Member is not enrolled in the program submitted in the Plan ID field for the Dispense Date Of Service(DOS) or an invalid Plan ID was submitted. Effective 1/1: Electronic Prescribing of Controlled Substances Required. The Processor Control Number (PCN) for SeniorCare member over 200% FPL is missing, or the PCN is invalid for a WCDP member, member or SeniorCare member at or below 200% FPL. Accident Related Service(s) Are Not Covered By WCDP. Detail To Date Of Service(DOS) is required. Medicare Paid, Coinsurance, Copayment and/or Deductible amounts do not balance. Header Billing Provider used as Detail Performing Provider, Header Performing Provider used as Detail Performing Provider. Rqst For An Exempt Denied. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental. Will Not Authorize New Dentures Under Such Circumstances. Denied. Verify billed amount and quantity billed. Home Health services for CORE plan members are covered only following an inpatient hospital stay. Service Denied. The Service Requested Is Considered To Be Professionally Unacceptable, Unproven and/or Experimental. Remark Codes: N20. FFS CLAIM PROFESSIONAL ASC X12N VERSION . Pricing Adjustment/ Level of effort dispensing fee applied. Dates Of Service For Purchased Items Cannot Be Ranged. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Member has Medicare Supplemental coverage for the Date(s) of Service. Denied. Invalid Service Facility Address. This service is not covered under the ESRD benefit. This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. Rqst For An Acute Episode Is Denied. This Dental Service Limited To Once Every Six Months, Unless Prior Authorized. Claim Denied. Claims may deny when a procedure defined as requiring an anatomical modifier is billed without an associated anatomical modifier. Occupational Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. Hearing aid repairs are limited to once per six months, per provider, per hearing aid. Other Payer Date can not be after claim receipt date. Please Rebill Inpatient Dialysis Only. Denied. Service not payable with other service rendered on the same date. Denied. Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement. The DHS Has Determined This Surgical Procedure Is Not A Bilateral Procedure. This Member is enrolled in Wisconsin or BadgerCare Plus for Date(s) of Service. Reimbursement For This Service Is Included In The Transportation Base Rate. Professional Components Are Not Payable On A Ub-92 Claim Form. is unable to is process this claim at this time. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. Suspend Claims With DOS On Or After 7/9/97. Questionable Long-term Prognosis Due To Poor Oral Hygiene. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. Condition code 20, 21 or 32 is required when billing non-covered services. Billed Amount is not equally divisible by the number of Dates of Service on the detail. Live-agent chat is the easiest and fastest way to get real-time support for an array of topics, including: Member Eligibility. All services should be coordinated with the primary provider. Principal Diagnosis 9 Not Applicable To Members Sex. A Reimbursement Request For A Level I Screen Must Be Received At Within A Year Of The Screen Date. Denied due to The Members Last Name Is Incorrect. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Pharmacy Clm Submitted Exceeds The Number Of Clms Allowed Per Cal. Claims may deny for the initial inpatient admission E&M if a provider from the same provider group and same specialty bills any other inpatient E&M visit, i.e. When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. The submitted claim contains value code 68 and 48 or 49 but does not contain revenue code 0634 or 0635 and HCPCS Q4055. Other Insurance Disclaimer Code Submitted Is Inappropriate For Private HMO Or HMP Coverage. Procedure Code or Drug Code not a benefit on Date Of Service(DOS). The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). These Supplies/items Are Included In The Purchase Of The Dme Item Billed On The Same Date Of Service(DOS). Referring Provider ID is not required for this service. This Claim Has Been Denied Due To A POS Reversal Transaction. WCDP is the payer of last resort. This Procedure Is Denied Per Medical Consultant Review. The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code. In addition, duplex scan of extracranial arteries, computed tomographic angiography (CTA) of the neck and magnetic resonance angiography (MRA) of the neck are not medically necessary for evaluation of syncope in patients with no suggestion of seizure and no report of other neurologic symptoms or signs. The Rendering Providers taxonomy code in the header is not valid. Claim Detail Is Pended For 60 Days. Our Records Indicate This Tooth Previously Extracted. Endurance Activities Do Not Require The Skills Of A Therapist. Denied due to Detail Dates Are Not Within Statement Covered Period. Procedure Code is not allowed on the claim form/transaction submitted. Procedure not payable for Place of Service. The Request Has Been Approved To The Maximum Allowable Level. Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid. This claim is eligible for electronic submission. Refill Indicator Missing Or Invalid. Dental X-rays Indicate A Dental Cleaning, Followed By Good Dental Care At Home, Would Be Sufficient To Maintain Healthy Gums. Non-preferred Drug Is Being Dispensed. Pricing Adjustment/ Medicare benefits are exhausted. Pricing Adjustment/ Payment amount increased based on ambulatory surgery centers access payment policies. Adjustment To Eyeglasses Not Payable As A Repair Service. Services are not payable. 2004-79 For Instructions. The From Date Of Service(DOS) for the Second Occurrence Span Code is invalid. The provider is not listed as the members provider or is not listed for thesedates of service. Patient Status Code is incorrect for Long Term Care claims. Do Not Use Informational Code(s) When Submitting Billing Claim(s). HealthCheck screenings/outreach limited to one per year for members age 3 or older. It Must Be In MM/DD/YY FormatAnd Can Not Be A Future Date. Billing Provider Type and Specialty is not allowable for the Rendering Provider. This detail is denied. Earn Money by doing small online tasks and surveys, What is Denials Management in Medical Billing? If Required Information Is Not Received Within 60 Days,the claim will be denied. Prescribing Provider UPIN Or Provider Number Missing From Claim And Attachment. The header total billed amount is required and must be greater than zero. EOB. Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). The Service Requested Is Inappropriate For The Members Diagnosis. POS codes are required under the provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The billing provider number is not on file. One or more Diagnosis Code(s) is invalid for the Date(s) of Service. Individual Replacements Reimbursed As Dispensing A Complete Appliance. Rendering Provider may not submit claims for reimbursement as both the Surgeonand Assistant Surgeon For The Same Member On The Same DOS. This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. Denied. The Revenue Code is not payable for the Date(s) of Service. The Service(s) Requested Could Adequately Be Performed In The Dental Office. Dental service limited to twice in a six month period. The Members Demonstrated Response To Current Therapy Does Not Warrant The Intense Freqency Requested. A valid Prior Authorization is required for Brand Medically Necessary Drugs. Services billed are included in the nursing home rate structure. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. Occurrence Code is required when an Occurrence Date is present. Denied. Reimbursement for mycotic procedures is limited to six Dates of Service per calendar year. Unable To Process Your Adjustment Request due to Provider ID Number On The Claim And On The Adjustment Request Do Not Match. Wellcare uses cookies. Valid group codes for use on Medicare remittance advice are:. This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim. Review Billing Instructions. OA 11 The diagnosis is inconsistent with the procedure. Personal care subsequent and/or follow up visits limited to seven per Date Of Service(DOS) per member. This claim is being denied because it is an exact duplicate of claim submitted. The Procedure Code is not reimbursable for the Rendering Provider Type and/or Specialty. OA 12 The diagnosis is inconsistent with the provider type. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent. Please watch future remittance advice. If it is medically necessary to exceed the limitation, submit an Adjustment/Reconsideration request with supporting documentation. This Is Not A Good Faith Claim. Limited to once per quadrant per day. Correct Claim Or Submi Paper Claim Noting That Verification Has Occurred. Claim Denied For Invalid Diagnosis Code Or Diagnosis Code/CPT Combination. Please Resubmit Your Non-healthcheck Services Using The Appropriate Claim SortIndicator Or Electronic Format. Reimbursement determination has been made under DRG 981, 982, or 983. Claim Is Being Special Handled, No Action On Your Part Required. The Member Is Also Involved In A Structured Living And/or Working Arrangement.A Reduction In Day Treatment Hours Is Indicated. You can choose to receive only your EOBs online, eliminating the paper . When coding HCPCS for outpatient services, the provider enters the HCPCS code describing the procedure. This Mutually Exclusive Procedure Code Remains Denied. Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item. This claim/service is pending for program review. Area of the Oral Cavity is required for Procedure Code. The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. Please Submit A Separate New Day Claim For Copayment Exempt Days/services. Maximum Number Of Outreach Refusals Has Been Reached For This Period. Denied due to Diagnosis Code Is Not Allowable. This Check Automatically Increases Your 1099 Earnings. Cutback/denied. This Payment Is To Satisfy Amount Owed For A Drug Rebate Prior Quarter Correction. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a Training Payment. Claim Detail Pended As Suspect Duplicate. Please adjust quantities on the previously submitted and paid claim. Claims For Sterilization Procedures Must Reflect ICD-9 Diagnosis Code V25.2. 