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Explanation of Benefits

Explanation of Benefits Code Listing

An Explanation of Benefits (EOB) code corresponds to a printed message about the status or action taken on a claim. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice.

EOB Code EOB Description
0000This claim/service is pending for program review.
0001Member's ForwardHealth I.d. Number Is Missing Or Incorrect
0002ForwardHealth Number On Claim Does Not Match ForwardHealth Number On Prior Authorization Request.
0003A minimum of one detail is required.
0004DME rental beyond the initial 30 day period is not payable without prior authorization.
0005Charges Paid At Reduced Rate Based Upon Your Usual And Customary Pricing Profile.
0006Amount Paid Reduced By Amount Of Other Insurance Payment.
0007Information inadequate to establish medical necessity of procedure performed.Please resubmit with additional supporting documentation.
0008The Number Of Weeks Has Been Reduced Consistent With Goals And Progress Documented.
0009Member Name Missing. Please Correct And Resubmit.
0010Member is enrolled in Medicare Part A and/or Part B on the on the Dispense Dateof Service.
0011Medicare Part A Services Must Be Resubmitted. Please Attach Copy Of Medicare Remittance.
0012Service Paid At The Maximum Amount Allowed By ForwardHealth ReimbursementPolicies.
0013Dollar Amount Of Claim Was Adjusted To Correct Mathematical Error.
0014A discrepancy exists between the Other Coverage Indicator and the Other Paid Amount.
0015Pediatric Community Care is limited to 12 hours per DOS.
0016Drug Dispensed Under Another Prescription Number. Multiple Prescriptions For Same Drug/ Same Fill Date, Not Allowed.
0017The Evaluation Was Received By ForwardHealth Fiscal Agent More Than Two Weeks After The Evaluation Date.
0018ForwardHealth Allowance For Coinsurance Is Limited To ForwardHealth Allowable Amount Less Medicare's Payment. Medicare Deductible Is Paid In Full.
0019Medicare Paid The Total Allowable For The Service.
0020Claim Reduced Due To Member/participant Spenddown.
0021Procedure Code is allowed once per member per lifetime.
0022Service(s) Must Be Submitted On Paper Claim Form Along With Preoperative History And Physical Report And Operation Report.
0023Performing Provider Is Not Certified For Date(s) Of Service On Claim/detail.
0024Provider Certification Has Been Suspended By The Department of Health Services(DHS).
0025Billing or Rendering Provider certification is cancelled for the From Date of Service.
0026ICD-9-CM Diagnosis Code 2 Is Invalid.
0027ICD-9-CM Diagnosis Code 3 Is Invalid
0028ICD-9-CM Diagnosis Code 4 Is Invalid.
0029Member last name does not match Member ID.
0030Referring Provider is not currently certified.
0031Reimbursement Rate Applied To Allowed Amount.
0032ICD-9-CM Diagnosis Code 5 Is Invalid
0033The Member Was Not Eligible For ForwardHealth On The Date ForwardHealth Received the Request. Contact Wisconsin ForwardHealth's Billing And Policy Correspondence Unit.
0034Service Billed Limited To Three Per Pregnancy Per ForwardHealth Guidelines.
0035Claim Denied Due To Invalid Pre-admission Review Number.
0036Payment For Immunotherapy Service Included In Reimbursement For Allergy Extract Injection.
0037Claim Denied. Consent Form Is Missing, Incomplete, Or Contains Invalid Information.
0038The Member Is Enrolled In An HMO. The Service Requested Is Covered By The HMO.
0039The Service Requested Is Not A Covered Benefit Of The ForwardHealth Program.
0040Rendering Provider ID is not on file.
0041The Procedure Requested Is Not On ForwardHealth's Files.
0042The Procedure Requested Is Not Allowable For The Process Type Indicated On TheRequest. Contact Wisconsin ForwardHealth's Billing And Policy Correspondence Unit.
0043The Service Requested Is Inappropriate For The Member's Diagnosis.
0044The provider is not authorized to perform or provide the service requested.
0045The Service Requested Does Not Correspond With ForwardHealth Age Criteria.
0046The Procedure Requested Is Not Appropriate To The Member's Sex.
0047These case coordination services exceed the limit.
0048The Modifier For The Proc Code Is Invalid. Please Supply The Appropriate Modifier. If The Proc Code Does Not Require A Modifier, Please Remove The Modifier.
0049More than 6 hours of evaluation/assessment in a 2 year period must be billed astreatment services and count toward the MH/SA policy limits for prior authorization.
0050Payment Reduced By Member Copayment.
0051The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days, or the From and To Dates of Service cannot be the same.
0052The Admit Date is required.
0053Service(s) Billed Are Included In The Total Obstetrical Care Fee.
0054Claim Denied Due To Absent Or Incorrect Discharge (to) Date.
0055Please Indicate The Dollar Amount Requested For The Service(s) Requested.
0056Detail From Date of Service is after the ICN Date.
0057Members Up To 3 Years Of Age Are Limited To 2 Healthcheck Screens Per 12 Months.
0058Targeted Rate Service
0059Normal delivery payment includes the induction of labor.
0060Admit Diagnosis is required.
0061Indicated Diagnosis Is Not Applicable To Member's Sex.
0062This Member Has Completed Primary Intensive Services And Is Now Only Eligible For after Care/follow-up Hours.
0063Reimbursement For This Service Is Included In The Transportation Base Rate.
0064Claim reduced to fifteen Hospital Bedhold Days for stays exceeding fifteen days.
0065The respiratory care services billed on this claim exceed the limit.
0066Claim Reduced Due To Member/participant Deductible.
0068Procedure Code is not payable for SeniorCare participants.
0069Please Furnish A CPT/HCPCS Code.
0070Please Furnish A NDC Code And Corresponding Description. (National Drug Code).
0071Claim Denied. Only One Outpatient Claim Per Date Of Service Allowed.
0072This Claim Paid At Rate Per Visit.
0073Please Furnish A UB92 Revenue Code And Corresponding Description.
0074Billing Provider is restricted from submitting electronic claims.
0075Please Furnish An ICD-9 Surgical Code And Corresponding Description.
0076Please Supply Modifier Code(s) Corresponding To The Procedure Code Description.
0077Member Successfully Outreached/referred During Current Periodicity Schedule.
0078Claim Indicates Other Insurance/TPL Payment Must Be Received Prior To Filing ForwardHealth Claim.
0079ForwardHealth Has Manually Split The Dates Of Service To Reflect 2 Fiscal Years/Reimbursement Rates.
0080Diagnosis Code submitted does not indicate medical necessity or is not appropriate for service billed.
0081Amount Paid By Other Insurance Exceeds Amount Allowed By ForwardHealth.
0082Prior Authorization Number Changed To Permit Appropriate Claims Processing.
0083Review Of Adjustment/reconsideration Request Shows Original Claim Payment Was Max Allowed For Medical Service/Item/NDC.
0084Provider signature and/or date is required
0085Different Drug Benefit Programs. Prescriptions Or Services Must Be Billed As ASeparate Claim.
0086Claim cannot contain both Condition Codes A5 and X0 on the same claim. PleaseResubmit Charges For Each Condition Code On A Separate Claim.
0087Supply The Place Of Service Code On The Request Form (the Place Of Service Where The Service/procedure Would Be Performed).
0088Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. Please Clarify.
0089Denied. Missing Or Invalid Level Of Effort And/or Reason For Service Code, Professional Service Code, Result Of Service Code Billed In Error.
0090Invalid Provider Type To Claim Type/Electronic Transaction.
0091A valid Referring Provider ID is required.
0092Facility Provider Number Required.
0093First modifier code is invalid for Date of Service.
0094Refill Indicator Missing Or Invalid. Please Correct And Resubmit.
0095Dispense as Written indicator is not accepted by ForwardHealth.
0096Other Insurance/TPL Indicator On Claim Was Incorrect. Please Correct And Resubmit.
0097Denied. Services Beyond The Six Week Postpartum Period Are Not Covered, Per DHS.
0098Capitation Payment.
0099Please Indicate Computation For Unloaded Mileage.
0100Denied as duplicate claim. Services on this claim were previously partially paid or paid in full.
0101This detail is denied. It is a duplicate of another detail on the same claim.
0102Duplicate Item Of A Claim Being Processed. Please Do Not File A Duplicate Claim.
0103Denied as duplicate claim. Services on this claim were previously partially paid or paid in full.
0104Non-Reimbursable Service. Service Fails To Meet Program Requirements.
0105Claim Denied. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information.
0106Invalid Medicare disclaimer submitted.
0107Benefit program funds are exhausted.
0108Denied. The Provider Type/specialty Is Not Recognized For These Date(s) Of Service.
0109Unable To Reach Provider To Correct Claim. Please Correct Claim And Resubmit.
0110Benefit Payment Determined By ForwardHealth Fiscal Agent Review.
0111The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services.
0112Service code is invalid.
0114Schedule 3, 4 or 5 drugs are limited to the original dispensing plus 5 refillsor 6 months.
0115Unable To Process Your Adjustment Request.
0116Procedure Code or Drug Code not a benefit on Date of Service.
0117A Version Of ForwardHealth Software (PES) Was In Error. You Received A PaymentThat Should Have gone To Another Provider. We Are Recouping The Payment. No Action Required on your part.
0118This Claim Is Being Reprocessed As An Adjustment On This R&s Report. Please Check The Adjustment Icn For The Reprocessed Claim.
0119Services Billed On This Claim/adjustment Have Been Split to Facilitate Processing.
0120Consistent With Documented Medical Need, The Number Of Services Requested HaveBeen Reduced.
0121The Service/procedure Proposed Is Not Supported By Submitted Documentation.
0122This Claim Is A Reissue of a Previous Claim.
0123This Is An Adjustment of a Previous Claim.
0124Thank You For The Payment On Your Account. Your 1099 Liability Has Been Credited.
0125A Photocopy Of The PA Request Form Has Been Mailed Separately Identifying the Reimbursement Rate For The Procedure Codes Authorized.
0126The Service Requested Is Not A Covered Benefit As Determined By ForwardHealth.
0127These Services Paid In Same Group on a Previous Claim.
0128Service Provided Before Prior Authorization Was Obtained Is Not Allowable.
0129Participant's Eligibility Not Complete, Please Re-submit Claim At Later Date.
0130Member has Medicare Supplemental coverage for the Date(s) of Service.
0131Partial Payment Withheld Due To Previous Overpayment.
0132Payment Is To Satisfy Amount Owed By ForwardHealth.
0133The Admit Type code is invalid.
0134Voided Claim Has Been Credited To Your 1099 Liability.
0135No Substitute Indicator required when billing Innovator National Drug Codes (NDCs).
0136A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. Use The New Prior Authorization Number When Submitting Billing Claim.
0137This Claim Paid At Per Diem Rate.
0138Service(s) Do Not Meet ForwardHealth Guidelines.
0139Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months.
0140Claim Denied. Please Refer To ForwardHealth Update No. 2004-79 For Instructions.
0141Claim Denied Due To Invalid Occurrence Code(s).
0142Denied. Resubmit the Claim with the Appropriate Modifier for Provider Type andSpecialty.
0143Patient Status Code is incorrect for inpatient claims with fewer than 121 covered days.
0144No Interim Billing Allowed On Or After 01-01-86.
0145NCPDP Format Error Found On Medicare Drug Claim. Please Resubmit.
0146Non-scheduled drugs are limited to the original dispensing plus 11 refills or 12 months.
0147Denied/cutback. Claim Must Indicate A New Spell Of Illness And Date Of Onset.
0148Dispensing replacement parts and complete appliance on same Date of Service not Allowed.
0149Amount Recouped For Duplicate Payment on a Previous Claim.
0150Amount Recouped For Mother Baby Payment (newborn).
0151Medicare Id Number Missing Or Incorrect. Please Correct And Resubmit.
0152Medicare paid amount(s) have been incorrectly applied to both the claim headerand details.
0153The header total billed amount is invalid.
0154Medicare Deductible Amount Was Incorrect Or Not Provided On Crossover Claim. Please Resubmit.
0155This Procedure Code Not Approved For ForwardHealth Billing. Please Resubmit using A ForwardHealth Approved CPT Or HCPCS Procedure Code.
0156The Medicare Paid Amount is missing or incorrect.
0157Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization.
0158Quantity Billed is missing or exceeds the maximum allowed per Date of Service.
0159A valid header Medicare Paid Date is required.
0160Medicare Allowed Amount Was Incorrect Or Not Provided On Crossover Claim. Please Resubmit.
0161Assistant Surgery Must Be Billed Separately By The Assistant Surgeon With Modifier 80.
0162Multiple Unloaded Trips for same day, same member, require unique Trip Modifiers. A code with no Trip Modifier billed on same day as a code with Modifier U1 are considered the same trip.
0163Service Denied/cutback. Day Treatment Exceeding 5 Hours/day Not Payable Regardless Of Prior Authorization.
0164Frequency or number of injections exceed program policy guidelines.
0165Two Informational Modifiers Required When Billing This Procedure Code.
0166The Procedure Code billed not payable according to DEFRA.
0167Requested Documentation Has Not Been Submitted.
0168Member Is Eligible For Champus. Please File With Champus Carrier.
0169Admission Denied In Accordance With Pre-admission Review Criteria.
0170Please Resubmit A New Adjustment/reconsideration Request Form And Indicate TheMost Recent Cclaim Number Where Payment Was Made Or Allowed.
0171Claim or Adjustment received beyond 365-day filing deadline.
0172Member is not enrolled for the detail Date(s) of Service.
0173Member Expired Prior To Date Of Service On Claim.
0174Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. If it is medical necessary for more than 13 or 14 services per calendar month, submit an adjustment request with supporting documentation.
0175Rendering Provider indicated is not certified as a rendering provider.
0176This Service Is Included In The Hospital Ancillary Reimbursement.
0177A Place of Service code is required.
0178The Service Requested Is Not Medically Necessary.
0179The Medical Need For This Service Is Not Supported By The Submitted Documentation.
0180Denied. Procedure Not Payable As Submitted.
0181The Narrative History Does Not Indicate the Member's Functioning is Impaired due To AODA Usage.
0182Billing Provider Type and/or Specialty is not allowable for the service billed.
0183Provider Not Authorized To Perform Procedure.
0184Procedure Code is restricted by member age.
0185Procedure Code billed is not appropriate for member's gender.
0186Vision Exam limited to one per year.
0187Only Four Dates Of Service Are Allowed Per Line Item (detail) For Each Procedure.
0188Ancillary Billing Not Authorized By State.
0189Acute Care General And Specialty Hospitals Are Subject To Pre-admission Requirements Or The Pre-admission Review Number Indicated Is Invalid.
0190This Member Has Received Primary AODA Treatment In The Last Year And Is Therefore Not Eligible For Primary Intensive AODA Treatment At This Time.
0191The Services Requested Are Not Reasonable Or Appropriate For The AODA-affectedmember.
0192Prior Authorization (PA) is required for this service. An approved PA was not found matching the provider, member, and service information on the claim.
0193Charges For Anesthetics Are Included In Charge For All Surgical Procedures.
0194Laboratory Is Not Certified To Perform The Procedure Billed.
0195This Member, As Indicated By Narrative History, Does Not Agree To Abstinence from Alcohol Or Other Drugs And Is Ineligible For AODA Treatment.
0196Individual Audiology Procedures Included In Basic Comprehensive Audiometry.
0197Drug(s) Billed Are Not Refillable. New Prescription Required.
0198Capitation Payment Recouped Due To Member Disenrollment.
0199Procedure Dates Do Not Fall Within Statement Covers Period.
0200Duplicate/second Procedure Deemed Medically Necessary And Payable.
0201Rendering Provider is not certified for the Date(s) of Service.
0202Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member.
0203Days supply is invalid.
0204Performing/prescribing Provider's Certification Has Been Suspended By DHS.
0205Detail Rendering Provider certification is cancelled for the Date of Service.
0206HMO Payment Equals Or Exceeds Hospital Rate Per Discharge.
0207Good Faith Claim Denied. Certifying Agency Verified Member Was Not Eligible for Dates Of Services.
0208The Nursing Home Condition Code Is A5.
0209Claim Denied Due To Incorrect Accommodation.
0210Independent Laboratory Provider Number Required.
0211Drugs Prescribed and Filled on the Same Day, Cannot have a Refill Greater thanZero.
0212Procedue Code is allowed once per member per calendar year.
0213The Service(s) Billed Are Considered Paid In The Payment For The Surgical Procedure.
0214PATIENT PAID PORTION USED TOWARDS DEDUCTIBLE.
0215Medicare Copayment Out Of Balance. Please Resubmit.
0216This Is A Manual Increase To Your Accounts Receivable Balance.
0217This Is A Manual Decrease To Your Accounts Receivable Balance.
0218Prior Authorization is required for service(s) exceeding mental health and/or substance abuse benefit guidelines.
0219Reimbursement For Panel Test Only- Individual Tests In Addition To Panel Test Disallowed.
0220Tooth surface is invalid or not indicated.
0221The detail billed amount is required.
0222Claim Currently Being Processed. No Action On Your Part Required.
0223Claim Currently Being Processed. No Action On Your Part Required.
0224Quantity dispensed is invalid.
0225This Member's Clinical Profile Is Not Within The Diagnostic Limitation For Medical Day Treatment.
0226Well-baby visits are limited to 12 visits in the first year of life.
0227Members Are Limited To 45 Dates Of Service Per Therapy/spell Of Illness without Prior Authorization.
0228Medicare Part B Deducted Charges.
0229The Type of Bill is invalid.
0230Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay.
0231Procedure Denied Per DHS Medical Consultant Review.
0232Source of Admit is missing or invalid.
0233The Documentation Submitted Does Not Substantiate Additional Care.
0234Second Rental Of Dme Requires Prior Authorization For Payment.
0235Denied/Cutback. Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization.
0236Normal delivery reimbursement includes anesthesia services.
0237Annual Physical Exam Limited To Once Per Year By The Same Provider
0238The Clinical Profile And Narrative History Indicate Day Treatment Is Neither Appropriate Nor A Medical Necessity For This Member.
0239Private Duty Nursing Beyond 30 Hrs /Member Calendar Year Requires Prior Authorization.
0240Prescription Number is required.
0241Benefit Payment Determined By DHS Medical Consultant Review.
0242Prescription Date is invalid.
0243The Functional Assessment Indicates This Member Has Less Than A 50% Likelihoodof Benefit, Therefore Day Treatment Is Not Appropriate.
0244Submit copy of the dated and signed evaluation and indicate if this is an initial Evaluation.
0245A SeniorCare drug rebate agreement is not on file for this drug for the Date of Service.
