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Last Modified: 8/12/2010
Location: FL
Business: Part A
Top rural health reject codes
The following is a list of the most frequent reject reason codes for claims processed by Florida Medicare Part A. The codes link to tips and resources to help you avoid these rejects.
Please share this information with your IT staff, billing staff, billing service, vendor, and/or clearinghouse. Remember, billing Medicare correctly the first time saves everyone time and money.
For tips on rejects for services other than rural health, click here.
• Remember: Questions about claim status, patient eligibility (Medicare, MSP and Medicare Advantage [formerly Medicare HMO]), deductible information, and your financial information (last three checks, month/year to date dollar amounts) can be answered via direct data entry (DDE) 
or must go through the Interactive Voice Response unit or IVR. Contact the Part A IVR by calling 1-877-602-8816. Refer to the Part A Quick Reference Guide for instructions.
or must go through the Interactive Voice Response unit or IVR. Contact the Part A IVR by calling 1-877-602-8816. Refer to the Part A Quick Reference Guide for instructions.• Under current guidelines, any reference to "UPIN" within the definition of codes should be interpreted as "NPI," the provider's national provider identifier. The Centers for Medicare & Medicaid Services (CMS) is not responsible for updating denial codes, so some definitions may reflect outdated verbiage.
Select a reject code from the list below for tips on how to avoid the error.
• 10416
• 10417
• 38109
• 38200
• U5200 -- see Avoiding reject reason code U5200 FAQ
Did you know you can create an account and receive your personalized Provider Data Summary (PDS) report?
The Provider Data Summary (PDS) is a comprehensive billing report designed to be utilized along with Medicare Remittance Notices (MRNs) and other provider-accessible billing resources to help identify potential Medicare billing issues. The PDS provides a detailed analysis of your billing patterns compared to similar providers.
Please visit our Provider Data Summary page to request the report via the PDS portal. Select the link titled “PDS Portal.” You will be given the option to log in, get help with a misplaced password, or create an account. The Provider Data Summary page also contains PDS resources including a guide and FAQs.
Source: FCSO Education Action Team
