SeniorCare member enrolled in Medicare Part D. Claim is excluded from Drug Rebate Invoicing. Transplants and transplant-related services are not covered under the Basic Plan. One or more To Date(s) of Service is invalid for Occurrence Span Codes in positions three through 24. Please Review Remittance And Status Report. Claims With Dollar Amounts Greater Than 9 Digits. You Must Adjust The Nursing Home Coinsurance Claim. Department of Health Services (DHS) Authorized Payment Is Being Withheld Due toa Final Rate Settlement. The Documentation Submitted Does Not Indicate Medically Oriented Tasks Are Medically Necessary, Therefore Personal Care Services Have Been Approved. Please adjust quantities on the previously submitted and paid claim. Psych Evaluation And/or Functional Assessment Ser. 100 Days Supply Opportunity. Please Bill Appropriate PDP. According to CMS policy and the American College of Radiology, a chest X-ray (CPT codes 71045, 71046) should not be performed for screening purposes in the absence of pertinent signs, symptoms or diseases. A claim cannot contain only Not Otherwise Specified (NOS) Surgical Procedure Codes. Claim Denied For Invalid Diagnosis Code Or Diagnosis Code/CPT Combination. Prior Authorization is required to exceed this limit. Explanation of Benefit codes (EOBs) Explanation of Benefit (EOB) codes are reported on your remittance statement. Claim Denied Due To Absent Or Incorrect Discharge (to) Date. The Reimbursement Code Assigned To This CNA Does Not Authorize A NAT Payment. Requested Documentation Has Not Been Submitted. Medicare Paid The Total Allowable For The Service. RN Home Health visits and Supervisory visits are not reimbursable on the same Date Of Service(DOS) for same provider. Request Denied Due To Late Billing. Denied by Claimcheck based on program policies. 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. Service Denied. This Check Automatically Increases Your 1099 Earnings. One Visit Allowed Per Day, Service Denied As Duplicate. Repackaging allowance is not allowed for unit dose NDCs. You can view these EOBs online by following these steps: Log in to your bcbsm.com account to view your prescriptions coverage. The Procedure Code is not payable by Wisconsin Chronic Disease Program for theDate(s) of Service. More Than 5 Consecutive Calendar Days Of Continuous Care Are Not Payable. Procedure Code is allowed once per member per lifetime. Early Refill Alert. Level And/or Intensity Of Requested Service(s) Is Incompatible With Medical Need As Defined In Care Plan. Intraoral Complete Series/comprehensive Oral Exam Limited To Once Every Three Years, Unless Prior Authorized. In 2015 CMS began to standardize the reason codes and statements for certain services. This Individual Is Either Not On The Registry Or The SSN On The Request D oesnt Match The SSN Thats Been Inputted On The Registry. Pricing Adjustment/ Maximum Flat Fee Level 2 pricing applied. Attachment was not received within 35 days of a claim receipt. The Number Of Weeks Has Been Reduced Consistent With Goals And Progress Documented. Members Age 3 And Older Must Have An Oral Assessment And Blood Pressure Check.With Appropriate Referral Codes, For Payment Of A Screening. The National Drug Code (NDC) submitted with this HCPCS code is CMS terminated or not covered by the program. Claim Detail from Date Of Service(DOS) And to Date Of Service(DOS) Are Required And Must Be Within The Same Calendar Month. The Hearing Aid Recommended Is Not Necessary; The Member Could Be Adequately Fitted With A Conventional Aid. This service was previously paid under an equivalent Procedure Code. Member eligibility file indicates that BadgerCare Plus Benchmark, CorePlan or Basic Plan member. Denied due to Provider Signature Date Is Missing Or Invalid. This service is not payable with another service on the same Date Of Service(DOS) due to National Correct Coding Initiative. Service Denied. Please Review The Cover Letter Attached To Your Claim, Any Informational Messages, And Provide The Requested Information BeforeResubmitting the Claim. Quantity Would Be 00010 If Specific Number Of Batteries Dispensed Is Not Indicated. The sum of the Accommodation Days is not equal to the sum of Covered plus Non-Covered Days. A Google Certified Publishing Partner. Revenue code submitted with the total charge not equal to