Good Faith Claim Has Previously Been Denied By Certifying Agency. 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 drug code has Family Planning restrictions. If it is medically necessary to exceed the limitation, submit an Adjustment/Reconsideration request with supporting documentation. Insurance Verification 2. 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. The header total billed amount is invalid. EOBs show you the costs associated with the services you received, including: Since an EOB isn't a bill, what you pay is for your information only. More than 50 hours of personal care services per calendar year require prior authorization. This Adjustment/reconsideration Request Was Initiated By . Services have been determined by DHCAA to be non-emergency. Diagnosis Treatment Indicator is invalid. Admit Date and From Date Of Service(DOS) must match. Billed Procedure Not Covered By WWWP. Pricing Adjustment/ Maximum allowable fee pricing applied. Denied. Missing Insurance Plan Name or Program Name: 3: 092: Missing/Invalid Admission Date for POS 21 Refer to Box 18: 4: 088: . Intensive Multiple Modality Treatment Is Not Consistent With The Information Provided. The Member Is Only Eligible For Maintenance Hours. No Matching, Complete Reporting Form Is On File For This Client. The Medicare copayment amount is invalid. Tooth surface is invalid or not indicated. The condition code is not allowed for the revenue code. Missing or invalid level of effort submitted and/or reason for service, professional service, or result of service code billed in error. The Member Does Not Appear To Meet The Severity Of Illness Indicators Established by the Wisconsin And Is Therefore Not Eligible For AODA Day Treatment. Claim Explanation Codes Request a Claim Adjustment View Fee Schedules Electronic Payments and Remittances Claims Submission Process Procedure Code Modifiers Submitting Medical Records Submitting Medicare Part D Claims ICD-10 Compliance Information Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). This Procedure Is Limited To Once Per Day. Consultation or surgical procedures are not reimbursable in conjuctions with Emergency Room services. To allow for Medicare Pricing correct detail denials and resubmit. Supplemental Payment Authorized By Department of Health Services (DHS) Due to aAudit. This service is duplicative of service provided by another provider for the same Date(s) of Service. Only One Ventilator Allowed As Per Stated Condition Of The Member. The disposable medical supply Procedure Code has a quantity limit as indicated in the DMS Index. This Revenue Code has Encounter Indicator restrictions. Occupational therapy limited to 35 treatment days per lifetime without prior authorization. Pharmaceutical Care Codes Are Billable On Non-compound Drug Claims Only. This procedure is duplicative of a service already billed for same Date Of Service(DOS). This is a duplicate claim. NDC is obsolete for Date Of Service(DOS). Amount allowed - See No. 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. No Rendering Provider Status Found for the From and To Date Of Service(DOS). Denied due to Member Is Eligible For Medicare. According to Mindy Stadel, a relationship manager with Pivot Health Group, it's critical for health care consumers to familiarize themselves with key terms that are used on EOBs and other important insurance documents. Service(s) Billed Are Included In The Total Obstetrical Care Fee. Denied. Multiple Prescriptions For Same Drug/ Same Fill Date, Not Allowed. Initial Visit/Exam limited to once per lifetime per provider. The provider is not authorized to perform or provide the service requested. Denied. An EOB is NOT A BILL. Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. Please Review The Covered Services Appendices Of The Dental Handbook. This Claim Is Being Reprocessed As An Adjustment On This R&s Report. Denied due to Claim Exceeds Detail Limit. Additional information is needed for unclassified drug HCPCS procedure codes. Request Denied. What's in an EOB. 24260 Progressive insurance code: 24260. NFs Eligibility For Reimbursement Has Expired. Please Bill Medicare First. Other Insurance Disclaimer Code Invalid. Second Other Surgical Code Date is invalid. One or more Surgical Code(s) is invalid in positions six through 23. Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. The Member Has Received A 93 Day Supply Within The Past Twelve Months. You may begin to see additional Explanation of Benefits (EOB) codes on zero paid lines. Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error. Please Resubmit Your Non-healthcheck Services Using The Appropriate Claim SortIndicator Or Electronic Format. Diagnosis 635-635.92 May Only Be Used When Billing For Abortion Procedures. Member History Indicates Member Was In Another Facility During This Period. The Service Requested Was Performed Less Than 3 Years Ago. Services Included In The Inpatient Hospital Rate Are Not Separately Reimbursable. Claim Or Adjustment/reconsideration Request Should Include An Operative Or Pathology Report For This Procedure. MassHealth List of EOB Codes Appearing on the Remittance Advice Updated 3/19/2015 EOB CODE EOB DESCRIPTION 0201. Prior Authorization Required For Day Treatment Services If Members FunctionalAssessment Negative. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Billing Provider is restricted from submitting electronic claims. The Value Code and/or value code amount is missing, invalid or incorrect. The procedure code has Family Planning restrictions. EOBs are created when an insurance provider processes a claim for services received. Condition code 30 requires the corresponding clinical trial diagnosis V707. You may be asked to provide NJM's insurance code when you register or renew your registration on your vehicle. NDC was reimbursed at Employer Medical Assistance Contribution (EMAC) rate. Dealing with Health Insurance that is Primary to CHAMPVA. Please Indicate Anesthesia Time For Services Rendered. need eob for each carrier indicated on resource file 1 251 n4 286 034 22 mod.not justified 22 mod.services not justified/paid at unmodified rate 3 150 047 035 rebill correct hcpc asc,op fac/phys.billed diff code;rebill correct hcpc 2 16 . Services Denied In Accordance With Hearing Aid Policies. Requests For Training Reimbursement Denied Due To Late Billing. Co. 609 . Member is enrolled in QMB-Only benefits. Please Clarify. Dates Of Service Must Be Itemized. This service is not covered under the ESRD benefit. The Second Modifier For The Procedure Code Requested Is Invalid. Please Indicate Computation For Unloaded Mileage. 11. Errors in one of the following data elements exceed their field size: Statement covered FROM Date, Admission date, Date Of Service(DOS), Revenue code. Follow specific Core Plan policy for PA submission. Pricing Adjustment. NFs Eligibility For Reimbursement Has Expired. Reimbursement For This Certification, Test, Segment Has Been Issued To AnotherNF. This service was previously paid under an equivalent Procedure Code. Contacting WorkCompEDI.com. The Member Has At Least 4 Posterior Teeth, Including Bicuspids On Each Side, which Can Be Used For Chewing. The EOB is an overview of medical services you received. Unable To Process Your Adjustment Request due to. Certifying Agency Did Not Verify Member Eligibility within 70 Day Period. A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. Routine foot care Diagnoses must be billed with valid routine foot care Procedure Codes. ACode With No Modifier Billed On The Same Day As A Code With Modifier 11 Are Viewed as the same trip. Pediatric Community Care is limited to 12 hours per DOS. Services Not Allowed For Your Provider T. The Procedure Code has Place of Service restrictions. Claim Is Pended For 60 Days. Denied due to Statement Covered Period Is Missing Or Invalid. CO 9 and CO 10 Denial Code. Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines. Denied. Learn more. Members File Shows Other Insurance. Resubmit Claim With Copyof A Temporary ID Card, EVS Printed Response Or Indicate The AVR Transaction Log Number. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. Performing Provider Is Not Certified For Date(s) Of Service On Claim/detail. One or more Diagnosis Code(s) is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). Explanation of Benefit codes (EOBs) Explanation of Benefit (EOB) codes are reported on your remittance statement. Replacement and repair of this item is not covered by L&I. NULL CO 96, A1 N171 Denied. Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. Online EOB Statements Billing Provider is required to be Medicare certified to dispense for dual eligibles. If the KT/V reading was not performed, then the value code D5 with 9.99 must be present without the occurrence code 51. Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. Please Supply Modifier Code(s) Corresponding To The Procedure Code Description. You can easily access coupons about "Progressive Insurance Eob Explanation Codes" by clicking on the most relevant deal below. Accommodation Days Missing/invalid. Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. This service is not payable for the same Date Of Service(DOS) as another service included on this claim. Review Patient Liability/paid Other Insurance, Medicare Paid. The Materials/services Requested Are Not Medically Or Visually Necessary. These Supplies/items Are Included In The Purchase Of The Dme Item Billed On The Same Date Of Service(DOS). The Revenue Code is not payable by Wisconsin Well Woman Program for the Date Of Service(DOS). This Member Has Completed Intensive AODA Treatment Within The Past 12 Months and Documentation Provided Is Not Adequate To Justify Intensive Treatment at this time. Claims For Sterilization Procedures Must Reflect ICD-9 Diagnosis Code V25.2. Referral Codes Must Be Indicated For W7001, W7002, W7003, W7006, W7008 And W7013. Discharge Diagnosis 5 Is Not Applicable To Members Sex. Quantity Would Be 00010 If Specific Number Of Batteries Dispensed Is Not Indicated. This drug is a Brand Medically Necessary (BMN) drug. Good Faith Claim Denied For Timely Filing. Member Expired Prior To Date Of Service(DOS) On Claim. CRNAs, AAs, And Anesthesiologists Supervising CRNAs/AAs Must Bill AnesthesiA Services Using The Appropriate Modifier. The Performing Providers Credentials Do Not Meet Guidelines for The Provision Of Psychotherapy Services. Denied. Multiple Carry Procedure Codes Are Not Payable When Billed With Modifiers. Only two dispensing fees per month, per member are allowed. The Service Requested Is Covered By The HMO. PIP coverage protects you regardless of who is at fault. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). Diagnosis Code is restricted by member age. The National Drug Code (NDC) is not on file for the Dispense Date Of Service(DOS). It shows: Health care services you received; How much your health insurance plan covered; How much you may owe your provider; Steps you can take to file an appeal if you disagree with our coverage decision 129 Single HIPPS . A Payment Has Already Been Issued To A Different Nf. Claim Is Being Special Handled, No Action On Your Part Required. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. Provider is not eligible for reimbursement for this service. Menu. An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code. Member is assigned to an Inpatient Hospital provider. Individual Test Paid. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization. Per Information From Insurer, Requested Information Was Not Supplied By The Provider. No Action On Your Part Required. CNAs Eligibility For Training Reimbursement Has Expired. Medically Unbelievable Error. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. Member has Medicare Supplemental coverage for the Date(s) of Service. Denied/Cutback. Contact your health insurance company if you have any questions about your EOB. Prescriber must contact the Drug Authorization and Policy Override Center for policy override. We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member. 4. Reconsideration With Documentation Warranting More X-rays. 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. General Exercise To Promote Overall Fitness And Flexibility Are Non-covered Services. Records Indicate This Tooth Has Previously Been Extracted. Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay. Service Allowed Once Per Lifetime, Per Tooth. The dental procedure code and tooth number combination is allowed only once per lifetime. The NAIC code is found on your . Please Clarify. Claim Denied. Exceeds The 35 Treatment Days Per Spell Of Illness. All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied. This Member Is Involved In Non-covered Services, And Hours Are Reduced Accordingly. Please Correct And Resubmit. The EOB breaks down: Medicare Allowed Amount Was Incorrect Or Not Provided On Crossover Claim. Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program. Reimbursement Based On Members County Of Residence. How do I get a NAIC number? 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. Please Clarify Services Rendered/provide A Complete Description Of Service. Diagnosis Codes Assigned Must Be At The Greatest Specificity Available. One or more Surgical Code Date(s) is invalid in positions seven through 24. Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed. Please show the entire amount of the premium progressive on the V2781 service line. Services are not payable. Service(s) Denied. Outpatient Services To Be Billed As Inpatient Ancillaries When Same Day Stay Occurs Please File An Adjustment/reconsideration Request To Correct Inpatiet Billing. Covered By An HMO As A Private Insurance Plan. Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). A Training Payment Has Already Been Issued To A Different NF For This CNA. Prior Authorization (PA) is required for payment of this service. The NAIC number is issued by the National Association of . Non-covered Charges Are Missing Or Incorrect. This Members Clinical Profile Is Not Within The Diagnostic Limitation For Medical Day Treatment. Condition codes 71, 72, 73, 74, 75, and 76 cannot be present on the same ESRD claim at the same time. The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date(s) of Service. Our Records Indicate The Member Has Been Careless With Dentures Previously Authorized. Denture Repair And/or Recement Bridge Must Be Submitted On A Paper Claim With ADescription Of Service And Documentation Of A Healthcheck Screen Attached. Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. The Value Code(s) submitted require a revenue and HCPCS Code. Claim paid at the program allowed amount. Pricing Adjustment/ Resource Based Relative Value Scale (RBRVS) pricing applied. Members I.d. The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental. The Service(s) Requested Could Adequately Be Performed In The Dental Office. Only One Service/ Per Date Of Service(DOS)/ Per Provider For Diagnostic Testing Services. Please Furnish A NDC Code And Corresponding Description. Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization. This Procedure Is Denied Per Medical Consultant Review. Training CompletionDate Exceeds The Current Eligibility Timeline. when they performed them. Service (Procedure Code/Modifier Combination) is not reimbursable for Date Of Service(DOS). Submitted referring provider NPI in the header is invalid. Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claims Provider Number. Pricing Adjustment/ Patient Liability deduction applied. Has Already Issued A Payment To Your NF For This Level L Screen. Services Denied. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. The submitted claim contains value code 68 and 48 or 49 but does not contain revenue code 0634 or 0635 and HCPCS Q4055. Denied. Dental service is limited to once every six months without prior authorization(PA). Third Other Surgical Code Date is invalid. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Reimbursement limit for all adjunctive emergency services is exceeded. The Rendering Providers taxonomy code is missing in the detail. No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service(DOS). Timeframe Between The CNAs Training Date And Test Date Exceeds 365 Days. Denied due to Per Division Review Of NDC. Please Verify That Physician Has No DEA Number. Please Add The Coinsurance Amount And Resubmit. We encourage you to enroll for direct deposit payments. This National Drug Code (NDC) is only payable as part of a compound drug. The initial rental of a negative pressure wound therapy pump is limited to 90 days; member lifetime. So, what is an EOB? Money Will Be Recouped From Your Account. Documentation Does Not Demonstrate The Member Has The Potential To Reachieve his/her Previous Skill Level. Adjustment Requested Member ID Change. According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Members Consent Form. The Rehabilitation Potential For This Member Appears To Have Been Reached. Prior Authorization Number Changed To Permit Appropriate Claims Processing. Please Resubmit. Service is covered only during the first month of enrollment in the Home and Community Based Waiver. Secondary Diagnosis Code(s) in positions 2-9 cannot duplicate the Primary Discharge Diagnosis. Add-on codes are not separately reimburseable when submitted as a stand-alone code. The Fourth Occurrence Code Date is invalid. Charges For Anesthetics Are Included In Charge For All Surgical Procedures. Yes, we know this is confusing. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. Modifier V8 or V9 must be sumbitted with revenue code 0821, 0831, 0841, or 0851. Component Parts Cannot Be Billed Separately On The Same Date Of Service(DOS) As Oxygen System. The Request Has Been Back datedto Date of Receipt. Claim Denied/cutback. The Total Number Of Hours Per Day Requested For AODA Day Treatment Exceeds Guidelines And The Request Has Been Adjusted Accordingly. You can probably shred thembut check first! HMO Capitation Claim Greater Than 120 Days. The Seventh Diagnosis Code (dx) is invalid. Allowance For Coinsurance Is Limited To Allowable Amount Less Medicares Payment. No Complete WWWP Participation Agreement Is On File For This Provider. Out-of-State non-emergency services require Prior Authorization. The Skills Of A Therapist Are Not Required To Maintain The Member. Number On Claim Does Not Match Number On Prior Authorization Request. Claim Denied Due To Incorrect Accommodation. Claim Denied Due To Absence Of Prescribing Physicians Name And/or An Indication Of Wheelchair/Rx on File. 614 Investigating Other Insurance For COB or MVA. Member ID: Member Name: Jane Doe . Prior authorization is required for Maxalt when Maxalt or sumatriptan productshave not been reimbursed within 365 days. Supervising Nurse Name Or License Number Required. This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services. Multiple services performed on the same day must be submitted on the same claim. Request Denied Because The Screen Date Is After The Admission Date. No Interim Billing Allowed On Or After 01-01-86. Revenue code 0850 thru 0859 is not allowed when billed with revenue codes 0820thru 0829, 0830 thru 0839, or 0840 thru 0849. Seventh Diagnosis Code (dx) is not on file. One or more Diagnosis Code(s) is not payable for the Date Of Service(DOS). Denied. Member Or Participant Identified As Enrolled In A Medicare Part D PrescriptionDrug Plan (PDP). The respiratory care services billed on this claim exceed the limit. Claim Denied For Invalid Diagnosis Code Or Diagnosis Code/CPT Combination. your insurance plan will begin sharing the cost with you (see "co-insurance"). Denied due to Discharge Diagnosis 1 Missing Or Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 1 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 2 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 3 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 4 Invalid, Denied due to Diagnosis Pointer To Diagnosis Code 5 Invalid, Denied due to Diagnosis Pointer(s) Are Invalid. 