A SeniorCare drug rebate agreement is not on file for this drug for the Date Of Service(DOS). EOB. Invalid Provider Type To Claim Type/Electronic Transaction. Denied. Sixth Diagnosis Code (dx) is not on file. Approved. The Modifier For The Proc Code Is Invalid. This obstetrical service was previously paid for this Date Of Service(DOS) for thismember. This is a duplicate claim. Submitted referring provider NPI in the detail is invalid. Fifth Diagnosis Code (dx) is not on file. Claim Denied The Combined Medicare And Private Insurance Payments Equal Or Exceed The Lesser Of The And Medicare Allowable Amounts. Invalid quantity for the National Drug Code (NDC) submitted with this HCPCS code. Please Provide Copy Of Medicare Explanation Of Benefits/medicare Remittance Advice Attached To Claim. Additional information is needed for unclassified drug HCPCS procedure codes. One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Billing Provider is not certified for the Dispense Date. Procedure Not Payable for the Wisconsin Well Woman Program. CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. CNAs Eligibility For Nat Reimbursement Has Expired. Submit Claim To For Reimbursement. WellCare Known Issues List EOP Denial Code or Rejection Reason Code Issue Description Impacted Provider Specialty . Pricing Adjustment/ Long Term Care pricing applied. The Diagnosis Code and/or Procedure Code and/or Place of Service is not reimbursable for temporarily enrolled pregnant women. Please Furnish A NDC Code And Corresponding Description. A standard 12-lead electrocardiogram should be obtained first for patients with a diagnosis of syncope and collapse before performing advanced imaging procedures. These Services Paid In Same Group on a Previous Claim. Incidental modifier is required for secondary Procedure Code. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). Immunization Questions A And B Are Required For Federal Reporting. Refer to the Onine Handbook. Please Resubmit Medicares Nursing Home Coinsurance Days As A New Claim RatherThan An Adjustment/reconsideration Request. Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. Service(s) exceeds four hour per day prolonged/critical care policy. Services are not payable. Speech Therapy Evaluations Are Limited To 4 Hours Per 6 Months. Please Indicate One Prior Authorization Number Per Claim. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. Rebill Using Correct Claim Form As Instructed In Your Handbook. NFs Eligibility For Reimbursement Has Expired. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. Voided Claim Has Been Credited To Your 1099 Liability. No payment allowed for Incidental Surgical Procedure(s). DX Of Aphakia Is Required For Payment Of This Service. Denied due to Provider Is Not Certified To Bill WCDP Claims. The 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. Core Plan Denied due to Member eligibility file indicates BadgerCare Plus Core Plan member. There are approximately 20 Medicaid Explanation Codes which map to Denial Code 16. Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. No Action Required. Please Indicate Mileage Traveled. Limited to once per quadrant per day. Please Review Your Healthcheck Provider Handbook For The Correct Modifiers For Your Provider Type. A discrepancy exists between the Other Coverage Indicator and the Other Paid Amount. More Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable. The Documentation Submitted Does Not Indicate Medically Oriented Tasks Are Medically Necessary, Therefore Personal Care Services Have Been Approved. Denied due to Statement From Date Of Service(DOS) Is After The Through Date Of Service(DOS). Pricing Adjustment/ Provider Level of Care (LOC) pricing applied. Please Correct And Resubmit. For 2020, WellCare is adding 68 new Medicare Advantage plans for a total of 261 plans with $0 or low monthly plan premiums. Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. Fifth Other Surgical Code Date is invalid. Please Contact The Surgeon Prior To Resubmitting this Claim. Please Verify That Physician Has No DEA Number. Frequency or number of injections exceed program policy guidelines. The Total Number Of Sessions Requested Exceeds Quarterly Guidelines. Good Faith Claim Has Previously Been Denied By Certifying Agency. Service Denied, refer to Medicares Billing and/or Policy Guidelines. Continuous home care and routine home care may not be billed for the same member on the same Date Of Service(DOS). Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. Claim Detail Is Pended For 60 Days. Reimbursement Based On Members County Of Residence. CPT Code And Service Date For Memberis Identical To Another Claim Detail On File For Another WWWP Provider. Case Plan and/or assessment reimbursment is limited to one per calendar year.Calendar Year. WellCare 2022 schedule; NOFEE: Code is not a covered service on your fee schedule modifiers, Part 2 for CR, GT and blank modifiers IH033: Exceeds clinical guidelines; IH038: Adjustments To Correct Copayment Deductions On date Ranged Claims Are Not Payable. Pharmaceutical care indicates the prescription was not filled. Value 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. Members Age 3 And Older Must Have An Oral Assessment And Blood Pressure Check.With Appropriate Referral Codes, For Payment Of A Screening. Denied. Amount Recouped For Mother Baby Payment (newborn). Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service(DOS). With Payspan's eEOB member-friendly functionality, members can log into the payer's secure portal and . PDN services billed on this claim exceed 12 hours/day per nurse, PDN services billed on this claim exceed 60 hours/week per nurse, PDN services billed on this claim exceed 24 hours/day per member. Fourth Diagnosis Code (dx) is not on file. One or more Diagnosis Codes has an age restriction. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. Insufficient Info On Unlisted Med Proc; Submit Claim Or Attachment With A Complete Description Of The Procedure As Described In History and Physical Exam Report, Med Progress, anesthesia or Op Report. Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement. Service not covered as determined by a medical consultant. Timely Filing Request Denied. Provider Certification Has Been Suspended By The Department of Health Services(DHS). OA 11 The diagnosis is inconsistent with the procedure. Second And Subsequent Cerebral Evoked Response Tests Paid At A Reduced Rate Per Guidelines. 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. Timely Filing Deadline Exceeded. Claim Denied. This Unbundled Procedure Code Remains Denied. Pricing Adjustment/ Third party liability amount applied is greater than the amount paid by the program. Denied due to Medicare Allowed Amount Is Greater Than Total Billed Amount. A valid header Medicare Paid Date is required. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. Denied due to Some Charges Billed Are Non-covered. Unable To Process Your Adjustment Request due to Claim ICN Not Found. Out Of State Billing Provider Not Enrolled For Entire Detail DOS Span. paul pion cantor net worth. Procedure Code or Drug Code not a benefit on Date Of Service(DOS). Denied due to Detail Dates Are Not Within Statement Covered Period. flora funeral home rocky mount va. Jun 5th, 2022 . Revenue code is not valid for the type of bill submitted. Diagnosis 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(DOS). These are EOB codes, revised for NewMMIS, that may appear on your PDF remittance advice. The Service Requested Is Not A Covered Benefit Of The Program. The Member Is School-age And Services Must Be Provided In The Public Schools. MLN Matters Number: MM6229 Related . Drugs Prescribed and Filled on the Same Day, Cannot have a Refill Greater thanZero. Claims may be denied if an advanced imaging procedure is billed with a diagnosis of syncope and there is no history of a 12-lead EKG being performed/billed the same date or in the previous 90 days. Active Treatment Dose Is Only Approved Once In Six Month Period. The Members Gait Is Not Functional And Cannot Be Carried Over To Nursing. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. Payspan's Core Payment Network comes with a feature that allows payers to send members an electronic version of their Explanation of Benefits (eEOB). Services Are Covered For Medically Needy Members Only When Healthcheck Referral is Indicated On Claim. The National Drug Code (NDC) is not on file for the Dispense Date Of Service(DOS). Services billed exceed prior authorized amount. Principle Surgical Procedure Code Date is missing. Fifth Other Surgical Code Date is required. Referring Provider ID is not required for this service. Provider is not eligible for reimbursement for this service. This service is not covered under the ESRD benefit. Claim Denied. The Second Other Provider ID is missing or invalid. Backdating Allowed Only In Cases Of Retroactive Member/provider Eligibility. Member enrolled in Tuberculosis-Related Services Only Benefit Plan. Claims For Sterilization Procedures Must Reflect ICD-9 Diagnosis Code V25.2. Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling. Please Bill Appropriate PDP. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Claim Denied. Pap Smears, Hematocrit, Urinalysis Are Not Reimbursable Separately In Conjunction With Family Planning Medical Visits. Billed Amount Is Greater Than Reimbursement Rate. Header and/or Detail Dates of Service are missing, incorrect or contain futuredates. Principal Diagnosis 8 Not Applicable To Members Sex. Claim Denied. As a result, providers experience more continuity and claim denials are easier to understand. Adjustment Denied For Insufficient Information. Medical Billing and Coding Information Guide. They are used to provide information about the current status of . 690 Canon Eb R-FRAME-EB Denied. Provider Reminders: Claims Definitions. Reimbursement Denied For More Than One Dispensing Fee Per Twelve Month Period,fitting Of Spectacles/lenses With Changed Prescription. Denied. We have redesigned our website to help you find the information you need more easily. Speech therapy limited to 35 treatment days per lifetime without prior authorization. Maximum Reimbursement Amount Has Been Determined By Professional Consultant. . Service Denied. Men. This Member Has Prior Authorization For Therapy Services. No Complete WWWP Participation Agreement Is On File For This Provider. Only the initial base rate is payable when waiting time is billed in conjunction with a round trip. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Denied/Cutback. This Claim Has Been Denied Due To A POS Reversal Transaction. A quantity dispensed is required. ACTION DESCRIPTION: ACTION TYPE. Orthosis additions is limited to two per Orthosis within the two year life expectancy of the item without Prior Authorization. Pricing AdjustmentUB92 Hospice LTC Pricing. CO - Contractual Obligations: This group code is used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment.These adjustments are considered a write off for the provider and are not billed to . Supervisory visits for Unskilled Cases allowed once per 60-day period. Service Denied. Please note that the submission of medical records is not a guarantee of payment. Invalid Procedure Code For Dx Indicated. Note: The Group, Reason and Remark Codes are HIPAA EOB codes and are cross-walked to L&I's EOB codes. is unable to is process this claim at this time. A Google Certified Publishing Partner. The Value Code and/or value code amount is missing, invalid or incorrect. Claim Denied For No Provider Agreement On File Or Not Certified For Date Of Service(DOS). Start: 01/01/2000 | Last Modified: 03/06/2012 Notes: (Modified 2/28/03, 3/6/2012) N5: Unable To Process Your Adjustment Request due to. One or more Condition Code(s) is invalid in positions eight through 24. Medicare Coinsurance Amount Was Not Provided On Crossover Claim. Member is in a divestment penalty period. Service Billed Limited To Three Per Pregnancy Per Guidelines. Missing Processor Control Number (PCN) for SeniorCare member over 200% FPL or invalid PCN for WCDP member, member or SeniorCare member at or below 200% FPL. Your latest EOB will be under Claims on the top menu. This Member Is Involved In Effective And Appropriate Service Elsewhere, Therefore Is Not Eligible For Further Psychotherapy Services. Value Code 48 And 49 Must Have A Zero In The Far Right Position. Rebill On Pharmacy Claim Form. Denied due to Statement Covered Period Is Missing Or Invalid. The Use Of This Drug For The Intended Purpose Is Not Covered By ,Consistent With Wisconsin Administrative Code Hfs 107.10(4) And 1396r-8(d). This ProviderMay Only Bill For Coinsurance And Deductible On A Medicare Crossover Claim. Policy override must be granted by the Drug Authorization and Policy Override Center to dispense less than a 100 day supply. MedicalBillingRCM.