B7
Provider not certified/eligible to be paid for this procedure/service on this date
What This Code Means
The rendering provider wasn’t certified or eligible to be paid for this specific procedure on the billed date of service.
Common Causes
- Credentialing with this payer not finalized as of the date of service
- Provider's certification for a specific procedure type lapsed or wasn't yet approved
How to Resolve or Appeal
- Confirm the provider's credentialing/certification effective dates with the payer
- Appeal with proof of active certification if the payer's records are incorrect
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.