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Last Modified: 8/12/2010
Location: FL
Business: Part B
Top rural health denial codes
The following is a list of the most frequent denial reason codes for claims processed by Florida Medicare Part B. The codes link to tips and resources to help you avoid these denials.
• Note: The top claim adjustment reason codes (CARCs) received by rural Florida providers are covered in this list. For a list of all possible codes and their definitions, refer to the Washington Publishing Company's website at www.wpc-edi.com/content/view/695/1 
.
.Please share this information with your IT staff, billing service, vendor, and/or clearinghouse. Remember, billing Medicare correctly the first time saves everyone time and money.
• Remember: Questions about claim status, patient eligibility (Medicare, Medicare secondary payer [MSP] and Medicare Advantage [formerly Medicare HMO]), or deductible information, as well as most clerical reopening requests for single-line claims, must go through the interactive voice response (IVR) system. Contact the Part B IVR by calling 1-877-847-4992. Refer to the IVR Part B Quick Reference Guide 
for instructions.
for instructions.For tips on denials for services other than rural health, click here.
Note: 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for Medicare & Medicaid Services (CMS) is not responsible for updating denial codes, so some definitions may reflect outdated verbiage.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 denial code from the list below for tips on how to avoid these errors:
• CO-B7
• PR-50
• PR-96
Steps you can take to reduce your number of claim submission errors
Claim submission errors significantly delay processing and payment. The following are additional tips to help you bill Medicare correctly the first time.
Did you review your batch detail control listing?
Claims submission errors may be obtained in a timely fashion through your electronic data interchange (EDI) gateway mailbox on a report titled batch detail control listing. Referring to this report will allow you to correct and resubmit claims quickly, resulting in a dramatically reduced turnaround time. This report will also inform you of any major problems with your claims, so the claims can be corrected before your cash flow is impacted.
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 personal 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
