wellcare eob explanation codes

External Cause Diagnosis May Not Be The Single Or Primary Diagnosis. Prior Authorization (PA) is required for this service. Unable To Process Your Adjustment Request due to Original Claim ICN Not Found. Wellcare Cvs Caremark Login - bwdkg.bluejeanblues.net EPSDT/healthcheck Indicator Submitted Is Incorrect. Medicare paid amount(s) have been incorrectly applied to both the claim headerand details. This National Drug Code (NDC) has diagnosis restrictions. Reason Code 162: Referral absent or exceeded. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent. The Non-contracted Frame Is Not Medically Justified. You Must Either Be The Designated Provider Or Have A Refer. EOB EOB DESCRIPTION. Denied. Admission Denied In Accordance With Pre-admission Review Criteria. The Modifier For The Proc Code Is Invalid. Newborn Care Must Be Billed Under Newborn Name And Number; Occurrence Codes 50& 51 Cannotbe Present if Billing Under Newborn Name. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. Denied/Cutback. Reimbursement For Panel Test Only- Individual Tests In Addition To Panel Test Disallowed. The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). ACCOM REV CODE QTY BILLED NOT EQUAL TO DTL DOS. This Claim Has Been Manually Priced Based On Family Deductible. The detail From or To Date Of Service(DOS) is missing or incorrect. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. Reimburse Is Limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services. Indicated Diagnosis Is Not Applicable To Members Sex. Member Is Enrolled In A Family Care CMO. Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. This HMO Capitation Payment Is Being Recouped It Was Inappropriately Paid During The Inital February HMO Capitation Cycle. Rqst For An Acute Episode Is Denied. Pricing Adjustment/ Level of effort dispensing fee applied. This notice gives you a summary of your prescription drug claims and costs. Paid In Accordance With Dental Policy Guide Determined By DHS. FFS CLAIM PROFESSIONAL ASC X12N VERSION . Questionable Long-term Prognosis Due To Apparent Root Infection. Value codes 48 Homoglobin Reading and 49 Hematocrit Reading, must have a zero in the far right position. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Pricing Adjustment/ Maximum Allowable Fee pricing used. Rendering Provider Type and/or Specialty is not allowable for the service billed. Reimbursement Rate Applied To Allowed Amount. Member is assigned to a Lock-in primary provider. The Procedure(s) Requested Are Not Medical In Nature. Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed. Only one initial visit of each discipline (Nursing) is allowedper day per member. Unable To Process Your Adjustment Request due to Claim ICN Not Found. Denied/Cuback. Prosthodontic Services Appear To Have Started After Member EligibilityLapsed. According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Members Consent Form. Req For Acute Episode Is Denied. Quantity Billed is invalid for the Revenue Code. Claim Is Being Reprocessed, No Action On Your Part Required. Documentation Does Not Justify Reconsideration For Payment. Approved. Recoding/adjusting claim may result in a different DRG code assignmentand reimbursement. Member enrolled in QMB-Only Benefit plan. Cannot Be Reprocessed Unless There Is Change In Eligibility Status. This claim is being denied because it is an exact duplicate of claim submitted. Service Denied. Medically Unbelievable Error. Inpatient mental health services performed by masters level psychotherapists or substance abuse counselors are not covered. The following are the most common reasons HCFA/CMS-1500 and UB/CMS-1450 paper claims for Veteran care are rejected: Requires the 17 alpha-numeric internal control number (ICN) [format: 10 digits + "V" + 6 digits] or 9-digit social security number (SSN) with no special characters. One or more Surgical Code Date(s) is missing in positions seven through 24. Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program. Service Denied. Non-preferred Drug Is Being Dispensed. Use The ICN which Is In An Allowed Or Paid Status When Filing An Adjustment/ReconsiderationRequest. Fifth Diagnosis Code (dx) is not on file. Requires A Unique Modifier. Resubmit Claim Once Election Form Requirements Are Met Per The Hospice Provider Handbook. OA 12 The diagnosis is inconsistent with the provider type. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. Denied. The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential. This service was previously paid under an equivalent Procedure Code. Denied due to Medicare Allowed Amount Is Greater Than Total Billed Amount. This Claim Has Been Denied Due To A POS Reversal Transaction. Claims may deny the chest X-ray billed when the only diagnoses is one of the following routine screening diagnoses: General medical exam (ICD-10 codes Z00.0-Z00.01, Z00.5, Z00.6, Z00.8), Pre-admission/administrative exam (ICD-10 codes Z02.0-Z02.6, Z02.8-Z02.89, Z04.6), Pre-operative exam (ICD-10 codes Z01.810-Z01.811, Z01.818), FL 42 Revenue Code Required. Denied. Correct And Resubmit. NFs Eligibility For Reimbursement Has Expired. Please adjust quantities on the previously submitted and paid claim. