B9 Services not covered because the patient is enrolled in a Hospice. B12 Services not documented in patients' medical records. B13 Payment is included in the payment already made. Level of subluxation is missing or inadequate. D2 Claim lacks the name, strength, and dosage of the drug furnished.
Claim lacks individual lab codes included in the test.
Claim did not include patient's medical record for the service. Claim lacks date of patient's most recent physician visit. Claim lacks indicator that x-ray is available for review. Claim lacks invoice or statement certifying the actual cost of the lens, less discounts or the type of intraocular lens used. Completed physician financial relationship form not on file.