0246Please Indicate The Revenue Code/procedure Code/NDC Code For Which The Credit is To Be Applied.
0247Procedure code has been terminated by CMS, AMA or ADA for the Date of Service.
0248Complete Refusal Detail Is Not Payable Without Referral/treatment Details.
0249A Second Surgical Opinion Is Required For This Service.
0250Maximum Number Of Outreach Refusals Has Been Reached For This Period.
0251This Is Not A Good Faith Claim. Resubmit Claim Through Regular Claims Processing.
0252Good Faith Claim Denied Because Of Provider Billing Error.
0253Multiple Referral Charges To Same Provider Not Payble.
0254Accommodation Days Missing/invalid. Please Correct And Resubmit.
0255Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail.
0256The Nursing Home Condition Code Is X0.
0257This Member's Functional Assessment Scores Place This Member Outside Of Eligibility For Day Treatment.
0258Claim paid according to Medicare's reimbursement methodology.
0259Denied. This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization.
0260Denied. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form.
0261Claim Denied. Only One Panoramic Film Or Intraoral Radiograph Series, By The Same Provider, Per Year Allowed.
0262The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus.
0263Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness.
0264Subsequent surgical procedures are reimbursed at reduced rate.
0265Newborn Care Must Be Billed Under Newborn Name And Number; Occurrence Codes 50& 51 Cannotbe Present if Billing Under Newborn Name.
0266Part Time/intermittent Nursing Beyond 20 Hours Per Member Per Calendar Year Requires Prior Authorization.
0267This Member Appears To Continue To Abuse Alcohol And/or Other Drugs And Is Therefore Not Eligible For Day Treatment.
0268Member is enrolled in Medicare Part D for the Dispense Date of Service. Prescription Drug Plan (PDP) payment/denial information is required on the claim to SeniorCare.
0269Services Cutback/denied, Charges Greater Than Patient Liability, ForwardHealthNot Responsible For Noncovered Services In Excess Of Patient Liability.
0270Any single or combination of restorations on one surface of a tooth shall be considered as a one-surface restoration for reimbursement purposes.
0271Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration.
0272This Member Does Not Appear To Be Suffering From A Chronic Or Acute Mental Illness And Is Therefore Not Eligible For Day Treatment.
0273Resubmit charges for ForwardHealth covered service(s) denied by Medicare on a ForwardHealth claim.
0274Complex care of 17-plus hours and complex care of less than 17 hours are not allowed on the same Date of Service.
0275Adjustment/reconsideration Request Denied Due To Incorrect/insufficient Information. Review Billing Instructions. Use This Claim Number If You Resubmit.
0276The sum of all Value Code amounts must be numeric and less than or equal to 999.999.999.
0277This drug/service is included in the Nursing Facility daily rate.
0278Member is covered by a commercial health insurance on the Date(s) of Service.
0279The Member Information Provided By Medicare Does Not Match The Information On ForwardHealth Files.
0280Incorrect Liability Start/end Dates Or Dollar Amounts Must Be Corrected Through County Social Services Agency Before Claim/Adjustment/Reconsideration RequestCan be Processed.
0281Member ID is Required.
0282Inpatient psychiatric services are not reimbursable for members age 21 — 65 (age 22 if receiving services prior to 21st birthday).
0283Adjustment Denied For Insufficient Information. Please Supply NDC Code, Name, Strength & Metric Quantity. Use This Claim Number For Further Transactions.
0284When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000.
0285Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. Additional servcies may be billed with H0046 and will count toward mental health and/or substance abuse treatment policy limits for prior authorization.
0286The Service Requested Is Considered To Be Professionally Unacceptable, Unproven and/or Experimental.
0287Member is enrolled in a State-contracted managed care program for the Date(s) of Service.
0288The Revenue/HCPCS Code combination is invalid.
0289Out-of-State non-emergency services require Prior Authorization.
0290Payment Recovered For Claim Previously Processed Under Wrong Member ForwardHealth ID Number.
0291All ESRD laboratory tests for a Date of Service must be billed on the same claim.
0292Intensive Rehabilitation Hours Are No Longer Appropriate As Indicated By History, Diagnosis, And/or Functional Assessment Scores.
0293Good Faith Claim Denied. Certifying Agency Did Not Verify Member Eligibility within 70 Day Period.
0294A one year service guarantee for any necessary repair is included in the hearing aid depensing fee.
0295Does not meet hearing aid performance check requirement of 45 post dispensing days.
0296All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied.
0297Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy.
0298Individual Replacements Reimbursed As Dispensing A Complete Appliance.
0299The Clinical Profile, Narrative History, And Treatment History Indicate The Recipient Is Only Eligible For Maintenance Hours.
0300All Home Health Services Exceeding 8 Hours Per Day Or 40 Or More Hours Per Week Require Prior Authorization.
0301Additional Encounter Service(s) Denied. The Diagnosis Does Not Indicate A Significant Change In the Member's Condition.
0302The Rehabilitation Potential For This Member Appears To Have Been Reached. The Member Is Only Eligible For Maintenance Hours.
0303The Date Of The Screening Request Or The Date Of Screening Is Invalid Or Missing. Please Correct And Resubmit.
0304This Claim Cannot Be Processed. Please Submit A Separate New Day Claim For Copayment Exempt Days/services.
0305The Member Is Also Involved In A Structured Living And/or Working Arrangement.A Reduction In Day Treatment Hours Is Indicated.
0306Serviced Denied. Three Or More Different Individual Chemistry Tests Performed Per Member/Provider/Date Of Service Must Be Billed As A Panel.
0307Service Denied. 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.
0308Claim Submitted To Good Faith Without Proper Documentation. See Provider Handbook For Good Faith Billing Instructions.
0309Consultation or surgical procedures are not reimbursable in conjuctions with Emergency Room services.
0310The Unit Dose Indicator is invalid.
0311Independent RHC's Must Bill Codes W6251, W6252, W6253, W6254 Or W6255.
0312Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines.
0313Claim Denied. Component Parts Cannot Be Billed Separately On The Same Date Of Service As Oxygen System.
0314This Member Has Already Received Intensive Day Treatment In The Past Year and is Only Eligible For Reduced Hours At This Time.
0315A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. Refer To The Wisconsin ForwardHealth Website @ dhs.state.wi.us
0316Back-up dialysis sessions are limited to three per lifetime.
0317The Value Code(s) submitted require a revenue and HCPCS Code.
0318Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service.
0319Four X-rays are allowed per spell of illness per provider. Reconsideration With Documentation Warranting More X-rays.
0320The Processor Control Number (PCN) for SeniorCare member over 200% FPL is missing, or the PCN is invalid for a WCDP member, ForwardHealth member or SeniorCare member at or below 200% FPL.
0321Oral exams or prophylaxis is limited to once per year unless prior authorized.
0322Service(s) Denied/cutback. The Maximum Prior Authorized Service Limitation Or Frequency Allowance Has Been Exceeded.
0323Psych Evaluation And/or Functional Assessment Ser. Performed After Therapy/dayTreatment Have Begun Must Be Billed As Therapy Or Limit-exceed Psych/aoda/func
0324ForwardHealth Has Recouped Payment For Service(s) Per Provider's Request.
0325Services have been determined by DHCAA to be non-emergency.
0326Services Billed Denied As Being Covered In The Payment For Day Rx Per Medical Day Treatment Guidelines.
0327This Member Is Receiving Concurrent AODA/Psychotherapy Services And Is Therefore Only Eligible For Maintenance Hours.
0328This Member Is Involved In Non-covered Services, And Hours Are Reduced Accordingly.
0329Reduction To Maintenance Hours. The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential.
0330Day Treatment Services For Member's With Inpatient Status Limited To 20 Hours.
0331Prior Authorization Required For Day Treatment Services If Member's FunctionalAssessment Negative.
0332All Day Treatment Services For Members With Nursing Home Status Should Be Billed Under Procedure Code W8912(pre 10/1/03)/h2012(post 10/1/03) And Require PriorAuthorization.
0333Procedure Code Used Is Not Applicable To Your Provider Type.
0334Inpatient mental health services performed by master's level psychotherapists or substance abuse counselors are not covered.
0335The Comprehensive Community Support Program reimbursement limitations have been exceeded.
0336Reimbursement limits for Community Care Services for the calendar year are close to being exceeded.
0337Denied. Provider Is Not A Qualified Provider For presumptively Eligible Recipients. A Qualified Provider Application Is Being Mailed To You.
0338Denied. 51.42 Board Director's Or Designee's Statement & Signature Required OnThe Claim Form For Payment Of Functional Assessment.
0339The Member's Past History Indicates Reduced Treatment Hours Are Warranted.
0340HMO Extraordinary Claim Denied. Documentation Does Not Justify Fee For ServiceProcessing .
0341Denied. No Extractions Performed. Edentulous Alveoloplasty Requires Prior Authotization.
0342The Request Does Not Meet Generally Accepted Conditions Requiring Fluoride Treatments.
0343Correction Made Per ForwardHealth Medical Consultant Review.
0344Medication checks by a Psychiatrist and/or Registered Nurse are limited to four services per calendar month.
0345Master Level Providers Must Bill Under A Mental Health Clinic Number; Not Under a Private Practice Or Supervisor Number.
0346The Service Requested Was Performed Less Than 3 Years Ago.
0347Description & Use Of Day RX Procedure Codes Based On Member's Status-not the place Of Service Where Day Rx Service Performed.
0348Dates of Service reflected by the Quantity Billed for dialysis exceeds the Statement Covers Period.
0349The Service Requested Was Performed Less Than 5 Years Ago.
0350Reimbursement is limited to one maximum allowable fee per day per provider.
0351Second And Subsequent Cerebral Evoked Response Tests Paid At A Reduced Rate PerForwardHealth Guidelines.
0352The billing provider number is not on file.
0353The Existing Appliance Has Not Been Worn For Three Years.
0354Non-preferred Drug Is Being Dispensed. Please Refer To The PDL For Preferred Drugs In This Therapeutic Class.
0355Member History Indicates Member Was In Another Facility During This Period.
0356Adjustments To Correct Copayment Deductions On 'date Ranged' Claims Are Not Payable.
0357Home Health Services In Excess Of 60 Visits Per Calendar Month Per Member Required Prior Authorization.
0358Summarize Claim To A One Page Billing And Resubmit.
0359Procedure Code Changed To Permit Appropriate Claims Processing.
0360Home Health Services In Excess Of 160 Home Health Visits Per Calendar Year PerMember Require Prior Authorization.
0361Dispensing fee denied. Only two dispensing fees per month, per member are allowed.
0362Services Denied In Accordance With Hearing Aid Policies. Please Refer To Your Hearing Services Provider Handbook.
0363This obstetrical service was previously paid for this Date of Service for thismember.
0364No payment allowed for Incidental Surgical Procedure(s).
0365Claim Denied/Cutback. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization.
0366A valid Prior Authorization is required for non-preferred drugs.
0367The Member Has Been Totally Without Teeth And An Appliance For 5 Years.
0368Comprehensive Screens And Individual Components Are Not Payable On The Same Date Of Service
0369This drug is limited to a quantity for 34 days or less.
0370Outpatient Services To Be Billed As Inpatient Ancillaries When Same Day Stay Occurs Please File An Adjustment/reconsideration Request To Correct Inpatiet Billing.
0371HCPCS Procedure Code is required if Condition Code A6 is present.
0372Lab Procedures Billed In Conjunction With Family Planning Pharmacy Visit Denied as not a Benefit.
0373Value Code 48 And 49 Must Have A Zero In The Far Right Position. Please Correct and Resubmit.
0374Participant 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.
0375Physical Therapy Treatment Limited To One Modality, One Procedure, One Evaluation Or One Combination Per Day.
0376This drug is limited to a quantity for 100 days or less.
0377The Tooth Is Not Essential To Maintain An Adequate Occlusion.
0378Tooth number or letter is not valid with the procedure code for the Date of Service.
0379Second Surgical Opinion Guidelines Not Met. See ForwardHealth Physician's Handbook For Details.
0380Denied. The Service Performed Was Not The Same As That Authorized By ForwardHealth.
0381Records Indicate This Tooth Has Previously Been Extracted. Correct Claim Or Resubmit With X-ray.
0382Denied. Crossover Claims/adjustments Must Be Received Within 180 Days Of The Medicare Paid Date.
0383Service Denied. Authorization For Surgery Requiring Second Opinion Valid For 6Months After Date Approved.
0384Transplant Procedures Must Be Submitted Under The Appropriate Provider Suffix for Prior Authorization Requests And The Billing Claim To Obtain The Exceptional Rate per Discharge.
0385Denied. Prosthodontic Services Appear To Have Started After Member EligibilityLapsed.
0386Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization.
0387Outside Lab,element 20 On CMS 1500 Claim Form Must Be Checked Yes When Handling Charges Are Billed.
0388A valid procedure code is required.
0389Header From Date of Service is required.
0390Compound Drug Service Denied. At Least One Of The Compounded Drugs Must Be A Covered Drug.
0391Denied. Adjustment To Eyeglasses Not Payable As A Repair Service.
0392The Member Has At Least 4 Posterior Teeth, Including Bicuspids On Each Side, which Can Be Used For Chewing.
0393Member File Indicates Part B Coverage Please Resubmit Indicating Value Code 81and The Part B Payable Charges.
0394Resubmit Professional Component On The Proper Claim Form With The EOMB Attached. Professional Components Are Not Payable On A Ub-92 Claim Form.
0395Denied. Services Not Provided Under Primary Provider Program.
0396Denied. Multiple Tooth Extract On Same Date Of Service Must Be Billed As Single And Additional Tooth Extract In Same Quadrant.
0397The Billing Provider On The Claim Must Be The Same As The Billing Provider WhoReceived Prior Authorization For This Service.
0398A valid Prior Authorization is required.
0399Date Of Service Must Fall Between The Prior Authorization Grant Date And Expiration Date.
0400The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File.
0401Claims For Sterilization Procedures Must Reflect ICD-9 Diagnosis Code V25.2. Please Correct And Resubmit.
0402Claim or adjustment/reconsideration request must have both a Revenue Code and either a HCPCS Code or CPT Code.
0403The Performing Provider Id, Member Id, And Date Of Service Must Match The Completion Certificate Received From Ddes.
0404The member has no Level of Care (LOC) authorization on file or the LOC on filedoes not match the LOC on the claim.
0405The Service(s) Requested Could Adequately Be Performed In The Dental Office.
0406Pap Smears, Hematocrit, Urinalysis Are Not Reimbursable Separately In Conjunction With Family Planning Medical Visits.
0407Personal Care Services Exceeding 30 Hours Per 12 Month Period Per Member Require Prior Authorization.
0408The Diagnosis Code is not payable for the member.
0409No Reimbursement Rates on file for the Date(s) of Service.
0410Timely Filing Request Denied. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration.
0411Timely Filing Deadline Exceeded. No Supporting Documentation. Please Refer To The All Provider Handbook For Instructions.
0412Timely Filing Deadline Exceeded. Documentation Does Not Justify Reconsideration For Payment. Please Review All Provider Handbook For Allowable Exception
0413Initial Visit/Exam limited to once per lifetime per provider.
0414Reimbursement of this service is included in the reimbursement of the most complex/complete procedure performed.
0415Payment reduced. All rental payments have been deducted from the purchase costsince the DME item was rented and subsequently purchased for the member.
0416Service Denied, refer to Medicare's Billing and/or Policy Guidelines.
0417The Service(s) Requested Could Be Adequately Performed With Local Anesthesia In The Dental Office.
0418Good Faith Claim Has Previously Been Denied By Certifying Agency. Resubmit Claim With Copyof A Temporary ID Card, EVS Printed Response Or Indicate The AVR Transaction Log Number.
0419These Urinalysis Procedures Reimbursed Collectively At The Maximum For Routine Urinalysis With Microscopy.
0420Prescription limit of five Opioid analgesics per month. Prescriber must contact the Drug Authorization and Policy Override Center for policy override.
0421Prescription limit of five Opioid analgesics per month. No policy override available for BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan.
0422An antipsychotic drug has recently been dispensed for this member. Only one antipsychotic drug is allowed without an Attestation to Prescribe More Than One Antipsychotic Drug for a Member 16 Years of Age or Younger
0424Billing Provider ID is Not on File.
0425Prescriber ID is invalid.e. Please Indicate Separately On Each Detail.
0426Claim Denied. Payment Is Limited To One Unit Dose Service Per Calendar Month, Per Legend Drug, Per Member.
0427Claim Payment Is Based On The Lessor Of The Number Of Certified Days On The PsrO Or 51.42 Board Stamp Or Admitting Calendar Month Days In Specialty Hospital.
0428Do Not Use Informational Code(s) When Submitting Billing Claim(s). Continue ToUse Appropriate Codes On Billing Claim(s).
0429The Procedure Code Indicated Is For Informational Purposes Only.
0430ForwardHealth Has Processed This Claim With A Medicare Part D Attestation Form.
0431Speech Therapy Limited To 35 Treatment Days Per Spell Of Illness w/o Prior Authorization.
0432Denied. Service Billed Exceeds Restoration Policy Limitation.
0433Physical Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization.
0434These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code.
0435Occupational Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization.
0436Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov.
0437Questionable Long-term Prognosis Due To Poor Oral Hygiene.
0438Service Denied. Referring Physician With Credential Other Than Md Is Not Applicable To Type Of Service Provided.
0439Service(s) paid at the maximum daily amount per provider per member.
0440Hearing aid repairs are limited to once per six months, per provider, per hearing aid.
0441Claim Or Adjustment Request Should Include Documents That Best Describe Services Provided (ie Op Report, Admission History and Physical, Progress Notes and Anesthesia Report).
0442Claim Denied Due To Absence Of Prescribing Physician's Name And/or An Indication Of Wheelchair/Rx on File. Please Correct And Resubmit.
0443Repair services billed in excess of the amount specified in the Durable Medical Equipment (DME) handbook require Prior Authorization.
0444Good Faith Claim Denied For Timely Filing.
0445Good Faith Claim Correctly Denied. Cannot Be Reprocessed Unless There Is Change In Eligibility Status.
0446This service is payable at a frequency of once per 12-month period, per provider, per hearing aid.
0447Hearing Aid Batteries Are Limited To 12 Monaural/24 Binaural Batteries Per 30-day Period, Per Provider, Per Hearing Aid.
0448Questionable Long-term Prognosis Due To Decay History.
0449Questionable Long Term Prognosis Due To Gum And Bone Disease.
0450No Separate Payment For IUD. Reimbursement For HCPCS Procedure Code 58300 Includes IUD Cost.