3101. Voided Claim Has Been Credited To Your 1099 Liability. Billed Procedure Not Covered By WWWP. Revenue code billed with modifier GL must contain non-covered charges. Claims may deny when reported and not meeting the ICD-10-CM Laterality policy for Diagnosis-to-Diagnosis comparison. Pricing Adjustment/ Patient Liability deduction applied. Up to a $1.10 reduction has been applied to this claim payment. The procedure code has Family Planning restrictions. Payment Recovered For Claim Previously Processed Under Wrong Member ID Number. Fifth Diagnosis Code (dx) is not on file. Critical care performed in air ambulance requires medical necessity documentation with the claim. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. Because a claim can have edits and audits at both the header and detail levels, EOB codes are listed . If some of the services were previously paid, submit an adjustment/reconsideration request for the paid claim. It has now been removed from the provider manuals . A NAT Reimbursement Request Must Be Submitted To WI Within A Year Of The CNAs Hire Date. Denied due to Add Dates Not In Ascending Order Or DD/DD/DD Format. Billing Provider ID is missing or unidentifiable. Effective September 1, 2021: Benefit Changes to Total Disc Arthroplasty for Medicaid and CHIP. Please Resubmit using A Approved CPT Or HCPCS Procedure Code. Dispense Date Of Service(DOS) is invalid. Services Beyond The Six Week Postpartum Period Are Not Covered, Per DHS. For over 40 years, Washington Publishing Company (WPC) has specialized in managing and distributing data integration information through publications, training, and consulting services. This drug is a Brand Medically Necessary (BMN) drug. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Admission Date is on or after date of receipt of claim. All Home Health Services Exceeding 8 Hours Per Day Or 40 Or More Hours Per Week Require Prior Authorization. NDC is obsolete for Date Of Service(DOS). The Service Requested Is Covered By The HMO. Denied/Cutback. Procedure Code Modifier(s) Invalid For Date Of Service(DOS) Or For Prior Authorization Date Of Receipt. Provider signature and/or date is required. Claims adjustments. Transplants and transplant-related services are not covered under the Basic Plan. Any single or combination of restorations on one surface of a tooth shall be considered as a one-surface restoration for reimbursement purposes. Member enrolled in QMB-Only Benefit plan. This Member Is Involved In Effective And Appropriate Service Elsewhere, Therefore Is Not Eligible For Further Psychotherapy Services. This Members Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment. Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit. A covered DRG cannot be assigned to the claim. Unable To Process Your Adjustment Request due to. A more specific Diagnosis Code(s) is required. Reimbursement limits for Community Care Services for the calendar year are close to being exceeded. Please Obtain A Valid Number For Future Use. Based on reimbursement guidelines it is not appropriate for providers to bill inpatient Evaluation and Management (E/M) services while the patient is in an observation status. This Claim Is A Reissue of a Previous Claim. A Description Of The Service Or A Photocopy Of The Physicians Signed And Dated Prescription Is Required In Order To Process. Your 1099 Liability Has Been Credited. SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Correct And Resubmit. This claim has been adjusted due to a change in the members enrollment. The Rendering Providers taxonomy code is missing in the detail. The taxonomy code for the attending provider is missing or invalid. Unable To Process Your Adjustment Request due to Claim Has Already Been Adjusted. Please Refer To The Original R&S. Anesthesia and moderate sedation services billed with pain management services for a patient age 18 or older may deny unless a surgical procedure CPT code range 10021-69990 (other than pain management procedures) is also billed on the claim. Phone: 800-723-4337. The Medicare Paid Amount is missing or incorrect. Service Billed Exceeds Restoration Policy Limitation. Hospital And Nursing Home Stays Are Not Payable For The Same DOS Unless The Nursing Home Claim Indicated Hospital Bedhold Days. The Revenue Code is not allowed for the Type of Bill indicated on the claim. Assistant Surgery Must Be Billed Separately By The Assistant Surgeon With Modifier 80. Service Denied. Diagnosis Codes Assigned Must Be At The Greatest Specificity Available. This Service Is Not Payable Without A Modifier/referral Code. Multiple Referral Charges To Same Provider Not Payble. Please Select A Procedure Code In The 58980-58988 Range That Best Describes The Procedure Being Performed. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Denied. Medication checks by a Psychiatrist and/or Registered Nurse are limited to four services per calendar month. Member Is Enrolled In A Family Care CMO. Was Unable To Process This Request Due To Illegible Information. Additional information is needed for unclassified drug HCPCS procedure codes. A Fourth Occurrence Code Date is required. Please Clarify. The Sixth Diagnosis Code (dx) is invalid. CNAs Eligibility For Nat Reimbursement Has Expired. Claim Denied Due To Incorrect Accommodation. Provider is not eligible for reimbursement for this service. Modifiers are required for reimbursement of these services. Therapy visits in excess of one per day per discipline per member are not reimbursable. Adjustment Denied For Insufficient Information. Medical Necessity For Food Supplements Has Not Been Documented. Claim Is Pended For 60 Days. Billing or Rendering Provider certification is cancelled for the From Date Of Service(DOS). Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. A discrepancy exists between the Other Coverage Indicator and the Other Paid Amount. Resubmit Private Duty Nursing Services For Complex Children With Documentation Supporting The Level Of Care. Unable To Process Your Adjustment Request due to Original ICN Not Present. Submitted referring provider NPI in the header is invalid. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. An ICD-9-CM Diagnosis Code of greater specificity must be used for the First Diagnosis Code. Out of State Billing Provider not certified on the Dispense Date. Services have been determined by DHCAA to be non-emergency. CPT Code 88305 (Level IV Surgical pathology, gross and microscopic examination) includes different types of biopsies. The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved. Independent Laboratory Provider Number Required. Prescription Drug Plan (PDP) payment/denial information is required on the claim to SeniorCare. Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement. Quantity Would Always Be 00010 If Number Of Pounds Not Indicated. Submitted rendering provider NPI in the detail is invalid. Service Not Covered For Members Medical Status Code. Service Billed Limited To Three Per Pregnancy Per Guidelines. A quantity dispensed is required. Denied/recouped. Reimbursement For This Certification, Test, Segment Has Been Issued To AnotherNF. Customer Service Agents are available to answer questions at this toll-free number: Phone: 800-688-6696. Denied due to Procedure Is Not Allowable For Diagnosis Indicated. For example, F80.2 (Mixed receptive-expressive language disorder) cannot be billed on the same claim as F84.0 (Autism Disorder) since ICD-10's Coding Manual views them as mutually exclusive dx codes. Pricing Adjustment/ Repackaging dispensing fee applied. The Members Profile Indicates This Member Is Possibly Alcoholic And/or Chemically Dependent, And Intensive Aoda Treatment Appears Warranted. Benefit code These codes are submitted by the provider to identify state programs. Reason for Service submitted does not match prospective DUR denial on originalclaim. Plan options will be available in 25 states, including plans in Missouri . Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months. Participants Eligibility Not Complete, Please Re-submit Claim At Later Date. 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. If correct, special billing instructions apply. The Hearing Aid Recommended Is Not Necessary; The Member Could Be Adequately Fitted With A Conventional Aid. Billing Provider Name Does Not Match The Billing Provider Number. A Previously Submitted Adjustment Request Is Currently In Process. Denied. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. These Urinalysis Procedures Reimbursed Collectively At The Maximum For Routine Urinalysis With Microscopy. A: This denial is received when Medicare records indicate that Medicare is the beneficiary's secondary payer. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office. The Primary Diagnosis Code is inappropriate for the Procedure Code. Claim/adjustment Received Beyond The 455 Day Resubmission Deadline. WellCare 2016 NA_11_16 NA6PROGDE80121E_1116 . This Information Is Required For Payment Of Inhibition Of Labor. The Diagnosis Code is not payable for the member. Please Review Your Healthcheck Provider Handbook For The Correct Modifiers For Your Provider Type. Please Correct And Resubmit. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. In addition, when distinct service modifier 59 or modifier XE is not appended to auditory screening services and tympanometry/impedance testing, these services may be denied. Please Resubmit. Billing Provider Type and Specialty is not allowable for the service billed. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. Denied/Cutback. The service requested is not allowable for the Diagnosis indicated. No payment allowed for Incidental Surgical Procedure(s). This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization. There are approximately 20 Medicaid Explanation Codes which map to Denial Code 16. Denied due to Medicare Allowed Amount Is Greater Than Total Billed Amount. Denied due to Some Charges Billed Are Non-covered. No action required. Condition Code 73 for self care cannot exceed a quantity of 15. Please Correct Claim And Resubmit. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. Unable To Reach Provider To Correct Claim. Early Refill Alert. Please Do Not Resubmit Your Claim. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. Bilateral Procedures Must Be Billed On One Detail With Modifier 50, Quantity Of 1.detail With Modifier 50 May Be Adjusted If Necessary. NUMBER IS MISSING OR INCORRECT 0002 01/01/1900 COULD NOT PROCESS CLAIM. The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. A code with no Trip Modifier billed on same day as a code with Modifier U1 are considered the same trip. 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. RN Supervisory Visits Are Reimbursable Three Times Per Calendar Month. Pricing Adjustment. Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. Crossover Claims/adjustments Must Be Received Within 180 Days Of The Medicare Paid Date. Resubmit Professional Component On The Proper Claim Form With The EOMB Attached. This service is not payable for the same Date Of Service(DOS) as another service included on the same claim, according to the National Correct Coding Initiative. Medicare Claim Copy And EOMB Have Been Submitte d For Processing Of Coinsurance And Deductible. This Service Is Included In The Hospital Ancillary Reimbursement. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. Denied due to Claim Exceeds Detail Limit. Member is enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Non-scheduled drugs are limited to the original dispensing plus 11 refills or 12 months. Denied. The Service Requested Was Performed Less Than 5 Years Ago. -OR- The claim contains value code 48, 49, or 68 but does not contain revenue codes 0634 or 0635. According To Our Records, The Hospital Has Not Received Prior Authorization For This Surgery. This change to be effective 4/1/2008: Submission/billing error(s). Allowed Amount On Detail Paid By WWWP. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel. The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services. Do Not Indicate A Hcpcs Or Cpt Procedure Code On An Inpatient Claim. Per Information From Insurer, Claims(s) Was (were) Paid. Records Indicate This Tooth Has Previously Been Extracted. This procedure is not paid separately. Please Submit On The Cms 1500 Using The Correct Hcpcs Code. Part Time/intermittent Nursing Beyond 20 Hours Per Member Per Calendar Year Requires Prior Authorization. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. Medicare Copayment Out Of Balance. Header To Date Of Service(DOS) is after the ICN Date. Complex care of 17-plus hours and complex care of less than 17 hours are not allowed on the same Date Of Service(DOS). Detail Quantity Billed must be greater than zero. Physical Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. 690 Canon Eb R-FRAME-EB Claim Denied For Future Date Of Service(DOS). In 2015 CMS began to standardize the reason codes and statements for certain services. The Quantity Allowed Was Reduced To A Multiple Of The Products Package Size. Referring Provider ID is invalid. Claim Detail Denied Due To Required Information Missing On The Claim. Denied. Unable To Process Your Adjustment Request due to Provider ID Not Present. Denied. Denied. Denied. Denied. Rental Only Allowed; Medical Need For Purchase Has Not Been Documented. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. The amount in the Other Insurance field is invalid. Claims may deny when reported with incompatible ICD-10-CM Laterality policy for Diagnosis-to-Modifier comparison. Denied due to Member Not Eligibile For All/partial Dates. A National Provider Identifier (NPI) is required for the Rendering Provider listed in the header. Procedure Not Payable for the Wisconsin Well Woman Program. Resubmit Complete And/or Second Page Of Medicares EOMB Showing All Total And Payments. Denied due to Take Home Drugs Not Billable On UB92 Claim Form. Restorative Nursing Involvement Should Be Increased. Service Denied. Date Of Service/procedure/charges Billed On The Adjustment/reconsideration Request Do Not Match The Original Claim. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. Claim Denied. Service(s) paid at the maximum daily amount per provider per member. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. Please Use This Claim Number For Further Transactions. Please Add The Coinsurance Amount And Resubmit. A federal drug rebate agreement for this drug is not on file for the Date Of Service(DOS)(DOS). Dates Of Service Must Be Itemized. Submit Claim To Other Insurance Carrier. All three DUR fields must indicate a valid value for prospective DUR. Individual Audiology Procedures Included In Basic Comprehensive Audiometry. All rental payments have been deducted from the purchase costsince the DME item was rented and subsequently purchased for the member. Denied due to The Members First Name Is Missing Or Incorrect. As a provider, you have access to a portal that streamlines your work, keeps you up-to-date more than ever before and provides critical information. Documentation Does Not Justify Medically Needy Override. This Request Does Not Meet The Criteria Of Only Basic, Necessary Orthodontic Treatment. Adjustment/reconsideration Request Denied Due To Incorrect/insufficient Information. Review Patient Liability/paid Other Insurance, Medicare Paid. Pricing Adjustment/ SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts. Avoiding denial reason code CO 22 FAQ Q: We received a denial with claim adjustment reason code (CARC) CO 22. Payment Is Limited To One Unit Dose Service Per Calendar Month, Per Legend Drug, Per Member. ACCOM REV CODE QTY BILLED NOT EQUAL TO DTL DOS. Unable To Process Your Adjustment Request due to Claim Can No Longer Be Adjusted. Denied. For 2020, WellCare is adding 68 new Medicare Advantage plans for a total of 261 plans with $0 or low monthly plan premiums. Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines. Pricing Adjustment/ Payment reduced due to the inpatient or outpatient deductible. Denied. Newborn Care Must Be Billed Under Newborn Name And Number; Occurrence Codes 50& 51 Cannotbe Present if Billing Under Newborn Name.