TRICARE Overseas Program Provider Manual

TRICARE overseas Program
Provider Manual
ToP: Explanation of Benefits Denial Codes and Remarks (continued)
Code Description Additional Information
044 Duplicate of services previously claimed (system).
045 Applied to deductible – see Item Six on Reverse.
049 Authorization not on file. Contact your HBA.
050 Insufficient Diagnosis – see Item Four on Reverse.
056 Chiropractic services not covered.
059 Obesity not a covered diagnosis – see Item Four on Reverse.
067 Medical need not documented.
070 Patient not eligible. Per DEERS, patient is not eligible.
072
Claim requires drug name, strength and quantity. See Item Two on Reverse for
time limit to send requested information.
074 Sponsor not on DEERS.
075 Patient not on DEERS.
077 Dependent patient not on DEERS.
080 ID card or eligibility expired on DEERS.
083 Insufficient information received.
126 Level of care billed not substantiated.
Information requested (such as
medical records) were insufficient
to support the care/request.
Upon review, it was determined
that the charges billed were for
more services than what was
actually provided. For example,
Provider is billing for a new patient
office visit when we have already
paid a new patient office visit for
the same Provider. So, the Provider
should have been billing as an
established patient office visit.
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