the rate times number of units. Admit Date and From Date Of Service(DOS) must match. Denied. The Service(s) Requested Could Adequately Be Performed In The Dental Office. Purchase of additional DME/DMS item exceeding life expectancy rRequires Prior Authorization. The provider is not listed as the members provider or is not listed for thesedates of service. We have created a list of EOB reason codes for the help of people who are . Member has commercial dental insurance for the Date(s) of Service. Pricing Adjustment. Claims may deny for a CT head or brain, CTA head, MRA head, MRI brain or CT follow-up when the only diagnosis on the claim is a migraine. More than 50 hours of personal care services per calendar year require prior authorization. Denied. The diagnosis codes must be coded to the highest level of specificity. Paid In Accordance With Dental Policy Guide Determined By DHS. flora funeral home rocky mount va. Jun 5th, 2022 . The Functional Assessment Indicates This Member Has Less Than A 50% Likelihoodof Benefit, Therefore Day Treatment Is Not Appropriate. Service Billed Exceeds Restoration Policy Limitation. No Substitution Indicator Invalid For Non-innovator Drugs Not On The Current Wisconsin MAC List. Condition code 20, 21 or 32 is required when billing non-covered services. Service Denied/cutback. Member is enrolled in a State-contracted managed care program for the Date(s) of Service. If this is your first visit, be sure to check out the FAQ & read the forum rules.To view all forums, post or create a new thread, you must be an AAPC Member.If you are a member and have already registered for member area and forum access, you can log in by clicking here.If you've forgotten your username or password use our . No Interim Billing Allowed On Or After 01-01-86. The Primary Diagnosis Code is inappropriate for the Surgical Procedure Code. August 14, 2013, 9:23 am . Level Of Care/accommodation Code Billed Is Not Applicable To Your Provider Specialty. Amount Recouped For Duplicate Payment on a Previous Claim. Denied. Billing Provider Received Payment From Both Medicare And For Clai m. An Adjustment/reconsideration Request Has Been Made To The Billing Providers Account. Election Form Is Not On File For This Member. Please Obtain A Valid Number For Future Use. The revenue accomodation billing code on the claim does not match the revenue accomodation billing code on the member file or does not match for these dates of service. Denied. This is a same-day claim for bill types 13X, 14X, 71X, or 83X and there are multiple units or combination of chemistry/hemotology tests. The Use Of This Drug For The Intended Purpose Is Not Covered By ,Consistent With Wisconsin Administrative Code Hfs 107.10(4) And 1396r-8(d). Denied due to Procedure Billed Not A Covered Service For Dates Indicated. -OR- The claim contains value code 49but does not contain revenue code 0636 and HCPCS Q4054. Supplemental Payment Authorized By Department of Health Services (DHS) Due to aAudit. Consent Form Is Missing, Incomplete, Or Contains Invalid Information. Superior HealthPlan News. Reimbursement rate is not on file for members level of care. Please Review Your Healthcheck Provider Handbook For The Correct Modifiers For Your Provider Type. Adjustment and original claim do not have the same finanical payer, 6355 replacing 635R diagnosis (For use of Category of Service only), 6360 replacing 635S diagnosis (For use of Category of Service only), 6365 replacing 635T diagnosis (For use of Category of Service only). Unable To Process Your Adjustment Request due to Member ID Number On The Claim And On The Adjustment Request Do Not Match. Services Must Be Submitted On Proper Claim/adjustment/reconsiderationRequest Form. Service Provided Before Prior Authorization Was Obtained Is Not Allowable. Effective 04/01/09, the BadgerCare Plus Core Plan will limit coverage for Hypoglycemics-Insulin to Humalog and Lantus. Claims may deny when DXA bone density studies (CPT 77080 or 77081) are billed and the only diagnosis on the claim is osteoporosis screening (ICD-10 code Z13.820) for a woman who is under age 65 or for a man who is under age 70. The Tooth Is Not Essential For Support Of A Partial Denture. The Narrative History Does Not Indicate the Members Functioning is Impaired due To AODA Usage. Pricing Adjustment/ Patient Liability