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. Change . Refer to the DME area of the Online Handbook for claims submission requirements for compression garments. Resubmit the Claim with the Appropriate Modifier for Provider Type andSpecialty. The appropriate modifer of CD, CE or CF are required on the claim to identify whether or not the AMCC tests are included in the composite rate or not included in the composite rate. Progressive Casualty Insurance . Restorative Nursing Can Provide Follow-through, Based On Diagnosis Of Long-standing Nature, And The Amount Of Therapy. Comprehensive Screens And Individual Components Are Not Payable On The Same Date Of Service(DOS). Requested Documentation Has Not Been Submitted. The Sixth Diagnosis Code (dx) is invalid. Procedure Code is not covered for members with a Nursing Home Authorization onthe Date(s) of Service. Services Denied In Accordance With Hearing Aid Policies. The provider is not listed as the members provider or is not listed for thesedates of service. A Payment Has Already Been Issued For This SSN. Denied due to The Members Last Name Is Missing. It has now been removed from the provider manuals . Reimbursement For IUD Insertion Includes The Office Visit. Please Add The Coinsurance Amount And Resubmit. Lenses Only Are Approved; Please Dispense A Contracted Frame. Prescription Drug Plan (PDP) payment/denial information required on the claim to WCDP. Sign up for electronic payments and statements before it's your turn. The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). Please Resubmit. This Member, As Indicated By Narrative History, Does Not Agree To Abstinence from Alcohol Or Other Drugs And Is Ineligible For AODA Treatment. Title 32, Code of Federal Regulations, Part 220 - Implements 10 U.S.C. It breaks down the information like this: The services we provided. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Reimbursement is limited to one maximum allowable fee per day per provider. This Dental Service Limited To Once Every Six Months, Unless Prior Authorized. Service(s) exceeds four hour per day prolonged/critical care policy. But there are no terms on this EOB that line up with 3, 6 and 7 above. The below mention list of EOB codes is as below, EOB codes list is updated as per the latest information gathered from authorized sources of information, if any discrepancy please let us know via the contact us page, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. The Revenue/HCPCS Code combination is invalid. Denied. Secondary Diagnosis Code(s) in positions 2-9 cannot duplicate the Primary Discharge Diagnosis. Revenue code submitted is no longer valid. The Members Reported Diagnosis Is Not Considered Appropriate For AODA Day Treatment. Pricing Adjustment/ The submitted charge exceeds the allowed charge. Handwritten Changes/corrections On The Medicare EOMB Are Not Acceptable. The Treatment Request Is Not Consistent With The Members Diagnosis. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. Submitclaim to the appropriate Medicare Part D plan. The Procedure Code billed not payable according to DEFRA. Pricing Adjustment/ Usual & Customary Charge (UCC) rate pricing applied. Member last name does not match Member ID. Denied due to Detail Fill Date Is A Future Date. Replacement and repair of this item is not covered by L&I. NULL CO 96, A1 N171 The Seventh Diagnosis Code (dx) is invalid. Goals Are Not Realistic To The Members Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service. Header Rendering Provider number is not found. Services billed are included in the nursing home rate structure. Please Complete Information. Tooth surface is invalid or not indicated. Please Correct And Resubmit. Private Duty Nursing Beyond 30 Hrs /Member Calendar Year Requires Prior Authorization. The Medicare copayment amount is invalid. It Must Be In MM/DD/YY Format AndCan Not Be A Future Date. This National Drug Code (NDC) requires a whole number for the Quantity Billed. Back-up dialysis sessions are limited to three per lifetime. Procedure Denied Per DHS Medical Consultant Review. 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. Only non-innovator drugs are covered for the members program. Members age does not fall within the approved age range. This Payment Is To Satisfy The Amount Owed For OBRA Level 1. Explanation of Benefits (EOB) An EOB is a statement from the health insurance company that describes what costs they will cover. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Diagnosis Code indicated is not valid as a primary diagnosis. The Value Code(s) submitted require a revenue and HCPCS Code. Mississippi Medicaid Explanation of Benefits (EOB) Codes EOB Code Effective Date Description 0000 01/01/1900 THIS CLAIM/SERVICE IS PENDING FOR PROGRAM REVIEW. Review Billing Instructions. Up to a $1.10 reduction has been applied to this claim payment. One or more Diagnosis Code(s) in positions 10 through 25 is not on file. Per Information From Insurer, Claims(s) Was (were) Paid. Denied. Claim or Adjustment received beyond 365-day filing deadline. Only One Panoramic Film Or Intraoral Radiograph Series, By The Same Provider, Per Year Allowed. (888) 750-8783. Quantity Billed is invalid for the Revenue Code. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. Documentation Does Not Justify Fee For ServiceProcessing . The National Drug Code (NDC) has an age restriction. Cutback/denied. Other Medicare Part A Response not received within 120 days for provider basedbill. Documentation Indicates That Client Is Able To Direct Cares And Can Safely Direct A PCW. Preventive Medicine Code Billed Is Allowed For Health Check Agencies Only With The Appropriate Healthcheck Modifier. Therapy visits in excess of one per day per discipline per member are not reimbursable. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. Denied/Cutback. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Final Rate Settlement. One or more Diagnosis Code(s) is not payable for the Date Of Service(DOS). Multiple Prescriptions For Same Drug/ Same Fill Date, Not Allowed. 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. Denied. The diagnosis code is not reimbursable for the claim type submitted. Billing Provider is restricted from submitting electronic claims. This Member Has A Current Approved Authorization For Intensive AODA OutpatientServices. Claim Denied. 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. Individual Test Paid. Claim Denied. Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. For Review, Forward Additional Information With R&S To WCDP. Adjustment To Crossover Paid Prior To Aim Implementation Date. This limitation may only exceeded for x-rays when an emergency is indicated. EOB: The EOB takes all the charges on the itemized bill and shows how much the insurance covers towards . This drug is not covered for Core Plan members. Service is not reimbursable for Date(s) of Service. The Members Demonstrated Response To Current Therapy Does Not Warrant The Intense Freqency Requested. A code with no Trip Modifier billed on same day as a code with Modifier U1 are considered the same trip. This Payment Is To Satisfy The Amount Owed For OBRA Nurse Aid Training. This Adjustment/reconsideration Request Was Initiated By . eBill Clearinghouse. Date Of Service/procedure/charges On Medicare EOMB Do Not Match The Original Claim. Laboratory Is Not Certified To Perform The Procedure Billed. Member is not enrolled in /BadgerCare Plus for the Date(s) of Service. Program guidelines or coverage were exceeded. Registering with a clearinghouse of your choice. Service Denied. Rental Only Allowed; Medical Need For Purchase Has Not Been Documented. Denied. The number of treatments/days reflected by the units entered with revenue code0821, 0831, 0841, 0851, 0880, 0881 exceeds the number of days included in the FROM and TO dates entered on this claim. CPT and ICD-9- Coding 5. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. Pricing Adjustment/ Revenue code flat rate pricing applied. Denied. The drug code has Family Planning restrictions. Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. The Members Past History Indicates Reduced Treatment Hours Are Warranted. No Complete Program Enrollment Form Is On File For This Client Or The Client Is Not Eligible For The Date Of Service(DOS) On The Clai im. The Rendering Providers taxonomy code in the detail is not valid. Denied. Denied. any discounts the provider applied to that amount. Quantity indicated for this service exceeds the maximum quantity limit established by the National Correct Coding Initiative. The Member Is School-age And Services Must Be Provided In The Public Schools. Service Denied. A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. See Physicians Handbook For Details. The procedure code is not reimbursable for a Family Planning Waiver member. Claim Detail Denied. Services Not Allowed For Your Provider T. The Procedure Code has Place of Service restrictions. The Billing Providers taxonomy code is invalid. A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. 095 CLAIM CUTBACK DUE TO OTHER INSURANCE PAYMENT Insurer 107 Processed according to contract/plan provisions. The Service Requested Was Performed Less Than 3 Years Ago. Pricing Adjustment/ Maximum Flat Fee pricing applied. Pricing Adjustment/ Medicare Pricing information. Billing Provider Type and Specialty is not allowable for the service billed. OFFHDR2014. Modifiers are required for reimbursement of these services. Claim Denied. Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. 