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Last Modified: 6/26/2014 Location: FL, PR, USVI Business: Part B

Common claim denials -- Part B

Reduce your claim submission errors

The following is a listing of the most common reasons Medicare Part B claims are denied by First Coast Service Options Inc. (First Coast). These codes link to tips and resources to help you avoid and reduce many of these issues.
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 external link.
Please share this information with all who need to know, such as your billing and IT staff, contracted billing service or clearinghouse, and software vendor. Correctly billing Medicare the first time saves everyone time and money.

Denial codes, descriptions, and tips or frequently-asked questions (FAQs)

Note: Under current guidelines, any reference to "UPIN" within the definitions of codes should be interpreted as "NPI."
OA-18
PR-22
PR-27
PR-49
CO-58
PR-96
CO-97
PR-119
PR-170
CO-236
CO-B7
PR-B9
Frequently-asked questions regarding claim denials -- click here
Other common tips on inquiries and denials -- click here

Additional tips

Use the following tips to help you find the answers you need about these additional topics:
Click here for questions about accessing claim status, patient eligibility (Medicare, MSP and Medicare Advantage [formerly Medicare HMO]), deductible information, and financial information (last three checks, month/year to date dollar amounts).
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 they can be corrected before creating an interruption in your cash flow.
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 through a detailed analysis of your personal billing patterns in comparison with those of similar providers. Use the PDS portal to request this useful report and enhance the accuracy and efficiency of your Medicare billing process.
Visit our Improve your billing page, which offers easy access to the PDS portal as well as an array of other helpful resources.
Source: Provider Outreach and Education

First Coast Service Options (First Coast) strives to ensure that the information available on our provider website is accurate, detailed, and current. Therefore, this is a dynamic site and its content changes daily. It is best to access the site to ensure you have the most current information rather than printing articles or forms that may become obsolete without notice.