0451A Previously Submitted Adjustment Request Is Currently In Process. Watch FutureRemittance And Status Reports For Its Finalization Before Resubmitting.
0452Claim Number Given Is Not The Most Recent Number. Please Review Remittance AndStatus Reports For More Recent Adjustment Claim Number, Correct And Resubmit.
0453Claim Denied For No Consent And/or PA. Please Resubmit With The Costs For Sterilization Related Charges Identified As Non-covered Charges On The Claim.
0454Denied. Recasing Or Replacement Of Hearing Aid Case Is Limited To Once Per 2 Year Period Per Member Per Provider.
0455Date(s) Of Service on detail must be within a Sunday thru Saturday calendar week.
0456Questionable Long-term Prognosis Due To Apparent Root Infection.
0457Our Records Indicate The Member Has Been Careless With Dentures Previously Authorized. ForwardHealth Will Not Authorize New Dentures Under Such Circumstances.
0458Documentation Provided Indicates A Less Elaborate Procedure Should Be Considered.
0459The Tooth Is Not Essential For Support Of A Partial Denture.
0460Supplemental Payment Authorized By Department of Health Services (DHS) Due to aAudit.
0461Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement.
0462Supplemental Payment Authorized By Department of Health Services (DHS) Due to an Interim Rate Settlement.
0463Supplemental Payment Authorized By Department of Health Services (DHS) Due to a Department Of Justice Settlement.
0464Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit.
0465Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Final Rate Settlement.
0466Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Interim Rate Settlement.
0467Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Department Of Justice Settlement.
0468Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date.
0469Claim Is Being Special Handled, No Action On Your Part Required. Please Disregard Additional Informational Messages For This Claim.
0470Claim Is Being Reprocessed, No Action On Your Part Required. Please Do Not Resubmit Your Claim. Please Disregard Additional Messages For This Claim.
0471Claim Is Being Reprocessed Through The System. No Action On Your Part Required. Please Do Not Resubmit Your Claim, And Disregard Additional Informational Messages for this claim.
0472Claim Is Being Reprocessed On Your Behalf, No Action On Your Part Required. Please Disregard Additional Information Messages For This Claim.
0473Claims Cannot Exceed 28 Details. Details Include Revenue/surgical/HCPCS/CPT Codes. Combine Like Details And Resubmit.
0474Services Denied. Once 50 Initial Visits/year Has Been Reached Within Any One Discipline All Home Health Services Require Pa.
0475Speech Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization.
0476Physical Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization.
0477Billing Provider indicated is not certified as a billing provider.
0478Claim Reduced Due To Member Income Available Toward Cost Of Care (Nursing Home Liability).
0479Previously Denied Claims Are To Be Resubmitted As New-day Claims. Use The ICN which Is In An Allowed Or Paid Status When Filing An Adjustment/ReconsiderationRequest.
0480Date Of Service/procedure/charges Billed On The Adjustment/reconsideration Request Do Not Match The Original Claim. Please Clarify.
0481Please Furnish A Breakdown Of Your Procedure Code And Charge In Question GivenOn The Adjustment/reconsideration Request. Please Use This Claim Number For Further Transactions.
0482Services Requiring Prior Authorization Cannot Be Submitted For Payment On A Claim In Conjunction With Non Prior Authorized Services. Please Resubmit Corr
0483Review Has Determined No Adjustment Payment Allowed. Original Payment/denial Processed Correctly.
0484Denied/recouped. Covered By An HMO As A Private Insurance Plan. You Must Either Be The Designated Provider Or Have A Referral.
0485Quantity limits exceeded.
0486Please Clarify Services Rendered/provide A Complete Description Of Service.
0487Please Provide A Legible Claim Form.
0488Please Provide One Way Mileage.
0489General Assistance Payments Should Not Be Indicated On ForwardHealth Claims. Please Correct And Submit.
0490Medicare RA/EOMB And Claim Dates And/or Charges Do Not Match.
0491To allow for Medicare Pricing correct detail denials and resubmit.
0492Changes/corrections Were Made To Your Claim Per Dental Processing Guidelines.
0493Claim Denied Due To Incorrect Billed Amount. Review Patient Liability/paid Other Insurance, Medicare Paid. Do Not Submit Claims With Zero Or Negative Net Billed,
0494Resubmit Complete And/or Second Page Of Medicares EOMB Showing All Total And Payments.
0495Resubmit With Original Medicare Determination (EOMB) Showing Payment Of Previously Processed Charges.
0496Resubmit The Original Medicare Determination (EOMB) Along With Medicares Reconsideration.
0497Please Submit Charges Minus Credit/discount.
0498Pharmaceutical care code must be billed with a valid Level of Effort.
0499Copayment Should Not Be Deducted From Amount Billed. Correct And Resubmit.
0500Extended Care Is Limited To 20 Hrs Per Day.
0501This Claim Is Being Returned. Please Review The Cover Letter Attached To Your Claim, Any Informational Messages, And Provide The Requested Information BeforeResubmitting the Claim.
0502Rental Only Allowed; Medical Need For Purchase Has Not Been Documented.
0503Purchase Only Allowed; Medical Need For Rental Has Not Been Documented.
0504Medical Necessity For Food Supplements Has Not Been Documented.
0505The Service Requested Is Included In The Nursing Home Rate Structure.
0506The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized.
0507The Hearing Aid Recommended Is Not Necessary; The Member Could Be Adequately Fitted With A Conventional Aid.
0508Member Or Participant Identified As Enrolled In A Medicare Part D PrescriptionDrug Plan (PDP). Please Bill Appropriate PDP.
0509The relationship between the Billed and Allowed Amounts exceeds a variance threshold. Verify billed amount and quantity billed. If correct, special billing instructions apply.
0510A valid Prior Authorization is required.
0511This National Drug Code (NDC) is only payable as part of a compound drug.
0512Please Furnish Length Of Time For Services Rendered.
0513Please Indicate Anesthesia Time For Services Rendered.
0514Recommendation Is Made For Extensive Amplification For A Hearing Loss That CanBe Alleviated With A Regular Fitting.
0515The Salzman Index Score Is Under 30.
0516This Request Does Not Meet The Criteria Of Only Basic, Necessary Orthodontic Treatment.
0517Proposed Orthodontic Service Denied; Examination/study Models Are Approved.
0518Quantity Would Always Be 00010 If Number Of Pounds Not Indicated.
0519Claim Denied for implementation of new Wisconsin Medicaid Interchange System.Resubmission of the claim is required due to new claim submission guidelines.
0520Please Indicate Mileage Traveled. Name And Complete Address Of Destination.
0521The Requested Procedure Is Cosmetic In Nature, Therefore Not Covered By ForwardHealth.
0522Gastrointestinal Surgery For The Purpose Of Weight Control Is Covered Only As An Emergency Procedure.
0523The Treatment Request Is Not Consistent With The Member's Diagnosis.
0524Psychotherapy Provided In The Member's Home Is Not A Covered Benefit Of ForwardHealth.
0525The Information Provided Is Not Consistent With The Intensity Of Services Requested.
0526Intensive Multiple Modality Treatment Is Not Consistent With The Information Provided.
0527Multiple Providers Of Treatment Are Not Indicated For This Member.
0528The Duration Of Treatment Sessions Exceed Current ForwardHealth Guidelines.
0529The Total Number Of Sessions Requested Exceeds Quarterly ForwardHealth Guidelines.
0530No Functional Regression Has Occurred To Warrant A Spell Of Illness; Submit AsA Prior Authorization Request.
0531Documentation Does Not Demonstrate The Member Has The Potential To Reachieve his/her Previous Skill Level.
0532Ulcerations Of The Skin Do Not Warrant A New Spell Of Illness.
0533Please Clarify The Number Of Allergy Tests Performed.
0534The Member's Poor Motivation, The Long-standing Nature Of The Disability and aLack Of Progress Substantiate Denial.
0535Other Therapies Currently Provide Sufficient Services To Meet The Member's Needs.
0536The Skills Of A Therapist Are Not Required To Maintain The Member.
0537Use Of Therapy Equipment Alone Is Not Sufficient To Justify Maintenance Therapy.
0538Endurance Activities Do Not Require The Skills Of A Therapist.
0539The Member Appears To Be At A Maximum Level For Age, Diagnosis, And Living Arrangement.
0540Goals Are Not Realistic To The Member's Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service.
0541The Procedure(s) Requested Are Not Medical In Nature.
0542The Member Is Involved In group Physical Therapy Treatment.
0543Please Indicate Quantity Dispensed.
0544The Member Is School-age And Services Must Be Provided In The Public Schools.
0545Member is enrolled in Medicare Part D for the Dispense Date of Service. Submitclaim to the appropriate Medicare Part D plan.
0546The Long-standing Nature Of Disability And The Minimal Progress Of The Member SSubstantiate Denial.
0547Restorative Nursing Can Provide Follow-through, Based On Diagnosis Of Long-standing Nature, And The Amount Of Therapy.
0548General Exercise To Promote Overall Fitness And Flexibility Are Non-covered ForwardHealth Services.
0549Activities To Promote Diversion Or General Motivation Are Non-covered ForwardHealth Services.
0550Modification Of The Request Is Necessitated By The Member's Minimal Progress.
0551Restorative Nursing Involvement Should Be Increased.
0552The Member's Demonstrated Response To Current Therapy Does Not Warrant The Intense Freqency Requested.
0553Maintenance Is 2 Times Per Week Or Less.
0554The Information Provided Indicates Regression Of The Member.
0555The Member's Gait Is Not Functional And Cannot Be Carried Over To Nursing.
0556The Materials/services Requested Are Not Medically Or Visually Necessary.
0557Rimless Mountings Are Not Allowable Through ForwardHealth.
0558The service requested is not allowable for the Diagnosis indicated.
0559The Maximum Allowable Was Previously Approved/authorized.
0560The Materials/services Requested Are Principally Cosmetic In Nature.
0561The Lens Formula Does Not Justify Replacement.
0562The Change In The Lens Formula Does Not Warrant Multiple Replacements.
0563Quantity Would Be 00010 If Specific Number Of Batteries Dispensed Is Not Indicated.
0564Lenses Only Are Approved; Please Dispense A Contracted Frame. The Non-contracted Frame Is Not Medically Justified.
0565The Request Has Been Approved To The Maximum Allowable Level.
0566The Clinical Status Of The Member Does Not Meet Standards Accepted By The Department Of Health And Family Services For Transplant.
0567The Requested Transplant Is Not Covered By ForwardHealth.
0568Level And/or Intensity Of Requested Service(s) Is Incompatible With Medical Need As Defined In Care Plan.
0569Level, Intensity Or Extent Of Service(s) Requested Has Been Modified Consistent With Medical Need As Defined In The Plan Of Care.
0570The Member's Profile Indicates This Member Is Possibly Alcoholic And/or Chemically Dependent, And Intensive Aoda Treatment Appears Warranted.
0571This Member Is Involved In Intensive Day Treatment, Which Is To Include Psychotherapy Services.
0572Additional Psychotherapy Is Not Considered Appropriate Or Inline With More Effective, Available Services.
0573Insufficient Documentation To Support The Request.
0574Only One Ventilator Allowed As Per Stated Condition Of The Member.
0575Medical Need For Equipment/supply Requested Is Not Supported By Documentation Submitted.
0576The Medical Need For Some Requested Services Is Not Supported By Documentation.
0577The Member's Clinical Profile/diagnosis Is Not Within Diagnostic Limitations for Psychotherapy Services.
0578The Type Of Psychotherapy Service Requested For This Member Is Considered To be Professionally Unacceptable, Unproven And/or Experimental.
0579This Member Is Involved In Effective And Appropriate Service Elsewhere, Therefore Is Not Eligible For Further Psychotherapy Services.
0580The Medical Necessity For Psychotherapy Services Has Not Been Documented, ThusMaking This Member Ineligible For The Requested Service.
0581The Performing Provider's Credentials Do Not Meet ForwardHealth Guidelines for The Provision Of Psychotherapy Services.
0582Less Expensive Alternative Services Are Available For This Member.
0583Therapy Prior Authorization Requests Expire At The End Of A Calendar Month.
0584Only One Service/ Per Date Of Service/ Per Provider For Diagnostic Testing Services.
0585Family Planning Indicator is invalid.
0586EPSDT/healthcheck Indicator Submitted Is Incorrect.
0587Supplemental tests billed on the same Date of Service as vision examination are not payable.
0588Supervising Nurse Name Or License Number Required. Please Correct And Resubmit.
0589Qty And/or Detail Charge Do Not Divide Out Equally For Dates Of Service and/orQty Given.
0590Personal Care In Excess Of 250 Hrs Per Calendar Year Requires Prior Authorization.
0591Procedure May Not Be Billed With A Quantity Of Less Than One.
0592Assessment limit per calendar year has been exceeded. Additional services mustbe billed as treatment services and count towards the Mental Health and/or substance abuse treatment policy for prior authorization.
0593Service Must Be Billed On Drug Claim Form Utilizing NDC Codes.
0594Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service.
0595The service was previously paid for this Date of Service.
0596Other Insurance Disclaimer Code Submitted Is Inappropriate For Private HMO Or HMP Coverage. You Must Either Be The Designated Provider Or Have A Refer
0597No Private HMO Or HMP On File. Other Insurance Disclaimer Code Used Is Inappropriate For This Member's Insurance Coverage. Submit Claim To Insurance Carrier.
0598Multiple Unloaded Trips For Same Day/same Recip. Requires A Unique Modifier. ACode With No Modifier Billed On The Same Day As A Code With Modifier 11 Are Viewed as the same trip.
0599Provider Not Eligible For Outlier Payment. Please Resubmit As A Regular Claim If Payment Desired.
0600Contact Member's Hospice for payment of services related to terminal illness.
0601A Hospital Stay Has Been Paid For DOS Indicated. Hospital And Nursing Home Stays Are Not Payable For The Same DOS Unless The Nursing Home Claim Indicated Hospital Bedhold Days.
0602Reimbursement For IUD Insertion Includes The Office Visit.
0603Language Comprehension And Language Production Are Equivalent To Cognition, Thus Formal Speech Therapy Is Not Needed.
0604Progress, Prognosis And/or Behavior Are Complicating Factors At This Time. Speech Therapy Is Not Warranted.
0605Comprehension And Language Production Are Age-appropriate. Formal Speech Therapy Is Not Needed.
0606Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim.
0607Medically Needy Claim Denied. Documentation Does Not Justify Medically Needy Override.
0608RN Supervisory Visits Are Reimbursable Three Times Per Calendar Month.
0609Denied. Ancillary Codes Dates Of Service And/or Quantity Billed Do Not Match Level Of Care authorized Dates.
0610No More Than 2 Medication Check Services (30 Minutes) Are Payable Per Date Of Service.
0611Denied. Only One Federally Required Annual Therapy Evaluation Per Calendar Year, Per Member, Per Provider.
0612Room And Board Is Only Reimbursable If Member Has A BQC Nursing Home Authorization. Contact The Nursing Home.
0613Services Submitted On Improper Claim Form. Rebill Using Correct Claim Form As Instructed In Your Handbook.
0614Member first name does not match Member ID.
0615Modifier Invalid: Modifiers Are No Longer Allowed For Procedure Code Billed.
0616Individual Vaccines And Combination Vaccine Code May Not Be Billed For The Same Dates Of ervice
0617Claim Denied. Please Verify The Units And Dollars Billed. Correct Claim Or Submi Paper Claim Noting That Verification Has Occurred.
0618Repackaging Allowance for this National Drug Code (NDC) is not reimbursable.
0619Claim Denied. Do Not Indicate NS On The Claim When The NDC Billed Is For A Generic Drug.
0620Continuous home care must be billed in an hourly quantity equal to or greater than eight hours, up to and including 24 hours.
0621Hospice Member Services Related To The Terminal Illness Must Be Billed By Hospice Or Attending Physician.
0622Continuous home care and routine home care may not be billed for the same member on the same Date of Service.
0623Inpatient Respite Care Is Not Covered For Hospice Members Residing In Nursing Homes.
0624Please Resubmit Your Non-healthcheck Services Using The Appropriate Claim SortIndicator Or Electronic Format.
0625According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Member's Consent Form. Please Contact The Surgeon Prior To Resubmitting this Claim.
0626Denied. Surgical Procedures May Only Be Billed With A Whole Number Quantity.
0628Note: This PA Request Has Been Backdated A Maximum Of 3 Weeks Prior To Its First Receipt By EDS, Based Upon Difficulty In Obtaining The Physicians Written Prescription.
0629Multiple services performed on the same day must be submitted on the same claim. If some of the services were previously paid, submit an adjustment/reconsideration request for the paid claim.
0630A Valid Level Of Effort Is Required For Billing Compound Drugs Or Pharmaceutical Care.
0631The member is locked-in to a pharmacy provider or enrolled in hospice. Contactmember's hospice for payment of services or resubmit with documentation of unrelated Nature of Care.
0632Independent Nurses, Please Note — Payable Services May Not Exceed 12 Hours/dayOr 60 Hours/week.
0633Clozapine Management is limited to one hour per seven-day time period per provider per member.
0634The Member Has Shown No Significant Functional Progress Toward Meeting Or Maintaining Established & Measurable Treatment Goals Over A 6 Month Period.
0635The Member Has Shown No Ability Within 6 Months To Carry Over Abilities GainedFrom Treatment In A Facility To The Member's Place Of Residence.
0636Program limits were exceeded.
0637Invalid/obsolete Procedure Code For Determination Of Refraction, Service Denied. Rebill Using Correct Procedure Code.
0638Denied/Cutback. Service(s) exceeds four hour per day prolonged/critical care policy. If it is medically necessary to exceed the limitation, submit an Adjustment/Reconsideration request with supporting documentation.
0639Please Provide Copy Of Medicare Explanation Of Benefits/medicare Remittance Advice Attached To Claim.
0640The maximum number of details is exceeded.
0641Healthcheck Screening Limited To Two Per Year From Birth To Age 3 And One Per Year For Age3 Or Older.
0642Referral Codes Must Be Indicated For W7001, W7002, W7003, W7006, W7008 And W7013.
0643Billing Provider is not certified for the detail From Date of Service.
0644Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Please Correct And Resubmit.
0645Research Has Determined That The Member Does Not Qualify For Retroactive Eligibility According To Hfs 106.03(3)(b) Of The Wisconsin Administrative Code.
0646Amount Indicated In Current Processed Line On R&S Report Is The Manual Check You Recently Received. This Check Automatically Increases Your 1099 Earnings.
0647Immunization Questions A And B Are Required For Federal Reporting. Please Complete Information.
0648Claim Not Payable With Multiple Referral Codes For Same Screening Test.
0649Please Indicate Charge And/or Referral Code For Test W7001 When Billing For Test W7006.
