Announcement for Behavioral Health Marketplace Providers Top Five Reasons for Denials EOB Code 1. BA1 2. MD3 3. 099 4. AZ1 5. 003 Description Service not a plan benefit, use of service code 510 Modifier inappropriate Duplicate charge previously submitted No authorization for services Member not enrolled on date of service How to Fix These Common Reasons for Denial 1. EOB BA1 – Resubmit the claim using service code 513 instead of 510. 2. EOB MD3 – Modifiers are not required for Marketplace, use rendering individual NPI. 3. EOB 099 – Claim has already been processed. Allow 30 days for electronic and 45 days for paper submission. 4. EOB AZ1 – Prior Authorization was lifted for outpatient therapy services on 2/1/14. All other services require prior authorization. 5. EOB 003 – Check member eligibility on myMDwise web portal for specific date of service. Dispute Process Our dispute process along with the dispute form can be found on our website at MDwise.org/forms/claims. If you have additional questions, please contact Marketplace customer service at 1-855-417-5615.
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