Unprocessable claim denials -- 1500 form item 27L, 42R, 52D

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Unprocessable claim denials -- 1500 form item 27L, 42R, 52D

Last Modified: 11/4/2011 Location: FL, PR, USVI Business: Part B

Unprocessable claim denials -- 1500 form item

• Claims submitted with incomplete or invalid information will be returned to the provider as unprocessable (RUC). Before submitting a claim, ensure the information submitted is correct.

• Example: Ensure the date(s) of service (DOS) on the claim corresponds to the number of units/days being billed.

• Access the CMS Internet-only manual (IOM) Publication 100-04, Chapter 26

for detailed instructions regarding completion of Form CMS-1500 and Publication 100-04, Chapter 1 -- General Billing Requirements

for instructions on handling incomplete or invalid claims.

• Complete the WBT titled “CMS Form 1500 (08/05) (July 2008)” available via the CMS website

• Refer to the Claim completion FAQs on the FCSO Medicare provider website for additional information.

• For more information on return unprocessable claim codes, refer to the Top Part B reasons claims were returned as unprocessable.

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Source: FCSO Education Action Team

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