EOB Codes

111

This claim is awaiting administrative information. Our assessment will follow once it is received.

116

Before any outstanding balance can be processed under your Health Spending Account, please submit your Explanation of Benefits from your carrier if you have not already done so.

117

**Missing information. Please resubmit claim indicating the correct…{dynamic}

121

The prescription(s) we have on file is not valid for this service date. Please submit a valid prescription.

122

**This benefit requires a prescription/referral from {dynamic}. Please submit a valid prescription.

132

According to our records, this plan is second payer. Please submit a copy of the statement from the first insurer.

133

Manitoba Health may provide coverage for this benefit. Please submit a copy of their assessment.

146

This benefit is reimbursement only and cannot be paid to the provider. Please submit a paid receipt.

154

Manitoba Blue Cross does not process claims for this Client. Please forward your claim to the correct carrier.

162

The Employee does not satisfy the eligibility requirements for group travel coverage.

163

The Service Recipient submitted on the claim is not listed under this contract number.

172

An adjustment has been made to this claim because there was a change to the coverage available under this plan.

173

An adjustment has been made to this claim because there was a change to the coverage available under this plan.

205

This benefit is not eligible but coverage is available for an alternative benefit. The eligible amount has been adjusted accordingly.

206

In accordance with the Fee Guide, the eligible amount for the Root Canal was reduced by the cost of a Pulpectomy/Pulpotomy already processed by our office.

207

In accordance with the Fee Guide, a Pulpectomy/Pulpotomy is included in the cost of a Root Canal.

208

In accordance with the Fee Guide, separate restorations on the same tooth should be combined and assessed according to the number of surfaces treated. The eligible amount has been adjusted accordingly.

209

In accordance with the Fee Guide, the billed amount for separate x-ray types should not exceed the billed amount for the total number of films under one series type. The eligible amount has been adjusted accordingly.

210

In accordance with the Fee Guide, Pulp Vitality Tests are included in the cost of a Complete Exam.

211

It is not considered Usual or Customary for Pulp Vitality Tests to be charged in conjunction with Root Canal Therapy.

212

In accordance with the Fee Guide, this Benefit is included in the cost of Crowns and Bridges.

213

In accordance with the Fee Guide, this Benefit is included in the cost of a Periodontic Appliance.

214

The eligible amount has been reduced in accordance to the provincial fee guide stipulations - payment reduced when submitted in conjunction with specific procedures

231

This benefit has been assessed at the semi private room rate since there is no private room coverage available under this plan.

232

This benefit requires that a patient be confined as an in-patient for 24 hours. The same admittance and discharge date were listed on the claim.

234

The Refund Allowance benefit requires that a patient requested a semi-private room but one was not available. Confirmation of the request and lack of room availability from the hospital is required.

235

Hospitalizations commencing prior to the coverage effective date are not eligible for coverage.

236

The number of days submitted does not match the start and end dates provided with the claim.

246

Kilometer charges are only eligible when billed outside of the base rate area. This is in accordance with the Provider Agreement.

249

The non-emergency ambulance benefits require the patient to be transported by stretcher on the authorization of the physician. Confirmation of authorization is required.

250

Emergency ambulance charges are not eligible when departure and destination indicate non-emergency service.

271

We require a copy of the approval or denial from Pharmacare. Please submit a copy of their assessment.

276

The expenses submitted exceed the credits available under this plan. Further payments may be available as credits accrue.

277

The expenses submitted exceed the credits available under this plan. No further credits will accrue.

302

**Missing information. Please resubmit claim indicating the correct…{dynamic}

303

Service must be paid in full for reimbursement. Please submit receipt indicating payment in full.

304

There is not enough detail to assess the claim. Please submit an itemized receipt/invoice, including service dates, patient name, and description of services.

307

The prescription submitted with the claim is not dated. Please submit a valid prescription.

308

The prescription submitted with the claim does not contain a diagnosis. Please submit a valid prescription.

310

According to our records, this plan is second payer. Please submit a copy of the statement from the first insurer.

311

A government program may provide coverage for this benefit. Please submit a copy of their assessment.

313

The Service Recipient's automobile insurance provider may provide coverage for this benefit. Please submit a copy of their assessment.

316

The Workers Compensation Board may provide coverage for this benefit. Please submit a copy of their assessment.THIS EOB CODE IS ONLY TO BE USED WHEN ADVISED BY CHRISTINE OR JAID. ALL THIRD PARTY CLAIMS MUST BE PASSED TO THEM BEFORE PROCESING.

318

A document you have uploaded to your mybluecross account is unreadable. Please resubmit your claim and documents ensuring all information is visible

320

Treatment associated with Temporomandibular Joint (TMJ) dysfunction is not eligible under this plan.