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

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