Frequency or number of injections exceed program policy guidelines. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. OA 10 The diagnosis is inconsistent with the patient's gender. The second occurrence span from Date Of Service(DOS) is after to to Date Of Service(DOS). Please Obtain A Valid Number For Future Use. Backdating Allowed Only In Cases Of Retroactive Member/provider Eligibility. NFs Eligibility For Reimbursement Has Expired. This Claim Has Been Excluded From Home Care Cap To Allow For Acute Episode. When a provider submits an E&M level of service that exceeds the maximum level of E&M service level based on the diagnosis submitted, the E&M code is recoded (and allowed to pay) to match the maximum level of E&M service allowed based on the severity of the medical diagnosis submitted. Please familiarize yourself with these new explanation codes and update your accounts receivable as indicated. Home Health Services In Excess Of 60 Visits Per Calendar Month Per Member Required Prior Authorization. This obstetrical service was previously paid for this Date Of Service(DOS) for thismember. Resubmit Claim With Corrected Tooth Number/letter Or With X-ray Documenting Tooth Placement. Complex Care Services Are Limited To One Per Date Of Service(DOS) Per Member. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. Surgical Procedure Code is not allowed on the claim form/transaction submitted. Referral/treatment Procedures Are Not Payable When Billed With A Complete Refusal Detail. Occupational Therapy Limited To 45 Treatment Days Per Spell Of Illness w/o Prior Authorization. CPT Code 88305 (Level IV Surgical pathology, gross and microscopic examination) includes different types of biopsies. Pricing Adjustment/ Patient Liability deduction applied. Diagnosis Treatment Indicator is invalid. The Procedure Code is not reimbursable for the Rendering Provider Type and/or Specialty. Claim Number Given On The Adjustment/reconsideration Request Form Does Not Match Services Originally Billed. Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. These Services Paid In Same Group on a Previous Claim. Purchase of a blood glucose monitor includes the first 30 days of supplies for the monitor. Inpatient psychiatric services are not reimbursable for members age 21 65 (age 22 if receiving services prior to 21st birthday). Claims may deny for audiology screening (CPT 92551, 92560, V5008) may be denied when a provider bills for auditory screening services at the same time as a preventive medicine visit (CPT 99381-99397) or wellness visit (CPT G0438-G0439), without appropriate modifier appended to the E&M service to identify a separately identifiable procedure. When Billing For Basic Screening Package, Charge Must Be Indicated Under Procedure W7000. Diagnosis Code is restricted by member age. Payment Subject To Pharmacy Consultant Review. 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. Denials with solutions in Medical Billing; Denials Management - Causes of denials and solution in medical billing; Medical Coding denials with solutions Denied. For over 40 years, Washington Publishing Company (WPC) has specialized in managing and distributing data integration information through publications, training, and consulting services. Procedure Not Payable As Submitted. At least one Remark Code must be provided (may be comprised of either the Remittance Advice Remark Code or NCPDP Reject Reason Code.) If you have questions regarding your remittance advice, please contact our Provider Call Center at 1-888-FIDELIS (1-888-343-3547) or your . Per Information From Insurer, Prior Authorization Was Not Requested/approved Prior To Providing Services. Adjustment/reconsideration Request Denied Due To Incorrect/insufficient Information. Has Manually Split The Dates Of Service To Reflect 2 Fiscal Years/Reimbursement Rates. Please note that the submission of medical records is not a guarantee of payment. This Is A Duplicate Request. Please Correct And Resubmit. Denied/Cutback. Dispense Date Of Service(DOS) is invalid. Billing Provider is not certified for the Dispense Date. An ICD-9-CM Diagnosis Code of greater specificity must be used for the SeventhDiagnosis Code. No action required. Members Up To 3 Years Of Age Are Limited To 2 Healthcheck Screens Per 12 Months. Revenue Codes 0110 (N6) And 0946 (N7) Are Not Payable