January 2021 top claim submission errors - Texas

1

96

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.

2

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:

You must send the claim to the correct payer/contractor. Please verify patient information using the IVR, Novitasphere or contact the patient for additional information.

3

18

Duplicate claim/service.

Please check claim status through the IVR or Novitasphere 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.

4

16

Claim/service lacks information which is needed for adjudication. Do not use this code for claims attachment(s)/other documentation.

At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an Alert.)

Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present. This segment is the 835 EDI file where you can find additional information about the denial.

Prior to submitting a claim, please ensure all required information is reported. To verify the required claim information, please refer to Completion of CMS-1500(02-12) Claim form located on the claims page of our website.

5

B9

Services not covered because the patient is enrolled in a hospice.

This service is not covered because the beneficiary is enrolled in a hospice.

6

97

The benefit for this service is included in the payment or allowance for another service or procedure that has already been adjudicated.

Medicare does not pay for this service because it is part of another service that was performed at the same time. The patient should not be billed separately for this service.