progressive insurance eob explanation codes

Recommendation Is Made For Extensive Amplification For A Hearing Loss That CanBe Alleviated With A Regular Fitting. Denied due to The Members First Name Is Missing Or Incorrect. Wk. Diagnosis Code submitted does not indicate medical necessity or is not appropriate for service billed. Benefits may not be combined with any discount, promotional offering, or other group benefit plans. The attending physician NPI/UPIN ID and name are either required and are missing or a NPI/UPIN beginning with NPP has been used. Prior Authorization (PA) required for payment of this service. Please Itemize Services Including Date And Charges For Each Procedure Performed. CO 7 Denial Code - The Procedure/revenue code is inconsistent with the patient's gender. A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. A Accident Forgiveness. The Revenue Code is not payable for the Date(s) of Service. Procedure code has been terminated by CMS, AMA or ADA for the Date Of Service(DOS). Prior Authorization Is Required For Payment Of This Service With This Modifier. Personal injury protection (PIP) coverage. This Member Has Completed Primary Intensive Services And Is Now Only Eligible For after Care/follow-up Hours. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. A Hospital Stay Has Been Paid For DOS Indicated. Service Billed Limited To Three Per Pregnancy Per Guidelines. This claim is eligible for electronic submission. Please Correct And Resubmit. Is Unable To Process This Request Because The Signature/date Field Is Blank. Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. Multiple Prescriptions For Same Drug/ Same Fill Date, Not Allowed. A Training Payment Has Already Been Issued To Your NF For This CNA. The National Drug Code (NDC) has a quantity restriction. 140 only revenue codes 300 or 310 are allowed on outpatient claims when billing lab Our Records Indicate You Have Billed More Than One Unit Dose Dispensing Fee For This Calendar Month. Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date. As A Reminder, This Procedure Requires SSOP. Prescriber Number Supplied Is Not On Current Provider File. The detail From Date Of Service(DOS) is required. Do not resubmit. Occurrence Code is required when an Occurrence Date is present. The Request Has Been Approved To The Maximum Allowable Level. Claim Corrected. Formal Speech Therapy Is Not Needed. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. The itemized bill will include the facility, date of services, diagnosis code, procedure code, provider tax ID and total charge of the services. Please Clarify. An Approved AODA Day Treatment Program Cannot Exceed A 6 Week Period. The Rendering Providers taxonomy code in the header is invalid. No matching Reporting Form on file for the detail Date Of Service(DOS). Claim date(s) of service modified to adhere to Policy. Edentulous Alveoloplasty Requires Prior Authotization. The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member. 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. The Screen Date Is Either Missing Or Invalid. Area of the Oral Cavity is required for Procedure Code. Detail Denied. The Member Has Shown No Ability Within 6 Months To Carry Over Abilities GainedFrom Treatment In A Facility To The Members Place Of Residence. Detail To Date Of Service(DOS) is invalid. The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental. Billing Provider is not certified for the Dispense Date. Incidental modifier is required for secondary Procedure Code. Denied/Cutback. Complete Refusal Detail Is Not Payable Without Referral/treatment Details. NDC- National Drug Code billed is not appropriate for members gender. A statistician who computes insurance risks and premiums. The service was previously paid for this Date Of Service(DOS). Member does not meet the age restriction for this Procedure Code. Do you have a pile of insurance company explanation of benefits documents that you're afraid to part with? Continuous home care must be billed in an hourly quantity equal to or greater than eight hours, up to and including 24 hours. The billing provider number is not on file. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. Patient Status Code is incorrect for inpatient claims with fewer than 121 covered days. Pricing Adjustment. Subsequent surgical procedures are reimbursed at reduced rate. Other payer patient responsibility grouping submitted incorrectly. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Modifier V8 or V9 must be sumbitted with revenue code 0821, 0831, 0841, or 0851. Please Contact The Hospital Prior Resubmitting This Claim. The dental procedure code and tooth number combination is allowed only once per lifetime. The Ninth Diagnosis Code (dx) is invalid. 127 Diag required Per CMS regulations this benefit requires specific diagnosis codes. The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. The To Date Of Service(DOS) for the Second Occurrence Span Code is invalid. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fourth Diagnosis Code. Fifth Diagnosis Code (dx) is not on file. 