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement. Refer To Dental HandbookOn Billing Emergency Procedures. Medicare Disclaimer Code Used Inappropriately. The Service Performed Was Not The Same As That Authorized By . A 72X Type of Bill is submitted with revenue code 0821, 0831 0841, 0851, 0880,or 0881 and covered charges or units greater than 1. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. The Hearing Aid Recommended Is Not Necessary; The Member Could Be Adequately Fitted With A Conventional Aid. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Hypoglycemics-Insulin to Humalog and Lantus. To access the training video's in the portal . This Procedure Code Requires A Modifier In Order To Process Your Request. Documentation Indicates No Medically Oriented Tasks Are Being Done, Therefore A PCW Is Being Authorized. Services billed exceed prior authorized amount. Denied. CRNAs, AAs, And Anesthesiologists Supervising CRNAs/AAs Must Bill AnesthesiA Services Using The Appropriate Modifier. RN And LPN Subsequent Care Visits Limited To 6 Hrs Per Day/per Member/per Provider. Per Information From Insurer, Claims(s) Was (were) Paid. Invalid/obsolete Procedure Code For Determination Of Refraction, Service Denied. Independent RHCs Must Bill Codes W6251, W6252, W6253, W6254 Or W6255. Service Denied/cutback. Documentation Indicates That Client Is Able To Direct Cares And Can Safely Direct A PCW. The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. The Number In The National Provider Identifier (NPI) Section On This Request IsNot A Number Assigned To A Certified Nursing Facility For This Date Of Service(DOS). The Information Provided Is Not Consistent With The Intensity Of Services Requested. PDF Crosswalk - Adjustment Reason Codes and Remittance Advice (RA) Remark NDC- National Drug Code is invalid for the Dispense Date Of Service(DOS). An ICD-9-CM Diagnosis Code of greater specificity must be used for the Third Diagnosis Code. Other payer patient responsibility grouping submitted incorrectly. Procedure not allowed for the CLIA Certification Type. The Requested Transplant Is Not Covered By . Denied. HMO Capitation Claim Greater Than 120 Days. MCR - 835 Denial Code List | Medicare Payment, Reimbursement, CPT code The Requested Procedure Is Cosmetic In Nature, Therefore Not Covered By . Pricing Adjustment/ Maximum Flat Fee pricing applied. Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. Superior HealthPlan News. Gastrointestinal Surgery For The Purpose Of Weight Control Is Covered Only As An Emergency Procedure. Prior Authorization (PA) is required for payment of this service. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. The Screen Date Must Be In MM/DD/CCYY Format. For 2020, WellCare is adding 68 new Medicare Advantage plans for a total of 261 plans with $0 or low monthly plan premiums. Unable To Process Your Adjustment Request due to Member ID Number On The Claim And On The Adjustment Request Do Not Match. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. 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. Services Can Only Be Authorized Through One Year From The Prescription Date. wellcare eob explanation codes Only One Interperiodic Screen Is Allowed Per Day, Per Member, Per Provider. Hearing aid repairs are limited to once per six months, per provider, per hearing aid. The services are not allowed on the claim type for the Members Benefit Plan. Find top links about Wellcare Cvs Caremark Login along with social links, FAQs, and more. Training Completion Date Must Be Within A Year Of The CNAs Certification, Test, Date. A new set of Generic Reason codes and statements for Part A, Part B and DME have been added and approved for use across all Prior Authorization (PA), Claim reviews . Condition Code is missing/invalid or incorrect for the Revenue Code submitted. An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code. Billing Provider Name Does Not Match The Billing Provider Number. This change to be effective 4/1/2008: Submission/billing error(s). Procedure Code or Drug Code not a benefit on Date Of Service(DOS). Billing/performing Provider Indicated On Claim Is Not Allowable. A valid Prior Authorization is required for Brand Medically Necessary Drugs. This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours. Private Duty Nursing Beyond 30 Hrs /Member Calendar Year Requires Prior Authorization. Personal Care In Excess Of 250 Hrs Per Calendar Year Requires Prior Authorization. This Mutually Exclusive Procedure Code Remains Denied. The Primary Diagnosis Code is inappropriate for the Revenue Code. Claims and Billing | NC Medicaid - NCDHHS All Home Health Services Exceeding 8 Hours Per Day Or 40 Or More Hours Per Week Require Prior Authorization. Occurance code or occurance date is invalid. Level, Intensity