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Last Modified: 1/6/2012
Location: FL, PR, USVI
Business: Part B
Top Part B claim denials
To increase the number of your claims that successfully complete processing and thereby enhance a positive cash flow, we are providing you with this helpful tool.
The following is a listing of the top reasons Medicare Part B claims submitted by jurisdiction 9 (J9) providers (Florida, Puerto Rico, and the U.S. Virgin Islands) during November 2011 were denied by First Coast Service Options Inc. (FCSO). These codes link to tips and resources to help you avoid many of these issues.
• Note: Only the top claim adjustment reason codes (CARCs) received by J9 providers for the stated periods 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 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.
• 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 Medicare Provider Part B IVR Quick Reference Guide 
for instructions.
for instructions.Select the denial code you received from the list below for tips on how to avoid these errors
Note: Under current guidelines, any reference to "unique physician identification number" or "UPIN" within the definitions of codes should be interpreted as "national provider identifier" or "NPI." The Centers for Medicare & Medicaid Services (CMS) and FCSO are not responsible for updating denial codes, so some definitions may reflect outdated verbiage.
• CO-11
• CO-18
• PR-22
• PR-27
• PR-49
• PR-50
• CO-58
• PR-96
• CO-97
• PR-119
• CO-B7
• PR-B9
• Other common tips on inquiries and denials -- click here
What other steps can you take to reduce your number of claim submission errors?
Errors in your claim submissions can significantly delay processing and payment.
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.
Would you like to create an account and receive your own 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.
• Obtain your personalized PDS report by visiting our Provider Data Summary page. You will find all PDS resources, including a guide, helpful FAQs, and the PDS Portal.
• Use the PDS portal to enhance the accuracy and efficiency of your Medicare billing process. You will be given the option to log in and retrieve your report, get help with a misplaced password, or create an account.
Source: FCSO Education Action Team
