Denial Code Resolution

View the most common claim submission errors below. To access a denial description, select the applicable Reason/Remark code found on Noridian's Remittance Advice. Select the Reason or Remark code link below to review supplier solutions to the denial and/or how to avoid the same denial in the future.

The Washington Publishing Company publishes the CMS-approved Reason Codes and Remark Codes.

  • Claim Adjustment Reason Codes (CARCs) communicate an adjustment, meaning that they must communicate why a claim or service line was paid differently than it was billed. If there is no adjustment to a claim/line, then there is no adjustment reason code.
  • Remittance Advice Remark Codes (RARCs) are used to provide additional explanation for an adjustment already described by a CARC or to convey information about remittance processing.
X
 
Reason Code Remark Code Common Reasons for Denials
4 M114
N565
  • HCPCS code is inconsistent with modifier used or a required modifier is missing
  • Item billed was processed under DMEPOS Competitive Bidding Program and requires an appropriate competitive bid modifier
4 N519
  • HCPCS code is inconsistent with modifier used or required modifier is missing
5 M77
  • The procedure code/bill type is inconsistent with the place of service
  • Missing/incomplete/invalid place of service
13  
  • The date of death precedes the date of service.
16 M51
  • Claim/service lacks information or has submission/billing error(s)
  • Missing/incomplete/invalid procedure code(s)
16 M77
  • Claim/service lacks information or has submission/billing error(s)
  • Missing/incomplete/invalid place of service
16 M124
  • Item billed does not have base equipment on file. Main equipment is missing therefore Medicare will not pay for supplies
16 MA13
N264
N575
  • Item(s) billed did not have a valid ordering physician name
16 MA13
N265
N276
  • Item(s) billed did not have a valid ordering physician National Provider Identifier (NPI) registered in Medicare Provider Enrollment, Chain and Ownership System (PECOS)
16 MA27
N382
  • Claim/service lacks information or has submission/billing error(s)
  • Missing/incomplete/invalid Information
16 M76
  • Claim/service lacks information or has submission/billing error(s) which is needed for adjudication. Missing/incomplete/invalid diagnosis or condition.
16 MA83
  • Claim/service lacks information or has submission/billing error(s).
  • Did not indicate whether we are the primary or secondary payer.
16 N286
  • The referring provider identifier is missing, incomplete or invalid
22 MA04
  • This claim appears to be covered by a primary payer. The primary payerinformation was either not reported or was illegible
29 N211
  • The time limit for filing has expired.
  • You may not appeal this decision.
31  
  • Patient cannot be identified as our insured.
35 N370
  • Maximum rental months have been paid for item
45 N88
  • Payment was made for this claim conditionally because an HHA episode of care has been filed for this patient.
50  
  • Claim is missing a Certification of Medical Necessity or DME Information Form
  • Claim is missing the KX modifier
  • This is not a service covered by Medicare
  • Documentation requested was not received or was not received timely
  • Item billed may require a specific diagnosis or modifier code based on related LCD
  • Item being billed does not meet medical necessity
50 M127
  • Documentation requested was not received or was not received timely
50 N115
  • Item billed may require a specific diagnosis or modifier code based on related Local Coverage Determination (LCD)
  • Development letter requesting additional documentation to support service billed was not received within provided timeline
  • Item being billed does not meet medical necessity
50 N130 Non covered services
50 N180
  • These are non-covered services because this is not deemed a 'medical necessity' by the payer.
  • This item or service does not meet the criteria for the category under which it was billed.
96 M18
  • Beneficiary was inpatient on date of service billed
96 N180
  • Non-covered charge(s). Item does not meet the criteria for the category under which it was billed.
96 N425
  • Non-covered charge(s). At least one Remark Code must be provided (may be comprised of either the NCPDP Reject Reason Code, or Remittance Advice Remark Code that is not an ALERT.) Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present
  • Statutorily excluded.
97 M2
  • Beneficiary was inpatient on date of service billed
97 M80
  • HCPCS billed is included in payment/allowance for another service/procedure that was already adjudicated
97 N390
  • HCPCS code billed is included in the payment/allowance for another service/procedure that has already been adjudicated
107  
  • The related or qualifying claim/service was not identified on this claim.
108 N130
  • Rent/purchase guidelines were not met.
  • Consult plan benefit documents/guidelines for information about restrictions for this service.
109 N104
  • Claim was submitted to incorrect Jurisdiction
109 N130
  • Claim was submitted to incorrect contractor
109 N418
  • Claim was billed to the incorrect contractor
  • Beneficiary was enrolled in a Medicare Health Maintenance Organization (HMO) for date of service submitted
109 N538
  • Beneficiary was inpatient on date of service billed
119 M86
  • Item has met maximum limit for this time period. Payment already made for same/similar procedure within set time frame.
150 N115
  • Policy frequency limits may have been reached, per LCD
151  
  • Equipment is the same or similar to equipment already being used.
  • There is a date span overlap or overutilization based on related LCD.
151 M3
M25
  • Item billed is same or similar to an item already received in beneficiary's history
151 N115
  • There is a date span overlap or overutilization based on related LCD
173 N668
  • Item billed requires an initial Certificate of Medical Necessity (CMN) or DME Information Form (DIF) be submitted
  • Initial CMN or DIF was not submitted with claim or on file with Noridian
175 N668
  • Prescription is not on file or is incomplete or invalid
176 N115
  • A recent break in medical need
  • 13/15 months have been paid
  • Same and Similar equipment on file
176 N592
  • Item billed requires a recertified or revised CMN or DIF to be submitted. Either a CMN/DIF was not submitted or not on file with Noridian
182 N517
  • Invalid modifier for date of service
204 N130
  • Noncovered item
  • Item is not medically necessary for DME
234 N20
  • Item billed is included in allowance of other service provided on the same date
A1 N370
  • Oxygen equipment has exceeded the number of approved paid rentals
B7 N570
  • This provider was not certified/eligible to be paid for this procedure/service on this date of service.
  • Missing/incomplete/invalid credentialing data.
B9  
  • Patient is enrolled in a hospice program.
B18 N522
  • Duplicate claim has already been submitted and processed
B20  
  • Item was partially or fully furnished by another provider
  • Was beneficiary inpatient?
B20 M115 N211
  • Procedure/service was partially or fully furnished by another provider.
  • This item is denied when provided to this patient by a non-contract or non-demonstration supplier.

 

Last Updated Tue, 17 Nov 2020 20:36:04 +0000