Or Extent Of Service(s) Requested Has Been Modified Consistent With Medical Need As Defined In The Plan Of Care. Secondary Diagnosis Code(s) in positions 2-9 cannot duplicate the Primary Discharge Diagnosis. Our Records Indicate This Tooth Previously Extracted. Out-of-State non-emergency services require Prior Authorization. Denied. The Member Is Involved In group Physical Therapy Treatment. With Payspan's eEOB member-friendly functionality, members can log into the payer's secure portal and . The following table outlines the new coding guidelines. Please Bill Appropriate PDP. Psychotherapy Provided In The Members Home Is Not A Covered Benefit Of . Prospective DUR denial on original claim can not be overridden. Claim Explanation Codes. CO/204/N30. ambulatory surgical center, outpatient hospital) exists for the same member, same date of service and the same procedure or service. Contactmembers hospice for payment of services or resubmit with documentation of unrelated Nature of Care. Explanation of Benefit codes (EOBs) - Claims Processing System | Health Please Bill Medicare First. Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). Please submit claim to BadgerRX Gold. This Surgical Code Has Encounter Indicator restrictions. Contact The Nursing Home. EOB Codes List|Explanation of Benefit Reason Codes (2023) February 7, 2022 by medicalbillingrcm. Resubmit Your Services Using The Appropriate Modifier After YouReceive A Update Providing Additional Billing Information. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. Risk Assessment/Care Plan is limited to one per member per pregnancy. Established in 1975 and incorporated in 1987, WPC is widely recognized as a leading expert in supporting the development, publishing, and licensing of complex . Pricing Adjustment/ Medicare crossover claim cutback applied. A Valid Level Of Effort Is Required For Billing Compound Drugs Or Pharmaceutical Care. It Corrects A Mispayment FoundDuring Claims Processing Or Resulting From Retroactive File Changes. is unable to is process this claim at this time. Detail Denied. Medicare Disclaimer Code invalid. Denied. If A CNA Obtains his/her Certification After Theyve Been Hired By A NF, A NF Has A Year From Their Certification, Test, Date To Submit A Reimbursement Request To . Contact Provider Services For Further Information. Members Age 3 And Older Must Have An Oral Assessment And Blood Pressure Check.With Appropriate Referral Codes, For Payment Of A Screening. Invalid Service Facility Address. Pricing Adjustment. This drug is not covered for Core Plan members. This Is A Manual Increase To Your Accounts Receivable Balance. Questionable Long-term Prognosis Due To Decay History. Services on this claim have been split to facilitate processing.on On Your Part Is Required. Use This Claim Number If You Resubmit. Please Use This Claim Number For Further Transactions. Explanation of Benefits (EOB) | Medicare - Welcome to Medicare | Medicare Documentation You Have Submitted Does Not Meet The Requirements Of HSS 107.09(4)(k). Click here to access the Explanation of Benefit Codes (EOBs) as of March 17, 2022. This CNAs Social Security Number, SSN, Is Not On The EDS Nurse Aide Registry File. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. NDC was reimbursed at State Maximum Allowable Cost (SMAC) rate. Denied due to Provider Number Missing Or Invalid. Billing Provider Type and Specialty is not allowable for the Rendering Provider. It has now been removed from the provider manuals . Dental service is limited to once every six months. The National Drug Code (NDC) is not a benefit for the Date Of Service(DOS). Claim Denied Due To Invalid Pre-admission Review Number. The Members Reported Diagnosis Is Not Considered Appropriate For AODA Day Treatment. Please Correct and Resubmit. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider. Medicare Providers | Wellcare Please Correct And Submit. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. Non-scheduled drugs are limited to the original dispensing plus 11 refills or 12 months. Claim Detail Denied For Invalid CPT, Invalid CPT/modifier Combination, Or Invalid Type Of Quantity Billed. This drug is a Brand Medically Necessary (BMN) drug. According to the American College of Radiology and the International Society for Clinical Densitometry, dual-energy X-ray absorptiometry (DXA) bone density screening (77080 or 77081) is not indicated for women under age 65 or men under age 70 without risk factors for osteoporosis. Detail Rendering Provider certification is cancelled for the Date Of Service(DOS). All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy. Header Rendering Provider number is not found. Claim Corrected. Recd Beyond 90 Days Special Filing Deadline FOr System Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing. Anesthesia Modifying Services Must Be Billed Separately From The Charge For Anesthesia Base And Time Units. More Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information. Claim Denied. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment. Active Treatment Dose Is Only Approved Once In Six Month Period. Inicio Quines somos? Out Of State Billing Provider Not Enrolled For Entire Detail DOS Span. Contact Wisconsin s Billing And Policy Correspondence Unit. The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. A valid Prior Authorization is required for non-preferred drugs. wellcare eob explanation codes. Participant Is Enrolled In Medicare Part D. Beginning 09/01/06, Providers AreRequired To Bill Part D And Other Payers Prior To Seniorcare Or Seniorcare WillDeny The Claim. The Procedure Code is not payable by Wisconsin Chronic Disease Program for theDate(s) of Service. For Newly Certified CNAs, Date Of Inclusion Is T heir Test Date. Denied. Claim Denied. This Is Not A Good Faith Claim. Dispensing fee denied. One or more Diagnosis Code(s) is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Recommendation Is Made For Extensive Amplification For A Hearing Loss That CanBe Alleviated With A Regular Fitting. Reimbursement For This Detail Does Not Include Unit DoseDispensing Fee. Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days. . Referring Provider ID is not required for this service. Prescriptions Or Services Must Be Billed As ASeparate Claim. Claim Denied. Please Itemize Services Including Date And Charges For Each Procedure Performed. The Surgical Procedure Code of greatest specificity must be used. Tooth number or letter is not valid with the procedure code for the Date Of Service(DOS). If authorization number available . Denied. Claims With Dollar Amounts Greater Than 9 Digits. the patient (or parent or guardian) at the address noted on the claim, be sure your doctor has updated your records with your current address. Explanation of benefits. A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date. The Service Requested Does Not Correspond With Age Criteria. PA required for payment of this service. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment. Please Correct And Resubmit. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. Revenue Code Required. Procedure Denied Per DHS Medical Consultant Review. This Member is enrolled in Wisconsin or BadgerCare Plus for Date(s) of Service. Indicator for Present on Admission (POA) is not a valid value. No Matching, Complete Reporting Form Is On File For This Client. Hospice Member Services Related To The Terminal Illness Must Be Billed By Hospice Or Attending Physician. Newsroom. Valid Numbers AreImportant For DUR Purposes. The Members Demonstrated Response To Current Therapy Does Not Warrant The Intense Freqency Requested. Emergency Services Indicator must be "Y" or Pregnancy Indicator must be "Y" for this aid code. Partial Payment Withheld Due To Previous Overpayment. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Department Of Justice Settlement. Claim Denied For No Client Enrollment Form On File. Service is covered only during the first month of enrollment in the Home and Community Based Waiver. Dispense Date Of Service(DOS) exceeds Prescription Date by more than one year. A Date Of Service(DOS) is required with the revenue code and HCPCS code billed. No Action Required. Detail To Date Of Service(DOS) is invalid. Pricing Adjustment/ The submitted charge exceeds the allowed charge. THE WELLCARE GROUP OF COMPANIES . An antipsychotic drug has recently been dispensed for this member. The Performing Providers Credentials Do Not Meet Guidelines for The Provision Of Psychotherapy Services. Separate reimbursement for drugs included in the composite rate is not allowed. Denied/Cutback. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. Pricing Adjustment/ SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts. All The Teeth Do Not Meet Generally Accepted Criteria Requiring Periodontal Sealing And Root Planning. Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection. Follow specific Core Plan policy for PA submission. Do not insert a period in the ICD-9-CM or ICD-10-CM codes. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. An Individual CBC Or Chemistry Test With A CBC Or Chemistry Panel, Performed Per Member/Provider/Date Of Service Must Be Billed w/ Appropriate Panel Code. Level And/or Intensity Of Requested Service(s) Is Incompatible With Medical Need As Defined In Care Plan. Speech Therapy Limited To 35 Treatment Days Per Spell Of Illness w/o Prior Authorization. Revenue code requires submission of associated HCPCS code. Pricing Adjustment/ Prescription reduction applied. DX Of Aphakia Is Required For Payment Of This Service. Invalid Admission Date. Referral Codes Must Be Indicated For W7001, W7002, W7003, W7006, W7008 And W7013. Please Correct And Resubmit. Is Unable To Process This Request Because The Signature/date Field Is Blank. Rebill Using Correct Procedure Code. Service Denied. The Value Code(s) submitted require a revenue and HCPCS Code. Basic Knowledge of Explanation of Benefits (EOB) interpretation. 