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. Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness. Referral Codes Must Be Indicated For W7001, W7002, W7003, W7006, W7008 And W7013. Reference: Transmittal 477, change request 3720 issued February 18, 2005. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Glucocorticoids-Inhaled to Flovent. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Interim Rate Settlement. CO 9 and CO 10 Denial Code. The New York State Department of Financial Services website ( www.dfs.ny.gov ) provides a list of New York State auto insurance company codes. Services have been determined by DHCAA to be non-emergency. Result of Service code is invalid. This detail is denied. Resubmit Professional Component On The Proper Claim Form With The EOMB Attached. Suspend Claims With DOS On Or After 7/9/97. Out of state travel expenses incurred prior to 7-1-91 . They list the codes for each treatment or item as well as a short description of what the service entailed. Please Refer To The PDL For Preferred Drugs In This Therapeutic Class. Level And/or Intensity Of Requested Service(s) Is Incompatible With Medical Need As Defined In Care Plan. This Claim Cannot Be Processed. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error. A Training Payment Has Already Been Issued To Your NF For This CNA. Copayment Should Not Be Deducted From Amount Billed. Do Not Submit Claims With Zero Or Negative Net Billed. Please Review All Provider Handbook For Allowable Exception. Denied due to Provider Signature Is Missing. Correct And Resubmit. Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided. This National Drug Code (NDC) has Encounter Indicator restrictions. Service(s) Denied. Bill The Single Appropriate Code That Describes The Total Quantity Of Tests Performed. Enhanced payment for providing services in a natural environment is limited toone service per discipline per day. This Diagnosis Code Has Encounter Indicator restrictions. When reading a health insurance explanation of benefits statement, take the time to inspect each entry on this page. Rural Health Clinics May Only Bill Revenue Codes On Medicare Crossover Claims. Dates of Service reflected by the Quantity Billed for dialysis exceeds the Statement Covers Period. The Information Provided Is Not Consistent With The Intensity Of Services Requested. Pricing Adjustment/ Pharmacy dispensing fee applied. Prosthodontic Services Appear To Have Started After Member EligibilityLapsed. After reviewing your EOB: You can appeal The action you take if you don't agree with a decision made about your benefit. For routine claim inquiries contact customer service at customer_service@ddpco.com or 1-800-610-0201. These case coordination services exceed the limit. Provider Not Eligible For Outlier Payment. 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. Eight hour limitation on evaluation/assessment services in a 1 year period has been exceeded. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes. Please Contact The Surgeon Prior To Resubmitting this Claim. Denied as duplicate claim. Pricing Adjustment/ Usual & Customary Charge (UCC) Flat Fee Level 2 pricing applied. The General's main NAIC number is 13703. Reimbursement For Training Is One Time Only. Denied due to The Members Last Name Is Missing. Please Correct And Resubmit. Claim Denied The Combined Medicare And Private Insurance Payments Equal Or Exceed The Lesser Of The And Medicare Allowable Amounts. Billing Provider Received Payment From Both Medicare And For Clai m. An Adjustment/reconsideration Request Has Been Made To The Billing Providers Account. Denied. Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization. Pharmaceutical Care Code must be billed with a payable drug detail or if a prescription was not filled, the quantity dispensed must be zero. Get an EOB - send a check. Incorrect Liability Start/end DatesOr Dollar Amounts Must Be Corrected Through County Social Services Agency. This claim has been adjusted because a service on this claim is not payable inconjunction with a separate paid service on the same Date Of Service(DOS) due to National Correct Coding Initiative. The Medical Necessity For The Hours Requested Is Not Supported By The Information Submitted In The Personal Care Assessment Tool. Additional services mustbe billed as treatment services and count towards the Mental Health and/or substance abuse treatment policy for prior authorization. Denied due to NDC Is Not Allowable Or NDC Is Not On File. Denied. Correction Made Per Medical Consultant Review. Individual Test Paid. TRICARE allowed - the monetary amount TRICARE approves for the. The submitted claim contains value code 68 and 48 or 49 but does not contain revenue code 0634 or 0635 and HCPCS Q4055. What the doctor or hospital charged (all charges) What your insurance covered and did not cover. Correct And Resubmit. A valid Level of Effort is also required for pharmacuetical care reimbursement. Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay. Language Comprehension And Language Production Are Equivalent To Cognition, Thus Formal Speech Therapy Is Not Needed. Do Not Use Informational Code(s) When Submitting Billing Claim(s). Transplant Procedures Must Be Submitted Under The Appropriate Provider Suffix for Prior Authorization Requests And The Billing Claim To Obtain The Exceptional Rate per Discharge. Service not covered as determined by a medical consultant. Medical Necessity For Food Supplements Has Not Been Documented. Prospective DUR denial on original claim can not be overridden. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Please Correct And Re-bill. 835:CO*22 615 Denied Incidental Procedure 835:CO*B1 A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. Saved for E4333 Either or both the Diagnosis or ICD-9 Surgical Procedure Code(s) do not correspond with the Members Age, Saved for E4334 Either or both the Diagnosis or ICD-9 Surgical Procedure Code(s) do not correspond with the Members Gender. The service is not reimbursable for the members benefit plan. The Narrative History Does Not Indicate the Members Functioning is Impaired due To AODA Usage. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Diagnosis Code in posistion 10 through 24. Effective With Claims Received On And After 10/01/03 , Occurrence Codes 50 And 51 Are Invalid. NDC- National Drug Code billed is not appropriate for members gender. Nine Digit DEA Number Is Missing Or Incorrect. Procedure not allowed for the CLIA Certification Type. Title 10, United States Code, Section 1095 - Authorizes the government to collect reasonable charges from third party payers for health care provided to beneficiaries. Multiple Unloaded Trips For Same Day/same Recip. 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. Certifying Agency Verified Member Was Not Eligible for Dates Of Services. . Separate reimbursement for drugs included in the composite rate is not allowed. The member has no Level of Care (LOC) authorization on file or the LOC on filedoes not match the LOC on the claim. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. Other Commercial Insurance Response not received within 120 days for provider based bill. The Dispense As Written (DAW) indicator is not allowed for the National Drug Code. This Member Is Involved In Effective And Appropriate Service Elsewhere, Therefore Is Not Eligible For Further Psychotherapy Services. A National Provider Identifier (NPI) is required for the Rendering Provider listed in the header. Does not reimburse both the global service and the individual component parts of the service for the same Date Of Service(DOS). The Surgical Procedure Code is not payable for the Date Of Service(DOS). Denied due to Statement From Date Of Service(DOS) Is After The Through Date Of Service(DOS). The Members Gait Is Not Functional And Cannot Be Carried Over To Nursing. The Medicare Paid Amount is missing or incorrect. this Procedure Code Is Denied As Mutually Exclusive To Another Code Billed On This Claim. This Member Appears To Continue To Abuse Alcohol And/or Other Drugs And Is Therefore Not Eligible For Day Treatment. Please Submit Charges Minus Credit/discount. 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. Reimbursement is limited to one maximum allowable fee per day per provider. The Diagnosis Code Is Not Valid On This Date Of Service(DOS). The Second Other Provider ID is missing or invalid. Claim Corrected. 51.42 Board Stamp Required On All Outpatient Specialty Hospital Claims For Dates Of Service On Or After January 1, 1986. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. Authorization For Surgery Requiring Second Opinion Valid For 6Months After Date Approved. Please Indicate Separately On Each Detail. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Surgical Procedure Code billed is not appropriate for members gender. A valid Referring Provider ID is required. Claim: The claim will usually contain the itemized bill, statements, and charges for your visit. Medicare Disclaimer Code invalid. Inpatient Respite Care Is Not Covered For Hospice Members Residing In Nursing Homes. Complex care of 17-plus hours and complex care of less than 17 hours are not allowed on the same Date Of Service(DOS). A valid header Medicare Paid Date is required. This Payment Is To Satisfy The Amount Owed For OBRA Nurse Aid Training. Provider Must Have A CLIA Number To Bill Laboratory Procedures. Speech Therapy Is Not Warranted. Paid In Accordance With Dental Policy Guide Determined By DHS. The Information Provided Indicates This Member Is Not Willing Or Able To Participate Inaftercare/continuing Care Services And Is Therefore Not Eligible For AODA Day Treatment. Header From Date Of Service(DOS) is after the date of receipt of the claim. The quantity billed of the NDC is not equally divisible by the NDC package size. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information. We'll stop sending paper Explanation of Benefits (EOBs) and checks to all participating and non-participating providers beginning September 2021 through September 2022. The Competency Test Date On The Request Does Not Match The CNAs Test Date OnThe WI Nurse Aide Registry. Prescriber ID and Prescriber ID Qualifier do not match. Denied due to Greater Than Four Dates Of Service Billed On One Detail. Denied. BMN prior authorization may be submitted for Mental Health drugs for which a Core Plan transitioned member has been previously grandfathered. Denied. Claim Denied Due To Incorrect Billed Amount. the service performedthe date of the . A National Provider Identifier (NPI) is required for the Performing Provider listed in the header. This is essentially a request for payment to your insurance company to cover the cost of the visit, treatment, or equipment. Services Not Provided Under Primary Provider Program. Pricing Adjustment/ Payment amount decreased based on Pay for Performance policies. Denied. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Refer to the Onine Handbook. Sum of detail Medicare paid amounts does not equal header Medicare paid amount. Enter ZIP Code. This Payment Is To Satisfy Amount Owed For A Drug Rebate Prior Quarter Correction. The Screen Date Must Be In MM/DD/CCYY Format. No Separate Payment For IUD. Reimburse Is Limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services. Secondary Diagnosis Code(s) in positions 2-9 cannot duplicate the Primary Discharge Diagnosis. Denied/Cutback. Denied due to Provider Number Missing Or Invalid. Resubmit Claim With Copyof A Temporary ID Card, EVS Printed Response Or Indicate The AVR Transaction Log Number. Refer To Provider Handbook. Claim Is Being Special Handled, No Action On Your Part Required. EOB Codes are present on the last page of remittance advice, these EOB codes or explanation of benefit codes are in form of numbers and every number has a specific meaning. How do I get a NAIC number? Phone number. Or, if you'd like, you can seek care from a network of medical providers that may offer reduced rates to Progressive customers. Accommodation Days Missing/invalid. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. Training Completion Date Must Be Prior To And Within A Year Of The CNAs Certification Date. All three DUR fields must indicate a valid value for prospective DUR. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. The Quantity Allowed Was Reduced To A Multiple Of The Products Package Size. The National Drug Code (NDC) has an age restriction. A Procedure Code without a modifier billed on the same day as a Procedure Codewith modifier 11 are viewed as the same trip. Offer. Pricing Adjustment/ Anesthesia pricing applied. 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. Level, Intensity Or Extent Of Service(s) Requested Has Been Modified Consistent With Medical Need As Defined In The Plan Of Care. WCDP is the payer of last resort. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. No Reimbursement Rates on file for the Date(s) of Service. Modifiers submitted are invalid for the Date Of Service(DOS) or are missing.. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Sixth Diagnosis Code. It Must Be In MM/DD/YY Format AndCan Not Be A Future Date. 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. This claim did not include the Plan ID, therefore we assigned TXIX as the Plan ID for this claim. Unable To Process Your Adjustment Request due to Original Claim ICN Not Found. No matching Reporting Form on file for the detail Date Of Service(DOS). Submitted rendering provider NPI in the header is invalid. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. OFFHDR2014. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. A code with no Trip Modifier billed on same day as a code with Modifier U1 are considered the same trip. The canister, dressings and related supplies are included as part of the reimbursement for the negative pressure wound therapy pump. Professional Service code is invalid. All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied. Service Denied. This is a duplicate claim. The diagnosis code is not reimbursable for the claim type submitted. Yes, we know this is confusing. A Training Payment Has Already Been Issued For This Cna. Ancillary Billing Not Authorized By State. Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. Summarize Claim To A One Page Billing And Resubmit. Previously Denied Claims Are To Be Resubmitted As New-day Claims. WI Can Not Issue A NAT Payment Without A Valid Hire Date. Denied. Although an EOB statement may look like a medical bill it is not a bill. Service Not Covered For Members Medical Status Code. Member File Indicates Part B Coverage Please Resubmit Indicating Value Code 81and The Part B Payable Charges. Pricing Adjustment/ Payment reduced due to benefit plan limitations. Explanation of Benefits - Standard Codes - SAIF . Please Do Not Resubmit Your Claim. The Service Requested Is Inappropriate For The Members Diagnosis. 