1095 and specifies: The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). It explains the calculation of your benefits. Modifier V8 or V9 must be sumbitted with revenue code 0821, 0831, 0841, or 0851. The Diagnosis Is Not Covered By WWWP. Pricing Adjustment. The total billed amount is missing or is less than the sum of the detail billed amounts. Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached. Recoding/adjusting claim may result in a different DRG code assignmentand reimbursement. Revenue code 082X is present on an ESRD claim which also contains revenue code088X (X frequency non equal to 9). Value Codes 81 And 83, Are Valid Only When Submitted On An Inpatient Claim. Claim Denied In Order To Reprocess WithNew ID. Medicare Deductible Amount Was Incorrect Or Not Provided On Crossover Claim. Do not resubmit. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. Unable To Process Your Adjustment Request due to Financial Payer Not Indicated. Speech therapy limited to 35 treatment days per lifetime without prior authorization. Missing Insurance Plan Name or Program Name: 3: 092: Missing/Invalid Admission Date for POS 21 Refer to Box 18: 4: 088: . Please Reference Payment Report Mailed Separately. General Assistance Payments Should Not Be Indicated On Claims. No Action Required. 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. Providers May Only Bill For Assessments And Care Plans Twice Per Calendar Year. Procedure Code is not allowed on the claim form/transaction submitted. This service is duplicative of service provided by another provider for the same Date(s) of Service. Four X-rays are allowed per spell of illness per provider. Each time they provide services to you, doctors, dentists, and other medical professionals will submit claims to your insurance. Medication checks by a Psychiatrist and/or Registered Nurse are limited to four services per calendar month. Reimbursement Rate Applied To Allowed Amount. Access payment not available for Date Of Service(DOS) on this date of process. Submit copy of the dated and signed evaluation and indicate if this is an initial Evaluation. Denied. Use This Claim Number For Further Transactions. Name And Complete Address Of Destination. Rejected Claims-Explanation of Codes. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). Condition code 80 is present without condition code 74. Insufficient Info On Unlisted Med Proc; Submit Claim Or Attachment With A Complete Description Of The Procedure As Described In History and Physical Exam Report, Med Progress, anesthesia or Op Report. Well-baby visits are limited to 12 visits in the first year of life. A National Provider Identifier (NPI) is required for the Billing Provider. Please Do Not Resubmit Your Claim, And Disregard Additional Informational Messages for this claim. Our Records Indicate This Tooth Previously Extracted. Claim Reduced Due To Member/participant Spenddown. One or more Occurrence Code Date(s) is invalid in positions nine through 24. This claim has been adjusted due to a change in the members enrollment. Understanding Insurance Codes To Avoid Billing Errors - Verywell . Services Requested Do Not Meet The Criteria for an Acute Episode. These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan. Denied. This Claim Is Being Returned. This Claim Cannot Be Processed. The Member Has Received A 93 Day Supply Within The Past Twelve Months. Will Only Pay For One. Participants Eligibility Not Complete, Please Re-submit Claim At Later Date. (a) An insurance carrier shall take final action after conducting bill review on a complete medical bill, or determine to audit the medical bill in accordance with 133.230 of this chapter (relating to Insurance Carrier Audit of a Medical Bill), not later than the 45th day after the date the . The Request Has Been Back datedto Date of Receipt. PNCC Risk Assessment Not Payable Without Assessment Score. Claim Currently Being Processed. Reimbursement limits for Community Care Services for the calendar year are close to being exceeded. Claim Detail Denied Due To Required Information Missing On The Claim. Ulcerations Of The Skin Do Not Warrant A New Spell Of Illness. The Information Provided Indicates Regression Of The Member. Services on this claim were previously partially paid or paid in full. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Condition Code 74 Codes 81 and 83, Are valid Only When submitted on Paper claim along! Only Benefit Plan claim to WCDP Greater specificity must Be Billed by Hospice or Attending.... With R & s to WCDP Therapy/spell of Illness no Functional or Maintenance.! Response Not Received within 120 days for Provider basedbill Psychiatrist and/or Registered Nurse Are limited to two orthosis! With Modifiers Are valid Only When submitted on an ESRD claim Which also contains revenue code088X X... Taxonomy and/or Zip +4 Code Later Date Registered Nurse Are limited to four services per calendar year agreement on for... Billed Are Included in reimbursement for this claim Number Missing From claim and Attachment and other medical professionals submit! Span Code ( dx ) is before Admission progressive insurance eob explanation codes services and is Therefore Only Eligible Maintenance! The Intense Freqency Requested for prospective DUR AODA OutpatientServices equal to 9 ) Allowed... May Be Allowed for Health Check Agencies Only with the Hospice Provider Being.... V8 or V9 must Be Billed on this Claim/adjustment Have Been Provided to the terminal Illness Be... Limit as indicated in the Dental Office you Can also use it track... Services Not Allowed for Health Check Agencies Only with the Appropriate NPI taxonomy! Please Dispense a Contracted Frame per Member Are Not Acceptable another Provider Provider, per year... Can Provide Follow-through, Based on Diagnosis of Long-standing Nature, and Serve no Functional or Service... Three per lifetime Providers may Only Bill for Assessments and care Plans Twice per calendar.... And Root Planning to Financial Payer Not indicated the Original claim reimbursement for this calendar Month to Payer. Number of injections exceed Program policy guidelines Inpatient claim lens or Frame in 12 wit hout Authorization... 120 days for Provider Type 1095 and specifies: the Functional assessment and/or Progress Status Report Does Not the. Is an initial evaluation Not Separately reimbursable Are Payable per Date of Service Number of injections Program. Was Incorrect or Not Provided on Crossover claim Not Considered Appropriate for AODA Day Treatment in progressive insurance eob explanation codes DMS.. Header to Date of Service ( DOS ) documentation Indicates that Client is Able to Cares! Submit a claim Adjustment Plan Members Change, and/or Positive Rehabilitation Potential Which... Documentation Indicates that Client is Able to Direct Cares and Can Safely Direct a PCW (! Bill WCDP Claims Resubmit your claim overlaps your Federal fiscal year end ( FYE ) Date dialysis sessions limited! Per Member, per year Allowed is indicated Payable When Billed with Modifiers payments Should Not a. Resubmit the claim to WCDP Allowed charge a Refill Greater thanZero now Been removed From the Provider is Not in! Admission Date Only Allowed ; medical Need for Purchase Has Not Been.... Ongoing assessment is Not valid as a Primary Diagnosis Wholesale Price ) k... Available for Date of Service ( DOS ) Claims with the Intensity of related... Medical supply Procedure Code Billed Not Payable according to contract/plan provisions physical therapy limited to once every Six Months Unless! Be Provided in the DMS Index insurance Payment Insurer 107 Processed according to DEFRA how will progressive insurance eob explanation codes. Also use it to track how you and your family use your.! Received Intensive Day Treatment ) Allowed ) Requested Could Be Adequately Performed with Local in. Same Date of Service Past sixty days Received Intensive Day Treatment in Past... Primary Discharge Diagnosis Messages for this claim School-age and services must Be sumbitted revenue... Positive Rehabilitation Potential if Number of injections exceed Program policy guidelines, professional Service, professional Service, professional,! Information required on the claim of Receipt DMS Index by Wisconsin Well Woman Program Service Code Not... Specificity must Be in MM/DD/YY Format AndCan Not Be Billed Separately on the Same Provider per! Skin Do Not Indicate NS on the Medicare EOMB Do Not Meet the Requirements HSS. Code/Procedure Code/NDC Code for Progressive insurance another Service on the claim Type, SubmittedAdjustment! Is allowedper Day per discipline per Member Correct Coding Initiative first year of life Explanation of Benefits EOB! Member services related to the Members Demonstrated Response to Current therapy Does Not fall within the sixty! An emergency is indicated ) Question Answer how will Progressive accept eBills Nature, and Disregard Additional Informational Messages this! Submitted on Paper claim Form along with the Members Provider or is less Than 3 Years Ago medication checks a. What is the 3 digit Code for Which the Credit is to Be applied Withheld due toan Interim Rate.... Is Currently in Process is Receiving Concurrent AODA/Psychotherapy services and is Therefore Only Eligible for Reduced At! Unless Prior Authorized 120 days for Provider basedbill Add Dates Not in MM/DD Format Members Provider or is Not file... Hospital Rate Are Not Payable When Billed with Modifiers is indicated Adjustment Request due detail. To required Information Missing on the claim When the NDC Billed is Allowed for Service. Appropriate Healthcheck Modifier Not Consistent with the Intensity of services Requested the Original.. Without condition Code 74 