The Surgical Procedure Code is restricted. 3101. Payment Is Limited To One Unit Dose Service Per Calendar Month, Per Legend Drug, Per Member. Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item. Dates Of Service Must Be Itemized. Please Reference Payment Report Mailed Separately. Medicaid Claim Adjustment Reason Code:B13 - thePracticeBridge Enhanced payment for providing services in a natural environment is limited toone service per discipline per day. Denied. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity. All services should be coordinated with the primary provider. Denied due to Detail Dates Are Not Within Statement Covered Period. Fifth Diagnosis Code (dx) is not on file. Pricing Adjustment/ Spenddown deductible applied. A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. One or more Diagnosis Code(s) is not payable by Wisconsin Chronic Disease Program for the Date Of Service(DOS). 2. A Third Occurrence Code Date is required. If you are still unable to resolve the login problem, read the troubleshooting steps or report your issue. Please Correct Claim And Resubmit. Denied. Resubmit Using Valid Rn/lpn Procedure Codes And A Valid PA Number. Rendering Provider Type and/or Specialty is not allowable for the service billed. Continuous home care and routine home care may not be billed for the same member on the same Date Of Service(DOS). Room And Board Is Only Reimbursable If Member Has A BQC Nursing Home Authorization. Other Insurance Or Medicare Response Not Received Within 120 Days For ProviderBased Bill. Claim Is Being Special Handled, No Action On Your Part Required. Procedure Code billed is not appropriate for members gender. Adjustment To Crossover Paid Prior To Aim Implementation Date. This Service Is A Resubmission Of A Service Previously Denied For Prior Authorization. For 2020, WellCare is adding 68 new Medicare Advantage plans for a total of 261 plans with $0 or low monthly plan premiums. Claim Generated An Informational ProDUR Alert, Drug-Drug Interaction prospective DUR alert, Drug-Disease (reported) prospective DUR alert, Drug-Disease (inferred) prospective DUR alert, Therapeutic Duplication prospective DUR alert, Suboptimal Regiment prospective DUR alert, Insufficient Quantity prospective DUR alert. Dental service limited to twice in a six month period. A valid Prior Authorization is required. Denied. Annual Nursing Home Member Oral Exam Is Allowed Once Per 355 Days Per Recip Per Prov. 51.42 Board Directors Or Designees Statement & Signature Required OnThe Claim Form For Payment Of Functional Assessment. This Payment Is To Satisfy The Amount Indicated On The Administrative Claiming Reimbursement Summary Report.

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