When Billed On The Same Dateof Service As Bedhold Days. This claim has been adjusted due to a change in the members enrollment. The service requested is not allowable for the Diagnosis indicated. Modifier Submitted Is Invalid For The Member Age. A National Provider Identifier (NPI) is required for the Performing Provider listed in the header. This Payment Is A Refund For An Overpayment Of A Provider Assessment, Thank You For Your Assessment Payment By Check, In Accordance With Your Request, EDS Has Deducted Your Assessment From This Payment. Medicare Id Number Missing Or Incorrect. Service Denied. Multiple Tooth Extract On Same Date Of Service(DOS) Must Be Billed As Single And Additional Tooth Extract In Same Quadrant. Alternatively, the provider has billed a prior inpatient E&M visit, without an inpatient discharge service (CPT 99238-99239) in the interim. PA required for payment of this service. Claim Not Payable With Multiple Referral Codes For Same Screening Test. PLEASE RESUBMIT CLAIM LATER. Case Plan and/or assessment reimbursment is limited to one per calendar year.Calendar Year. Denied due to Claim Contains Future Dates Of Service. Details Include Revenue/surgical/HCPCS/CPT Codes. Denied. Third Other Surgical Code Date is invalid. Date of service is on or after July 1, 2010 and TOB is 72X, value code D5 mustbe present. Claim Paid Under DRG Reimbursement, Except For Transplants Billed Using Suffixes 05 Through 09. The information on the claim isinvalid or not specific enough to assign a DRG. The Member Is Enrolled In An HMO. Program guidelines or coverage were exceeded. Reimbursement For IUD Insertion Includes The Office Visit. Claims may deny the chest X-ray billed when the only diagnoses is one of the following routine screening diagnoses: General medical exam (ICD-10 codes Z00.0-Z00.01, Z00.5, Z00.6, Z00.8), Pre-admission/administrative exam (ICD-10 codes Z02.0-Z02.6, Z02.8-Z02.89, Z04.6), Pre-operative exam (ICD-10 codes Z01.810-Z01.811, Z01.818), FL 42 Revenue Code Required. Professional Service code is invalid. You can view these EOBs online by following these steps: Log in to your bcbsm.com account to view your prescriptions coverage. Find top links about Wellcare Cvs Caremark Login along with social links, FAQs, and more. This procedure is limited to once per day. The From Date Of Service(DOS) for the Second Occurrence Span Code is required. Policy override must be granted by the Drug Authorization and Policy Override Center to dispense less than a 100 day supply. Please Correct And Re-bill. flora funeral home rocky mount va. Jun 5th, 2022 . Modification Of The Request Is Necessitated By The Members Minimal Progress. Remark Codes: N20. Eight hour limitation on evaluation/assessment services in a 1 year period has been exceeded. 10 Important Billing Tips for FQHC and RHC Providers. The Narrative History Does Not Indicate the Members Functioning is Impaired due To AODA Usage. Has Already Issued A Payment To Your NF For A Level I Screen With The Same Admission Date. Non-preferred Drug Is Being Dispensed. The Member Does Not Meet The Criteria For Binaural Amplification; One Hearing Aid Is Authorized. Denied. Prior Authorization Is Required For Payment Of This Service With This Modifier. Psych Evaluation And/or Functional Assessment Ser. This Claim Cannot Be Processed. Denied. DME rental beyond the initial 30 day period is not payable without prior authorization. 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: Service Denied. Occurrence Codes 50 And 51 Are Invalid When Billed Together. Denied due to Procedure Or Revenue Code(s) Are Missing On The Claim. Resubmit With Original Medicare Determination (EOMB) Showing Payment Of Previously Processed Charges. Our Records Indicate This Provider Is Not Certified For AODA Day Treatment. Claim Denied Due To Incorrect Accommodation. Recoding/adjusting claim may result in a different DRG code assignmentand reimbursement. Correct Claim Or Submi Paper Claim Noting That Verification Has Occurred. A New Prior Authorization Number Has Been Assigned To This Request In Order ToProcess. Supervising Nurse Name Or License Number Required. Claim Denied. There are many different remittance adjustment reason codes (RARCs) established for Medicare and we understand their explanations may be "generic" and confusing, so we have provided a listing in the table below of the most commonly used denial messages and RARCs utilized by Medical Review Part B during medical record review. This procedure is duplicative of a service already billed for same Date Of Service(DOS). that provide either supplemental explanation for a monetary adjustment or policy information are required in the remittance advice transaction. Prior Authorization (PA) required for payment of this service. 