Medicare claim submission/reason code errors for July 2017 by Novitas

Written by Reed Tinsley | August 30, 2017

 

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Explanation of Medicare Benefits Message

Description

Resolution

1

96

Non-covered charge.

Prior to performing or billing a service, ensure that the service is covered under Medicare. Please refer to the Centers for Medicare & Medicaid Services Internet Only Manual, 100-02, Chapter 16.

2

109

Claim not covered by this payer/contractor.

This denial indicates that the service is one that is processed or paid by another contractor.

Examples of these types of service are:

Durable Medical Equipment
Hospice related services
Medicare Advantage

You must send the claim to the correct payer/contractor.

3

18

Duplicate claim/service.

Please check claim status through the IVR to see if another claim was paid or is currently being processed. To prevent duplicate denials, allow us sufficient time to process a claim before submitting a second.

4

26

Expenses incurred prior to coverage.

Our records show the patient did not have Part B coverage when you provided this service. If you disagree, please contact us at the customer service notice on this notice.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.

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