deduction applied. PLEASE RESUBMIT CLAIM LATER. The Rendering Providers taxonomy code is missing in the detail. Physical Therapy Treatment Limited To One Modality, One Procedure, One Evaluation Or One Combination Per Day. Private Duty Nursing Beyond 30 Hrs /Member Calendar Year Requires Prior Authorization. Policy override must be granted by the Drug Authorization and Policy Override Center to dispense less than a 100 day supply. Member has Medicare Supplemental coverage for the Date(s) of Service. Dialysis/EPO treatment is limited to 13 or 14 services per calendar month. Once Therapy Is Prior Authorized, All Therapy Must Be Billed With A Valid Prior Authorization Number. Services Not Payable When Rendered To An Individual Aged 21-64 Who Is A Resident Of A Nursing Home Imd. A WCDP drug rebate agreement for this drug is not on file for the Date Of Service(DOS). This Claim Is A Reissue of a Previous Claim. No Action Required. 1. Previously Denied Claims Are To Be Resubmitted As New Day Claims. Medicaid id number does not match patient name. The Reimbursement Code Assigned To This Certification Segment Does Not Authorize a Training Payment. Procedue Code is allowed once per member per calendar year. AODA Day Treatment Is Not A Covered Service For Members Who Are Residents Of Nursing Homes or Who Are Hospital Inpatients. Service Paid At The Maximum Amount Allowed By ReimbursementPolicies. Service Denied A Physician Statement (including Physical Condition/diagnosis) Must Be Affixed To Claims For Abortion Services Refer To Physician Handbook. Service Denied. Follow specific Core Plan policy for PA submission. The Medical Necessity For The Hours Requested Is Not Supported By The Information Submitted In The Personal Care Assessment Tool. Please Indicate Computation For Unloaded Mileage. This Payment Is To Satisfy The Amount Owed For OBRA Level 1. Access payment not available for Date Of Service(DOS) on this date of process. Refer To The Wisconsin Website @ dhs.state.wi.us. Please Correct And Resubmit. Services Submitted On Improper Claim Form. Eyeglasses limited to original plus 1 replacement pair, lens or frame in 12 wit hout Prior Authorization. Room And Board Is Only Reimbursable If Member Has A BQC Nursing Home Authorization. Ongoing assessment is not reimbursable when skilled nursing visits have been performed within the past sixty days. The Rendering Providers taxonomy code is missing in the header. Acknowledgement Of Receipt Of Hysterectomy Info Form Is Missing, Incomplete, Or Contains Invalid Information. Please correct and resubmit. Has Recouped Payment For Service(s) Per Providers Request. Please watch for periodic updates. A Training Payment Has Already Been Issued For This Cna. Please Ask Prescriber To Update DEA Number On TheProvider File. The maximum number of details is exceeded. Because a claim can have edits and audits at both the header and detail levels, EOB codes are listed . Primary Tooth Restorations Limited To Once Per Year Unless Claim Narrative Documents Medical Necessity. Capitation Payment Recouped Due To Member Disenrollment. CO/96/N216. Please Resubmit using A Approved CPT Or HCPCS Procedure Code. The Automated Voice Response System is encouraged to obtain claims status using a touch-tone phone. Service(s) Denied. Services on this claim have been split to facilitate processing.on On Your Part Is Required. Please Add The Coinsurance Amount And Resubmit. Please Bill Medicare First. A code with no Trip Modifier billed on same day as a code with Modifier U1 are considered the same trip. Was Unable To Process This Request. Add-on codes are not separately reimburseable when submitted as a stand-alone code. Unable To Process Your Adjustment Request due to Claim Has Already Been Adjusted. Diagnosis Indicated Is Not Allowable For Procedures Designated As Mycotic Procedures. CO/204. Medicare Part A Or B Charges Are Missing Or Incorrect. Denied. Invalid Procedure Code For Dx Indicated. Service(s) Denied By DHS Transportation Consultant. It Must Be In MM/DD/YY Format AndCan Not Be A Future Date. Denied. Permanent Tooth Restoration/sealant, Limited To Once Every 3 Years Unless Narrative Documents Medical Necessity. Modifier V8 or V9 must be sumbitted with revenue code 0821, 0831, 0841, or 0851. Refer To Dental HandbookOn Billing Emergency Procedures. Reimbursement