Explanation of Medicare Benefits Message
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.
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
You must send the claim to the correct payer/contractor.
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.
These are non-covered services because this is not deemed a ‘medical necessity’ by the payer.
Please ensure to follow Medicare guidelines, national and local coverage determinations for the service billed.