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. Billing Provider indicated is not certified as a billing provider. Pricing Adjustment/ Usual & Customary Charge (UCC) flat fee pricing applied. The Existing Appliance Has Not Been Worn For Three Years. Please Furnish An ICD-9 Surgical Code And Corresponding Description. Principal Diagnosis 6 Not Applicable To Members Sex. Up HMO Payment Equals Or Exceeds Hospital Rate Per Discharge. Competency Test Date Is Not A Valid Date. Denied. Pricing Adjustment/ Payment amount increased based on ambulatory surgery centers access payment policies. Rural Health Clinics May Only Bill Revenue Codes On Medicare Crossover Claims. Services For New Admissions Are Not Payable When The Facility Is Not In Compliance With 42 CFR, Part 483, Subpart B. Denied. Discharge Date is before the Admission Date. Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed). List of Explanation of Benefit Codes Appearing on the Remittance Advice These codes provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or convey information about remittance processing. Submitted rendering provider NPI in the header is invalid. Member is not Medicare enrolled and/or provider is not Medicare certified. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. Discharge Diagnosis 4 Is Not Applicable To Members Sex. 0; Limited to once per quadrant per day. Denied due to Some Charges Billed Are Non-covered. Third modifier code is invalid for Date Of Service(DOS). NDC was reimbursed at Employer Medical Assistance Contribution (EMAC) rate. Payment Recovered For Claim Previously Processed Under Wrong Member ID Number. The Rendering Providers taxonomy code in the header is invalid. Bilateral Surgeries Reimbursed At 150% Of The Unilateral Rate. All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. Result of Service code is invalid. The second occurrence span from Date Of Service(DOS) is after to to Date Of Service(DOS). One or more Occurrence Span Code(s) is invalid in positions three through 24. An Alert willbe posted to the portal on how to resubmit. Reduction To Maintenance Hours. PDF WellCare Procedure Codes - HealthHelp Adjustments To Correct Copayment Deductions On date Ranged Claims Are Not Payable. Correction Made Per Medical Consultant Review. Voided Claim Has Been Credited To Your 1099 Liability. Head imaging in the form of CT scans, MRI or MRA is allowed only when the service is medically reasonable and necessary. Claim/adjustment Received Beyond The 455 Day Resubmission Deadline. that provide either supplemental explanation for a monetary adjustment or policy information are required in the remittance advice transaction. Please Select A Procedure Code In The 58980-58988 Range That Best Describes The Procedure Being Performed. Normal delivery payment includes the induction of labor. Drug Dispensed Under Another Prescription Number. Denied. The procedure code has Family Planning restrictions. Header From Date Of Service(DOS) is invalid. Pregnancy Indicator must be "Y" for this aid code. This Request Can Only Be Backdated To The Date EDS First Receives The Request In The Mailroom. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Please Submit A Separate New Day Claim For Copayment Exempt Days/services. Explanation of Benefits Messages - Wisconsin The Services Requested Are Not Reasonable Or Appropriate For The AODA-affectedmember. A valid header Medicare Paid Date is required. Prescription Drug Plan (PDP) payment/denial information required on the claim to WCDP. Medicare Coinsurance Amount Was Not Provided On Crossover Claim. Claim Or Adjustment/reconsideration Request Should Include An Operative Or Pathology Report For This Procedure. If you have questions regarding your remittance advice, please contact our Provider Call Center at 1-888-FIDELIS (1-888-343-3547) or your . Reason Code 160: Attachment referenced on the claim was not received. (Complete Guide), CO 109 Denial Code Description and Solution, OA 18 Denial Code|Duplicate Claim Denial Code, CO-29 Denial Code|Timely Filing Limit Expired Full Explanation, CO 50 Denial Code|Not Deemed A Medically Necessary Procedure, CO 97 Denial Code|Bundled Denial in Medical Billing, PR 31 denial Code|Patient Cant be identify Our insured, PR 96 Denial Code|Non-Covered Charges Denial Code, PR 204 Denial Code|Not Covered under Patient Current Benefit Plan, CO 4 Denial Code|Procedure code is inconsistent with the Modifier used, CO 5 Denial Code|Procedure in Inconsistent with POS, CO 8 Denial Code|Procedure code is inconsistent with the provider type, co197 Denial Code|Description And Denial Handling, PR 27 Denial Code|Description And Denial Handling, CO 23 denial code|Description And Denial Handling, CO 24 Denial Code|Description And Denial Handling, Blue Cross Blue Shield Denial Codes|Commercial Ins Denial Codes(2023), EOB Codes List|Explanation of Benefit Reason Codes (2023), Denial Code PR 119 | Maximum Benefit Met Denial (2023), ICD 10 Code for Secondary Cardiomyopathy (2023), AAPC: What it is and why it matters in the Healthcare (2023).