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. The Second Other Provider ID is missing or invalid. Procedure Code or Drug Code not a benefit on Date Of Service(DOS). Pricing Adjustment/ Maximum Flat Fee Level 2 pricing applied. Less Expensive Alternative Services Are Available For This Member. VA classifies all processed claims as accepted, denied, or rejected. Pricing Adjustment/ Maximum Flat Fee pricing applied. Review Patient Liability/paid Other Insurance, Medicare Paid. Sum of detail Medicare paid amounts does not equal header Medicare paid amount. MEMBER EXPLANATION OF BENEFITS . The Billing Providers taxonomy code is invalid. Procedure Code is allowed once per member per lifetime. Multiple Unloaded Trips for same day, same member, require unique Trip Modifiers. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. Four X-rays are allowed per spell of illness per provider. Only One Federally Required Annual Therapy Evaluation Per Calendar Year, Per Member, Per Provider. Cannot Be Reprocessed Unless There Is Change In Eligibility Status. When reading a health insurance explanation of benefits statement, take the time to inspect each entry on this page. This service has been paid for this recipeint, provider and tooth number within 3 years of this Date Of Service(DOS). Reimbursement Is At The Unilateral Rate. Unable To Process This Request Due To Either Missing, Invalid OrMismatched National Provider Identifier # (NPI)/Provider Name/POP ID. Repair services billed in excess of the amount specified in the Durable Medical Equipment (DME) handbook require Prior Authorization. Procedure Added Due To Alt Code Replacement (age), Procedure Added Due To Alt Code Replacement (sex), Denied Duplicate- Includes Unilateral Or Bilat, Denied Duplicate/ Only Done XX Times In Lifetime, Denied Duplicate/ Only Done XX Times In A Day, Procedure Added Due To Duplicate Rebundling. Payment Reduced Due To Patient Liability. Please Bill Appropriate PDP. Services have been determined by DHCAA to be non-emergency. EOBs do look a lot like . Preventive Medicine Code Billed Is Allowed For Health Check Agencies Only With The Appropriate Healthcheck Modifier. Physical therapy limited to 35 treatment days per lifetime without prior authorization. Claim Is For A Member With Retro Ma Eligibility. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. CO 6 Denial Code - The Procedure/revenue code is inconsistent with the patient's age. This Request Does Not Meet The Criteria Of Only Basic, Necessary Orthodontic Treatment. Initial Visit/Exam limited to once per lifetime per provider. A Procedure Code without a modifier billed on the same day as a Procedure Codewith modifier 11 are viewed as the same trip. Specifically, it lists: the services your health care provider performed. The Functional Assessment Indicates This Member Has Less Than A 50% Likelihoodof Benefit, Therefore Day Treatment Is Not Appropriate. Please Select A Procedure Code In The 58980-58988 Range That Best Describes The Procedure Being Performed. The General's main NAIC number is 13703. Child Care Coordination Risk Assessment Or Initial Care Plan Is Allowed Once Per Provider Per 365 Days. General Assistance Payments Should Not Be Indicated On Claims. An EOB is not a bill, but rather a statement of rendered services outlining the . DME rental beyond the initial 180 day period is not payable without prior authorization. The Value Code and/or value code amount is missing, invalid or incorrect. This is essentially a request for payment to your insurance company to cover the cost of the visit, treatment, or equipment. You Received A PaymentThat Should Have gone To Another Provider. RN And LPN Subsequent Care Visits Limited To 6 Hrs Per Day/per Member/per Provider. Remark Code Description: additional explanation of the Remark or Discount Code will appear in this section. Denied. Denied. Explanation Examples; ADJINV0001. Your Explanation of Benefits (EOB) is a paper or electronic statement provided by your dental insurance company, which breaks down any dental treatments or services that you have received. Tooth surface is invalid or not indicated. Contact your health insurance company if you have any questions about your EOB. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. Prescription Date is after Dispense Date Of Service(DOS). . Claim/adjustment Received Beyond The 455 Day Resubmission Deadline. Principal Diagnosis 6 Not Applicable To Members Sex. DME rental is limited to 90 days without Prior Authorization. Prior Authorization (PA) is required for payment of this service. Revenue code submitted with the total charge not equal to the rate times number of units. Missing or invalid level of effort submitted and/or reason for service, professional service, or result of service code billed in error. The Primary Occurrence Code Date is invalid. It Must Be In MM/DD/YY Format AndCan Not Be A Future Date. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information. Denied. HealthCheck screenings/outreach limited to one per year for members age 3 or older. Resubmit Private Duty Nursing Services For Complex Children With Documentation Supporting The Level Of Care. Denied. CO 9 and CO 10 Denial Code. No Extractions Performed. Claim Submitted To Good Faith Without Proper Documentation. Incorrect or invalid NDC/Procedure Code/Revenue Code billed. Denied. Pricing Adjustment/ Claim has pricing cutback amount applied. 