For This Service Is Included In The Transportation Base Rate. Dental service is limited to once every six months. The number of treatments/days reflected by the units entered with revenue code0821, 0831, 0841, 0851, 0880, 0881 exceeds the number of days included in the FROM and TO dates entered on this claim. Two Informational Modifiers Required When Billing This Procedure Code. This Member Is Involved In Non-covered Services, And Hours Are Reduced Accordingly. The Member Was Not Eligible For On The Date Received the Request. The header total billed amount is required and must be greater than zero. The Members Gait Is Not Functional And Cannot Be Carried Over To Nursing. A Rendering Provider is not required but was submitted on the claim. Cannot bill for both Assay of Lab and other handling/conveyance of specimen. The Service Requested Was Performed Less Than 5 Years Ago. A HCPCS code is required when condition code A6 is included on the claim. Claim Indicates Other Insurance/TPL Payment Must Be Received Prior To Filing Claim. Maximum Reimbursement Amount Has Been Determined By Professional Consultant. A National Provider Identifier (NPI) is required for the Billing Provider. Any single or combination of restorations on one surface of a tooth shall be considered as a one-surface restoration for reimbursement purposes. Documentation Does Not Justify Fee For ServiceProcessing . Pricing Adjustment/ SeniorCare claim cutback because of Patient Liability and/or other insurace paid amounts. Billed amount exceeds prior authorized amount. Prescriber ID Qualifier must equal 01. Member is not enrolled in /BadgerCare Plus for the Date(s) of 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. In general, the more complex the visit, the higher the E&M level of code you may bill within the appropriate category. To allow for multiple biopsies for investigation and diagnosis of certain disease entities, WellCare applies max units editing for CPT code 88305 based on gastrointestinal (GI) and prostate-related diagnoses. Medicare Disclaimer Code invalid. Claim Denied. Unable To Process Your Adjustment Request due to A Different Adjustment Is Pending For This Claim. All rental payments have been deducted from the purchase costsince the DME item was rented and subsequently purchased for the member. Please Correct and Resubmit. According to the American College of Emergency Physicians, the American Heart Association and the American College of Cardiology Foundation, CT, CTA, MRA, MRI should not be performed routinely for evaluation of syncope in the absence of related neurologic signs and symptoms. The Second Occurrence Code Date is invalid. Supplement Payment Authorized By Department of Health Services (DHS) Due to a Final Rate Settlement. 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). Billing Provider is restricted from submitting electronic claims. 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. This diabetic supply has been paid under an equivalent code on this Date Of Service(DOS). The Number In The National Provider Identifier (NPI) Section On This Request IsNot A Number Assigned To A Certified Nursing Facility For This Date Of Service(DOS). Unable To Process Your Adjustment Request due to Claim ICN Not Found. Day Treatment Services For Members With Inpatient Status Limited To 20 Hours. Type of Bill indicates services not reimbursable or frequency indicated is notvalid for the claim type. The Member Is Only Eligible For Maintenance Hours. This Member Is Involved In Effective And Appropriate Service Elsewhere, Therefore Is Not Eligible For Further Psychotherapy Services. BMN prior authorization may be submitted for Mental Health drugs for which a Core Plan transitioned member has been previously grandfathered. A Previously Submitted Adjustment Request Is Currently In Process. Please Correct And Resubmit. Denied due to The Members Last Name Is Missing. Service is reimbursable only once per calendar month. Prescription Drug Plan (PDP) payment/denial information is required on the claim to SeniorCare. Amount Indicated In Current Processed Line On R&S Report Is The Manual Check You Recently Received. Resubmit With All Appropriate Diagnoses Or Use Correct HCPCS Code. Rendering Provider is not a certified provider for Wisconsin Well Woman Program. Claim Payment Is Based On The