B7: This provider was not certified/eligible to be paid for this procedure/service on this date of service
On Call Scenario:
Claim denied as This provider was not
certified/eligible to be paid for this
procedure/service on this date of service
↓
May I get the denial date?
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What is the exact issue?
↙ ↓ ↘
The rendering provider The referring provider The procedure code is inconsistent
is not eligible to perform is not eligible to refer with the provider type/specialty
the service billed the service billed or taxonomy code is invalid
↓ ↓ ↓
Click Here Click Here Click Here
Important Note:
Claim denied as This provider was not
certified/eligible to be paid for this
procedure/service on this date of service
↓
May I get the denial date?
↓
What is the exact issue?
↙ ↓ ↘
The rendering provider The referring provider The procedure code is inconsistent
is not eligible to perform is not eligible to refer with the provider type/specialty
the service billed the service billed or taxonomy code is invalid
↓ ↓ ↓
Click Here Click Here Click Here
Important Note:
- Click on the link to follow a specific scenario.
In this Denial of B-7 , there can be issue of contract / Credential termination. Pls add this too.
ReplyDeleteWhen you receive a denial with B7, it means:
ReplyDeleteThe provider (doctor, hospital, etc.) was not authorized, licensed, or enrolled to provide or bill for that specific procedure on the date the service was rendered.
It could be related to:
Outdated certification
Missing enrollment in the payer's network
License issues or specialty mismatches
The provider billed for something outside their scope of practice
Thanks for sharing this information!
Delete