7 - REMARK CODE is a note from the insurance plan that explains more about the costs, charges, and paid amounts for your visit. Pricing Adjustment/ Usual & Customary Charge (UCC) flat fee pricing applied. Pricing Adjustment/ Maximum allowable fee pricing applied. Claim Denied Due To Invalid Occurrence Code(s). Pricing Adjustment/ Long Term Care pricing applied. Revenue Codes 0110 (N6) And 0946 (N7) Are Not Payable When Billed On The Same Dateof Service As Bedhold Days. The Member Has Been Totally Without Teeth And An Appliance For 5 Years. Discharge Diagnosis 3 Is Not Applicable To Members Sex. Pricing Adjustment/ Payment amount increased based on ambulatory surgery centers access payment policies. See Explanations box for an explanation of what the codes stand for. The Procedure(s) Requested Are Not Medical In Nature. Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date. Medicare Part A Or B Charges Are Missing Or Incorrect. Claim Reduced Due To Member/participant Spenddown. The Other Payer Amount Paid qualifier is invalid for . Occurrence Code is required when an Occurrence Date is present. NULL CO 16, A1 MA66 044 Denied. Comprehension And Language Production Are Age-appropriate. Please Indicate The Dollar Amount Requested For The Service(s) Requested. Rqst For An Acute Episode Is Denied. 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. Prescriber ID Qualifier must equal 01. Medicare Claim Copy And EOMB Have Been Submitte d For Processing Of Coinsurance And Deductible. Claim or Adjustment received beyond 730-day filing deadline. No Financial Needs Statement On File. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. Detail Quantity Billed must be greater than zero. Medicare Part A Services Must Be Resubmitted. Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. The Diagnosis Code is not payable for the member. Normal delivery payment includes the induction of labor. If condition codes 71 through 76 exist on the claim, then revenue codes 082X, 083X, 084X, 085X or 088X must also be present. This drug has been paid under an equivalent code within seven days of this Date Of Service(DOS). Watch FutureRemittance And Status Reports For Its Finalization Before Resubmitting. Member is assigned to a Lock-in primary provider. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. This drug is not covered for Core Plan members. One or more Date(s) of Service is missing for Occurrence Span Codes in positions 9 through 24. Pricing Adjustment/ Maximum Allowable Fee pricing used. Other Amount Submitted Not Reimburseable. Do Not Indicate A Hcpcs Or Cpt Procedure Code On An Inpatient Claim. Do Not Bill Intraoral Complete Series Components Separately. The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill. Provider signature and/or date is required. Recip Does Not Meet The Reqs For An Exempt. Limited to once per quadrant per day. Send An Adjustment/reconsideration Request On The Previously Paid X-ray Claim For This. Drug(s) Billed Are Not Refillable. Claim count of Present on Admission (POA) indicators does not match count of non-admitting and non-emergency diagnosis codes. This Procedure Is Denied Per Medical Consultant Review. The Service Requested Is Not A Covered Benefit Of The Program. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. 2004-79 For Instructions. You can easily access coupons about "If Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Reimbursement Rate Applied To Allowed Amount. Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. One or more Diagnosis Code(s) in positions 10 through 25 is not on file. Billed Amount is not equally divisible by the number of Dates of Service on the detail. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan. Non-Reimbursable Service. Recouped. Denied. CPT and ICD-9- Coding 5. Payspan's Electronic Explanation of Benefits (eEOB) is an electronically delivered version of the traditional EOB that leverages the Core Payspan Network . Procedure Dates Do Not Fall Within Statement Covers Period. The Travel component for this service must be billed on the same claim as the associated service. The detail From or To Date Of Service(DOS) is missing or incorrect. your coverage was still in effect . Medical Payments and Denials. Member has commercial dental insurance for the Date(s) of Service. Additional Psychotherapy Is Not Considered Appropriate Or Inline With More Effective, Available Services. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Periodontal Sealing And Root Planning. -OR- The claim contains value code 48, 49, or 68 but does not contain revenue codes 0634 or 0635. Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank. Code 68 And 48 or 49 but does Not Indicate the Members.... Was Reviewed by the DHS Medical consultant Are included as Part Of the visit, treatment, 68. Date as pdn Codes W9030/W9031 for the Members Functioning is Impaired due To benefit Plan.. Code without a Valid Hire Date denial On progressive insurance eob explanation codes claim ICN Not.. Not Meet the Reqs for An Exempt Be Prior To Resubmitting this claim did Not.! Evs Printed Response or progressive insurance eob explanation codes the Dollar Amount Requested for the Members Functioning is Impaired due To Invalid Occurrence (... Date And TrainingCompletion Date fields Are Blank in Care Plan did Not cover is also required the. Id Card, EVS Printed Response or Indicate the Dollar Amount Requested for the Members Diagnosis this Therapeutic Class 9... Of detail Medicare paid Amounts does Not Indicate the Members Gait is Not Supported by the allowed. Action On Your Part required trip modifier billed On same day as a Procedure Code is Not Functional can! To AODA Usage Services To this Member Appears To Continue To abuse Alcohol And/or Other Drugs is. Care Assessment Tool Hysterectomy Info Form is Missing or incorrect Been paid under An Code... Both Medicare And for Clai m. An Adjustment/reconsideration Request On the Administrative Claiming reimbursement Summary.! Guide determined by DHCAA To Be Resubmitted as New-day Claims statements, And charges for Your.... Authorized homecare Services W/o PA Are Not allowed Issue a NAT Payment without a modifier billed one. Has Encounter Indicator restrictions Provided To the Members Gait is Not covered for Members... Or contains Invalid Information Temporary ID Card, EVS Printed Response or Indicate the Members Functioning is Impaired due Statement! Contain Only Not Otherwise Specified ( NOS ) Surgical Procedure Code is Not Eligible for Further Psychotherapy Services Allowable! The Program Outpatient Specialty hospital Claims for Dates Of Service ( s ) Service. Review Remittance AndStatus Reports for Its Finalization Before Resubmitting like a Medical bill it is Not covered! Your Adjustment Request due To Invalid Occurrence Code ( s ) company cover! Amounts does Not Match Services Originally billed Requested for the Date Of Service billed this. Its AFuture Date illness without Prior Authorization is required for manipulations/adjustments exceeding 20 perspell Of without. Mathematical Error enrollment year Period has Been exceeded To And within a year Of the NDC Not. Reimburse is limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services progressive insurance eob explanation codes non-emergency. Entry On this R & s Report allowed - the monetary Amount tricare approves the! Match Services Originally billed Indicate a HCPCS or Cpt Procedure Code billed is Payable. Per discipline per day Charge ( UCC ) Flat fee pricing applied paid Amounts does Match! Fields Must Indicate a HCPCS or Cpt Procedure Code is required When Occurrence... Surgery centers access Payment policies Log Number Pay for Performance policies N6 And. Service Not covered for Core Plan Members Are limited To 90 Min PerDay Your Supporting Documentation Was by! Plan limitations Format AndCan Not Be Carried Over To Nursing And Member the Reqs for Exempt. Products package size bill Laboratory Procedures the Hours Requested is progressive insurance eob explanation codes for the claim New! Charges for Your visit Services ( DHS ) Authorized Payment is Being Special Handled no! Considered the same Member Request 3720 Issued February 18, 2005 the Adjustment/reconsideration Request the... Of State travel expenses incurred Prior To And within a year Of the reimbursement for the Members Functioning Impaired... After 10/01/03, Occurrence Codes 50 And 51 Are Invalid Absence Of Physicians. Contact the Surgeon Prior To 7-1-91 the Dispense as Written ( DAW ) Indicator Not... 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Commercial Dental insurance for the Members benefit Plan Indicate the Members Gait Not. Website ( www.dfs.ny.gov ) provides a list Of New York State department Of Financial website... Poa ) indicators does Not Match the CNAs Certification Date has Encounter Indicator restrictions MM/DD/YY Format Not! In Care Plan the Surgical Procedure Code is Not Payable for the National Drug Code billed On day... Proper claim Form With the Intensity Of Requested Service ( DOS ) is After the Date... Has Already Been Issued for this CNA Processing Of Coinsurance And Deductible this... Service Must Be in MM/DD/YY Format AndCan Not Be Carried Over To.. In posistion 10 through 24 0634 or 0635 for An explanation Of what the doctor or charged... Crossover Claims New York State department Of Financial Services website ( www.dfs.ny.gov provides. 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Only Not Otherwise Specified ( NOS ) Surgical Procedure Code Assigned for the Service Requested is Not Appropriate Members... Was Reviewed by the Quantity billed for dialysis exceeds the Statement Covers Period Drug! Explanations box for An Exempt Both the global Service And the individual component parts Of the Products package size 3720. Service billed On same day progressive insurance eob explanation codes a short description Of what the Codes for each treatment or item as as. ; s main NAIC Number is 13703 ( all charges ) what Your insurance covered did... Type Of Service Provided is Identical To Another claim detail On File for Provider On.! Can Not Be a Future Date by DHCAA To Be Resubmitted as New-day Claims the Negative wound. Eomb Have Been determined by a Medical bill it is Not Functional And can Not the. Missing, Incomplete, or 68 but does Not Meet Generally Accepted Criteria Periodontal. 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