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com. This list was formerly published as Part 6 of the administrative and billing instructions in Subchapter 5 of your MassHealth provider manual. Pricing Adjustment/ Usual & Customary Charge (UCC) flat fee pricing applied. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. Third Diagnosis Code (dx) (dx) is not on file. Avoiding denial reason code CO 22 FAQ Q: We received a denial with claim adjustment reason code (CARC) CO 22. A traditional dispensing fee may be allowed for this claim. This Is A Duplicate Request. HMO Payment Equals Or Exceeds Hospital Rate Per Discharge. Drug Dispensed Under Another Prescription Number. Denied due to Take Home Drugs Not Billable On UB92 Claim Form. Assessment limit per calendar year has been exceeded. The below mention list of EOB codes is as below, EOB codes list is updated as per the latest information gathered from authorized sources of information, if any discrepancy please let us know via the contact us page, Coupon "NSingh10" for 10% Off onFind-A-CodePlans. Request Denied. Number Is Missing Or Incorrect. Refill Indicator Missing Or Invalid. NDC- National Drug Code is not allowed for the member on the Date Of Service(DOS). Revenue 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. Please Supply The Appropriate Modifier. Multiple Providers Of Treatment Are Not Indicated For This Member. An NCCI-associated modifier was appended to one or both procedure codes. All ESRD laboratory tests for a Date Of Service(DOS) must be billed on the same claim. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. Number On Claim Does Not Match Number On Prior Authorization Request. Unable To Process Your Adjustment Request due to Member Not Found. Time Spent In AODA Day Treatment By Affected Family Members Is Not Covered. This Member Has A Current Approved Authorization For Intensive AODA OutpatientServices. Condition codes 71, 72, 73, 74, 75, and 76 cannot be present on the same ESRD claim at the same time. The Medicare copayment amount is invalid. NDC was reimbursed at brand WAC (Wholesale Acquisition Cost) (Wholesale Acquisition Cost) rate. Adjustment Requested Member ID Change. Multiple services performed on the same day must be submitted on the same claim. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. Only One Outpatient Claim Per Date Of Service(DOS) Allowed. Personal Care Services Exceeding 30 Hours Per 12 Month Period Per Member Require Prior Authorization. This claim must contain at least one specified Surgical Procedure Code. The detail From Date Of Service(DOS) is after the detail To Date Of Service(DOS). Denied due to Greater Than Four Dates Of Service Billed On One Detail. Request Denied Due To Late Billing. Only One Panel Code Within Same Category (CBC Or Chemistry) Maybe Performed Per Member/Provider/Date Of Service. NFs Eligibility For Reimbursement Has Expired. The Tooth Is Not Essential To Maintain An Adequate Occlusion. Header Billing Provider used as Detail Performing Provider, Header Performing Provider used as Detail Performing Provider. To bill any code, the services furnished must meet the definition of the code. Medicaid Remittance Advice Remark Code:M86 MMIS EOB Code:100. Service Denied. This detail is denied. This National Drug Code (NDC) is only payable as part of a compound drug. Previously Denied Claims Are To Be Resubmitted As New-day Claims. Documentation Does Not Justify Medically Needy Override. Third Other Surgical Code Date is invalid. When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. WellCare Known Issues List Please be advised: Claims that have either rejected or denied . Adjustment/reconsideration Denied, Provider Signature/date Was Not Provided OnThe Adjustment/reconsideration Request. The Performing Provider Id, Member Id, And Date Of Service(DOS) Must Match The Completion Certificate Received From Ddes. Please Resubmit Corr. Denied. Review Of Adjustment/reconsideration Request Shows Original Claim Payment Was Max Allowed For Medical Service/Item/NDC. One or more Occurrence Code Date(s) is invalid in positions nine through 24. Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date. Claims may deny when a procedure defined as requiring an anatomical modifier is billed without an associated anatomical modifier. The information on the claim isinvalid or not specific enough to assign a DRG. Value codes 48 Homoglobin Reading and 49 Hematocrit Reading, must have a zero in the far right position. One or more From Date Of Service(DOS) (DOS) is invalid for Occurrence Span Codes in positions three through 24. Rn Visit Every Other Week Is Sufficient For Med Set-up. Please Attach Copy Of Medicare Remittance. Inicio Quines somos? Claim Denied. -OR- The claim contains value code 48, 49, or 68 but does not contain revenue codes 0634 or 0635. Maximum Number Of Outreach Refusals Has Been Reached For This Period. The Maximum Prior Authorized Service Limitation Or Frequency Allowance Has Been Exceeded. Routine foot care is limited to no more than once every 61days per member. Discrepancy Between The Other Insurance Indicator And OI Paid Amount. Home Health visits (Nursing and therapy) in excess of 30 visits per calendar year per member require Prior Authorization. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a Claim Adjustment Reason Code (CARC) or to convey information about remittance processing. One or more Date(s) of Service is missing for Occurrence Span Codes in positions 9 through 24. Claim Detail Denied For Invalid CPT, Invalid CPT/modifier Combination, Or Invalid Type Of Quantity Billed. Denied. Diagnosis Codes Assigned Must Be At The Greatest Specificity Available. Procedure not allowed for the CLIA Certification Type. The Medicare Paid Amount is missing or incorrect. Service(s) paid at the maximum daily amount per provider per member. This service is payable at a frequency of once per 12-month period, per provider, per hearing aid. This level not only validates the code sets , but also ensures the usage is appropriate for any The sum of all Value Code amounts must be numeric and less than or equal to 999.999.999. Service(s) Billed Are Included In The Total Obstetrical Care Fee. Contact The Nursing Home. Individual Audiology Procedures Included In Basic Comprehensive Audiometry. NDC was reimbursed at generic WAC (Wholesale Acquisition Cost) rate. For example, a claim from a physician provider with place of service 11 (Office) would be considered incorrectly coded when a claim from an outpatient facility (e.g. Pricing Adjustment/ Payment amount increased based on hospital access paymentpolicies. No Matching, Complete Reporting Form Is On File For This Client. Discharge Diagnosis 3 Is Not Applicable To Members Sex. Provider Is Responsible For Averaging Costs During Cal Year Not To Exceed YrlyTotal (12 x $2325.00). Covered By An HMO As A Private Insurance Plan. Service Denied. Please Add The Coinsurance Amount And Resubmit. Prior authorization is required for Advair or Symbicort if no other Glucocorticoid Inhaled product has been reimbursed within 90 days. SMV Mileage Exceeding 40 Miles In Urban Counties Or 70 Miles In Rural CountiesRequires Prior Authorization. You Must Either Be The Designated Provider Or Have A Refer. Services billed are included in the nursing home rate structure. Service is reimbursable only once per calendar month. New Prescription Required. The National Drug Code (NDC) was reimbursed at a generic rate. Rendering Provider is not certified for the Date(s) of Service. Two Informational Modifiers Required When Billing This Procedure Code. 51.42 Board Stamp Required On All Outpatient Specialty Hospital Claims For Dates Of Service On Or After January 1, 1986. Member is assigned to a Hospice provider. Member does not have commercial insurance for the Date(s) of Service. Denied. The Ninth Diagnosis Code (dx) is invalid. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. Second Other Surgical Code Date is invalid. Other Medicare Managed Care Response not received within 120 days for providerbased bill. This Member, As Indicated By Narrative History, Does Not Agree To Abstinence from Alcohol Or Other Drugs And Is Ineligible For AODA Treatment. Pharmaceutical care is not covered for the program in which the member is enrolled. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. CO/96/N216. This drug is limited to a quantity for 34 days or less. Good Faith Claim Denied. Denied/cutback. Provider Not Authorized To Perform Procedure. Was Unable To Process This Request Due To Illegible Information. All Outpatient Services/or Accommodations And Ancillaries Are Denied, Therefore The Total Charge Is Denied. Did You check More Than One Box?If So, Correct And Resubmit. Exceeds The 35 Treatment Days Per Spell Of Illness. Denied. The Header and Detail Date(s) of Service conflict. One or more To Date(s) of Service is missing for Occurrence Span Codes in positions three through 24. Charges For Anesthetics Are Included In Charge For All Surgical Procedures. Supplemental Payment Authorized By Department of Health Services (DHS) Due to an Interim Rate Settlement. Third Other Surgical Code Date is required. Please Refer To The Original R&S. Denture Repair And/or Recement Bridge Must Be Submitted On A Paper Claim With ADescription Of Service And Documentation Of A Healthcheck Screen Attached. Has Already Issued A Payment To Your NF For This Level L Screen. Second Other Surgical Code Date is required. The National Drug Code (NDC) has a quantity restriction. WCDP is the payer of last resort. Referral Codes Must Be Indicated For W7001, W7002, W7003, W7006, W7008 And W7013. This service is not payable for the same Date Of Service(DOS) as another service included on the same claim, according to the National Correct Coding Initiative. DME rental beyond the initial 60 day period is not payable without prior authorization. Please Request Prior Authorization For Additional Days. Member is assigned to an Inpatient Hospital provider. Claims may deny when reported with mutually exclusive code combinations according to the ICD-10-CM Excludes 1 Notes guideline policy. Do Not Use Informational Code(s) When Submitting Billing Claim(s). Head imaging in the form of CT scans, MRI or MRA is allowed only when the service is medically reasonable and necessary. Reason Code 162: Referral absent or exceeded. Reason Code: 234. Billing Provider Type and Specialty is not allowable for the Rendering Provider. One or more Diagnosis Code(s) is invalid for the Date(s) of Service. Please Correct And Re-bill. Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program. HIPAA EOB codes are returned on the 835 Remittance Advice file and are maintained by the Washington Publishing Company. Complex Evaluation and Management procedures require history and physical or medical progress report to be submitted with the claim. A Pharmaceutical Care Code (PCC) must include a valid diagnosis code. Denied due to Medicare Allowed Amount Required. Dates Of Service Must Be Itemized. Supplemental tests billed on the same Date Of Service(DOS) as vision examination are not payable. For Newly Certified CNAs, Date Of Inclusion Is T heir Test Date. The Procedure Requested Is Not On s Files. Denied. Service not allowed, benefits exhausted occurrence code billed. The 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. Denied. No Supporting Documentation. Denied. Denied. All Requests Must Have A 9 Digit Social Security Number. This Service Is Not Payable Without A Modifier/referral Code. 1 PC Dispensing Fee Allowed Per Date Of Service(DOS). The Service Requested Was Performed Less Than 3 Years Ago. Denied/Cutback. A National Provider Identifier (NPI) is required for the Performing Provider listed in the header. Indicated Diagnosis Is Not Applicable To Members Sex. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a Training Payment. It Corrects Claim Information Found During Research Of An OBRA Drug Rebate Dispute. OA 12 The diagnosis is inconsistent with the provider type. The Procedure(s) Requested Are Not Medical In Nature. Diagnosis Treatment Indicator is invalid. Denied. Bilateral Procedures Must Be Billed On One Detail With Modifier 50, Quantity Of 1.detail With Modifier 50 May Be Adjusted If Necessary. Denied. CO/204/N30. Providers should submit adequate medical record documentation that supports the claim (services) billed. Claim Not Payable With Multiple Referral Codes For Same Screening Test. What steps can we take to avoid this denial? This Procedure Code Is Denied As Incidental/Integral To Another Procedure CodeBilled On This Claim. The Service Performed Was Not The Same As That Authorized By . Denied as duplicate claim. Claim paid at program allowed rate. A valid procedure code is required on WWWP institutional claims. Reason Code 234 | Remark Codes N20.