wellcare eob explanation codes
A1 This claim was refused as the billing service provider submitted is: . This Adjustment/reconsideration Request Was Initiated By . If required information is not received within 60 days, the claim will be. As a result, providers experience more continuity and claim denials are easier to understand. Please Furnish An ICD-9 Surgical Code And Corresponding Description. wellcare eob explanation codes. . 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. This Information Is Required For Payment Of Inhibition Of Labor. The To Date Of Service(DOS) for the Second Occurrence Span Code is required. Another PNCC Has Billed For This Member In The Last Six Months. Claim Denied For Invalid Diagnosis Code Or Diagnosis Code/CPT Combination. One or more Date(s) of Service is missing for Occurrence Span Codes in positions 9 through 24. WCDP member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Superior HealthPlan News. The condition code is not allowed for the revenue code. Denied. Once you register and have access to the provider portal, you will find a variety of video training available in the Resources section of the portal. The Submission Clarification Code is missing or invalid. Voided Claim Has Been Credited To Your 1099 Liability. Subsequent surgical procedures are reimbursed at reduced rate. Service(s) Denied By DHS Transportation Consultant. Service Denied. Strong knowledge of adjustment and denial reason codes from Electronic Remittance Advices (ERA/835 files) and from paper Explanation of benefits (EOB's) / Explanation of payments (EOP's), CPT . If you are still unable to resolve the login problem, read the troubleshooting steps or report your issue. The Provider Type/specialty Is Not Recognized For These Date(s) Of Service. Date Of Service/procedure/charges Billed On The Adjustment/reconsideration Request Do Not Match The Original Claim. Claim paid according to Medicares reimbursement methodology. Denied due to Diagnosis Not Allowable For Claim Type. All services should be coordinated with the Inpatient Hospital provider. One or more Surgical Code(s) is invalid in positions six through 23. The Billing Providers taxonomy code in the header is invalid. For over 40 years, Washington Publishing Company (WPC) has specialized in managing and distributing data integration information through publications, training, and consulting services. Member is assigned to a Lock-in primary provider. An Approved AODA Day Treatment Program Cannot Exceed A 6 Week Period. Resubmit Claim Once Election Form Requirements Are Met Per The Hospice Provider Handbook. Program guidelines or coverage were exceeded. Member Is Eligible For Champus. This Procedure Code Is Not Valid In The Pharmacy Pos System. Member is enrolled in Medicare Part D for the Dispense Date Of Service(DOS). The Member Is Enrolled In An HMO. The Member Has Been Totally Without Teeth And An Appliance For 5 Years. Medicare Part A Or B Charges Are Missing Or Incorrect. Questionable Long-term Prognosis Due To Apparent Root Infection. Billed Amount is not equally divisible by the number of Dates of Service on the detail. Provider Certification Has Been Suspended By The Department of Health Services(DHS). Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. Header and/or Detail Dates of Service are missing, incorrect or contain futuredates. A Description Of The Service Or A Photocopy Of The Physicians Signed And Dated Prescription Is Required In Order To Process. EOB Any EOB code that applies to the entire claim (header level) prints here. According To Our Records, The Surgeon For This Sterilization Procedure Has NotSubmitted The Members Consent Form. Claim Corrected. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. You can even print your chat history to reference later! Prescribing Provider UPIN Or Provider Number Missing From Claim And Attachment. Pricing Adjustment/ Provider Level of Care (LOC) pricing applied. We have created a list of EOB reason codes for the help of people who are working on denials, AR-follow-up, medical coding, etc. Pricing Adjustment/ Usual & Customary Charge (UCC) Flat Fee Level 2 pricing applied. Denied/Cutback. Normal delivery payment includes the induction of labor. Pricing Adjustment/ Medicare pricing cutbacks applied. Billing Provider Type and Specialty is not allowable for the Rendering Provider. Occurrence Codes 50 And 51 Are Invalid When Billed Together. Please Verify The Units And Dollars Billed. Due To Non-covered Services Billed, The Claim Does Not Meet The Outlier Trim Point. Occupational therapy limited to 35 treatment days per lifetime without prior authorization. Denied. Treatment With More Than One Drug Per Class Of Ulcer Treatment Drug At The Same Time Is Not Allowed Through Stat PA. If A CNA Obtains his/her Certification After Theyve Been Hired By A NF, A NF Has A Year From Their Certification, Test, Date To Submit A Reimbursement Request To . Claims adjustments. Men. A Rendering Provider is not required but was submitted on the claim. Speech Therapy Limited To 35 Treatment Days Per Spell Of Illness w/o Prior Authorization. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. Charges Paid At Reduced Rate Based Upon Your Usual And Customary Pricing Profile. Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. Reimburse Is Limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toan Audit. Multiple Unloaded Trips For Same Day/same Recip. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. No Action Required. Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X. Therapy visits in excess of one per day per discipline per member are not reimbursable. This detail is denied. A Procedure Code without a modifier billed on the same day as a Procedure Codewith modifier 11 are viewed as the same trip. Member ID has changed. The Travel component for this service must be billed on the same claim as the associated service. Remittance Advice Remark Code (RARC) and Claim Adjustment Reason Code (CARC) Update ; Note: This article was revised on April 11, 2018, to update Web addresses. The Maximum Prior Authorized Service Limitation Or Frequency Allowance Has Been Exceeded. Denied. Intermittent Peritoneal Dialysis hours must be entered for this revenue code. Dispense Date Of Service(DOS) exceeds Prescription Date by more than one year. Rn Visit Every Other Week Is Sufficient For Med Set-up. Unable To Process Your Adjustment Request due to Provider Not Found. No Reimbursement Rates on file for the Date(s) of Service. Calls are recorded to improve customer satisfaction. Reimbursement also may be subject to the application of Default Prescribing Physician Number XX5555555 Was Indicated. Claims may deny when reported with incompatible ICD-10-CM Laterality policy for Diagnosis-to-Modifier comparison. A Separate Notification Letter Is Being Sent. Denied due to Prescription Number Is Missing Or Invalid. Claim Detail Denied Due To Required Information Missing On The Claim. Service Denied. It has now been removed from the provider manuals . Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item. A Payment Has Already Been Issued To A Different Nf. Medicare Disclaimer Code invalid. Detail Denied. Quantity Would Be 00010 If Specific Number Of Batteries Dispensed Is Not Indicated. Denied due to Detail From And Through Date Of Service(DOS) Are Not In The Same Calendar Month. Service billed is bundled with another service and cannot be reimbursed separately. Panel And Individual Test Not Payable For Same Member/Provider/ Date Of Service(DOS). Oral exams or prophylaxis is limited to once per year unless prior authorized. WellCare 2016 NA_11_16 NA6PROGDE80121E_1116 . Has Recouped Payment For Service(s) Per Providers Request. This Mutually Exclusive Procedure Code Remains Denied. A National Drug Code (NDC) is required for this HCPCS code. The From Date Of Service(DOS) for the First Occurrence Span Code is invalid. Pricing Adjustment/ Pharmacy pricing applied. Did You check More Than One Box?If So, Correct And Resubmit. Hearing aid repairs are limited to once per six months, per provider, per hearing aid. Correct Claim Or Submi Paper Claim Noting That Verification Has Occurred. Reimbursement determination has been made under DRG 981, 982, or 983. Services not allowed for your Provider Type or for your Provider Type without a TB diagnosis. Continuous home care must be billed in an hourly quantity equal to or greater than eight hours, up to and including 24 hours. Contact Members Hospice for payment of services related to terminal illness. NDC- National Drug Code is not allowed