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. Rqst For An Acute Episode Is Denied. Number On Claim Does Not Match Number On Prior Authorization Request. Revenue Code 082X is present on an ESRD claim which also contains revenue codes 083X, 084X, or 085X. Submit Claim To For Reimbursement. Received Beyond Special Filing Deadline For ThisType Of Claim Or Adjustment/reconsideration. Our Records Indicate This Tooth Previously Extracted. Service is reimbursable only once per calendar month. Quantity Billed is invalid for the Revenue Code. Repackaged National Drug Codes (NDCs) are not covered. Request Denied Because The Screen Was Done More Than 90 Days Prior To The Admission Date. Claim reimbursement has been cutback to reimbursement limits for denture repairs performed within 6 months. Contact Wisconsin s Billing And Policy Correspondence Unit. Supervisory visits for Unskilled Cases allowed once per 60-day period. Please verify billing. Independent Laboratory Provider Number Required. Provider Is Not A Qualified Provider For presumptively Eligible Recipients. Denied due to Procedure Billed Not A Covered Service For Dates Indicated. PDN Codes W9045/w9046 Are Not Payable On The Same Date As PDN Codes W9030/W9031 For The Same Provider And Member. The Total Number Of Sessions Requested Exceeds Quarterly Guidelines. Members do not have to wait for the post office to deliver their EOB in a paper format. Please Correct And Resubmit. Either The Date Was Not In MM/DD/CCYY Format Or Its AFuture Date. Invalid/obsolete Procedure Code For Determination Of Refraction, Service Denied. Reimbursement For This Certification, Test, Segment Has Already Been Issued ToYour NF. Six hour limitation on evaluation/assessment services in a 2 year period has been exceeded. Reimburse Is Limited To Average Monthly NHCost And Services Above That Amount Are Consider non-Covered Services. Recouped. Speech Therapy Is Not Warranted. Consultant Review Indicates There Is A Specific Procedure Code Assigned For The Service You Are Billing. Only Healthcheck Modifiers Can Be Billed With Healthcheck Services. The Functional Assessment And/or Progress Status Report Does Not Indicate Any Change, and/or Positive Rehabilitation Potential. We have redesigned our website to help you find the information you need more easily. Denied/Cutback. A Training Payment Has Already Been Issued For This Cna. Other Insurance Disclaimer Code Used Is Inappropriate For This Members Insurance Coverage. Please Verify The Units And Dollars Billed. Denied. NFs Eligibility For Reimbursement Has Expired. First modifier code is invalid for Date Of Service(DOS). Denied. Amount Paid On Detail By WWWP Is Less Than Billed Or Reimbursement Rate Due ToPrior Payment By Other Insurance. Alternatively, CPT XXXXX has been billed in the previous 10 days for a CPT code with a 10-day post-operative period, or in the previous 90 days for a code with a 90-day post-operative period by the same provider. MLN Matters Number: MM6229 Related . CPT Code And Service Date For Member Is Identical To Another Claim Detail On File For Provider On Claim. Example: Diagnosis code 285.21 is entered as 28521, without a period or space. Timeframe Between The CNAs Training Date And Test Date Exceeds 365 Days. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. A new set of Generic Reason codes and statements for Part A, Part B and DME have been added and approved for use across all Prior Authorization (PA), Claim reviews . Please Bill Appropriate PDP. Edentulous Alveoloplasty Requires Prior Authotization. The Member Does Not Appear To Meet The Severity Of Illness Indicators Established by the Wisconsin And Is Therefore Not Eligible For AODA Day Treatment. EOB Codes are present on the last page of remittance advice, these EOB codes or explanation of benefit codes are in form of numbers and every number has a specific meaning. Compound drugs not covered under this