0650Please Provide The Type Of Drug Or Method Used To Stop Labor. This Information Is Required For Payment Of Inhibition Of Labor.
0651One RN HH/RN supervisory visit is allowed per Date of Service per provider permember.
0652Supervisory visits for Unskilled Cases allowed once per 60-day period.
0653Insufficient 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.
0654Prior Authorization Is Required For Payment Of This Service With This Modifier. Please Indicate One Prior Authorization Number Per Claim.
0655Cutback/denied. $150.00 Reimbursement Limit Has Been Reached For Individual And Group Pncc Health Education/nutritional Counseling.
0656An ICD-9-CM Diagnosis Code of greater specificity must be used for the First Diagnosis Code.
0657An ICD-9-CM Diagnosis Code of greater specificity must be used for the Second Diagnosis Code.
0658The Quantity Billed for this service must be in whole or half hour increments(.5) Increments.
0659Dental service is limited to once every six months without prior authorization(PA).
0660This Payment Is To Satisfy The Amount Owed For OBRA Nurse Aid Training. PleaseReference Payment Report Mailed Separately.
0661For Correct Liability Reimbursement, Do Not Adjust The Level Of Care Days Claim. You Must Adjust The Nursing Home Coinsurance Claim.
0662Revenue Code Required. Do Not Indicate A Hcpcs Or Cpt Procedure Code On An Inpatient Claim.
0663Another PNCC Has Billed For This Member In The Last Six Months. Concurrent Services Are Not Appropriate.
0664An ICD-9-CM Diagnosis Code of greater specificity must be used for the Third Diagnosis Code.
0665Modifiers are required for reimbursement of these services.
0666A Description Of The Service Or A Photocopy Of The Physician's Signed And Dated Prescription Is Required In Order To Process.
0667This HMO Capitation Payment Is Being Recouped It Was Inappropriately Paid During The Inital February HMO Capitation Cycle.
0668An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fourth Diagnosis Code.
0669An ICD-9-CM Diagnosis Code of greater specificity must be used for the Fifth Diagnosis Code.
0670Prior Authorization Is Required For Payment Of Hospital Exceptional Claims.
0671Denied/Cuback. Risk Assessment/Care Plan is limited to one per member per pregnancy.
0672External Cause Diagnosis May Not Be The Single Or Primary Diagnosis.
0673This Service Is Not Payable Without A Modifier/referral Code.
0674Adjustment/reconsideration Denied, Provider Signature/date Was Not Provided OnThe Adjustment/reconsideration Request.
0675Summarize Claim To A One Page Billing And Resubmit.
0676Service Denied. Please Itemize Services Including Date And Charges For Each Procedure Performed.
0677Subsequent Aide Visits Limited To 7 Hrs Per Day/per Member/per Provider.
0678Billing Provider Type and Specialty is not allowable for the Rendering Provider.
0679The Surgical Procedure Code of greatest specificity must be used.
0680Billing/performing Provider Indicated On Claim Is Not Allowable. This ProviderMay Only Bill For Coinsurance And Deductible On A Medicare Crossover Claim.
0681RN And LPN Subsequent Care Visits Limited To 6 Hrs Per Day/per Member/per Provider.
0682Please Resubmit Medicare's Nursing Home Coinsurance Days As A New Claim RatherThan An Adjustment/reconsideration Request.
0683Member enrolled in QMB-Only Benefit plan. Only Medicare Crossover claims are reimbursed for coinsurance, copayment, and deductible.
0684Files Indicate You Are A Medicare Provider And Medicare Benefits May Be Available On This Claim. Please Bill Your Medicare Intermediary Prior To Submitting To ForwardHealth.
0685Claim Paid Under DRG Reimbursement, Except For Transplants Billed Using Suffixes 05 Through 09.
0686This Payment Is To Satisfy The Amount Owed For OBRA Level 1. Please Reference Payment Report Mailed Separately.
0687Maximum Reimbursement Amount Has Been Determined By Professional Consultant. Submit Claim To ForwardHealth For Reimbursement.
0688HPSA-enhanced reimbursement included.
0689Denied. This Dental Service Limited To Once Every Six Months, Unless Prior Authorized.
0690Bill The Single Appropriate Code That Describes The Total Quantity Of Tests Performed.
0691Denied. Service Allowed Once Per Lifetime, Per Tooth.
0692Our Records Indicate This Tooth Previously Extracted. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement.
0693This dental service limited to once per five years.Prior Authorization is needed to exceed this limit.
0694Denied. Primary Tooth Restorations Limited To Once Per Year Unless Claim Narrative Documents Medical Necessity.
0695Denied. This Dental Service Limited To Once A Year.
0696Denied. Outside Lab Indicator Must Be Y For The Procedure Code Billed.
0697The number of tooth surfaces indicated is insufficient for the procedure code billed.
0698Member is not enrolled in ForwardHealth/BadgerCare Plus for the Date(s) of Service.
0699According To Our Records, The Hospital Has Not Received Prior Authorization For This Surgery. Please Contact The Hospital Prior Resubmitting This Claim.
0700Diagnosis Treatment Indicator is invalid.
0701Service Denied. Diagnosis V25.2 May Only Be Used When Billing For Sterilization Procedures. Please Correct And Resubmit.
0702Member has commercial dental insurance for the Date(s) of Service.
0703Date Of Service/procedure/charges On Medicare EOMB Do Not Match The Original Claim. Please Clarify.
0704Claim Denied The Combined Medicare And Private Insurance Payments Equal Or Exceed The Lesser Of The ForwardHealth And Medicare Allowable Amounts.
0705Healthcheck screenings or outreach is limited to six per year for members up to one year of age.
0706Healthcheck screenings or outreach limited to three per year for members between the age of one and two years.
0707Healthcheck screenings or outreach limited to two per year for members betweenthe ages of two and three years.
0708HealthCheck screenings/outreach limited to one per year for members age 3 or older.
0709One Visit Allowed Per Day, Service Denied As Duplicate.
0710Members Age 3 And Older Must Have An Oral Assessment And Blood Pressure Check.With Appropriate Referral Codes, For Payment Of A Screening.
0711All The Teeth Do Not Meet Generally Accepted Criteria Requiring Periodontal Sealing And Root Planning.
0712All The Teeth Do Not Meet Generally Accepted Criteria Requiring Gingivectomy.
0713Dental X-rays Indicate A Dental Cleaning, Followed By Good Dental Care At Home, Would Be Sufficient To Maintain Healthy Gums.
0714Backdating Allowed Only In Cases Of Retroactive Member/provider Eligibility.
0715The Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS.
0716The Value Code and/or value code amount is missing, invalid or incorrect.
0717Billing Provider Name Does Not Match The Billing Provider Number.
0718Referring Provider ID is invalid. Referring Provider ID is not required for this service.
0719Admission Date does not match the Header From Date of Service.
0720Billing Provider is not certified for the Date(s) of Service.
0721More Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable.
0722Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months.
0723A Procedure Code without a modifier billed on the same day as a Procedure Codewith modifier 11 are viewed as the same trip.
0724Disposable medical supplies are payable only once per trip, per member, per provider.
0725Medicare Part A Or B Charges Are Missing Or Incorrect.
0726Non-covered Charges Are Missing Or Incorrect.
0727Payment Subject To Pharmacy Consultant Review.
0728Bilateral Surgeries Reimbursed At 150% Of The Unilateral Rate.
0729Dental service is limited to once every six months. This limitation may only exceeded for x-rays when an emergency is indicated.
0730Only the initial base rate is payable when waiting time is billed in conjunction with a round trip.
0731Payment Reduced In Accordance With ForwardHealth Guidelines For Ambulatory Surgical Procedures Performed In Place Of Service 21.
073251.42 Board Stamp Required On All Outpatient Specialty Hospital Claims For Dates Of Service On Or After January 1, 1986.
0733Day Treatment exceeding 120 hours per month is not payable regardless of PriorAuthorzation
0734Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd.
0735The DHS Has Determined This Surgical Procedure Is Not A Bilateral Procedure. Reimbursement Is At The Unilateral Rate.
0736Payment Reduced Due To Patient Liability. Incorrect Liability Start/end DatesOr Dollar Amounts Must Be Corrected Through County Social Services Agency.
0737Paid In Accordance With Dental Policy Guide Determined By DHS.
0738Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook.
0739Nursing Home Visits Limited To One Per Calendar Month Per Provider.
0740Anesthesia Modifying Services Must Be Billed Separately From The Charge For Anesthesia Base And Time Units.
0741Procedure Code 59420 Must Be Used For 5 Or More Prenatal Visits With One Charge. Dates Of Service Must Be Itemized.
0742TPA Certification Required For Reimbursement For This Procedure
0743This Adjustment Was Initiated By ForwardHealth. It Corrects A Mispayment FoundDuring Claims Processing Or Resulting From Retroactive File Changes.
0744Multiple Carry Procedure Codes Are Not Payable When Billed With Modifiers.
0745Reimbursement for mycotic procedures is limited to six Dates of Service per calendar year.
0746Routine foot care is limited to no more than once every 61days per member.
0747Routine Foot Care Procedures Must Be Billed With Valid Routine Foot Care Diagnosis.
0748Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures.
0749Routine foot care Diagnoses must be billed with valid routine foot care Procedure Codes.
0750Nine Digit DEA Number Is Missing Or Incorrect.
0751Denied. No Substitution Indicator Invalid For Non-innovator Drugs Not On The Current Wisconsin MAC List.
0752The Total Number Of Hours Per Day Requested For AODA Day Treatment Exceeds ForwardHealth Guidelines And The Request Has Been Adjusted Accordingly.
0753This Request Can Only Be Backdated To The Date EDS First Receives The Request In The Mailroom.
0754An Approved AODA Day Treatment Program Cannot Exceed A 6 Week Period.
0755Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. The Request Has Been Back datedto Date of Receipt.
0756The Request Can Only Be Backdated Up To 5 Working Days Prior To The Date Eds Receives The Request In Eds' Mailroom If Adequate Justification Is Provided.
0757This Member Has A Current Approved Authorization For Intensive AODA OutpatientServices.
0758The Members Reported Diagnosis Is Not Considered Appropriate For AODA Day Treatment.
0759Our Records Indicate This Provider Is Not Certified For AODA Day Treatment.
0760There Is Evidence That The Member Is Not Detoxified From Alcohol And/or Other Drugs and is Therefore Not Currently Eligible For AODA Day Treatment.
0761The Member Does Not Appear To Be Able Or Willing To Abstain From Alcohol/drug Usage While in Treatment And Is Therefore Not Eligible For AODA Day Treatment.
0762The Information Provided Indicates This Member Is Not Willing Or Able To Participate Inaftercare/continuing Care Services And Is Therefore Not Eligible For AODA Day Treatment.
0763The Member Does Not Appear To Meet The Severity Of Illness Indicators Established by the Wisconsin ForwardHealth And Is Therefore Not Eligible For AODA Day Treatment.
0764This Member Has Completed Intensive AODA Treatment Within The Past 12 Months and Documentation Provided Is Not Adequate To Justify Intensive Treatment at this time.
0765This Program Does Not Appear To Meet The Minimum Requirement For AODA Day Treatment Programming (10hrs) And Does Not Qualify For Aoda Day Treatment.
0766AODA Day Treatment Is Not A Covered Service For Members Who Are Residents Of Nursing Homes or Who Are Hospital Inpatients.
0767Time Spent In AODA Day Treatment By Affected Family Members Is Not Covered.
0768HMO Capitation Claim Greater Than 120 Days.
0769Only One Interperiodic Screen Is Allowed Per Day, Per Member, Per Provider.
0770The Revenue Code is not allowed for the Type of Bill indicated on the claim.
0771Member has Medicare Managed Care for the Date(s) of Service.
0772Occurrence Codes 50 And 51 Are Invalid When Billed Together.
0773Occurrence Date is missing or invalid
0774Services Included In The Inpatient Hospital Rate Are Not Separately Reimbursable.
0775Service Denied. Modifier Submitted Is Invalid For The Member Age.
0776The provider is not listed as the member's provider or is not listed for thesedates of service.
0777This Payment Is A Refund For An Overpayment Of A Provider Assessment
0778Thank You For Your Assessment Payment By Check
0779In Accordance With Your Request, EDS Has Deducted Your Assessment From This Payment
0780This Represents Your Incentive Payment
0781Thank You For Your Assessment Interest Payment.
0782This Payment Is To Satisfy Amount Owed For A Drug Rebate Prior Quarter Correction.
0783Service Denied. Only One Panel Code Within Same Category (CBC Or Chemistry) Maybe Performed Per Member/Provider/Date Of Service.
0784Denied/Cutback. Only one initial visit of each discipline (Nursing) is allowedper day per member.
0785A Less Than 6 Week Healing Period Has Been Specified For This PA. Therefore itIs Not Necessary To Wait The Full 6 Weeks After Extractions Before Taking Denture Impressions.
0786Denied. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity.
0787Denied. Intraoral Complete Series/comprehensive Oral Exam Limited To Once Every Three Years, Unless Prior Authorized.
0788Denied. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period.
0789Dental service limited to twice in a six month period.
0790Service Denied. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19.
0791Denied. This Procedure Is Denied Per Medical Consultant Review.
0792Denied. Procedure Code Modifier(s) Invalid For Date Of Service Or For Prior Authorization Date Of Receipt.
0793Denied. Provider Must Have A CLIA Number To Bill Laboratory Procedures.
0794Procedure not allowed for the CLIA Certification Type.
0795Complex Evaluation and Management procedures require history and physical or medical progress report to be submitted with the claim.
0796Handwritten Changes/corrections On The Medicare EOMB Are Not Acceptable. Please Request A Corrected EOMB Through The Medicare Carrier And Adjust With The Corrected EOMB.
0797This Procedure Code Requires A Modifier In Order To Process Your Request.
0798The Second Modifier For The Procedure Code Requested Is Invalid.
0799Reimbursement Denied For More Than One Dispensing Fee Per Twelve Month Period,fitting Of Spectacles/lenses With Changed Prescription.
0800Payment(s) For Capital Or Medical Education Are Generated By EDS And May Not Be Billed By The Provider.
0801One or more Diagnosis Codes are not applicable to the member's gender.
0802Discharge Diagnosis 2 Is Not Applicable To Member's Sex.
0803Discharge Diagnosis 3 Is Not Applicable To Member's Sex.
0804Discharge Diagnosis 4 Is Not Applicable To Member's Sex.
0805Discharge Diagnosis 5 Is Not Applicable To Member's Sex.
0806Etiology Diagnosis Code(s) (E-Codes) are invalid as the Admitting/Principal Diagnosis 1.
0807Diagnosis Code indicated is not valid as a primary diagnosis. Correct And Resubmit.
0808Secondary Diagnosis Code(s) in positions 2-9 cannot duplicate the Primary Discharge Diagnosis.
0809This claim must contain at least one specified Surgical Procedure Code. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes.
0810A covered DRG cannot be assigned to the claim. The information on the claim isinvalid or not specific enough to assign a DRG.
0811Relative Weight Not On File.
0812Denied/Cutback. Reimbursement limit for all adjunctive emergency services is exceeded.
0813Claim reimbursement has been cutback to reimbursement limits for denture repairs performed within 6 months. If laboratory costs exceed reimbursement, submit a claim adjustment request with lab bills for reconsideration.
0814Service not covered as determined by a medical consultant
0815Denied/Cutback. Home Health visits (Nursing and therapy) in excess of 30 visits per calendar year per member require Prior Authorization.
0816Denied/Cutback. Therapy visits in excess of one per day per discipline per member are not reimbursable.
0817Charges For Additional Days Of Stay Or Final Payment Must Be Submitted As An Adjustment.
0818Six Week Healing Time Is Required Between Endentulation And Final Impressions.Payment For Dentures Will Be Denied Or Recouped If Healing Period Is Not Observed.
0819Denied/Cutback. Limited to once per quadrant per day.
0820CRNA's, AA's, And Anesthesiologists Supervising CRNA's/AA's Must Bill AnesthesiA Services Using The Appropriate Modifier. Refer To Provider Handbook.
0821Assessment Is Not A Covered Service Unless All Four Components Of Skilled Nursing Are Present: Assessment, Planning, Intervention And Evaluation.
0822Documentation Indicates That Client Is Able To Direct Cares And Can Safely Direct A PCW.
0823Documentation Indicates No Medically Oriented Tasks Are Being Done, Therefore A PCW Is Being Authorized.
0824Procedure Code is not covered for members with a Nursing Home Authorization onthe Date(s) of Service.
0825Case Plan and/or assessment reimbursment is limited to one per calendar year.Calendar Year.
0826Service is reimbursable only once per calendar month.
0827As A Reminder, This Procedure Requires SSOP. If You Have Already Obtained SSOP, Please Disregard This Message.
0828Claim Denied. Level Of Care/accommodation Code Billed Is Not Applicable To Your Provider Specialty. Please Contact Your District Nurse To Have This Corrected.
0829Timely Filing Deadline Exceeded. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation.
0830Timely Filing Deadline Exceeded. Claim/adjustment Received Beyond The 455 Day Resubmission Deadline.
0831Timely Filing Deadline Exceeded. Rec'd Beyond 90 Days Special Filing Deadline FOr System Generated Adjmts/Medicare X-overs/Other Insurance Reconsideration/Cou rt Order/Fair Hearing
0832Orthosis additions is limited to two per Orthosis within the two year life expectancy of the item without Prior Authorization.
0833Rn Visit Every Other Week Is Sufficient For Med Set-up.
0834Critical care performed in air ambulance requires medical necessity documentation with the claim. Critical care in non-air ambulance is not covered.
0835This Member Has Prior Authorization For Therapy Services. Once Therapy Is Prior Authorized, All Therapy Must Be Billed With A Valid Prior Authorization Number.
0836For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present.
0837Individual Test Paid. Panel And Individual Test Not Payable For Same Member/Provider/ Date Of Service. Previously Paid Individual Test May Be Adjusted Under a Panel Code.
0838Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days.
0839Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling.
0840Denied. Bilateral Procedures Must Be Billed On One Detail With Modifier 50, Quantity Of 1.detail With Modifier 50 May Be Adjusted If Necessary.
0841The timely filing deadline was exceeded.
0842Denied. Member Is Enrolled In A Family Care CMO.
0843All three DUR fields must indicate a valid value for prospective DUR. A valid Level of Effort is also required for pharmacuetical care reimbursement.
0844Personal care subsequent and/or follow up visits limited to seven per Date of Service per member.
0845Service(s) Denied. SMV Or Prescribing Provider Description Code(s) Missing OrInvalid.