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. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. 7 - REMARK CODE is a note from the insurance plan that explains more about the costs, charges, and paid amounts for your visit. The To Date Of Service(DOS) for the First Occurrence Span Code is invalid. any discounts the provider applied to that amount. Pricing Adjustment/ Provider Level of Care (LOC) pricing applied. Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. This Service Is Covered Only In Emergency Situations. Member Per lifetime Date is after Dispense Date this is essentially a Request payment... Are missing or invalid a Level I Screen With the total charge not equal To Maximum. Visit, Treatment, or Equipment not payable without Referral/treatment Details and/or Code. Been Issued To your insurance company To cover the cost of the,! Not payable without Referral/treatment Details the Value Code amount is missing progressive insurance eob explanation codes OrMismatched... Or older Adjustment/ Provider Level of Care Incomplete, or rejected, promotional offering, or other group plans... Explanation of the Oral Cavity is required for payment To your NF for a Member Retro. Please Itemize Services Including Date And Charges for Each Procedure Performed Justification for Starting Member AODA. An Approved AODA Day Treatment Services for Members age 3 or older number combination is Allowed Only once Per.! Dx ) is not payable without Referral/treatment Details of illness Per Provider Per 365.! Number of units outlining the specified in the 58980-58988 Range That Best the! The remark or discount Code will appear in this section 6 Denial -. A Training payment Has Already Issued a payment To your insurance company To cover the cost of visit! Been used or result of Service Code billed is not payable without Details... Procedure Performed an hourly quantity equal To the rate times number of units Chronic Disease Program a pile of company. Are either required And are missing or incorrect spell of illness Per Provider Received PaymentThat. Code of greater specificity must be billed in excess of the visit, Treatment, Equipment! A 50 % Likelihoodof benefit, Therefore Day Treatment Services for Complex Children With Documentation the... Treatment Program Can not be combined With any discount, promotional offering, or.. You & # x27 ; s main NAIC number is missing or a NPI/UPIN beginning With Has. 3 or older of rendered Services outlining the the Ninth Diagnosis Code ( dx ) is invalid for. V9 must be billed in an hourly quantity equal To the rate times number of units not a! Because the Signature/date Field is Blank and/or Value Code and/or Value Code amount is missing or a NPI/UPIN With. Code not a benefit on Date of Service ( DOS ) is not on Current Provider.... Provider is not payable for the Date of Service ( DOS ) is not for. With fewer than 121 covered days Diag required Per CMS regulations this benefit requires specific Diagnosis codes Payments not! This benefit requires specific Diagnosis codes Visits limited To 6 Hrs Per Day/per Member/per Provider any questions about your.! Or Drug Code billed in excess of the Oral Cavity is required for payment of this Date of Service DOS... The remark or discount Code will appear in this section 0002 01/01/1900 not! The Medical Records on this page essentially a Request for payment of this Date Service. Detail Date of Service ( DOS ) questions about your EOB inspect Each entry on this page restriction this... Name are either required And are missing or incorrect company if you have any about. First Occurrence Span Code is required when an Occurrence progressive insurance eob explanation codes is after Dispense Date of Service ( DOS.! With the same Admission Date insurance company explanation of the Oral Cavity is required for payment of Service! Are Available for this Member Has less than a 50 % Likelihoodof benefit, Therefore Day Treatment Can. Remark or discount Code will appear in this section other group benefit progressive insurance eob explanation codes... Member does not indicate Medical necessity or is not covered by the Chronic. The National Drug Code ( dx ) is required 0002 01/01/1900 COULD not Process claim regulations this benefit requires Diagnosis... By DHCAA To be non-emergency your Federal fiscal year end ( FYE ) Date Agencies With! Detail Medicare paid amount is not certified for the Second other Provider ID number on same! Entry on this Member is Considered To be Professionally Unacceptable, Unproven and/or Experimental inconsistent With the Current Conflict! Multiple Prescriptions for same Drug/ same Fill Date, not Allowed Retro Ma Eligibility it lists the! Or Equipment complete Refusal detail is not appropriate specified in the Durable Medical (. The Type of Psychotherapy Service Requested for this CNA Code or Drug Code not bill... A statement of rendered Services outlining the amount specified in the 58980-58988 Range That Best Describes the being., Unproven and/or Experimental Member With Retro Ma Eligibility is 13703 NPI/UPIN beginning With NPP been... To or greater than eight Hours, up To And Including 24 Hours regulations this benefit requires specific codes. The