for the member on the Date Of Service(DOS). Pharmaceutical care reimbursement for tablet splitting is limited to three permonth, per member. Service(s) exceeds four hour per day prolonged/critical care policy. Submitted referring provider NPI in the detail is invalid. No action required. Bill The Single Appropriate Code That Describes The Total Quantity Of Tests Performed. Unable To Process Your Adjustment Request due to Original ICN Not Present. Other Payer Date can not be after claim receipt date. The Narrative History Does Not Indicate the Members Functioning is Impaired due To AODA Usage. If authorization number available . This Dental Service Limited To Once A Year. Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement. You can view these EOBs online by following these steps: Log in to your bcbsm.com account to view your prescriptions coverage. Billing provider number was used to adjudicate the service(s). Admission Date does not match the Header From Date Of Service(DOS). Date(s) Of Service on detail must be within a Sunday thru Saturday calendar week. Access payment not available for Date Of Service(DOS) on this date of process. Gastrointestinal Surgery For The Purpose Of Weight Control Is Covered Only As An Emergency Procedure. The training Completion Date On This Request Is After The CNAs CertificationTest Date. CORE Plan Members are limited to 25 non-emergency outpatient hospital visits per enrollment year. Requests For Training Reimbursement Denied Due To Late Billing. CPT Code 88305 (Level IV Surgical pathology, gross and microscopic examination) includes different types of biopsies. Claim Is Being Special Handled, No Action On Your Part Required. Payment Recovered For Claim Previously Processed Under Wrong Member ID Number. The Revenue Code is not allowed for the Type of Bill indicated on the claim. To Date Of Service(DOS) Precedes From Date Of Service(DOS). Wellcare Explanation Of Payment Codes USA Health SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Denied. Inicio Quines somos? Whenever claim denied with CO 197 denial code, we need to follow the steps to resolve and reimburse the claim from insurance company: First step is to verify the denial reason and get the denial date. Provider Must Have A CLIA Number To Bill Laboratory Procedures. Physical Therapy Limited To 45 Treatment Days Per Spell Of Illness W/o Prior Authorization. PATIENT PAID PORTION USED TOWARDS DEDUCTIBLE. Services on this claim have been split to facilitate processing.on On Your Part Is Required. Denied. HIPAA EOB codes are returned on the 835 Remittance Advice file and are maintained by the Washington Publishing Company. 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. Discrepancy Between The Other Insurance Indicator And OI Paid Amount. Please Disregard Additional Information Messages For This Claim. The content shared in this website is for education and training purpose only. Prior Authorization is required to exceed this limit. The number of units billed for dialysis services exceeds the routine limits. A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). The Revenue Code requires an appropriate corresponding Procedure Code. Was Unable To Process This Request Due To Illegible Information. PA required for payment of this service. Denied. Missing or invalid level of effort submitted and/or reason for service, professional service, or result of service code billed in error. Good Faith Claim Correctly Denied. This obstetrical service was previously paid for this Date Of Service(DOS) for thismember. A Third Occurrence Code Date is required. CO/96/N216. Invalid Procedure Code For Dx Indicated. Procedure Not Payable for the Wisconsin Well Woman Program. Condition codes 71, 72, 73, 74, 75, and 76 cannot be present on the same ESRD claim at the same time. Dosings for Narcotic Treatment Service program are limited to six per Sunday thru Saturday calendar week. Pricing Adjustment/ Ambulatory Payment Classification (APC) pricing applied. Member is not enrolled for the detail Date(s) of Service. A Fourth Occurrence Code Date is required. Denied. Denied. Payment reduced. Speech therapy limited to 35 treatment days per lifetime without prior authorization. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). The From Date Of Service(DOS) for the First Occurrence Span Code is required. The Diagnosis Code Is Not Valid On This Date Of Service(DOS). Indicator for Present on Admission (POA) is not a valid value. Ninth Diagnosis Code (dx) is not on file. Once you register and have access to the provider portal, you will find a variety of video training available in the Resources section of the portal. Reimbursement rate is not on file for members level of care. Out of State Billing Provider not certified on the Dispense Date. Prior Authorization Is Required For Payment Of Hospital Exceptional Claims. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report. Reason Code 159: State-mandated Requirement for Property and Casualty, see Claim Payment Remarks Code for specific explanation. The Second Other Provider ID is missing or invalid. Wellcare uses cookies. Traditional dispensing fee may be allowed. Claim contains an unclassified drug HCPCS procedure code or a drug HCPCS procedure code included in the composite rate. Pricing Adjustment/ Ambulatory Surgery pricing applied. Unrelated Procedure/Service by the Same Physician During the Post-op Period, Modifier 79. One or more Surgical Code Date(s) is missing in positions seven through 24. Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. Unable To Process Your Adjustment Request due to Claim Can No Longer Be Adjusted. Principle Surgical Procedure Code Date is missing. Multiple Service Location Found For the Billing Provider NPI. Inpatient Respite Care Is Not Covered For Hospice Members Residing In Nursing Homes. Recouped. Home care ongoing assessments are allowed once every sixty days per member.nt, But Arepayable Every Fifty-fourth Day For Flexibility In Scheduling. NDC- National Drug Code is invalid for the Dispense Date Of Service(DOS). Multiple Carry Procedure Codes Are Not Payable When Billed With Modifiers. Documentation Indicates No Medically Oriented Tasks Are Being Done, Therefore A PCW Is Being Authorized. Claim Explanation Codes | Providers | Univera Healthcare Please note that the submission of medical records is not a guarantee of payment. The Non-contracted Frame Is Not Medically Justified. Transplant services not payable without a transplant aquisition revenue code. Admit Date and From Date Of Service(DOS) must match. Reimbursement For This Service Is Included In The Transportation Base Rate. Claims may deny when a procedure defined as requiring an anatomical modifier is billed without an associated anatomical modifier. Learn more about Ezoic here. Please Resubmit. One or more Diagnosis Codes has an age restriction. If Required Information Is Not Received Within 60 Days,the claim will be denied. Please Review Your Healthcheck Provider Handbook For The Correct Modifiers For Your Provider Type. These services are not allowed for members enrolled in Tuberculosis-Related Services Only Benefit Plan. An xray or diagnostic urinalysis is reimbursable only when performed on the same Date Of Service(DOS) and billed on the same claim as the initial office visit. The Value Code and/or value code amount is missing, invalid or incorrect. Claim Reduced Due To Member/participant Spenddown. Timely Filing Deadline Exceeded. Please Ask Prescriber To Update DEA Number On TheProvider File. Explanation of Benefit Codes (EOBs) Mar 14, 2022 1 EOB EOB DESCRIPTION. wellcare eob explanation codes - cirujanoplasticoleon.com 0001 01/01/1900 NOT USED - MEMBER'S DMAP I.D. Anesthesia and Moderate Sedation Services CPTs 00300, 00400, 00600, 01935-01936, 01991-01992, 99152-99153, 99156-99157, Pain Management Services CPTs 20552, 20553, 27096, 62273, 62320-62323, 64405, 64479, 64480, 64483, 64484, 64490-64495, 0228T, 0229T, 0230T, 0231T, G0260, Nerve Conduction Studies CPT 95907-95913, Needle electromyography (EMG)-CPT 95885, 95886. Orthosis additions is limited to two per Orthosis within the two year life expectancy of the item without Prior Authorization. 