Lessor Of The Number Of Certified Days On The PsrO Or 51.42 Board Stamp Or Admitting Calendar Month Days In Specialty Hospital. The Non-contracted Frame Is Not Medically Justified. Claim Denied. Please Verify The Units And Dollars Billed. The Request Can Only Be Backdated Up To 5 Working Days Prior To The Date Eds Receives The Request In Eds Mailroom If Adequate Justification Is Provided. The Maximum Prior Authorized Service Limitation Or Frequency Allowance Has Been Exceeded. A: This denial is received when Medicare records indicate that Medicare is the beneficiary's secondary payer. Individual Replacements Reimbursed As Dispensing A Complete Appliance. Please Resubmit As A Regular Claim If Payment Desired. Service(s) Denied/cutback. Secondary Diagnosis Code (dx) is not on file. A Trading Partner Agreement/profile Form(s) Authorizing Electronic Claims Submission Is Required. Surgical Procedure Code is not related to Principal Diagnosis Code. A Separate Notification Letter Is Being Sent. A six week healing period is required after last extraction, prior to obtaining impressions for denture. Adjustment Requested Member ID Change. The Member Is Involved In group Physical Therapy Treatment. Please Submit With Completed timely Filing Form In The All Provider Handbook And Supporting Documentation. One or more Occurrence Span Code(s) is invalid in positions three through 24. Correct And Resubmit. No Complete Program Enrollment Form Is On File For This Client Or The Client Is Not Eligible For The Date Of Service(DOS) On The Clai im. Purchase Of A DME/DMS Item Exceeding One Per Month Requires Prior Authorization. Payment Authorized By Department of Health Services (DHS) To Be Recouped at a Later Date. The Performing Or Billing Provider On The Claim Does Not Match The Billing Provider On Theprior Authorization File. Bilateral Surgeries Reimbursed At 150% Of The Unilateral Rate. Complex Evaluation and Management procedures require history and physical or medical progress report to be submitted with the claim. An amount in the Gross Amount Due field and/or Usual and Customary Charge field is required. The Member Has Received A 93 Day Supply Within The Past Twelve Months. Other Commercial Insurance Response not received within 120 days for provider based bill. Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing; Search for a Reason or Remark Code. Procedure Code Used Is Not Applicable To Your Provider Type. One or more From Date Of Service(DOS) (DOS) is invalid for Occurrence Span Codes in positions three through 24. X-rays and some lab tests are not billable on a 72X claim. According To Our Records, The Hospital Has Not Received Prior Authorization For This Surgery. Duplicate Item Of A Claim Being Processed. The Diagnosis Is Not Covered By WWWP. Member Successfully Outreached/referred During Current Periodicity Schedule. Submitted referring provider NPI in the detail is invalid. Billed Procedure Not Covered By WWWP. Denied. Inicio Quines somos? Claim Explanation Codes. Member Has Already Been Granted Actute Episode for 3 Months In This Cal Yr. Reimb Is Limited To Average Monthy NH Cost And Services Above That Are Consider Non-covered Services. Only One Ventilator Allowed As Per Stated Condition Of The Member. Second Other Surgical Code Date is required. Claim Denied. You should receive it within 30 to 60 days of services provided, but it's not an official bill. Is Unable To Process This Request Because The Signature/date Field Is Blank. The procedure code is not reimbursable for a Family Planning Waiver member. Please Refer To The Original R&S. The Requested Procedure Is Cosmetic In Nature, Therefore Not Covered By . The Medicare Paid Amount is missing or incorrect. This service or a related service performed on this date has already been billed by another provider and paid. Denied due to Diagnosis Code Is Not Allowable. This obstetrical service was previously paid for this Date Of Service(DOS) for thismember. These Supplies/items Are Included In The Purchase Of The Dme Item Billed On The Same Date Of Service(DOS). Members Aged 3 Through 21 Years Old Are Limited To One Healthcheck Screening per 12 months. Rebill On Pharmacy Claim Form. Members age does not fall within the approved age range. Part Time/intermittent Nursing Beyond 20 Hours Per Member Per Calendar Year Requires Prior