program. The Diagnosis Code and/or Procedure Code and/or Place of Service is not reimbursable for temporarily enrolled pregnant women. Pricing Adjustment/ Payment reduced due to benefit plan limitations. Please Correct And Resubmit. The first position of the attending UPIN must be alphabetic. Schedule 3, 4 or 5 drugs are limited to the original dispensing plus 5 refillsor 6 months. NFs Eligibility For Reimbursement Has Expired. Accommodation Days Missing/invalid. Claim Denied. Total Rental Payments For This Item Have Exceeded The Maximum Allowable Forthe Purchase Of This Item. ACCOM REV CODE QTY BILLED NOT EQUAL TO DTL DOS. Denied. No Action Required. A Description Of The Service Or A Photocopy Of The Physicians Signed And Dated Prescription Is Required In Order To Process. Rendering Provider is not certified for the Date(s) of Service. The Reimbursement Code Assigned To This CNA Does Not Authorize A NAT Payment. As A Reminder, This Procedure Requires SSOP. According to the American Association of Neuromuscular & Electro-Diagnostic Medicine and CMS Policy, nerve conduction studies and a needle electromyography (EMG) must both be performed in order to diagnose radiculopathy (pinched nerve in back or neck). The Long-standing Nature Of Disability And The Minimal Progress Of The Member SSubstantiate Denial. This Mutually Exclusive Procedure Code Remains Denied. Claim contains duplicate segments for Present on Admission (POA) indicator. Pricing Adjustment/ Inpatient Per-Diem pricing. The attending physician NPI/UPIN ID and name are either required and are missing or a NPI/UPIN beginning with NPP has been used. In the above example the claim was denied with two codes, the Adjustment Reason Code of 16 and then the explanatory Remark Code of N329 (Missing/incomplete/invalid patient birth date). The taxonomy code for the attending provider is missing or invalid. A Payment Has Already Been Issued For This SSN. Routine foot care is limited to no more than once every 61days per member. The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code. Denied due to Quantity Billed Missing Or Zero. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Glucocorticoids-Inhaled to Flovent. They are used to provide information about the current status of . This drug is limited to a quantity for 34 days or less. Medicaid Remittance Advice Remark Code:M86 MMIS EOB Code:100. For RHCs, place of service is 72, however, you can bill lab services with a place of service 11. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. Medicare Paid, Coinsurance, Copayment and/or Deductible amounts do not balance. The Surgical Procedure Code has Diagnosis restrictions. Pricing Adjustment/ The submitted charge exceeds the allowed charge. Claim Denied. Denied due to Procedure/Revenue Code Is Not Allowable. Service Denied. This National Drug Code (NDC) has diagnosis restrictions. Pricing Adjustment. HIPAA EOB codes are returned on the 835 Remittance Advice file and are maintained by the Washington Publishing Company. Member has Medicare Supplemental coverage for the Date(s) of Service. Denied. Other Amount Submitted Not Reimburseable. Documentation You Have Submitted Does Not Meet The Requirements Of HSS 107.09(4)(k). Claims adjustments. Do not leave blank fields between the multiple occurance codes. Here are just a few of them: EOB CODE. Reimb Is Limited to the Average Monthly NH Cost and Services Above that Amount Are Considered non-Covered Services. Pregnancy Indicator must be "Y" for this aid code. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Hypoglycemics-Insulin to Humalog and Lantus. The service was previously paid for this Date Of Service(DOS). Urinalysis And X-rays Are Reimbursed Only When Performed In Conjunction With An Initial Office Visit On Same Date Of Service(DOS). Tooth surface is invalid or not indicated. If authorization number available . The Member Appears To Be At A Maximum Level For Age, Diagnosis, And Living Arrangement. Please Do Not Resubmit Your Claim, And Disregard Additional Informational Messages for this claim. The Request May Only Be Back-dated Two Weeks Prior To Receipt By EDS. Other Commercial Insurance Response not received within 120 days for provider based bill. Submit Claim To Insurance Carrier. The Related Surgical Procedure is not a covered service under Wisconsin Medicaid or BadgerCare