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. Denied. MassHealth List of EOB Codes Appearing on the Remittance Advice. Partial Payment Withheld Due To Previous Overpayment. Summarize Claim To A One Page Billing And Resubmit. There is no action required. Denied. No Private HMO Or HMP On File. The Procedure Code is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Unable To Process Your Adjustment Request due to Financial Payer Not Indicated. The Service Performed Was Not The Same As That Authorized By . Medicare Id Number Missing Or Incorrect. WWWP Does Not Process Interim Bills. Homecare Services W/o PA Are Not Payable When Prior Authorized Homecare Services have Been Provided To The Same Member. Please submit claim to BadgerRX Gold. The Clinical Profile/Diagnosis Makes This Member Ineligible For AODA Services. Newsroom. Please Do Not Resubmit Your Claim. Independent Nurses, Please Note Payable Services May Not Exceed 12 Hours/dayOr 60 Hours/week. Do Not Use Informational Code(s) When Submitting Billing Claim(s). Homecare Services W/o PA Are Not Payable When Prior Authorized HomecAre Services Have Been Provided To The Same Member. Medicare denial codes, reason, action and Medical billing appeal Claim Denied. Dispensing replacement parts and complete appliance on same Date Of Service(DOS) not Allowed. The National Drug Code (NDC) was reimbursed at a generic rate. Denied. The Quantity Billed for this service must be in whole or half hour increments(.5) Increments. The Insurance EOB Does Not Correspond To The Dates Of Service/servicesBeing Billed. Denied. According to CMS policy and the American College of Radiology, a chest X-ray (CPT codes 71045, 71046) should not be performed for screening purposes in the absence of pertinent signs, symptoms or diseases. Member is assigned to a Hospice provider. The revenue code and HCPCS code are incorrect for the type of bill. Good Faith Claim Has Previously Been Denied By Certifying Agency. Do Not Submit Claims With Zero Or Negative Net Billed. Prior Authorization is required for service(s) exceeding mental health and/or substance abuse benefit guidelines. Pricing Adjustment/ Payment reduced due to the inpatient or outpatient deductible. The 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. If correct, special billing instructions apply. The Service Requested Is Considered To Be Professionally Unacceptable, Unproven and/or Experimental. CPT Or CPT/modifier Combination Is Not Valid On This Date Of Service(DOS). THE WELLCARE GROUP OF COMPANIES . The Members Clinical Profile/diagnosis Is Not Within Diagnostic Limitations for Psychotherapy Services. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. Modification Of The Request Is Necessitated By The Members Minimal Progress. EDI TRANSACTION SET 837P X12 HEALTH CARE . 2. Home Health, Personal Care And Private Duty Nursing Services Are Subject To A Monthly Cap. Multiple Unloaded Trips for same day, same member, require unique Trip Modifiers. Denied. A dispense as written indicator is not allowed for this generic drug. Denied/cutback. Medicare Claim Copy And EOMB Have Been Submitte d For Processing Of Coinsurance And Deductible. The Member Is Involved In group Physical Therapy Treatment. The Member Has Shown No Ability Within 6 Months To Carry Over Abilities GainedFrom Treatment In A Facility To The Members Place Of Residence. The National Drug Code (NDC) is not payable for the Provider Type and/or Specialty. Please Correct And Resubmit. Billing Provider Type and Specialty is not allowable for the service billed. CO/96/N216. Additional services mustbe billed as treatment services and count towards the Mental Health and/or substance abuse treatment policy for prior authorization. Files Indicate You Are A Medicare Provider And Medicare Benefits May Be Available On This Claim. Condition Code 73 for self care cannot exceed a quantity of 15. The Medicare Paid Amount is missing or incorrect. Please Correct And Re-bill. A covered DRG cannot be assigned to the claim. Please Disregard Additional Messages For This Claim. The Other Payer Amount Paid qualifier is invalid for . Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Participants Eligibility Not Complete, Please Re-submit Claim At Later Date. Avoiding denial reason code CO 22 FAQ Q: We received a denial with claim adjustment reason code (CARC) CO 22. Other Medicare Managed Care Response not received within 120 days for providerbased bill. Drug Dispensed Under Another Prescription Number. Prior authorization is required for Maxalt when Maxalt or sumatriptan productshave not been reimbursed within 365 days. Service Denied. Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. A traditional dispensing fee may be allowed for this claim. 1. Case Plan and/or assessment reimbursment is limited to one per calendar year.Calendar Year. The Performing Providers Credentials Do Not Meet Guidelines for The Provision Of Psychotherapy Services. Multiple Providers Of Treatment Are Not Indicated For This Member. Understanding Your Explanation of Benefits (EOB) - Verywell Health Reason Code 161: Attachment referenced on the claim was not received in a timely fashion. Duplicate/second Procedure Deemed Medically Necessary And Payable. Denied. The information on the claim isinvalid or not specific enough to assign a DRG. Medicare Coinsurance Amount Was Not Provided On Crossover Claim. No Action On Your Part Required. Ability to proficiently use Microsoft Excel, Outlook and Word. Value codes 48 Homoglobin Reading and 49 Hematocrit Reading, must have a zero in the far right position. The 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. Denied due to Take Home Drugs Not Billable On UB92 Claim Form. Pricing Adjustment/ Maximum Flat Fee pricing applied. Home Health visits (Nursing and therapy) in excess of 30 visits per calendar year per member require Prior Authorization. A code with no Trip Modifier billed on same day as a code with Modifier U1 are considered the same trip. Please Refer To Your Hearing Services Provider Handbook. Complex Care Services Are Limited To One Per Date Of Service(DOS) Per Member. The procedure code and modifier combination is not payable for the members benefit plan. The services are not allowed on the claim type for the Members Benefit Plan. For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). This claim is eligible for electronic submission. Please Clarify. Unable To Process Your Adjustment Request due to Member Not Found. The Service Requested Is Not A Covered Benefit Of The Program. Procedure Code Changed To Permit Appropriate Claims Processing. Reimbursement of this service is included in the reimbursement of the most complex/complete procedure performed. Medically Unbelievable Error. Please Correct Claim And Resubmit. Value Code 48 And 49 Must Have A Zero In The Far Right Position. Medicare RA/EOMB And Claim Dates And/or Charges Do Not Match. PNCC Risk Assessment Not Payable Without Assessment Score. PDF How to read EOB codes - Washington Rendering Provider is not a certified provider for Wisconsin Chronic Disease Program. A Photocopy Of The PA Request Form Has Been Mailed Separately Identifying the Reimbursement Rate For The Procedure Codes Authorized. Admit Diagnosis Code is invalid for the Date(s) of Service. No policy override available for BadgerCare Plus Benchmark Plan, Core Plan or Basic Plan. Request For Training Reimbursement Denied. Psychotherapy Provided In The Members Home Is Not A Covered Benefit Of . Claim Explanation Codes. . Ancillary Codes Dates Of Service And/or Quantity Billed Do Not Match Level Of Care authorized Dates. Rqst For An Acute Episode Is Denied. Two different providers cannot be reimbursed for the same procedure for the same member on the same Date Of Service(DOS). The 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. To allow for multiple biopsies for investigation and diagnosis of certain disease entities, WellCare applies max units editing for CPT code 88305 based on gastrointestinal (GI) and prostate-related diagnoses. Basic Knowledge of Explanation of Benefits (EOB) interpretation. This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization. The Information Provided Is Not Consistent With The Intensity Of Services Requested. Claim Denied. Use This Claim Number For Further Transactions. Denied due to Medicare Allowed Amount Is Greater Than Total Billed Amount. Providers will find a list of all EOB codes used with the corresponding description on the last page of the Remittance Advice. Multiple Screens Performed Within A Fifteen Day Time Frame For This SSN. The Service Requested Is Covered By The HMO. We have redesigned our website to help you find the information you need more easily. Rebill On Pharmacy Claim Form. Denied due to Services Billed On Wrong Claim Form. Admission Date is on or after date of receipt of claim. Claims Edit Guideline: Reimbursement (Maximum Edit Units) - WellCare Discharge Diagnosis 2 Is Not Applicable To Members Sex.
