Vague revenue code NOT 761 or 940 Fertility services covered by network Requires per diem pricing EXC_MN_ModSG EXC_Natpath Strapping code(s) billed with PT benefit High Importance note from 2016 Newborn: no outreach done Taxonomy code 246Z00000X Medical student taxonomy code EXC_Tattoo Lesser-of requiring override Benefit Amount >$500k Benefit amount >$100k, <$500 AA off for BR that goes to audit Documentation code(s) >$0 Override to member's cost- sharing Gap exception requiring override Dependent not found maxTimes1 Override to Bariatric Surgery benefit Dual coverage requiring override Third adjustment Newborn: outreach done, pend Vague revenue code NOT 761 or 940 Fertility services covered by network Requires per diem pricing EXC_MN_ModSG EXC_Natpath Strapping code(s) billed with PT benefit High Importance note from 2016 Newborn: no outreach done Taxonomy code 246Z00000X Medical student taxonomy code EXC_Tattoo Lesser-of requiring override Benefit Amount >$500k Benefit amount >$100k, <$500 AA off for BR that goes to audit Documentation code(s) >$0 Override to member's cost- sharing Gap exception requiring override Dependent not found maxTimes1 Override to Bariatric Surgery benefit Dual coverage requiring override Third adjustment Newborn: outreach done, pend
(Print)
Vague revenue code NOT 761 or 940
Fertility services covered by network
Requires per diem pricing
EXC_MN_ModSG
EXC_Natpath
Strapping code(s) billed with PT benefit
High Importance note from 2016
Newborn: no outreach done
Taxonomy code 246Z00000X
Medical student taxonomy code
EXC_Tattoo
Lesser-of requiring override
Benefit Amount >$500k
Benefit amount >$100k, <$500
AA off for BR that goes to audit
Documentation code(s) >$0
Override to member's cost-sharing
Gap exception requiring override
Dependent not found
maxTimes1
Override to Bariatric Surgery benefit
Dual coverage requiring override
Third adjustment
Newborn: outreach done, pend
