Last Modified: 5/16/2020
Location: FL, PR, USVI
Business: Part B
Q: We received a RUC for the claim adjustment reason code (CARC) CO109. What steps can we take to avoid this RUC code?
Claim/service not covered by this payer/contractor. You must send the claim/service to the correct payer/contractor.
A: The first step in avoiding the reason code CO109 is to check what type of insurance coverage the patient has and verify their eligibility status prior to submitting claims to Medicare.
If the claim has been filed to Medicare in error it will be returned as an unprocessable claim and will need to be resubmitted to the correct payer/contractor for payment.
In receiving this error the provider can also refer to their remittance advice (RA) by evaluating the accompanying remittance advice remark code (RARC) to determine the correct payer/contractor of service.
• Railroad Retirement benefits (RRB)
• Receiving Part A benefits in a Skilled Nursing Facility on the date of service
• Medicare Health Maintenance Organization (HMO)
• Durable medical equipment (DME)
• Claim(s) submitted to different region (other than beneficiary resides in)
Ways to avoid:
• Check beneficiary eligibility prior to submitting claims to Medicare
• Click here
to obtain options on how to access a beneficiary's eligibility
• Secure Provider Online Tool (SPOT) will also display an alert on the eligibility screen notifying the beneficiary is a Railroad Retiree
• SPOT will only furnish information regarding payments processed by First Coast
• Medicare payments for DME or railroad claims will not be displayed
Claims that are returned as unprocessable cannot be appealed
, for more information click here
Source: Education Action Team (EAT)
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