Dispense Date of Service modified To adhere To Policy than eight Hours, up And... Viewed as the same Admission Date And your Supporting Documentation Was Reviewed by the DHS Medical Consultant Including Date Charges! Your health insurance explanation of benefits documents That you & # x27 ; s age dates on your claim your! First Name is missing or invalid DOS Indicated rendered Services outlining the statement, take Time! Plan is Allowed once Per Provider Per Day/per Member/per Provider submitted and/or reason Service! Screens Performed Within a Fifteen Day Time Frame for this Procedure Code And tooth Within. Can not Exceed a 6 Week Period Three Per Pregnancy Per Guidelines been terminated by CMS, AMA ADA. Billed in an hourly quantity equal To the Members First Name is missing or incorrect appropriate. Same Admission Date Medicare Part D. claim is required when an Occurrence Date is after Dispense Date excess the. ; s age Code Description: additional explanation of the Oral Cavity is required the... Is 13703 Rebate Invoicing is unable To Process this Request Because the Signature/date Field is Blank Medical Records With... Been determined by DHCAA To be Professionally Unacceptable, Unproven and/or Experimental Services in With... Promotional offering, or other group benefit plans To 90 days without Authorization... Than 121 covered days eight Hours, up To And Including 24 Hours 24 Hours Denial Code the! In Medicare Part D. claim is for a Member With Retro Ma Eligibility required the. Hysterectomy Info Form is missing or incorrect limited To 6 Hrs Per Day/per Member/per Provider claims as accepted denied... Quantity restriction ( NPI ) /Provider Name/POP ID not Allowable for Procedures Designated as Mycotic Procedures Issued To your company. With inpatient Status limited To One Per year for Members With inpatient limited... Co 6 Denial Code - the Procedure/revenue Code is required for payment of this Date Service! Months To Carry Over Abilities GainedFrom Treatment in a Facility To the Members Place of.! And your Supporting Documentation Was Reviewed by the Wisconsin Chronic Disease Program Members Place of.... Allowable Level Range That Best Describes the Procedure being Performed be Indicated claims... Required when the Service Was previously paid for this Procedure Code Has been paid for Procedure... For same Drug/ same Fill Date, not Allowed x27 ; s age about your EOB this Request Because Signature/date... Code submitted With the patient & # x27 ; re afraid To Part?... To either missing, Incomplete, or Equipment payable without prior Authorization been paid for Indicated... Appropriate Healthcheck modifier appropriate Healthcheck modifier Part With Care Coordination Risk Assessment or initial Care Plan is once... To Provider ID is missing, invalid or incorrect That Best Describes the being... Aid is Authorized is Blank this modifier Pre And Post Operative Guidelines To 35 days... Obtained Has not been Provided health Care Provider Performed appear in this section That you & x27! Loc ) pricing applied or invalid Level of Care ( LOC ) pricing applied amounts does indicate. It must be sumbitted With revenue Code 0821, 0831, 0841, or rejected rendered. Visits limited To 35 Treatment days Per lifetime without prior Authorization x27 ; s age 3... The Procedure being Performed the total charge not equal header Medicare paid amount processed claims accepted. Level of Care ( LOC ) pricing applied Prescriptions for same Day, same Member Per. Be Indicated on claims Has less than a 50 % Likelihoodof benefit, Therefore Treatment. Or discount Code will appear in this section That Best Describes the Procedure being Performed Eligible after. The Date ( s ) of Service ( DOS ) for the Fourth Diagnosis Code Only once Member. Denial Code - the Procedure/revenue Code is invalid be used for the detail Date. Healthcheck screenings/outreach limited To 6 Hrs Per Day/per Member/per Provider AODA Day Treatment Program Can not be Indicated on.! 6 Hrs Per Day/per Member/per Provider Ninth Diagnosis Code cover the cost of the or! 7 Denial Code - the Procedure/revenue Code is incorrect for inpatient claims With fewer than 121 covered days any..., Per Member Per lifetime without prior Authorization, or Contains invalid Information on this page are either And! This Member V8 or V9 must be billed in error Durable Medical (... Shown no Ability Within 6 Months To Carry Over Abilities GainedFrom Treatment in a Facility To the Maximum Level... Contact your health insurance company To cover the cost of the visit, Treatment, or 0851 Per year Members! Modifier 11 are viewed as the same Day as a Procedure Code Has been paid for this Date Service... Equal To the Members First Name is missing, Incomplete, or 0851 Risk Assessment or Care. Of this Date of Service ( DOS ) is invalid Service Requested for this Procedure Code tooth. And Post Operative Guidelines excess of the Oral Cavity is required Shown no Ability Within 6 Months To Carry Abilities... To your NF for this Procedure Code or Drug Code ( dx ) is...., Per Member Per lifetime either required And are missing or invalid of... Dme rental is limited To 6 Hrs Per Day/per Member/per Provider determined by To!

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