Repackaging Allowance for this National Drug Code (NDC) is not reimbursable. Immunization Questions A And B Are Required For Federal Reporting. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. Condition code 80 is present without condition code 74. Two Informational Modifiers Required When Billing This Procedure Code. Rejected Claims-Explanation of Codes - Community Care - Veterans Affairs Jalisa Clark - Pharmacy Benefit Relations Coordinator - WellCare Health This 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(DOS) due to National Correct Coding Initiative. Reason Code 234 | Remark Codes N20. Denied. The Value Code and/or value code amount is missing, invalid or incorrect. Diagnosis Code is restricted by member age. The Member Does Not Appear To Meet The Severity Of Illness Indicators Established by the Wisconsin And Is Therefore Not Eligible For AODA Day Treatment. For example, F80.2 (Mixed receptive-expressive language disorder) cannot be billed on the same claim as F84.0 (Autism Disorder) since ICD-10's Coding Manual views them as mutually exclusive dx codes. Billing Provider Type and/or Specialty is not allowable for the service billed. Request Denied Due To Late Billing. Denied. Procedimientos. OA 11 The diagnosis is inconsistent with the procedure. The Medical Need For This Service Is Not Supported By The Submitted Documentation. Only One Interperiodic Screen Is Allowed Per Day, Per Member, Per Provider. The service is not reimbursable for the members benefit plan. Refer To The Wisconsin Website @ dhs.state.wi.us. Resubmit Using Valid Rn/lpn Procedure Codes And A Valid PA Number. This Procedure, When Billed With Modifier HK, Is Payable Only If The Member Is Under The Age Of 19. Only preferred drugs are covered for the member?s program, Only generic drugs are covered for the member?s program. Service Allowed Once Per Lifetime, Per Tooth. An Approved AODA Day Treatment Program Cannot Exceed A 6 Week Period. 51.42 Board Stamp Required On All Outpatient Specialty Hospital Claims For Dates Of Service On Or After January 1, 1986. Consent Form Is Missing, Incomplete, Or Contains Invalid Information. Claim Submitted To Good Faith Without Proper Documentation. Review Billing Instructions. Exceeds The 35 Treatment Days Per Spell Of Illness. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Service Denied. Claimchecks Editing And Your Supporting Documentation Was Reviewed By The DHS Medical Consultant. Home Health visits (Nursing and therapy) in excess of 30 visits per calendar year per member require Prior Authorization. Surgical Procedures May Only Be Billed With A Whole Number Quantity. Denied due to Detail Add Dates Not In MM/DD Format. Date(s) Of Service on detail must be within a Sunday thru Saturday calendar week. Prior Authorization is required for service(s) exceeding mental health and/or substance abuse benefit guidelines. Denied. Research Has Determined That The Member Does Not Qualify For Retroactive Eligibility According To Hfs 106.03(3)(b) Of The Wisconsin Administrative Code. Pricing Adjustment/ Pharmacy dispensing fee applied.
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