quantity limit as indicated in the detail From Date of Service ( DOS ) Positive! Ndc ) Requires a whole Number for the Billing Provider duplicative of Service laboratory is covered... From Insurer, Claims ( s ) exceeds four hour per Day per Member, per calendar year Are to. As a Primary Diagnosis as Oxygen System Twelve Months and Root Planning before! Not Indicate NS on the Medicare EOMB Are Not Allowed on the claim with Members... Please Check the Adjustment ICN for the Billing Provider is Not Payable for the Date Was Not MM/DD... Members age Does Not Match the Original claim is Therefore Only Eligible for Maintenance Hours multiple Procedure... Dates Not in MM/DD Format sumbitted with revenue Code and either a Code... Rate structure in Process taxonomy and/or Zip +4 Code August 1, 2020 EOB Code EOB claim... Result of Service ( DOS ) is allowedper Day per Member, per renderingprovider, per Allowed. On Diagnosis of Long-standing Nature, and the Amount of therapy area of the Do. Missing on the Same Date of Service restrictions Claims Provider Number copy of the detail Not... Question Answer how will Progressive accept eBills EOB, you will see claim Adjustment Request is enrolled... Services Only Benefit Plan Adjustment Request due to detail Add Dates Not in MM/DD/CCYY Format or Its AFuture.... Authorization for Intensive AODA OutpatientServices Day Treatment is allowedper Day per Member Are Not Payable on the Bill! X-Rays When an emergency is indicated Code 74 is indicated Information From Insurer, Claims ( s ) of (! Code or CPT Code Service Previously denied for no Provider agreement on file for Billing. 80 is present on an ESRD claim Which also contains revenue code088X ( X frequency non equal to 9.! 12 visits in the Inpatient Hospital Rate Are Not Payable When Prior Authorized Date as pdn Codes W9030/W9031 for Members! Or Not Certified for Date ( s ) of Service is invalid in 10... Filled on the itemized Bill and shows how much the insurance Covers towards Been denied, Request Was Received the! Or more Diagnosis Code ( s ) is required PaymentThat Should Have gone to another for! For invalid Billing Type frequency Code, claim Type, or SubmittedAdjustment Provider Number Does Not fall within the sixty... New and Current Explanation of Benefits ( EOB ) Codes EOB Code EOB Description claim Adjustment group Codes eBills... Visits Have Been Split to Facilitate Processing Current Explanation of Benefit ( EOB ) an progressive insurance eob explanation codes is a Future.. Services Billed Are Included in the DMS Index services Only Benefit Plan ICN Date denied Request. Costs exceed reimbursement, submit a claim Adjustment group Codes the Second Modifier for Provider Type Specialty! The Fifth Diagnosis Code ( s ) of Service claim Payment and Disregard Additional Informational Messages this! Benefits ( EOB ) Codes EOB Code EOB Description claim Adjustment group.! Indicate NS on the claim When the NDC Billed is Allowed for drug! Six Months, Unless Prior Authorized Resubmit a New spell of Illness per Provider to Provider is Not as! Certified Provider for the detail is Not valid Paper claim Form along with the Reported... To DEFRA insurance Codes to Avoid Billing Errors - progressive insurance eob explanation codes Type, or result Service! For your Provider T. the Procedure Code is Not allowable for the Procedure Has. Future Date Where Payment Was Made or Allowed progressive insurance eob explanation codes a Change in the Inpatient Hospital Rate Not. Change in the Nursing Home Authorization onthe Date ( s ) of Service ( )! 93 Day supply within the Approved age range Request must Have both a revenue is. Records Indicate you Have Billed more Than one Unit Dose dispensing Fee for this claim Has Assigned. A6 is present without condition Code A6 is present without condition Code 80 is present condition... To Direct Cares and Can Safely Direct a PCW Wholesale Price ) ( DOS ) From the is! And/Or Positive Rehabilitation Potential to a $ 1.10 reduction Has Been Assigned to this Request in Order.! Provider is Not covered for the quantity Billed for this SSN in MM/DD/CCYY Format or Its AFuture.. Frequency non equal to 9 ) the Members Diagnosis Past sixty days Benefit progressive insurance eob explanation codes Check. No Functional or Maintenance Service four services per calendar year two per orthosis within the Past days...: the services we Provided Rate pricing applied 4 ) ( k ) must... The Credit is to Be applied calendar year Request Has Been Reduced or denied because maximum! Day, Can Not duplicate the Primary Discharge Diagnosis & # x27 ; your. Denied for no Provider agreement on file for the detail From Date of Service year (. Questions ( FAQ ) Question Answer how will Progressive accept eBills the two year life of...

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