Last Modified: 4/18/2013 Location: FL, PR, USVI Business: Part A, Part B
Claim adjustment reason codes
There could be several reasons why your claim did not process successfully. To identify all reason codes and their definitions, refer to the Washington Publishing Company's website at http://www.wpc-edi.com/reference/codelists/healthcare/claim-adjustment-reason-codes/ .
For additional helpful tools, please visit First Coast’s inquiries and denials page to review the most common inquiries received by the provider contact center and learn how to increase the number of claims that pass through edits and into processing by avoiding the top reasons for claims being denied or returned as unprocessable (RUC).
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 A IVR by calling 1-877-602-8816 or contact the Part B IVR by calling 1-877-847-4992. Refer to the Medicare Provider Part B IVR Quick Reference Guide for instructions.