0846Denied. This Procedure Code Is Not Valid In The Pharmacy Pos System. Please Submit On The Cms 1500 Using The Correct Hcpcs Code.
0847Pharmacy Clm Submitted Exceeds The Number Of Clms Allowed Per Cal. Wk. (part JHandbook).
0848Medicare Coinsurance Amount Was Not Provided On Crossover Claim. Please Add The Coinsurance Amount And Resubmit.
0849We Have Determined There Were (are) Several Home Health Agencies Willing To Provide Medically Necessary Skilled Nursing Services To This Member.
0850Claim Detail 'from' Date Of Service And 'to' Date Of Service Are Required And Must Be Within The Same Calendar Month.
0851Principal Diagnosis 6 Not Applicable To Member's Sex.
0852This National Drug Code (NDC) requires a whole number for the Quantity Billed.
0853Dispense date of service is required.
0854Principal Diagnosis 7 Not Applicable To Member's Sex.
0855Principal Diagnosis 8 Not Applicable To Member's Sex.
0856Principal Diagnosis 9 Not Applicable To Member's Sex.
0857Denied. Resubmit Private Duty Nursing Services For Complex Children With Documentation Supporting The Level Of Care.
0858The revenue accomodation billing code on the claim does not match the revenue accomodation billing code on the member file or does not match for these dates of service.
0859Modifiers submitted are invalid for the Date of Service or are missing..
0860An ICD-9-CM Diagnosis Code of greater specificity must be used for the Sixth Diagnosis Code.
0861An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code.
0862An ICD-9-CM Diagnosis Code of greater specificity must be used for the Eighth Diagnosis Code.
0863An ICD-9-CM Diagnosis Code of greater specificity must be used for the Ninth Diagnosis Code.
0864Documentation You Have Submitted Does Not Meet The Requirements Of HSS 107.09(4)(k).
0865This Service Is Covered Only In Emergency Situations. Refer To Dental HandbookOn Billing Emergency Procedures.
0866Value Codes 81 And 83, Are Valid Only When Submitted On An Inpatient Claim.
0867Denied. This Procedure Is Limited To Once Per Day. Please Review The Covered Services Appendices Of The Dental Handbook.
0868Denied. Election Form Is Not On File For This Member. Resubmit Claim Once Election Form Requirements Are Met Per The Hospice Provider Handbook.
0869Denied. Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member.
0870Denied/cutback. Complex Care Services Are Limited To One Per Date Of Service Per Member.
0871Denied. PNCC Risk Assessment Not Payable Without Assessment Score.
0872This Payment Is To Satisfy Amount Owed For OBRA (PASARR) Level II Screening.
0873The Medical Necessity For The Hours Requested Is Not Supported By The Information Submitted In The Personal Care Assessment Tool.
0874The Documentation Submitted Indicates The Tasks Specified Can Be Completed During The Visits Approved.
0875Recouped. Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member.
0876Child Care Coordination services are reimbursable only if both the member and provider are located in Milwaukee County.
0877The Quantity Allowed Was Reduced To A Multiple Of The Product's Package Size
0878The Documentation Submitted Does Not Indicate Medically Oriented Tasks Are Medically Necessary, Therefore Personal Care Services Have Been Approved.
0879DX Of Aphakia Is Required For Payment Of This Service
0880Dates Of Service For Purchased Items Cannot Be Ranged. Only One Date For EachService Must Be Used.
0881ICD-9-CM Diagnosis Code 6 Is Invalid
0882ICD-9-CM Diagnosis 7 Is Invalid
0883ICD-9-CM Diagnosis 8 Is Invalid
0884ICD-9-CM Diagnosis Code 9 Is Invalid
0885The Use Of This Drug For The Intended Purpose Is Not Covered By ForwardHealth,Consistent With Wisconsin Administrative Code Hfs 107.10(4) And 1396r-8(d)
0886Denied. The Service Billed Does Not Match The Prior Authorized Service.
0887Default Prescribing Physician Number XX5555555 Was Indicated. Valid Numbers Are Important For DUR Purposes. Please Obtain A Valid Number For Future Use.
0888Default Prescribing Physician Number XX9999991 Was Indicated. Valid Numbers Are Important For DUR Purposes. Please Verify That Physician Has No DEA Number.
0889Prescriber Number Supplied Is Not On Current Provider File. Valid Numbers AreImportant For DUR Purposes. Please Ask Prescriber To Update DEA Number On TheProvider File.
0890Claim Corrected. Revenue Code 0001 Can Only Be Indicated Once.
0891Claim Corrected. A Total Charge Was Added To Your Claim.
0892Payment Reflects Allowed Services In Accordance With Pre And Post Operative Guidelines.
0893Service Denied. Please Select A Procedure Code In The 58980-58988 Range That Best Describe's The Procedure Being Performed.
0894Rendering Provider may not submit claims for reimbursement as both the Surgeonand Assistant Surgeon For The Same Member On The Same DOS.
0895Two different providers cannot be reimbursed for the same procedure for the same member on the same Date of Service.
0896Active Treatment Dose Is Only Approved Once In Six Month Period.
0898Claims With Dollar Amounts Greater Than 9 Digits.
0899Service Denied. Case Planning And/or On-going Monitoring For Both Targeted Case Managementand Child Care Coordination Are Not Allowed In The Same Month.
0900Due To Non-covered Services Billed, The Claim Does Not Meet The Outlier Trim Point.
0901The From Date of Service and To Date of Service must be in the same calendar month and year.
0902You Must Bill Medicare, ESRD Patient.
0903The Member Has Received A 93 Day Supply Within The Past Twelve Months.
0904Other Insurance Or Medicare Response Not Received Within 120 Days For ProviderBased Bill.
0905Per Provider, Second Opinion Obtained
0906This Adjustment/reconsideration Request Was Initiated By ForwardHealth. It Corrects Claim Information Found During Research Of An OBRA Drug Rebate Dispute.
0907Our Records Indicate You Have Billed More Than One Unit Dose Dispensing Fee For This Calendar Month. Reimbursement For This Detail Does Not Include Unit DoseDispensing Fee.
0908This Payment Is To Satisfy The Amount Indicated On The ForwardHealth Administrative Claiming Reimbursement Summary Report. This Report Was Mailed To You Separately.
0909Denied. Effective With Claims Received On And After 10/01/03 , Occurrence Codes 50 And 51 Are Invalid. Please Resubmit Using Newborns Name And ForwardHealth Number.
0910ForwardHealth Payment Recouped. Medicare Claim Copy And EOMB Have Been Submitte d For Processing Of Coinsurance And Deductible. No Action Required.
0911Service(s) Denied By DHS Transportation Consultant. Prescribing Provider UPIN Or ForwardHealth Provider Number Missing From Claim And Attachment.
0912Denied. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member.
0913Service Denied. Prescribing Provider UPIN Or ForwardHealth Provider Number Missing.
0914Service Not Covered For Members Medical Status Code.
0915Denied. Revenue Codes 0110 (N6) And 0946 (N7) Are Not Payable When Billed On The Same Dateof Service As Bedhold Days.
0916Pharmaceutical Care Codes Are Billable On Non-compound Drug Claims Only.
0917Denied. Care Does Not Meet Criteria For Complex Case Reimbursement. Resubmit Using Valid Rn/lpn Procedure Codes And A Valid PA Number.
0918Medicare Disclaimer Code invalid. Member is not Medicare enrolled and/or provider is not Medicare certified.
0919Billing Provider does not have required Certification Addendum on file.
0920Other Coverage Code is missing or invalid.
0921Service(s) Approved By DHS Transportation Consultant.
0922Duplicate ingredient billed on same compound claim.
0923Reimbursement for this procedure and a related procedure is limited to once per Date of Service.
0924Request Denied. The Medical Records Submitted With The Current Request Conflict Or Disagree With Our Medical Records On This Member.
0925This procedure is limited to once per day.
0926Denied. Preventive Medicine Code Billed Is Allowed For Health Check Agencies Only With The Appropriate Healthcheck Modifier.
0927Claim Denied. Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item.
0928A six week healing period is required after last extraction, prior to obtaining impressions for denture.
0929Denied. Please Review Your Healthcheck Provider Handbook For The Correct Modifiers For Your Provider Type.
0930Reimbursement Based On Members County Of Residence
0931Condition Code is missing/invalid or incorrect for the Revenue Code submitted.
0932Only Healthcheck Modifiers Can Be Billed With Healthcheck Services.
0933Service is covered only during the first month of enrollment in the Home and Community Based Waiver.
0934Denied. Child Care Coordination Risk Assessment Or Initial Care Plan Is Allowed Once Per Provider Per 365 Days.
0935Invalid Billing Of Procedure Code.
0936Approved. To Continue Treatment With Two Anti-ulcer Drugs Beyond Authorized Limit Please Submit Request On Paper With Clinical Documentation Clearly Indicating medical necessity.
0937This claim is being denied because it is an exact duplicate of claim submitted.
0938Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA.
0939Denied. Units Billed Are Inconsistent With The Billed Amount. Please Correct And Re-bill.
0940DME rental is limited to 90 days without Prior Authorization.
0941This Unbundled Procedure Code And Billed Charge Were Rebundled To Another Code, Which Was Either Billed By The Provider On This Claim Or Added By Claimcheck.
0942this Procedure Code Is Denied As Mutually Exclusive To Another Code Billed On This Claim.
0943This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim.
0944Quantity Billed is not equally divisible by the number of Dates of Service on the detail.
0945Services on this claim have been split to facilitate processing.on On Your Part Is Required.
0946This Unbundled Procedure Code Remains Denied. Please Refer To The Original R&S.
0947This Mutually Exclusive Procedure Code Remains Denied. Please Refer To The Original R&S.
0948This Incidental/integral Procedure Code Remains Denied. Please Refer To The Original R&S.
0949Claimcheck's Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Reimbursement For This Service Has Been Approved.
0950Denied. Do Not Bill Intraoral Complete Series Components Separately. Send An Adjustment/reconsideration Request On The Previously Paid X-ray Claim For This
0951Services Can Only Be Authorized Through One Year From The Prescription Date.
0952Claimcheck's Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Additional Reimbursement Is Denied.
0953Billing Provider Received Payment From Both Medicare And ForwardHealth For Clai m. An Adjustment/reconsideration Request Has Been Made To The Billing Providers Account.
0954Denied. Dispensing Two Lens Replacements On Same Date Of Service Not Allowed.
0955Per Information From Insurer, Claims(s) Was (were) Paid.
0956Per Information From Insurer, Claim(s) Was (were) Not Submitted.
0957Other Payer Coverage Type is missing or invalid.
0958Denied. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment.
0959Denied. The Insurance EOB Does Not Correspond To The Dates Of Service/servicesBeing Billed.
0960Denied. These Supplies/items Are Included In The Purchase Of The Dme Item Billed On The Same Date Of Service.
0961Speech therapy limited to 35 treatment days per lifetime without prior authorization.
0962Member does not have commercial insurance for the Date(s) of Service.
0963Physical therapy limited to 35 treatment days per lifetime without prior authorization.
0964Denied. Medicare Disclaimer Code Used Inappropriately.
0965Occupational therapy limited to 35 treatment days per lifetime without prior authorization.
0966Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. Services In Excess Of This Cap Are Not Reimbursable for this Member.
0967This Claim Has Been Excluded From Home Care Cap To Allow For Acute Episode. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00).
0968Denied. Services For Members With Medical Status Code TR, SH, SJ, TS Or ST NotAllowed For Your Provider Type, Or For Your Provider Type without a TB Diagnosis.
0969Member enrolled in Tuberculosis-Related Services Only Benefit Plan. Services not allowed for your Provider Type or for your Provider Type without a TB diagnosis.
0970More than 50 hours of personal care services per calendar year require prior authorization.
0971Denied. Exceeds The 35 Treatment Days Per Spell Of Illness. Please Request Prior Authorization For Additional Days.
0972Denture Repair And/or Recement Bridge Must Be Submitted On A Paper Claim With ADescription Of Service And Documentation Of A Healthcheck Screen Attached.
0973Per Information From Insurer, Requested Information Was Not Supplied By The Provider.
0974Denied. Providers May Only Bill For Assessments And Care Plans Twice Per Calendar Year.
0975Per Information From Insurer, Prior Authorization Was Not Requested/approved Prior To Providing Services.
0976Resubmit On Paper For Special Handling.
0977Claim Or Adjustment/reconsideration Request Should Include An Operative Or Pathology Report For This Procedure.
0978Abortion Dx Code Inappropriate To This Procedure
0979Pharmaceutical Care Code must be billed with a payable drug detail or if a prescription was not filled, the quantity dispensed must be zero.
0980Service Denied. Invalid Procedure Code For Dx Indicated.
0981Service Denied. Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code.
0982Reimbursement Is Limited To The Average Monthly ForwardHealth Nursing Home Cost And Services Above That Amount Are Considered Non-covered Services.
0983Rqst For An Acute Episode Is Denied. Services Requested Do Not Meet The Criteria for an Acute Episode. Reimb Is Limited to the Average Monthly ForwardHealthNH Cost and Services Above that Amount Are Considered non-Covered Services.
0984Rqst For An Exempt Denied. Recip Does Not Meet The Reqs For An Exempt. Reimb Is Limited To The Average Montly ForwardHealth NH Cost And Services Above that Amount Are Considered non-Covered Services.
0985Rqst For An Acute Episode Is Denied. Member Has Already Been Granted Actute Episode for 3 Months In This Cal Yr. Reimb Is Limited To Average Monthy ForwardHealth NH Cost And Services Above That Are Consider Non-covered Services.
0986Req For Acute Episode Is Denied. The Services Requested Do Not Meet Criteria For An Acute Episode. Reimburse Is Limited To Average Monthly ForwardHealth NHCost And Services Above That Amount Are Consider non-Covered Services.
0987Surgical Procedure Code is not related to Principal Diagnosis Code. DRG cannotbe determined. Reimbursement determination has been made under DRG 981, 982, or 983. Recoding/adjusting claim may result in a different DRG code assignmentand reimbursement.
0988Claim Is For A Member With Retro Ma Eligibility. Wis Adm Code 106.04(3)(b) Requires Providers To Reimburse The Person/party (eg, County) That Previously
0989Claim Denied. Attachment was not received within 35 days of a claim receipt.
0990Denied. Services For New ForwardHealth Admissions Are Not Payable When The Facility Is Not In Compliance With 42 CFR, Part 483, Subpart B. Refer To Notice From DHS.
0991Non-payable Informational Pcc Detail
0992Denied/Cutback. The disposable medical supply Procedure Code has a quantity limit as indicated in the DMS Index. Prior Authorization is required to exceed this limit.
0993Claim Denied/cutback. This Dms Item Is Limited To 12 Per 30 Days, Per Provider, Without Prior Authorization.
0994Compound drugs require a minimum of two components with at least one payable FowardHealth covered drug.
0995Claim Denied. Resubmit Your Services Using The Appropriate Modifier After YouReceive A ForwardHealth Update Providing Additional Billing Information.
0996Pharmacuetical care limitation exceeded. Refer To Your Pharmacy Handbook For Policy Limitations.
0997PA Received With Web Pcst Summary Sheet.
0998SMV Mileage Exceeding 40 Miles In Urban Counties Or 70 Miles In Rural CountiesRequires Prior Authorization.
0999Rural Health Clinics May Only Bill Revenue Codes On Medicare Crossover Claims
1000Claim Pended For Examiner Review
1001COB- Benefit Plan
1002COB — Payer
1100The amount in the Other Insurance field is invalid.
1101Quantity Billed is invalid.
1102The Admit Date is invalid.
1103The Number of Covered Days is required.
1104A number is required in the Covered Days field.
1105One or more Occurrence Code Date(s) is invalid in positions nine through 24.
1106Interim billing criteria not met.
1107Admit Date and From Date of Service must match.
1108An amount in the Gross Amount Due field and/or Usual and Customary Charge field is required.
1109Rendering Provider is not a certified provider for ForwardHealth.
1110Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program.
1111Rendering Provider is not a certified provider for Wisconsin Well Woman Program.
1112A National Provider Identifier (NPI) is required for the Rendering Provider listed in the header.
1113Services are not payable. Member is in a divestment penalty period.
1114Denied. The Dispense As Written (Daw) Indicator Is Not Allowed For The National Drug Code.
1115Denied. This National Drug Code Has Diagnosis Restrictions.
1116The Revenue Code requires an appropriate corresponding Procedure Code.
1117The National Drug Code (NDC) has an age restriction.
1118The National Drug Code (NDC) has a quantity restriction.
1119One or more Diagnosis Codes has an age restriction.
1120One or more Diagnosis Codes has a gender restriction.
1121Member does not meet the age restriction for this Procedure Code.
1122Family Planning Funding 90% .
1123Family Planning Funding Fed Match
1124Family Planning Funding Error
1125A federal drug rebate agreement for this drug is not on file for the Date of Service.
1126Second modifier code is invalid for Date of Service.
1127Third modifier code is invalid for Date of Service.
1128A tooth number or letter is required.
1129Occurrence Code is required when an Occurrence Date is present.
1130One or more Condition Code(s) is invalid in positions eight through 24.
1131The Primary Occurrence Code is invalid.
1132A Primary Occurrence Code Date is required.
1133Principal Surgical Code Date is invalid.
1134First Occurrence Span Code is invalid.
1135One or more From Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24.
1136The Area of the Oral Cavity is invalid.
1137Value Code is invalid.
1138Value Code amount is invalid.
1139Header From Date of Service is after the date of receipt of the claim.
1140A WCDP drug rebate agreement for this drug is not on file for the Date of Service.
1141Member enrolled in Medicare Part D for the Dispense Date of Service. Prescription Drug Plan (PDP) payment/denial information required on the claim to WCDP.
1142This Modifier has been discontinued by CMS or AMA for the Date of Service(s).
1143Accomodation Code(s) is not payable.
1144This National Drug Code (NDC) has been terminated by CMS for the Date of Service.
1145Area of the Oral Cavity is required for Procedure Code.
1146The Second Other Provider ID is missing or invalid.
1147Admit Diagnosis Code is invalid.
1148Second Diagnosis Code is invalid.
1149Third Diagnosis Code is invalid.
1150Fourth Diagnosis Code is invalid.
1151The Fifth Diagnosis Code is invalid.
1152The Sixth Diagnosis Code is invalid.
1153The Seventh Diagnosis Code is invalid.
1154The Eighth Diagnosis Code is invalid.
1155The Ninth Diagnosis Code is invalid.
1156Primary Diagnosis Code is invalid.
1157One or more Diagnosis Code(s) is invalid in positions 10 through 25.
1158Primary Diagnosis Code is required.
1159One or more Diagnosis Code(s) is invalid for the Date(s) of Service.