Plus. Member enrolled in Medicare Part D for the Dispense Date Of Service(DOS). The Maximum limitation for dosages of EPO is 500,000 UIs (value code 68) per month and the maximum limitation for dosages of ARANESP is 1500 MCG (1 unit=1 MCG) per month. Member is not enrolled in the program submitted in the Plan ID field for the Dispense Date Of Service(DOS) or an invalid Plan ID was submitted. Information Required For Claim Processing Is Missing. The Procedure Requested Is Not Appropriate To The Members Sex. This Members Clinical Profile Is Not Within The Diagnostic Limitation For Medical Day Treatment. Only non-innovator drugs are covered for the members program. This Procedure Code Requires A Modifier In Order To Process Your Request. SMV Mileage Exceeding 40 Miles In Urban Counties Or 70 Miles In Rural CountiesRequires Prior Authorization. It Corrects A Mispayment FoundDuring Claims Processing Or Resulting From Retroactive File Changes. The Primary Occurrence Code Date is invalid. Assessment Is Not A Covered Service Unless All Four Components Of Skilled Nursing Are Present: Assessment, Planning, Intervention And Evaluation. The Diagnosis Does Not Indicate A Significant Change In the Members Condition. Questionable Long-term Prognosis Due To Poor Oral Hygiene. . Additional Psychotherapy Is Not Considered Appropriate Or Inline With More Effective, Available Services. The From Date Of Service(DOS) for the First Occurrence Span Code is required. A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. Personal Care In Excess Of 250 Hrs Per Calendar Year Requires Prior Authorization. This claim must contain at least one specified Surgical Procedure Code. EOB Codes List|Explanation of Benefit Reason Codes (2023) February 7, 2022 by medicalbillingrcm. Member is enrolled in Medicare Part D for the Dispense Date Of Service(DOS). The Service Requested Is Not Medically Necessary. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a NAT Payment. The Pharmaceutical Care Code (PCC) does not have a rate on file for the Date Of Service(DOS). Claim Denied. Prescriptions Or Services Must Be Billed As ASeparate Claim. Member is enrolled in a commercial health insurance on the Dispense Date Of Service(DOS). Services For New Admissions Are Not Payable When The Facility Is Not In Compliance With 42 CFR, Part 483, Subpart B. Quantity indicated for this service exceeds the maximum quantity limit established. Denied/Cutback. Physical Therapy, Occupational Therapy Or Speech Therapy Limited To 90 Min PerDay. According to the American College of Radiology and the American Academy of Neurology, a CT of the head or brain, CTA of the head, MRA of the head or MRI of the brain should not be performed routinely for patients with a migraine in the absence of related neurologic signs and symptoms. There Is Evidence That The Member Is Not Detoxified From Alcohol And/or Other Drugs and is Therefore Not Currently Eligible For AODA Day Treatment. Training CompletionDate Exceeds The Current Eligibility Timeline. A Payment For The CNAs Competency Test Has Already Been Issued. This National Drug Code Has Diagnosis Restrictions. Member is assigned to an Inpatient Hospital provider. Second Rental Of Dme Requires Prior Authorization For Payment. Service Denied, refer to Medicares Billing and/or Policy Guidelines. Two different providers cannot be reimbursed for the same procedure for the same member on the same Date Of Service(DOS). The Insurance EOB Does Not Correspond To The Dates Of Service/servicesBeing Billed. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone. Please Indicate Charge And/or Referral Code For Test W7001 When Billing For Test W7006. Benefit code These codes are submitted by the provider to identify state programs. Language Comprehension And Language Production Are Equivalent To Cognition, Thus Formal Speech Therapy Is Not Needed. Please Indicate One Prior Authorization Number Per Claim. Service(s) paid in accordance with program policy limitation. NDC- National Drug Code is not allowed for the member on the Date Of Service(DOS). Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. Medically Unbelievable Error. To bill any code, the services furnished must meet the definition of the code. This drug has been paid under an equivalent code within seven days of this Date Of Service(DOS). Crossover Claims/adjustments Must Be Received Within 180 Days Of The Medicare Paid Date. Please Clarify Services Rendered/provide A Complete Description Of Service. The diagnosis code is not reimbursable for the claim type submitted. 