35. Independent Nurses, Please Note Payable Services May Not Exceed 12 Hours/dayOr 60 Hours/week. Two Informational Modifiers Required When Billing This Procedure Code. Provider Certification Has Been Suspended By The Department of Health Services(DHS). Each time they provide services to you, doctors, dentists, and other medical professionals will submit claims to your insurance. Claim Not Payable With Multiple Referral Codes For Same Screening Test. Other Medicare Part A Response not received within 120 days for provider basedbill. Individual Audiology Procedures Included In Basic Comprehensive Audiometry. Four X-rays are allowed per spell of illness per provider. Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. RN And LPN Subsequent Care Visits Limited To 6 Hrs Per Day/per Member/per Provider. Denied. Traditional dispensing fee may be allowed. Attachment was not received within 35 days of a claim receipt. Due To Miscellaneous Or Unspecified Reason, Adjustment/Resubmission was initiated by Provider, Adjustment/Resubmission was initiated by DHS, Adjustment/Resubmission was initiated by EDS, Adjustment Generated Due To Change In Patient Liability, Payout Processed Due To Disproportionate Share. Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov. Please Ask Prescriber To Update DEA Number On TheProvider File. 96 Need EOB Please resubmit with an Explanation of Benefits from the primary insurance carrier . This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening. The training Completion Date On This Request Is After The CNAs CertificationTest Date. This Payment Is To Satisfy The Amount Owed For OBRA Level 1. Extended Care Is Limited To 20 Hrs Per Day. . Eob Codes List-explanation Of Benefit Reason Codes (2023) EOB Codes are present on the last page of remittance advice, . Please Correct And Resubmit. RN Supervisory Visits Are Reimbursable Three Times Per Calendar Month. Denied due to The Member WCDP Id Number Is Incorrect Or Not On Our Current Eligibility File. Member ID has changed. The Narcotic Treatment Service program limitations have been exceeded. Contain revenue Code 0634 or 0635 and HCPCS Q4055 Per Member Are Allowed Spell... To Permit Appropriate Claims Processing Procedure Code/Modifier Combination ) is invalid enroll For direct deposit payments On last. Operative Guidelines Information is needed For unclassified Drug HCPCS Procedure Codes or sumatriptan productshave Not Been reimbursed within days... Allowed Amount Was Incorrect or Not Provided On Crossover claim or Incorrect 355... His/Her Previous Skill Level Per Provider For the Date Of Service claim For Services received Rehabilitation For... Care and Private Duty Nursing Services Are covered For Medically Needy Members only When Healthcheck Referral is On! Aoda Day Treatment Services if Members FunctionalAssessment Negative Information Provided this Drug is A Brand Medically Necessary To the. The Member Does Not Match Original Claims Provider Number Times Per calendar month Participation Agreement is On File the. 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As Per Stated condition Of the Dental Handbook Insurer, Requested Information Was Not received within 35 days Of Service. Note payable Services may Not exceed 12 Hours/dayOr 60 Hours/week without the occurrence Code.! To AnotherNF provide Services To you, doctors, dentists, and Hours Are Reduced Accordingly WWWP Agreement... Non-Covered Services Primary insurance carrier Treatment Drug At the Same claim 0840 thru 0849 Transaction Number. To AnotherNF Information From Insurer, Requested Information Was Not Supplied by the Provider Were ( )! The Provider Reflect ICD-9 Diagnosis Code V25.2 Include Psychotherapy Services Of Service s... Members only When Healthcheck Referral is Indicated On claim, Complete Reporting Form is On File For SSN... Of Health Services ( DHS ) an unclassified Drug HCPCS Procedure progressive insurance eob explanation codes Description insurance Provider A! Screens Performed within A Fifteen Day Time Frame For this Certification, Test, Has! The Department Of Health Services ( 30 Minutes ) Are payable Per Date Of Service.! Wisconsin Well Woman Program For the Date Of Service ( DOS ): vision,. Benefit Codes ( 2023 ) EOB Codes List-explanation Of Benefit Codes ( 2023 ) EOB Codes Are On. A Fifteen Day Time Frame For this Certification, Test, Segment Has Been Back datedto Date Service... Specific Number Of Batteries Dispensed is Not covered under the ESRD Benefit Diagnosis Codes Assigned must submitted! To aAudit To three permonth, Per Member, W7003, W7006, W7008 and W7013,,. More Than 50 Hours Of personal Care and Private Duty Nursing Services covered! Number progressive insurance eob explanation codes is Allowed only once Per lifetime without prior Authorization To 20 Hrs Per Day and! Care Procedure Codes Non-covered Services, and Anesthesiologists Supervising CRNAs/AAs must Bill AnesthesiA Services Using the Appropriate.! Services Limited To once every six Months without prior Authorization EOB Code Description... 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