| Providers in AR, CO, LA, MS, NM, OK, TX, Indian Health & Veteran Affairs | |
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# |
Explanation of Medicare benefits message |
Description |
Resolution |
1 |
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. Please verify patient information using the IVR, Novitasphere, or contact the patient for additional information. |
2 |
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 14-29 days to process a claim before resubmitting. Reference: CMS IOM Pub. 100-04, Claims Processing Manual, Chapter 1, section 70 |
3 |
B15 |
This service/procedure requires that a qualifying service/procedure be received and covered. The qualifying other service/procedure has not been received/adjudicated. |
Payment is included in another service received on the same day. |
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4 |
22 |
Our records show that Medicare is the patient's secondary payer. This claim must be sent to the patient's primary insurer first. |
This care may be covered by another payer per coordination of benefits. Please check eligibility through the IVR, Novitasphere, or check back with the patient. |
5 |
26 |
Expenses incurred prior to coverage. |
Our records show the patient did not have Part B coverage when the service was provided. If you disagree, please contact us at the customer service number shown on this notice. Please verify patient information using the IVR, Novitasphere, or contact the patient for additional information. |
6 |
96 |
Non-covered charge. |
Prior to performing or billing a service, ensure that the service is covered under Medicare. Please refer to the CMS IOM Pub. 100-02, Benefit Policy Manual, Chapter 16. |
7 |
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. | Note: Claim adjustment reason codes and remittance advice remark codes are found on electronic remittance advice and the paper remittance to communicate information related to the processing of your Medicare claim/s. CARC's detail the reason why an adjustment was made to your claim: while RARC's represent non-financial information critical to understanding the decision made on your claim. CARCs and RARCs are maintained by the Washington Publishing Company (WPC). For a free listing, please visit the WPC website.
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