0001 01/01/1900 NOT USED - MEMBER'S DMAP I.D. The Revenue Code is not payable for the Date Of Service(DOS). Please File With Champus Carrier. Denied. Anesthesia and moderate sedation services billed with pain management services for a patient age 18 or older may deny unless a surgical procedure CPT code range 10021-69990 (other than pain management procedures) is also billed on the claim. Denied. Unrelated Procedure/Service by the Same Physician During the Post-op Period, Modifier 79. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. Modifier invalid for Procedure Code billed. Denied. Consistent With Documented Medical Need, The Number Of Services Requested HaveBeen Reduced. LTC hospital bedhold quantity must be equal to or less than occurrence code 75span date range(s). Per Information From Insurer, Requested Information Was Not Supplied By The Provider. Limited to once per quadrant per day. Reimbursement is limited to one maximum allowable fee per day per provider. This Claim Has Been Manually Priced Based On Family Deductible. Other Medicare Part A Response not received within 120 days for provider basedbill. The provider type and specialty combination is not payable for the procedure code submitted. Consultation or surgical procedures are not reimbursable in conjuctions with Emergency Room services. Pharmacy Clm Submitted Exceeds The Number Of Clms Allowed Per Cal. Referring Provider is not currently certified. Rqst For An Acute Episode Is Denied. Member first name does not match Member ID. Service Billed Exceeds Restoration Policy Limitation. Combine Like Details And Resubmit. For Revenue Code 0820, 0821, 0825 or 0829, HCPCS Code 90999 or Modifier G1-G6 must be present. Pricing Adjustment/ Anesthesia pricing applied. Billing Provider is not certified for the detail From Date Of Service(DOS). Dispensing fee denied. The Service Requested Is Not A Covered Benefit As Determined By . Repackaging allowance is not allowed for unit dose NDCs. The Revenue Code is not reimbursable for the Date Of Service(DOS). Claim Denied Due To Invalid Occurrence Code(s). Valid NCPDP Other Payer Reject Code(s) required. Was Unable To Process This Request. The To Date Of Service(DOS) for the Second Occurrence Span Code is invalid. Denied. Please Correct And Submit. NDC was reimbursed at State Maximum Allowable Cost (SMAC) rate. All Home Health Services Exceeding 8 Hours Per Day Or 40 Or More Hours Per Week Require Prior Authorization. Hearing aid repairs are limited to once per six months, per provider, per hearing aid. Medicare Coinsurance Amount Was Not Provided On Crossover Claim. Surgical Procedure Code is not related to Principal Diagnosis Code. A Qualified Provider Application Is Being Mailed To You. Please Attach Copy Of Medicare Remittance. The Procedure Code Indicated Is For Informational Purposes Only. All three DUR fields must indicate a valid value for prospective DUR. The Requested Transplant Is Not Covered By . Maximum Number Of Outreach Refusals Has Been Reached For This Period. CPT Code 88305 (Level IV - Surgical pathology, gross and microscopic examination) includes different types of biopsies. Please Refer To The Original R&S. Part A Reason Codes are maintained by the Part A processing system. Case Planning And/or On-going Monitoring For Both Targeted Case Managementand Child Care Coordination Are Not Allowed In The Same Month. Refill Indicator Missing Or Invalid. Revenue code billed with modifier GL must contain non-covered charges. Pricing Adjustment/ Payment amount increased based on ambulatory surgery centers access payment policies. Six Week Healing Time Is Required Between Endentulation And Final Impressions.Payment For Dentures Will Be Denied Or Recouped If Healing Period Is Not Observed. Amount Indicated In Current Processed Line On R&S Report Is The Manual Check You Recently Received. Only One Interperiodic Screen Is Allowed Per Day, Per Member, Per Provider. Service(s) exceeds four hour per day prolonged/critical care policy. The sum of the Medicare paid, deductible(s), coinsurance, copayment and psychiatric reduction amounts does not equal the Medicare allowed amount.