1160Primary Diagnosis Code is not on file.
1161Secondary Diagnosis Code is not on file.
1162Third Diagnosis Code is not on file.
1163Fourth Diagnosis Code is not on file.
1164Fifth Diagnosis Code is not on file.
1165Sixth Diagnosis Code is not on file.
1166Seventh Diagnosis Code is not on file.
1167Eighth Diagnosis Code is not on file.
1168Ninth Diagnosis Code is not on file.
1169One or more Diagnosis Code(s) in positions 10 through 25 is not on file.
1170Tenth diagnosis is invalid.
1171Eleventh diagnosis is invalid.
1172Twelfth diagnosis is invalid
1173Tenth diagnosis is not on file.
1174The procedure code is not reimbursable for a Family Planning Waiver member.
1175The Patient Status Code is invalid.
1176Denied. Claim/adjustment/reconsideration Request Received After 730 Days From Date(s) of Service.
1177Patient Location is invalid.
1178Service is not reimbursable for Date(s) of Service.
1179Valid quantity billed is required.
1180Prescription Date is after Dispense Date of Service.
1181Dispense Date of Service exceeds Prescription Date by more than one year.
1182Incorrect Or Invalid National Drug Code Billed.
1183Header From Date of Service is after the header To Date of Service.
1184The Header and Detail Date(s) of Service conflict.
1185The Procedure Code is not payable by Wisconsin Chronic Disease Program for theDate(s) of Service.
1186The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service.
1187The Revenue Code is not payable for the Date(s) of Service.
1188The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date(s) of Service.
1189The Revenue Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service.
1190One or more Diagnosis Code(s) is not payable for the Date of Service.
1191One or more Diagnosis Code(s) is not payable for the Date of Service.
1192One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service.
1193Dispense Date of Service is after Date of Receipt of claim.
1194Billed Amount is not equally divisible by the number of Dates of Service on the detail.
1195The Procedure Code is not reimbursable for the Rendering Provider Type and/or Specialty.
1196Denied. Member In TB Benefit Plan. Services Not Allowed For Your Provider T
1197The Procedure Code has Place of Service restrictions.
1198A National Drug Code (NDC) is required for this HCPCS code.
1199Multiple National Drug Codes (NDCs) are not allowed for this HCPCS code or NDCand HCPCS code are mismatched.
1200The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program.
1201Invalid quantity for the National Drug Code (NDC) submitted with this HCPCS code.
1202Prescriber ID is required.
1203Out of State Billing Provider not certified on the Dispense Date.
1204Billing Provider is not certified for the Date(s) of Service.
1205Out Of State Billing Provider Not Enrolled For Entire Detail DOS Span.
1207A National Provider Identifier (NPI) is required for the Billing Provider.
1208Multiple Service Location Found For the Billing Provider NPI
1209Rendering Provider is required.
1210Missing Processor Control Number (PCN) for SeniorCare member over 200% FPL or invalid PCN for WCDP member, ForwardHealth member or SeniorCare member at or below 200% FPL.
1211The Surgical Procedure Code has Diagnosis restrictions.
1212This National Drug Code (NDC) has Encounter Indicator restrictions.
1213The Procedure Code has Encounter Indicator restrictions.
1214This Revenue Code has Encounter Indicator restrictions.
1215This Diagnosis Code Has Encounter Indicator restrictions.
1216This Surgical Code Has Encounter Indicator restrictions.
1217The Surgical Procedure Code is restricted.
1218The Procedure Code is restricted.
1219Revenue Encounter Billing Rule edit.
1220Fourth position modifier is invalid.
1221Diag Restriction On ICD9 Coverage Rule edit.
1224Prospective DUR alert
1227The Other Payer ID qualifier is invalid for ForwardHealth.
1228The Other Payer Amount Paid qualifier is invalid for ForwardHealth.
1229Compound drugs not covered under this program.
1230The Medicare copayment amount is invalid.
1231Principle Surgical Procedure Code Date is missing.
1232Non-preferred Drug Is Being Dispensed. Please Refer To The PDL For Preferred Drugs In This Therapeutic Class.
1233The Submission Clarification Code is missing or invalid.
1234This National Drug Code (NDC) is not covered.
1235Diagnosis Codes Assigned Must Be At The Greatest Specificity Available.
1236Pricing Adjustment — Health Provider Shortage Area (HPSA) incentive payment was not applied because provider and/or member is not HPSA eligible.
1237The Billing Provider's taxonomy code is invalid.
1238The Rendering Provider's taxonomy code in the header is invalid.
1239The Procedure Code has Diagnosis restrictions.
1240Pharmaceutical care indicates the prescription was not filled. A quantity dispensed is required.
1241Only preferred drugs are covered for the member?s program
1242Only generic drugs are covered for the member?s program
1243Only non-innovator drugs are covered for the member's program.
1244Eleventh diagnosis is not on file.
1245Twelfth diagnosis is not on file.
1246Rendering Provider indicated is not certified as a rendering provider.
1247Tax amount nonreimuburseable.
1248Other payer patient responsibility grouping submitted incorrectly.
1249Other Amount Submitted Not Reimburseable.
1250Valid Place of Service is required.
1254DME rental beyond the initial 60 day period is not payable without prior authorization.
1255DME rental beyond the initial 180 day period is not payable without prior authorization.
1256Member is enrolled in Medicare Part A on the Date(s) of Service.
1257Member is enrolled in Medicare Part B on the Date(s) of Service.
1258Service(s) paid in accordance with program policy limitation.
1259Header Billing Provider certification is cancelled for the Date of Service.
1260The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days.
1261Detail To Date of Service is invalid.
1262Detail To Date of Service is required.
1263Header and/or Detail Dates of Service are missing, incorrect or contain futuredates.
1264Admit Diagnosis is required.
1265The Admit Type code is required.
1266Patient Status Code is incorrect for Long Term Care claims.
1267The Patient Status code is required.
1268Medicare Paid, Coinsurance, Copayment and/or Deductible amounts do not balance.
1269The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount.
1270The header total billed amount is required and must be greater than zero.
1271The Total Billed Amount is missing or incorrect.
1272Total billed amount is less than the sum of the detail billed amounts.
1273Quantity Billed is invalid for the Revenue Code.
1274The total billed amount is missing or is less than the sum of the detail billed amounts.
1275Quantity Billed is restricted for this Procedure Code.
1276Claim or Adjustment received beyond 730-day filing deadline.
1277Member is not enrolled in the program submitted in the Plan ID field for the Dispense Date of Service or an invalid Plan ID was submitted.
1278Place of Service code is invalid.
1279Procedure not payable for Place of Service.
1280Rendering Provider Type and/or Specialty is not allowable for the service billed.
1281Surgical Procedure Code billed is not appropriate for member's gender.
1282PA required for payment of this service. Procedure Code and modifiers billed must match approved PA.
1283Prior Authorization (PA) required for payment of this service.
1284Rendering Provider is not certified for the From Date of Service.
1285The Prescriber ID is invalid.
1286Days supply is required.
1287Quantity dispensed is required.
1288Submitted rendering provider NPI in the header is invalid.
1289Type of Bill indicates services not reimbursable or frequency indicated is notvalid for the claim type.
1290Type of Bill is invalid for the claim type.
1291Valid Source of Admission is required.
1293Prescription Date is required.
1294Header Bill Date is before the Header From Date of Service.
1295This NDC is invalid.
1296Services billed are included in the nursing home rate structure.
1297Member is enrolled in a commercial health insurance on the Dispense Date of Service.
1298Member ID is not on file.
1301This procedure is duplicative of a service already billed for same Date of Service.
1302This service is duplicative of service provided by another provider for the same Date(s) of Service.
1303Program guidelines or coverage were exceeded.
1304The dental procedure code and tooth number combination is allowed only once per lifetime.
1305The dental procedure code and tooth number combination is allowed only once per lifetime.
1306Add-on codes are not separately reimburseable when submitted as a stand-alone code.
1307Enhanced payment for providing services in a natural environment is limited toone service per discipline per day.
1308This service was previously paid under an equivalent Procedure Code.
1309This drug has been paid under an equivalent code within seven days of this Date of Service.
13101 PC Dispensing Fee Allowed Per Date Of Service
1311This service was previously paid.
1312This service has been paid for this recipeint, provider and tooth number within 3 years of this Date of Service.
1313Pharmaceutical Care is not covered by the Wisconsin Chronic Disease Program.
1314New Negative Contra Audit.
1315Patient reason for visit is invalid.
1316External cause of injury is invalid.
1317A Revenue Code is required.
1318Fifth Other Surgical Code is invalid.
1319First Other Surgical Code is invalid.
1320Fourth Other Surgical Code is invalid.
1321Incorrect or invalid NDC/Procedure Code/Revenue Code billed for Date of Service.
1322Incorrect or invalid NDC/Procedure Code/Revenue Code billed.
1323One or more Other Procedure Codes in position six through 24 are invalid.
1324One or more Surgical Code(s) is invalid in positions six through 23.
1325Other Procedure Code is invalid.
1326Principal Procedure Code is invalid.
1327Principal Surgical Code is invalid.
1328Procedure code is invalid.
1329The Revenue Code is invalid.
1330Second Other Surgical Code is invalid.
1331Revenue Code is invalid.
1332The Revenue Code is not reimbursable for the Date of Service.
1333Third Other Surgical Code is invalid.
1334Header From Date of Service is invalid.
1335Header To Date of Service is invalid.
1336Header To Date of Service is required.
1337A valid Prior Authorization is required for Brand Medically Necessary Drugs.
1339The Diagnosis Code and/or Procedure Code and/or Place of Service is not reimbursable for temporarily enrolled pregnant women.
1340Reimbursement rate is not on file for member's level of care.
1341Billing Provider ID is missing or unidentifiable.
1342Dosings for Narcotic Treatment Service program are limited to six per Sunday thru Saturday calendar week.
1343The Narcotic Treatment Service program limitations have been exceeded. Refer to the Onine Handbook.
1344Header Rendering Provider number is not found.
1345Submitted referring provider NPI in the header is invalid.
1346Billing Provider is not certified for the Dispense Date.
1347Billing provider number is not found.
1348Billing Provider Type and Specialty is not allowable for the service billed.
1349LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s).
1350Denied. Prescriber ID Qualifier must equal 01
1351National Drug Code (NDC) billed is not appropriate for member's gender.
1352National Drug Code (NDC) is not allowed for the member on the Date of Service.
1353National Drug Code (NDC) is invalid.
1354National Drug Code (NDC) is not on file.
1355National Drug Code (NDC) is required.
1356National Drug Code (NDC) is invalid for the Dispense Date of Service.
1357National Drug Code (NDC) is not covered on a pharmacy claim.
1358National Drug Code (NDC) is restricted by member age.
1359Member is enrolled in QMB-Only benefits. Only Medicare crossover claims are reimbursable.
1360Rendering Provider is not a certified provider for ForwardHealth.
1361Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program.
1362The Dispense As Written (DAW) indicator is not allowed for the National Drug Code.
1363The National Drug Code (NDC) is not on file for the Dispense Date of Service.
1364The National Drug Code (NDC) is not payable for the Provider Type and/or Specialty.
1365The National Drug Code (NDC) is not a benefit for the Date of Service.
1366The National Drug Code (NDC) is not payable for a Family Planning Waiver member.
1367This National Drug Code (NDC) has diagnosis restrictions.
1369Pharmacuetical care limitation exceeded.
1370Member is assigned to a Hospice provider. All services should be coordinated with the Hospice provider.
1371Member is assigned to a Lock-in primary provider. All services should be coordinated with the primary provider.
1372Member is assigned to an Inpatient Hospital provider. All services should be coordinated with the Inpatient Hospital provider.
1373Denied/Cutback. RN Home Health visits and Supervisory visits are not reimbursable on the same Date of Service for same provider.
1374An ICD-9-CM Diagnosis Code of greater specificity must be used for the Diagnosis Code in posistion 10 through 24.
1375Submitted rendering provider NPI in the detail is invalid.
1376Submitted referring provider NPI in the detail is invalid.
1377The Procedure Code has Diagnosis restrictions.
1378The Revenue Code is not payable for the Date of Service.
1379The services are not allowed on the claim type for the Member's Benefit Plan.
1380The Surgical Procedure Code is not payable for ForwardHealth/BadgerCare Plus for the Date of Service.
1381The Surgical Procedure Code is not payable for Wisconsin Chronic Disease Program for the Date of Service.
1382One or more Diagnosis Code(s) is not payable for the Date of Service.
1383The first occurrence span from date of service is after the to date of service.
1384The second occurrence span from date of service is after to to date of service.
1385Dispense date of service is invalid.
1386Billing Provider is required to be Medicare certified to dispense for dual eligibles.
1387Other Coverage Indicator is invalid.
1388The Procedure Code is not reimbursable for the Rendering Provider Type and/or Specialty.
1389These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan.
1392Compound Drugs require a minimum of two ingredients with at least one payable BadgerCare Plus covered drug.
1393Discharge Date is before the Admission Date.
1394From Date of Service is before Admission Date.
1395Admission Date is on or after date of receipt of claim.
1397The Fifth Condition Code is invalid.
1398The Fourth Condition Code is invalid.
1399The Primary Condition Code is invalid.
1400The Second Condition Code is invalid.
1401The Seventh Condition Code is invalid.
1402The Sixth Condition Code is invalid.
1403The Third Condition Code is invalid.
1404Fifth Occurrence Code is invalid.
1405One or more Occurrence Code(s) is invalid in positions nine through 24.
1406Seventh Occurrence Code is invalid.
1407Sixth Occurrence Code is invalid.
1408The Fourth Occurrence Code is invalid.
1409Eighth Occurrence Code is invalid.
1410The Second Occurrence Code is invalid.
1411The Third Occurrence Code is invalid.
1412A Fourth Occurrence Code Date is required.
1413A Second Occurrence Code Date is required.
1414A Third Occurrence Code Date is required.
1415Eighth Occurrence Code Date is invalid.
1416Eighth Occurrence Code Date is required.
1417Fifth Occurrence Code Date is invalid.
1418Fifth Occurrence Code Date is required.
1419One or more Date(s) of Service is missing for Occurrence Span Codes in positions 9 through 24.
1420One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24.
1421Seventh Occurrence Code Date is invalid.
1422Seventh Occurrence Code Date is required.
1423Sixth Occurrence Code Date is invalid.
1424Sixth Occurrence Code Date is required.
1425The Fourth Occurrence Code Date is invalid.
1426The Primary Occurrence Code Date is invalid.
1427The Second Occurrence Code Date is invalid.
1428The Third Occurrence Code Date is invalid.
1429Fifth Other Surgical Code Date is required.
1430First Other Surgical Code Date is invalid.
1431First Other Surgical Code Date is required.
1432Fourth Other Surgical Code Date is invalid.
1433Fourth Other Surgical Code Date is required.
1434One or more Surgical Code Date(s) is invalid in positions seven through 24.
1435One or more Surgical Code Date(s) is missing in positions seven through 24.
1436Fifth Other Surgical Code Date is invalid.
1437Second Other Surgical Code Date is invalid.
1438Second Other Surgical Code Date is required.
1439Third Other Surgical Code Date is invalid.
1440Third Other Surgical Code Date is required.
1441One or more Occurrence Span Code(s) is invalid in positions three through 24.
1442Second Occurrence Span Code is invalid.
1443One or more From Date(s) of Service is missing for Occurrence Span Codes in positions three through 24.
1444One or more To Date(s) of Service is missing for Occurrence Span Codes in positions three through 24.
1445The From Date of Service for the First Occurrence Span Code is invalid.
1446The From Date of Service for the First Occurrence Span Code is required.
1447The From Date of Service for the Second Occurrence Span Code is invalid.
1448The From Date of Service for the Second Occurrence Span Code is required.
1449The To Date of Service for the First Occurrence Span Code is invalid.
1450The To Date of Service for the First Occurrence Span Code is required.
1451The To Date of Service for the Second Occurrence Span Code is invalid.
1452The To Date of Service for the Second Occurrence Span Code is required.
1453Value Code amount is missing.
1455Service (Procedure Code/Modifier Combination) is not reimbursable for Date of Service.
1456Detail Quantity Billed must be greater than zero.
1457Header To Date of Service is after the ICN Date.
1458The detail From Date of Service is after the detail To Date of Service.
1459The detail From Date of Service is invalid.
1460The detail From Date of Service is required.
1461The detail From or To Date of Service is missing or incorrect.
1463The Revenue Code is not payable by Wisconsin Chronic Disease Program for the Date of Service.
1465The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service.
1466One or more Diagnosis Code(s) is not payable by Wisconsin Chronic Disease Program for the Date of Service.
1468Compound Ingredient Quantity must be greater than zero.
1492The Billing Provider's taxonomy code is missing.
1493The Rendering Provider's taxonomy code in the header is not valid.
1494The Rendering Provider's taxonomy code is missing in the header.
1496The Rendering Provider's taxonomy code is missing in the detail.
1497The Rendering Provider's taxonomy code in the detail is not valid.
1498Processed Per Policy
1499Processed Per Policy
1503A Rendering Provider number is required.
1504Performing Provider number is not found.
1505The Billing Provider's taxonomy code in the header is invalid.
1506A National Provider Identifier (NPI) is required for the Performing Provider listed in the header.
1507A Rendering Provider is not required but was submitted on the claim.
1508This claim was processed using a program assigned provider ID number, (e.g, ForwardHealth provider ID) because ForwardHealth was unable to identify the provider by the National Provider Identifier (NPI) submitted on the claim. Please submit future claims with the appropriate NPI, taxonomy and/or Zip +4 Code.
1509Billing Provider indicated is not certified as a billing provider.
1510Rendering Provider indicated is not certified as a rendering provider.
1511The Surgical Procedure Code is not payable for the Date of Service.
1512The Procedure Code/Modifier combination is not payable for the Date of Service.
1514Fourth Modifier is invalid.
1515The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code.
1516The Primary Diagnosis Code is inappropriate for the Revenue Code.
1517The Secondary Diagnosis Code is inappropriate for the Procedure Code.
1518Diagnosis Code is restricted by member age.
1519The Primary Diagnosis Code is inappropriate for the Procedure Code.
1520The Secondary Diagnosis Code is inappropriate for the Procedure Code.
1521Procedure Code is not allowed on the claim form/transaction submitted.
1522Surgical Procedure Code is not allowed on the claim form/transaction submitted.
1523Admit Diagnosis Code is invalid for the Date(s) of Service.
1524Billed amount exceeds prior authorized amount.
1525Family Planning related
1526Services billed exceed prior authorized amount.