Authorization. Revenue codes 0822, 0823, 0825, 0832, 0833, 0835, 0842, 0843, 0845, 0852, 0853, or 0855 exist on the ESRD claim that does not contain condition code 74. (National Drug Code). Medically Needy Claim Denied. This Is Not A Preadmission Screen And Is Not Reimbursable. Refer To Your Pharmacy Handbook For Policy Limitations. Denied. Vision Diagnostic Services Limited To 1 Of These: Vision Exam, Diagnostic Review, Supplemental Test Or Contact Lens Therapy. These Individual Vaccines Must Be Billed Under The Appropriate Combination Injection Code. Diag Restriction On ICD9 Coverage Rule edit. This Member Appears To Continue To Abuse Alcohol And/or Other Drugs And Is Therefore Not Eligible For Day Treatment. Header To Date Of Service(DOS) is invalid. The Service Performed Was Not The Same As That Authorized By . Questionable Long-term Prognosis Due To Poor Oral Hygiene. Unable To Process Your Adjustment Request due to. If you haven't created an account yet, register now. Effective With Claims Received On And After 10/01/03 , Occurrence Codes 50 And 51 Are Invalid. The Eighth Diagnosis Code (dx) is invalid. Billing Provider is not certified for Substance Abuse Day Treatment for the Date(s) of Service. Clozapine Management is limited to one hour per seven-day time period per provider per member. Goals Are Not Realistic To The Members Way Of Life Or Home Situation, And Serve No Functional Or Maintenance Service. Please Re-submit This Claim With The Insurance EOB Showing A Denial OrPartial Payment. Occupational Therapy Limited To 35 Treatment Days Per Spell Of Illness W/o Prior Authorization. Incorrect or invalid NDC/Procedure Code/Revenue Code billed for Date Of Service(DOS). Your Adjustment/reconsideration Request For Additional Payment Has Been Denied, Request Was Received Beyond The 90 Day Requirement For Payment Reconsideration. Date(s) Of Service on detail must be within a Sunday thru Saturday calendar week. Each month you fill a prescription, your Medicare Prescription Drug Plan mails you an "Explanation of Benefits" (EOB). Copayment Should Not Be Deducted From Amount Billed. This is a duplicate claim. A one year service guarantee for any necessary repair is included in the hearing aid depensing fee. Date Of Service Must Fall Between The Prior Authorization Grant Date And Expiration Date. Please File With Champus Carrier. Members I.d. Claim Paid In Accordance With Family Planning Contraceptive Services Guidelines. Disposable medical supplies are payable only once per trip, per member, per provider. Adequate Justification For Starting Member In AODA Day Treatment Prior To Authorization being Obtained Has Not Been Provided. Phone: 800-723-4337. If you are having difficulties registering please . For FQHCs, place of service is 50. The From Date Of Service(DOS) for the Second Occurrence Span Code is required. Prior Authorization is required for manipulations/adjustments exceeding 20 perspell of illness. 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: Denied due to Take Home Drugs Not Billable On UB92 Claim Form. Seventh Occurrence Code Date is required. These Services Paid In Same Group on a Previous Claim. Denied/Cutback. Denied. Dates Of Service For Purchased Items Cannot Be Ranged. A Third Occurrence Code Date is required. If required information is not received within 60 days, the claim will be. Different Drug Benefit Programs. A Training Payment Has Already Been Issued To Your NF For This CNA. Denial Codes. Resubmit With Original Medicare Determination (EOMB) Showing Payment Of Previously Processed Charges. Single Bitewing X-rays Limited To Once Per Day And No More Than Two InA Six Month Period. This Is Not A Good Faith Claim. Based on these reimbursement guidelines, claims may deny when the following revenue codes are billed without the appropriate HCPCS code: Multiple Prescriptions For Same Drug/ Same Fill Date, Not Allowed. One or more Diagnosis Code(s) is not payable by Wisconsin Well Woman Program for the Date(s) of Service. Billing Provider is not certified for the Dispense Date. qatar to toronto flight status. Only Four Dates Of Service Are Allowed Per Line Item (detail) For Each Procedure. WellCare 2016 NA_11_16 NA6PROGDE80121E_1116 . This HMO Capitation Payment Is Being Recouped It Was Inappropriately Paid During The Inital February HMO Capitation Cycle.