Texas top claim submission / Reason code errors

Texas top claim submission / Reason code errors - August 2017

Texas Top Claim Submission / Reason Code Errors - August 2017

Explanation of Medicare Benefits Message

Description

Resolution

Non-covered charge.

Prior to performing or billing a service, ensure that the service is covered under Medicare. Please refer to the Centers for Medicare & Medicaid Services Internet Only Manual, 100-02, Chapter 16.

109

Claim not covered by this payer/contractor.

This denial indicates that the service is one that is processed or paid by another contractor.

Examples of these types of service are:

Durable Medical Equipment

Hospice related services

Medicare Advantage

You must send the claim to the correct payer/contractor.

Duplicate claim/service.

Please check claim status through the IVR to see if another claim was paid or is currently being processed. To prevent duplicate denials, allow us sufficient time to process a claim before submitting a second.

These are non-covered services because this is not deemed a 'medical necessity' by the payer.

Please ensure to follow Medicare guidelines, national and local coverage determinations for the service billed.

References:

CMS Internet Only Manuals

CMS National Coverage Determinations Manual, Pub. 100-03

Novitas Local Coverage Determinations

Comments

What is QMB / MQMB stands for?

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Rejection Procedure note qualifier is missing

Need to check the Charges tab and double click on the Procedure Code line to open up the Charge Entry window. There is a Notes section on the right hand side. If there is a note typed, we need to select the type. Need to select field and select the appropriate type of note you are sending. Save the changes made Check all the procedure if submitted many procedure. Save the visit again and submit the claim.

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