1527Prior Authorization (PA) is required for payment of this service. Procedure Code and modifiers billed must match approved PA.
1528The Revenue Code is not payable by Wisconsin Well Woman Program for the Date of Service.
1529A more specific Diagnosis Code(s) is required.
1530Claim contains duplicate segments for Present on Admission (POA) indicator.
1531Indicator for Present on Admission (POA) is not a valid value.
1532Claim count of Present on Admission (POA) indicators does not match count of non-admitting and non-emergency diagnosis codes.
1533Real time pharmacy claims require the use of the NCPDP Plan ID. This claim did not include the Plan ID, therefore we assigned TXIX as the Plan ID for this claim.
1534ACCOM REV CODE QTY BILLED NOT EQUAL TO DTL DOS
1535Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Hypoglycemics-Insulin to Humalog and Lantus.
1536Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Glucocorticoids-Inhaled to Flovent.
1537Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Brochodilators-Beta Agonists to Proventil HFA and Serevent.
1538Denied. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. Please submit claim to BadgerRX Gold.
1539Denied. A dispense as written indicator is not allowed for this generic drug.
1540Contingency Plan for CORE and HIRSP Kids — Suspend all non-pharmacy claims.
1541The procedure code has Family Planning restrictions.
1542The revenue code has Family Planning restrictions.
1543The drug code has Family Planning restrictions.
1544The service is not reimbursable for the members benefit plan.
1545The diagnosis code is not reimbursable for the claim type submitted.
1546This claim is a duplicate of a claim currently in process. There is no action required. Please watch future remittance advice. Do not resubmit.
1547No Rendering Provider Status Found for the From and To Date of Service.
1548Claim date(s) of service modified to adhere to ForwardHealth Policy
1549Sum of detail Medicare paid amounts does not equal header Medicare paid amount.
1550Transplant services not payable without a transplant aquisition revenue code.
1551The provider type and specialty combination is not payable for the procedure code submitted.
1552This procedure is age restricted. Member's age does not fall within the approved age range.
1553The procedure code and modifier combination is not payable for the member's benefit plan.
1554The claim type and diagnosis code submitted are not payable for the member's benefit plan.
1555A valid Prior Authorization is required. Follow specific Core Plan policy for PA submission.
1556This National Drug Code is not covered under the Core Plan or Basic Plan for the diagnosis submitted.
1557This drug is a Brand Medically Necessary (BMN) drug. BMN prior authorization may be submitted for Mental Health drugs for which a Core Plan transitioned member has been previously grandfathered.
1558This drug is not covered for Core Plan members. Prior authorization requests for this drug are not accepted.
1559Core Plan — Denied. Member eligibility file indicates BadgerCare Plus Core Plan member. Please submit claim to HIRSP or BadgerRX Gold.
1560Birth to 3 enhancement is not reimbursable for place of service billed.
1561Eight hour limitation on evaluation/assessment services in a 1 year period has been exceeded. Prior Authorization is needed for additional services.
1562A valid procedure code is required on WWWP institutional claims.
1563When diagnoses 800.00 through 999.9 are present, an etiology (E-code) diagnosis must be submitted in the E-code field.
1564Payment may be reduced due to submitted Present on Admission (POA) indicator.
1565100 Days Supply Opportunity. Policy override must be granted by the Drug Authorization and Policy Override Center to dispense less than a 100 day supply.
1566Denied/Cutback. One BMI Incentive payment is allowed per member, per renderingprovider, per calendar year.
1567Denied/Cutback. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year.
1568Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days.
1569PDN services billed on this claim exceed 12 hours/day per nurse
1570PDN services billed on this claim exceed 60 hours/week per nurse
1571PDN services billed on this claim exceed 24 hours/day per member
1572Denied. Home Health services for CORE plan members are covered only following an inpatient hospital stay. Hospital discharge must be within 30 days of from date of service.
1573The total of amounts billed for the DOS on the claim exceeds the allowed dailylimit for PDN services.
1574This diabetic supply has been paid under an equivalent code on this date of service.
1575Denied. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor.
1576Prior authorization is required for Maxalt when Maxalt or sumatriptan productshave not been reimbursed within 365 days.
1577Denied. Procedure code 00942 is allowed only when provided on the same date ofservice as procedure code 57520.
1578Transplants and transplant-related services are not covered under the Basic Plan.
1579An xray or diagnostic urinalysis is reimbursable only when performed on the same date of service and billed on the same claim as the initial office visit.
1580Pharmaceutical care is not covered for the program in which the member is enrolled. This member is eligible for Medication Therapy Management services. A traditional dispensing fee may be allowed for this claim.
1581The Travel component for this service must be billed on the same claim as the associated service.
1582Cannot bill for both Assay of Lab and other handling/conveyance of specimen.
1583Diagnosis code V038 or V0382 is required on an cliam when billing procedure code 90732 only or 90732 and G0009 together for the same date of service.
1584Service billed is bundled with another service and cannot be reimbursed separately.
1585Revenue code 0850 thru 0859 is not allowed when billed with revenue codes 0820thru 0829, 0830 thru 0839, or 0840 thru 0849.
1586Condition code 20, 21 or 32 is required when billing non-covered services.
1587Revenue code submitted with the total charge not equal to the rate times number of units.
1588The quantity billed of the NDC is not equally divisible by the NDC package size.
1589Do not leave blank fields between the multiple occurance codes.
1590Service not allowed, billed within the non-covered occurrence code date span.
1591Service not allowed, benefits exhausted occurrence code billed.
1592CPT/HCPCS codes are not reimbursable on this type of bill.
1593Condition code 30 requires the corresponding clinical trial diagnosis V707.
1594This service is not payable for the same date of service as another service included on this claim.
1595Quantity indicated for this service exceeds the maximum quantity limit established.
1596This service is not covered under the ESRD benefit.
1600ICD-9-CM Diagnosis code in diagnosis code field(s) 1 through 9 is missing or incorrect.
1601Errors in one of the following data elements exceed their field size: Statement covered FROM Date, Admission date, date of service, Revenue code.
1602Occurance code or occurance date is invalid.
1603Condition code must be blank or alpha numeric A0-Z9.
1604The attending physician NPI/UPIN ID and name are either required and are missing or a NPI/UPIN beginning with NPP has been used.
1605The first position of the attending UPIN must be alphabetic.
1606Modifier is invalid.
1607A date of service is required with the revenue code and HCPCS code billed.
1608The use of value code is incorrect.
1609A HCPCS code is required when condition code A6 is included on the claim.
1610Intermittent Peritoneal Dialysis hours must be entered for this revenue code.
1611Value codes 48 — Homoglobin Reading and 49 — Hematocrit Reading, must have a zero in the far right position.
1612The revenue code and HCPCS code are incorrect for the type of bill.
1613The revenue code and HCPCS code are incorrect for the type of bill.
1614The diagnosis code on the claim requires Condition code A6 be present on the Type of Bill.
1615Revenue code is not valid for the type of bill submitted.
1616The Revenue code on the claim requires Condition code 70 to be present for this Type of Bill.
1617Revenue code submitted is no longer valid.
1618This is a same-day claim for bill types 13X, 14X, 71X, or 83X and there are multiple units or combination of chemistry/hemotology tests. Please show the appropriate multichanel HCPCS code rather than the individual HCPCS code.
1619Condition codes 71, 72, 73, 74, 75, and 76 cannot be present on the same ESRD claim at the same time.
1620Condition code 70-76 is required on an ESRD claim when Influenza/PPV/HEP B HCPCS codes are the only codes being billed with condition code A6.
1621If condition codes 71 through 76 exist on the claim, then revenue codes 082X, 083X, 084X, 085X or 088X must also be present.
1622Revenue codes 0822, 0823, 0825, 0832, 0833, 0835, 0842, 0843, 0845, 0852, 0853, or 0855 exist on the ESRD claim that does not contain condition code 74.
1623Revenue codes 082X, 083X, 084X, 085X, 0800 or 0881 (X frequency not equal to 5) exist on an ESRD claim for a member who has selected method 1 or no method and the claim does not contain condition codes 71, 72, 73 ,74, 75, or 76.
1624The condition code is not allowed for the revenue code.
1625The value code 48 (Hemoglobin reading) or 49 (Hematocrit) is required for the revenue code/HCPCS code combination.
1626This revenue code requires value code 68 to be present on the claim.
1627The submitted claim contains value code 68 and 48 or 49 but does not contain revenue code 0634 or 0635 and HCPCS Q4055. -OR- The claim contains value code 49but does not contain revenue code 0636 and HCPCS Q4054. -OR- The claim contains value code 48, 49, or 68 but does not contain revenue codes 0634 or 0635.
1628Revenue code 082X is present on an ESRD claim which also contains revenue code088X (X frequency non equal to 9).
1629Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X.
1630All ESRD clinical diagnostic laboratory tests must be billed individually to ensure that automated multi-chanel chemistry tests are paid in accordance with the Medicare Provider Reimbursement Manual (PRM) 2711.
1631The appropriate modifer of CD, CE or CF are required on the claim to identify whether or not the AMCC tests are included in the composite rate or not included in the composite rate.
1632A value code of A8 or A9 is required.
1633Medically Unbelievable Error. The Maximum limitation for dosages of EPO is 500,000 UI's (value code 68) per month and the maximum limitation for dosages of ARANESP is 1500 MCG (1 unit=1 MCG) per month. Please correct and resubmit.
1634Excessive height and/or weight reported on claim. ESRD claims are not allowed when submitted with value code of A8 (weight) and a weight of more than 500 kilograms and/or the value code of A9 (height) and the height of more than 900 centimeters.
1635Value code 48 exceeds 13.0 or value code 49 exceeds 39.0 and HCPCS codes Q4081or J0882 are present but either modifer ED or EE are not present.
1636A 72X Type of Bill is submitted with revenue code 0821, 0831 0841, 0851, 0880,or 0881 and covered charges or units greater than 1.
1637The statement coverage FROM date on a hemodialysis ESRD claim (revenue code 0821, 0880, or 0881) was greater than the hemodialysis termination date in the provider file.
1638The number of treatments/days reflected by the units entered with revenue code0821, 0831, 0841, 0851, 0880, 0881 exceeds the number of days included in the FROM and TO dates entered on this claim.
1639X-rays and some lab tests are not billable on a 72X claim.
1640Payment has been reduced or denied because the maximum allowance of this ESRD service has been reached.
1641The number of units billed for dialysis services exceeds the routine limits.
1642The claim contains a revenue code and/or HCPCS that price by a fee amount, butthe rate field is blank or contains zeros on the HCPCS file.
1643This is a duplicate claim. Please adjust quantities on the previously submitted and paid claim.
1644Valid Other Payer Date required.
1645Other Payer Date can not be after claim receipt date.
1646Valid NCPDP Other Payer Reject Code(s) required.
1647Other Payer Date is Invalid
1648Repackaged National Drug Codes (NDCs) are not covered.
1649Revenue code requires submission of associated HCPCS code
1650Provider is not eligible for reimbursement for this service. Member must receive this service from the state contractor if this is for incontinence or urological supplies. If not, the procedure code is not reimbursable.
1651Saved for E4333 — Either or both the Diagnosis or ICD-9 Surgical Procedure Code(s) do not correspond with the Member's Age
1652Saved for E4334 — Either or both the Diagnosis or ICD-9 Surgical Procedure Code(s) do not correspond with the Member's Gender
1653Invalid POA indicator on HAC code.
1654Procedure Not Payable for the Wisconsin Well Woman Program.
1655A split claim is required when the service dates on your claim overlaps your Federal fiscal year end (FYE) date.
1656Condition code 80 is present without condition code 74. Please verify billing. Reference: Transmittal 477, change request 3720 issued February 18, 2005.
1657Revenue code billed with modifier GL must contain non-covered charges.
1658HCPCS procedure codes G0008, G0009 or G0010 are allowed only with revenue code0771.
1659More than one PPV or Influenza vaccine billed on the same date of service for the same member is not allowed.
1660Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. Additional information is needed for unclassified drug HCPCS procedure codes. Separate reimbursement for drugs included in the composite rate is not allowed.
1661The HCPCS procedure code listed for revenue code 0624 is either invalid or non-reimburseable.
1662Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present.
1663For dates of service on or after 7/1/10 for TOB 72X an occurrence code 51 and value code D5 are required when the KT/V reading was performed. If the KT/V reading was not performed, then the value code D5 with 9.99 must be present without the occurrence code 51.
1664Modifier V8 or V9 must be sumbitted with revenue code 0821, 0831, 0841, or 0851.
1665Unable To Process Your Adjustment Request. Member ID Not Present.
1666Unable To Process Your Adjustment Request. Financial Payer Not Indicated.
1667Unable To Process Your Adjustment Request. Provider ID Not Present.
1668Unable To Process Your Adjustment Request. Claim ICN Not Found.
1669Unable To Process Your Adjustment Request. Original ICN Not Present.
1670Unable To Process Your Adjustment Request. Member Not Found.
1671Unable To Process Your Adjustment Request. Provider Not Found.
1672Unable To Process Your Adjustment Request. Original Claim ICN Not Found.
1673Unable To Process Your Adjustment Request. Claim Has Already Been Adjusted.
1674Unable To Process Your Adjustment Request. A Different Adjustment Is Pending For This Claim.
1675Unable To Process Your Adjustment Request. This Claim Is In Post Pay Billing For Third Party Liability Payment.
1676Unable To Process Your Adjustment Request. Claim Can No Longer Be Adjusted. Contact Provider Services For Further Information.
1677Unable To Process Your Adjustment Request. The Claim Type Of The Adjustment Does Not Match The Claim Type Of The Original Claim.
1678Unable To Process Your Adjustment Request. Member ID Number On The Claim And On The Adjustment Request Do Not Match.
1679Unable To Process Your Adjustment Request. Provider ID Number On The Claim And On The Adjustment Request Do Not Match.
1680Modifier V5, V6, or V7 must be included on the latest line item date of service billing revenue code 0821.
1681Condition Code 73 for self care cannot exceed a quantity of 15.
1682The initial rental of a negative pressure wound therapy pump is limited to 90 days; member lifetime.
1683Additional rental of a negative pressure wound therapy pump is limited to 90 days in a 12 month period.
1684The canister, dressings and related supplies are included as part of the reimbursement for the negative pressure wound therapy pump.
1685Billing Provider Type and Specialty is not allowable for the Place of Service.
1686This service is not payable with another service on the same date of service due to National Correct Coding Initiative.
1687An NCCI-associated modifier was appended to one or both procedure codes.
1688Service Denied. Diagnosis 635-635.92 May Only Be Used When Billing For Abortion Procedures. Please Correct And Resubmit.
1689ForwardHealth does not reimburse both the global service and the individual component parts of the service for the same date of service.
1690Quantity indicated for this service exceeds the maximum quantity limit established by the National Correct Coding Initiative.
1691This service is not payable for the same date of service as another service included on the same claim, according to the National Correct Coding Initiative.
1692Adjustment and original claim do not have the same finanical payer
16936355 replacing 635R diagnosis (For use of Category of Service only)
16946360 replacing 635S diagnosis (For use of Category of Service only)
16956365 replacing 635T diagnosis (For use of Category of Service only)
1937ForwardHealth is unable to is process this claim at this time. An Alert willbe posted to the ForwardHealth portal on how to resubmit.
2037Member ID has changed. No action required.
2040NDC is obsolete for date of service.
2222Policy not currently enforced.
2268SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing.
3001This Member is enrolled in Wisconsin ForwardHealth or BadgerCare Plus for Date(s) of Service. WCDP is the payer of last resort.
3002Denied. The Member WCDP Id Number Is Incorrect Or Not On Our Current Eligibility File.
3003Denied. The Member's Last Name Is Missing.
3004Denied. The Member's Last Name Is Incorrect.
3005Denied. The Member's First Name Is Missing Or Incorrect.
3006Denied. Member Not Eligibile For All/partial Dates. Please Rebill Only CoveredDates.
3008This Claim Has Been Manually Priced Based On Family Deductible.
3009Claim Denied. No Financial Needs Statement On File.
3101Denied. Provider Number Missing Or Invalid.
3200Denied. Procedure Or Revenue Code(s) Are Missing On The Claim.
3201Denied. NDC Code Is Missing.
3202Denied. Procedure/Revenue Code Is Not Allowable.
3203Denied. Prescription Number Is Missing Or Invalid.
3204Denied. Service Is Not Covered For The Diagnosis Indicated.
3205Denied. NDC Is Not Allowable Or NDC Is Not On File.
3206Denied. Diagnosis Code Is Not Allowable.
3207Denied. Procedure Is Not Allowable For Diagnosis Indicated.
3208Denied. Procedure Billed Not A Covered Service For Dates Indicated.
3209Suspend Claims With DOS On Or After 7/9/97.
3210Denied. Diagnosis Not Allowable For Claim Type.
3211Denied. Per Division Review Of NDC.
3212Prescriber ID and Prescriber ID Qualifier do not match.
3268WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing.
3300Denied. Other Insurance Disclaimer Code Invalid.
3301Denied. Discrepancy Between The Other Insurance Indicator And OI Paid Amount.
3302Denied. Accident Related Service(s) Are Not Covered By WCDP.
3303Denied. Member's File Shows Other Insurance. Submit Claim To Other Insurance Carrier.
3304Not A WCDP Benefit. For Review, Forward Additional Information With R&S To WCDP.
3305Medicare Disclaimer Code Invalid.
3306Denied. Medicare Allowed Amount Required.
3308Denied. From Date Of Service/date Filled Is Missing/invalid.
3310Denied. Claim Or Adjustment Received After The Late Billing Filing Limit.
3311Denied. Statement Covered Period Is Missing Or Invalid.
3312Denied. Statement From Date Of Service Is After The Through Date Of Service.
3313Denied. Claim Contains Future Dates Of Service.
3314Denied. Detail Dates Are Not Within Statement Covered Period.
3315Denied. Provider Is Not Certified To Bill WCDP Claims.
3316Denied. Detail Fill Date Is A Future Date.
3317Denied. Not A Benefit Of WCDP.
3318Denied. Add Dates Not In Ascending Order Or DD/DD/DD Format.
3319Denied. Not Covered By WCDP.
3321Denied. Member Is Eligible For Medicare. Please Bill Medicare First.
3323Denied. Take Home Drugs Not Billable On UB92 Claim Form. Rebill On Pharmacy Claim Form.
3400Denied. Quantity Billed Missing Or Zero.
3402Denied. Detail Billed Amount Missing Or Zero.
3403Denied. Medicare Allowed, Deductible, Coinsurance And Paid Amounts Do Not Balance.
3405Denied. Medicare Allowed Amount Is Greater Than Total Billed Amount.
3406Denied. Some Charges Billed Are Non-covered. Please Rebill Inpatient Dialysis Only.
3500Denied. Detail From And Through Date Of Service Are Not In The Same Calendar Month.
3501Denied. Greater Than Four Dates Of Service Billed On One Detail.
3502Denied. Detail Add Dates Not In MM/DD Format.
3503Denied. Provider Signature Is Missing.
3504Denied. Provider Signature Date Is Missing Or Invalid.
3505Denied. Services Billed On Wrong Claim Form.
3506Denied. Claim Exceeds Detail Limit.
3507Previously Denied Claims Are To Be Resubmitted As New Day Claims.
3509Adjustment Requested Member ID Change. Claim Denied In Order To Reprocess WithNew ID.
3601Denied. Discharge Diagnosis 1 Missing Or Invalid.
3602Denied. Diagnosis Pointer To Diagnosis Code 1 Invalid.
3603Denied. Diagnosis Pointer To Diagnosis Code 2 Invalid.
3604Denied. Diagnosis Pointer To Diagnosis Code 3 Invalid.
3605Denied. Diagnosis Pointer To Diagnosis Code 4 Invalid.
3606Denied. Diagnosis Pointer To Diagnosis Code 5 Invalid.
3610Denied. Diagnosis Pointer(s) Are Invalid.
3700Claim Previously/partially Paid. Please Review Remittance And Status Report.
3701Claim Previously/partially Paid. Please Review Remittance And Status Report.
3702Claim Previously/partially Paid. Please Review Remittance And Status Report.
3704Claim Previously/partially Paid. Please Review Remittance And Status Report.
3705Claim Previously/partially Paid. Please Review Remittance And Status Report.
3706Claim Previously/partially Paid. Please Review Remittance And Status Report.
3707Claim Previously/partially Paid. Please Review Remittance And Status Report.
3801Billed Amount On Detail Paid By WWWP. Billed Amount Is Equal To The Reimbursement Rate.
3802Allowed Amount On Detail Paid By WWWP. Billed Amount Is Greater Than Reimbursement Rate.
3803Billed Amount On Detail Paid By WWWP.
3804Claim Has Been Adjusted Due To Previous Overpayment. Money Will Be Recouped From Your Account.
3805Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance.
3806Claim Detail Denied As Duplicate. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim.
3807Claim Detail Pended As Suspect Duplicate. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider.
3808Claim Detail Denied For Invalid CPT, Invalid CPT/modifier Combination, Or Invalid Type Of Quantity Billed. Billed Procedure Not Covered By WWWP.
3809Claim Detail Denied. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service.
3810Claim Denied For Invalid Diagnosis Code Or Diagnosis Code/CPT Combination. The Diagnosis Is Not Covered By WWWP.
3811Claim Denied. The Diagnosis Code Is Not Valid On This Date Of Service.
3812Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service.
3813Claim Denied For No Client Enrollment Form On File.
3814No matching Reporting Form on file for the detail Date of Service.
3815Claim Detail Denied Due To Required Information Missing On The Claim.
3816Claim Is Pended For 60 Days. No Complete Program Enrollment Form Is On File For This Client Or The Client Is Not Eligible For The Date Of Service On The Clai im. If required information is not received within 60 days, the claim will be
3817Claim Is Pended For 60 Days. No Complete WWWP Participation Agreement Is On File For This Provider. If Required Information Is Not Received Within 60 Days,the claim will be denied.
3818Claim Is Pended For 60 Days. Information Required For Claim Processing Is Missing. A Separate Notification Letter Is Being Sent. If Required Information Is not received within 60 days, the claim detail will be denied.
3819Claim Detail Is Pended For 60 Days. No Matching, Complete Reporting Form Is On File For This Client. If A Reporting Form Is Not Submitted Within 60 Days, The claim detail will be denied.
3820Claim Denied For Future Date Of Service.
3821Claim Denied. WWWP Does Not Process Interim Bills.
3822Claim Denied For Invalid Billing Type Frequency Code, Claim Type, Or SubmittedAdjustment Provider Number Does Not Match Original Claim's Provider Number.
3823Detail Denied. To Date Of Service Precedes From Date Of Service.
7001Claim Generated An Informational ProDUR Alert
7002Denied For ProDUR Reasons
7003Drug-Drug Interaction prospective DUR alert
7004DD Prospective DUR alert; EOB Not Used
7005Drug-Disease (reported) prospective DUR alert
7006MC Prospective DUR alert; EOB Not Used
7007Drug-Disease (inferred) prospective DUR alert
7008DC Prospective DUR alert; EOB Not Used
7009Therapeutic Duplication prospective DUR alert
7010Drug-Pregnancy prospective DUR alert
7011Early Refill prospective DUR alert
7012Additive Toxicity prospective DUR alert
7013Drug-Age prospective DUR alert
7014PA Prospective DUR alert; EOB Not Used
7015Late Refill prospective DUR alert
7016High Dose prospective DUR alert
7017Suboptimal Regiment prospective DUR alert
7018Insufficient Quantity prospective DUR alert
7019Early Refill Alert. Policy override must be granted by the Drug Authorizationand Policy Override Center to dispense early.
7020Reserved for Future Use.
7021Reserved for Future Use.
7022Reserved for Future Use.
7200Denied by Claimcheck based on program policies.
7201Denied by Claimcheck based on program policies.
7211Procedure Is Invalid For Patient's Age
7212Procedure Added Due To Alt Code Replacement (age)
7213Procedure Is Invalid For Patient's Sex
7214Procedure Added Due To Alt Code Replacement (sex)
7215Procedure Code Is Incidental
7217Procedure Code Has Been Rebundled
7218Procedure Added Due To Rebundling
7219Procedure Is Mutually Exclusive
7233Denied Duplicate- Includes Unilateral Or Bilat
7234Denied Duplicate — Is Bilateral
7235Denied Duplicate — Only Done XX Times In Lifetime
7236Denied Duplicate — Only Done XX Times In A Day
7237Denied Duplicate (rebundled)
7238Procedure Added Due To Duplicate Rebundling
7239Procedure Is A Possible Duplicate
7256Modifier invalid for Procedure Code billed.
7257Incidental modifier is required for secondary Procedure Code.
7258Review Modifier 51
7259Split Decision Was Rendered On Expansion Of Units.
7290Invalid modifier removed from primary procedure code billed.
7291Incidental modifier was added to the secondary procedure code.
7503Reason for Service submitted does not match prospective DUR denial on originalclaim.
7504Denied. Professional Service code is invalid.
7505Denied. Result of Service code is invalid.
7506Denied. Prospective DUR denial on original claim can not be overridden.
7507Denied. Result of Service submitted indicates the prescription was not filled.
7508Denied. Result of Service submitted indicates the prescription was filled witha different quantity. Quantity submitted matches original claim.
8000Resolution review.
8001ForwardHealth Was Unable To Process This Request Due To Illegible Information.
8002ForwardHealth Unable To Process This Request Due To Either Missing, Invalid OrMismatched National Provider Identifier # (NPI)/Provider Name/POP ID.
8003The Number In The National Provider Identifier (NPI) Section On This Request IsNot A Number Assigned To A ForwardHealth Certified Nursing Facility For This Date Of Service.
8004ForwardHealth Was Unable To Process This Request. The Resident Or CNA's Name Is Missing.
8005ForwardHealth Was Unable To Process This Request. All Requests Must Have A 9 Digit Social Security Number.
8006ForwardHealth Is Unable To Process This Request Because The Signature/date Field Is Blank
8007The Screen Date Is Either Missing Or Invalid. The Screen Date Must Be In MM/DD/CCYY Format.
8008OBRA-nurse And/or Level 1.
8009Invalid Admission Date. Either The Date Was Not In MM/DD/CCYY Format Or It's AFuture Date.
8010This Is Not A Reimbursable Level I Screen. Did You check More Than One Box?If So, Correct And Resubmit.
8011Request Denied Because The Screen Date Is After The Admission Date. This Is Not A Preadmission Screen And Is Not Reimbursable.
8012Request Denied Due To Late Billing. A Reimbursement Request For A Level I Screen Must Be Received At ForwardHealth Within A Year Of The Screen Date.
8013Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date.
8014This CNA's Social Security Number, SSN, Is Not On The EDS Nurse Aide Registry File. This Individual Is Either Not On The Registry Or The SSN On The Request D oesn't Match The SSN That's Been Inputted On The Registry.
8015The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment.
8016The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a Training Payment. The CNA Is Only Eligible For Testing Reimbursement.
8017Unable To Process This Request Because The Competency Test Date And TrainingCompletion Date Fields Are Blank.
8018Competency Test Date Is Not A Valid Date. It Must Be In MM/DD/YY Format AndCan Not Be A Future Date.
8019Training Completion Date Is Not A Valid Date. It Must Be In MM/DD/YY FormatAnd Can Not Be A Future Date.
8020The Competency Test Date On The Request Does Not Match The CNA's Test Date OnThe WI Nurse Aide Registry. For Newly Certified CNAs, Date Of Inclusion Is T heir Test Date.
8021WI ForwardHealth Can Not Issue A NAT Payment Without A Valid Hire Date.
8022CNAs Eligibility For Nat Reimbursement Has Expired. The Timeframe Between Certification, Test, Date And Hire Date Exceeds A Year.
8023NF's Eligibility For Reimbursement Has Expired. A NAT Reimbursement Request Must Be Submitted To WI ForwardHealth Within A Year Of The CNA's Hire Date.
8024NF's Eligibility For Reimbursement Has Expired. If A CNA Obtains his/her Certification After They've Been Hired By A NF, A NF Has A Year From Their Certification, Test, Date To Submit A Reimbursement Request To ForwardHealth.
8025Request For Training Reimbursement Denied. Timeframe Between The CNA's Training Date And Test Date Exceeds 365 Days. Training Completion Date Must Be Within A Year Of The CNA's Certification, Test, Date.
8026NF's Eligibility For Reimbursement Has Expired. Requests For Training Reimbursement Denied Due To Late Billing.
8027Training Request Denied Because Either The Training Date On The Request Is After The CNA's Certification Test Date Or It's Not Within A Year Of That Date.
8028CNAs Eligibility For Training Reimbursement Has Expired. Training CompletionDate Exceeds The Current Eligibility Timeline.
8029NF's Eligibility For Reimbursement Has Expired. Training Reimbursement DeniedDue To late Billing. Request was not submitted Within A Year Of The CNA's Hire Date.
8030The Reimbursement Code Assigned To This CNA Does Not Authorize A NAT Payment.
8032This Is A Duplicate Request. ForwardHealth Has Already Issued A Payment To Your NF For This Level L Screen. Check Your Current/previous Payment Reports forPayment
8033This Is A Duplicate Request. ForwardHealth Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date.
8034Multiple Requests Received For This Ssn With The Same Screen Date. A Payment Has Already Been Issued To A Different Nf.
8035Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. ForwardHealth Will Only Pay For One. A Payment Has Already Been Issued For This SSN
8036A Training Payment Has Already Been Issued To A Different NF For This CNA.
8037A Training Payment Has Already Been Issued To Your NF For This CNA.
8038Reimbursement For Training Is One Time Only. A Training Payment Has Already Been Issued For This Cna.
8039A Payment For The CNA's Competency Test Has Already Been Issued.
8040The training Completion Date On This Request Is After The CNA's CertificationTest Date. Training Completion Date Must Be Prior To And Within A Year Of The CNA's Certification Date.
8041Reimbursement For This Certification, Test, Segment Has Been Issued To AnotherNF.
8042Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF.
8183Patient Liability Adjustments
8186Mass Adjustment — Provider Rate Process.
8188MASS ADJUSTMENT — VOID TRANSACTIONS
8192This claim has been adjusted due to Medicare Part D coverage.
8193This claim has been adjusted due to a change in the member's enrollment.
8194This claim has been adjusted because a service on this claim is not payable inconjunction with a separate paid service on the same date of service due to National Correct Coding Initiative.
8200TPL Private Health Insurance — Carrier
8201TPL Private Health Insurance — Provider
8202TPL Private Health Insurance — Member
8203Auto Liability — Carrier
8204Auto Liability — Provider
8205Auto Liability — Member
8206Non-auto Liability — Carrier
8207Non-auto Liability — Provider
8208Non-auto Liability — Member
8209Worker's Comp — Carrier
8210Worker's Comp — Provider
8211Worker's Comp — Member
8212Probate's Estate
8213Income Pension Trust Recoveries
8214Victim's Restitution
8215Absent Parents
8216TPL Error
8217Due To Miscellaneous Or Unspecified Reason
8222Adjustment/Resubmission was initiated by Provider
8225Capitation — Death Of Member
8226Capitation — Member Incarcerated
8227Capitation — Epsdt Claim
8228Capitation — Member Enrolled In Error
8229Capitation — Family Planning
8230Capitation — Incorrect Rate Catego
8231Capitation — Demographic Change
8232Capitation — Other
8233Adjustment/Resubmission was initiated by DHS
8234Adjustment/Resubmission was initiated by EDS
8240Adjustment Generated Due To SUR Review
8241Adjustment Generated Due To Change In Patient Liability
8242Adjustment Generated Due To Rate Change
8244Payout Processed Due To Disproportionate Share
8245Point Of Sale
8246Point Of Sale Reversal
8299Adjustment To Crossover Paid Prior To Aim Implementation Date. This Claim HasBeen Manually Priced Using The Medicare Coinsurance, Deductible, And Psyche RedUction Amounts As Basis For Reimbursement.
8410Financial Check Void/Stop Pay
8515This Claim Has Been Denied Due To A POS Reversal Transaction.
8901Other Commercial Insurance Response not received within 120 days for provider based bill.
8902Other Medicare Part A Response not received within 120 days for provider basedbill.
8903Other Medicare Part B Response not received within 120 days for provider basedbill.
8904Other Medicare Managed Care Response not received within 120 days for providerbased bill.
8999Supersuspended For Missing Disposition
9000Pricing Adjustment — The submitted charge exceeds the allowed charge. Claim paid at the program allowed amount.
9001Pricing Adjustment — Reimbursement reduced by the member's copayment amount.
9002Pricing Adjustment — Payment amount increased based on ambulatory surgery centers access payment policies.
9003Pricing Adjustment — Third party liability amount applied is greater than the amount paid by the program.
9004Pricing Adjustment — Amount paid is zero.
9005This claim is eligible for electronic submission. Up to a $1.10 reduction has been applied to this claim payment.
9006Access payment included.
9007Access payment not available for date of service on this date of process.
9008Pricing Adjustment — Payment amount decreased based on Pay for Performance policies.
9013Pricing Adjustment. The Pharmaceutical Care Code (PCC) does not have a rate on file for the date of service. Traditional dispensing fee may be allowed.
9020Service paid in accordance with program requirements.
9801Claim Paid At Per Diem Rate
9802Claim Paid at % of Billed Charges
9803Pricing Adjustment — Medicare benefits are exhausted. Claim paid at program allowed rate.
9804Dispensing fee denied. Missing or invalid level of effort submitted and/or reason for service, professional service, or result of service code billed in error.
9805Pricing Adjustment — Payment reduced due to the inpatient or outpatient deductible.
9806Pricing Adjustment — Payment reduced due to benefit plan limitations.
9807Header Billing Provider used as Detail Performing Provider
9808Header Performing Provider used as Detail Performing Provider
9809Pricing Adjustment — Maximum Allowable Fee pricing used.
9810Pricing Adjustment — Repackaging dispensing fee applied.
9811Pricing Adjustment — Pharmaceutical Care dispensing fee applied.
9812Pricing Adjustment — Level of effort dispensing fee applied.
9813Pricing Adjustment — Traditional dispensing fee applied.
9814Pricing Adjustment. A Pharmaceutical Care Code (PCC) must include a valid diagnosis code. Traditional dispensing fee may be allowed.
9815Refer to the DME area of the Online Handbook for claims submission requirements for compression garments. The topic of Requirements for Compression Garments can be found in the Claims Section, Submission Chapter.
9816Pricing Adjustment — Payment amount increased based on hospital access paymentpolicies.
9817Billing provider number was used to adjudicate the service(s)
9818Repackaging allowance is not allowed for unit dose NDCs.
9900The National Drug Code (NDC) was reimbursed at a generic rate.
9902Pricing Adjustment — Inpatient Per-Diem pricing.
9905Pricing Adjustment — Medicare Pricing information
9906Pricing Adjustment — Medicare pricing cutbacks applied.
9907Pricing Adjustment — Third party liability deducible amount applied.
9908Pricing Adjustment — Pharmacy pricing applied.
9909Pricing Adjustment — Paid according to program policy.
9910Pricing Adjustment — Pharmacy dispensing fee applied.
9911Pricing Adjustment — Long Term Care pricing applied.
9912Pricing Adjustment — Ambulatory Surgery pricing applied.
9914Pricing Adjustment — Revenue code flat rate pricing applied.
9915Pricing Adjustment — Medicare crossover claim cutback applied.
9916Pricing Adjustment — Usual & Customary Charge (UCC) rate pricing applied.
9918Pricing Adjustment — Maximum allowable fee pricing applied.
9919Pricing Adjustment — Provider Level of Care (LOC) pricing applied.
9920Pricing Adjustment — Resource Based Relative Value Scale (RBRVS) pricing applied.
9921Pricing Adjustment — Prior Authorization pricing applied.
9922Pricing Adjustment — Spenddown deductible applied.
9923Pricing Adjustment — Patient Liability deduction applied.
9926Pricing Adjustment — Claim has pricing cutback amount applied.
9928Pricing Adjustment — Amount paid is zero
9929Pricing Adjustment — Anesthesia pricing applied.
9932Pricing Adjustment — DRG pricing applied.
9933Pricing Adjustment — Ambulatory Payment Classification (APC) pricing applied.
9934Pricing Adjustment — Prescription reduction applied.
9935Pricing Adjustment — Maximum Flat Fee pricing applied.
9936Pricing Adjustment — Maximum Flat Fee Level 2 pricing applied.
9937Pricing Adjustment — Usual & Customary Charge (UCC) flat fee pricing applied.
9938Pricing Adjustment — Usual & Customary Charge (UCC) Flat Fee Level 2 pricing applied.
9941Pricing Adjustment--UB92 Hospice LTC Pricing
9942Quantity reduced based on DHS policy
9943Pricing Adjustment — SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts.
9944Pricing Adjustment — Incentive Pricing
9948NDC was reimbursed at AWP rate.
9949NDC was reimbursed at SMAC rate.
9950NDC was reimbursed at EMAC rate.
9951NDC was reimbursed at brand WAC rate.
9952NDC was reimbursed at generic WAC rate.
9999Processed Per Policy
 
 
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